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Episode 95: The Good, The Bad, and The Ugly: Navigating Physical Therapy with Dr. Caitlin Casella
782 Plays8 days ago
In this insightful episode, Dr. Sarah Court sits down with Dr. Caitlin Casella, PT, DPT, to discuss the evolution and current state of physical therapy. Dr. Casella shares her journey from being a full-time yoga instructor to becoming a PT, the transition from yoga to developing her own physical therapy practice, and her thoughts on the business models in PT clinics today. They delve into the challenges of the current healthcare system, share personal experiences and lessons learned from clinical rotations, and discuss the importance of sustainable career practices to avoid burnout in the industry. This conversation is an invaluable resource for current and prospective PTs, and movement professionals considering a transition into physical therapy.
00:41 Journey to Becoming a Physical Therapist
00:56 Transition from Yoga to Physical Therapy
02:59 Starting a PT Clinic
04:15 Clinic Operations and Burnout
05:55 Specialized Services and Classes
07:16 Menopause and Women's Health
09:47 First Experiences with Physical Therapy
13:29 Clinical Rotations and Pandemic Challenges
19:07 Inpatient vs. Outpatient PT
22:43 Cash-Based vs. Insurance-Based Clinics
30:04 Balancing Medicare and Cash Patients
34:21 Private Practice Setup
34:41 Balancing Rates and Burnout
35:09 Recognizing Burnout Signs
38:25 Transitioning to Private Practice
39:51 Challenges in PT Profession
43:47 Advice for Aspiring PTs
48:54 PT School Experience
57:52 Practical Application of PT Education
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Resources:
Practice Human website
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Transcript
Introductions and Podcast Overview
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices.
Guest Introduction: Dr. Caitlin Casella
00:00:32
Speaker
Let's dive in.
00:00:45
Speaker
Welcome to the Movement Logic Podcast. My name is Dr. Sarah Court. I am a physical therapist. And today's episode, I get to talk with Dr. Caitlin Casella.
00:00:56
Speaker
Dr. Casella is a doctor of physical therapy. She spent 14 years teaching yoga and mentoring yoga teachers before transitioning into other systems of holistic movement, somatics, strength, and conditioning.
From Yoga to Physical Therapy
00:01:10
Speaker
She received her doctorate from Hunter University, and she recently opened her own practice called Practice Human in New York City. At Practice Human, she sees patients for rehab as well as teaching group classes and small group training sessions that bridge the gap between PT rehab and returning to robust physical activity.
00:01:32
Speaker
I've known Caitlin for several years and i was delighted to get to sit down and have what I thought of as like a state of the union conversation around the world of PT warts and all.
00:01:45
Speaker
And I thought it was a really great talk. So I hope you enjoy our conversation. are
00:01:55
Speaker
Thank you so much, Dr. Caitlin Casella, PTDPT, for joining us on the podcast today. I'm thrilled to have you and I know you're busy. So thank you for taking the time to come on the show with us.
00:02:08
Speaker
Thank you. oh Thank you, Dr. Sarah Court. I know. Sometimes I just scribble down notes for ideas for podcasts. And I had one and it said, I want to talk to Caitlin about the state of physical therapy because I think we both have a lot of opinions based on our experiences.
00:02:27
Speaker
both as patients and then as PTs and working in different kinds of clinics. So I wanted to get a chance to talk to you about that. So thank you so much for coming on the show. And the first thing I want to ask you, you know, I could tell probably an hour long version of how I came to become a PT, but that's pretty dull but for most people. I think if you had to briefly describe your journey to becoming a physical therapist, what does that look like?
00:02:52
Speaker
Yeah, I would say the main thrust of it was that I was a yoga teacher for about, don't know, there's been a 10 to 15 year period of having taught yoga full time that I was hitting a ceiling in what I was qualified to do That was the main thing, right? I was working with a number of yoga students one-on-one who had pain and injuries, chronic kind of persistent conditions.
Establishing a Private Practice: Practice Human
00:03:17
Speaker
And I felt like it was time to take the next step to be able to formally evaluate, diagnose, and offer therapeutic treatment.
00:03:26
Speaker
I was ready to do that. So part of it was like hitting a ceiling in terms of what I was qualified to offer. The other part of it is i love being a student. And I was ready to just dive fully into something as a next step. It was also like I was going through a reckoning period with yoga and whether I should be calling myself a yoga teacher anymore. And I decided not to be calling myself a yoga teacher anymore.
00:03:51
Speaker
So then PT school gave me this container of when I was going through an identity crisis, something to attach myself to that was like, okay, the next thing is I will be ah physical therapist. So I needed that for like direction at that point in my life. I also felt like I needed the educational component to fully immerse myself in something new and just put both feet in and and go for it.
00:04:14
Speaker
Nice. Yeah. I had a very similar experience where I also hit a ceiling on what I knew when I was within the yoga community the people that I knew in New York. Other yoga teachers would send me people with various pain issues or frankly, situations where now I might be like, you know what, I'm not totally qualified to do this, but it was just offering yoga. Like i was working with someone with Parkinson's and things like that.
00:04:42
Speaker
And i also had the same thing where I hit the ceiling and I was like, I know that I have the capacity to do more than this, but I don't have the education. And so, yeah, I had a similar experience. And so now you were a PT and then now you own a PT clinic.
Clinic Model and Community Focus
00:05:00
Speaker
Was that always a goal to to be a clinic owner? Yes. It was always a goal to work for myself. It wasn't something that I thought I would do as soon as I did. so there's a Kind of a long story that I can make short.
00:05:18
Speaker
but but The short version is i was working for someone at my former boss at his clinic. I could have happily worked for him for another five years. He decided to close his practice.
00:05:31
Speaker
It was a great opportunity for me to take over his lease, stay in the same place and retain all of my patients. I wouldn't have had an opportunity like that at another time or to be able to keep all of my patients coming to me without feeling like I was stealing patients away from someone else's business when I left.
00:05:48
Speaker
All of that just fell into my lap at a time that was like, I wasn't really intending to own my own practice this early. Yeah. But I did because that opportunity arose and and I made the right decision. It's great. It's great. I love having my practice, um but it happens more than I thought it would.
00:06:07
Speaker
But I knew i knew i would go that at some point. Yeah. Your clinic, Practice Human, it's not just PT, right? You do all kinds of classes and group sessions. And can you tell us a little bit more about that?
00:06:17
Speaker
Sure. Yeah. So that's what I really love about it. And that's why i have built my business model the way I have so that it is sustainable for me. And I know we're going to get into some of the nuts and bolts of the burnout that goes on in PT outpatient settings for physical therapists, like how that business model is not so great for workers in the industry.
00:06:37
Speaker
And we'll get to that. But I also knew partly from my background hustling as a yoga teacher, teaching privates. And I learned early on how exhausting it is to teach a number of classes in privates back to back all day, working with different people and different energies.
00:06:54
Speaker
And so I knew that for this to be sustainable for myself, I couldn't do just back-to-back patient care all day, five days a week. yeah And I think a lot of PTs cannot do that. And we can get to that. but I can't.
00:07:07
Speaker
And if anything, as I get older, it gets worse. I'm like, that's for a 20-year-old. That's for someone who went to PT school right out of college and has like that 20-year-old energy where they can work 40 hours a week, 30 hours a week and be like, that's fine. But that's, i don't think that really ever was me.
