And we are live.
Welcome back, Dave Kittle.
How's your day going?
Good morning.
I'm feeling great.
I mean, let's go.
Nothing bad happens before eight thirty
a.m.
I'm going to do the best I can.
We've got some crummy weather and crummy
Internet conditions.
So, all right.
Jimmy McKay is out for the day.
He is South Carolina.
Is that where he is?
I didn't catch it.
He's with Danny Mata or Mate.
I forget how you say it,
but I'm looking forward to hearing how
things go when he comes back.
Uh,
you shared something kind of interesting.
Let's talk about the deal where you had
a client that found you starting with a
Google search.
Yes.
Um,
So this is a sister of a prospective
client in Manhattan.
So sometimes,
you know how sometimes it happens where
there's like a family member that's
searching for healthcare providers.
I don't know if it's common near you,
but for us it's like,
I don't know if the,
if the person is like a busy professional
and maybe they're not taking their health
seriously,
then sometimes like a family member steps
in.
So this family member found us on Google
for in-home physical therapy in Manhattan
for their brother.
And,
I always, before I call,
because if it's me calling,
I'll usually call from my personal cell
phone number,
not even like the go high level number.
Because when I text them first,
I want them to make sure that the
phone gets answered.
And if it's iMessage,
then it's a blue text message,
not a green text message.
So a little bit of logistics up front.
So I'll text, you know, hi, so-and-so,
this is Dr. Kittle,
Concierge Pain Relief PT.
You called in regards to,
and I'll call you back personally in a
few minutes.
How did you hear about us?
Were you referred by?
a physician, Google, or best of NYC list.
And this person wrote,
truly started with a Google search and
went from there.
After finding your website,
I went on to look at reviews on
other sites, comma, your Instagram,
et cetera,
and thought that you and your team could
be a great fit, exclamation point.
I'm like, there's some emotion here.
They saw our Instagram.
Now, what's amazing is,
i pitched you know five fifty a visit
for weekends three fifty visit monday
through friday or normal self-pay rates
and they didn't balk at all they were
they they were like totally warmed up and
so i want to stop and say thank
you to tony maritato thank you to jimmy
mckay for nudging me and uh urging me
to build up my instagram for concierge
pain relief because
This is just validation.
This person has not followed my account.
They haven't looked at our stories.
They haven't liked anything or commented.
It's like they're invisible and they're
completely in the ether until you get some
type of feedback like this.
Either they follow your account or they
mention it like this.
And I had to dig for it.
They didn't voluntarily say it up front.
So thank you, first of all.
And any feedback, any response to that?
Yeah,
that's an interesting situation because I
used to say that it was horrible to
ask how you found out about us.
How did you hear of us?
Before you built a relationship,
you just said it's the first thing you
say before you even talk to the person.
Yes,
because once you get into the
relationship, Tony, people forget.
They're like, oh, I don't know.
One of the websites online or somebody
mentioned.
People forget, at least in my experience.
People don't recall.
So I want to ask it before there's
any relationship.
That is literally typically the first
question.
Usually if someone calls in,
the answering service is answering our
phones right now.
They're supposed to ask it.
They don't always do because I'm paying a
thousand dollars a month for an answering
service.
So it's kind of like they're humans.
They read through a script,
but they don't always ask every aspect of
the script or the questions of the of
the script.
So, you know,
they're good enough until the AI bots take
over.
So we ask that up front because I've
learned that if I ask it later,
people forget they have they don't recall.
I want to for information.
is it chat gpt is it google is
is it a friend is it a physician
because if it's a physician if it's a
friend word of mouth i say to them
well can you was it tony or jimmy
or who was it on a podcast that
mentioned you know because we like to send
a handwritten thank you note to whoever
referred you to us so i want to
ask it right away when it's fresh in
their memory
Right.
Makes sense.
I mean, it makes total sense.
And the reality is we are getting most
of our referrals through physician
referrals.
So it doesn't even, you know,
it's not as relevant for us.
But typically, you know,
my standard advice would be
Don't come out with guns blazing,
trying to figure out how you're going to
get your next patient from this patient,
chill out first day,
give them a little space,
let them breathe,
like get to know them a little bit.
And then two,
three sessions in and be like, Hey,
you know, I meant to ask you,
how did you find out about us?
Like,
You know,
especially when we'll usually ask, like,
have you been to therapy somewhere else?
I always say,
what did you like about it when you
went there?
What did you not like?
I had an interesting call the other day,
younger female patient.
calling, looking for self-pay rates.
And this person was like,
basically had been in a car accident and
had some back pain.
I don't know how the conversation came
this way, but I said, oh,
so they were like, well,
I was going to this other therapy clinic,
but it was too expensive.
Looking to see what else is in the
area.
And I was like, oh, okay, well,
what'd they do that you liked?
What'd they do that you didn't like?
Did they do any manual therapy?
Because we're
We are so conditioned to think everybody
wants to be touched.
Oh, no, I hate manual therapy.
I've got fibromyalgia.
I don't want anybody to touch me.
I just I did best when we did
core exercises.
I was like, holy ass.
This is my kind of person.
Let's go bring it in here.
We can take good care of you.
So.
Interesting, interesting story.
I found a website.
