Getting to the Bottom of Musculoskeletal Health (f Dr. Larry Benz)

WEBVTT

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Let's go.

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All right, ladies and gentlemen,

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welcome to another episode,

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another round.

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Everybody gets drinks all

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around a PT Pinecast.

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Today, we're diving deep,

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getting to the bottom of the pint,

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into the world of

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musculoskeletal health with

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someone who's done this before.

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I've been doing it for a while,

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the mastermind behind Confluent Health,

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a powerhouse in private physical therapy,

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digital health, education,

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occupational medicine,

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and provider network management.

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That's all I could get out on one breath.

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There's more.

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With more than 700

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outpatient PT clinics under his belt,

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our guest today's influence

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in the profession that

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we're in is nothing short of monumental.

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And I'm not overusing that term.

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Plus,

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his Twitter handle is the envy of

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almost all physical

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therapists who use that platform.

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Let's say cheers to none

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other than Dr. Larry Benz.

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Larry, welcome to the show.

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Well, thank you, Jim.

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I really appreciate it.

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Thanks for the very kind, warm intro.

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It's a pleasure watching

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what you've accomplished

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with this podcast and other

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things that you've done.

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So thank you for all the

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work you're doing as well.

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Well, thank you.

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The hardest question is always first,

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what are we drinking?

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Well, we're drinking,

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people are going to be surprised,

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but I'm a Miller Lite guy.

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So I'm a Miller Lite guy, love the taste.

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I'm the anti-beer snob.

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Now when it comes to wine,

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I'm a little bit more discerning.

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Bourbon, I drink Old Foe,

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which is one of the

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cheapest bourbons you've got.

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But Miller Lite,

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it's won a bunch of awards.

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It says right on the bottle,

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a fine pilsner, lists all the awards,

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up here on the label,

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and then its quote is, quality,

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uncompromising, and unchangeable.

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Now,

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how could you beat a beer that's got that,

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Jimmy?

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You can't.

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And see,

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I like this is I always like I

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like what I like.

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You like what you like.

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And by changing what I do

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based on what someone else

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likes feels disingenuous.

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The funny part is I did a

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lot of that in my 20s, not 20 somethings.

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But then all of a sudden I realized,

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why am I doing this?

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Why not do the thing that I like,

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even if it upsets someone else?

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Here's the funny part.

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Most of the time, other people don't care.

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They really don't.

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In fact, they get a kick out of it.

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I go to places like Austin,

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Texas a lot on Rainy Street.

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You go to these places,

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100% of the beers are craft beers.

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And it's really,

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really impossible for me to distinguish.

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So I just always ask,

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what is the one that's most

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like Miller Lite?

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And they give me some type

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of pills that are usually a lager.

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So it makes things easier.

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I'm a big believer in decision fatigue.

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And so when it comes to beer,

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there's not a lot of

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decisions for me to make.

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The decision fatigue was famous,

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or I think the first person

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I learned about the term was Steve Jobs.

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I think a lot of people

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learned about decision

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fatigue from Steve Jobs,

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where he just said, I've got, you know,

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a bunch of black

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turtlenecks and jeans and

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these plain sneakers and people like,

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but you're worth a bajillion dollars.

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Why don't you have this and this and this?

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And he went full.

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I think he just went full

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circle on me because I like

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this and it works and I

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want to pay attention to other things.

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No, that's exactly right.

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I think it plays out in different people,

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different ways.

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For some, it's their dress.

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For some, it's the way they choose to eat.

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I know people eat the same

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thing for lunch every day.

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They don't want that decision.

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I do think when you're an

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executive level or had a

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lot of decisions to make,

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be mindful that your

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decisions are like a muscle

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and they can be subject to fatigue.

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So be careful with it.

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I do that with breakfast.

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I know about me that I can't

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really do anything terribly

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creative until 10 o'clock in the morning.

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So it's two eggs, scramble them up,

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a little bit of cheese, a little tortilla,

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and it's a breakfast

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burrito and I'm fine.

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And I don't, some people will say,

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but you know,

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variety is the spice of life.

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And I said, but for breakfast,

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it's not all food.

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I understand that.

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And it sort of removes that

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from my plate and I can,

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I can focus on other things.

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And I've,

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I've learned this from other

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people where focus is often,

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I was taught an example.

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It's like a flashlight.

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You only have so much of it

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and it can only see so much.

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So when you remove some

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things from your plate or

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the darkness that you don't

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need to pay attention to

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the things that you do,

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you can give more focus.

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Focus is it's, it's, it's tangible.

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You can run out.

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No, that's exactly right.

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I look at a bunch of things that way.

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Not only decision-making,

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I also look at willpower.

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how do you avoid um having

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to exert too much willpower

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because at some point that

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will also give out all it

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does in all humans and

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again it manifests itself

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differently so don't put

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yourself in a position

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where you have to uh

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fatigue it yeah a lot to it

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yeah people will talk about

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that like how do you you

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know there's a common theme

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and we'll get to themes I

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promise we didn't plan that

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we were going to go in this

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direction first but

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I think there's a common trend right now.

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Everybody wants to hack something.

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So biohacking, schedule hacking,

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the daily routine, what does this CEO do,

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the first five things they

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do in the morning,

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I should adopt those things.

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And one that I saw that actually worked,

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because I try a couple of these things,

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was understanding the first

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three things I'm going to do tomorrow.

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I get up and I sort of walk

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around the house.

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It's like, well, I could clean that.

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I could mow the lawn.

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I could get these emails done.

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I could do a lot of things.

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But what are the three

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things I should be doing?

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And the person had framed it up.

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Should versus could.

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In this day and age with our tools,

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we have a lot of coulds.

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But at the end of the day,

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I need a lot of those or at

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least the three most

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important shoulds being done.

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Yeah, absolutely.

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The way it manifests for me

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is I look at it as a return

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on my energy investment.

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Will that give me a return

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in excess of that energy

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that it takes to do or

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adopt something new?

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I think routines and all

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that stuff is great.

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And I think the thing that

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makes us distinguishedly

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human is ability to personalize habits,

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rituals, routines to ourselves.

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Right.

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Find out what works for us.

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Right.

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To think that that's going

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to work for everybody is, is naive.

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Yeah, absolutely.

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All right.

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Well,

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I said the hardest question comes up

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first Miller light.

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I, I am, I am a man as well.

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I do like, you know,

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trying some other bills,

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but when I'm hanging out in

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the summer and it's something easy,

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it's a Miller light.

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It's a Coors light.

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It's a Mick ultra.

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So cheers, Larry.

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Thanks for coming on the show.

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Thank you.

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Yeah.

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Cheers.

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First round brought to you

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by Owens recovery science, our friends,

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uh,

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Johnny Owens and the team owns

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recovery science.com.

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If you're looking to get

00:06:12.151 --> 00:06:13.132
certified and personalized

00:06:13.173 --> 00:06:14.012
blood flow restriction,

00:06:14.052 --> 00:06:14.973
rehabilitation training,

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I have never known where

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Johnny and Johnny is.

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He lives in Texas.

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We flies around people BFR.

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So, uh, if you're looking, he's great.

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We use his products and, um,

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I have the military

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connection with him personally,

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so now I'm a big fan.

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Yeah.

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All right, let's start.

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We mentioned trends a second ago.

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As where you sit in the profession now,

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and we can go backwards

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through your career,

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you've sort of done a lot of things.

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You've gone up, down, left, and right.

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You've got a unique

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perspective now on your experience,

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the things, the people you interact with,

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the things that you get to do.

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What are some of the

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significant trends you're

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seeing right now in our profession,

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knowing that things come and go,

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and by the time the first

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person listens to this episode...

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Or the 10,000th time someone

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listens to this episode.

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Those things will change

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because we know the only

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constant is change.

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But what are some that you

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see specifically in

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physical therapy practice?

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What are some of the trends

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that you actually think are significant?

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Yeah.

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So I think there are two

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sides of a coin on the very,

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very positive side of things.

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Physical therapy is in, it is fashionable.

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We are in soap operas,

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we're in movies and we are

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in social media and

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everybody loves their physio,

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loves their PT.

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That is fantastic.

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Unfortunately,

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the dent that we have made

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is about 10 to 12% in

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musculoskeletal health.

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So all your aches, pains, sprains,

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and strains of the worlds,

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we're at best 12% of them.

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And so as fashionables we are,

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the amount of growth that

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we have in our future is unbelievable.

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I mean,

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we are capturing 12% of a market

00:07:48.891 --> 00:07:49.732
that we should at least

00:07:49.812 --> 00:07:51.392
capture statistically 95%

00:07:51.392 --> 00:07:52.334
because the other 5% need

00:07:52.374 --> 00:07:53.093
to go emergency to surgery.

00:07:55.615 --> 00:07:56.435
you know all those kind of

00:07:56.475 --> 00:07:58.298
things so that's very very

00:07:58.377 --> 00:08:00.139
exciting the flip side of

00:08:00.178 --> 00:08:02.380
that coin is if we get what

00:08:02.461 --> 00:08:04.182
we want and what we deserve

00:08:04.523 --> 00:08:05.845
and what we're good at how

00:08:05.904 --> 00:08:07.925
are we gonna how are we gonna accommodate

00:08:08.865 --> 00:08:09.966
the influx of patients,

00:08:10.867 --> 00:08:11.827
we have a mass shortage.

00:08:12.067 --> 00:08:13.187
And this shortage has been

00:08:13.228 --> 00:08:14.088
around for a while.

00:08:14.689 --> 00:08:16.730
It was disguised pre-COVID,

00:08:17.009 --> 00:08:17.589
but it was there.

00:08:18.471 --> 00:08:20.791
COVID accelerated shortages

00:08:20.992 --> 00:08:22.232
in all healthcare professions,

00:08:22.312 --> 00:08:23.192
particularly PT,

00:08:23.233 --> 00:08:24.213
where it was reported about

00:08:24.213 --> 00:08:24.634
15,000 to 20,000,

00:08:24.634 --> 00:08:26.714
depending on whose numbers you believe,

00:08:26.774 --> 00:08:27.254
sat out.

00:08:27.634 --> 00:08:28.915
Most of them didn't come back.

00:08:29.276 --> 00:08:29.415
Now,

00:08:29.576 --> 00:08:30.656
I'm old enough to remember the

00:08:30.675 --> 00:08:31.437
balanced budget.

00:08:32.236 --> 00:08:33.678
amendment years and years ago,

00:08:33.698 --> 00:08:34.599
where they drastically

00:08:34.639 --> 00:08:35.700
changed the reimbursement

00:08:35.740 --> 00:08:36.660
for physical therapists,

00:08:37.081 --> 00:08:38.022
occupational therapists,

00:08:38.221 --> 00:08:39.823
and speech in a nursing home setting.

00:08:40.283 --> 00:08:41.966
And there was a massive

00:08:42.025 --> 00:08:43.226
number of therapists that

00:08:43.246 --> 00:08:44.628
were laid off during those days.

00:08:44.768 --> 00:08:45.629
And during those days,

00:08:45.708 --> 00:08:46.730
less than a third of those

00:08:46.789 --> 00:08:48.870
PTs came back to work.

00:08:49.192 --> 00:08:50.952
So I've seen this cycle before.

00:08:50.972 --> 00:08:52.534
It's just a little bit different.

00:08:52.975 --> 00:08:54.015
The problem is we're only

00:08:54.056 --> 00:08:56.357
graduating about 12,000 new

00:08:56.378 --> 00:08:57.158
graduates a year.

