Oct. 3, 2025
Is it ILLEGAL for DNPs to call themselves Doctors?
Is it ILLEGAL for DNPs to call themselves Doctors?
Transcript
WEBVTT
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Hey guys,
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welcome back to PT Breakfast Club.
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There's the AI generated yetis.
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Good morning.
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I'm back.
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I missed you guys.
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And we're back.
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And we're back.
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How were your travels?
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Travels were great.
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Did some family stuff in Oklahoma.
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And then did some work stuff in Roanoke,
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Virginia, which someone asked me, hey,
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have you ever been to Roanoke before?
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And I said, absolutely not.
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And then I walked into the hotel we
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were having the conference in.
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I was like, oh,
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I've been in this hotel.
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So that's when you know you maybe travel
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a lot.
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And you can't remember being in the hotel
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that you are currently in,
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in the city that you thought you'd never
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been to.
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But I've been there.
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Yeah, for a wedding.
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Very nice.
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Yeah.
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All right.
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So this came across in the group chat
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just a couple of days ago.
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An article out of California.
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I feel like there's a lot of things
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going on in California these days.
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And a court ruled saying that nurses...
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And I guess effectively they're they're
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they're issuing the ruling for health care
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providers at large.
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But in this specific case,
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the ruling came that said nurses can't be
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called doctor in California,
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even if they have a doctoral degree.
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The federal judge ruled that the nurses
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with doctorates in California can't
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actually use the title because it could be
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confusing.
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They cited doctors.
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a survey from the AMA showing that thirty
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nine percent of patients mistakenly
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believe that DNPs are physicians.
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I will say that survey is from the
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AMA,
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which is completely comprised of
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physicians.
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So, I mean, we bring this up.
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We don't really talk a lot about nurse
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practitioners here,
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but obviously the parallels between the
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physical therapy profession and the
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decision there are pretty, pretty close.
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Where where are your thoughts on this
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issue?
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This comes up everywhere.
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This comes up as a trend every once
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in a while and then goes away.
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Let's just throw out a few, I think,
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potential facts before we get into our
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opinions.
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So the DNP, the degree,
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correct me if I'm wrong, the DNP.
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So is it a doctor of nurse practitioner
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that is the degree?
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I believe so.
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Okay.
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So the degree has doctor in it.
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It has the word D-O-C-T-O-R.
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It has the word doctor in it.
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Correct.
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Doctor of nursing practice.
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Correct.
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Right, right.
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Same thing with us.
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I'm looking at my degree right here.
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Doctor of Physical Therapy.
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It doesn't say Master of Physical Therapy.
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It doesn't say Bachelors, Associates,
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whatever.
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So if it's in the degree,
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And the physical therapist,
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or in this case, the nurse practitioner,
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assuming neither of them are suggesting
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that they are a physician,
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none of them are saying I am a
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physician the way that some of the
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chiropractors are saying I'm a
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chiropractic physician,
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which is maybe a little bit of a
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sidebar.
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If the degree has the word doctor in
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it, I don't see the problem here.
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So I was asking chat GPT yesterday,
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you know, hey,
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what are some current affairs that might
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impact the PT profession and give me some
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ideas for tomorrow's podcast?
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This article came up,
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then I asked further, I said,
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and I remember the origins of this,
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which I'll bring up in a second.
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I said,
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is this going to affect all allied health
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care?
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Also, is it just for nurses?
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And Chad GPT's impression was it was
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pretty much just in California,
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just nurses, and more specifically,
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just in clinical settings.
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And it was referencing like, look,
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if you're in a hospital,
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there are people coming in and out of
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the room constantly.
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If everybody is calling themselves doctor
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because that's what their degree is in,
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then you don't know who the medical doctor
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is,
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who the MD is or the DO or
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whatever the internist is.
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So there were some guidelines around.
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It's not that you can't say you don't
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have a doctorate degree.
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You can't say I'm a doctor of nursing
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or physical therapy or whatever.
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It is kind of in very specific settings.
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But this goes back, and I remember this.
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There was a nurse who called herself
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doctor because she had a doctorate degree
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on social media who ended up getting into,
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I think,
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legal and financial issues and
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Every time any of us see somebody making
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crazy claims on social media,
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we're always like, you know, who is this?
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What is this?
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What are the credentials?
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Is it a chiropractor?
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Is it a medical doctor?
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Whatever.
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And I, for one,
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as a consumer of media,
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I want to know who's the crazy I'm
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listening to at this moment.
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Yeah.
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Just because you have an MD after your
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name doesn't mean you're not crazy.
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It just gives me some perspective on what
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kind of crazy you are.
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Right.
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So I totally get it.
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Now, you, Dave,
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can probably make the best arguments here
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because I don't have a DPT and I
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don't think Jimmy has a DPT.
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I don't I don't I didn't know that
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Dave had a DPT because you never mention
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it.
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But that being said,
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there are some specifics around it.
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Yes,
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we've had therapists and I've never
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stopped anyone from saying, hey,
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my name is, you know.
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X, Y, Z,
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I'm a doctor of physical therapy.
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That's fine.
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And we've had patients that appreciated
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that they were working with a doctorate
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level individual.
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But I will also say,
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and then I'll turn it over.
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I've also had patients that they were
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like, oh,
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how many weeks does it take to become
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a physical therapist?
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And then I tell them I was a
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personal trainer before I became a
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physical therapist.
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And they're like, what?
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You're a personal trainer?
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That's amazing.
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And they go crazy for it.
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So, you know, it's marketing,
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it's branding.
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At the end of the day,
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it's just a label that could mean a
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lot or it could mean nothing.
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Jimmy, what are you thinking?
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Well, Dr. McKay, actually,
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I do have the doctorate because I
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graduated in twenty sixteen when it was
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mandatory.
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Do I?
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How do I not know both of you
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guys have a doctorate degree?
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Because we don't talk about it because.
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While I was in school and I graduated
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in twenty sixteen,
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I heard from the social media audience
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that it was imperative that the only way
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we're ever going to gain respect
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was to use that title ad nauseum.
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And then I heard in the classroom from
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my professors at Marymount University,
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they were named Sky and Julie,
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and they had PhDs.
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Like my professor Sky has a PhD in
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biochemistry.
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Like that's Dr. Jones or Dr.
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Dre territory.
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That's different types of doctors there.
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But they were very, very...
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insistent that we call them by their names
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and they you know if you so if
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you wanted so we have to go with
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words and i love me some words so
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number one doctoring isn't a job physician
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is right so like there's the disconnect so
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all of a sudden we've gone kleenex and
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cadillac on the title doctor now do i
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think a media campaign is going to change
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public perception of if someone says my
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kid just graduated from college she's a
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doctor
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we tend to assume that that person is
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in fact a physician.
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I get that.
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That's what I would assume, right?
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But no one has any problem when Short
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Round says, no time for love, Dr. Jones.
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And he's referring to Dr. Indiana Jones,
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who is an archaeologist, right?
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So it's funny because in some places,
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like Dr. Dre or Dr. Seuss or Dr.
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Ruth Westheimer,
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we've got a list of doctors everywhere,
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right?
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For some reason,
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it's OK in some contexts and not in
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the other.
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And again,
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I am in favor of communicating clearly so
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I can see where someone saying, hey,
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thirty nine percent of patients polled no
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data on how many people were actually
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polled or in what settings or what
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questions they were asked were confused.
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So that's why.
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APTA goes out of their way to actually
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message, I am Dr. Johnson,
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your physical therapist.
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Make sure you qualify what you're actually
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a doctor of.
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Do I think it's confusing?
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I don't know.
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Yeah, a little bit.
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Do I think it's necessary?
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I don't know if it always is.
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If someone asks what your qualifications
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are,
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Tony just mentioned someone got super
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excited because they found out he's a
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physical therapist and he was a personal
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trainer before that.
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I think the person is always listening to
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see how this person, Tony,
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or whoever's in front of them,
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how is what they know going to help
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me?
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And I'll close with that famous quote.
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I think it was Eleanor Roosevelt says,
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no one cares how much you know until
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they know how much you care.
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Neither of those things are true.
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They don't care how much you know.
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They don't really care how much you care.
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They care,
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do you understand what problem I have?
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And are you capable of helping me solve
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it?
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I understand how using that title doctor
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can give you a little puff out your
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chest a little bit and say like, oh,
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I have advanced qualifications.
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So I get that.
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But you shouldn't sacrifice quality for
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clarity in certain situations.
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So I think it's nuanced.
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I think this conversation is going to come
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up over and over again,
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and it's never going to get solved.
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The example of a hospital room where
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there's providers coming in and out and
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the patient or the family not knowing who
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the medical doctor is, the actual MD is,
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is ridiculous.
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Because in every hospital,
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a PA that walks in the room,
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in a hospital,
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and also where I used to work,
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my first job was a physician in practice,
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outpatient ortho,
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and those PAs also wore white coats.
00:09:46.144 --> 00:09:47.765
They looked exactly like the physicians.
00:09:47.826 --> 00:09:50.107
So even though I just looked up that
00:09:50.128 --> 00:09:51.948
the AMA, the American Medical Association,
00:09:51.989 --> 00:09:52.629
was not
00:09:53.049 --> 00:09:55.511
a part of any of this nurse practitioner
00:09:55.631 --> 00:09:57.073
expansion programs and all that.
00:09:57.114 --> 00:09:58.794
So they've generally been opposed to all
00:09:58.815 --> 00:10:00.736
this the whole time across the country
00:10:00.917 --> 00:10:01.238
anyway.
00:10:01.437 --> 00:10:03.379
I thought that they were a part of
00:10:03.419 --> 00:10:03.539
it.
00:10:03.679 --> 00:10:04.200
I looked it up.
00:10:04.279 --> 00:10:05.701
As we were talking in ChatGPT,
00:10:06.001 --> 00:10:07.342
they've always been generally opposed to
00:10:07.403 --> 00:10:07.503
it.
00:10:07.884 --> 00:10:10.865
So then why do physicians allow PAs that
00:10:10.885 --> 00:10:13.087
are under the guidance of those physicians
00:10:13.849 --> 00:10:15.250
to walk in a room with a white
00:10:15.269 --> 00:10:17.350
coat on, and I know this for years,
00:10:17.389 --> 00:10:19.490
where the patient will say, oh, hey,
00:10:19.530 --> 00:10:21.011
doctor so-and-so, hey,
00:10:21.091 --> 00:10:23.952
and the PAs do not correct the patient,
00:10:24.153 --> 00:10:24.812
the family.
00:10:24.993 --> 00:10:26.592
They do not say, oh, I'm a PA,
00:10:26.994 --> 00:10:29.774
I'm Steve, not Dr. Kelly, or whatever,
00:10:29.855 --> 00:10:30.034
right?
00:10:30.075 --> 00:10:32.635
Like, I'm Steve, I'm the PA for,
00:10:33.076 --> 00:10:33.775
they don't correct them.
00:10:34.035 --> 00:10:35.196
Just like in physical therapy,
00:10:35.216 --> 00:10:37.657
the PTAs do not really typically,
00:10:37.996 --> 00:10:39.197
in my experience,
00:10:39.918 --> 00:10:42.599
They don't correct patients when a patient
00:10:42.639 --> 00:10:44.639
calls them their therapist or the patient
00:10:44.678 --> 00:10:47.120
calls the PTA, that's my PT.
00:10:47.379 --> 00:10:48.379
I don't know how it is in Tony's
00:10:48.440 --> 00:10:48.720
office,
00:10:48.759 --> 00:10:50.620
but in all the offices I've ever been,
00:10:50.961 --> 00:10:52.942
patients do not know the difference
00:10:52.981 --> 00:10:55.182
between a PT and a PTA for the
00:10:55.221 --> 00:10:55.721
most part.
00:10:56.142 --> 00:10:57.663
And so it's just the way it is,
00:10:57.722 --> 00:10:59.962
whether it's the physician,
00:11:00.323 --> 00:11:01.604
the MD and the PA,
00:11:02.083 --> 00:11:03.923
or it's an NP or a nurse practitioner.
00:11:03.964 --> 00:11:05.465
And also, by the way, the sidebar,
00:11:06.897 --> 00:11:10.158
nurse practitioners and DNPs and DNPs,
00:11:10.278 --> 00:11:11.099
I'm pretty sure both,
00:11:11.178 --> 00:11:13.940
but definitely the doctor, the DNP,
00:11:14.360 --> 00:11:15.860
I'm pretty sure both though can prescribe
00:11:15.879 --> 00:11:16.480
medication.
00:11:16.520 --> 00:11:18.701
So also like they can prescribe
00:11:18.721 --> 00:11:19.341
medication.
00:11:19.381 --> 00:11:21.982
So who cares about the doctor label?
00:11:22.023 --> 00:11:25.183
They're doing some major role in the
00:11:25.203 --> 00:11:28.585
healthcare system that physicians also do.
00:11:28.684 --> 00:11:29.946
That takes a lot of training and
00:11:30.046 --> 00:11:31.485
understanding and you have to know
00:11:31.885 --> 00:11:33.267
pharmacology and all, you know,
00:11:33.366 --> 00:11:35.207
side effects and contraindications and all
00:11:35.227 --> 00:11:35.408
that.
00:11:35.467 --> 00:11:35.967
So it's like,
00:11:37.793 --> 00:11:38.452
Who cares?
00:11:38.472 --> 00:11:40.073
Because the physicians allow the PAs to
00:11:40.094 --> 00:11:41.475
look exactly like themselves too.
00:11:42.296 --> 00:11:43.296
I'll tell you who cares.
00:11:44.557 --> 00:11:45.336
Well, two sides.
00:11:45.957 --> 00:11:46.837
The practitioner,
00:11:47.198 --> 00:11:50.900
because we are hierarchical in this world,
00:11:51.341 --> 00:11:51.561
right?
00:11:51.721 --> 00:11:52.221
Yep.
00:11:52.301 --> 00:11:52.922
It's just ego.
00:11:53.101 --> 00:11:54.043
It's just ego and status.
00:11:54.082 --> 00:11:57.163
Yeah, that's it.
00:11:57.364 --> 00:11:59.405
It is not about protecting the consumers
00:11:59.605 --> 00:11:59.865
at all.
00:12:01.433 --> 00:12:02.073
It's not.
00:12:02.254 --> 00:12:04.176
But from the consumer perspective,
00:12:04.235 --> 00:12:04.816
I'll tell you,
00:12:04.855 --> 00:12:06.157
because I've gone through the health care
00:12:06.177 --> 00:12:07.618
system, not a lot with myself.
00:12:07.638 --> 00:12:08.898
I've been relatively healthy up to this
00:12:08.957 --> 00:12:10.919
point with my parents, though.
00:12:11.200 --> 00:12:12.340
The question is always like,
00:12:12.900 --> 00:12:15.341
are we getting the doctor or are we
00:12:15.381 --> 00:12:15.881
getting there?
00:12:15.961 --> 00:12:17.623
Like, are we getting the second one?
00:12:17.803 --> 00:12:18.344
Are we like,
00:12:18.683 --> 00:12:19.825
are they just in their office?
00:12:21.068 --> 00:12:22.551
So it's not a knock on the person
00:12:22.591 --> 00:12:23.371
in front of you, but it's like,
00:12:23.652 --> 00:12:25.254
why am I not getting the person?
00:12:25.554 --> 00:12:26.736
Because if there's an error,
00:12:27.096 --> 00:12:28.600
I'm going to go back to this moment
00:12:28.659 --> 00:12:29.942
as the fork in the road and go,
00:12:30.361 --> 00:12:31.803
why didn't I have that other person in
00:12:31.844 --> 00:12:32.164
front of me?
00:12:32.365 --> 00:12:33.767
I'm paying the same rate, right?
00:12:33.807 --> 00:12:34.609
Wouldn't you be pissed?
00:12:35.868 --> 00:12:37.129
It might not be the same rate.
00:12:37.149 --> 00:12:37.489
I don't know.
00:12:37.908 --> 00:12:40.191
If you didn't get the mechanic,
00:12:40.650 --> 00:12:43.332
but you got the mechanic's assistant who
00:12:43.352 --> 00:12:44.893
went through five hundred hours of
00:12:44.933 --> 00:12:46.193
training and not ten thousand hours of
00:12:46.234 --> 00:12:47.495
training and something goes wrong with
00:12:47.514 --> 00:12:48.775
your car and you crash, you'll be like,
00:12:49.096 --> 00:12:50.256
we didn't get the assistant.
00:12:50.356 --> 00:12:51.376
That's where the thing was.
00:12:51.738 --> 00:12:53.599
So I think that that's the thing for
00:12:53.619 --> 00:12:53.778
me.
00:12:53.818 --> 00:12:55.720
Both my parents like who when the person
00:12:55.740 --> 00:12:57.441
would come in, give their spiel and leave.
00:12:57.760 --> 00:12:58.902
Is that who who is that?
00:12:58.981 --> 00:13:00.062
What's their qualifications?
00:13:00.403 --> 00:13:01.803
There's unclarity there.
00:13:03.024 --> 00:13:04.686
And the title doesn't clear it up.
00:13:05.307 --> 00:13:06.467
That's a problem for me.
00:13:06.508 --> 00:13:07.628
I won't say that's the problem,
00:13:07.889 --> 00:13:08.788
but that's a problem.
00:13:08.828 --> 00:13:09.710
We want to understand.
00:13:10.629 --> 00:13:12.110
Look, now more than ever,
00:13:12.552 --> 00:13:13.893
who am I taking advice from?
00:13:13.993 --> 00:13:14.092
Well,
00:13:14.113 --> 00:13:16.614
there's a guy giving advice on medication
00:13:16.673 --> 00:13:18.775
right now that, as far as I know,
00:13:19.056 --> 00:13:21.577
has no minutes worth of medical training
00:13:22.038 --> 00:13:24.318
but a very large podium and just told
00:13:24.379 --> 00:13:26.860
a bunch of people that nothing bad can
00:13:26.900 --> 00:13:27.260
happen.
00:13:27.501 --> 00:13:28.542
Only good can happen.
00:13:28.982 --> 00:13:29.842
Only good can happen.
00:13:30.082 --> 00:13:30.803
And he's not Yoda.
00:13:30.823 --> 00:13:32.245
He's the president of the country.
00:13:33.164 --> 00:13:34.066
giving medical advice.
00:13:34.086 --> 00:13:35.005
And we're saying, okay,
00:13:35.086 --> 00:13:35.966
well that sounds legit.
00:13:36.366 --> 00:13:39.847
That is a scary thing to happen.
00:13:39.888 --> 00:13:42.308
Going back to one of the things that
00:13:42.349 --> 00:13:45.710
Dave said about like,
00:13:46.030 --> 00:13:48.772
I remember this conversation happening
00:13:48.792 --> 00:13:50.312
years ago, you know,
00:13:50.351 --> 00:13:52.653
physical therapist assistant in the
00:13:52.852 --> 00:13:54.594
hospital based outpatient,
00:13:54.793 --> 00:13:56.235
either they weren't wearing their name
00:13:56.274 --> 00:13:57.796
badge or their name badge was always
00:13:57.836 --> 00:13:58.755
flipped over and
00:13:59.542 --> 00:14:00.942
I mean, the reality is,
00:14:01.243 --> 00:14:02.842
I'll take this in two directions.
00:14:02.903 --> 00:14:05.224
From the sales and marketing perspective,
00:14:05.504 --> 00:14:07.764
why don't they correct the patient when
00:14:07.783 --> 00:14:10.585
the patient says doctor or therapist or
00:14:10.605 --> 00:14:11.065
whatever?
00:14:11.625 --> 00:14:13.785
Because you get better buy-in with some
00:14:13.826 --> 00:14:14.265
patients.
00:14:14.306 --> 00:14:16.706
So you're going to leverage the name.
00:14:17.826 --> 00:14:19.067
You're going to leverage that with the
00:14:19.087 --> 00:14:20.248
people who care about it.
00:14:20.288 --> 00:14:21.687
And there are people who care about it.
00:14:22.008 --> 00:14:22.609
Like Jimmy said,
00:14:22.649 --> 00:14:24.188
there are people who want the doctor,
00:14:24.249 --> 00:14:25.328
the medical doctor.
00:14:26.870 --> 00:14:27.570
I'm going to say...
00:14:29.219 --> 00:14:31.860
Yes, they're here in my clinic.
00:14:32.080 --> 00:14:34.120
I don't want differentiation between me
00:14:34.139 --> 00:14:34.961
and my assistant.
00:14:35.721 --> 00:14:37.821
Why don't I want differentiation between
00:14:37.880 --> 00:14:38.841
me and my assistant?
00:14:38.881 --> 00:14:40.461
Why don't I think it even matters?
00:14:40.961 --> 00:14:43.062
Because the reality is what is being
00:14:43.102 --> 00:14:43.682
delivered,
00:14:43.722 --> 00:14:45.523
the service that is being delivered,
00:14:45.923 --> 00:14:48.464
my assistant is equally qualified,
00:14:48.683 --> 00:14:49.764
equally educated,
00:14:49.984 --> 00:14:51.825
equally licensed to deliver the
00:14:51.865 --> 00:14:52.404
intervention.
00:14:53.067 --> 00:14:54.768
After your evaluation?
00:14:54.788 --> 00:14:56.149
I'm not going to say that he is
00:14:56.188 --> 00:14:58.410
the therapist doing an evaluation because
00:14:58.451 --> 00:15:00.792
he is not licensed to do an evaluation.
00:15:01.232 --> 00:15:03.114
There's going to be differentiation when
00:15:03.153 --> 00:15:05.255
it's a physical therapy evaluation.
00:15:05.735 --> 00:15:07.456
But when we take it to treatment,
00:15:07.496 --> 00:15:08.977
delivery of the intervention,
00:15:09.437 --> 00:15:13.660
he is equal to me in all capacities
00:15:13.922 --> 00:15:16.283
relative to education, licensure,
00:15:16.643 --> 00:15:18.625
experience, all of that kind of stuff.
00:15:19.160 --> 00:15:21.222
So it doesn't help him do his job
00:15:21.302 --> 00:15:24.445
any better if the patient thinks, oh,
00:15:24.504 --> 00:15:25.885
I'm getting a lesser person.
00:15:25.926 --> 00:15:27.346
And this goes to Jimmy's point,
00:15:28.368 --> 00:15:31.509
where the PA or the medical doctor,
00:15:32.410 --> 00:15:33.831
in what they're actually doing at the
00:15:33.851 --> 00:15:34.652
moment,
00:15:34.672 --> 00:15:36.894
they are probably equally trained and
00:15:36.974 --> 00:15:38.975
equally qualified to deliver that.
00:15:39.456 --> 00:15:42.557
So I do think that we're dealing with
00:15:42.618 --> 00:15:45.639
an uneducated population in the
00:15:45.679 --> 00:15:46.660
terminology of
00:15:47.692 --> 00:15:49.312
Um, so of course, like, shoot,
00:15:49.352 --> 00:15:52.053
if I could get a premium, you know,
00:15:52.073 --> 00:15:55.294
the highest expert in the land to paint
00:15:55.315 --> 00:15:56.855
my bathroom, I've said this before,
00:15:56.895 --> 00:15:58.836
like Pablo Picasso could come paint my
00:15:58.876 --> 00:16:01.337
bathroom or I could get John down the
00:16:01.398 --> 00:16:01.898
street.
00:16:02.258 --> 00:16:04.198
Both of them are equally qualified to
00:16:04.239 --> 00:16:05.019
paint a bathroom,
00:16:05.480 --> 00:16:08.000
but I can't get John to paint,
00:16:08.380 --> 00:16:09.041
you know,
00:16:09.140 --> 00:16:11.142
a masterpiece that's going to hang in a
00:16:11.241 --> 00:16:11.782
museum.
00:16:11.922 --> 00:16:13.602
Like these are different things.
00:16:15.226 --> 00:16:17.529
But you do bring up a point,
00:16:17.590 --> 00:16:19.432
which is actually the reverse,
00:16:19.933 --> 00:16:21.296
which is a lot of times you're so
00:16:21.436 --> 00:16:22.057
educated,
00:16:22.277 --> 00:16:24.100
you've gone so far up the ladder,
00:16:24.120 --> 00:16:25.923
you're so removed from doing the everyday
00:16:25.962 --> 00:16:28.166
tasks that a lot of times John the
00:16:28.206 --> 00:16:29.047
painter is better.
00:16:29.628 --> 00:16:31.328
Because Picasso's over here whining and
00:16:31.369 --> 00:16:32.769
dining people to get in the Louvre.
00:16:32.788 --> 00:16:33.669
I don't know if he was ever in
00:16:33.690 --> 00:16:33.990
the Louvre,
00:16:34.289 --> 00:16:36.250
but John's the guy doing the thing.
00:16:36.711 --> 00:16:39.052
So it might actually be reversed.
00:16:39.072 --> 00:16:40.231
You're looking for that person with the
00:16:40.251 --> 00:16:40.991
qualifications,
00:16:41.212 --> 00:16:42.633
but they've spent so much time in
00:16:42.673 --> 00:16:44.413
classrooms getting the qualifications.
00:16:44.734 --> 00:16:46.195
Maybe they're not doing stitches.
00:16:46.274 --> 00:16:48.816
So the PA next to you is actually
00:16:48.836 --> 00:16:49.556
the best person.
00:16:49.936 --> 00:16:51.297
But we are stuck on those labels
00:16:51.336 --> 00:16:51.897
because...
00:16:52.775 --> 00:16:53.756
That's the only thing we can,
00:16:54.157 --> 00:16:56.479
that's the only star we can check off.
00:16:56.499 --> 00:16:59.321
There's no other thing to Yelp people
00:16:59.380 --> 00:16:59.961
about, right?
00:17:00.001 --> 00:17:00.822
It's just, well,
00:17:00.923 --> 00:17:02.303
what are your letters after your name?
00:17:02.644 --> 00:17:05.205
Which goes back to why we chase letters
00:17:05.286 --> 00:17:06.606
after our name, because we're big,
00:17:06.666 --> 00:17:07.268
dumb animals.
00:17:07.347 --> 00:17:10.109
I mean, another major PT organization,
00:17:10.891 --> 00:17:11.730
which surfaced,
00:17:11.872 --> 00:17:13.653
and if memory serves me right,
00:17:14.032 --> 00:17:15.894
they were all about advocacy,
00:17:17.076 --> 00:17:18.616
are now releasing their own continuing
00:17:18.636 --> 00:17:19.538
education units.
00:17:20.406 --> 00:17:21.106
Oh, boy.
00:17:21.146 --> 00:17:22.347
Are you serious?
00:17:22.627 --> 00:17:26.288
Guys, the carousel does two things.
00:17:26.528 --> 00:17:27.689
The carousel does two things.
00:17:27.848 --> 00:17:29.630
It goes up, down, round, and round.
00:17:29.650 --> 00:17:32.490
It goes up, down, round, and round.
00:17:32.530 --> 00:17:36.132
This is all the same thing.
00:17:36.172 --> 00:17:40.053
This is my shocked face.
00:17:40.113 --> 00:17:41.074
We knew this was coming.
00:17:41.114 --> 00:17:42.233
You knew this was coming.
00:17:43.036 --> 00:17:44.477
A little bit of a quick story.
00:17:44.557 --> 00:17:45.277
A week or two ago,
00:17:45.317 --> 00:17:46.156
we took our son.
00:17:46.416 --> 00:17:46.836
He's fine,
00:17:46.856 --> 00:17:48.557
but we took him to a local urgent
00:17:48.577 --> 00:17:48.837
care.
00:17:49.198 --> 00:17:52.019
And one of the so the first person
00:17:52.038 --> 00:17:54.619
that came in announced themselves as like
00:17:54.680 --> 00:17:55.721
the medical assistant.
00:17:55.760 --> 00:17:56.401
So, you know,
00:17:56.461 --> 00:17:58.761
like some subjective questions and,
00:18:00.041 --> 00:18:00.221
you know,
00:18:00.241 --> 00:18:01.282
like height and weight or whatever,
00:18:01.303 --> 00:18:02.022
like that type of stuff.
00:18:03.873 --> 00:18:05.674
Then a provider comes in.
00:18:06.234 --> 00:18:09.018
It says the provider didn't announce,
00:18:09.479 --> 00:18:11.000
like they kind of mumbled their name.
00:18:11.039 --> 00:18:11.380
I was like,
00:18:11.441 --> 00:18:12.821
I think that was the first name,
00:18:12.842 --> 00:18:14.123
but it was just like one name.
00:18:14.163 --> 00:18:16.726
It'd be like Dave or, you know, Kittle.
00:18:16.746 --> 00:18:17.507
I don't know.
00:18:17.567 --> 00:18:18.567
She like mumbled her name.
00:18:20.269 --> 00:18:21.852
She mumbled her first or last name,
00:18:21.872 --> 00:18:25.656
but just one word and did like,
00:18:25.717 --> 00:18:26.837
you know, looking in his mouth,
00:18:26.857 --> 00:18:29.300
looking in his ears and like kind of
00:18:29.320 --> 00:18:29.942
like an exam.
00:18:30.061 --> 00:18:30.383
Great.
00:18:30.542 --> 00:18:30.843
Awesome.
00:18:30.883 --> 00:18:32.746
Like that's and then I know we've talked
00:18:32.766 --> 00:18:33.486
about this other times,
00:18:33.507 --> 00:18:34.548
like I'm just there for.
00:18:35.588 --> 00:18:37.089
I don't really care if it's a physician
00:18:37.230 --> 00:18:41.513
or an NP or a DNP or whatever,
00:18:41.594 --> 00:18:42.454
or I don't know,
00:18:42.494 --> 00:18:44.135
a nurse or a PA.
00:18:44.155 --> 00:18:45.576
We don't know.
00:18:45.596 --> 00:18:46.678
I don't know who it is.
00:18:46.798 --> 00:18:48.900
And the badge says the woman's first and
00:18:48.940 --> 00:18:50.780
last name and it says provider.
00:18:51.080 --> 00:18:52.603
And I'm like, that's a weird,
00:18:52.623 --> 00:18:54.003
I hate that title, but keep going.
00:18:54.394 --> 00:18:54.994
Yeah, I know.
00:18:55.175 --> 00:18:55.476
Right.
00:18:55.536 --> 00:18:57.076
So because I'm in health care and then
00:18:57.096 --> 00:18:58.438
I'm like, I asked it anyway,
00:18:58.458 --> 00:18:59.498
but I know I'm like this.
00:19:00.019 --> 00:19:00.959
This woman's probably going to get
00:19:00.979 --> 00:19:02.619
offended because like it's I'm a male and
00:19:02.640 --> 00:19:04.761
she's a woman and I'm and I'm I'm
00:19:04.821 --> 00:19:05.061
nice.
00:19:05.102 --> 00:19:07.583
I'm not challenging what she is,
00:19:07.623 --> 00:19:09.104
but it's kind of like your company should
00:19:09.144 --> 00:19:09.463
have.
00:19:10.384 --> 00:19:13.826
the NP or PA or MD,
00:19:13.846 --> 00:19:15.446
just put a couple of those letters there.
00:19:15.527 --> 00:19:16.208
I'm just curious.
