E198 | Commiting To Clinical Excellence With Jay Myerson

Episode 198 is my interview with Jay Myerson of Performance Physical Therapy (now Stive2LiveWell).  They have various locations in and around Connecticut and one location in New York City, NY.  Jason is a physical therapist and certified orthopedic specialist based out of their Westport location. 

Jason graduated from Quinnipiac University with a masters in Physical Therapy and went on to earn his doctorate from Arcadia University. He plays an active role in mentoring all clinical staff at Performance including the Orthopedic Residents and students of physical therapy programs completing their affiliations.

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Episode Transcription:

What's up, guys? Doc Danny here with the PT Entrepreneur Podcast and I got Jay Myerson on today who's the director of clinical development at Performance Physical Therapy and a few practices between Connecticut and New York.

We are mutual friends with our buddy Duane Scotti, who is at next right now with him, who we had a chance to talk to you a few episodes ago, who's also adjunct faculty there, has his very own cash-based practice and Jay and I get to meet both these guys, at CSM this year in DC, Washington.

They came to the five-thirty person CrossFit workout that we did, which was, which was super cool, I think. Did you say that was your first time doing a CrossFit workout? For me. Yes. Yeah. Which was a great one to get introduced to you, man. A lot of bodyweight stuff, but like misery loves company. And early mornings is like, you know, people rolling in with a, you know, they're coming from all over the country.

So, that was fun, man. I enjoyed getting a chance to meet you guys and then also kind of learning a little bit more about what you do. And it's an exciting story.

So I'm looking forward to getting a chance to, you know, get delve into what you're doing now. So, for those of us that are, you know, there are listening in that don't know you. If you could just take some time and give everybody sort of your background from the time that you know, you graduated from school and then where you're at now.

Jay: [00:02:26] my background started the traditional, you know, I graduated a Quinnipiac university, I won't say the year, and got my master's degree and started practicing in a conventional outpatient orthopedic practice, for one of the largest nationwide company, outpatient or physical therapy practices.

And, I worked for about five or six years, and then a program got offered a certification in orthopedic manual therapy program was provided to a bunch of people in the area. So I completed that with a bunch of friends from the company and about in a year.

Teaching continuing education and teaching at a local university as an adjunct and also practicing in a clinical setting.

Danny: [00:03:34] So at this point, you're, you're still acting like clinically seeing, seeing patients.

Jay: [00:03:38] Yes. I'm treating in the clinic between 24 and 27 hours a week.

Danny: [00:03:42] Okay. So, you know, I was having a conversation with somebody yesterday, even talking about how important it is to maintain.

You know, clinical hours, even as we start to kind of grow into these other roles. I feel like, I feel like it's essential. Otherwise, I feel like you sort of lose touch with, you know, what you went in the profession, to begin within the first place. Do you know? How do you feel about that?

Jay: [00:04:03] I love treating patients.

I like the grind. I like the struggle. I like the rewards, the whole nine yards, just working with people. And that's why I got into it. And that's why I did a lot of my advanced training is, you know, to help others, you know, help others reach their goals, to help guide them. And, you know, I hope to treat till I'm eight years old, but I know now luckily, get to take a step out of that role a little bit and dabble in some other areas that are started rewarding

Danny: [00:04:27] for me.

So I want to talk about that because, you know, I know when we had, we had, kind of just exchange some emails and you, you had told me that, you know, you were thinking about starting your practice and then you were able to create this essential position for yourself that kind of meshed together.

A couple of areas that you were interested in. And I'd kind of, and I'd like to talk about how you were able to, you know, make that role work. Right. Cause I always tell people, like if you can't find the job of your dreams, you have to create it. But it sounds like you can find it and not have to create your own thing, which is, which is this idea of entrepreneurship versus entrepreneurship, which, you know, staying within a more prominent organization, not necessarily going out on your own.

And it's that mixture of things. I think that's so helpful for longevity in the profession and not getting burned out. So how did that, how did that transition occur? Like how did you end up with this position that you, you know, created within a more prominent company is performance? PT is, is the name of the group, so, yeah.

How'd that happen?

Jay: [00:05:28] Well, it, it kind of built up over a while, I guess. I was with this large company or the largest for 13 years, and the company is fantastic and what is fantastic about it, you know, I was a part of their faculty for weekend courses and developing programs with them. But the problem was that there were in-network, and I've physically couldn't treat any more people.

You know, burnout. Burnout was coming in fast, and my plate, I had a little too much on my plate. So I like looked at like, how can I make a change? And the only way I saw that was. To go out of network or to go cash-based. So I read, well, I read your book, and I read many other books and podcasts and listen to your podcast.

