In this episode, Sports Physiotherapist and Researcher, Loïc Bel, talks about his experience as an up-and-coming sports physiotherapist and researcher in the industry. Today, Loïc talks about complexity and uncertainty, clinical work and mental health, and the importance of having a team around the patient. How does Loïc deal with imposter syndrome? Hear about Loïc’s experience in Monaco, why he decided to keep getting more degrees, his thoughts on Physiotherapy Associations, and get Loïc’s valuable advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You can’t just use one factor to influence the whole situation. You have to accept the complexity. You can’t control everything.” “Nobody puts the bad stuff up on social media. It’s only all the successes.” “To be successful, we have to fail.” “Sports and physical activity as a whole is one of, if not the best, tool for health.” “As health professionals, we have to think about what we do, because it has a cost on society.” “Knowledge a collective thing.” “Don’t give up and don’t blame yourself.” “If you believe in your profession, try to get involved.” “Communication is everything.” “Try to ask yourself more questions. Don’t think that everything you learn is true, even at school. Question things a lot more.”   More about Loïc Bel Loïc Bel is a physiotherapist since 2.5 years ago. He graduated with a Bachelor degree in physiotherapy in Switzerland and is now in the last semester of his Master Degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for 3 days a week, and during the other 2 days, he studies in Bern towards his Masters degree. He is currently involved in the ‘Commission for the Promotion of Physiotherapy’, that is a branch of his regional physiotherapy association. He is also a board member of ‘Le Réseau’ – which can be translated as ‘The Network’, which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. On an international level, he currently is a board member of ‘Long COVID Physio’ as an education co-director. A recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Ducrest, Nicolas Mathieu, and Mario Bizzini. The paper was about injury prevention in sports related to performance. Injury prevention is a subject that he tries to develop an expertise in, and he really fell down the rabbit-hole during his Bachelor graduation work that developed into that paper. His professional goals are to end his Master Degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Injury Prevention, Sports, Exercise, Research, Knowledge, Education, Mental Health,   Read the paper: Lower Limb Exercise-Based Injury Prevention Programs Are Effective in Improving Sprint Speed, Jumping, Agility and Balance: an Umbrella Review   To learn more, follow Loïc at: LinkedIn:         Loïc Bel Twitter:            @bel_loic   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, Net Health Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a new offer. If you sign up complete a marketing audit to learn how digital marketing solutions can help the clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li T z y to sign up for your complimentary marketing audit today. Alright, so a big thanks to Net Health now on to today's podcast. So my guest today is like Bell. He's a physio therapist since two and a half years ago, he graduated with a Bachelor degree in physiotherapy in Switzerland and is now in his last semester of his master's degree in sports physiotherapy, also in Switzerland. He currently works in an outpatient clinic in a small city in Switzerland for three days a week. And during the other two days he studies in Bern towards his master's degree. He is currently involved in the commission for their promotion of physiotherapy, that is a branch of his regional physiotherapy Association. He is also a board member of labor. So and I'm sure I butchered that, which can be translated as the network which is an association that aims to connect health professionals working in sports and other professions that promote health through physical activity. on an international level. He is currently a board member of long COVID physio as an education co director. Our recently big achievement was the publication of his first paper with his friends and colleagues, Vincent Newcrest, Nicholas Matho, and Mario Barzini. We talked about that paper in this interview, and it was about injury prevention in sports related to performance. Injury Prevention is a subject that he tries to develop an expertise in and he really fell down the rabbit hole during his bachelor graduation work that developed into that paper. His professional goals are to end his master degree in the first place. An ongoing project right now is to find funding to start a PhD on the subject of injury prevention. And in today's episode, we talk about a little bit more about the IOC conference that was back in November. And also we talk about clinical uncertainty, mental health of new graduate physio therapists dealing with imposter syndrome, and the importance of our physiotherapy association. So a big thank you to Luke for coming onto the podcast and being so open and honest and sharing his experience as a newer graduate in the physiotherapy field.   03:23 Hey, Lloyd, welcome to the podcast. I'm so happy to have you on and it's so nice seeing you again after it's been a couple of months since we met in Monaco. So welcome. Yeah, thanks for having me. I'm really happy to be to be here enough time to. Yeah, and I'm, I'm so excited to have you on to talk about.   03:43 We'll talk a little bit about your experience in Monaco and your big takeaways from that and tell me your what what you thought and what your takeaways were. Yeah, it was it was a last minute chose to go to Monaco. And, and don't forget that actually.   03:58 It was the second big Congress for me. So it was a bit of euphoria. I went to Geneva when there was the World Congress to So second bit Congress on sports physios. So kind of specialization I'm doing right now. And it was it was bigger than I thought it would be actually. And it was really hard to do some take home, because there was so many things to, to take with so many new ideas, maybe so many new ideas about all ideas that were totally deconstructed. So that was a goal of mine to go in. And be like, Yeah, I want to unlearn what I what I had learned during school and during my students. And I know we discussed it together quite quite some time about the takeaway. So there was one word that came a lot during the Congress. I think it was the context, context matters. So you can have   05:00 The best exercise you can have the best the best plan you can have the best program you want. If people don't do it on buying it's, it won't matter much, actually.   05:12 I think one big thing is that maybe we don't know, as much as we think we did. It discussed it with a smart non on a recent Muscats podcast to   05:25 lots of talk, discussed some things that we thought we knew. And maybe they don't work as planned, or they don't work   05:35 in the nation an efficient way, like we started did. And it was a great, great symposium on the complexity, like everything interacts, you can't just use one factor to to influence the whole situation you have to you have you have to accept the complexity, you can't control everything. And, and yeah, you go home and you don't really know what to do anymore. You don't really know if if you did things right, you don't really know if you will do things, right. So that's kind of the takeaway I took from like for me.   06:13 Yeah, and I would agree, I left like God, I feel like I don't know anything and stuff that I didn't know, I had now have to sort of deprogram myself to   06:25 reprogram with new information and new research, which, I mean, if you asked me that's a sign of a good conference. Yeah, I said the same. If I, I'd be pretty, pretty sad to go to a conference and go with only a big confirmation bias, you know, like, Okay, I did everything right. That's fine. So it's a good thing. Yeah. Like you learn something, if you unlearned things. So yeah, it was great.   06:55 Yeah, I agree. And let's, let's kind of dive into this idea of complexity in practice. Right. So like you said, there's so much more to an injury than just the injury, right? So if someone has an ACL injury, it's more than just the physical rupture of an ACL and then knee. So can you talk a little bit more about complexity in practice, whether it be your personal experience?   07:25 And and how you tolerate that uncertainty in the clinic? I mean, if if we speak about Monaco, the big thing was when when you come home is Watson, how do I apply the things I learned? And what I feel like when I when I go to Congress is or to any symposium that speak about research, I'm always like, Yeah, but in research, we control so many things. We want to control the most things we can to better understand the mechanism. And then you arrive in practice, and it's the chaos. You can't control everything you've gone through in research.   08:03 I have a pretty young conditions, I ended school like two and a half years ago. And every time I discussed the topic with some more experienced clinicians, they always answer with the Yeah, experience helps.   08:20 Yeah, but what do you do when you don't have, you don't have that much experience, you have to build some. So you try to rely on research, you tried to, to you try your things, basically, you have some tools, try to use your tools.   08:37 That gives you some idea when you try what should be best practice in research. But sometimes it doesn't work as planned, and you have to deal with it. So you try to adapt. You try to modify things a bit. And you have to go with intuition sometimes. And   08:54 yeah, it can be a hard feeling to deal with. I mean,   08:58 I tweeted like, a few weeks ago about that, because I had a rough day, I really have a rough day. Like I had three patients, it didn't go as planned. We had to go back to the search, and we had to discuss things. And it's really exhausting. I feel like to come home and nothing worked as planned. You go like with 1214 patients a day. And this tree will stay on your mind like the whole evening the whole evening. You don't know you're just thinking about how could I help? What's next try to plan for you and for them.   09:35 Yeah, I don't know we can you can deal with it. You have to acknowledge that it can happen. And you have to. Sometimes you have to take a step back and be like, yeah, what did I do? Did I do something wrong? Or not? Because maybe you did nothing wrong actually. And how could I figure out a new strategy to to advance and do better? Yeah,   10:00 It sounds to me, like what you do when you have those days, and we all have them where you're like, I'm a loser, like, I can't help anyone, no one's getting better, what am I doing? But that instead of going back and sort of wallowing in it for the whole night, I think you can wallow for a little. But it sounds to me like what you do is you kind of reflect on that re reassess how you did things, and really look at what can I do differently? I don't want to say better, but what can I do differently. And if it's something, then you always have another time to try. And if it's, you know, I think that I did what was appropriate, then maybe it's let's go in and have a deeper conversation with this patient, you know, let's see what other part of this complex person in their ecosystem will allow us to move forward. So that's what I got from what you just said that you really take that time to kind of reflect, reassess, and then move in the next day, or the next time you see them. So they agree, and complexities are also about how it works with the with the other colleagues to other professions around the patient. So you have to reach out for other people, you have to discuss things with them. And you have to you have to explain what you did you have to, to also be confident about what you did. And and that's that can be quite confronting to, to do. So. Yeah.   11:39 Many things to deal with. But in the end, you have to go forward and keep on keep going.   11:45 Absolutely. And you know, as a newer ish grad,   11:49 you know, you kind of   11:52 knowing what you don't know. And maybe knowing what you do know, how do you sort of keep putting one foot in front of the other because I'm assuming imposter syndrome may come up   12:05 every once in a while. So what do you do to keep moving forward? And maybe what advice can you give to let's say, a new graduate that's graduating tomorrow, given the experience that you have over the past couple years?   12:21 You're right, it happens from time to time. And and I mean, social media don't don't help with that. I think, as a whole, yes. Because there are lots of success story. There are not much stories about failure. Well, I mean, here's the thing. No, nobody, nobody puts the bad stuff up on social media. It's only All successes, right? So you have to take that step back and be like, yeah, maybe maybe they fail to. And to come back to Monaco, there was a great great one. That was about the biggest mistakes. So did a motor compress was something about learn from our biggest mistakes. So it was with Yvette for Heigen Carolyn, a bullying Caroline Emery to.   13:09 And I think it was great to have like to be in a Congress with what you can call like, a camera like her from speakers in the world about injury prevention, and, and, and hear them like, we failed. But we kept on moving. We kept on trying. And we did really, really better and we try every day to do better. So it was one good thing is that for once there was there were people that acknowledge that they failed, but they kept on going in and it was it was yeah, they deal with things with the tools they had at that moment and that you can't have everyday data you you want at every moment. So you have to try. And another thing I'd say is that personally, I try to really reflect and reflect on on on what I don't know I try to Yeah, we can speak a lot about metacognition and and identify your knowledge identify your lack of knowledge in some in some topics, so I try to identify my weaknesses. And then I try to read because I can't just be with patients 24/7 So I have to read about them and and and try   14:29 that said so I said I see the things   14:32 there's a quote I like that that say what I believe is a process rather than a finality. I don't know who Who is this this from but I like it a lot like you have it never stops you have to keep on moving don't stay like in a stone try to tie traveled. Yeah, and that's how I said things. Yeah, and I I missed that talk at Monaco. Now, I really wish I went to it on the   15:00 You know, yes, we failed at these things, learn from our mistakes. And I would argue that the most successful people in the world have failed more times than they've been successful. Right? Because they're taking chances. They're putting themselves out there and, and they're making mistakes, learning from them and then pushing forward, which can be your stepping stone to success. Yeah, I'm a pretty firm believer that to, to be successful, you have to fail. Because if you just have success, I mean, first of all, it's not realistic. But I feel like if there was only on the success, and you couldn't fail,   15:42 you'd stop working. You don't anything to do anymore. You. You're not on this planet. So yeah, I think that's you. But every, every failure you have is a small break towards the Big House of success. Basically.   15:59 I couldn't agree more. And you know, in talking about all of this, you know, we're talking about failures and imposter syndrome and not knowing, and you're in a clinical setting, you're working with people. With all of that on your mind, it can certainly take a toll on your on mental health as a clinician. So what what do you do? Or what advice do you have when it comes to that clinical work? And mental health? Your own mental health?   16:28 Yeah, so I feel like we have a really demanding job, from a psychological perspective, because like I said, sometimes you fail, you have that bad day, and you come home, and you're like, Yeah, rethink, everything is worthless. So you have to do to overcome that. And with that, you have to, to add all the pressure about knowing things, because patients want answer answers. So you have to know things, you're the professional they want, they want to know, as sometimes you don't.   17:02 Now to, to put less pressure on me, I am honest with the patient, when I don't know, at the beginning, during my internships, I was always trying to find the right answer. And sometimes I didn't have it. And I try to find the thing to say. And now I feel like yeah, it was really unethical. First of all, and   17:27 no idea, say, I don't know, but we'll try to figure it out, basically. And one phrase I do, I do say a lot, when situations are complicated is that we'll try to improve the best we can. But I don't know until when we can, until what level we can improve, we'll figure it out. But maybe it will be only only a small portion and, and you'll have to try other things and physiotherapy.   17:58 And basically, you have to take care of your mental health and health professional for that. So I'm not ashamed to say that I wanted to psychologist and I discussed this topic, too. I didn't go for that. But I discussed it because it was really taking a toll sometimes my on my health. And now I learned to take a step back to be honest with the situation and discuss   18:24 discussing with patients and be open to criticism from patients to isolate them, you can tell me if if something isn't right, will change what we do. Finding yourself and being confident enough in yourself to say I don't know, is very, very beneficial for everyone involved, because you don't want to make something up.   18:47 Right. So if you don't know, I think what you said, you know, I don't know, but let's figure this out together. I'll look up some research, we'll figure this out. And if we can't figure it out, then I think it goes into another topic that you wanted to cover. And that's having this sort of entourage around the patient. Right? Because it's not your the two of you aren't on an island together, and there's no one else around, hopefully.   19:14 So can you talk a little bit about the importance of that, that team or that entourage around the patient? Yeah. So I think that I'm really lucky because   19:26 I met some awesome people in Switzerland during my studies and when I went to congresses,   19:33 I can mention someone It's Susan God that was in Monaco too.   19:38 She she's she's helping me on a daily basis. Basically. I'm often writing to her and and some other colleagues, some of the friends and colleagues that are my age we try to we try to figure out stuff together too.   19:55 I think   19:57 we are in a profession where   20:00 You can't have all the knowledge and some people already belt, some strong knowledge on some specific topic. So when I have a situation, for example, with Suzanne from with the shoulders, I write to her, because she's the experts in my, in my network, she's the expert on shoulder, so I don't hesitate to, to to write her to ask the patient if I can take, for example a video of or picture of the problematic I have. And I asked, I tried this, I tried that I have this situation right now. It's not have evolving, it's yeah, it's it's staying the same. We don't find a way to, to overcome the situation. What do you think about it, and then we discuss it and, and sometimes she she has some really great things that I never would have thought about. And I do the same with with friends.   20:56 I have some friends with my part time studies. They have the same problem as me. Sometimes they write to me and I try to help sometimes they do say I do thing with them. And sometimes nothing comes out from it. But at least we tried. And   21:15 and yeah, I try to do the best with the tools I have right now. And I feel like they are getting sharper every month, every year. But right now, yeah, it's not the best strain to get the tree with the knife the moment sometimes so. So yeah, it's gonna get better.   21:33 So what made motivates you to kind of to keep going and keep learning and keep sharpening those tools?   21:40 Right now, I think that's the first thing is that I want to help the people I work with, I don't I don't often tell the term patient. I think I work with people not with patient, they're productive. So yeah, I want to help them. So that's, that's one of the reason. And the other reason is that I don't like not know, to not know. So big. So I'm really curious. And I want to know, and yeah, again, you have to cope with not knowing but but I try to dig it always a little deeper and try to understand the mechanism of what I do have of I don't know, special battleship or stuff like that.   22:24 These are the two things, I'd say, drives me the most. And then I fell into sports physio. And I was like, yeah, it can be fun because I, I always liked sports. And I always did some. But it was also because I believe that sports and physical activity as a whole is one of the if not the best tool for health. And you have to understand what you do. I mean, we speak a lot about sickness size, about active therapy, you have to understand what you do. If you just give some exercises and you don't know what consequences can be.   23:05 Again, it's not the best gear you can provide. I feel like so I don't I don't like and it happens sometimes. But I don't like when people go home and they and they come I don't know, two days, three days after the treatment. And they tell me Yeah, I was feeling horrible for for two days. Because we because I did something that was too much volume or too intense. I don't know. But yeah, basically, that's it. And I feel like you have to be a Swiss knife, you have to add some tools to your toolbox. You have to add communication, for example. That's that's one that's the most important tool in in relationship   23:47 with these people and, and personal experience, I feel like is a is a big driver, too. I feel I felt right when I went to the psychologist and I could discuss and I could communicate. So   24:01 understanding what it feels like yourself, drives me to do better for the people that come to. I think it's it's important.   24:12 Yeah, and I'm so happy that you said communication is I would say the communication is most important any relationship period. That's true, whether that be personal professional, client patient, it is number one, and that that is a skill that can be learned. You know, there are books, there are classes that you can take on how to be a better communicator.   24:35 But I think it starts with knowing what you know, and being able to admit what you don't know and learning more. So kind of everything that you said throughout this podcast, I think really comes down to that piece on communication and it's huge. I'm so happy that you brought that up. And on that note, we're going to take a quick break to hear from our sponsor and be right back with more   24:58 when it comes to boosting your   25:00 Next online visibility, reputation and increasing referrals. Net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   25:35 Why move on to higher and higher degrees? Right? So for you, why do a master's degree in Switzerland when a bachelor degree is enough here in the US? We had started with a bachelor's, I went to a master's. Now we're at a doctorate level clinical doctorate. So why move forward through all of that when Hey, maybe if a bachelor's is enough or a master's was enough, why why keep pushing forward on the degrees? I think it's a big topic in Switzerland too, because we have the other countries around us that all go to the master degree level, we are maybe one of the only country left in Europe that doesn't ask for a master's degree to be in the clinic, maybe I don't know not the last bit. We're not like in the best situation right now. And that's that's me. That's me, critics from our colleagues and other students in PT school actually, to to that I wanted to go further. And some some told me that I wanted to prove that I was better than them, or that I wanted to be paid more, so I can be paid more. I can't ask for more money, because I got a master's degree. So these are not the reasons. But the main reasons from me with were like when I went into my internships, during my degree, I was really feeling clueless. And I felt like I didn't have the tools to do anything.   27:06 I was a big, big, big manual therapy for years. For three years at school until the I was lucky in the last year there was the Geneva Congress, the World Congress in Geneva, and I went to the to the conference from Peter Sullivan and Jeremy Lewis. And it really blew my mind. And I was like, that's what I want to do. And it really changed my perspective on things. And I was like, Yeah, I want to upgrade my skills, I want to get a better understanding of everything. And, and that's, that's what drives me, it drove me in the first place.   27:44 provide the best care.   27:47 And I think you have to, like I said, to better understand that. And I feel like, as health professionals, we have to, we have to think about what we do, because it has a custom sort of site society, basically. And I was happy to go to that conference, because I realized what I what I participated in, when I was only providing passive, passive treatments. And now I think it's like I have to participate in reducing the costs. I have, it can be by by encouraging people to move more it can be by maybe avoiding a surgery, you can you can have ACL conservative treatments, more and more, it becomes a big bigger trend than before. And that's how I see things right now. And   28:43 one other things with the master degrees, that I like to research and you have to have a master degree to do research in Switzerland. So you I mean, you don't have to, but it's way easier with a master's degree. And I always wanted to add my break to the brick house because I really liked doing my beach law, graduation work. And I think that knowledge is a collective thing I published with the with the colleagues of mine, Mario pizzini, the kilometer in France and UK recently the my first paper and I don't feel like it's only my paper. It's like we did this. We did it us for and it's only for people that come and add just a break to injury prevention and non subject so   29:38 that's what I want to do. Basically I want to I want to add Matt, just my break. I don't want to be remembered for it. But I want to help things move on and go further. And domestically. We can help me understand the research better and help me to understand how to conduct it's basically so that was one of the reasons and   30:00 As, as a young clinician   30:03 research I rely a lot on.   30:09 And if we speak about the funnel model from   30:14 evidence based practice, you have best evidence on the top. You know, it's better than me with the conference at that spot physio. So I think that's that's an agreement.   30:26 Research is at the top. Great. But if you can't read research, you can't use it. So that's that's one of the reasons.   30:35 Yeah, well, I think that's a fabulous reason. And just so people know, we'll have a link to the paper that you just mentioned in the show notes at podcast at healthy, wealthy, smart, calm. So we'll have a link to that. Do you want to talk briefly about what give give the abstract, if you will, of that paper? That's exciting. By the way, congratulations. Thank you. It was I worked on it during my master's degree during two years, I didn't think it would last this long to publish it. But we finally made it. But the idea was, was that   31:12 was that we thought that injury prevention programs for the for the lower limbs could improve performance. And the we evaluated that through a numpy review. And the logic behind it is that   31:29 we have a big utterance problem with these programs. So how could we improve the utterance and there was a talk, we can come back to Monaco, again, about never mentioned prevention, we only speak about performance, you know,   31:42 it's it's the main driver of sports, affiliate sports. And I'd say even off amateur sports, you want to you want to win. So how do you sell it to these guys and women's? So elite athletes, athletes wanna want to be the best. So performance is a key things.   32:02 So it was the logic behind it. We want to we wanted to explore that. Does it affect performance, just by doing these programs? And we can say it has, it has an effect, it doesn't have the best effect. I think   32:17 you better trend for performance than doing these warm ups, for example, if you want to improve performance,   32:23 but it's, you can you can say that it could help. But I think more on on not much level, not knowledge level, it won't be strong enough stimulus for them.   32:39 Excellent. Well, thank you for that quick, abstract, or quick synopsis of that paper. And again, it'll be in the show notes for this podcast. Now.   32:49 As we start to kind of wrap things up, I'd love to talk a little bit more about physiotherapy association. So we have in the United States, the American Physical Therapy Association, we have world   33:04 confederation of physical therapy, which was that was hosted in Geneva a couple of years ago, I was there as well. Do you think they're important? Do you think they serve a purpose? Or no,   33:17 I think they are a big key to, to promoting our profession. Actually, I don't know how it is in other countries actually, with the with the contact with the public with maybe the politics too.   33:34 But they out. I mean, you can you can go and ask the politics and the public everything that you want. If you only one, it won't work. If you come as a group, and with tons of people, maybe it will change things. And that can come back to to the master degree. Step. Two, we need people with an expertise to push the job. And that can be made through associations. We have to actually make the knowledge and then we have to do a diffusion of knowledge. And that's a great way to help people we see so many things that are   34:14 pseudoscience on I don't know a low back pain for example, that goes to the public maybe that's if we could promote what we think is best care and what would help people it would it would be great and I think we have to do it as a group as an association, our gateway for that. And I'm on the I'm a board member of the local zoo that can be translated as the network   34:41 I'm one of our I'm one of the if not the youngest, and with the less experienced in the group but   34:49 we want to promote like physical activity for for health. We want to regroup every everyone you don't have to be a physio but everyone working in sports in   35:00 In movements, and oh, by now and go and promote that for everyone. And   35:09 and I'm also on the commission for the promotion of physiotherapy,   35:14 in my region, Switzerland, so we do, we do some, some really versatile stuff. So we are going to public conferences for everyone to attend. So we want to disseminate knowledge in an understandable way for everyone. So we invite speakers, and they tried to keep it short and simple for everybody to understand. And we have some more professional conferences.   35:43 For example, we did one a year ago, a small workshop with Darren brown on long COVID. It was not really discussed at that moment. So I wanted to have people in Switzerland health professional,   35:58 better understand they had the occasion to discuss with Iran for like, nearly an hour. And   36:06 he answered every question, and I Big shout out to them. Because he He's He's amazing. Everything he does seem to push. Yeah. Everything it does. Yeah. I don't have any words to describe him. Yeah, I don't have amazing, but yeah, that's the thing I think we have to do. And again, it's about accumulating, and if diffusion, you have to accumulate the knowledge, you have to defer to big diffusion to concern people. And I couldn't have done it without an association. And it's rich, it's stretched, maybe, I don't know, 120 feet do   36:49 that could treat lung COVID patients better. And that wouldn't just use exercise.   36:59 To try to to improve things, skirted codes, wasn't everything. So it's important to have that and it's it offers a big platform to reach public your wants. So that's why I think that you have you have to go in this association. You don't have to agree with everything. I don't agree with lots of things in the Swiss physical physiotherapy Association, and quite vocal about it. In my regional Association, I say that I don't like lots of stuff. And I tried to make things move from the inside. Not always easy. But you have to try. But yeah, the problem with that is that I'm on the board with the Huizhou. I'm on the board with the promotion of physio, I'm I don't do much to be honest. I'm on the board from long COVID physio to. And that's can be tons of projects, actually.   38:03 With all the side projects with the clinic,   38:07 with my students who have to write my thesis, I only have a few months left, and I'm crawling compare workloads right now. But yeah, you have to deal with it. And that's, that's kind of the situation right now.   38:21 Yeah, I mean, I agree with you on Darren Brown. He's outstanding. I interviewed him for the podcast about lawn COVID. And it was a wonderful interview. We're going back and forth. And I finished I said, Do you have notes in front of you? He's like, no, yeah. He's like, That's, like, yeah, I met him in Geneva, at the Indaba. Part was where everyone can come and just speak, and there were topics, didn't have a clue on the topic. And it was like you everything.   38:54 And at the end, I discussed with him and I was like, yeah, do you know something on the topic? And he was like, no, no, I was just going with the flow and okay.   39:04 But   39:05 he's just like that. He's, he's, he's an awesome speaker is a wonderful person, and I can't, I can say, Yeah, and it's more about him. That's only praises for him. I agree. I'm with you. I have 100% only praise for that man. And I think he's, he is pretty remarkable. And what a great asset to the profession of physiotherapy. And he has that ability to disseminate information to the public very well. So he knows how to simplify things, not dumb them down, but simplify them to make the average person understand and that's a very special skill. And I think he has it inherently so that he can sleep good. Yeah, it. Yeah, it's a great skill to have. Okay, so now that we're really wrapping things up here, what would you like for let's say two or three times   40:00 takeaways of our conversation to be for, let's say, younger physical physio therapists or even physiotherapy students that you can impart to them after being out in the world for the last two and a half years or so. Yeah, the first one I think would be   40:24 don't give up. Could it be an advice? I don't know. But don't give up and don't blame yourself could be a good one, I think   40:32 you have, I think that you have to deal with the situation with the tool you have at the moment you live it.   40:42 Sure, that's now some situations I had like two and a half years ago, I would deal with them better right now. And some that I have right now, I will deal better with them in a few years. But you only have these tools in your toolbox right now. And try to do your best and don't blame yourself you fit doesn't go like you planned it would go if it doesn't go like you would have liked to go.   41:12 You can you can fail then like we said it will help you change the way you do it the next times. And you'll do better. Basically, that would be the first I think   41:26 with that with the mental health. So don't blame yourself because don't take a toll on it.   41:33 I think it's important.   41:36 But to be a second ones.   41:40 Get involved. I think if you believe in your profession, if you believe in physiotherapy, if you believe in health movement communication, tried tried to get involved. You don't have to do every project like like, I think I do, or like I think many people that came on that podcast do, I think you you should choose. Just quick on that. I think that maybe we have culture and physiotherapy where we think we have to accept everything. Don't do it.   42:13 Better, choose the projects, better choose to and do it, do them greatly. And then choose eight and fed them. Choose your projects, but try to get involved. If you if you believe in it, try it, try it, it will be worth it, you will meet some awesome people, you will make some connections and it will be worth it in the end. Anyways. So I think there's that and I think that's that maybe   42:41 maybe to come back on that we should find a way to to propose these projects to young clinicians as at least into a salon. We don't have anything to anything to get them involved. Maybe we should find a better way to propose the projects to to ask them. I think they have an I have a fresh vision on lots of things. And I think that's one of the reasons why we should we should have younger clinicians come in and express themselves. Because we live in an era where things go really fast. And if we only have the same old people that do it for 50 years, maybe that won't make it.   43:26 And let think I don't know, actually, what would be the last thing? Do you have an idea?   43:34 I mean, I think what you said was great, the only thing I would just like to reiterate from this conversation. So the big thing that I took away is that communication is everything. And that really finding a mentor finding, like you said an entourage of people to help you sharpen those tools. Those are my big two takeaways from, from our discussion today. And finally, I always ask, but you probably just answered this, but I'll ask it anyway, since I asked everybody is knowing where you are now, what advice would you give to yourself as a new grad? So not random? New Grad, but you yourself going back in time? What would you say to yourself? So as a new grad?   44:26 I'd say accept, say, say no to lots more things. I say that because sometimes I get really overwhelmed, overwhelmed with the things I do.   44:39 I think I would say that. And if I go back in time even more, maybe like in my first year of PT school, I'd say try to   44:50 try to ask yourself more questions.   44:54 Don't think that everything you learn is true even at school.   45:00 Question things, lots more, even even if it's teachers, even if it's school, a question things, it's not always the best, the best that you learn our school question lots of things.   45:14 Excellent advice. And now where can people find you if they want to follow you? They want to ask you questions they want to get in touch where's the best place for them to reach you? It could be kind of on like on social media, where wherever is best for you. I think that Twitter is the best for everything physio related. You can go on what is it like Bell B, L underscore like, Oh, I see.   45:38 I think it's the best way. Oh, by all by email, if you text me on Twitter, it's my DMs are open. I think I can give you my email if you perfect problem. I think I don't think we need to give give your email.   45:54 Yeah, well, we'll we'll stick we'll stick to the Twitter app for now. So people can find you on Twitter, we'll have a link to that. Well, I want to thank you so much for coming on the podcast and you know, as a newer ish grad, if you are indicative of others in the field. And I think the future of physical therapy is looking really bright. So I want to thank you for coming on and for sharing all this great information with us and your takeaways from Monaco and everything else in between. So thank you for the invitation. It was really great. It was fun. I had lots of fun, at least it's got my pleasure. Good. That's all I liked to hear my pleasure. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart. And a big thank you to Lloyd for being so honest and open with us about his experiences as a newer grad physio therapist and of course, thanks to Net Health. So again, they have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit today to get your clinics online visibility, reputation and referrals boosted   47:10 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media

