Healthy Wealthy & Smart

LIVE from the APTA Combined Sections Meeting in Denver, Colorado, I welcome Tannus Quatre on the show to discuss marketing. Tannus Quatre is Vice President of Sales for Net Health, a leading software company serving therapists across the care spectrum. Tannus speaks nationally on the topics of entrepreneurship, marketing, and finance, and has been published in numerous publications including PT in Motion, Impact Magazine, and Advance for Directors in Rehabilitation. In this episode, we discuss: -What do new clients look for when they choose their physical therapy provider -How to ask your practice ambassadors for a five-star review -What branding strategies hold the best investment for your practice -How to convert marketing touchpoints to new client leads -And so much more!   Resources: Tannus Quatre Twitter Tannus Quatre Facebook Tannus Quatre Instagram Tannus Quatre LinkedIn    Email: tannus.quatre@nethealth.com   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 Tannus: Tannus Quatre is Vice President of Sales for Net Health, a leading software company serving therapists across the care spectrum.  Tannus studied physical therapy at the University of California at San Francisco, and has practiced as a PT in outpatient, inpatient and home health settings.  In 2007, he founded Vantage Clinical Solutions, a business services firm specializing in marketing and revenue cycle management for rehab therapists in private practice.  Tannus speaks nationally on the topics of entrepreneurship, marketing, and finance, and has been published in numerous publications including PT in Motion, Impact Magazine, and Advance for Directors in Rehabilitation.   Read the full transcript below: Karen Litzy (00:01): Hey everybody, welcome back to the podcast. I'm your host, Karen Litzy. Today, as you can probably hear in the background, it's a little bit louder than it normally is and that's because I am recording this live at the American physical therapy associations combined sections meeting in Denver, Colorado, which has about 15,000 plus people and I am currently in the exhibit hall getting ready for a great interview about why patients come to see us. What is the why behind when the patient coming to see us, what can we do as physical therapists to reach those patients? As we know, there's a lot of people that need physical therapy and a lot of them do not come to see us. To help me through all this, I'm really happy to have Tannus Quatre here to talk about what we as physical therapists can do to help get patients in to see us and to be happy with their courses of care. So Tannus, welcome. All right, so let's just jump right in. Why don't you give the listeners just a little bit more about you and how you went from a practicing physical therapist into more kind of the marketing side of physical therapy. Tannus Quatre (01:12): Perfect. Yeah. I started as a physical therapist about 20 years ago. And in my clinical career, I had found that I was much more driven towards being curious about how patients find physical therapists, how physical therapists can run efficient practices so that at the end of the day they can grow their practices and be in business for a long time and care for lots of folks in their community. So I was just really programmed to be interested in those types of things. And so I went off and started my own company that focused in areas like that specifically in the areas of marketing, which a lot of what we're going to be talking about today. Karen Litzy (01:56): So then tell us now, why are first time patient s coming to your practice? So in your experience and what you've seen with people you've helped, why are they coming? Tannus Quatre (02:08): Yeah. So I mean there's a couple layers to this. So the obvious one is they're coming because they've got something that they need to be fixed or something they need to have addressed, right? They're in pain or, or some sort of, some level of function that they're not currently able to achieve. At a deeper level. And I think this really ties into where we need to be thinking with regard to our marketing strategy is a customer or a patient comes to us because they're looking for hope. They're looking for some better path towards a better life that they are not currently experiencing due to some type of functional limitation or pain or other illness or injury that they're undergoing. Karen Litzy (02:46): So oftentimes when people are seeking out a physical therapist, do you think the average person is saying, well, I'm going to look up this physical therapist. I'm going to look up their education. I'm going to see if they did a residency. I'm going to see if they're board certified. Did they do a fellowship or are they saying, how far is this from my home? Do they have parking? Can I get there easily? Do they have appointment times at work for me. So there's a lot of variables there. So what do you think weights as more? Tannus Quatre (03:21): Yeah, so really, really great question. I will answer that with kind of a story that pertains to me. I don't know the first thing about cars, but I know that I have to have a car that functions in order to have a productive life, get from a to B, take the kids where they need to go and so forth. So when I need to get care for my vehicle, I go to see a mechanic and I choose that mechanic based on interestingly what, what I think is, is a really good parallel to how customers choose us as physical therapists. I assume going in as I choose a mechanic that most auto mechanics are going to hit a certain threshold for quality. I assume that I go in, I pay my money, my car is going to come out and it's going to work. Tannus Quatre (04:05): Sometimes that's not the case, but the most times, and I've used different mechanics over the years, most of the time they hit that threshold. So then the question becomes what are all of the other things that, that not only brings me to find a mechanic in the first place, the one that I choose, but why do I keep going back time and time again? For me, that answer comes down to mostly trust. I in that trust had, there's a lot of tentacles to that rapport, likability, timeliness reliability and so on. But really I keep going back to someone or to a mechanic for reasons other than the fact that they've got the best pedigree and the latest state of the art equipment when it comes to fixing my car because my assumption is my car is going to be fixed when I leave. Tannus Quatre (04:57): And I think that that's a mindset that helps me calibrate around what are really truly the drivers of a consumer that comes in and chooses Karen Litzy as their provider and then stays with you over time. I think that assumption that we should be thinking from is that frame of mind shouldn't be that the assumption is the customer's going to get good care and they expect that, but that's the basic bar. It's all of the other things. How much do they like you? How quickly do you respond? How deep is that bond and that relationship you've created that makes them say, I'm going to come back and see you time and time again and not even bother Googling for somebody else that may be out there in their market. Karen Litzy (05:37): And I think, I love kind of taking an example outside of physical therapy and as you are saying that in my head I'm thinking like I get my hair colored and I love my colorist. She moved out of New York city. I tried someone else, like the color was good, but I didn't have that bond or that relationship. Like the color is just wasn't, we didn't click, we didn't vibe. So now I'm willing to take an hour and a half train ride to New Jersey to get my hair colored because of the relationship that I have with this stylist, with this colorist. And so I think if we can think about it in those terms, choosing a physical therapist should kind of be the same. So I think you are going for the culture, for the person, for the relationship. And like you said, the baseline should be you get better, right? Tannus Quatre (06:33): Absolutely. your hair looks beautiful by the way. But yeah, I think that's a great example. So, you know, another way to maybe say it is how I think about it is we're looking for peace of mind. We're going to have different challenges throughout our life, whether it's our car or our body and we need a doctor as a physical therapist or a medical doctor. We need folks that help us complete our life and our ability to have peace of mind that we have put together that network that is going to help us feel comfortable with the choices that we've made and be able to efficiently realize that the outcomes that we're looking for, even though technically speaking, maybe you could find somebody who is a better colorist for your hair that might even be closer to you, but you've got peace and you've got everything you need and you've got that relationship you need and your meeting that bar for quality. So you go back to time and time again. And I think that's really the threshold we should be thinking about with our customers. Karen Litzy (07:35): That kind of segways beautifully into what I wanted to ask next and what is success? So when we think about a successful plan of care or a successful business, is it good outcomes or great outcomes or is it good relationships or maybe it's a combination of both. I don't know. Tannus Quatre (07:56): Yeah, great question. So obviously outcomes are extremely important. So I look at that as a baseline. That's the proof that we've set out to achieve with our customers. So outcomes undoubtedly. But when you do look deeper beyond that and you're looking for metrics that help you understand, am I doing a good job of yes adhering to or you know, treating through a plan of care and making sure that I'm doing good in the moment with this one customer. Outcomes is definitely something you should be looking at. But looking deeper than that are we creating a lifestyle that is going to be sustainable beyond us? I start to think about things like, okay, how compliant is a customer or is a patient with the plan of care that I'm putting into place? Tannus Quatre (08:50): How good of a job am I doing at influencing that customer to believe they need to be compliant with what I'm asking or prescribing them to do? And then loyalty. Are they coming back? Are they completing their entire episode of care or not if they, you know, do I see them through one episode and then I never hear from them again for the rest of their life when I know for a fact that they're going to need myself or a substitute for myself at some point in time. To me those are really, really important indicators of success when it comes to how good of a job are we doing, not just being technicians as rehab therapists but as educators and ambassadors for the profession. That really the better job that we do there to set our clientele up to be able to know when to use us effectively and how to adhere to what we prescribed to them. To me, that's really where success comes in because by us planting those seeds correctly and motivating an influence in our customers to participate, that's ultimately how they're going to keep themselves healthy for a lifetime. Karen Litzy (09:57): I love that you use the word ambassador. I use that all the time cause someone asked me a couple of weeks ago, well I don't want to say, I don't want to say you're a referral source, I don't want to say Oh my patients are referral sources and there's something else I can use cause it just feels icky to this person. It feels icky to me too. And I said, well I, instead of saying referral sources, I say that my former patients or clients are all ambassadors for my practice. And that's what I say to them. Like, thank you for being such a great ambassador. So I don't have a referral fee or anything like that. I just have like a lot of thank you cards. They say thank you for being such a great ambassador. So I'm really glad that you use that because I think that's a mindset that brass people have to get out. Tannus Quatre (10:48): Yeah, absolutely. And I appreciate that point. I would say also that I love the word ambassador and I think that by that ambassador, being an ambassador is very empowering and empowering somebody is a gift. And we have the ability to provide that gift to our clientele by helping them feel like they're now part of the profession by going out and encouraging others to experience the same benefits that they have. And if we get that mindset right and we're really have a culture of ambassadorship both within our profession as our professionals and with those that we serve, sky's the limit for what we can create. Karen Litzy (11:28): And I think it goes beyond your individual practice, but it helps to elevate the profession of physical therapy. Tannus Quatre (11:35): Absolutely. Yeah. And it makes things like when we're talking about marketing, marketing is kind of like a logistical, tactical, strategic thing, right? It's like how do we attract people to us? It makes it very authentic and simplifies it quite a bit when we really think about it from the standpoint of building ambassadors through quality, passionate care that people want to go out and rave about. Karen Litzy (11:58): Absolutely. And now I know we've been kind of interchanging these words throughout the interview, but we've got patients, customers, clients. In your experience, what kind of clicks for that potential person coming to see you? What do they want to be called or what should we be calling them or does it matter? Tannus Quatre (12:21): Yeah, I think they probably want to be called by their first name. I think that what we want to I think that the mindset that we want to be in though is that, and this is my personal preference, but I'm an ambassador of this idea, so I'm going to be passionate about this is customers have a choice and choice is the key. If we look at that variable there, a customer can choose to come see us for the first time and they can come, they can choose to come see us time and time again. They can choose to be compliant with their prescribed therapies which sometimes are painful or not very enjoyable at all. Right? The choice is really that key term. And for me, choice equates to being a customer. Customers have a choice. So if when we use the word patient, although it's you know, in our vernacular and along the health paradigm in healthcare patient to me is being instructed or being prescribed as to what to do. It's the opposite of having a choice. And so for me, when I'm having this conversation with my customers who are private practice owners like yourself, I really I really advocate for the use of customer because I think it really represents what we're trying to do, which is have customers choose us. Time and time again. Karen Litzy (13:46): Be sort of more active, play a more active role. Patient can sometimes have more of a passive connotation that I'm just here waiting to hear what the PT needs to tell me what to do instead of having a shared decision making about their plan of care. Tannus Quatre (14:00): Yes, yes. And, as we know and more proof of the phrase customer. Our customers are researching us out before coming in. They're looking us up on Google. They're doing all the things that we do if we're buying a product on Amazon, right? So that those are customer behaviors. And I think by us really embracing that, it allows us to be more agile and strategic about our marketing efforts. Karen Litzy (14:24): So now let's talk about, you just mentioned Google. So people are going to Google us, they're going to look at Google reviews, Yelp reviews. So, what drives these positive reviews that people are reading hopefully reading about us.   And on that note, we're going to take a quick break to hear from our sponsor net health and we'll be right back. This episode is brought to you by net health, net health outpatient EMR and billing software. Redox 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 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. Tannus Quatre (15:25): So interestingly what's not driving the positive reviews is strictly about outcomes and the quality of care, which is really what we're all about at the end of the day. Right? We kind of started with that. What's driving positive reviews? I would just put it into one word, which is relationship. If you have a strong relationship and within that relationship you identify as part of it, like you're really, really an ambassador raving fan. It's not even if you were to request a happy customer, Hey would you, would you mind saying some positive about me? Absolutely. They're going to want to do that. But, if you think about what really drives someone to take it upon themselves to say, you know what, you are so damn good that I'm going to go out and do a solid for you because I want to help build your business for you. Tannus Quatre (16:14): That's based on a relationship. And I think part of it is the identity too, of feeling proud about the fact that like if you get the latest iPhone all right and you're stoked about it, don't you feel kinda good about the fact that you're the one going out bragging about the fact that you're one of the first on the block that's gotten the latest and the greatest in that same sentiment or that same idea is what drives us to go online and be public about positive experiences we have with our rehab therapists. Karen Litzy (16:44): And now let's say we're going to get to marketing in a second, but let's say you're a physical therapist, a private practice owner or you're working for a private practice. How do you bring up to your client or your customer like, Hey, I would really love for you to leave a review on Yelp or on Google, when is the right time to do that? And is there any verbiage that we want to avoid? Tannus Quatre (17:10): Yeah. Okay. I love the question. The answer is yes, there's a right time. What I coach therapists to be looking for is I just call it the opportunity and it's happening like right now as we speak. By the time we're done with this, it'll have that opportunity will have happened in hundreds of clinics throughout the U S as we speak. That opportunity can come by way of a customer saying, Hey, I feel great today. That's a lead for us, right? That's somebody who's happy and they're expressing that to us. It can be somebody who has achieved an outcome that they had not yet achieved or they met a goal that you had established together and you both acknowledge that in the moment. There's really deep moments too and we've all had them where a customer or a patient gives us a big warm hug and tells us that they love us and they've never ever been in this position before having met us and they're that emotionally bonded to us in that moment. Tannus Quatre (18:11): They might even have a tear in their eye. Those are all opportunities and there's infinite flavors of what those can look like. But the first thing we need to do is identify or be trained, really to like see that as truly an opportunity to now build an ambassador. Because now the next step is to empower that patient or that customer to go out and do something that's gonna make them feel even better and it's going to give back to the profession and it's gonna support your business. So once you identify that opportunity, it's a very, in a very authentic and sincere way to say, Hey, listen what you just expressed to me as, as my patient or as my customer means the world to me. And that's why I exist and I want is to help people just like you. Would you be willing to help me help others experience what you're going through in this moment? Tannus Quatre (18:58): Right now the answer is going to be a resounding yes. Now it's logistics. Okay? Would you like to know how this is what you can do? Are you on Google? Do you have a Facebook account? Are you on Yelp? You figure out what, what flavor suits your business needs best. We find that most, it's easiest on Google or Facebook because most people are there. But it's simply, Hey, if I provide you with a link and all you had to do is click that link and leave a positive review, would you be willing to do that? Would you make that commitment? To me, the answer is going to be a resounding yes. And we find that to be highly successful at tying the opportunity to the ask and to the results. Karen Litzy (19:37): Perfect. Thank you. I'm sure a lot of people will find that super helpful. So now we spoke about why people are coming to you for the first time. What does success look like? What drives those reviews? How we should be thinking about our customers or clients, patients, customers or clients. So let's now tie that altogether and talk about marketing. So how does all of that tie into the way we should or could be marketing our practice? Tannus Quatre (20:09): Yeah, I mean in infinite ways. Karen Litzy (20:14): It's an easy question, right? Tannus Quatre (20:16): Yeah. Well I mean to me that's all the fodder that the best marketing plans out there for large organizations or small should be using, which is do we have our fundamentals right? Do we have customers that we can benefit? Do they say positive things about us? Are there signs of success that they're coming back for more and more? Are they compliant? Are they loyal to us? If you have those two things you can now take that and deliver that out into your community as evidence or social proof that you are the provider of choice. And how do you do that? You know, how can that be constituted within the context of a marketing plan? We believe a lot in content marketing because really everything we do, including this podcast right here, it's all content, right? Tannus Quatre (21:06): And content is the best tool that you can be using for marketing. Cause you can use it to draw people near to you. So whether it's taking that a script that we just discussed to generate a five star review online, that by itself is one prong of a marketing plan. That is a content marketing plan that's driven by content that's coming from a happy patient that they're then posting online, taking testimonials or if you use outcomes tools and you're able to demonstrate that you're better in your market than your peers and taking that content and then dripping it out via social channels via the press, via email, name, the channel, it doesn't matter. But by dripping that out there into the community and using that to pique curiosity, curiosity and interest, that's basically leveraging your fundamentals into a very, very strong marketing plan. Karen Litzy (22:00): And let's talk about consistency. So we know that it takes a lot of touch points before someone will purchase. Like, I think I was doing some research a couple of months ago and came across this study where I think it took 20 touch points for someone to buy a chocolate bar and it was like 300 before they would buy an expensive set of headphones. And so a touch point can be just like you said, it could be something on social media, could be something they read in, in a publication or a blog or, so we know a lot of touch points are necessary for something that might cost a little bit more money or a little bit more time. Right. So let's talk about consistency of marketing and what, what can we do? Tannus Quatre (22:41): Yeah, it's a consistency of those touch points is, is really everything. So, we tabulate that basically in terms of impressions. So how many times do eyeballs or ears meet with the brand that we're promoting. And then in addition to that, you want to have a variety of how those touch points are experienced. So it would be one thing to have you just to use your examples. Let's say it's 20 touchpoints or  300 touch points through email. You think about that, that's going to have one type of impact on you, right? And that impact might be, I'm getting too much email. Okay, well but if you, if you get to that 20 or that 300 points and it's through a combination of certain percentage of email, social media, I'm getting some through the podcast, a little bit on the new station. Tannus Quatre (23:34): I'm getting, you know, something in my snail mail mailbox at home. All of those different touch points aggregated together. It's really how all the big brands do it. If you think about that when we buy an iPhone or we buy a Nike or something like that, we don't just see him in sports illustrated or the Apple store, we see it in multi channels every single day. We'll see. We have about 6,000 brand impressions that a customer is exposed to every single day. Right? And in order to permeate that as physical therapists, we have to have true consistency and volume when it comes to touch points, what that exact number is, if it's 20 or 300, it's going to depend on a lot of variables that are going to be unique to your market or your practice. But the key is you have to be consistent and you have to be, you have to be multichannel. Karen Litzy (24:27): Different spokes in that wheel, right. In that marketing wheel. It's not just snail mail or it's not just a Facebook ad here and there. It's a lot, especially in a world where people are bombarded on a daily basis by stuff. Right? Tannus Quatre (24:45): Yeah, no, absolutely. Yeah. So, so then I will sometimes get the same question, like, how many times do I have to, you know, touch a customer with a piece of collateral? Or how many times do I have to market to an influencer or a physician before I can expect them to do X, Y, and Z ? And that's the wrong question to be asking because there's no straight answer. It's iterative. If you track your data, you're going to know for you exactly how much budget and how many impressions you need to see in Facebook in order to generate a lead, right? It's going to look different maybe for email, but the key is to really understand your own business and don't be afraid to try something new. If you're not doing email campaigns, which I would suggest to you're doing right, try email campaign, track your conversion rates and see if it's something that's working for you. Karen Litzy (25:38): And you know, we'll start wrapping things up here a little bit, but if you could give a physical therapy, let's say a private practice owner, we'll use that. What would be, and again, knowing there's a million tips, but what are your top few tips on how to market efficiently and with integrity and to not feel like a used car salesman? Tannus Quatre (26:06): Yeah. okay. A couple of things. So the first thing is believing in yourself and your value proposition. That's the biggest threat that we have to our profession is that sometimes we feel like we're too expensive or we feel like there's too much cash that's owed up front from a patient. And we start to second guess ourselves so that in any marketing channel we were not as effective. Okay. So, so that would be the first thing I would say is really understand and believe in your value in everything you craft around that's going to have a lot of authenticity, sincerity, and passion and that will be felt and heard. Okay. And I think the second thing that I would probably offer is know your lane. There are if you take some of the big brands out there, they have resources to be able to succeed at a certain scale that doesn't work at a smaller scale. Tannus Quatre (27:05): Okay. So just because it can be effective to have the name of your company splashed on the, you know, the outfield fence, you know, for a major league ballclub doesn't mean it's right for you. Right. so knowing what your lane is and a lot of times if I kind of now bring it down to kind of the micro level and talk about a small private practice, a small private practice trying to do a whole bunch of different marketing things, man, it's going to be hard to do. And probably what's going to end up happening is you're not going to really hit the bar on any one of those things. So I would much rather counsel a private practice to say, Hey, we're going to dominate these three areas. We are going to lead our community with workshops. Tannus Quatre (27:54): We're going to do better than anybody else with holding workshops in our facility. We're going to do it consistently. We're going to pour the resources on and make sure that every single month we're doing workshops and we're also going to dominate Instagram. You know, if you said those are the two things, because that's, you know, it, it comes naturally to you. It's channels that you're familiar with and it was just those two things and you didn't do anything else. I think you're going to have more of ability, more of an ability to have success. And if you don't have success or you do to be able to understand and tweak your success if you choose those lanes because they can work for you. And I see far too many people trying to do a little bit of everything, throwing spaghetti at the wall to see what sticks and the reality is you don't meet the threshold anywhere and you really don't know what's working anywhere. So you don't know how to, how to tweak things and make them better over time. So I think that the authenticity and believing in yourself and really knowing your lane and choosing to stay in that lane are the two things. Karen Litzy (28:55): Some advice and it's, you know, if we put it into our client language, we would never give a patient 10 exercises on the first time we see them. We would give them maybe one or two so they can master those. Because if you are trying to do 10 you end up doing none. So I can understand that. If you're a small business owner, I'm a small business owner. If I tried to do a million different marketing ideas, I'd be like, forget it. This isn't, I'm not doing anything. I'm done. No more marketing. Yep. Tannus Quatre (29:24): And, and, and, and that's kinda what happens. It's a lot of back to you mentioned consistency. It's a lot of starting and stopping. When you try to do too much, it's you say, okay, I'm doing a lot of everything. I don't know what's working or what's not. So pivot, try something else. It may or may not be more successful. Right. Karen Litzy (29:38): Great. Great advice. All right, now it's a question I ask everyone. Knowing where you are now in your life and in your career, what advice would you give to yourself as a new grad right out of PT school? Tannus Quatre (29:52): Okay. love the question. Leave fear at the door. I spent too much of the early part of my career, probably the first five to seven years or so. Asking for a lot of permission. Thinking that there was a lot of things that weren't quite right for me and that there was some excuse or some magic wand that other people had to achieve things that I thought were really compelling or intriguing. Instead of just getting out there and saying, screw it, let's just fail fast, fail often and like get on the path to success. So I think that's the one thing that I would have told myself to do out of PT school. Karen Litzy (30:33): Excellent advice. And that could be at any stage of life. Great advice. So now where can people find you? Tell us a little bit more about your company and where they can find it. Tannus Quatre (30:42): Yeah, absolutely. So I am proud to be part of the net health company, so I can be emailed at tannus.quatre@nethealth.com. You can also find me on all of the social channels at Tannus Quatre. Karen Litzy (31:02): Awesome. Well, thank you so much for taking the time out and in the middle of CSM, and hopefully this isn't too loud for all of you listening. I don't think it is, but thank you so much, Tannus. This was great. And again, if anyone wants to reach out to Tannus, we will have all of those links in the show notes at podcast.healthywealthysmart.com so thank you. Tannus Quatre (31:22): I love it. Thanks for having me, Karen.   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 Domenic Fraboni on content creation for social media.  Domenic Fraboni is a physical therapist in Los Angeles, California and lifestyle consultant focusing on mindset, movement and meals through online coaching. In this episode, we discuss: -How to choose the right social media platform for your target audience -The importance of developing engagement with your content -How to stay authentic and avoid the negativities of social media use -And so much more! Resources: Domenic Fraboni Instagram Domenic Fraboni Twitter 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 Domenic: Domenic Fraboni is a Doctor of Physical Therapy and Certified Strength and Conditioning Coach. He earned this after graduating from Mayo Clinic School of Health Sciences in Rochester, MN IN 2018. He is a member of the American Physical Therapy Association (APTA), attending many events nationwide to advocate for the advance of the physical therapy profession as well as accessibility to higher quality of care. As a recent member of the APTA Student Assembly Board of Directors and active advocate for healthcare reform, Domenic likes to focus his efforts on systemic healthcare change. He was an avid coach, unified partner, and volunteer coordinator for Special Olympics. He now has relocated to Los Angeles where he coaches people into their bodies using a unique approach of Health and Lifestyle consulting in the areas of mindset, movement, and meals through his company, The Wellness Destination. Domenic focuses his services on the true and authentic connection he hopes to create with patients, clients, or those who looking for help on their health journey. Then he may be able to help empower individuals overcome some barriers and create true progress and independence in their lifelong healing journey!    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 (00:01): Hello, this is Jenna Kantor with healthy, wealthy and smart, super excited to be here at Graham sessions 2020 with Domenic Fraboni, who I know from student assembly running for that, the board of directors and then also now on social media, which is our big focus because he has been putting a lot of work specifically on Instagram. So I wanted to have a discussion on this journey, I'm going to call you Dom now. Let's make it casual with Dom, so, first of all, thank you so much for coming on. Domenic Fraboni (00:37): Thanks for having me and being interested in what I might have to say. It's been kind of a journey this past six months with a lot of changes for me, especially career-wise, location-wise, and the social media thing. You just want me to dive in a little bit. Jenna Kantor (00:50): Actually first, let's start with why you chose Instagram, because when choosing a social media platform that you're thinking of a specific audience, so would you mind diving into that so people can start picking their brain and thinking, even if Instagram is where their audience is? Domenic Fraboni (01:06): I think my choice in platform had a little less to do with what I was wanting and just have more by chance. You know, I started dating somebody who has a big following and notice some of them started taking a liking in me or an interest in me. And it was at that point that I realized, Hey, Instagram, I've wanted to find a place I can start creating some content, whether it's recording exercises, whether it's just putting out thoughts, thought provoking things for potential clients or potential humans. I'm all about getting access to good information out to the humans so that they can make the decisions for themselves. And we know in this online era and the age of information, I would love to be contributing to what I think can be, you know, more trustworthy information that's online. So I started getting this Instagram following and I'm like, okay, let's do this. Let's put out some content. And I think it worked great for that because a lot of times people go to Instagram for content of that sort. So I'm like, Hey, great marriage. So that's kind of how choosing Instagram as a platform came about more by chance than by my direct choice. Jenna Kantor (02:12): How did you figure out what your content would be on? Domenic Fraboni (02:19): Yeah, that's another great question. I'm kind of in my purpose moving into this career as a professional. I always said I want to empower people to independence in their journey, right? And then kind of my themes that came out of that were movement. I'm a doctor of physical therapy. So clearly movement is huge to me and how I deal with clients and patients. Mindset. Cause I do also understand that in the psychosocial realm of how we treat humans and how we deal with humans, our mindset, our emotions, our mental state has a lot to do with how we feel physically and how we move and meals. So I'm like, Hey, maybe if my content surrounded those three themes, that can be my stick mindset, the movement and the meals. And it had a little, a little bit of a ring with the three M's there. Domenic Fraboni (03:03): So that's where I just started with those three things in mind and trying not to question myself was the biggest thing going in where you asked, Hey, how'd you know what kind of content to put out? I knew I had these people following me and that they might be interested in what I have to say. So my first step was just doing, it was starting to put out content and asking questions. If you ever have a time online where you have people following you and you don't know what they want, ask them. And so I started asking questions. I was very lucky to have people around me who had kind of gone through a transition like this into putting themselves out there. And a lot of what they said is just do it. You know what you're good at, you know what you're passionate about. These people have started following you for a reason, the ones that need to hear it will resonate and the ones that want certain things, we'll let you know when you ask. So I started asking questions to the people that were following me and they also just started putting out content and realizing what it was that people resonated well with. Jenna Kantor: (04:04): And for you, what were your measures that you are using to go, Oh, this is what they want to see from you?   Domenic Fraboni: So I like to say that and a lot of people in social media want to try to separate the success of their posts and their media from the likes and the comments and that stuff. And it can get really kind of cloudy in our head as, Oh, why did this not have as many likes as this? And so really early on when I started doing this, I tried separating myself from likes. Everyone wants a lot of likes on their stuff and it really is not likes on your posts that mean people are engaging with it or connecting with it. The things that I really started to realize is the more direct messages, the more DMs or the more comments that people are connecting with are saying like, Hey, I love this. Domenic Fraboni (04:56): I tried it. It feels this way or I'm glad you shared that. Thanks so much for sharing more about yourself, whatever that means that I'm connecting with them personally in some manner. And so I liked to kind of dive into those ones that got a lot of personal direct messages or comments. And I'm big when it comes to feel and the energy between an interaction with people. So when I got interactions back from people that fueled that same purpose or energy, that was the reason I put that post out. There we go. Like those are my metrics. And I live in more of a subjective world myself because research makes me cringe a little bit sometimes. But it's the field that you can't get away from. So when I had people responding to me that made me feel something, I understood that maybe they took something away from that that made them feel something inside. Domenic Fraboni (05:43): So try to steer away from becoming obsessed with likes or comments and really steer towards and into the things that, you know, people feel something when they read it and will connect with it and reach out because of that. And I feel like I've helped to engage my audience a little more.   Jenna Kantor: I love that. And with all the content that you're doing, how did you figure out how often you're going to be posting?   Domenic Fraboni: Yeah, so like the frequency is huge too because consistency breeds trust, you know, people, although we are putting out this free content and it does take time to put together, you know, people like following, you know, people are content providers that they know are going to be there for them or that they know are going to be there and continue to put that out. So I'd say the first thing was like, okay, I need to be consistent. Domenic Fraboni (06:35): And initially when I was starting this, I had a little more time on my hands and I was, I decided, okay, I can take Sundays off and I'll post six times a week. And then I realized as I started getting more coming onto my schedule that that was a bit tough and so I landed on doing something about three times a week, three to four times a week and making sure I'm very consistent in that, but then also engaging when possible and making sure that those connections that are made aren't just done because I need to make my three posts a week again is all has to come from this intention inside me, so whether it ends up being two times a week or six times a week, I know that it's all still coming from this great energy that I trust and in behind what I'm putting out. Domenic Fraboni (07:18): Again to create those relationships, whether online or whether in person or whether just through DMs or comments. We are creating relationships and connections with these people in some way and so if the post I can put out has a slight influence on that energy that might drive them to be open to different options, then that's what I'm going to put out. I've landed somewhere in that realm of three or four days just based on how much other work I have in my collective sphere right now. But I think that's plenty for me to continue that frequency of engagement to make sure people know that I'm going to show up. Domenic Fraboni (07:54): Do you have to know everything to start something on Instagram? Yes. If you're not an absolute expert, then you no, absolutely not. And I think if you look through Instagram pretty quickly, you'll realize that not everybody is an absolute expert or knows everything in what they're posting. And I hear a lot of PTs or specifically younger PTs who will see other pages and be like, what the heck is this? Like, this isn't how it is or this isn't how you should do that exercise. Or like, wow, they aren't even paying attention to this. And my thing to them is like, we'll record an exercise and put it out or record a video of yourself doing it and say like, this is how I do it. Not to bash or be against that person. I'm very, very much so against calling people out. I put my air quotes over that even though we're on audio, but calling people out or having turf Wars with other people because you don't agree with them. We don't have to agree. We do also just have to understand that there are a lot of people that are open to those other routes. And this isn't for PTs. Jenna Kantor (08:56): This is for people. Domenic Fraboni (08:57): Yeah. So leave your ego at the door, leave your ego away from your phone and put out great content that you know you can stand behind and you won't have to worry about that as much. Jenna Kantor (09:10): I love that so much. What has been the biggest lesson you've learned since really diving into your consistency and all your content on Instagram? Domenic Fraboni (09:19): Yeah. Be authentic and trust yourself. It's really empowering. Well one, when you find that empowerment within you just to say like, I know what I know and I know where that comes from. And when you sit in that space, no matter what you put out or what someone says about it can impact that. And so yeah, I spend time on posts that I put out and they don't go anywhere. Maybe I have a slight bid or a question in my head like what happened there? Why did that not get that following? But I don't emotionally attach myself to any expectation on that. So the biggest challenge is the expectation of yourself or the comparison bug that might come out. Instagram's doing this thing where they're taking away the ability to see likes on a lot of posts now, which I think in a lot of aspects is great cause there are a lot of people in these younger generations that are going through anxieties and depressions because of this technology addiction, which is a whole nother topic. Domenic Fraboni (10:17): And that's the initial reason I never wanted to get into this cause I knew technology draws on these very addictive processes to get people to continue to use and to continue to abuse those processes until literally we are physiologically addicted. And that's why I stayed away from it. And instead knowing that that can happen and the intent from where I'm coming, I know that we can use these processes that may be addictive to get great information out to people and to help them understand and have access to that kind of stuff. So yeah, my biggest challenge, a challenge is going back to your initial question was you know, comparison and seeing what other people are doing, which is why I brought up the likes and like, Oh they got that many likes and they have this many followers and this and that. You know, like you start wanting to do that in your head again, shut those things down right away because you don't know what their purposes are, where the people that follow them are coming from or what they're looking for. And so be authentic and try not to get that comparison bug on your shoulder. Jenna Kantor (11:18): Boom, Shaka Laka I love that. So where can people find you on the Instagram? Domenic Fraboni (11:24): So if you type in doctor, just drDomDPT, it's drDomDPT, you can find me. I put out stuff on movement, mindset and meals. And my goal is to empower you to independence in your journey. Cause everybody could use a little bit of good information to maybe open up what other possibilities could be on your path. Jenna Kantor (11:45): I love that. So thank you for everyone who tuned in to listen to this podcast. You can also get that information on where to find Dom in the bio as well. Dom, thank you so much for coming on. Domenic Fraboni (11:56): Thanks. This has been amazing. Jenna. I love getting to see you here at Graham sessions and thanks for interviewing me.   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!

