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Called to Care Spotlight: What If Caring More Prevents Burnout? · The Operator | Healthcare Business

0:05
And we're reintroducing the Call to Care
0:07
podcast for the next several weeks.
0:09
We are relaunching the book.
0:11
It's an expanded, revised edition,
0:14
includes some chapters in burnout, AI,
0:17
all the things around telehealth,
0:19
lots of things going on.
0:20
That's all the good news.
0:21
But the better news is we're dedicating a
0:23
hundred percent of the proceeds from the
0:25
second edition of Call to Care to the
0:26
Rising Tide Foundation.
0:28
And after today's podcast and talking to
0:31
the founder of Rising Tide,
0:33
who is also the founder of WebPT,
0:35
you'll understand why,
0:37
that the mission that they are all about,
0:39
which is really driven by human connection
0:42
and putting the right humans in the
0:43
profession,
0:44
is the same argument we make in the
0:46
book.
0:46
So I'm pleased to introduce you to Heidi
0:48
Janenga.
0:48
Heidi,
0:49
we're gonna start out with a short
0:51
introduction to you,
0:52
but I really wanna do the real
0:54
introduction,
0:54
which is that how you started out with
0:56
a knee injury at UC Davis.
0:59
Yeah,
1:00
I think we as physical therapists all kind
1:02
of have that sort of moment when we
1:05
knew this is the path that we wanted
1:07
to take.
1:08
And mine was in college.
1:10
I was actually pre-med going into college.
1:12
I was a basketball athlete at UC Davis
1:14
and went down my junior year with a
1:16
knee injury that was inconclusive on MRI
1:19
of whether they
1:20
whether or not I had torn my ACL,
1:22
they thought I had torn my ACL, but,
1:24
uh, it just wasn't conclusive.
1:25
So they sent me to a physical therapist,
1:27
which, you know, you're,
1:29
I'd spent a lot of time in the
1:30
athletic training room,
1:31
but had never really interacted with a PT
1:33
and, um,
1:35
This happened,
1:36
my injury happened like early in
1:38
preseason.
1:38
And so I was able to rehab back,
1:41
wore a brace,
1:42
but came back that year to be able
1:45
to play in the final parts of the
1:47
season and into the playoffs and rehabbed
1:50
again with this therapist all summer long
1:53
and was able to play my senior year
1:55
with no brace and
1:56
set a few uh scoring records along the
1:58
way but man that changed yeah changed my
2:01
trajectory and sort of what I wanted to
2:03
do um in terms of always knowing that
2:06
I wanted to work with athletes but in
2:08
this capacity of really having experienced
2:11
it myself really wanting to then go back
2:13
and be able to do that for for
2:14
other athletes uh yeah it was a turning
2:16
point in my career and
2:18
Boy, you know,
2:19
it's turning the lemons into lemonade
2:23
where an injury could be devastating to
2:25
especially at that level of an athlete.
2:27
But, you know,
2:28
having that experience changed the
2:31
trajectory of my life.
2:33
That's an incredible story.
2:34
If you look at how things have evolved
2:36
for women in sports in general,
2:38
and basketball in particular,
2:40
it's a whole new world.
2:42
The attendance at women's WNBA, college,
2:46
college volleyball,
2:47
it's just been incredible.
2:49
Look at the opportunities that sports has
2:51
continued to provide for things like
2:52
physical therapists.
2:54
I want to segue this a bit with
2:58
Rising Tide,
2:59
which is not the first company,
3:00
or in that case,
3:02
maybe it is the first nonprofit you
3:03
founded,
3:03
but it's not the first company you
3:04
founded.
3:05
But you wrote that sports was the first
3:07
place that you didn't feel like an
3:10
outsider.
3:12
And you put your name sort of on
3:14
the topic of workforce diversity when
3:16
nobody was solving it.
3:17
Nobody probably in those days was even
3:19
calling it workforce diversity.
3:23
Tell us about Rising Tide and tell us
3:25
how it is building that same feeling for
3:29
those that are coming outside into the
3:32
profession.
3:34
Well, I am...
3:36
a product of an immigrant father who
3:39
immigrated to this country from Austria.
3:42
My mom is Japanese.
3:43
She was first generation Japanese American
3:46
born in Hawaii before Hawaii was a state.
3:51
And so having two parents who essentially,
3:55
you know,
3:57
came from nothing to,
3:59
and my mom was one of nine, um,
4:01
grew up in, in, in general poverty, um,
4:04
and to, to come up to,
4:06
to be able to have opportunity to, uh,
4:08
my dad ended up going to Cornell.
4:10
Um,
4:11
he landed in Hawaii after working on
4:13
merchant Marine ships for ten years, um,
4:15
got set up with my mom on a
4:16
blind date, and, uh, that's how they met,
4:19
uh, in Hawaii, and then he,
4:21
went on to Cornell to get his PhD
4:23
and work for US Department of Agriculture.
4:27
My mom was a schoolteacher,
4:30
and so their hard work,
4:31
their work ethic that they instilled in me
4:34
early on was something that was really
4:36
important, that has been formidable.
4:39
However, being what they call in Hawaii,
4:43
hapa haole,
4:44
half Asian, half white,
4:46
like you'd think that you'd fit into a
4:47
lot of different categories.
4:49
Well,
4:49
sometimes you fit into some groups and not
4:52
others.
4:53
But what I've discovered about myself is
4:56
that it's made me somewhat of a chameleon
4:59
where I am able to sort of
5:03
find ways to connect with people of
5:08
different backgrounds,
5:10
different ethnicities in all those ways.
5:13
But initially it was the opposite that I
5:17
just,
5:17
I never felt like I really fit into
5:19
one group because I was different.
5:22
And finding sports and having that
5:26
connection with a team,
5:27
in which you are all working towards one
5:29
goal, no matter where you are,
5:32
who you are,
5:32
what you're doing and whether you're
5:34
friends off the court or on the court,
5:35
once you step on that court,
5:37
you're there for a common purpose.
5:39
And sort of that sort of mentality allowed
5:43
me to really feel connected to those
5:45
teammates and feel connected no matter
5:48
about my background.
5:49
Right.
5:50
And especially as a female athlete,
5:52
you know, I,
5:53
I had natural leadership tendencies in
5:56
which I rose to being a captain.
5:59
Those coaches and other teammates finding
6:03
those qualities in me that maybe I didn't
6:05
even see in myself at the time were
6:08
formidable to be able to sort of lean
6:12
into those things when they were
6:14
successful, right?
6:15
And so as I look to Rising Tide,
6:18
right,
6:18
these are students who are first
6:21
Sheri Byrne- generation college goers they
6:25
don't have a lot of family support or
6:27
or experience from from people around
6:29
them, who have been there done that.
6:32
Many of them are supporting themselves as,
6:34
you know,
6:35
having jobs at the same time as going
6:36
through PT school.
6:38
And so their work ethic,
6:41
their drive to really want to pursue this
6:45
profession, having that common purpose,
6:48
like all of those things kind of coming
6:50
together.
