How to Fix the Most Expensive Mistakes in Your PT Clinic

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. i want to say big thanks to empower emr if your clinic is stuck in an emr that slows you down that's not cool man empower gives you speed clean workflows and features pts actually asked for the stuff you asked for better notes faster documentation smoother operations those three those are the things people keep asking for them i know because i'm in the facebook groups with you and those are the things you're asking for all those things wrapped up in customer support that doesn't ghost you that's also what you're asking for upgrade your clinic's brain with empower emr they also know switching gives you a feeling way down deep.

0:41 They understand that. They make it easy. So go kick the tires. Go slow. Do it right. EmpowerEMR.com. That is EmpowerEMR.com. Wow, look at this. Surprise. Today's guest. Where most physical therapy clinics, they don't fail because of bad clinicians. They struggle because of invisible systems. This was not on the syllabus, kids, in PT school, unfortunately. I can't change that, but I can at least enlighten you now. And every day, time just leaks out through scheduling friction. Listen right now. You can hear it. Oh, it's not good. How do I fix it? Documentation drag, billing delays, workflow bottlenecks that nobody ever trained you to see. It's not your fault. You weren't trained, but you do have to own it because if you don't, oh, that dripping, you're still going to pay for it.

1:26 And it doesn't really show up on a balance sheet. It does, but you don't know where to look on the balance sheet. It's sort of in between the lines. It shows up as burnout, staffing stress, cashflow anxiety. Where's it coming from? I have a full schedule, then why do I feel fragile? We're going to talk about those things, the invisible, hairy, scary things. So our guest today has spent more than two decades, I want to see how he feels about that, two decades I get to say now, inside of those invisible systems where the leaks are, helping design and evolve the operational backbone of PT practices that are still around. Because if you don't fix the leaks, your boat don't float. From first patient contact to discharge and beyond, this guy's, again, two decades, you see things come and go.

2:12 He's worked across product, sales, marketing, and operations in this space. His resume and theory is boring. Just one thing, doing this for twenty-one years. That's when you know you know the nooks and crannies. So let's bring him in, Sharif Zeed. Sharif, welcome back to the show, man. Hey, thanks for having me, Jimmy. Always a pleasure to be here and excited. Yeah, there's always something new to talk about. That's for sure. Isn't that crazy that there's always something new to talk about and you look at this one little area of our practice and even that little area of our profession still is enough to annoy people, scare people, put people out of business and enough things always changing to still have stuff to talk about, right?

2:54 Totally. I mean, I jokingly say I started in the PT EMR world when it was a covered wagon. And now we've got space space shuttles going to Mars or whatever. So it's definitely a change. And we still call it an EMR. And when when I started, it really was EMR like documentation. And now it's the everything engine or that's what it's supposed to be. Right. That's the promise. So, yeah, things are changing. And I will say. The pace of change, it's not linear anymore. It's exponential. I mean, sort of the expectations, the desires, the promise continues to grow. And so do the challenges. So it's just a mixed thing. And there's always good things.

3:36 There's always bad things. There's challenges. There's opportunities and the whole thing in between. Yep. So you sit down with practices that are across specialties, across timelines, brand new, maybe not started yet, brand new, legacy, all those things. Someone like you can sort of see things coming. I imagine most of the time, the clinician or the business owner is sitting there explaining things to you. And you're probably biting your tongue, waiting for them to run out of air before you go, Oh, okay, I've seen this before. You probably have it figured out in the first Yeah. I mean, first of all, definitely working with practices all across the spectrum, right?

4:16 So what's the same and what's different? They're all outpatient rehab. That's our thing. That's what we do. So PTOT speech, no inpatient, no skilled nursing, nothing like that. So that's the same, if you could even call that the same. And yeah, what's different is where they are in their practice life, you know, start up to mature and the size of the practice solo to the supporting, trying to support dozens or hundreds of clinicians, the single location, the multi-location, and then really an increasingly differentiating factor is just where they are in their business cycle. Are they shooting for growth? Are they trying to maintain stability? Are they struggling? What are they trying to achieve? Like you said, some are pushing for that next level of profit or revenue and others are just like, hey, I've just got to make it to hire the next clinician.

