Conquering Physical Therapy Workforce Struggles & Boosting Productivity

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I'll have to edit that part out.

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That's not supposed to play.

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But Larry, welcome back to the show, man.

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Appreciate your time.

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Thanks.

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Anytime.

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You're doing something different.

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You're writing a lot.

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You're writing often.

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You've got a Substack platform.

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For people who don't know that,

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that's a really simple or

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streamlined or easily

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digestible way for someone

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to take words and thoughts.

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And then get them to a lot

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of people who might want to

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sort of tap into that.

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Where back in the day,

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it would be like a list

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serve or an email list.

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And I think now we're

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getting more sophisticated.

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Ironically,

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we're getting more

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sophisticated by making it simpler.

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And you're using Substack

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and people can find you on Substack.

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What is the way that all

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things physical therapy?

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All things physical therapy.

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I think I'm also known as

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physical therapist on their

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physical therapy there.

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Yeah, absolutely.

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Now,

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before we get into this kind of

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two-part series that caught

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my eye because you show up in my inbox,

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why did you decide to start

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writing so much?

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What do you get out of that?

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Why?

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Because there's effort involved in that.

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No, absolutely.

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I think a couple of things.

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One is I've been writing for a long time.

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If you look at my body of work,

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we were the first multi-author blog.

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on the Internet and it was

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under evidence in motion,

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which still houses all my blog posts,

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hundreds and hundreds of them literally.

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At the time,

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we were creating vibe in the

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industry by challenging

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some of the assumptions.

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So many years that I was a CEO,

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I did just as much writing,

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but I was writing different

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for my own employees.

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And not so much on the

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politics and the rules and

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regulations of PT,

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but more on employee

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motivation and culture and values.

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And now I've transitioned back.

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I've had this sort of pent

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up stuff on my brain for a

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long time about PT.

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And so I'm writing to my

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colleagues and if they find

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it useful and valuable, great.

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If they don't,

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or if it sparks some creativity, great.

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I charge nothing for it.

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There's no profit motive at all.

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I really just try to get

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some conversation going and

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I try to expose things that

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a lot of people aren't talking about.

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Well, the reason this one, you know,

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I wanted to have you on for

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this is I saw it in my inbox.

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I saw it online and I saw

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people starting to engage.

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And I like that.

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I like when people agree or disagree,

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but have an opinion like challenge.

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And you sort of put it out

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there a few times,

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which is like challenge this.

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Like, is everything I say perfect?

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Absolutely not.

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But you got the conversation going.

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And I say this line a lot

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when people come to me like,

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how do I create content?

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I'm like,

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don't try to create social media content.

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Try to try to create

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something media that is social.

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If you said that a water cooler,

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would someone agree with

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their eyebrow go up?

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So this is a two part series

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and we'll give a link in the show notes.

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People can go read and sort

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of go deep into this.

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But in the series,

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you revealed that PTs only

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see around four hundred

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patient visits per year.

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While our colleagues that

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are orthopedic surgeons are

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doing about eight hundred

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visits annually and family

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physicians manage nearly two thousand.

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And you write physical

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therapists on a per visit

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basis are only roughly

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about fifty percent as

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productive as an

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orthopedist and twenty

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percent as a family physician.

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So why do you think PTs are so much less?

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I'll use air quotes

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productive by comparison.

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And what are the biggest

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factors that contribute to this this gap?

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Yeah,

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so in order to get to the answer to that,

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but what sparks all this is

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workforce development.

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If you look at some of the

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more academic writing that I've done,

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it has really been

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publishing articles that

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challenge workforce

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development that the APTA

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and the Workforce

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Development Study did not.

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now many years ago where

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they effectively said by

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this time we would have an

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abundance and have an

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oversupply of physical therapists.

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When the market has

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something to say about that

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and the expansion of the PT

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practice has something to

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say about it and the fact

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that at best we see twelve

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to fifteen percent of the

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population that needs us

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has something to say about

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that and the practice expands.

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And things have moved out

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from a hospital and

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institutional environment

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to outpatient and to a

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wellness perspective that a

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lot of PTs work in.

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And so I've always had, you know,

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a keen sense of workforce development,

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how many PTs there are,

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how many programs there are, as you know,

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I'm very active in higher education,

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a physical therapist.

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And so I've always wanted to

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know what is our supply,

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what is our demand?

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There is a forthcoming work

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group that APTA put

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together that will have a

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paper that is right now under, you know,

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sort of confidentiality,

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but it will come out and I

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don't think the results of

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it will be surprising to

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anybody without letting the

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cat out of the bag there.

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But at the end of the day,

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let's look at our own

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profession and now let's

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analyze ourselves a little bit.

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We have about two hundred

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and fifty thousand PTs in the US.

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We have roughly,

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and this is multiple data

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sources that suggest we

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have about a hundred

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million visits per year.

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Now those visits can take

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the form of an outpatient location,

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they can take the form of an inpatient,

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and really then you can

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extrapolate from it how

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many visits per PT per day.

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Now, many years ago,

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I want to go backwards one more time.

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I was on the advisory panel

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on practice for APTA for many years,

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appointed position.

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I think it's one of the

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highest regarded

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appointments that APTA does.

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And I was on it many moons ago.

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And through that,

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I got to know Andrew

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Guccione extremely well,

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who was head of that on APTA,

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who I have tremendous respect for.

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He's also a good friend.

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And I would have meetings

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with him back in these days,

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and he would say, Larry,

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we have too many therapists.

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And I said, what do you mean?

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He says, well,

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just take the number of

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potential visits that a PT can do,

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multiply it,

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and you'll see we have too many PTs.

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And to a certain extent, he was right.

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And I'll tell you why.

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If you took two hundred and

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fifty thousand PTs that are

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licensed in the U.S.

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and let's say they average

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all average six or seven visits a day.

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There's not enough patients

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in the population of the United States,

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about three percent of

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which are getting PT at any given time.

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It's too many PTs.

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What you find, most surprisingly,

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is that only about twenty percent,

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it's actually slightly less,

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of licensed PTs are seeing patients.

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Count me guilty.

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I'm one of them who isn't.

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And I know a lot of others that aren't.

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Where do they work?

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They work in academia.

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They work PRN.

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They work in research.

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They work in manufacturing.

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And some of them have left

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the profession altogether.

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And that's a really, really small number.

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Now,

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we produce about twelve thousand PTs a

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year.

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So here's another way to look at it.

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We have a very inefficient

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education system in the

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United States for PTs.

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We have about three hundred

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programs producing twelve

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thousand grads a year.

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By contrast,

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physicians have about one

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hundred and fifty programs

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in the US producing about

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twenty thousand graduates a year.

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It would take the number of

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orthopedic practices, by the way,

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got twenty nine thousand

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practicing orthopedists,

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seven hundred fifty

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graduates from their

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residency programs per year.

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You know that it would take

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thirty eight years to

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reproduce the number of

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orthopedists we have and

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the number of orthopedists.

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They work well into their sixties.

