How PTs Can Fight Health Inequity Without Leaving the Clinic

WEBVTT

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There's the intro.

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What do you think?

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That's down the street.

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I did a little time lapse.

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Okay.

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Nice, nice.

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Because we're supposed to look over there?

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No, look at me.

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Most people aren't going to watch the live

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stream.

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I said most people aren't going to watch

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the live stream.

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They're going to listen to the podcast

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anyway.

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Rupa Patel is on the podcast.

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No stranger to the show, Rupa.

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Welcome to Anaheim.

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Thank you.

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This was my first CSM ten years ago.

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Wow.

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How many are you at?

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What's your what's your CSM?

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Probably around thirty.

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Oh, really?

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Yeah.

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Missed maybe four or five.

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I love CSM.

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I think I missed one.

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So this is nine or ten for me.

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Favorite city for CSM.

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What do you prefer?

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Probably New Orleans.

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Really?

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Yeah.

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You're going to go to San Antonio.

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Yeah.

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San Antonio.

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But, you know, I'm from Texas,

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so I go to San Antonio a lot.

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I enjoyed New Orleans.

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I enjoyed San Antonio.

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Not that I don't like D.C.

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It's cold, man.

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And I like Southern California.

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It's always fun.

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It's not bad.

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I have friends here.

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Today's my birthday.

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Today's your birthday?

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Today's my birthday.

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We get RuPaul on her birthday.

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Well, happy birthday.

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Thank you.

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That's fantastic.

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I got to go to Disney yesterday,

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so that was fun.

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What was on the hit list at Disney?

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What was half to see?

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They have a new Star Wars.

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Did you do it?

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Yeah, we went there,

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rode in the Millennium Falcon.

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I was one of the gunners, you know,

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to try and defend the Empire, I guess.

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Did you drop three bills on a lightsaber?

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No, we didn't do that.

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Smart move.

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There were quite a few stormtroopers

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walking around asking people for

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identification.

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We all thought that was a little...

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what's going on in the world right now.

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You're challenging PTs to confront

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inequity,

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engage in advocacy and become clinicians

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for life, not just for episodes of care.

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So let's start with this.

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Why is the profession in an inflection

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point now?

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Because it's your birthday or are there

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other reasons?

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Why are we at an inflection point now?

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Oh, well,

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I think we're at an inflection point

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because one, you know, we're still in,

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I feel like we're still a profession

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that's growing.

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We've about a hundred years old, right?

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We had,

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we had a birthday a few years ago,

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a couple of years ago.

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And I think, you know, we,

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we were born out of,

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I call us an extra appendage of the,

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um, you know, primary care physician that,

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you know,

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with the world wars and we took care

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of soldiers and we took care of, uh,

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you know,

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after someone got injured and then now

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what happens, right?

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But now as we've evolved and now we're

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in a doctoral, you know,

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education standpoint,

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now i think we really need to think

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about how do we actually help transform

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society in order to do that we have

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to look at the big killers in the

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world and not just treat people but like

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how do we stop heart disease how do

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we stop cancer how do we stop you

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know a pain chronic pain and so to

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do that we really have to go upstream

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and we have to think about like those

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kind of things so from education to

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practice i think we're at an inflection

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point

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that we're evolving into our second

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century as a profession and we really need

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to think about you know our just our

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mindset and our frame of like you know

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who we are and what we can do

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to transform society you know and not just

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take care of people after an injury or

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to prevent just a musculoskeletal injury

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but to really manage you know lifestyle

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and manage these chronic

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It's nice to put on a wall.

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It's nice to put on a t-shirt, right?

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Transform society by optimizing movement

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to improve the human experience.

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And I get it.

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Yeah, most of the words, right?

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But how do you do that?

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So how do social and structural

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determinants shape outcomes?

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That sounds like upstream,

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downstream to me.

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It does.

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And, you know,

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I think as physical therapists,

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we don't necessarily focus on some of

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those upstream factors because we're so

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kind of focused on, okay,

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here's the person with the shoulder injury

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or the back pain,

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and I've got to fix this.

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But then we're sending them back in

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environments where health happens,

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where they work, where they play.

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where they pray, where they're growing,

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where they're going to school.