00:08:58.125 --> 00:08:59.547
But it's 12,000 that don't

00:08:59.626 --> 00:09:01.086
all even sit for their exam.

00:09:01.567 --> 00:09:03.087
It's 12,000 that certainly

00:09:03.128 --> 00:09:04.249
don't all do clinical work.

00:09:04.269 --> 00:09:05.208
Many of them work remotely.

00:09:05.229 --> 00:09:06.349
Many of them don't even work

00:09:06.408 --> 00:09:08.009
in a clinical sense whatsoever.

00:09:08.549 --> 00:09:09.370
And that's okay.

00:09:09.990 --> 00:09:11.471
But we do not have enough to

00:09:11.652 --> 00:09:13.432
answer the call of trying

00:09:13.471 --> 00:09:14.513
to get from 12%

00:09:14.513 --> 00:09:17.354
musculoskeletal health to 95%.

00:09:17.354 --> 00:09:18.974
So how can we accommodate that?

00:09:19.154 --> 00:09:20.134
And accommodating that

00:09:20.174 --> 00:09:21.394
through omnichannel means,

00:09:21.455 --> 00:09:22.395
multimodal ways,

00:09:22.936 --> 00:09:23.875
variety of things that we

00:09:23.916 --> 00:09:24.657
could talk about.

00:09:25.116 --> 00:09:26.256
But the education challenge

00:09:26.277 --> 00:09:27.878
has me the most concerned

00:09:27.918 --> 00:09:29.057
at night because we've had

00:09:29.097 --> 00:09:30.979
an incredible drop in the

00:09:31.019 --> 00:09:32.538
number of applicants in

00:09:32.578 --> 00:09:33.799
physical therapy programs.

00:09:34.220 --> 00:09:37.581
About 70% of all students

00:09:37.620 --> 00:09:38.740
who apply to PT school now

00:09:38.821 --> 00:09:40.481
get accepted into PT school.

00:09:41.042 --> 00:09:42.143
I'm from old school days

00:09:42.182 --> 00:09:43.410
where less than 10, 15,

00:09:43.410 --> 00:09:45.585
20% would get accepted in.

00:09:46.004 --> 00:09:47.485
We saw the same phenomenon

00:09:47.525 --> 00:09:48.746
happen in law schools where

00:09:48.807 --> 00:09:50.827
many law school programs are not being,

00:09:50.868 --> 00:09:52.749
their entire class is not being,

00:09:52.769 --> 00:09:54.389
if they have 100 slots or 80 slots,

00:09:54.870 --> 00:09:57.312
it might be at 50 or 60, 70% of that.

00:09:57.331 --> 00:09:59.033
It's a real challenge in law.

00:09:59.153 --> 00:10:00.734
And it's a good analogy for PT.

00:10:01.594 --> 00:10:02.254
because what ends up

00:10:02.274 --> 00:10:03.494
happening is we have to

00:10:03.573 --> 00:10:04.914
lower our admission standards.

00:10:05.595 --> 00:10:06.995
And so we're taking students

00:10:07.095 --> 00:10:08.174
that are probably less

00:10:08.316 --> 00:10:09.416
academically prepared than

00:10:09.456 --> 00:10:10.475
they've ever been in the past.

00:10:10.855 --> 00:10:11.755
Now I'm okay with that.

00:10:11.796 --> 00:10:12.875
If they've got the passion,

00:10:12.916 --> 00:10:13.856
the drive and the hunger to

00:10:13.897 --> 00:10:15.356
become a good PT, that's all good.

00:10:15.876 --> 00:10:17.658
But the reality is out of that 12,000,

00:10:17.658 --> 00:10:19.738
let's say there's really a

00:10:19.817 --> 00:10:21.337
pool of 10,000 therapists.

00:10:21.738 --> 00:10:23.818
Out of that 10,000, you got long-term care,

00:10:23.879 --> 00:10:25.678
which is rising like crazy

00:10:25.698 --> 00:10:27.399
and for good reason, home health,

00:10:27.460 --> 00:10:28.919
acute care, other settings.

00:10:29.519 --> 00:10:31.763
You're maybe leaving, you know,

00:10:31.802 --> 00:10:32.923
three to four thousand at

00:10:32.984 --> 00:10:34.365
best for the outpatient world,

00:10:34.926 --> 00:10:35.986
the world that I live in

00:10:36.067 --> 00:10:37.249
for musculoskeletal health.

00:10:37.369 --> 00:10:39.150
It's not the only PT world, obviously,

00:10:39.211 --> 00:10:41.212
but it's what my main concern is.

00:10:41.774 --> 00:10:42.875
And so this shortage is

00:10:42.894 --> 00:10:44.636
going to be around for a long, long time.

00:10:45.443 --> 00:10:46.823
Now, years ago,

00:10:46.884 --> 00:10:48.345
we had a similar phenomenon

00:10:48.544 --> 00:10:50.086
and me and some others

00:10:50.206 --> 00:10:52.466
postulated that our best

00:10:52.546 --> 00:10:53.506
and brightest were not

00:10:53.547 --> 00:10:54.726
going into PT school

00:10:54.787 --> 00:10:56.207
because at that particular time,

00:10:56.248 --> 00:10:57.587
we saw them migrate to

00:10:57.648 --> 00:10:58.849
technology fields and

00:10:58.889 --> 00:11:01.509
finance fields and financial technology,

00:11:01.570 --> 00:11:02.529
fintech type stuff.

00:11:03.279 --> 00:11:04.740
And PT school went from two

00:11:04.760 --> 00:11:05.642
years to three years.

00:11:05.701 --> 00:11:06.423
So all of a sudden,

00:11:06.763 --> 00:11:08.424
you have this education creep.

00:11:09.205 --> 00:11:10.385
It was driven by higher ed.

00:11:10.405 --> 00:11:11.927
It was not driven by our profession.

00:11:12.648 --> 00:11:13.769
And so you're not going to

00:11:13.808 --> 00:11:15.049
get out at seven years,

00:11:15.370 --> 00:11:16.631
best case scenario,

00:11:17.091 --> 00:11:18.974
and starting salaries are

00:11:19.234 --> 00:11:20.514
the $70,000 range.

00:11:20.595 --> 00:11:22.756
So the reality is we saw

00:11:22.797 --> 00:11:23.878
this coming years ago.

00:11:24.359 --> 00:11:25.720
And so me and some colleagues said,

00:11:25.759 --> 00:11:27.802
let's reduce PT school from

00:11:27.841 --> 00:11:28.642
three years to two.

00:11:29.543 --> 00:11:29.942
And we did,

00:11:29.962 --> 00:11:31.224
and we've done it very successfully.

00:11:31.244 --> 00:11:32.644
People thought we were crazy at the time.

00:11:32.684 --> 00:11:34.005
We knocked on hundreds of doors.

00:11:34.245 --> 00:11:36.047
I was going to say, how was that received?

00:11:36.528 --> 00:11:37.207
It was, you know,

00:11:37.707 --> 00:11:39.149
the two themes that have

00:11:39.208 --> 00:11:40.870
under underscored my career.

00:11:40.910 --> 00:11:42.432
I remember I was a military therapist.

00:11:42.491 --> 00:11:44.332
I went into private practice and my member,

00:11:44.373 --> 00:11:46.173
the biggest naysayers when

00:11:46.214 --> 00:11:46.955
I went into private

00:11:46.995 --> 00:11:48.054
practice for my colleagues

00:11:48.475 --> 00:11:49.735
were other physical therapy.

00:11:49.775 --> 00:11:49.855
Oh,

00:11:49.895 --> 00:11:51.236
you're going to go into private practice.

00:11:51.297 --> 00:11:52.937
Are you money grubbing capitalists?

00:11:52.977 --> 00:11:53.739
What, you know, what are you,

00:11:54.038 --> 00:11:54.740
you shouldn't do that.

00:11:54.799 --> 00:11:56.600
Healthcare shouldn't have, you know,

00:11:56.980 --> 00:11:57.421
be owned.

00:11:57.480 --> 00:11:57.822
So that was,

00:11:58.522 --> 00:12:00.383
When it got to this education thing,

00:12:00.842 --> 00:12:01.744
our colleagues were our

00:12:01.764 --> 00:12:02.624
biggest nightmare.

00:12:02.683 --> 00:12:03.884
We had academics writing

00:12:03.965 --> 00:12:06.186
letters to the accreditors saying,

00:12:06.206 --> 00:12:07.907
you can't possibly do two years.

00:12:07.966 --> 00:12:09.187
We had all kinds of people

00:12:09.246 --> 00:12:10.888
laughing at us and calling

00:12:10.967 --> 00:12:12.668
us names and throwing rocks at us.

00:12:12.749 --> 00:12:14.049
And then we'd go on the

00:12:14.110 --> 00:12:16.091
steps of higher education

00:12:16.171 --> 00:12:18.211
and we got nosed by so many.

00:12:18.951 --> 00:12:19.472
colleges,

00:12:19.513 --> 00:12:20.653
and we finally found one that was

00:12:20.693 --> 00:12:21.693
ready to take a little risk,

00:12:22.615 --> 00:12:24.596
which was South College down in Tennessee,

00:12:24.636 --> 00:12:25.356
a for-profit.

00:12:26.217 --> 00:12:28.320
And now we have one program

00:12:28.340 --> 00:12:30.321
there that's got two cohorts a year.

00:12:30.400 --> 00:12:31.302
It's 200 students,

00:12:31.341 --> 00:12:32.462
and we've opened up in Atlanta,

00:12:32.482 --> 00:12:34.104
and we'll open up in Nashville with them.

00:12:34.784 --> 00:12:35.524
At the same time,

00:12:35.585 --> 00:12:36.865
all the ones who did this

00:12:36.905 --> 00:12:38.067
with me were all from Baylor,

00:12:38.126 --> 00:12:39.668
John Childs and Tim Flynn

00:12:39.687 --> 00:12:40.509
and Rob Wainer and

00:12:41.024 --> 00:12:43.264
So Baylor took us on and they said,

00:12:43.304 --> 00:12:44.306
we'll do it once you get

00:12:44.326 --> 00:12:45.265
accredited because it's

00:12:45.386 --> 00:12:46.267
very difficult to get

00:12:46.307 --> 00:12:47.567
accredited as a two year program.

00:12:47.587 --> 00:12:48.248
When you're trying to do

00:12:48.288 --> 00:12:50.950
hybrid learning techniques, it's very,

00:12:50.970 --> 00:12:51.549
very difficult.

00:12:51.629 --> 00:12:53.331
Again, this is all nine, 10 years ago,

00:12:53.370 --> 00:12:54.572
so well before COVID.

00:12:55.172 --> 00:12:55.952
COVID hits.

00:12:56.712 --> 00:12:57.673
And now all of a sudden,

00:12:58.192 --> 00:13:00.033
every academic faculty

00:13:00.094 --> 00:13:02.774
member saying who used to say never, ever,

00:13:03.034 --> 00:13:04.375
ever over my dead body

00:13:04.394 --> 00:13:05.735
while I teach an online course.

00:13:05.775 --> 00:13:06.296
Well, you know what?

00:13:06.676 --> 00:13:07.316
During COVID,

00:13:07.495 --> 00:13:08.636
you're teaching an online course,

00:13:08.677 --> 00:13:09.616
you're going to be terminated.

00:13:10.037 --> 00:13:11.758
And so they all pivoted, if you will.

00:13:12.298 --> 00:13:14.197
Most did it very poorly, by the way,

00:13:14.258 --> 00:13:15.178
because it's a different

00:13:15.239 --> 00:13:16.379
skill set that allows an

00:13:16.438 --> 00:13:17.779
instructor to teach online.