00:07:24
Speaker
And it's certainly not me now. And I think as well, similarly, it's that feeling like yoga teachers have where it's, I am hustling. I'm teaching so many classes because I need to pay my rent. I've got bills, right? So yeah you start to reach that burnout that ends up being pretty easy to reach. So you've set up your clinic so that you don't have to do that.
Women's Health and Strength Training
00:07:45
Speaker
Correct. I have a combination. um I do a combination of things throughout the week that include one-on-one patient care with PT. I also do one-on-one sessions that I call it movement coaching for sake of a better term for that service, but it's not working with any PT diagnosis or pathology. It's just working with people who want to achieve certain goals with their Movement, much of it is strength training and some coaching on conditioning outside of the work that we do together in our sessions for strength.
00:08:22
Speaker
And then I have group classes in here that I teach that I collaborate with other teachers to co-teach small groups. we We teach groups of four to six people. Mm-hmm.
00:08:32
Speaker
for eight to 12 or 20 week series of classes. So it's progressive. We're definitely working with the same group week by week for progressive overload in our strength work and in a small group setting where they get a lot of feedback.
00:08:45
Speaker
And i am in the kind of online and online education educational space as well. So like you and Laurel are, i offer some things that are kind of niche-based yoga slash PT slash strength training, working with people with osteoporosis, working with people in perimenopause, very similar to you yeah know yeah wheelhouse here MovementLogic and what you and Laurel do, which is awesome. Yeah.
00:09:11
Speaker
Yeah, I think there's definitely been ah shift in, i don't think it's just because i am post-menopause and many of my friends and colleagues and people that laur let Laurel and I attract are of our general age.
00:09:28
Speaker
I don't think it's just that. I think that honestly, there's been this shift where talking about menopause, talking about perimen, talking about the things that could be issues for you coming up,
00:09:39
Speaker
discussing women's health issues past their reproductive health is becoming more common. We're seeing it more just in the zeitgeist. And I think that's also part of what's, I do feel with Laurel, like we hit our stride with this because we've landed right in the middle of something big that's happening.
00:09:58
Speaker
but This is becoming apparent to a lot of women. I get a lot of women coming into the clinic and saying, I need to work on my strength or i am post-menopausal and osteoporosis runs in my family.
00:10:09
Speaker
And I want to make sure that I don't get it. Things like that. i don't know if you're having that experience as well. Oh, for sure. And it's for sure part of like, if I was going to say, give a certain patient archetype that I see, it all relates back into our experience with yoga as well for me here in New York. So I'm seeing longtime yoga practitioners who are peri or postmenopausal, who've never lifted weights before formally, learned how to strength train before, who are hearing and like the whole world is telling them they need to strength train.
00:10:41
Speaker
On the PT side, this is a time that comes with a pretty common occurrences of joint pain, tendinitis, tendinosis type conditions, gluteal tendinosis, hip pain, rotator cuff related pain, frozen
Personal Experiences in Physical Therapy
00:10:59
Speaker
shoulder. this This is like this whole cluster of diagnoses too that we see a lot, particularly for women in this age group.
00:11:06
Speaker
And I think just in my clinical experience and my understanding of the research, also, this is probably correlating quite a bit with lack of loading, decreased loading on the body, these tendinosis and joint pain type conditions as well. It's just a tissue thickness decrease overall, to put it like very broadly, all tissues. Yeah. Becoming less thick, less robust, less dense. I think it all shows up together, like a constellation of all of these factors.
00:11:36
Speaker
And coming from the yoga world, I see that from people who are longtime yoga practitioners, especially. Totally. I want to shift directions a little bit. What was your first ever experience with physical therapy for yourself as a patient?
00:11:51
Speaker
This is an interesting question. I knew you were going to ask this question because you put it in the list, but I had never gone to physical therapy until I started PT school. No way. Yeah, yeah, for real. I'm not one of those people. I know it's so common. Like you meet ah your classmates in PT school and they're like, I sustained this major injury and I was drawn to the profession because of my experience with physical therapy, got me back on my feet. And I don't have a story like that.
00:12:18
Speaker
i I did start going to... very carefully chosen physical therapist through some of my time in PT school with things that I personally needed help with. But I didn't have any experience with physical therapy as a patient before PT school.
00:12:34
Speaker
Yeah. It's rare, I think. It is rare. i think it is rare. It's some people show up to a yoga teacher training having never taken a yoga class. I don't think it's quite as extreme as that because you were you've been in the movement world. You've been teaching movement. You were teaching...
00:12:48
Speaker
ways to help people get out of pain, you knew generally what it was going to be. It was just the encyclopedia of knowledge that you were going to get was not something that you yet had. My first PT experience was after my first hip surgery. I knew nothing about PT. I'd never been. The surgery that I had, I needed to do PT for like almost a year. It was a long time.
00:13:09
Speaker
And When I look back at it now, in terms of what kind of a clinic was it, I'm not sure at the time, because this would have been the early 2000s. I'm not sure at the time that the insurance issues had become quite so terrible as they are now.
00:13:25
Speaker
But my biggest memory is that my PT... It was mostly about her outfits. I didn't know enough to be like thinking about like now if I was going to go to PT, umd I'd be like in my brain going through what was happening.
00:13:36
Speaker
At the time, I didn't know anything. So mostly I was like, I wonder what she's going to wear today because she would wear these matching short sleeve button down shirts and shorts. that would be like a jungle pattern.
00:13:49
Speaker
Nice. More birds, but they would match always. Yeah. And then nude pantyhose and then white nurse sneakers. I love it. It was amazing. And she had this like yeah flock of seagulls hair.
00:14:04
Speaker
Like she was one of the PTs that became a PT in like 1980. And was like, just buy the book, all of that kind of stuff. I do remember she was not great in the sort of psychological, emotional support category because there was one day when I turned up and I was just so frustrated and tired and I started crying.
00:14:22
Speaker
And my recollection is that she barely looked up from her notes and she just picked up a box of tissues and handed it in my direction. I was like, okay. and She was like, I'll see you in the gym.
00:14:34
Speaker
So I was like, okay, I guess I'll pull myself together and go do my exercises. So I think one of the things for people who've had a PT experience and that's what made them go to physical therapy, I've since had phenomenal PT experiences before PT school, but It's as much, and I had this experience with yoga as well, where sometimes what you're learning from it is what you don't want to do or the kind of PT that you don't want to be. I never wanted to be the kind of PT where if someone was having ah visibly emotional, upset, frustrated, all of those things, which we see, it's frustrating to be injured or hurting.
00:15:10
Speaker
I never wanted to be the kind of PT that just handed someone a box of tissues. And was like, good luck with that. Right? Yeah. So you started having more experiences, not as a full-time PT, but when you had to do your clinical rotations, I would imagine that was suddenly much more exposure to clinics, right?
00:15:29
Speaker
In PT school, we do clinical rotations. Different schools do different time periods, but... between six to eight to 12 to 16 weeks, something like that, where you go into a clinic, you're still a student, but you get to practice under the supervision of the full-time PTs there.
00:15:46
Speaker
And it's really invaluable because the difference between what you're learning in school and what's going on in the clinic ah is very different a lot of the time. It's so different. Do you have any great stories or funny stories or horror stories? I have all of those categories from my rotations.
00:16:01
Speaker
Yeah, I think I have all of those as well. And the thing that is unique about my experience is when I went into my spring semester second year, that was spring of 2020.
