June 26, 2024

First Day Jitters: Balancing New Grad Expectations and Patient Load

Show Notes
Transcript

In this episode of PT Pintcast, we dive into the challenges new graduate physical therapists face on their first day on the job. Join us as we discuss the expectations, realities, and coping strategies for managing patient load and integrating into clinic culture.

Main Topic/Theme:

Navigating the challenges faced by new grad physical therapists on their first day, including managing patient load and understanding clinic culture.

Key Points Discussed:

Balancing the expectations of being a licensed therapist versus being a new graduate.
Strategies for handling multiple new patient evaluations on the first day.
The importance of understanding and fitting into the clinic's culture.
Real-life examples and experiences from seasoned physical therapists.
Potential solutions for burnout and job dissatisfaction among physical therapists.

Special Guests:

Tony Maritato, PT
Dave Kittel, PT

HOT QUOTES

"If you're not ready to treat patients on day one, but you want full pay on day one, we need to figure this out."

"The better you educate someone, the better they're going to perform in the beginning anyway."

"Find a problem that everybody's looking at and saying, 'not my problem,' and solve that problem."

WEBVTT

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and there we are we're live

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breakfast uh club pt pt

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breakfast club no matter

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which way you say it which

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I always uh he's tony

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maritato I'm jim mckay it

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is bright and early on

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tuesday morning and we're

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waiting for dave kittel

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because that's how things

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work and that kind of fun

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where you can just

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essentially broadcast a tv

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show from our living rooms

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and dave will just join whenever

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It's just incredible.

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Now, for people watching,

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I thought this would be interesting.

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Dave and I were talking.

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He's coming in in a minute.

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This is a webcam.

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So this is the Brio.

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Yeah, this is the Brio 4K.

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I don't know if I'm just not

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using it right or I just

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feel like the image is terrible.

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My DSLR is with my oldest boy.

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He's doing a bunch of

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footage for a theater camp.

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But I figured I'd show Dave.

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We can bring him in whenever you want,

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Jimmy.

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I figured I'd show Dave, like,

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this is what the Brio 4K

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looks like compared to my normal,

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you know, like it's a deep focal length.

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Like everything's in focus.

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You don't have the rich

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colors and it's just not

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nearly what it's like with the DSLR.

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Yeah.

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If you ask yourself,

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is the juice worth the squeeze?

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You don't need to spend $10,000.

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You don't even really even

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need to spend a thousand dollars.

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But if you spend a couple hundred,

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the difference between a 99, well,

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how much is the Brio?

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The Brio is like a hundred bucks, right?

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uh yeah I think it went up

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to like 120 but this is

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actually interesting so

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jimmy you're on a dslr

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right right so you've got

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jimmy on the dslr I'm on

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the brio dave's on the

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webcam on the like laptop webcam so

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It makes a difference,

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especially if you're going

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to use it a bunch of times,

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if you're going to use it more than once.

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And we can get into if

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you're going to use it with telehealth,

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if you're going to use it

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with shooting content or

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live streaming and doing it.

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There's a minimum.

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There's a floor,

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Dr. Bose saying top of the morning.

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What do you want to start with?

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You want to start with my topic?

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I came across this online

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and this was someone we

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actually from an

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organization we just talked to.

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We talked to Pedro,

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Dr. Pedro from Prediction Health.

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And then this is how it works.

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I, of course,

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on LinkedIn and follow

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prediction health because I was like,

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I don't know, Pedro seems cool.

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And they released this

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article written by their director,

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their VP of business development,

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who I don't know.

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But now I come across their

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article because I start

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following the organization.

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This is Andrew Schaefer.

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And Andrew essentially

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breaks down what it costs

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to lose a therapist.

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He actually brings the receipts,

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which I like.

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So we're diving in deep to this topic,

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I thought.

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He went really,

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really deep to show like we all know like,

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well, yeah, losing a therapist,

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you're not going to be able

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to bill as much.

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You're down one licensed therapist.

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But he went deeper into the

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costs to actually give it

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an objective measure.

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And I think he really,

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really – I would love your

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thoughts because both of you do this,

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and I just watch from the sidelines –

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He was estimated $65,000 per

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therapist departure.

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Before we get into his receipts,

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is his number low, pretty close, or high?

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I mean, I hear, you know,

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everybody will tell you

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it's more expensive to have

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high turnover than it is to

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keep an employee.

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And they'll tell you that if

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somebody is going to leave

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and they're a good employee,

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you're better off to pay

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them more money and just

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keep them on board.

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Um, but I think like most things, right,

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we're physical therapists.

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It depends.

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That's the saying, uh,

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I'm going to share my

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experience on how I used to

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optimize my business for high turnover.

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I would not expect somebody to be with me.

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You wanted high turnover.

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That's what you just said.

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You optimize for high turnover.

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Okay.

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Yeah.

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Go for it.

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So here's the thing.

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Going into physical therapy

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as a business 20 plus years ago,

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I realized if I wanted the

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best people on my team,

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they were not going to be

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satisfied being the same

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person doing the same thing

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for a 20-year career.

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They weren't widget makers.

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They're not going to just come in,

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clock in, clock out.

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Those are not the best people.

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The best people have high ambitions.

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The best people are expecting to grow.

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In fact...

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Dave, you would know this Ben Galen.

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Is that his last name?

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Yes, Ben.

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Yeah,

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so I was on office hours with Ben

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recently,

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and Ben and I had very opposing views.

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And I mean,

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I can't even compare to Ben's success,

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so I don't want to pretend

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that I'm on the same level.

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But I had said something

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regarding kind of the

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employees running the ship instead of me,

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the captain, running the ship.

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And he had an opposite view.

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And I think it's totally legitimate.

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So from my perspective,

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and this is a theme that

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carries through my entire life,

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Um, I don't,

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I'll take on a battle if I

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think the reward is worth it,

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but most of the time I'm

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not looking for battles.

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I'm not looking for friction.

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I'm going to take the easy route.

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And so when I recruit a therapist,

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if I think it's an amazing therapist,

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I know that their life with

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me is very short because

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they're going to move on to

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bigger and greater things.

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And if I start a business,

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Dave and I talked about it,

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I'm starting the business

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with the exit strategy in mind.

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Everything is about kind of

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building to an end.

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And so for me, when I optimize,

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I'm planning on that person leaving,

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hopefully not before 18 months,

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but probably not staying

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with me longer than three years.

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So I think my cost,

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cost of turnover is very low,

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because I know what's coming.

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I know where I'm going.

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But if I'm blindsided and I

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think this is going to be a

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20 year clinician and I put

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all my eggs in that basket

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and I'm not recruiting and

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I'm not planning,

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I'm not looking for new opportunities.

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Yeah, you're going to get crushed.

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Somebody is going to quit.

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Then they're going to walk out the door.

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Then you're going to have a month,

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two months,

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three months of low productivity.

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You're going to miss out on

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patient visits.

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You're going to have recruiting costs.

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You're going to pay a

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premium for probably

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somebody who's not even

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worth the premium.

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Um,

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so I understand where the article is

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going,

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but I think if we're in this world

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and we think we're going to

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recruit the best clinicians,

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if Dave wants to come work for me,

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Jimmy was going to come work for me.

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I can't expect guys like

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that to stay with me for a

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40 year career.

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There's no growth.

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There's no longterm.

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Go ahead.

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It sounds as if I'm going to

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use a analogy metaphor.

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I don't know.

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Someone will check me on that.

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It sounds like you're

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preparing yourself to be a really,

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really good AAA baseball team.

00:06:54.656 --> 00:06:55.257
You're like, hey,

00:06:55.276 --> 00:06:57.420
I want the best players on their way up,

00:06:57.860 --> 00:06:58.360
hoping,

00:06:58.622 --> 00:07:00.103
knowing that the really great ones

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are hopefully going to leave.

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And then maybe you'll wash

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the rest of them out and

00:07:05.036 --> 00:07:05.576
send them off to a

00:07:05.617 --> 00:07:06.757
different team or drop them

00:07:06.797 --> 00:07:07.817
down to double A. But

00:07:07.836 --> 00:07:09.096
you're optimizing for this.

00:07:09.237 --> 00:07:10.677
So what did you do to optimize for it?

00:07:10.718 --> 00:07:12.177
So you built in failure,

00:07:12.338 --> 00:07:13.278
which I think is probably

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more realistic than I'm

00:07:14.759 --> 00:07:16.038
going to find the best four

00:07:16.059 --> 00:07:17.178
therapists in my area.

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I'm going to provide the

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greatest working environment ever,

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and they're going to stay forever.

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And that, to be honest,

00:07:24.180 --> 00:07:25.721
that one sounds just insane

00:07:25.961 --> 00:07:26.641
to even suggest.

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So how did you optimize for

00:07:28.541 --> 00:07:29.961
knowing that these people

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were going to leave?

00:07:32.127 --> 00:07:32.447
it was,

00:07:32.627 --> 00:07:34.127
it's different based on the phase

00:07:34.168 --> 00:07:34.728
of the business.

00:07:34.767 --> 00:07:36.427
So at one point in the business,

00:07:36.567 --> 00:07:38.247
I was looking at, you know,

00:07:38.348 --> 00:07:40.069
negotiating things that

00:07:40.269 --> 00:07:42.288
were not 20 year thing.

00:07:42.348 --> 00:07:43.790
So if somebody wanted more

00:07:43.829 --> 00:07:44.970
time off and less pay,

00:07:45.329 --> 00:07:46.089
I can provide that.

00:07:46.629 --> 00:07:48.771
If somebody wanted exposure,

00:07:48.831 --> 00:07:49.850
so they wanted to get on

00:07:49.891 --> 00:07:50.730
social media and they

00:07:50.750 --> 00:07:52.031
wanted to use my platform,

00:07:52.230 --> 00:07:53.031
I could provide that

00:07:53.151 --> 00:07:55.391
knowing that I'm creating a

00:07:55.432 --> 00:07:56.591
personal brand for them to

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then leverage on their own.

00:07:58.052 --> 00:07:58.093
Um,

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But also just in terms of compensation,

00:08:02.074 --> 00:08:02.334
you know,

00:08:02.375 --> 00:08:03.735
like I might be able to start

00:08:03.776 --> 00:08:05.958
somebody at a higher initial compensation,

00:08:06.057 --> 00:08:07.639
knowing that I'm not

00:08:07.699 --> 00:08:08.620
starting at one hundred

00:08:08.660 --> 00:08:10.422
thousand getting to one twenty.

00:08:10.442 --> 00:08:12.023
I'm starting at one hundred

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thousand and they're going

00:08:13.264 --> 00:08:14.464
to leave in two years.

00:08:14.605 --> 00:08:14.925
That's OK.

00:08:15.925 --> 00:08:17.567
But I'm going to do what I

00:08:17.608 --> 00:08:18.970
need to do for the business,

00:08:19.009 --> 00:08:21.112
for that person to make

00:08:21.172 --> 00:08:22.653
everything work using the

00:08:22.694 --> 00:08:23.595
baseball analogy.

00:08:23.634 --> 00:08:24.855
And this will turn over to

00:08:24.896 --> 00:08:25.716
Dave in a second.

00:08:26.918 --> 00:08:27.959
I'm not going to recruit a

00:08:28.158 --> 00:08:30.622
pitcher and make him play left field.

00:08:31.262 --> 00:08:33.304
I understand what the role

00:08:33.345 --> 00:08:34.265
of that person is.

00:08:34.365 --> 00:08:34.586
Now...

00:08:35.711 --> 00:08:37.172
Full 180 degrees.

00:08:37.392 --> 00:08:39.753
My team today is the team.

00:08:40.293 --> 00:08:41.774
They're going to die on the ship.

00:08:41.833 --> 00:08:43.154
They're going to stay with me.

00:08:43.195 --> 00:08:45.035
They've been with me over 11 years.

00:08:45.096 --> 00:08:46.256
They're not going anywhere.

00:08:46.517 --> 00:08:47.477
Some is family.

00:08:47.577 --> 00:08:49.818
Some are close relations now.

00:08:50.379 --> 00:08:51.799
When they leave, I'm done.

00:08:52.059 --> 00:08:52.681
I'm out.

00:08:52.780 --> 00:08:54.201
I'm not staying in business.

00:08:54.261 --> 00:08:56.182
I'm not replacing them with new employees.

00:08:57.403 --> 00:09:00.283
So like everything, business has changed,

00:09:00.403 --> 00:09:02.403
philosophy has changed, my ideas changed.

00:09:02.423 --> 00:09:03.043
But in the beginning,

00:09:03.484 --> 00:09:05.144
I did build and I remember

00:09:05.184 --> 00:09:06.524
distinctly talking to new

00:09:06.565 --> 00:09:08.264
grads that I was hiring saying, look,

00:09:08.585 --> 00:09:09.926
this is not your job for

00:09:09.946 --> 00:09:10.785
the next 40 years.

00:09:11.385 --> 00:09:13.265
I hope to get your best two

00:09:13.306 --> 00:09:14.005
or three years.

00:09:14.626 --> 00:09:16.287
And then you grow, then you improve,

00:09:16.307 --> 00:09:17.726
then you move on to the next job.

00:09:20.508 --> 00:09:21.488
Dave, you're up in the batting order.

00:09:22.284 --> 00:09:24.265
yeah so recently um there

00:09:24.285 --> 00:09:24.966
was also something that

00:09:24.986 --> 00:09:26.827
came out from uh ben fong

00:09:26.888 --> 00:09:28.149
with updoc media and it was

00:09:28.188 --> 00:09:29.389
similar to this uh this

00:09:29.450 --> 00:09:31.051
write-up and the

00:09:31.150 --> 00:09:32.672
replacement timeline was

00:09:32.711 --> 00:09:33.672
something around six to

00:09:33.711 --> 00:09:34.913
eight months you know per

00:09:35.092 --> 00:09:35.994
per therapist so you look

00:09:36.014 --> 00:09:37.014
at the timeline which is

00:09:37.094 --> 00:09:38.294
significant you look at

00:09:38.315 --> 00:09:39.436
this dollar amount which is

00:09:39.596 --> 00:09:40.976
you know a pretty you know

00:09:40.996 --> 00:09:43.057
big chunk of change um but

00:09:43.097 --> 00:09:43.999
at the end of the day like

00:09:44.198 --> 00:09:45.879
this is also like just to

00:09:45.919 --> 00:09:47.280
pause for a second like this is

00:09:48.061 --> 00:09:49.322
This goes on in every industry.

00:09:49.642 --> 00:09:50.923
This is no different now

00:09:51.004 --> 00:09:52.664
than any other time in physical therapy.

00:09:53.686 --> 00:09:54.767
And here's an example.

00:09:54.846 --> 00:09:56.248
So like when I came into

00:09:56.288 --> 00:09:57.308
Brooklyn from New Jersey,

00:09:57.749 --> 00:09:58.850
I was a clinic director for

00:09:59.311 --> 00:09:59.990
Metro Sportsman.

00:10:00.051 --> 00:10:00.851
It became motion.

00:10:02.413 --> 00:10:04.095
I eventually left to go do my own thing.

00:10:04.154 --> 00:10:04.355
Right.

00:10:05.155 --> 00:10:07.216
And then the next person,

00:10:07.277 --> 00:10:08.038
the next therapist that

00:10:08.057 --> 00:10:09.519
came in after me was a

00:10:09.558 --> 00:10:10.519
staff physical therapist

00:10:10.539 --> 00:10:11.100
somewhere else in the

00:10:11.140 --> 00:10:13.062
company that moved over to that location.

00:10:13.883 --> 00:10:14.663
And then that physical

00:10:14.703 --> 00:10:15.605
therapist left to go.

00:10:15.664 --> 00:10:16.706
And now I think he's in like

00:10:16.726 --> 00:10:17.607
Texas or some other state,

00:10:17.628 --> 00:10:18.889
but he left also to go do

00:10:18.909 --> 00:10:20.230
his own business and his own practice.

00:10:20.871 --> 00:10:22.354
And so this is something

00:10:22.413 --> 00:10:23.475
that organizations just

00:10:23.514 --> 00:10:25.017
have to understand.

00:10:25.116 --> 00:10:25.798
And most of them that are

00:10:25.957 --> 00:10:27.360
way bigger than Tony and I,

00:10:27.399 --> 00:10:29.283
like most of them understand this point,

00:10:29.342 --> 00:10:29.763
which is,

00:10:30.881 --> 00:10:32.023
The staff physical therapist

00:10:32.062 --> 00:10:33.464
will absolutely come and go.

00:10:33.484 --> 00:10:35.745
And if you want to identify

00:10:35.804 --> 00:10:37.145
talent and retain talent,

00:10:37.706 --> 00:10:39.248
then you have some ladder.

00:10:39.307 --> 00:10:41.688
You have some clinic director,

00:10:42.129 --> 00:10:43.431
regional director, whatever.

00:10:43.471 --> 00:10:45.192
You have some ladder track

00:10:45.231 --> 00:10:46.552
that's potentially

00:10:46.572 --> 00:10:47.774
available for them to see

00:10:47.854 --> 00:10:48.453
and acknowledge and

00:10:48.474 --> 00:10:49.215
understand where they can

00:10:49.235 --> 00:10:49.955
kind of grow into,

00:10:50.014 --> 00:10:51.336
whether it's an increase in

00:10:51.375 --> 00:10:52.277
salary over time,

00:10:52.317 --> 00:10:53.136
which is usually going to

00:10:53.177 --> 00:10:55.058
be increased in responsibility and role.

00:10:55.938 --> 00:10:57.559
Maybe more treating patients,

00:10:57.580 --> 00:10:59.100
but obviously there's a ceiling there.

00:10:59.721 --> 00:11:00.662
So this is no different than

00:11:00.702 --> 00:11:02.144
any other time other than just like,

00:11:02.283 --> 00:11:03.264
you know, prediction health.

00:11:03.664 --> 00:11:04.926
I think a pretty solid blog

00:11:04.966 --> 00:11:06.466
article with the dollar amount.

00:11:07.126 --> 00:11:08.048
Then at the end, of course,

00:11:08.087 --> 00:11:09.149
they're pitching their own service.

