Architects of the Future: Ali Hartman & Bethany Ayer from Graham Sessions

0:01 You're listening to the PT Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. Live at Graham Sessions again. If it looks like we're blurry, it's because we are blurry. We're not worried about the camera. I'm not sure why it's... There we go. Now it's focused. And there we are. And we fixed it. Allie, Bethany, superhero backstory. I asked you this last night. Hmm. It was lackluster last night. No, it wasn't. It was good. You said at first, I don't have one. And I said, everybody has one. And then you gave me one and it was great. So how do you, how do you frame this as we go live from Graham sessions here at APT headquarters? Where, how did, where are you in the profession? How'd you get there? Yeah, I am in the profession and I think a misfit space.

0:42 Good. Island of Misfit Toys was the fun part of the movie. Definitely Island of Misfit Toys. Anyone that knows Mike Eisenhardt, I'm one of his misfit toys. With Proactivity, I found my way there because I did not feel like I could tolerate any other kind of traditional setting. I very much like to be a thousand places at once and running around. Good. And so a traditional setting was not for me. And so I'm in a direct to employer prevention based model. So day to day is kind of everything from helping my team get around different places, keep people away from physical therapy as much as possible and taking better care of themselves in very like dirty jobs, micro type of environments.

1:23 I like it. I already see an Instagram series for productivity in my brain. And Bethany, you're a clinician working in a role that is non-traditional, but doesn't mean you don't bring your clinical skills to a non-traditional place. How do you describe what you get to do? There we go. You're good. I feel like Chris Collins. You're right. We're calling things here as we watch everybody eat lunch. So what do you get to do? So I was an OT. I practiced for about ten years. I worked mostly in acute care in the hospital setting. And then I always found that I worked in like the land of red tape and I hate red tape and I felt like I was running into walls all the time. And I would then bring things to an executive team or a finance team and they didn't give me the credibility.

2:08 that i felt like we deserved as a therapy profession because i think they felt like i didn't speak their finance language so i went back to get an mba specifically with the vendetta feeling with both tools to be able to say no i speak both languages and i want everyone else to speak both languages If it's a clinician, I want them to be able to speak the financial side. If it's a finance person, I want them to be able to speak and understand the clinical side. So I do find my job very rewarding right now because the primary aspect of my job is bridging those two components. I already hear the name of this episode when I publish it. It'll be B for Vendetta. Bethany for Vendetta.

2:49 You literally were like, hey, if you think I'm not understanding your language, I'm literally going to go back to school and prove it to you and slap you across the face with it. I think that might be a slight issue of my psyche. I like it. All right, so is this your first? How many gram sessions is this for? Three gram sessions. Me too. Three-timers club. How many of this is for you? This is my first one. brand new, brand new, uh, situation. So we'll start with Bethany. First one, what'd you think it was going to be? And then what has it actually been like? Well, I think you did a good job prepping me. How did I prep you? I can't remember. I don't remember. You said it was like cool kids. Yeah. And you said it was, um, people are more authentic and more open and I think willing to have harder conversations.

3:33 Yeah. so but i would not have i actually would have expected it to be a little bit more cagey cagey yeah spears later don't worry about it i'm waiting for it yeah i'm waiting for it two years ago i got thrown off the roof really no not really but that'd be that'd be a great story just always say two years ago a guy got thrown off the roof and then be like i can't remember who was i can't talk about there's legal situation um i think the people in this room are traditionally people who are um not afraid or it's not a fear thing they are more apt to make noise and they are talking more this is not better this is not worse this is just different i see you know people next to me i won't say who right because it's like vegas you can't say who's here i see academy president i see another academy president i see ceo i see state chapter president I see he does like fifteen different.

4:24 But these are the people who were like they say things that piss you off or you agree with on LinkedIn. The funny thing is most these people don't care if you agree with them or piss. Just say something like do something. Why did you come to your first Graham sessions and why did you come back? Good question. I came with Mike. He said he made you. Yeah, he kind of made me. He said, I think you'll like this. And I had I just read the description online. I'm like, cool. And I came and I shared at the end of it that it felt very reminiscent. I'm from New Jersey. I'm Italian. It felt like dinner, like a lot of yelling. And that was my love language is like yelling and cussing at each other. which there was both of. So I liked that.

5:05 I liked that I had grown kind of frustrated with the professional conferences because I felt like we just talked about the same stuff. And nobody had the courage to disagree. And I didn't feel that at Graham Sessions. So I came back and got more and more interested. And here I am three years later. All right. So now we're level set. I'll just keep it easy. What's one thing... that excited you that you've either heard already or you've seen on the program that we're going to talk about? And what's one thing that you're like, dude, where's this? Like, hey, you're missing this one. So we'll start with the thing that's there. What's something that you're excited to that's either already been talked about here halfway through the first day or something that's coming up that you're excited about?

