The AI Shift in PT: Letting Go, Leveling Up

0:09 All right, we're doing PT Breakfast Club a little early. I'm on the left coast today. I've only been out here a couple times, but I'm near San Francisco. So I'm doing it live at five thirty. I must like you guys without coffee, by the way, because the downstairs, the breakfast at the hotel lobby didn't crank in front of the thirty minutes. But Tony Maritella, you're up and you're up and about here at eight thirty in the morning on the East Coast. What's going on? Yeah, not much. It's beautiful, beautiful, sunny day here in Ohio. I already started treating patients. Dave Kittle is out for the day. I'm not sure what he's doing, but he's out and about. So I wanted to ask you, you and I had talked about this a while back today on the episode.

0:50 I want to talk about AI agents. Jerry Durham, I still don't know exactly what he's doing, but he's doing a ton of stuff, it sounds like, with AI agents and automating things. I want to talk about not selling the outcome. which is what most of the time I'm hearing people say. People say, sell the outcome, sell the dream, sell the vision, sell the European trip, not the flight there, not the TSA, not the baggage check, not the screaming kid kicking your seat. I don't know. I don't think we can get away with selling the outcome. There's a part of that, but the reality is, We're the ones in the trenches actually having to make the patient do the exercise.

1:34 We're the ones having to make the patient do the thing that they probably didn't want to do. I think we have to focus on attracting patients who want the experience, want the adventure. And I was thinking about this, and I'll turn it over to you. This morning, I'm talking to my wife. We have our coffee. We're just hanging out. We're chit-chatting. And she was like, why are so many women in particular so afraid of lifting heavy weights? And I think CrossFit did a lot to help change that paradigm. But even within my family, I've got women in their fifties, sixties, you know, in-laws and different people that I'm associated with.

2:15 You give them an eight pound dumbbell and you would think you ask them to lift one hundred and fifty percent of their body weight, which should be lifted like a reasonable. So the question is. Why are we so scared to lift heavy things? Why are we not more focused in therapy on selling and packaging the experience rather than the outcome? The outcome doesn't matter. Even if you give them pain relief, it's temporary. Everybody's going to get pain again of some kind. Let's focus on marketing the experience. Yeah, Rory Sutherland is big on this where he says, Well, OK, so who does sell the outcome in our profession or in health care?

2:57 And I found this when I was treating patients, which was patients would come post knee replacement, hip replacement, some surgery, and they would say, I don't understand any of this like this. This was not in the brochure. Somebody, maybe a surgeon, had sold the outcome, which is, hey, twelve months from now, you'll be able to do those things. What they forgot to mention was the thing that you'll need to do or the things that you'll need to do from day one post-surgery until that twelve months. And unfortunately, PTs were sort of caught in the crossfire. We were now looked at. This was not. Am I an abnormality? Is this going wrong? So Rory Sutherland talks about this in terms of people don't fear necessarily pain.

3:39 People fear uncertainty where I think people are smart enough to know that, like, if I'm going through physical therapy, it's, there'll be something physical on it. And most of them are smart enough to know it's not just something physical a therapist is going to do to them. So they don't necessarily fear the pain or the difficulty or the lifting of the weights. They fear the uncertainty of knowing like, is this going to work? How hard will it actually be? Will I be able to do it? Will I keep up with it? So the worst part of PT isn't maybe the actual things that you're doing, it's the not knowing. So going along your lines of saying, don't just sell the outcome. Don't just sell the lifting the grandkids again. Be like, I've seen a lot of great PTs and a lot of people in business too.

4:20 You get to the no as quickly as possible. Like that's one of the ideas. Get to the no as quickly as possible. Meaning, you want to weed people out who are, who aren't going to make it past visit three. Anyway, this isn't going to be for you. Right. I'm, you know, fight club them. And I think I have to qualify down that because of the movie has been out for so long. Fight club them is, you know, there was this super elite underground fight club in a movie with Brad Pitt and Ed Norton and anybody that wanted to apply. I don't think I have to say spoiler alert. If the movie is more than two years old, right. Anybody that wanted to apply to get into this, like it was a cult. I mean, essentially what fight club was, it was a cult, but anybody that wanted to get in, you'd be originally told no. Like, no, you're too, and the person, if the person was tall, they were too tall.

5:03 If they were short, they were too short. If they were fat, they were too fat. So you had to fight club them. And then the idea was if they stuck around long enough, they were the people who actually wanted to get in. Academics feels a lot like this. A job that you want, like really a tough job that you're really reaching for feels like this because usually you're denied once and you've got to go through another acceptance process again. So everybody wants to know how long this will take. Am I doing it right? Is this even working? I think what's worse than a difficult journey is when you don't know when the end is. So instead of just selling the outcome or not selling the outcome or not selling the outcome, I think you should show, if you create and sell clarity, that's something that's even more powerful.

5:48 So I was just working with a patient ten minutes ago and we were talking about some painful areas on his body. And he was saying, you know, man, this thing is just not getting better. And I was like, you know, I mean, it might never get better. And I said air quotes better because I'm like, it's it's it's one of those things that they're degenerative changes. There's other stuff that absolutely we can't change. It's not about feeling good or getting to that point where you're quote healed. It's about the journey. It's about coming in every day. It's about working out. It's about getting stronger and improving yourself. And I feel like, If we talk about burnout and frustration and therapists who just feel like they're treading water and they're never getting anywhere.

