Called to Care Spotlight: What If Caring More Prevents Burnout?

WEBVTT

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And we're reintroducing the Call to Care

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podcast for the next several weeks.

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We are relaunching the book.

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It's an expanded, revised edition,

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includes some chapters in burnout, AI,

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all the things around telehealth,

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lots of things going on.

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That's all the good news.

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But the better news is we're dedicating a

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hundred percent of the proceeds from the

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second edition of Call to Care to the

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Rising Tide Foundation.

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And after today's podcast and talking to

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the founder of Rising Tide,

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who is also the founder of WebPT,

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you'll understand why,

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that the mission that they are all about,

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which is really driven by human connection

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and putting the right humans in the

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profession,

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is the same argument we make in the

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book.

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So I'm pleased to introduce you to Heidi

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Janenga.

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Heidi,

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we're gonna start out with a short

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introduction to you,

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but I really wanna do the real

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introduction,

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which is that how you started out with

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a knee injury at UC Davis.

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Yeah,

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I think we as physical therapists all kind

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of have that sort of moment when we

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knew this is the path that we wanted

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to take.

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And mine was in college.

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I was actually pre-med going into college.

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I was a basketball athlete at UC Davis

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and went down my junior year with a

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knee injury that was inconclusive on MRI

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of whether they

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whether or not I had torn my ACL,

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they thought I had torn my ACL, but,

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uh, it just wasn't conclusive.

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So they sent me to a physical therapist,

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which, you know, you're,

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I'd spent a lot of time in the

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athletic training room,

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but had never really interacted with a PT

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and, um,

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This happened,

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my injury happened like early in

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preseason.

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And so I was able to rehab back,

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wore a brace,

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but came back that year to be able

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to play in the final parts of the

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season and into the playoffs and rehabbed

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again with this therapist all summer long

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and was able to play my senior year

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with no brace and

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set a few uh scoring records along the

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way but man that changed yeah changed my

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trajectory and sort of what I wanted to

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do um in terms of always knowing that

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I wanted to work with athletes but in

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this capacity of really having experienced

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it myself really wanting to then go back

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and be able to do that for for

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other athletes uh yeah it was a turning

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point in my career and

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Boy, you know,

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it's turning the lemons into lemonade

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where an injury could be devastating to

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especially at that level of an athlete.

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But, you know,

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having that experience changed the

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trajectory of my life.

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That's an incredible story.

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If you look at how things have evolved

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for women in sports in general,

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and basketball in particular,

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it's a whole new world.

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The attendance at women's WNBA, college,

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college volleyball,

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it's just been incredible.

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Look at the opportunities that sports has

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continued to provide for things like

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physical therapists.

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I want to segue this a bit with

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Rising Tide,

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which is not the first company,

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or in that case,

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maybe it is the first nonprofit you

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founded,

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but it's not the first company you

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founded.

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But you wrote that sports was the first

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place that you didn't feel like an

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outsider.

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And you put your name sort of on

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the topic of workforce diversity when

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nobody was solving it.

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Nobody probably in those days was even

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calling it workforce diversity.

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Tell us about Rising Tide and tell us

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how it is building that same feeling for

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those that are coming outside into the

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profession.

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Well, I am...

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a product of an immigrant father who

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immigrated to this country from Austria.

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My mom is Japanese.

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She was first generation Japanese American

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born in Hawaii before Hawaii was a state.

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And so having two parents who essentially,

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you know,

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came from nothing to,

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and my mom was one of nine, um,

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grew up in, in, in general poverty, um,

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and to, to come up to,

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to be able to have opportunity to, uh,

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my dad ended up going to Cornell.

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Um,

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he landed in Hawaii after working on

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merchant Marine ships for ten years, um,

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got set up with my mom on a

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blind date, and, uh, that's how they met,

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uh, in Hawaii, and then he,

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went on to Cornell to get his PhD

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and work for US Department of Agriculture.

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My mom was a schoolteacher,

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and so their hard work,

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their work ethic that they instilled in me

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early on was something that was really

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important, that has been formidable.

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However, being what they call in Hawaii,

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hapa haole,

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half Asian, half white,

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like you'd think that you'd fit into a

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lot of different categories.

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Well,

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sometimes you fit into some groups and not

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others.

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But what I've discovered about myself is

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that it's made me somewhat of a chameleon

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where I am able to sort of

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find ways to connect with people of

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different backgrounds,

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different ethnicities in all those ways.

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But initially it was the opposite that I

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just,

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I never felt like I really fit into

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one group because I was different.

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And finding sports and having that

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connection with a team,

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in which you are all working towards one

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goal, no matter where you are,

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who you are,

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what you're doing and whether you're

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friends off the court or on the court,

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once you step on that court,

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you're there for a common purpose.

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And sort of that sort of mentality allowed

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me to really feel connected to those

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teammates and feel connected no matter

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about my background.

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Right.

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And especially as a female athlete,

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you know, I,

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I had natural leadership tendencies in

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which I rose to being a captain.

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Those coaches and other teammates finding

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those qualities in me that maybe I didn't

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even see in myself at the time were

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formidable to be able to sort of lean

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into those things when they were

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successful, right?

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And so as I look to Rising Tide,

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right,

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these are students who are first

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Sheri Byrne- generation college goers they

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don't have a lot of family support or

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or experience from from people around

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them, who have been there done that.

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Many of them are supporting themselves as,

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you know,

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having jobs at the same time as going

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through PT school.

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And so their work ethic,

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their drive to really want to pursue this

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profession, having that common purpose,

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like all of those things kind of coming

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together.

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You know,

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I see a lot of them or I

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see myself in a lot of them.

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Right.

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And helping them to sort of hopefully

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remove some of the barriers and the

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lack of confidence that maybe i had um

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to help support them and move them along

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even faster than uh they potentially think

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that they could themselves and of course

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as you know larry it's the financial

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barriers uh that it's the big one right

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uh these are students that are taking on

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more student than debt than an average

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person to be able to get through because

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not only are they coming into dpc school

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having to get additional funding but they

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already have debt from undergrad

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And so that's the essence of part of

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the essence of rising tide and, you know,

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why it's been so impactful.

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It's interesting that you mentioned the

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financial, which is obviously number one.

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But I would also offer up that as

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physical therapy schools got harder and

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harder to get into,

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they made the criteria the most risk free

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criteria.

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And by doing that really left out.

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underrepresented minorities in a major way

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such that you know PT is one of

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the most lacking of all healthcare

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professions and we'll get into that a

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little bit but what you've done is not

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only supply scholarships but you've also

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supplied resources and other things from a

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psychosocial standpoint that make it even

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easier better give them a better chance

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for success but the odds in their favor

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Correct me if I'm wrong,

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but I think you're at one hundred eighteen

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scholars.

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Is that right?

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One hundred eighteen,

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two and a half million dollars at least

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plus.

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And what does that taught you about the

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barriers that money alone doesn't solve?

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Because certainly with that many scholars,

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you now have seen enough enter to learn

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from you got some of the financial thing,

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help them resolve.

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What are some of the other factors that

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the profession does that makes it

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difficult?

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Well,

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as you have eloquently written about so

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much,

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it's so much about the human relationship,

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right?

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And while everybody applies because of the

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scholarship,

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What we have come to find out is

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probably even more rewarding to the

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students and their success and support

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ongoing is the educational enrichment,

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the networking,

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the connections that we're able to help

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them get to that is really making the

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difference.

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been written about, you know,

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like it's all in who, you know, well,

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you know,

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the fact that someone like yourself will

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come and do a keynote and come to

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a happy hour.

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And while you might've seen a seemed out

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of reach, um,

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you're right there with them and they're

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able to shake your hand,

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have a conversation like those types of

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things for these students seem out of

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reach and out of touch.

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And, um, you know, what we've,

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Maureen Reyes- learned even from early on,

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is the educational enrichment components

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to what we're doing so just as a

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backdrop right,

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we do offer the scholarships,

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we have twenty scholarships that we offer

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per year for DPT students.

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And then we also do five scholarships for

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residents per year.

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So it's twenty five scholarships annually

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that we're giving.

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And in addition to that,

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we have quarterly webinars with our

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scholars and we bring them all to Phoenix,

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Arizona,

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where I happen to live for an annual

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what we call our North Star Summit

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Conference.

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in which all the current students come to

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Phoenix.

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We fly them all in for two days

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of sort of networking and they get a

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full day of curriculum based on volunteer

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speakers and amazing folks who come

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together to help educate and bring

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educational opportunities for them.

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And so all of those components and then

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I mean,

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I could go on forever on this, Larry.

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It's just so inspiring.

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But what we've also found is we had

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a record number.

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Every year it's been increasing the number

00:11:08.947 --> 00:11:10.609
of applicants, which is fantastic,

00:11:10.629 --> 00:11:12.510
which means more people are knowing about

00:11:12.610 --> 00:11:12.770
us.

00:11:12.910 --> 00:11:14.412
I would hope it also means that we

00:11:14.491 --> 00:11:16.653
are improving the diversity of the

00:11:16.673 --> 00:11:17.433
classes,

00:11:18.355 --> 00:11:20.535
those that are being admitted into DPT

00:11:20.576 --> 00:11:20.956
school.

00:11:23.158 --> 00:11:25.720
But we had over five hundred applicants

00:11:25.740 --> 00:11:27.041
this year for twenty spots.

00:11:27.100 --> 00:11:27.240
Wow.

00:11:29.065 --> 00:11:32.628
So it's it's incredibly competitive and

00:11:32.687 --> 00:11:36.130
it's hard as hell to say no to

00:11:36.150 --> 00:11:38.052
some really qualified people.

00:11:38.633 --> 00:11:43.736
And so knowing that we have also built

00:11:43.777 --> 00:11:45.317
a community we call our tide pole.

00:11:45.337 --> 00:11:49.020
We have a technology platform in which we

00:11:49.600 --> 00:11:51.003
a community platform which we can bring

00:11:51.023 --> 00:11:51.842
them all together.

00:11:52.384 --> 00:11:54.524
We provide educational resources for them

00:11:54.585 --> 00:11:55.125
as well.

00:11:55.225 --> 00:11:56.366
So we're not just

00:11:57.142 --> 00:12:00.043
catering only to these twenty folks per

00:12:00.083 --> 00:12:00.524
year,

00:12:00.884 --> 00:12:03.144
our hundred and eighteen scholarships

00:12:03.405 --> 00:12:03.926
winners,

00:12:04.046 --> 00:12:06.847
but the entire sort of application pool

00:12:06.927 --> 00:12:08.629
over the years, which now is, you know,

00:12:08.808 --> 00:12:10.490
upward of close to two thousand people in

00:12:10.610 --> 00:12:11.970
our our database.

00:12:12.750 --> 00:12:13.390
That's amazing.

00:12:13.530 --> 00:12:15.793
And as somebody who's who helped score

00:12:16.785 --> 00:12:17.826
Your scholarships.

00:12:18.288 --> 00:12:20.090
It was the most difficult scoring.

00:12:20.250 --> 00:12:22.573
I've scored for entrance into PT school.

00:12:22.634 --> 00:12:24.475
I've scored entrance into medical school

00:12:24.515 --> 00:12:25.216
and dental schools.

00:12:25.236 --> 00:12:26.578
I've been on all kinds of committees.

00:12:27.200 --> 00:12:28.741
That was one of the most difficult thing

00:12:28.782 --> 00:12:30.764
to do because they were all so worthy.

00:12:32.129 --> 00:12:34.090
which really brings me to the next

00:12:34.149 --> 00:12:36.532
question is that what does the, you know,

00:12:36.792 --> 00:12:38.153
these are all for the most part,

00:12:38.212 --> 00:12:39.994
I would guess first generation students,

00:12:40.014 --> 00:12:41.434
first college generation students,

00:12:41.775 --> 00:12:43.836
what does the profession really get wrong

00:12:43.856 --> 00:12:44.357
about that?

00:12:44.418 --> 00:12:45.378
Why did we get it?

00:12:45.859 --> 00:12:47.220
When you look back on this,

00:12:48.464 --> 00:12:49.684
And I go back, you know,

00:12:49.705 --> 00:12:51.125
I've been in physical therapy world since

00:12:51.145 --> 00:12:51.907
the mid eighties.

00:12:51.927 --> 00:12:53.607
They've always had diversity, you know,

00:12:53.628 --> 00:12:55.328
awareness and minority awareness

00:12:55.369 --> 00:12:57.370
scholarships at APTA, for example,

00:12:57.390 --> 00:12:59.472
and I'm not necessarily pointing at APTA,

00:12:59.493 --> 00:13:01.995
but they've done probably an okay job with

00:13:02.014 --> 00:13:02.235
that.

