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Now displaying: August, 2020
Aug 31, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michael Greiwe on the show to discuss telemedicine.  Dr. Michael Greiwe is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.

In this episode, we discuss:

-The benefits of telemedicine for both the patient and provider

-Choosing the right telemedicine platform for your practice

-How to meet patient privacy and compliance requirements

-Practical tips for a seamless telehealth visit

-And so much more!

 

Resources:

Ortho Live Website

Michael Greiwe LinkedIn

Michael Greiwe Twitter

Email: mikegreiwe@ortholive.com

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.   

For more information on Dr. Greiwe:

Dr. Michael Greiwe, M.D., is a surgeon by day and tech guru by night. He is a practicing orthopaedic surgeon with OrthoCincy, near Cincinnati, Ohio, and the founder of the OrthoLive and SpringHealthLive telemedicine platforms. The platforms allow medical practices to deliver telemedicine visits through real-time HIPAA compliant video conferencing between provider and patient increasing practice revenue, efficiency and patient satisfaction.

Dr. Greiwe is a nationally recognized expert on how telemedicine technology is changing the practice of medicine. TV news stations and podcasts across America have interviewed him about the future of telemedicine and how to use it to improve the patient experience.

He attended the University of Notre Dame, where he won the prestigious Knute Rockne Award for excellence in academics and athletics. He completed his Founder and CEO of OrthoLive orthopaedic surgery training at the University of Cincinnati Department of and SpringHealthLive Orthopaedic Surgery and Sports Medicine. In 2010, Dr. Greiwe completed his fellowship in shoulder, elbow and sports medicine at Columbia University, training with the head team physician for the New York Yankees, Dr. Christopher Ahmad.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey Dr. Greiwe, welcome to the podcast. I am so happy to have you on today to talk all about telemedicine.

Michael Greiwe (00:08):

Oh, thanks so much, Karen. I'm glad to be here. I really appreciate you having me on the show.

Karen Litzy (00:11):

Yeah. So for any of the long time listeners of this podcast, you know that back in March and April, when the covid pandemic hit, we talked a lot about tele-health. But I think it's great to sort of revisit that now that we're a couple of months in and perhaps more people are using telehealth at this time, then were back then. But what I want to know is Dr. Greiwe, did you just start using telehealth when the pandemic hit or were you more of an early adopter?

Michael Greiwe (00:42):

Yeah, thanks for the question. I kind of carrying out with sort of like an early adopter. You know, I started using telemedicine back when it really wasn't cool, I guess. It was like back in the 2016 time period. And I knew it was great for my patients cause they live pretty far away. I had patients that live like two or three hours away and they would drive and try to meet me. And then you know, I'd only see them for 15 minutes. I felt really bad about that. So I started using telemedicine and it's been a great thing for my practice. And then of course, you know, recent things changed everything and it's now exploded.

Karen Litzy (01:16):

Right. And like I said, in your bio is that you're an orthopedic surgeon. So one question that I think is probably good that you probably get asked all the time is how in the heck do you see someone for an orthopedic condition when you can't put your hands on them and kind of feel what's going on?

Michael Greiwe (01:37):

Yeah, that's a great question. I get it all the time. And it's one of those things where, you know, for me, and I'm sure for you as a physical therapist, you know, so much when you hear about the history of that patient. So like the history gives you probably 80 to 90% of what you need. And then the rest is sort of verifying things through, you know, a physical exam and there's certain things on video that you can kind of catch. So like if I have somebody with the rotator cuff problem, I can watch their arm move. And I just know that the rotator cuff is bothering them. And then I'll maybe order like an MRI or something along those lines sort of confirm. But ultimately for me, it's more about like, you know, I may have to see this patient in the office at a certain point in time, but I don't always have to do that. It's kind of like depends on what the history gives me.

Karen Litzy (02:22):

Yeah. And I agreed from a physical therapy standpoint. I get that question all the time is, well, how can you do physical therapy on someone if you can't, if you're not in the same room. And again, it comes down to listening to the patient. Like they will tell you everything you need to help treat them to help diagnose them. If you just listen in the beginning and then you can tailor your program accordingly. Now of course, like you said, there are times where you have to see the person in person, right. And sometimes that's the same with PT. So I think oftentimes when people think about tele-health, they just paint with a very broad stroke and they think, well, how can you do that? So what do you say to people who sort of have that mentality of all or nothing?

Michael Greiwe (03:13):

Yeah. I think if they experience it for their, you know, themselves, they can sort of see that, okay. You know, this really works and it works because, you know, if you have somebody on the other side that's engaging you and asking the right questions, you're going to eventually come to the right answer. You know, I've had patients with a frozen shoulder and I'm sure you've treated patients with frozen shoulder. It sort of have classic signs and symptoms. Sometimes the history isn't like exactly, they're just sort of out, well, you know, my shoulder has been hurting and it kind of came on over the last several months and now I can't really move my arm as well as I used to. Or maybe you might not hear that. You just hear like, well, it hurts all over all the time, but if you kind of ask some leading questions, you have the right examiner, you can find out the answer. And so I think that's really, the key is having the right person on the other side of the screen, you know, asking the right questions. I'm sure you do the same in your practice with physical therapy.

Karen Litzy (04:06):

Yeah, absolutely. And you know, when we're talking about our different practices and our businesses because of the COVID pandemic, a lot of places had to shut down there in person I'm in New York city. So talk about being shut down. So we were shut down quite early. Now other parts of the country are flaring up and there's a lot of uncertainty here. So when it comes to tele-health and our business, how can tele-health help our practices grow and help our businesses grow?

Michael Greiwe (04:41):

That's a great question. I think it's something that people are sort of finding out more and more about right now. I mean, there's so many ways to be able to utilize telemedicine in our practices to help it grow. I mean, first of all right now as an orthopedic surgeon, I see patients from around my area because of COVID in the situation we're in right now, they don't want to come into the office, you know, so they're looking online and they find, Oh, Dr. Greiwe has got an open slot to be able to be seen via telemedicine. So we're kind of advertising that at ortho Cinc, where I practice to say, Hey, anybody that might want to come in for telemedicine appointment, you can. And it just gives me access a lot better than it normally would to be able to see patients. And then I think there's other ways too.

Michael Greiwe (05:25):

So for instance you know, for physical therapists, you might work with employers for instance, or workplaces that need a physical therapist and you put like an iPad there to say, if you need a physical therapist, here's how I can help you, you know, call me or whatever through this device. And so there's just so many ways for us to do that inside ortho, specifically postoperative recheck appointments, they open up slots of time that, you know, you typically wouldn't have because it's a lot more efficient to see someone via telemedicine than it is in person. And you know, also there's a lot of downtime kind of between surgeries for us too, so that downtime can be utilized for telemedicine too. So there's a lot of ways we can sort of generate you know, revenue through that and kind of open up our practice a little bit more.

Karen Litzy (06:13):

And, what I found is I can actually help more people.

Michael Greiwe (06:17):

Oh yeah, absolutely. Because you could probably have group visits too. Right. You could have you know, on those group visits or are you talking about just sort of more you know, area? Yeah.

Karen Litzy (06:29):

Like you were saying before we went on is sometimes you have people have to drive two to three hours to see you. Right. You know, that's really, that can be really difficult. So imagine if you have, you know, this really aching shoulder pain and you have to drive two hours.

Michael Greiwe (06:45):

Right. Absolutely. You're absolutely right. I think what helps, what helps you is, you know, with telemedicine, you've got the reach to be able to see somebody that's five hours away or even across the country that's heard about you or, you know, maybe they know that you have certain techniques that they like. I sort of developed like a posterior shoulder replacement where it's kind of a muscle sparing approach to the shoulder. And so I have people come from like California, Texas, Montana, you know, and now I can kind of see them postoperatively and preoperatively with telemedicine. So it's a really nice, it's a nice tool from that standpoint too.

Karen Litzy (07:19):

Yeah. That's great. Yeah. So you could see them preoperatively, if they're across the country, they come in, you do the surgery and then you can then see them postoperative. So they don't have to stick around by you for six weeks.

Michael Greiwe (07:33):

Right. So I'll have him stay for the first week and then we'll have the incision to make sure everything's looking good. Take x-rays and then they'll go back home and then I'll check in with them every four or five weeks, they'll be doing physical therapy kind of in their local area. Or of course I could refer them to you to remote therapy, but yeah. So that's how they do it currently is they go back home, they work and they get their motion back. And then we'll check in again, virtual.

Karen Litzy (07:57):

Now how about prescribing medications? Is that something that you can do via tele? How does that work?

