Why Neuro PTs Need to Start Charging What They're Worth

0:01 Thanks, Voice Guy. First, I want to say thanks to Brooks IHL. If you're thinking residency, fellowship, or just want deeper clinical mastery, at least kick the tires. Brooks IHL has programs that actually shape better clinicians, not just give you letters. Everybody likes letters. Letters are great. But really, you want the other stuff. I know what you want. Brooksihl.org. That's brooksihl.org. Orthopedics, neuro, geriatrics, pediatrics. There's more. I just don't have a list in front of me. And do, in this tenth anniversary year of the podcast, who knew this would go more than ten weeks?

0:44 Never mind a decade. Brooks has been here for a couple years supporting the show. So thanks, Brooks. Brooksihl.org. Today's guest... spent nearly a decade, also a decade, a decade, a decade, working with patients who challenged the norms of recovery and rehabilitation. But somewhere along the way, she realized it wasn't just the patients who needed new ways to move. It was the profession itself. It was us. The call was coming from inside the house. Now she's on a mission to flip the script in neurologic physical therapy, building a movement, a business, and a mindset that says we don't have to wait for someone else to fix it. Spoiler alert. No one's going to fix it. We either fix it or it falls apart. We all know that. She's changing the game for clinicians who want more than burnout and low-ball paychecks.

1:28 I love this. Let's get into the studio. Lauren Young, you mentioned spicy and salty before we got started. I was like, yeah, and we could tell with that intro. We're bringing a little salt. Yeah, we're here. Jimmy, it's funny that you say it's been ten years because I'm pretty sure I've been listening to your podcast from the origins. Really? Well, when did you, all right, so I always love this. This is not scripted, nothing scripted. How did you, do you remember how you found the show and where were you in school? Like where were you in your life? I was early, early career clinician whenever I found out. When did you graduate? I was twenty sixteen. Me too. Yeah. So I was working and I don't it had to be something that like the APTA put out.

2:13 And if you were a part of it, I don't remember. And I've been trying to remember. But I remember very vividly listening to your podcast. And I can tell you, I don't know what episode, I don't know where, but you said, the problem is we are salespeople, but we are not doing a good job selling. And in that moment, I was like, light on. So I will tell you, I thought all these years of listening to your podcast was like, man, if I make it on that podcast, I will have made it. And here I am. And here we are the pioneer of I mean, you were really the first one in this space talking about the things that people didn't want to talk about. And I whispered them.

2:53 They whispered them or said them without putting their name on them at happy hours. This is why I'll podcast like, you know, I don't drink a beer in every episode anymore. I did at one point drink a beer in every episode. You know, my waistline would appreciate that. We'll do it in person. But what I kept seeing was there was two reasons. I think I started this. I sat in a room full of a thousand people watching a person give a presentation that I was like, this is cool, but I don't get all of it and met the person after in the bar and it was a totally different person and the words and the vibe was different. And I was like, you're just as brilliant here but I didn't understand you on stage. Why did you do that? Do this there. And then the other thing was that, which is like, we all complain.

3:35 Like I'm going to Graham sessions in a couple of weeks. Do you know what Graham sessions are? A lot of people don't. I didn't know. It's like an invite only thing. It's only one hundred fifty people and it's meant to be. And I'm not knocking the reasoning behind it. But it's meant to like, well, we talk about it and we can talk about whatever we want, but nobody pays repercussions. And I'm like, but then there's no stakes. There's no tension. If there's no tension, I start off. I didn't expect this to go this way, but we'll keep going. Whenever I'm working with someone, doesn't matter what. If it's a company, right? I'm sitting in front of three people and they're like, maybe we want to work together, do a project. I go, one of my go-to questions, which is great for clinical care, what happens if we do nothing in six months?

4:18 And people are like, what do you mean? Well, you've done nothing for a while. What happens if we do nothing for six more months? What I'm doing is I want them to envision the stakes. What fails? What doesn't grow? What does that feel like? Are we still pissed? What happens if I don't do my dishes for another day because I live alone? I have to walk by them and they smell and then I feel even worse. And then there's more dishes because I have to keep eating. And that's the only way to get me to do anything. The other good question I like is, if this doesn't get fixed, or if we proceed with option A, B, or C, and it fails, who's in trouble? And I don't say that to be like, let's point blame. That doesn't help. What I mean is like, who's going to own this and champion this with me?

