Decision Fatigue Is Costing Your Clinic More Than You Think

0:02 Broadcasting way too early from three separate wifi connections. It's PT breakfast club with Tony Meritato, Dave Kittle and Jimmy McKay. In the first rule food in the studio, like running a little late this morning. Uh, he's Tony Meritato. I'm Jimmy McKay. Dave Kittle will be showing up pretty soon. Uh, beer league hockey game went late. It's like, but I'm wired when I get home. Yeah. Then I go to bed at like midnight or one AM and I'm like, you know, and then I wake up late and I'll meet my breakfast at eight thirty on a live stream.

0:45 So. So is it wrapped in a burrito, eggs, sausage? Yeah. I was telling Tony, yeah. I am nothing if not predictable with a lot of things, right? Breakfast, I don't like to think in the morning. Steve Jobs talked about this and I actually had a conversation about decision fatigue. Yeah. And I thought it was like, woo woo or like what decision fatigue. Oh yeah. But like Steve would always say that he ate this or, you know, did the same things that weren't important so that when the important things happened, He had the bandwidth, you know, like an executive, your job is to make decisions. So if you can reduce the number of decisions, like I don't care about food.

1:27 Right. Some people are foodies. I eat because every seven, eight hours I get real hungry and feel like I'm going to die. And then I eat stuff. Like there's some things I like, but I'm not one of those people who's like, oh my gosh, I have to try this and do whatever. I sort of don't care. So yeah. So that's why I eat the exact same thing every day for breakfast, decision fatigue. Dave, do you ever get decision fatigue, especially now as a relatively new dad? Good morning. First comment, I was going to ask, why is Jimmy in the Batcave right now? It looks a little dark there. Yeah, the lights are halfway on. It's all good. Decision fatigue. Yeah. I mean, I feel like sometimes I will I think I'm I think I'm no different than a lot of prospective patients out there where I'll delay making a decision because I don't want to make the wrong decision.

2:16 One example is having more front desk help, like virtual assistants or someone U.S.-based or abroad that's answering the phone calls, that's doing a lot of the callbacks. I have a whole bunch of self-limiting beliefs around it because I feel like I'm the best one to do it. And I feel like I have the best ability to demonstrate, like, authority and status over some of the big personalities that call in. Or it's, like, the personalities of the patient's assistant or, you know, executive assistant or whatever. So, like... Just around that is one example. And I have numerous examples. And in general, I would not have been able to get to this point where I'm at right now with full-time team members and all that if I didn't take the reins and just...

3:05 make decisions and like kind of figure it out later, reassess, maybe I made the wrong decision, no problem, go back and change it. But when it mounts up to so many decisions as a business owner, there can be decision fatigue. I mean, I went through this with electronic medical records. I went through it with payroll software. Eventually, like for me, what helps is like, it's easier to say, it's harder to do, but it's so easy to say, and what I would suggest anyone do, You have to just pick a lane, pick a path, make a decision knowing that it might not be the best therapist or the best software or the best approach. You realize like, oh, wow, this is wrong.

3:47 We talked about house cleaners here on the show months ago. And Tony said that they don't like, you know, they used to do it and then they don't like it and why we were doing it and all that. And I didn't even tell you guys, but since then we've gone through like three or four different cleaners slash cleaning companies. Because the first person comes, the business owner, with an assistant, and that first time is amazing. I'm like, oh, this is their model. Their model is, then they leave this assistant that's barely trained for all the follow-up visits. Sounds similar to some of the physical therapy out there. Yeah. uh and so then it's like okay well they missed this they missed this they missed this like let's give them another shot they get another shot they missed this they missed a bunch of stuff um then we switch right so business for at least for me is just like in a never-ending onslaught of decisions so if you're not okay with that if you're if you are petrified of making any decision you're probably not an entrepreneur you hit two topics that i'd like to develop One, I don't want to forget them.

4:54 One is talking about outsourcing, like intake and outsourcing and that kind of stuff. I had a conversation with Joey Albritton and I was telling him, I was like, dude, the clinic's blowing every number out of the water. We're doing better in a single location than we have in ten years. I'm like, you know why? I said, because I have my wife who's a licensed physical therapist, a far better physical therapist than me doing front desk. And I can absolutely tell you, she is a thousand times more valuable to the company doing front desk. And when I say doing front desk, that includes admissions, answering the phone, making callbacks.

5:38 It also includes all of the billing, pre-authorization, calling insurance companies, follow-ups. I need her brain operating that department of the business. I cannot outsource that to a company overseas. I can't outsource that to even a twenty five dollar an hour person with a bachelor's degree. You need the clinical brain who can identify a problem, develop a solution for the problem, systemize that solution, prevent that problem from ever happening again. Right. That is what we need at that position. And because we got that in her clinical mind, A monkey can treat a patient.

6:22 I need her to do the creative aspect of figuring out how to get paid. So he was like, in no world does it make sense to pay a licensed therapist to be a receptionist. I said, well, heck, it does in my world because for ten years we've never made this much money and had this much consistency and been this busy without that person in that role. Would she need to be a PT or does she just have that mind? No. You just need that mind. You just need curiosity, creativity, analytics. You need to be able to identify. But PTs tend to have that kind of brain. That's what we do. We do it in the clinic. It's just if I let her do it out there, we're not going to get paid.

7:07 If I have her do it in here, we're going to get paid. And so the second part that Dave brought up, the mistake that cleaning company made, and it's the mistake that therapists make all the time, that cleaning company put their best foot forward, got in the door, blew you out of the water with how amazing the experience was, then filled it with somebody who can't fulfill on the expectation they established. if i establish a lower expectation in the clinic on day number one that is what the patient has benchmarked as this is what i'm gonna get and as long as i continue to fulfill on that you know seventy percent uh expectate awesome but like and this is why As the owner, as the founder, you know, like if Dave goes out there and does the first visit and just blows the patient out of the water, then brings in somebody who might be good, just not as good as Dave.