And I have a couple of friends that are doing this, and their quality of life is just so

Danny: [00:06:17] different. They

Jay: [00:06:17] don't have to treat 20 patients a day. They can give that one on one care. They could listen to their patients, and that's what I was lacking, but not because of the company, because of the in-network model.

And how it works. So I did my research. I started developing a footprint in a local community, really trying to reach out, really trying to do a bunch of pro bono work and. Make, make connections, and I found, I found a box and a, I was ready to sign the deal or set up shop. And right as that happened, literally like within the week, a

Danny: [00:06:50] former student,

Jay: [00:06:52], a or even a student, a friend, a mentee of mine, reached out to me.

He goes, well, what are you doing with your career? What's your next step? And I'm like. I don't know. I don't know what my next step is, but I need a change. And the change led me to talk with him and the company of performance, and it seemed like they had a need. You know, they're out of network model, and they scaled to about six or seven offices, and they were lacking someone to kind of groom the clinicians with continuing education, clinical development, set up tracks for growth and success.

So literally, I kind of saw what I was doing, and I wanted to treat patients. So that could occur. I want to help grow all the clinicians in the company. I want to help share all the knowledge I've learned over the years in regards to manual therapy, exercise, pain, evaluation, treatment, just how to manage the patient experience and teach.

So now, luckily, They picked me up, and it's so beautiful relationship we're having now where I could treat mentor, teach, and still be part of my local community as well as teach as adjunct faculty at Quinnipiac University. I know it sounds like a lot, but for me, this is the right dosage for what works

Danny: [00:08:08] well.

I think. That's kind of the most challenging part, right? Is, you know, I what, what is it that, that somebody does, and it doesn't just be to our career, but specifically let's talk about physical therapy. Like what, what is it that people do that gives them energy, right? So like a task that when you, when you do it afterward, you know, you just feel excited and.

I think for a lot of people, they like working with patients and them, but they may not want to do that at the volume that's at the amount that is expected. When you're at, you're at a clinic that's essential, you know, very much high volume and, and, and even if you're an out of network clinic, like I get this from, you know, younger practitioners, even our staff, I mean, like my staff

, I would like to, they would prefer to do, you know, clinical work, but also have something else that they, you know, they can work on. Outside of that like other, you know, wherever part of the business or elements of that, that that might be not direct clinical care. I think that's normal, man. Like to want to.

You know, kind of work on multiple things. It makes your time more enjoyable. Right? So for you, like what percent is split up right now between, you know, clinical, mentorship, education at the, for the practice, and then training at the university? So,

Jay: [00:09:35] I'm 40 hours a week at, at the clinic, 27 to them being clinical hours, but give or take an hour here and there.

You know, you always got to stay late or come in early, depending on who you're treating. It doesn't change in any model. It just is what it is. Depending on the semester, I'm usually about. Eight hours, maybe a little more, a little less at the university. And then I teach a lot of weekends continuing education.

So maybe, well, it's been a lot less lately, so I'm probably at like eight or ten weekends a year teaching. We can con ed courses and then, believe it or not, even though it sounds like a lot, I have a lot more time with my family. You know, my wife and I have a ten-month-old daughter. So the quality of life has changed.

Danny: [00:10:15] Yeah. Yeah, no, it's, well, here's the other thing, like even volume-wise, like let's say, you know, your hours were the same  do you feel at the end of the day versus when you were

Jay: [00:10:29] working for,

Danny: [00:10:30], you know, a traditional practice, just seeing just straight volume and grinding out as many visits as you possibly can.

Like how, how is your energy level, how's your time around your family after you're done with the typical workday?

Jay: [00:10:42] Now it's great. I go home energized, you know, you know, I have, I have like a 30, 35-minute drive and I just feel like on top of the world, you know, the stress of treating a million patients is less.

So I come home, and I want to do things. So I want to spend time with my wife, spend time with my daughter, hang out with friends, watch a little TV. Whereas in the past, I just wanted to crash. And then the cycle repeats. Yeah, the cycle repeats. So I just, you know, I feel alive again.

Danny: [00:11:10] And burnout is such a big issue.

Man. A friend of mine, his name is Brett Bartholomew. He's, he's written, wrote a book called conscious coaching, but he's done a lot of work on burnout, a lot of research on burnout, has written a lot of blog posts on it, and it's a, it's a real problem in, in particular, you know, in these, direct.

People to people, relationship kind of based professions. So for him, a lot of it is about burnout with strength coaches, but I see the same thing occur within, you know, within our profession. And as well. I love the fact that you were able to, you know, sort of creating this role that didn't exist, but I'd be interested to hear, you know, how did that conversation go?

Like, did you have to pitch yourself? Did you come up with a, yeah, here's what I think I can do for you guys? I see a need here, or this is what my role can be. And like, what was that process like to actually. You know, pitch your services, your, your skillsets for a position that didn't exist within this other company.