6:35 Because we're trying to help consumers, again, that don't really want what we want them to want. I think if we do what CrossFit did, what yoga does, what all these other brands do. They repel the wrong people. They attract the right people. You did a triathlon, right? You did the Iron. I was the Ironman. Yeah. So so that takes a very special kind of human wanting to achieve a special kind of thing. And it wasn't just about, you know, how you place. It was about the experience of doing it. It was. I feel like we need to figure out for ourselves, OK, what do I deliver for me? I don't deliver pain relief.

7:16 Pain relief is a lucky, you know, lucky thing that might happen because even if we achieve pain relief today, I don't have pain relief tomorrow. Like there's no guarantee. I want to achieve for me, education, information, empowerment, I want you to feel good doing hard things. And I want people coming to me that want that experience. And so that's what I try to convey in my messaging. That's what I try and convey in my ads and my social media. It's not about achieving pain relief. It's about doing more things with the same pain, maybe even with more pain, like pain is just a part of life. We can't be void of pain forever.

7:57 And I think that would help just so many therapists, if they embrace that, hey, we're not a drug that relieves pain, you know, maybe some people do. But the rest of us, we want you to want to be healthy. We want you to want to do hard things. We want you to not be scared of lifting eight pounds, when it's reasonable that you should be lifting a hundred and eight pounds. So I sort of took this into account, I think, maybe on my own experience of not understanding, like, where are we in this? Like, wait, was this forever or whatever? So this is a dummy account. This is the Othellus AI scribe.

8:39 And I've been playing around with this. one of the things that allows you to do is when you're done, when it's every, everyone knows an AI scribe will write the note for you, right? It'll suggest billing codes, yada, yada, yada. What I like about this one too is it'll, it'll create an email for the patient and the referring provider, but then I can go in and judge up. How do I write? Number one, at no point will any email I send say, I hope this email finds you well. Like I literally wrote that if that comes out, that is, I've been kidnapped by the way. Like that's my, If I've been kidnapped, I will give you a proof of life and it'll say, I hope this finds you well. Blink three times if you're not okay. So I literally put that in the prompt. Do not say cliches like, I hope this email finds you well.

9:20 But it might be hard to see here, but it says, based on similar cases... I'd say you're currently at about sixty percent of your normal status with our plan. We aim to get you as close to one hundred and dancing without issues. This is like a mock patient who hurt herself dancing. But I think if you set the expectation early, they understand like, OK, I'm going to buckle. I'm going to buckle up or OK, like we're we're almost towards the end. If I just finish this thing, I'll get a little a little bit more out of it. Both of those things are clarity. They're setting you up for success. at least being okay with what, or understanding, not even being okay, understanding what happens next.

10:02 And I was on a big kick for a while there. Like what I think the reason for communication is the reason for communicating isn't to have communicated. Like the reason for, for going to the gym isn't to have gone to the gym. It's to elicit a change, right? I know that going to the gym and doing whatever I do isn't going to, be the whole thing, but it's going to elicit a small change and then change over time. Well, the goal of communication is to have it is to achieve understanding, right? So I give this example too, which is like, I could be the most efficient third grade teacher ever. I could save school districts so much money. I'll teach the entire third grade curriculum in like three weeks.

10:43 That's it. I could blow, dude, I've read the third grade curriculum. There's not a whole, it hasn't changed since I was in school, right? So I could rip through that whole third grade curriculum in three weeks. Now, I will have a bunch of third graders staring at me very confused because I went way too fast, you know, because if the goal is just blow through the curriculum, that's easy. I could read out loud and blow through it. But if the goal is to make sure third graders go from not understanding to understanding, that's different. So understanding what the goal is. I think what you're talking about is shifting the goal of what we're actually being able to provide, which is the journey. And if you don't like this, I can't, you're going to hate me. I'm really sorry. Don't step in here. Don't start.

11:24 And we met those people on initial evals where you're like, this person isn't sticking. You know that, but you go through it anyway. Yeah, I was listening to a guy. It's a new to me marketing channel. And he was talking about like, you don't go to a buffet for an amazing steak experience. Right. You go to a steakhouse. It's a completely different experience. And I think Dave's not here. I was going to talk to him about this. Like Dave Kittle would be the quintessential steakhouse. And you have the well-trained server and you have the wine list and you have all this stuff. And then my kids love Golden Corral. You know, you go to Golden Corral and, For fifteen bucks or whatever it is, you've got a thousand options and the dessert bar and they go straight for that.

12:11 None of the food is amazing, but you're not there for amazing food. You're there for a breath, a wide experience of different foods. And the same thing within what we do. If you look at most physical therapy websites, it's more reflective of Golden Corral. than it is of a high-end steakhouse. Oh, they want anybody and everybody. Yeah, like everything is on the menu. Everything is being offered. None of it is going to be amazing, but it's all going to be relatively good enough. But I just, I go back to so many of our listeners, people that are paying attention to this show, You deliver that steakhouse experience, fine dining like that's what you want.

12:53 But I don't know that it's really conveyed to the right people. And then the real killer is the person who wants to deliver the fine dining experience at a buffet style price. Yeah. And you just you can't burn that candle from both ends. I was just I was just thinking that. And then and then and then hold on. There's one more level. There's the people who want to deliver or they're okay. So there's the people who are or want to deliver the steakhouse feeling Smith and Walensky in either a Smith and Walensky setting. Those people are fine. Those people are not in Facebook groups pitching. They understand who they are, what they deliver. And if they're not finding the people that want to buy it, they're either selling the wrong thing in the wrong place or they're not good at it.

