0:32

figure put a little rock music in the background get

0:34

people waking up this morning uh that's dave

0:37

kittle nope this way that's dave kittle on the right

0:40

side of your radio dial I'm jimmy mckay absent today uh

0:44

on the screen but not in our hearts is tony maritato

0:47

as he's hanging out with some family today dave how we doing

0:52

Jimmy, good morning. Feeling great. And in case Tony happens to

0:55

be tuning in live on a run or something,

0:59

he'll notice my AirPods are in and he might get upset.

1:02

But Tony, I got my microphone,

1:04

my Yeti plugged in, and we're just using this

1:07

to block out some background noise.

1:09

Let's just keep it like that. Okay. Okay.

1:11

And from the former radio guy, stop touching the microphone.

1:14

Okay? Stop touching it. Fix up sound. All right.

1:18

So Tony is out, but we're actually going to bring him in.

1:20

He doesn't even know this, but he's going to be here

1:23

just not only in spirit and mind,

1:25

but let's kick off today's

1:28

conversation on PT Breakfast Club with some

1:31

conversations that are going around the internet.

1:33

We have our fingers right here on the pulse.

1:37

of the profession and some

1:39

results have been coming out this week and people

1:42

always eager to share

1:44

successes and failures. You like to see that to

1:46

people sharing publicly failures and how to rebound

1:49

from them because it happens. And a big one is results

1:52

came out just a couple of days ago. A lot of our colleagues now

1:55

are a little heavier in terms of their email signature,

1:59

and they've got more letters after their name talking,

2:01

of course, about Clinical Specialist Examinations.

2:06

And for maybe those PT students,

2:09

or I heard from some pre-PT students who actually

2:11

listen to the show and the streams when we put these things.

2:15

Clinical Specialization, Dave, how would you frame it?

2:19

It's a school for people who want to go to more school.

2:24

I think that is the perfect way to frame it.

2:26

Yeah, just advanced degrees, really. Or advanced certifications.

2:30

It's not degrees, it's certifications. So more specialization maybe

2:33

in your practice area. Some examples. I'm not going to list them

2:36

all because I'll miss one and then you'll be angry at me.

2:39

Orthopedic clinical specialist, sports clinical specialist,

2:44

pelvic health specialist. clinical specialist, pediatrics,

2:47

geriatrics. So different areas of

2:49

physical therapy practice that you can specialize in,

2:52

you go and take this examination. And if you pass, poof,

2:56

you are now a more competent and confident

3:00

physical therapist, as we say. so this question one of my

3:03

new favorite websites I was big on reddit maybe five

3:05

six years ago and then like took a reddit purge but now

3:09

I'm back on it baby I got the notifications and

3:11

everything and this was a great question posed uh by

3:16

maestro it almost looks like maestro clitoris but

3:19

it's not that's the person's uh username

3:22

Hi, my annual review is coming up and I just passed my OCS exam.

3:26

Congratulations. How much money should I ask for?

3:31

Which is not an invalid question, right?

3:34

They back it up by saying they work at an outpatient

3:37

clinic in Pennsylvania. They're currently at 85K a

3:41

year with five years of experiences.

3:45

uh annual reviews coming up and with a newly obtained

3:47

ocs title how much raise should I ask for well first

3:50

of all you've been out for five years you're in pennsylvania with 85k we're

3:52

going to talk about that um

3:54

but dave you're somebody who employs other

3:57

clinicians tony will weigh in on this on the next time

4:00

we have him on the stream but I wanted to get your thoughts Does adding the OCS to someone make you,

4:07

someone who employs clinicians, automatically give them a

4:11

raise if they came to you? If this person came to you,

4:14

what would Dave say? No,

4:19

it does not automatically give a therapist a raise.

4:22

It might be shocking. Oh, by the way, by the way,

4:24

that music playing, I thought it was another

4:26

thing in my browser. So I'm like, I got this music playing.

4:29

Sorry, I turned it off. Yeah, yeah, okay, we're good.

4:32

I didn't wanna say anything, but now I said it's all good.

4:36

It was going. Okay, so no, I mean,

4:39

it doesn't necessarily result in a higher salary.

4:43

It depends on like the intent and all of that.

4:46

And yes, I mean, you also share with us in

4:50

the chat with Tony and I, a screenshot that we'll get

4:53

to as well about I think it was like a comment and then

4:55

you reply to it so that that person's comment I

4:59

believe in and we and we can maybe pull up on the screen in a minute but um

5:03

it does not automatically um result in a race

5:08

unfortunately the biggest driver of all this again it

5:10

all comes back to reimbursement and insurance and all that so that is not

5:13

increasing it's you know plateauing or in some cases

5:16

shrinking or declining so it's hard to say okay

5:21

Um, now you have your OCS, which by the way,

5:23

that should be no surprise. Like every practice is probably like helping these therapists,

5:28

right. Go into the OCS or GCS or whatever.

5:30

And it should be, hopefully they should be right.

5:34

And, and they might even be covering it. So that's, I don't know.

5:36

I don't know. I think it's maybe a couple of thousand bucks. I think it's,

5:39

I think someone was just telling me, I think it's like 1500

5:42

bucks when all said and done, you got to pay for a little

5:45

nickel and dime fees that they hit you with. Yeah, so all of this, by the way,

5:50

I believe, regardless of the size of the practice,

5:53

organization, whatever, that should be discussed ahead of time.

5:56

So if Jimmy's a therapist in

5:59

my practice and if Jimmy comes to me and says, hey, I'm looking to sit and get my OCS,

6:08

we would have a conversation about it. I'd be like, oh, interesting.

6:10

Or maybe if the employer,

6:12

especially if the employer is saying to their staff, hey,

6:15

we have a tract where you can get an OCS or do this

6:18

or that and we'll pay for it or whatever.

6:22

There should be some conversation. Maybe it's not. I feel like there's these

6:25

comments on Facebook and Reddit and all over because

6:27

the employer is probably not saying, oh,

6:29

by the way, like this is going to be great for you, your resume, your confidence,

6:33

your differential diagnosis, whatever it might be. But in that conversation,

6:37

if it's brought up by the employer or me in this case

6:40

with Jimmy as my pseudo

6:42

physical therapist, I think it's kind of on me to say, hey,

6:45

here's what that would look like. Here's what that would do

6:48

for your clinical practice. for your compensation.