6:51
You know,
6:52
I see a lot of them or I
6:54
see myself in a lot of them.
6:56
Right.
6:56
And helping them to sort of hopefully
6:59
remove some of the barriers and the
7:02
lack of confidence that maybe i had um
7:05
to help support them and move them along
7:06
even faster than uh they potentially think
7:09
that they could themselves and of course
7:11
as you know larry it's the financial
7:13
barriers uh that it's the big one right
7:16
uh these are students that are taking on
7:19
more student than debt than an average
7:22
person to be able to get through because
7:25
not only are they coming into dpc school
7:27
having to get additional funding but they
7:29
already have debt from undergrad
7:32
And so that's the essence of part of
7:34
the essence of rising tide and, you know,
7:37
why it's been so impactful.
7:40
It's interesting that you mentioned the
7:41
financial, which is obviously number one.
7:43
But I would also offer up that as
7:45
physical therapy schools got harder and
7:47
harder to get into,
7:48
they made the criteria the most risk free
7:51
criteria.
7:52
And by doing that really left out.
7:55
underrepresented minorities in a major way
7:57
such that you know PT is one of
8:00
the most lacking of all healthcare
8:01
professions and we'll get into that a
8:03
little bit but what you've done is not
8:05
only supply scholarships but you've also
8:09
supplied resources and other things from a
8:12
psychosocial standpoint that make it even
8:14
easier better give them a better chance
8:17
for success but the odds in their favor
8:20
Correct me if I'm wrong,
8:20
but I think you're at one hundred eighteen
8:23
scholars.
8:24
Is that right?
8:24
One hundred eighteen,
8:25
two and a half million dollars at least
8:27
plus.
8:29
And what does that taught you about the
8:33
barriers that money alone doesn't solve?
8:35
Because certainly with that many scholars,
8:39
you now have seen enough enter to learn
8:42
from you got some of the financial thing,
8:45
help them resolve.
8:46
What are some of the other factors that
8:47
the profession does that makes it
8:49
difficult?
8:51
Well,
8:51
as you have eloquently written about so
8:53
much,
8:54
it's so much about the human relationship,
8:56
right?
8:57
And while everybody applies because of the
9:01
scholarship,
9:03
What we have come to find out is
9:06
probably even more rewarding to the
9:08
students and their success and support
9:11
ongoing is the educational enrichment,
9:16
the networking,
9:18
the connections that we're able to help
9:21
them get to that is really making the
9:24
difference.
9:27
been written about, you know,
9:28
like it's all in who, you know, well,
9:30
you know,
9:31
the fact that someone like yourself will
9:33
come and do a keynote and come to
9:35
a happy hour.
9:36
And while you might've seen a seemed out
9:39
of reach, um,
9:40
you're right there with them and they're
9:42
able to shake your hand,
9:43
have a conversation like those types of
9:45
things for these students seem out of
9:48
reach and out of touch.
9:49
And, um, you know, what we've,
9:54
Maureen Reyes- learned even from early on,
9:56
is the educational enrichment components
9:59
to what we're doing so just as a
10:02
backdrop right,
10:03
we do offer the scholarships,
10:05
we have twenty scholarships that we offer
10:07
per year for DPT students.
10:10
And then we also do five scholarships for
10:12
residents per year.
10:13
So it's twenty five scholarships annually
10:15
that we're giving.
10:18
And in addition to that,
10:20
we have quarterly webinars with our
10:22
scholars and we bring them all to Phoenix,
10:27
Arizona,
10:27
where I happen to live for an annual
10:30
what we call our North Star Summit
10:31
Conference.
10:33
in which all the current students come to
10:37
Phoenix.
10:37
We fly them all in for two days
10:39
of sort of networking and they get a
10:42
full day of curriculum based on volunteer
10:47
speakers and amazing folks who come
10:50
together to help educate and bring
10:53
educational opportunities for them.
10:56
And so all of those components and then
11:00
I mean,
11:00
I could go on forever on this, Larry.
11:01
It's just so inspiring.
11:03
But what we've also found is we had
11:06
a record number.
11:07
Every year it's been increasing the number
11:08
of applicants, which is fantastic,
11:10
which means more people are knowing about
11:12
us.
11:12
I would hope it also means that we
11:14
are improving the diversity of the
11:16
classes,
11:18
those that are being admitted into DPT
11:20
school.
11:23
But we had over five hundred applicants
11:25
this year for twenty spots.
11:27
Wow.
11:29
So it's it's incredibly competitive and
11:32
it's hard as hell to say no to
11:36
some really qualified people.
11:38
And so knowing that we have also built
11:43
a community we call our tide pole.
11:45
We have a technology platform in which we
11:49
a community platform which we can bring
11:51
them all together.
11:52
We provide educational resources for them
11:54
as well.
11:55
So we're not just
11:57
catering only to these twenty folks per
12:00
year,
12:00
our hundred and eighteen scholarships
12:03
winners,
12:04
but the entire sort of application pool
12:06
over the years, which now is, you know,
12:08
upward of close to two thousand people in
12:10
our our database.
12:12
That's amazing.
12:13
And as somebody who's who helped score
12:16
Your scholarships.
12:18
It was the most difficult scoring.
12:20
I've scored for entrance into PT school.
12:22
I've scored entrance into medical school
12:24
and dental schools.
12:25
I've been on all kinds of committees.
12:27
That was one of the most difficult thing
12:28
to do because they were all so worthy.
12:32
which really brings me to the next
12:34
question is that what does the, you know,
12:36
these are all for the most part,
12:38
I would guess first generation students,
12:40
first college generation students,
12:41
what does the profession really get wrong
12:43
about that?
12:44
Why did we get it?
12:45
When you look back on this,
12:48
And I go back, you know,
12:49
I've been in physical therapy world since
12:51
the mid eighties.
12:51
They've always had diversity, you know,
12:53
awareness and minority awareness
12:55
scholarships at APTA, for example,
12:57
and I'm not necessarily pointing at APTA,
12:59
but they've done probably an okay job with
13:02
that.
13:02
But ultimately it still resulted in an
13:05
under-representation.
13:07
So what has our profession got wrong about
13:09
all this?
13:10
Well, it's,
13:13
it's a little bit of chicken and egg,
13:16
right?
13:16
Um,
13:18
I think that, you know,
13:20
you and I have talked about the ninety
13:21
percent, right,
13:21
that ninety percent of people out there
13:23
don't know what a physical therapist is,
13:25
what what we do,
13:27
the impact that we have.
13:29
And I think that's probably doubled when
13:31
it comes to the minority population just
13:33
because they maybe don't have the same
13:35
sort of access to care and that kind
13:38
of thing.
13:38
So they haven't encountered physical
13:40
therapy maybe as much as somebody else.
13:43
Right.
13:43
And so and then when you do.
13:45
you go to see a physical therapist,
13:48
there's no one that looks like you, right?