00:16:15
Speaker
So I was right in the thick of like our most intense period of coursework when we went online for the pandemic. So the bulk of my didactic learning in the classroom was on Zoom.
00:16:29
Speaker
Almost all of it. It was brutal. It was horrible. but It was like, it was horrible before we went online and then it got worse when we went on Zoom. for me, when i finally was like, it was like I was set free into the world in so many ways when I went into the clinic for my clinical rotations and the way they had to reorganize our lives coursework, like our whole curriculum schedule was such that we finished all of our time in the classroom.
00:17:04
Speaker
And then we did three clinical rotations back to back once we were um completely done with our coursework, which is not typically how it went at my school. So that moment that I had completed all my coursework and went to clinic and that, and this was still, so this was November and December, 2020. And was in an and inpatient surgical step-down unit. So I was in a hospital.
Choosing Outpatient Orthopedic PT
00:17:29
Speaker
This before anyone was vaccinated. Many of my classmates were on cardiopulme units, proning COVID patients. Can you explain what a surgical step-down unit is? Yeah. Oh, so this was great.
00:17:41
Speaker
I loved being on a surgical step-down unit. And i it was also a relief because I wasn't on a COVID unit. The hospital I was placed didn't allow students on the COVID unit. I was in a unit that it was mainly elective surgeries, people who had come in to get a total hip replacement, total knee replacement, reverse shoulder replacement.
00:17:59
Speaker
That's most of what I saw. And this was when things had just a little bit opened up for these patients to have surgeries after the real crisis of the pandemic in early 2020 in New York City.
00:18:11
Speaker
And I think maybe the This sounds a little bit morbid, but one of the best things about that was we had some trauma cases.
00:18:24
Speaker
And every morning when I went in, I had no idea what was going to be on our floor. Who and what injuries were going to be on our floor. And so this is New York City and there were some wild trauma cases. And I can say this lightly and joke about this now because the patients that I encountered were okay. Like some of the wilder ones, they were fine.
00:18:48
Speaker
yeah They had surgery, they healed, they got better. but like very strange circumstances for some of these injuries in New York City.
00:18:59
Speaker
So like- I'm thinking about things like knife wounds and gunshot wounds, but you're saying- what There was some of that. amazing But okay, so I'll tell one story of one specific case, because this guy was fine. So I can tell this and laugh about it now, because he was laughing about it after. he had come in the night before, and all that we had was that it was a fall from a third floor window,
00:19:20
Speaker
and that he had, i think he had a fracture to his tibia and his radius.
Cash-Based vs. Insurance-Based Clinics
00:19:25
Speaker
I remember so there was some combination of he was lucky that he could weight bear on his upper extremities because he couldn't weight bear on one of his lower extremities so he could use crutches to get home and get out of there something.
00:19:36
Speaker
But he he had fractures. in a couple of places. And the story was that he, ah young guy with roommates, got locked somehow in his bedroom on the third floor.
00:19:50
Speaker
And the rest of their apartment where the living room was and where his roommates were, was on the second floor. So he decided it'd be a good idea to try to climb down the outside of the building from the third floor to the second floor to get in through the living room window. And he fell.
00:20:05
Speaker
Like a 21-year-old dude. And he was fine. And yeah we all laughed about it. And he got discharged the next day. And he left on crutches with his mom to go home with his mom to Westchester so be there where there weren't stairs while he healed.
00:20:19
Speaker
So he was okay. But like, we would see things like this. There was a guy doing tricks on a bicycle that like, i think it was also like a tibial plateau fracture something. All he wanted to know is how soon he could go skiing because he had a ski trip planned in two months.
00:20:33
Speaker
And we were like, like you know way just with like wild accidents that were like, when can I get out of here? How soon can I start doing tricks on my bike again? yeah So that was, it was fun to see who was going to come in the door. and It was totally unpredictable. Like I never knew what I was going to see that day when I walked in it was just fun.
00:20:50
Speaker
I did inpatient at the VA a hospital. so there was a lot of veterans. It was a lot of psychological stress. I knew for sure that I did not want to work inpatient or certainly not that kind of inpatient.
00:21:03
Speaker
At what point were you like, I want to do outpatient orthopedic, which is for listeners, let's say you sprained your wrist or it had a knee surgery and you don't have to stay in the hospital, but you need PT. So the kind of PT clinic you go to that's a separate clinic.
00:21:16
Speaker
place, that's called outpatient orthopedic because we're looking at musculoskeletal conditions that do not have a neurologic component. So for the most part, you're not seeing people who've had strokes or spinal cord injuries or things like that. They would go to a neurologic outpatient clinic. But so what made you want to go into outpatient ortho?
00:21:38
Speaker
When I decided to go to PT school, that was always what I had intended to do because it was the most closely related to the types of environments I'd worked in privately as yoga teacher or so so I thought. And that that seemed like a natural next step.
00:21:53
Speaker
I almost did get pulled into inpatient rehab because I loved working with patients recovering from stroke. i just couldn't I just couldn't do the poop. I love the stroke rehab. I couldn't do it. I couldn't too. Also just, it was like hospital bureaucracy and poop and- Which is like two sides of the same coin, basically. Yeah, all of that. Just the poop and hospital bureaucracy. And I was like, no, I don't think this is a place for me, but I love the work there. And I always figured I would go into outpatient setting, mostly because I also have always had a strong interest in strength and conditioning.
00:22:31
Speaker
and wanted to work with people of bridging the gap between PT rehab and moving toward more robust exercise. And maybe we'll get to this, but that's a really nice thing about a cash-based practice that it's not tied to insurance.
00:22:43
Speaker
We can really work with people for the long haul for a like longevity and sustainability of their activity yeah because insurance doesn't cover return to sport, which is the most ridiculous thing you ever heard of because no, we wouldn't want to keep people active and fit and healthy long-term. Then they won't buy the drugs that we can charge them for. Anyway, but yeah, i I always knew I would go in that direction. Yeah.
00:23:09
Speaker
just to i just want to go back and clarify, when you're talking about hospital administration and poop, but if you've ever done any work in a hospital, it's deeply frustrating because it's trying to get anything to happen. feels like you're trying to turn a cruise ship.
00:23:22
Speaker
And also depending on the hospital, like at the VA, I'd come in and they'd be like, we don't have any grippy socks today. I'm like, oh, okay. So how would you like my patient who had a hip replacement yesterday to walk safely? Stuff like that.
00:23:34
Speaker
But also could just be, there's so much paperwork. There's so much stuff in the way. There's a lot of inertia. There's not a lot of... desire to change anything. There's a lot of, this is working so far, so we're just going to keep going like this.
00:23:47
Speaker
And then the poop is just literally poop because what I found was that but you're going in, the PT is maybe the first person who has gotten the patient out of bed and moving, standing up and walking in in inpatient.
00:24:00
Speaker
And inevitably, that starts to get the peristalsis and the digestion and everything going again. And quite often, partway through your treatment, the patient is, I need to poop.
00:24:10
Speaker
And you're like, okay. And you might end up doing some cleanup that you were like, ah this is not my job.
Preventing Burnout in Physical Therapy
00:24:17
Speaker
And my experience was that anytime it happened, nurses were gone. They were all disappeared somehow. And I was in charge of the poop. So I had the same experience where i was like, this is not for me. I cannot be doing...