00:13:18.659 --> 00:13:19.759
Just like a therapist needs

00:13:19.820 --> 00:13:21.821
a different skill set to do, you know,

00:13:21.880 --> 00:13:23.000
telehealth than they do in

00:13:23.061 --> 00:13:24.841
clinic setting or additional skill sets,

00:13:24.902 --> 00:13:25.302
I should add.

00:13:26.211 --> 00:13:27.692
And so today, as we speak,

00:13:27.712 --> 00:13:29.333
there are about 13 to 15

00:13:29.333 --> 00:13:30.554
programs that are two year

00:13:30.595 --> 00:13:34.037
programs of approximately 300.

00:13:34.037 --> 00:13:35.719
So we barely move the needle.

00:13:36.519 --> 00:13:37.019
And, you know,

00:13:37.039 --> 00:13:38.701
the reality is there's not

00:13:38.801 --> 00:13:41.623
enough motivation for most

00:13:41.682 --> 00:13:43.183
schools to reduce their

00:13:43.224 --> 00:13:45.345
tuition cycle from three years to two,

00:13:46.025 --> 00:13:47.567
even with declining enrollments.

00:13:48.067 --> 00:13:48.847
So then you say, well,

00:13:48.868 --> 00:13:50.828
how can we correct the program?

00:13:50.869 --> 00:13:52.230
Well, you know, Dr. Rick Shields,

00:13:52.269 --> 00:13:54.291
who's a tremendous research

00:13:54.370 --> 00:13:58.072
scientist out of University of Iowa,

00:13:58.173 --> 00:13:59.114
who's just been incredible

00:13:59.134 --> 00:13:59.953
in the neural world,

00:13:59.974 --> 00:14:00.995
has started to apply his

00:14:01.054 --> 00:14:02.096
research techniques to

00:14:02.115 --> 00:14:03.856
higher ed and particularly PT school.

00:14:04.537 --> 00:14:05.217
And one of the things he

00:14:05.258 --> 00:14:06.938
found is that the net present value,

00:14:06.999 --> 00:14:08.980
when it gets to about what it is in PT,

00:14:09.039 --> 00:14:11.382
about $85,000, $86,000,

00:14:11.381 --> 00:14:12.722
people migrate towards

00:14:13.303 --> 00:14:16.385
nurse practitioner and PA and pharma,

00:14:16.625 --> 00:14:18.126
and in some case, veterinary medicine.

00:14:18.427 --> 00:14:19.548
The idea being that for the

00:14:19.587 --> 00:14:20.989
same amount of schooling,

00:14:21.109 --> 00:14:21.769
those who are really

00:14:21.809 --> 00:14:22.309
interested in the

00:14:22.330 --> 00:14:23.291
healthcare field are going

00:14:23.311 --> 00:14:24.152
to go to those where it's a

00:14:24.491 --> 00:14:25.493
little bit less schooling

00:14:25.572 --> 00:14:26.293
or about the same,

00:14:26.413 --> 00:14:27.394
and the starting salaries

00:14:27.453 --> 00:14:28.054
are much higher.

00:14:28.910 --> 00:14:30.692
And so we have this, you know,

00:14:30.812 --> 00:14:31.831
and then the other figure

00:14:31.851 --> 00:14:32.832
to keep in mind is what I

00:14:32.873 --> 00:14:34.774
call the 150 Mendoza line.

00:14:34.813 --> 00:14:36.594
And that basically is at

00:14:36.594 --> 00:14:38.254
$150,000 of student debt.

00:14:38.975 --> 00:14:39.875
As a profession,

00:14:39.916 --> 00:14:41.636
you're no longer an attractive profession,

00:14:41.937 --> 00:14:42.937
right, wrong, or indifferent.

00:14:43.477 --> 00:14:45.378
Artificial line, is it true in every case?

00:14:45.518 --> 00:14:45.739
No.

00:14:45.778 --> 00:14:46.798
So what you do have, though,

00:14:46.818 --> 00:14:49.419
is many less applicants is

00:14:49.779 --> 00:14:51.061
the end result of this.

00:14:51.921 --> 00:14:52.922
So how can we change this?

00:14:53.461 --> 00:14:53.621
Well,

00:14:53.662 --> 00:14:55.243
one of the ways we can change it is

00:14:55.302 --> 00:14:57.803
to change our mindset about

00:14:57.844 --> 00:14:59.605
a physical therapist, education,

00:14:59.705 --> 00:15:00.666
curriculum and training.

00:15:01.265 --> 00:15:02.527
And it's my contention that

00:15:02.586 --> 00:15:03.908
midway through their education,

00:15:03.947 --> 00:15:05.008
whether in a traditional

00:15:05.048 --> 00:15:05.908
three year program that

00:15:05.928 --> 00:15:07.068
would be at 18 months at a

00:15:07.109 --> 00:15:08.529
two year program would be at a year,

00:15:09.030 --> 00:15:10.110
you would sit for the first

00:15:10.171 --> 00:15:11.131
part of your state boards.

00:15:11.812 --> 00:15:13.173
You would have underlying

00:15:13.693 --> 00:15:15.056
being able to do clinical exam,

00:15:15.115 --> 00:15:16.697
understand clinical prediction rules,

00:15:16.758 --> 00:15:17.479
understand clinical

00:15:17.519 --> 00:15:18.899
guidelines as promulgated

00:15:18.980 --> 00:15:22.124
by the Orthopedic Physical

00:15:22.144 --> 00:15:23.885
Therapy Association of the APTA.

00:15:24.486 --> 00:15:25.067
And you would have a

00:15:25.126 --> 00:15:26.548
competent set of skill set.

00:15:26.568 --> 00:15:27.710
You'd get a master's degree,

00:15:27.890 --> 00:15:28.711
sit for your boards,

00:15:29.251 --> 00:15:30.952
It's contingent upon you

00:15:30.993 --> 00:15:32.953
finishing the balance of your DPT.

00:15:33.433 --> 00:15:34.374
At the end of that DPT,

00:15:34.394 --> 00:15:35.495
you get full licensure.

00:15:35.934 --> 00:15:37.596
But the difference is as a

00:15:37.696 --> 00:15:39.136
licensed therapist during that time,

00:15:39.157 --> 00:15:39.836
you could bill for your

00:15:39.876 --> 00:15:41.077
services because the

00:15:41.138 --> 00:15:43.839
problem we have now is we we have a faith,

00:15:43.859 --> 00:15:44.999
hope and prayer technique

00:15:45.019 --> 00:15:45.960
for training therapists.

00:15:46.000 --> 00:15:47.841
We send them out to anywhere

00:15:47.921 --> 00:15:49.361
who wants to take students

00:15:49.922 --> 00:15:51.822
and we try to make them clinically ready.

00:15:52.623 --> 00:15:53.344
well here's the other

00:15:53.744 --> 00:15:54.745
interesting phenomenon

00:15:55.285 --> 00:15:56.707
pre-covid when there wasn't

00:15:56.947 --> 00:15:57.989
as much of a shortage there

00:15:58.009 --> 00:15:58.809
was still a shortage but

00:15:58.850 --> 00:16:00.611
not as profound lots of

00:16:00.793 --> 00:16:02.014
lots of practices stopped

00:16:02.033 --> 00:16:03.515
taking students we limited

00:16:03.556 --> 00:16:04.517
the number of students in a

00:16:04.557 --> 00:16:05.418
lot of our places to

00:16:05.457 --> 00:16:06.639
certain academic programs

00:16:06.658 --> 00:16:08.561
just just because we could

00:16:08.581 --> 00:16:09.381
you know capacity

00:16:10.062 --> 00:16:10.202
Well,

00:16:10.222 --> 00:16:11.144
then what happened is when the

00:16:11.183 --> 00:16:14.065
shortages came out, everybody said, well,

00:16:14.105 --> 00:16:15.725
technique for getting more students,

00:16:15.787 --> 00:16:16.907
they're getting recruiting

00:16:16.966 --> 00:16:18.207
is to take on more students.

00:16:18.248 --> 00:16:21.649
So we've actually, in a way, diluted,

00:16:21.750 --> 00:16:22.370
liquidated,

00:16:22.429 --> 00:16:24.071
dummy down to a certain extent,

00:16:24.192 --> 00:16:24.951
even the educational

00:16:25.011 --> 00:16:26.273
training of our current PTs.

00:16:26.793 --> 00:16:27.553
but if they took their

00:16:27.573 --> 00:16:28.874
licensure exam you'd be

00:16:28.894 --> 00:16:30.034
able to bill you'd be able

00:16:30.054 --> 00:16:30.754
to they'd be able to see

00:16:30.774 --> 00:16:31.735
medicare patients you'd be

00:16:31.755 --> 00:16:33.037
able to pay them you'd be

00:16:33.057 --> 00:16:34.397
able to pay them a modest

00:16:34.576 --> 00:16:36.519
amount maybe 50 60 of a

00:16:36.578 --> 00:16:38.340
starting pt you'd also be

00:16:38.360 --> 00:16:39.299
able to add revenues to

00:16:39.340 --> 00:16:41.561
your clinic and that amount

00:16:41.600 --> 00:16:42.261
would lower their

00:16:43.081 --> 00:16:44.682
It's like paying student athletes, right?

00:16:44.962 --> 00:16:45.744
It would lower their

00:16:45.823 --> 00:16:47.384
educational costs overall.

00:16:47.403 --> 00:16:48.465
So I think that's one idea

00:16:48.485 --> 00:16:50.145
and one thing to be considered.

00:16:50.686 --> 00:16:51.826
The other major challenge

00:16:51.846 --> 00:16:52.826
that I just alluded to is

00:16:53.466 --> 00:16:54.427
now we're getting students

00:16:54.488 --> 00:16:55.908
who've graduated, this 12,000,

00:16:55.908 --> 00:16:57.469
that's really probably 10,

00:16:57.469 --> 00:16:58.690
and then on an outpatient basis,

00:16:58.750 --> 00:16:59.649
really three or four,

00:17:00.171 --> 00:17:00.831
and their clinical

00:17:00.910 --> 00:17:02.432
readiness is at an all time worse.

00:17:03.052 --> 00:17:04.553
And so we are seeing new graduates,

00:17:04.573 --> 00:17:06.093
and this is not their fault.

00:17:06.113 --> 00:17:07.473
This is not an accusation

00:17:07.513 --> 00:17:08.253
towards the students.

00:17:09.595 --> 00:17:10.976
It's an accusation towards the system.

00:17:11.576 --> 00:17:12.336
we're not training them to

00:17:12.375 --> 00:17:13.237
be clinically ready.

00:17:13.297 --> 00:17:14.738
And so to bring them up to

00:17:14.798 --> 00:17:15.897
par to where they could see

00:17:15.917 --> 00:17:16.979
a full load of patients

00:17:17.078 --> 00:17:18.299
could take weeks and months

00:17:18.380 --> 00:17:19.480
and more mentoring and more

00:17:19.539 --> 00:17:21.260
remediation and more level setting.

00:17:21.820 --> 00:17:23.481
And so lots of therapists, you know,

00:17:23.521 --> 00:17:24.682
we have all these residency

00:17:24.722 --> 00:17:26.483
training residencies around the country.

00:17:26.503 --> 00:17:28.125
We have the largest residency in the US,

00:17:28.164 --> 00:17:29.265
but the numbers are down

00:17:29.605 --> 00:17:30.746
because the base therapists

00:17:30.786 --> 00:17:31.705
coming out of three years

00:17:31.786 --> 00:17:32.747
are coming in burned out.