00:11:09.188 --> 00:11:09.609
But, you know,

00:11:09.869 --> 00:11:10.690
that's just the way I guess

00:11:10.710 --> 00:11:13.071
blogs are not magically

00:11:13.150 --> 00:11:14.611
book at the end of it.

00:11:14.652 --> 00:11:15.513
Book, you know, book now,

00:11:15.572 --> 00:11:16.833
book a call now for

00:11:16.913 --> 00:11:18.034
prediction health AI thing,

00:11:18.695 --> 00:11:20.176
which and I've heard from Serti McKay.

00:11:20.216 --> 00:11:21.197
I've heard prediction health

00:11:21.777 --> 00:11:23.097
and I didn't talk to Pedro with you guys,

00:11:23.138 --> 00:11:23.259
but.

00:11:24.038 --> 00:11:26.039
I heard that the software is

00:11:26.081 --> 00:11:27.201
pretty cool and it works

00:11:27.662 --> 00:11:28.822
really well on the practice

00:11:28.861 --> 00:11:29.482
management side.

00:11:29.962 --> 00:11:30.484
But again,

00:11:30.624 --> 00:11:31.945
it's no big like this is just

00:11:31.985 --> 00:11:32.725
something that's happened.

00:11:32.784 --> 00:11:34.186
Like this is just it happens.

00:11:34.846 --> 00:11:36.967
And if you want to keep great therapists,

00:11:37.388 --> 00:11:38.668
you have to pay them more

00:11:38.729 --> 00:11:39.870
or find places for them.

00:11:39.950 --> 00:11:41.910
And then I'll kick it back to you guys.

00:11:41.931 --> 00:11:43.251
But like I put out an

00:11:43.292 --> 00:11:45.313
episode last week with Chris Naipaul.

00:11:45.354 --> 00:11:46.615
He was an excellent physical

00:11:46.634 --> 00:11:48.696
therapist with me, young, energetic,

00:11:48.755 --> 00:11:49.876
motivated therapist.

00:11:50.153 --> 00:11:51.495
worked with me for like a year or two.

00:11:51.875 --> 00:11:53.596
And then went and started his own practice,

00:11:53.975 --> 00:11:55.515
kind of competing with me in Manhattan,

00:11:55.537 --> 00:11:56.356
but not really because he

00:11:56.397 --> 00:11:57.857
takes Medicare Part B. So

00:11:57.898 --> 00:11:59.758
it's like some of these folks also,

00:11:59.817 --> 00:12:01.318
by the way, we just, we can't retain.

00:12:01.438 --> 00:12:02.679
Like if Tony and I hire like

00:12:02.720 --> 00:12:04.321
an entrepreneurial physical therapist,

00:12:04.921 --> 00:12:06.442
they might have a detour

00:12:06.481 --> 00:12:07.782
with us for one to three years,

00:12:08.442 --> 00:12:09.062
but they're going to go do

00:12:09.082 --> 00:12:10.383
their own thing anyway, regardless.

00:12:10.964 --> 00:12:12.264
If you're hiring really

00:12:12.344 --> 00:12:13.825
great A players and then

00:12:13.865 --> 00:12:15.966
you're surprised when they go A play,

00:12:18.227 --> 00:12:19.369
Say that again to yourself.

00:12:19.989 --> 00:12:21.929
You're hiring people who are motivated,

00:12:22.409 --> 00:12:24.171
who want to do above the average,

00:12:24.370 --> 00:12:25.350
and then you're shocked

00:12:25.691 --> 00:12:27.351
when those people succeed.

00:12:28.011 --> 00:12:29.712
I was taught this in radio

00:12:29.832 --> 00:12:30.753
is you should be training

00:12:30.793 --> 00:12:32.394
those people out of a job.

00:12:32.413 --> 00:12:33.274
You should essentially be

00:12:33.374 --> 00:12:34.815
training those people so

00:12:35.215 --> 00:12:36.216
that at some point,

00:12:37.235 --> 00:12:38.576
they do go on to bigger and

00:12:38.616 --> 00:12:39.136
better things.

00:12:39.677 --> 00:12:40.677
Or you should be training

00:12:40.697 --> 00:12:42.197
your replacement so you can

00:12:42.238 --> 00:12:44.018
go on to bigger and better things.

00:12:44.398 --> 00:12:45.138
I just liked the article.

00:12:45.177 --> 00:12:46.399
I thought it was a cool

00:12:46.418 --> 00:12:48.558
analysis of all the costs

00:12:48.599 --> 00:12:50.460
that we might mention in

00:12:50.519 --> 00:12:52.480
terms of impact to the patients,

00:12:52.620 --> 00:12:53.640
impact to the team,

00:12:54.400 --> 00:12:56.140
training and onboarding, hiring,

00:12:56.260 --> 00:12:57.961
travel therapists, recruitment costs,

00:12:58.001 --> 00:12:58.861
which can be about...

00:12:59.902 --> 00:13:01.903
uh 25 of the clinician's

00:13:01.942 --> 00:13:03.364
salary which I had no idea

00:13:03.484 --> 00:13:04.464
that's how some similar

00:13:04.484 --> 00:13:05.585
figures is that a little

00:13:05.605 --> 00:13:06.544
high it's a little it's a

00:13:06.585 --> 00:13:08.966
little high 10 I like me

00:13:09.025 --> 00:13:10.807
likey at 10 but I'm also on

00:13:10.846 --> 00:13:12.388
the employer side so like

00:13:12.607 --> 00:13:13.447
the new york city where

00:13:13.548 --> 00:13:14.769
where the population

00:13:14.808 --> 00:13:15.668
density and therapists

00:13:15.710 --> 00:13:16.570
might be a little faster to

00:13:16.629 --> 00:13:17.831
find easier to find less

00:13:17.850 --> 00:13:18.890
competitive well more

00:13:18.951 --> 00:13:20.871
competitive for them better for you

00:13:21.946 --> 00:13:22.826
Let's not forget though,

00:13:22.885 --> 00:13:24.067
this is a tech company.

00:13:24.246 --> 00:13:27.048
Tech rates are just outrageous.

00:13:27.347 --> 00:13:28.788
So I wouldn't be surprised

00:13:28.889 --> 00:13:30.548
if tech recruiting costs,

00:13:30.629 --> 00:13:31.929
executive recruiting costs

00:13:32.070 --> 00:13:33.929
are in that 25% range.

00:13:35.811 --> 00:13:36.871
One thing I was gonna say though,

00:13:36.892 --> 00:13:38.231
when we're looking at this, and I think,

00:13:39.373 --> 00:13:40.332
did this one also talk

00:13:40.352 --> 00:13:41.493
about burnout a little bit

00:13:41.633 --> 00:13:42.673
or was that something else?

00:13:42.874 --> 00:13:43.494
Yeah, they started,

00:13:43.573 --> 00:13:44.735
they mentioned burnout.

00:13:44.754 --> 00:13:46.815
It was actually, that was the title,

00:13:46.815 --> 00:13:48.375
$65,000 per therapist departure,

00:13:48.596 --> 00:13:49.956
understanding the true cost

00:13:50.076 --> 00:13:51.136
of a PT's burnout.

00:13:51.754 --> 00:13:52.115
Yeah.

00:13:52.515 --> 00:13:53.758
I don't make that connection,

00:13:53.817 --> 00:13:55.700
but either way.

00:13:56.221 --> 00:13:56.822
Let's keep going.

00:13:57.466 --> 00:13:58.566
Either way,

00:13:58.946 --> 00:14:01.006
I think there's a misconception, you know,

00:14:01.167 --> 00:14:03.106
and this this discussion,

00:14:03.167 --> 00:14:04.008
I might not take it the way

00:14:04.028 --> 00:14:04.687
Dave's thinking,

00:14:04.727 --> 00:14:06.847
but we hear all these

00:14:06.908 --> 00:14:08.068
discussions about minimum

00:14:08.089 --> 00:14:09.308
wage thresholds and you

00:14:09.349 --> 00:14:10.208
have to have a minimum

00:14:10.249 --> 00:14:11.710
minimum wage and all that stuff.

00:14:11.789 --> 00:14:14.750
And to me, it just goes back to, look,

00:14:15.049 --> 00:14:18.071
if I'm going to come in and no disrespect,

00:14:18.130 --> 00:14:19.471
like I'm the owner of my

00:14:19.530 --> 00:14:20.731
clinic and I clean the

00:14:20.772 --> 00:14:21.652
toilet in my clinic.

00:14:22.131 --> 00:14:23.332
But if I was being hired to

00:14:23.373 --> 00:14:24.913
clean the toilet in the clinic,

00:14:25.094 --> 00:14:26.855
I'm paid to clean the toilet,

00:14:26.895 --> 00:14:27.976
whatever that is worth.

00:14:29.057 --> 00:14:32.379
Not Tony Meritato is worth this much.

00:14:32.419 --> 00:14:33.721
So that's what he's getting paid.

00:14:33.760 --> 00:14:35.201
And when we look at burnout,

00:14:35.241 --> 00:14:36.543
when we look at frustration,

00:14:36.582 --> 00:14:37.803
I think there are so many

00:14:37.864 --> 00:14:38.625
elements to that.

00:14:39.384 --> 00:14:40.765
I want to mention two real quick.

00:14:41.407 --> 00:14:42.587
One is I think it's the

00:14:42.648 --> 00:14:44.448
therapist who thinks I'm

00:14:44.489 --> 00:14:45.509
going to come get a job at

00:14:45.529 --> 00:14:46.250
the skilled nursing

00:14:46.289 --> 00:14:47.610
facility to deliver

00:14:47.672 --> 00:14:48.972
physical therapy services.

00:14:49.753 --> 00:14:50.793
That's what the job is.

00:14:51.173 --> 00:14:52.813
It's not at the highest

00:14:52.874 --> 00:14:54.053
possible level and you're

00:14:54.073 --> 00:14:54.653
going to get all these

00:14:54.715 --> 00:14:55.934
extra certifications and

00:14:55.955 --> 00:14:57.274
you're going to be, you know,

00:14:57.335 --> 00:14:58.716
this this amazing physical

00:14:58.755 --> 00:15:00.056
therapist and compensated

00:15:00.155 --> 00:15:01.235
for your amazement.

00:15:01.817 --> 00:15:03.037
It's you're coming to

00:15:03.096 --> 00:15:04.977
deliver physical therapy services.

00:15:05.057 --> 00:15:06.738
And that is a basic minimum

00:15:06.778 --> 00:15:08.178
wage physical therapy job.

00:15:08.719 --> 00:15:09.879
And so I don't care if you

00:15:09.899 --> 00:15:12.559
stay 20 years or two years or, you know.

00:15:13.279 --> 00:15:15.301
That is what the job pays.

00:15:15.461 --> 00:15:16.241
If you want to be

00:15:16.282 --> 00:15:17.503
compensated for your

00:15:17.663 --> 00:15:18.403
achievement and your

00:15:18.423 --> 00:15:19.524
knowledge and your success,

00:15:19.604 --> 00:15:20.924
go into private practice or

00:15:20.965 --> 00:15:23.206
go work for a business that

00:15:23.307 --> 00:15:25.288
recognizes that Medicare

00:15:25.307 --> 00:15:26.568
doesn't recognize that the

00:15:26.609 --> 00:15:28.149
same therapist gets paid

00:15:28.210 --> 00:15:30.572
the same rate for the same CPT code,

00:15:30.631 --> 00:15:32.192
regardless of their education,

00:15:32.253 --> 00:15:33.113
their expertise,

00:15:33.153 --> 00:15:34.413
how much the patient enjoys it.

00:15:34.894 --> 00:15:35.495
So I think they get

00:15:35.595 --> 00:15:36.716
frustrated because they're like,

00:15:36.755 --> 00:15:37.855
I've been working 20 years.

00:15:37.916 --> 00:15:39.256
I put every ounce of effort

00:15:39.356 --> 00:15:41.038
in and I'm getting paid, you know,

00:15:41.139 --> 00:15:43.039
the same as I got paid 10 years ago.

00:15:43.760 --> 00:15:44.422
That's the job.

00:15:44.903 --> 00:15:45.764
You're getting paid for that.

00:15:45.784 --> 00:15:46.285
Go ahead, Dave.

00:15:47.099 --> 00:15:48.980
Tony and I disagree on a lot.

00:15:49.200 --> 00:15:50.000
I think that's a good thing.

00:15:50.080 --> 00:15:51.840
And sometimes we've had good

00:15:51.899 --> 00:15:52.801
feedback from others that

00:15:52.841 --> 00:15:53.900
say they kind of love the

00:15:53.941 --> 00:15:55.280
conflict and the back and forth.

00:15:56.022 --> 00:15:57.282
But I agree with you on this, Tony.

00:15:57.361 --> 00:15:59.322
You said it right away that

00:15:59.442 --> 00:16:00.503
I don't make the connection either.

00:16:00.842 --> 00:16:01.763
And I kind of feel like when

00:16:01.783 --> 00:16:02.744
I read this blog article,

00:16:03.144 --> 00:16:04.583
I feel like they put the

00:16:04.604 --> 00:16:05.644
word burnout in there just

00:16:05.663 --> 00:16:07.205
to get more clicks or more

00:16:07.304 --> 00:16:08.504
views or whatever.

00:16:08.884 --> 00:16:10.285
The word should not be burnout.

00:16:10.326 --> 00:16:12.245
It should be, okay, here's the blog title,

00:16:12.505 --> 00:16:14.246
65K per therapist departure.

00:16:14.826 --> 00:16:15.246
colon,

00:16:15.586 --> 00:16:17.307
understanding the true cost of a

00:16:17.327 --> 00:16:18.048
PT's burnout.

00:16:18.428 --> 00:16:19.690
It should be understanding

00:16:19.730 --> 00:16:21.110
the true cost of a PT's

00:16:21.169 --> 00:16:23.071
replacement cost or hiring

00:16:23.091 --> 00:16:24.231
and recruiting or whatever.

00:16:24.532 --> 00:16:25.393
And they put the word

00:16:25.432 --> 00:16:27.333
burnout in here just like

00:16:27.614 --> 00:16:28.333
because- Can I tell you why

00:16:28.394 --> 00:16:29.134
I think they did that?

00:16:29.595 --> 00:16:30.034
I mean, you know,

00:16:30.054 --> 00:16:30.956
because more of this

00:16:30.975 --> 00:16:31.816
negative crap like on

00:16:31.855 --> 00:16:33.017
Facebook groups with PTs,

00:16:33.037 --> 00:16:34.677
like all the negative, the more negative,

00:16:34.697 --> 00:16:35.057
the better.

00:16:35.097 --> 00:16:35.798
Let's share it.

00:16:35.817 --> 00:16:36.778
Yeah, maybe.

00:16:37.099 --> 00:16:37.919
I think they put it in there

00:16:37.940 --> 00:16:39.080
because if they did the

00:16:39.179 --> 00:16:41.461
real cost of a clinician's departure,

00:16:41.701 --> 00:16:42.861
the article would only

00:16:42.942 --> 00:16:44.082
appeal to clinic owners

00:16:44.870 --> 00:16:46.312
I think if you put burnout,

00:16:46.572 --> 00:16:48.033
I see me as a clinician in

00:16:48.073 --> 00:16:50.235
there and then I see cost and departure.

00:16:50.296 --> 00:16:51.697
And so it appeals to two

00:16:51.778 --> 00:16:53.139
audiences if you write it that way.

00:16:53.240 --> 00:16:53.519
I don't know.

00:16:53.539 --> 00:16:54.520
I'm not saying he did it like that.

00:16:54.841 --> 00:16:55.481
But who are they selling

00:16:55.501 --> 00:16:56.082
their software to?

00:16:57.498 --> 00:16:57.937
Right, right, right.

00:16:58.238 --> 00:16:59.099
But the way to get more

00:16:59.139 --> 00:17:00.438
blogs to get more clicks at

00:17:00.458 --> 00:17:02.419
the bottom is to become a blog article.

00:17:02.659 --> 00:17:03.120
I agree.

00:17:03.341 --> 00:17:05.000
If it was devious and I would, you know.

00:17:05.480 --> 00:17:07.481
They're TMZing the blog article headlines.

00:17:07.541 --> 00:17:07.821
Sure.

00:17:08.182 --> 00:17:09.962
Don't you think I DMed the

00:17:10.123 --> 00:17:11.163
author of the article and

00:17:11.183 --> 00:17:12.503
just let them know, hey, great article.

00:17:12.523 --> 00:17:13.904
We'll be talking about it

00:17:13.924 --> 00:17:14.964
tomorrow on our live stream.

00:17:15.185 --> 00:17:15.746
Yes, I did.

00:17:16.226 --> 00:17:17.646
To see if they would, you know,

00:17:17.767 --> 00:17:20.248
comment on it or decide to show up.

00:17:20.948 --> 00:17:22.809
So it was sharing information.

00:17:23.309 --> 00:17:24.250
So the other aspect,

00:17:24.290 --> 00:17:25.332
and this might be a little

00:17:25.352 --> 00:17:26.693
mini segment here talking

00:17:26.733 --> 00:17:29.455
about burnout is I think a

00:17:29.496 --> 00:17:31.538
big part of the burnout problem.

00:17:31.657 --> 00:17:32.798
I don't even think it's pay.

00:17:33.299 --> 00:17:34.500
Like I know, you know,

00:17:34.540 --> 00:17:35.501
we don't get paid enough.

00:17:35.541 --> 00:17:36.563
We hear all those stories,

00:17:36.623 --> 00:17:38.785
but I think it's just so

00:17:38.825 --> 00:17:40.446
many therapists are in a position.

00:17:40.567 --> 00:17:41.488
They're powerless.

00:17:42.048 --> 00:17:44.868
to not treat patients who

00:17:45.009 --> 00:17:46.569
don't want to be treated.

00:17:46.609 --> 00:17:46.789
Now,

00:17:46.890 --> 00:17:48.711
I've been sharing some Facebook and

00:17:48.790 --> 00:17:50.411
LinkedIn posts about this.

00:17:50.451 --> 00:17:52.172
I'd be curious to hear your

00:17:52.231 --> 00:17:53.432
guys' perspective.

