Redefining Success in PT: Clinic, Concierge, and Career Freedom

0:01 It makes for some really good audio. Hang on. There we go. Cody, cheers. Cheers to you and cheers to me. There we go. I'm drinking a Pabst Blue Ribbon. This was the beer that me and my friends made fun of when we were kids because it was like the old man beer and I never had it, you know, in my twenties. And I think I had it like in my thirties and I was like, this beer isn't awful. I was like, this is actually pretty good beer. Like, it's funny how like we just, we make an assumption about something and then that's, that's the world. And then all of a sudden that sticks. yeah and that assumption gets challenged twenty years later you're like what else was I like guacamole looked gross to me when I was a kid never ate it and now I'm like oh my god how many years did I not have guacamole because it looked gross and now it's missed out yeah cody what's your superhero backstory for people who don't know superhero backstory so um background physical therapy um my interesting I'd say my my twist is that I entered the clinic a month after or before covet happened so I finished pt school in twenty nineteen moved to nashville took my first clinic job I was going through clinical mentorship um just kind of get my get my feet wet and uh covet happened so that kind of spun everything out of control a little bit um as we all remember um but what kind of happened there is like I got put in a little bit of like a like say leadership position, but I became the tenured PT in my clinic.

1:26 Right. So you've been here for nine weeks. You're in charge. I'll be good. Maybe three weeks. Right. And so my clinic director, he went to another, uh, he's overseen two clinics. And so I ended up with a lot of time on my hands and, um, I like filling my time. And so, you know, being, I guess, maybe a problem solver at heart, I really just kind of looked at the PT space. I was like, my clinic days are not very full, began exploring just, you know, what was out there and trying to stay interested in things and had met some people here in Nashville that they'd had some success on the tech side. And it kind of simulated some interest in me, started inventing medical device really early on.

2:08 Um, learned a lot through that, met some really great people, um, spent about two years full-time in the clinic and just determined that full-time clinic care is not really what I wanted to invest like my whole life trajectory into. Love clinic, love treating, love the patient care sides of things, but just didn't quite see, it didn't resonate with where I wanted to go, right? So moved to more like PRN type positions, worked in a hospital system, covered everything from you know, your cardiac step downs to joint outpatient. Like it was a really cool experience just covering everything, working at a high pace, fast paced sports orthopedic practice, doing a lot of post-op and then launched a concierge business of my own.

2:54 And then ultimately, maybe about two and a half years into that, connected with the company that I'm with now. They were looking for a project-based PT to use their technology, ran a six-week day program for them, got to the end of six weeks, patient's like, that was awesome. We'd love to keep doing it. So I turned and looked at the team. I was like, hey, are we going to keep doing this? So did another six weeks, then a third six weeks, and a fourth and fifth. A year later, had a fully operational day program going for them. We're seeing patients one day a week. They opened up a spot on their biz development team and joined that. So that was about a year ago doing that. And yeah, here I am.

3:36 So let's go deeper into the tech, right? Like, help us understand what it is. What does it do? How does it work? Like, you know, you're a biz dev guy now. Yeah, I'll embrace that. So the device is called the Ryzen Walk. It's the first full spectrum, we call it rehab station, but it's a gate training technology. So it's a three in one, meaning it can be used seated, standing. And then the body weight support system, it's a tower that rotates. So you essentially have two body weight support zones on either side. So it's a very unique piece of equipment that is really addressing some big needs when it comes to like inpatient rehab space, working with patients that have considerable mobility deficits that require maybe a team of people to get the the high intensity high repetition gate training that research is really coming out to say that it's it's needed it's that's what's driving the neuroplastic changes that are uh required for somebody after a stroke just to get back on their feet and be able to you know engage in the community What's, um, what's something that shocked you like taking on this, on this role?