00:17:33.446 --> 00:17:34.667
And now we have to mentor

00:17:34.688 --> 00:17:35.587
them and remediate.

00:17:36.048 --> 00:17:37.669
And so lots and lots of

00:17:37.769 --> 00:17:39.150
challenges going on in there.

00:17:39.190 --> 00:17:40.070
And so I think, you know,

00:17:40.902 --> 00:17:41.981
When you ask me that question,

00:17:42.001 --> 00:17:42.903
that's the first and

00:17:43.022 --> 00:17:44.063
foremost thing that comes to mind.

00:17:44.403 --> 00:17:46.124
What would need to change to

00:17:46.183 --> 00:17:47.064
make that possible?

00:17:47.324 --> 00:17:48.845
Your idea of halfway through

00:17:48.865 --> 00:17:49.444
your education,

00:17:49.484 --> 00:17:50.885
either at 12 months or 18 months,

00:17:51.246 --> 00:17:52.445
would it be you need to

00:17:52.546 --> 00:17:53.826
advocate for rules change?

00:17:53.906 --> 00:17:54.747
Is it academia?

00:17:54.767 --> 00:17:55.126
Where is it?

00:17:57.307 --> 00:17:58.650
It's a combination of things.

00:17:58.690 --> 00:17:59.871
You'd have to get a meeting

00:17:59.891 --> 00:18:00.932
of the minds together,

00:18:01.092 --> 00:18:03.634
an unholy alliance consisting of CAPTI,

00:18:04.115 --> 00:18:09.559
of APTA, of the Academy of Academics,

00:18:09.720 --> 00:18:10.119
ACAP,

00:18:10.800 --> 00:18:13.584
and certainly the Federation of

00:18:13.624 --> 00:18:14.805
State Licensure Boards,

00:18:14.884 --> 00:18:16.747
because in order to take an exam,

00:18:16.767 --> 00:18:17.807
you have to have a degree.

00:18:18.367 --> 00:18:20.028
And so you'd have to get

00:18:20.368 --> 00:18:21.630
agreements that you can do

00:18:21.670 --> 00:18:22.829
that at a master's degree

00:18:22.890 --> 00:18:24.810
level and that their DPT

00:18:24.851 --> 00:18:26.051
would be contingent upon that.

00:18:26.092 --> 00:18:26.711
It's not any different than

00:18:26.731 --> 00:18:27.633
what happens in med school

00:18:27.653 --> 00:18:28.532
when they start sitting for

00:18:28.573 --> 00:18:30.473
boards during their second

00:18:30.493 --> 00:18:31.074
and third year.

00:18:31.513 --> 00:18:32.835
It's just a take off on it

00:18:33.095 --> 00:18:33.955
and creating more of a

00:18:34.195 --> 00:18:35.395
traditional medical model

00:18:35.476 --> 00:18:36.656
or proven medical model.

00:18:37.237 --> 00:18:38.758
rather than the system we have now,

00:18:38.798 --> 00:18:39.877
which is it's three years,

00:18:39.938 --> 00:18:41.097
but six months of it or a

00:18:41.298 --> 00:18:42.459
year of it is throwing them

00:18:42.519 --> 00:18:45.900
out to an uncertified group

00:18:45.940 --> 00:18:48.580
of clinics that is

00:18:48.621 --> 00:18:50.141
completely removed from an academic.

00:18:50.641 --> 00:18:51.402
And so it is,

00:18:51.942 --> 00:18:53.501
if I take an academic position,

00:18:53.561 --> 00:18:55.482
it's very unnerving to send

00:18:55.903 --> 00:18:57.363
your students out to a

00:18:57.423 --> 00:18:58.644
non-academic setting.

00:18:59.625 --> 00:19:01.186
and expect similar results

00:19:01.247 --> 00:19:02.388
from practice to practice.

00:19:02.429 --> 00:19:04.172
And so if you talk to any of

00:19:04.211 --> 00:19:06.935
the better PT programs across the country,

00:19:07.196 --> 00:19:08.638
they can tell you off the

00:19:08.679 --> 00:19:09.339
tip of their tongue,

00:19:09.359 --> 00:19:10.181
what are the four or five

00:19:10.240 --> 00:19:11.143
programs that they really

00:19:11.182 --> 00:19:12.404
want their students to be trained in.

00:19:13.665 --> 00:19:16.287
And that is, as you mentioned,

00:19:16.326 --> 00:19:17.047
not at random,

00:19:17.067 --> 00:19:18.347
but it's at the mercy of

00:19:18.428 --> 00:19:20.328
who has availability and

00:19:20.348 --> 00:19:21.128
who is willing to take

00:19:21.169 --> 00:19:22.049
students at that time.

00:19:22.309 --> 00:19:23.450
And then, you know, I mean,

00:19:23.490 --> 00:19:24.431
I knew this from being in

00:19:24.451 --> 00:19:25.171
PT school and just

00:19:25.211 --> 00:19:26.811
listening around now is by

00:19:26.832 --> 00:19:28.132
the time you get there as a student,

00:19:28.152 --> 00:19:29.153
that therapist you repair

00:19:29.192 --> 00:19:30.073
with might not be there anymore.

00:19:30.691 --> 00:19:31.790
No, that's exactly right.

00:19:31.872 --> 00:19:33.511
And then you throw in the

00:19:33.592 --> 00:19:34.633
regulatory side of it.

00:19:34.673 --> 00:19:36.493
They've got to learn a new EMR every time.

00:19:36.513 --> 00:19:37.394
They've got to learn the new

00:19:37.433 --> 00:19:38.654
rules of the trade at that

00:19:38.694 --> 00:19:41.076
particular clinical practice.

00:19:41.215 --> 00:19:43.576
And all these things happen.

00:19:43.596 --> 00:19:45.018
And what happens is as an employer,

00:19:45.038 --> 00:19:47.278
they land on our desk

00:19:47.739 --> 00:19:49.680
needing more training, burned out.

00:19:50.680 --> 00:19:51.880
lost their zest for the

00:19:51.920 --> 00:19:52.881
profession and they haven't

00:19:52.901 --> 00:19:54.020
even started their career

00:19:54.040 --> 00:19:55.601
yet and so those are the

00:19:56.020 --> 00:19:57.382
you know challenges and

00:19:57.442 --> 00:19:58.041
they're not going to go

00:19:58.061 --> 00:19:59.461
away easily and so how does

00:19:59.501 --> 00:20:00.461
it manifest itself in the

00:20:00.501 --> 00:20:01.583
workplace right now well

00:20:01.603 --> 00:20:03.282
the average pt according to

00:20:03.343 --> 00:20:04.583
some new pt according to

00:20:04.603 --> 00:20:05.663
some survey data lasts

00:20:05.682 --> 00:20:06.584
about eight months on their

00:20:06.624 --> 00:20:09.124
new job yeah that's down

00:20:09.163 --> 00:20:10.644
from nine months uh from a

00:20:10.765 --> 00:20:12.924
few years prior and look at

00:20:12.944 --> 00:20:13.964
the retention rates the

00:20:14.005 --> 00:20:15.165
retention rates are you

00:20:15.185 --> 00:20:16.286
know at best you're seeing

00:20:17.026 --> 00:20:19.148
um you know 15 to 25 percent

00:20:19.729 --> 00:20:21.010
of the staff and these are

00:20:21.230 --> 00:20:22.451
therapists that are less

00:20:22.491 --> 00:20:23.413
than call it a year and a

00:20:23.472 --> 00:20:26.856
half of graduation um going

00:20:26.957 --> 00:20:27.897
on to bigger and other

00:20:27.938 --> 00:20:28.999
things all right let's

00:20:29.038 --> 00:20:30.039
combine the last two things

00:20:30.059 --> 00:20:31.561
we talked about which is

00:20:32.737 --> 00:20:34.259
Um, I'll never, you know,

00:20:34.578 --> 00:20:35.779
programs can never go hybrid.

00:20:35.819 --> 00:20:36.480
It can happen.

00:20:36.760 --> 00:20:37.942
And then a pandemic comes

00:20:38.001 --> 00:20:38.863
and it's necessity is the

00:20:38.883 --> 00:20:39.462
mother of invention.

00:20:39.482 --> 00:20:40.663
And, oh, look, we can do that.

00:20:41.105 --> 00:20:42.385
And this thing that you're proposing,

00:20:42.826 --> 00:20:43.926
what would need to happen

00:20:43.987 --> 00:20:44.968
to actually make this,

00:20:45.409 --> 00:20:46.809
to make this thing a reality?

00:20:46.869 --> 00:20:47.369
Is there some,

00:20:47.470 --> 00:20:48.651
is there some dynamic change?

00:20:48.691 --> 00:20:50.553
You said, you know, getting an alliance,

00:20:50.633 --> 00:20:52.674
this unholy alliance, but what would,

00:20:52.775 --> 00:20:53.655
what could cause it?

00:20:53.675 --> 00:20:54.416
Because I feel like

00:20:54.457 --> 00:20:56.278
everybody is in alignment

00:20:56.317 --> 00:20:57.199
in terms of wanting to

00:20:57.219 --> 00:20:57.940
better the profession.

00:20:58.359 --> 00:20:59.601
and how everybody decides

00:20:59.621 --> 00:21:00.560
that happen is of course

00:21:00.621 --> 00:21:01.541
can be vastly different.

00:21:01.561 --> 00:21:02.942
But is there something that

00:21:02.961 --> 00:21:04.702
can be a catalyst to move

00:21:04.742 --> 00:21:05.763
the profession so we don't

00:21:05.804 --> 00:21:06.844
burn students out and we

00:21:06.884 --> 00:21:08.484
make them better clinicians?

00:21:09.021 --> 00:21:09.221
Yeah, well,

00:21:09.241 --> 00:21:10.423
those are two very different things.

00:21:10.442 --> 00:21:11.782
We can talk about burnout

00:21:11.883 --> 00:21:12.824
separately because those

00:21:12.864 --> 00:21:14.325
are very different dynamics.

00:21:14.464 --> 00:21:17.246
But to get to where it costs

00:21:17.326 --> 00:21:18.826
them less or they result in

00:21:18.866 --> 00:21:19.988
less student debt,

00:21:20.548 --> 00:21:21.268
where you're going to need

00:21:21.307 --> 00:21:22.449
to put these meeting of the minds,

00:21:22.489 --> 00:21:23.348
going to take leadership

00:21:23.409 --> 00:21:24.809
from each one of those levels,

00:21:25.190 --> 00:21:26.411
the private practice level

00:21:26.431 --> 00:21:27.371
vis-a-vis the private

00:21:27.391 --> 00:21:28.332
practice section and the

00:21:28.372 --> 00:21:29.393
great leadership that Mike

00:21:29.413 --> 00:21:29.992
has done there.

00:21:30.492 --> 00:21:32.094
You also have the APTQI,

00:21:32.535 --> 00:21:34.696
which is a quality alliance,

00:21:34.797 --> 00:21:35.817
and that's consisted of a

00:21:35.857 --> 00:21:36.657
lot of private equity

00:21:36.678 --> 00:21:38.539
backed and public company, PT companies.

00:21:38.619 --> 00:21:39.340
It's significant.

00:21:39.381 --> 00:21:40.842
It's profound in terms of size.

00:21:41.221 --> 00:21:42.462
You get leadership from APTA,

00:21:42.722 --> 00:21:43.644
leadership from CAPTI,

00:21:43.703 --> 00:21:44.845
leadership from the Academy

00:21:45.506 --> 00:21:47.166
of the academics on the PT

00:21:47.207 --> 00:21:48.729
side who helped direct the curriculum.

