It’s Okay to Be a Generalist

WEBVTT

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She's like, I'm in bed.

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The best conversations happen at happy

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hour.

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Welcome to ours.

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Welcome aboard.

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This is the PT podcast.

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Here's your host, physical therapist,

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Jimmy McKay.

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Good timing.

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Live from CSM.

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Twenty twenty six here in Anaheim.

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In a profession obsessed with

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specialization,

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our next guest is here to make the

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case that being a generalist isn't a

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weakness, it's preparation.

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Ben Lindeman, welcome to the show.

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Thanks for having me.

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Appreciate it.

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Where are you from, man?

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I live in Philadelphia.

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nice yep right now where this little

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shindig will be next year yeah yeah i'm

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right down smack down the middle of the

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city in the convention are you from pa

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uh born and raised in iowa but then

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moved out to pa for grad school and

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then just never left fantastic all right

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so uh there was an oxford debate a

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couple years ago at generalization versus

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specialist uh it was very interesting as

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oxford debates which should be brought

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back to the apta that's a hill i

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will die on and i'll keep pitching about

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until it gets brought back um and it

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was interesting to hear both sides yeah

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We like chasing things like titles and

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specializations.

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It is neither good nor bad.

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It just is.

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So why do PTs feel pressure to sort

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of specialize or do these things?

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I don't know.

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I think it's a couple things.

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I think if you, like,

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zoom out and just healthcare in general,

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like...

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physicians like everyone has a specialty

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and I feel like every time I have

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patients they're like yeah I have to go

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see the ortho guy but then he specializes

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in the knee and then it's only the

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right knee but not the left knee and

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I think it's just how our health care

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is designed from a top-down approach and I

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think it's just trickled into PT and

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there's a time and a place like I

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have my neuro specialty I'm not here to

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rag on it but I think just so

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often I hear oh you need to go

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see Ben he's the neuro guy he's the

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neuro guy and I'm like

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People are people.

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You don't necessarily need to have the

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specialization to provide best care for

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them.

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I get people know me because I have

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a podcast.

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And people are like, he's the podcast guy.

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And I'm like, actually,

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I have a degree in communications and

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journalism.

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So I could do words, too.

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Or I could do pictures.

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Or I could do a combination of both.

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So yes, you might be a neuro PT.

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You're still PT and there's a time and

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a place and neither is better or worse.

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But where does that pressure come from?

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Is that is the call coming from inside

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the house?

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I feel like it's like patients like some

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want that specialization because they feel

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that they're going to get better outcomes

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because of it.

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So I think it's a patient

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customer service based marketing thing.

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I'll take credit.

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Yeah.

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Shame.

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Yeah.

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And then I think it's, you know,

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people want to have that identity of like,

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I have this thing that nobody else has

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or very few people have.

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And so then it promotes this level of

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autonomy that you maybe don't have as a

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generalist or in that sense.

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So I think there's

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like talking about in absolutes,

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like it's just patients or just therapists

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or just administration.

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Never is.

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No.

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Yeah.

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But yeah,

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it's just one of those things that it

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was always kind of annoying when I was

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in full-time clinical practice was like,

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You know,

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I would just get all these people like,

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oh, Ben, you're the neuro guy.

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I want you to see this person.

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I'm like,

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did you even do anything with this?

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Like, did you eval them?

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And they're like, well,

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I don't have like you have skills like

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you graduate as a generalist and you like

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very few times I had to like truly

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dig in with my neuro knowledge and like

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to provide care that that probably that

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therapist could have done.

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But I'm like,

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ninety percent of what this person needed

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was just basic attention or a set of

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eyes,

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all those all those different things.

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What do we lose when we undervalue a

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generalist?

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I mean, here's the thing.

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We're at APTA.

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Fifty state chapters.

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Eighteen components.

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None of the components.

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There's pediatrics, geriatrics,

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orthopedic sports.

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There's no academy of generalists.

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I know.

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So maybe it's a little bit of like,

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well, if I don't belong somewhere,

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I don't belong.