4:41 Like you got to bring a clinical mindset to a group of people who probably have really good technology background and sales and sales isn't a bad word. People just want to make sure people understand that it's not a bad thing. Um, what was the biggest thing that surprised you? Like walking in with your clinical mind? Cause you're going to look at the exact same thing everybody else is. You're just going to look at it differently. Right. You know, what I've found is that, uh, specifically I'd say with this, like, tech uh you know wave that we're riding kind of all across healthcare is that we don't have an innovation problem um we really have an adoption problem and so it's it's what's interesting has been the real challenge for me is is marrying the the clinical need with the business value um and it's a fun challenge because you know the two really operate almost in silos um you know you can go to a rehab team and you can get clinical buy-in And you can say, hey, I have a whole clinic full of patients that would benefit from this technology.

5:44 We're doing it the old fashioned way. You can kind of show maybe where things can be optimized you know and then it's it's bridging that to you know the business operations and I think that's where you're seeing some of these large hospital systems that you know when we look at our healthcare system maybe just specifically on the rehab side comparing it to some of the other countries that are maybe a little bit more advanced than we are I'm not in those countries. I don't know how those systems necessarily work, but what I see on our end a lot is that there tends to be some dragging of feet. People are not really willing to invest maybe what they can into supporting the rehab process.

6:28 When you look at a healthcare system, everything is diagnostic driven. How can we get a patient that has a problem? How can we identify it and get them into a treatment path? But then know when we're looking at the whole patient how do we then actually tangibly get them better and get them back on their feet and I think that's where I mean that's the value of rehab and pt that you know unfortunately it's just hard to get you know some people to invest that way yeah what do you think other clinicians that you talk to or maybe still in clinic right and again I love how you said that which is like Not that I didn't love it. It's I wanted to try something else, which is kind of kind of what we're on this rock for is try a bunch of stuff. If you find something you love, do it.

7:08 But you sort of you sort of adopted neuro rat neuro rehab and technology. What's the biggest misunderstanding other clinicians, people that you knew before or people that you meet after? What's the biggest misunderstanding they have about technology in rehab? Yeah, I think there's two big things there. One, I think just the technology in general, you know, PT is a very interaction driven space where we get to work with those patients. And I think in some way people look at technology, specifically some things here as something that if they introduce, it's going to kind of remove them from that. So I think there in some ways people think that, you know, this technology is going to take their job or something like that, which Again, that's a, you know, we can unpack that further, you know, if you want.

7:54 We can do a whole hour on that. whole hour on that right um you know but I think the other side of it is that you know we're very much like a research based uh healthcare you know we want to see things that are proven we want to see data that backs up why something works the way it does and I think sometimes that's too thick of a filter to take something that you can look at just based on principle and see what it does um You know, one thing I talk about when I get people that kind of lean in on the research side of things. So backing up, end-effector technology, which is kind of the category that our device falls into, it's been around for like, twenty years, right? So we didn't come out and invent something game-changingly new.

8:38 What type of technology? What was the word? It's called end effector. I don't know that. Oh, effects the end user. Exactly. Or the ends, your extremities. If you look at an exoskeleton, that's very much bolt-on where you are articulating across a joint and you're influencing movement there. And so you can see, yeah, I love that you were able to pull that up. I don't know if that's, I'm assuming that's showing up for everybody. But yeah, you can see articulating with the hands and feet, right? So it's a very open based system where, let me see, let me do this back up again or zoom out again. If you go hover over rise and walk, I'm going to see if we can pull up the video.

9:19 Oh, wait, right there. Watch the video. It's right there. It's cool to see it in motion, right? So let me get back to it. kind of where I was and affect it, right? It's meaning articulates with the ends of our hands and feet. So very unique piece of technology that ultimately does heavy lifting that's the way I look at it and so you know when I'm talking to clients they're like okay what's the research say what does it show which we have research that shows it but it's also a category of equipment that's been around for a bit so we haven't had to do all this like leading edge proof of concept type of research out there that some people really want to see right and so there's that resistance they go oh well you know you don't you don't have that so you know I'm not going to look at this and I go okay well if you know in your clinic you have weight right so did you go through and study the efficacy of a twenty five pound weight to then put it in your space no most people say no right but I can take a twenty five pound weight and I can do ten thousand different exercises with it and you know and have some you know, good outcomes there.

