Healthy Wealthy & Smart

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization. As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. In this episode, we discuss: -Why your website is one of your most important marketing tools -The art of simplicity in branding -How to track the customer lifecycle -The top tools you need to upgrade your website -And so much more! Resources: Anne Stefanyk Twitter Drupal Anne Stefanyk LinkedIn Kanopi Website HotJar Google Pagespeed Accessibility Insights WAVE Web Accessibility Google/Lighthouse Use user research to get insight into audience behavior How to make your site last 5 years (possibly more) 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 Anne: As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne fell into the Drupal community in 2007 and admired both the community's people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013. Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she's not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew. Read the full transcript below: Karen Litzy (00:01): Hey Anne, welcome to the podcast. I am so excited and happy to have you on. Anne Stefanyk (00:06): Nice to see you. Thank you so much for having me. Karen Litzy (00:09): So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years? Anne Stefanyk (00:47): Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent. Anne Stefanyk (01:39): And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first. Anne Stefanyk (02:28): Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy. Karen Litzy (03:03): Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it. Anne Stefanyk (03:22): Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them. Karen Litzy (03:34): Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us? Anne Stefanyk (04:00): Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL. Karen Litzy (04:56): Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools. Anne Stefanyk (05:06): We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix. Karen Litzy (05:15): Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that? Anne Stefanyk (05:34): Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey. Anne Stefanyk (06:27): And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats. Anne Stefanyk (07:09): I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible? Anne Stefanyk (07:52): Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them. Anne Stefanyk (08:43): That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance? Anne Stefanyk (09:27): And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps. Karen Litzy: And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone. Anne Stefanyk (10:14): Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity. Anne Stefanyk (11:01): And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of. Karen Litzy (12:04): Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage? Anne Stefanyk (12:16): Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events. Anne Stefanyk (13:01): They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be. Karen Litzy (13:47): Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes. Anne Stefanyk (14:20): So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to. Anne Stefanyk (15:22): And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time. Karen Litzy (16:18): Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that? Anne Stefanyk (16:51): Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't. Anne Stefanyk (17:31): It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint. Karen Litzy (18:16): Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier? Anne Stefanyk: So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book. Anne Stefanyk (19:11): It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client. Anne Stefanyk (19:57): But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar. Anne Stefanyk (20:47): And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps. Karen Litzy (21:42): Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that. Anne Stefanyk (22:11): Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right? Karen Litzy (22:46): Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle. Anne Stefanyk (23:41): Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart. Karen Litzy (24:44): When you say accessibility for a website, what exactly does that mean? Anne Stefanyk (24:48): I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output. Karen Litzy (26:12): Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites? Anne Stefanyk (26:28): Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices. Karen Litzy (27:28): Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more. Anne Stefanyk (27:45): Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is. Karen Litzy (28:27): Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well? Anne Stefanyk (28:44): Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it. Karen Litzy (29:14): Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here. Anne Stefanyk (29:47): Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website. Anne Stefanyk (30:26): Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better. Anne Stefanyk (31:16): You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest. Karen Litzy (31:41): Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation? Anne Stefanyk (31:56): I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business. Karen Litzy (33:00): Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started. Anne Stefanyk (34:21): Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others. Anne Stefanyk (35:04): And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah. Karen Litzy (35:36): Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing. Anne Stefanyk (35:48): Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves. Karen Litzy (36:47): Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi. Anne Stefanyk (37:00): So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there. Karen Litzy (37:23): Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough. Anne Stefanyk (37:39): Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic. Karen Litzy (37:45): Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Gabbi Whisler on anxiety. Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found. In this episode, we discuss: -When anxiety manifests in the career cycle of a physical therapist -3 practical steps towards mastery over your anxiety -Why communication is important to break down the stigma surrounding mental health -The future role for physical therapists in mental health treatment -And so much more! Resources: Gabbi Whisler Instagram Gabbi Whisler Facebook Mind Health DPT Website A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Gabbi: Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found. "I've shared intimately my experiences with anxiety, panic attacks, alphabetizing, fixations, and suffering. Meds failed me. Doctors failed me. Anxiety controlled my life. I was drained, exhausted and defeated. I knew something had to change and I had to do it myself. I created freedom. You can too." For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University's Physical Therapy Program. She is also a co-founder of the podcast, "Physiotherapy Performance Perspectives," has an evidence-based monthly youtube series titled "Injury Prevention for Dancers," is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor(00:03): Hello. Hello. Hello. This is Jenna Kantor with the podcast, healthy, wealthy, and smart. I'm here with Gabbi Whisler, like give a little whistle and I'm so excited to be jumping on and talking about anxiety and if you can tell from my energy, Oh gosh, I never deal with that. What physical therapist deals with anxiety. So first of all, Gabbi, thank you so much for popping on. What got you interested in really focusing on anxiety for physical therapists? Why this passion? Why not just treating patients and focusing on the patients and their anxiety? Gabbi Whisler: Yeah, so it's kind of an ironic story because I was out in California working as a travel PT. I was maybe four or five months out from graduation from PT school and I was miserable. I was like, I cannot do this the rest of my life kill me. Gabbi Whisler(00:59): I just can't. It was awful. And Andrew Tran, owner of physio memes is my now roommate, but he was actually across the country, I think in North Carolina maybe. And he was one of my colleagues that do travel PT to somewhere and I called him and I was like, Andrew, I can't do this. It's miserable. And I don't know what else to do. I just racked up $180,000 in debt. Like I'm supposed to love this. It's supposed to be great. I'm helping people but I hate it. What do I do? And he was like, well, what do you want to do? What are you good at? What would you love? And I was like, I honestly have no idea. So I had to go to the drawing board and really do some digging. And I was like, what would I love? And the very first thing that popped in my head is I dealt with anxiety all my life. Gabbi Whisler (01:38): I'm in a much better place. I can't think of anything better than helping other people to get to that destination as well. And I was like, I can do that as a PT though, right? And I called Andrew and I was like, am I even allowed to do this? Like is this a thing? And he was like, well it is if you make it. And something just clicked. And I was like, well that's kind of cool and ever since I still don't always know what I'm doing but I'm making the path to be able to do it. So it's a lot of fun. But I still, like I said, I don't know what I'm doing most days and I still deal with anxiety myself as well. So it's kind of this ironic but fun twist because that allows me to connect with my clients now on a deeper level than as a PT. Gabbi Whisler (02:19): I've never dealt with a shoulder replacement or a knee replacement or anything like that to really connect with my patients in the outpatient ortho setting or I've never really had like a major fall to connect with my geriatric patient, but to connect with a 28 year old woman sitting in front of me who's had major anxiety, doesn't want to take meds and it's like, what are my other options? And to show her how to use exercise and kind of monitor what she's eating and drinking and just a mindfulness approach to feel better is incredible. And we can do that. As PTs, we learned about breathing, we learned about reflexes, we learn about exercise and movement and it's a lot of fun. Jenna Kantor: So I love that. And, why do you think there's the whole thing with anxiety and PT? I think this goes hand in hand with burnout. Gabbi Whisler (03:07): Yeah, it does. So from a clinician perspective or from a patient perspective, because it's on both ends actually, which is really focusing on clinician focusing on the physical therapy. Yeah, a lot of it is burnout. A lot of it is expectations that I don't think we're prepared for in PT school. Well I think going into PT school, we have this grand idea that, you know, we're a doctor of physical therapy, we have all this autonomy and we have the ability to almost do what we want. And it's really quite the opposite out there for most of them. Until we realized that we are able to kind of break out of that mold. But in the traditional setting, we're very limited in what we can do and we're dictated and governed by doctors and other clinicians and our patients and insurance, and we think we're going to have all this freedom to make this what we want. Gabbi Whisler (03:58): Certainly cannot always do that. And I think that leads to a lot of anxiety that that gap in expectations, expectations from other people and expectations within ourselves in there are aligned. And that's what causes burnout as well. So it goes hand in hand. Jenna Kantor: Yeah, I totally get that for forgive the sounds, the grumbling sounds, I just want to give a complete, you know, story here that's construction in the building, not me being gassy. Okay. I just want that to be clear as we are all just massive ladies here for anxiety, for anxiety. You were saying, it's interesting where you're saying, I don't know anything about this, but then you clearly have a drive to know more in order to help other people. What is it within you that's getting you to help out other people when you are dealing with it yourself? Gabbi Whisler (05:00): Yeah. Yeah. So I know what it's like to be at like that rock bottom and not have any outlet. Cause when I was going through all of this, you know, dealing with anxiety, depression, OCD, I knew in my heart I did not want to take medications. I knew in my heart talk therapy wasn't for me. I had given it a try and I was like, this is just, it's awkward for me. And I never felt like I left there feeling better. So I was like, I'm not going to continue wasting my money. And it was one of those things, I sat down with my primary care doctor and I was like, okay, what's next? And he had no direction for me. And I just remember what that felt like. And now as a PT, I know. So I said, I know, I said I don't know what I'm doing. And that's true. I don't necessarily know the direction my career is going. Yeah. PT, I know what I'm doing. Gabbi Whisler (05:38): I know how to prescribe all of these exercises. But at the same time I don't, and I think that's how we all feel in our careers. So really it's not anything I'm normal but knowing that I have tools that other people are searching for, knowing that someone out there needs what I have to offer but I'm just too afraid to put it out there sometimes is what gives me that little motivation or that little push to go ahead and do it anyway. You probably deal with that too cause your niche is so specific and so focused and so high performance. I'm sure you encounter that as well too. Jenna Kantor: Yeah, I get that. I get that. I hadn't really dealt with anxiety until after the conference. Smart success physical therapy like just this past year. And it was when I came back home and I have a best practice where I work with dancers and all of them were better, which of course it's great, but as business goes freaking out, Oh my God, I was just like, this is the worst thing in the world and we're, for some people that would be something to brag about. For me that was something to significantly freak out about. Jenna Kantor(06:55): Awful, awful, awful, awful. I do not recommend anxiety and stress at all. Not even a little, Oh my God, this sucks so bad. So that's my experience with anxiety and it's gone. I've gotten better with it over time and I think that has to do with really acknowledging taking action for myself. So for you, with people, what are your like big overall tips that you just, when somebody reaches out to you and they're like, Oh my God, I'm about to like, collapse my anxiety so bad right now. What are things that you give them to kind of help them out at that point? Yes. So like top five things or three or 20 I don't know what your number, I'm just saying numbers. Gabbi Whisler (07:54): Very first thing I tell