Solving the Physical Therapy Staffing Crisis

WEBVTT

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Hey everybody,

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welcome to today's live stream,

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PT Breakfast Club.

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I'm Jimmy McKay,

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and I'm thrilled to have

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you here with us as we dive

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into some of the most

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pressing issues in our profession.

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We'll be joining me today,

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my esteemed co-host,

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Tony Meritato and Dave Kittle.

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We'll bring them in in just a second,

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but I wanted to set you up

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for what we're talking about today.

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Today,

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we're looking at two critical topics,

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the ongoing staffing

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shortages in physical therapy,

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and on the other side,

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the long wait times for

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patients trying to access our services.

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These challenges not only

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affect us as practitioners,

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but also impact the quality

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of the care our patients receive.

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Let's get into the root

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causes of these problems.

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And then of course,

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we're gonna give some

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solutions and suggestions

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and see if we can innovate some ideas.

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And of course, since this is a live stream,

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you can chime in as well.

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on any of the platforms you're watching.

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Without further ado,

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and you know how much I

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love me some Badoo, let's start.

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I figured I'd try the cold open.

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You know what I mean?

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I'd come in, get them all hot.

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I'm like your warm-up act.

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And then I'm like setting the stage.

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And then as promised, here they are.

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Tony Maritato in the middle.

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And Dave Kittle.

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Good morning, gentlemen.

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How are you guys?

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Good morning.

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Amazing.

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I'm so happy to be back.

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We were just talking about

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the summer festivities.

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I feel like my summer's

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already just about winding down.

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What about you, Dave?

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Don't say that.

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All is well here.

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Family visiting, leaving today.

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We still have a lot more this summer,

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as well as the men's

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weekend baseball league that I'm in.

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So other than that, I mean, same old,

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same old.

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Hey, you know what?

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Talking about baseball real quick.

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Did you watch any of the

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drafts last night?

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I would love to talk about it briefly.

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I don't know if you want to do it now.

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Go ahead.

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Let's start with that.

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Okay.

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Okay.

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I love baseball.

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The MLB is failing.

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The top six picks of the

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draft were physically not at the draft.

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They were in their living rooms.

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The top six,

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they knew they were gonna get picked.

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They knew they were gonna

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get picked in the top 10 or

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15 or somewhere.

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For the NFL or any other major sport, NBA,

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whatever,

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it's in Times Square in New York City.

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It's an event.

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You bring your whole family.

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All these guys know they're

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going to get drafted somewhere.

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And the fact that the first

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six picks were physically –

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or six or seven – were

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physically not at the place

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in San Antonio, Texas or whatever.

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Also,

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I don't know because it was in like a –

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like one of those like rodeo, like stocks,

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whatever they call it.

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Like, yeah, maybe that's it.

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Cause maybe it,

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maybe they perceive like it

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was going to smell or it

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was not a great venue or I don't know.

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But Major League Baseball is

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absolutely failing at

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creating the aura around the draft,

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which probably will result

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in less views and all that.

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I think we can learn something from it.

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Maybe it's a talking point.

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I'm just, as a baseball fan,

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I think the MLB is just

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failing at so many things.

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We can get into it.

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Yeah, I mean, as a lifelong baseball fan,

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I've watched my – I think

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it's my former favorite

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sport sort of have their throne,

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their position atop of

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America's sport just slowly erode.

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For a while there,

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and I don't know the intricacies of it,

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I think I never noticed,

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but there was a deal where

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MLB wouldn't let anybody

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share clips of plays online.

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Like early social media, they were like,

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no,

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because then who would watch the game?

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And I was like,

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a lot of people would watch

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the game if they're

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watching guys make great plays.

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They'd say, look what I'm missing.

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It's the hors d'oeuvres and

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come by the steak.

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That's amazing to me.

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We've seen other sports, notably hockey,

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which was always like

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fourth in terms of

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attention in the four major sports.

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They might still be there,

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but they're gaining.

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They did their,

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you know where they did their draft?

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No.

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No.

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everything should be at the

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draft should be at the sphere in Vegas.

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And that thing was a show.

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Like they blew that thing up.

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So unless there was a compelling reason,

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like my only question would be,

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are those six top players on the road?

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Like,

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are they like with their teams right now?

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Are they playing?

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No,

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they were literally at home in their

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living rooms with their families.

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And no,

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they're not playing any other team.

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Cause they're about to get drafted.

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They're done college ball.

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Maybe they're playing summer ball,

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but like,

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they're probably not playing summer ball.

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Cause they don't want to get

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hurt before the draft.

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So they're probably just training.

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Not cool.

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I mean, in my opinion, hype this up, man,

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like 15 year old kids want

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to see 19 year old kids.

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You know what I mean?

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Like getting drafted or 22 year old kids.

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Like, and if you're a fan,

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you want to see where's the franchise,

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where's the franchise going.

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And you don't want to see it

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in mom's living room football.

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I get, cause there's like a, you know,

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you know, like I'm on the third day,

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right?

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If you didn't,

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if you knew you weren't

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going to go on the first two rounds,

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you might be sitting on the couch.

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I don't

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I will say though,

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I'm not a huge sports nut.

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My wife is more of a sports

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nut than I am by a mile.

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MLB is the only professional

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sports that we still go to

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that I feel like is still within reach.

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It's like affordable.

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We pack up the family.

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We go two, three games a year.

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We have an amazing time.

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I love going to the Reds games.

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I love going to the Dayton Dragons games.

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I haven't been to a Savannah Bananas game,

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but that's the next one on the list.

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So I will say that what it's

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got going for it is they

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play a ton of games.

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It's an affordable event.

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We can get there like we can

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interact with the players.

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I also wanted to say plug

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for Middletown where my

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physical therapy practice is.

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So the 27th, yeah,

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27th pick was Dante Nori.

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Just a little background.

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So Fred Nori, local celebrity,

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his grandson, Dante Nori,

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got picked last night.

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27th went.

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I don't remember where he went.

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But then Nori also helped with Schwarber,

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Kyle Schwarber.

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He's a local kid.

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So like we've got all these

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deep baseball roots, you know,

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and one of the things that

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I think is always interesting,

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like my kids love baseball,

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my twins in particular.

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So like they have access to Fred Nori,

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who has access to Dante or

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Dante Nori and Schwarber

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and all of these guys.

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It's just it kind of goes

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back to and I feel like

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this will come up at some point.

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The connections, you know,

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the connections you have,

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either the connections you

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have through family,

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the connections you have through location,

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those connections are so powerful.

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And we're talking about Middletown.

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It's a steel town.

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It's not, you know, New York City.

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It's not Manhattan.

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But I think the connections

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you make growing up are just so powerful.

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We don't even realize it as

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we become adults and kind

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of move move into the professions.

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Yeah.

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Banana ball should be a

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future episode for us just

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watching what they did.

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I mean, it's brilliant.

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It's really brilliant.

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Dude, we covered it.

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We'll do it again.

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We covered it when you were

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just going in there.

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Yeah.

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Also, real quick, so the MLB,

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I want to give them one area of credit.

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They now, in the past year or two,

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they are the only pro sport

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that interviews and speaks

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to their players through an

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earpiece during a play with

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a player on the field.

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So they'll pick Aaron Judge.

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They'll, you know,

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just one inning while

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they're on the field.

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Mookie Betts, Bryce Harper.

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So they have tried to

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highlight some of their top players.

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And the player is like, all right,

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hold on.

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Like, you know,

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I got to feel this ground ball.

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So the balls hit to them and he throws,

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you know,

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throws it over to first for the out.

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And he's speaking to the

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announcers who are doing

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like the ESPN or whatever, you know,

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game commenting.

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So that's really cool

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because you're speaking to

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someone and they're like

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answering questions.

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Sometimes it's a fan question.

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Sometimes it's a joke

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question from like one of

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their teammates.

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And so they, you know,

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they get a little bit of a laugh.

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It's a little bit of like

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locker room banter.

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And so they're talking about the season,

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they're answering questions, whatever,

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but it's during live play.

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That's one thing that the

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other three major sports do not do.

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So it's like, you know,

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who's steering the ship here?

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That's great.

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I love, I want to give them,

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I wanted to mention it now,

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but the other thing is they're failing.

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As a lifelong baseball fan,

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it's the only sport you

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could do that and not get

00:08:47.667 --> 00:08:48.267
someone murdered.

00:08:48.922 --> 00:08:49.201
Yeah.

00:08:49.422 --> 00:08:50.982
Do that as a left wing and

00:08:51.003 --> 00:08:51.722
you'll get killed.

00:08:52.163 --> 00:08:53.823
Do that as a linebacker and

00:08:53.844 --> 00:08:55.745
you'll get run over.

00:08:56.125 --> 00:08:56.965
Do it as a point guard and

00:08:56.985 --> 00:08:57.946
you'll get run to a screen.

00:08:58.326 --> 00:08:59.905
So baseball is more of a chess game,

00:09:00.046 --> 00:09:00.606
right?

00:09:00.626 --> 00:09:02.366
A lot of waiting around and

00:09:02.407 --> 00:09:03.947
then a flurry of action.

00:09:04.288 --> 00:09:05.107
I do want to note this.

00:09:05.148 --> 00:09:06.308
This wasn't in the script.

00:09:07.253 --> 00:09:08.552
We go live to a bunch of our

00:09:08.592 --> 00:09:10.053
social media channels twice

00:09:10.073 --> 00:09:10.673
a week with this,

00:09:10.994 --> 00:09:11.894
and I just noticed we're

00:09:11.933 --> 00:09:12.854
not live on Twitter.

00:09:12.994 --> 00:09:15.615
I got an alert here on the dashboard,

00:09:16.054 --> 00:09:16.534
and it says,

00:09:16.995 --> 00:09:18.014
I now need to pay for a

00:09:18.154 --> 00:09:20.855
premium account in order to stream.

00:09:20.956 --> 00:09:22.015
This is brand new.

00:09:22.056 --> 00:09:23.255
We just did this a couple days ago.

00:09:23.275 --> 00:09:24.057
This was not an issue.

00:09:24.797 --> 00:09:27.277
Now, this I want to highlight.

00:09:27.756 --> 00:09:30.817
You rent space on these platforms, right?

00:09:31.681 --> 00:09:33.201
understand why your website

00:09:33.241 --> 00:09:34.342
and your email list are

00:09:34.442 --> 00:09:35.383
terribly important.

00:09:35.643 --> 00:09:37.443
Because at the drop of a hat,

00:09:37.524 --> 00:09:38.264
Twitter can say,

00:09:38.284 --> 00:09:39.504
remember that thing you

00:09:39.565 --> 00:09:41.485
used to do to get a bunch of attention?

00:09:41.966 --> 00:09:42.787
Well, that's okay.

00:09:42.826 --> 00:09:43.827
We understand how valuable

00:09:43.847 --> 00:09:44.548
that attention is.

00:09:44.908 --> 00:09:45.889
You now have to pay us a

00:09:45.948 --> 00:09:47.048
nickel every time you want

00:09:47.068 --> 00:09:47.870
to drive on that highway.

00:09:47.889 --> 00:09:48.350
It's a toll.

00:09:48.629 --> 00:09:49.431
So understand that that's

00:09:49.530 --> 00:09:51.652
brand spanking new on this platform.

00:09:52.970 --> 00:09:53.390
at a solo.

00:09:53.410 --> 00:09:53.831
Good morning.

00:09:54.511 --> 00:09:54.731
All right.

00:09:54.793 --> 00:09:56.214
Which, which, uh, Oh,

00:09:56.294 --> 00:09:57.115
she said she's located

00:09:57.155 --> 00:09:58.017
close to you in center.

00:09:58.037 --> 00:09:59.057
She's in Centerville, Ohio.

00:09:59.318 --> 00:10:00.000
Well, good morning.

00:10:00.019 --> 00:10:01.341
I've got family in Centerville.

00:10:01.461 --> 00:10:01.981
That's awesome.

00:10:02.668 --> 00:10:04.708
All right, so we're focusing on, I think,

00:10:05.330 --> 00:10:06.650
two ends of sort of a bell

00:10:06.691 --> 00:10:07.510
curve this morning,

00:10:08.171 --> 00:10:10.913
which is waiting for

00:10:10.952 --> 00:10:12.974
patient care is definitely

00:10:13.394 --> 00:10:17.356
the end of where our services are, right?

00:10:17.376 --> 00:10:18.118
So we're saying that we're

00:10:18.138 --> 00:10:20.719
seeing a long wait time for

00:10:20.759 --> 00:10:22.679
patients to receive care, a wait list,

00:10:22.780 --> 00:10:23.640
four to six weeks,

00:10:23.701 --> 00:10:24.442
I saw in some of the

00:10:24.481 --> 00:10:25.822
discussions that you had

00:10:25.861 --> 00:10:27.182
prompted on LinkedIn, Tony,

00:10:27.202 --> 00:10:28.163
in the last couple of days.

00:10:28.644 --> 00:10:29.764
as well as the other end of

00:10:29.784 --> 00:10:30.865
the spectrum in terms of

00:10:30.966 --> 00:10:32.606
hiring clinicians,

00:10:33.028 --> 00:10:34.328
which ones do you guys want

00:10:34.349 --> 00:10:35.230
to tackle first?

00:10:36.610 --> 00:10:38.793
Let's get into wait times.

00:10:39.072 --> 00:10:40.474
Back to Winston Churchill,

00:10:40.533 --> 00:10:42.414
never let a crisis go to waste.

00:10:42.576 --> 00:10:44.096
I think wait times are the

00:10:44.136 --> 00:10:45.317
greatest opportunity to

00:10:45.357 --> 00:10:46.759
push our profession forward.

00:10:47.740 --> 00:10:49.600
Maybe that I've seen in my

00:10:49.721 --> 00:10:51.043
professional career, 22, three years.

00:10:53.163 --> 00:10:55.505
Um, and nobody's taken advantage of it.

00:10:55.846 --> 00:10:57.707
Nobody is leveraging this as

00:10:57.748 --> 00:10:58.687
an opportunity.

00:10:58.788 --> 00:11:00.370
Nobody is trying to figure

00:11:00.450 --> 00:11:01.450
out how we can make this

00:11:01.509 --> 00:11:03.912
work for both ends of the bell curve.

00:11:04.312 --> 00:11:06.474
And what I mean by that is, you know,

00:11:06.533 --> 00:11:09.096
my easy answer is raise your prices,

00:11:09.135 --> 00:11:11.677
sell more cash pay, like make them pay.

00:11:11.778 --> 00:11:13.558
Twitter is showing us today,

00:11:13.719 --> 00:11:15.520
make them pay for access.

00:11:16.081 --> 00:11:17.301
Somebody wants to jump to

00:11:17.321 --> 00:11:18.142
the front of the line.

00:11:18.581 --> 00:11:19.142
I'm here.

00:11:19.261 --> 00:11:20.381
We have Kings Island,

00:11:20.422 --> 00:11:22.062
which is a major amusement

00:11:22.101 --> 00:11:23.102
park down the road.

00:11:24.663 --> 00:11:25.763
If my kids want to get to

00:11:25.783 --> 00:11:26.543
the front of the line,

00:11:26.563 --> 00:11:28.464
they have to buy a gold pass.

00:11:28.524 --> 00:11:29.464
Disney does it.

00:11:29.524 --> 00:11:30.644
We see it all over the place.

00:11:31.105 --> 00:11:32.345
So that's the easy answer.

00:11:32.664 --> 00:11:34.164
And then, of course, the resistance is,

00:11:34.205 --> 00:11:34.424
well,

00:11:34.485 --> 00:11:36.105
what about the people who can't

00:11:36.125 --> 00:11:36.586
afford that?

00:11:37.482 --> 00:11:42.187
OK, so who is taking the wheel and saying,

00:11:42.368 --> 00:11:43.208
I'm going to create an

00:11:43.269 --> 00:11:44.410
affordable solution for

00:11:44.451 --> 00:11:45.371
people who are waiting

00:11:45.412 --> 00:11:47.514
three to six weeks to get

00:11:47.614 --> 00:11:49.015
the services that they need?

00:11:49.076 --> 00:11:49.275
Now,

00:11:49.917 --> 00:11:53.039
is no service better than online service?

00:11:53.100 --> 00:11:53.360
You know,

00:11:53.399 --> 00:11:54.601
maybe therapists don't want to do

00:11:54.642 --> 00:11:55.182
telehealth.

00:11:55.201 --> 00:11:56.263
They don't want to do digital.

00:11:56.302 --> 00:11:57.485
They think YouTube isn't

00:11:57.504 --> 00:11:58.245
good enough for them.

00:11:59.115 --> 00:11:59.996
But you're leaving these

00:12:00.037 --> 00:12:01.116
patients with nothing.

00:12:01.957 --> 00:12:03.558
I think we can address both

00:12:03.639 --> 00:12:04.840
ends of the bell curve.

00:12:05.460 --> 00:12:08.182
And let's just kind of share some ideas.

00:12:08.201 --> 00:12:09.143
So right off the bat,

00:12:09.182 --> 00:12:09.942
and then you guys think

00:12:09.982 --> 00:12:11.104
about what you want to say.

00:12:12.184 --> 00:12:13.765
I would say for both ends,

00:12:14.405 --> 00:12:15.907
the premium service, right,

00:12:16.288 --> 00:12:18.509
the affluent community who wants access,

00:12:18.969 --> 00:12:20.309
you sell an access pass.

00:12:20.389 --> 00:12:22.491
I've talked about this, a membership pass.

00:12:23.152 --> 00:12:25.072
The privilege of paying for

00:12:25.254 --> 00:12:27.195
a $500 a month membership

00:12:27.774 --> 00:12:30.596
is you get access to me through text,

00:12:30.716 --> 00:12:31.658
through email.