00:24:30
Speaker
I'm okay with some blood and a little phlegm, but somehow the poop just was like the line that I could not cross. Okay. So let's see, talked about it a little bit, but let's get into it. So my experience is that this is what I see in LA and I think it's probably the same all over the country, or at least in New York.
00:24:47
Speaker
There's basically, if you're going to run a brick and mortar PT clinic, there's basically two scenarios. You can do cash-based where in that situation, you're The clinic can determine how much time you get with a PT and they can be very generous. Like the clinic where I am, you could have an hour with me, right?
00:25:06
Speaker
But that's because we don't accept insurance. When it's a cash-based clinic, you can submit the visit to your insurance and they might reimburse you some amount.
00:25:17
Speaker
That's very dependent on your insurance and how good it is essentially. That's one option. The other option is that the clinic takes insurance, but you don't get good care because the payments that the insurance company pays out per patient is often really small. And so the model then needs to be cram as many patients into a day as possible, because it's just these iterations of $25 at a time. And that's not enough. We can't have you see a patient for an hour and only get $25 for it.
00:25:53
Speaker
So sometimes it's more, but it's not much. And so that's when you have an experience that I had in a clinical rotation, and know a lot of people have had as their PT experience where you go in, you have maybe 15, 20 minutes with a physical therapist, and then you're handed off to an aide who literally can be just like someone off the street. It can be anybody. They do not have to be trained in any way.
00:26:16
Speaker
They watch you do some exercises and then maybe someone does some manual therapy or you get put on the STEM or the ultrasound because they can charge for those things, not because you need those things.
00:26:28
Speaker
So this seems to be the basic situation for outpatient ortho PT at the moment. It's either cash-based or it's insurance-based and the insurance-based model, a lot of the time you're not getting great PT.
00:26:44
Speaker
So sometimes this is a very long question, but sometimes i come to the place of, because when we run a cash clinic, it's not cheap. really. And so sometimes I run up against the feeling of I'm only treating the people who can afford this or people who can afford to put this money out and get paid back afterwards.
00:27:04
Speaker
At the same time, for a lot of the people that I work with, I'm like, I need an hour. like This person needs an hour. What are your general thoughts around this situation as the owner of a cash-based clinic?
00:27:17
Speaker
Yeah. So I have a lot of thoughts on this. And probably that I know you do too. Yeah. And I'll just start to before I close out this like clinical rotation experience thing, I'll say that i also did have one rotation in a high volume clinic.
00:27:34
Speaker
where just to to give like listeners an example of like numbers of visits that I'm talking about, here at my practice, my enough is about 20 visits a week on my schedule.
00:27:46
Speaker
I'm usually somewhere between 18, which feels really nice. 25, which feels super intense for me, that's in a week, an absolute max 25 visits in a week.
00:27:57
Speaker
At the high volume clinic that I worked at in the pandemic, I was seeing 25 to 30 visits five days week. five days a week And I'm grateful for the skills that I have from waiting tables in New York City when i moved here originally because it felt like waiting tables. Like it was, I was like literally turning tables. Okay, get that, drop the check over here while I get the ice on that person, turn the tables over because there are people in the waiting room that need that table.
00:28:25
Speaker
So I'm like putting ice on here and taking ice off there, getting that person over to the aid to do their exercise and just like shuffling them through. So I did have that experience. I knew that I didn't want to work in that setting.
00:28:37
Speaker
Interestingly enough, during that time, I saw patients getting very good results from
Educational Gaps and Curriculum Needs
00:28:44
Speaker
their treatment. And I think much of that had to do with active Upper West Siders in New York City whose gyms were closed and it was the pandemic and they wanted to be social and they wanted to act. exercise. And this was a place where they're like, hey, I can get on the stationary bike and I can lift some weights and I can use the equipment and I can socialize with everybody here.
00:29:05
Speaker
So they had a great time. I actually had a great experience because of that and probably a little bit unique to the timing of it, the time and place. But there were lot of people who got some pretty good results from their time there.
00:29:17
Speaker
Yeah. Yeah. When I worked at the mill that I worked at, if you came in with something very straightforward, yeah not complicated, you didn't have a lot of comorbidities or a history of lots of things, you were probably going to be get better because you didn't need like that close attention that people need sometimes from their PT.
00:29:39
Speaker
But i what i was briefly a bartender and I was terrible at it, but i so I was never a waitress. But my experience in that rotation is when I learned how to be quicker. yeah Because school didn't teach me how to go through the kind of, okay, what are the things I need to do quickly? They taught me what to do, but that place taught me to get much faster.
00:29:58
Speaker
And I did, that was a valuable thing to learn for sure. Yeah. Yeah. And also like how to build a therapeutic alliance with someone over a very short period of time, one-on-one too, because I did see that happening in that clinical rotation. And yeah, and it's totally true that people with very straightforward conditions and also we forget about this. I think this will really speak to your listeners as well.
00:30:21
Speaker
In this bubble of people who love movement and love exercise are totally nerds about this stuff, we forget that there's a vast majority of the population that just doesn't give a shit about their bodies or exercise.
00:30:34
Speaker
They're like, I'll just do whatever the doctor told me. okay just tell me what to do and I'll do it. I want to get out of here as soon as possible because i really don't want to commit this time two days a week to come here and there's other things I'd rather be doing.
00:30:45
Speaker
So let's just get through it and get it done. And I'm out of here. Those are not the people who are going to pay $250 an hour for one-on-one PT, right? Like it's they just don't value it. And I'm not saying that they're like, and no comment on who these people are. They're not bad people. Just some people don't value mobility, movement, physical capacity, all of that, like so many of us do in our little bubble. So it's like, for them, they're like, it's good enough. It's fine. I had a good time. My PT was funny.
00:31:14
Speaker
I was social and I got better because probably like a lot of natural history too. And Like natural history is just like with intervention or not, regardless, you're going to get better and recover from the conditions. there's a lot of that as well. Yeah. I think it's maybe for, for a lot of people, it's maybe like a step above jury duty where it's like, all right, I have to do it.
00:31:35
Speaker
It's just that something has happened and I have to take care of this. Okay, fine. But they're not like, oh it's fascinating how they bend your elbow. This happened. They're not nerding out on all that kind of stuff.
00:31:46
Speaker
More cash clinic related thoughts. So cash clinic related thoughts are, I love working the way I work because I get to work with the people who are here. It's pretty niche, right? They're like here to see me for the things I do best.
00:32:00
Speaker
And so I love that when someone is prioritizing their therapy or their physical care, and willing to pay a premium for that.
00:32:13
Speaker
they're coming because they recognize that I have a skillset that matches what they're looking for. And so it's exciting for me because I get to work with the people that like I can serve the best actually and get the best results for because I have expertise in that area.
00:32:29
Speaker
But also here at my practice, when I started, I decided to do a hybrid where I accept Medicare. and So i am not in network with any commercial insurance company.
00:32:40
Speaker
I accept Medicare and that's been important to me because much of my client base is ages 65 and over. And a lot of the people I treat with osteoporosis are in that age group.
00:32:52
Speaker
And, and, It creates a really nice community here as a way in that's accessible for people to start seeing me. And then being a part of a bigger community where there are things like group classes available, which are more accessible financially as ongoing events.
00:33:12
Speaker
care after physical therapy. So that's where I'm like really working on bridging this gap between a PT plan of care, maybe billing claims through Medicare. And then once they get to a point where they're becoming more independent with the exercise they're doing on their own, if they want to keep coming in person,
00:33:29
Speaker
they could move over into something that's not physical therapy. It's more of a like a small group class setting. So that transition over from Medicare, Plan Care, other offerings here at my practice is really valuable yeah and really helps me out feel comfortable with this. I'm not only treating people who can afford yeah this high cash rates.
