and there we go happy tuesday uh he's
tony maritano i'm jimmy mckay and this is
pt breakfast club dave will be here in
a minute um we had a lot of
action in the uh the group chat the
last couple days a lot of things that
were going on what do you want to
start with first
You go.
You look at it because my computer is
rebooting.
Oh, yeah, yeah, yeah.
Well,
first was the response to Sam Altman
saying that there will be a one-person
AI-built billion-dollar industry.
Did you see that, the company?
He has said that since the release of
ChatGPT-Tree.
So I haven't seen anything recent,
what's going on.
And then I think David shared this.
um someone had said they had done it
but really what the guy was doing was
he was just he was just using ai
to just create hundreds and hundreds and
hundreds of ads and then connect them to
things to people actually doing the thing
so he was he was selling glp ones
so i think it's yeah i think what
it is i think dave is sharing that
because he's saying look ai isn't all it's
cracked up to be it's not doing this
thing i also don't think either of us
think ai is going to do everything
But I think AI is doing a lot
of different things and you can choose
where in your life.
Remember that like in Mario Kart,
where there was those things you could go
over,
you drive over and all of a sudden
the car would just sort of boost forward.
Yeah.
That's sort of what AI is, right?
It's going to do the same thing that
you're doing now.
It's just going to give you a little
bit of an edge in doing it.
I did read a statistic yesterday.
I was talking with Andrea.
We do sort of a marketing show every
week.
And she quoted the statistic that I had
actually already found.
An MIT study showed that about ninety five
percent of AI pilots in health care
Never leave the pilot stage.
So essentially,
a tech company makes a bold claim.
This will save every one of your providers
three hours of documentation time per day.
They do a pilot and it doesn't move
forward.
And I sort of read that as we're
coming in this thing pretty hot where
everybody's got the solution.
eventually someone will have a better
solution to do this or the writer's
solution or the easier solution.
So I think David shared some information
like that too.
Yeah, but I mean, so two things here.
First, the original point of, okay,
this guy created a billion dollar
business, air quotes.
How do we define what a business is?
He's using AI to do these things to
make this money.
Um,
just because he's not like in a lab
making the GOP one,
he's reselling it effectively.
Uh, I still say it's a business.
It's still a functional business.
It's still a single person business.
Go back.
Twenty or thirty years.
He couldn't have done what he's doing
right now.
Um, so, you know,
maybe it's not the business we expected,
but still works.
Right.
It shows up in his bank account or,
you know,
it showed up in his bank account.
And two,
why are so many of these pilots not
taking off?
Is it the technology or is it the
human that refuses to adopt it?
I look at how long it takes me,
how long it took me to adopt EMR,
how long it took me to bring in
and really,
really refine the system for AI
documentation.
and even now it's far from perfect but
it's like we're under such a heavy burden
of compliance and hipaa and state laws and
local laws and federal laws and
association all of this stuff is virtually
impossible i mean i can't imagine where
healthcare would be if we eliminated so
much of the burden of compliance and
regulation i i think we'd be so far
ahead
Some of the discussion I've had with
people who are in technology that bring it
to healthcare is, well,
it might be a few months into the
person already having developed the
technology and the question is, well,
why can't we just do it this way?
And the answer is, I don't know,
because we can't.
You need a way around that.
It being a bad idea doesn't prevent it
from being the rule or the law.
Dave is doing some construction.
Setting up the lighting.
Good morning.
Dave,
you shared a story about a former NHL
player opening up what looks like a PT
and rehab center in Connecticut.
Yeah,
I figured I figured you would like it.
Hockey player Jimmy is still playing men's
league hockey and any anything that is
serving the neuro population is wonderful.
I'm not sure if you guys had much
to look into it,
but anything that even if it's against the
traditional rehab,
like you share something maybe a few
months ago where it was like just.
personal training and not physical therapy
or not rehab, but nonetheless,
anything that is like this, um,
especially if it's someone that is,
or previously was in the public eye and
is serving the neural population,
it's a wonderful thing.
Yeah.
So I can't see the story cause it's
gate kept, but is it,
is it not a PT clinic,
but it's on the outside or what is
it?
So I think it's both.
I think they do therapy and then also
training.
So it would be maybe after...
And this is the unfortunate thing that
when someone has a neurological condition,
it's obviously like a long-term thing,
but most insurances are only going to
cover like a certain amount of visits per
year or even the first year.
And so it seemed like it would be
a way to kind of segue those folks
into training in the same facility after
they have like their acute outpatient
experience of rehab and therapy.
Yeah.
I just talked to the AP,
the president of APTA Minnesota.
I'll bring up her website.
I've talked to a guy by the name
of Yanni Corey,
who's decided to essentially make gyms
filled with equipment that's perfect or
tailored to people with spinal cord
injuries, post-stroke,
traumatic brain injury.
And the thing missing from the location
are the PTs because they're too expensive.
So that model will not allow it.
The insurance won't cover it.
So it doesn't cover things.
and but but we understand especially with
with the populations we're talking about
that ongoing treatment is needed and yet
the financial model isn't there so they
flipped it so they've made it more of
a gym model and they find a way
to make it work it just sucks the
fact that like we know these these people
need this it's ongoing and we have to
come up with
I mean, I like creativity,
but it sucks that we have to come
up with creative ways to give people a
thing that we know will help them.
