Stand 4 PT,OT,SLP Town Hall

Thank you, Seth. So, guys, listen, this is the bottom line of it. From my perspective. This is the only thing that I'm going to share that's like, hey, this is what I think. Otherwise I want this to be more of a group discussion and that is there's a mindset shift in the industry that has to occur more than anything else. It's this way that we think about ourselves as healthcare providers in the space that we are, regardless of the legalities of being able to refer to ourselves as doctor. The truth is we need to think of ourselves as doctors in the community instead of some service that gets referred out to and oftentimes. Listen, I have been officially diagnosed with anxiety a number of times in my life. I am not speaking from a place of. I've never had a problem with this and I see it in the industry. I legitimately, when I started my practice, I was overwhelmed with fear over Medicare audits and making sure that I was following the eight minute rule and is a doctor going to send me a patient? I lived in this mindset of like, if I have a problem, new patients can fix all of my problems. As an entrepreneur, right? And there's a lot of problems that a bunch of new patients don't fix. But more importantly, I was fear based. I was scarcity mindset around everything. And then I had this wonderful journey that happened to me around being exposed to incredible men and women who lead in other industries. And I was able to see that difference in our industry versus others. So I don't really feel the need to like, talk about how we got here. I just, it's kind of like my dad, I'm from, all my family's from East Texas. And so my grandmother would always say, you know, you don't worry about, you don't worry about who left open the gate when the alligators are biting. And that's the state that we're in right now with. I think recently with inflation, it's just made this issue a lot more concerning. But as I look to the future of our industry, I'm fearful in a healthy way. Like, concerned is probably the better approach. Knowing that if something doesn't shift dramatically, we are going to be watering down our industry to some major degree that is going to look like some shadow of what it is today. And what it is today isn't that great. But it is at least what we want it to be in the sense that we have control that, that we have some degree of like, influence over our patients and each other and all those things. That we do. Right. And over time I've, most of my mentors have been outside of physical therapy. My current mentor is actually a retired CEO of a billion dollar software company, Global. And so when I meet with him, he, I share with him the data and the trends and everything in our industry. And he goes, yeah, everything's going to be down, is going to be replaced, most everything will be replaced by other companies that are stretch based apps that show exercises and all these things. And it's not, I'm not saying that as like a methodology of like trying to create fear. I'm just saying I've had multiple people share with me that similar perspective of like where we're headed if we don't turn it around. So I would just like to have an open discussion with you guys around three things, what we should start doing as a, as an industry, stop doing as an industry and keep doing as an industry. So what do you guys feel we should start doing as an industry that we're not doing right now? And I'll be writing, I'll be taking notes on all this. If someone's talking and you have an idea, just throw it into the chat. And if you guys need a couple minutes to process, that's fine too.

Well, do you want us to raise our hand or do you want us to just.

Yeah, let's do their hand raising. That would be fantastic. That way everyone can feel like they have a voice in this, which is a big part of tonight. Right? So yeah. Carrie, go first please.

Okay. Well, I'm new, I'm Carrie Hall. I'm in Seattle, Washington in my car at the moment and actually you can't see my sunroof, but there's sun here today.

And it's going to be short lived, but we do have sun today. I am actually semi retired. I sold my company after 27 years at the helm in December. And I'm actually trying to move into the mentorship role, both clinical and non clinical, kind of straddling both sides of that coin. But as a former business owner and I was mentored by Shirley Sarvin out of Washington University, so I've had this mentality my whole career, 39 years so far and counting. And that is, she didn't use this term, but it's a buzzword. Today it's D2C which is direct to consumer. And I've always been marketing directly to the consumer. Not to say that I wasn't developing relationships with my referring providers, but I was always marketing to the consumer through a variety of Methods. But I was then therefore able to have the patients be my best marketer. So they'd go back to their doctors, they'd go back to their friends and family. You get the mom on board, you get everybody on board. Hate to say that, but it's true. And that's always been my. My kind of approach in marketing. The second thing is the language that we use. We have to stop saying.

Did you get pt? Did you do pt? Did you do your pt? And I got pt. It didn't work. That has to stop. So when a patient says that to me, I said, oh, you mean you saw a physical therapist or you saw a physical therapist and you received physical therapy services. So we are not a thing. As long as we continue to be a thing, then that's what we are to everybody out there. We are skilled and knowledgeable healthcare professionals, and everybody should have their physical therapist, just like they have.

Their PC, their dentist. Do you have a pt? Who is your pt? I think that's super important. And also the fact that we use the word discharge. Why are we discharging patients? Does your PCP discharge you? You, as a professional, are building your caseload. You are their physical therapist. Now, if they have a problem that's not in your wheelhouse, you refer to that to the appropriate healthcare professional, but you are their pt. And so we need to be building all of those things into the way we behave, what we say, how we talk about, what we. What we do, and how we market D2C. There's my spiel, Carrie.

