E832 | Where Is Physical Therapy Heading With APTA President Kyle Covington

Inside the APTA: The Future of Physical Therapy with Dr. Kyle Covington

Ever wonder what the APTA is actually doing behind the scenes?

You’re not alone. Most PTs have no idea what the organization does day-to-day—or how it’s fighting to fix the exact problems we all complain about: poor reimbursement, high burnout, outdated laws, and a lack of clarity about where we fit in the healthcare system.

In this episode of The PT Entrepreneur Podcast, Doc Danny sits down with APTA President Dr. Kyle Covington to talk about the real issues facing our profession—and where we go from here.

If you’re frustrated with insurance, curious about AI, or just want to know how PT evolves in the next decade… this is for you.

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What’s Really Holding Our Profession Back

The truth? We’re still playing by rules written for a different era.

Most PT laws and reimbursement models were created when physical therapists were seen as secondary providers—just following physician orders. Even though we know more, do more, and can solve more than ever… the system hasn’t caught up yet.

That’s starting to change—but it’s slow.

There’s no national policy fix. It’s 51 different battles in every state (plus the VA/military), layered on top of private insurers, Medicare, and old-school rules. And those rules? They’re not written with autonomy or efficiency in mind.

But Kyle and his team are working to change that—one law, one contract, one win at a time.

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Why Cash-Based PT is Exploding

There’s a reason so many clinicians are going hybrid—or going all-in on cash.

It’s not always about wanting to “make more money.” It’s about control.

Most PTs are sick of being forced to see 20+ patients a day just to keep the lights on. You can’t practice the way you were trained—or the way patients deserve—when you’re burned out and underpaid.

Kyle agrees: if you’re taking bad contracts, you’re letting insurance companies win.

That’s why he sees a silver lining in the cash-based movement. These clinics are proving something powerful: when patients understand your value, they will pay for it. And when clinicians are forced to explain that value clearly, everyone wins.

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How the APTA is Fighting for the Profession

Here’s what’s happening behind the curtain:

• Direct access is now legal in all 50 states.

• Aetna just dropped physician referral and plan-of-care requirements for PTs—impacting 27 million people.

• States like Massachusetts are negotiating up to 73% increases in CPT code reimbursement.

• The APTA is now at the table with major players like Google, Apple, and the AMA to shape the future of healthcare and AI.

That’s not fluff. That’s real progress.

But we have to keep pushing—and more importantly, we have to get involved. These changes don’t happen from the sidelines.

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Why Communication and Sales Matter Now More Than Ever

Here’s a truth most PTs don’t want to hear: being clinically excellent isn’t enough anymore.

Whether you’re insurance-based, hybrid, or fully cash—you need to be able to communicate your value. Kyle puts it best:

“Every PT should learn to advocate for their care like a cash-based clinician does.”

Selling isn’t sleazy—it’s service. You’re helping people understand why your care is the best solution to their problem.

If we taught this more in PT school, fewer new grads would be burned out and questioning their future two years into the job.

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The Role of AI (and Why It Won’t Replace You)

Yes, AI is coming. But no, it won’t replace physical therapy.

What it will do is:

• Eliminate hours of administrative burden

• Help document faster and more accurately

• Surface better clinical data in real time

• Enhance—but not replace—your clinical decision-making

Kyle sees AI as a “force multiplier,” not a threat. But we have to adopt it faster—or risk getting left behind.

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What’s Changing in PT Education

One of the biggest shifts is happening inside the classroom.

PT programs are finally leaning into:

• Emotional intelligence

• Patient communication

• Behavioral change

• Social and economic factors that affect care

These used to be “soft skills.” Now they’re essentials.

But there’s still a long way to go—especially when it comes to reducing the cost of education. Kyle says programs will soon be asked to prove not just educational outcomes, but patient outcomes as a result of their training.

That’s a major shift. And a needed one.

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Final Thought

We’re at a crossroads.

You can sit back, get frustrated, and hope someone else fixes the system. Or you can start being part of the change—through how you practice, how you educate your community, or how you plug into the movement.

Physical therapy isn’t going away. In fact, it’s more needed than ever.

But the future of PT will belong to the clinicians who evolve, lead, and stay human in a world of rapid change.

If that’s you—we’ve got your back.

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Podcast Transcript

Danny: [00:00:00] Hey, what's going on? Danny Matta here with the PT Entrepreneur Podcast, and today we're talking to Kyle Covington. And Kyle, you are, you do a lot of stuff, man. Uh, looking up your, your bio and your background and, and a little bit more about you. It's been interesting to, you know, kind of learn more about you, but you're obviously physical therapist.

You're a professor at Duke, and you are the reigning champ, A PTA president currently, uh, which is a relatively new position for you as well. So, um, I, I'm always interested, how do you, how do people like yourself intro, how do you introduce yourself at a dinner party? Like, you have a lot going on. Like, what do you tell people if you're meeting them for the first time?

Kyle: Oh, uh, well first of all, it is great to be here. Uh, I've been looking forward to this conversation, so, uh, thanks for having me. Um, I, I honestly, probably at a dinner party just say. Hey, I am Kyle and, and start with, uh, I'm, I'm a dad. Um, and, and I, uh, talk about my kids probably is, is the first thing I do before I get into any of the other stuff.

Um, and, and then the [00:01:00] second thing I would always say is I'm a physical therapist. You know, everything else, um, no matter what my roles are or have been, that's at the heart of why I'm involved in all the things I'm involved in. So I'm a physical therapist. Um, and you know, then if, if the conversation, the dinner party keeps going, um, I'll talk about my roles at, at Duke and, um, at A-P-T-A-A little bit more.

Danny: Yeah, the, the physical therapy intro is the way to go in my experience, because it's quite possibly the most valuable thing out of everything that you do. You know, not to discount education or work with the A PTA, but to other people. Everybody has an injury. You have an injury, you hurt your foot recently, right?

Like yeah. Like, and the knowledge base we have there, it, it, I've never really found myself in a position where I tell people I'm a physical therapist and then not had a follow up. Like, can you tell me why my wife's wrist hurt, you know, is hurt or something like that, or, so I think it's an incredibly like, you know, just valuable career field to other people.

Kyle: Absolutely. And I think it also, you know, everybody's got that experience with an injury or a [00:02:00] family or friend that's had an injury or they're just curious and it, it also always, I find, gives me a great opportunity to sort of, um, help people know more about what physical therapists do. You know, even if it's not practice I'm familiar with, I can always get them, uh, and help them understand.

We can probably help with that as a, as a profession, whatever, whatever it might be.

Danny: Yeah. And so, uh, looking up your background, it's interesting you went to, literally, you spread yourself across three different schools in North Carolina, which is maybe a smart move on your end, uh, to just diversify. Uh, but I think the only one you've left out is in North Carolina.

Uh, yeah, like Chapel Hill. Other than that, you've got 'em all.

Kyle: Yeah, I did my undergrad at Wake Forest, uh, university. So I was a health and exercise science major there. What, what feels like a long time ago now. And then I came and did my DPT degree at Duke. That was back when the DPT degree was, was very new.

Um, yeah, so I was one of the [00:03:00] first classes at one of the first programs to do that. Um, and then several years later, uh, I had joined faculty. Um, always kinda had an interest in, in more training. And so I did my, uh, PhD at North Carolina State University and that was in, um, educational research and policy analysis.

So,

Danny: yeah. Yeah. That's interesting. You know it, but then you went neuro, you, you became a neuro pt.

Kyle: Yeah, yeah, absolutely. So I was, um, I, I was interested in neuro, um, I got, I got involved in physical therapy as a profession because of a, of an orthopedic injury. Um, yeah. So I had, uh, I was in a farming accident, um, and farming

Danny: accident,

Kyle: is that what you said?