00:13:02.674 --> 00:13:05.017
But ultimately it still resulted in an

00:13:05.157 --> 00:13:06.298
under-representation.

00:13:07.078 --> 00:13:08.919
So what has our profession got wrong about

00:13:09.019 --> 00:13:10.480
all this?

00:13:10.541 --> 00:13:13.163
Well, it's,

00:13:13.443 --> 00:13:16.066
it's a little bit of chicken and egg,

00:13:16.245 --> 00:13:16.525
right?

00:13:16.926 --> 00:13:17.606
Um,

00:13:18.905 --> 00:13:20.086
I think that, you know,

00:13:20.147 --> 00:13:21.268
you and I have talked about the ninety

00:13:21.307 --> 00:13:21.928
percent, right,

00:13:21.948 --> 00:13:23.831
that ninety percent of people out there

00:13:23.971 --> 00:13:25.792
don't know what a physical therapist is,

00:13:25.873 --> 00:13:26.994
what what we do,

00:13:27.114 --> 00:13:28.254
the impact that we have.

00:13:29.154 --> 00:13:31.236
And I think that's probably doubled when

00:13:31.277 --> 00:13:33.840
it comes to the minority population just

00:13:33.860 --> 00:13:35.861
because they maybe don't have the same

00:13:35.902 --> 00:13:38.563
sort of access to care and that kind

00:13:38.583 --> 00:13:38.844
of thing.

00:13:38.864 --> 00:13:40.365
So they haven't encountered physical

00:13:40.466 --> 00:13:43.128
therapy maybe as much as somebody else.

00:13:43.268 --> 00:13:43.447
Right.

00:13:43.629 --> 00:13:44.789
And so and then when you do.

00:13:45.774 --> 00:13:47.335
you go to see a physical therapist,

00:13:48.775 --> 00:13:50.918
there's no one that looks like you, right?

00:13:50.957 --> 00:13:52.839
So you don't have aspiration to

00:13:52.899 --> 00:13:55.201
potentially want to become a physical

00:13:55.260 --> 00:13:56.802
therapist because you don't really see

00:13:56.841 --> 00:13:59.663
anybody that's in your community or that

00:13:59.683 --> 00:14:02.206
looks like you that actually can inspire

00:14:02.265 --> 00:14:04.048
you to want to become a PT, right?

00:14:04.087 --> 00:14:06.850
And so it's been this slow sort of

00:14:06.929 --> 00:14:10.893
role of more minority physical therapists

00:14:10.913 --> 00:14:11.232
that are

00:14:11.653 --> 00:14:14.553
becoming more outspoken and more advocates

00:14:14.594 --> 00:14:17.315
for the profession in which you are in

00:14:17.335 --> 00:14:19.155
with social media and other things like

00:14:19.176 --> 00:14:19.316
that,

00:14:19.355 --> 00:14:21.316
you now actually see people that look like

00:14:21.355 --> 00:14:21.517
you.

00:14:21.716 --> 00:14:23.576
We hear this all the time with our

00:14:23.657 --> 00:14:24.398
applicants, right?

00:14:24.437 --> 00:14:25.618
Like, what inspired you?

00:14:25.638 --> 00:14:27.158
A lot of them are similar to mine

00:14:27.178 --> 00:14:29.339
where they had an athletic injury,

00:14:29.918 --> 00:14:32.399
but a lot of them now have actually

00:14:32.440 --> 00:14:36.341
had a family member who went to PT.

00:14:37.695 --> 00:14:41.977
And got care by Hispanic PT or an

00:14:42.038 --> 00:14:45.500
African-American PT in which they saw the

00:14:45.541 --> 00:14:47.802
care that was delivered to that family

00:14:47.822 --> 00:14:50.063
member and the impact that they had on

00:14:50.104 --> 00:14:53.267
their entire family that they were so they

00:14:53.287 --> 00:14:55.288
were very inspired to now I want to

00:14:55.307 --> 00:14:56.028
be that person.

00:14:56.610 --> 00:14:56.870
Right.

00:14:57.331 --> 00:14:59.774
And so the more that we can have,

00:15:00.155 --> 00:15:03.341
it's got to be this kind of slow

00:15:03.380 --> 00:15:04.123
progression.

00:15:04.884 --> 00:15:07.928
And as far as what what did we

00:15:07.969 --> 00:15:08.590
get wrong?

00:15:08.929 --> 00:15:09.471
I think it's.

00:15:11.528 --> 00:15:14.110
um it's what the ninety percent problem

00:15:14.129 --> 00:15:15.951
like it's just that we haven't done enough

00:15:15.990 --> 00:15:19.293
pr about what physical therapists the

00:15:19.312 --> 00:15:22.134
impact that we actually in uh have and

00:15:22.553 --> 00:15:25.695
more patient stories more um you know

00:15:25.735 --> 00:15:27.576
physical therapy physical therapist

00:15:27.615 --> 00:15:31.638
stories out there to to let more people

00:15:31.677 --> 00:15:33.859
know who we are what we do the

00:15:33.918 --> 00:15:37.179
education that we have um and

00:15:37.720 --> 00:15:39.544
how important we are to the overall

00:15:40.025 --> 00:15:43.232
wellbeing of patients in healthcare in

00:15:43.273 --> 00:15:43.552
general.

00:15:44.778 --> 00:15:46.879
Yeah, I so much agree.

00:15:46.899 --> 00:15:48.960
I mean, it's sort of bi-directional.

00:15:49.880 --> 00:15:51.701
You don't see anybody in that role,

00:15:51.741 --> 00:15:54.442
so you don't have an aspirational side.

00:15:54.743 --> 00:15:56.403
The flip side of that is also true.

00:15:56.423 --> 00:15:58.365
When you do not have caregivers that look

00:15:58.404 --> 00:15:59.365
like your patients,

00:16:00.105 --> 00:16:02.647
outcomes and access really suffers.

00:16:02.706 --> 00:16:07.328
We've opened clinics in very minority

00:16:08.470 --> 00:16:10.410
areas, heavily impoverished,

00:16:10.850 --> 00:16:11.772
trying to get

00:16:12.532 --> 00:16:13.312
Effectively,

00:16:14.212 --> 00:16:16.075
traditional PTs to go to those areas is

00:16:16.134 --> 00:16:17.196
very, very difficult.

00:16:17.875 --> 00:16:19.778
And so you have this recruitment problem

00:16:19.798 --> 00:16:20.337
of people in,

00:16:20.357 --> 00:16:22.799
but then you also have patients that don't

00:16:22.820 --> 00:16:23.721
look like you either.

00:16:23.760 --> 00:16:25.923
So it really does work both ways.

00:16:25.962 --> 00:16:28.004
And it's getting a little better,

00:16:28.043 --> 00:16:29.544
but it's got a long way to go,

00:16:29.605 --> 00:16:31.567
especially when you think of the access

00:16:31.647 --> 00:16:34.328
point of those who aren't really able to

00:16:34.389 --> 00:16:36.410
access PT are in part because of the

00:16:36.471 --> 00:16:37.831
type of caregivers that are out there.

00:16:39.283 --> 00:16:40.764
Let's switch a bit and talk about some

00:16:40.784 --> 00:16:41.645
of the other barriers.

00:16:41.725 --> 00:16:43.147
Debt, you mentioned earlier,

00:16:43.307 --> 00:16:46.048
is a barrier that everybody points to

00:16:46.129 --> 00:16:46.788
student debt.

00:16:47.909 --> 00:16:49.510
Is it the biggest one you think,

00:16:49.551 --> 00:16:51.711
or is it just the most measurable one?

00:16:52.032 --> 00:16:54.673
Particularly when you think of the student

00:16:54.714 --> 00:16:56.554
population, like there's those,

00:16:56.575 --> 00:16:57.816
like you said, you had so many apply,

00:16:57.855 --> 00:16:58.836
many of them didn't get in.

00:16:59.557 --> 00:17:01.177
What are some of the other,

00:17:02.119 --> 00:17:04.280
are they able to overcome the finance,

00:17:04.760 --> 00:17:06.922
or is the debt the automatic one that

00:17:06.961 --> 00:17:07.903
disqualifies them?

00:17:09.824 --> 00:17:14.326
um i think the debt is the a

00:17:14.346 --> 00:17:17.147
hundred percent the the biggest one um and

00:17:17.228 --> 00:17:20.089
i'll just say this year more than any

00:17:20.170 --> 00:17:22.871
other year through the application cycle

00:17:22.931 --> 00:17:25.432
especially during the interview process we

00:17:25.491 --> 00:17:29.894
heard over and over again that they were

00:17:29.934 --> 00:17:32.816
even second guessing um if they didn't get

00:17:32.875 --> 00:17:34.676
this scholarship or they didn't get other

00:17:34.717 --> 00:17:37.459
scholarships that they weren't sure how

00:17:37.558 --> 00:17:38.839
financially they were going to make it

00:17:38.880 --> 00:17:39.180
through

00:17:39.903 --> 00:17:41.586
on top of the debt load they were

00:17:41.605 --> 00:17:43.067
already carrying, right?

00:17:44.587 --> 00:17:47.631
And so that really gave me pause because

00:17:48.491 --> 00:17:49.813
it is a critical problem.

00:17:49.833 --> 00:17:51.054
We've heard it time and time again,

00:17:51.074 --> 00:17:53.395
but to hear it from these students who

00:17:54.037 --> 00:17:56.578
are uniquely qualified and are probably

00:17:56.598 --> 00:17:58.361
going to be fantastic PTs,

00:17:59.096 --> 00:18:01.198
not only is it a problem upon entry,

00:18:01.719 --> 00:18:02.799
but as you know,

00:18:03.079 --> 00:18:04.942
it's a retention issue as well.

00:18:05.363 --> 00:18:08.546
Because to the point we were making

00:18:08.605 --> 00:18:08.987
earlier,

00:18:09.106 --> 00:18:10.868
a lot of these students have aspirations

00:18:10.929 --> 00:18:13.592
of wanting to go back to their own

00:18:13.632 --> 00:18:15.854
communities and create community centers

00:18:15.953 --> 00:18:17.095
or work in their community.

00:18:18.455 --> 00:18:20.817
there's not already a pt practice there or

00:18:21.116 --> 00:18:24.118
you know there may be not the opportunity

00:18:24.219 --> 00:18:27.980
the insurance reimbursement um for you

00:18:28.000 --> 00:18:30.561
know whatever insurances are more specific

00:18:30.582 --> 00:18:33.743
to that location or they may just not

00:18:33.804 --> 00:18:36.845
have funding in general right to be able

00:18:36.865 --> 00:18:38.705
to come to pt to pay their co-pays

00:18:38.726 --> 00:18:39.527
things like that so

00:18:41.078 --> 00:18:43.500
there's a little naivete as as far as

00:18:43.580 --> 00:18:45.343
you know their aspirations of what they

00:18:45.383 --> 00:18:47.525
want to do but then how do you

00:18:47.605 --> 00:18:50.487
actually create a business or uh with the

00:18:50.507 --> 00:18:53.369
um you know the issues that are at

00:18:53.410 --> 00:18:55.692
hand uh to make a be a you

00:18:55.711 --> 00:18:57.292
know a successful business a profitable

00:18:57.333 --> 00:18:59.474
business a way to make a living uh

00:18:59.535 --> 00:19:02.136
wanting to do that so i think that

00:19:02.156 --> 00:19:05.160
there's the debt is a huge problem

00:19:06.290 --> 00:19:11.913
um i think secondarily uh just um and

00:19:11.972 --> 00:19:13.534
why we're doing some of the educational

00:19:13.554 --> 00:19:15.713
enrichment we're doing is how to navigate

00:19:16.035 --> 00:19:19.796
salary negotiations how to find the right

00:19:19.836 --> 00:19:21.856
job that's right for you not just the

00:19:21.896 --> 00:19:23.717
highest paying job right and this is a

00:19:23.757 --> 00:19:25.137
lot of times what they're doing now

00:19:25.178 --> 00:19:27.118
because the debt load is so high they're

00:19:27.138 --> 00:19:30.039
going to go to whatever job is willing

00:19:30.180 --> 00:19:32.619
whether they are passionate about this

00:19:32.740 --> 00:19:33.840
area or not like

00:19:34.381 --> 00:19:35.501
this is going to get me through my

00:19:35.561 --> 00:19:37.042
first two or three years and then I'll

00:19:37.063 --> 00:19:39.503
have more choices.

00:19:39.564 --> 00:19:40.785
I got to pay this debt down.

