PT Breakfast Club 10/14

0:01 Dave, I am loving that shirt. It's so silky and smooth. Got to dress up sometimes. All right. So guys, welcome back. Is it Tuesday? I think it's Tuesday morning, October fourteenth. I pulled up some topics across chat GPT. And then I got a message, and I'm just prefacing. We can talk about anything you want. It's getting harder for growth to be funded by loans. There are a couple headlines out there saying that PT clinics are having a hard time borrowing or refinancing units. George Malavasic, hinge and sword or full on changing obviously the future of the profession, and I think it got me thinking about some stuff that's pretty interesting for what like the future patient is like.

0:55 And then I got a message talking about Chick-fil-A and how a therapist was playing pickleball with some students that are in school, but working at Chick-fil-A and how much they love it and how passionate they are. And this therapist was talking about PT school and what a grind it could be for so many. It wasn't for me, but I know how crazy PT school can get for some. Where do you guys want to start? Gosh, we can do it. We can go into that. Sounds like a lot. Let's talk about the PT school experience. So so basically what and they didn't say I could share their name, so I'm not going to.

1:39 But what this person was saying was he remembers, you know, PT school and the experience. Now, I'll tell you guys candidly, like I did not take PT school seriously. I already owned my business for a couple of years before I went to PT school. We had two locations. We just opened a third location. So for me, you know, I had been a strength coach before that. I had my bachelor's in kinesiology. There was nothing like PT school wasn't about learning things that I was going to do and maybe exploring new careers. I already had my career.

2:19 Outpatient ortho, I would literally... leave my house on Monday morning, drive three hours to South Florida, to Miami, attend classes, leave either Thursday night if I could skip Friday classes or Friday as soon as classes ended. And, you know, PT school is just a barrier between me and a license. That's all it was. So I didn't take it too serious. I didn't get stressed out. If I got A's or B's, cool. I couldn't get a C or I got kicked out. That's kind of what it was for me. What was it like for you guys?

3:00 Jimmy, you were next in line chronologically. I mean, for me. Right. Right. Right. Or when you graduated after me or you're a little bit. I think so. Yes. Fourteen. All right. So then I'm next. I don't know. Can I graduate in twenty eleven? I mean, I don't know. I took it seriously because I didn't have the whole business like you did, Tony. Like I didn't already have like. Did you go straight from high school to bachelor's to master's or doctorate? What did you do? yeah so from from high school i selected a school that had the three and three programs so the three-year accelerated undergrad and then the three-year dpt all the same all the same school all the same campus so if you did two schools it would be four years to get your bachelor's and then three years to go transfer somewhere else to get your DPT.

3:45 So it'd be seven years. So it was three years total, uh, but partly choosing that because I was able to play D two baseball and get some baseball money. Um, and it wasn't that far away and kind of had all the, all the amenities of, uh, you know, sucking an eight year old into the vortex. So, no, I mean, I took it, I took it, as you can imagine i took it pretty seriously uh because it was challenging and like some holidays i wouldn't go home i'd be studying like certain you know easters or whatever i'd be you know staying home i'd be staying on campus and uh and studying so i took it pretty seriously although at this point like I'm barely treating and I'm trying to grow the practice and the business. So it's kind of, you know, a little ironic, but like, I don't know, like what are, what's, what's someone else's alternative?

4:31 Like, of course they're, I think take it seriously because, uh, otherwise it's like, you know, I can give quick anonymous stories, but folks that like failed out of our school or failed out of other schools, uh, they're not crushing it most likely in life right now. You know, if you, if you pull it up their, their social media or, or whatever, you know, like their, their actual, uh, situation. So, you know, I think for me, which is something to, you know, push through just like everything else, whether it's training for baseball and sports or, you know, whatever. So yeah, but my program anyway, it was, uh, at the end of the six years, you would get the bachelor's and the doctorate at the same graduation ceremony. So yeah.

5:12 Before Jimmy goes real quick, you brought something up like I also made the choice. I remember I applied to pretty much all the schools around me. So that was like four schools. But the biggest thing that was the decision maker was which one had the quickest program. I got into two of them. But for the record, I was missing five prereqs that I never took in undergrad. I never took any chemistry, never took any math. something else. I was missing a physics, missing a psychology. So there were five prereqs. Two schools let me in conditionally on, okay, you got to get the chemistry done.

5:53 Never did it. But within those two schools, the difference was one took a summer off and the other one didn't. So I was graduating six months earlier in the school that didn't take the summer off. And I think the main kind of message in this was, and you guys probably know this, I think the culture of the programs, it's like, there's probably a work-life balance here that gets lost. I think there's too much emphasis, too much importance put on stuff that really isn't that important. Like, I go back to all of the things we've probably all forgotten.

6:35 that was so stressed and so important and, you know, put so many gray hairs on some people's head prematurely that really now, like five years in, ten years in, twenty years in, it doesn't even matter. I don't even remember the stuff that I've forgotten. For the right person. For the right person. It's probably useful. Jimmy, what was your experience? Yeah. So, I mean, I went through my bachelor's and then worked for fifteen years and then I knew I was going to have to take all all all of the prereqs before I could apply for for school. And I was doing that while I was working full time.