Jay: [00:12:01] Believe it or not, it just meshed. It just happened. There was no pitching. It was they had a need, and they caught me at the right time, and it worked out. I know that's such a general answer to your question, but what I'll give, I'll go in deeper. I promise I won't leave you hanging, but as that colleague of mine just reached out to me, you know.

I talked to the owner and CEO of the company, and they asked, what am I looking for? And I told them correctly to the T what I wanted. I was able to create an onboarding program for the large company that I worked with. I was able to develop a mentorship program for all clinicians that are out within one or two years.

I said, if I go to your company, I want to do the same thing. I want to be able to groom the younger clinicians in a one to two-year process to get them. Where they should be kind of like a hybrid. I hate to use the word residency, but like basically like a, a manual therapy, clinical skills boot camp to keep them up with the literature, but also how to deal with patients, how to deal with clients, how to talk to people, how to set up the patient experience.

And then I told him that I still need to teach at the university. And then I still want to treat patients, and that was their need. Their need was because the company was growing and scaling, and they wanted to have the same product in each office—kind of like the Starbucks model. You know you get the same cup of coffee everywhere you go.

They needed someone to. Take over that role and grow. So I'm hoping that I eventually will have some people that I will have underneath me that I could help use them to help improve the clinicians as well. So it's not just me. I have maybe eventually a team as this company grows and scales.

Danny: [00:13:36] Yeah. That's awesome.

I mean, it's exciting. That model is smart. The owner of this practice must. Spent a lot of time, you know, working on their business, they've scaled to number the number of methods they have. That's amazing. And you know, I think like reinvesting in your people is always such a smart idea.

You know, like the con ed side of your new grads just make such a big, only a big, big difference and time especially. So like how much time are you able to spend with, you know, mentoring? Like if you have a new, let's say it's somebody less than a year out. You know, what does that look like with this practice in terms of how much direct mentorship they get from somebody that's a more senior practitioner?

Jay: [00:14:16] Well, again, I've been with this company for four months, so we're just starting, but this is where we're at now. We're, When at any time we hire someone new, they spend three to four hours with me going over documentation, appropriate ethical billing. Also, learning about kind of how the clinic runs, and I also talk to them about what their type of continued education goals is to help them create a plan right off the bat.

So that's what they do right away as part of the onboarding process. Then after that. I usually spend four hours Tuesdays and four hours. Thursdays with a different, yeah, a different person. Each week. Now that my schedule changes a little bit at the university, that's kind of what I'm doing. But in the past, when I first started a couple of months ago, all my Tuesdays I would spend at different clinics.

I would go to one clinic and hang out with one or two clinicians for four hours, and I go to another clinic and hang out for four hours. What can I tell you a little bit more about some other cool things or unique things that we have

Danny: [00:15:12] doing?

Jay: [00:15:14] So, Oh, it's so tough to like close down the clinic and like have like workshops during the week because you lose productivity.

Well, we're in that out of network model, so we have a little bit of wiggle room. So what we did about a couple of weeks ago was our first skills lab where I took—half the clinicians in the morning. And we did a three-hour skills labs on literature, manual therapy, all lab component on the upper quarter.

We worked on the scapula, the shoulder, and different pathologies and conditions using different models to help manage our patients. And then later in the day, I had the other half of the clients, or sorry, the PTs that I worked with. So I was able to like get them out of the clinic, which is great to help burn out, you know, grinding out dead grinding all day.

And you know, you get a little break, you have to learn, you get to laugh, you get to practice some skills. And we're planning on doing this quarterly. And I think that's amazing. And another thing that we do that they've been doing well past me is what's called grand rounds, where once a month we meet for an hour or two at an office, and we have a guest speaker.

It could be a doctor, and it could be a. Well, we had a nutritionist come in last, last month. I'm speaking next week about the patient experience. A month or so ago, I talked about managing and understanding pain. Well, we have new people coming in every month to talk about hot topics and where we're going and things like that.

So it breaks the monotony of just patient care.

Danny: [00:16:39] Well, it sounds like it's also just culturally probably a good thing for you for your company. You know the team environment is so important. And, and you know, we found a scaling to additional providers within our company is, is communication is massively essential.

And so is, is being able to show and, and demonstrate that your, you value the people in your company more than just. Productivity, you know? And it sounds like that is something that, that you, you've found within this, this cool practice, but seeing this from the side of a professor as well, so you teaching at a university and, and you know, being involved in academia, what do you, what, what kind of questions and what kind of, what type of position do you take with students?

Like when they ask you, Hey, I don't think I want to work in a high volume clinic, but that seems to be. One of the only choices that I have for sure at school. What's your advice to them?