00:19:42.526 --> 00:19:43.606
Then one other thing, Larry,

00:19:43.626 --> 00:19:46.268
I'll just say uniquely to this group is

00:19:48.048 --> 00:19:49.630
a lot of times they are now going

00:19:49.650 --> 00:19:51.151
to be the breadwinner in their family.

00:19:51.991 --> 00:19:53.732
They are not only supporting themselves,

00:19:54.315 --> 00:19:56.296
that they are going to be relied upon

00:19:56.415 --> 00:19:59.637
to support other family members that are

00:19:59.678 --> 00:20:00.538
looking to them,

00:20:00.577 --> 00:20:02.778
that have sacrificed for them to go

00:20:02.939 --> 00:20:04.700
through their DPT program,

00:20:05.180 --> 00:20:06.221
become a doctor,

00:20:06.901 --> 00:20:08.442
be the highlight of the family,

00:20:08.781 --> 00:20:10.722
and then be able to give back, right?

00:20:10.863 --> 00:20:12.963
And whether that's through providing

00:20:13.003 --> 00:20:15.565
housing or sending funds back to their

00:20:15.605 --> 00:20:17.605
family, things like that,

00:20:17.846 --> 00:20:19.988
it's really unique to this population.

00:20:21.367 --> 00:20:27.171
to really have more mouths to feed,

00:20:27.211 --> 00:20:29.352
more people to be responsible for than

00:20:29.392 --> 00:20:30.133
just themselves.

00:20:31.113 --> 00:20:32.153
Well, that's fascinating.

00:20:32.614 --> 00:20:35.454
That's quite the dynamic.

00:20:35.494 --> 00:20:36.655
When you have student debt,

00:20:36.935 --> 00:20:38.616
you have all the psychosocial issues and

00:20:38.636 --> 00:20:41.518
barriers surrounding entry to work.

00:20:41.577 --> 00:20:42.679
And thankfully,

00:20:42.719 --> 00:20:44.940
groups like yours are helping to solve and

00:20:44.980 --> 00:20:48.981
enrich them with systems and resources.

00:20:49.021 --> 00:20:49.962
But then on top of it,

00:20:50.919 --> 00:20:52.240
they're supplying their whole family.

00:20:52.319 --> 00:20:52.940
In some cases,

00:20:52.980 --> 00:20:54.621
I would imagine their extended family.

00:20:54.800 --> 00:20:57.481
Wow, what a challenge.

00:20:57.701 --> 00:20:58.642
Yeah, it's a challenge.

00:20:59.041 --> 00:21:00.502
But at the same time, gosh,

00:21:00.522 --> 00:21:01.442
they are passionate.

00:21:02.064 --> 00:21:03.443
They are so passionate about this

00:21:03.483 --> 00:21:04.163
profession.

00:21:04.243 --> 00:21:07.865
They are wanting to give back in so

00:21:07.905 --> 00:21:08.326
many ways.

00:21:08.365 --> 00:21:10.446
I know you've had the pleasure of meeting

00:21:10.507 --> 00:21:14.888
some of our scholars and community members

00:21:14.929 --> 00:21:15.509
in the past.

00:21:16.628 --> 00:21:18.890
They are future leaders.

00:21:19.049 --> 00:21:20.371
They are change makers.

00:21:20.911 --> 00:21:23.833
They see the issues and they are coming

00:21:23.893 --> 00:21:25.974
to the table with some solutions that they

00:21:26.015 --> 00:21:28.096
think, you know, can make a difference.

00:21:28.156 --> 00:21:31.318
And so that's the most I think a

00:21:31.378 --> 00:21:34.340
lot of the inspiring part is like we're

00:21:34.361 --> 00:21:37.703
giving them a platform to be able to

00:21:38.423 --> 00:21:40.526
have the right connections earlier in

00:21:40.546 --> 00:21:43.047
their careers to be able to affect change.

00:21:43.087 --> 00:21:44.387
And so, you know,

00:21:44.848 --> 00:21:46.849
I can't wait to just watch this trajectory

00:21:46.869 --> 00:21:48.892
over the next ten years of trying to

00:21:49.699 --> 00:21:51.980
collect all of the information of wow what

00:21:52.060 --> 00:21:54.162
what has the impact really been it's more

00:21:54.201 --> 00:21:57.044
than just you know funding scholarships

00:21:57.064 --> 00:21:59.846
like it's it's bigger than that absolutely

00:21:59.905 --> 00:22:01.788
and you're and you're doing it and when

00:22:01.807 --> 00:22:04.349
you think about the best employers for a

00:22:04.509 --> 00:22:09.232
rising tide scholar on um is there

00:22:09.272 --> 00:22:12.375
anything unique that an employer needs to

00:22:12.634 --> 00:22:16.498
offer or understand uh about managing you

00:22:16.518 --> 00:22:17.098
know um

00:22:18.086 --> 00:22:20.730
these types of scholars or as all

00:22:20.769 --> 00:22:21.832
employers are equal,

00:22:21.872 --> 00:22:23.714
let's find the one that's the best match

00:22:23.775 --> 00:22:26.439
based on set of criteria that you think

00:22:26.479 --> 00:22:26.700
about.

00:22:28.040 --> 00:22:28.280
Yeah,

00:22:29.461 --> 00:22:31.122
I'd love to say all employers are equal,

00:22:31.162 --> 00:22:32.582
but, you know, that's not true.

00:22:36.222 --> 00:22:37.883
For sure, you know,

00:22:38.403 --> 00:22:40.743
the mentorship component is big for this

00:22:40.763 --> 00:22:43.784
group because, again,

00:22:43.844 --> 00:22:47.065
it's not just the PT clinical mentorship,

00:22:47.265 --> 00:22:48.924
it's life mentorship, right?

00:22:49.045 --> 00:22:50.625
It's navigating

00:22:52.145 --> 00:22:54.647
How to, you know,

00:22:54.748 --> 00:22:57.170
balance these family obligations as well

00:22:57.269 --> 00:22:59.311
as, you know, the work.

00:22:59.692 --> 00:23:01.554
I will just say the work ethic with

00:23:01.953 --> 00:23:03.335
the majority of our students that I've

00:23:03.375 --> 00:23:05.576
seen is just is high.

00:23:05.616 --> 00:23:09.319
And so also managing burnout because they

00:23:09.440 --> 00:23:09.619
are.

00:23:10.946 --> 00:23:15.288
uh, wanting to be, uh, very, um,

00:23:15.307 --> 00:23:16.828
financially efficient in,

00:23:17.028 --> 00:23:18.690
in not only are they're working jobs on

00:23:18.710 --> 00:23:20.390
the weekend and they're doing other things

00:23:20.430 --> 00:23:23.050
because they understand that debt is not

00:23:23.111 --> 00:23:24.991
something that they, they want or need.

00:23:25.491 --> 00:23:25.672
Um,

00:23:26.432 --> 00:23:27.873
and they want to get rid of it

00:23:27.913 --> 00:23:28.893
as fast as they can.

00:23:28.952 --> 00:23:31.074
And so they're doing a lot of things

00:23:31.114 --> 00:23:31.874
to try to, you know,

00:23:32.134 --> 00:23:34.875
additional work on top of what their one

00:23:34.914 --> 00:23:35.935
nine to five might be.

00:23:36.675 --> 00:23:39.596
Um, and so having that, um,

00:23:41.941 --> 00:23:42.801
you know, just again,

00:23:43.061 --> 00:23:45.142
the personal side of mentorship as well as

00:23:45.182 --> 00:23:47.242
the education or the clinical side,

00:23:47.262 --> 00:23:48.442
I think is really important.

00:23:48.923 --> 00:23:50.923
But also I would say finding,

00:23:51.243 --> 00:23:52.104
they love working.

00:23:52.223 --> 00:23:52.525
So,

00:23:52.785 --> 00:23:54.545
but also not putting them only in

00:23:55.065 --> 00:23:57.566
positions where they are uniquely

00:23:57.605 --> 00:23:58.125
qualified.

00:23:58.165 --> 00:24:00.747
For example, you know,

00:24:00.767 --> 00:24:03.307
a lot of our Hispanic students will say,

00:24:03.448 --> 00:24:05.028
well, you know,

00:24:05.048 --> 00:24:06.888
I got hired because they needed someone

00:24:06.909 --> 00:24:07.868
who could speak Spanish.

00:24:09.049 --> 00:24:10.329
And while that's a great legacy,

00:24:10.696 --> 00:24:11.596
put in the door.

00:24:12.258 --> 00:24:12.958
You know what I mean?

00:24:12.978 --> 00:24:15.159
Like, they're more than that, right?

00:24:15.259 --> 00:24:18.539
And so making sure that they are given

00:24:18.660 --> 00:24:22.321
the opportunities to expand their great

00:24:22.342 --> 00:24:24.061
clinicians and their, you know,

00:24:24.102 --> 00:24:25.163
potential leaders,

00:24:25.282 --> 00:24:26.863
not just only because they speak Spanish,

00:24:26.923 --> 00:24:27.604
as an example.

00:24:28.544 --> 00:24:29.864
Yeah, no, that's fascinating.

00:24:29.884 --> 00:24:31.065
You know, if you look at

00:24:32.741 --> 00:24:33.001
what I,

00:24:33.201 --> 00:24:34.923
what I seeing in the workplace now,

00:24:34.942 --> 00:24:36.343
and I've written about mentoring,

00:24:36.462 --> 00:24:38.884
mentoring's a little bit of an irritant to

00:24:38.903 --> 00:24:39.443
me right now,

00:24:39.483 --> 00:24:40.784
because so many people say they have

00:24:40.844 --> 00:24:41.243
mentoring,

00:24:41.284 --> 00:24:43.924
but they don't because by design,

00:24:44.085 --> 00:24:46.205
you have to have some structure to it

00:24:46.685 --> 00:24:47.546
and most don't.

00:24:47.705 --> 00:24:49.846
And then on top of that, you need,

00:24:49.886 --> 00:24:50.906
just as you alluded to,

00:24:50.946 --> 00:24:53.748
you need these informal social systems

00:24:54.167 --> 00:24:56.307
from a mentoring standpoint outside of the

00:24:56.327 --> 00:24:57.729
clinical realm, right?

00:24:57.949 --> 00:24:59.409
How to navigate, you know,

00:24:59.449 --> 00:25:01.990
how to navigate life, you know, um,

00:25:02.827 --> 00:25:04.549
And good employers do both.

00:25:05.090 --> 00:25:07.053
They have sort of a big sister,

00:25:07.093 --> 00:25:08.673
big brother that helps you on the

00:25:08.753 --> 00:25:09.816
non-clinical side,

00:25:09.836 --> 00:25:12.657
and then they have a clinical mentor who's

00:25:12.699 --> 00:25:15.040
tasked with helping you on the clinical

00:25:15.080 --> 00:25:15.361
side.

00:25:16.542 --> 00:25:19.125
I'm hoping that more employers understand

00:25:19.144 --> 00:25:19.305
those,

00:25:19.346 --> 00:25:20.666
they're fundamentally two different

00:25:20.686 --> 00:25:20.967
things,

00:25:21.007 --> 00:25:22.888
and they both have a major role in

00:25:22.949 --> 00:25:24.330
what I would call burnout prevention.

00:25:26.050 --> 00:25:27.991
I want to pivot a little bit to

00:25:29.292 --> 00:25:31.354
all of your history in terms of web

00:25:31.394 --> 00:25:32.815
PT and technology.

00:25:33.756 --> 00:25:35.936
And now you have,

00:25:36.676 --> 00:25:38.259
you have the benefit of time.

00:25:38.519 --> 00:25:40.319
You've been in the career a long time

00:25:40.980 --> 00:25:42.961
and your vantage point is much different

00:25:42.981 --> 00:25:44.942
from the early days of developing,

00:25:45.643 --> 00:25:48.045
you know, an EMR system,

00:25:48.085 --> 00:25:49.486
a documentation system is where you

00:25:49.526 --> 00:25:50.145
started out.

00:25:50.707 --> 00:25:52.048
But now I want you to think about

00:25:52.107 --> 00:25:53.709
today when you're scholars and,

00:25:54.867 --> 00:25:57.469
and your residents from rising tide go

00:25:57.628 --> 00:25:58.469
into a clinic,

00:25:59.048 --> 00:26:01.709
where does a clinician's day actually go?

00:26:01.749 --> 00:26:03.049
And if you were going to change one

00:26:03.089 --> 00:26:05.150
thing anymore, what is it?