5:01 Not fight me, but it's like, who gets in trouble? Because if five people... First of all, if you can't answer that, and you're like, well, us and this and it's not... No one owns it, so they won't get in trouble. And if five people own it, same thing. won't change. And what's the trouble, right? Like, I see identify the trouble PT world, we all think, like the highest stake is like losing the license, I'm in a clinic where I just opened, you know, I have this setup that I'm okay, if it fails, I don't think it's going to fail. I'm not intending for it to fail, but like, I'm not going to lose my license if it fails. Like, what do I actually lose? And I think people don't delve into that question enough.

5:42 And so they are just paralyzed by fear because they don't realize what it is that I'm losing. Really, it might be six months of my life and I've learned a lot doing this. So have I really lost even if it doesn't work out? No, I've learned a ton that I would take back into a different clinic with me. This is a sports analogy, but it still works, which is there's a difference between playing to win and playing not to lose. Did you play sports? Were you an athlete, former athlete? High school, but yeah. But what sports? I can use that analogy. What sport? Yeah, it's softball. Yeah, like it's funny. I played baseball and softball and all of a sudden you're up by six and one run goes in and you're like, well, we're up by five.

6:26 So let's just get this. Like, let's just be safe and keep the ball. It's like next thing you know, you're down by two and you're like, what happened? Where did it go? That's playing not to lose instead of like, I need to win now. Pretend like it's tied. Pretend like we're down one. You know, I play old man beer league hockey now and we'll be sitting on the bench. And I just quote, like, I don't even know where it came from. Probably watching some game on TV. And they were like, oh, we're up to two goal lead. Worst lead in hockey. Why? Because you're comfortable. Because you're comfortable and you're like, well, I just, I won't push. It's like, you have to act as if it matters. Not act as if I got to throw ten Hail Marys and risk losing everything, but act as if what I'm doing is going to affect what happens three, six, nine, twelve months from now.

7:08 And I think that's part of the I don't want to say issue, but issue with our profession is everyone's comfortable. We're all comfortable. We have a system. It sort of works depending on who you talk to. I don't think it works great, but it does what it's intended to do, but then that's the baseline. And I think we have the ability to do so much more, but so many people come out of school. You've got debt, all of these things. We go into a clinic, we start the nine to five, we see twenty four patients a day. And by year five, we're burned out because we were comfortable. Did you see the movie? It was George Clooney up in the air where he's the guy who flies around and fires people.

7:49 So his job is you, a company hires him to go around the country and like do layoffs. He's the guy who sits in the room. You get called into his office. He's the grim reaper. And who's the guy from Whiplash? Remember the movie about the drummer? I'm a terrible movie person. But it's that guy. The guy is getting fired. So George Clooney is sitting across. Someone's yelling it right now at the speakers. Like, how come you don't know this? And he's sitting across and he's looking and he's firing this guy. And the guy's like in his sixties. And he's looking at this guy's resume and he goes, hey man, I saw on your resume, like you went to the Culinary Institute and now you work here at XYZ Cubicle. And then George Clooney said, because this guy's pissed.

8:31 He's like, you guys are firing me? I've worked here for twenty five years. And Clooney's like, it's not me. But he looks at him and he goes, how much did they pay you to first? How much did they pay to give up your dream? And then the guy stops and he takes a breath and he said, like twenty three thousand dollars, twenty three thousand five hundred dollars in health insurance. And that was twenty five years ago. And it's like, you came, you didn't come this far to come this far. Like, and I'm not saying cash out your four Oh one K and just throw, just wing it. That's not what I'm saying. What I'm saying is like what you do now will come about three, six, nine, twelve from now. If you do something now, we say this to patients all the time and then we don't do it.