7:16 And then I went up, I think I taking my last like two or three. I like left work, you know, retired and then took my last two or three projects while I was applying and then went into the program full time. And it was three years straight up. So you didn't work in the program. You were working full-time. I worked on the side, but I didn't work full-time. Like doing the job that I was going to do, there were no PT programs. Actually, yeah, the University of Scranton. I don't know. I think I just wanted to be done with it. I didn't want to be in Northeast Pennsylvania anymore if I wasn't doing radio. So I just sort of left. Yeah. Very nice. yeah yeah i mean same thing right like for me it was jump in with both feet and be fully immersed and i was a college student again with all the with all the strengths and all those different thing uh stresses and different things that came with it definitely wasn't expecting that it's not like it's not like college was like easy the first time i was a communications major i loved it this i liked too but like it was there was a lot of stresses for things that i don't remember anymore but like yeah i remember professors trying to talk me off a ledge like i don't know why you're so stressed out over you know, getting an eighty seven.

8:26 And I'm like, well, why didn't I get a ninety? And like, it sort of doesn't matter. Like, why didn't I? You know, like, yeah, I think it just comes into like social hierarchy. Like, how come that person was able to do it and I wasn't in six months? What if I'm not able to do that or what else am I? You know, so like for me that that was that was a struggle. That a lot of my classmates were like, Dave, they were they were going right through school where I'd taken a break and done something a little bit. not related to the material we were studying that particular day. Yeah. So, Tony, the reason to bring this up is what again? More just to understand and kind of discuss the culture of academics versus, you know, are we putting too much stress on DPT students?

9:11 Can we make it more enjoyable? If we know enrollments are down, we know that therapists aren't getting paid enough, if we want to grow the profession still, Is there an opportunity here to kind of make the academics programs more enjoyable, more appealing, more attractive for students to come in? And just kind of the person who messaged me, I've said before, like, I have to actively work to kind of protect the passion for what I do. Because if I just fall into the routine, I'm going to get so sick of it and burn out. And I think that starts happening in school before you even become a therapist.

9:51 therapists are getting burned out in the programs. So I just wanted a flow to buy you and hear your back story. I want to, I have a response to that, but go ahead and read out Jeremy Sutton's response here that we have on the screen. Go to measurements stress me out so much. I don't remember the last time I touched the goniometer. Yeah, I just watched a guy, I didn't share it publicly, but this would be a separate topic. He was on TikTok, amazing clinician. I would send any of my family to him, but he literally went through every single special test when doing like, I'm going to say an upper quarter screen or something like that.

10:32 Tested every reflex, did every special test, looked at every like articulation and he did it quick, but air quotes quick was like twenty minutes. I was like, holy crap, why are you looking at all of this stuff for normal people? And it brings up the question, like if I go to the doctor, the doctor doesn't order every test possible. You let the condition kind of guide your evaluation and your assessment. But he basically came out because other people had said it and he was like, but you're a shitty therapist. You got to find out if it's upper motor neuron. And I had to look up what that means because I forgot. You have to do all of these things. I'm like, no, you don't.

11:13 Like, let context of the situation guide your decisions down the road. We don't have to do every single thing. Go ahead, Dave. So I just saw recently a Nick Saban video where he was saying every person that gets into medical school is intelligent, but not everyone makes it through. And everyone that makes it through and becomes a doctor, not everyone is a great doctor, depending on your definition of great or excellent or average or subpar and all that. with physical therapy, whether it's medical degree, physical therapy degree, nursing, whatever. I know we kind of talked about it before in the show of licensure and the hurdles and the things that are out there for multiple reasons to protect the public.

11:59 But then also through our programs, it's like there has to be some amount of challenge to filter out people. Otherwise, like either either the profession or any profession gets you know flooded with a bunch of new workers that maybe are you know some of them are actually subpar or would have been inappropriate for the normal safeguards or guide rails or you know structure of what type of person or professional or skill set and or combination of all those things uh is typically going to be like the ideal worker or professional for whatever industry that might be and so I know you guys talked about it before of like the licensure now or in general for anything for you know a license or you know insurance for plumbing or for your roofer or whatever like there's some protection there and some of it was you know with the intent of also protecting the consumer or the patient in this case but my stance is that all of this schooling there has to be some challenge it needs to be hard it it it pulls out folks that have the character the work ethic the the drive the grit you know all these things that we we talk about we hear about um there has to be some challenges right so like I don't see anything wrong with it at all.

13:28 And when I was going through school, like I never heard the word burnout ever. Now, after twenty eleven, I graduated twenty eleven and in twenty fifteen and covered in twenty nineteen and twenty twenties and all that. And somehow this word is like everyone's burnout all the time. And so I'm sure the other physical therapists that are, you know, fifty, sixty, seventy years old, I feel like they've never heard the word burnout either. And so I know the burnout thing over. We're not talking about the whole career. We're talking about like the schooling part. But anyway. Final comment on it is like there needs to be some big challenges, whether for us it was gross anatomy. Right. So you had the eight weeks of cutting open cadavers and dissecting, you know, head to toe that weeded out like twenty five percent of the class, like people that just couldn't get through it.

14:17 They failed it. They had to either retake it or just leave, leave the school, go to another school or find a different. bachelors, find a different program, go, you know, study business or accounting or whatever. I think these things are great. I think these things are important. I think they're needed. And I don't see any changes, you know, with it coming forward. Yeah, I don't disagree. I can see it. But we do live in a world of participation trophies. Everyone gets a medal, everyone walks away happy, and nobody's happy. Jimmy? yeah i mean uh i don't think i used the word the phrase burnout much when i was going through undergrad or really even in work i loved what i did but i did hear it a lot and i started to experience it when i was in pt school and i was a decade older than everybody else um i don't I don't claim to be an expert on where that came from, but it was there.

15:11 I don't know what if it was, was the curriculum the same? Were the things that the hoops that we were jumping through the same? Was it this cohort of people around us, right? The Stanford prison experiment. What can the people actually create the environment? Do the people become the roles where they just used to be told, being told that this is too much. And when this is too much, I'm burned out. I don't know the answer. I think it's multifactorial. I'm sure some people in academics study it because now they're seeing a problem. They're seeing one generation of PTs telling the others, don't come into this profession. School is way too hard. It stresses you out. When you get out there, the risk versus reward isn't enough. And those people aren't doing it. And the proof, that's objective, right?