Yeah. I grew up on a large dairy farm in Central North. Oh, wow.

Danny: Okay.

Kyle: Um, so a lot, I got a lot of skills, uh, in dairy farming. Um, but I, um, I ended up in a farming accident, broke three of my four limbs in that accident, and, uh, subsequently had a lot of physical therapy. So I was a [00:04:00] classic story of, you know, an injury exposed me to the profession.

Um, but then I was mostly familiar with orthopedic care because of the clinic I had gone to and the care I had received. And then when I started doing sort of my observation hours, um, spent some time in a neuro rehab hospital and was really, you know, sort of intrigued by, uh, patients with spinal cord stroke, neuromuscular um, disorders, but always kind of enjoyed both.

So after school, um, worked primarily in neuro over in Winston-Salem first, um, at Novant Health Center. Um, but then ultimately landed as a neuro therapist in an outpatient orthopedics clinic. So, got a little bit of a blend there, which was nice.

Danny: Yeah. Yeah. I mean, so I, I guess, you know, for me kind of figuring out how you ended up where you are.

It's a ve it's starting to even sound even more kind of, you know, uh, undulating than I would've thought. Right? You go from dairy farmer to neurophysical therapist to then [00:05:00] professor, to then, you know, uh, uh, the, the president position at the A PTA, which, which obviously we can get into. But, um, you know, when, when we chatted, I don't even remember when that was, uh, maybe a month or two ago.

Um, I really enjoyed having a conversation about your perspective on the physical therapy school population, the, um, the, the, the things that students are seeing, the, the, the struggles that maybe they have, the opportunities they have, and being able to kind of see a snapshot into, you know, the people that are gonna essentially lead the profession, uh, in real time as they're going through school.

Right? And, and, and I really, I found that very interesting. And I want to, to have a conversation with you, not just about the A PTA, which, which I honestly don't know too much about. And I would say most people in our field probably don't. So this is probably a good opportunity for them to learn just like me, but also, uh, from the, the profession as a whole.

Right. Because, uh, for 15 years I've been in the profession, which is far less than [00:06:00] some people and far more than others. And even in the last 15 years, I feel like I've seen a massive amount of change. I'm interested in your perspective now that you've been in, let's say 20 years in the profession roughly.

Um, and some of that in school, some of that as an actual provider, and, and now in more, you know, an administrative sort of lead leadership position. Uh, what do you think has changed most about the profession over the last 20 years? And, and, and do you think it's good or do you think it's potentially not so great?

Uh, in terms of the direction that we're headed?

Kyle: Um, yeah, I mean, I think there's been a ton of change. Like, it's hard to believe, you know what, like at our core, we always have done the same things as a profession, right? We're, we're the profession that, that analyzes movement, like rehabs people back to performance and, and uses, you know, our hands and our brains and our heart to do that.

But then the way we've done it has evolved fairly dramatically over, over the century, plus then the last two decades, right? Like, I mean, just thinking about what we teach in our [00:07:00] classrooms here, compared to what I learned here at Duke, I, you know, 20 years ago is, is very different in a lot of ways. Um, I think the biggest changes have been the expansion of PT in other practice areas.

Um. Women's and pelvic health were just starting to be a conversation 20 years ago, and now it's one of the fastest growing areas in practice. Um, and, uh, sort of direct to consumer, direct to employer sort of practice models, cash-based practice models didn't really exist. And if they did, they were, they were rare and you didn't hear as much about it.

We were, we were a hundred percent insurance driven or, you know, not a hundred percent, but, but, but those other alternative sort of models of practice, um, weren't as pervasive and we didn't learn about 'em. Um, you know, in PT school, you know, other areas of practice, I think we've grown a lot in, um, as well as begun to see ourselves as a profession as a much [00:08:00] more.

Autonomous, um, answer not only to, um, injury rehab, but prevention and, and health and, and optimization and performance in ways that weren't part of sort of our training or our mindset even a couple of decades ago in the same way that they're now. So I think it's really, it's really exciting. Uh, to me, I think it, it's all good.

Like those, those areas of practice, I, I, I say a lot to folks, you know, we're a hundred year old profession, a little bit more than that now. Um, that's not that old in terms of the healthcare professions like medicine and nursing. Um, so we're a bit in our adolescence, I think as a, as a profession. And, and that comes with some, some growth and some rebellion and some, and some learning and, and challenge.

And I think, uh, that, that exactly speaks to sort of where we are right now as a profession. And I think it's exciting and, and all good.

Danny: Yeah. And, and I think ultimately trying [00:09:00] to figure out where we fit within the, the healthcare landscape Yeah. Is, is interesting. Right. And you even, uh, I was, I was reading some of your, uh, the studies that you've been a part of in one of those is, uh, can we learn in the same sandbox, in the sandbox together interprofessional, uh, case conferences as facilitation tools, which I thought was really interesting because, uh, I guess, you know, you can maybe elaborate that a little bit if you want, but it, it sounds like learning from each other with different healthcare providers, whether it's PAs, you know, orthopedic surgeons, PTs, you're just describing my time in the military.

Like this is, this is a, what we call troop medical clinic. Right? Like if I. If I had somebody that I was concerned with, you know, maybe there's some red flags showing up, I would just walk them over to the PA that was on the other side of the hall and then we'd have a discussion. Or if I wanted to talk to like the, the sports Med doc about an injection, I, uh, I thought, you know, maybe needed to, to happen as we were going through a plan of care.

I just would go over there and we would sit down and we would do collaborative learning together. And, and, um, and it was, it was really an enjoyable, uh, [00:10:00] place to work and environment. And I, I think what we're, what we're trying to figure out in the civilian world is where do we fit in a model that is not socialized?

The, the military is a socialized medical system and it has pros and cons. One of the pros is we can learn from each other. One of the cons is to incredibly slow. You pay for it with your time. Uh, but you know, like that, that collaborative effort, I think. One of the challenges for us is where do we fit?

'cause it feels like in some ways we step on other people's toes who don't want us to take a piece of their pie. Uh, and, and it can get very sort of, um, competitive.

Kyle: Yeah. You know, and absolutely your military experience. Uh, in a lot of ways it was really similar to my early practice experience 'cause I was in neuro rehab hospitals, so yeah, all the providers were right there together, like making decisions together around the patient and with the patient.

And so you were never more than literally a few feet from four other different provider types. And so like, that was just always natural to me for that interprofessional decision making practice, plan of care work. Um, [00:11:00] so, you know, as my career moved into different practice areas and it was, it was almost, uh, it, it was almost a learning experience to realize that's not necessarily how every PT practiced because, um, it because of the environments they're in.

I think it's, I think a couple of things, you know, that you touched on there. O of course we're better when we work with other people. Um, and, and then we, and then we all have our sort of defined areas of strength, but there's tons of overlap and I think we have spent a lot of time historically fighting for territory.

Um. And, and that got us a lot of progress as a profession. Um, it also probably caused some wounds, uh, with colleagues in, in other professions. And, and I've seen a real turn just in my advocacy work, uh, through a PTA through a PT in North Carolina. Prior to that, you know, in the last sort of, i'd, I'd say six or seven years, it started with the opioid [00:12:00] epidemic moved into COVID where professionals just sort of put the, the walls down and said, you know what?

There's, there's plenty of people out there that need us and need our care. And how about if we go after improving healthcare together for all of those patients, and then they're going to find the ones that best match with their needs, their mindsets, their, their frame of reference. So we have to continue to fight those battles to progress physical therapy.