5:02 Others yet are like, I just got to get out of treatment. I need to hire some people and kind of change my role in the clinic from being working in the business to working on the business kind of thing, as they say. All right. So if I changed your role for just a second, we pretend if you go from what you do in EMR and technology to a plumber, when you walk in to a practice where the plumber's like something's leaking, they're like in their mind, they're probably like, it's one of these four places. Let me go check those in order of importance. When you get brought into a practice from across hundreds of clinics that you've seen, Where are the practices that you work with quietly losing the most time every week without realizing it?

5:44 So we'll start with time. Where are they losing time the most? Yeah, I think the number one answer I would give to that is what I would just put under an umbrella called one word, adoption. So many practices have lots of tools and they don't know what to do with them or they're not using them to the fullest extent that they can. And that happens for a variety of reasons. But the one I see the most often, and honestly, if I'm being honest, the most frustrating is adoption. They're letting perfect be the enemy of good. So there is no perfect system. There is no software product you can buy that's going to be check off every single box. And I see some practices trading off, hey, it can't do this last ten percent I want it to do, so I'm not going to do the ninety percent that it can do.

6:33 There are always trade-offs. If you have a seven-figure budget for software and you want to go have something purpose-built for your practice, you can get exactly what you want. Honestly, maybe not even in that case, but let's just be high level here. You could probably get what you want if you're willing to spend that kind of money. even the largest practices, even the largest chains are not building custom software. So that means that no matter what you hear from whomever is selling you on a product, there's always going to be some, um, you know, imperfection, something that's not a hundred percent target on target with what you're trying to do with your workflow or your people or your patients or whatever. A great concrete example of this is very simple.

7:16 Um, online booking used to be a very taboo some years ago. Now it's much more accepted, but there are still a lot of practices we talk to that won't let patients book online. Why? Because it's not perfect. They can't replace the front desk. They know I'm special. I have this special scheduling process that needs to be done. And, you know, you can, you know, say with Empower, you can usually mimic the vast majority of those rules in those settings. But yeah, there might be an edge case or a fringe case where, you know, the system may allow a booking where your front desk person would have blocked them out or vice versa, disallows a booking that you may have wanted. But, you know, again, if you're hitting ninety, ninety five percent of cases, like what are you doing?

7:58 Why aren't you offering that? That's your time that you're leaking right there in your front desk. That's your patient visits that you're leaking on the side there. Because you're, again, letting perfect be the enemy of, frankly, great in some cases, but certainly better in most. So it's just one example. There are dozens of them. But implement, adopt, use, do. Those are the verbs I would try and I would harp on constantly. Does adoption also encompass... What I talked about in the intro, which is change. Listen, I like my bank. Maybe I don't like my bank, but I'm thinking, God, the amount of things I'll have to do to get rid of my bank.

8:39 Even if great was right across the street, I'm like, I'd be so much better. I'm thinking, not even thinking, I'm feeling of what change feels like. And I don't even, it doesn't even crack the top ten. Does that prevent, I imagine that's got to be up there. Absolutely. I mean, change is like this concept that's far beyond just business and practice, right? It's hard to change in your personal life. It's hard to deal with somebody who is changing for better or for worse. You know, there's these, you know, all these books about self-help and change and all these things. In business, it can be true. There oftentimes can be friction that is, you know, also being generated, I would say, from external, like, you know, your team might be giving you friction, your patients might be giving you friction in just beyond your own innate, you know, inertia that's causing you to have heartburn with change.