8:06 It's never going to feel as good as the first day when the patient had Dave. We have to let those other clinicians who are not owners, who are not at the level that you're at, go with it from day number one. You don't forget it. That was it. That was the second. The second was the fact that that cleaning company made a mistake by doing so great on the first day, establishing the bar so high. Right. Outsourcing. Right. So Dave, we'll go to you. You brought something up I didn't even think about and never thought about. A lot of times you might not even be talking to the potential patient or client on the first day.

8:46 You're talking about assistants or staff members booking for those people. So how do you go about... doing this or is this is this bad like do you set the bar with dave and then when someone else shows up it might not be good better or worse it's just different well first of all i don't like it i don't like it because i want to i want to i want to speak to the decision maker right right now we're historically me my wife has done callbacks before i've had other folks try and help us do callbacks before We're always going to be professional and respectful with the third party. Believe it or not, like, there's families in New York City where, whether it's remotely or in person, they have an assistant, like, for their life.

9:31 Like, for their, like, doctor's appointments and, like, booking travel and all that. Like... Some are remote. Some are literally in person during the physical therapy visits at the home, which is just I mean, it's wild. Like they're getting paid a full like seventy, eighty, whatever thousand dollar salary to be a full time assistant. It's like kind of it's kind of crazy. But I would love to get to that. I can't wait to get to that point. So I don't I want to speak to the decision maker. I want to speak to the person that's in pain because then I can ask the consequence questions like, hey, so Tony, you have this knee pain. What if you do nothing? What if nothing changes in six months? Where might you be? I want to ask the pain point challenge and the consequence questions.

10:14 If I'm speaking to the assistant or the... uh the executive assistant or something like that it's unfortunately like they're just going to pass along like the numbers and the figures and how much we can we cost it's it's not the full it's not the full it's not the full like it's not the full sales process because I mean, we can still ask all those things, the same thing that we would do, like what makes it better, what makes it worse, like why now, all that type of stuff. But unfortunately, like these assistants sometimes have very overbearing, strong personality type boss that they're working for. And they've been kind of trained and trained they've been geared to kind of just do these like transactional phone calls.

10:57 And it's kind of hard sometimes to kind of like break through the glass and kind of like, like break through their, their shell. Cause they have a shell, like an outer shell that's like tough because they've developed that because that's their job. And they work with someone who is a multimillionaire or, or a billionaire or whatever. So, um, but yeah, sometimes that, in fact, um, we have a client right now. That's why, that's why I brought it up is we have a client right now where the, the, The family's assistant is remote living in Colorado, but she literally signed the paperwork, sent sent the credit card information, did all the phone calls, did all the text messages and emails and all the organizing of everything. And I and we we haven't spoken to the mother or father for the under eighteen year old client.

11:41 So it's it's kind of like it's a little wild, but it is what it is. Yeah, I know some people I know. I know several people who have that job. They are the executive assistant. And you hear the word assistant and you automatically assume, well, how much they bring to the table. These people are running the show. They can be running the show. Right. Like what they're able to do, what you're actually able to do, like sort of alluding to like I've never met her. Like, I'm pretty sure she exists. But Tony says, you know, his wife. Right. what they're able to do is they're not they're able to follow one two three four five step directions but they're also able to think when three goes sideways we throw four and five out what is the actual thing we're solving for okay that's gone you know like the computer systems are down what do we do they're able to think four steps ahead that is a skill that is a valuable skill because they understand Like the trains don't run when something goes sideways and how do we keep things together?

12:44 They are booking crazy expensive private flight tickets and vacations and obviously doctor's appointments because they're calling us or physical therapy. I think an average person would be like, okay, are you the right provider? Where is your office? What date is the appointment? Those are basics. Good ones that I know and I've seen them worked with are asking, they're smart enough to know They've been burned by the hot stove. They've booked an appointment. The boss or whoever they work for went to it and was like, that doctor sucked. How'd you vet them? And they were like, vet them? I thought I was supposed to get the appointment book.

13:25 The smart ones go, got it. When I'm called to question on why I made decision A and not F, I have to have good reasoning and those things like, are you saving me time? Clicking book, book, you know, and selecting a time and date is not saving the time picking the right provider or the right, Oh, you, you got me the right flight for the cheapest price, but I have a six hour layover in, you know, in Iowa. What are you doing? Why don't you think about that? They're paying you to think. And you just brought up a good point, which is sometimes historically we would say to these assistants, uh, like, Hey, hey hey tom um i know first of all it sounds i know you have a tough job we have a lot of clients that have called in over the years where they have an assistant or an ea or uh uh executive assistant or whatever like different um different like different titles but like hey tom um first of all i just want to let you know that we have we've onboarded a lot of uh high profile clients over the years through their assistants and i just want to let you know that First of all, this is my direct number.

14:31 This is how you can reach us. This is the easiest way. And also, we're going to try to set this up. And I'm asking these questions to make sure that it's the right fit for both of us. So I want to make sure that your boss, this client, is the right fit for us. Not just are we the right fit for you and your boss, but I want to make sure that you're the right fit for us. So they're a little bit of status. But at the same time, we want to come back and say, hey, Tom, by the way, We've had a lot of these scenarios where an assistant like you has booked for their client. And I wanna let you know that we understand that you're sticking your neck out here. Like there is some risk and we don't wanna, we do not wanna make you look bad. It is our focus that we're also gonna try to get your boss, the client better with the back pain or whatever.

