Why Physical Therapy Needs to Rethink Education NOW

0:02 You're listening to the PT Pinecast, where smart people in healthcare come to make noise. Here's your host, Jimmy McKay. All right. Thanks, voice guy. Eric Robertson, Jimmy McKay. Eric Robertson, no stranger to podcasting and thinking about big ideas. I like big ideas. These are the kinds of things that you do. You think about big ideas and you tell people about them. Yeah. Well, you can't just have big ideas. You kind of have to share them a little bit. And we used to share them in blogs. You started a blog a long time ago. Really long time ago, yeah, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, I think, in, in our profession and the idea is great get in a room talk about them but am i you and myself like i hope you get some solutions while you're in there it's like talking about problems is fun we call that therapy it needs to be some constructive thoughts let's do something about this so what are you ex so the also the rule when respect the rules of graham sessions is you're supposed to not attribute it to any to anyone and by it i mean an idea so you can say what was said but not who said it this way people are free to move about the idea spectrum What have you been excited to see either discussed or at least on the docket?

1:21 Because we're still at noon on the first day. Yeah, I mean, we're just getting going, which is great. And it's already been so energizing and so inspiring, as it always is. And I think the thing that really got me going was the last session. It was about collective bargaining and mega groups. And I have to be honest, when I saw that on the agenda, I was like, what's that? I don't think I want that. But yeah. know what it was about was pts coming together and uh using their collective power to gain leverage right and so there was this idea of uh listen payers don't really care about value which is a little uh like surprising it hurts but okay yeah you compassionately argue value and but they don't respond to that they'll be like happy to hear it but they're going to respond to leverage and the next step of that was learning what can we incorporate in our business of physical therapy that dentists have done right who's done it who's faced similar or the same or similar problems and what have they done about it and then does that apply to us because not everything applies across different verticals and that's what the the nice part of this conversation was was it was constructive it was people who were already solving it that way people have created these uh mega groups if you will or you know collaborative networks where they've gained leverage and they've been successful.

2:41 So you have MSOs, Managed Service Organization, or IPAs, Independent Practice Associations, and again, there's more experts in the room. How do we come together without having to be bought and sold into each other? We can remain separate. How do we get a bunch of tubes on a lake and just hang on and now we're a big group, but at any point I can be like, I'm good, I'm still my own tube. Right. Right. Yeah. And, you know, that was another idea that came up in this is that, you know, the business of physical therapy isn't really complicated. Right. It's like people come in, you do a thing that we all know how to do to them and then we build them for it. Right. So there's nothing necessarily secret about physical therapy as a business. Right. And so it was about sharing and collaborating and stopping the kind of the fear of, you know, or this like maybe misguided but totally understandable sense of like, well, I need this autonomy.

3:33 Because at the end of the day, you gain more autonomy by collectively owning the practice of clinical physical therapy. And now you can use that long lever arm, and you can bargain for things like better rates. Yeah, I like the lever arm pull in there. Now we can leverage. That's one topic that was on there. What's something you wish was on here? What's something that you're like, hey, man, maybe next year, but why aren't we talking about this? Yeah. So, you know, Graham Sessions has its roots in private practice, right? That's where it started from. And at first, when I first was coming to Graham Sessions, I think my first one was like the second or the third one. I can't remember which, but it was almost exclusively private practice owners in the room.

4:16 And it's since diversified, right? And so now I think they announced there was seventeen of the eighteen sections or something represented here, which is fantastic. But there's still like a very business heavy focus in that, which is good, like, but Sometimes I think education happens in a different universe, right? And so the things that are happening in the economics that drive decisions in education are very different from the economics and the realities of what clinicians in practice are experiencing. So a good example of that would be, you know, we're educating for less time. Right. Which makes sense. Right. Education costs are so expensive. Cut a year. Yeah. Let's cut a year. You know, but on the other side, well, where does where you didn't learn something for a year.

4:58 Right. Right. Or you learned it, but it was twice as fast. So it's half as good. And I'm making numbers, but you get. Yeah. And, you know, and OK, we can't generalize that all the way across. But but in general, I think business owners are concerned that PTs are coming out and they need more training. And so where does that come from? How do you do that? And I think that's something we need to talk about. As a matter of fact, somebody said, like, OK, well, we're talking about primary care physical therapy. And somebody mentioned, well, residencies could solve that. And I'm thinking to myself, OK, well, there's like, what, six hundred residency slots and most of them orthopedics. How many primary care residency slots do we have to fix that? It might be four. Maybe it's ten. I don't know. Somebody surprised. Not a lot. Right. But it's if you compare that to the twelve thousand graduates we have each year.

