On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Stephanie Weyrauch on advocacy mentorship.  An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership. In this episode, we discuss: -Why you need an advocacy mentor to help guide you through healthcare policy -The benefits of being a mentor -The key to having successful advocacy efforts -And so much more! Resources: Stephanie Weyrauch Instagram Stephanie Weyrauch Twitter Stephanie Weyrauch Facebook Email: sweyrauchpt@gmail.com   A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.                                                                      For more information on Stephanie: An active member of the national physical therapy community, Stephanie has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Stephanie is a nationally sought after speaker and consultant for topics on social media use, generational issues, and organizational membership. Stephanie serves as the Vice President for the Connecticut Physical Therapy Association. She is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery.   Stephanie is a Passionate Chicago Cubs fan who enjoys playing the saxophone, writing and weightlifting in her spare time. During business and leisure travels, she is always up for exploring local foodie and coffee destinations.   For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor (00:03): Hello. Hello. Hello, this is Jenna Kantor. I'm here with Stephanie Weyrauch. You guys probably know. I mean she's not any stranger to this podcast. How many podcasts have you done on this specific one? I wish I could say third time as a charm as we go. But I wanted to bring on the good old Stephanie Weyrauch however you want to refer to her. Or you could be like, hello, master or master, whatever you prefer. I'm going to bring on Stephanie today because she's actually my advocacy mentor. And I wanted to bring her on to talk about this because I don't think people realize this can be a thing. And so I'm like you want to come on, she's all, yo, let's do it. So this is where we are. And I wanted to open this up, especially to any student physical therapist grads who are looking to get more involved with the APTA and just don't get that guidance from someone that they trust and who believes in that. So Stephanie, why do you think I wanted to work with you? Stephanie Weyrauch (01:21): I think that to do with the women in PT summit. I mean I know that, I remember the first time that we met Jenna, we were at the women in PT summit. I had seen a lot of your videos on social media and you and I were friends in social media and so I remember I came up to you and I said, Oh, you're going to at four. And you said, Oh my God, you've seen my stuff. That's so cool. Sort of talking and I think you based off of your interest in advocacy and based off of, I think you knowing that I was involved in advocacy, we just started talking about it and I think that that's just how the hell, it was a really organic thing. It wasn't anything that was really formal. It was just like, Hey, we have this common interest. We know we both enjoy. I mean we both are passionate about the profession and I think that's kind of what led you to me. Jenna Kantor (02:12): Yeah. It's funny to say it's not horrible, but to be, I remember when I asked you, I felt like I was asking you to be my girlfriend. Will you? Will you be my advocacy is a big deal. I think this is important to bring up as somebody who's really watched to continue my involvement with the APTA making changes that I foresee that will be so great for its growth. I really wanted to bring this up because it's necessarily easy to find the right person. I think of it as dating. At the end of the day, there's a lot of people who will give you tidbits, but for somebody like you or I can say, Hey, I need to talk to, they'll be available to talk to like brainstorm or whatever, or even if it's just a hard time, get through a Rocky space. Just brainstorming, but that's extremely valuable. A lot of physical therapists who are involved, they don't necessarily believe in beyond that level where I feel comfortable to be open. Stephanie Weyrauch (03:23): Yeah, I mean I think that, you know, you make a really good point about finding the right person because you know, while people say that you can go up to anybody and say, Hey, will you mentor me? I mean you really have to build that relationship, which is what advocacy is all about, right? I have been a really good advocate. It's all about building relationships and so finding that person that you can be yourself around yet that person is going to be honest enough with you to tell them you know, the things that you either need to improve on. Be that critical feedback, but also give you that positive feedback to reinforce that you're doing the things and finding that balance. So I think that you make a good point about making sure that you're finding the right person. And my advice to people is if you are interested in finding an advocacy mentor, just a mentor in general, try to foster that connection. That relationship is really important. Jenna Kantor (04:27): I remember it was a process for me because now they know what they're doing. They have what I want and everything, but I didn't feel a hundred percent and I think that is something we forget. You just think they're amazing, but how do they make you feel about yourself when you're with them? Do they make you feel good? I've had conversations with you where you've started to get me, you know, you're like, I think this, and I said our walls, that's not where you want. It may have been with the step never on me. Things that were my specific goals and values about within myself. It's been very helpful finding someone who I can be me all the way, which is a challenge. Stephanie Weyrauch (05:28): And I think that that's an important thing for mentors is that creating a mini, you're creating a person who is their own individual person and has attributes that they can bring to the table to make them strong advocate or you know, whatever the mentorship relationship is about, you're just moving them along. I always think that, you know, being a mentor is even cooler than accomplishing something yourself because the mentee accomplishes something in that route. And you foster that accomplishment by, you know, facilitating their growth and making sure that they're connected with the right people. I mean, that's just as rewarding and if not even more, all the extra people that you get to touch in addition to, you know, your own personal development as an advocate in your own personal development as a leader. So I think that, you know, it's something that not only helps you as the individual mentee, but you as the mentor, it allows you to have a larger reach and what you will have just in your little bubble who in your own advocacy thing. Jenna Kantor (06:44): Yeah, that's true. That's really, really true. And it's not easy because like you mentioned earlier, there are people who many people say, Oh yeah, I just spoke to anyone. So you have to make a decision for yourself. Are you good with getting snippets of people and having a law or would you want someone that's going to be viable for you, devoted to investing time, give you that advice and guidance? There's no wrong answer to that. I discovered that I needed only one. Stephanie became Michael B wonder what would be a Harry Potter reference. Stephanie Weyrauch (07:30): So I mean, Elvis stumbled or of course not Baltimore. Baltimore does not. Definitely not. No way. Don't compare me to Baltimore compared me to the more. I think that that's another thing about mentorship that can be challenging is the time commitment. And you're right, you can have multiple mentors that you know, don't really need, that you don't really need to spend a lot of time with. But again, if that mentor is really into facilitating your growth, they're going to be, it's going to be okay that they're going to invest time. And you know, it may not be like a one hour weekly phone call when you see them. Like they're going to want to spend two hours. You can just catch up and see how you're doing. Or they'll text you or email you back and forth. And those are the men. Those are the relationships that are built on, that are built on exactly what you said, relationship. It's not just built on a normal face to face. I mean somebody that you barely know, this is something that you've cultivated, watered, and now the seeds are growing in the beautiful tree is starting to really fester to help kind of bring about that relationship that's needed to have that effective mentor help you. Jenna Kantor (08:57): I'm realizing we're making an assumption here. So let's answer the question. Why is it good? Why is it beneficial to have? Stephanie Weyrauch (09:04): I think that the benefit for it is because it helps you prep, it prevents you from making mistakes that most people make. And when I think one of the best things about having a mentor, you grow and become better, faster than maybe somebody who had to figure out along the way. Granted there's been multiple people along in the history of time who've been able to figure out their own way, but potentially they could have burned some bridges along the way. They could have had some set backs, they may have missed opportunity. And if there's one thing we know about advocacy, it's all about opportunity. And it's all about presenting your argument in the right way, at the right time for the right things that are going on. And so understanding that and understanding that, especially in today's very polarized political environment, making sure that you are approaching these issues in a way that is proper and in a way that's going to be effective. Because ultimately when you're advocating, you're advocating for your patients, you might be advocating a little bit through your profession, but in general, when you advocate, you make sure that people are getting great care. And right now our healthcare policy is very polarizing. There's lots of different opinions about it. And if you are with the right person and they're guiding you the right way, you're going to go about it in a way that's not going to be as potentially detrimental to the message that you want to send. Jenna Kantor (10:45): Yeah. And you're hitting on lots of great. Just like anything, any relationship that relationships, and I'm going to sum it up with a word. You could get blacklist, you can't, it's not like there's a horrible place. Nobody that made no, ain't nobody got time for that. But if you're a person who's constantly coming out like a douche, you're not going to want to know you. Just like you make me feel like crap. That's a thing. So to get, and it's even if you think you are doing something, you never really realize. If you might be cutting down on someone who was put in a lot of hard work, a lot of hard work for zero reimbursement for the profession and that has to be considered even if you completely disagree with it. Stephanie Weyrauch (11:40): Right. Well and advocacy takes a long time too. I mean, it's not something that you can go to one meeting and all of a sudden now you have a law passed. I mean it takes 10 it can take up to 20 years as we saw with the Medicare therapy cap to have something actually happen. And that's like a long history of that's like a, Oh that's a history in itself. 20 years. I mean I'm only 30 years old. That means that when I was 10 stuff was going on that I don't even wouldn't even know about. And if I don't have that historical knowledge and that historical information, how can I be an effective advocate? So by having a mentor who knows that history and can help guide you along some of those talking points that you have, because either you don't know the history, you're too young to know the history or you just aren't as familiar with the talking points themselves. You have that person there can give you that. And then when you go to advocate, you have that much more credibility. If there's anything that is really important in advocacy, it's first off, it's credibility and second off it's relationships. What type of relationship have you built with that person? Because if you're a credible person and you have a relationship with them, the chances of them actually listening to you when that app comes, who's a lot better than you're just random person that has no credibility, right? Jenna Kantor (13:09): Does natural delight is the things that I personally want to change just for voices, lesser known voices too. That's my own little personal agenda is the important part of this podcast. Very important part. Very, important part of advocacy. Advocate for lameness. So after answering, why do you have to, is it a must in order to achieve what you want within the physical therapy profession? Advocacy wise? Stephanie Weyrauch (13:50): I mean I would say yes because I don't know how many of our listeners are experts in healthcare policy, but my guess is that there's not a ton that are experts in health care policy and if you are an expert in health policy, my guess is that you've had a lot of mentorship along the way. I know for me, I mean healthcare policy changes daily and for me, how I have learned has been from being by people who I would consider our healthcare policy experts in addition to them giving me resources that I can use so that I myself can become a health care policy, not to mention really keep emotion out of politics and that is path of what advocacy is, is trying to present a logical argument that isn't based off of emotion, was based off of somebody else's emotion. That's going to further the policy agenda that you're trying to advocate for. And I think one of the hardest parts about advocacy, personal emotion out of the picture. Stephanie Weyrauch (15:10): You're there to advocate for your patients. You're not there to advocate for yourself in the end. It doesn't really matter what you believe, it matters what is needed for your patients. And so having just a mentor there to guide you through some of those, that emotional roller coaster of politics and emotion, individual politics with societal politics I think is an essential part of being an effective healthcare advocate. Additionally, there's so much information and having somebody there to help you kind of focus that information and help you figure out what you need to learn and what you can focus on is also really important. I would say yes. Having a mentor is extremely important. Jenna Kantor (16:02): I love that and on that note person who has been on this podcast now for this is four times. How can people find you if they haven't listened to you? Stephanie Weyrauch (16:20): So you can find me on Twitter. My Twitter handle is @TheSteph21 I'm on Facebook and Instagram. You can find me there or if you want to email me, you can email me sweyrauchpt@gmail.com but I would say the best way to reach out to me is probably Twitter. Jenna Kantor (16:48): Tweet, tweet, tweet, tweet, tweet. Well, thank you so much Stephanie, for coming on. It's a joy to share your expertise, to share you with others. Even though I want to claim you all. Stephanie Weyrauch (17:04): Thank you for the wonderful opportunity to come on. I'm healthy, wealthy, and smart. Well, once again, and of course it's always great to chat with you about something that I really love. Advocacy. Jenna Kantor (17:16): Heck yeah, me too.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Andrew Ball on rehab after COVID-19.  Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques). In this episode, we discuss: -The pathophysiology of COVID-19 -Physical therapy treatment considerations in acute and outpatient settings -Post Traumatic Stress Disorder among patients and family members -Functional tests appropriate for patients following COVID-19 infection -And so much more!   Resources: Email: drdrewPT@gmail.com Andrew Ball Instagram APTA Cardiovascular & Pulmonary Section COVID-19 Resources United Sauces Website    A big thank you to Net Health for sponsoring this episode!  Learn more about The ReDoc® Patient Portal here.                                                                       For more information on Andrew: Dr. Andrew Ball is a board certified orthopaedic physical therapist with nearly 20 years experience in physical therapy. Drew has earned numerous advanced degrees including an MBA/PhD in Healthcare Management, and post-professional DPT from MGH Institute of Health Professions. He has completed a post-graduate fellowship in Leadership Education in Neurodevelopmental Disabilities (LEND) at University of Rochester, and a post-doctoral clinical residency in Orthopaedic physical therapy at Carolinas Rehabilitation in Charlotte, North Carolina. Clinically, Drew has mastered a wide-range of manipulative therapy techniques and approaches via continuing education and residency experiences (ultimately creating and co-creating several new techniques). He is certified by the National Academy of Sports Medicine (NASM) as a sports performance enhancement specialist (PES) and was personally trained and certified (CMTPT) by Janet Travell’s physical therapist protégé (Dr. Jan Dommerholt of Myopain Seminars) in myofascial trigger point dry needling. Dr. Ball serves on the Specialist Academy of Content Experts (SACE) writing clinical questions for OCS exam, as well as research and evidence-based-practice questions for all of the physical therapist board certification exams. Dr. Ball currently serves on the clinical and research faculty at the Carolinas Rehabilitation Orthopaedic physical therapy residency teaching research methods and evidence-informed clinical decision making, but also contributes to the clinical track mentoring residents in manipulative therapy and trigger point dry needling. His publication record is diverse, spanning subjects ranging from conducting meta-analysis, to models of physical therapist graduate education, to political empowerment of patients with physical and intellectual disability. Dr. Ball’s most recent publications are related to thrust manipulation and can be obtained open-access from the International Journal of Physiotherapy and Rehabilitation. Drew is married to his wonderful wife Erin Ball, PT, DPT, COMT, CMTPT. Erin is Maitland certified in orthopaedic manual therapy (COMT), certified in myofascial trigger point dry needling (CMTPT), and has extensive training in pelvic pain, urinary incontinence, and lymphedema management. They live with their two dogs one of which is a tripod who was adopted after loosing his hind-leg in a motor-vehicle accident.   For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor (00:02): Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I'm super excited because I have Dr. Andrew Ball here who is going to be interviewed on COVID-19. Has anyone heard of it? Anyone? Bueller, Bueller and return to performance post infection. This is such an important conversation. I'm really excited and grateful to have you on Dr. Ball. Thank you. Andrew Ball (01:26): Well, first of all, please call me Drew. And second of all, let me thank you and your listeners for having me on. Jenna Kantor (01:34): Wonderful. It's really a joy. Would you mind telling people a little bit more about yourself so they can better get acquainted with Mr. Drew? Andrew Ball (01:46): I have been doing physical therapy for, I have a 20 year history in physical therapy. I've taught for a good majority of that time. I started out in pediatrics doing what I was told was the first fellowship in pediatric physical therapy and neurodevelopment at the university of Rochester, which has since kind of turned into a PTA accredited residency program at the strong center for developmental disabilities and then evolved into doing orthopedics. I hold an MBA, PhD in health care management. I went and did a post-professional DPT, but I got to sing. None of that matters really the salient point. And I think I'm using that word correctly. But don't go with it. Go with the pertinent point is that I could be any one of your listeners who treats in outpatient orthopedics who treats in sports. Andrew Ball (02:48): My passion is working with musical athletes. I started working with guitarists. I played piano at Peabody when I was a little kid, put that down and Mmm. And ultimately I got back into music by playing guitar, by being forced to play guitar because I was working with guitarists. And at some point it's like working with a football player and never having played football or treating dancers and never having dance. There's a point where there's a level of respect from your patients. You just don't have it unless you actually have, okay, I've done the work. You can't really speak the language. So I recognized that there were two ways, one of two ways to do that. One was to begin building guitars. So I started doing that. And then ultimately one of the guys that I built a guitar for who plays guitar for Carl Palmer formerly of Emerson Lake and Palmer in Asia. Andrew Ball (03:58): Basically he told me like, this guitar is great, but you really have to learn how to play or, yeah, I mean you really are going to have to learn the language of the little things like the posture and the whole, you can talk about holding the guitar, but you know, if you're a grunge player and you're playing bass, you've got to play that guitar and you gotta play that bass guitar and your name and it doesn't matter. Cause it doesn't look cool to have it in the right, you know, proper position. And the muscle memory that these guys had been in gals have been doing, you know, since they were you know, 12 years old you know, you're not going to change that. It's like changing someone's golf swing or if you're going to change it, they have to understand that it is going to be for a greater good. Andrew Ball (04:45): Like being able to play a 60 date tour versus having shoulder pain after 30. So, I kind of weaved and wobbled through trigger point dry needling. And I also teach for my pain seminars, but that got me into working with the Jamaican Olympic track and field team. It got me into working with the Charlotte symphony and I'm one of the physical therapists for them. But ultimately I am trust like any one of your performance PTs who is interested in that population and at the same time truly truly wants to help individuals that have a hard time finding care. And so that, is that correct? Jenna Kantor (05:37): Yeah, I think that's great. I mean you could go on for a very long time and I really want to get to the point because this man clearly he is a person to learn from. He has so much information to share and I'm really happy about this topic that we're diving into with COVID-19. Let's go straight into the point COVID-19. What are the effects that it has on the body that we need to start paying attention to? Andrew Ball (05:57): Like the first things that we have to just acknowledge cause this is going to be something new to us to consider. Right. So there's a lot of things that we need to consider. The physical I'll talk about first. And the psychological, which is a piece that we don't, that certainly performance, that's a huge issue, but that's certainly not something that most PTs outside of the performance training group really, really focuses on. So I'll start out with a friend of mine who was one of the first a thousand people to be diagnosed with COVID. She was in Washington state. She was one of the first 250. She's super, super bright. She holds a PhD in aerospace engineering or aerospace engineering design. Andrew Ball (06:57): She's a little bit younger than I am. How old am I? Not quite 48 years of age. And she was, is extremely fit very outdoorsy plays an instrument. So I just want to kind of walk through what she experienced. And this could be again, any one of your listeners on days zero, we'll call it before she was diagnosed. She was skiing I believe snowboarding, but skiing and had some aches and a dry cough and fatigue and experienced something that she had never experienced before that she described as chest awareness. Now your patients and folks that you work with are very acutely aware of breath. Andrew Ball (08:06): Right? So I kind of asked her, was that what you meant? She's like, no. I felt like I had to consciously think about every inhalation and exhalation that I chose. And that was before, before a diagnosis, but that was faint. She described it as on day one, which is the day that the fever tends to rise. Not everybody has a fever. So there's variability here that she spiked a fever of 102. She had difficulty breathing day two, that worsen. She had a dry cough and we should get into the idea of a dry cough versus a wet a cough a little bit later when we talk about the physiology of this and how it differs from a pneumonia. And had some GI dysfunction as well. And although we kind of talk about the upper respiratory issues, we also need to understand that the virus enters through the injury. Andrew Ball (09:16): The angiotensin converting enzyme to receptors. And, there's obviously the majority of those are or in the lungs, but there are some in the GI tract as well. They're actually all over the body, but and that's why some of the lesser talked about symptoms include things like GI disturbance and urinary issues. And in her case loose bowels by day three, that's when she had a virtual visit. And luckily because there were so few folks being diagnosed at that time, she was able to get a clinical diagnosis by that evening coded by Dave. Or that's when she went to the emergency department because she felt like she thought she had a pneumothorax. She felt like she was unable to fill her left lung with air. And they did a chest X Ray. Andrew Ball (10:19): They did the nasal swab. That was day four. She described it as touching her brain. I mean, it's a significant swap. /you have to go all the way up to the back of the throat in order to get right. Which is why many folks who feel like they have a mild case when they hear that they choose not to engage the healthcare system. And I really think that's a bad, bad, bad, bad decision. Because yes, 80% of folks are gonna have a mild to moderate case, but those 20% that you carry it to can have a severe reaction to the virus. That can be, it can be fatal. Five through nine, her fever began to break. Roughly day seven, she had a reflexive excuse me cough. Andrew Ball (11:21): She was unable to sleep. She felt like your ears were completely clog. She was coughing up blood and coughing so much that she had conjunctive like conjunctivitis, like that redness in the eyes. Day nine was what she described as noteworthy and describe that as intense exhaustion to the point where she had trouble lifting a spoon. She had trouble zipping up a jacket. And it wasn't until day 11 that she felt like having any kind of food or any kind of coffee. Now here's the critical point is performers or super, super attuned to the idea of I felt bad. The show must go on. I've got it. Push it there. And roughly day 11 through day 14, that's when the viral load is decreasing, but the inflammation is increasing. That's when people go on to ventilators. That's when people kick into this cytokine storm that we've heard of. Andrew Ball (12:27): And it's critical to understand that as a healthcare provider and certainly as a patient or performer, cause there have been a number of cases where people had mild cases and they push themselves during this phase a little bit too soon and died having had very, very mild symptoms and then took a turn as a day 14, she still had some difficulty concentrating. She was still exhausted. She found it exhausting to speak and still had a morning sore throat and that's considered a mild.   Jenna Kantor: Okay. Wow. So I think that's, that's important to understand where these people have come from. You know, we don't, well we can get into the idea of ventilation and whatnot before we do it probably makes a little bit more sense to get into this kind of case and how we would treat them coming out of this when they can have contact and we can help them. Andrew Ball (13:36): Yeah, absolutely. Yeah. So kind of jumping forward into well let's take a step back before we do that. If you don't mind just into the pathophysiology a little bit, where would you like to jump back and forth? Let's if we do the pathophysiology, just because I don't want this podcast to be too long. Let's make it very brief, very, very brief so that way we can move forward. So I think it's important to understand that COVID-19 is not influenza, it's not cystic fibrosis, it's not pneumonia. And those are the diseases that when you took cardiopulmonary physical therapy, like that was the primary focus was these diseases where the airways would fill with mucus. That is not at all what happens in COVID-19. So a percentage of folks get acute respiratory distress syndrome and it's a dry cough. Andrew Ball (14:32): And the reason that it's a dry cough is that the airways don't fill with mucus. What's happening is that the capillaries begin to leak fluid into the lung tissue itself. So think that like lymphedema of the lung, which sounds horrible, right? So the airways are getting, a couple of things are happening, the airways are getting squashed, but still get kind of in and out, but the elasticity of the lungs is going to decrease considerably. And why she felt like she had pneumothorax. Exactly. So, the lungs start to stiffen. Much more fluid within the lungs in the lungs lining. So if you think of the lining like a balloon and having that kind of the alveoli, having that kind of consistency, normally it's as though you took Vaseline and you just slathered the balloon with Vaseline and then expect for the gas to exchange at the same rate in between that membrane and it just does a brand harder thinking of this and that. Andrew Ball (16:10): So the problem is not mucus. The problem is ventilation and perfusion. So part of the reason why I got very interested in this is there is a role obviously for quarantine workouts. And by that I don't mean, you know, our brave soldiers within our profession that are in acute care in the ICU and are turning patients so they don't get bed sores and turning them into prone for optimal ventilation profusion. That's not what I'm talking about. I'm talking about the therapist that the only thing that they're posting is information on what healthy people can do when they're stuck at home. And there's a place for that short, but I really feel like there is a role and a responsibility that our profession has to educate the public and to educate each other about COVID-19 and little things. So I started out just asking questions about what can we as physical therapists do? Andrew Ball (17:20): Right. You know, I went back to my cardiopulmonary books, you know, what is the role of putting people into a head down, a position that postural drainage. So they can get the mucus out. Well, newsflash, they don't have mucus, right? So that's not going to help. And it's not the best position for Benadryl for ventilation profusion. So that's important. And the other thing I started asking was, well, what about chest PT? You know, I was awesome at chest PT. I haven't done it since graduation, but I remember that as well. The problem with that, again, no mucus, the clear, the only thing that you are going to do if you are trying to help a performer with a mild case who is getting over COVID-19 is you will weaponize an aerosol the virus. So, you know, there were several folks that were suggesting that based on a poor understanding of the physiology and now we really have to retool and get the information out that no, the best position for somebody who has an active case of COVID-19 is prone because that optimizes ventilation profusion because of fluid dynamics and the anatomy of where the alveoli are. Andrew Ball (18:37): So I think that's important to understand because in performance, you know, we fast forwarding, we like to think about things like posture, right? Posture may, it can't hurt, but it's not going to make the huge effect that we think of. With some of the other respiratory structural kinds of problems. Can you see, Oh, taping can be somewhat helpful for folks who have breathing dysfunction and until folks get very, very, very far in their recovery process, that's probably not going to be helpful. When I talk about prone, these folks have been placed in a prone position for the minimum protocol I've seen is 12 hours, but usually it's somewhere between 16 and 18 hours a day and a 24 hour period to optimize ventilation perfusion. Jenna Kantor (19:35): Right. That's exactly right. Well, the other issue getting into the psychology of all this, Isolation, psychosis, delirium, and these are people who are in pain and I have a hard time taking a breath. Right? They can't have family members can't have family members in there. Right. So what do you think the impact of that is going to be when you see the patients six to eight weeks after the resolution of symptoms in outpatient or as a performance based therapist?   Andrew Ball: Yeah, it's going to be probable in more than 50% of cases, 54% of cases. It's going to have a huge mental health impact that you can see at least 12 months later as PTSD. Now, I don't know about you and the musicians or performers that you've worked with myself included. Andrew Ball (20:42): I don't think that we're the least bunch and you layer, post traumatic stress a top that and what you end up with if you don't understand that walking into the room with the patient when you do the evaluation or when you treat them is a whole group of individuals, half of these folks who are going to have behavioral reactions to everything from the frustrations of making their appointments down to frustrations with the treatment process. It's just going to blow up seemingly out of nowhere. And I'm here to tell you it's not out of nowhere. Jenna Kantor (21:25): I get it. When you're talking about the psychological component, Oh, that's such an untapped situation. This is also new to us. Jenna Kantor (21:39): I don't know. I mean I guess it would just, I mean, off the top of my head would just how I am with my people when I'm with them. It's just really checking in, just checking in, asking. I would just keep asking and being like, are you okay? Let me know if this is starting to freak you out in any way. I think that that's gonna be the big thing. Like I need you to feel comfortable. I need you to feel safe and has to just be that level of, I mean, which we always have any way, but a new level of thought process, you know, sensitivity where something like going, even prone could make them go, you know, and they don't even know. They don't realize they're doing it. Their whole body could just even just naturally tense up and it could just become harder to breath just because they develop a new habit to feel like that's what it's going to feel like when they're on their stomach. We don't know. Andrew Ball (22:28): Fortunately or unfortunately, there's a ton of research. Oh, I'm working with patients with post traumatic stress as a function of you know, I don't want to get political here, but as a function of endless military action that are had over the course of the past years. So there's a fair amount of information on that, but awareness is going to be critical in working with these patients. Going back to infection though the question that I get asked probably more often than anything else is when is it appropriate to begin working with these folks without personal protective gear? And the answer to that is, there's some guidelines from the European rehabilitation society, but we really don't know. What we know is that patients can go stealth and can be contagious long after their symptoms disappear. Andrew Ball (23:37): And there's at least one case study a well written case study showing that the symptoms that the patient can shed the virus for 37 days after they're no longer symptomatic. And the problem with that is that here in the United States testing is scarce, right? To diagnose it, to say nothing of when are you clear completely of the virus. I'm not aware of widespread secondary testing. And then some of the guidelines from like the world health organization suggest that someone needs to be tested. I think it was in China. Needs to be tested twice and have a negative result twice before they're clear. And if we're not doing that, then we really have to wait six to eight weeks. Andrew Ball (24:44): And that's why, because you're going to be long, long past what we know to be the longest reported case. Now whether or not your patient is that, you know, new one that can where they stick around shedding the virus for 42 days or 48 days, you know, we don't know. And one of the scarier things from a public health perspective for me is the recognition that this is an RNA virus, which means that it's going to be harder to create a vaccine because like the common cold, like the rhino virus it slips, it mutates quickly. No, fortunately that has not happened. Andrew Ball (25:49): But there is every reason to be worried. And I don't want to freak people out, but there's every reason to be concerned that if we don't kill this thing this year, that it's going to come back every year in a slightly different form, perhaps more contagious, perhaps more stealth, perhaps more deadly. Perhaps it will shed the virus for a longer period of time before we were able to begin working with patients, which kind of gets to that economic effect. I understand that people are hurting. I understand that folks have private practices and cash based practices that have limited cashflow and they're hurting. I totally get that. Yeah. I mean, you know, and folks go, Oh, you don't understand. You work in a situation where you don't own your own practice. Andrew Ball (27:01): Well, that's true. You know, I have a significant impact income from teaching. So, you know, I get it. I understand that the dollars are tight, but if you told me that if we shut down for an additional two weeks and we can kill this thing completely, I would do that even if that meant a significant decrease in my salary. And at some point, I think that, and I'm not saying that everyone is a clinical doctor in our profession, I've gotten some feedback for that. But as a clinical doctoring profession, I do think that we have a solemn responsibility to the public in terms of educating on COVID-19 versus kind of filling the Instagram space with Mmm. Lots of home workouts, which are important. People need to keep fit and certainly keep their minds going while they're in quarantine. Andrew Ball (28:10): The problem is that there's so many outpatient private practice, cash based PTs that have a such a voice on Instagram that some of this information about just the mechanics of the disease, the physiology of the disease, how long you need to wait in order to protect yourself and your patient from either reinfection or infecting others just isn't pushing through. So, once again, thank you for allowing me to come on this podcast because I do think that those of us who have a voice in that space have an obligation to get some of this information. Jenna Kantor (28:57): Wow. Yeah. Yeah. It really, it is very valuable. I want to actually dive in, even though we've been going for a while, I think it is important to dive into now somebody who had the ventilator. Yeah. I think that, that we can't overlook that. There will be some people who've been that unfortunate. So could you talk about what that means with somebody who has been fortunate to recover from such a horrific. Andrew Ball (29:28): Sure. So, as I said, about 80% of patients are going to have a mild to moderate and they won't be hospitalized. They may, because of the stress and strain on their lungs, they may develop pneumonia, so they may actually end up, you know, having secondary sputum. But those are folks who, even with the pneumonia are going to have something that we consider a fairly mild case. 20% are going to be severe to critical. And the severe group are the ones who are going to have dyspnea. They're the ones who are going to have rapid breathing that's defined as more than 30 per minute. Their oxygen saturation is going to drop to 93%, and they'll have on a cat scan, you'll be able to see lung infiltrate. That looks like kind of a grounded glass appearance of about 50%. Andrew Ball (30:30): So, and then you've got 14% that are severe that fit that classification and about 6% that are critical. And that's respiratory failure, septic shock, multiorgan failure. And within that group, okay 20%, about 25%, we'll end up in the intensive care unit most of which or many of which will end up on a ventilator. And if you end up in the ICU on a ventilator, your chance of survival is about 50%. So what tends to happen with that ventilated population is on roughly about day 14 we talked about how the viral load increases and then decreases while the inflammation increases. Well as the inflammation in the lung increases okay. A percentage of those folks, as I said, will end up roughly around day 15 needing to be ventilated for about four to five days. And half of them will come off and half of them will not. So the people who come off their recovery. So their recovery we don't, again, there haven't been a ton of folks, so we don't know a ton. What we do know is that in severe cases, there's going to be ICU acquired muscle weakness. They're going to have a severe loss of lung function, a severe loss of muscle mass. Andrew Ball (32:16): Yeah, we're getting younger too, but just as things been saying percentages. Yeah. neuropathy, myopathy. The good news is, is that we can begin to protect recovery. And the greatest, what we know is that the greatest amount in physical function will be seen. If the patient falls into acute respiratory failure, we'll see that within roughly the first two months of discharged. So that gives us some kind of a gauge. In addition the degree of disability at about a week after discharge determines the one year mortality and recovery trajectory of that individual. So we have some guidelines as far as that's concerned from acute respiratory distress syndrome, right? So that's not necessarily coded, but we believe that we can extrapolate in general what we haven't talked about is the impact on them. Andrew Ball (33:30): And the fact that about 30% of family members of individuals with acute respiratory syndrome end up with PTSD. So now you have this group, we're 50% of folks who have been in the ICU have PTSD and 30% those folks have family members who have PTSD. How do you think that's going to go down or like, a lot of them can't go into the hospital, but they can do a FaceTime video. So what they get to see in that FaceTime video with their loved ones in the hospital, I'm talking about after they're discharged. I'm talking about later. Yeah. No, but I'm just saying the family members with the person, I'm like their interaction. That's what I'm referring to, their reaction with it. If you're prone for 16 to 18 hours a day, right? Jenna Kantor (34:07): Yeah. So what do you do with these folks when you finally see them? Right. So you're going to have chocolate. Chocolate makes people happy. Right? It's funny, it's funny you say that. I'm doing a webinar with some some other instructors that I teach with and we're kind of talking about the format. And I'm a huge fan of the old school. I love the daily show, but I'm a huge fan of the old daily show with Craig Kilborne. He used to do the thing where he would like ask opinion questions. I'll ask you Reese's pieces or M&Ms no, I'm sorry. The correct answer is eminence. No, I'm sorry you were wrong. No, I would agree. But that's what he would say. Jenna Kantor (35:13): He would end with those kinds of questions. Kind of like his version of the James Lipton kind of five questions. What do you hope that God says when you die anyway, we're getting off track. So what I'd like to kind of go through is you're going to have folks that have worked with you in the past. They are post infection. Ah, they’re your dancers, they're your musicians in the pit. They're your directors. They're your loved ones that are going to refuse to see anyone. But yeah.   