Michael Greiwe (08:03):

Yeah, it still works pretty well via telemedicine, but I don't really do any like schedule three narcotics, you know, things like that. We don't do, but you know, anti-inflammatories, you know you know, if somebody has had some nausea like Zofran or, you know, things of that nature are pretty easy to prescribe and we still prescribe and have the same prescribing practice that we do in person, it's just, I get a little bit more wary and I think it's prudent to be more wary about, you know, narcotic prescriptions and things like that, especially in the world that we live in right now. We've gotta be very careful about that. So, we're super careful with that, but I think most of the other prescriptions are totally they're okay to do.

Karen Litzy (08:46):

And how about this is a question that I get sometimes is what about privacy and compliance and making sure that meeting all those standards. So how can we ensure that we're doing that as a healthcare practitioner on tele-health?

Michael Greiwe (09:04):

That's a great question. I think, you know, it is very important, obviously. So HIPAA compliance is what it's sort of called as you know, and it's what everybody's sort of, doesn't like to have to worry about, but it's very important for our patients, right? I mean, it's, people are very much in tune with their privacy. Data privacy is becoming like a really big thing right now, but really people's healthcare privacy and their you know, their medical privacy is very, very important. So the telehealth platform that you choose, you have to make sure that that is HIPAA compliant. And that means end to end encryption. That means like the data that starts out, you know, it's carried through the internet and it's encrypted and then wherever it's housed, it's also encrypted there too, so that no one can sort of get to that information. I think that's really critical, very important for our patients and most of the platforms they will advertise whether or not they're HIPAA compliant. And you want to know kind of how many you know, what type of bit encryption they are and things like that when you look at platforms.

Karen Litzy (10:06):

What was that last thing you said?

Michael Greiwe (10:09):

Yeah, it's sort of like, as the information is traveling across the internet there's sort of, you know, bytes of information, right? And so the amount of encryption can be sort of leveled up so that, you know, basically you can have like 64 bit encryption, or you could have 264 bit encryption there's certain levels. And so it takes, it's like a string of numbers. And so that string of numbers is how much it would take to crack the code essentially. So 256 bit encryption is like, you know, a massive amount of code breaking has to happen to catch that while it's traveling through, you know, the inner web.

Karen Litzy (10:50):

Well, no, that's really good because I think that's something that if people are choosing a platform, it's definitely something that as a provider you want to be looking at.

Michael Greiwe (11:00):

Absolutely. It's very important, you know, and most providers are pretty in tune with that, but right now, like, you know, they're allowing telemedicine to occur on FaceTime and some other platforms.

Karen Litzy (11:12):

Now FaceTime is not HIPAA compliant.

Michael Greiwe (11:17):

Yeah. So we don't want to really be using that right now. And there are some providers out there that are doing it, maybe just for ease of use and because the pandemic it's happened. But ultimately what we really need to make sure is that we don't use those platforms. Those platforms are not safe, not secure.

Karen Litzy (11:35):

Are there any other sort of things that you want to watch out for when you're let's say, well, first we'll start with looking at different tele-health platforms. So what are the things that you want to be looking for? And if you have any advice on a do's and don'ts, while you're actually in your tele-health session, I know some of them seem like, should be common sense, but you never know. So let's go with, what should you look at first? What should you be looking at in your telehealth platform?

Michael Greiwe (12:11):

It's a great question. I think the first thing that's really important for patients is making sure that, you know, the HIPAA compliance there, we covered that, right? So HIPAA compliance, probably number one, number two is, does this platform allow you to, you know, keep a schedule? So one of the most frustrating things as a provider of telemedicine is, and this is what I found out many, many years ago is that there is no schedule. You know, you have to send the invitation to the patient. The patient sort of says, yes, I'd like to do this. And then, you know, they link up eventually, but what you really want us to be able to schedule the appointments, that way you can move from one person to the next, and you're not really leaving a screen and trying to come back and forth just from an efficiency standpoint.

Michael Greiwe (12:53):

It's not very efficient to do that. Another thing that's important, I think is being able to chat with your patient. Sometimes it's important to be able to have a conversation. And it's also important to answer questions. And so being able to have kind of a text based chat that's secure as well, that might be, you know, maybe they can send you a picture. Maybe you can send them a video. Maybe you can send them sort of a document that gives them some exercises or what have you. And that's really important too. But I think one of the other things I was gonna mention is consenting. A lot of platforms don't have consent and of course that's part of the law. You have to consent that patient for telemedicine before you have a visit in most of the States, I think 45 of the States, you have to have a consent. So very important for the consent process to happen also. And that allows you to have a legal telemedicine appointment.

Karen Litzy (13:44):

And that consent process. Can that be in your initial paperwork? So if you're onboarding someone and, you have, I mean, we've all been to the doctor's office, you have to fill out a million different forms, right? So same thing with PT. So can that consent to tele-health be in that onboarding or does it have to be every time you connect for a telehealth visit, do they have to consent every single time?

Michael Greiwe (14:11):

That's a great question. And it's really just a onetime consent, so it doesn't have to be, you know, every time. So if they just come to your office first time, you're going to maybe have him sign some paperwork that says consent to telemedicine, and that's fine. You're good to go. But in the case where you have a new patient, it's very important to make sure that you have that consent process. And so for us and what we do at ortho live and spring health live, we just have them sign off one time that they agree to telemedicine. And then we assume every time they visit the platform, they know what they're doing and they've already agreed to it.

Karen Litzy (14:44):

Yeah. Yeah. Cause I have woo. You just gave me a little sigh of relief cause I have it again as part of my onboarding paperwork that people are consenting to their telehealth visits, but I don't do it every single time for each visit.

Michael Greiwe (15:00):

Right. Then I think it's just sorta like the billing practices in your practice too. And that people sign off that they're okay with billing and that they just do it once they're not signing it every time that they come back, it applies similarly to telemedicine.

Karen Litzy (15:12):

Got it. Got it. Okay. So those are the things you want to look at when you're kind of shopping around for a platform. Now let's talk about some things that you want to have in mind as the healthcare practitioner during your telehealth visit with your patient on the other end.

Michael Greiwe (15:30):

Yeah. It's a really good question. So the first thing is if you're going to use a phone, you know, and sometimes you're using a phone because you might be on the go or maybe your platform only allows you to have a phone it's really important to make sure that you don't like hold the phone, like right underneath your nose. Because it sort of gives you like kind of the up the nose shot a little bit. So I always tell people, you know, prop your phone up in front of you, like on your keyboard, maybe that's a really good place for it. Or if you're using a laptop, obviously like your face is kind of directly in front of that camera. And it just gives you more of a conversational type of appearance to your patient rather than you're not like talking straight down to them.

Michael Greiwe (16:06):

I think that's important. The other thing to sort of test out is just make sure that like, you know, when you move your right arm, like your right arm is like going up in the correct location in the camera. So you're not off to the side, you know of the camera when you're trying to show them kind of what you expect, I imagine for physical therapy and you can answer this, you know, too, I imagine for physical therapy that you may have to be seen, like your full body may need to be seen at some point in time.

Karen Litzy (16:33):

Yeah. Yeah. You definitely need like a decent amount of space so that you can lay down on the ground. You can come up to kneeling, you're standing you're so yeah, for physical therapy, you do need a good amount of space. So it comes down to finding those spaces, whether it's in your home or your office, where you can kind of get the right angle and good lighting.

Michael Greiwe (16:54):

Right. That's great. I think that's really important. You know, for your listeners on the physical therapy and for us, it's also being able to screen share too. If you can screen share, then you can show x-rays MRIs, things like that. And just getting tests sent out. Like I know for my practice, you know, we had a lot of physicians go live as soon as COVID hit and nobody had practiced. And so it was disaster on the first day, it was like, you know, it was like Groundhog day. And like no one knew what they were doing. And I was running around different pods trying to help everybody. But it's important to practice just like we would never go to surgery, not practicing what we're doing, you know, you practice to on your side to make sure that everything's working properly, your camera, your audio and all of that.

Karen Litzy (17:36):

Yeah. Do a couple dry runs with friends and family, make sure it's working well. Yeah, that's excellent advice. And now what do let's say, physicians or therapists what do they need to do now to kind of quickly adapt to this telehealth? Because from like, I look at, it's such old hat now, but I've been doing it since March. So now you have other parts of the country who are sort of trailed behind New York city. So they're in lockdown maybe for the first time and they really need to start adapting quickly. So what advice do you give to those practitioners?

Michael Greiwe (18:12):

Well, you know, providers of medical services always have a hard time with change, right? I think that's like one of the tenants of being a type a personality, the personality that ends up getting into medical practices or, you know, we're very particular. So we don't like to change. That's the first thing to recognize. And, and so there's going to be bumps in the road and they're just going to be hurdles. And I think it's really important to just understand like, Hey, you got to sort of roll with the punches a little bit, understand is not usually too difficult. We just need to kind of figure out what your plan of attack is going to be. Are you going to see tele-health patients in the morning and then see your regular, you know business in the afternoon, if you're completely shut down, how are you going to adapt to that? How are you going to get the word out? Are you going to be able to market this really, really important for you to make sure you kind of figure all that out on paper before just sorta like saying, yeah, I'm going to buy this telehealth cloud from when we get rolling, you know, it's like let's plan an attack and how we're going to be seen and how we're going to be able to see patients. I think that's really, really important.