00:12:31.717 --> 00:12:33.259
You get 24 hour support.

00:12:33.578 --> 00:12:35.000
You call me in the middle of the night.

00:12:35.080 --> 00:12:36.421
You've had a knee replacement.

00:12:36.520 --> 00:12:38.283
You're bleeding through the dressing.

00:12:38.602 --> 00:12:39.624
You don't know what to do.

00:12:40.203 --> 00:12:40.783
Give me a call.

00:12:40.903 --> 00:12:42.264
I'll wake up at 2 a.m.

00:12:42.725 --> 00:12:43.886
and I will look at it

00:12:43.947 --> 00:12:44.706
through a telehealth

00:12:44.726 --> 00:12:45.827
platform and tell you what

00:12:45.868 --> 00:12:46.889
I think you should do next.

00:12:47.849 --> 00:12:49.389
But the other benefit of a

00:12:49.450 --> 00:12:50.530
membership like that is

00:12:50.890 --> 00:12:51.850
premium scheduling.

00:12:52.230 --> 00:12:55.192
Nobody gets access to my Monday, Wednesday,

00:12:55.232 --> 00:12:58.414
Friday schedule between 930 a.m.

00:12:58.575 --> 00:12:59.475
and 11 a.m.

00:12:59.855 --> 00:13:01.436
who isn't a premium member.

00:13:02.136 --> 00:13:03.437
And you get first pick.

00:13:03.456 --> 00:13:04.538
You get top priority.

00:13:05.471 --> 00:13:05.711
Okay,

00:13:06.131 --> 00:13:07.893
the other end of the bell curve is

00:13:08.693 --> 00:13:11.254
I'm gonna can or productize

00:13:11.774 --> 00:13:13.895
what I do every single day in the clinic.

00:13:14.056 --> 00:13:15.297
I am going to record,

00:13:15.336 --> 00:13:16.596
I'm gonna document what I

00:13:16.636 --> 00:13:17.357
do in the clinic.

00:13:17.418 --> 00:13:18.518
I'm gonna provide those

00:13:18.638 --> 00:13:20.619
answers in a video format

00:13:20.678 --> 00:13:21.720
so that somebody who is

00:13:21.820 --> 00:13:23.701
sitting there on a six week waiting list

00:13:24.260 --> 00:13:27.524
can buy the videos, can buy the course,

00:13:27.583 --> 00:13:28.585
whatever you want to call it,

00:13:29.145 --> 00:13:30.827
and get their questions answered.

00:13:30.888 --> 00:13:32.249
I can't even tell you how

00:13:32.328 --> 00:13:34.431
many people come into my clinic saying,

00:13:34.892 --> 00:13:37.114
I've binge watched a bunch

00:13:37.153 --> 00:13:38.375
of your YouTube videos.

00:13:38.414 --> 00:13:39.677
You answered all of my questions.

00:13:39.736 --> 00:13:40.697
Even the questions I didn't

00:13:40.738 --> 00:13:41.739
know that I would have,

00:13:42.298 --> 00:13:43.640
you had answers to them.

00:13:43.660 --> 00:13:45.241
I can't thank you enough.

00:13:45.302 --> 00:13:46.244
So that's something that I

00:13:46.283 --> 00:13:47.104
give away for free.

00:13:47.764 --> 00:13:48.905
But it could be packaged.

00:13:48.985 --> 00:13:50.099
It could be a $10, $20,

00:13:50.099 --> 00:13:51.488
$30 digital product,

00:13:51.528 --> 00:13:52.688
and it could help anywhere,

00:13:52.828 --> 00:13:54.070
not even just in this country,

00:13:54.129 --> 00:13:56.051
but now we can go overseas.

00:13:56.471 --> 00:13:57.831
So those would be my two

00:13:57.871 --> 00:13:58.972
solutions to somebody who

00:13:59.013 --> 00:14:00.594
wants to help with the

00:14:00.673 --> 00:14:02.375
waitlist problem and

00:14:02.456 --> 00:14:04.437
understands that there's huge value.

00:14:04.476 --> 00:14:05.717
This is a hungry audience

00:14:05.758 --> 00:14:06.918
that's not getting served.

00:14:09.317 --> 00:14:09.557
Yeah.

00:14:09.658 --> 00:14:10.979
So in terms of us,

00:14:12.139 --> 00:14:13.938
we just simply raise our prices.

00:14:14.239 --> 00:14:16.320
And I think also that this

00:14:16.399 --> 00:14:17.500
is great for every cash

00:14:17.539 --> 00:14:19.100
practice across the country, wait times.

00:14:19.520 --> 00:14:20.301
Now, like you said,

00:14:20.400 --> 00:14:21.922
we always want to talk about, you know,

00:14:21.961 --> 00:14:22.961
there's certain folks that

00:14:23.001 --> 00:14:23.701
just can't afford it.

00:14:23.721 --> 00:14:24.602
We understand it, whatever.

00:14:24.623 --> 00:14:24.682
But

00:14:27.100 --> 00:14:29.124
As a sidebar, Tony,

00:14:29.144 --> 00:14:30.485
you've probably heard or seen this.

00:14:30.546 --> 00:14:31.787
There's people that have

00:14:31.826 --> 00:14:32.768
contacted our practice over

00:14:32.807 --> 00:14:34.129
the years that they're like,

00:14:34.149 --> 00:14:35.390
do you take Medicaid?

00:14:35.812 --> 00:14:37.813
My mother or father's on Medicaid.

00:14:38.335 --> 00:14:39.755
And then we go through the

00:14:39.796 --> 00:14:40.496
whole rigmarole.

00:14:40.517 --> 00:14:42.198
We go through a whole call or two.

00:14:42.659 --> 00:14:44.721
Then let's say myself or one

00:14:44.741 --> 00:14:45.702
of my therapists over the years,

00:14:45.744 --> 00:14:46.865
we go to the home.

00:14:48.153 --> 00:14:49.455
Turns out they're very wealthy.

00:14:49.514 --> 00:14:50.496
They had moved all their

00:14:50.557 --> 00:14:52.599
assets from the mother or

00:14:52.639 --> 00:14:53.399
father to the son or

00:14:53.419 --> 00:14:55.020
daughter and waited three to five years,

00:14:55.041 --> 00:14:55.902
then applied to Medicaid.

00:14:55.922 --> 00:14:56.783
Then it looks like you are

00:14:56.842 --> 00:14:58.625
actually low income.

00:14:59.346 --> 00:15:00.326
So there's all those games.

00:15:00.366 --> 00:15:01.548
So it's like, I know,

00:15:01.948 --> 00:15:02.850
but there is still a small

00:15:02.870 --> 00:15:04.851
chunk that I think, I agree with Tony,

00:15:04.892 --> 00:15:06.413
they're like the folks that truly,

00:15:06.452 --> 00:15:07.434
truly cannot afford

00:15:08.134 --> 00:15:09.416
Um, there, there should be something,

00:15:09.436 --> 00:15:10.256
there should be something.

00:15:10.797 --> 00:15:11.878
Um, but the challenge, Tony,

00:15:11.918 --> 00:15:14.139
I think is that those folks will say,

00:15:14.178 --> 00:15:15.820
well, don't you just take my Medicaid?

00:15:15.840 --> 00:15:17.081
Like here's my insurance card, whatever.

00:15:17.140 --> 00:15:18.241
And a ton of practices

00:15:18.282 --> 00:15:19.802
across the country don't,

00:15:19.883 --> 00:15:21.344
or are taking Medicaid less

00:15:21.364 --> 00:15:21.943
and less and less.

00:15:22.303 --> 00:15:22.825
And they're going to say,

00:15:22.884 --> 00:15:23.684
why am I paying out of

00:15:23.725 --> 00:15:25.166
pocket for this digital experience,

00:15:25.186 --> 00:15:26.086
this digital course,

00:15:26.126 --> 00:15:27.868
whatever Tony Meritato is talking about,

00:15:28.488 --> 00:15:28.727
you know,

00:15:28.908 --> 00:15:29.928
don't you just take my insurance?

00:15:29.948 --> 00:15:30.950
Don't you just take my Medicaid?

00:15:31.250 --> 00:15:31.950
So there's always that

00:15:32.150 --> 00:15:33.370
that's always going to be the challenge.

00:15:33.410 --> 00:15:35.373
Now, in terms of the overall, uh,

00:15:36.163 --> 00:15:37.365
Wait times across the country.

00:15:37.845 --> 00:15:38.664
It's definitely great for

00:15:38.684 --> 00:15:39.806
cash based physical therapy.

00:15:39.826 --> 00:15:41.025
It's definitely great for

00:15:41.066 --> 00:15:43.706
cash practices where the

00:15:43.726 --> 00:15:44.868
best practices will win.

00:15:45.168 --> 00:15:46.427
And the folks that are like, oh,

00:15:46.467 --> 00:15:48.089
there's a wait time at these two, three,

00:15:48.129 --> 00:15:49.450
four other places that I called.

00:15:49.850 --> 00:15:51.250
And then they found, you know,

00:15:51.551 --> 00:15:52.831
my practice or some other practice.

00:15:53.171 --> 00:15:53.831
They read the reviews.

00:15:53.871 --> 00:15:55.152
They check out the website, whatever.

00:15:55.172 --> 00:15:55.871
They're like, yeah,

00:15:56.072 --> 00:15:57.113
I could see why you guys

00:15:57.133 --> 00:15:58.394
charge out of pocket or

00:15:58.573 --> 00:15:59.313
after the phone call.

00:15:59.634 --> 00:16:00.474
It's now I get it.

00:16:00.774 --> 00:16:01.274
I hear it.

00:16:01.794 --> 00:16:02.816
It's a different phone call.

00:16:03.155 --> 00:16:03.495
I get it.

00:16:03.596 --> 00:16:04.596
That's why it's out of pocket.

00:16:05.636 --> 00:16:07.197
So I just it's in a good way.

00:16:07.217 --> 00:16:08.719
It hurts some of the population.

00:16:08.918 --> 00:16:10.340
I mean, I'm not in a good in a bad way.

00:16:10.360 --> 00:16:11.760
It hurts some of the population,

00:16:11.961 --> 00:16:12.642
but in a good way,

00:16:12.741 --> 00:16:14.582
it can help the cash based practices.

00:16:15.123 --> 00:16:15.663
I don't know.

00:16:15.683 --> 00:16:16.464
Then you got all the big

00:16:16.504 --> 00:16:17.284
corporates in the middle

00:16:17.345 --> 00:16:19.405
that I don't know if this

00:16:19.505 --> 00:16:20.386
even affects them or not.

00:16:20.427 --> 00:16:20.687
I don't know.

00:16:22.934 --> 00:16:25.576
Yeah, a story comes to mind.

00:16:25.875 --> 00:16:27.336
You know me, I always go on a tangent,

00:16:27.356 --> 00:16:28.496
but I'm going to bring it back, baby,

00:16:28.537 --> 00:16:28.976
trust me.

00:16:30.357 --> 00:16:31.457
People were complaining at

00:16:31.638 --> 00:16:33.519
LAX airport about the long

00:16:33.639 --> 00:16:35.600
wait times for their luggage.

00:16:35.899 --> 00:16:37.820
They'd get off the plane, they'd deplane,

00:16:37.860 --> 00:16:39.600
they'd go stand at the carousel,

00:16:39.620 --> 00:16:41.302
and they'd wait.

00:16:42.216 --> 00:16:42.875
They'd complain.

00:16:43.235 --> 00:16:45.576
So an optimization expert was brought in.

00:16:46.057 --> 00:16:47.018
How do we get the luggage

00:16:47.097 --> 00:16:48.678
off the plane to the carousel faster?

00:16:48.698 --> 00:16:50.460
And he figured out you can't.

00:16:50.879 --> 00:16:52.120
They were actually doing it

00:16:52.179 --> 00:16:54.740
with the volume that LAX was receiving.

00:16:54.780 --> 00:16:55.881
They were doing it as fast

00:16:55.922 --> 00:16:57.503
as they possibly could.

00:16:58.123 --> 00:16:59.263
So here's how he reduced

00:16:59.322 --> 00:17:00.803
complaints because that was his job.

00:17:00.903 --> 00:17:01.783
Reduce the complaints.

00:17:01.823 --> 00:17:02.865
He figured out he couldn't

00:17:03.384 --> 00:17:04.865
make the bags go faster.

00:17:05.586 --> 00:17:07.308
He made the walk from the

00:17:07.449 --> 00:17:10.093
airplane to the carousel longer.

00:17:10.673 --> 00:17:11.615
So essentially what I'm

00:17:11.654 --> 00:17:13.017
saying is he gave them

00:17:13.136 --> 00:17:15.580
something to do while they

00:17:15.621 --> 00:17:16.721
were waiting so they didn't

00:17:16.741 --> 00:17:17.604
realize they were waiting.

00:17:18.512 --> 00:17:21.114
Yeah, right.

00:17:21.193 --> 00:17:22.615
Here's a couple of my suggestions.

00:17:23.255 --> 00:17:23.935
Number one,

00:17:23.955 --> 00:17:26.517
I get ads all the time for this.

00:17:26.557 --> 00:17:28.018
It's more focused on business.

00:17:28.417 --> 00:17:29.678
But now that I'm sort of

00:17:29.718 --> 00:17:30.578
helping to take care of my

00:17:30.618 --> 00:17:31.519
dad post-stroke,

00:17:32.200 --> 00:17:33.559
I get text messages from

00:17:33.599 --> 00:17:36.442
his health care service all the time.

00:17:37.321 --> 00:17:39.903
a week, three days, the day before.

00:17:40.003 --> 00:17:40.804
Are you still good?

00:17:41.184 --> 00:17:42.045
Just clarifying.

00:17:42.105 --> 00:17:42.965
If you want to change,

00:17:43.185 --> 00:17:44.346
here's the link right here.

00:17:44.386 --> 00:17:45.146
I don't have to call.

00:17:45.487 --> 00:17:46.008
I can do it.

00:17:46.167 --> 00:17:46.948
Never while I'm driving.

00:17:46.968 --> 00:17:47.669
I would never do that

00:17:47.909 --> 00:17:48.628
because that's not good.

00:17:48.910 --> 00:17:50.971
But while I'm in the grocery store, oh,

00:17:50.990 --> 00:17:51.451
you know what?

00:17:51.550 --> 00:17:52.451
Dad's not feeling great.

00:17:52.551 --> 00:17:53.531
Tomorrow's not going to work.

00:17:53.592 --> 00:17:54.932
Let me make sure I don't get

00:17:54.992 --> 00:17:56.713
hit with that fee or just not show up.

00:17:57.295 --> 00:17:58.316
And I can do it right there

00:17:58.395 --> 00:18:00.356
and reschedule with one thumb.

00:18:01.604 --> 00:18:04.766
Make it easy for them, right?

00:18:04.806 --> 00:18:06.387
So if you're saying a cancel, a no-show,

00:18:06.428 --> 00:18:07.147
right, there's a list,

00:18:07.888 --> 00:18:08.828
go hit that list up.

00:18:08.868 --> 00:18:09.789
But you got to make room.

00:18:09.829 --> 00:18:10.711
And the answer shouldn't

00:18:10.871 --> 00:18:12.852
only be have your providers

00:18:12.932 --> 00:18:14.032
work for an extra couple of

00:18:14.093 --> 00:18:15.114
nickels on a Saturday.

00:18:15.513 --> 00:18:16.394
I don't think that's the

00:18:16.454 --> 00:18:17.655
answer to keep people happy

00:18:17.675 --> 00:18:18.596
in terms of clinicians.

00:18:18.977 --> 00:18:20.758
So what I'm saying is leverage technology.

00:18:21.038 --> 00:18:22.699
There's AI-based technology

00:18:22.719 --> 00:18:24.381
that can do this thing once

00:18:24.401 --> 00:18:26.021
you set it up to make sure

00:18:26.061 --> 00:18:28.884
you have people making sure they show up.

00:18:30.094 --> 00:18:31.575
If they're scheduled and

00:18:31.634 --> 00:18:33.296
give them an easy option to reschedule.

00:18:33.355 --> 00:18:34.217
The second would be

00:18:34.576 --> 00:18:36.357
leveraging technology and telehealth.

00:18:36.718 --> 00:18:37.739
Could you be doing some

00:18:37.838 --> 00:18:39.921
triage before they ever come?

00:18:39.980 --> 00:18:41.481
If you've got a six-week wait time,

00:18:41.781 --> 00:18:43.563
can you get a telehealth visit first?

00:18:44.143 --> 00:18:44.423
Tony,

00:18:44.483 --> 00:18:45.904
is there a regulation that the first

00:18:45.984 --> 00:18:47.184
visit has to be in person

00:18:47.204 --> 00:18:47.905
or anything like that?

00:18:48.705 --> 00:18:49.926
No, no, no, not at all.

00:18:49.946 --> 00:18:51.346
And as far as, you know,

00:18:51.527 --> 00:18:52.827
legislation goes right now,

00:18:52.847 --> 00:18:53.807
telehealth is still a

00:18:53.847 --> 00:18:54.709
coverage service under

00:18:54.749 --> 00:18:57.769
Medicare benefit until the

00:18:57.930 --> 00:18:59.470
end of this calendar year,

00:18:59.509 --> 00:19:01.351
until December 31st, 2024.

00:19:01.351 --> 00:19:02.372
Now, right now,

00:19:02.412 --> 00:19:03.612
there is no proposal to

00:19:03.672 --> 00:19:05.472
extend telehealth coverage.