them is give yourself grace and permission. Cause so often we can find ourselves to the notion that anxiety is this horrible thing and cause anxiety and depression are just emotions truly like their emotions and we so often label them as good or bad emotions in general and we always strive to feel happy and we strive to run away from anxiety and depression. The very first thing I told girls or guys or whoever I'm working with is let it be your anxious, like accept it and just sit with it for a minute and allow your body to feel that because your body needs it. It's very uncomfortable. It's very uncomfortable. It's like not butterflies, but it's like, Oh it's very uncomfortable. It's hard. Her own skin. That's the best word that I can think of. Like you literally want to run out of your own body. Gabbi Whisler (08:43): Yeah, yeah. Lots of you can have a moment. So that's what I was like, give yourself the grace to be human. The fact that you're experiencing this and then use it as an indicator. So like, so often we're controlled by our emotions and they tell us how to live our life. You know, when we were anxious we want to sit in bed but instead use as an indicator. What's this trying to tell you? Like what's going on in life? You feel this way? And beyond that, what can you do about it? So like you said, action, what action can you take to move on from this? Cause so often we let it paralyze us, but that's really when we need to take some sort of action, whether it's to talk to someone or maybe getting a medication or going to talk therapy or going for a run or lifting weights or like what needs to happen to make you feel better. Gabbi Whisler (09:31): And it's different for every person. So those are my top three starting points. I guess. Three is my number, but really it's giving yourself that grace, using as an indicator and then taking action. Jenna Kantor: Yeah. Yeah, that definitely makes sense. When you're saying give grace, what are ways that you can, because it's not just like, okay, I'm giving myself grace. What are things where you could actively be, you know, literally taking actions, you know, like cleaning the dishwasher, you know, what are things that you could do to help you start learning what it is to give yourself grace? Do you know what I mean? Gabbi Whisler: Yeah. So I'll just share examples of what I do in my own day cause I think that might be easier. But when I get anxious, I literally will sit with myself and say, Hey Gabbi, it's really okay that you feel this way. Gabbi Whisler (10:18): And I just kind of let my body off sit with it for a minute, you know, I recognize, okay, my chest is tight, my fingers are tingling, my eyes, my vision sometimes changes just a little bit. And I'm like, this is normal. It's nothing to panic over. This is my body's response. Okay. It's okay in the moment. Like it doesn't take it away, but it's like, okay, I know I'm not dying in the moment because often we do, right? Like, we're like, Oh my gosh. Gabbi Whisler (10:55): So I'll sit with it and then from there, a lot of times what I'll do is I like to have one person in mind for, you know, if I'm feeling angry, it might be my sister that I call if I'm feeling hurt, it's my mom that I call who's really good at helping me through whatever I'm feeling in the moment. And I always have that on the back burner and that's the first thing that I'll do is get it out because the more we hold it in ourselves, the worst off we get. And sometimes it's not even talking to the most sometimes like I'll literally sit in my room in front of a mirror and talk to myself. Jenna Kantor(11:46): It's cool you can out like get it out. Like you did get it out in the universe. You know, before we started recording today, you were sharing something with me about wanting to just get out in the, because once you do that, you're more likely to follow through and take action and feel better about it. It's true. It's true. Like I'm doing this, I'm doing this. It's true. But I never thought about it in a way where you would use it as a tool with when you're like feeling it because it's like a zit that's dying to pop. Jenna Kantor(12:26): Yeah. So for you, where do you find in the physical therapists life with people reaching out you a common time when people, are you actually, okay, I'm going to actually separate this out. Common point in someone's career, whether it be student, new, grad or professional, where are you finding a real, like this is where it's happening a lot specifically in the physical therapy career. Gabbi Whisler: The answer's kind of funny, but all of the above. So for students I'll kind of go through each one cause I think we all do, it's just a matter of like, so each stage will have points throughout it that are very specific when that anxiety is like greatest. But for students it's typically right before the NPTE or right before an exam, like a lab practical that students are reaching out to like, Oh my gosh, I'm so anxious. Gabbi Whisler (13:18): I don't know how to handle this. I've never really experienced anxiety until now. Usually that's when they're noticing it is in grad school. And they're like, what can I do? And then, you know, I'll try to talk with them through that. As far as anxieties go, a lot of new grads experience it. Cause again, it's expectations. They're in school for so long and they have people guiding them and now all of a sudden they're kind of fed to the wolves and they're expected to do things that they weren't, they weren't yet in their minds, comfortable with. And also seasoned clinicians, a lot of times they're like, it's either burnout, it's not finding satisfaction in their career. It's wanting something more like, not feeling, they're not necessarily burned out, but they're also, they feel like they're doing the same thing day in and day out and they're not contributing to the world in a greater way, I guess. Gabbi Whisler (14:08): Or they're not seeing, yeah, just frustrating for them, but also sad from an outside perspective. Cause they're still making a huge impact, but they're just, it's routine for them now, so they're not seeing, so it's not as fulfilling. They feel like they're very separate from what they're doing. Jenna Kantor: Yup. Exactly. Exactly. Wow. That's powerful. Right. Because they're still, they're changing people's lives. Like every 20 minutes are changing someone's lives, but they're just doing it so often they don't see it. Where does shame come into all this? Gabbi Whisler: Ooh, that's a good question. I think it's very specific person to, but probably again, that mismatch in expectations so they don't feel like they're providing the care that they should be for their patients and then in front of their patient, you know, they have to continue and be professional and carry on throughout their day, but inside their brain, they're like, am I really the best person to be helping this person? You know, we tend to tell our story ourselves, stories like that. So that's true. That's insanely true. Jenna Kantor(15:44): Yeah. Wow. Yeah. If there was going to be, I would say one big vision you have for physical therapists regarding anxiety, what would be your big like one day Do you know what I mean? Gabbi Whisler: So this is kind of a far stretch, but I'll bring it back full circle model clinician because right now as PTs we can't treat anxiety or we can't treat mental health. It's just not like fully within our scope of practice. So myself and another PT are actively working to try to get PT into, there's a world Federation for mental health and there's other countries that are participating in and it's specific to physical therapy. So we're hoping to get PTs in that role because I think right as PTs were very uncomfortable with the idea of mental health because it doesn't get talked about in PT school. We don't really talk about it with our patients. It's one of those things we try to skate around as much as possible and there's some clinicians out there who are great at it and I think we're as a whole, we're getting better. Gabbi Whisler (16:36): But the more we can certainly the more we can start talking about it to our patients, the more we feel comfortable within ourselves talking about it to other people and opening up as well. Cause if we can't get other people to open up, how are we ever going to open up ourselves? So it goes both ways. If we can't open up, then we can't get other people to open up. So I think once we're able to, as PTs kind of get into this role just a little bit more, and it's not that every PT has to treat mental health specifically, but we find ways of bringing it into, because we know if someone's struggling with their mental health, their physical health suffers. And so if we're not addressing that, it's so true. And if we're not addressing that first with our patients, then we're probably not getting them the results that we need. Gabbi Whisler (17:22): But if we can't do that, if we don't know how, and that goes back to our own lives as well. So it all kind of comes full circle. So my big goal is to get PTs to be able to go to conferences at CSM, for example, and have a course, have a talk on the side of mental health. Cause right now there's very little out there for us. So truly but surely like nothing. And it's because we're so uncomfortable with it. So that's my dream is to be able to get us in that scope of practice and also show clinicians how to handle in our patients. And I'm hoping through that they see how they can handle it within themselves as well. And kind of tackle it from that approach. Jenna Kantor: Yeah, yeah, that makes sense to me. Oh my gosh, this is perfect. Thank you so much for coming on. I would love to ask for you to just have your mic drop moment and this could be for anyone who may be dealing with anxiety right now and I would love for you to just acknowledge that person and just give him some big picture advice if they're really feeling stuck. Gabbi Whisler (18:46): Yeah. So, Oh my gosh, I have so much in my head right now. Start with the word you. So if you are feeling super anxious and having a hard time handling this, especially throughout the workday, my biggest piece of advice for, I guess this is the direction I would go, so specific to clinicians who are feeling anxious throughout the day. And I actually have a couple girls who I work with right now, her PTs and their new grads and they're feeling this way too. They feel like they have to compartmentalize this and they can't talk about it at work. Talk to someone like whether it's your boss or a coworker, someone there needs to know that you're dealing with this because if you continue to try to do this on your own, it's only going to snowball and then your boss is going to come to you one day and be like, what in the hell is going on right now? Gabbi Whisler (19:35): You know what, what? Cause your performances is often the way you speak to patients. So the earlier you can nip it in the bud and let them know, Hey, I'm dealing with this right now. I don't want to go into details. Or you can say whatever the heck you want to, but they need to know about it. And the more comfortable you get talking to your boss, the more comfortable your boss gets talking to their employees about it as well. So you might be opening up the door for another clinician right next to you because more than likely everyone in your building is dealing with some form of anxiety. Jenna Kantor(20:16): That's true. It's not talking about it. That's very true. That's very, very true for clinicians. I love that. Oh my gosh. Thank you so much for coming on. How can people find you, find you and contact you. Thank you. Gabbi Whisler: First, thank you for having me on. But yeah, @mindhealthDPT, that's my Instagram and Facebook handles, so they're free. Jenna Kantor: Got it. Wonderful. Thank you so much for coming on. This was an absolute joy. I think that this is going to be extremely helpful for people who are dealing with anxiety. So you guys don't be afraid to reach out to her. She's here to help you. In fact, you're one of many. 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! 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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Christa Gurka on the show to discuss marketing. An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka's reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami's Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction. In this episode, we discuss: -Why you should design an ideal client avatar -How a small marketing budget can make a big impact -Crafting the perfect message to attract your ideal client -The importance of continual trial and error of your message -And so much more! Resources: Christa Gurka Instagram Christa Gurka Facebook Pilates in the Grove Christa Gurka Website FREE resources A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Christa: An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka's reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami's Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction. Read the full transcript below: Karen Litzy (00:01): Hi Christa, welcome to the podcast. I'm happy to have you on. So today we're going to be talking about three strategies for marketing for cash based practices. And the good thing about all of these strategies is they don't cost a lot of money, right? And that's important when you're starting a business. You know, we don't want to have to take out a bunch of loans, we don't want to have to spend a lot of our own money. We want to try and start up as lean as we can. And so I'm going to throw it over to you to kick it off with. What is your first strategy for marketing for cash based practices? Christa Gurka (00:43): Perfect. So one of the reasons I just want to start with saying why I'm a little passionate about this marketing thing is because myself included when I first started, I really kind of, I felt like I started backwards almost like from the ends. And I think it's really so helpful for people to learn to start kind of from the beginning. Right? So my very first strategy that I think is really, really important is to have a real good idea of who your ideal customer or who your target audience is. And I get often some pushback from people saying, well, everybody can use my services. Of course everyone can use physical therapy. Absolutely. And that doesn't mean you have to single anybody out. But you know, I think Marie Forleo said it or maybe somebody said it to her, but when you speak to everyone, you really, you speak to no one and so slew thing, your who, your ideal customer is, how they feel, how they think. Christa Gurka (01:45): It's very, very beneficial. So if you want, I can kind of go through like a few questions that I use to kind of narrow down who that person is. So one of the things to know when we go through our ideal customer, we actually give this person a name, an age, a gender demographic, married, not married, retired, not retired, education