Monday, March 30, 2015

Academic Endurance, Term After Term...

I think it is more than fair to say I've done enough school in my life. Having experienced upper education thrice, all different fields and industries, I figured this is a good time to write such a blog as the experiences remain fresh.

And so, I'm proud to share....!

Academic Endurance, Term After Term...
  • First 1-3 weeks are always awful...
    • And, I mean REALLY awful. This typically occurs because you're getting used to the term, the time in life, any changes, a new professor, and an entirely new topic at hand. The rhythm is all different and feels like you're completely off beat. You'll get through it. Take the first 1 - 3 weeks as a time to smartly gauge how the professor is going to teach, grade, and structure the course. What is going to be important? What isn't? Where can you save time? This will get you a nice big step ahead of the curve. Nevertheless, if you feel life sucks and its still week 3? It's okay. It's about to get a lot better.
  • Rent books, don't buy.
    • I cannot believe that I spent the better part of 12 years of my life in school not knowing how awesome some of the textbook rental companies are. While I'm not officially endorsing any single one of them, I can tell you that Chegg has been amazing to me, personally. It's way cheaper and we all know that we are all NEVER going to look back into our text books... not the majority of them any way. Also, PDF rentals are nice too, the access allows you to bookmark and word search the content to quickly get to what you need to find.
  • Summer terms will always suck.
    • Summer terms are typically hyper-accelerated and condensed. You're stressed. People around you are stressed. Your professor is stressed. It's just a lot of stress in a very short amount of time. I wouldn't advise taking more than two courses of full weight in a summer term. More than that can be a little crazy, if not damaging.
  • Do your essentials, then run around.
    • Some aspects of academia are essentials, others are fluff and busy work. Do the essentials first, then run around and finish off the details. This is really helpful when you have 4 or 5 classes that have nothing to do with each other. This forces you to tack down the tasks (say projects, homeworks, or studying for exams) that you absolutely must do before you deal with some of the less critical pieces of content.
  • Work hard/play hard.
    • It's therapeutic ;) Is there anything else to be said? :)  Okay, I guess just my quick share. During my DPT student years, I drove from Los Angeles to San Diego and back, every single weekend (2-3 hour drives one way). I would surf on Saturday mornings and spend as much time relaxing with family and friends as I could. I literally did almost no studying during the weekends. I know some people have called me crazy; crazy for driving that much and far all the time and crazy for never studying on the weekend, but hey! I did pretty well!
  • Group projects, be selective if you can.
    • Groups can make or break you. Doesn't it always feel like you're the hardest working one in the group? And, if you're EVER lucky, the group dynamic feels like everyone's mind is in sync like the Borg? This is likely a psychological effect based on communication preferences. Nevertheless, try (if you are able) to select up the best team members, particularly ones you've worked well with in the past.
  • NEVER do more than 1 numbers course at a time... unless you're a numbers person or are studying numbers.
    • I had to take accounting and finance together for a summer term in the completion of my MBA. All I have to say is, DON'T DO IT! It was one of the most grueling terms I've ever experienced. Not only was it a summer term, I put two numbers based courses together. It was awful. Now remember, I have an engineering background so numbers are familiar to me -- it's just that I think the human brain can only stand up to so many numbers. Now if you are a concentrating/majoring in numbers, well... you asked for it. Otherwise, if you have the choice. Don't do it!
  • Take advantage of vacations.
    • As the final piece of advice, I can't stress enough that it is best to take advantage of any breaks in academic calendars. Whether its Spring break, three day weekends, around Christmas or Thanksgiving, summer time... what have you. Make sure you rest and recuperate. Studying is like a job; there is such a thing as burn out. Preempt that by taking staycations, vacations, road trips, or even just as simple as giving yourself a weekend off. Maybe, even a just a well deserved day off...

Some Closing Thoughts
Academia is becoming longer and more intense in all directions. PTs used to be registered, then they got a bachelors, then a masters, now a doctorate. Physicians used to just go to medical school, now they need a bachelors prerequisites, take the MCATs, get the MD, go through post-graduate residency, and for many, fellowship. It's getting crazy. All that said, one must truly have a healthy habit of academic endurance in order to make it that far.

Keep the goal in mind. It helps knowing there's a finishing point and a purpose to it all. Be sure you rest, relax, and play. After all, life isn't all work. Find a balance. Take up a physical hobby such as martial arts, hiking, surfing, running, swimming, what have you. Also, do your best to eat and sleep healthy. I know.... I was there too.... sleeping 3-5 hours a day and eating nothing but ramen, canned foods, and when desperate, cracker (or rice) and ketchup. We've all been there.

Perhaps the best advice I can give... find a mentor. Mentors don't have to be proper, formal, nor official. Just someone you trust and can identify with... someone you can communicate with and even vent to. This person could be family, friend, upperclassmen, a minister, or even someone already in the profession. This person can serve as your guide, sanity check, and linchpin when you think all is lost. It's good to know you don't have to face hard times alone. If you can find a mentor, do it. It's a lesson I wish I learned earlier.

I hope you enjoyed this special, student oriented post!

As always, I remain yours in service,

PS. My wife has made me vow against any more schooling.
I've agreed.