00:19:05.853 --> 00:19:06.874
But all that means is that

00:19:06.993 --> 00:19:08.334
then telehealth becomes a

00:19:08.394 --> 00:19:09.974
self-paced service or online.

00:19:10.775 --> 00:19:12.576
or telehealth can become a

00:19:12.655 --> 00:19:13.596
marketing service.

00:19:13.957 --> 00:19:15.157
And this is the thing that

00:19:15.678 --> 00:19:18.559
we do so many things that are an expense,

00:19:18.880 --> 00:19:21.382
but they're also a marketing investment.

00:19:21.422 --> 00:19:23.784
And so I would say if a telehealth visit,

00:19:23.943 --> 00:19:25.163
or we haven't talked about

00:19:25.305 --> 00:19:27.826
RTM or remote therapeutic monitoring,

00:19:28.266 --> 00:19:29.267
I've got two interviews

00:19:29.307 --> 00:19:30.288
coming up probably in the

00:19:30.327 --> 00:19:31.828
next week for different

00:19:31.929 --> 00:19:32.749
remote therapeutic

00:19:32.788 --> 00:19:34.009
monitoring companies that

00:19:34.029 --> 00:19:34.990
approach it differently.

00:19:35.010 --> 00:19:36.251
I think there's huge

00:19:36.311 --> 00:19:37.592
opportunity to leverage that.

00:19:39.053 --> 00:19:39.794
Finish your thought.

00:19:39.874 --> 00:19:40.673
And then I want to talk

00:19:40.713 --> 00:19:42.414
about Rory Sutherland and

00:19:42.555 --> 00:19:43.875
his approach to solving

00:19:43.914 --> 00:19:45.336
that problem for transportation.

00:19:45.675 --> 00:19:45.855
Yeah.

00:19:45.875 --> 00:19:46.876
The last thing I'll say is, look,

00:19:46.916 --> 00:19:47.997
I just I just highlighted

00:19:48.057 --> 00:19:49.337
two uses of technology,

00:19:49.357 --> 00:19:50.678
but they solve a people problem.

00:19:51.157 --> 00:19:51.398
Right.

00:19:51.479 --> 00:19:53.378
So understand if you can solve my problem,

00:19:53.398 --> 00:19:54.319
like Tony said,

00:19:54.380 --> 00:19:57.020
don't don't let a crisis go unused.

00:19:57.520 --> 00:19:58.342
The people that are

00:19:58.402 --> 00:20:00.102
leveraging this make no mistake about it.

00:20:00.142 --> 00:20:01.103
The people that are already

00:20:01.163 --> 00:20:02.022
doing the things that I'm

00:20:02.042 --> 00:20:03.183
mentioning or smarter

00:20:03.243 --> 00:20:04.124
things that I'm mentioning,

00:20:04.644 --> 00:20:05.924
they're not talking about it online.

00:20:06.644 --> 00:20:07.885
Watch the people online.

00:20:07.905 --> 00:20:08.487
They do this.

00:20:08.527 --> 00:20:10.147
They complain because they

00:20:10.208 --> 00:20:11.909
can't figure out we have these problems.

00:20:12.650 --> 00:20:13.609
The people that are actually

00:20:13.690 --> 00:20:15.471
solving it are busy solving it.

00:20:16.172 --> 00:20:17.953
So understand people are

00:20:18.074 --> 00:20:19.515
doing the things that I'm saying.

00:20:19.775 --> 00:20:20.715
They're not talking about it

00:20:20.736 --> 00:20:21.736
because they're busy winning.

00:20:23.518 --> 00:20:24.278
So stop looking for

00:20:24.317 --> 00:20:25.739
validation because you'll

00:20:25.759 --> 00:20:28.662
be 59th in a race out of 70.

00:20:28.662 --> 00:20:29.622
Try some of these things.

00:20:29.662 --> 00:20:30.163
Try one.

00:20:31.002 --> 00:20:32.463
And my suggestion is you'll

00:20:32.544 --> 00:20:33.125
over serve them.

00:20:34.234 --> 00:20:34.595
All right.

00:20:34.674 --> 00:20:36.016
Ohio is representing.

00:20:36.096 --> 00:20:37.455
Here's Cameron Dennis.

00:20:38.436 --> 00:20:40.538
Cameron's a couple hours north of me.

00:20:40.617 --> 00:20:41.278
He's come down.

00:20:41.317 --> 00:20:42.578
We've met in person before.

00:20:42.659 --> 00:20:43.959
He's got a great practice.

00:20:43.999 --> 00:20:44.818
He's actually working.

00:20:44.838 --> 00:20:45.480
Well,

00:20:45.500 --> 00:20:46.940
I think he still might be working

00:20:46.980 --> 00:20:48.240
with Joey Albritton,

00:20:48.260 --> 00:20:50.201
who is on the podcast a couple weeks ago.

00:20:51.663 --> 00:20:53.124
So Rory Sutherland,

00:20:53.403 --> 00:20:56.207
one of my favorite marketing geniuses,

00:20:56.287 --> 00:20:59.470
like Seth Godin, Rory Sutherland.

00:20:59.829 --> 00:21:00.971
These guys are amazing.

00:21:01.971 --> 00:21:05.296
Rory talked about the transportation time.

00:21:05.375 --> 00:21:06.175
I'm going to say commute

00:21:06.217 --> 00:21:08.979
time for the I call it a train.

00:21:08.999 --> 00:21:10.279
I don't remember what he called it.

00:21:11.080 --> 00:21:13.061
It was like the city,

00:21:13.642 --> 00:21:15.701
they invested hundreds of

00:21:15.761 --> 00:21:17.143
millions of dollars to try

00:21:17.202 --> 00:21:18.623
and speed up the commute

00:21:18.762 --> 00:21:20.344
from two major cities.

00:21:21.723 --> 00:21:22.663
And one of the things that

00:21:22.683 --> 00:21:25.964
he said was it really is insignificant.

00:21:26.065 --> 00:21:27.826
So let's imagine, Dave,

00:21:27.846 --> 00:21:28.566
you're going from New

00:21:28.605 --> 00:21:29.726
Jersey to Manhattan.

00:21:30.266 --> 00:21:32.086
Maybe it's a 40 minute commute.

00:21:32.166 --> 00:21:33.926
You want to speed it up to 20 minutes.

00:21:33.926 --> 00:21:35.607
20 minutes isn't going to

00:21:35.627 --> 00:21:36.708
make that much of a difference.

00:21:37.701 --> 00:21:38.882
But he said what they could

00:21:38.902 --> 00:21:41.383
have done was take the $2

00:21:41.383 --> 00:21:43.124
billion investment to get a

00:21:43.203 --> 00:21:45.263
little bit of time savings,

00:21:45.865 --> 00:21:49.025
put it into hiring the most beautiful,

00:21:49.085 --> 00:21:50.705
attractive male and female

00:21:51.945 --> 00:21:53.547
people to work on the trains.

00:21:54.186 --> 00:21:56.107
train the staff to become

00:21:56.147 --> 00:21:58.548
comedians and make the commute fun,

00:21:59.087 --> 00:22:00.288
invest in Wi-Fi,

00:22:00.348 --> 00:22:01.348
invest in these extra

00:22:01.388 --> 00:22:03.108
services so that the

00:22:03.169 --> 00:22:04.470
commuters on the train

00:22:04.509 --> 00:22:05.730
don't even care that it

00:22:05.789 --> 00:22:07.611
took an extra 20 minutes.

00:22:07.671 --> 00:22:08.810
They would want the train to

00:22:08.871 --> 00:22:10.471
go slower because the

00:22:10.550 --> 00:22:12.031
experience would be so much

00:22:12.092 --> 00:22:13.672
more enjoyable that they

00:22:13.711 --> 00:22:14.692
don't even need to get to

00:22:14.731 --> 00:22:16.173
their destination any quicker.

00:22:17.073 --> 00:22:18.694
And so to Jimmy's point,

00:22:18.875 --> 00:22:19.895
when we're looking at these

00:22:19.955 --> 00:22:20.836
long wait times,

00:22:20.896 --> 00:22:23.398
if you refuse as a business owner,

00:22:23.459 --> 00:22:24.880
if you refuse to do the

00:22:24.960 --> 00:22:26.681
things to reduce the wait times,

00:22:27.261 --> 00:22:29.344
as in raise prices until

00:22:29.344 --> 00:22:31.325
60% of the wait list drops off,

00:22:32.306 --> 00:22:33.767
do these other logistical

00:22:33.826 --> 00:22:34.867
things that allow you to

00:22:34.948 --> 00:22:36.730
leverage the opportunity.

00:22:37.539 --> 00:22:38.980
then just make it a more

00:22:39.039 --> 00:22:40.260
enjoyable experience.

00:22:40.340 --> 00:22:42.480
Start the initial contact sooner.

00:22:42.601 --> 00:22:44.942
Start to give those people

00:22:45.001 --> 00:22:46.143
that are waiting things to do.

00:22:46.182 --> 00:22:47.403
Go back to waiting for food

00:22:47.462 --> 00:22:48.863
at a restaurant.

00:22:49.564 --> 00:22:51.084
It was such a game changer.

00:22:51.124 --> 00:22:52.284
I'd never go out to eat,

00:22:52.544 --> 00:22:54.105
but when I would go downtown,

00:22:54.704 --> 00:22:56.846
we would get, you could text,

00:22:56.865 --> 00:22:58.366
they would text you when

00:22:58.426 --> 00:22:59.748
your table was ready.

00:23:00.107 --> 00:23:01.048
So we could go to two or

00:23:01.068 --> 00:23:02.449
three bars down the road

00:23:03.009 --> 00:23:04.391
and get drinks and hang out

00:23:04.431 --> 00:23:05.851
and have a good time and then come back.

00:23:06.030 --> 00:23:07.172
Instead of what it used to

00:23:07.211 --> 00:23:08.113
be when I was younger,

00:23:08.613 --> 00:23:09.854
you'd get that little disc

00:23:09.913 --> 00:23:10.713
that would light up and

00:23:10.794 --> 00:23:11.934
vibrate when you're waiting

00:23:11.974 --> 00:23:13.455
for a table and you'd sit

00:23:13.496 --> 00:23:14.395
there and you'd watch all

00:23:14.415 --> 00:23:15.537
these other people coming

00:23:15.596 --> 00:23:16.557
in and out and you'd watch

00:23:16.576 --> 00:23:17.678
all these people eating or

00:23:17.698 --> 00:23:19.278
you'd wait outside and hang

00:23:19.318 --> 00:23:20.240
out with the smokers.

00:23:20.299 --> 00:23:22.361
Like it was a miserable experience.

00:23:22.621 --> 00:23:22.760
Yeah.

00:23:23.305 --> 00:23:24.965
They figured out how to make

00:23:25.006 --> 00:23:26.446
the wait times more enjoyable.

00:23:26.467 --> 00:23:29.470
I think clinicians need to

00:23:29.529 --> 00:23:30.810
invest a little bit of effort.

00:23:30.871 --> 00:23:31.111
You know,

00:23:31.131 --> 00:23:32.392
we think the only thing that

00:23:32.451 --> 00:23:33.573
matters is the quality of

00:23:33.613 --> 00:23:35.453
the patient care experience

00:23:35.473 --> 00:23:36.414
when you're face to face.

00:23:36.515 --> 00:23:38.557
It's all the theater around

00:23:38.616 --> 00:23:39.938
that experience that matters.

00:23:40.258 --> 00:23:41.419
We sell an experience.

00:23:41.499 --> 00:23:42.420
Pay attention to that.

00:23:43.220 --> 00:23:44.260
Are we good on that?

00:23:44.340 --> 00:23:44.580
I mean,

00:23:44.601 --> 00:23:45.801
I don't think we solved the whole

00:23:45.821 --> 00:23:46.663
damn thing, but I mean,

00:23:46.702 --> 00:23:47.503
I wanted to make sure

00:23:48.064 --> 00:23:51.085
we had time to jump into the

00:23:51.244 --> 00:23:52.286
other side of the coin or

00:23:52.306 --> 00:23:54.645
the other side of the process.

00:23:55.626 --> 00:23:55.767
Yeah.

00:23:55.787 --> 00:23:56.866
Let's talk about hiring.

00:23:56.906 --> 00:23:57.988
Let's talk about staffing.

00:23:58.647 --> 00:23:58.968
Man.

00:23:59.087 --> 00:23:59.307
All right.

00:23:59.327 --> 00:24:00.729
So where are the bottlenecks

00:24:00.769 --> 00:24:01.788
in terms of staffing?

00:24:01.828 --> 00:24:03.190
So let's set the stage.

00:24:03.230 --> 00:24:04.369
You guys are practice owners.

00:24:05.009 --> 00:24:05.609
Set the stage.

00:24:05.891 --> 00:24:06.790
Where's the problem?

00:24:07.131 --> 00:24:08.191
Because some people will say

00:24:08.751 --> 00:24:09.872
nobody wants to work.

00:24:10.612 --> 00:24:12.073
And then so where are the people?

00:24:12.113 --> 00:24:13.933
We know we keep graduating PTs.

00:24:14.013 --> 00:24:15.054
We know that they're out there.

00:24:15.314 --> 00:24:16.433
Are they leaving the profession?

00:24:16.453 --> 00:24:17.555
Are they going out on their own?

00:24:18.316 --> 00:24:19.477
Are they becoming accountants?

00:24:19.576 --> 00:24:21.019
Are they just launching podcasts?

00:24:21.059 --> 00:24:22.481
What are they doing?

00:24:22.541 --> 00:24:23.643
Let's figure out what the

00:24:23.663 --> 00:24:24.785
problem actually looks like.

00:24:24.884 --> 00:24:26.366
What are we looking at here?

00:24:27.028 --> 00:24:27.909
Dave, let's start with you.

00:24:28.755 --> 00:24:29.675
Yeah, I'll go first.

00:24:29.796 --> 00:24:31.336
And then Tony will come in

00:24:31.376 --> 00:24:32.557
with probably a crisper,

00:24:32.617 --> 00:24:35.819
more concise opinion and an angle.

00:24:35.900 --> 00:24:37.340
So like usual.

00:24:37.441 --> 00:24:41.022
So with with this, there's several things.

00:24:41.083 --> 00:24:41.223
Right.

00:24:41.243 --> 00:24:43.444
So there's a lot of DBTs graduating.

00:24:44.025 --> 00:24:45.165
They come out with student loan debt.

00:24:45.547 --> 00:24:48.307
There's a combination of sentiment around.

00:24:49.348 --> 00:24:50.450
I need to be paid an X

00:24:50.509 --> 00:24:51.990
amount because I have some

00:24:52.049 --> 00:24:53.570
level of student loan debt.

00:24:54.191 --> 00:24:55.511
There's a little bit of

00:24:55.612 --> 00:24:56.711
contribution to these

00:24:56.771 --> 00:24:58.192
online communities where

00:24:58.732 --> 00:25:00.634
some of the voices,

00:25:00.993 --> 00:25:02.335
some voices are louder than others.

00:25:02.414 --> 00:25:02.974
And there's this

00:25:05.151 --> 00:25:06.132
Negative camaraderie

00:25:06.172 --> 00:25:07.834
sometimes and sometimes good, like,

00:25:07.993 --> 00:25:08.473
you know, good,

00:25:08.515 --> 00:25:09.915
like someone created in the

00:25:09.976 --> 00:25:11.557
New York physical therapy Facebook group,

00:25:11.597 --> 00:25:12.478
someone created like a

00:25:13.179 --> 00:25:15.000
spreadsheet of like all the

00:25:15.101 --> 00:25:16.762
in maybe across the country,

00:25:16.782 --> 00:25:17.963
but definitely in New York,

00:25:19.065 --> 00:25:20.465
like certain areas of.

00:25:21.740 --> 00:25:23.240
certain regions and how much

00:25:23.321 --> 00:25:24.102
they were offered and

00:25:24.142 --> 00:25:25.701
whether it was part-time or full-time.

00:25:25.721 --> 00:25:29.303
And so it was like an anonymous insight,

00:25:29.983 --> 00:25:31.604
transparency around job

00:25:31.663 --> 00:25:32.825
offers and what type of

00:25:32.884 --> 00:25:34.025
jobs and was it outpatient

00:25:34.085 --> 00:25:35.545
or was it a sniff or was it

00:25:35.585 --> 00:25:36.746
home health or whatever?

00:25:37.905 --> 00:25:38.506
So there's that,

00:25:38.685 --> 00:25:40.247
that like the online collaboration,

00:25:40.287 --> 00:25:41.146
there's some good there,

00:25:41.787 --> 00:25:42.587
but then I think there's

00:25:42.607 --> 00:25:44.607
also some negative sentiment around like,

00:25:44.688 --> 00:25:45.888
oh, well, like I have, you know,

00:25:45.888 --> 00:25:47.969
$250,000 of student loan debt.

00:25:48.009 --> 00:25:49.890
So I need, you know, DBTs need to be paid.

00:25:49.890 --> 00:25:52.631
100 grand or 120 or 110 or

00:25:52.651 --> 00:25:53.431
something out of school

00:25:54.290 --> 00:25:55.911
when they have minimal

00:25:56.691 --> 00:25:57.751
hands on experience with

00:25:57.971 --> 00:25:59.412
real patients other than rotations.

00:26:00.511 --> 00:26:01.271
And they need a lot of

00:26:01.333 --> 00:26:02.292
coaching and handholding

00:26:02.313 --> 00:26:03.292
and all that because I know

00:26:03.353 --> 00:26:05.232
I did like the first year or two.

00:26:06.013 --> 00:26:07.894
So there's some of that.