15:51 I don't know the reason, but... they're right because less people are applying and less people are going to PT school. So what is it? I don't know if you can tease out what those things actually are to keep keeping qualified students from applying these days. I don't know what it is. Nice. You guys want to move on? Dave, what were we talking about? We were talking about last week and we said we want to get Tony's take on the conversation we had on Thursday. There was the Jared Hall post about a physical therapist who over... over assume they they think they're treating a ton of patients but then because of canceled no shows and seasonality and scheduling and whatever uh i forget how it was phrased i think there was like a graph or something but it was from last week jared hall posted and i feel like i typically disagree with like a lot of what he posts but like this one is i'm like yeah i could get on board with that i that would make sense tony re-shared it he uh tony if you maybe want to pull up your post or if you recall your sentiment around it um i i agree because i've been in you know a couple different in-network practices that were not like crazy mills but like you know three patients an hour uh but then you get the cancels and no shows and all that so the assumption is that the physical therapist feels like they're treating twenty or thirty patients a day and then when you look at the averages it's like you know i don't know thirteen to fifteen or something a day

17:22 Yeah, I replied to this. I shared it. I agree with most of Jared's posts. I love his posts. And I've talked to like we've had team meetings when we have big teams. We have team meetings when we have small teams. It's look, you guys and me included, we're going to remember the ten o'clock hour where the the, you know, nine thirty patient showed up late. The eleven o'clock patient showed up early. The ten o'clock patient showed up on time. Somebody walks in the schedule and we took them as a walk in about we're going to remember that. but we're going to forget that the one o'clock patient showed up, you know, canceled and all of these other gaps, just human nature.

18:05 It's just the way our brains are wired. Like you, if you, especially if you feel stressed, this goes back to students and all that stuff. Like if you're naturally a person who gets stressed, you get a stress response. The adrenaline starts flowing. You start thinking about all these things. It's going to be even that much more impactful because, It's fine. Like I acknowledge that is a human trait. But when you're thinking about compensation, when you're thinking about, you know, expectations, when you're thinking about your reward for what you do, please just take a second, go back, look at the absolute numbers, clear your mind of the emotional experience.

18:46 And just be like, oh, dude, seems like I was so busy, but I actually only generated one hundred and twenty seven units this week and I got paid for forty. Yeah. If we want to be scientists, let's look at this scientifically. Don't even count visits, because sometimes there's going to be people that have shorter visits, less units. Look at the absolute unit value produced for the number of hours worked. And I think most therapists will realize they were not as busy as they thought they were. Is there a psychological phenomenon that explains this? Like, is there some term that you guys are the know of?

19:28 Because I would say for this, I would say one reason I would bet, I'm just guessing, this is an assumption. Any physical therapist that has an electronic medical record that the front desk, the admin, their booking evaluations, the booking patients onto the calendar of that physical therapist, this is where I believe this directly relates to. A physical therapist comes into work right now, eight, fifty two a.m. on a Tuesday, and they see X amount of patient visits on the calendar for that day. Now, of course, some cancel no show, get sick, flat tire, kids are sick, they can't come in, the new patient eval gets lost, they go to the wrong building, whatever, and things happen.

20:10 And then at the end of the day, they actually treated less than what they saw on their electronic medical record calendar. But when they saw their calendar for that day, there must be some psychological, Something that's what they're perceiving. At the end of the day, they're like, this is all the patients I'm going to see and treat. So maybe there's some expansion of their mind of, okay, I'm treating fifteen patients today. And then at the end of the day, if it is only eleven patients and four cancel no-show, get sick, they don't want to come in, they drop off, whatever, that physical therapist still thinks that they Like they had already registered the fifteen visits for that day, like in the memory bank.

20:53 And there was no there's no changing that registration of like, actually, let me recorrect it. Let me course correct. It was actually eleven and not fifteen. That's what I bet some of this comes from. I'm curious if there's some psychological phenomenon or explanation. Yeah, the other one I can find really that came close was from Daniel Kahneman. Did you guys read Thinking Fast and Slow? That was like, that was, that was his jam. The planning fallacy, tendency for people to underestimate how much time tasks will take or overestimate how productive or busy they'll be, even when they don't have experience or data to show otherwise. So you're saying there was a dashboard at the bottom of the screen, like a scoreboard, what inning it was and how many patients they had seen.

21:40 You're saying they would over, this is saying they would overestimate how many things that they had done versus how many things that had actually been completed. I think so. And there's an example like when I did one of my rotations at a hospital that was eight weeks long. You would have a you would have a schedule for that day. But then throughout the day, you would get these add ons and like you would have to like, my CI would have to like call the office like the outpatient office downstairs or call some rehab manager. I don't even remember what it was. And they would ask or we would find out if there were like add ons. like new patients that like just got medically cleared for physical therapy to get out of the bed and walk and move around or whatever, and, you know, check their vital signs, whatever it is.

22:27 And because those new add-ons, like the time between, like we had visited all the patients that we had to for that day. Now it's like, okay, let's check if there's any add-ons. And let's say there was like one or two other patients to be added on. The time duration between when we found out there was a new add-on patient and when we actually went to go visit them and treat them was, like, such a short, like, little time window that I bet, like, the opposite is true here, where it's, like, I treated more patients or visited more patients in the hospital, but I didn't feel like I had... because i i didn't have enough mental time to like process like i had this huge calendar and like all these patients are here but it was like less in a hospital potentially or at least my experience and then there was these add-ons but the add-ons like yeah it was kind of like uh like this this you know like this the ci's hoping there's no add-ons but like she's calling for add-ons anyway like that's just her job but we would go ask for an add-on we would see if there is we would go visit them within ten minutes, fifteen minutes, twenty minutes, something like that.