Sunday, March 29, 2015

Taiwanese Style, Stewed Pork and Rice

Otherwise known in the Mandarin Chinese pinyin as "Lu(3) Rou(4) Fan(4)," this Taiwanese home style comfort dish is perhaps a ubiquitous growing up staple for likely anyone with cultural heritage to that region of the world. Perhaps the pork version of chicken soup or even pickled pork, beans, and rice in the south, Stewed Pork and Rice is typically best made by one's grandmother. Usually some secret combination of ingredients plus years of masterful improvements and decades of care is the only way to really make this dish truly perfect. Well, it was high time I tried my hand at it.

This is how it went down....

Taiwanese Style, Stewed Pork and Rice

I started by chopping up onion's into 8ths, smashed garlic, chopped up some leek, and made tiny cubes of potatoes. While this may be a more American take to the situation, I figured the aromatic flavors added would be nice. I also put in some Chinese cooking wine and ginger while I sauteed all the aromatics with a light layer of butter.

Then, I took up an advice from my mom to blanch the pork in water with splashes of vinegar and cooking wine; this is apparently a trick to get rid of any strange gamey tastes you may incur with a pork stew (and may very well work for lamb).

Once all the pork was blanched, I returned it to all the aromatics.

I then opened up the handy-dandy Five Spice Marinade, purchased at your local Asian ethnic grocery story. For me, being in Southern California, I bought this from 99 Ranch Market.

In went the whole thing! I also put in 1/2 a bottle's volume of water so it wouldn't be all too salty.

I stewed this baby on low heat for about 4-5 hours and added some firm tofu near the last hour, just for a little variety of protein.

This was the end result.

It was a fun experiment! I feel like the flavors didn't completely marry the way my grandmother makes it so. Nevertheless, it felt good to try to replicate the effort. The onions and leek gave a wonderful flavor and the garlic was surprisingly pleasant (and buttery melting in mouth). The pork could have been more tender, perhaps I needed more time to let things really break down. However, that archetypal bacon layer on top .... mmmmmmm. Yep, that's the good stuff.

Well, I suppose that's it! It was a fun experiment; a little bit spur of the moment. It's a fun addition to my culinary experiments. Now.... to find my next quarry!

Saturday, March 28, 2015

Ben's Whiskey Review

It's no secret that I'm a fan of whiskey; scotch and bourbon are my particulars. Since the #bourbonPT and #scotchPT folks like to come out and play every once in a while... AND, since PT Pub Night has gotten uber popular... I figured to write this fun little post.

Ben's Whiskey Review

BEFORE WE GET TO FAR! Glassware. Yes, glassware absolutely matters. I know its getting a little into snob-ville when we start talking glassware but its worth mentioning since smell has so much to do with our perception of a tasting event. As such, I must say that while I absolutely love the look of a rocks glass, it pains me to say that personally, I find the snifter glasses actually pool all the aromas the best for me. Yes, yes... I know. Nosing glasses aka the all famous glencairn glass is supposed to be the best for whiskies. Personally, I just don't like the shape and I find the glass too small for my hand. However, a nice firm rocks glass or a snifter just feels nice in the palm and sturdy against the fingers. But, really, when it comes to it... glassware is important for two reasons. Smell. And, style. Really now, do you truly want to sip a fine single malt out of a red solo cup? Please...