Jay: [00:17:38] It's hilarious. You say that. Every every fall I lecture in a different class at the university for the D two students called what's next?

It's an hour and a half. Talk about. What do you do after you graduate and includes your continuing education recommendations, residency, fellowship, Ph.D. if you want to be if you're going to teach at a university, what if you want to travel? So I give them a snapshot of all that. To answer your question, in those, in the company that I worked for, you need to be a top-notch clinician to stay afloat.

You know, our clientele that comes in, you know, they need the highest, most optimal care. So I'd have to say where I work right now is not for everyone, but it is for the advanced or highly motivated orthopedic sports space. Physical therapists can you least appreciate that.

Danny: [00:18:35] Yeah, for sure. And I think that that's, that's the challenge, right?

I mean, if you're a new grad, and this is, I get these questions a lot and. I would say my answer has changed a little bit. You know, for initially a couple of years ago, when people would ask me this, they're students. I would tell them like, dude, just go get your reps in for a year, at a clinic. Don't sign a crazy noncompete or take any bonuses to stick around for a long time.

You know, get your reps in, feel comfortable with, you know, working with, with patients and then, you know, go and decide to do your own thing from there if that's what you want to do. Because you know, if you're going to be seeing high volume. For more than a couple of years, you're going to start to resent it.

You're going to start to resent. Your profession, the fact that you, you know, have all these loans from school, and now you don't even like your job anymore. And it's not the, and it's not the position, it's just the, it's the context of it in which they have to work. So what, for a lot of them, I've even said now, like just straight out of school, it depends on their background, right?

Like if they have a background in, let's say there was some sort of—coach of some kind before going to school. And a lot of, a lot of performance kind of minded PTs are, you know, they're coached weightlifting or CrossFit or maybe running, or there was a triathlete themselves, and they want to work a triathlete.

So they have this inherent coaching experience. Their clinical skillset might be lacking right there, but their coaching experience might be excellent and have a lot more to offer there. And a lot of those people can. Honestly, they can go straight into private practice, straight into a cash-based practice, in particular, focus on their niche and be just fine and learn their clinical skillset along, you know, along the way.

But I think it's a tough challenge in students. And you've probably more attuned to this than then I am reaching out to me. They know, and they're just like, dude, I don't want to do this. You know, and I'm not sure what to tell them. What do you, what do you say.

Jay: [00:20:19] Well, I think you hit the nail on the head with a couple of points.

Times have changed. You can't, and you can't tell students to just go into the clinic and deal with it for a couple of years.

Danny: [00:20:27] That was a good

Jay: [00:20:28] point. But everything around us has changed. Like the models are a lot different, you know, a lot more of the out of network cash-based places, people opening up their clinics that are coming, a more common practice.

So what I tell them is this, I tell them. Interview a lot of places, and when you interview, if they asked you to come back,  the shadow. See what you're getting into before you sign any papers or sign any contracts and to take any job. And when you shadow, make sure you shadow on a Monday or Wednesday in the afternoon when it's busy, not on times where it's slow was you want to see the culture of the clinic before you take

Danny: [00:21:04] the position.

Yeah.

Jay: [00:21:06] Awesome. Also, I help guide them. You know, if people ask, saying like, you know, there's a lot of these big-name companies in there that want to see high productivity, what do you recommend? And I would tell them this. I say, look at some of the smaller mom and pop places. Check out those, check into some home care agencies to do that as well.

Or. Tell them up front that when you want to work, you want, you don't want to treat 20 patients a day. That's not what you're looking for. You're looking for a smaller model, and

Danny: [00:21:35] I don't know what

Jay: [00:21:35] the owners or directors would say about that. I'm not sure if they would give pushback or maybe take it as a compliment that they want to get patient care.

Metrics are metrics. So a lot of the big companies manage metrics and.

Danny: [00:21:47] You know you need to make money.

Jay: [00:21:49] But my point of telling students this is they have some control. They don't have to take the job. There will be many jobs available to them. And my big message to them is, you want to find a job that you're comfortable with.

You want to find a job that you can grow. And for continuing education, I always tell them. Work, work for six months. Then reflect upon what you see and what you treat and then take courses that will help grow you in where you are. Don't just take classes arbitrarily because you want to make an instrument course or Kinesio tape or needling. You have to take something that's going to help grow your practice.

So I usually have them after six months, reflect on what they say.

Danny: [00:22:25] Well, I think it's a challenge, right? Sometimes students come out, and they don't, I didn't know what I want to delve into, you know, all I knew was. I had four and a half years old, the army. So I was just going to go straight into a kind of sports orthopedic setting and, and it wasn't until man, I would say, you know, around that six-month mark of me being out of school and having a lot of repetitions under my belt, that's, that I sort of started to realize like, man, I feel like I'm getting kind of stuck here. I want to be able to help people do this.