6:56

I think that needs to be part of the conversation.

6:59

And the fact that it's not is why these therapists go

7:01

online and write all these comments. We can turn this into Reddit as well.

7:05

If you're watching a live stream, you can drop a question or a comment.

7:08

You want to chime in below, you can do that.

7:10

We did have comments because that's how Reddit works.

7:13

And I'll get into some of my thoughts, but I wanted to share some

7:15

of what these came up. Let's see.

7:19

No, let's do this one. Yeah. Josh Funk, Rehab to Perform chimed in,

7:25

raise plus potential employee classification change.

7:29

Example, staff PT to senior PT,

7:32

salary change and benefits improvement.

7:35

Now, Josh is the kind of person though,

7:37

that here's the key that Dave mentioned that I want to highlight.

7:40

This is to me, the hinge point. Josh lays this out before,

7:45

before you start, I'm guessing, I don't know this,

7:48

before you start working for rehab to perform,

7:51

there is a clear track and clear progression.

7:54

Now, someone like Josh or a forward-thinking clinic owner says, well,

7:58

I can't bill more for

8:01

somebody who has their OCS. Maybe you can't.

8:05

Right. I mean, I worked at a clinic where I was a new grad PT and the rate was cash based,

8:10

was X. And to work with one of the senior PTs was different.

8:13

And people understood that because we explained it differently.

8:18

We explained the value proposition differently.

8:20

Jimmy's great. Someone else has been doing it longer and you can pay for that.

8:24

Right. So the reimbursement from the insurance company might

8:28

not be different. Right. That's flat. They don't care.

8:31

That's okay. You know who does care? The person you're putting your hands on,

8:35

the person looking you in the eye, that patient might care.

8:38

So if you can explain that value, can you get more for giving more?

8:43

You just gave, I just mentioned, it's $1,600 to get your OCS, I believe,

8:47

after fees on top of if you pay for resources to study with it.

8:51

By the way, my podcast offers one of those resources,

8:53

one of the sponsors of the show, the Academy of Orthopedic

8:55

Physical Therapy, Current Concepts. That's the one I did a Twitter poll.

8:59

That's the one most people use, right? So you're talking $1,600 in fees plus $300,

9:04

$400 in resources. You're investing in yourself.

9:07

Fantastic. How can you reap that reward?

9:11

Can you as a cash practice

9:14

or a practice that is going to bill insurance and build

9:19

this into a tract? Because as we mentioned before,

9:22

one of the leading causes of burnout is... not seeing a clear path to growth.

9:27

If you can't see that, you're going to feel frustrated.

9:30

But I'm guessing someone like Josh Funk right there says, yes.

9:33

And he was able to respond rather quickly after I posted this.

9:36

He didn't make this answer up. This answer is baked into the cake.

9:40

He didn't think about this. John DeLucci, also on LinkedIn,

9:46

he said he would research internally before taking

9:48

too much external feedback. I take this as John saying like, hey,

9:51

before you just walk into your boss's office, slinging guns,

9:56

double six shooters, like he's saying the same thing,

9:59

which is like, make sure you understand what your employer is

10:04

talking about or where this goes. Do this before you sign up for the test.

10:07

Because ironically, results are going out right now.

10:11

It's also time to sign up for the next clinical

10:14

specialist examination season. This thing is just circular,

10:16

round and round. It's like a carousel up and down.

10:18

So John is saying like, gather objective data,

10:21

tangible performance data, like this.

10:23

John's saying, go in armed with information.

10:25

This makes Dave nod and smile.

10:28

Why does this make you nod and smile? Because it needs to be

10:32

backed up by something objective. And if you're speaking to a decision maker,

10:37

a manager, a director, especially some co-owner or

10:40

an owner of a practice who's going to be the main decision maker,

10:43

I want to see that.

10:45

I want to see objective data because otherwise it's just subjective and it's like touchy feely.

10:48

It's like, oh, this is good because I,

10:51

you know, alphabet soup after my name.

10:53

No therapist says this, but again,

10:55

it's subjective. about my ego and you know I'm I'm you know better

10:59

complete I'm better I'm completing more things I'm

11:02

I'm doing more things but then it's like yeah but

11:04

like uh are you know are you getting more google

11:07

reviews are you uh having lower cancel no show rates

11:10

are you getting more word

11:12

of mouth referrals that are coming back and saying I

11:15

you know I want to work with jimmy and and as opposed to I want to work

11:18

with concierge pain relief so those are the things you

11:20

should also consider uh making objective

11:25

You present that to your employer, then the employer is like, oh, yeah,

11:27

you're right. Like if we did this, this, this, like you're showing like

11:32

objective improvement or objective findings or support for this,

11:37

it makes it a lot easier. And again, all this should be discussed

11:39

ahead of time. The fact that then a therapist goes

11:42

I kind of, I kind of get it when I,

11:44

by the way, I, when I first read some of these things this morning, I was like,

11:48

I can't wait for this episode. I'm going to be yelling in the microphone.

11:52

These therapists are ridiculous. Uh, but again, the,

11:55

some of the blame does need to go into the side of the

11:57

employer because there's obviously a lack of communication.

12:00

So again, therapists gets their OCS or

12:02

advanced certification. They go on Twitter, LinkedIn, uh, Reddit,

12:07

wherever. And, um, either complaining or asking

12:10

about this or that with a raise. I mean, all that should be discussed.

12:13

Like how come the employer is not saying, okay, you have five years experience.

12:19

You sit for your OCS. If you get your OCS, it'll include a bump of whatever.

12:24

And it might be like, or if you want to raise in

12:27

salary 5% or 10% or whatever, maybe that includes X, Y, Z,

12:31

other responsibilities that we're going to kind of add

12:34

into your whole role. But you as the clinic owner

12:37

should be able to, you should be able to get

12:39

more out of someone with more experience. Like you should be able to

12:42

make sure that you can convert on that.

12:45

now I want to do we're watching a live stream if you happen to be watching

12:47

the podcast I'll narrate it for you dave I want you to

12:50

turn turn to your right on the camera turn rotate

12:52

right so you're facing me yeah Yep.