I think Carrie just dropped so much value that it's a little bit crazy. So don't be afraid, guys. Down in the reactions, Michelle leveraged it. If you're not familiar with Zoom, you hit reactions, you can hit heart. Thumbs up, you know. Applause. I saw Kaylin doing one of these things. I love that encouragement. Because that's what we need more of, right? We don't get enough of. And as entrepreneurs, we tend to be on these islands alone, fighting the major battles and knowing that, like, this is our tribe, like, this is who we were meant to be with. And is there a greater cause that we could be united under? I don't think so. So let's go now to the next one.

Can I add one more? Yeah, Carrie, please, can I add one more thing? Well, just based on what you just said, I also, in my marketing, it was never about our company specifically. It was about the profession of physical therapy. You know, did you know that a PT can help you with your bone density? Did you know, you know, whatever. So then it was my logo. Yes. It was my company that I was representing, but it was always marketing the profession and what we can do and why you should have a PT on your healthcare team.

So that was another thing is like, stop competing against each other. There's enough patience around for everybody. Like, let's elevate the profession so the consumers are aware of what our knowledge base. They should be seeing us for what we know more than for what we do.

That's amazing. You know, going along with that. It's that idea that, like, no one says, oh, I tried dentistry.

Exactly.

They say, Dr. Smith was a jerk. That's what they say. Don't go to him. He was a horrible. And that's. That's part of the reason, I think, the quality of our experience as therapists. And we've all, if you're a business owner on this call, you've all accidentally hired someone that you're like, oh, crap, that person. I mean, we see it more as like, we have to deal with that because we don't want our patients negatively impacted by that, that pt. But what we. If our profession stood the way that Carrie described it, I could see where we would drowned out. A lot of these pts are kind of just swimming in the commoditization of the ocean that we've created by saying with our language. Right. That thing that you said. So, Kerry, that was great. And also, please model things after what Kerry did. After you raise your hand, introduce yourself to the group. Make it as personal as you want. Remember, we're building more of a community here. We can't have success as a movement unless we really have strong ties and loyalty to each other and what we're doing. So it all starts with just getting to know you. So let's go over now to Candace, who had her hand up next, and then we'll go to Kaylin after that. And then we'll pause after that and go through some of the meeting chats. They're wonderfully popping up as we talk. So, Candice, the floor is yours.

Hey, everyone, Sorry, I am not on video because I'm driving and it's dark, so you wouldn't see me anyway. So, full disclosure, I'm actually an occupational therapist, but I've employed physical therapists for the last 15 years. I do pediatrics, so I've been at OTPD and Speech Private Practice for the last 15 years, owning my own business. And I know my answer is probably going to be very different from some of your adult orthopt practices. But.

We have to fight for our profession with our insurance companies. And I know that that seems like a, you know, the battle that none of us want to take on. But about six years ago I formed an advocacy group here in Nebraska with OTPT speech and we've successfully passed three laws to eliminate or to make telehealth permanent, to eliminate MPPR and to.

Require a 60 day notice for any policy changes. And that's just for Medicaid. That's what we've accomplished in the last five years. And then our next bill is to tackle MPPR for all of our private insurance companies. And we're starting that in 2023. And I think, you know, it's easy for a lot of us to say, well, I'm just going to get more cash based services, I'm just going to do this, I'm just going to do that. But my mission is really to serve all of the populations around me and I want to be able to serve those insurance based patients because they pay for it, gosh darn it, you know, they pay those high premiums. They deserve to be able to, to get what they need out of their insurance companies. And, and I think collectively as a group ot PT speech, we need to fight these companies to prove our value and our worth. And I know, I know when I say this, it's not easy and people are just like, I don't want to do that. But I am here to tell you that if you can form a group and you can do that, you can make change because that's what we're doing in little old rural Nebraska. And clearly I'm an advocate for this and I'm hopping on a soapbox here, but the ways to do that through your state association or national associations, the PACs for your national associations, reaching out and collaborating with all of the practices in your own community rather than being competitors and really band together because there's power in numbers and insurance companies prove that day after day when they, you know, don't negotiate with us or limit visits. But we've had a lot of success here and I'm actually on a national.

Task force to eliminate mppr, which is also, you know, that's the long haul. So that's sort of my soapbox. And again, I'm in pediatrics and I serve a very different population. But I think that as a profession, the three professions need to fight for who we are and why we deserve these insurance companies to pay us fair wages when they're making it, you know, Billions and billions every year. And just so you guys know, there's a study that AOTA just did that shows that.