And I was then going down the rabbit hole of like, people that were, that we're better at those things. Then I was at where they were teaching about it. This is precisely how I got involved with, with MobilityWOD, you know, from an early age or for, from a first point. Like I didn't, I didn't reach out to MobilityWOD cause I thought I wanted to teach for them.

I started watching every single video Kelly's rep put out because it was helping me clinically, you know? And that I, that just takes some context for a student to realize what they want to do and what they don't or they don't know. So, I love the fact that you tell them to like. You see, it takes some time and figures that out.

How, how do you recommend people, you know, with your experience at this point where clinical education, how, what's the best way that you found to actually like assimilate and get the most out of the information that you're learning at a clinical education course when you get back into the, into the clinic.

Cause we all know you get bum-rushed on Monday, you got a ton of people. I'm sure you'd love to do this new shit. You just learn. But it doesn't mean it's always going to happen that easily.

Jay: [00:23:51] Oh, that's a tough one. Let me say, so I guess the best way is I tell students when they take these continuing education courses, and when you try to apply all this information that you learned in about 14 hours on the back of your manual, or a separate piece of paper.

Write yourself a few side notes which you could use this on the kind of like, you know, a bill with back pain or Mary with the tricky name. So the idea is that you can't retain all the information that you get on these courses. And if you don't use it, you lose it. But if you write a couple of notes on these weekend con ed of like how you can take it the Monday morning when you prepare for your day, you can be like, okay, I learned this technique for the knee.

That's good for improving extension. I have this patient, Mary, let's try this on Mary or Bob suffering from some persistent pain. I just learned about central sensitization. I want to talk more about nociceptors and pain. What it is, write a few comments on it. You know, set a time that I'm going to speak to bill or Bob about this, but of course, don't overdose with this information, but the idea is to kind of prioritize.

And a lot of, a lot of students or a lot of PTs in general, after they take these

Danny: [00:25:04] courses,

Jay: [00:25:05] you lose a lot. So again, taking your notes on the side is very, very helpful. And then I always tell people to practice on your family, practice, on your friends, especially with the manual therapy techniques. You know, if you don't use it, you'll lose the psychomotor skill of it.

And on the weekend, you'll probably try each technique about three to five times. That's not enough reps. You need hundreds of reps to be proficient at performing them. So again, you know, practice on your significant other. That's the big thing. As well for, for continuing education when it comes to jobs.

Also that you kind of touched upon. One of the important things I tell the students is mentorship. So, you know, even though you didn't have a, like, I don't know if you have a mentor through your, through your pathway.

Danny: [00:25:46] Yeah. And so in the army, you get assigned, like when I, when I first got out, my, your, your clinical, your clinic director, for new grads turns into your

s Clinical mentor and so, so yeah, my, my first position I did for about a year. Still, then I was assigned to an infantry brigade, and there I was the only one in the only physical therapist in that brigade. So that's when it gets a little tricky cause yeah. They throw you in this environment of like 3,500 soldiers, and they just tell you to like.

Go ahead and help implement performance optimization, injury prevention programs, and then treat the injuries. And that's it. So you're there a year out of school by herself just trying to figure out what the hell to do. So at that point, no.

Jay: [00:26:29] Oh, well, luckily. A lot of companies offer the kind of like direct mentorship and like really having a mentor rather than just, don't worry, and I'll take you under my wing.

So I always tell students to like take a job where you have a structured mentor that will work with you for one to two years, but even if they can't, even their dream job doesn't allow that. There are digital or distance space mentorship programs. Like, I'm not going to start listing out all the names, but you know, they have monthly meetings or weekly webinars, and they'll help bro.

But, I remember my first few years, I had a mentor, and I had two mentors, and it was terrific. And I think that's what got me to where I am now is from the upbringing. So that's why I pushed the students to like, don't believe that you know, everything. Don't go on your own yet. Work under a mentor, learn, get groomed into it, and then branch out in the way you feel like you need to go.

Danny: [00:27:20] Yeah, that's, I mean, that's, it's, it's so valuable, and I think that It's something that there's, there's, there's more there though from what I've found with the, so we have three staff PTs, every single one of them, except for the second one that we brought on was directly out of school. Like literally hired him straight out of undergrad or out of their doctoral program, I should say.

And. So there's a lot of mentorships that was necessary. And, for the first two months, they don't even touch a patient. Like they just literally like work with me every single day. I'm just only exclusively doing clinical mentorship work. And then they spent, they spent a day with us or with me for the entire first year.