13:50
So you don't have aspiration to
13:52
potentially want to become a physical
13:55
therapist because you don't really see
13:56
anybody that's in your community or that
13:59
looks like you that actually can inspire
14:02
you to want to become a PT, right?
14:04
And so it's been this slow sort of
14:06
role of more minority physical therapists
14:10
that are
14:11
becoming more outspoken and more advocates
14:14
for the profession in which you are in
14:17
with social media and other things like
14:19
that,
14:19
you now actually see people that look like
14:21
you.
14:21
We hear this all the time with our
14:23
applicants, right?
14:24
Like, what inspired you?
14:25
A lot of them are similar to mine
14:27
where they had an athletic injury,
14:29
but a lot of them now have actually
14:32
had a family member who went to PT.
14:37
And got care by Hispanic PT or an
14:42
African-American PT in which they saw the
14:45
care that was delivered to that family
14:47
member and the impact that they had on
14:50
their entire family that they were so they
14:53
were very inspired to now I want to
14:55
be that person.
14:56
Right.
14:57
And so the more that we can have,
15:00
it's got to be this kind of slow
15:03
progression.
15:04
And as far as what what did we
15:07
get wrong?
15:08
I think it's.
15:11
um it's what the ninety percent problem
15:14
like it's just that we haven't done enough
15:15
pr about what physical therapists the
15:19
impact that we actually in uh have and
15:22
more patient stories more um you know
15:25
physical therapy physical therapist
15:27
stories out there to to let more people
15:31
know who we are what we do the
15:33
education that we have um and
15:37
how important we are to the overall
15:40
wellbeing of patients in healthcare in
15:43
general.
15:44
Yeah, I so much agree.
15:46
I mean, it's sort of bi-directional.
15:49
You don't see anybody in that role,
15:51
so you don't have an aspirational side.
15:54
The flip side of that is also true.
15:56
When you do not have caregivers that look
15:58
like your patients,
16:00
outcomes and access really suffers.
16:02
We've opened clinics in very minority
16:08
areas, heavily impoverished,
16:10
trying to get
16:12
Effectively,
16:14
traditional PTs to go to those areas is
16:16
very, very difficult.
16:17
And so you have this recruitment problem
16:19
of people in,
16:20
but then you also have patients that don't
16:22
look like you either.
16:23
So it really does work both ways.
16:25
And it's getting a little better,
16:28
but it's got a long way to go,
16:29
especially when you think of the access
16:31
point of those who aren't really able to
16:34
access PT are in part because of the
16:36
type of caregivers that are out there.
16:39
Let's switch a bit and talk about some
16:40
of the other barriers.
16:41
Debt, you mentioned earlier,
16:43
is a barrier that everybody points to
16:46
student debt.
16:47
Is it the biggest one you think,
16:49
or is it just the most measurable one?
16:52
Particularly when you think of the student
16:54
population, like there's those,
16:56
like you said, you had so many apply,
16:57
many of them didn't get in.
16:59
What are some of the other,
17:02
are they able to overcome the finance,
17:04
or is the debt the automatic one that
17:06
disqualifies them?
17:09
um i think the debt is the a
17:14
hundred percent the the biggest one um and
17:17
i'll just say this year more than any
17:20
other year through the application cycle
17:22
especially during the interview process we
17:25
heard over and over again that they were
17:29
even second guessing um if they didn't get
17:32
this scholarship or they didn't get other
17:34
scholarships that they weren't sure how
17:37
financially they were going to make it
17:38
through
17:39
on top of the debt load they were
17:41
already carrying, right?
17:44
And so that really gave me pause because
17:48
it is a critical problem.
17:49
We've heard it time and time again,
17:51
but to hear it from these students who
17:54
are uniquely qualified and are probably
17:56
going to be fantastic PTs,
17:59
not only is it a problem upon entry,
18:01
but as you know,
18:03
it's a retention issue as well.
18:05
Because to the point we were making
18:08
earlier,
18:09
a lot of these students have aspirations
18:10
of wanting to go back to their own
18:13
communities and create community centers
18:15
or work in their community.
18:18
there's not already a pt practice there or
18:21
you know there may be not the opportunity
18:24
the insurance reimbursement um for you
18:28
know whatever insurances are more specific
18:30
to that location or they may just not
18:33
have funding in general right to be able
18:36
to come to pt to pay their co-pays
18:38
things like that so
18:41
there's a little naivete as as far as
18:43
you know their aspirations of what they
18:45
want to do but then how do you
18:47
actually create a business or uh with the
18:50
um you know the issues that are at
18:53
hand uh to make a be a you
18:55
know a successful business a profitable
18:57
business a way to make a living uh
18:59
wanting to do that so i think that
19:02
there's the debt is a huge problem
19:06
um i think secondarily uh just um and
19:11
why we're doing some of the educational
19:13
enrichment we're doing is how to navigate
19:16
salary negotiations how to find the right
19:19
job that's right for you not just the
19:21
highest paying job right and this is a
19:23
lot of times what they're doing now
19:25
because the debt load is so high they're
19:27
going to go to whatever job is willing
19:30
whether they are passionate about this
19:32
area or not like
19:34
this is going to get me through my
19:35
first two or three years and then I'll
19:37
have more choices.
19:39
I got to pay this debt down.
19:42
Then one other thing, Larry,
19:43
I'll just say uniquely to this group is
19:48
a lot of times they are now going
19:49
to be the breadwinner in their family.
19:51
They are not only supporting themselves,
19:54
that they are going to be relied upon
19:56
to support other family members that are
19:59
looking to them,
20:00
that have sacrificed for them to go
20:02
through their DPT program,
20:05
become a doctor,
20:06
be the highlight of the family,
20:08
and then be able to give back, right?
20:10
And whether that's through providing
20:13
housing or sending funds back to their
20:15
family, things like that,
20:17
it's really unique to this population.
20:21
to really have more mouths to feed,
20:27
more people to be responsible for than
20:29
just themselves.
20:31
Well, that's fascinating.
20:32
That's quite the dynamic.
20:35
When you have student debt,
20:36
you have all the psychosocial issues and
20:38
barriers surrounding entry to work.
20:41
And thankfully,
20:42
groups like yours are helping to solve and
20:44
enrich them with systems and resources.
20:49
But then on top of it,
20:50
they're supplying their whole family.
20:52
In some cases,
20:52
I would imagine their extended family.
20:54
Wow, what a challenge.
20:57
Yeah, it's a challenge.
20:59
But at the same time, gosh,
21:00
they are passionate.
21:02
They are so passionate about this
21:03
profession.
21:04
They are wanting to give back in so
21:07
many ways.
21:08
I know you've had the pleasure of meeting
21:10
some of our scholars and community members
21:14
in the past.
21:16
They are future leaders.
21:19
They are change makers.
21:20
They see the issues and they are coming
21:23
to the table with some solutions that they
21:26
think, you know, can make a difference.
21:28
And so that's the most I think a
21:31
lot of the inspiring part is like we're
21:34
giving them a platform to be able to
21:38
have the right connections earlier in
21:40
their careers to be able to affect change.