12:55

I like this. I like this. Are we going to do role play?

12:59

Here's how this is. I'm turning like this.

13:01

Right now, it's Drew McKay saying, hey, boss, I got my OCS right now.

13:05

And Dave's thinking, cool story, bro.

13:08

Tell it to someone else. Now, right now, we're opposed.

13:11

This is me trying to get a raise from Dave going, hey, man,

13:14

give me some more money. But what I think having the

13:18

conversation beforehand does is now face the camera, Dave.

13:22

Now we're on the same team. Like we are both on the same side here.

13:26

I want you to advance as a therapist. You want to make more money.

13:30

I want you to make more money because if we can make more money,

13:34

it's a wee thing and not a, Hey, give me,

13:37

it's a stick up. It's not a stick up here. Right?

13:39

So having that conversation early, which is what I like about

13:42

Josh Funk is he built this into the cake,

13:44

right? He's like, how do I keep therapists around longer?

13:49

We mentioned before on an episode, you really can't keep great

13:51

therapists forever, right? Because they're going to break out of that mold.

13:54

But how do you keep them happy while they're there? Happy,

13:57

well-trained therapists make great PTs.

13:59

They make great healthcare. So this conversation needs

14:02

to happen before... It's sign-up time right now in July 2024.

14:06

If you're just signing up willy-nilly,

14:09

and I just texted a friend who's like, I'm going to sign up,

14:12

find out what this gets you besides being more confident.

14:16

And that's a great investment in yourself. But if you'd like to see a

14:19

return on your investment, and you should because

14:22

you're a fantastically qualified healthcare professional...

14:26

have the conversation first. Can I, so I'm going to mention in my,

14:31

this is my opinion. This is a, I know this goes out to a PT

14:34

podcast and learn, learn Medicare billing

14:36

potentially also today, but this is my opinion.

14:39

And this is, this is against like,

14:41

like the corporates in the mills. Okay. So if you are potentially

14:46

working for one of these higher volume places and they allow you,

14:51

they cover, they pay for you to go through, you know, go do your OCS, whatever.

14:56

And let's say it might even have been that therapist that posted on Reddit about, hey,

15:00

I'm five years out. I just got my OCS.

15:02

What type of raise should I ask for? I could, if I had to bet $1,000,

15:07

I would bet that that person in general that asked that

15:13

question would be working for a larger corporate or

15:16

mill because a lot of these

15:19

corporates and mills have the recruiting power and

15:24

they know that they're going to have people come in and out. They have a whole system

15:27

built for recruiting and hiring and all that. And they don't,

15:32

I don't want to say they don't care, because of course they don't

15:37

want therapists leaving. But a therapist who leaves a

15:40

private practice is significantly more damaging

15:43

and challenging for the practice owner compared to

15:46

a corporate that has a booth at every conference

15:50

and can outspend everyone

15:52

on Indeed ads or whatever. Like those corporates,

15:55

they have more slots because they have more therapists, right?

15:58

So they have more slots. They can avoid the loss. They can absorb the loss.

16:01

They have more slots for DPT students,

16:04

right? So they have a bigger net in

16:06

terms of like the minor league system of like bringing therapists up

16:09

through DPT clinical

16:11

rotations and then hiring. So they don't have to communicate this.

16:20

Or they feel like they don't have to. They feel like they don't have to say,

16:23

okay, we'll pay for your OCS. And then it includes an

16:26

increase of salary or roles,

16:29

responsibilities, whatever. And it probably goes back to

16:33

some of the insurance ceiling with payment reimbursement.

16:37

Like they don't wanna be like, hey, here's how you can ascend

16:40

and climb up the ladder in the organization, which is different than Josh Funk who,

16:44

I mean, he's got 10 locations, which is pretty darn big

16:47

scale and pretty impressive. But he's still focused on

16:52

everything that he puts out, everything, all the decisions, whatever.

16:55

It's as if like he's still operating as like a three

16:58

person practice or something like he really does care.

17:01

He arguably he cares a lot more than and he likes to

17:06

be open and transparent and communicate that with his staff.

17:10

And that's that's the difference between his

17:12

comments about this as opposed to some of these others.

17:15

And I almost bet that these that in general,

17:18

when someone asks this question, they're working for some

17:20

bigger place that doesn't really care about the whole

17:23

ladder being built out and communicating and having a

17:26

collaborative like we did a little role play in the whole collaborative thing.

17:29

They just they have so many candidates.

17:32

They they probably feel like they don't need to.

17:34

I don't know. Yeah, I think that's the difference between

17:36

growing and scaling. like josh is trying to grow

17:40

or practices like that and I know I know it's more

17:43

than rehab to perform we keep mentioning josh just

17:46

because he had that comment but I think it's the difference between growing

17:48

and scaling where scaling

17:51

is like how do I put a zero behind this and clinics

17:56

going from five to ten they're trying to put a one

17:58

behind they're trying to add one instead of multiple

18:00

they're trying to plus one instead of 10x And you can only do that by retain.

18:06

You can't lose two therapists, is my guess,

18:08

at a location and stay afloat for long,

18:12

is my guess.

18:16

Real quick, shout out to Will Boyd.

18:18

Join in live. Thank you for the comment, Will. Yeah,

18:20

we're going to have Will on the show. And Josh. We've mentioned Josh in the

18:23

last couple of weeks. I feel like Josh... And Josh...

18:27

should have his own show or podcast.

18:29

He does. Well, yeah, but we have to perform does we

18:32

talked about, I mean, I talked about him with him

18:35

a couple of years ago and I was like, there's no reason you shouldn't.

18:39

And he, they do now. I'll have to check it out.

18:43

So bottom line, ask first,

18:47

if it's not in place, bring a proposal.

18:49

Oh,

18:51

I want to mention another metric that someone had said. I can't remember who said it though,

18:56

so apologies. I'm good at that. I remember the quote, but not the author.

19:01

Track your show versus no show,

19:04

your cancellation rate over six months.

19:08

Give it like a decent amount of time and see if it's

19:10

different than some of your coworkers. That was, I think,

19:15

that was like an Instagram comment. Yeah, that was a quote I had on Instagram.