In this episode, AAPT President, Rob Tillman, talks about leadership and diversity in physical therapy. Today, Rob talks about being a leader, effective delegating, and the problem of bad advice by industry leaders. How Does Rob balance his life? Hear about Rob’s journey to where he is today, advocating for diversity, and the shortfalls of the industry, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You can’t get anybody stronger by giving them opioids. You can’t correct biomechanics by having somebody on muscle relaxers.” “Change doesn’t happen overnight. Attitudes can happen overnight. Mindsets take a little bit longer to change.” “Competency burns down barriers.” “The key thing in business is to manage as many variables as you possibly can.” “Not only do we not have diversity when we’re looking at the body types we have to work with, we’re not having systemic diversity at all in medicine.” “You can treat everybody fair, but it’s impossible to treat everybody the same.” “The outcome is when you get them back to doing what they want to do in their lives.” “The best leader shows people how to do it.” “There’s a difference between believing in something and living something.”   More about Rob Tillman Rob Tillman is the president of Ortho Rehab & Specialty Centers. In 1986, he received his degree in physical therapy from the University of Missouri. Rob immediately saw the need to attain a level of clinical competence that would allow him to effectively address the complex needs of his patient population. With this in mind, he enrolled in a post graduate residency training program with the Sorlandets Institute which later became known as the Ola Grimsby Institute. He is a Fellow of the American Academy of Orthopedic Manual Physical Therapy and American Academy of Physical Therapy. Rob attained the highest level of clinical certification available in the field of orthopedic rehabilitation. Since then, he has received international recognition for his research on the lumbo pelvic system and has written benchmark works on the thoracic and cervical regions, as well. Rob has presented at several national and international conferences on a wide range of healthcare-related topics. He is also a recognized authority in the arena of sports medicine, having been credited with the rehabilitation design and training programs for many professional athletes and organizations including professional baseball, a Superbowl MVP quarterback, an NBA championship-winning power forward and a four-time golf world long drive champion.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Rehabilitation, AAPT, APTA, Priorities, Education, Diversity, Leadership, Advocacy,   To learn more, follow Rob at: Call the office: 501-975-4040 Website:          https://www.pt-orthorehab.com AAPT:             https://www.aaptnet.org LinkedIn:         Rob Tillman Facebook:       Rob Tillman   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:00 Hello, this is Jenna cantor. I am here with the ROB Tillman who is currently the president of a PT and also is in charge of the ortho rehab and specialty centers. He is just a top physical therapist in the profession. We got I had the major pleasure of meeting him in person for the first time at the APTA 100 years Gala. Was it 100 years? It was, yeah, yeah, we were all dressed up, I got to freak him out with my excited energy, because I was so excited to be meeting you, Rob. And I, by luck convinced you to come on this fun ride and do this interview with me on healthy, wealthy and smart. Thank you so much for agreeing to come on. My pleasure. It same. It absolutely is just wonderful. So um, I would love to just start with if people could learn more about how you got to these leadership positions, start from wherever you feel comfortable. But I would love to hear how you got to now. I mean, you're heading these things. Of course, I mean, so many things. So please share.   01:10 Well, to be honest with you, I I didn't really seek to be president or leader of anything. I just really wanted to I went to physical therapy school and I wanted to do sports medicine. So I learned that while I was trying to do sports medicine and orthopedics most patients have that come to an outpatient physical therapy clinic have neck or back pain. So I decided to go ahead and learn something about how to deal with neck and back pain. So I did a residency with a group called Restore Landis Institute, which is now the older Grimsby Institute for four years and did a residency and passed by competencies and became what's called a level two manual therapist by the Norwegian standards. And I think it's still the highest level of competency, internationally recognized in orthopedic manual therapy, started teaching courses, and orthopedic manual therapy after I gained my level of competency and start working with the group was held South back then it was the world's largest healthcare Corporation geographically. And I started troubleshooting clinical operations, and learned how to do the administrative things. And then next thing you know, I'm a vice president. And then I'm a senior vice president, and then they have their accounting scandal. And then, so I started my own company about 18 years ago. And all the while while I'm doing my, my, my core competencies and working, you know, to make a living and moving up in the in the company I was with. I'm at a group called the American Academy of physical therapy that was established about 30 years ago. And   02:54 it was in 1989. Yeah,   02:57 it was it was a black folks that had concerns about access to physical therapy, school and quality care in the black community. And I learned about them through who is now my best friend, Leon Anderson, the third, his dad, Leon Anderson, Jr. is the founding president of the American Academy of physical therapy. And I just really started teaching what I had learned to the group and expose them to the specialty of manual therapy, and I just kind of hung around and enjoyed myself with them because that's the first time I really experienced unconditional love, professionally, in physical therapy, because they just made me feel welcome. A lady who's deceased now named Diane Ellsbury. I call her my PT mom. She'd says, Hey, Rob, baby, how you doing? And just hug me and just what do you need anything? Are you taking care of yourself? You're not working too hard. Are you just like an auntie type thing. And then I became more involved in the operations and joined a committee called the innovative services committee. And innovative services was that's exactly what it does. It does cool and innovative things like create programs, we established a navigation program for mentorship for for our young folks coming through an advocacy wing that was concerned about practice acts and access to care and licensure issues and things like that. In the process, I somehow got appointed to the Arkansas State Board of physical therapy. So that's how I ended up wearing these hats. And while I'm on the board and Arkansas State Board of physical therapy beginning about 1617 years ago, I'm currently still on the board. And it's it's rewarding. It's rewarding. It's a lot of work, but it's rewarding, and I'd rather be at the table than not be at the table for a lot of the things that are going on because our profession continues to evolve. The physical therapy profession continues to evolve. And as an E involves then we have to be able to apply the clinical concepts that we are. In general learning in physical therapy school. State practice acts can hinder your ability to perform the things that you've learned if you're not careful. So we really have to make sure that all of the practice extra current and access to physical therapy is available because we are the most green profession. In healthcare. It's all hands on care and exercise. You can't get anybody stronger by giving them opioids. Okay, you can't correct biomechanics by, you know, having somebody on muscle relaxers, you know, it's kind of hard to strengthen somebody while on muscle relaxers also, by the way, but as we're looking at all these things that I'm doing at the same time, it's just when people ask me to do something, I don't want to be the person that's complaining about things not being done appropriately. I want to be the person that's kind of like a catalyst, or at least an advocate or participant in moving things forward and making things better. And sometimes you don't get paid for. Okay, but but, but that's why I love the Academy because it's the service academy. It's, you know, it's a place to come and serve and love the people that you're with and be loved, have a positive attitude and move some things forward.   06:21 I think sometimes people get caught up into looking at the AAPT or the APTA as something that needs to serve them. The APTA is also a giant service group. If we look at it appropriately, and as we come together, and share concepts and ideas, the current leadership of the APTA has done a lot better on sitting down and really trying hard to understand the challenges of the black community, just so my my hat's off to past president, Sharon Dunn, and also the current president, Roger Ver, and, and Justin Moore, the CEO, and Carmen Elliott, who's vice president over Dei, I think that they're really putting their best foot forward on working towards things. I think that we all have to be patient, and monitoring the progress as we do blend initiatives and work together on things. Because change doesn't happen overnight. attitudes can happen overnight, mindsets take a little bit longer to change as far as our train of thought. But behavior patterns take a lot longer than that, and coordinating behavior with other groups and other people take even longer. So I've learned to be a bit more patients in my practice, and my working with folks. And I've also learned that not everybody that doesn't understand the EI or the hardships that other groups are having. They're not all necessarily opposed to other folks doing well, or what somebody would call a racist or something like that. They just don't get it. And sometimes people want to get it. And those are the ones that we have to engage in conversation with and share ideas and have our thick skin on, to work together on things and not be so easily offended because we've all got pasts. I try not to be so easily offended and angered by things. But also, I have still pretty good intolerance of people that are in denial about other people's hardships. That's a little bit tough to be in full denial about other people's hardships. And there's current legislation that's going through several states that actually don't want America to tell America's full story. Because some people aren't comfortable with hearing about America's past and some of the impressive things that have taken place in this nation. But while we're deleting some truths that need to be spoken about America's past, we're deleting the chance for especially when in this case, black people to tell our kids and society in general, the challenges that we've had, and the reality of how we got to where we are and what we need to do collectively about. So that's another thing that's happening in today's society, but I do believe in general things are moving forward. As far as being president of the Academy, I never wanted to be president of the Academy. I wanted to be the guy that shared the cool clinical stuff. And just got to hang out with people that were just loving folks. I became chair of the innovative service committee. When BV Clemens retired, one of our founding presidents. He was later President second president of the Academy. And when he retired and took a step back, I took over the innovative services committee. And then I was asked to run for the director position, which the innovative services committee reported reports through the director director's position. It's now under the director, our current director, Renee crater Dr. Crater, great lady. Man few years ago, they asked me if I would consider being president of the Academy. Are you sure you want to do that? But my skill set on big A former officer in a large company and my background and all the things that I've been working on and still doing, including being on boards and things like that fit the skill set that was needed for the president at that time. And again, I'm humbled and honored to serve as the president of the Academy. I've done it for the last three and a half years, I can't wait to get the next crew of people trained up and ready to take over as we're pushing forward on things. But right now, it still currently fits my skill set and and and I hope that the academy is satisfied with my leadership and innovation and my quirky ways of dealing with things but it certainly has been my pleasure still serve as president of the Academy.   10:46 I'm so everything you shared, i Nobody sees me. But I have this very excited smile, listening and everything. And I love hearing things. In your own words, you are a very, very humble individual and the amount of service you have provided to the physical therapy profession at large. Thank you.   11:06 So it's my pleasure. It's my pleasure. It really is. It doesn't even seem like work.   11:12 Right? And and that shows anyone who works with you, like I've known you for a blink of an eye. I mean, it's been, gosh, half a year now. Yeah. But like it from for you are so kind you know how to like enter a room, whether it's on email, or text or whatever, in the friendliest way. You are. So I find you to be so approachable. And very, as a leader, it's still no denying what your position is. I just really think you are really, you said, I love what you bring to the table. Love it, just enjoy very much. Yeah, from the from the amount of time I've known you. How do you handle things with being what doing what you're doing? And I've never asked you this before. And that life balance, you know, people talk about work life balance. How do you do that? From what I've seen, you have specific times, you're like, I am not replying back, which is great. Could you talk about that a little bit more where you kind of set boundaries and stuff. So that way, you're able to handle everything and not overwhelm yourself.   12:20 Sometimes I My wife's a surgeon, she's a breast cancer surgeon, the Chief Chief of breast cancer at the University Hospital here. She's comfortable multitasking and doing a bunch of stuff. I really want to make sure I'm a perfectionist and whatever I put my hands on. So if my attention is split, if my attention is split, I know that I'm not going to do the thing that I'm working on, as well as I could. So I do one thing at a time. I do one thing at a time. When I'm in clinical notes. Sometimes I can reply to a text sometimes I can't. But I want to make sure when I fix a problem, that problem that has my undivided attention, my total undivided attention and I'm giving it my best that I possibly can. As I'm trying to resolve the issues that I have in front of me. I love that I feel   13:15 like it's a very attainable way to approach life rather than just going just one thing at a time. Do that. Good. All right. I love that. I've actually even been doing that this week. Not even purposely because you said but now I'm going to be like Rob said this I'm inspired. I've been doing that this week where I I had it upon me to finish up the project we're working on together and I was like nope, let's hone in and now like it's at a really good spot you know now and then I moved on to it. I've already moved on to other things because again,   13:47 that's it's because even in relationships if I know I'm doing the best I can with that relationship even if it goes awry. At least I know for sure I did the best I could with it. Oh I love that. I love that so much that way you don't have any regrets. Yeah, yeah, yeah, it   14:03 makes me think of what that tattoo that that tattoo where it says no regrets but regrets is spelled in properly regards because I love that I kind of want I'm not into tattoos but if I got one it'd be either Disney or that. I love that so much. So now as when you are a leader of a as a leader of a PT how is that different from being a leader at a clinic? Like a clinic owner? How is that different?   14:38 I'll say it's the same it's just the objectives are different. Objectives are different. Okay. Now when when you're dealing with a clinical situation it to me if you're doing it the right way you're focused on your outcomes. Yeah. I'm not in a silo to where you know the orthopedic surgeons are upstairs and they own my my practice you They're gonna send me patients regardless of company, you know, so we're outcome oriented. And we get the things that are a little bit tougher than the guys that have the automatic referral that own their own PT practice. I've learned that competency, burns down barriers. You know, people don't care if your margin, if you know what you're doing and they got back pain, they're going to come and see you. That's true, that's true. But key thing in the key thing in business is to manage as many variables as you possibly can. Because they're variables that you can't manage. So being timely looking professional, okay, incompetent, having the tools that you need to get people better. I mean, how many PTSD see that, that work for a group that owns the practice that doesn't even have the tools to get the outcomes that they need, and they're working with the only resistive equipment they have is exercise to me. You know, you have to have what you need. And I'm our chief proponent of physical therapists independent practice, but I'm also a huge proponent of us owning our own businesses. And not working for groups that own you.   16:14 Yeah, we do. Uh, you know, I really see and feel what you're saying there, I have my own practice. And there's a lot to be said, because we all shine in a different way. We're all doing evidence based, but when we're able to come through as a as the autonomous decision maker that we've been trained to be, we can really help those patients, we can be a best service. I truly do believe that.   16:40 Yeah, I think so. But, you know, by the same token, we have to go the next step, and do what's defined by the way that the APTA is going, and the different academies and specialization. Oh, yeah, I've heard somebody give the worst advice at a three state meeting once and I'm not going to get the states because it might tip it off, it will. But this guy stood up and said, to the students, when you graduate, don't worry about training anymore. You already know enough, you know, you know, everything you need to know, to really make it. And I sit there. And then I asked the question, I said, Well, I think that the APTA is going towards specialization. So how does this fit in with that, but I know darn good. And well, after serving a four year residency in orthopedic manual therapy, that I'm a far better and more competent clinician. Also, you know, even being a co author and co author in some textbooks and defending my my thesis internationally at the First and Second World Congress on low back pain. It helped me to learn more, always active clinician, because I've learned more. And I have a more diverse patient population, because I'm a specialist in orthopedic manual therapy that's paid his dues. And and I believe we get superior outcomes when you go through residency training. Of any comment. Yeah, of any kind. So that was the absolute worst advice I've ever heard anybody give some young kids right out of school.   18:10 I think there's been a lot of advice out there that can be off, but I definitely think that's really, it's off. I'm thinking you got me thinking of I grew up as a ballerina. And ballet is impossible to perfect, however, that every ballerina is trying to perfect it what we're doing with our lines or bodies, you know, it's definitely out of the anatomical positions. And when you first start out like that, you learn all the dance steps, you learn all that, does that mean? I'm done? No. I'm always taking class, I'm always working to get better. And I learned so much from my life as a ballerina, I was pretty intensively in it at one point for a good portion of my life. And I learned the importance of always learning, always practicing and having to be passionate about it. Because if I wasn't passionate about it, I wouldn't be showing up and putting in my best. So having that background and then going into physical therapy as my new profession. Definitely was in line the idea of, of course, I'm always going to be learning Absolutely. What Why would that would make me the worst person to work with if I was start in one year of Tottenham?   19:22 No, I'm haunted by what he said. But it motivated me to teach something different to people in that. Yeah. With me, because I hear somebody saying something in full. He said it in full sincerity. He really didn't think anybody need to learn anymore. Yeah, but that's terrible. So let me go and teach people why they need to learn more. Yeah. Because especially when you're minority or a woman, you had better have it together. If you're out there on your own, you have better have a superior product because you're not in that good old boy network. Well, you're an outsider, also, if you better do it better.   19:56 Yeah, it's yes. And also If we're going off that you're going off with the research at the time that you learned it, we did not do diverse bodies, we do not have diverse bodies in research, we are massively lacking that, you know. So we need to be open and ready and seeking and creating more of that information to learn from to better serve.   20:20 I'm glad you're saying that because not only do we not have diversity, when we're looking at the body types that we have to work with, we're not having systemic diversity at all in medicine, because different people, the guy named D'Amato wrote a book a long time ago called Eat right for your blood type. And he talked about how different types of blood types have different types of foods that they can metabolize, and using their systems and have it not function in a fashion that's detrimental to the person. And lo and behold, different people can eat different things and perform differently. I'm gonna type O blood time, I need dense protein. Some people that are more of a type A blood type may not need as much dense protein, they may be able to make it by carb loading and eating pastas and things like that. If I eat a bunch of pasta before I go into an athletic endeavor, I'm going to suffer versus somebody else may be able to metabolize that and move forward with it. So everybody's different. And I think we're just now getting to the point to where we're paying respect to the difference in the different physiologic physiologies that different people have. And it just so happens that certain physiologies are grouped together in different ethnicities. Yeah, and because of because of that, because of that, then we have we have an evolving ability to specialize care to specific individuals. Yes. When When, when it's all mainly designed for just one certain group, or one certain physiology. Mm hmm. Body Type one certain athletic performance level?   21:59 Yeah, no different different, different, different, different levels of stress and anxiety, depending on what your background is. The stress and anxiety, someone gets the food, the blood type, that all affects healing. Yes. And it can definitely take away from the exercises they're doing.   22:18 Or give you a specific example of that, I'll give you some with COVID. With COVID. They're finding the people that get most sick from COVID have low vitamin D levels. Okay? Now, black people can't synthesize vitamin D, vitamin D is actually more of a hormone than it is a vitamin. Okay. And when you're exposed to sunlight, your body synthesizes its own vitamin D, which is a vital hormone for the basic function of your system, in your in your body. Okay? Well, black people can't synthesize as well, because we have more melanin in our skin. And the melanin reflects the sunlight. And so we have to have an increased exposure to sunlight to have the appropriate vitamin D level. Well, everybody was told to stay home for first three or four months during COVID. And lo and behold, black folks died at a higher rate than everybody else did. Okay, sky like, wet, your black folks have a more problem with high blood pressure, isn't it, and we eat the same thing that everybody else eats. But just so happens that affects us differently. And it may be because certain ethnic groups can't metabolize that metabolize the same foods the same way that other folks can. And so I think as we look at those things, and be more specific with it, we can teach through the whys. We're talking about, you know, masking up and what to do to not get COVID. But we're not telling people in specific you need to have this number of these nutrition nutrients every day. Okay, to where your system is more healthy. And your hydration level needs to be exactly this. I think that we could have done a far better job and still can have telling people what they need to have in their systems to be healthy.   24:07 And on that note, we'll take a quick break to hear from our sponsor and be right back. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   24:50 I agree. I absolutely agree. And for me, I I haven't even gone into the nutrition stuff in massive detail with my patients and now you're opening up another door I've actually been getting into cognitive behavioral therapy, right now learning about that not to become a therapist, not at all. But to better compliment how I communicate with people who could do well with it or watch out for trigger words, all that kind of sensitivities. Because the individuals I find my patients really do open up to me a lot. They have been through or going through some of the most jaw dropping things in their lives. And yes, that affects their healing. So I need to make sure I'm not triggering them. By my, the way I speak, if anything, complimenting a journey of healing, as we are working towards a healthier, healthier movement, decrease pain in their life. So yeah, yeah, I definitely get it from from where I've been with the anxiety stuff. Yeah,   25:51 you're dealing with people in their complexity. Journey, people that deal with people in the same with patient care. Now, let's go back to them. You know, zoom out zoom. And you've heard me say that, Oh,   26:01 I love that. Yeah.   26:02 So the deal is, okay, let the we've zoomed in so tightly, let's zoom out so that we can see everything again. And now let's zoom back in. Because, you know, you can teach a kid how to hit a baseball, and he can hit every type of baseball pitch at every speed. But what if he gets hit in the ribcage? Oh, you don't want to get hit the ribcage again? Right? So is that going to alter his ability to perform? Well, if he's so afraid of getting hitting and hurting, then it may be in the back of his mind that he's gonna have problems. So you know, it can alter his performance. So yeah, but the mental aspect of performance of any time. You know, my daughter suffers from anxiety disorder. And and it's hard. But we have to work through it. Because, you know, let's let's be sympathetic to us. But we need to be more patient with some folks and see what we can do to integrate them into a functional position in society. You can treat everybody fair. But it's impossible to treat everybody the same. Ah,   27:06 amen. Amen. All right, I'm going to switch completely into another because it just popped into my head. And I was like, oh, I want to ask regarding leadership. I was talking with another business owner, she's actually new to owning her own private practice. And, and then there's another person who's much more seasoned with his pride, like, yeah. And he said, I'm working on delegating more. And further, and I cringe, because we like to really Oh, that is that's it? How could you talk about your journey with delegation, because as you get, you know, the more of the leader, the higher leadership position, you do have to delegate more. How do you do you know, like,   27:51 Well, yeah, yeah, but here's what needs to happen is you've defined your clinical product, okay? You have to replicate that product, either you have to do it or somebody has to be able to produce the same clinical product that you produce. And it just so happens with mine. It's it's specific care in orthopedics with a high level of differential assessment of Neurophysiology histology and Arthur kinematics, and the appropriate prescription of hands on care and exercise from that. So if somebody comes to work for me, especially in the main office, they're not going to have their own patient load for six months. Until they go through the readings. And they they learn the basic clinical practice for dealing with an upper cervical problem, a lower cervical problem, ribcage issue. Problem with a hyper lordotic spine, a problem with a hyper mobile spine, problem with pelvic issue, be it internally, as far as pelvic floor issues, or biomechanically, when the sacred tubers and sick response ligaments are a little bit loose, and they can't withstand the normal loading. But they should be able to, they have to be able to do all those differentials in there to be a predictable application based upon that assessment and diagnosis, to where we're replicating the outcomes that we need to replicate with patients that present with those pathologies. And that takes time. So now let's go back to the guy that says that the students don't need to learn anymore. Well, they're going to get their lunch eat. All right. There are guys out there that then and ladies that have been doing this forever, that have the highest level of competencies, that'll run them out of business. If the playing field is indeed level, and there's access to the same level of referrals, and getting a good outcome doesn't mean that a person comes and says, Well, I hurt when I'm riding a bike for a long period of time. Well, why don't you take a walking instead? Now that's not an outcome. The outcome is when you get them back to doing what they want to do in their lives. Yes, that's it not modifying their life but getting them back to doing what they want to do so that they can maintain the quality of life that they desire, not telling them that well, if it hurts to bend forward, quit bending forward. No, that's not. That's not an outcome. Right? Right. modification.   30:09 Yeah, yeah. And it's so interesting you say that, because always learning, I have my practice where I'm 100% virtual. And that happened from the pandemic, I was not expecting that, and my performers love it for access everything. And it got me very into, you know, I'm not going to go into the details of what I do. But regarding outcome measures, I literally, that's what we very intensely focus on what they ultimately want to do not just like, oh, I have no shoulder pain, you know, they want to know if they can do this arm movement. And when they dance, you know, every time can they do that without having to worry about it. And then we get them there. And that is why I have a massive increase in satisfaction, because we are fully getting them to that to that their specific goals. I love them for   31:01 that. I'm very, very slow to accept praise for anything that I might do. Because the patient's the one that's got to do most of the work at the end. In the very end, and you're really is only as good as your last patient. You're only as good as your outcomes. Say that you are, yeah, doesn't matter how much you walk around talking about how great you are and how smart you are, if the patient didn't get better than you fail?   31:23 Well, because it's not about us. It's not about us,   31:26 it's about them, it's about getting them better, you know, and that is the most rewarding thing. You know, like, it's, it's,   31:35 I've built my company, we've got five facilities now. But it's one patient at a time, one outcome at a time. And most of the patients that we get come by word of mouth. Nice. Yeah. So you just get after it and handle your business and maintain and be a good steward of the opportunities that come to you. And take care of people the way that you'd want to be taking care of yourself. But back to the point of leadership. Yes. Your best, the best leader shows people how to do it, instead of trying to do   32:05 Yeah, and that's a skill. That is a skill. Oh, well,   32:11 the funny thing about it is I've always gone to church, and I've you know, I've always gone to church, and different people have different ideas of spirituality and religion. But there's a difference between believing in something. And living something. Yeah. Okay. There's a big difference in believing something and living something. And I go to church now, the preachers, my brother in law, and I was kind of skeptical because my sister in law married this guy, and he's preaching, I was like, you know, just because you got to church doesn't mean I'm gonna be hanging out at church on time. That's such a good guy. He's such a good guy, and he lives it. So now I went from saying that to actually being a part of the service every Sunday and doing devotion at the start of service. So you know, if somebody sees you living something sincerely, and not saying one thing, and then doing another and behaving in a way that's totally outside of what's your professing in a crowd, and I think that's a lot. That's, that's what a lot of people away from spiritual base. Community, is, people are observing what people are saying. And then they're observing that person's application of what they're saying. And seeing if it adds up. And a lot of times that, yeah, you know, a lot of times does, yeah, and I think that's led to a whole lot of skepticism and a lot of our religious organizations. Yeah,   33:35 yeah. Actions do speak louder than words they do. It's just like, exercises,   33:41 exercises. Think about it. Think about it, you know, you know, the only Torah or Qur'an or Bible that people see in public are the behaviors of those people that profess those religions a lot of times, hmm. So, you know, are we living testimony to the Torah, or the Quran or the Bible? Are we are we living testimony to because if we were as diverse as we are with religious beliefs, if it's obvious that we're living, right, you know, everybody, I think would get along a whole whole lot better if the Pharisees were zeroed out. Yeah,   34:19 yeah. But that's where that's where you you jump in for this leadership and for all this volunteer work, because you want to start being the change you want to see in the world and be rather than just being an outsider. Like, let's take action for this change, which I so appreciate that about you.   34:35 Well, I just I'm slow to accept it. But if I do, I'm all in. Yeah, yeah. If I do, I'm all in. Yeah. It's It's It's humbling to be asked to serve in a leadership role of any form of any form, to be called upon to serve because that means somebody thinks enough of you to ask you to think about doing something and being an agent of change or or a vessel of service. Yeah, and that's what I always think about my wife gets a lot of a lot of requests to serve as well. And so we're very understanding of one another's roles. When we're asked to do things that might eat away from our our family time.   35:16 Yeah. Yeah. Kind of hard. Yeah,   35:19 it's rewarding. It's rewarding. I love that.   35:23 Thank you so much for coming on. I know this can inspire so many people. Just when you speak if you ever are at an event and you see Do not be afraid to approach Him, He is the nicest human. Like, go say hi. Ask questions, everything like you're like, Oh, God, no, I'm gonna get   35:42 this better than others.   35:44 Well, yes, you are still human. Of course, of course. But you're very good at communicating that you're like, Hey, you said that with me. You're like, now's not the time. Let's connect another so we did, which was incredible. So yeah, it definitely just a great leader to know to learn from and just, you're just good people. So just thank you for being you.   36:05 Thank you. Thank you for having me. Yes. Turned out to be the way that you wanted it to be this time.   36:09 Oh, my gosh, this is all every time. I feel lucky.   36:13 We'll do it again, if we need to. Oh, my God, I   36:15 would love to. And then, um, how if people want to reach out and connect with you? What is the best way if somebody wants to reach uncle? Oh, I want to I want to ask them a question.   36:25 Well, they can call the main office here in Little Rock 501-975-4040 Or you can look us up on our website at ortho rehab comm and leave a message there, somebody will check it.   36:41 Wonderful.   36:42 Thank you so much. And also don't forget about the American Academy of physical therapy. If people are curious about that. It's a wonderful service based organization designed to deal with healthcare disparities in the face of black community, but we're trying to help everybody, but our leg laser focus for us is to work with the black community and then try to help everybody else as we can.   37:03 I love it. Thank you.

Episode Summary In this episode, Co-Founder of Aivo Health, Melissa Farmer, talks about the mind-body approach to treating chronic pain. Today, Melissa talks about the mind-body approach, getting patients to be more receptive to the mind-body approach, and how practitioners can recommend psychological care for chronic pain. How can psychology work to treat people with chronic pain? Hear about the gaps in chronic pain measurements, the psychology behind farming pain out, the Aivo Health App, and get Melissa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The body and mind aren’t separate. They work together, they interact, and that impacts the experience of someone who lives with chronic pain.” “Just because we can’t measure it with an existing tool, doesn’t mean it doesn’t exist.” “A patient saying that they’re in pain is all the proof that you ever need to believe that they’re in pain.” “We all have a collective responsibility to empower people who have been living with chronic pain.” “One of the most powerful tools for pain relief is between peoples’ ears.” “Your identity is not your accomplishments.”   More about Melissa Farmer Melissa Farmer is a veteran chronic pain researcher-turned-entrepreneur. During her graduate studies at McGill University, she trained with a world-class multidisciplinary team at the chronic pain center founded by pain research legend, Ronald Melzack. She earned a doctorate in clinical psychology and neuroscience. Dr. Farmer went on to pursue postdoctoral training with neuroimaging pioneer Vania Apkarian at Northwestern University, where she specialized in brain imaging of hard-to-treat chronic musculoskeletal and pelvic pain.   In 2018, she left academia to co-found Aivo Health, a startup with Vania Apkarian and a chronic pain patient/entrepreneur. Their mission is to bring insights from the top tiers of pain science directly to people living with chronic pain.   On twitter, Dr. Farmer has an international following of influencer physiotherapists who appreciate her ability to translate basic pain science research into understandable language.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Chronic Pain, Psychology, Treatment, Mindfulness, Meditation, Therapy, Trauma, Pain Relief, Mind-Body,   To learn more, follow Melissa at: Email:              melissa@aivohealth.com Website:          https://aivohealth.com LinkedIn:         Melissa Farmer Twitter:            @Farmer_MindBody   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hey, Melissa, welcome to the podcast. I am so happy to have you on I have heard raving reviews from Sandy Hilton and Sarah Haig about you. So it's great to have you here.   00:15 Thank you so much, it is a pleasure to be here with you. And today we're going to talk about treating patients living with chronic pain from a mind body approach. So before we get into the meat of the interview, can you define what a mind body approach to the treatment of chronic pain is? Sure, a mind body approach to the treatment of chronic pain acknowledges that we are embodied in these, you know, this skin, muscle bone, that we feel emotions in our bodies, that sensations have emotions that are attached to them. And it also acknowledges that all of these conscious experiences like pain and chronic pain arise from the brain. So they're conscious perceptions that are shaped by our thoughts and emotions and feelings and past experiences. So it's an acknowledgement that the body and mind are separate, that they work together they interact. And that impacts the the experience of someone who lives with chronic pain. And now here's here's the hard part as clinicians, what can we do to help our patients be more receptive to this approach when it comes to pain management, because chronic pain, any clinician will tell you is not an people living with chronic pain, excuse me, it's not a it's not an easy road. So what can we do to allow our patients to be more receptive to this? Because oftentimes people will say, so you're saying it's all in my head? And that's not hopefully not what we're saying. So got it? Oh, not at all. So one of the most powerful things I think, that we as clinicians can start with is a simple statement, I believe you, which is something that many people with pain don't ever hear. And it can be such a powerful statement, because then instead of coming to an appointment with, you know, evidence that they've prepared to prove that their pain is real, you know, tests, scan results, etc. You push all that off the table, you say, I believe that you're in pain right now, and I'm ready to help you. That's, that is, I think, one of the first pieces of resistance that we can remove, just by validating their experience.   02:53 And I think especially whenever people have lived with chronic pain, and have seen many, many, many, many doctors, they get used to this feeling that they need to   03:08 convince the person in front of them that their suffering is real. And if we just if we   03:19 if we get up that out of the way, just by acknowledging that common humanity, I think there's there's one level of resistance that's removed quite quickly. And what about providers, or medical professionals who our education, whether it be formal education school, our clinical rotations, has sort of trained us to look at scans and say, Oh, this is it. This is what's causing it. So what can we do as providers to? To break us out of that, if it's in the scan, then that's, that must be what it is. Do you know what I mean? Mm hmm. I think getting in touch with some humility. So crepe is a great way to start. Because one of the issues with scans and test results is that these are things that   04:14 scientists and the medical professional has decided these are measurable, objectively accessible, indices that we've all sort of mutually agreed, indicate that something you know, there's some sort of structural abnormality or whatnot. In other words, we're testing to look for what we know might exist. Another way of saying that is that we're only testing for the things that we've thought about before, and that we know how to measure and there's a lot of things that we don't know about and we don't know how to measure. And just because we can't measure it with an existing tool, doesn't mean it doesn't exist. And, you know, from a basic science perspective, right   05:00 My background is in basic science of chronic pain, we do not know a lot about chronic pain mechanisms. And so having sort of the humility to recognize that   05:18 the nervous system is incredibly complex, the brain is incredibly complex, there are many things we don't know how to measure, and it doesn't mean that they aren't there,   05:30 we tend to cling to tests that reflect our particular training. And from a patient perspective, what that means is that they get different types of snapshots. For instance, if someone has   05:45 lower back pain, they may get MRI scan to one, you know, from one doctor, if there's comorbid, visceral pain, which could be referred, for example, they might get a colonoscopy from another doctor, each of every every, you know, we've talked about silos before, you know, in the general field.   06:06 Each of these silos have their preferences for these different tools, and they all provide small snapshots. And it's sort of like the, you know, the blind men feeling on different parts of the elephant, you know, that really handy metaphor, just because you're a trunk expert, or you're a, you know, a, an, an elephant foot expert doesn't mean that you're able to see the entire picture. So Humility is a great attribute. Yeah. And where do you think this kind of false dichotomy between the body and mind originates from? Is it that, you know, Decart Deyan? Theory, you know, that happened centuries ago that we continue to accept? Or is it that we put more weight to the objective and less weight to the subjective? Or is it both? Or is it all the above and more,   07:06 all of the above, for sure, especially in the pain field, Decart has, he said, really strong influence, and he suggested that the body is like a machine. And you can sort of causally identify almost like a, you know, knocking down a line of dominoes. A cause effect, cause effect cause effect. And that's how you understand a more complex organism. But   07:34 what he, he sort of, it's interesting, he, he essentially said that, you know, like the body, the material, it works on different rules than consciousness. And he sort of made this blanket statement that we all accepted. So in a sense, relying on the words of a philosopher 400 years ago, is the basis for our logic today is a little a little surprising. But it's something that many people haven't questioned. And, unfortunately, in the, in standard medical training,   08:09 I'm sure you're familiar that like, especially in Northern America, in medical school, they receive anywhere between four and 11 hours of pain education,   08:21 there isn't enough time to go into the depth, the proper depth that this subject deserves. So I think that it's a, unfortunately, a reflection of these overly simplistic heuristics that medical professionals and other practitioners receive.   08:40 That that just doesn't do justice, to pain at all. Yeah, and like you said, because pain is so complex, because pain is an emotional and   08:54 physical state   08:57 that I think people are always looking for the answer. I know, patients are always looking for that one doctor, that one test that one scan that will say, Oh, this is it. This is the problem because people like logical things, right? People like well, point A, here's the problem. I can do B and I will end up with C feeling better. But when it comes to chronic pain, we can't look at the body and mind as separate. And I think a lot of people do and that does really is a recipe for some really ineffective treatments for pain. So what what can we do if a patient comes to us and they have sort of accepted that their mind body and mind are totally separate? And their kindness I must have done something I've got I've had this pain. I you know as a practice, I'm sure you've heard it. I hear it all the   10:00 Time, I'm sure I did something again, or I must have done something to flare it up. So how can we respond to that in a way that's accurate and helpful.   10:12 One of my beliefs, and this may not be a popular belief is that   10:19 the body has done nothing wrong, whenever it creates chronic pain, the body and mind it that chronic pain isn't a mistake.   10:29 And I say that from a scientific perspective, because whenever I've studied the mechanisms from the nerve ending on the skin, you know, whenever pain signals or nociceptive signals are transmitted from the surface of the skin, to the spinal cord to the brain, the body is naturally designed in a way that amplifies pain signals. So amplifying pain is how nature works. And it works that way. Because pain is a really important thing to notice. Pain is a primary reinforcer. And that means, by definition, it's aversive, you don't need to condition or to pair it with anything for an animal or for a person to try to avoid something, it's painful. And that's why it's always sensory and always emotional. It's always aversive.   11:23 And whenever, you know, as I've studied chronic pain populations over the years, and I've looked and really considered and reflected on the biological changes that I see all of these, these mechanisms that sort of turn up the volume of pain, whether it's at the nerve and the surface of the skin, or in the spinal cord, or in the brain, they're all there for a reason. And it's because the signal is incredibly evolutionarily important to respond to.   11:55 And the division happens in the brain where once it gets to the brain, and creates a emotional memory, or a fear memory. That's whenever the brain adapts and changes in response to that incoming signal. So in a sense, that's the point where the brain begins to adapt to accommodate the pain in someone's life, rather than just being passively responding to the environment. And that's one of the   12:31 one of the main features of chronic pain, where it's no longer just a, you know, whenever you see a patient to   12:42 has pain that still increases and decreases in response to external stimuli. That's a great sign because it means that the nervous system is still really closely linked with the environment. Once pain fluctuations start to vary independent of the environment, that means that it's become   13:01 more hard coded into the nervous system.   13:05 So that whenever I see patients who you know, who do have pain that's responsive to seeing the environment, I congratulate them.   13:15 But again, the idea that   13:19 it's adaptive to remember what causes pain means that it's also adaptive to create pain memories. It's also adaptive to change how you move in relation to pain. And it's adaptive, to feel depressed, and to feel anxious. Those are all completely normal, understandable responses to pain. And the   13:44 thing that isn't as natural and healthy is the inability to go back to baseline after you've hit that new state. And one of the reasons is that whenever you have chronic pain, so many experiences during your daily life, reinforce that cycle that you don't have many opportunities to learn what the lack of pain is like.   14:07 And something this is something I call relief learning. So it's natural for us to pay attention to periods of escalating pain. It's something it's a skill that can be learned to pay attention to periods of pain relief. And that's something that a lot of patients don't naturally do. And it's something that   14:31 if you don't come at it from a brain perspective, you might not see the importance of it. But anytime pain is decreasing, or it's lower than it normally is. That's the time that you should be focusing on positive emotions, relaxing the body, learning new skills, that's optimal learning time. So of that, one of the reasons I bring that up is that the the brain even though it's responsible for creating this chronic state   15:00 It's also the key to changing it and shifting back and reversing to the pain free state. The plasticity of the brain is is just a never ending thing of beauty. Absolutely. Absolutely. Well, now let's talk about, because it sounds like, and I love what you just said, it sounds like we're really focusing on sort of psychological care, which is part of care for chronic pain. And I love something that you wrote in that if mind based treatment helped my pain, then my pain must not be real. Hmm. Right is maybe something that might be in the back of someone's mind someone living with chronic pain are in the forefront. So how, how can   15:45 psychological care? Whether that be CBT, or mindfulness, or you know, there's a million different kinds of, I'm sure scientists, psychological care. So   15:58 how can people use psychological care, but not D legitimize their pain experience, not make them feel like, well, if, if this helped, then   16:10 my pain wasn't real, because if it were real, then that injection would have taken it away, or that movement or that stretch, etc, etc.   16:20 One of the things about trading   16:25 one of the things about psychology is   16:30 that sort of inherent in this illusion that the mind and body are separate   16:37 is that   16:40 whenever you have a new experience, there are measurable neuronal changes in the brain, there is a physical change that occurs, there is a measurable change that occur that occurs, even if you know we don't have the tools right away to measure it.   16:58 psychological changes are biological changes. And there's what 4050 years of science that reinforces that. So just because a psychological treatment can help doesn't mean that it isn't biological, it just reinforces that this source of the biological change is different from what you expected it to be. So I know that a lot of people with pain   17:27 you know, if for instance, their lower back hurts, or if a certain limb hurts, they assume that the source of the pain must be in that body part.   17:38 And although this is getting a little high up,   17:44 in terms of mechanisms, one of the reasons why we can even tell where our body parts are, is that there are maps in the brain. For instance, you know, one of the examples of this is the homunculus. But there are actually four different maps in different parts of the brain, that help us understand where our body is in space, and where our hand is where our lower back is. So you don't know where your lower back is, unless your brain helps you decipher where in the body map it is. So, you know, in multiple levels, this this idea of separation is really artificial, it really doesn't serve the experiences of people with pain.   18:25 I understand that.   18:28 Also, that one of the reasons why patients may adopt this kind of thinking is because they're   18:37 trying to work with the perspective of the provider who's treating them. If the provider has these assumptions, patients naturally, just to adapt, they have to play the same bowl game they have to in you know, they might do this through Google searches, or educating themselves on the web, or looking into pain, neuroscience education.   