“Discharge Monkey” Isn’t A Job Title

0:01 You're listening to the PT Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. If I had a time machine, I would go back. I wouldn't name it PT Pinecast. That was a goof. This was because we drank beers after class and we're like, oh, I get it. We want it to be fun and like a happy hour. I don't even, I mean, I like beer, but I don't love it. Like people like, they want to talk to me about beers and I'm like, I don't know, man. I like regular beers. It's not my identity. That's my problem. But now that beer follows me everywhere. Although it is good at CSM because you know what people... When they see me walking through the hotel bar, everybody wants to buy me a beer. So I saved myself a couple of bucks. Rebecca Griffith, Drew McKay.

0:43 We were just chatting before we hit go live. You got a... Someone commented. They didn't DM you. They commented on something. So set the story up. And I was going to put the thing on the screen, but I don't want to... I don't want to blast the person. Yeah, I don't want to put this person on blast, but let's talk about the reason this person... Yeah, so kind of the context is I posted a video about the difference between an emergency department physical therapist and an acute care physical therapist. Got it. It's a question that I get asked, like, how is that different than regular acute care? How is it different than an outpatient PT? And so it was really just sort of clarifying that. And then the person just sort of said, like, sounds like a physical therapist who works in the emergency department.

1:25 There's no such thing as an ED physical therapist. Which, you know, if you want to split hairs, fine. I personally feel like a physical therapist, no matter where you are, you're a physical therapist. I'm fine with that. That's okay. But then the person went on to say in the hospital, we're all just physical therapists. There are no specialized PTs in the acute or emergency department world, whether we're ED or acute, we're all just discharge monkeys. And that made me really sad. In the Oxford debate at CSM this year, too, for the acute care academy, the question was, float or focus? Should we be generalists or should we be really specialized in the acute care world?

2:07 But I think what bothers me here is that I feel like this person has lost their agency. Yeah, like their way. Yeah. And I feel like a lot of physical therapists are feeling like that, regardless of the setting that they're in, whether they're in the rehab setting, the acute care setting, the home health setting. I feel like we're all sort of feeling like we're practicing the way that we're told, not the way that we could or should be practicing. So number one, I'm on purpose, like just being quiet, which is painful for me, but I'm going to jump in now. So like this person is having a bad experience where they are.

2:50 So like, I think this person, that's why I don't want to put them on blast as the kids say, I don't even know what the kids say that anymore. This sucks. Like this part, like, okay, so let's unpack. The person actually said there are no EDPTs. There's no difference. Listen, Rebecca is not, you are special. but you're not special because you work in the ED, but there are some skills you pick up there versus working in peds or geriatrics. We are all PTs. Yes. You're just playing a different position, right? Like I'll use a sports analogy. We're both baseball players, but if you put Jimmy at third base, that doesn't make any sense. Right. I could learn it maybe, but I'm also left-handed. That doesn't make any sense. But anyway, I digress.

3:31 This person's in a bad, this person's in a bad system, right? And maybe they're too far gone. Maybe they're just like, if we're like, all I am is a discharge monkey, I'm really sorry you feel that way. Well, and that was exactly how I responded. I literally said, I'm really sorry that's been your experience. Yeah. You're in a bad system. That sucks because I also don't think this is isolated. I think a lot of people will start to feel like this. No, and I know there are more trends in the acute care setting where physical therapists are told that you can't make a specific discharge recommendation. You can't say acute rehab or sub-acute rehab. You have to say post-acute rehab or, and that's not isolated to any one hospital system.

4:12 I've been hearing that from people across the country. And the reason for that, like if we really stop and think, is it to strip physical therapists of their autonomy and their discharge planning and their expertise? No, it's because we work in payer-centered healthcare, right? It's not patient-centered, it's payer-centered care. And so when the case managers go and they have to actually find a discharge plan for this patient, and we've narrowed it down to this one thing, that patient may not have access to that, right? So by changing it to a more general recommendation, our case managers may actually be able to get the patient some level of care. So I think it's Instead of fighting that system, we're accommodating to that system.

4:54 And I think that's the frustrating part. And I think therapists who are also accommodating to that, right? And that's top of facility. Like you're just doing what you're told at the place where you work. It does not lessen your expertise. But when you think about who is really taking away your autonomy and authority, it's really the healthcare system around us. It's payer-centered care. It's not that hospitals don't value your expertise. This is also a situation where if you go back at this person like a keyboard cowboy and you're like, you're wrong. All you're going to do is bark at each other like two dogs through a fence.

5:35 This person is talking from emotion. So if we come back with logic, we miss. If we're like, but you're wrong. The person, I'm going to defend them. They're not wrong because they're talking about how they feel. Yeah, and it's been their experience. And it's their experience. And I've consulted with enough hospitals to know that that's not a unique experience right and there is also this conversation too like in in acute care settings are you an interventionalist are you a consultant are you a discharge consultant or are you an interventionalist and i think there's space for both right and i think hospitals might also benefit from dividing their teams and these are the people that make discharge recommendations and these are the people that intervene on the patients that can't discharge And maybe you are a little more effective that way.

