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Healthcare’s Leadership Trap: Why Promoting Great Clinicians Can Break Clinics · The Operator | Healthcare Business

0:05
Everybody in healthcare says they want
0:07
better leaders, but Larry,
0:09
your latest article makes a sharper point.
0:11
Maybe healthcare doesn't have a leadership
0:13
shortage.
0:15
Maybe it has a leadership selection
0:16
problem.
0:17
So for years,
0:18
platforms have rewarded people who can
0:20
talk terms like EBITDA, scale, synergy,
0:24
and then everybody acts shocked when
0:25
clinical culture starts cracking.
0:27
And that's what happens when you take
0:29
maybe the best clinician in the room,
0:31
the mentor, the culture carrier,
0:33
the glue person,
0:35
and you promote them out of the clinic
0:38
where they were good.
0:38
Title goes up, meetings go up,
0:40
clinical impact, though, going down.
0:42
So today...
0:44
And this week we're asking,
0:45
are we developing leaders or are we
0:48
removing the people who were already
0:51
leading?
0:52
So Larry, let's start there.
0:54
You open up with the idea that healthcare
0:55
platforms think they have a leadership
0:58
problem,
0:58
but they misdiagnose it as a talent
1:00
shortage.
1:01
What do you mean by that?
1:03
Yeah,
1:04
so first let me give credit where credit
1:05
is due on this.
1:06
I learned this phenomenon when I was in
1:09
high school and our star quarterback went
1:13
down for an injury.
1:15
And so what did we do?
1:16
We took the wide receiver who was probably
1:18
the best athlete on the team and we
1:20
made him the quarterback.
1:22
Well,
1:22
what you really didn't realize is you're
1:24
really replacing two positions at that
1:26
point.
1:27
And that's stuck with me for a long,
1:28
long time.
1:29
And I've just seen it in healthcare
1:31
platforms all the time.
1:32
When a platform's struggling,
1:34
clinical turnover is high, for example,
1:37
culture is deteriorating,
1:39
your outcomes aren't getting what you
1:41
want.
1:41
More importantly, organic growth,
1:43
which is the ultimate litmus test of how
1:47
things are going is flat or declining.
1:50
The first diagnosis,
1:51
the first place we always look is we
1:53
need better people.
1:54
We need to recruit differently.
1:56
We have a talent problem.
1:58
And I understand why that's the conclusion
2:01
because it's the comfortable one.
2:02
It locates the problem outside the
2:04
organization.
2:05
Nobody likes to look internally.
2:06
The people we hired weren't good enough.
2:08
We need to upgrade, you know,
2:10
all of those gains top grade.
2:12
You hear these terms,
2:12
we need to find better ones.
2:14
What I'm arguing really is that the
2:16
problem is almost never the talent.
2:19
The PTs, for example, the hygienists,
2:21
the nurse practitioners,
2:22
the dentists coming out of programs,
2:24
they're well-trained, they're motivated.
2:25
They genuinely want to do excellent work.
2:27
The problem is what happens to them after
2:30
they arrive.
2:32
And what I see is most companies don't
2:33
have a talent management human capital
2:35
machine.
2:37
And so what they do is they don't
2:38
have the correct compensation structures,
2:40
the leadership of the people above them.
2:45
or the development programs are the
2:47
problem.
2:47
And all these things contribute to an
2:49
organizational design problem.
2:51
And you don't solve organizational design
2:54
by recruiting harder and harder.
2:57
They get solved by designing differently.
2:59
Same thing happens in sports.
3:01
If you have a screwed up organization,
3:03
you're not going to all of a sudden
3:05
recruit better people and think that the
3:07
organizational architecture is going to
3:09
is going to change.
3:10
So the misdiagnosis is very expensive
3:12
because it sends you looking in the wrong
3:13
direction.
3:14
The talent was there.
3:15
The organization wasn't built to keep that
3:18
talent.
3:20
Now you bring up Peter Drucker and his
3:21
distinction.
3:23
Management is doing things right.
3:26
leadership is doing the right things.
3:28
And I feel like I read that several
3:30
times.
3:31
I was like, oh, I should remember this.