19:03 In order to be heard, I need to study the way that this is described online and in the literature, I need to be able to talk to my doctor in a way that they can understand.   19:16 And even that   19:19 even even that point where it's like I need to interpret my internal experience into something else so that someone else will believe me, I feel is sacrificing their internal experience of pain. No doctor   19:35 I almost think that like   19:38 a patient saying that they're in pain is all the proof that you ever need   19:45 to believe that they're in pain. You don't need a test. I really believe this. And so much the point that you know, I've I've I worked with Dr. Vani up caring for many years. The reason why his research   20:00 has been replicated so many times and has been published in such higher to high tier papers is because he looked at the patient's perception of pain and mapped brain signals to that perception.   20:17 He listened to the patients from the very beginning, he didn't say, Well, you have to finish the standardized questionnaire. And that'll tell me, that'll be the way that I measure whether your pain is there or not. He had a moment by moment, measure of pain intensity that he used to extract the signals from the brain during these brain scans. And that's how he found his fantastic findings that have been replicated again, and again, by different by different groups. And those are the findings that reinforced that as pain becomes more chronic, the brain regions that are correlated with the perception of pain change from sensory related regions early on, to emotional related regions within a year. In other words, after a year of living with pain, emotional brain regions are correlated with the sensory perception of pain.   21:15 Another way of saying that is that the sensation becomes emotional.   21:21 And that isn't saying that it's not real that saying that it's so real, you can measure it on a brain scan, you can see the pictures, you can replicate it across studies. It's that real?   21:34 So I feel like I've sort of No, no, gone in a few directions to answer your question. But   21:44 all all patients,   21:47 all we need to do is take patients word for their pain, we don't need any extra evidence that it exists, we just need to take them seriously. And to reinforce that, it's not your fault that you have this pain, you did not cause your illness, your body was doing exactly what it was designed to do exactly what we would expect a healthy person's body to do. It's not your fault. So let's, let's work together and find   22:19 your own path to pain relief learning. Right. And obviously, everyone's path is different and individualized. And I think we can all agree on that. There was something that you had said,   22:31 as you were speaking, that popped something that caused me to think that sometimes I don't know if you've seen this, but is it easier for patients to sort of farm their pain out to sort of third person their pain, versus first person their pain, meaning they may describe it, or they may listen to the way the doctors describe it, and not think of it as their first person pain, but think of it more as third person. And I'll give you an example of what I mean by that. So I have a long history of chronic neck pain   23:07 during my 30s, like, literally, the decade of my 30s For the most part. And I had I was giving a keynote talk a couple of years ago. And so I joined a speaker salon, or speaking group to help with this talk. And it was about they wanted me to talk about my experience with pain. So I went out there and I started it like imagine a patient walked in and had all these symptoms, right. And the woman who is not a clinician, a health care practitioner in any way. She is a writer, director and speaking coach, her name is Tricia Brooke. She said, Well, hold on a second. I'm gonna I'm gonna stop you for a second. I said, yeah, yeah. What is it? She's like, Is this about you? And I said, Yes, it is. And she's like, Well, why are you talking about it in the third person?   23:57 I said, Oh, well, because at the end is the big reveal that it was me and she's like, people know, it's you. You're up there talking about it. Like so why don't we change it to the patient and change it to me. And I started and within five minutes, I was crying so much I couldn't continue.   24:15 And I was like, This is why it's not first person because it was so hard. For me it was a lot easier to sort of third person it out or farm it out. And then going through this for eight weeks, I was finally able to get through the whole talk and someone came up to like, you know, I really liked those parts when we were first doing it when you were crying a little bit. I'm like, that wasn't part of the bit. That wasn't a bit that was me not being able to talk about my experience with pain, because it's emotional and sensory. So the although at this point now I had not had pain in years. To the extent I had it when I was speaking about it right, but to your point   25:00 The emotional attachment was still there.   25:04 So what do we do with that?   25:10 That's such a great   25:13 question.   25:18 I think it's self protective. Initially, whenever just just as you described, it's self protective and that you live with the pain every day.   25:30 It's a way to distance yourself from the suffering.   25:36 So on one hand, I understand 100% Why people do that. And in a lot of the patients that I've seen, over the years have done that too.   25:50 I think that   25:58 something that comes up for me right now, is that the words that one person uses for their own pain are the most therapeutic words that they could   26:10 use.   26:12 In that, engaging in the pain memory, from a psychological perspective, is one of the things that allows you to change that memory.   26:23 And I kind of wasn't planning on going here. But it's, it's an opportunity.   26:29 One of the reasons why psychological approaches to   26:34 chronic pain care have the potential to be so effective is that if pain is an emotional memory,   26:45 we know from 20 years of basic science, neuroscience, that emotional memories can be fundamentally change. There are rules, there are very clear rules.   26:59 The rules are you revoke the memory, on purpose as fully as possible.   27:07 You ideally introduce some type of contradictory experience something surprising, because that really makes the   27:20 the brain state more salient, it makes the brain pay more attention to what's happening. And then within three hours, you induce relief, psychological relief, deep breathing, I've worked with patients where we administered propranolol under the guidance of their you know, their doctors, but deep breathing is enough. And that if you are able to induce in sort of controlled conditions, these experiences where you fully experience pain, how it is for you, using your words, the emotions that come up in your body. That is how you fundamentally changed the memory structure of chronic pain.   28:06 Fascinating, you can do that in little bits across time.   28:12 Under more controlled conditions, you can do it in one big whammy exposure session.   28:17 Interesting, I think I did it in little bits over an eight week period in front of an audience   28:23 in front of a very safe audience of 14 amazing women. And you were also in a sense, potentially reshaping your pain narrative, as you're going through this, too. So you know, per Gillette Abelton.   28:38 You know, working with the pain narrative, and changing the meaning of the pain story over time is one of the another way that   28:48 that your pain story itself can be really therapeutic. Yeah, yeah, it was. It was wild. But it's it's a good example, I think of how even though I had not had pain for years, but the emotional attachment to it was so strong that I couldn't even get through a paragraph of this talk without crying. I was like, I think I need to come off the stage. And then each time it got, you know, it took more and more time, I guess before I would have like a really emotional response. But I have to say since then it was like,   29:28 like a weight off my shoulder. You know, and this is years after not years, maybe like six years after I really had more consistent chronic pain. So it was years and it was it was years after the pain had the chronic pain had subsided.   29:45 That's interesting too, because it suggests that there's a larger memory structure underneath there that even if the sensory aspects have been remodeled, the emotional attachment can still remain. And so in a sense, perhaps   30:00 that experience helped to heal the entire memory structure in a way that it you know, it wasn't quite complete just with the sensory pain being gone. Yeah, yeah, maybe it closed the circuit a little bit, so to speak. But anyway, it was it was highly, that's fantastically effective. But it just goes to show and again, I wasn't working with a professional perhaps if I were maybe I would have closed that circuit a little earlier. Or maybe not. Maybe this was the time, we don't know, too many questions to answer. So it's just right, you didn't just write for us at the right time. So, you know, just goes to show that when we're when we are treating chronic pain, we need to target the brain. Right? I think you need to have psychological care. So what do treatments look like? Obviously, reminding the audience that everyone is different, and everyone is individualized. But what are some examples of how psychology can work with people with chronic pain?   30:57 Well, so there are a number of evidence based approaches.   31:01 So cognitive behavioral therapy is one that everyone knows about Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, even pain, neuroscience education for some people. And whenever I think about these things that I typically look at the biases of the person in front of me, is the person in front of me a highly logical, rational type of person, I'll direct them to cognitive behavioral therapy, are they more embodied emotional person, they might be more open to mindfulness meditation approaches, or Acceptance and Commitment Therapy.   31:38 I think, especially people who have been in the healthcare system, go around for years and years and have some trauma related to being a chronic pain, patient benefit from pain, neuroscience education, just because it helps them get a better understanding of what they've been working with. So in a sense, you know, we have sort of a number of different tools that we know of in the literature, and adjusting each tool based on the the worldview of the patient is the best way to go. I think that's such a great way to look at it. And what advice do you have for let's say, physical therapists, occupational therapists who are working with patients with chronic pain? What is your advice to us to recommend psychological care? How, how can that conversation initiate?   32:36 And what is the best way for us to refer out?   32:46 I think that one of the best ways to initiate the conversation is by expressing empathy, and compassion, it looks like you're really having a tough time with this.   33:01 And from what you've described, it seems to impact many areas of your life, I see that you feel anxiety, I see that you've experienced some depression, I see that this stresses you out,   33:16 have you thought about support some sort of psychological support? To help you through this, that's, I think one of the most open ways that that this can, this can happen and a lot of physical therapists that I'm that I've interacted with, have taken it upon themselves to learn some of the psychological purchase, because it's almost   33:41 because they've sort of found themselves in the position of being the psychologist whether they liked it or not, or whether they had the training or not. And I've really admired a lot of the physical therapists that I've interacted with, because they've gone extra steps to learn what it is that they might need to know in order to provide better psychological care, as you know, as a physical therapist.   34:09 However, there are lots of times whenever the degree of distress or the degree of suffering, it is beyond training, you know, the training that you might have as a, as a physical therapist. So that's whenever it's time to bring in a professional   34:29 in terms of identifying   34:32 the optimal type of treatment or making referrals. That's very tricky of because there aren't a lot of pain psychologists in North America.   34:47 Even if I were to come up with a list of them, a lot of them that I know of are in academia and the people that   34:55 are in sort of the private sector. They have that specialization just   35:00 because they have lots of experience there. So it's, I kind of, I don't have, I don't have many suggestions. In this case, I do have a suggestion of a tool that I've helped to develop, that could supplement that in a way.   35:19 But in terms of finding the optimal,   35:25 as per the optimal psychologist, I think it would come down to therapeutic alliance. And that's something that each person has to feel out for themselves. And that, okay, you have a person who's highly rational, logical CBT might be the thing for them, have them talk to three different suggests they talk to three different people who feels right.   35:45 Because I'm a firm believer of therapeutic alliance, in the larger sense. And the the foundation of therapeutic alliance was best articulated by drum Frank, in his book, persuasion in healing. And one of the things he described is the healer suffer relationship. And one of the core tenants of the healer separ relationship, the healer believes that they can heal, the suffer, believes that the healer can help them. And they come together and interact with a number of rituals together, that are intended to relieve the suffering. So if you have someone who's on your side, even if they don't have the right training, but you trust them, you feel like they get you, that's more therapeutic than their training proper.   36:35 And that's, it's it's tricky. But for instance, even just talking on the phone for 15 minutes, to three different practitioners is enough to be able to get that feeling. Yeah, that's great advice. Thank you for that. And now, as we wrap things up here, what would you like the listeners to take away from this conversation? If you could wrap it up in a bow? What would that what would that present look like?   37:06 I think   37:08 we all have a collective responsibility to empower people who have been living with chronic pain.   37:20 And I think that,   37:22 you know, based on our conversation, one of the most powerful tools for pain relief is between people's ears. And I really think that that's the most empowering approach as well. And that I, at my core, I don't believe that we, that people need to rely on   37:40 doctors or medications or even approaches nearly as much as their own brains.   37:48 I, I know that it's difficult to get access to tools and psychological approaches that enable that. One of the things I'm doing,   38:00 you know, just from a, from an entrepreneurial background, is working on tools that will help people with that. But the key to long term pain relief, is teaching people to attend to patterns of pain relief, and what really feels like even if it's just a few moments every day. So my overall bold statement would be the key to your pain relief is paying attention to whenever the pain is less whenever you have time, to enjoy things in life to engage in positive emotional learning. Those are the keys to pain relief, because the more you focus on those moments during the day, and the more we encourage our patients to focus on those moments, the better they'll get, and the more quickly they'll get better.   38:50 I love that. And now where can people find you? What do you have going on? What's coming up? Let us know. Yes. So one of the things that I've done in the past few years after leaving academia, thank goodness, is I co founded a startup with Vanya, up Korean and a chronic pain patient, make Mika Michalak. So he's an entrepreneur, finished entrepreneur who has had chronic pain himself. And we   39:18 created a tool that is essentially insights from Bonniers research in an app form.   39:29 And it contains Mindfulness Based CBT exercises and tools that I wrote, and pain neuroscience education that I wrote. So in a sense, it is a expert created tool that is designed to give all of these insights directly to a patient without them having to rely on doctors or any formal care.   39:56 Because one of the apps Oh, the app is   40:00 Ava health app.   40:02 So if you go to www dot Evo health.com, you can learn more about it. And one of the one of the things that I it's a real conviction of mine, the science that's needed to heal chronic pain exists today.   40:21 You know, this is work that Vanya has been doing for years. And the time that it takes to sort of for that knowledge to trickle down to clinicians and to, you know, clinical guidelines, is 10 to 15 years. And one of the reasons why we decided to do this was because if it exists today, patients deserve to have it today.   40:42 So it's, it's a labor of love.   40:46 And I invite anyone listening to this podcast, to recommend to check it out yourself, to recommend it to your patients. And to contact me directly at Melissa at Ava health.com. If you'd like some more information about how to use it to help your patients. I'm very open to that. I love it. And we'll have the link to that in the show notes at podcast dot healthy, wealthy, smart, calm. And again, that website is www dot A i V as in Victor Oh health.com Just so people have the spelling of that.   41:27 And now one last question that I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, let's say a fresh face out of grad school or maybe undergrad wherever you want, wherever you want to take that starting point.   41:45 I would say Melissa,   41:49 you're either identity is not your accomplishments.   41:55 Think about what   41:58 drives you what creates the most passion in you. It's to help people get better. And to support people while they're healing.   42:08 instead of chasing after the shiny ego cries that other people applaud you for take a step back and focus instead on what makes people feel better now make choices to help people heal.   42:32 Now, don't worry about long term research because long term research won't help people now.   42:39 I love that advice. Thank you so much. This was a wonderful conversation. I always learn such I always learned something new. And this was a lot of new so I want to thank you for coming on. Thank you so much for having me. And I really appreciate it was wonderful and everyone thank you so much for tuning in. Again. If you have any questions for Melissa you can reach her at a vo help calm and have a great couple of days and stay healthy, wealthy and smart.

In this episode, Dr. Jenna Kantor talks with Dr. Drew Contreras about the rigors of working as a PT for the President of the United States.    More about Drew Contreras: Drew Contreras, PT, DPT, SCS  – received his Master of Physical Therapy from Gannon University in 1998 and his Doctorate of Physical Therapy from the University of North Carolina at Chapel Hill in 2008.  He is board an APTA board certified Sports Clinical Specialist since 2003.  His professional interests are sports medicine; manual therapy; blood flow restriction; bio-technology; musculoskeletal injury prevention, diagnosis and rehabilitation as well as human performance optimization.   Serving over 20 years on active duty as a career military officer and practicing physical therapist within the US Army & Department of Defense, Drew has served in a number of settings and military units throughout his career before his retirement in 2020. He spent his early career at Ft Benning, GA and then moved on to Ft Bragg, NC.  His skills were put to work extensively in 2006-2007 during a 15 month continuous deployment during Operation Iraqi Freedom where he was the first physical therapist to serve in sustained combat operations with the 82nd Airborne Division. After returning Drew moved to Washington DC to work at the Pentagon Health Clinic where he served as the Director of Wellness and Physical Therapy.  During this time he served as a consultant to the White House Medical Unit and was then chosen as a by name selection by President Obama to serve as the first ever full time physical therapist at the White House.  There he served as the Physical Therapist to the White House Medical Unit and President of the United States Barack Obama from 2010 until the end of the administration in 2017.   To learn more, follow Drew at:  His Website Twitter   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read The Full Transcript Here: Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everyone, welcome back to the podcast. I am your host Karen Litzy. And today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and referrals, net Hills Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using NET Health's private practice EMR, be sure to ask about his new integration, head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today. All right onto today's episode, Dr. Jenna Cantor is back and today she is interviewing Dr. Andrew contrary us he received his master of physical therapy from Gannon University in 1998 and his doctor physical therapy from the University of North Carolina at Chapel Hill in 2008. He is board certified sports clinical specialist and has served over 20 years on active duty as a military officer and practicing physical therapist within the US Army and Department of Defense. He has served a number of settings and military units throughout his career before retiring in 2020. After retiring drew moved to Washington, DC to work at the Pentagon health clinic where he served as the director of wellness and physical therapy there. During this time, he served as a consultant to the White House medical unit and was then chosen as a by name selection by President Barack Obama to serve as a first ever full time physical therapists at the White House. There he served as the physical therapist to the White House medical unit and President of the United States, Barack Obama from 2010 till the end of the administration 2017. He has worked with a wide variety of government officials as well as police and law enforcement agencies. And today he's going to talk a little bit more about his experience. And it just goes to show you that there are so many options and so many settings that physical therapist can work in. So I think Drew and I think Jennifer great episode. Hello, this is Jenna canter so honored to be hosting this podcast for healthy, wealthy and smart. I am here with Dr. Drew Contreras who just said Just call me Drew. And I was like, Oh, that's so cool. So Drew or gesture is one you want to get his autograph when you know what he has done. This is the the physical therapist for Brock Obama and Michelle Obama. And then the current president and first lady, which is just not and as soon as I learned this, and then got to hear him speak at a conference. I was like, this is somebody that I am desperate and enamored, inspired by must feature on this podcast. And I approached him a complete stranger. At this conference, I sat right next to him dinner and as he didn't know me, and he said, Yes, this superstar said yes to doing this podcast. So Drew, thank you so much for agreeing to come on to this podcast. My pleasure. Right, like   03:54 it   03:55 is I appreciate the kind words thank you very much. Absolutely. And that's how I'm going to be approaching this this podcast as a young professional in the physical therapy industry that saying, How did you do this? How did you get to this point, and we're just talking about executive medicine here to really understand point a point B, I feel like from the conversations I've had with people outside this podcast, there isn't one way to eat a Reese's. It's not some clear pathway if you want to get this way you you're gonna fit in this box and it's very much like the performing industry. It's like there's no it's not one agent that's going to get you that movie. So we're here to just hear hear your story where where you got started and how that led to such a   04:43 prestigious and how honor what an honor, I have a position to get to do. Yeah, um, so I think that   04:55 I think that regardless of like what you're pursuing, right, whether   05:00 That's, you know, working in executive medicine or like you said, working with a performing arts group or, you know, working with a traveling band or a sports team or whatever, right, I think the thing that people   05:14 really de emphasize, which is the exact opposite of what should happen is, you need to be really, really good at what you do. Right, there needs to be no question that you are exceptional about what it is that you provide. And I think that people get lost in wanting the end state. And they, they don't go through the process properly. Right. So just just to be blunt, right? Like, if you've got, you know, 18 months of experience, you probably shouldn't be the person on the sidelines on a high contact sporting event, who's the only person that's available? Right, that's probably not the best plan. And likewise, right, like, you probably shouldn't be the sole healthcare provider on a plane someplace when like, you barely really know what you're doing it. So I think that people get confused with, in order to get to the end state, right, I need to go through these, like, I need to know somebody or I need to, I need to have a, like you said, there's a person who will get me there.   06:17 The only thing that will ever get you there is is being exceptional what you do, right? Because when you start talking about things, especially like executive medicine, you have to realize that the people that make it to this point or this level up are exceptional at what they do, right. And they have made a living off of calling people out on the BS card. Right? Like, they know when you are not exceptional at what you do, because they they've seen it for so long. So if you're not at least there, right, if you haven't found your, your, your apex of your skill set, it's not a place you want to be. Right. So first get there, right, get really, really good at what you do. And then if that's if you've made it to that point, opportunities will unfold themselves, right? If you're prepared if you're really good at what you do. So I think that's the best thing I can say to people is, like you said, there's no, there's no cookie cutter path to getting into this, as there shouldn't be right, because it's certainly not for everybody.   07:23 Yeah, I think that's really well said, and I want to tap on the assessment of what it means to be good at what you do. And this is my opinion, but I'm going to put it in here. And then I would love your thoughts. But don't base your success off of other PTS opinions based off of other patients opinions.   07:47 I think we really mix that up. I think we really do. And it's just not everyone. What are the patients saying? What is your success rate? There are the ones that if they do get do they come back to get I would base it off that I think we worry too much about what our   08:02 comrades that's the word that's in my head right now are thinking. I think you're absolutely right. Right. Like if   08:11 I think there's a difference between   08:15 external validation, right, which is kind of what people say about you. And that can be rewarding, right. It can also be incredibly destructive, but but it can be rewarding for some people. And that's different than than defining   08:31 a level of expertise or level of success. Right. That should be pretty objective. You should be able to measure that with clinical outcomes. You mean, like you said, even just sheer recommendations and referrals from existing patient? Right, or sources? Right. That's it. That's a better   08:51 litmus test than who said, what about you on Twitter? Yes, yes, yes. Or if you're, if you're there a different way. So what about you or say you go to a conference like CSM, and everybody has been in this industry for certain periods of time. And when we create relationships with people, the ones where we are really more connected to we just generally bond with just like our friends in life outside of the business? Are even if they're not, you're not friends with the right people. It doesn't mean anything. It doesn't mean anything. I have a friend who just got on Broadway, she had zero friends who are on board, you know, like, she wasn't like, let me see of friends on Broadway, but not like close, close. You know, I just I think we can get stuck in that. Like, I'm associated with them. So therefore, like I can't, in the, like I said the reality is, even if that association gets you a conversation or a phone call, right? It won't sustain you for very long. Yeah, yeah, absolutely. What is the schedule and   10:00 Life, like in regards to when you're doing such a high profile job? Yeah, you know, I bet   10:12 I think I would average it out to people would call me get a hold of me at least two or three times a month and say like, they wanted to be the White House physical therapist, and I finally got it down to like, okay, um, that's, that's great that you're interested, I need to know, if you're okay with this, you will not have any vacation days throughout the year zero, you can never buy a ticket. That's non refundable to anything, you must be okay, giving up attending any sort of family event, kids sporting games, whatever it may be.   10:47 In the event that you actually do get to go on vacation somewhere, you must be okay with it, they call you you have to leave immediately and come back. If you're okay, with these basic things, we can have a conversation, right? And most people immediately are like, well, that's not what I wanted. I just wanted to fly on a jet. You know, and, you know, have people think that I'm, you know, in this prestigious environment, like   11:11 all these things come in a price, right? It's, it's not, it's not an easy price, right? I will forever   11:19 hold Brock Obama responsible for the fact that we both started there with black hair, and ended up with gray hair.   11:28 super stressful environment, it's long hours, it's unpredictable at times. chaotic, and it's just not an easy place to to exist in, if you aren't already comfortable in your own skin, right? So to basically understand is that   11:47 your professionalism has to supersede what your personal goals are, or your personal life is if you're going to be successful in that environment. And that's just the level of dedication that it takes. When you say professionalism. Would you mind defining that? Because professional means of a profession? And so that can be very vague. Yeah, I think that it means right.   12:12 I think that it means that you need to be willing to put forward   12:19 your best on any day in any place, and do the best you can for those patients, or those people that you're serving. And it's really, you know, kind of a, a selfless service attitude that would make you successful. And that's what I mean by professionalism. Right? It has to come first, right? It doesn't matter if you had, you know, plans to do a thing, or you were supposed to be going out to dinner with your spouse or whatever, right? Like, that's the level of professionalism that's expected. Absolutely. I like thank you so much for that. I was thinking it was singing, it actually really reminded me of swings on Broadway, they have a very similar situation, except they're not the main person, but they have to be available at a moment's notice. So just like and during the Christmas breaks that the leads or the ensembles take, they're the ones that jump in, and if anything comes up, they're the ones that are, I mean, if I want to say somebody who truly has probably the least brake, in the run of a Broadway show, it's the swings. So that's it. That's just where my brain went. because theater is my background theater is my sport, my sport. Absolutely. So I like that. That's so interesting. And, and I think it's always good to know the full picture of what it means to do something. I'm going to compare it to Broadway and musical theater because that's what I know. It reminds me when including myself when you first graduate school and you're a performer, singer, actor, dancer, you're like, oh, I want to make it on Broadway. However the schedule on Broadway, it's six days a week, one day off, the main holidays you are going to be performing that's when you have the most people attending. You're going to miss on so many things that go on in your life for being dedicated to the Broadway show. So knowing that you're going to miss so much of life not just a little like a lot like your nephew's events, whatever you're going to miss everything. And in in your downtime the days that you have one show your whole day is revolved subconscious or consciously around putting on your best performance that night so you have to be careful with your energy everything because that is there that is your main job that's your main go to so it it really does sound so reminiscent of that you got to have a passion for it as much I do think there's a little bit more selfish and that's okay to be selfish. It will regarding performing because you are a person who loves applause loves that stage and everything you are of course giving I would say it's like   15:00 5050 But I do think it would be different compared to the physical therapy job that you're doing. Because the only reason why and we discussed this before, the only reason why we can even say your name in association with a be with these people is because they have publicly said your name, you know, and that's that's an end. But if you didn't have that we would not that's that would we would be doing all this other words to go around it appropriately, you wouldn't talk about in the reality of it is   15:33 another, I was doing something else. And somebody asked me, they were like, What would you consider one of the biggest achievements that you've done professionally? And I would say that   15:44 until after 2017. Right? Nobody knew who I was and what I was doing. Right. And that was that was my goal, right was that nobody knew that. I was a White House physical therapist, nobody knew who I was where I was at the things I was doing, because that was the job. Right? The job wasn't to be. It's not it's not the world's business. Right. Right. And then so, and I think that that's fair. Right. I think then that and I think that that's really important. And then so like you said, you kind of have to understand that like,   16:16 the people who are concerned with the trappings, right with, like, what do I get out of it? Right, will be severely disappointed. And executive medicine, because that should never be what it's about. Right? It should never be about what are you getting out of it? Because if that's the case, you know, you won't be doing it for very long, right? There's, there's a saying in the in the Gulf PT community is, you know, if you want to be around a long time, you don't want to be around all the time. Right. And basically, what that means is like, you should not be trying to be, you know, the inner circle person. Right? You shouldn't try to be the best friend of these, these high profile individuals, if your goal is to, you know, be of service and do your job for a long time. Because you because that's just not the way it works. Right. So that's just kind of a reference point that I, I found, just like you said, very similar to performing arts, right. It's just kind of there's there's parallels and all these different sub communities. I mean, it really goes back to just loving truly loving what you do, and it's okay, if you don't, it's okay. Not every job, or every specific thing is meant for everyone. That's why we have so many different options and more options keep popping up after the pandemic now.   17:34 Yeah, you have to love what you do. You have to love what you do. See, I love being the center of attention, because I'm a performer and a physical therapist. So I know, right off the bat, that couldn't be for me, because for me not to be able to be like them. And the way that I was in like, doing a whole photo shoot there trying out different heels for the photoshoots. All that stuff. Like that would be the I would be the worst person because I'd be mourning getting to do that. It's so right. So there's always the question, people would ask, like, Oh, can you do this there? Or can you do that? Or can you do this? And the answer is always you can do whatever you want on your last day. You want today to be your last day. Feel free to do that. Yeah. Yeah. I mean, it's HIPAA compliance. I mean, that's the biggest thing. It's a HIPAA compliance. And then we have people they're just taking care of the United States.   18:29 That's such a high level. It's such high level, you know, I mean, wow, wow.   18:35 I was wondering for you, because it's this level of executive medicine is very   18:45 high profile. There's a lot going on there. I'm not asking for details behind the scenes. That's none of our business. But I'm, I'm curious about how it affected your stress levels and your anxiety while there and how you manage that during that time to make sure you were able to be fully present and helpful, even though it may have kind of fallen on your shoulders a little bit. And on that note, we'll take a quick break to hear from our sponsor and be right back with Drew's response   19:17 when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found, get chosen and definitely get those five star reviews on Google. Net Health is a fun new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about this new integration. Head over to net health.com forward slash li tz y to sign up for your complimentary marketing audit.   19:53 You know the best way   19:58 to kind of describe that   20:00 Is is, I think that it's important to surround yourself with, with people that are understanding of your situation, right? Because because   20:13 it's inevitable that you will have conflicts or that you'll have to back out of things, right. And if people don't understand your situation and the level of service and dedication you have, they just think you're selfish, right? So like the, I'm sorry, I know, I said, I was gonna come to your barbecue, but I just can't, I can't make it now. And, and I need you to be okay with that, and may not provide you an explanation of why. Right? And that's a hard thing, right? And you will find out pretty quickly, like, who, who's accepting of you and who's not? Right, because because most people will just stop inviting you to things right? Or they'll just, they'll just cut you out of their life. And there's some degree rightfully so. Right.   20:52 So I think it's just important to make sure that you surround yourself with that. And if you're a person with the family, right, like, this has to be an honest conversation that you have upfront.   21:02 This is not something that you kind of tiptoe around or like, make it up to you. Like, you'll be saying that forever, you'll never make it up, right? It just needs to be an acceptance of like this is this is part of what's acceptable.   21:17 And that's not like you said, That's not for everybody, right? It's absolutely not for everybody. So I just think that in order to be able to perform at a sustained sustainable level, right, for a duration, not just like,   21:31 once, or like, twice, right, but to continue to do that, you have to accept that. So I will. Another thing that comes to mind is, I once saw an interview with Michael Jordan, who is, you know, arguably one of the greatest basketball players of all time, regardless of what you think. Right? And Michael Jordan was interviewed and, and, and he said, you know, what's, what's it, what's difficult about it, and he said, you know, people who want to be Michael Jordan for a day or a game, you know, like, of course, I'd love to be Michael Jordan for a day or a game. But being me for a season, right? Or for a year, or for a couple of years of a championship run year after year after year, right? The commitment and sustainment that that requires, like, people don't want to do that. Right. And that's what I would say to people to like, it's super cool to work at the White House for a day for a weekend. Right, right. But do it for do it for a year, or an administration. Right? Or be stupid enough to come back and do it again. If somebody asks you, right, like, that's, that's a whole different level. Right? So it's super exciting. You know, it's interesting for for a weekend or a day or whatever, but like, but long term, right? Like, it's a commitment. Yeah, that makes me think of certain roles. I'm always going to bring it back to theater because that's my brain. It makes me think of Elphaba in in Wicked or Vita in Aveda, where Aida and Aida where they are literally doing like vocal aerobics, they don't stop singing. So when they are outside of the show, from   23:09 what I've learned, and especially if you're talking about a Broadway one, so they are doing what is it seven to eight shows a week, they get the one day off, they are not talking much outside of that show. If you want to reserve like or if they do they know what they can and cannot handle. Because the amount of singing. Elphaba I've learned is such a difficult track because of how you're, you're going from one part even if you're not in a scene for a moment you're rushing doing a costume change it's it's a very non stop role. So if you are looking to lose weight, no,   23:47 no but it so it just makes me think of that, you know, different things can cut you out of living your life, which is why I've always said I would love to do Elphaba at a regional theater for three weeks.   24:03 done done like like he's like Michael Jordan said for temporary. I think it's so good to take in this perspective and take things in as a whole. We were talking when we met the group was discussing how really understanding in this is a bigger picture thing but really understanding what physical therapy is before you even decide to join the profession as a big deal that needs to be much more transparent. And we can sit there and see all these shiny other things like oh, I want to trade for Broadway or I want to do executive medicine or oh, I want to work for this sports team. But really asking yourself all the tough questions on what goes into that? Well, I mean, if you're talking about money, great, but like, Have you ever had money and then like how fast did that money go? Did it really make you happy? So many so many things on that.   24:52 But   24:53 the details of the job will that will you enjoy that? That's your life. You're going to spend the majority of your time on the job not   25:00 off the job. So you got to make sure it's something that you like and really do your due do your due diligence in that. But I think it can be very difficult to give and provide the full picture to for anything. I don't know, I don't really know, have a clear way to make it clear.   