We have to sort of like skirt the
rules and figure out ways around it or
remove PTs from the equation altogether.
Or, hold on, hold on.
Go ahead, Tony.
I was just going to say,
put PTs in the role that we were
designed for.
We are not designed for counting reps and
sitting there watching the patient.
We're designed for the evaluation,
developing the plan of care,
establishing the patient-centered goal,
teaching, all of these things.
Dave, go ahead.
While you do talk, Dave, Jimmy,
I shared two links related to this topic
in the chat just now.
Go ahead, Dave.
So let me let me double click on
what you said.
So I agree with everything you're saying,
except then you're saying that physical
therapist develops the plan of care.
But then, all right,
let's have some PTA or unlicensed person
carry out the plan of care.
It's it it doesn't I don't know.
It doesn't fully make sense.
It's as if like an orthopedic surgeon
would say, all right, you need surgery.
And here's why you would need surgery.
And here's why your insurance will pay for
it.
But then I'm going to turn it over
to an esthetician or someone that's not a
surgeon.
I get what you're saying for financial
reasons and all that.
Logistically, it doesn't make sense.
If money was not a factor here, right,
Tony?
Wouldn't you have physical therapists do
the evaluation and go through the plan of
care?
Or maybe the first three to five visits
or something and make sure the person's on
the right track and make sure that they
are...
getting the differential diagnosis correct
and making sure that the patient does not
need to be referred back for advanced
imaging.
Maybe it's, you know,
a tumor or something malignant or
something that is, you know, serious.
And then after visit number three or five,
then they go to a PTA or then
they go to, you know,
this unlicensed person that's like part of
the team,
but they're not a licensed healthcare
provider.
If money's not an issue,
if money was not a factor,
that's the thing I would like to talk
about.
Yeah, if oxygen wasn't an issue,
I'd live on the moon, but it is.
So I think money is always a factor
for the majority of the population,
not everyone, but a lot of people.
And so, yeah, if money wasn't a factor,
I'd eat off gold plates and I'd drive
a Lamborghini, but it is.
So Jimmy, real quick, this is a company,
they're franchising that machine.
It's all crazy expensive.
I don't know why somebody did it,
but this is for individuals with
neurologic conditions like brain injury,
stroke, that are finished with PT,
finished with OT,
self-paying out of pocket to come sit in
this machine and work on motor function.
uh all self-pay i think they're charging
three hundred a month but don't quote me
on that no no therapist in the building
this is just post rehab and then the
other one is stroke fitness which dave and
i talked about last week uh same thing
they have a series of machines people who
have had strokes go in for for exercise
there's no pts on site ot's on site
and it's it's post rehab and i think
they're around that same price point two
three hundred dollars a month i mean these
are popping up obviously because there's
clearly need and it's clearly lacking and
the system is screwed in terms of
insurance we'll say i mean that's how you
know i'll bring up the website in a
second but that's where next step fitness
which essentially is this model and yanni
the guy i met years ago friend had
a spinal cord injury and said i was
told i was going to get
three weeks worth of PT.
I wasn't even going to be at a
hospital yet that I was going to be
done,
but was told I had all this function
still to go and it wasn't going to
be covered.
Now he was financially able to fly himself
across country and live somewhere while he
was getting treatment.
But he's like,
I understand that that's not possible for
everybody.
So he decided to build sort of that
gym model.
But I mean,
this goes back to the conversation we've
had before, which is,
I understand what Dave's talking about.
In a cash model,
if someone can afford it,
if oxygen wasn't an issue,
you'd want the person who's got the most
skill doing the most time with the person
who's paying the most money.
In an insurance model,
you get paid the most for doing the
evaluation,
and then you're underwater for doing
anything past that, it seems,
or close to it, right?
I mean... Dave?
Yeah, well, yeah, but...
We've had other examples on the show
historically,
like when I brought up the Spiro Clinic,
I think they're in like Arkansas and they
charge like an enormous,
I think it was like forty grand,
forty two thousand for what they do to
help people with complex regional pain
syndrome and reflex,
reflex dystrophy and all that type of
stuff.
So like the real like POTS and MCAS
and all these like global
rheumatological slash neurological
multi-system presentations.
And they help,
and I'm not saying this is great.
I'm not saying this is,
I'm not saying even what I'm about to
say, I'm not saying this is the solution,
but they help their potential clients set
up GoFundMes to raise the money.
And I'm not saying that's great or just
or the right solution or anything,
but that's just another way.
That's another solution.
So this practice that does
That charges forty two thousand dollars
for however long the plan of care is.
I think it's like I think it's like
three or four or six months.
It's like a really long time.
You would go and live in the town
to get your treatment for however long.
And they have people that fly in from
every state, every country.
And.
That's not the best solution maybe,
but that is just what they've found to
work for them.
And they help their patients set up
GoFundMes to raise money from their
friends, their family,
their community members, all that.
So, I mean,
a good sales question in general for any
sales is like,
if someone presents some investment or
some whatever, some service or whatever,
it's like, you know,
do you have the funds for this investment?
Or do you know people that would have
funds for this investment?