00:19:16.407 --> 00:19:18.189
I'm just curious who's looking in my son's
00:19:18.249 --> 00:19:18.388
ears.
00:19:18.949 --> 00:19:20.569
I just want to know, hey,
00:19:21.589 --> 00:19:22.130
this is awesome.
00:19:22.171 --> 00:19:22.431
Great.
00:19:22.471 --> 00:19:23.090
There was no wait.
00:19:23.111 --> 00:19:23.810
It was a Saturday.
00:19:23.851 --> 00:19:24.310
This is awesome.
00:19:24.330 --> 00:19:25.751
You guys are places clean.
00:19:25.852 --> 00:19:26.231
Wonderful.
00:19:26.271 --> 00:19:26.972
Everyone's smiling.
00:19:27.333 --> 00:19:28.432
I had no problems at all.
00:19:28.573 --> 00:19:29.233
I was just curious.
00:19:29.253 --> 00:19:30.513
I was like, hey,
00:19:30.554 --> 00:19:32.335
are you one of the physicians here or
00:19:32.414 --> 00:19:35.396
PA or NP or RN?
00:19:36.457 --> 00:19:39.259
And she said a PA.
00:19:39.278 --> 00:19:40.859
But she held up her badge like,
00:19:42.161 --> 00:19:42.500
it's right here.
00:19:42.520 --> 00:19:43.540
And I'm like, no, it's not right there.
00:19:43.560 --> 00:19:44.261
It says provider.
00:19:44.721 --> 00:19:45.863
But I didn't say that.
00:19:45.883 --> 00:19:46.583
But I was kind of like,
00:19:47.523 --> 00:19:48.044
I don't know.
00:19:48.084 --> 00:19:50.065
It's just like another ridiculous aspect
00:19:50.105 --> 00:19:50.625
of health care.
00:19:51.326 --> 00:19:53.207
Or at least this company.
00:19:53.827 --> 00:19:55.167
Why have provider on there?
00:19:55.208 --> 00:19:57.289
Is that, again, so that maybe,
00:19:57.690 --> 00:19:58.470
like Tony said,
00:19:58.509 --> 00:20:00.751
patients don't ask for the physician or
00:20:00.791 --> 00:20:02.093
the DNP or whatever.
00:20:02.173 --> 00:20:04.453
And it's the PA or an RN or
00:20:04.473 --> 00:20:05.994
someone that's coming in to do that.
00:20:06.194 --> 00:20:08.655
lot of basic stuff i'd say that's more
00:20:08.695 --> 00:20:11.136
misleading than anything i mean right i
00:20:11.156 --> 00:20:13.498
mean exactly exactly the front desk can
00:20:13.538 --> 00:20:15.419
provide some things i mean we all provide
00:20:15.618 --> 00:20:18.359
i i get the provider payer sort of
00:20:18.420 --> 00:20:20.820
conversation that shouldn't be in an exam
00:20:20.861 --> 00:20:23.362
room that's a weird weird use of words
00:20:23.382 --> 00:20:25.702
there and she held up her badge like
00:20:25.742 --> 00:20:28.124
almost like it's right here mister and i'm
00:20:28.144 --> 00:20:30.785
like no it's not there it says provider
00:20:31.085 --> 00:20:31.805
that could be anything
00:20:33.951 --> 00:20:36.334
So Ryder could be an RN or whatever.
00:20:36.374 --> 00:20:37.574
I think we agree this is never going
00:20:37.614 --> 00:20:38.974
to end.
00:20:39.015 --> 00:20:41.537
This will just, again, carousel.
00:20:41.656 --> 00:20:42.978
So let me pose this question to you
00:20:42.998 --> 00:20:43.298
guys.
00:20:43.417 --> 00:20:44.398
Will this spread?
00:20:44.459 --> 00:20:47.059
Will the DNP, so two questions.
00:20:47.279 --> 00:20:49.501
Will the NPDNP being barred,
00:20:49.642 --> 00:20:50.863
will it happen in other states?
00:20:51.143 --> 00:20:51.982
One first question.
00:20:52.384 --> 00:20:54.204
And then will it eventually trickle over
00:20:54.244 --> 00:20:55.925
to PT and be barred in California or
00:20:55.986 --> 00:20:56.586
some other states?
00:20:57.426 --> 00:20:57.547
Um.
00:20:59.691 --> 00:21:01.373
Using doctor, if you're not a physician.
00:21:01.492 --> 00:21:02.594
It's funny because when I read this
00:21:02.634 --> 00:21:02.973
article,
00:21:05.175 --> 00:21:06.837
they were framing this under a First
00:21:06.897 --> 00:21:09.420
Amendment issue, which First Amendment,
00:21:09.480 --> 00:21:11.521
getting a lot of press these days.
00:21:11.622 --> 00:21:12.623
It's every couple of years,
00:21:12.702 --> 00:21:13.364
the First Amendment.
00:21:13.703 --> 00:21:16.026
So what they're really doing is they're
00:21:16.125 --> 00:21:19.269
framing this as commercial speech versus
00:21:19.328 --> 00:21:20.910
First Amendment protected speech.
00:21:21.191 --> 00:21:21.951
So let's be very clear.
00:21:22.332 --> 00:21:23.653
If it's commercial speech,
00:21:23.673 --> 00:21:25.074
it's not protected under the First
00:21:25.114 --> 00:21:25.555
Amendment.
00:21:26.451 --> 00:21:30.113
So that's where I don't think it will
00:21:30.153 --> 00:21:31.294
gain legs.
00:21:31.554 --> 00:21:32.714
I don't know if it'll,
00:21:32.875 --> 00:21:34.516
I don't think it'll spread to another
00:21:34.615 --> 00:21:35.016
state.
00:21:35.375 --> 00:21:37.076
And I don't think it'll spread to other
00:21:37.896 --> 00:21:40.538
professions only because there's no money
00:21:40.578 --> 00:21:40.818
in it.
00:21:41.138 --> 00:21:41.298
Like,
00:21:42.339 --> 00:21:44.121
I don't see someone like getting all in
00:21:44.181 --> 00:21:45.781
a tizzy, unless it's the AMA,
00:21:45.821 --> 00:21:47.022
which did not start this,
00:21:47.163 --> 00:21:48.103
unless it was the AMA,
00:21:48.383 --> 00:21:49.263
which to my knowledge,
00:21:49.284 --> 00:21:50.223
according to this article,
00:21:50.605 --> 00:21:52.925
weren't the ones who initiated this.
00:21:54.632 --> 00:21:57.353
I don't know why it wouldn't gain traction
00:21:57.573 --> 00:21:59.333
because, you know,
00:21:59.373 --> 00:22:01.834
if you paid hundreds of thousands of
00:22:01.894 --> 00:22:03.294
dollars for those letters,
00:22:03.334 --> 00:22:04.835
you want to protect those letters.
00:22:04.894 --> 00:22:06.315
This irony in this,
00:22:06.914 --> 00:22:09.675
as we saw from Lifetime Family Fitness,
00:22:10.215 --> 00:22:13.517
we can't even protect DPT.
00:22:13.737 --> 00:22:15.798
I could be a dynamic personal trainer
00:22:15.837 --> 00:22:16.657
tomorrow.
00:22:17.958 --> 00:22:20.459
There's no lawsuits have been won.
00:22:21.118 --> 00:22:23.140
Nobody has stopped using those letters
00:22:23.220 --> 00:22:23.660
like DPT.
00:22:24.115 --> 00:22:26.637
So, I mean, this just goes back to,
00:22:27.659 --> 00:22:31.281
I understand the desire to know who am
00:22:31.362 --> 00:22:32.041
I talking to?
00:22:32.103 --> 00:22:33.163
Who am I listening to?
00:22:33.202 --> 00:22:35.525
Where is this information coming from as a
00:22:35.565 --> 00:22:36.046
consumer?
00:22:36.685 --> 00:22:38.807
I understand the desire to protect your
00:22:38.847 --> 00:22:41.170
credential as a person who paid six
00:22:41.210 --> 00:22:42.171
figures for it.
00:22:42.570 --> 00:22:42.790
Hey,
00:22:43.050 --> 00:22:45.553
I bought this just because it's two
00:22:45.593 --> 00:22:46.034
letters.
00:22:46.193 --> 00:22:47.815
I don't want anybody else to use it.
00:22:48.895 --> 00:22:50.998
So I can see it on all fronts,
00:22:51.357 --> 00:22:53.140
but then it still goes back to,
00:22:53.980 --> 00:22:55.902
society and language,
00:22:56.021 --> 00:22:57.383
it's constantly changing,
00:22:57.462 --> 00:22:59.163
constantly evolving, you know,
00:22:59.263 --> 00:23:00.865
so at some point,
00:23:00.924 --> 00:23:03.926
it's just going to be worthless to have
00:23:03.987 --> 00:23:06.368
those letters or to use that word or
00:23:06.449 --> 00:23:07.950
to do any of that stuff.
00:23:08.471 --> 00:23:09.351
So, you know,
00:23:09.632 --> 00:23:11.593
the reason why it's still a topic is
00:23:11.633 --> 00:23:13.013
because there's still probably some
00:23:13.054 --> 00:23:13.914
inherent value,
00:23:13.934 --> 00:23:15.655
whether it's the university selling the
00:23:15.695 --> 00:23:16.296
doctorate,
00:23:17.156 --> 00:23:19.018
they want to protect the value of that
00:23:19.077 --> 00:23:20.940
six figure education and label.
00:23:21.915 --> 00:23:22.757
Or it's, you know,
00:23:22.797 --> 00:23:25.439
the business selling the impression of
00:23:25.519 --> 00:23:27.040
expertise to the consumer.
00:23:27.740 --> 00:23:28.182
And again,
00:23:28.281 --> 00:23:30.503
I say the impression because we all know
00:23:30.564 --> 00:23:33.705
plenty of doctorate level professionals
00:23:34.106 --> 00:23:36.268
who are not experts in any way.
00:23:36.828 --> 00:23:37.189
You know,
00:23:37.269 --> 00:23:39.310
either they've been in it too long or
00:23:39.351 --> 00:23:40.912
they haven't been in it long enough.
00:23:41.532 --> 00:23:43.974
But there's plenty of craziness and stuff
00:23:43.994 --> 00:23:46.656
going on out there.
00:23:46.737 --> 00:23:48.459
Yeah, this is about money and ego.
00:23:48.538 --> 00:23:49.338
I mean, Lizette.
00:23:50.313 --> 00:23:51.734
summarize that's a little bit of a long
00:23:52.055 --> 00:23:53.696
long comment but can we admit this is
00:23:53.737 --> 00:23:56.359
all about money and md fears i want
00:23:56.380 --> 00:24:00.203
to make sure i have my i it's
00:24:00.223 --> 00:24:02.346
just ego and status you know respectfully
00:24:02.366 --> 00:24:04.528
we all know physicians we know we all
00:24:04.548 --> 00:24:06.771
know many of them i have many you
00:24:06.791 --> 00:24:09.374
know physician buddies and friends uh
00:24:11.049 --> 00:24:12.211
some physicians that were like,
00:24:12.250 --> 00:24:13.931
I'm actually on first name basis with like
00:24:14.030 --> 00:24:14.510
in the area.
00:24:14.951 --> 00:24:16.412
So that's, that's pretty quiet.
00:24:16.432 --> 00:24:17.613
I thought that was like refreshing.
00:24:17.893 --> 00:24:19.673
Um, but yeah,
00:24:20.374 --> 00:24:21.534
and not all of them are like this,
00:24:21.574 --> 00:24:23.654
but there is like the whole God complex
00:24:23.755 --> 00:24:25.315
and you know, that, you know,
00:24:25.355 --> 00:24:27.115
they are at the highest point of the
00:24:27.175 --> 00:24:28.316
hierarchy, Jimmy, like you said.
00:24:28.896 --> 00:24:29.356
So, um,
00:24:30.287 --> 00:24:32.368
Yeah, but again, just to recap,
00:24:32.469 --> 00:24:34.111
these nurses in this article in
00:24:34.151 --> 00:24:36.773
California, as far as we know,
00:24:37.355 --> 00:24:39.636
they're not telling patients that I'm your
00:24:39.758 --> 00:24:40.077
MD.
00:24:40.679 --> 00:24:42.160
They're not telling patients I'm your
00:24:42.200 --> 00:24:42.901
medical doctor.
00:24:43.481 --> 00:24:45.564
They're saying I am Dr. Smith.
00:24:46.265 --> 00:24:47.445
I'm Dr. Johnson.
00:24:48.227 --> 00:24:50.368
So, and I agree, Tony, like,
00:24:52.304 --> 00:24:53.845
I'm Dr. Kittle, your physical therapist.
00:24:54.164 --> 00:24:55.586
When I text patients, I use Dr.
00:24:55.786 --> 00:24:56.326
Dave Kittle.
00:24:56.365 --> 00:24:58.887
When I email them on my business cards,
00:24:58.928 --> 00:24:59.769
on my website, Tony,
00:24:59.788 --> 00:25:00.548
that means you haven't looked at my
00:25:00.568 --> 00:25:01.869
website, on the About Us page,
00:25:02.289 --> 00:25:03.951
all of my therapists are listed as doctor
00:25:04.511 --> 00:25:05.432
if they have a doctorate.
00:25:06.232 --> 00:25:08.394
But it says doctor of physical therapy.
00:25:08.755 --> 00:25:11.777
Nowhere on any of our correspondence or
00:25:11.957 --> 00:25:13.238
anything, anywhere ever,
00:25:13.938 --> 00:25:15.558
are we saying physician, doctor,
00:25:16.440 --> 00:25:19.300
chiropractic physician whatever that is uh
00:25:19.641 --> 00:25:21.102
we're not saying md we're not saying
00:25:21.142 --> 00:25:23.803
medical doctor we're not saying medical
00:25:23.843 --> 00:25:26.384
school nothing nothing to you know it's
00:25:26.483 --> 00:25:29.365
very clear delineation yeah clarity should
00:25:29.404 --> 00:25:31.026
be king i i am a little bit
00:25:31.105 --> 00:25:32.886
irked about the grammar of doctor of
00:25:32.946 --> 00:25:33.807
chiropractic
00:25:34.912 --> 00:25:35.932
it feels like there should be a word
00:25:35.972 --> 00:25:37.294
after that, like chiropractic,
00:25:37.433 --> 00:25:39.476
something doctor of chiropractic is a
00:25:39.557 --> 00:25:39.856
title.
00:25:39.896 --> 00:25:40.257
And I'm like,
00:25:40.738 --> 00:25:42.499
that's why they call themselves car.
00:25:42.519 --> 00:25:44.320
Some say chiropractic physicians.
00:25:44.601 --> 00:25:47.003
Yeah, that I'm sorry, but that,
00:25:47.023 --> 00:25:48.045
that one feels like it's,
00:25:48.704 --> 00:25:50.606
is it the state that determines if they
00:25:50.727 --> 00:25:52.028
use the label physician?
00:25:53.384 --> 00:25:54.026
Most likely.
00:25:54.145 --> 00:25:54.465
I think so.
00:25:54.526 --> 00:25:55.968
I think so.
00:25:56.208 --> 00:25:57.609
So that's why I think it's interesting
00:25:57.630 --> 00:25:59.971
that this started in California.
00:26:00.092 --> 00:26:01.874
It could be a sign that they're trying
00:26:01.913 --> 00:26:02.094
to,
00:26:02.134 --> 00:26:04.557
because I think if you can get traction
00:26:04.596 --> 00:26:06.219
in California, New York, Florida,
00:26:06.659 --> 00:26:07.940
I think you might be able to challenge
00:26:07.960 --> 00:26:08.760
this other places.
00:26:09.082 --> 00:26:10.242
But did it say in the article who
00:26:10.303 --> 00:26:11.124
initiated this?
00:26:11.144 --> 00:26:13.586
I don't know.
00:26:13.866 --> 00:26:15.468
It just said a federal judge has ruled
00:26:15.548 --> 00:26:15.929
that.
00:26:19.612 --> 00:26:20.712
I would want to know who actually
00:26:20.752 --> 00:26:21.673
initiated this.
00:26:22.394 --> 00:26:25.696
I'm sure the AMA dropped off a briefcase
00:26:25.737 --> 00:26:26.897
of cash to this judge.
00:26:27.259 --> 00:26:28.779
I'm half joking, half serious.
00:26:29.039 --> 00:26:30.361
I'm half joking, half serious.
00:26:31.142 --> 00:26:32.042
These days, you never know.
00:26:32.363 --> 00:26:33.523
You can't track cash.
00:26:34.605 --> 00:26:36.126
Maybe there's barcode numbers or whatever,
00:26:36.166 --> 00:26:36.267
but
00:26:37.816 --> 00:26:40.316
So let me pivot just a little bit.
00:26:40.395 --> 00:26:42.477
I had an interesting experience yesterday.
00:26:43.737 --> 00:26:44.717
Longtime patient.
00:26:44.817 --> 00:26:45.797
This was an individual.
00:26:45.856 --> 00:26:47.817
I've probably worked with this individual,
00:26:48.077 --> 00:26:49.917
let's say a decade now, on and off.
00:26:51.238 --> 00:26:53.959
This individual has ties to my family.
00:26:54.898 --> 00:26:57.419
We've known each other since before this
00:26:57.479 --> 00:26:59.119
person needed physical therapy.
00:27:00.440 --> 00:27:02.559
This particular individual is on a
00:27:02.640 --> 00:27:05.181
Medicare Advantage plan and had a twenty
00:27:05.240 --> 00:27:06.941
visit limit for the calendar year.
00:27:07.756 --> 00:27:08.316
That's horrible.
00:27:08.355 --> 00:27:10.096
Had a procedure, had a procedure,
00:27:10.136 --> 00:27:10.936
came to us.
00:27:10.997 --> 00:27:12.317
We did physical therapy,
00:27:12.916 --> 00:27:14.377
utilized the twenty visits.
00:27:14.438 --> 00:27:16.857
This individual continues to need therapy
00:27:16.897 --> 00:27:17.518
services.
00:27:17.557 --> 00:27:20.759
So we invited this person to our non
00:27:20.818 --> 00:27:24.160
cover or non covered maintenance program.
00:27:24.180 --> 00:27:25.319
Some people would call it a wellness
00:27:25.359 --> 00:27:25.759
program.
00:27:25.779 --> 00:27:27.560
We're like, look, hundred dollars a month.
00:27:27.980 --> 00:27:29.121
You come in twice a week.
00:27:29.540 --> 00:27:31.080
You have access to all of the equipment.
00:27:31.121 --> 00:27:32.182
You have access to us.
00:27:32.201 --> 00:27:33.461
We'll make sure you're doing everything
00:27:33.541 --> 00:27:33.821
right.
00:27:34.861 --> 00:27:35.401
And, you know,
00:27:35.441 --> 00:27:37.883
this was an affordable alternative option
00:27:38.542 --> 00:27:39.743
for this individual.
00:27:40.924 --> 00:27:42.766
It's not a money driver for us.
00:27:42.925 --> 00:27:44.027
We make a little bit of money.
00:27:44.366 --> 00:27:45.027
It's fine.
00:27:45.268 --> 00:27:47.288
But it's more just to keep engagement,
00:27:47.308 --> 00:27:48.650
keep the community coming.
00:27:48.670 --> 00:27:48.930
You know,
00:27:48.990 --> 00:27:51.351
somebody who has made the effort to get
00:27:51.391 --> 00:27:53.152
in their car and drive to our clinic.
00:27:53.211 --> 00:27:55.054
I'm never going to say you can't come
00:27:55.513 --> 00:27:57.174
because you can't afford it or your
00:27:57.234 --> 00:27:58.776
insurance doesn't cover it or whatever.
00:27:59.701 --> 00:28:02.461
So this is something we offer a lot
00:28:02.561 --> 00:28:04.782
of post discharge patients.
00:28:05.883 --> 00:28:07.143
I got a call yesterday.
00:28:07.782 --> 00:28:10.344
This person was so upset and I understand
00:28:10.423 --> 00:28:10.544
it.
00:28:10.923 --> 00:28:12.984
This person was like, Tony, I'm so sorry.
00:28:13.045 --> 00:28:14.464
My doctor said I have to go to
00:28:14.525 --> 00:28:15.425
their therapy.
00:28:15.965 --> 00:28:18.967
This was a local hospital doctor and
00:28:18.987 --> 00:28:19.567
they're like,
00:28:19.707 --> 00:28:21.928
you need therapy for this other condition
00:28:21.968 --> 00:28:23.127
and you have to come to us.
00:28:23.900 --> 00:28:25.921
I'm like, hey, that's totally fine.
00:28:25.980 --> 00:28:26.740
I totally get it.
00:28:26.780 --> 00:28:28.840
Listen, it's really not a big deal.
00:28:28.901 --> 00:28:30.241
I think it's great for patients to see
00:28:30.281 --> 00:28:31.021
other therapists.
00:28:31.082 --> 00:28:32.402
I'm sure those therapists are going to be
00:28:32.461 --> 00:28:32.761
great.
00:28:33.561 --> 00:28:33.762
I said,
00:28:33.782 --> 00:28:36.722
but I want you to understand you've
00:28:36.762 --> 00:28:39.304
exhausted your twenty visit limit for the
00:28:39.344 --> 00:28:40.064
calendar year.
00:28:41.003 --> 00:28:43.085
It's a hospital based outpatient clinic.
00:28:43.125 --> 00:28:45.486
You are going to be charged two to
00:28:45.506 --> 00:28:47.185
three hundred dollars a session.
00:28:48.509 --> 00:28:50.029
She was like, I totally get it.
00:28:50.151 --> 00:28:50.570
I know.
00:28:50.611 --> 00:28:52.651
But I feel like there's nothing I can
00:28:52.671 --> 00:28:52.830
do.
00:28:52.851 --> 00:28:54.471
I was like, you always have a choice.
00:28:54.751 --> 00:28:55.751
You're free to choose.
00:28:55.791 --> 00:28:57.452
But I totally understand the pressure.
00:28:58.093 --> 00:28:59.633
Listen, don't worry about it.
00:28:59.692 --> 00:29:01.153
But I'm just curious.
00:29:01.534 --> 00:29:02.794
So what are they doing there?
00:29:02.814 --> 00:29:05.115
Well, you know,
00:29:05.154 --> 00:29:07.476
the therapist had me sucking in.
00:29:07.536 --> 00:29:07.695
Yeah.
00:29:09.953 --> 00:29:14.297
What was the first thing you said?
00:29:14.738 --> 00:29:17.319
The therapist had me sucking in my tummy
00:29:17.980 --> 00:29:21.623
and pumping my ankle and lifting my leg
00:29:21.663 --> 00:29:22.443
and bending over,
00:29:22.483 --> 00:29:23.865
but it really hurt when I did it,
00:29:23.904 --> 00:29:25.086
but I did it anyway.
00:29:26.086 --> 00:29:28.669
And so in my mind, obviously I'm thinking,
00:29:28.909 --> 00:29:29.869
you know, okay,
00:29:30.029 --> 00:29:31.471
she's getting the standard of care.
00:29:31.651 --> 00:29:34.953
Like she's not getting what the standard
00:29:35.013 --> 00:29:36.535
of care would consider bad therapy.
00:29:36.555 --> 00:29:37.615
It's what everybody's going to do.
00:29:38.472 --> 00:29:40.574
She's going to walk away with thousands of
00:29:40.634 --> 00:29:42.556
dollars in, you know, bills.
00:29:43.355 --> 00:29:45.217
She could come to us here.
00:29:45.998 --> 00:29:48.019
She was doing all sorts of, you know,
00:29:48.118 --> 00:29:48.999
function based.
00:29:49.339 --> 00:29:50.140
I've got videos,
00:29:50.180 --> 00:29:51.961
published videos of her getting on the
00:29:51.980 --> 00:29:53.442
floor, getting off the floor,
00:29:53.501 --> 00:29:55.022
doing functional transfers.
00:29:56.104 --> 00:29:57.243
There's a whole bunch of stuff.
00:29:57.324 --> 00:29:59.125
But I'm just like, once again,
00:29:59.205 --> 00:30:02.688
we talk about the power of, you know,
00:30:02.887 --> 00:30:03.688
influence.
00:30:04.269 --> 00:30:05.930
Whoever the medical doctor is,
00:30:06.049 --> 00:30:06.410
I don't know.
00:30:06.450 --> 00:30:08.111
I have no connection to this physician.
00:30:09.073 --> 00:30:11.734
But I'm like, one thing is said,
00:30:12.155 --> 00:30:13.876
likely because they're being pressured by
00:30:13.916 --> 00:30:15.759
upper management to keep all the referrals
00:30:15.818 --> 00:30:16.420
in-house.
00:30:17.279 --> 00:30:20.722
And now potentially this individual is
00:30:20.742 --> 00:30:22.545
going to have five years,
00:30:22.585 --> 00:30:24.145
ten years of medical bills that are
00:30:24.247 --> 00:30:25.548
probably never going to get paid.
00:30:26.343 --> 00:30:28.164
Because they have access to me,
00:30:28.204 --> 00:30:29.046
but they're not,
00:30:29.266 --> 00:30:30.826
they think they can't come to me for
00:30:30.846 --> 00:30:32.067
a hundred bucks a month and they're going
00:30:32.088 --> 00:30:34.611
to go to this hospital outpatient clinic
00:30:34.651 --> 00:30:36.532
where the therapist probably has no idea
00:30:36.932 --> 00:30:38.634
they're charging three hundred dollars a
00:30:38.694 --> 00:30:39.055
session.
00:30:39.955 --> 00:30:40.256
You know,
00:30:40.616 --> 00:30:42.438
any thoughts on that whole kind of
00:30:42.498 --> 00:30:44.240
experience?
00:30:44.299 --> 00:30:44.980
It's a wrecking ball.
00:30:47.474 --> 00:30:48.154
How do we change it?
00:30:48.295 --> 00:30:49.016
How do we stop it?
00:30:49.056 --> 00:30:50.715
How do we make it better?
00:30:50.856 --> 00:30:51.217
Well,
00:30:51.317 --> 00:30:52.998
one thing that I think you floated to
00:30:53.038 --> 00:30:53.238
her,
00:30:53.438 --> 00:30:54.857
you kind of said that you always have
00:30:54.917 --> 00:30:55.318
choice.
00:30:55.338 --> 00:30:56.159
Yeah.
00:30:56.278 --> 00:30:57.640
I think you said to her directly,
00:30:58.160 --> 00:31:00.760
it sounds like you said to her directly,
00:31:00.800 --> 00:31:01.942
you don't have to go there.
00:31:02.001 --> 00:31:02.981
You can come to our clinic.
00:31:03.001 --> 00:31:04.202
You can go to some other place down
00:31:04.222 --> 00:31:04.563
the road.
00:31:04.603 --> 00:31:05.423
You have choice.
00:31:06.022 --> 00:31:08.064
But she's trusting and believing in the
00:31:08.904 --> 00:31:10.444
MD, the medical doctor here,
00:31:10.785 --> 00:31:11.566
the main physician.
00:31:12.086 --> 00:31:14.227
They're saying you have this other
00:31:14.267 --> 00:31:14.707
condition.
00:31:14.747 --> 00:31:16.268
You need this treated immediately.
00:31:16.667 --> 00:31:18.048
and you have to go to this hospital-based
00:31:18.169 --> 00:31:20.391
practice that is i don't say it's not
00:31:20.490 --> 00:31:22.511
fraud what i mean it's wrong it's the
00:31:22.551 --> 00:31:24.913
physician the patient has choice the
00:31:24.993 --> 00:31:26.575
healthcare consumer has choice they can go
00:31:26.654 --> 00:31:28.497
anywhere they want to go they can go
00:31:28.517 --> 00:31:31.179
to a household-based clinic and you know
00:31:31.199 --> 00:31:32.499
rack up that bill of five grand or
00:31:32.519 --> 00:31:33.920
whatever if they want to of their own
00:31:33.961 --> 00:31:35.642
volition this doesn't sound like it was
00:31:35.701 --> 00:31:37.063
under her own volition it sounded like she
00:31:37.083 --> 00:31:40.005
was pressured to do so which is ridiculous
00:31:40.788 --> 00:31:41.867
I mean, the thing is,
00:31:42.709 --> 00:31:45.150
you look at the most influential people.
00:31:45.230 --> 00:31:45.470
Now,
00:31:45.809 --> 00:31:48.451
I think we probably have a different
00:31:48.490 --> 00:31:51.313
perspective on anyone in healthcare.
00:31:51.932 --> 00:31:54.173
I fully admit it.
00:31:54.334 --> 00:31:54.993
I am biased.
00:31:55.513 --> 00:31:56.595
You, Dave Kittle,
00:31:56.615 --> 00:31:58.215
who I respect implicitly,
00:31:58.256 --> 00:31:59.215
come to me and say, Tony,
00:31:59.256 --> 00:32:00.155
you should be doing this.
00:32:00.817 --> 00:32:02.317
I'm generally going to disagree.
00:32:02.717 --> 00:32:04.117
My immediate response is,
00:32:04.157 --> 00:32:05.038
Dave's probably wrong.
00:32:05.097 --> 00:32:06.078
Dave doesn't understand.
00:32:06.118 --> 00:32:07.318
He doesn't know my context.
00:32:07.338 --> 00:32:08.420
He doesn't know what's going on.
00:32:09.098 --> 00:32:11.380
I'm always going to go against anyone in
00:32:11.440 --> 00:32:13.241
authority who tells me to do something
00:32:13.281 --> 00:32:14.823
just because that's my nature.
00:32:14.883 --> 00:32:16.663
I'm always going to second guess what you
00:32:16.703 --> 00:32:19.384
say until you prove that I am wrong
00:32:19.565 --> 00:32:20.465
in second guessing you.
00:32:21.095 --> 00:32:22.836
But so many of our patients are like,
00:32:22.976 --> 00:32:25.476
look, my priest and my doctor,
00:32:25.936 --> 00:32:28.798
that's who I listen to, like nobody else.
00:32:29.377 --> 00:32:32.538
And so even with our history of over
00:32:32.598 --> 00:32:34.859
a decade of working together and family
00:32:34.900 --> 00:32:36.819
connections and knowing each other,
00:32:37.400 --> 00:32:39.520
the doctor said, do this.
00:32:40.080 --> 00:32:42.102
There is no way this person is not
00:32:42.142 --> 00:32:42.561
going to do it,
00:32:43.142 --> 00:32:44.502
even if it's to their detriment,
00:32:44.962 --> 00:32:45.962
even if she gets worse,
00:32:46.564 --> 00:32:48.223
even if she has a negative experience,
00:32:48.304 --> 00:32:50.384
a negative outcome and wastes a ton of
00:32:50.424 --> 00:32:50.625
money.
00:32:51.394 --> 00:32:53.557
she cannot go back in her mind to
00:32:53.577 --> 00:32:54.819
that doctor and say,
00:32:55.461 --> 00:32:56.742
I didn't listen to you.
00:32:58.076 --> 00:33:00.616
We don't realize the impact and the power
00:33:01.057 --> 00:33:02.356
that physicians,
00:33:02.396 --> 00:33:04.298
but even we at a certain level,
00:33:04.758 --> 00:33:06.598
have over these individuals.