So here we go. In no particular order, these are some of my memorable whiskey experiences. (Whisky for you scotch fans)
  • Macallan 12
    • I'd be remiss not to start with this, perhaps the brand name Cadillac of popular culture scotches. After all, even James Bond prefers this brand. The Mac 12 is an amazing spirit. Perhaps one of the most balanced of all the single malts. It is quite smooth for a scotch and delivers a very nice nose of malt. If you dig deep enough you'll also find a nice boldness of oak and honey. For you bourbon fanatics, the malt will likely throw you off. But, not to worry. Just keep sipping; it's gets better.
  • Oban 14
    • I've recently taken the pleasure of re-experiencing this very fine single malt, aged 14 years. It should be noted the some of the very best of scotches are now made in Japan. And, new recent as even this week named a Taiwanese scotch as #1. Who knew?! In any case, this thing is as smooth as silk and soft as butter. It actually has a very familiar taste with the Macallan 12. However, there is a very fine hint of peat which goes beyond the "Highland" style of single malts... reaching just enough into the Islay realm to make me smile. If you like Speyside or Highland style scotches, I dare you to try the Oban 14. You'll be happy you did.
  • Booker's Bourbon
    • Ahhhh yes. Bourbon. American. Brave. Bold. Powerful. Booker's Bourbon remains, by a wide margin, my very favorite bourbon. Let's not even mention that it is uncut, unfiltered, and boasts something 125-130 proof spirit. If you want a whiskey experience, this has become my true north in bourbons. Booker's has amazing flavor ranging from oak, chocolate, tobacco, vanilla, and in my humble opinion, just a bit of rose. Enjoying this work of art requires three stages, first done neat. Follow this up with but a couple milliliters of fresh water. Then, close it out with a nice splash of water. What you'll notice is that the oaky smokey flavors will turn more caramel and chocolate and finally mature into sweet candy barbaque essence. If you ever have a chance to try Booker's bourbon, you better make it a double.
  • Four Roses Single Barrel
    • A shout out to Jerry Durham for this one, advising me it was one of his faves. This little wonder has many of the similar flavors of a hardcore bourbon ie Booker's without the fire of it. It's relatively smooth for a bourbon and has a very nice char to it; it's a fine choice for $33 dollars circa Winter of 2014 via Costco and worth every penny. I found that doing half pours with in a small rocks glass is preferable; it forces much of the bouquet to open up. No need to add any ice or water to this beauty, just take it neat and enjoy.
  • Bulleit 10 year
    • This special version of Bulleit boasts more of a rye flavor along with fruit and a nice subtle sweetness. I'm actually a big fan of Bulleit, however, I have to say that for twice the price of their regular bottle, I was a little disappointed. The rest of the experience was very similar to the normal label with no additional fire nor flavors. I think it was a good try and I did appreciate they made the 10 year quite smooth. But personally, I like my whiskies firey. If I want to drink something smooth, I'll drink water.
  • Trader Joe's Bourbon
    • Now before you trigger the laugh track, I put this up here on purpose. First to say, Trader Joe's has some really nice labels, their rum and their tequila are actually quite competitive to the $20 mainstreamers, costing about half that. Their bourbon is no exception and is perhaps the best of their private labels. TJ's bourbon has a strong flavor and I like it that way. While the bouquet could be a little more developed, for $15 per 750mL, you really can't complain. The fire in this bourbon is definitely present; however, you can definitely appreciate the difference between this and a higher end bourbon where the fire destroys the flavors versus enhances it. Nevertheless, if you've had a hard week, pour yourself a double on this.... heck even add ice. You know what, make it a triple. It was a hard week, right? ;)
  • Knob Creek
    • We're on a bourbon kick, why stop? Knob Creek was perhaps the first bourbon to really capture me. Unlike Jack Daniels, Jim Bean, or even Maker's Mark, good old Knob had the answer to my taste for whiskey. Personality. Knob Creek is a 100 proof bourbon aged 9 years. Let me tell you, it needed those 9 years. Supposedly, the longer whiskey ages in a barrel, the more sophistication and the more mellow the spirit comes out. If 9 years is what Knob needed to even be considered in the realm of tame, wow. But more about it, I love the deep bourbon feel of this spirit. The flavors could actually be more pronounced, but hey as the one up of Jim Bean, they made a heck of an improvement! It's not smooth, it's not friendly, and it has all sorts of wonderful vanilla and caramel oak notes. If you're stuck in a bar with no set orientation and you see this on the shelf, call it out! You can't go wrong.
  • Baker's Bourbon
    • Since we're running down the Jim Bean products, let's close it out with Baker's Bourbon. Baker's is actually a wonderful product. It is one of the smoothest bourbons I've had and has an excellent bouquet. Perhaps what they had to sacrifice for said smoothness was the marginal losses in flavor and fire. If you do a side by side of this and its bigger brother Booker's Bourbon, don't even bother with a palate cleanser when going from Baker's to Booker's... Booker's still has the heat. Baker's has a surprisingly long finish for its smoothness to where you can really appreciate that familiar vanilla tone with a spicy finish.
  • Bowmore
    • Okay, back to scotches. It has been years since I had any Bowmore spirits. But, it is important to me because Bowmore got me onto Islay scotches. Islay scotches are famous for their flavour, heavy peat, and long warm finishes. I can recall this for a birthday present long ago and can still say, it delivered on all three. Very fond memories.
  • Laphroaig 10 year
    • Laphroaig 10 is my go to Islay scotch. Other than the $40 dollar price tag circa early 2015, there's absolutely nothing I could complain about with this spirit. Sure, it lacks the usual 2 more years for an even 12 year aged single malt, but wow does it have flavor! And, that's what they are known for as the "most flavorful" of scotches. Expect a wonderfully long finish, sweet smoke, peat, and a comforting barbeque char.
  • Laphroaig 18 year
    • A dear colleagues bought me a round one time as we were transitioning throughout our careers. I was taking a promotion to become a director and she was moving up the ranks as an advanced clinician. In our celebrations, we were exploring our scotches and I called this one out for me. Much like the 10 year, it boasts the wonderful oaky smokey you expect from any respectable Islay. However, unlike many longer aged scotches, the mellowness was not a disappointment but rather a wonderful addition to the scotch itself. What I lost in mellowness I gained in so many interesting subtleties, primarily in varied levels of sweetness, pepper, floral notes, and earthen essence.
  • Laphroaig Quarter Cask
    • This is perhaps the 50 cal of all Islays I've tried. I recall this experience fondly as the scotch version of Booker's Bourbon. They had so very many similarities in that the fire enhanced the flavor. The finish was epic in length; probably lasting a good minute per sip. Flavors were very bold, the usual oak, smoke, char, peat, and earthen depth. Being far greater than the usual 43% concentration of single malts and rising to the challenge of 48%, you definitely find the differences between this and the humble 10 year as the minors versus the major leagues. If you love your Islay scotches, do NOT miss out on a chance to sample this one.