19:18

I asked this question on Instagram. Why is that important, Dave?

19:22

that so so you want to read

19:24

it I have it pulled up yeah who said that give credit

19:27

uh at the pelvic mama okay

19:31

all right so so she commented to you on

19:33

instagram um let me just

19:35

make this a little bit brighter sorry okay so uh

19:40

at the pelvic mama said ocs

19:42

here and this is my take document your cancellations

19:45

and no shows versus what you produced in the past or

19:49

versus other clinicians, which is genius.

19:52

Yes. This is what we're talking about.

19:56

They said, I saw my productivity increase tremendously.

19:59

Not sure if it was because I projected more confidence

20:01

subconsciously as I felt I

20:03

finally understood what I was doing or if my skill

20:07

sets actually improved too. But patients would show up

20:11

like clockwork to my appointments and even suggest that they were about to cancel,

20:15

but came when they heard that they were seeing this therapist.

20:20

So yes, the numbers of improvement, uh,

20:25

They said, but you have to show consistent

20:28

consistently high numbers that you can take to your

20:31

boss and ask for that raise.

20:34

I did and I got it. And then, Jimmy, you commented positively.

20:40

So that is how you approach things.

20:44

If your employer does not give you the track with

20:46

here's the raise bump, here's the increase in

20:49

compensation or roles or responsibilities.

20:52

Speak my language, man. Speak. Talk to me about me.

20:55

It's the sexiest sound I'll ever hear. And talk to me in my language.

20:59

Right. That's why I learn all the hip, cool kid jargon.

21:03

You know, skibbity toilet. My friends like understand

21:06

how to talk to people in their language and their ears perk up.

21:09

So talk to me about why your batting average is 20 points higher than,

21:14

you know, it's why that would the stat wins above replacement.

21:18

Yeah. War. Yeah. Your, your, your war above replacement is

21:23

like when you're, when you're at work and you're in the lineup, we do better.

21:26

We win more. So I want to not lose you because you're,

21:32

As a baseball fan, I can't believe I never made that connection.

21:34

So thank you, Mr. Yankee fan here.

21:37

All about war. All right. So would love to hear from you.

21:41

I have this post up on all my socials, but you can comment on the

21:44

live stream or wherever, even if you're watching recorded.

21:47

Would love to know your experiences, too,

21:50

because I understand this. We're giving tactical advice

21:53

or what would you do? And this is not a vacuum, right?

21:57

I bet you some people have done things like this and

21:59

bosses have said, eh, tough,

22:02

not giving you the raise, right? Here's a question for you.

22:06

She mentioned, Pelvic Mama had mentioned

22:09

that she felt more

22:11

confident when she had her OCS. Is this like...

22:15

chicken or the egg people who sign up to take a

22:17

clinical specialist exam think that they can pass

22:21

that exam or think that they're worth it or going through the experience is

22:24

worth it those people probably feel more

22:26

confident and then that confidence is that

22:29

contagious so is it like is it self-selection bias I

22:32

think I'm using that term right like the people who

22:35

are self-selecting for this probably are good clinicians

22:40

Yes. And then once they actually

22:44

get the OCS or whatever, you know,

22:46

the neuro or the geriatric or whatever certification,

22:50

then they pass it and then they even have more confidence now.

22:53

So it like steps up a level. It's confirmed.

22:57

Yes. And arguably, like, I think.

23:01

those therapists typically

23:03

have like better, you know, maybe patient communication styles,

23:07

like they're outgoing. They already kind of have

23:12

the total package. Now they just add something else and it boosts their,

23:16

I don't want to say like their pride, their ego, a little bit all that.

23:19

It's badge value. You know what I mean? It's badge value.

23:23

Will Boyd giving like another perspective on this.

23:26

If you view yourself as a revenue producing team member,

23:30

You're in the lineup, you're on the team, especially in a small practice.

23:34

Even more important if you're in a small practice

23:36

because it's a smaller boat, man. You're not on an aircraft

23:39

carrier or on a destroyer.

23:41

And you track your own metrics like you're a small

23:44

business owner within the small business. right trust me man as a as a

23:49

former has been baseball player I knew pretty much

23:52

what my average was I knew my last 10 at bats I know

23:55

how many strikeouts I'd had so track your metrics like

23:59

you're a small business owner within the small business and you can demand

24:03

more pay it's just showing

24:06

it's showing stats and uh

24:09

that's what I get that's what it talks someone's language

24:14

My first couple of years out of school, I know recently I was telling you guys that my

24:17

first job was a physician in practice in New Jersey.

24:20

I did this. I tracked within the medical

24:24

record or something, I tallied up. So there were a couple of

24:27

different therapists. There was a senior part-time

24:30

physical therapist. There was a PTA who was full-time. There was myself and another

24:34

physical therapist that were full-time. I compared my completed

24:37

visits to the other full-time physical therapist and compared

24:41

That therapist, we were kind of around the same age and experience

24:45

level and all that, right? I forget the number,

24:48

but on an annual basis, looking back,

24:52

I was about to sit down with the guy who is the

24:56

physician and the physical therapy practice manager,

24:58

so the decision maker. I prepare for this.

25:01

I forget the number, but I had completed dozens and dozens,

25:05

maybe even maybe even like a hundred or

25:11

something visits difference,

25:13

a hundred or two, like a lot, a lot more visits than my

25:16

counterpart of like, we're both full-time

25:18

physical therapists and we have the same years of experience,

25:21

whatever. And I knew that therapist

25:24

completed visits and I took my

25:27

productivity and that therapist productivity. And I said to the practice manager,

25:30

I forget, I went to some like little calculation,

25:32

whatever. I'm like, you know, if you're, if you're making a hundred

25:35

or whatever dollars per in revenue per visit and times

25:39

the here's times the extra

25:42

visits that I saw above my counterpart,

25:45

that Delta, I came up with some number.

25:47

And then I said, I'll percentage of that number. And it was like, I said, $10,000.

25:50

So I was like, my rate should be $10,000. And the practice manager said, Laughed in my face.

25:58

Wow. What year was this?

26:08

2012 or 2013. Yeah. Okay.