So that's like an Alex Ramosy quote.
He'll say that,
or they would say that when they're
selling gym launch to gyms.
So you could take out a credit card,
you could get a line of credit,
you could get a bank loan, whatever.
And people have done that just to join
gym launch.
And people will do the same thing for
these opportunities.
I'm not saying it's the right way,
but there are solutions out there.
There are workarounds to make things
happen depending on if
the end consumer, in this case,
the patient,
the client that maybe has a neurological
condition,
wants above and beyond what their current
insurance will pay.
You mentioned GoFundMe.
I got to tag you.
Kara Wilkie had asked in the OT group,
If anybody had ever heard of setting up
GoFundMes,
like a clinic doing it to pay for
their patient's care,
I had forgotten you had mentioned that.
Separately, Jimmy,
I don't know if you ever,
did you interview this guy?
He's an OT, Dr. Phil, the OT professor.
he does a neuro boot camp he's got
a growing tick tock channel he basically
either he goes to them or they come
to him and it's this intensive multi-hour
you know multi-day just taking patients
who have had strokes and brain injuries
and putting them through all of these
workouts it's really impressive like a and
then that goes back to dave's point what's
that
Like a train the carer?
Like he trains people who are going to
then train the trainer?
No, no.
It's a neuro boot camp is what he
calls it.
And he's training the patient more than
anything.
But just high intensity,
long duration sessions.
And this goes to Dave's point.
I don't think you could outsource
something like that.
Like the OT is doing it because these
are complex cases and you're spotting the
person and...
They're gonna fall,
they're gonna get hurt.
Speaking of which,
this is kind of an interesting,
we had a patient fall in the clinic
the other day.
And I generally pride myself on never
letting anyone fall.
And I'm asking you guys, peer to peer,
I was thinking about it and I'm like,
I'm always a defensive therapist.
I'm never going to put someone in a
position to get hurt.
I will tell everyone coming into my
clinic, you might not get better,
but you won't get worse.
You might not reach your goal,
but you're not going to get hurt in
the process, right?
The difference between me and a CrossFit
coach is the CrossFit coach is going to
make you achieve outcomes you've never
imagined possible.
I'm just not going to make you get
hurt.
I'm not even going to make you sore.
My question to you guys is,
if we are really in the business of
improving and challenging patients and
making them do things that they want to
achieve, accidents are going to happen.
People are going to get hurt.
Jimmy gets hurt playing hockey.
Dave gets hurt on the baseball field.
I get hurt running down the block.
Like,
are we underdosing to the point that,
you know,
we're just so conservative and so scared
of the liability?
I mean, is it reasonable to say, okay,
I'm probably going to drop two or three
people a year.
This is going to be the price that's
paid for helping these people go into
challenging positions.
Is that a reasonable expectation?
I think so.
There's a lot of PTs out there across
the country on Instagram that are always
making fun of traditional PTs saying,
you know,
nothing's going to happen with a yellow
TheraPan.
There was like the gif of the older
woman deadlifting and she's got like gray
hair.
And she said there was like a talk
bubble and it was like, you know,
I don't need your yellow TheraPan or
something like that because she's
deadlifting like two hundred pounds or
something.
So there are a lot of PTs that
have already
acknowledged that a lot of the traditional
in network physical therapy practices not
or or not even i won't even say
i'll just say traditional pt not even in
network uh are under loading their
patients and clients they're using you
know therabands when they could be doing
like a a farmer's carry with a dumbbell
or like an overhead you know with a
with a kettlebell overhead walk
things like that,
or sideline arm bar with a kettlebell as
opposed to the yellow TheraBand.
So there's a lot of PTs out there
that have kind of identified this over
time.
That is the price that we pay, Tony.
It's kind of like that trade-off.
And we have clients that we interact with.
And it's like, sometimes they're one way,
Tony, and sometimes they're the other way.
Sometimes they are afraid to get sore.
They're
afraid of the current issue getting worse.
They're afraid of the previous issue
coming back.
Some have a lot of anxiety or nervousness
around how they're going to respond.
And we tell them up front, like, hey,
thank you for sharing that.
And that's totally fine.
I'll communicate that with the therapist
and make sure, hey,
start this person really low and
progressive and really slow and easy.
And then we can minimize their soreness or
their discomfort or things like that.
versus if it's like a marathon runner and
they're twenty five years old,
they're used to getting sore and we want
to ramp them up as fast as possible.
So then we want to it really for
us, it depends on the patient.
We can deliver either experience.
We don't want to be one or the
other, Tony.
But yes,
if someone is sixty five or seventy five
and they want to avoid falling,
then we have to say, hey,
we really need to push you outside of
your comfort zone.
And when we're working together, you know,
we're going to have a gate belt around
you or whatever.
But
it's possible that you might fall.
Maybe you slip out of my grasp,
even if we're doing tactile cues and we're
holding them with their gait belt,
they still might fall.
And then of course, Tony,
if you're away from them and they're doing
a ladder drill, stepping through a ladder,
they might trip and fall on their own.