But more so we have to, to sort of link arms, uh, with the other professions and just improve healthcare in general. Um, because there's, there's plenty of work to do and there's plenty of patients that need providers. And I think, you know, both at the patient level working together and at the macro advocacy level, working together in those coalitions is, is a huge benefit.

Danny: Yeah. And I, I think it's a, it's a very tricky situation, to be honest with you. I, I just [00:13:00] even look at direct access, you know, laws and, and, uh, I'm not sure how many states are complete, you know, like direct access. Many of them in Georgia being one of 'em as well is, is partial. I think we have 30 days, uh, you know, to, to see somebody or three weeks, whatever it is.

Um. But I always found that very strange. You know, whenever, when I left the Army, I, I took a massive step backward in the state of Georgia. Um, not, and, and I didn't really even realize, uh, what the difference was gonna look like until I started practicing, you know, in, in private setting. And I, I just found myself questioning, why is it like this?

Because I know like. We have decades of federal employees that have been able to work in a complete direct access setting, doing many things that you can't do as a civilian PT with no negative effects that, that I know of. Uh, you know, aside from maybe reduction of costs, uh, in the, the healthcare system.

So this is where I'm assuming, [00:14:00] you know, your work with A PTA and the things they do from the actual, like, you know, lobbyist side, the, the legal side, um, there's, there's gotta be a reason why they wouldn't want to have, you know, pt c people directly and in certain states they do, and others they don't. Um, and I'm assuming that just has to do with interest that other groups have.

Kyle: Yeah, I think in, in some cases it does. In some cases it's just history that has to be rewritten in the present. You know, I mean, I think, um, you know, our, our profession started at least in the, well, our profession started primarily in the military as a response to sort of World War I in the, in the polio epidemic.

But then as it spread into the civilian population, we were really. Historically a referral-based service, you know? Right. Physicians referred to us, uh, told the physical therapist the plan of care, and the physical therapist executed. So as the profession was forming all those laws, regulations, practice, acts, matched that model.

But as we've evolved as a [00:15:00] profession, it's not easy to change. Those laws change those regulations change insurance and payment requirements. And you know, that, that you have, we could talk all day about challenges in the payment model. Um, a lot of those flow from the fact that we were not an autonomous profession and we were a secondary service to a referral.

Hmm. Um, so it's sort of unwinding a lot of that history that's baked into practice acts, regulations, laws, and in a country like the United States where that's at a state level, right. We're gonna, we have to do that in 51 different. State and District of Columbia jurisdictions, plus the 52nd jurisdiction, which is the military and VA system.

Um, and then, you know, I don't even know how many different insurance providers we have that have their own regulations on top of the state regulations. So it's, you know, it's uh, uh, anytime we have those, uh, I have those discussions with people about like, how do we fix or [00:16:00] improve our advanced payment and practice in areas like direct access and referrals and.

Um, you know, another hot topic, uh, the last few years has been sort of prescriptive authority. In the military, you could order a limited set of, of, uh, medications and, and x-ray. We're starting to gain traction in several states in those areas. Um, but it's just, uh, it's, it's that old adage of how to eat an elephant in one small body at a time.

And, and that's sort of on these practice issues because they live and are regulated in so many different places. Um, it's not, it's not an easy switch to flip. I'll say, you know, with the direct access, um, we just got direct access in all 50 states last year, like, so it's been a, it's been a long battle. Um, and there's still improvement in a lot of states to, to sort of widen that access point.

A PT just released a sort of state of direct access, big report that sort of goes through that history, the where we [00:17:00] are now kind of thing. So, um, that's a good resource, but, um. Uh, but we're also starting to see that trickle now into payers. So, uh, recently Aetna just removed all sort of referral, uh, and plan of care restrictions in physical therapy.

So, you know, 27 million Aetna subscribers can now go directly to their PT without a physician referral, without a signed plan of care, without, uh, prior authorization. So we're starting to see that sort of mindset around us as a autonomous profession really begin to take off in sort of those practice and payment areas.

Danny: It's, it's interesting, you know, if you look at the cost of it, right? Like it seems, if I was an insurance company, like it would be a no brainer. You know, I mean, this, it's the reason why the military does, I mean, they, they're not going to, if you have a socialized setup, um, I. You know, our, [00:18:00] the, the surgeon that, you know, refers me an ACL patient to rehab or whatever, he gets paid to do his job, not necessarily based on how many surgeries he does or how many patients I see, or any, anything to that, to that, that nature.

Right. Um, but the, yeah, the cost effectiveness and, and even for me, whenever I got, I got assigned to a brigade, which is an interesting job because, you know, it's, they, they drop you into a group of about 3000 soldiers and they tell you you're in charge of injury prevention, injury treatment, and human performance optimization.

You do all these things, which is impossible. Um, and now they. I don't really do it that way anymore, but I was one of the earlier ones that got, got put in a position like this, and I could just quickly see like how valuable it was just for me to be there, like on site, right? And like in, in the mix with everything because of the speed at which we could make changes and things speed at which I could help, like treat patients and, and uh, you know, it's hard to justify or hard to know what the, the cost reduction is.

Um, but it was enough to where they continued to evolve that program. And, you know, I, I. I think if we prove ourself to be a [00:19:00] cost saver, it's a fantastic place to be. You know, I mean, I feel like PAs are already going that direction. Nurse practitioners, you're seeing these mid-level sort of healthcare providers because they're not quite as expensive.

They don't take as long to train up. Um, you know, I, I don't know if you see a similar trend and, uh, and what your thoughts are on the direction the PT should go, but for me, I, I feel like we're, we're cost savers, you know, and, and we're force multipliers in a lot of ways.

Kyle: Absolutely. And, you know, I think that's another thing that's different now than it was 20 years ago.

Going back to that question, we have a lot more evidence that what we've always known is true. Right? We've always known that we save the system money, that we save the patient money and time. Um, but now we actually have really solid evidence in, in the many diagnostic categories to back that up. And that's one of the things, you know, a TA put out a big value of PT report last year that goes in.

Very complex, um, statistical methodology to show the cost savings per patient, um, [00:20:00] across, uh, eight, I think, uh, musculoskeletal diagnoses that it's that kind of thing that's leading to these growing wins in direct access reimbursement payment. Um, because, you know, for a long time we knew it, but it wasn't quite enough to say, well, we know we save money.

Uh, you gotta have that evidence. And, and we're, we're really exponentially growing that now, um, which I think is gonna just continue to sort of take off, uh, in, in those ways that you're talking about. I mean, and I think we're seeing, um, seen as that sort of valuable money and time saver, uh, for the patient.

I think it's still a challenge to help the population know that, right. Uh, there's still a, a knowledge gap for a lot of people in what all we can do, but, um, but we're, we're making a lot of progress in that.

Danny: Yeah, I, I realized that there's, PT has a branding problem, and I realized this at a, I was actually, when we just moved back to Atlanta, um, my, my wife's, uh, stepmother, they was [00:21:00] right, we're at their house for some reason or other people there, and she introduced me to one of her friends and she's like, this is, you know, this is Danny.

He's a physical therapist. He's basically like, imagine like a massage therapist and a chiropractor mixed together, you know? And, and I was like, you just took like, oh, I, I was so offended. Uh, I was like, you literally took two other professions to describe my profession. Uh, you know, and, and, but that, that, that's the way that she described it, you know, so I think we have a real, you know, an, an issue, an identity issue in some ways.

Um, but we also have a reimbursement issue, and I think this is the, the reason that the work that we do has exploded as much as it has is not necessarily, um, for a great reason. It's because, you know, it like, if I could take insurance and get reimbursed what I needed to get reimbursed in order to have a lower volume clinic, uh, and not burn my people out.