15:16 But at the same time, Tom, We will not make you look bad. I actually will be sending Dr. Andrew. He's one of my most professional prompt physical therapists. He runs marathons. He helps with back pain. He can do all the things. But also, he knows how to manage your type of boss, the person that you're describing, like the strong personality, the ego, the busy schedule, all of that. He knows how to manage that. He's confident and he's clear on the game plan and also experienced in dealing with this type of clientele. And no matter what happens, we're going to make sure that we over communicate with you because you're sticking your neck out here. You're finding a...

15:56 random physical therapy practice on Google. I mean, obviously a word of mouth referral is best, but sometimes they're finding us on Google or something. And so we will literally say, hey, just want to let you know that we've gone through this a million times before. And we really focus on making sure that you, whoever's reaching out, the assistive, will not look bad here we never want you to look bad in fact we want your boss to speak with you privately in the coming days or weeks and say oh my gosh i cannot believe that you found this type of practice and they got a doctor of physical therapy degree and they come here for an hour and then the obviously the self-pay figures like don't even matter but it's really about wow that you found a great person a great fit a great company thank you so much we want the we want the client to be saying that to their assistant That's our goal.

16:46 When you start talking to someone like that, that is a pattern interrupt. Like when you're on the call with an EA and you're like, hey, listen, we've done this before. Let's make sure this is the right fit so that your boss gets the right experience. What you've just said is I understand what you're solving for. I've seen and done this before. Let's make sure I can solve your problem. Not even your boss's problem yet. It's now both of your problem. And when someone hears that, their defenses are way down. It's two problems. Yes. It's two different problems. Yes, correct. It is. I need to make sure my boss isn't pissed off. I need to make sure that we solve my boss's problem.

17:28 You're going to handle my other problem. You're going to handle my boss's problem. My problem is finding the right provider. then your problem is solving my boss's shoulder issue but it's amazing how like You can learn. Can you learn that in school? You probably can. You can learn lots of things in school. I didn't. I learned a lot of the stuff that I learned in my background on internships. And I think I lucked out. Or I don't even know what luck is anymore. But I worked for some really good people who, when something happened, explained to me what just happened. And I was able to be like, oh, that's what actually happened. That's a lesson here. That's valuable. I need to remember this going forward. So here's something I want to bring up.

18:09 And this is like, it starts to get a little weird, but talk it with Larry Benz. He brings up these different things called like paradoxes. Like, have you ever heard of like Jevons paradox? It's like these, like these concepts and like economics or psychology is usually where they are. Jevons paradox is when something becomes really cheap. We don't actually use less of it. We use more of it because it's cheap. So like the example is like when coal got efficient, we didn't ship less stuff. And we're like, look at all that savings. We shipped more stuff. We actually took the savings and we're like, well, screw the savings. Look how great this is. So I started looking around and when people start beating the drum about saving, saving, saving, all of a sudden my brain put two and two together.

18:53 And I'm like, hey, when we start talking about AI scribes saving hours and hours of time, is that going to be the case? Because I looked behind me and I said, with all this technology that's come around in my forty six years of being. Yeah. We still work as much, if not more. So it's just changing what we might do more, but it's not actually reduced. The careful ones say it doesn't save like four hours of time. It saves four hours of documentation time a week. But you're also like the smart clinicians go, but you're going to put me to do so. I'm going to see more patients now. And if you're okay with that, then it's a win. I just see all this, like we're not using less AI because AI may be more efficient.

19:38 I'm not just, well, I'm done now and I'm going to leave. No, we're just doing more and more. You guys know the subtle art of not giving a fuck, Mark Manson. I read Mark Manson's email. I read very few emails. Seth Godin, Mark Manson, and who's Five Bullet Friday? Tim Ferriss. That's about it. And Mark Manson was talking about this. He's like... He's a really itchy brain guy. He's like, in the last three months, if I'm not using AI, I feel like I'm falling behind. And this is a guy who's probably at the bleeding edge. So relating it to practice, Dave talks about the apps and the things that he uses. I still got to get the name of that app that you use because that you can watch...

20:19 like a replay of like a eval audio audio audio only audio only okay got it that's still really valuable like the transcript you can ask it questions so i guess the question is is the juice worth the squeeze i mean it must be right like with tony tony's affiliated with hippo scribe so he's got to jump in here first about uh ai scribes and all that Yeah, I agree with Jimmy. I agree with the paradox, the idea that the more time it saves, the more we do other stuff, we fill that time. There's never a point in anyone's life where you're actually doing nothing.

20:59 Even if you're recovering, even if you're resting, watching Netflix and chilling, whatever, you're always going to fill that time with something. I brought the AI Scribe in, right? I've been using it for years. I will never function without an AI Scribe in physical therapy. But all that does is it allows me to do more video content, more other stuff. I'm sitting here right now I've got this box that came yesterday, a new compression device that the company upgraded and sent me. Jimmy, I still haven't seen your live selling product stuff. Where do you at, bro?

21:40 It's on Amazon Live. I got to go find it. I'm going to go watch it. So, yeah, we totally just do more. I mean, and that's human nature. Like, that is the way it's supposed to be. What frustrates me the most is when I do see somebody... Who like, I don't know, they don't create more. They don't do more. They have all these amazing tools. Best time to ever be alive as a human being in the history of the world. And if you watch TikTok, you would think we live in the worst time to be alive. I mean, it's such a bizarre time right now. I think if you brought in a psychologist, and I will, because I got a buddy who's a psychologist, and if I give him enough time, he'll think about stuff like this.

22:24 Could the idea, if people do honestly believe this is crazy and this is the worst time ever... Do you think it's the paralysis or the abundance of all the things I could or should be doing and that feels so heavy? Because when you watch someone succeeding and you're like, I'm so far behind. I've been doing this. I should be doing that. Let me drop this and do that. And some of those things are just not possible. You can't. Comparison is the thief of joy. And... This is a comparison machine, right? It's great if you want to figure out something new. It's horrible if you get stuck comparing yourself to everybody else, which is a simple, that's a human nature thing. Yeah. Especially, you know, depending, I was thinking on the way in this morning, You hear the saying, you're the average of the five people you spend the most time with.