00:26:07.913 --> 00:26:10.555
I think that's one of the biggest things.

00:26:10.615 --> 00:26:11.714
But then at the same time,

00:26:12.454 --> 00:26:14.415
There is, Jimmy, I think,

00:26:14.435 --> 00:26:16.537
because I come from a blue collar family.

00:26:17.038 --> 00:26:17.938
I think there is,

00:26:17.958 --> 00:26:19.578
and I never even heard the

00:26:19.618 --> 00:26:21.940
word burnout until, I don't know,

00:26:22.140 --> 00:26:23.800
five years ago or something.

00:26:24.080 --> 00:26:27.583
Like recently, I graduated in 2011 and I,

00:26:27.682 --> 00:26:28.884
you know, my first job or two,

00:26:28.903 --> 00:26:30.805
I was doing three or four

00:26:30.884 --> 00:26:32.046
nights working in

00:26:32.086 --> 00:26:33.125
outpatient clinics because

00:26:33.145 --> 00:26:34.186
that's just how it is, right, Tony?

00:26:34.207 --> 00:26:34.707
Like, you know,

00:26:34.747 --> 00:26:35.728
you got to close the clinic

00:26:35.807 --> 00:26:37.648
and there's patients that want the 5, 6,

00:26:37.648 --> 00:26:38.449
7, 7.30 p.m., whatever time.

00:26:42.751 --> 00:26:45.273
And so there I think there is some of that,

00:26:45.294 --> 00:26:46.295
whether it's the profession

00:26:46.335 --> 00:26:47.175
attracts some of those

00:26:47.296 --> 00:26:48.737
styles of individuals.

00:26:48.797 --> 00:26:49.337
I don't know.

00:26:50.878 --> 00:26:52.300
There's there's multiple things here.

00:26:52.361 --> 00:26:53.260
That's why we're talking about it.

00:26:53.300 --> 00:26:54.321
That's why it's an ongoing

00:26:54.382 --> 00:26:56.384
topic across the industry,

00:26:56.463 --> 00:26:57.345
across the profession,

00:26:57.924 --> 00:26:59.426
across different podcasts

00:26:59.567 --> 00:27:02.388
and online sentiment, offline sentiment.

00:27:02.950 --> 00:27:04.010
There's multiple things here.

00:27:04.211 --> 00:27:05.392
That's my take so far.

00:27:05.451 --> 00:27:07.233
I would love to hear what Tony thinks.

00:27:08.787 --> 00:27:12.069
Um, so this, these two topics are married,

00:27:12.130 --> 00:27:12.369
right?

00:27:12.470 --> 00:27:14.991
We, we started talking about it because if,

00:27:15.152 --> 00:27:16.113
if I don't have staff,

00:27:16.353 --> 00:27:17.574
I have a long waiting list

00:27:17.634 --> 00:27:18.875
and all this stuff works together.

00:27:18.894 --> 00:27:21.396
Uh, I wanted to mention John DeLucci.

00:27:21.436 --> 00:27:21.676
Now.

00:27:21.696 --> 00:27:23.337
I think I have been

00:27:23.397 --> 00:27:25.799
following him from Facebook

00:27:25.839 --> 00:27:26.700
like years ago.

00:27:27.800 --> 00:27:28.903
Some of these names start to

00:27:28.923 --> 00:27:30.324
get twisted in my head,

00:27:30.344 --> 00:27:32.026
and I don't remember who's who,

00:27:32.586 --> 00:27:35.570
but he's great on LinkedIn, John Delucci.

00:27:36.491 --> 00:27:37.893
He's got some great feedback

00:27:37.972 --> 00:27:39.375
on this topic in particular,

00:27:39.414 --> 00:27:40.336
and then some other stuff.

00:27:40.375 --> 00:27:41.297
He's been sharing a bunch of

00:27:41.336 --> 00:27:42.018
great content.

00:27:42.598 --> 00:27:44.641
But when I'm looking at this...

00:27:45.461 --> 00:27:47.143
I never tend to agree with

00:27:47.303 --> 00:27:50.125
the conventional wisdom, which is, well,

00:27:50.184 --> 00:27:52.266
pay more, offer bonuses.

00:27:52.326 --> 00:27:53.146
Somebody had mentioned

00:27:53.166 --> 00:27:56.188
either on John's thread or on mine, well,

00:27:56.288 --> 00:27:57.909
we can increase capacity by

00:27:58.088 --> 00:27:59.730
offering our current team

00:28:00.191 --> 00:28:01.750
to be able to work extra hours,

00:28:01.832 --> 00:28:02.632
work the weekends.

00:28:02.672 --> 00:28:04.732
And I'm like, I don't know about you guys,

00:28:04.972 --> 00:28:06.733
but the people that I hire,

00:28:06.773 --> 00:28:07.694
and maybe it's just the

00:28:07.755 --> 00:28:09.115
culture of the people that

00:28:09.256 --> 00:28:10.817
work well within my team,

00:28:11.457 --> 00:28:12.597
they don't want to work more.

00:28:13.097 --> 00:28:14.878
Like my most powerful

00:28:14.939 --> 00:28:16.118
incentive for people who

00:28:16.159 --> 00:28:17.920
come work for me is typically, look,

00:28:17.980 --> 00:28:21.000
you can work less and make the same pay.

00:28:21.540 --> 00:28:23.221
Like they want time with family.

00:28:23.241 --> 00:28:24.423
They want time to travel.

00:28:24.462 --> 00:28:26.323
They want time to think and be creative.

00:28:26.644 --> 00:28:27.624
And that's what I want.

00:28:27.723 --> 00:28:28.743
So it's probably my own

00:28:28.763 --> 00:28:30.025
biases that attract that.

00:28:30.625 --> 00:28:32.185
But I've never found a

00:28:32.246 --> 00:28:33.807
clinician in 22 years who

00:28:33.886 --> 00:28:35.988
is motivated by financial incentives.

00:28:36.508 --> 00:28:37.968
They want to get paid what

00:28:38.008 --> 00:28:39.108
they need to get paid to be

00:28:39.608 --> 00:28:40.549
feel valued.

00:28:40.869 --> 00:28:42.170
And this goes to Dan Pink

00:28:42.230 --> 00:28:43.030
and his research.

00:28:43.651 --> 00:28:45.932
But so when I'm looking at that, I'm like,

00:28:45.951 --> 00:28:46.172
all right,

00:28:46.791 --> 00:28:48.113
more pay is not going to

00:28:48.153 --> 00:28:50.854
produce significantly more production.

00:28:50.874 --> 00:28:52.775
I'm going to take that off the table.

00:28:53.295 --> 00:28:55.175
So I would start to use our

00:28:55.215 --> 00:28:56.517
clinical brains and say, well,

00:28:56.757 --> 00:28:58.557
what's really the problem here?

00:28:59.317 --> 00:29:00.878
How can I increase capacity?

00:29:01.459 --> 00:29:02.558
Even if I was to find an

00:29:02.619 --> 00:29:04.420
amazing young person, I'm like, hey,

00:29:04.440 --> 00:29:06.300
I'm going to pay for your education.

00:29:06.361 --> 00:29:07.102
It's six years.

00:29:07.442 --> 00:29:08.241
It's seven years.

00:29:08.301 --> 00:29:09.623
I'm not going to have them

00:29:10.143 --> 00:29:11.384
in my ecosystem.

00:29:12.144 --> 00:29:13.304
Then I look at PTA.

00:29:13.904 --> 00:29:14.424
And of course,

00:29:14.484 --> 00:29:16.246
I posted a question that I

00:29:16.486 --> 00:29:17.546
would like to hear your

00:29:17.586 --> 00:29:19.047
guys's feedback on this.

00:29:19.166 --> 00:29:20.468
My understanding is.

00:29:21.528 --> 00:29:22.709
outside of the things that

00:29:22.769 --> 00:29:25.050
are not part of the PTA curriculum.

00:29:25.171 --> 00:29:26.712
So PTAs are not trained to

00:29:26.772 --> 00:29:27.933
evaluate a new patient.

00:29:27.953 --> 00:29:28.855
They're not trained to

00:29:29.214 --> 00:29:30.655
establish a plan of care

00:29:30.715 --> 00:29:32.417
and do the things that are

00:29:32.518 --> 00:29:34.159
unique to physical therapists.

00:29:34.819 --> 00:29:37.422
But when it comes to patient care delivery,

00:29:37.461 --> 00:29:38.844
to the actual treatment,

00:29:39.104 --> 00:29:40.924
I do not see a difference

00:29:41.605 --> 00:29:44.429
in the expectation or the qualification

00:29:45.028 --> 00:29:46.390
of a PT versus a PTA.

00:29:46.770 --> 00:29:48.491
They should be exactly the same.

00:29:48.653 --> 00:29:49.794
Even in Dave's world,

00:29:50.354 --> 00:29:51.796
a PTA stepping into a

00:29:51.855 --> 00:29:54.018
cash-based system should be

00:29:54.198 --> 00:29:55.519
just as qualified to

00:29:55.578 --> 00:29:58.162
deliver the visit that a PT

00:29:58.241 --> 00:29:59.082
is qualified to do.

00:29:59.423 --> 00:30:00.923
So that's my perspective.

00:30:00.943 --> 00:30:01.765
So I'm like, all right, well,

00:30:02.125 --> 00:30:03.946
PTAs seem to be more abundant.

00:30:04.567 --> 00:30:06.128
PTAs seem to come with a

00:30:06.189 --> 00:30:07.611
different perspective and

00:30:07.691 --> 00:30:08.832
different mindset, right?

00:30:09.852 --> 00:30:10.732
from the PT.

00:30:10.792 --> 00:30:11.952
So that's why I tend to

00:30:12.032 --> 00:30:13.314
focus on building a team of

00:30:13.354 --> 00:30:15.154
PTAs over building a team

00:30:15.194 --> 00:30:17.316
of PTs for my current business model.

00:30:18.196 --> 00:30:19.817
But then I even take it a step past that.

00:30:19.836 --> 00:30:20.438
I'm like, well,

00:30:21.516 --> 00:30:22.395
Follow me on this.

00:30:23.237 --> 00:30:25.817
If most of our patients are

00:30:25.917 --> 00:30:27.238
now experiencing higher

00:30:27.337 --> 00:30:28.218
out-of-pocket costs,

00:30:28.238 --> 00:30:29.939
so Medicare Advantage plans

00:30:29.999 --> 00:30:33.140
are typically paying $35 to $50 copays.

00:30:34.361 --> 00:30:35.861
Other non-Medicare plans,

00:30:35.881 --> 00:30:37.061
they have high deductibles.

00:30:37.142 --> 00:30:38.662
My personal health insurance,

00:30:38.721 --> 00:30:40.002
I have a high deductible plan.

00:30:40.742 --> 00:30:42.523
So if these individuals are

00:30:42.544 --> 00:30:43.443
going to be paying more out

00:30:43.463 --> 00:30:44.404
of pocket anyway,

00:30:45.224 --> 00:30:46.705
isn't it reasonable that I,

00:30:47.286 --> 00:30:48.426
as the physical therapist,

00:30:48.487 --> 00:30:50.147
could perform the evaluation,

00:30:50.188 --> 00:30:51.368
make the determination on

00:30:51.409 --> 00:30:52.788
what this patient actually needs?

00:30:53.289 --> 00:30:55.451
And then my feeling is I

00:30:55.530 --> 00:30:58.511
could train a non-licensed

00:30:58.672 --> 00:31:01.013
individual to deliver the

00:31:01.054 --> 00:31:02.273
patient care experience

00:31:02.294 --> 00:31:03.875
that I believe is best for

00:31:03.894 --> 00:31:04.955
this particular patient.

00:31:05.016 --> 00:31:05.175
Now,

00:31:05.855 --> 00:31:08.037
These are not medically complex cases.

00:31:08.096 --> 00:31:09.978
These are people that need somebody to,

00:31:10.758 --> 00:31:11.019
you know,

00:31:11.078 --> 00:31:12.819
make the experience more enjoyable,

00:31:12.920 --> 00:31:14.039
to laugh, to joke,

00:31:14.079 --> 00:31:16.300
to have fun and keep them motivated.

00:31:16.760 --> 00:31:17.721
I'm not talking about

00:31:17.781 --> 00:31:18.903
somebody who's at risk for

00:31:18.942 --> 00:31:19.923
a major medical event.

00:31:20.563 --> 00:31:22.263
And so where historically

00:31:22.304 --> 00:31:23.045
what we've seen in the

00:31:23.085 --> 00:31:25.246
profession is busy clinics

00:31:25.286 --> 00:31:28.567
would use AIDS to deliver insurance,

00:31:28.788 --> 00:31:29.928
build services.

00:31:30.087 --> 00:31:31.229
That's not what I'm talking about.

00:31:31.848 --> 00:31:33.069
But what I'm saying is if

00:31:33.089 --> 00:31:35.172
somebody is going to have a $45 copay,

00:31:35.192 --> 00:31:36.953
can I craft an experience

00:31:37.493 --> 00:31:39.276
that exceeds the cost of

00:31:39.276 --> 00:31:41.958
$45 in worth to that individual?

00:31:41.978 --> 00:31:42.398
It's worth $100.

00:31:43.419 --> 00:31:44.780
They're going to pay me $45.

00:31:45.201 --> 00:31:46.281
But it's delivered by a

00:31:46.362 --> 00:31:47.583
non-licensed individual

00:31:47.623 --> 00:31:48.903
that I have personally

00:31:48.983 --> 00:31:51.165
trained in the experience

00:31:51.205 --> 00:31:52.106
that I want to deliver.

00:31:52.146 --> 00:31:53.248
And I think that's where the

00:31:53.428 --> 00:31:55.210
answer comes for a lot of us,

00:31:55.289 --> 00:31:58.032
at least in outpatient ortho worlds.

00:31:58.573 --> 00:31:58.833
You know,

00:31:58.873 --> 00:32:00.574
a lot of my patients don't need a

00:32:00.634 --> 00:32:02.134
skilled therapist to be

00:32:02.214 --> 00:32:03.635
with them watching every

00:32:03.675 --> 00:32:04.756
minute of every session.

00:32:05.435 --> 00:32:06.576
I think I can build that.

00:32:06.676 --> 00:32:07.636
I think I can build the

00:32:07.698 --> 00:32:09.018
experience and I can train

00:32:09.057 --> 00:32:10.338
the individual to deliver

00:32:10.419 --> 00:32:12.259
it for less than the cost

00:32:12.299 --> 00:32:13.921
of a copay and still run a

00:32:13.961 --> 00:32:15.121
profitable business.

00:32:15.721 --> 00:32:17.801
It allows me to reduce barriers to care.

00:32:18.242 --> 00:32:20.304
It allows me to expand resources.

00:32:21.104 --> 00:32:21.544
And again,

00:32:21.564 --> 00:32:23.664
there are so many ways we can

00:32:23.704 --> 00:32:24.424
approach this,

00:32:24.505 --> 00:32:25.846
but that would be the

00:32:25.885 --> 00:32:28.287
direction that I would take my business.

00:32:28.846 --> 00:32:30.008
And I think the numbers

00:32:30.067 --> 00:32:32.509
would prove that it's well

00:32:32.548 --> 00:32:33.909
received by the consumer.

00:32:33.949 --> 00:32:35.690
The patients are happy with that.

00:32:36.170 --> 00:32:36.671
Go ahead, Jimmy.

00:32:36.691 --> 00:32:37.230
What are you thinking?

00:32:37.673 --> 00:32:38.694
This touches an emotion.

00:32:38.875 --> 00:32:40.375
So I sort of watched Tony

00:32:40.435 --> 00:32:41.717
tip his cards a little bit.

00:32:41.757 --> 00:32:42.518
And this is why you should

00:32:42.577 --> 00:32:43.638
follow Tony on any of his

00:32:43.679 --> 00:32:46.560
social platforms is when he gets an idea,

00:32:46.641 --> 00:32:47.801
he starts poking at it like

00:32:47.821 --> 00:32:50.104
the Raptors in Jurassic Park.

00:32:50.124 --> 00:32:50.463
He's like,

00:32:50.503 --> 00:32:51.924
I'm never going to test the same

00:32:52.005 --> 00:32:52.945
part of the fence twice.

00:32:52.986 --> 00:32:53.685
I'm just going to figure

00:32:53.726 --> 00:32:55.528
this out by doing asking,

00:32:55.788 --> 00:32:56.909
throwing out ridiculous

00:32:56.989 --> 00:32:57.788
things that are actually

00:32:57.828 --> 00:32:58.609
not that ridiculous.

00:32:59.190 --> 00:33:00.632
But the thing you're suggesting, Tony,

00:33:00.692 --> 00:33:02.772
is going to touch an emotional.

00:33:03.753 --> 00:33:04.334
It's going to touch the

00:33:04.453 --> 00:33:06.056
heart and emotion of P.T.

00:33:06.036 --> 00:33:06.076
's.

00:33:07.289 --> 00:33:09.330
a lot of them, who are staunch,

00:33:09.652 --> 00:33:10.731
who do not want to change.

00:33:11.292 --> 00:33:12.574
And I'm very sorry to you,

00:33:12.713 --> 00:33:13.634
but we understand that if

00:33:13.653 --> 00:33:14.714
you don't change, you lose.

00:33:14.994 --> 00:33:16.195
Again, back to the dinosaurs,

00:33:16.675 --> 00:33:17.317
evolve or die.

00:33:18.196 --> 00:33:20.618
So what I think I started to

00:33:20.679 --> 00:33:21.579
read in your comments when

00:33:21.599 --> 00:33:22.619
you were saying, hey, listen,

00:33:22.920 --> 00:33:24.401
what if we could reduce cost?