00:17:54.593 --> 00:17:56.133
I never worked in skilled

00:17:56.173 --> 00:17:58.713
nursing for any length of time.

00:17:58.775 --> 00:17:59.894
I never worked in acute care

00:17:59.934 --> 00:18:00.875
for any length of time,

00:18:00.914 --> 00:18:02.556
but I did clinical rotations.

00:18:02.576 --> 00:18:03.496
You guys did too.

00:18:04.176 --> 00:18:05.616
I remember sitting in there

00:18:05.797 --> 00:18:06.917
looking at patients,

00:18:06.958 --> 00:18:08.038
looking at therapists.

00:18:08.077 --> 00:18:09.659
The patient has zero interest

00:18:10.578 --> 00:18:11.599
They're rarely conscious,

00:18:11.700 --> 00:18:12.961
but even the ones who were

00:18:13.040 --> 00:18:15.222
have zero interest in doing

00:18:15.403 --> 00:18:17.263
anything the therapist wants them to do.

00:18:17.825 --> 00:18:17.984
Now,

00:18:18.184 --> 00:18:20.166
here's the full context to the best of

00:18:20.186 --> 00:18:20.666
my ability.

00:18:21.587 --> 00:18:22.708
Medicare is paying the bill.

00:18:22.848 --> 00:18:25.711
This is not a patient self-pay situation.

00:18:26.490 --> 00:18:27.811
Medicare is paying the bill.

00:18:28.472 --> 00:18:29.653
The therapist is under

00:18:29.713 --> 00:18:30.994
pressure from management to

00:18:31.075 --> 00:18:32.576
get the CPT codes bill,

00:18:32.635 --> 00:18:34.798
to get the minutes of therapy delivered,

00:18:34.837 --> 00:18:35.919
to do whatever it is.

00:18:36.519 --> 00:18:38.300
The patient is begging the

00:18:38.340 --> 00:18:40.002
therapist to leave them alone.

00:18:40.163 --> 00:18:41.325
I don't want to do this.

00:18:41.664 --> 00:18:42.526
Please stop.

00:18:43.386 --> 00:18:45.490
To the point where I remember as a student,

00:18:45.890 --> 00:18:48.613
my CI was working with a patient.

00:18:49.595 --> 00:18:52.637
I think it was in the parallel bars.

00:18:53.159 --> 00:18:54.240
The patient was like, no,

00:18:54.299 --> 00:18:55.561
I don't want to do it, please.

00:18:55.622 --> 00:18:56.363
I don't want to do it.

00:18:57.182 --> 00:19:00.345
And the the therapist basically forced,

00:19:00.384 --> 00:19:00.545
like,

00:19:00.625 --> 00:19:02.185
drag the patient out of the

00:19:02.226 --> 00:19:03.746
wheelchair to make them stand.

00:19:04.165 --> 00:19:05.186
And I remember talking to

00:19:05.227 --> 00:19:07.327
somebody else later and them saying, look,

00:19:07.407 --> 00:19:09.368
now put yourself in a courtroom.

00:19:09.969 --> 00:19:10.910
You're the therapist.

00:19:11.289 --> 00:19:12.210
That's the patient.

00:19:12.269 --> 00:19:13.010
That's the lawyer.

00:19:13.050 --> 00:19:14.250
That's the patient's family.

00:19:14.730 --> 00:19:15.372
The you know,

00:19:15.412 --> 00:19:17.593
the judge says or whoever the

00:19:17.633 --> 00:19:20.153
patient's like, I beg them to stop.

00:19:20.394 --> 00:19:22.055
And the therapist wouldn't stop.

00:19:22.474 --> 00:19:24.955
That's really what's happening there.

00:19:25.135 --> 00:19:26.997
But we're in a vacuum.

00:19:27.037 --> 00:19:27.917
We're stuck in this.

00:19:28.018 --> 00:19:29.577
So I can imagine the

00:19:29.617 --> 00:19:31.118
disconnect in the patient's brain,

00:19:31.179 --> 00:19:33.059
no matter who the, sorry,

00:19:33.119 --> 00:19:34.101
the therapist's brain,

00:19:35.141 --> 00:19:36.041
they know the patient

00:19:36.082 --> 00:19:36.882
doesn't want to do it.

00:19:38.077 --> 00:19:39.098
I wouldn't want to do it if

00:19:39.179 --> 00:19:40.179
I was a therapist,

00:19:40.559 --> 00:19:41.180
but you've got this

00:19:41.259 --> 00:19:43.301
productivity hanging over your shoulders.

00:19:43.342 --> 00:19:43.501
Like,

00:19:43.602 --> 00:19:45.583
I think that's a major part of burnout.

00:19:45.623 --> 00:19:46.784
Now compare that to like

00:19:46.864 --> 00:19:48.684
Dave situation where

00:19:48.724 --> 00:19:50.405
patients are throwing money at him,

00:19:50.486 --> 00:19:52.688
begging him to come help,

00:19:53.228 --> 00:19:55.650
to work with them, highly motivated,

00:19:55.710 --> 00:19:57.211
like highly appreciative.

00:19:57.931 --> 00:20:00.231
um it's just so many of our

00:20:00.291 --> 00:20:01.811
clinicians profession-wide

00:20:01.852 --> 00:20:03.152
are stuck in situations

00:20:03.211 --> 00:20:04.012
where they know what

00:20:04.053 --> 00:20:06.053
they're doing is wrong I

00:20:06.073 --> 00:20:07.133
would say at minimum

00:20:07.292 --> 00:20:09.034
ethically wrong probably

00:20:09.233 --> 00:20:11.693
like legally wrong and yet

00:20:11.753 --> 00:20:13.115
they're forced or compelled

00:20:13.174 --> 00:20:14.414
to do it that's what's

00:20:14.434 --> 00:20:15.355
burning out the profession

00:20:15.375 --> 00:20:16.576
I mean also go to just you

00:20:16.615 --> 00:20:17.915
know you know quote regular

00:20:17.996 --> 00:20:19.316
outpatient pt the person's

00:20:19.375 --> 00:20:20.076
showing up because they

00:20:20.096 --> 00:20:21.336
feel like they need to but

00:20:21.376 --> 00:20:22.436
maybe they don't really know

00:20:22.856 --> 00:20:24.416
why they showed up, right?

00:20:24.497 --> 00:20:25.376
Aren't you supposed to do

00:20:25.396 --> 00:20:26.377
the thing with the heat or

00:20:26.397 --> 00:20:27.718
the shocky shock or the

00:20:27.877 --> 00:20:29.917
cuppy cup things that make

00:20:29.938 --> 00:20:30.738
me look like I got attacked

00:20:30.758 --> 00:20:32.078
by an octopus?

00:20:32.979 --> 00:20:34.398
And most of your day isn't

00:20:34.538 --> 00:20:36.078
using the highest level of your brain.

00:20:36.138 --> 00:20:36.898
Most of it is like,

00:20:37.358 --> 00:20:40.319
I've seen therapists bribe, convince,

00:20:40.700 --> 00:20:42.720
and I'm with them sort of like, I get it.

00:20:42.779 --> 00:20:45.240
Like your job is to get them to arrive,

00:20:45.320 --> 00:20:46.961
pay, stay, keep coming back,

00:20:47.020 --> 00:20:48.020
do all those things that we

00:20:48.060 --> 00:20:49.761
talk about here and other places.

00:20:50.461 --> 00:20:51.981
And it feels like most of the time, like,

00:20:53.386 --> 00:20:54.727
You're bribing people or

00:20:54.747 --> 00:20:55.468
trying to convince them to

00:20:55.508 --> 00:20:57.868
do something you know is

00:20:57.929 --> 00:20:59.249
right for them will be helpful.

00:20:59.788 --> 00:21:01.450
They kind of believe it,

00:21:01.569 --> 00:21:03.009
but the juice ain't worth the squeeze.

00:21:03.210 --> 00:21:04.030
That's why they're there in

00:21:04.050 --> 00:21:04.671
the first place.

00:21:05.411 --> 00:21:06.111
So I could see that.

00:21:06.250 --> 00:21:06.892
I felt that.

00:21:07.051 --> 00:21:07.672
Most of the time,

00:21:07.711 --> 00:21:09.452
it was try to get someone

00:21:09.472 --> 00:21:10.333
to do something.

00:21:11.192 --> 00:21:12.374
People don't want to go to the gym.

00:21:12.394 --> 00:21:13.574
They want to have gone to the gym.

00:21:13.973 --> 00:21:15.034
People don't want to do PT.

00:21:15.054 --> 00:21:16.295
They want to have done PT.

00:21:16.454 --> 00:21:17.095
I get that.

00:21:17.615 --> 00:21:18.976
And that was hard for me to reconcile.

00:21:19.556 --> 00:21:20.655
I can see that being a major

00:21:21.557 --> 00:21:22.356
friction burnout point.

00:21:22.679 --> 00:21:23.898
So Scott said, Tony,

00:21:23.939 --> 00:21:25.059
you're spot on dealing with

00:21:25.099 --> 00:21:26.640
those kinds of patients all day long.

00:21:26.680 --> 00:21:28.101
We'll suck the life out of you.

00:21:28.141 --> 00:21:30.320
And by the end of the day, absolutely.

00:21:30.661 --> 00:21:31.281
Absolutely.

00:21:31.582 --> 00:21:34.021
So is that what you said too?

00:21:34.363 --> 00:21:35.182
Cause I'm not a parent.

00:21:35.222 --> 00:21:35.762
You guys are,

00:21:35.803 --> 00:21:36.883
is that what it's like being a parent?

00:21:36.903 --> 00:21:38.564
Dave's, you know, pretty new.

00:21:39.263 --> 00:21:41.184
I think I'm too new to even comment.

00:21:41.224 --> 00:21:42.164
Tony, what do you got?

00:21:42.404 --> 00:21:43.345
I do like how Tony's

00:21:43.365 --> 00:21:45.185
drinking from his world's best dad mug,

00:21:45.226 --> 00:21:46.885
like throwing it in Dave's face.

00:21:46.965 --> 00:21:47.527
Like, I don't know.

00:21:47.626 --> 00:21:49.987
Family cup for me.

00:21:50.007 --> 00:21:51.968
I've got world's best dad, but absolutely.

00:21:52.147 --> 00:21:53.229
I feel like it's like being

00:21:53.249 --> 00:21:54.169
a little bit of a parent,

00:21:54.189 --> 00:21:54.890
but you don't have that

00:21:54.970 --> 00:21:56.250
leverage over a patient,

00:21:56.290 --> 00:21:58.432
which is this is what's best for you.

00:21:58.652 --> 00:22:00.073
I know you don't see it now,

00:22:00.613 --> 00:22:01.794
but if you do this,

00:22:01.973 --> 00:22:03.214
you'll get the thing that you want.

00:22:03.454 --> 00:22:04.215
And that's tiring.

00:22:05.288 --> 00:22:07.451
I don't see it's not like being a parent,

00:22:07.490 --> 00:22:08.171
at least not.

00:22:08.271 --> 00:22:08.951
I don't think so.

00:22:08.991 --> 00:22:09.853
There are frustrating

00:22:10.073 --> 00:22:11.213
aspects to being a parent.

00:22:11.314 --> 00:22:12.634
One thousand percent.

00:22:14.056 --> 00:22:15.096
And I'm always cautious to

00:22:15.136 --> 00:22:16.458
bring up parent analogies

00:22:16.478 --> 00:22:17.238
because I don't want it to

00:22:17.278 --> 00:22:18.358
sound condescending.

00:22:18.960 --> 00:22:20.881
But but no, you know,

00:22:21.701 --> 00:22:23.282
it's not it's not like that

00:22:23.403 --> 00:22:25.664
because my kids, I don't know,

00:22:25.724 --> 00:22:26.905
it's just different.

00:22:27.385 --> 00:22:29.627
But Jimmy brought up the word bribe.

00:22:30.307 --> 00:22:33.049
Dave mentioned bribe and manual therapy.

00:22:33.089 --> 00:22:34.131
Let's touch on this real

00:22:34.151 --> 00:22:35.531
quick because this is an important one.

00:22:35.571 --> 00:22:36.412
This is a good one.

00:22:37.313 --> 00:22:37.653
Dave,

00:22:37.932 --> 00:22:40.335
talk about the manual therapy being a

00:22:40.355 --> 00:22:40.734
bribe.

00:22:42.355 --> 00:22:43.196
First of all, for the record,

00:22:43.336 --> 00:22:44.218
I don't think it is,

00:22:44.357 --> 00:22:46.098
but Tony Meritato has said

00:22:46.118 --> 00:22:47.380
that it is several times

00:22:47.460 --> 00:22:48.980
over the past several years, I believe.

00:22:51.944 --> 00:22:53.226
So there's some points you said, Tony,

00:22:53.287 --> 00:22:53.446
right?

00:22:53.467 --> 00:22:55.428
So you said some insurance companies,

00:22:55.448 --> 00:22:55.647
I think,

00:22:55.688 --> 00:22:57.068
are paying less for the manual

00:22:57.088 --> 00:22:59.010
therapy CPT code compared

00:22:59.030 --> 00:23:00.372
to therapeutic exercise,

00:23:00.692 --> 00:23:02.373
which kind of has some parallels, I think,

00:23:02.393 --> 00:23:03.934
to the whole telehealth

00:23:04.515 --> 00:23:05.875
extension or boom or whatever,

00:23:05.915 --> 00:23:07.356
where obviously those

00:23:07.376 --> 00:23:08.657
therapists can't do manual

00:23:08.678 --> 00:23:09.499
therapy and they're doing

00:23:09.538 --> 00:23:10.460
therapeutic exercise.

00:23:10.519 --> 00:23:12.020
And so, Tony,

00:23:12.101 --> 00:23:14.403
you kind of said some

00:23:14.442 --> 00:23:16.523
insurers might be understanding that,

00:23:16.564 --> 00:23:16.984
whether they're

00:23:17.765 --> 00:23:18.825
making their own assessments.

00:23:18.845 --> 00:23:20.165
They're doing their own data collection,

00:23:20.185 --> 00:23:20.486
whatever.

00:23:22.307 --> 00:23:24.268
And I kind of can see either way,

00:23:24.347 --> 00:23:25.548
but like at the end of the day,

00:23:25.567 --> 00:23:26.887
there's certain people that

00:23:26.929 --> 00:23:29.169
have like a stiff knee and

00:23:29.269 --> 00:23:29.809
they're not going to

00:23:29.970 --> 00:23:31.009
exercise their way out of it.

00:23:31.049 --> 00:23:31.609
They're not going to get

00:23:31.670 --> 00:23:33.131
more range of motion of their knee.

00:23:33.191 --> 00:23:34.611
Let's say like not knee replacement.

00:23:34.631 --> 00:23:36.352
Let's just say like a stiff, you know,

00:23:36.392 --> 00:23:37.031
arthritic knee.

00:23:38.272 --> 00:23:39.212
And they tried, you know,

00:23:39.413 --> 00:23:40.453
on a recumbent bike and

00:23:40.473 --> 00:23:41.394
they tried walking and they

00:23:41.413 --> 00:23:42.513
tried just doing the stairs

00:23:42.554 --> 00:23:43.755
in their apartment building or whatever.

00:23:44.454 --> 00:23:45.756
and they can't get more

00:23:45.776 --> 00:23:46.675
range of motion and they

00:23:46.715 --> 00:23:48.037
have knee pain and they

00:23:48.076 --> 00:23:49.417
might just need some manual

00:23:49.438 --> 00:23:50.939
therapy knee mobilizations

00:23:50.999 --> 00:23:51.838
that's just how I am

00:23:51.858 --> 00:23:52.900
because I come from like

00:23:53.059 --> 00:23:54.421
ortho outpatient type of

00:23:54.461 --> 00:23:57.782
world um so I don't think

00:23:57.803 --> 00:23:58.843
it's a bribe but I think

00:23:58.942 --> 00:23:59.644
tony I think it would be

00:23:59.663 --> 00:24:00.503
better if you kind of speak

00:24:00.544 --> 00:24:01.424
on it because you've kind

00:24:01.464 --> 00:24:03.246
of said that it could be or

00:24:03.266 --> 00:24:05.126
it is a bribe to get

00:24:05.166 --> 00:24:06.307
patients to come back and

00:24:06.407 --> 00:24:08.929
continue or to kind of give

00:24:09.028 --> 00:24:10.349
some people what they want because some

00:24:10.349 --> 00:24:11.170
Some people are looking for

00:24:11.210 --> 00:24:12.351
like the touchy feely stuff,

00:24:12.451 --> 00:24:13.471
even though Tony's not as a

00:24:13.490 --> 00:24:16.132
patient and patients like Tony Meritato,

00:24:16.792 --> 00:24:18.093
some people don't want to be touched.

00:24:18.614 --> 00:24:19.314
And that's like a whole

00:24:19.354 --> 00:24:20.114
other conversation.

00:24:20.634 --> 00:24:21.575
I don't think it's a bribe,

00:24:22.214 --> 00:24:23.336
but I could see your,

00:24:23.875 --> 00:24:25.817
your argument as specially

00:24:25.896 --> 00:24:27.477
without patient, you know,

00:24:27.517 --> 00:24:28.377
if Jimmy's my patient,

00:24:29.337 --> 00:24:30.538
I'll you know do the like

00:24:30.558 --> 00:24:31.619
you said some cuppings and

00:24:31.640 --> 00:24:32.461
this and that some soft

00:24:32.480 --> 00:24:33.982
tissue work whatever some

00:24:34.022 --> 00:24:34.943
you know some people think

00:24:34.983 --> 00:24:36.345
massage they get massage

00:24:36.365 --> 00:24:36.965
and physical therapy

00:24:36.986 --> 00:24:38.446
whatever I could certainly

00:24:38.547 --> 00:24:40.308
see manual therapy as a

00:24:40.348 --> 00:24:41.869
bribe especially in the

00:24:41.890 --> 00:24:43.311
outpatient physical therapy

00:24:43.332 --> 00:24:44.272
world I don't think it is

00:24:44.593 --> 00:24:46.454
but I could certainly see the argument

00:24:48.088 --> 00:24:48.568
Yeah,

00:24:48.709 --> 00:24:51.269
so what's unique about the three of us,

00:24:51.690 --> 00:24:53.431
we can bring perspectives, I think,

00:24:53.471 --> 00:24:54.730
to the conversation, right?