So they're there on a four day schedule, and they spend the entire day with me for the first year. And for a lot of people, they think that. A, as a business owner, man, that's kind of excessive. But for us, it's not because we want to have these high-quality providers, you know, going forward. And that mentorship is essential.

And here's what I would tell you. And I wonder, I want to see what you, how you feel about this. Because often students want to know about like clinical mentorship, right? Like how do I get better clinically? What I've found with our staff. When we take a step back, and we started to talk to them about things outside of the clinic, you know, and, and just sit down and be like, dude, how's your life going?

You know, and have a conversation about the things that they're interested in accomplishing outside of the clinic. That's been fantastic for us, and it's helped us with defining our, our, our culture, and maintaining a high-quality lifestyle. So how about you? Have you guys delved into just getting outside of them or talking to them about things outside of the clinic and seeing what, what else you are trying to accomplish in life?

Like how's your life going?

Jay: [00:28:58] I think that's a fantastic topic. And. I tried to do that as much as I can. And it seems like you're doing a tremendous job the way you are mentoring your clinicians. I think that's awesome how you're able to take them under your wing. And one of the things I believe that you do that's as great as you teach your patients about your patients.

You teach the young PTs to talk to patients. I think that's a huge asset. And to build on that, aye. Speaking to the PTs, kind of in my company, one thing that I like to talk about is like vacations. I would like to ask that because that's usually how they decompress. No, where are you going? Where do you want to travel?

What do you do for fun? You know, we had one PT. I work with that just once. Europe, we have another PT that's big into golf. We have one PT that likes to do some adventure activities. So it's cool just to like know people, not only on a clinical level of what their skillsets are but what they do on the off time, how they unwind, how they decompress.

Are they getting engaged? Are they getting married? Things like that, you know, that's important with you want to build a relationship with them, not just the hierarchical model of how do I grow you into a better clinician?

Danny: [00:30:06] Well, I want to, you know, you said something about talking to patients and me.

We spent a ton of time on that it half the time I feel like. I mean, that's probably 75% of our time. Like these soft skills are these like hands-on skills and things where we're, you know, whatever manual therapy or progressions of exercises, regressions, you know, clinical reasoning. All of that is great.

And is it essential for sure? But man, if you can't connect with somebody verbally. And via, you know, your body language and understanding, you know, what they're telling you, even non-verbally, you have a much less, you know, likely chance of getting them to commit to solving this problem for you when we're asking them to make severe, permanent changes primarily.

So. How do you go about, you know, structuring that with students? Like how much of your mentorship time is spent with, Hey, I know you want to learn how to do this manipulation, or whatever it might be, but let's talk about how you engage with another human being in an office like this.

Jay: [00:31:06] So a big, a big part of one of the lectures I did at that grand rounds was known basically about understanding pain and the experience.

And how to use their soft skills to kind of help explain different diagnoses. So you've heard all these papers like sticks and stones and words matter and many other aspects of that. But it's how do we tell a patient what's going on with their body without using the word tear, rip degeneration.

So when they see my work in the clinic and. When they observed me do my evils, they see the words that I use and how I talk to someone and how I downplay the severity of an image. Finding and up to play their functional goals and what we're going to do to reach them. But also active listening. I try my hardest to let the patient speak for a while before I interrupt or before I ask my questions.

And that's all good skill. So I think the way they've been working is they've heard me through lectures, but many people were also doing this. Also. When they observe, when I shadow or mental with a mentor with them, they see how I talk to patients as well. And you know, they, they learn from that aspect.

But also when they come to my clinic and shadow with me, they see how kind of I work. Too, I do a lot of followup emails. I'm huge on after the initial evaluation, writing a followup email to thank them for their time and to summarize the findings. You got it. Yeah. I was just telling them what's going on with them.

They usually forget half of the stuff you say when you put in an email, summing it up and thanking them for their time. I think that's a tremendous skill and they're like, well, not many people do that. So I think that helps to build that patient

Danny: [00:32:42] experience. I do. I could not agree with you more. We spend more time.

I, I, I, this is, I don't, I don't even know, like to put an hour marker on this and we spent hours and hours and hours refining. How we write a, follow up email after the initial visit, like, and it's, it's long. I get, we'll probably, it probably takes our staff 15 plus minutes to write the email. After their, their initial visit and it's precisely that.

It's like, Hey, thank you so much for your time today. I wanted to be able to summarize what we went over, here's what it is, and being able to, not just summarize what that initial visit is, but also start to pre-frame what we expect them to see in terms of changes in potential setbacks.

Right. So like. Let's say we have somebody that has this long-standing history of lower back pain. We know the likelihood of them having some sort of regression during the time that they're with us is very high. So if we can go ahead and pre-frame the fact that we say, Hey, we expect your symptoms to feel better over the next couple of days.