9:27 But This is also a surmountable problem in the business world, I think, or in the practice world, right? Just make the changes modest, make them consistent. So you're changing regularly, but you're biting off small things. The other end of the scale with adoption of too little adoption is too much adoption too fast. and this is how you trash your team right as if like you know if let's say you watch this podcast like i'm really motivated by sharif which would be a miracle and you're like i'm gonna go implement ninety three things on monday morning and you go in there the way your team's gonna perceive it is now you're just yelling at them there's no rhyme or reason too much too fast and then all of your initiatives will fail so Got to find the seesaw balance between, you know, trying to make steady incremental progress in the practice and blowing everybody out and and or not doing anything at all, which is without naming anything specific.

10:21 Yeah. How does someone pick which one? Hey, I've got a list of ninety three. I'm hearing what Sharif is saying. I get it. He's right. How do you know which is the one to say, okay, I'm going to do this one this quarter? How do you pick? How do you decide? Yeah. I mean, here's the two answers, right? The formal answer, which I actually think is a good exercise, and if you can do it, it would be great. You take the ninety three things you you try and rank them by effort and pay off. And then you make a grid and you do the low effort, high payoff ones. That's like the business textbook answer. The not business textbook answer is you're the owner. You probably already intuitively know what your biggest like you just I don't have enough patients or I have too many patients.

11:07 And, or I don't have enough profit, which can often be like too many patients, but you know, not the right mix of patients to deliver the profitability that you want. So, you know, I think a lot of effort, you know, and I'm a, I'm a business guy, right? By education, I went to business school and all that stuff. And you can get really wrapped up in the consulting method of, of thinking. Sometimes it's just too much, like intuitively, what's your issue? Like, what's going on this week? Wow. Really high cancels and no shows. Okay. There's your problem. Let's work it. um not enough patience we didn't bring enough evals in last week so our pipeline's a little bit low okay work that problem that's a top of funnel problem um we looked at the numbers and we're billing record amounts and our reimbursements are in the trash can okay now you have a billing problem so intuition's fine and and i think it's underrated sometimes and people want to go read the book or ask your favorite ai What should I work on in my practice when you probably already know?

12:03 Last thought is if you don't know, if you really have no idea, which would be crazy, then go ask your team. Maybe they'll tell you what the problem is. Hey, I'm burned out on this or I can see the cancellations hitting my desk or I'm having trouble collecting money and here's why, and work those problems. If you ask people for their opinion, they will give it to you. Don't worry about that. They will give it to you. Sure, sure. If you have a team of ten, you'll have twelve opinions. Because you can ask the same person and get the same different opinions on two different days on the same thing. All right, let's go to bottlenecks. Points of friction is the fancy word, right? If you had to name three most common, the things that pop up, again, you've been doing this for twenty one years, the three most common workflow bottlenecks in outpatient PT today, what shows up almost everywhere?

12:53 Almost everywhere. I have to say, the owner oftentimes pops up as a bottleneck. They don't want to hear that though. It's maybe not the most popular thing to say, but I think there's some level of understanding that this is an issue. And sometimes it can be too much control. Like one of the biggest windows we get into a practice is during onboarding. It's a time of great change. They're switching systems. The team is doing stuff. I would never call an onboarding a stress free time. There's no such thing. So you're watching a practice under stress. And, you know, usually the ones that go well are where it's for lack of a better sort of a democratic process, right?

13:34 The different constituencies in the practice, the front desk, the billers, the providers are all involved in their respective ways in that onboarding. It has a tendency to go less well when there's a singular point of contact and it's always the owner and the other folks aren't on the calls and they're not given leeway to ask their own questions. That's just one window into how you look at it, but you can look at all of those things. When I review a call, for example, and I hear at the end that all the tasks in the call were assigned to the owner, all of them. I'll do that. I'll put that on my plate. I'll take that to my list. that's really when you start to have now it ties into the same theme, which is delegation also has to include some measure of letting go, some measure of accepting good and not perfect at some cases.

14:22 And sometimes, but you know what, like the good that you had to put in, the perfect that you had to put a hundred and twenty percent effort into as an owner with all these different things that you've got to do. Uh, so that's number one. Number two is, um, you know not in not investing uh in your systems so you know it's funny transition to go from this onboarding conversation but like that's a time of of known in investment of time into a system you know you're going to have to put some time in don't stop you have to keep investing in the systems and in the people who run those systems in order to continue to maximize and first of all like we just talked about the system itself is probably changing like there's new stuff happening so where are you are you keeping up with that stuff are you taking advantage of it And AI is just the latest in that litany of things.