level, median income. And when we do anything in our business now, so we are ideal customer, her name is Georgia. And so we say every time we have a meeting we say, well what will Georgia think about this? Well Georgia like this, so we're Georgia not like this. So that's the very first thing. And we refer to that person as their name. And then you want to go through like what are their biggest fears about whatever problem they're looking to solve. Christa Gurka (02:40): People buy based on emotion. And so get into the underlying source of that emotion is really, it can be very powerful. So what are their fears? What do they value? Right? Cause when it comes to money, people paying for those, it's not always a dollar amount. It's more in line with what do they value? And if you can show these clients that you serve, offered them a value, the money, the dollar amount kind of becomes obsolete. So things like that. What could happen, what would be the best case scenario if this problem were solved for them? What would be the worst case scenario of this problem were never solved. So in terms of physical therapy, let's say generalize orthopedics, right? Back pain. 80 million Americans suffer from back pain. Yeah. So an easy one to start with, an easy one to start with, right? Christa Gurka (03:35): So let's think of, you know, back pain, it's so general, right? But if you can say, what is the worst thing that can happen because of this back pain, right? So maybe the worst thing that could happen is this person loses days at work because they have such bad back pain, they can't sit at their desk or maybe they have such bad back pain that there performance drops and so that cause they can't concentrate. And so now maybe they lose their job or they get emoted because their back pain. So the worst case scenario is maybe they're not, they ended up losing their job because of back pain. So you kind of take it all the way back. And then if you could speak to them about how would it feel if we were able to give you the opportunity to sit eight hours at a desk and not think of your back pain one time and what would that mean to you? So really kind of under covering a lot, a lot, a lot about who your ideal customer is. It's my number one strategy. Karen Litzy (04:39): And I also find that it's a great exercise in empathy. So for those that maybe don't have that real innate sense of empathy, it's a way for you to step into their shoes. And I always think of it as a what are their possible catastrophizations? So if we put it in the terms that the PT will understand, like when I did this number of years ago, I sort of catastrophized as this person. What would happen if this pain didn't go away? I wouldn't be able to take care of my children. I wouldn't be able to go to work. It would affect my marriage. My marriage would break up, I would be a single mom. I would, you know, so you can really project out really, really far and then reel it back in, like you said, and say, well, what would happen if they did work with you? What is the best case scenario on that? So yeah, I just sort of catastrophized out like super, super far and it's really helpful because when that person who is your ideal client then comes to you and you're doing their initial evaluation, you can ask them these questions. Christa Gurka (05:51): Yeah. Yeah. It's very powerful. And I love how you brought in, like you empathize with them and you know, and by the way, a lot of our clients do catastrophize, right? And we have to reel them, we have to reel them back in. So that was a really great point. I also think it can be sometimes on the flip side where somebody maybe comes in and their goal is very benign. Maybe it's, I really want to be physically fit. I want to look good. Right? So you kind of think, well, what's the catastrophe if that doesn't happen? But maybe, maybe they're in a relationship where they're a partner. Aesthetics is a big part of that. And maybe they feel insecure and they feel if they don't present well to their partner, their partnership may dissolve whatever the case may be. So now you're getting to an underlying, it really is more emotional than physical, right? So now you're being able to empathize with them in that way and speak to them in those terms, give them positive things that maybe they don't even realize they need. Karen Litzy (06:53): Exactly. And then it also seems like once you're in those shoes or walking in their shoes, in their footsteps, however you want to put it, that's when that person does come to you, you can have a conversation with them that's maybe not so much centered around back pain, but that's centered around their life. And that's when people make that connection with you. Right? So when we're talking to patients who are not sure that they want to start physical therapy, if we kind of get them, they're much more likely to come and see us. So it's not about the back pain, it's not about the knee pain. It's about how are we going to make a difference in their life. And if we can make that, like harking back to what you said earlier, it's an emotional experience and people tend to buy things based on emotions and their gut feelings and how they feel. So if we can tap into that in a really authentic way, then talk about a great marketing strategy. Christa Gurka (07:58): Excellent. Exactly. Karen Litzy (08:00): And then, okay, so we've got our ideal customer, client avatar. Now what do we do? Christa Gurka (08:10): Great. Now what? So you've got your ideal customer, right? And so by the way, people also sometimes think like, well, I don't want to pigeonhole myself into this, right? But by the way, your ideal customer may change. It's okay first of all to change. And he doesn't have more than one. You can have more than one. Certainly we have more than one in our business. And by the way, you may start out thinking about one ideal customer, but the people that keep coming back, maybe somebody else and you're like, Oh, obviously, maybe I have to rethink this. Right? And again, it doesn't mean that you can't serve someone else. It just means that when you're thinking about marketing and stuff, you're going to go after everything should funnel into one specific thing. So then the next step in the marketing is, okay, so where do these people live? Christa Gurka (08:59): And I don't mean live like literally what neighborhood do they live in? Where do they live in terms of getting their news information? Where do they live in terms of being on social media? Where do they live in terms of, you know, what do they value as far as like personal or professional life? So one thing I see is, you know, people you know are like, well, I'm gonna put an ad in the newspaper, that's great. But if you live in an area where nobody reads the newspaper, then you're putting your money somewhere that you're not going to be seen. Or maybe the flip side is, well, I'm going to do a lot of stuff on Instagram. Well, if you were, your clientele is over 65 studies show that most people over 65 are not on Instagram. That doesn't mean they're nobody is, it just means, you know, or vice versa. Christa Gurka (09:50): If your client is 25, they're probably not on Facebook anymore, right? So, then again you can be, this is why it won't cost you a lot because you can narrow down where you are going to spend your money, right? Also, if you're running Facebook ads, which will then go on Instagram you can narrow down in your audience when you build out your audience to be very, very, very specific based on are you a brick and mortar establishment? So are you trying to get people to come in to your place? Right? So you want to say, well, if people are not, if you know that your ideal customer's not convenience as important and they're not going to travel more than five miles, you shouldn't market to people that live or work outside of a five mile radius from your studio. Right? So that's important to know as well as also maybe your customer gets their information from friends or relatives, you know, or like someone said, you know, you need to go see Karen, she's been really great for me and that's how they get to you. Christa Gurka (11:00): So how can you then get in front of your client's friends, right? Maybe you could do an open house, invite a friend, bring them in. Let's do one-on-one, you know, just kind of like a talk, right? Maybe you could bring them in if, say your ideal customer, let's say your ideal customer is in their sixties, what are some things that people in that age group are going through? Maybe you can have a talk about that specific thing. Not necessarily a therapy, but now you get everyone to kind of come to you. It's not even about what you actually do cause you can need them based on where they are. And most people, by the way, they say there's the numbers range, but usually they have to see you about seven times or have seven points of contact with you before they're comfortable buying from you. So these are just way to get people to know, like, and trust you and then they'll buy from you. So that's strategy number two. Once you know really who your customer is and they could take a couple years to really start to peel back all the onion of that, then the next thing is be where they are, be in front of where they are. Karen Litzy (12:13): Yes, absolutely. And, I love that you mentioned the different types of social media and who's on where, because like you said, this is something that isn't going to break the bank because you have narrowed down exactly where you want to spend your money. Right? So we're taking who that ideal person is, where finding out where they like to hang out, what they read, who they're with, all that kind of stuff. So that when you build out a marketing campaign for your business, you kind of know who and where to target. Christa Gurka (12:49): Right? Exactly. Yes. And even so, even with Facebook, yeah. When you build out your audience, right? So you can have a variety of audiences. You can create lookalike audience, which I'm sure is like a whole podcast onto itself, but you can also target people that like certain brands. So when I do my ideal customer, I'm like, well what brand do they resonate with? In other words. So I would say that our brand is a little more towards Athletica versus like Lulu lemon. And that's not to say one is better than the other. It just means that's who my generally customer is. And why, what do they value? They value that customer service. You get, you know, Athletica has like a, you can take anything back all the time, right? So when you build out a Facebook ad, you can also target, that's right. They've bought from Athletica online. Right. So now you're reaching people. So you kind of near just keep narrowing it, narrowing it, narrowing it down, which can be, you know, other interests is your client. Do you do pelvic health? So obviously women, although men do it right, if moms can you target people that like mom influencers on Facebook or on the internet. So these are all just ways that the more you know about them, then you can use that in your marketing strategies afterwards. Karen Litzy (14:15): Absolutely. Fabulous. Okay. So know who the person is, know where they're hanging out. What's number three? Christa Gurka (14:23): Okay. So number three to me is the most important, the most, most important. And that really is messaging. So when you're working with your ideal, when you're working through that ideal customer you know, workbook getting to them, to you for them to use their own language for you. So I see this very, very commonly, and I am sure you can attest to it too. When physical therapists, we love what we do. We are passionate about movement and anatomy and biomechanics but you know what, the general population has no idea what we're talking about. None. Zero. Yeah. And so oftentimes I feel like, and by the way, I'm not saying I did this for a long time too. I think that we're trying sometimes to get other practitioners to say, Oh, that's a really good therapist. So we're talking about pain science and biotech integrity and fascial planes and the general population. Christa Gurka (15:32): The end consumers, like I have no idea what you're talking about. So you need to speak to them at their level based on what their problem is. And kind of like how we spoke about before. It's not always the back pain, it's what the back pain is keeping them from doing. Right. it's not always, let's take pelvic health for example. Right? A lot of pelvic health issues or not necessarily painful. Okay. So say you have moms, this is super, super common stress incontinence. They leak, they leak when they jump and they go to CrossFit and they're embarrassed to start with a jump rope because they, it's not, why? Why do women go 16 years after childbirth? Because you know what? It's not really painful. So they don't consider it a problem. Like physical therapy is not going to help me with it. So, but if you say to them, Hey, that might be common, but that's not normal, and guess what? Christa Gurka (16:25): There's a solution to that, you know? That is something that will resonate with them. Do you like things like, do you feel, do you worry when you're out at a restaurant as it gets later and later that the line at the bathroom is going to be too long and you stop drinking because you're afraid to wait in line for the bathroom? Right. So some women will be like, Oh yeah, I totally do that. Right? Are you afraid to chaperone your child's field trip? Because the bus ride is going to be three hours and you don't think you can hold it three hours on the bus without a bathroom. That's terrible for a mom. She can't chaperone her kids field trip because she's embarrassed that she might have to go to the bathroom. So using their language. So I like to send out surveys very frequently. Christa Gurka (17:09): Google doc is super easy. Survey monkey and ask them things like, what are your fears about whatever it is you're trying to sell. Right. what are your fears about exercise? What are your fears about back pain? How does it really make you feel? Okay. what are your, like maybe even if you could pay and if money was not an issue and you could pay anything, what would that look like for you? How would that make you feel and starting to, then you start to use that language. We've all seen marketing campaigns where you're like, yes, exactly. Totally. That's how you need to get into them. Right? And so maybe maybe as a physical therapist, it's tough for us because we're like, well, no, their hamstrings are not tight. It's not hamstring tightness. It's neural tension and it's the brain and the nervous system, but they don't, they don't understand. Christa Gurka (18:06): So you got to get them in. What they feel is that they have hamstring tightness. So you got to tell them that you can fix their hamstring tightness. And then little by little you explained to them that it's neural tension, right? But if you start off with neural tension, they're going to go somewhere