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And so if those environments,

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social as well as physical,

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are not optimal for them to continue

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sustaining what we did in the clinic,

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we're not doing that patient any service.

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They're going to be back in the system.

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It's going to cost us more.

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We're going to rehab them again.

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They're going to go back into a system

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and a structure that's not conducive to

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health.

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So I think screening for and addressing

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those things.

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I think a lot of people think, oh,

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well, I'm not a social worker.

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I'm not a psychologist.

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That's not my lane,

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but it's all of our lanes.

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Again, if we want to transform society,

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if we want to optimize that movement,

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improve that human experience,

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we have to kind of think about, okay,

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what is the whole health of this person?

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What is it that we're

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trying to do here with this person not

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just repair their shoulder or you know

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knee pain but like okay they're working in

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a factory and they're going to have to

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stand all day well how is that going

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to impact them i've rehabbed their knee

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but can they stand for eight hours a

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day uh with only two breaks and a

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thirty minute meal you know and so i

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think just looking at you know at those

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things the structural and systemic things

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are so important

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And the data is so strong.

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Like where you live determines your

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mortality.

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Like zip codes.

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Yes.

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And so it was Mark Milligan once the

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first time he didn't invent it,

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but like he pointed it out.

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And I was like, yeah,

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I'm asking people that I trust.

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I'm like, is this true?

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And they're like, it is so true.

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And if we, and that same slide,

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I still use that slide for Mark.

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And he looked at like, you know,

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in Austin, Texas,

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where all the PT clinics are.

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versus where are the populations that

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actually have the health,

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the biggest health disparities.

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And there's no clinics on that side of

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town.

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What,

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what on the other side of the tracks

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meant, like it wasn't,

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it's just not an ism.

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It's a, it was the thing.

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And I'm like, Oh wow.

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And you can put, you know,

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literally you can look at those maps in

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every city and you see the same thing

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that, you know, where's the care,

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whether it's physical therapy or other

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care.

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And it's not in the, in,

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in the places,

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the zip codes where the population has the

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most disparities and needs us, you know,

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and,

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I mean, that's true in Houston, too,

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where I live.

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And it's challenging because, you know,

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the patients that need us,

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we're not there.

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So those structures and systems and then

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zip codes, you know,

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so looking at our patient's zip code and

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saying, oh, you live here.

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And then looking up, okay,

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for that zip code,

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what is the mortality and how is it

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different than the clinic that they're

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coming to?

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And what do I need to do to

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change or help the patient or empower the

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patient?

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So I think a lot of times we

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think we have to be the one to

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change their environment.

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No,

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we have to be the one to empower

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patients to say, hey,

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this matters to your health.

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I can help you with this,

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but now when you go back in this

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community and you have

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poor sidewalks, there's poor safety,

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poor lighting, there's crime.

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Those are the things that need to change

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for you to continue to walk,

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continue to ride your bike so that you

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can stay healthy and not end up back

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in the clinic, right?

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And so some of that is a very

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different way of educating ourselves and

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educating our patients than we've done

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like, okay,

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go home and do your exercises kind of

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thing.

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Yeah.

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Why is this statement

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Apathy is more dangerous than resistance.

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What does that mean?

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Oh, my gosh.

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Well, how do we dig into that?

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Well,

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I think if you're apathetic and you stay

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home and you don't get out there to

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advocate, then things won't change.

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And, you know.

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I feel like that happens a lot in

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our profession.

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That happens a lot in our country.

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If you just look at elections and the

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last time we had elections,

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more people stayed home than who voted for

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the winning candidate.

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And so apathy, you know, and then,

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then people are upset about some things

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that are going on, but like, okay,

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what'd you do about it?

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Yeah.

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Where were you?

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I feel like apathy is more dangerous than

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resistance because once someone becomes

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apathetic and they're like, I'm out,

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the chance of getting them back is super

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low.

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Where just resistance means like,

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I'm still questioning you,

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I don't believe you yet.

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There's still a chance there.

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But so like apathy leads to,

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I feel like I'm trying to be Yoda

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here,

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like apathy leads to just disenchantment

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and then you don't get a second bite

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at the apple sometimes.

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I'm looking around this CSM Expo Hall and

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every second person is a student or a

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new grad and they're bright-eyed and

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bushy-tailed right now.