9:13 So you said PTs need to stop being bleeding hearts. I say Peace Corps gene. You say bleeding hearts. Pretty much same thing. What do you mean by that? And then what do we need to do instead? I think that in school, because I've done a lot of thinking about this, because I've run, I just in October put my application in to be only Medicare. Like I'm only accepting Medicare as an insurance. And that's a lot of. Maybe before we get into this, give people the setup so they understand where you're coming from and where you are. Yeah, so I worked in clinic-based settings across the continuum of care for seven-ish years, full-time.

9:55 I'm in academia now while running. It was a cash-based clinic, now starting in network with Medicare. A lot of that is because of the rules that we have that we can't, as physical therapists, opt out of Medicare. So you really don't have a choice if you want to see that patient population. um and a lot of neuro folks that i'm a neuro clinical specialist i should probably say that too um a lot of neuro folks are medicare beneficiaries so um you know it's kind of from a business perspective you i had to i didn't really have a choice um so now i've got i was doing mobile um out of network and i opened up a clinic and so essentially looking at all of this You say I've heard the conversation that trying to charge cash for something that Medicare or that insurance covers is unethical.

10:47 We shouldn't do this. Like, where is the tipping point? But then I look and see massage therapists, chiropractors, personal trainers, exercise physiologists, you name it. they're charging cash for their service that, you know, I'm not going to say is exactly the same as ours, but there is some overlap at some points where we're all doing very similar things. And so if people are willing to pay those practitioners, I think that we are doing the profession and ourselves a disservice as physical therapists by being a bleeding heart and saying, well, no, no, no, let me figure out a way so you can use your insurance.

11:27 When these people are coming to you and saying, I'm happy to pay you out of pocket. So that's what I mean by bleeding heart. I think we need a little more business knowledge, not a little, a lot more business knowledge in our PT schools. Even if you're going to go work for someone else, understanding this is how you can maximize billing. I can tell you for seven years of my career, I charged an eval and that's it. That's crazy. I should have been charging therapeutic activity because I spent fifteen minutes explaining a home exercise program or teaching how the proper way to move them from the bed to wherever.

12:13 But it was never presented to me in a business manner of here's what you're doing. Here's how you do it. In a way to to make revenue, because that's where this all goes is I feel like we are. pushing the profession to a point where it's not gonna be sustainable. Because we are such bleeding hearts, patients aren't gonna have a place to go because there's not going to be a business to sustain that. I've used this before and I can't remember who I stole it from, which was like the lifeboat analogy. If you have a lifeboat and it says this lifeboat will hold one thousand pounds and you've got ten people that are all one hundred pounds.

12:54 I don't know who these people are. They're all one hundred pounds, but I'm not good with math. And there's one more person in the water and you pull them in. You all sink. I nobody wants to leave most people. Most people don't want to leave an extra person in the water. Right. Ninety nine percent of all PTs would opt to bring that person in the water or sorry, in the boat. But then we like if the clinic goes down, we help no one. So we need how do we scrub this from our DNA? How do we get the Peace Corps gene out of it without losing the heart? Yeah. Which is and again, Lauren, myself, most people are not asking you or telling you to do anything unethical.

13:34 We're asking you to understand how gravity works and sunlight and physics and understand the physics of what you're talking about. But here's a question, but it's almost rhetorical, but like, where do you put this in PT school? Is this a hot topic? weekend? Is this a day? Is this sprinkled throughout? We've got, I mean, what do you take out? We've got, you know, you getting hit with a fire hose. I don't know the answer because I'm not an academic. I'm going to stop talking about academic things because I haven't been in it. So I can't speak on that behalf. No, I think that you're right, though. I mean, the program that I teach in is accelerated. Our students are getting their doctorate in two years. So you talk about firehose of traditional PT program and now you've accelerated it.

14:19 And I think, you know, even in PT school, would I have been receptive to this? Would I have had the context to then understand? what is trying to be said to me when I haven't gone out and build. I mean, like I said, I was seven years in and I was angry when my clinic was like, we're gonna stop buying in the really good E-Stim pads and we're gonna buy the E-Stim pads that work, but they're not top of the line. I was like, this is ridiculous. And now looking back, I'm like, oh, I see, I understand. So I think for me, my clinic giving me that information and saying, because I'm looking at hiring someone to come in and help me.