00:33:52
Speaker
And I do have a billing team that bills out of network for certain patients will bill on their behalf yeah out of network. Okay. And then this is just my own personal interest.
PT Licensing Exam Critique
00:34:03
Speaker
How do you figure out the percentage of patients that you're seeing in a week so that yes, you're seeing Medicare patients, but not to the point that you're not making enough money to keep the clinic open. Because I can't imagine Medicare reimburses a ton.
00:34:15
Speaker
Yeah, it reimburses like actually a lot better than in-network commercial insurance. Yes, that I believe. But not as high a rate as my cash rate. And my Medicare follow-up visits are 45 minutes, so I'm not doing a full hour with them. um I do an hour evaluation, 45-minute follow-up.
00:34:33
Speaker
And my non-Medicare is an hour evaluation, 50-minute follow-up. So... I usually am about 50-50. And that works for me to be about half and half between Medicare and non-Medicare.
00:34:46
Speaker
And I just lump everything else together non-Medicare because if we're billing on a patient's behalf and it's out of network, we're billing at a rate that I'm getting back. at a minimum, my cash price to cover my services and usually more actually when someone has a good out-of-network plan.
00:35:02
Speaker
It all evens out nicely for me if ah if i have about a 50-50 split. And then I'm also, this is also a piece of it and in a clinic, an outpatient clinic, I am bringing in a so student for the first time this spring. So nice not that I'm going to be like a high volume mill all of a sudden, but we can double up. I can see more than a max of 25 visits in a week when I have a student here.
00:35:27
Speaker
And so those periods where I start having students in the clinic will also help to actually make my services more accessible yeah two more people to get really high quality one-on-one care. there There's a lot of ways that I'm like dovetailing in other things to make it all work. And a lot of that does have to do with the other services and other offerings here outside of physical therapy.
00:35:49
Speaker
I am have total admiration for you and other people who run brick and mortar clinics because it's not easy. And especially in a big city where the rent is too damn high and all of that kind of stuff. There are a lot of moving parts that can make it very challenging to do.
00:36:09
Speaker
I benefit from my private patients that I see. the This house that I live in has an office for me where they can enter separately so they don't go through my house. And then there's also a bathroom attached to it. So they really don't have to go through my house.
00:36:24
Speaker
And i don't know that is free for me because it's just part of, it's not totally free. I pay rent to live here, but I don't pay additional rent for a studio. yeah So and not having to worry about things like that means that privately when I see people, my rate is a lot lower than it is at the clinic because I want to be able to serve people who maybe couldn't afford the clinic kind of thing.
00:36:46
Speaker
Yeah. So yeah, I think we're always in this position of trying to figure out how do I keep the lights on? How do I pay all the things that I need to pay? How do I not overwork to make that happen and burn out?
00:36:57
Speaker
And then also, how do I have a mix so that I'm getting to serve them the most number of people from different financial statuses? let's Let's talk about the burnout thing, because I think it happens for everybody who teaches movement, not just PTs.
Reflecting on PT Education and Future Goals
00:37:13
Speaker
I have had a few burnout moments. You'd think you'd only need one, but I've had a few. but for I didn't learn from it, apparently. like I've had a few burnout moments, and the thing about having it more than once is now I know i can identify it much more quickly when it's beginning, as opposed to being suddenly in the middle of it and being like, is this what burnout feels like?
00:37:34
Speaker
What's happening? Right. And I have a I'm curious if you have this. I have a ah very clear indicator for what it's happening, which is i don't care about anything.
00:37:47
Speaker
So somebody's sitting there explaining like what did this and then I tweaked my knee. And then when I walked, it felt worse. But then I sat down and it felt better. And in my mind, I'm going, I don't care. I don't care. don't care.
00:37:58
Speaker
And that sort of lack, like total sympathy is out the window. Like I'm literally like, so just put some ice on it. What? So that's my indication. When I start to think that way, I'm like, okay, I am massively overbooked, overworked. Something's got to give basically.
00:38:16
Speaker
Do you have like a tell like that for yourself? Or you're like, oh, hang on. Yeah, I do. And I had never realized that I do until you started describing yours. And I was like, oh, I know what mine is.
00:38:28
Speaker
So I'm just realizing this now in the moment. But mine is, so in my, and I've experienced here, experienced it too when I worked for my former boss. And that was like a little bit more,
00:38:41
Speaker
ah It was a high volume. We did one-on-one, but I saw 35 to 40 visits a week when I worked for my former boss. We have a little intercom buzzer system in this building where somebody buzzes in just, don't know, five, six minutes before their appointment. It'll like, boom. And I'll be like, okay, that's my next patient.
00:38:56
Speaker
I have this with the buzzer when I'm too booked. Yeah. I have this feeling when they arrive of, damn it, why is this person coming right on time for their appointment? Like this, like I want deep down, I want them to cancel or show up late.
00:39:17
Speaker
and So I have 10 minutes of, oh, they're late. I have a moment. I can go to the bathroom or whatever. Like this moment when like everyone is arriving, like clockwork. right on time showing up for their appointment.
00:39:31
Speaker
If that starts to make me irritated, this is a problem because that should not irritate. It should be great. It should be great. The flow of my day is perfect. Everybody's coming on time. We're getting the sessions, just write it on time, using our full time. That should feel good, like a good rhythm.
00:39:47
Speaker
So I know if I book myself too much, If that starts to grate on me throughout the day, that's no good. It's like a Pavlovian response, but in a negative way. Like the sound of the buzzer, you're like, ah another one.
00:40:01
Speaker
Yeah. Why do they keep coming? Yes. and They keep coming. with and Who organized this? All these people keep showing up. Yeah. Oh, man. And I'm just waiting for someone to be a no-show or cancel at the last minute, right? That's saying, if you need that break, you need the break. You need a break.
00:40:20
Speaker
Yeah. I mean, with that said, i have just recently given my notice at the clinic. Oh. And I'm going to go to full-time private patients, which is very exciting.
00:40:33
Speaker
Congratulations. Thank you. is exciting. Thank Because to your point about when you were working for your former boss and you were doing like 35 to 40 patients a week, I don't have the tolerance in any setting, whether it's my private patients that I see in my space or at the clinic, I don't have the tolerance to see 35 to 40 people in a week. It's too exhausting for me. yeah yeah It's too much. now And so when I was telling my boss that I was going to be leaving,
00:40:59
Speaker
And she was like, well but you never really got into the like 35, 40 patients a week. I was trying to just be very professional. But in my head, I was like, I want to have a life. I don't want to work 40 hours a week in PT.
00:41:12
Speaker
It's like teaching if if you were teaching 40 yoga classes a week. Yeah. Right. You would never do it. You can't do it. I remember being amazed at the people who did 20 or 25 yoga classes a week. I could never do it.
00:41:25
Speaker
So maybe that's a, like we were saying earlier, that's a 20 year old's game, right? 40 patients a week is something maybe a 20, mid twenties into mid thirties possibly.
00:41:36
Speaker
But I want to have time to do my own working out, not just feel like I have to shove it in wherever there's a possible, if someone cancels, fingers crossed, and then I can work out or something like that. But I think, yeah, the burnout thing, I think there is this expectation. And actually, I'm curious to hear your experience. When I was in PT school, we had some quote unquote PT business classes that were taught by the same man.