23:31 And then so we would actually visit and treat more patients per day in a hospital, at least my experience, than what was originally scheduled at the top of the morning. So it's almost like the opposite. Like I maybe and that's whether it's the great hours of working, you know, eight to four or nine to five or whatever in a hospital and, you know, decent benefits from a hospital system. Maybe there's some uh truth here of like therapists in a hospital are less likely to be burnt out because the opposite is true like you have a shorter you know more concise patient census or whatever you want to call it and then more get added later but you didn't have those added on at the beginning of the day and the whole day didn't look as daunting i don't know that just possibly this, we always talk about crafting the patient experience.

24:16 Like how do we make the patient feel, you know, important and listened to and heard and all this stuff. Now we're getting into how do you craft the employee experience? How do you screen? So you understand the personality of the person you're hiring. Um, you're gonna have people that crumble under the pressure of seeing a full schedule. So you're like, all right, I want this person on the team. I know they can't handle seeing a full schedule. It doesn't make them feel excited to tackle the challenge of a full schedule. So I'm gonna unload the schedule, but then gradually add people onto the schedule throughout the day as the openings allow. Like that's kind of what was happening in the hospital setting that you're describing.

24:59 You walk in, you're like, oh, hey, we're done. We've got extra capacity. Let's add some on. That was maybe more tolerable than just having those people on the schedule ahead of time. Exactly. Yeah. And I know for myself, you know, like when I go out for a long run, I can't think, all right, I'm going to run six miles today because I'll never do it. I'll quit at three. But I'm like, I'm going to go out and I try to intentionally pick routes or pick directions that I'm never crossing my house because I'll stop if I cross my house. So you're playing this psychological game with yourself. And I bet there are situations where, you know, during the initial interview, if you could figure out what this person's personality is like, what they thrive on, are they the kind of person that wants the challenge of give me thirty patients today and I'm going to see them all and they're going to be amazed and nobody is going to cancel.

25:56 You just got to understand those personality traits when you're bringing them on board. Because I think that's huge. I mean, I think it's human nature to be sitting there at like four o'clock and just, if anybody's going to cancel, you want it to be your four-thirty patient, right? I mean, it's not, you know, a three-thirty patient canceling is sort of a waste. It's like, what does that do? You've still got to be here, right? Well, now, this is why many practice owners, I won't mention any names because I don't have their approval to say this, but many practice owners that I know either sold their practice in the past or they still have a practice. And this is why they specifically hire people individuals who either previously were athletes high school athletes college athletes and or worked in hospitality and if they don't have one of those two things they may not hire them or they don't hire them because the person that previously went through high school sports or college sports there's adversity of course if you work in hospitality you're a waiter waitress you you were a bartender whatever it might be if you worked in hospitality or the service industry and or your high school or college athlete, you've gone through a lot of different adversity.

27:02 I'm not saying you haven't gone through adversity elsewhere. Like Jimmy obviously had had a ton of adversity and challenges, you know, in real time on live radio. And that's like, that would be, you know, kind of like a unicorn situation where that could get him hired by some of these practice owners as well the reason i mentioned in this is because the the high school or college athlete or the person that works in hospitality would be okay with that jimmy they would be okay with the three thirty patient cancel but they still have that four thirty patient and they're not hoping that the four thirty patient cancels they're like i'm a gamer you know is there an add-on for third four third three thirty and i'll see the three thirty and the four thirty so like not every day is like that maybe maybe they don't always have the same motivation like that every day but in general that's who you're hiring I'll run the extra five miles, but if we're going to, if we're going to skip something, why not skip the last five miles?

27:50 Why not? You know, if someone said like, we're going to pause in the middle, I'd be like, this is a waste of time. Like, let's keep moving. In fact, I said, the athlete would be like, let's be smarter about this. If we're going to cancel something, I got stuff to do. Cause I got to hit the gym. Go ahead. So that's, that's the person who's going to get on the phone, call the four thirty and move them to four. That's the person who's going to get on the phone, call the eval for tomorrow and say, Hey, I got an opening today. And like, I always go back to, can you train that into somebody or is that just in their nature? And I look at my four boys. I'm like, look, same parents, same household. I understand the idea that things are different even in the same house.

28:32 But one of my boys, he's going to be the one who's like calling ahead, getting people moved up, moving people around, just staying productive. And then my other boy would love to have an hour break where he's going to go hide in the bedroom, sit in the back, sip some coffee and, you know, watch YouTube. So those personalities, man, they can be powerful. Okay. And I would like to hire one and not the other. Dave, go ahead. I was going to say, the topic we were talking about on Thursday, Tony, when you weren't here, did you listen at all? Were you able to hear it at all? I tried to, but I didn't hear this part. So the athletic club started, it's an eight-facility gym in New York City.

29:16 It started out as sort of outdoor free workouts, you know, show up, we're going to do a group of twenty people working out, and it grew into brick and mortar, and it grew into a decently large business. And Dave and I were talking, like, sort of impromptu steal the strategy. If you're hearing this and you own a brick and mortar clinic, I know you do some things that are similar. Why wouldn't a clinic facilitate this? Why wouldn't you at least try it with one of those go-getter employees and say, let's try this for three months. If you can cultivate a following, if you can cultivate a group who shows up in unused clinic hours before work, after work, this is now part of your job and you can take a cut of this because this is above and beyond.