Reimbursement from 2009 to 2019 is stagnant and has gone down 15%. And when you compare that to the inflation rate for those same years, we're at A net negative 33% of reimbursement. And I know that that's not feasible. I know that, you know, we all have to seek out those cash based services but dammit, we deserve to be paid. So that's my soapbox. Sorry. Thanks for listening.

Anyone else get chills? When she was talking, when she said damn it, we need to get paid, I really felt that. And Candace, one of the most interesting things that happened when I sent that video out was I was reached out to by two groups. One was OT and one was slp. And they're like hey listen, you know, you were talking about physical therapy specifically, but we're all in this exact same fight. Why don't we unite around this? And maybe that's something that hasn't been considered in a serious way. I don't know. Again, I don't want to pretend like I've been fighting this aggressively for 20 years. I've only come up for error recently after selling my practice and really started to see this from a different angle and get concerned. But I, I agree with you 100 Candice that we need to be in a position where we're fighting this united. Right now there's roughly 200 and some change physical therapists, 22 to 25,000 PT business owners. There's a whole nother section. There's an equal amount. I think it's 150,000 occupational therapists. I think it's another 150 to 200,000 speech therapists. Like there's. We could literally double our efforts by uniting ourselves around this. And the louder we are, the more concentrated we are and again, the more it's being led by, in my opinion, this entrepreneurial mindset of taking a stand for things, the more response we're going to get regardless if the techniques we've done to this point have, have proven to be the correct steps. Right. So let's go now to Kaylin.

Sorry, I must be in the wrong place. I thought this was a video game Addiction Anonymous meeting, but that's why I wore my headset.

My apologies. Well then say hi, my name is Kaylin. And we'll say hey Kalin.

Hi, my name is Kaelin and I'm a physical therapist. Hi I live in Baltimore now, originally from Philadelphia, and I was a late bloomer to PT. So I actually had a career for 10 years before decided to go back and be a physical therapist. And the reason I point that out is that I was a marketing major beforehand, took a lot of entrepreneurship classes and things like that. So my mindset has always been about finding and solving the problem, which works very well for people that are taught to diagnose and evaluate dysfunction.

I don't do outpatient. Necks and back scare me. I actually work between wound care, emergency department, medical icu, cardiovascular icu.

We.

I see ECMO patients who are people who are dying. So my realm is very different from what a lot of you guys are talking about. However, we still see the same problems in terms of insurance because we can't get them. We can't get them out. So, yes, I'm 100% on board. If I could burn every insurance company down, I would, but I think that's illegal. So we're going to. We're just going to. We're going to go back to that one later. But one of the things that I've noticed consistently, and Carrie talked about it perfectly, was we're a consult service, right? It is run primarily by the physicians in the hospital. But then we are pulled in where we need to. We come up with a plan of care and we write orders the same as the doctors do, and the nurses carry them out, right? So if we can see somebody three times a week, the nurses are mobilizing them the other.

Three times a day when we can't. And I think that one of the benefits that I have seen was really to run physical therapy not as well. I'm just a pt. Well, this physical therapy is different. And it is different, right? We show up and we spend 45 minutes to an hour with people as opposed to five minutes. And then the med tech comes in and takes blood pressure and things like that. But what I found was, and this is specifically because I came in, I didn't know what I was doing. So I was a resident first. And what I found was that medical model worked. And to own what you know, own what you don't know, seek out that knowledge and become an expert is not something that we need to take for granted. But instead, put that on display, right? We all have feelings about chiropractors, but holy shit, they fucking own it. And we should be doing that also. We should be. If you're in a hospital setting, we should be wearing white coats. If you're not in A hospital setting, you just want to make sure that you look comfortable and you want to carry through of, you know, maybe you're only going to spend 15, 30 minutes, you're going to talk to the patient, you're really going to identify, you're really going to evaluate and then you're going to move on to your next person and say, hey, listen, here's your prescription.

Go.

If you are sick and go in and you're like, hey, I got a cold. You go in and get your medications from the doctor. You then go home and take your prescribed medications. We need to be seeing people identifying what's going on, seeing what the problem is, coming up with a prescription and then having them complete what they need to do. I think think it's brilliant. That carries like, why are, why are we discharging people? Why aren't people coming back for one month or six month or three month follow ups? And if we're not because of insurance, is there a way to set up some form of, you know what, for $75, you're just going to come in, we're going to meet for 15 minutes. I'm going to walk you through your new program. You can go to any gym and do this because everybody's got equipment sitting around their outpatient offices that aren't being used.