25:20 I think that   25:23 I think that like part of that, I think is our own fault is PTS, right? I think that the general public struggles to understand what we do as a whole, right? It's, it's easy to do it in in subsets. Like it's easy to understand. Okay, well, I was on crutches. And I had a cast, and then I had to see a PT because my ankle was broke, right? Or the, you know,   25:52 mom had a stroke. She's in rehab, she sees a PT every day, so she can get better and come home. But the hard thing is like,   26:03 the professions bigger than that, right? It's, it's more and we've overcomplicated it instead of really kind of simplifying it down. Because the reality is right. What do PTS do? Well, we help people do whatever it is they want to do. And we get them back to or allow them to do the things that they want to do.   26:24 And that's it, that that's the that's the big selling point of it is, if you're not interested in doing that, I'm, like you said just about every day of your life, this is not the right profession for you. Right? Like, if you thought that, well, I would, I will have a very nice car, and I will have these set hours and I will you know be able to do these things like you're going to be miserable hate because I think that people didn't get into the profession for the wrong reasons, just like any job. When eventually, right? It will be taxing to you. And if you're not down with whoever that person is, it's you're talking to and working with, if you're not okay with, I'm here to get you to where you want to be. So that whatever that thing is, whether that's walking your kid down the aisle at a wedding, whether that's going on a hike, again, whether it's walking the dog, right or like putting your shirt on by yourself, right, whatever those things are. Now in a handstand, of course,   27:26 like if you're not okay doing that,   27:29 we're never going to be happy with with what PT does, right? So I think that that's the thing that people need to kind of understand if I wish, if I had anything to say to anybody who's listening who's like thinking about it, think about that. Are you okay with doing that, that be your role in life? And if that is not appeal to you, you need to find something else. Yeah, absolutely. Absolutely. It really is a   27:55 job board, you're of service, but you have to love being of service in this manner. Like if it doesn't feed your soul, like then how, like no money can ever pay you enough. It's never never enough. It'll never be enough. And that's okay. That's okay. It's I take like, exactly, you got to figure out what you love. I feel pretty lucky. Because I went into school, dreading that I was going to school and I felt like public embarrassment in the musical theater world because I entered school as a quitter. Because that's what it looks like, like, I'm leaving my profession. And so I had people offering me get professional gigs while I was in my first year of school. And I was embarrassed. Meanwhile, other people were posting and going, Oh, I started up in school, because it was a prestigious school and everything. And I was like, quiet for the first at least a year, if not more about what where I was.   28:52 I mean, it's all perspective. But then I learned I got a sometimes don't just take that one experience. And for me, I had that which was beautiful, seeing how it can change people. And yeah, yeah, but if that doesn't work for you, it doesn't work for you. I love that. Yeah, so for you. In executive medicine, I don't know if you know, the data on this. I don't even know if it exists. But is there kind of an average of how, how long medical professionals usually stay within executive medicine? Or is there kind of like, usually it's about five or 10 years or something just because it is such a commitment and you're talking about family and all these things. Just wondering, I think that there's a there's a there's it is a   29:38 Oh, I think there's a short hump and a long term home. I don't think there's a lot of people in the middle. Oh, interesting. Yeah. I think that if most I would probably say two thirds right. It's a short   29:55 I don't know. I'm guessing you know, five to seven year experience, right? The people   30:00 Do that short. Yep. And then   30:04 yes, yes. I think there's nobody that's kind of in that like seven to 15. Year. And then I think you get another the the last third is in the 15. year plus right. So wow, a career choice, or have made that shift for whatever reason. In that direction. I think they kind of stay there.   30:28 But I don't think it's, yeah, yeah. I don't think it's a mid career thing. It's either a stop along the way, or eventually it becomes your, your pathway. The business side, I have a real dorky question here. It's not dorky. And because there are people who be curious, I'm curious about documentation. For some reason, I feel like it's gonna be theirs. Let's compare to a Rite Aid receipt versus a CVS receipt. I feel like it's probably a CVS receipt, am I wrong?   30:59 Here's what I would say. Right?   31:03 If you treat everybody the same, and document the same, you're always okay. That's it. Right? In, that's where you have to be, again, like you got to be good at what you do. And you got to be very comfortable with that, right? Because   31:18 you people, you'll be second guessed right, there will be consultations with other providers. That's just the nature of executive medicine, right. And so you need to be okay with what you're doing. And documentation is part of that, right, making sure that you're you're very clear about your plan of care and the things that you're doing and why you're doing them.   31:37 But if you, you know, if you do it the same, it doesn't matter, right? It's universal precautions, right? If you if you do it the same no matter what you're good to go. So that that'd be my two cents on that. And then we also think it might differentiate and regarding plan of care, because we're talking about exercise adherence, which is something that physical therapists are was talking about, it's one of my biggest passions is getting exercise. And it's so great when it works.   32:03 For your patients in general, that have a high anxiety life, lack of sleep life, how do you achieve that adherence in a realistic way to get results? Does that make sense? I'm trying to generalize, even though every patients different, but this is we're talking about a very specific level of high stress. Right? I think that you have to understand that when you're working in this kind of subset, the biggest commodity for people, their biggest asset, the thing that is the most valuable to them is time, time is their most valuable asset, right? It's not money, it's not, you know, I have stuff do I have, you know, it's not the resources of equipment, or what, like, it's time, their time is very valuable.   32:55 And you have to, you have to be a good steward of that, right? You have to respect that. And so you have to,   33:04 you're not going to give somebody you know, a printout with 15 exercises, that's going to take an hour and a half for them to do and tell them to do it three times a day, right? Like, this is not how this how it's gonna work. Right. So I think that if you understand that concept, in build your plan around that about what is the most effective thing I can do with you, or this amount of time, which is limited, and then you have to understand that that's, it's finite, right? There's not It's not unlimited, that there's a million priorities that are trying to take that time. And if you are, are good about using it and understand that it's a limited resource, then they'll appreciate it.   33:49 I just realize you have unusual, wonderful access to collaboration over there. And I started to think about food. Could I mean, you could No, here's, here's No, there's a purpose, because digestion, if their digestion is off, that actually can have a big effect on their healing process. Have you had opportunities to collaborate with the the shatter? That is so cool. Oh, that is like the best. Right? And again, right, like you, you have to get the most value out of the things that you can write. And it's really interesting in this world is that like, it's, it's usually a matter of making sure that you know, that people are meeting the caloric minimum, right that there because again, they're so busy, or figuring out what is the more effective way of doing this or how can we provide the requirements despite a busy travel schedule, right, or all the other you know, things that are demanding and then right and then also right, like, yeah, work with chefs nutritionist. Work with other   35:00 With personal trainers, massage therapists, you know, other health care providers like you just so cool. Like you're part of the bigger picture.   35:11 If you're there for that it'll work itself out. Yeah, it sounds like I mean, I'm sure there are discussions that have to happen. But it sounds like the dream collaboration because you have access to literally everybody in the picture that you would want to be present in the picture there. That is just so cool.   35:28 Like, Oh, yes. Oh, God, if I said that to any of my performers, hey, can you connect me with your, your nutritionist or your chef, so I can work? And be like, Are you kidding? Get out of here.   35:40 But wow, that's that's really, really cool. That's, that's getting the opportunity for next level. Next level stuff. Um, I was wondering if you have any fun memories from your first day on the job without getting specific about the individual, but just any? Yeah. So. So the very first day,   36:04 you know, I'm working with President Obama, right. It's a   36:09 White House is an interesting place, because   36:13 there's the work areas, there's were offices and whatnot. But then there's also an area called the residence, and that's where the family lives. And it's off limits to the staff, like people don't, nobody goes into the residents. That's their home. Right. So I was going to see the President and   36:33 in order that we were going up through to the president, so we get into their private elevator, right. And it was, you know, people that Oh, my God, he's getting in the elevator with them. And I didn't know any better, right? So I just, I just introduced myself to him. He's like, okay, hey, come with me. We're gonna go on the elevator and go upstairs. And, you know, I'll get changed up and then we'll go start work. I was like, Okay, great. So I come in the elevator, and he's like, you know, Hey, man.   36:58 What part of the island are you from? And I was like, I'm sorry. He's like, You. You're from Hawaii right? Now, in context. He's Hawaiian. Right? And people probably can't see me, right. But, you know, I'm absolutely a Pacific Islander. And I said, Actually, man, I'm from Cleveland. And he was like, wait, what? I said, Yeah, I'm, I'm from Cleveland. He's like Cleveland. And this was big, right at the time, where LeBron James had just left Cleveland to go to Miami. And if anybody knows anything about Obama, he's quite the basketball fan. So he turns to me and says, Cleveland, ah, that's too bad about LeBron. Like, without, like, I just met this man. Like, and, and so like, you know, growing up in Cleveland, like, I immediately got defensive. And I was like, well, that's too bad that Chicago sucks and everything. Right? So like, immediately, like, and then I was like, oh, oh, I'll be shooting that right. Like, but like he put, I just was completely caught off guard and put me on my heels. And I got defensive about clean. He was like, looked at me, and was like, we're gonna be okay, like, we're gonna get along. All right, right. So that's great. Then people always ask, like, What are you talking about? What you know, what things and things I would tell people is, like, we talked about three things for the majority of our entire interactions, sports, weather, and kid. Those are the three topics that we could talk about, if the conversation ever went somewhere else, right? My answer was usually, like, there's probably somebody who could talk about that, but it's not me. But you mean, referred to. And I think the weather is going to be crappy today, right? Like, and I kind of focused on that right to make sure that I was doing my job, right. And those topics we kind of came to through through just general conversations, these topics are safe and easy for us to talk about, and allowed him to be a patient and allowed me to be a clinician. Yeah, because if you want into anything else, Woof woof. Yeah, yeah. Yeah, too much. That's really cool. I like I like how you found a way to be sensitive and helpful with that sensitivity, you know, to give a human a break.   39:20 For real Oh, that's so magnificent. I think this is perfect. We're going to end here thank you so much for coming on. I'm not sure if there is is there a way for people to reach out to you and contact you if they wanted to? I don't know somehow connecting you can probably the easiest way for the general audience is just find me on on social media. Right? You can find me on Twitter, you see on Twitter. Yeah. DC underscore PTS easy to find me. You know, and eventually I'll, I'll look at it and get back to people but that's probably the easiest way for Pete for this audience to get a hold of me if somebody you know, is interested or just wants to you know,   40:00 Here's something else let me know. Thank you so much for coming on and looking forward to people. Hearing this interview I have learned so much and grown so much and honestly just left very, very inspired. Thank you so much drew for coming on. Thank you. A big thank you to Jenna and drew for a wonderful interview. And of course, thanks to Net Health for sponsoring so again they have a new offer if you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. Head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit so you can boost your clinics online visibility, reputation and referrals. Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media

In this episode, Founder and CEO of CARR, Colin Carr, talks about commercial real estate for healthcare professionals. Today, Colin talks about the top mistakes healthcare providers make with their office leasing, the financial side of real estate transactions, and important considerations when making decisions on lease agreements. Should business owners buy their space or lease their space? Hear about how and when to negotiate, the importance of having representation, and hear Colin’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways The best time to negotiate the lease is typically 12 months before it’s going to expire. “If you were serious about capitalising, you would’ve engaged an expert.” “You should not be telling the landlord anything that hurts your posture or position.” “When it comes to real estate, talk to real estate professionals. Don’t talk to other doctors about that stuff if they don’t know what they’re doing.” “Realise what’s on the line. If you make a mistake in it, the world’s not going to end, but it will cost you hundreds of thousands of dollars in additional payments that you could have avoided.” “Surround yourself with the most successful people that’s you can get around.” “There’s no substitute for hard work.” “Work it as hard as you can and then learn from your mistakes.”   More about Colin Carr Colin Carr is the founder and CEO of CARR, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations. Colin has been involved in commercial real estate for over two decades and has personally completed over 1,000 transactions. Colin educates thousands of healthcare professionals, administrators, business owners and students on an annual basis through national meetings, conventions, study clubs, associations, universities, and webinars.   Suggested Keywords Healthy, Wealthy, Smart, Healthcare, Commercial, Real Estate, Negotiations, Representation, Leasing, Finance, Business,   To learn more, follow Colin at: Website:          https://carr.us LinkedIn:         Carr Healthcare Facebook:       CARR Instagram:       @carrhealthcare   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read The Full Transcript Here:  00:02 Hey Collin, welcome to the podcast. I'm happy to have you on today.   00:06 Glad to be here.   00:08 And so today we're going to be talking all about commercial real estate for healthcare, healthcare practitioners. So this is something that you've been doing for quite some time now since 2009. So before we get into the top mistakes healthcare practitioners make when it comes to their office space, can you give us the quick version of how you got into this space working particularly with health care professionals when it comes to their commercial real estate and office needs?   00:38 Yeah, absolutely. So started in 19, Managing apartment complexes back in East Lansing, Michigan, little bit away from where I grew up, moved to Colorado, my early 20s started managing some mid rise, high rise complexes, downtown Denver, and I got into brokerage about 23. And I worked for a gentleman that did a lot of large national retailer. So Walmart's Wendy's blockbuster. And that's how I got into brokerage over the years, I started doing more industrial, more office. And a couple years in, I started doing medical office buildings and working on hospital campuses, Class A medical buildings, and just fell in love with working with healthcare providers. And after a number of years of doing that, I realized that the healthcare industry was one of the largest, most unrepresented segments and all of all of real estate, you know, every time there was a listing, there'd be four or five brokers trying to get that listing, whether it was office or medical. But when it came to actual doctors running around town trying to find space or trying to negotiate, I didn't see anyone doing it. So I've made a focus made an intentional effort to start helping more healthcare providers, and then in 2009, launched our company.   01:47 That's excellent. And as most health care providers can say, we did not go to school for any of this stuff. I can say, as a physical therapist, I didn't go to school to understand how to negotiate commercial leases, and office space and things like that. So having professionals with the best interest of the healthcare provider in mind is so incredibly helpful. And I'm sure you're quite busy. But now let's get to what are the top mistakes healthcare providers make with their office space and their leasing needs, so I will hand it over to you.   02:20 Okay, so we'll have a couple there's, there's more than a few. The first mistake that healthcare providers make is they don't know when to start the negotiation. You've got healthcare providers that are trying to negotiate with two, three years left on their lease, and there's no leverage, there's no incentive for the landlord to do anything for them, the landlord knows they're locked, and they're on the hook in that lease contract for another two or three years. And so they have no posture, they have no leverage. Other side of the coin is they try to negotiate when there's two, three months left in the lease. And the landlord is assuming that they're not paying attention. They haven't hired representation. They don't know the market, they're behind the eight ball. And so you can start the transaction too early. And it's a it's a sign that you don't know what you're doing. And you can start it too late, which is a clear sign you don't know what you're doing. And either scenario, the landlord is gauging how serious you are. How savvy Are you? Do you have other viable options? Are you willing to move? Do you really understand the market? And are you going to fight hard for the terms that are commensurate with the type of property with the the market you're in with the economic climate? Or are you just bartering or bluffing? Are you just hoping for a better deal and guessing? So starting the transaction at the wrong time? That's a that's a big one right there. And   03:38 where and where is the sweet spot then? So it's like, it's like, what is that? Is it the the three bears? Goldilocks and the Three Bears like one bed was too soft, one was too hard to kind of have to find that sweet spot in the middle. So when it comes to negotiating, when should healthcare providers be thinking, Alright, now it's time to reach out to my landlord and start this process?   04:01 That's great question typically is right around 12 months from when your lease is about to expire. If you go outside of 12 months, again, the landlord's just don't have any real incentive to negotiate, because in their mind is I'll deal with it later. They can't go anywhere for 12 months or longer, and so they don't pay attention. But again, if you get too close, if you need to relocate, you don't have time to make that transaction happen. If you need to go to a new property, the negotiation process, the site selection that can take several months on average, you know, getting landlords to respond and negotiating the terms, getting an architect involved to look at the floor plan that takes a few months, it can take a month or two just to negotiate the actual lease contract Once you agree on terms working with the with the attorneys. And then if you need build out and you have to pull a permit or get contractors involved that can take another three or four months as well. So the ideal time is right about 12 months, that gives you enough time to handle each one of those steps that I just mentioned, but it's not too far out there.   04:56 Right. Excellent. All right. So Mistake number One not knowing when to negotiate. Now we have a better idea. What's another mistake?   05:06 Another mistake? And I'd say it's probably the top mistake. It's the do it yourself approach,   05:11 do ya probably be that would probably be was something I would do? Yeah.   05:15 Well, and there's a lot of reasons people take the DIY approach. Number one, it's typically because they're so busy, they don't know who to contact, they don't have time to do the research or due diligence in their opinion. And then it just comes up if the lease agreement shows up in the form of a landlord knocking on their door or property manager saying, Hey, listen, your lease is coming up, what do you want to do, and they just say, hey, send me a proposal. And that that starts the process of them doing it themselves. Or maybe you're looking for a new location or your first office, he started driving around, and you pick up the phone, and you start calling the listing broker landlord, asking questions, and all of a sudden, you have engaged and start the process all by yourself. The problem with this is that that is not the game plan for successful companies. If you take any national retailer that people would respect and say, hey, they do a great job, you take a Starbucks or Chipotle, they don't have some random person calling on properties or asking for proposals. They have a team of in house professionals and they utilize outsource experts that all these people do is negotiate professionally for a living. So when a landlord gets a phone call from a doctor or an office manager, no matter how well meaning that person is, the landlord is going to assume they don't know what they're talking about. And it's not, they're not trying to take shots at the person, they're just going to assume, Hey, you don't know the market, you've not want to look at 10 or 15 properties, you're probably not negotiating with three or four landlords simultaneously going three or four rounds of negotiations. And at the end of the day, if you were really serious about capitalizing and saving $100,000, on your next commercial lease, you would have engaged an expert, it's it's similar to, if you get audited by the IRS, if you don't get a really good CPA involved, you're probably not too serious about getting the outcome you're looking for. If you go to court, and someone's bringing a claim against you, or they ask you to go to mediation and arbitration, and you show up by yourself, you get your signaling, I'm probably willing to accept a much inferior result because I don't have the time, the money, the resources or whatever. And so when a landlord sees a tenant show up on representative, it doesn't matter if it's health care, or, or retail or office, they just assume that that person doesn't know what they're doing. And so that's, that's gonna cost the person a lot of money.   07:31 Yeah, so you really want to have the right professional at your side, so that you're not getting taken advantage of you're not prolonging things. And like you said, I love how you said that they're there thinking that you're willing to accept an inferior result. And as as a health care provider, or a physical therapist, like if, if someone broke their leg, and they need to rehab, well, they're not going to go to their account, and they're going to want to go to a physical therapist, that you don't want to do it on your own, because you're not going to get the right results. So same thing, right? You always want to have the right professional at your side.   08:08 Yeah, I mean, this would be much different than if a patient you know, if you talk to a patient or potential patient, and they needed to rehab something, and you knew it was an advanced rehab, and it's a time you have you have instruments, you have technology of equipment. And their response is, Well, I'm just going to head and figure it out. Like I'm going to search the web and just do some research, your response would be well, there's, there's a better game plan like you can, you can do that. And you can get some type of result or some type of an outcome. Just like a landlord knows, hey, you can you can lease a space without representation, but it's probably not going to be the most effective approach, you're probably gonna waste a significant amount of time. It's probably gonna cost you quite a bit of money. It's very similar.   08:41 Yeah, yeah. Okay, so don't know when to negotiate the DIY approach. What else? What's another big mistake?   08:51 Yeah, another big mistake. And I mentioned it briefly. It's negotiating on only one property. And this is different when you when you compare residential versus commercial real estate, okay. And residential. If you're going to buy a house or buy a condo or townhome, you go look at properties, you search online. And then when you find the property you're interested in, your agent writes a contract for you and they deliver it to the seller. If the seller signs it, you're under contract, you have the ability to cancel that contract with inspection, objections, financing, deadlines, and so forth. But you submit an offer towards one property and if they say yes, you're under contract, it's a binding contract. Commercial Real Estate works on what's called a letter of intent and loi, or a request for proposal and RFP. In either scenario, those are typically non binding. 99.9% of are non binding. There's, there's ways you can make them binding, but they're intended to be a non binding negotiation. And so in commercial real estate, the most strategic gameplan is you go look at X number of properties that meet your criteria. you narrow it down to the top three or four properties that are the best fit, even if one or two property One of your properties are the clear winners, alright, but you still negotiate on three or four properties. And you might even go two or three rounds of negotiations. The reason you do this is because it gives you the true picture of the market. You can't just go off what they're asking as a quote and lease rate on a brochure, because there's too many variables. Is the lease going to be a three year term? Or a 10? year term? Are you asking for no money for improvements? Are you asking for a couple? $100,000? Do you need a free build out period? Do you need free rent Upon moving? Or the annual increases? 2% 3% 4%? Are you going to personally guarantee the lease Are you trying to have your practice or business guarantee it, there's all these variables that are there. And so you've got to negotiate with multiple landlords to get a real feel for what the market offers. And when you do that, a couple things happen. Number one, landlords get more aggressive and competitive when they know they're competing. If a landlord thinks that this is the only property you're interested in, and you tell them, hey, this is my dream location, or you show them your cards, you're not going to achieve the best terms possible. And so being able to leverage multiple landlords against each other, again, respectfully with dignity, not you know, not not doing things in a way that's that lacks integrity, or cuts corners. But if you do it properly, you're going to know if that lease rate is market below or above, you're going to know if that's the right TI allowance, the right free rent package. And if you're getting three or four landlords to do something over here, and another, and another one over here is not one that you can leverage those against each other. And that, ultimately, is how that's one of the top ways that you achieve the most favorable terms possible.   11:31 Got at first, I thought you meant Wait, how many properties Am I getting, but it's not negotiating. It's not for you to have multiple properties. But it's for you to negotiate a single property, but through a lot of different through a couple of different landlords so that you you're kind of getting a better idea of the landscape,   11:52 you're you're gonna pick three or four properties to negotiate with, you're only going to choose one of them at the end of the day. But again, every landlords motivations are different. And so you might have two properties that you like equally, one landlord might be much more aggressive than negotiation. And if you add up all of the economic terms, you might find that two properties that appear very similar, that start out with pretty similar starting or quoted lease rates, you might end up with 100 $200,000 savings on one, or 100 or $200,000, in increased costs on the other. So just because the properties look similar, because they have close to starting lease rates, by time you actually work through all those economic terms, you can end up in a very different economic situation. Oh,   12:34 my God, I love that that is such a good tip. And I'm sure that's something I would never even think about. I would just think, well, I guess I'll just go with one property. So that is a great, great tip. Anything else? What other big mistakes and I know you said there's probably so so many, but maybe we'll keep it to like four or five.   12:52 I'll do two more of this. Okay, you quit, okay, I'm gonna kind of hinted at it. The next mistake healthcare providers make they tip their hand to the landlord, they tell the landlord, this is the property I want, or this would be the perfect space for me, or during a lease renewal negotiation, which is by which is by the way, that's the number one transaction in all commercial real estate, more lease renewals happen every year than any new office or purchase or relocation, okay? The number one mistake they make there is they talk to the landlord, landlord comes their office, the landlord might even be a patient, you know, property manager stops by and they say, Hey, your lease is coming up for renewal, what do you want to do, and the doctor says something along the lines of why don't want to move, or the space works great, send me a proposal. And again, what you have just signal to the landlord is you're not looking at the market, you're not hired representation, you don't know if it's going to be a good deal or a bad deal. And most likely you will accept an dramatically inferior deal. So signaling to the landlord again, you should not be telling the landlord anything that hurts your posture position, and they're looking for you, they're going to ask you questions, trying to get you to tip your hand. So that happens all the time. Here's why healthcare providers get into health care typically, because they want to help people. They're fascinated by the science. They're fascinated by the ability to transform people's lives to help protect lives, save lives, enhance lives. And they're not getting into health care, because they want to be a stone cold killer negotiator. Yet they're going up against landlords that are not playing games that have buildings that are worth 10s of millions of dollars. And those landlords get into real estate because they wanted to be a professional negotiator. So just be very careful what you say the best way to avoid this is to hire representation, let them talk to the landlord for you. And they will keep a very tight posture in the entire process.   14:43 Excellent. Okay, what's number five? Five, the   14:46 last one? Yep. Five. The last one is healthcare providers love talking to their peers and colleagues. And then they take that information that becomes the standard. And that's a really bad way of doing business. So So you might be in a building with with other tenants might be a dry cleaner could be another healthcare provider could be a restaurant. And they'll ask those tenants or neighbors, Hey, what are you guys paying? Or what did you get on your last negotiation, and then they share that information. But what they don't realize is they're asking people who may or may not have gotten a very good deal. We had this scenario, once we were helping a doctor in a building, it was a completely medical building two floors, six or seven doctors on one floor, six, seven doctors on the second floor, and we were talking to the doctor, we were looking at his lease, and he was significantly above market. And we said, hey, who's negotiate and what the last two or three renewals you've done? And you said, Well, I've done it myself every time. And we said, you know, how do you feel about these terms? Because this is exactly where the market is. And I said, How do you know that he goes, Well, I'm, I'm good friends with three out of the six doctors on this floor, we talk to each other all the time, we refer patients back and forth, we've we've swapped leases, everyone's paying the same thing. We're all paying $30 per square foot. And I said, well, like just so you know, their marketing space in the building, way lower than that. And we just negotiated a brand new lease on the first floor for a doctor at $21 per square foot. So you're gonna dollars a square foot above market, okay? And you haven't got any free rent your last couple of renewals. You haven't got any tenant Premadasa, renovate your space, and you're telling me you didn't get those because no one gets those I'm telling you right now, you and your three or four friends have been consulting with each other, you just have no clue what you're doing. So taking advice from somebody who is bad at negotiating or getting a really bad deal is super common. And so people share stories. They're on all these, you know, Facebook groups throughout all these threads, and everyone's sharing their experience, and it is their experience, but it might not be the best gameplan. So that's another big one we see too is talk to your friends about things clinically, when it comes to real estate, talk to real estate professionals when it comes to legal things, talk to attorneys comes to financials, talk to CPAs don't don't talk to other doctors about this. If they don't know what they're doing.   17:05 What a gut punch is, right? That guy must have been like, what $9? Over? Oh my gosh, what a Yeah, what a kick in the pants. That is. Okay, so those are really great. Five Great tips, five mistakes that people often make with their commercial real estate. And throughout that one theme certainly seem to emerge. And that is having representation on your side. So when it comes to commercial real estate agents, let's start with number one. How do you choose the best commercial real estate agent? And then how much does it cost? Because the cost is probably why people end up doing mistake number two, the DIY approach, right? Okay,   17:48 both both great questions. There's a handful of ways to find a really good real estate agent. Number one, if you're a healthcare provider, you want someone that has healthcare experience, it's very different talking to a real estate agent that focuses on million square foot distribution centers for Amazon, than it is someone who's working on a 2000 square foot physical therapy space, very different transaction. And commercial real estate, you got people that all they do is apartments, all they do is Office, all they do is retail, you want to find someone that understands healthcare that works in the healthcare space, number one. Number two, you want to find someone who's only going to represent your interests, commercial real estate, and residential real estate are known for agents that try to work what we call both sides of the deal. They're trying to represent the lammeter seller, and also the tenant or buyer, that is a clear conflict of interest. You can't negotiate for two opposing parties. It doesn't work that way. And so this is the idea of saying if somebody is suing you and you're going to court and you're asking the prosecuting attorney, if they'd give you advice, like that's literally what's happening, their client, the landlord or seller, they have a fiduciary to help that person or that group, make as much money as possible in the transaction and protect their interests, they cannot do the same for you. So you need to find someone that's not going to have a conflict of interest, someone who works in the tenant buyer side, who doesn't have listings with landlords in the area that you're looking because you want an unbiased approach with someone who's going to protect you right now. So those are two really important things. The next thing you say is, well, how do I find those people? You can search online, but typically, in any healthcare industry, you're going to have people that if you ask them, Hey, who do you know that specializes in healthcare, real estate for doctors, you're gonna have lenders that tell you, hey, this person or these people do, you're gonna have architects, contractors that have worked with these agents on a number of deals. And so there's a lot of referral partners in the industry that can weigh in on the topic. And so if you ask a handful, you should be able to get a few names very quickly, people that specialize in that area, and then what you need to do again, and that process only takes a little bit of time. It's not it's not no one's asking you to take a whole week off to spend dedicated towards that. But once you find a couple names, you need to speak with these people. You need to interview them, you need to talk them and say, what would your strategy be to help me maximize my profitability in my next transaction? How are you going to protect my interest? How can I know that you are the best fit for me? And like any other relationship or service provider, you're going to know quickly? What their responses just like a patient would say to you. Hey, how are you going to? How are you going to get me healed up? What is your game plan for me to get restored? Or to get you know, rehabilitated? What do you want to do, and you've got to earn their trust, it's the same way in real estate. And I tell doctors this all the time. If you talk to an agent, and you don't think that agent is the best fit, move on to the next one. And I mean, that's what we do for a living, I tell doctors, then if it's not us move on to the next person. Like it's, there's too much on the line for you to for you to just take whoever's there, don't settle in this area, find the person that you trust that you want to work with, that you believe has your interests in mind. And then that's how you get engaged. Yeah,   20:55 great advice. You beat me to the punch, I was going to ask you what questions to ask how do you vet and you just gave us those answers. So that was amazing. Now, let's talk about the money side of things. Because health care practitioners, yes, we get in to help people, we have our own business, it's also a business. So we want to make sure that we're maximizing our earning potential, if you will. So let's talk about one How much does it cost to hire a Commercial Real Estate Agent?   21:24 Okay, so that's one of the best parts of this entire conversation, it will not cost you as the doctor any money to hire a real estate agent. It's just like residential real estate. If you are a buyer, or a tenant residential real estate, you engage an agent as your exclusive agent, and they receive a portion of the commission from the landlord of the seller. So commercial works just like residential, again, for anyone in residential that's ever owned a house, when you hired an agent, you agreed to pay two Commission's one to your agent, and one to the buyer's agent, Sandman commercial real estate. And this is one of the biggest mistakes that healthcare providers make as well, we could put this as number six, if we wanted to, is they assume they're going to save money by not having an agent. And so they say, You know what, I'm not going to hire an agent. So I'm going to save money. But here's the reality, you're not determining whether or not a commission is paid or not paid. You're not determining what that commission amount is, when you go to a property, that landlord already has money set aside for every transaction. Even if they don't have a listing agents, they're doing it internally, they still have a commission set aside for every transaction. And if you do a deal as a doctor all by yourself, the listing broker gets a double commission, not one, but two, they double up to take both sides of it, or the landlord just keeps that money. And this is this is what happens is, you know, a lot of doctors have this like the do it yourself mentality. I always joke, it's like, every time you see a U haul moving truck, it says move yourself and save, right. But if you're moving yourself and give you a U haul, yes, you save money because no one's offering to pay your $3,000 movie bill. In commercial real estate, there's a commission set aside for the listing agent, and for the tenant or buyer's agent. And when the doctor the tenant doesn't have an agent, listing broker takes a double Commission, or the landlord just pockets that money. So it's 100% free service, it's not going to increase the lease rate for you, it's not gonna cost you money, it'll save you a significant amount of time. It'll help you avoid costly pitfalls, and it should save you a significant amount of money as well.   23:27 Okay, and that leads perfectly into my next question. So you had said earlier that lease negotiations or lease renewals, I'm sorry, are the thing that happens the most when it comes to commercial real estate? So how can healthcare providers or anyone for that matter, save $100,000? Or maybe more on their next lease renewal?   23:52 Great question. So we're gonna take, we're gonna accumulate my prior answers, and we're gonna, those are all the ingredients in that. And then here's what it looks like. So 12 months prior to your lease expiring, and you're going to look at your leisure going to figure out when you're when your dates show that you expire 12 months before expiring, you're going to start the process of finding an expert, commercial real estate agent in your area that represents healthcare, attendance and buyers that knows your industry, you're going to you're going to, you're going to call x number of people until you find the right person that you want to go forward with, you're going to engage that agent and you're going to have an exclusive relationship with that person, okay? That agent is going to take your requirement, and they're going to go to the market and we're going to find every property that meets your requirement. And they're going to whittle it down to the top three or four properties, even if you don't want to move. Even if you think that moving would be a convenient, they're still going to do their due diligence, and they're going to they're going to take their time energy and they're going to negotiate with three or four landlords simultaneously. And they're going to get to what's called best and final term so we're you know, if you were going to move to the property across the street, or down the street or across the city, you're going to know exactly what it would cost to do that, and you're gonna know what the economics would look like if you wanted to transact there. Once you have that information, you can now go to your, that agent can now go to your current landlord, and can negotiate with factual data, and with a very specific game plan. And here's why this is so important. Again, you can get this thing backwards. If you go to your landlord, and you ask them for an offer, you start negotiating. Here's the question, compared to what, how do you know if it's aggressive? You can compare it to what you're currently paying. But again, what if you're above market, and they say, well, I'll bring you down $2 a square foot, you can say why just save a bunch of money? Well, if you can move across the street don't say $5 a square foot. Or if you get a better landlord, or a better space or a larger space, you can't compare your current economics unless you are comparing them to other properties. So your agent goes, the market gets the top options negotiates, and then goes to your current landlord, and says, Listen, we brought to the market, we know what's happening. I'm a market expert, my clients now educated, and we got three or four other viable options, we'd like to have a negotiation and discussion with you, but it's gonna have to meet our criteria, because we've got two or three other properties, that could make a lot of sense for us, if you don't want to get competitive. And when landlords know that you're not an idiot, you know, you're not, you're not ignorant, you're not, you're not, you're not just gonna take whatever they give you, they come to the table with a much different approach. And when they know you're represented by an agent that is an expert, they're not going to waste their time trying to convince an expert that their deal is good if it's not good. So that that's the process. In a nutshell, there's a lot more to it than that. But that's how you get to the landlords, that will actually give you a good deal. Because at the end of the day, if you do move out of that property, they're not going to get the next tenant to pay above market, they're not going to get away with not giving them a tenant proven allowance or not giving them free rent, or trying to gouge them, because the new tenant won't take it, they'll just have go somewhere else. And so the landlord, if they think they've got you know, pushed into a corner, you have no other options, they will stick it to you. If they think that you have the freedom to move that you're willing to move, you got the help to move, they will come with a much more aggressive offer. And typically, at an average space of two 3000 square feet on a five or seven year deal. Those those numbers add up to usually a minimum of $1,000. And oftentimes hundreds of 1000s of dollars, that can be one in   27:23 your favor. Amazing. Again, having the right people in your corner doing your research coming to the table with facts and figures so that you have leverage to negotiate. All makes perfect sense. And now as we start to wind things up here, I just have a one, I think really interesting question, because I hear this quite a bit chatter on social media, when it comes to at least physical therapy business owners is do you buy your space? Or do you lease your space? So can you talk about that?   27:54 That is a great question. That's probably one of the top questions that we receive. The answer to that is you should look at both your options, don't pray determine one or the other, because every markets different, every economic climates different. And you could be in some markets where where you have multiple options to own and it's phenomenal other markets, there's not one option to own. So I mean, if you're doing real estate in a suburban Tulsa, that's different than if you were downtown Manhattan. I mean, you've got to know the different markets. What we tell healthcare providers is listen, we're going to go to the market for you and find the top properties that meet your requirements. And we're going to look at office options to lease and options to purchase, we're going to look at retail options, we're going to look at office options. And we're going to show you the top of what's available, you then are going to choose which properties that you're the most excited about. And then we're going to negotiate on three or four properties simultaneously. And then economics will tell you very quickly which property is going to make the most sense for you. If you can find a property to purchase. That's that's a top property if you love it, and the economics makes sense. We are a huge proponent of owning commercial real estate, you're building an additional asset, if you sell your practice, you can lease out the space. And typically that real estate is going to sell for more than your practice will sell for. We track this across the country, we work with 1000s of providers every year, and the real estate sells for more than the practice over 75% of the time. So if you could be an immediate to pay rent or mortgage either way, you've got to pay a landlord or or pay a company a mortgage company. So you're basically paying yourself in certain aspects of it. You got to make a payment either way, if you can own real estate and economics work phenomenal. A lot of times what you'll find is are you willing to pay more to own than to lease because of the upside. And so you might have scenario where it costs you an extra couple $1,000 a month to own and you get you have to decide is it worth that? Is it worth the extra expenditure to pick up some additional tax deductions to pick up that principal pay not every month you got to check X number of dollars go to pay down principal on the loan, your net worth goes up every month. And so we have those scenarios, if it's if it's 6000, or 6000, at least that's a no brainer at the back, right? If it's 10,000, or 6000, at least, you got a decision to make there a lot of times it's, you know, 12, or $15,000, or 6000. The least. And you have to decide which makes the most sense for your practice. And then you get in another 10, different evaluations, what's the downpayment? What's the cost of entry? What are the economic financing terms available to you? Is this space gonna fit you for three years? Or five years? Because if so, we don't want to purchase that we'd rather lease for three or five years, and then have you purchased the next location, if it's gonna fit you for the next 20 years? Again, that's a different story. So there's all these different variables, there's no one size fits all. There's there's groups that we help lease a couple spaces for that purchase, purchase couple spaces, then lease a lot of variables there.   