So yes,
it would be the price that you pay
depending on the patient's clients' goals
and also how you, the therapist,
develop your therapeutic exercise and
balance like is it low level or is
it you know pushing them outside of their
comfort zone where those falls would then
be more likely
Yeah, I mean, even Tony just saying, like,
I had a patient fall brought me back
to,
I can picture the woman and what it
felt like the second.
And I think I, like,
rolled myself underneath her to, like,
brace her.
And I thought I was like,
everything's over.
It doesn't count.
It doesn't count if they fell on you
and they didn't hit the floor.
It doesn't count.
The funny part is I can still picture
this woman's feet because she would come
and flip-flop, like, not even flip-flops,
like, slide-ins.
And I remember being like,
let's just go barefoot because that'd be
like, you're going to trip on these.
And she's like, I'm fine.
I'm fine.
And we're doing like step ups on a
box and she, she eats it.
And I'm like, I knew it.
I didn't push hard enough, but like,
That's the thing, right?
We're taught the goal is don't lose.
I was taught when I started in radio,
the goal is don't lose the license of
the radio station.
Not win, not win, win later,
but make sure you do not lose, right?
Like loss aversion.
So, I mean,
you can't walk onto a baseball field.
You can't walk into a playground,
a tennis court,
a skate park without walking past a sign
that is large enough for a lawyer to
say there's no possible way you could miss
that by saying,
anything that happens here, it's on you.
And then for some reason, we're very,
very nervous.
And I get it.
Listen, if you prove negligence, listen,
if you've got a person on a BOSU
ball on one foot with, you know,
It sort of sucks.
I get what you're saying.
I think most people are like, just don't
Don't lose.
Don't lose the license.
Don't get fired.
But yes,
I think doing things that are hard and
just outside of someone's capability is
the point.
And that, someone can math this,
over X number of patient interactions in a
year, it's almost like a fall.
Falling is normal.
We don't care.
We sort of look and think it's cute
when a kid falls, right?
They're learning to do something they
haven't done or they're trying to do
something they haven't done in a while.
And then we do it with an adult
and we're like, absolutely not.
Absolutely not.
So I, I, I lately meant,
I lately mentioned cash-based PT,
but I want to just mention that guy,
Preston,
I think Preston Alexander from LinkedIn.
I shared that with you guys in the
chat.
Right.
He, I don't even know what he does,
but he gets like a ton of views
and engagements and comments on his
LinkedIn posts.
And he's the one that's been really
outspoken against insurance companies and,
you know,
like big pharma and big medicine and all
that type of stuff on LinkedIn.
And then I was really surprised.
I haven't been doing a lot of LinkedIn,
but now I'm back on LinkedIn doing some
recruiting.
So yeah.
Yesterday,
I saw that Preston posted some posts that
he was doing self-pay physical therapy.
And I thought that was really interesting
because I didn't think, I don't know,
like I just, I didn't,
I feel like there's not a lot of
people that are non-physical therapists
that ever post that they're the patients
of a self-pay physical therapist and like
why they're going.
Any thoughts on that post?
yeah i mean number one so i looked
up who he was and he's definitely talking
about health care in three hundred and
sixty degrees right like he's talking
about payers like that's his whole angle
is like don't let payers fleece you and
this goes into the fact that wellness and
fitness is now a status symbol it's a
possession
now.
You can own fitness.
And people sort of brag about the
equipment they have,
how often they work out,
what type of diet they have.
I think you're going to see more of
this.
In fact, as you're saying it,
I'm sort of surprised that you're not.
How many people, if they had one,
a personal chef,
I mean,
that's sort of what he's sort of talking
about.
He's like,
my therapist doesn't have to check his
watch to see when we're ending because
essentially I pay him well enough where
time is no longer the factor.
Skill is now the factor.
I pay this because I want the result.
I don't think you could have talked your
way into this situation ten years ago or
it would have been really hard for a
small group of people.
I think it's easier because you have to
convince people less of how valuable being
well is.
yeah i i agree the new status and
and we saw one of the guys from
uh one of the investors from uh
a show that I used to watch all
the time.
He was saying that... Shark Tank?
Yeah, one of the Shark Tank guys.
He was like,
the modern flex is being strong,
being healthy.
I think Dave asked if that was an
AI video or a real video.
I mean, the guy looked great.
Okay, you did.
Yeah, and so it's totally true.
Herjavec has always looked great.
I saw so much of his content in
a short period of time.
It just seemed too right.
You know what I mean?
Like that's sort of like the litmus test
that we're going to have in a year.
I don't know if we're gonna be able
to tell the difference between some of
this stuff.
Remember the test like a year ago,
it was like,
there's six fingers on that person's hand
or they spell the word guarantee with
three E's.
It's like, that was obvious.
Although,
if I were trying to get a group
of population on a planet indoctrinated
into being able to think they can see
through AI and then completely pull the
wool over their eyes,
step one would be make it sort of
a C+.
and then jump to the A-plus, it's over.
Because you're like, oh,
I can spot this stuff.
It's super easy.
And then jump to it.
So I saw so much of it.
He didn't seem like the kind of guy
or doesn't seem like the kind of guy
who needs to be shooting a bunch of,
I'm just walking to get a cup of
coffee video.
And I happened to be like sort of
looking over my shoulder and like talking
to my videographer about lessons in money.