Andrew Ball: Right. And of those folks, you're going to need to know what to, you know, what to do. I would say if you hear nothing else from me, remember your vitals and there's, it has to be a Renaissance now of taking heart rate, taking respiratory rate, taking oxygen saturation, taking blood pressure with every patient. Andrew Ball (36:12): The functional tests that we're probably gonna have to start using are things like ambulatory distance, which is going to be severely decreased. We'll be lucky if some of these folks are able to walk 300 feet. Some of them, right, if they're severely impaired. You know, that's not far enough to get from your car to a doctor's office. You normally need about 500 feet for that to say nothing of getting back to your daily life and doing your own grocery shopping with which you need at a super target or R or Walmart, you need a good half mile, you need a good 2,500, 2,500 feet. But things like the five times sit to stand test or test that we're going to need to brush up on the six minute walk test. Fortunately we can remote monitor some of those things. Andrew Ball (37:05): Tele-Health isn't just you know, getting on a zoom call with somebody tele health, we need to think of that in an expanded way, right? There's apps that will allow for you to do a six minute walk test or your patient to do a six minute walk test and then send you those results remotely from there, from their app. Some folks aren't going to be able to walk for six minutes, right? So at that point we're going to have to back up into feet per second or four meters per second. And we have some metrics for that. You know, we know that somebody who's under 70 at a normal walking pace should be able to walk a good 2,500 feet at a 4.0 feet per second. So, you know, somebody comes in completely deconditioned and they're walking 1.5 feet per second for 500 feet. We've got some work to do. Jenna Kantor (38:36): Yeah, totally. Yeah. You know, don't forget about deep breathing, deep dive. And I don't just mean you know the breath, but I mean the breadth, I mean the deep diaphragmatic breathing, bringing it all the way down into your belly, your performers should be well for those dancers who sing, that's huge. That's so huge to reconnect with it, even though that may seem so basic with them before, but have they caught the disease. And, for sure to make sure that starts to get all connected and back in check and not a stressful Andrew Ball (38:43): Right. You know, and then I look into things that, Mmm, that as I've spoken with some cardiopulmonary specialist, you know, all of this comes from the European rehab society. I also want to plug the American physical therapy association. I shouldn't have done this at the very top of the of the discussion. But the pacer project, the post acute  COVID-19 exercise and rehabilitation program, it is completely free, but it's time intensive. Mmm. You know, they've tried to break things down into 45 minutes or hour and a half lectures, but there's like eight or 10 of them. You don't have to watch all of them. It's free. If you want to get the certification and the CEO's is fine, go through the APTA learning center, but they've put everything up on YouTube and all you have to do is search APTA cardiovascular section and you'll get the the literature. I think a lot of orthopedic sports performance based PTs they're really tech savvy and they kind of want to get the information through podcasts or a like a one hour presentation. So that's, well, essentially what I'm trying to do is to translate. Jenna Kantor (40:08): That's what's so great. I mean I'm going to be sharing this in groups as well to keep spreading the information, which is absolutely wonderful. This is good. Andrew Ball (40:21): Well, I do add in a couple of things that I've kind of brought to there. Okay. So some of their attention and because they're kind of case study oriented, they're like, well, we're really not teaching that. But particularly for it can't hurt. And particularly for performers humming and I don't mean like humming a song. I mean a long, deep droning Andrew Ball (40:52): There's evidence to suggest that it temporarily increases carbon dioxide and it temporarily increases nitric oxide. And in so doing leads to temporary base or dilation, so it can't hurt. I don't know how long it actually lasts. Certainly the deep breathing and increasing walking distance and walking speed is more important. But if you're bored and have nothing else to do while you're in quarantine humming is probably not thinkers would appreciate that. Jenna Kantor (41:28): They'd be like, yeah, for sure. That will be a vocal way for them to get that all connected. Also nasal, yeah, there's a lot of stuff with training and staying vocally fit, if you will. So that would actually speak to there values. Andrew Ball (41:44): Yeah. Yeah. I could go into a lot more here. I just want to make sure that that folks have a good kind basic understanding here. You know, we've heard, you know, wash your hands, wash your hands, wash your hands. So I'll make a plug for wash your hands, wash your hands, wash your hands. And even in some other countries where the health care workers understood the severity of COVID-19 the healthcare workers seem to be a risk to themselves because they didn't properly and thoroughly and frequently wash their hands. I would say whatever you think you're doing, it's probably not enough. Okay. The other thing that I would say about the hand sanitizers that we tend to use the world health organization and FDA suggest 75 to 80% alcohol. Andrew Ball (42:50): And that is not what most clinics have. Most have like the foam sanitizer or the like the Purell, which is 60%. Okay. You know, plugging performers amazing, okay. Guitarists, my performance Buddha and spirit animal is Ron Bumblefoot fall who is in the band spun. Do you know who that is? No, it's not the name. He's in sons of Apollo. He was the lead vocalist for Asia this last tour. And those of you who love guns and roses he was the guitarist the main guitarist on the last guns and roses album. Chinese democracy is ridiculous as a player and he's amazing as a teacher as well in any of that. He also has a line of hot sauce and one of the, and I just love when performers do this and kind of take responsibility for the position that we're in, but a Unitedsauces.com which is the distributor that he works with has retooled one of their lines to put out hand sanitizer that is 75 to 80% alcohol. Andrew Ball (44:20): So that will in fact kill the Corona virus. So, Mmm. Great. Local company here in Charlotte. Highly, highly recommend and plugged them. Hey, you want to support a performer you know, during these times. And the last thing that I will leave folks with is as you are working with patients post infection, ask yourself, do you need to put your hands on this patient? Can this be done remotely? And I'm really more talking you know, it really more talking to the folks who do outpatient work, who have their own side hustle who do work in a healthcare system who are going to be pulled inpatient, right? You know, either somewhere like New York city where you are. And folks have to be kind of pulled in, you know, right down to the rural hospital you know, in the middle of nowhere. Andrew Ball (45:32): And there's two physical therapists, one inpatient, one outpatient, and they need help working because now they have more folks that are getting ill. You know, really ask the question, both inpatient in your cash practice, in your private practice for the sake of killing this thing. And for the sake of decreasing whether or not you're a force vector, do you need to provide that treatment? And is there someone else who can be your hands? Can you delegate that to a nurse? Can you delegate that to a family member? I really think that we're going to a friend of mine who runs another podcast Adam Meakins, has been talking about physical therapy in terms of AC DC during COVID and after COVID. And I really think that all areas of practice are going to change as a result ranging from the little things that I just talked about, you know, having to do vital signs with everybody right down to really asking the question, can I go from an interdisciplinary model of care to a transdisciplinary model of care? Andrew Ball (46:58): Can I let go of that professional boundary and ego. And I know that a lot of my contemporaries are not going to be comfortable with that. I think we have to be secure in the knowledge that we have more than the hands that we place on people. It's all important, but I do think that there's going to be a paradigm shift. Jenna Kantor (47:30): I love it. Thank you. So, for coming on, Drew, this was an absolute joy. Where can people find you and reach out to you either on social media or email? Andrew Ball (47:39): Well they can reach out to me. I'm on Instagram @drdrewPT. They can email me at drdrewPT@gmail.com. If I don't respond, I have a ton of spam filters. So don't be shy about reaching out to me through social media. But I really want to make it clear. I'm not the expert here. The true experts, you know, are people like Steve Tepper Ellen Hilda grass Angela a beta Campbell Telia polic you know, these are the folks that we really should be talking to are Eric. And if you really want more information, I'm happy to direct people to it. Jenna Kantor (48:37): That is helpful. Yeah, absolutely. Andrew Ball (48:39): The Easter projects, the post acute COVID-19 exercise rehabilitation project is really where folks want to go for more in depth information from physiology to post acute through the entire spectrum of post acute care. Jenna Kantor (49:00): Absolutely. Thank you. Thank you. Thank you for coming on. You guys give a big shout out to him if you have seen this, just so he can really see how he has impacted so many. Thank you so much for coming on, Drew. Have a great day, everyone.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Elizabeth Santos on the show to discuss burnout among new graduates. Elizabeth Santos is a Physical Therapist, Naturopathic Practitioner and Author of 'New Graduate's Guide to Physiotherapy: Avoid Burnout and Injury, Build Resilience and Thrive in Clinical Practice’ an academic style of book designed to be a supplementary text for final year students and new graduates.  Elizabeth has a special interest in maternity health care and works for a talented team of physiotherapists in a musculoskeletal private practice that focuses predominantly on running and sports, pelvic floor health and pregnancy and postnatal care. She is also an active member of the Australian Physiotherapy Association, and a member of the University of Adelaide Physiotherapy Advisory Board. In this episode, we discuss: -Are new graduates prepared for clinical practice? -Why new graduates are most at risk for burnout -The signs and symptoms of burnout -Elizabeth’s book, New Graduate’s Guide to Physiotherapy: Avoid burnout and thrive in clinical practice -And so much more! Resources: Elizabeth Santos Facebook Elizabeth Santos LinkedIn Elizabeth Santos Website New Graduate's Guide to Physiotherapy: 10% off with code: hwspodcast   A big thank you to Net Health for sponsoring this episode!  Learn more about Secure Videoconferencing and Text Messaging for Telehealth.   For more information on Elizabeth: Elizabeth Santos is an Australian physical therapist, naturopathic practitioner and author of ‘New Graduate’s Guide to Physiotherapy.’ Elizabeth completed a bachelor of physiotherapy at the University of South Australia in 2006 and then went on to work across a range of clinical areas, from acute care within the public hospital system, to aged care,  rehabilitation in the home, and musculoskeletal physiotherapy where she now works exclusively. She has a special interest in maternity healthcare and works for a talented team of physiotherapists in a clinic that focuses mainly on running and sports, pelvic floor health and pregnancy and postnatal care. Elizabeth also completed a second bachelor degree in Health Sciences – Naturopathy in 2014 so that she could provide a holistic and integrative approach to her clients. Elizabeth is an active member of the Australian Physiotherapy Association (APA) and member of the University of Adelaide Physiotherapy Advisory Board. During her career, Elizabeth became curious about the pervasive burnout she saw in the profession so she spent seven years reading literature on the subjects of injury, attrition and burnout in physiotherapy. Elizabeth has written an academic style of book that is full of the latest research to guide new physical therapists and is designed to be a supplementary text for final-year students and new and recent graduates. The book covers key areas of clinical interest for new graduates, including how to successfully gain employment, find a mentor, understand insurance and medico-legal requirements, build relationships with clients and colleagues, and learn how to work through professional challenges as they arise. Elizabeth provides one-to-one mentoring for new graduate physical therapists and also hosts in-person and online workshops for helpers and health professionals who wish to prevent burnout, build resilience and truly thrive in the roles they have chosen. She believes that when we take good care of ourselves we can be of greatest service to others. Elizabeth’s intention is to help new graduate physiotherapists truly thrive in those first years of clinical practice and beyond.   Read the full transcript below: Karen Litzy (00:01): Hi Elizabeth, welcome to the podcast all the way from Australia. I'm so happy to have you on the program. Elizabeth Santos (00:08): Thank you for having me. Karen Litzy (00:09): And now a couple of weeks ago, this is just for the listeners, a couple of weeks ago, I interviewed Tavana Boggs on burnout and physical therapy and she was talking about some of the clients that she works with and yeah, we were sort of centering the talk around people who are 12 to 15 years out of physical therapy school. They've been practicing for a long time. So today we're taking a different take on burnout. So today we're going to be talking about avoiding burnout as a new graduate. And Elizabeth has written a book, new graduates guide to physiotherapy, avoid burnout and injury and build resilience and thrive in clinical practice. So we are going to talk about burnout with new grads because sadly it's a thing. Elizabeth Santos (01:01): Right? It is, it is. It's a thing. Karen Litzy (01:04): I wish it weren't, but it's a thing. So go. So talk about why you took the steps to write this book in the first place. Elizabeth Santos (01:14): Thank you for the introduction. And look. Firstly, I want to say it's a really exciting time to be a new graduate. I think there's so much opportunity for new graduates and for physiotherapists right now, particularly. I wrote this book last year. It was published. It really was the culmination of lots of reading and research over many, many years and actually took me seven years to put it all together. From the moment I started taking notes in the clinic one day just on some letterhead and I thought, Oh, you know, what's going on here? What's happening in the profession? I was curious about the burnout that I saw and also attrition. So physiotherapists leaving the profession because they were feeling unhappy or not really wanting to continue for some reason. I actually looked into some research on this and found a study from Curtin university in Perth, Western Australia. And that study showed that up to 65% of the participants interviewed who were new graduates anticipated leaving within 10 years. It was so, I thought, what's going on here? You know, why is this so high and what can we do about that? Karen Litzy (02:33): I mean that does seem very high. So they've just graduated and they already have the plans to get out of the profession. Elizabeth Santos (02:42): Yes, it was quite an alarming study and I've seen it those results actually communicated at conferences since and people bringing it up as a real talking point. Within the same study they found that 25% of participants predicted a long term career in physio therapy. So there were some people who were saying, you know, I am going to stick this out and I do see this as a long term plan, but not as many as you'd expect at that point in their studies. You'd be expecting them to come out fresh and excited and ready to take on the world. Karen Litzy (03:17): And what do you feel that it is a lack of readiness? Are they not ready for clinical practice? Are they not ready for the real world? I mean, what are your thoughts on that? Elizabeth Santos (03:30): That's a great question because that's also something that's been looked at in the literature a lot in Australia particularly, you know, that sense of our physio therapists actually ready to step into the real world and step into their shoes. As a clinician, you know, we try to make sure that physical therapists have adequate clinical placements and exposure to different areas of physiotherapy because we know that helps them to make decisions about their career pathway. You know, they've got that knowledge to draw on when they're choosing their first job or their second job. But there are other things that can help physio therapists prepare and feel job ready. So some of the things that have been highlighted in Australian research where that physios who have as students had experienced in sporting teams or had additional training in radiology. So people who've gone on to study and look at scans in a bit more detail, have had good experiences with that and that's inspired them to go on and perhaps work in orthopedics or musculoskeletal physiotherapy. Elizabeth Santos (04:43): We've also found that practicing building a supportive relationship and mentorships with colleagues, but also with other professionals. So whether that's social workers or psychologists or doctors and other allied health professions, that's become something that's really big. And there's lots of research behind that now as well. And just, you know, starting to think about which areas might interest you and what professional development you're going to go down. Which pathway are you going to go down once you graduate? And there's more and more internships which are becoming available too, which are privately operated internships through private practices and things. But yeah, so there's some of the things that new graduates can do to sort of help themselves feel that little bit more prepared and job ready. Karen Litzy (05:32): And so what I'm hearing is, you know, getting some inspiration from your placements, getting inspiration and that can come from different places, right? That can come from a mentor, like do they mention finding a good mentor, whether that be within your Institute, your educational institution or outside of, within the profession. Does that help with burnout? Elizabeth Santos (05:57): So there is some research to show that mentoring actually helps not only the new graduates, so the fresh physiotherapists coming through, but it actually helps the more experienced ones as well. It helps them to develop a sense of meaning in their work. So finding the right mentor is really crucial and I think for new graduates and for students really, you know, they've got that mentoring in built beautifully in the undergraduate training programs. So they've got these really inspiring, highly qualified, highly skilled therapists teaching them, taking them through step by step. And it's a really important relationship. But then when they become a new graduate, they suddenly lose that sense of being protected by the university. You know, they're out in the real world. It's like leaving home for the first time, you know, it's a little bit scary being out in the world. Elizabeth Santos (06:52): And then they've got to find mentors in other ways. And so there's two ways that you can go about finding a mentor and one is to have a mentor who's actually got really more of a vested interest in seeing you succeed. So they're the ones who probably your employer because they're going to want to see you grow and they want to see you help clients and they want to see you do the best that you can because it's going to be beneficial for you and it's going to be beneficial for the practice. But then there are other people who become mentors in your life because they've got some sort of interest in seeing you thrive as well. So it might be someone who's a family member who's a physical therapist or someone who's been an educator, but then you've formed a relationship that's perhaps, even outside the university, which does happen too with different training programs and things. So I guess it is a really important piece of the puzzle and something that, and new graduates can, you know, definitely look into and find someone who's gonna help them. Karen Litzy (07:59): Yeah. Yeah. And, one thing that I found very interesting from a conversation I had a couple of weeks ago about sort of helping new graduates find a roadmap for their career is to really be very clear on what your vision or what your individual mission statement is. Mmm. And it's hard, right? You really have to do some soul searching and find out what is your mission statement. And this is from Tracy Blake. She is a physiotherapist in Canada and she suggested that everyone have a mission statement and that that mission statement should not have jargon in it. It should not have physical therapy jargon, right? So you want to try and find what your mission is even as a new graduate. Write your mission out, repeat it over and over again. Elizabeth Santos (08:53): Tell it to people. So that becomes real. Karen Litzy (08:56): And I think that will help you gravitate towards the right mentor. Elizabeth Santos (09:02): Fantastic. I really love that. That's a great idea. And something that's really practical that the listeners who are tuning into this podcast can actually sit down and do it is it aligns with something that I read a while ago about new graduates and is actually in the book and I can't find the source unfortunately, but it was to picture your list in two years time and work towards it now. So if you can actually start, you know, that sense of who do I want to work with, what kind of clients really light me up, you know, who do I feel called to serve? And being okay with that changing over time as well and knowing that through different phases of your life. It, it may change for a little and that's okay. It was actually an experienced physiotherapist. I've just had a flash of the face where that quote came from, so I can't give him credit by name, but Karen Litzy (10:06): But that's fine. He'll know when he listened to that it was him. Yeah. And I always find that I love that you said it may change and morph over time because I think what gives people a lot of stress is that when you graduate, like let's say you say, I'm going to work with children, this is what I want to do, I know it, this is going to be my life's work. And then you start to work and you're like, you know, I kind of like working with athletes, I kind of like working with pregnant moms, moms to be right. Karen Litzy (10:42): I think to avoid some burnout and avoid some guilt, you have to give yourself permission to change because if you don't, I feel like you're carrying this baggage with you and can’t that also contribute to burnout. Especially if you're a year or two out and you're like, Oh wait a second, this isn't quite what I thought it was going to be. I kinda like doing this. But I said I was going to do this and now I guess I have to do it right. And I'm sure you've heard that before. Elizabeth Santos (11:10): Absolutely. And so knowing that the path will unfold step by step, job by job, and you may not be in the same role for 20 years if that doesn't feel aligned for you. And that's okay. And it's that sense of knowing and trusting, which yeah, it's just something that you cultivate over time and have to feel confident in. But it's hard in the beginning because I've heard a lot of new graduates say to me that they're concerned that if they take this first job in aged care, or if they take this first job in musculoskeletal private practice, then they're locked into that, you know, and there's no way out and there's no, and if they want to change their mind and do this, and quite often it's me then encouraging them just to make a decision. And I never you know, I never really help anyone to make a decision. Elizabeth Santos (12:04): I just help them to sort of look inside themselves and make lists of the things that light them up and like we've discussed. So that mission statement kind of idea is going to help them find the right path and then reconcile that and you know, and back themselves and go for it.   Karen Litzy: Yeah, I think that's great advice. And now in the book, Mmm. You also say that burnout as we are talking about is an issue for new physiotherapists, right? So we talked about some things that maybe they can do, but let's back it up. Why are they at risk for burnout if they haven't even started?   Elizabeth Santos: Hmm, good question. Because burnout is something that we know about and we've all talked about. We've heard about it, we've read articles, there's a huge body of research looking at burnout among nurses and doctors and psychologists. Elizabeth Santos (13:04): And there is a relatively smaller but growing body of research about burnout in physio-therapy too. And we know it's because there's parallels between those professions. And because physiotherapists in direct patient care, really with clients every day lots of different people from all walks of life. And there's lots of different social and psychosocial elements that go along with that. But on top of the therapeutic relationship that you're building with clients and all of those things, new graduates are juggling seeing more clients than before as well. So they might've been able to cope with seeing and processing, you know, the pain or the stories of three or four patients in one day. But then when they've got to do that for 20 or in some hospital environments and clinics, even more than that with classes and things, you know, it can take its toll. And so navigating that professional work environment and even for physiotherapists, you know, navigating their own personal processing of that can the mental load and it can add up to burn out. Elizabeth Santos (14:15): So I guess we can also hypothesize that new graduates are really trying to put their best foot forward too and they want to work really hard and they want to be as good as they can for their employers. So they're going to be at risk a little bit there too. Karen Litzy (14:52): Yeah. So it's a lot of external and internal pressures. Yeah. That kind of happened all at once. Right? You graduate and all of a sudden, boom, you've got all of these pressures from the outside. And how do you deal with that mentally and emotionally? And it almost makes me think that there should be a, maybe there are, I don't Sort of mental health support groups for new graduates so that they can almost like an alcoholics anonymous, right? So they can go in and discuss the things that are causing them to have these feelings of burnout. I don't know if that exists. Do you know, is that a thing? Elizabeth Santos (15:09): It doesn't to my knowledge, but it sounds like a great idea, you know, just that community. And look, I think there are some communities on Facebook that we possibly don't know about because we're not new graduates. And I do know of some student association groups and we certainly have some great new graduate programs through the professional association in Australia in terms of building those support networks in. So, you know, that's up and coming as well, which is really exciting. Karen Litzy (15:46): It's definitely a growth area. Awesome. All right. So let's talk about what are the signs of burnout? So signs of burnout. Let's say if you're the new grad or let's say you're someone like me who's been out for quite some time, can I see these signs of burnout in new graduates? So go ahead. Elizabeth Santos (16:07): Yes, you can definitely see signs of burnout in people. And I think it's important to differentiate signs and symptoms just like you would if you were, you know, a medical practitioner. Even as physiotherapists, we do look at those things separately. So the signs would be seeing that reduced employee engagement. So perhaps loss of enthusiasm for new projects or for jobs that you're given. Perhaps less willingness to contribute. A sense of lack of transparency around how you're really feeling or what's really going on for you. So quite often new graduates will try and hide their emotions a little bit or hide that vulnerability and just put, you know, hold their chin high and keep going instead of being honest about where they're actually at. If we look at symptoms, they're actually the things that you're feeling as a physiotherapist. So whether you're a new graduate or an experienced physiotherapists, they're going to be quite similar. Elizabeth Santos (17:13): So they will be things like fatigue. It's going to be different for everyone, but you might get headaches or you might feel nauseous at work or you might have a sinking feeling or that sense of dread about going to work. For some new graduates I've spoken to, they've even been in tears in the car going into the job in extreme cases where they're feeling not supported in their workplace or they're feeling like they want to quit or leave that particular role. So it's actually coaching people through those feelings, those emotions because they're the symptoms. You actually manifest in the body. But then there are the signs which are those bigger picture things which people on the outside looking in tend to see. If we look a little bit deeper, we can actually look at some of the research around this and look at the validated tools which have been used to assess the burnout in society. Elizabeth Santos (18:13): So particularly in the health professions, the mass like burnout inventory has been used. And this is a 22 item outcome measurement tool, which takes about 10 or 15 minutes to complete and it's been considered the gold standard since it was created in the 1980s it's obviously been updated since then and there are now five different inventories which are used across different settings. And they're used in the research a lot because they contain some great questions which respondents can answer. So things like I feel used up at the end of the day and you would score that with never being a zero through two every day being a six. And there's different subsets within the outcome tool so you can score each subset or each part of it. And what it does is it actually provides some information for people who are looking at burnout in different populations and it helps to categorize them into three distinct categories. Elizabeth Santos (19:17): So the first one is emotional exhaustion, which is where physical therapists become depleted and they might be starting to feel a bit fatigued or some of those symptoms I mentioned. And this then leads to that second stage of burnout, which is called depersonalization in which the physiotherapists stops empathizing as well as they normally would and they might even start to become detached from their clients or show signs of cynicism, which is unfortunately not a good sign as a practitioner if you're having a dig at clients or locking them in some way. Yeah, it's a sign of burnout and then that third stage, yeah, it's reduced personal accomplishment. So for new graduates this might look like, you know, compromised standards of care or reduced sense of personal achievement. Then starting to wonder if they're even a good physio at all, if they even know anything at all. And that kind of ties in with the imposter syndrome and you know, that sense of being a fraud, which I talk about in the book as well, that these are all things that you can look at if these signs are starting to emerge and take some action, talk it through, find some strategies.   Karen Litzy: And I was just thinking as an employer, is this, let's say doing this Burt, the mass, like burnout, inventory, giving this to your employees, is that a good or a bad thing? Elizabeth Santos (20:49): I can a great question. I can't quite put my finger on that. It could go either way, couldn't it? It could, right? It could go either way. And sometimes just sitting down and having those honest conversations and actually you don't necessarily need to ask your employees if they're feeling burnt out, but you can check in on engagement and check in on, you know, are they feeling inspired? Do they have enough to work on? What kind of clients do they want to be working with? Looking at the personal mission statement stuff, sharing wins, you know, that's a big one. That sense of positivity. And that's something we do in the clinic a lot as a team, which is fantastic. Karen Litzy (21:31): That is fantastic. And, and I would imagine that all of that just becomes, just gives that new graduate, especially a sense of being taken care of. We spoke a little bit beforehand and we talked about the word comfort. So I can only imagine if you're the employer, if you're the more experienced, even if you're not the employer, if even if you're the more experienced physical therapist in the clinic or in the hospital and you're just checking in with people on a weekly basis, ask them, how are you doing? How can I help? What do you need help with? Are you stuck? I can only imagine that it would give, cause I know when people check in on me, it does give me a sense of comfort like, Oh, this person's in my corner. This is great. Elizabeth Santos (22:16): Yes. It's just that caring approach that we have to our clients that we need to then reflect out into the world, you know, for our team and checking in on people is a beautiful way to do that. And then extending that care to ourselves as well. So going, am I okay? Actually, no, I'm not. What's going on for me? What do I need to do about that? How can I take responsibility for changing that with the support of my employer? Karen Litzy (22:44): Yeah. Yeah. So again, we go back to having that both internal and external check-in, which seems to be a theme here. Okay. So what other big issues do new graduates face at the moment? So just so people know, we are recording this, it is in the middle of the covid-19 pandemic and there are changes in health systems, changes all around the world. How will new grads be affected by this? Elizabeth Santos (23:15): I think there is a level of uncertainty about the impact of covid-19 across the board at the moment. And we can hypothesize that the current situation is going to impact on physiotherapists who are final year students who are graduating out into the world. They're going to be unsure about what's available for them, you know, where they're going to be needed. Certainly clinical placements are going to be impacted. This at the moment, and this is something that I know in Australia we're working really hard on the Australian physiotherapy association as part of their advocacy role, which is wonderful. Just protecting those and making sure that we've got those roles for physiotherapy students and that they're getting all the experience they need because they do need that experience. I think we're going to see some really positive things in terms of the workforce because we're going to see more jobs. Elizabeth Santos (24:13): So it's actually a really positive time and a really exciting time to be a new graduate physiotherapists. So if you can look at that and think, you know, we are going to need therapy physiotherapists in key roles in assessment and treatment of injury both in the community, in the hospital setting, helping to increase or facilitate discharge I should say, and making sure that, you know, clients are actually, patients are leaving the hospital system in due course. You know, we really need those beds and the staff to be looking after people who of all walks, you know, they're still going to be in the hospital system, but yet really we need physiotherapists on the frontline as essential workers. We're seeing a huge uptake in telehealth at the moment, which is also really exciting. And that's because of the social distancing policies that are being put in place. Well clinics and hospitals remain open. Some people are still having services in those clinics and in the hospitals, but there is a large movement towards the telehealth sphere. So this is something really exciting that new graduates can learn about and put into their toolkit for use now and into the future as well. Elizabeth Santos (25:34): I don't see tele-health going away when social distancing rules are lessened. So I think as a new graduate it is really exciting to be able to have so many options. And because of the pandemic, all of these people who are sick and who are recovering, they're going to need our help. You know, like you said, we are essential and I think that as a new graduate that really at this point, yes, there's a lot of uncertainty but there's uncertainty across the board. But I don't think that new graduates have to be in great despair at the moment. I understand, you know those final year students who like you said, are trying to get their clinical placements, which is all over the place and just graduate for God's sakes are having a lot of stress at the moment. But I agree, I think that physical therapists or physiotherapists are in a unique position here to really show up and be part of the team. Karen Litzy (26:44): Earlier you mentioned being part of the team of physicians and nurses and doctors and psychologists. I mean we are going to be an essential part of that team. So hopefully if the research shows that being part of a team helps with burnout, it'll help with our new graduates now. Elizabeth Santos (27:02): Absolutely. And there are those vulnerable groups and vulnerable patients who are really going to need the support that physiotherapists have to provide and anyone in the community who's wanting to keep their exercises going and do those online classes and all of those opportunities which are unfolding. It's a great and exciting time to be part of the profession. Karen Litzy (27:23): I can't agree more. And now how can new graduate physios keep confident and keep positive? Right now we've said, Hey, it's, you know, it's not like it's a horrible time to be a PT, but how can they keep confident, positive and take care of themselves? Elizabeth Santos (27:42): That sense of reassurance I'd like to really impart, you know, just for new graduates to keep taking care of themselves. It's those simple things that they can do, like making sure that they keep their nutrition up and exercise and really try and inspire themselves at the moment and look after themselves and get plenty of sleep and those basic things which are useful for anyone to be honest. Because we all need to be practicing good sleep hygiene, keeping off our phones or having some boundaries around social media and the news and just looking for jobs, getting support with looking for jobs if they're in that phase, reaching out to a mentor, a debriefing if they've just started in a new role this year. So making sure that if things feel overwhelming or if they're unsure that they're asking for help and that they're asking questions and that they're supporting their teammates as well. You know, every country is going through lots of changes and there are some really sad and heartbreaking things happening in the world and we can't look away from those and we can't ignore them, but we can stay still keep moving forward as individuals and as a profession and feel hopeful about the role that we have to play. Karen Litzy (29:01): Yeah, I agree. And I think that was very well said. Now Elizabeth, let's talk, can you talk a little bit about the book. Elizabeth Santos (29:09): Good, thank you. I am really excited to reach as many new graduate physios who need this reassurance and this support the people who are looking for that sense of comfort or unsure about which role is right for them. So it's a mentor in your pocket style of book, which has an academic undertone. So there's lots of research in there. But then there's some light and funny comics which I had commissioned as well to kind of make it a little bit more enticing read so it wasn't dry because if it's too evidence heavy it can sometimes be hard to sift through. But our physiotherapists are good at that and it's designed to help you navigate all of the tricky areas as a new graduate. So things like negotiating a contract, building therapeutic relationships with clients, how to find the right mentor, how to choose professional development. Elizabeth Santos (30:11): So what you should be doing versus what your employer perhaps thinks you should be doing or what you know based on your mission statement I think is a good way to choose. But it also talks about the highs and the lows that you might experience and the mistakes that you'll probably make, which are part and parcel of being a physical therapist and then how to put all of that together and sort of trust the journey as it unfolds and build resilience over time. And it's written in the third person. So as I said in that sort of academic tone, but then there are some simple questions, journal prompts at the end of each chapter that you can workshop as well. And I'm happy to support people through because I think it helps to have that self reflection and actually to write some things down and go, what is working for me and what's not and what am I having trouble with here? Elizabeth Santos (31:04): So it's designed to help them kind of workshop and for it to be a little bit like a Bible for that first year or two. So if they have a really rough day, they can actually go home and flick it open to that chapter and go, okay, what happened here? What could I do differently? How could I learn from perhaps some of the mistakes that are talked about in the book, you know, and how can I integrate this and move forward and get the best outcome for myself and for the client, for the practice, for the team if I'm in a hospital or wherever I might be. Karen Litzy (31:37): Nice. So it's more than just a once read and done. You can go back to it and kind of use the tools in the book over and over again, which I think is great. And just for all the listeners for a limited time, Elizabeth is offering a 10% discount on her book when you use the code HWSpodcast at checkout. And we'll have her website, which is ElizabethSantos.com.edu over at podcast.healthywealthysmart.com and we'll splash it across social media. So we'll make it really, really easy to do this. So again the discount code is HWSpodcast. So Elizabeth, I've asked the same question to everyone at the end of each interview and I feel like in this particular episode it is the perfect question to end with. And that is knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad? Elizabeth Santos (32:37): It's a lovely question. Funnily enough, I taught to my younger self a lot when I wrote this book because I needed her insights and I needed her stories and she had a lot of wisdom to share, which I wove through the book. And it wasn't just my experiences, it was all of the experiences of all the physiotherapists I'd ever known and spoken to. So it was a real collective of wisdom and inspiration that went into the book. And I'm grateful for that. And it's a nice moment to thank all of those people who were part of it in some way because it's created a meaningful resource. But if I could go back to 2006 I would say congratulations. And I know how excited I was at that time. And I would probably say straight up, listen, you're going to make some mistakes, you're going to make a lot of mistakes and you're going to really want to beat yourself up about those. Elizabeth Santos (33:38): And you're going to question the choices you've made in therapy and in your career. And you won't know if you made the right choice, but you'll have to back yourself and you'll have to know that you are enough and you have got a lot of knowledge to share. And you know, it's student experiences and it's life experience as well. So I always encourage new graduates to really draw on everything they have and know that they're always going to be in some small way, the expert in the room, you know, even if you think you don't know anything you actually do and you can draw on, okay. That strength and that knowledge in those moments. But I'd also really offer some words of comfort because it's hard to know if you're doing the right thing and it's hard to know if you've made those right choices. Elizabeth Santos (34:30): I'd tell myself to take some regular holidays too because I know I didn't do that enough in my first couple of years, so yeah, but just knowing that you can inspire others and that you can inspire yourself is probably the biggest and yeah, it's a really exciting time for all the physios out there and I hope that they can find some inspiration in this podcast and in these answers.   Karen Litzy: Thank you. I'm sure they will. And now, Elizabeth, where can people find you on social media?   