  • Dalmore 12
    • I miss this. It has been years since I've had a good Dalmore. This brand used to be sold for $22.99 at Trader Joe's. Then, it became $23.99. Then, it disappeared altogether. This Highland scotch is a smooth operator, boasting great flavors with minimal burn. I typically dislike this attribute; however, it was one for the firsts to make it to my lists of faves. My best memory about this was how dangerously fast it disappears in the hands of guests, weary at the strength and boldness of scotch only to be fascinated by its sweetness, the mystic of the malt, the slight of peat, and the humble hue it possess.
  • Dalwhinne 15
    • I'm sorry. This, is a disappointment. As a Highland scotch, I expected much more personality but I really only sensed a subtle Speyside style scotch. I don't have much to say except that I bought this years ago under the highest of recommendations of a scotch enthusiast only to be disappointed by the lack of flavor, no personality, and weak bouquet. Maybe its because I like things to burn... maybe I was in a bad mood. I don't know. I just remember telling one of my buddies, "Dalwhinne? More like, Dal-whimpy." It still makes me sad to think about it. If the company or any of your enthusiasts want me to try my 2nd at it, I'll do so if you're buying! ;) Otherwise, I wouldn't recommend it, especially for something like $40-50 a bottle.
  • Aberlour 12
    • Aberlour is celebrated as one of the most celebrated for Speyside style scotches. My first go around, I didn't like it so much. The second time, much better. Speyside scotches are all about the flavor. They should be like a 7 course meal of the senses with very little burn. You can expect sweetness, fruit, spice, even cinnamon, chocolate, and coffee... if your palate and imagination stretch that far. I highly suggest you enjoy this little treat in a snifter so that all the flavors can open up. It's a smooth one, if you like that sort of thing.
  • Finlaggan
    • This is a mystery, apparently. Kind of like how no one can ever find the full print of The Princess Bride, no one really knows much about this Islay single malt. I can say that for less than $20 a bottle, it's a good buy! There is plenty of peat and the personality is more of a highland style scotch. Personally, I almost feel like its a blend of Islay with a Highland flavor. It's a good one if you just need your scotch without anything special behind it. The flavors are all good and present and its kind of a bargain.
  • Highland Park 12
    • Ahhhh. Highland Park. It's a contradiction in terms since Highland Park is actually an Island scotch. I remember appreciating that Highland Park has the highland flavor with just a hint of peat. In a way, it reminded me of a more bold Oban, come to think of it. Being that it has been a severely long time since I've had this scotch, I can only say that I remember the flavors being very balanced despite the boldness, and a smoothness in character that didn't leave you wanting because of a well done finish. It's an excellent choice.
  • Highland Park 15
    • This is where my concerns start with aged scotches. I've tried a lot of aged scotches both blended and single malts. All I can say is that I feel the mellowness actually kills some of the personality. It's like that one time I went sake tasting; out of the four grades of sake, I enjoyed the 2nd to the highest shelf samples the best. Highland Park 15 lost a lot of the umph I enjoyed from the 12 year. I remember buying the 12 and 15 as a dual gift for a close buddy of mine during Christmas. Doing the side by side, we both agreed the 12 was actually better. Not that the 15 was bad, it's just that the 12 offered more. I guess this goes in line to say sometimes, less is truly more.
  • Glenlivet 18
    • To me, this one is a tragedy. Now, I know that the vast majority of the Glen's out there are really more commercial items than true enthusiast brands. I had to try. I was sad. All I tasted was this timid maltiness. No burn. No flavor. No style. Nothing. I didn't like it. This was actually the taste that killed it for me when it comes to really far aged whiskies. One day, I'll make my way to sample out something in the 25-30 year range... but, it'll have to be a truly special occasion and I better bring a good old 10-12 year as a sturdy backup.
  • Some honorable and some dishonorable mentions...
    • 1972
      • I had this bourbon some time ago and sadly, I had to dismiss it as a "regular" bourbon. I just remember tasting it and saying, "Yep. That's bourbon." .... and, that's all I had to say.
    • Jack Single Barrel
      • I'm not to big of a fan of Jack. Of course, in Vegas, it's Jack & Coke all the way. However, I did try this and Gentleman Jack. Both are basically smoother versions of the next. It's good enough, but, I'll stick to my scotch and bourbon.
    • Lagavulin
      • This one is immensely popular in the market, but, I didn't dislike it... but I didn't appreciate it to the fullest per se. It didn't have enough peat for me as an Islay and honestly tasted more like a Highland or Speyside with peat.
    • Basil Hayden's
      • I had the same response as to the 1972. Meh. Sorry.
    • Maker's Mark vs. Jack Daniel's
      • I just don't like the sour mash.
    • Woodford Reserve
      • This is a solid bourbon, but honestly, I'd pick Knob over this - mostly because of price.
    • Johnnie Walker Black
      • I had this at an airport once. I remember it being ... o... kay? And, that's about it.
    • Wild Turkey 101
      • You know what they say, people who drink Wild Turkey, turn into them.
OOOOH WAIT! But that's not all! There is one more whisky to review.
  • The Knockando 1976, Single Malt Speyside.
    • Honestly, I don't know much about this beautiful and tragically waning label. All I know is that it is a speyside style scotch with a strong highland style taste. Much like the Oban 14, there's a hint of peat, enough to make an Islay fan like me perk my ears. However, the strength of body, lasting finish, and what I can only describe as an old-style-flavor is one of a kind. I'm not even sure of how rare or interesting this bottle actually is. I know that it was a gift from a business associate to my grandfather back in the day. He kept it for years without any interest in it. Eventually it went to my father and we decided to have a go. It's been nursed for a long time. Even after a tragically broken cork, it is still being appreciated to the finish. I must say that this is perhaps the most unique of all scotches I've ever had. Drop by drop, it's being appreciated, savored, and mourned. I have found other vintages in the market, but, nothing to specifically replicate the 1976 year. Who knows how significant that actually is. It could be a terrible brand. All I know is, this is the only scotch that was bottled near 40 years ago that I've ever tried... and, I like it!
I think that's all I can strain my memory banks for. All in all, I love a good bourbon and I love a good scotch. Really, it depends on the mood. I love the power a bourbon brings and I really enjoy the sophistication you can find in a good scotch. I guess it's all a matter of mood and circumstance. Nevertheless, I'm glad to say I can never go wrong with a good Islay scotch or a strong bourbon like Booker's.