6:22 And people get to do what they want a little bit more, but I don't think anybody went to PT school to become a discharge monkey and tell people like, I, I am going to say this patient can discharge or not. Like, that's not, I would say that's not the dream. Right. Of course not. I mean, maybe for some people. I mean, I don't know. Some people. But I would say a majority. Like in the middle of the bell curve, the answer is no. What would you say to this person if they were like in front of you? I think your first move would be you'd wait to let them get all the air out and get all their... That's the smart move, right? But after the person did that, what would a conversation like this person and you look like?

7:04 I think the first question that I would ask, obviously, is just like receiving a patient history. I would say, tell me, like, tell me all about it. Tell me about your experience so I can understand what your experience is, both in the acute care setting and the emergency department setting. And then once, as you said, they like let all the air out and they feel like they've really been heard because they think that's the thing. This person clearly doesn't feel heard, valued, or respected for their expertise. I would ask them, what do you want it to look like? What changed? What would you like, like, what would success look like for you in your current role? And what does it look like? Because right now they would describe it as discharge monkey, which is valid. It sounds like I'm being like real woo-woo, but I'm not.

7:45 I'm just like, okay, to get this person to see something differently, potentially, I have to try to understand what they think they're seeing. Because whatever they think they're seeing, they are seeing. Most likely, you and I both know this, it's the system they're in. We can be mad at a system, but then recognize the system's just made up of a bunch of people who are all in constraints. And they might not have a lot of like, well, I want to blow up the system and change it. It's like the system is people. We're going to all come back together. I understand. But the system is also massive and interconnected. I'm not saying it can't be done. I know it should be done. But that stops so many conversations. This is not a great social media strategy is when someone comments on one of my videos.

8:26 Well, then they need to lower tuition costs. And I was like, who are they and how will they accomplish this by yelling at schools? What do they do? Stand outside the school like from the movie, say anything with a boombox and just stand there until it changes. No, it's not going to work. What would you do? This is when other organizations go, APTA doesn't do it right. I go, how would you do it? I would just accomplish it. Great. How would you do that? No answer. No answer. I would just make them with what? A gun? What would you do? What would you do realistically? And the answer is they don't know. I love when people do lobbying. Like I would love to have just, I've talked to Justin Alley before. I would love, he would never be able to answer my questions.

9:07 He shouldn't. As a media professional, I'll be like, Justin, do not answer my questions. Because I would love to hear what people yell at him. Like, why don't you just do this? And he's like, he's probably thinking, I freaking do do that. Me and a team of people who this is our freaking job and we've been doing it for decades. We do that. or they're like why don't you do this you're like that doesn't that's not the way it works like that's like me yelling at my auto mechanic to blah blah blah it's like that ain't the way it works numb nuts and it's funny that you mentioned that i was interviewed for research studies today about prescriptive authority for physical therapists for imaging labs or imaging image labs and durable medical equipment and one of the questions they asked me were like how did you get that authority and what were the barriers that you had and how did you overcome those barriers And I was like, well, let me tell you.

9:53 I was a member of the APTA. I became the APTA president. Advocacy, working with our lobbyists, testifying with many, many, many, many steps. I didn't stand there and say, physical therapists should have this, and that's that, or be mad about it. So it was interesting to actually have to explain that. But I think for somebody like this, the place that I would start with that is, are you behaving like a discharge monkey? Okay, great. So step one is, what does a discharge monkey mean? Help me understand. Yes, and you can control what you can control, right? Correct. And I talk about top of license, top of facility, and top of scope, and that we have limitations at every single one of those layers.

10:38 But for this patient, let's say they're not able or willing to do anything at the licensure level or even at the facility level. They still have their own scope, right? When you walk into a room, in the acute care setting, are you walking in there bringing discharge monkey energy, or are you bringing comprehensive doctor of physical therapy, patient management energy into that room? It may be, you know, they may be telling you, you have to see this many patients a day. We really need discharge recommendations. That's our focus here and that's okay. But how are you interacting and engaging with that patient? You can still be the discharge monkey and add value to that patient encounter. Yeah, I mean, I've got experience outside PT.

11:22 It's where most of my career was. I could have done the exact same things that I did to, and I'm using air quotes here, be innovative and be energetic and bring good energy. And I could have had a crappy boss and I would have never gotten promoted. I would have been dumped on, not allowed to do things. And I would have been the same person in a different system and got crappy results. And then I would have been jaded and said, the system sucks. I think I lucked out. this person might be or might have been a very optimistic, energetic, let's go change the world in a good way, however I can. And if you're in a system where someone just, I mean, let's be honest, like if you got a crappy boss or you're in a crappy system with no rigidity, I've worked in hospital systems, in communications.

