General Supervision Is Here: What New York Just Changed for PTAs

WEBVTT

00:00:10.147 --> 00:00:11.128
Hello, everyone,

00:00:11.208 --> 00:00:13.169
and Happy New Year to our audience.

00:00:13.630 --> 00:00:15.131
We have a show for you today.

00:00:15.590 --> 00:00:17.353
I'm so excited to have on the show

00:00:17.733 --> 00:00:18.432
two guests.

00:00:18.954 --> 00:00:21.995
And our conversation kind of came from a

00:00:22.076 --> 00:00:22.795
LinkedIn post,

00:00:22.835 --> 00:00:23.657
and we'll get to that in just a

00:00:23.696 --> 00:00:23.896
minute.

00:00:23.977 --> 00:00:25.437
But I want to tell you a little

00:00:25.518 --> 00:00:26.457
bit about them first.

00:00:26.638 --> 00:00:27.379
In healthcare,

00:00:27.759 --> 00:00:30.060
change rarely happens by accident.

00:00:30.120 --> 00:00:31.641
It takes time, persistence,

00:00:32.121 --> 00:00:33.503
and people who are willing to show up

00:00:33.963 --> 00:00:36.304
a long time before the win is guaranteed.

00:00:36.783 --> 00:00:37.463
In New York State,

00:00:37.503 --> 00:00:39.505
that work recently just paid off with new

00:00:39.524 --> 00:00:41.945
legislation allowing physical therapist

00:00:41.985 --> 00:00:43.667
assistants to practice under general

00:00:43.726 --> 00:00:46.448
supervision, expanding access and care,

00:00:46.508 --> 00:00:48.689
reinforcing the strength of the PT-PTA

00:00:48.728 --> 00:00:49.368
relationship.

00:00:49.868 --> 00:00:51.490
But what does that actually mean for

00:00:51.530 --> 00:00:53.390
clinics, rural communities,

00:00:53.511 --> 00:00:54.851
and for the future of our profession?

00:00:55.371 --> 00:00:55.692
Today,

00:00:55.731 --> 00:00:57.412
we are joined by two clinicians who don't

00:00:57.432 --> 00:01:00.113
just talk about advocacy, they live it.

00:01:00.753 --> 00:01:02.475
practice owners, community leaders,

00:01:02.575 --> 00:01:04.995
and longtime believers in the PTPTA team

00:01:05.156 --> 00:01:05.536
model.

00:01:05.897 --> 00:01:08.278
We have with us Megan O'Brien and Jeremy

00:01:08.317 --> 00:01:08.658
Biddle.

00:01:09.037 --> 00:01:09.858
Welcome to the show.

00:01:10.558 --> 00:01:11.179
Hello.

00:01:11.239 --> 00:01:11.659
Thank you so much.

00:01:11.679 --> 00:01:11.859
Hello.

00:01:11.900 --> 00:01:12.920
Thanks for having us.

00:01:12.959 --> 00:01:13.540
Yes.

00:01:13.640 --> 00:01:13.960
Yeah.

00:01:14.040 --> 00:01:15.281
Thanks for coming on.

00:01:15.740 --> 00:01:17.542
So I'm going to pop up here on

00:01:17.581 --> 00:01:18.763
the screen real quick.

00:01:19.543 --> 00:01:23.424
This is what I saw on Jeremy's LinkedIn.

00:01:23.765 --> 00:01:25.445
So this is the new win from New

00:01:25.465 --> 00:01:26.307
York State.

00:01:26.387 --> 00:01:27.346
Super exciting.

00:01:29.087 --> 00:01:30.930
this is we were trying to like problem

00:01:30.969 --> 00:01:33.753
solve before we hopped on um and hit

00:01:33.813 --> 00:01:38.237
record as to what other states don't have

00:01:38.298 --> 00:01:40.180
general supervision right now we were we

00:01:40.219 --> 00:01:41.641
weren't really able to kind of come up

00:01:41.661 --> 00:01:43.423
with a full and complete answer for that

00:01:43.722 --> 00:01:45.685
but we think that it might be um

00:01:46.105 --> 00:01:49.209
somewhere around um forty nine-ish states

00:01:49.248 --> 00:01:50.769
or something like that based on a quick

00:01:50.810 --> 00:01:51.951
search that we did before we

00:01:52.412 --> 00:01:54.474
hopped onto the show but before we dive

00:01:54.493 --> 00:01:55.935
into the questions i want to give you

00:01:55.954 --> 00:01:57.876
two a little bit of time to kind

00:01:57.896 --> 00:02:00.197
of explain where you're from and tell us

00:02:00.218 --> 00:02:03.641
about your practice whoever wants to go

00:02:03.680 --> 00:02:06.643
first i can go first okay um so

00:02:06.722 --> 00:02:09.805
we are from rural western new york um

00:02:10.126 --> 00:02:11.225
if you split the difference between

00:02:11.266 --> 00:02:12.747
rochester and buffalo and basically went

00:02:12.768 --> 00:02:14.248
to the pennsylvania border we're right

00:02:14.269 --> 00:02:18.572
along that area um we own a outpatient

00:02:18.671 --> 00:02:19.552
private practice

00:02:20.288 --> 00:02:23.195
And within the borders of that outpatient

00:02:23.216 --> 00:02:23.697
private practice,

00:02:23.717 --> 00:02:25.961
we also have a lot of contract PT

00:02:26.062 --> 00:02:27.967
and PTA work that we also provide to

00:02:27.986 --> 00:02:28.528
the community.

00:02:29.832 --> 00:02:31.234
yeah and we'll talk about some of the

00:02:31.274 --> 00:02:34.096
challenges later um but i would say that

00:02:34.156 --> 00:02:36.578
in the last three years we've streamlined

00:02:36.698 --> 00:02:40.020
our outpatient business um into a more

00:02:40.060 --> 00:02:43.081
focused model going from three clinics to

00:02:43.242 --> 00:02:46.044
one while we've expanded our external

00:02:46.104 --> 00:02:48.806
offerings and done more with contract work

00:02:48.825 --> 00:02:52.109
which has been easier to manage in some

00:02:52.149 --> 00:02:54.830
ways but also certainly improved in terms

00:02:54.850 --> 00:02:56.271
of payment but we can talk about that

00:02:56.292 --> 00:02:58.233
at a later time but the business model

00:02:58.272 --> 00:02:59.234
continues to evolve

00:03:01.949 --> 00:03:02.269
Yes,

00:03:02.389 --> 00:03:04.350
and I feel like I should also kind

00:03:04.371 --> 00:03:06.151
of just pre-warn the audience.

00:03:06.192 --> 00:03:07.793
You could probably tell from my voice I

00:03:07.832 --> 00:03:11.594
have been struggling with this cold,

00:03:11.675 --> 00:03:13.856
whatever it has attacked me in the last

00:03:13.896 --> 00:03:14.056
week.

00:03:14.076 --> 00:03:15.877
So I will try to do my best

00:03:15.918 --> 00:03:19.700
to not cough or to interrupt our guest

00:03:20.741 --> 00:03:22.962
or to whatever.

00:03:23.043 --> 00:03:24.963
I hope that my voice comes through fairly

00:03:25.003 --> 00:03:25.224
clean.

00:03:25.264 --> 00:03:26.384
But anyways,

00:03:26.465 --> 00:03:27.566
I just kind of wanted to say that

00:03:27.605 --> 00:03:27.906
up front.

00:03:28.227 --> 00:03:30.207
I realize I don't sound like the normal

00:03:30.228 --> 00:03:31.549
Katie that's typically on here.

00:03:32.269 --> 00:03:33.971
I'm so excited to talk to you two

00:03:34.070 --> 00:03:34.591
about this.

00:03:34.812 --> 00:03:35.651
And, you know,

00:03:35.671 --> 00:03:37.633
it's always interesting to me is,

00:03:37.774 --> 00:03:39.074
you know, I'll reach out to somebody.

00:03:39.115 --> 00:03:42.237
And so I literally just reposted Jeremy's

00:03:42.277 --> 00:03:43.098
post and said, hey,

00:03:43.479 --> 00:03:44.639
do you want to come on and talk

00:03:44.659 --> 00:03:45.360
to me about this?

00:03:45.760 --> 00:03:47.323
I mean, this is a really important thing.

00:03:47.362 --> 00:03:49.383
So obviously this podcast is just for

00:03:49.403 --> 00:03:49.884
PTAs.

00:03:50.925 --> 00:03:53.026
It's by me, I hosted,

00:03:53.105 --> 00:03:54.725
I am a physical therapist assistant.

00:03:55.225 --> 00:03:56.727
All of the work that I do is

00:03:56.787 --> 00:03:59.507
trying to elevate the PTA and to

00:03:59.646 --> 00:04:01.747
strengthen the PT PTA relationship.

00:04:02.168 --> 00:04:03.747
So having you two on,

00:04:03.848 --> 00:04:06.229
I think is just super key to us

00:04:06.288 --> 00:04:07.729
really kind of solidifying that

00:04:07.769 --> 00:04:10.990
relationship and seeing how we have PTs

00:04:11.009 --> 00:04:12.610
that are fighting for us every day as

00:04:12.650 --> 00:04:14.911
well to make sure that our patients can

00:04:14.950 --> 00:04:16.071
get the access that they need.

00:04:16.511 --> 00:04:17.771
And I think that we can address that

00:04:17.812 --> 00:04:18.973
through some of the things that you're

00:04:18.992 --> 00:04:21.314
talking about today with rural health and

00:04:21.394 --> 00:04:24.336
the contracts that you guys are doing.

00:04:24.416 --> 00:04:26.218
So let's just jump right in.

00:04:26.257 --> 00:04:27.519
We're going to start with the win,

00:04:27.639 --> 00:04:28.240
the big win.

00:04:28.560 --> 00:04:31.622
So New York State's allowing PTAs to have

00:04:31.701 --> 00:04:32.663
general supervision.

00:04:32.702 --> 00:04:34.064
This is kind of like a big deal.

00:04:34.964 --> 00:04:36.386
And so from your perspective,

00:04:36.406 --> 00:04:37.346
what I would like to know,

00:04:37.807 --> 00:04:40.189
what makes this legislation historically

00:04:40.288 --> 00:04:42.110
important?

00:04:42.129 --> 00:04:43.831
This didn't happen overnight, right?

00:04:43.870 --> 00:04:44.050
Right.

00:04:45.091 --> 00:04:47.913
So I would start by saying APTA New

00:04:47.954 --> 00:04:50.214
York has been fighting for this change

00:04:50.254 --> 00:04:50.714
forever.

00:04:50.834 --> 00:04:52.315
And there are key players across the

00:04:52.355 --> 00:04:53.737
state, one of which is in Rochester,

00:04:53.757 --> 00:04:56.538
who was our professor in college,

00:04:57.017 --> 00:04:58.178
Marsha Miller Spoto,

00:04:58.699 --> 00:05:03.482
who is the chairperson of the Public

00:05:03.562 --> 00:05:04.461
Policy Committee.

00:05:05.163 --> 00:05:08.663
And she has fought for legislation for

00:05:08.704 --> 00:05:10.685
many years on many different topics,

00:05:10.706 --> 00:05:11.985
but this is one of her huge wins,

00:05:12.005 --> 00:05:13.067
which is great.

00:05:13.992 --> 00:05:14.533
And to us,

00:05:15.954 --> 00:05:17.774
it really allows for greater flexibility.

00:05:18.415 --> 00:05:21.278
And so from the PT's perspective and from

00:05:21.298 --> 00:05:23.038
the scheduling person's perspective,

00:05:23.059 --> 00:05:26.141
Megan creates all of our schedules on the

00:05:26.201 --> 00:05:28.541
outpatient side and also kind of organizes

00:05:28.581 --> 00:05:29.983
things with our contracts.

00:05:30.002 --> 00:05:31.004
So I'll let her talk about it in

00:05:31.024 --> 00:05:31.324
a minute.

00:05:33.757 --> 00:05:34.458
Essentially,

00:05:34.958 --> 00:05:36.920
every time there was someone calling in

00:05:36.959 --> 00:05:39.182
sick or anytime someone went on vacation,

00:05:39.983 --> 00:05:41.684
it created a huge issue where instead of

00:05:41.744 --> 00:05:42.985
canceling one schedule,

00:05:43.005 --> 00:05:44.666
you'd have to cancel two schedules because

00:05:44.687 --> 00:05:46.468
there was no on that particular day.

00:05:47.471 --> 00:05:49.252
When looking at hiring a PTA,

00:05:50.153 --> 00:05:53.214
you always had to think about what PT

00:05:53.254 --> 00:05:56.117
was working, what their hours were,

00:05:56.677 --> 00:05:59.399
would the PTA that you were interviewing

00:05:59.978 --> 00:06:02.300
be okay with working that person's hours?

00:06:02.339 --> 00:06:04.060
Because obviously when you hire a new

00:06:04.100 --> 00:06:04.600
employee,

00:06:05.101 --> 00:06:07.622
you don't necessarily want to change an

00:06:07.663 --> 00:06:09.704
existing employee's schedule to fit into

00:06:09.723 --> 00:06:10.725
that supervision model.

00:06:12.007 --> 00:06:13.771
So those were some of the difficulties

00:06:13.810 --> 00:06:15.995
that kind of stand out right off the

00:06:16.036 --> 00:06:18.161
bat that will be alleviated with this.

00:06:18.180 --> 00:06:21.267
You know, in terms of

00:06:22.165 --> 00:06:24.444
the PT PTA team, which you mentioned,

00:06:24.964 --> 00:06:27.906
we were strong believers for a very long

00:06:27.966 --> 00:06:31.567
time in collaboration and looking at the

00:06:31.607 --> 00:06:33.867
strengths of the PTA in terms of their

00:06:34.387 --> 00:06:36.387
education, training, licensure,

00:06:36.466 --> 00:06:37.267
all those things.

00:06:37.927 --> 00:06:41.148
And while it is a very collaborative

00:06:41.168 --> 00:06:41.867
relationship,

00:06:42.389 --> 00:06:44.389
I think that our PTs really have a

00:06:44.728 --> 00:06:46.769
appreciation for the knowledge of the PTA

00:06:46.788 --> 00:06:49.189
and what they're able to do within their

00:06:49.230 --> 00:06:49.970
scope of practice.

00:06:51.089 --> 00:06:53.774
I think that lastly,

00:06:54.295 --> 00:06:55.838
the other thing it does is elevate the

00:06:55.877 --> 00:06:56.598
PTAs

00:07:01.704 --> 00:07:06.028
job value or their marketability.

00:07:07.069 --> 00:07:08.331
And so I think that it makes them

00:07:08.372 --> 00:07:09.093
more marketable.

00:07:09.192 --> 00:07:10.353
So it elevates their status.

00:07:10.634 --> 00:07:11.875
That was the word I was seeking a

00:07:11.915 --> 00:07:12.355
minute ago.

00:07:12.896 --> 00:07:14.538
But it elevates their status to the point

00:07:14.579 --> 00:07:17.942
where if a PTA and a PT apply

00:07:17.983 --> 00:07:19.324
for the same position,

00:07:20.144 --> 00:07:22.067
it makes them more parallel in terms of

00:07:22.911 --> 00:07:23.112
you know,

00:07:23.132 --> 00:07:25.553
the employer's eyes and what they have to

00:07:25.593 --> 00:07:25.894
do.

00:07:26.074 --> 00:07:26.935
Based on flexibility.

00:07:26.975 --> 00:07:27.855
Right, based on flexibility.

00:07:27.875 --> 00:07:29.536
So prior to this legislation,

00:07:29.576 --> 00:07:32.199
it would be like if a PTA applied,

00:07:32.740 --> 00:07:32.860
well,

00:07:32.879 --> 00:07:33.879
how are we going to fit this into

00:07:33.899 --> 00:07:34.860
our supervision model?

00:07:35.382 --> 00:07:37.202
Can we put them in an external contract?

00:07:37.362 --> 00:07:39.305
Do we have to position them in an

00:07:39.404 --> 00:07:41.466
outpatient clinic where we might not even

00:07:41.605 --> 00:07:42.627
have a full-time job?

00:07:42.706 --> 00:07:43.927
And so it really provides a lot of

00:07:43.947 --> 00:07:46.189
flexibility and elevates the status and

00:07:46.230 --> 00:07:47.370
marketability of the PTA.

00:07:47.771 --> 00:07:49.271
And I'll let Megan chime in on some

00:07:49.310 --> 00:07:50.531
of those topics that I kind of.

00:07:50.632 --> 00:07:52.851
Yeah, I would say that, you know,

00:07:52.971 --> 00:07:54.173
even when you discuss,

00:07:54.572 --> 00:07:56.413
it's never been a real limiting factor for

00:07:56.733 --> 00:07:58.494
us because we always do see the value

00:07:58.533 --> 00:07:58.913
in that.

00:07:59.113 --> 00:08:00.714
And we have a great team and we

00:08:00.735 --> 00:08:02.514
have great physical therapists that are

00:08:02.555 --> 00:08:04.615
flexible and also know that we're flexible

00:08:04.636 --> 00:08:05.036
with them.

00:08:05.276 --> 00:08:05.435
So.

00:08:05.995 --> 00:08:06.235
you know,

00:08:06.336 --> 00:08:07.877
our employees can work a full time job

00:08:07.918 --> 00:08:08.617
in three days a week,

00:08:08.697 --> 00:08:09.579
they can work in a four days a

00:08:09.598 --> 00:08:10.579
week, they can work in five,

00:08:10.620 --> 00:08:11.180
like we're pretty,

00:08:11.641 --> 00:08:13.843
pretty open to what works for people's

00:08:14.403 --> 00:08:15.884
work life balance their life in general,

00:08:16.845 --> 00:08:18.646
but have always had the caveat of but

00:08:18.687 --> 00:08:19.627
if you're the PTA,

00:08:19.646 --> 00:08:20.567
then we have to figure out how to

00:08:20.588 --> 00:08:21.408
make that happen.

