Why Resilient Clinicians Will Survive What’s Coming

WEBVTT

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You're listening to the P.T.

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Pinecast,

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where smart people in health care come to

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make noise.

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Here's your host, Jimmy McKay.

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All right,

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our guest right now returning to the show,

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obsessed with systems,

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not just how things work.

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I feel like why they work and why

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they might break or how to make it

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better.

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Someone who's seen the complex web of

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clinical operations,

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but see it like a circuit board and

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maybe where the,

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I learned this term from an engineer,

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points of failure.

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Not the whole thing isn't bad,

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there's a point of failure.

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A person that we're gonna talk to today,

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constantly analyzing how decisions are

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made in one corner of the organization,

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how it affects the others.

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It's called a ripple.

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One thing affects others.

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We know this cause, effect.

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Today we talk systems thinking,

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clinical innovation,

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what happens when PTs are empowered to

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actually fix

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the things breaking under the surface

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before they fall.

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Welcome, Alex Banderski, back to the show.

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Alex, man, good to see you.

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Pleasure to be here, Jimmy.

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This has been years in the making,

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and finally I get a presence here.

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It is truly a joy.

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Well,

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we had you on the show in DC.

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True, true.

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Yeah.

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We did that at the Future of Rehab

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Therapy Summit.

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As someone who went to that,

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that's Drew Contreras of APTA going,

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all right,

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let's throw a bunch of people in the

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room and see what happens.

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What would you,

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this is not on the script,

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but what'd you think about that event?

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And then what would you hope that event

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feels like, smells like,

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tastes like ten years from now if they

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keep doing it?

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I think it's a perfect reflection of our

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profession.

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I think doing a panel,

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you had five panelists that are these

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brilliant entrepreneurs that are designing

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technology that can help MSK care.

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And when it came time to question the

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panelists, there was a line of two people.

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Nobody had any questions.

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And then when there was a commercial panel

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of how to monetize this,

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the line was out the door.

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So as an industry,

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we care so much about commercialization.

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We have so little.

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Is our profanities allowed in this

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episode?

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Yeah, sure.

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OK,

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so we give so few fucks about the

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actual content and substance, right?

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Like we just want to make money on

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it, which to me like that.

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I think the entire conference was a an

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excellent idea,

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but it was not the future we have.

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It was the present of rehab.

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If you want to do the future rehab,

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you really have to look into what's ahead,

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not what's here.

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And certainly getting a keynote speaker

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that sells soap is always a plus,

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but soap is not the future.

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Right, right.

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I mean,

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I think the guys from Source Soap are

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there to show you like, hey,

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you can have an idea and you can

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just do something with it.

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Like, I think that was a great story.

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It's a great human story.

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But I think you're right, which is like,

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what's around?

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The first time I ever heard this term

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was from a guy, you know, Guy Kawasaki.

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Yeah, I'd never heard of him.

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And then I read his book like ten

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years ago or something,

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and he was like employee seven at Apple

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or one of the first people there.

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The term I'm talking about is like

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paradigm jumping,

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and he explained it in his book,

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which was like,

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I don't need you to make the widget

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red, even though no one's made it red.

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That doesn't jump a paradigm.

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I need you to make it wireless or

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I need you to make it think for

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me.

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or predict and not react.

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And I remember thinking, oh yeah,

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that's how things are.

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That's how things progress is when you,

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Example, maybe an example,

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when Apple changes their charger every

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three years and they don't really give you

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the option, that's sort of the only way.

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You have to sort of burn the boat.

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You can't go back.

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There's no undo the update.

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You have to go forward.

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And the funny thing is, six months later,

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you're like, oh, this is actually better.

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I actually like it better.

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It's like, yeah,

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but you had to go through the

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uncomfortable part of doing it.

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So maybe that is a good point.

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It's like that was a good snapshot of

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the present of where we are.

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But what is peering around the paradigm to

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see what comes next?

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It's the nudge versus sludge, right?

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Like nudging,

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like the Apple charging chargers.

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That's a nudge moment.

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They're nudging you into changing

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something that may be more efficient.

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And sludge is these purposeful friction

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points.

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You create friction because you want to

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slow down progress.

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Because you want people to absorb it.

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Both hold value.

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The sticky shit on the floor,

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that's sludge.

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There's one that I saw,

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and I can't prove that it happened,

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but I play video games and I play

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Call of Duty,

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and they stopped sort of moderating one of

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the games,

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and they made cheating sort of run

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rampant.

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because they had a new game coming out.

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So they were pissing people like me off

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who were like, hey,

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I just want to be on an even

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playing field.

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I know you're better than me, but like,

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I want to get better.

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But then they just allowed like auto aim,

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aim bot, cheating,

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guys were under the map and could just

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kill you and you couldn't do anything

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about it.

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So I would rage quit.

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And I think that you're doing that because

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they're like, we have a new game coming.

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Like this game is just, hey,

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you can't do anything about it.

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And I'm going,

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I don't know anything about programming,

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but I'm like, you could...

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you could easily ban these people who are

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cheating pretty damn quick.

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Yeah.

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I mean,

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have you ever heard of a concept of

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planned obsolescence?

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Yes.

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That's what they're doing.

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That is planned obsolescence.

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The first light bulb, I think,

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was designed to last a hundred years.

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It's not a great business model.

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No.

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I can't sell a light bulb to last

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a hundred years.

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So they spent thousands of dollars

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reengineering so that it actually is going

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to start.

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I think the same goes for all of

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this.

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Let me ask you this,

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because what is the planned obsolescence

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for our industry?

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I think right now we're in that, like,

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you see all the chatter, right?

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And I agree with you.

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Actually,

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I really like your point of view.

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You're an optimist.

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I think you're a realist,

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but you're an optimist.

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So you see that there's no reason to

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be down in the profession when it's going

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through a hard time,

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but you have to have action steps.

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And I think that we are, like,

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the obsolescence is that old antiquated

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model.

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Like,

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how do we get out of this excellence

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and model into something that actually is

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resilient?

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So what's what's I've talked I think I

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had a year, you know, and again,

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it's really it's I understand it's really

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easy for me to make predictions and then

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never have to back it up.

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It's like being a weatherman.

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It's like it's probably going to be great

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tomorrow when it's not.

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It's like, well, whether, you know,

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I think I said, you know,

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I like throwing out crazy ideas,

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which was like,

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is the future of rehab a person?

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who's a PTOT speech, like,

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is there this physiatrist absorbing some

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of the, all these things?

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Maybe not all of them,

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because I feel like speech is sort of

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on an edge.

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Like, I don't, but is there like,

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we started as,

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What therapy aids, right?

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Which was the construction.

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Right.

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Reconstruction is right.

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Is there this like like I didn't even

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know what a physiatrist was until I was

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like halfway through PT school.

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I had no idea.

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And then I was like, oh,

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they're sort of like us,

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but they do all this other stuff.

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And so I was like, yeah.

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And I go, doesn't that make us nervous?

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And they're like, well, no.

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And I'm like, I don't know, man.

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When you start like sanding things down

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and getting rid of the bumps,

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maybe we morph into something like that.

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I don't know.

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I think that's a perfect segue into the

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complex systems theory, right?

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So the interconnectedness and

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non-linearity is part of the connected

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complexity,

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is that the interconnectedness,

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everything is connected to it.

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All of the things,

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all of the nodes are connected somehow,

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right?

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We're all atoms from some star that blew

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up a millennia ago.

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right but at the same time it's not

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like the progress is not linear it's never

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linear it's it's at best it's curvilinear

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but it's not it's it's this just complete

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zigzag roller coaster yeah and and so we

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we like that the future like it's the

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prediction of the future um

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I think physical therapists need to

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understand that health care as a system

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also has all of these entities and there's

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a power effect to these entities.

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And so the power effect is that the

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star can produce a lot more energy because

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it's big and it's bright and it's

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hard to touch.

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And then a little planet like us doesn't

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have as much energy, but we substantiate.

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Same with healthcare.

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You have some entities with more power.

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At this point, it's payers and providers.

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Some things have less power,

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like therapists and allied health

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professionals.

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And some things have even less power.

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But the nonlinearity of it is if you're

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cruising along and if you're trying to get

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a little bit more

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having a higher stake at the game,

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then you have to understand the

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interconnectedness of the entire system.

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You have to understand what these

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stakeholders do,

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and you have to essentially,

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like in layman's terms, play the game,

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right?

00:08:29.757 --> 00:08:32.479
That would give you a much better position

00:08:32.499 --> 00:08:33.399
of the complexity.

00:08:33.919 --> 00:08:35.301
yeah step one understand what game you're

00:08:35.321 --> 00:08:37.864
playing like i've said this it's this

00:08:37.884 --> 00:08:39.245
isn't the conversation we'll get into but

00:08:39.304 --> 00:08:41.687
i i am as like you said i

00:08:41.726 --> 00:08:43.869
think i think i agree i am a

00:08:43.990 --> 00:08:46.831
hopeful optimist but also like a realist

00:08:46.851 --> 00:08:48.673
like uh on the there's a dungeons and

00:08:48.714 --> 00:08:49.214
dragons

00:08:49.934 --> 00:08:52.378
like that nine like are you neutral evil

00:08:52.437 --> 00:08:54.799
chaotic good whatever i'm sort of in the

00:08:54.960 --> 00:08:58.043
middle but i'm like listen this sucks but

00:08:58.083 --> 00:08:59.725
we got to do something about it bitching

00:08:59.764 --> 00:09:02.248
is is you're allowed to bitch for hours

00:09:02.268 --> 00:09:03.509
when something bad happens then you gotta

00:09:03.528 --> 00:09:04.650
put your shoes on and you gotta go

00:09:04.750 --> 00:09:06.812
do something about it there was actually

00:09:06.893 --> 00:09:09.014
that was that was one thing they found

00:09:09.274 --> 00:09:11.017
when they when they looked at um

00:09:11.998 --> 00:09:14.000
uh women and men going through navy seal

00:09:14.100 --> 00:09:16.461
training it wasn't strength endurance

00:09:16.481 --> 00:09:19.044
cardiovascular fitness it was like who

00:09:19.105 --> 00:09:21.486
rallies around this they called it the

00:09:21.586 --> 00:09:24.109
suck it's like hey we have to carry

00:09:24.129 --> 00:09:25.730
a log on the beach and we're cold

00:09:25.750 --> 00:09:27.913
and sandy and wet and you know what

00:09:27.932 --> 00:09:29.333
we're gonna do we're gonna sing a song

00:09:29.374 --> 00:09:31.976
called you and it's gonna be about the

00:09:32.017 --> 00:09:33.518
log and we're just gonna sing the song

00:09:33.538 --> 00:09:34.859
it's like because this sucks right now but

00:09:35.120 --> 00:09:36.240
we're gonna have beers in a week

00:09:36.841 --> 00:09:38.500
yeah and it's like all right between now

00:09:38.520 --> 00:09:39.402
and then there's going to be a lot

00:09:39.422 --> 00:09:40.581
of suck and how do we get there

00:09:40.902 --> 00:09:44.863
yeah lift the log though like let's lift

00:09:44.883 --> 00:09:46.344
the log like we have to lift a

00:09:46.364 --> 00:09:48.303
lot or cut the log up into pieces

00:09:48.724 --> 00:09:50.924
or make the log out of aluminum now

00:09:50.965 --> 00:09:52.965
so it's lighter or like what can you

00:09:53.004 --> 00:09:54.846
control you can't change the log okay

00:09:55.605 --> 00:09:56.746
What can we change?

00:09:57.048 --> 00:09:59.230
So basically the suck is the game, right?

00:09:59.309 --> 00:10:00.432
That's the game.

00:10:00.471 --> 00:10:01.072
That's the game.

00:10:01.732 --> 00:10:02.693
You chose this.

00:10:03.455 --> 00:10:06.378
When you signed up for the poster next

00:10:06.398 --> 00:10:07.278
to the Navy SEALs,

00:10:07.340 --> 00:10:10.442
you wanted the uniform and the emblem on

00:10:10.462 --> 00:10:11.985
your chest.

00:10:12.004 --> 00:10:12.544
That's good.

00:10:13.792 --> 00:10:15.193
It's not bad news or good news.

00:10:15.433 --> 00:10:16.554
News is to get it,

00:10:16.615 --> 00:10:17.917
you have to go through this.

00:10:18.076 --> 00:10:18.457
Otherwise,

00:10:18.498 --> 00:10:19.979
they just hand them out on the corner

00:10:20.240 --> 00:10:21.341
and that's not what you want.

00:10:21.721 --> 00:10:23.243
I know you signed up for the brochure,

00:10:23.263 --> 00:10:24.745
which is I show up, I help people,

00:10:24.764 --> 00:10:25.605
I get paid, I go home.

00:10:25.885 --> 00:10:26.206
Yes.

00:10:27.278 --> 00:10:28.639
It's just not as smooth as that.

00:10:28.700 --> 00:10:29.941
There's some suck to it.

00:10:30.261 --> 00:10:31.864
And that's where the episode we did this

00:10:31.923 --> 00:10:33.566
morning was choose your heart.

00:10:33.666 --> 00:10:34.947
If you don't like this,

00:10:35.368 --> 00:10:39.393
don't quit or change the things you can

00:10:39.432 --> 00:10:40.833
change because there's something you

00:10:40.874 --> 00:10:41.215
can't.

00:10:41.274 --> 00:10:42.475
Medicare doesn't care.

00:10:42.756 --> 00:10:43.096
It doesn't.

00:10:43.116 --> 00:10:45.038
It's not going to listen to you.

00:10:45.120 --> 00:10:46.681
In forty years, here's my prediction,

00:10:47.221 --> 00:10:48.201
It's never going to get better.

00:10:48.261 --> 00:10:49.783
It's going to be just as crappy,

00:10:49.982 --> 00:10:50.663
maybe crappier.

00:10:50.864 --> 00:10:51.884
That's my only prediction.

00:10:51.903 --> 00:10:52.764
As bad as it is,

00:10:52.783 --> 00:10:54.304
it will get worse.

00:10:54.325 --> 00:10:55.024
The difference, Jimmy,

00:10:55.065 --> 00:10:57.306
between someone who complains and someone

00:10:57.365 --> 00:10:58.407
who actually does shit.

00:10:58.787 --> 00:10:59.687
Before we went live,

00:10:59.866 --> 00:11:02.528
you were showing me your evolution for the

00:11:02.548 --> 00:11:02.989
new year.

00:11:03.089 --> 00:11:04.448
I think that's actionable,

00:11:04.528 --> 00:11:05.470
whether you execute on it,

00:11:05.710 --> 00:11:06.990
whether you get misogyny or not.

00:11:07.451 --> 00:11:08.390
It's still an evolution.

00:11:08.630 --> 00:11:09.871
You are refining yourself as an

00:11:09.932 --> 00:11:10.412
individual.

00:11:10.471 --> 00:11:12.032
And that is the only power you have.

00:11:12.072 --> 00:11:13.013
You have the power of one.

00:11:13.552 --> 00:11:14.474
Make yourself better.

00:11:14.553 --> 00:11:16.034
Make yourself a better fit for your

00:11:16.075 --> 00:11:16.716
environment, right?

00:11:17.076 --> 00:11:19.357
The system, again, like the system adapts.

00:11:19.378 --> 00:11:22.000
And when you can adapt and when you

00:11:22.019 --> 00:11:22.961
can't habituate.

00:11:23.981 --> 00:11:24.981
So the habituation,

00:11:25.022 --> 00:11:27.725
like the peer models suck.