00:26:05.349 --> 00:26:07.891
And is there a substantial difference

00:26:07.931 --> 00:26:11.151
between today and when you started and

00:26:11.191 --> 00:26:12.672
what is the role or what could be

00:26:12.711 --> 00:26:14.771
the role of technology in all of that?

00:26:15.471 --> 00:26:16.592
It's a lot of questions there,

00:26:16.612 --> 00:26:17.692
so you can unpack it any way you

00:26:17.712 --> 00:26:17.952
want.

00:26:19.792 --> 00:26:21.336
Yeah, that's a loaded one.

00:26:21.415 --> 00:26:23.279
And I'll just say, I can't believe it,

00:26:23.319 --> 00:26:27.208
but this year marks twenty years since we

00:26:27.268 --> 00:26:28.911
started building WebPT.

00:26:30.413 --> 00:26:31.413
um, in,

00:26:32.673 --> 00:26:34.815
in sort of the idea and building before

00:26:34.855 --> 00:26:36.516
we launched, I'm sorry, in twenty,

00:26:36.635 --> 00:26:37.916
two thousand six, um,

00:26:38.076 --> 00:26:40.157
in building and before the launch in two

00:26:40.178 --> 00:26:40.837
thousand eight.

00:26:41.519 --> 00:26:44.079
And so a lot has changed in twenty

00:26:44.119 --> 00:26:44.740
years, right?

00:26:44.779 --> 00:26:46.701
We were the first web based application

00:26:46.780 --> 00:26:48.422
and, and now, you know,

00:26:48.521 --> 00:26:50.063
things are moving much more towards

00:26:50.143 --> 00:26:53.585
automation and, um, you know, uh,

00:26:53.605 --> 00:26:55.005
use of AI, uh,

00:26:55.224 --> 00:26:56.746
as far as technology goes.

00:26:57.626 --> 00:26:58.186
And, um,

00:27:01.049 --> 00:27:03.152
And alongside of all of that,

00:27:03.192 --> 00:27:06.374
because technology has infiltrated,

00:27:07.836 --> 00:27:11.438
there's also now this administrative

00:27:11.478 --> 00:27:16.342
burden that is weighing heavy because so

00:27:16.382 --> 00:27:19.565
much regulation has piled up on top of

00:27:21.467 --> 00:27:22.887
what we're required to do,

00:27:24.108 --> 00:27:25.470
on top of just seeing the patient.

00:27:25.930 --> 00:27:27.872
And I know you've written tons about this.

00:27:29.073 --> 00:27:30.173
And so,

00:27:31.653 --> 00:27:32.373
Today,

00:27:34.394 --> 00:27:38.076
the evolution of technology is much more

00:27:38.277 --> 00:27:39.817
in, hopefully,

00:27:40.337 --> 00:27:42.900
less hands-on to a computer,

00:27:45.141 --> 00:27:49.644
more automation for AI and machine

00:27:49.683 --> 00:27:54.105
learning to be able to assist with some

00:27:54.145 --> 00:27:55.666
of that administrative burden.

00:27:56.387 --> 00:27:57.969
And so I'm...

00:28:01.058 --> 00:28:03.483
optimistic about you know what the

00:28:03.523 --> 00:28:06.490
potential is um as long as we continue

00:28:06.530 --> 00:28:09.817
to have human in the loop right to

00:28:09.836 --> 00:28:11.400
to have our

00:28:12.030 --> 00:28:14.491
differentiator as a clinician,

00:28:14.653 --> 00:28:17.834
as a provider of putting hands on patients

00:28:18.013 --> 00:28:20.496
and having that patient relationship,

00:28:20.536 --> 00:28:24.357
that human connection that we are,

00:28:24.857 --> 00:28:25.118
you know,

00:28:25.199 --> 00:28:28.339
still uniquely positioned to have in the

00:28:28.400 --> 00:28:31.481
multiple sessions that we are able to have

00:28:31.501 --> 00:28:32.323
with a patient,

00:28:32.903 --> 00:28:36.305
that that still continues to be the most

00:28:36.345 --> 00:28:37.226
important thing.

00:28:38.586 --> 00:28:39.426
But, you know,

00:28:40.470 --> 00:28:42.090
it's not just about documentation.

00:28:42.111 --> 00:28:43.392
You've got authorization,

00:28:43.412 --> 00:28:44.573
you've got eligibility,

00:28:44.593 --> 00:28:46.114
you've got denials to rework,

00:28:46.153 --> 00:28:47.815
you've got revenue cycle,

00:28:47.855 --> 00:28:49.516
the whole component of revenue cycle

00:28:49.557 --> 00:28:50.017
management.

00:28:50.037 --> 00:28:51.137
Like, how do we get paid?

00:28:51.157 --> 00:28:51.298
Like,

00:28:51.337 --> 00:28:52.699
it seems to get harder and harder and

00:28:52.739 --> 00:28:53.118
harder.

00:28:53.159 --> 00:28:54.299
And now, you know,

00:28:55.487 --> 00:28:57.367
you know, with a lot of what,

00:28:57.708 --> 00:28:59.407
what PT is doing now and in the

00:28:59.468 --> 00:29:02.128
relaunch of our, our platform, um, with,

00:29:02.348 --> 00:29:03.990
uh, being AI native, like it's,

00:29:04.450 --> 00:29:05.690
it's going to be a game changer.

00:29:06.070 --> 00:29:08.431
Um, but it's honestly, Larry,

00:29:08.451 --> 00:29:09.231
it's the evolution.

00:29:09.271 --> 00:29:10.872
Like it's happening in a lot of different

00:29:10.932 --> 00:29:11.551
industries.

00:29:11.612 --> 00:29:13.212
It's just, obviously for us,

00:29:13.272 --> 00:29:14.173
it's front and center,

00:29:14.252 --> 00:29:16.854
especially when you think about, uh,

00:29:17.013 --> 00:29:19.734
you know, the, the computer having,

00:29:20.355 --> 00:29:22.016
you just don't want that, um,

00:29:22.724 --> 00:29:26.450
computer components to take over what we,

00:29:26.910 --> 00:29:27.431
in essence,

00:29:28.172 --> 00:29:29.794
are trying to do with patients every day.

00:29:30.788 --> 00:29:32.308
Yeah, no, it's fascinating.

00:29:32.328 --> 00:29:32.648
I mean,

00:29:32.669 --> 00:29:34.650
when I think back on my career and

00:29:34.670 --> 00:29:35.470
when I started,

00:29:36.411 --> 00:29:38.092
even as a military therapist,

00:29:38.971 --> 00:29:41.492
where you basically hand wrote your notes

00:29:41.573 --> 00:29:42.834
on cards and, you know,

00:29:42.854 --> 00:29:44.894
then things progressed obviously towards,

00:29:45.154 --> 00:29:46.695
towards, towards an EMR.

00:29:47.336 --> 00:29:49.116
But I would say the biggest difference and

00:29:49.156 --> 00:29:51.998
my biggest hope is that what automation

00:29:52.018 --> 00:29:54.098
can do is eliminate the noise that goes

00:29:54.118 --> 00:29:55.539
through your head constantly.

00:29:56.361 --> 00:29:56.921
Back then,

00:29:57.405 --> 00:29:58.767
Never thought about an insurance

00:29:58.787 --> 00:29:59.527
verification.

00:29:59.567 --> 00:30:00.968
Never thought about is what I'm going to

00:30:00.988 --> 00:30:02.167
do paid or not paid.

00:30:02.688 --> 00:30:04.088
Never thought about, well,

00:30:04.128 --> 00:30:05.630
do I have to do this many units

00:30:05.670 --> 00:30:06.650
or not do this many units?

00:30:06.769 --> 00:30:06.849
Oh,

00:30:06.910 --> 00:30:08.530
never thought about how many patients per

00:30:08.570 --> 00:30:09.451
day am I averaging,

00:30:09.471 --> 00:30:10.912
how many units and all the other kind

00:30:10.951 --> 00:30:12.272
of things there.

00:30:12.772 --> 00:30:16.034
That noise constantly is in your head when

00:30:16.054 --> 00:30:17.115
you're a clinician right now.

00:30:18.136 --> 00:30:19.897
Now, we can eliminate a lot of it,

00:30:19.938 --> 00:30:20.698
maybe not all of it.

00:30:20.718 --> 00:30:22.877
We also have to teach the clinicians how

00:30:22.897 --> 00:30:23.499
to, you know,

00:30:23.598 --> 00:30:24.739
get rid of that noise too.

00:30:25.439 --> 00:30:28.079
But that's where I'm real hope is that

00:30:28.099 --> 00:30:28.799
a clinician,

00:30:29.000 --> 00:30:31.800
it gives them back the time to spend

00:30:31.820 --> 00:30:32.641
with their patient.

00:30:32.661 --> 00:30:34.241
For years, all I ever heard of, oh,

00:30:34.261 --> 00:30:35.281
we don't get to spend enough time with

00:30:35.321 --> 00:30:35.701
patients.

00:30:36.001 --> 00:30:37.462
Documentation in our studies,

00:30:37.542 --> 00:30:38.103
at some points,

00:30:38.123 --> 00:30:39.702
we're taking up to thirty percent on a

00:30:39.742 --> 00:30:41.443
Medicare patient of a patient encounter.

00:30:42.403 --> 00:30:44.025
What I'm seeing in the marketplace,

00:30:44.065 --> 00:30:46.546
though, isn't that a little bit of, oh,

00:30:47.026 --> 00:30:48.186
I'm giving them their time back.

00:30:48.227 --> 00:30:49.586
Now they can spend it with their families.

00:30:49.646 --> 00:30:50.728
And I do get that, by the way.

00:30:50.748 --> 00:30:52.209
Like if you're doing documentation at

00:30:52.249 --> 00:30:53.848
night and you're able to get back your

00:30:53.868 --> 00:30:55.109
families, I'm all in on that.

00:30:55.130 --> 00:30:55.730
OK, I get it.

00:30:56.130 --> 00:30:58.471
But what it really should be aspirational

00:30:58.511 --> 00:31:00.471
around is in the clinic giving you time

00:31:00.491 --> 00:31:01.353
back with the patient.

00:31:02.607 --> 00:31:04.469
That's what my hope is.

00:31:04.910 --> 00:31:05.970
Eliminate the noise,

00:31:06.009 --> 00:31:07.510
give you time back for the human

00:31:07.550 --> 00:31:08.112
connection.

00:31:08.332 --> 00:31:09.813
Because if you get the connection,

00:31:09.853 --> 00:31:12.294
which I call the fuel in the loop,

00:31:12.453 --> 00:31:14.875
the human loop, you alluded to it,

00:31:15.076 --> 00:31:15.997
when you lose that,

00:31:16.376 --> 00:31:18.597
that's the main driver of burnout.

00:31:18.637 --> 00:31:19.898
Burnout's multidimensional.

00:31:20.318 --> 00:31:21.839
It's got a number of drivers of it.

00:31:21.980 --> 00:31:23.662
But the main driver of it is when

00:31:23.682 --> 00:31:27.124
you lose that immediate loop connection

00:31:27.163 --> 00:31:28.525
fuel between you and a patient.

00:31:29.125 --> 00:31:30.826
And you go into surface acting rather than

00:31:30.865 --> 00:31:31.486
deep acting.

00:31:32.105 --> 00:31:33.846
And you do all kinds of things that

00:31:34.027 --> 00:31:35.487
then you get cynical and you get,

00:31:35.586 --> 00:31:36.188
you know, oh,

00:31:36.228 --> 00:31:38.949
now I am listening to pre authorization.

00:31:38.989 --> 00:31:42.329
And it just it starts to compound and

00:31:42.390 --> 00:31:43.250
escalate a little bit.

00:31:43.829 --> 00:31:45.310
But anyhow, sorry.

00:31:46.010 --> 00:31:47.432
No, not at all.

00:31:47.592 --> 00:31:49.852
I think it's really important because I

00:31:49.892 --> 00:31:51.032
think, you know,

00:31:51.073 --> 00:31:51.313
when

00:31:53.054 --> 00:31:55.335
companies start thinking about retention,

00:31:55.535 --> 00:31:57.296
they start throwing money at a lot of

00:31:57.336 --> 00:31:58.176
different things.

00:31:58.277 --> 00:31:59.837
But to your point, like,

00:31:59.897 --> 00:32:02.338
why did we get into this profession?

00:32:02.679 --> 00:32:03.799
A lot of it has to do with

00:32:03.819 --> 00:32:05.921
that human interaction, right?