00:42:00
Speaker
We had three classes with him. They were supposed to be on different topics. They were basically all the same. He would reuse his slides. He was terrible. But the upshot was what we were told was like, when you're going into your career, you have a few options.
00:42:15
Speaker
You can do outpatient ortho, and then you're going to be working for somebody else and you're going to doing 40 hours 30, 40 hours a week. Or you can be in a hospital. and But there was no like, wait a minute.
00:42:25
Speaker
Is that reasonable to expect people to be able to do that much work on their psyche? And it's so many and so many people. It's so much people coming at you.
00:42:37
Speaker
Yeah, I think that's really the hard part of it is going from one person to the next and everybody's got... different energy and different like coming in with just whatever's going on that day related to their diagnosis not related probably all of it's related right all of it is important but like just so much stuff that they come with every day and just to go from one person to the next like that is yeah It's just emotionally, mentally, physically, all the things exhausting and unsustainable.
00:43:09
Speaker
And I know there's some a lot of data out there. I don't have in front of me. I can't give exact numbers, but like numbers of people who go to PT school, work for a period of time and then completely leave the profession. It's pretty high, the numbers.
00:43:22
Speaker
And I already know several people who are classmates of mine in PT school who are not working as physical therapists. They've gone on to do other things since we graduated just in 2021. And like when you say that that high volume setting is for like someone in their 20s, I would say, yeah, it's like for someone just out of PT school it might be 23, 24, and they might leave the profession entirely while they're still in their twenty s Because they realize either a this isn't sustainable for me to work in this way, or B, oh, I'm going to really quick quickly hit a point here at this particular job where I will never get a raise again. This is as much money as I'll ever make.
00:44:05
Speaker
And if I'm going to make this one much money, I'm going to have to be a clinical director where I'm doing like piles of admin work on top of seeing people. 30 patients a day. and I think people realize that really quickly. That it's like, where am I going to in this career?
00:44:21
Speaker
and I cannot sustain this. And yeah, and it's really unfortunate that people with a clinical doctorate will just completely bounce out of the profession within a couple of years because of their experience working in an outpatient PT clinic. Yeah. That's an expensive that's an expensive little you know journey or i wouldn't I wouldn't call it a mistake necessarily. It's just it's unfortunate that that is...
00:44:48
Speaker
the model that is put out there for people versus, yeah and and maybe it's changing. I think this kind of hybrid approach and at Align at the clinic where I'm currently working, we do the same thing. We see PT clients.
00:45:02
Speaker
We also have an entire gym with barbells and a rack and we have multiple reformers. And so we have trainers that come in We have a Pilates instructor that comes in.
00:45:14
Speaker
I often start to transition my patients from PT into what we would call wellness, which is just like, you don't have anything. There's no diagnosis that we're working on. We're just working on something a like a capacity for your life.
00:45:27
Speaker
So I think understanding that like, that's a more viable model, not just for a clinic, but like for the PT where you're not, you're not going to risk getting burnout quite so early.
00:45:47
Speaker
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00:46:00
Speaker
If you'd like to sample a free workout from this progressive barbell course, join us April 26th at 11 a.m. m Eastern, 8 a.m. m Pacific. If you already have barbells, great. And if you don't, bring your weights and a dowel or a broomstick. You will receive live feedback on technique if you want it.
00:46:16
Speaker
Camera off if you don't. If you can't make it live, you'll get a replay. Click the link in our show notes to sign up.
00:46:28
Speaker
Sometimes people ask me for advice because they're thinking about becoming a physical therapist. And I'm always torn because I i believe 100% we need more good PTs out there.
00:46:40
Speaker
But I also know how hard it is to make a living without burning out if you're stuck in this model of 40 patients a week. Based on your experience, what do you tell people when they come to you?
00:46:53
Speaker
As far as, should I become a PT? What do you think? Yeah, I think one of the things that i hear a lot, because I do have a lot of conversations with people who are coming from the movement space, yoga and Pilates teachers, for example, who are considering going to PT school.
00:47:08
Speaker
One of the things that I find a lot is... that population and as well as like the entire population doesn't really have much of an idea of how variable a PT's career could be or how many different settings and specialties a PT could go into. So yeah for example, some people will happily work in neuro rehab setting for Decades. Or an inpatient rehab type of setting or at a school-based setting if they're working with pediatrics.
00:47:43
Speaker
There's a lot of areas within the PT profession that I think are not known to people until they... get into PT school, actually, it's start to see what's in the curriculum and start to go on clinical rotation. So one thing i do try to express it to people who are interested is that there might be a place for you where you would have and high a high interest and could have a really long, sustainable career as a physical therapist if you're not just looking at the traditional
00:48:15
Speaker
outpatient, more corporate insurance-based outpatient pc type of setting. And there is room for having an unconventional or mixed career path as well.
00:48:27
Speaker
For example, i have colleagues here in New York who do a combination of home care where they travel to patients around the city, like a small part of their schedule is that. And And then they work part time at a pelvic health clinic or something where they're seeing people one on one and it's more out of network or cash based. So I do know a number of people who will piece together a career for themselves that doesn't burn them out and is varied enough that it's interesting enough, it has breaks from certain types of settings or certain types of patient populations that it feels like refreshing enough to switch in the week from one thing to another. There there is opportunity for that.
00:49:10
Speaker
I think, especially as I don't even honestly know what's going to happen in this country with any kind of medical healthcare settings that accept insurance because it's all falling apart. It's all completely falling apart.
00:49:24
Speaker
yeah So there's got to be other things being built and nurtured and growing out of this place where it's just not sustainable to keep going. Doctor's offices too. Like all of my patients are like, I can't find a doctor.
00:49:39
Speaker
I can't find a neurologist. There's no one I can go to in network. Everyone's going out of network across the entire healthcare care profession and because it's become like impossible to have a business and stay within commercial insurance.
00:49:56
Speaker
Yeah. These practices. So something's going to change, but it's like in the meantime, we have to create the world we want to see for the patient and for the way we want to work as therapists. Yeah. Yeah. I've thought for a while that I should go back. I'm not getting really anybody, but there should be one day at PT school where someone comes in and is, this is how it is in the real world. Right.
00:50:20
Speaker
Because yeah there's none of that. yeah And you might come away from PT school with ah an impression of like how, because they're normalizing this 30, 40 patient week,
00:50:31
Speaker
weak That you're like, that must be sustainable because why would they tell me to do it otherwise? And then you quickly discover it's super not sustainable. But yeah, I've always thought that there should be someone who comes and is like, look, but what about a hybrid model? What about these other things? What about considering doing, like you were saying, sometimes this kind of works, sometimes some home health, sometimes you're in a neuroclinic.
00:50:53
Speaker
I have done some neuro rehab and I loved it. I really enjoyed it. And at this point, it doesn't make any sense for me. I'd have to get the NCS, which is like a specialty degree to go work at a neuro rehab clinic. Like I would not be able to do it just with what I have. And it it would be too difficult. It would not be the right thing to do, but for people, like you were saying, going to PT school, the idea that like, actually let's say you did outpatient orthopedic for five years.
00:51:22
Speaker
you started in your 20s and now you're 30 something, maybe you want to switch and start working with neuro rehab. Or you're like, you know what, I always loved kids. I want to work with kids or whatever it might be. and Okay, so let's talk about PT school for a moment.