00:08:22.069 --> 00:08:22.750
They're not

00:08:23.350 --> 00:08:25.593
I think we are unique in that flexibility

00:08:25.632 --> 00:08:27.595
with everyone and a lot of places aren't.

00:08:28.175 --> 00:08:31.218
So especially if you're looking at a

00:08:31.259 --> 00:08:32.299
practice that isn't ours,

00:08:32.600 --> 00:08:35.381
there's probably a lot more likelihood

00:08:35.402 --> 00:08:38.245
that that could be a barrier to, well,

00:08:38.264 --> 00:08:39.605
I'm not interested in managing

00:08:41.488 --> 00:08:44.289
a pta schedule when someone calls in i'm

00:08:44.330 --> 00:08:46.272
not interested in managing a pta schedule

00:08:46.351 --> 00:08:48.754
over the holidays i'm not those little

00:08:48.774 --> 00:08:50.414
things that like we've always done it

00:08:50.836 --> 00:08:53.557
we've always seen value in a pta the

00:08:53.878 --> 00:08:55.580
you know from the start the facility we

00:08:55.600 --> 00:08:57.760
both worked at prior to opening and having

00:08:58.000 --> 00:09:00.403
um our own practice we always had a

00:09:00.462 --> 00:09:02.985
pt pta team so it was kind of

00:09:03.005 --> 00:09:04.866
a non-negotiable for us and we've always

00:09:04.886 --> 00:09:06.008
been open to it but for people that

00:09:06.028 --> 00:09:07.548
were less open to that and saw some

00:09:07.568 --> 00:09:07.808
of the

00:09:08.610 --> 00:09:09.671
things that may be more difficult to

00:09:09.711 --> 00:09:11.472
manage and aren't interested in adding

00:09:11.533 --> 00:09:12.854
another thing to manage when you're

00:09:12.894 --> 00:09:14.416
running out outpatient clinic.

00:09:14.436 --> 00:09:17.438
You know, that's not an excuse.

00:09:17.538 --> 00:09:18.900
There's no reason to say that anymore

00:09:19.020 --> 00:09:21.383
because now they can work and they can

00:09:21.442 --> 00:09:24.046
be in a contract and they can

00:09:25.399 --> 00:09:26.639
you know if the pt calls in sick

00:09:26.659 --> 00:09:28.341
or the pt oversleeps or the pt all

00:09:28.361 --> 00:09:29.743
the million things that happen with all

00:09:29.763 --> 00:09:32.264
the moving parts that we have then it's

00:09:32.284 --> 00:09:34.407
not a problem and you know our ptas

00:09:34.506 --> 00:09:37.309
are in our clinic are some of our

00:09:37.409 --> 00:09:40.032
longest standing employees and super

00:09:40.052 --> 00:09:42.514
valuable and great at what they do so

00:09:42.914 --> 00:09:45.697
it's so frustrating and insane sometimes

00:09:45.716 --> 00:09:46.937
when you look at something and you're like

00:09:47.138 --> 00:09:47.479
oh well

00:09:48.774 --> 00:09:49.855
so they should not be able to work

00:09:49.895 --> 00:09:52.658
this day because so-and-so called in,

00:09:52.878 --> 00:09:54.440
like that doesn't even make any sense

00:09:54.519 --> 00:09:56.321
because they can see all these patients.

00:09:56.341 --> 00:09:57.741
They don't need someone standing there,

00:09:58.543 --> 00:09:58.923
you know?

00:09:58.962 --> 00:09:59.964
So for us,

00:10:01.905 --> 00:10:04.227
we've been in practice for twenty years

00:10:04.288 --> 00:10:05.028
plus, each of us,

00:10:05.849 --> 00:10:07.870
and this has been something that's been

00:10:07.889 --> 00:10:09.871
discussed for the majority of that

00:10:09.932 --> 00:10:11.092
timeline in New York State.

00:10:11.212 --> 00:10:11.894
So, you know,

00:10:12.374 --> 00:10:15.336
we're old and it's really been a long

00:10:15.376 --> 00:10:16.937
standing like the PTA supervision,

00:10:16.957 --> 00:10:17.979
PTA supervision, PTA,

00:10:18.658 --> 00:10:20.159
So when it actually shows up and you

00:10:20.201 --> 00:10:21.120
see it, you're like, oh my gosh,

00:10:21.160 --> 00:10:21.621
it happened.

00:10:21.701 --> 00:10:22.402
It actually happened.

00:10:22.462 --> 00:10:23.644
It wasn't something that, you know,

00:10:24.464 --> 00:10:26.765
in the amount of work that goes into

00:10:26.785 --> 00:10:28.847
that behind the scenes from people like

00:10:28.868 --> 00:10:31.269
Jeremy mentioned is just crazy, you know,

00:10:31.289 --> 00:10:32.691
over the course of years and how important

00:10:32.711 --> 00:10:34.793
that passion is to push it forward and

00:10:34.832 --> 00:10:35.394
make it happen.

00:10:36.034 --> 00:10:36.375
I mean,

00:10:36.394 --> 00:10:38.037
just to give you some perspective on how

00:10:38.096 --> 00:10:39.837
slow New York is, two years ago,

00:10:40.577 --> 00:10:42.919
PTAs were not able to get paid under

00:10:43.159 --> 00:10:45.261
our workers' compensation fee schedule for

00:10:45.302 --> 00:10:46.302
workers' comp visits.

00:10:46.923 --> 00:10:47.644
Now they can.

00:10:48.183 --> 00:10:50.826
So this is just another positive step in

00:10:50.846 --> 00:10:53.868
the right direction to really allow PTAs

00:10:54.969 --> 00:11:01.594
the professional freedom and ability to

00:11:01.634 --> 00:11:03.775
collaborate that they deserve based on

00:11:03.836 --> 00:11:05.476
their training and their expertise.

00:11:05.950 --> 00:11:08.471
And I also think we were talking before

00:11:08.510 --> 00:11:09.811
we started this, but in this world,

00:11:10.272 --> 00:11:10.491
you know,

00:11:10.532 --> 00:11:12.312
we're all used to seeing extenders for

00:11:12.351 --> 00:11:13.852
like primary care, right?

00:11:13.932 --> 00:11:14.932
So you sick,

00:11:14.972 --> 00:11:16.153
you need a doctor's appointment.

00:11:16.394 --> 00:11:18.214
Do you see a doctor or do you

00:11:18.254 --> 00:11:20.455
see a physician's assistant or a nurse

00:11:20.475 --> 00:11:21.015
practitioner?

00:11:22.615 --> 00:11:24.076
I was just talking about this with

00:11:24.096 --> 00:11:24.897
somebody the other day.

00:11:25.532 --> 00:11:25.792
Yeah.

00:11:25.812 --> 00:11:26.513
And the beauty of that,

00:11:26.572 --> 00:11:28.234
especially for us in rural health care,

00:11:28.673 --> 00:11:30.174
where it's difficult to recruit a PT,

00:11:30.195 --> 00:11:31.375
it's difficult to recruit a PTA.

00:11:31.796 --> 00:11:33.836
It's very difficult to recruit a physician

00:11:33.917 --> 00:11:34.496
to, you know,

00:11:34.517 --> 00:11:38.379
for our local health care networks is that

00:11:38.960 --> 00:11:40.280
when you call in our second, they're like,

00:11:40.301 --> 00:11:41.240
yeah, we can get you in.

00:11:41.621 --> 00:11:42.761
They're getting you in because they have

00:11:42.822 --> 00:11:45.264
extenders like that is that's who's saving

00:11:45.303 --> 00:11:45.683
the day.

00:11:46.163 --> 00:11:47.304
And I know, you know,

00:11:47.485 --> 00:11:48.586
I've spent years where.

00:11:49.326 --> 00:11:51.148
of course there's a supervising physician,

00:11:51.587 --> 00:11:53.528
but I'm seeing an extender for all of

00:11:53.548 --> 00:11:53.909
my care.

00:11:53.950 --> 00:11:55.311
My child sees an extender for all of

00:11:55.331 --> 00:11:55.811
their care.

00:11:55.890 --> 00:11:57.272
And like, I don't think twice about it.

00:11:57.613 --> 00:11:58.833
They spend a lot of time with you.

00:11:59.214 --> 00:12:00.134
They're able to listen.

00:12:00.514 --> 00:12:03.857
Their paperwork and like supervision

00:12:03.878 --> 00:12:06.899
components that the physician has are not

00:12:06.940 --> 00:12:08.600
burdensome to them in the same way.

00:12:09.022 --> 00:12:10.062
And so sometimes you're like,

00:12:10.143 --> 00:12:11.624
I got better care from that.

00:12:11.683 --> 00:12:12.705
I think the same thing happens in

00:12:12.745 --> 00:12:15.907
parallels in PT and PTA and then that

00:12:15.947 --> 00:12:16.587
relationship.

00:12:16.668 --> 00:12:16.927
And so

00:12:18.341 --> 00:12:19.363
the fact that it took so long is

00:12:19.403 --> 00:12:21.163
kind of insane when you look at the

00:12:21.224 --> 00:12:24.186
comparative mathematical model that does

00:12:24.206 --> 00:12:25.908
the exact same thing.

00:12:25.927 --> 00:12:27.408
There are so many things that I could

00:12:27.469 --> 00:12:30.030
say based on the few minutes that you

00:12:30.051 --> 00:12:31.272
two have both been talking.

00:12:31.831 --> 00:12:33.894
I think that, you know,

00:12:33.913 --> 00:12:35.254
I think it was Jeremy that mentioned

00:12:35.355 --> 00:12:36.936
elevating the PTA status.

00:12:37.437 --> 00:12:39.177
I think that having a win like this

00:12:39.298 --> 00:12:41.239
is going to open that up for

00:12:42.159 --> 00:12:46.000
PTAs to feel that they have the

00:12:46.041 --> 00:12:46.880
permission,

00:12:47.181 --> 00:12:48.741
that they have the motivation to maybe

00:12:48.841 --> 00:12:51.582
seek out more of those certifications or

00:12:52.043 --> 00:12:55.703
specialties or trainings because they can

00:12:55.803 --> 00:12:58.163
feel themselves being elevated based on

00:12:58.804 --> 00:12:59.664
this law alone.

00:13:00.365 --> 00:13:01.566
Now I come from Ohio,

00:13:01.986 --> 00:13:04.609
we have had general supervision in the

00:13:04.649 --> 00:13:05.450
state of Ohio,

00:13:06.190 --> 00:13:08.753
other than private practice for many years

00:13:08.913 --> 00:13:11.575
up until Medicare changed their rule last

00:13:11.595 --> 00:13:11.894
year.

00:13:12.355 --> 00:13:14.418
So it was always very strange to me.

00:13:14.577 --> 00:13:16.960
I grew up in the outpatient world,

00:13:17.780 --> 00:13:18.961
group as in like, you know,

00:13:19.302 --> 00:13:20.143
as a baby PTA.

00:13:21.102 --> 00:13:23.304
growing up in the outpatient world,

00:13:23.325 --> 00:13:26.027
but I was in a hospital-based setting.

00:13:26.508 --> 00:13:27.187
So to me,

00:13:27.388 --> 00:13:29.889
I didn't really ever think about it from

00:13:29.950 --> 00:13:33.052
the private practice perspective is all of

00:13:33.092 --> 00:13:34.573
those barriers that you just mentioned,

00:13:35.094 --> 00:13:37.155
calling off and having to cancel a whole

00:13:37.515 --> 00:13:38.397
caseload of patients.

00:13:38.417 --> 00:13:41.318
That's just crazy to think about that

00:13:41.339 --> 00:13:42.340
because in the state of Ohio,

00:13:42.360 --> 00:13:43.660
it wasn't something I ever dealt with

00:13:44.500 --> 00:13:46.461
Not in a hospital based setting anyways,

00:13:46.922 --> 00:13:48.462
but it was always so interesting to me.

00:13:48.523 --> 00:13:49.423
I would explain this.

00:13:49.503 --> 00:13:49.942
I teach.

00:13:50.283 --> 00:13:52.583
And so I'm teaching PTA students up until

00:13:52.624 --> 00:13:57.365
last year that the PTAs in outpatient

00:13:57.405 --> 00:14:00.268
practice have general supervision across

00:14:00.307 --> 00:14:00.807
the street.

00:14:01.687 --> 00:14:03.408
There could be a private practice.

00:14:03.827 --> 00:14:05.928
They needed that direct supervision based

00:14:05.969 --> 00:14:06.769
on Medicare rules.

00:14:07.548 --> 00:14:09.350
And to see the confusion on my student's

00:14:09.370 --> 00:14:11.389
face was I'm like, I don't,

00:14:12.010 --> 00:14:13.191
I know it doesn't make sense.

00:14:13.630 --> 00:14:14.311
I understand that.

00:14:14.370 --> 00:14:16.011
And I can see what you're telling me

00:14:16.052 --> 00:14:17.272
by the look on your face,

00:14:17.293 --> 00:14:19.212
but it was the role at the time,

00:14:19.692 --> 00:14:20.894
just absolutely insane.

00:14:20.933 --> 00:14:23.735
So I love that you guys brought up

00:14:23.835 --> 00:14:25.995
all of these things about, um, you know,

00:14:26.115 --> 00:14:27.836
the barriers that it had caused and

00:14:27.855 --> 00:14:29.836
created and, um,

00:14:31.097 --> 00:14:34.279
that it's elevating that PTA status,

00:14:34.600 --> 00:14:36.121
that it's elevating the PTPTA

00:14:36.162 --> 00:14:36.922
relationship.

00:14:37.783 --> 00:14:39.423
And then the advocacy that's been done,

00:14:39.464 --> 00:14:41.145
like you said, this didn't happen quickly.

00:14:41.186 --> 00:14:42.706
This is something that New York has been

00:14:42.746 --> 00:14:44.748
wanting to have happen for a long time.

00:14:45.308 --> 00:14:46.470
And I don't know, maybe,

00:14:47.389 --> 00:14:49.272
was it the push from the Medicare

00:14:49.312 --> 00:14:51.113
perspective that whenever that freed up,

00:14:51.133 --> 00:14:53.054
do you think then that gave New York

00:14:53.075 --> 00:14:54.436
like the freedom to feel like, okay,

00:14:54.475 --> 00:14:55.336
now we can do it?

00:14:56.017 --> 00:14:57.697
Or was it coming anyways?

00:14:57.837 --> 00:14:57.977
Like,

00:14:57.999 --> 00:14:59.419
do you feel like it was already in

00:14:59.440 --> 00:14:59.860
the works?

00:15:00.777 --> 00:15:02.798
I think that the government,

00:15:03.177 --> 00:15:05.339
whether it's federal or New York,

00:15:05.958 --> 00:15:10.201
is starting to see the squeeze that the

00:15:10.240 --> 00:15:12.942
health care system has on providers.

00:15:13.663 --> 00:15:17.445
And in some cases where they can pluck

00:15:17.504 --> 00:15:18.644
at low hanging fruit,

00:15:19.125 --> 00:15:22.006
they're allowing some of the burdensome

00:15:22.047 --> 00:15:25.207
regulation to be relieved so that health

00:15:25.227 --> 00:15:25.989
care providers

00:15:26.908 --> 00:15:28.809
and patients have better access to each

00:15:28.870 --> 00:15:29.090
other.

00:15:29.690 --> 00:15:32.272
And I think this was part of what

00:15:32.331 --> 00:15:35.232
would be called reducing burdensome

00:15:35.273 --> 00:15:38.333
legislation and burdensome regulation in

00:15:38.453 --> 00:15:40.475
our healthcare environment.

00:15:40.595 --> 00:15:41.676
And so I think it was part of

00:15:41.716 --> 00:15:45.697
that essential focus point to try to

00:15:45.977 --> 00:15:47.698
increase some of the bottlenecking that's

00:15:47.719 --> 00:15:49.580
going on because of the lack of providers

00:15:50.139 --> 00:15:51.341
and all the difficulties we have in the

00:15:51.380 --> 00:15:52.120
healthcare system.

00:15:53.054 --> 00:15:54.134
I will tell you that, you know,

00:15:54.255 --> 00:15:55.096
over the course of years,

00:15:55.135 --> 00:15:58.076
you get information from your local state

00:15:58.476 --> 00:15:59.177
APTA.

00:15:59.998 --> 00:16:01.057
For us, it's NYAPTA,

00:16:01.077 --> 00:16:03.859
but whatever state it's in, you know,

00:16:03.958 --> 00:16:04.639
here's this letter,

00:16:04.700 --> 00:16:08.041
send this letter to this representative

00:16:08.061 --> 00:16:09.140
that's your local, you know,

00:16:09.201 --> 00:16:11.022
we've always done things like that.

00:16:11.042 --> 00:16:13.202
We've always filled in and added and

00:16:13.243 --> 00:16:15.484
supplemented and really felt like that was

00:16:15.504 --> 00:16:16.224
something like it's,

00:16:16.624 --> 00:16:17.825
they basically write the whole letter for

00:16:17.845 --> 00:16:17.904
you.

00:16:17.924 --> 00:16:18.884
Of course I can send this.

00:16:18.965 --> 00:16:19.625
It's insane.

00:16:19.706 --> 00:16:20.265
Easy peasy.

00:16:21.317 --> 00:16:23.778
But being able to back that with the

00:16:23.818 --> 00:16:25.219
Medicare thing, you know,

00:16:25.418 --> 00:16:28.500
adding in that like that gives more bulk

00:16:28.519 --> 00:16:29.059
to your letter.

00:16:29.179 --> 00:16:30.340
Right.

00:16:30.399 --> 00:16:32.961
And every other state has been saying that

00:16:33.000 --> 00:16:34.280
about other states for years.

00:16:34.321 --> 00:16:37.621
But now this national payer is saying,

00:16:38.042 --> 00:16:38.542
what are you doing?

00:16:39.423 --> 00:16:40.322
So, you know,

00:16:40.442 --> 00:16:43.124
being able to send information to your

00:16:43.163 --> 00:16:44.224
representatives that.