Karen Litzy (19:12):

Yeah. Makes sense. And now let's talk about the platforms. Let's talk about the platforms that you're involved with and how you got involved. So there's ortho live and spring health live, right? So how are you an orthopedic surgeon with all of the work that surrounds that and then sort of this tech person entrepreneur on the side. So you must have some spectacular time management skills.

Michael Greiwe (19:44):

Well, I've got a very forgiving wife. I know that that's number one. But you know, it is like a it's a wonderful thing for me because I really enjoy doing kind of creative things. Things that might help my patients and telemedicine was one of those things I think really was, was a great thing for my patients ultimately. But for me, telemedicine was a way for my patients to be helped in a way that we couldn't really help them through anything else. And so there wasn't a great solution. So I decided to found ortho live about three years ago, that was 2016. And it was only because I was looking around to try to find a solution for patients and for providers that was really efficient and that worked really smoothly. But what I found was that really didn't exist and it was really hard to find the right solution.

Michael Greiwe (20:32):

And so I decided to create it after speaking with a CEO of a telemedicine company out in the California area, he kind of runs a lot of the video for MD live and some of the other larger companies. And he said, Mike, you know, this is a great idea. You ought to kind of through on your vision to do this for orthopedics. And so I did that with ortho live and it's been really successful and I kind of knew what we needed. We just, you know, we didn't have the efficiency in a way to be able to see patients in a streamlined fashion. So we created that within orthopedics, which I knew very well. And then we kind of branched out and now we're offering services to other specialties and subspecialties as well with spring health live.

Karen Litzy (21:11):

And within these platforms, do you have ways to do objective measurements within these platforms? Cause I know some do some don't so how does this, how does this work let's say from an orthopedic standpoint.

Michael Greiwe (21:27):

Yeah. So I mean, if you want true objective measurements we have to kind of integrate with braces and things like that. So, you know, we're like a smartphone application. And so we do have API APIs that can integrate and take in information like that. It's not something that, you know, orthopedic surgeons really use on a daily basis. I would see that more for physical therapists. So we kind of have the ability to integrate with you know, applications that give you range of motion and actual discrete data. I think that's really important because it does give you some actual feedback on a day to day basis, how a patient's doing. But from an ortho standpoint, we don't really need those, like the discrete data points we just sorta need to see, okay, well, how was that patient performing?

Michael Greiwe (22:09):

Are they having difficulties still, you know, moving their knee, let's see you bend your knee. And if it's not really going as well as we want, we know we need to up the physical therapy, we need some more intensity there. And it's more of a good stall for us. Less on the discrete hard numbers, but with therapy, I feel like it is really important to have that feedback to say on a day to day basis that patient's not doing well, how can we help them? Do we need to intervene sooner? So maybe that's what you're getting at, but, but yeah, we have the ability to kind of feed that information back into our platform.

Karen Litzy (22:39):

Yeah. Yeah. That's cool. Because a lot of times it's, you know, you could say, well, if 180 degrees of shoulder elevation is considered full, it looks like maybe they're at 75% or they're at 50%. So, but it's hard to get those, like you said, very discrete numbers because we can't measure it. Right. So having the ability to kind of integrate applications to be able to do that, I think is it can be really helpful. Although I, yeah, I guess sort of postsurgical when the patient is perhaps limited to X amount of degrees of movement, I think is where that comes in really handy.

Michael Greiwe (23:21):

Right. Right. And we have them sort of stand kind of at the side and like watch for inflection and things like that. So I think we get, you know, to within probably five to 10 degrees, but if you're looking for exact degrees, that's where those programs, which, you know, you can strap like an iPhone to your leg now and like move your knee. And it measures range of motion through like some little track pads and things like that. And there's ways to, to really effectively get that, that motion and understand what's happening with the patient and recovery, which is nice. And so we've allowed the ability to integrate those types of applications to our platform, which is cool.

Karen Litzy (23:56):

Yeah. That's really cool. I was working with some developers based in Israel who have an app for gait. And so you put it in your pocket and what it does is it can tell you the excursion of your hip range of motion from flexion through extension pairing side to side, your stance time steps per minute all sorts of stuff. I think there's up to like seven or eight discrete measurements, which is super cool. So again, in times like this, this is where the technology 10 years ago didn't exist.

Michael Greiwe (24:33):

Yes. A hundred percent.

Karen Litzy (24:36):

Having that now is allowing healthcare professionals to continue to help their patients during this pandemic.

Michael Greiwe (24:46):

No question. I was speaking with a group that has some special socks that like will measure stride length and things like that. So they know when a person may be like, you know, unsteady with their gait when they might be a fall risk which I think is a great, it's a great thing. And so, you know, understanding when patients may need some therapy to try to help with balance is critical. I mean, falls are a multibillion dollar issue in the United States today. And if we kind of cut down on falls, it's a great, great opportunity. And so we're, I think we're leveraging little things like, you know, from a data standpoint to be able to improve population health. I think it's great. Yeah.

Karen Litzy (25:26):

And where do you see telemedicine moving in the future? The pandemics over is everybody just gonna wrap it up and call it quits? Or what, where do you see that moving towards in the future?

Michael Greiwe (25:39):

No, I think telemedicine is here to stay Karen, I think you know, so-called genies out of the bottle, you know, there's a lot of great things that have happened with telemedicine recently. I think it's here to stay. We're gonna end up seeing telemedicine continue to spike. It was on the rise. Even before the pandemic, we were seeing multi millions of patients that were being seen every year. It was doubling every year. And now it's like, I mean, I think it's gone up by 10 X. So there's going to be a lot more telemedicine, I think, in people's future.

Karen Litzy (26:10):

Yeah. And as we were discussing before we came on the air hopefully the providers of insurance will also agree with that and say, we are going to continue paying for these because look at the advantages it's giving look at the money we're saving because of this. Cause like you said, if you can have a telemedicine visit with someone and it prevents a fall, which is a multibillion dollar industry, would you rather pay the $2-300? Whatever it, I don't know how much it is or have that person hospitalized for hundreds of thousands.

Michael Greiwe (26:48):

You're absolutely right. And so if there's any, you know, any of the insurance industry listening is very, very critical that we continue with telemedicine for their patients. And it's so beneficial, not only in protecting them during this time period, you know, we definitely don't want to let them go out of the house or 70 year old patients that are potentially sick and I'll really you know, it's for their safety and it's also for the benefit of the patient. I mean, it's way more convenient for them. And so I think without a doubt, it is so important to make sure that our legislature continues to support telemedicine and telemedicine billing.

Karen Litzy (27:25):

Absolutely fingers crossed fingers crossed that that happened. So I'm with you on that. Alright. Now, before we start to wrap things up, is there anything that we didn't cover or anything that you want the listeners to sort of walk away with from our discussion on telemedicine?

Michael Greiwe (27:43):

Oh, I think the main thing is, is that, you know, there's a lot of great people out there trying to provide health care. And many of them are trying this, you know, as a new you know, thing for them in their practices. And I think supporting them in that is important. I think everybody inside their local community is really trying to do things via telemedicine now and they weren't doing that before. And so being flexible, I think with those providers, I think is important, but I also think that telemedicine is here to stay. It's one of these things where there's so much benefit on both the provider and the patient's end that it'll just continue to be here and be a part of society and medical care going forward.

Karen Litzy (28:20):

Yeah, absolutely. And now I have one question left and it's a question I ask everyone, and that's given where you are now in your life and in your career. What advice would you give to yourself as a fresh medical school graduate?

Michael Greiwe (28:36):

That's a good question. I love this question. I think for me, I was such a you know, a worrier, like I was, I was always worried about, you know, what was I going to be good enough? Was I going to be smart enough? And you know, I always knew that I believed in myself, but I didn't trust myself back in those days enough to know that I was going to be okay. And I think the thing to remember is like, you know, you went into this medical profession for a reason you want to take good care of patients. You got to believe that, you know, you're a hard worker and you're going to continue to do as best you can to take good care of people. And you're not, you know, even a few fail it's okay. I think failure is it's okay to fail. I think that's another thing that I would tell myself to, because I was so worried about failing that I wasn't willing to like branch out and take risks. But I've learned that now. And I think if I could go back, I'd tell myself, don't worry about failure. Just you're gonna be fine. Just keep working hard.