Then I would do it, but the reality is I can't. Right. So maybe the steps that we're taking now are, will lead to a resolution there, if any at all. But what are your thoughts on how we get paid more by insurance? Because at the end of the [00:22:00] day, uh, that would be probably the, the greatest change that could happen within the profession to where we could, you know, really decrease some of the, the burnout that we see because of high volume.

I know you see that a couple years after students graduate. I see the same thing. Um, and uh, and, and we could really allow people to de decrease some of the out-of-pocket costs, uh, that they have working with us, which would be obviously a win-win.

Kyle: Yeah, I mean, I think it's one of our biggest challenges right now is the payment and reimbursement.

Uh, you know, it's no secret cuts have continued to happen, um, while costs have continued to go up and that just doesn't work, right. I mean, that's just basic. Budgeting. Um, and so how do we change that? Well, it's hard to get costs down. Um, so you gotta figure out ways to get the, the money and, and profit up.

Um, you know, it it, like I said before, it's, it's sort of that same as the direct access conversation. It's so complicated because some of that lives in federal [00:23:00] policy, some of that lives in state-based policy. Some of that lives in insurance regulations and policy. Um, so where do you attack? Um, and at the same time, we gotta prove our worth and prove our value and show the evidence.

Um, and so all those things sort of factor together in that conversation about reimbursement. I also think, you know, a piece of that is. We have to be better and consistent across the profession at practicing at a high level and, and, and showing we have positive outcomes. Again, we know we do. Yeah. Um, and, but, but that takes good documentation.

It takes, it takes, uh, practicing by, you know, evidence-based, uh, clinical practice guidelines and, and doing the right things so that we're getting the best outcomes so that then we can show to insurance companies. Um, no, see, like, I'm, I'm saving money. I'm doing it efficiently and, and quickly. Um, and then really that, that advocacy, uh, takes time, but it, it, [00:24:00] it pays off in the long run.

And, and we're seeing those wins. We're not seeing 'em, 'em as fast as I wish we were. Uh, everybody wants, um, wants, uh, quicker solutions to what's a really big problem right now. Um, but, but we kind of have to attack it on a lot of different fronts, um, because there's no one single. Place or solution to, to improving this problem?

Danny: You know, I, I feel like what you're describing is so complex. There's so many factors and, and I, I think this is one of the reasons why a lot of people and myself included, you know, we're, we kind of get to the point where we say, well, I don't really want to try to figure out the insurance game. I don't really want every, you know, all of my staff to have to see two people per hour, you know, at, at, at a minimum.

But I need to be able to generate enough money to have a business that can pay for them and, and overhead and everything else that goes with that. So we just opt out, right? Like, that's, that's what I did. And I see so many [00:25:00] people moving the same direction. Maybe not entirely, but so many insurance-based clinics that are moving to a hybrid models, you know, so many that are maybe a hybrid model that they're dropping as many insurances as they possibly can.

You know, and, and, um, I. I don't know if that pressure on the insurance, uh, the lack of providers that want to actually accept their insurance creates any positive change for the profession, but it's obviously trending that direction. How do you feel about that? Like, at a certain point if enough of us are just like, we're not taking, you know, sorry United, we're not taking your healthcare.

Like are they finally have to say, okay, cool, we'll have to pay you guys more.

Kyle: Yeah, I mean, um, I think it's hard to sort of face that reality, but if we take bad contracts. Then the insurance company has, has won, right? Like, and that's easy for me to say. I don't work in a private practice environment. My, my salary's not dependent on, on, you know, insurance reimbursement.

But we ha we do have a challenge, right? Because we've [00:26:00] been in a system that was nobody's fault really. Where you have, you need to, you need to have a livelihood, you need to have a profit, you need to pay your, your, your employees. And so. People feel like they have to take what's offered by the insurance companies.

Um, a TA private practice, um, you know, which is a, an academy within a PTA. They have a lot of really strong data now on where they're seeing improvements in and in PTs ability to successfully negotiate better contracts. So, you know, that narrative is changing a little bit too. And so we're seeing, um. PTs that have the, the resources, the training, the, the skills to negotiate those contracts are being successful, uh, on the whole.

Um, so we just need to help, uh, each other be more successful in those, in those negotiations, I think, which is, which is going to help us a lot. And, and, and it's even [00:27:00] happened, you know, uh, in some states, like Massachusetts, uh, as a state recently was able to sort of negotiate, uh, like up to almost 73% increases in some of the codes at a state-based level.

So, so, um, we're getting savvier and more skilled as individual providers as states and as a profession in being able to, to negotiate our worth on those contracts. You know, the thing that I think, um, is really. Positive about cash-based therapy. Um, I, I have students when we talk about payment models and, and reimbursement, that, and, and the question always comes up, well, you know, is cash-based PT better?

And I say it's not, it's not better or worse. PT iss great every, in every practice and, and payment model. What, what I wish every pt, no matter what their payment model or practice scenario had, was the ability that a cash-based PT has to have to sell the [00:28:00] worth of their services. Right. Um, I think if we all advocated to every individual patient about how worthwhile our services are, um, there would be very little question in the system and in patients and in the population about that worth.

Um, but, you know, practicing in the health system, I didn't, I didn't have to sell, um, my services and their value in the same way. That you do in a cash-based model. Um, and I think that that's a really valuable adv advocacy skillset. Um, is the advocacy we do at the individual patient level to help them and our surrounding communities understand our worth.

Danny: Yeah, that's an interesting point. You know, I, I think that, um, it's, it's a, it's a skill set that we don't learn in school. Uh, but you inevitably have to learn it. And ironically, we're pretty good at it. You know, like when I, when I teach [00:29:00] sales to, to PTs and, and you look at, for these. Underlying skills for somebody that's, that's gonna be good at sales.

You know, high emotional intelligence, being able to like, think on the spot, which we have to do constantly, you know, being able to document things, you know, to be able to follow up, understanding the

Kyle: person's needs and adapting. Exactly. I mean, it's, what we do is PTs, you know,

Danny: it's what we do all you're doing instead of, uh, submitting, you know, or giving them a prognosis and a plan of care is it's, it's whatever it is that you're essentially trying to sell.

It's the same thing. You know, you're solu we're solution people. Like we, we, we are problem solvers. And, uh, it's incredibly valuable, you know, not just in our profession, but just j the skillset in general. Um, you know, I, I think, I think the other big thing that, that I've noticed, and, you know. Like any profession, there's fantastic lawyers and there's not so great lawyers.

There's fantastic, you know, CPAs and there's like not so great CPAs. There's, for some people it's, it's what they do. It's their, it's their like art. It's their [00:30:00] thing that they love. And for other people it's their job and then they go home. Um, you know, I, you cannot hide from your outcomes in a cash-based clinic period.

People have higher expectations of you. You have higher expect expectations of yourself. You are, uh, your reputation's very important. And I think that is the other reason why we tend to feel like those, those types of clinics, um, have the opportunity to have better outcomes. And I, I, I think it's because you have to care more.

Uh, and not to say that people don't care more in high volume clinics, but I've worked in multiple settings and, and, um, yeah, I mean, dude, if I'm in a federal, if I'm in a federal hospital, I. It doesn't really affect me so much if it's my, if it's my clinic, it's my reputation. It affects me a massive amount.

You know, so, so I, I find the clinicians that are just like their, it's their art, it's their thing that they wanna be the best in the world at. They're their con ed nerds. They wanna learn nothing else but about, you know, the intricacies of foot [00:31:00] mechanics and whatever they're into. And they continue to wanna be a lifelong army.