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And I think they're trying to probably

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funnel that population into the new

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primary care and specialization stuff.

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Oh, that's a good point.

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Yeah.

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So to me, I view the primary care,

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this is my own thought,

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it's like you're kind of now a specialized

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generalist, if that makes sense.

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Now we're just going in circles.

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Now we're just talking in circles.

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I mean,

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it's just also like I enjoy the variety.

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I enjoy working with people with

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neurological conditions,

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but I love treating my runners.

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I love treating, you know,

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anybody who has a pulse.

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Really, I'm happy to work with them.

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So well said.

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So how does value based care change this

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type of conversation?

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That's a tough one.

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So I think.

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You have to define,

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like how would you define value though?

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Like what does that mean to a payer?

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What does that mean to the consumer?

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What does it mean to me as a

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therapist?

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And probably all answers are different.

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Yeah.

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They have to be.

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They will be.

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They have to be.

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Yeah.

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So I don't know.

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I haven't really given that one too much

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thought.

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But I think it would be kind of

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understanding or triaging or better

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triaging like who is truly going to

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benefit from a specialized individual.

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And I was, before I came on,

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I was like looking into some research and

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there is at least some research to

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support.

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Yeah.

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If you have like F and D or

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something that's really, really niche,

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then yeah,

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you're probably going to be best off with

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somebody who specializes.

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Cause some of this stuff is coming out

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of Australia.

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They're putting a lot more research into

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this idea of generalist versus specialist.

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And they're basically just saying, yeah,

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like you may need a specialist for like

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certain very niche things,

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but probably you don't need it for

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everything.

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Yeah.

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I mean, it's probably like a bell curve.

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Yeah.

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There is an extreme on either side that

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will need it.

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And then there's the middle of the bell

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curve and that's how bell curves work.

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Yeah.

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Crazy.

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It's nuts.

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Yeah.

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Yeah.

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Um,

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Why is generalist thinking critical in

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rural and primary care settings?

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Because you might be the only person

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within

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hundreds of miles or months.

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Yeah.

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The only person in health care.

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Yeah.

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And so having that adaptability in that

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range and that depth of knowledge is

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you're it.

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So because these people may not

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necessarily have specialists with access,

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even with telehealth.

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So having that really strong generalist

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mindset, I think, is what's needed,

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to be honest.

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And so many times it's just

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Yeah.

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I had a patient last week who was

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like, yeah, I went to this physician.

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I went to this physician.

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I went to that physician.

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Now I'm back in PT.

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And I was like,

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you just went to twelve physicians and

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still aren't anywhere near where you need

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to be.

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So, yeah,

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I think generalists are what's needed,

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especially in those settings for sure.

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You can't walk more than ten feet without

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running into a pack of students at CSM.

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Yep.

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It's a constant question from,

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I don't know, second grade.

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What are you going to be when you

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grow up?

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And then you get close to college.

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What are you going to major in?

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And when you're in PT,

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where are you going to practice?

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It's constantly what is next.

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Yeah.

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So...

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how would you speak to a younger clinician

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talking about identity and scope in terms

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of generalists during specialists?

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How would you,

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would you tell them to slow it down?

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Would you tell them to,

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what would you tell them?

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So my path into PT was I graduated

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then went right into a neuro residency.

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And I think that,

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accelerated my thinking in some aspects

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but i think it really put me in

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this kind of pocket of all right this

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is all i'm doing and this is all

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i can do and then once i actually

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got out into practice full time it's like

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i actually kind of like more of the

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generalist thing so i for a younger

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clinician i think you know try it out

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like pt is such a versatile profession

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where you don't have to be a specialist

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like you know a physician going from med

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school to residency

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Um, so like, yeah,

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take the first couple of years,

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like work in a place that's going to

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have lots of variety, right?

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Whether it's an outpatient,

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whether it's impatient, whatever.

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Um,

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and not feel pressured to feel like you

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need to define who you are right when

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you leave PT school.

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Cause I don't think that's,

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it needs to be the case.

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You get one PT license.

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Yeah.