23:13 Who are the people around you? We should do an episode on what we listen to, what we watch. So I'm on this running program. ChatGPT is my running coach. I'm trying to bring my diastolic blood pressure down. I have not been able to do it by myself without medication for three years. I want my diastolic. My systolic is doing great. My diastolic will not come down. I'm trying all these different things. So anyway, every run that I do, I don't listen to music. I listen to the All In podcast. I listen to Peter Diamandis.

23:53 I listen to these business and technology guys that get me so pumped, get me more pumped than music gets me pumped. While I'm running that by the end of my run, not only do I have the endorphins of the run, but I feel so positive about the future of society, about how successful we can be, about how easy it is in today's world to get what you want. And I'm just like, I just, I feel bad for other people who maybe don't have that resource available or don't know it exists. Yeah. Yeah. Quick translation is Tony goes on a run and he gets the runner's high and then he gets the entrepreneurship high.

24:35 I love it. What do you listen to, Dave? Not in my life could I listen to a podcast while running. Just couldn't do it. So more so music. But I have learned that when I go out for like a four or five, six mile run, historically, I will run the first mile too fast. Like I'm just bad at pacing myself. So I will specifically put on an audio book or a podcast in the beginning to slow myself down. to like take it easy. And then if I need like a boost, maybe I'll put on some, you know, fast, uh, like, like rap, hip hop or anything that's like house music or even rock or whatever. Um, but I have listened to like, I remember specifically like Robert Cialdini's persuasion.

25:20 Like I've listened to that running and I mean, I don't know, Tony, like, does it take away from the run? Who cares? Like you're out running. Like at least for me, I don't know, like maybe I'm running slower or whatever, but, um, I've listened to a ton of business and marketing audio books and podcasts while running. Um, for me, I don't know. You can't go wrong, but typically I'll only listen to music if I'm running or working out. Otherwise any other time driving it's audio books or, or podcasts, uh, in the subway, audio books and podcasts always learning. Yeah. Uh, you can't, you can't, you can't increase your, you can't, you're not really helping yourself by listening to more music ever.

26:02 Like it's, it's not, it's not producing any new thoughts, new stimulation. It's not, it's not, it's, I don't think it, I don't think it's going to help you, your family, your income, your future. No, so I can't listen to someone speaking when I'm running. I and what I've found out is the best music for me to listen to is EDM, electronic music. And the reason is there's not a whole lot. There's not a lot of lyrics typically. And I begin having internal conversations then. Like that's when I sort of put things... That's when I start drawing lines between things that I've learned. That's almost like when you're sleeping and when you dream, that's when you actually synthesize everything as someone's thought.

26:43 But for the life of me, there's no way I could listen to anything words. When I'm walking... going somewhere, traveling, that's when I listen to words, read books, coffee shop, words, books, all those different things. I just want to clarify. I'm saying that by me listening to audio books and podcasts, it will make me more money versus listening to music. Okay, so you agree with that? You agree with that, okay. Yes and no, because I put things together when I'm not thinking, like in the shower or the back seat. So like I need to eat, listen, read to words, and then I need to like chew and digest. I need to zone out. Like, so I need to do both of those things.

27:24 I need to synthesize. and working out for me because i'm an endurance guy right i just do one thing slowly for a long time that's like my skill um for me there's a lot of time to chew and digest because you want to i don't want to look at the clock i'll turn the clock off i'm like my i'll stop running when the machine says stop running i said forty five minutes i'll do forty five minutes um that's for me is chew it like like breaking things down i listen to chialdini's book for me for some reason listening to books isn't great podcast conversations are good but i need to read the book we're just wired everybody's wired there's no right or wrong i wish i could listen to books it's terribly efficient for me, I don't know if I do a lot of the zoning out.

28:08 If I do, I don't feel like that's my building time. I don't feel like that's my critical decision time. I don't feel like that's when I'm implementing something or making moves or whatever. Although I'm not saying the zoning out is... pointless i think it's important but i'm saying you're saying you'll listen to the edm and zone out and i'm saying uh i i i'm not i feel like i'm not constructive if i'm zoning out if that makes sense right i feel like i am constructing what i'm not thinking about the problem or learning more again you can only be like you know putting food in the mouth or chewing and digesting one or the other um real quick yeah real quick kind of off this topic i shared a post about using chat gpt i said clinicians have a real opportunity right now there's still enough people who aren't on like any ai platform consistently enough to understand how to use it and how to extract value from it me using chat gpt as my running coach a couple big realizations for me One is I put in, I think I put in three objectives.

29:19 The primary objective being bring my diastolic blood pressure down. Secondary objective was increase my volume so that I would be comfortably running ten miles. I was at about four to five. And then number three was I'm stuck at this body weight. I have never weighed this much. I understand the principles of nutrition and thermodynamics and all that crap. it's not working like I'm not getting my body weight down I need my body weight to come down but I said I don't want to sacrifice diastolic reduction with calorie burning so that's a third priority um I took screenshots of all my running analytics from the past month when I had started put that in put my body weight put my daily blood pressure numbers in and it's an amazing running coach one of the big realizations for me one was just running too fast like its big push was get your heart rate down heart rate dictates pace you cannot exceed most of my runs you cannot exceed one fifteen to one twenty five heart rate to to focus on that diastolic you know blood pressure reduction i was like oh my gosh i feel like i'm walking yeah what do i do um and i finish these runs and i'm like ah i'm dying to do more but it's like no you cannot do more you have to pace yourself I think therapists have the opportunity right now to say, hey, you, me, and ChatGPT, we're going to work together.