21:43
And so, you know,
21:44
I can't wait to just watch this trajectory
21:46
over the next ten years of trying to
21:49
collect all of the information of wow what
21:52
what has the impact really been it's more
21:54
than just you know funding scholarships
21:57
like it's it's bigger than that absolutely
21:59
and you're and you're doing it and when
22:01
you think about the best employers for a
22:04
rising tide scholar on um is there
22:09
anything unique that an employer needs to
22:12
offer or understand uh about managing you
22:16
know um
22:18
these types of scholars or as all
22:20
employers are equal,
22:21
let's find the one that's the best match
22:23
based on set of criteria that you think
22:26
about.
22:28
Yeah,
22:29
I'd love to say all employers are equal,
22:31
but, you know, that's not true.
22:36
For sure, you know,
22:38
the mentorship component is big for this
22:40
group because, again,
22:43
it's not just the PT clinical mentorship,
22:47
it's life mentorship, right?
22:49
It's navigating
22:52
How to, you know,
22:54
balance these family obligations as well
22:57
as, you know, the work.
22:59
I will just say the work ethic with
23:01
the majority of our students that I've
23:03
seen is just is high.
23:05
And so also managing burnout because they
23:09
are.
23:10
uh, wanting to be, uh, very, um,
23:15
financially efficient in,
23:17
in not only are they're working jobs on
23:18
the weekend and they're doing other things
23:20
because they understand that debt is not
23:23
something that they, they want or need.
23:25
Um,
23:26
and they want to get rid of it
23:27
as fast as they can.
23:28
And so they're doing a lot of things
23:31
to try to, you know,
23:32
additional work on top of what their one
23:34
nine to five might be.
23:36
Um, and so having that, um,
23:41
you know, just again,
23:43
the personal side of mentorship as well as
23:45
the education or the clinical side,
23:47
I think is really important.
23:48
But also I would say finding,
23:51
they love working.
23:52
So,
23:52
but also not putting them only in
23:55
positions where they are uniquely
23:57
qualified.
23:58
For example, you know,
24:00
a lot of our Hispanic students will say,
24:03
well, you know,
24:05
I got hired because they needed someone
24:06
who could speak Spanish.
24:09
And while that's a great legacy,
24:10
put in the door.
24:12
You know what I mean?
24:12
Like, they're more than that, right?
24:15
And so making sure that they are given
24:18
the opportunities to expand their great
24:22
clinicians and their, you know,
24:24
potential leaders,
24:25
not just only because they speak Spanish,
24:26
as an example.
24:28
Yeah, no, that's fascinating.
24:29
You know, if you look at
24:32
what I,
24:33
what I seeing in the workplace now,
24:34
and I've written about mentoring,
24:36
mentoring's a little bit of an irritant to
24:38
me right now,
24:39
because so many people say they have
24:40
mentoring,
24:41
but they don't because by design,
24:44
you have to have some structure to it
24:46
and most don't.
24:47
And then on top of that, you need,
24:49
just as you alluded to,
24:50
you need these informal social systems
24:54
from a mentoring standpoint outside of the
24:56
clinical realm, right?
24:57
How to navigate, you know,
24:59
how to navigate life, you know, um,
25:02
And good employers do both.
25:05
They have sort of a big sister,
25:07
big brother that helps you on the
25:08
non-clinical side,
25:09
and then they have a clinical mentor who's
25:12
tasked with helping you on the clinical
25:15
side.
25:16
I'm hoping that more employers understand
25:19
those,
25:19
they're fundamentally two different
25:20
things,
25:21
and they both have a major role in
25:22
what I would call burnout prevention.
25:26
I want to pivot a little bit to
25:29
all of your history in terms of web
25:31
PT and technology.
25:33
And now you have,
25:36
you have the benefit of time.
25:38
You've been in the career a long time
25:40
and your vantage point is much different
25:42
from the early days of developing,
25:45
you know, an EMR system,
25:48
a documentation system is where you
25:49
started out.
25:50
But now I want you to think about
25:52
today when you're scholars and,
25:54
and your residents from rising tide go
25:57
into a clinic,
25:59
where does a clinician's day actually go?
26:01
And if you were going to change one
26:03
thing anymore, what is it?
26:05
And is there a substantial difference
26:07
between today and when you started and
26:11
what is the role or what could be
26:12
the role of technology in all of that?
26:15
It's a lot of questions there,
26:16
so you can unpack it any way you
26:17
want.
26:19
Yeah, that's a loaded one.
26:21
And I'll just say, I can't believe it,
26:23
but this year marks twenty years since we
26:27
started building WebPT.
26:30
um, in,
26:32
in sort of the idea and building before
26:34
we launched, I'm sorry, in twenty,
26:36
two thousand six, um,
26:38
in building and before the launch in two
26:40
thousand eight.
26:41
And so a lot has changed in twenty
26:44
years, right?
26:44
We were the first web based application
26:46
and, and now, you know,
26:48
things are moving much more towards
26:50
automation and, um, you know, uh,
26:53
use of AI, uh,
26:55
as far as technology goes.
26:57
And, um,
27:01
And alongside of all of that,
27:03
because technology has infiltrated,
27:07
there's also now this administrative
27:11
burden that is weighing heavy because so
27:16
much regulation has piled up on top of
27:21
what we're required to do,
27:24
on top of just seeing the patient.
27:25
And I know you've written tons about this.
27:29
And so,
27:31
Today,
27:34
the evolution of technology is much more
27:38
in, hopefully,
27:40
less hands-on to a computer,
27:45
more automation for AI and machine
27:49
learning to be able to assist with some
27:54
of that administrative burden.
27:56
And so I'm...
28:01
optimistic about you know what the
28:03
potential is um as long as we continue
28:06
to have human in the loop right to
28:09
to have our
28:12
differentiator as a clinician,
28:14
as a provider of putting hands on patients
28:18
and having that patient relationship,
28:20
that human connection that we are,
28:24
you know,
28:25
still uniquely positioned to have in the
28:28
multiple sessions that we are able to have
28:31
with a patient,
28:32
that that still continues to be the most
28:36
important thing.
28:38
But, you know,
28:40
it's not just about documentation.
28:42
You've got authorization,
28:43
you've got eligibility,
28:44
you've got denials to rework,
28:46
you've got revenue cycle,
28:47
the whole component of revenue cycle
28:49
management.
28:50
Like, how do we get paid?
28:51
Like,
28:51
it seems to get harder and harder and
28:52
harder.
28:53
And now, you know,
28:55
you know, with a lot of what,
28:57
what PT is doing now and in the
28:59
relaunch of our, our platform, um, with,
29:02
uh, being AI native, like it's,
29:04
it's going to be a game changer.
29:06
Um, but it's honestly, Larry,
29:08
it's the evolution.
29:09
Like it's happening in a lot of different
29:10
industries.