00:51:36
Speaker
There's always similarities and differences between different schools and experiences. But if you had to sum up your experience broadly, what would you say about it? Was it a good experience? Was it and not a good experience? Did you feel like you learned a lot? Did you feel like you didn't learn anything?
00:51:52
Speaker
So it shifted from the beginning where it felt like such a relief to just sit in a classroom and have someone else teaching because I'd been a teacher for so long. I was like, what a treat.
00:52:03
Speaker
this is awesome. nice I just get to sit here and learn and I learn all and it starts with like clinical anatomy and cadaver dissection and all the things a movement nerd loves, right? So it's so good in the v beginning.
00:52:16
Speaker
And then we went into some of the really basic stuff like use of assistive devices like crutches and walkers and and gait and like some of those things that were very physical and we were up on our feet and we were moving around.
00:52:29
Speaker
was like, this is awesome. We're learning how to transfer someone from a treatment table to a wheelchair. And so it started off really well. And then it got really didactic and it started to get really into the weeds of things that were outdated musculoskeletal type of information that I knew enough going into it that I was pretty jaded in in that area.
00:52:57
Speaker
And then we went on Zoom, so we were entirely online. And it very quickly turned from, this is wonderful, I'm a student again, to literally my main objective at all times was do the bare minimum I needed to do to get more than 70% on the exam. So I pass all the exams, so I pass everything so that I can complete it.
00:53:21
Speaker
And then I learned the bare minimum I need to pass the boards, and I pass the boards. So it was like, check the box. I was not doing, and in terms of the curriculum, I got to a point where I was like, I'm putting no additional effort into this. Then like I pass every exam I take and then i graduate and then i bare minimum study for the boards to pass the boards and pass the boards.
00:53:47
Speaker
And then in the meantime, i just decided to study all the stuff that I wanted to study outside of PT school. o instead of putting a lot of effort toward the curriculum because I was starting to see what would serve me better in the areas that I wanted to work after school.
00:54:07
Speaker
That's what it turned into for me. hu How about you? Yeah, similar but different. i I felt a lot of pressure the entire time. Yeah. Some of that is self-applied.
00:54:18
Speaker
I tend to put a lot of pressure on myself, but I do remember feeling the stress of it pretty consistently all the way through. in particular in the first year, actually, because our first semester was 17 units, which is an insane amount of classes. Yeah. And, but they front load all of it and they made it, it's like, you don't get to take the next semester if you don't pass everything in the semester before. That's the way our classes were set up.
00:54:41
Speaker
I don't know if yours was the same. So there was a lot of pressure, like you have to pass all these classes. And i had a classmate who didn't pass, had to roll out, wait a year, join the cohort below. So the stress of that was always hanging over. Yeah.
00:54:55
Speaker
I had the same experience around a lot of the a lot of the measurements, a lot of the tests, and then a lot of the manual interventions. Yes.
00:55:07
Speaker
Like not until we got to what was called at my school advanced ortho, where we were actually watching movement and looking for quote unquote movement faults or whatever. I remember with that class, because all the like joint mobility stuff and all the like high velocity for people listening, they teach us how to do a lot of stuff that chiropractors learn, including like spinal manipulations, but also going in and doing these manual manipulations on people's joints in an attempt to do.
00:55:35
Speaker
reduce pain or make them move better. There was so much of that. And that was all so new to me that I always felt like I was just barely hanging in with it. And then we got into the part where we were looking at movement. And I remember like the second week I went up to the teacher and I was like, I'm just concerned that something's wrong because I am not finding this difficult.
00:55:54
Speaker
And he was like, no, that's because you came from a yoga background. You're used to looking at people move and being able to tell what's going on. So I had a flip where the latter part of school, I enjoyed a lot more than the first part of school.
00:56:06
Speaker
Interesting. Yeah. ah But i have a friend who calls any kind of advanced degree. She says, it's just your expensive receipt that shows that you did the thing and now you're allowed to do this job. So I had a lot of similar in the didactic portions where they would just be talking about these outdated concepts and I was like, all right, I'm going to have to memorize this for the board exams because they're teaching in school what's going to be on the exam.
00:56:32
Speaker
So let me memorize it and then dump it. And I really basically did. Which is frustrating because you would hope that going into PT school, you would learn all the things you need to be a PT. But it turns out you don't really learn them until you start being a PT.
00:56:46
Speaker
And a lot of it you learn just from the experience of working with people. Yeah, we had zero therapeutic movement and exercise in our program, like none.
00:56:56
Speaker
Wow. There was a class that was supposed to be that. ah It was taught by hand therapist. Not to say there's anything wrong with hand therapist, but his specialty was... hand therapy. That's what he worked in for many years. And he taught that class and it really taught nothing in terms of therapeutic exercise. yeah And so if I hadn't gone into it with a yoga background or like my classmates who were personal trainers for a number of years before they went to PT school or had some other kind of movement background, like a dancer who was teaching Pilates for a few years before PT school.
00:57:30
Speaker
um For everyone else, like they went on their first outpatient clinical rotations with no understanding at all of how to cue movement, how to look at mut movement exercises that are out there in the world that...
00:57:43
Speaker
people could do for a therapeutic purpose. There was like none of it at all. So yeah. So I, I was a little baffled by that. And I think since my program has now changed some things to include a tiny bit of therapeutic exercise, but it's like such a tiny, this is another thing where I'm like, when I talk to movement professionals who are thinking about going to PT school, I'm like, just so you know, it's just a teeny tiny slice of the pie here but we're talking about people moving, looking at movement, therapeutic exercise and movement.
00:58:16
Speaker
It, yeah, it's wild how little of it is included the school curriculum and how much grades one, two, and three, whatever joint mobilizations and still ultrasound settings for therapeutic ultrasound that is still on the board exams, yeah things like that. Yeah. Come on. Yeah. Yeah. It's like the books need to change and the curriculum needs to change and the exams need to change. And I don't know which one needs to change first, but it's part of, I think part of the difficulty also is the board exam, which in order to have a license to practice physical therapy in the state that you live in, you have to pass an exam.
00:58:55
Speaker
So if let's say I moved to New York, like because I'm going to go work for Caitlin, I have to now take the New York board exam, even though I've passed the California board exam and vice versa if she came here or any other state. And the exam 250 multiple choice questions, at at least in California. And you have about five hours to do it. And it was split into 50 question blocks.
00:59:19
Speaker
one of the blocks isn't actually real questions. They're just testing potential different questions yeah that might not be, there people might find too difficult, right? So any of these sections, like I remember being, there were sections where i was like, oh, I really fucking hope that this section is the fake one because i there's a lot of things in here that I'm having a hard time with.
00:59:38
Speaker
But to test how well, how good of a PT you might actually be, they would have to set up a situation where there's one-on-one diagnose and treat.
00:59:51
Speaker
where you're treating a patient and somebody is watching you do it and evaluating how you're doing it. But the reality of that is impossible. The manpower needed, it it would just be an impossible thing to try to set up. So they've settled for this computerized exam, which tests how well you take a multiple choice exam.
01:00:10
Speaker
It tests nothing about how good you are with people. And I've said this and and it's true. There's people that I went to PT school with that I would never want to have as my PT. Not because they were bad people or anything like that, but because they didn't have a lot of those soft skills yeah that I think are so important.