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They're at the peak of their career.

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Their best highest use is seeing patients.

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They're allowed to use extenders.

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They make a lot of money.

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Average salary,

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four hundred thousand dollars.

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Family practice physicians.

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OK,

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we have roughly four thousand four

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hundred graduates of family

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practice residencies per year.

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About one hundred thousand

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of them practicing would

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take them twenty two years

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to reproduce their their numbers.

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In PT,

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we have two hundred fifty thousand

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producing twelve thousand

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graduates a year take twenty years.

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The reality, though,

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is only take a few years if

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all the PTs saw patients full time.

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Right.

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So the math on it is

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actually spellbinding.

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And then you get to some of

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the reasons why.

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Now, my post, quite honestly,

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and I reveal this in the second iteration,

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I'm not really,

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I don't really care about

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productivity arguments.

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I'm not, you know,

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the fact that I'm comparing

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an orthopedic to a family

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practice to a PT is ridiculous.

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Honestly, quite irreverent and irrelevant,

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both of them.

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But I am trying to show that

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our best and highest use as

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a PT is obviously not clinical.

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If that were the case,

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we'd have more than twenty

00:08:28.637 --> 00:08:29.497
percent of the PTC.

00:08:30.817 --> 00:08:31.899
And we're restricted and

00:08:31.918 --> 00:08:33.220
we're restricted horribly.

00:08:33.240 --> 00:08:34.181
We effectively have a

00:08:34.240 --> 00:08:36.363
compensation cap on the

00:08:36.503 --> 00:08:37.504
earnings that a physical

00:08:37.524 --> 00:08:38.403
therapist can do.

00:08:38.744 --> 00:08:39.904
Let me give you an example, Jimmy.

00:08:40.105 --> 00:08:41.447
Let's hypothetically say a

00:08:41.506 --> 00:08:42.827
PT works in an outpatient

00:08:42.868 --> 00:08:44.369
clinic and one hundred

00:08:44.428 --> 00:08:45.549
percent of their patients

00:08:45.850 --> 00:08:46.870
is either Medicare or

00:08:46.931 --> 00:08:48.552
Medicare Advantage or a

00:08:48.672 --> 00:08:49.773
payer in some states,

00:08:49.812 --> 00:08:51.815
the blues that follow Medicare rules.

00:08:52.711 --> 00:08:53.672
They effectively,

00:08:54.152 --> 00:08:55.614
the max revenue they can

00:08:55.653 --> 00:08:57.154
generate by seeing eight or

00:08:57.195 --> 00:08:58.176
nine patients a day,

00:08:58.495 --> 00:08:59.817
forty six weeks a year,

00:08:59.918 --> 00:09:01.538
forty seven weeks a year is

00:09:01.578 --> 00:09:03.880
around two hundred ten thousand dollars.

00:09:03.900 --> 00:09:04.642
That's gross.

00:09:04.982 --> 00:09:06.083
That's before overhead.

00:09:06.264 --> 00:09:06.644
Overhead.

00:09:06.703 --> 00:09:06.964
Right.

00:09:07.144 --> 00:09:07.345
Yeah.

00:09:07.705 --> 00:09:08.605
And so that's before you

00:09:08.645 --> 00:09:09.447
paid for the lights.

00:09:09.947 --> 00:09:11.708
You've paid for revenue cycle management.

00:09:12.149 --> 00:09:13.269
You've paid for any support

00:09:13.289 --> 00:09:14.230
staff that you need that

00:09:14.270 --> 00:09:15.932
contributes to you seeing those patients.

00:09:16.393 --> 00:09:18.053
And why are we at such limitations?

00:09:18.134 --> 00:09:19.294
There, you've got a lot of factors.

00:09:19.315 --> 00:09:20.996
Our own profession has just

00:09:21.116 --> 00:09:22.278
really restricted us in

00:09:22.317 --> 00:09:23.999
terms of the RCs and

00:09:24.320 --> 00:09:26.642
exclusive PT can only be one-on-one,

00:09:26.721 --> 00:09:27.662
all that kind of BS.

00:09:28.143 --> 00:09:29.964
But the payers have also restricted us.

00:09:30.125 --> 00:09:31.285
They have superimposed rules

00:09:31.326 --> 00:09:32.326
that do not allow us to use

00:09:32.366 --> 00:09:33.366
extenders like PT

00:09:33.407 --> 00:09:34.989
technicians or PT

00:09:35.009 --> 00:09:36.250
assistants at the top of

00:09:36.350 --> 00:09:37.471
our license to use our

00:09:37.750 --> 00:09:38.812
extenders at the top of

00:09:38.831 --> 00:09:39.993
their license like ortho

00:09:40.013 --> 00:09:41.173
and family practice have.

00:09:41.995 --> 00:09:43.336
And then the other one, frankly,

00:09:43.535 --> 00:09:44.197
is cultural.

00:09:45.208 --> 00:09:45.990
A lot of people come into

00:09:46.009 --> 00:09:46.870
our field for the inherent

00:09:46.889 --> 00:09:48.030
flexibility so they can

00:09:48.051 --> 00:09:49.211
come in and out of the profession.

00:09:49.912 --> 00:09:51.693
I think then that culture, though,

00:09:51.714 --> 00:09:53.534
has got some negative connotations to it.

00:09:53.934 --> 00:09:56.056
How many great clinical PTs do you know?

00:09:56.417 --> 00:09:57.618
I got board certification in

00:09:57.638 --> 00:09:59.219
two areas that are then

00:09:59.578 --> 00:10:01.379
incentivized to get out of

00:10:01.440 --> 00:10:02.380
seeing patients because

00:10:02.400 --> 00:10:03.201
they can make more money.

00:10:03.280 --> 00:10:04.903
They get rewarded by it, in essence,

00:10:04.923 --> 00:10:06.202
through management and

00:10:06.342 --> 00:10:07.504
other kinds of things.

00:10:08.625 --> 00:10:09.546
We have a higher burnout

00:10:09.586 --> 00:10:11.447
rate than a higher attrition rate.

00:10:12.673 --> 00:10:13.995
probably than any other profession.

00:10:14.336 --> 00:10:16.076
But the biggest concern I have,

00:10:16.857 --> 00:10:17.719
all that is a concern,

00:10:17.759 --> 00:10:18.720
but the biggest concern is

00:10:18.799 --> 00:10:20.381
I have is name me one industry,

00:10:21.423 --> 00:10:23.384
one profession that you

00:10:23.424 --> 00:10:25.706
could say is less productive today,

00:10:25.746 --> 00:10:26.587
given the advent of

00:10:26.628 --> 00:10:28.049
technology and innovation

00:10:28.309 --> 00:10:29.291
than physical therapy.

00:10:29.850 --> 00:10:31.111
The data will tell you that

00:10:31.432 --> 00:10:32.373
when we used to average

00:10:32.393 --> 00:10:33.595
about twelve patients a day,

00:10:33.615 --> 00:10:35.277
we're now averaging closer to ten.