00:33:06.659 --> 00:33:07.838
And it's scary.
00:33:07.898 --> 00:33:09.358
I mean, it's shockingly scary.
00:33:09.618 --> 00:33:12.799
I know I have told people things off
00:33:12.819 --> 00:33:15.661
the cuff that I thought had zero value.
00:33:16.101 --> 00:33:18.842
And they come back and tell me how
00:33:18.942 --> 00:33:20.403
impactful that was.
00:33:20.502 --> 00:33:21.623
And it blew my mind.
00:33:22.247 --> 00:33:23.027
Yeah.
00:33:23.086 --> 00:33:23.968
How would you fix it?
00:33:24.367 --> 00:33:25.689
If you were in charge and you could,
00:33:25.769 --> 00:33:26.949
and you can wave a magic wand,
00:33:27.009 --> 00:33:27.670
I have an idea,
00:33:27.990 --> 00:33:29.170
but I want to hear from you guys.
00:33:29.190 --> 00:33:30.030
Well, how would you fix it?
00:33:30.671 --> 00:33:31.651
Dave, any ideas?
00:33:31.751 --> 00:33:32.412
I have no idea.
00:33:32.571 --> 00:33:33.352
I'm out of ideas.
00:33:34.292 --> 00:33:36.253
I, I was going to say, I don't,
00:33:36.433 --> 00:33:37.374
I don't know how to fix it.
00:33:37.433 --> 00:33:39.835
I think it's extremely challenging because
00:33:40.375 --> 00:33:42.656
a lot of the individuals that Tony is
00:33:42.717 --> 00:33:44.277
referring to, like, it's not, it's,
00:33:44.297 --> 00:33:45.397
it's not, it's not, it's not, it's not,
00:33:45.417 --> 00:33:46.417
it's not, it's not, it's not, it's not,
00:33:46.439 --> 00:33:47.519
it's not, it's not, it's not, it's not,
00:33:47.538 --> 00:33:48.278
it's not, it's not, it's not, it's not,
00:33:48.298 --> 00:33:49.380
it's not, it's not, it's not, it's not,
00:33:49.420 --> 00:33:50.440
it's not, it's not, it's not, it's not,
00:33:50.460 --> 00:33:51.621
it's not, it's not, it's not, it's not,
00:33:51.641 --> 00:33:51.681
it
00:33:52.659 --> 00:33:55.076
the more likely they are to like just
00:33:56.423 --> 00:33:59.203
just bow and listen and do whatever the
00:33:59.223 --> 00:34:00.943
physician says, regardless, like,
00:34:01.484 --> 00:34:02.444
you know, Oh, I need,
00:34:02.545 --> 00:34:03.484
I need a new statin.
00:34:03.765 --> 00:34:04.285
I, you know, I got,
00:34:04.365 --> 00:34:05.266
I need a new stat and I got
00:34:05.286 --> 00:34:06.226
to get it on a new stat and
00:34:06.346 --> 00:34:09.086
like, like no pushback, no research, no,
00:34:09.407 --> 00:34:10.786
let me try to change my diet and
00:34:10.847 --> 00:34:11.628
exercise.
00:34:11.688 --> 00:34:13.907
And let me, you know, just, just like,
00:34:14.047 --> 00:34:14.608
I will do that.
00:34:14.648 --> 00:34:14.869
Like,
00:34:14.889 --> 00:34:16.628
it's very robotic for the older
00:34:16.929 --> 00:34:17.469
population.
00:34:17.610 --> 00:34:19.489
And I think the opposite for the twenty,
00:34:19.530 --> 00:34:20.170
thirty year olds,
00:34:20.650 --> 00:34:22.891
forty year olds that are like questioning.
00:34:22.951 --> 00:34:24.791
So they're like, Tony, you know, Tony's a,
00:34:26.072 --> 00:34:27.454
uh you know a little bit a little
00:34:27.474 --> 00:34:28.855
bit older than that but tony still has
00:34:28.875 --> 00:34:30.597
like that younger mindset of like uh
00:34:30.637 --> 00:34:32.438
questioning and pushing back and i'm the
00:34:32.458 --> 00:34:35.501
same way and so i don't know if
00:34:35.521 --> 00:34:36.722
there's any way to change it but the
00:34:36.762 --> 00:34:38.384
younger population the younger generation
00:34:38.423 --> 00:34:40.706
now will continue to be that way they're
00:34:40.726 --> 00:34:41.827
going to question things they're going to
00:34:41.847 --> 00:34:43.307
do research they're going to ask friends
00:34:43.347 --> 00:34:45.170
and colleagues and do you maybe do you
00:34:45.190 --> 00:34:46.710
know a physician or a physical therapist
00:34:46.751 --> 00:34:48.713
to speak with and there's just more
00:34:49.653 --> 00:34:51.153
I don't know if it's because of social
00:34:51.173 --> 00:34:54.014
media or the internet or YouTube or just
00:34:54.295 --> 00:34:56.815
available information that's readily
00:34:57.295 --> 00:34:58.295
accessible anywhere.
00:34:59.275 --> 00:35:01.215
The younger population is more likely to
00:35:01.456 --> 00:35:02.317
challenge things,
00:35:03.577 --> 00:35:06.297
even push back a little bit or do
00:35:06.317 --> 00:35:07.557
some other research before they make a
00:35:07.597 --> 00:35:07.958
decision.
00:35:07.998 --> 00:35:09.438
Whereas someone who's sixty, seventy,
00:35:09.518 --> 00:35:09.717
eighty,
00:35:09.777 --> 00:35:11.797
ninety is not going to do any of
00:35:11.818 --> 00:35:12.239
that stuff.
00:35:12.318 --> 00:35:13.418
It's just like, oh, I heard it.
00:35:13.438 --> 00:35:14.079
I heard this.
00:35:14.498 --> 00:35:15.119
This is it.
00:35:15.199 --> 00:35:17.920
I'm taking it basically as gospel and
00:35:18.320 --> 00:35:19.159
there is no pushback.
00:35:20.813 --> 00:35:20.934
Yeah,
00:35:20.954 --> 00:35:22.596
the example that I thought of is I
00:35:22.615 --> 00:35:23.836
just got a new car a couple months
00:35:23.876 --> 00:35:26.400
ago, and it's really cool on the inside.
00:35:26.519 --> 00:35:27.360
Looks really slick.
00:35:27.442 --> 00:35:28.922
It's Toyota Camry hybrid,
00:35:28.943 --> 00:35:29.923
in case you guys were wondering.
00:35:30.764 --> 00:35:32.626
But I'm not much of an aesthetic guy,
00:35:32.967 --> 00:35:34.590
but there's part of the inside of that
00:35:34.610 --> 00:35:36.271
car that is absolutely ruined.
00:35:36.791 --> 00:35:40.275
And it's the part of the visor that
00:35:40.315 --> 00:35:40.795
shows.
00:35:41.217 --> 00:35:42.338
And there's a warning on it.
00:35:42.838 --> 00:35:44.079
It's not a sticker.
00:35:44.440 --> 00:35:45.360
I can't pull it off.
00:35:45.420 --> 00:35:46.342
Like I saw the warning.
00:35:46.362 --> 00:35:47.023
God, I can't pull it.
00:35:47.123 --> 00:35:49.204
It is painted on there.
00:35:49.344 --> 00:35:50.326
I have no idea what it's even about.
00:35:50.365 --> 00:35:52.068
Probably airbags or wear your seatbelt or
00:35:52.168 --> 00:35:52.588
I don't know.
00:35:52.889 --> 00:35:53.849
But it's printed on there.
00:35:55.469 --> 00:35:56.449
Do you, Tony,
00:35:56.710 --> 00:36:00.373
have to have signs posted in the break
00:36:00.414 --> 00:36:01.474
room at your clinic?
00:36:02.034 --> 00:36:05.739
Things about like FMLA or FSLA or EEO?
00:36:05.798 --> 00:36:06.179
Yeah,
00:36:07.119 --> 00:36:08.922
I'm looking across it right in front of
00:36:08.942 --> 00:36:09.623
me right now.
00:36:09.682 --> 00:36:11.764
And there's all these Ohio Labor signs.
00:36:13.846 --> 00:36:14.947
federal posting requirements all this
00:36:14.967 --> 00:36:17.889
garbage so if this really was an issue
00:36:18.088 --> 00:36:20.269
if this was important like so it sounds
00:36:20.309 --> 00:36:21.931
like if i get a referral from the
00:36:21.972 --> 00:36:23.411
hospital i just have to go to the
00:36:23.472 --> 00:36:25.893
outpatient i don't they said go talk to
00:36:25.934 --> 00:36:28.215
karen down the hall and you just feel
00:36:28.235 --> 00:36:30.436
like you're ushered down the hall i feel
00:36:30.456 --> 00:36:31.757
like you should have to be given a
00:36:31.858 --> 00:36:34.340
yellow piece of paper that says like stop
00:36:35.059 --> 00:36:36.380
These are your rights.
00:36:36.420 --> 00:36:38.340
And I know hospitals give you â probably
00:36:38.360 --> 00:36:40.981
they participate in a little bit of what's
00:36:41.001 --> 00:36:42.981
called malicious compliance, right?
00:36:43.382 --> 00:36:44.742
Well, I have to give you some paperwork.
00:36:44.981 --> 00:36:46.762
So I'm going to give you seventy-two pages
00:36:46.802 --> 00:36:47.402
of paperwork.
00:36:47.422 --> 00:36:48.882
So I'm going to dilute everything that you
00:36:48.922 --> 00:36:49.402
have to do.
00:36:49.824 --> 00:36:51.884
But if we said you have to post
00:36:52.284 --> 00:36:53.463
this poster,
00:36:53.764 --> 00:36:56.244
this has to be handed in card form
00:36:56.485 --> 00:36:58.146
to every single person you're going to
00:36:58.166 --> 00:37:02.947
give a referral to to â
00:37:00.065 --> 00:37:02.728
the Ten Commandments of your rights as a
00:37:02.788 --> 00:37:03.208
patient,
00:37:03.268 --> 00:37:05.190
you do not have to actually go to
00:37:05.271 --> 00:37:06.030
where this place is.
00:37:06.070 --> 00:37:07.793
You can, but you don't have to.
00:37:08.253 --> 00:37:09.655
If it was that big of a problem,
00:37:09.855 --> 00:37:11.175
that's the thing I would march to
00:37:11.215 --> 00:37:12.117
Washington and say,
00:37:12.737 --> 00:37:13.978
if I were a profession,
00:37:14.539 --> 00:37:15.300
we're getting smoked.
00:37:15.320 --> 00:37:17.021
I mean, Tony's idea the other day was,
00:37:17.061 --> 00:37:17.422
you know what?
00:37:17.481 --> 00:37:18.242
Just let them have it.
00:37:18.362 --> 00:37:19.003
Let them have that.
00:37:19.023 --> 00:37:20.563
We'll do everything else, right?
00:37:20.885 --> 00:37:21.545
I understand that.
00:37:21.585 --> 00:37:21.784
Like...
00:37:22.505 --> 00:37:24.806
never retreat, never leave a man behind.
00:37:25.128 --> 00:37:26.867
Well, no, sometimes they leave men behind.
00:37:26.949 --> 00:37:29.010
Sometimes you retreat to fight another day
00:37:29.170 --> 00:37:31.110
or this isn't the hill I want to
00:37:31.170 --> 00:37:31.791
die on.
00:37:32.231 --> 00:37:34.293
So if this was actually important,
00:37:34.373 --> 00:37:36.094
either do something about it big enough to
00:37:36.134 --> 00:37:37.554
make change or don't.
00:37:37.914 --> 00:37:40.956
So that would be my simple but not
00:37:41.056 --> 00:37:41.797
easy solution,
00:37:41.836 --> 00:37:43.878
which is you have someone's going to write
00:37:43.918 --> 00:37:46.378
that letter of the law and it has
00:37:46.398 --> 00:37:47.300
to be handed out.
00:37:47.360 --> 00:37:48.800
And if not, there's a fine.
00:37:48.820 --> 00:37:49.780
There's got to be some sort of
00:37:49.820 --> 00:37:51.081
consequences for not doing it.
00:37:51.744 --> 00:37:53.143
I'm going to go a different direction,
00:37:53.463 --> 00:37:54.885
but real quick, Ray's here,
00:37:54.925 --> 00:37:55.885
Stephen's here,
00:37:57.465 --> 00:37:58.985
Will Boyd was here earlier.
00:37:59.485 --> 00:37:59.606
Okay,
00:37:59.686 --> 00:38:01.425
I'm going to go a different direction,
00:38:01.465 --> 00:38:03.507
though, because like you just said,
00:38:03.547 --> 00:38:06.088
you have that massive warning over your
00:38:06.168 --> 00:38:06.748
visor.
00:38:06.947 --> 00:38:08.068
You don't even know what it says.
00:38:08.128 --> 00:38:10.869
I've got employment records on the wall.
00:38:11.329 --> 00:38:12.869
Nobody who works for me knows what they
00:38:12.969 --> 00:38:13.208
are.
00:38:13.670 --> 00:38:15.590
Going to the government once again to
00:38:15.630 --> 00:38:18.650
protect, you know, it never works.
00:38:18.690 --> 00:38:19.351
It never works.
00:38:20.889 --> 00:38:22.690
The same doctor, I would bet,
00:38:22.791 --> 00:38:24.913
the same doctor who said you have to
00:38:24.952 --> 00:38:27.074
go to our physical therapy clinic probably
00:38:27.114 --> 00:38:28.954
said you shouldn't eat McDonald's,
00:38:29.534 --> 00:38:32.036
and yet the consumer will continue to eat
00:38:32.077 --> 00:38:32.717
McDonald's.
00:38:33.458 --> 00:38:35.259
Shout out to my McCafe, right?
00:38:36.239 --> 00:38:38.920
It's not about forcing people to do
00:38:38.981 --> 00:38:39.561
something.
00:38:40.101 --> 00:38:40.641
It's about...
00:38:41.652 --> 00:38:43.554
finding the motivation that makes them
00:38:43.594 --> 00:38:46.496
choose to do what they want to do
00:38:46.576 --> 00:38:47.036
ultimately.
00:38:47.536 --> 00:38:49.036
Why is she going to therapy there?
00:38:49.117 --> 00:38:51.577
Not because she wants to go to therapy
00:38:51.637 --> 00:38:52.059
there,
00:38:52.278 --> 00:38:54.139
not because the doctor is forcing her as
00:38:54.219 --> 00:38:57.420
much as she wants to please the doctor.
00:38:57.440 --> 00:38:58.581
There is an inherent,
00:38:59.101 --> 00:39:02.463
I want to get affirmation from you,
00:39:02.603 --> 00:39:03.224
doctor,
00:39:03.664 --> 00:39:05.465
to tell me that I'm doing the right
00:39:05.505 --> 00:39:05.766
thing.
00:39:06.827 --> 00:39:09.409
So I think the way you change that
00:39:09.509 --> 00:39:11.731
is direct-to-consumer marketing.
00:39:12.231 --> 00:39:13.952
This is where you get the messaging in
00:39:14.012 --> 00:39:14.434
hand.
00:39:15.153 --> 00:39:15.474
Again,
00:39:15.514 --> 00:39:17.516
you sacrifice the label of physical
00:39:17.577 --> 00:39:19.378
therapy, which who even cares anymore?
00:39:19.438 --> 00:39:22.681
Those words have very little value in
00:39:22.722 --> 00:39:23.842
today's market,
00:39:24.242 --> 00:39:25.684
especially if we're talking outpatient
00:39:25.744 --> 00:39:26.264
orthopedic.
00:39:27.498 --> 00:39:29.818
And we pivot to what are the things
00:39:29.858 --> 00:39:32.159
these consumers are buying anyway?
00:39:32.199 --> 00:39:33.740
What are the things that they want?
00:39:33.800 --> 00:39:35.561
What are the things that they desire?
00:39:36.101 --> 00:39:37.583
Let's bring that out.
00:39:37.922 --> 00:39:39.784
Let's develop and harness that.
00:39:40.364 --> 00:39:42.465
And then I think it doesn't matter what
00:39:42.505 --> 00:39:43.204
the doctor says.
00:39:43.264 --> 00:39:44.686
It doesn't matter if they're going to
00:39:44.726 --> 00:39:46.007
therapy at the other place.
00:39:46.126 --> 00:39:47.487
I've had plenty of patients that go to
00:39:47.507 --> 00:39:48.927
therapy at one place and then come to
00:39:48.947 --> 00:39:51.648
me because they want what I have.
00:39:51.688 --> 00:39:53.070
They know that I can make them feel
00:39:53.090 --> 00:39:53.269
good.
00:39:53.831 --> 00:39:54.172
You know,
00:39:54.592 --> 00:39:57.434
and so I don't think government
00:39:57.494 --> 00:39:59.195
intervention is going to do anything to
00:39:59.215 --> 00:40:00.416
fix a problem like that.
00:40:01.577 --> 00:40:03.679
The law already exists that you have to
00:40:03.719 --> 00:40:04.860
give patients choice.
00:40:04.960 --> 00:40:05.661
They don't do it.
00:40:06.382 --> 00:40:08.103
There's all these laws on the books that
00:40:08.143 --> 00:40:09.324
are pretty much useless.
00:40:09.704 --> 00:40:10.965
I think you have to get the patient
00:40:10.985 --> 00:40:12.947
to want to come to you,
00:40:14.387 --> 00:40:15.889
whether however you do that.
00:40:15.969 --> 00:40:16.929
But I think it's marketing.
00:40:18.413 --> 00:40:20.815
The handout, Jimmy, I love the idea,
00:40:21.034 --> 00:40:25.498
but also the incentives and the money with
00:40:25.538 --> 00:40:26.478
these health systems,
00:40:26.577 --> 00:40:29.519
with these hospital systems and the AMA,
00:40:29.740 --> 00:40:31.521
the American Medical Association,
00:40:31.561 --> 00:40:34.043
like all that in terms of, I mean,
00:40:34.063 --> 00:40:34.943
they would just block it.
00:40:34.983 --> 00:40:35.784
They would just block it,
00:40:35.824 --> 00:40:36.625
like to make that,
00:40:36.864 --> 00:40:38.505
they would figure out ways to have
00:40:38.565 --> 00:40:40.208
lobbying and just block that.
00:40:40.268 --> 00:40:42.309
I mean, that would be a great start.
00:40:44.090 --> 00:40:45.090
But then to push back a little bit
00:40:45.130 --> 00:40:46.411
on Tony's thing, like,
00:40:47.545 --> 00:40:47.885
Yes,
00:40:47.965 --> 00:40:49.268
there are some of those patients that want
00:40:49.288 --> 00:40:51.730
to just please the physician.
00:40:51.750 --> 00:40:54.331
They want to do whatever they say.
00:40:54.972 --> 00:40:55.273
But again,
00:40:55.313 --> 00:40:56.153
that's kind of what I was saying.
00:40:56.594 --> 00:40:57.074
Many of them,
00:40:57.335 --> 00:40:59.836
that's just the way they've been raised.
00:40:59.896 --> 00:41:01.318
And that's what their parents did and
00:41:01.338 --> 00:41:02.159
their parents did.
00:41:02.219 --> 00:41:03.920
And that's just the way it has always
00:41:03.960 --> 00:41:04.201
been.
00:41:04.902 --> 00:41:07.684
And so, yeah, overall,
00:41:07.864 --> 00:41:08.405
at the end of the day,
00:41:08.445 --> 00:41:09.144
I think it's a shame.
00:41:09.206 --> 00:41:11.306
It's a shame that these physicians...
00:41:12.088 --> 00:41:14.509
are not being clear and truthful to these
00:41:14.528 --> 00:41:16.909
patients and saying that you actually have
00:41:16.969 --> 00:41:19.431
choice you can go to our physician-owned
00:41:19.471 --> 00:41:21.251
practice or our hospital-based practice
00:41:21.271 --> 00:41:23.333
that's you know right here attached to our
00:41:23.353 --> 00:41:26.233
hospital or you can also go to total
00:41:26.273 --> 00:41:28.695
therapy solutions down the road and you
00:41:28.715 --> 00:41:30.315
know also have a great experience and
00:41:30.335 --> 00:41:31.976
they'll take your insurance unless you use
00:41:32.016 --> 00:41:32.197
your
00:41:33.277 --> 00:41:35.458
twenty Medicare Advantage plans and visits
00:41:35.478 --> 00:41:36.780
for the year, then, you know, whatever.
00:41:37.121 --> 00:41:38.481
So, I don't know.
00:41:38.501 --> 00:41:40.204
It's just a shame that when there's some
00:41:40.224 --> 00:41:43.586
of this money and incentives involved that
00:41:44.427 --> 00:41:46.329
they're not going to say that.
00:41:46.349 --> 00:41:47.391
They're not going to tell the patient.
00:41:47.411 --> 00:41:50.393
They're not going to disclose something to
00:41:50.414 --> 00:41:50.574
them.
00:41:50.634 --> 00:41:52.114
Now, here's the question real quick, Tony.
00:41:52.476 --> 00:41:54.998
If that physician instead said to your
00:41:55.038 --> 00:41:55.378
patient,
00:41:56.434 --> 00:41:57.275
You have a choice.
00:41:58.114 --> 00:41:59.195
You have this other condition.
00:41:59.795 --> 00:42:00.217
Oh,
00:42:00.317 --> 00:42:03.179
and she tells the physician that my
00:42:03.199 --> 00:42:04.820
therapist, Tony Meritato says, you know,
00:42:04.840 --> 00:42:07.362
I can continue to come out of pocket
00:42:07.981 --> 00:42:09.762
and go there and do my therapeutic
00:42:09.802 --> 00:42:10.664
exercise or whatever,
00:42:11.164 --> 00:42:12.385
because I already burned up my twenty
00:42:12.405 --> 00:42:14.106
Medicare Advantage visits for the calendar
00:42:14.146 --> 00:42:14.306
year.
00:42:15.688 --> 00:42:17.190
If that physician had said to her, oh,
00:42:17.230 --> 00:42:17.871
that's awesome,
00:42:18.010 --> 00:42:19.492
I know him or I don't know him
00:42:19.532 --> 00:42:22.273
or whatever, you have the option.
00:42:22.315 --> 00:42:26.057
You could go to our hospital-based clinic,
00:42:26.117 --> 00:42:26.777
outpatient clinic,
00:42:26.818 --> 00:42:28.980
for this other condition and be treated
00:42:29.019 --> 00:42:29.260
there,
00:42:29.900 --> 00:42:31.882
or you could also stay there with him,
00:42:32.242 --> 00:42:33.503
or you could go to some other clinic,
00:42:34.423 --> 00:42:35.284
any other clinic down the road.
00:42:35.445 --> 00:42:36.706
I think you just need movement,
00:42:36.726 --> 00:42:38.166
you need some physical therapy or
00:42:38.427 --> 00:42:40.409
supervision by a physical therapist or
00:42:40.449 --> 00:42:40.769
whatever.
00:42:41.210 --> 00:42:42.990
If that physician had said that to her,
00:42:43.972 --> 00:42:44.853
you knowing her,
00:42:45.313 --> 00:42:47.034
would she still be in your practice or
00:42:47.054 --> 00:42:47.916
would she be going to the office?
00:42:47.936 --> 00:42:48.416
A thousand percent.
00:42:49.317 --> 00:42:51.079
So that's a shame, right?
00:42:51.298 --> 00:42:52.059
That's ridiculous.
00:42:53.021 --> 00:42:54.202
Yeah, yeah.
00:42:54.934 --> 00:42:56.096
But even on that front,
00:42:56.115 --> 00:42:57.936
and I'm sure you guys have seen it
00:42:57.976 --> 00:42:58.317
too,
00:42:58.677 --> 00:43:00.759
like I've seen the shift in physician
00:43:00.798 --> 00:43:01.298
culture.
00:43:01.398 --> 00:43:04.141
I've seen the shift in referrals.
00:43:05.141 --> 00:43:07.262
Twenty five years ago when we started,
00:43:07.684 --> 00:43:10.585
like we were getting all of the referrals
00:43:10.666 --> 00:43:12.186
with very specific,
00:43:12.726 --> 00:43:13.927
you're going to do this and you're going
00:43:13.947 --> 00:43:15.208
to do that and you're going to do,
00:43:15.228 --> 00:43:15.568
you know,
00:43:15.989 --> 00:43:17.630
they would tell us what to do.
00:43:19.010 --> 00:43:20.112
And talking to,
00:43:20.811 --> 00:43:22.954
they were old physicians back then,
00:43:24.054 --> 00:43:25.375
many of them probably aren't alive
00:43:25.414 --> 00:43:26.856
anymore, but talking to them,
00:43:27.235 --> 00:43:29.197
the culture and the mindset of the doctor
00:43:29.237 --> 00:43:31.157
was, I am the doctor,
00:43:31.277 --> 00:43:32.679
this is what the therapist does,
00:43:32.739 --> 00:43:34.139
you do what I tell you to do.
00:43:35.123 --> 00:43:39.023
Now, as that culture has shifted out,
00:43:39.204 --> 00:43:41.043
I talk to a lot of younger MDs,
00:43:41.103 --> 00:43:43.125
younger than me, and they're like, oh,
00:43:43.164 --> 00:43:44.244
you guys are professional.
00:43:44.284 --> 00:43:45.585
You know what to do.
00:43:45.925 --> 00:43:47.465
I worked with a lot of great therapists
00:43:47.485 --> 00:43:48.706
during my rotations,
00:43:48.786 --> 00:43:51.226
and you guys know more than me when
00:43:51.266 --> 00:43:53.306
it comes to this and that.
00:43:53.367 --> 00:43:54.266
You guys take the reins.
00:43:54.847 --> 00:43:57.268
So I do see a shift within the
00:43:57.307 --> 00:43:59.487
mindset and the culture of the medical
00:43:59.547 --> 00:44:02.849
doctor and how they view themselves on a
00:44:02.989 --> 00:44:03.989
team approach and
00:44:05.574 --> 00:44:07.155
um i think it's positive i think it's
00:44:07.175 --> 00:44:09.237
positive for all allied healthcare not
00:44:09.277 --> 00:44:12.800
just us but so maybe maybe i would
00:44:12.840 --> 00:44:15.282
revise my thing from saying okay direct to
00:44:15.302 --> 00:44:17.623
consumer marketing to we also have an
00:44:17.684 --> 00:44:20.547
element of marketing to physicians and
00:44:20.626 --> 00:44:22.909
student physicians you know residents and
00:44:23.469 --> 00:44:25.490
letting them know and see and understand
00:44:25.550 --> 00:44:25.931
kind of
00:44:26.411 --> 00:44:29.693
what, what our role in the ecosystem is.
00:44:30.155 --> 00:44:31.795
And, and, and being collaborative.
00:44:31.856 --> 00:44:34.056
Like I, did I tell you, Tony,
00:44:34.117 --> 00:44:36.478
that I was a week or two ago,
00:44:36.958 --> 00:44:38.000
I went with my, one of my,
00:44:38.239 --> 00:44:39.481
one of the only patients that I'm seeing.
00:44:39.860 --> 00:44:41.641
And I took him to a pain,
00:44:42.003 --> 00:44:43.043
a pain orthophysician,
00:44:43.103 --> 00:44:44.503
non-surgical physiatrist.
00:44:44.684 --> 00:44:45.724
And I went to the visit.
00:44:46.105 --> 00:44:46.686
I went to the visit.
00:44:46.766 --> 00:44:47.445
I didn't tell you guys this.
00:44:47.485 --> 00:44:49.166
No, I don't think so.
00:44:49.186 --> 00:44:50.728
I totally, totally forgot to tell you.
00:44:51.909 --> 00:44:52.670
And when I did,
00:44:52.750 --> 00:44:53.750
I did my Tony Maritato.
00:44:53.829 --> 00:44:55.331
I got the patient's permission ahead of
00:44:55.371 --> 00:44:55.572
time.
00:44:56.452 --> 00:44:57.512
I even told the physician,
00:44:57.612 --> 00:44:59.913
texted the physician, hey, you know,
00:44:59.952 --> 00:45:02.454
he already knew I was sending this patient
00:45:02.494 --> 00:45:02.813
to him.
00:45:03.514 --> 00:45:05.155
And I just want to get his permission
00:45:05.175 --> 00:45:06.375
just because I haven't done it before.
00:45:06.434 --> 00:45:07.135
And I just, whatever.
00:45:07.195 --> 00:45:07.554
I'm just like,
00:45:07.614 --> 00:45:08.375
let me run this by you.
00:45:08.394 --> 00:45:09.976
You know, if that's cool.
00:45:10.275 --> 00:45:10.556
You know,
00:45:10.815 --> 00:45:12.536
the patient already gave permission.
00:45:13.697 --> 00:45:15.336
And so it was great.
00:45:15.396 --> 00:45:16.157
So like that,
00:45:16.518 --> 00:45:17.797
like I know you've been doing that, Tony,
00:45:17.818 --> 00:45:18.217
for years.
00:45:18.257 --> 00:45:20.398
But more collaboration now,
00:45:20.759 --> 00:45:23.099
less of the top-down hierarchy and,
00:45:23.159 --> 00:45:23.460
you know,
00:45:23.500 --> 00:45:26.182
the â
00:45:24.679 --> 00:45:26.081
all knowing, all being, you know,
00:45:26.121 --> 00:45:27.382
physician from, you know,
00:45:27.443 --> 00:45:29.565
fifty plus years ago.
00:45:29.605 --> 00:45:30.164
So how'd it go?
00:45:30.244 --> 00:45:30.885
Tell us about it.
00:45:30.925 --> 00:45:31.867
We have a couple of minutes.
00:45:32.708 --> 00:45:34.208
Yeah, well, yeah,
00:45:34.248 --> 00:45:36.831
he was he gave maybe twenty or something
00:45:36.871 --> 00:45:38.413
minutes in terms of, you know,
00:45:38.492 --> 00:45:39.454
in the exam room and all that.
00:45:39.474 --> 00:45:40.775
So that was great in terms of time.
00:45:41.135 --> 00:45:41.556
Twenty minutes,
00:45:41.576 --> 00:45:42.577
maybe even twenty five minutes.
00:45:42.976 --> 00:45:44.179
It was great in terms of time.
00:45:46.108 --> 00:45:47.630
We did have to wait like an hour.
00:45:47.789 --> 00:45:49.690
And I almost, I almost,
00:45:50.271 --> 00:45:51.411
I said to my patient,
00:45:51.452 --> 00:45:52.693
now the patient I have a great rapport
00:45:52.713 --> 00:45:52.793
with,
00:45:52.813 --> 00:45:53.873
cause I've been treating him for like a
00:45:53.913 --> 00:45:55.153
year and a half with a, you know,
00:45:55.233 --> 00:45:56.074
neuro situation.
00:45:56.815 --> 00:45:58.615
And I said, I said,
00:45:58.655 --> 00:45:59.936
should I go outside?
00:45:59.956 --> 00:46:00.896
Like, I think like,
00:46:00.956 --> 00:46:02.197
is it possible that they forgot us?