Fantastic at that. They actually get very frustrated in such situations and settings where they can't use their skillset the way they deserve. It's like they've, it's like they've built themself, this Porsche, and they can only drive it in first gear, and they get really, really frustrated with that. They wanna actually put their skillset to a test and have the time and the bandwidth and the, and the sometimes complexity of patients that come our way, uh, as like last resort providers and they wanna see what they can do, you know?

And so I think that naturally some of those folks are gonna go there not for business purposes, just because they can't. Function the way that they want in a setting that, that they're in and they haven't been able to find that, so they kind of create this job for themselves.

Kyle: Yeah, I mean, I think, I think you're, you're right.

Like I think there's no bad practice setting. There's no bad model. Um, but we inherently each have skill sets and, and preferences that I think draw us into certain types of practice settings and, and models and patient types. And so I think different, [00:32:00] you know, a, a cash base or a one-on-one type model, um, appeals to a different person than a, um, multi patient, um, uh, you know, health system or, you know, uh, rehab hospital type of model may so, so I think you're right.

Like, and what I think is, what I think we don't do well as a profession is sort of alright, there are skills that might be more inherent and and helpful in those different models. I. But they could translate and, and, and, and make therapists in other settings be even more successful too. So how do we take that entrepreneurial, uh, sort of sales, um, and advocacy mindset of a cash-based PT and put it in the brain of an acute care therapist And, and how, how could that pay off for the profession and the patient there?

And, you know, the, the therapist that's in a model where they're, um, where they're managing multiple patients and triaging sort of [00:33:00] over the course of time. Well, that's a skillset. And so how does that translate, um, and what's beneficial about that skillset in a one-on-one care model? Because there's, there's things that I think would help us all out, but it's sort of hard to, to, to teach those skills across practice models.

If we could figure that out. I think the whole profession, no matter what the model is, would be stronger.

Danny: What's happening at the university level as far as, uh, you know, those types of skills are concerned and, and not necessarily obviously sales, but just communication in general or, or just like, uh. A friend of mine, uh, he wrote a book called Conscious Coaching, and it's all about the idea of buy-in, right?

Uh, and it's from an athlete perspective, uh, standpoint, he was a strength coach and he was kind of talking about these archetypes and how to do that. I found that information to be incredibly helpful for me to get, uh, buy-in on somebody, you know, wanting to actually like, do the work, uh, you know, compliance and, and, um, you know, making difficult, habitual lifestyle changes.

I mean, these are really challenging things that affect our outcomes as a [00:34:00] clinician. Right. So I haven't been in school in a long time. Uh, you know, it's been a minute. So like at Duke, what, are you guys leaning into any variation of that type of, um, you know, education or classes or is that something people are learning on their own?

Kyle: No, I mean, absolutely. I think going back to your first questions about what's different than it was 20 years ago, and this isn't just at Duke, I think it's education across the board. The, the way we teach around communication, uh. Integrating the patient's needs and what the breadth of those personal factors are into your care is like.

Exponentially more than it was when mm-hmm. When you and I went to PT school, right. Like when I went to PT school, um, it was listen to the patient and ask 'em what their goal is. Like. That was about as far as it got. And, um, and now it's what are all these factors? Economic, social, um, demographic factors, um, how do they influence their [00:35:00] outcomes?

How do they influence their care? What do you do as the therapist to influence those? Which ones can you not influence? And then what do you do about that? And, you know, what are you, what are your personal factors that are maybe influencing your patient with or without you knowing it? Like, all of that is content that they get and that they're assessed on.

Um, and that's actually part of a required curriculum now. So, so it's, um, way more. I mean, you know, working with humans is complex. And so I think we have, as healthcare providers, PTs in particular, really leaned into the complexity of the patient. And, and while we have evidence-based and clinical practice guidelines that I was, you know, uh, bragging about earlier, you also gotta apply 'em to an individual and all those different factors that they bring to the table.

And so I think the education around that is, is vastly more than it than it was when I went to school and maybe even eight years ago. [00:36:00] You know, I, there's been a big explosion in sort of, um, in, in that, uh, and even now starting, um, conversations around like. Gene genomic factors related to physical therapy outcomes, right?

Like we wouldn't, like years ago, we wouldn't have even sort of had that conversation. And now, like at that level, how is MyCare, um, going to sort of influence outcomes and then let alone like the infusion of, of digital and, and technology and ai, like that's the next big front. Um, yeah, we've gotten the personal factors now and now we're going on the digital side and how is that gonna be infused in our practice as, as an adjunctive and ethical and productive aspect of what we do as physical therapists.

Um, so all that's gotta find ways into, into training, um, you know, uh, and it's tough. It's tough to get all that in, in, in, in a couple or three years.

Danny: I mean. Dude, it's so much. Yeah. You know, [00:37:00] I mean, just, just, it's great to hear that, that, that, that transition's occurring. Um, I, I agree with you. Like when I was in school, it was, it was very much about, um, clinical prediction rules and understanding these sort of like more hard set, you know, I guess best outcome options that we had.

That, I mean, those, those have evolved obviously quite a bit over time. But, um, you know, I think everybody, you know, maybe they have different, different, uh, situations where they realize, oh shit, there's a human in front of me, you know, and like when that first person just breaks down on you, you know, or they, they, they start talking about something not related whatsoever to their, to their injury, but in actuality is a huge stressor in their life that you have a chance to like, you know, like at, at least listen to them about when maybe no one that's a medical provider has done.

So, um, that was not something that was taught to. To me at all. And it seems common sense, but I mean, dude, I went to the Army's program, right? Like, it wasn't like, uh, emotional intelligence was not a component of [00:38:00] that at all. But it's such a big part of outcomes and, and being able to build rapport with people and frankly, just working with human beings in general.

And I think it's also, it's, it's maybe the most technologically insulated thing that we have, uh, right now. Uh, is this sort of human to human. Understanding like the person in front of you being face-to-face and not faking empathy through a large language model, but actually truly, you know, being there and being able to understand somebody sope speaking of this direction, where we're going, which is the technological things that are happening.

And I mean, dude, it's a wild world that we live in. The speed at which things are changing, like how old are your kids?

Kyle: Uh, I'm about to have a high schooler and a seventh grader. So I have a high schooler is in driver's, like classroom driver's ed this week. And I'm, oh my god, wreck.

Danny: We're close. Like, so I have a, my son is going to eighth grade, my daughter's going to sixth, so they'll both be middle school.

Kyle: We a year apart. Yeah,

Danny: yeah, yeah. We're very close. And [00:39:00] I mean, just like the technology changes that I've seen with, with, with what they use in school and access to things, I'm, I'm sure it's, who knows what it'll be five years from now. So how do you feel about artificial intelligence development in particular with physical therapy?

And where that's gonna fit and potentially where that might even create competition for what we do.

Kyle: Yeah. I mean, you know, uh, I think we all are, are recognizing or, or recognize that, that the horses left the barn on ai, right? Like it's, it's here and, and we either sort of figure out how to work with it or.

Or risk some real problems. And so I think, you know, something at a TA, we're doing a lot of work in that AI front, like, uh, A-A-P-T-A has joined, um, and is sort of a founding member of a nationalist, um, of, of NAM and their AI work. And, and so like we're, we have a seat at the table with the A MA, uh, the PA association, [00:40:00] the family practitioners as well as like Google and Epic and, and Apple are all at the table around what's tech and AI going to look like in healthcare.

So that's an exciting table to be at as a profession and as an organization. And so, you know, I think APTAs take, and, and my personal take is, um, artificial intelligence can't replace. You know, what's sort of endemic to us as a profession, but it can likely be very helpful in things like reducing administrative burden, um, getting us quicker, more evidence-based answers to diagnoses we haven't seen or haven't seen in a long time.