30:48 Yeah, and and again, that's where coming together with your team makes a lot of sense, and and doing your pros and cons. But I hear that quite a lot. So thank you so much for your input on that question. And now, if you could put a bow on this conversation, what are the top things you want healthcare providers to walk away from when it comes to their commercial real estate questions?   31:17 Yeah, that's a great question. I would say, just realize what's on the line. We're not talking about, you know, did you overpay for a box of gloves, you weren't paying attached, you ran out and you know, you overpaid by $2, for a box of gloves, and you can go, you know, buy in bulk next week, or you have your supplier set, you know, whatever, we're talking about a transaction that you engage in every once once every five, seven or 10 years. If you make a mistake in it, again, the world's not going to end. But it will cost you 10s, or hundreds of 1000s of dollars in additional payments that you could have avoided. And there's a lot of other things that are on the line. Like there's economic terms, there's also business terms, what happens when you want to sell your practice, can you get off the lease, or you get stuck guaranteeing a lease for the person that buys your practice, because you don't have the right assignability class. So I would say this, make sure that you're treating your commercial real estate with the respect that it's still again, I mean, you can still do a lease, you can still stay in practice, etc. But again, the world's not gonna end. But there is a cost or a penalty to messing up here. And it's pretty high. Find a good agent, find someone that you trust, and that person will save you literally 3040 hours of your valuable time, they'll save you a significant amount economically, it's usually usually a minimum of 10s of 1000s, if not hundreds of 1000s. They'll also help you avoid complications and delays that come up all the time in commercial real estate when people are not paying attention. And then the last thing I'll say and I think this is more important than all these is that person's going to give you peace of mind. You're not going to have to wander every night you go to bed and put your head on your pillow for the next 10 years, you're not going to wander Did you get a good deal or a bad deal? You're going to know exactly what what terms you negotiate and how they compare to the market, you're not going to wander if you miss seeing a better property and you should leave somewhere else you chose, you chose the third or fourth best product in the market, he's just would have gone to market you would have known better, you're gonna have that peace of mind. So we can talk about saving time saving money, avoiding complications, delays, pitfalls, but I think ultimately, that peace of mind is invaluable. And for me, that's that's what I'm trying to deliver every time that I work with a client.   33:19 Yeah, you had me at saved 30 to 40 hours of your time. You could have ended it there. But I love having that peace of mind being able to sleep at night knowing that you really got the best deal that you possibly could because you started 12 months ahead of time you hired someone you had a team by your side. So perfect sense. So now, Collin, where can people find you? If they want more information? They have some more questions. What's your contact?   33:49 Absolutely, the best way to get ahold of us is our website. And that is car that US ca rr.us. On our website in the upper right hand corner, we have a couple options on our navbar that are of importance. Number one, you can click the Find an agent in your area. We've got agents coast to coast, we represent 1000s of healthcare providers every year, and we are working, we're working literally in all 50 states plus DC. So click Find an agent in your area. And then that's a great way to start. Another thing we have is a free lease evaluation. If you want to know where you stand in the market, even let's say you signed a lease last year and you got nine years left, we can still do a free lease evaluation for you. And we'll tell you where you stand based upon the market currently, if the market corrects, as we've seen some crashes last two years, who knows what we're going to be tomorrow, let alone five years now we can update that over time. So if you want to know where you stand in the market today, in a few years, we do that all the time, we can do it very quickly. And again, we can give you the peace of mind knowing where you're at and if you're way above market, then we're gonna try to capitalize on the next transaction. If you did a good job in your last deal, again, that gives you peace of mind knowing that you're in a pretty good position. We want to protect that or reserve that in your next negotiation. And then the third thing is we have a ton of resources if you want to study up, if you want to get educated, we got literally hundreds of articles, blogs, educational videos. And if you're interested in commercial real estate because it affects your practice, and you want to know more, we will give you information that will make you the subject matter expert.   35:21 Excellent. That was perfect. Now I have one more question that I asked everyone. And that is knowing where you are now in your life and in your career. What advice would you give to your younger self? So let's say that 19 year old in Lansing, Michigan, what advice would you give to him knowing where you are? Now?   35:39 That's a great question, I would say, surround yourself with the most successful people that you can get around. If you can get around them personally, and they'll spend time with you then do it. If you can't, then get around them through watching their podcasts through reading their books, you know, following their history. And then I would say that there's there's no substitute for hard work, you're gonna make mistakes, you're gonna fall down, you're gonna you're gonna do things that in hindsight, were less than intelligent to say them politely. But you just that's part of the process, owning a practice, you know, becoming a professional, anything in life, working as hard as you possibly can, and then learn from your mistakes.   36:17 I love it. This was so great. Thank you so much for taking the time out. I mean, I was taking notes furiously over here because I think this is such great information for certainly for healthcare providers, but I would say anyone that is looking to get into a commercial space, this was wonderful. So thank you so much. Absolute. It's been a pleasure to be with you. And everyone. Thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Dr. Jenna Kantor interviews Dr. Sherrill Williams about diversity, equity, and inclusion in physical therapy.  Mabout Dr. Williams here:  A lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying Ballet, Modern, Jazz, and Hip Hop. It was not until her commitment to losing 90 lbs that she fell in love with fitness, and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led to Dr.Williams receiving her Doctor of Physical Therapy degree from New York University. Shortly after she founded Leg Up Fitness and Wellness, an online fitness company for performers that want their workout to feel less like exercise and more like dance. Leg Up's client credits include but are not limited to The 1st US National Tour of Aladdin, Hamilton, Lion King, Lizzo, Jidenna, John Legend, Todrick Hall, and Complexions Contemporary Ballet. Dr. Williams is a passionate advocate for dance injury pre-habilitation and rehabilitation and loves helping dancers around the U.S. virtually and in person. Follow Dr. Williams:  www.leguppt.com Instagram TikTok Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here: 00:07 Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness and entrepreneurship. We give you cutting edge information you need to live your best life healthy, wealthy and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now, here's your host, Dr. Karen Litzy.   00:35 Hey everybody, welcome back to the podcast. I'm your host Karen Litzy. Today's episode is brought to you by Net Health. So when it comes to boosting your clinics, online visibility, reputation and increasing referrals, net house digital marketing solutions, has the tools you need to beat the competition. They know you want your clinic to get found get chosen and definitely get those five star reviews on Google. They have a fun new offer if you sign up and complete a marketing audit to learn how Net Health Digital Marketing Solutions can help your clinic when they'll buy lunch for your office. If you're already using that health private practice EMR Be sure to ask about its new integration, head over to net health.com forward slash li tz why to sign up for your complimentary audit today. And like I've said before I actually use this product it works man did a bump me up in the Google search was awesome. Now on to today's podcast, which is being hosted by the ever wonderful Dr. Jenna cantor. And in today's episode, she interviews Dr. Cheryl Williams, a lifelong dancer and lover of the performing arts, Dr. Williams committed most of her life to studying ballet, modern jazz and hip hop. It was not until her commitment to losing 90 pounds that she fell in love with fitness and wanted to find a way to fuse her love of dance with health and wellness. This new mission sparked a fire that led Dr. Williams to receiving her doctor physical therapy degree from New York University. Shortly after she founded leg up fitness and wellness an online fitness company for performers that want their workout to feel less like exercise and more like dance leg UPS client credits include but are not limited to the first US national tour of Aladdin, Hamilton Lion King Lizzo Jidenna John Legend Todrick Hall, and complexions contemporary ballet. Dr. Williams is a passionate advocacy for dance injury, pre habilitation, and rehabilitation, and loves helping dancers around the US virtually and in person. So big thank you to Jenna and to Sherelle for coming onto the podcast so everyone enjoys today's interview.   02:42 Hello, healthy, wealthy and smart. This is Jenna cantor. I'm here with Dr. Sharon Williams, and I cannot be so grateful. So much more grateful right now to be on here with you. First of all, thank you, Sharon, for coming on to talk. Thank   02:54 you. Thank you for having me. I'm excited to be Yeah,   02:59 I love it. I'm really grateful on so many levels, the one we're friends to. And I think this is where I'm starting with where I'm comfortable and where I need to expand. So I'm just owning up to this. In physical therapy. I don't know a lot of black physical therapists, like holy crap. And so you're one of my few. And when I really took account, I took accountability. And I was like, Oh my God, a few people that I know who are black. So I'm starting with people I know. And then I'll expand out to more and more and more and more and more people and increase my network. But that is sad. After calling myself out. I am really excited to be talking about diversity equity inclusion. I feel like that was a pretty good segue because that is yeah, that is legit. So let's go back. You are a new grad congratulations. Thank you. We made it. We made it made it Sherelle is one of those people who thinks big and then achieves the big. So she's a nice person to be regularly inspired by and I'm super grateful to know you Sherelle. So diversity, equity and inclusion. What rehearing that whole statement in as one what are some first thought that comes to mind when it when it comes to physical therapy? There is no wrong answer. I just want your truth.   04:29 Well, I was gonna say when you like yeah, you're like one of the few black people I know that's a physical therapist. I was like me too, girl. Oh, no, me neither. Oh, I didn't know. Yeah, um, to be honest, I think it was CSM where they had a, a networking event and I was like, oh, there is a little community of us but we're just all scattered or you know around the world. But when I think of the Diversity, Equity and Inclusion within physical therapy, you know? No, I don't want to say non existent, but it's just, it's very small. You know, when I went to NYU, you know, I did visit a few schools. When I was doing the audition process when I was   05:22 Joe and I both are performers, as well. So that's what why audition process came to her mind. That's hilarious.   05:31 When I was going through, like the interview process, and I was looking at different schools, and like NYU, you was one of the few schools that you know, I did see quite a few black people. And I had, there was seven of us in my class, and two men, two black men, which is like crazy that I'm excited about to black men. But like, you don't see it at all.   05:59 No, you don't.   06:02 And it's an it's unfortunate, because it's such an amazing field. And I'm still kind of at the point where I'm like, is it that we are not applying? Because we don't know? Or is it that? You know, they're not letting us in the door? And I haven't really figured that out yet. But I do I do feel like a part could be, we don't know. Because a lot of times I feel like especially in the African American community. And you can also say African because those communities are very different. Culturally, you know, people No, go go be an ND nd ND, ND, ND nd? Or what do we need to do to get more people of color in or black people. Because I think that's going to do wonders when it comes to the community and getting people up. And, and healthy. Because unfortunately, in our culture, not many of us, I think my generation is more, it's a lot more active, but the older generation, not move until I think when we get more more people of color in into the field, and then we're talking about it. And we're excited about it, you know, then the community will come to and we'll see, you know, more people being active. And that's just my theory. That's what I've seen based on, you know, my family when I started school, that's what I'm talking about. I'm talking about moving. And my mom is like, oh, yeah, I'll go get a trainer. Or I'll do this or I'll move or they you know, they see me we can lead by example.   07:42 This is so helpful. Because everything and what you're calling rambling I call a more clear insight into what's true in your mind regarding diversity, equity and inclusion. And it's not just one component that it there's a need to be looking upon. First of all, with defining diversity, equity inclusion for you, like it seemed as though we're talking about black people, right now, we're just in which is that's absolutely, we're not seeing it. i There were very few in my class, and I didn't think anything of it. You know, to me, the fact that there were some people who are black, there were some people who were Asian, there were some people of some sort of Indian descent was like, wow, look at us, but there could be more. I agree from what, yeah, I still as a white person, I did not feel like a minority at all. In that group. In that setting. I felt just like, you know, hey, which is Yeah. My point is, from all these little things, let's start separating out different things that you were mentioning, first of all, with getting people in getting people into the profession, how did you get reached?   09:05 I, to be honest, I sort of think I got into NYU, praise God, I did apply to like 13 schools. I only got into NYU, and I honestly think it's because they had an interview process. Because on paper I didn't have like a four Oh, and I had some C's and I had to retake some classes. But when you get me in person, I can tell you and and why you happen to have an interview process and and I was able to shine in that way. And I think that speaks volumes. I hope that maybe other schools can adopt that because sometimes our paper with we don't, you know, I mean like but that doesn't have anything to do with, you know, how compassionate we are or how smart we are what will be Be like as, as a physical therapist, especially based oh my god, we had the GRE, I   10:08 didn't do the grade on that either. It's interesting, you're saying that because everything on paper only shows part of the picture. So when the schools are making it like that, and they're just looking at paper, I mean, right there, we are automatically going to be leaving a lot of people out, because our school systems are not equal. Yeah, what people are learning are not equal. So if you're just going off of what they happen to be born into, we're really cutting people off. We're really, really cutting people off from opportunity, and therefore, just continuing the cycle of a lot of whiteness in our field.   10:47 And something that I saw that I think would be also be great, like, okay, let's say we don't have time for the interview process, some of the HBCUs. Or if you don't know, historically black colleges and universities, they did like a video, like you had to send in a video and answer a prompt. And that way you get you get to show yourself. And I thought, you know, that was that was great. You know, I mean, it's something that could also be adopted by other schools. To give us a chance, you   11:24 know, I mean, absolutely, I think I think that that's a great idea as a way to be the change be the change. I don't know if you've ever heard this where it's, you know, God, it's a very I don't like this rhetoric, but it's the one where people are saying, not everyone, but people are saying, Oh, well, now people are just getting in because they're black. Can you share some thoughts to that? Because for so you know, I have an angry look on my face and Sherelle rolled her eyes. We're not shy about that. All right, would you mind response to that? Because, I mean, it angers me, but let's talk about this.   12:08 And on that note, we're gonna take a very quick break to hear from our sponsor, and be right back with Shirelles response. When it comes to boosting your clinics, online visibility, reputation and increasing referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition. They know you want your clinic to get found get chosen, and definitely get those five star reviews on Google. Net Health is a fun new offer. If you sign up and complete a marketing audit to learn how digital marketing solutions can help your clinic when they will buy lunch for your office. If you're already using Net Health private practice EMR, be sure to ask about its new integration, head over to net help.com forward slash li tz y to sign up for your complimentary marketing audit.   12:52 Wow, I've also never discussed this. I mean, if I was just to like speak, honestly,   12:57 yes, please.   13:01 White people get things because they're white all the time. Like not based on merit, not based on skill based on who they know. Or a back door. You know what I mean? And I as   13:17 a person who has benefited in that way, I can absolutely agree. It's Yes, yes. It's true. It's legit happened to me. I like I'm grateful. That's amazing. But like, also, that's so true.   13:32 And, and we're like we said this, the schools are not always even, we don't always have, you know, these connections. But a lot of times when you give us a chance, we go above and beyond, because we're like, hey, my ancestors didn't die for this. So I mean, like, and we deserve the chance, I just think we deserve the chance. The playing field is not going to even and this is our opportunity to try and be able to own probably, I think it kind of goes deeper than just Oh, black you let Black people in. But for so long. We couldn't get education. You know, we were enslaved. We built this. We literally built the US, you know, we couldn't own property. So now it's like, Hey, we're trying to get in these professions, so that we can make something of ourselves we can start building generational wealth. Like for me right now. I am like the person. I am the person right now and 2021 that is trying to start building generational wealth for my family, but why people have had this opportunity to do this and save and know about mutual fund all these different things and I'm just now learning and having the opportunity to get to you've been able To do that,   15:01 oh, for a very long time, and for anybody who says, Oh, the history that you're mentioning, I'm just acknowledging this history that you're mentioning from a bit ago that how black people came into, it's still not 100% there for basic rights for black people, they don't have access to the education that I got, you know, in this, I grew up in California, in a small town, California, if you don't know, if you buy a shed of your own, it can be worth a million cost a million dollars. It's ridiculous. It's a running joke. California is not it's just a well off area to be living, and which is unfortunate. And from that, we are lacking diversity in our areas, and they are people are not getting getting that access. I also feel like that there's an assumption when people are saying, Oh, now black people are getting in just because they're being black. What if? Let's say this black person, maybe it's just one? Oh, you know, come on, like, you know that Gatson is extremely intelligent and more intelligent than you and has had to put a lot more work in to get into prove themselves just to get in? And you actually don't belong? What if? What about what that? What about that? What about that consideration that there could actually be a lot of people of color, who are more intelligent than a lot of people who've been regularly led into school.   16:30 Everything that you just said? That was awesome. Like,   16:36 I love that we're sitting on this for a bit, because getting people into PT school is like the base, you know, how do we reach them? How do we access them and everything. And if then we have people saying it's because they're black. They're people who are black are already dealing with so much this is from what I've learned not experienced, obviously, like you're already dealing with so much discrimination on a regular basis. So to So to finally get that opportunity to come in and then be discriminated against, you've worked your tail off more than the average white person is just preposterous, and we need to call ourselves out on it, in order to be the change. Sure, I was just gonna read this smile. She's   17:25 emotional mom, because you know, it's like, these are the conversations and these are the things that are said within our circles. But then when you have the ally, say, and you see it, and it's like, oh, it's just so nice to be seen and heard. Oh, and then somebody gets it.   17:42 Oh, my God, I do. I do make mistakes. As I go. I've made I've made plenty. And I will continue to do stupid things. But I keep learning and making the changes as I go. But I so grateful that you're on to talk about this. What have you seen, that you think schools are doing that is working to bring in dei and that in schools versus we're taught we've talked a lot about what's not working? What are the schools doing that is working? And what could we do more of pull it out of your buttons fine. Just like brainstorm like, what are the things?   18:15 I mean, like I did say the video. I'm having professors,   18:22 oh my god, I had a black professor. That was the most amazing thing I had ever had one. I remember   18:29 it was so funny. She came in and I was like, Are you a grad student? And she was like, no, actually, I'm a new professor. I remember Mike, one of my classmates, she walked out. We were like in the computer lab. And she was like, now that I see this woman as my, I know, I can do anything. That's what she said. Yeah, so having more black African American ever, professors. If if there can be some type of outreach, I know with my class, so my class isn't good class because I graduated in the middle of a pandemic. So our plan was like, we had many plans and COVID killed the plans. But one of the conversations that I had with a good friend, classmate of mine, she wasn't black, she was a Puerto Rican. And she was like, Oh, I would love to go out to high schools. Let's get a group together and go do it. And then COVID happen and killed everything and we couldn't go anywhere. But I do think in the future. And I know you know, PT school as hard as it is and stressful, but doing some type of outreach in in PT schools and just saying, Hey, this is what you know, get to make it like   19:47 a career day kind of thing. When people come and visit and say, Hey, this is a career you can I do think yeah, definitely. Especially in neighborhoods where my dad's a dentist, okay. I have a family of dentists do Wish total stereotype halacha just brush your teeth, Jenna. So what's my upbringing? Look, I oh my god,   20:10 I missed you.   20:13 The the, but because I had, I grew up with that with people living these amazing careers, I didn't need somebody to come visit because I was surrounded by their neighbors doing a chiropractor friend, one of my best friends her dad was a chiropractor. This was just commonplace. Just in my world. People don't have that. So, uh, yeah, I can even see more. Having people in the profession, someone like my dad even coming and saying, Hey, this is something you could do is great. I think that's, I think that's a really great idea, just literally coming to the schools coming to them. And people don't like if you sit there and just do a social media post and be like, here come to us. Like, it doesn't work that way. Nobody, including any listener, or Sherelle, or myself, we'd like people to just come to us, as we're living our lives.   21:06 This is something I just thought about. I don't even know if it could actually happen. Ooh. Like, can we have like a work study? or some type of like, even be volunteer like work study. And like a student? A student runs an Instagram and it's specific for that school. And it's specifically for, like, adding teens or, you know, people of color and and making content that's relatable. Yeah. So that it's, you know, a track. It's attractive, so people learn more you know about it. I think social media is just such, it's just a force right now.   21:54 It really is it really,   21:56 I don't know what that really looks like. But, you know, yeah. But in talking about, you know, I don't know it just in a creative way.   22:08 No, I get what you're saying. I just, I just recently had a big screening with a ballet company. And I contact a local school and had PT students come volunteer and take measurements and everything was awesome for them to get to experience that would have killed for something like that as a student, but things like that, that other businesses are doing schools are doing, they can have events of some kind to bring that in that that could be I don't know what but because we're like in the like, no mode. But I love that. I love that. Let's let this lay as like the EU, we just let this kind of drop as a potential idea. I have only a few more minutes left with you. I would love to two more things. What have you personally been doing to help bring more dei into the profession?   23:00 I don't know that I necessarily have because I was so engulfed in school by having this conversation. Literally while you were saying that I was like, Oh, I have some ideas. Like I want to start doing this. But I definitely you know, I speak within my family on my social media. You know, I I talk about, hey, let's be more active, I do a lot around how we can move instead of having to go to the MD The MD is going to tell me to take a pill and then sit you don't have bed rest. But I definitely can do more. I can call myself out about that. You know, when I'm back up, you know, hey, I'm going to be very intentful about a purposeful about doing this. I'm excited actually, unfortunately, I passed my boards. I I kind of had this injury and then I wasn't able to do everything that I wanted. So when I'm back up and I'm full, I'm like, Ah, let's go. Let's add this to the list. I'm happy that you asked me that question, which made me get you know, the juices going and Right,   24:09 right. Uh, yeah, I love it. I love it. I give complete credit to Lisa van who's for that question. She said ask this question. I said okay, okay. Where can people we are now coming down to an end. Where can people find you? Sherelle on social media. They can follow you connect. Where can they find you?   24:29 You can find me on Instagram at Lego fitness. I believe Oh, well. I do search my name on Facebook, which is Sherwin Williams. Those are the two places that I live right now. At my website is you know is what is it like up pt.com If you want to see a little bit more about me there.   24:56 And then if anybody might want to email you some people do prefer the email   25:00 Oh yes, my email is right now is just Sherelle w@icloud.com   25:08 I love it. Wonderful. Thank you so much for coming on. You are a force. I frickin love you.   25:16 Thank you for having me. This is so amazing.   25:20 A big thank you to Jenna and Ciara for a great interview on D AI initiatives in the world of physical therapy and of course a big thanks to Net Health. So again when it comes to boosting your online visibility, reputation and referrals, net Health's Digital Marketing Solutions has the tools you need to beat the competition they know you want your clinic to get found, get chosen and get those five star reviews. They have a fun new offer if you sign up and complete a marketing audit, so they can help your clinic when they'll buy lunch for your office. Head over to net help.com forward slash li T zy to sign up for your complimentary marketing audit today.   25:57 Thank you for listening and please subscribe to the podcast at podcast dot healthy wealthy smart.com And don't forget to follow us on social media  

In this episode, Founder of FitBUX, Joseph Reinke, talks about financial planning. Today, Joseph talks about financial planning technology, the three buckets of financial planning, and the importance of focus. How can FitBUX help people with financial planning? Hear about thinking about percentages, self-employed financial planning, and get Joseph’s advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Money is always relative.” “The big takeaway is percentages.” “If I focus on one, maybe two things, I’m going to accomplish things much faster.” “The more you concentrate on something, the sooner you’ll realize it.” “This should be complementing your life, not dictating it.” “Focus.”   More about Joseph Reinke Joseph Reinke is a Chartered Financial Analyst (CFA) Charterholder and is the founder of FitBUX. FitBUX has helped more than 11,000 PTs manage $1.6 billion in debt and assets. In addition, FitBUX recently partnered with the APTA to provide APTA members with awesome discounts on their technology. Joseph has appeared on numerous industry podcast, been an author for various industry publications, and has done over 200 student loan workshops at university graduate programs, SIGs, Conclaves, and annual conferences throughout the country.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Finance, Financial Planning, Income, Expenses, Debt, Money, Technology, Retirement,   Resources FitBUX Investment Round: https://republic.com/fitbux   To learn more, follow Joseph at: Website:          https://www.fitbux.com LinkTree:         https://linktr.ee/fitbux Instagram:       https://www.instagram.com/fitbuxofficial Facebook:       https://www.facebook.com/groups/FitBUXOfficialGroup   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the Full Transcript Here:  00:03 Hey, Joe, welcome back to the podcast. I'm happy to have you on again.   00:07 Yeah, I'm glad to be here. It's been a long time. It's the very first time. I think there's like a third time, maybe the fourth time. But yeah, it's been quite a journey. So glad to be back.   00:18 I'm happy to have you back. Especially because today we're going to be talking about financial planning. Now, I know a lot of people might be like, oh, gosh, this is so boring. But regardless of whether you own your own business, you're working for someone else, you have to have a good financial planning, because you want to be able to get through the rest of your life and have the security of knowing you're financially sound. Right.   00:46 Exactly, exactly. So we'll make it we'll make it exciting. We'll give you some, some tidbits that you don't hear anywhere else. So   00:54 yes, excellent. Well, let's let's start out with what are a couple of tips for the audience, that you counsel people on when it comes to financial planning?   01:06 Yeah, so a lot of us to help is all about the technology, and we're there to guide them through it. And it's really geared around a lot of stuff that I learned when I was in wealth management. You know, everybody always talks about, oh, the problem in financial planning and financial education, and this and that. And basically, what I look at used to look at is everybody in the financial industry, they just double down on using the same stupid stuff. And then when the technology comes out, they just put some cute interface to it, and it just doesn't work. Okay. And there's, there's two areas that I could, you know, illustrate on that. One is like, on these apps, so like these budgeting apps, I won't name any names, I won't pick on anybody, but there's a lot of big popular apps out there. Or maybe you just use Excel. And a lot of times what they do is they just throw a bunch of stuff in basically an Excel sheet, and they put a user interface around that. And it's like, okay, well, where does all my money go? Like, this doesn't make any sense. So that's the first issue that we've seen in the second one, I used to joke around about this, this is where financial technology that I used to have, like, you know, a 60 year old client would come in with like, a stack of paperwork with like, an inch or two thick and say, Okay, what am I supposed to do? And to me, all FinTech did was take that makes file and put it on the internet. And just make a pretty little graph around it. It's like, okay, this doesn't tell me anything. Like, what if I want to buy a house versus rent? What if I want to pay off my loans versus well forget? How am I supposed to look at these things? Like, am I supposed to decide this? And so those are the two big areas that is like, how do you do this. And so the first big tidbit on financial planning to satisfy that first problem, just one big thrill plus, you got to think of things in almost buckets when you start stretching out your plan. So you have things like your income and your expenses. And I'm not talking about like your debt expenses. I'm literally talking about your day to day expenses, like food and rent and utilities. So that's like, step one is your income and your day to day expenses that is happening today. The second step is to say, Okay, how much is going towards investments and how much is going towards debt? And that's the step two is over the long term. And then step three is, well, what am I doing to protect my financial plan? Those are things like insurances. So life insurance, long term care, insurance, disability insurance, home insurance. And so the way you can think about it is, this is day to day, this is long term. And and this is risk management, because protection. And when you start thinking about it that way, it makes life a lot easier to do it. And then you know, we'll pause there, and then go into also, you know, what happens like, Well, what about projecting? What about managing this over time? What's an easy way to set this up from there, but that's the primary the main component of in terms of just setting up the plan itself, of those three buckets when you start thinking about this stuff?   04:09 Yeah. And so you suggest people kind of sit down and look at all of those things and kind of write them out. So they have they know their income, they know what their expenses are. They know what they have asset wise, debt wise. So when you're talking debt, can you be a little more specific? Are we talking long term debt like loans or short term debt like credit cards, or bony   04:32 any real debt, I mean, credit card. So with credit cards, if you're paying them off monthly, we don't even consider it that we just consider that day to day stuff. But we're talking about where like you have a monthly payment, so car loans, student loans, mortgages, if you do have credit card debt, and you refinance it, for example, into a personal loan, and you're paying that off over time, if you have business debt, whatever it may be, that's the debt that we're that we're talking about in that step two.   04:56 Yeah. Thank you. Thanks for the clarification on that. And then of course, All the insurances and things like that, that we all need, that we all should have moving forward, I would say especially if you're a physical therapist, and especially if you're in private practice, boy, do you need those insurances to be on point?   05:16 Yeah, exactly the biggest, like the most overlooked one is disability insurance. Because it's like, what do you do if you go to say, well, I can't do my profession anymore. It's like your financial plan completely just ruined if you don't have that. And that's the way you can think about insurance is okay, well, I did my step one, I did my step two. Step two happens over time. What happens if I don't have time because of whatever it is. So like, what happens if I become disabled? My financial plan crumbles. What if I'm married, and I pass away or my spouse passes away? Like we have children like our plan crumbles? What happens if I have a car and I don't have the proper car insurance and I get in a car accident? I don't, I can't buy another car. Now my plan crumbles because I gotta get all this auto debt for another car. So that's what you can think about insurance is protecting just in case time doesn't happen?   06:03 Yeah, fair. Okay, so great. Tip number one, just to recap is to break up into three areas, income expenses, assets, debt, and the third protection, or, and that's where all your insurances come in. Okay, what other what other tip do you have when it comes to financial planning?   06:22 This one is one of the most important and this, this makes life so much easier, both when you're setting up a plan. And also when you're actually like monitoring your plan. Oftentimes, somebody will come to me and say something like, you know, I'm paying $1,500 a month on my student loans. Is that a lot of money? And it's like, I don't know, like, Well, what do you mean, you don't know you're an expert? Don't you know if that's a lot? It's like, well, no, what I mean by that is, do you make $300,000? Or do you make $30,000? Because it's all relative to your income. And money is always relative. Another example of that, like investments, somebody can't come to me and says, I made $10,000 on my investment. And it's like, okay, is that good? It's like, I don't know, like, Did you invest? 20,000? I'm like, Yeah, I'll just do that. But if you invested a million and only made 10,000, like, that's horrible. Like, don't quit your day job, like, what are you doing? Right? So it really just depends on percentages. And you can take that knowledge and apply it to your financial plan. So when you're actually setting these things up, especially on step two, where you're saying, where's What am I investments? Or what am I debt, when you look at percentages of where your money is going and allows you to say, hey, like, I want to focus on, you know, paying off my mortgage? Well, if that's not your biggest percentage of where your money is going, and you're not focusing on that, okay, and this is like, it's funny, because people like, how did you come up with that percentage thing? And I'm like, well, one of the ways I did was when I first started working, I put all the percentages there. And I realized how much money was going to taxes. It was like, Holy crap, like, what can I do to reduce that? So I'm the financial dork that I am, I went and read the IRS tax code. But it's like, those percentages that I assume realized, from a financial planning aspect, it makes life easy, not just setting up your plan, but actually following it. Because if you say, Look, I have 20% going towards my student loans, I have 5%, going towards savings for a down payment for a house, I have 4% going towards my 401k. Over time, your income should be going up. So it makes it very easy. You don't have to think about how much of my money should be going where you just keep the percentages the same and increase how much you're doing in those categories. Or if you get a bonus or a tax return, say great, I take the percentage, I put it to those categories. If I want to do more, I'm fine. But I don't need to I can go out and actually enjoy this money if I want to and not feel guilty about it. Cuz I know I'm following my plan. And then once you're following that plan, let's just say you have a good life event happened. Like let's just say you paid off debt, you paid off a student loan, you paid off an auto loan, well, then great, you just look at the percentage and say, Okay, where do I move this now to meet my next goal? Very quick and easy. Or maybe you have a negative life event, like you get a car accident, You wrecked your car, and you need to buy a new one, where it's like, okay, well, I have I was focusing on this. But if I've moved this percentage and this percentage here, I'm good to go. And that's it. And then you can actually go out and simulate that and I'll talk about simulating that in a minute. But that's the key thing. One of the biggest takeaway that you can take from this podcast as percentages, what percentage of my money is going where and then from there, instead of tracking your dollars and cents, every single place that goes track the percentages are my percentage is going to where I said they're going to especially going towards your investments and your debt. Some people really like looking at those percentages on their day to day expenses too. That's fine if you want to go that into it for me, as long as you're following the assets and debt sureselect don't enjoy. That's the way I look at it. Because that second floor of the building assets and debt, that's the financial plan. So that's the key thing. There's that percentages, percentages, percentages. And, you know, I wish I could talk to everybody that's like 40 and 50 and 60 that have been doing like the dollar amount their entire life. And it's like, I just switched to this. It's easier, like, do that. Yeah. So that's the big takeaway is percentages.   10:26 Yeah, I switched over to percentages a couple of years ago, and it's like a no brainer. You know, so like, when, like you said, for example, a tax return comes in. So I had a tax return. I know it was last year, the year before. And I knew exactly where all of that money was going. Because it was in my percentages. Yep. So it just makes life so much easier. And you'll see you'll accumulate wealth in the places that you need to, because that's your plan.   10:53 Yep. And you'll realize, while if I focus on one, maybe two things, I'm going to accomplish things a lot faster. And so that's where the the behavioral side of finance comes in to. And it's a proven fact that more you concentrate on something that the sooner you're able to realize it. And so one of the big mistakes that we see people make, especially on that step two, they're like, Alright, I'm going to save in a Roth, I'm going to save in a 401k, I'm going to save for my child's 529 plan, I also need to save for a house and I want to save or pay off my student loans. And it's like, you're going to do none of those. Like, if you're trying to do all that good luck. Like seeing the percentages and how thin they are, and how long it's gonna take you to accomplish those is a red light to a lot of people, it's like holy cow, like, will instead I just focus on like, paying off my loans, for example. And your my retirement for the time being, you're gonna be able to accomplish a lot more sooner. And then you can get to those other things down the road. So that's another big takeaway is focus, focus, focus, focus.   