Episode 1763 - You can't save everyone

Alan Fredendall // #LeadershipThursday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, ICE Chief Operating Officer Alan Fredendall discusses how to approach helping patients who don't want help

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EPISODE TRANSCRIPTION

INTRODUCTIONGood morning, everybody. Welcome to the PT on Ice Daily Show. My name is Alan, happy to be your host today. I currently have the pleasure of serving as our Chief Operating Officer here at ICE and a faculty member in our Practice Management in Fitness Athlete Divisions. It is Thursday. We talk all things leadership, business ownership, practice management. Leadership Thursday also means it is Gut Check Thursday. It is the 4th of July, so we have a gnarly hero workout planned for you all this week. The workout, I just finished it. It is called Glenn. Glenn is named for former U.S. Navy SEAL and CIA operator Glenn Doherty. He was killed in the attack on the U.S. Embassy in Benghazi back in 2012. And so this is a very long Very kind of moderate intensity piece with a bunch of different stuff thrown together. So the workout starts with 30 clean and jerks Recommended weight there for guys 135 95 for ladies that should be a weight that you can hit for smooth consistent singles getting done somewhere between maybe three to five minutes out the door for a mile run a 2k row for guys 1600 meter row for ladies or a 4k bike for guys 3200 meter bike for ladies After that cardio piece, you're back in the door for 10 rope climbs. That also looking to be done in maybe 3-5 minutes, a rope climb every 15-20 seconds or so. If you can't rope climb, we have some scaled options for 20 pull to stands. or 30 strict pull-ups, whether that's with actual strict pull-ups or with a band, but some sort of challenging vertical pulling motion that's going to get you done in three to five minutes. Back out the door, repeat that mile or that row or that bike, and then come in the door one final time for the coup de grace, 100 burpees. For a lot of folks, this is going to take maybe 45 to 60 minutes. It's going to depend obviously a lot on your mile run time, your ability to cycle that barbell, and your ability to motor through, more importantly, those 100 burpees at the end. Treat this workout just like a run where you're maybe aiming to decrease your split time, start slow, build up speed. The worst thing you can do is race through those clean and jerks in that first run. and then crash into a wall on those rope climbs that second mile and definitely you can hit the wall if you're not careful on those burpees and turn that into a really miserable end to the workout. So just pace yourself, go slow, get faster kind of mindset. So that's Gut Check Thursday. Today is 4th of July. We're kind of talking about a topic related to the 4th of July in the United States of America. The American mindset, the cultural mindset that we can and we should and we have to save everybody, right? We have to be the world's police and the world's diplomat and inside of America as healthcare providers and physical therapists, we have to save every patient. So the title of today's topic is You Can't Save Everyone. I don't want this to be a pessimistic episode where you leave feeling discouraged and like you should give up. I hope you actually leave this episode feeling maybe a little bit more relaxed, a little bit more empowered in your practice. This topic came from a question we had from a student at the Fitness Athlete Live Summit a couple weeks ago. So, on Sunday mornings of Fitness Athlete Live, we take Q&A. We get some really good questions, we get some really good discussion points. And a student named Trevor, Trevor Purcell, who's nearby me here in Clarkston, Michigan, had a question. He said, hey man, you know, you're doing the thing, you're using the symptom behavior model, you're finding out what's wrong with people. you're giving them manual therapy and exercise that's reducing their symptoms, you're trying to get them into loading and higher intensity exercise, you're figuring out what music they like, you're pumping the jams, you're trying to high five, like you're bringing it, right? In every aspect of your practice, the clinical reasoning, the manual therapy, the exercise, the personable skills, the DJ skills, you are bringing the heat And that person is just straight up not feeling it. Like how, what do you do, how do we get those people to get more serious, to get them to maybe transition to doing a maintenance program with us at the clinic, or maybe transitioning to a fitness program out in the community with a resource that you may have associated with your clinic. Like what do we do with those people who seem to, no matter what, no matter what value we're showing them, just really don't seem interested in picking up what we're putting down. And so my answer back to Trevor was be careful, right? Be careful that we don't try to save everybody, even people who don't want to be saved. And so today I want to talk about that. I want to unpack that answer in a little bit more detail. I want to talk about the numbers behind the physical therapy profession and how many people were expected to help. I want to talk about what I call the lie, how we learn to help people in physical therapy school. And then I want to finish and talk a little bit about the reality of what it actually looks like in practice to work with those people and some tips and tricks for that. THE NUMBERS So let's start with the numbers. Numbers are boring. As Jeff Moore, our CEO, would say, data doesn't change behavior, but I'm a firm believer that even though data doesn't directly change behavior, telling somebody they're going to die early if they don't lose weight or stop smoking or sleep better or exercise more, all that stuff, we know That just doesn't flip a switch in people and all of a sudden they change all of their less than optimal health behaviors. But that being said, even if data doesn't change behavior, I'm a big believer that data does inform decisions. And so knowing the data going into any situation can make us better prepared for that situation, even if it doesn't directly influence a decision in that situation. And so stepping back on a macroscopic level and looking at analysis of our profession, there are about 300,000 licensed physical therapists in the United States of America versus a population of 330 million Americans. So if we were to pair up one physical therapist with patients and say, this is your charge, this is your crop of people that you need to help every year, get moving, stay moving, stay with whatever fitness program they've been turned on to, you would need to help 1100 individual people per year. Now, the truth of that 300,000 is that those aren't all full-time practicing physical therapists. We have about 90,000 full-time physical therapists in outpatient. We have about 60,000 in acute care, skilled nursing, inpatient rehab, sort of the hospital side of the equation. and we have about 26,000 folks working in home health for a total of 176,000 full-time licensed practicing physical therapists. People getting up every day, putting on the uniform, and going out to man their post on the trench, right? So automatically that cuts our profession in about half. All the rest of those people are in academia, they are in management or ownership, they're no longer practicing, they are part-time, or even many of them are retired and they just want to keep their license because once you let it lapse, it's a lot harder to get it back than if you just keep it renewing. So that changes the equation a lot. That means every physical therapist now has to help about 1,900 patients, right? Almost double the amount of patients. And if we take a hypothetical scenario where you are an outpatient physical therapist, your productivity is maybe moderate. You see a patient every 45 minutes. You see about 12 patients a day, 60 patients a week. We know those are all highly unlikely to all be unique visits, each with a different patient, that a lot of those folks are coming maybe two to three times a week. And so if we assume that those folks are coming twice a week, then you're probably only interacting with 30 unique people or so per week, and then if the average plan of care is about 10 visits, or about five weeks of care, that we probably only interact with somewhere between 250 to maybe 500 unique patients per year, and that would be a very high volume productivity model. That would be a model where maybe you are seeing a patient every 15 minutes or so, or maybe even more. And so just thinking that statistically already the math doesn't add up, right? That puts us at about 20%. We're helping about 20% of the people we need to if our belief is that we should be helping and saving everybody with getting them moving, helping them stay