00:32:06.000 --> 00:32:08.241
It's that patient relationship building,

00:32:08.281 --> 00:32:10.782
that progress that you see by what you

00:32:10.823 --> 00:32:13.785
did, putting your hands on or, you know,

00:32:14.545 --> 00:32:15.424
exercise, prescription,

00:32:15.464 --> 00:32:18.186
whatever it is to make that to help

00:32:18.207 --> 00:32:19.247
that patient improve.

00:32:19.287 --> 00:32:19.547
And so,

00:32:22.184 --> 00:32:24.127
Being able to find more time with your

00:32:24.167 --> 00:32:24.568
patients,

00:32:24.608 --> 00:32:26.913
I think is a fantastic way to think

00:32:26.952 --> 00:32:27.354
about it.

00:32:27.394 --> 00:32:29.657
Like if we might even steal that from

00:32:29.698 --> 00:32:29.798
you.

00:32:29.817 --> 00:32:31.381
Yeah.

00:32:31.421 --> 00:32:32.583
And it's what I call allow you to

00:32:32.603 --> 00:32:33.324
be more human.

00:32:34.476 --> 00:32:37.018
I've really been promoting humanness as

00:32:37.057 --> 00:32:38.940
the differentiator in healthcare and what

00:32:38.980 --> 00:32:41.040
we do as hands-on caregivers because

00:32:41.060 --> 00:32:42.643
there's not a tremendous number of

00:32:42.682 --> 00:32:43.963
hands-on caregivers left.

00:32:44.483 --> 00:32:45.605
It leads me to the last question I'll

00:32:45.644 --> 00:32:45.865
ask you.

00:32:45.884 --> 00:32:46.645
I know we're going to go back and

00:32:46.665 --> 00:32:47.586
forth on some questions,

00:32:47.625 --> 00:32:49.827
but you alluded to it earlier about the

00:32:49.867 --> 00:32:52.690
whole idea on the importance of retention,

00:32:52.730 --> 00:32:55.152
which is the cheapest form of recruitment

00:32:55.251 --> 00:32:56.053
that exists, right?

00:32:57.554 --> 00:32:59.035
Every clinician who lives sort of,

00:32:59.275 --> 00:33:01.257
you know, mid-career, you know,

00:33:01.576 --> 00:33:03.818
costs more pipeline than a scholarship

00:33:03.858 --> 00:33:04.420
replaces,

00:33:04.460 --> 00:33:06.000
and that's a whole different podcast for

00:33:06.020 --> 00:33:06.721
another time.

00:33:08.864 --> 00:33:10.924
But they're not the same, right?

00:33:10.984 --> 00:33:13.227
And so do we have a recruitment problem?

00:33:13.267 --> 00:33:14.808
Do we have a retention problem?

00:33:14.828 --> 00:33:16.329
Can two things coexist?

00:33:17.191 --> 00:33:18.711
When you look at the number of clinicians

00:33:18.751 --> 00:33:19.992
we have in the PT world,

00:33:20.032 --> 00:33:22.194
it's far less than the number of PTs

00:33:22.214 --> 00:33:22.875
that we have.

00:33:22.935 --> 00:33:23.977
How do you think about these kind of

00:33:23.997 --> 00:33:24.237
things?

00:33:26.307 --> 00:33:28.730
Well, I think it goes both ways.

00:33:28.789 --> 00:33:35.634
I think that we also had a disconnect

00:33:35.993 --> 00:33:39.376
educationally to reality of the PT world.

00:33:39.797 --> 00:33:43.058
I think that the lag of academics to

00:33:43.318 --> 00:33:45.580
what the real world of PT and what

00:33:45.601 --> 00:33:47.882
happens in a PT practice I think is

00:33:48.001 --> 00:33:49.202
also an issue, right?

00:33:50.652 --> 00:33:52.692
in the recruiting cycle, you have,

00:33:53.212 --> 00:33:53.432
you know,

00:33:53.452 --> 00:33:54.953
just like recruiting to any company,

00:33:55.354 --> 00:33:59.155
you get the shiny version of what you're

00:33:59.215 --> 00:34:01.416
aspiring to do and to be but you

00:34:01.436 --> 00:34:03.277
don't really know the inner workings of

00:34:03.317 --> 00:34:05.117
the business side and all the things that

00:34:05.157 --> 00:34:08.719
kind of come with, you know,

00:34:09.219 --> 00:34:10.860
what it means to be a physical therapist.

00:34:10.940 --> 00:34:11.260
And so

00:34:12.454 --> 00:34:12.655
You know,

00:34:12.695 --> 00:34:14.576
I think that we've gotten better.

00:34:14.976 --> 00:34:15.155
I would,

00:34:15.175 --> 00:34:17.217
I hope we've gotten better on the

00:34:17.356 --> 00:34:19.777
recruitment side in terms of not just

00:34:19.797 --> 00:34:20.898
focusing on, because it was so,

00:34:20.998 --> 00:34:22.438
even when I went to, got into PT,

00:34:22.458 --> 00:34:23.519
it was so competitive.

00:34:23.559 --> 00:34:26.201
Like there are tons of applicants.

00:34:26.300 --> 00:34:28.222
And so you had to have some sort

00:34:28.282 --> 00:34:33.083
of way to limit your applications down.

00:34:33.184 --> 00:34:35.144
So you looked at GPA and you looked

00:34:35.264 --> 00:34:37.686
at SAT scores and, you know,

00:34:37.726 --> 00:34:38.706
all those kinds of things.

00:34:38.746 --> 00:34:40.806
But the soft skills, which we know is,

00:34:41.451 --> 00:34:43.331
probably the most important thing as a

00:34:43.391 --> 00:34:45.192
physical therapist outside of your

00:34:45.331 --> 00:34:49.313
academic prowess is is the patient

00:34:49.353 --> 00:34:50.934
building that patient rapport building

00:34:50.954 --> 00:34:54.195
that patient um relationship is and you've

00:34:54.215 --> 00:34:56.295
written about this right of how the

00:34:56.375 --> 00:34:58.795
outcomes are based more on that than they

00:34:58.856 --> 00:35:01.577
actually are the the actual uh things that

00:35:01.597 --> 00:35:04.318
you're you're doing with the patient and

00:35:04.378 --> 00:35:04.538
so

00:35:06.106 --> 00:35:08.309
I think that we have done better in

00:35:08.369 --> 00:35:09.951
terms of the interview,

00:35:09.990 --> 00:35:11.112
at least some schools,

00:35:11.632 --> 00:35:14.496
the interview process and screening for

00:35:14.516 --> 00:35:17.518
those soft skills to put some more

00:35:17.559 --> 00:35:20.041
prioritization on that in the recruiting

00:35:20.081 --> 00:35:24.786
process for the students that they are

00:35:24.827 --> 00:35:26.487
letting into PTE programs.

00:35:28.768 --> 00:35:30.869
So I think we're doing better in that

00:35:30.889 --> 00:35:31.269
regard.

00:35:31.329 --> 00:35:33.351
I mean, I know right now it's difficult.

00:35:33.891 --> 00:35:36.552
Applications are down for most programs.

00:35:37.873 --> 00:35:38.193
You know,

00:35:38.514 --> 00:35:40.114
you look at Reddit and you search physical

00:35:40.155 --> 00:35:40.574
therapy,

00:35:40.594 --> 00:35:41.456
you're not going to see a whole lot

00:35:41.476 --> 00:35:42.436
of positive things.

00:35:44.217 --> 00:35:46.798
So we're getting scarred a little bit

00:35:46.838 --> 00:35:49.300
right now on the branding of PT.

00:35:49.380 --> 00:35:52.081
And then on the

00:35:53.242 --> 00:35:57.304
know retention side you know i it's just

00:35:57.385 --> 00:36:00.306
tough right now it's it's tough when the

00:36:00.367 --> 00:36:03.909
student that issue um is is real um

00:36:04.449 --> 00:36:07.010
cost of education is not commensurate with

00:36:07.070 --> 00:36:09.813
what the potential for what you can make

00:36:09.833 --> 00:36:12.173
from a salary range is at the moment

00:36:12.494 --> 00:36:14.016
um and so i do think that there's

00:36:14.135 --> 00:36:15.936
we're at a critical juncture in the

00:36:15.956 --> 00:36:17.838
profession that we have to make some tough

00:36:17.858 --> 00:36:21.059
decisions um you know i

00:36:22.574 --> 00:36:24.693
I'm an advocate that we became doctors,

00:36:24.733 --> 00:36:27.414
but at the same time,

00:36:27.715 --> 00:36:32.096
all of the additional cost and things that

00:36:32.135 --> 00:36:34.275
have added on to that since that decision

00:36:34.315 --> 00:36:37.157
was made and the cost of education has

00:36:37.197 --> 00:36:38.797
been really a detriment, I think,

00:36:38.836 --> 00:36:43.617
to the potential for becoming a PT.

00:36:43.677 --> 00:36:44.478
And of course,

00:36:44.559 --> 00:36:47.199
that leads to the retention because they

00:36:47.398 --> 00:36:49.099
come out and they see that they can't

00:36:49.260 --> 00:36:50.059
pay their debts off.

00:36:51.440 --> 00:36:56.621
either go into a non-clinical work or jump

00:36:56.681 --> 00:36:57.802
out into a different profession.

00:36:58.163 --> 00:37:01.784
This year was the first time in our

00:37:01.804 --> 00:37:04.304
six years of awarding scholarships that

00:37:04.344 --> 00:37:09.706
we've had somebody drop out of PT school

00:37:10.228 --> 00:37:13.628
after receiving a scholarship and decided

00:37:13.668 --> 00:37:15.449
to go on to PA school because

00:37:17.132 --> 00:37:19.153
The research that they had done or talked

00:37:19.173 --> 00:37:20.514
to people and they just,

00:37:20.914 --> 00:37:22.315
after their first year, they said,

00:37:23.295 --> 00:37:25.476
I'm going to go to PA school instead

00:37:25.817 --> 00:37:26.396
and dropped out.

00:37:27.577 --> 00:37:29.898
It's interesting because I'm from the era

00:37:29.938 --> 00:37:31.980
where we had PAs and nurse practitioners

00:37:32.000 --> 00:37:33.280
that went back to go to PT school.

00:37:36.050 --> 00:37:38.132
It's an amazing flip-flop, but yes,

00:37:38.192 --> 00:37:40.152
the cost of education is not kept up

00:37:40.213 --> 00:37:41.833
lockstep with the salaries.

00:37:41.853 --> 00:37:43.394
The salaries are not kept up lockstep,

00:37:43.454 --> 00:37:45.856
and others would argue that they can't.

00:37:47.737 --> 00:37:48.858
I remain less convinced.

00:37:48.898 --> 00:37:49.838
I think they can.

00:37:49.958 --> 00:37:51.599
I think the profession needs to

00:37:51.639 --> 00:37:55.600
fundamentally shift to a more –

00:37:55.106 --> 00:37:56.467
beneficial model for PTs.

00:37:56.507 --> 00:37:57.726
I think PTs should be paid more.

00:37:57.987 --> 00:37:59.688
I think we need less administrative costs,

00:37:59.728 --> 00:38:00.489
less managers,

00:38:00.528 --> 00:38:02.369
and more PTs making more money.

00:38:02.469 --> 00:38:03.489
And I think that would be helpful.

00:38:04.110 --> 00:38:05.690
But that's a different topic for a

00:38:05.751 --> 00:38:06.431
different time.

00:38:06.452 --> 00:38:08.632
So happy to answer any questions you have

00:38:08.672 --> 00:38:12.355
around rising tide and how call to care

00:38:12.394 --> 00:38:14.976
is going to do our best to help

00:38:15.016 --> 00:38:15.115
them.

00:38:16.057 --> 00:38:16.538
Yeah, well,

00:38:17.199 --> 00:38:19.159
how did so so first of all,

00:38:19.199 --> 00:38:21.019
congratulations on the revamp.

00:38:21.081 --> 00:38:21.460
Obviously,

00:38:21.481 --> 00:38:23.141
a lot of a lot has happened since

00:38:23.742 --> 00:38:25.922
the original publication.

00:38:26.003 --> 00:38:28.403
So I guess what sort of prompted you

00:38:28.844 --> 00:38:31.385
to sort of do this reboot?

00:38:31.465 --> 00:38:32.226
You know, it's interesting.

00:38:32.266 --> 00:38:34.166
So the book came out at the beginning

00:38:34.186 --> 00:38:37.108
of two thousand twenty right in the you

00:38:37.128 --> 00:38:38.989
know, we're in the midst of covid early,

00:38:39.088 --> 00:38:40.090
early days of covid.