00:10:35.956 --> 00:10:37.379
And that is because of the

00:10:37.558 --> 00:10:38.980
external constraints,

00:10:39.041 --> 00:10:39.642
the rules and the

00:10:39.682 --> 00:10:41.062
regulations that are placed on us.

00:10:41.504 --> 00:10:43.225
I know no of no other

00:10:43.466 --> 00:10:45.729
medical professional that can say that.

00:10:46.089 --> 00:10:47.431
And that is a root cause

00:10:47.490 --> 00:10:48.653
problem that we got to address.

00:10:49.153 --> 00:10:49.472
Yeah,

00:10:49.493 --> 00:10:50.673
that was going to be one of my next

00:10:50.714 --> 00:10:51.154
questions.

00:10:51.195 --> 00:10:52.054
And it was that stat

00:10:52.095 --> 00:10:53.296
dropping from about twelve

00:10:53.336 --> 00:10:55.538
patients per day to ten, you know,

00:10:55.557 --> 00:10:57.059
despite technology and automation.

00:10:57.679 --> 00:10:59.481
Why is that moving backwards?

00:11:00.642 --> 00:11:03.104
Is it is it is this self-caused?

00:11:03.284 --> 00:11:04.966
Is this a little bit of us

00:11:05.005 --> 00:11:06.586
and a little bit of everybody else?

00:11:06.606 --> 00:11:08.028
I mean, because ultimately,

00:11:08.688 --> 00:11:10.190
If it's caused by us,

00:11:10.470 --> 00:11:11.470
that's sort of good because

00:11:11.490 --> 00:11:12.250
we can control it.

00:11:12.291 --> 00:11:13.331
If it's caused by other people,

00:11:13.451 --> 00:11:14.591
we can blame it.

00:11:14.610 --> 00:11:15.831
We can write about it on the internet.

00:11:15.851 --> 00:11:17.192
That doesn't do a whole lot, right?

00:11:17.613 --> 00:11:18.812
But it draws attention to it.

00:11:19.192 --> 00:11:20.854
So how do we dig out of that?

00:11:21.533 --> 00:11:25.416
It's a multitude of reasons, by the way.

00:11:26.197 --> 00:11:29.000
One reason very simply is on

00:11:29.019 --> 00:11:30.721
the math is that, you know,

00:11:30.740 --> 00:11:31.941
let's say ten to fifteen

00:11:31.961 --> 00:11:33.721
percent of your patients cancel per day.

00:11:34.081 --> 00:11:35.222
That automatically brings

00:11:35.243 --> 00:11:36.764
your productivity ability down.

00:11:37.163 --> 00:11:39.024
So we can use technology to

00:11:39.044 --> 00:11:40.046
help us with quick call

00:11:40.105 --> 00:11:41.706
lists and with patients

00:11:41.726 --> 00:11:42.427
because there's a high

00:11:42.466 --> 00:11:43.827
demand for PT right now.

00:11:44.148 --> 00:11:45.227
I believe that problem is a

00:11:45.307 --> 00:11:47.109
little bit fixable.

00:11:47.409 --> 00:11:48.389
I think we can get it down

00:11:48.409 --> 00:11:49.931
to five percent open table

00:11:49.971 --> 00:11:51.591
and other kinds of things that use it in

00:11:52.131 --> 00:11:53.153
non-physical therapy have

00:11:53.192 --> 00:11:54.913
done a good job of reducing

00:11:54.972 --> 00:11:56.033
no-show cancellations.

00:11:56.494 --> 00:11:58.335
And when you have no-show cancellations,

00:11:58.735 --> 00:11:59.576
filling it back,

00:11:59.596 --> 00:12:00.676
filling it in with somebody

00:12:00.716 --> 00:12:01.716
who will sit at that table.

00:12:02.057 --> 00:12:03.277
So that's a fixable problem.

00:12:03.636 --> 00:12:05.038
The second fixable problem is,

00:12:05.057 --> 00:12:06.739
is we've got to completely

00:12:07.479 --> 00:12:08.779
renovate our own profession.

00:12:09.240 --> 00:12:10.801
We have RCs, you know,

00:12:10.860 --> 00:12:12.321
practice restrictions and

00:12:12.701 --> 00:12:14.182
stuff within our profession

00:12:14.361 --> 00:12:16.743
that limit certain tasks

00:12:16.763 --> 00:12:18.303
that we do to exclusive

00:12:18.484 --> 00:12:20.224
one-on-one of a physical therapist.

00:12:20.604 --> 00:12:22.024
Can you imagine orthopedics

00:12:22.504 --> 00:12:23.666
or family practice

00:12:23.686 --> 00:12:26.506
physician advertising that

00:12:26.547 --> 00:12:27.427
patients should come to

00:12:27.466 --> 00:12:28.187
them because they get

00:12:28.227 --> 00:12:29.368
exclusive one-to-one?

00:12:29.594 --> 00:12:29.754
No,

00:12:29.793 --> 00:12:31.336
they operate at the top of their license,

00:12:31.355 --> 00:12:33.076
which I call neck up skills,

00:12:33.096 --> 00:12:34.177
which is a term I borrowed

00:12:34.538 --> 00:12:36.080
from my good friend, Carl DeRosa,

00:12:36.100 --> 00:12:37.041
who first started talking

00:12:37.061 --> 00:12:38.522
about this probably twenty years ago.

00:12:39.523 --> 00:12:41.184
And the reality is we have

00:12:41.205 --> 00:12:42.866
to change those limitations.

00:12:43.307 --> 00:12:44.067
Most of the time.

00:12:44.107 --> 00:12:44.807
Here's the irony.

00:12:45.009 --> 00:12:45.448
Most of the time,

00:12:45.469 --> 00:12:46.990
our practice acts allow it.

00:12:47.791 --> 00:12:49.153
So it's not our practice act.

00:12:49.192 --> 00:12:51.895
Some states, New York, Massachusetts,

00:12:51.916 --> 00:12:52.697
there are some states that

00:12:52.736 --> 00:12:53.798
are really restrictive,

00:12:54.138 --> 00:12:55.620
just penalize our own profession.

00:12:56.160 --> 00:12:58.102
But it is it is our profession itself.

00:12:58.462 --> 00:13:00.524
And it is the payers that arguably,

00:13:00.686 --> 00:13:01.687
you know, restrict them.

00:13:02.187 --> 00:13:03.908
So that's a second factor

00:13:04.509 --> 00:13:05.691
that really drives it.

00:13:06.392 --> 00:13:07.552
And, you know, then, of course.

00:13:08.413 --> 00:13:10.354
The third piece that is also

00:13:11.794 --> 00:13:14.537
fixable is that we have a

00:13:14.576 --> 00:13:17.239
fee-for-service system that

00:13:17.339 --> 00:13:19.860
effectively has made us hourly workers.

00:13:21.282 --> 00:13:22.523
Every CPT code,

00:13:22.543 --> 00:13:23.523
with the exception of a few,

00:13:23.562 --> 00:13:24.364
are time-based.