15:08 what I said is if we understand this to the point where we can maximize our billing, again, like you said, without being unethical, without totally being soulless, because I'm not, I got in this to help people, but I also see, again, we have to make this sustainable to be able to continue to help people. If we can maximize our billing and maximize our time and maybe pick up other sources of revenue, then I can pay you more. But we have these students who are coming out of school and they want a hundred thousand dollars. your clinic's not making a hundred thousand dollars. How do you expect them to pay you that?

15:48 You know, if you're willing to come in and say, I have these six ideas that I think we could maximize billing in this way, and we could be a hybrid and I'll run this extra class three days a week after hours or whatever, now pay me more money. Okay. Let's talk. But I think that it's clinic owners too. And I'm really talking because you look at some of these big private equity groups, it's volume, right? They can take that low contract because they're willing to put their therapist seeing twenty, thirty people a day, which is crazy to me. I've only worked in places that I see one patient an hour, but it is a little different in neuro.

16:33 But, you know, it's these smaller clinics that are getting taken out of essentially our economic chain because they can't keep up with the low contract rates that other larger companies are acquiring because they have the volume to do so. But then we're losing. We're losing wonderful clinicians because they're tired. In what other profession does someone go get a doctorate degree and within five years is burned out and leaves the profession? Yeah, I mean, I was listening to a talk on burnout every day and I don't disagree that it's there. I felt it. Why does it come about? This could be its own series.

17:14 I could do an entire week of things like this, right? But if I feel like I'm getting taken advantage of, That is like a rock in my... A pebble in my shoe every step. So burnout doesn't come like a... I touch the hot stove and there's a scar. It's like it's small and a pebble in every step until it's this thing that won't heal. You mentioned somewhere... That feels like it's opposite. It feels like when someone says cash-based something, it's orthopedics. Why do you think cash... These two terms feel like they don't puzzle piece together ever. Cash-based neuro. This goes like soulless.

17:55 I'm using air quotes here. Cash. And then all of the hearts and feels, neuro. It feels like those two things don't go together. But... They did, obviously. You put them together. Why do you feel like those two things together get so much pushback, especially from inside the profession? up. I think there's a lot of reasons. I think one big reason that PTs feel this way is because, and I do think that there is a shift. I've talked to people on social media and, you know, kind of across the country. I do think there's a shift people are seeing. I think the big piece is, you know, a neurologic injury, spinal cord injury, brain injury, stroke, they're not cheap. And so there are so many other medical factors that are coming into play.

18:41 The Other thing that I think why it works, what I'm doing, and again, I like to be very transparent. I'm a low volume clinic. want forty patients per week because I can't give everything that I need to give. You know, I'll leave a patient's house and I might make two hours of phone calls getting wheelchairs ready, getting DME splints, getting bath equipment coordinated with other departments in the state. You know, doing that forty hours a week, then I'm back to where I was seven years ago. And I was like, I'm done. I will go work at Lululemon.

19:22 I'm finished being a PT. And so I think where my clinic's vision initially was is that there is a subset of people who get discharged from insurance, from physical therapy, sorry, from physical therapy because of insurance limitations, you know, lack of progress, whatever it may be, who still want care because it's twelve weeks of neurologic specific physical therapy isn't getting most people back to where they want to be so what we're seeing is a lot of people coming into that space what mine has evolved into is people who want more frequency so i'll have people who see their you know insurance-based therapist two or three days a week and then they see me the other one or two days a week and then they're getting four to five days a week of therapy and we know what that means for neuroplasticity But they don't have the bill that comes along with an out of network therapist for five days a week.

20:25 So again, it's creating a model. And what I try and tell people is like, what is your quality of life worth? You know, if your quality of life is, is worth what insurance is going to pay. then that's fine. That's your choice. But if you want more, insurance isn't going to cover everything that you need, nor, you know, does it always. We always have, and too, we can get into a lot of these places, you know, it might take an hour to get this person out of bed, dressed, ready to go. Then you've got a You know, an out of network therapist is going to cost.