29:11
It's just, obviously for us,
29:13
it's front and center,
29:14
especially when you think about, uh,
29:17
you know, the, the computer having,
29:20
you just don't want that, um,
29:22
computer components to take over what we,
29:26
in essence,
29:28
are trying to do with patients every day.
29:30
Yeah, no, it's fascinating.
29:32
I mean,
29:32
when I think back on my career and
29:34
when I started,
29:36
even as a military therapist,
29:38
where you basically hand wrote your notes
29:41
on cards and, you know,
29:42
then things progressed obviously towards,
29:45
towards, towards an EMR.
29:47
But I would say the biggest difference and
29:49
my biggest hope is that what automation
29:52
can do is eliminate the noise that goes
29:54
through your head constantly.
29:56
Back then,
29:57
Never thought about an insurance
29:58
verification.
29:59
Never thought about is what I'm going to
30:00
do paid or not paid.
30:02
Never thought about, well,
30:04
do I have to do this many units
30:05
or not do this many units?
30:06
Oh,
30:06
never thought about how many patients per
30:08
day am I averaging,
30:09
how many units and all the other kind
30:10
of things there.
30:12
That noise constantly is in your head when
30:16
you're a clinician right now.
30:18
Now, we can eliminate a lot of it,
30:19
maybe not all of it.
30:20
We also have to teach the clinicians how
30:22
to, you know,
30:23
get rid of that noise too.
30:25
But that's where I'm real hope is that
30:28
a clinician,
30:29
it gives them back the time to spend
30:31
with their patient.
30:32
For years, all I ever heard of, oh,
30:34
we don't get to spend enough time with
30:35
patients.
30:36
Documentation in our studies,
30:37
at some points,
30:38
we're taking up to thirty percent on a
30:39
Medicare patient of a patient encounter.
30:42
What I'm seeing in the marketplace,
30:44
though, isn't that a little bit of, oh,
30:47
I'm giving them their time back.
30:48
Now they can spend it with their families.
30:49
And I do get that, by the way.
30:50
Like if you're doing documentation at
30:52
night and you're able to get back your
30:53
families, I'm all in on that.
30:55
OK, I get it.
30:56
But what it really should be aspirational
30:58
around is in the clinic giving you time
31:00
back with the patient.
31:02
That's what my hope is.
31:04
Eliminate the noise,
31:06
give you time back for the human
31:07
connection.
31:08
Because if you get the connection,
31:09
which I call the fuel in the loop,
31:12
the human loop, you alluded to it,
31:15
when you lose that,
31:16
that's the main driver of burnout.
31:18
Burnout's multidimensional.
31:20
It's got a number of drivers of it.
31:21
But the main driver of it is when
31:23
you lose that immediate loop connection
31:27
fuel between you and a patient.
31:29
And you go into surface acting rather than
31:30
deep acting.
31:32
And you do all kinds of things that
31:34
then you get cynical and you get,
31:35
you know, oh,
31:36
now I am listening to pre authorization.
31:38
And it just it starts to compound and
31:42
escalate a little bit.
31:43
But anyhow, sorry.
31:46
No, not at all.
31:47
I think it's really important because I
31:49
think, you know,
31:51
when
31:53
companies start thinking about retention,
31:55
they start throwing money at a lot of
31:57
different things.
31:58
But to your point, like,
31:59
why did we get into this profession?
32:02
A lot of it has to do with
32:03
that human interaction, right?
32:06
It's that patient relationship building,
32:08
that progress that you see by what you
32:10
did, putting your hands on or, you know,
32:14
exercise, prescription,
32:15
whatever it is to make that to help
32:18
that patient improve.
32:19
And so,
32:22
Being able to find more time with your
32:24
patients,
32:24
I think is a fantastic way to think
32:26
about it.
32:27
Like if we might even steal that from
32:29
you.
32:29
Yeah.
32:31
And it's what I call allow you to
32:32
be more human.
32:34
I've really been promoting humanness as
32:37
the differentiator in healthcare and what
32:38
we do as hands-on caregivers because
32:41
there's not a tremendous number of
32:42
hands-on caregivers left.
32:44
It leads me to the last question I'll
32:45
ask you.
32:45
I know we're going to go back and
32:46
forth on some questions,
32:47
but you alluded to it earlier about the
32:49
whole idea on the importance of retention,
32:52
which is the cheapest form of recruitment
32:55
that exists, right?
32:57
Every clinician who lives sort of,
32:59
you know, mid-career, you know,
33:01
costs more pipeline than a scholarship
33:03
replaces,
33:04
and that's a whole different podcast for
33:06
another time.
33:08
But they're not the same, right?
33:10
And so do we have a recruitment problem?
33:13
Do we have a retention problem?
33:14
Can two things coexist?
33:17
When you look at the number of clinicians
33:18
we have in the PT world,
33:20
it's far less than the number of PTs
33:22
that we have.
33:22
How do you think about these kind of
33:23
things?
33:26
Well, I think it goes both ways.
33:28
I think that we also had a disconnect
33:35
educationally to reality of the PT world.
33:39
I think that the lag of academics to
33:43
what the real world of PT and what
33:45
happens in a PT practice I think is
33:48
also an issue, right?
33:50
in the recruiting cycle, you have,
33:53
you know,
33:53
just like recruiting to any company,
33:55
you get the shiny version of what you're
33:59
aspiring to do and to be but you
34:01
don't really know the inner workings of
34:03
the business side and all the things that
34:05
kind of come with, you know,
34:09
what it means to be a physical therapist.
34:10
And so
34:12
You know,
34:12
I think that we've gotten better.
34:14
I would,
34:15
I hope we've gotten better on the
34:17
recruitment side in terms of not just
34:19
focusing on, because it was so,
34:20
even when I went to, got into PT,
34:22
it was so competitive.
34:23
Like there are tons of applicants.
34:26
And so you had to have some sort
34:28
of way to limit your applications down.
34:33
So you looked at GPA and you looked
34:35
at SAT scores and, you know,
34:37
all those kinds of things.
34:38
But the soft skills, which we know is,
34:41
probably the most important thing as a
34:43
physical therapist outside of your
34:45
academic prowess is is the patient
34:49
building that patient rapport building
34:50
that patient um relationship is and you've
34:54
written about this right of how the
34:56
outcomes are based more on that than they
34:58
actually are the the actual uh things that
35:01
you're you're doing with the patient and
35:04
so
35:06
I think that we have done better in
35:08
terms of the interview,
35:09
at least some schools,
35:11
the interview process and screening for
35:14
those soft skills to put some more
35:17
prioritization on that in the recruiting
35:20
process for the students that they are
35:24
letting into PTE programs.
35:28
So I think we're doing better in that
35:30
regard.
35:31
I mean, I know right now it's difficult.
35:33
Applications are down for most programs.
35:37
You know,
35:38
you look at Reddit and you search physical
35:40
therapy,
35:40
you're not going to see a whole lot
35:41
of positive things.
35:44
So we're getting scarred a little bit
35:46
right now on the branding of PT.