Don't be surprised. As you know, we get into this over the next few weeks or whatever it might be. You might have a little bit of setback, and pain might come back. Positionally it's hard to say what's causing that, but don't worry, we're on the right track, and this is what it looks like. So when that happens.

You know when some, instead of somebody freaking out and being like, Oh shit, they don't know what they're doing. My back is bugging me again. It allows us to sit and have already put it out there, and they think, Oh, they previously mentioned this. Cool. This is just a minor setback. This is normal. And then they don't, they don't freak out over that, which we know can be such a problem just with chronic pain patients in particular.

So, you know, I love that you guys do that. Is that something that everybody in the, in the clinic does.

Jay: [00:34:23] It started to become more common practice. I'd be lying if I said I did that with every single patient, but I tried to do it for most, especially the complex cases or people that are not buying it right away.

You know, you have the patient that comes in, and sometimes you build a fantastic relationship right off the bat. You just read it off, and you know, things are going to be great, but I make sure that I do it for those patients that are kind of on the fence or a little skeptical, or maybe I've seen a couple of providers before.

So like with, with that said, it is, it's a challenge, but the idea is that we have an event in our to-do our Val, so we're not rushed to squeeze someone in for a half an hour, 40 minutes. So in that Val time, you know, we're taking the history, we're taking our vitals, we're doing our best evaluation that we can, and we're implementing treatment.

And sometimes, treatment might start with just education. And even with that said, I've had a couple of patients lately that I told them that I'm not sure what to do yet. Let me have the night to think about it, and I'll email you our plan. And I'm honest because I don't want to just throw things arbitrarily at them.

Movement-based exercise or manual therapy techniques. Sometimes I get a process, and I've been out for about 14 years, and I tell, well, the clinicians that I'm not perfect. I make mistakes. I piss people off. I also get people better, but it's going to happen. And if you're honest and you're open with your patients and set realistic expectations, you usually get better outcomes.

And one of the big things I try to do is I try to underdose so like, yeah, for day one, even if I do something or give them an exercise or stretch and they say, wow, I feel so much better. I usually tell them that this is not going to last. This is going to be a short live win, but it's a small win in the continuum of everything.

A bunch of small wins added up. We'll get there, but yes, of course, we're going to have setbacks. So I tell them that this is just because you feel right now doesn't mean that it's going to last for a while. Also, you might expect to be a little sore later because we're moving tissue that hasn't moved in a while.

So I try to set realistic expectations, so the patient comes back and goes, you know what? You were right. I was sore. Rather than I let them leave and saying they feel great and then come back and say, wow, I'm a little sore now. I'd instead set the expectation going forward.

Danny: [00:36:32] Well, I think these little, you know, things that you're talking about this, this idea of mastery or excellence within a particular profession, you know.

Early on, and I think you probably see this a lot with students. This is the way I was. I felt that I just needed to become the most exceptional manual therapist in the world. Like I wanted to be able to do every manual therapy technique you could imagine. I spent a ton of time doing that. I spent a ton of time with fellows, and then I started realizing, well, crap, now I need to be able to progress people better like I need to improve.

You know how I'm like coaching people. The movement started to become relevant. I started delving into that and mixing that with manual therapy, and after about five years, I thought, man, I've got this figured out. And then every once in a while, I'll get people that I just couldn't get better, and it would frustrate the crap out of me.

And then I finally realized after about five years, and no one ever talked to me about this before, that it. It was all, I mean, the last little piece and not, and we don't get everybody better. Nobody does, but, but the last little bit for me came down to what you're talking about, these small things of communication, of how you interact with somebody and.

I honestly feel like that is the variable that from the start needs to be emphasized and can make such a big difference in, in terms of not just how well you can get people better or your, your percentage of success, but you know, is okay to say, you know what? I don't know. Like I'm going to, I'm going to spend some time figuring this out, though.

And that right there, like the trust you'll build. Somebody's honest and just letting them know like, you know, I don't know, but I'm going to work on this for you. I'm going to figure it out. Like, good, Lord. Like, that's so rare. Do you know what I mean? Like, that's so rare and, and you think about, think about this.

I had a, and I had a, a personal injury attorney that told me the best, the best approach to not get sued is not to be an asshole.

I think that's pretty solid advice for anything. And. But he also told me, he said, you know what? Honestly, Danny, 90% of the cases that we have, with, with, physicians or surgeons would probably go away if they just apologized. If they just said like, I'm sorry, you know, this isn't a transmission. It's a human body.

Things happen. It wasn't intentional. It's my fault. I'm sorry. Do you know? And, but people don't do that. And I think that's a huge flaw. So how do you work on that with your students, how you work on this, sort of like education of communication and being honest and patient with them? Because I think it's so hard when you're first coming out of school.