00:24:54.790 --> 00:24:56.412
We've got different experiences,

00:24:56.612 --> 00:24:58.093
different backgrounds.

00:24:58.153 --> 00:24:58.732
Just like I said,

00:24:58.772 --> 00:25:00.012
I remember being a student

00:25:00.073 --> 00:25:00.894
and seeing that poor

00:25:00.933 --> 00:25:03.094
patient suffer through that treatment.

00:25:03.694 --> 00:25:04.894
I also remember,

00:25:05.115 --> 00:25:05.815
and I bet a lot of

00:25:05.855 --> 00:25:06.596
listeners are going to

00:25:06.635 --> 00:25:07.796
remember this as well,

00:25:08.836 --> 00:25:09.797
I would be sitting there in

00:25:09.836 --> 00:25:11.237
an outpatient ortho clinic,

00:25:11.537 --> 00:25:13.218
and I would hear the therapist say,

00:25:13.557 --> 00:25:15.519
that patient's only coming for treatment.

00:25:15.838 --> 00:25:16.941
the manual therapy,

00:25:17.342 --> 00:25:18.443
and they would leave the

00:25:18.503 --> 00:25:19.846
manual therapy treatment

00:25:19.886 --> 00:25:20.929
intervention for the end of

00:25:20.969 --> 00:25:21.990
the treatment to get the

00:25:22.030 --> 00:25:22.873
patient to do all the

00:25:22.932 --> 00:25:24.174
exercise that needs to be done.

00:25:24.815 --> 00:25:26.816
Now, this is a blurry line.

00:25:26.895 --> 00:25:28.017
I'm the first one to admit it.

00:25:28.037 --> 00:25:28.376
Like, yeah,

00:25:28.396 --> 00:25:30.017
there's benefits to manual therapy.

00:25:30.037 --> 00:25:31.077
I'm not denying that.

00:25:31.518 --> 00:25:33.058
But what I'm saying is we

00:25:33.098 --> 00:25:33.939
have to understand the

00:25:33.979 --> 00:25:35.640
motivations behind it, right?

00:25:35.680 --> 00:25:37.221
So Dave said it,

00:25:37.701 --> 00:25:39.122
I see a lot of knee replacements.

00:25:39.162 --> 00:25:40.422
If I'm doing manual therapy

00:25:40.481 --> 00:25:41.323
on a knee because I'm

00:25:41.343 --> 00:25:42.303
thinking I'm gonna improve

00:25:42.702 --> 00:25:44.183
range of motion, reduce guarding,

00:25:44.263 --> 00:25:46.325
reduce inhibit pain response,

00:25:47.065 --> 00:25:48.125
all totally clinical,

00:25:48.266 --> 00:25:49.385
all totally reasonable,

00:25:49.486 --> 00:25:50.426
huge benefits to it.

00:25:51.067 --> 00:25:52.588
But if I'm gonna rub their

00:25:52.628 --> 00:25:54.391
back and I'm gonna save

00:25:54.451 --> 00:25:55.951
that back rubbing for the

00:25:55.991 --> 00:25:57.113
last 10 minutes of the

00:25:57.153 --> 00:25:58.394
session because they won't

00:25:58.454 --> 00:26:00.076
come if they don't get their back rubbed,

00:26:00.902 --> 00:26:01.742
To me, that's a bribe.

00:26:02.123 --> 00:26:03.403
And it's no different than

00:26:03.443 --> 00:26:04.865
me giving them a $20 bill

00:26:04.904 --> 00:26:06.105
because I'm going to get a

00:26:06.105 --> 00:26:06.806
$100 reimbursement.

00:26:07.267 --> 00:26:08.508
It's no different than me

00:26:08.567 --> 00:26:09.749
bringing in some sort of

00:26:09.788 --> 00:26:12.651
special cupcakes at the end

00:26:12.711 --> 00:26:13.751
to get them to come.

00:26:14.192 --> 00:26:15.212
Going back to kids,

00:26:15.512 --> 00:26:17.054
it's just like bribing your kid.

00:26:17.094 --> 00:26:18.575
You can play video games for

00:26:18.575 --> 00:26:20.036
60 minutes if you eat your

00:26:20.056 --> 00:26:20.676
broccoli tonight.

00:26:22.518 --> 00:26:25.039
So I do think historically,

00:26:25.059 --> 00:26:28.000
a lot of the things, passive modalities,

00:26:28.102 --> 00:26:29.021
manual therapy,

00:26:29.102 --> 00:26:30.063
they have been used as

00:26:30.123 --> 00:26:32.743
bribes in clinics to get

00:26:32.804 --> 00:26:33.944
patients to comply.

00:26:33.984 --> 00:26:34.806
Now, you could say, well,

00:26:34.846 --> 00:26:37.027
it's with good intent because it's like,

00:26:37.067 --> 00:26:37.247
look,

00:26:37.287 --> 00:26:38.807
if the patient doesn't do the exercise,

00:26:38.847 --> 00:26:39.888
they're not going to get better.

00:26:40.568 --> 00:26:42.170
But I go back to if the

00:26:42.210 --> 00:26:43.171
patient's paying the bill.

00:26:43.891 --> 00:26:44.451
That's fine.

00:26:45.211 --> 00:26:46.392
I mentioned the continuum

00:26:46.432 --> 00:26:47.732
the other day where you've got,

00:26:48.272 --> 00:26:49.613
I don't care who the human is.

00:26:49.673 --> 00:26:50.413
I'm just treating the

00:26:50.453 --> 00:26:52.434
condition to the other side

00:26:52.555 --> 00:26:53.134
where it's like,

00:26:53.375 --> 00:26:54.655
I don't care what the condition is.

00:26:54.796 --> 00:26:55.776
I'm just going to do what

00:26:55.796 --> 00:26:56.977
the human wants in front of me.

00:26:57.576 --> 00:26:58.436
There's a continuum.

00:26:58.457 --> 00:26:59.198
We're all going to fall

00:26:59.258 --> 00:27:00.198
somewhere in between.

00:27:00.298 --> 00:27:02.618
But if the insurance company,

00:27:02.659 --> 00:27:04.200
if Medicare is paying the bill.

00:27:05.279 --> 00:27:06.921
I am compelled because I

00:27:06.980 --> 00:27:07.862
signed a contract.

00:27:07.981 --> 00:27:10.303
I agreed with Medicare's terms of service.

00:27:10.403 --> 00:27:11.443
I am going to do what

00:27:11.483 --> 00:27:12.704
Medicare is paying me to do

00:27:12.744 --> 00:27:14.465
within the scope of what they allow.

00:27:15.105 --> 00:27:16.467
If the patient's paying me the bill,

00:27:16.487 --> 00:27:18.067
totally different story.

00:27:18.688 --> 00:27:20.368
So I would just ask you,

00:27:20.750 --> 00:27:21.609
I don't care what you do.

00:27:21.849 --> 00:27:22.770
I would just ask you to

00:27:23.030 --> 00:27:24.832
really look at what you are doing.

00:27:24.872 --> 00:27:26.212
Look at what your team is doing.

00:27:27.212 --> 00:27:28.453
Where's the motivation?

00:27:28.953 --> 00:27:30.134
And what's interesting here

00:27:30.213 --> 00:27:31.954
is we've all been privy to

00:27:32.075 --> 00:27:33.695
different conversations, right?

00:27:33.736 --> 00:27:35.316
When I sit in a group of

00:27:35.416 --> 00:27:36.457
just business owners,

00:27:36.497 --> 00:27:37.576
just practice owners,

00:27:38.698 --> 00:27:39.557
I'm a practice owner.

00:27:39.637 --> 00:27:40.439
I literally get

00:27:40.519 --> 00:27:41.598
uncomfortable with some of

00:27:41.618 --> 00:27:42.818
the conversations because

00:27:42.858 --> 00:27:45.380
it is so focused on units

00:27:45.441 --> 00:27:47.540
and productivity and minutes and dollars.

00:27:48.281 --> 00:27:49.461
I love me some dollars.

00:27:49.701 --> 00:27:51.343
I'm not against profitability,

00:27:51.883 --> 00:27:53.844
but it's so far to one extreme.

00:27:54.284 --> 00:27:55.325
But on the flip side,

00:27:55.545 --> 00:27:56.964
when I sit in another group, Jimmy,

00:27:57.005 --> 00:27:57.766
I listen to your

00:27:57.905 --> 00:27:59.787
conversation with the two

00:27:59.826 --> 00:28:03.048
individuals from the geriatric section.

00:28:03.808 --> 00:28:04.388
Amazing.

00:28:04.528 --> 00:28:06.250
Like they're so intelligent.

00:28:06.289 --> 00:28:07.769
They were just brilliant individuals,

00:28:07.830 --> 00:28:09.391
so passionate about what they're doing.

00:28:10.112 --> 00:28:11.311
But I felt like they were so

00:28:11.372 --> 00:28:12.873
disconnected to what the

00:28:12.913 --> 00:28:14.453
insurance company is paying for.

00:28:15.454 --> 00:28:17.856
That again, there's just, you know,

00:28:17.876 --> 00:28:19.479
there's too much space

00:28:19.538 --> 00:28:20.900
between what they want us

00:28:20.940 --> 00:28:22.422
to do as geriatric physical

00:28:22.461 --> 00:28:24.144
therapists compared to what

00:28:24.163 --> 00:28:25.724
we're being paid to do as

00:28:25.765 --> 00:28:27.346
geriatric physical therapists.

00:28:27.866 --> 00:28:29.669
And this is a disconnect

00:28:29.729 --> 00:28:31.810
where the therapist or,

00:28:32.071 --> 00:28:33.232
and this is I think a big one,

00:28:33.573 --> 00:28:35.013
is what you're taught in school, right?

00:28:35.034 --> 00:28:35.914
Because the people I talk to

00:28:35.934 --> 00:28:36.736
from geriatrics,

00:28:36.796 --> 00:28:39.159
Jackie Osborne and Ken Miller,

00:28:39.679 --> 00:28:40.638
They're educators,

00:28:40.679 --> 00:28:41.420
they're clinicians who've

00:28:41.440 --> 00:28:42.700
been around for a million years, right?

00:28:43.280 --> 00:28:44.320
And they're so smart.

00:28:44.921 --> 00:28:47.362
And then students receive this information,

00:28:47.422 --> 00:28:49.603
go out to the, in this place apparently,

00:28:50.304 --> 00:28:52.064
real world, and it's different.

00:28:52.324 --> 00:28:54.525
And that misaligned

00:28:54.565 --> 00:28:56.445
expectation scares the crap

00:28:56.486 --> 00:28:57.487
out of students because they're like,

00:28:57.567 --> 00:28:59.247
I got to do this for 20 or 30 years?

00:28:59.807 --> 00:29:01.667
This is not, this was not on the brochure.

00:29:01.688 --> 00:29:02.348
I thought I was just going

00:29:02.368 --> 00:29:03.469
to be an amazing person and

00:29:03.909 --> 00:29:05.269
uplift and change human lives.

00:29:05.289 --> 00:29:06.931
And they're like, yes, but...

00:29:07.611 --> 00:29:09.652
And I think that missed

00:29:09.711 --> 00:29:11.073
alignment and expectation

00:29:11.113 --> 00:29:12.913
and reality scares the crap out of people,

00:29:13.034 --> 00:29:14.035
and they look for the door,

00:29:14.474 --> 00:29:15.434
and I sort of don't blame them.

00:29:17.056 --> 00:29:18.376
I saw an interesting post in

00:29:18.457 --> 00:29:19.478
one of the bigger groups,

00:29:19.557 --> 00:29:20.738
and it was a new grad who

00:29:20.778 --> 00:29:23.279
was taking this person's first job.

00:29:24.000 --> 00:29:25.381
And the first day of the first job,

00:29:25.421 --> 00:29:26.761
they had three evals scheduled.

00:29:26.801 --> 00:29:27.801
Now, I don't know the setting.

00:29:27.862 --> 00:29:29.403
I'm assuming it was a skilled nursing,

00:29:29.442 --> 00:29:30.163
maybe something.

00:29:30.242 --> 00:29:31.483
I don't know.

00:29:31.824 --> 00:29:35.967
But you can see the polar opposites of...

00:29:36.807 --> 00:29:39.367
I would say 60% of the responses were like,

00:29:39.647 --> 00:29:40.607
that is ridiculous.

00:29:40.667 --> 00:29:41.327
I can't believe they're

00:29:41.347 --> 00:29:42.028
giving you three new

00:29:42.048 --> 00:29:43.909
patients on the first day of business.

00:29:44.048 --> 00:29:46.068
You're a new grad.

00:29:46.470 --> 00:29:47.970
No, you're a licensed therapist.

00:29:48.470 --> 00:29:49.069
So it's like,

00:29:49.089 --> 00:29:50.830
if you're not ready to treat

00:29:50.871 --> 00:29:52.270
patients on day number one,

00:29:52.310 --> 00:29:55.251
but you want a full pay on day number one,

00:29:55.372 --> 00:29:55.592
like...

00:29:56.132 --> 00:29:57.614
Okay, we need to figure this out.

00:29:58.154 --> 00:29:59.637
Now, that being said,

00:29:59.698 --> 00:30:01.200
Dave resonates with that message.

00:30:01.440 --> 00:30:02.942
I also understand.

00:30:02.962 --> 00:30:03.042
Yeah,

00:30:03.763 --> 00:30:05.487
there are going to be people that are

00:30:05.507 --> 00:30:06.147
going to come in,

00:30:06.188 --> 00:30:08.431
they're going to work at 20% efficiency,

00:30:08.490 --> 00:30:09.813
and we're going to wear kid

00:30:09.853 --> 00:30:11.336
gloves when we're handling them.

00:30:11.415 --> 00:30:11.476
And

00:30:11.976 --> 00:30:12.296
You know,

00:30:12.615 --> 00:30:14.277
we're going to bring them up to speed,

00:30:14.797 --> 00:30:15.997
but that goes to the

00:30:16.037 --> 00:30:16.977
culture of the business.

00:30:17.037 --> 00:30:19.137
So you have to understand as a new grad,

00:30:19.317 --> 00:30:20.518
where are you going to work?

00:30:20.617 --> 00:30:22.679
What are what's the expectation of it?

00:30:23.939 --> 00:30:26.480
But and what is your personality type?

00:30:26.539 --> 00:30:27.619
Are you the kind of person

00:30:27.799 --> 00:30:30.760
we lost Dave that can jump in?

00:30:30.780 --> 00:30:33.020
If you're a traveler, you better jump in.

00:30:33.500 --> 00:30:35.842
You know, if you're covering a vacation,

00:30:35.922 --> 00:30:37.382
you better be able to jump in.

00:30:38.342 --> 00:30:40.242
But what are your thoughts on that, Jimmy?

00:30:40.717 --> 00:30:42.817
Yeah.

00:30:43.258 --> 00:30:44.878
Having been a new grad, my thoughts were,

00:30:45.240 --> 00:30:47.040
yeah, I want to be brought along slowly.

00:30:47.060 --> 00:30:50.082
At the same token, on day one,

00:30:50.363 --> 00:30:50.923
I agree with you.

00:30:50.962 --> 00:30:52.364
I was a licensed physical therapist.

00:30:53.613 --> 00:30:55.094
What should be the issue?

00:30:55.753 --> 00:30:56.535
I think it should be true

00:30:56.575 --> 00:30:57.694
just like a new employee.

00:30:57.714 --> 00:30:59.155
If I hired someone at a

00:30:59.195 --> 00:31:00.596
radio station or a construction site,

00:31:01.017 --> 00:31:03.438
there needs to be some speed on this.

00:31:06.299 --> 00:31:07.599
The better you educate someone,

00:31:07.619 --> 00:31:08.480
the better they're going to

00:31:08.520 --> 00:31:10.122
perform in the beginning anyway.

00:31:10.182 --> 00:31:12.383
So I can see it from your side,

00:31:12.423 --> 00:31:13.042
and I agree.

00:31:13.682 --> 00:31:14.384
What's Dave think?

00:31:15.818 --> 00:31:17.039
all right so I just got

00:31:17.079 --> 00:31:18.560
bounced out I'm off I'm all

00:31:18.941 --> 00:31:19.741
on tilt now I don't know

00:31:19.781 --> 00:31:20.842
what happened I'm back in I

00:31:20.862 --> 00:31:21.942
don't know what's going on

00:31:21.962 --> 00:31:25.204
with my internet uh so the

00:31:25.265 --> 00:31:27.307
yeah the fact that uh this

00:31:27.386 --> 00:31:29.147
is a different culture now

00:31:29.208 --> 00:31:30.229
than before with with

00:31:30.368 --> 00:31:31.528
therapists and I don't know

00:31:31.588 --> 00:31:32.609
what I i have several

00:31:32.630 --> 00:31:33.510
things to comment on and

00:31:33.691 --> 00:31:34.351
hopefully I can do it

00:31:34.811 --> 00:31:36.792
efficiently um the thing

00:31:36.833 --> 00:31:38.054
like you just said tony of

00:31:38.413 --> 00:31:39.835
a therapist having three

00:31:39.875 --> 00:31:41.375
new evals it doesn't matter if you're

00:31:41.796 --> 00:31:43.817
skilled nursing, acute care, outpatient,

00:31:44.479 --> 00:31:45.880
uh, your new therapist first day,

00:31:46.180 --> 00:31:47.461
you got to build a caseload, right?

00:31:47.780 --> 00:31:48.362
How do you do that?

00:31:48.682 --> 00:31:49.502
New patient of Al's.

00:31:49.962 --> 00:31:52.005
So maybe that could be

00:31:52.586 --> 00:31:53.787
mentioned to the therapist.

00:31:53.846 --> 00:31:55.188
Like we got to really coddle

00:31:55.208 --> 00:31:56.528
you and let you know, Hey,

00:31:56.950 --> 00:31:57.950
in your first week,

00:31:58.270 --> 00:31:59.592
in your first day or two,

00:31:59.991 --> 00:32:00.673
you might have a whole

00:32:00.692 --> 00:32:02.453
bunch of new evaluations to

00:32:02.493 --> 00:32:03.414
build up a caseload.