30:52 Every time a patient walks in my door, the first thing we should do is pull up your ChatGPT, your Gemini, your Claude, whatever you're going to use. Let's put in your data together. Let's see its analysis along with our analysis. And then between sessions, This is going to be the third party. This is going to be the coach that walks you through every day. I want you to tell it. How did your knee feel? How did your shoulder feel? What did you do differently? Find the patterns that are exacerbating the symptoms. And then let's identify those trends to improve your outcome. We should be doing that as a paid service. We should be incorporating that right now.

31:32 And I don't think me included, I don't think any of us do. Why not? I don't know. Because we're afraid. We're the magician. And if I show you that I'm using a tool, it takes away the magic of me being like, there's an ace up my sleeve, right? I don't think so. I think it's just the friction of changing to a new system. It's the friction of incorporating something different. You need to create new wear patterns, and that takes work. That is mental fatigue that it's like I can turn my brain off and go treat ten hours of patients and not think a single thought and be totally comfortable with it.

32:17 But to bring in a new thing like that, I don't know. It just seems too powerful. Like, again, I use Peloton. I got a treadmill and I got a bike. props to Facebook marketplace. And it constantly is looking at my data. Like it's constantly like, Hey, based on the last three weeks, you should be running longer. Like you said, you're cause it asked me for my goals. And I was like, you know, increased distance or whatever. Genius. Genius. What's that? genius yeah it's like based on this based on this goal you're not getting there like you said you wanted to be doing this by this i used i've been using chat gpt to say you want to talk about a place i cannot focus and walk out and have no idea what i just did there is a supermarket so i'm like listen i like five meals these are the only five meals i like my goal is weight loss and you know healthy eating Give me five recipes and then tell me what I need to buy.

33:15 Right. The only next step would be I'm going to give you the layout of my supermarket. Tell me what to get in every single aisle. Have you guys seen this? There's a shopping cart at one of the two supermarkets I live near. I log in with my little plus number, my phone number to give me like, you know, the nickel off of whatever. I then scan items as it goes into the shopping cart. And then I just check out. It knows what's in there. Because it's got cameras, it knows if I only scanned one peanut butter and not two. And it has like... It will weigh fruit. It is wild. And it knows, of course, that's cool.

33:55 So I'm like playing with it, really. And then as I get on the paper towel aisle, I hear a ding and I go, did I press something? Did I touch something? It's like, no, brawny paper towels are fifty cent off. And I'm like, how smart is that? Because I don't buy brawny. I usually buy this other one. And now it's saying, ding, I know exactly where you are. If you're in the aisle, I know what I generally know what your problem is. I'm going to nudge you towards me. And it just seems like we're using it to sell paper towels, but not to help human beings become and stay healthy. Wild. Yeah. Changing topics. I want to hear about Dave's vlog and driving and recording and sharing information.

34:39 What's been going on with that? I was just cutting out. I didn't hear it. About your vlog. You're driving and yapping. Yes. I'm just trying to test out new formats. I think the immediate response was that it's better or faster to get to, I don't know. Again, we're talking low views, but faster to get to four hundred views compared to other reels or whatever. It certainly seems to be working. This has been inspired by the GaryVee videos where he was in the back of you know, taxi cabs or, or like whatever Ubers and things like that.

35:22 Um, so my, I, I pitched my wife on recording it because we were going into, uh, treat her at the office over the weekend. Just like some plantar fasciitis type stuff. And there was like a, a red light machine and a laser machine, which we also have separate content on and that's coming out soon. But I was like, you know, I was like, let's, you know, Jimmy helped me with picking out the road lapel mics. So I was like, let's get, let's get that on my, my collar. And I said, Hey, the easiest thing to my wife, Annie, I was like, the easiest thing is like, can we just use hit record? I'm like, we'll just go back and forth and we'll have a conversation literally just like this show. and she's like no and i'm like all right so hit record and i'm gonna freestyle the way that i can that i know took years to be able to do because it's like totally not comfortable at all but i was like all right let's just i want it i want to bang out this content i know i think it'll be interesting um who wouldn't want to see i don't know it's different see a pt driving around you see buses and taxi cabs and whatever it just It's not anything groundbreaking, but it's just a different format compared to like, here's an exercise on, you know, a hip mobilization or, you know, a posture exercise or, you know, a spinal manipulation that, you know, a crack and pop that all the chiros do just trying to be different.

36:40 That's all. How are you picking what to talk about? Is it whatever comes to mind? Exactly. So started talking about, um, even in network, like what, like, of course you want to use your network insurance and blah, blah, blah. It's not your fault. And you know, here's why we don't take it. And talking about, um, manual therapy versus I use chat GPT maybe a couple of weeks ago on what, and I think Tony has done this. What are like the most provocative polarizing topics in physical therapy? And I posted some stuff about it. So like one is, um, cash pay or out of network versus in network. That's one topic. Another topic is manual therapy versus exercise only.

37:21 So I've, I've talked about that. I've made other posts about it. Um, but are you, are you keeping like, are you like me where you'll just jot down a few things in a note or on a, or on a piece of paper? And then when you hit record, you're like, just right there off the dome, off the cuff. Yeah. I'll do like notes just so I don't forget about it. So when I sit down and say, I've got an hour to do this, And I've been doing a lot. I haven't done it recently, but I was doing a lot of series where I was like, I have an idea. I'm like, okay, let's pose six solutions to this one problem and I'll just do them in a row. And the reason I like doing that is, especially on Instagram, that you can link... one video to another. So I sort of daisy chain the video together and I made all the thumbnails the same.

38:05 Like for one series, it was black background, white text, same text. And it was like number seven, number six, number five with the idea. If you trip across one, you're going to go up and down the chain. we were driving through manhattan and we were using external i i i was using external things to immediately come off the cuff with a topic so we're on we're on park ave we're turning left on the fifty seventh street and it's traffic even though it was uh sunday there's traffic there's a traffic cop in the middle of fifty seventh and park and he's waving us through so i said to annie i'm like hey hit record and you can see the traffic cop right out my window and i and i go all right so you're recording okay so i'm driving here through traffic You just saw the traffic cop.