00:11:28.445 --> 00:11:31.447
They've definitely packed you as a lowest,

00:11:31.628 --> 00:11:33.048
like as a pawn on the chessboard.

00:11:33.548 --> 00:11:35.071
And we'll continue to be pawns because

00:11:35.390 --> 00:11:36.971
we're not doing much to change that right

00:11:37.011 --> 00:11:37.312
now.

00:11:37.673 --> 00:11:39.014
Doesn't mean that in ten years we're going

00:11:39.033 --> 00:11:39.514
to be pawns.

00:11:39.953 --> 00:11:41.515
But in order to grow from a pawn

00:11:41.556 --> 00:11:42.316
to an actual...

00:11:44.437 --> 00:11:47.057
You need to do shit to refine yourself

00:11:47.097 --> 00:11:47.778
as a professional.

00:11:47.798 --> 00:11:48.658
If you're in the field,

00:11:49.019 --> 00:11:50.740
learn something today that you didn't know

00:11:50.779 --> 00:11:51.240
before.

00:11:52.220 --> 00:11:53.980
Plan how you're going to climb.

00:11:56.100 --> 00:11:57.042
I'm not even sure if it's a Russian

00:11:57.062 --> 00:11:57.201
thing,

00:11:57.241 --> 00:11:59.802
but I never want to be among soldiers

00:11:59.822 --> 00:12:01.442
who don't see themselves as generals in a

00:12:01.682 --> 00:12:02.023
few years.

00:12:02.864 --> 00:12:03.923
You don't want to surround yourself with

00:12:03.964 --> 00:12:05.384
people that are just complaining but not

00:12:05.403 --> 00:12:06.585
doing shit about it.

00:12:07.664 --> 00:12:08.504
We as an industry,

00:12:09.826 --> 00:12:10.926
I've never been a part of any other

00:12:10.966 --> 00:12:11.385
industries,

00:12:11.446 --> 00:12:14.886
but we suck at forecasting the future

00:12:15.067 --> 00:12:16.866
because we just want to complain about the

00:12:16.886 --> 00:12:17.187
past.

00:12:18.087 --> 00:12:18.508
But no,

00:12:18.827 --> 00:12:21.268
it's better days ahead because systems

00:12:21.969 --> 00:12:22.729
organize themselves.

00:12:23.769 --> 00:12:24.989
Self-organization is part of the

00:12:25.028 --> 00:12:25.490
complexity.

00:12:25.889 --> 00:12:29.210
It's from order to chaos,

00:12:29.269 --> 00:12:30.591
but it's through an organization.

00:12:31.150 --> 00:12:31.610
Truthfully,

00:12:31.630 --> 00:12:32.630
there's no such thing as chaos.

00:12:32.650 --> 00:12:34.652
Chaos is just a loosely organized system

00:12:34.711 --> 00:12:34.792
too.

00:12:36.474 --> 00:12:39.318
So as clinicians, what can you do?

00:12:39.339 --> 00:12:40.260
What impact do you have?

00:12:40.341 --> 00:12:41.964
I was talking to Dana yesterday.

00:12:41.984 --> 00:12:44.730
So Dana and I are doing this side

00:12:44.769 --> 00:12:45.772
project with MedBridge.

00:12:46.340 --> 00:12:48.500
uh and we're exploring the obviously

00:12:48.520 --> 00:12:50.461
value-based systems but but in terms of

00:12:50.883 --> 00:12:52.984
what can you as a practice owner do

00:12:53.024 --> 00:12:54.264
to participate in these alternative

00:12:54.283 --> 00:12:57.826
payment models well let's step one explore

00:12:58.226 --> 00:13:01.087
step two plan step three strategize and

00:13:01.107 --> 00:13:03.048
step four execute like just go boom boom

00:13:03.068 --> 00:13:04.750
boom and wait a second at no point

00:13:04.789 --> 00:13:06.431
in those four was it complain about it

00:13:06.471 --> 00:13:07.772
though where does the complaining go

00:13:08.852 --> 00:13:09.994
At all four steps you can complain.

00:13:10.333 --> 00:13:11.556
In the background.

00:13:13.116 --> 00:13:14.879
Negativity bias is part of our thing.

00:13:16.080 --> 00:13:18.822
Negativity saves you from that cobra in

00:13:18.842 --> 00:13:20.884
the woods that's making the noise.

00:13:20.924 --> 00:13:23.326
You want to have that aversion behavior

00:13:23.366 --> 00:13:24.488
because it saves your ass.

00:13:24.989 --> 00:13:26.470
But complain and do shit.

00:13:26.529 --> 00:13:28.371
Don't complain and just sit and groan.

00:13:29.072 --> 00:13:29.793
That's not actionable.

00:13:30.254 --> 00:13:31.695
My dad was a firefighter.

00:13:31.975 --> 00:13:33.875
And when I feel like my dad was

00:13:33.895 --> 00:13:35.897
like drilling me and testing me as a

00:13:35.976 --> 00:13:37.138
kid, nothing dangerous,

00:13:37.177 --> 00:13:38.457
but like he put like it would be

00:13:38.498 --> 00:13:38.898
driving.

00:13:38.918 --> 00:13:40.519
He put me in a scenario and there

00:13:40.538 --> 00:13:42.620
was one message that he had,

00:13:42.679 --> 00:13:43.740
which is he watched

00:13:44.706 --> 00:13:46.168
kids in a fire,

00:13:46.227 --> 00:13:47.149
he was a New York City fireman,

00:13:47.729 --> 00:13:49.971
they would hide because fire is scary and

00:13:49.990 --> 00:13:51.111
your first reaction is hide.

00:13:51.312 --> 00:13:51.972
But in a fire,

00:13:52.373 --> 00:13:52.974
you want to get out.

00:13:53.014 --> 00:13:53.653
You don't want to hide.

00:13:53.793 --> 00:13:54.654
You can't hide from fire.

00:13:55.034 --> 00:13:56.615
So they were taught to look for kids

00:13:56.736 --> 00:13:58.817
under beds, in showers, in toy boxes,

00:13:58.857 --> 00:13:59.458
in closets.

00:13:59.859 --> 00:14:01.279
So he would drill why that's not a

00:14:01.299 --> 00:14:01.880
good idea.

00:14:01.921 --> 00:14:03.282
And I remember at like, eleven years old,

00:14:03.302 --> 00:14:03.662
he was like,

00:14:04.101 --> 00:14:05.163
what's the worst thing to do in a

00:14:05.202 --> 00:14:06.104
panic situation?

00:14:06.224 --> 00:14:07.125
And I was like, I don't know,

00:14:07.205 --> 00:14:09.346
hide or he goes, no panic.

00:14:09.365 --> 00:14:10.768
And I remember like,

00:14:11.823 --> 00:14:12.945
oh, that's a trick question,

00:14:13.004 --> 00:14:14.505
but it stuck with me.

00:14:14.525 --> 00:14:16.005
And I was like, OK.

00:14:16.066 --> 00:14:18.006
He goes, it's a panic situation.

00:14:18.047 --> 00:14:19.288
The situation is panic.

00:14:19.607 --> 00:14:21.489
Your response should not be the panic.

00:14:22.330 --> 00:14:23.269
And then he goes,

00:14:23.289 --> 00:14:24.530
a minute later after I digested that,

00:14:24.551 --> 00:14:24.890
he was like,

00:14:24.931 --> 00:14:26.432
what's the second worst thing to do?

00:14:26.511 --> 00:14:27.873
And I was like, uh, and he goes,

00:14:28.133 --> 00:14:28.472
nothing.

00:14:30.673 --> 00:14:31.813
So what's the worst thing to do in

00:14:31.833 --> 00:14:32.914
a complaining situation?

00:14:33.254 --> 00:14:33.754
Complain.

00:14:34.375 --> 00:14:35.715
What's the second worst thing to do?

00:14:35.914 --> 00:14:36.274
Nothing.

00:14:36.654 --> 00:14:38.615
So do something, right?

00:14:38.635 --> 00:14:39.576
What did Churchill say, right?

00:14:39.596 --> 00:14:40.735
When you find yourself going through hell,

00:14:40.755 --> 00:14:41.235
keep going.

00:14:41.517 --> 00:14:43.817
Keep going, right.

00:14:44.157 --> 00:14:45.057
And it's tough, man.

00:14:45.076 --> 00:14:45.456
It's tough.

00:14:45.517 --> 00:14:46.898
It's a tough environment, right?

00:14:46.957 --> 00:14:47.518
I can see.

00:14:47.577 --> 00:14:50.298
So at CSM last year, we spoke.

00:14:50.317 --> 00:14:52.198
We had a panel about non-clinical jobs.

00:14:53.198 --> 00:14:54.720
And so the panelists are like all of

00:14:54.740 --> 00:14:55.500
these pegs, right?

00:14:55.600 --> 00:14:56.860
So you have a couple of academics,

00:14:56.900 --> 00:14:58.302
you had a couple of entrepreneurs,

00:14:58.322 --> 00:15:00.964
and then you had a schmuck like me

00:15:01.004 --> 00:15:02.465
sitting there who was still trying to

00:15:02.504 --> 00:15:03.125
figure this shit out.

00:15:04.666 --> 00:15:05.426
And the point is,

00:15:08.280 --> 00:15:11.482
when you are a new grad pto when

00:15:11.503 --> 00:15:12.823
you've been out in the field for five

00:15:12.864 --> 00:15:14.625
years that extra five ten thousand dollars

00:15:14.644 --> 00:15:17.106
you can make from a sales job it

00:15:17.167 --> 00:15:19.668
may have a positive effect short term but

00:15:19.687 --> 00:15:21.168
at the same time is it teaching your

00:15:21.208 --> 00:15:23.311
skills is it teaching you to do something

00:15:23.370 --> 00:15:25.111
different is it bettering right is it

00:15:25.152 --> 00:15:27.212
helping you actualize as a professional as

00:15:27.232 --> 00:15:29.153
a person and if not it's just revenue

00:15:29.173 --> 00:15:30.394
dude like that ten thousand dollars you

00:15:30.434 --> 00:15:31.655
make up at the tail end of your

00:15:31.696 --> 00:15:33.976
career but you just spent seven years of

00:15:34.017 --> 00:15:34.437
your life

00:15:34.998 --> 00:15:36.980
getting to this place and now two years

00:15:37.019 --> 00:15:39.221
later you're pissing and groaning right do

00:15:39.261 --> 00:15:41.643
you even like it yeah well but there's

00:15:41.663 --> 00:15:43.125
like ten grand is a lot but like

00:15:43.184 --> 00:15:44.446
ten grand over twelve months

00:15:45.309 --> 00:15:45.590
Yeah.

00:15:45.629 --> 00:15:47.432
That's not a big payment to do something

00:15:47.451 --> 00:15:48.111
that you don't like.

00:15:48.152 --> 00:15:49.332
I'm not saying the sales job is bad.

00:15:49.352 --> 00:15:50.914
I'm saying if you don't like it,

00:15:50.934 --> 00:15:52.416
the juice ain't worth the squeeze.

00:15:52.436 --> 00:15:53.716
Yeah, for sure, dude.

00:15:53.976 --> 00:15:54.817
So there's two.

00:15:55.038 --> 00:15:56.058
It's an economy, right?

00:15:56.139 --> 00:15:58.100
It's a happiness in your job and happiness

00:15:58.181 --> 00:15:58.841
with your job.

00:15:59.241 --> 00:16:00.023
And most of us,

00:16:00.682 --> 00:16:01.683
and I've been through a couple of

00:16:01.724 --> 00:16:02.965
iterations already.

00:16:03.044 --> 00:16:04.907
I've been in the PT field for over

00:16:04.927 --> 00:16:06.807
twenty three years and I've been playing

00:16:06.827 --> 00:16:08.350
around the systems for a decade.

00:16:08.669 --> 00:16:09.571
So now.

00:16:10.191 --> 00:16:12.572
happiness with your job is that like

00:16:12.611 --> 00:16:14.773
there's a selection bias like the job

00:16:14.793 --> 00:16:16.453
finds you just like you find your job

00:16:16.855 --> 00:16:19.296
what gets most pts to become pts well

00:16:19.336 --> 00:16:20.876
i had this experience i broke my leg

00:16:20.956 --> 00:16:23.057
i had an acl tear i really thought

00:16:23.077 --> 00:16:24.158
it was cool so i became a pt

00:16:24.437 --> 00:16:26.440
like that's self-selection dude and then

00:16:26.519 --> 00:16:28.120
once you get into the field you you

00:16:28.240 --> 00:16:29.801
discover that you don't get to take care

00:16:29.821 --> 00:16:31.761
of the happy motivated sixteen-year-olds

00:16:31.782 --> 00:16:32.722
you get to take care of

00:16:33.423 --> 00:16:34.663
Sixty-five-year-olds with multiple

00:16:34.683 --> 00:16:37.046
comorbidities with the entire psychosocial

00:16:37.105 --> 00:16:38.907
baggage who never leave.

00:16:39.366 --> 00:16:41.268
Who don't want to change.

00:16:41.328 --> 00:16:41.408
Yeah.

00:16:41.589 --> 00:16:43.389
They want to have changed.

00:16:43.750 --> 00:16:44.650
Yeah, exactly.

00:16:44.671 --> 00:16:45.932
But that's not happiness.

00:16:46.072 --> 00:16:48.533
You're not unhappy with your job.

00:16:48.572 --> 00:16:49.734
You're unhappy in your job.

00:16:49.953 --> 00:16:50.394
Change.

00:16:50.475 --> 00:16:51.434
Find a different position.

00:16:51.735 --> 00:16:52.456
Do home health.

00:16:52.515 --> 00:16:53.996
Do whatever the fuck it is that you

00:16:54.057 --> 00:16:55.837
want to do where you're actually

00:16:55.898 --> 00:16:59.539
actualizing on your profession because –

00:16:58.763 --> 00:17:00.803
Like it's you can always find a sales

00:17:00.823 --> 00:17:01.485
job ultimately.

00:17:01.504 --> 00:17:01.825
And again,

00:17:01.865 --> 00:17:02.924
I'm not going down on sales job.

00:17:02.945 --> 00:17:04.246
I'm like I'm a salesperson.

00:17:04.326 --> 00:17:06.528
I would like the company right now.

00:17:08.008 --> 00:17:09.409
That's sales is good.

00:17:09.628 --> 00:17:10.390
Everybody sells right.

00:17:10.609 --> 00:17:13.751
Daniel Pink likes to sell this.

00:17:14.271 --> 00:17:14.491
Right.

00:17:14.751 --> 00:17:18.153
But sales is still part of your clinical

00:17:18.193 --> 00:17:18.693
experience.

00:17:18.954 --> 00:17:19.494
As a clinician,

00:17:19.535 --> 00:17:20.776
you are salesman because you're selling

00:17:20.816 --> 00:17:22.757
plan of care, you're selling services.

00:17:23.797 --> 00:17:25.838
But there's always so much more.

00:17:26.739 --> 00:17:28.119
Sales is just one of the skills you

00:17:28.160 --> 00:17:28.901
have as a clinician.

00:17:29.260 --> 00:17:31.482
You also have a skill of communication.

00:17:31.522 --> 00:17:33.544
You have a skill of problem solving.

00:17:33.564 --> 00:17:35.566
You have a skill of weaving out

00:17:35.605 --> 00:17:36.165
complexity.

00:17:37.106 --> 00:17:38.188
Those are all skills.

00:17:38.488 --> 00:17:40.910
And together, it makes you an expert.

00:17:40.990 --> 00:17:42.911
And expertise is this entire bucket of

00:17:42.951 --> 00:17:44.972
different vegetables sprinkled around that

00:17:45.012 --> 00:17:46.053
makes you a clinician.