00:33:24.961 --> 00:33:25.962
What if we could utilize

00:33:26.022 --> 00:33:27.242
PTAs at what they're great

00:33:27.343 --> 00:33:29.825
at and utilize this DPT for

00:33:29.845 --> 00:33:32.047
what they're good at, get better care,

00:33:32.146 --> 00:33:34.327
reduce cost or make more money?

00:33:34.788 --> 00:33:36.009
And what did you see, Tony,

00:33:36.048 --> 00:33:36.730
in terms of that?

00:33:37.589 --> 00:33:42.750
I saw a lot of undeserved

00:33:42.971 --> 00:33:44.291
rage against PTAs.

00:33:44.791 --> 00:33:45.731
They don't know.

00:33:45.751 --> 00:33:48.113
They don't have the level of experience,

00:33:48.353 --> 00:33:49.432
a lot of finger wet.

00:33:49.532 --> 00:33:51.153
How do you know what a PTA knows?

00:33:51.232 --> 00:33:52.673
Well, in my experience,

00:33:52.933 --> 00:33:54.594
the plural of anecdote is not data,

00:33:54.614 --> 00:33:55.034
my friends.

00:33:55.114 --> 00:33:56.974
The plural of anecdote is not data.

00:33:58.048 --> 00:33:58.648
So what I think you're

00:33:58.669 --> 00:34:00.509
saying is leverage PTAs who

00:34:00.549 --> 00:34:02.130
are professionals and what

00:34:02.150 --> 00:34:02.651
they're good at,

00:34:03.191 --> 00:34:05.892
they're still under the guidance of a PT.

00:34:06.051 --> 00:34:07.172
And this brings up one of my

00:34:07.372 --> 00:34:08.813
favorite pyramids.

00:34:09.373 --> 00:34:10.932
And this is the four levels of value.

00:34:10.952 --> 00:34:12.114
Have you guys seen this one before?

00:34:12.813 --> 00:34:13.514
Loves pyramids.

00:34:14.054 --> 00:34:14.273
Okay.

00:34:16.014 --> 00:34:18.376
At the bottom, we have implementation.

00:34:18.396 --> 00:34:19.596
There's four levels of value

00:34:19.635 --> 00:34:21.096
for the podcast listeners.

00:34:21.117 --> 00:34:22.376
The four levels of value.

00:34:23.338 --> 00:34:25.340
And the value is at the bottom.

00:34:25.760 --> 00:34:26.280
We go up.

00:34:26.340 --> 00:34:27.081
It's more valuable.

00:34:27.101 --> 00:34:28.541
The bottom is implementation.

00:34:28.581 --> 00:34:29.782
That's doing the thing

00:34:30.242 --> 00:34:31.603
that's making the donut.

00:34:32.043 --> 00:34:32.364
OK,

00:34:32.744 --> 00:34:33.864
and that's why you saw a lot of

00:34:33.903 --> 00:34:35.664
suggestions in the chat saying, well,

00:34:35.684 --> 00:34:36.565
what if you could do some

00:34:36.626 --> 00:34:37.706
things at night or what if

00:34:37.766 --> 00:34:39.847
you could work on every other Saturday?

00:34:40.347 --> 00:34:41.807
That doesn't scale because

00:34:41.847 --> 00:34:42.748
what you're asking people

00:34:42.789 --> 00:34:44.829
to do is do more of the thing.

00:34:45.822 --> 00:34:46.141
OK,

00:34:46.643 --> 00:34:48.885
you have to go up higher in the value

00:34:48.945 --> 00:34:49.385
pyramid,

00:34:49.565 --> 00:34:52.347
inverted pyramid to become more valuable.

00:34:52.427 --> 00:34:54.128
The next step up is unification.

00:34:54.248 --> 00:34:55.789
That's where Tony's living right now.

00:34:55.849 --> 00:34:56.570
That's where Tony wants

00:34:56.590 --> 00:34:58.692
people thinking as a PT or

00:34:58.751 --> 00:34:59.452
business owner.

00:34:59.893 --> 00:35:01.335
How can you have a PT manage

00:35:01.394 --> 00:35:02.355
several people so you can

00:35:02.394 --> 00:35:03.255
have more people getting

00:35:03.275 --> 00:35:04.777
care at the same time from

00:35:05.177 --> 00:35:06.858
more good care from people

00:35:06.898 --> 00:35:08.579
who are qualified to do this?

00:35:08.679 --> 00:35:09.581
What you're saying is I have

00:35:09.601 --> 00:35:10.382
a baseball team.

00:35:10.782 --> 00:35:11.463
I want the person.

00:35:11.963 --> 00:35:12.902
You're telling me my best

00:35:13.023 --> 00:35:14.403
fielder is going to play first base?

00:35:14.804 --> 00:35:15.503
I feel like they should be

00:35:15.523 --> 00:35:16.463
playing shortstop because

00:35:16.583 --> 00:35:17.744
more balls get hit over there.

00:35:18.344 --> 00:35:19.985
Can I put a less good

00:35:20.065 --> 00:35:21.045
fielder at first base?

00:35:21.105 --> 00:35:22.106
Not to knock first baseman,

00:35:22.166 --> 00:35:23.065
I was a first baseman.

00:35:24.025 --> 00:35:24.606
So what they're saying,

00:35:24.706 --> 00:35:25.545
can you put people in

00:35:25.585 --> 00:35:26.987
different positions and get

00:35:27.027 --> 00:35:27.686
a better outcome?

00:35:27.786 --> 00:35:28.786
That's unification.

00:35:29.306 --> 00:35:32.347
Can you utilize PTs and PTAs

00:35:32.547 --> 00:35:34.809
as a powerful duo, as a battery?

00:35:35.309 --> 00:35:36.128
I think you can.

00:35:36.168 --> 00:35:37.188
That's what Tony's getting at.

00:35:37.548 --> 00:35:39.730
Tony was also getting at communication.

00:35:40.460 --> 00:35:41.780
Recording what you're doing

00:35:41.820 --> 00:35:42.621
and you're saying that when

00:35:42.641 --> 00:35:43.842
I'm putting out this information,

00:35:43.882 --> 00:35:45.103
people already understand

00:35:45.322 --> 00:35:46.182
they're picking you over

00:35:46.242 --> 00:35:47.402
someone else because they

00:35:47.443 --> 00:35:48.923
have this affinity to you.

00:35:49.003 --> 00:35:50.063
That's the third level in

00:35:50.083 --> 00:35:51.505
the value pyramid with the

00:35:51.545 --> 00:35:52.164
four levels of value.

00:35:52.204 --> 00:35:53.105
Communication and

00:35:53.164 --> 00:35:54.706
imagination is taking

00:35:54.746 --> 00:35:55.806
something that doesn't

00:35:55.846 --> 00:35:56.867
exist right now like a...

00:35:58.648 --> 00:35:59.847
telehealth triage,

00:36:00.648 --> 00:36:01.829
make the experience and

00:36:01.889 --> 00:36:03.471
waiting however long that wait time,

00:36:03.670 --> 00:36:05.271
make the train ride really fun.

00:36:05.371 --> 00:36:06.472
That's imagination.

00:36:06.793 --> 00:36:07.813
If you can do something like

00:36:07.932 --> 00:36:10.094
that or a combination of all four,

00:36:10.454 --> 00:36:11.034
my friends,

00:36:11.516 --> 00:36:14.217
this is how you become more valuable.

00:36:14.557 --> 00:36:15.737
And that's how we choose things.

00:36:15.797 --> 00:36:17.639
We choose things on cost and

00:36:17.739 --> 00:36:18.719
perceived value.

00:36:19.000 --> 00:36:20.961
And we weigh those things.

00:36:21.302 --> 00:36:22.483
Today is Amazon Prime Day.

00:36:23.362 --> 00:36:26.344
Amazon Prime Day likes to focus on cost,

00:36:26.423 --> 00:36:29.365
but Amazon Prime focuses on value.

00:36:29.445 --> 00:36:30.606
That's how they make sure

00:36:30.626 --> 00:36:31.726
that twice a year when they

00:36:31.766 --> 00:36:32.487
say it's Prime Day,

00:36:33.487 --> 00:36:34.387
you're putting things in

00:36:34.407 --> 00:36:35.728
your cart and seeing what's coming up.

00:36:35.909 --> 00:36:37.469
So I think, Tony,

00:36:37.489 --> 00:36:38.690
I think what you're getting at is, hey,

00:36:38.730 --> 00:36:39.911
what about this player

00:36:39.951 --> 00:36:41.391
who's on the bench that we barely,

00:36:41.811 --> 00:36:44.833
you know, we underutilize the PTA?

00:36:45.313 --> 00:36:46.833
Is that part of our solution?

00:36:47.373 --> 00:36:48.755
And I got to be honest,

00:36:48.934 --> 00:36:49.835
I'm agreeing with you on that.

00:36:50.666 --> 00:36:52.646
I want to ask Dave, I want to ask you,

00:36:52.686 --> 00:36:52.887
Dave,

00:36:52.927 --> 00:36:54.047
and I know you're going to talk about it.

00:36:55.367 --> 00:36:57.807
So like your clientele, I think,

00:36:58.447 --> 00:36:59.568
and I could be totally wrong.

00:36:59.588 --> 00:37:00.847
You're selling the title.

00:37:01.449 --> 00:37:02.889
You're selling the prestige.

00:37:03.409 --> 00:37:03.789
You know,

00:37:04.309 --> 00:37:06.590
I can choose to hire the best of

00:37:06.650 --> 00:37:08.670
the best and I can buy the

00:37:08.730 --> 00:37:10.550
Ferrari or I can get a kit

00:37:10.610 --> 00:37:12.291
car that looks like a Ferrari.

00:37:13.411 --> 00:37:15.592
So what are your thoughts on that?

00:37:16.744 --> 00:37:19.246
hiring a an aid that you

00:37:19.286 --> 00:37:19.925
have particularly

00:37:20.005 --> 00:37:21.327
personally trained to

00:37:21.447 --> 00:37:23.507
deliver just the same quality of care,

00:37:24.168 --> 00:37:25.987
or a physical therapist assistant,

00:37:26.027 --> 00:37:27.148
and I'm not, you know,

00:37:27.168 --> 00:37:28.289
saying the two are the same

00:37:29.150 --> 00:37:30.090
for your clientele.

00:37:32.025 --> 00:37:34.425
Funny you ask because it

00:37:34.485 --> 00:37:35.266
just started to be

00:37:35.306 --> 00:37:36.786
implemented last week or

00:37:36.806 --> 00:37:38.068
the week before very recently.

00:37:38.387 --> 00:37:39.568
Now you, I was, I wanted to ask,

00:37:39.588 --> 00:37:40.688
cause you were saying PTA, Tony,

00:37:40.708 --> 00:37:42.210
but then you also said unlicensed, right?

00:37:42.230 --> 00:37:43.030
So you're saying either an

00:37:43.271 --> 00:37:45.010
aid or can I look between

00:37:45.030 --> 00:37:46.351
the lines at personal

00:37:46.411 --> 00:37:47.393
trainers or whatever?

00:37:47.413 --> 00:37:48.193
Like that's kind of,

00:37:49.519 --> 00:37:50.221
And that's the thing.

00:37:50.260 --> 00:37:51.641
Like, I think you have levels,

00:37:51.782 --> 00:37:52.561
but when I look at the

00:37:52.601 --> 00:37:54.322
resources we have available,

00:37:55.063 --> 00:37:56.123
if I want to build

00:37:56.204 --> 00:37:57.505
something that's more accessible,

00:37:57.545 --> 00:37:59.266
that's still insurance covered,

00:37:59.726 --> 00:38:00.686
I would go to the physical

00:38:00.726 --> 00:38:01.646
therapist assistant.

00:38:01.746 --> 00:38:02.467
And I believe that the

00:38:02.507 --> 00:38:03.208
physical therapist

00:38:03.268 --> 00:38:04.208
assistant is equally

00:38:04.268 --> 00:38:05.329
qualified to the physical

00:38:05.369 --> 00:38:06.550
therapist when it comes to

00:38:06.630 --> 00:38:08.871
everything between the bookends,

00:38:08.972 --> 00:38:11.012
between the evaluation and the discharge.

00:38:11.072 --> 00:38:11.333
Right.

00:38:12.534 --> 00:38:14.275
But if I'm looking at going cash base,

00:38:15.054 --> 00:38:16.835
I would not even necessarily

00:38:16.916 --> 00:38:18.257
limit myself to a physical

00:38:18.297 --> 00:38:19.458
therapist assistant.

00:38:19.579 --> 00:38:21.099
I would go unlicensed.

00:38:21.760 --> 00:38:23.822
I would hire for personality.

00:38:23.842 --> 00:38:26.583
I would hire for other soft

00:38:26.664 --> 00:38:28.724
skills because now I can

00:38:28.784 --> 00:38:30.487
cast a wider net and

00:38:30.527 --> 00:38:31.487
there's far more

00:38:31.568 --> 00:38:33.349
opportunities for me to go

00:38:33.548 --> 00:38:35.289
outside of just licensed

00:38:35.329 --> 00:38:37.112
individuals in a cash-based world.

00:38:39.045 --> 00:38:39.625
I love,

00:38:39.664 --> 00:38:41.726
so sometimes on these shows or

00:38:41.786 --> 00:38:43.487
other shows I listen to, it's, you know,

00:38:44.108 --> 00:38:46.009
pie in the sky or theoretical, whatever.

00:38:46.248 --> 00:38:47.489
We're going to go tactical right now.

00:38:47.530 --> 00:38:47.889
We're going to go,

00:38:47.909 --> 00:38:48.811
I'm going to share numbers.

00:38:49.331 --> 00:38:50.271
I'm going to share steps.

00:38:50.572 --> 00:38:52.112
This is, we just implemented this.

00:38:52.773 --> 00:38:54.773
I have, I mentioned this with Tony before,

00:38:54.793 --> 00:38:55.875
maybe on this show or another show,

00:38:55.894 --> 00:38:57.135
but we've had,

00:38:57.175 --> 00:38:57.916
we have certain clients

00:38:57.956 --> 00:38:59.717
that use us for three, four, five,

00:38:59.797 --> 00:39:01.237
sometimes more days per week.

00:39:01.257 --> 00:39:02.199
I know it sounds excessive,

00:39:02.239 --> 00:39:03.259
but maybe they're geriatric.

00:39:03.278 --> 00:39:04.619
The family wants them to keep moving.

00:39:05.280 --> 00:39:05.460
And I,

00:39:06.141 --> 00:39:06.960
sometimes they don't even

00:39:07.041 --> 00:39:08.302
care they literally will

00:39:08.342 --> 00:39:09.521
tell me like just they they

00:39:09.541 --> 00:39:10.902
want us like oh you can't

00:39:10.942 --> 00:39:11.963
find a physical therapist

00:39:12.163 --> 00:39:14.322
like who else could you you

00:39:14.362 --> 00:39:15.304
know hire or whatever

00:39:15.384 --> 00:39:16.443
literally some families say

00:39:16.483 --> 00:39:18.643
that to us okay so one of

00:39:18.664 --> 00:39:20.724
these families recently um

00:39:20.985 --> 00:39:21.985
I was having challenges

00:39:22.065 --> 00:39:23.405
with covering because I'm

00:39:23.445 --> 00:39:24.126
trying to do some of this

00:39:24.186 --> 00:39:25.646
semi maternity leave thing

00:39:25.706 --> 00:39:26.927
and they just want some

00:39:27.047 --> 00:39:27.867
they just want someone to

00:39:27.887 --> 00:39:29.827
come to exercise with the

00:39:30.086 --> 00:39:31.148
uh the older family member

00:39:32.108 --> 00:39:33.168
Five days a week, okay?

00:39:33.708 --> 00:39:35.630
I had to pay a therapist a

00:39:36.190 --> 00:39:37.431
while ago a little bit extra.

00:39:37.452 --> 00:39:38.893
So instead of $80 a visit,

00:39:38.952 --> 00:39:39.672
it was $90 a visit.

00:39:39.713 --> 00:39:41.014
Then I said, hey,

00:39:41.454 --> 00:39:42.315
I need you to see this

00:39:43.034 --> 00:39:44.416
client as much as possible.

00:39:44.456 --> 00:39:45.617
Like I said, pick a number.

00:39:45.677 --> 00:39:46.697
Like what's your number?

00:39:46.898 --> 00:39:47.918
That'll be a no brainer for

00:39:47.938 --> 00:39:48.478
you to come do this.

00:39:48.518 --> 00:39:50.239
He goes $130 a visit because

00:39:50.280 --> 00:39:52.081
obviously we're charging like 250 a visit,

00:39:52.141 --> 00:39:52.282
right?

00:39:52.742 --> 00:39:54.842
So the therapist says $130 a visit.

00:39:54.862 --> 00:39:55.824
I go, okay, done.

00:39:56.344 --> 00:39:58.945
So he starts seeing this client three,

00:39:59.005 --> 00:39:59.907
four, five days a week.

00:40:00.889 --> 00:40:01.831
for about a month or two.

00:40:02.253 --> 00:40:03.155
And then the therapist says,

00:40:03.175 --> 00:40:04.137
because the therapist lives

00:40:04.177 --> 00:40:05.822
in Manhattan and this other client is

00:40:06.996 --> 00:40:07.456
in Brooklyn,

00:40:07.496 --> 00:40:08.438
somewhere kind of out of the way.

00:40:08.918 --> 00:40:09.599
So the therapist says,

00:40:09.659 --> 00:40:10.639
I want to stay in Manhattan.