00:08:26.877 --> 00:08:27.456
And, uh,

00:08:27.476 --> 00:08:28.596
when you want to go from piece of

00:08:28.617 --> 00:08:30.298
geriatrics or there's no,

00:08:30.858 --> 00:08:31.937
there's no toll booth.

00:08:32.138 --> 00:08:32.317
Yeah.

00:08:32.357 --> 00:08:33.658
There's no one saying you have to have

00:08:33.697 --> 00:08:34.038
this thing.

00:08:34.057 --> 00:08:36.019
And that's a little, it's, it's awesome.

00:08:36.078 --> 00:08:36.219
Yeah.

00:08:36.938 --> 00:08:38.539
I went from sports outpatient to peds,

00:08:38.559 --> 00:08:39.860
and I was sort of like waiting for

00:08:39.921 --> 00:08:40.221
someone.

00:08:40.400 --> 00:08:41.422
I was looking to get pulled over.

00:08:41.442 --> 00:08:42.481
I was like, where's the cop?

00:08:42.562 --> 00:08:43.602
And they're like, there's no cop.

00:08:43.643 --> 00:08:44.462
You can just do that.

00:08:44.482 --> 00:08:47.424
And that's, I think, part of our strength,

00:08:47.985 --> 00:08:49.306
but also maybe part of our weakness when

00:08:49.326 --> 00:08:51.927
it comes to explaining to people what we

00:08:51.966 --> 00:08:53.967
can do because you're a PT.

00:08:54.587 --> 00:08:55.188
Who do you work with?

00:08:55.208 --> 00:08:56.229
And you're like, okay,

00:08:56.369 --> 00:08:58.190
so I could work with this to this

00:08:58.210 --> 00:08:58.690
to this to this.

00:08:58.730 --> 00:08:59.770
So it is a strength,

00:08:59.791 --> 00:09:02.672
but it's hard to explain a profession to

00:09:02.731 --> 00:09:04.692
people or the many possibilities.

00:09:04.753 --> 00:09:05.114
For sure.

00:09:05.274 --> 00:09:05.734
A hundred percent.

00:09:06.222 --> 00:09:07.423
would you say to a pt who feels

00:09:07.563 --> 00:09:10.645
less than for not specializing how would

00:09:10.666 --> 00:09:11.966
you make them i feel like we need

00:09:11.986 --> 00:09:14.889
like soft music like okay sit down look

00:09:14.928 --> 00:09:18.211
right into my eyes i don't know like

00:09:19.971 --> 00:09:21.452
where is that thought coming from though

00:09:21.592 --> 00:09:23.594
like where who put that in your head

00:09:23.614 --> 00:09:25.355
that you needed to specialize or that you

00:09:25.394 --> 00:09:26.515
need to do that like

00:09:27.769 --> 00:09:29.831
So I would want to tell that person,

00:09:29.850 --> 00:09:29.991
well,

00:09:30.011 --> 00:09:32.114
you need to get new friends because that

00:09:32.134 --> 00:09:34.336
thought didn't come from just organically

00:09:34.375 --> 00:09:34.836
probably.

00:09:35.037 --> 00:09:37.219
But I think you then just go back

00:09:37.259 --> 00:09:39.321
to your patient outcomes.

00:09:39.360 --> 00:09:40.922
Are your patients getting better even if

00:09:40.942 --> 00:09:41.942
you're not a specialization?

00:09:42.083 --> 00:09:43.164
Do you like doing this?

00:09:43.245 --> 00:09:43.585
Yeah.

00:09:43.644 --> 00:09:45.346
And then is this satisfying to you?

00:09:45.407 --> 00:09:47.629
If you hate neuro and want to be

00:09:47.649 --> 00:09:49.331
a neuro specialist, then that's on you.

00:09:49.451 --> 00:09:50.211
Yeah.

00:09:51.077 --> 00:09:51.458
Yeah,

00:09:51.479 --> 00:09:53.301
I think there are people that love

00:09:53.341 --> 00:09:55.143
specialization, and that's their jam,

00:09:55.543 --> 00:09:57.024
and I'm not here to rain on that

00:09:57.044 --> 00:09:57.445
parade.