00:17:46.314 --> 00:17:48.015
So when you choose to leave because you

00:17:48.035 --> 00:17:49.036
were just like, ah, fuck it.

00:17:49.056 --> 00:17:49.935
Like, it's not for me.

00:17:49.955 --> 00:17:51.597
I've spent two years at this...

00:17:52.377 --> 00:17:55.281
grind like a chop shop of a physical

00:17:55.301 --> 00:17:55.883
therapy clinic.

00:17:56.163 --> 00:17:57.065
I'm just going to leave.

00:17:57.645 --> 00:17:59.188
No, dude, like it's not enough.

00:17:59.248 --> 00:18:01.511
Like certainly if it's been long enough

00:18:01.531 --> 00:18:03.173
and if you try different iterations and

00:18:03.193 --> 00:18:04.476
you're like, I tried A, B, C, D,

00:18:04.596 --> 00:18:06.159
E, F, and I'm still not happy.

00:18:07.829 --> 00:18:08.431
Goodbye, sir.

00:18:09.571 --> 00:18:10.752
But to get to that point,

00:18:10.792 --> 00:18:11.973
you just can't react.

00:18:11.993 --> 00:18:13.674
And reactance, I think, is what we do.

00:18:13.796 --> 00:18:15.336
We're losing ten percent of our workforce

00:18:15.356 --> 00:18:17.878
because we are like, I'm done with this.

00:18:17.959 --> 00:18:18.720
Like, that's it.

00:18:18.740 --> 00:18:19.300
I'm reacting.

00:18:19.381 --> 00:18:20.142
I'm going to do this.

00:18:20.422 --> 00:18:21.942
I see that there's a really nice

00:18:21.962 --> 00:18:22.804
opportunity available.

00:18:22.864 --> 00:18:23.404
I'm going to leave.

00:18:24.657 --> 00:18:25.898
Is that really the right choice?

00:18:26.420 --> 00:18:27.019
Beyond the fact,

00:18:27.039 --> 00:18:29.501
the economic stupidity of losing two

00:18:29.521 --> 00:18:31.443
hundred and fifty thousand dollars plus

00:18:31.463 --> 00:18:33.144
the earnings you did not earn because you

00:18:33.224 --> 00:18:34.286
entered the graduate training.

00:18:34.566 --> 00:18:36.248
So for every year you are paying tuition,

00:18:36.268 --> 00:18:37.067
you're not earning.

00:18:37.107 --> 00:18:39.230
So if you look at the externalities of

00:18:39.250 --> 00:18:40.070
becoming a PT,

00:18:40.111 --> 00:18:42.092
you are down half a million dollars by

00:18:42.112 --> 00:18:42.952
the time you graduate.

00:18:43.192 --> 00:18:44.574
Yeah,

00:18:44.713 --> 00:18:47.656
but actualize like there's so many

00:18:47.676 --> 00:18:48.237
different settings,

00:18:48.257 --> 00:18:49.678
there's so many different ways to

00:18:49.838 --> 00:18:50.919
actualize as a professional.

00:18:51.220 --> 00:18:52.280
And if nothing else, like

00:18:53.121 --> 00:18:54.541
If you can't find a setting you are

00:18:54.561 --> 00:18:56.124
happy in, open your own clinic,

00:18:56.223 --> 00:18:57.104
put a shingle on a wall.

00:18:57.525 --> 00:18:59.086
Like if you are really personable and

00:18:59.226 --> 00:19:00.467
don't have a lot of expertise,

00:19:01.087 --> 00:19:02.868
maybe you can just provide care to these

00:19:02.888 --> 00:19:05.050
like low complexity cases that that's your

00:19:05.090 --> 00:19:05.371
niche.

00:19:05.991 --> 00:19:08.354
Like, why not?

00:19:08.374 --> 00:19:09.775
But don't just like react and say,

00:19:10.214 --> 00:19:11.715
not for me, I'm going to do it.

00:19:11.996 --> 00:19:13.577
So you talk a lot about in systems

00:19:13.617 --> 00:19:14.478
thinking, right?

00:19:14.538 --> 00:19:15.618
And a lot of times we think,

00:19:16.440 --> 00:19:17.800
like I mentioned, circuit boards,

00:19:18.080 --> 00:19:18.721
machines,

00:19:18.961 --> 00:19:20.722
but like where two people interact,

00:19:21.103 --> 00:19:21.884
that's a system, too.

00:19:22.384 --> 00:19:23.964
And in between them is that space.

00:19:24.665 --> 00:19:25.686
So you mentioned, hey,

00:19:25.767 --> 00:19:27.567
if someone's in a clinical role or in

00:19:27.607 --> 00:19:30.390
an owner role, what are the signs?

00:19:31.150 --> 00:19:32.411
How does a PT,

00:19:32.510 --> 00:19:34.413
a clinician or a clinic leader or an

00:19:34.472 --> 00:19:35.532
owner know

00:19:36.601 --> 00:19:37.862
when their system is breaking down?

00:19:38.041 --> 00:19:39.344
What are the early indicators?

00:19:39.423 --> 00:19:40.984
What are the canaries in the coal mine?

00:19:41.046 --> 00:19:41.806
What are the things,

00:19:42.166 --> 00:19:45.069
the signals that people should be looking

00:19:45.190 --> 00:19:47.311
for to know what to actually put their

00:19:47.392 --> 00:19:48.833
good attention towards instead of just

00:19:48.853 --> 00:19:49.153
complain?

00:19:50.172 --> 00:19:51.372
I think that for me,

00:19:51.711 --> 00:19:54.173
the number one sign is psychological and

00:19:54.192 --> 00:19:55.093
intellectual safety.

00:19:55.113 --> 00:19:57.213
What do you mean by that?

00:19:57.233 --> 00:19:59.054
You have to feel safe in your workplace.

00:19:59.314 --> 00:20:00.535
And that means you have to feel safe

00:20:00.555 --> 00:20:02.115
to express yourself and you have to feel

00:20:02.174 --> 00:20:03.295
safe to receive feedback.

00:20:03.974 --> 00:20:06.135
That psychological safety in a workplace

00:20:06.236 --> 00:20:07.635
is essential and a lot of times not

00:20:07.675 --> 00:20:08.076
found.

00:20:08.416 --> 00:20:09.656
And the psychological safety gets

00:20:09.696 --> 00:20:12.116
destroyed through failure of initial

00:20:12.156 --> 00:20:12.657
conditions.

00:20:13.557 --> 00:20:14.438
And just as an example,

00:20:14.498 --> 00:20:16.999
if it's an initial condition where you are

00:20:17.058 --> 00:20:18.078
set up for failure

00:20:18.778 --> 00:20:21.240
in that grind the assembly line therapy

00:20:21.279 --> 00:20:23.701
place right because you you the economics

00:20:23.760 --> 00:20:26.020
are setting you up to not be successful

00:20:26.101 --> 00:20:28.041
so you you either can become a very

00:20:28.061 --> 00:20:31.282
good hustler uh or a very shitty artist

00:20:31.522 --> 00:20:34.002
um but but you're not going to become

00:20:34.022 --> 00:20:35.763
a successful professional when when the

00:20:35.824 --> 00:20:37.544
economics are set up against you against

00:20:37.564 --> 00:20:38.884
your human capacity to provide

00:20:39.923 --> 00:20:43.689
valuable care but psychological safety on

00:20:43.749 --> 00:20:46.271
expression is also the fact that if you

00:20:46.352 --> 00:20:48.515
are in a clinic and you can't go

00:20:48.575 --> 00:20:50.017
to your administrator or your manager and

00:20:50.037 --> 00:20:51.798
say like dude i'm just not feeling this

00:20:51.859 --> 00:20:54.282
like i i'm breaking down like it's it's

00:20:54.403 --> 00:20:56.424
it's great it's making me like

00:20:57.105 --> 00:20:59.127
go bananas i'm like really not in a

00:20:59.147 --> 00:21:01.169
good place if you don't feel comfortable

00:21:01.209 --> 00:21:02.711
doing this like that you're not in a

00:21:02.730 --> 00:21:04.412
good setting like because you have to have

00:21:04.451 --> 00:21:07.413
this freedom and safety to communicate how

00:21:07.433 --> 00:21:09.796
you are and in return receive feedback

00:21:09.816 --> 00:21:11.037
from your manager to say like you know

00:21:11.096 --> 00:21:12.939
you're just like a wimp like suck it

00:21:12.979 --> 00:21:15.119
up motherfucker like it's like it's okay

00:21:15.140 --> 00:21:17.501
to do that too because ultimately a lot

00:21:17.561 --> 00:21:19.084
of people don't have the capacity or the

00:21:19.104 --> 00:21:20.444
resilience that you're saying about navy

00:21:20.464 --> 00:21:22.946
seals right the navy seal can take uh

00:21:23.666 --> 00:21:25.407
a cold water plunge and stay in a

00:21:25.428 --> 00:21:27.789
fifty degree temperature water for hours,

00:21:28.049 --> 00:21:29.971
not because they're better or bigger than

00:21:29.990 --> 00:21:30.351
you are.

00:21:30.592 --> 00:21:32.071
It's because they have the capacity to

00:21:32.113 --> 00:21:32.673
externalize.

00:21:32.692 --> 00:21:34.513
They have the capacity to distance

00:21:34.534 --> 00:21:36.394
themselves from the immediate suck because

00:21:36.414 --> 00:21:38.076
they are forecasting that beer in a week.

00:21:38.096 --> 00:21:38.175
Yeah.

00:21:39.576 --> 00:21:41.057
If you're in a clinic and you are

00:21:41.218 --> 00:21:43.440
being asked to fulfill a specific quota of

00:21:43.660 --> 00:21:44.820
X amount of patients per day,

00:21:45.540 --> 00:21:47.300
Because ultimately, you have to.

00:21:47.320 --> 00:21:48.102
You have to see patients.

00:21:48.122 --> 00:21:49.041
You have to generate revenue.

00:21:49.142 --> 00:21:50.721
You have to make the clinic profitable.

00:21:51.122 --> 00:21:52.022
Profit is good.

00:21:52.262 --> 00:21:53.002
Money is good.

00:21:53.363 --> 00:21:54.222
And volume is good.

00:21:54.542 --> 00:21:56.064
But if you don't have the capacity,

00:21:56.564 --> 00:21:57.723
you have to have a communication with your

00:21:57.763 --> 00:21:58.804
manager and say, like, dude,

00:21:58.884 --> 00:21:59.664
I'm not feeling this.

00:21:59.684 --> 00:22:00.785
And the manager should say, like, well,

00:22:00.825 --> 00:22:02.884
maybe you need to attend a few CU

00:22:02.924 --> 00:22:04.145
courses so you become more comfortable

00:22:04.165 --> 00:22:04.705
managing patients.

00:22:05.046 --> 00:22:07.268
Maybe you need to utilize ancillary stuff

00:22:07.288 --> 00:22:08.548
because you can't do this alone.

00:22:08.567 --> 00:22:09.489
You shouldn't do this alone.

00:22:09.828 --> 00:22:11.990
BTs try to do everything by themselves

00:22:12.411 --> 00:22:13.652
from point A to point Z.

00:22:13.932 --> 00:22:15.093
We onboard patients.

00:22:15.393 --> 00:22:16.874
We design plan of care.

00:22:17.193 --> 00:22:18.615
We designate plan of care.

00:22:18.835 --> 00:22:20.056
We execute plan of care.

00:22:20.395 --> 00:22:21.517
We complete plan of care.

00:22:21.797 --> 00:22:23.518
Why the fuck are we doing everything?

00:22:23.699 --> 00:22:24.999
We're the only profession that does that.

00:22:25.078 --> 00:22:27.760
But your clinic has support staff.

00:22:28.080 --> 00:22:29.782
Maybe have a conversation that we need to

00:22:29.962 --> 00:22:31.644
add additional support staff so they can

00:22:31.763 --> 00:22:33.825
oversee this low value redundant care

00:22:34.065 --> 00:22:34.546
capacity.

00:22:35.165 --> 00:22:36.227
But that's communication, right?

00:22:36.507 --> 00:22:38.708
And if you don't have that safety or

00:22:38.728 --> 00:22:40.949
that capacity to talk to your peers,

00:22:40.969 --> 00:22:42.069
to talk to your superiors,

00:22:42.750 --> 00:22:43.470
find a different setting,

00:22:43.670 --> 00:22:44.471
find a different position.

00:22:44.911 --> 00:22:46.352
Right.

00:22:46.451 --> 00:22:47.132
Yeah.

00:22:51.073 --> 00:22:54.214
analyzing the system figuring out what's

00:22:54.275 --> 00:22:57.156
not working and bringing a solution and

00:22:57.196 --> 00:22:59.077
then there's also complaining that this

00:22:59.117 --> 00:23:02.441
sucks and one of them does not on

00:23:02.480 --> 00:23:04.261
the first iteration or one try get to

00:23:04.281 --> 00:23:06.363
a solution but the other one definitely

00:23:06.403 --> 00:23:08.203
doesn't i mean i know it feels good

00:23:08.223 --> 00:23:09.605
in the moment i've been guilty of it

00:23:09.644 --> 00:23:11.405
myself like this sucks everything sucks i

00:23:11.425 --> 00:23:12.926
want to go home let's you know let's

00:23:12.946 --> 00:23:13.567
throw in the towel

00:23:15.215 --> 00:23:16.215
But I think you bring up a good

00:23:16.257 --> 00:23:16.477
point,

00:23:16.517 --> 00:23:18.938
is if this place isn't ever going to

00:23:18.978 --> 00:23:19.438
listen to me.

00:23:19.538 --> 00:23:20.699
I've worked at places like that.

00:23:20.939 --> 00:23:22.398
Yeah, you bring up good points, Jimmy.

00:23:22.499 --> 00:23:22.578
OK,

00:23:22.599 --> 00:23:23.440
are we going to do anything about it?

00:23:23.579 --> 00:23:24.740
No.

00:23:24.800 --> 00:23:25.000
Cool.

00:23:25.040 --> 00:23:25.840
I don't want to be here anymore.

00:23:25.881 --> 00:23:28.061
But to be honest, I'm able to dissociate,

00:23:28.082 --> 00:23:28.701
be like, got it.

00:23:28.781 --> 00:23:31.884
This boat isn't going in the direction

00:23:32.263 --> 00:23:32.844
that I want.

00:23:33.003 --> 00:23:34.325
I'm going to get off this boat.

00:23:34.404 --> 00:23:35.025
I've looked at it.

00:23:35.465 --> 00:23:36.286
I've looked at the course.

00:23:36.445 --> 00:23:37.046
It's not good.

00:23:37.567 --> 00:23:38.727
I'm not going to yell at the person

00:23:38.747 --> 00:23:39.508
to change course.

00:23:39.807 --> 00:23:41.567
I've already tried, whispering.

00:23:41.769 --> 00:23:42.489
They're not listening.

00:23:42.749 --> 00:23:43.189
Therefore,

00:23:43.308 --> 00:23:44.230
I have decided to look for a new

00:23:44.269 --> 00:23:44.450
boat.

00:23:46.275 --> 00:23:46.515
Dude,

00:23:47.214 --> 00:23:50.796
I think Annie Duke had a book called

00:23:50.855 --> 00:23:51.536
Quit, right?

00:23:52.816 --> 00:23:53.796
Oh, she was the poker player,

00:23:53.816 --> 00:23:55.676
pro poker player.

00:23:55.696 --> 00:23:55.936
Yeah, yeah.