29:59 so i i actually called my buddy who's a psychologist i lucked out because he was on a business trip so he was driving and had like two hours to talk to me about this but we talked all about the psychological factors that were a play a lot of them which i brought up on the episode that that um get brought into play when someone registers for like a marathon through maybe a nonprofit, a charity, and they have to fundraise and they get into the marathon for free, I'm using air quotes, but they also get this community of people who are also doing that thing too. He told me a couple of different things. Social identity theory, people want to belong to a group that they identify with. How do you know someone does CrossFit? Don't worry, they'll tell you about it. You wear the jackets.

30:39 People who do Ironman triathletes, I cannot understand this, I've done several. And kudos to each their own. They get the tattoo. I can't do it. I can't do it. What about the lady, the eight-year-old lady? Do you see that? Have you been following? Yeah, the eight-year-old lady crossing the finish line. That was awesome. Great chair. She fell at the end. I was like, get up. Did she finish? So social identity theory, the moment you know the names and goals of the people around you, your fitness journey becomes part of their shared story and not a solo grind. I've been in triathlon clubs where we weren't even training for the same race. But on Saturday morning or Sunday morning, we'd go for the long ride. And if someone wasn't there, you sort of got heat for it. You know, where were you at? We did this.

31:19 And where were you? It's because people like us, as Seth Godin would say, people like us do things like this group cohesion and commitment. This is the thing we're looking for, which is like, all right, if you're laying in bed, I used to run with some buddies in high school. If we know we're going to, we did like a five K series, a five K every Sunday for six weeks. You can't skip one. Cause they're at, we all signed up together. Like we jumped into this together. A consistency principle, that's from Robert Cialdini, the guy who wrote Presuasion and Influence. Once somebody commits to a group, especially publicly, that's where I think this athletic club did it right. They're psychologically driven to stay consistent with that commitment, even when that magic M thing, motivation, lapses.

32:04 Everybody's like, where do I get motivation? Ironically, it's chicken or the egg. You got to keep showing up, and then you get motivation. Are you guys on LinkedIn at all? Yeah. LinkedIn was smart. They jumped on the whole wordle sort of phenomenon and they created a handful of games and they reward you with nothing more than a number of a streak of how many days in a row you've played that game. And then after you hit, you know, twenty five, fifty, one hundred, you sort of get a little badge. You know who cares about that? Nobody cares about that except for you. I care about that because I'm on one hundred nineteen days of playing the whatever, whatever game it is that I play with the five words. So there's a couple of things that you can build into this.

32:44 But Tony, we're not taught any of these things in PT school. We're taught about units. We're talking about what Dave was talking about. You show up to a hospital, you are handed a schedule. This sounds like entrepreneurship plus psychologically creating a group. I feel like this would be something if you did it in your community, you'd be pissed. Here's the thing. Again, we talked about like Nike strength club and I'll get to another example that fortifies this. You'd be pissed if some, and I'm using their quotes again, non-credentialed non-professional went and just did this exercise, this medicine and you're out there just prescribing it willy nilly in the park.

33:25 Um, Of course, I'm being facetious and I feel like I have to say that, but you'd be pissed if someone else did it. And yet, I don't know if a lot of people are doing this. Why? Dave, were you going to say something? No, I don't know. I don't know why more people aren't doing this because obviously it works. Is it physical therapy? Is that the thing? Like, is this physical therapy? So that's outside of my scope. I'll just worry about what's between the lines. I'm going to play this game. This is the game I signed up to play. Well, so then you wonder, do you go back to the whole idea of public education and, you know, we're raised to be cogs in a wheel. And I do think the physical therapy profession, I mean, it tends to attract those who are academic achievers, those who have done well on testing, those who have done well in academic settings, those, you know, the creatives, the leaders, the ones who break the rules, they're not generally the ones that are attracted to this kind of thing.

34:24 We always have the conversation about chiropractors versus PTs. Like chiropractors go in expecting to open their private practice. PTs go in generally expecting to have a job available. Like this is a safe profession. The streak is really what you're describing. It's protecting the sanctity of the streak. I've done this so many times. Even if I don't feel like I want to do it, I'm going to keep doing it because it's a streak. We've got patients. This is a new phenomenon for us. We've been bringing Tucker. He just came in here because when he comes to the clinic, he has to come back here and say hi. We bring Tucker, my doodle, in and patients now are showing up with treats.

35:05 They're coming just to see Tucker and they'll do physical therapy because they're here. You know, I would guarantee compliance goes up, show up rates go up, cancellations go down just because they want to come in and pet Tucker. I mean, like there are so many ways to approach this. So what would you do? What would you what would you do to create if someone said, I'm opening a clinic, I'm a year old, I've been in business, but I needed a little boost. If someone said it suggested this, would you suggest it as a viable option? Hundred percent. Yeah. Let's let's pick something to build the community around to to establish the streak of showing up.

35:48 We know that it doesn't matter what you do. I don't care if you're doing glute sets or if you're doing manual therapy or if you're doing heavy deadlifts. I don't care. Do something. You can't do it if you're not here. So let's get you here. You know, let's get you in the door. We've got Dale and Don out there who are bringing their joke books. And like that, that's a major consistent streak that has been going on for years and years and years here. um build a streak around whatever you want but find something to build the streak around and build the community around uh this leads me sort of to something i was planning on talking about but i just felt like it fit and i think we've brought up this strategy before was panera bread Panera Bread offers eleven ninety nine a month unlimited coffee.