15:10 And again, it's driving the pace up very high. And you shouldn't worry about chasing an unholy pace that's going to kill your practice. But you need to continue to evolve and do things. And so if you talk to a practice and they essentially tell you they're doing things the same way they were doing them, say, five years ago, I mean, You know, COVID now was in twenty twenty, right? The five years ago, like just five years ago, that was twenty twenty one. So where are we at? Like if you're doing something the same way, then if you're doing the same processes you were doing in twenty eighteen, you know, things have definitely moved and definitely changed. So a bottleneck is just not investing into the system, into the time, the time that's needed into continuing growth.

15:54 to to make the most and then the last one i i guess i would say for bottleneck is like i i would call it um metric fatigue so there's a lot of you know information like copious amounts of information out there that you can read from all sorts of different sources and every month somebody invents a new metric that is like super interesting and you can read about it and it sounds great and then you're just bottlenecking everybody because you're pushing them into some new metric that you just woke up and decided was important that day and it's not consistent whereas the core metrics that hasn't changed you know what's your day plus ar that hasn't really changed and for good reason how many visits did you bring in how many evaluations so i think a balance there would would be better instead of just trying to slow everybody down with too much stuff to focus on and i've seen practices where they're trying to track like three dozen metrics and it's so overwhelming that actually none of them get any meaningful attention and um people end up slowing themselves down to try and meet one of them and probably have unintended consequences with others.

16:57 So it just becomes like a cluster. You don't want that. I just ask people to envision the, you know, the middle school custodian and how many keys they have around their, their key chain. You can't have seventy eight KPIs. That's not yet. You should have, you know, three. I don't know the answer, but it's not seventy eight. Right. It's not zero, but it's not seventy eight. Right. So we talk a lot about clinician burnout. We didn't think we were going to get into this here, but this is where the friction is. So a lot of people will say, where's the burnout? And they'll look around and say, well, it's in here. It's in my gut, it's in my heart, it's in my head. But you can actually show friction equals heat and heat equals burn and burnout.

17:39 How much of burnout today, I won't hold you to an actual number, but how much of burnout today is actually operational and not clinical? Yeah, it's a good question. As a joke, I would have to say, because the kids are always on me, I would have to say six, seven, just because I'm not actually sure what it means, but I hear it constantly. I don't know what it means either, but we're still mocking it. You got to stop saying this. I would actually take a bold statement and say the majority of it is really operational. That's, of course, coming from somebody who's buried in operational software and so forth, so take it with a grain of salt. The majority of it is operational. And AI has, again, mixed promise, mixed delivery so far in terms of what it can do.

18:25 That's not the sales talking. That's just reality. And that's not just PT. That's across all industries, right? There's a huge burst of... big bubble of AI. We're still all trying to figure out exactly what it can and can't do. But I do think in the documentation realm, things like Ambient Scribe and other AI tools for documentation are showing some meaningful promise after many years of you just write your note. You've got to take advantage of some of these newer tools. Again, I'm amazed at the range I see out there in practices from the cutting edge AI everything to basically using an emr like sort of like a word processor and and not really evolving it much more than that and then there's many practices that are in the middle of that bell curve which is crazy people are still using dragon and i was like my man dragon was in cutting edge when i was starting in college that shows you how old i am i'm like you're still legitimately using dragon and they're like yeah and i am i'm not in the seat that you're in and i'm still Yeah.

19:31 Yeah. Well, it's a lot. The other thing I have to say is, you know, it's funny how the waves of themes happen. Like you've lived through these because you do this all the time. But like compliance seems to be one of these roller coasters run. Right. There'll be high points where everybody's talking about compliance and then it kind of dips and then it comes back. And but like one one area is I see that's often needs to be talked about and isn't enough is over documentation, for example, has become these. So like, what are you asking your your therapist to do? The worst case example I can tell you is when we see a practice that effectively is writing therapy. an initial evaluation level note for every visit, including for daily.