00:23:55.957 --> 00:23:56.757
She was a poker player with a PhD

00:23:56.777 --> 00:23:59.596
in psychology or something like that.

00:23:59.637 --> 00:24:02.538
But quitting is not against the rules.

00:24:02.998 --> 00:24:03.718
It's not a bad thing.

00:24:05.298 --> 00:24:05.598
Well, look,

00:24:05.638 --> 00:24:07.618
it's perfect that she would have

00:24:07.659 --> 00:24:10.338
psychology in poker because folding means

00:24:10.378 --> 00:24:10.838
giving up.

00:24:10.859 --> 00:24:11.960
But we all look at poker and we're

00:24:11.980 --> 00:24:13.240
like, if you don't got it, fold.

00:24:13.859 --> 00:24:16.060
yeah right yeah yeah yeah because you're

00:24:16.080 --> 00:24:19.282
you're just gonna you're just gonna go

00:24:20.044 --> 00:24:21.625
you're you're gonna keep putting more in

00:24:21.644 --> 00:24:24.205
and you're gonna lose more seth godin had

00:24:24.226 --> 00:24:26.446
a a book and he was smart because

00:24:26.467 --> 00:24:29.528
he writes really short books so then you

00:24:29.548 --> 00:24:30.809
got to buy the next book but he

00:24:30.970 --> 00:24:32.211
had one called the dip

00:24:33.290 --> 00:24:34.872
And essentially it was like sort of like

00:24:34.912 --> 00:24:35.833
talking about the suck,

00:24:36.292 --> 00:24:37.594
which which David Goggins,

00:24:37.614 --> 00:24:38.714
who is a Navy SEAL, talks about.

00:24:38.795 --> 00:24:39.835
He's like, listen,

00:24:39.935 --> 00:24:40.955
I worked at a radio station.

00:24:41.076 --> 00:24:42.356
My job was like play music,

00:24:42.416 --> 00:24:44.018
give away beer and concert tickets like

00:24:44.038 --> 00:24:44.979
that's a cake job.

00:24:45.199 --> 00:24:45.739
Still a job.

00:24:46.559 --> 00:24:47.140
He's like, listen,

00:24:47.400 --> 00:24:48.421
no matter what your job is,

00:24:48.441 --> 00:24:50.241
there's going to be a dip into this

00:24:50.582 --> 00:24:52.242
into stuff that you have to do,

00:24:52.363 --> 00:24:53.463
but don't love to do.

00:24:53.483 --> 00:24:54.585
But it's got to get done because that's

00:24:54.605 --> 00:24:55.025
your job.

00:24:56.843 --> 00:25:00.464
pick your Beck's dip, understand,

00:25:00.565 --> 00:25:02.164
do you like this suck or not?

00:25:02.685 --> 00:25:05.126
And if you're like, this ain't for me,

00:25:05.146 --> 00:25:06.646
like if I taught elementary school

00:25:06.686 --> 00:25:08.448
students, I think I'm smart enough,

00:25:08.688 --> 00:25:09.788
but I wouldn't like that.

00:25:09.949 --> 00:25:11.829
I wouldn't like the stuff that a good

00:25:11.890 --> 00:25:13.609
elementary school teacher would like,

00:25:13.650 --> 00:25:14.550
the dip would kill me.

00:25:15.070 --> 00:25:15.931
And Seth Godin was like,

00:25:15.951 --> 00:25:16.811
it's okay to get out.

00:25:17.465 --> 00:25:19.548
this this stay with a job thirty years

00:25:19.587 --> 00:25:23.571
because you're loyal um that's not a great

00:25:23.652 --> 00:25:24.874
if it's not a good fit it's not

00:25:24.894 --> 00:25:26.255
i don't think an employer wants you to

00:25:26.295 --> 00:25:27.816
stay for thirty years if you're miserable

00:25:27.836 --> 00:25:30.278
either on the on the flip side i

00:25:30.298 --> 00:25:31.980
i don't think you you you have

00:25:32.825 --> 00:25:34.586
anything to give to your employer anymore

00:25:34.686 --> 00:25:36.367
after x amount of years unless you're

00:25:36.387 --> 00:25:38.470
always growing and even in that job that's

00:25:38.490 --> 00:25:40.392
a good point right like you don't like

00:25:41.152 --> 00:25:42.874
and i'll use an analog clinical analogy

00:25:42.953 --> 00:25:44.515
right like there's there's a law of

00:25:44.555 --> 00:25:46.336
diminishing returns uh when it comes to

00:25:46.376 --> 00:25:48.959
clinical care you know that visit two in

00:25:49.118 --> 00:25:50.881
the pt clinic is very different than the

00:25:50.901 --> 00:25:53.363
visit in terms of what you're getting out

00:25:53.403 --> 00:25:55.605
of your encounter because there's

00:25:55.664 --> 00:25:57.145
diminishing returns you you become

00:25:57.165 --> 00:25:58.186
indoctrinated into that

00:25:58.707 --> 00:26:00.448
structure into that setting,

00:26:00.768 --> 00:26:02.088
but you're not getting the same level of

00:26:02.128 --> 00:26:03.950
skill as you were initially because now

00:26:04.029 --> 00:26:05.510
you are the expert patient.

00:26:05.530 --> 00:26:07.151
You gain expertise of being a patient.

00:26:08.031 --> 00:26:08.771
On the job,

00:26:09.132 --> 00:26:11.773
unless your job has specific milestones,

00:26:11.874 --> 00:26:13.294
growth milestones,

00:26:13.314 --> 00:26:14.494
developmental milestones,

00:26:15.715 --> 00:26:17.856
after a certain amount of years,

00:26:17.977 --> 00:26:20.817
you just ingrain into this minutia of

00:26:21.018 --> 00:26:22.638
monotony, like I'm going to do this,

00:26:22.939 --> 00:26:24.180
and then you become that assembly line

00:26:24.220 --> 00:26:24.519
worker.

00:26:24.920 --> 00:26:26.421
A neurosurgeon becomes an assembly line

00:26:26.441 --> 00:26:26.560
worker.

00:26:26.740 --> 00:26:28.942
right yeah there was a an article a

00:26:28.962 --> 00:26:30.683
couple of years ago actually more than a

00:26:30.703 --> 00:26:31.964
couple years ago but it looked into that

00:26:32.005 --> 00:26:34.086
the diagnostic expertise and efficiency of

00:26:34.105 --> 00:26:36.208
physicians leaving residency and they

00:26:36.228 --> 00:26:37.568
looked into that like the diagnostic

00:26:37.628 --> 00:26:39.329
accuracy after a certain like i think

00:26:39.369 --> 00:26:41.111
after five years the agnostic accuracy

00:26:41.131 --> 00:26:42.992
plateaus and after ten years it wanes

00:26:43.492 --> 00:26:45.193
like so so in a way like you

00:26:45.594 --> 00:26:47.875
you have five years to ramp up to

00:26:47.996 --> 00:26:50.396
like to become efficient to become good uh

00:26:50.477 --> 00:26:51.877
and then you you can cruise along for

00:26:51.917 --> 00:26:53.038
a few years you can kind of kind

00:26:53.077 --> 00:26:54.719
of and then you just like you stop

00:26:54.739 --> 00:26:56.500
giving because then like yeah i'm a

00:26:56.519 --> 00:26:58.421
neurosurgeon i'm gonna go get out get this

00:26:58.461 --> 00:26:59.321
glioblastoma out

00:26:59.761 --> 00:27:02.222
I've done three thousand of them.

00:27:02.604 --> 00:27:03.903
If you haven't learned anything,

00:27:04.084 --> 00:27:06.105
but I think as a neurosurgeon,

00:27:06.125 --> 00:27:06.905
you have the capacity,

00:27:06.925 --> 00:27:10.347
you have the diversity in your profession

00:27:10.587 --> 00:27:12.028
that allows you to expand to different

00:27:12.048 --> 00:27:12.409
medium.

00:27:12.769 --> 00:27:13.689
As a physical therapist,

00:27:13.868 --> 00:27:16.029
if you're working in that assembly line

00:27:16.270 --> 00:27:17.111
outpatient clinic,

00:27:18.132 --> 00:27:19.511
you're not even seeing the diversity

00:27:19.531 --> 00:27:21.113
because you're indoctrinated into this

00:27:21.873 --> 00:27:24.194
volume and managing.

00:27:24.575 --> 00:27:26.135
You no longer get satisfaction for what

00:27:26.175 --> 00:27:28.096
you think you've entered the profession

00:27:28.116 --> 00:27:28.297
for.

00:27:28.676 --> 00:27:32.180
then find something else like your own um

00:27:33.000 --> 00:27:35.363
actualizer yeah i was looking at that in

00:27:35.403 --> 00:27:36.845
radio not to bring everything back but

00:27:36.865 --> 00:27:38.286
that's my only that's my only other

00:27:38.346 --> 00:27:40.788
experience was things were getting very

00:27:40.827 --> 00:27:43.851
homogenized i ran a local radio station

00:27:43.891 --> 00:27:46.614
for a number of years i made all

00:27:46.653 --> 00:27:49.276
the decisions and then these big companies

00:27:49.296 --> 00:27:50.597
were coming in and they were buying

00:27:51.778 --> 00:27:52.958
more and more stations and they were

00:27:52.978 --> 00:27:53.137
going,

00:27:53.518 --> 00:27:55.798
we don't need a hundred dudes in a

00:27:55.858 --> 00:27:57.378
hundred cities making a hundred different

00:27:57.398 --> 00:27:57.819
decisions.

00:27:58.299 --> 00:27:59.859
We're gonna make one decision and then

00:27:59.920 --> 00:28:01.200
multiply it by a thousand and then you

00:28:01.220 --> 00:28:01.921
just execute.

00:28:01.941 --> 00:28:02.721
And I looked and I was like,

00:28:02.740 --> 00:28:05.421
that's not fun anymore though.

00:28:05.761 --> 00:28:08.342
I'm here to do the radio station was

00:28:08.382 --> 00:28:10.143
a giant social test in real time.

00:28:10.163 --> 00:28:11.042
Awesome.

00:28:11.692 --> 00:28:12.773
All the ideas that I have are like,

00:28:12.794 --> 00:28:13.634
this is going to be cool.

00:28:13.674 --> 00:28:14.256
And they flop.

00:28:14.316 --> 00:28:15.616
I was like, huh, why did it flop?

00:28:15.737 --> 00:28:16.759
Or this idea, I'm like, eh,

00:28:16.778 --> 00:28:17.579
it's not going to go anywhere.

00:28:17.599 --> 00:28:18.180
And it blows up.

00:28:18.200 --> 00:28:18.661
And you're like,

00:28:18.740 --> 00:28:20.603
why did that blow up and this didn't?

00:28:21.083 --> 00:28:22.204
And the answer a lot of times was,

00:28:22.224 --> 00:28:22.765
I don't know.

00:28:22.805 --> 00:28:23.486
Let's try it again.

00:28:23.925 --> 00:28:25.228
And they were going to take that away.

00:28:25.327 --> 00:28:26.368
And that's when I started looking for the

00:28:26.388 --> 00:28:26.568
door.

00:28:27.509 --> 00:28:28.909
I'm not going to be able to contribute

00:28:29.549 --> 00:28:30.470
to the outcome here,

00:28:30.769 --> 00:28:32.431
except also my name's on the door.

00:28:32.471 --> 00:28:34.270
So if this doesn't work, I get fired.

00:28:34.671 --> 00:28:36.432
So I take all the risk and failure

00:28:36.811 --> 00:28:38.532
and none of the reward and success.

00:28:38.653 --> 00:28:40.272
I have no part to play in either.

00:28:40.653 --> 00:28:42.273
And that was demeaning.

00:28:42.413 --> 00:28:43.413
Well, yeah, demeaning.

00:28:43.433 --> 00:28:45.615
It was just like, it was deflating.

00:28:45.634 --> 00:28:47.375
So I can tell you,

00:28:47.454 --> 00:28:49.016
you have layers of complexity, Jimmy.

00:28:49.036 --> 00:28:51.997
Have you ever read Nassim Taleb's Skin in

00:28:52.017 --> 00:28:52.277
the Game?

00:28:52.797 --> 00:28:53.938
No, I've heard of it, though.

00:28:54.058 --> 00:28:55.240
What's that one about?

00:28:55.259 --> 00:28:55.740
Nassim Taleb.

00:28:56.662 --> 00:28:58.323
I always like to read books,

00:28:58.363 --> 00:28:59.505
and then I want to read about people

00:28:59.545 --> 00:29:00.905
who wrote these books because that's

00:29:00.986 --> 00:29:02.067
almost just as interesting, right?

00:29:02.087 --> 00:29:03.368
Yeah, go one layer deep.

00:29:03.628 --> 00:29:04.891
Yeah, so this dude,

00:29:05.270 --> 00:29:06.633
he's a mathematician that entered the

00:29:06.673 --> 00:29:07.354
financial market.

00:29:08.434 --> 00:29:11.076
and understood the actual Black Swan

00:29:11.096 --> 00:29:11.436
events.

00:29:13.057 --> 00:29:15.019
Most of the catastrophic or most of the

00:29:15.038 --> 00:29:17.721
fundamental changes in the economics and

00:29:17.980 --> 00:29:20.262
in the market happened from these isolated

00:29:20.303 --> 00:29:21.482
events like in the year of two thousand

00:29:21.502 --> 00:29:22.824
and eight.

00:29:22.983 --> 00:29:24.545
So he has a book called Skin in

00:29:24.585 --> 00:29:24.965
the Game,

00:29:25.066 --> 00:29:27.406
essentially is that it's the agency and

00:29:27.446 --> 00:29:27.907
autonomy,

00:29:27.928 --> 00:29:29.348
your ability to control your environment.

00:29:30.028 --> 00:29:31.829
But then here's another one that's called

00:29:31.971 --> 00:29:32.830
Anti-Fragile,

00:29:33.371 --> 00:29:33.751
which

00:29:34.412 --> 00:29:35.893
Yeah, delicious.

00:29:36.173 --> 00:29:39.775
The book is like a cheeseburger with some

00:29:40.075 --> 00:29:41.576
real turkey bacon on top of it.

00:29:42.455 --> 00:29:46.817
And the antifragile is exactly what you

00:29:46.837 --> 00:29:47.358
were discussing,

00:29:47.439 --> 00:29:49.099
is that when you have the suck,

00:29:49.500 --> 00:29:50.279
the fragility,

00:29:51.641 --> 00:29:53.321
if you collapse under the first point of

00:29:53.362 --> 00:29:53.882
adversity,

00:29:54.321 --> 00:29:56.002
if you crumble down and you start crying

00:29:56.022 --> 00:29:57.624
in a corner and saying, this sucks.

00:29:58.304 --> 00:29:59.683
You need to admit that things suck.

00:29:59.743 --> 00:30:01.765
You actually need to tell yourself that

00:30:02.224 --> 00:30:03.445
right now we're going through a shitty

00:30:03.465 --> 00:30:03.806
period.

00:30:03.905 --> 00:30:05.365
Maybe the shitty period lasts a year and

00:30:05.385 --> 00:30:06.586
maybe the shitty period lasts a fucking

00:30:06.605 --> 00:30:06.986
decade.

00:30:07.707 --> 00:30:10.646
But it's okay because the fragility comes

00:30:10.688 --> 00:30:12.288
for those who succumb to this shitty

00:30:12.327 --> 00:30:14.388
period instead of for those who are able

00:30:14.409 --> 00:30:15.068
to persevere.

00:30:15.189 --> 00:30:16.128
And those who persevere,

00:30:16.388 --> 00:30:17.970
they learn every fucking element from the

00:30:17.990 --> 00:30:19.130
shitty period because that makes them

00:30:19.170 --> 00:30:19.710
stronger, man.