10:29 And so technology like ours, we're really driving the high, high rep, high intensity type of activity. Um, we've got this particular design in ours that allows us to actually accurately dose it, which if you go into the weeds of the research behind this technology, you know, a lot of what they said about research, which is, or about, um, gate training technology is that you can't dose it accurately enough to challenge somebody. There's not that active participation in a granular level where you can, um, you know, really challenge someone at the level that they're at. And so we really set out to solve a lot of those problems, you know, some application problems, some personnel problems, and some support problems that, you know, ultimately allowed our device to actually mesh with the U.S.

11:14 healthcare system. Yeah, you're talking about a system, right? That's like the screwy part. It's like you're talking about clinician, patient, technology. That's a really great triangle. And then you bring in the system. And I bet you a lot of things, and we don't... I mean, again, we could do another hour just on this, which is you've said healthcare... is hurting rehab departments that we are bleeding out. And then how can we fix it? Cause that's, that's where we plug into this system. So like, what is it? Who's going to pay for it? Is it, how are we going to get reimbursed for it? Like, I imagine like those are the first two questions, right? How, how, how are we going to get reimbursed for it? And then how much is it, which is how long, how often do I have to use it so I can at least pay for itself and then be getting, making money, which sounds like a dirty question, but it's just like, we got to be able to make enough money to pay for it.

12:05 And then also we have to pay for people's salaries and health insurance and lights and, and the parking lot and all those things that people forget about. Yeah. The ugly truth is that healthcare is a business, right? And so you can preach outcomes and, you know, to preach to people in the face, but in the day it's a business and you have to cater to the business side of it. And so I think when you look at technology in this space, it wasn't, a lot of it wasn't designed in the U S you know, you got big players in Israel and, you know, Italy and, you know a lot of these kind of europe and asian countries um that they're designing this technology to you know meet a patient profile or meet something that they're seeing within their industry but then it's being you know pushed over into the us you know for the market that we have here and it's just not designed to meet the needs that we have and so that was one of the considerations that we had is we were like we knew to succeed that we would have to make something that really worked with with our patient population but know to your point how do you get paid like reimbursement is is what it drives so you know unfortunately and I think this is something that you know we'll hopefully see in the next couple years is some type of cpt kind of reform or evolution there that you know we've we've learned how to abuse that system and you know unfortunately on the rehab side of things cpt codes and what we're currently being reimbursed for our services you know they leave a lot of these rehab departments unfortunately in the red and when you look at a large healthcare system it's hard for them to

13:36 justify investing in a I mean a great piece of technology that will undoubtedly help their patients and help their clinicians you know but it's like hey we're not making money in this department so why are we going to invest in something like that and so it's an unfortunate reality again it's a business and you got to play the game and so I think at some point something will will change because if you look at somebody that has a spinal cord injury or a stroke it's not the same episode of care like somebody has a knee replacement right knee replacement you might get two to three months of pt and then they're off managing their their care on their own but you know somebody has a some kind of incomplete spinal cord injury, or, I mean, any type of neurological injury, like it's going to affect them for probably the majority of the rest of their life, if not the whole thing.

14:23 And, you know, our one thing that I really love about our technology is that it, it provides an environment for somebody to get the same general activity that I can go. And I got a garage, I got a gym in my garage, very blessed there. So it's really convenient for me to go exercise and train, but somebody that has a mobility deficit. you know, they can't just go walk around the neighborhood to go for a run or lift weights. And so it's really hard to give somebody the opportunity to exercise and expect, you know, get the cardiovascular benefits that we can get by walking. And I think, you know, that's something that, again, it's unique that we're able to do that.

15:04 And I'm proud of our technology and what we're able to do. So, yeah. You've also taken your skills abroad. Is that true? What's something you did to medical mission work? What's what's something from your from your work that stays with you every day here now that you're back in the US? Yeah, so when I was in PT school, I had an instructor. And shout out Todd Bourgeois. I'll send him this. He's the man. He's a mentor of mine. But he and I, I was in St. Augustine. We surfed all the time. And, you know, it came summertime. He's like, hey, man, we got a team of PTs and, you know, kind of hodgepodge rehab professionals, medical professionals.