11:55 Yeah. And it's okay to move those percentages around as your life changes. And as things change in life. It's good. Yeah. Okay, cool. Yep. So now, yeah. What I mean, this all sounds great. And I'm sure a lot of people are wondering like, oh, okay, how am I supposed to keep track of all this? How am I supposed to do all this? This sounds complicated. I don't work in Excel. QuickBooks makes me nauseous. What can I do? Like, so explain to us how fit books, can I help people with some of this financial planning stuff?   12:28 Yeah, this is where I'm so personally excited. Because this is where we always wanted to take the company even like, it was one of like, five years ago, I first came on the show on your podcast, we specifically we knew this technology was gonna take a long time to build. And so we specifically started the first piece of the technology around student loans to help students, new grads, and then we've been building it, especially during COVID, we've been building out more and more, as long as we don't lose engineers that COVID Every other week. But we've been building out more and more, and we launched the first version out of beta last November. And it literally does all that for you. So when you go to build your plan, like step one is income expenses that two is is your asset contributions, your debt contributions, that three goes into risk management. And then we took it a step further, actually, on step four, you can add in goals and life events. So everything from like getting married or buying a house, or whatever it is that you're going to do. And what that allows you to do is it allows you to say, Hey, this is the plan that I want to follow. And you can actually build out the entire thing and see in the long run what it does, or you can run simulation. So if you're trying to say Hey, should I pay off my loans versus loan forgiveness, or should I rent versus buy, or I'm married, and we just had a child should myself or my spouse stay at home instead of working so we don't have to pay for daycare, you can simulate all those to decide what you want to do. Okay. And then with the technology, once you say this is what I want to do, we take all these complex components, so like your income and your expenses and your assets and your debt. And we bought them all into one data point we called the fitbug score. So you can really easily compare everything and what the fitness score is in the short run, it looks like your risk and your profile and everything else. And then by the time you hit retirement is basically the probability of you hitting retirement and not running out of money. Okay. And so once you say this is the plan that I want to follow, you can then link your financial accounts into the hitbox profile, track yourself right on your profile, and it literally tells you step by step each month, are you doing this right or not. And then if you have one of those life events where you have to change your percentages around you just go back in and have your plan with the percentages around hit save and go back on with your life. So that's why I'm so excited because we've been building that literally for like two and a half years that that bigger technology and it's finally out. So I can actually smile and have a few more gray hairs because of it but it's out So that's where we're at right now.   15:03 Yeah, it sounds it sounds like definitely makes life a little bit easier. And now does this connect to your bank accounts or to your QuickBooks and all that kind of stuff so that it's constantly updating? How does that   15:17 work? Yeah. So it doesn't connect to QuickBooks, it connects to bank accounts, credit cards, some debt. So it connects almost everything not, you know, there's some credit union stuff that it doesn't link into. Some accounts are more thorough. So like the bank accounts, or the savings accounts are all in there. Some debts, like some companies, like first of all, some companies are there, some aren't. Even if they're not, you can still manually put them in. And I just tell people updated like once a month with your transactions. So it can up to date tell you, the big thing is, is making sure that your gross income is in the technology? Because that's how we base everything, are you following your your plan, based on these percentages, and the only way we know that percentage is if your gross incomes, they're not your net, your gross income. Because we want to see, we want you to see where your taxes are going and everything else in your entire paycheck. And so yeah, you can link your accounts, we do it through a company called plaid, which is, you know, the other major banks use them and everything. So that is who we use to link the accounts.   16:17 And can you quickly just for people who don't know, define gross versus net income?   16:24 Yeah, so gross income is what you get from your employer on quote, unquote, that top line, so it's what you're actually paid. And then from there, they deduct out things like your taxes, your Social Security taxes, your unemployment taxes, your Medicare taxes, any contributions to your 401k that you're making, anything that you're paying in terms of like medical care, dental care, whatever it is. And then after that is your net pay. So when you get a deposit into your bank account, that's what we see as net pay. And so you have to reconcile that the gross income. And so what we try to do on the technology to make it easy is is once you put in one of your gross incomes, so like if you get a net pay of like two grand, and then you reconcile it to say 3000. Next time we see $2,000, we automatically reconcile it for you. So you don't have to keep doing it. But yeah, we need that done a few times. So that way the technology updates and can start learning what that is and make those adjustments for you. But yeah, that's the difference between gross and net income.   17:27 Perfect. And let's say you're self employed, and maybe you're so you're not getting a steady paycheck, but maybe your pay can fluctuate slightly from month to month. So how does the technology work with that? Is it like, on our end, when it comes to a little   17:45 bit more, yeah, a little bit more, because you don't know what that income cash flow looks like. But what I tell everybody, like when you're setting up your plan, and you have variable income, so you might not even be self employed, you know, just be based on commission or commission. And what we tell people on that is be very conservative. So like, if you typically make like 80 grand a year and commission or self employed income, do your financial plan based on 60 grand, and do those percentages. And then every month, when you get those waves of money coming in, just take the percentages, and that's what you do. And so again, it makes life very easy. Like if you're putting money to the SEP IRA, or whatever it is, you just know what those percentages are. And that's what you put in. Instead, try where I see a lot of commission based or business owners where they make mistake is actually on twofold. They try to do everything monthly. And then they ended up in a month. It's like, oh shit, I don't have any money. Like, oh, or they go the opposite. They say, I'm gonna do this every six months, I'm gonna see where I'm at, I want to put money into these things. And then six months go by and they're so busy, they just forget. No, they don't do anything. And then all of a sudden, they have 50 or 100 grand sitting in cash, just not doing anything for them. And they don't even realize that it's sitting there. It's like, fantastic. And so, yeah, that's another place where those percentages come in into play big time.   19:09 And do you suggest people looking at, look at all of these percentages every month.   19:16 If they're following the percentages every month, the only real time you need to change them is when one of two things happen. The first one would be is if you have a major life event happen. So things like you get married, you have a child, there's a debt, you're inheriting money, whatever it is, those are major life events, that's when you go in and change it. Or you hit a major goal. So you pay off one of your debts or something like that, and you have a lot of money now that you need to move around. So those really are the two times and that's one of the big reasons why I'm so excited about the technologies because when I was in wealth management to me, it's like this whole model is messed up like you pay 1000 to $3,000 to a person to come up with a plan and then you walk out and it's completely obsolete. And in some of these guys charge $100 a month, but they don't track anything. They don't have any technology to actually even track anything. So what the hell are they doing for $100 a month? So we were like, Okay, well, we give out the financial planning technology, it's free to build your financial plan, you can even talk to a coach, and it's free to build it. And then when you track it, we could charge a monthly subscription fee, that's, you know, 20, or $30, whatever we charge on that. And it's there, you don't have to worry about spending $3,000 a year, any of that garbage. It's like, oh, it frustrates me so much when I talk about it, because the whole model is just like, completely upside down. And actually, the stuff we're coming out with Next, we just started working on it. As far as investment recommendations for allocations and how you had your investments allocated. And I had heart, I'm an investor, I mean, that's what I've been doing since I was like 12. And so I'm just starting to get my tea sharpened on that one, I'm hoping to have it out by March or April this year, where you can literally build your profile. And then it will tell you how your allocation should be on your investments, how much risk you shouldn't be taking. And the big part that's different, we didn't touch on this. We factor in this thing called human capital into our analytics. We ask everything from like, what's your profession to things? Like do you run marathons? Because that all goes to speak about behaviors. And just like healthcare 80% of outcomes and behaviors, it's the same thing in finance. And so there's no point in our technology saying, Hey, you should do this complex plan, when the behavior is not necessarily there yet. And so we factor all that into our algorithm. And that's part of what we're going to be coding next with the investment allocation. Which that's a whole minefield that to me, is that all traditional advice, like, Hey, you're young, like you can afford, you know, to put everything in the stock market. It's like, No, you can't like you know, what happens if you have $5,000 in emergency fund, and you have $5,000 in a 401k and COVID hits and your 401k goes down 50%. And you also just got laid off that $2,500 that just went out the door might be pretty valuable. So why were you aggressively invested at that point in time? Like, it makes no sense? Yeah, so I, yeah, I can go off for hours on that investment allocation stuff. But that might be a far whole nother podcast.   22:27 And that's okay. We'll have you back on. That's not a problem. Well, it sounds like a lot of exciting stuff and a lot of stuff that's really user friendly, and really good for people who aren't financial planners, right? Who like they didn't go to school for this. And they need a little bit of guidance, a little bit of coaching. And this certainly sounds like it makes it very easy for people to do that. Now, what are I know that you said this before? But I'll have you repeat it. If people take away anything from this, what is a big, big thing that you want people to take away from this talk?   23:01 Yeah, keep it easy in terms of how you set it up. So again, today, what's your expenses? What's your income today? What are you doing over time with your investments and your debt? And then the third piece is what am I doing to protect my financial plan, that's insurance. The second big takeaway is following your percentages of your income, it will make your life extremely, extremely easy. And then to your key point, caring. This stuff should be complementing your life not dictating it. And it should be easy. And again, that's one of the hours that retirement of it for a PT when I decided, yes, I'm going to launch the company. And the main reason was because I was like, I always wanted to invent something in terms of technology to help people like, but I'm not. I can't like I'm not Elon Musk, I'm not gonna build neuro link or some of these other companies, right? It's not gonna happen. But I know finances. And it's like, okay, well, if we can develop a technology that reduces the amount of time you need to think or stress about money, that means you can do what you're supposed to be doing when you're going to school, like being a PT. Or if you're an engineer, and you're the next Elon Musk, you don't have to think about money because that part of your life is actually taken care of. So it's my small contribution, if you will, to the technology world. Just funny because everyone's like, you're a founder of a technology company. I'm like, I'm a finance guy. I know algorithms. I know math, and I know money. And I'd like I give it to coders and engineers, right? They do it. Right, right, right.   24:31 Hey, listen, that's why it's we always work better as a team, right? It's hard to do everything on your own, if not impossible. And now where can people find more about all of this info and how to sign up and how to start using this?   24:45 Yeah, so Bostock comm just go on build, your profile is free to go on and you can build like all the tools are accessible to you to build your plan. You can schedule a call with a coach which we highly recommend because this version of the technology We built specifically for people to actually call us and have them help us walk you through the technology to make sure you're using it correctly. And then as we grow, we're building out more and more automation. So that way, it's easier. And then once you want to sign up and say, This is the plan I want to do, that's where you start the subscription and go from there.   25:19 Perfect. All right, so that's fit bucks fit bu x.com. Yep, you're right. All right. So before we end, before we wrap things up. Last question, I asked everyone, and that's knowing where you are now in life and career, what advice would you give to your younger self? I know you've answered this question before answer it again, come up with a new piece of content, you get to say more advice to your younger self instead of just one piece.   25:47 Yeah, this one, I touched on it earlier, and I can't stress it enough as focus. You know, I'm the type of person that like I was at CSM last week. And I pretty sure that I wrote down like seven or eight business ideas. And I'm the type of person that just wants to start working on everything. Like, I used to joke around with my wife. I was like, you know, this was back when I was doing my investment trading. I was like, if I come up with something, I will literally be up for 72 straight hours researching this and figuring out if it works or not. And sure enough, the very first time like, I came up with something, I stayed up, I was on our 71 I thought it was gonna work. And then our 72 is when I found out that it will work. But focus is we're so distracted with things. We're so distracted. You know, that's one of the behavioral things I'll share is like, when you start saying, This is what my focus is, and you have a fundamental reason of why you're doing it. And it's not because you're, you think you're gonna make a lot of money or you think you're gonna do this, but you have a real fundamental, real reason why you're doing it. Focus actually becomes very easy. Like you no longer care about watching TV, like I'm a big sports person. I haven't watched sports in about eight years. Just because there's like, I won't play I was watching a football game. I'm like, Well, this sucks. I'm wasting four hours. And the game's only an hour and a half and watching commercials. So let me TiVo it. And I started TiVoing. And I'm like, wow, they're still wasting an hour watching this thing. Like, I'd rather be doing something else, which I stopped watching sports. And so it's like, if I could go back, I just think about it. Like if I had that same mentality when I was like, 20, instead of getting that mentality when I was 28 or 29. I'm like, my life would be looking a lot different right now. So focus, focus, focus, focus.   27:36 Great advice. Joe, thank you so much for coming back on the podcast, giving us great tips for financial planning. I'm sure everyone will take a lot away from this podcast. So thanks so much for coming on. Yeah, thank you for having me. Anytime and everyone. Thanks so much for tuning in and listening and have a great couple of days and stay healthy, wealthy and smart.

In this episode, Pain Scientist, Clinician, and Distinguished Professor at the University of South Australia, Lorimer Moseley, talks about pain and research. Today, Lorimer talks about his many streams of research, assessing cognitive flexibility, and his MasterSessions. What is cognitive flexibility and how does it affect pain? Hear about the social determinants of pain, COVID’s impact on Pain Revolution, the complexity of chronic pain, and the responsibility that comes with doing pain research, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “One of the biggest determinants of your health in the US is your zip code.” “[Cognitive flexibility is] the ability of your system to change its behaviour when the task requirements or conditions change.” “If you’re going to label something, it should be what it says it’s doing.” “[chronic pain] is one of the most burdensome health conditions in the world.” “There’s genuine, realistic, scientifically-based reason to hope things will keep improving for people with chronic pain.” “Love and be love.”   More about Lorimer Moseley Lorimer is Bradley Distinguished Professor at the University of South Australia. He is a pain scientist, clinician and educator. He has made seminal contributions to how we understand pain and why it sometimes persists and has developed treatments that are now considered front line interventions in clinical guidelines internationally. He has authored 370 research articles and seven books. His contributions have been recognised by government or professional societies in 13 countries. In 2020, he was made an Officer of the Order of Australia for distinguished contributions to humanity at large in the fields of pain science and pain medicine, science communication, pain education and physiotherapy. He lives and works on Kaurna Country in Adelaide, Australia.   Suggested Keywords Healthy, Wealthy, Smart, Physiotherapy, Pain, Research, Cognitive Flexibility, Chronic Pain, Perception, Responsibility, Recovery,   Notable Mentions Caitlin Howlett. Dan Harvie. Pain and Perception, by Dan Harvie and Lorimer Moseley. Epiphaknee, by Lorimer Moseley, David Butler, and Tasha Stanton. Participate in research (it takes just 20 minutes). MasterSessions.   To learn more, follow Lorimer at: Website:          https://www.tamethebeast.org                         https://www.painrevolution.org                         https://people.unisa.edu.au/Lorimer.Moseley   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read The Full Transcript Here:  00:03 Hi, Lorimer, welcome back to the podcast. I'm so excited to have you back on.   00:08 Good. Thanks for having me.   00:10 And so today we've got a lot to cover, because we are going to be talking about some of your current projects, new developments that maybe happened since 2021, where you had well over 30 publications. So you had a very, very busy year, I would say. But as we go, as we kind of go through and talk about some of the things that you're working on, I just want you to let me know if there's anything that you're like, Whoa, hey, I can't talk about that. Or if there is reason to be a little vague, because things might be ongoing trials and things like that. So we'll definitely keep that in mind. Now, let's say you've had a lot of publications over the last year, what are some current projects, or discoveries or developments that really stuck out for you in your most recent research?   01:08 Ah, nice question. Um, one of the things about being a scientist in a clinical field is that here, it's not often that you get a revolutionary discovery, it's quite unusual. So what I think the things that I'm most excited about are not, not so so much particular papers, although there, there are some really tiny phones, there's one that's not published yet, but will will be out in the next couple of months that I'm particularly excited about. And I can allude to that. But I think sort of like these, these streams of research in which I'm involved that are turning me on a bit, the moment and one of those is a continuation of the whole explain pain thing. But over the last sort of four or five years, we have discovered, we've looked really closely at but at the the outcomes of clinical practice in where people are delivering great educative interactions and, and I've had a fair degree of, of influence over them. So I feel really confident that I did, they're supposedly doing well. And those data from a big cohort of people suggests that, in about half of the people with chronic pain, they see they have this shift in understanding of the problem, but a real flip. And it's in a predictable way, you know, shifting towards really deep in your belly can conceptualizing pain as a protective feeling that's being produced for a reason. And we need to work out what that reason is, and it will almost well, it will certainly not be a single reason, there'll be all these little contributors. So real flipping, understanding. And, and I guess, understanding that as pain persists, the system becomes over protective, and, and really embracing that as a reality. And that's a really hard thing to do. But those those half of the people who do it has great outcomes a year later. That's a for me, that's a really exciting discovery. The half of the people who don't don't have great apples. So for me, again, it's a really exciting discovery. The problem is that we're only winning in half the people. You know, we're only nailing it in half the people and the interventions good across seems to be good across everyone. So clearly, our markers are what's good intervention, they're not accurate. So my gut feeling about that was not accurate. So we've been looking deeply at how, how can we expand that group from half to bigger and, and unexpectedly for me, doubling down on the on the criticality of learning. So I've been learning a lot about learning. And that's been infiltrating our research and infiltrating the whole way we go about helping people with chronic pain or at risk of chronic pain. And so I'm really excited about that. And we're seeing its scientists talk about seeing a signal amongst the noise. And in chronic pain, there's just so much noise, right? Because chronic pain is this truly, in my view, truly bio psycho biggest and it's more or less social thing. And if we can intervene and see a signal in that group, that's a really exciting development. And   05:03 I, I'm more excited than I was maybe seven or eight years ago about the potential power of of new and better ways to get people to give people understand. And I started banging on about this in conferences and stuff maybe three or four years ago. And I have this slide that that is intentionally slightly provocative, particularly to the physical therapy world. And that sort of pain science education world, I think in in the US the brand name as popular as paid in neuroscience, education, p and E. These are all brand names, right? PMA expired pain is a brand name. So I like to avoid the brand name. So I call it sort of pain science education or modern pain education. So this slide is meant to be slightly provocative, in say, has education become the objective, instead of learning being the objective, and I think for me, education became the objective. And that was a mistake that, that I made. And I think my research made that mistake, and my clinical practice probably made that mistake. And my own outcomes over the last 10 years, and I get I keep really tight audit data, I can see the benefit of my own development as a, as a clinician, educator, and probably as a human on outcomes. So I'm excited about that, for sure. And I can give a little, a little teaser to the paper that we expect to come out the next couple of months in a big journal near you, which looks at a clinical trial of chronic back pain, where we have done two things that I think are really unusual for our field. One is we've tested, I think, a new complex intervention. And it's made up of less new interventions, but they're all sort of put together into a package if you like. And the other thing that was different that we did that, that are Yeah, I think I'm really proud of the team led by James McCauley is the senior author on it. And Ben once and I were important in sort of formulating the treatment, but Ben's been really critical. But we were all very keen to make the control group the best placebo intervention, we could. So we put a lot of effort into credible brain targeted treatments, matching the educative component. And testing whether people had different expectations or perceived credibility or beliefs about whether they are in treatment or not. So from my perspective, it's a very tight trial. And James and I were fully expecting that we would not see a signal in this. But we would be interested in secondary analyses which tell us mediating effects like what, even though there wasn't an overall effect, where what worked, what what might have been helpful. So that's what we were expecting, but in fact, we saw a clinically important signal. And that's very unusual in back pain trials. It's if you have a control group where you've got a waiting list or usual care, or you've gotten there's been a couple of trials published slightly, or you've got open labeled saline injections, you know, these treatments that will have some sort of effect, but they're no match. Right? So you're not really asking, are the particulars throughout this treatment? Important? All of those treatments will show a signal they all they always do they show exactly the same signal. I've done those randomized control trials. So that's one thing, you can design a trial in a way that you'll show signal. But it's a bit meaningless to us as real world clinicians. Or you can design a trial that we would call an explanatory trial that says, Okay, we've kept all of these things the same in the two groups and the things that we kept the same were as much of that nonspecific therapeutic alliance engagement, credibility expectation, which, which I think is a big part of the whole pain science education thing. So I do think we have to monitor that. You might hear my dog the other   09:38 room. Right. All right. We're pet friendly around here. What's exciting   09:42 about that is that it means there's some sort of delivery bandwidth to be won, I think it might be this new piano that I discovered even better. Yeah. So anyway, so that will be coming out. I can't say anything more about that, but, but it's a really exciting development. And we've got we've got a few trials that are testing versions of these sorts of things for for different conditionals. But uh, going at the moment and the way we're constructing the education component and integrating it with the movement and loading and anti inflammatory component. So that is three pronged approach. Really exciting for me, as I, you know, I've been doing this for quite a while that feels like, I still feel like a kid. But, you know, I have been researching for a while. And this is a really exciting time, I reckon, in the chronic pain world, because I think we're starting to chug forward again, I feel like the field was stalled a bit. But jumping forward. That's one thing. And then then on the other other side research streams, one of our team called Dr. Emma Karen is doing really difficult and really important, work really well investigating the influence of social determinants of health on chronic pain outcomes. First focusing on low back pain. She's published a couple of systematic reviews, and mixed method study on that, that is pretty intimidating. For those of us trying to move the the outcomes in a positive direction, because as we were talking about before, caring that the social determinants of health are very powerful, and they're powerful in back in back pain and pain outcomes. They're really hard to shift, you know, they're very hard to do much about so. At our field, the pain, field musculoskeletal, the the sort of arthritis field has or has engaged with, it's way better than then the non Arthritis, Musculoskeletal pain, pelvic pain, Fibro fields, we, you know, it's remarkable how little attention, it gets the biggest social and when we talk about the biopsychosocial model, we nearly always conceptualize that as a smallest session and the people around you social, which is important. But we haven't really integrated the biggest social Yeah, the world in which you live in your access to health care, illiteracy. Poverty.   12:29 Yeah, that sort of stuff. Absolutely. And I think you kind of hit the nail on the head as clinicians, oftentimes when we talk about the bio psychosocial, we think of the socials, what's your support system at home? You know, do you have, you know, can you get to, can you get to therapy? Do you have access to therapy? But what we're not asking is, do you have access to other medical care? If you need it? Do you have access to fresh foods and vegetables, which we know can play a part in, let's say inflammatory responses in the body? Do you have access to a pharmacy? Do you have access? I mean, all of these things make a huge difference, you know, or do you? Is your social part of that bio, psychosocial? Are you working three jobs and raising children and not having time to fit some of this stuff in? Right? So social part becomes a really big S for a lot of people. Certainly in the United States, like I said before, one of the biggest determinants of health of your health in the United States is your zip code.   13:37 Yeah, it's remarkable.   13:40 So social determinants of health is is high priority. And I think maybe people shy away from it, because it's can be so overwhelming. So I don't know what you guys are finding research wise, if there are way and how you can address that?   13:56 Oh, it's it's overwhelming, for sure. And I totally understand why there is a reluctance to go there. And there are also I think there's very complex ethical considerations about going there. We've we've been planning a study in the northern suburbs of Adelaide where I live, which is an area that's really different to the say, the inner suburbs of Adelaide with respect to all that sort of predictable social determinants. But one question that we've had to look in the mirror about is if if we develop this so we're working on developing a screening tool. If we start to identify people that have significant unmet social needs, and we can't do anything about it, is that is that a ethically defensible position? Yeah, we were able to say to people, okay, we know what the problem is, you know, this, you can't have because we got no mechanism Have of meeting that need. So it's quite a challenging area to move into. Because if you if you imagine that the understanding and overcoming persisting pain is a very slow step by step journey. And now we really have to imagine that instead of going in a straight line, we're almost going in a circle, and we're making slow step by steps of the entire circumference of the circle, you know, and you move a little bit, then you have to stop and move a little bit more somewhere else. Otherwise, you're going to break. And the people who suffer when you break will be the same people, you know, the, the more vulnerable people. So it's a really challenging field. And yeah, I can't, I'm excited to be getting dragged along by Mr. and her colleagues on on this. But I'm also so impressed with how, how robust the approaches to it. So yeah, there's a couple of her papers out already and more, more coming. And I think there'll be really influential in the field. Because no one there are people there. There are people who are engaging in this, but very few people are thinking to themselves, I'll take on that challenge. Yeah,   16:28 yeah. Very, very difficult.   16:31 It's relevant to it's really relevant, or I guess my interest in it was sparked by our work with pain revolution, which is an outreach project program for rural areas. And it sounds like it's similar in the US. But there's there's areas in Australia not far from big cities, what we would call a big city of Adelaide a million people. There's areas two hour's drive from Adelaide that cannot get a GP or a physio, or a psychologist or an occupational therapist, to worth it. And they've got, you know, wanting four of them have a persisting pain problem that affects their lives. There's no, what do we do? What do we do about that. And so pain revolution is, is really trying to ultimately build workforce capacity. In giving people health professionals have some description, when I care what description, in fact, we were, were looking for money to try our non healthcare professional, being coached and becoming a rural coach. But the idea of that is that if people we know I think from other areas of the pain field that if if a healthcare professional of any persuasion, understands deeply contemporary pain, Science and Management, and takes a defendable, scientific, and now evidence based approach, then outcomes can be better for sure. And outcomes will be promoted by engaging in in care locally, the moment the only model we've got is a fly in fly out model, which is where, you know, the health professionals go from the city and spend a day in the country and come back a month later, in my view, of very limited benefit. Or we've got a full five model where the patients, that consumers come down to the city. And in many cases, that's a 810 12 hour drive. Get an assessment? Yeah, there's no there's no way of training those people or providing effective care for these people. So yeah, yeah.   18:55 And I, you know, yeah, no, no, you know, it this, this conversation about this kind of rural outreach and, and maybe training someone who's not in the medical field, reminded me of a documentary that I saw, Oh, gosh, I can't remember the name of it, if I can ever And i'll put it in the show notes. I can't remember it right now. But it was on it was more psychology based around loss and trauma. And there was a woman in Africa, who was not, not a psychologist, she was not trained. But she, she, I think she was trained in some basic coaching skills, but she lived in the community. And people there were more likely to go to her because she understood the community. She was part of the community and they had really good outcomes. So I'm wondering even if training someone who is not a medical professional, but if it's possible to train them even in you know, you don't have to be there in person, but would that person because they're part of this rural community, maybe have better results and someone just flying in for the month and flying out where you have someone who knows the community understands the struggles, and maybe has known some of these people their whole lives. You know, we talked about therapeutic alliances and trust and beliefs. So with people they're more likely believe someone who's part of their community than someone who's doing a fly in fly out. I don't know, it just reminded me of that documentary.   20:24 Yeah, I totally get that. And I guess we were really embracing that in, in one aspect with pain revolution, because we're training rurally based healthcare. And that was the impetus you know, they're connected to their communities and their communities are really well connected more so than certainly in Australia, in the cities. You know, you're the physio, if there is a physio will be on the sideline at the Netball day or the football game, way with the consumer, you know, these, these people's normal lives and accessibility and those things that I think reduce the power differentials that that contaminate a lot of healthcare interactions. Was it a part of our drive to drive pain revolution rurally, to tap into this already, and you know, the vision that we state, the pain revolution is that all Australians and I think we're going to change that to all people will have the skills, the knowledge and access to local resources to prevent and overcome persistent pain. And that's the real emphasis that we embed the knowledge and skills locally. And, you know, that's, you know, I've been talking to 1010 years about recovered consumers being coaches, not the healthcare person, but recovered consumers, because they have all this knowledge and expertise that no one else can have. Right.   21:56 They're very deep understanding of pain.   21:59 Absolutely, yeah. And pain, and not not only the lived experience of pain, but the lived experience of recovery. And I think that's a untapped massive resource. But there are significant regulatory medico legal barriers to us just pushing forward on that, that we're still negotiating. So that's yeah, that's been at least a decade. My perspective. But paint ray of is is so exciting. It's, it's really cool. Like, we are doing it on a shoestring. And I think we now at the end of this year, we will have, I think we'll have about 35 Local pain collective. So these are networks of healthcare professionals around geographical regions that get together, learn more about how pain works, and the best ways of treating it collectively problem solve pain, rave feeds them. curricula, but really, it's a collective problem solving facilitated group. And yeah, I think the panorama was responsible for delivering around about around about 400 community outreach sessions, amazing Australia, in the middle of COVID.   23:17 I was gonna I was gonna ask, How has COVID affected? What pain revolution has been able to do, let's say last year, as opposed to previous years?   23:29 Yeah, it's, well, it's had its impacts, for sure. And depends where you live in Australia. So two of our states have had a longer period of of living in a COVID world I guess. And in those places, there's there's been no face to face. stuff. They are 2021 outreach tour that we do. So we run this circus that gets a lot of attention raises a fair bit of money on our level of what a fair bit of money is, it's got in the commercial sector be like someone's bonus for the week. But in our sector, it keeps us alive. And we go from town to town, and we run these public outreach and health professional outreach events. We're all dressed up in library, we ride our bikes, and it's all this cool thing. And that's part of a wider program with two other projects that dovetail into that dedicated to the region. And we didn't run that in 2021. And we won't run that in 2022. And that's a big hit for us because it's our main fundraising Avenue. So that's that's a real challenge. Some states in Australia have had basically no COVID And one state still basically there's no COVID Western Australia they They pay us closed to the rest of Australia in the world. And I think they're aiming to reopen in February. Tasmania has recently reopened and they're starting to get cases. But now we're where I live. We are, we're at the beginning of our wall of Omicron. And we really don't know what this year looks like. So we don't have the experience that a lot of places do. And we're very grateful for that. But we also clearly like deer in the headlights at the moment. Federal governments are going everything. Rules are changing all the time, we and you know, we're not as prepared as you would expect us to be having had a month's notice. So that will impact pain revolution for sure. The we're a really small outfit we have I think we have 1.5 full time equivalent staff delivering hundreds of programs, or events, and we're very resilient. And yeah, well, yeah,   26:11 we'll you'll get this done. And And if people want more information, they can go to pain. revolution.org, correct. Correct? Yes. All right. So pain revolution.org, if you want more information about what pain revolution is doing, and maybe how you can help or contribute, if you so if you see if it if it aligns with what you believe in, then I suggest go for it because it is a very worthy cause for sure. And now, it's kind of switching gears a little bit something that we were speaking about sort of before we hit the record button here. And it's a concept that I had to kind of look up a little bit before our talking here. And it's that concept of cognitive flexibility. I think it's interesting. I think it's worth talking about. So I will hand the mic over to you to sort of talk a little bit more about what that is, and how does cognitive flexibility fit in with people living with pain and maybe with practitioners treating those living with pain?   27:21 Yeah, well, thanks. And again, yeah, I feel like I don't actually actually do much of the good work, it feels a little bit like because this work is has been done by Caitlin halat, who's a PhD student about to finish and has a background in psychology. We embarked on a new direction probably three years ago, with with a really sensible prediction, I think that possible contributed to not recovering after an acute episode of pain based on if people familiar with Bayesian or other predictive processing models, based on the idea that the outputs that we generate predictions and the system is influencing itself according to predictions, then we need to update the internal models of the models in order to resolve so if I was to cover that really quickly, if we, if we said, when you bend over and you don't have pain, that what what could be happening there is that your brain predicts that this will be safe, your brain produces a feeling that's consistent with that mn let's say you tweak the annulus of a intervertebral disc or something, you get no sensitive data that are that are within the sensory load. And I like to say within the Tampa symphony of Dallas, extraordinarily complex, beautifully evolved system of of information about what's happening in the tissues, we get data that says this is not what I predicted. The evaluator for this is not what I predicted. So we update the internal model to say the back is vulnerable in some way, let's say. And then the new prediction is, well, let's make pain. And let's influence the system differently. And then if we go in the other direction, and every time we've been able to get this nociceptive data within the symphony, and then one day you don't I know you've been over and and you don't get that. And now the theory is the system detects that error says Hang on. That's not what I predicted. So it updates the internal model to say the back is less vulnerable. And now your brain doesn't produce as much pain or produces no pay, and then you've recovered fantastic. So one potential barrier to recovery according to that theory is failure to update yourself. Title model. And and that should happen. If, excuse me, that shouldn't happen if you if you don't detect the error. So if for some reason you don't, your system doesn't detect that the predicted data, the predicted data, which was not receptive, in part hasn't been hasn't eventuated. And therefore you don't update your internal models. So on the basis of that, we became quite interested in this broad field of flexibility, cognitive flexibility, which has been defined in many ways. But I guess the way that we were thinking about it was the ability of your system to change its behavior are when the task requirements or conditions change. So in the language of have that sort of Bayesian idea, and to your ability to update your internal model of things. So we started digging around in this field, or Kaitlyn really started digging around in this field. And often in a PhD, you'll start with a systematic review of the literature on a question that's most most aligned with what our hypothesis will be driving. So. So Caitlin took on what we thought would be a reasonably straightforward job to review the literature in cognitive, mental and psychological flexibility. So the barrel phrases that are used, often interchangeably, particularly cognitive and mental flexibility. And with the question that would help us determine which is the best way to assess it's what's the best way to assess flexibility. And there's two broad approaches to assessment. One is self report, questionnaires. And they have they were developed out of a line of research, starting with personality tests in the 1960s. And that's this sort of this long line of stuff. And someone I can't remember who but in the, I think in the 60s or 70s.   32:18 proposed that I think it was empirically based but propose that good communicators perform the answer these sub questions in a certain way. And that research would describe them as positive and flexible people and are good communicators. And then that infiltrated the field. And we eventually got to this situation, we've got cognitive, cognitive flexibility scales, things like that. The CFS or, and there's a few of those, completely independently from that was the development of behavioral tests. The most famous and most common is a thing called the Wisconsin card sorting test. In that, in that test, you you sort cars according to one of three criteria, shape, shape, or number, I think, sorry, shape, color, or number. And the rules for sorting change, and you only realize that change when you make an error. Yeah, that so you put a card in a certain pile, and the tester or the machine goes about anything, what should work, and you have to work out what the next set of rules. And the people doing these studies somewhere in the 80s. Or maybe it was a bit later than that, call this cognitive flexibility. So we've got two independent lines, joining a company flexibility, and then that's then all the whole field just went nuts cross contaminating and all that. So Caitlin has now published and once just been accepted last week, to systematic reviews that are massive. And she had to contact authors for nearly every single one of these studies to get data, asking the question How well do those two approaches to testing 100 Flexibility correlate? Because if the system the same thing that should correlate quite well, one of those systematic reviews is in Healthy People. And one is in people with a diagnosis clinical groups. And in both of those studies, there is absolutely no relationship between those two approaches.   