21:11 And for me, I come to your home. So now all that travel and everything isn't isn't there anymore. So I think you're right. It's not done. And there's a few. So so part of the bleeding heart issue is part of it. The other part is the Medicare issue. You know, we can't opt out of Medicare if I go in and say. you're a Medicare beneficiary, I'm going to do an evaluation on you and it's two hundred dollars. I've just committed fraud and I have legal risks. So you can't do it. And that's a whole nother conversation that could take up more time. But that being said, I think that those are two big reasons of why you're not seeing this as much.

21:57 But it's coming. I really think that it's coming. Have you ever heard of next step, next step fitness? So I met Yanni Corey who founded that, you know, and I, you know, I was just thinking, I was like, I haven't had Yanni on the show in a couple of years. He hates the system, but loves PTs. And then he's like, I've taken heat from PTs because he sets up essentially next step fitness is like Yanni got injured. went through PT. It wasn't enough, right? The insurance didn't cover what he needed. He was at least financially able to go get that. He's like, dude, I was in the point one percent who was able to fly to Kentucky and live there and work with this really advanced neuro PT for months.

22:43 Who can do that? So his next step is essentially he wants to set up gyms that have the right equipment that people pay membership to be at. But he's like, I have to leave PTs out of the equation because they're too expensive. But he's like, I want their brain, but I can't pay for this. And he's right that math doesn't math. So what he does is he brings PTs into train trainers. to make sure that they're, they're understanding. And like, I'm like, but here's the point. If PTs don't like that, it's like people are still getting great care and a PT touched them one degree removed. So it's like Yanni was like, I'm not going to stand here yelling at clouds. I'm just going to fix, I'm going to create something.

23:24 I, he had to create his own solution and he did. You can't fault someone for that. No. And is he based out of Kansas city? He is based at a, he probably, his goal is to have one of these at least in every state. So he's out of California. I know that, but I think he has one in Kansas. Yeah, here it is. LA, Atlanta, Kansas City, Orlando, Raleigh, Vegas, Pittsburgh, New Zealand, Ukraine. So those are all the locations. Wow. I've got, so I've got two, I've lived in Kansas City. I've got two former patients who go there and they love it. They've been going there for, I mean, I've been gone from Kansas City for almost four or five years. They've been going there that long. And, you know, like you said, I think that's the big piece of it is they have the equipment.

24:04 Yes, that's the FBS bike. They've got the arc X that's now come out standing frames, the excite. I mean, every piece of equipment and at least the one in Kansas City is it does all diagnoses, but it's really specialized to spinal cord injury. um and so it's like you know these things are pieces of equipment i mean the arcx is forty thousand dollars like you know but they have it and again it's it's based on a cash pay rate it's someone else who found people will pay you if you show up so you know at that point Why aren't we doing more of this?

24:49 And I totally agree. I think people are much more willing to pay a trainer, fifty to seventy dollars an hour than they are to pay a PT, one hundred and twenty five, whether you're going to get better or different care from either one. At some point, the cost is the problem. So how do we fix that? Well, we now hire those personal trainers. We oversee what's happening. I mean, eventually in my mind, that's where I want this to head is that I want to oversee personal trainers who are willing to work with this population because it's a very niche population.

25:29 Personal trainers can go out and work with anyone who is an able-bodied individual. You bring in someone who's swinging at you mid-session or crying mid-session or has bones that are super brittle because they haven't stood or walked in years. It could be a recipe for disaster if it's not properly supervised. So I do think that... There's got to be a way that we can all play nice in the sandbox, but there's just a very big divide between that model right now. I said you could be mad. You could be as mad as you want. at the situation, but don't be mad at someone else for solving the problem that they're stuck in.

26:13 Yanni's in a chair, man. And so the only way to get better was to quite literally chart his own course. He's nice enough to not, I mean, he could have just bought all this stuff himself or just solved his own problem. He now takes his time, his effort, his, you know, his energy, and he tries to solve it. And again, ambitious goal. He's like, I want one of these in every state, in every major city. And the fact that he's the only one should, you know, anger people. Right. So look him up. I'll give the next step fitness.org. Just look into it. If it's in the city, go tour it. Yeah. Yanni's the first guy who go come in here, steal everything I'm doing and go do it somewhere else. He's the first guy. He'll show you how to do it. I bet.