13:35 The person is like, I am a high-performance physical therapist. I'm going to work with elite athletes. And enough athletes show up and go, no, for whatever reason. And those people wash out. The funny part comes in when the people who are delivering or attracting buffet-style customers yell at the large PT chains for being mills. That's the funny part, right? So like you said, is McDonald's good or bad? Oh, it's horrible. It's horrible. Well, not for, I don't know, a million people per day per location. I don't know. I don't know what the data is on each McDonald's franchise. But like enough people understand what they're getting at McDonald's.

14:17 If McDonald's put a filet mignon on their – menu what like that would be a great social experiment like what would happen like would people not order it because like this doesn't make sense or they'd be like this is a great deal because I'm getting a filet mignon at McDonald's like why don't you think they do they could they could it doesn't make sense they could they choose not to because they understand the business they're in the messaging did you see that post that I shared with Ronald McDonald no Oh, it's on LinkedIn. I shared it last night. I prompted chat GPT to give me an image of Ronald McDonald.

14:57 I said with his big clown feet up on the desk, hands behind his head, stacks of money around him laughing, saying, quote, Oh, no, they can make a better hamburger because the whole the whole post was about that. McDonald's, I showed my kids last night the stock chart of McDonald's, and it's just a beautiful slope up accelerating. They make so much money, they don't care. Yeah, this was from ChatGPD. They don't care about everybody else who can make better food. They understand the business they're in. They serve millions of happy customers every single day. They don't care what everybody else thinks of them.

15:40 The they've embraced who they are, what they are, what they do best. And they're amazing at it. And I mean, there's very few stock charts over the course of a lifetime of the business that can show that kind of success and growth. That's what drives me crazy when therapists love to beat up on, quote, the mills, corporate PT, all this other stuff. And in reality, they wouldn't exist if there wasn't a need, if there wasn't demand, if they weren't doing something right. There's a function and a purpose for them in the market. So what do you think people should take most away from that post? To me, I'll tell you what I took away.

16:21 You tell me if that was part of your intent. To me, it's understand what you... Where would you start? I would start with what you want to provide. Because if you come into a profession or if you're like, I'm going to open a business and look, there's a big need, you could be successful. But if you don't like it, six months or a year down the line, You're going to hate it. Right. So I think start with what you like to do. And if it's working with this type of patient or doing these types of things, start there. Then you have to look at if if there's a need for it, like maybe you're in a really saturated market. Right. So then you have to change. You can't be McDonald's. You have to be Wendy's, which is similar.

17:01 But they make a point of pointing out where their differences are. Right. So what was the what do you what were you hoping people were taking away from from that? I think my main intent with that post was really just to say, you know, it doesn't matter what you like. It doesn't matter what you want. I'm going to go opposite of what you said in the sense that, like, just look at nature. Like, you can't control nature. You know, the rhino. is like the perfect amalgamation of all of these different traits for the environment the rhino is supposed to live in. Put the rhino in Manhattan, he's going to die. He just can't survive. So it's like, I don't think about what I want.

17:44 I think about what the environment supports, what is already proven to be successful out there, and is there an opportunity for me to build something that's going to fit into that environment? If I want to go big, if I want to scale, if I want hundreds of locations and a thousand therapists, that is going to be a very different animal than if I want to do just me doing, you know, manual therapy for sixty minutes, one on one with every individual. And if that's the business that I'm going to build, then I'm going to do it at a three hundred, four hundred, five hundred dollar price point, not at Medicare reimbursement rates.

18:25 But I have to put that animal in the right environment. I can't force the environment to accept the animal that I want to deliver to it. Right. I was saying start with what you want because if you're actually starting a business, I don't know that you'd want to keep doing it. Ask yourself, is this the business I actually want to get in? Because I think a problem comes in a lot of times when people start in two ways. They conform to what they think they need to do. Right. Well, this is how it's going to be. And you hear those people complaining a lot. And then three years in, they're like, I'm still doing this because the goal was to do this and then change. And yet you built a business that was built on this.

19:06 Or. Yeah, not understanding what you will actually drive you like I knew in PT school, I didn't want to do patient care, but I kept going because that's what I was supposed to do. Yeah, I'm halfway through the degree and I'll learn to like it. And I was surrounded by thirty seven other people. who the more they did it, the more they liked it, or at least that that's what they were saying. And I was like, Oh man, I'm the, I'm the mole of the group. Like, what do I, what am I supposed to do here? But I knew. And then I tried a couple of different settings. I was like, I it's, it's not, it's not me. I don't, I don't like what is me. I don't like this. So I need to find something different and that's okay. Yeah. What would be, what would be not okay is me sitting in a clinic bitching about it. Right.

19:48 Right. You knew, you knew what it was. So real quick, Will Boyd's here. Will, I am trying program, no, what is it? Like whatever Facebook automated ads are right now, I'm trying it where I basically just told Facebook, here's my, I think it recommended a three dollar budget. Here's my three dollar daily budget. Just run whatever ad you want to run. And I gave it a list of videos that are already on my Facebook business page. So I didn't give it any other information than that. I'm going to see what Facebook does with that information, which kind of leads us into the next topic about AI agents.

20:29 And, you know, Facebook has AI running ads right now. It's making decisions just knowing, OK, Tony wants more inbound leads. I want people messaging me and calling me. never do a facebook will is saying no with several with several o's never do a facebook suggest always always ends up the worst performance and then he says call but keep me posted keep me posted so he's he's telling you to to go left when you're going right well we're gonna see what happens so uh I could I could handle losing three dollars a day um but yeah like we we know we're moving towards A AI future.

21:12 I think I shared this. Did we talk about this? You got to tell me. Back in the day, you remember being up late at night, two o'clock in the morning, infomercials took over television. Television used to end. There was a point where you'd see the American flag and one of, you know, I don't know, was it the anthem or Star Spangled Banner or something was playing and literally the television would end broadcasting. Then infomercials came on because that attention could be monetized. And I was thinking about it this week. I was like, man, if people are in pain and I don't want to sell a solution for pain, but if people are in pain, they're up at night.