15:46 We go to El Salvador every year. um go there for you know a week week and a half whatever it may be um you know we get to surf we get to treat we get to work with their you know their underserved populations along the coast there and you know it's it's kind of just like a good vibes trip we bring people we we do as much good work as we can and then we enjoy it and you know we come back and so I was blessed to get invited as a student um went two times there um I think I've been back now six times so we've been doing these trips they've been doing them for I want to say like ten or twelve years but you know it's been great to um go to central america see what's happening there from like a development standpoint um get to serve populations of people that just in some ways maybe feel forgotten.

16:36 They have socialized medicine, so care is accessed much differently. So yeah, those have been some awesome experiences for me, especially starting as a student, getting into clinic care, and then continuing to go down there and see these communities that we've been serving for years now. did one in my third year a service learning trip I did one my third year pt school and I love cliches right I like to make fun of cliches and the cliche with like a trip like that is you get out much more than you put in and it's true like I learned I I thought I definitely thought I couldn't wait because there's a team of third year pt students that were going to go down there and show how smart we were and I learned the whole time It's amazing.

17:25 Like you, I was just, I mean, once that was the thing, once I was able to sort of like drop it and stop trying to show, and I was just able to like absorb and take in, that's when I was like, Oh, I don't, there's a whole lot more I could learn. Yeah. We, we've coined these terms, these trips as a stoke trips. Right. And so the idea that like, we all have this kind of inner fire, if you will, that is kind of like passion driven. Right. And so just like, you know if you build a fire you have to tend it you have to stoke it and so these trips for us it's kind of a a play on words if you will because we get to surf right so there's a lot of like sure you know stoke on that side of it right but you know for the deeper sense of like we get to go there and we get to treat people who don't expect a group of americans to show up and give freely and just help them right they're in these communities that know I mean they don't have medical care they have to hop on a bus it takes them three hours just to get into the city just to sit in line to potentially seen by a doctor that day they have to you know labor and walk to get water just to bring it back to you know the little place that they might live in and so to show up and and just sit there and just to do whatever we can for them, whether it's medical, whether, you know, it's just saying, you know, I'm gonna pray for you or something like that.

18:45 You know, it's like just the way that it's received and the joy that these people live with is, I mean, it sticks with you. Like you said, you bring it back with you. I get as much out of it, if not more than what I leave behind. Yeah, it's a big deal. So more emotions, more stoke. A lot of PTs might say, you know, it's either clinical or non-clinical, right? There's burnout or you're bailing out. You're doing a little bit of both. I, I've given a talk, um, at nazareth college uh thanks to professor mike houston up there he brings me in and a couple other clinicians who have either traditional or non-traditional practices he brings in what like russ russ is a pt he's got a brick and mortar clinic and he brings in this other woman who's like I treat out of my house I got a little room in my house he brings me in because I'm a weirdo like I do communications whatever I do I'm all over the place.

19:42 And I like to put it in their words. I love to use patient's words or audience words. I say it's hips and shoulders. A hip and a shoulder, they're both ball and socket joints, right? Hip is going to be super deep, right? A lot of stability. Some mobility, right? But a lot of stability. That to me is like a nine to five job. Right? So there's nothing wrong with that. If you're like, I'm going to have a nine to five job, and I'm going to have this thing on the side, now you've got a shoulder, which is every other weekend I do aquatics on my own or something. A lot of flexibility, a lot of mobility, some stability, right? And you can have all shoulder.

20:23 Some people are just like, I do whatever I want, however I want. And one of the students was like, which one's better? And I said... which one is better for you? Like you're looking for the answer and you knew that they're smart kids, right? I call them kids. Cause they feel so much younger than me, but I'm like, you know, the answer is it depends. It's going to, and also it doesn't have to be, this is what I do forever. I could do this. You were doing your stuff for six weeks at a time. Had you said, I don't like this anymore. You would have been like, all right, well, thanks so much for the last six weeks. Like, you know, and we're going to part ways. So I feel like what have you learned that could help others by being able to say, hey, I don't want to be in a clinic eight hours a day, five days a week.