Those are just one of like 45 things that I can die on that hill today. And then the other piece that I think Will talked about in one of his much previous videos is that I don't understand everybody's problem with the apta. I'm sure that I have some issues with it as well, but we're not supporting the one agency that's fighting for us. I have, I can't tell you how many people are not APT members at my hospital. Candace talked about being OTs. AOTA is the same issue. The SLPs seem to have it on board. So they're all at asha, at ASHA this week. But anyway, that's my soapbox that I'm more than happy to yammer on whenever, whenever we have time.

Well, thank you, Kaylin. Honestly, that's very helpful and useful and I'm really clear. I know eventually we're going to get to a place where we're getting into this get to know each other stage at this first meeting. And so there'll be some niceties I think that will drop. I think we're going to debate some of these topics a little bit more in the future. Right now we're in that brainstorming session where we just want everything on the table and create the space for us. So I agree with you in everything that you were saying around that. And let's go to orit. Actually, before we go to orit, I just want to give some, some recognition and visuals to what's been put there. Michelle, do you mind reviewing those with, with the group?

Absolutely. Okay, so I'm going to start here at the top. It says start fighting to remove mppr, which is a little bit of what we discussed. And I'm excited to hear about some action on that. And then stop saying I'm just a pt. I can't tell you how much I love to hear that being one of the things that we need to stop doing because it just diminishes us as a profession. So I think that's a charge that we need to do. In addition to stop saying discharge, maybe graduate them from that one plan of care. But they're not discharged from our, from our, from us. Right. Deb, I am part of a national advocacy group which we're excited to hear about. How can I help? Candace, I can assure you that Apta Oata are using your dues to fight for our profession. So that's great to hear as well.

Love it. Okay, let's move to orit.

Hi, also in Washington.

And yes, the sun has gone away because the sun has set, unfortunately, Carrie, but it's still there somewhere behind the clouds. So I'm Orit Hickman. I am an owner of a private practice here in Burie in Washington. It's just outside of Seattle. And I so something that I was thinking about as Candace and Kaylin were talking, you know, both of them said, you know, I'm, I'm different than you guys, right? I'm in pediatrics or Kaylin's and not going to touch outpatient with a 10 foot pole. Something that occurred to me and this is something that's been sticking with me for a while and that is that when we first got into the pandemic, Medicare, there was a, there was, there was a, I think some legal stuff that was coming through where Medicare was going to drop.

They were going to do another big, huge cut. And there was this massive, massive response by physical therapists across the country in all the different realms of physical therapy to advocate, right. Everybody was messaging their, their, their representatives and it was this huge, huge thing, this grassroots thing that just like it just knocked it down really fast because it was one of these things where everybody was like, wait a minute, we're in the middle of a pandemic. You can't possibly consider dropping reimbursement when all this stuff is happening. And everybody just banded together. And there was a huge response from an advocacy standpoint, and it knocked it down really fast. And it was really inspiring to me because it felt like, wow. Nobody said, hey, I'm a PT in outpatient, or, I'm a PT in inpatient. Everybody said, well, I'm a pt, and we all treat Medicare patients, and how dare you do this to us? But as things have kind of moved us back to, I think, the new normal there, there seems to be, all of a sudden, everybody's kind of going back into their silos. So I love. I love the fact that, you know, people are starting to come out and say, okay, well, maybe we need to all think about how we can band together and that it does impact us all directly, equally, when we are not respected for what we do as a profession, when they don't know what it is we do as a profession, when we don't speak about ourselves with respect. So I'm sort of echoing everything that everyone said, but, Kaylin, you're not that different. Candace, you're not that different. We're all rehab professionals. We all went to school, we all have degrees, we all have loans, and we're all working very hard to treat these patients within the confines of insurance. And I'm also in agreement that my team and I, we talked about it, should we go to cash pay? And all of them were like, no, we want to be able to treat these patients. We don't want to limit our access for them to come to us. So I think that we definitely need to think about how can we all band together as the rehab professionals that we are, the doctors of physical therapy, the doctors of ot. And I don't know if speech therapists are doing doctor as well, but if they are, all right, I love it.

Well, and by the way, even if we can't call ourselves Dr. For whatever legal reasons, Tony, thanks for sending that article in your Facebook group. You know, there's. There's the mindset. It's more about our mindset. And I love how you say that, Ori, because it's this very beautiful way of just indicating we need to get together and have more unification. And if that just. I don't think it's like an either or. I don't think it's like APTA or, you know, occupational therapy or what we're doing here now, which is going to be defined as we move forward, like I think it's yes and yes and yes and. And the more that we support in different angles, the more influence that we're going to have around this. But the point is, we haven't really gotten together for a few reasons. One of them being the fact that when you own a practice or you're an entrepreneur or. Or an entrepreneur, a leader in someone else's company, it becomes very hard if you don't have time to take care of yourself, which is a big complaint I see when people don't exercise and they're like, I don't know if I can be enough for my kids. And like, you know, whatever their thing is, not being enough kind of like defines the major barrier that we'll get into down the road in a future discussion. But, like. But to your point, however, we need to overcome that. Orit. I love that idea of you saying, let's just band together and maybe redefine what banding together looks like and supporting it in that way.