36:36 And if you work or live anywhere near one and you drink coffee and you love talking about coffee, people love talking about coffee and how much they love coffee. Unlimited coffee for Panera Bread at some point. I mean, I know coffee is relatively when you do it at scale, relatively inexpensive to prepare and sell. But they've talked about how it's been a million or billion dollar idea because it builds consistency. if I go there to get coffee, do you think people walk in to get coffee and then they don't get their lunch or they're not getting the next thing that they're doing? Or now if it's a jump ball, if they're at work and their coworkers are saying, where do you want to go for lunch? It's like, well, you get free iced coffee over here or I could not get free.

37:18 I've already spent that twelve dollars. I feel like I'm I'm it's owed to me. So this is a strategy that I know Tony has talked about before. I just feel like sometimes people might look at things we talk about on the show and that's OK and say, well, that's that works there, but that wouldn't work here. Or that's not what I do, which is a hundred percent fine. Or I don't know if I could do that. This is just showing that their whole goal was to build, was to build a habit. And now you're, you have a Panera habit in a good way. And they've got you on the hook. Similarly to Amazon, I've already paid the Amazon prime fee. So where am I going to, where am I going to shop? I've got that little free, we had that free shipping. So basically, these are the psychological principles that are at play.

38:02 You can use these things for your advantage, especially if you're upfront about it, especially because if you believe in the thing that we sell, which is health, wellness, becoming something different, a transformation, I'd actually say it's your professional duty to use and pull all the levers that you have to pull to get someone to do something. So I thought the bear bread example was interesting. I think Dave does a great job with that. You know, Dave has the capacity to deliver that kind of connection and experience with his clients, with his team's clients. He's talked about things that he's done in the past that exceed the expectation. If you're able to do it, why not?

38:43 Yeah, but you can't do it if you're struggling at a minimum wage reimbursement. Let me mention real quick, because now we've kind of moved into these relational relationship connections. Yesterday, you know, I never buy supplies. I just hardly ever do. If I do, I just go straight to Amazon. I buy whatever is quick and easy because I know it's going to be here tomorrow and I know it's probably priced competitively. I haven't done Iontophoresis, if you guys remember that, in at least ten years. I had a box of Ionto patches. Dave, do you ever use those? It's been, I did in my first job, my first couple years out of school, yes, but it's been a while.

39:28 So you used to use the phoreser, a little machine, and the patient would have to sit there for thirty minutes or whatever. Now they have patches that are self-contained. They're pretty cool. And superficial conditions like, you know, Lateral epicondylitis, whatever. So yesterday I've got a referral for a patient. I want to use Dex. I need to get this guy back to sport like immediately. He needs to cover the symptoms. He's got two more weeks left to play. Then he's got months off. Let's just get you back in. So I'm out of patches. I've got the dexamethasone. I don't have any way to dispense the dexamethasone. I go to Amazon. They don't have any patches in stock.

40:09 I'm like, crap, what am I? Start searching. Walmart doesn't have any, walmart.com. I go to my last resort, which should be my first choice, David Ruin. I'm like, hey, David, I know I've never bought anything from you. You have no reason to help me on this. But listen, you guys, I was on your site. I'm looking for a patch. What can we do? And like, David is not a salesperson. This is his company and, you know, all this stuff. And he still took the time, hooked me up, got me to two boxes of patches, twelve patches total shipped out like yesterday. He's like, we get it out right now.

40:50 Get it to you. I'm like, what do I do about paying? He's like, look, I know where to find you. Just I'll send you an invoice. That was amazing. You know, and that's the kind of thing that whether it's a patient who calls Dave, Dave, I haven't seen you in a couple of years. My back's killing me. I need help like right now. Or it's a guy like David who helping me out of a jam because I've got this athlete that literally every single day counts for him to get back. to the state, the state meet, we leverage those. Obviously they have to be bi-directional. Like I have to extend something good back to David.

41:31 That's probably why I'm mentioning it here. But these are some of the connections that I think are run deep in the profession and we can really leverage in both directions, you know, to help both of us. Love it. All right. Kittle, you shared something about credentialing, social media credentialing. It was in the group chat. Social media credentialing. I'm trying to remember. Let me pull it up. Jimmy will find it. It says, when did medical credentialing become social media following? Oh, yeah. So did you guys watch that? If not, I can just give you a quick rundown. Did you see that video? Give us the rundown. So the rundown was someone who posted a video talking about how the healthcare providers, physical therapists, physicians, nurses, all that are the ones that have like the training, the licensure, the background, they went through the schooling, all that for whatever it is, all the conditions, diagnoses, treatment, all that type of stuff, any, you know, medical terminology.

42:34 But the ones that get the most attention are these like, I don't think the video mentioned specifically, but I'll jokingly say like, you know, like the health coaches or like these people that like all of a sudden, like they, respectfully they gave birth once and now all of a sudden they're like a postpartum pre and postpartum mommy coach to help diastasis recti and leakage and incontinence and all this other stuff and it's like it is a little crazy it is a little crazy uh that the now there there's there's pros and cons one is like it's kind of interesting and cool that like you could if you have great content like tony does if you have great content you generate a following over time because you put in the time and the effort and you recorded videos and you put it out there and all that you generate a following then you can sell courses or coaching or supplements or products or just affiliate codes and amazon affiliate codes or whatever But that's not what we're all taught and trained, and that's not what healthcare providers typically do until they have a practice or a business where they want to get in front of the camera more, because that's just not what we're, that's not our intent, and that's not our, typically, our skill set as a whole.

43:42 Tony and Jimmy and many others have done really, really great with this over time. But this is basically what the video is saying is like, yeah, when did medical credentials become social media following or vice versa? Like the social media influencers that are not healthcare providers, they don't have licensure. They absolutely do say some things that are incorrect, that goes against science, that goes against proven. Go ahead, keep going. All right, Jimmy popped out. You all right? Yeah, yeah, sorry. I don't know what's going on.