26:54 You mentioned, you mentioned being in academics. You've called out or mentioned how, how does PT education misses its Mark? If you were building a, a PT program, dry erase board, blank, what would you change? Oh, man. Stop, start, continue. What would you stop doing? Start doing, continue. What does it look like? Or what's your one or two suggestions if you had a magic wand? If I had a magic wand, I would put everyone who is in academia back in the clinic and learning about what the billing is, what the AI is doing right now, what does a typical day for a physical therapist look like in your average PT clinic?

27:36 That would be thing number one. Not just our four hours or our eight hours that are given to us in our contract. The other thing is, and I think it kind of rolls off of that, is things are changing and PT school education just isn't keeping up. So I think... The hands of time moves slowly in academia, and I think that just and I work for a very progressive program. That's the kind of crazy thing, but there's other. factors at play that you really have to stay within the constraints of the academic system.

28:16 So even though you might be as progressive as you want to be, I mean, they're a two-year program and they started this ten years ago. You know, when you start this, you can be progressive, but you still have constraints that you have to monitor. So I think putting people in the clinic, one thing that comes to mind is like documentation. We spend time, you know, grading, soap notes, and all of these things. And I'm like, man, AI is doing most of this now. And then I took Tony Meritato's course, Zero to Paid. And he's like, you know what Medicare requires for a certified plan of care?

28:57 Here's your three things. And I'm like, why are we in school teaching students that they have to write this novel when one AI will do it for you, which granted, I'm not saying like you have to go and you have to check it, right? I'm not saying we use AI unchecked, but we're using AI and Medicare doesn't require this novel. So why are we writing one? Somebody did an analysis years ago by APTA. We were over-documenting by a crazy double digit percentage and under-billing by a crazy double digit percentage and then saying we're overworked and underpaid. the calls coming from inside the house.

29:39 The writing is on the wall. Yeah, and that's the thing is like again, it all goes back to we have to have educators who are educated in what's coming next and what's what's happening. And then we have to have a system who's willing to make these changes. And it's not just like this cool feature in a course. It's like this is how PT is is evolving and how it's going. You know, I've talked. Generally, with a friend, they own like, fifteen PT clinics and he's always approached me. He's like, let's start our own PT school. I'm like, no, no, no, we don't need to do that. But what we've talked about is how do you make something that's specialized to where if you're ready to run, if you know you're going to open a clinic, you start.

30:27 It's a dual program. It's an MBA or a master's in health administration, something dual enrolling with PT and you come out and you're ready to go because. this journey of opening a clinic and just figuring out what are the rules, what can you do, what can't you do, has been just completely eye-opening. At some points I'm like, where do you even learn this? I've called people, I've had to use resources because it's like a secret club. It's like the Graham session sometimes. That's how I feel. If you don't know a mentor in the field, that's already done this who can help you?

31:11 Where do you go? Where is the magic bullet of information that says, here's how you open a clinic? It's everywhere and nowhere. It's like you don't need permission, but you also need guide rails, but you could figure it out. But not everybody has the money, the time, or the risk tolerance. We need more people to do it, but whose job is it to help? It's everybody's job, but it's nobody's job. Who gets in trouble if we don't do this, and who's going to help us? Before I forget, I'll say thanks to Empower EMR, the platform helping clinics simplify documentation, improve patient engagement, and get their time back. EMR doesn't have to be painful. That's a choice, as long as you pick the right one. And who knows if Empower EMR is the right one for you?

31:51 They understand there's a cost involved in change. So go just talk to Sharif there. EmpowerEMR.com. It's EmpowerEMR. You've mentioned being considered a graduate degree versus a professional degree before. I think that's, we started talking about that. That's the thing that was all the rage and we were signing petitions and we were going to March, March in Washington on this. How dare you? And I was like, you know, this is where I liked hanging out with Tony. He's a lot. He's like, did anything change besides a word in a book? It didn't matter anyway. Yeah. To begin with? Correct. That was the thing. When someone pointed that out, I didn't know. They're like, we didn't have the designation. It was sort of like we were on double secret probation.