00:30:19.829 --> 00:30:21.931
like and i hate the cliches of like

00:30:21.951 --> 00:30:24.172
the steel is forged through heat but it

00:30:24.231 --> 00:30:25.732
is dude like you like you have one

00:30:25.772 --> 00:30:27.453
life i'm kind of like i'm an agnostic

00:30:27.513 --> 00:30:31.234
non-practice agnostic right so like uh

00:30:31.256 --> 00:30:32.635
this is like to me this is it

00:30:32.675 --> 00:30:34.317
like you're born you go through these

00:30:34.396 --> 00:30:36.077
eighty two years of and then you die

00:30:36.097 --> 00:30:37.558
and then you become dust right so is

00:30:37.598 --> 00:30:39.980
the game that's the thing yeah yeah like

00:30:40.000 --> 00:30:41.359
the is the game so like like even

00:30:41.400 --> 00:30:43.020
if you're going through it like the shitty

00:30:43.040 --> 00:30:44.682
chapter of your book it's still a shitty

00:30:44.701 --> 00:30:46.303
chapter like it's like you're writing it

00:30:47.222 --> 00:30:48.624
like it will be the maybe the chapter

00:30:48.644 --> 00:30:50.285
you want to flip later on but it's

00:30:50.384 --> 00:30:52.306
it's your chapter so yeah that's where

00:30:52.326 --> 00:30:54.487
like i don't read it or pay attention

00:30:54.507 --> 00:30:55.827
to them as much as i should like

00:30:55.847 --> 00:30:59.109
i'm not a practicing stoic um but whenever

00:30:59.170 --> 00:31:00.750
i come across like a ryan holiday i'm

00:31:00.790 --> 00:31:04.173
like like simply changing what is this why

00:31:04.212 --> 00:31:06.894
is this happening to me to what what

00:31:06.934 --> 00:31:09.776
am i learning from this is a wild

00:31:09.836 --> 00:31:10.136
flip

00:31:11.576 --> 00:31:12.257
It's weird.

00:31:12.798 --> 00:31:14.718
I've had people say, your personality,

00:31:14.817 --> 00:31:15.938
I'm pretty high energy.

00:31:15.978 --> 00:31:16.679
I'm all over the place.

00:31:16.719 --> 00:31:17.798
I jump from topic to topic.

00:31:18.159 --> 00:31:19.578
And then I tell them what sport I've

00:31:19.618 --> 00:31:21.480
been doing since I graduated from college.

00:31:21.500 --> 00:31:22.400
Now, in high school,

00:31:22.460 --> 00:31:25.921
I did immediate reaction sports, baseball,

00:31:26.000 --> 00:31:26.901
hockey, tennis.

00:31:27.561 --> 00:31:29.321
I want immediate return on investment.

00:31:29.422 --> 00:31:30.942
I want instant gratification.

00:31:31.423 --> 00:31:32.522
And then after college,

00:31:33.022 --> 00:31:34.943
marathon running and long distance

00:31:34.983 --> 00:31:35.443
triathlon.

00:31:35.463 --> 00:31:35.903
And they're like,

00:31:35.943 --> 00:31:37.203
that's weird because there's no one to

00:31:37.243 --> 00:31:37.644
talk to.

00:31:37.663 --> 00:31:38.644
There's no one watching you.

00:31:38.664 --> 00:31:39.744
There's no return on investment.

00:31:40.365 --> 00:31:42.445
for days weeks or months and i was

00:31:42.465 --> 00:31:44.665
like yeah it slowed everything about my

00:31:44.705 --> 00:31:47.866
thinking down to how do you feel what

00:31:47.886 --> 00:31:49.728
should you change now so three miles later

00:31:49.748 --> 00:31:51.728
you don't feel like crap and how are

00:31:51.748 --> 00:31:52.909
you gonna get to the finish line and

00:31:52.929 --> 00:31:55.148
there's no help and i was like i

00:31:55.348 --> 00:31:57.130
loved it so i wish i i don't

00:31:57.150 --> 00:31:58.049
know that i would have been able to

00:31:58.089 --> 00:32:00.691
do the long distance stuff as a great

00:32:00.750 --> 00:32:02.590
one year old but post-twenty-one-year-old

00:32:03.191 --> 00:32:04.971
it was great for my my mental health

00:32:05.632 --> 00:32:06.353
Oh, dude.

00:32:06.393 --> 00:32:07.313
So I'm a marathoner, right?

00:32:07.513 --> 00:32:09.194
And I'm probably the world's second worst

00:32:09.255 --> 00:32:11.257
marathoner.

00:32:11.356 --> 00:32:13.759
My wife, she comes and cheers me on.

00:32:14.578 --> 00:32:17.181
I just ran Madison Marathon in twenty

00:32:17.201 --> 00:32:17.501
five.

00:32:18.001 --> 00:32:18.402
And she's like,

00:32:18.442 --> 00:32:20.124
I can fucking see you from a mile

00:32:20.163 --> 00:32:22.045
away, like this complete graceless,

00:32:22.465 --> 00:32:23.946
like stumbling around like this,

00:32:23.987 --> 00:32:26.229
like little like bag of bones,

00:32:26.269 --> 00:32:27.369
like moving forward,

00:32:27.670 --> 00:32:27.789
just

00:32:28.170 --> 00:32:29.590
hoping for momentum to take you through

00:32:29.611 --> 00:32:30.192
the finish line.

00:32:32.012 --> 00:32:32.413
You know this.

00:32:32.553 --> 00:32:33.173
You're a distance runner,

00:32:33.193 --> 00:32:34.755
so you know that there's a point where,

00:32:34.994 --> 00:32:35.816
like mile eighteen,

00:32:35.855 --> 00:32:37.376
where everything sucks.

00:32:38.097 --> 00:32:39.638
Your mental state is shit.

00:32:39.719 --> 00:32:40.459
Everything aches,

00:32:40.759 --> 00:32:41.640
and you just want to be done.

00:32:41.920 --> 00:32:43.161
But the ability to go through that,

00:32:43.201 --> 00:32:44.823
because in another seven miles,

00:32:44.903 --> 00:32:45.883
you're going to be at the finish line,

00:32:45.903 --> 00:32:46.884
and there's going to be cold beer,

00:32:47.183 --> 00:32:48.025
and then you're going to sign up for

00:32:48.045 --> 00:32:49.205
the next one.

00:32:50.247 --> 00:32:51.688
The thing is, like people have said,

00:32:52.347 --> 00:32:54.148
if you sign up for the marathon or

00:32:54.209 --> 00:32:55.671
triathlon for the finish line,

00:32:56.411 --> 00:32:58.551
you might not get there if you you

00:32:58.592 --> 00:33:00.053
have to learn to like the tr the

00:33:00.113 --> 00:33:03.075
training is the gift it's not the metal

00:33:03.715 --> 00:33:05.876
it's not the t-shirt in fact when i

00:33:05.997 --> 00:33:07.417
look when i put on an old race

00:33:07.438 --> 00:33:10.119
shirt i think about where i was training

00:33:10.339 --> 00:33:13.541
i rarely think about race day it's it

00:33:13.561 --> 00:33:14.903
i and i just gave advice to another

00:33:14.942 --> 00:33:16.584
pt who did their her first iron man

00:33:17.084 --> 00:33:19.384
and i said um this is a catered

00:33:19.424 --> 00:33:19.826
workout

00:33:20.595 --> 00:33:21.634
This is not a race.

00:33:23.536 --> 00:33:25.817
Your success or failure has already sort

00:33:25.856 --> 00:33:26.877
of been determined,

00:33:27.238 --> 00:33:28.719
unless you get hit by a car on

00:33:28.739 --> 00:33:29.838
the race course or something.

00:33:30.278 --> 00:33:33.039
But you're not going to pull out seven

00:33:33.059 --> 00:33:35.520
miles in a row of running two minutes

00:33:35.540 --> 00:33:37.041
faster per mile out of nowhere.

00:33:37.102 --> 00:33:37.721
You're probably not.

00:33:38.083 --> 00:33:39.103
So it's already been determined.

00:33:39.522 --> 00:33:41.064
Put it on cruise control.

00:33:41.104 --> 00:33:42.403
Whatever you've been able to do,

00:33:42.825 --> 00:33:43.684
do that now.

00:33:46.215 --> 00:33:47.836
yeah and it's a mind it's it's it's

00:33:47.856 --> 00:33:50.118
that it's and i agree with you completely

00:33:50.138 --> 00:33:51.901
that the training is the gift the training

00:33:51.980 --> 00:33:53.122
is like it gets you out of the

00:33:53.162 --> 00:33:55.384
house like and like and if you train

00:33:55.423 --> 00:33:57.707
for like i run chicago marathon frequently

00:33:57.967 --> 00:33:59.428
and so you do your longest miles in

00:33:59.448 --> 00:34:02.191
the hottest days in chicago yeah and

00:34:02.211 --> 00:34:03.531
there's nothing more delicious than

00:34:03.592 --> 00:34:05.394
struggling like just like completely like

00:34:05.433 --> 00:34:07.296
dying like you you have to do a

00:34:07.316 --> 00:34:08.757
twenty miler and you're in mile six and

00:34:08.777 --> 00:34:09.398
you're already dying

00:34:09.797 --> 00:34:09.998
You know,

00:34:10.018 --> 00:34:11.838
it's going to be a lot more sweating,

00:34:11.878 --> 00:34:12.960
like the eyes are burning.

00:34:13.019 --> 00:34:14.380
And but then you come home and you

00:34:14.400 --> 00:34:14.760
know what,

00:34:14.800 --> 00:34:15.780
like you feel like shit and then you

00:34:15.800 --> 00:34:17.161
feel better and then you recover.

00:34:17.442 --> 00:34:18.302
You know, man,

00:34:18.663 --> 00:34:19.764
do you know what I do on race

00:34:19.784 --> 00:34:20.003
day?

00:34:20.143 --> 00:34:21.644
I play games, right?

00:34:22.184 --> 00:34:23.806
And I like messing with other people in

00:34:23.846 --> 00:34:24.226
good ways.

00:34:24.246 --> 00:34:25.367
I don't ever actually like throw people

00:34:25.447 --> 00:34:25.567
off.

00:34:25.606 --> 00:34:26.588
But in triathlon,

00:34:26.608 --> 00:34:30.190
you have to wear your race number turned

00:34:30.230 --> 00:34:30.590
around.

00:34:30.630 --> 00:34:32.590
So it's like on your back, right?

00:34:33.192 --> 00:34:34.711
And your name,

00:34:34.871 --> 00:34:36.393
your first name is below your number.

00:34:37.134 --> 00:34:38.974
So I'll be passing someone on the bike.

00:34:39.994 --> 00:34:41.815
And I'll go, Alex, looking great, baby.

00:34:41.855 --> 00:34:42.675
How we doing today?

00:34:43.476 --> 00:34:45.777
And I love watching people's face go, who?

00:34:45.838 --> 00:34:46.579
How does he know who?

00:34:47.539 --> 00:34:48.079
And then all of a sudden,

00:34:48.099 --> 00:34:48.840
you see the light bulb go on.

00:34:49.161 --> 00:34:51.163
And there's that laugh between both of us.

00:34:51.882 --> 00:34:53.985
And that propels the crap out of me,

00:34:54.144 --> 00:34:55.246
because we're both in pain.

00:34:55.606 --> 00:34:56.967
I don't care that you're twenty minutes.

00:34:57.106 --> 00:34:58.527
You started twenty minutes behind me or

00:34:58.547 --> 00:34:59.449
twenty minutes in front of me.

00:35:00.009 --> 00:35:01.210
We are in the suck together.

00:35:01.690 --> 00:35:03.070
I got news for people near me.

00:35:03.510 --> 00:35:04.652
We're not going to the Olympics.

00:35:05.233 --> 00:35:06.492
We're just trying to get home.

00:35:06.934 --> 00:35:08.514
That's the gift.

00:35:08.675 --> 00:35:10.076
The training is the gift.

00:35:10.215 --> 00:35:11.476
It's the best one with it.

00:35:12.157 --> 00:35:14.277
I have a blessing of being ridiculously

00:35:14.318 --> 00:35:14.898
slow, too.

00:35:15.137 --> 00:35:17.438
You get more race.

00:35:17.478 --> 00:35:18.619
You get to do more race.

00:35:18.639 --> 00:35:19.099
Oh, yeah.

00:35:19.219 --> 00:35:20.541
I'm getting my money's worth, man.

00:35:20.820 --> 00:35:22.402
I'm getting my four and a half hours

00:35:22.442 --> 00:35:23.202
worth of money's worth.

00:35:23.981 --> 00:35:26.623
But usually at the last couple of miles,

00:35:26.862 --> 00:35:28.083
I'm just schlepping along.

00:35:28.483 --> 00:35:30.224
And it's all of the other schleppers like

00:35:30.264 --> 00:35:32.126
me just trying to get there, right?

00:35:32.545 --> 00:35:34.327
And you just start talking to me.

00:35:34.367 --> 00:35:34.887
Like, oh, yeah,

00:35:34.907 --> 00:35:35.967
I'll get you to the next mile,

00:35:35.987 --> 00:35:37.088
and you get me to the mile after

00:35:37.108 --> 00:35:37.288
that.

00:35:37.768 --> 00:35:38.847
we'll do it together and you meet some

00:35:39.047 --> 00:35:41.188
like awesomest people the dude and chicago

00:35:41.208 --> 00:35:44.108
marathon and maybe like i think that had

00:35:44.128 --> 00:35:45.489
a bib and it was like this was

00:35:45.530 --> 00:35:48.110
my last marathon and i'm like dude why

00:35:48.210 --> 00:35:50.050
is this your last marathon and he's like

00:35:50.070 --> 00:35:52.030
you know i've run and they've all been

00:35:52.090 --> 00:35:55.411
my last marathons so yeah like it's it's

00:35:55.472 --> 00:35:57.132
that right like it's the people you meet

00:35:57.152 --> 00:35:58.492
right but but don't you wouldn't you agree

00:35:58.532 --> 00:35:59.793
and just to pivot a little bit but

00:36:00.353 --> 00:36:01.693
it is about the people too like a

00:36:01.733 --> 00:36:03.853
lot of times like so you were talking

00:36:03.873 --> 00:36:04.753
about like that uh

00:36:05.353 --> 00:36:07.295
Changing the framework from Stoics and how

00:36:07.356 --> 00:36:09.219
Ryan Holiday tells you to reframe things.

00:36:09.619 --> 00:36:09.818
Now,

00:36:10.239 --> 00:36:13.023
the best reframing that I learned is that

00:36:13.824 --> 00:36:15.105
whenever you have to tell yourself,

00:36:15.244 --> 00:36:15.965
I have to,

00:36:16.445 --> 00:36:18.289
you have to change it to I get

00:36:18.349 --> 00:36:18.489
to.

00:36:19.141 --> 00:36:19.840
Like when you,

00:36:20.001 --> 00:36:21.282
when you have to take out the trash

00:36:21.322 --> 00:36:21.641
and you,

00:36:21.661 --> 00:36:22.583
your wife tells you to take out the

00:36:22.603 --> 00:36:24.224
trash and you say, ah, fuck,

00:36:24.304 --> 00:36:25.204
I have to take out the trash.

00:36:25.704 --> 00:36:26.764
I get to take out the trash.

00:36:26.885 --> 00:36:28.226
I get to walk outside.