I saw this.
We're going to switch topics just a little
bit,
but I want to get your take on
it.
A guy came in actually yesterday.
He was an investor in a new startup.
It is a neuro rehab,
but he is not a physical therapist.
They do have a physical therapist on site,
but it is not physical therapy.
It's designed for individuals who have
Parkinson's, stroke,
Traumatic brain injury.
It is not insurance-based.
It's self-pay.
They have basically games and equipment
that you get on with virtual reality and
the goggles and all the stuff that we've
heard about.
They're brand new to the area.
I think they have five other locations
around the United States.
They're trying to build a footprint.
And the guy was nice enough.
He said,
we got to talking and he was in
sales for other things, got into this.
I'm like,
who's handling your social media?
He was like, you're looking at him.
We started talking about it a little bit,
but immediately after he left,
an ad popped up on Facebook.
Tell me they're not listening.
for something very similar.
So I'm going to pull it up on
the screen.
For those of you listening,
it's called stroke.fitness.
This particular one,
it's different from the guy who came in
yesterday, but there's some similarities.
This is down in Tampa, Florida.
And basically what this is, it's self pay.
It's not therapy.
It's for individuals who have had a stroke
who want to get into fitness.
They have a series of machines.
I'll see they have a bunch of video
testimonials.
I'll see if I can find some of
the pictures of the equipment they have.
Pricing plans,
one hundred and seventy nine dollars a
month for remote membership, which,
you know,
that doesn't seem like it'd be effective,
but three hundred and seventy nine a
month.
For on-site membership.
For context,
we charge a hundred a month for patients
to come in and just kind of work
out thirty to forty minutes,
usually twice a week.
So, you know,
they're they're almost four times the
price.
But I don't understand why a great
neurotherapist wouldn't do something like
this.
Any thoughts on your end?
I love it.
Struck out fitness.
um, neuro, this could be,
you just use the equipment by yourself or
is it like you have a coach trainer
person or is it group?
There's a coach on site.
Uh, there's guided, you know, workouts.
They don't have a great website.
I've seen actually on their Facebook.
Let me see if I can pull up
their Facebook.
Um, some videos of, of their,
of their clients, um,
Yeah, they have videos and testimonials,
but really like as somebody looking into
this, I want to see what they're doing.
OK,
so here you should be able to see
that, you know,
here's the video of somebody walking into
the facility.
These are the machines they have.
I think we're going to see a lot
more of this happening.
where physical therapists,
occupational therapists,
we're not satisfying the need.
We're not providing access.
We're not getting to enough people.
And you're going to see entrepreneurial,
business-minded, non-clinicians say, hey,
there is a gap in the market.
We could do it cheaper.
We could probably do it better.
We could do it with more accessibility to
more people.
And this is what's going to make up
the difference for
Fewer therapists going into school,
fewer therapists paying the money to get,
which we'll talk about the longevity of a
career in a minute.
I think this is going to be what
happens.
And just last thing before you go,
before you talk,
I went into chat GPT and I was
like,
how many licensed therapists are in the
United States right now?
And it was like almost three hundred
thousand.
How many licensed physical therapist
assistants are in the United States right
now?
And it was under one hundred thousand,
which I was surprised.
I thought it would be more.
And then I said,
if you took all of these licensed
therapists,
assume they work forty hours a week,
assume they see one patient an hour.
How many total with the capacity,
how many total visits could be delivered?
And then I said,
are there any objective numbers out there
for how many people in the United States
actually need or would benefit from
physical therapy?
And Chachi PT was like, conservatively,
a hundred million people would benefit
from PT.
PTs right now, if everybody was working,
everybody did one an hour,
you'd be looking at something like it was
like a one fifth.
We can handle one fifth of the capacity
of what actually needs to be served.
Well, I mean,
there's a lot there because there's always
going to be some patients and clients out
there that don't want treatment.
I mean,
there's patients and clients out there
that don't want to go to their primary
or haven't seen their primary in ten or
twenty years, right?
So I think there's similar numbers,
you included.
There's similar numbers for I think any of
the health care providers out there.
So, of course,
we're not going to be able to serve
everyone.
And then there's the combination of like
cost or travel to an office or
If it's home visits, it's more convenient,
but that's through their insurance maybe.
Or if it's self-paced,
that might price out certain people,
right?
Even in New York City,
there's some people that don't want to pay
out of pocket for the convenience or for
like a different experience.
There's some people that just don't want
to do the effort that would be required
for this type of stroke fitness or stroke
rehab or whatever the treatment might be.
Let me ask you a question in terms
of the licensed health care providers for
like physical therapists that can help
folks with stroke or any other movement
issues.
What would be the ideal number?
Like,
should we have one to one from should
we should we have one hundred million
physical therapists?
Should we have PTs and OTs or anyone
that can help with stroke or movement
issues or even if it's back pain or
everything?
Should it be one to two?
What's the number?
You're saying one to five?
I don't know.
I don't know if there's any research on
even that.
Is that good enough?
Does that supply the demand based off of
what the market yearns for, desires,
wants, is already utilizing?
That's kind of like a big question that
maybe has never been answered or maybe
can't be answered.
Yeah.
Yeah, well,
this is what I've been thinking about so
much.