LIVE from the Graham Sessions 2020 in Nashville, Tennessee, I welcome Erica Meloe on the show to discuss how to create a brand ambassador. Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem-solving skills into the clinic. She specializes in treating patients with persistent unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other. In this episode, we discuss: -The lack of public understanding of the role of a physical therapist -How to turn your patient into your brand ambassador -Inexpensive acts of kindness that will make you memorable -Why you should network outside of your profession -And so much more! Resources: Erica Meloe Website Tought to Treat Podcast Why do I hurt? Book Velocity Physio Website Erica Meloe Twitter Erica Meloe Facebook   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 Erica: Erica Meloe is a board certified physiotherapist in private practice in NYC. After a decade solving financial puzzles on Wall Street, Erica took her MBA and her problem-solving skills into the clinic. She specializes in treating patients with persistent unsolved pain and her mission is to raise awareness of the physical therapy profession to a level like no other.   Erica is co-host of the podcast "Tough To Treat: A physiotherapist's guide to managing those complex patients." She is also a thought leader in the profession and helps her patients, as well as her colleagues, empower themselves to lead and live with purpose.   Erica has also been featured in Forbes, BBC, Women's Day, Better Homes and Gardens, Muscle and Fitness Hers, and Health Magazine. She is also co-host of the Women In PT Summit, held annually in NYC. Erica is actively involved in spreading the word on social media and at her website www.ericameloe.com   Read the full transcript below: Karen Litzy (00:01): Hey everybody, welcome back to the podcast today. I am here with physical therapist, Erica Meloe and we are live in Nashville, Tennessee at the Graham sessions. And for those of you that don't know, Graham sessions is all about bringing up big bold ideas, things that might be controversial, things that may be we're not talking about as much in the profession and it's like a big think tank. And so today Erica and I are going to try and take that in, miniaturize it down to a podcast. So one of the things that really I guess gets to Erica is the lack of knowledge of what we as physical therapists do, how we operate and how we can help people. So Erica, what are some things that you have maybe even experienced? I'm sure this comes out of your experience as a practice owner and as a physical therapist for many years. So I'm just going to hand it over to you and let you kind of talk about some of the things that really get to you. And if you have any suggestions or solutions for other physical therapists or the general public that we can do to perhaps mitigate this situation. Erica Meloe (01:14): Well, thank you Karen. Thank you for having me on the podcast. Graham sessions is wonderful in Nashville. I've never been to Nashville, so I know it's quite nice. One of my mentors or business coaches asked me a while ago, what can't you shut up about and what I can't shut up about? I mean, there's many things, but this so irritates me is that people still, consumers and other healthcare professionals do not understand what we do at all. They don't understand. They think we're all exercise. And I know that this is a topic that's been beaten around for many, many years. And for me it's just, it drives me crazy. And I'll just tell you a story related to Karen. I had a patient of mine who just texted me. I'm an out of network practitioner and she has a certain like a deductible. Erica Meloe (02:03): She has to meet. She's like, well, I'm going to wait to see you. I'm going to wait to see. I'm going to go meet my deductible. I'm like, well, why don't you meet your deductible with me? Am I not as my profession? Not as valuable to you in your mind. And I think as a profession we need to start when we can talk about the marketing and the branding, but that's not what this is about. We need to start at the grassroots level with our patients. I mean our patients are our voices and we need to develop relationships with them and we need to actually make the ask. I think we sometimes in our profession, we're not shy, but we don't make the ask and I'm guilty of this. We don't make the ask of our patients. Erica Meloe (02:50): What is your view of me as a therapist? What is your view of me as a profession? How can I get a seat at the table? For example, you know in a discussion in Washington, how can I get a seat at the table? You know, at an AMA conference. I know a lot of physical therapists out there are speaking at other non PT conferences. But I think it first starts with our patients developing, we talked about you know, a lot of these business and leadership skills, these soft skills and yes, those are very important. But the relationship with our patients, the patients will get that word out. I mean there are time and time again, we both experienced it. You treat so-and-so and the word gets out. This physical therapist is different, this is what they do. And I think that starting with the interpersonal relationships, relationships matter, I think it was on Twitter, somebody mentioned recently that she spent 40 minutes on the phone talking to an insurance company or a doctor and was that worth her time? And you know, she got a lot of comments and it was like relationships matter and that's value to the patient. Karen Litzy (04:02): Oh, absolutely. So I agree with you. It's all about relationships and those relationships, that Alliance that you create with your patient, that patient then goes out and they become your ambassador and not only an ambassador for you, but an ambassador for the profession as a whole. So instead of saying, which we heard today, people say, I went to PT and it was crap and they didn't do anything. But instead, wouldn't it be great if all of us PTs are forming these relationships, are treating patients with the latest evidence, are not wasting people's time, are making people feel better. Or I would even argue making people more functional, getting people to an elite level of sport. And that's what physical therapists can do. And I feel like a lot of patients, if they have gone to a physical therapist and they say, I did, they just put a hot pack on me and then some Estim, then do my exercises. And then I left. And you know who that patient was? My own dad. My own dad was like, well, why would I do that? He's like, I can put a hot pack on at home and go to the gym. Well that's not quite the care that your talking about. Erica Meloe (05:21): Right. So that was your dad. So you know, he would never say anything to you like you know he would not basically say, you know, all physical therapists are like that because you're his daughter. So you know, I talk about, you know, building relationship with your patient and your patients. Number one are your advertising or your marketing and your brand. You know, we can spend a lot of money and we, you know, a lot of people do on all of these business courses and that, you know, marketing and the branding and the social media and that's all great. But if you don't have a relationship with your patient, it doesn't matter. Karen Litzy (05:58): What are some tips that you can give to the listeners to create a good relationship with your patient. Erica Meloe (06:03): But say, you know, and I speak from experience and seeing other therapists work over my years, go the extra mile for your patient. Go. There are many times in patients, for example, they're going, they'll email me, they'll text me and on weekends and I answer those text messages and I answer those emails and they are like, thank you so much for answering an email on a weekend. And yes, that's a very basic example, but actually matters to these people. Karen Litzy (06:37): Well, the basics matter. That's the simple little things that you can do that takes two seconds of your time. Erica Meloe (06:45): And also just listening to your patients. And yes, I do have a tendency to run a bit late when I see patients, but I will tell you, Karen's laughing cause you know, but if someone asks you a question and you're 10 minutes late for your next patient, you don't just say, I can't answer it now. You know, and this is obvious, but that patient, they may have gotten a hundred percent better with you, but they're, Oh, they're going to remember it. That last encounter. You need to make every encounter matter, whether it's listening to the patient, whether it's you know, listening to them about something that's unrelated to physical therapy. And going that extra mile. And asking the patient, you know, what do you want from this relationship? It's a relationship and it's a trusting relationship. And, once again, you know all the branding is fabulous, but they're your voice. Karen Litzy (07:49): Yeah, absolutely. And I think it's also important to remember that this isn't a relationship of you being above your patient. It's a partnership relationship. Erica Meloe (08:07): And what do partnerships do? You know, they give and they take and there's a sacrifice, but I would offer this advice is your patient is your patient for life. Right? It's like that lifespan practitioner that we talked about so often and they should be treated as such. For example, when they leave your office for, let's say you've seen them for 10 visits, their back pain's gone and they're kind of good to go, but they're not really, once again, we don't discharge patients, you just, you know, see them and then they come back whenever they've got something else going on. It's not a word I like to use that. It's funny, I often say I don't use discharge anymore. I actually say you know, I'll see you if you have any other problems, just just come on back and I will keep in touch. I actually think using direct mail, and I've tried this, said this before really helps. Erica Meloe (08:52): I actually send birthday cards out and thank you cards and thank you cards after I have a a new patient, I will send a thank you card. Thank you so much. Nice meeting you. And patients are saying they come back and they're like, that was a great touch. I really appreciated your card. Honestly go into your database. I’d get an Excel spreadsheet of all your birthdays of all their patients birthdays. It is an easy thing to do and then just note them down and write them, go on a Sunday, spend an hour and a half doing that. It will matter. I know, it's funny because I had an assistant of mine do that and I was like, Oh, she has a birthday very similar to mine and you know, and, and they actually do appreciate that. Erica Meloe (09:37): And you know, I've been a patient myself and I, you know, we hope we can get the odd email and everybody's about, you know, the email marketing. Yes. However, it's not the same.   Karen Litzy: No, it's definitely not the same. And, and I also can appreciate those tips that you just gave, listening to the patient, sending a birthday card, a thank you card and helping them kind of understand what we do and taking the time for them. These are not huge things. You don't need a certification for it. You don't have to spend money for it unless you get a stamp or something. It's very easy, accessible ways for everyone to enhance that relationship. Erica Meloe (10:33): Right. I think someone mentioned today that you might not be the best therapist in the world, but if you've developed a relationship with your patient, that's golden. And I received something from one of my coaches recently and it was a card and it said the best is yet to come. And I was like, Whoa. I was so touched by that. And it took her what, maybe five minutes to write that and not even, and that, and I remember that. I remember that. And when someone is sending that to you before you have to renew a coaching program or before you have to do something, I'm going to renew. I'm going, of course I'm going to renew because that was a great touch. You know, that's the customer service that people forget that we actually need to do in our field.   Karen Litzy: Well, it makes you feel quite simply that you matter. Yes. And isn't it great that we as physical therapists can give to our patients the gift that they matter because they might not be getting that elsewhere. So if you can do that for your patient, they're your brand ambassador for life. Erica Meloe (11:20): Absolutely. You know, and when I started early on, you know, as a business owner, I was actually afraid to ask my patients for referrals. You know, I really was. And to this day it still is hard, but it comes out a bit easier now, you know, if you know of anybody else that could need my services, I really enjoy treating the difficult patients. Just, you know, send them my way and it comes out easier that way and we all have a different view, but they fade like you, you will do that. Karen Litzy (11:54): And I remember thinking to myself, Oh, I don't want to do that. It sounds so slimy. Like used car salesman. I don't want to do that. I don't want to be that person. And I remember somebody saying to me, but you're not slimy. So it would never come out that way. So if you're not slimy and gross and you ask someone, Hey, listen, I love doing this. If you know someone, definitely send them my way. I'm accepting new patients anytime. Like it's only slimy I think if you're a slime ball. Erica Meloe (12:17): Exactly. And it comes out very you know, with integrity, right? And it's not, of course not because, and if you say it with the passion, like you just did, you know, I love to treat these patients. I love to treat patients just like you. How special is that, right? That you make them feel special and they'll be like, Oh, of course, you know, it's like asking for reviews on a podcast. Oh, I didn't know I had to write a review. You know, can you write me a review? Boom. They don't understand it. And I think that is a good relationship. And once they realize that you'll be in the top of their brain and then they're going to be like, well, that experience was very valuable to me. You know, the birthday cards, the, just developing the rapport, rapport and just establishing relationships that, where it's a, you know, a given a take, but it's almost like a marriage in a way. I mean I'm not married and I certainly know I'm experiencing that, but when you have business partners or podcast partners, it's a given a take. And the ones that last the longest are the ones that, that work together. They collaborate. That's the best recipe for success. Karen Litzy (13:24): Right? And exactly what Erica just described is how we as physical therapists can help the general public know what we do, right? So it goes back to the thing that gets Erica every time is people don't know what we do, but there are what 300,000 physical therapists in the United States? It's a lot of people. And so if we can make a difference with every person, then can that cause a little ripple that can become a wave. Erica Meloe (13:50): Right. And I would also urge patient physical therapist to go to conferences that are not physical therapy related. Go to a leadership conference, go to a medical writing conference. Go to an urology conference or a women's health conference or that's the wheel. You'll develop relationships and you'll be the brand ambassador cause you'll be the only physical therapist there. Karen Litzy (14:23): Very true. Right. Great advice. Well what are the big things that you want the listeners to take away from this? Erica Meloe (14:29): That it's the small things that really matter. It's kindness. That's my word of the year by the way. I remember had the word of the year, that's my word of the year. Kindness. It's the little things that matter. Sometimes we need to go back to business 101 like direct mail that actually does work. You know, it really does. That's the main thing. And don't be afraid to collaborate with nonphysical therapist acupuncture as they're developing a relationship there. Cause you will educate them, you really will. And you have to be passionate about this. If you don't, if you're not as passionate about it as I am, you'll do it like half assed in a way. And you know, so, but start with your patients and pick a few patients you really like and you, you know, send birthday cards, send thank you cards, do it for one or two months and see if you get any return on your $1 investment. It's nothing. Karen Litzy (15:27): Great advice. And now what advice would you give to yourself knowing where you are now in your life and in your career? What advice would you give to you as a new grad right out of PT school? Erica Meloe (15:40): Stop overthinking. I analyze, overanalyze everything and that's good and bad. And I think that if I were coming out of PT school right now, it's not the latest and greatest social media course or marketing course or branding course. You could easily do those via YouTube. I mean, and obviously, you know, but it's really about what are your strengths? We talked about this at the women in PT summit. You need to play to your strengths. Like I like to problem solve. That's one of my strengths and so I would suggest anybody coming out of PT school, do a deep dive into what your strengths are, there's many StrengthFinders is a great one. I would really do a deep dive into looking at what your strengths are and play off of those. Get really good at those and you will find ways to apply those in physical therapy. Karen Litzy (16:36): Fabulous. And where can people find you? Erica Meloe (16:38): Oh gosh. Online. We've got an Ericameloe.com my velocityphysiony.com and I'm in New York city right across from Bloomingdale's and all my Facebook, Twitter, Ericameloe. My podcast with my wonderful cohost, Susan Clinton. Tough to treat. And my book, Why do I hurt? Discover the surprising connections that caused physical pain and what to do about them. That's on Amazon, Barnes and noble Karen Litzy (16:50): Awesome. And just so everyone knows, we will have links to all of Erica's information under this episode at podcast.healthywealthysmart.com so Erica, thank you so much. Thanks so much for listening and 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!

Keaton Ray and Scott McAfee, co-founders of MovementX, are on a mission to revolutionize physical therapy. They discuss the importance of effective communication in partnerships and how identifying team strengths can drive success. The pair share their journey in healthcare innovation and the concept of the '11-star experience' for patients. Emphasizing the power of vulnerability, they reveal how authenticity can foster a supportive company culture. Tune in for insights on aligning passion with purpose in business!

LIVE on the Healthy, Wealthy and Smart Podcast Facebook page, I welcome Chris Napier on the show to discuss the science of running.  Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia. In this episode, we discuss: -How to bring a wearable to market for running retraining and injury risk reduction -What to look for when investing in wearable technology -The importance of translating the research to both the clinician and athlete -Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training -And so much more! Resources: Science of Running: Analyze your Technique, Prevent Injury, Revolutionize your Training Chris Napier Twitter Email: chris.napier@ubc.ca Chris Napier Research Gate   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 Chris: Chris Napier is a Sport Physiotherapist with a PhD in running biomechanics and injury prevention. He has an appointment as Clinical Assistant Professor in the Department of Physical Therapy at the University of British Columbia. In addition to working on research projects, Chris continues to be a practicing physiotherapist with Restore Physiotherapy and Athletics Canada. He has competed at the national level as a successful middle-distance runner, earning medals at the Canadian Track & Field Championships in 1996 and 1997. He is also an accomplished marathon runner with a personal best time of 2 hours, 33 mins.     Read the full transcript below: Karen Litzy:                   00:01                So welcome everyone. So for those of you who are watching live, thank you so much for taking the time out of your day and coming on to watch and learn. Oh good. I'm just making sure that it works. So I just had to check on my iPad to make sure we're live and we are. So thanks so much for taking the time out. As we go along. I may ask you just to kind of write in the comment section where you're listening from. If you have any questions, by all means, definitely, definitely ask. Now is your chance, I'm sitting here with Dr Chris Napier. He is an expert. He is a new author. We'll be talking about his book, the science of running in just a little bit, but Chris, just to kind of allow people to get to know you a little bit more. Why don't you kind of give the listeners and the viewers here a little bit more about you. Chris Napier:                 01:05                Sure. well thanks again for having me on Karen. I feel like I've really made it big time. Now. I'm on the Karen Litzy podcast. It's huge. So thanks again for having me on. So I'm a sport physiotherapist. I've been practicing for almost 20 years now. And, I've worked with a range of sports. But I sort of ended up coming back to the sport I'm most passionate about. The one I love which is running. About 10 years ago I started really focusing more on running and it was basically because I'm a runner myself. Out in the community running with the various sort of recreational races training with different clubs and so then and talking to people who are running all the time. So it really sort of just made sense for me to kind of work a bit more clinically in that field. Chris Napier:                 02:00                And at the same time I was getting interested in pursuing more research. And so I started my PhD in about 2012, 2013. And I focused on running and I was really interested in being able to quantify aspects of running in terms of running form and biomechanics. So my PhD was on running biomechanics and sort of clinical interventions using gait retraining to prevent injury. And so I finished that in 2018 and I've moved now more out of the lab so to speak out of the biomechanics lab but still interested very much in the mechanics of how we run. And I'm now working with a group of engineers at Simon Fraser university doing my postdoctoral fellowship there where they actually develop a wearable. And so we're doing some really cool stuff there in terms of actually developing potentially products that will be available to clinicians and to runners to measure their gait. Karen Litzy:                   03:13                Very cool. And I will also add that you are sort of at the helm of the third annual world conference of sport physiotherapy in Vancouver this year. It was an amazing event. You and the team you guys did such an amazing job and I'm sure that's the feedback that you've have probably got from the conference, from the people who attended. So I just wanted to give you guys some more accolades and a nice shout out cause it was a really, really well run conference with some great info. Chris Napier:                 03:48                Yeah, that is the feedback we've had, which was fantastic to hear from across the board. And, I'm really looking forward to our continued support for your therapy candidate conferences, which will be a biannual event and as well the next world Congress, which will be excellent, I'm sure as it's being hosted in Denmark. Karen Litzy:                   04:08                Yeah. Yeah. That'll be fun. And that's in 2021. So that'll be a good time. And again, if you're watching live, I know I saw a couple of viewers watching live at the end of this, hopefully we're going to give away Chris's book. It doesn't come out until February 4th, but if you write your name or a comment or where you're watching from in the comment section, you're automatically in the running for a free copy of the science of running by Chris Napier, which is very exciting. So Chris, let's talk about wearables. So when I think of wearables, to me it makes me think of like a Fitbit or maybe an Apple watch or something like that. So in your introduction, you'd said that you're working with a lab as a postdoc. So when you say wearables, is that what you mean or are you talking about something else? Chris Napier:                 05:11                Yeah, so I mean a wearable is really a broad category. And you know, for anyone who follows the consumer electronics show, which was just recently in Las Vegas you know, I think that area is huge right now across the board. And, we think of it very much in the health lens. But really a wearable, wearables, anything you can wear on your body that tracks something whether it's, you know, your heart rate or your breathing rate or your pulse or your blood pressure or skin temperature or joint angles, impact forces. I mean, it goes on and on. Really anything we can measure through something we can wear. So, you know, by nature it's something that's portable often, you know, connect with some sort of app either on a Bluetooth device or we'll sort of record onto the actual hardware itself or download later. Chris Napier:                 06:15                But you know, that's the other side of it is, you know, beyond the wearable, the actual interpretation of the data and the visualization of that and that sort of thing. That's a whole other field as well. But the lab I'm in is looking at wearables that can measure health-related metrics. And so some of the projects we have going on there are looking at recovery from stroke or looking at you know, more fine motor function, that sort of thing. And my area specifically is looking at an application to running. Karen Litzy:                   06:53                And so when, you know, I think about application to running and you think about, you know, perhaps using a wearable to enhance someone's running, whether it be their running gait, their endurance, their times. And what I think of right off the bat is a running analysis where you've got someone on a treadmill and you've got multiple cameras and they've got dots all over them and all their joints, which is not something that every clinic has the ability to do because those setups can be quite expensive. So what are you doing within your research that might be a little different and offer clinicians something that might be more practical? Chris Napier:                 07:40                Yeah, so what you described there that sort of motion capture 3d motion capture analysis which is sometimes done on an instrument, a treadmill, which will give you force information as well as the joint position movements. But that was my PhD. So that's what I did. I looked at basically a snapshot of people running and then assume that that's how they ran when they left the lab. Which is a big assumption, right? And so what we're doing is we're trying to get those same measurements but in something that can be worn outside of the lab and in the natural environment which gives us it opens a whole other world to what we can measure. We can measure things where, you know, rather than on a treadmill, which might be unnatural for a lot of people, we can measure them running on the road or through trails or uphill or downhill. Chris Napier:                 08:40                We can measure how their mechanics changed throughout the course of a run. You know, so we can see what happened when they start to get fatigued. We can measure in a race situation you know, when people perhaps run differently cause they're pushing themselves to their limits. And we can also measure over time, over a weeks or training blocks so we can see what happens to people's mechanics. As a more chronic sort of fatigue sets in. So there's a lot of stuff that we can study. And, in our lab we have sort of the ability to embed some of these wearables into garments. And so essentially we're developing smart garments. And we published a recent paper looking at using a set of running plates to measure hip, knee and ankle kinematics during running. And, we developed this and I think it compared to the gold standard, which is still the three D motion capture and these tights do very well at measuring that movement. Which is exciting cause then, you know, we can start to produce these and runners can start collecting data wherever they run. Karen Litzy:                   10:01                Yeah. Which obviously seems a little bit more practical than, like you said, just being on a treadmill. We know running on a treadmill is definitely different than running on the road or the track or real life situations. And is that something that a, let's say your average physical therapist practicing PT like myself, if someone comes to me with a running related injury and I mean, I don't have access to a three D running analysis, is this something that I would be able to say to this potential patient he lives in? I have some wearable technology that you can use that might give us a better picture as to what's happening when you're running. Chris Napier:                 10:49                Yeah, I mean, we're not there yet, but that's certainly where we're going. So, you know, I guess potentially we could, we could put this pair of tights on a runner and we could track their hip, knee and ankle kinematics while they run either on the treadmill in the clinic or we could send them outside and have them go for a run and come back. And or you know, these could be something that the clinic can loan out or rent out and maybe patients keep them for a week so we can track their running mechanics over the course of a week. And then that could potentially be uploaded to a cloud or brought back to the clinic and downloaded so that you can look at their data over time. And what we're using our strain sensors to be able to measure kinematics. Karen Litzy:                   11:38                And what does that mean? What's a strain sensor? Chris Napier:                 11:40                Well, essentially these are thread like sensors that the amount of strain produced can give us an idea of how much movement is occurring. Karen Litzy:                   11:52                That's sort sewn into the fabric. Chris Napier:                 11:54                Exactly. And we've done, you know, a lot of the research we do is looking at where we need to place these and how many sensors we need and that sort of thing. And so that was the big work sorta involved in developing these tights is to figure out how many, you know, can we get away with just having three or four sensors which reduces the you know, the cost of energy and also the amount of processing involved and where can we put those to optimize you know, the metrics we're looking at. But you can also then add inertial measurement units or I am use which have accelerometers and gyroscopes in them, which can then add a whole other layer so we can look at you know, impact. We can look at angular philosophy and things like that. So, you know, we're looking at integrating those things right now as well. Karen Litzy:                   12:53                And all of that can be so knit fabric of a pair of tights. Chris Napier:                 12:57                Yeah, yeah. We're talking about pretty small. Karen Litzy:                   13:01                That's wild. And so, you know, you did a study kind of taking these tights and looking at, well, how many sensors do we need and where do they need to be placed? And was this sort of a preliminary study, cause I can understand the need for knowing how many sensors you need and where to place them and then kind of recruiting a larger amount of runners to kind of study to see does this do what it says it's going to do it in a nutshell. So right now, just so that the viewer isn't, so that I myself get a better idea. So right now you're sort of in that developmental stage where you're looking at where to place them and how many, and do they work? Chris Napier:                 13:48                Yeah, we've done that. So basically this study was that, so we were happy with where they are and the number for what we want to measure. And so now what we're doing is can we use these to give us information about you know, the fatigue state that runners are in. So, you know, when we're getting into machine learning and that sort of thing as well with this. So you know, can we classify a runner as being fatigued or not? For instance, based on the information we're getting from these tights or, you know, and then as I said before, like, can we get these out now and actually get people using them so we can start collecting large data sets. You know, that's where it gets interesting. Can we get these out to hundreds and thousands of people to be able to start collecting data on those numbers and really start to refine the technology and perhaps see some interesting patterns. Chris Napier:                 14:49                And you know, there's some of the studies coming out of refurbish lab in Calgary have been doing that. They use the now defunct Lumo device, which I am used situated on the waste. And they've done some really interesting work with Christine Claremont leading that and Learn Benson looking at sort of classifying situations or types of runners based on the data they've gotten from those devices. So we'd be looking at maybe doing some similar work with ours. Karen Litzy:                   15:30                Yeah, I mean, very cool. And, I guess the next question is why should we care? So as physical therapists or even as runners, like, yes, this technology is cool, it has the potential to give us a lot of data and a lot of information, but why do we care about that? Chris Napier:                 15:54                Yeah, exactly. So, you know, I think first of all, we have to figure out, is this going to give us information? That is I think we can be happy that it would be reliable, but really we're looking at the validity. Are we getting information where we're going to see patterns that lead to injury. And that's again, that's kind of where we're going with this. But at this point we can't say that that's where we need those large numbers. And hopefully I think that's what we will find is that we can kind of see trends. I mean, there may be a time where, you know, these are sold in running stores and people just wear them and then, you know, they get injured and they come in and say, Hey, yeah, here's my data. Chris Napier:                 16:41                Check it out and, you know, see if you can figure out why I got injured. You know, maybe we'll get to that point. But I think for now it offers the clinician a chance to be able to analyze someone's running gait. So you get that kind of objective information. And then maybe they can use that over sort of repeated visits if they're looking at trying to retrain someone's gait or if they're looking for you know, some changes due to the intervention that they're applying, whether it's strengthening or gait retraining or something else. So I think that it gives us another tool really to measure something dynamically that, you know, until now we could only really do in a specialized biomechanics lab, which as he said, is very expensive and time consuming and really maybe only giving us a snapshot. Karen Litzy:                   17:40                Right. Right. Versus being able to see the bigger picture of a runner. Yeah. Yeah. Very cool. Chris Napier:                 17:49                And also, you know, maybe some of the work I'm doing is looking at monitoring, training load and you know, if you're kind of familiar with the training load research there's this sort of concept of internal and external load. And you know, the external load might be the number of kilometers or miles that you run in a week or the number of minutes that you run in a week. And the internal load would be some sort of intensity measure or rate of perceived exertion. And so, you know, my interest is, can we get a bit more specific perhaps about that external load. So we're not just looking at minutes or miles, but we're looking at you know, cumulative impact and that actually got a paper in review right now where we looked at that using the run scribe sensors, which are little pods you put on your laces on your shoes and they can measure shock, which is sort of a result of impact force results in acceleration when you hit the ground. Chris Napier:                 18:56                And we looked at whether there's a difference between looking at just a cumulative minutes, you know, run versus number of steps versus cumulative shock. And we found differences and with the cumulative shock we're going to know a deeper analysis. I'm not sure where we're looking for, are there changes depending on the type of run that the person did. So is it more specific measure? When someone is changing the terrain they're running on or changing their intensity on a regular basis? If someone goes and runs the same route every day at the same pace, then we're probably not going to get more information by a cumulative shock. But if they're running in trails one day and roads the next day and then they're doing interval workout or then they're doing a long run we might get more information out of cumulative shock or some similar measure as opposed to just the minutes or miles that they run. Karen Litzy:                   19:56                Right. Yeah. So just adding another element to, again, the overall picture of that runner. So like for example, like you said, you could have someone who says, Oh, I ran, I run 10 miles, I'm just making this up 10 miles every week and I haven't changed how many miles I run. But yet they're coming to see you for patellofemoral pain. Or maybe they're coming to see you with anterior shin pain. But what you're not getting is, well, I run the same amount, but this time I did on a trail and this time I did it on concrete and this was on a rubberized track or something like that. So I would assume that with that shock, you would be able to kind of see the difference and then as a therapist say, Hey, I don't want you to stop running, but maybe let's stop doing X, Y, Z. Chris Napier:                 20:52                Yeah. It allows us not only to look at what has happened, but also to prescribe in the future. Right. So potentially we can then say, okay, we need to keep that cumulative shock below a certain level or, you know, increase it gradually. And so if that's something that they can monitor on their own outside the clinic. Great. and I've done that a little bit with some people just more experimentally at the moment. But I've had people who are really interested in sort of tracking that. They've done that and it's actually been quite successful so far. Karen Litzy:                   21:24                Yeah, no, it sounds very reasonable to me as a therapist and certainly as I would think for the runner because, you know, oftentimes when runners get injured and first of all, they're told to not run. That doesn't go over very well. Chris Napier:                 21:42                No, no. Karen Litzy:                   21:46                And it's also not just the running, but it's part of stress-relief. It's part of what makes them happy. And so to be able to say, Hey, listen, we're collecting all this data on you and this is what we found. This is what you can do. I feel like it gives control back to the patient or to the runner so that we're not spinning. Right. Chris Napier:                 22:07                Yeah. There was a great paper just published last month that essentially looked at what their runners do when they can't run. Right. So if they're injured and they can't run, what do they do? And the answer was, Oh no, they didn't do other activities. They just say they just want to run. And that sort of, I think validated your