12:06 And I came in there ready to change the world. I was like, look at all these great things that happen at a hospital. This is going to be the easiest and greatest job in the world. All I have to do is tell stories of great people doing great things every day. And then I got slapped with so many rules and constraints that someone like me, I was like, I can't do this. It takes me forty nine steps to tell one story on Facebook. I'm out. I got that way. But I recognize it was the system. I'm like, I just can't operate here. I got to go somewhere else. Well, and that's the thing. So people will come to me and they'll say, well, I really want to practice the top of my scope, but they will let me. So we have that conversation, right? Who is they? Why won't they let you? And what can you do about it? And you can advocate for change within your facility.

12:47 You can advocate for change within your license, but you can also advocate for change within yourself. And if you're not able to bring that expertise, that authority, that energy that you want to the place that you work, You're making the choice to do that every day. Like bottom line. I mean, that's what you can control. And, and I, I know that we, it's more nuanced than that. I know we have golden handcuffs. I know we have to pay off our debt. We have children to support. Like I have three kids. I understand that. But I also know that I've chosen different paths so that I can feel comfortable about what I'm doing so I can advocate for the change and still meet those goals.

13:30 And I know not everyone has the freedom to do that. Yes. So if you don't, I totally respect that. But who are you showing up as? Don't let them take that from you. That should be the one thing you try to hold on to. I mean, I had bad bosses. I had bosses who stole my ideas. I had bosses who just wouldn't let me do anything. And I was just like, okay. I looked, I stole a line from Mr. Rogers was like, that whole line where he says, look for the helpers. He was teaching kids how not to be traumatized in a crazy event. He was like, just focus on the positive. So I would look and they're there. They're the ones that make eye contact with you in a meeting when you brought a good idea or a good idea is said and watch them, even if they don't nod because maybe they can't.

14:15 Their eyebrows go up and they start looking around the room going, who are the... Alan Jetty taught me a term. Is Alan Jetty still the editor of PTJ? He was. I haven't. Anyway, he taught me this phrase. He gave a talk. It was called positive deviance. Yes. So a lot of times people... If I were to describe myself as a deviant, that sounds negative. But deviant just means to deviate. I know it's used a lot of times. Kids are just deviants. They're down there with the skateboards and whatever. It's looked as negative. But when you put that word positive in front of it... Um, it's like, I'm here to shake things up because I want the same things you do, but I have to hold up a mirror a lot of times in projects and meetings to people and be like, you're telling me to do it the same way and expecting a different outcome.

15:08 And we know that's the cliche of cliches. Yeah. So how can we do it differently? And I can give you ten ideas knowing we can only do one. That's okay. I'm the idea machine. You help me pick and then we'll execute. And the problem is sometimes the machine doesn't want to change. Sometimes it's too big. Or it doesn't know how. Or it doesn't know how. That's what I look at myself or I try to be the idea to change Sherpa. Which is like, I don't know the way but I know that there's I just steal. Like, look, look what they did. Look what they did. Could we steal the elements of that that made that successful? Hold on.

15:48 Like, I know like in PT school, everybody loved case studies. They're great, right? Because they're real. And like, look at the elements of a case study. A thirty nine year old woman like, oh, I can I can see that. OK. And she does this and she lives. I loved case study because there are many stories. Right. Right. I love case studies in marketing and communications and ideas and ideation and innovation because it's like, I know we're not Yahoo or Netflix or Amazon, but you can be like, they were faced. I learned one today. I'll teach it to you. This was a while ago. This was years ago. Netflix was getting a lot of complaints early on. They used to be, kids, they used to be a DVD mail service.

16:33 So DVDs were like videos on discs, on coasters. When they went to All Streaming, They were the first streaming platform. You use a remote control to go on the internet on your TV and watch things. And they were receiving their number one complaint was not what movies they had or didn't have or any of those things. It was, you're buffering a lot. I'm in the middle of a movie and it's grainy or it buffers. And Netflix could have done a national ad campaign saying, We don't control your internet speed. It's buffering because Spectrum or Optum or all the different, wherever you live, they're lying to you.

17:17 When you say you're buying your plan at however many gigabytes per minute download, whatever, I don't even know what good is. That isn't the actual speed. They could have done this education campaign where they just pointed and placed, they moved the blame. They didn't do that. Somebody in the room was like, it's not going to work. Great. What should we do? They launched a website called, I think it was called fast.com. And it's similar to like internet speed test.com. Have you ever done internet speed test.com? It's just a way of actually measuring your speed right now in this moment, upload, download speed. So they were like, hey, test this out.

18:00 And then when you got the data, like this was your speed, this is what you need to actually stream a movie reliably without problems we don't offer the streaming so that's okay like they were bringing people to like the two yard line going who's problem who is actually the person screwing you over on watching this movie we're giving you the access you need the person who's bringing you here is the internet service provider the isp So it was a great power play. So my example is like, oh, if we're getting a lot of complaints, let's look at people who solved complaints innovatively. And I think when you're this person and you are probably objectively pretty burnt out and kind of given up on things, I think you're lacking that feeling of power, that lack of the agency, the control.

