Hard Work Didn’t Stop Working — Physical Therapy Stopped Rewarding It

0:00 You're listening to the P.T. Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. All right, ladies and gentlemen, doing a quick Monday live stream because there's some interesting things on LinkedIn. And when there are interesting things on LinkedIn, I like to point them out because there's not always interesting things on LinkedIn. Sometimes it's just a lot of, well, noise. But I thought some good points were being made by this guy right here, Rob Panarella. And I wanted to share them. He had a post, and I think he got such a good response from it that he had a follow-up post, and then a follow-up to the follow-up post.

0:41 which is always great. Interesting conversations happening. And this has been over the last couple of weeks. And before anybody tightens up, I'm not here to take down somebody. I think Rob brings up some really, really, really good points. But something is breaking in the profession and how we talk to each other about this. Maybe you want to call it a generational divide. I don't know. It keeps being framed as a work ethic problem. I don't think it's a work ethic problem. This feels a little bit, I know this is a podcast. We're also doing a live stream. I know it's a podcast and you can't, but it feels finger waggy. And I don't think it's a work ethic problem. And that's why I think we keep talking past each other and not to each other to find a solution.

1:26 In my opinion, if we keep framing this as a work ethic problem, I'm going to use hyperbole here. These kids today don't understand what hard work is. Back in my day, agreed, said that, heard that. Again, if I don't think it's a work ethic problem, then what is it, Jimmy? I think it's a conversion problem. Again, I think Chris Voss, who's an FBI hostage negotiator, would point this out and he would say, one side of the argument is talking in logic and the other is talking about emotion and neither is better and neither is right and neither is wrong. How could that be? Someone's gotta be right. Let's walk through this. First of all, you have to know who these people are.

2:07 Rob has more than more than forty years experience in the profession. He's not theorizing the things he's talking about and describing in terms of a career path. He actually lived. He actually walked and he's written. And here's I'm going to quote as much as possible. So I don't put words in anybody's mouth. I have enough words in my mouth. He said to achieve the professional and financial success desired, a physical therapist must provide value. Don't disagree. He continues, founded upon an exceptional work ethic and clinical knowledge and skill set exceeding those of your peers. That's true. Historically, that worked.

2:47 The latter looked a little something like this. Would love for you to correct me if I'm wrong. Anybody listening or watching. Get really good, produce great outcomes, earn trust, build referrals, gain leverage, see financial upside. That ladder existed. A lot of people climbed it. Rob is one of them. That's what it feels like. So I'm trying to read into what Rob said. I don't disagree. I think Rob is also very clear about something that people keep misinterpreting as well. Rob says, working hard was not implying to increase the number of patients seen in a day. I think that's a quote. I think that's good news for everybody.

3:30 Rob defines hard work in this way. Here's a quote, working hard implies continuing education, spending time with surgeons, learning the business of physical therapy. All the things I just said, Bill value. The question I think newer physical therapists are asking isn't whether everything Rob said creates value. It's whether that value still converts into upside predictably. See how I'd pause for dramatic effect? Because I think that's why I don't think it's a hard work problem. I think this is a conversion problem. Let me give you a scenario that I read often.

4:12 A new grad PT starts their first job, ready to work hard. Productivity expectations, let's say, fourteen to sixteen patients a day. Documentation bleeds into nights. Student loan payments begin a few months after graduating. They're encouraged to get involved, do some of that hard work. Unpaid weekends, we can call it what it is, unpaid weekends, shadowing surgeons, more courses. while raises are modest and ownership isn't really on the table a lot of times. Is this why we see a lot of the single provider clinics popping up? Spoiler alert, I believe so.

4:54 In my example there, that new grad PT or that plucky PT isn't avoiding effort. They're asking a question. They're trying to understand the return. This goes back to my premise. Is this a hard work problem or a conversion problem? The question I feel like we're being asked is, or that the new grad PT is asking, if and when I become exceptional to what Rob just said, Who gets rewarded for that? Now, keep in mind, I like to look at similarities and differences. So Rob did this as well. He brought it and we'll bring up an Elon Musk reference later. But let me bring up some parallels and we'll see if they're similar or different.