00:46:02.237 --> 00:46:03.438
And he said, he said,
00:46:03.478 --> 00:46:04.219
if my wife was here,
00:46:04.239 --> 00:46:05.338
she would have already been outside.
00:46:05.358 --> 00:46:06.900
I was like, oh man.
00:46:06.960 --> 00:46:07.260
Yeah.
00:46:07.280 --> 00:46:08.420
So, but now he came in,
00:46:08.460 --> 00:46:09.021
it went well.
00:46:09.041 --> 00:46:12.282
And also going through the exam and the
00:46:12.302 --> 00:46:13.443
subjective and you know,
00:46:14.103 --> 00:46:15.846
uh in the middle and then towards the
00:46:15.925 --> 00:46:18.108
end the physician was kind of turning to
00:46:18.168 --> 00:46:21.130
me after i gave some subjective in the
00:46:21.230 --> 00:46:22.831
in the beginning but then in terms of
00:46:22.851 --> 00:46:24.612
the plan and you know setting up imaging
00:46:24.652 --> 00:46:26.795
and going from there uh the physician was
00:46:26.815 --> 00:46:28.096
turning to me and was kind of like
00:46:28.456 --> 00:46:29.998
is that almost was like is that what
00:46:30.038 --> 00:46:31.438
you guys were kind of looking for like
00:46:31.458 --> 00:46:32.800
any other questions then anything else i
00:46:32.820 --> 00:46:34.021
can help you with or like are we
00:46:34.041 --> 00:46:36.043
on the same page here and i'm like
00:46:36.063 --> 00:46:38.164
yeah totally that exactly what i wanted
00:46:38.224 --> 00:46:39.766
like he's got you know multiple
00:46:40.487 --> 00:46:42.909
orthopedic issues on top of a neurological
00:46:43.690 --> 00:46:44.170
condition.
00:46:44.210 --> 00:46:46.150
So there's a lot going on here and
00:46:46.190 --> 00:46:47.632
that's why I was referring him to you.
00:46:47.672 --> 00:46:47.932
So yes,
00:46:47.952 --> 00:46:50.134
we're on the same page and everything that
00:46:50.173 --> 00:46:51.755
you mentioned in terms of
00:46:53.014 --> 00:46:54.235
potential next steps,
00:46:54.295 --> 00:46:55.496
like right on the same page,
00:46:55.516 --> 00:46:56.617
exactly what we're looking for.
00:46:56.956 --> 00:46:58.257
So then he kind of looped me back
00:46:58.336 --> 00:47:00.237
into this three-way conversation between
00:47:00.398 --> 00:47:02.298
he and I and the patient right there
00:47:02.338 --> 00:47:02.878
in the office.
00:47:03.500 --> 00:47:04.539
So it went well.
00:47:06.021 --> 00:47:07.420
And we'll see, we'll see, you know,
00:47:07.460 --> 00:47:08.541
how many more of those I can do,
00:47:08.601 --> 00:47:10.722
but that would, oh, I did,
00:47:10.822 --> 00:47:12.402
I did message you guys because I did
00:47:12.443 --> 00:47:14.384
say about the weight and you- I remember
00:47:14.403 --> 00:47:14.563
now, yeah.
00:47:14.583 --> 00:47:15.824
Yeah, yeah.
00:47:15.864 --> 00:47:17.326
So historically you said, you know,
00:47:17.365 --> 00:47:19.045
you gotta be prepared for, you know,
00:47:19.085 --> 00:47:20.927
like a two or three hour window sometimes
00:47:20.947 --> 00:47:21.987
with like the whole,
00:47:22.989 --> 00:47:25.351
experience you know so that's it's all
00:47:25.391 --> 00:47:27.172
good just like building relationships and
00:47:27.193 --> 00:47:29.273
um but that's kind of where i'm at
00:47:29.293 --> 00:47:32.876
in terms of physician marketing and that
00:47:32.896 --> 00:47:34.516
whole you know collaborative approach
00:47:34.556 --> 00:47:37.438
which again i i would never i don't
00:47:37.458 --> 00:47:39.000
think i would do it you know historically
00:47:39.039 --> 00:47:40.780
but now i'm doing it more as i
00:47:40.800 --> 00:47:43.202
kind of see the vibe of other physicians
00:47:43.302 --> 00:47:45.264
and you know things that work so you
00:47:45.284 --> 00:47:46.523
know it was just part of like the
00:47:46.563 --> 00:47:48.385
marketing strategy and just again building
00:47:48.425 --> 00:47:48.965
relationships
00:47:50.210 --> 00:47:51.793
So again, this is, you know,
00:47:52.414 --> 00:47:54.599
Dana Strauss and value-based care and
00:47:54.639 --> 00:47:55.981
having a seat at the table.
00:47:56.041 --> 00:47:58.786
And there's different approaches to how we
00:47:58.827 --> 00:47:59.286
get there.
00:48:00.088 --> 00:48:03.375
You can go the route of, um,
00:48:04.695 --> 00:48:05.456
I don't even know.
00:48:05.556 --> 00:48:07.117
I don't know what everybody else is doing.
00:48:07.719 --> 00:48:09.880
When I want a seat at the table,
00:48:09.920 --> 00:48:11.742
when I want to build a relationship,
00:48:11.902 --> 00:48:14.465
we used to bring lunch in or breakfast
00:48:14.485 --> 00:48:15.606
for the entire office.
00:48:15.646 --> 00:48:16.748
We'd get a couple minutes.
00:48:17.248 --> 00:48:19.590
We were a nuisance to the medical
00:48:19.610 --> 00:48:20.150
practice.
00:48:20.231 --> 00:48:22.152
Nobody wanted to deal with us.
00:48:22.914 --> 00:48:23.394
But now...
00:48:24.554 --> 00:48:25.653
I go with my patient.
00:48:25.775 --> 00:48:26.775
I haven't done it in a couple of
00:48:26.795 --> 00:48:29.956
years, but still the opportunity is there.
00:48:30.976 --> 00:48:32.536
You go there and you sit down.
00:48:32.617 --> 00:48:34.538
The doctor is getting paid for that time.
00:48:35.117 --> 00:48:36.458
I'm representing the patient.
00:48:36.478 --> 00:48:38.199
I'm saving the physician some time.
00:48:38.259 --> 00:48:39.139
I'm communicating.
00:48:39.179 --> 00:48:40.199
I'm building a rapport.
00:48:40.239 --> 00:48:41.519
I'm making the connection.
00:48:42.201 --> 00:48:43.561
Once you do it a couple of times,
00:48:43.601 --> 00:48:45.702
they get to know you on a personal
00:48:45.742 --> 00:48:48.382
level here where we are.
00:48:49.507 --> 00:48:51.931
The doctors still will very,
00:48:51.971 --> 00:48:54.733
very rarely send me patients in
00:48:54.773 --> 00:48:55.253
Middletown.
00:48:55.313 --> 00:48:55.434
Now,
00:48:55.494 --> 00:48:57.675
Middletown is about five miles up the road
00:48:57.715 --> 00:48:58.757
from where I am right now.
00:48:58.817 --> 00:48:59.858
Right now, I'm in Monroe.
00:49:01.340 --> 00:49:03.161
But every single patient in Monroe comes
00:49:03.181 --> 00:49:03.402
to me.
00:49:04.063 --> 00:49:06.005
And that is because...
00:49:06.525 --> 00:49:09.246
Those doctors know me on a personal level.
00:49:09.307 --> 00:49:10.467
We have a relationship.
00:49:10.509 --> 00:49:11.668
We've talked to each other.
00:49:12.010 --> 00:49:13.851
We kind of have a sense for what
00:49:13.891 --> 00:49:15.172
we're doing and who we are.
00:49:15.251 --> 00:49:17.574
The only way I could build that is
00:49:17.614 --> 00:49:19.815
by attending those follow-up visits with
00:49:19.876 --> 00:49:20.617
my patients.
00:49:21.938 --> 00:49:23.079
And the docs who don't want to do
00:49:23.139 --> 00:49:24.179
it, they're not going to do it,
00:49:24.219 --> 00:49:25.121
but it doesn't matter.
00:49:25.340 --> 00:49:27.503
Just like any other networking,
00:49:27.543 --> 00:49:29.643
there's people you connect with and people
00:49:29.664 --> 00:49:30.105
you don't.
00:49:30.824 --> 00:49:31.585
So yeah,
00:49:31.625 --> 00:49:33.126
I just think it's such a missed
00:49:33.166 --> 00:49:34.666
opportunity for so many.
00:49:35.126 --> 00:49:37.168
And I would say it's really should be
00:49:37.268 --> 00:49:39.148
a paid opportunity.
00:49:39.548 --> 00:49:40.449
I don't know if you did it,
00:49:40.849 --> 00:49:42.590
but for other therapists listening,
00:49:43.391 --> 00:49:44.670
like it should be a paid session.
00:49:45.072 --> 00:49:46.472
It's not covered by insurance.
00:49:46.831 --> 00:49:48.132
It should be paid out of pocket.
00:49:48.802 --> 00:49:50.603
I bet the family would be willing to
00:49:50.643 --> 00:49:52.804
pay to send you,
00:49:52.864 --> 00:49:54.143
somebody the patient knows,
00:49:54.184 --> 00:49:55.103
likes and trusts,
00:49:55.463 --> 00:49:57.485
to be there as a representative.
00:49:57.545 --> 00:49:57.864
Jimmy,
00:49:57.905 --> 00:49:59.804
you've been in that world with your dad.
00:50:00.206 --> 00:50:02.786
Like having somebody who understands the
00:50:02.846 --> 00:50:04.206
system, speaks the language,
00:50:04.286 --> 00:50:06.146
being there with somebody you care about,
00:50:06.666 --> 00:50:08.806
probably more impactful than, you know,
00:50:08.847 --> 00:50:10.648
a spouse being there who doesn't know what
00:50:10.668 --> 00:50:10.887
to do.
00:50:11.447 --> 00:50:13.168
Three things, time, money, headache,
00:50:13.748 --> 00:50:15.329
and averting crisis.
00:50:15.349 --> 00:50:17.110
I mean, I have someone.
00:50:17.150 --> 00:50:20.311
I have a former nurse who's a medical
00:50:20.431 --> 00:50:21.813
advocate, a nursing advocate,
00:50:21.833 --> 00:50:22.954
a geriatric advocate.
00:50:22.974 --> 00:50:24.974
You know how many times that I've been
00:50:24.994 --> 00:50:25.175
like,
00:50:25.215 --> 00:50:27.436
should I bring my dad to the doctor,
00:50:27.476 --> 00:50:30.376
the urgent care, the emergency room,
00:50:30.416 --> 00:50:30.878
or wait?
00:50:31.657 --> 00:50:33.079
And she'll ask me two or three questions
00:50:33.099 --> 00:50:33.518
and then say,
00:50:33.838 --> 00:50:35.159
it's my recommendation that you do this.
00:50:35.260 --> 00:50:36.059
And I'm like, great.
00:50:37.541 --> 00:50:38.561
But I can go around with her.
00:50:38.661 --> 00:50:39.942
I can say, well, I don't understand that.
00:50:39.961 --> 00:50:40.523
Can you explain it?
00:50:40.543 --> 00:50:41.103
She's like, sure.
00:50:41.123 --> 00:50:42.523
Do you want me to explain it now?
00:50:42.543 --> 00:50:43.463
Do you want me to write it down?
00:50:43.523 --> 00:50:45.025
And I'm like, sure.
00:50:45.065 --> 00:50:45.846
Just explain it to me now.
00:50:46.885 --> 00:50:48.007
time, effort, money,
00:50:48.166 --> 00:50:51.268
pain and averting crisis like these things
00:50:51.288 --> 00:50:52.369
are valuable.
00:50:52.509 --> 00:50:54.489
So this goes back to a conversation I
00:50:54.510 --> 00:50:55.469
was just having with someone the other
00:50:55.489 --> 00:50:55.630
day.
00:50:55.670 --> 00:50:57.931
We typically devalue the things we know
00:50:57.952 --> 00:50:58.592
because they're easy.
00:50:58.652 --> 00:51:00.353
We know that even someone stupid like me
00:51:00.393 --> 00:51:02.074
knows that everybody must know it.
00:51:02.873 --> 00:51:04.094
So we devalue what we know.
00:51:04.494 --> 00:51:06.135
But I look at my buddy who I
00:51:06.215 --> 00:51:07.797
reference him a lot down the street who's
00:51:07.817 --> 00:51:08.336
a mechanic.
00:51:09.490 --> 00:51:12.572
I'm like, you're like a wizard, man.
00:51:12.612 --> 00:51:13.632
I don't know how to make the car
00:51:13.871 --> 00:51:15.512
stop doing the noise and make sure it's
00:51:15.532 --> 00:51:16.092
safe to drive.
00:51:16.373 --> 00:51:17.253
I have no idea.
00:51:17.494 --> 00:51:19.393
I could not begin to watch a YouTube
00:51:19.434 --> 00:51:19.653
video.
00:51:19.693 --> 00:51:19.994
It's easy.
00:51:20.014 --> 00:51:20.255
I'm like,
00:51:20.775 --> 00:51:21.655
I don't even know what parts you're
00:51:21.675 --> 00:51:22.474
talking about, man.
00:51:22.534 --> 00:51:23.456
I wouldn't even begin to scratch the
00:51:23.496 --> 00:51:23.755
surface.
00:51:23.856 --> 00:51:25.076
I wouldn't even open the textbook.
00:51:25.655 --> 00:51:26.637
That's valuable.
00:51:26.737 --> 00:51:28.097
That's why people pay for that.
00:51:28.336 --> 00:51:29.978
So, yes, it is of value.
00:51:30.797 --> 00:51:32.498
What I think is interesting there is you
00:51:32.559 --> 00:51:36.139
said medical advocate and then you said
00:51:36.219 --> 00:51:36.579
nurse.
00:51:37.309 --> 00:51:39.429
And so if you had originally and both
00:51:39.449 --> 00:51:40.411
would do the same thing.
00:51:40.490 --> 00:51:42.431
I think any nurse that you hired would
00:51:42.731 --> 00:51:44.931
function as a medical advocate.
00:51:45.472 --> 00:51:47.092
But as soon as you say the words
00:51:47.152 --> 00:51:49.572
medical advocate, the consumer is like,
00:51:49.592 --> 00:51:51.092
yes, that's exactly what I need.
00:51:51.112 --> 00:51:52.632
I don't need another nurse.
00:51:52.672 --> 00:51:53.393
I've got a nurse.
00:51:53.432 --> 00:51:54.913
I need a medical advocate.
00:51:54.952 --> 00:51:56.614
I need somebody who's going to advocate
00:51:56.653 --> 00:51:58.393
for me, be on my side,
00:51:58.454 --> 00:51:59.693
be my representative,
00:51:59.733 --> 00:52:02.695
speak a language and fight for what I
00:52:02.775 --> 00:52:03.215
need.
00:52:03.614 --> 00:52:06.976
Um, so once again, that, that name,
00:52:07.036 --> 00:52:07.838
that word,
00:52:07.878 --> 00:52:10.159
that sound coming out of your mouth has
00:52:10.219 --> 00:52:12.800
significantly higher value in the context
00:52:12.981 --> 00:52:15.802
of what the consumer believes they need
00:52:16.342 --> 00:52:17.643
than just saying nurse,
00:52:17.784 --> 00:52:20.545
even though technically I would imagine
00:52:20.865 --> 00:52:23.206
anybody in the world can hang a shingle
00:52:23.246 --> 00:52:24.547
saying medical advocate,
00:52:24.568 --> 00:52:26.849
but you have to go through extensive
00:52:26.989 --> 00:52:29.170
training and education and licensure to
00:52:29.251 --> 00:52:30.711
hang a shingle that says nurse.
00:52:31.228 --> 00:52:31.449
Right.
00:52:31.528 --> 00:52:32.250
So she did both.
00:52:32.269 --> 00:52:33.992
She was a nurse for twenty something years
00:52:34.032 --> 00:52:35.052
in a bunch of different settings.
00:52:35.092 --> 00:52:35.693
And then she's like,
00:52:35.773 --> 00:52:36.634
now I want to do this.
00:52:37.034 --> 00:52:37.715
So she's, you know,
00:52:38.036 --> 00:52:39.536
her pitch is essentially a family member
00:52:39.556 --> 00:52:40.858
founder for me online.
00:52:41.199 --> 00:52:43.822
The pitch was I've been that provider and
00:52:43.862 --> 00:52:45.483
I know how people can get lost and
00:52:45.583 --> 00:52:47.005
I sort of know how to cut through
00:52:47.025 --> 00:52:47.445
the BS.
00:52:47.865 --> 00:52:48.626
She's annoying.
00:52:49.730 --> 00:52:50.409
At hospitals.
00:52:50.630 --> 00:52:51.070
Not to me.
00:52:51.170 --> 00:52:51.251
Yeah.
00:52:51.831 --> 00:52:54.273
No, I need this paperwork.
00:52:54.413 --> 00:52:55.132
I will get it to you.
00:52:55.273 --> 00:52:56.534
I'm not leaving until it is.
00:52:57.114 --> 00:52:58.695
This is his right.
00:52:58.735 --> 00:53:00.315
He has a right to have this paperwork.
00:53:00.635 --> 00:53:01.536
We will not leave.
00:53:01.635 --> 00:53:02.817
Oh, what's your supervisor?
00:53:03.557 --> 00:53:04.117
What's your name?
00:53:04.137 --> 00:53:05.679
I'm going to write down that we can't.
00:53:05.739 --> 00:53:07.159
It's nine twenty four.
00:53:07.179 --> 00:53:09.201
We requested it and I'll write down when
00:53:09.221 --> 00:53:09.661
we get it.
00:53:10.141 --> 00:53:11.822
And I get to just be guy in
00:53:11.842 --> 00:53:13.202
the corner who's just like, hey, dad,
00:53:13.222 --> 00:53:14.784
let's watch the Yankee game on TV while
00:53:14.804 --> 00:53:15.824
we're in the emergency room.
00:53:16.164 --> 00:53:18.105
So it was it valuable?
00:53:18.646 --> 00:53:19.106
Hell, yeah.
00:53:20.838 --> 00:53:21.739
Yeah.
00:53:21.760 --> 00:53:23.161
Let's think about parting shots.
00:53:24.041 --> 00:53:25.242
I don't know if you guys caught it
00:53:25.302 --> 00:53:26.083
over the weekend.
00:53:26.844 --> 00:53:28.965
The Mets went down in a blaze of
00:53:29.005 --> 00:53:30.005
glory and the Reds.
00:53:30.025 --> 00:53:30.505
The Reds are in.
00:53:30.525 --> 00:53:31.327
The Reds are in, baby.
00:53:31.527 --> 00:53:32.327
Congratulations.
00:53:34.228 --> 00:53:35.610
I don't know what's going to happen
00:53:35.670 --> 00:53:37.030
against the Dodgers tomorrow.
00:53:37.291 --> 00:53:37.572
Tomorrow?
00:53:37.592 --> 00:53:38.112
Tonight.
00:53:38.311 --> 00:53:39.032
I think it's tonight.
00:53:40.333 --> 00:53:42.054
That could get ugly, but hey,
00:53:42.074 --> 00:53:43.677
we're going to celebrate while we can.
00:53:43.697 --> 00:53:45.918
Good for you.
00:53:45.958 --> 00:53:47.039
How's my parting shot?
00:53:47.059 --> 00:53:47.900
What do you guys got?
00:53:49.815 --> 00:53:50.894
Other than Go Phillies,
00:53:50.954 --> 00:53:53.356
we got the two seed first round buy.
00:53:53.416 --> 00:53:56.737
Other than Go Phillies, yeah,
00:53:56.777 --> 00:54:00.117
just going back to this whole shenanigans,
00:54:00.197 --> 00:54:03.398
I think this whole topic is just crazy
00:54:03.438 --> 00:54:04.659
that we just covered today.
00:54:04.778 --> 00:54:07.278
And so if, I don't know,
00:54:07.458 --> 00:54:09.639
if there's NPs and PAs that...
00:54:11.172 --> 00:54:13.375
have their name badge and they're
00:54:13.474 --> 00:54:13.974
displaying it.
00:54:14.014 --> 00:54:14.675
And then like Tony said,
00:54:14.695 --> 00:54:15.596
they're not flipping it around.
00:54:15.615 --> 00:54:16.356
They're not hiding it.
00:54:17.516 --> 00:54:18.657
Just do the right thing.
00:54:19.219 --> 00:54:20.960
Then I don't see how anything could be
00:54:20.980 --> 00:54:23.981
misleading or misrepresentation or
00:54:24.101 --> 00:54:24.461
whatever.
00:54:26.043 --> 00:54:28.724
And also, yeah, I don't know.
00:54:28.784 --> 00:54:29.925
I'm not sure if it'll make that big
00:54:29.945 --> 00:54:30.826
of a difference either way,
00:54:30.865 --> 00:54:32.527
but patients are definitely...
00:54:33.467 --> 00:54:35.949
uh influenced and sometimes positively
00:54:35.989 --> 00:54:38.251
surprised when i hear that we have doctors
00:54:38.291 --> 00:54:39.751
in physical therapy like i mentioned it i
00:54:39.771 --> 00:54:41.432
don't like sell it hard but like i
00:54:41.472 --> 00:54:44.135
think it's cool to mention because that's
00:54:44.155 --> 00:54:46.376
what my diploma says that's what i got
00:54:46.416 --> 00:54:48.536
licensed you know with and all that so
00:54:48.637 --> 00:54:50.577
like why wouldn't i use it in like
00:54:50.617 --> 00:54:53.860
the most respectful way and we're not
00:54:53.900 --> 00:54:55.481
saying physician or medical doctor or
00:54:55.501 --> 00:54:57.161
anything like that so um
00:54:58.202 --> 00:54:58.503
Hopefully,
00:54:58.523 --> 00:55:01.025
this is not an ongoing trend with other
00:55:01.065 --> 00:55:04.987
states barring nurses from saying doctor
00:55:05.268 --> 00:55:07.190
if they're DNP or NP or whatever.
00:55:07.929 --> 00:55:09.331
Because if that's the case,
00:55:09.351 --> 00:55:11.612
then it could certainly trickle down or
00:55:11.652 --> 00:55:13.793
trickle over to physical therapists as
00:55:13.833 --> 00:55:14.034
well.
00:55:14.094 --> 00:55:14.574
So we'll see.
00:55:15.239 --> 00:55:17.900
Yeah, I'd say in the end, clarity wins.
00:55:18.902 --> 00:55:20.704
The person who is most clear wins.
00:55:20.744 --> 00:55:22.465
And I know if you're saying, hey,
00:55:22.786 --> 00:55:25.387
the AMA is doing this because of hierarchy
00:55:25.427 --> 00:55:27.750
and ego, don't do the same thing.
00:55:27.969 --> 00:55:28.911
Aim for clarity,
00:55:28.931 --> 00:55:31.012
and I think you don't miss.
00:55:31.052 --> 00:55:33.315
I think people want to default to, like,
00:55:33.394 --> 00:55:35.617
I need to win every single conversation
00:55:35.657 --> 00:55:36.157
and argument.
00:55:36.518 --> 00:55:39.079
You never win every single conversation
00:55:39.159 --> 00:55:39.621
and argument.
00:55:39.981 --> 00:55:41.101
I think the person who communicates
00:55:41.141 --> 00:55:42.302
clearly, concisely,
00:55:42.362 --> 00:55:44.344
consistently is the one who wins.
00:55:44.445 --> 00:55:45.565
But you got to decide what winning looks
00:55:45.606 --> 00:55:45.806
like.
00:55:45.827 --> 00:55:47.849
All right, gentlemen.
00:55:47.869 --> 00:55:48.568
Right on.
00:55:48.648 --> 00:55:49.389
Love it.
00:55:49.409 --> 00:55:49.931
Have a great week.
00:55:49.951 --> 00:55:50.851
We'll see you back on Thursday.
00:55:51.072 --> 00:55:53.273
I'm sure something insane will happen in
00:55:53.293 --> 00:55:55.175
the healthcare world in our profession
00:55:55.496 --> 00:55:56.996
between now and Thursday for us to
00:55:57.036 --> 00:55:57.458
discuss.
00:55:57.518 --> 00:55:59.099
But if you have any topic suggestions,
00:55:59.460 --> 00:56:00.820
feel free to hit us up online and
00:56:00.840 --> 00:56:01.802
we will bring it to the show.
00:00:05.605 --> 00:00:06.086
Hey guys,
00:00:06.487 --> 00:00:08.228
welcome back to PT Breakfast Club.
00:00:09.830 --> 00:00:12.012
There's the AI generated yetis.
00:00:12.553 --> 00:00:12.954
Good morning.
00:00:12.993 --> 00:00:13.513
I'm back.
00:00:13.734 --> 00:00:14.574
I missed you guys.
00:00:15.355 --> 00:00:16.257
And we're back.
00:00:16.678 --> 00:00:17.498
And we're back.
00:00:17.859 --> 00:00:18.859
How were your travels?
00:00:19.580 --> 00:00:20.481
Travels were great.
00:00:20.902 --> 00:00:22.564
Did some family stuff in Oklahoma.
00:00:24.443 --> 00:00:26.184
And then did some work stuff in Roanoke,
00:00:26.204 --> 00:00:27.864
Virginia, which someone asked me, hey,
00:00:27.885 --> 00:00:29.045
have you ever been to Roanoke before?
00:00:29.106 --> 00:00:30.266
And I said, absolutely not.
00:00:30.786 --> 00:00:32.067
And then I walked into the hotel we
00:00:32.088 --> 00:00:33.429
were having the conference in.
00:00:33.469 --> 00:00:33.869
I was like, oh,
00:00:33.909 --> 00:00:34.969
I've been in this hotel.
00:00:35.470 --> 00:00:37.231
So that's when you know you maybe travel
00:00:37.271 --> 00:00:37.631
a lot.
00:00:38.432 --> 00:00:40.834
And you can't remember being in the hotel
00:00:40.874 --> 00:00:41.914
that you are currently in,
00:00:42.094 --> 00:00:43.375
in the city that you thought you'd never
00:00:43.396 --> 00:00:43.716
been to.
00:00:44.017 --> 00:00:45.137
But I've been there.
00:00:45.176 --> 00:00:45.758
Yeah, for a wedding.
00:00:46.595 --> 00:00:47.476
Very nice.
00:00:47.576 --> 00:00:48.277
Yeah.
00:00:48.317 --> 00:00:48.537
All right.
00:00:48.578 --> 00:00:50.219
So this came across in the group chat
00:00:50.880 --> 00:00:53.402
just a couple of days ago.
00:00:54.243 --> 00:00:55.784
An article out of California.
00:00:55.804 --> 00:00:56.646
I feel like there's a lot of things
00:00:56.686 --> 00:00:57.966
going on in California these days.
00:00:58.688 --> 00:01:04.614
And a court ruled saying that nurses...
00:01:05.396 --> 00:01:07.158
And I guess effectively they're they're
00:01:07.537 --> 00:01:09.640
they're issuing the ruling for health care
00:01:09.659 --> 00:01:10.900
providers at large.
00:01:11.341 --> 00:01:12.442
But in this specific case,
00:01:12.462 --> 00:01:14.805
the ruling came that said nurses can't be
00:01:14.844 --> 00:01:16.587
called doctor in California,
00:01:17.287 --> 00:01:18.849
even if they have a doctoral degree.
00:01:18.868 --> 00:01:20.611
The federal judge ruled that the nurses
00:01:20.631 --> 00:01:22.012
with doctorates in California can't
00:01:22.052 --> 00:01:24.454
actually use the title because it could be
00:01:24.515 --> 00:01:25.135
confusing.
00:01:25.194 --> 00:01:26.316
They cited doctors.
00:01:28.103 --> 00:01:30.165
a survey from the AMA showing that thirty
00:01:30.204 --> 00:01:31.927
nine percent of patients mistakenly
00:01:31.947 --> 00:01:34.289
believe that DNPs are physicians.
00:01:34.328 --> 00:01:35.689
I will say that survey is from the
00:01:36.109 --> 00:01:36.569
AMA,
00:01:36.590 --> 00:01:38.111
which is completely comprised of
00:01:38.272 --> 00:01:38.871
physicians.
00:01:40.233 --> 00:01:41.855
So, I mean, we bring this up.
00:01:41.915 --> 00:01:43.115
We don't really talk a lot about nurse
00:01:43.156 --> 00:01:43.855
practitioners here,
00:01:43.876 --> 00:01:46.438
but obviously the parallels between the
00:01:46.838 --> 00:01:48.239
physical therapy profession and the
00:01:48.299 --> 00:01:50.621
decision there are pretty, pretty close.
00:01:51.322 --> 00:01:52.703
Where where are your thoughts on this
00:01:52.763 --> 00:01:52.963
issue?
00:01:52.983 --> 00:01:53.844
This comes up everywhere.
00:01:53.864 --> 00:01:55.305
This comes up as a trend every once
00:01:55.325 --> 00:01:56.287
in a while and then goes away.
00:01:57.436 --> 00:02:00.978
Let's just throw out a few, I think,
00:02:01.078 --> 00:02:03.320
potential facts before we get into our
00:02:03.340 --> 00:02:03.760
opinions.
00:02:03.820 --> 00:02:07.203
So the DNP, the degree,
00:02:08.585 --> 00:02:11.586
correct me if I'm wrong, the DNP.
00:02:11.627 --> 00:02:14.169
So is it a doctor of nurse practitioner
00:02:14.209 --> 00:02:15.049
that is the degree?
00:02:15.068 --> 00:02:16.730
I believe so.
00:02:16.830 --> 00:02:17.151
Okay.
00:02:17.191 --> 00:02:19.673
So the degree has doctor in it.
00:02:19.752 --> 00:02:21.834
It has the word D-O-C-T-O-R.
00:02:21.854 --> 00:02:23.055
It has the word doctor in it.
00:02:23.536 --> 00:02:24.475
Correct.
00:02:24.836 --> 00:02:26.358
Doctor of nursing practice.
00:02:26.377 --> 00:02:26.538
Correct.
00:02:28.188 --> 00:02:29.090
Right, right.
00:02:31.451 --> 00:02:32.171
Same thing with us.
00:02:32.271 --> 00:02:33.872
I'm looking at my degree right here.
00:02:34.174 --> 00:02:35.534
Doctor of Physical Therapy.
00:02:36.716 --> 00:02:39.176
It doesn't say Master of Physical Therapy.
00:02:39.298 --> 00:02:41.459
It doesn't say Bachelors, Associates,
00:02:41.519 --> 00:02:41.900
whatever.
00:02:42.900 --> 00:02:44.420
So if it's in the degree,
00:02:45.731 --> 00:02:47.052
And the physical therapist,
00:02:47.092 --> 00:02:48.493
or in this case, the nurse practitioner,
00:02:49.054 --> 00:02:51.936
assuming neither of them are suggesting
00:02:52.015 --> 00:02:53.276
that they are a physician,
00:02:53.717 --> 00:02:54.877
none of them are saying I am a
00:02:54.937 --> 00:02:55.997
physician the way that some of the
00:02:56.038 --> 00:02:57.639
chiropractors are saying I'm a
00:02:57.679 --> 00:02:58.719
chiropractic physician,
00:02:58.759 --> 00:02:59.879
which is maybe a little bit of a
00:02:59.979 --> 00:03:00.400
sidebar.