Let's go to Angie now.

Hey, Will, you were just saying kind of that. Yes. And comment there. And we had talked about stopping discharging patients.

We used that word.

And while I completely agree, I think that to piggyback on that, we need to start the kind of the. And part of that is to start using the other side of our profession, which is the wellness and prevention side that is typically in. I know it's in our Florida State practice Act, and I'm not sure everybody has to look into their own practice act, but not only can we assess dysfunction and injury, but we can also assess for wellness and injury prevention and those sort of measures. And, you know, a lot of us are in the. Just the dysfunction side of things. And so to open up a whole nother. A whole nother avenue of wellness and prevention, that is the. We don't discharge. And in fact, you know, one of the ways that we create change is language, Right? And so we actually have created new language in our practice that we're not allowed to discharge patients. I think I have some people on my call today. Can somebody say, what. What do we do instead of discharge?

Oh, somebody.

You got.

Nobody gets lunch tomorrow. What is happening?

They might be tuning in. I saw Don. I don't think. Is Don here? Don's here. Don, where you at, buddy?

Oh, we can't hear you, man.

Oh, we can't hear you.

You're not muted either. So it's not. It's. There's something.

Okay, well, we don't discharge patients. We excel patients. So Our word is Excel. So we've changed the language in the practice around and setting that mindset. So we ask them, what's next for you? Where would you like to excel? And then that takes us into an entire wellness, you know, the entire wellness part. So I think, you know, we stop discharging, we start excelling, and then we keep. One of the most amazing things that I think we all do as physical therapists is we keep building lifelong relationships with our community and our patients and our clients.

Yeah, Angie, that is so cool. I want to, like, have this moment where we all just take a second and think about the language we use and how we could redefine, find the language. Carrie. Carrie was the first one who brought that up. Right? Like, this idea of, like, how. How we speak about things has so much to do with it. And it's interesting because when I. One of my favorite coaching programs I went to was this real high dollar amount, like, event where I was allowed in because I was the youth leader of the guy, right? Of the guy's son. And I will never forget being in this room, like, surrounded by very successful people. And the thing that we talked about was language, how language is the foundation of creation. And so what we say is how we materialize the reality that we're in. And so this whole, like, I've never heard of that stuff until this call, I've never thought of discharge as a negative thing. Like, it's not. That's the cycle of the patient care visit. But accelerating in the vision of us being the real opportunity here is the fact that there's this gap left by the old healthcare system that some of you might remember. I had Dr. Huxton growing up, my family physician. He was this really nice guy who'd always give me a lollipop. I think I saw him until my early 20s, if I'm being really honest, because I was afraid to go somebody else. I was like that full grown adult on the engines. He's like, dude, you just got to get off the engine. But it's like the reason I went there is because he loved and cared for me. As you guys all know, I fell off a Mountain at 17 and broke 20 bones in my arms and legs, which was what got me into PT and partly why I' so passionate about it. And he was there in the ER with my parents. Like, he. He was a family member. And you guys know that's who you are as entrepreneurs. Not maybe all of your team is all the time, but you guys know that feeling when the Patient leaves and they say, man, I love coming here. It's just as much mental therapy as physical therapy or occupational therapy or whatever that is. That's what we live for. That's what we're protecting.

Is that because no one else can do that? That's the reason I chose this profession over anything else. Just real quick, Kerry, you had your hand up.

I believe.

You'Re muted. I definitely want to. I don't want to take time from you talking. Everything you've said has been so powerful.

Yeah, I actually put it in the, in the chat. You know, it's just about the mythology surrounding.

That Insurance companies won't pay for booster sessions. That's. There are some timeline issues with Evicor, their third party utilization management, but I've never been denied payment on a booster session with a patient. So it's just up to you to determine with that patient you've reached your goals. But I want to make sure that you don't fall off the wagon, so to speak. Some patients may not need a booster session. They're not going to come back to you until they have another problem. But others, you might want to see them quarterly, semi, annually. Annually just depends on the patient. And I think we need to move into that space. I think you've got to shift the mentality. Don't rush to discharge. You need to be sure that that patient is enabled in their movement related physical activity, their therapeutic activities, everything that you have control over. We are primary care. We need to embrace that.