I'm like,
I've been vocally kind of saying PT is
probably not going to exist in another
decade, right?
The physical therapy profession,
physical therapist.
So I'm like, well, why?
What are the threats to the profession?
What's going on?
When I research it,
it says enrollment is up.
That's not my impression based on what I
see within my echo chamber, right?
So we know that PTs are complaining about
not getting paid enough.
We know that PTs are complaining about
treating too many patients.
Everywhere I look, most of the PTs,
OTs and SLPs are all saying the same
thing.
I mean, I just listened to this.
This woman on TikTok drives me crazy,
but I can't stop listening because it's so
stupid and absurd.
But then the algorithm thinks that I like
it.
So it gives me more of it.
And this person wants to be an advocate
for the OT profession.
And I'm like,
she has no knowledge or no understanding
of all the other stuff that goes into
the business of OT.
Not just, yeah,
you can be an amazing OT,
but like you need a foundation and
understanding the rest of it anyway.
There are so many, I think,
existential threats to the professions.
One of which is, yes,
we are beneficial to the population.
Yes, we help a lot of people.
We reduce healthcare costs.
We can change,
fundamentally change a patient's life.
We can keep them in the home longer.
We can do so many amazing things.
But if we don't get the numbers up,
if we don't increase access,
we become so small.
When I talk to docs and the doc
is like, yeah, I would refer to PT,
but they can't get in for six weeks.
I'm not going to bother.
Right.
We become irrelevant.
Because we can't serve enough people.
It's just like a family restaurant that's
local in the community.
The line is out the door.
It doesn't matter how many more people
want to come to them.
They can't serve more food.
There's a limit.
There's a bottleneck there.
I think that's what's going to really,
in the end,
that's what's going to destroy the
profession is the therapists who are
existing right now don't want to see more
patients.
They don't take pride in seeing more
patients.
They're not excited to see more patients.
They want to see fewer patients.
which is fine.
But at some point you become irrelevant
because if you can't help more people,
you eventually can't help anybody.
And the people sending patients to us
won't send to us anymore.
They will send other places.
They will find other solutions.
So that's what got me thinking about this
originally.
Let me double click on that.
I heard something from Ben Boggy on a
video recently.
So he owns Prokinetics.
He does a clinical marketer with Jordan
Mather.
So Ben said something like,
uh, he'll listen to calls, uh, from,
for his practice.
And someone will say like, Oh,
like I called these other in network
offices and it's like,
it takes four to six weeks to like
get in.
And you're saying you can get me in
like this week.
Like, are you guys like not great?
Like, are you not,
cause you're not busy or like they were
kind of,
it was almost like the ability to get
in sooner was almost like a drawback or
like, why is that?
How come you guys have availability,
but these other places don't.
So,
Ben's team member or whoever is kind of
like, well, those other places,
they're so busy because they accept every
insurance under the sun.
And they have historically, not always,
but historically had to have their
therapist treat fifteen to twenty five or
thirty or whatever patient a day when they
may not want to.
And it's resulted in apparently some of
these therapists across the country in
general,
like there's a little bit of a trend,
maybe you can push back on it,
of therapists not wanting to be in those
models anymore, right?
Not wanting to be treating twenty or
thirty patients a day.
So they'll leave some of those bigger in
network corporate companies.
And so now when they leave,
they're not those companies are not always
able to hire the next physical therapist
to supply the inflow demand of new in
network insurance patients.
And so therefore that also creates a
waiting list.
So there's,
there's a waiting list because they accept
all insurances.
So it's just volume as you know,
but then also therapists are not wanting
to go there, work there,
stay there longer because of more
patients, more notes,
the quote unquote burnout type stuff.
When he said that, I was like, Oh,
actually that makes sense.
So like Ben and his team member on
the phone is basically saying like,
we have, you know,
eight or nine therapists here that are
full time.
But we do all one-on-one visits.
And so we are able to hire more
therapists.
The places that you just called have one
or two or three therapists only because
they take your insurance and because the
therapists have to see fifteen or thirty
or whatever patients a day and they're not
able to retain physical therapists.
Any thoughts on that?
I mean, I heard, I was like, wow,
that was like a light bulb moment.
I was like, that makes sense.
Of course, that makes some sense.
Now, of course,
that's not going to be every,
that's not every in-network office across
the country.
We don't have to name all the corporates
or the big, you know, the big team,
the big companies that are like that.
However,
I think there is some truth to that,
that would result in them having more
waiting lists because of the lower
reimbursement,
which results in having to see more
volume,
which results in therapists not wanting to
stay in that model in general.
Some will, but some don't like it.
Any pushback on that?
Is there any truth in that?
Is it like half truth, half assumption?
I don't know.
What do you think?
Yeah, I think about that a lot.
So yesterday I was on the phone with
a couple of new patients who were calling
to get scheduled.
And every single time I answer the phone
and it's a new patient wanting to
schedule, I'm like,
I can get you in today.
How about you come in this afternoon?
How about you come in tomorrow morning?
And in the back of my mind,
I am thinking,
this person should be thinking,
why can you get me in so quick
when the hospital has a six-week wait
list?
Now, very, very, very infrequently,
you might hit a consumer who's that
knowledgeable and understands and is
thinking that.