00:16:45.004 --> 00:16:46.585
they can look at it and have the

00:16:46.605 --> 00:16:48.705
same perspective of what your PTA students

00:16:48.725 --> 00:16:51.605
had is probably, you know, more valuable.

00:16:51.745 --> 00:16:52.466
Why?

00:16:52.586 --> 00:16:54.386
Why would we do this when other states

00:16:54.427 --> 00:16:54.927
aren't doing this?

00:16:54.966 --> 00:16:56.908
And now Medicare's not doing it.

00:16:56.927 --> 00:16:57.947
It doesn't even make any sense.

00:16:58.107 --> 00:16:58.927
So, yeah.

00:16:59.008 --> 00:17:02.928
One thing I mentioned was in regard to

00:17:03.009 --> 00:17:04.670
elevating the PTA status.

00:17:04.910 --> 00:17:08.451
So I think even within our own profession,

00:17:09.659 --> 00:17:12.640
there is some friction at times and in

00:17:12.660 --> 00:17:15.580
certain environments between PTs and PTAs.

00:17:15.661 --> 00:17:19.522
And I think that sometimes PTAs disengage

00:17:20.103 --> 00:17:23.203
because they feel like there's a barrier

00:17:23.223 --> 00:17:23.525
there,

00:17:24.045 --> 00:17:26.625
which we don't want there to be a

00:17:26.665 --> 00:17:27.145
barrier,

00:17:27.185 --> 00:17:30.287
but I think that we understand PTAs

00:17:30.567 --> 00:17:31.188
perceive

00:17:32.067 --> 00:17:34.190
there is a barrier and perception is

00:17:34.230 --> 00:17:34.970
reality, right?

00:17:35.069 --> 00:17:37.332
So this has also been recognized at the

00:17:37.392 --> 00:17:41.255
APTA level and there's a lack of

00:17:41.315 --> 00:17:43.796
membership from PTAs,

00:17:45.116 --> 00:17:47.179
PTA or APTA New York.

00:17:47.298 --> 00:17:49.660
And, you know, I think nationally

00:17:50.907 --> 00:17:54.270
APTA is looking at ways to re-engage PTAs,

00:17:54.711 --> 00:17:57.313
and I know there is a sort of

00:17:57.333 --> 00:18:00.734
a certification track program that they're

00:18:00.755 --> 00:18:01.096
looking at,

00:18:01.135 --> 00:18:02.717
that they're looking at implementing to

00:18:03.817 --> 00:18:05.578
allow PTAs some of that professional

00:18:05.618 --> 00:18:08.040
development opportunity that maybe wasn't

00:18:08.080 --> 00:18:08.280
there.

00:18:08.300 --> 00:18:10.102
But I also think that this type of

00:18:10.162 --> 00:18:13.105
legislation helps to relieve some of that

00:18:13.144 --> 00:18:13.565
friction,

00:18:13.605 --> 00:18:14.144
but also

00:18:15.145 --> 00:18:18.508
helps PTAs to know that they're

00:18:18.548 --> 00:18:22.069
appreciated and that they are free to do

00:18:22.131 --> 00:18:23.590
some things that are well within their

00:18:23.611 --> 00:18:25.092
scope and well within their training,

00:18:25.673 --> 00:18:28.674
and they can really work on being the

00:18:28.714 --> 00:18:30.195
best professional they can be.

00:18:31.656 --> 00:18:33.438
So you hit the nail on the head

00:18:33.577 --> 00:18:35.019
when you said perceived barriers.

00:18:35.439 --> 00:18:36.779
I say this a lot on the show,

00:18:36.819 --> 00:18:37.140
too.

00:18:37.880 --> 00:18:41.563
I kind of feel like when I started

00:18:41.583 --> 00:18:42.103
the show,

00:18:42.383 --> 00:18:43.023
I don't know that

00:18:47.098 --> 00:18:47.861
Am I muted?

00:18:47.881 --> 00:18:49.846
I hear you.

00:18:49.886 --> 00:18:50.469
You can't hear me.

00:18:55.979 --> 00:18:57.200
so one of the things that you had

00:18:57.240 --> 00:18:59.280
mentioned was the the ptas perceive

00:18:59.300 --> 00:19:01.082
something and perception is reality right

00:19:01.442 --> 00:19:02.884
and this is something that i talk about

00:19:03.023 --> 00:19:06.086
a lot on this show is that when

00:19:06.145 --> 00:19:09.268
ptas bring up barriers to me i often

00:19:09.307 --> 00:19:10.848
want to ask them the question is that

00:19:10.888 --> 00:19:13.309
what your perception is or is there really

00:19:13.349 --> 00:19:15.551
truly a barrier or have you not asked

00:19:15.872 --> 00:19:17.613
the right questions like did you not go

00:19:17.633 --> 00:19:20.154
to the right person um and and figure

00:19:20.174 --> 00:19:21.996
out what's going on here because sometimes

00:19:22.056 --> 00:19:24.438
i think that it is truly a perception

00:19:24.478 --> 00:19:24.657
thing

00:19:25.057 --> 00:19:27.039
and that we hear assistant and we kind

00:19:27.079 --> 00:19:29.602
of run with that that you know well

00:19:29.682 --> 00:19:31.423
assistant makes me less than or or

00:19:31.483 --> 00:19:34.027
whatever that might be um so i'm excited

00:19:34.047 --> 00:19:35.347
to hear about these tracks is this a

00:19:35.387 --> 00:19:37.509
new york thing that they're they're coming

00:19:37.529 --> 00:19:39.832
up with tracks or it's an apta this

00:19:39.912 --> 00:19:43.415
is apta national and so i'm i double

00:19:43.476 --> 00:19:45.678
as the vice president of the academy of

00:19:45.718 --> 00:19:48.721
leadership and innovation for oh yeah i've

00:19:48.740 --> 00:19:50.122
had a couple people on from lamp

00:19:51.096 --> 00:19:51.396
Yes.

00:19:54.122 --> 00:19:57.970
I get some information sometimes earlier

00:19:58.390 --> 00:19:58.971
than other people,

00:19:59.031 --> 00:20:00.494
but they are developing these tracks.

00:20:00.674 --> 00:20:02.057
But I think the key point is that

00:20:03.483 --> 00:20:07.667
APTA for years has known there's an issue

00:20:07.928 --> 00:20:09.808
and they know there's an issue because

00:20:09.828 --> 00:20:11.310
there's disengagement at that level,

00:20:11.371 --> 00:20:11.611
right?

00:20:12.131 --> 00:20:13.392
And so if there's disengagement,

00:20:13.491 --> 00:20:14.792
you have to get to the reason why

00:20:15.054 --> 00:20:15.854
are they disengaged?

00:20:15.913 --> 00:20:17.055
How can we engage them?

00:20:17.695 --> 00:20:18.737
And I think one of the things they

00:20:18.757 --> 00:20:21.159
were hearing was professional advancement.

00:20:21.578 --> 00:20:23.119
And so I think even in our own

00:20:23.140 --> 00:20:23.540
clinic,

00:20:24.040 --> 00:20:27.463
we're constantly seeking ways to try to

00:20:27.683 --> 00:20:28.163
elevate

00:20:28.984 --> 00:20:30.445
the professional status the practice

00:20:30.465 --> 00:20:33.167
status of our ptas and like you know

00:20:33.188 --> 00:20:35.229
i'm mckenzie certified an example is well

00:20:35.449 --> 00:20:37.250
a pta can take mckenzie part a and

00:20:37.269 --> 00:20:39.652
mckenzie part b but they can't take part

00:20:39.672 --> 00:20:41.573
c or part d or part e and

00:20:41.653 --> 00:20:43.213
like e doesn't really exist anymore but

00:20:43.233 --> 00:20:46.695
that's a different story right but you

00:20:46.715 --> 00:20:49.357
know why can't a pta take advanced problem

00:20:49.377 --> 00:20:51.358
solving that so there's different things

00:20:52.059 --> 00:20:52.220
um

00:20:54.785 --> 00:20:56.125
that these initiatives, I think,

00:20:56.145 --> 00:20:58.247
will allow PTAs to do things that they

00:20:58.287 --> 00:20:59.768
weren't doing and focus on things that

00:20:59.788 --> 00:21:00.868
they haven't been able to focus on in

00:21:00.888 --> 00:21:03.289
the past and allow themselves professional

00:21:03.329 --> 00:21:05.550
development to a degree where they're able

00:21:05.611 --> 00:21:11.375
to interact with PTs on a state or

00:21:11.414 --> 00:21:12.454
national level more,

00:21:12.875 --> 00:21:14.777
which hopefully engages them and brings

00:21:14.797 --> 00:21:17.157
them back into that centerpiece.

00:21:18.173 --> 00:21:19.434
Yeah, I love that.

00:21:19.494 --> 00:21:22.457
I always think of the example for me

00:21:22.497 --> 00:21:23.416
in the state of Ohio,

00:21:23.636 --> 00:21:24.978
PTAs can't do dry needling.

00:21:25.739 --> 00:21:27.880
There's no reason for me to do dry

00:21:27.900 --> 00:21:29.721
needling as a PTA in the state of

00:21:29.760 --> 00:21:30.060
Ohio.

00:21:30.561 --> 00:21:32.303
But if I'm going to work in a

00:21:32.343 --> 00:21:33.363
clinic that does it,

00:21:34.044 --> 00:21:35.964
I better understand it.

00:21:36.045 --> 00:21:36.705
I don't have to

00:21:37.645 --> 00:21:38.807
do it to understand it.

00:21:38.988 --> 00:21:40.150
I can have conversations.

00:21:40.230 --> 00:21:42.893
I can do a little bit of education

00:21:42.932 --> 00:21:43.354
on the side,

00:21:43.374 --> 00:21:44.955
but patients are going to ask me

00:21:45.016 --> 00:21:45.656
questions.

00:21:46.538 --> 00:21:50.884
So I better be prepared to answer at

00:21:50.923 --> 00:21:52.625
least some of those or to be able

00:21:52.646 --> 00:21:54.107
to direct them back to the PT who

00:21:54.148 --> 00:21:55.009
did the treatment with them.

00:21:55.430 --> 00:21:57.290
But just because I understand it doesn't

00:21:57.330 --> 00:21:58.372
mean that I can do it and vice

00:21:58.392 --> 00:21:58.612
versa.

00:21:58.751 --> 00:21:59.333
You know what I mean?

00:21:59.772 --> 00:22:00.053
So like,

00:22:00.133 --> 00:22:02.194
I don't see that there should be any

00:22:02.255 --> 00:22:04.576
perceived barriers from that perspective

00:22:04.836 --> 00:22:06.718
of you can gain the knowledge.

00:22:07.137 --> 00:22:08.338
We might not be able to do every

00:22:08.378 --> 00:22:09.019
single skill,

00:22:09.500 --> 00:22:11.201
but I should still have a very

00:22:11.240 --> 00:22:13.343
foundational understanding of what the

00:22:13.383 --> 00:22:15.263
physical therapist is doing that I'm

00:22:15.304 --> 00:22:16.625
working with.

00:22:16.865 --> 00:22:19.326
I should have that basic foundation.

00:22:19.446 --> 00:22:20.768
If you're on the healthcare team and you

00:22:20.807 --> 00:22:22.229
have that knowledge and,

00:22:22.599 --> 00:22:24.602
as the pta you could say do you

00:22:24.642 --> 00:22:26.663
think patient a would benefit from

00:22:26.863 --> 00:22:29.325
treatment x because i went to this

00:22:29.345 --> 00:22:30.986
training and this is part of my knowledge

00:22:31.006 --> 00:22:32.247
and i think that they would and like

00:22:32.468 --> 00:22:34.689
that's what collaboration is about so the

00:22:34.729 --> 00:22:36.471
pta can do it but you can certainly

00:22:36.510 --> 00:22:38.291
suggest it understand it and try to

00:22:38.352 --> 00:22:41.394
elevate the status of your patient um by

00:22:41.433 --> 00:22:42.194
knowing those things

00:22:42.662 --> 00:22:43.883
Which is no different than even if you

00:22:43.903 --> 00:22:45.143
look at us from the perspective of our

00:22:45.182 --> 00:22:46.503
physician relationships, right?

00:22:47.144 --> 00:22:49.105
So you see a patient and you,

00:22:49.326 --> 00:22:49.506
I mean,

00:22:49.526 --> 00:22:51.406
just the other day I called on a

00:22:51.446 --> 00:22:51.686
patient,

00:22:51.707 --> 00:22:53.048
I have a vestibular certification,

00:22:54.248 --> 00:22:55.868
and I called on a patient that,

00:22:56.068 --> 00:22:56.288
you know,

00:22:56.328 --> 00:22:57.630
primary care is trying to manage,

00:22:57.690 --> 00:22:59.570
but the real story is they're primary

00:22:59.590 --> 00:22:59.891
care.

00:22:59.951 --> 00:23:01.192
They know a lot about everything.

00:23:02.133 --> 00:23:03.093
I know a lot,

00:23:03.113 --> 00:23:04.554
a lot about this one thing.

00:23:05.034 --> 00:23:08.056
So I can't order imaging.

00:23:09.106 --> 00:23:10.167
this person needs imaging.

00:23:10.268 --> 00:23:12.229
So I call and say, Hey, you know,

00:23:12.388 --> 00:23:14.050
I evaluated such and such be the, this,

00:23:14.070 --> 00:23:14.770
this, this, this, this.

00:23:14.830 --> 00:23:15.030
Well,

00:23:15.652 --> 00:23:16.813
I have to have an understanding of

00:23:16.913 --> 00:23:17.192
imaging.

00:23:17.232 --> 00:23:18.354
I have to have an understanding of the

00:23:18.374 --> 00:23:19.433
physician's viewpoints.

00:23:19.515 --> 00:23:20.815
I have to have an understanding of that

00:23:21.215 --> 00:23:23.037
whole medical management that, you know,

00:23:23.376 --> 00:23:24.738
treating this person is outside of my

00:23:24.778 --> 00:23:25.078
scope.

00:23:25.278 --> 00:23:26.278
They don't need PT,

00:23:26.779 --> 00:23:28.580
but I'm going to have this conversation

00:23:28.621 --> 00:23:29.981
that I have to have an understanding of

00:23:30.021 --> 00:23:31.823
everything to be able to get my point

00:23:31.843 --> 00:23:33.324
across and to make any gains for the

00:23:33.364 --> 00:23:33.744
patient.

00:23:34.184 --> 00:23:35.365
So, and you know,

00:23:35.385 --> 00:23:36.767
we have direct access in New York state.

00:23:37.426 --> 00:23:37.587
It's,

00:23:38.387 --> 00:23:40.749
somewhat limited compared to other states.

00:23:40.808 --> 00:23:42.969
But I don't have to have a physician

00:23:43.249 --> 00:23:45.710
tell me what I kind of can't do,

00:23:46.029 --> 00:23:48.589
but I need to understand their perspective

00:23:48.630 --> 00:23:50.170
and be able to communicate with them in

00:23:50.191 --> 00:23:52.411
a way that makes change for the patient.

00:23:52.431 --> 00:23:55.192
Yeah, I love the comparison.

00:23:56.932 --> 00:23:59.031
In New York,

00:23:59.051 --> 00:24:00.153
we can't dry needle at all,

00:24:00.192 --> 00:24:01.073
although we would love to.

00:24:01.913 --> 00:24:02.393
Oh, okay.

00:24:02.673 --> 00:24:03.252
That's interesting.

00:24:03.353 --> 00:24:04.252
I didn't realize that.

00:24:04.272 --> 00:24:05.894
Yeah, that's what I was about to say.

00:24:07.798 --> 00:24:10.339
yeah yeah it's um it's so interesting to

00:24:10.519 --> 00:24:11.859
to think about all of the different

00:24:11.901 --> 00:24:14.801
nuances in in state laws um so there

00:24:14.862 --> 00:24:17.962
is a a facebook group love it or

00:24:18.002 --> 00:24:20.163
not it kind of depends on how people

00:24:20.523 --> 00:24:22.423
like facebook and social media and things

00:24:22.463 --> 00:24:24.404
like that but there's a facebook group um

00:24:24.444 --> 00:24:25.846
called i think it's called pta

00:24:25.885 --> 00:24:28.666
professionals um and lots of really

00:24:28.747 --> 00:24:30.287
interesting information comes through

00:24:30.307 --> 00:24:32.367
there you can kind of see and feel

00:24:33.048 --> 00:24:37.051
like the stress points in PTs, PTAs,

00:24:37.092 --> 00:24:37.732
that kind of thing.

00:24:38.554 --> 00:24:39.894
But it's always interesting to me when

00:24:39.934 --> 00:24:41.436
people pop in like, hey,

00:24:41.457 --> 00:24:42.958
can I do X, Y, and Z?

00:24:43.419 --> 00:24:44.680
And me as an educator, I'm like,

00:24:44.720 --> 00:24:46.342
you got to go back to your state

00:24:46.382 --> 00:24:49.003
practice act and find out, you know,

00:24:49.023 --> 00:24:50.085
like in the state of Ohio,

00:24:50.506 --> 00:24:52.067
you're not going to find the word joint

00:24:52.106 --> 00:24:53.729
mobilization in our practice act.

00:24:53.788 --> 00:24:54.329
It's silent.

00:24:54.410 --> 00:24:55.170
It's not in there.

00:24:55.790 --> 00:24:58.732
So that opens up a whole other can

00:24:58.792 --> 00:24:59.594
of, you know,

00:24:59.634 --> 00:25:00.773
worms whenever it comes to the

00:25:00.814 --> 00:25:02.715
conversations about joint mobilizations

00:25:02.736 --> 00:25:04.297
with PTs and PTAs in the state of

00:25:04.336 --> 00:25:04.596
Ohio.

00:25:04.997 --> 00:25:05.738
But you can, like,

00:25:06.798 --> 00:25:08.038
type in the search bar and try to

00:25:08.058 --> 00:25:09.019
find joint mobilizations.