00:03:01.401 --> 00:03:03.782
If the degree has the word doctor in
00:03:03.822 --> 00:03:06.343
it, I don't see the problem here.
00:03:08.663 --> 00:03:11.385
So I was asking chat GPT yesterday,
00:03:12.306 --> 00:03:12.987
you know, hey,
00:03:13.008 --> 00:03:14.829
what are some current affairs that might
00:03:14.908 --> 00:03:17.591
impact the PT profession and give me some
00:03:17.651 --> 00:03:19.111
ideas for tomorrow's podcast?
00:03:19.872 --> 00:03:21.074
This article came up,
00:03:21.433 --> 00:03:23.496
then I asked further, I said,
00:03:24.637 --> 00:03:26.258
and I remember the origins of this,
00:03:26.277 --> 00:03:27.519
which I'll bring up in a second.
00:03:28.276 --> 00:03:28.697
I said,
00:03:28.897 --> 00:03:31.338
is this going to affect all allied health
00:03:31.359 --> 00:03:31.758
care?
00:03:31.938 --> 00:03:34.140
Also, is it just for nurses?
00:03:34.300 --> 00:03:36.663
And Chad GPT's impression was it was
00:03:36.742 --> 00:03:38.383
pretty much just in California,
00:03:38.764 --> 00:03:41.346
just nurses, and more specifically,
00:03:41.485 --> 00:03:43.247
just in clinical settings.
00:03:44.026 --> 00:03:45.668
And it was referencing like, look,
00:03:45.707 --> 00:03:46.867
if you're in a hospital,
00:03:47.188 --> 00:03:48.389
there are people coming in and out of
00:03:48.408 --> 00:03:49.770
the room constantly.
00:03:50.289 --> 00:03:52.290
If everybody is calling themselves doctor
00:03:52.330 --> 00:03:54.231
because that's what their degree is in,
00:03:54.692 --> 00:03:57.393
then you don't know who the medical doctor
00:03:57.453 --> 00:03:57.673
is,
00:03:57.712 --> 00:04:00.153
who the MD is or the DO or
00:04:00.234 --> 00:04:02.134
whatever the internist is.
00:04:02.681 --> 00:04:06.443
So there were some guidelines around.
00:04:06.484 --> 00:04:08.004
It's not that you can't say you don't
00:04:08.044 --> 00:04:09.125
have a doctorate degree.
00:04:09.145 --> 00:04:11.045
You can't say I'm a doctor of nursing
00:04:11.105 --> 00:04:12.606
or physical therapy or whatever.
00:04:13.266 --> 00:04:16.709
It is kind of in very specific settings.
00:04:16.749 --> 00:04:20.711
But this goes back, and I remember this.
00:04:21.211 --> 00:04:24.091
There was a nurse who called herself
00:04:24.151 --> 00:04:26.012
doctor because she had a doctorate degree
00:04:26.213 --> 00:04:28.514
on social media who ended up getting into,
00:04:28.634 --> 00:04:28.975
I think,
00:04:29.154 --> 00:04:32.036
legal and financial issues and
00:04:32.704 --> 00:04:35.307
Every time any of us see somebody making
00:04:35.387 --> 00:04:37.230
crazy claims on social media,
00:04:37.271 --> 00:04:39.473
we're always like, you know, who is this?
00:04:39.512 --> 00:04:40.074
What is this?
00:04:40.134 --> 00:04:41.095
What are the credentials?
00:04:41.154 --> 00:04:42.216
Is it a chiropractor?
00:04:42.255 --> 00:04:43.838
Is it a medical doctor?
00:04:45.420 --> 00:04:45.821
Whatever.
00:04:47.836 --> 00:04:49.197
And I, for one,
00:04:49.257 --> 00:04:51.119
as a consumer of media,
00:04:51.759 --> 00:04:53.661
I want to know who's the crazy I'm
00:04:53.701 --> 00:04:55.002
listening to at this moment.
00:04:55.021 --> 00:04:56.822
Yeah.
00:04:56.843 --> 00:04:58.744
Just because you have an MD after your
00:04:59.105 --> 00:05:00.605
name doesn't mean you're not crazy.
00:05:00.665 --> 00:05:03.947
It just gives me some perspective on what
00:05:03.987 --> 00:05:05.189
kind of crazy you are.
00:05:05.209 --> 00:05:05.449
Right.
00:05:05.749 --> 00:05:07.290
So I totally get it.
00:05:07.389 --> 00:05:08.451
Now, you, Dave,
00:05:08.490 --> 00:05:10.531
can probably make the best arguments here
00:05:10.552 --> 00:05:12.512
because I don't have a DPT and I
00:05:12.552 --> 00:05:13.954
don't think Jimmy has a DPT.
00:05:13.973 --> 00:05:15.654
I don't I don't I didn't know that
00:05:15.694 --> 00:05:18.216
Dave had a DPT because you never mention
00:05:18.276 --> 00:05:18.375
it.
00:05:18.997 --> 00:05:20.478
But that being said,
00:05:21.338 --> 00:05:23.139
there are some specifics around it.
00:05:23.619 --> 00:05:24.060
Yes,
00:05:24.279 --> 00:05:26.560
we've had therapists and I've never
00:05:26.761 --> 00:05:28.802
stopped anyone from saying, hey,
00:05:28.841 --> 00:05:29.783
my name is, you know.
00:05:30.786 --> 00:05:31.125
X, Y, Z,
00:05:31.206 --> 00:05:32.608
I'm a doctor of physical therapy.
00:05:32.947 --> 00:05:33.487
That's fine.
00:05:33.908 --> 00:05:36.250
And we've had patients that appreciated
00:05:36.269 --> 00:05:38.072
that they were working with a doctorate
00:05:38.132 --> 00:05:40.093
level individual.
00:05:40.132 --> 00:05:41.153
But I will also say,
00:05:41.173 --> 00:05:42.175
and then I'll turn it over.
00:05:42.855 --> 00:05:45.497
I've also had patients that they were
00:05:45.577 --> 00:05:46.999
like, oh,
00:05:47.119 --> 00:05:48.439
how many weeks does it take to become
00:05:48.459 --> 00:05:49.439
a physical therapist?
00:05:49.480 --> 00:05:50.540
And then I tell them I was a
00:05:50.600 --> 00:05:52.163
personal trainer before I became a
00:05:52.202 --> 00:05:52.923
physical therapist.
00:05:52.942 --> 00:05:53.624
And they're like, what?
00:05:54.024 --> 00:05:55.264
You're a personal trainer?
00:05:55.625 --> 00:05:56.565
That's amazing.
00:05:56.605 --> 00:05:57.766
And they go crazy for it.
00:05:58.336 --> 00:06:00.177
So, you know, it's marketing,
00:06:00.319 --> 00:06:01.098
it's branding.
00:06:01.218 --> 00:06:02.259
At the end of the day,
00:06:02.399 --> 00:06:04.482
it's just a label that could mean a
00:06:04.521 --> 00:06:06.083
lot or it could mean nothing.
00:06:08.084 --> 00:06:09.425
Jimmy, what are you thinking?
00:06:09.464 --> 00:06:10.605
Well, Dr. McKay, actually,
00:06:10.625 --> 00:06:11.507
I do have the doctorate because I
00:06:11.526 --> 00:06:12.767
graduated in twenty sixteen when it was
00:06:12.807 --> 00:06:13.348
mandatory.
00:06:13.867 --> 00:06:14.149
Do I?
00:06:14.668 --> 00:06:16.529
How do I not know both of you
00:06:16.569 --> 00:06:18.031
guys have a doctorate degree?
00:06:18.271 --> 00:06:19.713
Because we don't talk about it because.
00:06:20.879 --> 00:06:22.701
While I was in school and I graduated
00:06:22.721 --> 00:06:23.562
in twenty sixteen,
00:06:24.182 --> 00:06:26.124
I heard from the social media audience
00:06:26.144 --> 00:06:28.487
that it was imperative that the only way
00:06:28.526 --> 00:06:30.487
we're ever going to gain respect
00:06:31.302 --> 00:06:33.244
was to use that title ad nauseum.
00:06:33.324 --> 00:06:34.824
And then I heard in the classroom from
00:06:34.863 --> 00:06:36.625
my professors at Marymount University,
00:06:37.004 --> 00:06:39.685
they were named Sky and Julie,
00:06:39.786 --> 00:06:40.925
and they had PhDs.
00:06:40.985 --> 00:06:42.507
Like my professor Sky has a PhD in
00:06:42.726 --> 00:06:43.627
biochemistry.
00:06:43.766 --> 00:06:46.848
Like that's Dr. Jones or Dr.
00:06:46.887 --> 00:06:47.608
Dre territory.
00:06:47.627 --> 00:06:49.869
That's different types of doctors there.
00:06:50.608 --> 00:06:51.470
But they were very, very...
00:06:52.910 --> 00:06:54.812
insistent that we call them by their names
00:06:54.971 --> 00:06:56.213
and they you know if you so if
00:06:56.252 --> 00:06:57.973
you wanted so we have to go with
00:06:58.093 --> 00:07:00.716
words and i love me some words so
00:07:00.755 --> 00:07:05.740
number one doctoring isn't a job physician
00:07:05.800 --> 00:07:08.302
is right so like there's the disconnect so
00:07:08.362 --> 00:07:09.923
all of a sudden we've gone kleenex and
00:07:09.983 --> 00:07:12.886
cadillac on the title doctor now do i
00:07:12.925 --> 00:07:14.807
think a media campaign is going to change
00:07:14.846 --> 00:07:16.788
public perception of if someone says my
00:07:16.829 --> 00:07:18.970
kid just graduated from college she's a
00:07:19.009 --> 00:07:19.370
doctor
00:07:20.413 --> 00:07:22.454
we tend to assume that that person is
00:07:22.473 --> 00:07:23.415
in fact a physician.
00:07:23.634 --> 00:07:24.214
I get that.
00:07:24.634 --> 00:07:26.036
That's what I would assume, right?
00:07:26.735 --> 00:07:29.036
But no one has any problem when Short
00:07:29.077 --> 00:07:31.819
Round says, no time for love, Dr. Jones.
00:07:32.178 --> 00:07:34.839
And he's referring to Dr. Indiana Jones,
00:07:35.141 --> 00:07:36.982
who is an archaeologist, right?
00:07:37.221 --> 00:07:39.302
So it's funny because in some places,
00:07:39.543 --> 00:07:42.324
like Dr. Dre or Dr. Seuss or Dr.
00:07:42.384 --> 00:07:43.264
Ruth Westheimer,
00:07:43.504 --> 00:07:44.906
we've got a list of doctors everywhere,
00:07:44.925 --> 00:07:45.466
right?
00:07:45.565 --> 00:07:46.286
For some reason,
00:07:46.326 --> 00:07:48.307
it's OK in some contexts and not in
00:07:48.327 --> 00:07:48.608
the other.
00:07:48.987 --> 00:07:49.387
And again,
00:07:49.788 --> 00:07:52.709
I am in favor of communicating clearly so
00:07:52.769 --> 00:07:54.451
I can see where someone saying, hey,
00:07:54.550 --> 00:07:57.692
thirty nine percent of patients polled no
00:07:57.733 --> 00:07:59.394
data on how many people were actually
00:07:59.434 --> 00:08:00.894
polled or in what settings or what
00:08:00.915 --> 00:08:03.076
questions they were asked were confused.
00:08:03.415 --> 00:08:04.177
So that's why.
00:08:05.156 --> 00:08:07.319
APTA goes out of their way to actually
00:08:07.358 --> 00:08:10.540
message, I am Dr. Johnson,
00:08:10.721 --> 00:08:12.482
your physical therapist.
00:08:12.701 --> 00:08:15.704
Make sure you qualify what you're actually
00:08:15.824 --> 00:08:16.584
a doctor of.
00:08:17.677 --> 00:08:19.016
Do I think it's confusing?
00:08:20.017 --> 00:08:20.437
I don't know.
00:08:20.598 --> 00:08:21.538
Yeah, a little bit.
00:08:21.697 --> 00:08:22.958
Do I think it's necessary?
00:08:23.437 --> 00:08:24.899
I don't know if it always is.
00:08:24.978 --> 00:08:27.059
If someone asks what your qualifications
00:08:27.139 --> 00:08:27.278
are,
00:08:27.600 --> 00:08:29.300
Tony just mentioned someone got super
00:08:29.360 --> 00:08:30.660
excited because they found out he's a
00:08:30.699 --> 00:08:33.421
physical therapist and he was a personal
00:08:33.461 --> 00:08:34.441
trainer before that.
00:08:34.640 --> 00:08:37.062
I think the person is always listening to
00:08:37.121 --> 00:08:38.741
see how this person, Tony,
00:08:38.961 --> 00:08:39.942
or whoever's in front of them,
00:08:40.342 --> 00:08:42.243
how is what they know going to help
00:08:42.283 --> 00:08:42.462
me?
00:08:42.743 --> 00:08:44.283
And I'll close with that famous quote.
00:08:44.844 --> 00:08:46.245
I think it was Eleanor Roosevelt says,
00:08:46.645 --> 00:08:49.549
no one cares how much you know until
00:08:49.570 --> 00:08:50.711
they know how much you care.
00:08:51.432 --> 00:08:52.614
Neither of those things are true.
00:08:52.714 --> 00:08:53.916
They don't care how much you know.
00:08:54.015 --> 00:08:55.278
They don't really care how much you care.
00:08:55.477 --> 00:08:55.859
They care,
00:08:56.219 --> 00:08:58.061
do you understand what problem I have?
00:08:58.381 --> 00:09:00.004
And are you capable of helping me solve
00:09:00.043 --> 00:09:00.104
it?
00:09:00.845 --> 00:09:02.725
I understand how using that title doctor
00:09:03.005 --> 00:09:04.706
can give you a little puff out your
00:09:04.746 --> 00:09:06.187
chest a little bit and say like, oh,
00:09:06.488 --> 00:09:08.109
I have advanced qualifications.
00:09:08.609 --> 00:09:09.369
So I get that.
00:09:09.730 --> 00:09:13.831
But you shouldn't sacrifice quality for
00:09:13.871 --> 00:09:15.773
clarity in certain situations.
00:09:15.972 --> 00:09:17.293
So I think it's nuanced.
00:09:17.533 --> 00:09:18.913
I think this conversation is going to come
00:09:18.953 --> 00:09:20.335
up over and over again,
00:09:20.654 --> 00:09:21.855
and it's never going to get solved.
00:09:23.307 --> 00:09:25.289
The example of a hospital room where
00:09:25.330 --> 00:09:28.272
there's providers coming in and out and
00:09:28.312 --> 00:09:29.873
the patient or the family not knowing who
00:09:29.893 --> 00:09:33.294
the medical doctor is, the actual MD is,
00:09:33.855 --> 00:09:34.655
is ridiculous.
00:09:35.317 --> 00:09:36.298
Because in every hospital,
00:09:36.398 --> 00:09:37.639
a PA that walks in the room,
00:09:38.078 --> 00:09:38.759
in a hospital,
00:09:39.000 --> 00:09:40.441
and also where I used to work,
00:09:40.480 --> 00:09:42.182
my first job was a physician in practice,
00:09:42.241 --> 00:09:43.143
outpatient ortho,
00:09:43.503 --> 00:09:46.105
and those PAs also wore white coats.
00:09:46.144 --> 00:09:47.765
They looked exactly like the physicians.
00:09:47.826 --> 00:09:50.107
So even though I just looked up that
00:09:50.128 --> 00:09:51.948
the AMA, the American Medical Association,
00:09:51.989 --> 00:09:52.629
was not
00:09:53.049 --> 00:09:55.511
a part of any of this nurse practitioner
00:09:55.631 --> 00:09:57.073
expansion programs and all that.
00:09:57.114 --> 00:09:58.794
So they've generally been opposed to all
00:09:58.815 --> 00:10:00.736
this the whole time across the country
00:10:00.917 --> 00:10:01.238
anyway.
00:10:01.437 --> 00:10:03.379
I thought that they were a part of
00:10:03.419 --> 00:10:03.539
it.
00:10:03.679 --> 00:10:04.200
I looked it up.
00:10:04.279 --> 00:10:05.701
As we were talking in ChatGPT,
00:10:06.001 --> 00:10:07.342
they've always been generally opposed to
00:10:07.403 --> 00:10:07.503
it.
00:10:07.884 --> 00:10:10.865
So then why do physicians allow PAs that
00:10:10.885 --> 00:10:13.087
are under the guidance of those physicians
00:10:13.849 --> 00:10:15.250
to walk in a room with a white
00:10:15.269 --> 00:10:17.350
coat on, and I know this for years,
00:10:17.389 --> 00:10:19.490
where the patient will say, oh, hey,
00:10:19.530 --> 00:10:21.011
doctor so-and-so, hey,
00:10:21.091 --> 00:10:23.952
and the PAs do not correct the patient,
00:10:24.153 --> 00:10:24.812
the family.
00:10:24.993 --> 00:10:26.592
They do not say, oh, I'm a PA,
00:10:26.994 --> 00:10:29.774
I'm Steve, not Dr. Kelly, or whatever,
00:10:29.855 --> 00:10:30.034
right?
00:10:30.075 --> 00:10:32.635
Like, I'm Steve, I'm the PA for,
00:10:33.076 --> 00:10:33.775
they don't correct them.
00:10:34.035 --> 00:10:35.196
Just like in physical therapy,
00:10:35.216 --> 00:10:37.657
the PTAs do not really typically,
00:10:37.996 --> 00:10:39.197
in my experience,
00:10:39.918 --> 00:10:42.599
They don't correct patients when a patient
00:10:42.639 --> 00:10:44.639
calls them their therapist or the patient
00:10:44.678 --> 00:10:47.120
calls the PTA, that's my PT.
00:10:47.379 --> 00:10:48.379
I don't know how it is in Tony's
00:10:48.440 --> 00:10:48.720
office,
00:10:48.759 --> 00:10:50.620
but in all the offices I've ever been,
00:10:50.961 --> 00:10:52.942
patients do not know the difference
00:10:52.981 --> 00:10:55.182
between a PT and a PTA for the
00:10:55.221 --> 00:10:55.721
most part.
00:10:56.142 --> 00:10:57.663
And so it's just the way it is,
00:10:57.722 --> 00:10:59.962
whether it's the physician,
00:11:00.323 --> 00:11:01.604
the MD and the PA,
00:11:02.083 --> 00:11:03.923
or it's an NP or a nurse practitioner.
00:11:03.964 --> 00:11:05.465
And also, by the way, the sidebar,
00:11:06.897 --> 00:11:10.158
nurse practitioners and DNPs and DNPs,
00:11:10.278 --> 00:11:11.099
I'm pretty sure both,
00:11:11.178 --> 00:11:13.940
but definitely the doctor, the DNP,
00:11:14.360 --> 00:11:15.860
I'm pretty sure both though can prescribe
00:11:15.879 --> 00:11:16.480
medication.
00:11:16.520 --> 00:11:18.701
So also like they can prescribe
00:11:18.721 --> 00:11:19.341
medication.
00:11:19.381 --> 00:11:21.982
So who cares about the doctor label?
00:11:22.023 --> 00:11:25.183
They're doing some major role in the
00:11:25.203 --> 00:11:28.585
healthcare system that physicians also do.
00:11:28.684 --> 00:11:29.946
That takes a lot of training and
00:11:30.046 --> 00:11:31.485
understanding and you have to know
00:11:31.885 --> 00:11:33.267
pharmacology and all, you know,
00:11:33.366 --> 00:11:35.207
side effects and contraindications and all
00:11:35.227 --> 00:11:35.408
that.
00:11:35.467 --> 00:11:35.967
So it's like,
00:11:37.793 --> 00:11:38.452
Who cares?
00:11:38.472 --> 00:11:40.073
Because the physicians allow the PAs to
00:11:40.094 --> 00:11:41.475
look exactly like themselves too.
00:11:42.296 --> 00:11:43.296
I'll tell you who cares.
00:11:44.557 --> 00:11:45.336
Well, two sides.
00:11:45.957 --> 00:11:46.837
The practitioner,
00:11:47.198 --> 00:11:50.900
because we are hierarchical in this world,
00:11:51.341 --> 00:11:51.561
right?
00:11:51.721 --> 00:11:52.221
Yep.
00:11:52.301 --> 00:11:52.922
It's just ego.
00:11:53.101 --> 00:11:54.043
It's just ego and status.
00:11:54.082 --> 00:11:57.163
Yeah, that's it.
00:11:57.364 --> 00:11:59.405
It is not about protecting the consumers
00:11:59.605 --> 00:11:59.865
at all.
00:12:01.433 --> 00:12:02.073
It's not.
00:12:02.254 --> 00:12:04.176
But from the consumer perspective,
00:12:04.235 --> 00:12:04.816
I'll tell you,
00:12:04.855 --> 00:12:06.157
because I've gone through the health care
00:12:06.177 --> 00:12:07.618
system, not a lot with myself.
00:12:07.638 --> 00:12:08.898
I've been relatively healthy up to this
00:12:08.957 --> 00:12:10.919
point with my parents, though.
00:12:11.200 --> 00:12:12.340
The question is always like,
00:12:12.900 --> 00:12:15.341
are we getting the doctor or are we
00:12:15.381 --> 00:12:15.881
getting there?
00:12:15.961 --> 00:12:17.623
Like, are we getting the second one?
00:12:17.803 --> 00:12:18.344
Are we like,
00:12:18.683 --> 00:12:19.825
are they just in their office?
00:12:21.068 --> 00:12:22.551
So it's not a knock on the person
00:12:22.591 --> 00:12:23.371
in front of you, but it's like,
00:12:23.652 --> 00:12:25.254
why am I not getting the person?
00:12:25.554 --> 00:12:26.736
Because if there's an error,
00:12:27.096 --> 00:12:28.600
I'm going to go back to this moment
00:12:28.659 --> 00:12:29.942
as the fork in the road and go,
00:12:30.361 --> 00:12:31.803
why didn't I have that other person in
00:12:31.844 --> 00:12:32.164
front of me?
00:12:32.365 --> 00:12:33.767
I'm paying the same rate, right?
00:12:33.807 --> 00:12:34.609
Wouldn't you be pissed?
00:12:35.868 --> 00:12:37.129
It might not be the same rate.
00:12:37.149 --> 00:12:37.489
I don't know.
00:12:37.908 --> 00:12:40.191
If you didn't get the mechanic,
00:12:40.650 --> 00:12:43.332
but you got the mechanic's assistant who
00:12:43.352 --> 00:12:44.893
went through five hundred hours of
00:12:44.933 --> 00:12:46.193
training and not ten thousand hours of
00:12:46.234 --> 00:12:47.495
training and something goes wrong with
00:12:47.514 --> 00:12:48.775
your car and you crash, you'll be like,
00:12:49.096 --> 00:12:50.256
we didn't get the assistant.
00:12:50.356 --> 00:12:51.376
That's where the thing was.
00:12:51.738 --> 00:12:53.599
So I think that that's the thing for
00:12:53.619 --> 00:12:53.778
me.
00:12:53.818 --> 00:12:55.720
Both my parents like who when the person
00:12:55.740 --> 00:12:57.441
would come in, give their spiel and leave.
00:12:57.760 --> 00:12:58.902
Is that who who is that?
00:12:58.981 --> 00:13:00.062
What's their qualifications?
00:13:00.403 --> 00:13:01.803
There's unclarity there.
00:13:03.024 --> 00:13:04.686
And the title doesn't clear it up.
00:13:05.307 --> 00:13:06.467
That's a problem for me.
00:13:06.508 --> 00:13:07.628
I won't say that's the problem,
00:13:07.889 --> 00:13:08.788
but that's a problem.
00:13:08.828 --> 00:13:09.710
We want to understand.
00:13:10.629 --> 00:13:12.110
Look, now more than ever,
00:13:12.552 --> 00:13:13.893
who am I taking advice from?
00:13:13.993 --> 00:13:14.092
Well,
00:13:14.113 --> 00:13:16.614
there's a guy giving advice on medication
00:13:16.673 --> 00:13:18.775
right now that, as far as I know,
00:13:19.056 --> 00:13:21.577
has no minutes worth of medical training
00:13:22.038 --> 00:13:24.318
but a very large podium and just told
00:13:24.379 --> 00:13:26.860
a bunch of people that nothing bad can
00:13:26.900 --> 00:13:27.260
happen.
00:13:27.501 --> 00:13:28.542
Only good can happen.
00:13:28.982 --> 00:13:29.842
Only good can happen.
00:13:30.082 --> 00:13:30.803
And he's not Yoda.
00:13:30.823 --> 00:13:32.245
He's the president of the country.
00:13:33.164 --> 00:13:34.066
giving medical advice.
00:13:34.086 --> 00:13:35.005
And we're saying, okay,
00:13:35.086 --> 00:13:35.966
well that sounds legit.
00:13:36.366 --> 00:13:39.847
That is a scary thing to happen.
00:13:39.888 --> 00:13:42.308
Going back to one of the things that
00:13:42.349 --> 00:13:45.710
Dave said about like,
00:13:46.030 --> 00:13:48.772
I remember this conversation happening
00:13:48.792 --> 00:13:50.312
years ago, you know,
00:13:50.351 --> 00:13:52.653
physical therapist assistant in the
00:13:52.852 --> 00:13:54.594
hospital based outpatient,
00:13:54.793 --> 00:13:56.235
either they weren't wearing their name
00:13:56.274 --> 00:13:57.796
badge or their name badge was always
00:13:57.836 --> 00:13:58.755
flipped over and
00:13:59.542 --> 00:14:00.942
I mean, the reality is,
00:14:01.243 --> 00:14:02.842
I'll take this in two directions.
00:14:02.903 --> 00:14:05.224
From the sales and marketing perspective,
00:14:05.504 --> 00:14:07.764
why don't they correct the patient when
00:14:07.783 --> 00:14:10.585
the patient says doctor or therapist or
00:14:10.605 --> 00:14:11.065
whatever?
00:14:11.625 --> 00:14:13.785
Because you get better buy-in with some
00:14:13.826 --> 00:14:14.265
patients.
00:14:14.306 --> 00:14:16.706
So you're going to leverage the name.
00:14:17.826 --> 00:14:19.067
You're going to leverage that with the
00:14:19.087 --> 00:14:20.248
people who care about it.
00:14:20.288 --> 00:14:21.687
And there are people who care about it.
00:14:22.008 --> 00:14:22.609
Like Jimmy said,
00:14:22.649 --> 00:14:24.188
there are people who want the doctor,
00:14:24.249 --> 00:14:25.328
the medical doctor.
00:14:26.870 --> 00:14:27.570
I'm going to say...
00:14:29.219 --> 00:14:31.860
Yes, they're here in my clinic.
00:14:32.080 --> 00:14:34.120
I don't want differentiation between me
00:14:34.139 --> 00:14:34.961
and my assistant.
00:14:35.721 --> 00:14:37.821
Why don't I want differentiation between
00:14:37.880 --> 00:14:38.841
me and my assistant?
00:14:38.881 --> 00:14:40.461
Why don't I think it even matters?
00:14:40.961 --> 00:14:43.062
Because the reality is what is being
00:14:43.102 --> 00:14:43.682
delivered,
00:14:43.722 --> 00:14:45.523
the service that is being delivered,
00:14:45.923 --> 00:14:48.464
my assistant is equally qualified,
00:14:48.683 --> 00:14:49.764
equally educated,
00:14:49.984 --> 00:14:51.825
equally licensed to deliver the
00:14:51.865 --> 00:14:52.404
intervention.
00:14:53.067 --> 00:14:54.768
After your evaluation?
00:14:54.788 --> 00:14:56.149
I'm not going to say that he is
00:14:56.188 --> 00:14:58.410
the therapist doing an evaluation because
00:14:58.451 --> 00:15:00.792
he is not licensed to do an evaluation.
00:15:01.232 --> 00:15:03.114
There's going to be differentiation when
00:15:03.153 --> 00:15:05.255
it's a physical therapy evaluation.
00:15:05.735 --> 00:15:07.456
But when we take it to treatment,
00:15:07.496 --> 00:15:08.977
delivery of the intervention,
00:15:09.437 --> 00:15:13.660
he is equal to me in all capacities
00:15:13.922 --> 00:15:16.283
relative to education, licensure,
00:15:16.643 --> 00:15:18.625
experience, all of that kind of stuff.
00:15:19.160 --> 00:15:21.222
So it doesn't help him do his job
00:15:21.302 --> 00:15:24.445
any better if the patient thinks, oh,
00:15:24.504 --> 00:15:25.885
I'm getting a lesser person.
00:15:25.926 --> 00:15:27.346
And this goes to Jimmy's point,
00:15:28.368 --> 00:15:31.509
where the PA or the medical doctor,
00:15:32.410 --> 00:15:33.831
in what they're actually doing at the
00:15:33.851 --> 00:15:34.652
moment,
00:15:34.672 --> 00:15:36.894
they are probably equally trained and
00:15:36.974 --> 00:15:38.975
equally qualified to deliver that.
00:15:39.456 --> 00:15:42.557
So I do think that we're dealing with
00:15:42.618 --> 00:15:45.639
an uneducated population in the
00:15:45.679 --> 00:15:46.660
terminology of
00:15:47.692 --> 00:15:49.312
Um, so of course, like, shoot,
00:15:49.352 --> 00:15:52.053
if I could get a premium, you know,
00:15:52.073 --> 00:15:55.294
the highest expert in the land to paint
00:15:55.315 --> 00:15:56.855
my bathroom, I've said this before,
00:15:56.895 --> 00:15:58.836
like Pablo Picasso could come paint my
00:15:58.876 --> 00:16:01.337
bathroom or I could get John down the
00:16:01.398 --> 00:16:01.898
street.
00:16:02.258 --> 00:16:04.198
Both of them are equally qualified to
00:16:04.239 --> 00:16:05.019
paint a bathroom,
00:16:05.480 --> 00:16:08.000
but I can't get John to paint,
00:16:08.380 --> 00:16:09.041
you know,
00:16:09.140 --> 00:16:11.142
a masterpiece that's going to hang in a
00:16:11.241 --> 00:16:11.782
museum.
00:16:11.922 --> 00:16:13.602
Like these are different things.
00:16:15.226 --> 00:16:17.529
But you do bring up a point,
00:16:17.590 --> 00:16:19.432
which is actually the reverse,
00:16:19.933 --> 00:16:21.296
which is a lot of times you're so
00:16:21.436 --> 00:16:22.057
educated,
00:16:22.277 --> 00:16:24.100
you've gone so far up the ladder,
00:16:24.120 --> 00:16:25.923
you're so removed from doing the everyday
00:16:25.962 --> 00:16:28.166
tasks that a lot of times John the
00:16:28.206 --> 00:16:29.047
painter is better.
00:16:29.628 --> 00:16:31.328
Because Picasso's over here whining and
00:16:31.369 --> 00:16:32.769
dining people to get in the Louvre.