00:40:10.918 --> 00:40:12.739
I'm getting my Manhattan caseload busy.

00:40:12.940 --> 00:40:13.601
So I don't want to go to

00:40:13.621 --> 00:40:14.460
Brooklyn anymore because

00:40:14.501 --> 00:40:15.942
this client is kind of out of the way.

00:40:16.001 --> 00:40:17.242
And I know you paid me extra

00:40:17.262 --> 00:40:18.143
because of the walk from

00:40:18.182 --> 00:40:19.384
the subway and all that.

00:40:19.824 --> 00:40:20.063
Okay.

00:40:20.385 --> 00:40:21.224
So then I lost him.

00:40:21.364 --> 00:40:23.206
I have tried Jimmy and Tony,

00:40:23.365 --> 00:40:25.086
guys and gals listening,

00:40:25.186 --> 00:40:26.568
physical therapists, purists listening.

00:40:26.967 --> 00:40:29.030
I have tried to get more

00:40:29.250 --> 00:40:30.429
therapists either hired.

00:40:30.530 --> 00:40:31.371
I've gone on LinkedIn.

00:40:31.650 --> 00:40:32.931
I've contacted PTAs.

00:40:33.251 --> 00:40:35.152
I've contacted PTAs on LinkedIn, called,

00:40:35.193 --> 00:40:35.952
sending them messages.

00:40:36.974 --> 00:40:37.675
It's been challenging.

00:40:37.974 --> 00:40:38.775
So this is what I did.

00:40:39.815 --> 00:40:40.637
I told the family, hey,

00:40:40.737 --> 00:40:41.518
we're going to we're going

00:40:41.557 --> 00:40:42.878
to hire a personal trainer.

00:40:43.259 --> 00:40:44.099
I'm going to handle everything.

00:40:44.840 --> 00:40:46.541
And we did two different.

00:40:46.842 --> 00:40:47.822
I picked two different companies.

00:40:47.943 --> 00:40:49.443
The first assessment was free.

00:40:50.925 --> 00:40:52.447
So I went on.

00:40:52.626 --> 00:40:53.467
This was a couple of weeks

00:40:53.507 --> 00:40:54.068
ago or whatever.

00:40:54.748 --> 00:40:56.829
I went to the normal visit

00:40:56.849 --> 00:40:58.331
time with this client who

00:40:58.512 --> 00:40:59.472
has been in our practice

00:40:59.512 --> 00:41:00.293
for almost four years.

00:41:00.333 --> 00:41:00.753
They love us.

00:41:01.827 --> 00:41:03.208
We can get into how we

00:41:03.347 --> 00:41:04.347
retain clients or whatever,

00:41:04.387 --> 00:41:06.389
but the family just wants

00:41:06.548 --> 00:41:08.170
the family member to move.

00:41:08.550 --> 00:41:10.010
So then I said, okay,

00:41:10.050 --> 00:41:10.789
let's try these two

00:41:10.891 --> 00:41:11.871
personal training companies.

00:41:12.570 --> 00:41:13.711
I'm gonna manage the whole thing.

00:41:15.152 --> 00:41:16.112
You're gonna continue to pay

00:41:16.152 --> 00:41:18.132
me the same rate.

00:41:18.833 --> 00:41:19.693
So here's some numbers.

00:41:21.010 --> 00:41:22.811
I bought, we go through two,

00:41:22.871 --> 00:41:23.891
two different companies.

00:41:23.972 --> 00:41:26.434
The first got, the first trainer was okay.

00:41:26.474 --> 00:41:27.856
The next one was like really great.

00:41:28.275 --> 00:41:29.597
And then, so we go, okay,

00:41:29.617 --> 00:41:30.677
I'm going to buy a $24, 24 visit package.

00:41:30.697 --> 00:41:31.057
It was like 1995.

00:41:31.097 --> 00:41:32.199
It came out to like $83 a session.

00:41:32.219 --> 00:41:32.639
I'm charging 250.

00:41:32.699 --> 00:41:33.079
Great margin.

00:41:43.740 --> 00:41:45.945
And I want to say it now and

00:41:46.005 --> 00:41:47.949
loud and proud that this

00:41:48.010 --> 00:41:49.974
personal training company, these trainers,

00:41:50.034 --> 00:41:51.077
the owner of the company,

00:41:51.237 --> 00:41:52.380
the owner is getting a little margin.

00:41:52.701 --> 00:41:53.643
The trainer is happy.

00:41:54.797 --> 00:41:56.318
And it's like, I'm looking at this, like,

00:41:56.338 --> 00:41:57.259
this is genius.

00:41:57.378 --> 00:41:59.079
And it's not, it's not through insurance.

00:41:59.099 --> 00:41:59.699
So it doesn't matter.

00:42:00.099 --> 00:42:01.161
Like, and it's not right now.

00:42:01.201 --> 00:42:02.121
It's not medically necessary.

00:42:02.521 --> 00:42:05.302
If he has a setback, some pain, injury,

00:42:05.342 --> 00:42:06.003
a fall, whatever,

00:42:06.422 --> 00:42:08.503
we'll either myself or we'll,

00:42:08.623 --> 00:42:09.523
we'll install a physical

00:42:09.543 --> 00:42:11.085
therapist back into the plan of care,

00:42:11.125 --> 00:42:12.625
back into the household and

00:42:12.664 --> 00:42:14.025
not have the personal trainer there.

00:42:14.186 --> 00:42:16.626
But my comment on this is this,

00:42:16.746 --> 00:42:17.467
these personal training

00:42:17.507 --> 00:42:19.507
companies are hungry and

00:42:19.547 --> 00:42:20.349
they're hungrier.

00:42:21.554 --> 00:42:22.235
Dare I say,

00:42:23.436 --> 00:42:25.077
they are hungrier than the

00:42:25.117 --> 00:42:26.619
doctors of physical therapy out there.

00:42:28.061 --> 00:42:29.601
It's unfortunate, but it is what it is.

00:42:31.164 --> 00:42:31.943
Well, you know,

00:42:32.425 --> 00:42:34.146
I've shared ideas similar

00:42:34.186 --> 00:42:36.128
to that where I've talked

00:42:36.188 --> 00:42:37.989
about finding LMT.

00:42:38.130 --> 00:42:41.893
So we're not a manual heavy clinic,

00:42:42.393 --> 00:42:43.795
but obviously we know there

00:42:43.815 --> 00:42:45.536
are clients who want manual therapy.

00:42:46.277 --> 00:42:48.458
It's easier for me to hire an LMT.

00:42:48.898 --> 00:42:49.878
But one of the things that I

00:42:49.918 --> 00:42:51.858
had done for a while was I

00:42:51.898 --> 00:42:54.260
would reach out to local LMTs that I know,

00:42:54.280 --> 00:42:55.519
that I trust, that I like,

00:42:55.539 --> 00:42:56.740
that I built rapport with.

00:42:57.181 --> 00:42:57.681
I asked them,

00:42:57.760 --> 00:43:00.641
what's a six visit package for you guys?

00:43:01.161 --> 00:43:03.382
Can you give me a discount on that?

00:43:03.422 --> 00:43:04.983
And I will sell that package for you.

00:43:05.663 --> 00:43:07.744
And so similar, a little bit different,

00:43:07.824 --> 00:43:08.744
but basically that's

00:43:08.784 --> 00:43:10.326
something where I don't

00:43:10.385 --> 00:43:12.387
have to put the money up up front.

00:43:12.927 --> 00:43:14.307
I can sell the package.

00:43:14.347 --> 00:43:15.489
Let's say it's $100 a

00:43:16.188 --> 00:43:18.190
massage and they're going

00:43:18.210 --> 00:43:19.952
to sell it to me for 70 a massage,

00:43:19.972 --> 00:43:20.552
but then they're going to

00:43:20.592 --> 00:43:21.552
get to keep the client

00:43:21.793 --> 00:43:23.172
after the six visit package

00:43:23.233 --> 00:43:25.255
is done anyway at the $100 rate.

00:43:26.474 --> 00:43:28.255
And what's really exciting about that,

00:43:28.295 --> 00:43:29.856
and I don't know if you're doing this,

00:43:30.438 --> 00:43:32.059
I didn't hear it in the details.

00:43:33.018 --> 00:43:34.119
What I would do is I would

00:43:34.199 --> 00:43:36.422
sell the six visit package

00:43:36.501 --> 00:43:37.922
to one of my clients,

00:43:38.382 --> 00:43:40.143
but I wouldn't pay the LMT

00:43:40.284 --> 00:43:42.826
until each of those sessions was used.

00:43:43.286 --> 00:43:44.806
So I would get the money up front.

00:43:45.307 --> 00:43:47.728
And if, which we know happens, you know,

00:43:47.809 --> 00:43:49.731
they buy six and they use four.

00:43:50.271 --> 00:43:51.931
I've only paid for four.

00:43:52.211 --> 00:43:54.653
I've got that extra two on

00:43:54.753 --> 00:43:57.576
loan until or if they ever use it.

00:43:57.675 --> 00:43:58.396
That's the only way,

00:43:58.416 --> 00:43:59.797
like back in the day with Groupon,

00:43:59.817 --> 00:44:00.797
I used to make a ton of

00:44:00.818 --> 00:44:01.699
money with Groupon.

00:44:02.418 --> 00:44:03.420
Even though I didn't make

00:44:03.500 --> 00:44:05.161
any money on the actual

00:44:05.641 --> 00:44:07.463
massage sessions that were used,

00:44:08.025 --> 00:44:09.505
I made all my money on the

00:44:09.505 --> 00:44:11.047
22% of massage sessions

00:44:11.088 --> 00:44:12.409
that were sold and never used.

00:44:13.050 --> 00:44:15.311
So there's all these little

00:44:15.431 --> 00:44:17.012
nuances to how this works.

00:44:17.773 --> 00:44:19.436
Um, not to go off track,

00:44:19.516 --> 00:44:21.539
but the other option here

00:44:22.219 --> 00:44:23.902
is just changing other

00:44:24.003 --> 00:44:25.003
elements in what we do.

00:44:25.063 --> 00:44:25.284
You know,

00:44:25.344 --> 00:44:26.967
I get so much resistance on

00:44:27.047 --> 00:44:28.068
single unit visits,

00:44:28.568 --> 00:44:30.090
but like if I was sitting

00:44:30.130 --> 00:44:31.612
there with a three,

00:44:31.713 --> 00:44:33.255
four or five week wait list, um,

00:44:33.615 --> 00:44:36.197
I would look at changing the model of care,

00:44:36.297 --> 00:44:37.920
how I'm delivering services.

00:44:38.480 --> 00:44:39.820
Is it possible that I could

00:44:39.880 --> 00:44:42.202
compress maybe a four unit

00:44:42.242 --> 00:44:43.764
session into a single unit

00:44:43.804 --> 00:44:45.125
session or maybe do four

00:44:45.224 --> 00:44:46.505
single unit sessions

00:44:46.927 --> 00:44:48.427
instead of one four unit

00:44:48.467 --> 00:44:49.668
sessions across the week?

00:44:49.728 --> 00:44:50.989
Now, I'm not mobile.

00:44:51.030 --> 00:44:52.251
I have a brick and mortar clinic,

00:44:52.271 --> 00:44:53.211
so it's easy for me to

00:44:53.251 --> 00:44:54.913
control capacity in that sense.

00:44:55.512 --> 00:44:56.914
Is it possible that I could

00:44:56.954 --> 00:44:59.255
deliver other services to an individual?

00:45:00.148 --> 00:45:01.369
who maybe doesn't need

00:45:01.389 --> 00:45:03.989
one-on-one care with a therapist,

00:45:04.170 --> 00:45:06.050
but more than once a week,

00:45:06.090 --> 00:45:07.112
but they still would

00:45:07.152 --> 00:45:08.393
benefit from just coming in

00:45:08.413 --> 00:45:09.052
and working out.

00:45:09.612 --> 00:45:11.574
Like so many of my caseload,

00:45:11.875 --> 00:45:12.835
they just need to move.

00:45:13.114 --> 00:45:14.295
They just need to exercise.

00:45:14.335 --> 00:45:14.916
They need to build

00:45:14.976 --> 00:45:17.117
confidence and feel like

00:45:17.157 --> 00:45:18.318
they're doing something.

00:45:18.418 --> 00:45:20.338
I think Jimmy said something about like,

00:45:20.820 --> 00:45:21.059
yeah,

00:45:21.139 --> 00:45:23.521
giving them something to occupy them

00:45:23.601 --> 00:45:24.961
so they have a locus of

00:45:25.041 --> 00:45:26.302
control that's internal.

00:45:27.043 --> 00:45:28.985
So much of what we can deliver,

00:45:29.065 --> 00:45:29.865
even if we don't have the

00:45:29.905 --> 00:45:32.969
capacity for billable minutes, is, look,

00:45:33.028 --> 00:45:34.489
let's give these patients

00:45:34.510 --> 00:45:36.192
something that empowers them,

00:45:36.771 --> 00:45:37.913
lets them see that they're

00:45:37.952 --> 00:45:39.474
moving the needle forward,

00:45:39.974 --> 00:45:40.976
even if it's just riding a

00:45:41.016 --> 00:45:41.956
bike for 20 minutes.

00:45:42.416 --> 00:45:43.677
You know, I've got a patient right now.

00:45:44.099 --> 00:45:45.300
He's been a patient a little

00:45:45.360 --> 00:45:46.181
over a year and a half.

00:45:47.021 --> 00:45:50.244
He's a single individual patient.

00:45:51.175 --> 00:45:52.735
He comes in and rides the

00:45:52.755 --> 00:45:53.876
bike for 60 minutes.

00:45:54.516 --> 00:45:56.478
He feels amazing riding the

00:45:56.518 --> 00:45:57.577
bike for 60 minutes.

00:45:58.159 --> 00:45:59.458
He feels like he's in

00:45:59.539 --> 00:46:00.960
control of a chronic

00:46:01.000 --> 00:46:02.320
condition that he's dealing with.

00:46:03.822 --> 00:46:04.902
It doesn't cost me anything

00:46:04.961 --> 00:46:07.583
for him to come in and ride the bike.

00:46:08.764 --> 00:46:09.804
But he's there,

00:46:10.344 --> 00:46:12.666
so when the time comes for skilled care,

00:46:12.686 --> 00:46:14.567
when the time comes for billable units,

00:46:14.706 --> 00:46:15.807
I can deliver them.

00:46:16.467 --> 00:46:17.668
But if I don't need to,

00:46:17.688 --> 00:46:19.911
he can just come in and ride the bike,

00:46:20.150 --> 00:46:20.472
you know?

00:46:20.532 --> 00:46:21.072
And so like,

00:46:21.813 --> 00:46:24.175
we tend to go down these other

00:46:24.275 --> 00:46:25.496
roads of what's always been

00:46:25.516 --> 00:46:26.556
done and what we think

00:46:26.577 --> 00:46:28.119
we're supposed to do and all this stuff.

00:46:28.139 --> 00:46:29.460
And we close the door on

00:46:29.920 --> 00:46:31.501
other opportunities that are out there.

00:46:31.722 --> 00:46:32.382
What were you going to say?

00:46:32.402 --> 00:46:33.764
I think I cut you off, somebody.

00:46:34.974 --> 00:46:36.797
I was going to ask or or say

00:46:36.817 --> 00:46:37.336
to both of you,

00:46:37.697 --> 00:46:38.518
the clinics that are

00:46:38.559 --> 00:46:40.161
successful three years from now,

00:46:40.240 --> 00:46:41.001
because right now we're

00:46:41.121 --> 00:46:42.123
everybody's in the same.

00:46:42.322 --> 00:46:43.804
We're all we're all in the same storm.

00:46:44.045 --> 00:46:45.166
We're just not the same boats.

00:46:45.786 --> 00:46:46.007
Right.

00:46:46.047 --> 00:46:46.947
That's the way to look at it.

00:46:47.813 --> 00:46:49.094
The clinics that are gonna

00:46:49.114 --> 00:46:50.494
see success in three years,

00:46:50.673 --> 00:46:51.375
what do you think they'll

00:46:51.394 --> 00:46:53.516
have implemented from what

00:46:53.536 --> 00:46:54.976
we talked about today?

00:46:54.996 --> 00:46:55.436
Ooh,

00:46:55.817 --> 00:46:56.836
clinics are afraid to use techs

00:46:56.856 --> 00:46:57.378
because they don't wanna

00:46:57.418 --> 00:46:58.418
take any chances and feel

00:46:58.438 --> 00:46:59.338
that they're gonna do something wrong.

00:46:59.719 --> 00:46:59.978
Listen,

00:47:00.619 --> 00:47:01.940
I thought of this when I saw people,

00:47:02.500 --> 00:47:04.041
PTs sort of chiming in and

00:47:04.420 --> 00:47:05.460
instantly jumping on, well,

00:47:05.481 --> 00:47:06.742
PTAs don't know this and

00:47:06.762 --> 00:47:07.963
they're not as good as me at this.

00:47:08.882 --> 00:47:10.784
Um, that reflects on you as a teacher,

00:47:10.824 --> 00:47:12.485
in my opinion, that reflects on you as,

00:47:12.625 --> 00:47:12.905
okay.

00:47:13.045 --> 00:47:14.005
I mean, like you said,

00:47:14.166 --> 00:47:15.306
hire for personality.

00:47:15.346 --> 00:47:16.507
I can teach you skills.

00:47:17.166 --> 00:47:18.847
So by saying like PTAs don't

00:47:18.867 --> 00:47:21.068
get this level of education, number one,

00:47:21.108 --> 00:47:21.710
do you know that?