00:38:41.260 --> 00:38:43.862
And which was a tough period,

00:38:43.902 --> 00:38:45.164
but it's a period that I remind,

00:38:45.204 --> 00:38:47.045
I talked to the medical students yesterday

00:38:47.065 --> 00:38:49.567
and I reminded them that PTs were heroes

00:38:49.967 --> 00:38:51.449
during the early days of COVID.

00:38:51.509 --> 00:38:52.610
Most people forget that.

00:38:53.090 --> 00:38:55.572
People were standing outside and

00:38:55.612 --> 00:38:57.994
applauding them and standing ovations and

00:38:58.034 --> 00:38:59.855
healthcare workers were indeed heroes.

00:38:59.875 --> 00:39:01.596
And they were, they absolutely were.

00:39:02.717 --> 00:39:05.778
But what really changed between in and was

00:39:05.818 --> 00:39:07.239
the research.

00:39:08.121 --> 00:39:10.945
And so we didn't have virtual health was

00:39:10.985 --> 00:39:14.048
just kind of evolving and got accelerated

00:39:14.088 --> 00:39:14.829
during COVID.

00:39:15.250 --> 00:39:16.652
Certainly didn't have AI.

00:39:17.610 --> 00:39:20.911
We didn't have the epidemic of burnout.

00:39:20.952 --> 00:39:23.552
So if we look at, historically,

00:39:24.034 --> 00:39:26.355
the post-COVID period was the first time

00:39:26.375 --> 00:39:29.315
that you had en masse exits from PT,

00:39:29.996 --> 00:39:31.657
medicine in general, dental,

00:39:31.856 --> 00:39:34.257
dental hygienists, mass exits,

00:39:34.518 --> 00:39:35.257
creating what?

00:39:35.358 --> 00:39:35.938
A shortage.

00:39:36.858 --> 00:39:38.639
And even though we have more PTs

00:39:38.659 --> 00:39:40.159
graduating than we've ever had,

00:39:40.199 --> 00:39:41.581
there still exists a shortage.

00:39:42.041 --> 00:39:43.780
So that was an impact.

00:39:43.820 --> 00:39:44.601
And then on top of...

00:39:45.242 --> 00:39:45.961
You know, the shortage,

00:39:45.981 --> 00:39:48.963
you had the incredible rise in inflation

00:39:49.023 --> 00:39:51.563
and all those things that after COVID made

00:39:51.943 --> 00:39:53.824
running a business very, very difficult.

00:39:54.664 --> 00:39:56.585
And so you add that and then you

00:39:56.605 --> 00:39:57.304
have burnout.

00:39:57.445 --> 00:39:58.945
And then you look at the statistics in

00:39:58.985 --> 00:40:01.505
PT where it's about nineteen percent on an

00:40:01.706 --> 00:40:05.047
FTE basis of all PTs that are licensed

00:40:05.067 --> 00:40:06.927
are actually seeing patients day to day.

00:40:09.291 --> 00:40:09.771
You then say, well,

00:40:09.791 --> 00:40:11.072
what the heck's going on here?

00:40:11.092 --> 00:40:12.054
And then you say, well, you know,

00:40:12.373 --> 00:40:12.994
physicians,

00:40:13.534 --> 00:40:15.856
seven in ten medical students report

00:40:15.896 --> 00:40:16.335
burnout.

00:40:16.416 --> 00:40:17.717
Now, when I say report burnout,

00:40:17.737 --> 00:40:20.239
that's not a subjective thing.

00:40:20.259 --> 00:40:22.099
They're taking the Maslow burnout

00:40:22.139 --> 00:40:23.199
inventory thing,

00:40:23.239 --> 00:40:25.141
the most validated instrument.

00:40:26.021 --> 00:40:28.282
Six in ten acting physicians are burned

00:40:28.382 --> 00:40:28.523
out.

00:40:28.663 --> 00:40:30.204
Seven in ten students, six in ten.

00:40:30.623 --> 00:40:31.784
It's worse in some of the other

00:40:31.824 --> 00:40:32.324
professions.

00:40:32.344 --> 00:40:33.965
You look at mental health workers who work

00:40:33.985 --> 00:40:35.106
with traumatized patients,

00:40:35.126 --> 00:40:37.027
it could be as high as eight out

00:40:37.068 --> 00:40:37.427
of ten.

00:40:37.467 --> 00:40:39.088
You look at dental hygienists, seven,

00:40:39.369 --> 00:40:39.969
eight out of ten.

00:40:39.989 --> 00:40:41.369
So burnout became this big deal.

00:40:42.349 --> 00:40:43.710
so when i started then looking at the

00:40:43.771 --> 00:40:45.992
research around burnout i started looking

00:40:46.092 --> 00:40:49.536
at high quality connections empathy active

00:40:49.576 --> 00:40:51.677
constructive responding all the things

00:40:51.697 --> 00:40:53.418
that call to care was meant to do

00:40:53.438 --> 00:40:55.400
which was to integrate positive psychology

00:40:55.440 --> 00:40:57.561
and the social sciences the so-called soft

00:40:57.601 --> 00:41:00.284
skills into the hard skills of medicine

00:41:00.764 --> 00:41:02.905
realizing that the best outcomes you have

00:41:02.945 --> 00:41:04.768
to have both and i thought the world

00:41:04.807 --> 00:41:06.449
of positive psychology had so many

00:41:06.489 --> 00:41:09.010
validated studies that just never made its

00:41:09.050 --> 00:41:10.172
way into our curriculum

00:41:10.552 --> 00:41:11.652
So you had all that kind of going

00:41:11.713 --> 00:41:12.373
on in my mind.

00:41:12.432 --> 00:41:13.012
And I said, wow,

00:41:13.052 --> 00:41:13.974
we need to expand it.

00:41:14.534 --> 00:41:17.074
And so I revised the research,

00:41:17.215 --> 00:41:18.295
update the research.

00:41:18.856 --> 00:41:19.856
And then on top of that,

00:41:19.996 --> 00:41:21.257
you have these other topics.

00:41:21.277 --> 00:41:25.019
So I had to redo a whole chapter

00:41:25.159 --> 00:41:26.579
on burnout,

00:41:26.699 --> 00:41:28.601
which is the most largest chapter in the

00:41:28.641 --> 00:41:29.081
book now.

00:41:30.141 --> 00:41:32.123
really revised everything around virtual

00:41:32.163 --> 00:41:32.503
health,

00:41:32.543 --> 00:41:34.885
around AI and what should AI be giving

00:41:34.945 --> 00:41:36.106
back to the clinician.

00:41:36.585 --> 00:41:37.306
And people say, well,

00:41:37.326 --> 00:41:38.527
there's not much research on it.

00:41:38.567 --> 00:41:38.806
You know,

00:41:38.887 --> 00:41:40.288
actually there has been some decent

00:41:40.327 --> 00:41:41.268
research on AI.

00:41:41.309 --> 00:41:42.128
You know, for example,

00:41:43.849 --> 00:41:45.570
they show that at AI Scribe, a six,

00:41:45.791 --> 00:41:47.012
you know, hospital system,

00:41:47.052 --> 00:41:49.112
and so you get a significant reduction in

00:41:49.152 --> 00:41:49.492
burnout,

00:41:49.532 --> 00:41:51.695
but what are you doing with that time

00:41:51.735 --> 00:41:51.914
again?

00:41:51.954 --> 00:41:53.235
Are you giving it back to the patient

00:41:53.396 --> 00:41:56.157
or are employers using it to make you

00:41:56.197 --> 00:41:57.157
more productive, right?

00:41:57.637 --> 00:41:58.759
And so then on top of that,

00:41:58.778 --> 00:41:59.699
there's this issue of,

00:42:00.521 --> 00:42:01.942
I started thinking about it and surveying

00:42:01.961 --> 00:42:03.382
the people that we had gone through call

00:42:03.402 --> 00:42:04.023
to care and said,

00:42:04.103 --> 00:42:05.806
what's holding you back from actually

00:42:05.826 --> 00:42:07.327
implementing some of these interventions?

00:42:08.507 --> 00:42:09.688
And learning about that,

00:42:09.748 --> 00:42:10.650
what is the hesitation?

00:42:10.670 --> 00:42:11.891
So we put a whole chapter in there

00:42:11.931 --> 00:42:13.672
on a concept called implementation

00:42:13.713 --> 00:42:14.313
intentions.

00:42:15.094 --> 00:42:17.474
which is a pre-commitment ritual around if

00:42:17.556 --> 00:42:19.317
this happens, then that happens.

00:42:19.356 --> 00:42:20.536
And so, you know,

00:42:20.697 --> 00:42:23.438
if I'm nervous and unwilling to have a

00:42:23.498 --> 00:42:24.599
conversation with a patient,

00:42:24.699 --> 00:42:26.280
I will do four breaths in,

00:42:26.320 --> 00:42:27.981
hold for two, six breaths out, you know,

00:42:28.061 --> 00:42:28.922
other techniques.

00:42:29.483 --> 00:42:31.164
If this happens, if, you know,

00:42:31.244 --> 00:42:32.764
patients that do shoulder, you know,

00:42:32.885 --> 00:42:33.844
exercise, you know,

00:42:34.344 --> 00:42:35.846
if I see my coffee maker in the

00:42:35.885 --> 00:42:36.246
morning,

00:42:36.407 --> 00:42:38.108
that's my trigger to do my shoulder

00:42:38.148 --> 00:42:39.869
exercises and my reward will be the

00:42:39.929 --> 00:42:40.228
coffee.

00:42:40.248 --> 00:42:41.650
And so there's a whole science around

00:42:41.690 --> 00:42:41.869
that.

00:42:42.329 --> 00:42:42.610
Actually,

00:42:42.630 --> 00:42:44.510
that had to expand everything around kind

00:42:44.530 --> 00:42:45.190
of mindfulness.

00:42:45.510 --> 00:42:47.132
Mindfulness has really evolved since two

00:42:47.152 --> 00:42:47.891
thousand twenty.

00:42:48.371 --> 00:42:48.492
Now,

00:42:48.512 --> 00:42:49.952
when you take all that and you start

00:42:49.992 --> 00:42:51.592
revising it and adding chapters,

00:42:51.612 --> 00:42:52.793
you end up with a book that's twenty

00:42:52.813 --> 00:42:54.293
five percent bigger.

00:42:54.675 --> 00:42:55.994
You not only have the revisions,

00:42:56.034 --> 00:42:57.356
then you have the twenty five percent

00:42:57.416 --> 00:42:57.695
bigger.

00:42:57.715 --> 00:42:59.436
And so I just started writing and writing

00:42:59.476 --> 00:43:02.237
and researching and doing all this and

00:43:02.577 --> 00:43:04.338
missed my deadlines with the publisher by

00:43:04.358 --> 00:43:04.938
about a year.

00:43:05.559 --> 00:43:06.958
So it just does all that.

00:43:06.998 --> 00:43:08.199
And then all of a sudden I start

00:43:08.219 --> 00:43:09.219
working in the dental profession.

00:43:10.030 --> 00:43:10.952
I find, oh my gosh,

00:43:10.972 --> 00:43:12.311
the dental profession is even worse than

00:43:12.331 --> 00:43:12.873
the medical.

00:43:13.092 --> 00:43:14.594
Seventy-five percent of patients that go

00:43:14.614 --> 00:43:15.994
see a dentist don't want to be there.

00:43:16.494 --> 00:43:18.436
And only forty percent of the population

00:43:18.456 --> 00:43:19.675
don't even go to a dentist because they

00:43:19.695 --> 00:43:20.356
don't want to be there.

00:43:20.737 --> 00:43:22.097
Seventy-five percent who go don't want to

00:43:22.137 --> 00:43:22.557
be there,

00:43:22.978 --> 00:43:24.298
but that doesn't count for the forty

00:43:24.318 --> 00:43:25.039
percent that don't.

00:43:25.358 --> 00:43:26.699
Then all of a sudden the dentist is

00:43:26.719 --> 00:43:28.641
in a mask and you're standing over you

00:43:28.661 --> 00:43:29.481
while you're like this.

00:43:30.342 --> 00:43:30.942
And, you know,

00:43:30.961 --> 00:43:32.643
what kind of communication is going on

00:43:32.663 --> 00:43:32.884
there?

00:43:32.903 --> 00:43:34.063
And so then, oh,

00:43:34.083 --> 00:43:35.525
but then you have a dental hygienist who

00:43:35.545 --> 00:43:37.106
spends about forty five minutes with the

00:43:37.126 --> 00:43:37.505
patient.

00:43:37.525 --> 00:43:39.007
The dentist spends about three minutes.