Karen Litzy (29:36):

Great, excellent advice. And now where can people find out more about you more about ortho and spring health live?

Michael Greiwe (29:43):

Great. Yeah. Well, they can actually look at our website. So our website is www.ortholive.com and then www.springhealthlive.com. So for me, I can be reached at mikegreiwe@ortholive.com. That's my email address and I'll be happy to respond.

Karen Litzy (30:08):

Perfect. And just so everyone knows, we'll have all of those links in the show notes under this episode at podcast.healthywealthysmart.com. So Dr. Greiwe, we thank you so much for coming on. And, and like I said, I've spoken about tele-health before, but it was way back when this started. So it's great to get more information out there for people to know that it's not just something that we're doing during the COVID pandemic, but that this is something that can be incorporated into your practice. It can help your business, help your patients. So thank you so much.

Michael Greiwe (30:43):

Oh, thank you, Karen. I was glad to be here. Appreciate it

Karen Litzy (30:45):

Anytime. And everyone. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

Aug 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.

In this episode, we discuss:

-How has the physical therapy profession evolved since the drafting of Vision 2020?

-The student loan debt to income ratio

-Advocacy efforts to achieve full direct access in all of the States

-The importance of lifelong learning and evidence-based practice

-And so much more!

 

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

APTA 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 Dr. Weinper:

Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.

Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.

Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.

On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.

A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.

For more information on Stephanie:

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She 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. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

Read the full transcript below:

Stephanie Weyrauch (00:00:01):

Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.

Michael Weinper (00:01:21):

Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.

Michael Weinper (00:02:21):

If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.

Michael Weinper (00:03:23):

So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.

Michael Weinper (00:04:25):

And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.

Michael Weinper (00:05:21):

So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.

Michael Weinper (00:06:18):

We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.

Michael Weinper (00:07:15):

We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.

Michael Weinper (00:08:31):

So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.

Michael Weinper (00:09:31):

And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.

Stephanie Weyrauch (00:10:58):

I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?

Michael Weinper (00:12:14):

Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.

Michael Weinper (00:13:29):

And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.

Michael Weinper (00:14:35):

So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.

Michael Weinper (00:15:30):

Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.

Michael Weinper (00:16:30):

Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.

Stephanie Weyrauch (00:17:31):

Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?

Michael Weinper (00:17:57):

Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.

Michael Weinper (00:18:47):

Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.

Michael Weinper (00:19:51):

And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.

Michael Weinper (00:20:55):

So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.

Stephanie Weyrauch (00:22:06):

Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.

Michael Weinper (00:22:58):

Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.

Michael Weinper (00:23:54):

We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.

Michael Weinper (00:24:40):

I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.

Michael Weinper (00:25:42):

I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000

Michael Weinper (00:25:58):

And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.

Michael Weinper (00:26:24):

And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.

Michael Weinper (00:27:36):

They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.

Stephanie Weyrauch (00:28:31):

Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?

Michael Weinper (00:30:04):

That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.

Michael Weinper (00:31:17):

It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.

Michael Weinper (00:32:25):

It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.

Michael Weinper (00:33:27):

All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.

Michael Weinper (00:34:26):

And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.

Stephanie Weyrauch (00:35:43):

Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.

Stephanie Weyrauch (00:36:29):

So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.

Michael Weinper (00:37:41):

Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.

Michael Weinper (00:38:46):

And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.

Michael Weinper (00:39:53):

And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.

Michael Weinper (00:40:47):

And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.

Michael Weinper (00:41:48):

A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.

Michael Weinper (00:42:43):

I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.

Michael Weinper (00:43:56):

Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.

Michael Weinper (00:44:50):

Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.

Michael Weinper (00:45:38):

I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.

Stephanie Weyrauch (00:46:26):

I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.

Michael Weinper (00:47:05):

Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.

Michael Weinper (00:48:05):

And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.

Michael Weinper (00:49:21):

And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.

Stephanie Weyrauch (00:49:52):

Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?

Michael Weinper (00:50:43):

Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?

Stephanie Weyrauch (00:52:13):

Oh yeah, that's a very familiar book.

Michael Weinper (00:52:16):

Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.

Stephanie Weyrauch (00:53:26):

Yeah.

Michael Weinper (00:53:28):

Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.

Michael Weinper (00:54:27):

So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.

Michael Weinper (00:55:22):

His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.

Stephanie Weyrauch (00:56:16):

And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?

Michael Weinper (00:57:24):

Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.

Michael Weinper (00:58:35):

And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.

Michael Weinper (00:59:35):

I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.

Michael Weinper (01:00:29):

So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.

Michael Weinper (01:01:17):

And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.

Michael Weinper (01:02:18):

We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.

Stephanie Weyrauch (01:03:09):

And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?

Michael Weinper (01:04:15):

Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.

Michael Weinper (01:05:34):

We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.

Michael Weinper (01:06:27):

When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back

Stephanie Weyrauch (01:07:55):

What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?

Michael Weinper (01:08:29):

Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.

Michael Weinper (01:09:41):

Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.

Michael Weinper (01:10:43):

I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.

Stephanie Weyrauch (01:12:11):

There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you stay healthy, wealthy, and smart.

 

 

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Aug 24, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier.

In this episode, we discuss:

-How has the physical therapy profession evolved since the drafting of Vision 2020?

-The student loan debt to income ratio

-Advocacy efforts to achieve full direct access in all of the States

-The importance of lifelong learning and evidence-based practice

-And so much more!

 

Resources:

Stephanie Weyrauch Instagram

Stephanie Weyrauch Twitter

Stephanie Weyrauch Facebook

Email: sweyrauchpt@gmail.com

APTA 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 Dr. Weinper:

Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California.

Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY.

Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA’s Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association’s chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA’s California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011.

On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers’ Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies.

A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications.

For more information on Stephanie:

Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company’s workforce. She 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. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation.

 

Read the full transcript below:

Stephanie Weyrauch (00:00:01):

Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself.

Michael Weinper (00:01:21):

Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I’m considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision.

Michael Weinper (00:02:21):

If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there.

Michael Weinper (00:03:23):

So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit.

Michael Weinper (00:04:25):

And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then.

Michael Weinper (00:05:21):

So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient.

Michael Weinper (00:06:18):

We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today.

Michael Weinper (00:07:15):

We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969.

Michael Weinper (00:08:31):

So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct.

Michael Weinper (00:09:31):

And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system.

Stephanie Weyrauch (00:10:58):

I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation?

Michael Weinper (00:12:14):

Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received.

Michael Weinper (00:13:29):

And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable.

Michael Weinper (00:14:35):

So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be.

Michael Weinper (00:15:30):

Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization.

Michael Weinper (00:16:30):

Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school.

Stephanie Weyrauch (00:17:31):

Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt?

Michael Weinper (00:17:57):

Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it.

Michael Weinper (00:18:47):

Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will.

Michael Weinper (00:19:51):

And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies.

Michael Weinper (00:20:55):

So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve.

Stephanie Weyrauch (00:22:06):

Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have.

Michael Weinper (00:22:58):

Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators.

Michael Weinper (00:23:54):

We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true.

Michael Weinper (00:24:40):

I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken.

Michael Weinper (00:25:42):

I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000

Michael Weinper (00:25:58):

And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment.

Michael Weinper (00:26:24):

And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to.

Michael Weinper (00:27:36):

They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do.

Stephanie Weyrauch (00:28:31):

Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA’s website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do?

Michael Weinper (00:30:04):

That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things.

Michael Weinper (00:31:17):

It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation.

Michael Weinper (00:32:25):

It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do.

Michael Weinper (00:33:27):

All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate.

Michael Weinper (00:34:26):

And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village.

Stephanie Weyrauch (00:35:43):

Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app.

Stephanie Weyrauch (00:36:29):

So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future.

Michael Weinper (00:37:41):

Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years.

Michael Weinper (00:38:46):

And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow.

Michael Weinper (00:39:53):

And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it.

Michael Weinper (00:40:47):

And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn’t be a PT, he went into motion pictures.

Michael Weinper (00:41:48):

A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is.

Michael Weinper (00:42:43):

I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today.

Michael Weinper (00:43:56):

Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it.

Michael Weinper (00:44:50):

Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public.

Michael Weinper (00:45:38):

I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us.

Stephanie Weyrauch (00:46:26):

I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey’s, you know.

Michael Weinper (00:47:05):

Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show.

Michael Weinper (00:48:05):

And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show.

Michael Weinper (00:49:21):

And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public.

Stephanie Weyrauch (00:49:52):

Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that?

Michael Weinper (00:50:43):

Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book?

Stephanie Weyrauch (00:52:13):

Oh yeah, that's a very familiar book.

Michael Weinper (00:52:16):

Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do.

Stephanie Weyrauch (00:53:26):

Yeah.

Michael Weinper (00:53:28):

Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get.