And it just felt too,
it felt too on,
it felt too on brand.
Yeah.
um but yes robert hershevek has always
sort of that's always sort of been his
angle which is like health's the only
thing you can't take away when you can't
buy anything else what do you buy buy
time or money or sorry time or health
because you can't buy either of those
things but you can flex on those things
yeah so i have no idea what video
you're talking about with robert persia
You shared it in the chat?
It wasn't even one particular video.
He just had so much content.
Obviously,
I probably watched one of his videos too
long.
And next thing I know,
I saw thirty of them in three days.
It looked like too much different content
coming out in a short period of time.
Either he banged out a hard session of
a weekend of just shooting stuff where the
videographer was like,
let's just do what you normally do on
a day.
Let's go get coffee and then give me
a story.
Give me a lesson in this.
That's what I, so I went to,
this is like a weird segue.
I didn't plan on doing this, but that's,
that's what happened when I went and Dave,
you'd be a perfect audience for this.
I don't think any small clinic should hire
a full-time marketing person.
If they're below, I don't know.
I'm going to say five full-time employees,
right?
Just making that number up.
It doesn't make any sense, math-wise.
If you're twenty-plus, maybe fractional.
If you're fifty-plus, full-time, right?
Again, making these numbers up.
So when I was at Danny Matei's event
two weeks ago,
a lot of the people I was talking
to were like, I've got three FTEs,
I've got five, I've got seven.
And I'm like, huh,
now you're in the territory where
You know you need some more volume to
keep those five or seven people busy.
You don't want it to be your job.
And I'm talking about the owner.
The owner is like,
I've been doing it for now.
Now there's sort of that step where you've
got to sort of hand that off.
So I've been toying with the idea of
you don't need someone who's on hand all
the time.
What you need is a hard weekend or
a hard two days of let's map out
what you're going to get,
bring in the team to do it.
record film walk people through it they
leave they edit everything and then dave
gets a google drive filled with everything
a kit that says here's enough i mean
you're smart enough because you've been
doing it but like here's what you have
here's what you ordered and here's what
you get it's like a custom burrito from
chipotle it's a marketing kit that's
delivered to you but that person doesn't
need to live in your clinic because that
math doesn't math
Yeah, for sure.
Speaking of videos and stuff, Jimmy,
I sent you a link.
Did you guys see that two thousand five
video that I shared?
Oh, yeah.
You were going full Gary Vee.
Oh, Dave, if you can pull it up.
Where is it?
i'll get it on facebook i i thought
i tagged you but maybe not we were
going my wife and i were going through
old kid photos and kid videos and we
came across a couple folders of uh videos
from and pictures from like and i had
no idea i completely forgot like look at
this this is like uh i'm holding i'm
holding a camcorder
I'm not spotting the poor guy.
I'm not guarding the poor guy.
Even in two thousand and five.
This is back in Florida.
I'm like focused on I need to get
the video.
I don't know what I was going to
do with it.
This this was, you know, so far back.
But this goes to like, remind people,
look,
I've been doing this over twenty years,
virtually the same stuff, you know?
Now, what this video did remind me of,
I can't believe this could be a scene
in my clinic today.
Like, we have not innovated.
I've still got people doing a sit-to-stand
from a bench.
Maybe not on an AirX anymore,
but I've got the AirX for other stuff.
I'm wearing the same clothes.
My geriatric seniors are exactly the same
except, you know,
a new generation of them.
It's like a time warp.
Other than my hair is darker and I
have a little more of it and I'm
thinner, but my clothes are baggier.
It could be today.
I love it.
Incredible.
I mean, yeah.
Tony,
this almost looks like the gentleman with
the joke book, like when he was younger.
Yeah.
I can't even tell you how many people...
over the years have been replicas of
themselves it's just oh yeah you know it's
just the same person keeps walking in my
doors but they're they have different
names paul's convinced you're a time
traveler there tony seriously
This is just a reminder,
like anyone that like,
sometimes like when I had the grant,
my grandfather-in-law video that now is up
to like one hundred and fifty six thousand
views, which is still like decent,
but not like.
And then you go to I go over
to Tony's Instagram and I look at those
reels and I look at the most viewed
and it was like two point three million.
I'm like and I got I got excited
from that video on my my account.
And it's like.
I can't even compare it.
Tony's been messing with these camcorders
in his clinic in two thousand one,
two thousand three, two thousand five,
like before Gary Vee was on YouTube before
there was a YouTube.
Right.
I'll bring up the post,
but I share this and I think both
of you are excited to talk about it.
Somebody anonymously.
posted in a large PT Facebook group that
they said,
I feel like I will have to spend
between five and eight thousand dollars to
get some skills before I can get in
my own cash practice.
Have any of you done that?
I rushed to the comments and
hoping and i'll bring the post up maybe
i was wrong but from what i remember
i rushed to the con to the comments
hoping people would be like you don't need
to do that do not do that you
don't need it fight why do you just
have five to eight k burning a hole
in your pocket if so happy to take
it off your hands but you don't need
to do that
And many of them were saying, yes,
I did the same thing,
but never saying I did the same thing
and it burned me.
I didn't need to do the same thing.
What were your thoughts when I shared
this?