Yep. That. would be. it. So that's Ben's Whiskey Review! I hope you had as much fun reading this as I did writing it. It's really enjoyable delving out content that's less serious and more personal in nature.

Well... Until next time, Cheers!

Thursday, March 26, 2015

DPT Student Sponsorship

So, after APTA's Combined Sections Meeting this year, there were whispers of interests regarding the sponsorship of DPT students, covering what financial burdens would be such that they can join in the largest Physical Therapy convention in the United States. Here are a few tweets on the topic at hand:

Answering the call, one of our favorite Physio anonymities approached me to say this.

From Cinema:

Intangibles are priceless. Goodwill is one of those intangibles. Generating and compounding Goodwill is something that can yield unexpected returns that have a strong potential to grow geometrically over time. Think about it this way: planting ONE seed of Goodwill will sprout into a plant that yields multiples of the ONE seed you originally planted. I can think of no better recipient of Goodwill in Physical Therapy than the passionate group of DPT students.

Twitter has been a game-changer for me by connecting me with Physio's I would never have met in-person, exposure to current issues in our industry, as well as current research. It also exposed me to highly driven DPT students who inspire me to be a better Physio. I want to give back. Let's get the Goodwill rolling.

As such, we had an extensive email chain which covered ideas on how to run a sponsorship campaign for DPT students to join in on the fun for CSM in Anaheim next year... and also talked about random topics such as our favorite whiskies. Trust me, it was important ;)

Haha, in any case, we finally landed on this:

At present, it isn't a widely used hashtag. However, I think there is potential to speak volumes. Since one of the key purposes of conventions such as CSM is professional advocacy, we decided that a social media contest would be the best way to bring light to those most deserving of sponsorship.

How It's Going To Work
The angle of this contest is 100% consumer oriented. Meaning, it isn't about the data or the statistics; it's about what physical therapists mean to our consumers. We're hoping that you will find clever ways to capture the following essence in whatever approach you're creative minds come across:

Imagine a Vine bit, 6 seconds only, and you record (with your patient's permission) them saying something like this...
"I'm back to running, and my times have never been better. #PTStrong"

Cinema and I liked the fact that Vine and Twitter being hand-in-hand allows for quick and sharable experiences. More importantly, it allows for simplicity to reign supreme. The strongest brands tend to have the simplest definitions. Therefore, we want to encourage this spirit of simplicity.

So here are the rules of the sponsorship challenge:
  1. With a patient's or past consumer's permission, film them stating their experience and how it made them #PTStrong.
  2. Tag your Vine video with #PTstrong and link it your Twitter account.
  3. Retweet and Favorite as many videos as you can.
  4. The Vines with the highest number of retweets will go through a run-off.
  5. Top voted Vine wins the prize.
  • All the sharing will only elevate PT brand's share of mind.
  • Everyone wins through this little contest as our consumers will become more aware and we will become more involved in the future of our profession.
  • Hopefully, we can do several runs of this contest so that more than one well deserving DPT student can win a sponsorship to attend CSM next year.
We want to encourage you to share this with all of your DPT compadres and even those who are long set in their careers. You see, our vision for the #PTstrong hashtag is one of brand presence. The more we see this on Twitter, through Vine, Instagram, Facebook, even Youtube, the better! We want to CHOOSE how our brand image is portrayed. What better than a grassroots social media movement, hearing out their voices in how we changed their lives and made them #PTstrong?

I know that many of you wanted in on the idea of sponsoring a DPT student to attend CSM next year. We hope the passion still burns fiercely that you'd consider joining us. Ultimately, the hope is to crowd fund as many sponsorships as we can through this Vine contest.

If you're interested, please let us know (email, tweet, message, whatever)! Then... we can get this thing started!!!

Tuesday, March 24, 2015

Reflections: PT Industry Analysis

Early this month, I finally posted a blog regarding an Industry Analysis on Outpatient Physical Therapy. I shared what I was able to share to keep within the framework of my commitments; even still, the results were rather shocking. First, and not necessarily a surprise, our branding is way off. Secondly, we've misplaced our value proposition. Third, and finally, we're driving profit from a misdirected sense of internal value. This post brings forth some of my personal reflections on the analysis now that near a month's time has passed and I've been able to gather a broader range of feedback. I highly recommend you read the post to normalize our discussion base.

Reflections: PT Industry Analysis

1. Exercise and Aides?
There were several voices which expressed the concern that the analysis may have been skewed by the amount of billing going on where PT Aides deliver Therapeutic Exercises which are then billed for by the PTs. This case may be prevalent enough to strike a bad taste in our profession; however, I find it difficult to fully dismiss the fact that OVER HALF of our industry's profitability comes from TherEx. Mind you, when I did this analysis, the operational marginal cost was calculated from PTs and PTAs. Meaning, even if it is grotesquely prevalent that there are unscrupulous PT firms billing TherEx while utilizing aides, TherEx being over 50% of our profit pool is an UNDERSTATEMENT of its profitability.

Now I will say this: Unethical and illegal billing need to stop. It needs to stop for PT and it needs to stop for all of healthcare. Such types of billing are indeed everywhere to some degree. And, such practices are only driving healthcare costs upwards into unsustainable considerations. I did speak of this in the original post under the third insight - and - I stand by the stance that "creative billing" is ONLY hurting us and every single stakeholder around us. IT NEEDS TO STOP.