Michael Weinper (00:54:27):

So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us.

Michael Weinper (00:55:22):

His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker.

Stephanie Weyrauch (00:56:16):

And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring?

Michael Weinper (00:57:24):

Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount.

Michael Weinper (00:58:35):

And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things.

Michael Weinper (00:59:35):

I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we’re mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end.

Michael Weinper (01:00:29):

So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment.

Michael Weinper (01:01:17):

And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians.

Michael Weinper (01:02:18):

We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more.

Stephanie Weyrauch (01:03:09):

And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000?

Michael Weinper (01:04:15):

Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice.

Michael Weinper (01:05:34):

We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it.

Michael Weinper (01:06:27):

When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them about what are their challenges, what can we do to help though, or thinking about things we can do to help them communicating better in collegially at different levels. Then we go a long way towards not only building those relationships, but most importantly, helping the patients we serve. So it's one thing to say your profession. That's another thing to give back to society and find different ways to give back

Stephanie Weyrauch (01:07:55):

What, you know, from this conversation. Obviously we've come a long way since 2000, we've achieved many things that vision 2020 set out to achieve, but we still have a lot that we yet need to achieve. So kind of on that note, Mike, you know, what is a clinical Pearl that you can kind of leave all of us with? What is some advice you could give a young graduate or somebody new in the profession that maybe you wish you would've known when you were coming out of school?

Michael Weinper (01:08:29):

Oh, that that's an easy question to answer because I oftentimes get asked by younger PTs, how did I become successful? I say very simply through volunteerism, volunteering your time to help your profession and help those we serve, whether it's going to a health fair and educating the public, you ever done that fascinating what they don't know and how the aha moments you see in the public. When you spend two minutes with them screening students preseason athletic screening, another great opportunity to follow tourism positions you're working with, Oh, that's how you do that. That's how you measure that. I didn't realize that. And that's another idea, again, of getting involved, getting I talked earlier about legislation, getting involved in legislation, getting involved in your association is what I think makes you successful. And to that point, I think that the best jobs of PTs get are not the ones they see through a Craigslist or three C on the association.

Michael Weinper (01:09:41):

Advertisements is from talking to other therapists, word of mouth learning, where are the best jobs to be had. And the only way to do that is not staying in your little house if you will, but getting out and talking to the PTs. That's like I said earlier, getting to know other PTs there's this PT pub nights that I see around the country, what a great idea I've gone to them. And they're actually fun. I stood out in the rain. They had an outdoor one here in Southern California, and you don't get a lot of rain here, but that particular night, we all were standing outside of this venue drinking our beverages of choice, getting soaked, but having a good time. And it's very memorable and getting to know other people and volunteering just goes a long, long way. I think, to learning more and learning what needs to be done, if you could learn what needs to be done and then not put it on somebody else, but say, I'm going to take responsibility again, getting back to I'm a professional.

Michael Weinper (01:10:43):

I need to be professionally responsible. I need to be the one who does this. I know you're one of those people. I'm preaching to the choir. Stephanie, when I say this and you know exactly what I'm talking about, but so many people who might be listening to a podcast like this, don't quite follow it. So my challenge to each of you would be get involved in your profession and spend a little time here and there, away from family away from work away from your social activities and back to your profession. That's part of being a professional. And as you give back, the more time you give the more you get. And I like to leave this thought with people. And that is for all the thousands of hours, I guess, at this stage of my career, I have given to my profession, whether it was the local district or my chapter or the national association or the private practice section or other sections I've been involved with or doing things in the public realm, getting involved in I was involved in a college board. So people got to know me as a PT and as an individual and get to know more about PT, getting involved in society, rather than just going home at night, turning on the TV, or turn on your computer or playing games, getting more involved with people and trying to do good things for the public benefits you directly.

Stephanie Weyrauch (01:12:11):

There were some wise words spoken by a true visionary of our profession. So thank you so much. And thank you for all of those who listened to this episode of the healthy, wealthy, and smart podcast and I'm your guest host Stephanie Weyrauch. And I hope that you 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!

Aug 17, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jamey Schrier on the show to discuss how to develop your dream private practice.  Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer.

In this episode, we discuss:

-Jamey’s entrepreneurial journey

-The importance of vision and giving yourself permission to imagine your dream practice

-How to generate revenue even during unprecedented times

-Why building a team of experts is necessary for you to grow your practice

-And so much more!

 

Resources:

Jamey Schrier Twitter

Jamey Schrier Instagram

The Practice Freedom Method Facebook

FREE GIFT

Practice Freedom Method Website

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Jamey:

Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer. Founder of Lighthouse Leader®, Jamey helps physical therapy owners create self-managing practices that allows them the freedom they want and the income they deserve. He is the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion

A graduate of The University of Maryland Physical Therapy School, Jamey specialized in orthopedics and manual therapy. He was the sole owner of a multi-clinic practice for more than 15 years.

Jamey’s passions are basketball, tennis, golfing, and reading. He and his wife, Colleen, and there 2 kids live in Rockville, Maryland.

 

Read the full transcript below:

Karen Litzy (00:00):

Hey, Jamey, welcome back to the podcast. I'm happy to have you on again.

Jamey Schrier (00:05):

Karen. It's lovely to be here.

Karen Litzy (00:07):

Yes, no stranger to the podcast. That is for sure. And that's because we love having you on because you always give such good information to us PT business owners. So thanks for coming back now, you were a PT business owner yourself. People can go back and kind of listen to the past podcast that you did with us to get even a dive in a little bit deeper to your history and how you kind of went from a business owner to now coaching and mentoring in a training business. But can you give the cliff notes version for us now?

Jamey Schrier (00:45):

The cliff notes. That's how I got through school. Yes. Be happy to give the cliff notes. So I always wanted to have my own business ever since I was younger and went with my dad to his store. I thought it was the greatest thing. So when I got the opportunity to open up and put up my shingle, I went all for it. And I had my fiancé Colleen at the time. Now my wife who you have met, she was, yeah, she was my fabulous front desk. So it was a perfect scenario. Right? I was the quote, the doctor doing the treatments. It was the happy go lucky front desk. And it was a perfect scenario. And that lasted for a couple of years until we started to hire people until I said, honey, do you want to get married?

Jamey Schrier (01:35):

And she said, sure, boom. She left. She got 35 books on weddings. And she was like, not really there that much. So we had to actually grow a real business. Well, I really didn't know how to hire. I just assume everyone worked like I did everyone thought like I did. Everyone just did quote the right thing. And that's when a whole lot of stress and a whole lot of struggle started to happen, which caused me to create this sense of anxiety that I really didn't experience before. Definitely not as an employee, but I didn't experience for the first couple of years in business. So my hours started to increase. So not only that I have to do the treating and some of the other duties that I had to, but I also had to oversee them and all their stuff. So I took half of their job as well.

Jamey Schrier (02:23):

And about four years into it, a crazy thing happened, which I've shared before, but I will quickly share. It is my place burned down. We had a fire and it burned down and I was caught with these weird feelings of feeling relieved. Great. I don't have to go to work on Monday and feeling scared to death and feeling, Oh my God, what do I do now? Not just similar to what has happened with, COVID like, Oh my God, I wasn't prepared for this. What do I do now?

Jamey Schrier (03:00):

So after some soul searching, I realized, I don't know anything about how to build a business. I was a very good clinician. I thought being a good clinician was enough. It was not. So I spent the next nine years learning, trying, failing, learning again, trying and failing of how to build a business that can literally operate with a little bit of maintenance, but not me. They're doing all of it. And fortunately I figured it out and in January of 2013, I removed myself scared to death, but I did it anyways. Remove myself from the schedule no longer I was treating my team was handling it and my business shot up. So I got more time and I made more money and my team was great and my patients were happy and I was like, Oh my God. So I went on a webinar. I believe it was the private practice section webinars that they do. And I just shared my story. People reached out. And next thing you know, I was in the coaching business because they were asking me how I did it. And I've been doing that and being on a mission to help other practice owners try to build, grow their business for the last seven years.

Karen Litzy (04:11):

Awesome. And the name of your courses?

Jamey Schrier (04:19):

So the name of the company is Practice Freedom U, the letter U kind of playing off the university thing. And it is a really a business training and coaching firm. So we help the practice owners and we help their teams and grow and build the kind of business they like. So they can have the kind of life that they want.

Karen Litzy (04:40):

Awesome. And now you had mentioned in your story about when your practice burned down, you kind of weren't prepared for it. It's like kick in the guts. So the country, the world continues, not has been, but continues to live through the COVID-19 pandemic. A lot of clinics had to close. Some may still be closed as we tape this. I am in New York city. We are just reopening now. So as owners begin to reopen and restart, delivering their patient care, what are some of the not so obvious things that they should be aware of?