Most consumers are like, okay, let's go.
We'll get it going.
I don't think it's because they're
overworked and underpaid and a lot of the
typical stuff you hear about PTs working
at hospital.
Hospitals are notorious for just
one-on-one
Around here,
hospitals are not pushing production.
Hospitals are not getting like thirty
patients a day.
Hospitals are like, no, we just need PTs.
We're going to lose money anyway.
You can see one an hour.
You can see him as long as you
want.
I just, I remember, and this goes back,
maybe it's just me.
I know there is a competitive streak in
you.
I remember like, I want to do more.
I want to produce more.
How many more can I see?
I handled twenty.
Can I handle twenty five?
I handle twenty five.
Can I handle twenty seven?
Like that was innate in my culture growing
up.
That was innate in me.
Now I always want to outperform.
I don't see that in today's market.
Hence,
I don't hire any physical therapists.
I don't hire any new clinicians.
I can't afford to pay them what they
want.
I'm not comfortable with the production
that they want to produce.
It's a culture that doesn't mix.
So I just say I'm not going to
do it.
Um, but I don't know,
I don't know if that comes out of
the school, out of the,
the educational process, you know,
I don't know where that happens, but like,
if you're in sports,
you want to score points.
If you're doing something you want to
overachieve,
why does it all of a sudden change
when we look at patient care?
Like, no,
I don't want to sacrifice outcomes.
But to me,
the better therapist can get better
outcomes and higher volume.
It's not a one or the other.
But we've talked everybody into like, no,
if you see more than one an hour,
you're going to get bad outcomes.
I get good outcomes.
I get great outcomes.
And I see more than one an hour.
And it makes me feel fulfilled to know
that I can help more people,
to know that I can get people in
within an hour sometimes.
So I understand what Ben's saying.
Totally get it.
I don't think it really applies broadly
because I don't think the consumer is
thinking about it that much.
In general, the consumer,
the patient is like,
my doctor told me to go to therapy.
What do I do?
And they're just playing a very passive
role.
So I get them in within twenty four
hours.
That's our objective.
Minute you call,
I want you in the clinic within twenty
four hours.
I want the evaluation done and I want
follow up scheduled the same week,
the same day, you know.
But that's always been our metric.
I don't think the consumer is going to
be like, oh, this place must suck.
Nobody wants to go here and they have
openings, you know.
Yeah, I mean, the consumer wants
access.
They want typically to use their
insurance.
They want to get scheduled.
They don't want a big waiting list
typically.
They want to get it done.
That's it.
I just had a person in here last
night.
I generated an eight team visit plan of
care.
I didn't realize the person wanted to get
four visits and go get an MRI.
You know,
so like that's why the person was here.
They were here to get their four visits
and go get their MRI.
They were not here to get better,
even though they were getting better.
They were doing amazing.
I was blown away by how well this
person had responded to therapeutic
exercise.
Didn't matter.
I'm here for four visits.
I'm going to get my MRI.
I'll tell you what the doctor says.
I was like, okay, that's fine.
You know, your coinsurance is blank.
We collect cash or credit and we let
them go.
I always have biases.
I think we all do.
Is it possible?
Cause I want to, I want to,
I want to mention that I have biases
first, but now I'm going to say, Tony,
you might have a bias.
Let me push back on it.
Right.
So, okay.
Is it possible?
Because for us, we,
we get some physician referrals,
but like we're mostly word of mouth or,
or Google.
So either Google organic listing or Google
ads.
Right.
So at any given time,
I'm spending a lot of money on Google
ads.
And sometimes I turn everything down to a
dollar a day budget.
So it's like,
Zero, basically.
So most of our patients are either from
word of mouth or Google.
And some physician referrals,
but not that many compared to you,
compared to historically how you build up
your practice.
So my pushback would be the people that
are finding us on Google or word of
mouth,
they are maybe putting in more effort or
it's a different approach because they're
seeking in-home physical therapy or
one-on-one therapy in our brick and mortar
office.
They want it.
And or just like the thing I mentioned
at the top of the show,
if the family members calling in,
we have to ask, Hey,
I know you're calling in for so and
so are they motivated to do this?
Or are they going to be pushing back?
And are we going to have, you know,
some issues here?
Our clientele typically is seeking a
solution, they want to walk better,
they want to decrease their back pain,
their neck pain,
they want to get back to sports or
walking in Central Park or whatever.
So they want what we have to offer
and they, not always,
but they're typically ready to focus on
that and put in the effort and follow
a treatment plan.
Whereas what you're talking about is their
physician told them to go to physical
therapy.
Is it possible that that's your bias
because that's where a lot of your
patients come from as opposed to half of
your patients saying that they found you
on Google and they're seeking it out
because they want to do it?
Yeah, a hundred percent.
You and I are fundamentally different
businesses.
I hate that you and I are even
called physical therapy because we are
such a different business,
such a different business model.
It goes back to Rory Sutherland.
You know,
I was listening to the clip last night
again,
where he talks about McDonald's versus a
Michelin star restaurant.
The thing with McDonald's is it's never
going to be as good as a Michelin
star restaurant,
but you're never going to get sick.
You're going to get consistent results.
You know exactly what's happening.