38:47 He's waving us through, right? He's kind of he's guiding us through. He's providing direction and support and he's making sure everyone's safe and all that. No different than what my doctors of physical therapy do. We're like not just health coaches, but we're going to guide someone through how they navigate a new injury, an old injury, even if they tried everything, even if they failed everything. So I'm able to go a minute or two completely off the cuff for something that I just saw out the car window. Then we're driving through. You'd make a great radio. That's it. That was the job. we're driving another block or two up at the seventh street. And then when you pass the, um, is it the, the, the Gucci store or whatever, like the whole, the whole building is the outside of like a, uh, a Gucci or a Gucci bag, like the whole, the whole building.

39:31 Right. So I'll be, every tourist is taking pictures of it. So I say to my wife, get your phone, start the video of, of the building of like the suitcase, the, the, the luxury suitcase building. Right. start recording and then pan it over to me. And I'm going to be like, yeah, you know why Gucci and Prada, like every single year they raise their prices. Why? Why? And I say, Annie, why, why can they do that? How are they able to do that every single year? If they can charge thousands of dollars for, uh, for bag, for purses, for bags, for luggage, whatever, like why, How can they do it? So she I'm pulling her in. So she starts to listen off things. And like the second thing she says is like brand. And I'm like, yes, brand. Exactly. And messaging and, you know, status and perceived value.

40:13 Right. And so we're going through that. And then I'm like, then I segue that right into like perceived value of concierge physical therapy, what we do out of pocket. So I'm pulling stuff out from the sidewalks and from. out the window and immediately make I think we only filmed like five I posted two so far I think we felt I think we felt like five uh or so we did some like driving from Brooklyn into the city into the into the tunnel so um I'll just be doing more of that just got to be on the road and have someone uh recorded or whatever but um it was fun for sure What's the best exercise to do? The one you're going to do. What's the best type of content to create? The one that you're going to continually create that you see resonating with an audience.

40:59 four hundred views is not a lot, but if it's the right four hundred people, it is a lot. I've got a friend, I helped launch a podcast, and she's like, I'm hovering around three, four hundred downloads an episode. I'm like, imagine you did this live at a bar and three or four hundred people showed up. I need you to start, and I call it, I need you to un-Kardashian that number. And understand that you're also talking... This is a PTA. This is a super narrow niche. There's, what, three hundred thousand PTs in the country? I don't know how many PTAs, but a lot less. I'm like, you have four hundred people listening to you yammer on about PTA stuff for forty minutes? That's a lot. I'm like, how many people work for this company?

41:39 Less than that. So I need you to understand that. So four hundred views is sort of... I know it's the beauty pageant metric. It really is. I mean... There are podcasts that get more listens, but I look at my number of... It's called quality listens. And what that means is when someone hits play... What percentage gets to the seventy five percent mark? So if a hundred people listen and I have eighty percent quality play, it means eighty out of one hundred at least hit three quarters of however long that episode is. If it's ten minutes or sixty minutes, that to me is actually more valuable. It means I'm talking about the right things to make people push play and stick around.

42:22 Instagram stuff is just pushing play. But you can look at some of the data. And I think I showed you, Tony, if you use the edits app, it'll get a lot more information. And I think they want you to use their editing app because they want you to stop using like things like CapCut, which is related to TikTok. So it'll give you more information if you use their apps. But I mean, it's hard to do, but get, you know, four hundred is still four hundred. It's still pretty good. the thing that i thought was interesting was i'm still not comfortable recording in front of my wife recording in front of my kids i i couldn't do what you did in that video just because i'd feel comfortable because because the the the i i know that the benefit of getting this recording getting this recorded and getting it out there.

43:13 And thank you to David. David Rubin is supporting me immensely on Instagram. He's commenting, he's liking, and he was loving those videos, the one or two that I posted so far. So David, thank you for the feedback there. I just know that the benefit of getting that out there the way that I can speak briefly on, on camera in, in that type of a setting where there's, there's like not that many people that are doing video like that in New York city in a car, like not that many, like. Ten, twenty, fifty. I mean, like there's not that many people doing it. So I'm like, in terms of PT, I I'm definitely the only PT that does it in New York city in a car. So it's like, it's, it's going to be unique.

43:53 And, I don't know if you stepped away from the video, Tony or not, but like my wife, I was like, all right, can we just, yeah, we can do it back and forth. And she's like, no. And I was like, well, hit record. I'm just going to talk about anything. Like, and so we're just going to go from there. And like, yeah, the first one was a little choppy. And then it was like, and I was just like right into it. Literally just like the show. So I think you could do it, Tony. I totally think you could do it. Yeah, it's like anything. You just got to start doing it. You got to either get mad enough, frustrated enough, hungry enough, do it, and you realize it's doable. I agree with Jimmy, though. Four hundred views doesn't tell me much. It's how much did they view of the total content. If they're viewing more than fifty percent is usually my metric.

44:36 Amazing. Like most people are not going to view more than fifty percent of it. And then shoot i had something that i was gonna oh i shared a screenshot with you guys maybe i posted it of the people also ask version on facebook you know google has people also ask on my facebook feed and i wasn't sure if other people were seeing it it's starting to show ai generated questions which is basically what google had forever as people also ask So as a content creator, now what you do is you put that piece of content up, you see what those are, and then you start creating new videos to answer those specific questions.