else. And so I kind of like, I use this example a lot if you, cause I think we can all relate to this. We're on tech right now, right? Okay. So if you have, I have a Mac, I have an Apple. If I go to the Apple store, cause my computer crashes or my phone won't turn on and I go talk to what are they, what are the genius bar, the genius bar. And the guy's like, you know, so what I see here is the motherboard has this month and this software program, you only have so many gigabytes. Christa Gurka (18:50): I'm like, can you fix my computer? That's all I want to know. And if he says yes, I'm like, I don't care how you do it. So whether you use taping or I use myofascial release or somebody uses Pilates or somebody uses craniosacral therapy, it doesn't matter to them. So the end consumer, they just want to know that you can solve their problem. People have problems and they want to know that you have the answer to solve their problem. And that's it. So messaging is really, I think, crucial. It's the crucial point of the puzzle. Karen Litzy (19:28): And now let's talk about messaging. Let's dive into this a little bit further. So I think we've all seen different websites of healthcare practitioners, physical therapists and otherwise that kind of make us go like, Karen Litzy (19:43): Oh boy cause it's in cringeworthy in that it comes off as a little too salesy, a little too slick, a little too icky. So how can we compose our messaging to avoid that? Unless maybe that's what their ideal patient wants. I don't know. But yeah, how can we craft our messages that are going to hit those pain points, get that emotion going without being like a salesy, weird gross Christa Gurka (20:18): So the other thing I think that's important to understand is people's buying patterns. And when people say no to you, maybe they're not saying no to you, they're just saying this. It's not a value to me at this time. So one of the phrases, one of the things that I've really restructured, cause I used it, take it very personally, if someone will be like, no, I know and I'd be like, what you mean I could totally help you? And now I'm like, you know what? It's basically I look at it like if I'm at a party or I'm having a dinner party and I serve or Durham and I'm like picking a blanket and be like, no thanks. I'm like, okay, walk away. So I say therapy with Krista. No thank you. No problem. Let me know if I can help you in the future. Christa Gurka (21:04): Right? So the way that I say it is if you just speak honestly to your customer, honestly, to your customers. Nobody can be you at being you. So be your authentic self, whatever that brand is for you. And whether it's your company or you yourself, and let that come through in your messaging. Right? So in other words, like if your messaging is also about mindfulness and positivity and looking past the pain and what is your relationship with your pain or dysfunction that should maybe come through in your messaging that you're more holistic, that you're not going to be a treat them and street them type thing. But maybe if your messaging is, Hey, we're going to treat you and street you and you'll be out of here in 15 minutes, you're going to attract that type of customer. So either one is fine, but I just say really be authentic. Christa Gurka (21:59): And the other thing is, I would say send your website. I don't put a lot, a huge amount of stock in my website to be perfectly honest. I do love my website. I'm a very like, analytical person. So the colors and where everything sits is important. But I don't think as, I'm not a big believer that as much selling goes on your website as a lot of people may think, I think it's a place where yes, people are going to Google, someone gives you a reference at a cocktail party, they're going to Google your website, but they're basically going to look like, does this resonate with me? So what you want to hear is, you know, that tagline at the very beginning, you know, is does that tagline, the first thing that they see, does that resonate with that person? Right. So we use, because we're Pilates and physical therapy, we will, right now our website's a mess because it's got coven. Christa Gurka (22:47): We're close, we're not close. But helping people heal with love, every twist, every turn and every teaser. Teaser is a plot. He's exercise. So we stuck that with love in there because that is part of who we are. We are a community. We care about our clients. So you're not just going to come in here for like two things. We want to help you where you are. So that's, so if someone's like, yeah, that's cheesy for me, then it's okay, they can go down the street. Right. and we don't, I used, by the way, this has come with like 10 years of testing. You just got to test it. You got to test it and you got to see like who does it resonate with? Send it to a bunch of people and ask people for their honest feedback. Give me, you're not going to hurt my feelings. I need to know like, what do you see when you see this? What, how does it make you feel? So ask people their opinions and not physical. Karen Litzy (23:45): Yes. Yes. And you know, I just redid a lot of the messaging on my website and I sent my website from what it was and I'm in a group of female entrepreneurs, none of whom are physical therapists. I sent it to them, they gave me some feedback, I changed a little things. I sent it again, they gave more feedback, I changed some more things and now I feel now they're like, Oh see this sounds more like you. So before what I had in my website is what I thought was me. But then once I really got like had other people take a look at it, they're like, Oh, no this sounds more like you. And yeah, I love that tagline on the front. Like the tagline on the top of my website is world-class physical therapy delivered straight to your door, Christa Gurka (24:28): Which is short and concise and what you do. And it's what I do. Very easy. Perfect people. Oftentimes I see these like tat and they're like, you know, they had their elevator pitch. I'm like, what's your elevator pitch? You know, people talk about, Oh, what's the elevator pitch? I'm like, if you cannot describe what you do and like two sentences or 10 words or less, how do you think other people are gonna if you can't understand it for yourself, how are other people gonna right, right. Like you said, that takes time though. It does. It does take time. I struggled with this for a while, but me always, yes, but I think as physical therapist, one of the reasons we struggle is for a number of reasons. One. If we're business owners, we tend to be overachievers, right? We tend to have weak temp. We're bred from a certain mold. Christa Gurka (25:18): Right? the other thing I think is physical therapist, we're very analytical. We're very left brains, right? We are, I mean I think it's what makes me a really great physical therapist. But then the flip side of that is we're perfectionist. Everything has to be analyzed. And so we get so caught up in like the details of analysis and we went to PT school. So we have to show how smart we are. But being smart also means understanding what your customer's going to understand. And so you kind of have to swivel out of that. So sometimes even in groups when I'm like, when we see people like, Hey, what do you guys think of my website? I'm like, don't ask us, we are not your customer. Go ask your customers like what they think of your website. And so when I was in a group, you know, my coach challenged me to narrow things down as well. And they used to say things like, if you were running through a desert and you like and you were selling water, what would your tagline be like what would you, what would your board say? And you know, people will be like ice cold, dah dah dah. And he was like, just say water. If someone's running through a desert, all they need is water, water will suffice. Water will suffice. Clean water less is more free water. Even less. Yeah. Karen Litzy (26:42): And I remember, this is even years ago, I was doing like a one sheet, like a speaker one sheet. This is a lot off topic but talking about how we need to tailor our message to our ideal audience. So I had, you know Karen, let's see PT and I remember the person was like, does that mean like part time personal trainer? And I was like no physical therapist. Like you need to write that out then because the average person like PT. Okay. Does that mean part time personal? Like what does that even mean? So it just goes down to or sorry, it goes back to kind of what you said of like we have to speak the language of the people who we want to come to see us. Right? And the best way to do that is on our websites is we just have to simplify things and it doesn't mean dumb it down. It just means like simplify. And I'm going to give a plug to a book. It's called simple by Alan Siegel and it's all about how to simplify your language, your graphics, and how everything comes together to create a site that people, number one are attracted to and number two want to hang out at. Christa Gurka (27:53): Right? Exactly. And there's a lot of testing and I'm a big thing like testing. It's just testing, testing, testing. We test our sales page, we test even now with like some of my coaching stuff, working with other female business owners, testing, sometimes going in and testing, switching a graphic, have what you have above the fold. So the fold for those of you that don't know is like when you're on a website, it's you don't have to scroll. So everything is above where you have to scroll. I'll call to action a CTA right at the top. Changing phrases, you know, not using broad language like confidence, like what does confidence actually mean, but maybe making it more specific using language so that that's a really good thing. Helping or like, you know, reading yourself a back pain so that you can live the life you desire and deserve. Christa Gurka (28:57): Right? So changing little, and you can change that by the way, mid campaign, mid launch daily. You could change it if your Facebook ads are so one of the things, if you're, if people are clicking on your ad, but when they're not converting on your sales page, that usually means that either the messaging and your ad is really off and they're, once they get to your sales page, they're not understood. There was a disconnect between what you're offering or your messaging is great, but your sales page sucks. Or vice versa. Maybe nobody's clicking on your ad. Then whatever you're trying to sell them there does not resonate with them, right? So there has to be a connection. And usually when people don't buy, there's either a, with your offer or a problem with your messaging. Christa Gurka (29:49): So test means put it out there, see what kind of feedback you get, and then it's think of it as, okay, what we do in therapy, right? So this, what do we do when we get a patient in, we assess, we treat, and then we reassess, right? So what's going on? Let's try a treatment in here. Let's reassess. Is it better? If it's not better, what do we do? We go back, assess again, and then do another treatment and then assess, right? Reassess. So in marketing it's the same. So let's say you wanted to do, let's say you're working on like a sales page on your website, right? A sales page. I know it sounds salesy, but it's basically your offer, right? If people are getting there, so you see people you can track. By the way, with Google analytics, like people coming to your site, if a lot of people are coming to your site but they're not clicking on the call to action or they're not following through to check out some, there is some disconnect there. Christa Gurka (30:56): So maybe it's the messaging. So then maybe try to change the messaging, tweak the messaging, and then watch the outcome again, maybe people get all the way to the checkout and then abandoned cart. Maybe it means that something they got confused with something at the end. Maybe there's the customer journey wasn't right. They got to the end because they put something in the cart and then maybe your checkout structure is off or something like that. So test it and then just retest until your numbers are like, now we hit it. And by the way, it's taken me. I mean I'm still testing. Hmm. It seems like it's a constant reinvention. Constant, constant. Because the market keeps changing. Especially now. By the way, by the way, right now I don't know why there are. So at the time of this recording, we are in the middle of COVID. So when people come back, your messaging, okay. Is going to have to change, right? So we need to be aware of that. Karen Litzy (31:49): Yes, Absolutely. All right. So as we start to wrap things up here, let's just review those three strategies again. So who is your target market is number one, where are they hanging out? Where are they living? Not physically their address, but you know, where, what are they reading? Where are they hanging out, what are they doing online, what are they doing offline? And then lastly is making sure that your messaging clearly conveys part one and part two. And how you can solve their problem. Awesome. So now if you were to leave the audience with you know, a quick Pearl of wisdom from this conversation, let's say this might be someone who's never even thought about any of this stuff before. What did they do? Christa Gurka (32:40): So in terms of like, never even thought about marketing before or going into brand new, brand new out of PT school are, or brand new, like they want to kind of dive in and start doing their own thing, but they want to do it in a way that's efficient and that doesn't break the bank, right? So I would definitely say, Christa Gurka (33:17): Start with the end in mind. So that's from a great book, right? So so start with the end in mind meaning, but don't start at the end. I think a lot of people confuse that with, they start with the end in mind, but then they go right to the end and they go to marketing, right? So I like to equate everything back to physical therapy, right? So when we learn about developmental patterns, we all know, like we start with rolling and then Quadruped high kneeling, right? So if you take a patient that's injured and has a neuro, you know, and motor control problem and start them in standing off with multiple planes, you've missed a bunch of it, right? So you start marketing without understanding who your ideal customer is and finding out what they think and how they feel. Christa Gurka (34:01): You're going to spend a lot of money and you're not going to know why it's not working. You're just going to think Facebook ads doesn't work or I'm not good enough, which is a very common thing, right? So take the time to do the work. The ground work. Nobody loves to learn rolling patterns. But why is it important? Because if you work from the ground up, you take the time to instill these good patterns underneath. So take the time to do that. And the other thing I would say is just decide, you know, don't go through