5:35 Journalism went through this. Retail went through this. Tech is going through this now. When professions move from apprenticeship ladders to efficiency systems ladders, excellence doesn't disappear, but when professions move from these ladders to efficiency systems, it just stops converting well. As in, hey, in my experience, work hard, work nights, work weekends at radio stations for little to no pay. Keep in mind, I worked for several years with no pay.

6:17 I was okay with that because I saw the ladder. I saw the first rung that I was on and I saw other people around me who were one, two, fifteen steps ahead. I understand this for that. Quid pro quo. Turns out studying Latin in journalism school actually makes sense. I think that's the shift people are reacting to, in that the latter isn't converting anymore. So they're not saying, I don't want to work hard. They're going to go, I'm going to keep staying on rung one. Why bother? What's my citation? People leaving the profession at mass.

6:57 So Rob is also direct about reimbursement, which I agree. Reimbursement rates will likely not increase soon. PTs are gonna have to work hard. Here's where I'm gonna, and I've invited Rob to talk about this. I don't understand what that part means because I think, I'll say it again, reimbursement rates will likely not increase soon. Hard disagree, I'm sorry, hard agree, agree. Agree, agree, agree. If you listen to our live streams with Tony and Dave Kittle, it's not going to. rob rob is actually kind reimbursement rates will likely not increase soon i would come in and go i will triple down on rob what rob said they will not increase soon or otherwise pretend they're zero what if insurance could be the loss leader that's a different conversation here's my confusion about rob's quote reimbursement rates will likely not increase pts are going to have to work hard agreed but that leads to a fair follow-up question how I don't think new grads or anybody, I don't think it matters where you are in your career.

8:02 I don't think physical therapists treating clinicians are avoiding effort for the most part. I'd stand behind that. I don't think they're avoiding effort. I think they're questioning the return, which is a thing I also hear many people say, well, then PT students need to understand, become financially literate. Get it economically literate. When you sign on that dotted line to take out your loan, understand what you're committing to and you pay back. You pay back every nickel. Agreed. I think what they're doing here while they work, they go, so I'm going to do this. I'm looking at the ladder and I don't see many people on it and the people that are aren't moving.

8:48 I don't think they're avoiding effort. They're questioning the ROI. That's not entitlement. This is where I think an agreement, the disagreement happens. Right here. This is the intersection. That's not entitlement, everybody. That's asking questions to become economic literacy. That's a path to it. Hey, I'm going to do all this. Good. I'm okay with that. And then I'm going to get... We'll figure that out later. Just... anybody who says that to you run away from that person when they clearly define what you need to do and then says, we'll figure out where this goes later.

9:29 I gotta be honest to me personally, big red flag. I think that's where the issue is. Um, now we go into, uh, a quote from Rob where he parallels this similarly to what I did, where I said journalism did this and retail. The examples in journalism, retail, and tech, journalism was be an apprentice, eat shit, make not a lot of money, work hard, but We all did it and we all progressed. Look, look around. That person's been there for three years, five years, seven years. Now see where they are now. Retail was the same way. Fold shirts, bus tables, be a waiter, become a manager, become a, like there was a ladder.

10:13 But those systems don't operate that way anymore. Neither does PT, in my opinion. Rob does something similar. He references Elon Musk as an example of what hard work can produce. Extreme effort can lead to extreme outcomes. Here's the problem. That's cherry picking. That's a logical fallacy. Outliers don't explain systems. They obscure them. Most PTs aren't trying to achieve the thing that Elon Musk is trying to achieve. They're not trying to become billionaires. They're trying to build sustainable careers. So I think that parallel, that one doesn't hold up. I also don't think this is old PT versus young PT.

10:56 I, again, will reiterate the core of what I think this is and is not. I don't think it's a work ethic issue versus entitlement. One is logic, one is emotion. See how Chris Voss, the hostage negotiator would come in and be like, you guys are just gonna be two dogs barking at each other and you're never gonna solve this unless you actually understand what the disconnect is. Here's what I mean. Here's where I agree with Rob. Hard work didn't stop working. the system stopped converting it into upside consistently. I think you need to ask yourself the question, which forms of hard, which forms of hard work still compound and which ones are just extractive?