21:54 My audience, total knee replacement. They can't sleep. They're up at night. They're flipping through late night TV, scrolling their phone. I'm like, why don't I buy that time? I used to only run ads during the day when I had people to answer the phone. But now I'm like, well, shoot, I can get cheaper ads in the middle of the night. I'm going to capture that. I'm going to focus the message on the person who's awake at night, can't fall asleep, getting frustrated. But I don't have somebody to answer the phone. So this is where we talk about automation, AI. Can I get an AI agent who can answer the phone for me at two thirty two a.m.?

22:36 What do you know about this? And I know Jerry Durham's talking about this a lot. Yeah. You, you could do this yesterday. You know, this was, I think, I feel like we, we, we, we knew this, like when you called Delta or whatever, like you knew that this was happening, right? We weren't, we weren't planning on doing this, but do you want to test one out? Sure. All right. So I'll just, I'm opening myself. While you're getting that ready, you know, my understanding, it was, what do I do? Thank you for calling Parabella. This is Sophia. How can I help you today? yeah I uh I was doing karaoke last night and I fell off the stage and I need a physical therapy appointment okay just to make sure you're looking to book at terra bella palo alto right yeah we have an appointment available with sarah thompson uh today tuesday may twenty seventh at nine o'clock a.m would that work for you no that's way too early anything later Let me check what else we have available for today.

23:39 Tuesday, May twenty seventh. We have an appointment with Sarah Thompson at two o'clock p.m. Would that be more to your liking? Yeah, that's better. All right, great. So to book that two p.m. appointment with Sarah Thompson today, Tuesday, May twenty seventh, I'll just need you to register with our system to finalize everything. Is that all right? Yeah. Before I go ahead and book that appointment, may I know your first name, please? So now the rest of that appointment will be making sure they know my name, spelled it properly, making sure what insurance I have and my numbers and what type and all that. So then it just it's going to appear on the EMR. for Sarah Thompson booked, right then and there. Now that was a pretty unsophisticated, medium sophisticated, right?

24:24 Sometimes when I do that demo, I always like do something funny. Like I fell off the stage doing karaoke or, you know, I was playing polo or whatever. Sometimes she'll react. Sometimes she'll go, oh my gosh, like I love karaoke. That's horrible. Sometimes she doesn't, like there, she was business, right? So can you program an AI agent to react in certain ways and triage? Yes. I'm working with a client right now who is a surgical center who also does like urgent care hours. And right now it's an answering service that has to figure out when to call the surgeon on call. And I'm like, well, how do they know? It's like we have a, remember logic in eighth grade or ninth grade math? Like if then, if then, if then.

25:05 That's what AI is. It's a big giant if then engine. So if the person says this, tell them, can you see the bone? Yes. Go to the emergency room. That's not us. Or just forward them to, I'm now forwarding you to nine one one. So can you, for what you're looking for, create an AI agent? Yeah, you could do it yesterday. Okay, so what was that agent that you just shared? Is that from Thales? That was from Thales, yeah. Okay, what are your thoughts on what you just shared with me? Yeah, I think it's a really good B-, I think it's a B- in terms of audio, right? Like, I want, like, I knew it was an AI agent because, I mean, I think most people would be like, yeah, okay, it's not a person yet.

25:50 I think in twelve months, maybe less, it'll be so sophisticated. Like, in terms of tone and time and delay and processing, like, again, you've called Delta, right? three years ago to change a flight and you knew you were talking to a robot representative representative like right just hitting zero like because it was annoying I think so much effort and people can see there's so many people looking for something like this now the average person's looking for this they're putting so much effort into the speech the tone the timing in twelve months you I don't know that you'll be able to discern discern the difference And we talked last episode about do we need to inform people?

26:33 I know there are some federal laws that were in place with health care and calls, robocalls and things like that. Did that say you're talking to an AI agent or what's the deal with that? It doesn't right now. I don't know the legality on that. I appreciate your honesty, Scott says. The latency is the killer part for me with that. But I think the latency could be addressed right now. I think you just say, hi, this is Sarah. I'm an AI agent for Total Therapy Solutions. I just wanted to let you know that there's going to be a slight delay while I process what you say, just so the person on the phone understands why.

27:19 Because the very first time that happened in that call, I was like, did we get cut off? Are we on mute? Like, what happened there? And it takes me a couple times to realize, oh, this is just latency. It's just taking longer. It's like, still, I think I use Waze. or Google maps in the car. And it gives me the turn just a half a second too late. Like I want it just a little bit earlier. I want that response just a little quicker or tell me I'm processing what you're saying. Give me just a moment and then give me the information, you know?

27:59 But like you said, I mean, months in months, it's going to be amazing. Right. Um, What other kind of uses do you see for something like that? Yeah, there's some insurance companies require that if you're going to work a certain denial, you've got to do it by phone or it's faster by phone, but then they'll put you on hold for an hour. What does that mean? So like if I get a denial on my claim as a provider. You might have to. There are certain situations or it's been elevated to the point where you have to call to actually work to get paid for that denial. So you could use an agent to now make the call.

28:40 So like I think in my mind, that's where my head went, which was it's a catcher. It's going to handle things. It's going to catch and block and route and understand. Take your information and put it into an EMR. well, we have, I don't have the video pulled up now, we have a demo of an AI agent calling a representative from an insurance company and saying, I'm here to work this, you know, there was a problem with this claim being paid. And you can tell the person on the other end probably knows a little, that knows that they're talking to an AI agent and is sort of giving her, and I'm using, let's use a pronoun, I just said her, using the AI agent a little bit of, eh, Like, well, what's the date of service?