34:39 So you have two different tracks on how to assess cognitive flexibility, and there is no correlation between them.   34:47 Not at all. And actually a lot of the tests, there's no reliability data for them. Now, there are some cognitive psychologists who won't be surprised at that finding. And they're the informed one Who, who have been working in this field? I guess. But for people like Caitlin and I and the rest of the team on this project, where clinically, it's such an attractive hypothesis, right? Like if if people can't change their, that if people don't easily change their beliefs, explicit beliefs, their implicit beliefs about the vulnerability of their body, what pain means that the targets of pain, science education, then we know those people who don't, don't change some of those targets of pain science education, don't do as well, when we know that. So it's such an attractive hypothesis that they might be less cognitively flexible. But the barrier with hit is so how do we find out? Because we don't actually know what any of these tests are actually.   35:56 What are they actually test   35:57 measuring? Yeah, yeah. So so the direction for that, and I've asked for money haven't got it yet to do that is to devise a a new way of assessing the ability to change your decisions when there is some sort of risk evaluation involved, because I think for, for pain, I think we talked about the meaning of things being important for painting. And I think one way to distill the meaning is about just a risk profile, that every nanosecond, our system is evaluating risk, and its risk, that determines our feelings. And I would categorize pain as a feeling bad. So my anxiety, fear, fatigue, lead to the toilet, lead to a thirst, all these things, in my view, feelings generated on the appraisal of risk. And, and if we don't have any risk, in an evaluation of our ability to change your behavior, under changing circumstances, and I'm even, I'm nervous to use the phrase cognitive flexibility now, because I know that whoever he is that there are three or four main ways that you understand that. And some of those would be totally different from otherwise. So I would prefer to say, if we keep assessing the ability to change your behavior, according to changed demand or environment. without risk, then I think we might not capture what we need to capture for understanding a potential contribution to the development of chronic pain or recovering from initial pain. So so that, you know, that was one of those, one of those PhDs where it's such an important discovery, actually, and and Caitlin's contribution to the field is very important. But it won't get the citation impacts and the Roth IRA. Because what the country contribution says is, hang on everyone. Why, you know, there are a whole journals dedicated to this. But what is it? What is it, we almost have to go back and start again and say, Okay, let's get really clear on what we're talking about. Let's use these phrases. Anyway, so but that's relevant to the very first question, what are you most excited about? I guess I'm, you're tired to be excited about, clearly, deflationary discoveries like that, but they're so important. They're really important, and they're harder to publish. But they shouldn't publish, in my view, they should publish top journal. In your face. Journal. Yeah. Well,   38:49 it's, it's like, yes, it's sort of this deflated response, if you will, to, to the systematic review, but it is important because it's important to use the right words, and to if you're going to label something should be what it says it's doing. Otherwise, why are you doing these tests? And why are you you know, labeling someone as very highly flex cognitive flexibility or low cognitive flexibility when you don't really know. And then exactly, so how do you then so then your treatment, I look at it from a clinician standpoint, how do you formulate a treatment plan around something that's, that's not accurate or unknown? So I think it makes it really difficult but it's it just underlines the importance of this kind of research.   39:41 And oh, go ahead. No, I was just gonna say I think that um, it Kayla's research doesn't doesn't tell us that these tests are uninformative. But what it does tell us is that we don't We don't know exactly what they what they mean. So that speaks to your point exactly Karen, that that. So what do we do about it? That's a difficult thing, because we don't actually understand them well enough, I think. But can I put in a plug for? Yes, a research project of Caitlin. So final project for a PhD that we desperately need participants form? Yeah. Because it's an online study. Okay. And it's, it's to do with this kind of flexibility. And we need people without pain, as well as people with pain. Well, that's a lot of types of it. But basically, everyone, anyone who has 20 minutes spare. It would be great if they just went and did Caitlin's experiment online. And maybe I could send you the link.   40:48 Yes. Yeah, you send me the link, I'll put it in the show notes. And also put it out on social media. So that girl can can take this online study. So if it's people with or without pain that takes in quite a lot of people, like you said, like, one? Yeah, so I'm assuming she wants a robust number.   41:11 We need lots. Yeah. Because we think the signal will be small amongst the noise. Yeah, but yeah, if we did it, and then ask one of their family members or mate, yeah, that'd be fantastic.   41:25 Yeah, I'd be happy to send you the way about that. Yeah, definitely do. And as I was, you know, as you were talking about this cognitive flexibility, or the ability of to adapt your behavior, and let's say cognitive strategies in response to a changing task, or to a threat or something like that, it, it always reminds me of this experience that I had. So most people who listen to this note that I had a very long history of chronic pain, I think you're well aware of that as well, about 10 years or so of neck pain, chronic neck pain. And it was this was a couple of years after I could say I was recovered, you know, of course, those times when you have flare ups and things like that, but largely recovered. And I was I was at Disneyland with Sandy Hilton and Sarah Hague. And we had waited in this long line, like an hour to go on what I thought was like a jungle cruise. You know, this very, like, get on a boat and cruise around the water kind of thing. Yeah. And we get up there. And all everywhere. Once we get inside, plastered everywhere was date, big danger signs, you know, the yellow dangerous sign, the red X, if you have neck or back pain, you know, this guy. And I was like, you know, so talk about a threat, right? So my normal behavior, and like, my hands were sweating, my heart rate was up, my eyes were dilated. My normal response, I guess, would maybe show my inflexibility would have been to find the nearest exit and leave. Yeah, yeah, get out as fast as possible. Right. And so I think, Sarah, and luckily, I was with two very incredible women who are very well versed in pain science, and I think I am as well, but when it's you, you're you're like, a big, you know, mashed potato, you know. And Sandy and Sarah just looked at each other and looked at me, and I was like, almost shaking. And Sandy's like, Okay, listen, it only tilts about 12 degrees, and it stops and goes, you're in taxi cabs, they stop and go, you're fine. It's this much of a tilt, you'll be fine. And then Sarah's like, yeah, and the person in front of us like six, you know, there's nothing over your shoulders. It's not that dangerous. And they kept playing down the danger. And so I did end up getting on it very, very nervous. And then I got off and I was fine. They were right. Then it allowed me to be flexible enough to then go on another ride after that. Whereas if I went with my original strategy, which would have been to leave, then I wouldn't have done anything else for the rest of the day. Yeah, so that threat, if left to my own devices would have gotten the, I don't want to say gotten the better of me, but I would have reverted back to the behaviors I had during the that sort of 10 years of living with pain.   44:24 Yeah. And, you know, I respect I respect both of those approaches where it makes sense for an organism when you see credible evidence that this is a dangerous situation to take a variety of action. Yeah, makes total sense. And I guess the, I think about the flexibility thing was evident, as Sandy and Sarah are problem solving with you gathering more data. And, and then your choice changed. That's the stuff that seems consistent with in quotation marks flexibility, you know that right? In the face of new data. So the new data, it could work both both ways. And I think there are some people with persisting pain problems where they behave the same way, even in the presence of significant danger cues. And that works against them because they the danger, for example, right, right. Yeah, can work both ways. Yeah, I think I think there's a rich there's there's a rich stream of, of understanding in there somewhere for us to, to uncover. But it does feel a little bit like that's going to require the the archaeologist among us to get out. This is a metaphor, obviously, to get out our brushes and blowers and slowly reveal what that stream of gold is, as distinct from the earth blasters obviously just want to revolutionize in a in a rapid way. And I fit more into the second category. You know, I lose steam on the very slow, the finite, made tool discovery thing. I'm very pleased to be around researchers who are excellent at that. Yeah, it's not so much.   46:25 And I always always think about that. What did I think David Butler said they were what did he call them? Oh, I don't know why I'm blanking. I have the book right here. Super. Ah, I'll think of it. It'll come up. It'll come up later. It's from explain pain supercharged, you know, the graph and everything leads. So if you have more, yeah. Dangerous safety Sims. He called them Super Dungeon Sims. Yeah. Jensen says, so he was like, Oh, I think Sara and Sandy were your super Sims at that moment, which is maybe what you needed? Maybe? I don't know. But like you said, it would have been just as valid as if I was like, I can't do this. It's too stressful. You know? Yeah, it's too dangerous. Too dangerous. Yeah. Because those   47:14 were the cues that you were, you're getting? Yeah, yeah. And just take it off. I always say it's important in a situation like this to take a moment to reflect on the contrast between the resources available to you in that moment. Right. Which, okay, Sandy and Sarah? Unique, exceptional, exceptional resources. Like, yeah, scrub exceptional. Yeah. But even without them, take your own resources. You know, you're informed, you're, you're resourced with intellectual and other capacities and understand how things work and biomechanics, you've got incredible resources, and then just take a moment to reflect on the contrast when you and most people? Yeah. And is it? Is it any? Is it any wonder at all that people face those situations? And yeah, there'd be a lot of people with chronic neck pain, even if they're on a recovery journey, who would get into that situation and their neck pain would flare up, they wouldn't even do the rod, that's right, leave and they kind of flare up and, and the rest.   48:24 And everything that comes after that, go back   48:27 to the doctor, get a new script, you know, and we do we attempt to, or they I think there's a tendency in our field to, to look, look down on that approach in some way. But, you know, as they are, that's substantive people. But it's totally predictable. And an excellent, excellent biological organism doing that. And we have to overcome, we just always have to remember the resource differential.   48:58 Yeah. Oh, that's, I never even thought about that. But that is so true. And, you know, it just goes to show you why people living with chronic pain, why the burden of disease is the high one of the highest in burden. It's the most one of the most burdensome health conditions and diseases in the world. In most countries. I mean, just low back pain alone, the burden of disease in the United States, I think is third, that's just low back pain. We're not talking about oh, a and other knee or neck pain, other chronic conditions. It's third Well, I mean, things might be different now with COVID. I don't know. But um,   49:38 you know, it's usually with disability. And they usually for disability metric for iPads way out in front. Yeah. Yeah. Yeah. I mean, on other metrics to use last year's lost, which includes mortality, then it drops down, right, just a bit.   49:56 Right, right. But you know, it just goes to show all of the things that you that you've been working on in 2021 and that you're excited about coming up, let's say in 2022 and all the incredible researchers and PhD candidates that you get to work with it just shows how complex and complicated chronic pain is. And that one or two sessions of pain science education in clinic cut it for most. No, absolutely. And it just shows the complexity of it and how difficult it is from a research standpoint, a clinician standpoint it is a tackle these problems on an individual basis and society as a whole. So I mean, keep keep doing that. Keep fighting the good fight, as they say.   50:40 That's scary. Because yeah, gobsmacked, nice weeks that I get to do this for a job and I get paid for it.   50:52 Yeah, speaking. And speaking of helping people around the world, you've got master sessions coming up. So you did this in 2021. So now you're doing it again in 2022. It's going to be May 13. To the 16th. Depends on where you live in the in the world. But you want to talk a little bit more about the master sessions, who's involved and what it's all about.   51:13 Well, yeah, that I mean, that was that was really cool. We sewing in 2021. No one's traveling, obviously. And noi group UK put, to me this idea of doing something a bit different. And it was really different like I was so that it it, we had two broadcasts, and they were timed friend friendly time zones for Europe or for the Americas. And then Australia and Asia sort of could go to one or the other with not quite as friendly. So for one broadcast, I was starting, I think at 6am. For another broadcast, I was finishing at about 11pm, something like that my time, but it was really well planned really well resource like they are, I'm in a studio basically, I was in that it was in the NOI group offices in Adelaide, but set up like a studio with a producer and sound people and a couple of cameras and Tim Cox working as emcee does a beautiful job on that. And we had a team of people downstairs ferreting around for the papers I was mentioning and all that sort of stuff. And it we were we didn't know how it would go because it was it's not like it's not like a zoom conference. Or, or cause it's really quite different from that there's a fair bit of interaction and it went, it went really well was really good fun, really well received. And the feedback has been overwhelmingly positive. I, I was joined by two people for 2021. social pressure Tasha Stanton came to speak. And she so she did a about a 30 minute talk. And then she and I chatted for about 45 minutes and and then we open it up to q&a and and that conversation between Tasha and I and then the other person who contributed that our two people were Mark Hutchinson, who's professor of everything. Adelaide University, one of the one of the exceptional communicators on neuro immunology, related to pain and defense, personal defense. And so same sort of format with him. And then with David Butler, who everyone knows, if you don't know, David, you, you're missing a key part of life you should have. So it was amazing. It was yeah, it was a really well, it's lots of comments like, I never thought online education could be like this and that sort of stuff. So that was really positive. So in 2022 in, and I think the dates you mentioned are probably the Americas day, so that we're doing to broadcast again, where we got feedback that we're responding to, so the schedule is changing slightly. Mark Hutchinson and Tasha are both coming back to do longer stints. And then we're also having in people with really interesting research and great clinical engagement. So for example, Dr. Jane charmers who's done some excellent work in pelvic pain. So she'll come and she'll do a talk and then we'll, I sort of interview them. So it's the massive sessions are a massive amount of work for me because I need to have my head around everyone else's stuff as well. So I can ask meaningful questions, but the, the feedback is is about how useful those conversations are as well. So yeah, so this Jen channels there's Haley leak, Haley leak has has started working with investigate what people who are recovering from paying value in learning about to publish one paper on that in pain, a beautiful paper, I think that I think should shift research direction of a few groups. Haley also has the probably unique among pain scientists brag point of winning the Australian survivor 2021. So she, she survived. And part of the reason for her survival, I think was her deep understanding of how pain works. And there was some great episodes where she there was one where she I think she was standing on like Pogi point things, Poles, they were all doing this with a with another thing coming slider down lower and lower for six hours.   56:08 And lead athletes x s as people have already fallen out and and so she's she's actually done an incredible job in disseminating modern understanding of pain to the wider community because they've all said, How did you do that. And she's able to talk about her understanding of pain. And pain does not mean damage pain is because it was a thing. So no wonder the host is making these comments like that they're trying to rev up my payment system. So incredible impact and she's got a high profile among the people who watch on Survivor on telly. So she's able to integrate that experience with her research. And she's very interesting person. So she's she's coming Sarah wall works doing really interesting work with younger kids. Looking at how how we can engage with young kids on everyday paints in a way that will help them be resilient later. So really fascinating work that she's doing. And then I'm on there as well. So I think I'll cover about half of the time. And it's great fun. Yeah. And you know, people go look at the reviews and all that sort of stuff. But yeah. Love people to to get involved in that. That's in that's in May. Yeah.   57:30 And is there? You may not know this, but is there like a cutoff date for signups? Or can you sign up like the day before? If you wanted to?   57:39 I think there's a right shift. Okay. I think there's an early bird, right. I think I actually don't know much about that sort of stuff. But they they do have to. I mean, the earlier they get a feel for numbers that they they're able to judge sure how to do it, because it takes a lot of bandwidth and all that sort of stuff.   57:59 Right? Yeah. All that behind all the behind the scenes production stuff. You're the On Air talent, you don't have to worry   58:05 Exactly. Worry about any of that. But But noi group, if they get annoyed by it, they'll learn everything   58:12 about it. Yeah, yeah. And again, I'll put the links in the show notes here. And we'll put it out on social media as well. So that if people are interested, then I highly suggest signing up because it what a great, what a great lineup. And it's not until May. So you have plenty of time to shift your schedule and try and figure out, you know, kind of block the time off so you can be part of it. And one other thing, I believe this is true, you can correct me if I'm wrong. But if you if you're in the Americas, and you you paid for it, you live in New York City, let's say I pay for I live in New York City, I can also watch the other, also get the recordings of the other broadcast.   58:55 That's correct. So you get both and you you don't have to be there live watching it in bed. But if you're not you, you're not engaging in the q&a and all that sort of stuff. Yeah, but you get access to both broadcast and you get access to the thing called the Padlet, which is it was an amazing resource from the first time because this is all of the stuff that the team downstairs is getting while the master sessions around. So let's say Professor Mark Hudson mentions this are really exciting new study from so and so which show this then someone downstairs will get that study put the paper on the Padlet. So it's some incredible resource as well. And they have access to that. I don't know for how long afterwards   59:40 Yeah, yeah, but you but you have it Well, it sounds amazing. And I think it's so great that this is probably something if not for COVID Maybe you would not have done and it's made a big impact, right so   59:54 and and when COVID no longer what it is I'd prefer to do it this way.   1:00:02 Yeah, yeah, amazing. Amazing. And now, I don't want to monopolize any more of your time. But is there anything that we didn't cover that you were like, Oh, I really want the listeners to know this or, or is there a big takeaway?   1:00:18 Ah, I think the takeaway is, it's really consistent over years, actually. Whenever I have an opportunity like this to chat, with such an informed and, and clever interviewer, like you, I'm always struck by how, how important people like you are for our community, because I see my role sort of knowledge generation and, and dissemination in sort of conventional ways, you know, books and articles and things like that. But we need people like you, to spread it, to play the critical role and getting it out to the, to the world in a way that's accurate and engaging and, and it's people like you who put in so much so much effort for your community. And whenever I think about takeaway, I just am reminded of of the potential benefit we can still bring to humanity by doing this chronic pain thing better. And we have made progress, know that we made progress. But it feels to me like were climbing up a really, really tall mountain. And now when we look back, we can see we've actually come quite a long way. But when you look ahead, there's still still a bloody big mountain. So all of these things would have hope. I think there's genuine, realistic, scientifically based reason to hope things will keep improving for people with chronic pain, that will people will have better outcomes. So that's my take home. But can I give a plug to a book that I'm an author on? Yeah, it's a self plug. But I'm not the main author. So Dan Harvey, a truly innovative scientist. And I don't say that lightly. There's not many innovators out there. But Dan Harvey is an innovator. And he's the first author on a book called pain and perception. And the Americans can get that through IPTp. Elsewhere, you can get through no group. And it's a I think it's a beautiful book. It's all about understanding through illusions, and sensorial experiences, more about how pain works, sort of like a coffee table, book waiting area book. The feedback has been fantastic. So yeah, I'm really excited to be involved with that with Dan. And I'll just mention another book that's available in in North America, but not in Australia. And it's called Epiphany. And test Stanton has joined Dave Butler and I to, to write a consumer focused book around the osteoarthritis.   1:03:17 And I will say, I, when I first saw this epiphany, it's not how you would normally spell epiphany. It's, it's, it's an what do they call it? It's an acronym an acronym? Yes. So it's explaining pain to increase physical activity in knee osteoarthritis.   1:03:39 Correct. It's spelled AP IPH a knee,   1:03:45 right? Yeah, very clever. Cuz I was like, epiphany. What did I say? Episode? I don't even know. What's epiphanies? And you're like epiphany. I'm like, oh, yeah, that definitely makes more sense. That definitely makes more sense. But yes. And we'll have we'll have links to all of this stuff, again, in the show notes. And, you know, one last question and talking about, you know, all of the work that you do that isn't in very important work, and it can impact not one or two people but millions of people living with chronic pain. So do you as a researcher, how do you deal with maybe feelings of overwhelm with the responsibility that that place is on your shoulders? Or do you think about that at all? Or am I just projecting what I would feel if I were in your position?   1:04:36 I think you're projecting. I don't, I don't feel overwhelmed in the slightest. I don't feel any sense of responsibility to humanity. That's, that's changed because of what I do. I feel I feel that I have a responsibility. I don't know if I feel I have responsibility. I want to use my resources and my knowledge and my skills, and my connections and my relationships to, to be the best Lorimar I can be if that makes any sense and, and the values by which I judge that are not at all on chronic pain outcomes. I'm a very sort of process driven person, I want to make sure that today I did the best thing I could do. And I don't have any illusion that I, I could use outcomes as a marker of, of how well I've lived my life. Because I just think there's too much noise for, for me to have a measurable signal in the world. So I want to make sure that in this moment, I'm being authentic and true and real. And today, I'm doing my very best, I do my very best. But I do that, because I like myself more when I'm doing my very best. But I feel any burden to humanity. That's different from the burden that I think anyone who grew up in my in my world and life with my skill set, and my influences would have.   1:06:24 Yeah. And I think that's great, universal advice for for anyone. And, you know, normally when we finish the show, I always ask people, What advice would you give to your younger self? So I don't know if any piece of what you said would be maybe part of that advice. But is there anything else that maybe you would give to a young a young Larmour? fresh out of university for first time University, not? Subsequent?   1:06:48 Yeah. I think that I would, I think there would be advice, I don't think it would be remotely relevant to my work, I think it would be love a beloved, look for that, and express and, and value that with the entire depth and breadth of your being. And for me, that includes being a neuroscientist and paying dude with a extraordinary fortune of being able to do the things I enjoy doing for work and resonate with my values and all that sort of stuff. And ultimately, I think we're such a sophisticated organism that, that we may want to one one day discover that it's all just to love and be loved. And I don't know, great advice.   1:07:43 Great advice. Thank you. I'm sorry, not a sage. But no, no, it's amazing advice. I appreciate it. Thank you so much for taking the time out to come on and talk about all the stuff you have going on. And is there a place where people can find you? If I don't know they have questions, websites, something like that.   1:08:07 Yeah, so finding and I've got a homepage at the University of South Australia they can find out about personal pain revolution is doing some good stuff on Annabelle, what we're doing that I I get a lot of emails and I just can't possibly respond to them.   1:08:26 We're not here to give out your your emails, or your personal phone number or anything but I think pain revolution, Oregon and the University of South Australia are great ways for people to find out a little bit more about you because as we said, before we get on the air you are not on social media. So there is no Twitter handles or Instagram or tic TOCs none of that stuff. None of that. So people can find you again, pain revolution.org or University of South Australia's website or you can just do a Google go to ResearchGate read all your papers. There's plenty of ways to find out more about your research and and what you have coming up. So plenty of ways to do that. So again, thank you so much for coming on. I appreciate it.   1:09:12 Oh, thanks so much for having me. You're a legend. Keep it up.   1:09:17 Thank you. Thank you so much and everyone. Have a great couple of days and stay healthy, wealthy and smart.

More About Osman Ahmed: Dr Osman Ahmed is a Physiotherapist at University Hospitals Dorset NHS Foundation Trust (Poole, United Kingdom) and a Visiting Senior Lecturer at the University of Portsmouth (United Kingdom). He trained as a Physiotherapist at the University of Nottingham in the United Kingdom, before undertaking his Postgraduate Diploma in Sports Physiotherapy and subsequently his PhD at the University of Otago, New Zealand. He is employed by the Football Association (FA) in England to work as a Physiotherapist with their elite disability squads and has been a member of the Team GB medical staff at both the 2008 Beijing and 2016 Paralympic Games. He teaches on the FA’s Advanced Trauma Medical Management course and has recently been appointed the Para Football Classification Lead at the FA. His PhD was focused on sports concussion and Facebook, and since then he has both published and presented widely (primarily on concussion in sport and technology in healthcare). He holds several governance roles within Para Sports federations including Medical & Sports Science Director at the International Federation of Cerebral Palsy Football, Medical Unit Co-Lead at the Para Football Foundation, and Medical Committee member of the International Blind Sport Association. He is a Co-Chair of the Concussion in Para Sport Group, and a Board Member of the Concussion in Sport Group. Osman holds Associate Editor positions at the British Journal of Sports Medicine and at BMJ Open Sport & Exercise Medicine and sits on the Institutional Ethics committee of World Rugby as an external member. He is also a Scientific Committee board member of the Isokinetic Football Medicine Conference. Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here: 00:03 Hey, Jasmine, welcome back to the podcast. I'm so happy to have you on and so happy to see you again.   00:09 Hi, Karen. Thanks for having me. Really good to be back.   00:11 Yes. And so Osman and I both at the International look, Olympic Committee conference in Monaco, a couple of weeks ago, we actually did a talk together. So for the first part of this interview, we'll talk a little bit about we spoke about what we spoke about, and and then get into some of your big takeaways from the conference. And then of course, some of your upcoming projects, papers and all that kind of fun stuff. So why don't I give the microphone back to you, and tell the audience what our talk was, and kind of what we spoke about it IOC? So go ahead.   00:52 Thanks so much, Karen, I probably first thing to say is that we've Omicron raging around the world in the week before Christmas, it feels a bit surreal to think back to what was less than a month ago when we're actually out in Monaco presenting together. So the world has changed very quickly. Hopefully, it changes just as quickly back to the nice, stable world that we were getting towards before then. So I have to see what happens in the coming weeks. But yeah, it was great to present together it was something I think that we've both been speaking about for a while in our respective areas about how clinicians can engage with the mainstream media and social media for injury prevention, and athlete welfare, and just generally for spreading positive public health messages to our patients and clients. And so how we did it, for those of you that weren't in the room, we started off by looking at some different examples of how the mainstream media discusses different injuries and issues. And we took the lens of sport concussion, because that's an area that I'm fairly familiar with. And I've got a bit of an interest in from a research perspective. So I talk through some of the different examples of how concussion had been discussed in the mainstream media starting way, way back with Charlie Chaplin, hitting people over the head, progressing through to the movie concussion, more recently with Will Smith, and also touching upon some South Park episodes, the office and new girl. So other examples of concussion being in the mainstream media. And we had a bit of a brainstorming session, really, it was a nice interactive workshop that we did to everybody. That wasn't a room there. Thank you for contributing so much. He made it a lot of fun and asked a lot of questions and stimulated a lot of discussion between the group. And yeah, I mean, it was quite a nice flowing dialogue between everybody there. And there was some really good examples that people in the crowd shared in terms of their experiences with either engaging in the mainstream media or seeing some negative examples, and some less than perfect discussions and injury representations and illness and medical representations, either in TV shows or in news reports and things like that. So yeah, I mean, session was pretty good. I thought I'm obviously I was one of the CO presenters. But yeah, that was a fun session to be part of. And then obviously, from your angle, Karen, it was really good to hear your thoughts in terms of how clinicians can engage with the media, coming up with some really practical tips for people that would be interested in doing that in terms of how to pitch to journalists, sort of things that you should do when you're reaching out to journalists, and some good examples of how clinicians have worked and engage with journalists in order to get positive, evidence based, accurate, scientifically valid information out to places like the Washington Post and New York Times and kind of upmarket newspapers in that regard. So yeah, it was a fun session to be part of and had some nice feedback afterwards, which was made it worthwhile. And yeah, it was a pleasure to be part of it.   03:51 Yeah, I really enjoyed the discussion within the workshop from with the participants, because a lot of the workshops and we know, we go to all these conferences, and it's usually the person up on stage speaking, and there's not a lot of interaction during the talk, except for maybe someone gets up and asks a question, they sit back down. But what I really loved is that, like you said, people were sharing their experience with maybe being in the media, or really asking the question of like, hey, is this movie concussion? Was this positive or negative? And it was interesting that people had a lot of different views on what they believed as was as positive was this negative? You know, I think we can all agree on some of the things like Charlie Chaplin hitting someone on the head or, or a head injury being the butt of the joke. We can all agree that's not great. You know, that would be a maybe a not so great representation of that. But with the movie concussion, I think they it brought a lot more conversation to the group. I don't know what do you think? Yeah,   04:58 absolutely. I think the noise thing about the topic that we discussed as it's something that everybody's got an opinion on. I mean, arguably, you don't even need to be a clinician to have an opinion on how injuries represented in the mainstream media. But certainly, I've seen lots of workshops and conferences and sessions where I'm not particularly ofay, or knowledgeable about the area that's been speaking about. And I probably wouldn't feel that comfortable in terms of sticking my hand up and joining into discussion in front of lots of other people. But because it was a mainstream topic about the mainstream media, there was lots of people that felt comfortable to do that. So yeah, it was great from that regard.   05:34 Yeah. And I think it gave people some tools moving forward, to maybe reach out to a journalist or to maybe even reach out to say, hey, this article wasn't the best. And do you think you can? Like, I'd be happy to contribute to give you a little bit more evidence to that. And I think that's something that instead of going on social media and complaining about an article or a video, instead, why don't we empower therapists and researchers with the tools, they need to reach out to the journalists to say, Hey, I appreciate you, including physio, therapist, researcher XYZ. But what they shared is probably the not not the most accurate or evidence based. And I'd be happy to give you some resources or speak to you or write a and an article follow up article.   06:31 Plenty, absolutely. And I think we're completely on the same page here. I mean, it's so easy to read something that you disagree with, get angry about it. So you may it's about a coffee time, and then maybe sharing a whatsapp link to your friends and laugh at it, it's a little bit more challenging, but a lot more productive to actually reach out to those people. And like you say, do something constructive, take control of the narrative, as we kept saying, so who is controlling the narrative, we can control the narrative. And that's a good way of controlling that narrative is by reaching out to those people, and suggested some of the things that you said there. So putting some evidence based links in talking about proper scientific evidence, correcting in a nice, gentle way, some of the inaccurate information that may have been shared in the article, there are really, really good things to do. I think so. Hopefully, if people in the audience doing that, and anybody listening, that's picking up between the lines of what we're saying here can do that as well. That'd be great.   07:24 Yeah, and it's easy. It doesn't cost any money. It just costs a little bit of your time. And I mean, like, a tiny bit of your time.   07:32 Yeah, absolutely. I mean, time is money to a lot of people work, especially if you work in private practice. I don't, but I'm sure a lot of people listening here well, but yeah, well, it doesn't really take that long, just drop a quick email or a note to a journalist, to tee up some potentially better ways of reporting on what they've reported on, maybe serve as a link for any future articles. I think it was one thing that we both touched on that, I think is a really nice way of sort of crossing that divide. And bridging that gap is by getting in contact with a journalist or newspaper and saying, Look, I'm a clinician, I work locally, if you've got any pieces that you're putting out about a health related issue or a medical condition, or if you want to check anything with me for accuracy, drop me a quick email, send me a quick text message or WhatsApp. And I'll get back to you about that. And then you're then in a position not to create content for the newspaper, you're not writing their article is not a freelancer for them. But what you are doing is kind of member checking and fact checking and steering the journalists towards more medically accurate correct reporting. So yeah, I think that was a key take home for for me and hopefully, for anybody listening today as well.   08:35 Yeah. And I think that's, that's a great take home from our talk. So from and also a nice transition into what were your other big takeaways and take homes, from some of the other sessions you went to? So if you want to maybe describe the session, and then what your biggest take this session, the speakers and your biggest takeaways?   09:00 Yep, so the one that definitely made a big impact on me was the session on hashtag metoo. So it's about abuse in sports, intentional abuse in sport, and I came up the topic from different angles. So my mount Joy talks about the Larina SAR case that I'm sure everybody listening will be familiar with, which is horrific. And I suppose, because it's maybe slipped out the media attention for a few months now, I wasn't completely familiar with a lot of the graphic and horrific details relating to it. So that was a real eye opener again, for me in terms of how endemic that was and how that could have been nipped in the bud at several stages earlier from the information that we were given there. And I think the other speakers in this session, we're fantastic as well. So Shree Becca, I'm a big fan of sharees work. I went to most of our sessions IOC in Monaco, and, again, she helped deliver a fantastic session around The similar areas as well. And yet, sir to a lackey, who is based at Yale in the US did a really good session about Ghanaian Paralympians, and the perceptions and abuse that they suffer as well back in the home country, with regards to being disabled, essentially, and being an athlete and the barriers that they face and the challenges they overcome. And I thought one thing that was really nice from yesterday's talk specifically was the fact that she sampled the video interviews, and she wove those into her presentation. So you can actually hear and see the Paralympians talking about those things. So unfortunately, like, you can't transport lots and lots of people to the conference to speak as part of your panel. But yes, I did the next best thing, I think in terms of getting the athlete voices literally embedded into a presentation. And that really did magnify and sort of hammer home the points in a really strong way. So for me, that's something that I've since gone back to some of the sporting federations I work with. So I'm involved with the if CPF, which is the International Federation of cerebral palsy, football, and power Football Foundation. And I've spoken to both of those organizations about this and the resources that were provided in that thought were really helpful, just to make sure that we're on top of all safeguarding issues in our sport, I think, for a lot of people listening, I mean, it might sound like quite a boring thing, and quite a basic thing. But ultimately, it's the most important thing I think we can do is to protect our athletes when they're in our sport, and make sure that we've got the right policies, the right procedures, and the right steps in place to look after them. Because as the Larina SRK, showed, I mean that the impacts of getting those sort of basic steps wrong or underestimating those sort of areas of sport are huge and can have profound and very long lasting effects to the athletes involved today. Yeah, for me, that was that was probably the session that had the biggest impact on me. Again, I'm qualitative in my research background, so I was really pleased to be a part of the session with Eva bahagian, Caroline barley, and Christina farga. I thought all three did a really good job of talking about qualitative research. And I think, looking at other talks as well, during the whole conference series, there's a lot more awareness. Now, I think that with athletes and with patients, generally, we don't just need numbers, we don't just need hard cold quantitative analysis, which undoubtedly, is very, very valuable in terms of what we're doing with our athletes and patients, we also need some context to that. And I do feel quite strongly that a lot of that context does come from qualitative research and listening to our players listening to athletes, getting that extra depth to their experiences to either layer on top of the quantitative data or to stand alone and just be independent data that we look at and say this data has got numbers, it's got words, but these are the patient's words. And these are what the patients and players think. And we're going to look at that data, we're going to analyze it, and we're going to respect that data, we're going to act on that data. So Alan McCall, I was in Alan session as well. And he's at Arsenal Football Club, and they do a lot of work there with readiness and return to play. And they collect a lot of data as part of that. But it's really pleasing for me to see some of those high profile as Alan, talking there about the importance of quantitative data and listening to play as the qualitative sorry. Data are listening to players and getting that information as well. So yeah, I mean, I wouldn't call it a revolution in terms of qualitative research. In sports medicine, I think it's a gradual evolution. I think, as we evolve and move through the 2020s as we are, I think there's going to be a greater appreciation, really of the power that qualitative research can bring. And we're going to see a lot more of it, hopefully.   13:43 Yeah. And in comparing IOC 2017 to this one, I don't know that there was much talk of qualitative data in any in any of the talks in 2017.   13:58 I can't remember why for dinner last week.   14:03 I don't. I don't I don't believe there was. And so I think there is this definite shift in thinking that, hey, if we want to keep our players safe and healthy, and reduce injuries, then we have to listen to them. And we have to incorporate this qualitative data into how we as clinicians, because you and I are clinicians, how we work with our patients, you know, it's a little more than, Oh, you just have to listen to them. Because I think you have to listen, and you also have to understand what their words mean.   14:43 Oh, yeah. Listening processing, as well. So you're not just a set of ears, you've got something between your ears as well. And that's the thing that you have to use to process it and then also, act on it. I mean, it's not just a case of listening and processing you need to be Some actions off the back of that change that results from that. So, yeah, completely agree.   15:05 Yeah. Because like you said, from the me to talk with Margo and Sheree, and policies and procedures, yes, of course we need to have those in place. But if you're not listening to your players, you can have all the policies and procedures you want. If the Larry Nasser case says anything, right, they had a lot of policies and procedures in place and USA Gymnastics. Yeah. But they weren't listening to the countless girls and women who are abused by this man over many, many years. Because they did speak some of them did tell people, nobody listened.   15:42 Again, it's the acting management if you're listening, maybe process maybe haven't. But is the acting that needs Yeah, as well. And that's a key part of it.   15:51 Yeah. And I think placing that that athlete in the center. In that case, in particular, it wasn't about the athlete, it was about all the money and all of the prestige that comes with those athletes in your program. So you don't want to blow up the program, they apparent from looking from from an outsider perspective, it's like they didn't want to blow up the program to help save the girls.   