35:49
And then on the
35:53
know retention side you know i it's just
35:57
tough right now it's it's tough when the
36:00
student that issue um is is real um
36:04
cost of education is not commensurate with
36:07
what the potential for what you can make
36:09
from a salary range is at the moment
36:12
um and so i do think that there's
36:14
we're at a critical juncture in the
36:15
profession that we have to make some tough
36:17
decisions um you know i
36:22
I'm an advocate that we became doctors,
36:24
but at the same time,
36:27
all of the additional cost and things that
36:32
have added on to that since that decision
36:34
was made and the cost of education has
36:37
been really a detriment, I think,
36:38
to the potential for becoming a PT.
36:43
And of course,
36:44
that leads to the retention because they
36:47
come out and they see that they can't
36:49
pay their debts off.
36:51
either go into a non-clinical work or jump
36:56
out into a different profession.
36:58
This year was the first time in our
37:01
six years of awarding scholarships that
37:04
we've had somebody drop out of PT school
37:10
after receiving a scholarship and decided
37:13
to go on to PA school because
37:17
The research that they had done or talked
37:19
to people and they just,
37:20
after their first year, they said,
37:23
I'm going to go to PA school instead
37:25
and dropped out.
37:27
It's interesting because I'm from the era
37:29
where we had PAs and nurse practitioners
37:32
that went back to go to PT school.
37:36
It's an amazing flip-flop, but yes,
37:38
the cost of education is not kept up
37:40
lockstep with the salaries.
37:41
The salaries are not kept up lockstep,
37:43
and others would argue that they can't.
37:47
I remain less convinced.
37:48
I think they can.
37:49
I think the profession needs to
37:51
fundamentally shift to a more –
37:55
beneficial model for PTs.
37:56
I think PTs should be paid more.
37:57
I think we need less administrative costs,
37:59
less managers,
38:00
and more PTs making more money.
38:02
And I think that would be helpful.
38:04
But that's a different topic for a
38:05
different time.
38:06
So happy to answer any questions you have
38:08
around rising tide and how call to care
38:12
is going to do our best to help
38:15
them.
38:16
Yeah, well,
38:17
how did so so first of all,
38:19
congratulations on the revamp.
38:21
Obviously,
38:21
a lot of a lot has happened since
38:23
the original publication.
38:26
So I guess what sort of prompted you
38:28
to sort of do this reboot?
38:31
You know, it's interesting.
38:32
So the book came out at the beginning
38:34
of two thousand twenty right in the you
38:37
know, we're in the midst of covid early,
38:39
early days of covid.
38:41
And which was a tough period,
38:43
but it's a period that I remind,
38:45
I talked to the medical students yesterday
38:47
and I reminded them that PTs were heroes
38:49
during the early days of COVID.
38:51
Most people forget that.
38:53
People were standing outside and
38:55
applauding them and standing ovations and
38:58
healthcare workers were indeed heroes.
38:59
And they were, they absolutely were.
39:02
But what really changed between in and was
39:05
the research.
39:08
And so we didn't have virtual health was
39:10
just kind of evolving and got accelerated
39:14
during COVID.
39:15
Certainly didn't have AI.
39:17
We didn't have the epidemic of burnout.
39:20
So if we look at, historically,
39:24
the post-COVID period was the first time
39:26
that you had en masse exits from PT,
39:29
medicine in general, dental,
39:31
dental hygienists, mass exits,
39:34
creating what?
39:35
A shortage.
39:36
And even though we have more PTs
39:38
graduating than we've ever had,
39:40
there still exists a shortage.
39:42
So that was an impact.
39:43
And then on top of...
39:45
You know, the shortage,
39:45
you had the incredible rise in inflation
39:49
and all those things that after COVID made
39:51
running a business very, very difficult.
39:54
And so you add that and then you
39:56
have burnout.
39:57
And then you look at the statistics in
39:58
PT where it's about nineteen percent on an
40:01
FTE basis of all PTs that are licensed
40:05
are actually seeing patients day to day.
40:09
You then say, well,
40:09
what the heck's going on here?
40:11
And then you say, well, you know,
40:12
physicians,
40:13
seven in ten medical students report
40:15
burnout.
40:16
Now, when I say report burnout,
40:17
that's not a subjective thing.
40:20
They're taking the Maslow burnout
40:22
inventory thing,
40:23
the most validated instrument.
40:26
Six in ten acting physicians are burned
40:28
out.
40:28
Seven in ten students, six in ten.
40:30
It's worse in some of the other
40:31
professions.
40:32
You look at mental health workers who work
40:33
with traumatized patients,
40:35
it could be as high as eight out
40:37
of ten.
40:37
You look at dental hygienists, seven,
40:39
eight out of ten.
40:39
So burnout became this big deal.
40:42
so when i started then looking at the
40:43
research around burnout i started looking
40:46
at high quality connections empathy active
40:49
constructive responding all the things
40:51
that call to care was meant to do
40:53
which was to integrate positive psychology
40:55
and the social sciences the so-called soft
40:57
skills into the hard skills of medicine
41:00
realizing that the best outcomes you have
41:02
to have both and i thought the world
41:04
of positive psychology had so many
41:06
validated studies that just never made its
41:09
way into our curriculum
41:10
So you had all that kind of going
41:11
on in my mind.
41:12
And I said, wow,
41:13
we need to expand it.
41:14
And so I revised the research,
41:17
update the research.
41:18
And then on top of that,
41:19
you have these other topics.
41:21
So I had to redo a whole chapter
41:25
on burnout,
41:26
which is the most largest chapter in the
41:28
book now.
41:30
really revised everything around virtual
41:32
health,
41:32
around AI and what should AI be giving
41:34
back to the clinician.
41:36
And people say, well,
41:37
there's not much research on it.
41:38
You know,
41:38
actually there has been some decent
41:40
research on AI.
41:41
You know, for example,
41:43
they show that at AI Scribe, a six,
41:45
you know, hospital system,
41:47
and so you get a significant reduction in
41:49
burnout,
41:49
but what are you doing with that time
41:51
again?
41:51
Are you giving it back to the patient
41:53
or are employers using it to make you
41:56
more productive, right?
41:57
And so then on top of that,
41:58
there's this issue of,
42:00
I started thinking about it and surveying
42:01
the people that we had gone through call
42:03
to care and said,
42:04
what's holding you back from actually
42:05
implementing some of these interventions?
42:08
And learning about that,
42:09
what is the hesitation?
42:10
So we put a whole chapter in there
42:11
on a concept called implementation
42:13
intentions.
42:15
which is a pre-commitment ritual around if
42:17
this happens, then that happens.
42:19
And so, you know,
42:20
if I'm nervous and unwilling to have a
42:23
conversation with a patient,
42:24
I will do four breaths in,
42:26
hold for two, six breaths out, you know,
42:28
other techniques.