26:10

I think we've come a long way since then. So I don't know.

26:16

I don't know. The practice manager, by the way, not a clinician and

26:20

oversees this big physician group, ortho surgeries and physical therapy,

26:24

whatever. So whatever. So they laugh in my face.

26:27

And then a year or so later, when I was moving up here to Brooklyn.

26:32

That practice manager was like, oh,

26:35

we heard that you're leaving. By the way, I gave like a month notice,

26:39

by the way, which I think is appropriate.

26:42

I gave a month notice. We got to the end of that month.

26:44

And then the practice manager asked me to stay

26:47

for another like two or three weeks to help with coverage.

26:52

I was like, have a nice life. Bye-bye.

26:56

What is your opinion on notice?

27:00

How long do you? It's got to be a month.

27:03

I mean, if you're a professional. Yeah. Like,

27:06

I think it maybe depends on the situation, but I would love, like,

27:11

I did it even though I had a bad taste in my mouth,

27:13

even for them at that point. You know what I mean?

27:16

And I was just a staff physical therapist. If I'm a clinic director,

27:20

absolutely a month or more. Will, man.

27:26

Will, you know me, man. You know me. In pediatrics,

27:30

it was funny because I was in pediatrics. And when I was hired, Amy, my mentor,

27:34

was like, just promise me one thing.

27:36

Because it was different in peds. She was like, these kids become attached to you.

27:40

She's like, you got to give me like a month and a half because like we

27:43

have to like we have to like get the kid used to

27:45

you leaving and someone else coming. And I was like, oh,

27:48

I never thought about that. But she had seen it and it

27:50

was not about a money thing with Amy and good beginnings, by the way,

27:53

in Virginia. It was not about a money thing.

27:56

It really was about like the children.

27:58

And she goes even more just as much as the kids. It's the parents to the

28:01

parents who start to freak out like what you're leaving.

28:04

You can't do that to us. What is your current stat in

28:07

your adult baseball league right now? What's your batting? I love this.

28:11

Well, I, we actually don't, I wish we used an app because I,

28:16

so a couple, okay. A couple 2019, this is before COVID.

28:19

I play for some league in central park and they track

28:21

like with the game changer app. And I led the league then in,

28:26

like average and hits and I

28:28

think RBI or whatever, but this weekend,

28:31

this weekend league I played now, it's like, it's a men's league.

28:34

It's, it's kind of a hodgepodge.

28:37

Like we, like the catcher calls balls and strikes.

28:40

Oh, yeah. Yeah. Yeah.

28:44

We wear like your, you know, we wear our,

28:46

our old high school and college jerseys. So it's, it's, it's,

28:50

it's less serious. So I don't know. I do have, I do have two home runs this,

28:54

this spring so far. Yeah. I'm a two,

28:57

I'm a two point per game Wednesday night beer league player,

28:59

just in case anybody keeping track. All right. There we go.

29:03

As well. Anything else you want to add for this?

29:06

I think we covered this one, this for me anyway,

29:08

all I wanted to go into this. Also.

29:10

So we'll we'll tag the therapist at,

29:14

at pelvic mama. Tavani.

29:19

Uh, so connect with her, connect with her, go follow her on Instagram.

29:23

And Will is probably, or either currently or used

29:25

to probably running her pelvic floor, uh, Facebook ads or whatever.

29:28

I know Will has been doing, uh, supporting pelvic floor

29:31

physical therapists like crazy, helping them grow their practices.

29:34

So that's awesome. All right. Second topic of the show.

29:37

I'll put it up on the screen and I'll read along. Here's a math question.

29:41

This one, I'm in the uncaged clinician category.

29:46

like they should have their own energy drink. Uncaged clinician Facebook group,

29:49

great group there. I love the anonymous feature, by the way,

29:52

on Facebook and how you can ask questions anonymously.

29:55

Why? Are you serious? I kind of like it because

29:57

some people don't want to know or they don't want to be known.

30:00

So the question is about, we'll get into why you don't like that,

30:02

but questions about cash-based gym opportunity.

30:05

Not everybody's as bold as you or me. The question about

30:08

cash-based gym opportunities. This would be their first

30:10

foray into this type of practice model. So they're relying on others' experience.

30:14

This is like a math question. And I think this is one of the reasons,

30:18

big reasons people don't take leaps is nobody, it's loss aversion.

30:23

No one wants to get hosed. We fear losses.

30:26

I just did an Instagram reel on this,

30:29

on the theory of loss aversion. We value, or we are more afraid,

30:34

we're twice, I'm making up numbers, we're twice as afraid of

30:36

losing as we are of winning. I'm twice as scared of

30:41

losing $50 as I am at potentially making $100.

30:44

And this is across the animal kingdom.

30:47

I'll get into that too. So here's the question from the clinician.

30:51

There's a new gym opening in their area. They're offering up 10 by 12 clinic rooms.

30:55

Now, I am a grammar guy, so I will pay attention to this. Clinic rooms as contracted space.

31:00

Because I stop right there and I go, rooms? Are you not the only

31:03

clinician that's going to be there? Rooms? Are you having competition

31:06

within your own environment? But we'll get into that. So I see that plural rooms and I go, whoa,

31:11

whoa, whoa. Or it could be like acupuncture,

31:14

one acupuncture, one PT, one cardio.

31:17

Still competition. Still potentially competition. Right.

31:19

I'm not moving into a strip mall and you're going to have a, you know,

31:21

a Qdoba next to my Chipotle. I'd be like, oh man, sorry, man.

31:25

I'm the burrito around here. Jim is going to provide a

31:29

scheduling and payment platform.

31:31

That's interesting. Slash EMR. Supplies.

31:36

including table, needles, IASTM tools,

31:39

cops. This is crazy. Referrals would likely be easy, proximity,

31:44

gym members, personal training clients. I would still operate under

31:47

my own LLC and liability insurance. Their offer is a 50-50 split.

31:52

I am not a math guy, but this feels, man,

31:56

they already have their hand, not even a little bit in your pocket.

32:00

And on whatever income appointments,

32:03

income my appointments make, given the conditions above,

32:06

does it seem like good terms? Dave's about to injure his neck.

32:09

He's shaking his head so fast.