So, Carrie, if we're not rushing to discharge, does that mean that we're about the money?

Nope. No, because we don't. I mean, we're not about seeing patients two, three times a week. You know, where patients come to us to learn what to do, not to do it. So we're enabling them, we're educating them. And so we wanted, you know, we always wanted to drag those visits out for as long as we possibly could. I don't want a bunch of visits concentrated in a short period of time. Healing doesn't work that way.

So it's not about the money. It's about public health. It's about. That's the space we need to move into. We are critical and vital for public health. We know that, but we have to embrace it.

Yeah, and obviously I don't believe in that mindset. It's just that we get that all the time. So it's almost like you guys have all had it from employees, right? Like, well, that makes you about the money. It's like no, I'm about the greater purpose. But we really need to start. As a side note, this is my little. Another little sidebox is that we have to change how this industry thinks about money. And I'm talking about rehab, I'm talking about OT speech and pt. We have to start thinking money about money differently. You have to start seeing it as the tool to get us to where we want to go and not the reason we're doing it because we're so hyper focused on like being altruistic and we think we're being altruistic. We're not being altruistic. We're destroying the very service that is benefiting people. Like you're saying Carrie. So let's go to Caitlin. You had your hand up. And then we were going to go to Paul. Anything else you would say to that?

I'll be super quick. One of the things.

That Kerry had mentioned, I think Candace can probably speak to this. I don't think that we spend enough time talking to our patients and we need to actually talk and actually listen to them. And ROT's are giving lectures on trauma informed care. And I have a patient that I bill for. It's a short session. She's dying. And I know she's dying, but I'm actually her only lifeline right now because she pissed off enough other people and I don't care about anything. It's great, it's beautiful. And so I go in and I talk to her and I get an earful and once she's calmed down, the anxiety settled and then she starts crying and we have a conversation and we focus on our goals, we focus on what we need to. But she, she gets more out of that therapy session by spending five minutes talking to me, three to four minutes doing some exercises. And I think she does them when I'm not there. I don't really know. But it's the kind of thing that it's actually what I take away from it is I hang my hat on it and I know she's getting something out of it, even if I'm not having her stand up and walk in the hallway or something like that. And I think that we've forgotten that at some point. I think that we've. I had a professor once upon a time refer to physical therapists as the bartenders of the medical field. And I thought it was the silliest comment ever. But we actually spend a lot of time and need to start paying attention and need to provide some therapeutic value to our conversations as well.

Love that thank you, Paul. After we go to you, we're going to give it back to Michelle to update us on the comments which you guys have beautifully been adding. I don't want to forget the voices in that column there. So we'll pass it to the man who I thought would have said something sooner because this is a very smart guy. Paul, let's hear what you got to say, bud.

Thanks, Will. No, I'll tell you all when, when Will sent the video out, he had me at the concept of and we take it. You know, we're taking this. And that was really what communicated, man, he was right. And I know it's a button that gets pushed by me. I'm a. I'm no longer in clinical practice, but I live in Tennessee and my practices are back in Kansas. But, and you know, I go back and forth every month. I'm not, I'm not. I'm here most of the time in Tennessee. So I'm really working on the development of the next phase of my, you know, not just my practice, but the, you know, the practice of PT in our area. One of the things, another thing that resonated to me, but what I loved about what Carrie said and I, because I actually trained my therapist in this concept, it's like, no, don't ever introduce yourself as a physical therapist. Therapist. No, I'm your physical therapist. And I always said that. I didn't even know why I said it until we had to really fight.

For.