21:04 And that's not necessarily quitting. It's not quitting. You just took your skills to a non-familiar place, to quote a friend. Yeah. Yeah. No, I think, I mean, if you just look at our education system, you know, we're kind of forced to make a decision super early on when we're still figuring things out. And so, you know, for me, like I went through undergrad, jumped right into PT school and then jumped right into my professional career. You know, the unique thing, what I identified pretty early on is that from a physical therapist standpoint, we get such a diverse background. We know so much about the human body. We get such a unique experience in our healthcare system from working in hospitals to outpatient clinics to private practice.

21:46 I mean, specialties, you name it. There's so many different things you can do. And I think people almost get maybe it's like analysis paralysis where they go, I don't know what else I can do. So I'm just going to stay in clinic care. You know, for me, what's been great is talking and networking and connecting with people in order to just see what's out there. Right. And so. I've had a very unique experience in my five and a half years, five years that I've been out of the clinic, you know, and I've done, I've touched so many different things and been in so many different settings, you know, and I, for me, I, it's hard not to get bothered when you hear people that are so divisive between clinical and non-clinical.

22:31 It's like, I do both, you know, I'm in a business development role. I work for a startup company, but I also have a concierge practice. You know, like I treat on the side, keeps my skills sharp. It allows me to be a resource in the communities around me to my friends, my family. And that's something that I think is very unique to the PTs. It's like we can walk in a room and we can have nothing but, I mean, our hands and, you know, a human in front of us and we can help them. We can talk them through things. We can explain things. And, you know, I think when we're trying to figure out, you know, what we want to do, how we want to, you know, engage with our healthcare system. It's like, we're, we're kind of dealt a tough hand of cards, but you know, we still have a very tangible way to help people.

23:17 And I'm never going to abandon that. I don't, I just encourage PTs that, you know, or maybe burned out by something that's in their day to day. It's like, don't, don't feel like you're stuck there. You know, we were put in a box where we're stuck in a little bit of a rigid structure with the healthcare system, but that doesn't mean you have to play by those rules. I joke around with the guys that I do live streams with. I'm like, you could go to a Facebook group and bitch about it. That's probably helpful. And listen, I've bitched about stuff too, but then you got to do something about it. And if you think you're going to change the system, great, get to work. Like, I don't know how to change the system. I've tried. Maybe I've had a little, little, little help in changing a big thing.

23:57 Great. The biggest thing you can change right away is like how, like your situation, you are a hundred percent in control of that. Right. So, you know, if you don't like it, you know, you could, you could scream at clouds or like you could just start and listen, and you are somewhere right now. where you are now living what you probably, however long ago, when you started thinking about this would have been like, that's the dream or that's, and I want to make sure I frame this right, which is you don't just hit the dream and then everything's coast mode, right? You're still working. Like, that's the thing is like, you're still your constant, but wherever you were two years ago, you'd be thrilled to know where you are now.

24:37 And if that's not the case, It's one day or day one. What are we going to do? I want to caution people too. You don't need to know what it looks like. What you should say is what do I want it to feel like? I like that. What do I want my perfect day to be? I'm like, I don't know, man, but I want to feel... heard and and helpful and uh you know I want to be doing a lot of different things or whatever start with the emotion because how it'll look is different than like how it'll feel and trust me the feeling is the thing that makes people want to run or that's that's that's what I think a lot of clinicians will say about burnout is they feel stuck that's what they'll say I feel stuck and I'll say I get it you know I remember when I was a student I I ran into a girl who was on who had graduated a year or two before me and she's like I work at this outpatient ortho clinic two days a week and I work at inpatient neuro three days a week and I was like you can't do that and she goes you can I remember just thinking like She's like, I just, I just told this clinic, I'm only going to work two days a week.