feelings. You know, when you talk about cross training and, you know, go get on the bike or go on a full run or a swim. But I mean, the greatest thing about running is you can put on some running shoes and head out the door and you can fit it in anywhere, anytime. So it becomes much harder to fit in that exercise when you have to go to a pool or go to a gym, get it done. Karen Litzy:                   22:51                Yeah. And then I would think it must be even harder for some, not all, but some runners to get back to running after an injury. You know, there's fear involved there. They don't want to get injured again. They may sort of taper back to the point where maybe now they're not even happy with their running. Chris Napier:                 23:16                Yup. Yeah. And often, you know, we prescribed like a walk run program to get someone back in because it's sort of graded impacts. Right. So again, looking at that key middle of shock is what we're trying to do there is gradually someone back in to doing that. Even if they've kept the fitness even if they have been on the bike or something like that when you get back after prolonged period off of running, it's still, it can hurt, right. Of the impacts you don't get in other activities. And so again, that's where, if we can measure that and monitor it, I think that's a big advantage. Karen Litzy:                   23:53                Absolutely. Now before we get to the book, which I want to get to in a second, are there any other cool tech things when it comes to runners that may be you've worked with or that you've seen? Maybe not, you know, in the lab that you are in, but that might be coming down the pipeline that we can as runners or as healthcare providers we can kind of get excited about. And the answer might be a lot, but you can just pick. Chris Napier:                 24:26                Let's say a lot of the kind of more research grade or maybe not a lot, but some of the more research grade companies are starting to shift I think a bit more to a clinician or consumer level products. And one reason for that is the hardware is just getting cheaper. So, it's possible. And then also I think you know, the ability to fit these into or integrate these into apps where you have the visualization side and you can actually easy interpretation of the data. I think that's you know, we're going to start to see more and more of these devices available in clinical settings and consumer settings. And I think one that comes to mind is I measure you, is basically an IMU inertial measurement unit that now owned by VI con, but you know, they're starting to I think offer products that are a bit more clinician friendly where you can get real time feedback. Chris Napier:                 25:40                You can stop these on someone's tibia and have them run in the clinic and get some real time feedback and visualize it and give feedback if they're reaching certain thresholds. So if you're trying to keep them and you're trying to get them to run softly, for instance, you can get them to run. And this'll give you feedback when they're going over a certain threshold. Another, a Vancouver based company that I'm doing some research with. It's called plant Tika. This is actually their product here. It's just an insole. So you can just pop this into your shoe lacing. So on your shoe and in the bottom of it, I don't know if you can see here, but there's an IMU here. So it's very thin. Obviously it fits right into the insole and you don't really feel it when you're in there. Chris Napier:                 26:30                But it's a very strong piece of hardware and you can pop that into your shoe. And I say, well, that it's actually measuring that it measuring accelerations so it's got an accelerometer, but it's measuring that impact at that point where it's hitting your body so it's right underneath your heel. You know, and so we're doing some interesting work where we're looking at different footwear and how that changes the impact at that point, because today a lot of the research is using ground reaction forces, which are measured underneath the shoe, right? That's the shoe round interaction. Or they're using to bill accelerometers, which are, you know, measuring that force once it's gone through the foot and the ankle complex and is reaching the tibia. Karen Litzy:                   27:21                Some of those courses have already been disordered right through the ankle or through the shoe. Chris Napier:                 27:30                Yeah. So this is a cool tool and I think they're really keen to start using this. They're targeting clinicians because I think this is an easy one that you know what, I'm using it in the clinic right now where people come in. And when we did the gait analysis, I just slipped these into their shoes and just cause it's that much more information. It visualizes asymmetries really nicely as well. And, and they're also looking at beyond running. They're looking at you know, ACL rehab and that sort of thing as well. Karen Litzy:                   28:02                And are there any things you can think of that let's say your average physical therapist needs to watch out for? Right. So you have a lot of, cause I know you had mentioned more research based consumer products. I'm assuming that there are products out there that might not be the best things that we as consumers, you know, without naming names obviously, but things that we look at when we're looking at a company that's selling one of these like wearables and what their claims are. Chris Napier:                 28:35                Yeah. So I think first of all, the hardware has to be good. And when I say that, I mean you need to have a high enough sampling rate to be able to measure what you want to measure. So, you know if you have an accelerometer, that's a sampling it 60 Hertz for instance. If you're trying to, we capture that and you're gonna miss peaks of data and steps. And so it's just not going to be something that's reliable. You know, if you're measuring it at up at the waist crowds, then it's okay because we don't need high as high frequencies at the waist. So no for that we need to how you need to have a product that can sample at a high enough rate and there's papers out there that have looked at that, you know for kinetic and kinematic information, that sort of minimum requirement you would need. Karen Litzy:                   29:36                And what would that be? Do you know, off the top? Chris Napier:                 29:38                Perfectly genetic information and it's about a, you need like 500 Hertz for it could be more like 200 Hertz, you know, for the kinetics is going to depend on the placement for sure. But typically you want to aim for something that's about 500 Hertz, you know, a lot of consumer level products wouldn't have. Chris Napier:                 30:00                And then also something like the dynamic range would be important. And that's just essentially how many Gs they can measure. And so if your using a something that only measures up to 10 G then when you put that on your shoe and you're trying to, and, and there's impacts that are up around 20 G, then you're really not going to be capturing sleep. Right. It's missing that information again. So that, I mean, that's something to be wary of thought of it outside of the hardware would be looking at the output you get. And so some of these outputs you get are very general. You know, typically you'll have like a, you know, I put on my Garmin watch and go for a run and at the end of it it tells me I need to rest for, you know, 36 hours before my next effort or something like that. Chris Napier:                 31:00                And you know, I never really sort of regard that it doesn't really doesn't make sense. I can interpret that much better myself than relying on my watch. It also spits out a bunch of other metrics. You know, some of them might be useful. Others I would just sort of disregard and I think that's where, you know, probably clinical decision making comes into it. And having a knowledge of the activity and the person in front of you don't overly reliant on just sort of what the metric is outputting. Karen Litzy:                   31:40                So if you have, let's say a certain wearable on and it gives you again, making something up like 10 different kinds of outputs. I don't even know if that's possible, but you want to kind of take, is it sort of like you're taking what you need as it relates to what the patient's going through? Or are you buying something that says, Oh, it can give me all this information, so I'm just going to use all of it. Chris Napier:                 32:11                So, I mean, someone like me, I like raw data because I can play around with it and I can plug it into things. I can graph it and I can do whatever I want. And it's that raw data is, you know, the highest frequency and so the best data I can get, so that's what I want. But most clinicians don't want that because they won't know what to do with that data. Right. So it's gotta be processed somehow. And so that processing you can lose data and you can lose focus and you can have misinterpretations along the way. And so it can be something is it can be processed down to the point of where something might give you an efficiency score, right. Which is, you know, unit and listen in essentially meaningless where it says, you know, your efficiency on that run was good, average or bad. Chris Napier:                 33:08                Yeah. I mean that's something completely processed down to the end where it gives you this kind of, you know three categories. I mean, what does that really tell you? Probably not, or it could be somewhere in between. And so I think that's the hardest part here. And you know, what would be appropriate for a clinician isn't necessarily going to be appropriate for a consumer. So I think again, we're going to start to see products that are aimed more at clinicians and at more consumers as the hardware gets cheaper and more widely available and people are going to kind of sort through and find things that work for them. Karen Litzy:                   33:52                Right? Yeah. So I guess it's when it comes to the output, it's kind of like food. You don't want things to be overly processed it’s not good for you. Okay. Cool. Well now let's get to the book. So I'm just going to read. So the book again for people watching the book is called the science of running and it will be available on February 4th, but you can go to anywhere books are sold, Amazon or what have you and you can preorder. But I'm just going to read a quick description. I won't read the whole thing, but I'll read a quick description. Science of running goes further than any other running book to intergrate the anatomy. And physiology of the runner showing how running in walls and affects every system of the body, including the effect of oxygen on the muscles. The book breaks down the runner's stride, scientifically showing what's going on under the skin at every stage of the running cycle. Highlighting common injury risk based on a readers natural gait and showing how to correct them, takes a head to toe approach to 30 key exercises for runners, annotating the muscles, ligaments and joints involved, and showing how to perfect precision in those exercises to optimize their benefits. Sounds great. Chris Napier:                 35:12                I could have used more time. Karen Litzy:                   35:15                He probably did that in a weekend, but I mean, this is a very involved book. It's not like just a pamphlet. Chris Napier:                 35:24                No, no, it, it was a lot of work. I won't deny that. And it was a really interesting process for me. Essentially it's like what we just talked about sort of bullying down that kind of raw data or the raw science and being able to filter down to a level that's interpretable by kind of the general public or the, you know, the average runner. Cause that's essentially what this is. It's a handbook for runners about their bodies, right? Karen Litzy:                   35:55                So this is for the average person runner and for the clinician, right? So not like overly overly technical, but technically simplified. Chris Napier:                 36:08                Exactly. I mean it's not simple. There's a lot of information in there, right. And we've done our best you know, with the artwork and that sort of thing to be able to explain the science behind all of this. But there's a lot of information in there. I mean, it's not a textbook. And it's not an academic book, but it's very much for runners and clinicians, I think to have on hand. You know, whether it's in a clinical context, if you want to be able to explain, you know, an injury to a runner or you know, explain what you mean by you know, what's happening during running stride. There's a lot of you know, artwork and chunks of text in there that can kind of help to explain that. And for the average runner, I think it's sort of something that they can keep on hand and use you know, if they're training for a race or just in general or something to kind of, you know, refer back to over, over and over again. And there's also a whole chapter full of training plans. It was co-written by my coach Jerry Zack and again, that's a very comprehensive chapter there. Karen Litzy:                   37:31                Fabulous. And so I'm going to say it again, so for the people that are watching if you leave a comment or a reaction, you're automatically in the running to win a copy of this book. So please, you know, give a thumbs up or a heart or throw in and whatever like where are your lists, where you're watching from or listening in from. Because we'll pick a winner and I'll contact you when we're done with the interview and everything. But so when you talk about a book like this is there ever sort of misinterpretation of by someone to say, Oh, it's a book on how not to get injured when you run? This is a book on preventing injuries? Chris Napier:                 38:22                Yeah, I mean, yeah, I mean for anyone familiar with the research on running injuries, that's a pretty murky field at best anyway. I think what I tried to do in this book was present what the research does tell us and kind of show, you know, let's take foot strike for instance. Cause everyone knows about, you know, foot strike pattern and you know, we talked about, okay, what happens when you were first strike? What happens when you forefoot strike? And rather than taking the approach that one is inherently bad and we'll give you an injury we talk about, you know, how they affect your stride and where those forces go and that sort of thing. To be able to educate the runner on that rather than talk about, you know, this particular way of running will prevent injury. There's also a large section we've got about 30 different strengthening exercises in the book where you can you know, go through and again, it's a little visualize with artwork showing different stages of the exercises on specific running, strengthening exercises that you can do in the gym or at home. Karen Litzy:                   39:42                Awesome. Well, it sounds like it's a great resource for clinicians and the runner alike and are you going to, after doing this, and this was, I'm sure an arduous task that took quite a while. Are you going to write a followup in the works or are you like, Oh my God, let's publish this book. Chris Napier:                 40:02                I haven't really even opened this book yet. I got it. About three weeks ago, and I don't think I might've just opened at once to kind of flip through very briefly. So at this point I'm ready just to kind of keep it on the shelf and see what happens. But no, nothing in the works right now. I'm focusing on some other things right now and if that opportunity comes up, you know, down the line then perhaps a look at that then, but this was a very interesting process to go through. I have no regrets. I think it's pretty cool to see, you know. But I think I'll take a little break for awhile now. Karen Litzy:                   40:47                I get it. For you, as now an author, what was the best part of writing this book for you? Might've been like, as a person, as a clinician, as a researcher, what was like the big positive for you? Chris Napier:                 41:03                You know, in research we're always talking about knowledge translation, right? You have to kind of get that research to the end user. And how you do that. It's often very difficult for research. This gave me a lot of tools I think in my own field of how to get that research to the end user, whether it's a clinician or a runner themselves. So that's been really useful. Also I think working in the clinic it made me really think about what are the exercises I think are most valuable or what is the most useful thing that a clinician would get out of this book? You know, I'm often sort of pulling out a textbook to try and explain something to a patient who is in the clinic because they've got an injury and I'm talking about too much too soon or some of that. And I want to graphic where I can say, look, this is why too much, too soon is bad, or this is why, you know, running the way you're running might've led to this injury. And I'm often sort of ending up doing Stickman drawings or something to try and illustrate. Karen Litzy:                   42:14                Well we all do that. Chris Napier:                 42:16                Which is fine. But you know, this gives me a resource and hopefully others a resource in the clinic to be able to sort of say here like this is what I'm talking about and here's a nice sort of visualization and in some kind of bullet points as to what I'm talking about. Karen Litzy:                   42:34                Yeah. That's great. So I feel like it, to me it sounds like it's made you maybe a little more present, a little more thoughtful about what you're doing with runners and why you're doing it. Great. And I'm assuming that's also the goal of the book is have people be a little bit more present, understand the way their body works. This is for the runner, the way their body works and why they're doing what they're doing. And for the clinician may be taking a larger analytical view in as to the person in front of them, the runner in front of them, and maybe why they're getting the injuries that they're getting. And some options on how to rectify that situation. Chris Napier:                 43:16                Yeah, I mean, I think runners, runners are typically type a people, right? And they, you know, they get really into running and they want to know more and they want to learn like, okay, what's you should I have and what's, you know, what's the best way to run and what's the best way to train? And you know, so they're on Google and they're trying to get all this information. There's tons of conflicting information out there. Even from, you know, some of the top sources, right. Sort of the top sources for that. So again, hopefully this is something that kind of boils it down. It's very evidence-based and something that runners can rely on as a resource for all things running. Karen Litzy:                   44:01                Sounds great. Now listen, before we wrap things up, I have one last question. It's one that I ask everyone and that's knowing where you are now in your life and in your career. What advice would you give to yourself as a new grad right out of physio school? Chris Napier:                 44:18                So I would right out of physio school, I think just get your hands dirty and see patients, try and get lots of different experiences. If you're interested in sports, volunteer with teams. You know, don't expect payment right away for those things. Get out and work with people and put in the time and you'll learn a lot and those will turn into opportunities in the future. I think getting out and I'm not saying no to things is a big, big thing. And I think that's how I kinda got involved in working with professionals and sort of national team athletics. It's because basically one opportunity led to another. And I didn't say no along the way and so it just, you know one thing snowballed into the next thing. So I think you know, that's probably my advice. Just get out, start getting your hands dirty and get the practical experience and don't say no. Karen Litzy:                   45:26                Awesome, great advice. Now, where can people find you if they have questions and they want to find more info about you and about the book, where can they find you? Chris Napier:                 45:35                Well, the best place is on Twitter. I'm fairly active on Twitter and they can find me @runnerphysio on Twitter and they can contact me through that. Also if people have, you know, wanting to access any of my papers, that sort of thing. They can reach me through my email address which is Chris.Napier@UBC.ca. I'm happy to send along papers or if you have any sort of specific questions, I'm happy to answer them if I can. Karen Litzy:                   46:07                Awesome. And what we'll do is when this broadcast ends, I'll go back in and I'll put a link to your Twitter and to some of the papers that we spoke about today and a link to the book. So people want to preorder the book, go for it. For all the people who are on and who had some reactions or comments. I will pick a winner for someone to win Chris's book and you'll be hearing from me. I'll get in touch with you via Facebook. So, Chris, thank you so much for taking the time out and coming on to do a live and then it'll be on the podcast as well but to do a Facebook live. So thank you. Chris Napier:                 46:45                Well, thank you. I've enjoyed it. It's been a good chat and thank you also for all your work in the lead up to the world Congress with all your Facebook live interviews with a lot of our speakers. Cause that was really great to be part of that. Karen Litzy:                   47:02                Yeah, that was my pleasure. It was great. So everyone who's on and watching. Thank you so much and 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, I welcome TaVona Denise on the show to discuss burnout in physical therapy.  Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, “success is 80% mental, 20% skill.” With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world. In this episode, we discuss: -Burnout in physical therapy and the tools you need to take the next steps in your career -Why a gratitude practice can help shift your mindset and elevate your to-do list -The importance of a coach that can identify your blind spots and keep you accountable -How to channel your fears and build confidence so you can tackle your biggest goals -And so much more!   Resources: TaVona Denise LinkedIn TaVona Denise Facebook TaVona Denise Twitter TaVona Denise Instagram TaVona Denise Website   A big thank you to Net Health for sponsoring this episode!  Check out Net Health's 4 Ways to Increase Patient Engagement!   For more information on TaVona: Atlanta-based business accelerator, success coach and avid cyclist, TaVona Denise lives and breathes by the motto, “success is 80% mental, 20% skill.” With certifications in life, weight and wellness coaching, her specialty is helping new entrepreneurs get past fear and overwhelm, get their business up and running, so they can help change the world.   Shortly after finishing college she started her first two businesses, but found herself burned out because they were not using her gifts. TaVona then used her skills as a physical therapist to start a physical therapy contracting company. Finally her own boss, the problem was, she basically created a job for herself, which was not the life she had envisioned.   It wasn’t until TaVona found the world of coaching, that she was not only able to successfully lose 80 pounds and keep it off, become an award-winning athlete, and build the business that would eventually provide the lifestyle she wanted.   Speaker and author of, Unstoppable Success: How to Finally Create the Body, Business and Lifestyle You Want, TaVona teaches entrepreneurs the steps she used to create lasting success as a lifestyle, in weight loss and in business. She believes there would be less addiction in the world if people were courageous enough to walk in their purpose. She is on a mission to help people find their zone of genius and make money by making a difference.   Read the full transcript below: Karen Litzy:                   00:01                Hey TaVona, welcome to the podcast. I am so happy to be interviewing you live here in Nashville, Tennessee at Graham session. So welcome to the podcast. TaVona Denise:             00:10                Thank you for having me. Karen, I'm so excited to be here and to be speaking with you today. Karen Litzy:                   00:15                Yeah, and I'm excited to have you because what we're going to talk about today is when a therapist, we'll stick to physical therapy, but this really could probably apply to most people in healthcare, let's say. But we'll stick with physical therapists because that's what we are. That's what we know. And we're going to talk about when, as a physical therapist, you kind of hit that crossroads in your career where you're not sure if what you're doing is what you want to continue to do. So TaVona, yourself as a physical therapist and as a coach, I'm sure you've seen this quite a bit. So can you talk to when therapists get to that crossroads and what you've learned from interviewing over a hundred different therapists? TaVona Denise:             01:03                Yeah. Well, it's a fascinating thing. I started to notice whenever I would remember to ask somebody, like, what year, how many years have you been in the game? What's going on with you? When they're coming to me for life coaching and they're thinking about making a change. The number 15 kept coming up. Every time I would write it down, they're like, yeah, I'm at year 15 I don't know if I was attracting them because that's about when I started to feel like, okay, I've been doing this 15 years. I know my job inside and out, backwards and forward, and I don't think I can do this for the rest of my life. And at that time I wasn't even 40 so I have plenty more work, work years left and I can't keep doing it. And so I just find that, especially for the women, either it's 15 years if they've gone straight through and sometimes it stretches to 20 if they have gone back into part time to rear their children. Karen Litzy:                   01:56                Okay. And in talking with all of these therapists, have you found any common themes that they get to this 15 to 20 year Mark? And they're like, Ugh, now what? TaVona Denise:             02:09                Well, that's exactly what they say. It's like, now what? I know my job, I don't necessarily want to keep practicing in this way. I feel stuck. I don't know what to do next. And part of the problem is they do not have a passion for research, academia or management. And so many of them are thinking, well, should I leave the profession? And if so, what does that look like? What does that mean? Am I throwing my degree away? And so what are the options? There are several. I think one of the things that we have to do is take a look at, well, why did you get into the profession in the first place? And can you reconnect with that? Are there aspects outside of what you're doing that you can bring into what you do now to help judge it up and renew it? To me, some people have reinvented themselves and said, okay, well maybe I don't necessarily want to stay on the rehabilitation side, but maybe I want to practice prevention and wellness. So I think for some people that's an easier transition because they get the sense of I continue to use my degree and leverage it to do something that still helps people. Karen Litzy:                   03:20                And if let's say I'm coming to you and I'm saying, Oh TaVona I just, I don't know what to do, I'm really stuck. I'm getting, you know, I'm starting to feel like I'm not making a difference anymore. So how would you, we can kind of go through a mock coaching session here. So what are some things that maybe you would want to ask me or want to know from me that maybe can help me figure out what to do next or what's your process like? TaVona Denise:             03:51                It really, really depends. Just like in an evaluation situation, like no two people are alike. So it depends on how they present, how they come to me. But I really want to know what do they enjoy at their job and what do they enjoy as a person working in a profession. Because sometimes there's an opportunity for a person to create a position for themselves or to create a program. And some of the clients that I've worked with have become what I call intrepreneurs. They have taken their skills, their expertise, their specialties, and then develop programs within the organizations that they work in, which it's a challenge. It's not as risky as being an entrepreneur and going off and doing it for themselves. They get to stay in that environment and not lose the years of service and PTO and all the perks and things. It's kind of like playing with the house's money so they get to do that. Sometimes it's a matter of just feeding the hobbies and things and taking time for themselves that they're not doing. Because we always hear the analogy of you have to put your own mask on first before you serve others. And so as caregivers, that's what we do. We care for others and sometimes we are forgetting to care for ourselves. So sometimes that's the approach we take. I find a lot of people, and this is also a strange one that I'm thinking about. A lot of people need to declutter their homes. Karen Litzy:                   05:14                Yes. 100% yes. I'm just going to say yes to that. I'm Marie Kondo in my home like five years ago and I have to tell you, decluttering my home kind of decluttered everything else for me, even part my practice and my thought process and I was able to then expand and do things that I couldn't even imagine were possible. So proceed. TaVona Denise:             05:42                Yes, 100% it was interesting, I listened to a coach that specialized in a relationship. It was one time and she was like, you need to make space in your closet for the person that you want to come in and so if your closet is jam packed. There's no room for anybody else. And I think about that too. Now that we're talking about this, the decluttering process I think gives people space, like you said, expand space to think, to breathe. So that, that like every time they pulled into the garage and they see all the boxes in the junk, it's irritating them. And so that's just one more thing. If they can declutter that, that's something that they have control over where it doesn't have to do with the manager sucks, the coworker sucks, the patient's suck and all of this thing, we've got to go to all these meetings, we don't like you can control your space. So I think that's part of the empowerment process and having them have a sense of control over their lives and looking at how we do anything is how we do everything. TaVona Denise:             06:32                Yup. And so once we take a look at that, then they can use the skills that they learned to, to go into other things. And it really goes into thought process too. So a lot of people are holding on to things that they shouldn't be. It's beliefs that they shouldn't. Stories that they shouldn't, grudges that they shouldn't. And we literally unpack that stuff as they start to declutter their homes. And I also found that when I decluttered my home, I mean I have a garage, but when I decluttered my home, when I would come home after a busy day of seeing patients, I was coming home to a space that was calm and that was peaceful and comfortable. And so I wasn't adding stress of ah, God, I gotta go home, I gotta put this away, I have to do this, I have to, I didn't have to do anything when I got home except take the time for myself and relax a little bit. TaVona Denise:             07:30                And so for me, I felt like that was really helpful in almost like avoiding burnout, if you will, at that stage of my career, which is about the 15 year Mark. Karen Litzy:                                           Yeah, I think you made an interesting point about the word have to, whenever I hear someone say I have to do something, my antenna goes up because it's a very disempowering thing to think I have to do something and whatever we have to do, we kind of resist. And so part of the resent and resent, right? So the burnout is coming from this resistance like, Oh, you can't tell me what to do. And so if we can just make that subtle shift to I get to do this thing, sometimes just that subtle shift of people thinking that they have to go to work. And this is really important for those who are considering building a business and they need to bridge, they can't just quit what they're doing in bridge, you know, it requires a lot of effort and energy to start a business as you know. TaVona Denise:             08:28                And so if we have that resistance and that resentment towards our job, that is actually paying the bills, right? We are exhausted at the end of the day and then there is no mental energy or emotional energy to put into our new baby over here. And so just one subtle shift. If listeners can think about anytime they say, I have to go to work, can you find the shift who I get to go to work and really be grateful and thankful. The things that go into work is providing you the opportunity to practice new skills, to make connections, to pay your bills without worrying about what it's doing to fund the software or the whatever that you need to in order to start this other venture. Karen Litzy:                   09:09                Absolutely. And I think I'm so glad that you brought up the get to versus the have to, because I admit I'm a have to girl sometimes and so now I am going to remember to say I get to, because you're right, when you get to, you're coming from a place of appreciation and of gratitude and we all know there's a lot of research out there on how gratitude can make you happier and gratitude can make you successful, can contribute to making you successful. And so I think that's a really important shift. And now what, are there any other, let's say little shifts like that that the listeners can do if they get to that point where they're like, Ugh, work, I don't want to do it. TaVona Denise:             10:00                Well, one favorite exercise I like to give people, especially if people are just zonked at the end of the day and they like to carry work home with them. One thing I have people do is put a journal or notebook. It doesn't have to be fancy or expensive in the car. And so what it does is when you get into the car, you get the opportunity to let your brain have it. Say they get the fuss out, whoever they want to from the day they get to say everything that they didn't get to say. They want it to say they think they shouldn't have said and all of that on paper. And just that bit of detachment from it. They can more easily evaluated and see the truth or the lie of it. And when they do that one, the brain gets to say it and then let it be done. And I've found that many people have thanked me because in their relationships get better cause they don't go home complaining to the partner or the spouse. The other thing that it does is it gives a clear break from the day. So the brain can say, okay, we're done with work. I've said my say and I can go to the gym, I can go enjoy time with my honey, my children, my whatever. And there is that separation. Karen Litzy:                   11:06                And in your experience in coaching, a lot of therapists, do they return to work? Do they switch gears? Would you, if you were to put a percentage on it, and I know that's probably tough and I'm making you do this on the spot here, but if you were to say, you know, after we came up with better strategies, they found the joy in their work again, or after coming up with better strategies, they were like, Oh, I think I want to do X, Y, Z. TaVona Denise:             11:34                I think it's so it's an interest in it, but it may be a 25 go back to work and they're excited and they're like, Oh, I'm renewed. 