Expanded access in Kansas for sure. And I was on that battle on that front for many, many years until we did get improved the public access to our care. But it's funny when you're willing to lose it when you, when you don't care, meaning, like, well, what if we didn't ever have access or what if you had to just, you know, my point is financially too, like this, the value proposition that we provide is so great in comparison to what we get paid. And I know you guys already know this, but our professionals don't know this. They don't have certainty on the fact that the value of what we do is so much greater. And, and we still have professionals and I, I still have to work with this on, with my own staff because there's a real disconnect in, in the differentiation of who we are as a professional versus a profession. And we can leverage that in our brand distinction in our own communities. And that, that direct to consumer is so, you know, is becoming so much more expansive. There is not a lack of people that will pay for our services regard. We're not responsible for their insurance contract. We have an contract with the insurance company, but we are not. We're responsible for that engagement with that, with that patient for their care. Who cares what it costs, you know, from. And I'm not trying to be insensitive when I say that, but it's. We're worth more than what we're getting paid. So we have to be willing to experience that with, with or without the insurance companies on a number of fronts. So there's so much opportunity, there's so much thinking money in the marketplace right now that nobody's going to care if any practitioner rips another million or two out of the market. You know, out of the market, out of your marketplace. Like, we're doing a disservice by not providing that value and having our staff recognize it. I know a big, A big strategy of ours in our organization is I'm just doubling down on my leadership. I'm building more leaders. So then when we bring in the new round of pts that we're going to tuck them in underneath these guys, we're training them. And on the entrepreneurial aspect, the entrepreneurial opportunities that exist within private practice because it's so poorly marketed and known, we have a branding problem not only with the public, but we have a branding problem with our professionals because they do not know the opportunity that exists for us as a private practice industry to make them truly independent entrepreneurs, not just autonomous practitioners. You know, that term was used for so many years. But as autonomous entrepreneurs that can survive in the marketplace with or without insurance companies, with or without docs, we can do it on our skill set alone because we have to take and better connect the human element of our brand to our organizations and to our community. We've let the industry dehumanize our brand. There's a human element that you've all communicated that, you know, the recognition, we all recognize it, but our staff doesn't always recognize that the value of the human element and the difference between price and value is our responsibility, not somebody else's. You know, the value is way above what we're getting paid. So we have to close that gap. And until we do it as professionals, as a profession and as a sector of the, of the, of the healthcare industry, we're gonna have a really tough time. So I'll get off my soapbox, but that's what I think.

That was awesome. And, you know, I love that branding problem that we have. It's. Is it ironic that we chose this profession because we're so excited and connected to the human element of health care. You know, no one became a PT thinking they're going to be rich. No one. I don't. I remember telling my wife in PT school, listen, we'll never be rich, but you'll have a happy husband. You know, I was right on half of that because owning a practice was, like, worse than falling off the mountain and breaking my arms and legs. Like, that was super hard until I got the right support. And as human, as human centric as we are, our industry is completely void of that connection and commoditized down to. Have you tried pt?

Do you know, Paul? All right, so before we go to Roy, Michelle, why don't you catch us up what's in the chat room, and then we're going to start winding down.

Okay. A lot of good stuff in the chat. So as I call out the name, if you want to speak into it a little bit or give us a little bit more, feel free. But, oh, my gosh, Paul, you got me fired up. Everybody's got me fired up. So I'm excited about where we can take this. Okay. Blaine says, I feel several pts like to bash on the overuse of radiology, and.

I think we need to embrace its application and fight for permission to order imaging. I believe that some states physical therapists can order X rays and MRIs. And then there was a comment in the state of Maryland, they can.

Yeah.

Okay, good, good.

Okay. And then Carrie mentioned what she talked about. She gave us an overview of the booster sessions and that she has been successful in getting those paid for by insurance companies.

And then Roy mentioned, be proud that you are a physical therapist. We are what most of these patients need, and we are the best communicators in the. In educating them. That's so true. So true.

Love that.

And Lee mentioned more idea sharing, less, say, siloed work groups and conversations, and more action.

Yeah, I have to jump in on that, Michelle. That was my biggest fear about holding this meeting. I'm like, what? Do we really need another meeting? You know what I mean? Like, but here's. Here's where I think we're different on this. And I think to that point is that this is the group that's going to complain if we don't in a way that's, like, universally accepted, and we start taking the action because, again, the reason I believe it's the entrepreneurs and the people who think differently than the rest of the industry are the ones who are going to make change. It's because all of you have a bit of a problem acting, maybe a little too much. Right. Like if you're on this call, you suffer from entrepreneurial mindset where you have the shiny object syndrome and you're constantly acting. Maybe most of you are going in too many directions at the same time. So if we could focus all that into one concentrated effort, we could actually make some change. Unfortunately, it still requires us to start with conversation. Sorry, Michelle, go ahead.

No, I love it. Okay. Orit mentioned psychologically informed physical therapists. PT is a cornerstone of how our clinic functions and more and more providers should get comfortable with this. However, not all clinics are set up to allow this to happen. Productivity driven settings do not allow for ideal practice.

Okay.

Jackie mentioned. I completely agree. We can't control insurance companies, we can't control anything we, we do not have direct influence over. But we do have complete control over the quality of care we give and making it a priority of educating our staff.

Love that.

And Paul mentioned get your PT booster. I love it.

That's awesome.

Candice mentioned we are all on the call because we want change. We are the change together. PTOT and slp. I couldn't agree more.

Holy crap, Candace.

Right.

Okay, Terry, if you are in a, in network practice, when you are valued for what you know, you will have higher levels of conversation. To cash pay a conversion. Sorry. To cash pay when payment is denied.

True.

And that, that's all of the.