42:29
If this happens, if, you know,
42:31
patients that do shoulder, you know,
42:32
exercise, you know,
42:34
if I see my coffee maker in the
42:35
morning,
42:36
that's my trigger to do my shoulder
42:38
exercises and my reward will be the
42:39
coffee.
42:40
And so there's a whole science around
42:41
that.
42:42
Actually,
42:42
that had to expand everything around kind
42:44
of mindfulness.
42:45
Mindfulness has really evolved since two
42:47
thousand twenty.
42:48
Now,
42:48
when you take all that and you start
42:49
revising it and adding chapters,
42:51
you end up with a book that's twenty
42:52
five percent bigger.
42:54
You not only have the revisions,
42:56
then you have the twenty five percent
42:57
bigger.
42:57
And so I just started writing and writing
42:59
and researching and doing all this and
43:02
missed my deadlines with the publisher by
43:04
about a year.
43:05
So it just does all that.
43:06
And then all of a sudden I start
43:08
working in the dental profession.
43:10
I find, oh my gosh,
43:10
the dental profession is even worse than
43:12
the medical.
43:13
Seventy-five percent of patients that go
43:14
see a dentist don't want to be there.
43:16
And only forty percent of the population
43:18
don't even go to a dentist because they
43:19
don't want to be there.
43:20
Seventy-five percent who go don't want to
43:22
be there,
43:22
but that doesn't count for the forty
43:24
percent that don't.
43:25
Then all of a sudden the dentist is
43:26
in a mask and you're standing over you
43:28
while you're like this.
43:30
And, you know,
43:30
what kind of communication is going on
43:32
there?
43:32
And so then, oh,
43:34
but then you have a dental hygienist who
43:35
spends about forty five minutes with the
43:37
patient.
43:37
The dentist spends about three minutes.
43:39
What's that dynamic and that relationship
43:41
all about?
43:41
So I said, well,
43:42
I can't put this in the call to
43:43
care.
43:43
I need to write a separate book about
43:45
that.
43:45
I'll just transfer the whole book,
43:46
write a few extra things.
43:47
And you realize you can't do that because
43:49
dental is so different.
43:50
And so while all this was happening,
43:53
I started writing on the dental call to
43:55
care, which will be out in October.
43:57
And I'm really,
43:58
really proud of it because I have not
43:59
seen anything in dental that really
44:01
accounts for non-clinical factors of
44:03
clinical success.
44:04
And so I'm really,
44:06
really excited about it.
44:07
It's a big industry.
44:07
It's a hundred and seventy to two hundred
44:09
billion dollar industry,
44:10
four times the size of PT.
44:12
So that was sort of the.
44:14
you know all the other underlying things
44:16
and um i still much i hate to
44:19
admit it you know the book didn't move
44:21
the needle i'm caring i think we care
44:22
less than we did then you know so
44:23
it's like can i move can i start
44:25
to move the needle a little bit better
44:27
yeah that's a good segue into the question
44:31
i've been wanting to ask you because
44:33
obviously the book has a lot to do
44:36
with empathy training and really trying to
44:39
get people to care more right yeah and
44:42
so the question is if if clinicians who
44:44
truly care the most are actually the ones
44:48
that are are least likely to burn out
44:51
why does everyone think it's actually the
44:53
opposite like that if i care so much
44:55
that and i can't do what i want
44:57
to do that that i'm going to be
44:59
the one that that first burns out
45:01
Yeah, it's a great question.
45:02
And I actually walked through three
45:05
hundred medical students yesterday on a
45:08
very similar question.
45:10
And what I explained to them,
45:12
which is a very similar, similar answer,
45:14
is there are actually two curriculums.
45:17
There's the curriculum you get in school
45:19
in buildings that are nice and people in
45:21
white coats and the academics and all the
45:24
pedagogy that goes with it.
45:25
And then there's the unwritten curriculum
45:27
when you go out and you start doing
45:29
clinicals and start doing observations.
45:32
And the unwritten clinical says you need
45:34
to be detached from your patients,
45:36
that if you get too connected to them,
45:39
you will get burned out and you will
45:41
be affected and you will have a bad
45:43
day at the end of the day.
45:44
Now,
45:44
I'm oversimplifying a bit because it's a
45:46
psychosocial process,
45:49
but that's exactly what happens.
45:50
And so we learn through the unwritten
45:52
curriculum this idea of detachment.
45:56
And when that happens,
45:57
you eliminate that loop human connection
46:00
fuel that I talk about,
46:01
that immediate outcome.
46:03
I use two examples from my career.
46:05
I was a military therapist,
46:07
and I was barely older than the soldiers
46:09
I was treating.
46:10
None of the soldiers I was treating...
46:12
female and male they didn't care less
46:14
about activities a daily and care less
46:15
about getting back to a sport they want
46:17
to get back to their unit they want
46:18
to get back to their spirit decor they
46:21
want to get back to being part of
46:22
their community and so the feedback was
46:24
immediate the connection was great because
46:26
man they were going right back to it
46:28
and so i had that human connection fuel
46:31
I didn't get it again until two thousand
46:33
ten.
46:33
You know,
46:33
I've had periods of my clinical career and
46:36
I still consider myself a clinician.
46:38
So we'll put my hands on patients.
46:40
But many years later, in two thousand ten,
46:42
when I went to Haiti under the worst
46:44
of the circumstances where you had nothing
46:46
of technology, you had no EMR,
46:47
you had
46:48
and you had buildings done and we had
46:50
patients without legs and you had,
46:52
you know, all this things going,
46:53
but the patients were the most incredibly
46:55
appreciative and they would look at you
46:57
with that Dushane smile,
46:58
which if you remember is the smile with
47:00
the muscles in your eyes,
47:01
cause you can't fake it.
47:03
And that's the feedback human connection
47:04
fuel loop.
47:05
But what happens is socialization says,
47:08
see more patients, do more units,
47:10
all of these X noise in your head
47:12
that in aggregate can,
47:14
really force you to not be connected to
47:16
the patient.
47:17
You've got too many things to think about.
47:18
You're multitasking in ways with noise
47:20
that you cannot control.
47:22
And you need to regain that.
47:24
And what they found,
47:26
and this is the interesting studies,
47:27
what they really found was that,
47:29
by the way,
47:30
the highest burnout is mental health
47:31
workers working with traumatized patients.
47:33
Not hard to believe, right?
47:35
Well, those workers,
47:36
you find them that are working fifteen,
47:38
twenty, thirty, forty years.
47:39
And you study them.
47:40
It's called positive deviance.
47:42
How do you study the ones who are
47:43
really, really flourishing?
47:44
And what you find is those that care
47:46
the most have the longest career.
47:48
But they do it in a way where
47:49
they're highly present,
47:50
which is hard to do in today's
47:51
multitasking society when you get in texts
47:53
and likes on Twitter and all these other
47:55
kind of things.
47:56
So they're highly present,
47:57
sensitively attuned, and well-boundaried.
48:00
And well-boundaried means you have a real
48:03
boundary between you and a patient when
48:06
you leave, but not a wall.