29:24 I don't have the date of service, but I have the total. So it knew, like, well, in lack of this, I have this. So it has access to all that information, and it's able to say, in lieu of this, do this. If this, then that. So it's able to make the phone call. You know, and I think the layup things, too, would be a phone call or a text message when someone has an appointment or has to take a turn. Make sure you give that person the text message, a reminder of their appointment in time and on time. So Scott brings up an interesting topic that we kind of talked about on a different topic. Scott says AI agents need a bit more empathy to improve engagement. My question is, and I think it's when I was talking about is an AI right now ready to, you know, generate my entire plan of care based on my clinical information that I provide.

30:16 When Scott says that, I think what Scott is comparing is his level of empathy and engagement to the AI. But what about the level of empathy and engagement across the entire profession? Like if we have two hundred plus thousand licensed therapists in the profession, is the level of empathy with AI right now higher than the average equal to below. I know a lot of angry, frustrated, just hateful physical therapists in the profession right now. I know a lot of angry, hateful, like unhappy front desk people right now. I think a completely muted agent is already better than a lot of what is out there right now.

31:03 And I remember having this conversation with Jerry Durham. The first time I met him, I was like, The standard of communication and empathy and happiness in health care right now across humans is so low. The bar is so low. You just have to be half awake and reasonably curious and you're going to be light years above everybody else. You're comparing this against your all star. Yeah. Yeah. And you're like, well, it's a be my like I was comparing that against a human being. She didn't have empathy, but if I did that same phone call with my same words ten times, she would say, she's done. Oh, I'm sorry to hear that. Karaoke is dangerous sometimes.

31:44 You could tell she understood what I was saying and played with it a little bit. Right. The other thing, I mean, I just we used to have a front desk person who when a new patient would call, they would follow this written out process of asking these questions, collecting this information, putting it straight into an EMR. That's obviously replaceable right now with the AI agents that are on the market today. Go through a twenty question and I can do this with ChatGPT right now. I've done it where I make up a fake case. I say, ask me twenty questions and then generate a physical therapy evaluation and plan of care.

32:25 Generate function-based goals, generate impairment-based goals, consider these CPT codes based on these typical conditions. And it's completely possible to have your finished physical therapy evaluation, documentation, plan of care, plus the next ten to fifteen treatment notes auto-generated right from that phone call before you've ever spoken to the human. You know, and we can do that right now. Yeah. So the funny part was, did you see the video that I had recorded in response to your question and the response and the, and the, and the comments in that, in that Facebook group?

33:07 Tell me about it. I don't know. So I was just, I was just pointing out how like people were like, people are quick to defend. Cause now it, the question feels pointed at them. Like, do we now have something like my mom worked for the New York state toll authority for years. Okay. And when they started putting easy pass in, I couldn't figure out why she was so pissed because I was like, this is great. Like, I don't think stop. Like, look at the traffic jams. Yeah. Memorial Day weekend. You knew every thirty miles on the New York State Thruway was going to jam up again because everybody had to get out their nickels. And throw it in a basket or hand over dollars. And they did it.

33:47 And it's just like multiply that times a hundred thousand cars. And it's chaos. Now we barely, we don't like, then, then you had to slow down to to get counted and now you don't even have to slow down. It's like, you don't even, Oh, is that a toll barrier? I wasn't even sure. Yeah. She was so angry. And I didn't understand why. I was like, this is great. And then I understood it. She was looking three or four steps ahead and saying, well, if they don't need us there, where else won't they need us? And where else won't they need us? But no, what I do is special. You need me to do this, right? So I think a lot of the therapists were – in that Facebook group who were writing comments were feeling a little bit like they're taking it personally. They were getting defensive of, of course not, because I am special and I have special this and I have special that, and you couldn't possibly know what I know.

34:35 So is this the trait of the entrepreneur? Because, you know, the entrepreneur in me, From the beginning, first time I ever read E-Myth Revisited, everything was about putting myself out of business, putting myself out of a job, putting myself out of business, replacing myself either with other humans or technology. Like my entire fifty years of life has been, how do I replace myself with something else? Whereas I can certainly see a person feeling threatened, their identity feeling threatened, I would hope that that person would recognize that it's just insecurity and kind of get past it.

35:17 What did your mom end up doing? Was that the point that she said, OK, I'm going to retire and I'm out of the workforce? Did she shift it into something else? She knew that this was her last job, but I think she was looking around. She's like, you know, there's kids who are twenty five years old who work here. But but I'll take a more modern approach. To me, I did the morning announcements in sixth grade. That's all I wanted to do. I was like, I don't know what this is, but I like it. Then went to school for communications, internships at radio stations, worked at radio stations, big ones, small ones, didn't matter. I was driving home. Now I'm twenty eight years old and I'm running my own. I'm running two radio stations like.

35:58 Four eleven year old me would look at twenty eight year old me and be like, holy cow, we made it like that's my that was my version of getting drafted by the Yankees and playing first base for the Yankees. Right. Which was my second choice. That was my second choice. Running radio stations was my first. And I'm driving home with my kids. We didn't call it an iPhone one. We just called it the iPhone because we didn't think there would be a two. We're like, this is revolutionary. Right. I'm driving home from the radio station one day at seven o'clock at night. And I plugged my iPhone into the aux cord, and someone had texted me a link. And I tapped it, and I was listening to KROQ LA while I was in Pennsylvania.