25% is like, thank you for those skills. I want to turn the page to the next chapter of my life and do my own thing. Whatever form comes in. And then there's this 50% that's kind of in the middle and they either don't move forward to practice the skills all the time. And we see this sometimes with fitness and anything in life, right? And I think, and here lately I've been wondering about that person, like what makes that person not move forward? And I've come to understand that that person is very much afraid. So we talked about those over 100 interviews I did last year. And in my note, taking some variation of the word fear came up in 90 something percent of those interviews. TaVona Denise:             12:34                And I thought to myself, well, what is really going on here? And what I've been thinking about here lately is how we in healthcare are taught to follow certain protocols and we're breaking out of that now, right? So people are not recipes and things like that, but there's still this underlying mentality that we need to have certifications that we need to follow rules that we need to play inside the lines and get it perfect and get it right. Because, I come from acute care background. So things that I do we do could literally kill a person. And so it can be very scary to make mistakes for the rest of us. It's very competitive to get into PT school. We were higher achievers, many of us athletes were used to getting stuff done and doing it well. After you've been in the profession for so long, it can be very difficult to be a beginner again and then be in something that nobody's written out. TaVona Denise:             13:28                A curriculum to tell you this is how to be an entrepreneur and be successful at it. And so people freeze. And I'm like, Whoa, I know the answer. Let's move forward. What? Why are we not moving forward? And it's something that I've come to understand is what I'm calling the confidence loop. So for example, a person may be uncomfortable in their situation and work, they want to make some kind of change is not really comfortable. They decide that they want to move to the next level. They're going to make some kind of change. The challenge is once they make that commitment, then the freak out occurs and it's like, well, I'm too old. I'm too young. I don't have this. I don't know what I'm doing. So and so failed. Right? So that's the freak out. What it requires is a bit of courage to take the first step and to keep on stepping. TaVona Denise:             14:18                That part, I call the gauntlet because it's very challenging mentally, emotionally, spiritually, sometimes, physically, depending on what the goal is. But if you can continue taking the moves forward and be consistent, what happens is you find clarity and you find competence. And from that clarity and competence where you know what to do and you know how to do it, people are confident. Like when you know what to do and you know how to do it, you're pretty confident. But when you don't know those things, you're not going to move forward. That can be paralyzing, very paralyzing. The problem is we're so used to knowing what to do. We won't keep invoking the courage to do enough of the things to be clear about what to do in house so that we can be confident. And the interesting thing that I realized about that was that when we were in PT school, that consistency was forced, right? TaVona Denise:             15:13                We had tests all the time that were given to us when we're in clinicals then should see, I would say go do that manipulation or mobilization or whatever, go take that as subjective like they forced us to do of it. If we decide to do something on our own, it's on us to keep moving through and to be courageous. And so that's what I call that pattern of the confidence loop that I've started to notice is why some people never get started in the first place. And the gauntlet part, that first part where it is where people get stuck. Karen Litzy:                   15:44                Yeah. And that's why people need a coach sometimes to keep us consistent. Right? Like I interviewed Steve Anderson a couple of months ago, so Steve is one of the founders of the Graham sessions. Like I said before, we're in Nashville and he is now doing executive coaching, not necessarily with physical therapists but with different C suite executives. And he was talking about the need for a coach. And one of them is accountability, which leads to consistency, right? And he said there's a reason why Roger Federer, who is one of the best tennis players in the world. You think, what does he need a coach for? He's already great, but he has a coach because that coach keeps him perhaps motivated and consistent and accountable. Yeah. And it's like, you know, we talk about doing exercises and we tell our patients all the time, you have to do this daily. Every other day. You have to be consistent and yet consistent physically, but being consistent mentally still changes the brain. TaVona Denise:             16:47                Oh, 100% I think the other reason why coaches in the way that I coach people is in finding the blind spots, right? So one form of coaching is to hold a person accountable. Did you do what you say you were going to do? And that forces the consistency so that you can move into clarity, competence, and confidence. One of the things that I'm very good at and work on with my clients where you were talking about the mental exercise of, okay, the courage, where is the fear coming from and can I help shine a light in that blind spot so that you can see that it's not as bad as you thought it was. So the big example that I have is many times when we would do a total knee or total hip replacements, the moment I would open the door to the stairwell, people would freak out. TaVona Denise:             17:33                Oh yeah. Because the fear of the fear or the anticipation of pain is worse than actually doing the thing. And so part of my job as a coach is to help coach them around that fear of anticipation of pain and to understand where it's coming from so that they can unlock themselves. Karen Litzy:                                           Yeah, I mean fear is a very powerful emotion and it can take many, many forms, which I'm sure you've seen, like not all fear is, Oh, I'm not going to do that. Sometimes fear could be self-destructive. We could be self destructive to ourselves or to others around us out of fear. And so if you were to give any advice for people who are at that point where they've got everything lined up but they're not taking the step because of fear, what do you say? Well that's a loaded question, right? TaVona Denise:             18:43                So going back to the journal is a very, very powerful tool if you're not working with a coach and you're trying to do this on your own. But the simple question of what am I afraid of? What am I afraid of? And if you will, after you asked that question, don't just ask it and just have like in your brain, like actually write it down because there is some power in the scene, the written word, and you giving yourself that distance because once it's on the page and out of your head, you can actually analyze it and see is that true and how can I mitigate the things that I'm afraid of happening? So Tim Ferriss calls it fear setting as opposed to goal setting. So what am I afraid of? What's the worst that can happen? And he borrowed some of this technique from stoicism and he asks you to answer those questions for yourself and see, okay, well I'll be out on the streets. TaVona Denise:             19:39                Well do I have family that I could stay with? He did. He actually went and did some couch surfing for a while before he took the leap. So he went and stayed on people's couches for a couple of weeks so that he could be in that space of is it actually that bad to have to sleep on somebody's couch or eat ramen noodles or something like that. So like what am I actually afraid of and write it down. Karen Litzy:                                           So, if I'm getting this concept correctly, and you can correct me if I'm wrong, so you write, what am I afraid of? Kind of write those fears. And then what's the worst that can happen if that fear were realized? Is that what you're kind of writing? TaVona Denise:                                     Okay, that's exactly right. So what am I afraid of? And what if this actually happened and how can I mitigate it? Got it. And he actually goes and practices it so that he can feel like, Oh, that's actually not that bad. Even if it does happen. And that you may even have more resources than you thought you did if your worst fear were realized. So again, I think it forces you to write things out and say, Oh well maybe isn't that bad. Karen Litzy:                   20:48                Or maybe it is really bad. I don't know. I guess it could go both ways. I'm not sure. TaVona Denise:             20:54                Well, they could. So one of my mentors says, whenever you choose to do something or not to do something, make sure you like your reason. TaVona Denise:                                     So, so many people are one, unclear about what they want in the first place. And two, if they know what they want, they're just not taking action, but they can't articulate why. So I just think if you can just start with that, those two simple questions that will give you a lot of information to get started with. You can find your why right. In some minuscule way in your life. Right? You can kind of find that why, which is often elusive to too many people. Yeah, I can because a lot of people, I think that's another thing that I've found is just the simple act of asking you what do you want? Many people are quick to tell me what they don't want and when they're very clear on what they don't want, but they can't tell me what they do want, they're also not going to make a move. Karen Litzy:                   21:53                Got it. So all of these little tricks that we play in our minds can work against us in so many ways and we don't realize it until we either, like you said, journal it, write it down, have an external eye, take a look at what you're doing to kind of shine that blind spot right into your face so you know what's going on. And then also just, I think, like you said, decluttering and really getting to the bottom of why at this point in your career, are you feeling the way that you're feeling? Trying to recap a little bit here. Yeah. Is that good? Okay. All right. So now in before we kind of wrap things up, I have a couple other things to ask, those were the key takeaways from our conversation, but what do you want the listeners to really kind of take with them? TaVona Denise:             22:50                I think we hold ourselves back unnecessarily. So I think it would be, if I were to give you like a step-by-step, if you will, a rough step-by-step is to one, figure out what you want, understand why you wanted, because the understanding of why you want it will help you move in the face of fear. Just like when we went to PT school, we had, there was a lot of fear involved and we moved through it anyway because we had a reason, right? So know what you want, know why you want it. Understand that fear is allowed to drive, ride the bus ride side car, but not allowed to drive the bus. And it's really going to be okay if you think about that confidence loop and I can share a diagram with you so that people can actually see a visual of it. But if you think about it, if you just keep going, you will get there. If you just keep going, you'll get there. Karen Litzy:                   23:53                Yeah. And I think to that point in a digital age where everything happens at the speed of light, that can be difficult because what if it takes longer than you think it should take? Right. So expectations, let's talk about that for a second. TaVona Denise:             24:14                Yeah. Because speed of light microwave society, here's something that I've been noodling over here lately. We want our business to take off like in 60 to 90 days. And Jen and I were talking about that today. Oh yes. And I was just thinking about this, like, why is that even fair? You need to learn marketing. You need to learn sales, you need to build an audience. I mean, there's so many pieces that you need to learn. If you would just flip the switch. So from have to versus get to right. Here's another little mental switch. What if it was just like going to PT school? So what's the average length of PT school now? Is it two and a half, three years? Yeah, so let's just say three years. What if you just said, I am going to learn what I need to learn all of these pieces of business and I'm going to not expect anything for three years and if I'm not as consistent as I was in PT school, which is full time, I don't think anybody can work and do PT school. If I am not putting in that amount of hours in that amount of effort that I did in PT school for three years, then I need to add a year for however much time and effort I didn't put in. If we can do that and give ourselves the mental space, time and grace, if we thought about how hard we worked and how long we worked in PT school and apply it to business, nobody should expect anything before three years of full time work and then it'd be great if it happens in a year. Karen Litzy:                   25:45                Yes, I agree. I think oftentimes people are fed false hopes and expectations in marketing ploys and whatnot, and that's just not how it works. It just, it just doesn't work that way and you got to work at it. And I think I agree with you. I think your expectations have to be realistic and to have a successful business in 60 to 90 days is not realistic. It's just well put, it ain't going to happen. Not a chance. Yes. So expectations are huge. Thank you for touching on that. Okay. Did we miss anything? TaVona Denise:             26:25                Not that I can think of. Karen Litzy:                   26:26                All right. Cool. Cool. All right, so then the last question before we get to how people can get in touch with you is knowing where you are now in your life and in your business, what advice would you give to your younger self as a graduate out of PT school? So this is advice to you from you, from future you, to past you from future. You got it? TaVona Denise:             26:57                Mmm. Don't be afraid to take risks. It's all going to be okay. The things that you think were for you that don't work out actually happened for you. Karen Litzy:                   27:19                Excellent. Excellent. So again, going, looking back, you can say to yourself, man, I was so upset that X, Y, Z didn't work out. But look where I am now. TaVona Denise:             27:31                Oh yeah, yeah. If I didn't get that great management position that I thought I was going to get. I wouldn't have gone to Costa Rica to Spanish immersion school if I didn't. If I got the other management position that I thought I was going to get that I didn't get, I wouldn't have written a book. I wouldn't be here talking to you all today. Karen Litzy:                   27:49                Amazing. What great advice. I love it. Now. Where can people find you and find out more about what you do? TaVona Denise:             27:55                Yeah. you can find me anywhere on the web at TaVona Denise. I'm most of the time on Facebook, sometimes Instagram and Tavonadenise.com. Karen Litzy:                   28:11                Perfect. And just so for all the listeners, we'll have links to all of that under the show notes for this episode at podcast.healthywealthysmart.com one click will take you to everything that TaVona has an and can offer to you. So TaVona, thank you so much for coming on. This was great. All right, and everyone, thanks 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!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Howard Luks on the show to discuss knee osteoarthritis.  Dr. Howard Luks, MD is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability.    In this episode, we discuss: -What is knee osteoarthritis and how is it diagnosed? -Modifiable risk factors for developing knee osteoarthritis -Indications for a total knee replacement -The importance of managing expectations for good patient outcomes -How to strengthen the physician therapist relationship for more patient centric care -And so much more!   Resources: Howard Luks Website Howard Luks Twitter Howard Luks Facebook Howard Luks Youtube   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 Dr. Luks: Howard Luks, MD - @hjluks - is a patient centric, Orthopedic Surgeon who has been in clinical practice for 20 years. Dr Luks utilizes his passion for patient engagement and his expertise in medicine and social media to educate a global audience through his website, twitter, facebook page and YouTube channel.  He serves as a consultant, board member and adviser to many companies in the mobile health, online health platform, and medical decision making start-up spaces. He served on the External Advisory Board of the Mayo Clinic for Social Media - a recognized leader in this space.   “Technology is not about replacing physicians ... instead, we must remember, change brings opportunity — and we must use these changing  times to  scale great physician thought leaders.” - Howard Luks   Howard Luks, MD (@hjluks) is an Orthopedic Surgeon practicing in Westchester and Dutchess Counties in New York. He specializes in the management of complex knee and shoulder injuries with a focus on ACL injuries, Patella Dislocations and Shoulder Instability.    As an early adopter of Twitter, Howard Luks MD also runs a blog (>100,000 unique monthly viewers), a Facebook Page, a YouTube channel and a personal site to educate, interact and engage a worldwide audience.   Read the full transcript below: Karen Litzy:                   00:01                Hi, Dr. Luks. Thank you so much for coming on the podcast and really looking forward to this today. Howard Luks:                00:06                My pleasure, Karen. I'm looking forward to it too. Karen Litzy:                   00:09                Okay. So today we're going to be talking about osteoarthritis. You had a great tweet thread back in, I believe it was the end of June, beginning of July, 2019 on osteoarthritis and got a lot of positive responses from people and I really wanted to talk to you a little bit more about osteoarthritis. First thing is what it is and what it isn't. So I will hand it over to you. Howard Luks:                00:40                So the reason why I decided to put that thread up was based on the fact that I keep hearing people become worried thinking that their body is wearing out and that our arthritis is a mechanical process and wear and tear process. So they're going to stop walking. They're gonna stop riding, they're gonna stop running, they're gonna stop their exercise. So in other words, they're going to increase their risk of dementia, heart disease, hypertension, diabetes, and other metabolic disorders because they think they're saving the lifespan of their knee. So in order to get across that osteoarthritis is really a biological process where the articular cartilage is starting to degenerate for various reasons and that their activity actually, if anything is beneficial is what led me to write that whole series of tweets. And I followed up with another one a few months later. That then started to throw in all the exercise patterns and activities that people can in fact pursue, especially with respect to runners. See, since I seem to attract a lot of runners, I wanted to be known that running is not damaging for a knee that doesn't have any significant mechanical issue or is recovering from a fracture. Karen Litzy:                   02:22                And when we talk about osteoarthritis, oftentimes people will come to us as physical therapists and they'll say, Oh, well, you know, it's bone on bone. That's what the x-ray shows bone on bone. So how do you respond to that? And how should a physical therapist respond to the patient in those scenarios? And in a way that doesn't undermine the physician that referred them to us, but being consistent with the evidence. Howard Luks:                02:51                It's quite a challenge, right? I mean, yeah. The interesting thing I always talk to our residents about is that, you know, I'm 56 now and I'm just starting to get really good at patient interactions and discussions and conversations in the office just in time for me to retire. And I talk about the fact that words harm, images, harm, and you really can't unsee your MRI or xray report. So it all comes back to communication and education. And that's one of the biggest problems in healthcare today, right? We're RVU driven. You guys are strapped if you're a network, you know, you can't make a living of $40 per hour. And so we're all seeing more people in less time and that really threatens our ability to have a good, actionable and meaningful conversation with people. Yet it's absolutely critical that we do so. Howard Luks:                04:02                So if I put an X Ray up showing bone on bone arthritis, I then immediately enter into a conversation about how you really treat people, not an image. And that even though they're bone on bone, you know, most likely I'm talking to someone who doesn't have severe quality of life limiting knee pain more often than not, and you know, a bone on bone knee that's relatively dry, meaning it doesn't have a significant effusion, it's really not going to be too terribly painful. You know, the bone itself isn't what hurts, you know, bone marrow edema hurts, synovitis, hurts. But not the bone itself. So I explained that I've run with people that I know have bone on bone arthrosis yet. I explained that I've also replaced knees in those with less severe arthritis because they had severe synovitis or bone marrow lesions that just wouldn't go away. Howard Luks:                05:16                So it's important to talk about the fact that the xray has only one small part of the overall evaluation and a very small part in determining what the treatment or treatments could be or should be. And that it really it's their story. It's their history, it's what they're telling us. And you know, when it hurts, how often it hurts and how severe that pain is. That's more important in terms of how we craft our treatment plan. And when, you know, I had a patient today actually asked me, well, when, when do you know, as the patient, when do you know that you need to have a joint replacement surgery and we'll stick with the knee. Karen Litzy:                   05:58                So when your patients come in and they asked you that question or you talk to them about the possibility of a total knee replacement or a partial knee replacement, what do you say and how does the patient know? Howard Luks:                06:23                Huh, that's a great question. And it's one that I'll get probably 15 times tomorrow so the discussion usually goes as follows. It's, you will know you're going to wake up one day and say, I just can't take this anymore. I've tried X, Y, and Z. I've done my exercises, I've lost weight, I have adjusted my diet. I've tried over the counter medications, Savage's bombs, ointments, suction cups, tape and everything else that their friends have told them to try and their pain is limiting their quality of life. So that's, you know, a very important part of the decision making process is you have to dive into their goals, right? You can run into a lot of trouble with people between 40 and 65, 40 and even 70, depending on how active they were, because you might have someone who's miserable, but it's simply because they can't play singles tennis anymore. Howard Luks:                07:37                Right? It's like having someone with shoulder pain in your office because they can't hit a second lob as like they used to. You know, that person who's going to be really unhappy with the results of surgery. Same with the knee replacement in someone who can't play a second set of tennis but could easily finish, you know, a three set doubles match. So we have to determine when the patient feels that their quality of life has suffered long enough that they wish to move forward. Then we need to dive into what their goals are. It should be simply that they want to get through their day without this horrible knee pain. Because if it's anything other than that they may not be all that satisfied with the end results of the surgery. Karen Litzy:                   08:33                Yeah, that makes a lot of sense. There's a big difference between the person who's having trouble walking from, you know, their bedroom to the bathroom or like you said, the person who can't get in another set of singles tennis. They're very, very huge quality of life differences there. Although that second set of tennis might be disappointing. It's different than not being able to walk a block. Howard Luks:                08:57                Correct. And we know, you know, both of us know there are significant number of knee replacement patients who have persistent pain after surgery and who are not happy with the overall results. And many times that might trace back to false expectations. So it's a really important discussion to have. And we also know there are many different patients out there. You know, there are some who have achiness and pain when they roll out of bed, but by the time they're done with their morning shower, they feel fine. Yet those people, some of those people might tell you that they want to have their knee replaced. So again, it's really important to dive deep into the reason why these people want to move forward and what their goals are. Karen Litzy:                   09:54                Yeah, I think that's a great point. Thank you for that. And now I just want to go back to one thing. When we were talking about osteoarthritis, one thing we didn't talk about were factors that may lead people to be at risk for osteoarthritis. Do we know what some of those factors are? And if so, are they modifiable? Howard Luks:                10:14                Sure. So first, you know, the, the big category now that requires everyone's attention is our metabolism. You know, we are bombarded daily now, especially on Twitter with all the ELA facts associated with a typical or standard American diet full of ultra processed foods. I'm not gonna get close to the Quito vegan world and subdivided. However, it's really important that people start to read this literature about the dangers of ultra processed foods. It's very clear that a calorie is not a calorie and that a hundred calories of ultra processed foods versus a hundred calories of real food is going to have very different metabolic affects on us. And we're finding that people with high homocysteine levels have a higher incidence of heart disease, cardio metabolic issues as well as joint related issues. We're finding the same with uric acid levels, which will my car lay with your fructose intake. Howard Luks:                11:38                So high fructose corn syrup, we find a correlation with lipid disorders and the prevalence of osteoarthritis people's weight will certainly have an impact. A lot of people don't know that what each step you take, you're putting, you know, five to seven times your body weight across the knee with each step. If you're achieving 10,000 steps a day, you weigh 250 pounds, you have an extra 60 pounds on your knee across 10,000 steps. That's a lot of an added weight across that knee. Now for those who do not have osteoarthritis already, that might not initiate the process for those in whom the process has started. An MRI studies on asymptomatic people show that the process has started in a majority of us over 50, then that excess weight and force or stress burden is certainly going to increase the risk of developing a more rapidly progressive arthrosis. Howard Luks:                12:50                Now by far the most common causes are genetics and people with structural issues. So a varus or Bodine or valgus or knock kneed that will set you up for unit compartmental changes or changes in either the middle or the lateral compartments. Why we seem to see a pretty severe patellofemoral disease and in some middle aged women, I'm not exactly sure, perhaps it's some degree of underlying map tracking. But in terms of the modifiable risk factors, without a doubt, our weight, our activity level, it turns out as we, as we just said, that's right. This is less common in runners. Cartilage likes that cyclical loading and likes to be exposed to force in a cyclical manner. I think we hit on many of them. Karen Litzy:                   13:54                Yeah. And then the only other thing I can think of is previous surgeries. So we know like ACL having an ACL surgery or ACL disruption, the majority of those people do develop osteoarthritis later in life. Especially if you're, you know, most of them happen when you're younger, usually. Howard Luks:                14:13                True. So you're absolutely correct. So upwards of 50% of people who have had an ACL tear will go on to develop arthritic changes. Even having just one Hema arthrosis, you know, blood in your joint elevates your risk of developing osteoarthritis because it changes the chemical compounds that's present in the knee. Once that has happened, now you'd go ahead and you add a mechanical issues such as a meniscus tear and your risks really start to go up dramatically. Karen Litzy:                   14:54                Yeah. And, I mean I have seen patients in their forties you know, who have had multiple ACL reconstructions on their knees cause they were high level athletes in their younger years. And those are people who, you know, we were talking about the people who can't play tennis versus the ones who are having trouble walking down the street. Those are the people that are having trouble walking down the street and they know it, but they're doing everything they can to not have the surgery as well. So it's, it's an interesting group. Howard Luks:                15:25                Correct. And they're not harming themselves. I don't care if you're limping if you can get away without having your knee replaced, you should do so. Karen Litzy:                   15:37                Absolutely. Absolutely. Certainly, certainly I think, you know, oftentimes people will hear, Oh, it's knee replacements are not that bad. It's not like it was years ago, but I mean, it's not great. Howard Luks:                15:49                Huh? Yeah. So there's, you know, the only surgery without risk is a surgery on somebody else. Yeah. If you're assuming an infection after a knee replacement has a low incidence, right. A 0.7 0.8%, but it's a life altering permanent problem. You know, you're going to need one to three operations to try and eradicate that infection. And if it's a nasty bug, it's going to end in an amputation. So, you know, are there a lot of amputations that happen each year because of knee replacement infection? No, but there are not zero. And there are a significant number of people who have persistent pain. I've looked, I perform a lot of knee replacements and I think it's a great operation for the right person. So there are significant upsides to a well functioning knee replacement and the vast majority of people are not going to get infected. However, when you start to push indications and you start to stretch them if you get into trouble with one of those people, that's an awful place for them to be. Karen Litzy:                   17:06                Yeah. Yeah. No question. No question. And now what I'd like to do is we've got a couple of questions from listeners that some of them are about you in particular and the way that you practice others. Again, continuing on the osteoarthritis subject. So one was from physical therapy and they're all from physical therapists. Gina Kim said, how do you set expectations for patients, especially for active busy ones, that conditions such as osteoarthritis, frozen shoulder can take months to resolve or can be something that you're managing, let's say. Because I would say osteoarthritis is something that you're managing. Howard Luks:                17:49                Correct. And sometimes the frozen shoulders too. So any of our patients with these longterm chronic conditions can get into trouble, especially when they're used to being high level weekend warrior as an athlete. The, you know, my goal is to keep that runner running. And most runners, if you sit down and say, look, we don't think that arthritis, we know that arthritis is most likely not caused by running. We really don't think that you know, running five miles at a reasonable pace is going to cause her arthritis to worsen more than it already has and more than the normal disease course will worse than that. So we think it's okay for you to keep running. 90% of real runners are going to take that and run with it, so to speak. They are not going to stop. And there's really no reason for them to stop, cut, stop. Howard Luks:                18:54                Cause a runner that stops running is not a whole person anymore. It's really embedded in our psyche. They're very unique people to deal with. So oftentimes we’re seeing a runner with a little swelling after a run, we're seeing them a little, a little achiness and pain the next day. Perhaps they can't run as fast as they used to or they have pain going down Hill. So they will very readily work with you. So what I will immediately start doing is dive in to their typical week. How many miles are they running? What pace are they running, what zone are they running in? Are they Hills or are they technical trails and the carriage are they road? I don't necessarily push people onto trails or onto roads but I might pull them off a technical trail or off of steep Hills. And I'll try to work with them. Craft a workout pattern and running strategy with them that will lead to very much acceptable or tolerable levels of knee pain. And then once they understand that the etiology of a cause of their arthritis and they understand you really didn't do anything wrong, it's not the running that led them to this point, most are okay and most will fight through again, a reasonable level of discomfort in order to allow them to run. Karen Litzy:                   20:35                Yeah, and I think that's the last thing you said is so important because oftentimes when people have more persistent pain, and I can say this from my own experience is when, when we, I guess I can say we, I'm part of that group. Oftentimes when we do things and it results in pain, we think that we're causing more damage. And I think it's really important that last point that you made that, Hey, listen, you might have a little bit of pain, a little bit of swelling, but from what we can tell, we know this isn't doing further damage. It isn't sort of creating more wear and tear. And I think that's really important to get across to the patient. Howard Luks:                21:16                I agree. I mean, if I start to get stress fractures and stress reactions and book painful bone marrow edema, lesions, you know, I'm going to change. But as I alluded to earlier, you know, imagine a runner who stops running out of fear not because of the level of pain. You know, they're now increasing their risk of any number of chronic diseases, right? Alzheimer's and heart disease and hypertension, diabetes and on in the, you know, in the hope that maybe they're going to save their knee and save the knee from what? So if, you know, a lot of them, even if, even if we knew that running caused it, they would sacrifice their need to keep, you know, their head clear from the benefit that they derive from their weekly run. Karen Litzy:                   22:21                Yeah, they're a motivated bunch, that's for sure. And, and motivated because like you said, it's the running. So when you're a runner, it's your running that allows you to do the rest of the things in your life. That may be work. It may be dealing with family, it may be dealing with colleagues that keeps your head clear. It could be meditative. So you're taking all of that away by saying you just have to rest. You don't, you shouldn't run anymore. Howard Luks:                22:46                Correct. Karen Litzy:                   22:47                Dangerous. Okay. Dangerous stuff. So let's go onto another question, Miranda Henry, and I think this is a nice question is how do you see the evolution of the patient doctor physiotherapist role in the care of osteoarthritis? Cause we know we've got baby boomers getting older, osteoarthritis is most likely going to be more prevalent. So how do you see that evolution of care from those roles? Howard Luks:                23:15                Sadly, in this environment I see it dwindling, which is really unfortunate, right? Because it should be increasing. There should be a direct electronic or otherwise communication between our offices. You know, we both have these five page electronic medical record nightmares that our office produced that we fax to each other, you know, for signatures to send back. Yet it doesn't have much actionable, useful and meaningful information. I have a number of a number of therapists who are my go to people in my region. And you know, we're on the phone a lot. Trying to share details about certain people in terms of progress yeah. Or roadblocks or other issues and what and why they're sending them back or why they're not. And it's, you know, an open channel of communications is just so critical. And we just have to keep in mind regardless of how busy and crazy our lives get as healthcare providers, that it really is a patient's life and wellbeing that's sitting at the end of these phone calls and things that are easily perceived as nuisance irritation. And so yeah, it is worth it in the end to go the extra mile and make that phone call. Karen Litzy:                   24:51                Yeah. And I think you just answered that with that answer. The next question is what do you see as the best way for that PT doctor patient to align themselves for best patient outcomes? Which I think you just answered. Just having good communication channels and being able to keep in mind that the patient is at the center. Howard Luks:                25:13                Correct. Yeah. Can't forget that. Karen Litzy:                   25:15                No, that makes perfect sense. I think you just answered it. And then finally, this is from Mark Rubinstein said what or who inspired you in your holistic approach to promoting health? Combining traditional orthopedic medicine with sort of lifestyle medicine? Howard Luks:                25:32                Ha. Good one. As I alluded to, as I said before, you know, you start to get much better at determining talking to people, listening to people asking the right questions. You know, my exam starts when I watch them walking in the hallway, you know, before you sit down on your stool, you know more about that patient. Then half the words they're going to say are going to tell you and you learn how to craft your messages and craft your, you know, your treatment plans accordingly and you find out that non-surgical management is often really effective. Then you realize, okay, you're 56, you know, what are you doing to change your life? So, you know, probably about six years ago I started to optimize my own lifestyle for my, not only longevity but health span, right? I want to go to the very end, hopefully running and then just drop off. I don't want to spend my last 10 years on cane's going to doctor's offices, being hobbled, being frail, et cetera. So as I started, you know, a lot of the more recent blog posts that I've written, I've just done in an effort to help me learn the topics. Karen Litzy:                   27:12                That's a great way to, it's a great way to learn. Howard Luks:                27:14                Right? Because I'm pulling all these papers and I'm doing all this reading. I might as well write it down on my website and share it. And so it started with my diet and then it started with a sleep. I read Matthew Walker's book and then it started to, it was exercise and muscle mass and atrophy, sarcopenia and everything else written about. And then you start to dive into the metabolic literature and you realize, Hey, you know, this is really important for our patients. And that's another motivation to get it up and get it on the website. And as we all know, it's really hard to change many people's habits, but if they have actionable information, if they have a thorough understanding of why they need to do this I'm getting a lot further with people in terms of committing them to dietary change, lifestyle changes, activity changes than I ever had in terms of success before in my career. And I think maybe it's just cause I'm communicating it better and perhaps cause I'm leaving it up on my website for them afterwards to revisit and share it amongst their family. Karen Litzy:                   28:48                Yeah. And they can kind of take a deeper dive into it after they leave the office and say to themselves, Oh, okay, now I think this is making more sense. Cause like we've all been to doctors. I mean sometimes you go in and you're like, Oh man, I really wanted to ask this question and I didn't. Or Oh he said this thing but I forgot. And so to have that backup on your website I think is probably really helpful. And like you said, is most likely helping you get some greater buy in from your patients do I think is fantastic. And I think it's also important to note that when you're writing that you're, at least, this is what I get from your writing style, is it's very relatable and approachable and it's so, it's very, I think patient forward. Howard Luks:                29:33                You'd be amazed at the comments that I get from editors editors or publishers or writers through channels, how unhappy they are with my writing style. I'm like, just, you just have to leave it alone. It is what it is. Karen Litzy:                   29:50                Yeah. And if it's relating, if it's relatable to your patient population, great. Correct. Great. All right. So before we wrap up, what are the big takeaways you want people to leave with this discussion today? Howard Luks:                30:06                So yeah, in an effort to save your knee, don't throw the rest of your health under the bus. You're not gonna save your knee. You can't stop arthritis from progressing. You can't cure it. You're not gonna waste your money on $10,000 in STEM cells cause that isn't going to work. You will know the day that you need your knee replaced. And hopefully your surgeon or therapist will help you better define what your goals can and should be following a knee replacement. Don't forget how important our entire lifestyle is in shaping how much pain we are going to have, how long we're going to have that pain and how long we're going to suffer with it. Our sleep matters. Our diet matters, what we stick in our mouth matters and our activity levels matter. If you don't optimize for your wellness today, you're gonna end up preparing for your illness and frailty later. So there's no better time to get moving. Karen Litzy:                   31:18                Great advice. And now last question I ask everyone is knowing where you are now in your life and in your career, what advice would you give yourself as a newly minted doctor? A new graduate from medical school. Howard Luks:                31:34                Yeah. you're not as good as you think you are. Right? You know, all these young docs on Twitter, I get a kick out of them, you know, they're great, but, and I wasn't any different. You know, the world is far more black and white when you're younger then as you get older but yeah, pay more attention to your elders. Pay more attention to your patients. You don't always have the right answer, you know, and just be willing to admit sometimes you don't know. And then look for the person with the knowledge and experience who can help you. Karen Litzy:                   32:22                Great advice. Now, where can people find you if they want to read your blogs and find you on social media? Very important. Howard Luks:                32:28                Just put my name on Google. I think I own the first 10 pages. Karen Litzy:                   32:33                Perfect. And we'll also have links under this episode at podcast.healthywealthysmart.com So if you want to get all of Dr. Luks’ info, it'll be right on the website here as well. Awesome. All right, well thank you so much for taking the time out. This is a great conversation and I hope you have a great start to your 2020. And everyone, thanks 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!