45:18 And it just, it spider webs out into a whole, you know, vertical silo of content around the topic. That's the concept of, and it's a paid tool, answer the public. Yeah. Answer the public was like, you put in a, we've all seen like a color wheel, right? Or a motion wheel. You put a question, usually it's better when a question goes in the middle and then it'll have you people also ask and it'll group it in who, what, where, when, how. And the idea there is like, what would you put, what would Dave's question in the middle be? Like, Pain relief, New York City. Where can I get pain relief in New York City? Or where can I get physical therapy? Or where can I get concierge physical therapy in New York City?

46:00 And then it'll have all the questions that are sort of secondary to that. You make sure you show up in as many of those as possible. And then I look at the world like a giant Venn diagram, right? This person knows this person, this person, but it's also this question. The person who's asked this question also is asking this question. If you can cover those things, you sort of own, you begin to own that category. I think another great direction for Dave is, and this could be on the business side or on the patient care side. I don't do this nearly enough. I was thinking this morning I need to do it more. Snap a screenshot of a Facebook post. do a green screen on Instagram with the image of the Facebook post behind you and just answer the question.

46:44 Like there's so many Facebook posts out there coming up with what do people want to see? That's the hardest part of what we do. But you just snap that screenshot, put it behind you. You answer the question, you read it, answer it. green screen it it is a piece of cake and you could crank out ten fifteen twenty of those in no time and then you just have that repository that you can either schedule or just post when you need to post them so i i i did i did one here's one right here a green screen this was maybe this was a few weeks ago, maybe a month ago. And then I went back in to try to do more green screens.

47:26 And it took a while because I was looking for it. And I had to ask ChachiBT, where is the green screen feature inside of Instagram? And they're like, well, update your app. I updated the app. It still wasn't there. Long story short, you have to download the new edits app. And it's in there. I was like, oh. i it spent a week looking for the green screen i'm typing a green screen by instagram green screen instagram that's weird i i i didn't download edits i know about it i found the green screen in instagram just regular instagram yeah i don't know if it was taken away things just changed and they always do and there's probably a reason there there are reasons for it um but it also pisses me off when it does.

48:11 But then you know what I do? I learn the new way and I just keep moving. That's what we all do. That's what they expect you to do. Yeah. All right, real quick. I don't know if we have one last topic. We're closing the show. Dave, I was thinking about you this morning. So my wife, huge baseball fan, knows all of the Reds' stats and history and all of this stuff. I found a reel this morning of a guy talking about old school baseball, grabbed a bunch of old school baseball clips. He was like, these guys used to hate each other. When you were running a second base, you would break up the double play by knocking out the second baseman. You'd run through the catcher, blood fights, like all that stuff.

48:53 and now and it's hilarious because my wife said she's like i don't like this new baseball like these guys are all buddy buddy so we have ellie de la cruz and he's talking to the second baseman on the other team and they're laughing and joking and patting each other on the bat on the butt totally different culture but it kind of got me thinking about you know modern physical therapy I see the new creators coming out on TikTok, on Instagram. I was listening to a guy this morning. He's talking about making twenty thousand a month right out of school, bought a lives in a van so that he could put all his money into building, you know, his physical therapy practice and nothing against him. It's it's the culture, the new culture of PT.

49:35 But like I am definitely old school PT and I don't have any interest in joining the new culture of physical therapy. Two topics blended together. When I play college baseball, D two baseball in Philly, I hated every other, every single team that we played. And then looking back on it, I would remember certain guys names and I would like, try to like connect with them on LinkedIn. And like, they wouldn't, they don't answer like my DMS or whatever. So I feel like that was a miss. I feel like that was a miss on future teams. networking because future connections and all that, because I played against a ton of people over the years. Right. Like travel ball, Legion baseball in South Jersey, college baseball, the summer leagues, everything like that.

50:20 That's how I was always geared, though, Tony, kind of like that old school mentality that like you don't even you don't even talk to the other team when you're on the field in the infield. I played in my whole life when you're on the infield and the other team hits a home run. You don't say to the guy rounding base, you don't say, hey, good hit, good job, nice thing. You don't, you scowl at them or you turn away. You don't talk to them. You don't say good hit, nice double, nice triple, blah, blah, blah. Nowadays, that is the case. And I'll, you know, younger guys say that to me. I get on base and all good swing, good hit this. And it's kind of wild. It's kind of different. I think in the future could help you just in terms of like the whole networking thing. But in terms of the competitiveness, it is a different dynamic.

51:01 Right. Hey, one more actionable marketing item. I don't know if you guys, did you see that post I made about aquatic therapy in the home? No. So I referenced Sam Walton because if I've got it right... In their tub or hot tub or what? Nope, nope. If I got this right, show me a note. Didn't Sam Walton or the Walmart people go up in a helicopter or an airplane and look for where they were going to put the next Walmart store? He got his own pilot's license. He got his own license and he would fly his own little Cessna by himself. Okay, so that got me thinking about it.

51:41 I was like, wait a minute. I remember flying back home to Sarasota. You'd look out the airplane window. You'd see pools everywhere. So I went on Zillow. I typed in Sarasota, which by the way, blew me away at how expensive houses are. But anyway, and I was like, holy crap. I switched it to satellite. I saw all of the pools. I was like, if I was a mobile therapist and I had any interest in aquatics, you know, pool therapy, This would develop my mailing list and I would use Dave's format for a postcard. And I would specifically target houses with a pool. preferably a million plus in value.

52:21 And I would just start direct mailing these houses with in-home outpatient physical therapy for aquatic therapy. And that's how I would grow my list for whatever it is that I wanted to do. And then that got me thinking about like, okay, well, what if I love dogs and I wanted to include the owner's dog in the therapy session, I would figure out a way to find out who owns a dog. And I would start targeting those houses. Maybe I buy the mailing list from somewhere and I would market specifically like pet and human, you know, combined therapy sessions. Let's include your dog. Let's get the dog out for a walk.