3:33
But where have healthcare platforms
3:35
confused these two terms?
3:38
Because they're almost used
3:39
interchangeably,
3:40
but they are not the same.
3:41
No, they're not.
3:42
They confuse them,
3:43
they conflate them and where it happens
3:46
almost everywhere.
3:46
But the clearest example is really what
3:49
happens when you do an acquisition.
3:52
You acquire a practice or you get a
3:54
new practice added on.
3:56
The first thing that gets deployed
3:59
is management infrastructure the systems
4:01
the compliance frameworks the productivity
4:03
targets the billing standardization all
4:05
these kind of organizational you know uh
4:08
connective tissue if you will um all those
4:11
things if you're adding something you're
4:14
buying them for the right reason they
4:16
could be doing some of those things
4:17
correctly
4:18
We assume they're all either being done
4:20
correctly or they're all being done
4:22
incorrectly.
4:23
What doesn't get deployed,
4:24
what often doesn't exist in the platform
4:27
is the leadership function.
4:29
Someone whose job it is,
4:30
is to figure it out.
4:31
It's a very human orientation kind of
4:34
thing where the organization is doing the
4:36
right things after the acquisition.
4:39
Are things running effectively?
4:40
Are they running efficiently?
4:42
Are the clinicians practicing to a
4:44
standard of care that they were trained
4:46
for?
4:46
Is the culture
4:48
Everybody wants their culture to be the
4:50
same.
4:50
Well, that's obnoxious.
4:51
You want each team having their own
4:53
microcultures.
4:54
That's just the way that things happens.
4:57
And the distinction matters because
4:58
management without leadership produces a
5:00
very specific kind of organization,
5:02
one that executes efficiently on
5:04
objectives that may no longer be the right
5:07
ones.
5:08
Healthcare platforms have become very good
5:10
at executing efficiently,
5:12
revenue cycle management for a while, HR,
5:15
paying the bills on time.
5:17
The question is whether they're executing
5:19
on the right things.
5:20
Are they executing on development,
5:22
on growing the clinic organically,
5:25
additional patients converting that to
5:27
cash flow?
5:28
That's a leadership function,
5:30
and it's the one that most consistently is
5:33
missing from the organizational chart.
5:36
yeah well let's talk about this clinical
5:39
leader extraction problem that you
5:41
described it sounds like you just touched
5:42
on it in terms of quarterback goes down
5:44
you bring in the next best athlete which
5:46
is wide receiver but here the best
5:48
clinician gets promoted out of the clinic
5:53
this isn't just a one-step problem though
5:55
why is that so damaging and then in
5:58
what ways is it damaging downstream
6:02
Yeah,
6:02
and I will say physical therapy platforms
6:07
Non-physician platforms,
6:09
behavioral health, physical therapy,
6:12
certainly OT, are the worst at this.
6:16
And let me describe the person we're
6:18
talking about because I think it helps to
6:19
sort of make that person a real person.
6:22
So take somebody,
6:23
take a gal who's the senior physical
6:25
therapist,
6:26
and let's say she's been at the clinic
6:27
for five to eight years.
6:29
She doesn't just have great clinical
6:31
outcomes and rapport with her own
6:32
patients,
6:33
she's changed
6:34
The culture around her,
6:35
she's lifted everybody up.
6:37
Her attitude,
6:38
the way she conducts herself,
6:39
the way she mentors.
6:40
New graduates come in and they learn
6:42
faster because she's built that.
6:45
She's mentored and she's out in the
6:46
community and she's doing all kinds of
6:48
things.
6:49
She runs the staff meetings.
6:52
All of this thing around culture.
6:54
She's just great at it.
6:56
The patient who's not adhering,
6:57
she knows how to do it.
6:58
She's not just a great clinician.
6:59
She's a force multiplier.
7:01
Her presence makes the clinic better.
7:04
Then what happens?
7:06
She gets promoted.
7:07
Not because they want to diminish the
7:09
clinic.
7:10
They think that's the only way they can
7:11
develop her or keep her.
7:12
Well,
7:13
we can only keep her if we put
7:14
her in a different position.