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Ryan Burklo on the show to discuss financial planning for small business owners.  Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners. Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit. In this episode, we discuss: -How to manage debt financing and make it work for you -What is tax efficient cash flow planning? -Retirement options for small business owners -The conversations you need to bring up with your financial advisor -And so much more! Resources: Quantified Financial Website Holistic Finance Podcast Ryan Burklo Twitter 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 Ryan: Ryan Burklo, RICP® is a financial planner, host of the podcast Holistic Finance, and co-owner of Quantified Financial Partners. He lives in Seattle, Washington with his wife and two kids.  After learning his son had a stroke while in utero he became an avid volunteer for Pediatric Stroke Warriors.  He learned much about the medical professionals who cared for his son and truly enjoyed working with them both on a personal and a professional level. Through his work as a financial planner, he works with medical practice owners to protect their practice, keep them financially efficient and assist with their eventual exit. His firm and his personal mission is to simplify finances so that you can focus on what you enjoy most. Read the full transcript below: Karen Litzy:                   00:01                Hey Ryan, welcome to the podcast. I'm happy to have you on. Ryan Burklo:                 00:06                Thanks for having me. Appreciate the invite. Karen Litzy:                   00:08                Yeah. And you know we're getting onto the end of the year and people are starting to think, look back on the year, look forward to next year talking about their businesses and maybe how they can move forward, expand, stay the same. Lots of stuff. But today we're going to talk about kind of the business side of things. And I absolutely love having people like you on the program because I didn't go to school to be a financial planner. I don't, I don't know what I, you know, this is not my specialty. So I love having folks like you on because I feel like I learned so much from you guys, plants and seeds in me that make me think, Hmm, maybe I need to make some changes in my practice. So thank you for coming on. Cause I'm definitely excited. Ryan Burklo:                 01:06                Yeah, I again appreciate being on. I actually started laughing when you said you didn't go to school to be a financial planner cause I was about to say neither did I. I think very few of us actually go to school to officially become a financial planner. I think it just kind of molds it's weighing falls into our lap. You know, life's events occur in the next, you know, you're, you know, you're in the industry and so it's very interesting. Had you told me that I would be a financial planner when I got out of college, I would have said you're drunk. I love what I do. Karen Litzy:                   01:41                Yeah. And here you are helping and I should mention that you do work with a lot of medical practices. Ryan Burklo:                 01:50                Yeah, that's really a majority of our focus is helping medical practices on the business side and merging that with the person side. Cause eventually we all exit our practice in some way, shape or form. And it turns into the personal side. So, you know, the two are married, yet business owners tend to only focus, they focus more on the business side because you know that that's the fun side. That's what they do every day. Karen Litzy:                   02:19                Exactly. Exactly. And so it's great to have people like you guys to help guide us through that. And now, you know, I've been taught, this has been in the news quite a bit. I had, you know interviewed someone a couple of weeks ago about debt and we hear debt a lot in the news. Mainly the focus is student loan debt, but there's all kinds of debt, right? And when you're a business owner, you may be in debt, you may not be in debt. But my question is, can debt work for you? Can it be a good thing sometimes. Ryan Burklo:                 02:56                Yeah. Yeah. I mean the quick answer is absolutely yes. You know, you brought up the media and everything we're hearing in the news and right now it's a lot of student loans. But you know, oftentimes there's also, you know, just debt is bad is the mantra and you should pay it off as fast as possible. And in some scenarios that makes sense in other scenarios that doesn't, you know, really depends on what kind of debt it is. You know, credit card debt for the most part isn't the best that I have because it tends to be high interest rate, right? You're getting in the double digits, 16, 17, 20% or so. But then there's other debts. Student loans can be one of them. You know, mortgages on real estate and other debts that are lower interest rates and you have to look at it at, if I'm going to put a dollar towards that debt, if I put my dollar elsewhere, how would that act? Ryan Burklo:                 03:52                How would that do differently? Right? And so the simple example of that is, you know, right now you can get a mortgage really, really inexpensive, you know, 3.8% or something like that on a 30 year mortgage. And so if your dollar can be put back into the business or put elsewhere and beat 3.8 at a relatively low low risk, well then you'd be better off putting your dollar elsewhere. Cause then you'd be making money on your money so you're leveraging that debt so your money can work harder. Whereas the credit card debt that I mentioned, you know it's a 20% interest rate. Well now I used to be 20% that's a lot harder and the risk is a lot higher. Karen Litzy:                   04:38                Got it. So, so for instance, if you take on the debt of a mortgage, whether that be, you know, let's say you bought a building for your practice or you bought space for your practice and like you said, the interest rate is 3.8% then that might be a good thing for your business because you're putting that money to better use for you or the equity is in the building is good. Is that kind of what you mean? Ryan Burklo:                 05:07                Well, to put it in another way, if you had $1 million of cash or $1 million sitting somewhere and you went to buy real estate and real estate was worth $1 million, we get to put the whole thing down, the million dollars sitting wherever it's sitting versus getting a debt and having to pay interest on that debt. You have to analyze what could that million dollars would be doing for you, and if that million dollars could be doing something better than a 3.8% yeah, we were just talking about why would you give the full million dollars to the bank. Got it, got it. And then you have the flexibility between it. All, right? Even if you're, maybe if you're just breaking even some people will get nervous about that too. We'll, again, you've got $1 million. How much more can you do with other stuff in your business because you've got that rather than just giving it to the bank, what type of flexibility do you possibly lose? Karen Litzy:                   06:15                Got it. Got it. Ryan Burklo:                 06:16                So that's just a simple example that I like to use. And that's not to say that you shouldn't pay off some debts. It does go by case by case, but you have to look at what your dollar could be doing elsewhere. And does that make more sense rather than only looking at it, well, Ryan, I'm going to pay more interest over 30 years. That's 100% true. And what could that dollar the other dollars be doing over the next 30 years? Karen Litzy:                   06:42                Got it, got it. So it could mean the difference between investing it into something that's going to give you a higher return or putting it to use elsewhere instead of hiring another doctor. Ryan Burklo:                 06:54                Well, another position that's going to grow revenue by X percent, that might be the better solution. Karen Litzy:                   07:04                Got it. Got it. See, this is why, you know, my brain does not work this way. This is why I need someone to kind of break it down and explain it to me as if you were explaining it to like a fourth grader. Ryan Burklo:                 07:18                Yeah. Well, my industry doesn't like to do that, but we like to confuse people. I try to make it as simple as possible because that annoys the crap out of me. Karen Litzy:                   07:25                Yeah. I appreciate that. All right, so that's a great way that we can kind of make debt work for us. If you have, are there other ways, I guess that you can make debt work for you? Any other easy, simple examples? Ryan Burklo:                 07:48                I threw a couple of examples just in that one. It's really about, again, it's just leveraging what you currently have. And so if you can get a loan, well, you know, let's just say we have a bit of a widget maker, right? And the widget maker needs to buy a machine to make more widgets. And they've got, they can go get a loan on it for X percent or they can just buy it in full. Well, what makes the most sense for your business? How are you leveraging your money to make it work as hard as possible for you? So it's a constant analysis of leveraging where the leverage is. Does it make more sense, can your money work harder outside of giving it to the bank? Karen Litzy:                   08:43                Got it. Yeah. So if you were to pay in full and you can make more widgets and sell more widgets to make more money, that might make more sense than making payments on that piece of equipment. Ryan Burklo:                 08:54                Exactly. Karen Litzy:                   08:55                Got it. All right. Excellent. Now I got it. Thank you so much. Sorry for being a little slow on the uptake there. Now the other thing that I really wanted to talk about is this idea of tax efficiency, cashflow. So in going through your website, I saw this and I thought, hmmm. Karen Litzy:                   09:16                This is really interesting to me because I don't know that I'm being as efficient as possible. So can you explain what tax efficiency cashflow means under the lens of, you know, your small business owner? Ryan Burklo:                 09:31                Yeah. So there's two sides of taxes, right? There's the taxes that you're going to pay now, right. Where the income that came in the door minus the deductions and everything that we can take as a business owner, what's leftover and what we're going to pay on taxes from that on the business side as well as from the income side and that's based on the rules and laws that are in place this year, 2019 then there's the tax side of what am I going to get taxed on 15 years from now, 10 years from now, 30 years from now, depending on where my money and my assets are sitting. That's the side that most people don't really consider because what they're only considered is I want to pay as little money in taxes this year. Karen Litzy:                   10:21                Yes, yes. Right. Ryan Burklo:                 10:24                So the next question you have to ask yourself, okay, 10 years from now or five years from now or whatever time period that is, where do I think taxes are going to go? And obviously we can't predict this. Oftentimes it depends on who's in office and what's going on in the economy, all that kind of fun stuff. But if you're of the opinion that taxes are going up, should you have a lot of money and assets where you have not paid taxes on yet? Karen Litzy:                   10:54                Yes. All right. I got it right. Ryan Burklo:                 10:56                Yeah, exactly. Because you've deferred the tax. So essentially if it taxes went up, now you're gonna pay more in taxes. Conversely, it taxes go down within, you wanted to defer the tax. And the problem is, is we don't know. And so much of this is, Karen Litzy:                   11:11                It's a gamble. Ryan Burklo:                 11:13                It's a balance is what I put in. So we talked about financial balance quite a bit and it's because we don't want all of our eggs in one basket, right? We don't want all of our assets to be tax deferred because what happens if tax go up? Conversely, like I just said, if taxes go down. Whereas we have our assets in different buckets now we can actually control what tax bracket we're in five, 10 20, 30 years from now. Just like kind of what we're doing right now in terms of lowering our tax bill this year. Karen Litzy:                   11:47                And so when you're looking at balancing and not having all your eggs in one basket, where would those eggs be? Ryan Burklo:                 11:57                Yeah, so it depends on what you're building in your medical practice or in your business. If your plan is, you know, take a solo practice, you know, at one doc and you know, the chances of a one doc practice being able to sell it is not very high, especially they're required. They're the ones that bring in the money anyways, right? You can't sell something if you're the person that you're trying to sell. So oftentimes those types of practices, they have to build side retirement accounts. Okay. Right? These are your traditional IRAs, your simple IRAs, your standard retirement accounts. And so you could be putting a bunch of money into those accounts where you deferred the taxes. So that's one asset. But we could be talking about, it's also an event. Conversely, if you've got the multiple doc practice, we've had a couple of partners and maybe it's an inside, say on, you're actually transitioning one doc out. Well, how do you consider the taxation of the business? What's the cost basis, and then how are we going to sell it? Oftentimes in insider sales, what they call that, oftentimes no one writes a lump sum check and says, here you go, doc, you're gone. It's normally let me pay you in installments over the next 10 years. I see. Okay, so now you have more taxes going on there. Karen Litzy:                   13:27                Oh, cause you, yeah. So you, if you are the doc that left the practice, you're paying taxes on that money that is coming to you in installments. Ryan Burklo:                 13:37                Correct. And if you're the doctor bought them out to pay that doctor, you need the revenue of your practice to be doing a certain amount. So there's taxations on both sides of that equation. Karen Litzy:                   13:50                Right, right. Oh my gosh. These are things like, I really thought you got bought out in one lump sum. That's why when you said that I started laughing, I'm like, Oh, okay. Yeah. I guess installments does make more sense. Ryan Burklo:                 14:04                Yeah. Do lump sum sales occur. Absolutely. That's not, that's not what normally occurs. What normally occurs is here's a 10 year buyout plan. Karen Litzy:                   14:15                Got it. That does actually make a lot more sense. Ryan Burklo:                 14:20                So yeah, the steps that I have our clients consider is, you know, which type of practice or which type of business are you, are you wanting to build for one? Are you building the business where you're at? And essentially you just kind of run off into the sunset and business kind of goes with you or you trying to build a practice or a business that you can actually sell. And early on it's kind of hard to know that, but as you're growing, you start to picture, you start to build towards one of those. And once you know that now you can get more efficient with your money and what's going on and where to put it, how to get after it. While it's taking into considerations, obviously we don't want to pay a lot of taxes right now, so how does this all come together in one cohesive plan? That's the conversation that people should be having with their advisors. Karen Litzy:                   15:14                Great. No, this is great. Yeah. And you know, we, you sort of mentioned the 401ks and setting up for retirement and things like that. And you know, I think we're, like I said, we're going into a new year, we're going into 2020, and maybe there are some listeners out there who are newer practice owners or perhaps they have not thought about their own retirement at the moment because they're building up their business. But can we talk a little bit about how one goes about setting up a retirement plan again, under that lens of a small business? Ryan Burklo:                 15:55                Yeah. So, you know, really depends on, you know, how many employees we've got. What type of plan do we have any employees that are what we would call a key employee. And so what I mean by key employee, if you have an employee that if  they quit or left and it either cost you a lot of money because they were the customer service side of the business or they were the office managers. So now you've got to go train and hire someone else and go do their work. So you can build in a retirement plan that, that helps keep that employee active and engaged in yours. And you're a business. And that can also be part of that transition that we were just talking about as well. And so, so, so much of it is what is it we're trying to build? Ryan Burklo:                 16:47                If we're looking with a starter business that you were just talking about and if you've got a couple employees, you know, it's looking at something like a simple IRA. That way it's low cost, easy to set up. You can set up matching type of contributions for your employees. You know, you can do like a 3% type match where you can go as low as 1% in the simple that allows your employees to be able to contribute and you match. Now they don't contribute, then you don't have to match. Right. And it's low cost. The 401K side of things is more, it's better for when you have a lot more employees, like 20 plus because there's more costs involved and it gets a little bit more intricate. That's when you can start to design it and really mess with a bunch of different things. And because you can mess with a bunch of different things, it costs money. Karen Litzy:                   17:40                Got it. So if you have a couple of employees, I like this simple IRA, a 401k for a larger company. How about if it's just you, you're a solo practitioner. How do you set up, what is your retirement plan look like? Ryan Burklo:                 17:58                Yeah. Yeah. So you could do a set by IRA if it's just you and you don't plan on hiring any employees you can do the traditional IRA route as well. Then there's Roth IRA, so you can still do that, that standard stuff. The SEP has more, has a higher contribution limit than say the traditional Karen Litzy:                   18:16                And what does SEP mean? So for people who aren't familiar with what that is exactly. Ryan Burklo:                 18:27                Yeah. So the simple IRA, well, I'm sorry, you mentioned the SEP IRA, sorry about that. So if you're looking at the SEP IRA, we're looking at a simplified employment. I'm sorry, I've got that all backwards now. The simplified employment pension is what that stands for. So SEP, S E P simplified employee pension. Okay. And the reason they call it that is, is just for yourself. And you're kind of setting yourself up for your own retirement plan, which is why the word pension is in there. It gets a little confusing. It's pension. Most people think of a pension has guarantees. It's not necessarily guaranteed, it's just setting yourself up with a plan for retirement. Karen Litzy:                   19:10                Got it, got it. So as a solo practitioner, you've got a couple of different options, and again, this is where sort of you're taxed now or taxed then, is that right? Depending on like a traditional versus a Roth. Ryan Burklo:                 19:28                Correct. So the traditional side is what they would call qualified money. That's tax deferred. You're deferring paying the taxes this year, you'll pay it when you start to pull the money out. The Roth IRA is you're paying the taxes this year on your money, it grows tax deferred and you can pull the money out, tax free passed age 59 and a half. Karen Litzy:                   19:54                But with the Roth IRA, if you make a certain amount of money, you can't contribute to it. Is that correct? Ryan Burklo:                 20:02                Yes, there are limitations. There are what they would call a backdoor roth IRA option where you can do, you can kind of go round that rule and there's a bunch of implications there depending on from taxation standpoint. But in general, there are some income limitations to do a direct contribution to a Roth IRA Karen Litzy:                   20:26                Yeah. And again, does that matter what state you live in or is that a federal thing? Ryan Burklo:                 20:32                That's a federal thing Ryan Burklo:                 20:38                IRA's contribution is $6,000 contribution limit below the age of 50. Karen Litzy:                   20:46                Right, right. Okay. Awesome. And like I have sort of a mix of all of these things, but I've been, you know, kind of contributing to this for many years. So let's say your in your thirties and you don't have any of this setup yet, are you done? Ryan Burklo:                 21:08                Not at all. No, not at all. I mean, unless, unless you're planning on retiring when you're age 31 then maybe. Karen Litzy:                   21:17                Right, right, right, right. Ryan Burklo:                 21:19                You know, step one, have a conversation with a professional that understands what you're building for. And I know we're talking about retirement plans, but you know, I'm really of the opinion of what, what do you have set up for yourself prior to a retirement plan? Like if you don't have, say an emergency fund set up, start there. Like you don't have to contribute to a retirement plan. The retirement plan is not the savior for your financial status. It really isn't like you can have all of your money outside of retirement plan and actually still retire. Ryan Burklo:                 21:57                There's this misnomer out there that when you have to put everything into a retirement plan and you know, for retirement only purposes, yeah, that's a good place to put money. But what can happen to a 30 year old prior to retirement over the next 10, 20, 30 years? A lot. A lot, right? Practice, growth opportunities, buying a house, selling a house, a bunch of different things. So having your money in what we would call a liquid type of asset where you can actually get after it without having to pay a bunch of taxes and penalties is something to really consider first prior to a retirement plan. Karen Litzy:                   22:41                Yeah, that makes sense. Because like you said, a lot can happen between your thirties to retirement at 70 or 75. Got it. So setting up that emergency fund and looking at your, kind of what we spoke about earlier, looking at your debt ratios and how can you make that work for you and look at what taxes you're paying now and how you're paying them. And then finally then looking at, well, what do I need for retirement? What do I need to do for retirement that makes sense for me right now because I can put money elsewhere. Like you said, maybe it's into real estate buying a home or something like that. Oh my gosh. There's so much to think about. Ryan Burklo:                 23:23                Yeah. The biggest thing, I've already said this once, I'll say it again. You know, I was talking about taxes. It's also where your money sitting. Again, don't put all your eggs in one basket. If you have your money in different sovereign account, you know, some in retirement plans, some in just a straight investment, some in real estate, some in savings. When you have that kind of diversification of where your money's sitting, how much more flexible is your life just from a financial standpoint? Karen Litzy:                   23:52                Yeah, I would think much more flexible. Ryan Burklo:                 23:55                A ton more flexible because of everything sending or retirement plan and you want to pull some money out to put into the practice. That might be the best thing to do, but you probably didn't pay taxes and penalties. Right, Karen Litzy:                   24:07                Right. So then you're kind of losing money there. Exactly. Karen Litzy:                   24:12                No, that makes a lot of sense. Lots of sense. This is really good stuff. Thank you so much for sharing all of this. Now, something that I know you guys do is you look at people's sort of financial wellbeing, if you will, but you also look at the person themselves, right? And so what are some things that maybe we can look at as ourselves at our business kind of reflect upon for next year? Like what, you know, cause I know that your process is a little bit different. You're really looking at not, like I said, not just the business or the cashflow, but you're looking at the person and their goals and visions and things like that. So how do you, what advice do you have for listeners out there who kind of want to get their financial house in order? But I'm sure there are some things to think about before you even have that discussion. Ryan Burklo:                 25:13                You know, there's maybe two or three things I'll say to you, to your question. The first and foremost, and this is often not spoke about, and this is going to sound probably kind of weird, is what is your philosophy with your finances? What is your value? Right? So in my family, when we'd look at money, right? It's not about, especially in medical practice and naturopath, some physical therapists, right? Like typically you're not getting into the industry to make a ton of money, although that might be a byproduct you're getting into it to help a bunch of people, right? So the value of the money oftentimes when asked that question is, well, I want to help as many people. Well, to do that, my practice has to be very successful. Ryan Burklo:                 26:02                Like without the cashflow coming into the practice and building that growth in the practice. How are you helping more and more people, maybe it's a different way, but what does that philosophy, what that does that that alone will have you direct where your money's going. Okay. And then step after you have that kind of philosophy. Step two is going to be more around where is it you are currently at? Like, how do we, how would like, you could do a quick net worth equation, right? Like add up all of your assets, checking accounts, savings accounts, retirement accounts, real estate, add up all your liabilities, student loans, cards, mortgages, and then so track the two numbers. That's your networth as it is today. And if you did exactly what I just said, we actually listed out your assets in one column, listed out your liabilities on the other column. You just got a lot of your balance, your balance sheet on one page. How many people I've ever seen that even though that's a simple activity to do. Karen Litzy:                   27:09                Yeah. Yeah. Great. Ryan Burklo:                 27:12                And then you can look at what you’re building next year. Okay. If your plan is to hire another doctor or buy real estate or invest in your practice more, what's your plan? How are you currently sitting and how could you possibly do that if you don't have liquid cash and liquidity to do that? Well now you're first, you know, your first step next year. It's actually having some money set aside that's liquid or accessible to do that. Karen Litzy:                   27:41                Yeah. So really like you said, having your philosophy, your values, and your goals. Look at what you have and what you don't have and see if you can help make a plan for 2020 I think that's great advice. Ryan Burklo:                 27:57                Yeah, it's, you know, money in America's taboo, right. It's a taboo topic to talk about it. We don't like talking about it. We don't even know half the time we don't even talk to our children about it. Right. And it's a taboo factor. It's a business factor. It's all this wrapped in one and for someone to take, especially as business owners, you know, we're wearing what sturdy different hats. One of those hats needs to be CFO. Right. So in your, hopefully we're taking a day out of the business to look at how the business is financially and that could be an exercise for that. Karen Litzy:                   28:33                Yeah. I like that. Taking a financial business day. Ryan Burklo:                 28:39                Yeah. Karen Litzy:                   28:40                I really love it. I'm going to start doing that. I have to put it into my calendar cause you know, if it's not in the calendar it doesn't get done. Ryan Burklo:                 28:48                Yup. I'm like you, I get it. Karen Litzy:                   28:51                Yeah. Yeah. This is great. Thank you so much. Is there anything that we kind of didn't touch upon that you're like, Ooh, I really wanted your listeners to get this info? Ryan Burklo:                 29:02                You know, the biggest piece that I want your listeners to get and really anyone to get is have conversations about money with someone you know and trust. Karen Litzy:                   29:14                Yep. That's great advice. Ryan Burklo:                 29:15                It really is that simple because it starts there. Karen Litzy:                   29:21                Yeah, you're right. It does. And we don't talk about it enough. I know I'd have, I probably don't talk about it enough and need, probably need a little more guidance and things like that. So I think that's great advice. So have more conversations about money with people you trust is great advice. And now my question that I always ask everyone, speaking of advice is knowing where you are now in your practice and in life, what advice would you give to yourself right out of college? Especially knowing that what you said at the beginning of the podcast here, but as someone said, you'd be a financial advisor. You'd be like, what? Ryan Burklo:                 30:03                I think it would have been slow down. Mmm Hmm. Karen Litzy:                   30:08                Yeah. Ryan Burklo:                 30:09                I was your traditional person that got out of college and said, I want to retire early. And so I hit the ground running and I started just grinding away. And not that that's a bad thing, but you know, as I've gotten married and have kids, I look back at that time and I'm like, you know, I could have done a couple of different things. I'd just slowed down and it wouldn't have affected me in a negative way the way I thought. And even if it affected me in a negative way, it might've been worth it. Karen Litzy:                   30:37                Right. Yeah. A lot of people say that same thing and it's always kind of slowed down and you know, enjoy where you are in the moment and you are not alone in that train of thought. For sure. Well, Ryan, thanks so much. Where can people find you? Ryan Burklo:                 30:55                Yeah. So if you want to go to quantifiedfinancial.com and you can find all the information you could possibly want about me, whether you like it or not. Karen Litzy:                   31:07                Perfect. And of course we'll have a link to the website at podcast.healthywealthysmart.com under this episode. So one click will take you all to Ryan's info about his company and their philosophy and how they work. And I highly suggest you click on over there. So Ryan, thank you so much for coming on. I really appreciate it. And we did a nice podcast swap, which I always love to do. So thanks so much. Ryan Burklo:                 31:35                Absolutely. I appreciate being on. Karen Litzy:                   31:37                And everyone, thanks so much for listening. Have a great a 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, I welcome Joseph Reinke on the show to discuss student loan debt solutions. Joseph Reinke is the CEO and founder of FitBUX, Inc which is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. In this episode, we discuss: -How family, work and financial goals effect your loan repayment options -Why refinancing public loans may not be an optimal strategy -Practical examples of loan forgiveness strategies -The personal and societal importance of financial literacy -And so much more!   Resources: FitBUX Website FitBUX Courses  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 Joe: Joseph Reinke is the CEO and founder of Fitbux, Inc. FitBUX is introducing innovative finance products and technology to the student lending industry with a specific focus on physical therapists. Thus far in FitBUX’s beta test, they have helped PTs develop financial strategies on over $11mn in student loans. Joe has been in the finance industry for over a decade and is one of the few CFA Charterholders in the world who has experience in both wealth management and business valuation (globally, there are only 120,000 CFA Charterholders). He has hosted numerous live chats about student loans with SPTs across the country, presented at the California Student Conclave, appeared on podcasts, and written numerous financial blogs.   