analysis paralysis. Decide and move. And the only way you're going to know is you got to put it out there. So you know, Facebook lives, Instagram lives. That's, you know, we didn't maybe start when social media was big, but which, so by the way, I have to make a point that I think that's why it's harder for us. Christa Gurka (34:52): So our generation did not, we didn't have, so I didn't even have a computer when I went to college. Nope. Like, so we didn't start with, I didn't have a cell phone like, so it's very different for us because this next generation coming up, they're comfortable on social media. We may not be, but the truth is, it's like everything else, just do it. The more you do it, the easier it becomes. So, and you know, if no one's what, well, I'm afraid no one's going to watch it. But who's watching it now, if you're not putting it out nobody. So you're no worse off. Right? So just do, create an action step. Like, you know there's a book and now I forget who the author is. It's called the one thing, right? And you just focus on thing. Focus on one thing that you can do today to improve on understanding your ideal customer. If you're already past that, what can you do today to understand more about your messaging? Karen Litzy (35:50): Easy. The one thing you could just, just choose one doesn't have to be a million things you don't have, it doesn't have to be perfect. No, and it doesn't have to be perfect. Just one thing. Just one thing. Awesome. And now last question is the one that I ask everyone, and that is knowing where you are now in your life and in your business and your practice, what advice would you give to yourself as a brand new physical therapist straight out of PT school? Christa Gurka (36:19): Woof. Mmm. I would probably say be open to the possibility. Yeah. Yeah. Just be open to possibility of what's possible. Yeah. Karen Litzy (36:35): Excellent advice. Now Christa, where can people find you if they have questions they want to know more about you and your practice and everything that you're doing? What the deal? Christa Gurka (36:44): So my business is Pilates in the groves, so they can always find Pilates in the Grove. All has everything about our business. But they can find more about me at christagurka.com. I have some freebies up there. So that's like Christa Gurka is more really about kind of business strategy. Okay, great. Like launch you know, mindset, that kind of stuff. And then the Pilates and the Grove website really if you want to look at what we do, brick and mortar wise, do it. But like I said, the websites kind of a mess. Right? Karen Litzy (37:21): We understand it's exceptional times. And, I know that you have some free resources and some freebies for our listeners, so where can they find that? Christa Gurka (37:33): Yep. So there is a link which we can either link up in your show notes, right? Or we can, so there's a marketing quiz that I created that basically will put people at, it'll kind of just give you an idea of where you are. Are you like a novice or are you a pro? Have you got this stuff down? And I could probably be calling you for advice. And then based on where you are, it kind of tells you kind of what you should focus on as well as then we have that lead you into. I have a social media and a Facebook live checklist. It kinda just gives you kind of a little bit of, I find structure helps me. So learning how to batch content, learning to say that like, okay, every Monday I'm going to do a motivational Monday post. Every Tuesday I'm going to do a Tuesday tutorial post. I think it just helps me map things out. And so I think it helps business owners also feel less overwhelmed when they can have a calendar. And we have national days. It has like a bunch of national days that pertain to our industry already built out for you, which is easy. Karen Litzy (38:35): Awesome. That sounds great. And I'm sure the listeners will really appreciate that. So thank you so much. This was great. And again, the thing that I love about all these strategies is it takes very little money to accomplish them. Just some time, which right now I think a lot of people have a lot of time. So thank you so much for taking the time out of your day and coming on. Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Javier Carlin on the art of listening. Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association. In this episode, we discuss: -The difference between nosy curiosity and coaching curiosity -How to frame questions to dive deeper into conversations -Verbal and nonverbal signals to watch for during client interviews -How your clinic environment can help develop deeper client relationships -And so much more! Resources: Javier Carlin Facebook Javier Carlin Instagram Life Coaching Academy for Healthcare Professionals Phone number: (305) 323-0427 A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Javier: Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association. Javier has always had a passion for health and fitness and his mission in life is to help you get back to doing the things that you love to do, pain-free. His goal is to inspire people to live a healthier, happier, more fulfilling live through simple and effective wellness principles; proper nutrition coupled with a great exercise routine and good sleeping habits works wonders in how you feel inside and out! Javier enjoys spending time with his family, he loves being by the water either soaking up the sun on the beach or on a boat! He is an avid traveler, enjoys exploring new places and experiencing different cultures. He also has an adventurous side; bungee jumping, skydiving, rollercoasters, cliff diving! 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 (00:04): Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I am here with Javier Carlin, thank you so much for coming on. It is an absolute joy Javier. As a physical therapist. He runs a clinic. What is the name of your clinic that you run? Javier Carlin (00:21): It's renewal rehab. Jenna Kantor (00:23): Renewal. Rehab. In what area though? In Florida. Cause you're part of a chain. Javier Carlin (00:27): Yeah, it's in Largo, Florida. So close to Clearwater. Jenna Kantor (00:30): Yes. I feel like the key Largo, Montego baby. What are we going to make it? I feel like that's part of a song. Right? Well thank you so much for coming on. You also, Oh, you also do have an online course. What's your online course? Javier Carlin (00:45): Yeah. Yeah, so it's a life coaching Academy for health care professionals where I teach healthcare professionals how to become life coaches and get their first clients. Jenna Kantor (00:54): Freaking awesome and perfect timing for that right now with everything. Corona. Thank you so much for coming on during this time and giving us both something to do. I wanted to bring Javier in because he has a skill, a magic skill that if you don't know him or you do know him now, you know, he is a Supreme listener. The first thing we did when we got on this call is, he goes, he just asked me questions just to listen what's going on. And I don't, of course I try to emulate it, but I'm not as good at him. You know, like I asked a few questions and I didn't deep dive as well as he does. So I want to dive into his brain and with this pen that I have holding and I'm going to part the hairs, get through the skull into the cerebrum. And so we can really deep dive into how your brain works when you are learning more about others, the art of listening. So first of all, thank you for having that skill. Javier Carlin (02:08): Yeah, no, absolutely. I honestly had no idea I had it until someone brought it up. And then looking into, it's kind of one of those things where, you know, I guess you have a skill. But you don't really know it. And then you try to dissect, okay, what exactly am I doing? Right? So, you know, leading up to this interview, I'm like, okay, let me actually think about this and reflect on what it is that I do. And what is it that I don't do? So that I can actually, you know, hopefully provide some value throughout the next few minutes. Jenna Kantor (02:40): Yeah, I would love to know. I think I want to just go into our conversation even before hitting the record button. What was in your brain when you first came on? Was it, Oh, I want to know what's going on. I'm just honestly like what was in that led you to start the conversation that way? Javier Carlin (02:58): That's a great question. So to be honest, I mean, I haven't seen you in a long time. We haven't spoken in a while. And so, I really, you know, did want to know what's been going on in your life? I've seen your, you know, posts on Facebook, but really had no idea what it is that you've been working on. And I always know you're up to something. So I really had a deep desire to really find out exactly what you've been working on and the people that you've been impacting. Just to know. I don't know. It's like, it's just natural for me. So, yeah. Jenna Kantor (03:38): You're like a curious George. Javier Carlin (03:40): Exactly. Yes. Jenna Kantor (03:42): Do you think that is a big base of it? It's just true curiosity. Javier Carlin (03:47): Yes. I think it's a curiosity and definitely curiosity. I'm always you know, really in tune with what people are doing. Cause I feel like it just, you know, looking deeper at it. I feel like there's, it just, I come from a place of always wanting to learn more about someone, deeply understand what they're doing and why they're doing it. Cause I think there's a lot to say about that. And it's very similar with you know, health care professionals in the sense that we're working with patients all day and we are truly, really trying to figure out you know, what's going on and where they want to get to and understanding really what they truly want the outcome to be when it comes to us helping them throughout, you know, our physical therapy and other rehab professions. And it's no different. Like that's the same, the same curiosity that I have when I, you know I'm serving patients I have with people in general. So I do believe that curiosity is a big thing and having the curiosity that's a, not in a nosy curiosity but more of like a coaching curiosity and really figuring out what's behind the words that someone is saying. Jenna Kantor (05:02): What do you mean by nosy versus coaching? Would you mind going into more depth on that? Javier Carlin (05:09): So, yeah, absolutely. So I believe, and this is, you know, there's a clear you know, when you're having a conversation with a friend, you're not really thinking about all these things. And then I think deeper into the coaching side of things, you start to think about the specific things. So when it comes to a nosy curiosity, there's always a story that someone's telling you and sometimes the story isn't even related to what the person is actually dealing with. So people use the story to kind of, let's see how I can put this to separate themselves from the interaction that you're having. Cause it's sometimes it's stuff for us to have conversations with people and really get deep down into our own emotions. So the story around it as you know, as someone who's dove into life coaching the story is actually at times something to distract people from that. And sometimes what I mean by nosy curiosity is that we actually get involved in that story, which has nothing to do with why the person is talking to you in the first place. Jenna Kantor (06:09): So it's like this superficial, superficial kind of thing, superficial thing, right? Javier Carlin (06:13): So instead of being nosy and it's the actual story and talking about the people that were in their story, we want to, you know, kind of separate that from the actual person and have a conversation about them and why that situation affected them as a person, not, you know, bringing everyone else. So that's what I mean by nosy. And he knows he's trying to get involved in their story and you know, getting involved in not just their emotions but everyone else's emotions and why they hate their boss and why this and why that. So it's really separating that from what they're telling you. Jenna Kantor (06:45): Hmm. I like that. Yeah. Yeah. Could you just keep talking cause I don't even know what question to ask next just because I'm really taking that in right now. Just tell me something else more about listening. Cause I know you came prepared just because when you're going into this, you just opened up a world of how much, I don't know, just from even that concept. So I feel a bit of the, honestly a lot of loss of words for it because just even that concept of the superficial versus diving deep down in, I guess my next question would be then when you deep dive in and you're getting, doing those investigative questions to really find out what really is the core of what's going on, how do you phrase your questions too? Because you're probably going to get to some real personal stuff. How do you do it delicately with them? So that way as you are deepening, deepening your listening, you're not invading their space. Javier Carlin (07:54): That's a beautiful question. So, I think a lot of it comes before you know, before you dive into that. So you know, you've heard of obviously you're building rapport, building trust, and at the end of the day, if someone's coming for help it typically comes with an idea that, okay, I'm going to have to, if I want someone to help me, then I have to open up to them. Otherwise, you can't really help someone. So I think, you know, it comes with that understanding and I think a lot of it also comes from coming from a place of neutrality. So not tying your emotions and your ideas and your thoughts and your beliefs and your opinions to what the person is telling you. Jenna Kantor (08:37): That's hard. That's hard. Yes. Very hard. Yeah. Javier Carlin (08:41): It really is. And, that's where, you know, that's when someone can actually feel that you're trying to either push them in a direction that they don't want to go, or that's where that nosy type of know feeling comes in, where they're like, Oh, like why are you, why are you asking me that? But I think the second thing is whenever you make an opposite, whenever you make a statement that's more of an observation or a fact Javier Carlin (09:08): As opposed to, you know, something that's a bit more emotional, you want to always end with a question. So as an example, a question. So after every statement you want to end with a question saying, Hey, you know, what's true about that? Or what comes to your mind when you hear that? Those, two questions allow you to kind of pull yourself from Hey, listen, what comes to your mind when I say that? As opposed to I'm saying this because Hey, you should do this or you should do that. Or you know, that came out like pretty that that came out as if, you know, instead of saying, Hey, you sound angry. Right? It's saying, okay, like what, you know, when I heard that it sounded like you, you know, there was some anger