What would have been your reaction had you
had been in that group when it was
shared?
What group was it in?
I remember the post.
Just the big physical therapy group.
Go ahead, Dave.
So the first distinction would be what
type of skills.
That's the, that's the biggest question.
Are we talking about clinical skills,
which in general you should have,
maybe not as a new grad.
Cause I think the first three years I
was like, I had a,
I had a big ego and then I
realized like how much I didn't know,
but I thought I knew a ton or
I thought I knew everything in the first
one or two years of being a DPT.
I think there was a lot of like
ego with that.
Um,
But are we talking about clinical skills
or are we talking about business marketing
sales, right?
So in cash practice,
you need marketing and sales.
You need repetitions of being told no,
which takes months, if not years.
You need the marketing.
You need the sales process of like,
how am I going to overcome the insurance
question?
How are we going to navigate?
What is the pricing?
Like, how do we do all that?
Like that we're not even taught in school.
And if you like,
we talked with Tony a million times,
if you didn't have a business before DPT
school, you haven't gone through this.
You haven't gone through rejection and
starting a business from scratch and all
that.
So are we talking about clinical skills?
If, if that's the case,
I think you had enough with DPT with
the DPT.
Or are we talking about business and
marketing skills?
If that's the case, yes, you probably do.
I didn't.
But you probably do need a coach that
you need to spend five or eight K
on for a course on how to do
Facebook ads or Google ads or set up
Google ads or how to have a coach
keep you accountable with reviewing your
sales calls,
with patients and overcoming their
objections, all that.
So it depends on what skills we're talking
about.
Right.
I read this first as clinical skills.
And then I read back and said, oh,
to get my own cash practice was hoping
they were talking about skills that they
weren't already taught.
So they weren't paying for them twice.
That is sort of the way I looked
at it.
I commented, I asked,
what skills are you looking for?
And they replied like pelvic floor
therapy, maybe manual therapy.
And if you scroll through the comments,
which you don't have to do now,
but one of my previous teachers,
Thomas Eberle,
He and I don't agree on a lot
of things.
We agree on some things.
He's working with Ron Miller down in
Florida now.
He's a cash PT, manual therapist.
But he had suggested, yes,
definitely you can't start a cash-based
therapy without better clinical skills.
And of course,
I knew the three of us would be
like, heck no, the clinical skills,
you just have to be not bad.
You just have to be good enough.
You need business skills,
marketing skills, communication skills.
You need to understand the consumer and
what the consumer is actually buying in
order to go into the cash-based world.
Yeah.
I do want to mention though,
I don't know if I was taught in
the DPT program or if we were,
I don't know if it was,
there was a big emphasis on it.
So for like orthopedic or outpatient PT,
I don't think I ever saw or remember.
And I,
please correct me if you guys got it
in your rotations or your first DPT job,
your first outpatient job about the pre
and post tests,
like to actually show the patient like,
okay,
so you're feeling seven out of ten knee
pain.
And then we're going to do some
interventions.
We're going to do,
knee joint mobilizations.
We're going to look at your hip.
We're going to do this,
that we're going to do.
single leg stand, whatever.
And then we're going to do these
interventions.
Then we're going to check your knee pain
again with whatever the squat or whatever
movement.
Okay.
Oh, now it's a five out of ten.
Okay.
So now it feels better.
And kind of showing the patient at the
eval, like, hey, like what we just did,
like what we just did in like a
treatment preview,
not even the full visit because we did
the whole evaluation and everything.
This is a treatment preview.
And we just dropped your pain down from
seven out of ten to five out of
ten.
That's a little bit of sales in a
way.
It's I think it's a great evaluation and
treatment for the first visit.
And the patient realizes that you can help
them.
And now it's like, hey,
if we string a bunch of visits together,
just can you can you imagine?
Like, obviously,
I would be the right one to help
you with this.
Tony,
is that something that you ever recall
your other therapist doing that had that
you taught them or they came out of
school with that or Jimmy?
I mean,
is this something that you learned or
what?
I know we did it in school.
We were taught pre-test, post-test,
you know, measure the difference.
In school,
we were taught it as this is good
clinical practice.
But as a business owner,
I knew this is a sales process.
The only reason why I'm doing this is
to be like, oh, my gosh,
you just improved thirty percent in twenty
minutes.
Like you said, Dave,
imagine what we could do over twelve
visits.
You know, it's totally a sales process.
But in school, yes, we did learn it.
We learned it as, you know,
this is what you document.
This is how you do a good assessment.
I don't think they even realized because
they were so stuck in academia that, no,
you're selling.
That's a sales process.
Paul, watching live,
anyone watching or listening live,
can you just comment wherever you're at,
YouTube, LinkedIn,
wherever this is being aired live,
can you comment if you learned it in
school or at a rotation or did it
in your first job?
Because maybe, Tony,
maybe everyone's getting it.
Maybe everyone's not.
I don't know.
Jimmy,
do you remember that in your DPT program?
I don't think it was in the program.
Again, it was a decade ago,
so I don't want to say it.
And of course, it'd be there.
But I think this is two different things.
Maybe three different things.
Is it clinical?
I guess.
But really, if it's clinical,
I think it's clinical psychology.
It's showing someone, hey, look,
you had this.