18:55 And probably there's some moral injury that goes with that too. Because you're not being who you want to be. Yeah, that sucks. That's not the person that's probably going to solve that. But I read a quote this morning that was like, excellence in healthcare comes at a cost. Pay it anyways. What we give doesn't always return, but what we give is always what we are. And that's like the kind of therapist that I want to be. So that's why I feel like when you go into that room whether you're tasked with being a discharge monkey or not do you bring that energy with you or are you bringing the physical therapist energy with you yeah like you can be angry you can be angry about it but are you taking that anger out on your patients yeah right right right right don't become the thing that don't become the thing that you're raging against Rage against the machine didn't say rage against the machine, then become a machine.

19:52 It said rage against it. But like, what are the different ways? It's not throw a brick. And even just like that little act of resistance where you're bringing the best you can into every room, even if you don't have the energy, if you don't have the skill set, you don't have the knowledge of how to advocate within your facility, within your profession, within your state, at the national level, please like advocate within yourself. Yeah. It's going to be frustrating too, because I'm sure like in your role, you've been with, you've been, I mean, now you're APTA Colorado president, but you've done other things. Right. And when you get a bunch of really motivated, passionate people together, who want to do fifty different things a hundred different ways knowing that you can't there are constraints there is bandwidth so you know which problem do you just I mean even deciding which problem to solve is a problem because you're going to make more enemies than friends I used to hate doing contests on the radio here's why Most of our audience, most of the listeners didn't participate for whatever reason.

21:01 They're busy. We surveyed people this. A lot of times they were like, mathematically, I'm not an idiot. I'm not going to win. So you're going to ask me to try something. I'm not going to win. I get it. I was the same way. I didn't always try to actively participate in contests. I mean, I did win one once. What'd you win? I won a signed copy of the Ray soundtrack. Remember that movie with Jamie Foxx? I won that and I won tickets to Evanescence. So I won twice, I guess. I used to love taking phone calls because the phone calls were great payoff, right? Always record the phone call as a radio DJ and then play it back because it's great energy. The person's happy, right? And I used to love, but one of my schticks was because I heard it enough.

21:44 People were like, Oh my God, I can't believe I won. I never won things. And I was like, I would be like, Rebecca, Rebecca. And like, yeah, like you can never say that again ever. Cause you won one thing for the rest of your life. Like play with it. Right. I always, I would also have fun with it. I would push back. So of course we would like Pavlovian dog, have a sound effect, be colored X, be color tan right now. Right. And people would call, Hey, This is the radio station. Who's this? Rebecca. Did I win? I would twist it. I'd be like, what are you calling for? And if you didn't know what the contest was, I clung up on you.

22:28 And that pissed off one person. But I made a hundred friends because they were like, good. I really wanted that. And I didn't win it. And I don't want her to have it because she didn't even know what it was. So that is the way, because I just said, I didn't like doing contests because in contests, you make one friend and ninety nine people get pissed. That math don't math. But I did. I twisted it. And I was like, no, you don't get it because you don't know what it was. You were caller ten and you can take this up with our lawyers. No one did. But I would have fun with it. I would also say, I'm going to ask for caller ten. You better know what you're trying to win. Just tell me. You don't have to be like, exactly. You're just like, oh, the tickets for the evidence. Got it. Yeah, you pay attention.

23:09 But if you didn't, I push back. That was a way of like me sort of combating the people listening going, I never win. They were okay with not winning as long as someone who in their eyes didn't deserve it didn't win either. Sometimes you win by losing. So whose job is it to talk to this guy at a hospital and be like, hey, man, tomorrow you're not working. We're going to pay you. You're coming to work. We're going to go hang out. And I need to listen to you and figure out how to get you back on our team. Is there a job for that? What job is that? I want that job.

23:49 Well, I think that I would love that job. I wish I could be a guidance counselor for physical therapists. Guidance counselors for companies. Yeah. Isn't that a job? I mean, HR, isn't that HR? I don't think so. Cause I think HR is all defense, right? They just work for the company. It's like defense and procedure, right? Like, I don't know that it's investment. Like there has to be like a human assets department, like a development department. Like, and I think, I think then you get into that like rabbit hole of management or leadership, right? you have a management team or do you have a leadership team right totally different and i think unfortunately the way most companies i don't just even want to throw hospitals under the bus most companies are set up to have supervisors and managers not like leaders and leaders also don't necessarily make good managers right so i feel like you have to have some combination of both but i feel like this is where your leadership maybe not your managers, have to step in and help lead people through.

24:56 But I don't think there is a job for that. I think that the organization would have to be big enough to financially afford that and then allow that person to... Invest in people. Invest in people. Did you ever hear of a story from Zappos? You know what Zappos is, right? It's like an online shoe store. And people were... People were like, to Jeff Bezos, when he launched Amazon, when he was just going to sell books, they were like, that is the dumbest idea ever. Who's going to buy a book online? And then you go to like, I know, me too. And then you go to shoes and people are like, you have to try shoes on. You have to walk around. Do you remember before the first day of school, how important it was to try it on?