32:34 We were like allowed to, but weren't. And then it was taken away. I was like, this is like when you're in sales and you're like, I lost the sale. It's like, did you have the sale? How'd you lose it? You didn't have it. It was never yours. Don't feel bad. So why was that? I feel like, why was that a distraction important for the future? Maybe, I guess, maybe it got our attention at least. that was it was nuts because it was like okay there were rumblings and then it got a little louder so you saw a few people start talking about it and then all of a sudden all of social media was doing the well if i'm not considered professional anymore like whatever and i'm like wait to be clear, we were never considered professional.

33:15 We didn't get anything taken from us. We just didn't get added to the list. But I think this is a really important because, you know, I have my own I have my own thoughts. I don't know that I have a strong opinion either way, which I think is kind of shocking for some people, because I can be very passionate about things when I'm ready. But I think the cost of tuition, when you look at our return on investment, is terrible. So something needs to change so we can, you know, have a better quality of life, essentially. I mean, there's people who are working three jobs to pay their student loans off. And that's, again, why are we burned out?

33:56 Because you're working nine to five, five to nine, and then on the weekends, like you have no life. So I think like that's part of the equation. But again, I don't I think it could be good. I think it could be really bad where nothing changes and there's no more PTs because they can't afford to go to school. Obviously, that scenario is not great. We're seeing it in education. I don't know about where you live, but where I live, a lot of my friends were teachers, right? And I remember when people my age, so people born in the late seventies, eighties, to get a job in education in where i live in new york or long island you had to know someone to know someone my grandma's neighbor is the school super like you had to to get any job never mind the subject or the age you wanted to teach didn't matter now I think they're just driving around handing out teaching positions.

34:59 Why? Because they made it a horrible thing. And now no one... And I mentioned this to someone else. Even if you made it great tomorrow, you're going to have to wait a few years for those high school kids to graduate, go through a couple years of school and come out and then start. We're not seeing... I feel like we're waiting for... We heard, we saw the lightning. We haven't felt the thunder yet. Yep. Yep. And that's what I feel like only time's going to tell with this decision, right? Is like, is it going to be a good thing? Is it going to be a bad thing? Because it's going to happen either way. So what do we do? And I think, you know, like I said, it was all the rage and then it kind of fizzled out. And again, it'll come back around when we start to see changes or things change.

35:46 in this nature, but I don't, again, like I said, I don't know how I personally feel. And I put a lot of stuff out on my social media and I'm like, you know, if you're called and you feel like you wanna petition, the APTA has very strongly said, you know, that they're against this, which makes sense because there could be potential really not great impacts in the profession. And I see that. I'm gonna have to rewind. Did I just say we heard lightning? Did you? Probably. So someone's probably going, who is this guy? Sure you can. All right. So you're clearly passionate about changing stuff that you're passionate about. What's one step for a PT in your mind who feels stuck in the old model?

36:30 Not not fifteen. Fifteen is too many. We know this with exercises, but we should also know this with professional steps. Give them one and you got a chance. Give them ten and you got no chance. What's one step for a PT who feels stuck in the old model and wants to break free? What advice would you give them? I would say go start an LLC. It takes, in most states, a hundred bucks. Go start your LLC. And I'm a big believer when I started this. I mean, some days I still don't know what I'm doing. But when I started this, I really didn't know what I was doing. I'm a... big, big believer in feel the fear and do it anyways. And so I was terrified.

37:10 I'm like, I don't know what I'm doing, but I started by saying, this is my business name. And from there I had somebody, I was here, well, I started my business. I maybe had had it for a month and I had a PT clinic reach out to me and they were like, we want you to come work for us and do this cash-based stuff out of our clinic. And like I got this feeling inside of me and I was like, oh, no, this is like my my brand. This is my thing. I'm really proud of it. And it was very easy to be like, oh, I know you're offering me more money than what this is going to make, but I'm not interested. And in that moment, I realized like how much this meant to me.