00:32:03.796 --> 00:32:06.198
I mean, it, it, to me, it seems obvious.

00:32:06.917 --> 00:32:07.018
Um,

00:32:08.176 --> 00:32:11.359
Like when I went to when I

00:32:11.400 --> 00:32:12.361
went to Metro Sports Med,

00:32:12.661 --> 00:32:14.242
my sixth day of work, Tony,

00:32:14.262 --> 00:32:15.443
my so the second Monday,

00:32:15.824 --> 00:32:16.884
my sixth day of working,

00:32:17.786 --> 00:32:19.027
the clinic director who did

00:32:19.067 --> 00:32:20.107
like half ortho and half

00:32:20.147 --> 00:32:21.608
pediatrics was out sick.

00:32:22.450 --> 00:32:23.911
And it was me and a new PTA

00:32:23.951 --> 00:32:25.413
that were new hires the

00:32:25.613 --> 00:32:26.693
previous six days.

00:32:27.897 --> 00:32:29.358
I don't treat pediatrics and

00:32:29.398 --> 00:32:30.579
I don't really have a lot of training.

00:32:31.020 --> 00:32:32.561
But the front desk, for whatever reason,

00:32:33.041 --> 00:32:34.343
moved half of his caseload

00:32:34.363 --> 00:32:35.483
that day onto my schedule

00:32:35.544 --> 00:32:37.625
and then the other half to the PTA,

00:32:37.986 --> 00:32:38.787
who was the new hire.

00:32:38.807 --> 00:32:40.367
The PTA had pediatric experience.

00:32:40.448 --> 00:32:40.748
I didn't.

00:32:41.148 --> 00:32:42.490
I ended up treating a...

00:32:44.050 --> 00:32:44.330
I don't know,

00:32:44.371 --> 00:32:45.731
like a three-month-old or a

00:32:45.791 --> 00:32:47.012
six-month-old with torticollis.

00:32:47.032 --> 00:32:48.053
And I had no idea.

00:32:48.073 --> 00:32:50.974
It was the first time treating an infant.

00:32:51.154 --> 00:32:52.836
And I had to ask therapists

00:32:53.096 --> 00:32:55.896
in the practice, hey, what do you do?

00:32:56.857 --> 00:32:57.798
I don't have experience.

00:32:57.817 --> 00:32:58.719
Should I see this patient or

00:32:58.759 --> 00:32:59.259
not or whatever?

00:32:59.598 --> 00:33:00.259
And guess what, Tony?

00:33:00.880 --> 00:33:02.200
I'm different than I think a

00:33:02.259 --> 00:33:03.221
lot of these new therapists.

00:33:03.260 --> 00:33:05.142
Because I was asking my colleagues,

00:33:06.041 --> 00:33:06.643
how do I do it?

00:33:06.663 --> 00:33:07.522
What do I negotiate?

00:33:07.563 --> 00:33:08.544
I'm looking at the past

00:33:08.604 --> 00:33:09.544
notes of this patient

00:33:10.044 --> 00:33:10.724
because the patient was

00:33:10.744 --> 00:33:11.345
already seen a bunch of

00:33:11.384 --> 00:33:12.365
times by the clinic director.

00:33:13.165 --> 00:33:14.586
And here I thought, Tony,

00:33:14.645 --> 00:33:15.527
I thought this was a test.

00:33:15.987 --> 00:33:17.247
I thought that they were testing me.

00:33:17.586 --> 00:33:17.866
And I,

00:33:18.126 --> 00:33:19.528
so the last thing I wanted to do was

00:33:19.567 --> 00:33:20.788
go up to the front desk and say, Hey,

00:33:20.847 --> 00:33:22.689
can you tell this, you know,

00:33:22.729 --> 00:33:23.689
call the parents and say,

00:33:23.749 --> 00:33:24.429
cancel the visit.

00:33:24.788 --> 00:33:26.309
That is just beyond like,

00:33:26.430 --> 00:33:28.109
and that maybe I'm more business minded,

00:33:28.150 --> 00:33:29.730
but like that's just beyond me.

00:33:29.769 --> 00:33:31.230
Like that's the last thing I would do.

00:33:32.301 --> 00:33:34.763
is phone it in and say, hey,

00:33:35.765 --> 00:33:36.924
I wanna cancel this patient

00:33:36.944 --> 00:33:38.425
because I have no pediatric experience.

00:33:39.106 --> 00:33:40.208
So I asked some of my colleagues,

00:33:40.228 --> 00:33:41.249
they gave me some confidence.

00:33:41.288 --> 00:33:41.788
They said, hey,

00:33:42.269 --> 00:33:43.369
go check the previous notes.

00:33:43.549 --> 00:33:44.371
Okay, I did that.

00:33:44.651 --> 00:33:45.731
Go check the previous notes

00:33:45.791 --> 00:33:47.212
and review what Dean has

00:33:47.232 --> 00:33:48.713
been doing for the patient

00:33:48.753 --> 00:33:50.875
and the parents home exercise program,

00:33:50.894 --> 00:33:51.536
because the parents were

00:33:51.576 --> 00:33:53.576
stretching the infants'

00:33:53.877 --> 00:33:55.198
torticollis and doing some

00:33:55.238 --> 00:33:56.358
home exercises for it.

00:33:57.380 --> 00:33:58.721
And I went through the visit.

00:33:58.840 --> 00:33:59.622
I went through the visit.

00:34:00.628 --> 00:34:02.912
did the visit and I believe now,

00:34:03.571 --> 00:34:04.993
I think the mom didn't look

00:34:05.013 --> 00:34:05.775
at me as like the best

00:34:05.795 --> 00:34:06.816
pediatric therapist ever,

00:34:06.836 --> 00:34:09.338
but the mom knew that I had

00:34:09.418 --> 00:34:10.239
some amount of either

00:34:10.679 --> 00:34:12.222
experience or just confidence.

00:34:12.882 --> 00:34:13.842
And I thought that was a test.

00:34:15.815 --> 00:34:18.155
The fact that I'm so glad I

00:34:18.195 --> 00:34:19.175
didn't even see this post.

00:34:19.275 --> 00:34:20.117
I'm getting riled up just

00:34:20.197 --> 00:34:21.177
hearing about this post

00:34:21.496 --> 00:34:22.637
through Tony that a

00:34:23.097 --> 00:34:24.038
therapist is going to take

00:34:24.057 --> 00:34:24.918
a new job somewhere.

00:34:25.057 --> 00:34:25.778
Like you said, Tony,

00:34:27.099 --> 00:34:27.958
they want the full pay

00:34:28.259 --> 00:34:28.960
starting on day one,

00:34:29.320 --> 00:34:31.079
maybe even the benefits on day one,

00:34:31.119 --> 00:34:31.960
potentially on how the

00:34:31.981 --> 00:34:32.760
organization is run.

00:34:33.121 --> 00:34:35.041
But don't give me three new

00:34:35.081 --> 00:34:35.702
patient of ours.

00:34:35.722 --> 00:34:36.681
That's too much work.

00:34:37.603 --> 00:34:38.242
Unbelievable.

00:34:40.016 --> 00:34:41.295
And I think the truth is, Dave,

00:34:41.335 --> 00:34:42.416
you were probably a better

00:34:42.496 --> 00:34:45.378
clinician after you had that experience.

00:34:45.398 --> 00:34:46.780
It forced you to grow.

00:34:46.860 --> 00:34:48.621
You probably learned new things.

00:34:48.820 --> 00:34:50.742
You made yourself better.

00:34:52.123 --> 00:34:53.844
But I think the big picture here,

00:34:53.885 --> 00:34:55.905
the message here is not that,

00:34:56.266 --> 00:34:57.106
and I'll say it's not that

00:34:57.146 --> 00:34:59.288
this person's right or wrong, good or bad,

00:34:59.327 --> 00:34:59.768
whatever.

00:34:59.789 --> 00:35:02.570
I think we see how important culture is,

00:35:03.431 --> 00:35:04.632
the culture of the business,

00:35:04.692 --> 00:35:06.592
the culture of the community,

00:35:06.672 --> 00:35:07.614
the patient base.

00:35:08.653 --> 00:35:09.974
I'll go into situations even

00:35:10.014 --> 00:35:11.594
in my own clinic where I

00:35:11.695 --> 00:35:14.195
know I'm walking into a firestorm.

00:35:14.956 --> 00:35:15.635
I was in the clinic

00:35:15.655 --> 00:35:17.056
yesterday covering covering

00:35:17.097 --> 00:35:18.197
vacation for somebody.

00:35:18.217 --> 00:35:20.438
I would say at least three

00:35:20.498 --> 00:35:21.518
people walked in who

00:35:21.557 --> 00:35:22.619
weren't on the schedule.

00:35:23.697 --> 00:35:24.938
My failure as a leader,

00:35:25.458 --> 00:35:26.880
my systems broke down,

00:35:27.420 --> 00:35:28.882
plus the three people that

00:35:28.961 --> 00:35:30.161
were on the schedule.

00:35:30.902 --> 00:35:33.684
And these are pretty complicated cases.

00:35:33.704 --> 00:35:35.025
You know, relatively speaking,

00:35:35.065 --> 00:35:36.666
they were pretty complicated cases.

00:35:37.086 --> 00:35:38.447
Was it comfortable for me?

00:35:38.668 --> 00:35:39.789
Was I happy that that

00:35:39.849 --> 00:35:41.329
happened the way it happened?

00:35:41.510 --> 00:35:42.030
It wasn't.

00:35:42.771 --> 00:35:44.331
But the culture of the business,

00:35:44.652 --> 00:35:46.414
the culture of the patients

00:35:46.494 --> 00:35:48.335
that were coming to my business,

00:35:48.996 --> 00:35:49.996
we all had a great time.

00:35:50.077 --> 00:35:51.358
We talked about gardening.

00:35:51.577 --> 00:35:52.559
One of the patients had just

00:35:52.619 --> 00:35:53.559
opened a restaurant.

00:35:54.079 --> 00:35:55.161
She was talking to us about

00:35:55.201 --> 00:35:56.882
how a restaurant's going.

00:35:57.021 --> 00:35:58.603
I'm in a relatively small town.

00:35:58.764 --> 00:35:59.764
Two or three of them were

00:35:59.804 --> 00:36:00.965
neighbors that knew each other.

00:36:00.985 --> 00:36:02.726
So it was no big deal.

00:36:03.007 --> 00:36:05.108
Nobody was offended or angry

00:36:05.188 --> 00:36:05.949
that they didn't get the

00:36:06.048 --> 00:36:07.250
one-on-one care of that stuff.

00:36:07.670 --> 00:36:09.132
I billed appropriately for

00:36:09.192 --> 00:36:09.931
the units that were

00:36:09.952 --> 00:36:11.012
delivered that were direct

00:36:11.112 --> 00:36:11.793
one-on-one care.

00:36:12.454 --> 00:36:12.554
Um,

00:36:12.914 --> 00:36:15.056
but the point of that is I think there

00:36:15.076 --> 00:36:16.076
are a lot of clinicians

00:36:16.195 --> 00:36:18.056
rightfully so that would

00:36:18.077 --> 00:36:19.818
acquit after something like that,

00:36:20.018 --> 00:36:21.099
because that is not

00:36:21.199 --> 00:36:22.679
something within their personality.

00:36:22.719 --> 00:36:23.619
It's not something that they

00:36:23.659 --> 00:36:24.280
want to deal with.

00:36:25.021 --> 00:36:25.121
Um,

00:36:25.641 --> 00:36:27.641
and that is not a clinician that should

00:36:27.661 --> 00:36:28.762
be working for my clinic,

00:36:28.862 --> 00:36:29.862
but that is a perfect

00:36:29.923 --> 00:36:31.423
clinician for going to

00:36:31.483 --> 00:36:32.425
someplace where maybe

00:36:32.445 --> 00:36:34.425
you're doing women's health, pelvic floor,

00:36:34.606 --> 00:36:34.865
you know,

00:36:34.925 --> 00:36:36.327
persistent pain you're dealing with.

00:36:36.666 --> 00:36:37.106
mobile.

00:36:37.306 --> 00:36:38.768
You're one-on-one with your client.

00:36:38.807 --> 00:36:39.427
You're never going to have

00:36:39.507 --> 00:36:40.807
five other clients walk in

00:36:40.847 --> 00:36:41.668
at the same time,

00:36:42.387 --> 00:36:44.608
but understanding the culture and,

00:36:44.829 --> 00:36:47.130
and kind of what the clinic is like,

00:36:47.349 --> 00:36:49.070
I think is so powerful.

00:36:49.110 --> 00:36:50.170
And again, back to burnout,

00:36:50.751 --> 00:36:52.030
why are therapists burning out?

00:36:52.090 --> 00:36:52.710
Cause they think they're

00:36:52.751 --> 00:36:54.050
just taking a PT job and

00:36:54.070 --> 00:36:55.152
they're not realizing all

00:36:55.172 --> 00:36:56.492
of these nuances that are

00:36:56.592 --> 00:36:57.831
so important to them.

00:36:58.472 --> 00:36:59.072
Where are they going?

00:36:59.112 --> 00:37:00.032
If they're not staying in the clinic?

00:37:02.030 --> 00:37:03.472
Where what?

00:37:03.512 --> 00:37:04.632
So one place that they're

00:37:04.653 --> 00:37:08.356
saying that they're going is... Drum roll,

00:37:08.376 --> 00:37:08.737
please.

00:37:09.737 --> 00:37:10.938
You got to give me a second here.

00:37:10.978 --> 00:37:12.260
I don't have the drum roll queued up,

00:37:12.280 --> 00:37:13.481
but you got it.

00:37:13.981 --> 00:37:14.443
Buc-ee's.

00:37:15.463 --> 00:37:17.045
In the home health group on Facebook,

00:37:17.125 --> 00:37:17.425
Tony...

00:37:19.105 --> 00:37:20.085
By the way, sidebar,

00:37:20.286 --> 00:37:21.487
I think I'm going to leave

00:37:21.567 --> 00:37:22.768
every Facebook group except

00:37:22.807 --> 00:37:24.068
for the ones started by

00:37:24.168 --> 00:37:24.989
Jimmy McKay and Tony

00:37:25.009 --> 00:37:27.150
Meritato because they're my buddies here.

00:37:27.552 --> 00:37:28.552
But I think I'm going to

00:37:28.592 --> 00:37:31.315
leave every Facebook group on Facebook.

00:37:31.414 --> 00:37:32.755
There is so much negative sentiment.

00:37:32.835 --> 00:37:33.976
It is unbelievable.

00:37:34.016 --> 00:37:34.858
And here's an example.

00:37:35.318 --> 00:37:37.099
I forget the title of the group.

00:37:37.139 --> 00:37:39.300
It's like Home Health, I don't know, PT,

00:37:39.481 --> 00:37:41.123
OTSLP, whatever, Home Health.

00:37:41.643 --> 00:37:42.724
So now, again,

00:37:42.744 --> 00:37:45.067
there's a lot of negative

00:37:45.086 --> 00:37:45.728
sentiment about

00:37:45.768 --> 00:37:46.648
productivity and all that.

00:37:47.489 --> 00:37:49.152
And you can maybe pull up

00:37:49.271 --> 00:37:50.333
like hiring if they have a

00:37:51.273 --> 00:37:53.096
job board with all the salaries.

00:37:54.757 --> 00:37:55.858
And even Greg Todd posted

00:37:55.878 --> 00:37:58.061
this recently about the hiring thing.

00:37:58.081 --> 00:37:58.961
And they had this, by the way,

00:37:58.981 --> 00:38:00.103
because I took a trip down

00:38:00.123 --> 00:38:01.284
to Georgia a year or so ago.

00:38:02.985 --> 00:38:05.188
And on the, even on the gas pumps,

00:38:05.228 --> 00:38:05.829
like they're, they're,

00:38:05.949 --> 00:38:07.329
they're advertising to hire

00:38:08.010 --> 00:38:09.711
everywhere for Bucky's and there's,

00:38:09.992 --> 00:38:10.472
there's home health

00:38:10.492 --> 00:38:11.934
physical therapists say that, Oh my gosh,

00:38:11.954 --> 00:38:12.594
this is amazing.

00:38:12.634 --> 00:38:15.076
Like, you know, $115,000 salary.

00:38:15.577 --> 00:38:15.956
Yeah.

00:38:16.277 --> 00:38:16.476
Yeah.

00:38:16.496 --> 00:38:17.257
You want to be an assistant

00:38:17.297 --> 00:38:18.759
manager and scrub a hundred

00:38:18.798 --> 00:38:19.719
toilets and make sure,

00:38:19.880 --> 00:38:20.559
and you've got to be

00:38:20.621 --> 00:38:21.420
managing people that are

00:38:21.440 --> 00:38:22.262
supposed to be scrubbing

00:38:22.302 --> 00:38:24.523
toilets and are not coming for a 20 hour,

00:38:24.523 --> 00:38:26.465
$20 per hour job.

00:38:26.985 --> 00:38:28.967
And you want to be managing, you know,

00:38:29.788 --> 00:38:30.588
ribs being cut.

00:38:31.612 --> 00:38:32.134
Go ahead.

00:38:32.193 --> 00:38:33.054
See how fulfilling that's

00:38:33.074 --> 00:38:34.657
going to be because, again,

00:38:34.677 --> 00:38:37.000
the grass is always greener.

00:38:38.382 --> 00:38:39.663
Maybe that's the thing is if

00:38:40.523 --> 00:38:42.085
people are willing to take less money,

00:38:42.266 --> 00:38:45.644
I was willing to work for –

00:38:45.644 --> 00:38:47.606
They want the same or they want more money,

00:38:47.826 --> 00:38:49.865
but they just want to have it their way.

00:38:49.905 --> 00:38:51.106
But the point is then

00:38:51.126 --> 00:38:52.467
they're going to be – you

00:38:52.487 --> 00:38:53.547
want to go in a food?

00:38:53.686 --> 00:38:55.907
You want to go cut ribs and

00:38:55.967 --> 00:38:57.268
cut the fudge at Bucky's

00:38:57.307 --> 00:38:58.849
and scrub toilets and manage?