25:38 And your mom was like, walk around in it. And then everyone's like watching you walk around. You're like, yeah, they're new shoes. Yeah. I don't know. Like, what am I supposed to feel? Anyway, I digress. So then someone launches Zappos.com and they're like, that's not going to work because shoes are all about touching the shoes and putting them on and feeling them. They had a problem with complaints. And the guy who launched Zappos was one guy. And then it was two people. And then it was All complaints went through this guy. Someone's going to Google the name of the CEO or whatever who came up with it. The Jeff Bezos of Zappos. And he realized he was handling every complaint because in his mind, he was like, I want to touch every complaint.

26:24 Good idea, but... bad execution because there were so many. You're an online retailer. And then the longer someone's complaint takes to get solved, the more pissed they are. You can't blame them, right? It's like an ounce of prevention, pound of cure. But that ounce of prevention needed to come in the first And I forget the exact dollar amount, but it was like, if you're taking the complaint, if you're John Smith on the phone at Zappos, And it's your complaint to handle. And the solution to make this person happy is less than two hundred dollars.

27:09 Just solve it. Just do it. Just write in the computer. This guy had a legit complaint. It was this and this. And I just gave him a two hundred dollar credit. And the guy was thrilled. And he was like, the time it took. was worth just solving it. Yeah. That's why like sometimes if you order like furniture is a big one. If you order something with furniture... And there's a problem with it. And you can prove it with a picture. And this is where also people start scamming the system. But a lot of times, they'll just be like, keep it. We'll send you a new one. And now you have a slightly damaged whatever. That's why you see them on Facebook. My buddy, you see them on Facebook Marketplace a lot. Because people are like, I don't know. Wayfair sent me a hot... My buddy's neighbor bought a nine thousand dollar hot tub or something crazy on Wayfair.

27:55 And there was a giant scratch in it. And no offense, but like... I dropped nine grand. I want the version without the scratch in it. Right. So they were like, we'll send you a new one. And he's like, what do I do with the old one? They're like, it's your problem now. He gave it to my buddy. He was like, do you want this? And my buddy was like, yes. And he's like, there's a scratch in it. And he goes, I don't care. But somewhere along the line, someone did the math and was like, I need that guy to be happy because that guy's, if he's dropping nine grand on a hot tub, his lifetime value of products is more than nine grand. Make him happy. How much does it cost to ship the first one back? Ship a new one. We already had to ship the second one. What do we do with the first one?

28:35 And then we ship it back? What are we going to do with it? I need to warehouse that. Now it's going to sit here. Now it's damaged. It's like, dude, deal with it. Well, and I think one thing that you point out really well and often, especially about communications, is that nobody owns it. Nobody owns that. And I think that's the same problem with this therapist, right? Like, the people making the decisions about how they will implement and utilize physical therapists are not taking any responsibility for that impact on that therapist, on how that impacts them, on how that impacts morale, because their job is not to advance physical therapy. Their job is to advance the mission of the hospital in the healthcare context that it exists in.

29:19 So there isn't anybody who is responsible for making sure that their therapists are feeling like They're well utilized, that they're competent and taken care of and practicing at the top of their scope. Like no one owns that. So when you say whose job is that? Nobody's. Nobody's. There's a hole there. And it's going to be a very expensive hole for a shortage. Good. But Rebecca, hiring someone just for that job? How will they ever meet their productivity? Well, not even that. Like we're going to pay someone to do this job that should just not be a problem. Sorry, it is. And then we can't pay for that. I would push back and go, you are.

30:01 It's just hidden in your P&L. And it's because you hired someone and they stuck around for two years and left. And now you had a vacancy for a year and you didn't fill it. And now you burn the rest of your staff out because they had to fill in because that's what people with a Peace Corps gene do. And we appreciate that. So we take advantage of it. You're paying for it, whether you're doing it or not. Well, statistically, presenteeism is worse than absenteeism. Wait, what is presenteeism? Presenteeism, you might have to look up the exact definition. I learned this from a course that I took with Mike Eisenhardt. Presenteeism is that person that shows up to work every day with that attitude. Which with, with which attitude?

30:41 Like the discharge monkey attitude. It doesn't matter. Like that, that person, the person who's like present, but pulling everybody down with them. They're like the vacuum in the room. The person's going to ruin it. Even if their stats, even if like their output was great, they're net negative by a lot. Cause they're going to make a lot of good people leave. And you would rather have that person not come to work. Yeah. Work every day and be this like net drag. Right. So they found that people who go to work like that just they just drain the system. And so if you're looking at like physical there to work with, like direct to employer type services will focus on those folks.

31:23 Right. They'll focus on the absentee folks too, right? Like, is that a health condition? But they're going to focus on all of those people to help bring them back to the pack, right? And make sure that everybody's attitude is better. But do you work on keeping everybody happy or do you have to focus on those people that are really causing the problem? Are you a hockey fan or are you a baseball fan? Are you a hockey fan at all? I'm a baseball fan. All right, so there is a stat for this in baseball. It's called WAR, W-A-R, Wins Above Replacement. I'm a baseball fan too, and I can't understand WAR. The idea is, as a right fielder, how are you compared to other right fielders? When you're in the game, do you do the intangibles well that never before showed up on the stat sheet?