00:25:09.079 --> 00:25:09.799
It's not in there.

00:25:10.221 --> 00:25:10.861
So, you know,

00:25:10.881 --> 00:25:12.362
whenever I see people post those kind of

00:25:12.382 --> 00:25:13.143
things, I'm always like, man,

00:25:13.182 --> 00:25:14.544
you got to go back to your practice

00:25:14.624 --> 00:25:17.085
act and really kind of dive in and

00:25:17.105 --> 00:25:19.426
talk to somebody from your board.

00:25:19.787 --> 00:25:20.847
There's got to be somebody from your

00:25:20.907 --> 00:25:22.288
licensure board that can answer some

00:25:22.348 --> 00:25:23.148
questions for you.

00:25:23.429 --> 00:25:24.390
And that's what they're there for.

00:25:24.650 --> 00:25:25.471
You know, they serve.

00:25:26.817 --> 00:25:29.180
And just one last point in regard to

00:25:29.861 --> 00:25:31.501
is the friction perceived or real?

00:25:32.103 --> 00:25:33.544
We've been in environments where it's

00:25:33.624 --> 00:25:33.923
real.

00:25:34.263 --> 00:25:38.428
So we've seen it where a PTA or

00:25:38.448 --> 00:25:39.348
I'm sorry,

00:25:39.368 --> 00:25:44.272
a PT or a certain system doesn't

00:25:44.292 --> 00:25:47.454
appreciate the value of the PTA and

00:25:47.776 --> 00:25:51.419
doesn't respect them practicing at the top

00:25:51.439 --> 00:25:52.259
of their license.

00:25:52.940 --> 00:25:53.400
And so

00:25:54.659 --> 00:25:56.039
we try to alleviate that.

00:25:56.059 --> 00:25:57.019
We try to not have that be the

00:25:57.059 --> 00:25:57.401
case,

00:25:57.441 --> 00:25:59.241
but we certainly have seen places where it

00:25:59.281 --> 00:25:59.701
happens.

00:26:00.162 --> 00:26:02.983
And so we can understand why in some

00:26:03.023 --> 00:26:06.184
cases that perception actually is reality.

00:26:06.526 --> 00:26:08.086
But like anything else,

00:26:08.146 --> 00:26:10.008
if that's your environment, get out,

00:26:10.087 --> 00:26:10.307
right?

00:26:10.887 --> 00:26:12.549
So, yeah.

00:26:12.569 --> 00:26:14.551
So I guess what I would like to

00:26:14.571 --> 00:26:16.335
kind of drop in right here right now

00:26:16.595 --> 00:26:18.356
is that if there's any students listening,

00:26:18.876 --> 00:26:19.818
these are the kind of things,

00:26:19.838 --> 00:26:21.099
these are the kind of conversations that

00:26:21.140 --> 00:26:22.240
you want to have with someone before

00:26:22.280 --> 00:26:22.961
you're getting hired.

00:26:23.583 --> 00:26:24.703
Whenever you're doing the interview

00:26:24.743 --> 00:26:25.164
process,

00:26:25.204 --> 00:26:27.366
how are you going to support me as

00:26:27.467 --> 00:26:28.608
a PT or a PTA?

00:26:29.789 --> 00:26:32.231
in my professional development because if

00:26:32.352 --> 00:26:35.453
you want your clinicians to to win um

00:26:35.574 --> 00:26:38.015
you're going to infuse every chance you

00:26:38.035 --> 00:26:40.135
get professional development or other kind

00:26:40.155 --> 00:26:42.538
of education to kind of make your team

00:26:42.577 --> 00:26:44.479
stronger so those are the kind of things

00:26:44.499 --> 00:26:45.720
that i always tell students i'm like you

00:26:45.740 --> 00:26:47.961
need to ask these things whenever you're

00:26:48.000 --> 00:26:50.442
taking your first job what does that look

00:26:50.482 --> 00:26:52.364
like for me how do you support the

00:26:52.423 --> 00:26:55.165
clinicians um the pts and ptas so that

00:26:55.185 --> 00:26:57.186
they can be better for your patients right

00:26:57.207 --> 00:26:58.827
yeah absolutely

00:27:00.239 --> 00:27:01.159
Yeah.

00:27:01.259 --> 00:27:02.220
Another interesting thing.

00:27:02.279 --> 00:27:03.220
And honestly,

00:27:03.579 --> 00:27:05.240
this conversation has went in so many

00:27:05.280 --> 00:27:06.000
different directions.

00:27:06.441 --> 00:27:07.961
I'm not even on like the pattern that

00:27:08.061 --> 00:27:09.122
I had initially, you know,

00:27:09.162 --> 00:27:10.221
kind of outlined in my head.

00:27:10.261 --> 00:27:12.823
But you mentioned the extenders.

00:27:13.482 --> 00:27:14.943
And I was just having this conversation

00:27:14.963 --> 00:27:16.064
with somebody the other day.

00:27:16.864 --> 00:27:18.244
When you go to the dentist.

00:27:19.144 --> 00:27:20.945
how long do you see the dentist?

00:27:21.705 --> 00:27:23.287
I think I see the dentist for about

00:27:23.346 --> 00:27:24.186
forty five seconds.

00:27:24.247 --> 00:27:24.487
Right.

00:27:25.007 --> 00:27:26.688
But I see a lot of other great

00:27:26.728 --> 00:27:29.169
providers that take very good care of my

00:27:29.229 --> 00:27:31.710
teeth and my my dental health and all

00:27:31.750 --> 00:27:32.430
of those things.

00:27:32.490 --> 00:27:32.770
Right.

00:27:33.611 --> 00:27:36.491
So we are building in these ways to

00:27:36.571 --> 00:27:38.012
support our health care system.

00:27:38.673 --> 00:27:38.792
Now,

00:27:38.833 --> 00:27:40.574
I know dentistry has a lot of other

00:27:40.594 --> 00:27:41.013
things that

00:27:41.673 --> 00:27:44.195
maybe we can learn from um you know

00:27:44.316 --> 00:27:46.416
or or not I'm not so sure but

00:27:46.797 --> 00:27:49.417
nurse practitioner I don't remember the

00:27:49.458 --> 00:27:51.519
last time I've seen a physician I have

00:27:51.558 --> 00:27:55.000
seen a nurse practitioner for years so you

00:27:55.020 --> 00:27:57.122
know it just kind of it can work

00:27:57.742 --> 00:27:59.864
um and I have full trust in these

00:27:59.923 --> 00:28:01.904
extenders right you know I've always

00:28:01.964 --> 00:28:04.086
received good care so um I think it's

00:28:04.125 --> 00:28:05.626
a very interesting parallel that we

00:28:07.448 --> 00:28:08.648
that we got going on there too.

00:28:08.709 --> 00:28:10.750
So, all right, so next question,

00:28:10.810 --> 00:28:11.651
reality check.

00:28:11.750 --> 00:28:13.432
I would really like it if you guys

00:28:13.451 --> 00:28:16.674
can kind of give us what this outpatient

00:28:16.714 --> 00:28:18.155
physical therapy looks like right now.

00:28:18.395 --> 00:28:20.497
So here you are in twenty twenty six,

00:28:20.538 --> 00:28:22.499
your private practice clinic owners.

00:28:23.180 --> 00:28:25.781
what is outpatient PT really like right

00:28:25.821 --> 00:28:26.063
now?

00:28:26.403 --> 00:28:28.224
And how does this regulation help or

00:28:28.265 --> 00:28:29.306
change that reality?

00:28:29.665 --> 00:28:31.428
So you can dive into all kinds of

00:28:31.468 --> 00:28:35.051
topics, staffing, reimbursement, burnout,

00:28:35.211 --> 00:28:35.952
sustainability.

00:28:35.992 --> 00:28:38.035
So like, where are we?

00:28:38.095 --> 00:28:39.256
What's going on right now in private

00:28:39.296 --> 00:28:39.676
practice?

00:28:39.696 --> 00:28:40.998
All of the above.

00:28:41.038 --> 00:28:42.038
So yeah, I mean,

00:28:42.220 --> 00:28:45.021
I think every place would tell you,

00:28:46.299 --> 00:28:49.261
So we struggle in New York state.

00:28:49.382 --> 00:28:51.203
So lowest-paid state,

00:28:51.544 --> 00:28:54.605
lowest-paid region for outpatient PT is

00:28:54.645 --> 00:28:55.145
where we live.

00:28:56.366 --> 00:28:57.807
Cost of living is also very low,

00:28:57.948 --> 00:28:59.650
to clear transparency.

00:29:00.170 --> 00:29:01.550
I actually, I don't even know why,

00:29:01.590 --> 00:29:03.291
but the other day I Alexa'd and said,

00:29:03.332 --> 00:29:04.913
hey, Alexa, why would anyone live in,

00:29:05.012 --> 00:29:06.114
and I said the name of my town,

00:29:06.374 --> 00:29:06.954
which is tiny.

00:29:07.434 --> 00:29:08.976
Because I was like, they know everything.

00:29:08.996 --> 00:29:09.676
What would they say?

00:29:10.037 --> 00:29:11.458
And they're like, a community feel,

00:29:12.198 --> 00:29:13.219
low cost of living.

00:29:15.345 --> 00:29:18.306
outdoor access nature like whatever so

00:29:18.807 --> 00:29:21.087
okay i mean to me it's like you

00:29:21.127 --> 00:29:23.188
joke because i'm born and raised here you

00:29:23.208 --> 00:29:24.788
wouldn't no one would live here why would

00:29:24.808 --> 00:29:27.450
you live here but we do have a

00:29:27.490 --> 00:29:29.090
lower cost of living we do have these

00:29:29.250 --> 00:29:30.951
these wonderful things but a lot of that

00:29:30.991 --> 00:29:32.873
is really difficult for outpatient

00:29:32.893 --> 00:29:36.074
practice um a lot of other areas that

00:29:36.094 --> 00:29:37.694
would be rural or have um

00:29:39.234 --> 00:29:40.836
some of the things or struggles we have,

00:29:41.195 --> 00:29:42.175
you can also get paid a lot of

00:29:42.215 --> 00:29:44.416
money that is not Western New York.

00:29:44.876 --> 00:29:47.397
So, you know, you mentioned staffing,

00:29:47.417 --> 00:29:48.419
you mentioned retention,

00:29:48.439 --> 00:29:49.278
you mentioned burnout,

00:29:49.338 --> 00:29:50.200
like all of those things.

00:29:50.279 --> 00:29:51.799
We struggle with all of those issues every

00:29:51.839 --> 00:29:52.279
single day.

00:29:52.740 --> 00:29:54.201
They are probably the top,

00:29:54.641 --> 00:29:55.362
every word you said,

00:29:55.521 --> 00:29:56.981
we talk about each one of those things

00:29:57.001 --> 00:29:57.603
at least once a day.

00:29:58.303 --> 00:29:58.442
Um,

00:29:59.651 --> 00:30:02.011
recruitment is super difficult because we

00:30:02.051 --> 00:30:05.634
are so rural and it turns out that

00:30:05.673 --> 00:30:07.414
when you're established somewhere you're

00:30:07.434 --> 00:30:08.134
not going to pick up and move your

00:30:08.154 --> 00:30:09.695
whole family and when you're not

00:30:09.736 --> 00:30:11.277
established somewhere you don't

00:30:11.317 --> 00:30:13.337
necessarily want to live in a place with

00:30:13.458 --> 00:30:15.578
you know the most excitement is that we

00:30:15.598 --> 00:30:18.240
have a white man's um which is a

00:30:18.259 --> 00:30:20.921
great grocery store two thumbs up but um

00:30:22.402 --> 00:30:24.262
we certainly struggle with

00:30:25.123 --> 00:30:25.782
all of these things.

00:30:25.843 --> 00:30:27.222
And we do tend to think, OK,

00:30:27.364 --> 00:30:28.104
that's where we live.

00:30:28.564 --> 00:30:30.284
But then we are also involved nationally.

00:30:30.364 --> 00:30:32.105
So we've gone to Graham Sessions for the

00:30:32.125 --> 00:30:34.144
private practice section.

00:30:34.244 --> 00:30:36.965
We just came back from PPS in Orlando

00:30:36.986 --> 00:30:37.905
for private practice.

00:30:38.365 --> 00:30:40.646
And every private practice is saying the

00:30:40.686 --> 00:30:41.067
same thing.

00:30:41.886 --> 00:30:43.186
And we giggle to ourselves because it's

00:30:43.207 --> 00:30:43.487
like, well,

00:30:43.527 --> 00:30:45.067
we make sixty two dollars a visit.

00:30:45.167 --> 00:30:46.508
You make one hundred and twelve.

00:30:47.248 --> 00:30:48.868
you think you got it bad, you know,

00:30:48.969 --> 00:30:50.190
because you're always comparing,

00:30:50.269 --> 00:30:51.150
but they do, you know,

00:30:51.170 --> 00:30:51.990
we're all struggling.

00:30:52.111 --> 00:30:53.932
So I would say generally across the board,

00:30:54.291 --> 00:30:56.673
there is a struggle and outpatient private

00:30:56.712 --> 00:30:57.913
practice for sure.

00:30:59.394 --> 00:31:00.035
For us,

00:31:00.414 --> 00:31:01.615
each and every one of those things you

00:31:01.655 --> 00:31:02.537
mentioned are difficult.

00:31:02.636 --> 00:31:04.877
It's hard to retain.

00:31:06.378 --> 00:31:08.779
We, because of burnout, you know,

00:31:09.059 --> 00:31:11.060
we just learned this better at remembering

00:31:11.080 --> 00:31:11.501
the numbers.

00:31:12.162 --> 00:31:12.923
I am not good at numbers.

00:31:13.363 --> 00:31:14.423
So I'll have a lot of time to

00:31:14.443 --> 00:31:14.923
speak to it,

00:31:14.983 --> 00:31:17.165
but about what happened in COVID.

00:31:17.465 --> 00:31:17.586
So.

00:31:17.946 --> 00:31:18.047
So,

00:31:18.086 --> 00:31:21.269
eleven percent of PTs and PTAs left the

00:31:21.289 --> 00:31:23.131
profession in twenty twenty one,

00:31:23.191 --> 00:31:23.632
I believe.

00:31:24.271 --> 00:31:26.433
And we currently have a ten percent

00:31:26.453 --> 00:31:27.674
deficit in hiring.

00:31:27.694 --> 00:31:29.876
So the people that left the profession for

00:31:29.896 --> 00:31:31.718
something totally entirely are the

00:31:31.738 --> 00:31:32.759
deficit.

00:31:32.999 --> 00:31:35.381
And so I would just kind of pick

00:31:35.401 --> 00:31:36.721
up where Megan left off and say,

00:31:37.603 --> 00:31:38.884
We've tried to address the things that we

00:31:38.923 --> 00:31:39.223
can.

00:31:39.443 --> 00:31:40.483
Number one, burnout.

00:31:41.805 --> 00:31:44.286
We used to run the typical thirty minute

00:31:44.306 --> 00:31:44.905
follow up,

00:31:45.346 --> 00:31:48.167
sixty minute evaluation schedule where the

00:31:48.188 --> 00:31:48.988
thirty minute follow up,

00:31:49.008 --> 00:31:50.769
they might be in the clinic for sixty

00:31:50.788 --> 00:31:52.490
to ninety minutes and you're billing

00:31:52.529 --> 00:31:54.691
concurrently doing all the things.

00:31:54.750 --> 00:31:57.051
But that schedule led to burnout because

00:31:57.071 --> 00:31:58.472
of the overlap between patients.

00:31:58.532 --> 00:31:59.932
And so we've moved to a forty minute

00:31:59.952 --> 00:32:00.993
scheduling model.

00:32:02.744 --> 00:32:05.945
That's been great for retention and to

00:32:06.205 --> 00:32:07.067
reduce burnout.

00:32:08.467 --> 00:32:11.888
But it also obviously impacts

00:32:11.929 --> 00:32:13.689
reimbursement because you're having less

00:32:13.729 --> 00:32:14.509
patients per day.

00:32:15.909 --> 00:32:19.349
um so even that came with its own

00:32:19.369 --> 00:32:21.089
challenge but you know our biggest

00:32:21.130 --> 00:32:22.630
challenge right now like megan said i

00:32:22.650 --> 00:32:26.230
would say is is recruitment and um you

00:32:26.270 --> 00:32:27.391
know some of it's a factor of

00:32:27.451 --> 00:32:30.031
reimbursement so this whole wheel is that

00:32:30.092 --> 00:32:32.132
every piece of the puzzle off the next

00:32:32.612 --> 00:32:34.113
and so if you're getting sixty one dollars

00:32:34.133 --> 00:32:37.472
a visit that's all you have to pay

00:32:37.492 --> 00:32:39.493
your people and so we you know if

00:32:39.594 --> 00:32:40.193
if they make

00:32:40.794 --> 00:32:43.055
eleven miles from where i live is the

00:32:43.095 --> 00:32:45.096
pennsylvania border they might make they

00:32:45.135 --> 00:32:46.797
might make ninety two dollars a visit on

00:32:46.876 --> 00:32:49.778
average eleven miles away where i'm making

00:32:49.837 --> 00:32:52.358
sixty one or sixty two and so if

00:32:52.499 --> 00:32:55.580
i'm making thirty percent more then i can

00:32:55.641 --> 00:32:58.682
pay my clinicians all or a portion of

00:32:58.721 --> 00:33:01.202
that to help recruit and retain them we

00:33:01.223 --> 00:33:02.804
don't have that and so it's very

00:33:02.844 --> 00:33:03.664
challenging and so

00:33:04.625 --> 00:33:05.965
I would say from a business model

00:33:06.006 --> 00:33:06.665
perspective,

00:33:07.266 --> 00:33:09.446
when you go to conferences like private

00:33:09.487 --> 00:33:10.287
practice section,

00:33:10.866 --> 00:33:12.748
everyone's looking at doing things

00:33:12.788 --> 00:33:13.228
differently.