We did this.
It led to this.
And then that is also sales.
So I don't know if it's clinical.
If it is,
it's on the side of patient buy-in.
Them seeing something and understanding
something.
Us showing that movement and doing these
movements will actually do better
outcomes.
So I think it's probably...
one,
if not all three of those different
things.
But I don't think it was ever actually
shown.
I think that was a problem for me,
is everything was shown like, oh,
you got to rub the knee counterclockwise
and not clockwise.
Otherwise, who did you learn from?
What book did you read?
You got to move the ultrasound one,
clockwise, not counterclockwise.
If you're north of the equator,
you go clockwise, you dumbass.
If you're south of the equator,
you go counterclockwise.
Otherwise,
the magic gnomes don't provide the
crystals to move in the right direction.
So I think I went in thinking there
was some magic and then realizing there
wasn't,
but then thinking I had to sort of
BS my way through things,
and I was like, nah, I'm good.
But I think showing someone after they do
something that there's not a fear,
not everything makes things worse,
I think that's the magic.
Yeah.
So Ben Galen commented live on LinkedIn.
He said, never really taught for me.
Paul commented live on YouTube.
He said that we did have pre post-test
as a point of discussion,
more for knowing if we're on the right
path versus a selling point.
Both are true.
Yeah.
You know,
it's funny going back to talking about the
soft skills.
I think we talked about it last week.
I had a patient, returning patient,
this patient has known me for five,
six years, had a rotator cuff repair.
Perfect example.
came into my clinic to schedule,
didn't call to schedule,
came to the clinic,
was physically present.
I said, hey, do you have fifteen minutes?
Let's do your eval right now.
So had a rotator cuff repair ten days
ago in the sling,
came from the orthopedic office,
was driving home, said, hey,
I'm going to stop into Tony's clinic and
schedule an eval.
I was like, you're here.
You're here.
You're not leaving unless we do an
evaluation.
And so I'm like, hey, you know,
I'm going to rub your shoulder and make
it feel a little better.
She's like, no, no, you can't touch it.
You can't touch it.
I was like,
what do you mean you can't touch it?
You just had a rotator cuff repair.
You're cleared to start therapy.
Let's go.
And she was like, no, no,
you can't touch it.
Anyway, needless to say,
the point in this was, okay,
I was able to diffuse,
and this is somebody who knew me,
but even knowing me was so scared that
I was going to do something wrong to
her shoulder that
I got her to stay,
rubbed her shoulder a little bit,
loosened her up.
She was like, oh,
I do feel so much better.
Fixed the sling.
Fifteen minutes, we were done.
Got the evaluation in the books and got
her scheduled for once a week follow up
for the next two weeks until we can
start doing more.
I don't know.
Like,
that's not the kind of thing you learn
in school.
You know,
but that's the kind of thing that I
think makes such a major impact.
That's not the kind of thing that a
typical employed therapist who's like,
why the patient's not expecting to get a
valve.
Now the patient's fine booking the
appointment and leaving and coming back.
Like these are skills and,
and I don't even want to call them
talents,
but something that if we could identify
them early enough,
in the individual, you know,
we talked about hiring before,
like these are the things that I'm looking
for.
And I don't even care,
it's not the money.
I don't care about the money.
This is a very low reimbursing insurance
plan.
It does not matter.
The money is not even gonna,
you're not gonna see it on a balance
sheet,
but it's the fact that the person was
there.
Why wouldn't I do the evaluation right
now?
Nobody else in the clinic needed me with
them for the next fifteen minutes.
I could give them some peace of mind.
I can calm her down.
I can make her feel a little bit
better.
Like that is what I wanted to do.
And if you're listening to this and you
find somebody out there who's a younger
person,
younger to work and has that kind of
perspective, you snatch them up.
You pay them whatever they want to get
paid and you put them on your team.
Like those are the things we're looking
for.
I totally believe that you can train that,
Tony.
You're almost saying like you think a
non-owner.
What?
I feel like you were kind of suggesting
like a non-owner.
It's hard for a non-owner to do that.
If you put that in your playbook,
I totally believe you can train that.
My therapist that's been with us just for
a little over like around seventy or
eighty days,
not like approaching his ninetieth day.
He's doing twenty visits a week.
He's making one hundred thirteen K on pace
for one hundred thirteen.
Like the paycheck was enough to be one
hundred thirteen K when one hundred
thirteen K when annualized.
Right.
And he's seeing twenty visits a week.
Right.
So he but he was selected or he
was interviewed and groomed to be doing
all this.
And he's doing what you're talking about.
Maybe not exactly the same because it's
some office visits and some home visits,
but.
I think it's possible.
It is possible to find these folks.
And I don't think it's just the owner
to do it.
Of course,
that the move that you that is an
owner move to do that.
But I believe anyone watching and
listening like you absolutely could be
finding folks, grooming them,
training them.
It's not going to be like you say
it one time and they just do it
right.
It's going to be like they need
repetitions of like, hey,
someone comes in,
they have a knee replacement.
Someone comes in,
they got a rotator cuff repair.
Someone comes in,
they have a balance issue.