32:08 It's a little easier to explain in hockey. Even not a hockey fan, you'll get this. So how do you get things in the back of your hockey card? Goals, assists, penalty minutes, time on the ice, how much you work. Those are easier to measure, right? Then they come up with this statistic called plus-minus. So let's say I'm on the ice and I actually... So the way to get an assist is I pass it to you and you score. I get an assist. Another way would be I pass it to Steve. Steve passes it to you. You get a goal. Steve gets an assist. I get an assist. But there's a lot of stuff going on on a hockey rink That isn't just that.

32:53 Like maybe I needed to dig the puck out of the corner of my own zone, then pass it to Steve, then Mike, then Rebecca. She scores. I got nothing on that. That's okay, but that's a thing. Or the guy who is always really good at communicating. But how do you put that on a stat sheet? So they came up with plus minus, which is when a goal is scored, the person in the booth and stats just writes everybody's name down who was on the ice. And that's a plus one. When a goal is scored against us, who is on the ice? That's a minus one. And just like a running count, if you're card counting in blackjack, what's the running count on Jimmy? Yeah.

33:34 Man, every time Jimmy steps on the ice, we get scored on. But we don't measure that because... I didn't get a goal. The goalie gets a goal against her or him because they're the goalie, but I'm just a forward. But it is my responsibility to guard my guy. And when I'm out there, I just sort of don't. And then that leads to a pass, which leads to a goal. So the answer was plus minus. So you want to be as plus as possible, which is like we get scored on as little as possible. We score as much as possible. It's an imperfect way of measuring the intangibles. That's hard to do in business. It is. Where would you do that? That's not a net promoter score.

34:15 It's not NPS. I also would love to see outcomes for people who feel like that, for those therapists who are really burned out and aren't bringing that energy into the room with them. Are you delaying people's discharge because you're not intervening the way that you should? Are your patients more hesitant to go home because they're Your attitude does not inspire confidence. Do your patients need home health more often? Are the home health therapists like, why is this patient in this bad of shape coming home? Are you discharging more people to rehab than home with an assistive device? What do your outcomes look like compared to people who are operating positively within their scope as opposed to walking into every room being like i'm just here to just make a trash recommendation and then leave i mean there was a guy who had the same job as me in radio there were four radio stations in one building all owned by the same company right and a guy ran a country station his office was next to mine and he was sort of an eeyore So I got told one day on a Tuesday that I had to go home and come back the next day and fire someone from my staff.

35:32 Have I told you this story before? I had to go home, Jimmy. You have to come home tomorrow, come back to work tomorrow. And my boss was like, tell me who to fire. It's your job. You're the boss. You get to get handed the trophies when you win. And then you got to do the bad work. So I went home, had a couple of Chardonnays because I was pissed. None of my people did anything wrong. They were all on the plus side and the plus minus. They were hard work. But I had to fire one of them because numbers. And that's a reality. So I went home and I thought about it similarly to how we're thinking about this. But I didn't think about it from my... particular small radio stations point of view. I thought about it from the entire building.

36:12 So four radio stations. And I was like, this guy over here is a, this he's a net negative guy. And he makes more money than my people. And the station he's running isn't performing well because of, I mean, my extrapolation because of his attitude, this guy could, you know, so I went back in the next morning, a little hungover and I said, Hey boss, I got a crazy idea. And he was used to me saying that. And he's like, Jimmy, this is not the time for a crazy idea. This is the time for an, I need an answer, dude. And I was like, I have an answer that is going to give you an answer that You're going to save more money and you're going to give me a raise.

36:54 And he was like, oh, I can't wait to hear this. And I was like, and I just made my case. I'm like, you got a guy over here running an entire radio station. And we both know He ain't going to get it done. And it's nothing he's doing. It's who he is. He's an Eeyore. And you can't out Eeyore this guy. And I was like, you're going to fire him. I'm going to take over his radio station. This was a country radio station. I knew nothing about country. And I said that, Bill, you know me. I'm a rock guy. I know nothing about country. He goes, yeah. How are you going to get around that? There's a staff on that radio station that knows all about country. I know how to work with people and be creative. I also know how to listen to people. So I'm going to do that guy's job.

37:35 You're going to save money because you're going to hire, you're going to fire another manager. You asked me to follow, you know, fire one of my people. He makes more money than them. You're going to give me a little bit of that money because now I'm going to do two jobs and net positive, we will, the team will be stronger for it. You're going to fire a good person and let a net negative person, what do you call them again? Like a... presentism you let that person stick around and when i made the case he was like you're right by five o'clock that day i was running two radio stations and someone was like sorry but i protected my people they did nothing wrong they were all plus plus minus people and you were a minus plus minus person and i want plus plus minus people and we would have been net negative if i hadn't pulled that move and i will do it ten times out of ten that's how i got my second radio station And I think, I think the question that people are probably asking if they are in management is how do I screen for those people to keep them onto our team?

