Future-Proof PT

Dana Strauss, PT, DPT and Alex Bendersky, PT, DPT

Want to stay ahead of the curve in physical therapy? Future Proof PT brings you straight-talking, no-nonsense conversations about what really matters in healthcare today. From dissecting policy risks and opportunities to exploring innovative practice and payment models to practical ways to accelerate your career growth, we're your go-to source for understanding the forces reshaping our profession and the healthcare industry at large. Through candid dialogue and real-world perspectives, we're building a community of forward-thinking professionals working both in and out of direct patient care. They aren't just adapting to change – they're shaping it. Whether you're looking to understand market dynamics or seeking professional growth, each episode delivers actionable insights that will transform how you view the future of healthcare. Come join the conversation!

  1. Episode 31: Physical Therapy is the Swiss Army Knife Profession

    4d ago

    Episode 31: Physical Therapy is the Swiss Army Knife Profession

    Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing instead A VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out." Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field. What we cover: Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary careWhere tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually doHow the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectoryWhy social media arguments about exercise intensity and volume miss the point, and what behavior change should look like instead Plus three threads that emerged outside the five-things framework: The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expectWhat top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuseThe phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change" Dr. Cook shares some uncomfortable numbers that we need to face to address. -75% of PT referrals never initiate, -30% drop off after the first visit, -and MSK patient outcomes have actually gotten worse over the last two decades Plus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in. Chapters 00:00 Introduction to Dr. Chad Cook 02:56 The Identity Crisis in Physical Therapy 05:47 The Role of Physical Therapists in Primary Care 08:33 The Precision Paradox in Treatment 10:51 The Emotional Aspect of Diagnosis 13:29 The Transition to Self-Management 15:41 The Impact of Digital Health Solutions 18:20 The Future of Physical Therapy 28:45 Navigating Uncertainty in Healthcare 30:45 The Digital Transformation of Health Systems 32:08 The Role of AI in Patient Care 36:51 Understanding Patient Recovery Trajectories 39:36 The Importance of Prognosis in Therapy 46:04 Redefining Exercise and Patient Engagement 50:48 The Power of Touch in Therapy 55:22 Negotiating Behavioral Change in Healthcare 59:09 The Future of Physical Therapy Find the full transcript here. Related: Episode 30 with Dr. Trevor Lentz About our Guest: Dr. Chad Cook is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries. Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: Many Paths to Recovery: The Case for Treatment Pluralism. About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession. Hosts: Alex Bendersky and Dana Strauss Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid." Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list. Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

    1h 1m

  2. May 2

    Episode 30: One Bad Experience with PT Loses Patients Forever with Dr. Trevor Lentz, PT, PhD, MPH

    And the active ingredients in PT often aren't even physical "We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor Lentz Dr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value. In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession. The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume. What you'll hear: Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.The challenge of fostering critical thinking and comfort with uncertainty in clinical education.Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.How Duke's Joint Health Program built a longitudinal care model before the payment model existed.Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.The AIM-Back trial and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care. Find the complete transcript and outline here. Chapters: 00:00 Introduction 00:23 Trevor's background and path to research 03:00 Day-to-day at Duke 03:54 Inductive vs. deductive reasoning in clinical practice 05:39 The No-Copay Revolution study 09:30 Horizontal vs. vertical value and the time-horizon problem 12:44 Rethinking incentives and longitudinal care 17:28 Why one bad PT experience ends the relationship forever 20:53 The identity crisis and language problem 26:57 Phenotyping and tiered, personalized care 39:32 The Pain Navigator program and AIMBAC trial 46:23 Navigators in the commercial space 48:14 Closing: the whole-person argument About the guest: Trevor Lentz, PT, PhD, MPH is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care. About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession. Hosts: Alex Bendersky and Dana Strauss Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid." Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list. Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