00:33:13.708 --> 00:33:15.788
And so whether it's a cash model or

00:33:15.828 --> 00:33:17.970
you're adding, you know,

00:33:18.569 --> 00:33:21.570
different fee for service services outside

00:33:21.611 --> 00:33:23.951
of the insurance model or in addition,

00:33:23.991 --> 00:33:24.432
like for us,

00:33:24.471 --> 00:33:26.613
we do contract based work with schools and

00:33:27.093 --> 00:33:30.294
local businesses and ARC facilities.

00:33:30.814 --> 00:33:32.355
That's been a huge help to try to

00:33:32.474 --> 00:33:32.914
offset

00:33:34.154 --> 00:33:35.737
the difficulties of the brick and mortar

00:33:36.237 --> 00:33:39.720
outpatient clinic um so it's it's very

00:33:39.740 --> 00:33:43.021
challenging and I would say it's probably

00:33:43.363 --> 00:33:46.365
the most challenging it's been uh right

00:33:46.404 --> 00:33:49.166
now and I would hope that at some

00:33:49.186 --> 00:33:52.170
point we feel like we've hit the pinnacle

00:33:52.210 --> 00:33:53.711
of the challenge and that maybe it's

00:33:53.730 --> 00:33:55.132
things get a little bit easier at some

00:33:55.172 --> 00:33:57.394
point but I guess we'll see

00:33:58.757 --> 00:33:59.877
Sounds like you guys are doing all the

00:33:59.897 --> 00:34:00.479
right things, though.

00:34:00.499 --> 00:34:03.080
You're putting yourself in the rooms where

00:34:03.101 --> 00:34:04.982
the conversations are happening and you're

00:34:05.022 --> 00:34:06.704
getting yourself into proximity with other

00:34:07.144 --> 00:34:08.626
private practice owners and really just

00:34:08.646 --> 00:34:10.088
kind of brainstorming to kind of think

00:34:10.148 --> 00:34:13.170
outside the box because we keep relying on

00:34:13.211 --> 00:34:14.992
an old system, an old system that's...

00:34:16.034 --> 00:34:17.355
not going to sustain and not going to

00:34:17.375 --> 00:34:19.996
do us any favors long term, right?

00:34:20.036 --> 00:34:21.237
So we got to kind of find a

00:34:21.277 --> 00:34:23.518
different way around all of these things.

00:34:24.398 --> 00:34:26.780
Tell me a little bit more about these

00:34:26.960 --> 00:34:27.539
contracts.

00:34:27.920 --> 00:34:28.900
So when you say contracts,

00:34:28.920 --> 00:34:31.422
like can you give our audience a little

00:34:31.442 --> 00:34:33.822
bit of a breakdown of what exactly this

00:34:33.902 --> 00:34:36.804
is that you're contracting to do and who

00:34:36.844 --> 00:34:38.146
are you sending into these contract

00:34:38.766 --> 00:34:39.106
settings?

00:34:39.126 --> 00:34:40.367
Okay.

00:34:40.407 --> 00:34:40.586
Yeah.

00:34:40.606 --> 00:34:41.987
So we'll give you three examples.

00:34:43.744 --> 00:34:46.925
One is a school-based model where we send

00:34:46.965 --> 00:34:49.867
a clinician into the school and all of

00:34:49.887 --> 00:34:51.427
the students that we see typically would

00:34:51.447 --> 00:34:52.349
have an IEP.

00:34:52.989 --> 00:34:55.329
And so they have some developmental

00:34:55.349 --> 00:34:57.351
disability where we're working with those

00:34:57.391 --> 00:35:00.172
students to help bring their gross motor

00:35:00.211 --> 00:35:01.193
skills up to par.

00:35:01.693 --> 00:35:03.315
And in order to qualify to have an

00:35:03.375 --> 00:35:03.894
IEP,

00:35:05.097 --> 00:35:07.659
they would have to have some physical

00:35:07.739 --> 00:35:10.181
issue that caused them to be less

00:35:10.222 --> 00:35:11.844
interactive with their school environment

00:35:11.864 --> 00:35:13.164
to the point where it was a detriment

00:35:13.204 --> 00:35:15.547
to their educational process.

00:35:15.887 --> 00:35:16.929
So that's one example.

00:35:17.989 --> 00:35:20.351
Basically, to achieve a model like that,

00:35:20.391 --> 00:35:23.534
you would speak with the CSE, principal,

00:35:23.614 --> 00:35:24.414
superintendent,

00:35:24.853 --> 00:35:26.576
come to terms on a contract where,

00:35:26.675 --> 00:35:26.876
you know,

00:35:26.916 --> 00:35:28.737
you pay us X dollars per hour.

00:35:29.157 --> 00:35:30.777
We'll see your students that have these

00:35:30.818 --> 00:35:31.237
needs.

00:35:31.719 --> 00:35:33.360
And it's basically just a fee-for-service

00:35:33.400 --> 00:35:34.159
contract model.

00:35:34.340 --> 00:35:35.181
So that's one model.

00:35:35.681 --> 00:35:37.481
One thing about that model and a reason

00:35:37.501 --> 00:35:39.023
why it really works for us is because

00:35:39.043 --> 00:35:39.884
we do live early.

00:35:40.224 --> 00:35:41.284
Our school districts are small.

00:35:41.844 --> 00:35:42.746
I was just going to say,

00:35:42.786 --> 00:35:44.226
you might have a small school district,

00:35:44.266 --> 00:35:44.467
huh?

00:35:45.050 --> 00:35:45.331
Yeah.

00:35:45.411 --> 00:35:46.411
And so if you have a small school

00:35:46.431 --> 00:35:46.751
district,

00:35:46.771 --> 00:35:50.052
you can't afford or have nowhere near the

00:35:50.092 --> 00:35:52.494
work required of having a full-time PT.

00:35:53.014 --> 00:35:56.034
So this allows them to have all the

00:35:56.114 --> 00:35:57.375
access to care that they need.

00:35:57.496 --> 00:35:59.335
So students are being serviced.

00:35:59.936 --> 00:36:01.356
And some of the school contracts we've

00:36:01.376 --> 00:36:01.996
done in prior,

00:36:02.036 --> 00:36:03.378
like there had been no PT in that

00:36:03.398 --> 00:36:05.918
school for a year or two years or

00:36:05.978 --> 00:36:06.478
whatever it may be.

00:36:06.498 --> 00:36:06.679
Wow.

00:36:07.478 --> 00:36:08.539
it's three or four kids.

00:36:09.519 --> 00:36:09.880
You know,

00:36:10.280 --> 00:36:11.760
we do have some bigger contracts where

00:36:11.780 --> 00:36:12.920
it's three full days a week,

00:36:13.239 --> 00:36:14.661
but even three full days is not five

00:36:14.701 --> 00:36:15.141
full days.

00:36:15.581 --> 00:36:18.521
So we can work all together and put

00:36:18.561 --> 00:36:20.101
in a clinician who is interested in doing

00:36:20.121 --> 00:36:21.822
that and happy to be in that position

00:36:22.322 --> 00:36:24.922
and allow children in a thirty mile,

00:36:24.963 --> 00:36:25.523
forty mile,

00:36:25.563 --> 00:36:28.123
fifty mile radius to get the services that

00:36:28.143 --> 00:36:28.583
they need.

00:36:29.083 --> 00:36:30.804
Whereas the school district can't afford

00:36:31.065 --> 00:36:33.085
to have a PT full time to see

00:36:33.224 --> 00:36:34.184
five kids twice a week.

00:36:34.204 --> 00:36:35.186
I mean,

00:36:35.246 --> 00:36:36.565
it just literally doesn't make any sense.

00:36:38.362 --> 00:36:40.324
So the second model is an occupational

00:36:40.344 --> 00:36:42.563
medicine model where even though we're

00:36:42.583 --> 00:36:42.884
rural,

00:36:42.903 --> 00:36:44.585
we actually have the number one rail car

00:36:44.605 --> 00:36:45.605
maker in the world here.

00:36:46.184 --> 00:36:49.045
And so we have a contract with them

00:36:49.105 --> 00:36:50.905
where we provide ergonomic assessments.

00:36:50.945 --> 00:36:53.626
And we also might go in to try

00:36:53.666 --> 00:36:55.726
to prevent injury with them again on a

00:36:55.786 --> 00:36:56.706
contract basis.

00:36:57.186 --> 00:36:58.567
And basically in that contract,

00:36:58.586 --> 00:37:00.507
you'd be talking to their health and

00:37:00.527 --> 00:37:01.507
safety team.

00:37:02.188 --> 00:37:03.971
to establish number one,

00:37:03.990 --> 00:37:06.293
your value and what you can bring to

00:37:06.333 --> 00:37:09.719
the company and then sell them on the

00:37:09.739 --> 00:37:10.159
service.

00:37:10.239 --> 00:37:13.103
And hopefully it's reduced workers

00:37:13.143 --> 00:37:14.365
compensation injuries,

00:37:15.126 --> 00:37:16.449
reduced workplace hazard.

00:37:17.210 --> 00:37:18.510
improved efficiency in terms of

00:37:18.570 --> 00:37:19.090
ergonomics.

00:37:19.110 --> 00:37:20.871
So that would be kind of that model.

00:37:21.472 --> 00:37:24.574
And then the third model has been actually

00:37:25.456 --> 00:37:27.016
one of our best recently in the last

00:37:27.036 --> 00:37:29.398
couple of years where we're doing work

00:37:29.478 --> 00:37:33.141
with ARCs and we're seeing adults with

00:37:33.481 --> 00:37:34.661
developmental disabilities.

00:37:34.681 --> 00:37:37.463
And this is a population

00:37:38.023 --> 00:37:40.505
who is extremely underserved.

00:37:40.905 --> 00:37:42.827
It's very difficult for them to find

00:37:42.887 --> 00:37:46.630
providers and it's really a niche that

00:37:46.650 --> 00:37:48.490
we've fallen into that we really enjoy.

00:37:49.251 --> 00:37:51.594
It really gives our clinicians great

00:37:51.614 --> 00:37:54.335
satisfaction and it gives the individuals

00:37:54.356 --> 00:37:57.257
that we see great satisfaction and a great

00:37:57.277 --> 00:37:58.297
service that they really need.

00:37:58.398 --> 00:38:01.601
So those have been really helpful to try

00:38:01.641 --> 00:38:03.181
to offset some of the difficulties we've

00:38:03.222 --> 00:38:04.782
been having in the outpatient environment.

00:38:05.376 --> 00:38:06.516
And if you look at, you know,

00:38:06.556 --> 00:38:07.836
who's providing these services,

00:38:07.856 --> 00:38:09.057
because you kind of mentioned that when we

00:38:09.097 --> 00:38:13.579
started, is the answer is both PTAs.

00:38:14.601 --> 00:38:17.181
So more specifically, in New York State,

00:38:17.222 --> 00:38:17.922
in the school,

00:38:18.063 --> 00:38:21.264
we have utilized PTA in the school,

00:38:21.523 --> 00:38:24.106
but because of the supervision need,

00:38:24.126 --> 00:38:26.126
it's more difficult, right?

00:38:26.146 --> 00:38:27.748
So then they have schedules,

00:38:27.768 --> 00:38:28.648
and they're coming from different

00:38:28.668 --> 00:38:29.128
directions.

00:38:29.168 --> 00:38:30.028
And are they carpooling?

00:38:30.088 --> 00:38:30.969
Are they not carpooling?

00:38:30.989 --> 00:38:31.449
Right, yeah.

00:38:32.503 --> 00:38:32.623
well,

00:38:32.643 --> 00:38:34.282
this person was at a school here and

00:38:34.302 --> 00:38:35.664
this person was at this clinic and how

00:38:35.684 --> 00:38:38.023
do we make those ends meet?

00:38:38.884 --> 00:38:40.764
So I can see that becoming easier,

00:38:40.965 --> 00:38:41.724
which would be great.

00:38:43.065 --> 00:38:45.565
And then also when we're the work with

00:38:45.585 --> 00:38:46.206
the ARC,

00:38:46.585 --> 00:38:50.007
we very consistently have a PTA because

00:38:50.086 --> 00:38:52.067
the restriction or the regulations is much

00:38:52.106 --> 00:38:53.047
easier in that setting.

00:38:53.847 --> 00:38:55.708
So we have one of our PTAs who

00:38:56.407 --> 00:38:59.648
works with us and Jeremy and I are

00:38:59.708 --> 00:39:01.568
the providers in those contracts as far as

00:39:01.588 --> 00:39:02.228
PT goes.

00:39:02.688 --> 00:39:04.309
So we have a PTA that works closely

00:39:04.329 --> 00:39:07.251
with us and like last week we saw

00:39:07.411 --> 00:39:09.251
all the people on one of the ARCs

00:39:09.291 --> 00:39:10.472
and next week she'll be seeing them.

00:39:10.572 --> 00:39:12.414
So we won't be in the building.

00:39:12.434 --> 00:39:13.353
We don't have to be in the building

00:39:13.454 --> 00:39:15.956
because that type of care was already

00:39:16.036 --> 00:39:17.675
outside of the loop of having to have

00:39:17.695 --> 00:39:18.516
direct supervision.

00:39:19.056 --> 00:39:20.697
So that's kind of been like the taste

00:39:20.737 --> 00:39:22.039
of it for us that we've had for

00:39:22.079 --> 00:39:23.000
years where we're like, well,

00:39:23.019 --> 00:39:23.681
this is great.

00:39:23.721 --> 00:39:25.021
Why can't it all be like this?

00:39:25.081 --> 00:39:26.282
Because, you know,

00:39:26.322 --> 00:39:28.224
she's and she's communicating with us.

00:39:28.784 --> 00:39:30.246
I don't need to be in the building.

00:39:30.306 --> 00:39:30.545
I mean,

00:39:30.606 --> 00:39:33.047
she's every day when she's done sends a

00:39:33.088 --> 00:39:34.548
big email and, you know,

00:39:34.688 --> 00:39:35.889
outlines information.

00:39:36.289 --> 00:39:37.451
If she has a question, she texts us.

00:39:37.490 --> 00:39:38.152
She calls us.

00:39:38.672 --> 00:39:40.534
You know, I see someone and say, OK,

00:39:40.574 --> 00:39:41.653
next week I want you to give them

00:39:41.673 --> 00:39:43.536
this home exercise program print out like,

00:39:43.556 --> 00:39:44.335
you know, so and so.

00:39:44.376 --> 00:39:45.217
Yep, I know so and so.

00:39:45.257 --> 00:39:46.157
OK, give them this.

00:39:46.478 --> 00:39:47.438
Let me know how it goes.

00:39:48.099 --> 00:39:50.320
none of that requires me to physically be

00:39:50.340 --> 00:39:52.280
standing there watching her provide care.

00:39:52.400 --> 00:39:53.501
Right.

00:39:53.521 --> 00:39:53.960
I love her.

00:39:54.440 --> 00:39:56.161
She does a great job and her,

00:39:56.561 --> 00:39:58.262
our level of communication and partnership

00:39:58.302 --> 00:40:01.222
and a team in that setting is exceptional.

00:40:01.503 --> 00:40:02.342
So, you know,

00:40:02.463 --> 00:40:03.483
that kind of gives you a taste of

00:40:03.523 --> 00:40:04.003
like, okay, this is,

00:40:04.463 --> 00:40:06.184
this is going to be so much better

00:40:06.204 --> 00:40:07.804
if we can push that forward into the

00:40:07.844 --> 00:40:08.405
school districts,

00:40:08.445 --> 00:40:09.425
if we can push it forward into

00:40:09.465 --> 00:40:11.425
occupational medicine and certainly in

00:40:11.445 --> 00:40:12.306
that setting.

00:40:13.686 --> 00:40:14.126
Yeah,

00:40:14.467 --> 00:40:16.268
I love everything about each one of these

00:40:16.307 --> 00:40:16.788
contracts.

00:40:16.847 --> 00:40:20.231
I think that they're a great addition for

00:40:20.311 --> 00:40:21.291
rural care.

00:40:21.471 --> 00:40:24.474
You know, I myself, I live very rural.

00:40:24.594 --> 00:40:26.434
I used to work in a very rural

00:40:26.514 --> 00:40:28.996
outpatient hospital based practice.

00:40:29.597 --> 00:40:31.639
And we did very similar things to this

00:40:31.980 --> 00:40:32.840
twenty years ago.

00:40:33.161 --> 00:40:37.887
But that was not necessarily out of a

00:40:37.967 --> 00:40:38.367
need.

00:40:38.929 --> 00:40:39.889
I don't want to say it was like

00:40:40.831 --> 00:40:42.554
a financial or sustainability model.

00:40:42.634 --> 00:40:44.155
It was because our patients didn't have

00:40:44.315 --> 00:40:44.757
access to

00:40:45.177 --> 00:40:45.336
Right.

00:40:45.637 --> 00:40:46.838
So this was, you know,

00:40:46.878 --> 00:40:48.137
twenty some years ago,

00:40:48.677 --> 00:40:50.077
our patients would come to us and say,

00:40:50.117 --> 00:40:53.199
can you provide PT for my infant?

00:40:53.259 --> 00:40:55.179
Because I cannot afford to drive to the

00:40:55.219 --> 00:40:56.800
next big city an hour away.

00:40:57.141 --> 00:40:58.400
I don't have transportation.

00:40:59.300 --> 00:41:00.782
And so we really did try to make

00:41:00.822 --> 00:41:03.282
ourselves very versatile in what we

00:41:03.402 --> 00:41:03.702
offered.

00:41:04.202 --> 00:41:07.003
We did a contract with a local facility

00:41:07.063 --> 00:41:08.583
to do aquatic physical therapy.

00:41:09.563 --> 00:41:12.606
closed down a hotel who had a pool,

00:41:12.985 --> 00:41:14.646
they would block it just for our patients.

00:41:14.666 --> 00:41:16.407
So we maintained confidentiality and

00:41:16.447 --> 00:41:16.726
everything.