Um, you know, helping us frame our notes and our reimbursement codes and, and our things to optimize those types of things. Um, so that, that administrative side of things, I think it's gonna be hugely successful and, and we're already [00:41:00] seeing some of that. Um, now that, that said, we also have to wrestle with.

It's, it's developing so fast. Like what are the ethical implications of it, right? Yeah. Like we've gotta make sure that the patient's privacy is protected, the therapist's privacy is protected, the, um, you know, and that we're using this in the right way. Uh, but as, as a historically hands-on profession, I'm not worried that we won't be.

Um, but I, I do sometimes hear therapists say, oh, tech or digital, or ai, that's not what we do as physical therapists. And my take is, you know, we gotta evolve and, and find the right ways to be a part of that wave, or we, or we risk getting left behind.

Danny: Yeah. You know, it is interesting that you're seeing that from such a high level perspective because, I mean, these.

These technology companies are massive and healthcare is a huge area of, uh, potential investments. [00:42:00] And, and it's quite archaic in a lot of ways too. Um, you know, and, and applying technology to smart providers is, uh, and in a couple ways obviously can make us better. You know, I mean, I, I think. Legitimately, uh, in the next, I don't know how many years it's gonna take, but at some point there's probably from, from a, from a, uh, a physician standpoint, it will probably almost be like malpractice.

If you don't have a secondary, you know, AI software that is, uh, overlaid what you're doing, you know, especially in radiology, it's already happening. And so, okay, cool. So that means we're right more often that that means that, you know, we're staying on top of current evidence, which can be hard to do if you're practicing in, in real time.

I mean, shit, man, you might, in your glasses, might be able to help you analyze somebody's squat patterns and, and realize how much hip and rotation they have on one side versus the other in a, in that pattern. Right. That would be awesome. I'd be like Tony Stark, uh, a physical therapist. That sounds super cool.

And I, but, and, and I think the mundane, we put our jobs and

Kyle: develop that right now.

Danny: Yeah. Yeah, dude. I mean, it's, it's, uh, I I'm [00:43:00] sure somebody, somebody's working on that, I'm sure. Yeah. Oh, dude. I'm sure. Like we have a, we have an ai, we. Uh, scribe tool that we developed for physical therapists, which is amazing, and we're seeing that it's saving, you know, an hour a day if you're, uh, a cash based provider.

More than that, if you have, uh, an insurance, uh, caseload because of the administrative burden and who, who wants to do that, right? That's none of us

Kyle: got into this job for that aspect of it.

Danny: None. And, and, uh, but it's an for evil, right? I mean, you know, yes, for sure. I totally understand why we have to do it, but it does add to burnout.

I mean, for a lot of people, especially doing that after work or on the weekend, so, okay, cool. We can take some of that stuff away. Here's what I will say about our profession, that's been very interesting to see. We are very slow to leaning into technology, like painfully slow to lean into technology. It's shocking to me how, how much we have to try to like.

Position technology that could benefit the profession or an individual. And they're just, they're like, no, I'm good. I'm gonna still write paper notes. You're [00:44:00] like, what? Like, I remember the difficulty of getting people to go from paper to a computer, you know, and, and it's like, it's almost like I've, I see it happening again.

Um, but, but. In some ways, I do think that there's gonna be some disruption with people being able to get a diagnosis. If they want to try to do some sort of rehab plan on their own, I think they'll be able to get a fairly good one. Uh, it's just a matter of whether they have the actual, like, you know, discipline to do it and if they're gonna do it, uh, correctly.

And, and all these, I think there's a place where that happens, uh, tech enabled, you know, uh, treatment of, of, of some sort. But I think it'd be very hard to replace the hands-on and the person to person, uh, side of what we do in any meaningful way anytime soon.

Kyle: Yeah, and I mean, you know, PTs only pro physical therapy is only provided by a physical therapist, physical therapist assistant, you know, like it, it's, it, it has to have a licensed professional involved.

So if it's an AI generated rehab protocol, that's not physical therapy. Um, but if it's [00:45:00] a rehab protocol that's a combination of the knowledge, AI can glean quickly and effectively. Supervised by and tweaked and, and applied to all those individual patient factors by the physical therapist, then, then that gives us a lot of potential to be even more effective.

Uh, save even more costs, uh, have better cases. You know, tying, tying all the previous conversations together, Ty having better case for re better reimbursement, like all those things. Um, I think, I think we just are on the cusp of understanding, um, how helpful that can be. Um, and, and I'm really excited that aps, uh, part of that National Academy of Medicine group because I think that's really putting us at the forefront of some really impactful discussions.

Danny: Yeah, it's, it's interesting. Um, and the profession feels insulated in some ways. Like I. I'm not sure our, our kids when they're of working [00:46:00] age, I'm not sure with the employment landscape how much it will change. I think it's gonna change in a, in a significant way. Um, and I, if my son was like, dad, I really want to be like a software developer, I would probably tell him, maybe, maybe pick something else like that is, uh, that, that, that is something that is, um, starting to become less and less necessary.

Uh, you know, some of these more tech based, uh, traditionally white collar jobs, very interesting to see what's happening. Even like I have family members that work at Microsoft and SalesLoft and, uh, and, and, and, you know, friends whose family works there and things. And, and I'm seeing these massive cuts in, in jobs in these more technical or, um, you know, traditionally computer-based jobs.

And it's gonna be interesting to see if physical therapy actually becomes more popular, uh, for people to go that direction. I mean, what would you tell your kids if your kids are like. Dad, I want to go, I'm going to PT school. It's what I want to do. Like what, what's your response?

Kyle: I mean, my daughter says that.

We'll, we'll see if it [00:47:00] sticks. Oh funny.

Danny: Okay.

Kyle: Uh, she's starting to, to look at other options. Um, but I would tell her, you know, great, you know, I, I think, I think the profession she will enter will be really different than the one I did. Um, yeah. And, and I think that that's exciting. It's gonna come with a lot of work that, that we have to sort of.

Affect change in these challenges that we've been talking about. But I, I'm with you. Like, I think, I think we're going to draw, um, different interested sort of types of people than we have in the past. Um, I think as PT becomes more pervasive in society, it's gonna open the doors for different types of people to seek that out as, as, as a profession.

Um. We have to sort of solve the challenges of cost of education and, and yeah. Um, reimbursement and earning potential and, and all those things. But, [00:48:00] you know, and, and a, a lot of the work you're doing and, and, you know, we're really finding more and more ways to help younger or, or younger or newer clinicians or clinicians in a stage of their life where they're wanting to sort of grow, um, their practices, be really effective and, and financially productive doing that.

It's not easy. Um, and you know that better than I do, but it's, uh, it's possible. And so I think that, um, I think there's so much potential, uh, as we sort of if move through what I call the adolescent phase of our profession, uh, before, um, so yeah, I, I would, I would not dissuade her from doing it.

Danny: Sure. Well, the, the cost is the barrier, right?

I mean, uh, it's funny, my son said something about it and. I, I just told him how the duration of time he is like, wait, three years after four years, seven years, you know, he was, he is like that math. I'm good. Uh, he says, I don't, [00:49:00] I don't know if that's, uh, gonna be in his will, if he's gonna be interested in that one day or not, but the cost of it is legitimately, uh, uh, a barrier for so many people.

I mean, to, to think, and I, I, I don't wanna mess this number up, but I believe it was around $150,000 is what the, A PTA, uh, states is sort of the average, um, cost. And I believe that's undergrad and grad school, uh, uh, total. That might just, that might just be PT school. You might know better than, than me. Um, but all in, let, let's say you're around that to, to be able to practice and, um.