36:38 And it was crappy. The signal was crappy, and it was buffering. Kids, there used to be this thing called buffering. Essentially, just like the internet wasn't working right. And I was listening to a radio station in Los Angeles while I was in Pennsylvania. And I was like, and I literally did the math. And I was like, I'm out. Like, I cannot compete with this. I could have hung on in radio for another ten years. So I could have went from twenty eight. I could went to thirty eight. But I was like, I don't like where this was going. Here's why. Because there were other things. People were simulcasting. So you'd have like a morning show in Dallas would be in Ohio, Florida, Seattle, LA. So you had simulcasting, right?

37:19 So you were able to do that. You had voice tracking. I was on the radio in Northeast Pennsylvania seven days a week. I wasn't at the radio station seven days a week. I was recording that. Right. And I was recording a lot of that one on one like that was only being used once. In that moment, like I knew I was recording for Tuesday at, you know, at three o'clock in the morning. Right. And then it was burned. But I was still like, this isn't a this isn't a place. This is a place where people scale. So I was looking at that the minute I saw the minute I heard KROQ in Pennsylvania. I'm out. Went to go to law school, hated it, went to go to business school. didn't hate it, didn't love it, came to PT, and I saw some opportunity.

38:02 But that's my point, which is like I don't – so to answer your question, yeah, I think it is part of your personality and my personality, which is like we're doing the math six or seven steps ahead, and you're like, nope. I either had to own the radio station at that point because even though I would sell that, actually, I wouldn't want to own that for very long, or I need to be somewhere else where I can – I can create something different because what I saw right then and there at twenty eight, I'm not going to be doing this at thirty eight. And I wasn't. And a lot of people who looked at me were like, dude, but you have the dream job. They were excited, too, because a lot of guys were like, well, Jimmy leaves. I can move up. I just move up one level on the ladder.

38:43 And I was like, get off the ladder. This is not a ladder to be on. This is like a ladder on the Titanic. And a lot of those guys and a lot of those girls don't have jobs anymore. So I think that's what a lot of those people in that Facebook group are looking at, which is like, they're just naysaying it. Like everybody was naysaying me. Radio is never going to die. Really? Okay. Well, I got the numbers to prove that podcast use has now surpassed radio use in the United States for people above twelve. That's not just adults. It's above twelve. Um. I think PTs are looking at that going, well, if this is true that I'm out of a job, I'm not valuable. I don't think that's true. I think you think that all this is part of the magic and you're so good at magic where I think that you need to be good at another part of this, which is the human connection.

39:30 So the saying was, you know, AI is not gonna put you out of a job. Somebody using AI will put you out of a job. I came to that and I said, yeah, AI, somebody using AI is gonna put ten people out of a job. And that's where I'm seeing the real sweet spot here. So we realized pretty quick AI isn't taking away the stuff that needs the actual human. AI is not going to rub my patients back. The human is going to rub my patients back. But AI is going to do a thousand times of a better job doing the evaluation, processing millions of cases, collecting the information. You and I talked about Hinge and Sword and a lot of these companies where what happened was in my best of times, I'm going to manage twenty or thirty active patients in a week that are coming two or three times a week at my best, at my peak.

40:26 A therapist working for Hinge or Sword is going to manage seven hundred patients because of the way the system is designed. Talking about what we've talked about, if the AI can do the interview, can collect the case history, can ask the questions, can process the information better than a human, better than me, the AI with me, now I've got clones of me, it can ask the questions that I would ask, it can learn from the way I do things, even if it's gonna replicate me in that sense, it gives me scale, it allows me to manage, Hundreds of patients now at the same time.

41:07 So the questions that I'm thinking about with this is, is this one solution to the declining workforce? If we're losing therapists, we don't have enough therapists to fill the jobs. Schools aren't attracting enough therapists because the return on investment isn't there. Can one therapist now do more without, you know, the typical expectation of you got to build more units and you got to see more people? You can see more people because the AI is allowing you to see more people. Laws are not going to keep up with AI. So now the question is, if I have all of the information required for the evaluation, but I'm missing the face-to-face time that is a required element of billing the evaluation, can I start a plan of care if all of the other checkboxes are checked?

42:00 Even if I can't bill for that plan of care, or excuse me, bill for the eval, If I have all the information, can the PTA or the other people start delivering the service? Because if the evaluation, if I could do a hundred AI evaluations in ten minutes, right, now the cost of an evaluation drops to virtually zero. Yeah, so I don't need the reimbursement for the evaluation, but I need the legal requirement of the evaluation. So what does the State Practice Act require for the evaluation? This opens a whole new line of thought in potential opportunity to let the people that are actually hands-on, boots on the ground, doing the care, do it in a different way.

42:52 Yeah, I was, uh, I was playing around with that, uh, that very question. But the question was, I was driving, and I was using AI hands-free. I was talking to ChachiBT hands-free, so don't come at me. And I have conversations, because instead of listening to a book, I'm like, I could have someone who has read every book answer me based on the author. And I was saying, and I have friends who are cops, family who are cops, but a significant portion of my little village's income is based on tickets. And some have been public and say we have quotas. So they know that that police officer is going to bring in X number or should be bringing in X number of dollars.

43:33 What happens when AI is driving cars? No more traffic infractions, right? Because the AI knows to turn the blinker on or it won't turn. The AI knows that this is fifty five. Do not do fifty six. Yeah. Now you have traffic cops going. How many traffic tickets did you write? Zero. So AI was I said, listen, based on the fact that you know that police officers and traffic infractions, it's an income driver. It got to a point where you can't erase it because it's I don't know, making up figures, but it's enough of a budget of a town where if you took it away, we'll collapse. I'm not anti-government, but I'm smart enough to know that the government is very, very efficient at doing a couple things.