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And how many will be gone in five

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years?

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Right.

00:08:18.870 --> 00:08:19.872
They're super excited.

00:08:19.932 --> 00:08:22.151
What can we do to prevent that?

00:08:22.172 --> 00:08:23.533
Because once they become apathetic,

00:08:23.552 --> 00:08:25.913
ounce of prevention, pound of cure.

00:08:26.194 --> 00:08:27.194
No, that's so true.

00:08:27.254 --> 00:08:28.334
That's a very good point.

00:08:28.375 --> 00:08:30.456
And I think, you know, as an educator,

00:08:30.555 --> 00:08:32.556
I really I want to be mindful of

00:08:32.576 --> 00:08:32.716
that.

00:08:32.777 --> 00:08:34.136
I tell my students all the time I

00:08:34.177 --> 00:08:35.857
teach health policy right now, you know,

00:08:35.898 --> 00:08:36.498
and like trying to.

00:08:36.919 --> 00:08:39.403
think about them becoming advocates for

00:08:39.423 --> 00:08:42.145
their patients and for our population and,

00:08:42.407 --> 00:08:43.967
and like, versus like,

00:08:44.129 --> 00:08:47.932
it's too hard and the resistance is

00:08:47.993 --> 00:08:48.553
futile.

00:08:48.854 --> 00:08:51.096
You know, that's Star Trek, not Star Wars,

00:08:51.136 --> 00:08:52.458
but I'm a big fan of that too.

00:08:52.479 --> 00:08:52.719
But yeah,

00:08:53.198 --> 00:08:54.099
It's like, no,

00:08:54.239 --> 00:08:57.259
empower yourselves so that you will have a

00:08:57.320 --> 00:08:57.841
profession.

00:08:58.140 --> 00:08:58.760
I always tell them,

00:08:59.821 --> 00:09:01.261
I'm a little bit on the tail end

00:09:01.302 --> 00:09:03.522
of my profession, but you're the future.

00:09:04.482 --> 00:09:07.243
I advocate for the future and for the

00:09:07.283 --> 00:09:08.303
future of our profession.

00:09:09.364 --> 00:09:11.044
you're going to be working in the future

00:09:11.144 --> 00:09:12.826
so you know advocate for that but i

00:09:12.846 --> 00:09:14.407
think that's a tough sell sometimes

00:09:14.427 --> 00:09:16.428
because there's so much information

00:09:16.489 --> 00:09:18.809
misinformation disinformation out there

00:09:19.230 --> 00:09:20.951
and people are just like i just need

00:09:20.971 --> 00:09:23.453
to focus on what i'm doing with my

00:09:23.494 --> 00:09:25.394
patient or in school and

00:09:26.311 --> 00:09:27.652
I'll figure all that out later.

00:09:28.732 --> 00:09:30.474
And then later comes and they're like,

00:09:30.533 --> 00:09:32.215
whoa, I have low reimbursement.

00:09:32.455 --> 00:09:33.556
I can't access my patients.

00:09:35.096 --> 00:09:35.437
Why?

00:09:35.677 --> 00:09:37.219
Oh, forget it.

00:09:37.458 --> 00:09:38.099
I'm out.

00:09:38.318 --> 00:09:39.059
I'm out of PT.

00:09:39.480 --> 00:09:40.681
I don't want to be in here anymore.

00:09:40.841 --> 00:09:41.782
I'll find something else.

00:09:42.501 --> 00:09:43.643
And so it is.

00:09:43.663 --> 00:09:45.024
I think it's an inflection point,

00:09:45.063 --> 00:09:45.745
like you said.

00:09:46.485 --> 00:09:48.866
We need to be better advocates.

00:09:48.886 --> 00:09:50.467
And I feel good about, I think,

00:09:50.508 --> 00:09:52.729
the next generation of therapists because

00:09:52.749 --> 00:09:53.129
they

00:09:53.590 --> 00:09:55.250
In their own way, you know,

00:09:55.390 --> 00:09:58.250
they're finding ways to do that, you know,

00:09:58.270 --> 00:10:00.511
and I think sometimes a little bit braver.