38:37 How do I avoid the conversion from a positive to a negative? Because I think that's a big one. Yeah. Cause everybody, yeah. No one shows up to be that right. And it does happen and it happens a lot and I see it and I see it everywhere in our profession, right? You just have to look at social media comments. Like, i tell people not to become a physical therapist because of x y like you're poisoning the well before they even got in the water right like why are we not making the profession better why are we just like i think what they're with i mean they're i mean a psychologist would say they're projecting right yeah and i've made videos i will not talk out of both sides of my mouth i am pissed off at the math because math don't care about vibes totally So I would like to change the system as well.

39:27 But yes, I agree with that. I mean, I put a comment every day that got... Someone asked about, should I become a PT? And I was like, do the math. If you really want to do this and you understand what it costs and you still go with it, great. Go with God. Knock yourself out. But like someone said, schools should do a better job educating. And I'm like, my man, they gave you the papers. All the numbers were in there. You're not looking at them as your fault. So I'm not saying don't pay back the loans or any of those things. I'm saying let's change that because this sucks. And down the line, we're going to have less good people on our team. And that's going to screw everybody.

40:09 So I'm not saying let's just erase it and say, ah, you made a bad move. Let's change the whole damn thing because it's not good. Never mind fair or equitable. It's deeper. It's not good for the system, for the person, for the people, for the organization. It's not good. So if something's not good, I thought we were supposed to be able to change it. And here's the problem. The parts of the system that make the decisions for not good, I'll talk to them. They're not listening to my podcast. I could talk about them for months. The people who decide what PT programs cost, from my understanding, I talk to people. It's not the professors, guys. Trust me.

40:49 They are not rolling in cash. I'm not saying they're not making money. They should be. They have a ton of experience and do a great job. It is not the chairs of the department. It is not the deans. people you've never met who are doing jobs that you have no idea. It's those people. They're not listening to you. They're not. That's probably their problem, but they are not incentivized to make you happy. They win the minute you apply and sign and someone gets paid. So how to fix it? I'm not saying I know how, but you're yelling at the wrong person. You're mad at the wrong people. It's also like saying that the APTA is somehow like in a hundred percent control of what we get paid.

41:29 Correct. I'm not saying you're not. You're yawning at the wrong people. Like they're doing the things, but you need to take all that energy and take it to where those decisions are made. And then talk is doing that. Right. And then talk to them in a language that they can understand. Listen, they know what they're doing. Right. They know what they're doing. There's just no reason for them not to do it. Oh, we should stop applying. And I go, would you have stopped applying? No. You wouldn't have. It will not change until the pain of inaction is greater than the pain of action. Did I do that right? Yeah. The pain of inaction is greater than. That's the only reason you get off the couch because you feel an internal pain that staying here hurts more than what it does when I just got to go run a couple of miles.

42:15 There's no reason for them to lower costs. This whole thing with the unprofessional Malone's thing, it's not going to change it. Not going to change cost. It will screw people because they won't be able to... It'll change who is able to apply from the smart people that I've talked to. I would love when people are in my DMs going, but, but, but... If there are forty seats at a program, as long as there's forty-one qualified applicants... Ta-da! There's no change. You need to have six applicants at most for five years before it would change. And I'm making up numbers, but you get what I mean. You need to be bleeding before you call the ambulance. It's not going to happen.

42:56 It's just like PT payment, right? PTs have been taking the payment the way that it is for so long. Why on earth would insurance companies suddenly be like, you know what? We were wrong. Correct. Let's pay you more money. The other way too, hey, we're taking jobs at salaries we shouldn't do. And you're saying we should unionize. And I'm going, great. Are you any good at organizing people? Yeah. I'm not saying don't do it. I'm saying the likelihood of that happening is low. Yes. I would love to be wrong here though. I would love to be. Maybe that is the only way. I don't know it. But being mad at the wrong people, it's a real waste of energy.

43:39 I don't blame them. I don't either. I don't blame them. We're measuring the wrong things. I don't know. It's easier to be wrong or being angry at a group of people or a perceived person in the entire system because if you're mad at the system, it feels too big to solve. Who gets yelled at when you don't like what a PT program is doing? The chair and the professors. They are not the ones setting the prices. My friends, if they were, they'd be setting their own salaries and trust me, they'd be higher. Like it's just not, it's not it. You're not wrong for being mad.

44:20 You're just yelling at the wrong thing. In my opinion, this is just everything here is my opinion. All right. So to make this tactical, let's say you did work for this person that we started this whole conversation around with. You work and you are in a position of leadership, not management, but management and or let's say leadership. What would you do? I would want to hear everything. Say it. Like, no holds barred. Like, this will not reflect poorly on you on your performance evaluation. This will not be held against you. Like, tell me everything. Tell me. Like, lay it on me. I even want to hear your personal stuff, too.