00:16:32.788 --> 00:16:33.669
I don't know if he was ever in
00:16:33.690 --> 00:16:33.990
the Louvre,
00:16:34.289 --> 00:16:36.250
but John's the guy doing the thing.
00:16:36.711 --> 00:16:39.052
So it might actually be reversed.
00:16:39.072 --> 00:16:40.231
You're looking for that person with the
00:16:40.251 --> 00:16:40.991
qualifications,
00:16:41.212 --> 00:16:42.633
but they've spent so much time in
00:16:42.673 --> 00:16:44.413
classrooms getting the qualifications.
00:16:44.734 --> 00:16:46.195
Maybe they're not doing stitches.
00:16:46.274 --> 00:16:48.816
So the PA next to you is actually
00:16:48.836 --> 00:16:49.556
the best person.
00:16:49.936 --> 00:16:51.297
But we are stuck on those labels
00:16:51.336 --> 00:16:51.897
because...
00:16:52.775 --> 00:16:53.756
That's the only thing we can,
00:16:54.157 --> 00:16:56.479
that's the only star we can check off.
00:16:56.499 --> 00:16:59.321
There's no other thing to Yelp people
00:16:59.380 --> 00:16:59.961
about, right?
00:17:00.001 --> 00:17:00.822
It's just, well,
00:17:00.923 --> 00:17:02.303
what are your letters after your name?
00:17:02.644 --> 00:17:05.205
Which goes back to why we chase letters
00:17:05.286 --> 00:17:06.606
after our name, because we're big,
00:17:06.666 --> 00:17:07.268
dumb animals.
00:17:07.347 --> 00:17:10.109
I mean, another major PT organization,
00:17:10.891 --> 00:17:11.730
which surfaced,
00:17:11.872 --> 00:17:13.653
and if memory serves me right,
00:17:14.032 --> 00:17:15.894
they were all about advocacy,
00:17:17.076 --> 00:17:18.616
are now releasing their own continuing
00:17:18.636 --> 00:17:19.538
education units.
00:17:20.406 --> 00:17:21.106
Oh, boy.
00:17:21.146 --> 00:17:22.347
Are you serious?
00:17:22.627 --> 00:17:26.288
Guys, the carousel does two things.
00:17:26.528 --> 00:17:27.689
The carousel does two things.
00:17:27.848 --> 00:17:29.630
It goes up, down, round, and round.
00:17:29.650 --> 00:17:32.490
It goes up, down, round, and round.
00:17:32.530 --> 00:17:36.132
This is all the same thing.
00:17:36.172 --> 00:17:40.053
This is my shocked face.
00:17:40.113 --> 00:17:41.074
We knew this was coming.
00:17:41.114 --> 00:17:42.233
You knew this was coming.
00:17:43.036 --> 00:17:44.477
A little bit of a quick story.
00:17:44.557 --> 00:17:45.277
A week or two ago,
00:17:45.317 --> 00:17:46.156
we took our son.
00:17:46.416 --> 00:17:46.836
He's fine,
00:17:46.856 --> 00:17:48.557
but we took him to a local urgent
00:17:48.577 --> 00:17:48.837
care.
00:17:49.198 --> 00:17:52.019
And one of the so the first person
00:17:52.038 --> 00:17:54.619
that came in announced themselves as like
00:17:54.680 --> 00:17:55.721
the medical assistant.
00:17:55.760 --> 00:17:56.401
So, you know,
00:17:56.461 --> 00:17:58.761
like some subjective questions and,
00:18:00.041 --> 00:18:00.221
you know,
00:18:00.241 --> 00:18:01.282
like height and weight or whatever,
00:18:01.303 --> 00:18:02.022
like that type of stuff.
00:18:03.873 --> 00:18:05.674
Then a provider comes in.
00:18:06.234 --> 00:18:09.018
It says the provider didn't announce,
00:18:09.479 --> 00:18:11.000
like they kind of mumbled their name.
00:18:11.039 --> 00:18:11.380
I was like,
00:18:11.441 --> 00:18:12.821
I think that was the first name,
00:18:12.842 --> 00:18:14.123
but it was just like one name.
00:18:14.163 --> 00:18:16.726
It'd be like Dave or, you know, Kittle.
00:18:16.746 --> 00:18:17.507
I don't know.
00:18:17.567 --> 00:18:18.567
She like mumbled her name.
00:18:20.269 --> 00:18:21.852
She mumbled her first or last name,
00:18:21.872 --> 00:18:25.656
but just one word and did like,
00:18:25.717 --> 00:18:26.837
you know, looking in his mouth,
00:18:26.857 --> 00:18:29.300
looking in his ears and like kind of
00:18:29.320 --> 00:18:29.942
like an exam.
00:18:30.061 --> 00:18:30.383
Great.
00:18:30.542 --> 00:18:30.843
Awesome.
00:18:30.883 --> 00:18:32.746
Like that's and then I know we've talked
00:18:32.766 --> 00:18:33.486
about this other times,
00:18:33.507 --> 00:18:34.548
like I'm just there for.
00:18:35.588 --> 00:18:37.089
I don't really care if it's a physician
00:18:37.230 --> 00:18:41.513
or an NP or a DNP or whatever,
00:18:41.594 --> 00:18:42.454
or I don't know,
00:18:42.494 --> 00:18:44.135
a nurse or a PA.
00:18:44.155 --> 00:18:45.576
We don't know.
00:18:45.596 --> 00:18:46.678
I don't know who it is.
00:18:46.798 --> 00:18:48.900
And the badge says the woman's first and
00:18:48.940 --> 00:18:50.780
last name and it says provider.
00:18:51.080 --> 00:18:52.603
And I'm like, that's a weird,
00:18:52.623 --> 00:18:54.003
I hate that title, but keep going.
00:18:54.394 --> 00:18:54.994
Yeah, I know.
00:18:55.175 --> 00:18:55.476
Right.
00:18:55.536 --> 00:18:57.076
So because I'm in health care and then
00:18:57.096 --> 00:18:58.438
I'm like, I asked it anyway,
00:18:58.458 --> 00:18:59.498
but I know I'm like this.
00:19:00.019 --> 00:19:00.959
This woman's probably going to get
00:19:00.979 --> 00:19:02.619
offended because like it's I'm a male and
00:19:02.640 --> 00:19:04.761
she's a woman and I'm and I'm I'm
00:19:04.821 --> 00:19:05.061
nice.
00:19:05.102 --> 00:19:07.583
I'm not challenging what she is,
00:19:07.623 --> 00:19:09.104
but it's kind of like your company should
00:19:09.144 --> 00:19:09.463
have.
00:19:10.384 --> 00:19:13.826
the NP or PA or MD,
00:19:13.846 --> 00:19:15.446
just put a couple of those letters there.
00:19:15.527 --> 00:19:16.208
I'm just curious.
00:19:16.407 --> 00:19:18.189
I'm just curious who's looking in my son's
00:19:18.249 --> 00:19:18.388
ears.
00:19:18.949 --> 00:19:20.569
I just want to know, hey,
00:19:21.589 --> 00:19:22.130
this is awesome.
00:19:22.171 --> 00:19:22.431
Great.
00:19:22.471 --> 00:19:23.090
There was no wait.
00:19:23.111 --> 00:19:23.810
It was a Saturday.
00:19:23.851 --> 00:19:24.310
This is awesome.
00:19:24.330 --> 00:19:25.751
You guys are places clean.
00:19:25.852 --> 00:19:26.231
Wonderful.
00:19:26.271 --> 00:19:26.972
Everyone's smiling.
00:19:27.333 --> 00:19:28.432
I had no problems at all.
00:19:28.573 --> 00:19:29.233
I was just curious.
00:19:29.253 --> 00:19:30.513
I was like, hey,
00:19:30.554 --> 00:19:32.335
are you one of the physicians here or
00:19:32.414 --> 00:19:35.396
PA or NP or RN?
00:19:36.457 --> 00:19:39.259
And she said a PA.
00:19:39.278 --> 00:19:40.859
But she held up her badge like,
00:19:42.161 --> 00:19:42.500
it's right here.
00:19:42.520 --> 00:19:43.540
And I'm like, no, it's not right there.
00:19:43.560 --> 00:19:44.261
It says provider.
00:19:44.721 --> 00:19:45.863
But I didn't say that.
00:19:45.883 --> 00:19:46.583
But I was kind of like,
00:19:47.523 --> 00:19:48.044
I don't know.
00:19:48.084 --> 00:19:50.065
It's just like another ridiculous aspect
00:19:50.105 --> 00:19:50.625
of health care.
00:19:51.326 --> 00:19:53.207
Or at least this company.
00:19:53.827 --> 00:19:55.167
Why have provider on there?
00:19:55.208 --> 00:19:57.289
Is that, again, so that maybe,
00:19:57.690 --> 00:19:58.470
like Tony said,
00:19:58.509 --> 00:20:00.751
patients don't ask for the physician or
00:20:00.791 --> 00:20:02.093
the DNP or whatever.
00:20:02.173 --> 00:20:04.453
And it's the PA or an RN or
00:20:04.473 --> 00:20:05.994
someone that's coming in to do that.
00:20:06.194 --> 00:20:08.655
lot of basic stuff i'd say that's more
00:20:08.695 --> 00:20:11.136
misleading than anything i mean right i
00:20:11.156 --> 00:20:13.498
mean exactly exactly the front desk can
00:20:13.538 --> 00:20:15.419
provide some things i mean we all provide
00:20:15.618 --> 00:20:18.359
i i get the provider payer sort of
00:20:18.420 --> 00:20:20.820
conversation that shouldn't be in an exam
00:20:20.861 --> 00:20:23.362
room that's a weird weird use of words
00:20:23.382 --> 00:20:25.702
there and she held up her badge like
00:20:25.742 --> 00:20:28.124
almost like it's right here mister and i'm
00:20:28.144 --> 00:20:30.785
like no it's not there it says provider
00:20:31.085 --> 00:20:31.805
that could be anything
00:20:33.951 --> 00:20:36.334
So Ryder could be an RN or whatever.
00:20:36.374 --> 00:20:37.574
I think we agree this is never going
00:20:37.614 --> 00:20:38.974
to end.
00:20:39.015 --> 00:20:41.537
This will just, again, carousel.
00:20:41.656 --> 00:20:42.978
So let me pose this question to you
00:20:42.998 --> 00:20:43.298
guys.
00:20:43.417 --> 00:20:44.398
Will this spread?
00:20:44.459 --> 00:20:47.059
Will the DNP, so two questions.
00:20:47.279 --> 00:20:49.501
Will the NPDNP being barred,
00:20:49.642 --> 00:20:50.863
will it happen in other states?
00:20:51.143 --> 00:20:51.982
One first question.
00:20:52.384 --> 00:20:54.204
And then will it eventually trickle over
00:20:54.244 --> 00:20:55.925
to PT and be barred in California or
00:20:55.986 --> 00:20:56.586
some other states?
00:20:57.426 --> 00:20:57.547
Um.
00:20:59.691 --> 00:21:01.373
Using doctor, if you're not a physician.
00:21:01.492 --> 00:21:02.594
It's funny because when I read this
00:21:02.634 --> 00:21:02.973
article,
00:21:05.175 --> 00:21:06.837
they were framing this under a First
00:21:06.897 --> 00:21:09.420
Amendment issue, which First Amendment,
00:21:09.480 --> 00:21:11.521
getting a lot of press these days.
00:21:11.622 --> 00:21:12.623
It's every couple of years,
00:21:12.702 --> 00:21:13.364
the First Amendment.
00:21:13.703 --> 00:21:16.026
So what they're really doing is they're
00:21:16.125 --> 00:21:19.269
framing this as commercial speech versus
00:21:19.328 --> 00:21:20.910
First Amendment protected speech.
00:21:21.191 --> 00:21:21.951
So let's be very clear.
00:21:22.332 --> 00:21:23.653
If it's commercial speech,
00:21:23.673 --> 00:21:25.074
it's not protected under the First
00:21:25.114 --> 00:21:25.555
Amendment.
00:21:26.451 --> 00:21:30.113
So that's where I don't think it will
00:21:30.153 --> 00:21:31.294
gain legs.
00:21:31.554 --> 00:21:32.714
I don't know if it'll,
00:21:32.875 --> 00:21:34.516
I don't think it'll spread to another
00:21:34.615 --> 00:21:35.016
state.
00:21:35.375 --> 00:21:37.076
And I don't think it'll spread to other
00:21:37.896 --> 00:21:40.538
professions only because there's no money
00:21:40.578 --> 00:21:40.818
in it.
00:21:41.138 --> 00:21:41.298
Like,
00:21:42.339 --> 00:21:44.121
I don't see someone like getting all in
00:21:44.181 --> 00:21:45.781
a tizzy, unless it's the AMA,
00:21:45.821 --> 00:21:47.022
which did not start this,
00:21:47.163 --> 00:21:48.103
unless it was the AMA,
00:21:48.383 --> 00:21:49.263
which to my knowledge,
00:21:49.284 --> 00:21:50.223
according to this article,
00:21:50.605 --> 00:21:52.925
weren't the ones who initiated this.
00:21:54.632 --> 00:21:57.353
I don't know why it wouldn't gain traction
00:21:57.573 --> 00:21:59.333
because, you know,
00:21:59.373 --> 00:22:01.834
if you paid hundreds of thousands of
00:22:01.894 --> 00:22:03.294
dollars for those letters,
00:22:03.334 --> 00:22:04.835
you want to protect those letters.
00:22:04.894 --> 00:22:06.315
This irony in this,
00:22:06.914 --> 00:22:09.675
as we saw from Lifetime Family Fitness,
00:22:10.215 --> 00:22:13.517
we can't even protect DPT.
00:22:13.737 --> 00:22:15.798
I could be a dynamic personal trainer
00:22:15.837 --> 00:22:16.657
tomorrow.
00:22:17.958 --> 00:22:20.459
There's no lawsuits have been won.
00:22:21.118 --> 00:22:23.140
Nobody has stopped using those letters
00:22:23.220 --> 00:22:23.660
like DPT.
00:22:24.115 --> 00:22:26.637
So, I mean, this just goes back to,
00:22:27.659 --> 00:22:31.281
I understand the desire to know who am
00:22:31.362 --> 00:22:32.041
I talking to?
00:22:32.103 --> 00:22:33.163
Who am I listening to?
00:22:33.202 --> 00:22:35.525
Where is this information coming from as a
00:22:35.565 --> 00:22:36.046
consumer?
00:22:36.685 --> 00:22:38.807
I understand the desire to protect your
00:22:38.847 --> 00:22:41.170
credential as a person who paid six
00:22:41.210 --> 00:22:42.171
figures for it.
00:22:42.570 --> 00:22:42.790
Hey,
00:22:43.050 --> 00:22:45.553
I bought this just because it's two
00:22:45.593 --> 00:22:46.034
letters.
00:22:46.193 --> 00:22:47.815
I don't want anybody else to use it.
00:22:48.895 --> 00:22:50.998
So I can see it on all fronts,
00:22:51.357 --> 00:22:53.140
but then it still goes back to,
00:22:53.980 --> 00:22:55.902
society and language,
00:22:56.021 --> 00:22:57.383
it's constantly changing,
00:22:57.462 --> 00:22:59.163
constantly evolving, you know,
00:22:59.263 --> 00:23:00.865
so at some point,
00:23:00.924 --> 00:23:03.926
it's just going to be worthless to have
00:23:03.987 --> 00:23:06.368
those letters or to use that word or
00:23:06.449 --> 00:23:07.950
to do any of that stuff.
00:23:08.471 --> 00:23:09.351
So, you know,
00:23:09.632 --> 00:23:11.593
the reason why it's still a topic is
00:23:11.633 --> 00:23:13.013
because there's still probably some
00:23:13.054 --> 00:23:13.914
inherent value,
00:23:13.934 --> 00:23:15.655
whether it's the university selling the
00:23:15.695 --> 00:23:16.296
doctorate,
00:23:17.156 --> 00:23:19.018
they want to protect the value of that
00:23:19.077 --> 00:23:20.940
six figure education and label.
00:23:21.915 --> 00:23:22.757
Or it's, you know,
00:23:22.797 --> 00:23:25.439
the business selling the impression of
00:23:25.519 --> 00:23:27.040
expertise to the consumer.
00:23:27.740 --> 00:23:28.182
And again,
00:23:28.281 --> 00:23:30.503
I say the impression because we all know
00:23:30.564 --> 00:23:33.705
plenty of doctorate level professionals
00:23:34.106 --> 00:23:36.268
who are not experts in any way.
00:23:36.828 --> 00:23:37.189
You know,
00:23:37.269 --> 00:23:39.310
either they've been in it too long or
00:23:39.351 --> 00:23:40.912
they haven't been in it long enough.
00:23:41.532 --> 00:23:43.974
But there's plenty of craziness and stuff
00:23:43.994 --> 00:23:46.656
going on out there.
00:23:46.737 --> 00:23:48.459
Yeah, this is about money and ego.
00:23:48.538 --> 00:23:49.338
I mean, Lizette.
00:23:50.313 --> 00:23:51.734
summarize that's a little bit of a long
00:23:52.055 --> 00:23:53.696
long comment but can we admit this is
00:23:53.737 --> 00:23:56.359
all about money and md fears i want
00:23:56.380 --> 00:24:00.203
to make sure i have my i it's
00:24:00.223 --> 00:24:02.346
just ego and status you know respectfully
00:24:02.366 --> 00:24:04.528
we all know physicians we know we all
00:24:04.548 --> 00:24:06.771
know many of them i have many you
00:24:06.791 --> 00:24:09.374
know physician buddies and friends uh
00:24:11.049 --> 00:24:12.211
some physicians that were like,
00:24:12.250 --> 00:24:13.931
I'm actually on first name basis with like
00:24:14.030 --> 00:24:14.510
in the area.
00:24:14.951 --> 00:24:16.412
So that's, that's pretty quiet.
00:24:16.432 --> 00:24:17.613
I thought that was like refreshing.
00:24:17.893 --> 00:24:19.673
Um, but yeah,
00:24:20.374 --> 00:24:21.534
and not all of them are like this,
00:24:21.574 --> 00:24:23.654
but there is like the whole God complex
00:24:23.755 --> 00:24:25.315
and you know, that, you know,
00:24:25.355 --> 00:24:27.115
they are at the highest point of the
00:24:27.175 --> 00:24:28.316
hierarchy, Jimmy, like you said.
00:24:28.896 --> 00:24:29.356
So, um,
00:24:30.287 --> 00:24:32.368
Yeah, but again, just to recap,
00:24:32.469 --> 00:24:34.111
these nurses in this article in
00:24:34.151 --> 00:24:36.773
California, as far as we know,
00:24:37.355 --> 00:24:39.636
they're not telling patients that I'm your
00:24:39.758 --> 00:24:40.077
MD.
00:24:40.679 --> 00:24:42.160
They're not telling patients I'm your
00:24:42.200 --> 00:24:42.901
medical doctor.
00:24:43.481 --> 00:24:45.564
They're saying I am Dr. Smith.
00:24:46.265 --> 00:24:47.445
I'm Dr. Johnson.
00:24:48.227 --> 00:24:50.368
So, and I agree, Tony, like,
00:24:52.304 --> 00:24:53.845
I'm Dr. Kittle, your physical therapist.
00:24:54.164 --> 00:24:55.586
When I text patients, I use Dr.
00:24:55.786 --> 00:24:56.326
Dave Kittle.
00:24:56.365 --> 00:24:58.887
When I email them on my business cards,
00:24:58.928 --> 00:24:59.769
on my website, Tony,
00:24:59.788 --> 00:25:00.548
that means you haven't looked at my
00:25:00.568 --> 00:25:01.869
website, on the About Us page,
00:25:02.289 --> 00:25:03.951
all of my therapists are listed as doctor
00:25:04.511 --> 00:25:05.432
if they have a doctorate.
00:25:06.232 --> 00:25:08.394
But it says doctor of physical therapy.
00:25:08.755 --> 00:25:11.777
Nowhere on any of our correspondence or
00:25:11.957 --> 00:25:13.238
anything, anywhere ever,
00:25:13.938 --> 00:25:15.558
are we saying physician, doctor,
00:25:16.440 --> 00:25:19.300
chiropractic physician whatever that is uh
00:25:19.641 --> 00:25:21.102
we're not saying md we're not saying
00:25:21.142 --> 00:25:23.803
medical doctor we're not saying medical
00:25:23.843 --> 00:25:26.384
school nothing nothing to you know it's
00:25:26.483 --> 00:25:29.365
very clear delineation yeah clarity should
00:25:29.404 --> 00:25:31.026
be king i i am a little bit
00:25:31.105 --> 00:25:32.886
irked about the grammar of doctor of
00:25:32.946 --> 00:25:33.807
chiropractic
00:25:34.912 --> 00:25:35.932
it feels like there should be a word
00:25:35.972 --> 00:25:37.294
after that, like chiropractic,
00:25:37.433 --> 00:25:39.476
something doctor of chiropractic is a
00:25:39.557 --> 00:25:39.856
title.
00:25:39.896 --> 00:25:40.257
And I'm like,
00:25:40.738 --> 00:25:42.499
that's why they call themselves car.
00:25:42.519 --> 00:25:44.320
Some say chiropractic physicians.
00:25:44.601 --> 00:25:47.003
Yeah, that I'm sorry, but that,
00:25:47.023 --> 00:25:48.045
that one feels like it's,
00:25:48.704 --> 00:25:50.606
is it the state that determines if they
00:25:50.727 --> 00:25:52.028
use the label physician?
00:25:53.384 --> 00:25:54.026
Most likely.
00:25:54.145 --> 00:25:54.465
I think so.
00:25:54.526 --> 00:25:55.968
I think so.
00:25:56.208 --> 00:25:57.609
So that's why I think it's interesting
00:25:57.630 --> 00:25:59.971
that this started in California.
00:26:00.092 --> 00:26:01.874
It could be a sign that they're trying
00:26:01.913 --> 00:26:02.094
to,
00:26:02.134 --> 00:26:04.557
because I think if you can get traction
00:26:04.596 --> 00:26:06.219
in California, New York, Florida,
00:26:06.659 --> 00:26:07.940
I think you might be able to challenge
00:26:07.960 --> 00:26:08.760
this other places.
00:26:09.082 --> 00:26:10.242
But did it say in the article who
00:26:10.303 --> 00:26:11.124
initiated this?
00:26:11.144 --> 00:26:13.586
I don't know.
00:26:13.866 --> 00:26:15.468
It just said a federal judge has ruled
00:26:15.548 --> 00:26:15.929
that.
00:26:19.612 --> 00:26:20.712
I would want to know who actually
00:26:20.752 --> 00:26:21.673
initiated this.
00:26:22.394 --> 00:26:25.696
I'm sure the AMA dropped off a briefcase
00:26:25.737 --> 00:26:26.897
of cash to this judge.
00:26:27.259 --> 00:26:28.779
I'm half joking, half serious.
00:26:29.039 --> 00:26:30.361
I'm half joking, half serious.
00:26:31.142 --> 00:26:32.042
These days, you never know.
00:26:32.363 --> 00:26:33.523
You can't track cash.
00:26:34.605 --> 00:26:36.126
Maybe there's barcode numbers or whatever,
00:26:36.166 --> 00:26:36.267
but
00:26:37.816 --> 00:26:40.316
So let me pivot just a little bit.
00:26:40.395 --> 00:26:42.477
I had an interesting experience yesterday.
00:26:43.737 --> 00:26:44.717
Longtime patient.
00:26:44.817 --> 00:26:45.797
This was an individual.
00:26:45.856 --> 00:26:47.817
I've probably worked with this individual,
00:26:48.077 --> 00:26:49.917
let's say a decade now, on and off.
00:26:51.238 --> 00:26:53.959
This individual has ties to my family.
00:26:54.898 --> 00:26:57.419
We've known each other since before this
00:26:57.479 --> 00:26:59.119
person needed physical therapy.
00:27:00.440 --> 00:27:02.559
This particular individual is on a
00:27:02.640 --> 00:27:05.181
Medicare Advantage plan and had a twenty
00:27:05.240 --> 00:27:06.941
visit limit for the calendar year.
00:27:07.756 --> 00:27:08.316
That's horrible.
00:27:08.355 --> 00:27:10.096
Had a procedure, had a procedure,
00:27:10.136 --> 00:27:10.936
came to us.
00:27:10.997 --> 00:27:12.317
We did physical therapy,
00:27:12.916 --> 00:27:14.377
utilized the twenty visits.
00:27:14.438 --> 00:27:16.857
This individual continues to need therapy
00:27:16.897 --> 00:27:17.518
services.
00:27:17.557 --> 00:27:20.759
So we invited this person to our non
00:27:20.818 --> 00:27:24.160
cover or non covered maintenance program.
00:27:24.180 --> 00:27:25.319
Some people would call it a wellness
00:27:25.359 --> 00:27:25.759
program.
00:27:25.779 --> 00:27:27.560
We're like, look, hundred dollars a month.
00:27:27.980 --> 00:27:29.121
You come in twice a week.
00:27:29.540 --> 00:27:31.080
You have access to all of the equipment.
00:27:31.121 --> 00:27:32.182
You have access to us.
00:27:32.201 --> 00:27:33.461
We'll make sure you're doing everything
00:27:33.541 --> 00:27:33.821
right.
00:27:34.861 --> 00:27:35.401
And, you know,
00:27:35.441 --> 00:27:37.883
this was an affordable alternative option
00:27:38.542 --> 00:27:39.743
for this individual.
00:27:40.924 --> 00:27:42.766
It's not a money driver for us.
00:27:42.925 --> 00:27:44.027
We make a little bit of money.
00:27:44.366 --> 00:27:45.027
It's fine.
00:27:45.268 --> 00:27:47.288
But it's more just to keep engagement,
00:27:47.308 --> 00:27:48.650
keep the community coming.
00:27:48.670 --> 00:27:48.930
You know,
00:27:48.990 --> 00:27:51.351
somebody who has made the effort to get
00:27:51.391 --> 00:27:53.152
in their car and drive to our clinic.
00:27:53.211 --> 00:27:55.054
I'm never going to say you can't come
00:27:55.513 --> 00:27:57.174
because you can't afford it or your
00:27:57.234 --> 00:27:58.776
insurance doesn't cover it or whatever.
00:27:59.701 --> 00:28:02.461
So this is something we offer a lot
00:28:02.561 --> 00:28:04.782
of post discharge patients.
00:28:05.883 --> 00:28:07.143
I got a call yesterday.
00:28:07.782 --> 00:28:10.344
This person was so upset and I understand
00:28:10.423 --> 00:28:10.544
it.
00:28:10.923 --> 00:28:12.984
This person was like, Tony, I'm so sorry.
00:28:13.045 --> 00:28:14.464
My doctor said I have to go to
00:28:14.525 --> 00:28:15.425
their therapy.
00:28:15.965 --> 00:28:18.967
This was a local hospital doctor and
00:28:18.987 --> 00:28:19.567
they're like,
00:28:19.707 --> 00:28:21.928
you need therapy for this other condition
00:28:21.968 --> 00:28:23.127
and you have to come to us.
00:28:23.900 --> 00:28:25.921
I'm like, hey, that's totally fine.
00:28:25.980 --> 00:28:26.740
I totally get it.
00:28:26.780 --> 00:28:28.840
Listen, it's really not a big deal.
00:28:28.901 --> 00:28:30.241
I think it's great for patients to see
00:28:30.281 --> 00:28:31.021
other therapists.
00:28:31.082 --> 00:28:32.402
I'm sure those therapists are going to be
00:28:32.461 --> 00:28:32.761
great.
00:28:33.561 --> 00:28:33.762
I said,
00:28:33.782 --> 00:28:36.722
but I want you to understand you've
00:28:36.762 --> 00:28:39.304
exhausted your twenty visit limit for the
00:28:39.344 --> 00:28:40.064
calendar year.
00:28:41.003 --> 00:28:43.085
It's a hospital based outpatient clinic.
00:28:43.125 --> 00:28:45.486
You are going to be charged two to
00:28:45.506 --> 00:28:47.185
three hundred dollars a session.
00:28:48.509 --> 00:28:50.029
She was like, I totally get it.
00:28:50.151 --> 00:28:50.570
I know.
00:28:50.611 --> 00:28:52.651
But I feel like there's nothing I can
00:28:52.671 --> 00:28:52.830
do.
00:28:52.851 --> 00:28:54.471
I was like, you always have a choice.
00:28:54.751 --> 00:28:55.751
You're free to choose.
00:28:55.791 --> 00:28:57.452
But I totally understand the pressure.
00:28:58.093 --> 00:28:59.633
Listen, don't worry about it.
00:28:59.692 --> 00:29:01.153
But I'm just curious.
00:29:01.534 --> 00:29:02.794
So what are they doing there?
00:29:02.814 --> 00:29:05.115
Well, you know,
00:29:05.154 --> 00:29:07.476
the therapist had me sucking in.
00:29:07.536 --> 00:29:07.695
Yeah.
00:29:09.953 --> 00:29:14.297
What was the first thing you said?
00:29:14.738 --> 00:29:17.319
The therapist had me sucking in my tummy
00:29:17.980 --> 00:29:21.623
and pumping my ankle and lifting my leg
00:29:21.663 --> 00:29:22.443
and bending over,
00:29:22.483 --> 00:29:23.865
but it really hurt when I did it,
00:29:23.904 --> 00:29:25.086
but I did it anyway.
00:29:26.086 --> 00:29:28.669
And so in my mind, obviously I'm thinking,
00:29:28.909 --> 00:29:29.869
you know, okay,
00:29:30.029 --> 00:29:31.471
she's getting the standard of care.
00:29:31.651 --> 00:29:34.953
Like she's not getting what the standard
00:29:35.013 --> 00:29:36.535
of care would consider bad therapy.
00:29:36.555 --> 00:29:37.615
It's what everybody's going to do.
00:29:38.472 --> 00:29:40.574
She's going to walk away with thousands of
00:29:40.634 --> 00:29:42.556
dollars in, you know, bills.
00:29:43.355 --> 00:29:45.217
She could come to us here.
00:29:45.998 --> 00:29:48.019
She was doing all sorts of, you know,
00:29:48.118 --> 00:29:48.999
function based.
00:29:49.339 --> 00:29:50.140
I've got videos,
00:29:50.180 --> 00:29:51.961
published videos of her getting on the
00:29:51.980 --> 00:29:53.442
floor, getting off the floor,
00:29:53.501 --> 00:29:55.022
doing functional transfers.
00:29:56.104 --> 00:29:57.243
There's a whole bunch of stuff.
00:29:57.324 --> 00:29:59.125
But I'm just like, once again,
00:29:59.205 --> 00:30:02.688
we talk about the power of, you know,
00:30:02.887 --> 00:30:03.688
influence.
00:30:04.269 --> 00:30:05.930
Whoever the medical doctor is,
00:30:06.049 --> 00:30:06.410
I don't know.
00:30:06.450 --> 00:30:08.111
I have no connection to this physician.