32:11

If not, what would standard in the industry be?

32:14

When we met, I suggested 30-minute appointments at a flat rate of 75,

32:18

which would include any manual therapy, needling, whatever.

32:21

Sorry. Okay. Thanks in advance for any insight.

32:24

Dave, thoughts? okay first of all um david

32:29

bailiff is a good friend of mine who runs the elm cage

32:31

clinician and if this if

32:33

this person by the way you

32:36

just use a search feature this has been posted on and

32:39

off for years in that group and and in every group in

32:41

the cash based physical therapy business success

32:44

group I mean this exact thing has been posted before

32:48

So people don't even, that's one thing that

32:50

annoys me with all the Facebookers, by the way, is people just ask questions

32:53

and they're like, hey. And it's like, there's a search feature

32:56

that shows like five years of questions.

32:59

I know, but have you met people? Have you met people?

33:03

That that's why I'm leaving more and more of these Facebook groups.

33:05

Okay. Um, okay. So by the way,

33:08

so you mentioned a couple of things about, um, the, the style about risk aversion,

33:13

all that. So one thing that sturdy McKee, my business partner

33:15

mentioned to me is the physical therapy profession

33:18

actually attracts more of those people. People that want security,

33:24

they want a salary. They don't want to go out on their own,

33:27

all that. And that post right there is

33:30

a signal because if you're even asking about that, I mean,

33:34

that's not, this is not a business really.

33:37

Like this is not you being an entrepreneur. This is like-

33:41

Yeah, you're an employee basically. So, I mean, the uncaged clinician,

33:45

uncaged means helping you like get uncaged from the

33:48

whole like healthcare system and working for

33:50

someone else and going out on your own, right? Like that's the whole point of this group.

33:53

And then this person is asking a question that is

33:56

not really reflective of going out on your own.

33:59

This is such an immature

34:01

question that this person

34:04

is obviously not serious and

34:07

And this is not like, this is a terrible deal.

34:10

This is a terrible deal because you're not going out on your own.

34:14

The place is gonna provide the EMR. You're a therapist.

34:18

You need to go shop around, do demos,

34:20

speak to different EMR companies, see which one you like,

34:24

You pick it. You build your own business.

34:26

You provide your own tools, your own supplies, your own needles,

34:29

table, cups, all that.

34:32

Some other place is going to provide all this? Like, that's just another job.

34:35

Why even post this in an entrepreneur group?

34:39

So, and then the anonymous post is just,

34:45

it's almost below my line, Jimmy. It is.

34:47

Oof. Almost. Almost.

34:50

Yeah. Well, people are afraid of the anonymous post. Go ahead.

34:54

If someone goes in one of these Facebook groups and posts a question with their

34:57

name next to it, guess what happens sometimes? people will comment below oh

35:01

that sounds like me or oh yeah I had was in the same

35:04

situation then you get messages you get you'll get

35:07

uh you'll send it people will other therapists like

35:10

you will send messages a direct message and then you

35:13

get more networking you get more connections you get you get to hear from other

35:16

folks that reach out to you when you post anonymously

35:18

it's so selfish there's no

35:21

collaboration there's no there's no sharing of

35:23

of information and experiences. It's very, very selfish.

35:27

Go ahead. Well, Christine is not anonymous.

35:29

She chimes in. She says, I'm looking at the same model,

35:32

but she's offering a 70-30 split.

35:35

Provider's 70. Is that better?

35:37

I mean, it's better. It's better than 50-50. Where do you feel on that?

35:40

I mean, That, that's, I mean, that,

35:44

that sounds awesome, Christine,

35:46

if you can make that work and if you can attract providers.

35:48

So Christine is on the business owner side. Sounds great.

35:52

I mean, so other business models,

35:55

by the way, with physical therapy, so brick and mortar, whatever,

35:57

like they want to have their whole salary compensation bucket,

36:01

like total compensation bucket at like 55 to 60%.

36:06

So if she can give that extra margin to the therapist and she's only

36:09

looking to do 30% pre-tax and make it work,

36:13

interesting. Maybe we should have her on the show. I mean, it sounds, it sounds great.

36:16

It sounds like doable.

36:18

Um, I'd be curious.

36:21

I don't know Christine, so I'm going to have to connect with her. And I don't know if she's

36:24

brick and mortar or mobile or what. But now we do because she

36:27

didn't answer anonymously. And that's the beauty of it.

36:30

Exactly. Exactly. So now it's like, okay,

36:32

I could go connect with Christine on Facebook or LinkedIn,

36:35

whatever, see what she's doing. Maybe refer therapists to her.

36:40

Maybe I get referrals and then I get a referral in that state.

36:44

And then I think of Christine and then I refer a patient and then she

36:47

benefits downstream from that, but not when you post anonymously.

36:50

Tony, I didn't see your comment on that thread, and I just brought it up

36:53

and didn't see it. So if you want to chime in here.

36:56

Oh, wait, maybe I did see his comment on that.

37:02

Here we go. No, this was something different.

37:04

Sorry. I didn't see that comment on the thread.

37:07

So if you want to chime in there. I love when you guys comment

37:10

now or later because I love sitting there and

37:12

responding or hearing the different opinions.

37:16

And I don't even know how to respond anonymously.

37:20

What else is on Dave's mind? I know we have Freedom coming up on Thursday.

37:24

It's 100% off on Thursday. Yes,

37:28

we do have the holiday weekend in the

37:32

4th of July on Thursday. I almost said Saturday.

37:34

Today's Tuesday. You make your clinicians work on Friday.

37:39

Like this year, July 4th falls into Thursday.

37:42

Are you open on Friday? Well,

37:45

my therapists make their own schedule. So if they want to, yes.

37:50

So they have their own... It's your call.

37:56

Yep. Let's see. I also brought in... This is another question

38:01

asked in LinkedIn. I'm stealing this from Cody Thompson,

38:03

promised we'd mention this. Here's a question he asked.

38:06

Cody asks, I'm calling on my cash pray

38:09

gurus for answers to these questions. Is there any reason a

38:12

solopreneur cash pay therapist couldn't or shouldn't accept a student

38:17

for clinical education? If you can,

38:19

do you charge the patient if the student is providing care?