and what's true about that and now you're giving them the ability to respond back to that. Javier Carlin (09:57): So now it's more of an observation as opposed to kind of like telling them, or you know, letting them know, Hey, you sound angry. Right? There's more emotion to that. It's more of like, Hey, you're coming at me now. That's when someone can get a bit defensive or feel like their space has been invaded. But when you just state a fact and then ask them a question, it makes it a lot easier to have that conversation moving forward. I hope that, does that make sense? Jenna Kantor (10:25): Yeah, that does. That does big time. It actually connects, it brings it back to a conversation I had with my brother. I'm going to go a little deep on my own thing. I remember my older brother and I don't have a good relationship, but this is back in high school and there's a point to this that's not just about me, even though if anyone knows me, I love talking about myself, but he, I remember there was one evening where he was more of a night elephant, and we started talking. It was a rare time, was a rare opportunity when you just get into a deep conversation about life and anything and we were already at least an hour or something in and I'm just feeling my eyes shut on me. And I remember going through this like I have two options to continue this conversation to continue this conversation with him. Jenna Kantor (11:29): So I remember I had this opportunity to continue the conversation and force myself to stay awake and I felt like it was a very vital conversation. There was this little thing that was like, if I cut this off, it will be cutting off something big in our relationship. Me not being here to be part and present when he's open and being open to talking to me, for me to be able to hear what he has to say. Do you think that and it has over time now we don't have more. We have more solidly not a strong relationship. Do think there are conversations like that that exists that if you are not present and listening and you push it away too soon, it could actually cause damage to that relationship long term. Javier Carlin (12:33): Oh, 150%. Yeah, absolutely. Absolutely. Yeah. Yeah. and you know, it's tough. You know, diving back into exactly, you know, what you were feeling and how you're feeling and why perhaps that conversation was maybe at that time of interest or something that, like you were saying, you know, you felt like maybe falling asleep. Javier Carlin (13:03): So, you know, there's a lot to it that we could dissect really. But yes, I do agree with that. I think what happens in many conversations especially, you know, looking into it even deeper, it's, you know, when people have make offhand comments you know, short little statements in between the conversation that you're having. Most people are quick to kind of just let that pass. But that's what the person truly deep, deep inside is actually feeling and really wants to talk about. Everything else is just surface level. So, you know, exploring those offhand comments goes a very long way. And that's when people really know that you're truly focusing on them. And listening to them and that's where you get into those deeper conversations now. Again, back to the story that you just shared. There's so many different factors when it comes to that, but I definitely do believe that that can have a massive impact on, you know, the relationship moving forward and with anyone with, you know, your patients, your clients, people remember how you made them feel and that really, really sticks. Jenna Kantor (14:19): Yeah, you guys can't see me, but I'm like, yes. Hey man, I feel like I just went to church on that. But it's how you made them feel. So then, back to the clinic, you could have say a busy time, a lot of people, a lot of patients and everything and your time is running short. How do you cater to these conversations? If you see that there needs to be more time or if you do need to cut it shorter, how do you continue to feed that relationship, that trust? So you can have find an opportunity maybe later to spend more time listening to them. If you don't have it right then. Javier Carlin (14:52): That's a great question. I think there's several different ways to do it. I'll speak to more cause there's a tactical way of doing it and that's, you know, with I guess you can call it, you know, nature and the relationship through other methods with text messaging, emails and all those things. Right. Where you feel that connection with someone and continue to develop that relationship over time through sometimes automated, you know, systems and or where you're actually just sending a mass email, you know, once a week where it can still actually help to build a relationship. Right. But on the other front, you know, with our clinic specifically the way that we do that, because we do work as a team cause we are, you know, we do have insurance based model. Javier Carlin (15:40): So we do see several patients an hour. Because of the team that we have where for us specifically, it's a PT, two PTAs and two techs. Once we have a fully established clinic and got into that point that is where the PTA is that we have actually step in to treat the other patients that are there. And if I noticed, cause there's a lot of so when it comes to listening, there's, you know, when people say active listening, active listening really is it's not just listening to the words that are coming out of someone else, someone else's mouth, but also painted with everything else that's going on the unsaid, right? You really want to explore the unsaid. And that comes with a body language. You know, a visual cue is a body posture. You know, the way someone says something, their tone, their pace, right? Javier Carlin (16:28): And obviously as you get to know someone, you really get to feel how they feel when they're having a great day and when they're having a not so good day. So, you know, not letting, again, kind of like not letting offhand comments go. You don't want to let those, the visual kind of feedback that you're getting you don't want to let that go either. So, when you do see someone that's in that specific state where they might be disappointed, angry, upset, frustrated, you want to make sure that you address that right there. And then, and the way that we do that specifically at the clinic is we take them into the evaluation room and we can do that because of the fact that we work as a team, everyone on the team knows exactly what every single patient should be doing and knows them at a deep level so I could actually step out and have that deeper conversation with whoever needs it at that time. Javier Carlin (17:20): We'll sit for, you know, five, 10, 15 minutes, however long we need, really to explore what is going on at a deeper level so that we can ensure that they don't drop off. Cause typically what happens is that when you don't, when you just kind of let that go, that's where you get a patient call in to cancel and then it happens not just once, but twice, three times, four times, and then they ghost you. So that's how we handle that situation. Jenna Kantor (17:50): Absolutely. Absolutely. I think that's a really important thing to put into place. So for clinics alone, how would you, if they don't have something set up and say they're a busy clinic and they don't have something set up where people can have the time to necessarily sit and listen, how could they start implementing that in order to improve the relationships with their patients and then they're showing up? Javier Carlin (18:13): Yeah, that's a great question. And I think there's so many variables depending on how the clinic is set up and ran. I believe that, you know, I think as you know, obviously as physical therapists ourselves, I think our first instinct is to always like go to like the physical, right? Like, you're feeling this way today. Okay, don't worry. Like, we're going to make you feel better after this. It's like, wait a second. Well maybe the person, maybe for those initial 30 minutes, they don't even need, you know, therapeutic exercises or whatever it is that we're prescribing them for that day. Maybe they just need to have a conversation, right, for 20, 30 minutes and just to let it all out. And those 30 minutes of actually just talking to them just because we can't bill for that time technically. That's going to be the difference maker between them actually seeing the results longterm and dropping off. So it's making that clear distinction and deciding, okay, what this person needs at this point in time is not, you know, to do a core exercises or to get manual therapy. What they need is to just have a conversation about what's going on in their world. Cause ultimately that's what matters the most event. Jenna Kantor (19:28): So yeah, true question. I think that was great. That was good. I just want you to know, okay. So then during this time, the Corona virus, what has your clinic been exploring on a listening standpoint with the switch to virtual to try to fit those needs? Like, I don't know, it's kind of an open ended question for you to interpret this however you'd like. Javier Carlin (19:58): Yes. So I think, you know, it's been, to be honest, it's been a challenge. And the biggest reason why is, you know, knowing that tele-health existed for, you know, the last year, two years, et cetera. And, has been existing, we didn't really make a push to have that as an additional service. So what's happening now is that it's like physical therapy, right? A lot of people still don't know what physical therapy is and it's not something that they necessarily want. It's just something that they need. Right? So, same thing with telehealth. It's something that, you know, now we're adding to things that people don't know, which is physical therapy and telehealth. And now we're, you know, most people are now trying to figure out, okay, how can we push tele-health without, you know, having any like, previous conversation about this. Javier Carlin (20:53): So that's where the challenge lies is that you have people who are, you know, the ones who do know what physical therapy is. We're coming in and you know, when they think of PT, they have this, you know, they have this picture in their mind because it's what they've been doing for the past, you know, X amount of weeks and now you're trying to get them to jump on to a different type of platform to, you know, provide a service that in their minds can only be done in person. So what we've seen started to do is we've started to offer complimentary telehealth visits. So the first visit is completely free 15 to 20 minutes in length. And offering that first, you know, giving the patient an opportunity to experience what it's like and showing them how valuable it can be. Javier Carlin (21:39): And then from there deciding to make an offer for them to actually purchase, you know, X amount of business. And typically, you know, your time is your time, so you want to typically charge the same that you would an actual in person session. But because this is so new, we have decided to offer it at a very, very low rate. So that barrier to entry is a lot less, especially in this time where you know, people's finances might not be at their all time high, or at least, they're not going to say, they're a little bit more reserved with what they're spending their money on. People are still spending money, but with what they're spending their money on. So that's how we're handling that now. A lot of, you know, constant communication through text messages, emails and just listening. Jenna Kantor (22:34): Yeah, yeah, yeah. Yeah. That's amazing. Thank you so much for coming on. Is there anything else you want to add in regards to the art of listening that you think is a key point for people to take home with them? Javier Carlin (22:47): Yeah, so I think the last thing, and this is actually a quote from Stephen Covey and I have it here cause I didn't want to butcher it, but basically he says most people do not listen with the intent to learn and understand. They listen with the intent to reply. They are either speaking or preparing to speak. So that's it. Jenna Kantor (23:09): That's great. That's a really good quote. Sums it up. Yeah. Well thank you so much for coming on Javier. How can people find you on social media? What are your addresses on Facebook, Instagram, all the above? Javier Carlin (23:32): Sure. So I'm on Instagram. I'm at @drJavierCarlin. So dr Javier Carlin on Facebook have your Carlin's so you can just look me up there and friend request me. I do have life coaching Academy for healthcare professionals a Facebook community. So you can always jump into that as well with a podcast coming out soon. And I think that's it. If you want to send me a, you know, text message and just link up my phone number is (305) 323-0427 to have a conversation. Jenna Kantor (24:05): I love that. I love that so much and if you guys want to see or hear him in action, if you're in the group or even in his future podcast, you'll see from the way he interviews and speaks with people how he really uses his curiosity and deep dives and learns more and listens so well. Just watching him in action alone, aside from just even experiencing it yourself, you'd be like, Oh wow, he's good at this. I feel very listened to, thank you so much for coming on. Everyone jumping in, thank you for joining and have a great day. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! 