5:40 something's not working about our residency model. And so I think these are things I would like to talk about is how do we reimagine clinical training that happens after you graduate that's still absolutely required and do that in a way that we can scale it. Do it from a position of abundance where you don't have to accept a low salary. You don't have to have a really long, very expensive, time-consuming residency that takes a year. And that's something that I've learned from my art world. So when I was in art school, you learn about residencies, and residencies are defined by the institution. So a museum might have a residency where you come in once a week and do some lectures.

6:20 A residency might be you go to Montana and live in the wilderness for six months and make art. So the institutions define the residency. And the analog into practice would be the practices define the residency. So seeing more residencies embedded or created by the practice. There are some out there that do that. Yeah, so residency is defined by the people who are delivering them, right? So if you have a clinic, there's going to be certain variables that are really important to you. Your values are going to be there, right? Maybe you value positive psychology education, right? Where does that go? How does that fit into an orthopedic residency, which the accreditation process requires the curriculum to be this big and full of all of these things of orthopedics?

7:01 Maybe you don't see anybody with feet, let's just say. You don't need the feet curriculum. But you don't want the psychology curriculum. And our current framework doesn't allow for that. And so I think we need to really shake some things up if we want to start training people more meaningfully after they graduate. What are you excited for in terms of the future of PT? I know a lot of times people look at, I don't think Graham Sessions is focused on the negative. I think it's focused on let's find ideas, not just problems. And we focus on, by our nature of humans, what's wrong. But what are you excited about in the future of PT where we are now? I like this question. You know, I had Jim Gordon on my podcast on PT Outcast a few months ago, and he said a thing that's been just percolating in my head.

7:43 And it's like, you know, the future is not guaranteed. And the people who are working today are defining the future. And it's that idea, right? Like, what is doesn't have to be, you know, and I think, you know, we have a lot of energetic people, just you look around this room, it's exciting. And one of the themes of this is right on the agenda that you know, diamonds are formed under pressure. And so as, as a profession, if we're struggling, if we're feeling some pain points, like let's lean in. Yeah, I like that. Hi. I guess session just let out. I don't know what was being discussed a second ago. I asked this question a few weeks ago because I wanted to get a good litmus test. I came to my first Graham Sessions ten years ago. Didn't know what to expect. I asked my audience on LinkedIn.

8:24 Of course, it's biased because it's my audience, whatever. And I just said, do you even know what Graham Sessions is? And it was like eighty percent. No. did not know what it was. So I think the funny part is we're like, make sure you don't tell anybody what was said here. I'm like, no one knows we're here. Look, we're like waving from the top of APTA Tower here, but no one, everyone's like, I don't know who that is. I got stuff to do. But how do we, my thought of doing these live streams was, let's get these ideas out of the room. I don't want, they're awesome here. Let's spread them. Uh, what's something that, uh, that you wish it will be on the docket tomorrow. You get the dry erase board, Keaton Ray and Sharon Dunn who facilitate this now come to you and they go, you got one slot. What are you going to talk about?

9:05 Oh, okay. Yeah. So, you know, Keaton and Sharon, by the way, are doing a great job, like running into this. This is, this is good to see them running. It's a good energy. Um, and, uh, and they've had some fun things happening. I think if I was going to have the dry erase marker, if I could do that, I would like to talk about the thing I brought up earlier, combining the worlds of education business decisions and business. And also the subcontext of that is the pending crisis in grad plus loans. Oh, yeah. Right? What would you now? Yeah, we have a problem already. And it's going to get worse. Yeah, it's going to get worse. And so I think that's the urgent thing that I wish would have been on the agenda. Well, there is some education in this room, but if that's true, which I think it is, this is more business heavy and that's fine.

9:51 It's housed under the APTA private practice section. Is there a space for a different name, but a Graham Sessions of Education where you get one hundred and fifty people in the room and they go, hey, man, hash it out. We're not unlocking the doors until you get some solutions. Yeah, you know, I think there is, but I think that would also be misguided. Oh, why? because the separate universe, right? The universes need to evolve together. Got it. Okay. Yeah. Yeah. So, so what I, what I think though, it may be Graham sessions that needs to maybe have a flavor of education, um, that leans in a little bit more, but you know, you gotta be careful because it's like different universes have different cultures. Right. And so there's a culture here that has existed and has evolved. And there, as you said, there's plenty of educators here in the room.