20:12 So they're seeing the patient, you know, three times a week and writing effectively three evaluations a week. And they're saying, well, we, you know, compliance, we want to make sure our notes are good and that's all like fair. Okay. I get that. But yeah, I mean, you're going to burn people out and create friction and problems. If you ask everybody to write that level note for every visit, every time for every patient, that's a lot. And so again, what I would say is you need to really look at all the processes you do that you do repeatedly, because if you can shave a few minutes off of one of those and you do it five hundred times a week, you know, now you get some time back. So, you know, I just there's so many things and so many themes and they come and they go.

20:54 And, you know, it's it's kind of crazy sometimes to keep up with them. But I've I've sort of seen all of them. And last year, I feel like was the big year of maybe twenty, twenty four to but like the big year of hiring conversations, you probably had a lot of guests talk about how to hire and how to make really great job postings and use AI and all that stuff. And then, you know, I found anyways, that conversations quieted down a little bit. And I don't know if it's because everybody hired who they wanted or more likely, you know, that they're just, we're just in a trough. Like people are just need to take a break from that conversation because the market is the labor market is what it is. And they can't either can't hire or they've scrounged up what they can and they're moving on.

21:36 So it'll come back. Everything always comes back. Burnout is a constant thing, et cetera. And compensation's a constant thing, but they all play in together. don't want you to name this person not that i think you would i don't want to hear who they are but what give me an example of what maybe one of the most expensive inefficiency you've ever seen in a clinic that maybe owners don't track like maybe you're doing a deep dive with a clinic owner who's like onboarding with you and you're like hang on a second like that moment you're like am i reading this right what's something you've seen that like just even shocked you even with twenty one years experience yeah the ones that often blow my mind are actually in in the billing realm like when i talk to a biller and they are like i effectively manually do anything one thing five things on each claim like really dumb examples like i look at every fifteen hundred form individually you know, before it's sent.

22:32 And I won't, can't or won't trust any automation or anything for it to do it for me. I'm going to review every one and like in an extreme case, review it more than once. This isn't normal stuff. You know, again, no one can, no one should say that a hundred percent of claims will go perfectly a hundred percent of the time. But you have to rely on systems and automation. And frankly, it's not even just a convenience thing anymore. It's a matter of survival. So if you're going to review every claim manually and spend two minutes per claim, and you've got you know, a modest size clinic and doing a few hundred visits over the course of a week, nothing big deal.

23:13 But I mean, right there, like this will blow your day out. It'll blow your week out to do this. So it blows my mind when I hear that because doing individual claim level stuff, it just breaks down so quickly, even at the most. So and you still have that. You still see that or even checking each individual billing code. And here's the thing that you correct. Correct me if I'm right or wrong. Correct me if I'm wrong. Just because you're doing that doesn't even guarantee it's being done well. So you are guaranteed a lot of effort, but you're not guaranteeing the outcome is even better. Yeah. Well, I mean, listen, you know, people will make their, so no, Jimmy, you're wrong. Of course we're guaranteeing the outcome, but reality is no one can guarantee the outcome.

23:55 And reality is, is the insurance is using the same things on their, in their quiver, you know, they're using automation. That's why they screw up claims sometimes, right? Cause they follow a playbook and they just follow it. And, you know, there's going to be five percent of claims that have an appeal or a denial that has to be dealt with and so forth. But you know they're not going to go through every claim individually that's crazy uh and unnecessary in a lot of ways and so you need to run the business from forty thousand feet like what is our what are our high level metrics what are we doing how many yeah i mean if you're if you're having to work on if half of your claims are denying you have a problem if two percent of your claims are denying that's not bad.