00:10:00.532 --> 00:10:00.711
I mean,

00:10:00.731 --> 00:10:01.912
I look at high school students here,

00:10:01.951 --> 00:10:02.633
you know, in Texas,

00:10:02.673 --> 00:10:04.472
like a lot of them walked out last

00:10:05.352 --> 00:10:06.833
week, you know, and I mean,

00:10:06.854 --> 00:10:08.053
in my school district, too.

00:10:08.134 --> 00:10:10.095
And I'm so proud of them, you know,

00:10:10.115 --> 00:10:12.835
for like standing up for their peers and

00:10:12.894 --> 00:10:14.796
people in their schools that they feel

00:10:14.836 --> 00:10:15.076
like.

00:10:15.456 --> 00:10:18.317
you know, maybe we're not treated justly,

00:10:18.337 --> 00:10:18.857
you know?

00:10:18.918 --> 00:10:20.418
And so I think that's good.

00:10:20.438 --> 00:10:22.019
You know, that makes me a little bit,

00:10:22.240 --> 00:10:23.240
you know, hopeful.

00:10:23.341 --> 00:10:24.481
Optimistic and hopeful.

00:10:24.782 --> 00:10:25.162
Yeah.

00:10:25.182 --> 00:10:26.363
I do want to say thanks to Steve

00:10:26.383 --> 00:10:28.423
Cohen and Sarah Health for supporting the

00:10:28.443 --> 00:10:28.884
podcast.

00:10:28.903 --> 00:10:29.904
Remote care platform,

00:10:30.184 --> 00:10:32.066
helping clinicians boost revenue without

00:10:32.105 --> 00:10:33.366
having to add staff.

00:10:33.486 --> 00:10:34.967
Sarah automates daily patient check-ins

00:10:34.988 --> 00:10:36.269
through simple text messages.

00:10:36.308 --> 00:10:38.850
That means no apps or a login for

00:10:38.870 --> 00:10:40.851
me to forget, which happens a lot.

00:10:41.111 --> 00:10:42.212
Just better follow through and better

00:10:42.274 --> 00:10:42.673
outcomes.

00:10:43.235 --> 00:10:44.716
Learn more at SarahHealth.com.

00:10:44.736 --> 00:10:47.440
That's S-A-R-A-Health.com.

00:10:47.900 --> 00:10:50.864
SarahHealth.com.

00:10:51.065 --> 00:10:53.386
How can PTs advocate within their own

00:10:53.488 --> 00:10:54.609
spheres of influence?

00:10:54.969 --> 00:10:56.971
That is their network.

00:10:57.192 --> 00:10:58.173
Because when you hear advocacy,

00:10:58.192 --> 00:11:00.056
you think I'm taking a trip to D.C.

00:11:00.355 --> 00:11:02.817
or Austin correct so how could they do

00:11:02.876 --> 00:11:05.898
the advocacy thing this is fun without

00:11:05.918 --> 00:11:08.139
getting off their couch or at a party

00:11:08.379 --> 00:11:09.359
how do you how do you how do

00:11:09.399 --> 00:11:11.539
you explain to do that yeah well it's

00:11:11.639 --> 00:11:13.740
so many different ways I feel like and

00:11:13.799 --> 00:11:15.240
I think APTA makes it a little bit

00:11:15.301 --> 00:11:17.942
easier because we do have action apps and

00:11:18.182 --> 00:11:20.543
you can sign up for news alerts and

00:11:20.702 --> 00:11:23.082
you know you get information literally and

00:11:23.283 --> 00:11:25.323
you just press it takes five ten seconds

00:11:25.344 --> 00:11:26.544
to just press a button if you don't

00:11:26.565 --> 00:11:27.625
want to make something personal

00:11:28.057 --> 00:11:29.298
And advocate with your,

00:11:29.619 --> 00:11:31.299
at least at the federal level, right?

00:11:31.460 --> 00:11:32.721
And then I think the same thing,

00:11:33.240 --> 00:11:34.162
the patient, you know,

00:11:34.182 --> 00:11:35.602
like if they come to me and say,

00:11:35.923 --> 00:11:36.783
hey, you know,

00:11:37.903 --> 00:11:40.046
I'm not getting reimbursed for, you know,

00:11:40.485 --> 00:11:44.048
this session or my sessions are limited.