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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tracy Blake on the show to discuss the evolving role of physical therapy in sport. Tracy's desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author. In this episode, we discuss: -The preventative and reactionary roles of physical therapists in sport -How to optimize the healthcare team's strengths to amplify the organizational mission -Equity and shifting power dynamics between the athlete and clinician -COVID-19 and ethical considerations in sport -And so much more! Resources: WCPT statement of diversity and inclusion WCPT symposium on diversity and inclusion 2016 consensus on return to sport Introducing patient voices Coin model of privilege and critical allyship Tracy Blake Twitter For more information on Tracy: The only daughter of Trinidadian immigrants, Tracy Blake and her youngest brother were raised in the multi-cultural, multi-ethnic, multi-faith, working class Toronto (Canada) neighbourhood of Rexdale on the traditional territory of many nations, including the Mississaugas of the Credit, as well as the Anishinabeg, Chippewa, Haudenosaunee, and Wendat peoples. Sport was a power source of connection and vehicle for connection throughout Tracy's upbringing. Tracy's desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author. Read the full transcript below: Karen Litzy (00:01): Hi Tracy, welcome to the podcast. I am happy to have you on. And I'm so excited to get to speak with you one on one. I heard you speak at WCPT in Geneva last year and I think I've told you this. It was one of my favorite sessions and we can talk a little bit about that session later. We'll probably sort of weave it in as we go along here, but it was a great session at WCPT and I'm really excited to have you on the podcast today to talk about the evolving role of physical therapy or physiotherapy in sport. So I'm just going to hand it off to you and if you can kind of let us know what that role kind of maybe where we were and how you see it evolving and how it has evolved up to this point. Tracy Blake (00:53): Yeah, so I think historically, physiotherapy or physical therapy, I'm Canadian, so I tend to use both. Historically in sport was seen as reactionary. So injury happens, enter physiotherapist from stage 1 right. And I think over time what has happened is that both from a clinician standpoint and an organization standpoint in sport there has been a change in perspective with an increasing level of focus on primary injury prevention. And so what that has meant is physiotherapists are not only responsible for there reactionary role, the rehabilitation, the remediation of injury, but also there has been a serious investment both in their time and an organization's resources around preventing injuries from occurring at all. I think the other part of this is that part of the evolution has been in the team around the team. So historically speaking, there may have been a physical therapist and athletic trainer, a doc, and that would sort of be the primary set of your team. Tracy Blake (02:14): Now, more and more organizations are having maybe multiple therapists, strength and conditioning, nutrition, dietician, sports psychology, other disciplines are involved in the team, which both alters the way in which we gather information, gather experience, the way we develop as practitioners, and also the way in which we engage in our role and in our competencies. Within a sport context. And I think that there's sort of three arcs in which I see physiotherapy in sport, which is consultant. So in a consultant role, you may not be actually involved with front-facing athlete care at all. You might be making recommendations or talking to ownership or be brought in special cases for example. As a concept, then you have external service providers. They might have more regular athlete contacts, but they're not embedded in the daily training environment, which is the third aspect. Each one of those rules has a role to play in today's modern sport, particularly as you get into more resource abundance levels, your high performance or Olympic level or professional level. But the arc of change for each of them is going to be different. The arc of evolution is different. And what that means for the practitioner and the profession will also be different. Karen Litzy (03:47): And so when we talk about those tiers, so let's say you sort of outlined consultant the external service provider and those people who are really embedded with the team on a day to day basis. And before we went on, you sort of use the example of the NBA example. So can you talk about that just to make that a little bit clearer? Tracy Blake (04:10): Yeah. So there was a time where like if you were, the internet still existed, but maybe like online rosters and Google's worth weren't quite as prevalent, I know, usage, but you wouldn't have been able to just go on and find a physical therapist listed on an NBA team. There might've been one a decade ago, maybe two. And now in today's days and times, every NBA team has at least one and sometimes multiple that are working in various specialties within physical therapy. And so I think that that is also something to consider it, right? So what exactly is your contribution to the team in the context of both your profession, which is a healthcare paradigm and your occupation, which is in a performance paradigm in your sector. And so how do you reconcile those two in a way that allows you to contribute and to be of service? Tracy Blake (05:11): And I think we were, I mentioned this to you as well, that I think that the only way to reconcile that in a way that is grounded and sustainable is to be really clear about what your specific mission is as a physical therapist. And then making sure that whatever role you're in, whatever tier you're in, in the incredibly fast paced moving world of physio and in the fast, fast moving world of sport that you're grounded to that regardless, it makes you more responsive and adoptive, particularly in these days and times where on top of the unpredictability of sports and the fast paced moving to sports, we now overlay a global pandemic into that. And so you lose your footing. It's real easy to lose your footing in sport these days. And so if you are not grounded in something that is separate from your job professionally, it is very easy to lose your way. Karen Litzy (06:10): And especially now that there is no sport happening. Correct. While we're in the midst of this global pandemic, there is no sport happening. And so I guess being very clear on what your mission is, does that then allow you to find other ways you can contribute to the team aside from direct we'll say patient care, athlete care or direct overview of strength and conditioning programs and things like that. Tracy Blake (06:41): Yeah. So, then the question becomes is how is a team still a team when they're not playing? So when the technical has been removed from you, what makes you a team? And then in that context, what is your role in maintaining that team in contributing to that team? So I think when we were at WCPT when I had mentioned the idea of what is your mission, I had told people to think about it and you're not allowed to use the words rehabilitation, remediation, illness or injury in whatever your mission statement is. The purpose of that at the time was that you were having conversations with people in sport who do not come from your health care background. So if you only use language that relates to health care remediatory way or inaction reactionary way, you're undervaluing what you do. And you also run the risk if that's not understood in the same way you intended. Tracy Blake (07:52): It turns out that that actually works out in this case as well because now we've taken all of the trappings or all of the preconceptions that come with our role have now been wiped away. Right. So what are you contributing to the team in this context? Are you, for example, as it's somebody who is usually in the daily training environment? Having a team that is sometimes centralized and sometimes decentralized. I made sure that I continue to talk to my team and do check-ins even when they're decentralized. So now we're decentralized longer than we would have been because the Olympics aren't happening. Right. But their communication with me isn't somehow new. Karen Litzy (08:42): Smart. Tracy Blake (08:44): So that's not everybody's option. But that is for me, a way in which the relationships we've had, we're not based on strictly what was on court in the team context. So therefore the relationships are able to be sustainable when an earth shifting history shifting thing is occurring. Karen Litzy: And, I have a question for you. What is your mission statement? Without using remediation, rehab, et cetera, et cetera. Tracy Blake: So my mission in sports specifically is the optimization of health function and performance, whatever your age, stage or field of play. Karen Litzy: Excellent. I love it when people are prepared. That was great. And I think it's very clear. I think that's very clear. It's short and sweet and to the point and people get an idea of what your mission is and what your function is within that team setting. And now let's talk about the team, but not so much the team that's on the court or on the field. But let's talk about the team around the team. So you had mentioned you've got maybe a couple of physical therapists the MD, the ATC, a sports psychologist, nutritionist, but let's talk about how the team around the team functions for the good of the team that's performing on the field, on the slope, on the court, et cetera. Tracy Blake (10:15): Yeah, I think that there is, so my circumstances were particularly interesting in my current situation with volleyball Canada in that I was brought in with the strength and conditioning coach halfway through a quad. Like going into Olympic qualifiers, which is highly unusual. Well we were very lucky was that we had our conversation right out of the gate and we were of a mind so to speak philosophically in this way. So we had our first conversation, I say lucky, I think our director of sports science, sports medicine and innovation would say that he planted this way cause he hired both of us. But we were lucky that we were philosophically aligned in both what we thought our jobs could be for the team in this setting and in this circumstance. And then turns out how we work together also worked quite well that way. So that becomes, I think one of the first things is what's your mission? Does it align with the people who you work with? That's the first thing. And then from that spot, how do you use your strengths of each of those team members to amplify what that organizational or team goal is. Tracy Blake (11:33): And then how can you also identify gaps in each other and fill those in. Because that's the thing, like people love to talk about their strengths. To a team and what they can contribute with their strengths. They're less comfortable, particularly in sports, particularly an environment that is bred on competition and winning. And there can only be one. It is much harder to feel comfortable with vulnerability and opening up something that feels like a gap or a weakness or an area that you're not as confident in and trust that somebody else will fill it without exploiting it. So I think both parts of those need to happen for a team to be both functional and that function to be sustainable for anyone for time. Karen Litzy (12:20): Yeah. And I think that's also where the learning happens, right? When you have that team of professionals around the team, I would think me as a physiotherapist or as a physical therapist can learn so much from those other partners. Tracy Blake (12:38): Yeah, I agree. And I'm a nerd. There's no getting around it. I love a learning moment. I love them all the time. I want to know everything. And so for me, I feed on that, but that is not everyone's experience. And so what I've had to learn is timing and approach and repetition. Frankly, being not just clear on my mission once, but clear on it over and over and over again. How do I express my mission in the big and small things that I do in a day so that I'm consistent and I'm transparent so that at no point somebody can be like, well you said that at the beginning but you did this and this and this. That was inconsistent with that. And so I want my own way. And so in those kinds of circumstances I'll be like, look, this is where I was coming from with this. Tracy Blake (13:30): This is why I thought it made sense. I went to a school where when I say school, like entry level physio training, was that a school where we didn't have traditional lectures? Very much. Almost everything was small group learning. And so I feel like that environment really fostered the way that I work in the team environment, in sport where everybody had the same questions. We all went off and found the information and key information, excuse me, and came back to it with our own whatever that information is plus our own experience and perspective layered in on it. And then you figured it out together what was useful, what was not. Karen Litzy (14:13): Nice. Well that's definitely set you up for being part of a team, that's for sure. And now let's talk about, so let me go back here. So we spoke about kind of the different tiers that may be a physiotherapist might be in how being part of the team is so important to understanding your mission, staying true to that. And I think being self aware enough to know that you're being true to that mission and that you can stand by it and back it up. And now let's talk about how does all of this that we just spoke about, what are the implications of that for athlete health and for support in sport? Tracy Blake (14:52): So for me, the cornerstone of every relationship but particularly in the context of sport is trust. I work in sport obviously, but I also work in acute inpatient healthcare. And I also worked in private practice for a long time and people often assume that my private practice life, my private practice, orthopedics and my sport life are the two that are most closely aligned. Okay. Particularly in recent years, I've corrected that. And then I actually think it's my hospital life in acute care and my sport life, particularly in high performance that are the most aligned and the reason why is the relationship building and the communication that they require. So when I'm working with an athlete, the way in which I can get the best out of that athlete is if they trust, but I'm working to the same goal they're working to. Tracy Blake (15:58): Now that does not mean that I don't care about health, right? Because sport is inherently a risky situation, right? There's a level of risk acceptance that you have to participate in them, particularly when the levels get higher. And I believe there was an article by Caroline bowling, it's a couple of years old now that actually talked about injury definition and asked high performance athletes, coaches and sport physios. And in that article, all injury was negative effect on performance. There's no mention of it risk, there's actually no mention of illness or injury. So if I can't have a conversation with you about what I think the injury is doing to affect your performance negatively, I'm only filling in half the picture. So I need you to trust me. And the way in which I garner that trust. The way in which I build that trust is making sure that you always know that I have your goal, which has performance in mind. And so I think that that component of the relationship is the cornerstone. What cannot be left out of it, however, is the role of equity and the power dynamics. Tracy Blake (17:23): Physio is a health profession. Health professions historically are in a position of power or a position of privilege in the context of your practitioner patient relationship, right? If that's the situation already to start, how can you know that the person is giving you the accurate information if they're already in a position where the power is shifted out of their favor? So knowing that and understanding that concept, I've tried to be really intentional and again, really consistent in actively working to even the scales. I do that. Yeah. So I regularly consistently ask athletes, not just what they think, but I start with the part that they know the most about because as it turns out, I've never played professional