You are satisfying the hunger problem.
You are not delivering a food dining
experience.
You go to a five-star Michelin restaurant.
I can go to, not saying you,
but I can go to an amazing physical
therapist who most of the time can deliver
an amazing experience.
but there are gonna be times where they
don't.
There are gonna be times where the patient
has a negative outcome.
The therapist did too much.
Like I get the stories of the therapist
did dry needling, the therapist did this,
the therapist did that,
and the patient now in their own mind,
it's all fabricated,
but they're disabled and they've got,
you know,
twenty years of dysfunction because of
something that a therapist did that they
were trying to use to help them get
better.
So you're going to have amazing results a
lot of the times,
but you're going to get a few that
are going to go south really quick,
really badly.
On my side,
you're never going to get an amazing
result, right?
You're going to get what you get.
You're going to feel better.
You're going to leave feeling better than
you come in.
You're going to get a little stronger.
You're going to get a little healthier,
maybe.
But you're never going to get worse.
You're never going to get a negative
outcome.
I am never going to take a chance
on an intervention that has a chance to
make you incredibly better,
but also has a chance to make you
worse.
Like that is that is not what we
do.
So, yes,
the people who come to us largely,
they don't want to get worse.
They don't want a negative experience.
And I will deliver that.
The people who find you,
they want improvement.
They're willing to do what needs to be
done and take that risk of having a
better than expected outcome,
knowing that there could possibly be a
negative experience in there too.
How do we wrap that?
How do we,
or put a pin in it until Jimmy
comes back?
It's not an easy scenario.
It's two different, like you said,
it's two different businesses.
Maybe we can have Jimmy on another time
when he comes back and we can joke
around about what should your business be
called?
What should my business be called?
Because it is different.
It's different populations,
different clientele,
different mindsets of folks.
So there's a lot there.
He shared a post that showed like a
technician compared to a,
I forget what the other word.
I didn't like the other comparison.
I like the idea of the technician and
the expert.
This comes from E-Myth Revisited.
I'm the technician still.
I'm out there doing the stuff.
I'm making the pies.
You know, like that's what I do best.
You come in, I'll rub your back.
I'll exercise you.
You'll leave feeling better than you
started.
That's it.
You, I would say,
is more on the expert side.
deep diagnosis,
looking at the case history,
like diving into all of these details.
You establish yourself as the expert.
People are coming to you already sold on
your expertise,
knowing that I can't get something this
good without paying for it.
So that's where I think we'll bring Jimmy
in and we'll take a look at that
comparison of, you know,
I'm fine being the builder.
You're more the architect.
Like I'm fine being the line cook.
You're more the head chef.
It's just we understand our role.
McDonald's doesn't try to be a five-star
Michelin restaurant.
They're happy being McDonald's and they
make billions of dollars doing it.
They are happy being transactional.
So...
Up on the screen right now, this was,
you shared it and then I also saw
it.
Matt Gregory,
I don't think I have any connection to
him,
but he posted that he came across an
interesting stat.
Seems the average length of a career in
physical therapy is only about seven
years.
He couldn't believe it.
He researched it.
Turns out that he believes it to be
true.
This could mean that careers would
obviously be less than that.
So like some people are getting in for
a year,
some people are getting in for a couple
of months.
Then he said,
who's going to school all those years and
running up huge debt for a career of
a couple of years,
looking at medical doctor career and it's
thirty to thirty five years.
So, you know, that's another good example.
And that's that's been around forever.
I was in school in the mid two
thousands and that was a stat that was
still there.
When I get a student,
when I get somebody who is like, hey,
I need ten observation hours.
One of the things we talk about is
like, look.
If you're female and you want to have
kids,
is it worth putting all this money in
for a couple of years and then getting
out and starting your family?
If you're a male and you want to
own a practice,
is it worth putting all this money in
when you want to get out of patient
care anyway?
Yes,
there is the archetype of I can afford
it.
I want to do this.
I'm not I don't care about the money.
I don't care if this earns me a
living.
This is what I want to do,
you know,
and I think that's the ideal candidate.
But what are your thoughts on seven years
as the average?
I mean, that sounds crazy to me.
I can't even I can't even hear that
before.
I don't think so.
I can't, I can't even fathom.
It doesn't even register.
Now, of course,
and I went off and I did the
initial,
the tech app and then came back and
you know, that,
that failed and then open up a practice.
It doesn't even make sense to me.
I don't get it.
Like, I think there candidly,
there are some people that like I've heard
of or knew of through school or other
schools where,
their family had money and they didn't
have to take out any student loan debt
and they bounced around to different
colleges and different programs.
And they,
they might've gotten different degrees and
then they come out and they,
I joked about this on the show before,
like they never got punched in the face
by life before.
Like they never had any real adversity.
And so they eventually maybe have some
adversity,
like a challenging patient and they're
treating patients a day and they have to
do notes a day.
And they had,
they had some challenging patients that,
didn't like them or whatever.
And they're just like,
they get jaded over time.
I don't know.
Like for me, like you said, uh,
already I liked I'm competitive.
I like to do more.
I like to strive, uh, for more.
So whether it's better patient results or
back when I was in, in network,
there were times where I had multiple pay,
multiple,
multiple patients at the same time that I
was treating.