00:13:25.083 --> 00:13:27.005
And that is the way that we're reimbursed.

00:13:28.265 --> 00:13:28.966
I don't think we're going to

00:13:28.985 --> 00:13:30.067
be jumping into value-based

00:13:30.106 --> 00:13:30.986
care anytime soon,

00:13:31.027 --> 00:13:32.687
but I hope we do in many ways.

00:13:32.768 --> 00:13:33.388
And if we do,

00:13:33.427 --> 00:13:35.509
that could change that element of it.

00:13:35.849 --> 00:13:37.849
So parts of these are indeed fixable.

00:13:39.250 --> 00:13:39.450
You know,

00:13:39.509 --> 00:13:41.429
PT's salaries have gone up in

00:13:41.470 --> 00:13:42.650
part because of inflation

00:13:42.870 --> 00:13:43.691
and because of the

00:13:44.091 --> 00:13:45.091
education degree and

00:13:45.152 --> 00:13:46.312
student debt and all the things.

00:13:46.412 --> 00:13:46.511
And

00:13:46.991 --> 00:13:48.313
most notably the shortages,

00:13:49.235 --> 00:13:50.657
but it still has a cap to it.

00:13:50.817 --> 00:13:53.279
And that cap at some point will burst.

00:13:54.400 --> 00:13:57.104
Employers at some level can't pay above.

00:13:57.524 --> 00:13:59.206
I think the number is probably, you know,

00:13:59.225 --> 00:14:00.347
one hundred fifteen,

00:14:00.388 --> 00:14:01.349
one hundred fifteen

00:14:01.369 --> 00:14:02.811
thousand a year in the in the

00:14:03.270 --> 00:14:04.192
in the most expensive

00:14:04.231 --> 00:14:05.653
markets because again that

00:14:05.692 --> 00:14:06.832
cap is going to be two

00:14:06.873 --> 00:14:07.614
hundred to two hundred

00:14:07.634 --> 00:14:08.514
fifty thousand on the

00:14:08.573 --> 00:14:10.115
revenue side and we have

00:14:10.174 --> 00:14:12.197
legitimate overhead yeah um

00:14:12.216 --> 00:14:13.537
so hopefully that those are

00:14:13.576 --> 00:14:14.457
the things that I've come

00:14:14.498 --> 00:14:15.458
up with certainly other

00:14:15.499 --> 00:14:17.019
people would speculate

00:14:17.059 --> 00:14:18.701
otherwise but um you know

00:14:18.721 --> 00:14:19.821
in many cases we are our

00:14:19.860 --> 00:14:20.922
worst enemy but there are

00:14:20.961 --> 00:14:22.663
lots of externalities that

00:14:22.682 --> 00:14:23.923
have put pressure on us as well

00:14:24.283 --> 00:14:25.046
yeah the thing that jumped

00:14:25.105 --> 00:14:25.746
out of me the quote that

00:14:25.767 --> 00:14:26.649
you had said in your

00:14:26.668 --> 00:14:28.432
two-part series was we must

00:14:28.451 --> 00:14:30.115
stop incentivizing pts to

00:14:30.275 --> 00:14:31.557
stop seeing patients

00:14:31.818 --> 00:14:33.341
through over emphasizing

00:14:33.402 --> 00:14:34.344
management roles that

00:14:34.364 --> 00:14:35.706
detract from patient care

00:14:37.442 --> 00:14:38.104
Absolutely.

00:14:38.264 --> 00:14:39.144
And that's what we do.

00:14:39.585 --> 00:14:40.385
How do you get ahead?

00:14:40.525 --> 00:14:41.768
You become a clinic director

00:14:42.107 --> 00:14:43.548
who then hires enough

00:14:43.589 --> 00:14:44.610
therapists where they don't

00:14:44.850 --> 00:14:46.251
get to see patients anymore.

00:14:46.511 --> 00:14:47.693
And everybody loses sort of

00:14:47.734 --> 00:14:49.355
in that process over the

00:14:49.394 --> 00:14:50.557
long run because you don't

00:14:50.596 --> 00:14:52.097
see a lot of PTs that get

00:14:52.177 --> 00:14:53.899
out of clinical care that go back in it.

00:14:54.380 --> 00:14:55.020
You just don't.

00:14:55.081 --> 00:14:55.721
Right.

00:14:56.982 --> 00:14:59.105
And so that's a tough nut to

00:14:59.164 --> 00:15:01.227
crack because our best and

00:15:01.268 --> 00:15:02.828
highest utilization might

00:15:02.869 --> 00:15:03.830
not be seeing patients.

00:15:03.950 --> 00:15:04.370
Arguably,

00:15:04.431 --> 00:15:06.212
it isn't because the majority of

00:15:06.273 --> 00:15:08.355
PTs aren't seeing patients.

00:15:09.216 --> 00:15:10.616
So it's a real problem.

00:15:11.018 --> 00:15:12.019
Still think we have the best

00:15:12.058 --> 00:15:12.940
profession going.

00:15:12.980 --> 00:15:14.500
We have so many good things going for it.

00:15:14.541 --> 00:15:15.701
But those challenges...

00:15:16.743 --> 00:15:18.044
are going to make it difficult.

00:15:18.184 --> 00:15:20.206
And private practice is

00:15:20.246 --> 00:15:21.248
really at the forefront of

00:15:21.268 --> 00:15:22.327
this because they get hit

00:15:22.349 --> 00:15:22.908
with all of these

00:15:22.969 --> 00:15:25.892
challenges occurring at the same time.

00:15:26.717 --> 00:15:27.418
right so you can wave a

00:15:27.458 --> 00:15:28.559
magic wand we'll sum it up

00:15:28.620 --> 00:15:29.860
right you can you can fix a

00:15:29.900 --> 00:15:31.782
few fronts I won't ask you

00:15:31.802 --> 00:15:33.344
exactly how to fix it but

00:15:33.403 --> 00:15:34.985
where's the where is it in

00:15:35.044 --> 00:15:37.187
washington is it within our

00:15:37.326 --> 00:15:39.208
own profession where are

00:15:39.249 --> 00:15:40.629
the places that things need

00:15:40.669 --> 00:15:41.711
to change I won't because I

00:15:41.730 --> 00:15:42.510
feel like the how many

00:15:42.530 --> 00:15:43.192
different things need to

00:15:43.231 --> 00:15:45.114
change might be a a a

00:15:45.173 --> 00:15:46.554
three-part episode but

00:15:46.654 --> 00:15:47.755
where are these things like

00:15:47.796 --> 00:15:49.898
where would you put if you only had

00:15:51.099 --> 00:15:51.619
uh a certain amount of

00:15:51.658 --> 00:15:52.480
effort where would you put

00:15:52.519 --> 00:15:53.461
the pressure to actually

00:15:53.500 --> 00:15:54.360
change the things the

00:15:54.422 --> 00:15:56.123
biggest levers to pull to

00:15:56.182 --> 00:15:58.504
sort of reverse this yes

00:15:58.644 --> 00:16:00.307
yes and yes so first thing

00:16:00.366 --> 00:16:01.807
I would do is I would start

00:16:01.827 --> 00:16:03.009
within our own profession

00:16:03.408 --> 00:16:04.770
and make physical therapy

00:16:04.811 --> 00:16:07.232
the exclusive provision of

00:16:07.253 --> 00:16:08.833
a physical therapist acting

00:16:08.953 --> 00:16:10.495
within their state practice act

00:16:10.875 --> 00:16:11.917
What does that mean?