5:50 I can answer the first one. I really liked the kind of disparaging the myth that it's just data that is going to help you with payer negotiations or contracts. I think we've all fallen, myself included, fallen victim to like, oh, if we just have enough data instead of, no, if we just have enough leverage. And so I think the leverage word, that has been stuck in my head. Yeah, and I wasn't in the room for that, but someone was explaining, is that more along the lines of the IPA discussion? Like, how do we band together? I think I used it as like a tubing at Lake Havasu. We can remain individual people in our individual tubes, but if we all link arms, now we can walk into a situation and we've got the leverage.

6:31 We have the longer lever. Yes, yes. We should wake up to that. Other people are doing that. And by people, I mean professions. So there were good examples. This has worked. This is not just in a vacuum. Something that excited you. I like the primary care topic a lot. Good. Why? I think that, well, to me, I'm like, don't we just all already do this? Like, I guess I'm naive. Wait, is this a new, this was already in the building. I just, I'm naive to traditional settings. So I kind of just assume that my experience is, which has been doing that and not having to ask someone to get paid for it and not having to worry about whether it was legal or not, or whether there was going to be some sort of regular, I'm like, this is just all I know.

7:12 So I'm excited to have had that conversation and that it's becoming something that's being pursued more. I'm allowed to talk about what I said in the room. I said, this is awesome. But if you don't message it for literally everybody else, I made everybody in the room look outside the windows from the seventh floor here, you can see DC, you can see Alexandria. I was like, if those people don't understand this very clearly, this could be awesome and will fail. Yeah. And I think that's why I feel sometimes like a broken record on the direct to employer because I don't have to market that to them because it's a small social network. So they just have to experience it and then it markets itself. They talk to each other. Right. It's a small social network.

7:53 I don't have to market it to however many thousand people live in my community. I market it to a group of five hundred and they have one experience of they helped me with this. I didn't know they could do that. And the social network markets itself. What's your wedge? How do you get into... Let's say you've got... What's a great type of company that you like to work with? Or give me examples that you work with. Yeah, like a grizzled industrial employer. Got it. Those are my people. How do you knock on the door? What's the email? How do you get the first coffee? Yeah, good question. At this point, it's more like knocking on our door because we built a relationship. Yeah, yeah, yeah. But if you're starting Xero, the grizzled industrial has no idea what the hell...

8:35 They look at you and they're like... What's this girl? Why are you all dressed up? We make we we you know, we make metal here. Yeah, that's it. Well, that is my exact client. OK, so how do you get them to go? Hey, hey. Well, first of all, you don't dress up. You look like them. When you show up for the meeting, you've got your steel toed boots and you've got your jeans and you look like you could go work in the steel mill. I can see you. I can see you. Yeah. You got to wear dress the part. Um, it's really pretty simple. It's that you have a problem. I know you have a problem. I know you have a healthcare cost problem. And I know musculoskeletal is in the top two, probably number one, if you're an industrial employer. And I'm a profession that knows how to solve that problem. Oh, and by the way, when I do that, I can solve your health problems.

9:15 Yeah, I want to rewind there, just like we are doing Monday Night Football. The first three things you said were about them. And that's when people listen. You didn't say, hi, I am Ali. I have a doctor and I don't care. You were like, hey, I see what you're doing. And then like when I'm pitching, like to do stuff with APTA state chapters, I'm like, let me take a guess. Do you have this, this and that problem? They're like, how did you know that? I'm like, first of all, you all have the same problems. But that's what people want to hear. Like, can you solve, am I solving your problem or are you helping me solve me problem? Because I want to talk about me problems. And then what are they looking for? What's the, I call it the eyebrow test. They're like, okay, you understand my problems.

9:56 What's the thing that, is it money? Is it downtime? It's all money, but it equates to money. But when do you see them go, ooh. I think when you make it clear, you know how to fix it and that it doesn't look like, and this is the exact plan because you don't even know my people yet. So how do you know what my problem is and how to fix it? Because my people are different than all the people you've ever met. Different, just like everybody else. Is this like you can curse on here? All of it. Yeah, there's no FCC. When it becomes very clear that you understand their problem, that you understand the solution, maybe not the specifics because you don't know the population, and you really give a shit, like you really give a shit about doing it, then it's not hard.