And they all seem to have gotten what
they wanted and like that experience and
all that.
So this, I don't know.
I think I got to bounce the ball
back to you because it doesn't even,
It doesn't even make sense because I don't
think maybe part of it is they're
seventeen and eighteen and maybe they made
the wrong decision.
Right.
When they when they made the decision.
I don't know.
I've never heard anyone discuss this,
but I searched a couple months ago the
gender distribution in PT-OTSLP.
I'll just read it from my side of
the screen, but basically,
and these are AI numbers,
so I can't guarantee accuracy.
It said, uh,
sixty-five percent of the PT population is
female.
Eighty nine percent.
Eighty nine percent of the OT population
is female and ninety five percent of
speech language pathologists are female.
Compare that.
Wow.
Yeah, it's massive.
Compare that to physicians.
Thirty nine percent.
Mostly male.
You know,
and I bet if you go into like
orthopedics or you go into specialties,
it's even a higher percentage of males.
Now, again, I go back to,
I don't know if this is sexist or
not.
I don't understand that stuff these days,
but the bottom line is I'm not having
a baby.
I'm not coming out of the profession to
have a baby to raise my kids.
Yes, I spent time with my kids.
I want them to be there when they
were young and I was fortunate enough to,
but
But if I'm the person who's birthing the
human, I'm not working during that time.
Right.
And it's really hard to go back after
you had that child.
We're in it.
I told you, I get it.
I get it.
I think that is a huge,
huge aspect of this.
You've got a huge population of females
within the profession.
They're getting pulled out to start
families, which is amazing.
I wish more would, but,
And a lot of them either aren't going
back at all or going back in some
capacity, going back part-time,
going back to do something.
So I think the numbers are a bit
skewed just because the gender
distribution is so different.
It's not a fifty-fifty deal.
But that being said,
you still have to be reasonable and say,
hey,
they're not charging women less than
they're charging men going into PT school,
right?
The degree costs just as much.
The degree cost takes just as much time.
The women are getting paid the same
salaries as the men.
So I think this is one of those
deals where probably these other factors
are contributing to it.
But if you're making that decision,
you want to be a PT.
Back in my day,
I paid like five thousand dollars a year
to be a PT.
You can do that and throw it away.
You can't pay two hundred thousand dollars
and just throw it away.
Now,
the seven years makes a lot more sense.
That makes a lot more sense in terms
of the timeline of my friends and folks
that I've known.
between leaving school and then getting
married or starting a family,
that timeline based off the gender
percentages in the therapies,
that makes a ton of sense.
Yeah.
So we're coming to the close.
Anything that's been on your radar lately,
anything that's interesting from a
business perspective that you've been
looking at or thinking about?
there might've been something that I
recently shared.
I'm trying to remember screenshots.
We covered that big one about therapists
leaving the profession.
I want to go back.
I got, I got something.
I want to go back to what you
said earlier.
I think you are completely wrong about the
physical therapy world basically being
non-existent in ten years.
Yeah.
These big companies that have fifty or
more locations,
you think they're
You think they're just going to dry up?
You just think they're going to start
closing locations and all that?
There's no way.
Will they have to figure out a way
to pay and keep up with cost of
inflation and all that?
Well,
I know some insider baseball here in New
York City.
There's a big corporate that I know
therapists that used to work there,
and they describe these –
corporates as places where all they do
it's kind of churning nowadays they're
kind of churning through new grads like
every office has like a clinic director or
a regional director that's seven or ten or
whatever years of experience but all the
treating therapists are new grads and so
i'm not saying that's great i you know
if if the the new grads are getting
patients better and the patients like the
experience and all that then that's fine
that's that's fine but the
Because of the cap of payment
reimbursement across all the payers,
these places can't,
they can't increase salaries every year by
three or five or ten percent every year
for therapists that stay in the practice
for ten, fifteen, twenty years.
So they just continually hire new grads
and then the new grads stay there for
one to three to five years and then
they leave, they move on.
That in itself is not great.
That's why we're different,
why we can pay therapists way higher.
But even with that,
I can't imagine how the physical therapy
profession is going to be
way different or non-existent in ten
years.
I think you'll still have new grads coming
out of school.
They signed up for the DPT.
They went through the boards.
They don't fully understand the financial
decision or the environment of capped
reimbursement, basically capped salaries,
and what they're signing up for.
And these DPT programs also have been
historically making a ton of money.
having you know going from bachelors to
masters and from back masters to doctorate
and you know if they could if they
could add a double doctorate tony they
would do it they would hey you want
to you want a double d you want
a double d dpt like if they can
do it they would they would absolutely you
want to you want a double big mac
with that dpt like they would they would
upsell you oh you want some fries with
that dpt let's let's like you want a
dbt plus a plus an ot or something
you know like if they could do that
they would and they're
You know this, I know you understand this,
which is like wherever the financial
incentives lie,
that's where you're going to find a lot
of the behavior.
So I can't imagine these big corporates
are going to change much in ten years
other than their compensation is going to
be a little bit more compressed,
their margins are going to be a little
bit more compressed unless they figure out
some self-pay stuff.