00:16:11.937 --> 00:16:13.077
That means that within our

00:16:13.118 --> 00:16:15.519
state practice act and almost every state,

00:16:15.558 --> 00:16:17.201
it calls for us to allow us

00:16:17.221 --> 00:16:18.201
to use extenders,

00:16:18.480 --> 00:16:20.022
allow us to leverage our

00:16:20.102 --> 00:16:21.342
neck up skills so that we

00:16:21.363 --> 00:16:22.644
can see more and more patients.

00:16:23.565 --> 00:16:24.686
Then we have to battle the

00:16:24.745 --> 00:16:25.886
payers and particularly the

00:16:25.907 --> 00:16:28.087
CPT code system itself and

00:16:28.187 --> 00:16:32.110
others that really reward us for value,

00:16:32.291 --> 00:16:33.091
not volume.

00:16:33.111 --> 00:16:33.251
Yeah.

00:16:34.032 --> 00:16:34.932
I was in the military.

00:16:35.072 --> 00:16:36.493
We had no CPT codes.

00:16:36.852 --> 00:16:37.552
The average number of

00:16:38.092 --> 00:16:40.333
patients that a therapist saw in the Army,

00:16:40.374 --> 00:16:42.375
Navy in those days was about,

00:16:42.434 --> 00:16:43.575
Air Force was about thirty

00:16:43.615 --> 00:16:45.076
a day and never felt

00:16:45.176 --> 00:16:46.655
overworked because we used

00:16:46.716 --> 00:16:47.755
ninety one J's and other

00:16:47.816 --> 00:16:49.616
technicians to help us leverage

00:16:50.116 --> 00:16:52.216
our ability to do evaluation skills,

00:16:52.277 --> 00:16:53.498
manual therapy skills,

00:16:53.918 --> 00:16:55.197
and the higher order skills

00:16:55.217 --> 00:16:56.138
that physical therapists.

00:16:56.158 --> 00:16:57.998
We became more case managers,

00:16:58.457 --> 00:16:59.859
but also utilizing our

00:16:59.918 --> 00:17:01.538
hands and our cognitive

00:17:01.558 --> 00:17:04.819
skills where that is what's the best way.

00:17:05.180 --> 00:17:06.299
The third thing is cultural.

00:17:06.980 --> 00:17:08.359
I would say we have to start

00:17:08.420 --> 00:17:09.859
shifting more compensation

00:17:09.880 --> 00:17:10.621
to our therapists.

00:17:11.181 --> 00:17:12.941
I know that sounds inherently obvious,

00:17:13.441 --> 00:17:14.721
but that means you have to

00:17:14.740 --> 00:17:16.182
stop rewarding middle management.

00:17:16.281 --> 00:17:16.721
You have to say,

00:17:16.741 --> 00:17:17.662
if you want to be a manager,

00:17:17.741 --> 00:17:18.602
you're going to take a pay cut.

00:17:19.135 --> 00:17:19.375
You know,

00:17:19.516 --> 00:17:21.278
if you become an office manager

00:17:21.317 --> 00:17:22.338
of an orthopedic practice,

00:17:22.358 --> 00:17:23.098
you make a whole lot less

00:17:23.118 --> 00:17:24.119
than the orthopedic surgeon

00:17:24.941 --> 00:17:25.981
or a family practice.

00:17:26.001 --> 00:17:27.442
And so you have to look

00:17:27.522 --> 00:17:29.085
organizationally and say, you know,

00:17:30.013 --> 00:17:31.013
PTs are pretty smart.

00:17:31.034 --> 00:17:32.295
They have transportable skills.

00:17:32.315 --> 00:17:33.234
They have good skills that

00:17:33.276 --> 00:17:34.635
lend themselves well for business,

00:17:35.056 --> 00:17:37.356
marketing, other uses.

00:17:37.917 --> 00:17:40.219
And a PT can both manage a

00:17:40.298 --> 00:17:41.838
practice without needing a

00:17:41.898 --> 00:17:43.220
middle manager who's also a

00:17:43.440 --> 00:17:44.340
physical therapist that's

00:17:44.401 --> 00:17:45.340
managing a practice.

00:17:46.121 --> 00:17:48.142
You don't see MD or

00:17:48.261 --> 00:17:50.002
orthopedic surgeons being

00:17:50.063 --> 00:17:51.723
the manager of two or three

00:17:51.763 --> 00:17:53.003
multi-site practices.

00:17:53.065 --> 00:17:55.085
You see office managers and

00:17:55.125 --> 00:17:56.385
other administrative folks

00:17:56.405 --> 00:17:56.986
when you need them,

00:17:57.026 --> 00:17:58.207
and they make a lot less.

00:17:58.547 --> 00:18:00.147
than that so I think part of

00:18:00.188 --> 00:18:01.869
it is is indeed cultural

00:18:02.130 --> 00:18:02.770
and that's going to take a

00:18:02.810 --> 00:18:04.952
long time yeah it's we have

00:18:04.972 --> 00:18:06.193
to reward our clinicians I

00:18:06.213 --> 00:18:07.634
mean you have to you know

00:18:07.674 --> 00:18:08.875
go to variable pay where

00:18:08.895 --> 00:18:10.237
they get a good base salary

00:18:10.817 --> 00:18:11.538
and I'm not saying this

00:18:11.597 --> 00:18:12.479
applies to everybody

00:18:12.499 --> 00:18:13.279
because some folks don't

00:18:13.319 --> 00:18:15.080
like to to you know work

00:18:15.141 --> 00:18:16.241
under incentives but if

00:18:16.281 --> 00:18:18.503
they view another job of

00:18:18.584 --> 00:18:19.984
moving that's non-clinical

00:18:20.006 --> 00:18:21.426
for more money you're

00:18:21.487 --> 00:18:22.748
better off saying you can

00:18:22.788 --> 00:18:23.769
make more money as a

00:18:23.828 --> 00:18:25.069
clinician and here's how

00:18:25.566 --> 00:18:27.186
Yeah, the culture change,

00:18:27.227 --> 00:18:28.207
definitely important and

00:18:28.247 --> 00:18:29.407
definitely rules and regulations,

00:18:29.428 --> 00:18:30.048
as you highlighted.