Jamey Schrier (05:23):

Yeah, that's a great question, Karen. What I learned in my experience when the place burned down and literally I had nothing to go back to, what was difficult about that was I was the only person going through that everyone else was just business as usual. And my initial instinct, because I am a high achiever because I am a doer was to do more like, okay, what do I got to do? What are we going to do? And it wasn't until maybe a couple days into it that I began to learn that, you know what me trying to do more me trying to be busy and filling up my day with just stuff. Even though I had no patience at all. And there was, by the way, there was no tele-health right. I mean, there wouldn't be telehealth right now if there wasn't a whole country, if it was just one person, the insurance companies wouldn't be changing all their rules.

Jamey Schrier (06:26):

So, but we didn't even have the technology for that. So what I did was I just started to sit and think and just sit with, well, okay, I'm going to rebuild this. If I'm going to rebuild this, what is it that I really want from this business? What wasn't working well. And I started to write out this, this idea, this outline of what I wanted the business to be. Now, mind you, I didn't know how I was going to get there. Right? I didn't know that, but the more I ask questions, the more I said, what would my business have to look like for me not to work 70 hours a week, which is what I was working, what would happen? What would my business have to be? If I didn't work the weekends, who would I need to hire ultimately to perhaps not have to treat or choose the people I want to treat.

Jamey Schrier (07:26):

So, as I started asking these questions and gave myself permission, love that word, I gave myself permission to imagine what it would look like. It started to create the outline. And this is exactly what I did and what I shared with other practice owners, what to do during this time. First of all, pause, acknowledge what the hell was going on right now, because it is unprecedented. I hate that word because everyone's saying it, but it is something that you are not prepared for. And it is something that everyone is going through. The people that are going to get through this and be better than they were before, or the people that are not trying to go back to where they were. It's the people that are pausing and saying what an opportunity to fix the things that were broken and to ultimately create what I want.

Jamey Schrier (08:21):

It doesn't mean it's going to happen today or even in a week, or even in a month, or even in six months. But it's something that can start to help you create the outcome you're looking for, which then causes you to focus on where do I work today, this week? Who should I keep? Who should possibly, I keep furloughed, right? If you're like me at the time I was treating for, you know, 12, 14 years, I was like, maybe you want to reduce your schedule. What would that have to look like to reduce your schedule? Because now's a great time to start searching for therapists. Cause they're out there. And then maybe you weren't as keen on some of the metrics you weren't as clear. Well, what a great time to start getting really organized. So I tell people the not so obvious things is for you to pause, reflect, and start to ask the question.

Jamey Schrier (09:21):

I love questions better than statements, but start to ask the questions. What would it look like in order to blank? What would it have to be? Who would I have to have in place? What technology we would have to be. You don't have to answer the questions. And that's the mistake that people make. They put all the pressure to have to answer them today because we are doers. We are problem solvers, give yourself a break, give yourself permission, just put them out there. And something interesting is going to happen. I know you and I have talked about this in the past. It's amazing how things start to happen. How people start to show up people that are like, wait a minute, fall into place. They start to fall in place. And it seems like this voodoo magic. It isn't, your mind will start to look for your subconscious mind will start to look for these and it could be right in front of you, but you never saw it before. It's kind of like, where's the salt honey, where's the darn salt. Then she comes in just right in front of you, your mind, wasn't seeing that. So that's kind of the things that I would initially suggest, and then that kind of guides you to. So what are the key elements that you have to do now, which I'm sure we can dive in.

Karen Litzy (10:34):

Yeah. So let's talk about that. So aside from the obvious safety of your staff and of your patients, that's clearly number one, right? And we want to make sure that when places reopened that that is number one priority. So putting that to the side, because that is hopefully a given for all physical therapy practice owners, right. If it's not, I think you need to go back and ask yourself some questions, but so that should be number one. I think the other thing that a lot of owners are struggling with is the lack of money, lack of revenue that you missed from your business, let's say over the past three months or so. So do you have any thoughts on how owners can build back that revenue?

Jamey Schrier (11:22):

Yeah. And that is from the people that I've spoken with the surveys we've done, I mean, that is the number one stressor. I mean, you would want to think it's safety it's to protection. Well, the thing that stresses us out is if we don't have any money, we don't have security and stability and we can't take care of our own family. And that stresses the living daylights out of us. Cause for many people, that's why we went into business to be able to have that control and freedom to create the lifestyle we want. So we know that the biggest stressor

Jamey Schrier (11:54):

Now, for many people, you have a PPP loan, you have maybe a EDIL loan. So it's important to get clear on what options you have find eventually. So some people are kind of coming out of that PPP loan, like the money's gone, they just reacted, they got the loan and they thought they were doing a good job by keeping their staff, even though their staff didn't do anything, except write some blogs and send out some YouTube videos, but it didn't generate anything. So you know, you have to look at what you have available. So that's number one, get your financials in check. So you know, for our business we brought in accountants, we brought in attorneys, I'm sure you know, Paul well so we brought in people and I know for me personally, when this happened, I reached out to experts in this area. I reached out to my accountant, to my financial advisor.

Karen Litzy (12:55):

Are you kidding me? I was on the phone with my accountant, like literally, almost every single day and emailing him several times a day and thank God for accountants, what gems.

Jamey Schrier (13:08):

Yeah. But you know, what's interesting, Karen, not everyone thinks like that. You see, we are rugged individualist at heart. What is this business? We struggled. We sacrificed, we studied, we got A's and that is not how you build your business. You need to be.

Karen Litzy (13:25):

Yeah. That's how I used to be. Now. I'm like could you help me with this, this, this, and this? I mean, because I don't, I'm not an account. I've never filled out. Like I got a PPP loan. I didn't know what I was doing. So I would take screenshots of everything, send it to him. And then he was like, put this number here, put this number here, put this number here. And I was like, did it digit to do? And guess what? It was approved. If I didn't have his help, I wouldn't have been able to do that. I have learned, I've seen the light.

Jamey Schrier (13:54):

Don't tell anyone. I did the same thing. I call my accountant very calmly. I said, Hey Greg, what should I do? He said, well, it makes no sense not to get the PPP loan. I mean, it's more or less going to be free money. Who knows what's going to end up happening with it. But go ahead and apply that. I said, great, can you have someone help me with that? Because if I don't feel like doing it and he's like, sure, yeah. So everyone's talking about PPP loan. Everyone's freaking out. I've had, I can't tell you how many dozens and dozens and dozens of conversations I've had with business owners. Because I asked him, I go, so who's on your team. Do you have an accountant, financial advisor, someone that understands this and they went, well, I have a friend or a neighbor that does my taxes. And I'm like, see there lies the problem because you don't look at your business as a team of people that are experts in different areas.

Jamey Schrier (14:52):

So if you're going to learn from this whole COVID thing, start building the experts in your business. So it doesn't fall on you to try to be the expert that you're not. And give yourself permission, Karen, like you did. And I did. I'm not the expert nor do I want to be. However, I do know enough to know that I need to talk to the accountant about this particular problem. Yeah. So talking to someone, even if it's your bookkeeper and start to design what you have available, because that is going to determine if you have literally no money available, then bringing back all your staff isn't feasible, right? It's just not going to happen. But if you have some money available, if you have some other loans, maybe you have equity in your house. Maybe you have some things, not that you're going to use it, but you have it there.

Jamey Schrier (15:46):

Then the next thing is, start to create the plan, have a plan. Now I typically teach what's called a 90 day sprint, right? 90 day sprint is what is the outcome? The number one outcome you want in the next 90 days, once you're clear on that outcome, let's say the outcome is I want to be a lot of outcomes for people. I know I want to be back up running the way we were before at the same level, it doesn't mean they're going to do it, but it's amazing how many people have believe it or not. It's amazing how many people have that. They are literally 80, 85% pre COVID and they just, you know, kind of reef officially grew up in a, you know, for six weeks ago. So it's amazing what happens when you put that scary goal out there. But the purpose of it is to just reverse engineer down to, so what has to happen this week?

Jamey Schrier (16:46):

What are the two or three things that have to happen this week for you to start moving towards that? So once you get clear on your financials, you got to start making decisions about your staff. The one thing I would be very weary of is diving back in. If you weren't that before, if you were not treating 40 hours a week, I would not knee jerk reaction to go back to that. The reason is this, I know it seems. Yeah, but if I do it, it's like free money because I'm not paying myself. Yes. That would seem to be the case, but it's not. It's actually going to cost you more money because your mind, your creative energy is all taken up by taking care of the patients in a very emotional setting, dealing with the notes and the insurances and all that. And you're not taking a step back and a 30,000 foot view and really seeing the different components of the business.