00:41:16.766 --> 00:41:18.748
Now there was all kinds of other things

00:41:18.768 --> 00:41:19.829
that came along with that too.

00:41:20.668 --> 00:41:22.510
We did the school-based contract as well.

00:41:22.570 --> 00:41:23.931
We had a home health contract.

00:41:24.570 --> 00:41:24.971
But again,

00:41:25.550 --> 00:41:27.572
it was out of the necessity that our

00:41:27.612 --> 00:41:30.414
patients didn't have access to those

00:41:30.534 --> 00:41:30.994
things.

00:41:31.514 --> 00:41:34.016
Now, access has improved in twenty years.

00:41:35.016 --> 00:41:37.137
Slightly not great,

00:41:37.518 --> 00:41:38.900
but it has improved a little bit.

00:41:39.639 --> 00:41:41.001
But the fact that you guys are doing

00:41:41.021 --> 00:41:43.063
this because of several different reasons,

00:41:43.422 --> 00:41:43.603
I mean,

00:41:43.623 --> 00:41:45.123
that says a lot about your your

00:41:45.164 --> 00:41:45.704
creativity,

00:41:45.804 --> 00:41:48.387
your innovation to drive your practice

00:41:48.407 --> 00:41:48.806
forward.

00:41:49.688 --> 00:41:52.128
This is only going to benefit everybody in

00:41:52.168 --> 00:41:53.150
the long run, right?

00:41:54.190 --> 00:41:54.570
We hope so.

00:41:56.041 --> 00:41:56.780
Yeah, definitely.

00:41:57.481 --> 00:41:59.902
So tell me a little bit about mentorship.

00:42:00.362 --> 00:42:01.503
So mentorship,

00:42:01.583 --> 00:42:02.643
I know you guys have already kind of

00:42:02.704 --> 00:42:04.304
talked and touched base on this a little

00:42:04.344 --> 00:42:08.367
bit as to how you value your clinicians

00:42:08.407 --> 00:42:10.088
and how you want to elevate them.

00:42:10.447 --> 00:42:12.268
But how does mentorship and leadership

00:42:12.309 --> 00:42:15.731
development evolve for both PTs and PTAs?

00:42:16.231 --> 00:42:18.751
And if this model is going to work

00:42:18.791 --> 00:42:19.992
well, like what does that look like?

00:42:21.722 --> 00:42:22.001
Yeah.

00:42:22.103 --> 00:42:24.563
So he pointed at me because that's those

00:42:24.585 --> 00:42:26.626
are sort of my main areas of focus

00:42:26.706 --> 00:42:27.907
and just stuff that I'm really.

00:42:27.947 --> 00:42:30.208
It's your bread and butter, huh?

00:42:30.228 --> 00:42:31.469
That I care about and that I find

00:42:31.510 --> 00:42:32.471
to be like rewarding.

00:42:34.291 --> 00:42:37.175
So as far as mentorship, I would say,

00:42:37.215 --> 00:42:37.675
first off,

00:42:37.695 --> 00:42:39.295
like we love hiring new professionals.

00:42:40.496 --> 00:42:43.500
It is wonderful to have someone with a

00:42:43.539 --> 00:42:44.199
clean slate.

00:42:44.300 --> 00:42:45.942
It is wonderful to have someone who is

00:42:46.021 --> 00:42:47.882
passionate about, you know,

00:42:47.943 --> 00:42:49.583
they just finished and they're so excited

00:42:49.623 --> 00:42:49.945
to work.

00:42:50.849 --> 00:42:52.411
I will also say that our longest standing

00:42:52.431 --> 00:42:53.731
employees that have been with us nine and

00:42:53.771 --> 00:42:55.472
ten years were new professionals, right?

00:42:55.552 --> 00:42:57.793
So they started with us as babies and

00:42:57.853 --> 00:42:59.813
now they're like seasoned professionals

00:42:59.893 --> 00:43:00.574
and, you know,

00:43:00.594 --> 00:43:02.735
getting gray hair and having children and

00:43:02.755 --> 00:43:05.115
doing all these things that we watched

00:43:05.235 --> 00:43:07.277
them progress through.

00:43:07.797 --> 00:43:09.757
So formally,

00:43:12.148 --> 00:43:13.568
We've always mentored, you know,

00:43:13.610 --> 00:43:14.851
and that's why these people are still with

00:43:14.931 --> 00:43:15.251
us, right?

00:43:15.291 --> 00:43:16.972
Because they felt like they had a

00:43:17.112 --> 00:43:18.534
relationship where they could grow and

00:43:19.195 --> 00:43:20.436
sustain and change over the years and

00:43:20.476 --> 00:43:22.918
still feel like they were being rewarded

00:43:23.018 --> 00:43:24.641
in the best way possible.

00:43:25.501 --> 00:43:27.063
We have more recently in the last few

00:43:27.083 --> 00:43:29.646
years come up with a more formalized

00:43:29.666 --> 00:43:30.686
mentorship program.

00:43:30.806 --> 00:43:31.567
So we...

00:43:32.347 --> 00:43:33.909
We've heard the need for it.

00:43:34.030 --> 00:43:34.251
You know,

00:43:34.291 --> 00:43:35.452
people are asking those questions.

00:43:35.472 --> 00:43:36.574
You say the students, you know,

00:43:36.594 --> 00:43:37.916
they are told, like, ask about this.

00:43:37.976 --> 00:43:39.318
It matters because it does matter.

00:43:40.820 --> 00:43:42.402
So we basically use the same program,

00:43:42.422 --> 00:43:43.824
whether it's a PT or PTA.

00:43:44.344 --> 00:43:46.086
It's easy for us to do that because

00:43:46.106 --> 00:43:47.369
we have really strong PTAs.

00:43:47.838 --> 00:43:48.559
So, you know,

00:43:48.579 --> 00:43:50.081
we have one of our long-term employees is

00:43:50.101 --> 00:43:50.461
a PTA,

00:43:50.862 --> 00:43:54.806
so she can very easily be a mentor.

00:43:55.407 --> 00:43:57.068
She practices PT,

00:43:57.108 --> 00:43:58.269
but she also does a lot of stuff

00:43:58.289 --> 00:43:59.550
for us that's administrative.

00:43:59.610 --> 00:44:01.152
Like she understands insurance.

00:44:01.193 --> 00:44:03.514
She understands, you know,

00:44:03.614 --> 00:44:05.177
if the phone is ringing and everyone's

00:44:05.197 --> 00:44:05.777
stressed out,

00:44:05.836 --> 00:44:07.139
like she's the first person who can answer

00:44:07.159 --> 00:44:07.498
the phone.

00:44:08.059 --> 00:44:09.420
and be like, yeah, I got it.

00:44:09.619 --> 00:44:11.001
And it's hysterical because I'm like,

00:44:11.021 --> 00:44:12.362
some of the PTs are like, oh,

00:44:12.382 --> 00:44:13.121
get into the phone.

00:44:13.563 --> 00:44:15.023
And the PTA is like, I got it.

00:44:15.123 --> 00:44:15.864
I can answer the phone.

00:44:15.923 --> 00:44:16.784
I can treat this person.

00:44:16.864 --> 00:44:18.545
I can answer somebody else's question

00:44:18.565 --> 00:44:19.686
about insurance authorization.

00:44:19.746 --> 00:44:20.266
I can do it all.

00:44:20.806 --> 00:44:22.608
So when we hire someone,

00:44:22.768 --> 00:44:24.449
we certainly have a structured program

00:44:24.469 --> 00:44:25.409
where within the first week,

00:44:25.429 --> 00:44:26.210
they're meeting with us.

00:44:26.570 --> 00:44:28.172
They're meeting with their mentor the

00:44:28.231 --> 00:44:32.134
first day, day one in reviewing goals,

00:44:32.193 --> 00:44:33.614
establishing that relationship.

00:44:34.014 --> 00:44:35.775
We have weekly check-ins for, I think,

00:44:35.835 --> 00:44:36.577
the first...

00:44:37.117 --> 00:44:38.318
month i'd have to look at it formally

00:44:38.340 --> 00:44:41.003
because we we're not in hiring we aren't

00:44:41.023 --> 00:44:42.987
in a window of hiring right now um

00:44:43.007 --> 00:44:45.632
because we can't find anyone but um we

00:44:45.692 --> 00:44:46.193
certainly

00:44:47.112 --> 00:44:48.253
I think it's the first month they're

00:44:48.273 --> 00:44:49.715
meeting once a week.

00:44:49.755 --> 00:44:51.297
Then we cut down to every other week.

00:44:51.577 --> 00:44:53.898
We do quarterly check-ins with the whole

00:44:53.918 --> 00:44:54.199
group.

00:44:54.219 --> 00:44:55.400
So the new hire,

00:44:55.500 --> 00:44:56.922
the established clinician,

00:44:56.981 --> 00:44:58.402
and then also Jeremy and I,

00:45:00.063 --> 00:45:00.885
and kind of review this.

00:45:00.985 --> 00:45:02.306
These are the things that have come up

00:45:02.346 --> 00:45:03.666
about in our mentorship meetings.

00:45:03.686 --> 00:45:04.527
These are the things that we're

00:45:04.547 --> 00:45:05.128
progressing to.

00:45:05.148 --> 00:45:06.009
These are the goals that we've

00:45:06.048 --> 00:45:06.530
established.

00:45:06.550 --> 00:45:08.050
And we run that whole program for two

00:45:08.070 --> 00:45:08.351
years.

00:45:08.992 --> 00:45:10.612
So for two years, there are,

00:45:11.514 --> 00:45:13.697
initially weekly then bi-weekly then

00:45:13.757 --> 00:45:16.579
monthly then quarterly check-ins between

00:45:17.059 --> 00:45:19.722
the new employee whether they're a new

00:45:19.762 --> 00:45:22.365
professional or not and the established

00:45:22.385 --> 00:45:25.409
employee and then us as well um and

00:45:25.489 --> 00:45:28.112
everyone's path is different so we hired a

00:45:28.172 --> 00:45:31.956
pt during covid who had all covid

00:45:31.976 --> 00:45:32.356
clinicals

00:45:33.818 --> 00:45:36.362
And she was like excited to work local,

00:45:36.641 --> 00:45:39.284
you know, great, great opportunity for us,

00:45:39.304 --> 00:45:40.166
great opportunity for her.

00:45:40.186 --> 00:45:40.746
But she was like,

00:45:41.047 --> 00:45:42.708
I didn't see any outpatients during the

00:45:42.748 --> 00:45:44.010
outpatient clinical rotation.

00:45:44.110 --> 00:45:45.771
It was the summer of

00:45:47.346 --> 00:45:48.987
So we hired her and for eight weeks,

00:45:49.007 --> 00:45:50.608
she basically had like a student rotation.

00:45:50.929 --> 00:45:51.690
So for eight weeks,

00:45:51.730 --> 00:45:53.751
her mentor and she worked together for

00:45:53.871 --> 00:45:54.251
eight weeks.

00:45:54.512 --> 00:45:56.974
You know, she had no, no,

00:45:57.034 --> 00:45:58.615
no individual schedule at all.

00:45:59.076 --> 00:46:00.617
And then we started what our normal

00:46:00.657 --> 00:46:02.760
process would be for when we hire,

00:46:02.780 --> 00:46:03.960
when we start, you know,

00:46:03.981 --> 00:46:04.701
the first couple of weeks,

00:46:04.721 --> 00:46:05.641
you're not seeing anyone,

00:46:05.661 --> 00:46:06.922
you're working through these sorts of

00:46:06.963 --> 00:46:07.264
things.

00:46:08.224 --> 00:46:09.726
We hired a PTA who,

00:46:11.114 --> 00:46:12.916
was transferring a license and she had not

00:46:12.956 --> 00:46:14.617
worked professionally but was licensed in

00:46:14.637 --> 00:46:16.059
a different state and there was a lapse

00:46:16.099 --> 00:46:17.721
in time and like she came and just

00:46:17.762 --> 00:46:20.463
hung out she learned she basically acted

00:46:20.483 --> 00:46:23.367
like a tech but it allowed her the

00:46:23.387 --> 00:46:24.967
window to kind of front load some of

00:46:24.987 --> 00:46:26.190
those things you may have done in a

00:46:26.210 --> 00:46:27.411
window where she wasn't able to see any

00:46:27.471 --> 00:46:29.452
patients yet and we did that until she

00:46:29.492 --> 00:46:31.094
was able to actually have her license

00:46:31.114 --> 00:46:32.876
transferred and start interacting with um

00:46:33.436 --> 00:46:34.577
with patients so

00:46:35.523 --> 00:46:38.186
know we have a framework it isn't everyone

00:46:38.206 --> 00:46:41.429
doesn't always fit into it but we will

00:46:41.449 --> 00:46:43.632
do whatever is needed in order to get

00:46:43.692 --> 00:46:44.873
us out of that kind of same starting

00:46:44.913 --> 00:46:46.875
point and then from there on everyone has

00:46:46.894 --> 00:46:49.438
the same mentorship opportunity um and we

00:46:49.458 --> 00:46:51.300
do try to specifically pick like

00:46:51.539 --> 00:46:53.262
personality type or who you think someone

00:46:53.302 --> 00:46:54.402
might jive with or who they might be

00:46:54.422 --> 00:46:57.246
more comfortable interacting with um and

00:46:57.286 --> 00:46:57.445
make

00:46:58.094 --> 00:47:00.315
that fit a positive one from the start

00:47:00.456 --> 00:47:02.597
so that people feel like they can go

00:47:02.617 --> 00:47:04.896
to their mentor every second you know not

00:47:04.916 --> 00:47:06.757
just during a once weekly meeting that

00:47:06.838 --> 00:47:08.057
that doesn't work you have to have a

00:47:08.117 --> 00:47:09.739
person that you can outreach to when you

00:47:09.759 --> 00:47:10.998
need it and when you need the support

00:47:11.018 --> 00:47:14.661
and the formal length process is twenty

00:47:14.681 --> 00:47:16.260
four months but it doesn't end there i

00:47:16.340 --> 00:47:17.961
just wanted to add that yeah for sure

00:47:18.021 --> 00:47:20.023
it is in perpetuity as long as they're

00:47:20.043 --> 00:47:20.983
both employees yeah so

00:47:21.652 --> 00:47:22.853
So you said twenty four months.

00:47:23.333 --> 00:47:24.856
Twenty four months is like a formal.

00:47:25.115 --> 00:47:25.916
Yeah, it was a formal.

00:47:25.936 --> 00:47:27.557
So for two full years,

00:47:27.717 --> 00:47:28.778
you're going to have somebody in your

00:47:28.818 --> 00:47:29.059
corner.

00:47:29.079 --> 00:47:29.159
Yeah.

00:47:29.900 --> 00:47:30.740
Yeah.

00:47:30.840 --> 00:47:31.942
Mm hmm.

00:47:31.961 --> 00:47:32.161
Yeah.

00:47:32.242 --> 00:47:33.402
And you can tell who was mentored by

00:47:33.443 --> 00:47:33.663
who.

00:47:33.802 --> 00:47:34.264
You know what I mean?

00:47:34.304 --> 00:47:37.085
You can tell who who was someone's mentor.

00:47:37.106 --> 00:47:38.067
You can tell in their personal

00:47:38.106 --> 00:47:38.748
relationships.

00:47:38.768 --> 00:47:40.048
You can tell and who they go to

00:47:40.068 --> 00:47:41.130
first to ask questions.

00:47:41.530 --> 00:47:42.210
You can tell it in.

00:47:43.518 --> 00:47:44.940
bought somebody's baby an extra present

00:47:44.960 --> 00:47:46.380
you could you know you could all those

00:47:46.400 --> 00:47:49.442
things because it's a relationship so yeah

00:47:49.541 --> 00:47:52.184
yeah definitely um yeah i mean i i

00:47:52.244 --> 00:47:54.284
have to say that i would not be

00:47:54.465 --> 00:47:56.166
or have had the opportunities that i've

00:47:56.206 --> 00:47:59.407
had had it not been for very specific

00:47:59.447 --> 00:48:02.188
mentors that were in my my path and

00:48:02.228 --> 00:48:05.411
my journey um and you know you mentioned

00:48:05.951 --> 00:48:07.612
that you guys have been to graham sessions

00:48:07.632 --> 00:48:09.773
you mentioned pps and that you're um

00:48:09.913 --> 00:48:11.353
actively involved in your state and

00:48:11.434 --> 00:48:12.735
advocacy and all of these things

00:48:13.255 --> 00:48:16.356
And I don't I don't preach to the

00:48:16.456 --> 00:48:18.838
audience about being an association member

00:48:18.878 --> 00:48:20.000
so I can beat them over the head

00:48:20.019 --> 00:48:20.320
with it.

00:48:20.340 --> 00:48:21.360
That's not my goal.

00:48:22.661 --> 00:48:24.443
My goal is for them to understand the

00:48:24.483 --> 00:48:27.425
connection between especially I think for

00:48:27.465 --> 00:48:27.985
PTAs,

00:48:28.005 --> 00:48:30.327
there's a lot of benefit there if you

00:48:30.447 --> 00:48:30.987
seek it out.

00:48:32.668 --> 00:48:34.989
But by getting yourself closer and in the

00:48:35.030 --> 00:48:37.331
proximity of the people who have like

00:48:37.371 --> 00:48:40.012
minded and they have the same issues as

00:48:40.052 --> 00:48:41.233
you and they're going through the same

00:48:41.273 --> 00:48:41.614
things,

00:48:42.114 --> 00:48:43.894
I think that that positions you a lot

00:48:43.934 --> 00:48:47.197
better to kind of take things on or

00:48:47.237 --> 00:48:49.139
to find opportunity or to find that

00:48:49.179 --> 00:48:50.559
mentorship and that leadership.

00:48:51.420 --> 00:48:53.942
And that's what kind of drives it forward.