So we'll go to one last comment with Roy and then we're going to wrap up really quick. For those of you who know me, you know how particular I am about time because it's about integrity and word. Which is also me saying this. So Carrie hears this after what happened at pps. So anyway, so we're going to stop right at the top of the hour and get to that point. So Roy, what do you have to share?

Well, you know, I think that of course, you know, I've been doing this for 41 years and it's always been a case of, you know, lacking respect. We lacked respect a lot in the medical community. You know, I can still remember that one of the first physicians I had just more or less that I was a glorified massage therapist. And the thing is that one, we got to get tough.

Two, start getting tough.

We've got to educate, we've got to continue to be those loud and speaking out. Unfortunately, there's still a lot of public that doesn't really know what we do. And that's a big issue. The thing is that you know, of course I market and put out and I do workshops, and we get people in there, and if I can get in front of them.

I can get them to be a patient, because, one, I wear my badge as a PT proudly. And I also have a strong knowledge base that I give to them and I share to them things that make sense and helping them make their own decisions and help. You know, it's like when we sit there and talk to them, you know, it's like, you know, if you go to a surgeon, they're going to give you a surgery, you know, consideration. You go to pain management, what are you going to do? But, you know, to have someone that sits there and goes, okay, these are your options. You know, certainly I'm biased to my degree, but at the same rate, you know, there's an awful lot that can happen from physical therapy that will benefit you, even if you have surgery or pain or to avoid those. And we're. One of my goals, really, is to reduce the amount of unnecessary surgery. And we're the best profession to do it. Let's just face it. And occupational therapy, definitely, and I can't say a speech as far as what they're doing related to surgeries, but we are very intelligent, we are very broad in our knowledges, and there's so many people that still don't know what we do, and we've just got to one market and do. My concern for our profession, though, is so many of us are employees, and they're not necessarily entrepreneurs or entrepreneurs, and they're not really out there being outspoken. I see a lot that I feel are apathetic, and that's a concern for us as we're moving forward, because I guarantee your chiropractors, every one of them is out there because, you know, there's money at stake for them, but we should be at stake for our patients, for those people out there, because I can't think of anyone that can make a bigger difference from the mass population than who we are.

Roy, that was awesome, and thank you for sharing that. Guys, we just have a couple minutes left. So here's our list that we have of what we're going to start doing. Don't worry if you can't understand that. I can have Michelle translate for that for me later. But, guys, listen, I want to just. First of all, thank you all. It means the world. I didn't know how many people were going to show up to this, and I was hoping that there would be. I was just really hoping that there would be People in there who not only would comment to a video, but take an hour out of their crazy schedule and be here. So just know that to me personally and I think to the profession at large, it is very significant that you're here. And I would say it says more about you than anything else you've done today to take a risk on just being in a part of a meeting. We don't know what this is totally. But we know it's change. And I feel that. I feel that very deeply and I'm excited to have just from the comments that were listed here alone that I. That what my how my mind has expanded around involving the other disciplines involving this branding problem we have and educating marketing the community on what we do. We're the ones with the patient email lists. We're the ones with the time and the. And the motivation to be able to influence things in a way that can be lasting. So I just want to recognize everyone. Part of me was going to say, what do you guys want to do next? I know what I'm doing. You're welcome to join me. If this was a good meeting for you and you feel inspired to go back to your busy day, then that served you. I would just ask you to please remember these things. But I'm going to be setting this meeting up every month. And for those of you who want to be on the next month's meeting, here's our homework assignment. Let's get to action. Let's just not have some nice words. I would love it if everyone here.

Would start identifying the language we use as unproductive. What's the language we use like? Discharge. There were so many little things that came up around that. The way we talk about ourselves. I would love for everyone to spend time thinking about the nomenclature that we leverage within our own industry and seeing if there's a more powerful way. I'd love to be able to bring that next call. We're going to go over what we should stop doing. This was a huge start doing. I'm going to keep this list together and by the end of the time that we get through, keep doing. We're going to create some action lists. Tell your friends about this call. If you're caring about this topic. Let anyone know on your team. I would have everyone on your team watch this recording. We covered some incredible topics in a mindset way that would support all of us in our business just to help people understand this side of the equation that they unfortunately don't see when they have $150,000 in student loan debt, and they're making 70,000 a year. Like, I respect the daylights out of that population. That's like, man, I'm just doing it because I love it. I have a free group that I run of just students and new grads, and they talk about this every day. What if we could be the ones who carved the path for them to change these things for us? So, guys, thank you for your time. I will post this recording up online. Have a wonderful evening, and we'll see you guys in one month's time. Keep your eyes and ears open for that invitation. It will be coming out next. It will do this in December, a couple of weeks before Christmas. Guys, have a great night. Thank you.

Thank you.