Jamey Schrier (17:50):

And if that happens, your natural response is going to be quick, impulsive decisions. Even you think you're a hundred percent sure of the decisions you can't trust yourself because of the emotional state that you're in. So if you've been a treater before, okay, if you want to go back to that fine, cause you still need to remove yourself at some point, even if it's cutting your schedule down, cause you need to look at things to run your business. So, but if you're not, take a survey of your staff, who's essential. Well, you need people that can generate money. I would choose the people that were the most productive before. COVID sounds obvious, but sometimes you kind of like so and so more, but even though they weren't a great therapist or not a producer and you make decisions like that, or you haven't really had numbers, you're not even sure what your metrics are.

Jamey Schrier (18:45):

We never really tracked productivity. I think this person was good. So look back at that. Or when, in doubt, who was sought after bring those people back. Now, if you're deciding on will Jamey, should it be full time or part time there's other models out there. I just got off a conversation with a guy that has a business around employment payment models. And he was talking about, you know, this model of shared risk is becoming more and more popular. So perhaps you do an hourly model. Perhaps you explore a shared risk model where the person gets maybe one third or 40% of their income and then they get targets and they make money based on that. You don't have to know what that is. You just have to know that someone is out there that knows what those options are. Your job is to go out there and find out about it and then share it with your staff.

Jamey Schrier (19:48):

So really getting clear on your team and who you need. I would absolutely bring a front desk back, obviously your billing and all that can be done from anywhere. And then the biggest thing is if you don't have patients in the door, none of this is going to matter. Your money will eventually run out. So I am a simple person, you know my stuff isn't rocket surgery. As one person once said it isn't rocket surgery. What was working before COVID hit? Like, what were you doing? I know most people will answer. I don't know. It was kind of word of mouth. I was kind of doing this. Like they weren't really clear on that. Well, first of all, moving forward, let's be really clear on that. What's working. What strategy was working. One of the most basic strategies you can use.

Jamey Schrier (20:39):

That's a human strategy is reach out to your people. If you haven't already, most people have reach out to your patients, reach out to the list of people, check in with them, see how they're doing. And they've been cooped up for months. I don't know about you, but I got problems all over the place. Cause I haven't been able to exercise the way I want I'm stress. Of course, stress goes to my back and my head shoulders, these people, it's not like COVID took their health. I mean, they still are human beings. They still have the same problems they did. If not worse, how can you help them? So approach it from, Hey, how are you feeling with all this? Well, my shoulder hurting, Hey, you know what? And then you just offered maybe a free consult. Then you do it either in person or through tele medicine.

Jamey Schrier (21:30):

Yeah. If you do that and you approach it genuinely like you want to help them, man, I've had people generate dozens and dozens of patients quickly. And I would put the people that are best on the phone that had the highest level of communication. Don't put someone that doesn't really like people that much, you know, like don't put that person on the phone. They're not going to like having that conversation. Same thing for your referral sources, same thing for your referral sources. And you know, can I share one strategy, marketing strategy, eight marketing strategy. And you and I were just talking about it right before this, you said, you know, I couldn't get half these people on my podcast and now what else are they doing? They're like, sure, I'll come and share all this stuff. Well, we have a simple strategy that is called an interview spotlight strategy.

Jamey Schrier (22:27):

And all you do, same thing. What we're doing here. You just reach out to a rep. We call them referral partners. But someone that oversees and has influence of your target audience, right? If you're going to do this, do it with someone that as you build a relationship can send you the kind of people you want and you offered to interview them and you choose the topic. That would be interesting to your audience, to your list of people. So do you specialize back pain? Are you a vestibular person? Are you pediatrics? Women's health doesn't really matter? And you say, Hey, I was you know, I was thinking we're starting in an interview. Spotlight interview love to interview you. It's all through zoom, 20 minutes, 30 minutes, whatever it is, we'll promote it to all of our people. So I'm sure you'll get some recognition and business out of it. And if you'd like, you could promote it to your people as well. And then you end up with marketing term leads, prospects as well. But what really happens is you start building a connection, a deeper connection with the referral source, who obviously is, you're going to be top of mind with them because you reached out and helped them. You weren't the person sucking on the teat did, give me, give me, you were actually providing something first.

Jamey Schrier (23:46):

One of my clients did this and he generated 50 cases, 50 in a very short period of time in New Hampshire, like massive town. And he said, this is like, I think it was like 52 people. Exactly. But he said, Jamey, this was easy. And it was fun. It was really a lot of fun. And because we're all used to zoom now, the technology is so easy to use. You just record it. Doesn't have to be video. You can do audio and you just save it and slap it in an email.

Karen Litzy (24:18):

Yeah. Yeah. That's a great marketing tip. Thank you for that. And just so people know it doesn't, you don't have to have a podcast to do that. You could just, like you said, save it, send it out to your list. Even if your list is five people or if it's 500 people just, you're just creating good content that people want to hear.

Jamey Schrier (24:40):

And you're meeting people, who's a great marketing, same and it can be used for anything. Always meet people where they are not where you want them to be. So if I was going to do this in New York and let's say reach out to some docs or reach out to some other people that may I'm like if you do with personal trainers or CrossFit or whatever your audience is, my approach in New York would be different than my approach in the Midwest. Of course, right now, the template's the same, but how you're going to do it, how you're going to, I mean, what you're going to talk about the content has to meet your people where they are. If you start talking about, Oh my God, we're opening up. Things are great. And all that. That's not going to land on a lot of people in New York.

Jamey Schrier (25:31):

So meet people where they are meet the doctor, meet the people, meet the other referral partners where they are and see how you can help start cultivating these relationships. And as your town opens up more and more and things get back to quote normal, whatever that is that bonding is what separates you. That's what keeps giving again. And again and again. So how many of these can you do? I mean, I know some people are doing like twice a month and they said, this is just fun and it's easy. And by the way, it does lead to other opportunities.

Karen Litzy (26:07):

Sure. Tell me about it.

Jamey Schrier (26:09):

I mean, your whole business is built on, you started this. You're like, I'm trying to figure this out and all of a sudden you've done. I don't know thousands of episodes. You've met all kinds of people. I know you used to travel around the world. So  this is a formula. And it's a really powerful formula. I'll tell you the hardest part about the whole thing.

Karen Litzy (26:31):

Yes, absolutely.

Jamey Schrier (26:35):

Passion. Don't let the little critic on your shoulder go, but you can’t do it. I think you need to be, you need to learn more about zoom. Just do it, just do it.

Karen Litzy (26:37):

Yeah. So yeah, it doesn't have to be perfect.

Jamey Schrier (26:49):

It better not be, if it's perfect. It's too late. You're not doing something that's rusty, not rusty, but like just rough around the edges and stuff. You've waited too long. You need to get what is called the minimum viable product up running and out. Then you learn from it and your fourth interview will be a hundred times better than your first. And there's nothing you can do about it. Yeah. So true. So how quickly can you get to the fourth interview?

Karen Litzy (27:19):

Yeah, that's great advice. And now as we kind of wrap things up here I know that as we were going through this conversation, one thing that struck out as like, you just can't do all of this stuff on your own. It's what I should say. You can, but it's really, really hard, right? Why would you, so having a mentor coach, is something that can be so helpful. So where can people get in contact with you if they feel like, okay, I've got this business, I'm ready for it to grow. I don't know what the hell I'm doing. So where can people find you and learn a little bit more about what you're doing and if you've got any free resources and things like that for people that would be helpful.

Jamey Schrier (28:12):

Sure. So I want to just real quick, I know we're coming up on time here, but I want to address real quick with the idea of the coach or a mentor. You know, a coach isn't the end all be all it. Isn't the person that has all the answers and all the solutions to your problem. The way I got into coaching was I resisted it because I was a rugged individualist. Who's smarter than most people who could figure it out. And eventually I started looking at my bank account, looking at the amount of stress I was dealing with and looking at how many hours I put in. And I said, these aren't the results I want. So whatever I think I am doing, it's not getting the results. So can I just swallow my pride and my ego and go ask for help.

Jamey Schrier (28:55):

And that is so hard for high-achieving individuals like ourselves. So if you are at the place where you're like, you know what, I want some guidance because to me, a coach is guiding you. It's a co collaborative effort. It's strategic thinking partners. If you want that person go and find the person that connects to at practice freedom U I built our company based in part of providing people that kind of business coach, that kind of guide that helped them through some of these problems. Cause it's hard to think of it. I've had a coach for over 14 years. I'll never not have a coach because I don't trust my own thinking because I don't know what, I don't know. So if you're interested in that, you can certainly reach out. You can check out our site, practicefreedomu.com.