11:39 That in my opinion, and I cannot speak for all of new grad PTs, that is what they're asking. I mean, it's very confusing to me when people say like these kids today don't want to work hard or are they looking at what the hard work is and downfield on what it might bring and saying that math don't math. I can't speak for everybody that would be disingenuous. I feel like that's what it is. I think Rob's experience matters a lot, forty years. And if you look at his resume and I'll share his LinkedIn profile, it's legit, man. This guy's done the thing. I also think new grad frustration matters and what they're looking at.

12:22 I think their response is actually appropriate. How could both people in this scenario be right? It's because one's talking about logic and the way something used to be, and one is talking about how it is now. What does this matter? My professor in PT school taught me research, Jason Craig, told me to look at things this way. What, so what, now what? I think the now what thing, we're seeing that. Professions don't lose talent when people stop caring or working hard. Nope. They lose talent when effort and reward drift too far apart. You're asking smart people, smart people to make a dumb decision and you're confused when they just don't.

13:06 And then you blame the effort. Isn't that funny? Like you're talking about logic. Hard work over time equals output, but not in this system. I don't know if anybody would disagree, but I would implore you to. And then in comes the new grad PT using that logic saying, okay, show me. Hard work over time equals ambiguity. So if we want to keep great people in physical therapy, which it sounds like we do, I don't know that there's much agreement there. We have to get honest about where effort still creates leverage.

13:46 Because it's not where it used to be. I'm going to say that again. It's not where it used to be. It's other places. I agree with Rob there. But that's where I think Rob's sentiments and his view of things, he's been doing it for forty years. I think that is a strength, but could also be a blind spot. Because what worked forty years ago doesn't always work now. So I'm going to give Rob a question list and I would love to hear his thoughts on this. I would love to hear yours because I think we are like two dogs just barking at each other. When one side of the equation says, these kids today don't work hard.

14:28 And the other side says, but that work won't lead to anything I value. Notice how I keep using the same words Rob did, which is good. It's not just money. I didn't go into radio to become Elon Musk. I wanted to get up out of bed and love what I did. But my first year out of college, I made fifteen thousand dollars a year. Sorry, fifteen thousand five hundred dollars a year in two thousand one. As a broadcaster, loved it, loved it, was OK with that until I did that for two years and got promoted three times in two years with no raise. And then I was looking downfield. oh, this isn't going to convert. So I was that plucky young journalist, that plucky young broadcaster who had to do the nights and weekends, sign up for sitting in the floats for all the parades, doing the things other people didn't wanna do, fine.

15:20 I wasn't ever gonna be a billionaire, also okay. I was fine with it. But when I started looking around saying, oh, this hard work isn't gonna move me up the rung. And when I was confronted with that math equation, I couldn't just go start a radio station in two thousand and two. You couldn't you couldn't do it. So I opted out. I worked from age eleven to age twenty one to be a broadcaster, became that, did it for two years, did everything right to me as an air quotes, did everything right. And still had. To ask myself that question, if I keep doing this, will the juice match the squeeze?

16:03 And the answer was no. So I left. I lucked out because on the way out the door, I ran into someone who said, I will reward that work and I will show you how to do it. So there are ways to do it. But simply blaming someone for doing the math and not liking the outcome, I got to be honest, it's lazy. if I channeled my own inner Chris Voss, I would say, understanding what logic and emotion the other side is living in is probably a good first step. So I'll have Rob on. I think we're, I mean, he brings up a great point. And I think the reason his posts caught fire and got a lot of interaction is because this is a really important issue that we haven't figured out yet.

16:53 And I'm not here to say that I've figured it out. But from my perspective, I feel like that might be one thing. And I'll reiterate it again as I close. My parting shot, this isn't a work ethic problem. Say that all day. I think you're wrong. It's a conversion problem. And until you fix that conversion factor, That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode. Want to go deeper? Hit us at pgpinecast.com. Or find us on YouTube and socials at pgpinecast. And legally, none of this was advice.

17:35 It's for entertainment purposes only. Bullshit! See, Keith? We read the script. Happy now?