7:16
The title changes, the pay goes up,
7:18
which is real and matters.
7:20
And she leaves the very room that she
7:21
was at.
7:24
What leaves with her?
7:25
All the informal intricacies, mentorship,
7:28
case review, the way she interacts,
7:30
her friendliness,
7:31
her relationship with patients,
7:32
her relationship with physicians.
7:34
But we think the only way to get
7:36
her to be better is to move her
7:39
to a different position.
7:40
So again,
7:41
we've taken the split end and made him
7:43
the quarterback, or in this case, a she.
7:46
None of that shows up on the dashboard.
7:48
The dashboard shows you now got a new
7:51
regional director.
7:53
Sometimes I've seen with board certified
7:54
therapists,
7:55
you move them into these kinds of
7:56
positions and you never really sit down
7:58
with the person and say,
7:59
do you want to be a clinician or
8:00
do you cut out to be a leader
8:01
manager?
8:02
We just assume they want to be a
8:04
leader manager.
8:05
And that's not only wrong, it's damaging.
8:07
Yeah.
8:09
You had this line that I loved and
8:10
I read it a couple of times.
8:11
I think I even emailed you and said,
8:12
this is it.
8:14
Your line in the article was,
8:15
it's like training chefs to read
8:17
spreadsheets and then wondering why the
8:18
food tastes like PowerPoint.
8:20
And that's fantastic.
8:23
So what are healthcare leadership programs
8:25
training people to actually do well?
8:26
Let's go to the positive side before we
8:28
come back to how does it need to
8:30
change?
8:31
What are they doing well while completely
8:33
missing the thing that actually makes a
8:34
clinical team work?
8:35
We've sort of touched on that,
8:36
but what are the leadership programs doing
8:38
well?
8:39
So we'll get into leadership programs a
8:42
bit,
8:43
I think with some additional conversation.
8:47
you know,
8:47
they are training clinicians to be fluent
8:49
in the language of the organization,
8:52
right?
8:53
P&L, EBITDA, scheduling optimization,
8:56
productivity,
8:57
how to read a variance report,
8:59
how to run a performance improvement
9:01
conversation, how to present, you know,
9:02
as sort of a regional director.
9:04
So we've taken this massive clinician,
9:06
probably board certified,
9:08
and we've taught them a new language.
9:10
And you know what?
9:11
I'm not against teaching financial
9:13
literacy for clinicians.
9:14
I think it's important that they
9:15
understand that.
9:15
I think it's important that they
9:16
understand the insurance and the
9:18
reimbursement system.
9:20
All of that better positions them to
9:22
advocate for patients and to be a better
9:25
teammate.
9:25
That's a legitimate skill.
9:27
The problem is that the curriculum stops
9:30
there.
9:31
What the programs are really never
9:34
teaching is how to build psychological
9:36
safety into a clinical team,
9:37
how to develop another clinician,
9:39
how to have situational leadership,
9:41
how to have culture diagnostic,
9:44
how to take personality inventories and
9:46
mesh them into a functioning collaborative
9:49
group,
9:50
how to preserve clinic culture through
9:52
change, how to manage change.
9:54
How to recognize sort of all these moral
9:56
injuries before the person drops out.
10:01
When you identify when somebody's probably
10:02
going to leave,
10:03
how to hold tension between the
10:05
operational team and understanding and
10:07
what I call normalizing discomfort and
10:10
holding that tension honestly rather than
10:12
just ignoring it.
10:13
These are leadership skills,
10:14
and those aren't part of that development.
10:17
The development is teaching spreadsheets
10:20
to get to the PowerPoint in a clinician.
10:23
We want to teach leadership skills,
10:25
tacit knowledge skills,
10:27
what we call soft skills,
10:29
these new smarts, as they're often called.
10:32
That's the kind of programs you want.
10:33
And right now,
10:34
we're just not seeing that in the
10:36
curriculum.
10:36
It's promoting,
10:38
teaching them financial literacy,
10:40
empowering them to make those kind of
10:41
decisions.
10:42
And you've now taken the split end and
10:44
made them a quarterback.