2. Should We Abandon Manual Therapy?
No! NO! No no no no no no no no... and no. I heard you. I see you. And, no, I am not advocating we just all together stop manual therapy because it isn't profitable enough. Let's look at the Profit Pool Analysis together, shall we?

Just to be clear on what this analysis indicates: It portrays that 52% of our profit from revenues comes from TherEx. It shows that operationally (without other costs considered, only direct operations), clinics can see this service return upwards of 350% in margins. Continuing, the graph also shows that Therapeutic Activities represents 12% of our profits at a declined level of profitability. Neuromuscular Re-Education represents 9% of our profits and Manual Therapy represents 13% of our profit pool, delivering about 200% in operational margins. These margins are still excellent. And perhaps more importantly, in the outpatient PT setting, manual therapy is a vital and inescapable aspect of our value proposition.

We clinically approach healthcare so very differently than ANY OTHER healthcare provider. Physicians tend to touch their patients at a minimum. Nurses tend to touch for invasive procedures or for positioning concerns. Physical Therapists are unique in that we have the option of touch as both assessment as well as our treatment modality; and, this can be delivered across a broad spectrum of treatment models.

So what about manual? Well, I think that we need to get a lot better at our manual therapy. What this graph tells me isn't that we need to only bank on exercise (while I do think we need to also be better at it). I think what this tells us about manual therapy is that we need to really ramp up our standards. We, as an industry and as a profession, need to set certain standards to what manual therapy actually means... what it means to us, to our consumers, and most importantly, what they can expect from manual therapy -- the experience, the results, the mechanisms of how and why it works, and how such an approach crosses over to their own functional independence and optimal health. THIS is where I think we're lacking and this is where I feel we really need to bolster our profession.

Exercise, then, is the corollary and therefore parallel concern and area of opportunity. It was communicated to me by many of you that the amount of exercise science, approach of progression, and breadth of knowledge is rather weak. I agree with that. It was even once mentioned to me that in the athletic community, clients go to PTs for the diagnosis and to athletic trainers for the treatment aka the exercises to get them better.

THIS IS A DANGEROUS LINE WE'RE WALKING. To this, I'll insert a quote from the original blog post to say:

Why not lobby to protect the prescription of exercise for healthcare and disease management as something truly unique, only to be given by the physical therapist? It may not be the popular thing within our profession, but boy, it seems quite popular to our consumers and stakeholders across the value chain.

I mean how POWERFUL would that be? PTs are the ONLY professional (licensed or not) legally allowed to prescribe exercise as medicine. But, why am I harping so very much on the exercise aspect? It has to do with where healthcare is going. We're seeing that the healthcare environment is heavily favoring a preventive model of care. The less intervention to be done, the more value you bring because you are keeping people and populations of people healthy. THIS is the new standard of value in the industry to which outpatient PT is a part. Manual Therapy is largely interventive; certainly, there are many cases which manual therapy is done for a wellness or maintenance concern. Nevertheless, manual therapy alone will not keep people healthy. However, the amount of evidence supporting exercise as a mode of maintaining and elevating health is undeniable. As such, why not go ahead and secure this low hanging fruit?

If we are truly experts of physical health, we need to stake our claim now while climate in healthcare has yet to settle into its new patterns. THIS is the time. THIS is the opportunity. So very many of our other goals can and will be met through this foothold. 

3. What About Our Brand?
Branding in healthcare is both a micro and macro concern. The profession at large needs to have a brand for the micro aspects to have any sure groundwork. This, of course, has been an ongoing problem for PT. I still suggest that we leverage exercise (one of the key value propositions our consumers look for and pay for) as both our differentiator and our answer to the changes in healthcare.

I know there's all sorts of talk which has reverberated for years about movement, manual therapy, health, wellness, function, the human experience... etc.  But, let's face it. We can't brand what we want until we reach out to our consumers regarding the brand image they already have of us.

And, I'll go out on a limb and say, while most of our retained consumers know what we do, most of our first time consumers will be expecting exercise. What's my "proof" on this? When's the last time someone came up to you, knowing that you're a PT, and said something like, "Hey... I got a thing about my back. Are there any stretches I can do to help?"

I find that's far more common than, "Hey... I got this thing about my back. You mind popping it for me?" when it comes to the vast majority of PTs. I know it's not a popular thing to say. But hey, if we're ignoring the data - AND - if we're ignoring our consumers, then what are we even doing?

Some Closing Thoughts
I don't really have much of a "here's the answer" conclusion regarding the PT profession and its brand, not to mention its segmented branding efforts. What I do have to say is that it all has to do with unity through leadership. When will that dynamic and equilibrium be met for truly meaningful and sweeping initiatives? My guess, in the next 5 - 10 years. It will happen in a time when so very many DPTs will have graduated and saturated the job market that a culture of being "fed up" with the status quo will go beyond lunch time grumblings and social media rants. It must and will reach a moment of critical mass where economically speaking, inaction will hurt more than the efforts of action. THIS is when things will change.

For the moment, however, we do have control over the micro brands that we own. The best advice I can give is that you seek to build your brand as part of a solution set to meet the needs of consumers. Give out the gains they want; eliminate the pains they have when it comes to meeting said needs. Such brands tend to have the highest brand equity and financial sustainability.

Well, that's it for now! For those of you coming across this industry analysis for the first time, thank you for sharing in my thoughts! For those of you revisiting it, I thank you for delving into it once again. And, for those of you who raised concerns, thank you for giving me the opportunity to clarify some areas in which perhaps I was not the most articulate in expression. In all cases, I hope you enjoyed this reflection.