    51 min

  3. Apr 18

    Episode 29: Build a PT and OT Clinic Where Therapists Want to Work

    Why content follows culture, and practical actions clinic owners can implement within the next 3 months. Find the full episode transcript here. Posting more isn’t a growth strategy. Kylie Williams joins us to break down why “marketing to patients” on social media is getting harder, and why the clinics that win are the ones building culture that therapists actually want to be part of. We talk retention, autonomy, flexibility, benefits that matter, and a simple “side quest” approach to content that does not derail clinical excellence. Kylie is a healthcare professional with 8+ years of experience in physical therapy as a PTA. Now in a non-clinical role, she focuses on industry market analysis and storytelling to help private practices grow, adapt, and stay strong in a change healthcare landscape. Key Topics: -Social media's impact on private practice growth -Creating a strong clinic culture to reduce turnover -Innovative marketing strategies for healthcare providers Chapters: 00:00 Introduction to Kylie Williams 01:36 The Importance of Culture in Physical Therapy 05:05 Defining and Building a Positive Work Culture 09:29 Targeting the Right Audience for Recruitment 18:15 First Principles for Engaging New Clinicians 23:07 The Impact of Social Media on Attention Spans 23:40 Balancing Attention and Depth in Learning 25:20 Navigating the Attention Economy 26:10 Attracting Talent in a Digital Age 27:04 Creating Value in Social Media Content 28:27 The Challenge of Teaching Value in Social Media 30:18 Connecting Social Media to Business Success 32:12 Investing in Marketing Education for Therapists 34:03 Finding Balance in Clinical and Promotional Roles 37:15 The Role of Influencers in Modern Careers 39:07 Empowering Clinicians to Pursue Side Projects 40:47 The Importance of Agency in Clinical Roles 42:36 Shifting Paradigms in Therapy Business Models 44:40 Embracing Creativity and Optimism in Therapy Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid." Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list for exclusive content. Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

    47 min

  4. Mar 27

    Episode 28: Skin in the Game: How PT Wins in the ACCESS Model

    How RVUs (Not the Conversion Factor) Quietly Squeeze PT and OT and the Practical Blueprint to Shift From "Minutes" to ACO-Ready Value (read the full transcript here) In this episode, Alex and Dana discuss the CMMI ACCESS Model and what it could unlock for MSK care inside ACOs. They debate digital enablement reality and explain how aligned incentives can reshape referral pathways. They make a direct case the that the physical therapy profession's future depends on understanding payment mechanics. A core theme of this episode is that if PT stays positioned as specialty care based on "treatment minutes" as the primary service, it will keep losing in a system shifting relative value units (RVUs) toward primary care and behavioral health. If PT repositions around evaluation-driven expertise and ACO partnership, the profession can move from survival to influence. Here's what else you'll learn: Why the ACCESS Model payments are intentionally low, and why that is not the point.How ACOs think about total cost of care and why MSK spend is hard for primary care to manage.What “aligned incentives” can look like in a PCP + ACO + ACCESS org + PT partnership.Why engagement is often 3–5% for digital MSK programs, and what that means in context.A practical “go do this tomorrow” play for clinics: identify local ACO participants and pursue Preferred Provider relationships.The RVU basics most therapists never learned, and why it changes your advocacy strategy.Why PTs should prioritize evaluation, differential diagnosis, and plan-setting, with PTAs executing more follow-up care.How waitlists and access challenges become non-starters if PT wants to play in ACO-aligned care.A potential new productivity mindset: RVU-based expectations instead of “visits per week.” Want more information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid." Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list for exclusive content. Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter every Sunday evening.

    1h 4m

  5. Mar 14

    Episode 27: The $900 Billion Problem | Can AI Actually Fix Musculoskeletal Care?

    A reality-check on what works today, what is hype, and what must improve before digital-first MSK care earns trust We sit down today with Sergei Polevikov (FixHealth.ai, Well.AI / Chart2Chart) for a reality-check conversation on what AI in healthcare actually is, where it genuinely helps today, and where the hype can cause harm. Sergei breaks down AI’s evolution from early machine learning to modern transformer models, then moves from definitions into the real stakes: transparency, validation, and workflow fit. Then we discuss with him the risk of overpromising in musculoskeletal care. The conversation zooms in on a massive, under-discussed shift: Medicare’s growing interest in digitally enabled care models that can substitute for traditional services, and what that could mean for PTs, patients, and outcomes. Sergei explains why digital-first triage is likely the future, while also outlining the biggest watch-outs right now, including hallucinations, automation bias, incomplete data, and the lack of real-time interoperability that healthcare needs most. We also cover a PT and OT relevant rubric for separating hype from real clinical value: does the tool augment PT judgment and continuity of care, or is it being positioned (and reimbursed) to substitute for PT, especially in emerging Medicare digital-first models? Takeaways from the episode should help outline what to pressure-test before adoption or referral: safety guardrails and hallucination risk, transparency and validation in real-world MSK populations, EHR/workflow fit (not “more clicks”), and whether the vendor’s incentives align with outcomes vs. billing. Clinicians are concerned about AI "replacing clinicians tomorrow," but that's not reality and it distracts from the real issue. The biggest threat is poorly governed digital care pathways that can bypass PT and OT, fragment care, and dilute instead of improve accountability unless the evidence and oversight are truly there. Follow Dana Strauss on Linked In. Follow Alex Bendersky on Linked In. Subscribe to the Future Proof PT Linked In page. Subscribe to the Future Proof PT YouTube Channel. Subscribe to our newsletter and email list for exclusive content.