10:45
So now I'm going to hit you with
10:46
the hard question, which is why?
10:48
Why are organizations continually moving a
10:51
wide receiver to quarterback?
10:52
Why aren't they growing people who want to
10:55
play a position and leaving the people who
10:58
want to do another thing well alone?
11:00
Why are they trying to have everybody go
11:01
the same path?
11:03
Yeah,
11:03
I think it's in general a compensation
11:05
problem.
11:06
If you look at the groups and the
11:09
practices that do that,
11:12
What they say is we will tap a
11:14
clinician out at their salary.
11:16
We may even have an incentive program.
11:18
We may even give them a two percent
11:20
a year raise.
11:22
But none of that was shaped around
11:23
clinical excellence,
11:24
about understanding what they do in the
11:27
bigger picture of things.
11:28
And so I think it's a compensation
11:30
program.
11:30
And I think what happens is if you
11:32
started paying clinicians more like they
11:34
deserve, you would need less management.
11:37
because they'd be so busy seeing patients
11:39
and doing productive work,
11:40
they have less management issues.
11:42
Hire business people to do business
11:44
things.
11:45
And yes,
11:45
you're always going to have some
11:46
clinicians who sometimes are better at
11:48
business and leadership.
11:50
I'm not saying you absolutely should get
11:52
rid of all of it,
11:53
but you need to get rid of the
11:54
whole notion that the only way you get
11:55
better here or make more money is to
11:57
be promoted into a position that takes you
11:59
out of the clinician.
12:00
And that's what I see happen all the
12:02
time.
12:03
The fix is not complicated.
12:06
it is difficult to execute because you're
12:09
now going to pay clinicians differently.
12:11
You're going to pay your, you know,
12:13
you're going to reward them in a much
12:15
more compensated way.
12:17
But, you know, other platforms,
12:18
primary care, orthopedic surgery, dental,
12:22
they all have migrated to that model.
12:24
But for whatever reason,
12:25
physical therapy and ancillary care
12:27
models, they just don't.
12:29
Yeah.
12:30
Are healthcare platforms overmanaged
12:32
today?
12:33
and under lead?
12:34
And again,
12:35
management is doing the things right,
12:38
leadership is doing the right things.
12:40
And if so,
12:41
what does that look like inside a clinic?
12:43
Probably wouldn't have said that some
12:45
years back, but now with AI and data,
12:49
I actually think they might be
12:51
over-managed.
12:53
I mean, look at the clinics,
12:54
they have metrics for everything.
12:55
We have data for everything.
12:57
It's like, oh,
12:58
don't show me anything unless you show me
12:59
data.
12:59
Patients per day, cancellation rate,
13:01
documentation, compliance,
13:03
net promoter score,
13:04
all these being tracked and reported.
13:07
You know,
13:07
therapists are getting their daily email,
13:09
how many units they build,
13:10
how many patients they saw, blah, blah,
13:11
blah, blah.
13:12
The management infrastructure has been
13:15
pretty thorough.
13:17
But what the clinic does not have someone
13:19
whose job it is,
13:20
is to ensure that the culture is intact.
13:23
Someone who knows whether the new graduate
13:25
is developing at the pace that it should
13:27
be.
13:27
Somebody who treats people like
13:29
individuals rather than a collective
13:31
community.
13:31
you know, group.
13:32
You're a physical therapist,
13:33
you're all the same.
13:34
Your personalities are all the same.
13:36
You're a dentist, you're a hygienist,
13:37
your personalities are all the same.
13:39
And someone who really has to look at
13:42
the plan of care completion rate and say,
13:44
how do we improve this metric?
13:45
What are the patients actually
13:47
experiencing here?
13:48
These are harder conversations and harder
13:51
to execute.
13:53
And they're much more difficult strategies
13:54
to implement.
13:55
But one of the key strategic undertones in
13:58
business is that strategies that are more
14:00
difficult to imitate,
14:01
that are harder to execute,
14:04
and that have sustainable competitive
14:06
advantage in the marketplace will always
14:09
have sustainable, you know,
14:12
competitive advantage in the marketplace
14:14
simply because their strategies are so
14:16
difficult to imitate.