00:38:58.949 --> 00:39:00.568
It's just no matter what,

00:39:00.588 --> 00:39:01.309
people want more money,

00:39:01.329 --> 00:39:02.670
but they want less responsibilities.

00:39:03.309 --> 00:39:03.730
Hold on,

00:39:03.829 --> 00:39:05.590
but you just said something and

00:39:05.610 --> 00:39:06.590
left it out, right?

00:39:07.070 --> 00:39:08.652
I'm being sold rewarding.

00:39:08.851 --> 00:39:09.612
I'm getting there.

00:39:09.692 --> 00:39:11.052
It's not rewarding or

00:39:11.132 --> 00:39:12.373
financially securing.

00:39:12.853 --> 00:39:13.753
I feel gypped out here.

00:39:14.556 --> 00:39:16.958
So part of the home health

00:39:16.978 --> 00:39:17.958
group that I'm referring to,

00:39:18.438 --> 00:39:20.179
as Tony and I have discussed many times,

00:39:20.360 --> 00:39:21.599
is these home health

00:39:21.639 --> 00:39:23.340
companies are usually Medicare Part A,

00:39:23.621 --> 00:39:24.802
which goes back to the patients.

00:39:25.141 --> 00:39:26.021
The therapists go to the

00:39:26.061 --> 00:39:26.663
patient's home and the

00:39:26.702 --> 00:39:28.342
patients start cursing out

00:39:28.364 --> 00:39:29.523
the therapist because the

00:39:29.623 --> 00:39:31.344
patient doesn't want the therapy.

00:39:31.885 --> 00:39:33.365
The hospital is sending the

00:39:33.385 --> 00:39:35.047
Medicare Part A company,

00:39:35.166 --> 00:39:35.746
and these are companies

00:39:35.786 --> 00:39:36.367
across the whole US.

00:39:36.387 --> 00:39:37.307
I'm not even going to name

00:39:37.347 --> 00:39:37.927
any of the companies,

00:39:37.967 --> 00:39:39.548
but it's not really the company's fault,

00:39:39.568 --> 00:39:41.630
but it's the business that they're in.

00:39:42.289 --> 00:39:43.971
That the patients don't

00:39:44.030 --> 00:39:45.371
really want the therapy.

00:39:45.751 --> 00:39:48.693
And then the therapists feel the anger,

00:39:48.793 --> 00:39:49.474
the frustration.

00:39:49.494 --> 00:39:50.534
They got to deal with someone.

00:39:50.775 --> 00:39:51.594
They're going into someone's

00:39:51.614 --> 00:39:53.717
home and the patient is literally cursing,

00:39:54.117 --> 00:39:55.557
using every curse word possible.

00:39:55.797 --> 00:39:56.418
This is what I've heard,

00:39:56.697 --> 00:39:57.438
not just in New York,

00:39:57.759 --> 00:39:58.599
but across the country.

00:39:58.940 --> 00:40:00.099
They're cursing at the therapist.

00:40:00.601 --> 00:40:02.161
And Scott, I think earlier,

00:40:02.322 --> 00:40:03.722
said that that will suck the...

00:40:05.182 --> 00:40:06.565
life out of you or energy out of you,

00:40:06.585 --> 00:40:06.865
whatever.

00:40:06.885 --> 00:40:08.067
I think he wrote that earlier today.

00:40:08.989 --> 00:40:09.509
Yeah.

00:40:09.568 --> 00:40:10.670
Dealing with those kinds of

00:40:10.710 --> 00:40:11.612
patients all day long,

00:40:11.672 --> 00:40:13.153
set the life out of you by

00:40:13.193 --> 00:40:13.755
the end of the day.

00:40:13.795 --> 00:40:14.536
And that's just one day.

00:40:14.596 --> 00:40:15.237
And then you got to work

00:40:15.257 --> 00:40:17.019
there multiple days until

00:40:17.139 --> 00:40:18.101
you find a different job,

00:40:18.201 --> 00:40:18.802
either at a different

00:40:19.182 --> 00:40:20.103
physical therapy practice

00:40:21.105 --> 00:40:22.047
or you go work at Bucky's.

00:40:22.887 --> 00:40:24.969
But again, it's like these therapists,

00:40:24.989 --> 00:40:26.170
like there's no other,

00:40:26.592 --> 00:40:27.672
there's no other opportunities.

00:40:27.753 --> 00:40:28.594
There there's no,

00:40:28.753 --> 00:40:29.635
in the States that they're in,

00:40:29.655 --> 00:40:30.596
like there's no other,

00:40:31.476 --> 00:40:32.657
I'm sure they could work for Luna.

00:40:33.077 --> 00:40:34.139
I'm sure Luna is in a lot of

00:40:34.159 --> 00:40:35.000
these States that these

00:40:35.019 --> 00:40:35.860
home health therapists are

00:40:35.880 --> 00:40:36.501
complaining about.

00:40:37.001 --> 00:40:38.443
And if you did a Luna 1099, even though,

00:40:40.489 --> 00:40:41.630
I think Tony has a lot more

00:40:41.650 --> 00:40:42.391
affiliation with Luna and

00:40:42.411 --> 00:40:43.672
I'm kind of like, Luna's like, to me,

00:40:43.713 --> 00:40:45.554
I'm like a competitor or I

00:40:45.574 --> 00:40:46.835
think Luna's a competitor,

00:40:46.856 --> 00:40:48.157
but I'll be nice to Luna right now.

00:40:48.617 --> 00:40:50.599
Those therapists could

00:40:50.699 --> 00:40:51.780
absolutely join Luna.

00:40:51.900 --> 00:40:52.621
And then guess what?

00:40:52.963 --> 00:40:55.746
Those patients want that therapist coming.

00:40:56.286 --> 00:40:57.686
That's the disconnect is

00:40:57.706 --> 00:40:59.228
like these therapists go on

00:40:59.248 --> 00:41:00.389
Facebook and they're like,

00:41:00.728 --> 00:41:02.811
this profession is done.

00:41:03.690 --> 00:41:04.572
There's so much burnout.

00:41:04.731 --> 00:41:05.532
This is terrible.

00:41:05.552 --> 00:41:06.552
We're not getting paid enough.

00:41:06.612 --> 00:41:07.634
I'm going to go work at Bucky's.

00:41:08.094 --> 00:41:09.635
Their heads are in the sand.

00:41:09.715 --> 00:41:10.755
They don't understand what

00:41:10.835 --> 00:41:11.476
business they're in,

00:41:11.516 --> 00:41:12.958
what therapy practice they're in.

00:41:13.378 --> 00:41:14.159
They can change it up.

00:41:14.199 --> 00:41:14.498
And instead,

00:41:14.518 --> 00:41:15.280
these therapists go on

00:41:15.340 --> 00:41:16.460
Facebook and they talk

00:41:16.681 --> 00:41:18.802
negative town all day long.

00:41:18.842 --> 00:41:19.623
It's unbelievable.

00:41:20.458 --> 00:41:21.438
Needs versus wants.

00:41:21.679 --> 00:41:22.818
People will not complain

00:41:22.878 --> 00:41:24.780
about the cost of a PS5.

00:41:24.840 --> 00:41:25.460
They might a little bit,

00:41:25.481 --> 00:41:26.360
but they're still going to buy it.

00:41:26.721 --> 00:41:28.141
But I will vehemently

00:41:28.202 --> 00:41:29.123
complain about the cost of

00:41:29.163 --> 00:41:30.724
gasoline or the cost of food.

00:41:30.943 --> 00:41:33.684
So I think when I went into

00:41:33.704 --> 00:41:34.445
this profession,

00:41:34.545 --> 00:41:36.487
I thought I was providing a need.

00:41:38.079 --> 00:41:39.981
But if someone doesn't want it,

00:41:40.541 --> 00:41:42.862
I am now the harbinger of bad news.

00:41:43.322 --> 00:41:44.804
Here I am again to make you

00:41:44.824 --> 00:41:45.684
do those things you don't

00:41:45.724 --> 00:41:47.266
want to do to get the thing

00:41:47.286 --> 00:41:48.487
that you do want.

00:41:48.567 --> 00:41:49.407
But it's so far in the

00:41:49.467 --> 00:41:51.128
future that you're willing

00:41:51.168 --> 00:41:52.489
to say no short term.

00:41:53.170 --> 00:41:54.231
And then I guess you'll

00:41:54.251 --> 00:41:55.530
expect that long term thing

00:41:55.570 --> 00:41:56.012
to come about.

00:41:57.152 --> 00:41:57.672
Here's the thing.

00:41:57.713 --> 00:41:58.452
I don't know if anybody's

00:41:59.094 --> 00:42:00.494
devastatingly wrong here.

00:42:01.414 --> 00:42:04.396
is the profession was sold to people,

00:42:04.536 --> 00:42:05.916
explained to people.

00:42:05.936 --> 00:42:06.697
That's what selling is,

00:42:06.757 --> 00:42:08.338
is explaining to people.

00:42:09.079 --> 00:42:10.079
And when you got there,

00:42:10.119 --> 00:42:11.280
it wasn't quite like that.

00:42:11.900 --> 00:42:14.181
So you got angry.

00:42:14.442 --> 00:42:15.762
And I understand that.

00:42:15.802 --> 00:42:16.802
I'm not saying any of these things.

00:42:17.103 --> 00:42:17.744
No one's wrong.

00:42:17.784 --> 00:42:19.244
And simultaneously, no one's right.

00:42:19.585 --> 00:42:20.244
Everybody is.

00:42:20.304 --> 00:42:20.824
It depends.

00:42:20.985 --> 00:42:21.706
We're all in the middle.

00:42:22.503 --> 00:42:24.025
Um, but really the goal, I mean,

00:42:24.105 --> 00:42:25.025
I'm trying to understand

00:42:25.045 --> 00:42:25.726
what they're complaining

00:42:25.766 --> 00:42:27.527
about and you're right too, David,

00:42:27.568 --> 00:42:29.730
you can go make $150,000 at Bucky's,

00:42:30.170 --> 00:42:31.152
but you got to do Bucky things.

00:42:32.112 --> 00:42:33.273
It reminds me, I think it was,

00:42:33.434 --> 00:42:34.135
everybody wants to be a

00:42:34.155 --> 00:42:35.396
gangster until it's time to

00:42:35.416 --> 00:42:36.157
do gangster stuff.

00:42:38.259 --> 00:42:38.458
All right.

00:42:38.498 --> 00:42:39.619
I don't want to be a gangster,

00:42:40.940 --> 00:42:42.943
but I don't know if we got too far,

00:42:42.963 --> 00:42:45.465
but I will bring one more element in.

00:42:46.447 --> 00:42:48.347
You know, I remember a couple of years ago,

00:42:48.389 --> 00:42:49.349
we went to a really,

00:42:49.389 --> 00:42:51.030
really nice steakhouse and

00:42:51.130 --> 00:42:52.951
we're talking to the server.

00:42:53.411 --> 00:42:53.692
Actually,

00:42:53.711 --> 00:42:55.032
this has happened a couple of times.

00:42:55.072 --> 00:42:57.695
We were in Tampa, Burns Steakhouse.

00:42:57.755 --> 00:42:59.315
I don't know if anybody's familiar,

00:43:00.175 --> 00:43:02.418
but then also here in Ohio, Cincinnati,

00:43:02.438 --> 00:43:03.257
there's a precinct.

00:43:03.297 --> 00:43:04.599
Like, so there's a couple of really,

00:43:04.659 --> 00:43:06.719
really fine dining, beautiful steakhouse.

00:43:06.739 --> 00:43:08.661
I remember talking to the server and,

00:43:08.681 --> 00:43:10.362
you know, you go in and it's quiet,

00:43:10.402 --> 00:43:11.664
it's soothing, it's relaxing.

00:43:11.704 --> 00:43:13.063
It's an amazing experience.

00:43:14.025 --> 00:43:15.244
And I think about this, I'm like,

00:43:15.264 --> 00:43:16.125
all right, this person,

00:43:16.945 --> 00:43:18.126
I'm asking them questions.

00:43:18.206 --> 00:43:19.945
And I think it was the one in Tampa,

00:43:20.025 --> 00:43:20.465
Burns.

00:43:21.047 --> 00:43:23.126
The servers had to work on the farm.

00:43:23.186 --> 00:43:24.867
The farm raises the cattle.

00:43:24.947 --> 00:43:26.268
The server had to understand

00:43:26.367 --> 00:43:28.407
what the cows eat and do

00:43:28.487 --> 00:43:30.469
all of these things before

00:43:30.509 --> 00:43:32.748
they could even begin to serve customers.

00:43:32.789 --> 00:43:33.329
And then they had to

00:43:33.369 --> 00:43:34.489
understand the wine list

00:43:34.509 --> 00:43:35.190
and they had to go through

00:43:35.210 --> 00:43:36.590
all of this extensive training.

00:43:37.369 --> 00:43:38.610
And then I look at the server, you know,

00:43:38.670 --> 00:43:39.811
and they might have one,

00:43:39.911 --> 00:43:41.452
two tables a night,

00:43:42.173 --> 00:43:43.213
but they make a ridiculous

00:43:43.253 --> 00:43:43.775
amount of money.

00:43:43.795 --> 00:43:44.014
I mean,

00:43:44.034 --> 00:43:45.195
these are the highest of the

00:43:45.275 --> 00:43:48.117
highest professionals for what they do.

00:43:48.717 --> 00:43:50.079
And then the next day I

00:43:50.539 --> 00:43:51.320
might drive through a

00:43:51.380 --> 00:43:53.242
McDonald's drive-thru to get a coffee.

00:43:53.262 --> 00:43:54.463
And I'm thinking of the

00:43:54.523 --> 00:43:55.844
people behind the window

00:43:56.003 --> 00:43:57.565
and they're running like crazy.

00:43:57.585 --> 00:43:59.126
The line is around the

00:43:59.166 --> 00:44:00.806
building 24 hours a day,

00:44:00.847 --> 00:44:01.648
seven days a week.

00:44:01.668 --> 00:44:03.289
And they're making now maybe

00:44:03.289 --> 00:44:04.130
20 bucks an hour.

00:44:05.391 --> 00:44:07.152
And I just think these are both humans.

00:44:07.753 --> 00:44:09.014
They're both intelligent.

00:44:09.355 --> 00:44:11.077
They're both serving food.

00:44:11.097 --> 00:44:12.478
They're in the same industry.

00:44:13.278 --> 00:44:14.481
But they were at such polar

00:44:14.601 --> 00:44:16.061
opposite ends of the spectrum.

00:44:16.842 --> 00:44:19.106
And I know when I look at

00:44:19.146 --> 00:44:20.047
the person working the

00:44:20.067 --> 00:44:21.128
McDonald's drive-thru,

00:44:21.148 --> 00:44:22.590
that person would probably

00:44:22.630 --> 00:44:23.851
go crazy thinking,

00:44:24.110 --> 00:44:26.072
sitting in the Burns Steakhouse,

00:44:26.152 --> 00:44:27.331
doing all of those things

00:44:27.411 --> 00:44:28.932
at such a slow pace in such

00:44:28.952 --> 00:44:30.012
a quiet environment,

00:44:30.193 --> 00:44:31.574
even if they were making more money.

00:44:31.974 --> 00:44:32.594
And flip side,

00:44:32.634 --> 00:44:34.034
the server at Burns is not

00:44:34.054 --> 00:44:35.675
gonna work the McDonald's drive-through.

00:44:36.215 --> 00:44:37.356
And it's similar for me.

00:44:37.996 --> 00:44:39.536
I go crazy when I'm in the

00:44:39.597 --> 00:44:41.297
clinic with an hour time

00:44:41.336 --> 00:44:42.757
slot for every patient and

00:44:42.797 --> 00:44:44.458
I see five patients in a day.

00:44:45.059 --> 00:44:47.119
I feel like I've just burned a day.

00:44:47.239 --> 00:44:48.780
I've lost so much productivity.

00:44:48.820 --> 00:44:49.559
There are so many more

00:44:49.599 --> 00:44:50.481
things I could have done.

00:44:51.820 --> 00:44:54.202
It just destroys me as a clinician.

00:44:54.902 --> 00:44:57.324
But I thrive in three, four,

00:44:57.385 --> 00:44:58.646
five people in the clinic.

00:44:58.686 --> 00:45:00.025
Everybody's kind of grooving

00:45:00.085 --> 00:45:01.427
and talking and socializing.

00:45:01.467 --> 00:45:02.347
We're having a good time.

00:45:02.427 --> 00:45:03.728
A day I'll fly like that.

00:45:04.389 --> 00:45:06.289
So back to once again,

00:45:06.710 --> 00:45:09.331
we can call ourselves physical therapists,

00:45:09.371 --> 00:45:10.552
but we can deliver such

00:45:10.693 --> 00:45:11.873
different experiences.

00:45:11.934 --> 00:45:13.715
We can enjoy such different settings.

00:45:14.094 --> 00:45:14.675
What's up, Jimmy?

00:45:14.795 --> 00:45:15.476
You look like you're going

00:45:15.496 --> 00:45:15.896
to say something.

00:45:16.396 --> 00:45:17.097
I was just agreeing.

00:45:17.117 --> 00:45:17.797
That's just my face.

00:45:17.956 --> 00:45:18.597
I always look like I'm going

00:45:18.617 --> 00:45:19.177
to say something.

00:45:21.148 --> 00:45:21.588
Yeah,

00:45:21.628 --> 00:45:23.369
Scott said Tony doesn't want to be a

00:45:23.429 --> 00:45:24.831
gangster, but he is a bike.

00:45:24.891 --> 00:45:25.110
Yeah.

00:45:26.192 --> 00:45:26.813
By the way,

00:45:26.833 --> 00:45:27.612
we still haven't seen this

00:45:27.632 --> 00:45:28.333
Harley Davidson.

00:45:28.494 --> 00:45:28.954
I know.

00:45:29.114 --> 00:45:30.135
I'm getting there.