53:02 Patients tell me all the time, they're like, I wish I could walk my dog. I can't do it anymore. Hey, guess what? There's a solution for that. And I think even a faster way, instead of trying to find a mailing list of people that have pools, you just go to the local pool companies and say, Hey, we would love to collaborate with you. All of our current clients that have pools, we would love to recommend you drop off brochures. We're going to be in their home treating them. And we're going to, you know, we can, bring up like oh hey your pool oh you're frustrated that you got to open your pool close your pool clean your pool all that why don't you use john's pool cleaner or whatever and then also by the way john's pool cleaner could you drop off our business cards or our brochures whatever when you do the pool cleanings and whatever and and do a little cross-pollination referral with that company which is what i try to do with that tub cut that tub cut cleaning company where it's like, hey, that's our ideal client.

53:57 There's literally no competition. It's two completely different services. So whether it's a mobile therapist, Tony, doing that with trying to find the million dollar home plus with a pool, you just go right to the pool company and say, hey, let's try to collaborate. Let's try to network together. Let's share each other's marketing materials with our current clients. Try to get on, try to have them share your information with their current clients. And then same type of thing. You go to the, even in Brooklyn, and I'm sure it's in Ohio and upstate New York, everywhere else, like all these mobile dog, these mobile dog cleaners, groomers. My cousin was a dog walker in Brooklyn and was making six figures. My cousin's husband.

54:38 Six figures. I'll yes and these two ideas. I think it was on the corner offense. I think it was Chris Corner. He was giving kudos to someone who figured out a way to use AI that would go to some satellite imagery, and they were a blacktop company. So they skipped, do you need a new driveway? The blacktop company was able to spot anybody with a driveway more than a thousand square feet, and it would send them a quote. Okay. And it would say, your driveway, because I scanned it from an aerial photograph and figured out how to measure and did it to scale. I know how many square feet your driveway is. For me to do that, it's this much money.

55:20 And they just kept repeating to those people in their area. They skipped anybody without a driveway. So they kept hitting the people over and over. The old school way is when your guys are out doing a driveway in Jimmy's neighborhood is take thirty postcards and go fifteen houses in either direction. That's fine. This guy was able to do it without ever leaving his house. And the cost of that is terribly low. But I'm pretty sure the margin on a blacktop and a driveway is pretty good. The thing that I like about the satellite more than the affiliation with the pool company, like I love that idea. The satellite gives me the geography. And so for a mobile therapist, like I would never be a mobile therapist who took people from all over the city.

56:03 I would be a mobile therapist who took people from a specific neighborhood that like literally I could walk house to house to house, knock out ten visits in a day instead of three visits in a day because of commute time. um that same chris corner did an episode where they looked at google street view and they used those images from google street view to create landscaping mock-ups so ai creates the landscaping mock-up but that got me thinking what about all the people if i was a therapist who did home modifications you know i would be looking at entryways i'd be looking at uh different things like that that as a therapist you would say oh we could get a handrail here.

56:45 We can, you know, change the entryway here. We can make these upgrades, even ramps and stuff, accessibility devices that help patients. All of that could be done from a simple photo of the front of the house, you know? So, and you send them out a quote, an estimate, Hey, if you're going to age in place and you're looking to stay safe in the home, like this is what we do. Yep. all right i think we're good we had such a completely random show today all over the place also tony's back there he's like taking care of business like uh behind the scenes like over his shoulder uh i don't know you're like checking a patient at the front desk you're going through here what's going on today Real quick, I scheduled a new patient that walked in the schedule.

57:36 Like, who walks in the schedule? Took a payment that would have been missed that we would have had to then invoice later. Got three people on the schedule for next week. Like, yeah, you just get it done while you're here. All right, parting shots. What do you got? Dave, you go first. I'll take the reflection of, and I'm not saying we're any better than anyone else out there, but what we just did today on this show of kind of bouncing all over different topics. Tony's in and out of the conversation. He's jumping right back into it. I don't think it's, I'm not saying we need any credit. I just think it's the ability to handle different things coming at you or even navigating different environments differently.

58:22 None of this was planned. We just we just smoothly go through it because we've had the reps of going through this show for two years and doing other shows for many more years before that. So I don't know if there's if that's a learning point. I think that's just something that would take time. And it's not something that you can necessarily replicate other than going back to the very first thing, which is don't overthink it. Just do it. You know, improve it. Change it as you go. I don't know what else to say other than that. Yeah, the theme today was definitely just hidden opportunities. We talked about ChatGPT being a hidden opportunity. We talked about marketing and satellites and so many creating content on the drive that would have been wasted time that now you're leveraging to grow your business.

59:07 There are so many hidden opportunities out there. You just got to pick one and go with it. I mean, people in healthcare are very smart. They're also... They don't need any change very much, which means if you do, all of a sudden you're the top one percent. And be okay with failing twenty times because that one success could lead you to a lot of stuff that someone else is not doing or not paying attention to. All right, we're back on Tuesday. What do you want Tuesday to be? Do you want us to, what you suggested, bring what we listened, like, almost like when you walk into a bookshop and the staff recommends a book, a podcast. Yeah, let's do a six-pack episode.

59:47 Two, two, and two. What is the topic? Book, podcast, blog? Yeah, the voices in our brains. Audio anything. Voice in our brains sounds good. Are you hearing voices? Yes, I am. See you back on Tuesday. Have a good weekend. That's it. We're out. Boys, what the hell are you doing? Follow Tony Maritano on YouTube at Total Therapy Solution. Find Dave Kittle at conciergepainrelief.com and on YouTube at The Dave Kittle Show. And follow Jimmy McKay at PT Podcasts on YouTube, the socials, and wherever you binge podcasts you pretend are for CEUs. And hey, just a reminder, none of this was for advice.

1:00:30 This was for entertainment only. Our lawyers say that counts. Thanks, Keith.