38:22

This is like a rules and regs question and later

38:25

clinical rotations. If so, do you charge more slash less?

38:33

I would charge the same dollar amount. Because as a student,

38:37

they can't necessarily bill. They can't bill.

38:40

Sorry, not necessarily. They can't bill. They're a student. It is under your license.

38:43

You are the one providing the care. They might be providing care

38:47

under your supervision. Someone's going to tear me

38:49

apart for how I'm saying these things. No, I get what you're saying.

38:54

So let's just say if a

38:57

practice is charging $250 per visit.

38:59

Because he's saying cash pay, out-of-pocket, physical therapy.

39:03

So if a practice is charging $250 a visit, and you're solo and you

39:09

don't have a student and you charge 250 and then two months later,

39:12

now you have a student, it should just be the same

39:15

dollar amount because the therapist is still going to be there.

39:19

The therapist has to still be there. The student is not being

39:23

paid because we covered that before.

39:26

The student is going through a clinical rotation,

39:28

which they're paying their school. the practice potentially

39:32

benefits because maybe we want to eventually hire that therapist.

39:35

So we, we get to, you know, we don't, we don't get paid either,

39:38

but we also have arguably free labor,

39:40

but it's, but our therapist still has to be there.

39:43

So it's like, not really like,

39:46

We're still paying for that labor. I'm paying for my therapist to be there.

39:49

So there's a couple of free rides there going on.

39:54

You charge the same dollar amount. I don't understand like, I mean,

39:57

sometimes these questions either on LinkedIn or Facebook,

40:01

I don't know about this guy. Hold on. Sometimes the questions are

40:05

coming from like marketers and it's like, they're trying to, you know,

40:09

they're for engagement. Right. And there's a couple of names.

40:11

There's a couple of names I could mention if you wanted, but like,

40:13

I like it. It's obvious. It's obvious. It's obvious.

40:16

I mean, I ask, I ask conversation starters too.

40:19

I know, but you, you don't do it from a sense of like,

40:22

then, so there'll be these marketers or these,

40:27

uh, business physical therapy, business coaches, they ask questions,

40:29

you click on their profile and they're like, they're a business coach consultant.

40:33

And then also like a, maybe a practice owner or, or,

40:35

or like a clinic director or something. Got it.

40:38

Um, so they, they want owners to like

40:41

comment and then they start a conversation with them in

40:43

the comments and then they try to take it to DM. And then they try to pitch

40:49

them their paid coaching. We're still doing that.

40:54

I think also the part of this question is like,

40:57

is there any reason a solopreneur cash-based therapist couldn't or

41:00

shouldn't accept a student for ClinEd? Tony not here today, but he's commenting.

41:05

He says, I'm not cash-based, but I would say, yes, they should be accepting students.

41:08

The value really isn't the patient treatment. It's not that you can or can't bill more,

41:12

less, whatever. It's a chance for the

41:16

student to understand and experience the process. He tells students that they

41:19

will have the rest of their career to treat patients. The value in a clinical

41:22

rotation is to get inside the business owner's head

41:26

or the CI's head and understand why they are

41:29

doing what you're doing. So much wisdom there.

41:33

So much wisdom. And he's not even here, but he's here,

41:35

but he's there, but he's not here. He's everywhere.

41:39

Did you have good clinical experiences? Do you look back fondly?

41:44

I did. I mean, my first one was at a skilled

41:48

nursing facility, which, I mean, I don't think you could pay

41:52

me to work at a place. But again, people need it and it's a

41:55

valuable place in the whole ecosystem.

42:00

My eventual mentor and coworker,

42:05

eventually, I met there. he was like working

42:10

part-time at the sniff. And then he got me my job at

42:13

the physician owned practice, helping negotiate my salary and all that.

42:16

So again, back to networking, whatever, um,

42:19

hospital rotation. I was like a day in two days in, I mean,

42:23

it was like, what's it like? It was like eight weeks long,

42:25

one or two days. And I'm like, I am never working in a hospital.

42:28

This is, this is not my style.

42:31

And then, uh, my two outpatient ones, uh,

42:33

market street in Philly with, um,

42:37

Moss rehab. That was awesome. And then outpatient for four

42:41

months in South Jersey. And I was like, yeah,

42:44

outpatient is obviously my, my, my jam.

42:48

I didn't do any home. I did like one home visit with my mentor or whatever, but yeah,

42:54

Definitely fond memories of rotations. It was a time for... I don't know.

42:59

Also, it was way less stress than studying

43:02

in physical therapy school. Even though you weren't being paid,

43:07

it was like this is... this is much better than

43:10

studying for a bunch of exams. So like I had a great time.

43:13

How about you? This will surprise you. One of my CIs said, wow,

43:17

I've never had someone who could tell the same story

43:20

26 times in a day and change it up a little.

43:22

I'm like, yes, I was in radio for 15 years.

43:26

We essentially said the same thing a thousand different ways.

43:29

There's only so many different ways I can tell you that Limp Bizkit is

43:32

coming to the Toyota Pavilion on next Thursday.

43:34

I've got to keep changing it up every single time. That was fun.

43:39

Tony did a double rotation at IMG Academy in Bradenton.

43:42

Oh, that's the big funnel for going pro.

43:46

NBA players, great experiences, a lot of cash pay.

43:49

Different environments, man. I'll tell you, your DCE,

43:52

your Director of Clinical Education, has a really big impact on...

43:59

your experience in PT school,

44:02

and some schools have a lot of interaction between

44:07

students in the DCE and some it's like nothing.

44:11

I mean, I think I had a 20 minute conversation with my DCE and she's like,

44:14

I understand you. And as the narrator voice

44:17

should be playing in your head right now, she in fact did not understand me,

44:22

but she was responsible for where I was gonna be placed

44:25

for how many weeks And this brought,

44:28

this is probably a time for a different conversation, but it's like an interesting dynamic.

44:31

And I know it's always been this way and that should scare people,

44:35

but different schools have

44:37

drastically different processes for getting your

44:40

next clinical placement. I would actually love to hear what the process is

44:44

like from the audience because it can highlight there.