00:11:44.489 --> 00:11:45.688
And you're telling them, hey,

00:11:45.749 --> 00:11:46.929
I can only see you for four.

00:11:46.950 --> 00:11:47.990
And they're like, what do you mean?

00:11:48.130 --> 00:11:49.231
I thought, you know, okay,

00:11:49.292 --> 00:11:51.552
here's how you can advocate for yourself.

00:11:51.974 --> 00:11:52.193
You know,

00:11:52.234 --> 00:11:54.235
let's look up and see who represents you.

00:11:54.669 --> 00:11:56.490
You can send a letter, you can call,

00:11:56.530 --> 00:11:58.793
you can give them a little script, right?

00:11:59.413 --> 00:12:02.455
And then there's lots of those things that

00:12:02.495 --> 00:12:04.576
take very little time and you can do

00:12:04.615 --> 00:12:05.236
it from the couch.

00:12:05.277 --> 00:12:06.597
Phone calls, emails,

00:12:07.278 --> 00:12:09.779
tagging on social media because

00:12:09.879 --> 00:12:11.140
everybody's looking at that.

00:12:11.801 --> 00:12:13.101
And then even with your insurance

00:12:13.142 --> 00:12:13.601
carriers,

00:12:13.642 --> 00:12:15.442
like a lot of times it's like call

00:12:15.482 --> 00:12:16.844
them and let them know, hey,

00:12:16.923 --> 00:12:18.804
why you think you need more care and

00:12:18.865 --> 00:12:19.725
what's going on.

00:12:19.745 --> 00:12:20.745
And, you know.

00:12:20.764 --> 00:12:21.745
Be the fly in the ointment.

00:12:21.926 --> 00:12:22.166
Yeah.

00:12:22.186 --> 00:12:22.745
Squeaky wheel.

00:12:22.785 --> 00:12:24.567
So I think there's lots of different ways.

00:12:24.647 --> 00:12:25.967
But at the federal level,

00:12:26.028 --> 00:12:28.308
I feel like the APTA, you know,

00:12:28.428 --> 00:12:30.549
action apps and things that we have are

00:12:30.590 --> 00:12:31.350
really helpful.

00:12:31.591 --> 00:12:33.772
And it makes it easier for us to

00:12:33.792 --> 00:12:34.211
do that.

00:12:34.658 --> 00:12:36.440
And then, you know, with patients,

00:12:36.460 --> 00:12:38.142
just empowering them, even saying, hey,

00:12:38.422 --> 00:12:40.202
make a little video of like why this

00:12:40.243 --> 00:12:41.744
is affecting you and send it to your

00:12:41.803 --> 00:12:43.586
congressman or your state legislature.

00:12:43.885 --> 00:12:45.307
Let them know, hey, I'm Mrs.

00:12:45.506 --> 00:12:47.269
Jones and I live in this neighborhood.

00:12:47.609 --> 00:12:48.269
And, you know,

00:12:48.429 --> 00:12:51.451
I'm in PT with this person and this

00:12:51.491 --> 00:12:53.052
is what she or he is helping me

00:12:53.092 --> 00:12:53.352
with.

00:12:53.693 --> 00:12:55.235
And I need more of that so that

00:12:55.315 --> 00:12:57.076
I can do X in my home or

00:12:57.115 --> 00:12:58.216
at work like that.

00:12:58.806 --> 00:13:00.947
teaching patients to do that because

00:13:01.287 --> 00:13:03.847
that's more powerful than me, the PT,

00:13:03.888 --> 00:13:04.808
going to my congressman.

00:13:04.828 --> 00:13:05.428
And it's larger.

00:13:05.448 --> 00:13:06.788
There's a larger number.

00:13:06.808 --> 00:13:07.830
Yeah, larger number.

00:13:07.889 --> 00:13:09.671
Last question I'll ask sounds like a good

00:13:09.811 --> 00:13:09.931
one.

00:13:10.931 --> 00:13:14.111
What discomfort do clinicians need to

00:13:14.173 --> 00:13:14.673
embrace?

00:13:15.568 --> 00:13:17.470
Usually we say to avoid at all costs,

00:13:17.509 --> 00:13:19.552
but that can't be the way, right?