44:14 One of them is separating money from its constituents. So AI just started extrapolating. It gave me like, like a lot of times you have to prompt AI to give you more than like five or six ideas. It gave me like fifteen. And it was like essentially like AI usage fees. It was infractions for what people are doing in the car, which I thought was funny. Like music's too loud. And I was like, oh my gosh, now we have to start policing things that are based on like activities right um it would give you well ais or these cars are driving on our streets then the usage fees on the streets would go up so it would just be a usage fee they would start passing that along to the door dash driver and by say driver I mean the the ai agent or whatever that's driving the car so the money's gonna come the same amount of money is gonna come from somewhere we're just gonna put a different label on it so as soon as you squish this out it's gonna pop out somewhere don't worry about it like they're gonna get their money They're already thinking about different ways to do that.

45:09 You should be already thinking about different ways to do this too, which is how can you provide something of value if the way that you're providing it now went away tomorrow? Kids, a thirteen-year-old used to bike around my neighborhood and throw newspapers at people's doors. And now... That would be most of the time. That's absurd. You get your news from a website or an email link sent to you every single morning. It's insane. It just changed. So I would start skating to where that change actually is. Yeah, you know, it's funny you bring that up. On a morbid fact side, I remember during COVID, somebody brought this up.

45:52 There were fewer drivers, fewer car accidents. I don't remember the exact number, but it was an unreasonable amount of number, a financial number. When a person gets in a car accident and dies on the road, somebody had calculated out how much money that pours into the system of local government. I don't remember like between hospital and ambulance and all the other stuff. Um, It just blew my mind. I had never thought that people dying on the road increased domestic product for the local government. One of the ideas on the AI side though, and this is the stuff that I talk to my kids about, I'm like, okay, so we drive virtually the same routes every day in my neighborhood, like around the city and going to baseball practice, going to school.

46:43 My phone is usually plugged in and sitting on the dash like a dash cam, although I'm not recording anything. And I told Lucas, I'm like, why hasn't somebody, one, created an app that follows GPS, starts tracking the timers on traffic lights, and starts getting a knowledge of understanding traffic flows so that it optimizes my speed? I am happy to drive slower. If there's a better chance that I'm going to make the traffic light and if the light's running on a sensor and there's cars ahead of me, the camera can see that. So there should be a predictive algorithm to say, Tony, if you drive slower, if you hit forty two right now, you're not going to have to hit the brakes.

47:25 And then the secondary benefit, I think this came from Joe Rogan. One of the main drivers of air pollution is brake pads wearing down. So if I need to hit the brakes less, there's less air pollution. If, you know, better economy of scale and I save gas and I'm like, I don't think that app exists. Why doesn't this app exist out in the wild? So I was thinking about this, too. We must think about weird things like this. We've just invented trains. Right. Because if I'm going from A to B and I just got in the car, why wouldn't I? And now I'm going to be on that road and I can't pass this guy because that would violate speed. Right.

48:05 We're going the same way. But now our now our cars just link up. And they're going to go the same rate and they're going to slow down or speed up based on intersections. Right. And this is also like why Americans we love we love ninety degree turns and red and red, yellow and green. But the rest of the world is like traffic circles. It's just more efficient. The traffic never stops. It just sort of slows down. We love our ways. So like I see the types of roads changing and how we're and how those things are monitored, because, yeah, if two of us are coming Towards a collision. Right. If we're coming at ninety degrees to each other, we don't have to stop anymore because the A. I'll be like, OK, I got it. I'm going to go because I couldn't communicate to Tony if I'm driving next to him unless I just do this. Honk, honk, honk, honk, honk.

48:46 Like honks just sound negative. Yeah. Like that doesn't say anything unless I'm tapping it out Morse code. So now you can now those cars can talk to each other and say, OK, we're going to keep this track because the purpose is to be the most efficient. Right now, the purpose of roads is just be a road and everyone has to follow this ridiculous set of rules. But I have friends who came from Asia and they're like, we thought we were a very neat and orderly society, but American driving is like, woo, like you guys have rules. And if you violate one of those rules, trust me, the other drivers are going to tell you those rules are going to have to go. They're going to start to go away from the humans won't have to understand those rules as much. I remember reading a book when I was in elementary school. This is in the eighties and looking at a car design.

49:28 where the front passengers, the parents, their seats swiveled backwards and they were playing a board game with their kids. Like that's not far away, right? Watching a movie or playing a board game, you know, whatever. turning around. Why do you have to look forwards? Like will, will, you know, Dave's got a one-year-old, right? Will Dave's one-year-old have a driver's license? Do you need a license to sit in a car and have something else drive? I, I don't think you will. So we're thinking three or four or five or ten steps ahead. I think healthcare providers have a big upside, but you have like, I give that monkey bar analogy. The only way to get ahead on the monkey bars, right? You got to reach forward big, see the future and, You got to let go.

50:09 You have to let go of some things. And some of those things are tied to your identity, where I think that's where the hesitancy is. Yeah. Yeah. Because we have a couple of young pilots in the family. These guys are just getting out of college. They're just getting into, you know, they've got their private. I don't even know what it is, but they can fly a private plane. They can't fly a commercial plane yet. And I'm talking to them like, guys, I don't understand this. If you're in a cockpit. You're looking at monitors basically all around you. Why is there a human pilot when there's all these laws and rules and restrictions against how much you can fly, when you can fly?