Read the full transcript below: Karen Litzy:                   00:01                Hey Joe, welcome back to the podcast. I am happy to have you back. Joe Reinke:                   00:07                Glad to be here. It's been a few years. I know that we see each other at different conclaves and different events and stuff, but it's been a few years since I've been on the podcast. Karen Litzy:                   00:16                It has. I know, I'm happy to have you. And, we'll talk a little bit about what a difference a couple of years make in a second. But the first thing I want to get to is student loans. So let's talk about first, cause I know you have a lot of data on this. You have a huge data set within fit box. So what is the average debt? And we'll stick with physical therapists. We don't have to go across the board, but the average debt for physical therapists loan debt. Joe Reinke:                   00:45                Yeah. So PTs or student loan debt. So we now have about 7,400 students and our platform, it comes out to about $900 million of student loan debt. The average is about $144,000 for PTs. We have some other graduate students that we also work with too. Before PTs, it's about $144,000 in debt. And like you just said too, it's like a moral, I know when we first came on the podcast years ago, we had like $30 million or something like that on the platform. And when I tell people we have like 850 $900 million down there, like, you know, congratulations like you know all the growth that you've had. And I look at it, I'm like, that's disgusting. Like the fact that there's graduates and it's like, okay, $900 million of debt, that must be a lot of people. It's like, no, that's only 7,400 people. Karen Litzy:                   01:35                Yeah, it's criminal, it's criminal. So let's say you've got 900 million in loans, the average of $144,000 which is mind blowing. So what are the options for these students coming out to help repay that loan? Joe Reinke:                   01:54                And the first challenge is trying to figure out how these things even play a role in the bigger picture. But then the government doesn't do us any favors. So right now there's nine different student loan repayment options and it's a minefield trying to figure out which one you should use. How does it play a role? Like what happens if I do this? What happens to my retirement, what happens to family planning? Can I get a mortgage? All these different things. And instead of just being like, okay, I'll pay back my loans, here's the answer. You've got gotta dig through all these things and that's where people get lost. So what we've done is simplify that into two strategies. Either you’re going to pay off your loans, or B, you're going to go on some type of loan forgiveness strategies. And the pay off loans is really dominated by the headlines of refinancing because that's what we get bombarded by in terms of advertisements. Karen Litzy:                   02:38                And what exactly does that mean when someone says they're going to refinance? Joe Reinke:                   02:43                Yeah. So refinancing means you go to a brand new lender and they offer you a brand new rate and a brand new loan and you're literally replacing your old loans with a brand new loan to get a lower interest rate. Okay, so like I know PTs they get bombarded by low road, which is one of our partners, but they get bombarded by a low road because a low road has a partnership with a PTA. So they just get bombarded. So we get everybody, everybody comes to us and like, well, I'm thinking about refinancing. I was like, well, why? It's like, well, I've got these things. That's what I see in my mailbox. And on the other side of that, they hear all these headline news articles about loan forgiveness and public service loan forgiveness and whatnot. So those two things dominate the headlines. But really it's even upload from that is either you're going to do a payoff strategy or loan forgiveness strategy. Joe Reinke:                   03:34                And what I mean by a payoff strategy is what we typically think about when we get a loan. Like you get a mortgage or a car loan, you make payments over a certain amount of time after that, it's over. You could do different things to be strategic with that. Like instead of doing a 10 year plan, you can do a 25 year plan. So you can make prepayment strategically and save money. You can do refinancing, you can see if refinancing is right for you. And those are the big things with the payoff strategies is just figuring out what's the most effecient way to make my payments. Now, unfortunately, one of the problems is that the loan servicers don't always apply your prepayments correctly, so you got to stay on them and make sure they're doing the right thing. But that's, that's a whole nother topic on that. Karen Litzy:                                           So quick question. When you say making prepayments, can you define what that is? Joe Reinke:                   04:16                Yeah. So when you have a payoff strategy so most of us on average, so like when a DPT graduates, they actually have between 10 and 20 loans. So when I say $144,000 in debt, it's not just one loan, it's like 10 to 20 loans. They're all different sizes, they're all different interest rates. And so what a required payment is the payments. They add up every payment on those loans and then say here's your required payments. So they might say it's $1,000 a month. So on that required payment, you don't have any say on that. You have to make that payment every single month. And then you don't have a say where it goes. They just throw it across all your loans equally. Okay. A prepayment is like the complete opposite. Joe Reinke:                   05:06                You have a hundred percent control of it, meaning you determine the dollar amount, you determine when you do it, but most importantly you can determine which loan that you want to go towards. So like if you wanted to pay your higher interest rate loans faster because that would save you the most money, you can do that. So the trick with payoff strategies is just knowing that general idea of the difference between a repayment, a PR, a required payment. And a prepayment is, well, how can I drop my required payment so I can increase my prepayment? Right? And so that's a lot of the tricks that we go through and mix and match the different plans to allow people to do that. And then you throw a refinancing on top of that and you can save even more. So that's really the payoff strategies. Karen Litzy:                   05:58                Yeah, it would seem to me that everyone should refinance to a lower percentage but like why wouldn't someone do that? Joe Reinke:                   06:03                It really depends. I'll give you a few examples. We might work with a travel PT for example, and with travel PTs. First of all it's harder because of the stipend. This is for OTs and nurses as well. It's a stipend, so it's actually hard to get qualified because they don't qualify that as income. So like we have nine lending partners, only three of them will do travelers first of all. So that makes it a little bit harder. But in that situation you're traveling so you don't know the cost of living when you're moving from place to place. You don't know how long it's going to be between contracts and you don't know, most importantly what your income's going to be when you stop traveling. So it's really hard to lock yourself into a refinance loan, even though you can always refinance again later, you might not qualify later to refinance. Joe Reinke:                   06:54                So oftentimes we do do refinancing with that, those types of individuals, but it's more strategic. So instead of doing like a 10 year loan, we might do a 20 year loan and instead of doing all their federal loan debt and refinancing, it might only be three or four of their higher interest rate loans. So just in case there's something there that they can't do they're not obligated to this huge monster payment every single month. So that's one example. Another example we see often times is, I'll give you an example. I just actually talked to somebody today. She had about $210,000 in student loan debt and she's paying it off. Mmm. And my thing was the tail are like, look, you know, slow down. Because when you do your budget and you're doing paper and pencil, all the numbers always looked like they make sense. But this individual just started working. Joe Reinke:                   07:49                They've never had a budget in their life. They've never had like real expenses in their life. It's like wait three or four months because you might decide that you can't make those payments. You rather do a loan forgiveness strategy and if you refinance, you can't do a loan forgiveness strategy anymore because private loans don't qualify for loan forgiveness strategies anymore. So just different situations will dictate. Does it make sense? And then sometimes the refinance rates are just not that good. So it just doesn't matter. Yeah, exactly. It's like stay there and just chip away at your loans. And I'll give you one more example, Karen. When you refinance, you also consolidate your loans. What that means is you merge your loans into one big, big, big loan. Karen Litzy:                   08:37                Got it. So for instance, if you took a loan from a bank or a federal loan or whatever, when you refinance did, so let's say you have a federal loan, does that federal loan is no longer a federal loan, it becomes a private loan. Joe Reinke:                   08:54                That is correct. And instead of having like 10 you might only have one big, big, big loan. So sometimes what happens, you have to understand how federal loans work though too. Like I said earlier, you have 10 to 20 loans, so every time you pay off one of those loans, your required payment actually drops. With the refinance loan, it won't drop because you have one monster loan, you never pay it off until the whole balance is zero. So sometimes people come to us and say, look, what am I goals is to buy a house in five years? And so if that's the case, we might turn around and say, okay, we'll stick in your federal loan. Because if you keep making prepayments and you pay these specific loans off, your required payment would go from $1,000 down to like $500 when you want to buy your house. Joe Reinke:                   09:37                Why is that a big deal? They use the required payment in the ratios for qualifying for a mortgage. So a lower lower required payment on your student loans, the easier it is to qualify for a mortgage. So that's some of the analysis that we would do to say, okay, well how much does a refi actually save you versus are you better off just trying to drop your monthly payment over time so you can qualify for your number one goal buying a house? And so that's what I meant earlier when I said these things. It is more than just the student loan strategy. Karen Litzy:                                           You've got to look at how does this thing play a role in the bigger overarching strategy, right? Because oftentimes I would think the student loan debt isn't the only debt. So can you explain how maybe you have to work around other debt as well and how to navigate all of that? Joe Reinke:                   10:27                Yeah. And I'll give you an example. We just did a poll and we also took some of the data from our members as well. And it was something like 68% have more than one form of debt. So that could be cars, mortgages, credit cards. And again, another example, I just talked to somebody today, and actually we get this probably four or five times a week where somebody calls us to talk about their student loan debt and we noticed that they have credit card debt. Okay. And we're like, look, you want to do this strategically with your student loans to drop your required payment as low as you can and focus on paying off your credit card debt. And it's like, I didn't even think about that. It's like, yeah, credit card debt, socks, get all of that stuff like as fast as you can and use the flexibility of refrigerator loans. Joe Reinke:                   11:10                That's another reason why you might not run a refinance is because the federal loans are more flexible. There's more options of what you can do. So if you have other debt, it may be allow you to pay that off faster. And that's why sometimes people go into the student loan forgiveness plans also in the short run is the drop that lower payment focus on something else and then go back to their student loan strategy and say, okay, now I'm going to go focus on that. What do I need to do to focus on my student loans now. Karen Litzy:                                           Got it. So it's all part of a bigger plan. So let's talk about quickly the student loan forgiveness because that's been in the news lately. I feel like there's been rumblings of that. It may not exist anymore, Betsy Devoss may cut it or what's the story? Joe Reinke:                   11:51                Yeah, so there's actually two different forms of forgiveness. Okay. And this is where people get confused. The actual repayment plan you're on is called an income driven repayment plan. And the government also says that these are things our student loan forgiveness plans. Long story short on these plans, your payment is based as a percentage of your income. And the payments really low is like 300 $400 a month. But for most of us, that means that we're not paying the interest that's being charged on loans, which means the balance of your loan Rose. And that actually will happen for about 20 or 25 years. And then under normal loan forgiveness at that 20 year Mark or your loans are forgiven, but you have to claim it as income and pay taxes on it. Joe Reinke:                   12:44                So your balance of what you owe will grow because they just add the interest of your balance, just like in your differing interests cause you're not making payments. Happens in these plans. Okay. So then you worked for 10 years or 20 years or whatever, and then your loan is forgiven. So in these plans loan forgiveness, they last for 20 or 25 years. Department of education forgives them. Okay. However, in this country, it doesn't matter what type of loan it is, it can be an auto loan, a mortgage, student loan. If it's forgiven, you have to claim that as income. Yeah, so like let's just use that example. $144,000 is the average person on our platform. If, you're single for those full 20 years, just working, whatever it is, your loan balance might grow, does being worth $200,000 in 20 years? Joe Reinke:                   13:44                So at that 20th year, the $200,000 is wiped out. You don't have to pay it anymore. But you have to claim that $200,000 as income, which means your ordinary income that you made that year. It's just here it is. You got to pay it. And so the goal on these plans is like the complete opposite. You're not trying to pay it off as fast as you can. You're trying to save for that tax liability as fast as you can. Cause like what we always tell people the number one risk on those plans, you don't know what the tax rate is going to be. That's right. It could be 35% it could be 80% it could be 60% now you also factor in like we just moved from California, so if you had $200,000 plus you made 120 grand because you're, you know, 20 years in as a PT in California and federal taxes, you're going to be in a 35 and 40% federal tax bracket. As of right now, plus a 12% tax bracket in California doubled on top of that. You should definitely move to Texas. Joe Reinke:                   14:50                But that's a big thing there. So that's normal loan forgiveness. Now there's another form of loan forgiveness. And this is the part that's been dominating the headlines where if you're on one of these plans, but you work for a nonprofit hospital, a hospital, it could be a full time teaching job. I mean you can say I don't even want to be a PT, OT, whatever anymore and I want to go work at Goodwill full time. I mean it just has to be at a nonprofit full time. And if you're on one of these plans working full time and you make 120 payments, your loans are forgiven in 10 years cause that's 120 payments and you owe nothing in taxes. Okay. And so those have been dominating the news recently because there's been 110,000 people that applied and only about a thousand people have gotten it actually approved. Joe Reinke:                   15:40                And people are like, Oh well that's less than 1% so that's like the big headline. You know, Loan forgiveness is failing. But when you actually dig into the numbers, over 90% of the people that have applied for that, it should never have even applied. Meaning, they don't even work in a nonprofit or they do work at a nonprofit, but they haven't worked for 10 years. Mmm. So they're finding the people for forgiveness and that they shouldn't even been filing it yet. And so that's where the news kind of distorts that stuff. But then at the same time, you have that percentage, two, three, 4% that is told the wrong thing by fed loan servicing. That's the company that, that does this. They're told the wrong monthly payments. They're told that their payments are qualifying even though they're not there. We're told that their employment qualified even though it's not. Joe Reinke:                   16:26                And so that's where the mass confusion comes in on that. I'm actually shameless plug. We just rolled out a new technology that actually tracks all that for you to make sure if you're on public service loan forgiveness, you're actually doing everything you need to do to get it forgiven. And we rolled that out. We rolled that out specifically because of all the headline news of all this stuff. People getting this stuff forgiven. They have nowhere to go to get the answer. So it's like well we can build this pretty easily. And it took us about three months to ramp it up and build it and it's like here it is and we're actually going to release that. We just got done testing it. It's going to be out in about a week or two. So yeah I'm excited about, it's given me a lot of gray hairs and a lot of sleep aside. I'm excited for it. Karen Litzy:                   17:07                Well I mean that's such a gift though. That's such a gift for people because there are a lot of physical therapists who work in hospital systems that would be considered nonprofits and so if they can just sign up for that and have something else, keep track of it for you. Like automation is so much easier in our lives. So this is a way to kind of automate your student loan forgiveness programs so that you don't have to keep track cause we've got a million other things that you have to keep track on. Because like you said before, you've got student loan debt, but then you may have credit card debt, you may have mortgage debt or you have a car loan. And so there's so much that kind of goes into this puzzle. I mean to say I did not realize that it was so, all this is so complicated because I graduated like in the stone age, you know, so I didn't really have all, I didn't have $144,000 in loans. Joe Reinke:                   18:01                Yeah, I mean it's amazing. And, that's why the big thing that I'm excited about. So like the average person that's gotten their loans forgiven so far has basically saved $62,000 okay. That's a lot. We're rolling this plan out for $5 a month and when we roll it out for the full 10 years, we're just charging a one lump sum fee of $300 if you just want us to track it for all 10 years. And it's like, you know, and we did that cause it's like guys, yeah cause somebody has, some of the people that signed up to beta test it for us. They're like dude we pay like a thousand dollars a year for this. I'm like no, no, no, no, no, no. Like the technology doesn't cost us that much to run like this stuff needs to be out there because again it plays a role in a bigger picture and fast forward, we haven't really disclaim this to very many people cause I don't know when it's going to actually roll out but it's supposed to come out next year. Joe Reinke:                   18:50                Like you said, all this stuff plays a role in the bigger picture. We're developing a technology where instead of just tracking the student loans, we track everything. Like, we help you set up the plan and as your 401k your retirement, your budget, your student loan plan, everything. And so to me, like when we say, Hey look, we're only charging, you know, $5 a month for this thing, it's making sure that it works. So when we roll out that bigger plan, it's like we got this piece checked off. We don't have to worry about it anymore. Cause again, I bring up those gray hairs. It gives me something else to worry about. Karen Litzy:                   19:25                There's always something else to worry about. So just one little part of it. So now, so let's talk about something that you had mentioned before we went on the air and it's, people don't really understand money. Karen Litzy:                   19:42                Tell me why you said that and tell me what people can do to better understand it. And on that note, we're going to take a quick break to hear from our sponsor and be right back. Karen Litzy:                   19:57                This episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. You can check out, optimize new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Learn about these trends for the new year at go OptimaHCs.com/healthywealthy2020 Joe Reinke:                   20:36                Yeah, so we have this big thing that like if you watch our courses that we released or go on the new website that we just released, we talk about our method and it's understand, plan, implement those like the big three things. You've got to understand, you've got to have a plan, you've got to have a way to implement that plan. And there's been a lot of chatter because it's political season and we've seen all the stuff about, Oh, this politician is gonna forgive X amount of student loan debt. And then another politician wants to one up and then say, well we're gonna forgive X amount and another politician wants to one up them and say we're going to forgive everything. And so it's like, well, you know, went up in each other to see who can get the most votes for this. And you know, I get the question all the time is what do you think about these policies? Joe Reinke:                   21:18                And I just turn around and say to people, it doesn't really matter because they're missing the root of the problem. You can forgive all the student loan debt. But like I brought this statistic earlier, over 60% of the people on our platform have more than one form of debt is not just doing loan debt. And it's not like these things like money problems didn't exist before. Student loan debt. I mean just before this we had the mortgage crisis. Okay. Like before that we had savings crisis. We still have people savings crisis, like retirement savings. I mean we talked about baby boomers and stuff like baby boomers. Like it's something that I saw a report the other day that 65% of them don't have enough to last like more than five years. Karen Litzy:                   21:58                Yeah. And they don't have student loans. And then isn't it true that the majority of Americans don't even have like a retirement plan or don't have that savings? Joe Reinke:                   22:12                They don't have anything and that they're dependent on social security, which the social security was never meant to be a retirement plan. It's supposed to be a supplement to retirement. But for a lot of retirement age individuals, that is their retirement. And I'll give you even more. I discussed the statistic I was about to write an article about this. Is something like 43%. It's somewhere in the forties, I want to say the low forties. I've got to look at the article again. It's in the low forties, that the super, that percentage of people in this country don't have enough money in their bank account to cover a $400 expense. Okay. So when we sit there and we talk about, Oh, well, you know, if we just forgave student loans, the problems of the world would be over. Joe Reinke:                   23:03                And it's like, well, no, no, no, no. You know, like, I give this example in a workshop all the time. I used to work a lot with athletes and statistically 60, the 70% go bankrupt within three years of being out of league that's in the NBA and NFL. Well, in those three years that they work and play football or basketball, they will make more money than the average American makes their entire working life span. Yep. They go bankrupt. Within three years, they had the complete opposite problem. They had all the money in the world and they still went bankrupt. So it goes back to that fundamental root of not understanding. And that's actually one of the reasons why, like we used to do, or actually we still, I shouldn't say used to, we do workshops. Oh, it's the last time I came on the podcast, like it was, I don't think we had any workshops before that. Joe Reinke:                   23:55                And then we started doing them. I've done over 120 workshops at different DPT programs and conclaves different conferences. And that was one of the big things that like, everyone's like, we love his workshops. Well, where can we learn more? And it's like, how, how do you explain this? Understand, plan implementing? And I couldn't find anything. So I was like, well, we're just gonna roll out our own courses. So we rolled those out about two months ago kind of in a soft launch type of beta test. And the feedback that we've gotten off of them is fantastic. So that's like our new thing that we just rolled out was the courses. The next new thing is that that public service loan forgiveness solution and the next year is like the big solution that we're coming out with. So it's exciting. But yeah, those courses, it's fun to see people taking them and being like, Oh my God, like this stuff is, makes so much more sense now. And it's, it's actually simple. That's my big thing. Keep it simple. Don't make it complicated. So, that's the bigger thing when I see the student loan forgiveness hype and all these political things, like it doesn't matter what happens there. You got to get that understanding. You've got to develop your plan, you've got a whole way, have a way to implement it. Karen Litzy:                   25:02                Yeah. And just so if people want to learn more about it, if you go to the fitbux website, it's under monies. Joe Reinke:                   25:10                Yeah. That is cool. Yup. Karen Litzy:                   25:13                What would you say in your opinion and in your work with people, what are maybe one or two fundamental misunderstandings about money that people have? Joe Reinke:                   25:18                I don't even know. No, I will narrow it down. This is one of the big things and this how we start off our workshops now when we start explaining some of this stuff. So, you know, and this is about a minute or two explanation on this, but then when I was back in wealth management, I would ask people what are your goals? And I started bucking those into three main groups. They would basically say my family goals, I have my work goal and then financial security. And what I mean by like family is like, okay, I want to do this. I wanna be able to buy a house because I want to provide for my family, my daughter, whatever it is. My work, my work, I want to have my work, have a meaning on life and an impact. Joe Reinke:                   26:07                People like I joke around with all the time. No, none of you went to school because you couldn't wait to have student loan debt. You went to school because you wanted to help people. That's what I mean by career goals or life goals. And then the third one was financial security. And when I started asking people, yeah, rank these, it was always in that order, family, their work and then financial security. But when I would ask him, where do you spend the most of your time? They'd be like, well, I spend about 90% of my time on financial security. I'm like, well, that doesn't make any sense. That's like your third goal. Like that. And then I would ask them, here's like, when you say a misconception, I would say, what is financial security? And they kept telling me a lot of money and I'm like, wait, wait a second. Joe Reinke:                   26:47                I just gave you that example of NBA players and NFL players. Lottery winners are the same statistics. They all go bankrupt. They have all the money in the world and they can't manage it. I used to manage people money that had millions and they were financial train wrecks. I know guys on wall street that were making million dollar bonuses every year that are financial train wrecks, so that can't be the case. So then I started looking at it and saying, well, what is it? And that's where we came up with the understand plan implements. Like those things is you've got to have a simple understanding. I mean I give examples of people that I know that are, have been barbers for 40 years. I mean they have no college education, they have none of this stuff and they live in San Jose, California, the most expensive place in the country. Joe Reinke:                   27:30                And they’re millionaires, like they had an understanding, a simple understanding of money. They had a simple plan, you know, and I joke around all the time about my dad. Like when I was 22 years old, like I come home from college thinking I'm like this big investment guru guy, right? Cause I'm a 22 year old punk kid and I'm just like, Oh I'm going to tell my dad. I'm like dad, you know, his strategy was always just, you know, he started a business when he's 18. Yesterday, he started, he bought it from my grandma and you're just put money in the bank and they would buy a piece of property and that's all he did. He never did the stock market anything. I'm like, dad, dad, dad, check this out. Like, if you would have done it, you know, in the stock market it would've been worth like $10 million. Joe Reinke:                   28:09                And he's just like, I don't give a shit. Like I don't know anything about the stock market. All right. That was his plan. It was simple and it works for him. Great. And then you had a simple way of implementing it. That was a thing that really lacked Mmm. Is everybody that I knew that had an understanding it and had a simple plan, it would taking them hours to implement it because it would have to do their own Excel sheets or they had these files all over the place. I've got gotta do it all by hand, but they did that. But those are the three big things. And so actually that's why people always ask like what's the technology behind FITbux and why do we do this stuff for free? Like why do we actually have people call us? And if we walk through their plan for free because we say the understanding and part is free and then the technology that we're building, especially for next year is going to be the part that helps them implement it. So they have to spend hours and 90% of their time doing that and they can spend that time doing something else. You asked about the biggest misconception that is the biggest misconception is what is financial security? It's not having a lot of money. It's those three things. Understanding, planning and implementing. Karen Litzy:                   29:13                And if someone, let's say someone were like me, so I don't have any student loan debt or credit card debt or any debt really. So if I wanted to use this technology, like does it apply to someone like me who's like, well, I don't have any debt, but I definitely want to try and buy an apartment in New York city, which we know is like not cheap. I mean, in all seriousness, to buy an apartment in New York city to get a decent apartment is $650,000. Yeah. And that's a lot of money. If I want to get an apartment with two bedrooms, it's like over a million dollars. Joe Reinke:                   29:43                Yeah. I was going to sell our apartment in San Jose and they got appraised that $900,000. And instead I was like, I'm just going to rent it and it's like $3,000. And then like I tell people, so I moved to Texas cause really I wanted to have a backyard for my daughter. And we bought like, it's like 0.3 acres and it's almost a 4,000 square foot house. It was a way too ridiculous. Like I don't use half the house and it's just ridiculous. And it was like 300 grand but yeah they like the technology but really on the next year. Joe Reinke:                   30:37                Yeah, definitely for people like you, it's actually for anything, and this is why so many people, we talk about the student loan stuff, but we already have a piece of the technology out to help people plan. And this actually leads to like the number two misconception that I would have to say when we sit down and people talk about budgeting. They used to always come to me and they still come to me and say, Hey Joe, I spend like $1,200 a month on my student loans. Is that a lot? And it's like I have no idea. Right? Because $1,200 for one person might be nothing for somebody else. Okay. And so what that means is when it comes to money, absolute numbers mean absolutely nothing. It all has to be relative. And the way we do that as percentages, so like when people sit down and look at their budget, they always look at absolute numbers. Joe Reinke:                   31:23                So if you go onto these budgeting apps and all this stuff, it's all absolute numbers and it's like, Oh well I'm going to cut, stop drinking coffee, you know, and boil and make my own coffee. It's like, great, you save $2 you know, a day or $50 a month. Like that might be 0.04% of your budget, but you don't want to learn something about retirement savings and taxes. I can save you like 10% like learn the learn. And so when you start looking at percentages, you start seeing where you should focus your time on. And so that's number one thing. But the number two thing would that allows you to do is then we could sit there and say, look we break this down very easily here, right? So we say the first formula is income minus expenses equals discretionary income. With that discretionary income, you can then do two basic things. Joe Reinke:                   32:09                You can either build assets or pay off debt and before you even decide what to do with that, we can upload it and say, okay, on average, a new grad PT for example, can take 30% of their gross income and put it to those two groups, assets or debt. You just got to figure out how you want to do that. And so if you have no student loan debt like yourself, Karen, you'd be like, okay, well can I do 30% can I do 35% can I do 40% once you figured that out, then it's, well, now what do I do? Do I do my 401K you know, do I have self-employed income? So can I do a SEP IRA? What about a Roth IRA? What about HSA? What about just brokerage accounts? Oh, well I also want to say for a down payment for the apartment, what do I need to start saving for that? Joe Reinke:                   32:50                What do I prioritize first? And then that, so that's the part that we'll have the technology that we have built now what we're building for next year is where we can say once you say, okay, this percentage is going here, this percentage is going here, this percentage is going here, implement link all your accounts into the profile. And they would automatically track to make sure you're moving those percentages and that you're doing it correctly. And so yeah, right now we only help anybody with student loans. And then we track the student loan strategy to make sure they're doing it the efficient way. And then next year we're going to roll out the bigger piece of the technology. And that was part of the preview with the courses is the courses talk about all that stuff. And that was like the first phase of what we're launching for next year. Joe Reinke:                   33:35                We just got the courses down early and we're like, let's get 'em out. Like people are asking for them. So happy to get those out. But yeah, next year if you want to sit down and talk, let me know. Karen Litzy:                                           I think I might have, I'm thinking about a lot here. So is there anything else that we didn't cover that you're like, Oh, I definitely want to talk about this. I wanted to get this in. Joe Reinke:                                           Like we've talked about the percentages. The reason why I'm so adamant on that is because then it makes life easy. And what I mean by that is if you say, look, I know 5% is going here, 10% is going to here, percent going there. Joe Reinke:                   34:21                Well guess what? You get a raise every year, so all you have to do is calculate and say, okay, well no, I just have to increase how much I'm going into those, those different areas. It's automatic discipline. You don't have to think about it anymore. And not only that, but like if you get a bonus or a commission or a tax return. Yeah, you already know the percentages. Take this here, take this here, take this here, put it here, the rest I can go use on vacation. Hell have fun with it and you don't have to think about it anymore. Instead, I see a lot of people being like, Joe, I just got this $5,000 bonus. Like I'm stressing about, do I put it in my investments? Do I pay off my student loan debt? It's like, well, if he's had those percentages that you don't have to think about anymore, you already know what you're doing with it. Joe Reinke:                   35:00                So that's, you know, one more like they played it was one last thing to add. That's one of the big things is those percentages I strongly recommended. It doesn't matter who you are, where you're at, if you have student loan debt or not. If you're saving for a wedding, saving for college, saving for you know, kids. By the way, if you do have kids and you're saving for college for them, don't do it. Save for your retirement first please. They can fund college other ways. But make sure you fund your own retirement first before you can fund your kids. That's one of the biggest mistakes I see parents make. They want to fund their, call it kids' college education and their retirement is lacking. It's like no on your retirement first on their stuff later. So those are the big takeaways. Karen Litzy:                   35:42                Awesome. I mean, such good information. I really appreciate all of this. And now this question I been asking everyone lately who come on the podcast and it's given where you are now with your life, your business, what advice would you give to yourself as that 22 year old punk going home to his dad more than he does? Joe Reinke:                   36:03                I wish I would draw my ego level way before. That was, I was an athlete at that time too. So you get once, yeah, once you stopped playing sports and reality starts hitting then and all of a sudden it's like Mmm, well not on this pedestal anymore. You get shot down a little bit. But no, actually at that time for me, my big thing was I grew up around, you know, the rule of finance because that's what my degree was and everything. I was around wall street guys. Joe Reinke:                   36:41                I had a plan for money coming out of school, but it was simply just to make a lot of money. And you quickly find out that if your motivation is money, you're going to end up burning out. It doesn't matter what you do. If that could be going to take a certain PT job simply because it pays more because you need to pay off student loans. So I guarantee you, you didn't go to school for student loans. You went to school to be a PT. So if you're going for income and that's your only reason you're going to burn out. Okay. And like I said earlier, I've seen guys making half a million dollar bonuses on wall street that don't even work in finance anymore because they're so burned out off of it. And it took me a long time to realize that you're not money that shouldn’t motivate you. Joe Reinke:                   37:28                It's whatever you're trying to accomplish, that it'd be building a technology that'd be treating patients. And if all you do is strive to be the best at building that, that certain thing or focusing on those first two goals, I talked about your family and your work and you're really focusing on those, that the monetary side will take care of itself in the long run. Like stuff will happen and take care of itself if that's what your main focus is. And like, I mean, fitbux is the living proof of that. I've said it from day one to our investors and everything. Don't ask me about revenue. Don't ask me about shiny objects. Like we talk about business owners all the time. It's one of the hardest things to do because you see so many opportunities out there. You're like, Oh, if I just do that, just a little shiny object, it's going to make me a couple extra thousand dollars, but it's going to be a distraction. Joe Reinke:                   38:18                It is not part of your main thing. Now you're chasing money instead of being focused on why you are doing what you're doing. And so that was one of the big things that I had to learn was, you know, it's not about making a million dollars or $5 million or $10 million. It's focusing on what you love doing and the recipe, it will come true. I mean like Karen and you're, you're a perfect example of that. You love doing the podcast, you love getting out there doing that stuff and helping people and guess what you've been successful at doing it. You've been successful as your PT career, all that stuff falls in line. If you're focusing on the right things and money's not the right thing to focus on is the bigger picture. What does money actually represent to you? What does it mean to you? Why do you want it? Because you can have all the money in the world. Do you want it to do something? Focus on that. Do something first and then the money will come from that because you're going to be the best at what you do. Karen Litzy:                   39:10                Great advice. I love it. And now where can people find more information about you? Contact you find more about Fitbux. Joe Reinke:                   39:20                https://www.fitbux.com/ As the website. As you said with the courses, it's just underneath money school. If you drop down the header underneath solutions, there'll be money school on there. That talks about our courses. If you want to come on and, you already know for example, that you want to do the student loan forgiveness strategy and you just want to sign up for our $5 a month tracking solution. You just go into solutions and sign up. We have a payoff strategy. We also had the loan forgiveness strategy. If you want to go in and use our refinance service, it's free. All you got to do is build your profile and schedule a call. We'll walk through making sure that refinancing is right for you and then go shop nine lenders. And if you have no idea what you're doing Joe Reinke:                   39:59                And don't feel ashamed, about 70% of the people that come on our platform don't have a clue where to even start. And that's statistically true cause we asked them have you looked at anything? And they say, I have no idea. And so we, that's all free too. We'll have you come on, you build your profile, we go through the payoff options, we go through the loan forgiveness options. And then depending on which one you feel more comfortable with, we'd go deeper and deeper into how to actually implement that strategy. I mean that's all free too. You just go to the website and click join now and sign up, schedule a call and we'll be talking soon. Karen Litzy:                   40:30                Perfect. And just so if people aren't familiar, it's fitbux.com. So Joe, thank you so much for coming on. This was great info. I learned, I learned a lot. So thank you so much. Glad that we can teach and it's always fun and hopefully we'll see you at another conference or conclave or something soon and I'm sure talk more. And everyone, thanks so much for listening. Have a great, 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!