    47 min

  6. Feb 20

    Episode 26: The PT Identity Project | The Problems Causing PTs Patients, Pay, and Progress

    We are tackling physical therapy's brand crisis head-on. From pop culture portrayals (yes, we're talking about that "Land Man" stripper scene) to CMS policy that treats PT as "substitute spend" for MSK digital health solutions, the evidence is clear: we have a public perception problem. We explore why professional identity matters, how specialization creates internal dissonance, and why evidence-based practice sometimes conflicts with how we want to be perceived. We talk about the importance of communicating our actual skill set, and why we need to stop being terrible at telling people what we do and why it matters. Why this matters right now: Value-based care and episode/bundled payment models are framed as the future: fewer visits, higher impact per encounter. But remaining the PT who serves as the primary provider for managing their patients' longitudinal spend. In those models, PTs “win” by preventing downstream costs (imaging, opioids, injections, surgery, prolonged disability). But that only works if we can show it. Key topics: professional branding, healthcare policy, payment models, public perception, advocacy, and the path forward for elevating the profession. Mentioned in the episode: Nassim Taleb | "Skin in the Game" Hidden Asymmetries in Daily Life Episode Quality Improvement Plan (EQIP) ACCESS Model ACCESS Technical FAQs

    33 min

  7. Jan 26

    Episode 25 | Pain Science, Manual Therapy, and the Economics of PT with Paul Ingraham

    Explore the intersection of evidence-based practice, healthcare economics, and pseudoscience in rehab, plus practical strategies for clinicians who want to do better without going broke Is your physical therapy practice built on evidence, or just what pays? In this episode, we sit down with Paul Ingraham, science writer and founder of painscience.com, to challenge the line between evidence-based practice and pseudoscience in rehab. We explore why manual therapy needs a serious reframe, how economic pressures push clinicians toward uncertain treatments, and whether honest patient communication can coexist with running a profitable practice. Paul doesn't hold back: he argues that most PTs operate in a gray zone where research is weak, outcomes are unpredictable, and informed consent is virtually nonexistent. You might not agree with everything he says—but you'll hopefully question what you do and why you do it. Maybe you'll look into the scientific evidence behind your current common care plans. Topics include: Evidence-based practice vs. pseudoscience: where's the line? Why manual therapy should be reframed as an experimental intervention in many casesThe role of informed consent in uncertain treatments (not unlike what we hope physicians do when prescribing a treatment plan whose results are uncertain)How value-based care incentives better outcomes and discourages pseudoscienceThe economics of PT: balancing integrity with incomeWhy strength training and exercise therapy are still key ingredients in PT treatment plansTeaching intellectual humility and critical thinking in healthcare educationPractical strategies for clinicians who want to practice honestly without going broke Paul Ingraham is a Vancouver science writer and a former Registered Massage Therapist, a profession he left in 2010 over concerns about its pseudoscientific nonsense. Since then, he has been publishing PainScience.com full-time, a website about the science of pain and injury, known for its rich footnotes and anti-quackery activism. The site offers hundreds of articles and ten books, all based on a huge bibliography. Paul was an active amateur athlete for decades, especially in ultimate (the Frisbee sport), but has now retired from competitive intensity and “just” does a lot of running and cycling, despite grappling with his own chronic pain/illness problems since 2015. Here's where you can find Paul! https://www.painscience.com/subscribe [free newsletter] https://www.painscience.com/ebooks https://www.facebook.com/painscience https://www.threads.net/@painsci https://bsky.app/profile/painsci.bsky.social https://x.com/painsci Sign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy. Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians. Subscribe to our YouTube Channel