01:00:27
Speaker
Of the things that you did learn in PT school, how many of them do you still use in your practice? Or are there categories of things that you might still use versus other things that you don't?
01:00:39
Speaker
For example, I don't pull out a goniometer unless it's someone who's had like a knee replacement and I want to be able to track their improved knee range of motion. A goniometer is like a, basically a protractor for angles. So you can measure the angle that someone's joint is getting to. And let's say if they've had surgery, their knee's not getting to the amount of flexion it's supposed to, you can measure over time.
01:01:01
Speaker
So every now and then I'll pull that out, but not a lot else, frankly. What about you? I think, yeah, agree with that. I don't, also, I just don't think it's valuable for someone who's not in a, has like a Actual joint restriction post-op.
01:01:17
Speaker
Anyone outside of that, I don't think it's useful for them therapeutically to be measured by angles and then to fixate on whether that got better or not. right Not great for their healing.
01:01:30
Speaker
process, of recovery process. I don't think, I don't think. But and so I try to stay away from some of those like really ah objective measures actually that kind of make someone feel like it's this idea like it's joked about and in memes in our circles. It's, oh, I went to physical therapy with one problem and came out with 80 more problems. I didn't feel like had. Like when you start measuring everything, one of my mentors, Greg Lehman would say diagnosis human, right? Like these are just normal things that we're measuring that that aren't pathology.
01:01:59
Speaker
So yeah, I have an agreement with you on that. I think one of the things that I utilize the most that came from my PT school education and something that was covered very well in my curriculum was was the kind of medical management information as it relates to comorbidities that prepared us for inpatient hospital and rehab settings. so Just with the patient profile that I see working with Medicare and working with patients who are in their 60s and 70s as like a pretty big percentage of my caseload, understanding the interplay between various health conditions and the way that could be affecting someone's persistent pain condition, a lot of that's become really valuable to me. And it's also because I treat through this lens of
01:02:53
Speaker
looking at the big picture of systemic health and physiology a little bit more than the mechanics of what's going on in someone's pain. So I really do take into consideration things that are going on with people who have metabolic disease, who have diabetes, things like that, and how that might be playing into the big picture of their pain condition and their recoveries. I do use, and I have, like I learned it, I used it, and then I moved away from it to a little bit more mechanical perspective for a period of time when I was a new grad working in an outpatient orthopic orthopedic setting. And then
01:03:32
Speaker
Since I've gotten more into treatment through strength and conditioning, it's moved me back towards this addressing the systemic components and the physiology.
01:03:44
Speaker
So it's something that I do draw from more than I thought I would when I learned that material and like exercise physiology and things like that, because that was all new to me. I didn't come from a lot of people go to PT school, come from a exercise physiology background as undergrads and then they go to PT school. So they already have a lot of that. I didn't have any of that as a yoga teacher.
01:04:07
Speaker
Yeah, me neither. And I remember that first semester of the biomechanics stuff, I was like, like the stress strain curve. I was like, what is happening? What is happening? yeah When you were talking, it reminded me that probably the most influential class that I took was ah from a professor who now is a head of another program here in Los Angeles, and another school rather.
01:04:28
Speaker
ah It was a pain science class. And he was someone who was doing, and and I believe still is doing pain science studies. where he would do things like have you think about a terrible incident that happened in your life and then see what your strength output was versus when you were thinking about something happy in your life and what your strength output was. right So a lot of the like cycle biopsychosocial component of pain science. And that was very influential for me, I think just throughout my career. That's probably the biggest I probably drew from that class the most.
01:05:01
Speaker
But yeah, I'm not ever doing like the empty cup test. There's a lot of pain provoking tests PT. And I'm always like, hand they're already in pain. Why am I trying to, why is it, I'm trying to establish this kind of like trust relationship.
01:05:14
Speaker
And the first thing that's happening is I'm provoking their pain. What do you, have you met humans? What do you think? yeah It's just so wild. Yeah. And I think those special tests too, so many of them are like in this realm of maybe it doesn't really matter exactly what the diagnosis is here.
01:05:33
Speaker
Yeah. Because a lot of people with say rotator cuff related shoulder pain, that's just the term that I've started using because it's so broad. They're all different because they're different people.
01:05:44
Speaker
It's a different person. person is going to present, walk into your office and present so differently than someone else who has the same, maybe the same diagnosis. But the specificity of that diagnosis or any of those special tests that might bring you to that matters so much less than what what's going on in your life right now. yeah What are you currently unable to do in your daily activities? Yeah.
01:06:07
Speaker
How do you feel about this? How do you feel about it? yeah What have you taken out of what things are you not doing that you used to love doing? and how can we get you back to doing those things? What is your life look like? How does, yeah, like how is this condition and your symptoms, how is that affecting your life right now? And it's wildly different for every person, even a bunch of people with the same diagnosis. And that's something that was not taught. In PT school. No. It was like all about treating a diagnosis and using special tests to drill down deeper and deeper, more specifically into the implicated structures or whatever. That probably doesn't matter at all.
01:06:45
Speaker
I agree. People will come in and they'll have some sort of shoulder pain or something. And I'll be like, should I get an X-ray or an MRI? And I generally, unless... ah Sometimes if I've been working with someone for a while and the interventions are not doing what I would expect, I might say it would maybe be good to get some imaging because let's see, let's just make sure that we really know what's going on in your shoulder. And also sometimes it gives us a better timeline for their expectations around healing.
01:07:11
Speaker
But a lot of the time people will come in and they'll be they'll have a whatever pain. They're like, do you think I should get ah an X-ray or an MRI? And I'm like, it's not going to change anything that I do. I'm not going to suddenly treat differently, most likely. so ah this And so the same with a special test. Like if you hold your arm out to the side and you internally rotate it and I press down and it hurts,
01:07:30
Speaker
Honestly, probably hurts on a bunch of people to do that shoulder pain or no. these These special tests that we learn, I don't do any of them ever basically, because the other thing with them, and I've talked about this before as well, is that a lot of that is so that you can convince insurance companies that they need to still be paying for physical therapy. So you do these tests because the tests are these kind of like standardized proof that. Right. They've got pain with this or they can't do this angle of movement or that. Yeah.
01:07:59
Speaker
ah Shoulder hurts. This person's shoulder hurts. This person, ouch your shoulder.
01:08:06
Speaker
yeah All right. Yeah. Thank you so much for taking the time to talk to me. I really enjoy talking with you every time I get to. And yeah, hopefully between the two of us, we're going to change the PT world.
01:08:17
Speaker
Yes, Sarah, it was great chatting with you. i love all the work that you and Laurel are doing. Fully support it. Thank you. It's awesome. yeah Mutual admiration society, I think, going on over here.
01:08:29
Speaker
All right. are
01:08:36
Speaker
All right, that was fantastic. Thank you again to Caitlin for taking the time to talk with me. If you want to know more about Caitlin and her practice, you can find her website at www.practicehuman.com or you can reach out via email at hello at practicehuman.com.
01:08:53
Speaker
She's also on Instagram at practicehuman. And I have linked all of those in the show notes. So you can check her out there. Please make sure you also rate, review, subscribe. We got a really nice review recently.
01:09:08
Speaker
It's always a pleasure when we get one of those. And don't forget to sign up for our free bone density class so you can get a sample of what the course is like. The class will be on April 26th at 11 a.m. m Eastern, 8 a.m. m Pacific.
01:09:21
Speaker
And we will see you next week.