Elizabeth Santos: So on social media, they can find me at whole living with Elizabeth Santos, which is my Facebook page, but the website, ElizabethSantos.com.edu probably has the most amount of resources and it has links to my new graduate mentoring and people can connect with me through email that way. And I do actually have a free chapter of the book available. If you want to jump on the email, you can do that and I'll send you a chapter to read and get a bit of a feel for what the book's about. Karen Litzy (35:38): Perfect. Well thank you so much. This was great and I just know that I think it will give new graduates inspiration. I think it will give new graduates a sense of comfort and of confidence as they go out into the world. So thank you so much Elizabeth. This was great. And to everyone listening, thank you so much. Have a great couple of days and stay healthy, wealthy, and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jason Van Orden on the show to discuss personal branding strategies. Jason helps thought leaders to reach a larger audience with their ideas, create new income streams from their expertise, and build business models that align with their values and goals. As a consultant, trainer, and strategist, he draws from more than fourteen years of researching top Internet influencers and experimenting with his own personal experience. His experience includes creating multiple successful brands, launching over 60 online courses, teaching more than 10,000 entrepreneurs, generating seven figures in online course sales, and 8 million downloads of his podcast. His mission is to help visionaries with impactful ideas to connect with the people they serve best and the problems they can most uniquely solve. In this episode, we discuss: -Three keys to good brand positioning -How to overcome imposter syndrome and position yourself as an expert -The magnetic messaging framework -The compounding effect of your impact on the world -And so much more!   Resources: Jason Van Orden Website Jason Van Orden Facebook Jason Van Orden Business Page Jason Van Orden Twitter Jason Van Orden LinkedIn Jason Van Orden Instagram Impact Podcast Free Gift: https://impactdownloads.com/messaging   For more information on Jason: Since 2005, Jason has worked with over 6000 students and clients, teaching them how to monetize their unique brilliance with content marketing, scalable courses, and automated sales systems. Many of his and students have built multi-million dollar businesses and have become top authors, bloggers, podcasters, and speakers in their field. In September of 2005, Jason co-founded the first ever podcast about internet business and online marketing. It quickly became one of the top business podcasts in the world. To this day it’s one of the most profitable podcasts on iTunes — having generated millions of dollars in sales directly from his podcast. Jason has spoken around the world at some of the biggest conferences (such as CES, National Association of Broadcasters, New Media Expo, and many others) teaching how to use Internet media to launch and grow influential personal brands. In 2006, he wrote the bestselling book, Promoting Your Podcast, in which he was the first to “crack the code” for optimizing podcasts to get maximum exposure on iTunes. His work has been used to teach marketing at the university level and has been referenced on sites such as Forbes.com and Entrepreneur.com. He also practices what he preaches, having created world-class, influential brands of his own.   Read the full transcript below: Karen Litzy (00:01): Hey Jason, welcome to the podcast. I am so happy to have you on today. Jason Van Orden (00:05): Well it's great to be here. Karen, thank you so much for having me. Karen Litzy (00:08): Yes, and as you know, I've been a fan of yours for a while and as my audience knows, I actually took your course on how to kind of juice up your podcast last year and I thought it was super helpful. So I want to thank you for that and I sort of raved about it to my fans on social media and here in the podcast. So it's such a, it's going to be so great to have you on today. So, yeah, thanks. And today we're going to be talking about if creating an irresistible brand and then once you have that brand, how do you create sources of income? Because of course we all want to make a living, we all want to help as many people as we can while we're doing it. But the first question I have for you is, what is your definition of a irresistible brand? Jason Van Orden (01:04): Sure, yeah. Good question. So in the work that I do, you know, I work with people who have expertise that they want to get out there in a bigger way and you know, some kind of message, some kind of stories. So you know, they really want to be recognized or known or even just increase their own ability to help and impact and reach people with what they do. So just to let people know, I'll be talking mostly in the vein of what a personal brand is. I know sometimes we would hear a brand and we think like Coca Cola or AT and T and certainly there are much bigger brand companies as well, but we also don't want to confuse it with brand identity like logos and like your letter head. And certainly, you know, those are assets that get used in order to maybe establish a recognition of a brand. Jason Van Orden (01:49): But really, yeah, what we'll be talking about and how I define as much more about like how are you perceived in the marketplace, especially by those that you want to reach and do business with you, you know, the people that you want to serve and that you want to perk up, pay attention, and listen when you've got something cool to share or sell or you know, offer as help. So, it has to do with, you know, them seeing, you know, here's who you are, here's what you do, here's who you help and here's what you have to offer to them. And hopefully those perceptions are accurate and complete and compelling so that you successfully can get their attention and move them towards doing business with you. So that's kind of an in brief how I would make some of the specifications of the word brand to make sure that we're clear about what we're talking about. Karen Litzy (02:38): Yeah. And I think that's really helpful because I think you're exactly right. When people think of brands, they do think of those big international, huge brands, like you said, Coca-Cola, Nike, Apple, which is certainly a brand. But I think for the sake of the audience listening to this, they want to know about that more personal brand identity that you were talking about. So let's talk about how to create that. So how do you create this sort of irresistible brand that you want your ideal customers, you want to be perceived as something that is so necessary for them. How do you create that? Jason Van Orden (03:21): So yeah, there are three pieces to having a good brand positioning. And, and by position, I mean, again, establishing that place in the marketplace that you want to sit. And so the first is to know like, okay, well here's who I ideally want to reach and serve and being very clear about that. I mean, there's an example I use for instance, digital photography is, I have a recently a client I was working with, who wanted, you know, a successful digital photographer wanted to get out there and help other digital photographers. You know, had great career, great clients and projects and things, and he knew there are a lot of people who kind of knew his work and wanted to be, do some of what he had been able to accomplish. And so, you know, I was like, okay, great. Jason Van Orden (04:09): I want to build up my brand more and not just you know, do this. This work where I got hired to go and do thermography and digital photography. And so I said, well, we need to get very clear about who do you want to help with these skills. Is it the already established professional? Is it the somebody who wants to make that jump now to being a professional, you know, they've studied and they've, you know, pretty serious hobbyist or something. Or do you want to help people who just have an iPhone and wanting to take more beautiful pictures with their iPhone? Like these are all different audiences, but under that umbrella of digital photography. So it's being very clear. And sometimes that's specifying a specific demographic though it needs to go. I think even in much, much deeper than that. Jason Van Orden (04:51): And you know, are there certain age groups, but the biggest thing to really understand is what are the outcomes or results that you want to help them to reach? I think it's really important to define the target customer, the intended customer in that way. Because when it comes down to it, I mean their age and their gender or these different things might help you if you're running ads and want to know where to reach them. But really ultimately the way you want to define them as it's like, Oh, these are their unfulfilled needs. These are what are the things they're actively looking for. These are the pains they're experiencing or the goals that they haven't met that they would like to meet. And those are the things that I can help them with, which is the second piece. Jason Van Orden (05:35): Once you know the ideal customer that you want to reach and serve, the second piece is, Okay, well how do you want to serve them? What are you going to deliver if you are there specific ones of their pains that you want to help them with or the unfulfilled goals that you want to help them with. And we call that, you know, the value proposition or the thing that you are presenting to them, whether, you know, and might be as services or products or other things we can get. It's a into that later. But so it's who are you serving, how are you going to serve them? And then there's also this third piece that's just who you are. And particularly in the work that I do and helping people with their personal branding there's a lot of noise on the internet and it can feel sometimes if you are somebody who ever does post on Facebook or put something out there and maybe you're hoping people might see it, it's easy to feel like, Oh, that's just going to get lost in this sea of sameness. Jason Van Orden (06:31): And so many people saying different things or the same seemingly the same things. And it's knowing that as tried as this might sound, you know, we each have our unique perspective, our unique approach, the experiences we've been through. We have our you know, our approach to things to bring to the table. And in the same way, here's my vision for people who want to have a personal brand is that in the same way that Spotify now has really trained us to be able to find whatever we want to listen to. I mean, whatever genre, whatever into your popular music like you can, there's a vast catalog and now it's not about what 100 CDs you own. It's like now you like near infinite choice. And so you have these very personalized playlist and stuff and Spotify is insanely good at them. Jason Van Orden (07:19): Making recommendations for us as well in that same way, be thanks to the internet over the last 10, 15 years, all the other myriad of problems and populations who need help out there and in solving and guidance, you know, there's a slice of the world that's looking for your approach, for your flavor. You are that hidden gem of a band on Spotify, quote unquote, right. So it's something about the way you show up and make them feel they're present the information or guide them or the values you have or some kind of shared meaning or something where you know, you seem a lot like they, you know, you've been in the place that they have in the past and they resonate with that. So that's the third piece of the personal brand is knowing what you bring to the table in those ways. Jason Van Orden (08:06): And it just really owning and realizing that you do have that perspective that many people will want to specifically hear from you.   Karen Litzy: Okay. Wow. Okay. So I am going to recap that really quickly. So first you're where you want to be clear about who you want to serve. Then you want to be clear on how you're going to serve them. And then who are you and what do you bring to the table? I mean these are, I feel like number one kind of getting clear about who you want to serve. I don't know for me that's probably the easiest of the three. But getting, I think drilling down to who are you and what do you bring to the table that can be kind of difficult to pull out of yourself. Do you have any tips for the listeners on how they might be able to do that? Jason Van Orden (09:04): Absolutely. For me, I'm being totally selfish, absolutely not a problem. It can be hard to uncover those things. And one of the reasons why is that we often don't see what is interesting or special or valuable because it's commonplace to us and you know, and then just get old human nature. We haven't yet imposture syndrome or just feel like, Oh to like, you know, say, Oh, I'm strong in this area. Just feels not humble or something. So, you know, these things get in our way of seeing what we have to offer. And so in the work that I do, I have a lot of exercises and frameworks and things that I walk clients through to help them uncover and discover the different parts of their voice and that we're talking about. So I'll just drill into to one area here that I think is really important. Jason Van Orden (09:53): Like I said, very noisy on the internet, but if you can get this, this sense of resonance resonances, you know, if you've ever you know, maybe you've been seeing it in the shower or something happened, just hear it just the right note and it's just like, Ooh, it just gets really big. And because you hit just that right note that in that space sounds really big and that's what you want when somebody comes across you and your message. So here's a little framework in my research about personal branding, I've seen a lot of work. I've seen a lot of research I've done out there about the importance of purpose based brands. And when I say that I'm talking about companies like whole foods or Patagonia, there's a very specific identity. They stand for certain things. They have a certain vision of the future. Jason Van Orden (10:38): They guide their company according to that. Their messaging community, certain things in a very clear and compelling way. And that's just two of many examples I could go to. And the research is clear that that leads to more loyal customers, repeat customers, you know, fans and advocates that share your stuff with other people. And this is what consumers want today. Thank goodness. You know, I think 10, 15 years of some really just like shenanigans in the corporate world, not only I dimension, just upcoming generation of millennials, that purpose based stuff has gotten really, really important. So what does that mean for you? How can you you know, if you're feeling driven by all this, you probably do have some kind of purpose inside you. But what does that even mean to like clarify and communicate that? So here's a little framework that I have. Jason Van Orden (11:23): I went and I study kind of the work I've done helping build personal brands as well as some of these companies and what they do. And I came up with five elements. I'll just briefly go through, I call this the magnetic messaging framework and it is one of many facets he can pull up to really find that uniqueness about you. So first thing is beliefs. What do you believe at the core that drives the core of the work that you do? What do you believe about the world? What do you believe that maybe goes counter to what is popular, you know, wisdom in your industry. What do you want the people that you want to reach and serve? What do you want them to believe after they've worked with you or come across, you know, your offerings, what do you want them to believe about themselves and about the world? Jason Van Orden (12:04): So I'll just use myself as a quick example here. I have this belief that we do need more people out there building that personal brand, rising up and owning it and going and finding that slice of the world that they can help. And if we can have a ground swell of that will solve a lot more of the world's problems than if we were just to leave it to, you know, big corporations, big organizations, government, whatever. I mean, Hey, they have their part to plead to. But this is a wonderful opportunity the internet has given us. And that's a belief that I have one of many that drive my work. Second of all, vision, what is the vision you have of the future? I'm not talking about just a vision statement for your business and all that might be important, but paint a picture like this is the future I want to see and work for and create. Jason Van Orden (12:44): I'll give you an example from another woman that I was coaching where she is in the health. And actually she was in the dieting, you know, what you'd call even the dieting industry and she has as a recently in last couple of years, stop using that word at all. She came across some research and things. She said, that's it. I gotta stop talking about dieting when it comes to the women I'm working with, you know, with helping them love their bodies and different things. And, you know, she decided I have to take a completely different approach and she now believes it has this vision of the future where like we get rid of the dieting industry or that world, it may seem like a huge daunting task, which is like, we absolutely need to take that down. It is not serving us well. Jason Van Orden (13:22): So that's, you know, a big vision thing. It's bigger than her. And when people do business with her, they are, they also see themselves as being a part of that and people want to be part of something bigger. Again, going back to companies like Patagonia or whole foods, there is a certain vision you know, Patagonia is all about like the sustainable future, right? So what does that vision you want to create? So beliefs and vision, value, we always talk already talked about it a little bit as being very clear about what you offer to them, what's in it for them if they do business for you. The fourth thing is contribution. So what do you bring? What does your work do that goes beyond the monetary exchange and the value exchange with your customer. I mean, that's important and they pay you and you render a service or give them the product or whatever the case may be. Jason Van Orden (14:04): But how does that contribute to the community or the industry or even the world at large? And I'd like to think that in the work that I do helping elevate all of these thought leaders that it contributes in that will solve more of the world's problems. I mean, I'm not claiming that myself, I can go in and help enough people to solve all the world's problems, but I'll make more of the dent if I help more people find with their ideas and their expertise, the people in the problems in the populations they can help the most. And so that's how I see my work contributing even beyond what it does for directly to my icons, my customers. And then the final thing is a reason why you do what you do other than making money. And for me, once I was one simple example is I see it as a compounding of my own impact and specifically working with people who want to have a personal brand and be a thought leader or get their ideas and things out there in a bigger way. Jason Van Orden (14:58): It's like, well, Hey, it's like compound interest. I help you know, a person they go help 10 or a hundred or a thousand. Then I helped another person and they help 10 or a hundred or thousand. And so that's a reason why I do what I do besides money or the freedom directly benefiting to me. So those five things, beliefs, vision, value, contribution, and reason why, if you flesh those things out and then talk about them in your content and your keynote speeches with your clients in your marketing, in your say on your website, on your about page, on your social media, now you're going to be creating something that really has a uniqueness around it. And that's one key way to do that. Karen Litzy (15:35): That was great. Thank you so much. And I really loved that end piece. How you finished on that? That concept of compound interest. Yeah. Because oftentimes we don't think about what we do as effecting the, we kind of only think about it as I am working with a patient and I make a difference in that patient's life. Right? But I'm not thinking that because I made a difference in this patient's life. They were able to make a difference in their children or their parents or their friends or their family because they're going out and doing what they're meant to do because I help them do that. Karen Litzy (16:18): And I just, yeah, I just, I love that concept and I don't think I've heard it really put quite that way before. And I think it's just wonderful to think about it that way so that when, cause oftentimes as healthcare providers we can be a little shy, I guess it could be the word or uncomfortable with asking for monetary exchange for what we do. Right, right. And yeah, a lot of times, especially in healthcare, you're tied to that insurance system where, you know, you're waiting for the insurance to pay you or you could have a cash based business where the patient pays you directly. But so often there's this shyness or this inability to kind of ask for that monetary contribution. And I think people get so fixated on that that you forget about all the other stuff that you're doing. That sort of compound interest that you said goes beyond that monetary amount. Because I think if people see that, then the monetary amount, yes, we need to make a living, but people will be like, yeah, sure, here you go. I get it. Jason Van Orden (17:33): Yeah. Right. And when they understand yeah, and it definitely comes across again, by the time they do business with you, with this kind of messaging. Yeah. People, not only are they just like identified with you and like, no, I want, I want you, I want to be the one to help me. But yeah, they understand that and whether it's conscious or unconscious and says, yeah, this idea of like, Oh, I'm also part of something a little bigger than me here. This is cool. You know? And that's what people want these days. Karen Litzy (17:59): Yeah, absolutely. Well, now let's say we fast forward. We have gone through that framework. We feel like we have a good solid footing on what our brand is and our messaging. So let's step into now how to create sources of income from that messaging. And that messaging, of course, is using our expertise. Jason Van Orden (18:28): Yeah. So when it comes to creating different sources of income, there's one key asset to be very clear with. And then I can share another four-part framework. I'm big fan of frameworks and we've actually covered some of the pieces of that framework which are being very clear. So there's four pieces to coming up with some kind of offer. When I say offer, it could be a service, it could be a product, you know, something that you're offering to people to buy and exchange value with you. So the first piece is well, we already talked about knowing very clearly who your ideal audience, customer client is. And then the second piece is being very clear about understanding the outcomes and the results and the unfulfilled needs. What's most important to them, what's top of mind? What is their, what I call their tooth ache, pain and other, they literally have a two thing. Jason Van Orden (19:18): But I use that as an example because if we have a tooth ache and it's not going away, we're going to call the dentist and go get it checked out. Right? It suddenly becomes a top of mind thing. So how do you know what that is? Well, you go when you talk to them. I'm always encouraging my clients to go and do market research in the form of having conversations with people who fit the description of their ideal person, the person that they want to reach. And this could be current clients or past clients are also just people who aren't, haven't done business with them. But you know, for you, Karen could be listeners of your podcast or people who are on your email newsletter list and you know if you regularly get on the phone with them and it's not to say like, Hey, I have this idea for a product. Jason Van Orden (19:59): What do you think? It's really to listen a lot and ask good questions to hear about their experience. You know, what are they dealing with? What are they trying to accomplish? Why haven't they reached that? That's the big thing is why haven't they been able to do that thing that they want to do yet? What myths and misconceptions are they maybe dealing with? What questions do they have? What's not? What knowledge gaps, what tools do they need to acquire, what have they tried before that maybe didn't work for them? So you know, the better you understand their experience in this way, then you as the expert can, you'll see the through lines, the thread that draws the jury, that ties these conversations together. And you can kind of like read the tea leaves so to speak and go, Oh, okay, I'm seeing something that's missing here. Jason Van Orden (20:36): Or something that I think that I could do in a particularly helpful way. And then at that point, you've got, you know, those first two key components, your ideal customer and their ideal thing that's really important to them. And that's, we're going to come up with a great, a great offer. Now to get a little more specific at that point, you as the expert have some kind of process and this is the third piece, some kind of process for helping them get from a to B. You know, so if you're a physical therapist, I mean, I, I'm not claiming to know that much about physical therapy, right? But like I've done some before. I had a knee injury and then you need to get some range of motion back. Right? So the third, the physical therapist I went to see, you know, immediately, you know, it was assessing and everything and then in her mind was, you know, going, okay, yeah, here are the things we're going to need to do to do over the next several weeks. Jason Van Orden (21:25): Then a process to bring that to bring that about. I have a certain process that I go through to help my clients, you know, figure out what their personal brand is or you know, create and launch their first online pro, you know, I different. And so if you're very clear about what that process is and particularly kind of your unique approach to it, again, going back to what's unique about what you offer that process now is something that you can wrap in a variety of what I call experiences, which is the fourth piece. So we have the ideal client or customer, we have their ideal outcome. We have your process for helping them reach that outcome. And now it's just a matter of wrapping it in different experiences. Now, here's what I mean by that. If we imagine a spectrum and on one end of the spectrum is kind of your, what I call your high end high high touch offers. Jason Van Orden (22:13): So that would be, you know, as a physical therapist, the hands on one-on-one work as a consultant, as a coach showing up one-on-one or the, you know, so it's much more nuanced and direct and people are going to pay more for that kind of experience and expertise on the other end of the spectrum with clients that I work with is something that would be like purely hands off. Something like a digital course for instance, that you know, somebody can buy the so, you know, say I went online and I'm sure there's a lot of physical therapists can be like, Whoa, bad idea. You need to actually go to a physical therapist and understand that maybe you know, putting aside my ignorance about all of the physical therapy, you know, maybe then as a thing, after they worked with you for several weeks or whatever, there's some, you know, downloadable set of videos that then they can go through on their own at home or you know, whatever it is that you're wanting to help people with. Jason Van Orden (23:02): So that's at the other end of the spectrum, purely digital do it themselves. And then there's everything in between and you're basically asking yourself three questions. It's like, okay, how are people going to get access to me through this offer? And so, you know, is that going to be direct one on one? Is it going to be, maybe there's some kind of, you know, a lot of my clients end up performing some kind of like group Q and a or coaching calls, whether they can help a group of people at once. It's kind of like, you know, your Lyft or Uber share ride. If the driver has three people in the car, they're getting paid by three people as opposed to one person. Right? So that's a, you know, how do they get access to you and finding a more scalable way to do that. Jason Van Orden (23:38): The second thing is how do they get access to the information? And that might be, you know, through like you did that podcasting course. I did that, the information, there was a series of group calls, several people on a call and I was doing those trainings and then saying, here's where you can walk away now and the action steps and what to do next this week with what we've talked about. So how do they access the information or the knowledge or the tools? And then the third question is how do they access each other? And this is a powerful thing and wrapping in an experience. Because if you have a lot of people showing up, have similar goals and desires, it's actually you really valuable for them to be a part of a group of people who are working towards similar things and normalizes, you know, the issues that they're dealing with. Jason Van Orden (24:22): And they can get insights from others who are in the same place as they are. And this is where we see things like Facebook groups or LinkedIn groups or Slack you know, channels or ways that your clients can actually talk to each other, which again, it's huge value without your direct input. Other than that you connected them. So when you have those four pieces, the ideal client, their ideal outcome, your process for getting them there and then deciding of what is the experience, you know, now you can craft. And the cool thing about knowing clearly what that process is and maybe take that first piece of the process that's like an assessment piece or whatever the first step is. And you can make that a smaller product and make it lower price. So it's easy for people to go like, okay, yeah, I'll say yes. Jason Van Orden (25:04): Did that baby step into doing work? You know, or experiencing your expertise in some way. And then all the research tells us they're likely that way. More likely now to do business with you again and spend more money with you at that point. Or maybe you decide it's time to write a book. Okay. The book is maybe an overview of your process or you get invited to do a keynote. It's like, okay, there's, well here's one slice of my process, one, one, one piece of what I help people with. And that can be the basis for that for that keynote. Or maybe you decide, okay, now I want the entire process packaged up as a group coaching type experience that happens over eight weeks online or a two day workshop or right now you can, you can play with it in a lot of different ways, but that process is a really important asset. So those are your four steps and kind of how all those pieces come together. Karen Litzy (25:51): Awesome. Well, I love a good framework. So thank you for that. And there's one thing that you said as you are kind of going through that framework that I just want to back up and touch upon is that idea of being an expert. So oftentimes, and again, you touched upon this as well, is that feeling of imposter syndrome and things like that. Is that feeling of, am I really the expert? Like there are people out there who might have more experience than I do. How can I put myself out there as the expert? So what do you say to that? Jason Van Orden (26:29): Well, there probably are plenty of people out there who have more expertise than you. There always will be there. People have there have more expertise or experience in marketing branding to me. But again, it goes, there are too for people to do business with you. It's about trust. And trust is actually made of two components. It's made of credibility, which, you know, that's expertise. Have you, you know, done the hours of mastery. You've gotten the degree if you need it or whatever. It goes into that credibility. Have you gotten results for people before? And we lean on that a lot and that's okay. It is important. But then likability, credibility plus likability is trust. And often that likability is even more important than the credibility. Now again, you need to be able to deliver the results, but what does that likability, well, that goes back to resonance and for some reason, I mean, I think we've all, you know, I could have gone to one physical therapist and been like, yeah, something just doesn't drive here. Jason Van Orden (27:16): I need to go to another whatever for whatever reason. Right? And at that point, it wouldn't have been like, which one has more experience? It's like, which one do I vibe with? Or if you've ever gone to like hired a therapist or something like that, right? Just to kind of give a little more of an extreme example. But so that's one thing I would say. Another thing is that you know, if you do struggle with impostor syndrome, a great Google search to do is imposter syndrome celebrities. And you're gonna see a huge list of like Tina Fey and Tom Hanks and Maya Angelou and people who are like stories. Like, why are these people like doubting themselves? They're like, amazing. Then another thing that I would say to that is, you know, that process of going and having those conversations with your marketplace, those can be very energizing and actually confidence boosting. Jason Van Orden (28:04): Cause as you're talking and hearing their experience, it starts, you start going seeing it's like, Oh yeah, I can help with that and start getting excited about it and wanting to do it. And so that's another, you know, little anecdote to that. And in the end it's, you know, you don't ever have to be claimed to be something that you're not, you know, you very clear and you know, again, what your strengths are, where you can create results to what extent, and there are going to be people that just decide to work with you for a number of reasons. And it's not just going to be price or geography. Sometimes it might be, but again, if you know, that resonance piece comes in a lot too. So there's a few different things. And then the last thing is all I can say is like, go back to my belief that it's like, look, there's so many people in this world, 8 billion plus lots of problems to solve. Lots of people looking for guidance and help. So, you know, be that one specific band on Spotify, be that one person that knows that slice of the world is looking for. I'm going, you know what, you're the person I've been waiting for to hear this from. So how can I work with you? And that's what we're going for. Karen Litzy (29:08): Perfect. I love it. Now as we wrap things up here if you could leave the audience, although I think what you just said was probably, I shouldn't have even asked this question, but I'm going to ask it anyway because I want you to be able to kind of give the major points you want people to walk away with from this conversation, even though there were so, so many, I took a lot of notes. Jason Van Orden (29:34): Yeah. I mean, I'll just punctuate kind of the big point. And, and with just a very brief anecdote or story, and that is like back in 2008, I got a phone call from a woman in Austin, Texas. She had a child, she was pregnant or no, she had two kids at the time. And she, both of her pregnancies had been very high risk. In fact, she had gotten put on bed rest, you know, or you have to stay there for months and I'm sure that's gotta be so stressful. And it was a really difficult time for her. She from the African American community and she just found that particularly in that population, the resources for high risk pregnancies were really under like the date. There just wasn't enough of them. So, you know, fast forward, she's got her two healthy kids, thank goodness everything. Jason Van Orden (30:19): And she's like, I want, I need to share my experience and my story, you know, she's even gotten, you know, gone and gotten some what's the word I'm looking for, you know, accreditations or even, I can't remember exactly what she, you know, went and trained in, but she definitely got some that credibility expertise part, but then she also wanted to share her story. And so she said, can you help me launch a podcast? I said, yes, absolutely. So she hired me to coach her and consult her through that. And you know, fast forward a few months, or maybe it was a half a year or so, and she started getting emails from people in Ireland and Australia and Oman in the middle East. And you know, this one woman and in Oman said look, I gotta thank you for helping. Like save my child. Jason Van Orden (31:04): I hadn't, no, when I found out that I had to be on bed rest and there was this high risk of losing my pregnancy, like I didn't know what to do and where I live, there really isn't like what much support or empathy and so your story, your podcast, your perspective, your expertise gave me the strength, the will, the knowledge to be able to get through that difficult time. So what I'm trying to punctuate there is like how many of those connections are waiting for you out there, the listener, you know, who's listening to this right now and whether you reach them through a podcast or a blog or videos or through social media or speaking or whatever the case may be. There are absolutely those stories. You know, that that story can be true of you. And that's why I do what I do is to multiply that phenomenon that I've seen time and time and time again over the last 10 or 15 years. Karen Litzy (31:54): Yeah, I mean you just, you never know who's listening or reading or watching and you never know how the words that you say can truly, truly affect another person. And that's a great exit story is a great example of that. Jason Van Orden (32:10): And I don't know if you can hear a little bit of music, Karen? But somebody is having a dance party with their car suddenly. So that's not just me like, you know, winding down our interview with like, I'm going to do a saucer. Karen Litzy (32:21): You're in a play, you're going to play yourself off at the Oscars. Just slowly playing yourself off. That's so thoughtful. Well, actually before you exit, I have one last question. So I ask everyone this, knowing where you are now, in your life and in your career, what advice would you give to yourself as that young guy straight out of school? Jason Van Orden (32:49): Yeah. Well wow, that's a big one. I mean, I think what I would say is that, you know, you're only scratching the surface when it comes to what's possible for you and especially in getting to know yourself. So just, you know, keep searching, keep looking, keep discovering and uncovering the layers of yourself. And because, you know, that guy thought he was going to be an engineer for the rest of his life and so many other, I'm such a different person now and that's good. I mean a lot of growth and hard things and went very different directions than I thought, but it would just be that encouragement. It's like, look, you're just getting started and thinking is going to be very different. But you know, keep, keep digging and hoping and pushing and even when it gets hard. Karen Litzy (33:35): Great advice. Thank you so much. Now Jason, where can people find you? Jason Van Orden (33:40): Yeah, so I actually have a new podcast where we dive into stuff like this. It's a podcast called impact, a subtitle, how to build or how to grow your thought leadership brand and business. And so you can check that out and find it on all the major directories or at jasonvanorden.com. And then the one other thing I'll mention is if you go to magneticmessaging.download, you can download, you know, I went very quickly through those five aspects of the messaging, but you can download the framework, it's like a full guide with questions. Take you through that and if you want to dig into that exercise some more. So that's magneticmessaging.download. Karen Litzy (34:20): Awesome. Well thank you so much. And just for everyone listening, we'll have the links to everything that Jason just said. So his podcast, his website and the magnetic messaging over at the show notes for this episode at podcast.Healthywealthysmart.com. So if you weren't taking notes like I did, don't worry one click and we'll take you to everything that Jason just mentioned. So Jason, thank you so much for taking the time out and coming on the podcast. I really appreciate it. This was great. Jason Van Orden (34:50): Yeah, so much fun. Thank you Karen Karen Litzy (34:52): And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Dr. Lex Lancaster on student loans. Dr. Lex Lancaster is a Doctor of Physical Therapy with a passion for performance, pelvic, and pediatric PT. Lex Lancaster also designs websites for health and wellness practitioners. In this episode, we discuss: -Lex’s experience navigating loan repayment as a new graduate -Considerations for pre-DPT students when applying to schools -Helpful tips to start tackling your student loan debt -And so much more! Resources: Email: AlexisLancasterpt@gmail.com Lex Lancaster Twitter FitBUX Website  Lex Lancaster Website   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!                                                                      For more information on Lex: Alexis Lancaster is the graphic designer on the Healthy Wealthy and Smart podcast. She earned her Bachelor of Science degree in Biology, a Graduate Certificate in Healthcare Advocacy and Navigation, and graduated with her Doctor of Physical Therapy program at Utica College in Utica, NY. Lex would love to begin her career as a traveling physical therapist and hopes to eventually settle down in New Hampshire, where she aspires to open her own gym-based clinic and become a professor at a local college. She loves working with the pediatric population and has a passion for prevention and wellness across the lifespan. Lex also enjoys hiking, CrossFit, photography, traveling, and spending time with her close family and friends. She recently started her own graphic design business and would love to work with you if you have any design needs. Visit www.lexlancaster.com to connect with Lex. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor (00:00): Hello. Hello. Hello. This is Jenna Kantor with Healthy, Wealthy and Smart. Really excited to be coming on and interviewing Dr. Lex. And what's really exciting is she is in the middle of this like name change possibility, so it may be Lancaster in the future or Brunel, her married name, we don't know. So you're getting an insight interview during the gray zone. Anyhow, want to thank you. First of all, thank you for coming on Lex for this interview. So for those who don't know, she actually works behind the scenes with Karen Litzy on this podcast and other things. She created the amazing logo for the women in PT summit and she's just kind of like really amazing on social media. For those who don't know, she's also a new grad who is dealing with loans. L. O. A. N. S. give me an L , give me an O, give me, ask him. Jenna Kantor (00:57): And that's right. That's what we are talking about. The fun, joyous roller coaster of student loans. Now before this. All right, before we go into details, right before we go into details of all your journey, if you were to compare the journey of loans, is it more the feeling that you get when you're going up the roller coaster and it's getting really, really high? You're like, Oh my gosh, am I going to live? Or is it that drop feeling like, Oh that first drop. So which one would you compare it to?   Lex Lancaster: It's more like, I would say it's more like the drop, but that drop happens like halfway through your third year of PT school and then you're like, crap. Oh my God. I guess that's if you're lucky. Cause sometimes you don't think about loans until after you graduate and then the rollercoaster happens. Then I will say though that after that initial drop and you really freak out, it gets better. Jenna Kantor (02:01): You remind me of Oscar in the office where he's talking to an imaginary child or person saying it gets better, it gets better, it gets better. Well, I wanted to reach out to, Lex, when I reached out to her because she had done a post on social media about loans and that's what inspired this in the first place. And I thought, of course there's great experts out there like Joseph Bryan who is a wonderful resource for loans. But I wanted to get a student perspective on this from beginning to end. So what were the first steps you did before you even graduated for your loans?   