00:30:09.073 --> 00:30:11.734
But I'm like, one thing is said,
00:30:12.155 --> 00:30:13.876
likely because they're being pressured by
00:30:13.916 --> 00:30:15.759
upper management to keep all the referrals
00:30:15.818 --> 00:30:16.420
in-house.
00:30:17.279 --> 00:30:20.722
And now potentially this individual is
00:30:20.742 --> 00:30:22.545
going to have five years,
00:30:22.585 --> 00:30:24.145
ten years of medical bills that are
00:30:24.247 --> 00:30:25.548
probably never going to get paid.
00:30:26.343 --> 00:30:28.164
Because they have access to me,
00:30:28.204 --> 00:30:29.046
but they're not,
00:30:29.266 --> 00:30:30.826
they think they can't come to me for
00:30:30.846 --> 00:30:32.067
a hundred bucks a month and they're going
00:30:32.088 --> 00:30:34.611
to go to this hospital outpatient clinic
00:30:34.651 --> 00:30:36.532
where the therapist probably has no idea
00:30:36.932 --> 00:30:38.634
they're charging three hundred dollars a
00:30:38.694 --> 00:30:39.055
session.
00:30:39.955 --> 00:30:40.256
You know,
00:30:40.616 --> 00:30:42.438
any thoughts on that whole kind of
00:30:42.498 --> 00:30:44.240
experience?
00:30:44.299 --> 00:30:44.980
It's a wrecking ball.
00:30:47.474 --> 00:30:48.154
How do we change it?
00:30:48.295 --> 00:30:49.016
How do we stop it?
00:30:49.056 --> 00:30:50.715
How do we make it better?
00:30:50.856 --> 00:30:51.217
Well,
00:30:51.317 --> 00:30:52.998
one thing that I think you floated to
00:30:53.038 --> 00:30:53.238
her,
00:30:53.438 --> 00:30:54.857
you kind of said that you always have
00:30:54.917 --> 00:30:55.318
choice.
00:30:55.338 --> 00:30:56.159
Yeah.
00:30:56.278 --> 00:30:57.640
I think you said to her directly,
00:30:58.160 --> 00:31:00.760
it sounds like you said to her directly,
00:31:00.800 --> 00:31:01.942
you don't have to go there.
00:31:02.001 --> 00:31:02.981
You can come to our clinic.
00:31:03.001 --> 00:31:04.202
You can go to some other place down
00:31:04.222 --> 00:31:04.563
the road.
00:31:04.603 --> 00:31:05.423
You have choice.
00:31:06.022 --> 00:31:08.064
But she's trusting and believing in the
00:31:08.904 --> 00:31:10.444
MD, the medical doctor here,
00:31:10.785 --> 00:31:11.566
the main physician.
00:31:12.086 --> 00:31:14.227
They're saying you have this other
00:31:14.267 --> 00:31:14.707
condition.
00:31:14.747 --> 00:31:16.268
You need this treated immediately.
00:31:16.667 --> 00:31:18.048
and you have to go to this hospital-based
00:31:18.169 --> 00:31:20.391
practice that is i don't say it's not
00:31:20.490 --> 00:31:22.511
fraud what i mean it's wrong it's the
00:31:22.551 --> 00:31:24.913
physician the patient has choice the
00:31:24.993 --> 00:31:26.575
healthcare consumer has choice they can go
00:31:26.654 --> 00:31:28.497
anywhere they want to go they can go
00:31:28.517 --> 00:31:31.179
to a household-based clinic and you know
00:31:31.199 --> 00:31:32.499
rack up that bill of five grand or
00:31:32.519 --> 00:31:33.920
whatever if they want to of their own
00:31:33.961 --> 00:31:35.642
volition this doesn't sound like it was
00:31:35.701 --> 00:31:37.063
under her own volition it sounded like she
00:31:37.083 --> 00:31:40.005
was pressured to do so which is ridiculous
00:31:40.788 --> 00:31:41.867
I mean, the thing is,
00:31:42.709 --> 00:31:45.150
you look at the most influential people.
00:31:45.230 --> 00:31:45.470
Now,
00:31:45.809 --> 00:31:48.451
I think we probably have a different
00:31:48.490 --> 00:31:51.313
perspective on anyone in healthcare.
00:31:51.932 --> 00:31:54.173
I fully admit it.
00:31:54.334 --> 00:31:54.993
I am biased.
00:31:55.513 --> 00:31:56.595
You, Dave Kittle,
00:31:56.615 --> 00:31:58.215
who I respect implicitly,
00:31:58.256 --> 00:31:59.215
come to me and say, Tony,
00:31:59.256 --> 00:32:00.155
you should be doing this.
00:32:00.817 --> 00:32:02.317
I'm generally going to disagree.
00:32:02.717 --> 00:32:04.117
My immediate response is,
00:32:04.157 --> 00:32:05.038
Dave's probably wrong.
00:32:05.097 --> 00:32:06.078
Dave doesn't understand.
00:32:06.118 --> 00:32:07.318
He doesn't know my context.
00:32:07.338 --> 00:32:08.420
He doesn't know what's going on.
00:32:09.098 --> 00:32:11.380
I'm always going to go against anyone in
00:32:11.440 --> 00:32:13.241
authority who tells me to do something
00:32:13.281 --> 00:32:14.823
just because that's my nature.
00:32:14.883 --> 00:32:16.663
I'm always going to second guess what you
00:32:16.703 --> 00:32:19.384
say until you prove that I am wrong
00:32:19.565 --> 00:32:20.465
in second guessing you.
00:32:21.095 --> 00:32:22.836
But so many of our patients are like,
00:32:22.976 --> 00:32:25.476
look, my priest and my doctor,
00:32:25.936 --> 00:32:28.798
that's who I listen to, like nobody else.
00:32:29.377 --> 00:32:32.538
And so even with our history of over
00:32:32.598 --> 00:32:34.859
a decade of working together and family
00:32:34.900 --> 00:32:36.819
connections and knowing each other,
00:32:37.400 --> 00:32:39.520
the doctor said, do this.
00:32:40.080 --> 00:32:42.102
There is no way this person is not
00:32:42.142 --> 00:32:42.561
going to do it,
00:32:43.142 --> 00:32:44.502
even if it's to their detriment,
00:32:44.962 --> 00:32:45.962
even if she gets worse,
00:32:46.564 --> 00:32:48.223
even if she has a negative experience,
00:32:48.304 --> 00:32:50.384
a negative outcome and wastes a ton of
00:32:50.424 --> 00:32:50.625
money.
00:32:51.394 --> 00:32:53.557
she cannot go back in her mind to
00:32:53.577 --> 00:32:54.819
that doctor and say,
00:32:55.461 --> 00:32:56.742
I didn't listen to you.
00:32:58.076 --> 00:33:00.616
We don't realize the impact and the power
00:33:01.057 --> 00:33:02.356
that physicians,
00:33:02.396 --> 00:33:04.298
but even we at a certain level,
00:33:04.758 --> 00:33:06.598
have over these individuals.
00:33:06.659 --> 00:33:07.838
And it's scary.
00:33:07.898 --> 00:33:09.358
I mean, it's shockingly scary.
00:33:09.618 --> 00:33:12.799
I know I have told people things off
00:33:12.819 --> 00:33:15.661
the cuff that I thought had zero value.
00:33:16.101 --> 00:33:18.842
And they come back and tell me how
00:33:18.942 --> 00:33:20.403
impactful that was.
00:33:20.502 --> 00:33:21.623
And it blew my mind.
00:33:22.247 --> 00:33:23.027
Yeah.
00:33:23.086 --> 00:33:23.968
How would you fix it?
00:33:24.367 --> 00:33:25.689
If you were in charge and you could,
00:33:25.769 --> 00:33:26.949
and you can wave a magic wand,
00:33:27.009 --> 00:33:27.670
I have an idea,
00:33:27.990 --> 00:33:29.170
but I want to hear from you guys.
00:33:29.190 --> 00:33:30.030
Well, how would you fix it?
00:33:30.671 --> 00:33:31.651
Dave, any ideas?
00:33:31.751 --> 00:33:32.412
I have no idea.
00:33:32.571 --> 00:33:33.352
I'm out of ideas.
00:33:34.292 --> 00:33:36.253
I, I was going to say, I don't,
00:33:36.433 --> 00:33:37.374
I don't know how to fix it.
00:33:37.433 --> 00:33:39.835
I think it's extremely challenging because
00:33:40.375 --> 00:33:42.656
a lot of the individuals that Tony is
00:33:42.717 --> 00:33:44.277
referring to, like, it's not, it's,
00:33:44.297 --> 00:33:45.397
it's not, it's not, it's not, it's not,
00:33:45.417 --> 00:33:46.417
it's not, it's not, it's not, it's not,
00:33:46.439 --> 00:33:47.519
it's not, it's not, it's not, it's not,
00:33:47.538 --> 00:33:48.278
it's not, it's not, it's not, it's not,
00:33:48.298 --> 00:33:49.380
it's not, it's not, it's not, it's not,
00:33:49.420 --> 00:33:50.440
it's not, it's not, it's not, it's not,
00:33:50.460 --> 00:33:51.621
it's not, it's not, it's not, it's not,
00:33:51.641 --> 00:33:51.681
it
00:33:52.659 --> 00:33:55.076
the more likely they are to like just
00:33:56.423 --> 00:33:59.203
just bow and listen and do whatever the
00:33:59.223 --> 00:34:00.943
physician says, regardless, like,
00:34:01.484 --> 00:34:02.444
you know, Oh, I need,
00:34:02.545 --> 00:34:03.484
I need a new statin.
00:34:03.765 --> 00:34:04.285
I, you know, I got,
00:34:04.365 --> 00:34:05.266
I need a new stat and I got
00:34:05.286 --> 00:34:06.226
to get it on a new stat and
00:34:06.346 --> 00:34:09.086
like, like no pushback, no research, no,
00:34:09.407 --> 00:34:10.786
let me try to change my diet and
00:34:10.847 --> 00:34:11.628
exercise.
00:34:11.688 --> 00:34:13.907
And let me, you know, just, just like,
00:34:14.047 --> 00:34:14.608
I will do that.
00:34:14.648 --> 00:34:14.869
Like,
00:34:14.889 --> 00:34:16.628
it's very robotic for the older
00:34:16.929 --> 00:34:17.469
population.
00:34:17.610 --> 00:34:19.489
And I think the opposite for the twenty,
00:34:19.530 --> 00:34:20.170
thirty year olds,
00:34:20.650 --> 00:34:22.891
forty year olds that are like questioning.
00:34:22.951 --> 00:34:24.791
So they're like, Tony, you know, Tony's a,
00:34:26.072 --> 00:34:27.454
uh you know a little bit a little
00:34:27.474 --> 00:34:28.855
bit older than that but tony still has
00:34:28.875 --> 00:34:30.597
like that younger mindset of like uh
00:34:30.637 --> 00:34:32.438
questioning and pushing back and i'm the
00:34:32.458 --> 00:34:35.501
same way and so i don't know if
00:34:35.521 --> 00:34:36.722
there's any way to change it but the
00:34:36.762 --> 00:34:38.384
younger population the younger generation
00:34:38.423 --> 00:34:40.706
now will continue to be that way they're
00:34:40.726 --> 00:34:41.827
going to question things they're going to
00:34:41.847 --> 00:34:43.307
do research they're going to ask friends
00:34:43.347 --> 00:34:45.170
and colleagues and do you maybe do you
00:34:45.190 --> 00:34:46.710
know a physician or a physical therapist
00:34:46.751 --> 00:34:48.713
to speak with and there's just more
00:34:49.653 --> 00:34:51.153
I don't know if it's because of social
00:34:51.173 --> 00:34:54.014
media or the internet or YouTube or just
00:34:54.295 --> 00:34:56.815
available information that's readily
00:34:57.295 --> 00:34:58.295
accessible anywhere.
00:34:59.275 --> 00:35:01.215
The younger population is more likely to
00:35:01.456 --> 00:35:02.317
challenge things,
00:35:03.577 --> 00:35:06.297
even push back a little bit or do
00:35:06.317 --> 00:35:07.557
some other research before they make a
00:35:07.597 --> 00:35:07.958
decision.
00:35:07.998 --> 00:35:09.438
Whereas someone who's sixty, seventy,
00:35:09.518 --> 00:35:09.717
eighty,
00:35:09.777 --> 00:35:11.797
ninety is not going to do any of
00:35:11.818 --> 00:35:12.239
that stuff.
00:35:12.318 --> 00:35:13.418
It's just like, oh, I heard it.
00:35:13.438 --> 00:35:14.079
I heard this.
00:35:14.498 --> 00:35:15.119
This is it.
00:35:15.199 --> 00:35:17.920
I'm taking it basically as gospel and
00:35:18.320 --> 00:35:19.159
there is no pushback.
00:35:20.813 --> 00:35:20.934
Yeah,
00:35:20.954 --> 00:35:22.596
the example that I thought of is I
00:35:22.615 --> 00:35:23.836
just got a new car a couple months
00:35:23.876 --> 00:35:26.400
ago, and it's really cool on the inside.
00:35:26.519 --> 00:35:27.360
Looks really slick.
00:35:27.442 --> 00:35:28.922
It's Toyota Camry hybrid,
00:35:28.943 --> 00:35:29.923
in case you guys were wondering.
00:35:30.764 --> 00:35:32.626
But I'm not much of an aesthetic guy,
00:35:32.967 --> 00:35:34.590
but there's part of the inside of that
00:35:34.610 --> 00:35:36.271
car that is absolutely ruined.
00:35:36.791 --> 00:35:40.275
And it's the part of the visor that
00:35:40.315 --> 00:35:40.795
shows.
00:35:41.217 --> 00:35:42.338
And there's a warning on it.
00:35:42.838 --> 00:35:44.079
It's not a sticker.
00:35:44.440 --> 00:35:45.360
I can't pull it off.
00:35:45.420 --> 00:35:46.342
Like I saw the warning.
00:35:46.362 --> 00:35:47.023
God, I can't pull it.
00:35:47.123 --> 00:35:49.204
It is painted on there.
00:35:49.344 --> 00:35:50.326
I have no idea what it's even about.
00:35:50.365 --> 00:35:52.068
Probably airbags or wear your seatbelt or
00:35:52.168 --> 00:35:52.588
I don't know.
00:35:52.889 --> 00:35:53.849
But it's printed on there.
00:35:55.469 --> 00:35:56.449
Do you, Tony,
00:35:56.710 --> 00:36:00.373
have to have signs posted in the break
00:36:00.414 --> 00:36:01.474
room at your clinic?
00:36:02.034 --> 00:36:05.739
Things about like FMLA or FSLA or EEO?
00:36:05.798 --> 00:36:06.179
Yeah,
00:36:07.119 --> 00:36:08.922
I'm looking across it right in front of
00:36:08.942 --> 00:36:09.623
me right now.
00:36:09.682 --> 00:36:11.764
And there's all these Ohio Labor signs.
00:36:13.846 --> 00:36:14.947
federal posting requirements all this
00:36:14.967 --> 00:36:17.889
garbage so if this really was an issue
00:36:18.088 --> 00:36:20.269
if this was important like so it sounds
00:36:20.309 --> 00:36:21.931
like if i get a referral from the
00:36:21.972 --> 00:36:23.411
hospital i just have to go to the
00:36:23.472 --> 00:36:25.893
outpatient i don't they said go talk to
00:36:25.934 --> 00:36:28.215
karen down the hall and you just feel
00:36:28.235 --> 00:36:30.436
like you're ushered down the hall i feel
00:36:30.456 --> 00:36:31.757
like you should have to be given a
00:36:31.858 --> 00:36:34.340
yellow piece of paper that says like stop
00:36:35.059 --> 00:36:36.380
These are your rights.
00:36:36.420 --> 00:36:38.340
And I know hospitals give you â probably
00:36:38.360 --> 00:36:40.981
they participate in a little bit of what's
00:36:41.001 --> 00:36:42.981
called malicious compliance, right?
00:36:43.382 --> 00:36:44.742
Well, I have to give you some paperwork.
00:36:44.981 --> 00:36:46.762
So I'm going to give you seventy-two pages
00:36:46.802 --> 00:36:47.402
of paperwork.
00:36:47.422 --> 00:36:48.882
So I'm going to dilute everything that you
00:36:48.922 --> 00:36:49.402
have to do.
00:36:49.824 --> 00:36:51.884
But if we said you have to post
00:36:52.284 --> 00:36:53.463
this poster,
00:36:53.764 --> 00:36:56.244
this has to be handed in card form
00:36:56.485 --> 00:36:58.146
to every single person you're going to
00:36:58.166 --> 00:37:02.947
give a referral to to â
00:37:00.065 --> 00:37:02.728
the Ten Commandments of your rights as a
00:37:02.788 --> 00:37:03.208
patient,
00:37:03.268 --> 00:37:05.190
you do not have to actually go to
00:37:05.271 --> 00:37:06.030
where this place is.
00:37:06.070 --> 00:37:07.793
You can, but you don't have to.
00:37:08.253 --> 00:37:09.655
If it was that big of a problem,
00:37:09.855 --> 00:37:11.175
that's the thing I would march to
00:37:11.215 --> 00:37:12.117
Washington and say,
00:37:12.737 --> 00:37:13.978
if I were a profession,
00:37:14.539 --> 00:37:15.300
we're getting smoked.
00:37:15.320 --> 00:37:17.021
I mean, Tony's idea the other day was,
00:37:17.061 --> 00:37:17.422
you know what?
00:37:17.481 --> 00:37:18.242
Just let them have it.
00:37:18.362 --> 00:37:19.003
Let them have that.
00:37:19.023 --> 00:37:20.563
We'll do everything else, right?
00:37:20.885 --> 00:37:21.545
I understand that.
00:37:21.585 --> 00:37:21.784
Like...
00:37:22.505 --> 00:37:24.806
never retreat, never leave a man behind.
00:37:25.128 --> 00:37:26.867
Well, no, sometimes they leave men behind.
00:37:26.949 --> 00:37:29.010
Sometimes you retreat to fight another day
00:37:29.170 --> 00:37:31.110
or this isn't the hill I want to
00:37:31.170 --> 00:37:31.791
die on.
00:37:32.231 --> 00:37:34.293
So if this was actually important,
00:37:34.373 --> 00:37:36.094
either do something about it big enough to
00:37:36.134 --> 00:37:37.554
make change or don't.
00:37:37.914 --> 00:37:40.956
So that would be my simple but not
00:37:41.056 --> 00:37:41.797
easy solution,
00:37:41.836 --> 00:37:43.878
which is you have someone's going to write
00:37:43.918 --> 00:37:46.378
that letter of the law and it has
00:37:46.398 --> 00:37:47.300
to be handed out.
00:37:47.360 --> 00:37:48.800
And if not, there's a fine.
00:37:48.820 --> 00:37:49.780
There's got to be some sort of
00:37:49.820 --> 00:37:51.081
consequences for not doing it.
00:37:51.744 --> 00:37:53.143
I'm going to go a different direction,
00:37:53.463 --> 00:37:54.885
but real quick, Ray's here,
00:37:54.925 --> 00:37:55.885
Stephen's here,
00:37:57.465 --> 00:37:58.985
Will Boyd was here earlier.
00:37:59.485 --> 00:37:59.606
Okay,
00:37:59.686 --> 00:38:01.425
I'm going to go a different direction,
00:38:01.465 --> 00:38:03.507
though, because like you just said,
00:38:03.547 --> 00:38:06.088
you have that massive warning over your
00:38:06.168 --> 00:38:06.748
visor.
00:38:06.947 --> 00:38:08.068
You don't even know what it says.
00:38:08.128 --> 00:38:10.869
I've got employment records on the wall.
00:38:11.329 --> 00:38:12.869
Nobody who works for me knows what they
00:38:12.969 --> 00:38:13.208
are.
00:38:13.670 --> 00:38:15.590
Going to the government once again to
00:38:15.630 --> 00:38:18.650
protect, you know, it never works.
00:38:18.690 --> 00:38:19.351
It never works.
00:38:20.889 --> 00:38:22.690
The same doctor, I would bet,
00:38:22.791 --> 00:38:24.913
the same doctor who said you have to
00:38:24.952 --> 00:38:27.074
go to our physical therapy clinic probably
00:38:27.114 --> 00:38:28.954
said you shouldn't eat McDonald's,
00:38:29.534 --> 00:38:32.036
and yet the consumer will continue to eat
00:38:32.077 --> 00:38:32.717
McDonald's.
00:38:33.458 --> 00:38:35.259
Shout out to my McCafe, right?
00:38:36.239 --> 00:38:38.920
It's not about forcing people to do
00:38:38.981 --> 00:38:39.561
something.
00:38:40.101 --> 00:38:40.641
It's about...
00:38:41.652 --> 00:38:43.554
finding the motivation that makes them
00:38:43.594 --> 00:38:46.496
choose to do what they want to do
00:38:46.576 --> 00:38:47.036
ultimately.
00:38:47.536 --> 00:38:49.036
Why is she going to therapy there?
00:38:49.117 --> 00:38:51.577
Not because she wants to go to therapy
00:38:51.637 --> 00:38:52.059
there,
00:38:52.278 --> 00:38:54.139
not because the doctor is forcing her as
00:38:54.219 --> 00:38:57.420
much as she wants to please the doctor.
00:38:57.440 --> 00:38:58.581
There is an inherent,
00:38:59.101 --> 00:39:02.463
I want to get affirmation from you,
00:39:02.603 --> 00:39:03.224
doctor,
00:39:03.664 --> 00:39:05.465
to tell me that I'm doing the right
00:39:05.505 --> 00:39:05.766
thing.
00:39:06.827 --> 00:39:09.409
So I think the way you change that
00:39:09.509 --> 00:39:11.731
is direct-to-consumer marketing.
00:39:12.231 --> 00:39:13.952
This is where you get the messaging in
00:39:14.012 --> 00:39:14.434
hand.
00:39:15.153 --> 00:39:15.474
Again,
00:39:15.514 --> 00:39:17.516
you sacrifice the label of physical
00:39:17.577 --> 00:39:19.378
therapy, which who even cares anymore?
00:39:19.438 --> 00:39:22.681
Those words have very little value in
00:39:22.722 --> 00:39:23.842
today's market,
00:39:24.242 --> 00:39:25.684
especially if we're talking outpatient
00:39:25.744 --> 00:39:26.264
orthopedic.
00:39:27.498 --> 00:39:29.818
And we pivot to what are the things
00:39:29.858 --> 00:39:32.159
these consumers are buying anyway?
00:39:32.199 --> 00:39:33.740
What are the things that they want?
00:39:33.800 --> 00:39:35.561
What are the things that they desire?
00:39:36.101 --> 00:39:37.583
Let's bring that out.
00:39:37.922 --> 00:39:39.784
Let's develop and harness that.
00:39:40.364 --> 00:39:42.465
And then I think it doesn't matter what
00:39:42.505 --> 00:39:43.204
the doctor says.
00:39:43.264 --> 00:39:44.686
It doesn't matter if they're going to
00:39:44.726 --> 00:39:46.007
therapy at the other place.
00:39:46.126 --> 00:39:47.487
I've had plenty of patients that go to
00:39:47.507 --> 00:39:48.927
therapy at one place and then come to
00:39:48.947 --> 00:39:51.648
me because they want what I have.
00:39:51.688 --> 00:39:53.070
They know that I can make them feel
00:39:53.090 --> 00:39:53.269
good.
00:39:53.831 --> 00:39:54.172
You know,
00:39:54.592 --> 00:39:57.434
and so I don't think government
00:39:57.494 --> 00:39:59.195
intervention is going to do anything to
00:39:59.215 --> 00:40:00.416
fix a problem like that.
00:40:01.577 --> 00:40:03.679
The law already exists that you have to
00:40:03.719 --> 00:40:04.860
give patients choice.
00:40:04.960 --> 00:40:05.661
They don't do it.
00:40:06.382 --> 00:40:08.103
There's all these laws on the books that
00:40:08.143 --> 00:40:09.324
are pretty much useless.
00:40:09.704 --> 00:40:10.965
I think you have to get the patient
00:40:10.985 --> 00:40:12.947
to want to come to you,
00:40:14.387 --> 00:40:15.889
whether however you do that.
00:40:15.969 --> 00:40:16.929
But I think it's marketing.
00:40:18.413 --> 00:40:20.815
The handout, Jimmy, I love the idea,
00:40:21.034 --> 00:40:25.498
but also the incentives and the money with
00:40:25.538 --> 00:40:26.478
these health systems,
00:40:26.577 --> 00:40:29.519
with these hospital systems and the AMA,
00:40:29.740 --> 00:40:31.521
the American Medical Association,
00:40:31.561 --> 00:40:34.043
like all that in terms of, I mean,
00:40:34.063 --> 00:40:34.943
they would just block it.
00:40:34.983 --> 00:40:35.784
They would just block it,
00:40:35.824 --> 00:40:36.625
like to make that,
00:40:36.864 --> 00:40:38.505
they would figure out ways to have
00:40:38.565 --> 00:40:40.208
lobbying and just block that.
00:40:40.268 --> 00:40:42.309
I mean, that would be a great start.
00:40:44.090 --> 00:40:45.090
But then to push back a little bit
00:40:45.130 --> 00:40:46.411
on Tony's thing, like,
00:40:47.545 --> 00:40:47.885
Yes,
00:40:47.965 --> 00:40:49.268
there are some of those patients that want
00:40:49.288 --> 00:40:51.730
to just please the physician.
00:40:51.750 --> 00:40:54.331
They want to do whatever they say.
00:40:54.972 --> 00:40:55.273
But again,
00:40:55.313 --> 00:40:56.153
that's kind of what I was saying.
00:40:56.594 --> 00:40:57.074
Many of them,
00:40:57.335 --> 00:40:59.836
that's just the way they've been raised.
00:40:59.896 --> 00:41:01.318
And that's what their parents did and
00:41:01.338 --> 00:41:02.159
their parents did.
00:41:02.219 --> 00:41:03.920
And that's just the way it has always
00:41:03.960 --> 00:41:04.201
been.
00:41:04.902 --> 00:41:07.684
And so, yeah, overall,
00:41:07.864 --> 00:41:08.405
at the end of the day,
00:41:08.445 --> 00:41:09.144
I think it's a shame.
00:41:09.206 --> 00:41:11.306
It's a shame that these physicians...
00:41:12.088 --> 00:41:14.509
are not being clear and truthful to these
00:41:14.528 --> 00:41:16.909
patients and saying that you actually have
00:41:16.969 --> 00:41:19.431
choice you can go to our physician-owned
00:41:19.471 --> 00:41:21.251
practice or our hospital-based practice
00:41:21.271 --> 00:41:23.333
that's you know right here attached to our
00:41:23.353 --> 00:41:26.233
hospital or you can also go to total
00:41:26.273 --> 00:41:28.695
therapy solutions down the road and you
00:41:28.715 --> 00:41:30.315
know also have a great experience and
00:41:30.335 --> 00:41:31.976
they'll take your insurance unless you use
00:41:32.016 --> 00:41:32.197
your
00:41:33.277 --> 00:41:35.458
twenty Medicare Advantage plans and visits
00:41:35.478 --> 00:41:36.780
for the year, then, you know, whatever.
00:41:37.121 --> 00:41:38.481
So, I don't know.
00:41:38.501 --> 00:41:40.204
It's just a shame that when there's some
00:41:40.224 --> 00:41:43.586
of this money and incentives involved that
00:41:44.427 --> 00:41:46.329
they're not going to say that.
00:41:46.349 --> 00:41:47.391
They're not going to tell the patient.
00:41:47.411 --> 00:41:50.393
They're not going to disclose something to
00:41:50.414 --> 00:41:50.574
them.
00:41:50.634 --> 00:41:52.114
Now, here's the question real quick, Tony.
00:41:52.476 --> 00:41:54.998
If that physician instead said to your
00:41:55.038 --> 00:41:55.378
patient,
00:41:56.434 --> 00:41:57.275
You have a choice.
00:41:58.114 --> 00:41:59.195
You have this other condition.
00:41:59.795 --> 00:42:00.217
Oh,
00:42:00.317 --> 00:42:03.179
and she tells the physician that my
00:42:03.199 --> 00:42:04.820
therapist, Tony Meritato says, you know,
00:42:04.840 --> 00:42:07.362
I can continue to come out of pocket
00:42:07.981 --> 00:42:09.762
and go there and do my therapeutic
00:42:09.802 --> 00:42:10.664
exercise or whatever,
00:42:11.164 --> 00:42:12.385
because I already burned up my twenty
00:42:12.405 --> 00:42:14.106
Medicare Advantage visits for the calendar
00:42:14.146 --> 00:42:14.306
year.
00:42:15.688 --> 00:42:17.190
If that physician had said to her, oh,
00:42:17.230 --> 00:42:17.871
that's awesome,
00:42:18.010 --> 00:42:19.492
I know him or I don't know him
00:42:19.532 --> 00:42:22.273
or whatever, you have the option.
00:42:22.315 --> 00:42:26.057
You could go to our hospital-based clinic,
00:42:26.117 --> 00:42:26.777
outpatient clinic,
00:42:26.818 --> 00:42:28.980
for this other condition and be treated
00:42:29.019 --> 00:42:29.260
there,
00:42:29.900 --> 00:42:31.882
or you could also stay there with him,
00:42:32.242 --> 00:42:33.503
or you could go to some other clinic,
00:42:34.423 --> 00:42:35.284
any other clinic down the road.
00:42:35.445 --> 00:42:36.706
I think you just need movement,
00:42:36.726 --> 00:42:38.166
you need some physical therapy or
00:42:38.427 --> 00:42:40.409
supervision by a physical therapist or
00:42:40.449 --> 00:42:40.769
whatever.
00:42:41.210 --> 00:42:42.990
If that physician had said that to her,
00:42:43.972 --> 00:42:44.853
you knowing her,
00:42:45.313 --> 00:42:47.034
would she still be in your practice or
00:42:47.054 --> 00:42:47.916
would she be going to the office?
00:42:47.936 --> 00:42:48.416
A thousand percent.
00:42:49.317 --> 00:42:51.079
So that's a shame, right?
00:42:51.298 --> 00:42:52.059
That's ridiculous.
00:42:53.021 --> 00:42:54.202
Yeah, yeah.
00:42:54.934 --> 00:42:56.096
But even on that front,
00:42:56.115 --> 00:42:57.936
and I'm sure you guys have seen it
00:42:57.976 --> 00:42:58.317
too,
00:42:58.677 --> 00:43:00.759
like I've seen the shift in physician
00:43:00.798 --> 00:43:01.298
culture.
00:43:01.398 --> 00:43:04.141
I've seen the shift in referrals.
00:43:05.141 --> 00:43:07.262
Twenty five years ago when we started,
00:43:07.684 --> 00:43:10.585
like we were getting all of the referrals
00:43:10.666 --> 00:43:12.186
with very specific,
00:43:12.726 --> 00:43:13.927
you're going to do this and you're going
00:43:13.947 --> 00:43:15.208
to do that and you're going to do,
00:43:15.228 --> 00:43:15.568
you know,
00:43:15.989 --> 00:43:17.630
they would tell us what to do.