Jay: [00:39:06] Well, a couple of things. From that, I think you hit a couple of good points, and one is that it doesn't matter how many manual therapy courses or certifications you get, you're still not going to get everyone better. Just because you're good at your hands doesn't mean you're the right person.

And I think. The best courses that you could take our courses and active listening and having a good conversation. He goes, some of the best PTs I know, or probably the most genuine people I know, which they could have a great discussion, they could talk about anything, and they listen. And that is basically what our literature supports.

It shows where, like almost all our manual therapy studies, the effects are short-lived, but a lot of our exercise research, the results are short-term, and the most significant things that we found are matching patient expectations and patient buy-in. So teaching clinicians and students how to have a conversation, how to have a relationship with your patient is very important.

And we talk about this in a lot of the ortho classes that the muscle classes that I, I, I teach, but it's also done throughout the whole curriculum. And one of the simple things is, Hey, can I get you a pillow? Hey, can I get you a glass of water? How was your weekend? Tell me about your daughter's dance recital.

Just asking these simple questions can help build a relationship and shows that you're caring. And caring is probably the best medicine that we could give in our profession.

Danny: [00:40:23] And well said. I agree. You know, and it's just, it's, yeah, it's, it's refreshing to hear that, to see, to see that firsthand and, and, you know, it's also so helpful, right?

Like we get to see these little miracles every day and a lot of it, we started to take a step back and realize that like, when we can connect with somebody on a, on a better level, on a deeper level, and understand why they're showing up in our office and the, and the, the real. Issues that they're dealing with and, and, and have a conversation with him about that and let them air their frustrations and, and express that verbally.

It's so beneficial and it, and it flips that switch from, you know, them not being sure if we're the right fit, then committing to what we have to do. And that's half the battle, man. So, you know, I, I love that you touched on that. I, I tell you, you know for me. I don't get into clinical stuff and PT stuff traditionally too much on this podcast.

I, you know, we try to try to Dell high dive into the business side more so, but I just loved it. We got a chance to talk about this stuff. I hope everybody, you know, finds value in this. They talk a little bit more about the clinical material and becoming an entrepreneur versus necessarily having to go out on your own and, and being an entrepreneur. I don't think you need to start your own company and be happy.

Starting your own company is. You are incredibly frustrated in the first few years. Incredibly terrifying. Do you know what I mean? Like you don't have to do it if you can find the job of your dreams that you get a lot of value out of. So, so for, for those people, you know, and just kind of parting shot of advice for them with, with people that are sort of frustrated in their thinking about, man, do I need to do my own thing?

Like, what's your advice to them to seek out opportunities to potentially become an entrepreneur? Whether it's with the company they're with or a different company instead of necessarily going out and doing their own thing.

Jay: [00:41:59] Well, the big part is you have to be happy, know that as a physical therapist, you could be working in any setting or you create your environment, you know?

Well, some PTs became know show hosts. Some PTs just do podcasts or some PTs that create products. There are some PTs that many different issues. So you've got to find out what's right for you, and you might not know right away. Well, when you figure it out, and you know what you want, go for it.

Take a risk, take a chance by yourself. I think that's one of the big messages that I'd like to get across. And the other. The thing is that we're always learning. You know, I'm, I'm in the field for 14 years now, and I still learn every day. I even make mistakes. I still fall, but I'll always get back up and, you know, knowing that not every day is going to be perfect.

That's a big thing. And burnout happens, you know? Burnout happens to all of us. It might happen for a long while, or it might happen for a day or here, but remember that our stresses with our jobs and you got to be able to cope. So having a life outside of work is very, very important, not just living and breathing your work.

Danny: [00:43:01] Yeah, dude. Well said, Jay, for people that want to reach out and connect with you, like where can they find out more about what you're doing and, and, reach out to you on social media or wherever the best channel is.

Jay: [00:43:11] Sure. on Instagram, I'm the craft manual therapist, and if you want to shoot me an email, J B Meyerson, M Y E R S O [email protected].

So the message my way, I'd love to chat with you.

Danny: [00:43:23] Cool. Well, Jay, thanks so much for your time today, guys. I hope you enjoy this. I hope this improves your clinical outcomes, gives you some things to think about in terms of becoming an entrepreneur. And as always, thanks for listening and we'll catch you next time.

Do you want more cash, PT, biz help? If so, get a copy of my book, Fuck insurance. It's your playbook—so successful performance, PT practice, and never having to deal with insurance again. You can get a free copy at Finsurancebook.com. Inside this book, you'll learn the direct techniques that we've used to become one of the fastest 100% cash PT practices in the country.

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