00:45:31.096 --> 00:45:33.777
My son has a little, what is it,

00:45:33.898 --> 00:45:36.460
a vending machine at that clinic,

00:45:36.480 --> 00:45:37.681
and he's dying for me to go

00:45:37.740 --> 00:45:39.222
there to see how much money he's made,

00:45:39.601 --> 00:45:40.563
my 11-year-old.

00:45:41.043 --> 00:45:42.204
So I will go there.

00:45:42.324 --> 00:45:43.684
I'll get a picture of the vending machine,

00:45:43.704 --> 00:45:44.965
and I'll get a picture of the Harley.

00:45:45.206 --> 00:45:46.807
Maybe I'll even put on some leather.

00:45:46.827 --> 00:45:47.088
Yeah.

00:45:47.619 --> 00:45:48.139
There we go.

00:45:48.900 --> 00:45:49.719
So I agree.

00:45:49.739 --> 00:45:50.760
I like that analogy, Tony,

00:45:50.860 --> 00:45:52.862
of the the waiter or the, you know,

00:45:52.882 --> 00:45:54.163
the food handler, whatever you want,

00:45:54.182 --> 00:45:54.963
whatever you call it,

00:45:55.003 --> 00:45:56.244
like the fast food person

00:45:56.264 --> 00:45:57.445
that's running around like crazy.

00:45:57.945 --> 00:45:59.467
They are based, you know,

00:45:59.586 --> 00:46:00.726
it's a volume type place

00:46:00.788 --> 00:46:02.389
versus the example of the

00:46:02.429 --> 00:46:03.949
waiter who's at a fine

00:46:04.389 --> 00:46:06.411
dining steakhouse who maybe

00:46:06.510 --> 00:46:08.472
has one table at a time and

00:46:08.512 --> 00:46:09.353
maybe they're only serving

00:46:09.413 --> 00:46:10.454
a couple of tables per night.

00:46:11.094 --> 00:46:13.398
They get paid a lot more and

00:46:13.438 --> 00:46:15.701
then they get tipped a

00:46:15.740 --> 00:46:17.262
large amount because of the

00:46:17.302 --> 00:46:18.525
cost of food and all that.

00:46:19.445 --> 00:46:21.969
That's the point is the

00:46:22.090 --> 00:46:22.911
people that are in that

00:46:22.951 --> 00:46:24.592
example that are working in

00:46:24.612 --> 00:46:25.934
the fast food industry,

00:46:26.135 --> 00:46:27.596
They don't understand like

00:46:27.615 --> 00:46:30.237
they need to either increase their skills,

00:46:30.317 --> 00:46:31.398
their understanding of like

00:46:31.458 --> 00:46:33.719
what else is possible in that industry.

00:46:34.018 --> 00:46:35.139
Like, hey, oh, wow.

00:46:35.219 --> 00:46:36.260
If I, you know,

00:46:36.280 --> 00:46:37.159
if I watch if I go on

00:46:37.179 --> 00:46:39.820
Netflix and I watch the show Bear,

00:46:39.840 --> 00:46:40.942
I don't know if you guys

00:46:40.981 --> 00:46:41.481
heard of the show.

00:46:41.521 --> 00:46:42.302
Have you guys heard of the show?

00:46:42.623 --> 00:46:42.722
Yeah.

00:46:42.762 --> 00:46:42.862
Yeah.

00:46:44.092 --> 00:46:45.293
So Tony has and Jimmy has.

00:46:46.134 --> 00:46:48.775
It's like a Michelin star

00:46:49.195 --> 00:46:52.476
chef who goes back to his roots.

00:46:52.536 --> 00:46:53.418
I think he learned in Paris

00:46:53.438 --> 00:46:54.177
and all these other places.

00:46:54.237 --> 00:46:55.239
And he's a Michelin star

00:46:55.659 --> 00:46:56.858
chef at some big restaurant.

00:46:56.878 --> 00:46:58.800
And then he goes back to his roots at some,

00:46:58.980 --> 00:46:59.201
what is it,

00:46:59.221 --> 00:47:02.302
like a roast beef or like a steak joint,

00:47:02.342 --> 00:47:04.822
a steak sandwich type place in Chicago.

00:47:05.384 --> 00:47:07.605
And then he brings the whole environment.

00:47:07.644 --> 00:47:08.605
He brings like, you know,

00:47:09.146 --> 00:47:09.965
you're doing everything wrong.

00:47:10.005 --> 00:47:11.067
Everything's dirty, this and that.

00:47:11.086 --> 00:47:11.907
Nothing's organized.

00:47:12.367 --> 00:47:13.648
And it's about the pride in the

00:47:14.068 --> 00:47:14.809
the work and all that.

00:47:16.909 --> 00:47:17.550
In the example,

00:47:17.570 --> 00:47:18.692
the folks that are in the

00:47:19.052 --> 00:47:22.554
fast food line working in those jobs,

00:47:22.675 --> 00:47:23.795
there's a disconnect.

00:47:23.896 --> 00:47:26.117
They can't fathom the difference.

00:47:26.398 --> 00:47:27.358
They don't need that much

00:47:27.458 --> 00:47:28.639
skill or that much

00:47:28.699 --> 00:47:30.079
understanding to change

00:47:30.119 --> 00:47:30.940
themselves from where

00:47:30.981 --> 00:47:32.922
they're at there to working

00:47:32.943 --> 00:47:34.304
at a fine dining establishment.

00:47:34.784 --> 00:47:35.543
we've all been at fine

00:47:35.583 --> 00:47:36.824
dining establishments and

00:47:37.083 --> 00:47:38.324
it's not just one type of a person.

00:47:38.385 --> 00:47:39.445
It could be someone who has

00:47:39.525 --> 00:47:41.005
tattoos or long hair or whatever,

00:47:41.344 --> 00:47:41.644
but it's,

00:47:42.065 --> 00:47:43.346
they got themselves into that

00:47:43.385 --> 00:47:45.286
position because they maybe

00:47:45.525 --> 00:47:47.226
want to make more per hour or whatever.

00:47:47.385 --> 00:47:48.706
And you do have to have,

00:47:48.786 --> 00:47:49.646
you do have to have some

00:47:49.706 --> 00:47:50.507
evolution of yourself.

00:47:50.527 --> 00:47:52.047
You have to increase your skills.

00:47:52.067 --> 00:47:54.047
You have to carry yourself differently,

00:47:54.106 --> 00:47:54.467
whatever.

00:47:55.427 --> 00:47:56.987
But I just would wish like

00:47:57.307 --> 00:47:58.668
the last thing to do is go

00:47:58.708 --> 00:48:00.028
on Facebook and say your

00:48:00.128 --> 00:48:02.168
whole industry is terrible and wrong.

00:48:02.588 --> 00:48:04.610
So that is never a good look, right?

00:48:04.750 --> 00:48:06.110
Because nobody wants to be

00:48:06.130 --> 00:48:07.050
with the whiners, right?

00:48:07.070 --> 00:48:07.911
We call them Eeyores.

00:48:08.512 --> 00:48:09.952
Nobody wants to be with an Eeyore.

00:48:10.152 --> 00:48:11.472
They drag everybody down.

00:48:11.672 --> 00:48:13.713
Even if they have some valid points,

00:48:14.375 --> 00:48:15.855
those people signal to the world,

00:48:15.875 --> 00:48:17.175
I am not about solving them.

00:48:17.195 --> 00:48:18.436
I am about sitting down and

00:48:18.556 --> 00:48:19.836
pointing at those things and saying,

00:48:19.876 --> 00:48:20.516
it's not fair.

00:48:20.878 --> 00:48:22.438
I'm taking my ball and I'm going home.

00:48:23.059 --> 00:48:23.398
So go.

00:48:24.380 --> 00:48:25.280
But those people stick

00:48:25.320 --> 00:48:26.422
around and they bring a lot

00:48:26.442 --> 00:48:26.882
of other people.

00:48:26.902 --> 00:48:27.742
So we're either in the

00:48:27.782 --> 00:48:29.644
business of fixing this or get out.

00:48:30.346 --> 00:48:30.505
Right.

00:48:30.545 --> 00:48:31.286
And there are enough.

00:48:31.626 --> 00:48:33.188
The funny part is and you'll

00:48:33.228 --> 00:48:34.710
find just saw a great bell

00:48:34.750 --> 00:48:36.052
curve diagram the other day

00:48:36.632 --> 00:48:39.155
is what you see and hear on

00:48:39.255 --> 00:48:40.496
social media everywhere.

00:48:40.556 --> 00:48:42.117
It's it's at a party to the

00:48:42.157 --> 00:48:43.759
bell curve exists at the party, too.

00:48:44.539 --> 00:48:46.221
You hear the far left and

00:48:46.240 --> 00:48:48.981
the far right of any argument the loudest,

00:48:49.081 --> 00:48:50.722
and you assume that those

00:48:50.762 --> 00:48:51.643
are the two options.

00:48:51.963 --> 00:48:52.483
That ain't true.

00:48:53.003 --> 00:48:54.384
There are the silent majority.

00:48:54.884 --> 00:48:55.985
We've got a couple people

00:48:56.025 --> 00:48:57.585
commenting on these live streams.

00:48:58.585 --> 00:48:59.945
I get X number of downloads.

00:48:59.965 --> 00:49:01.086
We get X number of views.

00:49:01.106 --> 00:49:02.766
We got 41 people watching

00:49:02.887 --> 00:49:04.748
right now and two people

00:49:04.887 --> 00:49:05.768
actively commenting.

00:49:05.889 --> 00:49:06.628
That math checks.

00:49:07.369 --> 00:49:08.489
There are people who want to

00:49:08.530 --> 00:49:09.869
learn and find solutions,

00:49:10.309 --> 00:49:11.550
but don't pay attention to

00:49:12.885 --> 00:49:13.666
Just the Eeyores,

00:49:13.726 --> 00:49:15.666
just the whiners all the time.

00:49:16.487 --> 00:49:17.867
Don't listen to what people say.

00:49:18.068 --> 00:49:18.927
Watch what they do.

00:49:19.608 --> 00:49:21.750
Smart people will tell you that.

00:49:21.809 --> 00:49:22.889
Don't listen to what I say

00:49:22.909 --> 00:49:23.730
in my books or my videos.

00:49:23.751 --> 00:49:25.210
Watch what I'm doing in the background.

00:49:25.710 --> 00:49:27.391
That is a successful.

00:49:27.472 --> 00:49:28.813
So find the PTs.

00:49:28.833 --> 00:49:29.172
I mean,

00:49:29.213 --> 00:49:30.233
if you really wanted to get out of this,

00:49:30.614 --> 00:49:31.534
find the PTs who are

00:49:31.574 --> 00:49:33.474
somehow happy in their jobs.

00:49:33.795 --> 00:49:34.416
Watch what they do.

00:49:35.335 --> 00:49:36.536
That's the end, in my opinion.

00:49:37.436 --> 00:49:38.757
And I think they're just happy people.

00:49:39.297 --> 00:49:40.458
I think it goes back to that.

00:49:40.860 --> 00:49:42.882
My wife could be happy doing

00:49:43.121 --> 00:49:44.023
anything because she is

00:49:44.063 --> 00:49:45.184
just a happy person.

00:49:45.603 --> 00:49:46.885
She's happy to be alive.

00:49:46.925 --> 00:49:48.686
She's happy to be healthy

00:49:48.786 --> 00:49:50.128
and moving around and doing

00:49:50.168 --> 00:49:50.949
the things that humans do.

00:49:52.871 --> 00:49:54.512
Real quick, as we wind down,

00:49:54.532 --> 00:49:55.891
I want to hit a tactical

00:49:56.771 --> 00:49:57.913
piece of information.

00:49:57.932 --> 00:49:58.913
I'm going to share this.

00:49:59.432 --> 00:50:00.134
Nancy Beckley,

00:50:00.173 --> 00:50:01.673
thank you so much for sharing this.

00:50:02.213 --> 00:50:04.855
So this was from Medicare Advocacy.

00:50:05.275 --> 00:50:06.735
And basically what it is,

00:50:06.896 --> 00:50:08.036
I'll scroll down to what I

00:50:08.076 --> 00:50:09.317
think is the key component.

00:50:10.117 --> 00:50:11.396
Under the final rule,

00:50:11.697 --> 00:50:13.398
covered entities and

00:50:13.478 --> 00:50:14.818
providers are required to

00:50:14.878 --> 00:50:17.139
provide qualified interpreters.

00:50:17.818 --> 00:50:19.878
People with LEP cannot be

00:50:19.958 --> 00:50:21.159
required to provide their

00:50:21.340 --> 00:50:23.000
own interpreters and

00:50:23.079 --> 00:50:25.639
notices and taglines are

00:50:25.701 --> 00:50:28.420
required to in the top 15

00:50:28.420 --> 00:50:30.041
languages spoken by people

00:50:30.601 --> 00:50:32.782
with LEP in each state.

00:50:32.842 --> 00:50:32.981
Now,

00:50:33.202 --> 00:50:35.503
LEP stands for Limited English

00:50:35.663 --> 00:50:36.342
Proficiency.

00:50:37.389 --> 00:50:38.996
So, basically, as I understand it,

00:50:39.016 --> 00:50:40.905
and I am certainly not an expert in this.

00:50:40.925 --> 00:50:42.090
This came out yesterday.

00:50:42.590 --> 00:50:42.811
Yeah.

00:50:43.231 --> 00:50:43.411
Yeah.

00:50:43.471 --> 00:50:45.351
This is brand new, hot off the presses.

00:50:46.193 --> 00:50:47.472
Private practice owners,

00:50:47.652 --> 00:50:50.735
we are required to provide interpreters.

00:50:51.175 --> 00:50:52.315
It is our expense.

00:50:52.755 --> 00:50:53.795
We have to pay for it.

00:50:54.775 --> 00:50:57.797
And this is one of those things where,

00:50:57.958 --> 00:50:58.338
again,

00:50:58.438 --> 00:51:00.418
like the manual therapy being a bribe,

00:51:00.978 --> 00:51:02.619
I'm so conflicted.

00:51:02.639 --> 00:51:03.960
I have such mixed feelings

00:51:04.019 --> 00:51:06.061
about this because on the one hand,

00:51:06.101 --> 00:51:07.081
I look at it and I'm like,

00:51:07.802 --> 00:51:09.903
Don't tell me what is right

00:51:09.963 --> 00:51:11.364
and what is what is wrong

00:51:11.525 --> 00:51:12.565
in regards to government.

00:51:12.626 --> 00:51:14.568
Like, don't legislate what I do.

00:51:14.588 --> 00:51:16.809
I understand we need to

00:51:16.869 --> 00:51:18.471
protect those that are vulnerable.

00:51:18.510 --> 00:51:19.492
But at the same time,

00:51:19.512 --> 00:51:21.094
this is going to put cost burdens.

00:51:21.173 --> 00:51:21.974
Now, I mean,

00:51:21.994 --> 00:51:23.496
the real reality is I've had

00:51:23.536 --> 00:51:25.918
like two in 20 years that

00:51:26.478 --> 00:51:28.179
are patients who needed an interpreter.

00:51:29.925 --> 00:51:31.086
But I'm sure there are

00:51:31.146 --> 00:51:33.347
places where this is a more

00:51:33.407 --> 00:51:34.528
common scenario.

00:51:36.170 --> 00:51:38.190
And what does it do at the end of the day?

00:51:38.210 --> 00:51:39.913
It drives small providers

00:51:39.952 --> 00:51:40.813
that can't afford an

00:51:40.873 --> 00:51:42.373
interpreter on top of

00:51:42.474 --> 00:51:44.315
Medicare reimbursement or even worse,

00:51:44.376 --> 00:51:45.655
Medicaid reimbursement.

00:51:46.237 --> 00:51:47.077
Just drives them out of the

00:51:47.097 --> 00:51:48.757
business like there is no way.

00:51:49.759 --> 00:51:50.659
Now, to Dave's point,

00:51:51.219 --> 00:51:52.380
this is where you go back

00:51:52.420 --> 00:51:53.360
to and you're like, all right,

00:51:53.460 --> 00:51:55.041
I could go into business for myself,

00:51:55.101 --> 00:51:56.422
but the expenses are too high.

00:51:56.822 --> 00:51:58.762
I can't afford a HIPAA compliant EMR.

00:51:58.862 --> 00:51:59.923
I can't afford HIPAA

00:51:59.983 --> 00:52:01.164
compliant privacy and

00:52:01.204 --> 00:52:02.625
policy manuals that cost

00:52:02.664 --> 00:52:03.644
fifteen hundred dollars.

00:52:04.126 --> 00:52:05.326
I can't afford, you know,

00:52:05.445 --> 00:52:06.967
ADA compliance if I'm going

00:52:06.987 --> 00:52:08.688
to open a clinic and facility.

00:52:09.608 --> 00:52:11.228
All of this legislation just

00:52:11.268 --> 00:52:12.429
makes it harder and harder

00:52:12.469 --> 00:52:13.550
for the individual to go

00:52:13.610 --> 00:52:14.992
into business for themselves.

00:52:15.693 --> 00:52:17.514
And so what you end up with

00:52:17.775 --> 00:52:19.056
is everything gets pushed

00:52:19.115 --> 00:52:21.818
toward where the money is, hospital loan,

00:52:21.918 --> 00:52:23.659
large facilities, things like that.

00:52:23.739 --> 00:52:24.280
And of course,

00:52:24.320 --> 00:52:25.079
they're the ones with the

00:52:25.099 --> 00:52:26.400
politicians in their pocket.

00:52:26.902 --> 00:52:28.682
They're the ones with the deep pockets,

00:52:28.742 --> 00:52:29.103
you know.

00:52:29.184 --> 00:52:30.304
So, yeah.

00:52:30.945 --> 00:52:32.347
I want to protect the vulnerable,

00:52:32.387 --> 00:52:33.469
but at the same time,

00:52:33.789 --> 00:52:34.911
there's got to be some free

00:52:34.972 --> 00:52:36.215
market because I know that

00:52:36.295 --> 00:52:38.038
so many of us can provide a

00:52:38.077 --> 00:52:38.940
better patient care

00:52:38.980 --> 00:52:40.521
experience if we didn't

00:52:40.561 --> 00:52:41.684
have so much regulation.