25:41 And they were like, so you can have two days or none. Me, you can have me here two days or none. And they were like, okay. And then the inpatient neuro clinic was like, we need you. So she's like, great. I'm only working three. And they're like, okay, now it's easier said than done, but keep looking like ask and you get told no, like, okay, keep, keep going. Like you have to pitch a lot to get the thing to work sometimes. Yeah, no, you touched on a lot of good things there. And one of my favorite sayings, it's like two best times to plant a tree, right? Right now and twenty years ago, right? You know, and so I think a lot of people have this paralysis when it comes to starting something that ultimately leads to inaction.

26:22 And I was fortunate to receive some good mentorship if you will um you know kind of early on that was pretty much like you just have to start that that means something different to everybody but you know the smaller you you make that first step the more realistic it's going to be that uh that you'll actually do it and you know I I went up full time and I was like okay well Like I said, this isn't really where I want to be. This isn't what the emotion wants. This isn't what the day to day wants. You know, so I was like, okay, well, how do I get to that five year point? How do I close the gap? Right. And for me, it was kind of like, okay, let's supplement things with some pure end type things.

27:04 And, you know, I was exactly that. I was in a hospital, you know, one to four days during the week. I was in an outpatient clinic, um, two to three times a week I take a whole week off you know and then I I just being the um side business side hustle person that you know I tend to kind of come up with I had a staging installation business I worked with interior designers just like doing manual labor like I love just you know staying active and busy and you know if you if you aren't happy where you're at. You just got to do something. You know what I mean? And it's just like, you'll get there. But I think people are too afraid to take that step. And I think it's very much too often that you just make that step too big.

27:46 You try to take a jump and it's just like, let's just like, let's walk before you run. Love that. the other quote I like with that the the quote that you mentioned which is the two best times to plant a tree twenty years ago and today I like to pair it with the other one too which is society grows great when old men plant trees whose shade they know they'll never sit in which is like you're gonna do something that you know you will never benefit from some of that work that you're doing you're not going to see the return But a lot of the things that you enjoy now were done by people who did it, who never saw the return. And that's just, that's a fancy way of saying like, sort of like pay it forward. But that's where your stoke trip to is like, maybe you never get paid for that trip, but you got paid for that trip.

28:32 You know what I mean? Like you got it in. Oh yeah. Yeah, absolutely. Cody, last thing we do on the show is called the parting shot. What's something you want to leave with the audience? What's your mic drop moment? You can use a quote. You can reuse stuff that's allowed, whatever you'd want to. What's the last thing you want to leave on people's minds? Yeah, you know, I think that's tough. I even knew this was coming, and I didn't, you know, like I thought I was going to have something good. I thought I was, you know. My thing is, it's like I got into PT because I wanted to help people. And, uh, for me right now, that looks a lot different than when I was full-time clinic care. And I think, um, not being afraid to be afraid of change, right?

29:19 I think that's, you know, things are fluid and things are changing and our healthcare system is all over the place. And, you know, it kind of changes one day at a time, change it one room at a time, one conversation at a time. And so, you know, being willing to ask, um, talk to people, um, That's one thing that I always appreciate. I get people to reach out to me on LinkedIn like, hey, how'd you get there? I love having those conversations because it just gets people to think differently. And we're institutionalized in a way where we're kind of developed to think in certain ways. And it's the people that kind of step outside of that and look around that ultimately get where they want to be. They're the happy ones because they didn't let somebody else dictate what they spent their time doing.

30:00 So, yeah, I think, you know, I don't know if that's quite the mic drop moment I was hoping for, but you know, if I can, if I can encourage one person to have a conversation and to reach out and just think differently about their current position, then, you know, I've won the day. Yeah. Yeah. It makes me think of another great quote. We're dropping quote bombs here. I love it. If the, it's a great quote for PT as well, or rehab or anything, which is if the plan doesn't work, change the plan, not the goal, like change the plan. So like your goal was to help people. And that in the beginning looked like walking into a clinic and helping people there. And then that didn't fulfill you, or maybe you just wanted to change. You change the plan, but not the goal.

30:42 The goal is still very much in your sights. Cody, appreciate the time, man. Thanks for doing this and sharing. And maybe one person out there is going, okay, all right, I saw one other person doing this. I was on the end of a diving board. I might do that too. So appreciate your time, man. Yeah, thank you.