14:19
And so there's a reward for doing it.
14:20
It's a premium in the market.
14:22
That premium is in growth,
14:23
in valuation and in compensation.
14:29
It's hard to show where that person exists
14:32
on the org chart, though.
14:34
They sort of have things that are not
14:35
necessarily always in the job description
14:38
or easily described in a job description.
14:42
You argue that many leadership development
14:44
programs are really management courses
14:47
with better snacks,
14:48
which of course helps people.
14:51
What are these programs teaching and what
14:53
are they missing?
14:53
Where's the lack?
14:55
Yeah,
14:55
and it goes back to doing the right
14:57
things by, you know,
14:59
it goes back to that quote as well.
15:01
What they're teaching,
15:02
they're teaching financial literacy,
15:04
operational analysis,
15:05
how to optimize scheduling,
15:07
productivity metrics, scale, efficiency,
15:10
growth.
15:11
how to speak all that language.
15:13
And yes,
15:14
there needs to be a level set to
15:16
clinicians who do need to understand some
15:19
of the sources of those.
15:20
But clinicians generally didn't go into
15:24
health care for that language.
15:26
They did it for the language of helping
15:28
people and working with people.
15:30
So what are they missing?
15:32
Everything that determines whether a
15:33
clinical team actually works.
15:35
How do you build psychological safety?
15:37
How do you have empathy and compassion?
15:39
How do you have difficult conversations?
15:41
How can you tell somebody is burned out?
15:44
How can you tell when I need to
15:45
promote somebody?
15:46
How can you talk to somebody about
15:48
compensation or about care differently
15:51
than you do?
15:52
So one is financial literacy.
15:55
The other is people literacy.
15:57
And what we're lacking is all of those
15:59
soft skills or what are called new smart
16:02
skills that make the dynamics of it,
16:05
that much better.
16:06
It's a failure of curriculum design.
16:09
So if a candidate can show all the
16:11
things, EBITDA improvement,
16:12
cost reduction,
16:13
all the things that should show up,
16:16
what question should or could a board ask
16:20
to tease that out if they have those
16:23
new soft skills,
16:25
assuming that person is actually good,
16:27
to figure out that person is actually a
16:28
good healthcare leader?
16:30
Yeah, no,
16:30
it's a great question because you have to
16:33
look, remember things evolve over time.
16:36
One of the interesting thing about
16:37
healthcare platforms,
16:38
they have no history that is meaningful.
16:40
What you did yesterday may not have any
16:41
effect on the next day unless you have
16:43
a great leader.
16:44
So the single most revealing question is
16:46
what did the organization look two years
16:48
after you achieve those results?
16:50
Not the moment of the results,
16:51
two years later.
16:53
Was EBIT improved?
16:54
Was organic growth being generated?
16:57
At month,
16:58
the turnover cohort is sort of gone.
17:00
You've kind of worked your way through all
17:02
those kinds of things.
17:03
And the financial statements have to be
17:07
analyzed.
17:08
So what I want to see is walk
17:09
me through, it's now,
17:11
walk me through the same store performance
17:13
in and .
17:15
That period had the fastest rate hike in
17:17
forty years.
17:18
Labor costs spiraling,
17:19
reimbursement pressure,
17:21
shortages everywhere.
17:23
You know, that's where operators really,
17:25
really got sorted.
17:26
It's kind of like builders during a bad
17:28
recession.
17:29
You know who the good ones are because
17:30
they're still working.
17:31
Right.
17:31
And many of them aren't.
17:32
And the ones who really maintain,
17:36
you know,
17:36
performance and semblance during that and
17:38
pull the team together.
17:40
Absolutely.
17:41
You know,
17:41
one of the examples I give is
17:43
I was fortunate enough to work with some
17:46
really great folks who during that COVID
17:50
time period where you had,
17:52
it was to advantage to a lot of
17:54
companies to lay people off.
17:55
They got unemployment, they got PPP money.
17:58
If you remember the PPPs of the world
18:00
and you had all that stuff going on,
18:01
we made a conscious decision not to lay
18:04
anybody off.