00:43:39.347 --> 00:43:41.268
What's that dynamic and that relationship

00:43:41.327 --> 00:43:41.768
all about?

00:43:41.829 --> 00:43:42.548
So I said, well,

00:43:42.568 --> 00:43:43.650
I can't put this in the call to

00:43:43.690 --> 00:43:43.869
care.

00:43:43.889 --> 00:43:45.170
I need to write a separate book about

00:43:45.230 --> 00:43:45.391
that.

00:43:45.411 --> 00:43:46.510
I'll just transfer the whole book,

00:43:46.530 --> 00:43:47.411
write a few extra things.

00:43:47.851 --> 00:43:49.213
And you realize you can't do that because

00:43:49.253 --> 00:43:50.333
dental is so different.

00:43:50.934 --> 00:43:53.394
And so while all this was happening,

00:43:53.434 --> 00:43:55.255
I started writing on the dental call to

00:43:55.275 --> 00:43:56.677
care, which will be out in October.

00:43:57.398 --> 00:43:57.978
And I'm really,

00:43:58.018 --> 00:43:59.940
really proud of it because I have not

00:43:59.960 --> 00:44:01.463
seen anything in dental that really

00:44:01.483 --> 00:44:03.224
accounts for non-clinical factors of

00:44:03.266 --> 00:44:04.266
clinical success.

00:44:04.887 --> 00:44:06.409
And so I'm really,

00:44:06.469 --> 00:44:07.311
really excited about it.

00:44:07.331 --> 00:44:07.972
It's a big industry.

00:44:07.992 --> 00:44:09.414
It's a hundred and seventy to two hundred

00:44:09.434 --> 00:44:10.474
billion dollar industry,

00:44:10.896 --> 00:44:12.338
four times the size of PT.

00:44:12.958 --> 00:44:13.980
So that was sort of the.

00:44:14.740 --> 00:44:16.601
you know all the other underlying things

00:44:16.842 --> 00:44:19.503
and um i still much i hate to

00:44:19.523 --> 00:44:21.045
admit it you know the book didn't move

00:44:21.065 --> 00:44:22.626
the needle i'm caring i think we care

00:44:22.666 --> 00:44:23.967
less than we did then you know so

00:44:23.987 --> 00:44:25.748
it's like can i move can i start

00:44:25.768 --> 00:44:27.329
to move the needle a little bit better

00:44:27.349 --> 00:44:31.253
yeah that's a good segue into the question

00:44:31.353 --> 00:44:33.094
i've been wanting to ask you because

00:44:33.193 --> 00:44:35.315
obviously the book has a lot to do

00:44:36.295 --> 00:44:39.217
with empathy training and really trying to

00:44:39.257 --> 00:44:41.880
get people to care more right yeah and

00:44:42.219 --> 00:44:44.661
so the question is if if clinicians who

00:44:44.702 --> 00:44:48.485
truly care the most are actually the ones

00:44:48.505 --> 00:44:51.206
that are are least likely to burn out

00:44:51.306 --> 00:44:53.228
why does everyone think it's actually the

00:44:53.307 --> 00:44:55.748
opposite like that if i care so much

00:44:55.769 --> 00:44:57.490
that and i can't do what i want

00:44:57.510 --> 00:44:59.152
to do that that i'm going to be

00:44:59.192 --> 00:45:00.693
the one that that first burns out

00:45:01.273 --> 00:45:02.353
Yeah, it's a great question.

00:45:02.554 --> 00:45:05.456
And I actually walked through three

00:45:05.476 --> 00:45:08.797
hundred medical students yesterday on a

00:45:08.856 --> 00:45:10.137
very similar question.

00:45:10.597 --> 00:45:11.818
And what I explained to them,

00:45:12.199 --> 00:45:14.340
which is a very similar, similar answer,

00:45:14.920 --> 00:45:16.840
is there are actually two curriculums.

00:45:17.420 --> 00:45:19.402
There's the curriculum you get in school

00:45:19.882 --> 00:45:21.742
in buildings that are nice and people in

00:45:21.782 --> 00:45:24.063
white coats and the academics and all the

00:45:24.163 --> 00:45:25.483
pedagogy that goes with it.

00:45:25.742 --> 00:45:27.704
And then there's the unwritten curriculum

00:45:27.963 --> 00:45:29.385
when you go out and you start doing

00:45:29.405 --> 00:45:31.664
clinicals and start doing observations.

00:45:32.164 --> 00:45:34.065
And the unwritten clinical says you need

00:45:34.106 --> 00:45:36.286
to be detached from your patients,

00:45:36.786 --> 00:45:39.288
that if you get too connected to them,

00:45:39.748 --> 00:45:41.608
you will get burned out and you will

00:45:41.628 --> 00:45:43.309
be affected and you will have a bad

00:45:43.349 --> 00:45:44.309
day at the end of the day.

00:45:44.489 --> 00:45:44.568
Now,

00:45:44.588 --> 00:45:46.690
I'm oversimplifying a bit because it's a

00:45:46.730 --> 00:45:48.909
psychosocial process,

00:45:49.170 --> 00:45:50.510
but that's exactly what happens.

00:45:50.550 --> 00:45:52.630
And so we learn through the unwritten

00:45:52.670 --> 00:45:55.271
curriculum this idea of detachment.

00:45:56.192 --> 00:45:57.311
And when that happens,

00:45:57.612 --> 00:46:00.492
you eliminate that loop human connection

00:46:00.532 --> 00:46:01.672
fuel that I talk about,

00:46:01.693 --> 00:46:02.813
that immediate outcome.

00:46:03.193 --> 00:46:04.753
I use two examples from my career.

00:46:05.153 --> 00:46:06.474
I was a military therapist,

00:46:07.135 --> 00:46:09.155
and I was barely older than the soldiers

00:46:09.235 --> 00:46:09.894
I was treating.

00:46:10.014 --> 00:46:11.356
None of the soldiers I was treating...

00:46:12.275 --> 00:46:14.036
female and male they didn't care less

00:46:14.056 --> 00:46:15.878
about activities a daily and care less

00:46:15.898 --> 00:46:17.179
about getting back to a sport they want

00:46:17.199 --> 00:46:18.820
to get back to their unit they want

00:46:18.840 --> 00:46:21.302
to get back to their spirit decor they

00:46:21.322 --> 00:46:22.842
want to get back to being part of

00:46:22.882 --> 00:46:24.923
their community and so the feedback was

00:46:24.943 --> 00:46:26.525
immediate the connection was great because

00:46:26.585 --> 00:46:28.106
man they were going right back to it

00:46:28.146 --> 00:46:30.628
and so i had that human connection fuel

00:46:31.427 --> 00:46:33.108
I didn't get it again until two thousand

00:46:33.148 --> 00:46:33.469
ten.

00:46:33.509 --> 00:46:33.668
You know,

00:46:33.688 --> 00:46:36.789
I've had periods of my clinical career and

00:46:36.889 --> 00:46:38.831
I still consider myself a clinician.

00:46:38.891 --> 00:46:40.132
So we'll put my hands on patients.

00:46:40.172 --> 00:46:42.213
But many years later, in two thousand ten,

00:46:42.233 --> 00:46:44.112
when I went to Haiti under the worst

00:46:44.152 --> 00:46:45.974
of the circumstances where you had nothing

00:46:46.014 --> 00:46:47.534
of technology, you had no EMR,

00:46:47.574 --> 00:46:47.835
you had

00:46:48.775 --> 00:46:50.155
and you had buildings done and we had

00:46:50.195 --> 00:46:51.735
patients without legs and you had,

00:46:52.235 --> 00:46:53.456
you know, all this things going,

00:46:53.777 --> 00:46:55.577
but the patients were the most incredibly

00:46:55.617 --> 00:46:56.998
appreciative and they would look at you

00:46:57.018 --> 00:46:58.559
with that Dushane smile,

00:46:58.898 --> 00:47:00.599
which if you remember is the smile with

00:47:00.619 --> 00:47:01.699
the muscles in your eyes,

00:47:01.739 --> 00:47:02.619
cause you can't fake it.

00:47:03.000 --> 00:47:04.800
And that's the feedback human connection

00:47:04.820 --> 00:47:05.420
fuel loop.

00:47:05.920 --> 00:47:08.121
But what happens is socialization says,

00:47:08.181 --> 00:47:09.742
see more patients, do more units,

00:47:10.382 --> 00:47:12.202
all of these X noise in your head

00:47:12.342 --> 00:47:13.784
that in aggregate can,

00:47:14.344 --> 00:47:16.467
really force you to not be connected to

00:47:16.487 --> 00:47:16.967
the patient.

00:47:17.108 --> 00:47:18.510
You've got too many things to think about.

00:47:18.550 --> 00:47:20.813
You're multitasking in ways with noise

00:47:20.833 --> 00:47:21.856
that you cannot control.

00:47:22.851 --> 00:47:24.753
And you need to regain that.

00:47:24.853 --> 00:47:25.833
And what they found,

00:47:26.014 --> 00:47:27.414
and this is the interesting studies,

00:47:27.713 --> 00:47:29.034
what they really found was that,

00:47:29.375 --> 00:47:29.974
by the way,

00:47:30.235 --> 00:47:31.695
the highest burnout is mental health

00:47:31.715 --> 00:47:33.436
workers working with traumatized patients.

00:47:33.516 --> 00:47:34.476
Not hard to believe, right?

00:47:35.056 --> 00:47:36.117
Well, those workers,

00:47:36.358 --> 00:47:37.998
you find them that are working fifteen,

00:47:38.018 --> 00:47:39.478
twenty, thirty, forty years.

00:47:39.679 --> 00:47:40.559
And you study them.

00:47:40.840 --> 00:47:42.179
It's called positive deviance.

00:47:42.219 --> 00:47:43.460
How do you study the ones who are

00:47:43.501 --> 00:47:44.501
really, really flourishing?

00:47:44.842 --> 00:47:46.141
And what you find is those that care

00:47:46.161 --> 00:47:47.483
the most have the longest career.

00:47:48.123 --> 00:47:49.262
But they do it in a way where

00:47:49.282 --> 00:47:50.304
they're highly present,

00:47:50.483 --> 00:47:51.463
which is hard to do in today's

00:47:51.503 --> 00:47:53.443
multitasking society when you get in texts

00:47:53.483 --> 00:47:55.264
and likes on Twitter and all these other

00:47:55.284 --> 00:47:55.844
kind of things.

00:47:56.144 --> 00:47:57.164
So they're highly present,

00:47:57.505 --> 00:47:59.885
sensitively attuned, and well-boundaried.

00:48:00.286 --> 00:48:03.907
And well-boundaried means you have a real

00:48:03.947 --> 00:48:06.467
boundary between you and a patient when

00:48:06.487 --> 00:48:07.706
you leave, but not a wall.

00:48:08.126 --> 00:48:09.347
A wall keeps you away,

00:48:09.628 --> 00:48:10.847
but a boundary doesn't.

00:48:11.228 --> 00:48:12.648
And you have to have that mentality and

00:48:12.668 --> 00:48:14.489
then this idea of detachment.

00:48:15.134 --> 00:48:17.215
Detachment doesn't work and it's one of

00:48:17.235 --> 00:48:17.797
the factors.

00:48:19.077 --> 00:48:21.161
Lots of great research since two thousand

00:48:21.201 --> 00:48:22.362
twenty on burnout.

00:48:22.742 --> 00:48:23.963
There are a multitude,

00:48:23.983 --> 00:48:26.666
it's a multi-dimensional construct.

00:48:27.226 --> 00:48:28.088
Interestingly enough,

00:48:28.108 --> 00:48:30.510
that only one of the five factors towards

00:48:30.570 --> 00:48:32.432
burnout relates to workload and

00:48:32.472 --> 00:48:33.213
productivity.

00:48:33.233 --> 00:48:34.996
The other four within your agency are

00:48:35.016 --> 00:48:36.318
within some sense of control.

00:48:37.478 --> 00:48:38.719
But you have to teach patients or you

00:48:38.739 --> 00:48:41.541
have to teach clinicians all about this as

00:48:41.561 --> 00:48:43.163
a primary source of prevention.

00:48:43.422 --> 00:48:44.563
You have to teach them to ask for

00:48:44.603 --> 00:48:44.864
help.

00:48:44.884 --> 00:48:46.065
You have to keep them in community.

00:48:46.085 --> 00:48:48.047
You have to keep them in a psychological,

00:48:48.186 --> 00:48:49.447
you know, safe place.

00:48:49.608 --> 00:48:50.668
And then the last thing I would say

00:48:50.708 --> 00:48:53.550
about it is empathy and caring is like

00:48:53.570 --> 00:48:54.052
a muscle.