Happy holidays to the Healthy, Wealthy and Smart family! This is a special episode where all the amazing women behind the show come together to discuss 2019 and what’s to come in 2020. Thank you for supporting us and we hope to continue to provide great conversations in the new year! In this episode, we discuss: -Why you should enlist a team to help grow your business -How to gracefully ride the ebbs and flows of entrepreneurship -Prioritizing your mental health to avoid burnout -New year intentions from the team -And so much more!   Resources: 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 Jenna: Jenna Kantor, PT, DPT, is a bubbly and energetic woman who was born and raised in Petaluma, California. She trained intensively at Petaluma City Ballet, Houston Ballet, BalletMet, Central Pennsylvania Youth Ballet, RDA Choreography Conference, and Regional Dance America. Over time, the injuries added up and she knew she would not have a lasting career in ballet. This lead her to the University of California, Irvine, where she discovered a passion for musical theatre. Upon graduating, Jenna Kantor worked professionally in musical theatre for 15+ years then found herself ready to move onto a new chapter in her life. Jenna was teaching ballet to kids ages 4 through 17 and group fitness classes to adults. Through teaching, she discovered she had a deep interest in the human body and a desire to help others on a higher level. She was fortunate to get accepted into the DPT program at Columbia. During her education, she co-founded Fairytale Physical Therapy which brings musical theatre shows to children in hospitals, started a podcast titled Physiotherapy Performance Perspectives, was the NYPTA SSIG Advocacy Chair, was part of the NYC Conclave 2017 committee, and co-founded the NYPTA SSIG. In 2017, Jenna was the NYPTA Public Policy Student Liaison, a candidate for the APTASA Communications Chair, won the APTA PPS Business Concept Contest, and made the top 40 List for an Up and Coming Physical Therapy with UpDoc Media. Jenna Kantor currently holds the position of the NYPTA Social Media Committee, APTA PPS Key Contact, and NYPTA Legislative Task Force. She provides complimentary, regularly online content that advocates for the physical therapy profession. Jenna runs her own private practice, Jenna Kantor Physical Therapy, PLLC, and an online course for performing artists called Powerful Performer that will launch late 2019. Jenna continues to perform in musical theatre and lives in Queens, New York with her husband and two cats.   For more information on Julie: Dr. Julie Sias, PT, DPT is the Producer of the Healthy, Wealthy and Smart Podcast. Julie received her Doctor of Physical Therapy degree from Chapman University. Julie loves to gain new insights and inspiration from the guests of the show in order to enhance her physical therapy private practice in Newport Beach, California. For more information on Lex: Alexis Lancaster is a student intern 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 is currently in her final year of the 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 Shannon: Dr Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women’s Health Physical Therapist and is currently the only Board-Certified Women’s Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.   Read the full transcript below: Karen Litzy:                   00:00:07           Hey everybody. Welcome to the last live podcast of 2019 I am your host, Karen. Let's see, and today's episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected, which is huge, and workflows that streamline patient care and save valuable time. You can check out Optima's new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Karen Litzy:                   00:01:14           Learn about these trends for the new year at go.Optimahcs.com/healthywealthy2020 and we will of course have a link to this in the show notes under today's episode. And I also want to thank net health not only for today, but for being such an amazing sponsor to this podcast. We couldn't do what we do every week without their help. So a huge thanks to net health. So definitely check them out. And notice I said we now it's because of course I cannot do this podcast alone by any means. And today I am so excited to have the powerhouse team behind this podcast for amazing physical therapy entrepreneurs for strong, amazing women who help bring this podcast to life every single week. So in this episode, I'm happy to have on doctors. So they're all doctors, Julie Sias, Jenna Kantor, Shannon Sepulveda, and Lex Lancaster. And what we did was I had a conversation with Jenna and Julia. Karen Litzy:                   00:02:18           You'll hear that in the first half of the podcast. And then in the second half of the podcast with Lex and Shannon and we talked about what our sort of our year in review, what 2019 did for us as people and as women and as entrepreneurs and physical therapists. And one theme that came across was that we're all doing things that make us happy and that in 2020 we want to continue that and we want to sort of construct the life that we want to see us leading. So that's in our personal lives and also in our life as physical therapists. So the amazing thing is Lex, Jenna and Julie are new grad physical therapists. Jenna and Julie have started their own practices. Lex has her own business outside of physical therapy, helping people with websites and graphics. Shannon, has an amazing practice in Bozeman, Montana. Karen Litzy:                   00:03:20           She has started her practice about two years ago. It has grown exponentially. So she talks about how she did that. And it's amazing. We talk about what I have coming up in 2020 including an online course to help all those physical therapists or occupational therapists out there who want to start their own practice in a way that feels good to them in a way that's going to make them happy, bring them joy. And also the most important thing as physical therapists is our job is to get people better. And in our conversations in this podcast, we talk about how what we do as individuals not only affects us, but it's exponential. It affects everyone around us, our communities, our friends, our families, and of course the patients that we serve. And we're so grateful to that. And of course, as the host of the podcast and creator of the podcast, I just want to thank all of these women because without them I wouldn't be able to do this. Karen Litzy:                   00:04:14           There's no way I can do this on my own. Like one of my guests said, Stephanie Nickolich and we mentioned this in the podcast is if you try and do it all, it'll keep you small. And when I was trying to do it all with this podcast, it was keeping me small. I wasn't able to upcycle this as much as I have with the help of these four women. So I just want to tell all of them and I say it in the podcast as well as that I appreciate them. I think they're amazing and I wouldn't be able to do what I do without them. And I just want them to know that my gratitude for this past year of 2019 is so immense and looking forward into 2020. I'm so excited to see what we all come up with. So I hope you guys really take in this episode because I think it's really special and of course to the audience thank you so much for another great year of listening and interacting with the podcast and being able to meet so many listeners all over the world has been a real joy to me in this past year. So everyone, thank you so much. Have a very, very happy new year and we'll be back with brand new episodes in 2020. Karen Litzy:                   00:05:24           Hey Jenna and Julie, welcome to the podcast. Welcome back to the podcast. Since you've both been on several times. The reason being is because we all work together on the podcast to make it what it is. So well, welcome, welcome. So we're wrapping things up for 2019 and I thought, well, what better way to do that then with the people who make this podcast happen every year and who I'm eternally grateful for and appreciate so much for all of your hard work and your dedication and your fun and your being you. So, thank you guys for everything that you do. And now let's talk about 2019. Right? So we have January, 2019 to now. So a lot of things have happened within that year. So Jenna, we'll start with you. What are some highlights for you that's happened over the past year that you can kind of share with all the listeners? Jenna Kantor:                00:06:34           Why hello listeners! Good, good evening and sun salutations. For me, I started my own practice literally on January 1st and we were driving back and I got my first patient that day. So literally my practice started this year. That was a big one for me. I also very quickly left all my PRN for those who don't know, that's working as needed, like a substitute teacher at a bunch of mills and I very quickly left all of them and I have been working for myself and it was the best decision I ever made. I have that musical theater background, which I'm sure listeners are quite familiar with, but if you don't know not, you know, and I was really not meant as a physical therapist to be sitting in one spot from nine to five. I really am not built that way and I love that I can make my own schedule, my own life and not feel like I'm really stuck in a location. It's a very, very big deal for me. That was something that was very concerned about as a performer. So I'm grateful to have made that move for myself. Karen Litzy:                   00:07:49           Awesome. And Julie, how about you? So what's happened from January till now? Julie Sias:                      00:07:54           So having been kind of mentored by Karen for the past three years, it was nice cause I also actually started my own practice and Karen was helping me along the way and everything. And January 1st yes, had my first patient and everything and it's been going really well, I haven't left my PRN jobs, but I do manage my concierge outpatient practice. And then I also see kiddos as like a consultation kind of gig. And then I work at a skilled nursing facility, PRN right now to supplement all that. But it's been a really exciting year because I finally have had a lot of control over all of my hours and it's been nice being out of school as a new grad. Karen Litzy:                   00:08:44           Yeah. And Julie, when did you graduate? What was your graduation? Julie Sias:                      00:08:49           So I graduated in the summer last year and then I took the licensing exam in November. Karen Litzy:                   00:08:56           Right, cause you had to wait that extra long time to take your licensing exam. Julie Sias:                      00:09:01           Yeah, so that was when I was just like a licensed applicant in California and I was working at the skilled nursing facility that I did a clinical rotation at. And then after I finally got my license, I was able to do all the paperwork to get a corporation and everything. Karen Litzy:                   00:09:16           Right, right. And Jenna, when did you graduate? Jenna Kantor:                00:09:19           That is so cool, Julie. I graduated in May 2018, took my boards in August and then I had a baby. No idea. I felt like, I think it was the rule of threes and I didn't have a three so I made up one. Karen Litzy:                   00:09:48           That's so funny. Can you imagine now people probably be like, Oh my God, if they get like just a little clip. Julie Sias:                      00:09:54           That's Jenna's one liner for the episode. We should make a graphic. I had a baby. Karen Litzy:                   00:10:06           So great that the two of you were able to have a good idea of what you wanted to do and then we're able to execute on that and take action on that because it's certainly not an easy thing to do, especially when you've just graduated and you're trying to, you know, sort of make your Mark and kind of find your way. So to be able to know that before you even graduated I think is is amazing. And do you have any advice? Let's say there are some new grads listening or some students who are getting ready to graduate on what they can do to get some clarity around maybe where they would want to start their career at. And I'll have either one of you can jump in. Julie, do you want to jump in? Julie Sias:                      00:10:56           Yeah, I'm ready to rock. So it was good to have accountability from you Karen because I kept telling you every year that I was going to do this. So then when it finally came to the time I couldn't really back down. So that was good. Cause then I had told everybody so if I ended up backing down that wasn't really going to look very good. And then I was also really clear with how I wanted my life to be. And going this route is definitely more of like a, it's tough, it's been tough kind of cause it's feast or famine sometimes and that's kind of like the ugly side of being an entrepreneur. But I have to like pause and just be grateful when I think about like my day and I just go, you know what, this is actually my ideal day. I got to go for a walk in the morning. Julie Sias:                      00:11:54           I saw two patients. Maybe it's not like whether I want to be for like a full time job eventually, but I just have to like take a second and just be grateful. So it's good to have a clear vision about what you want your days to look like and then just know that when you put in the hard work eventually it will pay off. Jenna Kantor:                00:12:41           Yes.  Amen, this is Jenna. I could not agree with you more. I think that is such a good point with any new practice owner is to stop and essentially smell the roses because it's easy to be, Oh my God, this is where I'm at. Oh my gosh. You know, living sometimes paycheck by paycheck and yes, you're not going to be rolling in the dough right away. It takes time. It takes patience, it takes persistence, all that stuff. But exactly what you said I think is a great way to approach it. I think a big thing, well there's a lot of big things for somebody. Big things when you graduate and you're trying to find a job, but there really is, from what I have seen, I know there's always an exception to the rule. There's really no help with the idea of graduating and getting a job from your school. They are focusing on teaching you what you need to know. You've got to pass those boards, boom, bada Bing. So if you're not going to continue and try to teach at the school that you were just at, you're not going to really get that guidance. The big thing now unfortunately as most of the jobs are at mills, there are places where people don't want to work for a long period of time. That's why they're always hiring. It just is what it is. And you could have this idea similar to me where you want to work with performing artists or say you want to work with tennis players. Say you want to work with geriatric patients only, but not by the hair of the chinny chin, Medicare, chin.  So you have a different vision on how you want to treat your patients. It's not easy to fully see that through when you graduate because you see this number of what you owe. Jenna Kantor:                00:13:50           So you're in this like fantasy world. You're in school, you're learning like, Oh that's what I'm going to do. You graduate, you see your debt, that number and that number changes everything for everyone you've finished. You're like I need to get a job now. And it's just ah, and then you start work and then I've heard from some people, cause I spoke to a lot of new grads since then, I'm coming to me and I've only been out for a year and four months, you know, since taking the boards and then coming to me, just so fearful of Jenna Kantor:                00:14:26           what if I quit? And that makes me look like a bad physical therapist. I always say the same thing. I don't care if it's your fourth, your fifth or 10th job that you're quitting. This is your life. None of us are living your life. So you got to make sure you are happy every time. You may get promises that, that they may not keep. And you need to keep track of that so you're not putting it on yourself. When you're not enjoying the job and you feel like you need to suck it up, you're not supposed to suck up life you’re supposed to enjoy life. You can't find that working for someone. You might be happy working at a mill. I'm not saying you wouldn't be, you wouldn't be, but most people aren't, unfortunately. So you're going to go through a journey most likely, unfortunately as a new grad of really having a hard time finding that fully right place for you to work long term. Karen Litzy:                   00:15:14           And I usually tell people to kind of when you're trying to figure out, well what do I want to do or where might I fit? I usually have people do a couple of different exercises and I mentioned this on the podcast before, but one is like, just make three columns. I'm a big column person, right? So you make three columns in the first, just put like what you love to do and the second column is what you're good at because they could be two different things. Just cause you'd love to do something doesn't mean you're good at it. Like I love to do graphics doesn't mean I'm good at it, but I love to do it but I'm not good at it. And then the third is what will someone pay you for? So if you can kind of find a through line there, I think it helps you to sort of drill into maybe what are your strengths, what are you good at? What do you love? What will someone pay you for? So I always say like, I'm really good at crocheting. I really love crocheting, but no one's going to pay me for it. So it's a hobby. See the difference, right? So you want to make sure that Karen Litzy:                   00:16:30           you're excluding your hobbies as being your full time job. But you know, for me, I some examples of what I'm good. Like I love curiosity, I love asking questions. I love, you know, networking and being with people and meeting new people. Those are things I really love and those are also things I'm good at. And so I was able to parlay that into a podcast and then parlay that into, through the podcasts and through networking into public speaking and into being asked to different conferences and stuff like that. So just know that not everything has to come from one singular job. You know like, and I think we can all say that here cause we've all got a couple of different things in the fire, stokes in the fire. Is that how you say it? I'm not really sure. Karen Litzy:                   00:17:22           At any rate I would say to new grads is to certainly find the job that's going to put food on your table and feed your family and feed yourself and feed your pets and feed your kids and feed whoever else is depending on you. But don't discount that this one thing is the only thing you're allowed to do. You're allowed to do a whole bunch of other stuff, you have to give yourself that permission to do that and then you never know where that's going to lead you. Because if I only stuck just to patient care, well I wouldn't have this podcast and I wouldn't be going all over the world speaking and I wouldn't be asked to coordinate social media for conferences around the world. I mean just wouldn't be a thing. But instead I just decided to do what I love and do it well and get paid for it. It's awesome. Julie Sias:                      00:18:28           Actually I have like a counter to that and that sometimes it's also good not to do what you love as a job cause it can be something that is your me time sort of thing. Oh that's like another counter to that. I was thinking about that maybe if you monetize something, it takes away the fun from it and then it becomes something where like I have to do this to make money versus I get to do this because I want to do it. Karen Litzy:                   00:18:59           Right. And I think when you reach that point, Jenna Kantor:                00:19:03           Yeah, I agree. Cut the cord if you don't like it's for me with performing I did. That was before me professionally for many years in musical theater. And I started to, I got into an eating disorder and I had to take a backstep cause it felt like a nine to five job going to these different States and I started doing community theater again to refine and which I did. And then I started working professionally again. So really was just, I realized I was just working at the wrong places. It's not that they were bad places, just not right for me. So yeah, I definitely agree with it's just assigned to cut the cord Karen Litzy:                   00:19:41           Like Julie said, when you get to that point where I love doing this thing, but now it feels like a chore. I think you have to really do some self reflection and kind of see like, boy this is not, maybe, maybe I made a misstep here, so I need to take a step back and reexamine what I'm doing and let it go. Or you can see are there ways that I can make it even better if I give up some of the controls. Hmm, nice. Right? So I felt what Julie just said is what I felt about the podcast a couple of years ago. This very podcast, I was like, Aw man, I have to do another podcast. But then, and I was like pissed about it cause I was like, Oh, but I have to do this and this and this and Oh now I have to make time for this. Karen Litzy:                   00:20:37           And I thought, all right, let me take a step back and kind of re-examine what I'm doing here. Cause there's gotta be a way that I can make this better and that I can make it bigger. And the thing for me was asking for help. So once I ask for help and let the control go, now all of a sudden it's, you know, more enjoyable and it's something that I continue to be very proud of, but that I'm not like, Oh no, not again, damn you podcast. You know, so it's instead of cutting the cord, I just tried, I took a step back and tried to look at ways that I can improve upon it and the improvement came with bringing people on board. So that's, you know, another all very valid kind of ways to look at things. Julie Sias:                      00:21:49           Yeah. Another way to look at it too is that when you were under a lot of pressure, that allowed you to kind of be more creative too, to look for solutions and sometimes you go in directions that you wouldn't have thought you were going to go just because you were under that pressure and boom. That's where sometimes magic happens too. Karen Litzy:                   00:22:09           That's right. Yeah. I think what Ryan Estis who was on the podcast a couple of weeks ago, what did he say? Like, when you're comfortable it breeds laziness or something like that, I'm really butchering his statement. I was like, boy, I really butchered that one up pretty well. But I remember when you said that, I was like, yes, that's so true. And yeah, it was something to the effect of like if he was looking at it from the point of view of an entrepreneur, that when you get to the level where you know you're consistently making money and you're consistently successful and then does that then breed complacency and does that take away your creativity a little bit? Julie Sias:                      00:22:58           Yeah. That's not really the magic zone for growing. Karen Litzy:                   00:23:01           Right, right, right. Yeah. And that's when you need some outside eyes to kind of take a look and see, and like Steve Anderson said last week, what is the role of a coach? And he said to give you those external eyes and ears that opens you up to things that you're just not seeing. And that's for everyone. Julie Sias:                      00:23:27           Yeah. I actually have a perfect example of this and it was when I was just graduated and I was a licensed applicant and I had gone to all of my clinicals and asked for a job because I needed to make money while I was studying for the boards and stuff. And so ended calling Karen up and I was just like, you know, this one job offer, I got sure, like I'll have guaranteed money and guaranteed hours and stuff, but I just, it's not sitting with me well, I didn't really enjoy that experience as much as I could have. And then you were just like, Oh well maybe that's not the right fit for you. And then I got really creative and asked for referral for another clinic and ended up getting a job that better suited me at that time. So it was kind of nice having you there cause I was in the trenches like, Oh I need to make money right now. And you were just like, no, just take a step back. And then I had all these other opportunities present themselves. Karen Litzy:                   00:24:24           Right. Right. And Jenna, that's kind of what you were saying. Right. When you graduate, like you said, all you're seeing is like, I've got debt, I need to make money. So you just take what you can. And so, you know, we don't always want to take just what we can, but you know, we want in an ideal world, we want to take what fits from all perspectives, what fits for the employer, what fits for you as a potential employee, what fits for you, whether you want to be an entrepreneur or you know, a part time entrepreneur, full time, whatever. But I think as a healthcare provider, if you find that job that fits, it just allows you to help more people. Karen Litzy:                   00:25:19           Right? And in the end, we're in the business of making people better. And if you're not in the job that allows you to do that or you're not in the head space that allows you to do that, then the people who ultimately suffer are not you. I mean, you do a little bit, but it's the people that we’re out there to help. We're there to help people. That's what our job title is. And so if you can't, you're not in a good head space to do that or in a good physical space to do that. Then I think it becomes very difficult. Like Julie said, well, I had a great day. I was able to do the things I want to do that keep me sane. So that when you show up for your patients, your clients, you're showing up fully for them. That's where I think the PT profession can Excel for sure. Jenna Kantor:                00:26:24           When I was filling in for PRN work, I would come in energized, positive. I would walk in and go, let's do some physical therapy. We're going to heal. And like people loved me, or at least I believe they did. I had the patients even though I was a substitute teacher, which is how I introduce myself. Jenna Kantor:                00:26:45           Like I really bonded with these people, you know, and I have that energy, but Oh yeah. If I had one full day or Oh my gosh, forgot it, two or three, Oh, can maybe have at once. Oh my God. Full days in a row, I would need days to recover, days to recover. Like I was like, I was gone, I was gone. I was like sleeping, like just feeling so tired throughout the day and it really made it so apparent to me that everyone else is doing this six days a week, maybe five, you know, I don't know, depending on there schedule, but I was just, Oh my God, I can't, you know, hence here we are a private practice owners on this call. Yeah, exactly. Karen Litzy:                                           Now let's talk about what's in store for 2020 new decade. New year. Jenna Kantor:                00:27:44           It's my birthday. I'm turning 40 years old. That means I'm going to be so mature. February 16th. I like flowers, see's candies and cats and Disney for anyone who wants to know. Yeah, we're getting a dog. But like I'm more of a cat person so, but it has to be cute cats cause there are those presents. But 2020 is going to be awesome. I'm sorry, I just jumped in. But I'm theater people love talking about themselves being the center of attention. It's great. So I am so excited about fairytale physical therapy. For those who don't know, Fairytale Physical therapy is where we bring musical theater shows to children in hospitals and teach choreography that’s secretly composed of therapeutic exercises. This whole past year we've been working on paperwork back and forth with the lawyers to get it done right. Jenna Kantor:                00:28:42           And we're like almost there every time. Like people ask, it was just us liberal almost there. Right now we're trying to get the right legal name because it's not as simple as you would think. So we're trying to figure out that legal name where they're not straying too far from what we are. And so that's going to exciting. And then for me, I am doing a lot of one-on-one beta tests with performers, for one course an online course for performers to essentially, those are going to be mini courses like say you have, hip tendonitis. All right? Now the majority of non-union musical theater performers do not have health insurance. And if they do, they have extremely high deductibles. So they usually just don't get help. So this is creating a wellness program that will be on that boundary of like, Oh my God, you doing like physical therapy stuff, but y'all do. Jenna Kantor:                00:29:42           It's about the patients. So I'm creating this for them. The people who don't have that access, they don't have the money, they don't have all that, where it's a program and right now I'm just testing it on people cause it's physical therapy. You have to test on people and see if it works, if they stick with it. And so that's really cool. So I'm literally doing it, I'm doing three different types of injuries, right? No, five injuries right now. And taking different people. They're essentially like patients where I'm talking to them every week and like upping the game and figuring out symptoms. So that's great. Move that over. Now I'm also starting next week, just walking into the new year one on one work with physical therapists who want to work with dancers and figuring out what they want to know to make them the confident, accessible and go to dance PT in their area. Jenna Kantor:                00:30:35           So I am working with now five, it was originally three 50 minutes ago, became five. I'm working with five and figuring out what they learned and basically giving, creating a course from this. So I'm very excited about two things cause it's where I want my energy to go. I love doing, like we were saying, find what you like doing. I like doing the creation of online stuff. And I've just encountered so many people with limited access to performing arts, physical therapists who specifically know that. And if they do know that our hearts, they don't have the insurance. You know, there's a lot, a lot of people in this world who don't get it. So I'm very excited to be bringing that help to performers at large. Whether it be giving that education to physical therapists or providing a program to them directly so that is exciting! Julie Sias:                      00:31:36           Jenna, I was like, I'm going to bring like some California chill into the conversation because when I think about 2020 it's more just like, okay, I got my income streams and their proportioned a certain way. I want my business to grow more than the other ones and slowly phase those out. So that's like my intention for 2020 but then every other intention has nothing to do with physical therapy. Karen Litzy:                   00:32:12           I love it. That's good. Julie Sias:                      00:32:16           I’ve just been spending too much time thinking about physical therapy this year too much time, so next year I'm just thinking about more time with family, more time exploring hobbies and stuff. Maybe then I'll feel refreshed and have some inspiration to do more online type services and stuff like that, but just going into 2020, I have I don't want to say low expectations, but just I don't want to set too many things, just see where it goes. Karen Litzy:                   00:32:40           You have sort of more relaxed expectations, so not that they're low. I think phasing out your PRN jobs and increasing your income that’s a big job. And it's awesome. So I think that's a great thing to focus on. That'd be fabulous. Julie Sias:                                              Karen, you haven't told us about your 2020. Karen Litzy:                   00:34:09           Why I am going to do nothing? No, I'm just kidding. I'm just stepping back and I'm going to live the life of Riley for the whole year. No, no, no. I am going to continue obviously with my concierge practice because I love it. I would like to take on another independent contractor onto the practice as well. Just to, even if it's just one or two patients a week, you know, just something to kind of help offset the amount of time I'm spending with patients, which I love. But, it's a lot. So oftentimes I get caught up working in the business instead of on the business. So that's something that I'd like to kind of get a better balance of. And I am also in the final stages of putting together an online program. I know I said I was going to do this year, and I did it because I was too fearful and just was too afraid of like, no one's gonna buy it. I'm going to look so stupid. And with that, you know, it's clear that has been holding me back. But I've been working with Adrian Miranda also. So he helped me with some videos and worked with Joe Tata, to help me come up with a great plan. And I've been working with copywriters throughout the year and some business coaches. And so I have a program that I was calling strictly business mastermind, but now I think we're might change it to the private practice mastermind, but that might be changed. I think someone else has a name that's pretty similar. Jenna Kantor:                00:35:20           You could do PP mastermind, so you could say pee pee like professionally, which would be funny. He'd be mad. Karen Litzy:                                           Oh boy. I didn't even think of that. Now that private practice mastermind PPM, I may need to rethink this. But we're hoping for like an end of January launch and it's not just me, there's myself, there's lawyers, there's accountants, there's PR professionals, marketing professionals, investment professionals, you know, investment 101 for entrepreneurs kind of thing. Got other successful physical therapists are going to come in and that's just the six week part of the course. So six modules over three months, but then it's a year long program. So each month I have new mentors coming into the group to talk about whatever the group is looking for. Whether that be, you know, practice succession or tax stuff, student loan stuff, whatever. Karen Litzy:                   00:36:38           So we'll have monthly webinars for the whole year. And then the best part is I'm doing the Marie Forleo model. So Marie Forleo started a B school, which is an online kind of business school, like abbreviated business school that she started several years ago. And once you purchase it once, that's it. So if we do it again and there are things added to it, you're always in the Facebook group. You don't get shut out of the Facebook group after a year. You don't have to pay for upgrades and all that kind of bullshit cause I think that's so stupid. So I'm going with the Marie Forleo model and it seemed to serve her well since she's made millions and millions of dollars and she's just helped so many people. And I think they just know that like, Hey, this is the deal. And so once you buy the program, once you're in it for life and you'll get the benefits of that for as long as you need or want said benefits. Karen Litzy:                   00:37:41           So I love it. I kind of liked that model. I just think it's, I dunno, it just fits my personality a little bit better, you know? So, we'll come up with a name, and then we'll unroll it hopefully at the end of January. Jenna Kantor:                                        Karen Litzy’s LIT program. Karen Litzy’s Master class cause you could do lit in LITzy. So that'll be like the fire. Oh, I see what you mean. That's a topless pizza delivery man. I dunno. I just, I was thinking lit. That's red fire color and nothing. What else is fire color? Oh, pepperoni. And then I went to pizza and that's where we got. Karen Litzy:                                           Well, I thought it was because I am from the pizza capital of the world, which I guess would make sense. That would be amazing. I love that. Yeah. Yeah. Old forge, Pennsylvania. Plug for my hometown, pizza capital of the world. But yeah, so, but that's pretty much. And then, I also am going to take a vacation. Julie Sias:                                              Where are you going? Karen Litzy:                   00:39:08           I don't care, but I'm doing it. I don't know where I'm going yet, Julie Sias:                                              You should go to Hawaii. Karen Litzy:                                           I love Hawaii. It's so nice. Jenna Kantor:                                        This morning you, I don't know what it is, but one, I have a friend that's gone on vacation that is when I decided to contact you. So it's not on purpose. It's just so when I'm contacting you I'll be like, wait a second. She's probably obvious. She's in Hawaii. She's in Hawaii. Karen Litzy:                                           So we'll see. I don't know, but 2020. I am definitely, cause I have not had like proper vacation in a long time. So my goal, one of my biggest goals, and this is not PT related, kind of like what Julie said, but is take a vacation and love that with Brett. He just doesn't know it yet. Karen Litzy:                   00:40:03           We just have to be after June. He worked for a state Senator in New York, so he's in session until in Albany, you know, you gotta, you gotta do what you gotta do. And then the other thing that I want to do, and Jenna can probably help me with this, is get a little more involved on the legislative side of things. Jenna Kantor:                                        Love that stuff, man. You want, it's that be the change you want to see in the world. Karen Litzy:                   00:40:50           That's another thing that I'd like to do, whether it's PT related or not PT related, but just try and push for things that I believe in that should be happening. Jenna Kantor:                                        So I think this has been the best podcast ever. I think for all of us were overjoyed to have us have cats. Julie, where's your pet? Julie Sias:                                              She's outside. Jenna Kantor:                                        There's that dog, a dog and two cats walk into a bar. Thank you so much for having us on Karen. Karen Litzy:                                           Yeah, this was great. And I'm just so happy to wrap up the year and I'm looking forward to lots of great stuff from everyone and with the podcasts and just kind of keep moving forward and trying to innovate and do some fun stuff. So that's the goal and I thank both of you. So Jenna, Julie, thank you again. Like I said in the beginning, I appreciate you guys so much for all of your hard work and help and making the podcast much better than it ever was. So thank you so much. And everyone we're going to take a quick break to hear from our sponsor and we'll be right back. Karen Litzy:                   00:42:20           This episode is brought to you by Optima, a net health company. Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. You can check out, optimize new on demand video to learn what's in store for outpatient therapy practices in 2020 with some of the biggest industry trends along with tips and best practices to successfully navigate these changes. Learn about these trends for the new year at gooptimahcs.com/healthywealthy2020. Karen Litzy:                   00:43:00           Hey Lex and Shannon, welcome to the podcast for our year end wrap up our year in review. So thank you so much for coming on and being on the other end of things for Shannon and the other end of things for Lex too. So thanks so much. So I spoke with Jenna and Julie the other day and now I have you guys here and I'll say the same thing to you guys that I said to them is that I'm so thankful and appreciative of both of you for being part of the podcast and really elevating it to a new level this year. Cause I really do feel like without your help and without your contributions that it just wouldn't have been what it was. So I just want to thank both of you and know that I appreciate both of you for your work in front and behind the scenes. So thank you so much. And now let's talk about 2019 because now is the time of year that everyone looks back on the year. So I'll ask the same question of both of you. Karen Litzy:                   00:44:14           Where were you at January of 2019 versus kind of where you are now. So Lex, why don't I have you start kind of what big things happened in your year? Where are you now? So it's way different than where you were in January. Lex Lancaster:               00:44:32           Yeah. It's pretty crazy to be honest. I was thinking about it last night. This time last year, I was preparing for my last clinical physical therapy school, so I was actually going to New Hampshire. Mmm. I was going to be in an outpatient clinic for 13 weeks. I was super excited because it was my last one, but I was also getting that full 13 weeks in outpatient clinics. I was like my powerful clinical, so super pumped. So I finished that and then I went to graduation and I actually got engaged on white coat night. So that was really, it was awesome. Kyle did a really good job. And then I graduated PT school, it was so awesome. I was so happy. And then the NPTE came around and that was a different experience altogether. I will say that I underestimated that completely. Just the preparation for it as a whole, but then I passed. So that was great. And then now, so I had this dream of being a travel PT. Lex Lancaster:               00:45:42           So, this past year, you know, I decided I was going to explore that. So right after I passed the NPTE, I accepted a contract with my fiance in Alaska. So we moved 3,500 miles away from home to an Island of 1200 people in Alaska. So now we're in Ketchikan where it's like the rain capital of the world. So I don't look at rain as like, let's keep me inside anymore. It's okay. It's always raining. It's never not raining. And it's pretty dark here. It's pitch black still right now. So we're currently in Alaska and an outpatient clinic. And to be honest, it's been a whirlwind transitioning from student to kind of a PT, but you're just studying for your exam to a full blown PT. It's been hard just because I didn't expect it. You know, I've done clinicals, I'm like, Oh, it's no big deal. It's totally different when you're the person. So I've spent a lot of time in the last 13 weeks just kind of getting used to that and getting the groove and I’m excited. I'm excited to see what the next year will bring because this year was just really, really awesome and I'm really excited for, you know, to see what's next. Karen Litzy:                   00:46:52           And you also, not to, I don't want to leave this out, but you also have an entrepreneurial streak in you. You have a company that you started this year as well. Am I correct? Lex Lancaster:               00:47:05           Yeah, yeah. And I shouldn't, you're right. So I guess I initially launched it in like the end of 2018 but this past year has just skyrocketed. I just went from, I mean, I guess word of mouth is kind of the way that it really worked out. And I get to design websites and graphics and I am a virtual assistant, so I get to work with people all over the country and all different professions. I have so much fun doing that and I started it in PT school as I admit. I used to do it when I was bored in class. And then, you know, it got to the point where that was how I took study breaks. So that was the way I decompressed and I found that that was a big stress reliever for me. Lex Lancaster:               00:47:56           So I explored that option and then I was kind of talking to Shante, movement Maestro and she was like, you know, you could really do something with this because I approached her at RockTape course and I was like, Hey, do you need an assistant? And that was right after I started working for you Karen. So like I was feeling pretty good. I was like, this is fun. I love doing this. And then I decided to do the whole web design business too and big changes for that coming next year. So yeah, it's been, it's been really, really cool. I've learned a lot about a lot of different people and I get to explore that all the time and I love it. Karen Litzy:                                           Yeah, I think that's great. What would you say to a physical therapy student right now? Who is set to graduate in, whether it be, maybe they're graduating now or maybe it's spring of 2020 given the huge changes that happened in your life over the past year. What would you say to them as they prepare to graduate or maybe they just graduated? Lex Lancaster:               00:48:48           A couple things I would say I would say really explore your mental health. I think that I didn't take that route when, as I was graduating, preparing for the NPTE and I feel like I truly drained myself to the point where if I could go back, I would invest in, you know, even a coach just to get me out of that sympathetic drive because I feel like my life just kind of, I just devoted all of my time and energy to the NPTE and it really did drain me. And, it was just a lot to manage. So let's say explore your mental health, get that in check and you know, really be prepared to learn a lot and find yourself in whether you're in your last clinical or just starting your job, you know, if you're the smartest person in the room, try not, you know, try not to be that. Lex Lancaster:               00:49:50           Like there's always something to learn and it's hard to go back to be in the clinic and be by yourself and not have someone to bounce ideas off of that's in your room. Like your CI. It's hard. And I truthfully would say get involved in Twitter. I've found that I've met the most incredible PTs on Twitter and I get so much good advice from them and I'm able to contact, you know, people have specialties that come into the clinic and I'm just like, wow, they could use some opinions on, you know, the vascular aspect and I'll find somebody on Twitter and they are more than willing to help me. I would say just reach out if you have any questions about patients because there are so many PTs on Twitter and social media in general that would help you. So I would say just keep your network huge. Karen Litzy:                   00:50:36           That's great advice. And you know, I feel like this, the first time I heard someone say take care of your mental health. I mean Shannon, like we've been the NPTE or the boards and on through to our career. Have you ever gotten that? I never got that advice to kind of take care of your mental health. I think it's great. Shannon Sepulveda:      00:51:00           Yeah. I mean I think it's super important. I mean, one thing like when I was a runner and an athlete and so I always made sure that like I worked out every day cause that really helped. But I remember like, just wait until you take your specialized board exam because then you don't get your results for three months. So it's like three months of like, okay, like is it June yet? You know? And so you don't even like, and like when I took my women's health board exams also I was postpartum so that like added a whole new mental health aspect to it. But I mean I studied for, you know, probably six months, probably pretty intensely for three months. And then you take the exam and it's very similar to the NPTE where you're like, I don't know if I pass this because the questions are similar where you're just like, ah, yeah, I don't really know. Shannon Sepulveda:      00:51:55           And then you have to wait three months to know if you pass. And so that's really hard. Lex Lancaster:                                       I'll say a week was really hard. So I give you a lot of credit. Yeah, I know it was a hard, and you walk out and you're like, then I have never felt like I have completely bombed a test, but I feel like I just bombed that and then everyone's like, don't worry, this is normal. Shannon Sepulveda:                              Oh, it was sort of like, even with like my women's health exam and then I was like, I think I failed that. And then I ended up getting like in the top 10 or 25 it was something like I did really well on it, but I thought I failed it. Lex Lancaster:                                       It's so odd that our brains do that, that all we remember all of the negative questions. We forget how many good ones there were and then we just kind of wrap around that. Karen Litzy:                   00:52:51           Yeah. And that's life, right? That's why people always say to like, keep a gratitude journal at night. So then you remember the good things that happen to you every day and you don't get wrapped up in the negative because I think that's, like you said, it's kind of where our brains tend to go. We remember those negative aspects before we'll remember the positive ones. It is amazing. Shannon Sepulveda:      00:53:15           Yeah. It's the same thing with patients. Like who do you go home and think about the one patient that didn't get better, not the six that you made better. Karen Litzy:                   00:53:27           Totally. And now, Shannon, speaking of changing lives, so going from January till now, what's been going on? What were your highs and lows and just so everyone knows, I mean they can go on the website, but you're a business owner. You're in Bozeman, Montana. And one of the only women health specialists in the state of Montana? Shannon Sepulveda:      00:53:53           I'm the only one that's taking the board exam. A couple women in Montana who have done the Herman and Wallace pelvic floor and they're super highly trained and there's other people in Bozeman that are women's health physical therapists, but I'm the only one that's taken the plunge to take the exam. But yeah, so 2018 so I know, I was thinking about this question. So I've been in my own practice for a little over two years. And so I was thinking, I'm like, where was I in January? And so since I take insurance, January is always like dead pretty much, but December is always nuts. I think I was still building my business like last January. I didn't really like have a full schedule. I had been in business for a little over a year. Shannon Sepulveda:      00:54:45           I changed my last name when I left my old clinic, just kind of to make a clean break with insurance and everything. And so I was still trying to get like name recognition and I do women's health also getting into like the Perinatal community in Montana. And so this year I'm finally like, like doctors know who I am and patients come in, they're like, I got referred by, you're like so-and-so. They said you're awesome. And so I'm getting like all of these women, especially postpartum women, that's generally who I see, who were like, Hey, so and so like saw you, you changed their lives and I'm here. And so I would say like probably well over 50% if not 80% of my patients are direct access word of mouth. And I'm just like, Oh, this is so nice because I don't have to like network anymore. Shannon Sepulveda:      00:55:49           I don't have to like spend my nights at like local networking events and which I was doing just to get some name recognition and now I feel like I can, I don't want to like totally rely on word of mouth. I still think I need to get out into the community but it's really nice just to like check my phone. I do online scheduling and be like someone's requesting an appointment and another person's requesting an appointment and know that like the patients are coming without me having to like really go out and spend a lot of time, which, and I think doing that really helped me now. I think I had to do that but now it's nice where like it's almost like an exponential growth cause moms tend to talk, which is really nice. And so the word of mouth has gotten really great for me. Karen Litzy:                   00:56:37           That's awesome. And you know, I think you bring up a really good point that you were in business for a year and you had a patient flow but it wasn't like you were overwhelmed and you know, you didn't have this full, full schedule. And I think for people starting out in business that is so important to realize that you don't start your business and in two months, it's rare it could happen. Yes. You're not usually on a full schedule within a month or two. Shannon Sepulveda:      00:57:09           No. And I think what was really important was like the time that I wasn't seeing patients, like I took that time to either like have lunch with somebody, like have lunch with a prenatal yoga instructor or like have lunch with, you know, really anybody, a doula and midwife, like whatever. And so I really like had a lot of lunches and coffees just to like meet people. So when I wasn't seeing patients, I was trying to meet people in the community. And I feel like those like one-on-one rather than like the big networking events were really important. And I sent like, it was great for me too because like I want to know who to send to for prenatal and postnatal yoga and I want to know who the good doulas are and who the good midwives and OBs are because I send people their way and who the good like trainers are that understand pregnancy and postpartum because I'm not a trainer. Like I get people to not pee their pants so they can go to the gym and see the trainer. Karen Litzy:                   00:58:10           Correct. It could be your slogan. And you know something that would work. Shannon Sepulveda:      00:58:19           Yeah, it was funny cause Shayla, the one that I did the podcast on with the hats she wanted, I got a bunch of my hats embroidered and she wanted me to put on the back leak-free thanks to my PT and I was like, that's awesome. You know, I don't know if people will wear that, but that's a really good slogan. Karen Litzy:                   00:58:39           That's great. I mean, you're really good at what you do. No, I mean that's great because what do people want? They don't, like you said, like I get them to not pee their pants so they can do other things. It's that simple. You don't have to overcomplicate things. Yeah, but I love that you're still kind of doing business. I call it like business generating activities, you’re not getting paid for it, but it's business generating activities, so it's still like a moneymaking activity. And you're right, the bigger, like Lex said, the bigger network you have, whether that be virtual in your case, because your business is in Bozeman, the bigger network you have a Bozeman, the more people are going to come your way. And so you did all of that work and now you're really starting to see the benefits of it and it's really exciting. Shannon Sepulveda:      00:59:28           Yeah. Karen Litzy:                   00:59:29           It's also good that you know the cycles of your business. So you know there's going to be really bit busy but January, not so much. You'd be like, okay, so January I'm going to set aside this time to do X, Y, and Z for my business. And if you know that those are the ebbs and flows because every business has an ebb and flow, then you know you can rely on that. And like I remember for me, my downtime is now around Christmas, new years, not a lot of people around. So that this would be the time where I would take a vacation or I would work on business plans for next year or I would, you know, just get things together. So, so to speak. So I think it's great that you brought up all those points. And Shannon, what would you tell a new business owner, regardless of what kind of PT business you have, whether it's a cash based business or your insurance or a hybrid, what have you learned that you're like, Oh man, I would tell everyone this. Shannon Sepulveda:      01:00:29           Yeah, I've learned that if you're good at what you do and you get patients better, they will tell other people. And so I don't want to say think of every patient as a referral source, cause that sounds like you're, you know, it sounds like you're categorizing them. But think of every patient as like, this person is very important. It's very important for me to get them better because that's what I do and what I'm good at. But it's also very important for my business because if you get them better and you treat them well with respect and you do everything, they're going to tell other people, especially in a small town. And so like I am very, like sometimes I come home and like after seeing like patients for an hour, so like I see like seven patients and that's a big day for me. Shannon Sepulveda:      01:01:22           And I am just like compassion fatigue is like full on set in because like I am so engaged for that period of time and with my population it's really important because it's really important for, they just need someone to listen to them. But if you think of every patient that way, it pays back. And every word that you use with the patient is very important. Because they come from like sometimes doctors that say things that I wouldn't necessarily say to a patient and they come in with, you know, thought viruses. Thank you Lorimer Mosley and you know, just talking to them but being really compassionate, you know, with all for your patients. Yes. Really in the end. And sometimes it's hard at like four o'clock at the end of the day, but it's really important. Karen Litzy:                   01:02:16           Yeah. And I always think of your patients instead of like you said, referral source, cause that is a little, that's, I don't know how to like how would you, I described them as ambassadors. Karen Litzy:                   01:02:30           So they become ambassadors for my practice. And that's the way that I don't treat them as a referral source. I treat them as an ambassador. So someone who chose because of the care you gave to them, you know, I would love for you to see this friend of mine or my daughter or my cousin or my, you know, X, Y, Z person, my coworker. Because like you said, you're listening to them, you're treating them with respect and kindness and compassion. And so to reduce that to a referral source is, I don't know, I agree with you. I like to use ambassador because they're new, that they want to be part of what you're doing. You pulling them in and saying, Hey, I'll give you a free X, Y, Z. If you refer me to five of your friends. Shannon Sepulveda:      01:03:24           But because they're choosing to represent you and they're so excited to tell people like that's what is so awesome about what I do is like, like I'll see people and be like, thank you so much for referring your friend. They're like, Oh my gosh, I am telling everybody because like we don't have to pee our pants anymore and we don't have to have painful sex anymore and this is just so great. And I'm like, yeah, it's great. Karen Litzy:                                           And Lex, you'll get more of that as you practice more, you know, you'll get people coming to the clinic you're in specifically to see you, which you might've already gotten so far is you're in this small town, right? Lex Lancaster:               01:04:07           Yeah. I actually wanted to say that because you used a word Shannon, you said, or a phrase, compassion fatigue. And I find that as a new grad, I'm learning how, cause that's me every day I do that. And you know, my patients come in and on the Island we don't, there's not a lot of doctors. The practitioners here, you know, they have to go down to Washington to see a specialist. So oftentimes people will come in with, you know, a lot of comorbid conditions and we have to sift through all of that and make sure they've seen the correct people. So there's nothing I love more than getting on the phone with four doctors for one patient. So, and I've found that like, that's caring about them and I'm like, Hey, look, I'm going to reach out to your doctor. And they love that. And, but I do find at the end of the day that I'm exhausted. And so I'm trying to find that balance where I'm giving, giving, giving, but also saving a little bit for myself at the end of the day. But yeah, there's been patients that are like that, Karen, they just, they're like, Oh, I've told my friend. And then that friend comes in and then they come see me and it's just like, this is amazing. And that's why I could see why having your own business, why that's so important. Because that word of mouth aspect, you really can't replace that.            Karen Litzy:                   01:05:24           Yeah. Yeah. And you know, I think most PTs have that kind of compassion fatigue. And one thing that has helped me is, I remember it was at, Oh, I dunno, it might've been Jason silvernail might've mentioned it on Twitter. I'm not a hundred percent sure, but I remember. So I think it was him saying that the thing that helped him the most and he's in the army, the thing that helped him the most is, is finally realizing that somewhat he is not responsible for a patient's outcome, that the patient's responsible for their outcome. So and that's hard because you're investing your time and your compassion and your emotions into this patient and your skills. But once I realized once I was able to kind of separate myself from like I am not the fixer, I'm there to guide and to coach and to diagnose and treat but not to fix and can separate the fact that I'm not responsible for this person's outcomes, that the person needs to embody that. Karen Litzy:                   01:06:32           Then the compassion fatigue is less, it's still there because we're all humans, but it's much, much less. And when you instill that into your patients, it's really fun. Like I had a patient who had chronic neck pain for five plus years and came in and he had stopped running, working out, doing this, doing good, going to CrossFit, doing everything. And I said, well, why, why, why do you think that is? And I understand I was the same way. And so we got him back to doing things and I would see him once a week, once every other week now, just once a month. And he's like, yeah, so I had like a week. I was like, I really didn't have any pain. He's like, and you know, it's because he's like, I work out like almost every day now. He's like, so you're here but it's not like what you're doing to me. He's like, I'm working out and that's what's making me feel better. I'm like, yeah, exactly. He was like, what? You gave me permission to work out again? I was like, yeah, I can do this. And I was like, I was like, you got like, that's exactly what you hope to hear is like, yeah, got it. It clicked. And you can tell it like clicked for him at some point that week. Like, I'm helping myself get better. Oh, I see how it works. Got it. Shannon Sepulveda:      01:07:51           Yeah. And that's, I think really like, it's hard. Like I try really hard not to make my patients dependent on me. Like I try really hard. I was like, my job is to empower you to get yourself better. Like I give you the tools to get yourself better and I don't tend to do a lot of like if someone's in like acute pain, I'll do some manual therapy, but I don't tend to do a lot of manual therapy because aye I can see like sometimes they'll become dependent and my job is to be like, no, you can do this. Like you, you can do this. It's all you. Karen Litzy:                   01:08:29           Yeah. And all the research that like Lex, I feel like, and I don't know Shannon, you could probably agree with me here, but I feel like Lex and like you guys and your new grads, like you guys are starting out on like second base. I started out, I didn't even start out in the dugout. Like when I started, I feel like I started out in like the showers. Like I didn't even get to the dug out yet. Karen Litzy:                   01:08:50           You know, with all of this sort of patient forward care and you know, the science behind pain and all this stuff that's this new research that has come out in the last 10 to 15 years. I feel like as a physical therapist it really gives us a headstart if you're keeping up with it. So like you're light years ahead of where I was. Lex Lancaster:               01:09:14           And I would say a lot of it too is because of people that share things. Because you know, even like on social media, you see something and someone shares, whether it's at a snippet of an article or something, you're like, where did they see that? And then you go read that and you're like, Oh wow, that was awesome. So you know, people post the books that Lorimer Moseley's books and you know, you see those posts, you're like, Oh, I should read that. And you read it and you just gain all this knowledge. And like I said, I feel like a lot of it is dependent on people that share things. So, you know, all the podcasts that are out, especially, I mean, especially yours, Karen, to be honest, I'll say, I look at all yours and I'm like, Oh my God, that's so amazing. So yeah, I feel like we do have an advantage, I would say, especially with the pain science literature, new curriculums like that, that like just the education piece that I give for pain, people just are like, Oh, okay. And then it's like immediate buy-in and it's so easy to just get people to, like you said, get ready to help themselves Lex Lancaster:               01:10:13           We're very ahead of the pain science literature. Karen Litzy:                   01:10:19           I know I looked back and I'm like, Oh man, I'm grateful. I'm so grateful. I'm better with these people. Shannon Sepulveda:      01:10:22           Oh yeah. I mean, I graduated in 2011 and there was nothing really, Oh yeah. I mean, well, in my PT education there was, yeah. I started learning some stuff after that, but there was nothing in my PT education about pain sciences and that was like, so I would have had like didactic until about 2010 early, you know, so I know it's like 10 years ago. Karen Litzy:                   01:10:59           I know. And like David Butler first published on sort of pain science stuff in 1996. Wow. You guys look it up. It was 96 or 97. And so, you know, we have, they say research to practice takes like 15 years. Shannon Sepulveda:      01:11:18           There it is. There it is. Karen Litzy:                   01:11:20           It's amazing. It's astounding to me. And, I find that if you stay engaged as a newer grad, that you really do have such an advantage, and advantage with your patients and I hope that people really no that and can appreciate that. Then new, newer ish grads can really appreciate how lucky they are coming up. As far as information, the information pipeline is so much easier. Now. I won't even tell you, like I had to do the Dewey decimals system. I'm so old. Shannon Sepulveda:      01:11:56           We were cleaning my house and I had all of my PT books and like my husband, so he works for the US geological survey and he has a PhD and I had all my PT books, what are you doing with these? I was like, he's like, have you looked at these in 10 years? And I was like, no. And he's like, everything's online now Shannon, you can get rid of these. Yeah, yeah. And like everything. Karen Litzy:                                           I got rid of my mind a couple of years ago. I'm like, what did I doing? And even if it's all these journals, like physical journals in my apartment, I'm limited space here in New York. I'm like, I gotta get rid of these journals. They're taking too much space. Karen Litzy:                   01:12:52           So let's talk about what's coming up in 2020. So what are you looking forward to? Do you have any goals or expectations or plans, whether Lex, I'm assuming you're going to get married. Lex Lancaster:               01:13:07           Yeah. So we finally set a date. The wedding has been interesting. So I didn't really want a wedding just because it is, it's overwhelming. It's a lot of stuff to plan. But then, you know, family, they're like, Oh, well you're the only girl. You really should do it. So we set a date for October 17th of next year, so we're going to get married in New York. I've done minimal stuff. I've gotten the venue, really making very slow progress. Lex Lancaster:               01:13:36           So working on that and then you know, for 2020, you know, I'm really looking at bringing, I just applied for a trade name for my business so I could take my name off it and just make it a new name. So I'm really excited to launch that eventually once I get that all set in stone and really trying to bump that side gig up just because I have found the value in the last couple months of doing things you like to do more often. So Kyle and I were actually talking the other day and you know, we're seeing the value of providers that have their cash based or insurance businesses and these small towns in their hometown. And we're seeing the value here. Like you get to know people, you get to know doctors. I love travel PT, I do, but I'm very far from home so I'm hoping I get closer back to home and we kind of want to land in a spot where we can kind of start our own thing. Lex Lancaster:               01:14:34           We were those people like we care, we want to reach out to people out. People know us back home. And we really wanted to start our own thing. So we're trying to get back toward, well and try to do that just because I see people, you know, as they have their own business, they make so many decisions that they get to see patients when they want to see for how long they want to see them. And sometimes, you know, I'm very jealous of that right now. You know, there are patients that I'd love to spend an hour and a half way, then I just can't. And so I think that's a major goal right now. It's just to get to that spot. And I understand as a new grad it's very hard. Yeah. I mean, I don't, and Julie did it, so I should probably reach out to her because, you know, everyone says like, it's really hard to do a business on your own as a new grad. Lex Lancaster:               01:15:21           I should reach out to her because that's what we want to do. And you know, we understand that will probably be hard, especially with student loans and whatnot, but at the same rate, like we're trying to define, you know, what's your happiness worth? And we just kind of find that right now the quality of care that we want to provide is sometimes limited by you know, whether it's because of insurance, a lot of dancers and we're finding it hard to justify their care even though they need it with insurance and people can't afford to do X, Y, and Z out of pocket. So we're trying to find, navigate all of that. So, I dunno, trying to, that's a goal just to get to a place where we can build our own, you know, set of patients. Karen Litzy:                   01:16:04           Awesome. And you're in upstate New York? Lex Lancaster:               01:16:08           That's where I'm originally from, but we're probably going to end up back in New Hampshire. Yeah, we both really love it there. And I don't think my parents will be in New York forever, so I think we're just going to go back to New Hampshire area. So we're close to Boston. Karen Litzy:                   01:16:23           Yeah, I think that's a great goal. And you should definitely talk to Julie about that. And the good thing is you have each other to give each other support. You and Kyle have each other so you can, you have that support from each other. And I think being able to do that with the two of you I think would be really exciting. Karen Litzy:                   01:16:42           If you build up your side gig, then you can slowly build up your practice. You know, you just to know where you have those income streams coming from. But I think that's cool. Lex Lancaster:               01:16:52           I'll say after reading Danny McTay’s book, it kind of gave us both a little hope of just that you can do it. It's just you have to decide if you're going to burn the ship or do it as a side gig for a little bit. And I think we're more or less thinking side gig for a little bit, even if it's just something, something to let us treat, you know, the high level athletes that we can't justify insurance-based for right now. Karen Litzy:                   01:17:18           Yeah. Basically. Yeah. You should talk to Julie cause that's what she's doing. She's sort of building it up slowly. We talked about it for this podcast. So. Perfect. And how about you Shannon? What's coming up for 2020? Shannon Sepulveda:      01:17:31           I was thinking about this, I'm like, what are my goals? So business is really good, which is awesome. I think one of my goals I need to try. So I really don't want to hire anybody. I do all my own billing, all my own scheduling. I see my patients. I need to try to figure out time management a little more. Because like I'll be in like I take Fridays off and I'm with my daughter and sometimes my son has off kindergarten on Fridays and I'll be like in the target parking lot. And now they know when I stopped the car and I like sit in the parking lot space, I'm like checking my email. They're like, mommy, don't check your email. We need to go into the store. And I'm like, like accepting patient appointments or just like, you know, I need to try to figure out how to do that because I want to do everything. Shannon Sepulveda:      01:18:26           But for myself. And so it may just be like saying no, it may just be having a wait list and trying to figure out like the feast or famine of owning your own business, like these ebbs and flows where like this month is like just absolutely nuts. Like I had five people call me in the last week trying to get in before their deductible resets. And so like I have like, I'm taking next week off and I'm not seeing anybody but like the 30th and the 31st, I think I'm like seven patients a day or something like that. 31st I have patients to like five 30 on new year's Eve because like, they're like, Oh please. And I'm like, okay, okay. You know, and because I know January is going to be really slow. And it's really hard. I'm staying up till 11 o'clock at night to finish my notes. And so I think either I just have to accept that that's the way it's going to be or do a little bit more time management. Karen Litzy:                   01:19:26           Or even sounds like maybe just setting your boundaries or boundaries for yourself and something that you're comfortable with. I think that that is something I will say that really helped me is saying, you know, listen, the last patient I'm going to see at night is seven o'clock at night. Like I'm not going to go later than that or I'm going to take at least one day off. Yeah. It may not be, may not be a Saturday or Sunday, but I'm going to take one day off during the week and this past what I've done is that I'm going to take five hours or four hour chunk of time and have that just dealing with business kind of stuff. You not teaching care. So I think if you look at your schedule and kind of set your boundaries, then I think you'll find that your time management just flows within that. Or you can get a virtual assistant. Shannon Sepulveda:      01:20:19           I know I could do that. Yeah. It's funny cause like for some reason my boundaries… Karen Litzy:                   01:20:24           Cause you're like me Shannon. I'm the same way. Like, I love to like keep everything close to me, but the moment you can like let just one little bit go. Karen Litzy:                   01:20:46           You'll be like, what the hell was I thinking? What would be the sooner? But you have to do it on your own timeline and when you feel like you can, you can let go of that. A little bit of control. Like I let go of like a smidge at a time. Yeah. And then for me it was easier then. Shannon Sepulveda:      01:21:03           It's really interesting because I think about, I'm like, okay, as a business owner it is not worth my time to spend. Like I tried to keep my Mondays as admin days like that is not worth my time to do. It's worth my time to pay someone to do the admin stuff, but I keep holding it in. Karen Litzy:                   01:21:20           Yeah. Yeah. That's a good way to look at it. If you have whatever your fee is, let's say your fee is, I don't know, I’m going to make this up $200 an hour. Karen Litzy:                   01:21:31           Right. The task you're doing as an admin at $200 an hour task, $25 an hour task, or maybe it's a $20 an hour task. So, and when you look at it that way, it's like what am I doing? Like I could pay someone to do four hours of work and what I get paid in one hour. Do you know what I mean? So when you look at it that way, the financial offset makes a lot of sense because your time is money. And like you said that that four hours could be an hour that you get to spend with your kids having lunch. So it doesn't necessarily mean it has to be with your business, but or it could mean that's your time for, you can go to the gym or you can do X, Y and you can meet with a doctor or doula or whatever. So you know like that is $200 an hour time spent when you're having lunch with like a possible referral source doing like weird admin stuff that you don't need to do is not $200 an hour work. Karen Litzy:                   01:22:35           That's what I did and just really like looked at everything, wrote down everything I do and you can attach sort of a monetary value to it. And then once it's down on paper you're like, Oh my God, okay. Shannon Sepulveda:      01:22:52           I know, I know and I haven't like it's interesting cause I hadn't gotten to that point until this December because like I'm still growing and so that's one of the things that I think I'm going to need to think about like, and I'm just going to see how like the ebbs and flows, like if it is still as nuts as it is right now, then like I got the, because the worst is, and honestly like the billing's not that hard. It's verifying the insurance benefits. And sometimes I can do it online and it's really easy. And then sometimes the online just tells me what their deductible is, not how much they've met. And so then I'm on hold with blue cross blue shield for like an hour while I'm trying to do other notes. Karen Litzy:                   01:23:40           And what you'll find is like you will grow, maybe not exponentially, but you will grow bringing help on, you know, I did an interview with this woman Stephanie Nicholitch, she's like a high performance coach and she said, you're trying to do it all. Keeps you small. Yeah. And, it's true, but you have to feel ready for it. So it's in your time and you'll know. Shannon Sepulveda:                              Yeah, I think I'll know. And the other thing is like one day, the other Monday I just like sat in front of my computer and I did my QuickBooks and my billing and I came home and I was like, I don't even feel like I've worked today. Yeah. He's like, I hadn't seen patient, I hadn't had that compassion fatigue. So some of it's like, can I actually handle that many patients? You know, can I give good care when I see my caseload. Karen Litzy:                   01:24:26           Yeah. And these are the growing pains that you have to deal with and it's a good growing pains, growing pains. So hopefully you'll continue with those growing pains. We hear it out in 2020. I think you will. Thank you. I want to thank you guys because like I said, if you do it all, it'll keep you small. There's no way I could do everything that is required of this podcast to keep it of good quality and to have good guests and good interviews and good graphics and good everything and make the guests feel like we're on their side, you know, and that there putting their best foot forward on the podcast. And I think that's what both of you and Julie and Jenna do is creates a good experience, really positive experience for the people who are on it. Karen Litzy:                   01:25:28           Like Shannon, we were saying like, people bought those hats and Carol and which I think is amazing. But you just never know how far the podcast is going to go. And you know, yesterday I was with some friends and we were talking about the podcasts and what's it on and you know, it's on Spotify and it's on, well iTunes is no longer a thing. So now it's just Apple podcasts and I looked up under medicine and it's like 52 out of all podcasts. For this fully female run podcasts. That is pretty good I think. Awesome. Yeah, it was really cool to see. Shannon Sepulveda:                              One of my PT friends in Bozeman. He like just moved to Bozeman a couple of years ago and he referred a patient to me and this was about a year ago and I called him and he was like, yeah, I was like listening to healthy, wealthy, smart. And you were on it. And I was like, Oh my gosh, she's in Bozeman. You were like randomly listening to the podcast and then you were like happy that it wasn't because I was in Bozeman, you were listening to it. He's like, no. And I was like, wow, that was awesome. It was a great moment. Karen Litzy:                   01:26:38           Yeah. And never know who's out there listening and you never know where, again, the podcast becomes a referral generator. We can call a referral generating. This we could say generates referrals, but it does and you never know who's listening and where it's going to kind of take you. So I think that's so good to hear. And like I was talking with a coach that I had on a couple of years ago and she's like, Oh yeah, I got two clients from you. And she referred one of her clients to be on my podcast, the one who was talking about poop. She ended up getting like three clients from being a guest. Whoa. All right. So I was like, Oh, that makes me feel so good that that's the case. So, you know, keep up the hard work and you know how much that I am thankful and appreciate it and wish both of you have very happy 2020 new decade so thanks again so much. And everyone out there listening. Thank you so much for listening all year and we all wish you a very happy new year and hopefully stay healthy, wealthy, and smart. Karen Litzy:                   01:27:58           And again, a big thanks to Jenna, Julie, Shannon and Lex for all of their work all year. And of course a big thanks to net health. This episode is brought to you by Optima net health company Optima therapy for outpatient is a software solution enabling therapists and staff to do their jobs efficiently and accurately. Their software provides anytime, anywhere access to documentation, even while disconnected and workflows that streamline patient care and save valuable time. Check out their new on demand video to learn what's in store for outpatient therapy in 2020 you can go to go.Optimahcs.com/healthywealthy2020.   Thanks for listening and subscribing to the podcast! 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