18:04
We may have reduced their
18:05
clinical hours and so if they work forty
18:07
down to twenty because of all the stuff
18:09
happening during COVID so be it we could
18:11
then supplement it with unemployment and
18:13
other kind of things and therefore after
18:15
that we really took off in terms of
18:18
organic growth because we didn't lose
18:20
clinicians where the shortage at least
18:22
went down you know fifteen to eighteen
18:24
percent nationally at least on an
18:26
outpatient basis so that's cultural
18:29
You have to really think about long-term
18:31
sustainability.
18:32
But what's happened in private equity in
18:34
particular,
18:34
it's all about the burning bed of private
18:36
equity.
18:36
Are you having a transaction every three
18:38
or five years and teeing up your company
18:41
to have this so-called great transaction
18:44
event?
18:44
That's not how businesses are built.
18:46
You need patient capital.
18:47
You need to have long-term sustainable.
18:50
Fortunately, right now,
18:51
with interest rates still high and
18:52
transactions
18:53
being pretty paltry in the marketplace,
18:56
you're starting to see things being
18:57
rewarded for sustainable patient capital,
19:00
putting things in succession vehicles and
19:02
other ways to keep the investment thriving
19:08
while also keeping the company thriving as
19:11
well.
19:12
So it sounds like the player on the
19:14
field that matters is the great clinician,
19:16
right?
19:17
If you weren't going to promote them out
19:19
of clinical care,
19:20
How would you design a better leadership
19:22
pathway for them?
19:24
What would it look like so that great
19:25
clinician could grow without being pulled
19:28
out of clinical excellence,
19:30
the thing they're good at?
19:31
Yeah, I'm going to mention a couple,
19:34
three things here.
19:35
And I'll start out by saying none of
19:37
these are easy to implement,
19:39
but they're critical.
19:41
So the three things...
19:43
in order of importance.
19:45
One is you have to have a clinical,
19:47
call it a clinical advancement track with
19:50
real compensation attached.
19:52
It does not require a management title.
19:54
It does not require a bureaucracy,
19:57
you know, senior clinician,
19:58
clinical specialist,
19:59
distinguished practitioner,
20:01
call it whatever the hell you want,
20:02
but make it a real career with real
20:04
pay that deepens clinical mastery, okay?
20:08
The message has to be your clinical work
20:11
has a ceiling only if we failed to
20:13
design it around you.
20:15
Other than that,
20:15
it shouldn't have a ceiling because right
20:17
now the ceiling is real and every,
20:19
every high performing clinician knows it.
20:21
That's why they leave to go to another
20:23
employer for an extra two thousand dollar
20:24
sign on bonus, right?
20:26
You're competing on benefits when you
20:29
really ought to be setting up your design
20:30
compensation.
20:31
So that's number one,
20:32
a real advancement track tied to
20:34
compensation.
20:35
The second is a mentorship structure
20:38
that formalizes what the best clinics are
20:41
already doing informally and pays for it.
20:44
Mentoring stipends,
20:45
protected time for case review and
20:47
teaching,
20:48
a career designation that says part of
20:50
your role is developing the clinician next
20:53
to you.
20:53
In the dental world,
20:54
we pay dental directors extra for teaching
20:57
on weekends or teaching in addition to
20:59
their other jobs so that they can be
21:01
compensated and make more money.
21:03
Never heard of a PT company that even
21:04
does that or thinks of doing it.
21:07
And I would say the third is a
21:08
real leadership curriculum,
21:11
not financial literacy training,
21:13
but one that actually teaches leadership
21:15
within a clinical context,
21:17
psychological safety,
21:19
how to get along with others,
21:20
how to have difficult conversations,
21:22
methodology and around the models of
21:24
mentoring.
21:25
And there's been a bunch of research on
21:26
this,
21:27
how to hold clinical values under
21:29
operational pressure when reimbursement is
21:32
down and you're having a bad day.
21:35
EQ and emotional intelligence and
21:38
compassion and all of those soft skills.
21:41
Do that, not just P&L literacy.
21:46
And the curriculum has to really,
21:48
really hone and treat those clinical
21:50
leadership skills.