00:36:28.266 --> 00:36:29.405
And like,

00:36:29.485 --> 00:36:30.706
it just immediately changes the

00:36:30.746 --> 00:36:32.867
perspective that if you get to actually

00:36:32.907 --> 00:36:33.768
wake up in the morning,

00:36:33.809 --> 00:36:34.748
that's really a blessing.

00:36:35.228 --> 00:36:36.489
If you get to get to work,

00:36:36.510 --> 00:36:37.951
that's a blessing, right?

00:36:38.030 --> 00:36:39.592
I think you hit a point in life

00:36:39.692 --> 00:36:41.972
and some people fortunately or

00:36:42.012 --> 00:36:43.813
unfortunately hit it earlier where I

00:36:43.873 --> 00:36:45.954
really didn't lose anybody in my family

00:36:46.375 --> 00:36:48.076
until I was like in my teens.

00:36:48.115 --> 00:36:48.255
Like,

00:36:49.096 --> 00:36:51.038
either my grandparents passed before I was

00:36:51.117 --> 00:36:53.521
born or they were just around.

00:36:53.860 --> 00:36:56.643
And I think losing people or seeing people

00:36:56.664 --> 00:36:57.925
like my dad had a stroke two years

00:36:57.965 --> 00:36:58.206
ago.

00:36:58.226 --> 00:37:01.128
So seeing him lose some abilities that

00:37:01.168 --> 00:37:03.690
puts things in perspective.

00:37:03.891 --> 00:37:06.655
Like otherwise I ran through like super

00:37:06.715 --> 00:37:08.476
privileged walking through life my first

00:37:08.556 --> 00:37:10.157
twenty, thirty something years.

00:37:11.164 --> 00:37:13.684
losing a grandmother and being like, well,

00:37:13.864 --> 00:37:15.306
she was old, like that happens.

00:37:15.907 --> 00:37:17.648
And then you start to see like other

00:37:17.688 --> 00:37:20.148
people like lose parents at a young age.

00:37:20.188 --> 00:37:20.528
And you're like,

00:37:20.708 --> 00:37:24.251
they had that perspective shift way

00:37:24.371 --> 00:37:24.791
earlier.

00:37:24.891 --> 00:37:27.353
Things got, gravity is not equal.

00:37:28.427 --> 00:37:29.507
You know what I mean?

00:37:29.586 --> 00:37:32.248
Gravity for someone who I imagine loses a

00:37:32.307 --> 00:37:35.009
parent as a child is vastly different than

00:37:35.088 --> 00:37:35.489
later.

00:37:35.889 --> 00:37:37.710
Or someone who lives in poverty then gets

00:37:37.849 --> 00:37:40.190
out, they have this perspective.

00:37:40.371 --> 00:37:43.871
And that can be a superpower or something

00:37:43.891 --> 00:37:44.831
that drains you.

00:37:45.532 --> 00:37:47.652
These are simple, not easy concepts.

00:37:48.213 --> 00:37:49.733
I think that it's also the culture and

00:37:49.753 --> 00:37:51.255
country we live in, Jamie.

00:37:51.335 --> 00:37:51.994
I'm an immigrant.

00:37:52.014 --> 00:37:52.614
So for me,

00:37:52.875 --> 00:37:54.255
it's an easy perspective of coming from

00:37:54.655 --> 00:37:55.255
Soviet Union.

00:37:55.936 --> 00:37:58.717
to know like how ridiculously spoiled we

00:37:58.777 --> 00:38:00.498
are that's why we don't know because we're

00:38:00.518 --> 00:38:02.300
in the pot we've this is all we've

00:38:02.320 --> 00:38:04.922
known oh you just we don't and and

00:38:05.461 --> 00:38:07.222
like so if you think about it like

00:38:07.262 --> 00:38:10.545
my my biggest blessing my my uh aunt

00:38:10.744 --> 00:38:12.126
who immigrated to the united states

00:38:12.246 --> 00:38:13.086
earlier with with

00:38:13.586 --> 00:38:14.867
male as like bubble gum.

00:38:14.887 --> 00:38:15.068
Right.

00:38:15.088 --> 00:38:16.768
And it was such a commodity in Soviet

00:38:16.827 --> 00:38:18.869
Union to have bubble gum because you

00:38:18.889 --> 00:38:19.630
didn't have bubble gum.

00:38:19.949 --> 00:38:21.990
So like we would chew bubble gum for

00:38:22.150 --> 00:38:24.452
days and like in the evening because it

00:38:24.472 --> 00:38:26.373
was a sign of state.

00:38:26.413 --> 00:38:26.532
Right.

00:38:26.572 --> 00:38:29.494
Like you were a hierarchy if you had

00:38:29.534 --> 00:38:30.773
bubble gum or you didn't have bubble gum.

00:38:31.074 --> 00:38:32.195
And if you show up to school chewing

00:38:32.235 --> 00:38:33.436
something, you're cooler.

00:38:33.496 --> 00:38:34.936
So like in the evening,

00:38:34.956 --> 00:38:36.036
you would put it in the windowsill and

00:38:36.056 --> 00:38:37.157
in the morning it would resume chewing

00:38:37.177 --> 00:38:38.318
your gum until it would just fucking

00:38:38.338 --> 00:38:38.818
disintegrate.

00:38:39.398 --> 00:38:41.478
But that gum would last you days and

00:38:41.498 --> 00:38:45.000
a few careful weeks because that was a

00:38:45.099 --> 00:38:47.661
privilege to have it.

00:38:47.702 --> 00:38:49.461
My first and only pair of jeans when

00:38:49.541 --> 00:38:53.164
I was a kid came six sizes too

00:38:53.204 --> 00:38:53.523
big.

00:38:54.184 --> 00:38:57.105
And then my grandfather had a sewing

00:38:57.125 --> 00:38:57.505
machine,

00:38:57.585 --> 00:38:59.226
so he sawed it in and I would

00:38:59.266 --> 00:39:00.706
fucking grow into these jeans for the next

00:39:00.746 --> 00:39:01.286
four years.

00:39:01.367 --> 00:39:02.887
It would expand and lengthen with me.

00:39:04.068 --> 00:39:06.632
But I didn't feel neglected.

00:39:06.652 --> 00:39:08.434
I didn't feel deprived because at least I

00:39:08.454 --> 00:39:08.954
had genes.

00:39:08.974 --> 00:39:11.096
Somebody else didn't, right?

00:39:11.115 --> 00:39:11.277
Right.

00:39:11.317 --> 00:39:12.737
But you need that perspective.

00:39:12.777 --> 00:39:14.239
It's like I could have nothing or could

00:39:14.260 --> 00:39:14.900
have something.

00:39:15.639 --> 00:39:17.681
my uh my i wore number eighty nine

00:39:17.942 --> 00:39:19.623
playing high school hockey because there

00:39:19.664 --> 00:39:21.804
was this player alex alexander mcgillney

00:39:22.186 --> 00:39:23.367
and he was on the famed red army

00:39:23.387 --> 00:39:25.407
limbs him sergey federov and and pablo

00:39:25.427 --> 00:39:27.889
buray and i believe it was mcgillney and

00:39:27.931 --> 00:39:29.672
i didn't know this story i just saw

00:39:29.692 --> 00:39:31.614
them as great hockey players and i assumed

00:39:31.634 --> 00:39:33.355
i don't know they just i looked at

00:39:33.474 --> 00:39:34.996
ivan draga that was my only experience

00:39:35.016 --> 00:39:37.338
with russians right he had this lab where

00:39:37.378 --> 00:39:39.179
he everything was great and then there was

00:39:39.599 --> 00:39:40.902
there was this story where

00:39:41.882 --> 00:39:43.907
Alexander McGilney was playing hockey and

00:39:44.407 --> 00:39:46.090
the skate was so big,

00:39:47.112 --> 00:39:48.476
he had to wear a shoe,

00:39:48.576 --> 00:39:49.637
not several socks.

00:39:49.938 --> 00:39:52.623
He had to wear a shoe in the

00:39:52.704 --> 00:39:53.164
skate

00:39:53.965 --> 00:39:56.266
And he still was, he just,

00:39:56.545 --> 00:39:57.347
he didn't know any different.

00:39:58.166 --> 00:39:59.827
By the time he had skates that fit,

00:40:01.407 --> 00:40:01.989
it was over.

00:40:02.028 --> 00:40:03.128
Like you couldn't catch this kid.

00:40:03.528 --> 00:40:04.789
But if you had said,

00:40:04.809 --> 00:40:06.190
we're gonna put this kid into skates that

00:40:06.251 --> 00:40:07.971
are like nine sizes too big,

00:40:08.050 --> 00:40:08.751
was that an option?

00:40:08.771 --> 00:40:10.552
We couldn't get one that well,

00:40:10.612 --> 00:40:11.632
it was a little tight or a little

00:40:11.672 --> 00:40:11.932
loose.

00:40:12.233 --> 00:40:14.153
He only knew just absolute

00:40:15.715 --> 00:40:16.735
uncomfortability.

00:40:16.835 --> 00:40:18.275
By the time you gave him real skates,

00:40:19.197 --> 00:40:19.677
it was over.

00:40:19.717 --> 00:40:21.518
Like the NHL was too easy for some

00:40:21.538 --> 00:40:21.998
of those guys.

00:40:22.590 --> 00:40:24.351
But it goes into that whole embracing the

00:40:24.411 --> 00:40:24.791
suck, right?

00:40:24.833 --> 00:40:26.233
Like sometimes the culture,

00:40:26.393 --> 00:40:28.655
sometimes it's the society that puts the

00:40:28.715 --> 00:40:29.335
suck on you.

00:40:30.775 --> 00:40:32.157
And then like your medium,

00:40:32.177 --> 00:40:34.398
your baseline is to be in a suck.

00:40:34.438 --> 00:40:35.840
Then it's just variable degrees of the

00:40:35.900 --> 00:40:36.159
suck.

00:40:36.840 --> 00:40:38.021
And you just want to suck a little

00:40:38.041 --> 00:40:39.202
bit less than everyone else, right?

00:40:39.222 --> 00:40:40.123
Right.

00:40:40.182 --> 00:40:41.643
But here, like, and again,

00:40:41.684 --> 00:40:42.724
it's a different perspective,

00:40:42.784 --> 00:40:45.565
but maybe it's immigrant optics,

00:40:46.086 --> 00:40:48.367
but we are so fucking blessed to have

00:40:48.407 --> 00:40:49.449
everything we have, right?

00:40:49.728 --> 00:40:52.331
We, like Anna Maslow's hierarchy of needs,

00:40:53.331 --> 00:40:54.831
we're continuously fighting over the last

00:40:54.851 --> 00:40:56.692
two chapters when nobody's fighting over

00:40:56.731 --> 00:40:58.333
the, like the safety and stability.

00:40:58.353 --> 00:40:58.632
Right.

00:40:58.693 --> 00:40:58.992
Right.

00:40:59.132 --> 00:40:59.773
It's a good point.

00:40:59.873 --> 00:41:00.492
Yeah.

00:41:00.532 --> 00:41:02.253
We're not, we don't have these problems.

00:41:02.333 --> 00:41:03.914
We're creating our own fucking problems

00:41:03.954 --> 00:41:05.655
because like all the problems that you can

00:41:05.695 --> 00:41:08.215
have that people do have, you know,

00:41:08.315 --> 00:41:10.596
like we, like, like we, we, we are,

00:41:10.695 --> 00:41:11.295
we're good.

00:41:11.416 --> 00:41:13.077
Like it's like, even when the things suck,

00:41:13.097 --> 00:41:14.516
they don't suck like they do for somebody

00:41:14.597 --> 00:41:14.836
else.

00:41:14.856 --> 00:41:16.137
So I remember I,

00:41:16.376 --> 00:41:19.277
I planned for a triathlon in Lake Placid

00:41:19.318 --> 00:41:20.699
and I think the race was in like

00:41:20.778 --> 00:41:21.338
September,

00:41:22.159 --> 00:41:23.519
And it's supposed to be cooler.

00:41:23.860 --> 00:41:24.940
And then all of a sudden a freak

00:41:25.001 --> 00:41:26.081
cold front came in.

00:41:26.523 --> 00:41:27.623
So now you have a bunch of people

00:41:27.744 --> 00:41:29.744
who are supposedly all about embracing the

00:41:29.784 --> 00:41:30.346
suck, right?

00:41:30.365 --> 00:41:32.807
These are Ironman triathletes doing a half

00:41:33.367 --> 00:41:34.268
Ironman.

00:41:34.628 --> 00:41:36.530
And we're standing on the edge of Lake

00:41:36.550 --> 00:41:39.172
Placid like in the morning ready to go.

00:41:39.313 --> 00:41:40.454
And it's cold.

00:41:41.735 --> 00:41:43.416
And Lake Placid is a very small town.

00:41:43.596 --> 00:41:44.836
I went out the day before.

00:41:44.856 --> 00:41:46.057
I was like, I didn't bring gloves.

00:41:46.077 --> 00:41:48.059
It's supposed to be like,

00:41:48.099 --> 00:41:48.800
I didn't bring gloves.

00:41:49.340 --> 00:41:50.442
No gloves in Lake Placid.

00:41:51.215 --> 00:41:53.476
so i did what my mom would have

00:41:53.496 --> 00:41:55.577
done which is like i cut some holes

00:41:55.597 --> 00:41:57.898
in socks man i just made mittens like

00:41:58.059 --> 00:41:59.498
make mittens out of socks right i had

00:41:59.539 --> 00:42:01.199
lots of socks and i remember people

00:42:01.239 --> 00:42:03.740
standing on the on the the shore of

00:42:03.760 --> 00:42:05.541
lake placid it was so cold out the

00:42:05.601 --> 00:42:08.043
lake was still warm there was like fog

00:42:08.123 --> 00:42:11.224
on it and people were bitching and i'm

00:42:11.244 --> 00:42:15.648
like do you think the race organizers did

00:42:15.708 --> 00:42:16.248
the weather

00:42:16.873 --> 00:42:19.114
Like you signed up for a hard race.

00:42:19.275 --> 00:42:19.974
I got bad news.

00:42:19.994 --> 00:42:21.335
You're probably not gonna set your

00:42:21.376 --> 00:42:22.496
personal record today.

00:42:23.177 --> 00:42:25.538
But that line from, oh God,

00:42:25.557 --> 00:42:26.398
who said it?

00:42:26.498 --> 00:42:28.699
Everybody wants to be a gangster until

00:42:28.739 --> 00:42:30.378
it's time to start to do gangster shit.

00:42:31.019 --> 00:42:32.340
It's like, I wanted to be an Ironman.

00:42:32.360 --> 00:42:33.681
You wanna wear the t-shirt and get the

00:42:33.721 --> 00:42:34.240
tattoo.

00:42:34.960 --> 00:42:35.621
We're here.

00:42:36.061 --> 00:42:38.523
This is some sideways next level stuff.

00:42:38.943 --> 00:42:40.304
And you're mad about it.

00:42:40.483 --> 00:42:42.043
And I remember being like, nah,

00:42:42.083 --> 00:42:43.364
tomorrow's gonna be a long,

00:42:44.105 --> 00:42:45.847
You're going to earn tomorrow's T-shirt.

00:42:46.487 --> 00:42:48.268
Tomorrow's shirt is going to be worth more

00:42:48.289 --> 00:42:49.409
than the one that had good weather.

00:42:49.570 --> 00:42:50.570
And let me ask you this, right?

00:42:50.590 --> 00:42:54.494
Like the things that are maybe you didn't

00:42:54.554 --> 00:42:55.213
your PR,

00:42:55.293 --> 00:42:56.835
but the things that were most miserable,

00:42:56.956 --> 00:42:58.137
the things you remember the most, right?