00:47:22.710 --> 00:47:23.632
Different schools teach

00:47:23.652 --> 00:47:24.371
different that different

00:47:24.391 --> 00:47:25.072
schools are better.

00:47:25.132 --> 00:47:25.632
Some are better.

00:47:25.672 --> 00:47:26.172
Some are worse.

00:47:26.733 --> 00:47:27.534
And if you can't take

00:47:27.574 --> 00:47:28.454
someone to make them better,

00:47:28.635 --> 00:47:30.034
that means that you are an

00:47:30.155 --> 00:47:31.436
implementer and you're not

00:47:31.456 --> 00:47:32.896
a communicator or a unifier.

00:47:33.117 --> 00:47:34.697
And that is why you have less value.

00:47:34.717 --> 00:47:35.559
I'm going to say that again

00:47:35.898 --> 00:47:36.639
for the people watching the

00:47:36.659 --> 00:47:37.639
live stream with the graphic.

00:47:38.019 --> 00:47:39.240
If you're staying down here

00:47:39.320 --> 00:47:40.742
at implementation,

00:47:41.141 --> 00:47:42.643
the only way to scale is do

00:47:42.702 --> 00:47:44.463
more work nights, work weekends.

00:47:45.628 --> 00:47:46.771
Now you could raise your prices.

00:47:46.791 --> 00:47:48.572
I agree with that.

00:47:48.592 --> 00:47:49.594
I agree with Dave.

00:47:49.655 --> 00:47:50.775
But if we're saying,

00:47:50.817 --> 00:47:51.557
if you can be better at

00:47:51.637 --> 00:47:52.920
unification and communication,

00:47:54.143 --> 00:47:56.146
and imagination, you can have more value.

00:47:57.407 --> 00:47:59.449
Do you think that the people

00:47:59.489 --> 00:48:00.789
that jump on this,

00:48:00.969 --> 00:48:02.030
utilizing people that are

00:48:02.070 --> 00:48:04.773
not PTs will have further success?

00:48:04.813 --> 00:48:07.255
That feels like the low effort,

00:48:07.576 --> 00:48:08.277
high reward,

00:48:08.336 --> 00:48:10.498
the quick win thing to do right now.

00:48:10.659 --> 00:48:13.181
Or I should say, maybe it's a high effort,

00:48:13.221 --> 00:48:14.202
high reward because it's

00:48:14.242 --> 00:48:15.143
investing in people,

00:48:15.523 --> 00:48:16.965
just a different professional.

00:48:18.541 --> 00:48:20.222
I think we saw farmers, right?

00:48:20.262 --> 00:48:22.384
They went from using a horse

00:48:22.443 --> 00:48:25.525
to pull a plow to having a tractor.

00:48:26.405 --> 00:48:28.246
Technology is always going

00:48:28.326 --> 00:48:30.387
to increase the efficiency,

00:48:30.467 --> 00:48:32.108
the effectiveness, the production.

00:48:32.128 --> 00:48:34.528
I think that's where three

00:48:34.548 --> 00:48:36.949
to five years is going to be technology.

00:48:37.010 --> 00:48:37.710
We're going to use

00:48:37.769 --> 00:48:39.010
technology to improve the

00:48:39.030 --> 00:48:40.150
patient care experience,

00:48:40.590 --> 00:48:42.512
whether that be providing

00:48:42.632 --> 00:48:44.413
things that they can do on their own,

00:48:44.492 --> 00:48:46.034
empowering individuals to...

00:48:47.094 --> 00:48:47.393
Jimmy,

00:48:47.454 --> 00:48:49.594
we talked about like the apps that

00:48:49.635 --> 00:48:50.655
are available right now

00:48:50.715 --> 00:48:51.757
that allow you to do more

00:48:51.817 --> 00:48:52.936
therapy on your own.

00:48:53.438 --> 00:48:54.637
The app combined with the

00:48:54.677 --> 00:48:56.378
human was the best outcome

00:48:56.518 --> 00:48:57.800
rather than the app alone.

00:48:58.360 --> 00:49:00.742
So that's really where I see

00:49:00.782 --> 00:49:02.902
it going is the adoption of technology,

00:49:02.943 --> 00:49:04.324
getting comfortable with how it works.

00:49:04.884 --> 00:49:08.005
Do you know the most efficient, I guess,

00:49:08.126 --> 00:49:10.467
calorie per output of watt

00:49:10.628 --> 00:49:11.688
animal on the planet in

00:49:11.748 --> 00:49:13.411
terms of like the most efficient,

00:49:13.690 --> 00:49:15.092
like endurance animal,

00:49:15.172 --> 00:49:16.193
the animal that burns for

00:49:16.233 --> 00:49:17.994
every one calorie, they go the furthest.

00:49:19.235 --> 00:49:19.414
No.

00:49:19.936 --> 00:49:20.715
Human on a bicycle.

00:49:21.297 --> 00:49:23.318
Like human was like, I forget the study,

00:49:23.378 --> 00:49:23.898
but it was the,

00:49:23.998 --> 00:49:24.739
I forget what the most

00:49:25.400 --> 00:49:26.661
efficient animal was.

00:49:27.141 --> 00:49:28.001
And humans were like 83rd.

00:49:29.666 --> 00:49:30.927
You put a bicycle.

00:49:31.047 --> 00:49:33.530
It is number one and it's not close.

00:49:33.931 --> 00:49:35.192
We still have to put in effort.

00:49:35.431 --> 00:49:37.014
But what can you get out of it?

00:49:37.414 --> 00:49:39.416
Stop focusing on just the input.

00:49:39.456 --> 00:49:39.596
Right.

00:49:39.635 --> 00:49:40.777
We can only do so much.

00:49:40.797 --> 00:49:42.318
Let's say let's say there's a rule.

00:49:42.358 --> 00:49:44.280
You can't work more than 40 hours a week.

00:49:44.501 --> 00:49:44.981
Can't do it.

00:49:45.081 --> 00:49:45.862
Let's just pretend.

00:49:46.322 --> 00:49:47.764
Pretend some rule somewhere

00:49:47.784 --> 00:49:49.204
in Washington says you can't do it.

00:49:49.646 --> 00:49:50.246
What do you do then?

00:49:51.507 --> 00:49:52.327
My rule is you're allowed to

00:49:52.347 --> 00:49:53.570
complain for 24 hours,

00:49:53.889 --> 00:49:54.610
and then you have to start

00:49:54.650 --> 00:49:55.532
doing something about it.

00:49:55.572 --> 00:49:56.952
So you have 24 hours to sulk,

00:49:57.213 --> 00:49:58.875
which I take all the time,

00:49:58.976 --> 00:49:59.835
usually with a bottle of wine,

00:50:00.177 --> 00:50:01.358
and then you have to get to work.

00:50:02.820 --> 00:50:03.880
I think the embracing of the

00:50:03.920 --> 00:50:05.081
PTA is going to be something,

00:50:05.222 --> 00:50:05.603
I don't know,

00:50:05.943 --> 00:50:06.603
could be one of the most

00:50:06.643 --> 00:50:07.304
important things in the

00:50:07.324 --> 00:50:08.184
next three years to keep

00:50:08.224 --> 00:50:09.186
clinics in business and

00:50:09.226 --> 00:50:09.726
make them valuable.

00:50:11.530 --> 00:50:12.710
Dave, you keep me updating.

00:50:12.751 --> 00:50:13.331
What do you see?

00:50:13.351 --> 00:50:14.811
At the same time, Jimmy,

00:50:14.851 --> 00:50:15.773
you know that the

00:50:16.012 --> 00:50:17.974
reimbursement for PTAs is being cut,

00:50:18.034 --> 00:50:18.235
right?

00:50:18.315 --> 00:50:19.496
Like over the past several

00:50:19.516 --> 00:50:20.056
years or whatever.

00:50:20.115 --> 00:50:23.458
So in the bigger practices,

00:50:24.239 --> 00:50:25.199
I don't know if that's

00:50:25.239 --> 00:50:26.181
something that they want to do.

00:50:26.221 --> 00:50:26.400
I mean,

00:50:26.420 --> 00:50:28.181
they're all optimized for billing

00:50:28.222 --> 00:50:29.382
and coding and, you know,

00:50:29.503 --> 00:50:31.505
maximizing units, you know, bill per day.

00:50:31.525 --> 00:50:32.425
But they make less, right?

00:50:32.565 --> 00:50:34.387
Someone's got to math this for me.

00:50:34.427 --> 00:50:35.286
So I understand that they're

00:50:35.306 --> 00:50:36.829
going to bill less, but they make less,

00:50:36.969 --> 00:50:37.168
right?

00:50:37.188 --> 00:50:37.268
Yeah.

00:50:38.452 --> 00:50:40.215
I would argue it's questionable.

00:50:40.817 --> 00:50:43.320
And this goes back to,

00:50:43.400 --> 00:50:44.983
are you being paid for the job?

00:50:45.103 --> 00:50:46.405
Are you being paid for your

00:50:46.445 --> 00:50:47.385
qualifications?

00:50:48.387 --> 00:50:49.710
I think the argument when

00:50:49.750 --> 00:50:51.192
this all started happening

00:50:51.873 --> 00:50:54.217
should have been, look, Medicare.

00:50:54.817 --> 00:50:56.197
are you paying for the

00:50:56.297 --> 00:50:57.719
intervention or are you

00:50:57.739 --> 00:50:58.820
paying for the person

00:50:58.860 --> 00:51:00.101
delivering the intervention?

00:51:00.221 --> 00:51:01.561
Clearly the decision was made.

00:51:01.601 --> 00:51:02.222
They're paying for the

00:51:02.242 --> 00:51:04.364
person delivering the intervention.

00:51:05.643 --> 00:51:07.204
So to Jimmy's question,

00:51:07.286 --> 00:51:08.746
like in my facility,

00:51:09.327 --> 00:51:10.907
PTAs earn just about the

00:51:10.947 --> 00:51:12.128
same amount as the PT.

00:51:13.710 --> 00:51:15.471
It really has gotten hard.

00:51:16.452 --> 00:51:17.652
The numbers that I've seen

00:51:17.833 --> 00:51:19.653
publicly posted is the PTA

00:51:19.693 --> 00:51:21.074
is generating or earning

00:51:21.594 --> 00:51:24.237
about 80% of what the PT is earning.

00:51:24.896 --> 00:51:26.117
I know that in home health,

00:51:26.217 --> 00:51:27.878
PTAs are making a ton of money.

00:51:28.880 --> 00:51:30.260
I'm sure there's going to be

00:51:30.681 --> 00:51:32.382
cases out there where PTAs

00:51:32.442 --> 00:51:35.344
are still making $20, $25 an hour.

00:51:35.384 --> 00:51:36.465
But generally speaking,

00:51:37.344 --> 00:51:39.005
PTAs are pretty close to

00:51:39.045 --> 00:51:40.166
what PTs are making.

00:51:40.206 --> 00:51:41.268
And the main reason is

00:51:41.327 --> 00:51:44.329
because the units are valued the same.

00:51:44.889 --> 00:51:46.532
or at least historically they had been.

00:51:47.152 --> 00:51:49.454
Now you've got that 15% reduction,

00:51:49.494 --> 00:51:50.896
which is a little bit nuanced.

00:51:50.956 --> 00:51:52.818
It's not actually 15% of the

00:51:53.318 --> 00:51:54.619
whole allowed amount.

00:51:55.119 --> 00:51:55.820
For Medicare,

00:51:55.920 --> 00:51:58.722
it's 15% reduction of the 80%

00:51:58.722 --> 00:51:59.704
that Medicare pays.

00:52:00.684 --> 00:52:01.365
Even with that,

00:52:02.375 --> 00:52:03.215
I would tell you,

00:52:03.235 --> 00:52:08.518
I think the real value in the PTA is one,

00:52:08.538 --> 00:52:10.099
you get the right one.

00:52:10.139 --> 00:52:11.239
Their clinical skill is

00:52:11.440 --> 00:52:12.880
equal to a PT when it comes

00:52:12.920 --> 00:52:14.021
to patient care delivery.

00:52:14.701 --> 00:52:15.041
Two,

00:52:15.641 --> 00:52:17.722
they tend to be more accessible than

00:52:17.762 --> 00:52:18.682
the PT right now,

00:52:19.023 --> 00:52:21.565
just because it's a shorter

00:52:21.965 --> 00:52:23.324
education cycle.

00:52:23.425 --> 00:52:24.885
They're graduating as many

00:52:24.925 --> 00:52:26.567
or more of them.

00:52:26.746 --> 00:52:28.268
Three, I think the PTA,

00:52:28.307 --> 00:52:29.849
because of the nature of

00:52:30.509 --> 00:52:32.230
The person going into PTA,

00:52:32.250 --> 00:52:35.492
you're kind of conditioned to be, okay,

00:52:35.532 --> 00:52:36.532
I'm part of the team.

00:52:37.333 --> 00:52:38.954
I'm going to follow the plan of care.

00:52:39.034 --> 00:52:40.536
So if you're a PT who wants

00:52:40.596 --> 00:52:42.476
somebody to kind of do it your way,

00:52:42.496 --> 00:52:44.257
the PTA is going to be more

00:52:44.297 --> 00:52:45.099
suited to do that.

00:52:45.559 --> 00:52:47.079
I could never hire Dave and

00:52:47.119 --> 00:52:48.240
expect Dave to treat a

00:52:48.280 --> 00:52:49.961
patient the way I treat a patient.

00:52:50.661 --> 00:52:53.204
But typically PTAs are going

00:52:53.284 --> 00:52:55.686
to follow my plan of care.

00:52:55.746 --> 00:52:56.487
Like that's the way the

00:52:56.527 --> 00:52:57.688
system has been designed.

00:52:58.329 --> 00:53:01.092
So I think there are a lot of advantages,

00:53:01.333 --> 00:53:03.054
but I don't think dollar

00:53:03.135 --> 00:53:04.976
savings is really the main

00:53:05.036 --> 00:53:07.298
advantage when it comes to PT versus PTA.

00:53:09.581 --> 00:53:09.760
Okay.

00:53:09.780 --> 00:53:09.862
Yeah.

00:53:11.018 --> 00:53:12.201
We've got nine minutes left

00:53:12.260 --> 00:53:13.202
or seven minutes left.

00:53:13.302 --> 00:53:15.364
I did want to reach out and

00:53:15.403 --> 00:53:16.025
talk about something we

00:53:16.065 --> 00:53:16.985
talked about last week,

00:53:17.025 --> 00:53:18.867
which was the hawk to a girl.

00:53:19.568 --> 00:53:19.688
Now,

00:53:19.728 --> 00:53:21.371
have you seen what she's been doing

00:53:21.391 --> 00:53:22.552
online?

00:53:22.592 --> 00:53:24.494
Number one, she had a company.

00:53:24.534 --> 00:53:26.315
We mentioned that she's come

00:53:26.356 --> 00:53:27.496
up in my feed and I don't

00:53:27.577 --> 00:53:29.378
follow her a dozen times.

00:53:30.693 --> 00:53:31.634
She's doing the tours.

00:53:31.934 --> 00:53:33.755
She's doing the concert and bar tours.

00:53:34.056 --> 00:53:36.938
Catch me in Sacramento next

00:53:37.018 --> 00:53:38.398
Tuesday at the concert.

00:53:38.918 --> 00:53:40.320
And she's doing a couple of

00:53:40.380 --> 00:53:43.722
different brand deals with

00:53:43.922 --> 00:53:45.744
some things that fit her personality.

00:53:46.164 --> 00:53:48.346
So concerts and bars and things like that.

00:53:49.166 --> 00:53:50.827
Saw a brilliant video of her

00:53:50.867 --> 00:53:51.807
because they probably sat

00:53:51.827 --> 00:53:52.708
down with this management

00:53:52.748 --> 00:53:54.449
company and said, and what I said,

00:53:54.829 --> 00:53:55.431
tell me about you.

00:53:55.451 --> 00:53:56.210
I don't know anything about

00:53:56.251 --> 00:53:57.351
you besides the one thing

00:53:57.371 --> 00:53:58.572
you spit out of your mouth.

00:53:59.715 --> 00:54:00.697
Outside of a bar.

00:54:00.717 --> 00:54:02.980
And it came up in that

00:54:03.019 --> 00:54:03.960
conversation I'm getting

00:54:03.981 --> 00:54:04.981
with this management company.

00:54:05.121 --> 00:54:05.742
I love pets.

00:54:05.802 --> 00:54:06.443
I love dogs.

00:54:06.784 --> 00:54:07.844
So there's a video of her

00:54:08.166 --> 00:54:09.547
going and spending 500

00:54:09.547 --> 00:54:11.009
bucks at PetSmart and then

00:54:11.048 --> 00:54:13.351
going to a shelter and, you know,

00:54:13.431 --> 00:54:15.954
giving the dogs treats and doing that.

00:54:16.155 --> 00:54:16.434
Useless.

00:54:16.755 --> 00:54:17.396
Useless content.

00:54:17.416 --> 00:54:17.735
I mean, just...

00:54:18.297 --> 00:54:19.557
For bringing her a little

00:54:19.577 --> 00:54:20.818
bit back towards the middle

00:54:20.858 --> 00:54:22.601
so she's not just this girl.

00:54:22.681 --> 00:54:23.021
But, hey,

00:54:23.081 --> 00:54:24.782
if you've got that wave of attention,

00:54:25.222 --> 00:54:27.505
how long can this 16 minutes of fame go?

00:54:27.545 --> 00:54:28.346
So I thought that was a good

00:54:28.445 --> 00:54:29.847
idea on her part.

00:54:29.967 --> 00:54:32.869
I will also – this is like a wrap-up.