00:43:19.010 --> 00:43:20.112
And talking to,
00:43:20.811 --> 00:43:22.954
they were old physicians back then,
00:43:24.054 --> 00:43:25.375
many of them probably aren't alive
00:43:25.414 --> 00:43:26.856
anymore, but talking to them,
00:43:27.235 --> 00:43:29.197
the culture and the mindset of the doctor
00:43:29.237 --> 00:43:31.157
was, I am the doctor,
00:43:31.277 --> 00:43:32.679
this is what the therapist does,
00:43:32.739 --> 00:43:34.139
you do what I tell you to do.
00:43:35.123 --> 00:43:39.023
Now, as that culture has shifted out,
00:43:39.204 --> 00:43:41.043
I talk to a lot of younger MDs,
00:43:41.103 --> 00:43:43.125
younger than me, and they're like, oh,
00:43:43.164 --> 00:43:44.244
you guys are professional.
00:43:44.284 --> 00:43:45.585
You know what to do.
00:43:45.925 --> 00:43:47.465
I worked with a lot of great therapists
00:43:47.485 --> 00:43:48.706
during my rotations,
00:43:48.786 --> 00:43:51.226
and you guys know more than me when
00:43:51.266 --> 00:43:53.306
it comes to this and that.
00:43:53.367 --> 00:43:54.266
You guys take the reins.
00:43:54.847 --> 00:43:57.268
So I do see a shift within the
00:43:57.307 --> 00:43:59.487
mindset and the culture of the medical
00:43:59.547 --> 00:44:02.849
doctor and how they view themselves on a
00:44:02.989 --> 00:44:03.989
team approach and
00:44:05.574 --> 00:44:07.155
um i think it's positive i think it's
00:44:07.175 --> 00:44:09.237
positive for all allied healthcare not
00:44:09.277 --> 00:44:12.800
just us but so maybe maybe i would
00:44:12.840 --> 00:44:15.282
revise my thing from saying okay direct to
00:44:15.302 --> 00:44:17.623
consumer marketing to we also have an
00:44:17.684 --> 00:44:20.547
element of marketing to physicians and
00:44:20.626 --> 00:44:22.909
student physicians you know residents and
00:44:23.469 --> 00:44:25.490
letting them know and see and understand
00:44:25.550 --> 00:44:25.931
kind of
00:44:26.411 --> 00:44:29.693
what, what our role in the ecosystem is.
00:44:30.155 --> 00:44:31.795
And, and, and being collaborative.
00:44:31.856 --> 00:44:34.056
Like I, did I tell you, Tony,
00:44:34.117 --> 00:44:36.478
that I was a week or two ago,
00:44:36.958 --> 00:44:38.000
I went with my, one of my,
00:44:38.239 --> 00:44:39.481
one of the only patients that I'm seeing.
00:44:39.860 --> 00:44:41.641
And I took him to a pain,
00:44:42.003 --> 00:44:43.043
a pain orthophysician,
00:44:43.103 --> 00:44:44.503
non-surgical physiatrist.
00:44:44.684 --> 00:44:45.724
And I went to the visit.
00:44:46.105 --> 00:44:46.686
I went to the visit.
00:44:46.766 --> 00:44:47.445
I didn't tell you guys this.
00:44:47.485 --> 00:44:49.166
No, I don't think so.
00:44:49.186 --> 00:44:50.728
I totally, totally forgot to tell you.
00:44:51.909 --> 00:44:52.670
And when I did,
00:44:52.750 --> 00:44:53.750
I did my Tony Maritato.
00:44:53.829 --> 00:44:55.331
I got the patient's permission ahead of
00:44:55.371 --> 00:44:55.572
time.
00:44:56.452 --> 00:44:57.512
I even told the physician,
00:44:57.612 --> 00:44:59.913
texted the physician, hey, you know,
00:44:59.952 --> 00:45:02.454
he already knew I was sending this patient
00:45:02.494 --> 00:45:02.813
to him.
00:45:03.514 --> 00:45:05.155
And I just want to get his permission
00:45:05.175 --> 00:45:06.375
just because I haven't done it before.
00:45:06.434 --> 00:45:07.135
And I just, whatever.
00:45:07.195 --> 00:45:07.554
I'm just like,
00:45:07.614 --> 00:45:08.375
let me run this by you.
00:45:08.394 --> 00:45:09.976
You know, if that's cool.
00:45:10.275 --> 00:45:10.556
You know,
00:45:10.815 --> 00:45:12.536
the patient already gave permission.
00:45:13.697 --> 00:45:15.336
And so it was great.
00:45:15.396 --> 00:45:16.157
So like that,
00:45:16.518 --> 00:45:17.797
like I know you've been doing that, Tony,
00:45:17.818 --> 00:45:18.217
for years.
00:45:18.257 --> 00:45:20.398
But more collaboration now,
00:45:20.759 --> 00:45:23.099
less of the top-down hierarchy and,
00:45:23.159 --> 00:45:23.460
you know,
00:45:23.500 --> 00:45:26.182
the â
00:45:24.679 --> 00:45:26.081
all knowing, all being, you know,
00:45:26.121 --> 00:45:27.382
physician from, you know,
00:45:27.443 --> 00:45:29.565
fifty plus years ago.
00:45:29.605 --> 00:45:30.164
So how'd it go?
00:45:30.244 --> 00:45:30.885
Tell us about it.
00:45:30.925 --> 00:45:31.867
We have a couple of minutes.
00:45:32.708 --> 00:45:34.208
Yeah, well, yeah,
00:45:34.248 --> 00:45:36.831
he was he gave maybe twenty or something
00:45:36.871 --> 00:45:38.413
minutes in terms of, you know,
00:45:38.492 --> 00:45:39.454
in the exam room and all that.
00:45:39.474 --> 00:45:40.775
So that was great in terms of time.
00:45:41.135 --> 00:45:41.556
Twenty minutes,
00:45:41.576 --> 00:45:42.577
maybe even twenty five minutes.
00:45:42.976 --> 00:45:44.179
It was great in terms of time.
00:45:46.108 --> 00:45:47.630
We did have to wait like an hour.
00:45:47.789 --> 00:45:49.690
And I almost, I almost,
00:45:50.271 --> 00:45:51.411
I said to my patient,
00:45:51.452 --> 00:45:52.693
now the patient I have a great rapport
00:45:52.713 --> 00:45:52.793
with,
00:45:52.813 --> 00:45:53.873
cause I've been treating him for like a
00:45:53.913 --> 00:45:55.153
year and a half with a, you know,
00:45:55.233 --> 00:45:56.074
neuro situation.
00:45:56.815 --> 00:45:58.615
And I said, I said,
00:45:58.655 --> 00:45:59.936
should I go outside?
00:45:59.956 --> 00:46:00.896
Like, I think like,
00:46:00.956 --> 00:46:02.197
is it possible that they forgot us?
00:46:02.237 --> 00:46:03.438
And he said, he said,
00:46:03.478 --> 00:46:04.219
if my wife was here,
00:46:04.239 --> 00:46:05.338
she would have already been outside.
00:46:05.358 --> 00:46:06.900
I was like, oh man.
00:46:06.960 --> 00:46:07.260
Yeah.
00:46:07.280 --> 00:46:08.420
So, but now he came in,
00:46:08.460 --> 00:46:09.021
it went well.
00:46:09.041 --> 00:46:12.282
And also going through the exam and the
00:46:12.302 --> 00:46:13.443
subjective and you know,
00:46:14.103 --> 00:46:15.846
uh in the middle and then towards the
00:46:15.925 --> 00:46:18.108
end the physician was kind of turning to
00:46:18.168 --> 00:46:21.130
me after i gave some subjective in the
00:46:21.230 --> 00:46:22.831
in the beginning but then in terms of
00:46:22.851 --> 00:46:24.612
the plan and you know setting up imaging
00:46:24.652 --> 00:46:26.795
and going from there uh the physician was
00:46:26.815 --> 00:46:28.096
turning to me and was kind of like
00:46:28.456 --> 00:46:29.998
is that almost was like is that what
00:46:30.038 --> 00:46:31.438
you guys were kind of looking for like
00:46:31.458 --> 00:46:32.800
any other questions then anything else i
00:46:32.820 --> 00:46:34.021
can help you with or like are we
00:46:34.041 --> 00:46:36.043
on the same page here and i'm like
00:46:36.063 --> 00:46:38.164
yeah totally that exactly what i wanted
00:46:38.224 --> 00:46:39.766
like he's got you know multiple
00:46:40.487 --> 00:46:42.909
orthopedic issues on top of a neurological
00:46:43.690 --> 00:46:44.170
condition.
00:46:44.210 --> 00:46:46.150
So there's a lot going on here and
00:46:46.190 --> 00:46:47.632
that's why I was referring him to you.
00:46:47.672 --> 00:46:47.932
So yes,
00:46:47.952 --> 00:46:50.134
we're on the same page and everything that
00:46:50.173 --> 00:46:51.755
you mentioned in terms of
00:46:53.014 --> 00:46:54.235
potential next steps,
00:46:54.295 --> 00:46:55.496
like right on the same page,
00:46:55.516 --> 00:46:56.617
exactly what we're looking for.
00:46:56.956 --> 00:46:58.257
So then he kind of looped me back
00:46:58.336 --> 00:47:00.237
into this three-way conversation between
00:47:00.398 --> 00:47:02.298
he and I and the patient right there
00:47:02.338 --> 00:47:02.878
in the office.
00:47:03.500 --> 00:47:04.539
So it went well.
00:47:06.021 --> 00:47:07.420
And we'll see, we'll see, you know,
00:47:07.460 --> 00:47:08.541
how many more of those I can do,
00:47:08.601 --> 00:47:10.722
but that would, oh, I did,
00:47:10.822 --> 00:47:12.402
I did message you guys because I did
00:47:12.443 --> 00:47:14.384
say about the weight and you- I remember
00:47:14.403 --> 00:47:14.563
now, yeah.
00:47:14.583 --> 00:47:15.824
Yeah, yeah.
00:47:15.864 --> 00:47:17.326
So historically you said, you know,
00:47:17.365 --> 00:47:19.045
you gotta be prepared for, you know,
00:47:19.085 --> 00:47:20.927
like a two or three hour window sometimes
00:47:20.947 --> 00:47:21.987
with like the whole,
00:47:22.989 --> 00:47:25.351
experience you know so that's it's all
00:47:25.391 --> 00:47:27.172
good just like building relationships and
00:47:27.193 --> 00:47:29.273
um but that's kind of where i'm at
00:47:29.293 --> 00:47:32.876
in terms of physician marketing and that
00:47:32.896 --> 00:47:34.516
whole you know collaborative approach
00:47:34.556 --> 00:47:37.438
which again i i would never i don't
00:47:37.458 --> 00:47:39.000
think i would do it you know historically
00:47:39.039 --> 00:47:40.780
but now i'm doing it more as i
00:47:40.800 --> 00:47:43.202
kind of see the vibe of other physicians
00:47:43.302 --> 00:47:45.264
and you know things that work so you
00:47:45.284 --> 00:47:46.523
know it was just part of like the
00:47:46.563 --> 00:47:48.385
marketing strategy and just again building
00:47:48.425 --> 00:47:48.965
relationships
00:47:50.210 --> 00:47:51.793
So again, this is, you know,
00:47:52.414 --> 00:47:54.599
Dana Strauss and value-based care and
00:47:54.639 --> 00:47:55.981
having a seat at the table.
00:47:56.041 --> 00:47:58.786
And there's different approaches to how we
00:47:58.827 --> 00:47:59.286
get there.
00:48:00.088 --> 00:48:03.375
You can go the route of, um,
00:48:04.695 --> 00:48:05.456
I don't even know.
00:48:05.556 --> 00:48:07.117
I don't know what everybody else is doing.
00:48:07.719 --> 00:48:09.880
When I want a seat at the table,
00:48:09.920 --> 00:48:11.742
when I want to build a relationship,
00:48:11.902 --> 00:48:14.465
we used to bring lunch in or breakfast
00:48:14.485 --> 00:48:15.606
for the entire office.
00:48:15.646 --> 00:48:16.748
We'd get a couple minutes.
00:48:17.248 --> 00:48:19.590
We were a nuisance to the medical
00:48:19.610 --> 00:48:20.150
practice.
00:48:20.231 --> 00:48:22.152
Nobody wanted to deal with us.
00:48:22.914 --> 00:48:23.394
But now...
00:48:24.554 --> 00:48:25.653
I go with my patient.
00:48:25.775 --> 00:48:26.775
I haven't done it in a couple of
00:48:26.795 --> 00:48:29.956
years, but still the opportunity is there.
00:48:30.976 --> 00:48:32.536
You go there and you sit down.
00:48:32.617 --> 00:48:34.538
The doctor is getting paid for that time.
00:48:35.117 --> 00:48:36.458
I'm representing the patient.
00:48:36.478 --> 00:48:38.199
I'm saving the physician some time.
00:48:38.259 --> 00:48:39.139
I'm communicating.
00:48:39.179 --> 00:48:40.199
I'm building a rapport.
00:48:40.239 --> 00:48:41.519
I'm making the connection.
00:48:42.201 --> 00:48:43.561
Once you do it a couple of times,
00:48:43.601 --> 00:48:45.702
they get to know you on a personal
00:48:45.742 --> 00:48:48.382
level here where we are.
00:48:49.507 --> 00:48:51.931
The doctors still will very,
00:48:51.971 --> 00:48:54.733
very rarely send me patients in
00:48:54.773 --> 00:48:55.253
Middletown.
00:48:55.313 --> 00:48:55.434
Now,
00:48:55.494 --> 00:48:57.675
Middletown is about five miles up the road
00:48:57.715 --> 00:48:58.757
from where I am right now.
00:48:58.817 --> 00:48:59.858
Right now, I'm in Monroe.
00:49:01.340 --> 00:49:03.161
But every single patient in Monroe comes
00:49:03.181 --> 00:49:03.402
to me.
00:49:04.063 --> 00:49:06.005
And that is because...
00:49:06.525 --> 00:49:09.246
Those doctors know me on a personal level.
00:49:09.307 --> 00:49:10.467
We have a relationship.
00:49:10.509 --> 00:49:11.668
We've talked to each other.
00:49:12.010 --> 00:49:13.851
We kind of have a sense for what
00:49:13.891 --> 00:49:15.172
we're doing and who we are.
00:49:15.251 --> 00:49:17.574
The only way I could build that is
00:49:17.614 --> 00:49:19.815
by attending those follow-up visits with
00:49:19.876 --> 00:49:20.617
my patients.
00:49:21.938 --> 00:49:23.079
And the docs who don't want to do
00:49:23.139 --> 00:49:24.179
it, they're not going to do it,
00:49:24.219 --> 00:49:25.121
but it doesn't matter.
00:49:25.340 --> 00:49:27.503
Just like any other networking,
00:49:27.543 --> 00:49:29.643
there's people you connect with and people
00:49:29.664 --> 00:49:30.105
you don't.
00:49:30.824 --> 00:49:31.585
So yeah,
00:49:31.625 --> 00:49:33.126
I just think it's such a missed
00:49:33.166 --> 00:49:34.666
opportunity for so many.
00:49:35.126 --> 00:49:37.168
And I would say it's really should be
00:49:37.268 --> 00:49:39.148
a paid opportunity.
00:49:39.548 --> 00:49:40.449
I don't know if you did it,
00:49:40.849 --> 00:49:42.590
but for other therapists listening,
00:49:43.391 --> 00:49:44.670
like it should be a paid session.
00:49:45.072 --> 00:49:46.472
It's not covered by insurance.
00:49:46.831 --> 00:49:48.132
It should be paid out of pocket.
00:49:48.802 --> 00:49:50.603
I bet the family would be willing to
00:49:50.643 --> 00:49:52.804
pay to send you,
00:49:52.864 --> 00:49:54.143
somebody the patient knows,
00:49:54.184 --> 00:49:55.103
likes and trusts,
00:49:55.463 --> 00:49:57.485
to be there as a representative.
00:49:57.545 --> 00:49:57.864
Jimmy,
00:49:57.905 --> 00:49:59.804
you've been in that world with your dad.
00:50:00.206 --> 00:50:02.786
Like having somebody who understands the
00:50:02.846 --> 00:50:04.206
system, speaks the language,
00:50:04.286 --> 00:50:06.146
being there with somebody you care about,
00:50:06.666 --> 00:50:08.806
probably more impactful than, you know,
00:50:08.847 --> 00:50:10.648
a spouse being there who doesn't know what
00:50:10.668 --> 00:50:10.887
to do.
00:50:11.447 --> 00:50:13.168
Three things, time, money, headache,
00:50:13.748 --> 00:50:15.329
and averting crisis.
00:50:15.349 --> 00:50:17.110
I mean, I have someone.
00:50:17.150 --> 00:50:20.311
I have a former nurse who's a medical
00:50:20.431 --> 00:50:21.813
advocate, a nursing advocate,
00:50:21.833 --> 00:50:22.954
a geriatric advocate.
00:50:22.974 --> 00:50:24.974
You know how many times that I've been
00:50:24.994 --> 00:50:25.175
like,
00:50:25.215 --> 00:50:27.436
should I bring my dad to the doctor,
00:50:27.476 --> 00:50:30.376
the urgent care, the emergency room,
00:50:30.416 --> 00:50:30.878
or wait?
00:50:31.657 --> 00:50:33.079
And she'll ask me two or three questions
00:50:33.099 --> 00:50:33.518
and then say,
00:50:33.838 --> 00:50:35.159
it's my recommendation that you do this.
00:50:35.260 --> 00:50:36.059
And I'm like, great.
00:50:37.541 --> 00:50:38.561
But I can go around with her.
00:50:38.661 --> 00:50:39.942
I can say, well, I don't understand that.
00:50:39.961 --> 00:50:40.523
Can you explain it?
00:50:40.543 --> 00:50:41.103
She's like, sure.
00:50:41.123 --> 00:50:42.523
Do you want me to explain it now?
00:50:42.543 --> 00:50:43.463
Do you want me to write it down?
00:50:43.523 --> 00:50:45.025
And I'm like, sure.
00:50:45.065 --> 00:50:45.846
Just explain it to me now.
00:50:46.885 --> 00:50:48.007
time, effort, money,
00:50:48.166 --> 00:50:51.268
pain and averting crisis like these things
00:50:51.288 --> 00:50:52.369
are valuable.
00:50:52.509 --> 00:50:54.489
So this goes back to a conversation I
00:50:54.510 --> 00:50:55.469
was just having with someone the other
00:50:55.489 --> 00:50:55.630
day.
00:50:55.670 --> 00:50:57.931
We typically devalue the things we know
00:50:57.952 --> 00:50:58.592
because they're easy.
00:50:58.652 --> 00:51:00.353
We know that even someone stupid like me
00:51:00.393 --> 00:51:02.074
knows that everybody must know it.
00:51:02.873 --> 00:51:04.094
So we devalue what we know.
00:51:04.494 --> 00:51:06.135
But I look at my buddy who I
00:51:06.215 --> 00:51:07.797
reference him a lot down the street who's
00:51:07.817 --> 00:51:08.336
a mechanic.
00:51:09.490 --> 00:51:12.572
I'm like, you're like a wizard, man.
00:51:12.612 --> 00:51:13.632
I don't know how to make the car
00:51:13.871 --> 00:51:15.512
stop doing the noise and make sure it's
00:51:15.532 --> 00:51:16.092
safe to drive.
00:51:16.373 --> 00:51:17.253
I have no idea.
00:51:17.494 --> 00:51:19.393
I could not begin to watch a YouTube
00:51:19.434 --> 00:51:19.653
video.
00:51:19.693 --> 00:51:19.994
It's easy.
00:51:20.014 --> 00:51:20.255
I'm like,
00:51:20.775 --> 00:51:21.655
I don't even know what parts you're
00:51:21.675 --> 00:51:22.474
talking about, man.
00:51:22.534 --> 00:51:23.456
I wouldn't even begin to scratch the
00:51:23.496 --> 00:51:23.755
surface.
00:51:23.856 --> 00:51:25.076
I wouldn't even open the textbook.
00:51:25.655 --> 00:51:26.637
That's valuable.
00:51:26.737 --> 00:51:28.097
That's why people pay for that.
00:51:28.336 --> 00:51:29.978
So, yes, it is of value.
00:51:30.797 --> 00:51:32.498
What I think is interesting there is you
00:51:32.559 --> 00:51:36.139
said medical advocate and then you said
00:51:36.219 --> 00:51:36.579
nurse.
00:51:37.309 --> 00:51:39.429
And so if you had originally and both
00:51:39.449 --> 00:51:40.411
would do the same thing.
00:51:40.490 --> 00:51:42.431
I think any nurse that you hired would
00:51:42.731 --> 00:51:44.931
function as a medical advocate.
00:51:45.472 --> 00:51:47.092
But as soon as you say the words
00:51:47.152 --> 00:51:49.572
medical advocate, the consumer is like,
00:51:49.592 --> 00:51:51.092
yes, that's exactly what I need.
00:51:51.112 --> 00:51:52.632
I don't need another nurse.
00:51:52.672 --> 00:51:53.393
I've got a nurse.
00:51:53.432 --> 00:51:54.913
I need a medical advocate.
00:51:54.952 --> 00:51:56.614
I need somebody who's going to advocate
00:51:56.653 --> 00:51:58.393
for me, be on my side,
00:51:58.454 --> 00:51:59.693
be my representative,
00:51:59.733 --> 00:52:02.695
speak a language and fight for what I
00:52:02.775 --> 00:52:03.215
need.
00:52:03.614 --> 00:52:06.976
Um, so once again, that, that name,
00:52:07.036 --> 00:52:07.838
that word,
00:52:07.878 --> 00:52:10.159
that sound coming out of your mouth has
00:52:10.219 --> 00:52:12.800
significantly higher value in the context
00:52:12.981 --> 00:52:15.802
of what the consumer believes they need
00:52:16.342 --> 00:52:17.643
than just saying nurse,
00:52:17.784 --> 00:52:20.545
even though technically I would imagine
00:52:20.865 --> 00:52:23.206
anybody in the world can hang a shingle
00:52:23.246 --> 00:52:24.547
saying medical advocate,
00:52:24.568 --> 00:52:26.849
but you have to go through extensive
00:52:26.989 --> 00:52:29.170
training and education and licensure to
00:52:29.251 --> 00:52:30.711
hang a shingle that says nurse.
00:52:31.228 --> 00:52:31.449
Right.
00:52:31.528 --> 00:52:32.250
So she did both.
00:52:32.269 --> 00:52:33.992
She was a nurse for twenty something years
00:52:34.032 --> 00:52:35.052
in a bunch of different settings.
00:52:35.092 --> 00:52:35.693
And then she's like,
00:52:35.773 --> 00:52:36.634
now I want to do this.
00:52:37.034 --> 00:52:37.715
So she's, you know,
00:52:38.036 --> 00:52:39.536
her pitch is essentially a family member
00:52:39.556 --> 00:52:40.858
founder for me online.
00:52:41.199 --> 00:52:43.822
The pitch was I've been that provider and
00:52:43.862 --> 00:52:45.483
I know how people can get lost and
00:52:45.583 --> 00:52:47.005
I sort of know how to cut through
00:52:47.025 --> 00:52:47.445
the BS.
00:52:47.865 --> 00:52:48.626
She's annoying.
00:52:49.730 --> 00:52:50.409
At hospitals.
00:52:50.630 --> 00:52:51.070
Not to me.
00:52:51.170 --> 00:52:51.251
Yeah.
00:52:51.831 --> 00:52:54.273
No, I need this paperwork.
00:52:54.413 --> 00:52:55.132
I will get it to you.
00:52:55.273 --> 00:52:56.534
I'm not leaving until it is.
00:52:57.114 --> 00:52:58.695
This is his right.
00:52:58.735 --> 00:53:00.315
He has a right to have this paperwork.
00:53:00.635 --> 00:53:01.536
We will not leave.
00:53:01.635 --> 00:53:02.817
Oh, what's your supervisor?
00:53:03.557 --> 00:53:04.117
What's your name?
00:53:04.137 --> 00:53:05.679
I'm going to write down that we can't.
00:53:05.739 --> 00:53:07.159
It's nine twenty four.
00:53:07.179 --> 00:53:09.201
We requested it and I'll write down when
00:53:09.221 --> 00:53:09.661
we get it.
00:53:10.141 --> 00:53:11.822
And I get to just be guy in
00:53:11.842 --> 00:53:13.202
the corner who's just like, hey, dad,
00:53:13.222 --> 00:53:14.784
let's watch the Yankee game on TV while
00:53:14.804 --> 00:53:15.824
we're in the emergency room.
00:53:16.164 --> 00:53:18.105
So it was it valuable?
00:53:18.646 --> 00:53:19.106
Hell, yeah.
00:53:20.838 --> 00:53:21.739
Yeah.
00:53:21.760 --> 00:53:23.161
Let's think about parting shots.
00:53:24.041 --> 00:53:25.242
I don't know if you guys caught it
00:53:25.302 --> 00:53:26.083
over the weekend.
00:53:26.844 --> 00:53:28.965
The Mets went down in a blaze of
00:53:29.005 --> 00:53:30.005
glory and the Reds.
00:53:30.025 --> 00:53:30.505
The Reds are in.
00:53:30.525 --> 00:53:31.327
The Reds are in, baby.
00:53:31.527 --> 00:53:32.327
Congratulations.
00:53:34.228 --> 00:53:35.610
I don't know what's going to happen
00:53:35.670 --> 00:53:37.030
against the Dodgers tomorrow.
00:53:37.291 --> 00:53:37.572
Tomorrow?
00:53:37.592 --> 00:53:38.112
Tonight.
00:53:38.311 --> 00:53:39.032
I think it's tonight.
00:53:40.333 --> 00:53:42.054
That could get ugly, but hey,
00:53:42.074 --> 00:53:43.677
we're going to celebrate while we can.
00:53:43.697 --> 00:53:45.918
Good for you.
00:53:45.958 --> 00:53:47.039
How's my parting shot?
00:53:47.059 --> 00:53:47.900
What do you guys got?
00:53:49.815 --> 00:53:50.894
Other than Go Phillies,
00:53:50.954 --> 00:53:53.356
we got the two seed first round buy.
00:53:53.416 --> 00:53:56.737
Other than Go Phillies, yeah,
00:53:56.777 --> 00:54:00.117
just going back to this whole shenanigans,
00:54:00.197 --> 00:54:03.398
I think this whole topic is just crazy
00:54:03.438 --> 00:54:04.659
that we just covered today.
00:54:04.778 --> 00:54:07.278
And so if, I don't know,
00:54:07.458 --> 00:54:09.639
if there's NPs and PAs that...
00:54:11.172 --> 00:54:13.375
have their name badge and they're
00:54:13.474 --> 00:54:13.974
displaying it.
00:54:14.014 --> 00:54:14.675
And then like Tony said,
00:54:14.695 --> 00:54:15.596
they're not flipping it around.
00:54:15.615 --> 00:54:16.356
They're not hiding it.
00:54:17.516 --> 00:54:18.657
Just do the right thing.
00:54:19.219 --> 00:54:20.960
Then I don't see how anything could be
00:54:20.980 --> 00:54:23.981
misleading or misrepresentation or
00:54:24.101 --> 00:54:24.461
whatever.
00:54:26.043 --> 00:54:28.724
And also, yeah, I don't know.
00:54:28.784 --> 00:54:29.925
I'm not sure if it'll make that big
00:54:29.945 --> 00:54:30.826
of a difference either way,
00:54:30.865 --> 00:54:32.527
but patients are definitely...
00:54:33.467 --> 00:54:35.949
uh influenced and sometimes positively
00:54:35.989 --> 00:54:38.251
surprised when i hear that we have doctors
00:54:38.291 --> 00:54:39.751
in physical therapy like i mentioned it i
00:54:39.771 --> 00:54:41.432
don't like sell it hard but like i
00:54:41.472 --> 00:54:44.135
think it's cool to mention because that's
00:54:44.155 --> 00:54:46.376
what my diploma says that's what i got
00:54:46.416 --> 00:54:48.536
licensed you know with and all that so
00:54:48.637 --> 00:54:50.577
like why wouldn't i use it in like
00:54:50.617 --> 00:54:53.860
the most respectful way and we're not
00:54:53.900 --> 00:54:55.481
saying physician or medical doctor or
00:54:55.501 --> 00:54:57.161
anything like that so um
00:54:58.202 --> 00:54:58.503
Hopefully,
00:54:58.523 --> 00:55:01.025
this is not an ongoing trend with other
00:55:01.065 --> 00:55:04.987
states barring nurses from saying doctor
00:55:05.268 --> 00:55:07.190
if they're DNP or NP or whatever.
00:55:07.929 --> 00:55:09.331
Because if that's the case,
00:55:09.351 --> 00:55:11.612
then it could certainly trickle down or
00:55:11.652 --> 00:55:13.793
trickle over to physical therapists as
00:55:13.833 --> 00:55:14.034
well.
00:55:14.094 --> 00:55:14.574
So we'll see.
00:55:15.239 --> 00:55:17.900
Yeah, I'd say in the end, clarity wins.
00:55:18.902 --> 00:55:20.704
The person who is most clear wins.
00:55:20.744 --> 00:55:22.465
And I know if you're saying, hey,
00:55:22.786 --> 00:55:25.387
the AMA is doing this because of hierarchy
00:55:25.427 --> 00:55:27.750
and ego, don't do the same thing.
00:55:27.969 --> 00:55:28.911
Aim for clarity,
00:55:28.931 --> 00:55:31.012
and I think you don't miss.
00:55:31.052 --> 00:55:33.315
I think people want to default to, like,
00:55:33.394 --> 00:55:35.617
I need to win every single conversation
00:55:35.657 --> 00:55:36.157
and argument.
00:55:36.518 --> 00:55:39.079
You never win every single conversation
00:55:39.159 --> 00:55:39.621
and argument.
00:55:39.981 --> 00:55:41.101
I think the person who communicates
00:55:41.141 --> 00:55:42.302
clearly, concisely,
00:55:42.362 --> 00:55:44.344
consistently is the one who wins.
00:55:44.445 --> 00:55:45.565
But you got to decide what winning looks
00:55:45.606 --> 00:55:45.806
like.
00:55:45.827 --> 00:55:47.849
All right, gentlemen.
00:55:47.869 --> 00:55:48.568
Right on.
00:55:48.648 --> 00:55:49.389
Love it.
00:55:49.409 --> 00:55:49.931
Have a great week.
00:55:49.951 --> 00:55:50.851
We'll see you back on Thursday.
00:55:51.072 --> 00:55:53.273
I'm sure something insane will happen in
00:55:53.293 --> 00:55:55.175
the healthcare world in our profession
00:55:55.496 --> 00:55:56.996
between now and Thursday for us to
00:55:57.036 --> 00:55:57.458
discuss.
00:55:57.518 --> 00:55:59.099
But if you have any topic suggestions,
00:55:59.460 --> 00:56:00.820
feel free to hit us up online and
00:56:00.840 --> 00:56:01.802
we will bring it to the show.