24:36 I mean, you know, you, you, you can't get away with zero percent. You'd love to, but you, so yeah, it's really the, the manual processes are the ones that really blow my mind when I hear about stuff like that. And, and it's, it's a lot of it sometimes it's not of course, ill intent by any stretch. It's usually a lot of it's driven by inertia. Like this is how we did it. This is how we've always done it, or we've done it since the nineties, or we had a billing system back then. And, or, you know, even five, ten years ago, and here's how we did it then. And we learned we had to do this because if we didn't, then, you know, and people start making weird associations. Like if I eat a ham sandwich while I do my billing, I never get any denial. So I always have a ham sandwich when I do my billing claims and you're like, well, hard to argue with results.

25:17 I mean, I do like a good ham sandwich, so I don't know what to say. Like it's hard, you know, and this is the life of a software person trying to make these weird connections with things, but people have their superstitions. So. All right. So when clinics do, let's talk about What happens after? Let's talk about the transformation, as we would say, right? When clinics do introduce real automation, not just eat a ham sandwich and now we get better results, not just faster clicks or less clicks, what start real automation? What usually changes first? Is it staff stress reduces, revenue goes up, what should they expect? What's the canary? Like, oh, we were doing what this guy Sharif said.

25:57 What should they look for in real terms? Yeah, I mean, I think, you know, definitely the team feeling, staff feeling is probably the one that is just, it's in front of you every day. It's not a metric, you're just seeing it. So there's no higher compliment to, you know, to the change or for us as a vendor, for example, when we hear that from clients, like, hey, everybody on the team's loving it, they're feeling better about it, they're coming to work more excited, they're more productive, more happy, and that we've solved a lot of problems uh that we had with the say a legacy system or a prior system that we were transitioning from so that's definitely just front and center um you have to get through the woods you know of the of that onboarding process which is you know made to be as easy as it can but again everybody's got to travel through those woods to get to the other side and and not kind of fall off the wagon uh prematurely or unnecessarily because it's you know we just had a bad day or there's something that's not perfectly going the same way So I think the staff one and then longer term, you know, I think a lot of vendors in my space make a lot of hay about, we can make you more money and so forth.

27:09 I'm not as sure that those are the right claims to be making or that they're fair claims to be making. Because really, I don't know, unless there's a different Aetna out there or a different United, they're all the same insurance. The fee schedules are all the same. A modern system should be able to help you or get your claims out in a pretty short order. So there's some convergence there on those basic things where where we're seeing more differentiation and the things we focus on are the marketing, the automation of core tasks, obviously AI driven workflows to help cut down on manual workflows. And that's really where the money's at these days in terms of what are you really looking for? and predicated upon the practice actually implementing them.

27:51 But you can definitely get some more visibility into stuff, hopefully make some better decisions about where the practice should go and that sort of thing. So I think, yeah, staff team is where you'd see it. Hopefully you hang on to an employee who is maybe borderline. Maybe they come in and they're like, you know what, this change really helped me. I'm spending more time with my family and I'm going to stay. Or I'm I don't need that raise. Nobody ever says that. But something like that to help ease things a little bit. So you're saying you're making the more real claim, which is something I don't see a lot of people... who do what you do often, which is, hey, listen, can we make you more money? I think the more clear line and the shorter line is I can show you where to stop losing time.

28:38 And I learned a long time ago that time equals money. So, but you're saying I can prove this. I'm not gonna lie to you. I'm not gonna dangle the carrot, like more money, save more. But what you're saying is, hey, listen, this is a process if we, going back to my plumber analogy, If we shore up the leaks, in theory, we should be able to see more money. But what we can really work on now is put your head down to this. It's spending less or losing less. That should be a very straight line and a very short line to making more. But those two things are not the same. They're not they're not precisely the same. Yeah. And working happier, too. I think there's something about satisfaction that that does matter, especially matters to your team.