37:50 And so I think if you start your LLC. And you're kind of. like protective of it and then from there you take steps when you have something legal that protects you you have your insurance in place now when that patient says hey do you see people on the side you can say yeah i sure do um i'm actually working uh with someone and we're We're hoping to start a cohort in April that talks you through how do you create a side hustle? Because for a lot of people, they don't want out of their nine to five job.

38:31 But if you can slowly make that transition into seeing three or four extra patients a week, Maybe you don't have to go work that PRN job eight hours a day on Saturday or Sunday or go to the nursing home for three hours every evening after work. And now it becomes you making the full amount of money instead of giving part of it to someone else. So that's my advice is like, just do it. Do the thing. If it sits there for two years, whatever. You did it. You took a step. Good. Okay. Are you ready to play a game? I've got a game. You ready to play a game? It must be my internet.

39:14 We're going to play a quick game. You ready for a quick game? Ready for a quick game. Okay. We're going to do clinical rebel or business boss. I'm going to throw a few situations your way. You tell me, does this make you a clinical rebel or a business boss or both? And then just give me like a half a sentence. Why? Um, you charge out of pocket for high value neuroservices. Are you a clinical rebel or a business boss or both? Yeah. Why? I think that you have to value your skills. It doesn't value your skills. Yeah. You create an online course for PTs that isn't CEU approved. but it's still valuable.

39:55 Business boss. Yeah. A hundred percent. I, I, when I started, I've done a couple of courses and I thought that you had to do it. And then I was like, you know what? You're going to get that for three hundred bucks from Medbridge anyway. Like, so you're here to learn stuff or for the little number at the end, whatever. Send it into your state. You can get it. Yeah. You say no to an insurance contract that underpays. Are you a clinical rebel or a business boss or both? Business boss. Listen, as soon as you sign, you can't complain. You have waived your right to complain because you signed the contract. You bring on a student intern but have them help with your social media strategy. Are you a clinical rebel or business boss or both?

40:37 I would say maybe business boss. Could be both because it could be clinical content too. could be and it's i guess what's the purpose is your purpose to build your brand if the purpose is to build your brand business boss is your purpose is for education clinical there's a both uh final question you tell a patient you need more than what insurance will cover and i can help you outside of it oh i think clinical rebel and business boss love it all right you're off the hot seat last thing we do on the episode is called the parting shot This is the parting shot. One last mic drop moment.

41:18 No pressure. Just your legacy on the line. pressure just your legacy i'm aligned uh but it's brought to you by u.s physical therapy building great pt clinics and great pt careers across the country usph.com they've got a lot of them you'll be hearing from them on this show in twenty twenty six and beyond usph.com so parting shot lauren waiting for a decade for this no pressure whatsoever what are you gonna leave with the audience leave the audience with today um you have to be the pt that you would want treating your parents whether that's in business in clinical in all of the things you have to want what is best for the person in front of you and that is and sometimes you need to make a business decision so you can exist long enough to help the person three five seven years in advance otherwise your heart can bleed all you want but if you ain't in business you ain't helping anybody if you're not a pt anymore because you got burned out by the system then all of that help and love that you have is gone No margin, no mission.

42:22 Lauren, where can people find you? Where, what's the, I'll put it in the show notes and everything, but where would you want people? What's like the one or two places you want people to go if they were like, yeah, I want to learn more. Yeah, go follow me on Instagram. It's at neuro elite PT. That's going to be the best place to find me. I'm happy to answer messages, questions. I think the biggest thing about PT is we have to be a community and help each other and lift each other up because we're all struggling. We all feel very similarly. So that's the place to do it. Love it. Lauren, appreciate the time. Thank you for doing this. Thanks, Jimmy. That's it for this one, but we're just getting warmed up. Smash follow, send it to a friend, or crank up the next episode.

43:04 Want to go deeper? Hit us at pgpinecast.com. Or find us on YouTube and socials at pgpinecast. And legally, none of this was advice. It's for entertainment purposes only. See, Keith? We read the script. Happy now?