00:13:19.572 --> 00:13:22.833
So what discomfort do clinicians need to

00:13:22.874 --> 00:13:23.313
embrace?

00:13:23.735 --> 00:13:26.897
I think the biggest discomfort is kind of

00:13:26.917 --> 00:13:29.619
thinking about looking at things

00:13:29.698 --> 00:13:31.100
holistically, you know,

00:13:31.240 --> 00:13:33.620
and that's uncomfortable because maybe

00:13:33.660 --> 00:13:34.802
that's not what I'm trained to do.

00:13:34.841 --> 00:13:36.062
That's not what I'm good at.

00:13:36.803 --> 00:13:37.943
But that's what's needed.

00:13:38.203 --> 00:13:39.585
Like that's what the patient needs.

00:13:39.664 --> 00:13:41.287
That's what the community needs if you're

00:13:41.307 --> 00:13:42.006
in the community.

00:13:42.326 --> 00:13:44.849
So like embracing that discomfort and then

00:13:45.216 --> 00:13:46.977
putting yourself out there a little bit,

00:13:47.057 --> 00:13:47.859
learning, of course.

00:13:47.879 --> 00:13:48.740
You know, as clinicians,

00:13:48.799 --> 00:13:50.341
we know where to look for good

00:13:50.380 --> 00:13:52.703
information, evidence-based, who to go to,

00:13:53.043 --> 00:13:55.186
networking with people who are in those

00:13:55.245 --> 00:13:55.866
spaces.

00:13:56.327 --> 00:13:57.948
And we need to embrace that because,

00:13:57.989 --> 00:13:58.208
again,

00:13:58.249 --> 00:13:59.591
it's about improving that human

00:13:59.650 --> 00:14:00.312
experience.

00:14:00.371 --> 00:14:02.413
And if we're uncomfortable with a patient

00:14:02.634 --> 00:14:03.534
who is just like,

00:14:04.235 --> 00:14:06.437
psychologically depressed or has other

00:14:06.476 --> 00:14:08.398
symptoms and you're like oh my god okay

00:14:08.418 --> 00:14:10.938
go see a psychologist first not me come

00:14:10.958 --> 00:14:12.779
back and see me after that's done right

00:14:12.820 --> 00:14:14.441
like that's because that's uncomfortable

00:14:14.461 --> 00:14:16.201
for me I haven't done that with many

00:14:16.241 --> 00:14:19.123
patients and so then first is like okay

00:14:19.182 --> 00:14:20.744
tell me more I may not be able

00:14:20.783 --> 00:14:22.624
to help you Jimmy but I want to

00:14:22.663 --> 00:14:23.504
listen and see

00:14:24.125 --> 00:14:25.265
what we can do together.

00:14:25.306 --> 00:14:27.027
And if I can refer you to someone

00:14:27.067 --> 00:14:27.748
or something like that,

00:14:27.768 --> 00:14:29.028
so that's uncomfortable,

00:14:29.469 --> 00:14:30.990
but that's so important.

00:14:31.110 --> 00:14:33.091
And that'll earn us the trust of that

00:14:33.131 --> 00:14:34.312
person, which is,

00:14:34.352 --> 00:14:35.254
which is the game we're in,

00:14:35.313 --> 00:14:36.354
which is the game we're in.

00:14:36.514 --> 00:14:38.836
And then opening up a conversation that,

00:14:39.297 --> 00:14:40.857
you know, they, they're probably thinking,

00:14:40.878 --> 00:14:42.479
you know what, she's going to ignore this.

00:14:42.599 --> 00:14:43.279
Like she's, you know,

00:14:43.299 --> 00:14:44.421
she's just going to focus on this,

00:14:44.461 --> 00:14:45.360
but that when you do,

00:14:45.682 --> 00:14:47.243
then you earn that trust and then you

00:14:47.283 --> 00:14:49.124
get into some things that maybe are really

00:14:49.144 --> 00:14:50.024
important, you know,

00:14:50.065 --> 00:14:51.525
and that will improve their human

00:14:51.586 --> 00:14:52.086
experience,

00:14:52.106 --> 00:14:53.807
which I think is what we're all about.