44:22 We're living in a world where this happens every single day. I don't think you need to dance around it. Like people buy a microphone for ninety bucks. And next thing you know, they can be influencing positively or negatively, depending on who you are, an insane amount of people. Yeah, yeah. So I don't know, where do we go from there? I mean, what's the solution other than like what we're doing? We're getting physical therapists to get out like Jeremy Sutton and do more video content, put out, you know, reach more people, help impact more people. There's definitely, I feel like there's more now than ever, physical therapists and physicians and other nurses, nurse practitioners, DOs, MDs, all these folks, more than ever now.

45:05 getting on social media. I've followed a ton on Instagram that are like New York City physicians and healthcare providers. And many of them, whether it's neurologists, you know, headache specialists, orthopedics, surgeons, like many of them are getting on social media, putting more videos out there. So that's great. That's amazing. I don't know who's forced them if they're doing it, if their team's forcing them to do it. We all know that it can help with marketing. We all know that it can help with impacting more patients putting out the correct information i think will always win out uh but i feel like healthcare has certainly lagged uh compared to these independent health uh personalities or whatever you know whatever we want to say that just because they had one experience now all of a sudden they can put out their own thoughts and uh their their opinions on medications and contraindications or treatments or whatever and so it's a little bit of the wild wild west but it's also a little bit of like there's more healthcare providers getting out there and getting popular on social media so i don't know i i think this has always been i think it's now very very it's a lot easier to spread.

46:21 Jenny McCarthy has had a mountain that she's loved to die on for years. And for some reason, she kept getting put on TV because she was Jenny McCarthy and she was a little crazy, but people who knew who she was, there was familiarity, right? Familiarity breeds contempt. There was familiarity and she said some crazy stuff to keep people watching. The problem was ideas spread like viruses. So people listened to her, right or wrong, based on nothing other than because she said it. There's a famous quote that I'll hack, which is like repeat a lie often enough, and it starts to taste like the truth.

47:01 Now it is infinitely, I mean, the cost to doing this is, I mean, basically zero. I mean, you know, or, you know, we can reduce the cost of this by three hundred, five hundred, a thousand percent. People are paying you. now to create content that actually works you are reducing the con the cost of creating content to a cost below a more than a thousand percent because now organizations will pay you you are the product that you are now being sold. So it's, it's just infinitely easier. And people, the problem is if you ask someone for their opinion, they're going to give it to you. And now it's really, really easy to make a following and make a living off doing that right or wrong. And they don't have licenses as we've talked about before.

47:42 There's no repercussions, right? What are they going to take your licensure away? You can't, you can't do it. Could you find someone civilly liable for spreading misinformation? Maybe I'm not a lawyer, but I think that's really, really hard to, it would be really, really hard to do. So it continues. Where will this go? I don't know. I think this might lead into a large conversation of like, what does this thing that wasn't around when I, when I graduated college kids, social media turn into in the future. I mean, I've been sharing some of those. Have you guys played around with Sora at all? Yeah. I mean, I've seen Tony been doing it. Looks incredibly easy. I haven't dug into it just yet, but looks incredibly easy to create videos that for half a second, you're like, wait a second.

48:30 Oh, I got it. That's not, you know, one of my former bosses is still a morning show host and he's like diving off the roof of a car at a Bills game. I'm like, he's not there. I get that. But like these are laughable right now. In six months, eighteen months, what is it going to be distinguishable from what we shoot or record? I don't know the answer to that. Where will that go? I don't I can't even see the around that corner. Yeah, but going back, you said it's been around forever, like the whole snake oil salesman idea. Like if you have a horse and a buggy and you can go town to town, as long as you stay ahead of the angry people in the last city you left, you can keep selling your magic sap.

49:18 You know, like there's no difference in that. And I mean, so I'm getting called out in my group, which is totally fine. And I'm being told, I'm being told effectively that like, I am the problem. I don't believe in the science, all this stuff. It goes back to the OT goal that PTs can't make goals for ADLs or can't use ADLs in treatment. Okay, that's fine. Like, and so there, there's apparently Randomized control trials, studies that were done proving the fact, I don't understand, I got to go back and look at them, that OT, PTs can't use ADLs for goals.

50:05 Just because you tell me I can't doesn't mean that I can't. If you want to tell the profession at large, they shouldn't. That's fine. You can do that. But I'm like, if I'm qualified and trained and I can do it, like, I don't care what everybody else is doing. You know, so it is what it is. There's always going to be disagreement. That's what makes it so great is that we can have these disagreements. The person who's telling me this is an awesome therapist. They're like, I would never take anything away from that person. But yes, hanging a shingle and just being like, hey, I'm an expert. I see it in people who are licensed.

50:46 I see it in people who are unlicensed. I see it all over the place. There's plenty of people with MD after their name selling some crazy ass stuff. It was a great conversation. I saw a snapshot of a conversation. You know, Dr. Mike Tortovic? Yeah, yeah, yeah. MD with a social media following. I wanted to send you, talk about that, because I wanted to send you a video that he did that I think you're going to reference. Yeah, he was talking with, and I didn't know the guy he was talking with, but the guy he was talking with sells prebiotics. And Mike was saying, I have thirteen million followers on this channel and I don't sell that.