But I don't really care because we're
going to operate in a busy market where
we can charge a premium rate and I
can pay therapists
hundred, you know,
hundred and twenty six thousand dollars,
one hundred and seventy thousand dollars
over time, you know,
base pay plus performance pay.
And I'm going to start advertising this
selfishly.
I'm going to I'm going to stand on
the soapbox right now and say I'm going
to start advertising this on social media
and saying that we pay therapists the
most.
I got to figure out the wording,
but we're going to be the only show
in town,
one of the only shows in town that
can do that because of our model.
and we'll see how that goes but i
threw a lot at you i i do
think that that profession is going to be
basically the same as right now in ten
years i think i think it's gonna be
the same the network is compressed out of
network self-pay is gonna get more and
more popular with online video and more
discretionary income and every everything
else is increasing in price and more
consumers are just gonna be like all right
i guess i gotta i guess i gotta
be a wise consumer and find a
PT or a chiro or someone to go
see and they charge out of pocket,
it's going to continue to become more and
more normal and appropriate to pay out of
pocket for physical therapy and health and
wellness services more every single year,
which benefits us.
So I don't know.
What do you think?
I intentionally said ten years to try and
overshoot the expectation that I actually
have.
You think it's five?
This is what I see.
I see hinge and sword.
I see these two companies coming out and
blazing a path to how do we get
one therapist to manage a thousand
patients as opposed to one therapist
managing eight patients.
I think what you're going to see and
you're going to see pressures from
multiple areas,
you're going to see these two companies
make all the mistakes,
but then figure out the solutions and take
AI to a place where one human therapist
can manage a thousand or more patients.
I think you're going to see,
you said DPT programs are profitable.
I don't know.
But on a university level,
when you look at where the university
makes its money,
I don't think they're profitable on the
university-like ecosystem.
So I think it's just a nuisance.
They're so small.
There's so few students.
Who really cares?
I just heard about one of the bigger
public universities cutting a whole huge
department off.
of linguistics.
And I'm like, okay,
why wouldn't they cut all these all little
tiny departments of PTO, TSOP,
all this stuff that really doesn't make,
it doesn't move the needle for them.
So I see departments cutting programs.
I see fewer students deciding to take on
the financial obligation.
I see it easier to get the education,
the information.
Like, I really think my kid,
my thirteen year old asked me the other
day, Dad,
do you think I could do everything a
physical therapist could do?
How long do you think it would take
me to learn that stuff?
I said, you know what?
Really?
Other than the evaluation.
You could do it all in a month.
You could learn how to count to ten
in a month.
You could learn how to pull that handle
thirty times like you could do that stuff
pretty quick.
What's going to take you time is learning
how to differentiate when it's a.
You know,
rotator cuff tear versus some other,
you know, issue with the shoulder,
the diagnostics, the case history,
learning how to build trust,
learning how to relate to your patients
like that.
That takes some time.
Years, years.
But there isn't a single person,
an adult today who can't get on AI
and probably learn all that stuff right
now without the college degree.
You know,
we're still in a situation where the
college degree, those three letters,
sometimes two after your name gives you
the license to bill insurance.
That's hardly worth it anymore.
There's no money in that anymore.
So why am I going to spend seven
years and two hundred thousand dollars so
I can bill insurance to get paid fifteen
bucks to get paid a dollar a minute?
I don't need that.
You know,
so so I think we're going to see
all these things.
We're going to see schools dropping the
programs because they're not making enough
money generally to support it.
We're going to see therapists with AI
treating thousands of patients a day
because they can do it.
They have the capacity now to do it.
They're going to replace me.
They're not going to replace you.
That's an important aspect here.
Agreed.
We're going to see fewer people interested
in taking on the debt to become a
therapist,
but learning all the information on their
own.
And effectively, I mean,
you're going to have at some point in
AI that better and more knowledgeable than
any physical therapist on the world to
answer your questions.
They can't rub your butt,
but they can answer your questions.
They can tell you what's wrong.
They can help you go through a twenty
question game and figure out what your
diagnosis is.
Probably better than the human who might
not have had their coffee,
who might have woken up on the wrong
side of the bed.
I mean, I listen to them on TikTok.
You know,
they break up with their boyfriend or
their girlfriend and they're a mental
wreck.
Like we have licensed professionals going
on TikTok today that are screaming because
they're upset about something.
I've never screamed in my life because I'm
upset about something.
That's not a stable human.
That is the profession as it shows to
the consumer right now across social
media.
I don't see it happening ten years from
now.
But your service will still be needed ten
years from now.
It just won't be physical therapy.
It won't have the name.
It won't have the title.
You threw a lot at me.
Two things.
One,
when we can share multiple universities
dropping the DPT programs on an article
online, show me that.
show me a trend of that show me
multiple schools dropping a dpt program
then what then i'll say i was wrong
tony i believe you jimmy you're refereeing
again put put your jimmy's in the middle
we're on either side and we can duke
it out if i see universities dropping dpt
programs which i haven't heard of it if
it if it happens please let us know
in the comments comment on yeah on the
youtube or wherever on facebook wherever
let us know if that if that starts
happening then
absolutely then of course you're right and
then also if sword health or hinge health
gets acquired by usph or select medical or
those are the two select medical i think
went private recently larry ben said but
yeah us usph is public if if one
of the big conglomerates that own or or
not concentra um what's the one that larry
used to be a part of confluent if
confluent or one of these big groups
acquire or invest in Sword Health or Hinch
Health,
then I will also come on here and
say Tony was right, I was wrong,
and that they are the only way that
they can get out of the in-network squeeze
of having all these brick and mortar
offices across the country would be
acquiring or partnering with Sword Health
or Hinch Health so that they can go
from one therapist to eight patients to
what you said,
one therapist to a thousand patients or
whatever.