00:14:54.351 --> 00:14:55.251
We have a Trish on the show.

00:14:55.272 --> 00:14:58.514
It's called The Parting Shot.

00:14:58.994 --> 00:15:00.134
This is The Parting Shot.

00:15:00.695 --> 00:15:02.095
One last mic drop moment.

00:15:02.775 --> 00:15:03.556
No pressure.

00:15:04.015 --> 00:15:06.116
Just your legacy on the line.

00:15:07.230 --> 00:15:07.950
You got to drop the mic.

00:15:07.970 --> 00:15:09.110
Do you want to say thanks to U.S.

00:15:09.150 --> 00:15:09.730
Physical Therapy?

00:15:09.772 --> 00:15:11.712
We're at their booth right now at CSM.

00:15:11.893 --> 00:15:12.452
Thanks, USPH.

00:15:12.472 --> 00:15:14.234
Thank you.

00:15:14.394 --> 00:15:15.914
Network of clinics focused on developing

00:15:15.955 --> 00:15:16.916
clinicians across the country,

00:15:16.956 --> 00:15:17.796
not burning them out.

00:15:18.235 --> 00:15:19.777
With leadership tracks, mentorship,

00:15:19.817 --> 00:15:21.278
career growth, and long-term stability,

00:15:21.739 --> 00:15:23.679
USPH supports PTs who want to build

00:15:23.740 --> 00:15:25.181
futures in this profession.

00:15:25.581 --> 00:15:26.520
USPH.com.

00:15:26.541 --> 00:15:28.462
It's USPH.com.

00:15:28.482 --> 00:15:29.883
So what's your parting shot, RuPaul,

00:15:30.124 --> 00:15:30.604
for pressure?

00:15:30.624 --> 00:15:30.943
My hat.

00:15:31.063 --> 00:15:32.364
There's no pressure, right?

00:15:32.424 --> 00:15:33.384
No pressure whatsoever.

00:15:33.424 --> 00:15:33.904
We keep it low.

00:15:33.924 --> 00:15:35.505
Yeah.

00:15:35.985 --> 00:15:37.645
I think my parting shot would be like,

00:15:37.745 --> 00:15:39.907
you know, it's very cliche, but, you know,

00:15:40.187 --> 00:15:41.748
I am an immigrant to this country from

00:15:41.807 --> 00:15:42.128
India.

00:15:42.187 --> 00:15:44.288
And so things that Mahatma Gandhi has said

00:15:44.328 --> 00:15:46.548
over his lifetime are so like part of

00:15:46.589 --> 00:15:47.190
who I am.

00:15:47.269 --> 00:15:47.929
And really,

00:15:47.950 --> 00:15:49.210
I think all of us need to be

00:15:49.230 --> 00:15:50.431
the change we want to see in the

00:15:50.471 --> 00:15:50.730
world.

00:15:50.890 --> 00:15:53.172
And it seems really cliche.

00:15:53.192 --> 00:15:54.631
But like, if you really think about it,

00:15:54.692 --> 00:15:57.072
like all of us can do that in

00:15:57.232 --> 00:15:58.533
some form or fashion.

00:15:58.594 --> 00:15:59.734
It doesn't have to be big.

00:16:00.053 --> 00:16:01.875
And you don't have to be a person

00:16:01.916 --> 00:16:04.477
in a powerful position or anything like

00:16:04.518 --> 00:16:04.798
that.

00:16:05.798 --> 00:16:07.681
The Mahatma was just a simple man,

00:16:07.740 --> 00:16:10.504
and yet he freed a country and led

00:16:10.604 --> 00:16:11.284
a resistance.

00:16:11.325 --> 00:16:12.566
And so you don't have to be a

00:16:12.645 --> 00:16:15.448
person in power or position to do great

00:16:15.509 --> 00:16:15.948
things.

00:16:15.989 --> 00:16:19.111
You can be that human being that can

00:16:19.152 --> 00:16:19.972
change the world.

00:16:20.153 --> 00:16:22.695
Rupa Patel, happy birthday again.

00:16:22.735 --> 00:16:23.296
Thank you.

00:16:23.316 --> 00:16:24.576
Thanks for stopping by here at CSM.

00:16:24.596 --> 00:16:24.836
Yeah.