You know, entry level, maybe you make half what you're taking out in debt. You know, like, I think that's a hard pill for people to swallow. There's, I, I don't know if I can name another profession where you come outta school that much in debt and you're making, you know, that, that starting income. I even, a friend of mine's an attorney and she was, you know, she was, uh, comparing what she paid for law school, for what she started out as a lawyer her first year.

And it was significantly different than, you know, the, the percentage of income that we have compared to the debt that, that we take out. So I don't even know what the problems are there. I mean, you're in education, like, [00:50:00] why is it so expensive? I, I feel like I. Do we, do we need three years? Do we, do we need, you know, like, uh, all these additional costs?

Like is it, is, is education the next thing that's gonna get, you know, really, um, turned on, uh, turned upside down with, with, uh, with AI and having like a AI professor, you know, that, that understands everything physical therapy related. And is the most patient professor ever created? Like, I don't know where that's gonna go, but I feel like the cost is prohibitive.

Kyle: Yeah. And you know, I mean, higher ed finance is like a whole, like I work in higher ed, I have for years. It's comp, it's, I mean, you don't wanna talk about complicated. That's complicated and yeah. Um. And, you know, the, the influence of research funding, you know, grant funding, tuition dollars, state-based versus private for-profit versus not-for-profit.

Like, all of that has, it factors in all the different types of financial aid, scholarship, money. Like, it's, it's such a complex, um, [00:51:00] environment. You know, as far as the future of education and how to save cost, um, it's hard for me to predict, uh, especially right now. 'cause so much is changing sort of in the, in the regulatory environment around, um, around that.

I've been saying for years, not so much about, um. The cost, but about the outcomes. Like, I think where we are is we're really, we're, there's been signs for the last five or six years decade, but I think we're really about to, my, my crystal ball prediction is there's gonna be a much higher expectation to prove outcomes of education.

Um, uh, you know, ironically education's been, been kind of protected from that. It's sort of been like, here's your diploma, you're good to go. Yeah. Um, in, in our instance as a profession, you pass a licensure board. So check. Um, but I think institutions and programs, um, there's gonna be a, just like we saw that wave 10 to 15 years ago, begin with outcomes in [00:52:00] healthcare.

Uh, and that's only gone up. I think we're gonna see that wave only increase, improving outcomes in education. Um, so. You know, it, it's, it's the same question like, is, is if you prove your outcomes, do you prove the worth? Um, in, in a different way? It, I don't know. Right. And, and it's always been hard and I'm a, I'm an ED researcher.

Like it's always like the sort of silver bullet in educational healthcare research is showing that not only your educational outcomes good, but your educational outcomes lead to better patient outcomes. So, you know, I think we're gonna start to see in the next decade a much bigger expectation for academic programs to prove what they're doing in the classroom.

And labs and clinic improves patient care. Um, and that's hard to prove, but I think there's gonna be the expectation to do it. [00:53:00]

Danny: Yeah, that's, that's really interesting. Um, you know, it, it, these are all like. It seems like there's so much change happening Yeah. At once. Like, does it not feel that way? I feel like I'm in, uh, oh.

I

Kyle: feel that way. Especially in this role as amputate president.

Danny: Yeah, I bet. I mean, good timing. You pick the, you pick, you pick the right time. I, and, and I don't, I, how do you decide what to focus on? You know, because I feel like, well, there's, there's, there's multiple things. Like, you know, you're, you're still teaching.

Obviously you have your family, you, you have, maybe you have hobbies. I don't even know if you have time for that. Uh, you have this role as a TA president. Like what, how do you juggle all of that?

Kyle: Well, well, the recently broken foot ended some of my hobbies for a little while, but, um, uh, how you break it, by the way, what happened?

Oh, well it turns out, is it cool or no? It turns out I'm not in my mid twenties. Um, I, I went, uh, to an indoor rock climbing wall for the first time ever and didn't stick the [00:54:00] landing on the way down. This is the short story, but, um,

Danny: oh no. Yeah.

Kyle: But, um, but, you know, my exercise, hobbies keep me sane from all the other stress.

Um.

You know, I think two things I think of right when you said so much is changing right now and you're, you're exactly right. I'm not sure that we've ever had so much changing so fast within the profession. Um, so we can either be stymied and paralyzed by that, or we can be invigorated and excited by it.

And I choose to be invigorated and excited about it and fully recognize not everything's perfect. We got a lot of work to do to continue to make improvements. But we've got change as a momentum and a catalyst right now, and we gotta capitalize on that. So then where do you focus? Well, I mean, I could bore you with the details of how a PT A comes up with a strategic plan and we're about to release a new one in 2026.

Um, [00:55:00] that's how the organization prioritizes. Um, so payments a big one. Uh, investing in members is a huge one. Um, and advancing practice will be some of the three biggest priorities of the organization. But within those priorities, there's an infinite number of ways, like I said, that eaten that elephant that you could attack those three big problems.

Um, so, you know, it's, it's a lot of, a lot of, um, a lot of good leaders, a lot of smart people, a lot of dedicated staff that are. You know, doing what we do at the individual patient level, which is researching, figuring out the right way to solve complex problems, setting good goals, going after it, um, uh, listening and learning and, and, and adapting.

And I think that's really what's gonna get us there.

Danny: Yeah. How did, how does somebody become the a PA president? Like, do you have to get voted in? Is this, uh, you know, like what's the process?

Kyle: Yeah. Um, I mean, the, the, the sort of, the [00:56:00] end of the, the end of the process is an election by the A PA House of Delegates.

So there's a, uh, there's a process by which you, you seek nomination from the National Nominating Committee. They form a slate of candidates that are qualified for the role, and then the A PTA House of Delegates, which is made up of, uh, representatives from every state and academy, um, vote. Uh, so that's, that's sort of the end process.

I mean, I, I, and, and everybody comes at these roles from a different sort of. Background and skillset. I, I, um, I had a lot of other sort of leadership and service roles within the organization and obviously within my, my day job. Um, which I think built my skillset and built my confidence and built my interest in seeking that role.

Um, but it's an interesting job and it's a, it's a complicated one for sure.

Danny: So like, do you have to, do you have to like lobby for the, like, are you like running a campaign to like, vote for Kyle, [00:57:00] here's what I'm gonna do for you? Or is this, is this more like conclave like, I dunno if you've seen that movie, like voting for you behind the scenes, you know, I dunno, it's between

Kyle: those two.

No. Um, so it's, um, yeah, there's no white or black smoke coming out the, there's, um. There, there is a sort of a candidacy phase process, uh, but it's not like campaigning like, you know, like what we think of in American politics. It's, it's a pretty structured, um, sort of written statements, recorded interviews, uh, and documents that you provide to the delegates, uh, that they review, uh, and then vote.

So, um, it's, it's less, um, of the like one-on-one political campaigning. Um, historically there was, there was some of that in the organization, but it's, it's moved away from that in, in the last decade.

Danny: So, I know you guys run a number of events, but CSM is a behemoth of an [00:58:00] event. Yeah. Um, how hard is it to pull that thing off?

Because, you know, we run, we run events with like 200 people at 'em, like twice a year, and it is a huge, it is a huge thing to, to pull off. I can't imagine, you know, I don't know how many people came to the last one, but I'm assuming it's. 10. Yeah. The last

Kyle: couple years it's been around, um, it, it's, it's ranged the last couple years between 14 to 17,000.