This stuff might happen.
But I believe in every in every,
not just every city, but in every,
not even metro, in every zip code,
there will still be a demand for the
one on one out of pocket physical
therapist who's going to charge one or two
hundred dollars plus per visit in podunk
little towns that have populations of ten,
twenty, fifty thousand people.
and you can get your dpt degree you're
going to know all your differential
diagnosis you're going to know when to
refer people out you're going to know you
plus you can use some of the ai
and other stuff to keep up with research
and your techniques and all that
So that's two things.
And then the other thing I want to
push back on is how come personal trainers
are not already using Claude, ChatGPT,
Gemini, all that to replace us?
How come they're not using these
technologies?
They've been around long enough.
Or even just basic Google that's been
around for the last fifteen or twenty
years or whatever.
How come personal trainers are not already
doing what you're saying,
which is
Getting smarter,
using technology to understand
differential diagnosis based off of where
the pain is and where the pain travels.
They could be doing all this already,
Tony.
They could be saying, oh,
you have pain that travels this way.
So that's, that's okay.
Let me see.
That's a long, this dermatome.
Let's pull up this script.
A personal trainer could be doing that
right now.
They're not.
I would disagree.
I would say they've been doing it for
years.
There's been corrective exercise
certifications for years.
You go on ACE or NASM or any
of the personal training certification
websites,
you're going to see personal trainers with
certifications for carpal tunnel,
for shoulder pain,
for all of these things that historically
physical therapists used to own the market
on.
We don't.
We can't protect the letters.
We can't protect licensure.
We can't even get lifetime to stop using
DPT,
which in every state should be protected
under the State Practice Act.
We lose that lawsuit every single time.
The Hinge Health, I just went online.
It's a three billion dollar market cap.
USPH is a one billion dollar market cap.
But we're talking about atoms.
We're talking about atoms and bits,
you know, like if anything ever happened,
Hinge would say, I'm going to acquire ATI.
I'm going to acquire USPH.
But then they're going to look at
themselves and be like,
why would we ever do that?
We have software that's scalable to
infinity.
We have virtually zero labor cost.
Why would we go pay for humans?
Why would we get into the world of
atoms when there's nothing good that comes
out of it?
And these other companies have been
suffering and floundering for years.
I really think...
agree with you i'd be interested to see
when the universities start making those
cuts um but i i really do think
that they are going to perfect the
technology that's going to increase access
that's going to wipe out the commoditized
service i deliver a commoditized service
we will be removed from the equation
because we bring the cost of care down
to virtually zero when we do that for
insurance companies i would imagine uhc
would buy hinge like that's that's the
acquisition that i would see um or build
their own in-house but yeah it'll be
exciting times bottom bottom line is if
you understand how to talk to humans if
people like you
If you're generally a happy person,
you're going to be successful the rest of
your life.
It doesn't matter whether you call it
physical therapy or you just say, hey,
I just help you feel better.
You know,
come hang out for an hour twice a
week.
I will help you feel better.
You'll live longer.
You'll move better.
You'll get off the chair without grunting
like an old person.
Like that's what I sell.
And it's not called physical therapy.
That was my parting shot.
What you got?
Yeah, well, I'll say my parting shot is,
well, you also have the cheers effect,
right, in your office.
So it's not,
you say that you are transactional and
you're the lowest cost and, you know,
the whatever, the lowest denominator.
But no,
you have people paying out of pocket for
the gym access.
They have access to you.
People want that.
I think even with all this technology
stuff and AI and all this,
there's still going to be people that want
the, the specialist, the expert,
the person that they can ask.
And they know,
like there's going to be some different
style of trust where they're going to
continue to trust you, Tony,
because they know that you've seen a ton
of people in person for years and you've
had to kind of navigate like the pros
and cons of that and successes.
And then some where it treatments didn't
work or something had like a bad response
or whatever.
Um,
And it's that human connection that I
think people will always want.
I think they'll always want what you have.
They like that it's lower cost that you
take a lot of the insurances and that
you take their Medicare.
So they like that,
but then they'll also pay out of pocket
for the gym experience or the next thing
that you might offer,
whatever that might be.
The commoditized practices that are
strictly transactional,
like the McDonald's version and
it's eight patients per one therapist.
Yeah,
I think those are gonna get swallowed up
and have to close and their margins are
gonna be continually tight.
Anyway, so that's it for me.
That's my parting shot.
All right, guys, come back and follow us,
join us, hang out with us Tuesday,
Thursday mornings,
eight thirty Eastern a.m.
Jimmy will be back next week and I'm
sure we'll get lots of stories about the
event he's at right now.
Dave, you enjoy your weekend.
Spend some time with your little boy.
Thank you.