50:50 Why not just put a person in front of a computer that looks just like a cockpit and let anyone from anywhere fly the plane? And they were like, I think part of it is the passengers want a human that if he dies or if we die, he dies. But when you look at those single passenger autonomous flights that are going like San Francisco and some of these places, none of them have pilots. Like you get in this thing, it lifts you and flies you across the river or wherever you're going. It's happening now. Right now, like right now, these are fully autonomous passenger flights.

51:32 I think it's one to four people. I just watched the big interview with four of the main companies that are doing this. They've got redundancy and all of this other stuff. People don't think of it like an airplane. So I think they're more willing to do it. Plus, they're in tech hubs. So the people there are just, yeah, they already have autonomous driving. They already have taxis that are driving them with no human. So it's just, these are the early adopters. Did you hear how, you know, you're familiar with Waymo, right? Yeah. Did you hear what they did when they were going to do a beta test in, I forget what city, probably somewhere, I'm out in California, probably somewhere out in California.

52:15 The first thing they did, it's a brilliant PR move. They understood the problem. They had the Waymo cars driving around without anybody in them for six months. OK, because they were going to ask people, these people, these people, that person here to eventually get in them and ride in them. So they let them watch them from afar. If you were going to have your kid pet a dog for the kid had never seen a dog. I don't think you run your kid right up to the dog. Maybe you would. And maybe that kid would have a fear of dogs. I think the smart people would let the kid watch the dog from across the room. First time, like you can't understand that. what it's like to see a dog for the first time when you've seen a dog your entire life.

52:59 You have the curse of knowledge. But looking at a three-year-old, it's hairy, and I've seen dogs on TV, but Bluey does not look like that because Bluey is a cartoon, right? But seeing it in real life is also real different. So Waymo was smart enough to say, we're going to let these cars just drive around town. and be there and people and of course you believe me when you when you drive next to a car with the steering wall on the other side you notice yes that's really because it's pattern interruption it's a purple cow it's one two one two wait a minute two one that doesn't make any sense so people were noticing these driverless cars for months and then they started taking passengers and it was less of a leap Right.

53:42 A leap from what we know to what is completely new is a giant leap. They just moved. They made the leap smaller and people it it it went smoother. I bet you if they did that beta test in a different town and went from we're legally allowed to take drivers and riders and we're taking riders, there would have been a lot more of this friction. I would actually love if they could test that because I think that would be a great way to prove the concept. But I saw that on Sixty Minutes or something and thought it was brilliant. Yeah, yeah. So let's wrap up the show. Let's bring it full circle. You know, when we were talking about cars and turning cars effectively into a virtual train with virtual connections, it reminded me, I had mentioned nature earlier, like how ants, we have leaf cutter ants at the Cincinnati Zoo and you see these leaf cutter ants just going in like synchronicity.

54:33 How do we bring some of these concepts back into patient care? I think going from in-person straight to telehealth is too big of a leap for a lot of people. So that's where you're like, you start to introduce telehealth, even from the respect of, okay, I send the human physical therapist assistant to the house and I'm there through the phone. And then eventually I start to step back from the phone until I'm not even, or the human is not there as much and we initiate the calls. I think it could be done and just like this we have telephone calls supplemented with the AI agent and then eventually the AI agent just completely takes over the telephone call which then eventually completely takes over the patient history gathering which then takes over the full evaluation.

55:28 I think inch by inch, we're going to get there. And I think that's going to be the solution to not having enough therapists, not having enough students going into the DPT programs. We have to be able to do this without the therapist feeling like we're taking away more of their independence. They still have to feel like they play a role, even though they probably don't do as much as they think they do. That's my parting shot. What you got? What is your parting shot? I feel like therapists don't do as much as they think they do. We need to start to bring these AI agents into our day-to-day operation, even if it's done subtly, until all of a sudden we realize it's doing way more than we ever thought it would do.

56:20 I would say... You can, you can do any, you can do a lot of things. You can. I think even if you're saying you're sitting there and you're, let's say you're on the far left of the bell curve. You're like, I'm never going to use AI. It's just, I don't love it. I hate it. It's going to replace humans. And I'm all about humans. Good. Understanding its capabilities and then doubling down the things that you think will take it the longest to get to. right? It's going to permeate in healthcare, in business, in remember movie phone? It used to be like a directory, a phone directory to find out what movies and book your tickets. But you can do a lot of things. Number one, staying right where you are. You can do that. You can.

57:01 I would not recommend it. There are still horse-drawn buggies in New York. There are, but they're the exception at the rule because they're the last one. Now they're cute, but they're not functional, right? I mean, they're functional for what they are. I would say paying attention to what AI can do simply and then how does it work you out of the business? Start with the stuff you hate doing, right? I've got I've got a bunch of things in the background that I do that I'm like, I hate doing this. I hope that I hope to tell me, figure out what to pack to come on this trip. And what time to leave to get to the airport efficiently?

57:42 Because I hate thinking about that. So I didn't. I didn't have to. Some people are saying it's going to create dumb humans. And I'm like, I don't know, man. I sat there and had that conversation about how municipalities will make money when no one's getting traffic tickets anymore. I liked to do that higher level idea. So AI, you can do a lot of things. So could AI find out what those things cross and where they don't. And I would spend a lot of times where they don't, at least right now. We're back on Tuesday. Dave will probably be back on Tuesday. Tony, have yourself a good week. I'm going to hang out here on the left coast. I'm going to go to an In-N-Out burger because people have been talking so much smack about it. I'll let you know on Thursday. Animal style, baby. Animal style. I'll do animal style, and I'll let you know if the juice is worth the squeeze.

58:25 All right. See you. We'll see you on Thursday, guys. Thanks.