Lex Lancaster: So my first and second year, and really the first part of my third year, I didn't even think about loans. I kind of thought in the realm of it's just another drop in the bucket at this point. You know, I just didn't think like money. It's not that money wasn't factor. Lex Lancaster (03:00): It's that I had to pay for things. So it's not like I said, well, I can't really afford tuition, so I'll see you later. So it was just a drop in the bucket. And you know, I got to the point where $1,000, $2,000 books, whatever it ended up being, was just that drop in the bucket and halfway through my third year, aye, what to say? I saw a fitBux post about student loans and I think I actually got a bill from one of my loan companies and they had said, you owe money halfway through my third year of PT school. And I was like, Whoa, that is not okay. So I ended up contacting them and it was just a, you know, mistake on their end because we have that forgiveness for six months after we graduate or the deferment. However, at that point I was like, wow, this is what my monthly payment is going to be. Lex Lancaster (03:56): And that's what I had seen. And that was only one company. So at that point I kind of, I want to say it was January because I was on my last clinical and I reached out to fit bux and I just basically said, Hey, I don't know what I'm doing. It's all I said. And Joe was extremely helpful. I ended up setting up a class, an online class, because the third year, most programs, you're off campus. So with our program we were all on clinical and I figured my entire class was struggling the same way I was. So we set up a seminar, an online seminar with Joe and he went through, or Joseph, he went through every single aspect of student loans, what to expect, how to choose your plan, what works best, what doesn't work. And you know, for the students that attended, it was super helpful. Lex Lancaster (04:44): So we left that little online webinar with him with understanding definitions of the financial world. Because at that point in time, I had no idea what any of the terms meant, Mmm, you know, it's extended prepay, blah blah, blah, blah, blah. All of the things that they talk about that you need to understand before you choose your plan, make your payments and really get going on student loans. So at that point I felt okay. I was like, all right, we're good. We've got a plan and we understand the layout plan. And then what happened was I had to register for the NPTE, buy my study materials and for lack of better terms, wait around to get a job. So in that period of studying, cause I finished clinical in March, I took the test in July. So luckily for me, I had my online business to kind of keep me afloat to make a little bit of money within that period. Lex Lancaster (05:49): But without that, I mean I still took out, I put my NPTE on a credit card, I put my study books on a credit card and it was an interest free credit card. So I knew that I would be able to pay that off once I got a job. But I was still struggling because throughout college I did not save money. I had a job, I was a graduate assistant, you know, I had jobs, I just wasn't smart about it. I didn't save money throughout the entire process and that kind of put me in a position after I finished clinical. So while I was studying for the NPTE kind of saved some money, what I could save paid what I had to, but I did not pay on my loans. So I left my loan to start paying until the six months after I graduated. Lex Lancaster (06:33): And for lack of better terms, I cannot remember what it's called. But we have that six month period after we graduate that you don't have to pay on them. And then when six months hits you have to start. So I started at six months. But anyway, long story short, I met with Joe probably four more times. Just I think it was four times we went through every possible scenario after I got a job so that we could decide what, how much money I should be paying each month. And we went through the technology on the Fitbux website. That helps you decide what payment plan is best for you. So really fit bux helped me the most. I did not, there's a lot of podcasts out there that you can listen to, but I stuck with fit bux because it was one, it was free to talk to them and to Joseph pretty much, you know, he found time for me to talk and I really appreciated that. Lex Lancaster (07:29): So I guess like I said, it was the roller coaster. The drop of the roller coaster was when I got that bill and then it continued dropping until about November when I made my first payment. And now at this point I don't even think about it. I don't see the money, the money that I pay toward my student loans, I don't even see it. It just goes into an account. My student loans pay by themselves and I don't do anything. I'm on automatic payments. So now I'm kind of at that coasting I guess. So, yeah. Well and you post what, what? I forgot what your post was. It was a good one that was very pointed. I'm trying to like look it up literally during the podcast interview cause that's the way to go. Well. So discover sent me an email cause I have a credit card with discover, that's who I took out my interest rate credit card with last spring. And they sent me an email and I just said, are you paying too much in student loans? And I got the email and I just kind of chuckled and I was like, how'd you know? So I posted on my story. Mmm. Basically, how are you a mind reader discover? And then I've said, you know, I do pay, I pay $1,400 a month right now for student loans. Mmm. And I basically said that my payment is semi aggressive. It's aggressive by any means. If that was the case, I'd be paying close to two. Jenna Kantor (09:00): Mmm. Lex Lancaster (09:01): But then I had said, did you know that income based repayment is not guaranteed? Your forgiveness after 2025 years is not guaranteed. The interest rate on that can go up. Mmm. Or the tax rate on that can go up. Excuse me. And you have no idea what that tax rate can be. And when you forgive your loans, you have to pay that tax right then and there. So the way that I just look at it and everyone always says to me, well why are you paying so much on your student loans? They always question it. They're like, well you don't have to do that. But in reality, you know, I'm just like, yeah I am paying a lot my student loans, but I have to do it. Cause if I didn't do it, I'd be putting the same amount of money in a savings account to pay the taxes 25 years later. So I was frustrated at that. I think that day I was semi frustrated just because I had gotten an email and I was like, how'd you know? Jenna Kantor (09:58): Yeah, I am paying a lot. This is your post. It was sad realizations of being an adult on a high deductible plan. I pay greater than 500 a month for health insurance. I still need to pay 6,000 out of pocket before my insurance will help me. What a broken system. And I don't have a suggested solution because this is me right now. And you showed your brain like, Oh yeah, that was, that was my one about health insurance. Oh, that was health insurance. Oh my gosh. That's my health insurance. But I gotta pull up my story. I have it somewhere. Well that one's, that's another one. Another, another thing. If you want to reach out to her, that was a sidebar. It was smooth and yet totally off topic. It was so good. I'm glad you brought it up. It just felt so good to go there. So would you say you're out of that stress zone, you're out of that stress zone. Now that you have that plan going for you with your loans, you're just like, we're good. Lex Lancaster (10:59): You know? Yes and no. Yes, because I don't see the money come out. I know it's being paid. I know I pay a little bit over what I need to pay, so I'm paying it off a little bit more aggressive than I need to. And I'm on a 20 year plan right now, but my goal is to pay it off in about seven or eight years. I would say that because I'm transitioning from travel PT to permanent I'm back on the nervous train because with travel PT you make more money. You do pay more because you have a Oh, a tax home and you have a, you know, you duplicate your living expenses, so you do pay more in rent, et cetera, but you make more money because you don't have that permanent home and you're away from home. So I used my travel salary, most of the, I think I was putting close to 50% Lex Lancaster (11:53): Toward loans in the beginning. But then as soon as I found out that I was not going to be a travel PT anymore, I stopped. So I backed off. I took my monthly payment and my required payments and I decided to pay about $250 extra for both companies each month. So that's not even close to what I was paying. So I'm like I said, I'm back on that. I'm a little bit nervous. I don't know how I'm going to afford living. I don't know. You know, because I have a mortgage for a loan payment and my fiance Kyle also has a mortgage for a loan payment. He's also a PT. So we're both just kind of at the point where we're paying our required payment, paying a little bit over, and then we're going to see how it goes. Well, like I said, I don't see that. Lex Lancaster (12:44): I don't physically pay it every month, so I feel like mentally it makes me feel better. I'm not watching the money go out of my account more or less. It's already paid. I don't have to worry about it. It's paid on by the due date and then that's that. Mmm. So yeah, I would say talk to me in about two months and we'll see how I'm feeling when everything changes and I transitioned to a permanent. Jenna Kantor (13:36): That's hard too because when you are graduating, I did see this with a lot of my fellow classmates. Everyone had this, Oh, I'm going to go for this, this, I'm talking about niches. You know what they want to treat, and I saw a lot of people just start working for anyone and I think that's because when they see that number, those loans you owe, it's just you get, it's like, I need a job right now. I need a job right now. I don't talk to me. I just need a job I need. And it's really unfortunate and you're experiencing that now you're going, okay, now I want to go for what I'm dreaming of, like my dreams and doing that. You're seeing how that's causing that anxiety again about the financial situation, which is just, it just sucks what we owe in school. It's just horrible. And then even with what we get reimbursed for us physical therapists for most of us get paid on the low end as new grads, which I think that's just, I think those words are just an excuse for employers to offer lower pay. That's it. They were like, Oh, new grad. Cool. I can only afford to hire new grads right now. Right. So that's bad. That's bad. That's feeding into a really bad system there. That's my opinion. But that being said, it just, and so then you're just barely surviving with that. But then if you want to go off and do your own thing, if you are really going to be listen to your loans, you want to do it for 20 years. Exactly. More different 20 years cause you're like, Oh I need that. Lex Lancaster (14:51): Mean I think a lot of people do that. It's scary. Right? But then we get burned out. Karen Litzy (15:05): And on that note we're going to take a quick break to hear from our sponsor net health. This episode is brought to you by net health net health outpatient EMR and billing software. Redoc powered by X fit provides an all in one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net hell's new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.nethealth.com/patientEngagement2020 Lex Lancaster (15:39): No I never see this money, but I hate my life. And that's, and that's the thing. It's like, you know, Kyle and I are starting a cash based PT on the side. Our side hustle. We are going to start that because we just want to, we want to treat how we want to treat and not be dictated by insurance, but that's a talk for another day. Mmm. And you know, that's, it's great for us. And you know, to be honest, we would, we would burn the ships and just do our cash business right now and just do that and not have a full time job. But we can't because we need to have money to pay our loans because the last thing we need to do is default. And you know, I guess our method of payment was based on travel PT, not based on permanent and a cash business. Lex Lancaster (16:22): So when we moved our loans from federal to private, we have to pay that payment. Now income-based isn't a thing. So we're required to wait. We need to wait because we need to have guaranteed income in order to not default on our loans. But like I said, as soon as you put out a budget, the loans are 1400 rent is 1800 and then you add food and you know, a little bit, you have to have fun money, a little bit of fun money. And that's almost 85% of our new salary. Yeah. So I don't, I don't really know how yet to fix that because what is your option? You know, you can't just make things, you can't make rent less expensive, you can't make your loans less expensive and they're not going anywhere. So unfortunately, I think that this is a scenario that a lot of people face out of school if they don't choose trouble. And that's why income-based is the most feasible. That makes sense because how else do you live on that? You know, I was just a grad student income. Right, right. You know, how else do you live? You don't have money to pay on those loans. And some States don't let you pay. Don't let you practice on that temporary license. Like New York state, a lot. A couple of my friends practice on temp licenses, so they were able to, you know, build up some Lex Lancaster (17:50): Money. But if you're not part of those States that allow you to do that, you can't practice until you pass your NPTE. So it's hard to build up that savings account. So that's one recommendation I have for anybody that's in school who's listening to this. Make sure you're saving money, whether it's 10 bucks a week, five bucks a week, it doesn't really matter throughout school. Save money and just put it somewhere and don't touch it because eventually you're going to need it. Even if you don't think you will neet it. And even if you think it's completely out of this world that you'll ever have a situation where you need a little bit of extra cash but save that money. Mmm. And for lack of better terms, I would not use it until you absolutely need to start the savings account now and don't wait until you have a job. Jenna Kantor (18:37): There's no reason why you can't save five bucks a week. Yeah, yeah, no, that, that does make perfect sense. And that's definitely been something that I've leaned on is having a savings account myself. So I get what you're saying. Yeah. And for anyone listening, I mean, if you might find yourself going, Oh, but where's the answer? It's the whole process of this interview itself is not necessarily to give you all the straight up answers. I really would like to just resort to the fact that it's good to know you're not alone. Yeah. And it's okay to talk about this with people. It's okay to be frustrated with your pay. It's okay to be freaking out about your loans. It's okay to feel burnt out because you're working somewhere you don't like just to get escape those loans. All of that's okay. I mean, this is unfortunately a very common struggle amongst new grads and something that the APTA is working, really trying to figure out how they can address this issue. Jenna Kantor (19:34): Cause really at the end of the day, it's the schools that are choosing to charge you guys as much. It's the Dean and it's not just the PT, it's the entire school that's saying, okay, let's increase the amount so we can make a new building or whatever they're going to use the money for. So with that increase in cost, it's all by school. That's where you need to look first in my opinion. Yeah. You need to look first. The APTA it’s like how we treat patients. You know, we sit there and we're treating the symptoms, you know, or do you look at what caused it all along? So same idea. And if you, I want to just focus on your own plate right now on what to do for yourself. Absolutely. If you really want to make a larger difference, it's talking to your institution and become the voice which works. Lex Lancaster (20:28): But if that's something you just made up right now that speaks to you? Well it makes sense because I have, I have people that I know that literally they graduated PT school with less than 70 grand of loans and that was putting everything on within a loan that was not paying for part of school out of pocket. They literally graduated with that much because their school cost that little bit of money. And when I heard those numbers and I'm, meanwhile I graduated after undergrad and graduate school. I was at about $220,000 is where I'm at. I don't know where I'm at today because I haven't looked at it to be completely honest cause it's like I'm just paying one month at a time. But I just, I was baffled. How did you get out of school with that little of loans? Lex Lancaster (21:24): Like how did you do that? And they basically said that when they chose a PT school, they chose a cheaper school and you know, I, I loved my school, absolutely loved my school. I would have not wanted to go anywhere else. That program alone has, you know, changed me as a person. I love Utica college. So I'm not saying that I would choose to go somewhere else. However, I was so baffled that the tuition is so different. I had no idea. I literally had no idea that different DPT schools have different such drastically different costs and that particular person almost has her loans paid off and she's, I think, Hmm. Five or six years out of school and she barely had to pay anything. Yeah. So I guess so what you're saying is so true. You know, we have to talk to the right people. Lex Lancaster (22:22): You know, why is this and it's an increased by, what is it like one or 2% for a year? It goes up. I have not kept up on that, but I do know that what our parents paid alone was significantly less than what we paid. Yes. So it's just, yeah, it's a really vicious, right now it's bad. It's bad. So, I mean, you could, you could sit there and think it's the loan company to get back. I'm like, no, it's your school. It's just school. They're the ones who said you need to pay this much. We don't get reimbursed that much to be able to pay that in a reasonable amount of time to live our lives. Yeah. That's very sad. It is very sad. And when our degree went up to the doctorate level, our reimbursement didn't increase. So it made it when we required more school. Yeah. Our reimbursement is actually now going down propose anyways, that 8% correct. That it's, that's for specific situations and it's not for sure yet. I say this now, but it's still being fought. We're not doing well in fighting it, but I believe it's not set in stone yet. Like I said, I don't know when they go out, so I'm curious. Lex Lancaster (23:46): The state of things will affairs will be at that point then. Yeah. The reimbursement doesn't reflect, we're just not paid enough reimbursement wise. So employers don't really have a choice. Yeah, it's, yeah, it stinks. It's a shame. It is a shame. Jenna Kantor (24:06): Well, thank you so much for coming on. I really appreciate it. Do you have any last words you would like to give just regarding loans and the stress of it that you would like to give to anybody listening? It's just really feeling helpless right now. Lex Lancaster (24:20): Mmm. My biggest piece of advice, well, I'll say two things. The first thing is, like I said before, start saving money. Now. Don't wait. And my second thing is reach out to the people who know what they're talking about. Don't try to solve problems yourself because you're going to waste time and you might even waste money. Mmm. Fit bux is completely free and it's a shameless pitch because of how much they've helped me. They are free to talk to. If you have questions please reach out to them. Joseph is incredible and his teammates are incredible and I still do not know what I'm doing down to the T. I use their program to decide what I'm doing. Reach out to those people. Don't waste your time trying to figure it out yourself and Lex Lancaster (25:12): Understand that it does get better. As awful as it seems when you first start out, it does get better and you start to figure out a plan and everything just kind of goes from there. Don't feel like you're stuck. Reach out to people. Twitter is amazing. You're not alone. A lot of people are going through this, probably every single PT in existence. So just reach out. Don't feel like you're alone ever. And yeah, I think that's it. Jenna Kantor (25:41): I love it. Thank you for coming on. How can people find you on social media or email? Lex Lancaster (25:47): So my email right now is AlexisLancasterpt@gmail.com and on social media. I am @LexLancaster_ So you can reach out to me there. Jenna Kantor (25:57): I love. Good underscore is nothing like a quality underscore. Well, on that note, thank you so much for coming on. Thank you everyone for tuning in and have a wonderful day.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

In this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Thompson on the show to discuss how to adapt your business during the COVID-19 Pandemic. Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star employees. Jennifer has 20+ years experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company. In this episode, we discuss: -Understanding the Impact of Online Reviews on Your Bottom Line -Why You Need to Provide Cross-Generation Communication Training to Your Staff -The Death of Social Media Marketing and What to Do Next -5 Ways to Create Big ROI with a Small Budget -And so much more! Resources: Insight Marketing Group Website Dr. Marketing Tips Twitter Insight Marketing Group LinkedIn Dr. Marketing Tips Podcast Loom InsightMG Podcast: Ep. 193 | Understanding the Impact of Online Reviews on Your Practice InsightMG Podcast: Ep. 221 | How to Get Started on Telemedicine in a Hurry InsightMG Podcast: Ep. 219 | How to Communicate During a Health Scare or Natural Disaster Insight Courses    A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Jennifer: Jennifer Thompson has served as President of Insight Marketing Group since 2006 and helps physicians and private medical practices throughout the U.S. attract and retain patients and rock-star employees. Jennifer has 20+ years of experience in marketing and business development for start-up organizations and as a marketing director for a Fortune 500 company.   In 2010 & 2014, Jennifer was elected to the Orange County Board of County Commissioners where she made decisions that impacted over 1.2 million citizens and 60+ million visitors. Jennifer was often recognized for her use of social media and community outreach in her elected role. In 2013, Jennifer’s company helped a client win the Social Madness competition in Central Florida and go on to place 8th nationally. Jennifer is a serial entrepreneur who wakes up every day at 4 am ready to change the world. She has been invited to share her knowledge at multiple MGMA association meetings and conferences, the Florida Bones Conference, the American Academy of Orthopaedic Surgeons and AOA-36 on the topics of social media, reputation management, and leadership. She is also the co-host of the DrMarketingTips Podcast available on iTunes.   Read the full transcript below: Introduction (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. Karen Litzy (00:41): Welcome back to the podcast. I am your host Karen Litzy. And in today's episode our discussions around covid-19 and what health care businesses, physical therapists, physician practitioners, what they can do to continue to help their clients and their patients during this time. So today I am so happy to have on the program, Jennifer Thompson. She has served as president of insight marketing groups since 2006 and helps physicians, physical therapists and private medical practices throughout the United States attract and retain patients and rockstar employees. Jennifer has 20 plus years of experience in marketing and business development for startup organizations and as a marketing director for fortune 500 companies. Now in today's episode we talk about how healthcare companies need to change the way they're doing things during the covid-19 pandemic. Jennifer's very specific and goes through certain phases that your company must do to continue to help people in your community. We also talk about understanding the impact of online reviews. Karen Litzy (01:57): This is during a pandemic and once we get through this, why you need to provide cross generation communication training to your staff, the quote unquote death of social media marketing and what to do next and then ways to create big ROI or return on investment with a small budget. I'm telling you, everyone take out your pen and paper, your computer, take notes. Everything in this episode is practical. You could start doing it today and for those of us who are anxious or struggling because maybe we're not seeing the volume of patients we used to and our incomes are starting to see that, starting to reflect that most of the things that Jennifer is suggesting we can do takes very little or $0 million to achieve it. So I want to thank Jennifer for her time and her expertise. And if you are a health care practice owner, you must listen to this podcast from beginning to end. Karen Litzy (03:12): So much good information there. So a huge thanks to Jennifer Thompson and if anyone has any questions, you could go to the podcast show notes at podcast.healthywealthysmart.com. You've got all of Jennifer's information there, all of the things that we talked about, one click will take you to it. So a big thank you to Jennifer and of course I want to thank you, the listeners for tuning in each week. We would love it if you could leave us a review on Apple podcasts and tell your friends, tell your family thank you so much and enjoy. Karen Litzy (03:51): Hi Jennifer, welcome to the podcast. I'm happy to have you on and I feel like you're here at like the perfect time. Jennifer Thompson (03:58): Absolutely. Thank you for having me. It's great to be virtual and all of us are kind of hunkering down at home, but this is a great way to pass some time. Karen Litzy (04:07): Exactly. And like I said in your bio, you have helped physicians and private medical practices attract and retain their patients. You've been doing this for a very long time, but I have to think the recent pandemic has kind of shifted things a little bit for medical practices. So before we get into the kind of the bulk of what we had originally planned to talk about a couple of weeks ago, I would love to get your professional outlook on marketing, on finding patients on how we can do that in these times of this pandemic. Jennifer Thompson (04:50): Yeah. And I think that like it's just the right place at the right time. So when all of this was starting to come to fruition and it looked like we were going to be on restrictions and stay at home orders our team, that really shifted very quickly to reach out to all of our clients and say, Hey, look, we want to be a resource to you. You're not set up yet on telemedicine, but let's get you set up. So we've had the opportunity to help about two dozen practices get up and going with the Titan telemedicine solution in about 24 hours. And so once we got them all going and everybody's kinda rocking and rolling right now we started shifting the conversation to, okay, well how can we take telemedicine now as an option? Like a tool in your toolbox and market that and how do you market the practice when you're only, you know, maybe you have or you have limited hours or you have limited access and maybe you still have providers coming into the office, but you know, it's just a different environment. Jennifer Thompson (05:50): And the telemedicine in general is a different environment. So I think the first phase of how you attract, retain patients in this new kind of unchartered territory first is you got to do the stuff that's immediate and you have to kind of put out all of these immediate fires. And so that's like, you've got to update your website. You've got to reach out to your existing patients to let them know you're still seeing patients. And maybe it's just a different method. You've got to go out and update all your Google my business listings to include telemedicine, to include it in kind of changes to your hours. So there's some immediate things that you have to do. Of course you've got to update all of your social media and you need to, you know, start thinking about one, you want to let people know you're doing telemedicine. Jennifer Thompson (06:39): But then second is you want to figure out how is this going to look for the short term after I've put out the immediate fire, how am I going to now get more patients in? One area that we've seen a bunch of success in is going old school, you know, like your referring partners. And there's so many times where we'll send somebody from the office over to our referring partners to bring them lunch or to kind of build those relationships and whatnot. Well, we can't do that anymore. So now there's only one industry left in the entire world that actually has fax machines. And I just sent out faxes this morning for a couple of clients where we're sending out big bulk faxes to all of their referring partners from their EHR. They're pulling it out, pulling down that data. Jennifer Thompson (07:28): And we're sending out kind of, Hey, we're open and accepting telemedicine appointments. And so yeah, there's some things that you have to do that are thinking outside of the box. And that was kind of the immediate, and then the second piece is what do you do now to keep yourself relevant? And so I was on a call yesterday morning with a bunch of orthopedic surgeons. We always meet at like 6:30 in the morning because that's always pre-surgery. And we were talking about the numbers of, you know, new patients versus returning patients and how are we like balancing the telemedicine appointments in terms of other appointments. And it looked as if the marketing, it's good right now, you know, you want a market that you have this as a tool in your toolbox, but it wasn't necessarily driving new patient counts. The telemedicine option, what was happening is your internal sales, your internal folks are the ones that are driving telemedicine appointments because you're looking at those followup appointments, people coming in for you know, second and third appointments and trying to get your, the ones that you at the end of the patients that you already had on the sheet and getting them into a telemedicine appointment instead of a standard. Jennifer Thompson (08:41): And then now, Oh, we're looking at kind of the big issue with practices is that not only do folks need to know we're doing telemedicine, but for most practices, still maybe not in New York city, but for most practices, you know, in areas not as populated. They're still up and running for business. You know, they're still doing emergency surgery and things of that nature. So how do you let patients know that you are up and running and do it in a way that's memorable or that is going to cut through all the noise and the clutter. And so like before when I was saying you gotta to put out the fire, you put out the fire, the immediate. So part of the immediate plan is you need to put a red bar and we say red because Red's a good emergency color that in healthcare you really shouldn't be using. Jennifer Thompson (09:26): You put a red bar at the very top of your website and you go straight to your covid-19 resources or any of your important announcements. But that kind of red bar, you know, people aren't going to your website to check it out to make you relevant. So now we need to think about how do you brand yourself and how do you brand yourself in a way using social media. And because social media is still free and if you're good at it, you'll get some traction. And, I talk a lot about this idea that social media is dead and I will say social media, if you're just on it, it is dead now. But if you're in it, it's very much alive. And so now's your chance to be in social media and to get your message across. And what I mean by that is we have a group this morning orthopedic group who wanted to really get the point across that they're still open, put together a great little video of a doctor with an athlete who was in there for a knee injury. Jennifer Thompson (10:24): She signed the waiver, the release on it. They put together a great video showing how they're treating patients. So they're both in their mask. He's washing his hands, you know, and he does the quick exam. Then he washes his hands and she sits in a chair. He's about 10 feet away. They've got the video, they've got some music to it, and it's just, Hey, we're here and we're open. We have a PT practice that we're working with. They've started doing telemedicine across 26 different office locations and all day, every day they're sending us videos and great photos of them in practice showing how the physical therapists are doing their job with a computer screen and showing us the different things that we're doing. So it's just how can you be relevant now and kind of spreading that message and having fun with it. Because when people are at home right now, they're either watching TV where they're scrolling through their feeds. So how can you create that thumb stopping content? Karen Litzy (11:27): Excellent. And I love in the putting out the fires, the Google my business listings saying that you're doing tele-health. Hello. I have to do that today. The moment we end this call, I am going to Google my business and putting that in there. I did not even think about that cause I'm thinking about, I'm calling all of my individual patients, I'm emailing people, I'm keeping people updated, I've updated my website, I've done all that stuff, but I have not done that piece so that I need to do that as that should have been my phase one. And then I love the kind of how you're getting new patients because it's true. I think you're seeing in a lot of practice, at least what I'm hearing is that you're existing patients are doing tele-health, but how can we get new patients on board? So do you have any advice, let's say a new patient contacts me, I do a free 20 minute consult with them, kind of explaining tele-health. Are there any sort of must have pointers or any way that we can close that to help that prospective patient feel confident that they're going to get what they need? Jennifer Thompson (12:37): Yes, and I think that, I think part of that falls on you making sure that the patient is ready for what this new experience is. But we were so my teams, we do marketing, so we have, we're in the trenches on the marketing side of things and then we have a training side of the business. And so we were looking at updating a patient experience training that we've got currently. And then, how do you update it kind of with this telemedicine and telehealth component to it? Because we've been having a bunch of conversations about, it feels a little bit like the wild wild West and when the regulatory environment was kind of opened up, we would see providers and some of them, a lot of the ones we would work with. And we would call and say, Hey, do you want us to get you set up? Jennifer Thompson (13:22): And they would be like, no, I've already got this covered. I'm doing it on FaceTime, I'm doing it in WhatsApp. And we were like, no, you've got like they may be, they may be allowing you to make some mistakes right now just to get through this. But you've got to train at your patients from the get go of how you want this. And so you can't take somebody from a FaceTime call to later on doing a HIPAA compliant portal that they have to log into a remember a password. So we want to train our patients from day one. So I think that's part of the decision that you as a provider have to make is what's going to work for you. Not just for today but for long term. And then from the training side of our business, of course, we're always looking for a way to have fun with it from patient experience we put together and I'll send the student, cause we put together these great, I think they're great videos a day in the life from the provider's standpoint. Jennifer Thompson (14:14): And it's a series of tips of things that you should remember. Like for example, you shouldn't drive your car and do a telemedicine appointment. You shouldn't. That seems reasonable. You shouldn't, you should tell everybody in your house that you're with patients so they shouldn't be walking around in the background in their underwear because these things happen. I was going to say like it seems basic but it's not. Yeah, you gotta be patient with people because they're also going through this experience for the first time. Just because you’re not in the same room doesn't mean you have to shout. They can hear you. You've got to remember that you might have a great connection and you have, you know, your wifi is strong, but you may be talking to somebody and they're receiving it differently. And so we're all going through this for the first time together. And so I think understanding, like just taking a step back and remembering that this is unchartered territory. And so you know, are there things to pay attention to? Yes. But I think it starts with the provider and how you prepare the patient for that visit. Karen Litzy (15:24): Excellent. I love that. Yes. And definitely send those videos along and we'll put them in the show notes. At podcast.healthywealthysmart.com under this episode because I think people will definitely get a lot of value from them. And again, I can't believe you have to say like don't walk around in your underwear, do you as you're doing that. But like, like you said, the videos are made for a reason. So people were doing it. Jennifer Thompson (15:52): We had a provider this week or last week send something in. It was like a picture cause we asked everybody like send them photos of you doing telemedicine so we can use them for things. And he sent a photo and he had a shirt was like stained up and like, Oh over here. And we're like, doc, no, we didn't see patients day to day like this. So you can't see patients that way either. Karen Litzy (16:17): Yeah. And I think that's something that's really important I think because people think, Oh well I'm at home. I can be super casual, but you don't want to be casual to the point of a stained shirt and looking unprofessional. Right. There are ways to be casual, whether it be like smart athletes, your wear or a pair of jeans and a top, but you still want to look presentable because especially if this is a new patient who's seeing you on telehealth as a physical therapist when this is over, maybe you want them to continue to see you. So those first impressions still make a difference. So thank you for bringing that up. Jennifer Thompson (16:54): They absolutely do. And I think people just forget that. And you know, I think, I think it's okay to have fun with it too. Like, you've got to be professional and you need to be the regular provider that you always are. But from a marketing standpoint, a little levity goes a long way right now. And what are some examples of a little levity going along way, if you have any off the top of your head? Yeah, so we're having a lot of fun with these kinds of patient experience, customer service, telemedicine training videos, which we put out our first round of them yesterday. So we're just trying to have fun with them, like make fun of how crazy it is. We have a group that has it's an orthopedic practice that has a lot of athletic trainers that they employ. Jennifer Thompson (17:38): So one of the athletic trainers, because nobody's in schools right now, has been furloughed. And so what we're doing with him is he's got like a four year old son at home and he's doing a daily series on social media as the athletic trainer, providing tips on how you can stay active and how you can prevent injuries at home. So he's doing things like yesterday, he's sitting on the couch with the son reading a book and he's like, Oh, I see now you're here. You know, welcome to my living room. Here I am at home with my four year old son, Jackson. We're going to read two pages of book and then we're going to do jumping jacks and then we're going to run in place. But he's doing a series just so it's fun and it's cute, but it gets a lot of engagement at the same time. He's like getting the main message across and it's something that people are stopping on and he got great traction. Maybe a thousand people looked at it yesterday. So, Hey, it's good traction, no money. And it's keeping them relevant. Plus it's keeping him relevant in a furloughed position. Karen Litzy (18:38): Yeah. Oh, how great. What a great idea. Love it. All right now something that I think we can talk about that can help your bottom line and that can help your practice grow is the impact of online reviews. And that is one thing that I don't think has had that much of a change even during this time. So can you speak to the importance of those online reviews and understanding them? Jennifer Thompson (19:06): Yeah, I absolutely can. So I think a lot of times practices will come to me and say, what if I could only focus on one thing because I don't have any money? What would be the one thing that you would tell me to do? And I hands down, always tell them that you should focus on getting as many reviews as you can and not because reviews you don't need just five star reviews, but you need lots of reviews. And I referenced back to a study that that we found that was, that was cited in the wall street journal and it was a study by a company named Juan plea. And I will send you the details of this for the show notes. So wildly does study of at 25,000 freestanding medical clinics. And one plea is actually a credit card processing company. So they were looking at cash based business for 25,000 freestanding medical clinics and they were tying the revenue to the cash based revenue, two star ratings and reviews. Jennifer Thompson (20:11): And so basically the couple of the top line, top level findings that they have are like medical centers that claims their listings on three or more of those websites, meaning like rate Indies, healthcare, vitals, Google, things of that nature. See 26% on average more revenue than practices that don't. So if there's ever been a reason for why you need to really pay attention to online reviews outside of, it's the number one way people choose their provider and if there's ever been a reason, it's because it's directly tied to your bottom line. Medical practices don't respond to online reviews, make 6% less than practices that do. And I'm not suggesting that you, that you respond in a way that violates HIPAA, but you can respond in a way that doesn't even identify that somebody is a patient and you can provide them a phone number that if they have something negative that they can follow up on, that's a 6% difference in revenue. Jennifer Thompson (21:10): And the one that really gets me the most is that practices that are rated five-star across the board actually see less revenue than practices that are afforded to a 4.9 star. And that's because we all realize that everybody is not perfect and the general public is not ignorant to that. So they expect that you're going to have some negative reviews. But it was just most interesting that you can see that that indirectly court, there was a direct correlation and you know, focusing on star ratings and then going into reviews. And for me it's just, it was just good data because everybody loves good data. Sure. And I got really involved in, I mean we identified that reviews were probably a place to focus our business. You know, years ago and things were just starting out. But I was in politics for years and when I was in politics it was right when social media was starting to take off. Jennifer Thompson (22:09): And just like medical providers are limited in what you can say and respond to. As an elected official, I was limited in the state of Florida to the sunshine law and the sunshine law prevented a lot of what I was allowed to say and not allowed to say online. So I got really interested in this whole like immediate feedback. Everybody thinks that they've got an opinion now and how these opinions get shared and then what you can and can't say to them. And then I would have doctors that would come to me and the doctors would say, Jen, I just want you guys to get rid of that negative review. And I referenced orthopedics cause I have a lot of orthopedic clients and this would happen a lot with them, but when it was a work comp case and somebody who didn't want to go back to work or if it was somebody that wanted opioids and they just couldn't get their fix, they would go online and just bash these doctors. Jennifer Thompson (22:59): And it got to the point that work comp aside, I would have to say to the doctor, doc, if you're consistently getting negative reviews, we've got to deal with what the root of the problem is and not keep dealing with the negative review themselves. And so we would start doing sentiment analysis on the reviews. So easy tool, especially if you're stuck at home and you've got some time on your hand, pull all of your reviews offline and take, hopefully you're using a service, you just couldn't get them in a spreadsheet. But look at the reviews and look at that data and figure out what it's telling you. Because usually it's not between the provider patient that somebody is upset, they're upset about a billion process or upset about a wait time. They're upset about some kind of follow through about some kind of customer service issue and that's how you can get to the bottom of your