00:09:58.066 --> 00:10:00.788
But I think it's just my clinical

00:10:00.849 --> 00:10:04.033
observations and just seeing that it just

00:10:04.092 --> 00:10:05.914
organically happens where people get boxed

00:10:05.955 --> 00:10:06.274
into these...

00:10:07.196 --> 00:10:09.616
profiles or demographics.

00:10:09.797 --> 00:10:12.258
And I think it just really then is

00:10:12.778 --> 00:10:14.479
challenging for younger clinicians because

00:10:14.499 --> 00:10:16.198
then people just keep getting triaged.

00:10:16.799 --> 00:10:18.259
And then you never fully develop a skill

00:10:18.299 --> 00:10:20.640
set because younger clinicians would be

00:10:20.660 --> 00:10:21.160
like, oh, Ben,

00:10:21.201 --> 00:10:22.142
I want you to see this person with

00:10:22.162 --> 00:10:22.562
a stroke.

00:10:22.961 --> 00:10:23.501
I'm like, well,

00:10:23.522 --> 00:10:24.903
you can still learn from this person.

00:10:24.962 --> 00:10:26.702
And now you're just really limiting your

00:10:26.722 --> 00:10:28.063
ability to work with all sorts of

00:10:28.083 --> 00:10:29.844
individuals because they get scared or

00:10:29.864 --> 00:10:30.745
they're not confident.

00:10:30.825 --> 00:10:31.245
And I'm like,

00:10:31.705 --> 00:10:33.986
you can still do the basics really well.

00:10:34.327 --> 00:10:34.888
And then, yeah,

00:10:34.927 --> 00:10:36.249
if the patient's not getting better,

00:10:36.308 --> 00:10:38.071
then potentially triage or something like

00:10:38.091 --> 00:10:38.311
me.

00:10:38.350 --> 00:10:38.630
Yeah.

00:10:39.451 --> 00:10:40.852
But so many people just punt the ball

00:10:40.873 --> 00:10:41.354
so quick.

00:10:41.994 --> 00:10:44.356
And I think that's just limiting your

00:10:44.376 --> 00:10:44.616
growth.

00:10:44.636 --> 00:10:45.456
That's internal, right?

00:10:45.477 --> 00:10:46.778
That's our own problem.

00:10:46.859 --> 00:10:47.399
I'm guilty of it.

00:10:47.479 --> 00:10:48.299
That's why I can spot it.

00:10:48.360 --> 00:10:49.140
Guilty of myself.

00:10:49.780 --> 00:10:50.682
I'm not the expert in this.

00:10:51.022 --> 00:10:52.102
But I heard someone smart say,

00:10:53.166 --> 00:10:55.750
most of the time because only the sith

00:10:55.831 --> 00:10:57.573
speaks in absolutes i learned that from uh

00:10:57.693 --> 00:11:00.619
star wars uh most of the time you've

00:11:00.639 --> 00:11:02.461
gotta you don't need to be the world's

00:11:02.562 --> 00:11:02.982
expert

00:11:03.840 --> 00:11:04.159
on anything.

00:11:04.259 --> 00:11:05.341
I've never been the world's expert on

00:11:05.600 --> 00:11:05.941
anything.

00:11:06.501 --> 00:11:07.842
We need you to have enough expertise to

00:11:07.883 --> 00:11:10.764
speak confidently and competently.

00:11:10.784 --> 00:11:13.466
Confidence and competence is sort of the

00:11:13.546 --> 00:11:14.326
ticket you need.

00:11:14.706 --> 00:11:16.408
And then when you realize, hey,

00:11:16.447 --> 00:11:17.788
spending more time with me will probably

00:11:17.808 --> 00:11:18.529
be a disservice,

00:11:18.909 --> 00:11:20.870
that's when you do that power move,

00:11:20.890 --> 00:11:23.793
which is a handoff, when you notice that.

00:11:23.832 --> 00:11:24.874
Last thing we do on an episode,

00:11:24.894 --> 00:11:27.916
we call it the parting shot.

00:11:31.052 --> 00:11:32.192
This is The Parting Shot.

00:11:32.732 --> 00:11:34.413
One last mic drop moment.

00:11:34.813 --> 00:11:35.595
No pressure.

00:11:36.054 --> 00:11:39.297
Just your legacy on the line.

00:11:39.336 --> 00:11:40.317
No pressure whatsoever.

00:11:40.337 --> 00:11:41.359
So you can have your own parting shot,

00:11:41.379 --> 00:11:42.779
or I can give you a parting shot

00:11:42.820 --> 00:11:43.220
prompt.

00:11:44.801 --> 00:11:45.381
Let's do the prompt.

00:11:45.442 --> 00:11:45.802
Prompt.

00:11:46.121 --> 00:11:48.604
What's one mindset shift physical

00:11:48.644 --> 00:11:50.264
therapists need to make about their

00:11:50.325 --> 00:11:51.346
clinical identity?

00:11:51.706 --> 00:11:52.285
That'll be your question.

00:11:52.306 --> 00:11:53.908
What's one mindset shift?

00:11:54.288 --> 00:11:55.668
I feel like you've said it a few

00:11:55.708 --> 00:11:56.208
times.

00:11:56.769 --> 00:11:57.250
Yeah.

00:11:57.309 --> 00:11:58.370
I think you just need to...

00:12:00.985 --> 00:12:02.687
know just eliminate the noise around you

00:12:02.787 --> 00:12:05.429
and like don't be influenced by what your

00:12:05.450 --> 00:12:08.032
boss wants you to do necessarily or what

00:12:08.091 --> 00:12:09.433
other people are doing around you like

00:12:09.793 --> 00:12:12.076
find what you want and make that your

00:12:12.136 --> 00:12:13.717
identity and if you haven't found it keep

00:12:13.738 --> 00:12:16.360
looking yeah yeah and if you need a

00:12:16.400 --> 00:12:18.023
place to look that's good too you don't

00:12:18.043 --> 00:12:19.543
know where to look uh come to an

00:12:19.583 --> 00:12:21.005
event like this yeah and just

00:12:22.096 --> 00:12:24.037
Listen, look, consume,

00:12:24.596 --> 00:12:25.437
figure out what you like,

00:12:25.476 --> 00:12:26.778
and then take bits and parts of your

00:12:26.837 --> 00:12:28.958
favorite things that you see and make your

00:12:28.999 --> 00:12:29.418
own thing.

00:12:29.639 --> 00:12:31.119
I'm a physical therapist radio DJ.

00:12:31.240 --> 00:12:32.440
I literally just made this up.

00:12:32.500 --> 00:12:33.500
You just make things up.

00:12:33.519 --> 00:12:34.181
You're an N of one, right?

00:12:34.201 --> 00:12:35.041
Yeah.

00:12:35.100 --> 00:12:36.442
I would have loved for some help along

00:12:36.461 --> 00:12:37.542
the way or like a guidebook,

00:12:37.601 --> 00:12:39.202
but you can just do things.

00:12:39.363 --> 00:12:39.482
Yeah.

00:12:39.503 --> 00:12:40.363
And that's how things happen.

00:12:40.383 --> 00:12:41.442
Well, and it's part of the growth.

00:12:41.604 --> 00:12:42.283
Like, you know,

00:12:43.144 --> 00:12:45.144
the struggle and making mistakes and

00:12:45.205 --> 00:12:45.904
trying to figure it out,

00:12:45.945 --> 00:12:47.206
like that's part of the journey.

00:12:47.225 --> 00:12:47.385
Yeah.

00:12:48.166 --> 00:12:49.148
what I like about it the most.

00:12:49.168 --> 00:12:50.169
Listen, I'm here for a good time,

00:12:50.190 --> 00:12:50.811
not a long time.

00:12:50.850 --> 00:12:51.071
Ben,

00:12:51.110 --> 00:12:53.755
appreciate the stop by here at APTA CSM.

00:12:53.855 --> 00:12:54.476
Here, in.