00:48:54.322 --> 00:48:54.681
So, yeah,

00:48:54.722 --> 00:48:56.103
it's not necessarily that I'm like, oh,

00:48:56.163 --> 00:48:57.423
you should be an association member

00:48:57.463 --> 00:48:58.664
because I say you should be one.

00:48:59.144 --> 00:49:00.887
It's because I have actually felt the

00:49:00.907 --> 00:49:01.306
benefit.

00:49:02.387 --> 00:49:04.568
My name has been brought up where it

00:49:04.648 --> 00:49:06.708
may have not originally been brought up.

00:49:06.829 --> 00:49:10.510
I've had doors open because of getting

00:49:10.610 --> 00:49:13.172
into the close proximity of the people

00:49:13.271 --> 00:49:13.771
around me.

00:49:14.512 --> 00:49:15.313
So to me,

00:49:15.733 --> 00:49:18.273
there is a tangible benefit to being a

00:49:18.313 --> 00:49:18.574
member.

00:49:19.494 --> 00:49:21.454
And I love seeing when we talked about

00:49:21.614 --> 00:49:24.235
advocacy and you said earlier something

00:49:24.275 --> 00:49:26.376
about, you know, like you were like, oh,

00:49:26.436 --> 00:49:28.038
wow, look, it finally happened.

00:49:28.518 --> 00:49:30.039
But there's something to be said when you

00:49:30.079 --> 00:49:31.260
were a part of that change,

00:49:31.599 --> 00:49:33.601
when you're like, I sent five letters.

00:49:34.440 --> 00:49:35.882
on behalf of this and look,

00:49:35.981 --> 00:49:36.902
it made a difference.

00:49:37.061 --> 00:49:39.242
Now maybe there was hundreds of other

00:49:39.282 --> 00:49:40.103
letters that went too,

00:49:40.143 --> 00:49:42.025
but to know that you took part in

00:49:42.045 --> 00:49:42.304
that,

00:49:42.985 --> 00:49:45.085
it feels good to know that your fingertips

00:49:45.106 --> 00:49:47.706
were on that particular action and that

00:49:48.047 --> 00:49:49.688
you did something good.

00:49:49.807 --> 00:49:51.009
It feels good.

00:49:52.009 --> 00:49:53.610
I love that you mentioned your PTA,

00:49:53.650 --> 00:49:55.492
who is a really great administrator too.

00:49:56.052 --> 00:49:57.873
That's kind of like where the whole PTA

00:49:57.914 --> 00:50:00.175
plus title came from was because I kept

00:50:00.496 --> 00:50:01.717
running into people who would say, well,

00:50:01.737 --> 00:50:03.679
I'm a PTA, but I'm also, you know,

00:50:04.079 --> 00:50:05.179
X, Y, and Z, fill in the blank.

00:50:05.239 --> 00:50:06.800
Like I do this, I do that.

00:50:06.900 --> 00:50:08.422
I personal train on the side.

00:50:08.523 --> 00:50:09.123
I, you know,

00:50:09.143 --> 00:50:10.403
I'm a marathon runner or whatever,

00:50:10.423 --> 00:50:11.304
you know, fill in the blank.

00:50:11.344 --> 00:50:12.706
And so that's kind of where that whole

00:50:13.106 --> 00:50:14.748
title came from was because I kept hearing

00:50:14.807 --> 00:50:16.849
people, PTs and PTA say, well, yeah,

00:50:16.869 --> 00:50:17.789
I'm a physical therapist,

00:50:17.849 --> 00:50:18.610
but also I'm

00:50:19.050 --> 00:50:20.652
I do all these other things that go

00:50:20.692 --> 00:50:22.954
beyond our title, right?

00:50:23.034 --> 00:50:23.534
Absolutely.

00:50:26.356 --> 00:50:27.898
The title is the title and the license

00:50:27.918 --> 00:50:28.538
is the license,

00:50:29.039 --> 00:50:31.920
but it's really about the people.

00:50:32.101 --> 00:50:34.603
Whether you're a PT or a PTA or

00:50:34.682 --> 00:50:38.186
a tech or whatever you are,

00:50:38.806 --> 00:50:40.606
There are certain personalities that are

00:50:40.646 --> 00:50:42.248
driven to be a certain way.

00:50:42.668 --> 00:50:43.027
And really,

00:50:43.047 --> 00:50:45.268
you just have to take that personality and

00:50:45.329 --> 00:50:46.710
cultivate it and allow it to be the

00:50:46.730 --> 00:50:47.369
best it can be,

00:50:47.429 --> 00:50:48.590
no matter what the title is.

00:50:49.070 --> 00:50:49.630
And obviously,

00:50:49.650 --> 00:50:51.291
you have to work within the restrictions

00:50:51.331 --> 00:50:52.393
of the title sometimes,

00:50:52.532 --> 00:50:55.534
but you allow the person to grow.

00:50:55.994 --> 00:50:57.934
And that's really what we've made our

00:50:57.974 --> 00:51:00.275
focus point is allowing the person to grow

00:51:00.315 --> 00:51:01.137
in the way they want to.

00:51:02.293 --> 00:51:02.875
I like that.

00:51:02.894 --> 00:51:04.876
Cultivate them where they are, right?

00:51:05.836 --> 00:51:07.217
Instead of trying to change it, like, no,

00:51:07.237 --> 00:51:07.918
you got to be this way.

00:51:09.518 --> 00:51:10.760
Personality and characteristics,

00:51:10.900 --> 00:51:11.960
those are hard to change,

00:51:12.501 --> 00:51:15.983
but cultivate what they have and drive

00:51:16.003 --> 00:51:16.583
that forward.

00:51:16.603 --> 00:51:17.784
So I like that.

00:51:17.804 --> 00:51:18.204
That's good.

00:51:19.385 --> 00:51:21.706
all right so the big ugly conversation

00:51:21.746 --> 00:51:24.547
that not everybody likes to talk about is

00:51:24.847 --> 00:51:27.730
the modifier question so what are ptas

00:51:27.809 --> 00:51:29.931
missing when it comes to understanding the

00:51:29.990 --> 00:51:32.652
language the contracts behind modifiers

00:51:33.913 --> 00:51:35.994
how their work is valued especially in

00:51:36.014 --> 00:51:37.855
these outpatient clinics so you know this

00:51:37.914 --> 00:51:38.516
is something that

00:51:39.175 --> 00:51:41.697
It's really hard to explain in an

00:51:41.797 --> 00:51:42.777
educational setting.

00:51:42.916 --> 00:51:45.338
This is something that you learn on the

00:51:45.358 --> 00:51:48.059
job whenever when I send students into the

00:51:48.079 --> 00:51:50.079
clinic so that they can learn from you

00:51:50.119 --> 00:51:51.579
for five, six, seven, eight weeks.

00:51:52.400 --> 00:51:52.900
Modifiers,

00:51:52.940 --> 00:51:54.141
this might be the first time that they've

00:51:54.161 --> 00:51:57.181
had any chance to see this or touch

00:51:57.202 --> 00:51:57.501
it.

00:51:57.561 --> 00:51:58.802
So tell me about that.

00:51:58.842 --> 00:51:59.443
What are we missing?

00:52:00.085 --> 00:52:02.746
So this is another piece where the medical

00:52:02.786 --> 00:52:05.248
model impacted us because this is already

00:52:05.309 --> 00:52:06.869
in place for PAs, right?

00:52:06.889 --> 00:52:08.530
And so a PA visit might have that

00:52:08.590 --> 00:52:09.630
modifier reduction.

00:52:10.731 --> 00:52:13.492
And so it's really important to understand

00:52:14.704 --> 00:52:15.485
how it works,

00:52:15.844 --> 00:52:17.385
which is obviously a fifteen percent

00:52:17.425 --> 00:52:18.947
reduction on any code that a physical

00:52:18.987 --> 00:52:22.849
therapist assistant performs more than ten

00:52:22.889 --> 00:52:23.351
percent of,

00:52:23.391 --> 00:52:27.253
which is almost anything for those payers

00:52:27.293 --> 00:52:28.655
that institute the modifier.

00:52:28.715 --> 00:52:32.818
But if I'm number one is really you

00:52:32.858 --> 00:52:35.099
want the place that you're working to have

00:52:35.739 --> 00:52:38.621
an EMR that automatically integrates the

00:52:38.661 --> 00:52:40.422
modifier so you don't have to think about

00:52:40.463 --> 00:52:41.043
it too much.

00:52:41.344 --> 00:52:43.684
And so, for example, our EMR,

00:52:44.085 --> 00:52:45.045
if I'm a PTA and I have a

00:52:45.106 --> 00:52:45.606
schedule,

00:52:46.126 --> 00:52:48.007
it's automatically implemented on every

00:52:48.047 --> 00:52:48.989
patient on my schedule.

00:52:49.528 --> 00:52:50.630
The one place where it gets a little

00:52:50.650 --> 00:52:53.771
bit tricky is like if PT one hands

00:52:53.891 --> 00:52:56.034
off to PTA one at the end of

00:52:56.094 --> 00:52:58.996
a session and I do one unit of

00:52:59.076 --> 00:53:00.856
Therax with that patient at the end and

00:53:00.896 --> 00:53:01.697
I'm the PTA,

00:53:01.898 --> 00:53:04.059
I then have to remember to manually add

00:53:04.079 --> 00:53:05.400
that modifier onto the end.

00:53:06.701 --> 00:53:07.581
That being said,

00:53:09.081 --> 00:53:12.684
the modifier shouldn't be there.

00:53:12.864 --> 00:53:15.786
It's another imposition from insurance

00:53:15.826 --> 00:53:17.347
companies that devalues

00:53:18.463 --> 00:53:21.106
a portion of the healthcare model at a

00:53:21.166 --> 00:53:23.226
time when we're just trying to allow

00:53:23.266 --> 00:53:25.668
patients to get proper access,

00:53:26.148 --> 00:53:28.130
whether it's through a PT or a PTA.

00:53:28.630 --> 00:53:31.873
And the standard of care that they receive

00:53:32.652 --> 00:53:34.675
is not going to be less when they

00:53:34.695 --> 00:53:35.215
see a PTA.

00:53:35.614 --> 00:53:36.476
And in some cases,

00:53:36.996 --> 00:53:38.456
it could potentially be more.

00:53:38.677 --> 00:53:42.119
And so it really is another one of

00:53:42.199 --> 00:53:44.141
those impositions by the insurance

00:53:44.181 --> 00:53:47.382
industry that, in my mind, should go away.

00:53:48.664 --> 00:53:50.092
Do you have anything to add?

00:53:50.735 --> 00:53:51.719
No, I think you covered it all.

00:53:54.588 --> 00:53:55.108
Yeah, you know,

00:53:55.628 --> 00:53:57.168
we could argue about it all day whether

00:53:57.188 --> 00:53:58.730
or not it belongs there or not, right?

00:53:58.750 --> 00:54:00.030
Yeah, but it is there.

00:54:00.851 --> 00:54:02.211
And there were a lot of people who

00:54:02.512 --> 00:54:05.992
really came down pretty hard on APTA

00:54:06.012 --> 00:54:08.014
whenever this whole change occurred.

00:54:08.054 --> 00:54:09.074
But, you know,

00:54:09.135 --> 00:54:11.076
I remember talking to the people who were

00:54:11.155 --> 00:54:13.016
literally right there in the, you know,

00:54:13.036 --> 00:54:15.617
like room whenever all of this kind of

00:54:15.637 --> 00:54:16.498
came down about it.

00:54:16.617 --> 00:54:19.000
And there was not really much APTA could

00:54:19.019 --> 00:54:19.619
do about it.

00:54:20.480 --> 00:54:22.041
But it's there and we have to work

00:54:22.081 --> 00:54:22.420
with it.

00:54:23.141 --> 00:54:23.262
Right.

00:54:24.282 --> 00:54:25.844
And it's not like it doesn't happen with

00:54:25.884 --> 00:54:27.545
other health professionals as well.

00:54:27.565 --> 00:54:28.746
Right.

00:54:28.827 --> 00:54:29.427
I mean,

00:54:29.447 --> 00:54:31.528
the APTA doesn't control the fee schedule

00:54:31.668 --> 00:54:32.690
any more than I do.

00:54:33.331 --> 00:54:35.932
And so it's imposed on us.

00:54:36.052 --> 00:54:39.275
And so if we want to reduce the

00:54:39.356 --> 00:54:40.697
impositions on us,

00:54:40.757 --> 00:54:43.039
we either have to continue to advocate or

00:54:43.079 --> 00:54:43.639
get out of

00:54:44.574 --> 00:54:46.755
that particular model scheme,

00:54:46.815 --> 00:54:47.757
the insurance model.

00:54:47.817 --> 00:54:49.018
So we either have to keep applying

00:54:49.057 --> 00:54:51.019
pressure in doing what we can as a

00:54:51.059 --> 00:54:51.420
group,

00:54:51.760 --> 00:54:52.742
or we have to get out of it.

00:54:53.161 --> 00:54:55.244
And those are the two choices.

00:54:55.384 --> 00:54:57.085
Otherwise people are gonna continue to

00:54:57.126 --> 00:54:58.786
shove rules down our throat that we don't

00:54:58.827 --> 00:55:00.849
like, because in the end,

00:55:00.889 --> 00:55:02.170
the insurance company is trying to make

00:55:02.230 --> 00:55:02.469
money

00:55:03.291 --> 00:55:04.692
And we're trying to survive.

00:55:04.791 --> 00:55:06.592
And so that's the constant struggle.

00:55:06.632 --> 00:55:07.932
They're trying to make as much money as

00:55:07.992 --> 00:55:09.972
possible by restricting access and

00:55:10.012 --> 00:55:10.773
restricting payment.

00:55:11.414 --> 00:55:13.014
And we're just trying to be professionals

00:55:13.434 --> 00:55:15.114
serving a population of people that need

00:55:15.155 --> 00:55:15.594
our care.

00:55:15.914 --> 00:55:18.195
So that's the challenge.

00:55:18.255 --> 00:55:19.576
It's no different than a little look at

00:55:19.596 --> 00:55:20.177
a fee schedule.

00:55:20.217 --> 00:55:20.436
You know,

00:55:20.496 --> 00:55:21.856
I can say I'm charging three hundred

00:55:21.876 --> 00:55:24.197
dollars for an evaluation and the

00:55:24.217 --> 00:55:25.398
insurance company is going to come back

00:55:25.438 --> 00:55:26.938
and say we pay you fifty.

00:55:28.936 --> 00:55:29.177
you know,

00:55:29.217 --> 00:55:30.838
we had a PT call us and say,

00:55:31.699 --> 00:55:31.818
well,

00:55:31.898 --> 00:55:33.840
APTA New York's not doing enough to get

00:55:33.900 --> 00:55:35.902
us paid at an appropriate rate.

00:55:36.481 --> 00:55:37.003
And I said,

00:55:37.222 --> 00:55:39.103
APTA New York has nothing to do with

00:55:39.143 --> 00:55:39.945
our fee schedule.

00:55:40.385 --> 00:55:42.467
Like you have to advocate on behalf of

00:55:42.487 --> 00:55:42.987
yourself.

00:55:43.027 --> 00:55:44.307
You have to get with other practices and

00:55:44.367 --> 00:55:45.648
advocate on behalf of the region.

00:55:46.048 --> 00:55:48.170
That's all we can do because the insurance

00:55:48.210 --> 00:55:49.612
companies in this model control

00:55:49.652 --> 00:55:50.032
everything.

00:55:50.112 --> 00:55:51.632
And that's where the heart of the issue

00:55:51.733 --> 00:55:52.253
is in our

00:55:54.304 --> 00:55:54.945
medical model.

00:55:56.666 --> 00:55:59.648
Every time I talk about it.

00:55:59.668 --> 00:56:00.929
Gets you fired up, huh?

00:56:00.949 --> 00:56:01.409
That's okay.

00:56:01.429 --> 00:56:03.911
There's a lot of things that we could

00:56:03.931 --> 00:56:05.373
talk about that could get us fired up.

00:56:06.094 --> 00:56:06.253
You know,

00:56:06.273 --> 00:56:08.036
it's interesting that you mentioned about

00:56:08.076 --> 00:56:09.376
the advocacy earlier.

00:56:09.416 --> 00:56:12.820
This is kind of on a slightly different

00:56:12.860 --> 00:56:14.081
topic, but, you know,

00:56:14.181 --> 00:56:14.621
Advocacy

00:56:16.583 --> 00:56:18.025
If other states are doing it,

00:56:18.065 --> 00:56:20.266
whenever New York has changed this general

00:56:20.307 --> 00:56:21.789
supervision or other states doing it,

00:56:22.269 --> 00:56:23.931
that's a little bit of advocacy one on

00:56:24.032 --> 00:56:24.132
one.

00:56:24.192 --> 00:56:25.833
I'm kind of an infant when it comes

00:56:25.853 --> 00:56:26.554
to advocacy.

00:56:27.034 --> 00:56:29.818
I've done Capitol Hill a couple of times.

00:56:30.119 --> 00:56:30.599
Think twice.

00:56:31.400 --> 00:56:33.702
I've done my state one time as well.

00:56:34.202 --> 00:56:35.923
But these are things this is the language

00:56:35.943 --> 00:56:36.605
that you learn.

00:56:36.925 --> 00:56:38.445
So when you go in and you're talking

00:56:38.485 --> 00:56:40.027
to the aides or if you're talking to

00:56:40.068 --> 00:56:40.949
the legislators,

00:56:41.429 --> 00:56:42.889
they're going to ask you that, like, well,

00:56:42.909 --> 00:56:44.050
who else is doing this?

00:56:44.512 --> 00:56:44.791
You know,

00:56:44.871 --> 00:56:46.072
so that's kind of like a little one

00:56:46.152 --> 00:56:48.195
on one tip is that if you know

00:56:48.976 --> 00:56:51.458
other states have similar practices or

00:56:51.518 --> 00:56:52.458
laws and rules,

00:56:52.898 --> 00:56:54.400
then that kind of gives you a little

00:56:54.420 --> 00:56:56.121
bit of an edge to is kind of

00:56:56.463 --> 00:56:57.423
having that information.