00:42:58.197 --> 00:42:58.657
Hell yeah.

00:42:59.057 --> 00:43:00.518
I assumed I was going to wear those

00:43:00.539 --> 00:43:01.659
gloves just for the bike.

00:43:01.780 --> 00:43:03.481
And I wore them the whole it was

00:43:03.521 --> 00:43:05.822
that cold where I was wearing the socks

00:43:05.862 --> 00:43:07.445
on my hands while I was running.

00:43:07.465 --> 00:43:08.505
I'm like, you know what?

00:43:09.266 --> 00:43:09.965
Go quit.

00:43:10.246 --> 00:43:10.547
Quit.

00:43:10.646 --> 00:43:12.407
There's a nice little that's why they make

00:43:12.427 --> 00:43:13.467
you ring the bell, I think,

00:43:13.608 --> 00:43:14.349
in the seals.

00:43:14.409 --> 00:43:16.730
It's like I need a physical representation

00:43:16.769 --> 00:43:17.329
of you quitting.

00:43:17.590 --> 00:43:18.670
Go sit in that thing over there.

00:43:18.710 --> 00:43:20.871
There's hot soup and there's a heater.

00:43:20.931 --> 00:43:21.693
Go sit over there.

00:43:21.713 --> 00:43:24.054
Yeah.

00:43:24.094 --> 00:43:27.675
How do you instill this in a clinician

00:43:28.496 --> 00:43:30.137
who maybe has known nothing?

00:43:30.217 --> 00:43:32.438
I'm not saying academics isn't rigorous or

00:43:32.478 --> 00:43:33.039
trying,

00:43:33.478 --> 00:43:35.500
but like in Maslow's hierarchy of needs,

00:43:36.360 --> 00:43:38.181
failing a test doesn't take food away.

00:43:39.952 --> 00:43:42.155
How do you always feel like resilience in

00:43:42.235 --> 00:43:43.757
people who are like, well, now I'm being,

00:43:44.878 --> 00:43:46.380
now I'm going through suck.

00:43:46.420 --> 00:43:48.902
Like, how do you help someone gain that?

00:43:50.105 --> 00:43:50.846
I will tell you,

00:43:51.585 --> 00:43:52.945
I don't think there's a clear recipe,

00:43:53.007 --> 00:43:55.507
but I think that there's at least a

00:43:56.427 --> 00:43:56.867
trait,

00:43:57.288 --> 00:43:58.929
which is absolute honesty and absolute

00:43:58.949 --> 00:44:00.070
transparency.

00:44:00.090 --> 00:44:01.130
Just be honest with people.

00:44:03.311 --> 00:44:04.552
It's one of those primitive senses,

00:44:04.592 --> 00:44:06.112
but I think all of us can sense

00:44:06.172 --> 00:44:08.293
bullshit and all of us can sense.

00:44:09.134 --> 00:44:10.494
And so be honest with people.

00:44:10.594 --> 00:44:11.655
You have capacity.

00:44:11.835 --> 00:44:13.215
Some things are controllable and some

00:44:13.255 --> 00:44:14.496
things are not controllable.

00:44:14.536 --> 00:44:16.237
Modifiable, non-modifiable factors.

00:44:16.476 --> 00:44:16.697
Yes.

00:44:17.657 --> 00:44:19.119
And so in a clinician,

00:44:19.139 --> 00:44:21.021
the modifiable and non-modifiable factors

00:44:21.101 --> 00:44:22.623
are such that if you are in a

00:44:22.702 --> 00:44:23.143
place,

00:44:23.222 --> 00:44:24.925
in an organization that doesn't have

00:44:24.965 --> 00:44:27.186
financial fortitude to pay you more,

00:44:27.688 --> 00:44:29.670
maybe they can give you the ability to

00:44:29.710 --> 00:44:30.931
actualize in a different way.

00:44:31.050 --> 00:44:32.371
Maybe you can organize a community,

00:44:32.632 --> 00:44:33.934
maybe whatever the fuck it is, right?

00:44:34.353 --> 00:44:35.335
But that's working together,

00:44:35.375 --> 00:44:36.677
that's communication and that's

00:44:36.876 --> 00:44:39.278
transparency and that's psychological

00:44:39.318 --> 00:44:39.699
safety.

00:44:40.219 --> 00:44:42.681
or you have safety to communicate that I

00:44:42.722 --> 00:44:43.842
know you want a pay bump.

00:44:44.003 --> 00:44:45.143
I can't give you a pay bump.

00:44:45.583 --> 00:44:46.844
But what I can do is I can

00:44:46.885 --> 00:44:48.264
put you in front of a basketball team,

00:44:48.465 --> 00:44:49.666
and you can work with younger athletes.

00:44:50.166 --> 00:44:51.327
Or what I can do is I can

00:44:51.748 --> 00:44:53.748
potentially make you an administrator next

00:44:53.789 --> 00:44:54.949
year when the job opens.

00:44:54.969 --> 00:44:57.632
Or I don't have anything to give you,

00:44:57.831 --> 00:44:59.313
but I can call my friend across the

00:44:59.333 --> 00:45:00.514
street who has a different clinic,

00:45:00.554 --> 00:45:01.353
who has more money.

00:45:02.215 --> 00:45:03.876
And I want to see you thrive.

00:45:03.956 --> 00:45:06.958
I think I've been in administrative roles

00:45:07.518 --> 00:45:07.838
pretty much.

00:45:07.858 --> 00:45:09.219
I opened my own clinic one year out

00:45:09.239 --> 00:45:09.860
of PT school.

00:45:10.800 --> 00:45:13.001
And then I've been managing and growing

00:45:13.081 --> 00:45:15.822
different legacy providers for years.

00:45:15.842 --> 00:45:18.983
And my responsibility was always to the

00:45:19.003 --> 00:45:19.862
people that I worked with.

00:45:20.123 --> 00:45:22.983
And financially, I probably lost from it.

00:45:23.184 --> 00:45:25.583
And career-wise,

00:45:25.603 --> 00:45:26.864
I probably lost from it because I never

00:45:26.905 --> 00:45:30.045
grew into that CEO-level position because

00:45:30.405 --> 00:45:31.166
I had a territory.

00:45:31.326 --> 00:45:32.146
I had five clinics.

00:45:32.246 --> 00:45:33.146
I had twenty clinicians.

00:45:34.246 --> 00:45:35.606
But the twenty clinicians that I worked

00:45:35.626 --> 00:45:36.987
with were the five clinicians I worked

00:45:37.088 --> 00:45:38.248
with, or the one clinician I worked with.

00:45:39.295 --> 00:45:41.056
My responsibility was to them because I

00:45:41.097 --> 00:45:43.798
was given the power to affect their lives

00:45:43.838 --> 00:45:44.458
and their careers.

00:45:44.518 --> 00:45:45.519
And I was going to do everything in

00:45:45.559 --> 00:45:47.822
my capacity to watch them grow.

00:45:48.362 --> 00:45:49.643
And if I didn't have the capacity to

00:45:49.722 --> 00:45:50.204
do that,

00:45:50.463 --> 00:45:51.364
then I was going to be honest with

00:45:51.385 --> 00:45:54.306
them and to guide them that like find

00:45:54.327 --> 00:45:54.927
a different job,

00:45:55.007 --> 00:45:55.987
find a different position,

00:45:56.849 --> 00:45:58.309
because that was my responsibility.

00:45:58.449 --> 00:46:00.251
And it probably sucked for people who were

00:46:00.291 --> 00:46:03.353
paying me to just maximize the whatever I

00:46:03.373 --> 00:46:04.894
can to squeeze all the juice out of

00:46:04.914 --> 00:46:05.315
these people.

00:46:05.335 --> 00:46:05.536
Right.

00:46:06.175 --> 00:46:08.077
But I slept at night and I feel

00:46:08.117 --> 00:46:09.858
like I did the right thing by people

00:46:09.898 --> 00:46:10.980
that I worked with because I was a

00:46:11.019 --> 00:46:12.601
human being and I was working with other

00:46:12.621 --> 00:46:13.081
human beings.

00:46:13.121 --> 00:46:13.402
Right.

00:46:13.461 --> 00:46:15.623
So this is not what I thought we

00:46:15.643 --> 00:46:16.264
would get into.

00:46:16.443 --> 00:46:17.644
I had all these like systems.

00:46:17.864 --> 00:46:19.226
So we're going to bring you back pretty

00:46:19.266 --> 00:46:20.967
soon to get into like systems talk and

00:46:20.987 --> 00:46:21.568
things like that.

00:46:21.608 --> 00:46:23.929
But I feel like this was I feel

00:46:23.949 --> 00:46:26.592
like a conversation like this needs to

00:46:26.652 --> 00:46:29.094
happen with leaders or clinicians.

00:46:30.168 --> 00:46:31.610
Long before we teach them,

00:46:31.990 --> 00:46:34.032
this is how you open a new patient

00:46:34.052 --> 00:46:34.773
in your EMR.

00:46:35.193 --> 00:46:37.476
This is how you discharge someone.

00:46:37.516 --> 00:46:39.057
This is how you send them their plan

00:46:39.097 --> 00:46:39.498
of care.

00:46:40.159 --> 00:46:42.019
This is this is the operating system of

00:46:42.039 --> 00:46:42.521
a human.

00:46:42.940 --> 00:46:43.101
Right.

00:46:43.141 --> 00:46:44.742
If you could tell how to get through

00:46:44.762 --> 00:46:46.945
the suck to someone in theory,

00:46:47.005 --> 00:46:48.365
what what could you throw at them that

00:46:48.385 --> 00:46:49.648
they're not going to be able to process?

00:46:49.668 --> 00:46:49.788
Yeah.

00:46:50.228 --> 00:46:52.768
But I think as an administrator,

00:46:54.188 --> 00:46:55.869
I can review the complexity in the next

00:46:55.889 --> 00:46:58.170
three minutes before we log off.

00:46:58.251 --> 00:47:01.132
But as an operator,

00:47:01.771 --> 00:47:04.432
you are operating like humans are not pegs

00:47:04.452 --> 00:47:05.072
in a machine.

00:47:06.173 --> 00:47:08.295
Humans are themselves bundles of

00:47:08.355 --> 00:47:08.894
complexity.

00:47:09.655 --> 00:47:11.735
And so managing this complex relationship,

00:47:11.755 --> 00:47:14.396
you can maximize the effort and you can

00:47:14.436 --> 00:47:17.237
maximize the output from this human by

00:47:17.538 --> 00:47:19.599
building a human relationship through

00:47:19.639 --> 00:47:20.219
communication.

00:47:20.858 --> 00:47:23.840
That will actually maximize how much you

00:47:23.880 --> 00:47:25.119
can get out of this individual,

00:47:25.581 --> 00:47:27.420
not because you are trying to,

00:47:27.481 --> 00:47:28.902
but because the individual will give it to

00:47:28.922 --> 00:47:29.021
you.

00:47:29.561 --> 00:47:32.923
Because we all are first order primates

00:47:33.644 --> 00:47:36.726
that have the luxury of living on this

00:47:37.126 --> 00:47:39.367
planet for eighty plus years.

00:47:40.369 --> 00:47:42.670
And once you have sincerity and once you

00:47:42.690 --> 00:47:43.731
have honesty with someone else,

00:47:44.070 --> 00:47:45.311
you are all going to work together towards

00:47:45.351 --> 00:47:46.353
something that you're building.

00:47:47.032 --> 00:47:49.215
Or you're going to admit that there's

00:47:49.255 --> 00:47:50.315
nothing for you to work with.

00:47:51.356 --> 00:47:52.416
In terms of complexity,

00:47:53.137 --> 00:47:54.858
there's all these nodes that need to be

00:47:54.918 --> 00:47:55.518
interconnected.

00:47:56.278 --> 00:47:57.480
And they're not connected linearly.

00:47:58.081 --> 00:47:58.960
Some are connected more,

00:47:59.001 --> 00:47:59.702
some are connected less.

00:47:59.722 --> 00:48:00.963
There's valence, there's power.

00:48:01.643 --> 00:48:02.623
And that changes.

00:48:02.664 --> 00:48:04.985
There's always entropy, right?

00:48:05.005 --> 00:48:05.826
There's always change.

00:48:07.956 --> 00:48:09.619
You don't always have the vision of it,

00:48:09.659 --> 00:48:10.860
but you need to have an awareness of

00:48:10.900 --> 00:48:13.963
it because entropy and complexity emerges.

00:48:14.284 --> 00:48:17.547
It goes from nothing to something.

00:48:17.567 --> 00:48:19.608
But you need to have enough capacity to

00:48:19.670 --> 00:48:21.612
adapt and habituate to this entropy,

00:48:21.652 --> 00:48:22.552
to this emergence.

00:48:22.932 --> 00:48:24.735
So that adaptiveness and adaptability is

00:48:24.755 --> 00:48:25.456
an internal trait.

00:48:25.496 --> 00:48:26.496
That's resilience.

00:48:26.597 --> 00:48:27.498
You're embracing the suck.

00:48:28.358 --> 00:48:29.838
And then embrace system dynamics.

00:48:29.978 --> 00:48:30.998
System dynamics change.

00:48:31.619 --> 00:48:33.260
If you're in a system that's a rigid

00:48:33.300 --> 00:48:33.639
system,

00:48:33.960 --> 00:48:35.481
system dynamics are much more controlled.

00:48:35.561 --> 00:48:36.920
If you're in a system that's more of

00:48:36.940 --> 00:48:37.702
an open system,

00:48:38.081 --> 00:48:40.623
system dynamics are much more loosely

00:48:40.663 --> 00:48:41.043
controlled.

00:48:41.702 --> 00:48:46.184
It's that the book by Ravi...

00:48:48.297 --> 00:48:48.878
Bloom shots.

00:48:49.119 --> 00:48:52.420
The book is called Bloom.

00:48:52.460 --> 00:48:53.521
Chantal.

00:48:53.581 --> 00:48:55.101
The phase transition.

00:48:56.143 --> 00:48:58.503
There's water and then there's vapor and

00:48:58.523 --> 00:48:59.284
then there's plasma.

00:48:59.324 --> 00:49:00.925
The plasma is what happens right before

00:49:00.945 --> 00:49:02.586
you're transitioning phases from water to

00:49:03.007 --> 00:49:04.347
solid, from liquid to solid.

00:49:06.289 --> 00:49:07.110
Be that plasma.

00:49:07.449 --> 00:49:09.771
Be that intermediary where you're neither

00:49:09.811 --> 00:49:10.391
here nor there,

00:49:10.431 --> 00:49:12.273
but you have the capacity to become solid

00:49:12.293 --> 00:49:13.974
when you need to and to become liquid

00:49:13.994 --> 00:49:15.054
when you need to.

00:49:15.074 --> 00:49:16.775
You have to have the capacity as a

00:49:16.795 --> 00:49:17.376
human being

00:49:18.570 --> 00:49:20.570
And then life will be good because life

00:49:20.590 --> 00:49:21.632
continues to turn, right?

00:49:21.652 --> 00:49:23.512
And there's most of the other factors in

00:49:23.532 --> 00:49:25.094
that complex systems are not under your

00:49:25.134 --> 00:49:25.434
control.

00:49:25.474 --> 00:49:26.835
You only control the system that's here.

00:49:27.096 --> 00:49:29.036
That's the only one you have control over.

00:49:29.056 --> 00:49:31.759
The only consistent is change, right?