00:18:30.468 --> 00:18:31.068
I actually believe we got an

00:18:31.169 --> 00:18:33.150
email today as we record two hours ago,

00:18:33.269 --> 00:18:34.510
APTA New York reporting

00:18:34.530 --> 00:18:35.830
that a bill was passed by

00:18:35.871 --> 00:18:37.291
the governor that allows

00:18:37.912 --> 00:18:40.413
OTAs and PTAs to provide care to workers,

00:18:40.452 --> 00:18:41.653
compensation patients under

00:18:41.713 --> 00:18:43.275
direct and supervision of

00:18:43.295 --> 00:18:44.675
an authorized power being a

00:18:44.736 --> 00:18:45.536
PT in New York.

00:18:45.556 --> 00:18:47.517
And that looks like more neck up skill,

00:18:48.017 --> 00:18:49.038
more neck up skills being

00:18:49.097 --> 00:18:50.878
rewarded for being a physical therapist.

00:18:52.477 --> 00:18:52.916
That's good.

00:18:53.377 --> 00:18:54.979
In Medicare, they went the opposite way.

00:18:55.400 --> 00:18:56.760
You get paid less if it's

00:18:56.780 --> 00:18:57.882
done by a PT assistant.

00:18:58.222 --> 00:18:58.482
Yeah.

00:18:58.782 --> 00:18:58.962
Yeah.

00:18:59.042 --> 00:18:59.963
And fighting those things.

00:19:00.825 --> 00:19:02.106
One of those things is under our control,

00:19:02.126 --> 00:19:03.107
which is culture change.

00:19:03.147 --> 00:19:04.729
I think a lot of people are

00:19:04.749 --> 00:19:05.549
starting to begin to

00:19:05.589 --> 00:19:07.231
recognizing it and your piece,

00:19:07.291 --> 00:19:08.031
writing about it,

00:19:08.712 --> 00:19:09.473
stirring the pot a little

00:19:09.513 --> 00:19:11.115
bit and putting it out there and saying,

00:19:11.155 --> 00:19:12.096
let's talk about this.

00:19:12.396 --> 00:19:13.478
Because if we don't talk about it,

00:19:14.358 --> 00:19:15.079
it doesn't change.

00:19:15.680 --> 00:19:16.540
What's your prediction next

00:19:16.560 --> 00:19:17.260
couple of years?

00:19:17.861 --> 00:19:18.842
Which one of these things is

00:19:18.922 --> 00:19:20.942
more likely to actually come to fruition?

00:19:20.962 --> 00:19:21.942
Is it the culture change?

00:19:21.982 --> 00:19:23.223
Because I always look at

00:19:23.284 --> 00:19:25.224
which one can I have my

00:19:25.305 --> 00:19:26.665
fingerprints on the most?

00:19:27.365 --> 00:19:31.167
And rules and regulations and advocacy,

00:19:31.327 --> 00:19:31.929
I'm all for.

00:19:32.249 --> 00:19:33.890
I'm glad someone else is doing it.

00:19:33.910 --> 00:19:34.569
That's not my bag.

00:19:34.589 --> 00:19:35.390
I'm glad it's going on,

00:19:35.410 --> 00:19:36.611
but I also recognize that's

00:19:36.631 --> 00:19:37.791
a long-term change.

00:19:38.071 --> 00:19:39.653
I look at culture being not...

00:19:40.292 --> 00:19:41.773
It's simple but not easy,

00:19:41.993 --> 00:19:43.494
but that's under our control.

00:19:43.575 --> 00:19:44.555
I feel like that's the

00:19:44.575 --> 00:19:46.375
control the controllables side.

00:19:47.336 --> 00:19:48.758
Yeah, so a couple things.

00:19:49.178 --> 00:19:51.019
One is I hope to see PTs

00:19:51.118 --> 00:19:52.579
regain productivity to more

00:19:52.599 --> 00:19:54.201
of the twelve rather than the ten.

00:19:54.861 --> 00:19:57.041
I think through AI and other things,

00:19:57.261 --> 00:19:57.883
if they can get the

00:19:57.942 --> 00:19:58.883
matching to the right

00:19:58.923 --> 00:19:59.663
fields and all the

00:19:59.683 --> 00:20:01.605
regulatory things done correctly,

00:20:02.484 --> 00:20:03.266
I think that could help

00:20:03.306 --> 00:20:04.086
productivity and probably

00:20:04.125 --> 00:20:05.146
limit burnout a little bit.

00:20:06.067 --> 00:20:06.948
However, my fear,

00:20:06.968 --> 00:20:07.567
and there was just an

00:20:07.627 --> 00:20:08.709
article written about this

00:20:08.749 --> 00:20:10.950
about physicians that, yeah,

00:20:10.970 --> 00:20:11.930
there's a balance there.

00:20:12.070 --> 00:20:13.290
If all of a sudden you don't

00:20:13.330 --> 00:20:14.951
have the constraints of an EMR,

00:20:15.051 --> 00:20:16.053
you're still can suffer

00:20:16.073 --> 00:20:18.233
from burnout by seeing too many patients.

00:20:18.713 --> 00:20:19.894
But I do think you'll see

00:20:20.154 --> 00:20:21.996
some incremental gains there.

00:20:22.135 --> 00:20:23.616
There's no reason why we

00:20:23.636 --> 00:20:24.896
should have productivity loss.

00:20:25.538 --> 00:20:26.438
Second thing is I'm hoping

00:20:26.458 --> 00:20:27.318
the culture changes.

00:20:27.419 --> 00:20:29.759
I think the economics of PT is such,

00:20:29.900 --> 00:20:31.181
we're a penny nickel business.

00:20:31.240 --> 00:20:32.300
We're not a dime quarter

00:20:32.340 --> 00:20:33.642
business nor a dollar business.

00:20:34.182 --> 00:20:35.461
as such that the margins are

00:20:35.522 --> 00:20:37.282
so small that you're gonna

00:20:37.343 --> 00:20:39.483
have to see scalability and

00:20:39.544 --> 00:20:40.963
moving to a management

00:20:41.044 --> 00:20:43.545
level that is skinny at best.

00:20:44.644 --> 00:20:45.905
And the good news is PTs

00:20:45.925 --> 00:20:47.165
don't need a lot of babysitting.

00:20:47.665 --> 00:20:49.126
They're trusted, they're autonomous.

00:20:49.547 --> 00:20:50.366
And here's the beauty,

00:20:50.666 --> 00:20:51.887
a PT that works in a more

00:20:51.928 --> 00:20:53.248
autonomous mastery

00:20:53.307 --> 00:20:55.209
purposeful environment

00:20:55.588 --> 00:20:58.470
thrives and needs less management.

00:20:58.509 --> 00:20:59.589
What I say to my employees

00:20:59.630 --> 00:21:00.670
all the time is those who

00:21:00.710 --> 00:21:02.070
manage best manage least.

00:21:03.151 --> 00:21:04.192
And then third thing is,

00:21:04.432 --> 00:21:05.313
I don't know whether

00:21:05.413 --> 00:21:06.834
value-based care is around.