00:56:58.103 --> 00:56:59.686
So no matter what you're fighting for,

00:57:00.409 --> 00:57:02.032
there's always someone who's going to be

00:57:02.072 --> 00:57:03.233
fighting for the opposite thing.

00:57:04.905 --> 00:57:08.307
And having proof of concept shows the

00:57:08.347 --> 00:57:11.590
legislator who are always afraid of the

00:57:11.630 --> 00:57:13.532
safety component of changing a law,

00:57:14.012 --> 00:57:16.373
that there has been no detrimental or

00:57:16.414 --> 00:57:19.275
negative effect of enhancing access of X,

00:57:19.315 --> 00:57:20.777
Y, or Z service, right?

00:57:21.317 --> 00:57:22.797
And so that's like this thing is proof

00:57:22.818 --> 00:57:23.478
of concept.

00:57:24.139 --> 00:57:25.559
Has there been a detrimental effect to

00:57:25.579 --> 00:57:28.422
kind of go against whoever your opposition

00:57:28.521 --> 00:57:28.722
is?

00:57:29.483 --> 00:57:31.963
But then also one of the biggest things

00:57:32.065 --> 00:57:32.184
is

00:57:33.338 --> 00:57:37.601
how is it going to impact the constituents

00:57:37.681 --> 00:57:38.402
of the legislator?

00:57:39.983 --> 00:57:42.166
Am I going to get voted back into

00:57:42.246 --> 00:57:44.867
office if I support this or is it

00:57:45.608 --> 00:57:46.849
people going to be against me and how

00:57:46.869 --> 00:57:49.532
many people does it impact and that sort

00:57:49.572 --> 00:57:49.931
of thing.

00:57:50.032 --> 00:57:53.295
So the constituency is a huge factor in

00:57:53.315 --> 00:57:56.277
having support for any sort of legislation

00:57:56.297 --> 00:57:58.199
that you're trying to move forward.

00:57:59.536 --> 00:58:01.597
And then of course you have a champion,

00:58:01.938 --> 00:58:03.778
like you have to have a champion that

00:58:04.699 --> 00:58:05.500
pushes it forward.

00:58:05.860 --> 00:58:07.981
And obviously if their status is as high

00:58:08.021 --> 00:58:09.543
as can be in whatever realm that you're

00:58:09.563 --> 00:58:11.943
trying to push this legislation forward

00:58:11.983 --> 00:58:13.344
in, that's very, very helpful.

00:58:13.565 --> 00:58:14.465
Well, and I would say like,

00:58:14.664 --> 00:58:15.545
it's interesting because this whole

00:58:15.565 --> 00:58:16.887
conversation started with the APTA

00:58:16.907 --> 00:58:17.547
conversation.

00:58:18.286 --> 00:58:19.827
And like, to me, that's,

00:58:20.108 --> 00:58:21.989
that's the whole point is that we have

00:58:22.068 --> 00:58:23.190
all these players, you know,

00:58:23.210 --> 00:58:24.130
there's payment people,

00:58:24.190 --> 00:58:26.012
there's legislation people.

00:58:26.791 --> 00:58:28.172
We can't be everything to everyone.

00:58:28.612 --> 00:58:28.853
You know,

00:58:28.932 --> 00:58:30.954
you can't be a private practice owner and

00:58:32.034 --> 00:58:35.036
running a business and providing care for

00:58:35.436 --> 00:58:38.536
patients and then also having these roles

00:58:38.637 --> 00:58:42.398
on national committees and then also be

00:58:42.418 --> 00:58:43.840
the person that's doing everything

00:58:43.880 --> 00:58:45.579
legislation wise or doing everything to

00:58:45.599 --> 00:58:46.641
get payment back.

00:58:46.681 --> 00:58:47.061
So like,

00:58:47.141 --> 00:58:49.041
that's why that's why I pay dues, right?

00:58:49.061 --> 00:58:51.643
Because I want to do some of that.

00:58:51.963 --> 00:58:53.523
I want someone who's as passionate as I

00:58:53.583 --> 00:58:55.385
am about employee engagement and

00:58:55.425 --> 00:58:55.985
mentorship

00:58:56.905 --> 00:59:00.088
But if it's about lobbying to change

00:59:00.128 --> 00:59:02.652
legislation or it's about lobbying to

00:59:02.672 --> 00:59:03.353
change payment,

00:59:03.793 --> 00:59:04.735
they're the people doing it.

00:59:04.795 --> 00:59:04.974
Like,

00:59:05.094 --> 00:59:06.757
here are my dollars so you can do

00:59:06.777 --> 00:59:07.838
that because you're going to be way better

00:59:07.858 --> 00:59:08.358
at it than I am.

00:59:08.876 --> 00:59:09.197
Yeah.

00:59:09.237 --> 00:59:09.918
Share the burden.

00:59:10.277 --> 00:59:10.458
Yeah.

00:59:10.958 --> 00:59:11.398
So true.

00:59:11.657 --> 00:59:13.798
And when you show up to Washington DC

00:59:13.818 --> 00:59:14.760
to go and advocate,

00:59:15.500 --> 00:59:17.860
there's a thousand other groups that are

00:59:17.900 --> 00:59:19.402
there to advocate on their own issues.

00:59:19.461 --> 00:59:20.601
If you don't make noise,

00:59:21.202 --> 00:59:22.103
you're going to be buried.

00:59:22.762 --> 00:59:24.603
So you can't assume that the person that

00:59:24.623 --> 00:59:26.625
you're talking to even knows what physical

00:59:26.664 --> 00:59:27.385
therapy is.

00:59:28.106 --> 00:59:29.726
You have got to come in prepared,

00:59:30.186 --> 00:59:32.867
ready to go and confident in your,

00:59:33.047 --> 00:59:33.608
your answers.

00:59:34.027 --> 00:59:34.248
Okay.

00:59:34.347 --> 00:59:34.829
Quick game.

00:59:35.748 --> 00:59:36.248
All right.

00:59:36.289 --> 00:59:37.548
So this is called advocacy,

00:59:37.608 --> 00:59:38.429
worth it or not.

00:59:38.630 --> 00:59:38.929
Okay.

00:59:39.309 --> 00:59:40.769
So we'll start with Megan first.

00:59:40.789 --> 00:59:41.730
You get the first question.

00:59:42.150 --> 00:59:43.731
I'm going to give you a topic and

00:59:43.751 --> 00:59:44.710
you're going to tell me if it's worth

00:59:44.731 --> 00:59:45.110
it or not.

00:59:45.170 --> 00:59:45.851
And then tell me why.

00:59:45.871 --> 00:59:47.471
You ready?

00:59:47.530 --> 00:59:47.771
Okay.

00:59:48.251 --> 00:59:49.811
Paying professional membership dues.

00:59:50.612 --> 00:59:50.972
Yes.

00:59:52.152 --> 00:59:53.092
I think I just said it.

00:59:53.112 --> 00:59:53.452
It's worth it.

00:59:53.512 --> 00:59:54.932
I know.

00:59:54.972 --> 00:59:56.793
So I'm happy to pay someone else to

00:59:56.833 --> 00:59:58.813
help me in those ways.

00:59:58.893 --> 00:59:59.112
Okay.

00:59:59.233 --> 00:59:59.994
Jeremy, you're next.

01:00:00.753 --> 01:00:02.534
Writing one email to a legislator.

01:00:03.358 --> 01:00:03.739
Worth it.

01:00:03.818 --> 01:00:04.898
And it's so easy.

01:00:05.518 --> 01:00:07.260
If you click a button now out of

01:00:07.500 --> 01:00:11.460
APTA general emails they send to your

01:00:11.541 --> 01:00:13.960
inbox or APTA New York or whatever state

01:00:13.981 --> 01:00:15.440
you're in, you click a button,

01:00:15.740 --> 01:00:16.722
put in your zip code,

01:00:17.081 --> 01:00:18.641
it sends it off and it's done.

01:00:18.742 --> 01:00:20.422
And then within three seconds,

01:00:20.541 --> 01:00:22.603
I get a reply from legislator's office.

01:00:22.943 --> 01:00:24.163
And then generally within a week,

01:00:24.603 --> 01:00:27.304
I get a more personalized reply from

01:00:27.344 --> 01:00:27.844
legislator's office.

01:00:28.224 --> 01:00:28.943
Definitely worth it.

01:00:29.641 --> 01:00:30.623
Yeah, absolutely.

01:00:30.902 --> 01:00:32.103
OK, Megan, you're next.

01:00:32.543 --> 01:00:35.105
Showing up to at least one advocacy day

01:00:35.244 --> 01:00:38.086
or event per year.

01:00:38.867 --> 01:00:40.648
If applicable and if you're able to do

01:00:40.688 --> 01:00:41.688
it, definitely worth it.

01:00:42.009 --> 01:00:44.411
So it gives you a viewpoint of what

01:00:44.431 --> 01:00:45.891
are my dollars going to like?

01:00:46.072 --> 01:00:47.733
It backs up all those other things of

01:00:47.753 --> 01:00:48.972
like I'm paying these dues.

01:00:49.134 --> 01:00:50.835
I'm struggling in this way.

01:00:51.054 --> 01:00:51.994
You're getting you get to see what's

01:00:52.014 --> 01:00:53.916
happening behind the curtain and you have

01:00:53.936 --> 01:00:55.556
a whole new appreciation and understanding

01:00:55.677 --> 01:00:57.318
for those sorts of things when you're able

01:00:57.338 --> 01:00:58.259
to immerse yourself in them.

01:00:59.286 --> 01:00:59.726
Really quick.

01:00:59.746 --> 01:01:00.507
It's so true.

01:01:00.547 --> 01:01:01.266
Yeah.

01:01:01.306 --> 01:01:02.188
Multiple things we've said,

01:01:02.228 --> 01:01:03.228
but like when we went to the Graham

01:01:03.268 --> 01:01:03.688
sessions,

01:01:04.208 --> 01:01:06.050
we sat at a breakfast table and everyone

01:01:06.090 --> 01:01:07.429
at the table was from a different state

01:01:07.809 --> 01:01:08.971
and they were all having the same

01:01:09.010 --> 01:01:09.811
challenges we were.

01:01:09.851 --> 01:01:11.932
So just by immersing yourself with people

01:01:11.972 --> 01:01:13.512
that are like-minded in a similar

01:01:13.572 --> 01:01:14.193
situation,

01:01:14.673 --> 01:01:16.054
it makes you feel better because you

01:01:16.094 --> 01:01:17.715
realize everyone has the same challenges.

01:01:17.735 --> 01:01:18.356
You're not alone.

01:01:18.376 --> 01:01:20.757
It's not just me.

01:01:20.777 --> 01:01:21.077
Yeah.

01:01:21.197 --> 01:01:21.436
Okay.

01:01:21.538 --> 01:01:22.878
Jeremy, I think this one's you,

01:01:22.938 --> 01:01:26.139
but educating one PTA student on policy.

01:01:27.702 --> 01:01:28.603
Oh, worth it, of course.

01:01:28.764 --> 01:01:29.023
I mean,

01:01:31.447 --> 01:01:33.550
it's important for them to for everyone,

01:01:33.570 --> 01:01:34.672
whether PT or PTA,

01:01:34.692 --> 01:01:36.934
to understand why we're doing what we're

01:01:36.974 --> 01:01:37.295
doing.

01:01:37.434 --> 01:01:39.518
And the education piece goes

01:01:40.692 --> 01:01:43.172
miles towards improving their

01:01:43.193 --> 01:01:45.494
understanding but also improving their

01:01:46.255 --> 01:01:48.795
perception of you and that if if you

01:01:48.916 --> 01:01:50.295
understand something and explain it to

01:01:50.315 --> 01:01:52.416
them in a way that they then understand

01:01:53.016 --> 01:01:54.978
they consider you to some extent a mentor

01:01:55.097 --> 01:01:57.179
they trust you in that realm in it

01:01:57.398 --> 01:01:59.500
and it might allow you to enhance your

01:01:59.539 --> 01:02:01.001
practice by having that person come back

01:02:01.041 --> 01:02:02.382
and work with you or whatever so of

01:02:02.422 --> 01:02:03.061
course worth it

01:02:04.297 --> 01:02:04.898
Great.

01:02:05.159 --> 01:02:05.760
Okay, Megan,

01:02:05.860 --> 01:02:07.322
I'm going to have you close this out

01:02:07.362 --> 01:02:08.443
with our plus point.

01:02:08.483 --> 01:02:09.364
And then Jeremy,

01:02:09.403 --> 01:02:10.945
you can also speak to this as well.

01:02:11.045 --> 01:02:14.269
But if a PTA in New York asked

01:02:14.289 --> 01:02:14.449
you,

01:02:14.530 --> 01:02:16.411
why should I care about legislation or

01:02:16.532 --> 01:02:17.474
advocacy at all?

01:02:17.813 --> 01:02:18.534
What would you tell them?

01:02:20.043 --> 01:02:21.083
I would tell them that it's going to

01:02:21.103 --> 01:02:22.123
affect them every single day.

01:02:22.485 --> 01:02:23.864
So you are a professional,

01:02:23.925 --> 01:02:25.726
you have a license in New York State,

01:02:25.867 --> 01:02:27.867
and every single day when you get to

01:02:27.887 --> 01:02:29.768
go to work and have the privilege of

01:02:29.829 --> 01:02:31.010
interacting with patients,

01:02:32.110 --> 01:02:33.871
legislation decides who that is we get to

01:02:33.891 --> 01:02:35.251
interact with and how we get to interact

01:02:35.271 --> 01:02:35.592
with them.

01:02:35.771 --> 01:02:38.653
So having an understanding,

01:02:39.074 --> 01:02:40.815
knowing even if you don't like something,

01:02:40.894 --> 01:02:42.596
that there's a way to work through it

01:02:42.655 --> 01:02:44.918
and figure out what you do and what

01:02:44.938 --> 01:02:46.438
you don't like and how you can impact

01:02:46.478 --> 01:02:48.500
change is of value every single day.

01:02:49.380 --> 01:02:51.181
And then I would say, you know,

01:02:51.481 --> 01:02:53.543
how much do you like the dollars you

01:02:53.583 --> 01:02:55.965
spent on your education and how much do

01:02:55.985 --> 01:02:57.186
you appreciate your paycheck?

01:02:57.226 --> 01:02:59.407
Because all of those things are dictated

01:02:59.867 --> 01:03:03.329
by advocacy and legislation, whether it's,

01:03:04.311 --> 01:03:04.490
you know,

01:03:04.710 --> 01:03:08.373
there's bills in New York about making PT

01:03:08.614 --> 01:03:09.713
a primary care

01:03:10.494 --> 01:03:14.097
co-pay profession versus a specialist

01:03:14.137 --> 01:03:16.217
where um you know the co-pays are

01:03:16.237 --> 01:03:18.539
generally higher so all of those things

01:03:18.619 --> 01:03:21.860
filter down to how much a pt or

01:03:21.880 --> 01:03:24.282
pta can get paid and by improving access

01:03:24.302 --> 01:03:26.063
and improving reimbursement and improving

01:03:26.103 --> 01:03:28.844
policy it all makes our profession better

01:03:28.885 --> 01:03:31.385
and if you plan on graduating from college

01:03:31.445 --> 01:03:33.608
and spending ten or twenty or thirty years

01:03:33.628 --> 01:03:35.469
in the profession you definitely

01:03:36.831 --> 01:03:38.893
should be slash could be interested in

01:03:38.934 --> 01:03:39.994
making it better every day.

01:03:40.175 --> 01:03:41.635
And you want it to be sustainable.

01:03:41.675 --> 01:03:42.737
Right.

01:03:42.777 --> 01:03:44.338
We didn't do all of that.

01:03:44.398 --> 01:03:46.378
We could start over.

01:03:46.458 --> 01:03:49.181
I like how you said improve because we

01:03:49.202 --> 01:03:50.282
can't change everything,

01:03:50.682 --> 01:03:52.164
but we can make improvements and

01:03:52.264 --> 01:03:53.405
incremental improvements.

01:03:54.706 --> 01:03:56.347
That moves the needle as well, right?

01:03:56.367 --> 01:03:57.568
Yeah, absolutely.

01:03:58.403 --> 01:03:58.724
Great.

01:03:59.364 --> 01:04:00.385
Jeremy, Megan,

01:04:00.445 --> 01:04:01.864
thank you so much for joining.

01:04:02.304 --> 01:04:04.445
I appreciate all of your wise words and

01:04:04.766 --> 01:04:07.126
really kind of helping us break this news

01:04:07.166 --> 01:04:10.668
from New York State on the whole general

01:04:10.967 --> 01:04:12.228
supervision for PTAs.

01:04:12.248 --> 01:04:12.849
It's a big deal.

01:04:12.949 --> 01:04:14.269
It really is and one that needs to

01:04:14.309 --> 01:04:14.889
be celebrated.

01:04:14.929 --> 01:04:17.630
So I appreciate you two giving us your

01:04:17.670 --> 01:04:18.411
time today.

01:04:18.871 --> 01:04:19.831
So thank you so much.

01:04:20.052 --> 01:04:20.972
Thank you.

01:04:25.643 --> 01:04:27.724
Thanks for listening to PTA Plus,

01:04:27.905 --> 01:04:30.887
the podcast for PTAs by PTAs.

01:04:31.567 --> 01:04:32.188
Subscribe,

01:04:32.288 --> 01:04:34.510
follow us on social and share the show.

01:04:35.050 --> 01:04:35.971
Elevate yourself.

01:04:36.490 --> 01:04:38.291
This show is for educational purposes

01:04:38.532 --> 01:04:38.793
only.

01:04:39.193 --> 01:04:40.853
No clinical decision making should be made

01:04:41.295 --> 01:04:42.034
from its content.

01:04:42.574 --> 01:04:43.155
See you next time.