10:40 I was just going to ask, are you doing like structural and environmental changes within the organization or just like direct to consumers? Sometimes it's all of the above. It depends. Whatever the population needs. That's awesome. Yeah, I was going to say a quote that I've sort of stolen from, I think, Eleanor Roosevelt. And she said, no one cares how much you know until they know how much you care. And I was like, that's bullshit. I love Eleanor. I love you, Eleanor. She's not with us anymore. But I think no one cares how much you know or how much you care until they know that you know how to understand their problem and can solve it. Now I'm like, oh, how much do you care? Cool. I want that person with me. But make sure you demonstrate, I see you, I hear you, I understand you.

11:22 That's what Oprah taught me. People want to be seen, heard, understood. Do that first. I see PTs all the time, and I love you, and I'm one of you. Stop talking about yourself. Yes, a hundred percent. Stop talking about yourself. They don't care about us. And to your point, they don't care that I'm a PT. They don't care about any of that. So don't focus on that. Focus on the problem. You don't do that, but you do something similar. You're not solving workforce, but you are because you work more technology. These are the things that, so you're sitting there pretending like, hmm, let me take a wild guess. You hate denials. Are denials an issue? Of course, it's a loaded question, but you're doing something similar but not the same.

12:02 What's a good wedge for you that makes someone go, oh, she, yes, okay, sounds like you might understand me. What are some things that you throw out in the beginning Well, I always focus on themes over any sort of features. So like, I don't really do anything about like, Hey, here's how we solve it. I like to figure out like what themes are people experiencing. And so I would say within the space that I work in within like revenue cycle, let's say, I would say a major theme is ownership, autonomy, transparency. That's what they're looking, that's what they want. That's what they want. People want to have ownership of their money, of their future, of their practice.

12:42 Their day. They started a business, now they're working for someone else, it feels like. Yeah, visibility. I think oftentimes people outsource completely because they know enough to say, I don't know about this. But then as they start to learn, then they realize, oh my gosh, I don't know anything about what's happening. And they don't know what step to take to then start to regain control. And then they don't know what they don't know. So just trying to also help uncover where the problem is and then being very transparent if we are not the right fit. Yeah, yeah, yeah. Try to get to the know as quickly as possible. Yeah. Confused people don't. So I know I have a problem, but I'm even confused what the next step is. So what do I do? Nothing. I just go, you know what? I'm going to solve the other problems because I at least know how to solve them.

13:26 This is what I'm like frustrated with. And I try to clean my house as little as possible. Like when there's people coming over, that's when I do it. But I find myself like I'm trying to do I was trying to change a flight and I was using an app and I couldn't get my password. I tried fourteen different ways. So I just stopped and cleaned my house. Because I knew I could control that. I was like, well, that's not happening. I'm going to do this. It's the same in business. If you're like, I know I'm leaking money. What do I do about it? I have no idea. So what do you do about it? Nothing. You move on to rearrange the deck chairs on my Titanic. Why? Because I can control that. And we're big, dumb animals, and we like control. This is a cool format, though, I think, a presentation. And then...

14:06 really dedicated time to hearing from the audience, right? I do think it's funny though, is that most people are falling into the trap I just did, right? So let's say you gave a presentation and I either agree or disagree, I'm gonna stand up and ask questions or make a statement, and then a lot of people spend the first forty-five seconds explaining who they are. And I'm sort of like, save that for later. Save, I don't care right now, unless it's directly in context, right? Which is like, I get it, but also I'm like, skip to the good part. All right. So third, first. And you're going to both speak next year. If you were going to speak next year, what would your talk be on? I'm cheering Allie on. That's my role next year.

14:47 We're going to do it together. Hold on a second. Wait, wait, wait. You spoke already. You gave a two-minute hot, coming in hot statement. I did. What was the gist? Let's just talk about the gist of it. Or do you have it memorized? No, I don't have it fully memorized. But the gist of it, I will say, and you tell me if I'm not doing this justice. But the gist of this is that I think in the therapy world specifically, we feel this need to either choose between doing well or doing good. And by that meaning, well is like we're financially thriving and our clinic's doing financially well. And then good meaning we're allocating everything we have to our patients and that. we do not have to choose one or the other, that we deserve both. But beyond that, like the survival of our entire profession relies on us having both.