45:02 Because maybe this person is under a lot of personal duress as well. Like, they have a health problem. They aren't making enough money for their family. They've had to pick up a second job. Like, I want to hear all of it. I want to hear why they wanted to be a PT. I want to hear why they're still a PT. I want to know why they feel the way they feel. And I just want to receive all that. I think that's step one, right? Just receiving all of it, not telling them, not explaining, not defending. Well, the hospital had to make this decision because I was like, we're not doing that today. We're just receiving all of that. What do you love about this job? I want to hear all of that too. Like, why did you take this job? Why are you still at this job? What would make this job feel worth it to you again?

45:42 And then like that stretch goal too, like what would make this job magical to you? Like what would make this job someplace that you wanted to be every day? And if you can't see a path to that, like if there's like nothing, if you're, if your answer is nothing, it's never going to be like, I don't. Then maybe we just be done. Maybe it's time for you to look for something else. Like, because I'm fully receptive to hearing from you, like what it would take to get you back on the horse. I want to get you back on the unicorn, but. If you can't see a path to that, I can't even meet you halfway. So I'm probably going to decrease my investment in you because you've decreased your investment in the organization.

46:25 And realistically, if you're bringing that energy into rooms, you've decreased your investment in your patients. And maybe at this point, you're a little bit of a liability. I don't know that for sure. I'm not like if I felt like I was in the hole that deeply, I would be worried about my ability to provide care. Yeah. So I would start there. Oprah said people want to be seen, heard, and understood. Yes. That's where I would start. And if there's the movie Jersey up in the air with George Clooney and Anna Kendrick. Yeah. Where they fire everybody. Well, their job is to be brought in and he had the one who's the guy from the drumming movie. Um, the guy that was in Top Gun too. No, J.K.

47:05 Simmons, the drumming instructor. Yeah. Not Miles Teller. So anyway, George Clooney is firing Miles Teller in this scene. It's a great scene. And of course, like J.K., is pissed his character jk simmons characters piss and he's like who are you you know f you and clooney and of course it's a movie guys i get it but he turns it into a story he read that guy's whole file before he brought him in to fire him whole file and jk simmons is in his fifties or sixties or whatever in this scene and he's essentially he's framing this as like a rebirth and he's like The whole pitch is he saw in the guy's file that he studied French culinary arts in college.

47:51 Like, that's not a gimme major. Like, that's hard. And, like, you're not going to make a billion dollars doing that, right? So he's like, and he's like, and you waited tables at El Picador. Like, he read the guy's file. And now he's in, like, some cubicle. And he's like, and his question was, how much did they pay you to give up on your dream? Ooh. And he was like, thirty eight thousand dollars in health insurance. And he's like, I'm not he's like, this is happening. But he's like, your next step is your choice to make. And you lose your job. It's not softening the blow, but at least it's at least saying like you could go find another one of these jobs and this could happen again.

48:36 And also you hate it here. Why aren't you in a kitchen? You wanted to be in that kitchen. And you made the smart move of getting a reliable job with four Oh one K and health insurance. I get it. But he made the guy look at himself. Cause you could be mad at the company or the machine or the world. And that isn't going to change it. But you reframing how you're going to look at it is the only, it sucks. You can control what you can control, but you can control it. So that was a great, I thought a great scene from that movie. Cause at least Clooney's character was like, Can you imagine? I couldn't do that job. The guy where you just fire everybody. Although someone's going to do it.

49:16 Someone's going to do it. It's happened. That was one of the lines. This is happening. But it showed he actually took the time because people want to be seen, heard, and understood, according to our friend Oprah. That's probably why she was pretty successful. To do that with that guy and the idea there is his character is now going to leave and inhale exhale while he takes his stuff to his car in a cardboard box and go what do i got twenty more years man what do i want to do go do that yeah go do that all right parting shots what do you got parting shots i think my parting shot is is to this therapist and in any therapist that feels like this we don't want to lose you like so Figure out what it would take for you to get back on the unicorn.

50:06 And if PT is not it, I get that. If it's the place where you work, I get that. But advocate within yourself, advocate within your facility and advocate within your profession. And if that feels like too much, then let it go. But we want you. We want you in this profession. And so do the best that you can. Control what you can control, which is what you bring to your job, what you bring to your patients every day. If I repeat it a couple times, it probably has to be a parting shot, which is people want to be seen, heard, and understood. I ain't magic. When I was a boss in radio, I didn't have a lot of levers I could pull. But I learned from my dad, who was a fireman. He was like, when you get promoted, you work for them.

50:46 You work for the people you oversee. So my job was like, how are you? And I can't be like, here's a bucket load more money. That wasn't an option. So how else can we creatively make this place something that you want to do again? Because supposedly when you came here to work, you wanted to do this. So people want to be seen, heard, and understood. Find Rebecca online, website. BDDPT.com. And we'll talk again soon. I think we need an actual official name for your recurring segment. I don't want to use AI to get it. I want it to be au natural. Maybe, but I will take comments or suggestions from someone watching or listening, but we'll be back next week with Rebecca.

51:30 That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode. Want to go deeper? Hit us at pgpinecast.com or find us on YouTube and socials at pgpinecast. And legally, none of this was advice. It's for entertainment purposes only. See, Keith? We read the script. Happy now?