16:17 Nine. I mean, in an ideal world, nobody should go to an international sports medicine conference and listen to a talk about that scale of abuse. But I mean, if if there is a positive about sitting in a session like that, so that you can spread the word about it. Take action to make sure that never happens again, in any sport ever. Exactly. Absolutely. abomination that happened.   16:38 Exactly. Exactly. And, you know, one of my biggest takeaways from the whole event is that context is, is everything. If you're not taking, whether it's quantitative data, qualitative data, exercises, application to the, into the clinic, if you're not looking at the context, around the person in front of you, then I feel like it's all for naught. And the other thing, my other big takeaway is like, I don't really know anything. So those are my two big takeaways.   17:11 I think that's always a good thing. If you go to a conference and come away realizing how little you know, I think you've been to a good conference. Generally, I think there's always so many clever people that you listen to and learn from. I went through a cardiology session as well as on absolutely not expert at all. But you go into sessions like that, and you learn a little bit and hopefully take stuff back. And you can apply some of it to your practice. And yeah, it's good that you felt that way. So I did as well.   17:38 wasn't just me, then. Yeah, I left. Oh, I'm the worst.   17:42 How do I not know anything? What am I doing in this job? It really spiraled down on the plane ride home.   17:49 Yeah, so any Junior clinicians or researchers listening, trust us. We're old in the tooth, myself and Karen. So if we feel like this, our stage of our career, then don't ever worry that if you're a new grad, and you don't know everything about everything, but there's something wrong with you, because it really is not, because you get to the end of your career, and there's still a lot of things you don't know, more things you don't know, at the end of your career than you did at the start of the career. So yeah, yes, definitely. Definitely a message I want to share.   18:14 Yeah. Excellent. Anything else from the conference that was for you? You know, a big takeaway from any part of it. Or do you think we covered it all?   18:27 For me, it was just how lovely and nice it was to actually see people face to face again, it just been such a rubbish. 1819 months leading up to that conference had been postponed two times. It was just lovely to actually get to a place. See people do want to give a lot of thanks to the people that hosted the conference. But the organization was next level in terms of how well run it was. Our safe, everybody felt everybody had masks on. I think we were talking about how good it was in terms of the COVID checks going into the venue, everything like that. So although there were, I think, seven 800 people there, there's a lot of people there. It never felt unsafe. And everybody there was glad to be there. And I think everybody seems to have a good time.   19:10 Yeah. And that's what Sheree and I spoke a cup of Sri Becker knights a couple days ago. And we said, you know, the thing that was so great was that everyone there, it felt like, people were there to support each other, and to support sessions and support individuals and, and maybe it's because there hasn't been like, a larger conference like this in quite some time. But it did feel like very inclusive and supportive, and that's kind of the vibe I got and Sheree said the same thing. It sounds like you might have felt the same. So maybe that an NF three is it's it's, it's true then.   19:52 Well, I'm a qualitative researcher, so I'll take those quotes and agree with those quotes. Yeah, I think it was just it was a nice nice yeah. place to be I think for a lot of people that first time they've left their country since COVID. It certainly was for me. And me too. Yeah, I think it'd be nice if that's the that's the vibe going forwards if we do go to a concert and can support each other's research, and there's not academic snobbery, or thankfully, I've not really been to any conferences that have been like that. But I'm aware that every now and again, there can be that element of needle two speeches and feedback and those sort of things. So hopefully, it will stays nice and constructive and supportive and positive objectives.   20:36 Agreed. Now, what do you have coming up? What do you have going on any new projects in the pipeline papers? If you can give us a preview? Obviously, can't give it all the way. But if you can give us a preview as to what you're working on, for 2022 and beyond?   20:55 Oh, okay. Well aware, a few different hats. So one of the hats that I wear is at the BDSM, the British Journal sports medicine. So I think it was announced on social media a little while ago that we're having the first BDSM Live, which is a in person, conference day that's being held in Brighton in the UK in May 2022. So we're quite excited about that. I'm hosting that with Fiona Wilson from Ireland. So it'd be really great to co chair the day with her. And that's certainly something I'm looking forward to. I am also off to the IPF spt. So the International Federation Sports Physical Therapy conference in Denmark in August, where I'm presenting a session with yourself again, Karen, so great to see you there. And again, that's following up on some of the BDSM work that I've done in terms of patient voices and athlete engagement. So I'm really looking forward to that one as well. A lot of 2021 was involved with the concussion and parasport group that I'm a member of so working with international colleagues are involved in Paris sports main concussion. So we released our position statement last year. And hopefully off the back of that there's going to be a lot more studies that take place in 2022. So one of the co authors, in fact, the lead author, Dr. Richard Wheeler, who's very passionate about the area, he's currently doing study looking at the perceptions of blind footballers towards concussion. And so he's done a lot of data collection from that. So I'll be working with him and the other co authors on that paper in the new year, which is exciting. And I'm also looking forward to working with Dr. Mark Murali in Australia, who's a digital health physiotherapist might be one of the best ways to describe him. He's very involved in the tech side of what we do is a professional physiotherapy and physical therapy. And he's got a grant that's been accepted on physio, digital health capabilities, and a model related to that. So I'm going to be working with him looking at that and looking at the digital side of physiotherapy as well. So got plenty of things to keep you busy. And I'm looking forward to hopefully a better year than last year.   23:05 Yes, well, you certainly have a lot to to keep you busy as well. And I should also say that you also work to your clinician.   23:14 Yeah, so my full time day job is at University Hospital, still on the south coast of England, and I'm a full time clinician, I also work part time for the Football Association as a clinician with their elite power football squad. So that's disability football. And in the new year, I'm also going to be starting a part time role there is the power classification lead for the elite disability football program. So looking after the classifications across all the athletes, power football, sports, I'm looking forward to that role as well.   23:44 Nice. And obviously, you'll eat and sleep at some point in between.   23:51 If you ask my wife, there's a lot of eating, and we missed out on those too.   23:56 Good and a little bit of relaxing and a little bit of fun, right?   24:00 Definitely. Always got time for fun. Excellent. Well,   24:03 before we wrap things up, where can people find you if they want to join some of the things you're doing? They want to have more information, they just want to say hi, where can they find you?   24:14 Yep, so probably the easiest way to get ahold of me is on Twitter and my handles, Osman H. Ahmed. And I think you'll probably share the link in the podcast. So that's probably the best way to find me and I'm pretty responsive on there if people do want to get in touch. Certainly if you're interested in concussion in disability sports, or want to talk more about our work that we've done with the mainstream media and how we can engage with them, then I'd love to hear from you.   24:39 Excellent. And yes, that will I will have that link at podcast at healthy wealthy, smart calm in the show notes in this under this episode. And finally, I think I've asked you this question before, but I'll ask it again because maybe you have new advice, but what advice would you give to your younger self knowing where you are now in your life and in your career?   25:03 For a couple of things really, don't take yourself too seriously. I think that's probably a key thing for any young clinicians that certainly when I was working in university, there was a lot of people that were really stressed and anxious to make a mark in the profession. And obviously, that is good. And that's commendable when you want to keep that about you. But also, I think, being relaxed in terms of the way that you do that, and doing it in a collegiate way, I think is probably a really good way to progress your career. I like to think I did that. So that that's less advice to me and more advice to other people. forced myself when I was younger. I'm not really sure to be honest, I'm, I'm pretty happy with the decisions I've made through my life so far. So yeah, probably. I don't know. Pass. Sorry, Karen,   25:52 know that the piece of advice that you gave, don't take yourself too seriously, is perfect. It's perfect. And I think that a lot of people will enter into we're both physio therapists into physiotherapy or healthcare. And kind of like you said, they really want to move their career forward. And so I think it's important to remember Yes, you want to move your career forward, but your underlying Why should be to improve the health of everyone to improve the health of your community, your population that you see, versus getting best of XYZ, or award for this and award for that. I did this look at how great I am. But instead, how are you really impacting your community through your work?   26:38 Absolutely. So keeping everything patient centered. I think that's basically what you're saying there. I think probably the other thing as well is your career is a marathon. It's not a sprint. So you don't have to achieve all of your career goals by the age of 30. spacings out and don't be afraid to reinvent yourself if you find you're in a career or a job that you're not massively enjoying. It's a big profession out there. You're not wedded to one job for your career or your life. There's other places that your career can take you with a degree in the skills that you've got.   27:11 Perfect. That is great advice. Well, thank you so much for coming on to the podcast again.   27:16 I really appreciate it and look forward to seeing you again in person in August. So thank you so much for coming on. Thank you, Karen. And everyone. Thanks so much for listening today. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Founder of Taylor Insurance and Financial Services, Eszylfie Taylor, talks about balancing and prioritizing the mind, body, and money. Today, Eszylfie talks about wearing many hats, how yoga has changed his life, and his work on Mind Body Money. How is short-term gratification hindering our progress? Hear about how Eszylfie fits so much into his life, how he picks himself up after a failure, and get his valuable advice for 2022, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “You miss 100% of the shots you don’t take.” “Only something good comes from being bold. Either you’re going to get something you didn’t have, or you’re going to continue not having what you didn’t have anyway.” “Pay yourself first.” “If you aim at nothing, you’ll hit it with amazing accuracy.” “You have to give up smaller short-term instant gratification things for the long-term greater thing.” “Ease is a greater threat to progress than hardship.” “Those who think they can do something and those who think they cannot do something are both right.” “The most successful people in life are those who can endure the most pain.” “No one is on their deathbed wishing they had more money.” “Never give up. You never know how close you are to your dreams.” “The road to walk a mile begins with a single step.”   More about Eszylfie Taylor Eszylfie Taylor is the president and founder of Taylor Insurance and Financial Services, and serves as financial advisor to individuals, business owners, and high net worth families. Over the past decade, he has been widely recognized as one of the most accomplished producers in the industry, receiving the National Association of Insurance and Financial Advisors (NAIFA) award, “Agent of the Year: Los Angeles" in 2010-2012. Additionally, Mr. Taylor is a 15-time "Million Dollar Round Table" qualifier, the last four of which he has been a "Top of the Table” producer, ranking him in the top 1% of all producers worldwide, and was the recipient of the 2015 Top Four Under Forty Award by Advisor Today Magazine. Mr. Taylor began his career at age 22 with New York Life Insurance Company, where he soon ascended to the Chairman's Council, reaching the ranking of #1 Broker in Los Angeles (2006-2013), and #1 Agent for the Company's African-American market (2006-2013). In 2007, he began building his own firm, Taylor Insurance and Financial Services. Mr. Taylor currently sits on the board of three non-profit organizations dedicated to business empowerment, children's health, and social services. He is the founder of the non-profit, Futures Stars Camp, which provides basketball training and life coaching skills (www.futurestarscamp.org) for kids. In addition to his passion for business, Eszylfie loves being a hands-on dad. Eszylfie holds a Bachelor’s Degree (magna cum laude) in Business Management from Concordia University. He has also earned the Series 6, 63, 65, and 7 licenses, and a Life and Health Insurance license.   Suggested Keywords Healthy, Wealthy, Smart, Finance, Financial Freedom, Success, Perseverance, Yoga, Mind Body Money, Long-Term Goals, Consistency, Resilience,   To learn more, follow Eszylfie at: Website:          https://www.mindbodymoney.com                         https://www.taylormethod.com                         https://www.futurestarscamp.org Instagram:       @EszylfieTaylor LinkedIn:         Eszylfie Taylor   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hi, Eszylfie welcome to the podcast. I'm happy to have you on.   00:07 Thank you for having me.   00:08 And I'm excited to talk about you and your journey and all the different hats that you wear in your, in your professional and in your personal life. So let's break all of this down. So you are a financial advisor. You're a yoga instructor, you're an entrepreneur, and you're a girl, dad, and I have a soft spot for I'm one of three girls, you've got three girls, I totally I get it. So if we can, let's first talk about how does all that happen in one life? How do you put that all together?   00:43 Yeah, I think, for me, when I was graduating college, I made a promise to myself that I would never look back at my life and say, what if what if I did this? Or what if I try this? And what if I went here? I just say I just say yes. Right? And as as as a result of that I'm a huge failure, probably arguably, the biggest failure you've ever met in your life. And that's also why I succeed, right? So I would rather try something and fail miserably might fall flat on my face and say, Okay, that wasn't for me and check the box, then just wish or assume. Right? And because, you know, again, I think I didn't want to be a grizzled old man sitting on my porch one day thinking of all the things that I could have done with my life that I should have done with my life and then look back with regret, no, no, no regrets?   01:32 And how do you pick yourself up after each one of those failures? Because, I mean, maybe my skin's a little bit thinner. But I would just I don't know that I would have the fortitude to continue to pick myself up and move forward again. So how do you do that?   01:48 I think for me, you know, sports sports played a big role in helping me create grit. You know, I have a nonprofit that I founded called future stars. And then I teach kids and I'm actually doing a camp right now for kids. And, and I told the kids today, I said, you miss 100% of the shots, you don't take this 100% of the shots you don't take. So my contention is, is I just tell myself, I tell others to be bold, right? Because only something good comes from being bold. Either you're going to get something you've never had, or continue, which you didn't have what you didn't have anyway, right? You're going to get something you didn't have or continue not to have what you didn't have anyway. So what do you lose? To your point? It's really just ego. Right? That's, that's right. Right. And so I'd rather hear or know, or face rejection and say, Okay, well, I didn't have it anyway. So what have I lost? That, you know, nothing, right? Yeah, I look at it, you know, it's, it's only it's only greed, right? It's only only upside.   02:50 And so you've so you say you've had all these failures, okay, I believe that, but you're also incredibly successful in multiple areas of your life, one of those being a financial advisor. So talk about how you got into the financial advising game, and then we'll maybe get since we're in the beginning of a new year is 2020, to maybe get a couple piece of pieces of advice from you, on how to set yourself up for success from a financial standpoint. But first, let's talk about how you became a financial advisor. And we'll take it from there.   03:29 Yeah, I started my career fresh out of college, I'm in the business which is unique, right, so the average financial advisors probably a 55, six year old white male, right, so I'm anything but that I had one simple, you know, modest dream coming out of college that was to become a millionaire by the time I was 25. Right. So 22 I figured what three years is that's that sample time, right? It's reasonable, you know, by three years, that's, you know, that's, that's that should happen. Um, and, you know, I was at a job fair at my university and you know, I'm going from from booth to booth and all the companies are kind of telling me the same thing. I'm gonna make somewhere between 4050 grand a year, and I'm scratching my head and I'm like, okay, like, I'm not the smartest guy in the world. But that doesn't add up, right? Like I get to a million bucks that way and so you know, by by chance, uh, you know, I found my way into this world of financial services and what drew me to the industry was that it was an industry as a field where I was paid for my work I work ethic and aptitude not my age or tenure. Right and so at the end of the day, I was gonna eat what I kill right I was gonna I was gonna I was gonna make as much money I was going to have as big an impact in the community in the world as I worked tap right and so you know, it's funny against the against the better advice of my father who told me no, you know, get go work for someone else get a job right? Go get a paycheck on the first and the 15th and I just like i Dad, I think, I don't know I like You know, I can't even tell you how I'm gonna do it. But I just believe doing it this way me being in control of my fate is just a better way to go. And 20 years later, you know, here I am.   05:12 And I, I can totally relate with the just get a job and get the paycheck. And because I remember leaving college, I thought I would get a job and a hospital or a clinic and I would work there until I retired. Right, because sometimes those worlds aren't open for you right away, and you have to kind of really forge your path. Now you were very successful, as are are very successful as a financial advisor. And then you moved into becoming an entrepreneur, starting your own brokerage. So we'll get to that in a second. But before we do, let's give people a little bit of advice for their financial success in 2022. What's your best advice for us?   05:55 Yeah, I mean, one of the guiding principles of creating financial security is the idea of paying yourself first, right? And, you know, tell people you if you work for a company, right, and and and they didn't pay you, would you continue to go to work? Virtually everyone says, Well, no, rather not go to work, have a good day. But my contention is, you get your paycheck, and you pay rent, and you pay your car lease, and you pay your credit card, and you pay your cell phone bill, right, and you don't put any money away, right? No money in savings investments for you, you just work for free, because none of that money went to create wealth for you. Right. So the the one thing that I would tell people is to pay yourself first. And this really comes first and foremost with creating a budget. Right? You have to have a plan, right? I would say if you aim at nothing, you'll hit it with amazing accuracy. Right? So you have a certain amount of money coming in. Okay, so if I make five grand a month, okay, well, what are your bills? My bills are three grand a month. Okay. That that gap between your income and your expenses? That's called your discretionary income? That's do I make dinner at home tonight? Or do I go to that steak house? That's do I, you know, do I go on vacation? Right, you know, to to Hawaii? Or do I just go camping, you know, down down down the road, right. And so those are your choices, right? Those are your choices. But I always tell people pay yourself first. And the reason and I wanted to drive home the importance of this, you want to get to the point where you can live off of interest, you want to get to the point where you've saved, you've accumulated so much money, that the yield the earnings from your money covers all of your expenses. That to me is retirement. It's not about being 65 or 67, or 70. It's the point at which you remove the half twos from the equation, you do things because you want to do them not because you have to do them. And the more money you put away, right, the longer it's working, the greater rate of return you're earning than the faster you get to that point, right. And so I don't care where it is, it could be a savings account to start. It can be a brokerage account, stocks, bonds, mutual funds, insurances, whatever, right? But something you must pay yourself first. Right? And that's, that's the first guiding, no first guiding principle.   08:10 And I love that I started doing that a couple of years ago has changed my life. Yeah. And it's like, it's so I feel like I have like less worry and less burden on my shoulders. Does that make sense?   08:23 Well, it does make perfect sense. And the challenge is, is people go oh, well, you know, I, my lifestyle will be, you know, be interrupted. And no, it won't, right. And if you think about this, and I love breaking down, and this is maybe a challenge that the listeners can can join in on, take the amount of money you're looking to save on a monthly basis, and break it down to the day makes it even more palatable. So you think about it. If I go, Hey, I want to save, you know, I want to save $1,000 a month. That's my target. Right? So what's that roughly about $33? A day. Right? So you get a lunch every day, Karen, you had to take me to lunch, right? Would that change your life? Would your life suffer? We just ended a living change? Probably not right? You're ready to retire? If I said you have $2 million in your retirement account. Would that help you with that? Would that change your life? I probably wouldn't hurt.   09:19 Yeah, it would be good. I'd be I be okay with that.   09:22 Right. And that is what you're giving up. So it's like we have to give up smaller short term instant gratification things for the long term greater good.   09:31 Yeah. And I think that's that mental shift is so important because we live in a world now where instant gratification is everything right? And so how do you counsel your clients who are used to an instant gratification world to be like, Hey, listen, this is going to come to you but you have to wait. Well,   09:50 I think the principle of saving and investing or paying yourself first doesn't mean you can't have fun. It doesn't mean you can't enjoy the fruits of your labor and I think people tend to, you know, live in these extremes, right? Like either save everything you must, you know, not spend don't have any fun like your life is over right? Or, or like, we only live once I'm gonna spend it all right and, and the reality of is there's a balance, you know in the middle, right? And so what I'm saying pay yourself first in that example if I make five grand a month and I have $3,000 a month of expenses, and I decide I'm gonna put away $500 Well, there's still 1500 bucks to go to the movies to go to dinner to go buy that, you know that handbag to go buy those shoes. You want it right, like, but you made yourself first.   10:36 Yeah, yeah, I love it. Like I said, that mentality has just changed and shifted everything for me. So hopefully, the listeners will take that and hold on to it through 2020. Now, like I said, you wear a lot of different hats. So financial advisors, one new or very successful financial advisor working for someone else. Right? And then you kind of made a shift, you kind of reached the point where, oh, I feel like I've got all this stuff. But I'm not sure that I'm happy in the place where I'm at. Is that right? Yeah, I   11:12 think, you know, for me, I realized I draw the analogy, I felt like I was a shark in a fish tank. Right. Like I had, I had outgrown, you know, the system that I was in. And in order to continue to to flourish, I needed to swim in larger waters, right? I believe in life, you know, you're green and you're Brown, you're growing and you're dying, you're getting better, you're getting worse, there's no staying the same, right? And so for me, I'm always looking to grow, I'm always looking to get better. I'm always looking to be pushed, and challenging. So you know, what better thing than, you know, leaving a 13 year career, you know, and multi multimillion dollar practice than to go out break out on your own and try to build something bigger. So that's exactly what I did.   11:57 And again, not easy. Now, was this around the same time that you started getting into yoga and becoming a yoga practitioner? And how did that change? What you do as a financial advisor and even as a dad and as a person? Kind of connecting that mind and body?   12:18 Yeah, I think it was somewhat around the same time I've been been practicing yoga for about 14 1415 years and and I've been independent now my own brokerage about 910 years and I think what yoga taught me not only what it did for me physically, but it I was very idealistic visit undermanned, right, this will happen, this lab, this will happen, right? I was very rigid, right? This, this, this. And what yoga taught me is it taught me to detach myself from outcomes. It taught me to detach myself from outcomes and to just focus on process. Right. And so there's a little Mater that I that I shared in the listeners can can take part in this as well. And you got a challenge in your life. Right? You got an issue in your life, you ask yourself questions, three questions. Do you have a problem? No. Okay. Don't worry about it. Right? No problem doesn't worry about. Do you have a problem? Yes. Can you do something about it? Yes. Okay. Don't worry about it. Do you ever problem? Yes. Can you do something about it? No. Oh, great. Don't worry about it. Which basically means all paths lead to not worrying about it. Right? So I believe that everything happens for a reason. And it's exact, perfect timing, even the crappy stuff. Right? Even the stuff you're like, This isn't fun. This hurts. Right? And, and, and, and one of the things that yoga has taught me is this just changes my mantras. I mean, even teaching it right, I have all these intentions and things that I that I that I share with with my students and that I have to also live by I can't say it not believe it or not live with it, right. And even this past week, my watch for classes that ease is a greater threat to progress than hardship. Right? And so through adversity through challenges, that is where we that is where we grow, that's where we get product progress, that is where grit is developed. And so for me, Yoga has softened me in so many ways. And let me accept things right, except that sometimes I will get exactly what I want. And sometimes the door will be slammed in my face and it's okay because if a door gets slammed in my face it was supposed to get now now the challenge is in the big so do you need me Sophie, every time you get rejected, you just accept it like know what I mean by trusting the processes. If I have done what is required of me, if I have done everything that I can do, then I can detach myself from the outcome. I don't mean that I'm sitting at home flipping TV. going like, I'm going to make a million dollars this year. Are you working today? Like no, but it's coming to me I'm manifesting. There's two keys to success in life. Number one, you have to believe that's the first part, those that think they can do something and those that didn't, they could not do something about usually right, then the second piece, then you have to do the work. Right. So what I always had was a tremendous work ethic that I always had. But what was flawed, flawed, or what was underdeveloped, if you will, was that mindset that, that that that positivity, that manifestation? That that, okay, this, this is what will happen, okay? This is what I want to happen, okay, and then go out and do the work.   15:38 Yeah. And boy, that second parts, the tricky bit, right, having to do the work. That's the hard part. And I know, and then, what I see a lot, and you probably see this on social media is people will say, Oh, I put it on my vision board, and it just happened. Or I manifested it, and it just happened. And then you're sitting there like, what, like, if that work is   16:02 because people people typically aren't posting their losses, right, people are posting their wins, you know, and the reality of it is, is that, you know, you take any anyone in any any arena sports, entertainment business, right there, they're all failures, all of them. They just were too stubborn to stay down. Right. And that's, that's the difference. I've come to believe that the most successful people in life are simply those who can endure the most pain, who can endure the most rejection who can in you know, indoor, and I think that's how I became successful in my business. I think, I think that I coined the phrase at the time when I was new advisor, I put in the phrase, tactical persistence, right? I'm going to be persistent tactfully. I think, in the first couple years of my career, people ultimately just did business with me, because I like, if I don't buy something from this guy, I think he's ever going away. Like, I don't think he is ever. Right. And so, you know, I was just there, they're there. And they're like, fine, right? I mean, you've developed a relationship and people know, right, then he's not going anywhere. He's gonna be here. Right. And, and, and, and I think I think that's, that's, that's important. I mean, anyone, uh, any one of the listeners, you know, of this program can tell you what is the easiest way to put off a salesperson or a telemarketer the easiest way to um, one simple phrase, call me later. And 99.9% of the time, they will not and you're off the hook. You don't even have to reject it. You did. So call me later because they didn't follow through. Right? Right. They didn't follow up. So you didn't have to actually, you know, say no, even right. And so, that's the thing for me, like, No, I'm gonna follow up and I'm gonna follow through and I'm gonna do everything that is required of me. Right. And if you ultimately type he's not right or my services are right then. Okay. Right. But I will not fail because I didn't do what was required. That will happen.   17:52 Yeah, yeah. That makes perfect sense. And, you know, speaking of tactful persistence, the other hat that you were is a dad to three girls, so I can only imagine tactful persistence comes in handy. So how has all of this your experience in business, your experience in yoga, your experience in life? How does that come together when it comes to raising three, three gals?   18:17 Yeah, um, you know, I, when I was a younger man, I used to pray to God that he'd sent girls to hang all over me. And he took me literally and it's like, here you go, here's three of them. Right? So be careful what you ask for my kid. I've got these three girls. And this is a prime example of you don't always get what you want, but you get exactly what you need. Right? me growing up as an athlete, I was a force for Letterman. In high school, I went on to play college basketball. You know, I recently got inducted into the Hall of Fame in my high school for sports. Right? So of course, I want Boys, boys continue to legacy and go on. And then I get three tall girls, two beautiful girls like oh, man, like God, why? But you know, just, I'm a different man. I'm a different father because I have these three girls. And I think, you know, my, my role and the one thing that I say is like as as a as a man, right of girl, Dad, if you will, I'm the first man they fall in love with. So it's my responsibility to show them, you know, respect and true love and chivalry, because that's where they're going to carry on in their relationships as they get older. And so I think, you know, I feel very blessed. Although, they are sisters and they're they're all flesh of my flesh and blood of my blood. There are three completely different people that represent three completely different sets of challenges and, and, and things to deal with. But I've been blessed because they're good girls, right? And I wish I could say it was because I'm such a great dad. But, um, you know, I think that they're they're just inherently they've got good sweet spirits, which is, which is a blessing to have. And then I'm just doing the best I can to guide them. I think we all can attest to this being as we get older, we become adults, we look back at our parents, and we realize every one of us has said this at some point, like, wait a minute, our parents didn't know what the heck they were doing. Right. Like, and some of us even called our parents out, right? Like, you were just winging it. They're like, Yeah, you know, and so I feel like, you know, I feel like, we're just all doing the best we can, you know, and that's, I'm doing the best we can as much as I feel like, you know, I'm doing all the things from I can from my, my daughters, I'm sure they'll tell you. Yeah, but he didn't do this, or this or this, but, but what they will definitely say is that, you know, I'm president and that I'm, I'm, I'm, I'm consistent, I'm a consistent, you know, consistent force in their life. Right. And that's, you know, that's the most important thing to me. I don't need them to always like me, I don't I don't need them to always agree with me, but I do need them to, to respect and honor Me and then with the love that we have, you know that that's something that you know, is so special, and then I feel blessed to be there for their father. Yeah.   21:20 Amazing. And you're putting all of this together, your financial advisor role your entrepreneur role, your community mindedness, your girl, Dad, your yoga, into mind, body money. So what is it? And what can we expect?   21:42 Yeah, Mind Body money is a docu series that I created. I have actually filmed all of season one, I'm in the process of talking to a variety of networks now to get it placed on on national television COMM And q1 Next year, so stay tuned. I've also created an app that's on the App Store mind dot body dot money that's on the app store as well. But the idea is that how do we become the best versions of ourselves? And we become the best versions of ourselves balancing those three areas in that order. Mind. Body, money, right? Mindset first manifestation, manifestation. Every day when people ask me how I'm doing I Thomas, the best day of my life, I say that every single day. Now, does that mean that everything is going well in my life at all times? Nope. But that's what I say. I'm manifesting positivity. Right. But health alone is so important. We're getting one body, right? Never no one's ever on their deathbed wishing they had more money. Right? So you got to take care of yourself. And then money, good stewardship of your money, right? Money can't buy you happiness, but it can pay your bills. So I can do a lot of stuff by hand. And so typically, what I find is people are unequally yoked right you might have the money hungry driven person and And admittedly, I was that person coming out of school, I want to be a million dollars. I want to, you know, you know, have a nice house nice car and buy stuff, right? But lacks substance lacked connectivity. Oh, right. And, and, and when I got all this stuff, what I realized, like, oh, an empty because it's not about the stuff. It's not about money. Right? It's about connections about love. Okay, and then you got the other people that understand spirituality? No, it's about mindset and in spirituality, and, and peace. And that's great that you feel like that you want to go on this yoga retreat. But I got a question for you. How do you pay your bills? Right. And so it's that it's the balance between those three areas. And that's what the show features different athletes, celebrities, entertainers, all the way down to your common men and women, and how the journey in life, right, you know, is navigating those three areas. And the one thing that I'll tell you, between all of the people, there is always a story of failure. There's always a story of doubt, or uncertainty that they all press through. And that's the one thing that I say common thread, like the most successful people, right that I've met in my life all can tell you a story where they were down and out or they didn't know what's gonna happen next, but they persevered, right? There's a, there's a, there's a little meme that I that I share when I'm doing my my talks and it has it's a photo of a goldmine that you can envision this in a person with a with a with a pitchfork, and they're digging in, they're digging, and they've dug like a 10 foot ditch and they get frustrated, and they turn around like, like I'm finished right? And they were only one foot away from actually hitting goal but they're like I've done so much And then the mantra here is don't don't ever give up. You never know how close you are, to, to your, to your goals to your dream. So So you swing away, you swing away until you get it. Right. And maybe maybe you'll get there in a week, they will take a year, they will take 10 years, right? Maybe Maybe it's not meant for you. Right. But But again, right, don't leave this earth wondering what if?   25:25 And out of all of the episodes that you've done and the people that you've met through mind body money? Is there a particular story that sticks out for you that you can share with the audience?   25:40 Yeah, there's two stories that come to mind. Actually, I'll share first one guest we had was on the show was Jordan sparks. She was the youngest American, I   25:51 love her. She's great.   25:52 She's awesome. Just as lovely. Off off screen as she is on screen. She shared with me so she goes on American Idol. She comes here to actually to Pasadena where I live, she cheats. She auditions at the Rose Bowl and gets cut. She didn't even make it to go see Simon and all those guys, right? She gets cut, right? And she says she remembers walking out, you know, through the parking lot with all these girls. And at the time, she was young. I think she was like 17 or so. But at the time, she said she remember seeing all these older girls and older by but I mean like 2526 year olds, I thought, Oh, my life is over. This is my only chance to make it big. And I'm done. And she thought to herself like, no, like, I'll come back don't get another way for me. So she goes back, she lives in Arizona. So she goes to a regional regional competition in in in Phoenix and wins, right and wins. And the prize for winning was a chance to go to the next city, which was in Seattle, and try again, audition again. And on that second audition, she gets picked up and then ultimately wins   26:58 the show. Amazing.   27:00 And so that story is when we're like wow, you know, like, wow, you know that what level of perseverance and just believe that like not this, isn't it? And how many of us would have faced that rejection or or stumbled in the live live? Yes, it wasn't in the cards for me. Right? But again, as long as you have breath in your body, keep pushing. Right. The other story I'll share is I had David Hasselhoff he was on my radio show my Ask the Experts radio show. And we're interviewing him. And David Hasselhoff was one of the principals of one of the first billion dollar TV franchises Baywatch, right? Um, I personally think that Knight Rider was cooler but for the for you. Gen Xers with me. But anyway, but but the US, you know, first building our franchise Baywatch, right, and we're talking about that. And again, what a lot of people don't know is that they watched initially was cancelled. It was cancelled after the first three episodes. Because yeah, they killed like five people in the first few episodes and and the viewers didn't like it. So the show got canceled. So in an attempt to revitalize the show, because like I need financing, so in little known, but David Hasselhoff in Germany is like he's huge, right? Like he's like, he's like, yeah, he's like, the biggest thing he's Yeah, yeah. Right. So he goes to Germany's like, they'll give you money, right? It goes in Germany. He raises some money. He gets like 1,000,005 to bring back the show, and comes back and does the show, right? Well, what happens is, they run out of money. They run out of money, they can't finish the episode. So like, man, we got 22 minutes of content, we need 25 And we don't have any more money. What can we do? How can we make the episodes longer slomo that is where slomo comes in. Slo Mo was to stretch out the scene so that they can get their minutes so funny that the most iconic part of the show was really a mistake was really because they didn't have money right? So story after story after story like that, that I've heard in my 22 year career most certainly in filming this Docu series is follow doc that like wow, like so many times people put a lay down so many times people could have you know, given a peck Jeff basals worked at McDonald's guys. You have like, like, like so so when somebody next to you when you're when you're working in Starbucks and the barista next to us like I'm going to be a billionaire and all scoff right you never know.   29:34 It can happen you never know. I love these like insider stories. I think it's so cool. So as we start to wrap things up, where can people find more about you about mind body money? Maybe see some little clips things like that. Where can where can people go?   29:53 Yeah, I'm pretty easy to find. My name is so unique. There's not a lot of me out there. He Sophie Taylor, Mama variety of social media platforms Instagram, Facebook, LinkedIn, that's at a selfie Taylor s ZYLF ie Taylor at the Sophie Taylor. For the show, we actually have a website, in addition to the social media platform. So we have a website Mind, Body money.com. So mind body money calm, you can also get information on the app store as well. You can download the app, the app store at mine dot body dot money, as well. And so yeah, we're out here we're continuing to push out new content, and, and keep everyone posted on the release of everything. But I'm super excited for what 2022 is going to bring and look forward to sharing. I feel like the bottom line for me is like when do you watch television? And and learn something? When do you watch television and feel better? And that's what I'm going to bring? That's what I'm going to bring to the world?   30:56 Well, the world certainly needs it at this point in time. So it sounds perfect to me. And now before we end, I asked everyone this same question. And it's knowing where you are now in your life and your career. What advice would you give to your younger self?   31:12 I would remind my younger self, that the road to walk a mile begins with a single step. No shortcuts. No matter how talented you are, no matter how smart you are, no matter how ambitious you are, right hard work is undefeated, you must do the work, right foot in front of the left one step at a time you'll get there. I think one of the biggest reasons that I'm successful today, it's all the slow, boring stuff. All the get rich quick, I'm gonna make a million dollars in a month and change the world all that stuff crashed and burned.   31:47 Right? So you mean all the stuff you see on social media?   31:51 Yeah, all that stuff crash and burn. It was it's the slow and steady. You know that? That is why you know, is why I'm here. Right. And so that's why I remind my younger self and it's hard, right? It's hard to listen, my long term plan at 22 was 25. Right? That was my long term plan. Right? I love that. Right? I mean, I was like, man, three years, that's 25 years old. Right? And so, you know, I can still couldn't even see past 30 like, well, what is what is that? You know, and, and then you you you blink? Right? You blink and you're like, well, 10 years has gone by 15 years gone by 20 years has gone by, you know and so that's what I would remind myself is just stay the course. Don't get you on the highs don't get too long. The lows the road to walk a mile begins with a single step. Just go.   32:37 I love it. Great advice. And Sophie, thank you so much for coming onto the podcast one more time. Where can people find out more about you?   32:48 Social media at ie Sophie Taylor, Facebook, Instagram, LinkedIn, at Mind Body money, Instagram as well. And at the mind body money.com site as well as a mind body about money on the App Store.   33:03 Perfect. Thank you so much for coming on. I appreciate it. I appreciate you. And I wish you all the best in 2022, including your show.   33:13 Awesome. Thank you. Thank you. I'll take all the well wishes and blessings I could get. Thank you very much.   33:18 You're welcome. And everyone. Thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.