Jamey Schrier (29:50):

You you can get my email from Karen, but one of the things that I thought would be a great thing for your audience is to give them a little insight on some of the things we talked about today and a lot more other things that I think are very appropriate in how to restart, rebuild, and build your business the right way. I did write a book called the practice freedom method and it's 12 chapters of various things from marketing to hiring, to financials a lot with my story and all the struggles I went through. I share all the crap that I went through. So you can learn from it and I wanted to give it to your people for free. You can download it immediately. It's the entire book, but feel free to just go through the chapters it's in digital form.

Jamey Schrier (30:42):

You just go to practicefreedomu.com/healthywealthysmart-podcast, and you'll just get it immediately. So that would probably be the first place that I would go. And if some of my stuff resonates and you want to have a conversation happy to do so, if not, I would just seriously, you know, consider getting a mentor, finding someone or even maybe a small mastermind group, just people you resonate that can think differently than you to help you through things that alone will take you down a better path, regardless of the specific strategy or tactic that you use.

Karen Litzy (31:21):

Right. Excellent advice. And thanks for the free book. And that'll also be on the podcast at podcast.healthywealthysmart.com under this episode. So one click and we'll take everybody right to that site. And now last question, knowing where you are now in your life and in your career, what advice would you give to your younger self? Say a young pup, right out of PT school?

Jamey Schrier (31:49):

Young Jamey Schrier that's scary. Cause I was one cocky son of a bitch. God, I knew it all. Fear is a part of this fear is a part of growth and it is never the right time. You will never feel like you're enough. And if I had to talk to myself before I would've told myself, swallow your frickin pride and start hanging around people that you want to be like, that you're in that you're impressed by something of what they're doing. Just be there, just be with them. And just soak up some of that. I didn't do that a ton. I had a little bit of an attitude towards that. I don't know why. I don't know where it came from, probably because I wanted to feel improved to myself. I wanted to do it on my own. And the reality I look back and I was like, God, that was the stupidest thing I ever did. So whatever your passion is, whether it's business and you want to do your own thing, whether it's side hustle, I know that. Or whether you just want to be the greatest therapist or clinician or researcher, just connect with other people. People are so awesome in giving and providing, but they're not going to do it without you coming to them.

Karen Litzy (33:10):

Yeah. They're usually not knocking on your door while you're on your couch watching TV.

Jamey Schrier (33:15):

They're not going to come to you and what the successful people out in the world. I don't just mean financial success. I mean success and happiness success and just who you are as a person, just your own wellbeing. All of those people have these groups, these connections, these people, they reach out to, they all do. They might not talk about it, but they all do. They all have coaches. They all have mentors. They all have people they connect with. And when you do that, it just makes this so much easier and so much more fun.

Karen Litzy (33:48):

Yeah, absolutely great advice. So Jamey, thank you so much for coming on and everyone again you could go to a podcast.healthywealthysmart.com to get the book or go to freedom practice U the letter freedompracticeu.com/healthywealthysmart-podcast for the book. And you can also find out more about Jamey, what Jamey's doing to help so many physical therapy business owners around the country. So Jamey, thanks so much for coming on again. I appreciate it.

Jamey Schrier (34:25):

Oh, thank you, Karen. Enjoyed it.

Karen Litzy (34:28):

Great. And everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy and smart.

 

 

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

Aug 10, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition.  Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.

In this episode, we discuss:

-The impact of optimal nutrition on performance

-How to detect and remedy vitamin and mineral imbalances in your body

-Mindfulness strategies to cope with quarantine stressors

-And so much more!

 

Resources:

Erica Ballard Website

Erica Ballard Instagram

Erica Ballard LinkedIn

Pantry Essentials Playbook

The Lies We've Been Fed Podcast

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Erica:

Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.

 

Erica Ballard:

Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.

Erica Ballard (01:02):

You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.

Erica Ballard (01:57):

And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.

Erica Ballard (02:46):

And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.

Karen Litzy (03:49):

That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.

Erica Ballard (04:42):

Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.

Karen Litzy (05:47):

Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?

Erica Ballard (05:58):

Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.

Karen Litzy (06:36):

I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?

Erica Ballard (07:10):

So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.

Erica Ballard (07:58):

You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.

Karen Litzy (08:45):

Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?

Erica Ballard (09:11):

So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.

Erica Ballard (10:22):

To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.

Karen Litzy (11:04):

And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.

Erica Ballard (11:19):

So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.

Erica Ballard (12:14):

But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.

 

Karen Litzy:

Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.

Erica Ballard (13:09):

Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.

Erica Ballard (14:00):

And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.

Karen Litzy (14:53):

Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?

Erica Ballard (15:03):

It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.

Karen Litzy (15:40):

Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?

Karen Litzy (16:28):

And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?

Karen Litzy (17:08):

I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.

Erica Ballard (18:06):

I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.

Karen Litzy (18:39):

Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.

Erica Ballard (19:09):

I wouldn't either if I had to.

Karen Litzy (19:11):

Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.

Erica Ballard (19:37):

Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.

Karen Litzy (20:53):

Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.

Erica Ballard (21:03):

Yeah. That's exactly in a nutshell.

Karen Litzy (21:05):

Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.

Erica Ballard (21:39):

That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.

Erica Ballard (22:36):

So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.

Karen Litzy (23:40):

Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.

Karen Litzy (24:20):

Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.

Erica Ballard (25:04):

Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.

Karen Litzy (26:10):

Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?

Erica Ballard (26:24):

I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.

Karen Litzy (26:49):

Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.

Erica Ballard (27:41):

Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.

Karen Litzy (28:26):

Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.

Erica Ballard (28:43):

Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.

Erica Ballard (29:25):

And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.

Karen Litzy (29:59):

Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school

Erica Ballard (30:12):

That I love this question and I really, really wish I knew this, that you can do it your way.

Karen Litzy (30:22):

Mm, powerful.

Erica Ballard (30:24):

It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.

Karen Litzy (30:41):

Excellent advice. And where can people find you social media website?

Erica Ballard (30:47):

Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.

Karen Litzy (31:12):

Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. 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!

Aug 10, 2020

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition.  Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules.

In this episode, we discuss:

-The impact of optimal nutrition on performance

-How to detect and remedy vitamin and mineral imbalances in your body

-Mindfulness strategies to cope with quarantine stressors

-And so much more!

 

Resources:

Erica Ballard Website

Erica Ballard Instagram

Erica Ballard LinkedIn

Pantry Essentials Playbook

The Lies We've Been Fed Podcast

 

A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.  

 

For more information on Erica:

Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.

 

Read the full transcript below:

Karen Litzy (00:01):

Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.

 

Erica Ballard:

Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health.

Erica Ballard (01:02):

You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there.

Erica Ballard (01:57):

And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better.

Erica Ballard (02:46):

And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy.

Karen Litzy (03:49):

That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means.

Erica Ballard (04:42):

Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain.

Karen Litzy (05:47):

Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that?

Erica Ballard (05:58):

Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about.

Karen Litzy (06:36):

I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean?

Erica Ballard (07:10):

So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining.

Erica Ballard (07:58):

You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate.

Karen Litzy (08:45):

Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that?

Erica Ballard (09:11):

So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard.

Erica Ballard (10:22):

To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements.

Karen Litzy (11:04):

And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this.

Erica Ballard (11:19):

So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work.

Erica Ballard (12:14):

But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.

 

Karen Litzy:

Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path.

Erica Ballard (13:09):

Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction.

Erica Ballard (14:00):

And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation.

Karen Litzy (14:53):

Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right?

Erica Ballard (15:03):

It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks.

Karen Litzy (15:40):

Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is?

Karen Litzy (16:28):

And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately?

Karen Litzy (17:08):

I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money.

Erica Ballard (18:06):

I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all.

Karen Litzy (18:39):

Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since.

Erica Ballard (19:09):

I wouldn't either if I had to.

Karen Litzy (19:11):

Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear.

Erica Ballard (19:37):

Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you.

Karen Litzy (20:53):

Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit.

Erica Ballard (21:03):

Yeah. That's exactly in a nutshell.

Karen Litzy (21:05):

Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will.

Erica Ballard (21:39):

That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there.

Erica Ballard (22:36):

So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be.

Karen Litzy (23:40):

Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four.

Karen Litzy (24:20):

Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit.

Erica Ballard (25:04):

Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end.

Karen Litzy (26:10):

Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with?

Erica Ballard (26:24):

I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary.

Karen Litzy (26:49):

Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan.

Erica Ballard (27:41):

Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do.

Karen Litzy (28:26):

Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get.

Erica Ballard (28:43):

Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time.

Erica Ballard (29:25):

And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook.

Karen Litzy (29:59):

Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school

Erica Ballard (30:12):

That I love this question and I really, really wish I knew this, that you can do it your way.

Karen Litzy (30:22):

Mm, powerful.

Erica Ballard (30:24):

It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside.

Karen Litzy (30:41):

Excellent advice. And where can people find you social media website?

Erica Ballard (30:47):

Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward.

Karen Litzy (31:12):

Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

 

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