21:51
And what does that take?
21:51
It takes feedback.
21:53
We use coaching now where
21:55
Take AI,
21:56
and we know we've always had a good
21:59
coaching mentality around our therapists
22:01
and now dentists,
22:02
but how can we get the coaches even
22:04
more supplemental stuff?
22:07
And so we now have humans and AI
22:09
asking the right questions and paying
22:11
attention to them.
22:13
Because at the end of the day,
22:14
those three things matter.
22:15
Compensation,
22:16
a real clinical track that does it, real,
22:19
real leadership, you know, training,
22:21
and then a formal structure around
22:24
mentoring that rewards teaching.
22:27
So it sounds like the big takeaway would
22:28
be healthcare doesn't just need more
22:31
leaders.
22:31
It shouldn't be one ladder.
22:32
It needs to stop confusing leadership with
22:34
management and giving people a pathway
22:36
that they actually value instead of
22:38
pulling them onto a pathway you think or
22:42
a business person might think is the only
22:44
valuable way.
22:45
No, that's right.
22:46
And I think, and by the way,
22:47
I've made all these mistakes in business
22:49
and management.
22:51
But then it occurred to me,
22:52
do you ever see an orthopedic surgeon as
22:54
a regional director overseeing six or
22:56
seven offices?
22:57
Do you ever see a dentist do that?
22:59
No.
22:59
Do you see them getting paid for clinical
23:01
mentoring?
23:02
Of course.
23:03
Do you see them getting paid for
23:05
organizing things and doing stuff and
23:07
being more productive?
23:08
Of course.
23:09
We have to apply that to the ancillary
23:11
professions a whole lot better.
23:13
Dental, primary care, orthopedic surgery,
23:16
those didn't get there overnight.
23:18
We now have to get behavioral health
23:21
physical and occupational therapy,
23:23
pharmacy and others, you know,
23:26
tied up in these healthcare platforms.
23:27
Optometry would be a big one too.
23:30
Ophthalmology is in pretty good shape
23:32
because their surgeons are rewarded and
23:34
compensated accordingly.
23:36
But generally the other ones suffer from
23:37
those same models.
23:39
So my goal in working with,
23:41
I've been fortunate to work with Jason
23:42
Wemble that Onus One now,
23:44
they're part of Prompt.
23:47
I can't remember the name of the new
23:49
division they call it,
23:50
but he's on a mission to do that
23:51
as well.
23:53
And I'm right there with him because I
23:54
think it's one of the areas that we
23:56
can gain in our profession without
23:59
sacrificing it.
24:00
Pay our therapists more.
24:02
You pay them more,
24:03
they need less people managing them.
24:05
The only way you pay more is to
24:06
take them out of a clinic role.
24:09
You're in bad shape.
24:10
And in PT,
24:10
only twenty percent of active licensed
24:12
clinicians on an FTE basis are even
24:14
practicing.
24:15
It's quite sad, actually.
24:17
Stop replacing your quarterbacks with wide
24:19
receivers.
24:19
You're going to get people who need to
24:21
pass the ball,
24:21
but they're good at catching the ball.
24:24
All right.
24:24
If this conversation hit a nerve,
24:25
go read Larry's full article on the
24:27
operator.
24:27
That's his sub stack.
24:28
The link is in the show notes and
24:31
the description.
24:32
And if this episode again made you feel
24:34
a little uncomfortable,
24:35
that's sort of the point.
24:37
Larry, appreciate the time.
24:38
Absolutely.
24:39
And by the way, our next series,
24:41
I think there's going to be six different
24:44
articles, is on meetings.
24:46
Wow.
24:47
How to hold a meeting and how inefficient
24:50
and especially under a world where remote
24:52
work for your corporate folks is dominant,
24:55
especially in healthcare platforms.
24:56
I'm not going to tell you what to
24:57
write, but when you said meetings,
24:58
the first cliche that came to my mind
25:00
was,
25:00
could this meeting have been an email?
25:02
And my guess is if the answer is
25:03
yes, don't hold the meeting.
25:05
All right.
25:07
Check out the operator on Substack.
25:08
The link is in the description.