reviews and then make changes at the practice level that are actually going to have a real impact on what people are saying about you a lot in public. So I think reviews are just a plethora of good information. If we start thinking about how we can use them to make small adjustments at the practice. Karen Litzy (24:05): Great. And how do you recommend clinicians ask their patients for reviews? Jennifer Thompson (24:15): I used to say suck it up and just ask for them and then it got to the point that I would say, here's a card to tell your patients where you want them to go. Now I would prefer the clinician not even be involved in the process at all. I would prefer that every practice out there work with some kind of third party partner that has a secure file transfer where you can send your list over of patients on whatever frequency you want. And then that provider, that software sends it out to your patients and they ask your patient for reviews. And that way every single patient gets treated the same. And you guys focus on delivering the best care possible and stop worrying about, you know, I'm not a sales person, I just want to focus on patient care. I don't want this person cause they might've been upset or I forgot to ask, don't worry. Like do I think that you should just remove yourself from that equation and just find a way to automate the process. Karen Litzy (25:11): Nice. And what are some examples of third party partners to help automate that process? Jennifer Thompson (25:17): So I exclusively use doctor.com now. But there's a bunch of them out there and so there's like review conciergedoctor.com. There's a bunch of them out there. Karen Litzy (25:29): Okay, cool. I've never heard of those, but that's really helpful. Thank you. Jennifer Thompson (25:33): Yeah, it is. It's a good way to get reviews and not to have to worry about it. And I will suggest this too, if you're at a practice that has like a lot of high volume have a page built on your website where you can capture internal feedback and then put signage up. Because that way if somebody is sitting in your waiting room and they're getting pissy that they'd been there too long, give them a way that they can get something off their chest so they feel like they need to go do, you know, leave you a negative review. Karen Litzy (26:03): Smart, smart. I like that. Right? So they can say, Oh, I've been here forever. Oh, I can complain here instead of complaining on Google or, Oh, fabulous. Exactly. Fabulous. So that could just be like a page on your website or something that says, Hey, if things weren't optimal for you, what can we do to help? Something like that. Feedback and feedback pages are very easy and everyone knows what to do. Yeah. Oh, excellent. Excellent. This is such good information. I'm taking so many notes. That's why I'm asking questions. I'm like, let's drill down into this further. All right. So something that seems like has been a constant theme from when we started about how do we kind of get through this pandemic in a way that's a positive for everyone involved and talking about reviews is communication. So let's talk about communicating with your staff and what do we need to provide within that communication training. I know it's a big question. Jennifer Thompson (27:13): So no, I love that you're asking it and I love that. I have some kind of relevant examples right now. So we do training for staff a lot around kind of employee engagement and everything kind of around how do you enhance the patient experience. So, and we put this together because of these docs saying, fix my reputation. And we said, you can't fix your reputation, so you focus on your people that plus unemployment's been at record lows. I mean, totally different conversation right now, but unemployment was at record lows. So how do you engage your employees? But we've been able to use the platform. So that's on demand training, delivering like 10 minutes a day type of thing. But we're using the platform to communicate with employees, but you don't need a platform to do this. Jennifer Thompson (27:59): So I think the very first step when you have a crisis is just to come up with a game plan and don't forget to think about it from a marketing perspective as well. You know, if you're going to communicate to your patients that you are offering telemedicine, don't assume that your employees know what's going on. And so, especially, if you're a large practice and you have people that work remotely or you're in multiple locations, consider putting together a weekly, maybe it's a video that you can send out. There's a great tool that I use all the time called loom L double O M love it free. You know, there's no reason not to and you don't have to house the videos. You can send it to people. Consider an email, like a regular email chain for those employees. But I've got a practice that I'm working with now that we actually got this off the ground this week and they have about 300 plus employees and they have multiple locations and a surgery center. Jennifer Thompson (28:59): And what we've done is basically we created a closed Facebook group for them and we are solely using it to communicate with employees that are now, some are in the practice, some are at home, some are furloughed. And the big concern is, especially in healthcare, is the bottom's not going to drop out from a revenue stream down the road. In fact, in a couple months, we're probably going to be working our tails off Saturdays and Sundays and nights because people are still going to want surgery. They're still gonna need their therapy. They're still, everything's going to happen. So you can't afford to lose furloughed employees. So now more than ever this practice in particular doubling down on communication and what they're doing is we're working so we manage the social for some of these accounts. So we're working on a patient facing social media, but now we're working on employee facing into closed groups. Jennifer Thompson (29:56): So now I'm reaching out to doctors saying, Hey, give me, send me a video offering words of encouragement. Show us how you're working from home. And then it's employees show us, you know, what you look like in your PPE. Show us how your eyes are having social distancing, talk to the people that aren't in the office and tell them how much you miss them. Celebrate birthday, celebrate anniversary. So it's this whole other thing. And I think that because social media allows us to create that sense of community and sometimes we lose that and not everybody's paying attention to emails and official communication. So it's working and it's a lot of work, but it's working and I think that it's going to do what it's supposed to do. Karen Litzy (30:37): Yeah, it's a great idea. And I think, I mean I have my own practice, I'm not an employee, but if I were an employee of a company and I saw that CEO or our owner getting on and giving us encouragement and at least acknowledging that we're still part of the company, even though maybe were furloughed or maybe were from home or now we're part time, I think that goes a long way. So I think that's a really a really great idea. And I'm assuming on these Facebook closed groups, you're not exchanging sensitive patient, Jennifer Thompson (31:13): Nothing like that. No, this is like top level and the CEO, this one, I've really got to commend him. He's being transparent, which I think is so important. Sharing the uncertainty of what's going on. You know, the practice applied for a PPE loan, they may not have gotten that PPE line. They've got about $3 million a month that they've got to deal with and overhead. So that's a big one. You know, as they typically give pay increases for working anniversaries, they had to tell everybody, you're not going to get these pay increases right now. We're going to deal with it in a couple months. Right now you're not. So just kind of communicating and answering questions that people are afraid to ask, but getting in front of it. And I think that that's a big kudo to that CEO. Karen Litzy (31:56): Fabulous. Good stuff. Good stuff. All right. Now we'll finish up with one more topic that I think we want to cover and again, relevant at this time, but ways to create some big return on investment or ROI with a small budget because I think now everyone's tightening their belts. We have, like you just said, what if you can't get these loans? What if you can't do X, Y, and Z? Everybody's budgets are shrinking. So how can, what are some ways that we can get some big impact on our shrinking or smaller budgets? Jennifer Thompson (32:30): All right. Couple of things that we're doing with our clients. So this is like real world may or may not be working, but we'll see. Cause we're pivoting like on an hourly basis sometimes yes. But first and foremost longterm strategies is double down on your online reviews. Thousand percent do that. Pay attention to where people are having conversations and become part of those conversations if you can. I say that specifically because we tell a lot of our clients, you know, you want to create great relationships  with your patients, you want to get lots of online reviews but really what you want are like raving fans and those fans that when somebody new moves into a community or has a need, the first place they're typically going is like to next door or to Facebook. And they're asking for recommendations for someone and you know, to help them with whatever their need is. Jennifer Thompson (33:27): And if you've got patients out there that are really like singing your praises, they will do this for you for these recommendations. And so you want to make sure that you stay top of mind and stay in top of mind. Doesn't mean spending a bunch of money. It means being visible. So it goes back to don't just be on social media and schedule some lame posts three days a week through a scheduling software. If you're going to do it, do it. And I think the pandemic is, is forcing us to think about sometimes some things outside the box that we've always said, I want to get to this, to create this great content, but I don't have time. Well, you have time now, so create the great content because in a couple of months you're going to be so busy, you're not going to know what to do with yourself. Jennifer Thompson (34:09): And so I think that's really important. And then maybe start thinking outside the box of things that you hadn't thought about doing before. I have a large practice that I work with that hosts an annual seminar, a biannual seminar where they offer CEUs to athletic trainers and allied health professionals lots of physical therapy people that come into this and they have their ortho doctors on their panels typically. And then they'll invite others from all over the country to come in. They'll get the CEUs and then they'll offer them, well, chances are, and they get about 700 people every time that come to the saying it's great for them, the chances are they're not going to be able to do it this year. And so we're already having discussions with their providers who they already have the credits so they can get in the next couple of weeks here, taking that all online and getting with for them particularly they're gonna focus on athletic trainers right now because they can offer those credits. Jennifer Thompson (35:10): But we're going to transfer that to an online forum and these doctors are going to give the same talks live in a zoom setting and at the end they can have the survey done and they can offer seat use. But it's a great way to build relationships that they typically wouldn't get that chance to do. And so just kind of things like that out of the box thinking like we have class or doing live Q and A's on Facebook and you know, taking those live Q and A's and then recording them and then we can use them in videos and other things down the road. So I think we just need to be authentic, you know, have fun with it, but have fun in a strategic way and then double down on being where your potential patients are being part of those conversations and then just making sure at the end of the day you deliver great customer service to everybody. Karen Litzy (35:55): I love it. And none of that takes a lot of money at all. No. As a matter of fact, a lot of that was free. Yup. It was all free for the most part. Yeah. Amazing. Amazing. Well, Jennifer, thank you so much. I mean you have given us so much to think about and ways that we can pivot our practices to be relevant in this time and to prepare for the future when hopefully things start to open up and return to different. I don't even want to say return to normal, but we'll return to a form of normalcy. I think it's always, I think things are always going to be a little different from now on, but to at least get out of more of a lockdown situation where we can actually see more people in real life. And I think it's like you said, putting out the fires are important, but then looking to the future is I should also be part of our plan. At least that's the big takeaway that I got from this. Absolutely. I think you hit the nail on the head. Yeah. Awesome. All right. Now the last question I asked this to everybody. Knowing where you are now in your life and in your career, what advice would you give to your younger self? Say straight out of school, Jennifer Thompson (37:13): Stop stressing out about everything so much. Just stop stressing out. You know, if you work hard and you put yourself in the right situation and you prepare yourself academically and through experiences, don't say no to things. Say yes, go in there. Experience so much of it and realize that as long as you're doing what you need to do, you're going to end up where you're supposed to be. Karen Litzy (37:35): Love it. Thank you so much. Now where can people find you? Where websites, social media. Jennifer Thompson (37:42): Yeah, absolutely. So you can find me at insightmg.com which is insight I N S I G H T M as in marketing, G as in group.com and you can find me on anything social under the under the handle at dr marketing tips. So that's dr marketing tips. And you can find us on iTunes at the dr marketing tips podcast as well. Karen Litzy (38:09): Awesome. Well thank you so much. This was great and everyone we’ll have all of those links and the show notes at podcast.Healthywealthysmart under this episode. Jennifer, thank you so much again. This was perfect for the audience and I think they're going to take a lot out of it. So thank you so much. And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart. Karen Litzy (38:36): Thank you for listening and please subscribe to the podcast at podcast.healthywealthysmart.com and don't forget to follow us on social media.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Daniel Chelette, Amy Arundale and Justin Zych on the show to discuss some questions from our presentation at the Combined Sections Meeting in Denver, Colorado entitled, Turning the Road to Success Into a Highway: Strategies to Facilitate Success for Young Professionals. In this episode, we discuss: -How work-life balance evolves in your career -The physical therapy awareness crisis -How to tackle the female leadership disparity in physical therapy -Burnout and when to pivot in your career -And so much more! Resources: Amy Arundale Twitter Daniel Chelette Twitter Justin Zych Twitter   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Daniel: Daniel Chelette is a staff physical therapist at Orthopedic One, Inc., a private practice in Columbus, OH. He graduated from Duke University with his Doctorate of Physical Therapy in 2015. He is also a graduate of the Ohio State University Orthopedic Residency Program and Orthopedic Manual Therapy Fellowship Programs. He became a Fellow of the Academy of Orthopedic Manual Physical Therapists in April. Since June of 2018, he has served as the Chair of the Central District of the Ohio Physical Therapy Association. Daniel’s interests include evaluating and treating the complex orthopedic patient, peer to peer mentorship, marketing and marketing strategy and advancing the physical therapy profession through excellence, expert practice, and collaborative care.   For more information on Justin: Dr. Zych currently practices physical therapy in Atlanta, GA as an ABPTS certified orthopaedic specialist (OCS) and a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) with Emory Healthcare. Additionally, Justin is an adjunct faculty member with Emory University’s Doctor of Physical Therapy program and a faculty member of Emory’s Orthopaedic Physical Therapy Residency. Justin earned his Bachelor of Science from Baylor University, then graduated from Duke University with his Doctorate in Physical Therapy. He has completed advanced training in orthopaedics through the Brooks/UNF Orthopaedic Residency and OMPT Fellowship programs, while concurrently practicing as a physical therapist and clinic manager in Jacksonville, FL. Justin is actively involved with the Academy of Orthopaedic Physical Therapy and Academy of Physical Therapy Education. He has identified his passions lie in clinical mentorship and classroom teaching, specifically to develop clinical reasoning and practice management for the early clinician.   For more information on Amy: Amelia (Amy) Arundale, PT, PhD, DPT, SCS is a physical therapist and researcher. Originally from Fairbanks, Alaska, she received her Bachelor’s Degree with honors from Haverford College. Gaining both soccer playing and coaching experience through college, she spent a year as the William Penn Fellow and Head of Women’s Football (soccer) at the Chigwell School, in London. Amy completed her DPT at Duke University, and throughout as well as after, she gained experience working at multiple soccer clubs including the Carolina Railhawks F.C. (now North Carolina F.C.), the Capitol Area Soccer League, S.K. Brann (Norway), and the Atlanta Silverbacks. In 2013, Amy moved to Newark, Delaware to pursue a PhD under Dr. Lynn Snyder-Mackler. Working closely with her colleague Holly Silvers, Amy’s dissertation examined primary and secondary ACL injury prevention as well as career length and return to sport, primarily in soccer players. After a short post-doc in Linkoping, Sweden in 2017, Amy took a role as a post-doc under David Putrino at Mount Sinai Health System and working as a physical therapist and biomechanist at the Brooklyn Nets. Outside of work, Amy continues to play some soccer, however primarily plays Australian Rules Football for both the New York club and US National Team. Amy has also been involved a great deal in the APTA and AASPT, including serving as chair of the AASPT’s membership committee, Director of the APTA’s Student Assembly, and as a member of the APTA’s Leadership Development Committee.   Read the full transcript below: Karen Litzy (00:00): Hey everybody, welcome to the podcast. I'm happy to have each of you on and I'm going to have you introduce yourself in a second. But just for the listeners, the four of us were part of a presentation at CSM, the combined sections meeting through the American physical therapy association in Denver a couple of weeks ago. And our talk was creating a roadmap for your physical therapy career. And afterwards we had a Q and a and we just had so many questions that we just physically couldn't get to them due to time constraints and the such at CSM. So we thought we would record this podcast for the people who were there and the people who weren't there to answer the rest of the questions that were in our Slido queue. Cause I think we had quite a bit of questions. So, but before we do that, guys, I'm just gonna shoot to you and have all of you give a quick bio, tell us who you are, what you do, what you're up to, and then we'll get to all of those questions. So Justin, I'll have you start. Justin Zych (01:00): Sure, so I'm Justin Zych. I'm currently with Emory university. I am teaching in an adjunct role with the DPT program and then also the orthopedic residency. I went through and did an orthopedic residency and manual therapy fellowship through Brooks rehab in Jacksonville and did my PT education with Duke university. Daniel Chelette (01:28): Hey everybody. My name's Daniel Chelette. I also graduated alongside Justin from Duke in 2015. And also completed an orthopedic residency at the Ohio state university and then stayed on and completed a fellowship and with manual therapy at Ohio state as well. And then worked in an outpatient orthopedic clinic for a couple of years and then was fortunate enough to have the opportunity to join on and work as a physical there, the player performance center with the PGA tour. So actually up to two months into that and it's been a pretty cool experience. So that's where we're at right now. Amy Arundale (02:15): Hi, I'm Amy Arundale. I'm a physical therapist and biomechanistic with the Brooklyn nets. I also went to Duke although a few years before Dan and Justin and then worked in North Carolina for a little while as a sports physical therapist as well as working with a large soccer club before going and doing a PhD at the university of Delaware under Ireland Snyder Mackler. So did research on primary and secondary ACL injury prevention did a postdoc in Sweden with Juan activist and Martin Haglins before moving here to do Brooklyn. Karen Litzy (02:56): Well, thank you all for joining me and allowing the listeners to get a little bit of a glimpse into our CSM talk for those who weren't there and for those who were, and maybe we didn't answer their questions while we were there. We can answer it right now. So Daniel, I'm going to throw it to you. I'm going to have you take the lead for the remainder here. So take it away. Daniel Chelette (03:20): Let's do it. All right, so just a quick little background of the foundation or basis for this talk. It really focuses on some lessons and things that we have learned through the four VAR unique experiences up until this point about professional growth and professional development and things we've learned, the easy way and things we've learned the not so easy way. And just tidbits of wisdom we've picked up along the way and we thought it'd be valuable to put it together and have a talk for CSM. And that's kind of what well what the basis of all this was. So towards the last portion of the talk we just opened up wide open Q and A. and we got through a few questions but we've got a handful more that we're going to go with. So we're going to start out with let's see. What do you recommend for the future PT that wants to get involved in a specific section of PT but wants to remain local to their community? Amy Arundale (04:26): I can start with that one. I think one of the nice things about being involved in the like sections is a lot of times they actually are based where you're at. So they don't necessarily, they may require going to conferences but they sometimes don't even require that. So it's really easy actually to stay local and still contribute and get involved in the sections. Really. The big piece there and is just reaching out and saying, Hey, I'm really interested in getting involved. How can I volunteer? And that might be, you know, helping with a membership that, which might be making phone calls or emails or following up with people who have maybe accidentally dropped their section or their APTA membership. It might be helping with various other projects, but a lot of times those are actually you know, maybe they're internet based or they're going to be through conference calls. So it's pretty easy to stay local. Karen Litzy (05:27): Yeah, I think that's a great answer. I'm pretty involved in the private practice section of the APTA and I would echo what Amy said. A lot of you can get involved in committees. So a lot of the sections have individual committees and most of that work is done online with, maybe you have to go to the annual meeting of that section, but that's just once a year. And the good news is if you're doing a lot of things online, you're meeting people. When you go to, let's say the section meetings each year, you'll get to know people in your immediate local area. And it's a great way to start making and nurturing those connections in those relationships. So then you'll have people in your immediate area that you can go to for guidance and just to hang out and have fun as well. But I think starting, like Amy said, just have to ask. Daniel Chelette (06:27): Yeah. That’s beauty of the age that we live in is that it's really easy to connect be a long distance. So technology allows us to do that. And I'm a part of a committee through the American Academy of orthopedic manual physical therapists. It's the membership committee. And everybody's all over the place where all across the country. And that was just something I got plugged into and I've met a lot of cool people through it and have made some connections within that realm. Be that, so there's a lot of different like online and long distance ways that you can get connected without being connected, which would be, is it helpful if there's a particular area you want to stay in, but you still want to get connected? Two people within your community but also outside. Karen Litzy (07:17): All right, Daniel, go ahead. Take it away. Daniel Chelette (07:21): All right. We're stepping it up here. This next, and this is a good metaphysical question. Do you compartmentalize your life? How do you approach the interaction between family and professional domains? Justin Zych (07:36): So yeah, that is a really deep question. I'll try to go through and answer to the best of my ability. I think that that intersects a little bit with my section of the talk, which really focused on trying to make sure that you could handle all of the new responsibilities that come with being a new physical therapist. I'm getting used to the responsibilities and productivity expectations, but while also at the same time understanding that it's important to have a balance outside of the clinic and a really good work life balance. So as far as compartmentalizing it, I don't know if I've specifically sat down and tried to put things into boxes. I do have a little bit of a blend. I mean, even my wife works for a different physical therapy company, so we share a little bit of a shared language with that. Justin Zych (08:24): But it's important that whether it's documentation or other things. When I leave the clinic, I try to leave and make sure that I have a little bit of time for me and time to focus on whether that's my own professional development going and taking advantage of opportunities like this to meet and talk with other people or just relax and kind of step away from the responsibilities that you go through throughout the day. So that's a great question, but a very, I think you're going to find a bunch of individual answers from it. Daniel Chelette (08:56): Yeah, I think it really, it's an individual question kind of like Justin mentioned in, I think for me. What I've found is, you know, maybe well work life, work life balance, particularly going through residency and a fellowship you know, work life balance, a 50, 50 split, maybe not completely realistic, it's a work life division. So where you just have, you have things within your life, be it relationships or activities or whatever. We are able to unplug a little bit from work. And those might be bigger parts of your life at different points in your life. But it's being able to, you know nurture and engage in all aspects of who you are as a person. And not just work, work, work, work, work but kind of be guided by what you're passionate about, what's important in your life. And those will take up bigger sections of your life pie at different points in your life. So it's just important to try to have a division but not necessarily think that you have to keep that division at a certain level at all times throughout your life because life changes. Amy Arundale (10:11): So my old advisor LENSTAR Mackler and I've also heard Sharon Dunn use the metaphor of juggling. And they talk about juggling rubber balls and crystal balls. So your crystal balls being the things that are like really, really important. The things that you have to keep in the air because if you drop they shatter, so those might be like family, they might be important relationships. They might be work. And then you also then also have rubber balls. So rubber balls would be then things that if you drop they'll bounce back. They're not quite as crucial to keep in the air all times. And, that balance between some of those rubber balls and crystal balls is always going to change. But that there are some things that you have to keep in the air and some things that you can let drop or you might have, they might have a different kind of juggling cycle than others. Amy Arundale (11:07): So yeah, I think it changes from time to time. You know, I've had periods of time where I've basically just worked full time. My postdoc was a great example. I was basically, you know, going to work during the day working on postdoc stuff and then coming home and trying to finish off revisions on my PhD papers. And I was in a long distance relationship at the time, so it kind of just worked that I was literally working, you know, 14 sometimes 14, 16 hours a day. That's not sustainable for a long period of time though. And I'm guilty of sometimes not being good at that balance. I would like to think as I've gotten older, I'm better at creating time where I'm not working or you know, actually taking vacations where I'm putting an email like vacation, email reminder on and not looking at emails. Amy Arundale (12:04): But it's going to change from time to time. Those priorities will change as your life changes. So I don't know if it's necessarily compartmentalizing, but prioritizing what needs to be, what's that crystal ball? Are those crystal balls and what are those rubber balls?   Karen Litzy: Okay. You guys, they were all three great answers and I really don't think I have much to add. What I will say is that as you get older, since I'm definitely the oldest one of this bunch, as you get older, it does get easier because you start to realize the things that drive your happiness and the things that don't. And as you get older, you really want to make, like one of my crystal balls, which I love by the way, it's Sharon Dunn is genius obviously. But for me, one of my crystal balls I'm going to use that is happiness. Karen Litzy (12:58): And so within that crystal ball, what really makes me happy. And that's something that I keep up in there at all times. And at times maybe it is work. Maybe it's not. Maybe it's my relationship, maybe it's my family or my friends or it's just me sitting around and bingeing on Netflix. But what happens when you get older is I think, yeah, I agree. I don't know. And I think we've all echoed this, that I don't think you compartmentalize. You just really start to realize what's the most meaningful things for you. Right now. And it's fluid and changes sometimes day to day, week to week, month to month, year to year. Daniel Chelette (13:55): All right. And one, one quick thing on that last question. Kind of a hot topic, particularly in the medical doctor community is burnout and resiliency and you'll see those terms thrown around a lot. And I think a big thing is to realize that those types of things as far as burnout and kind of getting to a point, we're just sort of worn out with what with the PT professional, which do on a daily basis everybody's susceptible to it. You know, we can all get caught in this idea that maybe we're indestructable or you know, Oh, I can take on as much as I wanted to or need to like machine X, Y and Z. At a certain point it's a marathon, not a sprint. And you have to sort of like Karen and Amy alluded to that prioritization is huge. And definitely gets a little bit easier as you gain more life experience and kind of see what matters and maybe what doesn't so much. Daniel Chelette (14:51): Okay, now they're kind of good solid question here. So I'm going to paraphrase a little bit in, So companies, businesses usually do something really specific now for a specific product or a service or something like that. They focus on one thing. Daniel Chelette (15:02): In PT, we do many things. Is there an identity crisis within the profession of physical therapy? And how do we address it? So I’ll kind of get the ball rolling? That's a heavy question. I think to a certain degree, I don't know if I would say crisis, but I do think at times like I use the situation of if somebody asked me what physical therapy is. Initially I have a little bit of a hard time describing it. I think, I guess the mission statement of the vision 2020 is sort of what I fall back to. It's a really good snapshot of how we can describe what we do. It's basically helping to optimize and maximize the human experience through movement and overall health and, you know, but that in itself is a little bit vague and a big picture and sort of hard to really put a specific meat too. So, yeah, I think, I think to a certain degree it's a little bit hard to say what is physical therapy’s identity? What do you guys think? Amy Arundale (16:21): I would say, I don't know if we have an identity crisis, but I think we have an awareness crisis. I think the general public's knowledge and awareness of physical therapy and then also within the medical profession, the awareness and knowledge of what physical therapy is I think is a massive problem because that knowledge and awareness isn't there. And probably part of it then comes from us. I think, you know, Dan, what you're saying, I think that is that kind of, if we can't describe ourselves then no wonder other people can't figure out what we do or how we do it. So I'll give a shout out actually to Tracy Blake who's a physical therapist and a researcher in Canada. And one of the things that the last time when we sat down and had a chat was, she kinda gave me this challenge was if someone were to walk up to you and ask you what you do, come up with a way to describe what you do without using any medical terminology. Amy Arundale (17:28): So without using movement, without using sports, without using some of our fallback terminology, like come up with that elevator pitch of this is what I do. So I'm happy if you've got that at the ready. If you understand that, if you can kind of, yeah, the drop of a dime, give that, you know, five seconds spiel about what physical therapy is, then suddenly, you know, that person knows. But we've all got to have that at the ready and we've all that. I'd be able to do that so that we can put it in a common language that, you know, your next door neighbor can understand, that your grandmother can understand. So when they come to you and say, you know, you know, my hip's been bothering me for six weeks and I've been going to a chiropractor you've got that language to be able to say, well, have you thought about physical therapy? Amy Arundale (18:29): When you're talking to a doctor in a hospital or even just in a, you know, normal conversation you know, you've got that ability to say, well, Hey, you know, what about PT? Yeah, let's not put them on an opioid. Let's get them into physical therapy. So I think it's really a Big awareness crisis.   Karen Litzy: Okay. So Amy then my challenge to you is to Tracy's point, how do you answer that question? And then I haven't even bigger challenge though I'll say to everyone, but how do you answer that question?   Amy Arundale: So I've written it down. Let's see if I can get it right. The short version of mine is that my goal is to help athletes at all levels develop into their optimal athletic being as well as develop their optimal performance. What if someone says, well, what do you mean by optimal? That's a good question. What does that mean exactly? How do I help you become the best you can be? Karen Litzy (19:27): Okay. Not bad. Not bad. Excellent. Very nice. Very nice. So now I have a challenge for the three of you and let's see. Daniel, well, no, we'll start with Justin. Let's put him on the spot first. Great. All right. So I was at an entrepreneurial meetup a couple of years ago, and the person who was running this, Mmm gosh, I can't remember his name now. Isn't that terrible? But he said, I want everyone to stand up. In five words. So you have five fingers, right? Most of us. So in five words, explain to me what you do. So talk about stripping it down to its barest essentials. Simplifying to the point of maybe absurdity. It's hard to say what you do in five words, but Daniel, I'll start with you. So someone comes up to you and you say, I'm a physical therapist. Five words. This is what I do. Help people live life freely. Karen Litzy (20:48): Okay. That's not bad. Not bad. Justin. Justin Zych (20:51): I'm not going to use a sentence, but facilitate. Educate. Yeah. Facilitate. Educate. Empower. Does that count that I repeated like six. Now, restore, empathize. Throw the thighs in there. Karen Litzy (21:09): Nice. Yeah. When I did this for this little meetup, I said, I help people move better. That's what I said. Those were the five words. I help people move better. But I do like where I think maybe if we put our heads together and we mashed up all four of ours, I think we'd come up with a really, really nice identity statement that is maybe 10 words. So maybe we can put our heads together after this and come up with a nice identity statement made up of 10 words. And if we were at CSM, we would have the audience do this. This would have been one of their action items. So what I'd be curious is for the people listening to this, you know, put an action item put, what are your five words, what would you do to describe what physical therapy is? And then if you're on Twitter, just tag one of us. You can find all of our Twitter handles at the podcast, at podcast.healthywealthysmart.com in the show notes here. So tag one of us and let us know what your five words are because I'd be really curious to know that. Excellent. All right, Daniel, where are we at? Justin Zych (22:42): So actually I want to, I still want to go back to the last question cause I think there's a really good point in there. So Amy hit it really well with the awareness issue versus the identity crisis within our profession. I, I think one of the things that sets us apart is how dynamic we're able to be. And the skill set that we're given in, you know, when we have our DPT education and when we graduate, you know, granted, you know, we're using the term as a generalist where you can go and specialize further. But I think that that's a, that's a rare but very very powerful trait of our profession is that we're able to help across a spectrum of a lot of patients. The challenge that I would say if that question was worded a little differently is if we focus specifically just on one section, so is there an identity crisis within the orthopedic section? Justin Zych (23:36): If somebody comes in and they have hip pain, are they going to be treated differently by all four of us and then therefore does that make it really tough for us to come up with this five words, 10 words statement? Because we're, we're very heterogeneous in how we, how we address patients still kind of within specific subsets. So I think that's probably the bigger crisis if you will. We still have a, you know, even within specific sections, a 10 lane highway instead of, you know, two or three based off of specific patient needs. Karen Litzy (24:10): And do you think that publication of CPGs helps that it for people who, and this is going off on a totally other question, I realize that, but following up with that, do you think CPGs published CPGs help with that and staying, I guess up and current on the literature can help with that? Do you feel like that is something that might close that gap of huge variability? Justin Zych (24:39): Yeah, I think the way that they're designed, that's exactly what they're trying to do is they're trying to take all of this, this you know, research literature review that we should all be doing and put it in a really nice, you know, consensus statement for us and then give us, you know, specific things to look deeper into the CPG. So I think that it's there, it's just again, how do you, is everybody finding that? And if they are finding it, are they applying it properly, you know, towards their practice. So I like that the information is coming out there. At this point, I'm not completely confident that it's reaching throughout, you know, the spectrum of everybody that it should be. But hopefully, you know, it continues, especially with, as we have new people graduating, we really start to develop that as more of the norm. And then it's a lot easier to not necessarily standardize but get everyone in in a couple of lanes instead of 10 lanes. Daniel Chelette (25:36): So Justin, just to play devil's advocate what about the good things that come with having 10 lanes versus two? And there's some people that I completely am on board with what you're saying, but I think there are plenty of folks that would say, well that's the beauty of physical therapy is that it can, you know, you can really make it make it individualized and what it is to you and you can treat. Obviously there's principles that you abide by, but you can be different then the PT next to you and different to the PT next to them and I can still offer high value. What would you say to somebody who would say that? Justin Zych (26:26): I think that your statement you just said is completely fine. But, the issue that comes about that is that therapist who wants to provide the individual approach, have they, you know, exposed themselves to enough different approaches or different ways that they would look at it, that they can be truly individual to the patient instead of saying, okay, I'm going to focus on I’m a, you know, to throw anyone or anything under the bus here, but I am specifically a Maitland therapist. I'm specifically a McKenzie therapist. And then that approach fits that patient all of a sudden, as opposed to being able to expose yourself enough to be able to flow in and out. Again, based off of what you said, which is I completely agree with that individual approach. So making sure that you have that dynamic flexibility to cater your skills. Sorry, a little bit of a tangent there, but can't help myself. Amy Arundale (27:37): I'll piggy back and put a shout out to people who want to get involved. But one of the things that the orthopedic and the sports section, I'm going to go back to their old names, the orthopedic section and the sports section. In the newer clinical practice guidelines. One of the things that I think Jay has done a great job of is kind of forming committees around each guideline on implementation. So when we did the knee and ACL injury prevention clinical practice guideline, we actually had a whole separate committee that we pulled together that was in charge of how do we help disseminate this information and help clinicians implement it. So that was putting together a really short synopsis for clinicians, a pamphlet or just like one pager that can be like just printed off and given to a clinicians. It was two videos. So videos of actual injury prevention programs, one for field based athletes on one for court based athletes. But getting those out, just like you talked about Justin, you know, that that's sometimes where that or that is where that gap between research and clinical practice comes. And that implementation is so important, but it means that yeah, there's a chance to get involved for people who are interested in helping those guidelines really kind of truly get disseminated in the way that they need to be. Karen Litzy (29:04): Great. And I think that's also really good for the treating clinician because oftentimes as a treating clinician, we feel like we're so far removed from the researchers and even from the journals that you think, well, what is my contribution going to do? Like how can I get involved? I'm the J word, just a clinician. And so knowing that these committees exist and that as a treating clinician, you can kind of be part of that if you reach out to get involved I think is really important because oftentimes I think clinicians sometimes feel like a little Karen Litzy (29:42): Left out, sort of and left behind as part of the club, you know. So I think, Amy, thank you so much for bringing that up. And does anyone else have any more comments on this specific question or should we move on to the next one? Daniel Chelette (29:59): Alright. So Amy and Karen, this question is geared towards you guys. So the question reads while PT is a female dominated field, there is still a disparity in female leadership. Do you have advice for female student physical therapists who may desire those leadership roles? Karen Litzy (30:24): I would say number one, look to the APTA. Look to your state organization, look to your, even where you're working and try to find a female physical therapist or even look to social media, right? Look to the wider world that you feel you can model. So I think modeling, especially for women, for people LGBTQ for people, minorities is so important. So you want to look for those models. Look for the people who are like, Hey, this person is kind of like me. So I really feel like I can follow a model, this person, I would say, look to that first and then follow that person, see what they're doing, try and emulate some of, not so much of what they're doing in PT, but how they're conducting themselves as a professional. And then like I said, during our talk, reach out, you know, try and find that positive mentor of try and find that the mentorship that that you are seeking and that you need and that you feel can bring you to the next level, not only as a therapist but you know, as a person and as a leader within the physical therapy world. Karen Litzy (31:46): And I think it's very difficult. I'll do a shameless plug for myself here really quick. We created the women in PT summit specifically to help women within the profession, a network, meet some amazing female and male leaders within the profession and have difficult discussions that need to be had to advance females within the profession. And I will also say to not block out our male counterparts because they need to be part of the broader conversation. Because without that, how can we really expect to move forward if we don't have all the stakeholders at the table. So I would say speak up, speak out, look at people who are at the top of their game. Karen Litzy (32:40): And then in a high level positions, Sharon Dunn, Claire, the editor of JOSPT, Emma Stokes, the head of WCPT. All of these people, if you reach out to them or you hit them up on social media, they will most likely get back to you. It may not be really fast, but they will probably do that. So I would say look to the broader physical therapy community. Look to the world of physical therapy right down to your individual clinics because I think that you'll find there are a lot of people to model. Amy Arundale (33:41): Mmm, yeah. Yeah. I 100% agree. I think modeling and mentorship are huge. Finding people that you connect with and who can give you honest, upfront feedback but also support. So I feel like I'm pretty lucky in both having really strong women who I consider as mentors, cause I think that is important. When I was part of the student assembly, Amy Klein kind of oversaw the student assembly and she became someone who I really look up to and admire and will go to for, I know she'll give me it straight whether it's you know, good or bad, I know she'll give it to me straight and I need that. But then also Joe Black is somebody who's also been a longtime mentor of mine recently. And the Stokes I've connected with and that was just meeting her at a conference. And we connected at a conference and had an amazing conversation and that's developed further too. So I think mentorship and then getting involved seeking the opportunities. Mmm. And seeking and creating, cause sometimes they're not already there. Sometimes, you have to create them yourself. Some of those opportunities that you want going out and saying, Hey, can I volunteer here? Where they may not have had volunteers before. So finding those opportunities that you want and that you think will help you develop towards your end goal. Justin Zych (34:53): I was just going to say really quick of course you two have been, you know, great examples of how females can Excel and create their own path. Justin Zych (35:08): The thing about mentors is with mentors, it's so important to have a variety of mentors because you're going to pick out different things that the mentors are going to help you with. One of my most influential mentors was a female. She was, you know, I was involved with her in the fellowship program that I was in. And she really helped give me some really blunt but helpful feedback that helped a lot with some of my soft skills. So I'm kind of exposing myself a little bit, but she told me that after my lecture, it was on the cervical spine. She was like, yeah, like the content was great. You just weren't likable and just kind of threw that right at me, let me chew on it a little bit. But that actually really changed how I approached a lot of different things and helped me develop those soft skills. Justin Zych (35:55): So at the same time, she helped me through some managerial struggles that I was having. So that variety is incredibly important. And I've been a mentor too. You know, some of my mentees were females and they're doing amazing things right now and I hope that whatever feedback I gave them, they took the right things from and continue to move forward. So it's an issue that goes across, you know, the gender lines. And as males, I want us to be aware that it's going on as well. And not to lead into that discrepancy that Karen described, but still provide that same level of mentorship, same level of opportunity and consideration. So it's a great question and hopefully the gap narrows as we go forward. Daniel Chelette (36:59): Oh, here's another good one. Any recommendations for a PT that is two years out and feels completely lost and, or in the wrong setting? Justin Zych (37:10): Yeah, so I'll start with that one. You know, of course understanding that I probably don't have the exact answer here. This really tied into my portion of the talk, which was the importance of the clinical environment within your first couple of years of development. And then also making sure that you understood that we clarified the difference between being engaged in your environment, in your system, and even in your organization versus being burnt out. And how those two aren't necessarily exactly the same thing. Burnout is something that we describe as more of like a longterm reaction with like physical manifestations where engagement is more of deciding how you want to use your remaining effort in the day, the effort that you can discern as I can do this to go home and watch Netflix or I can do this to really give back into my system. Justin Zych (38:06): So I actually had somebody right after the talk come up to me and just say that she really appreciated just hearing it and understanding that there are a lot of people that have that same sense where your question's coming from. So I just want to put that out there first of all. So I would say first reflect on what first off what you want out of your clinic and see what they are and are not matching. And if you've been in that for two years, that's a pretty good trial run to figure out if there's a different environment that maybe you would want to consider that's going to work more on engagement. What maybe that you want to be more involved in a clinical instruction and be a CI. Maybe you want to do some project management, have some more specific mentorship or it's just the way that they're setting up their productivity. So is it a question that I'm glad you're steering into right now? But it's gonna take a little bit of reflection not only on what your expectations are of the clinic and how you see yourself as a therapist but going even further, you know, keeping your system, your clinic accountable for are they meeting or at least trying to meet and keep me engaged in those environments. So we should, I wish you luck with that reflection. Amy Arundale (39:27): Nailed it. Daniel Chelette (39:29): Crushed it, man. I just got, I mean, that was a sick answer, man. That was right, right on the money. And the one thing that I would highlight is what I spoke on in my portion of the talk is try to strip it back and think, okay, like what am I about as far as life goes? Like, what am I passionate about? What am I into? What gives me energy? And then kind of builds yourself back up, okay, what as far as work goes, what aligns with that? And then why do I feel a disconnect with where I'm at? And are there ways that I can change my current situation kind of within it? Or do I need to you know, do I need to move on or do something different? Daniel Chelette (40:22): So I would try to use your personal passions and sort of your foundation of who you are as a person to help you kind of reset and try to figure it out. But you know, I think that's a great question cause we all go through it at some point in time. And you know, the concepts of burnout. Mm. Oh, reduced engagement and things. That's all part of the game. And those are completely, but I think burnout obviously isn't a good thing, but don't feel bad or guilty if and when you run into those things. Cause we're all humans. And, they can happen but know that there are ways that you can move out of that and move past that. And that's one of the cool things about PTs. There's so much to so many different things to do and get involved in. But yeah, great question. Amy Arundale (41:15): That passion was just like the one word that I felt like we needed in that answer. So I think those two are perfect.   Karen Litzy: So we're good. We hit all the questions. So I'm going to ask one last question. It's a question that I ask everyone and Justin, I'll start with you. Not to put you on the spot again, but given what you know now in your life and in your career, what advice would you give yourself as a new grad fresh out of Duke. Justin Zych (41:47): Okay. Yeah, no, that's an awesome question. I think the biggest advice that I would give myself is to not have expectations of quick motion, quick development. I'm going through. And in my talk I talked a little bit about, we were in Denver for CSM. So I talked about using the French fry approach with skis where you go down quickly or the pizza approach where you go slowly. So making sure that at times, I was looking at the, you know, what I would tell myself now is make sure that you're looking at just that next step and not focusing on the step that's three or four away. So that you're really present in those moments cause there's a lot of development things that you can potentially miss over as you're trying to really quickly make it to that next step. So take a little bit more of that ski pizza approach. Amy Arundale (42:40): Fabulous. Daniel, go ahead. Daniel Chelette (42:42): I think what I would say is it's a marathon, not a sprint. You know, it's as far as, you know, career goes in, life goes, it's not just, you know, going 110% each and every day. It's being able to look at the long game. So with the short game, kind of along the lines of with what Justin said, just keeping in mind that Mmm,  it's a marathon, not a sprint. You have to keep the big picture in mind. Amy Arundale (43:47): For me, it would be like give yourself permission and that I think that extends to a number of different things. But you know, one of the big ones is kind of self care, you know, kind of giving your self permission to take that time off or to let something else be a little bit higher priority. Whether that's working out or spending time with people, kind of give yourself permission to you know, take that step back and look at things from that 30,000 foot view. So you can really see that big picture. So I think that would probably be mine. Karen Litzy (44:32): Excellent. And then I feel like I've answered this question in various iterations over the years, but I've really think what I would tell myself. Yeah, right. Knowing what I know now and when I first graduated, which was quite a long time ago, would be from a career standpoint to get more involved. Whether that be in the APTA or sections or things like that. Because I really wasn't involved and from a personal standpoint is like I needed to calm down. Yeah. Like the Taylor Swift song, like I needed to calm down and that's what I would tell myself. Like I was always kind of go, go, go, go, go and I have to do this and I have to do that. And so I would tell myself like, calm down. Karen Litzy (45:27): Things will happen. Kind of echoing Justin and Dan, like I really that's advice I would give to myself is like, calm, calm down, you'll be fine. So that's what I would give to myself. So you guys, thank you so much. All of you for taking the time out and answering all the rest of these questions I think will be really helpful for people who are there and people who weren't to get a little taste of what we spoke about at CSM. And like I said, everybody's social media handles and info will be on the podcast website at podcast.healthywealthysmart.com in the show notes under this episode. So you guys, thank you so, so much. I really appreciate it. And everyone, thank you so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.     Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

In this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Adrian Miranda on the Academy of Orthopedic Physical Therapy.  Adrian Miranda, class of Ithaca College Physical Therapy '07, was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition, he is a medical consultant and content creator at a Virtual Reality rehab start-up called Reactiv. In this episode, we discuss: -Educational resources available at the Academy of Orthopedic Physical Therapy -Diverse mediums used to disseminate research to clinicians -How to be involved in advocacy on the state and federal level for the PT profession -The importance of research for both advocacy efforts and clinical practice -And so much more!   Resources: Email: AMiranda84@Gmail.com Cell phone: (585) 472-5201 Academy of Orthopedic Physical Therapy Twitter Academy of Orthopedic Physical Therapy Website JOSPT Website   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!                                                                      For more information on Adrian: Adrian Miranda class of Ithaca College Physical Therapy '07 was born and raised in Manhattan. He currently practices at Windsor Physical Therapy in Brooklyn, NY. In addition he is medical consultant and content creator at a Virtual Reality rehab start up called Reactiv. In the past Adrian has also worked in media including video producer and a television host for BRIC TV ("Check out the Workout") a local television station in Brookyn. Previously he was a faculty member in the TOURO College Orthopedic Physical Therapy Program as the Director of Clinical Residency education. He also was an instructor for Summit Professional Education teaching continuing education (Shoulder Assessment and Treatment) He is currently the Chair of the PR/Marketing committee for the Academy of Orthopedic Physical Therapy (APTA) and contributes to APTA Diversity, Equity, and Inclusion initiatives. He previously held positions in the NYPTA as Chair of the Minority Affairs committee of the NYPTA, member of the programming committee, and Brooklyn/Staten Island Legislative liaison. He also teaches media including video editing, video production at Brooklyn media non profit BRIC. In his spare time he swing dances, does crossfit, has a web series called Gross Anatomy on Firework, and dabbles in theater.     For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor (00:00): Hello. Hello. Hello, this is Jenna Kantor. Welcome back to another episode on healthy, wealthy and smart. I am here with Adrian Miranda who is a physical therapist who you have probably seen on social media quite a bit. Adrian, would you first tell everyone exactly what your job is that we are going to be discussing and in which section of the APTA? Adrian Miranda (00:21): So my name is Adrian Miranda. I am the chair of the public relations committee for the Academy of orthopedic physical therapy. Jenna Kantor (00:30): Yes, that's right. A mouthful in which I could not get off. So I had Adrian saved for me. Well Adrian, first of all, thank you so much for popping on today for a nice little interview. So I want to first just dive in because I don't know anything about the orthopedic section in the sense of what is it is that you guys are doing for me as a new grad, I'm always thinking the JOSPT, that is a great resource and that is it. So we're going to be diving into more of what the orthopedic section is doing at this point so we can all learn and better appreciate it. And also for those who are considering joining the section, you'll go, Oh, this is for me. Or actually it's not for me. I'm just gonna be sitting with other sections instead. So first of all, what is the big focus for the orthopedic section? Adrian Miranda (01:23): Well, the orthopedic section does a lot of things. But let's talk about the focus on education. So as you said, the JOSPT that is actually a joint collaboration between the Academy of orthopedic physical therapy and Academy of sports physical therapy. One thing, so I became the chair, I guess I spent two years I believe now or going into my second year, but I was part of the community for about six months before that. And one thing I would challenge anyone or ask anybody to do is actually go to the website, orthopt.org. Look at all the tabs, scroll through it. And you can find so many things that when I became the actual a chair and I went, I'm just perusing and just looking at what the Academy does. Cause my goal was like I think the Academy does a ton of stuff that not many people know about. Adrian Miranda (02:12): You're going to learn so much about how much work and effort goes into and how many resources you can find for yourself or your colleagues educationally. There's a lot of independent study courses. The one that you may know if you've either going through residency finishing residency and taking your OCS, but it's the current concepts which is of, I say it's a staple. If you want to take the OCS, you should have the current concepts, you should be looking for the current concepts and reading through it. That's going to be a huge, huge resource and who get better to go to then the Academy itself. Besides that, cause there's so many courses, even things that I didn't know about. For example, there was actually a concussion independent study course. As you know, many of us, even myself in the clinic are starting to get more and more referrals for patients who have had a concussion diagnosis. So that's out there. There are other courses that are older. Some you get the current courses you get see you use for their courses that you don't get. For example, there is a triathlete course, there is a postoperative course, there is a work related injuries course, auto accident, all these are resources that anybody can use. And that's just kind of the tip of the iceberg as far as courses that you can purchase. And moving forward there are some free resources as well. Jenna Kantor (03:31): That's very helpful. So for somebody who doesn't have time, Oh, I feel like I'm speaking for everyone when I say that than going, Oh my God, I have to go and like playing the tabs. How much time is that? I have other things on my to do list. You just gave an overview of the education part, but what are some highlights on things that stood out to you personally within that that's being offered? Adrian Miranda (03:54): So none of us have time. You're right. And so I think one of the things that you're going to start to see is easier access to information. So for example, even if you look at any of our social media threads which if you’re looking at orthopedic within a you're gonna find, for example, we had a patellofemoral infographic. You're going to start to see some more smaller snippets because the Academy has realized that yes, people don't know how to digest the information and put into clinical practice right away. You have to really large clinical practice guideline is 70 pages or 50 pages. And then how to kind of digest that and to put it back out in the clinic. We’re trying to create easier versions of that, whether it's infographics. We are also partnering with podcasters like yourself to disseminate information from the authors themselves to give you the information so you can have passive listening. Adrian Miranda (04:46): In other words, you don't have to read, you can actually be driving to work going on the subway. You can be on your lunch break and listening to information from authors or researchers of these publications. So we're trying to make smaller tidbits to make it digestible in a form that's also accessible to most people. So we've been looking to long form writing. But right now it's infographics are trying to get onto podcast and educate more people, but we are looking into the fact that there is a time constraint in our physical therapy profession. Jenna Kantor (05:20): Yeah. That's excellent to learn. So for the orthopedic section, with the information that you have provided that they're already offering, which is incredible, who is your audience when you're creating the infographics or the infographics for us to better understand, are they infographics where we can reshare it to patients? Adrian Miranda (05:45): So good question. These are for us. So the push is actually for us clinicians to get a better grasp of this literature and a cliff notes initial format. However, if you look at JOSPT and I think moving forward, we're trying to also create a little bit of public awareness. So have you seen in JOSPT patient perspectives? That's one way that you can utilize and share it. And I actually remember when they first came out in my clinic, I printed them out in color, put it on the walls and the rooms and patients actually read it and ask questions about it. But as far as what you'll see further moving forward, like the infographics, it's going to be more for us, for the clinician so that we can actually suck in the information and be able to distribute it out to our patients in the easier manner. Jenna Kantor (06:27): Yeah, that's a big deal. As a clinician myself or I'm putting together a lot of dance research and creating it on this long form document with links to different research to have it disseminated will be great because the time is taking me to create that. It's a lot of time. It's a lot of time. And I know other clinicians don't have that, so I'm creating this for the dance community at large. So I think that's a really big deal that you guys are looking to make that information more available because there's always regular research and I just want to point this out because nobody can see it. Adrian Miranda (07:05): Anyways, I just wanted to put this out there before we continue. Another question. We are also looking for ideas. We want to engage with our members. So if you have any ideas about how to disseminate this information in a different way, we're talking about even long form writing. Some people love to read and that's totally fine. We're trying to look into different options. We're definitely looking for suggestions, people to collaborate with us people to a similar to what you are doing Jenna. To collaborate with us, give us new ideas. We're definitely looking for innovative ways even some old ways that we can bring back to help our clinicians better understand this information and be able to utilize it. Jenna Kantor (07:44): I love that. So this is a newer concept, but we have discussed about it. How is the orthopedic brainstorming, how to bring in other people who are providing information and education to help what we bring to patients. Adrian Miranda (07:58): I think it's people who are doing the work. Researchers, also clinicians, people who are in the clinic and researching, you know, we're in the clinic and researching. But the Academy definitely has some of the top researchers, people who have their pulse on newer topics. And one of the things that, that also stand in me was when the concussion dependence study came out. And I think that's to show that right now we're going to see an uptake in physicians referring concussion patients to our profession. And we have to be ready for that. Jenna Kantor (08:31): You are on the PR committee, so you know a little bit about the public and the relations. You're like Samantha from sex in the city, but not anyway, so I digress. What is it that you guys are doing and focusing on within the marketing committee alone and who is your audience for that? Adrian Miranda (08:50): We just want to show you stuff. We want to show you and teach you things. For example, if you look at our recent posts, we wanted to share what happened at CSM. We actually have the Rose award, which if you were in a, for example, a rural setting, if you're doing home health care, you can actually watch his full speech on his study. That had to do with how many visits was optimal for home health, physical therapists. So those are the things that we want to kind of bring you inside and say, Hey, look, this is what we're doing. We are finding committee members who are have skills in different aspects of the media. Which like I said, we're looking for people, we're always looking for people and new ideas. But when I came in, as I told you I wanted to share everything that the Academy was doing at one point I will look there's actually even some certification for imaging. Adrian Miranda (09:43): If you are interested in imaging or you think you want to dive into any type of imaging for your research, your PhD or even if you're a new graduate who says, Oh, I really want to learn more about imaging. There is a special interest group for imaging with resources and there's I believe there is either a discount or something and you can again, you can kind of scroll through the social media cause we did post it at one point. We just go through so much information that I can't tell you everything on the up the top of my head. But we're trying to share information that you would actually have to go and scroll and look for on the website. We're trying to make it more accessible. So there's just so many things that we want to it's like a media company really. Adrian Miranda (10:23): We're just trying to share what things we do and what opportunities. Oh, another example is the federal advocacy forum. So there is the money into the Academy will provide to a student to actually attend the federal advocacy forum. I believe the deadline has passed for that to apply for the scholarship or the grant. But those are things that we're trying to do. Before I was at CSM and the chair of the practice committee came up to me and said, Hey, is there any way that you can share this? And so those are things that we, even through email marketing, you may have seen it. There was also other programs like CoStar, which you'll have to kind of look it up or go online or go on the website or social media to find out about it. Adrian Miranda (11:07): It was about innovation and science. And it's not just for physical therapy. So there's a lot of opportunities, volunteer opportunities, ways to get involved, resources, educational materials. So the peer committees, just trying to say, Hey, you know, those of you on social media, there's all this stuff that you can do. Right now if you look online, soon enough there'll be like a residency Q and A. So there are many of you who are interested in going into residency or currently in residency and we're trying to reach out to that population as well. So there's a target population. It's really the Academy members. So we don't have new grads or old grads. There is a little bit more of a push to get attention from new graduates and students, but we want to be able to share as much information that will help our members. So we are a member facing organizations. Jenna Kantor (11:58): That's really great. That's actually fantastic. Okay. I'm going to ask a controversial question more because the concept and idea is definitely backwards was what we're pushing for in the physical therapy profession regarding research. We want to be research based, we want that these studies to back up everything we do. We're doctors for, you know, for sake. So what about physical therapists who are just going, I don't need the research in order to treat these patients and get them better. I'm not saying this to criticize them. I'm not saying this to separate us. For somebody who's not interested in all this data and everything, what do you guys have to provide for them that they would be specifically interested in where it is, where they treat primarily orthopedic cases. Karen Litzy (13:00): And on that note, we're going to take a quick break to hear from our sponsor and be right back with Adrian's response. This episode is brought to you by net health net house outpatient EMR and billing software. Redoc powered by X fit provides an all one software solution with guided documentation workflows to make it easy for therapists to use and streamline billing processes to help speed billing and improve reimbursement. You could check out net health’s new tip sheet to learn four ways that outpatient therapy providers can increase patient engagement in 2020 at go.net health.com/patientengagement2020 Adrian Miranda (13:34): Well, I mean, you can believe that, but it's the cases that you need research to show data, to show numbers, to go to Congress, to go to insurance, to push things and push agendas. Jenna Kantor (13:44): Oh, I like what you're saying regarding going to Congress advocating, thank you. Continue. Yeah. Adrian Miranda (13:48): So you need to prove that things work. Now there's many things that you cannot get data on or you just haven't created the right methodology for it. So you haven't created the right structure, the right research methods, the right way to capture those results. We're in a big data-driven time right now. So whether you believe that you don't need research and that it's there and we have to utilize it and it is actually necessary to help with reimbursements. So it might not hit you right in the face when the patient walks in, but it's going to hit you somewhere. So yes, research is extremely important. And it's not the end all be all as well. The way we get research is from an evidence case reports from the things that just occur. And then you go back and say, Hey, why did this work? Adrian Miranda (14:34): It didn't work. Or it did work and it worked because for all the wrong reasons. But if you don't have a scientific method for that, you're never going to know. Listen in the PR committee. So I'll tell you something. And many of you may be in the technology sector, marketing sector and digital marketing. We analyze what our members were engaging with and it turned out that CPGs our members were engaging with and we actually pivoted a bit more to give you more of that content. And we're seeing that you are engaging with it more. So if we didn't have that data, we wouldn't be able to give you what you want or even what you need. It is very important. You may not see it right away, but there are things that help agendas be moved forward and prove our worth. Adrian Miranda (15:20): As physical therapists, you can say it all you want, but if you have numbers, you really can't argue with numbers unless you're dealing with larger entities that have bigger pockets than you. But even at the end of the day, you fight hard enough for it. You're gonna get it. Direct access is moving along okay. And they're saying, we don't have any restricted direct access, but if we didn't have studies that are coming out saying that early intervention, but physical therapy reduces costs of healthcare achieves healthcare savings, we can't push that bill forward because we didn't have the data. Now we do have the data. So I would say that the sometimes or the reason for not agreeing with research has, you know, personal experiences and negative experiences. Maybe not even understanding research and what it does. Maybe you're wasting money on. These are one large universities doing all this data and research, but you need to think about it a little bit differently. Adrian Miranda (16:17): And the more research we have, the better research and better data. The more that you'll see we're helping more people in the community. The more that you're seeing businesses, physical therapy, business thriving, and being able to kind of give back to the community and give back to their employees as well. So it's this kind of circle. It's almost like a spin diagram that without research, without the community, without the clinicians to enforce it, we're not going to go anywhere. So I would say those people that don't believe in research it's like air. It's there. You need it. Love that. Jenna Kantor (16:50): Start to touch upon it. I want to dive into it. More advocacy. What is it that the orthopedic section, say three things right now that you know of, that they're advocating for on Capitol Hill? Adrian Miranda (17:03): Okay. So one of the things that did for the 40th anniversary was create almost like a mini documentary. Which was eyeopening to me. I didn't realize how much the Academy of orthopedic physical therapy advocated for States and governor and national issues. They actually were very instrumental in practice things all over the country and even helping with the right access bills right now at this moment. I couldn't tell you specific things. But if you go look at that video, which I think it was ast year, CSM I interviewed a lot, most if not most of the past orthopedic presidents who actually served on the APTA board. And yes, and some of them currently do it will be enlightening to see how much advocacy in the Academy actually provides. So having said that I couldn't tell you on top of my head exactly what they are working on at this moment legislatively, but just know that they are and they're also helping other components with their efforts and their resource. So if you, again, maybe you don't want to be in the public relations and marketing, but if you have some type of legislative issue or some type of issue that you have reached out to the Academy, they might be able to either guide you, steer you or help you connect with the APTA itself. Anybody in the government affairs, we actually have a committee directly for government affairs. Jenna Kantor (18:38): That's great. And you can even go on the website I'm seeing right now there is a tab for governance. It's literally on the major main page, so you go to governance and when you put your little mouse or a little hand on there, it'll go down and you can get information on what they're doing in their strategic plan. You click on that and it will take you into vision statement and goals so you can really see what they're doing right now for the lines with you and what you want them to be fighting for or if you want, there are points you want them to address in which you can then reach out to them to make that difference. Thank you so much, Adrian, for coming on to speak and educate about the orthopedic section. I really am a beginner with this myself because I've been a member for, since I was a first year student and never looked into any of the resources until this conversation right now. I think this is literally with the exception of joining the performing arts special interest group. The only time I've really gone into the the webpage. Oh look and we just opened it up. So current practice issues right now. Jenna Kantor (19:43): In what month, we are March, 2020 direct access imaging, dry needling, mobilization versus manipulation and practice issues state by state. And then you can get more details on that as well on orthopt.org. You just click on that governance and it'll get you there. Adrian Miranda (20:03): Is that answering the question about what issues are being dealt with by the Academy? Jenna Kantor (20:08): Yes, that does. That does. And the one who clicked and fell and grabbed that page. So we could just go onto practice, current practice issues and boom, bada bang. Thank you for coming on. Are there any last words you have for anybody who is considering joining the orthopedic section? But they're on the fence right now. Adrian Miranda (20:27): Join. There's really no drawbacks. If anything, here's what I recommend to anybody. If you have, there's two aspects. If you really want to get involved, there's someone who has been involved in school or someone who really wants to help other PTs. You wanna help the profession get involved. There's ways to get involved. You can be a member and do nothing and just hang back however you can make such an impact. I've had people recently asked to join or to be able to assist in the public relations committee. If you are somebody who has a lot of gripes and is really upset with what we're doing, go ahead and join anyway because you could actually be a change. I remember having this conversation with somebody in New York state. I was at a PT pub night and they were complaining to me about what this time I was actually in the NYPTA and what the APTA does. Adrian Miranda (21:11): And I let him go and just vent. And finally after like 20 minutes of venting, I was like, you know, I'm the chair of this committee, I'm a part of this committee. I'm on the MIP team that the board needs. I thank you for saying all that stuff. And his whole face going to drop. Like, Oh my gosh, I'm talking the wrong person. And I said, no, no, no. The fact that you're that passionate about it, you should join and you should make a change. All of a sudden, you told me you should bring it up at meetings or talk to your district. That's at the state level. At the Academy level. You can do this same thing if you're upset at the laws of dry needling and your state joint Academy, see how you can be part of the practice committee if you're upset about direct access, if you want to get involved in writing, if you want to get involved in editing you know, there's small, obviously there's very few worlds for that, but there are opportunities if you wanna get involved with pure committee, please join. Adrian Miranda (22:04): But there's so many things that you can help fix if you're upset about something and there's so many things that you can help improve if you're pleased with it. So I think there are so many opportunities to also enrich your life, enrich some of your skills and goals and even your practice. So I don't think there's any drawbacks to joining. And then we would love to have as many members as possible. You also want to have members that engage. I think when I talked to the board, we have meetings, our main goal and the people who've been around longer is that our members engaged with us. And you're not just someone who's going to sit back and just watch. Although that is okay, we want to be members. But I think it's also important to if you have a skill, if you have a passion and if you want to help our profession or your community get involved in and find where your spot is. Adrian Miranda (22:48): There's so many areas. There are seven special interest groups, there's several committees. There are several task force that you can be a part of. So I would definitely encourage you to reach out and listen. Organizations are challenging. There's a lot of people, there's a lot of need out there. There's a lot of different opinions and even it might say, this is an issue in my practice is an issue. My employees is my employers. That reimbursement is patients, this the demographics. There's a lot of things that we can help with numbers. Just like we're talking about research, we have a lot of numbers can be powerful. So if there's anything I can impart is that you can help be part of improving or be part of a change.   Jenna Kantor: I love that. Thank you so much. Adrian. How can people find you on social media and do you also have an email even for them to reach out to you? Adrian Miranda (23:36): Well, how about this? I'll do you one better because I learned it because usher and Gary Vaynerchuk are doing it now. I'll give you my cell phone. Feel free to reach out. I will give you my email just for sure. The social media Academy of orthopedic physical therapy. And my name is Adrian Miranda. You can find me at AMiranda84@Gmail.com. And my cell phone is 585- 472-5201. I'm very available. So I happy to talk on the phone cause sometimes, actually nowadays that's quicker than an email or even texting back and forth. Send me a text message. I would love to hear your input and hopefully we want to hear how we could be better as well.   Jenna Kantor: Wonderful. Thank you so much for coming on. Have a great day. Everyone.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Social Distancing for Rehab Therapists Leveraging Part-B In-Home Care and Telehealth in Your COVID-19 Response   Recorded Thursday, March 26, 2020  |  2:00PM EST   In light of the recent COVID-19 pandemic, the CDC has recommended ‘social distancing’ as a key tactic to help reduce the spread of the virus. In this webinar, our guest speakers will discuss two options to help rehab therapists continue delivering care during COVID-19. Hilary Forman, PT, Chief Clinical Strategies Officer for HealthPro-Heritage, a leading consulting and therapy management firm, will share best practices for effectively and safely delivering care through Part-B in-home care. Additionally, consultant Rick Gawenda, PT, President of Gawenda Seminars & Consulting, will discuss telehealth legislation now in effect, which supports the practice of ‘social distancing’ while continuing to deliver necessary outpatient rehab care. Included in the webinar are details related to: COVID-19 pandemic and CDC recommendations Risks associated with traditional therapy ‘clinic’ settings during COVID-19 Benefits and best practices associated with delivery of Part-B in-home care Telehealth legislation and application for rehab therapists   The continuation of outpatient rehab care plans during this unprecedented time requires careful thought as to how we adhere to new recommendations while providing the quality of care traditionally delivered in public locations such as outpatient clinics and gyms. This webinar is designed to help you as you seek ways to adapt your care delivery in today's new environment.   Resources: Gawenda Seminars Website Healthpro Heritage Website Rick Gawenda Twitter Hilary Foreman LinkedIn   For more information on Hilary: Hilary is an experienced, sought-after health care reform expert with a dynamic approach to advising providers within the post-acute care industry. As a solutions-oriented leader and consultant, she meets the challenges of a rapidly changing health care environment with innovative clinical and financial strategies. With more than 15 years of experience in rehab management, Hilary has worked with hundreds of clients to optimize marketplace strategy, clinical program development, and compliance integrity. Hilary has presented at several association meetings to share up-todate information and insights as well as her thought- provoking approach to meeting the challenges of health care reform initiatives. She has established a reputation for facilitating meaningful partnerships between post-acute care (PAC) providers and upstream and downstream cohorts. Hilary’s philosophy encourages open collaboration, proactive communication, and honest dialogue regarding outcomes, safe care transitions, and financial opportunities/pitfalls. With a keen sense of humor and a no-nonsense approach to solving problems, Hilary has the ability to assist groups in thinking strategically, challenge the status quo, and ultimately succeed in leveraging positive outcomes.   For more information on Rick: Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States. He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services.   