00:21:49.449 --> 00:21:50.670
and the Federation of State Boards,

00:21:50.710 --> 00:21:51.471
and you got to get them in

00:21:51.490 --> 00:21:53.372
a room and drive consensus

00:21:53.452 --> 00:21:54.133
and then have that

00:21:54.173 --> 00:21:55.433
consensus drive their

00:21:55.473 --> 00:21:56.755
constituency groups and get

00:21:56.795 --> 00:21:57.596
everybody on board.

00:21:58.037 --> 00:21:59.198
I'm convinced it could be done,

00:21:59.238 --> 00:22:01.459
but it's going to take effort, time,

00:22:01.559 --> 00:22:02.640
certainly some resources,

00:22:02.660 --> 00:22:03.540
certainly some money.

00:22:03.922 --> 00:22:05.323
But the end result is we

00:22:05.403 --> 00:22:08.125
need to be attractive as a profession,

00:22:08.164 --> 00:22:09.967
number one, to get our applications up.

00:22:10.386 --> 00:22:11.107
the only way you make it

00:22:11.147 --> 00:22:12.930
more attractive is two ways

00:22:13.029 --> 00:22:14.231
less student debt or more

00:22:14.291 --> 00:22:15.051
salaries well the

00:22:15.093 --> 00:22:16.334
reimbursement climate is

00:22:16.433 --> 00:22:17.375
certainly not going to wake

00:22:17.434 --> 00:22:18.215
up one day and say we're

00:22:18.236 --> 00:22:19.917
underpaying pts right that

00:22:19.958 --> 00:22:21.179
only leaves the lever arm

00:22:21.319 --> 00:22:24.103
of decreased tuition and or

00:22:24.222 --> 00:22:25.845
remuneration for the pts

00:22:25.884 --> 00:22:26.625
while they're in school

00:22:27.105 --> 00:22:28.207
I have tons of colleagues.

00:22:28.267 --> 00:22:29.287
Granted, I'm a little bit older.

00:22:29.307 --> 00:22:31.188
I went through the military's program,

00:22:31.208 --> 00:22:31.748
but I have tons of

00:22:31.768 --> 00:22:33.588
colleagues that when PT was

00:22:33.628 --> 00:22:34.528
a four year degree,

00:22:34.910 --> 00:22:36.769
the last two years was PT school.

00:22:36.789 --> 00:22:39.412
A lot of employers paid 100% of it then,

00:22:40.071 --> 00:22:41.712
and they had a commitment

00:22:41.732 --> 00:22:42.472
to go work for them.

00:22:42.893 --> 00:22:44.173
Now we do a commitment and

00:22:44.213 --> 00:22:45.474
we pay for their residency

00:22:45.535 --> 00:22:46.996
because it's a year or 18 months,

00:22:47.036 --> 00:22:48.176
but we can't pay for three

00:22:48.196 --> 00:22:49.478
years of PT school or two

00:22:49.518 --> 00:22:51.960
years of PT school at the tuition rates.

00:22:52.519 --> 00:22:55.383
Higher education is a broken system,

00:22:55.423 --> 00:22:56.943
in my opinion, for a lot of reasons.

00:22:57.845 --> 00:22:59.005
They rely on endowment,

00:22:59.066 --> 00:22:59.986
student tuition and

00:23:00.006 --> 00:23:01.708
philanthropy as their revenue sources,

00:23:01.768 --> 00:23:02.667
and those are going away.

00:23:03.949 --> 00:23:04.949
And what happens is they try

00:23:04.989 --> 00:23:06.230
to make margin in graduate

00:23:06.250 --> 00:23:06.970
school programs.

00:23:06.990 --> 00:23:07.970
So they charge a lot more

00:23:08.009 --> 00:23:09.691
for PT and for dentistry

00:23:09.770 --> 00:23:11.270
and for veterinary and for the others.

00:23:11.310 --> 00:23:12.830
And so they expect those

00:23:12.932 --> 00:23:14.311
margins in those programs

00:23:14.352 --> 00:23:15.832
to subsidize their losses

00:23:15.872 --> 00:23:16.613
that they might have in

00:23:16.653 --> 00:23:17.553
certain programs on an

00:23:17.593 --> 00:23:18.472
undergraduate level.

00:23:18.913 --> 00:23:21.554
So we're victims to a

00:23:21.594 --> 00:23:22.854
certain extent in a higher

00:23:22.894 --> 00:23:23.953
education theater of

00:23:24.015 --> 00:23:25.134
absurdity pool right now.

00:23:25.535 --> 00:23:25.775
Yeah.

00:23:26.234 --> 00:23:28.276
You mentioned your career in the military.

00:23:28.316 --> 00:23:30.395
What's a lesson or something

00:23:30.415 --> 00:23:31.195
you learned during that

00:23:31.236 --> 00:23:32.916
that you still use today?

00:23:34.061 --> 00:23:34.261
Well,

00:23:34.382 --> 00:23:36.124
I love the military system because it

00:23:36.163 --> 00:23:37.704
was extremely well organized.

00:23:37.744 --> 00:23:38.645
You certainly didn't have to

00:23:38.685 --> 00:23:39.946
worry about reimbursement.

00:23:40.347 --> 00:23:41.067
And for that matter,

00:23:41.107 --> 00:23:42.028
most of the compliance

00:23:42.088 --> 00:23:43.990
rules that they place on every other, uh,

00:23:44.431 --> 00:23:45.813
on all the non-governmental

00:23:46.012 --> 00:23:46.913
organizations.

00:23:47.814 --> 00:23:48.375
And, um,

00:23:49.201 --> 00:23:51.501
you really truly had the

00:23:51.721 --> 00:23:53.182
patient's best interest at heart.

00:23:53.261 --> 00:23:55.102
We were musculoskeletal evaluators then,

00:23:55.142 --> 00:23:56.323
so we had direct access.

00:23:57.323 --> 00:23:59.282
We had ability, prescriptive authority.

00:23:59.323 --> 00:24:00.604
We had the ability to get x-rays.

00:24:00.963 --> 00:24:02.423
We were truly looked at as a

00:24:02.463 --> 00:24:03.344
collaborative partner with

00:24:03.384 --> 00:24:05.605
the orthopedist who didn't

00:24:05.644 --> 00:24:06.625
want to see garden variety,

00:24:06.664 --> 00:24:07.244
low back pain.

00:24:07.265 --> 00:24:08.724
They only want to see surgical candidates.

00:24:09.165 --> 00:24:10.486
And so that inverted system,

00:24:10.506 --> 00:24:11.486
which we're now trying to

00:24:11.526 --> 00:24:12.546
see in the private sector,

00:24:13.767 --> 00:24:14.987
the lesson I learned is that it works.

00:24:15.628 --> 00:24:16.869
Yeah, that's important.

00:24:16.890 --> 00:24:18.351
And you hear that you hear a lot.

00:24:18.371 --> 00:24:19.391
There's there's many loud

00:24:19.451 --> 00:24:20.951
voices and getting louder and saying,

00:24:21.011 --> 00:24:22.313
how do we get closer to this model?

00:24:22.333 --> 00:24:24.013
We have proof that this thing works.

00:24:24.134 --> 00:24:24.534
Exactly.

00:24:24.713 --> 00:24:25.535
There's great research

00:24:25.555 --> 00:24:26.796
coming out that supports that.

00:24:26.836 --> 00:24:30.377
So hopefully that's that's a

00:24:30.438 --> 00:24:31.238
victim of time and

00:24:31.278 --> 00:24:32.338
hopefully time will change that.

00:24:32.901 --> 00:24:34.162
No doubt.

00:24:34.541 --> 00:24:34.842
So, Larry,

00:24:34.922 --> 00:24:36.823
I believe that social media is a tool.

00:24:36.923 --> 00:24:39.105
Some people will say it is good or bad.

00:24:39.125 --> 00:24:39.984
I was actually involved in

00:24:40.005 --> 00:24:41.425
an Oxford debate a few years ago.

00:24:41.807 --> 00:24:42.547
And the question was,

00:24:42.626 --> 00:24:44.807
is social media is it has

00:24:44.867 --> 00:24:45.588
that was the prompt is

00:24:45.628 --> 00:24:46.690
carefully worded is social

00:24:46.710 --> 00:24:48.170
media hazardous profession

00:24:48.210 --> 00:24:48.990
of physical therapy.

00:24:49.351 --> 00:24:50.751
And then I was placed on the pro side.

00:24:50.771 --> 00:24:51.512
I had to say it was

00:24:51.593 --> 00:24:52.593
hazardous and then build my

00:24:52.653 --> 00:24:53.773
argument towards that.

00:24:53.794 --> 00:24:54.653
So I still stand by that.

00:24:54.693 --> 00:24:56.776
I still think it's it could be hazardous.

00:24:57.256 --> 00:24:58.657
like a hammer could be used

00:24:58.758 --> 00:24:59.739
to build a tool or to do

00:24:59.778 --> 00:25:00.480
harm on somebody.

00:25:00.819 --> 00:25:01.740
But I do think it's a tool,

00:25:01.780 --> 00:25:02.602
and I like that analogy.

00:25:02.801 --> 00:25:04.022
You can use it to see things

00:25:04.042 --> 00:25:06.586
like a telescope, to test something,

00:25:06.645 --> 00:25:07.787
to connect, to learn.

00:25:08.248 --> 00:25:09.429
It's more like a Swiss Army knife,

00:25:09.449 --> 00:25:11.511
in my opinion, if used correctly.

00:25:11.531 --> 00:25:13.394
So how do you use social media

00:25:13.953 --> 00:25:14.554
And I got to know the

00:25:14.594 --> 00:25:17.035
backstory behind how you

00:25:17.055 --> 00:25:18.576
got in at the ground floor, right?

00:25:18.596 --> 00:25:19.955
The first person to get, you know,

00:25:20.635 --> 00:25:22.876
the right URL for a website

00:25:23.237 --> 00:25:25.317
has got a great corner on the internet.

00:25:25.657 --> 00:25:28.499
You got at physical therapy on Twitter.

00:25:29.058 --> 00:25:30.038
Yeah.

00:25:30.159 --> 00:25:32.140
And at physical therapist on Instagram.

00:25:33.519 --> 00:25:34.681
Yeah, I can get through those stories,

00:25:34.740 --> 00:25:36.000
but I think in general, the way I,

00:25:36.020 --> 00:25:37.382
you know, I'm an old guy,

00:25:37.422 --> 00:25:38.682
so I use social media just

00:25:38.721 --> 00:25:40.042
for primarily fun and to

00:25:40.163 --> 00:25:41.262
promote the profession and,

00:25:41.767 --> 00:25:42.707
and to promote some of the

00:25:42.727 --> 00:25:43.448
interests that I'm on.

00:25:43.567 --> 00:25:44.887
I don't use it to have

00:25:44.948 --> 00:25:45.847
transparency on what's

00:25:45.887 --> 00:25:46.788
going on in my life and

00:25:46.827 --> 00:25:47.588
what I'm eating and where

00:25:47.608 --> 00:25:49.088
I'm at every given day.

00:25:49.108 --> 00:25:50.950
I've always been much more

00:25:50.970 --> 00:25:52.309
of a private person in that respect.

00:25:52.769 --> 00:25:53.650
Although I've got great

00:25:53.710 --> 00:25:55.211
friends who are the

00:25:55.351 --> 00:25:56.310
opposite of me and do it

00:25:56.451 --> 00:25:58.692
absolutely a different way.