10:33 Yeah. Um, How do we take that? I don't really know. Maybe that's the topic that we put on the agenda. Maybe we ask the room. Yeah, right. I mean, like you said, when it started, it was business, business, business, and then somebody along the way probably said, we're talking a lot about academics, but none of them are here to defend or explain. Maybe we should invite some. A long time ago in Graham Sessions, we had a session that was, are we admitting the right people to PT school? Right, right, right, right, right. And it was fascinating, right? They did StrengthsFinder, and they did it with entry-level PT students, and then they did StrengthFinder with... For all the people who are attending Graham sessions who are leaders of the profession and like thought people and and what would they find out completely different Wow, not a shock though not a shock but completely different right the in general PTs were like harmonizers and relators and And then the people in the room were not they were the strategy people.

11:20 They were the confronters. They were yeah competition people Have you ever taken that I have what do you do you remember one or two? There's five, right? Yeah, five. Yeah. Yeah. Do you know yours? I do Yeah, so it was ideation. We got it strategy. Okay communication, competition, and my favorite one is woo. I'm a woo. I'm a number one woo. I know, that's why we hang out. Woo, communication, but my communication was third, ideation, futurist, and one more. And then I bring this up because I took StrengthsFinders once, and it's one of those like It's a strengths test. What's the one with the INTP or whatever? That's a personality test.

12:02 This is a strengths test, which I know we're splitting hairs. And I remember I was working for this big, big, huge PT company, and my boss, who was not a PT, he was a management guy, was like, I want to talk to you about your spreadsheets. I was like... I immediately broke out into sweat. And I was like, cool. All right. And he's like, I want you to spend a lot of time getting better at spreadsheets. And I was like, okay. Now I have a counter idea. And he's like, what? And I was like, are the people at this organization who are great at spreadsheet already, are they getting better at communication and ideation? And he's like, well, no, that's ridiculous. And I go... then why don't you just give the spreadsheet test to the spreadsheet people and let me go woo and I do. I'm going to go out and woo. And that didn't go over well because he just wanted me to get in line. And that's why I was like, my time here is limited.

12:42 I understand I'm in the wrong spot. We have a tradition on the show. Every episode, it's called The Parting Shot. This is The Parting Shot. One last mic drop moment. No pressure. Just your legacy on the line. All right, first time I've ever done live streams from anywhere other than my living room. We've recorded but never just streamed this. So I'm dumbfounded people are watching. What are you doing? Don't you have a job? It's the middle of the day. It is the middle of the day. Parting shot brought to you by our friends at Empower EMR. They're giving you what clinicians are at least asking for is smoother documentation, faster documentation, ease of use in the app you most likely, fortunately or unfortunately, use a lot in your life.

13:24 Kick the tires and light the fires at EmpowerEMR.com. All right, so your parting shot, your last chance for a mic drop moment or a soapbox statement. What do you got? What do I got? I'm going to go back to this residency model. I think it's time, and I think I'm ready to disrupt this residency model and kind of turn it on its head. Um, in the spirit of Graham sessions being a little spicy, spicy, I want to wreck the accreditation model for residency. I think that's completely broken. It doesn't serve the profession. Uh, and so that's what I'm trying to do with brain Smith, uh, with, with this new entity that I'm starting. So talk about that. We didn't get into that. What is brain Smith? Yeah. Brain Smith is a new education company. We launched it last October and we're going to be offering a really, uh, excellent limited library, but very highly curated, uh, real high quality instructor content for continuing education.

14:08 And then we're going to be partnering with clinics and building residency programs for them. They are not good at it. They don't have the time or the expertise. And you're like, I slide in. You want the want, but you don't have it. This is what we can do. Yeah, I've spent the past several years of my career building hybrid programs and developing hybrid programs, building lots of curriculum and content. And so I've developed really nice systems for this. So let me do that. And you do. I'll save you time because you'll pay me, but I'll get the thing done faster, better than you would. Right. And you continue to do the thing that you do. Yeah. And then it'll be nice because, you know, the clinician or the clinic rather gets to define what their values are. I see what you mean. Now, this looks like them. This looks smells like them.

14:48 Right. As it should. Right. Right. So it's not like here's my residency certificate. curriculum you take it and go with this it's going to be like i have no idea what i want but i can tell you the ingredients or what i want it to feel like yeah the end we treat butterflies at this clinic okay so i have a butterfly course got it right like that kind of a thing perfect and where do people go to find out more brainsmith.org brainsmith.org uh eric robertson appreciate you uh having the guts to do the live stream yeah we survived it's a good time it's a good time we survived back to grams 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. Want to go deeper? Hit us at pgpinecast.com or find us on YouTube and socials at pgpinecast.

15:31 And legally, none of this was advice. It's for entertainment purposes only. Bullshit! See, Keith? We read the script. Happy now?