Read the full transcript below: Tannus Quatre (00:00:02): Welcome everyone. My name is Tannus Quatre and today I'll be kicking us off with our webinar on social distancing for rehab therapists. Before getting into our topic I'd like to take a moment to acknowledge and appreciate each of you that are on the call today, as well as the teams that you work with to serve patients in your communities. As a physical therapist myself and as part of an organization that proudly serves rehab therapists, this is a really heart wrenching time as we watched this coronavirus pandemic unfold and impact lives across the world, including the interruption of the care that you provide to your communities. As part of our effort to help rehab professionals continue to deliver care in your communities during a time of putting my hands in quotes here, social distancing and sheltering in place, phrases that are new to us, we've assembled a team to present for you two business models today, part B in home care and e-visits. Tannus Quatre (00:01:03): And we hope that these will facilitate the continuation of the care that you provide while helping your patients and your staff adhere to guidelines that require that during this time we limit our physical exposure to one another. We've got an amazing speaker lineup for you today. Starting off with Rick Gawenda, physical therapist, compliance and billing expert and president of Gawenda seminars. Rick's going to help us understand some recently expanded legislation regarding telehealth and e-visits for rehab therapists. We have Hilary Foreman, physical therapist and chief clinical strategies officer with HealthPRO heritage. Hillary is going to walk us through health pros, part B in home rehab model and how this model is uniquely positioned to help protect her patients and her team during a time of social distancing. And we have Sheila Cougras, registered nurse and director of compliance at net health, who together with Sarah Irey, also a physical therapist will be setting the stage for us today by introducing us to COVID 19 and considerations that impact us as rehab professionals. Tannus Quatre (00:02:12): Now, today's webinar represents our best efforts to help rehab therapists adapt to a very unique circumstance. We're working right alongside you to adjust and learn as things change and I know for all of us things are changing hour by hour at this point. So in our webinar today we'll be sharing some information that is both fairly broad in nature and then we're going to be zooming in to discuss details that are really pretty technical. So we hope that the information will help you stimulate thoughts and ideas that you can use to continue care for your customers, but please do know that the information is changing rapidly and you're going to need to verify if and how this information applies to your particular business. Now finally for me on a housekeeping note, we're going to be pretty fluid with this webinar today and we're going to take the time needed to cover the information that we have planned as well as time for Q and A at the end. Tannus Quatre (00:03:06): If you have questions that come up during the presentation, please use the Q and A function that you'll find on your desktop or your phone and we'll get to as many of your questions as we can. At the end of the webinar, we have about a thousand attendees on the call today, so we probably won't be able to get through all questions. So we'll be providing our contact information following the webinar so you can reach out to us for followup if and where that that is needed for you and for those that cannot attend, that may be within your organization or colleagues that you'd like to have attend this webinar after the live version. We will be sharing a recording following the live presentation today, so expect that in your inbox. So with that, I'm going to hand it over to Sheila Cougrass and Sarah Irie to introduce us to COVI- 19 and clinical considerations that apply to rehab therapists. Sheila Cougras (00:04:00): Thank you, Tannus. As Tannus mentioned, I'm a registered nurse and a certified wound care nurse that is certified in healthcare compliance. I have been at net health for the past 12 years and serve as the compliance subject matter expert for our products. But before I even get started, I really sincerely want to thank all of you on the front lines who are caring for our patients and communities. What you're doing is really, really appreciated and very much noticed throughout the world. I'm going to also first state that we recognize that all of you are being inundated with a lot of information for COVID-19 that's coming in through, you know, firehoses a lot of information and it only seems so appropriate though that we open with a high level of information we're receiving every day from the CDC to other regulatory and professional agencies across the country. It's also important to note the information is being updated every minute. Even as we speak. I'm reading and learning that new regulations and legislation is introduced at us at a startling pace. We already have over 500 bills and 250 regulations that have been introduced and proposed across the States and the use of the executive order has skyrocketed. Sheila Cougras (00:05:17): So we also recognize that this information varies for all of you. Depending on where you provide services, you may be in a home health, you may be in a SNF, acute hospital, private practices, assisted living facilities and with that said you may have a lot of variations with your facility and local policies and federal guidelines. So we want to keep that in mind. As we know, corona virus has been around for a long time. It is a group of related viruses such as SARS that causes disease in humans, in animals, the world health organization, they recently identify COVID-19 is a new virus group, Corona virus which typically respiratory illnesses and most will recover as we know without special treatment. As we've heard, it mostly impacts our elderly population and those that have specific underlying conditions or immunocompromised. We are also hearing about many of the treatments that are off label that are now being made available being introduced today for treatment. But currently there is no vaccinations and treatments are just now starting to be introduced off-label. It is active in all 50 States and I guess it's also active within our surrounding four jurisdictions of our country. And the last we seen reported I know that this is obviously probably updated since, but the last reported by the CDC is 27 are reporting community spread. Sheila Cougras (00:06:46): We are hearing that it is also being noted by the new England journal of medicine that COVID-19 is also stable in aerosols and on surfaces that can last from several hours to several days. So we want to keep that in mind when a person sneezes or coughs without proper coverage into their elbow or their sleeve, it creates a bubble of air that contains the virus. It could be suspended for hours and so with that said, if someone walks through that area an hour later, they could potentially pick up the virus. Sheila Cougras (00:07:23): So this slide is not only to share with you common recommendations from CDC and the world health organization, but also think about setting up competencies for your staff and educating your patients. We obviously want to maintain that good hand hygiene as being occurring washing for at least 20 seconds with soap and water and hand sanitizer with at least 60% alcohol reasoning is because those soaps we use contains surfactins which neutralizer removes the germs from the pathogens such as COVID-19 that has a crown like structure and outer membrane made of lipid molecules and protein that is then runs down the drain. Do not touch your face. We hear that a lot with unwashed hands is specifically your eyes, your nose in your mouth where there's much entry into your system. Where if face mask, if indicated by your facility policy protocols, we know there's a lot of uncertainty in this area due to the limitation of supplies. Sheila Cougras (00:08:21): So please check how and when you are to utilize face mask and the type of mask you should be wearing Disinfect your common touched surface areas. Often whether it be tables or knobs, countertops, desk, phones, keyboards in any other equipment that has commonly touched you. It's also helpful if you increase ventilation by opening windows or adjusting the air conditioning and we also want you to limit food sharing, stay home if you're feeling ill or have an ill family member and most importantly is you're going to hear threaded throughout this presentation and as Tannus mentioned is social distancing maintaining a safe distance three to six feet between you and others. It's so important given how this virus is transmitted. Sarah will speak to this further but before I hand it off to her, I want to share that a I have been listening to other professional organizations speak about ideas and best practices they're sharing. Sheila Cougras (00:09:14): I was on a call a couple of days ago with American hospital association in CMS with Sima Burma where she was encouraging the physicians to share ideas. Some are setting up tents outside of their offices to do the screening conducted prior to allowing the patients or staff to enter the building. Some are calling the patients prior to their appointments and asking a series of questions provided by the CDC to triage those patients. And many of you are hearing utilizing telemedicine and you will hear more from our other panel speakers on that topic. Additionally, I heard that in HPCO, which is a hospice professional organization just yesterday. They're getting so creative that they're providing care through windows and standing outside of the patient's home and looking at the patient through the window and addressing the needs with the caregiver at the door. So as we know, this is the time to really get creative and treat your patients safely as much as you can. Sarah Irey (00:10:07): Thanks for that great information Sheila. Before we start, I'll let you know a little bit about me. I'm a clinical liaison for net health, but my background is as a physical therapist with nearly 20 years of experience working in various settings including private practice, hospital outpatient and acute care and skilled nursing facilities. I'm lucky enough to use my clinical experience here at net health, but I do some clinical work still now and then. Let's continue to build on what you learned from Sheila. An important part of social distancing includes being able to identify patients and staff who have COVID-19 or who may be a risk of carrying or contracting the disease. Many facilities are now using screening protocols, as Sheila mentioned, to identify these individuals. If you're part of a larger organization, check your organization protocols to determine the process for screening patients and staff and know how to refer them for additional testing if they're possibly infected. Sarah Irey (00:11:12): If you don't have a formal protocol, you might want to consider creating one using sources from the CDC website as well as checking with your state. The CDC outlined some recommendations such as using your clinical judgment. Clinicians should use their judgment to determine if a patient has signs and symptoms of COVID-19 and should be tested so the signs and symptoms that you've heard about include fever, cough, and difficulty breathing. Other risk factors are having contact with someone who has or is suspected to have COVID-19 or pneumonia of an unknown cause within the last 14 days. Someone who's recently traveled outside of the United States or in an effected area and someone who has residents in an area with community spread of COVID-19. Like Sheila mentioned, your screening can actually begin before your patients arrive at your clinic. When you're making appointment reminder calls. Sarah Irey (00:12:09): You might want to consider asking screening questions and making recommendations for exposure risks in mildly ill or high risk patients to stay home per social distancing guidelines. We realized that many of you may still need to see patients in a clinical setting. So let's consider some ways to keep you and your patients safe while keeping social distancing in mind no matter where you treat your patients. First, follow the screening guidelines we just discussed to decrease your risk in your clinic. You also may want to ask patients to wash their hands prior to starting the treatment session and after you could even maybe consider having them stand on one foot to practice balance while they wash if it's safe, right? Wash your hands as well. Always follow standard precautions and use PPE per your organizational protocols. Be mindful to follow the six foot social distancing guideline in the waiting area and your treatment space. Sarah Irey (00:13:09): So you might need to modify your waiting area seating setup or your schedulings practices to support this model. Maybe use private treatment rooms for patient visits instead of the gym area. Avoid group and concurrent therapy treatment and consider treating patients in their rooms if they reside in a skilled nursing or assisted living facility. Also think about if you can change treatment and treatment plans to decrease physical contact with your patients, but still provide quality care. Examples of this might include instruction and self mobilization techniques instead of manual adjustments or mobilization or instructing the patient in use of tools for soft tissue mobilization such as foam rollers and trigger point release balls rather than direct therapist to patient touch. Also consider keeping your patients with one provider per visit instead of sharing care to decrease contact. So you may need to change your scheduling and staffing practices there. Finally consider educating patients on alternative treatment options such as part B in home rehab and eVisits. So let's learn more about part B in home rehab with Hilary foreman from HealthPRO heritage. Hilary Foreman (00:14:22): Thank you so much Sarah. And as Sarah said, my name is Hilary foreman. I am the chief clinical strategy officer at HealthPRO heritage. I am a PT by background and I've been lucky enough to be with HealthPRO for about 18 years now. I'm moving from operations into our clinical role. I have the honor of being in charge of our clinical and consulting business lines over our rehab services that span across the post-acute continuum. So as Sarah said, I wanted to talk to you about our first business model, which is part B in home rehab. Though HealthPRO heritage did not start this model in light of the current COVID-19 situation, it now more than ever in this era of social distancing has become one of our standards as it makes more sense as a consideration. This model can be used by both rehab companies and home health agencies to better meet the needs of some of our seniors. Hilary Foreman (00:15:19): So let's start with what is part B in home rehab. Very simply, it's the concept of the traditional outpatient therapy model being provided in a patient's home as opposed to a free standing clinic or the gym of a senior living community. Services still remain covered under Medicare part B. They may also be covered by managed B or some commercial payers as well. By being able to deliver this service in a patient's home, it provides a lot less anxiety for a patient and a much happier person. Patients in this scenario are not home bound, but due to other circumstances prefer to stay in their home, whether it be convenience, safety, or cost. One caveat to this model is that because patients aren't home bound, they can also not be receiving any part a benefits as this is a part B benefits. So those two insurances do have to be separated. Hilary Foreman (00:16:27): So why would we do part B in the home first? As I said, it would be convenience of care. According to some recent AARP statistics, over 89% of patients over 50 years old would prefer to receive these type of services in their home for many of their own reasons, but now in the era of social distancing, this can be a more protected setting. This can also be a great solution for protecting some of our most vulnerable patients, but continue to provide those essential rehab services with reducing the risk of illness or injury to those patients. Hilary Foreman (00:17:14): As we continue down the path of why we would do this, one of the other has to do with a lot of the regulations going into place. Many of us are looking to expand our referral base, so whether you're a rehab company or a home health agency, chances are you're looking for different partnerships in your community. In light of changes with PDPM on the skilled side and PDGM on the home health side and changes and just the level of competition in many markets, you may be looking at different ways to partner with other people in your community. Whether you're looking to expand with physician services, many outpatients we think of as partnering with orthopedic physicians. We all know that orthopedic physicians tend to use their own clinics or hospital based rehab settings. In this model. Healthpro heritage chose to partner more with primary care physician groups in order to better expand into the community. Hilary Foreman (00:18:17): These primary care physician groups, we're community-based or we're already partnering with many of the senior living and assisted living communities in the areas. This paired nicely with their house calls programs, so we just like the physicians would start making house calls. It became a very good word of mouth referral source for us as well as a network between different senior living communities who wanted to partner their therapy across all their levels of care. So having therapists provide services through the home health agency as well as part B in the home. This helped the therapist become a standard part of the community, whether it be on that campus or in the greater community. Another reason you may consider why we would do part B in the home is just to reduce overhead for providers. This model reduces costs associated with brick and mortar clinics and the costs associated with keeping those running or even dedicating space within an assisted living or independent living community for patients. Hilary Foreman (00:19:27): This reduces a lot of their anxiety. It may also save time, money and effort for them traveling, worrying about parking and worrying about keeping all their appointments straight by having us go to them. It is a lot of their worry. And lastly, in order to follow any of the trends in healthcare, we all have to change, diversify and grow. Most importantly, meeting people where they are and where they want to be. Chances are that is going to be in their homes. We wanted to be able to offer more alternatives to where they could get the essential rehab they needed. Now again, in the era of social distancing, we were able to meet them in their homes and it was a great new business model for us as well. So killing two birds with one stone, but now as Sheila shared in the era of COVID-19 we did have to take some additional rehab considerations. Hilary Foreman (00:20:28): So we at HealthPRO heritage, decided to do a few things before we ever entered someone's home. First, we implemented a very strict policy of staff monitoring where staff self-monitor temperature checks twice a day, attest to whether or not they have any signs or symptoms. We even instituted a smell check. Some of the more recent literature indicated that people ahead of coming down with the symptoms of COVID-19 had actually lost their sense of smell. We also reviewed contact or exposure history, looking at what would be a low or high risk exposure and choosing whether or not therapists would see some of our most immunocompromised patients in their homes or not. We also instituted patient screening calls as Sarah suggested, making sure that we not only asked about the patients themselves, but anyone else that might be in the home at the time of the visit. Hilary Foreman (00:21:28): So many of our seniors have their spouses or older children home with them. They may be caregivers for grandchildren, so we did want to make sure that in addition to asking just about the patient, we knew about them as well. We did follow the CDC guidelines on what we could and couldn't ask, but it also helped us explain to our patients what infection control steps we would take prior to coming into their home. We did focus a lot on our staff and making sure that they understood what those infection control steps were. We did add additional steps in light of the current situation, especially when it came to clean bag and equipment technique. We wanted to take extra care of everything we did or did not take into a patient's house and how we were able to take care of that. Hilary Foreman (00:22:19): The other issue we have run into, and I'm sure many of you on the call have as well, is the availability of PPE. In cases where we do have low risk or high risk situations, patients still may have required care and we did have to make sure that people had the correct availability of PPE and understood proper use and retirement of that PPE well in the home. We did ask our therapists to continue to maintain social distancing rules from others in the house, in the apartment or in that senior living community. We did see that there was a lot of opportunity there as well. We were able to be another set of eyes for our seniors in the community or in the senior living community. Looking for other needs they may have. Being able to address things such as medication that may need to be delivered, additional signs and symptoms of other issues outside of COVID-19 that may increase a patient's risk of rehospitalization and we were able to work better with our senior living communities in that way. Hilary Foreman (00:23:29): So now that you know a little bit about our model and now it's time to look to see if this is the right model for you as you're possibly considering this as part of your growth and diversification strategies. There are a few things both pro and con you should consider if you are a home health agency, there are differences between billing part a and part B. You still do have a homebound requirement. You have to look at what those billing differences as well as what the different therapy documentation rules might be because this is part B and the home. It does follow traditional part B documentation and billing guidelines with all of the modifiers attached. A benefit to this is for the home health agency. Being able to provide additional rehab services after perhaps nursing services have ceased as a need, gives you the ability to divert those critical nursing visits to more high risk patients that may be elsewhere in the community. In this case, rehab would focus mostly on safety in the home and basic ADLs. If you're a rehab company, there's a little bit more to consider here. We were able to, in different parts of the country operate this model either under a group practice or a rehab agency. These both models have specific regulations by state that vary and we did need to look into all of those different rules and regulations and setting up the different practices and different locations. Hilary Foreman (00:25:05): The other challenge we had was looking at our therapists and their skill sets. This is a unique model because you do blend the skillsets of a home health therapist by being in the home, being more innovative and looking at what you have available to you in a home to provide therapy while mixing it with true outpatient skills. So looking at our therapists being able to work at the top of their license and looking at things from medication management all the way down to manual therapy. As Sarah shared, we did have to make some alterations in the care we've provided recently in light of some of our infection control procedures. But to our patients still receiving that essential therapy was still most beneficial in some cases in making this decision, you may have to actually look for additional consulting services in your area to help you either set up this program or work through the regulations. I hope this gave you a good overview of this possible new business model. And now to talk about our second alternative business model, I pass to our next speaker, Rick Gwenda. Rick Gawenda (00:26:16): Thank you very much. My name is Rick Gawenda. I am a physical therapist. My wife, I and another business partner do own two clinics here in Southern California. And then also for the past 17 years I have been a national speaker and national consultant in outpatient physical occupational speech therapy as relates to documentation, CPT coding, diagnosis, coding, payment reimbursement compliance. And all stuff nobody really likes to talk about. So with that, we're going to talk today about telehealth and e-visits. As we go to the next slide. This information I'm going to share with you is current as of 2:00 PM Eastern time today. Cause obviously I used to say things, you know, change weekly or monthly things are changing hourly. We're seeing many state governors mandate insurance plans in their state cover telehealth. We're seeing insurance companies doing this on their own saying they're adding PT OT SLP as telehealth providers. And we are waiting patiently for updates from these centers for Medicare and Medicaid services. So again, everything is current as I speak today. Most likely things would change either tomorrow or early next week. We are in the Medicare program as well as maybe other insurances in many States. Rick Gawenda (00:27:47): So speaking with the Medicare program first, so CMS, the centers for Medicare and Medicaid services issued a document over a week ago and they talk about three types of virtual services that you see here on this slide. And the commom mistake I'm hearing people make is they're using the terms eVisits and Telehealth interchangeably synonymously, the same as, and they're not the same. They're completely different. So again, three types of virtual services per the Medicare program right now. Medicare telehealth visits, which we're going to give you the current status of that coming up, virtual check-ins, which were not apply right now to PTs, OTs and or SLPs. And then we're going to talk about eVisits that will apply to PTs, OTs and SLPs. Rick Gawenda (00:28:45): So as I speak to you today, now about, I believe it's around 2:30 East coast time, March 26, the Medicare program still does not pay for tele health services for outpatient, physical, occupational and or speech therapy services. They consider this a non-covered service because the Medicare program does not pay for these services for therapy and they consider it non-covered. You right now today can provide tele health services to your Medicare part B beneficiaries and charge them your cash rate for the telehealth services. And an ABN, an advanced beneficiary notice of non-coverage would not be required to be issued to the Medicare beneficiary. You can issue a voluntary ABN to the Medicare beneficiary if you want to and I do recommend you do that but it's not mandated. You issue an ABN to the Medicare beneficiary and the reason why it's not required is an ABN is only issued when normally the services are covered by the Medicare program, but under the circumstance you think Medicare is not going to pay or since right now today, March 26 telehealth services provided by PT OT SLPs or statuary, non-covered and ABN would not be required. Rick Gawenda (00:30:24): Also, if you are familiar with the ABN form in section G there's three boxes and the patient's supposed to select one of those three options in section G since your issue in a voluntary ABN, you are not going to ask the patient to choose an option. The patient does not need to sign and date the ABN because you're not going to be submitting the claim to the Medicare program. So people haven't been asking me, well, Rick, what CPT codes do we bill to Medicare for telehealth? You're not going as I speak today, you will not submit a claim to Medicare if you are providing telehealth services for outpatient PT, OT SLP to a Medicare part B beneficiary because it's statutorily non-covered. And since these services are non-covered, the mandatory claim submission is not required. Now I will say there is a barrel that we expect the house to vote on tomorrow called the creating opportunities now for necessary and effective care technologies. Rick Gawenda (00:31:32): The acronym is connect, C O N N E C T act, the connect act and in section three seven zero three of that bill. If it gets passed by the house passed by the Senate, everything stays in president Trump signs it. It's going to broaden the authority of the secretary of health and human services to wave tele-health requirements as they currently are. So we're hoping that once the house is supposed to take a voice vote on that sometime tomorrow followed them by the Senate. My opinion only, it should pass pretty easily. Hopefully the president signs it, then hopefully then the secretary of health and human services would then waive the current restrictions house for Medicare beneficiaries and allow PTs, OTs and SLPs divide those services and build the Medicare program for that. Also, as we speak today in the office of management and budget, there is an interim final rule regarding COVID-19 and some updates in that interim. Rick Gawenda (00:32:43): Final rule. Unfortunately we have no clue what's in that interim final rule. It could be some things way too. What I'm still going to talk about here today about E-visits could be about tele-health, could be about easing restrictions and supervision, requirements of assistance, could talk about certifications recertifications it could have nothing about therapy and you know, we don't know again, it's still in the office of management budget to OMB. Hopefully it leaves there either later today or tomorrow and then gets published in the federal register. But that's why I add that disclaimer. We expect things to change with the Medicare program here shortly. We expect clarification to come out from CMS on some things we're talking about right now during today's presentation. Rick Gawenda (00:33:38): Let's talk about now e-visits. So again, e-visits and tele-health are not the same. The two are completely different things. So CMS did come out over a week ago and say that they would pay for eVisits provided by physical therapists, occupational therapists and speech language pathologists. I cannot stress enough that top bullet point, they must be initiated by the patient for each E visit, which means the patient needs to reach out to you, the provider, either via a phone call, via an email request. In this E visit. Now CMS did clarify you, the provider of therapy services can educate the beneficiary on the availability of this service. So you can send out an email to your current established patients about the option for ae-visit and all of that. So you can quote I guess like a better word, advertise this service. However the patient must initiate this visit now, but we don't know. Rick Gawenda (00:34:42): Here's this third bullet point says patient must be an established patient with the provider who is conducting the visit. And what we're hoping to get soon from CMS is clarification and the definition of an established patient. Because these G codes I'm going to talk about in a moment on the next slide, they actually are brand new this year just came out January 1st of 2020 and to be honest with you, they were not designed for what CMS is allowing us to use them for right now. This is not the purpose of these codes. Now these codes are kind of a, a knockoff, kind of a shoot off of the nine eight, nine seven zero CPT code nine eight nine seven one CPT code nine eight nine seven two CPT codes that are used by physicians for evaluation and management services for these visits done through an online patient portal. Rick Gawenda (00:35:45): Now when you look at the physicians and the definition of established patient for a position, this is somebody that has, you know, maybe seen that physician within the last three years. We don't know how CMS is using that definition of established as it pertains to PT, OT, SLP. I'll be honest, it could be established patient as in this is a patient that you were currently seeing for therapy services and now they can't come into your clinic right now you've shut down your clinic, you want to do an visit. Is that what they mean by established patient? Could established patient mean this is the patient you've seen sometime in the past three months, the past six months. Are they going to have to go back, you know, quotes three years like they do physicians. We don't know the answer right now. What we do know though is if you're going to do an evisit any Medicare beneficiary that that patient could not have been seen by you for a physical visit within the previous seven days for the same condition. Rick Gawenda (00:36:48): And then once you do this evisit they're not coming in to see you within seven days for that problem. Now, CMS does say that you must use an online patient portal. And I'm giving you the definition of an online patient portal by the office of the national coordinator for health information, which is a secure online website that gives patients can be it 24 hour access to personal health information from anywhere with an internet connection. And there's the URL link for you cause people, you know, if you read the CMS information that's come out, you know, you saw, CMS mentioned that they're the lax scene, they're kind of easing the HIPAA rules and regulations. You know, you saw CMS mentioned Skype and mentioned FaceTime, they mentioned Skype and FaceTimes for tele health services, not for E visits. So right now again we're trying to seek clarification from CMS and boy, can you do a phone call, can you use FaceTime, can you use Skype before we get that clarification. Rick Gawenda (00:37:57): I've got to, you know, talk here and say you have to use an online patient portal. And again, you can go on the worldwide web, go to any search and you want to go to, I just use Google and type in a search box, you know, types of online patient portals. You know, what is an online patient portal? You know, I know my physician, and again, I'm not endorsing this product. My physician uses the call it, it's called charm, C, H, A, R, M, all capital letters where she can send me my test results. You know, my lab results. She can give me updates on my medications. You know, I create an account, I log in, I see my test results, I see her email, I can respond to her, she gets notification and with things like that. But again, it must be initiated by the patient for each E visit. Rick Gawenda (00:38:54): Next slide. So here are the three G codes, G 2061 G 2062 G 2063 and I cannot stress enough those words that are underlined, assessment and management, and then shooting the tib time during the seven days. So let's talk about what are the seven days. When is day one? When is day seven so here's my example. Let’s say on Monday, March 23rd the patient reaches out to you either via a phone call or an email requests in any visit. You don't respond to them until March 25th. March 25th is going to now be day one, which means six days later that's going to end that seven day period. So, so say you know, March 23rd the patient's sent you an email requesting any visit and they had some questions for you maybe about their home exercise program or should I use ice or should I use heat or how many times do you want me to do my exercises a day? Rick Gawenda (00:40:03): Things like that. You respond to them on March 25th and as I say, I'm going to make math easy here today. You spend five minutes typing out the instructions, answering their questions. You send that to them on March 25th on March 27th the patient responds, requested another e-visit with additional questions on Friday, March 27th and you spend another five minutes, you know, answering their questions, whatever that may be, send it back to them on Tuesday. March 31st patient requests another E-visit with additional clarification. They want some information from you. You spent another five minutes on March 31st answering their questions via email or via that secure online patient portal. You send it back to them. That's, and that's it. There's no more other e-visits within that seven day period. So I kept math simple. So you did three separate eVisits spent five minutes each time answering their questions via email, sending it back to them. Rick Gawenda (00:41:12): When you add up five plus five plus five that is 15 minutes, that's going to fall between 11 to 20 minutes. So on that last day to service, during that seven day period on March 31st you're going to bill one unit of G two zero six two because the QM to time during that seven day period was 15 minutes. And the question I know you want to ask me is, Rick, can we do more than one seven day period? You know, can I bill G 2060 to say from March 25th to March 31st but that from say April 3rd to April 9th, I spend 27 minutes. Can I do G two zero six three and ms dancer, you hate for me today, we don't know. We're seeking clarification from CMS because again, these codes were not developed for this purpose. We did not know COVID 19 epedemic was coming when these codes became effective January one of 2020. So we're not sure if CMS as well as other insurance companies are going to allow us to build these G codes for more than one seven day period. Now you see it says underlying assessment and management as the go to the next slide. Rick Gawenda (00:42:33): People always want to know what is a qualified healthcare professional. And this definition comes straight from the American medical association. So if you have a CPT book, you know, especially or more current one, but if you have like a 2018 2019 2020 CPT books at the beginning of the CPT book, a Roman numeral number of pages explains how the book works, where the AMA provides this definition of a qualified healthcare professional. And in really the key is the words or the sentence who performs a professional service within his, her scope of practice in independently reports that professional service. Well, as a physical therapist, an occupational therapist, a speech language pathologist, you meet this definition because in a private practice you enroll with Medicare, you enroll with other insurance companies, you get an NPI number, you can report the CPT codes independently of anybody else that people was asked for. Rick Gawenda (00:43:35): Rick, what about a physical therapist assistant or an occupational therapy assistant? Can they report these G codes you just spoke on was to go to the next slide. You can now see the definition of a clinical staff per the American medical association. And you see in that first bullet point is a person who works under the supervision that'd be physician or other qualified healthcare professional that goes on to say, but who does not individually report that professional service. So that would include a physical therapist assistant and an occupational therapy assistant. So right now it's my interpretation. I know APTA interpretation that PT assistants, OT assistants, you know, can't provide the evisit. And also if you get a definition, if you go back to two sides from replays, you know it says assessment and management and really who's assessing the patient, who's managing and changing what's going on with the patient. And that's really within the scope of practice of the therapist, not the assistant. Now again, we're hoping to be CMS allows assistants do these G codes. We don't know waiting for clarification, but right now I don't feel comfortable saying they can do it based on the definition of a qualified healthcare professional as well as the words assessment and management. Because that is done by the therapist, not the assistant. Rick Gawenda (00:45:09): Now how about modifiers? Now, CMS did say if you are submitting a claim on a 1500 claim form and if your Smith claims on a 1500 claim from you are a private practice, the Medicare program did say to attach this CR modifier to the applicable G code. If you are a non private practice, you submit claims you be zero for claim form. You would not only attach the C R modifier to the G code but you also need as a condition code the R. So again that R is not a modifier that R is a condition code. Now we are hearing issues and concerns from households around the country that these G codes can't be submitted, can't be built on the UBS or four claim form. We are still waiting for clarification from CMS on this. You know, can hospitals, can facilities that submit claims any UBS four claim form? Can they bill the G codes? A part of me thinks yes, I'll be honest. Part of me thinks no because again, these G codes, a kind of a knockoff of the nine eight nine seven zero (989) 719-8972 CPT codes which are really the physician codes and typically physicians are only been at any 1500 claim form. But again, we are just waiting for clarification with CMS as well as other insurance companies. Can non private practices bill these G codes and get paid by that insurance company. Rick Gawenda (00:46:56): Now, documentation for an evisit extremely important that at minimum each E visit you do must have the following documentation. You must document that the patient initiated and or requested the visit. You must document the patient consented to the visit and then you must document these services, the education, the training that you provided during that e-visit. So an example I gave where you did visits one on March 25th one on March 27th one on March 31st you would have a note for each date of service that will contain at minimum these three bullet points, but the billing would not occur to a date service March 31st Rick Gawenda (00:47:51): Now let's talk about telehealth and tri care. You know Tri-Care, believe it or not does cover house services and they've done so since July 26 2017 and that top moral point, that sentence is right out of the tri care manual that they cover telehealth services if these services are otherwise covered. Tri care benefits, well since Tri-Care covers outpatient PT, OT, SLP services, this means that they would cover telehealth services for PT, OT and or SLP services and nicely my Tri-Care is they allow payment for telehealth provided both asynchronous and synchronous. Now non-Medicare, it's the answer you hate. You've got to go check with every insurance company. And when I say every insurance company, we estimate they're over 6,000 insurance companies in the United States. Whether they cover telehealth, it's all over the board. If they do cover tele-health, which CPT code or CPT codes they allow or want to see all over the board, which modifier or modifiers do they want and every CPT code all over the board. Rick Gawenda (00:49:17): You know, this is changing hourly because we're seeing many state governors issue declarations, issue orders mandating all insurance plans in their state that are overseen by their insurance commission, you know, cover tele-health. That's great. You know, we've seen some insurance companies like Michigan blue cross California blue shield of blue cross blue shield of North Carolina do this voluntarily where they now expanded telehealth for PT, OT SLP on a temporary basis. And again, the CPT codes, IMC and I'll all over the board which ones they want. Just, you know, when to kind of maybe give you some guidance here. The most common codes I'm seeing be and allowed for tele-health a PT and OT are nine seven one one zero 30 exercise nine seven one one two neuro re ed nine seven five three zero safety activities, nine seven five three five self care, home management and for speech is nine two five zero seven. Rick Gawenda (00:50:30): The treatment of speech, language, voice communication, Archway processing disorder. You know, don't try billing ultrasound for through telehealth. A manual therapy would also be a no through tele health cause your hands have to be on the patient. The other thing to ask when you check with these insurance companies is are they covering tele-health for only patients that were already established. You know, you've already seen them for therapy. There's already an active, you know, plan of care going on and now they can't come to your clinic. Or are they also covering tele-health for new patients as well? That's something you're going to want to check. If you're in a private practice setting they usually want to see for the place of service code for telehealth be a zero two. So again, extremely important to check with each insurance company and their coverage of telehealth services. Rick Gawenda (00:51:34): You know, how do you keep up to date with all this, you know, number one, stay current with your national associations. APTA. Also check your state associations website. You know, most of them now have a dedicated page for COVID-19 many of them are, you know, doing daily updates and information that they find out. You know, why not go bookmark your top four or five, six insurance companies that you deal with in your practice. You know, and again, go to Google and search box. Just type in for example, Georgia Medicaid provider page, tri West provider page, Nebraska blue cross blue shield provider page. In those last two words, stay the same provider page. That's what you want to get to on insurance company's website to provider page. And most of them now have a dedicated COVID-19 page and they've got dedicated page for, you know, quote, telemedicine, tele rehab, tele-health and those three terms don't all mean the same thing we've got. I think we're using them synonymously right now and I'm okay with that. But they are different. But get on those payers websites. If you're not on social media, get on social media, get on Twitter, get on Facebook. Many of us are putting out tons of information hourly on all of the changes. Rick Gawenda (00:53:02): Not to get too excited about these G codes. Just so you know, the Medicare program has about 112 different payment localities across the United States on just using each choice, Michigan. And you see the approximate payment amounts here. And before we go to get questions. And one thing I really want to say about tele-health. You know, normally if you're gonna start tele-health in your practice in your organization, it's usually about a four, five, six, seven, eight weeks start up. Yeah, I know a lot of people are trying to start tele-health in 24 hours and 48 hours. Be careful, you know, even though CMS has eased the HIPAA enforcement doesn't mean you can be careless. Just because CMS has eased HIPAA does not mean other insurance companies may not come after you. You know, you got to make sure you have your policies and procedures in place. Rick Gawenda (00:53:52): They're going to do telehealth, you