44:47

There's not two ways. There's like 50 different

44:49

ways that students get placed and how they can, how they can,

44:53

you know, sort of, advocate not at all there's

44:56

ranking systems there's one school who does it as a

44:59

live like uh draft almost

45:01

like we just had at the sphere with the nhl draft

45:03

so I would love to hear from the audience if you'd

45:06

like to hear about that because it this is a I mean

45:09

everything should be up for for overhaul or at least

45:12

looked at as an audit like are we using the most

45:14

effective model for students who are paying not

45:18

a little bit of money um to

45:21

be affected by this And then Tony chimes in for the record,

45:24

his DCE didn't help with anything. He made the connection and

45:26

secured the contract. And that's awesome. Some schools would penalize

45:30

a student for that. You would not only not get that,

45:35

there might be repercussions. So it's just wild, man.

45:39

And Bo chiming in, go Yankees. But it's wild.

45:42

I was going to make a joke and say, I didn't know IMG Academy

45:45

was around back when Tony was a student, but I...

45:50

I said it anyway. Tony, you're not that old,

45:52

and you have so much wisdom. We love you. We miss you. All right.

45:55

We are off on Thursday because I will be having

45:58

two scoops of freedom. I don't know about you guys. I'll be holding a bomb pop,

46:01

doing backflips into my pool. Bo did a simple ranked choice.

46:06

I did nothing. It was like fortune cookies.

46:10

That's what I got. Where are you going? Hey, look at that.

46:13

Right. So that's fun. So ranked choice. I'd love to hear about that.

46:17

So we're off on Thursday. You should be off on Thursday.

46:19

Don't listen to any like this is the anti podcast and live stream.

46:23

Don't listen to our podcast on Thursday. Do something with family or friends.

46:27

Don't buy anything that we sell. Don't consume anything that

46:31

we make yourselves. Listen to some good old

46:35

fashioned Freedom Rock. We used to do that.

46:37

We would do it. We would do a weekend on my radio station because

46:40

everybody loved to hate Nickelback. And I ran a rock radio station.

46:43

We played Nickelback because people listened when you

46:45

played Nickelback. But we had a big weekend

46:47

where we were like, we're kicking out the we're

46:49

kicking out the Canadians. It's a no Nickelback weekend.

46:53

And it would just be American bands. But the funny part is you

46:56

lose a lot of bands that you're like, oh, they're not American.

46:59

because a lot of rock bands around the world sound

47:02

because they emulate, like they grew up listening to Kurt Cobain.

47:05

So now, you know, one of the notable bands that I interviewed,

47:07

Sean Morgan from a band Seether, he,

47:10

you know, walked in the studio and said, Hey, what's up? And I'm like, Oh wow.

47:13

Gigantic. I mean, he's from South Africa. I knew that, but like huge accent.

47:17

I'm like, Oh, you literally turn it on.

47:19

So anyway, we went down a rabbit hole, but anyway, do something freedom related.

47:23

And I want you to come back with all your fingers and toes and,

47:27

Firework accidents are not okay. These are your livelihoods for some people,

47:31

so don't do that. And by the way,

47:33

I was just texting with Brian Williams,

47:35

one of my buddies, who's been on your show a bunch. He was at Marymount University.

47:38

We went to the same PG school. Yeah, so last week he said that he went to

47:42

a Rolling Stones concert. I was like, they're still touring?

47:45

And then he said they just came out with an album. I was like, they're creating more new music?

47:49

I wouldn't know. Amazing. Why wouldn't they? Amazing.

47:51

Why wouldn't they? All right, Dave, parting shot.

47:54

Parting shot. Easy peasy. Here we go. Bring the numbers.

47:57

All right. If you're looking to negotiate your salary or

48:00

you're doing your OCS, your advanced certification,

48:02

and then you're like, hey, what's in it for me? What's the pay bump?

48:05

What's this? Bring the numbers.

48:08

I mean, if that doesn't work, maybe you need to leave

48:11

that place or you need to say, okay, am I at the ceiling of

48:15

compensation for this role, even with an OCS or whatever?

48:19

if I'm at the ceiling, what other responsibilities

48:22

or tasks can I do for more compensation?

48:25

And some therapists might not like that. So if you don't like it, then you leave,

48:28

you go find another job. But if you're at the ceiling of compensation at whatever

48:31

practice you're at, then it might be like,

48:33

you need to add, you need to do other stuff, right?

48:36

It might be this, it might be video content, audio.

48:38

It might be social media posting. It might be other marketing initiatives,

48:42

whatever. But like, if you get to a point where you're at the ceiling somewhere,

48:46

regardless of the customers,

48:48

the health care, the reimbursement, the payment model, whatever.

48:52

then the next thing would be more responsibilities, which yes,

48:56

would also be, you know, more time and effort. And if you don't like that, then yeah,

48:59

yeah. Leave, go somewhere else, find another job, but bring the numbers, start with that.

49:05

Compare yourself to other clinicians in the practice,

49:08

in the company that have the same type of like role

49:10

and maybe even years of experience. And if there's a difference there,

49:14

then it should be clearly evident to your decision

49:16

maker or your boss, whoever to give you a pay bump.

49:19

And again, yeah, if that doesn't work, reach out to me.

49:22

Maybe you could relocate to New York City or you could

49:24

go work somewhere else. With great power comes great

49:27

responsibility, right? If you're going to get a bump, there's going to be more responsibility.

49:30

That's okay, but it should be commiserate with the impact you bring.

49:34

Dave went objective. I'm going to go subjective.

49:37

You don't walk into the batter's box without understanding what the

49:39

strike zone is or how things work. So open those lines of communication.

49:44

Ask before you sign up and drop $1,600 on a clinical

49:47

specialist exam. Hey, what is this going to do for my career?

49:50

What could that do here? Now, I'm not saying that... Money should be the only

49:54

driver for educating yourself. I'm going to hard say that.

49:56

I am not saying that. But understanding what your

49:59

value is so that you can help more people and then

50:02

be compensated for that so

50:05

you can stick around and help more people. This is cyclical.

50:09

So Dave went with objective. My parting shot is subjective.

50:12

Communicate early and often and know the rules of the game.

50:16

We're off on Thursday. We're back in seven days. Thanks for listening.

50:19

Thanks for watching.