00:21:06.954 --> 00:21:08.895
I suspect it isn't because

00:21:09.195 --> 00:21:10.958
providers are unwilling to

00:21:11.959 --> 00:21:12.818
take on risk when they've

00:21:12.838 --> 00:21:13.980
got their shins kicked in

00:21:14.000 --> 00:21:15.080
us for a lot less

00:21:15.121 --> 00:21:16.082
reimbursement over the last

00:21:16.102 --> 00:21:16.622
several years.

00:21:16.642 --> 00:21:18.564
And let's face it, value-based care,

00:21:18.903 --> 00:21:19.825
while it's attractive in

00:21:19.865 --> 00:21:21.165
many ways from a practice

00:21:21.185 --> 00:21:22.146
independent standpoint,

00:21:22.426 --> 00:21:23.907
It's not economical in most

00:21:23.928 --> 00:21:25.048
of the primary care models.

00:21:25.067 --> 00:21:26.989
I mean, you saw what's happening with CVS.

00:21:27.009 --> 00:21:28.568
They're trying to now branch

00:21:28.648 --> 00:21:29.929
it in a separate company

00:21:29.949 --> 00:21:30.930
because of their they have

00:21:30.950 --> 00:21:31.769
the insurance side,

00:21:31.789 --> 00:21:33.510
but they also have the provider, you know,

00:21:33.530 --> 00:21:34.651
business side of it as well.

00:21:35.530 --> 00:21:36.471
And then I think lastly,

00:21:38.259 --> 00:21:41.941
we have to get the payers to change their,

00:21:42.461 --> 00:21:43.560
the fee for service

00:21:43.621 --> 00:21:46.122
environment to a per diem

00:21:46.701 --> 00:21:50.803
or an episodic case per day, you know,

00:21:50.863 --> 00:21:52.643
per, per, per case, whatever.

00:21:53.782 --> 00:21:55.384
Really instead of value-based care,

00:21:55.403 --> 00:21:55.844
you're going to see

00:21:55.884 --> 00:21:57.564
alternative payment models,

00:21:57.963 --> 00:21:58.865
which is different, right?

00:21:58.904 --> 00:21:59.765
They're, they're, they're,

00:21:59.884 --> 00:22:01.125
the one is not necessarily

00:22:01.204 --> 00:22:01.884
part of the other.

00:22:02.285 --> 00:22:03.006
And those alternative

00:22:03.046 --> 00:22:04.925
payment models may be,

00:22:05.185 --> 00:22:07.388
uh allow a therapist to

00:22:07.469 --> 00:22:09.069
scale and use their uh neck

00:22:09.109 --> 00:22:10.912
up skills uh I hope we go

00:22:10.972 --> 00:22:12.733
more to a military model

00:22:12.753 --> 00:22:14.056
you know from that

00:22:14.096 --> 00:22:15.416
standpoint yeah I've been

00:22:15.457 --> 00:22:17.519
hearing uh current and

00:22:17.559 --> 00:22:19.301
former military therapists

00:22:20.979 --> 00:22:21.818
acting confused.

00:22:22.180 --> 00:22:23.319
Why is it this way when I

00:22:23.380 --> 00:22:24.160
leave the military?

00:22:25.040 --> 00:22:26.942
We do so well and it's so effective.

00:22:26.961 --> 00:22:28.061
And look, we have data.

00:22:28.241 --> 00:22:29.542
It's not just we think, we feel,

00:22:30.303 --> 00:22:30.843
we believe.

00:22:30.884 --> 00:22:32.263
It's look at this data and

00:22:32.284 --> 00:22:33.805
the outcomes and how effective,

00:22:33.944 --> 00:22:36.205
cost effective and quality

00:22:36.286 --> 00:22:37.105
outcome effective.

00:22:37.586 --> 00:22:39.227
And it's twenty twenty four.

00:22:39.267 --> 00:22:40.028
I've been hearing this since

00:22:40.087 --> 00:22:41.867
I was in school in twenty fourteen.

00:22:41.887 --> 00:22:43.528
Well, it's very simple, though, Jimmy.

00:22:43.548 --> 00:22:43.729
I mean,

00:22:43.769 --> 00:22:45.269
the government always absolves

00:22:45.289 --> 00:22:46.250
themselves of the rules

00:22:46.269 --> 00:22:47.371
they place on everybody else.

00:22:49.133 --> 00:22:50.953
That doesn't feel fair, Larry.

00:22:50.973 --> 00:22:52.354
No, I hear you.

00:22:54.214 --> 00:22:55.415
So if these are the kinds of

00:22:55.476 --> 00:22:58.217
topics that you want to dig into,

00:22:58.596 --> 00:22:59.617
I want people who are

00:22:59.657 --> 00:23:01.198
listening and watching to understand,

00:23:01.238 --> 00:23:02.098
like you're having these

00:23:02.159 --> 00:23:03.499
conversations pretty regularly.

00:23:03.519 --> 00:23:04.180
You're creating, you're,

00:23:04.519 --> 00:23:05.019
you're having these

00:23:05.059 --> 00:23:06.980
conversations with yourself in your head.

00:23:07.000 --> 00:23:09.342
You're talking to friends with a keyboard.

00:23:09.701 --> 00:23:11.163
And then that's the beauty of this,

00:23:11.682 --> 00:23:12.583
not social media,

00:23:12.623 --> 00:23:14.124
but media that's social is

00:23:14.483 --> 00:23:15.365
these are the things that

00:23:15.384 --> 00:23:16.865
are in Larry's head all the time,

00:23:16.904 --> 00:23:17.925
or these conversations that

00:23:17.945 --> 00:23:18.506
are happening.

00:23:19.006 --> 00:23:21.008
in rooms around the country, right?

00:23:21.288 --> 00:23:22.387
We're coming up on PPS.

00:23:22.888 --> 00:23:23.848
A lot of these things,

00:23:24.190 --> 00:23:25.570
plus a couple other hundred

00:23:25.590 --> 00:23:26.611
topics get discussed,

00:23:26.891 --> 00:23:27.692
but now you're able to have

00:23:27.731 --> 00:23:28.673
those conversations at

00:23:28.712 --> 00:23:29.913
scale and share those

00:23:29.952 --> 00:23:31.273
things and people can interact,

00:23:31.615 --> 00:23:32.535
which to me is,

00:23:33.035 --> 00:23:34.016
instead of just arguing

00:23:34.375 --> 00:23:35.376
what we do on Twitter a lot,

00:23:35.396 --> 00:23:36.678
these are the good outcomes

00:23:36.917 --> 00:23:38.699
of platforms like Substack.

00:23:38.719 --> 00:23:39.519
So all things physical

00:23:39.559 --> 00:23:40.440
therapy on Substack.

00:23:40.460 --> 00:23:41.340
We'll share that link again.

00:23:42.121 --> 00:23:42.922
Larry, parting shot.

00:23:42.942 --> 00:23:43.461
What do you want to leave

00:23:43.481 --> 00:23:44.042
with the audience?