00:25:58.751 --> 00:26:00.392
And I believe that you have

00:26:00.432 --> 00:26:01.432
the ability as a human

00:26:01.472 --> 00:26:02.593
being to be distinguishing.

00:26:02.633 --> 00:26:03.853
And we have cognitive skills

00:26:03.873 --> 00:26:04.614
that allow us to say,

00:26:05.173 --> 00:26:06.513
what's the best movie to watch?

00:26:06.574 --> 00:26:06.814
Well,

00:26:06.933 --> 00:26:08.734
you should apply that same thinking

00:26:08.755 --> 00:26:09.535
to social media.

00:26:10.115 --> 00:26:11.355
And you have to determine

00:26:11.395 --> 00:26:12.897
whether it is information

00:26:12.938 --> 00:26:13.959
or misinformation.

00:26:14.519 --> 00:26:16.040
And that's where it can be harmful.

00:26:16.101 --> 00:26:17.122
I have seen a lot of

00:26:17.142 --> 00:26:17.842
physical therapy

00:26:17.882 --> 00:26:19.002
self-promotion where it's

00:26:19.384 --> 00:26:20.585
stuff that's not backed by

00:26:20.644 --> 00:26:21.605
research or evidence.

00:26:22.105 --> 00:26:23.507
So we have to be careful about it.

00:26:24.327 --> 00:26:25.308
In terms of how I got the

00:26:25.328 --> 00:26:26.869
name physical therapy, it's interesting.

00:26:26.890 --> 00:26:27.431
Many years ago,

00:26:27.451 --> 00:26:28.311
I used to go to the TED

00:26:28.372 --> 00:26:29.251
conference every year,

00:26:30.093 --> 00:26:31.453
particularly when it was in Long Beach.

00:26:31.493 --> 00:26:32.555
And this is years ago and

00:26:32.654 --> 00:26:33.936
just a tremendous amount of fun.

00:26:34.676 --> 00:26:36.140
And I remember at the time,

00:26:36.180 --> 00:26:37.161
there were only two people

00:26:37.201 --> 00:26:37.821
from the whole state of

00:26:37.862 --> 00:26:39.163
Kentucky that were going to

00:26:39.203 --> 00:26:39.785
that conference.

00:26:39.865 --> 00:26:41.247
And they did a variety of

00:26:41.326 --> 00:26:42.249
events where you tried to

00:26:42.288 --> 00:26:42.910
meet one another.

00:26:42.970 --> 00:26:44.412
And back then,

00:26:44.451 --> 00:26:45.574
you would have your name and

00:26:45.594 --> 00:26:46.315
you were never allowed to

00:26:46.375 --> 00:26:47.936
promote any kind of business or anything,

00:26:47.977 --> 00:26:48.838
but you'd have three things

00:26:48.878 --> 00:26:49.980
that you were interested in and

00:26:50.915 --> 00:26:51.537
And they'd have these little

00:26:51.557 --> 00:26:52.396
cocktail parties.

00:26:52.517 --> 00:26:53.919
And right in front of me at

00:26:53.959 --> 00:26:54.878
one of the cocktail parties

00:26:54.960 --> 00:26:55.599
is a gentleman,

00:26:55.660 --> 00:26:57.342
and he ordered a Maker's Mark.

00:26:57.362 --> 00:26:58.281
Well, I'm from Kentucky,

00:26:58.323 --> 00:27:00.263
and so he orders a Maker's Mark.

00:27:00.304 --> 00:27:02.266
They have some conversation

00:27:02.286 --> 00:27:03.207
to talk to him about.

00:27:03.247 --> 00:27:03.866
We turned around,

00:27:03.886 --> 00:27:06.549
and his name was Evan Williams.

00:27:06.849 --> 00:27:08.590
And I said, oh, my gosh.

00:27:09.251 --> 00:27:10.532
Your name is Evan Williams,

00:27:10.673 --> 00:27:11.532
and you've just ordered a

00:27:11.573 --> 00:27:12.534
Maker's Mark because Evan

00:27:12.554 --> 00:27:14.234
Williams is a bourbon name as well.

00:27:14.255 --> 00:27:15.194
It's owned by Heaven Hill.

00:27:15.214 --> 00:27:16.075
It's a pretty good bourbon.

00:27:16.095 --> 00:27:18.336
Same people make Elijah Craig,

00:27:18.376 --> 00:27:20.176
same people who make Larceny.

00:27:21.038 --> 00:27:22.479
Some people make Old Fitzgerald.

00:27:22.499 --> 00:27:22.979
Really, really,

00:27:23.019 --> 00:27:24.559
Heaven Hill is just a tremendous company,

00:27:24.599 --> 00:27:25.420
one of the few that's still

00:27:25.460 --> 00:27:26.721
locally owned here in Kentucky.

00:27:27.461 --> 00:27:28.582
And so I started talking to

00:27:28.642 --> 00:27:29.741
him about Maker's Mark and

00:27:29.761 --> 00:27:30.982
his name being Evan Williams and,

00:27:31.002 --> 00:27:31.202
you know,

00:27:31.929 --> 00:27:33.190
And invariably, what do you do?

00:27:33.250 --> 00:27:33.990
How'd you get here?

00:27:34.069 --> 00:27:35.150
Well, I used to work at Google.

00:27:35.210 --> 00:27:36.871
I started this blogging software.

00:27:38.132 --> 00:27:39.652
Now I've just left Google

00:27:39.711 --> 00:27:42.814
and I started a new a new

00:27:42.854 --> 00:27:43.693
thing called Twitter.

00:27:43.753 --> 00:27:45.055
We just exhibited it at the

00:27:45.075 --> 00:27:46.855
South by Southwest thing a few weeks,

00:27:46.894 --> 00:27:48.236
literally like a few weeks ago.

00:27:48.675 --> 00:27:49.455
And he was telling me a

00:27:49.476 --> 00:27:50.237
little bit about it.

00:27:50.336 --> 00:27:51.596
And in my head was spinning like,

00:27:51.757 --> 00:27:53.137
I don't quite get this,

00:27:53.417 --> 00:27:55.098
but this guy seems really smart.

00:27:55.118 --> 00:27:55.719
Yeah.

00:27:55.919 --> 00:27:58.363
And so immediately after

00:27:58.403 --> 00:28:00.164
that cocktail party went back to my room,

00:28:00.184 --> 00:28:01.186
I think back in those days

00:28:01.207 --> 00:28:02.269
you had to do the plug-in with the,

00:28:02.930 --> 00:28:04.632
you know, just get to the internet.

00:28:04.672 --> 00:28:05.673
I signed up on Twitter and

00:28:05.693 --> 00:28:07.115
signed up as at Physical Therapy.

00:28:07.175 --> 00:28:09.338
So that's how I got at Physical Therapy.

00:28:09.358 --> 00:28:10.840
The physicaltherapist.com was –

00:28:11.561 --> 00:28:13.243
Legit, very early days.

00:28:14.085 --> 00:28:14.905
We were the first company

00:28:14.925 --> 00:28:16.227
back then to have a website.

00:28:16.267 --> 00:28:16.867
So we reserved

00:28:16.887 --> 00:28:18.068
physicaltherapist.com with

00:28:18.108 --> 00:28:19.150
my friend Rick Schutz.

00:28:19.590 --> 00:28:20.852
And then my own company back then,

00:28:20.892 --> 00:28:22.794
which was called CORT, K-O-R-T,

00:28:22.814 --> 00:28:23.994
Kentucky Orthopedic Rehab Team.

00:28:24.316 --> 00:28:24.776
We literally,

00:28:24.796 --> 00:28:25.737
I think we're the first PT

00:28:25.757 --> 00:28:26.678
practice to have a website.

00:28:26.698 --> 00:28:27.618
So we tried to be early

00:28:27.659 --> 00:28:28.839
adopters of technology,

00:28:28.880 --> 00:28:30.041
more out of interest level

00:28:30.082 --> 00:28:30.801
than anything else.

00:28:31.502 --> 00:28:32.604
And then I don't know how it

00:28:32.624 --> 00:28:33.423
happened on Instagram.

00:28:33.463 --> 00:28:34.384
I guess I signed up pretty

00:28:34.424 --> 00:28:35.925
early because that may have

00:28:35.945 --> 00:28:36.786
been a stroke of luck to

00:28:36.826 --> 00:28:38.326
get a physical therapist there.

00:28:38.768 --> 00:28:40.307
I was not an early adopter

00:28:40.327 --> 00:28:43.109
of Instagram like others that I know.

00:28:43.609 --> 00:28:43.871
You know,

00:28:43.931 --> 00:28:44.990
I consider myself pretty

00:28:45.010 --> 00:28:45.892
innovative as I pay

00:28:45.912 --> 00:28:46.932
attention to things like that.

00:28:47.032 --> 00:28:48.933
But it shows that you leapt

00:28:49.013 --> 00:28:50.775
before you understood fully.

00:28:51.194 --> 00:28:52.895
You understood what the

00:28:52.935 --> 00:28:53.757
buy-in needed to be.

00:28:53.777 --> 00:28:54.517
You were going to go to a website.

00:28:54.537 --> 00:28:56.057
You were going to spend some time.

00:28:56.077 --> 00:28:57.499
You were going to pay attention, right?

00:28:57.558 --> 00:28:58.338
Spend attention time.

00:28:58.559 --> 00:28:58.700
Yeah.

00:28:59.599 --> 00:29:01.779
And before really understanding it,

00:29:01.800 --> 00:29:03.280
because really, if you want to look at it,

00:29:03.300 --> 00:29:03.941
the only way you can really

00:29:03.961 --> 00:29:04.780
understand something is

00:29:04.820 --> 00:29:05.881
sort of by banging on it

00:29:05.921 --> 00:29:06.862
and kicking the tires and

00:29:06.902 --> 00:29:07.922
taking off the test drive.

00:29:08.321 --> 00:29:09.301
So you had that connection

00:29:09.342 --> 00:29:11.142
with a human and you were able to say,

00:29:11.162 --> 00:29:12.462
I don't really know what this is,

00:29:12.482 --> 00:29:13.563
but the barrier to entry is

00:29:13.563 --> 00:29:14.762
15 minutes of my time.

00:29:15.083 --> 00:29:15.522
Exactly.

00:29:15.722 --> 00:29:17.104
And you were lucky enough to say, well,

00:29:17.183 --> 00:29:17.443
all right,

00:29:17.463 --> 00:29:18.884
if I'm going to give myself a handle,

00:29:18.923 --> 00:29:20.503
if I'm going to have a stamp somewhere,

00:29:20.523 --> 00:29:23.125
why not use the word of the profession?

00:29:23.144 --> 00:29:25.545
I think if only more people

00:29:25.565 --> 00:29:26.625
were able to say something

00:29:26.645 --> 00:29:28.105
like that or operate that way.

00:29:28.944 --> 00:29:30.246
and kick the tires of things

00:29:30.346 --> 00:29:31.185
instead of saying, well,

00:29:31.226 --> 00:29:32.987
what's my five year plan with this?

00:29:33.047 --> 00:29:34.567
Unless I know that sometimes

00:29:34.587 --> 00:29:35.509
we can over prepare.

00:29:36.189 --> 00:29:36.869
That's right.

00:29:37.849 --> 00:29:38.431
No doubt about it.

00:29:39.010 --> 00:29:39.730
No doubt about it.

00:29:39.770 --> 00:29:39.931
Yeah.

00:29:40.491 --> 00:29:40.612
Yeah.