00:52:43.137 --> 00:52:45.119
I skip right to how can we

00:52:45.179 --> 00:52:46.019
tactically solve this

00:52:46.079 --> 00:52:47.960
problem on a scalable way.

00:52:48.021 --> 00:52:49.621
Like hospital systems, a lot of times,

00:52:49.780 --> 00:52:51.922
hospitals had this problem for, or this,

00:52:52.242 --> 00:52:52.963
I shouldn't say problem,

00:52:52.983 --> 00:52:53.923
but they had this situation

00:52:53.963 --> 00:52:54.784
for a long time, right?

00:52:55.284 --> 00:52:55.965
Where they would have a

00:52:56.125 --> 00:52:57.485
service and you would bring

00:52:57.525 --> 00:52:59.065
in a phone and then that

00:52:59.085 --> 00:53:00.067
would have access to

00:53:00.146 --> 00:53:01.306
interpreters somewhere in a

00:53:01.367 --> 00:53:02.148
central database.

00:53:02.867 --> 00:53:04.108
So it was like syndicating,

00:53:04.548 --> 00:53:05.829
nationally syndicating or

00:53:05.869 --> 00:53:07.751
worldwide syndicating an interpreter.

00:53:08.471 --> 00:53:09.192
Now you've got AI.

00:53:09.952 --> 00:53:10.632
I know it says something

00:53:10.672 --> 00:53:11.552
about artificial

00:53:11.592 --> 00:53:12.954
intelligence in that article,

00:53:13.893 --> 00:53:15.815
but those services out there exist.

00:53:15.934 --> 00:53:17.775
Can you just pay per use on that?

00:53:17.836 --> 00:53:19.217
Would that mitigate the cost

00:53:19.257 --> 00:53:20.217
and reduce the burden?

00:53:20.956 --> 00:53:21.215
Yeah.

00:53:21.275 --> 00:53:22.996
So later it says the new

00:53:23.036 --> 00:53:24.318
rule also addresses the

00:53:24.398 --> 00:53:26.420
emerging area of machine AI

00:53:26.480 --> 00:53:28.360
interpretation and translation.

00:53:28.440 --> 00:53:30.561
It's expressly accounts for

00:53:30.802 --> 00:53:32.164
intersectional

00:53:32.324 --> 00:53:33.824
discrimination in health care.

00:53:33.844 --> 00:53:35.445
Yeah.

00:53:35.666 --> 00:53:38.148
I mean, every time government passes a law,

00:53:38.228 --> 00:53:40.048
hence Nancy Pelosi is the

00:53:40.088 --> 00:53:41.949
best investor of all time.

00:53:42.550 --> 00:53:44.070
Every time government passes

00:53:44.211 --> 00:53:46.052
more regulation and more laws.

00:53:46.273 --> 00:53:48.134
How does she know what to invest in?

00:53:48.213 --> 00:53:48.835
How does she know?

00:53:49.175 --> 00:53:50.034
Insider trading.

00:53:54.759 --> 00:53:55.719
Sign language interpreter

00:53:55.760 --> 00:53:57.840
for a client lost 75 a visit.

00:53:57.920 --> 00:53:59.842
It happened once, but he slept well.

00:54:00.382 --> 00:54:01.224
But it's like, hey.

00:54:03.501 --> 00:54:04.563
Here's the definition of

00:54:04.603 --> 00:54:05.623
innovation that I stole

00:54:05.684 --> 00:54:07.264
from a former boss, David Petrino.

00:54:07.405 --> 00:54:08.206
Find a problem that

00:54:08.266 --> 00:54:09.347
everybody's looking at it and saying,

00:54:09.367 --> 00:54:10.047
not my problem.

00:54:10.447 --> 00:54:11.248
Solve that problem.

00:54:11.568 --> 00:54:12.989
So this only happened to Michael once.

00:54:13.309 --> 00:54:14.831
And it's unfortunate that he

00:54:14.891 --> 00:54:16.112
was able to provide great care.

00:54:16.592 --> 00:54:17.092
He did that.

00:54:17.132 --> 00:54:17.893
The person got it.

00:54:17.952 --> 00:54:18.373
And Michael,

00:54:18.454 --> 00:54:20.594
good for you on losing $75 a visit,

00:54:20.614 --> 00:54:21.315
but still doing it.

00:54:21.755 --> 00:54:22.936
He shouldn't have had to do that.

00:54:23.657 --> 00:54:24.878
This person should have also

00:54:24.918 --> 00:54:27.139
gotten the best care

00:54:27.179 --> 00:54:28.400
possible in the way they wanted.

00:54:29.001 --> 00:54:30.242
Someone solves this problem.

00:54:31.806 --> 00:54:32.806
That's a business, right?

00:54:32.947 --> 00:54:34.007
The problem we're talking about,

00:54:34.188 --> 00:54:36.048
ASL or different languages.

00:54:37.929 --> 00:54:39.510
Scott said, I'm in Florida.

00:54:39.771 --> 00:54:41.012
Do I hire a therapist that

00:54:41.032 --> 00:54:43.313
speaks Spanish or do I hire,

00:54:43.554 --> 00:54:44.474
pay for an interpreter?

00:54:45.215 --> 00:54:45.434
I mean,

00:54:45.474 --> 00:54:46.635
if you're a physical therapist who

00:54:46.655 --> 00:54:48.396
speaks another language and

00:54:48.436 --> 00:54:51.057
you can now be zoomed in to a...

00:54:52.204 --> 00:54:54.126
And now that is a provided service.

00:54:54.547 --> 00:54:54.847
Gosh,

00:54:55.027 --> 00:54:57.050
an EMR company could embed that in

00:54:57.090 --> 00:54:58.351
their EMR with a little button.

00:54:58.431 --> 00:54:59.472
I need someone right now

00:54:59.572 --> 00:55:01.213
live or I see it on my

00:55:01.275 --> 00:55:02.795
schedule that this person

00:55:02.815 --> 00:55:03.496
speaks this language.

00:55:03.516 --> 00:55:04.717
So can you can you like

00:55:04.777 --> 00:55:06.059
reserve the Uber ahead of time?

00:55:06.099 --> 00:55:07.380
Can you reserve the interpreter?

00:55:07.661 --> 00:55:08.202
Because I'm going to need

00:55:08.222 --> 00:55:08.961
that person in front of

00:55:08.983 --> 00:55:09.802
their computer because I'm

00:55:09.822 --> 00:55:10.463
going to be in front of my

00:55:10.503 --> 00:55:12.286
computer with that person at one thirty.

00:55:13.494 --> 00:55:14.494
And Scott just said it

00:55:14.534 --> 00:55:15.496
should be on the patient.

00:55:15.657 --> 00:55:16.197
Should it not?

00:55:16.336 --> 00:55:19.019
So my feeling like as a practice owner,

00:55:19.760 --> 00:55:20.541
it's got to be either on

00:55:20.561 --> 00:55:21.402
the patient or it's got to

00:55:21.422 --> 00:55:22.903
be on Medicare or the

00:55:22.963 --> 00:55:23.824
insurance companies.

00:55:23.945 --> 00:55:25.706
And ideally, it's easier to just say, oh,

00:55:25.726 --> 00:55:26.547
it should be these, you know,

00:55:26.567 --> 00:55:27.347
these multibillion dollar

00:55:27.367 --> 00:55:29.150
insurance companies to pay for this.

00:55:29.210 --> 00:55:29.990
And it should have already

00:55:30.010 --> 00:55:32.032
been some CPT code like 20

00:55:32.032 --> 00:55:32.853
years ago or something.

00:55:33.253 --> 00:55:34.815
The fact that it's not is crazy.

00:55:35.735 --> 00:55:36.275
Michael Silva,

00:55:36.295 --> 00:55:36.876
thank you again for your

00:55:36.896 --> 00:55:37.936
comment live here.

00:55:38.556 --> 00:55:38.916
And yeah,

00:55:38.956 --> 00:55:41.436
he absorbed the $75 per visit charge.

00:55:41.476 --> 00:55:43.538
But imagine if that was like, you know,

00:55:43.597 --> 00:55:44.619
three patients a day,

00:55:45.179 --> 00:55:46.699
like in some clinics, like you can't,

00:55:47.159 --> 00:55:48.420
practice is not going to absorb that.

00:55:48.460 --> 00:55:49.059
That's crazy.

00:55:49.119 --> 00:55:49.900
Like that's absurd.

00:55:50.481 --> 00:55:50.900
That's absurd.

00:55:50.960 --> 00:55:51.782
Like, how do you compete?

00:55:51.902 --> 00:55:52.061
Like,

00:55:52.202 --> 00:55:53.422
let's say if you're in some inner

00:55:53.443 --> 00:55:54.503
city and what if like 50%

00:55:54.503 --> 00:55:57.284
of your caseload was like a

00:55:57.364 --> 00:55:58.545
mix of all different languages,

00:55:58.784 --> 00:56:00.005
not like the example of, oh,

00:56:00.045 --> 00:56:01.327
let me hire one therapist

00:56:01.347 --> 00:56:02.306
that can speak Spanish.

00:56:02.586 --> 00:56:04.188
But let's say like even here in Brooklyn,

00:56:04.208 --> 00:56:05.929
like you walk down the

00:56:06.128 --> 00:56:07.809
street here in Brooklyn, you hear Russian,

00:56:07.869 --> 00:56:10.271
Bengali, English, Polish, Spanish,

00:56:10.371 --> 00:56:11.052
you hear everything.

00:56:11.532 --> 00:56:13.652
So if some practices,

00:56:13.693 --> 00:56:15.114
this would like annihilate

00:56:15.153 --> 00:56:15.855
these practices.

00:56:15.894 --> 00:56:16.014
So

00:56:16.835 --> 00:56:17.135
I mean,

00:56:17.514 --> 00:56:19.155
it should be on the patient or it

00:56:19.195 --> 00:56:20.396
should be on the Medicare

00:56:20.496 --> 00:56:21.295
or the insurances,

00:56:21.356 --> 00:56:23.237
but to have it be the cost

00:56:23.317 --> 00:56:24.777
of the practice is absurd.

00:56:25.277 --> 00:56:26.297
What if Michael crushed it

00:56:26.438 --> 00:56:29.079
and all the people in the area were like,

00:56:29.099 --> 00:56:30.699
this guy's great, and they start going,

00:56:30.719 --> 00:56:31.920
and what is he supposed to do?

00:56:32.840 --> 00:56:33.481
Right.

00:56:33.541 --> 00:56:35.342
Let's tease a future episode.

00:56:35.501 --> 00:56:37.003
I love business ideas.

00:56:37.603 --> 00:56:37.862
I mean,

00:56:37.882 --> 00:56:39.764
there are multiple business ideas

00:56:39.804 --> 00:56:41.523
that come out of this new law,

00:56:41.583 --> 00:56:43.164
this new legislation from

00:56:43.324 --> 00:56:45.585
obviously AI technology to

00:56:45.766 --> 00:56:47.106
even I'll tease this one.

00:56:47.186 --> 00:56:48.606
So Dave and I talked about

00:56:49.027 --> 00:56:50.288
cash therapists who are

00:56:50.367 --> 00:56:51.708
unaffiliated with Medicare

00:56:51.847 --> 00:56:53.568
can't do a Medicare covered

00:56:53.588 --> 00:56:55.510
evaluation without billing Medicare.

00:56:55.889 --> 00:56:56.869
So what should they do?

00:56:56.949 --> 00:56:58.650
They could hire a contracted

00:56:58.690 --> 00:57:00.431
therapist to telehealth in themselves.

00:57:01.192 --> 00:57:02.572
do the evaluation,

00:57:02.994 --> 00:57:03.554
and then make the

00:57:03.594 --> 00:57:05.135
determination if future

00:57:05.175 --> 00:57:06.257
services are covered.

00:57:06.436 --> 00:57:06.976
If they're not,

00:57:07.438 --> 00:57:09.360
the cash PT can deliver those services.

00:57:10.000 --> 00:57:11.702
I see the same opportunity here.

00:57:11.742 --> 00:57:12.463
I've talked about this

00:57:12.543 --> 00:57:14.804
actually a bunch of times where I said,

00:57:14.864 --> 00:57:17.106
look, if I'm a Spanish speaking,

00:57:18.027 --> 00:57:21.150
if I'm a French speaking native therapist,

00:57:21.210 --> 00:57:23.052
if I'm in the Philippines

00:57:23.152 --> 00:57:24.193
and I can speak their

00:57:24.233 --> 00:57:25.554
language and they're

00:57:25.655 --> 00:57:26.574
This should be an

00:57:26.655 --> 00:57:28.215
opportunity for bilingual

00:57:28.255 --> 00:57:29.516
or multilingual therapists

00:57:29.556 --> 00:57:32.637
who offer telehealth services to come in.

00:57:32.757 --> 00:57:33.918
And there's a very specific

00:57:33.958 --> 00:57:35.297
way that this could be done

00:57:35.759 --> 00:57:37.458
where I don't have the

00:57:37.639 --> 00:57:39.119
exaggerated fees to pay for

00:57:39.139 --> 00:57:39.920
an interpreter,

00:57:40.380 --> 00:57:42.420
but I can make this work financially.

00:57:42.501 --> 00:57:44.661
Let's talk about that on the next episode.

00:57:45.442 --> 00:57:46.802
Ooh, the forward tease.

00:57:46.942 --> 00:57:47.141
All right.

00:57:47.161 --> 00:57:47.842
Parting shots.

00:57:47.882 --> 00:57:48.762
We doing parting shots.

00:57:49.643 --> 00:57:50.224
You go, Dave.

00:57:50.603 --> 00:57:52.764
Trying to take a deep breath

00:57:52.784 --> 00:57:53.744
here on this parting shot.

00:57:53.804 --> 00:57:54.425
Parting shot.

00:57:55.942 --> 00:57:59.164
Man, there's happy people,

00:57:59.204 --> 00:58:00.106
there's unhappy people.

00:58:00.166 --> 00:58:01.286
It's in every profession.

00:58:01.306 --> 00:58:03.889
I appreciate you guys being

00:58:03.929 --> 00:58:04.750
a sounding board here.

00:58:04.789 --> 00:58:05.710
Hopefully we were putting

00:58:05.791 --> 00:58:07.532
out some insightful,

00:58:07.592 --> 00:58:10.094
entertaining content at the same time,

00:58:10.476 --> 00:58:11.436
trying to be optimistic.

00:58:11.536 --> 00:58:12.438
We're trying to be happy.

00:58:13.297 --> 00:58:15.199
And so if I have a problem

00:58:15.260 --> 00:58:17.382
with either Tony or Jimmy

00:58:17.643 --> 00:58:19.344
or the physical therapy profession or

00:58:21.018 --> 00:58:21.880
whatever taxes,

00:58:21.920 --> 00:58:23.141
I don't know anything politics.

00:58:23.541 --> 00:58:23.882
You know, I'm not,

00:58:23.902 --> 00:58:24.461
I'm not going to go in a

00:58:24.481 --> 00:58:25.623
Facebook group and talk

00:58:25.663 --> 00:58:26.443
negatively and just do

00:58:26.483 --> 00:58:27.244
blanket statements.

00:58:27.344 --> 00:58:29.846
So, uh, hopefully I wasn't too negative.

00:58:29.865 --> 00:58:30.706
You guys can, you know,

00:58:30.806 --> 00:58:32.789
the public at large can give me some, uh,

00:58:33.009 --> 00:58:35.150
private DMS and texts based

00:58:35.190 --> 00:58:36.371
on your feedback or insight.

00:58:37.371 --> 00:58:38.112
Uh, how about you guys?

00:58:38.193 --> 00:58:38.592
What's your feet?

00:58:38.632 --> 00:58:39.293
What's your takeaways?

00:58:39.833 --> 00:58:40.295
Parting shots.

00:58:40.815 --> 00:58:41.155
Yeah,

00:58:41.295 --> 00:58:42.297
I would just say you got to

00:58:42.336 --> 00:58:43.557
understand the culture of

00:58:43.597 --> 00:58:45.239
the environment you're in.

00:58:45.398 --> 00:58:47.699
If you don't resonate with that culture,

00:58:47.780 --> 00:58:50.541
just move, change, switch, do something.

00:58:51.463 --> 00:58:53.023
If I can't find people that

00:58:53.083 --> 00:58:53.844
I resonate with,

00:58:54.003 --> 00:58:55.085
I go find them on YouTube.

00:58:55.545 --> 00:58:58.286
I go find them in podcasts like this.

00:58:58.606 --> 00:58:59.887
That's why I listen to so many.

00:59:00.847 --> 00:59:02.268
Yeah, I've got two.

00:59:03.150 --> 00:59:04.530
I mean, I'll play off of Dave's,

00:59:04.550 --> 00:59:06.271
which is when you were a kid,

00:59:06.291 --> 00:59:07.833
your parents told you you

00:59:07.853 --> 00:59:09.072
could grow up to be anything you want.

00:59:09.132 --> 00:59:09.914
Don't choose to be an a**.

00:59:11.043 --> 00:59:12.105
And also everybody wants to

00:59:12.144 --> 00:59:13.206
be a gangster until it's

00:59:13.246 --> 00:59:14.507
time to start doing gangster.

00:59:15.128 --> 00:59:16.208
So decide if you're a

00:59:16.228 --> 00:59:17.269
gangster and then

00:59:17.309 --> 00:59:18.731
understand what is required

00:59:18.771 --> 00:59:19.492
to do that stuff.

00:59:19.592 --> 00:59:19.791
Right.

00:59:19.831 --> 00:59:21.793
This is this is not this

00:59:22.233 --> 00:59:23.175
being a great physical

00:59:23.195 --> 00:59:25.237
therapist appears to be simple,

00:59:25.277 --> 00:59:26.137
but it's not easy.

00:59:26.338 --> 00:59:27.659
But if it's right for you,

00:59:28.338 --> 00:59:29.139
it could be worth it.

00:59:29.159 --> 00:59:30.320
We'll be back on Thursday.

00:59:31.322 --> 00:59:32.103
Same bat channel.

00:59:32.182 --> 00:59:32.802
Same bat time.

00:59:32.943 --> 00:59:33.324
Thanks, guys.

First Day Jitters: Balancing New Grad Expectations and Patient Load

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