know, have you updated your consent forms to include telehealth services, have you gotten your consent forms to your patients for them to sign, you know, how you document in the medical record and keep a track of, is the patient consenting to telehealth, have they consented to be videoed and have that recorded and saved in case they want to look back at it? You know what happens if you are doing a telehealth visit and you're doing it with Tannus and you see Tannus all of a sudden he grabs his chest, becomes short of breath, he falls off his chair, there's an emergency situation. You know, what's your policy? What's your procedure to address those kinds of things because you could have a liability. So again, you need to check with a healthcare attorney to make sure you got the proper policies and procedures in place. Because my hope is those of you that initiate tele-health, like right now when the COVID-19 pandemic is done, I'm hoping you're not done with telehealth. I hope you continue to do tele-health into 2021 2022 2023 as I think this is an important aspect of your business growth. Keep in mind, tele-health is not appropriate, not applicable for all of your patients. Tannus Quatre (00:55:16): Outstanding. Thank you so much Rick. Hilary, Sheila, Sarah wonderful presentation. We're going to get into some Q and a now and I will go ahead and moderate this portion of the webinar. And while we're doing this, we have our contact information up on the screen. So for those that would like to get in touch with us, if you have further questions or would like to learn more about what each of us and our organizations are doing to help rehab professionals adapt to COVID-19. We want to have this up on the screen. So with that we've got a lot of questions coming in and I know that we're right up against the hour. Like I said before, we're going to be kind of fluid with this, so if you're able to stay on, we're gonna answer as many of these as we can and then anything that we're not able to get to, we'll figure out a way to follow up with you independently afterwards. So I'm gonna start with I'm going to start with one here. For Rick, would encrypted organization based email be considered a secure patient portal for delivering he visits? Rick Gawenda (00:56:23): Yeah. Great question. And again, my opinion, my interpretation as it stands right now today is yes, because the email is encrypted, which usually requires a patient, you know, to create a username and a password to then access that encrypted email. Tannus Quatre (00:56:24): Perfect. Another one for Rick here. Are these codes billable by home health organizations or just outpatient organizations? Rick Gawenda (00:56:54): Well you know, when you say home health, if you're doing quote part B in the home which we believe you can bill the G codes. Again, we're just saying for clarification where if you're talking to home health under say part a under a home health agency plan of care, the G codes would not be applicable to that setting. Tannus Quatre (00:57:19): Excellent. Thank you. And we're going rapid fire here with Rick. I've got another one here for you. What POS code should be used for hospital-based outpatient clinics with any commercial insurers? Should it still be zero two or does it need to be different? Rick Gawenda (00:57:33): Yeah, great question. And again, if you are a private practice, and again some hospitals you've got offsite clinics that are set up as a private practice and you submit any 1500 claim form if you do in telehealth services, the place of service code would be a zero two. If you are a non private practice, which again could be, you know, as a hospital outpatient department, you know, hospitals can I have clinics ops site but they still fall under the hospital umbrella. You submit claims, NAU B zero four claim form in place of service codes are not used, most likely what you're going to have to use, which we didn't really talk about today. When you go to CPT codes you plugging up to put you to modify your GT or a modifier nine five on the CPT codes and that indicates that it was tele-health provided through a synchronous communication. Rick Gawenda (00:58:32): Now I know the follow up question is going to be which modifier do I use? It depends on the insurance company. You know, some insurance companies may tell you to use modifier nine five some may say to use GT if you're not a private practice. So again, unfortunately you just have to check with every insurance company you want to do tele-health with. And that's why I'm stressing so much to make sure you've got your policies and procedures in place and you've checked this through risk-management your attorneys to make sure you got your I's dotted, T's crossed and all of that. Tannus Quatre (00:59:08): Excellent. Thank you. Okay, so one here about part B in home. So Hilary if you can unmute. How is reimbursement different for part B in home versus in a free standing outpatient clinic? Right. Hilary Foreman (00:59:21): Great question. It is not that is why if a home health agency does choose to implement this program, they are going to have to look into a different way to do their billing. So it is still done by CPT code with modifiers just like a traditional outpatient setting. Tannus Quatre (00:59:41): Great. Thank you. Hillary. Another one about part B and home, how long does it take to launch part B in the home? If I only have done freestanding outpatient therapy? Hilary Foreman (00:59:55): It would depend on two things. One, if you were going to go a group practice or rehab agency route group practice is much quicker to get up and running, but there are some restrictions, especially depending on the state that you're in. A rehab agency is a much longer process and does require some additional filings. Some of them depending on the state you're in, you can do some retro billing in some cases. So you are able to start before everything is completed, but it's very state specific. If you, whoever asked if you want to reach out and let me know the state, I'd be happy to point you in the right direction for those answers. Tannus Quatre (01:00:36): Great. Thank you, Hillary. Okay. Another one here for Rick regarding eVisits. So per webinar a previous webinar or attended Medicare calls, e-visit a non face to face consultation, therefore Skype and such may not be required can be done via email or phone call. Is this accurate? Rick Gawenda (01:00:57): I'm sorry, what? I'm not understanding the question. Are they asking, is Skype and FaceTime allowed for a e-visit? Tannus Quatre (01:01:03): I'm interpreting this as is it required. So this, I'm going to go ahead and restate it. So Medicare calls e-visit and non face to face consultation, therefore Skype and such not required, can be done via email or phone call. Rick Gawenda (01:01:21): Well again, as I said during the presentation when CMS discussed Skype and FaceTime in that publication they released, they were using Skype and FaceTime for quote telehealth services not for an E visit. So right now an E visit needs to occur via email or a secure online patient portal. We are waiting for clarification with CMS regarding a phone call. You know what a phone constitute that cause right now as you know, a phone is not considered an online secure patient portal. So right now I can't tell you to use a phone to do an E visit. So right now I would say use encrypted email or use a secure online patient portal such as charm or you know, other online patient portals that are available to you. Tannus Quatre (01:02:17): All right, thank you Rick. Okay. Another one on E visits. When asking for an evisit do they have to, so the patient, does the patient have to directly address it as this or can they electronically ask a question? So for example, through a communication portal for us to then address outside of the clinic and we can count this as a patient contact. Rick Gawenda (01:02:41): Yeah, it's a great question because you know, again, this is like not what these codes are designed for. So obviously if a patient sends you an email asking a question I guess my recommendation if you want to play it safest, which is what I really have to do right now on this kind of call, is do you respond to the patient and say, you know, would you like me to respond to your question via an encrypted email via a secure patient portal, as an E visit? And if that patient then responds, yes, I would, you know, then I think that that's the request. And then you, I think you then save that email and then you go and address their question or questions that they had. In my opinion only is I think CMS is going to kind of be lenient on this right now. Rick Gawenda (01:03:34): I think other payers would be lenient on this right now, but again, you just in case something were to happen, you kind of need to cover your rear end and have that documentation there. I also think that since these codes don't really pay a whole heck of a lot of money you know, when you look at that G 20, 63, you're spending, you know, 21 or more minutes with them during a seven day period, you know, that payment's going to be somewhere between 32 to $36 depending on what state you're in, what locality you're in. So I don't see CMS really doing a bunch of audits on all of this stuff, but it's more just from a legal perspective and to protect yourself in case something happened where it happened with the patient. Tannus Quatre (01:04:19): Great. Thank you. So I've got one here. I'm gonna pose this to Hillary and then Sarah, you may want to chime in on this as well. Are you tracking COVID-19 related cancellations? How are you doing this in your EMR? Hilary Foreman (01:04:36): We are tracking missed visits in our EMR. We just haven't placed in the notes section. And we're just trying to look at it. We unfortunately are seeing quite a few many more and the home health side then on the senior living side. But I think as we go we are starting to see more and more people I want to say get more comfortable with infection control both on their side and on our side. So we expect to see that pick back up. Our customers are able to, for some of our products create custom questions or custom cancellation reasons so that they can just click that that was the reason and then they can run some cancellation reports on cancellations due to COVID-19. Tannus Quatre (01:05:30): Great. Related, do you know or have an estimate of how many PT clinics are still open versus temporarily closing doors due to COVID-19. Anybody want to take a stab at that? Hilary Foreman (01:05:47): I can speak for healthpro heritage that's very state specific. We have some States where it was ordered that they all closed, voluntarily closed due to whether or not they were treating a very immunocompromised caseload. They voluntarily chose to close for safety reasons. But I would say maybe half and half at this point for us. Rick Gawenda (01:06:19): And this is Rick, I think, is this an educated guess? I agree. I think it is state specific. I would also say it's probably also region specific within a state and the number of cases going on. And as I said already, the types of patients you're seeing in terms of diagnosis and also the age of the patient, their comorbidities, their risk for COVID-19. You know, obviously, did you have a patient that was now diagnosed with COVID-19 and they were already in your clinic yesterday or two days ago, three days ago. Is that going to force you then shut down and quarantine your staff? I think it's going to be a tough number to really figure out until months down the road. Tannus Quatre (01:07:02): Yeah. And some of the tracking that I've had some visibility into from a new claim flow perspective, I'm seeing we're seeing about 40 to 60% kind of in that range, regional specific decrease in the flow of new claims. And so you can kind of extrapolate from there in terms of what utilization is looking like in some private outpatient practices. So thank you. Okay, so this one's for Rick. When billing the G codes on a CMS 1500 form, would we bill just the CR modifier or would we bill GP CR or a PT E visit? Rick Gawenda (01:07:45): That is a great, great question. And you're going to love my answer. I think everybody knows my answer by now. We're seeking clarification of CMS on this and now if you are familiar with what CMS calls always therapy or sometimes therapies, CPT codes, those are the ones that always have to have the GP, the G O or the G. And modifier attach them when submitted to Medicare if done under a PT OT SLP plan of care, we're in the 2020 version of always in. Sometimes there'd be codes G 2061 G 2062 G 2063 are not listed in that file, which means right now as we talk today, they're not considered always or sometimes therapy codes, which technically means then GP, G O G N would not be required. However, we are hearing rumors from CMS that for some strange reason they're going to actually add G 2061 G 2062 G 2063 as sometimes therapy CPT codes. Then that would require GP, G N G O modifier, which then means they would actually apply to the annual therapy dollars threshold. Now that's what we're hearing rumors that they're going to do again, so we don't know right now, you know, because we're waiting for clarification. You know, obviously people like me, we've submitted all these questions to CMS trying to get clarification, but as you can imagine, they're swamped. They're trying to figure things out and we're just waiting for those answers to come out. Tannus Quatre (01:09:28): Thank you. Rick. got one here for Rick or perhaps Sheila. Do some of these probable changes in Medicare also apply to Medicaid? Rick Gawenda (01:09:39): Well it's number one. No. so you think Medicare changes is for Medicare and again, as I always say as I use the word Medicare, that is traditional Medicare doesn't include Medicare advantage. Now would that be in said by law, Medicare advantage plans at minimum have to offer and cover the same services that traditional Medicare does while since traditional Medicare is now covering. So they say those threeG codes, 2061 2062 2063. That means the Medicare advantage plan is also supposed to cover those codes as well. But this is not applied to Medicaid because Medicaid is state specific. Tannus Quatre (01:10:27): Great. Thank you. Okay. Hillary how many patients per day can a typical therapist see in part B in home care versus traditional settings? Hilary Foreman (01:10:42): Oh, it'll be significantly less. It depends on if you are doing the party in the home. On a senior living campus where the residents are much closer together or if it is in the larger community. So it is very different than a traditional clinic. It would be much more aligned to a home health type where you're counting more visits per day. So when doing modeling for that if you have access to what traditional, depending on your geography productivity expectations on the home health side, where they would be much closer to that. So it could be again, depending on your geography could be 50 to 60% of what a traditional outpatient would be. Thank you. Rick. Regarding initiation and consent by patient, does this have to be written or can it be verbal? Rick Gawenda (01:11:41): Well, it's going to be verbal. You almost find a recorded. So I would get it written just to cover yourself. So that again, I, you know, any time you're on this, these kinds of calls and as a consultant, you always gotta, you know, give I guess the most stringent advice or whatever. So I would say to have it written. And it could be something too that, you know, do you send them a document out and once they request a visit, do you create a document that you can send to them? Again, I'm not endorsing this product, you know, via DocuSign or some other format where this is all typed out and you had the patient, you know, electronically sign and date, you sign and date and then you say, that document is what I would do because you also gonna need to figure it out if you're going to be doing tele-health because how you get an EMU consent forms and all of that, that they're going to be consented to telehealth if they can be consented to being videoed and it'd be recorded and all of that. Rick Gawenda (01:12:41): So I will always say to try to have as much written down that a patient signs or they sent you an email, something like that that you can save to show just in case you got called out on it. Tannus Quatre (01:12:55): Great advice. Okay. What is synchronous versus asynchronous? Rick Gawenda (01:13:03): You know, asynchronous would be like that online patient portal. So again, I'm not endorsing the product called charm, so it's kind of a one way communication. It's kind of delayed. We're not live together. My doctor sends me an email, she maybe sends it at 11 o'clock in the morning. I comes into my email box. I may not sign into my account to eight o'clock tonight. I go lead, but she says I may or may not respond to her today. I may wait till tomorrow. Send her a question back or say thank you for sending. When should I come see you were synchronous talk communication, which is really what I think I hope you're going to be doing. If you're doing tele-health. It's live simultaneous two way audio, visual communication. So you know, think of face time. Okay. But you know, there's, and again, as I say some of these platforms and not endorsing them, like doxy, zoom. I know Google has something out there. There's a lot of platforms out there, think of FaceTime. So I can see Ben, Ben can see me. I can demonstrate exercise to Ben, I can watch, do the exercises, correct him. So it's live, simultaneous audio, visual communication. Tannus Quatre (01:14:20): Great. Thank you. Rick Gawenda (01:14:21): And again, I love Google. Just go to Google and type in asynchronous versus synchronous communication and all that will come up and you can also find different platforms you can use as well. Tannus Quatre (01:14:35): Okay. Awesome. okay. Hillary. I'm a physical therapist in private practice. Am I allowed to do in-home part B or is it only for a group practice and or rehab agency? Hilary Foreman (01:14:48): It would be for a rehab agency or a group practice. So there are ways to convert into those to be able to, there's some filings, again, depending on the state you're in that can easily allow for that. But you do have to go through some of those hoops to get there. Tannus Quatre (01:15:07): Okay. Thank you. Rick. Okay. So this one says just clarifying that we cannot do an evisit to qualify as a fifth or 10th visit. Rick Gawenda (01:15:20): Correct. So as we understand it an e-visit is not going to count as a visit towards the Medicare 10th visit progress report. So, for example, you know, you had a patient you know, come in and they had already had eight visits and then you shut the clinic down. A patient is apprehensive about coming in for an actual visit and now you do two eVisits, that's the next, you know, on March 26 and March 31st that's not visit nine and visit 10 towards a 10th visit progress report. So as we understand it today, e-visits do not count towards the 10th visit progress report. They don't count as an actual visit where a patient came in to see you. Tannus Quatre (01:16:12): Okay. Thank you. Okay. And I'm doing a time check here. We're going to continue for a few more minutes. We got a lot of questions coming in so we will do some followup from here. But, but I am going to kind of roll through a few final questions here. So this one can be, this may be Hillary, Sheila, Sarah. What PPE do you recommend or are you seeing in use for an asymptomatic home therapy patient? Sheila Cougras (01:16:41): This is Sheila. Hi. I would definitely recommend that you check with your local carrier or not your local carrier, but your local facility protocols and what supplies are available and what they have set up. It's been strongly recommended that protocols are set up at the local levels and what your state, local health departments are recommending. That would be your first place to check because I'm not sure which state you're in, but there is a website for all the States and you can check your local Health department. Tannus Quatre (01:17:19): Yes. absolutely. So we can work that into our followup communications. Here's another one. Can you elaborate? This is for Hillary. Can you elaborate a little more on the differences between home health provided via home health agency versus rehab company or provide a good resource, which explains the difference. Hilary Foreman (01:17:39): I'm sure I could actually provide we have a side by side that I could provide that you could share as part of the followups from this. A lot of it has to do with the billing process. Some of it has to do with credentialing of the therapists. For example, in a group practice, there's eight 55 B forms where therapists have their own PTN numbers. Only therapists can provide services under a rehab agency. Different States, different filings. Assistants might be able to provide those services to do the part B in the home. So there are the state specifics and then there's the therapist specifics. And then there's the billing specifics. So those are probably the three big buckets. But like I said, we have a side by side that I'll make sure that you have to send out. Tannus Quatre (01:18:32): Thank you. Hillary. Rick, are eVisits covered at the same 80, 20 percentage as a typical outpatient visit where the patient is responsible for a 20% co-insurance or that 20% gets sent along to their supplemental or secondary insurance. Rick Gawenda (01:18:49): Yes. CMS did say that the, you know, the G 2061 2062 2063 that they would count towards, you know, any deductibles, any co-insurance would apply. So again, the Medicare program and on my last slide where I gave you the pricing for Detroit, Michigan, the Medicare program with the 80% of that allowed amount and if they have a supplemental plan your that their Medigap plan, hopefully they would pick up the other 20%. They don't have a supplemental plan and then the patient would be responsible for the other 20%. Tannus Quatre (01:19:26): Thank you Rick. Are work comp carriers, paying for telemedicine for PT. Rick Gawenda (01:19:34): And my favorite answer, yes. No maybe so it depends and again, I noticed the answer people hate. Unfortunately back when I graduated PT school way back in 1991, it was pretty easy for us back then because every state just had one worker’s comp. We've had Michigan worker’s comp, Nebraska work comp California work comp, but now we have all these middlemen like align network, one call, med risk, etc. You have unfortunately have to do due diligence and check with every insurance company. And I'll be honest, you could call an insurance company and we're just going to make it Ben and you talk to Ben Monday, Tuesday, Wednesday, Thursday, Friday. And you asked them the exact same questions. I have days in a row and Ben gives you five different answers on five different days. Now that's not because he has five different personalities, more, no offense to the people on the insurance lines right now. Rick Gawenda (01:20:27): They have an impossible job right now there that they're not knowledgeable on COVID-19 and all of these changes that are going on and things like that. Because I'm hearing people all the time say, why called United health care? And they tell me they pay for telehealth with therapy. Where did you get the link? Did you get the citation somewhere on their website? No identity. Because if you go to the UHC website, UHC, that paid for telehealth. So again, what you're being told on the phone may or may not be correct. So again, very important to know how you're asking the question. And maybe kind of go for the answer you want to get, you know, kind of phrase the question. So the answer may be your way, but you have to answer your way. Ask them for the citation, you know, ask them on your website. Where is it, you know, can you walk me to a site? I can see it in writing cause it was not in writing. It may or may not be true what they're telling you on the telephone. Tannus Quatre (01:21:27): Thank you. Okay. So we're going to do three more questions and then we'll go ahead and wrap up at that point in time. So I just want to do a time check here. We're mindful of everyone's time. Hilary, how are you documenting new patient screening calls prior to initiating care? Hilary Foreman (01:21:47): In a variety of our systems we were able to add an additional note. In some systems we actually added the screening questions. So either we would do the screening questions and then the patient note would be together. So then once we did the visit, they would be together. And in some cases we've done the screening questions followed by a withheld or a refusal. If something in that screening then indicated that we should not be seeing the patient that day or they refuse that day or whatever those challenges might be. But we actually had added those to the system for that exact reason. Tannus Quatre (01:22:28): Thank you. Sarah, do you have anything to add on that? I'm not sure if there's anything that you're seeing with customers documenting screening calls. Sarah Irey (01:22:36): I would agree definitely with Hillary. The only thing is, you know, check with your organization. Sheila Cougras (01:22:42): Depending on, you know, your organization might want you to put it in your registration software if you have a hospital interface versus the actual act up documentation application. But definitely important to document those screens. Tannus Quatre (01:22:58): Okay. Thank you. Okay. Rick, are there any differences for critical access hospitals with telehealth? Evisits billing or reimbursement? Rick Gawenda (01:23:10): You know, again, with the e-visits we are waiting for clarification and CMS on, you know, can non-private practices, you know, go for the G codes, be paid for the G codes. So once we get that answer, of course that would apply, you know, whether you're a hospital or a regular hospital a while. So, you know, put a class that's health was, you are not paid under the Medicare physician fee schedule. You are paid any cost ratio basis. That's the other code unknown. And again with Keller house, do you want to check your conditions or participation with the Medicare program as a telehealth provider? Again, Medicare does not pay for telehealth, then they have to meet the two contracts with the other insurance companies that you've signed. So again, I think whether you're a critical access hospital, a regular hospital, your home health agency, do you impart, be in the home, you're a private practice. It's kind of doing your due diligence and check in with all those other insurance companies. Tannus Quatre (01:24:09): Okay. Thank you. So, Sheila, I'm going to direct this one to you. And this is in, and then more broadly, we're getting a lot of questions have come in about specific guidelines with regard to protecting employees and patients and use of masks and PPE. So, the one question that I think encapsulates it here, do employees have the right to refuse to treat positive COVID-19 patients if PPE is not available? We know that PPE is in short supply and not available in some areas. And so the way that I think that we should frame this up is do you have a recommendation for resources that our audience can use locally that can help guide them in the right direction for some of these broad questions about safety of caregivers and how they're treating patients in this COVID-19 period. Sheila Cougras (01:25:04): Yes, that's a really tough question. There are some resources like you said, that they could check with our state practice acts as well as looking at their local professional chapters and seeing if they can provide guidance there as well as their local health departments. And what are their rights? Is employees and receiving that PPE, I am hearing that quite a bit. And it's all over the news. That PPE, is it a high demand and there's shortage everywhere across the country. So that's a really hard one for me to give guidance or advice on, but there definitely are resources where you could check where are your rights in protecting yourself when you're employed. So I would start with your state practice act as well as your professional organizations and your local health departments. Tannus Quatre (01:26:01): Great. Thank you. Okay. So we're about to wrap it. There have been some questions coming in about access to these materials including the slide deck. Yes, we will make this all available to you. The recording. I think it's going to come out to you automatically and we will find a way to get you the slide deck as well, whether that's an included in a link in that email or some other means. So yes, we'll make sure that you've got all of the information here. I want to thank our presenters. This is just you know, we spun this up very quickly you know, over the past few days, I really appreciate you taking the time and investing in our ability to help our rehab professionals get this valuable information. Tannus Quatre (01:26:47): So special thank you to Rick Gawenda and Hilary Foreman. Also Sarah and Sheila for helping us put this together and to all of you that are out there on the front lines adapting your business models to continue the rehab care that is needed in your communities. We just really appreciate you. Thank you and are thinking about you constantly. We will have additional webinars that are coming out of the net health organization by you registering for this webinar. We will be able to make contact with you and let you know about those if you would like to attend more sessions and once again thank you so much for attending be safe and be well.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Clay Watson, Tyler Vander Zanden and Kelly Reed on the Private Practice Section’s Key Contacts. PPS is more effective with the support of members who are dedicated to advocating on behalf of the industry. You can get involved in the section's advocacy efforts by becoming a Key Contact, joining the key contact subcommittee, or by taking action online via the APTA Legislative Action Portal. In this episode, we discuss: -What are the responsibilities of the PPS’s Key Contacts? -How a Key Contact bridges the gap between legislators and constituents -The personal and professional benefits of being a Key Contact -And so much more!   Resources: Tyler Vander Zanden Twitter Private Practice Section Key Contacts   A big thank you to Net Health for sponsoring this episode!  Check out Optima’s Top Trends For Outpatient Therapy In 2020!                                                                      For more information on Clay: Clay Watson a Physical Therapist and owner/operator of Western Summit Rehabilitation, a consulting and therapy services staffing agency for home health. He is a  Past President of the Homecare and Hospice Association of Utah, a member of the Utah Falls Prevention Alliance and a recipient for an NIH falls prevention grant. This year I received the Excellence in Home Health Therapy Leadership Award from the Home Health Section of the APTA. For more information on Kelly: Kelly received her COMT (Certified Orthopedic Manual Therapist) from the North American Institute of Orthopedic Manual Therapy in 1994 and is an Orthopedic Certified Specialist (OCS). She received her Physical Therapy degree from Pacific University in 1983. Kelly prides herself as being an excellent general orthopedic physical therapist. She specializes in lower-extremity dysfunctions, biomechanical assessments related to running/sports injuries, and assessments from minimalist training to custom-molded orthotics. She focuses on injury prevention through balancing the full body, not just the area of pain.  Additionally, she has specialized in the area of Temporomandibular dysfunction (TMD) for over 30 years. Most recently she has been active in starting a BreathWorks program focusing on evaluation and education related to breathing physiology and its effect on overall wellness and healing. Her clinical skills continue to move in a direction that empowers clients to achieve their highest level of function in a balanced fashion. Kelly was a 3-sport collegiate athlete and continues her love of athletics through her own personal training, running, yoga  and being a supportive presence  at her kids’ sporting events. An outdoor enthusiast, she loves trail running, hiking, gardening, camping, and keeping up with her husband Greg and their 3 active kids. For more information on Tyler: Dr. Tyler Vander Zanden is the former Founder and CEO of Movement Health Partners, a private practice company partnering with federal, corporate, and educational agencies to provide physical therapy services.  Tyler currently serves as a member of the Key Contact Subcommittee for the Private Practice Physical Therapy Section (PPS), where he meets with legislators to increase awareness of the key issues facing physical therapist-owned businesses and their patients. Tyler earned his Doctorate of Physical Therapy from Marquette University along with a BS in Exercise Science.  Upon graduation, he completed a post-doctoral residency in Orthopedics from the University of Wisconsin-Madison.  Tyler is a board-certified by the American Board of Physical Therapy Specialties (ABPTS), as a clinical specialist in Geriatric Physical Therapy. Tyler has an avid passion for high performance, technology and entrepreneurship and speaks regularly about finance and technology as it relates to the future of physical therapy.  He currently resides in Austin, TX where he serves his church and community and is launching his next start-up venture. For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor (00:00): Hello, this is Jenna Kanter with healthy, wealthy, and smart. I am here with three newer friends this year. We all our key contacts with the private practice section and we're coming on. Well, they're going to do more of the talking here. I'm just going to be doing the questions and if we're coming on to just say, Hey, this is a great opportunity to get involved. If you do not like the CMS cuts, this is what we do. We go and speak with the legislators to talk about that. We're getting more people to come and join us in this huge movement to fight for our profession, especially the private practices for all you people are working for private practices. This is the committee to be a part of, so please, please join the APTA, come join us and be a part of this great movement. I am here with Kelly Reed, Tyler Vander Zanden and Clay Watson. Yes, you guys. First of all, thank you so much for coming on. So I'm going to hand it to you first. Kelly, how did you first learn of being a key contact? Kelly Reed (01:06): Yeah, so I've been a member of PPS since I got out of PT school and I've always been involved. I've been on the board of PPS and wanting to get back into it. And so I just put my name out there, who needs help, how can I be helpful, wanted to kind of get on the government affairs committee. And instead I got asked to be on the key contact task force and it's been amazing. Clay Watson (01:33): I'm friends with some other physical therapists who've participated in this project and we had some interesting legislative successes in our state that helped reform some payment policy issues. And it kind of led to them asking me to help out with the congressional level. Tyler Vander Zanden (01:53): I actually got invited last year at the 2019 Graham sessions in Austin and I live in Austin. And that really kind of propelled me to do something, a call to action and how can I get involved personally. And so I looked at PPS to see where I could be of service and one of the openings was this key contact position. Jenna Kantor (02:15): I love it. And just to make sure for any students who might be listening, PPS stands for private practice section. So it is a section of the APTA. Clay, I'm going to move to you just because my eyes just happened to look up at you. So what does a key contact do? Clay Watson (02:33): We have been asked to develop relationships with specific legislators and every member of the private practice section and the APTA lives in a congressional district or they have a Senator and it makes sense to pair up people who have vested stake in policy to have a relationship with a representative or a Senator from their state. And this program designed to help us have longterm relationships so that when policy needs are coming up, we'll have a listening ear and there'll be able to hopefully hear the sides of our argument that are most beneficial to our profession. Jenna Kantor: Kelly, what is the time commitment with this? Kelly Reed (03:14): Yeah, minimal. We are asked, well a couple things, we have a monthly meeting and we are given contacts of which you just email the people and try and hook them up with their legislator and that might take, depending on how long your list is, you know anywhere between 15 to 45 minutes. Then we have an hour meeting and then the bigger thing is that we are provided all the information we need and when an action item comes out they send it to us and then all we have to do is basically cut and paste a letter and send it off to our legislature.   Jenna Kantor: Yes. Would you Tyler mind differentiating between being a key contact with private practice section and also being a key contact on the committee? Tyler Vander Zanden (04:09): Yes. So being a key contact in general, what we're asking of those individuals that they be a private practice member and that they live in the district to what we're trying to assign them to. So we want them to have a relationship with that Congressman or Congresswoman in their specific district. So like as Kelly said and clay said, when there's an issue at hand in the profession or just to private practice in general, that congressional leader has a name and face of a person or a clinic that they can say, Oh, wow, you know, Kelly or Jenna or clay, like, you know, you're dealing with this right now and you're one of my constituents. And so we can have that relationship. And so that's what it looks like more at the key contact level. For us, like Kelly said we're on the committee side. Tyler Vander Zanden (04:55): We're the ones who are providing education to that specific key contact in the form of emails. We'll kind of give them block templates. So when they have to make that communication, it's not so hard. We send them and the practice or a chapter here sends us emails that they can be kind of up to speed on these legislation things. And then we recently had shot some videos in DC explaining the roles of the key contact. And so there'll be some videos that we'll have on the PPS website that they'll be able to always link back to if they need more education. Kelly Reed (05:33): Yeah. And I just wanted to build on those videos. They're short snippets, they won't take a lot of your time, but it gives you a lot of key information, just the nuts and bolts of what you need and you can look at them at your leisure and really helpful information.   Jenna Kantor: Yeah. Clay, does it work? Does making a phone call if instructed to do that to sending an email or meeting with the legislator? Does that or is that a waste of people's time? Clay Watson (05:59): Well, it wouldn't be a waste of time or we wouldn't do it. Right. I mean one of the most interesting things when we had a legislative fly in this fall, I was with another therapist who had actually written the letter to get the wife of one of our congressmen into physical therapy school and it was her first employer. Now she's a home health physical therapist and that's what I do. I'm private practice owner, but I work in home health and when we are asking him questions specific to our industry, he understands private practice and he understands home health better than almost any Congressman out there. And so that's just a huge listening ear that we wouldn't have if we didn't have those longterm relationships. Jenna Kantor (06:41): I really just want to add in person is more effective than on the phone. On the phone is more effective than email. It is like any other relationship. So really the best way to make no change is to not do anything. What we're doing is the best way to make a change. It's where we have this insane power as constituents. Now for you, Kelly, what has been the biggest thing that has moved you and how the private practice section runs and works with the key contacts? Like what do you think is just so incredible that they do to make us so efficient with what we do to put our message out there to the right people? Kelly Reed (07:27): Yeah, I've been really impressed with the amount of information that PPS already has put together and the task force and members before us that are currently on the task force. Basically they hand you everything you need to be able to do your job to make and develop a relationship with your Congressman. It's really easy and I want to say for those who may be put off a little bit about not getting politically involved, we have to, this is our profession and when we know what we know, we know what we love and all we have to do is communicate that message. We build relationships every single day and that's exactly what this is just talking about what we love. Jenna Kantor (08:11): I think that's excellent. And any last words that any of you would like to say in regards to becoming a key contact for anyone who might be hesitant on jumping in? Clay Watson (08:23): One of the most important things I've learned is the value of the mentorship I've received from participating in this. Every time I have a question about how to approach an issue with one of our legislators, I have three or four other therapists who are also doing it that I can ask. They may know context about the legislature themselves and how to approach them on specific issues and they know the nuance of the issues in a way that helps me understand them with a lot more depth. So it's sort of like a pretty high value team to help the whole situation move forward and that's invaluable. Jenna Kantor (08:56): I love that. Thank you so much. And if you're wondering, I don't know what this is for me, why am I listening to this? They're just selling me, telling me to get involved. This is where the change you want to happen. I get the most interactions on my personal Facebook page when I write the word happiness because people are happy in the physical therapy world. This is what we are doing to make that huge change. I am saying this statement very strongly. I know everybody can have their own opinion. This is mine, but this is the majority of the profession in which I interact with which are non-members. This is the big culture of unhappiness and this is where we make that change. The private practice section are movers and shakers and are listening and taking such great action. These people who are here, who I'm interviewing are passionate, kind humans. We are all volunteering our time. We are all not getting paid and we're all doing it for you and we would love for you to join us because your voice is valuable. Clay Watson (09:58): Well, I think most of the time the people who are unsatisfied with the profession are the least engaged and sometimes they are very engaged in are not happy. But generally speaking, the more you're involved with the APTA, the more voice you have and the more ability you have to affect change. As physical therapists, our whole life is based on helping people affect change. And if you feel disempowered or however you want to describe it, the way to get that power back is to follow your own practice and dig in and take responsibility for it as much as you can. And there are many times when you're going to do it for not, that's just how life works. But the truth is trying to get better is amazingly empowering. And once in a while you get lucky and you actually do make a big change. Tyler Vander Zanden (10:46): Yeah. And I just wanted to say one more thing to dovetail is you're not alone. So if you're right now, if you're stuck and you're trying to figure out what to do, you have to start somewhere. And one of the beautiful things about getting on this subcommittee now less than a year is the networking and everything that the PPS and all the people that I've been able to meet not only in private practice, but then as a result of this legislative work that we've done. So something really to consider and if your slot is taken if you want to get on here and we don't have a specific slot open in your district, you can always start these efforts on your own and we would always be able to help you with that education that's still on the website there for your use. Jenna Kantor (11:28): I love it. Thank you. Thank you to each of you for coming on, this has meant so much to me. I know it means a lot to you as well. If any of you want to learn more, you can go to the private practice section website. It's under the advocacy tab where you'll find committees and you'll find key contacts. That's how you can get involved. Thank you for tuning in. Take care.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!