Until Next Time, I Remain Yours In Service,

Friday, March 13, 2015

Animal Style Fries

Okay. So we all know I love to cook (see Beef Bourguignon)... mostly because I love to eat. I was issued the challenge (by my wife) to make one of her favorites from In and Out's secret but not so secret menu, Animal Style Fries.

This is how things went down....

Animal Style Fries!

1. Start with some crinkle fries... I know this is heresy since In & Out does everything fresh. But, let's be honest. The amount of effort, energy, and resources to chop up your own fries and get oil up to temp to fry them in and all that.... ugh. Just too much. I'm a fan of taking tactical short cuts when needed ;) So yes.... get some fries-a-baking!

2. While the fries are warming up, sautee some sweet onions. In this case, I used Hawaiian Sweet Onions. Mostly butter and some olive oil to keep things from sticking.

3. Mix up your spread. About a 1:2 ratio of ketchup to mayo.

4. It should come out to this type of color hue; then you know you've got it.

5. If you timed things out, the 25-30 minute crinkle cut fries cook time should also coincide with your onions getting caramelized, like so!

6. Go ahead and melt some American cheese on top. I decided to mix it up with shredded and single's-style cheese.

7. Add your well caramelized onions on top of that once it melts... there should be plenty of heat to melt the cheese as is. Of course, if you want to pop it back into the oven to speed up the process, go for it!

8. Top off this California classic with your spread and enjoy!

Finally, be prepared that your home smells like Animal Style Fries for the next 36-72 hours. I do have to say though, that the homemade version is significantly more savory that from the restaurant. I think much of it has to do with the size of the fries. The rest of it has to do with the fact you get to add as many onions and as much cheese as your sinful heart desires. Regardless of how to put this all together...


Bon app├ętit!

PS. We left out the relish. My wife hates pickled anything....

Tuesday, March 10, 2015

5 Thoughts, 5 Years Later

I've been meaning to write a post as a five year reflection to my graduating with a DPT, practicing in every healthcare setting (from acute hospitals to rural home health), and my transition to the business side of life. It's been a very interesting journey. I look back and I realized some of the most enlightening situations came at the hands of being mentored or mentoring others. As such, I wanted to impart a few thoughts now that I've been in the industry for a little while, in a very much delayed post of chronology.....

5 Thoughts, 5 Years Later

1. I was always ready.
What I felt was (and perhaps is still) a certain stance of "conventional" wisdom was this: school only prepared the new graduate just enough so they didn't end up hurting anyone. They knew enough that they could get by with thorough mentorship because experience was the only legitimate teacher of competency.

To that I say: Phooey!

The fact was that I was most definitely ready. I came out of school ready to rock and roll with short exposure to any given work environment. I didn't need sharpening or tinkering out of the box, I was good to go! In fact, I felt like comparatively, I was advanced in many ways - much like new cars to old models. And, shouldn't that be the case? Shouldn't education IMPROVE over time? Certainly there were odd cases that required experience to truly absorb the clinical presence of what was wrong. But, I felt that wasn't a measure of readiness. That was simply an experience of fortune; a clinician that was in the field was at the right time in the right place to observe and experience a rare diagnosis. That didn't mean they were any more competent or ready than I was, it was simply they saw it one more time in life than I ever did. Yet, for all that, there were so very many diagnoses that "senior" clinicians missed that I caught. Why? Because of my education. For what my experience lacked, my training sufficed. Different generations of clinicians receive different generational thoughts and foci in their didactic and clinical experience prior to joining the industry at large. For those reasons, it may be perhaps that the senior clinicians had a wider breadth of treatment options than I did, however, I had a far better grasps of differential diagnosis than they did.

Does that mean I was better or worse? That they were better or worse? NO! It meant that I was ready. I was more prepared and trained for diagnosis and they were more prepared and trained for treatment. Did that relate to superior outcomes one way or the other? Nope. Actually, if anything, it was the work ethic that changed things when it came to the available data we had. I was more productive. Maybe I was younger. Maybe I was hungrier. Maybe I just wanted it more. Or maybe, I was just ready to go -- out of the box, just as any top-shelf capital should be. After all, after nearly a decade of education and training, you would HOPE someone would come out of the box ready to shoot. This leads to realization #2....

2. Time isn't the X-Factor, performance is the X-Factor.
I found that not only was I ready, I was out performing certain compadres both in clinical productivity as well as outcomes and patient satisfaction. Now, not that all my seniors were being out performed by me. Far from it. Actually, one of my favorite clinicians had been in the field 30+ years and her level of spunk, energy, zeal, passion, and ability was like Yoda. It was like she could see what was to happen before things happened and her patients couldn't have been happier. Ultimately, we bonded over tackling the "trouble" patients that our colleagues didn't really want to see. Magically, they always did better when we saw them. They weren't any trouble at all. They weren't rude, inappropriate, or difficult. They were actually quite great!

See... time isn't the x-factor. It's not the number of years of experience or the loyalty to the company or seniority. It's plain performance. Better clinicians are better because they bring better results. The same goes for employees, managers, team members, etc. It spoke to me a lot when I actually had a complaint filed against for being TOO productive!

It was incredulous! How could anyone complain about a colleague picking up the slack? I talked it out with management who was actually really receptive once we dug into the heart of the issue.


Well guess what?! Too bad. Your time is trumped by my performance. 