48:08
A wall keeps you away,
48:09
but a boundary doesn't.
48:11
And you have to have that mentality and
48:12
then this idea of detachment.
48:15
Detachment doesn't work and it's one of
48:17
the factors.
48:19
Lots of great research since two thousand
48:21
twenty on burnout.
48:22
There are a multitude,
48:23
it's a multi-dimensional construct.
48:27
Interestingly enough,
48:28
that only one of the five factors towards
48:30
burnout relates to workload and
48:32
productivity.
48:33
The other four within your agency are
48:35
within some sense of control.
48:37
But you have to teach patients or you
48:38
have to teach clinicians all about this as
48:41
a primary source of prevention.
48:43
You have to teach them to ask for
48:44
help.
48:44
You have to keep them in community.
48:46
You have to keep them in a psychological,
48:48
you know, safe place.
48:49
And then the last thing I would say
48:50
about it is empathy and caring is like
48:53
a muscle.
48:54
If you don't emphasize it,
48:55
encourage it culturally,
48:57
it's going to waste away.
48:58
And so you have to replenish it
49:00
frequently.
49:00
You could take,
49:01
you go in maintenance mode for a while.
49:03
Right.
49:03
You go in that mode.
49:04
But ultimately,
49:05
you have to keep facilitating,
49:07
encouraging.
49:07
So I think it's cultural, too.
49:09
I think organizations that emphasize care
49:11
and culture and do all those kind of
49:13
things around it have less burnout.
49:16
The standard right now in the industry is
49:17
what, twenty percent.
49:18
If you're doing twenty percent,
49:19
if you're if you only have one in
49:20
five leaving, you're doing great.
49:22
Well, that's you know,
49:23
I always I still remember the small
49:25
business industry.
49:26
and growing up in the first business i
49:29
ever started i just the thought of any
49:31
employee ever leaving my employee was like
49:33
i wouldn't sleep that night we need to
49:36
go back to that a little bit wow
49:39
i love i love that you i think
49:42
you refer to it as um is it
49:46
the human connection is the dosage
49:49
Something like that.
49:51
Yeah.
49:51
Words are dosage.
49:52
Human connection is the connection fuel.
49:55
It's a fuel.
49:55
Got it.
49:57
Yeah.
49:57
It's the fuel that allows you to keep
49:59
connecting.
49:59
Right.
50:00
So it's, it, it, it, it, it accretes.
50:03
And, um,
50:04
You can develop good habits around it.
50:06
I just love certain clinicians when you go
50:08
to see them.
50:08
They're so engaged with you.
50:10
Like you're the only thing that's on their
50:12
mind.
50:12
You know, when you ask,
50:13
forget about the clinical realm,
50:14
forget about health care for a minute.
50:16
And you think of the most impressive
50:17
people you've ever met in your life.
50:19
It was because when you were talking to
50:21
them,
50:21
the only thing that was on their mind
50:23
was you.
50:25
And that's what I want our patients to
50:27
feel like.
50:28
And there's a great instrument for it
50:29
called the Compassion Relational Empathy
50:31
Care Measure.
50:32
And it's a measure of how much your
50:35
patient cares about you,
50:36
how much the patient thinks you care about
50:38
them, I should say,
50:39
how much your patient cares about you.
50:41
There's a great concept, by the way,
50:42
I love teaching this one.
50:44
I know we're going long,
50:45
but I cannot leave this one out.
50:46
It's this idea of proxy efficacy.
50:48
So proxy efficacy, your self-efficacy,
50:51
which is incredible.
50:52
I've got a whole chapter on it in
50:53
the book.
50:54
And it's really how you should get
50:55
patients the belief because, you know,
50:57
just like the good wizard of Oz,
50:59
he didn't give them anything they didn't
51:00
already have, right?
51:01
But he gave them belief in what they
51:02
had to be used.
51:04
Well,
51:06
proxy efficacy is when you go to see
51:08
a doctor,
51:09
it's your belief that that's the best
51:11
doctor for you.
51:12
They're the best, right?
51:14
And so there's validated instruments that
51:16
measure proxy efficacy.
51:19
And why is that so important?
51:20
As it turns out, proxy efficacy is
51:26
is a good proxy for self-efficacy.
51:28
So that the more you believe that your
51:31
provider's the best for you,
51:32
the more you believe you're going to get
51:34
a better outcome.
51:35
You know, they work hand in hand together.
51:38
And it makes sense, right?
51:39
Because you have more confidence in your
51:41
doctor to diagnose and treat you than you
51:43
do in yourself.
51:44
If you didn't,
51:45
you would just go to chat GPT,
51:46
find your diagnosis and live for yourself,
51:48
right?
51:50
But you go there with confidence in them.
51:52
And so I think, you know,
51:53
these are concepts that I think are just
51:55
really, really important.
51:56
Some of them weren't around in two
51:57
thousand twenty.
51:58
And I felt I felt the need to
52:01
write about it.
52:02
Now, whether anybody reads it or not,
52:03
I don't know, but I love them.
52:06
Well, I love it.
52:09
actually think that what we're doing with
52:12
our,
52:12
with rising tide is somewhat similar to
52:15
what you're doing,
52:15
what you just talked about,
52:17
like this proxy of,
52:19
of surrounding them with people that
52:21
really believe that they can do it.
52:24
When again, like kind of,
52:25
kind of like we started this conversation,
52:27
right?
52:27
It's, it's,
52:28
it's why mentorship is so important.
52:29
It's why seeing people who have made it,
52:32
who've run the gauntlet and made it to
52:34
the other side,
52:36
that they're there to support you.
52:39
um in the time when maybe you don't
52:41
believe that you could even do it yourself
52:43
and so um it's exactly it's a good
52:46
segue because that's exactly what i think
52:47
we're doing with rising tide too
52:49
absolutely and that's part of my part of
52:52
my talk in a few weeks you'll get
52:53
a kick out of that perfect well yeah
52:57
thanks larry i really appreciate and gosh
53:00
on behalf of everyone at rising tide and
53:01
our scholars we are just so grateful for
53:04
your generosity and
53:07
You know,
53:07
giving your proceeds from the book to our
53:10
scholars in our program, you know,
53:14
obviously dollars won't be squandered.
53:16
They're going to a great cause.
53:18
And we're so excited to have you as
53:19
our keynote speaker at our next Northwest
53:21
Summit as well.
53:22
Well, you're welcome.
53:23
I'm so looking forward to it.
53:25
Looking forward to being in Arizona and
53:26
being amongst your folks.
53:27
I've had a chance to meet many of
53:28
them.
53:28
They're just incredible.
53:30
And the organization,
53:31
the people that you have around there,
53:32
the volunteers that are just passionate
53:34
and the folks that work for you.
53:36
So congratulations.
53:37
We'll try to turn down the temperature a
53:38
little bit before.
53:39
We'll try to turn down the temp before
53:40
you get here.
53:41
It's been cold all over the country.
53:43
So, well, great.
53:46
Awesome.
53:46
All right.