00:29:40.632 --> 00:29:41.311
All right.

00:29:41.352 --> 00:29:43.012
So you're involved in education.

00:29:43.452 --> 00:29:44.554
I always love asking people

00:29:44.594 --> 00:29:46.535
who are who pay attention

00:29:46.815 --> 00:29:48.155
and focus on education.

00:29:49.017 --> 00:29:50.678
What are some things outside

00:29:50.718 --> 00:29:51.978
of the profession that

00:29:52.038 --> 00:29:53.259
really excite you right now?

00:29:53.278 --> 00:29:54.619
And I don't want to give it a medium.

00:29:54.680 --> 00:29:56.441
It could be a book, a movie, a podcast.

00:29:57.020 --> 00:29:57.461
anything,

00:29:57.541 --> 00:29:58.603
but what's something right now

00:29:58.643 --> 00:30:00.625
that you are using as a

00:30:00.664 --> 00:30:01.786
tool to educate yourself

00:30:02.105 --> 00:30:02.906
anywhere in your life?

00:30:03.468 --> 00:30:03.647
Well,

00:30:03.667 --> 00:30:05.068
you'd have to be under a rock if you

00:30:05.088 --> 00:30:07.751
didn't mention AI and all

00:30:07.791 --> 00:30:10.034
of the different offshoots from it.

00:30:10.714 --> 00:30:14.719
Again, very early adopter of ChatGPT,

00:30:14.778 --> 00:30:15.980
very early adopter of even

00:30:16.000 --> 00:30:17.862
the preliminary ones before that,

00:30:18.402 --> 00:30:20.003
before there were large language models.

00:30:20.604 --> 00:30:22.884
I've been trying to use it in my writing.

00:30:23.085 --> 00:30:24.125
I've been trying to use it

00:30:24.286 --> 00:30:26.547
in other things to construct emails.

00:30:27.186 --> 00:30:29.307
I used it to help cast some

00:30:29.428 --> 00:30:31.689
scripts of some movie films

00:30:31.729 --> 00:30:32.388
that we do and are

00:30:32.429 --> 00:30:33.750
company-wide for the last

00:30:33.769 --> 00:30:34.990
few years over certain sort

00:30:35.009 --> 00:30:36.631
of psychological topics.

00:30:36.671 --> 00:30:38.011
I've had great success with it.

00:30:38.731 --> 00:30:40.031
I'm intrigued by how it can

00:30:40.092 --> 00:30:41.093
impact our profession.

00:30:41.952 --> 00:30:43.974
um it's very difficult to

00:30:44.035 --> 00:30:45.896
take an unregulated medium

00:30:46.076 --> 00:30:47.357
and put it in a regulated

00:30:47.458 --> 00:30:49.538
medium the part that scares

00:30:49.619 --> 00:30:52.020
me about pt is not ai I

00:30:52.102 --> 00:30:53.303
think ai can come in and

00:30:54.022 --> 00:30:55.324
artificially scrub records

00:30:55.384 --> 00:30:56.444
for compliance and take

00:30:56.484 --> 00:30:57.526
that off our chest I think

00:30:57.586 --> 00:30:58.586
it could artificially come

00:30:58.686 --> 00:31:00.387
in and do all of our notes

00:31:00.868 --> 00:31:01.929
that's not a problem but

00:31:02.029 --> 00:31:03.590
will our industry and will

00:31:04.090 --> 00:31:05.752
CMS and Medicare and the

00:31:05.792 --> 00:31:07.654
other payers allow these

00:31:07.694 --> 00:31:08.535
things to be done.

00:31:08.575 --> 00:31:10.057
And can we match the fields

00:31:10.116 --> 00:31:11.637
that the EMR says they have

00:31:11.678 --> 00:31:13.579
to be in with what the AI

00:31:13.880 --> 00:31:15.141
is trying to put them in?

00:31:15.961 --> 00:31:17.963
And so the constraints are

00:31:18.023 --> 00:31:19.085
not the technology,

00:31:19.144 --> 00:31:20.547
the constraints are the regulations.

00:31:21.207 --> 00:31:22.248
And so my hope,

00:31:22.407 --> 00:31:23.769
my genuine hope is that our

00:31:23.828 --> 00:31:25.049
younger therapists will

00:31:25.150 --> 00:31:26.611
benefit tremendously

00:31:27.030 --> 00:31:28.632
because death by a thousand

00:31:28.672 --> 00:31:29.732
clicks is very real.

00:31:30.212 --> 00:31:32.194
I would say if you're taking

00:31:32.335 --> 00:31:35.136
burnout at its core, lost of zest,

00:31:35.477 --> 00:31:36.278
feeling like you're not

00:31:36.597 --> 00:31:37.838
professionally getting ahead,

00:31:38.058 --> 00:31:38.900
what you're accomplishing

00:31:38.940 --> 00:31:40.441
isn't making a dent in the universe.

00:31:41.121 --> 00:31:42.962
If we can eliminate the

00:31:43.042 --> 00:31:44.983
regulatory constraints and

00:31:45.023 --> 00:31:47.164
documentation suck up that

00:31:47.326 --> 00:31:48.646
in Medicare takes up 25% of your time.

00:31:48.727 --> 00:31:48.946
Wow.

00:31:50.887 --> 00:31:52.368
I talk to my friends in education,

00:31:52.409 --> 00:31:52.970
they have the same

00:31:53.049 --> 00:31:54.931
complaints in the sense that, you know,

00:31:54.971 --> 00:31:57.133
it isn't teaching kids that I don't like.

00:31:57.353 --> 00:31:58.453
It's the reports I have to

00:31:58.473 --> 00:31:59.855
give back to my boss or to

00:31:59.895 --> 00:32:02.357
the system makes me do all of these,

00:32:02.817 --> 00:32:03.057
you know,

00:32:03.137 --> 00:32:04.839
so-called process improvement

00:32:04.900 --> 00:32:06.461
plans that have nothing to

00:32:06.500 --> 00:32:08.403
do with the core, in that case,

00:32:08.462 --> 00:32:09.503
teaching or in our case,

00:32:09.784 --> 00:32:10.865
applying to patients.

00:32:11.404 --> 00:32:12.424
it's really sad that we

00:32:12.464 --> 00:32:14.286
think it's good if a pt can

00:32:14.326 --> 00:32:15.445
see let's say 10 to 12

00:32:15.445 --> 00:32:17.405
patients a day well the

00:32:17.425 --> 00:32:18.287
only reason they you know

00:32:18.307 --> 00:32:19.067
when I was in the military

00:32:19.106 --> 00:32:20.166
we saw a lot more than 10

00:32:20.166 --> 00:32:21.186
to 12 patients a day and we

00:32:21.207 --> 00:32:22.448
had a tremendous effect it

00:32:22.488 --> 00:32:24.248
had nothing to do with our

00:32:24.387 --> 00:32:26.127
ability our throughput it

00:32:26.147 --> 00:32:28.128
had the fact that we didn't

00:32:28.169 --> 00:32:30.249
have the constraints of all

00:32:30.328 --> 00:32:31.730
these requirements that we

00:32:31.769 --> 00:32:32.829
superimposed on everybody

00:32:32.910 --> 00:32:34.609
else and so my genuine hope

00:32:34.670 --> 00:32:35.891
is that ai so that's been a

00:32:35.931 --> 00:32:37.550
personal interest of mine I'm

00:32:37.550 --> 00:32:40.635
I'm fascinated by the ability to interact.

00:32:40.896 --> 00:32:42.199
I think there will be a time

00:32:42.219 --> 00:32:43.080
in the near future where

00:32:43.101 --> 00:32:44.482
you'll have a telephone and

00:32:44.522 --> 00:32:47.067
be able to talk to an AI PT

00:32:47.127 --> 00:32:48.269
and give you the basics.

00:32:49.190 --> 00:32:49.931
I still don't think

00:32:50.131 --> 00:32:53.452
ultimately that will replace any PT.

00:32:53.692 --> 00:32:56.255
You know, there's a movement, a float,

00:32:56.795 --> 00:32:58.296
what I call a displacement

00:32:59.036 --> 00:33:00.356
movement that really thinks

00:33:00.376 --> 00:33:02.337
you can displace PT with technology.

00:33:02.357 --> 00:33:03.219
And I think that's sad.

00:33:04.140 --> 00:33:05.641
We take a very different approach.

00:33:05.721 --> 00:33:08.241
My approach is augmentation approach.

00:33:08.682 --> 00:33:09.903
I think you use these tools

00:33:09.962 --> 00:33:12.365
to help you get your hands on patients.

00:33:12.964 --> 00:33:14.465
Let's face it, 80,

00:33:14.465 --> 00:33:16.227
90% of all PT will be done

00:33:16.428 --> 00:33:18.028
in a clinic in the future.

00:33:18.249 --> 00:33:19.529
That's not going to change.

00:33:19.730 --> 00:33:20.790
What will change is we have

00:33:20.871 --> 00:33:21.971
tools to help you in

00:33:22.011 --> 00:33:23.192
between your clinic spots

00:33:23.613 --> 00:33:25.233
from an accountability and

00:33:25.273 --> 00:33:25.854
everything else.

00:33:26.295 --> 00:33:27.895
You're going to see RFID and

00:33:27.915 --> 00:33:29.237
other kinds of technology

00:33:29.257 --> 00:33:30.356
be able to tell us

00:33:31.238 --> 00:33:32.259
Very simply whether our

00:33:32.278 --> 00:33:33.980
patient did our exercise, okay?

00:33:34.440 --> 00:33:34.980
You're gonna wear this

00:33:35.019 --> 00:33:36.580
sensor to do the exercise.

00:33:36.601 --> 00:33:37.842
It'll automatically upload.

00:33:38.122 --> 00:33:39.482
I'll be able to remote monitor you.

00:33:39.522 --> 00:33:40.284
And if something goes wrong,

00:33:40.324 --> 00:33:41.423
I might get on the phone with you and say,

00:33:41.444 --> 00:33:41.664
you know,

00:33:41.684 --> 00:33:42.605
you didn't do your at-home

00:33:42.684 --> 00:33:43.445
exercises there.

00:33:43.506 --> 00:33:44.807
You didn't do certain instructions.

00:33:45.027 --> 00:33:46.407
I think those tools are all great.

00:33:47.087 --> 00:33:48.108
But ultimately,

00:33:48.148 --> 00:33:49.089
a physical therapist's

00:33:49.109 --> 00:33:50.810
skills are neck-up skills.

00:33:50.851 --> 00:33:52.092
They're cognitive skills.

00:33:52.551 --> 00:33:53.712
We have hands-on skills,

00:33:53.752 --> 00:33:54.814
but that's secondary to our

00:33:54.874 --> 00:33:55.575
neck-up skills.

00:33:56.275 --> 00:33:58.557
And that's not going to be displaced by AI,

00:33:58.797 --> 00:34:00.637
but it could be augmented by AI.

00:34:01.259 --> 00:34:03.019
I mean, to me, I keep paying attention,

00:34:03.200 --> 00:34:04.862
and I mentioned biases.

00:34:05.402 --> 00:34:06.323
I come at things with a

00:34:06.383 --> 00:34:07.844
background in radio broadcasting,

00:34:07.884 --> 00:34:09.826
and really that's relationship building,

00:34:09.925 --> 00:34:10.085
right?

00:34:10.106 --> 00:34:12.447
That's high frequency over time.

00:34:12.987 --> 00:34:14.809
And I look at what AI is allowing,

00:34:15.750 --> 00:34:16.269
will allow...