51:27 I could sell them prebiotics, but I don't. And essentially he was like trying to talk this guy off a ledge. And he was like, why don't you think I could make a lot of money selling I could sell your prebiotics on my YouTube channel that has thirteen million followers. Why do you think that I don't? And the guy was like, it's like a therapy session. He's like, well, I guess you don't believe in them. He goes, the science hasn't proved a consensus of my colleagues that this is a good idea to tell people at mass. And he's like, well, that's what you believe. I love the example of what we so this might be a condition of like also what we're talking about at the beginning of the show. Right. It's been hammered in everyone's head. We all have an opinion and our opinions are all worth something.

52:12 Right. And they're all equal. But that last part isn't true. And here's the example I'll give. My dad was sitting here at pre-stroke and we both had an opinion. And they're both equal. But the house was on fire. And I said, I think we should run to the basement. And my dad, who for twenty five years fought fires in New York City, said, no, we should jump out the window because fire is going to do this. What should we do? Well, we should sit still and wait for a third person to arrive because our opinions are equal. No, some opinions aren't equal. In that situation, we should listen to the fireman, right? So in this conversation, that's what it felt like. It felt like a fireman, Mike, a medical doctor was talking to this other guy.

52:57 I don't know his credentials, but I know it wasn't medical doctor was saying, I know you sell prebiotics. Help me logic this. I like to make money, says Dr. Mike. Why aren't I selling prebiotics at mass? Because they're not a consensus good idea to do that. And the other guy was like, that's your opinion. Our opinions are equal. But they're not. Correct. Agreed. Agreed, agreed, agreed, agreed. Your hundred thousand followers on Instagram means you're very good at... creating followers on Instagram, but we do confuse size of following with validity of words and your cred, right? Your credentials and cred. Two different things sound similar, but one is like credibility or clout.

53:40 Maybe we'll start talking clout. Your clout online does not directly equal credibility. Look at all you nitwits who listen to my podcast when I started as a PT student. You're listening to a podcast hosted by a PT student. I didn't know anything. I was smart enough to say, I'm going to hold the microphone and put smart people in front of the microphone or the camera. We didn't have a camera back then. But I let them hang themselves or lift themselves by their own words. Like I was very clear. This person is giving their opinion. And if there's a different opinion, I will listen to it. So my lack of cred was my clout. I was like, I don't know this, but we're going to get to the bottom of it. I'm going to make someone use their own words.

54:23 So we're wrapping up the show. We're wrapping up the show. The clip that I saw that you weren't talking about, same Dr. Mike guy. He was, I don't remember if he was in front of like a conference talking to a group of other physicians, but basically what he was saying was, look, we have this incredible knowledge base, research, support, all of this stuff, but somebody with none of it has a big social media platform. They produce a video that reaches tens of millions of people completely like off base. Then the AMA comes out and puts this little tweet saying that, you know, that's inaccurate information that reaches a thousand people is like, why don't we have more, more people like me, he's saying him, um, out there, you know, reaching millions.

55:18 Now, I would say, obviously, you got to have, like, the looks. He's got it. He's the right age. He's the right demographic. He's got the right personality. Like, you've got to have the other mixture of things to get to that point where you can build a platform that now he's built. Now, he can lift other people up and he can do other things, right? But I thought it was really interesting that he was trying to show the AMA, just like others have tried to show the APTA. Look, we need to leverage social media. It's not about putting out the same ridiculous dry statistics that this many people follow a year.

55:59 It's about engaging and storytelling and connecting with humans and making the content something they want to hear and they're seeking out. The irony, large organizations get nervous when the idea is push publish a lot. Yeah. They confuse... slowness of speed with safety. Well, let's get fifty people to look at this to make sure this is OK, because because we understand what Spider-Man said with great power comes great responsibility. If we say it and we're wrong, it could echo and we can't wipe that off. I agree with that. I agree with that.

56:41 So then. How has how have great news organizations. been able to publish multiple times a day or week or month, and they still have credibility. That's where I've said, I said this years ago and I just stole it from someone else. I need your organization to become a media company. I need you to understand that. And I don't know that they will. I don't know that enough of them will, enough of the good ones will. I hope that the APTA does, but Oh, this breaks my heart too. I won't say who it is, but I see great companies saying we need to be on media. Let's double down. And they want to do like a funny dance.

57:22 And they're like, let's triple down on the cute. Let's triple down on the cute because Dr. Walkie here is right. Algorithms reward engagement, not accuracy. So that's the safe thing. Let's do the cute thing and we don't have to talk about the real thing. The only thing I'll push back on, Mike is a handsome dude. He is well-spoken. He is smart. I think it's in reverse order of why he's successful. I think he was consistent, smart, picked the right topics, and he's well-spoken and a good-looking dude. So I will not say none of those things don't help. I think the fact that he showed up early, if he did three videos a month, he wouldn't be where he was. He quadrupled down on that.

58:04 I think most organizations are so scared of this. that they don't do anything. All they do is publish Marvel movies over and over again. Let me show you the Apple, the camera zooming, all those things. That doesn't do anything. It doesn't. The person is listening to the thirty-minute diatribe on which prebiotics they should take because they're tired. I don't see it getting better. Gosh, I've gone from being optimist to a pessimist. In just a short time. All right, parting shot, Dave. You're up. Parting shot. I like the theme of chatting about this specifically about the unlicensed, basically uneducated folks on social media that just put out a ton of random thoughts and videos and opinions, typically not really backed by anything other than their own.

58:55 one person experience versus the challenge of the slow, big risk averse organizations and companies and hospitals. And those two, like that is those two things. That is one has no, no hesitation. One side has no hesitation to hit publish. And the other side has like significant hesitations to hit publish. And that's why we're where we're at. Sounds good. All right, guys, come back and see us Thursday, eight thirty, eight thirty a.m. Eastern. Jimmy, Dave, I appreciate you guys. Enjoy your day. Thank you.