Well,
there's no there's no time better than
right now right tony like let's do it
yeah what's the comment say uh ben saying
it's the difference between a restaurant
that stays open until the last person
leaves versus one that shuts the kitchen
at nine because they close at ten have
to clean for an hour it's a culture
not a not a something you can necessarily
teach yeah i agree with that last
statement more it's the culture not a
teaching amen
If you're part of the organization,
if you empower someone to sort of be
able to make decisions,
you'll make better decisions because you
understand it's not the letter of the law,
it's the spirit of what we're actually
here to do.
And I empower you to do that.
I use the Zappos example all the time.
They realized that customer service was a
big bottleneck and they said, listen,
if it costs less than five hundred bucks
to solve the problem,
just solve the problem.
Just understand, I might be like,
why did you just give that person a
five dollar gift card?
It's like I wanted to shut them up.
Not a good answer,
but it's like they got screwed.
The system didn't work for them.
So I just credit them back their shoes.
Good use of that hall pass or whatever
they want to call it.
So I agree with Ben.
They're saying it is the culture,
not something you can't write down an SOP
for four billion possibilities.
You can't foresee that.
You can't write it down and you wouldn't
be able to find and say, well,
what do we do in this situation?
No.
Do right, fear no man.
That's what they're trying to say.
Understand that all these different
options are within your purview.
Pick the best one at the right time.
Get close.
What other topics do we have?
I don't know.
I think we blew through all of them
for today.
Well, Jimmy's coming north of Columbus.
Uh, we're going to connect.
A lot of these APTA chapters are turning
seventy-five and doing celebrations.
So it's like a one day conference and
then they're throwing a big old party.
So you're, so if you're traveling,
you're going to be here Thursday or are
you traveling Thursday?
Traveling Thursday.
I'll be there Thursday night.
Okay.
So Jimmy's out.
I will see if I can connect with
Dave for PT Breakfast Club Thursday
morning.
I should be able to do that.
Let's just do parting shots.
We don't have to go the full hour.
Dave, what's on your mind?
What do you got?
Well,
I really like the comment from Ben about
culture and not necessarily a teaching
thing for every aspect.
So that's just on my mind right now,
trying to recruit more therapists.
And
keeping, keeping like the, the, the,
the main thing,
the main thing in terms of what's best
for the client,
what's best for the practice, what's,
you know, what is that intersection?
And of course it doesn't matter what type
of practice you're in,
but if they stop in physically to say
hello or book visits, yeah.
Why, why wouldn't you say, Hey,
why don't we just do a quick screen,
a quick eval, you know, get them going.
I just, for me, it's a great reminder.
And that's something that
you could always put more stuff into your
playbooks around what to do when,
but I love the,
I love the reminder of like,
it's kind of like the culture and it,
you can't lay out every little scenario,
but if it's kind of embedded in like
the onboarding and the mentorship and the
coaching and the training of therapists,
then they typically would do the right
thing.
Right.
So like I would,
I want to get to the point where
if,
we have therapists in our office,
I'm not there,
but they would do what Tony did.
A patient comes in, previous client,
whatever,
or like a spouse or a friend of
a client,
and they come in and they're like looking
to, you know,
tour the office and look around or
whatever.
And can that therapist segue them into a
quick consult or a vow like that,
and then get them going and lay out
a plan of care and all that.
So like that, again, just culture.
And for me right now,
recruiting and retaining the team.
yeah simple not easy i think i i
think it's one of those things where like
parent like i'm a parent i look at
my kids i'm like did they come this
way or did i have any kind of
influence on them um i think a lot
of it is they came this way and
especially i always say like if we had
one of the kids first we would think
we were brilliant parents and we'd write a
book and we'd tell dave
how to be a better dad.
If we had a different kid first,
we would be like, oh my gosh, Dave,
what do I do?
How do I become a better dad?
Same with employees.
I just think you hire someone,
you bring them on the team,
they come with raw materials.
Yes, some can be influenced.
I think it's really a lot easier if
they just come that way.
If they're the person that's going to pick
up the trash, not because it's their job,
just because it's trapped on the floor and
I need to pick it up.
I'll close with this quick story.
I had a patient yesterday in the clinic.
This patient has been a hairdresser in her
seventies, still works, still active,
wants to get stronger.
I had another patient who fell,
second patient who fell but didn't fall in
my clinic, fell somewhere else.
The hairdresser noticed he was bleeding.
And so she goes over there,
grabs tissues and starts like dabbing
blood on his face.
I would hire that woman in a second.
I don't care how old she is.
I don't care what her skill set is.
Just the fact that she saw a problem.
She saw this guy sitting in a chair,
blood dripping down his face that he
didn't realize.
No concern for pathogens and infection.
She just goes and grabs a tissue and
starts dabbing his head.
That's a person I would hire in a
heartbeat.
So, you know, that's the job interview.
Not tell me about a challenging customer
you work with.
That's useless.
Yeah.
Show me, don't tell me.
And I think to go full circle,
we started talking about marketing.
You show that off,
but from a customer or patient
perspective,
viewpoint,
which is here's what I want or need.
Show me that.
And then I understand that you're the
person who can help me get that show
beats tell.
I think I'll be back Thursday.
I don't think my flight is until late.
So we'll see you guys then.
All right.
See you then.