15:32 And that was it. I don't need to divulge that. It was really good. I love the doing well versus doing good. And then you brought in also a topic that I guess was in last year. I wasn't here last year, but they were talking about artificial intelligence last year. It's not on the docket this year because apparently we've solved all that. I was out of the room when we solved AI. Your angle was AI is not the thing. It's the thing that will help you do the thing. AI is not the answer. It's the vehicle you will get in to solve this or this or at least work on this or this or this. Yes. Yes. Yeah. That was my kind of thought. That could be an entire talk, though. You did it in two minutes. You could go deeper and wider. Yeah, I could. You might have just accidentally talked yourself into a talk.

16:13 Allie, you're on the docket next year. What are you talking about? With your hands. I am this afternoon doing one on gentelligence. Oh, no, I knew that. You are talking this year. Yes, my head is on that because at a lot of conferences, I feel like I feel this very emotional distress around the younger generation or the younger generation against older generations. And so I feel like honest conversations are needed there. So that's where my head is at right now. Next year, I don't know. So what do you hope people walk away thinking, feeling, doing after they listen to your talk today? I hope that instead of just being frustrated and angry and being like, they need to change either direction.

16:53 They need to change. They need to change either direction. It's their fault. We come to understand like nobody's probably going to change. So let's figure out what to do about it because otherwise our profession will fail to exist. In twenty years, if we don't make a profession that the younger generation wants to be a part of. They're going to leave. Then they're going to leave and we won't have one. So I guess that's my hope is that people think about it differently. Yeah. I'm in a discussion. I'm going to have this guy on, but there was a guy on LinkedIn writing thoughtfully. And essentially he was like, I'm paraphrasing. I won't put words in his mouth. He's going to put words in his mouth. I'm paraphrasing, you know, like we got to work harder. Like people don't want to work hard. And I was like, is that it?

17:34 Like this generation just woke up and doesn't want to work hard. And then I sort of broke it down. Maybe I used AI to an equation. And I was like, is the, is it the conversion factor? If I used to work ten hours, units of work hard i used to get twelve f units of payoff and now i do ten efforts of work hard and i get six and i'm not stupid that doesn't work and then his sort of counter was like well you could start your own company i said we're talking about the conversion factor of this system going outside the system is valid i'm a radio dj pt i went outside the system i made this up I'm okay with how much work I do for what I get. Would I like more? Sure.

18:14 So I want to work on two things, how much work I do, hard, and the conversion factor. Because wouldn't it be great if the amount I'm doing now could just yield more? Clinicians and clinics want that. They're like, I want to put it in this system. I don't want to run my own company. Why is that a bad thing? Neither good nor bad. It's right or wrong for you. So I want to focus on the conversion factor because it didn't used to be this way. Right. I put that on like Instagram and I was waiting for like the younger generation to agree with me and the older to disagree. And the funny part was they both agree. They were like, yeah, it didn't use. I was there in the eighties. It used to be this gotcha that now it's this gotcha this. And that sucks. But I am close to retiring and I'm like, that does suck.

18:56 But these people aren't. So what are we doing about it? Uh, so that's what my thing would be is what's the conversion factor of hard work? What's hard work worth these days? Um, We have a tradition on the show before we end every episode. It is called the parting shot. This is the parting shot. One last mic drop moment. No pressure. Just your legacy on the line. Just you can reiterate an idea, a thought, a concept, a quote. Doesn't matter. It's just whatever you want. The last thing the audience hears from you. What do you want to be? I would just say that going to what you said about systems that I would just reiterate that we aren't just participants of a system.

19:36 We are architects of the future for it. Architect. Look at you dropping crochet that on a pillow. That was beautiful. You look following that. I mean, it's a bar. You got to get over that bar. Yeah, no. I'm going to get over it by just using one of her lines. There you go. Smart, smart. I'm going to use Bethany's line of, I love the concept that you don't have to trade doing well for doing good. And I think if we just put a lot more of our effort on how and what are innovative ways to make that happen, then we would build a better profession and one that maybe the next generation wants to be in. And how do you find those? I'll steal words from someone else. Good artists borrow, great artists steal. Look at what other people are doing.

20:16 In class, you weren't allowed to look at other people's papers. In life, we sort of are. We could just be like, I don't know, what's OT doing? What's dental? What are aeronautical engineers doing? What can I steal in a good way? The essence of, and then just plug it in over here. Does it work? I don't know. Let's try it. Good artist borrow, great artist steal. Allie, Bethany, appreciate the time here at Graham Sessions. We're going to have some graham crackers and some s'mores here as we live stream from the top of the APTA's venue. That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode. Want to go deeper? Hit us at pgpinecast.com or find us on YouTube and socials at pgpinecast.

21:01 And legally, none of this was advice. It's for entertainment purposes only. Bullshit! See, Keith? We read the script. Happy now?