29:20 You know, they don't have the ownership maybe that you do, obviously, where you have a direct like, hey, if I make this company practice worth more, I'm worth more at exit, which was never a conversation five years ago. But now any conference you go to, all you hear about is multiples and exits and private equity and all these different terms that never were in the lexicon a few years ago. But your team, these folks are working hard for your practice. They're working hard for their own personal future. So there's a happiness factor quotient there that's been that intangible in the hiring process that you can try and hear people articulate all the time. And so that's meaningful as well. And you just want to run. I mean, I have very traditional business values, I guess.

30:01 So, you know, I think you should just run a good, clean, well-functioning business. And that means like your system and processes are good. And when I'm given the opportunity to talk to or address a group. i always ask them to think about what companies they're having the best experiences with right now and then when you do a little exercise why are they doing well it always comes down the same thing their operations are really smooth like that's what makes a great experience with a business so it is the amazon model like amazon's website hasn't changed that much actually if you look at it in the last ten years you know they kind of still looks the same the product pages look similar they've made more information but it's a similar layout but their operations are unbelievable.

30:43 I mean, the next day, the two day, as soon as you add something to your cart, they're moving the product closer to you if it's not already. So when you think about practices, the ones that are making the booking easy, the ones that are making the intake easy, the ones that are sending you like nice curated emails, this is all a level of professionalism that really resonates with people. And it's a subtle resonation. It's not like man, that was the best thing ever. It's just like, wow, they kind of have it together. Like they just seem like they have it together. And that's what I think impresses patients and referring sources is when it all just seems to just work and nobody thinks about it. It's all background stuff. And like, it's pretty good. I want to make this part of a series.

31:24 I sent you a couple of topics because I think these things are not in a silo. So this will be part one. I do want what's called front tees, which is look for part two. We're going to focus next on AI and PT, what's real, what's hype, what will actually change. Instead of buying the hype, right? And then the third part of this really will be from full schedules to full profit. How do you go from beginning to end? Why? And then where most busy clinics still struggle financially. So those will be coming up. But before we wrap up this episode, we bring you the parting shot. This is the parting shot. One last mic drop moment. No pressure. Just your legacy on the line.

32:12 I feel like you could pick six, seven, eight things, six, seven things from the episode today to reiterate, but what would you want to stamp on people's brains, particularly people either who are running a practice who want to do that? What's your parting shot that they should just, if you're going to give them one thing to hold on to, what is it? My parting shot would be, It's twenty twenty six. Your biggest task this year is to separate out signal from noise. That's it. Like there's too too much. I don't know. Am I contributing to too much on this podcast? I hope not. I hope I've delivered something valuable to some people and something resonates. But there's so much signal out there.

32:55 There's also so much noise. You cannot possibly keep up with everything you're hearing. You cannot possibly do everything every talking head is suggesting. You've got to think about what is your practice. It's January right now. Where do you want to be in December? What are you going to do to get from here to there? I don't know. In my experience, you're judged or your outcomes are as much by what you say no to as what you say yes to. So if you can't get some focus, your team won't have any focus. And you'll be sitting here in another year saying, we didn't really make any progress because we didn't really know exactly what finally we wanted to work on. So Find your signal and get on that.

33:36 I like that. Find your signal. I would end with, and I heard this from someone else. I forget who it was. They said, there are people dumber than you making more money with less trust. So that should piss you off. And it should also motivate you like, hey, maybe I'm... overthinking a lot of these things. Maybe I'm listening to too much noise and not enough signal. And there are people dumber than you making more money with less stress. Let's focus on that. Don't be jealous. Be motivated by that. EmpowerEMR.com if you want to go a little bit deeper into this. Take one little step. Sharif's not going to handcuff you to anything. But reach out to Empower as an organization. I appreciate your time, Sharif. Thanks for this, man. Thank you. Thanks for having me. And we'll see you back at part two and part three.

34:18 And maybe this is your signal versus noise ratio that we need to focus on. Right on. That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode. Want to go deeper? Hit us at pgpinecast.com or find us on YouTube and socials at pgpinecast. And legally, none of this was advice. It's for entertainment purposes only. Bullshit! See, Keith? We read the script. Happy now?