00:54:33.150 --> 00:54:34.130
I mentioned in the beginning

00:54:34.170 --> 00:54:35.771
that I got this alert when

00:54:35.791 --> 00:54:36.793
we started streaming.

00:54:36.932 --> 00:54:38.173
I now need to apparently pay

00:54:38.233 --> 00:54:42.077
to stream to X slash Twitter.

00:54:43.217 --> 00:54:44.400
I've never really jumped on

00:54:44.440 --> 00:54:45.481
a lot of the platforms

00:54:45.681 --> 00:54:46.661
while we're streaming to

00:54:46.702 --> 00:54:47.523
see what it looks like,

00:54:47.603 --> 00:54:48.724
but I decided to do that.

00:54:48.824 --> 00:54:49.525
Have you ever been on

00:54:49.585 --> 00:54:50.786
LinkedIn while you're streaming?

00:54:50.806 --> 00:54:51.688
Do you know what your

00:54:52.208 --> 00:54:53.550
LinkedIn profile looks like

00:54:53.590 --> 00:54:55.251
when you are streaming to LinkedIn?

00:54:55.692 --> 00:54:56.733
I didn't until today.

00:54:57.393 --> 00:54:58.514
They're doing the opposite.

00:54:58.735 --> 00:54:59.795
They're saying we're going

00:54:59.815 --> 00:55:01.117
to give you such a valuable

00:55:01.518 --> 00:55:02.559
great screenshot, Jimmy.

00:55:03.820 --> 00:55:05.282
essentially your banner,

00:55:05.322 --> 00:55:07.143
your header banner is now a

00:55:07.302 --> 00:55:09.364
TV screen while you're live streaming.

00:55:09.384 --> 00:55:10.244
So they are going in the

00:55:10.425 --> 00:55:11.425
other direction saying,

00:55:11.885 --> 00:55:13.586
not only do we want you to stream,

00:55:13.606 --> 00:55:14.427
we're not just going to put

00:55:14.467 --> 00:55:15.449
it in the feed.

00:55:15.949 --> 00:55:17.429
We're going to make your

00:55:17.590 --> 00:55:19.512
profile page a billboard.

00:55:19.552 --> 00:55:20.952
So it's the destination.

00:55:21.757 --> 00:55:22.639
So we see two different

00:55:22.659 --> 00:55:24.081
platforms going in two

00:55:24.121 --> 00:55:24.742
different directions.

00:55:24.922 --> 00:55:26.744
One is saying,

00:55:27.125 --> 00:55:29.387
similar to a clinic who has

00:55:29.427 --> 00:55:30.007
a long wait list,

00:55:30.289 --> 00:55:31.530
we know we've got a lot of attention.

00:55:31.550 --> 00:55:32.391
We know it's valuable.

00:55:32.711 --> 00:55:33.612
Now you've got to pay up if

00:55:33.652 --> 00:55:34.574
you want to keep doing it.

00:55:34.994 --> 00:55:36.275
The other is saying we want-

00:55:36.777 --> 00:55:37.436
They want more of it.

00:55:38.217 --> 00:55:39.820
So I thought that was a tale

00:55:39.840 --> 00:55:41.001
of two cities on two

00:55:41.021 --> 00:55:41.961
different social platforms

00:55:42.242 --> 00:55:43.063
and a hawk to a girl.

00:55:44.045 --> 00:55:46.487
I mean, X, Twitter, whatever.

00:55:46.507 --> 00:55:47.228
It's just, I guess,

00:55:47.248 --> 00:55:48.409
looking to monetize a little bit.

00:55:48.429 --> 00:55:50.472
They already have a lot of

00:55:50.532 --> 00:55:51.773
engagement where the native

00:55:52.253 --> 00:55:52.914
engagement is...

00:55:53.695 --> 00:55:55.255
Text and and or, you know,

00:55:55.295 --> 00:55:56.536
some memes like there's

00:55:56.697 --> 00:55:57.518
there's not there's not a

00:55:57.577 --> 00:55:58.898
ton of like video and

00:55:59.199 --> 00:56:00.340
pictures on the platform.

00:56:00.440 --> 00:56:02.822
It's mostly it's mostly text

00:56:02.862 --> 00:56:04.262
based or again, you know,

00:56:04.322 --> 00:56:05.603
memes or pictures or, you know,

00:56:06.684 --> 00:56:07.505
tweet threads or whatever.

00:56:07.525 --> 00:56:09.186
And then LinkedIn, you know,

00:56:09.668 --> 00:56:10.668
we've all seen it over the

00:56:10.688 --> 00:56:11.309
past couple of years,

00:56:11.349 --> 00:56:12.650
like trying to do more content.

00:56:12.670 --> 00:56:13.610
They want more content.

00:56:13.630 --> 00:56:14.891
They want more video, all of that.

00:56:15.512 --> 00:56:17.032
So that doesn't surprise me at all.

00:56:17.072 --> 00:56:18.293
I would love to hear Tony's

00:56:18.492 --> 00:56:20.114
thoughts on the differences

00:56:20.153 --> 00:56:23.014
between the two platforms and, you know,

00:56:23.074 --> 00:56:24.054
how other therapists or

00:56:24.135 --> 00:56:25.876
owners can utilize that.

00:56:26.556 --> 00:56:28.657
And I love the comparison, Jimmy.

00:56:29.554 --> 00:56:29.853
Yeah.

00:56:29.994 --> 00:56:30.295
You know,

00:56:30.434 --> 00:56:32.476
looking at our numbers and not

00:56:32.536 --> 00:56:33.438
being on Twitter,

00:56:34.057 --> 00:56:35.079
it looks like there was a

00:56:35.119 --> 00:56:36.960
lot of volume on Twitter,

00:56:37.041 --> 00:56:38.983
but I think Dave or Jimmy,

00:56:39.023 --> 00:56:41.085
somebody said could just be bots.

00:56:41.565 --> 00:56:43.027
Like even though you see

00:56:43.086 --> 00:56:44.208
this high view count,

00:56:44.668 --> 00:56:46.590
it could just be bots off of Twitter.

00:56:46.650 --> 00:56:48.952
So now a lot of that is wiped out.

00:56:49.072 --> 00:56:50.875
Now we have a true audience here.

00:56:50.894 --> 00:56:50.934
Um,

00:56:52.416 --> 00:56:54.797
But I just like these experiments.

00:56:54.898 --> 00:56:56.139
I like to see businesses

00:56:56.199 --> 00:56:57.641
that go in opposite directions.

00:56:57.760 --> 00:56:59.623
Dave and I go in opposite directions.

00:56:59.722 --> 00:57:00.983
Both of us are successful.

00:57:01.623 --> 00:57:03.485
I think we can learn lessons from both.

00:57:04.347 --> 00:57:06.088
That's the thing that excites me the most.

00:57:06.188 --> 00:57:07.289
You know, at heart,

00:57:07.869 --> 00:57:09.612
I just love the process and

00:57:09.652 --> 00:57:10.932
I love seeing how it goes.

00:57:11.492 --> 00:57:12.974
What are the closing thoughts?

00:57:13.375 --> 00:57:13.934
Parting shots.

00:57:13.974 --> 00:57:14.516
Dave, what do you got?

00:57:16.684 --> 00:57:17.304
Parting shots.

00:57:18.304 --> 00:57:18.764
Let's see.

00:57:18.905 --> 00:57:20.565
We covered a bunch of different things,

00:57:20.606 --> 00:57:23.606
but around the whole staffing crisis,

00:57:23.706 --> 00:57:26.027
I think it's still good and

00:57:26.987 --> 00:57:28.108
productive to have these

00:57:28.148 --> 00:57:29.028
types of conversations.

00:57:29.048 --> 00:57:30.409
So whether it's between owners,

00:57:30.469 --> 00:57:32.190
it's between physical therapists,

00:57:32.230 --> 00:57:33.391
other folks in the industry,

00:57:34.550 --> 00:57:36.271
this is the best way to navigate it,

00:57:36.291 --> 00:57:37.913
which is kind of trying to

00:57:37.992 --> 00:57:40.614
troubleshoot solutions and

00:57:41.014 --> 00:57:43.235
whether it's using, you know,

00:57:44.315 --> 00:57:46.657
unlicensed uh aides or or

00:57:46.777 --> 00:57:48.257
other folks on your team to

00:57:48.938 --> 00:57:49.518
carry out some of the

00:57:49.539 --> 00:57:50.300
services that are not

00:57:50.340 --> 00:57:51.300
medically necessary that

00:57:51.340 --> 00:57:53.382
are not uh billable or

00:57:53.443 --> 00:57:55.244
covered by insurance that

00:57:55.284 --> 00:57:57.985
makes sense um I i think

00:57:58.226 --> 00:57:59.427
the best way for us to

00:57:59.527 --> 00:58:00.849
navigate out of this is to

00:58:00.869 --> 00:58:03.271
be open and to like tony

00:58:03.291 --> 00:58:03.971
said whether it's a

00:58:04.030 --> 00:58:05.592
combination of tech and

00:58:05.773 --> 00:58:07.853
apps and some technology

00:58:08.014 --> 00:58:09.155
and the human connection I

00:58:09.155 --> 00:58:12.177
100 agree with that I think our clientele

00:58:13.280 --> 00:58:15.081
only really wants and needs

00:58:15.181 --> 00:58:16.742
the human interaction

00:58:17.382 --> 00:58:18.443
across the country and all

00:58:18.463 --> 00:58:19.322
these other practices.

00:58:19.342 --> 00:58:21.463
I can see the value of apps

00:58:21.483 --> 00:58:23.224
and technology as a way to

00:58:23.324 --> 00:58:26.947
assist and the apps and the

00:58:27.166 --> 00:58:28.827
technology will definitely, I just,

00:58:28.967 --> 00:58:29.528
I cannot see,

00:58:31.981 --> 00:58:33.322
like normal treatment or

00:58:33.382 --> 00:58:34.302
conservative care be a

00:58:34.322 --> 00:58:36.103
hundred percent through an app that,

00:58:36.643 --> 00:58:37.724
but I'm biased because of

00:58:38.123 --> 00:58:39.844
how I want to go to a

00:58:39.925 --> 00:58:40.786
professional and a

00:58:40.905 --> 00:58:42.686
physician or a therapist.

00:58:43.067 --> 00:58:43.987
And I'm also biased because

00:58:44.027 --> 00:58:44.967
of my clientele who

00:58:45.108 --> 00:58:47.389
literally never asked for an app.

00:58:47.708 --> 00:58:49.610
They don't ask for any technology.

00:58:49.650 --> 00:58:50.690
They don't ask for a portal.

00:58:50.871 --> 00:58:52.130
They don't ask for a chat widget.

00:58:52.652 --> 00:58:53.271
They don't want to,

00:58:53.871 --> 00:58:55.713
they will text me or my therapist,

00:58:56.313 --> 00:58:58.034
but then they want to convert that to a,

00:58:58.193 --> 00:58:58.894
an in-person visit.

00:58:58.914 --> 00:58:59.894
Like I had this issue and I

00:58:59.934 --> 00:59:00.856
want to do it in person.

00:59:01.635 --> 00:59:02.016
But anyway,

00:59:02.036 --> 00:59:02.655
we're talking about the

00:59:02.715 --> 00:59:04.016
physical therapy staffing crisis,

00:59:04.056 --> 00:59:04.996
the challenges out there

00:59:05.918 --> 00:59:07.157
with recruiting and hiring.

00:59:07.958 --> 00:59:10.059
And I think this is where

00:59:10.259 --> 00:59:11.559
we're well on our way to

00:59:12.179 --> 00:59:13.780
figuring out solutions and

00:59:13.800 --> 00:59:15.601
the challenges that the

00:59:15.641 --> 00:59:16.320
solutions are going to be

00:59:16.360 --> 00:59:17.581
different for different

00:59:17.601 --> 00:59:18.742
practices and different companies.

00:59:20.605 --> 00:59:20.985
P.T.

00:59:21.126 --> 00:59:21.525
P.T.

00:59:21.585 --> 00:59:22.266
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00:59:22.365 --> 00:59:25.367
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00:59:26.188 --> 00:59:26.949
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00:59:26.989 --> 00:59:29.230
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00:59:44.619 --> 00:59:44.860
Jimmy.

00:59:45.528 --> 00:59:47.309
I think the rising tide lifts all ships.

00:59:47.789 --> 00:59:48.871
I would say there's a great

00:59:48.911 --> 00:59:50.132
quote from Emerson that I

00:59:50.152 --> 00:59:51.893
just shared across all the platforms,

00:59:51.932 --> 00:59:53.934
which is, if you build a better mousetrap,

00:59:53.974 --> 00:59:55.355
the world would be the path to your door.

00:59:56.255 --> 00:59:56.916
What I want people to

00:59:56.936 --> 00:59:58.336
understand is what business are you in?

00:59:58.597 --> 00:59:59.717
You are not in a mousetrap

00:59:59.737 --> 01:00:01.619
business because that is a product.

01:00:01.838 --> 01:00:03.099
You are in a service business.

01:00:03.679 --> 01:00:04.420
So your job should be,

01:00:04.460 --> 01:00:05.742
how can I over-serve?

01:00:06.442 --> 01:00:07.523
What can I add to this?

01:00:08.023 --> 01:00:09.784
How can I make the wait time

01:00:09.804 --> 01:00:11.264
shorter just by making the

01:00:11.304 --> 01:00:11.865
walk time longer?

01:00:14.166 --> 01:00:16.329
How can I make the clinical experience?

01:00:16.668 --> 01:00:18.871
It's not just going to get more CEUs.

01:00:18.971 --> 01:00:19.652
It's not that.

01:00:19.811 --> 01:00:20.532
I'm not saying don't be

01:00:20.572 --> 01:00:21.313
clinically excellent.

01:00:21.413 --> 01:00:23.054
What I'm saying is I think

01:00:23.094 --> 01:00:24.175
the door is wide open for

01:00:24.195 --> 01:00:25.436
making the experience better.

01:00:25.896 --> 01:00:26.998
And that's what people are

01:00:27.137 --> 01:00:27.918
actually buying.

01:00:28.119 --> 01:00:29.920
They're buying the results.

01:00:30.561 --> 01:00:31.601
That's what they'll pay for.

01:00:31.762 --> 01:00:33.503
So I would say if you build

01:00:33.543 --> 01:00:34.583
a better mousetrap,

01:00:34.623 --> 01:00:35.905
the world will be the path to your door.

01:00:36.184 --> 01:00:38.027
But if you build a better experience,

01:00:38.967 --> 01:00:39.827
people are going to show up

01:00:39.869 --> 01:00:41.409
more and they'll wait longer.

01:00:42.230 --> 01:00:43.391
for that experience if they

01:00:43.411 --> 01:00:44.271
understand what they're gonna get,

01:00:44.590 --> 01:00:46.012
but also do they have to?

01:00:46.132 --> 01:00:47.552
Or can you give them something to read?

01:00:47.592 --> 01:00:47.773
I mean,

01:00:47.793 --> 01:00:49.153
the first person to put a magazine

01:00:49.193 --> 01:00:51.175
in a waiting room, how smart was that?

01:00:51.514 --> 01:00:52.175
Just give them something to

01:00:52.195 --> 01:00:53.596
look at or put a TV in the

01:00:53.675 --> 01:00:54.556
dentist office waiting.

01:00:54.817 --> 01:00:55.958
That was brilliant, right?

01:00:56.458 --> 01:00:58.139
Great, what can you do?

01:00:58.199 --> 01:00:59.440
How can you expand on that?

01:00:59.480 --> 01:01:00.780
Does it have to be in the waiting room?

01:01:00.800 --> 01:01:01.380
Can it be home?

01:01:01.740 --> 01:01:03.661
Giving me something to stay engaged.

01:01:04.222 --> 01:01:04.422
I mean,

01:01:04.442 --> 01:01:05.822
a simple chat widget to say like

01:01:06.282 --> 01:01:07.143
something opened up.

01:01:07.884 --> 01:01:09.445
This was big in the restaurant industry.

01:01:09.465 --> 01:01:10.585
It was like, take my shift.

01:01:11.382 --> 01:01:12.523
Instead of you having to

01:01:12.623 --> 01:01:13.903
text 20 of your colleagues and say,

01:01:14.143 --> 01:01:14.903
I can't work tonight,

01:01:15.505 --> 01:01:18.206
you put it up on an app and

01:01:18.226 --> 01:01:19.206
then 20 colleagues would

01:01:19.365 --> 01:01:20.206
automatically get it.

01:01:20.686 --> 01:01:21.467
And then you'd have your

01:01:21.527 --> 01:01:23.288
problem solved because I need the money.

01:01:23.327 --> 01:01:23.748
I'll take it.

01:01:24.047 --> 01:01:24.367
It's mine.

01:01:24.447 --> 01:01:24.708
It's mine.

01:01:24.748 --> 01:01:25.228
It's mine.

01:01:25.929 --> 01:01:26.869
Everybody wins that.

01:01:26.969 --> 01:01:27.809
Figure out a way to make

01:01:27.849 --> 01:01:28.949
everybody win and the world

01:01:28.989 --> 01:01:29.889
will be the path to your door,

01:01:29.989 --> 01:01:31.831
even if you don't sell mousetraps.

01:01:32.030 --> 01:01:33.132
We'd love to hear from you.

01:01:34.612 --> 01:01:35.431
Let us know what you think

01:01:35.472 --> 01:01:36.693
about this via all the

01:01:36.733 --> 01:01:38.213
platforms that Tony had mentioned.

01:01:38.773 --> 01:01:39.414
And thanks for listening.