00:23:44.343 --> 00:23:45.123
Hopefully a good note.

00:23:45.163 --> 00:23:45.824
Hopefully a good note.

00:23:46.203 --> 00:23:47.805
No, it's a word of encouragement.

00:23:47.845 --> 00:23:49.086
There's nothing wrong with data.

00:23:49.487 --> 00:23:51.228
Just realize it and then

00:23:51.288 --> 00:23:52.648
reflect on it and say,

00:23:52.709 --> 00:23:54.230
how can I as a clinician

00:23:55.050 --> 00:23:56.413
continue to sustain an

00:23:56.492 --> 00:23:57.413
environment throughout my

00:23:57.472 --> 00:23:59.255
career where clinical

00:23:59.355 --> 00:24:00.615
emphasis is maintained as

00:24:00.675 --> 00:24:01.596
priority number one?

00:24:01.957 --> 00:24:02.938
If I'm an employer,

00:24:03.157 --> 00:24:04.637
what can I do to keep my

00:24:04.678 --> 00:24:06.398
clinicians practicing clinically?

00:24:06.699 --> 00:24:07.940
And what am I doing through

00:24:08.480 --> 00:24:10.601
the unintended consequences

00:24:10.701 --> 00:24:12.481
or causing my clinicians to

00:24:12.563 --> 00:24:14.743
practice less clinically?

00:24:15.104 --> 00:24:16.964
And then from an advocacy standpoint,

00:24:17.065 --> 00:24:18.345
what can we agree with?

00:24:18.384 --> 00:24:19.705
Can we agree that physical

00:24:19.726 --> 00:24:21.946
therapists under the domain

00:24:22.007 --> 00:24:23.567
of physical therapy are the

00:24:23.627 --> 00:24:25.749
arbitrators and should be

00:24:25.788 --> 00:24:27.069
able to practice clinically?

00:24:27.250 --> 00:24:29.251
through their state practice acts,

00:24:29.352 --> 00:24:32.054
which are heavily vetted at

00:24:32.074 --> 00:24:34.214
the state level through associations,

00:24:35.375 --> 00:24:36.317
rather than under the

00:24:36.336 --> 00:24:37.897
constraints of payers,

00:24:38.317 --> 00:24:40.019
or in our own particular case,

00:24:40.480 --> 00:24:41.540
our own profession,

00:24:41.921 --> 00:24:43.442
which has told us that

00:24:43.602 --> 00:24:47.105
one-on-one care is the way, the truth,

00:24:47.144 --> 00:24:47.644
and the life.

00:24:48.066 --> 00:24:49.186
That's very unfortunate.

00:24:49.807 --> 00:24:50.769
yeah yeah we did a live

00:24:50.808 --> 00:24:53.114
stream with about this and

00:24:53.335 --> 00:24:54.798
where's the value in being

00:24:54.817 --> 00:24:56.902
a pt and we we came upon or

00:24:56.942 --> 00:24:58.163
my my sort of outcome of

00:24:58.183 --> 00:24:58.865
that is it's a little

00:24:58.885 --> 00:25:01.009
culture change right we think

00:25:01.942 --> 00:25:03.384
Like if you the biggest

00:25:03.444 --> 00:25:04.345
mistake you can make if you

00:25:04.546 --> 00:25:05.547
if you create a product or

00:25:05.606 --> 00:25:06.667
a service or you provide a

00:25:06.728 --> 00:25:09.790
service is assuming what

00:25:09.911 --> 00:25:10.811
about that product or

00:25:10.852 --> 00:25:13.835
service your customer actually values.

00:25:14.355 --> 00:25:15.615
I mean, so many providers will tell me,

00:25:15.695 --> 00:25:17.258
well, one on one care, they value it.

00:25:17.617 --> 00:25:18.900
And I'll say like every time

00:25:19.079 --> 00:25:20.401
you're saying every single one,

00:25:20.441 --> 00:25:21.382
because if you can solve my

00:25:21.422 --> 00:25:22.462
problem in half the time,

00:25:22.663 --> 00:25:24.125
I actually value that more.

00:25:25.493 --> 00:25:26.994
Now, this is case dependent,

00:25:27.296 --> 00:25:28.957
but what I mean is it's case dependent.

00:25:29.196 --> 00:25:30.758
So it's not just more

00:25:30.857 --> 00:25:31.959
one-on-one time is better.

00:25:31.999 --> 00:25:33.019
Why not two hours then?

00:25:33.039 --> 00:25:35.101
Why is one-on-one for an hour?

00:25:35.121 --> 00:25:36.701
Why should it be one patient a day then?

00:25:36.883 --> 00:25:37.563
Right, right, right.

00:25:37.583 --> 00:25:39.243
If it's so much better, then over-serve.

00:25:39.284 --> 00:25:40.484
Do a patient for eight hours.

00:25:40.865 --> 00:25:42.145
And of course, that's funny.

00:25:43.027 --> 00:25:44.248
but that's going to the edge

00:25:44.288 --> 00:25:44.868
of that argument.

00:25:44.909 --> 00:25:46.130
So like, let's figure it out.

00:25:46.369 --> 00:25:47.830
Like figure out what the

00:25:47.990 --> 00:25:48.751
answer actually is.

00:25:48.832 --> 00:25:51.114
And that's just not assume all things,

00:25:51.153 --> 00:25:52.295
physical therapy on sub stack.

00:25:52.315 --> 00:25:52.934
We'll share that link.

00:25:52.954 --> 00:25:54.316
Larry, are you headed to PPS?

00:25:54.336 --> 00:25:54.916
We're going to see.

00:25:54.957 --> 00:25:55.457
Absolutely.

00:25:55.477 --> 00:25:56.458
It'll be a PPS.

00:25:56.498 --> 00:25:56.738
Sure.

00:25:56.778 --> 00:25:57.098
Stop.

00:25:57.138 --> 00:25:57.818
Come talk to me.

00:25:58.160 --> 00:25:58.940
That's how I get all my

00:25:59.000 --> 00:26:00.461
ideas is through interactions.

00:26:00.541 --> 00:26:03.003
I talk to physical therapists, owners,

00:26:03.064 --> 00:26:04.704
practice folks all the time.

00:26:05.286 --> 00:26:06.006
And these are the kinds of

00:26:06.026 --> 00:26:06.787
things that they're,

00:26:06.807 --> 00:26:08.147
that are on their mind and,

00:26:09.088 --> 00:26:10.451
And now I just have the

00:26:10.490 --> 00:26:11.373
ability to kind of write

00:26:11.393 --> 00:26:12.473
about them and report what

00:26:12.493 --> 00:26:13.855
people are telling me.

00:26:13.876 --> 00:26:14.376
The internet,

00:26:14.497 --> 00:26:16.740
it has some good uses as well.

00:26:16.780 --> 00:26:17.162
Larry Bench,

00:26:17.182 --> 00:26:18.423
appreciate you stopping by on the show.

00:26:18.844 --> 00:26:19.305
Absolutely.