    1h 12m

  8. Jan 17

    Episode 24: The Economics of PT-First | Real Data on Cost Savings and Outcomes

    How crazy is it that proven interventions in healthcare take so long to spread, even when they show clear economic and clinical benefits? Innovation in healthcare is painfully difficult to get into widespread adoption, even after proven successful. This episode discusses the results of a nine year-old study at Geisinger Health System on a PT-First "bundle" that's just as relevant today. But the disturbing part about it is it's not common to find a structure like this one, where a shift in incentives changed the care pathway for patients. Here are major takeaways from the episode: PT-First Models Are Economically Proven: When properly structured with the right incentives, physical therapy as a first-line intervention for musculoskeletal conditions reduces costs and improves outcomes. This has been demonstrated at scale.Risk Stratification Is Your Friend: Implementing tools that identify high-risk patients (for joint replacement, high utilization, poor psychosocial factors) helps you target PT-first interventions where they'll have the most impact.Understand the Regulatory Landscape: Know the difference between what commercial plans can do versus Medicare constraints. This helps you understand why some innovations work in certain settings but not others, and where to focus your advocacy efforts. And don't forget to explore CMS Innovation Center Models! They are a key opportunity for Medicare to offer flexibilities outside of statute and PTs and OTs can 100% benefit from this!Patient Incentives Matter as Much as Provider Incentives: Waiving or reducing copays for PT-first approaches changes patient behavior. Consider how your practice can work with payers to create these incentives.Think Beyond Traditional Treatment: The food-as-medicine example challenges PTs to consider all drivers of health outcomes, not just manual therapy and exercise. What are the non-medical factors affecting your patients' success?Health Systems with Their Own Plans Are Innovation Leaders: These integrated systems have the most flexibility and motivation to try new models. Consider targeting these organizations for partnerships or employment.The "Why Not Everywhere?" Question: Just because something works doesn't mean it spreads quickly in healthcare. Understanding the barriers to adoption (regulatory constraints, organizational inertia, population mix) helps you be more strategic about implementing change.Keep It Simple: As Alex notes - "kiss things" "(keep it simple, stupid"). The most successful innovations have clear, straightforward incentive structures that are easy for patients and providers to understand and act on. Find the article we discuss in this episode on a PT-First payment model here. Sign up for our newsletter, where Alex shares weekly literature summaries and links relevant to therapy. Sign up for our sister publication, authored by Dana, Timeless Autonomy. Dana covers weekly health policy insights and tips on career growth for clinicians. Subscribe to our YouTube Channel We also discussed in this episode the "Geisinger Fresh Food Farmacy" research. The pilot evaluated whether providing free, healthy food for the entire household of a food-insecure adult with Type 2 diabetes improves health outcomes and reduces healthcare use. In the podcast, Dana described what she recalled from memory. The study is found here but we can't find access to the article unlocked. Asking "Claude.AI," it said in this observational pilot study with 37 participants showed a 2.1% average drop in HbA1c levels and an 80% reduction in healthcare costs (from $240,000 to $48,000 per member per year). Additional research has recently been published put we can't locate it unlocked online. It looks like funding was from the 2018 Farm Bill.

    33 min
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Ratings & Reviews

About

Want to stay ahead of the curve in physical therapy? Future Proof PT brings you straight-talking, no-nonsense conversations about what really matters in healthcare today. From dissecting policy risks and opportunities to exploring innovative practice and payment models to practical ways to accelerate your career growth, we're your go-to source for understanding the forces reshaping our profession and the healthcare industry at large. Through candid dialogue and real-world perspectives, we're building a community of forward-thinking professionals working both in and out of direct patient care. They aren't just adapting to change – they're shaping it. Whether you're looking to understand market dynamics or seeking professional growth, each episode delivers actionable insights that will transform how you view the future of healthcare. Come join the conversation!

Information

  • Creator
    Dana Strauss, PT, DPT and Alex Bendersky, PT, DPT
  • Years Active
    2025 - 2026
  • Episodes
    31
  • Rating
    Clean
  • Copyright
    © Copyright 2025 Dana Strauss, PT, DPT and Alex Bendersky, PT, DPT
  • Show Website
    Future-Proof PT

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