volleyball, I've never played any sports at a high level, right? So if I start with the part that they know the most about the technical components of that, the way that training happens, the way practices are organized. If I start with what they know and ask questions about that, and then I work the way in which I build a program back from that, what I often say to people, not just athletes, but obviously this applies to athletes as well, is that I say I know bodies, you know your body and what we're trying to do is take what we know about those two things and put them together in a place that gets you to where you want to go. Tracy Blake (19:02): And anything that you think I'm doing that either doesn't make sense for that for you or that you think is working against that you need to tell me early and often. And so that's the framework. That's a conversation that's happening like right away. First day. Karen Litzy (19:19): Hmm. Tracy Blake (19:19): And then I give them opportunities to come back to that over and over. And not everyone communicates the same way. So you can't expect somebody to like just be like, you spit out five minutes of like clinical decision making information at them and they're going to be like, yeah, aha, Oh by the way, this, this, that and the third. Right. That's not going to be how it happens all the time. So making sure that people have time to think about it. Give time to reflect how the place to come back to you. Some athletes want to break it down into small bite size pieces. Some athletes want to be like, just fix it. I don't want to talk about it. And that's also my responsibility to make sure all of those different types of personalities, those people with different relationships with their bodies. How the power of the emboldened to be able to say what they need to say to meet their goal. And so that's what for me, that communication and relationship building part has to be the cornerstone because it's the only way we can get anything done with the kind of both the speed in which we need to get it done in the context of sport, but also in a sustained way. Because if someone keeps getting hurt, that is also not going to help anybody's situation both from my job security or theirs. Karen Litzy (20:34): Right, right. Absolutely not. And so again, this kind of goes back to being part of the team. And so what I'm sensing is, and again, I feel like as therapists, we should all know this, but the team around the team also includes the team. You can't just have the team around the team making the discussions and these return to play decisions without involving the members of the team without involving that athlete. Tracy Blake (20:48): Correct. And one of the things that I found, like I'm saying a lot of these things to be clear, I'm saying them now and it sounds Zen, but I found out most of these things through failure to be clear of course a million times over. It has brought me to where I am having this conversation today, but I just wanted to be clear that I did not like walk out of entry-level physio with this knowledge on a smorgasbord. No, I know. Shocking. Shocking. What kind of program was this? You went to again, that didn't prepare you for high level sport athletes shawty is what it was. But the idea that the idea that an athlete, an essential part to their healthcare team still is radical for many and they see it, they see it. Tracy Blake (22:03): But what happens is when there actually requires an actual power shifts to make happen. Yeah. It's hard for people when it actually requires them to let go of some of their power if it requires them to acknowledge. There was a moment in the process of programming, in the process of delivery, in the process of recovery that they are not the expert in the room. It can be a blow, particularly people who've spent in our cases years getting to that point. Karen Litzy: Oh absolutely. And I think in several presentations I've seen in writings of Claire ardor and I feel like she goes through this which with such specificity and simplicity that it makes you think, well of course, kind of what you just said. Like for some people it's a radical view that the athlete should take this big part in their recovery and their return to sport or in their health. But when you listen to folks like you or like Claire, it's like, well yeah, it all of a sudden turns into a no brainer. So where do you think that disconnect is with those people who still considered a radical idea and the people who are on the other end who are like, well, of course they should be part of it. Tracy Blake (23:09): Some of it is experience. And so what I mean by that is not just like length of time experience, but I found that when everything's going well, it's going well, right? There is no impetus to change. There is no disruptor that actually acts to give you a moment to or recalibrate as you need. And so when I say experience, I mean I've had instances where, to be honest, I wasn't sure if it was going well. I wasn't sure I was doing what I thought needed to be done and I was doing what felt right. Again, I was aligning with the mission that I had because I didn't have any real world context in this specific sport or circumstance that I might've been in. And then something goes wrong. And you realize in the aftermath of that, whether it's an illness, whether it's an injury, whether it's something off court altogether, right? Whether it's an abuse and harassment situation, whether it's a boundary situation, whether it's a patient confidentiality situation, right? You realize when those things go sideways, but that's whereyour power and your metal is tested professionally. Tracy Blake (24:46): And so I think that's one part of it. I think another part is there's ability to what they call it mission creep, right? Where over time you sort of like, this is what you think your mission is, but then you did a little of this and you do a little of this and the next thing you know, you're far away from where you started. And I think that a lot of people, I think they're in service to the mission one in sometimes they actually end up in service to the business model. And particularly in sport where the jobs or when I say sport, like high performance sport professional sport, where the jobs are few, where the jobs are highly competitive. I don't think I've ever applied for a sport job that had less than 75 applicants and upwards of several hundred in some cases. Tracy Blake (25:43): Wow. Everybody wants that gig. And so people can sometimes get led by the, or creeped away from their mission by the instinct to do what is necessary to stay in the position rather than what is necessary to optimize the health function and performance of their athlete. So having a situation where you've been tested and sometimes don't, aren't successful and mission creep. Those two things I think are maybe the biggest ways that aren't just related to like personality. Like those are that things can be trained or modify. Those are like the modifiable things I think. Karen Litzy (26:44): Great. And then, you know, we had said as we are recording this, we are in the middle of the global covid-19 pandemic. And so there is no sport going on. And so to the best of your ability, and we're not asking you to be a future teller here, but what do you think will happen to the role of physiotherapy in sport and the medical teams in sport? Tracy Blake (27:28): I don't know necessarily what will happen. What I hope happens is that all healthcare practitioners, but particularly physical therapists in our case because I'm biased in that direction that they recognize their role in contribution to population health in the context of sport. So public health in the context of sport, we often think of sports as a bubble and it is to a certain extent, but that bubble is manufactured. That means all parts of an athlete's existence are manufactured, right? All parts of what the athlete is provided with from a health perspective are manufactured. So have gaps are left in that it's up to you as the person who is actually in the sport context to identify and try to remedy and resolve. Right? It's deeply problematic for athletes to not have the same information that somebody who works in the public house. It's deeply problematic for athletes too, not have access to labor rights. It's deeply problematic for athletes to not have be informed and be given informed consent to participate in mass gatherings during a time of pandemic. Tracy Blake (29:02): And I also think there is a strong ethical quandary that comes with providing services, two events that fly in the face of public health recommendations during times like this. And I've been on record with this, I said this a couple of weeks ago, I posted about it on Twitter where there was a massive wrestling tournament happening and I thought to myself, it's wrestling, it's a combat sport. It can't happen. Like they literally would have no insurance if there was no medical covenant medical coverage provided. So if you didn't have medical coverage, the event couldn't happen. So how does medical coverage or physio coverage or what have you happen against public health recommendations? We can't continue to act in separation with each other. We need to view sports as part of population health. And then we need to make sure athletes and those in the sporting community are acting in accordance with the public health. Tracy Blake (30:11): At the times demand as well. And I think the Rudy go bear situation was truly, genuinely shocking for a lot of people. They were unprepared at every level, not just sports medicine and sport physical therapy. And so what I hope lingers for people is that we think about emergency action plans a lot, right? We think about how we're going to get somebody off the court in the case of an emergent issue, Encore, how are we preparing them for life in that same context? How are we in preparing ourselves as professionals in that context? And I hope that those conversations, because it turns out you don't need to be in person for that. Tracy Blake (31:01): That people are reflecting on that now and that steps are being taken to improve both the gaps that are specific to the city, the situation with the pandemic now, but also how do we identify these things going forward. And I think some of that had already started to show its colors around issues of food insecurity, issues of education, issues of like the younger your players are coming in. Are you providing appropriate development? I went to you as a, you know, I went to the United nations last year for the sporting chance for him, which is around sport and human rights. And last year, 2019 was the year of the child. And so there had been a special rapport to report on the rights of the child and child exploitation and snails. There is an entire section dedicated to sport and how sport has been used as a vehicle for the exploitation of the child. Tracy Blake (32:08): And I think of things like that, like those are the kinds of gaps. But now that you know that these kinds of gaps exist now you know, you understand in a very real way and it's kind of, it's telling in some kind of ways that it needs to strike so personally close to people's wallets and they'll help. But now that we've had that touch, now that we've been exposed in this kind of way, can we continue to be proactive in the way we address other things going forward? That would be what I would hope to see. Karen Litzy (32:40): Well, and I think that's I feel like very doable hope. I don't think it's like a pie in the sky. Hope. I think all of those conversations can be had and hopefully can be had by everyone surrounding sports, not just the physiotherapist or just the medical team, but straight up to owners and players and everyone else in between. So Tracy, thank you so much for such a great conversation. Tracy Blake (33:13): Yeah, it's been great. And I think again, like physios are really well situated because you have physiotherapists who have really like have access to the player and have access to the coaching, the ownership, the administrative stakeholders. They're well situated to be able to bring these things to light on both sides and be involved in those conversations even if they don't have out right decision making power. Karen Litzy (33:38): Right. Absolutely. Tracy Blake (33:39): Yeah. Thanks for letting me out of the shadow. Karen Litzy (33:42): Oh, it was great. Thank you so much. And then before we sign off here, I have one more question that I ask everyone. And knowing what you know now and where you are in your life and in your career, what advice would you give to yourself as that fresh graduate, straight out of physiotherapy school? Tracy Blake (34:04): I would say that you need a mission early and you need to speak it into existence. It's not good enough to keep it in your head. You need to say it out loud to people and you need to get feedback from people and whether it's clear or not. And I also think that one of the things that I learned I was 36 almost 37 when I took my first dedicated health equity class and aye, it was a workshop. And in the beginning she said for some of you this will be new information and it was specifically targeted at health professionals, not just physio. And some of you would have learned this in, you know, your first year equity studies, first year gender studies kind of course. And after the weekend where I slept for basically three days because of all the information floating in my head, I was like, there are 18 year olds walking around with this in there. And so I think that if I could go back now, I'd be like, you need to start taking those courses early. You need to start embedding it into your thinking early. Maybe you'll be better at being intentional about how you use it earlier. Karen Litzy (35:11): Excellent, excellent advice. Now, where can people find you if they want to shoot you a question or they just want to say how great this episode was? Tracy Blake (35:22): So I'm active on the Twitter, so my Twitter handle is @TracyABlake. I am not as active on the on Instagram. My Instagram still private, but if you shoot me a message I usually find it anyway. So that also works. Same handle @TracyaBlake. Karen Litzy (35:38): Perfect. And just so everyone knows, we will have links to certainly to your Twitter at the show notes over at podcast.Healthywealthysmart.com. So Tracy, thank you so much. I really appreciate it. This is a great conversation. Thank you so much. This is quite the podcast debut. I appreciate it anytime and everyone, thanks so much for tuning in and listening. Have a great couple of days and stay healthy, wealthy, and smart. Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

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

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

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

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

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