00:48:54.371 --> 00:48:55.672
If you don't emphasize it,

00:48:55.753 --> 00:48:57.054
encourage it culturally,

00:48:57.414 --> 00:48:58.434
it's going to waste away.

00:48:58.675 --> 00:49:00.157
And so you have to replenish it

00:49:00.197 --> 00:49:00.757
frequently.

00:49:00.777 --> 00:49:01.157
You could take,

00:49:01.376 --> 00:49:02.878
you go in maintenance mode for a while.

00:49:03.398 --> 00:49:03.599
Right.

00:49:03.639 --> 00:49:04.500
You go in that mode.

00:49:04.760 --> 00:49:05.661
But ultimately,

00:49:05.721 --> 00:49:07.161
you have to keep facilitating,

00:49:07.181 --> 00:49:07.583
encouraging.

00:49:07.882 --> 00:49:09.264
So I think it's cultural, too.

00:49:09.423 --> 00:49:11.827
I think organizations that emphasize care

00:49:11.927 --> 00:49:13.467
and culture and do all those kind of

00:49:13.487 --> 00:49:15.710
things around it have less burnout.

00:49:16.170 --> 00:49:17.771
The standard right now in the industry is

00:49:17.811 --> 00:49:18.652
what, twenty percent.

00:49:18.672 --> 00:49:19.614
If you're doing twenty percent,

00:49:19.673 --> 00:49:20.914
if you're if you only have one in

00:49:20.954 --> 00:49:22.456
five leaving, you're doing great.

00:49:22.916 --> 00:49:23.677
Well, that's you know,

00:49:23.876 --> 00:49:25.938
I always I still remember the small

00:49:25.978 --> 00:49:26.760
business industry.

00:49:26.980 --> 00:49:29.041
and growing up in the first business i

00:49:29.061 --> 00:49:31.222
ever started i just the thought of any

00:49:31.262 --> 00:49:33.204
employee ever leaving my employee was like

00:49:33.644 --> 00:49:36.347
i wouldn't sleep that night we need to

00:49:36.387 --> 00:49:39.510
go back to that a little bit wow

00:49:39.530 --> 00:49:42.452
i love i love that you i think

00:49:42.492 --> 00:49:46.614
you refer to it as um is it

00:49:46.635 --> 00:49:48.416
the human connection is the dosage

00:49:49.710 --> 00:49:51.492
Something like that.

00:49:51.512 --> 00:49:51.592
Yeah.

00:49:51.652 --> 00:49:52.753
Words are dosage.

00:49:52.853 --> 00:49:55.016
Human connection is the connection fuel.

00:49:55.097 --> 00:49:55.757
It's a fuel.

00:49:55.838 --> 00:49:56.177
Got it.

00:49:57.280 --> 00:49:57.619
Yeah.

00:49:57.780 --> 00:49:59.342
It's the fuel that allows you to keep

00:49:59.382 --> 00:49:59.882
connecting.

00:49:59.943 --> 00:50:00.222
Right.

00:50:00.242 --> 00:50:02.405
So it's, it, it, it, it, it accretes.

00:50:03.126 --> 00:50:03.527
And, um,

00:50:04.231 --> 00:50:06.114
You can develop good habits around it.

00:50:06.333 --> 00:50:08.275
I just love certain clinicians when you go

00:50:08.295 --> 00:50:08.635
to see them.

00:50:08.655 --> 00:50:09.956
They're so engaged with you.

00:50:10.376 --> 00:50:12.077
Like you're the only thing that's on their

00:50:12.117 --> 00:50:12.498
mind.

00:50:12.539 --> 00:50:13.239
You know, when you ask,

00:50:13.278 --> 00:50:14.460
forget about the clinical realm,

00:50:14.480 --> 00:50:15.721
forget about health care for a minute.

00:50:16.282 --> 00:50:17.623
And you think of the most impressive

00:50:17.663 --> 00:50:19.184
people you've ever met in your life.

00:50:19.804 --> 00:50:21.326
It was because when you were talking to

00:50:21.346 --> 00:50:21.606
them,

00:50:21.646 --> 00:50:23.967
the only thing that was on their mind

00:50:23.987 --> 00:50:24.327
was you.

00:50:25.976 --> 00:50:27.538
And that's what I want our patients to

00:50:27.577 --> 00:50:28.077
feel like.

00:50:28.117 --> 00:50:29.657
And there's a great instrument for it

00:50:29.697 --> 00:50:31.599
called the Compassion Relational Empathy

00:50:31.679 --> 00:50:32.498
Care Measure.

00:50:32.978 --> 00:50:35.599
And it's a measure of how much your

00:50:35.639 --> 00:50:36.840
patient cares about you,

00:50:36.900 --> 00:50:38.960
how much the patient thinks you care about

00:50:38.981 --> 00:50:39.581
them, I should say,

00:50:39.860 --> 00:50:41.141
how much your patient cares about you.

00:50:41.420 --> 00:50:42.661
There's a great concept, by the way,

00:50:42.681 --> 00:50:43.581
I love teaching this one.

00:50:44.402 --> 00:50:45.143
I know we're going long,

00:50:45.182 --> 00:50:46.523
but I cannot leave this one out.

00:50:46.583 --> 00:50:48.422
It's this idea of proxy efficacy.

00:50:48.844 --> 00:50:51.264
So proxy efficacy, your self-efficacy,

00:50:51.284 --> 00:50:52.063
which is incredible.

00:50:52.105 --> 00:50:53.125
I've got a whole chapter on it in

00:50:53.164 --> 00:50:53.485
the book.

00:50:54.005 --> 00:50:55.246
And it's really how you should get

00:50:55.286 --> 00:50:57.626
patients the belief because, you know,

00:50:57.666 --> 00:50:59.047
just like the good wizard of Oz,

00:50:59.068 --> 00:51:00.268
he didn't give them anything they didn't

00:51:00.289 --> 00:51:01.110
already have, right?

00:51:01.130 --> 00:51:02.911
But he gave them belief in what they

00:51:02.971 --> 00:51:04.311
had to be used.

00:51:04.831 --> 00:51:05.092
Well,

00:51:06.592 --> 00:51:08.715
proxy efficacy is when you go to see

00:51:08.755 --> 00:51:09.335
a doctor,

00:51:09.434 --> 00:51:11.356
it's your belief that that's the best

00:51:11.396 --> 00:51:12.157
doctor for you.

00:51:12.797 --> 00:51:14.217
They're the best, right?

00:51:14.438 --> 00:51:16.599
And so there's validated instruments that

00:51:16.699 --> 00:51:18.981
measure proxy efficacy.

00:51:19.001 --> 00:51:20.442
And why is that so important?

00:51:20.862 --> 00:51:23.264
As it turns out, proxy efficacy is

00:51:26.099 --> 00:51:28.304
is a good proxy for self-efficacy.

00:51:28.684 --> 00:51:31.329
So that the more you believe that your

00:51:31.349 --> 00:51:32.690
provider's the best for you,

00:51:32.710 --> 00:51:34.134
the more you believe you're going to get

00:51:34.153 --> 00:51:34.775
a better outcome.

00:51:35.639 --> 00:51:37.760
You know, they work hand in hand together.

00:51:38.501 --> 00:51:39.460
And it makes sense, right?

00:51:39.481 --> 00:51:41.242
Because you have more confidence in your

00:51:41.302 --> 00:51:43.943
doctor to diagnose and treat you than you

00:51:43.963 --> 00:51:44.702
do in yourself.

00:51:44.742 --> 00:51:45.224
If you didn't,

00:51:45.244 --> 00:51:46.623
you would just go to chat GPT,

00:51:46.983 --> 00:51:48.804
find your diagnosis and live for yourself,

00:51:48.844 --> 00:51:49.105
right?

00:51:50.405 --> 00:51:52.626
But you go there with confidence in them.

00:51:52.686 --> 00:51:53.766
And so I think, you know,

00:51:53.806 --> 00:51:55.447
these are concepts that I think are just

00:51:55.487 --> 00:51:56.407
really, really important.

00:51:56.427 --> 00:51:57.547
Some of them weren't around in two

00:51:57.568 --> 00:51:58.268
thousand twenty.

00:51:58.909 --> 00:52:01.269
And I felt I felt the need to

00:52:01.289 --> 00:52:01.809
write about it.

00:52:02.070 --> 00:52:03.291
Now, whether anybody reads it or not,

00:52:03.371 --> 00:52:04.311
I don't know, but I love them.

00:52:06.650 --> 00:52:07.498
Well, I love it.

00:52:09.530 --> 00:52:12.211
actually think that what we're doing with

00:52:12.411 --> 00:52:12.532
our,

00:52:12.612 --> 00:52:15.112
with rising tide is somewhat similar to

00:52:15.152 --> 00:52:15.672
what you're doing,

00:52:15.693 --> 00:52:16.893
what you just talked about,

00:52:17.273 --> 00:52:18.612
like this proxy of,

00:52:19.172 --> 00:52:21.614
of surrounding them with people that

00:52:21.693 --> 00:52:23.974
really believe that they can do it.

00:52:24.054 --> 00:52:25.514
When again, like kind of,

00:52:25.554 --> 00:52:27.175
kind of like we started this conversation,

00:52:27.235 --> 00:52:27.494
right?

00:52:27.534 --> 00:52:27.894
It's, it's,

00:52:28.155 --> 00:52:29.775
it's why mentorship is so important.

00:52:29.876 --> 00:52:32.295
It's why seeing people who have made it,

00:52:32.336 --> 00:52:34.817
who've run the gauntlet and made it to

00:52:34.856 --> 00:52:35.677
the other side,

00:52:36.016 --> 00:52:38.097
that they're there to support you.

00:52:39.137 --> 00:52:41.219
um in the time when maybe you don't

00:52:41.239 --> 00:52:42.958
believe that you could even do it yourself

00:52:43.039 --> 00:52:46.000
and so um it's exactly it's a good

00:52:46.039 --> 00:52:47.840
segue because that's exactly what i think

00:52:47.880 --> 00:52:49.302
we're doing with rising tide too

00:52:49.822 --> 00:52:52.463
absolutely and that's part of my part of

00:52:52.483 --> 00:52:53.643
my talk in a few weeks you'll get

00:52:53.663 --> 00:52:57.903
a kick out of that perfect well yeah

00:52:57.983 --> 00:53:00.065
thanks larry i really appreciate and gosh

00:53:00.184 --> 00:53:01.846
on behalf of everyone at rising tide and

00:53:01.905 --> 00:53:04.586
our scholars we are just so grateful for

00:53:04.686 --> 00:53:05.806
your generosity and

00:53:07.202 --> 00:53:07.583
You know,

00:53:07.603 --> 00:53:10.746
giving your proceeds from the book to our

00:53:10.786 --> 00:53:14.451
scholars in our program, you know,

00:53:14.510 --> 00:53:15.992
obviously dollars won't be squandered.

00:53:16.253 --> 00:53:17.815
They're going to a great cause.

00:53:18.414 --> 00:53:19.896
And we're so excited to have you as

00:53:19.956 --> 00:53:21.518
our keynote speaker at our next Northwest

00:53:21.579 --> 00:53:22.260
Summit as well.

00:53:22.914 --> 00:53:23.635
Well, you're welcome.

00:53:23.675 --> 00:53:25.096
I'm so looking forward to it.

00:53:25.275 --> 00:53:26.677
Looking forward to being in Arizona and

00:53:26.717 --> 00:53:27.677
being amongst your folks.

00:53:27.717 --> 00:53:28.838
I've had a chance to meet many of

00:53:28.858 --> 00:53:28.978
them.

00:53:28.998 --> 00:53:30.338
They're just incredible.

00:53:30.358 --> 00:53:31.159
And the organization,

00:53:31.179 --> 00:53:32.360
the people that you have around there,

00:53:32.679 --> 00:53:34.380
the volunteers that are just passionate

00:53:34.460 --> 00:53:36.202
and the folks that work for you.

00:53:36.242 --> 00:53:37.382
So congratulations.

00:53:37.402 --> 00:53:38.382
We'll try to turn down the temperature a

00:53:38.422 --> 00:53:39.043
little bit before.

00:53:39.063 --> 00:53:40.644
We'll try to turn down the temp before

00:53:40.664 --> 00:53:41.264
you get here.

00:53:41.804 --> 00:53:43.186
It's been cold all over the country.

00:53:43.206 --> 00:53:44.686
So, well, great.

00:53:46.027 --> 00:53:46.427
Awesome.

00:53:46.887 --> 00:53:47.188
All right.