00:49:31.778 --> 00:49:33.519
That's the stupid cliche, but that's,

00:49:33.619 --> 00:49:34.800
I mean,

00:49:34.820 --> 00:49:36.402
you can't boil it down any more simple

00:49:36.422 --> 00:49:36.862
than that.

00:49:36.882 --> 00:49:38.784
Those are the things that are so cliche,

00:49:38.804 --> 00:49:39.224
but you're like,

00:49:39.583 --> 00:49:40.784
no one's been able to improve them.

00:49:40.804 --> 00:49:42.346
That's why they're repeated so many damn

00:49:42.365 --> 00:49:44.086
times is because you can't boil them down

00:49:44.146 --> 00:49:45.027
to something more basic.

00:49:45.168 --> 00:49:46.449
Those are the elements of life.

00:49:46.469 --> 00:49:47.068
That is life.

00:49:48.849 --> 00:49:51.012
What was that book again from the guy

00:49:51.032 --> 00:49:51.711
who wrote Anti-Fragile?

00:49:51.731 --> 00:49:52.472
What was the other book again?

00:49:53.413 --> 00:49:53.974
Skin in the Game.

00:49:55.193 --> 00:49:56.474
Nasim Taleb, Skin in the Game.

00:49:56.494 --> 00:49:57.295
So all his books,

00:49:57.436 --> 00:49:58.697
I think it should be a mandatory read

00:49:58.717 --> 00:49:59.838
for any human in the works to serve.

00:50:00.577 --> 00:50:03.219
Black Swan is about these outlier events

00:50:03.400 --> 00:50:05.882
that actually have a fundamental effect on

00:50:05.922 --> 00:50:06.041
us.

00:50:06.382 --> 00:50:07.001
So Black Swan,

00:50:07.021 --> 00:50:08.342
it's like somebody dying in your family.

00:50:08.362 --> 00:50:09.123
That's a Black Swan event.

00:50:09.423 --> 00:50:10.344
It's an anticipated, but

00:50:11.152 --> 00:50:12.351
It's a betful.

00:50:12.391 --> 00:50:13.972
Stock market crashing is a black swan

00:50:13.992 --> 00:50:14.213
event.

00:50:14.632 --> 00:50:17.193
PTs transitioning from fee-for-service

00:50:17.233 --> 00:50:19.333
model into more recapitated risk-based

00:50:19.373 --> 00:50:19.693
models.

00:50:20.054 --> 00:50:21.833
It's a black swan event because sooner or

00:50:21.853 --> 00:50:22.114
later,

00:50:22.153 --> 00:50:24.295
the CMS is going to come in and

00:50:24.315 --> 00:50:24.875
say, fuck it.

00:50:25.094 --> 00:50:26.355
We don't see value in PT at all.

00:50:26.414 --> 00:50:27.855
We're just going to continue to reduce

00:50:27.875 --> 00:50:29.775
your fee schedule by fifteen percent until

00:50:29.795 --> 00:50:30.635
you're getting paid nothing.

00:50:30.996 --> 00:50:32.215
And then are you willing to continue to

00:50:32.255 --> 00:50:33.876
maximize your volume or are you going to

00:50:33.916 --> 00:50:35.177
start to explore like, look,

00:50:35.237 --> 00:50:36.896
I'm going to take on some risk and

00:50:36.916 --> 00:50:38.117
I'm going to take on this at-risk

00:50:38.157 --> 00:50:40.057
population because I know my skill set.

00:50:42.699 --> 00:50:44.380
But it will happen.

00:50:44.440 --> 00:50:47.322
So yeah, Nassim Taleb is the man.

00:50:47.342 --> 00:50:49.445
Dude, there's so much good reading.

00:50:50.065 --> 00:50:51.626
I guess the biggest blessing for me in

00:50:52.606 --> 00:50:55.268
that late forties of my life is that

00:50:55.309 --> 00:50:56.891
capacity to go on the long run and

00:50:56.911 --> 00:50:58.751
to actually listen to an audio book or

00:50:58.771 --> 00:50:59.472
to read in the evening.

00:50:59.512 --> 00:51:02.195
But yeah, Jimmy, this has been a pleasure,

00:51:02.215 --> 00:51:02.394
dude.

00:51:02.815 --> 00:51:04.456
And for what it's worth,

00:51:04.876 --> 00:51:05.898
you have a voice.

00:51:06.237 --> 00:51:08.018
I think your voice resonates with the

00:51:08.039 --> 00:51:08.519
community.

00:51:08.539 --> 00:51:10.001
You also have a community that listens to

00:51:10.021 --> 00:51:10.081
you.

00:51:10.561 --> 00:51:11.882
So you have a lot of capacity and

00:51:14.123 --> 00:51:16.666
ability to be the agent of change.

00:51:16.706 --> 00:51:18.268
Because once you have people's ears,

00:51:19.748 --> 00:51:20.909
make others actualize.

00:51:21.831 --> 00:51:22.552
N equals one.

00:51:23.052 --> 00:51:24.833
It takes one individual trying to change

00:51:25.213 --> 00:51:28.317
himself or herself that will have a title

00:51:28.396 --> 00:51:29.777
effect on the entire community.

00:51:31.047 --> 00:51:35.027
I see a lot of ceiling for the

00:51:35.068 --> 00:51:37.469
profession, even though a lot of times,

00:51:37.509 --> 00:51:38.148
myself included,

00:51:38.168 --> 00:51:40.909
we focus on how the floor is going

00:51:40.949 --> 00:51:41.269
down.

00:51:41.449 --> 00:51:42.291
I'm like, yeah,

00:51:42.311 --> 00:51:43.490
but I can't control the floor,

00:51:43.550 --> 00:51:45.072
but I want to connect myself to the

00:51:45.132 --> 00:51:45.472
ceiling.

00:51:45.492 --> 00:51:47.072
And the funny part is that people who

00:51:47.112 --> 00:51:49.773
bitch about CMS reducing payments or

00:51:50.132 --> 00:51:51.793
inflation pretty much eating away,

00:51:52.266 --> 00:51:52.867
I'm like, okay,

00:51:53.288 --> 00:51:54.248
that's where I go back to like,

00:51:54.748 --> 00:51:55.929
not to mention too many Navy SEALs,

00:51:55.969 --> 00:51:58.510
but Jocko Willeneck, he's like, good,

00:51:59.050 --> 00:52:00.311
gonna force me to get stronger.

00:52:00.612 --> 00:52:02.132
And it's gonna eliminate the people who

00:52:02.152 --> 00:52:02.612
won't change.

00:52:02.992 --> 00:52:04.454
Good, the net negative,

00:52:04.753 --> 00:52:06.074
the net result is positive for our

00:52:06.094 --> 00:52:06.454
profession,

00:52:06.474 --> 00:52:07.635
because it's gonna wipe out the people who

00:52:07.675 --> 00:52:08.135
won't change.

00:52:08.635 --> 00:52:09.476
Maybe that's what we need.

00:52:09.576 --> 00:52:10.257
Maybe we need a flood.

00:52:10.777 --> 00:52:12.518
Maybe in the notes for this episode,

00:52:12.577 --> 00:52:14.237
include that five-minute video he has on

00:52:14.277 --> 00:52:15.259
YouTube about good, right?

00:52:16.018 --> 00:52:17.958
It's my go-to video when everything sucks

00:52:17.998 --> 00:52:19.079
and I'm down in my lock and I'm

00:52:19.099 --> 00:52:19.539
like, fuck it.

00:52:19.599 --> 00:52:20.440
This is just not good.

00:52:20.980 --> 00:52:21.179
I mean,

00:52:21.320 --> 00:52:22.900
I lost my job for the first time.

00:52:22.940 --> 00:52:24.121
I got fired as a – I got

00:52:24.922 --> 00:52:26.242
fired at forty-five,

00:52:26.362 --> 00:52:27.583
three hundred and sixty-four days.

00:52:27.603 --> 00:52:30.882
I got fired the day before my –

00:52:29.563 --> 00:52:30.302
and honestly,

00:52:30.322 --> 00:52:31.744
the next morning I woke up and I

00:52:31.864 --> 00:52:33.143
literally was just like, good.

00:52:33.905 --> 00:52:35.045
I was not a good fit.

00:52:35.644 --> 00:52:36.806
I was not a good fit.

00:52:37.306 --> 00:52:37.766
I wasn't.

00:52:38.365 --> 00:52:39.547
i could be mad at the people who

00:52:39.567 --> 00:52:40.527
were like you're not a good fit here

00:52:40.547 --> 00:52:42.268
but i was like uh they're right i

00:52:42.289 --> 00:52:44.409
didn't like it i was not good and

00:52:44.449 --> 00:52:45.931
didn't like it it's different if i was

00:52:45.971 --> 00:52:46.851
like i'm not good at it but i

00:52:46.992 --> 00:52:48.972
want to be that's different that's like

00:52:49.253 --> 00:52:50.233
that's how i was in the beginning of

00:52:50.253 --> 00:52:51.614
radio i was like i'm pretty terrible but

00:52:51.655 --> 00:52:53.376
i'm i'm gonna show up and i'm gonna

00:52:53.416 --> 00:52:56.018
be less crappy today but like yeah i

00:52:56.038 --> 00:52:56.699
will that that

00:52:58.353 --> 00:53:01.494
that dialect when he was like,

00:53:01.514 --> 00:53:02.175
I know what you're gonna say,

00:53:02.195 --> 00:53:02.855
you're gonna say good.

00:53:02.875 --> 00:53:03.094
He's like,

00:53:03.235 --> 00:53:04.516
why do you think I'm saying good?

00:53:04.695 --> 00:53:06.135
I don't know, you just,

00:53:06.255 --> 00:53:08.697
like when things suck, it's like, no.

00:53:08.717 --> 00:53:09.697
I can't control that.

00:53:10.157 --> 00:53:11.657
I can control, all right, good.

00:53:12.436 --> 00:53:13.217
Like that whole,

00:53:13.237 --> 00:53:14.358
we don't go to war with what we

00:53:14.777 --> 00:53:15.217
need,

00:53:15.277 --> 00:53:16.418
we go to war with what we have.

00:53:17.559 --> 00:53:19.199
Like my marketing budget,

00:53:20.079 --> 00:53:21.800
the radio station I ran grossed between

00:53:21.880 --> 00:53:23.219
five and seven million dollars a year.

00:53:23.519 --> 00:53:26.300
My annual marketing budget was zero

00:53:26.340 --> 00:53:26.900
dollars.

00:53:27.657 --> 00:53:29.039
do you mean if i wanted to do

00:53:29.079 --> 00:53:31.481
a promotion around t-shirts i needed to

00:53:31.521 --> 00:53:34.204
create a promotion that was so valuable in

00:53:34.244 --> 00:53:36.186
attention that i could get someone to pay

00:53:36.226 --> 00:53:39.409
for the t-shirts and margin and i hated

00:53:39.429 --> 00:53:40.891
that at first because there were radio

00:53:40.911 --> 00:53:43.554
stations in my market that had six figure

00:53:43.574 --> 00:53:46.978
budgets it made me crafty

00:53:47.677 --> 00:53:49.378
Because the minute your budget went away,

00:53:49.619 --> 00:53:50.278
you were done.

00:53:50.739 --> 00:53:52.121
I knew how to make fire.

00:53:52.340 --> 00:53:53.402
You were handed fire.

00:53:53.862 --> 00:53:55.684
I knew how to rub two sticks together

00:53:55.704 --> 00:53:56.364
and build fire.

00:53:56.744 --> 00:53:57.945
You don't want to compete against that

00:53:57.985 --> 00:53:59.567
dude.

00:53:59.807 --> 00:54:01.949
On day one,

00:54:01.969 --> 00:54:03.010
you want to compete against that dude

00:54:03.030 --> 00:54:03.911
because he's got no fire.

00:54:04.190 --> 00:54:05.331
On day three, sixty five,

00:54:05.351 --> 00:54:07.353
when he can create fire from nothing,

00:54:07.773 --> 00:54:09.315
that's a dangerous dude.

00:54:09.635 --> 00:54:10.356
That's danger.

00:54:11.231 --> 00:54:13.594
And you also have to have enough vision

00:54:13.653 --> 00:54:15.476
that you may not be able to create

00:54:15.516 --> 00:54:16.936
fire today.

00:54:17.057 --> 00:54:18.838
It's nothing that in a year.

00:54:18.858 --> 00:54:20.601
Dude, it's been a blast.

00:54:20.940 --> 00:54:21.402
It's awesome.

00:54:21.422 --> 00:54:23.282
So keep making that fire, dude.

00:54:23.302 --> 00:54:24.445
Keep running and keep doing everything

00:54:24.505 --> 00:54:24.664
else.

00:54:25.385 --> 00:54:26.346
We'll get you back on the show and

00:54:26.365 --> 00:54:28.367
we'll talk specific systems because I feel

00:54:28.427 --> 00:54:28.668
like

00:54:29.248 --> 00:54:30.710
PTs don't talk in systems,

00:54:31.309 --> 00:54:32.891
but they live in systems whether they like

00:54:32.911 --> 00:54:33.391
them or not.

00:54:33.771 --> 00:54:35.992
And systems are human to human or human

00:54:36.012 --> 00:54:37.893
to computer and computer to computer and

00:54:37.913 --> 00:54:38.873
then computer back to human.

00:54:38.893 --> 00:54:39.634
These are all systems.

00:54:39.753 --> 00:54:41.614
It's wherever things are interconnected.

00:54:41.735 --> 00:54:43.376
What's your parting shot?

00:54:44.115 --> 00:54:46.797
Your parting shot, the last idea, concept,

00:54:46.818 --> 00:54:47.358
we always do that.

00:54:47.378 --> 00:54:48.378
What's the last thing you want to leave

00:54:48.398 --> 00:54:48.978
with the audience?

00:54:49.199 --> 00:54:50.759
Could be a quote, could be a whatever,

00:54:50.800 --> 00:54:51.340
just an idea.

00:54:52.262 --> 00:54:55.125
um i think wake up in the morning

00:54:55.505 --> 00:54:57.106
and express one point of gratitude to

00:54:57.266 --> 00:54:58.947
anything and everything like i'm grateful

00:54:58.987 --> 00:55:01.028
for my coffee today so like today i

00:55:01.068 --> 00:55:04.751
have a trader joe's uh winter blend which

00:55:04.791 --> 00:55:07.112
has peppercorns and something else in it

00:55:07.253 --> 00:55:09.434
yeah and i'm grateful for this so show

00:55:09.454 --> 00:55:11.894
gratitude uh alex appreciate the time and

00:55:11.914 --> 00:55:13.476
thanks for uh thanks for the discussion

00:55:13.496 --> 00:55:15.257
this woke me up i love it that's

00:55:15.297 --> 00:55:15.878
good thank you

00:55:17.833 --> 00:55:18.914
That's it for this one,

00:55:19.173 --> 00:55:20.775
but we're just getting warmed up.

00:55:21.315 --> 00:55:23.217
Smash follow, send it to a friend,

00:55:23.436 --> 00:55:25.139
or crank up the next episode.

00:55:25.619 --> 00:55:26.500
Want to go deeper?

00:55:26.980 --> 00:55:31.023
Hit us at pgpinecast.com or find us on

00:55:31.063 --> 00:55:33.625
YouTube and socials at pgpinecast.

00:55:34.045 --> 00:55:36.327
And legally, none of this was advice.

00:55:36.387 --> 00:55:38.068
It's for entertainment purposes only.

00:55:38.088 --> 00:55:39.769
Bullshit!

00:55:39.809 --> 00:55:40.409
See, Keith?

00:55:40.590 --> 00:55:41.670
We read the script.

00:55:41.951 --> 00:55:42.612
Happy now?