Just before COVID. We were at 19. We, we thought in 2020 we topped 28,000. But, um,

Danny: yeah, obviously, oh, I was there. That's the last one that I went to in Denver. Right. Uh, but, uh, yeah, what I mean. That must be a massive lift. Like how many people on the APA APTAs team work on that? You know, one event, it's once a year.

So like what, what does that look like?

Kyle: I honestly don't know the numbers. And the thing about combined sections, meaning that's, that's really wild and I don't think people really recognize is it's actually 18 different small conferences within one umbrella. Big conference. Because each of those 18 [00:59:00] specialty academies of a TA is a stakeholder in combined sections meeting.

So they're all sort of running their own three day conference with their own programming and their own meetings. And then it's just all happening in the same place with some overarching A PTA events and a PTA support in the exhibit hall. Um, so it's a shared. It's a shared financial and management model of A PTA and the sex and the 18 specialty academies and sections.

I, one of the jobs I had at A PTA for a few years was as one of the combined sections, programming chairs. And that, that's a job. Um, yeah, I mean, and it is work. Uh, so it's, um, uh, but it's, you know, you have volunteer leaders that are helping determine and, and deliver the programming. You've got permanent A PTA staff that are in sort of the meeting planning department, but CSM is not the only thing they do.

They're doing other major, uh, major and minor events throughout the year. You have staff from each of those [01:00:00] 18 specialty academies, and then there's contract staff that come in for those four or five days. And then there's local, you know, support from the convention centers and the hotels and the, um, I mean.

I and a lot of a PTA staff, you know, a PTA as an organization has about a hundred and forty, forty five full-time staff in Virginia's. Um, most of those are not in meeting planning. Um, they're in a lot of other departments, but for three or four days, a big chunk of them get deployed, sort of to, to combine sections, meaning to do jobs that are not their normal sort of roles, uh, for those three days to support that event.

But yeah, it's a, it's a big one.

Danny: Well, um, this year, or I guess not this year. 26, uh, Anaheim. Right? Um, yeah, that's, that's gonna be the next, the next one that I go to, I haven't been since 2020. Um, I plan on being out there with, uh, with my, my buddy Kelly Stare, [01:01:00] uh, shout out to him. By the way, I have had zero to do the A PTA since I was a student, to be honest with you.

I, uh, just didn't really, I don't know, didn't do anything with it. If I was gonna do con ed hours, I would usually pick something specific to what I wanted to learn, or a mentor that I was trying to learn from. And, uh, you know, to, to have somebody like him or someone like our friend, Meg Brown, who's gotten very involved and has, has, uh, very positive things to say about the direction of the A PTA, like that, that those two people, their opinion means a lot to me.

Um, you know, it's, it's been interesting to, to get to, to know you a little bit more and your philosophy on things and, you know, I'm, I'm. Very optimistic for the profession. It sounds like it's, uh, it's trending in a, in a interesting, in a, in a positive way during a very interesting time. Uh, you know, so it's, it's, it's gonna be interesting to watch from, from the distance wall or you, the heavy lifting.

I'll sit back and critique it. Uh, yeah. You don't go watch from

Kyle: a distance. We'll, we'll, we'll take you, we'll take you a

Danny: Sure. We, we can go grab dinner, uh, in, uh, in, in California. I'm, I'm good for that. [01:02:00] Uh, or if you wanna talk squat mechanics with Kelly and actually don't know much about that shit anymore, I pretty much just talk business.

I might need some

Kyle: help with that after my, uh, my, yeah, you might,

Danny: you might. Ironically, I almost broke my ankle the other day too. I was skateboarding and my kids, my wife's like, don't skateboard down the house. Like the, the street in front of our house is steeper and I'll skateboard in the school parking lot across the street from us.

So I was like, feeling good. You know, I, and I'm, I'm carving back and forth and I hit basically like I. It was a small rock. And next thing I knew, I'm like off my board and I tried to put my foot down, but I put it down and it was still pointed down that my shoe caught it, and I almost like snapped my ankle and I was limping around for a couple days and it just, my reflexes are not what they used to be.

And it's a, it's a sad thing to realize. Yeah. Uh,

Kyle: you know, yeah, it is because I, it doesn't feel good. I still feel young and strong, um, but just didn't quite get the feet in the right position when I landed.

Danny: But no, luckily for me, I, uh, I avoided, uh, uh, you know, a more significant injury, but, um, but no, I'm, I'm excited to, to hopefully get a chance to meet in [01:03:00] person and, and I appreciate your time.

I know obviously you have so much going on. Uh, so carving out an an hour to have a conversation with me about this stuff is, uh, you know, I, I, I really appreciate it. I hope people that listen to this, uh, you know, appreciate the conversation as well and have a better idea about like what the AP a PT is doing, because, you know, there's a lot going on.

Um, you guys are getting into so much stuff that helps the profession and I think in a lot of ways I. We kind of don't really know the average, I would say the average PT maybe has no clue exactly what's going on the a BT 'cause there's, there's so much that's happening.

Kyle: Yeah, no, I, I, again, I, I really appreciate the opportunity.

It's a fun conversation and I think you hit on it like that. That's sort of my bottom line message is, is it is an interesting time, it's a complex time. We've got really complex challenges. Um, in healthcare and as a profession. Um, and that's why on the surface, it, it's hard when you're sort of just watching and feeling frustrated and wanting improvements in, in all the same places.

We all want improvements. Um. The, the, [01:04:00] the, the problems and the challenges are so clear and the solutions are so complex. And that's why it's, it, we've all got to work together, um, in, in, in a multitude of different ways. There's the stuff I do as a PT president, there's the stuff you do, you know, with your individual patient.

Um, but that's all sort of gotta move us in a cohesive direction to, to solve these really complex, um, but clear challenges. And, you know, a PT is working on all of that. And I think, um, you know, we take, we take flack and we take criticism, but, uh, yeah, but we also appreciate the passion that, that everybody in the profession has.

Um, and, and I think my message is always like, we're working on it. We hear you, we, we know. Um, and, and we're really tackling these complex issues on, on multiple fronts all the time. And change is happening, um, not as fast as we would all want it to, but we're committed to, to playing that long game and. And, um, continuing to make, uh, [01:05:00] to make this a really successful and and fruitful profession.

Danny: Yeah, it's a, a great conversation. I really appreciate it. If people wanna learn more about a PTA or kind of find out more with, with what you have going on, what's the best place for them to, uh, to go?

Kyle: Yeah, I mean, obviously the website's got a ton of information, a ton of resources. There's, there's tons of resources on there that are.

For anyone, not just members. Um, so that's a great place to start. Um, you know, I think, I think that's such a surface level view of what the organization is doing. I would say, you know, find a way or a person or a member to plug in personally with, uh, whether that's at the state level. If, if you're sort of really interested in that advocacy kind of thing.

A good place to get plugged in is at the state level. That's where a lot of that grassroots sort of change is happening. We're seeing huge wins across the board. Like we're, we're having state based wins. Uh, rapidly and like never before in the history of the organization right now. So that's a great place to get plugged in.

It's sort of specialty practices your area get plugged in, in, in your [01:06:00] academy, you know, whether it's orthopedic, sports, private practice, um, you know, and the list goes on and on. Um, that, that's a great, but I think that finding somebody that you can connect with, talk to, um, and, and get that personal, um, personal in to find how you can best fit and, and find sort of your community within this huge sort of organization is, is really important.

Uh, you know, reach out. Uh, I, I don't think you'll ever be told, uh, no. Or, or we don't have a place for you to contribute.

Danny: Yeah. That's great. No, that's, that's, that's, that's a fantastic way to end it. Uh, Kyle, thank you so much again for your time. I really appreciate it. And as always, thanks so much for listening to the podcast.

Thank you. Thanks.