00:34:17.971 --> 00:34:19.952
professions like ours to do is do that,

00:34:20.152 --> 00:34:23.351
is to show not tell a value

00:34:23.592 --> 00:34:25.692
in frequency over time when

00:34:25.711 --> 00:34:26.293
the person doesn't

00:34:26.333 --> 00:34:27.472
necessarily need to just be

00:34:27.492 --> 00:34:27.992
in front of you.

00:34:28.432 --> 00:34:29.833
You can help from afar,

00:34:30.393 --> 00:34:31.934
but I think someone has the

00:34:31.974 --> 00:34:33.733
great line where AI won't replace people,

00:34:33.833 --> 00:34:34.793
AI will replace people who

00:34:34.833 --> 00:34:35.614
don't embrace the

00:34:35.653 --> 00:34:36.974
technology that is being

00:34:37.114 --> 00:34:39.034
used and will allow them to

00:34:39.074 --> 00:34:39.934
have further reach and

00:34:39.954 --> 00:34:41.295
build relationships in the future.

00:34:41.875 --> 00:34:42.635
No, I think that's right.

00:34:42.655 --> 00:34:43.996
I also think it depends on

00:34:44.715 --> 00:34:46.076
your mindset's really important.

00:34:46.860 --> 00:34:48.001
So if you fundamentally

00:34:48.081 --> 00:34:49.802
think that PT could be displaced,

00:34:49.963 --> 00:34:51.023
you're looking at AI

00:34:51.083 --> 00:34:52.525
solutions very differently

00:34:52.545 --> 00:34:54.788
than folks like myself and

00:34:54.867 --> 00:34:56.048
others that I'm teammates

00:34:56.128 --> 00:34:57.751
with who are looking at AI

00:34:57.771 --> 00:34:59.311
to help us augment or

00:34:59.373 --> 00:35:00.673
enhance the experience for

00:35:00.693 --> 00:35:02.355
the patient and ensure a

00:35:02.396 --> 00:35:03.556
better clinical outcome.

00:35:04.016 --> 00:35:05.898
Very different usage cases

00:35:07.800 --> 00:35:08.641
that we're trying to model.

00:35:09.059 --> 00:35:10.000
I was trying to explain it to a friend.

00:35:10.019 --> 00:35:10.260
I said,

00:35:10.320 --> 00:35:11.840
you can still chop the tree down

00:35:11.900 --> 00:35:12.541
with the ax.

00:35:12.702 --> 00:35:13.501
You can do that,

00:35:13.842 --> 00:35:14.842
but you have to understand

00:35:14.862 --> 00:35:15.724
that the world has been

00:35:15.764 --> 00:35:17.284
given for better or worse.

00:35:17.324 --> 00:35:17.565
And again,

00:35:17.585 --> 00:35:18.925
this goes back to the tool analogy,

00:35:19.445 --> 00:35:20.786
a chainsaw or a machine

00:35:20.806 --> 00:35:22.728
with 10 chainsaws that drives around.

00:35:22.789 --> 00:35:24.150
So how will you use that?

00:35:24.190 --> 00:35:25.331
Can you use it for bad and good?

00:35:25.510 --> 00:35:26.150
The answer is yes.

00:35:26.670 --> 00:35:27.231
Absolutely.

00:35:27.411 --> 00:35:28.632
But hopefully we have enough

00:35:28.833 --> 00:35:29.733
people in our profession.

00:35:29.753 --> 00:35:30.853
And I think we do to

00:35:30.994 --> 00:35:31.974
hopefully figure out how to

00:35:32.275 --> 00:35:33.155
amplify this tool.

00:35:33.695 --> 00:35:34.077
No doubt.

00:35:34.097 --> 00:35:35.378
All right.

00:35:35.398 --> 00:35:36.378
The last thing we do on the show,

00:35:36.398 --> 00:35:38.559
Larry is called the parting shot.

00:35:52.875 --> 00:35:53.074
All right,

00:35:53.114 --> 00:35:54.056
Parting Shot brought to you by

00:35:54.096 --> 00:35:54.635
our friends from the

00:35:54.675 --> 00:35:56.876
Academy of Orthopedic Physical Therapy.

00:35:56.916 --> 00:35:58.478
Their current concepts of

00:35:58.557 --> 00:35:59.759
orthopedic physical therapy.

00:35:59.798 --> 00:36:00.518
If you want to go from

00:36:00.539 --> 00:36:01.300
wherever you are in your

00:36:01.340 --> 00:36:02.840
career to taking that

00:36:02.880 --> 00:36:04.701
current concept or sort of that OCS exam,

00:36:05.021 --> 00:36:06.922
find them online at orthopt.org.

00:36:07.443 --> 00:36:08.483
Parting Shot, Larry,

00:36:08.503 --> 00:36:10.224
you just chanced for a mic drop moment,

00:36:10.264 --> 00:36:11.324
your soapbox statement.

00:36:11.344 --> 00:36:12.144
What would you want to leave

00:36:12.184 --> 00:36:13.025
with the audience today?

00:36:13.672 --> 00:36:14.791
I'd say there's three things

00:36:14.871 --> 00:36:17.592
I would want to get folks

00:36:18.032 --> 00:36:19.512
lined up on or aligned on.

00:36:20.233 --> 00:36:21.414
The first is that I do think

00:36:21.454 --> 00:36:23.034
physical therapists will be

00:36:23.094 --> 00:36:24.554
the focused access points

00:36:24.655 --> 00:36:26.735
for all things MSK, all aches, pains,

00:36:26.755 --> 00:36:27.514
sprains, and strains.

00:36:28.036 --> 00:36:31.155
It'll be multimodal, it'll be omnichannel,

00:36:31.476 --> 00:36:34.297
and things will still happen in a clinic,

00:36:34.436 --> 00:36:35.896
but PTs will be that

00:36:36.117 --> 00:36:37.797
centric point for sure.

00:36:39.231 --> 00:36:40.992
I don't see the overall

00:36:41.032 --> 00:36:43.094
population health changing dramatically,

00:36:43.273 --> 00:36:43.753
even with the

00:36:43.793 --> 00:36:45.755
semi-glutathione drugs and medications.

00:36:46.394 --> 00:36:46.635
You know,

00:36:46.675 --> 00:36:48.795
right now we're at the 10 to 12%.

00:36:48.795 --> 00:36:52.277
I expect PT to be at 15 to 25% of MSK,

00:36:53.057 --> 00:36:53.778
certainly hope so.

00:36:53.838 --> 00:36:54.898
So our growth rate will be

00:36:54.938 --> 00:36:56.619
profound and how we address

00:36:56.639 --> 00:36:57.539
that challenge is something

00:36:57.679 --> 00:36:58.701
you and I just discussed.

00:36:59.181 --> 00:37:00.402
The last parting shot I

00:37:00.442 --> 00:37:01.202
would say is that

00:37:01.282 --> 00:37:02.882
reimbursement isn't all of

00:37:02.922 --> 00:37:04.744
a sudden gonna suddenly change.

00:37:05.344 --> 00:37:07.005
Our fee for service models

00:37:07.844 --> 00:37:09.967
have increased the cost you

00:37:09.987 --> 00:37:10.967
know it used to be called

00:37:10.987 --> 00:37:12.228
the affordable care act and

00:37:12.248 --> 00:37:13.489
it was called obamacare and

00:37:13.510 --> 00:37:14.090
I'm not trying to get

00:37:14.150 --> 00:37:15.512
political but it's the last

00:37:15.532 --> 00:37:16.052
thing that it is is

00:37:16.333 --> 00:37:17.753
affordable our health care

00:37:17.773 --> 00:37:19.735
costs are ups you know

00:37:19.755 --> 00:37:21.978
they're obscene and we are

00:37:22.057 --> 00:37:23.978
going to have to go to some

00:37:24.119 --> 00:37:25.920
type of alternative payment

00:37:25.981 --> 00:37:27.181
model now notice I didn't

00:37:27.202 --> 00:37:28.664
say value-based care

00:37:29.304 --> 00:37:31.005
where PTs are likely going

00:37:31.025 --> 00:37:33.547
to be paid alternatively

00:37:33.646 --> 00:37:34.947
based on a number of things.

00:37:34.967 --> 00:37:36.148
It could be risk triage.

00:37:36.548 --> 00:37:38.170
It could be access points,

00:37:38.250 --> 00:37:39.351
getting patients in,

00:37:39.751 --> 00:37:40.992
being able to avoid

00:37:41.052 --> 00:37:43.333
downstream pharma imaging surgery,

00:37:43.813 --> 00:37:45.195
all those kind of things.

00:37:45.255 --> 00:37:46.456
But as a physical therapist,

00:37:46.536 --> 00:37:48.137
we cannot withstand that.

00:37:48.436 --> 00:37:49.577
the decreased payments that

00:37:49.597 --> 00:37:50.579
we're getting in medicare

00:37:50.599 --> 00:37:51.739
and medicare advantage and

00:37:51.800 --> 00:37:53.240
survive and it's

00:37:53.280 --> 00:37:54.221
unfortunate that our

00:37:54.240 --> 00:37:55.302
patients who need us the

00:37:55.342 --> 00:37:57.182
most the elderly will have

00:37:57.222 --> 00:37:58.563
the least access because

00:37:58.583 --> 00:37:59.545
their payment system is

00:37:59.565 --> 00:38:01.085
screwed up so the only way

00:38:01.106 --> 00:38:02.726
to course correct that is

00:38:02.766 --> 00:38:03.807
through some sense of

00:38:03.867 --> 00:38:05.048
alternative payment model

00:38:05.068 --> 00:38:06.610
whether us as a value-added

00:38:06.690 --> 00:38:08.751
partner in it some aspect

00:38:08.791 --> 00:38:10.413
of risk sharing I don't

00:38:10.512 --> 00:38:12.114
know but it has to change

00:38:12.996 --> 00:38:13.197
Yeah.

00:38:13.597 --> 00:38:15.380
And one of those we have more control over,

00:38:15.981 --> 00:38:16.141
right?

00:38:16.181 --> 00:38:17.282
Waiting for someone else to

00:38:17.322 --> 00:38:18.983
wake up and decide we are valuable.

00:38:19.603 --> 00:38:22.367
To me, it's going to take too long,

00:38:22.887 --> 00:38:23.568
if ever at all.

00:38:23.688 --> 00:38:24.329
One of those things,

00:38:24.909 --> 00:38:26.030
you can pull a lever and

00:38:26.070 --> 00:38:26.771
have more results.

00:38:26.811 --> 00:38:28.773
And it's showing value and

00:38:28.813 --> 00:38:31.197
leaning into the larger

00:38:31.217 --> 00:38:33.239
than 15% that we're affecting now.

00:38:33.798 --> 00:38:34.280
Absolutely.

00:38:34.878 --> 00:38:36.061
Well, we've mentioned it several times.

00:38:36.081 --> 00:38:37.844
I don't think I need to push too hard,

00:38:37.864 --> 00:38:38.545
but if you'd like to follow

00:38:38.565 --> 00:38:39.427
this guy on social media,

00:38:39.487 --> 00:38:40.230
at Physical Therapy.

00:38:40.269 --> 00:38:40.851
Larry,

00:38:41.152 --> 00:38:42.313
appreciate the time having a Miller

00:38:42.333 --> 00:38:42.675
Lite with me.

00:38:43.235 --> 00:38:43.737
Absolutely.

00:38:43.777 --> 00:38:44.137
Thanks, Jimmy.

00:38:44.157 --> 00:38:44.778
You do a great job.