3. Politics was problematic. I wasn't prepared.
I think what I was NOT prepared for "out of the box" was the political battlefield. The DPT educational experience didn't teach me several things, one of which was how to navigate the heavily striated battlefield that is healthcare and healthcare administration.

I was too gung-ho in my earliest years. For that, I was beat up, bullied, and told to calm down. It sucked. Not only that, but I found that it was strange that it was my PT colleagues at large (both within and outside of my immediate business unit) that were harshest to me, telling me to cool my DPT jets. Funny enough, nurses loved me. The nursing staff, administration, physicians, and especially marketing & PR adored my energy, my level of contribution, and my can-do attitude in the face of any situation. I loved that level of support. Unfortunately, I didn't understand how to garner the same positivity from my own professional colleagues.

It took several years for me to navigate that path. It was hard. I felt ostracized by my own kind, at it were. Sadly, this isn't a unique story. I know of MANY new graduates (my time, the time before, and now) who experienced this problem. They are dumped into a political landmine, not being told so... and wished a back-handed, "Good luck." This needs to change.

4. Social media = Super charger.
I want to say I joined up for social media visibility around Summer of 2011? Something like that.

It changed my life.

Social media has provided me with more opportunity, more leverage, a larger platform, and a far greater level of connectivity than anything I was attempting in my networking efforts prior. Social media is an equalizer. People who spam, are called out. People who give, are appreciated. It's basically that simple. I was and remain all about giving back and paying it forward. I feel there is more to life than selfishness (not that people shouldn't be making strategic profits because of wise choices). As such, I can't speak enough about the importance of social media. For me, Twitter was the best platform. I made it work for me. I know Facebook has the largest usage, but, I feel the authenticity and convertibility on the FB isn't as good as in Twitter or other outlets (for now).

In any case, social media changed my professional and personal life. To that, I credit my wife. It was her idea and a truly wise one at that.

5. I was begging for business solutions.
The other area that I felt my DPT education failed me was in business. While it can be argued political savvy is part of a strong business education, I'm actually referring to the operational, marketing, and strategic aspects of healthcare as a business and social construct. Coming out of school, I barely had any understanding of how or why I billed for services the way I did, what units would translate to, what CPT codes would work and which ones wouldn't, and the fee schedule and reimbursement patterns available to the PT profession.

What was worse was I saw ALL sorts of problems needing to be solved. I wanted to solve them and I had great ideas of how to push them through. Some ideas were widely accepted, especially if management backed them up. Other times, they would be left to fizz out, a truly frustrating tactic managers use when they don't want to "yes" because it wasn't their idea. Don't worry, they'll bring it up and credit themselves in the next year or two... just you watch.

As such, when I sought mentorship for advice in this channel, I was told that there is no better venue for me to find answers than getting an MBA. Yup, that's right. Back to school for a Masters in Business Administration. That's how I ended up here!

I think much is to be gained if DPT programs network with business savvy leaders (not just PTs) out there, if anything, just to have two or three Google Hangout or Skype conversations (if not in person) with their 1st year students. Orient these doctoral candidates to the industry environment and strategic positioning they will be subject to upon graduation and licensure; it would accelerate a culture of professional advocacy both internally and externally. Most importantly, I think this would bring value across our supply chain and most definitely to our industry stakeholders.

Well! That's it for now. I just thought to catch up on this post since I planned on doing it quite some time ago. As always, I'm just a tweet or email away!

Until next time,

5 Resume/CV Tips for Healthcare

Resumes and Curriculum Vitaes (CVs) have been around for a long time. We used to use them as a good-faith, honest account of who we are and what we offer in the job market. It was supposed to be an accurate representation of our professional footprint. Now, with the advent of social media like Linked In, we're seeing that resumes/CVs are around simply for verification. It has become a formality really, not so much a function anymore. Increasingly, the job market is more about relationships. That said, every single application you fill out *will* want a resume or CV out of the principle of the matter.

So without further ado....!

5 Resume/CV Tips for Healthcare

Regardless if you are a new grad, recent grad, or seasoned professional, NO ONE CARES about where you went to school, what your GPA was, what you other test scores were, or anything else. There are over 200 PT schools, nearly 2000 nursing programs, and roughly 150 medical schools in the United States. Do you really think that a hiring manager will know every single one of them? Their reputation? How good or bad the program is?


Chances are, unless you went to a big name university, no one will know or care about where you went to school. Rather, they will be more interested with where you did your clinical rotations. This leads us to our first tip:

Tip #1: Highlight clinical experiences.

Once you've established: Hey! I did this and that, worked with so and so with this much experience and credentials for so long. I gleaned everything I could in that time and was seeing this many ranges of patients, you have now made yourself more valuable. Why? Because now, the hiring manager doesn't have to worry about spending exorbitant amounts of time and resources training you on the job. You already got it before and probably just need a quick refresher.

After this, the next concern of the hiring manager will be how best to discern your work ethic, leading us to...

Tip #2: Highlight your productivity.

By showing the manager reviewing your resume how productive you were as an intern, they can basically extrapolate how productive you will be in their clinic/department. For this reason, I always encourage students to fulfill some basic operational goals during their rotations. Namely, I tell them to appropriately request that their CI train them to qualify as an entry level co-worker: "Teach me what I need to know to work here with you."

So, it's getting exciting. You've demonstrated that you rotated at some pretty cool clinics. You've seen a nice range of patients, know how to treat them, and more than that, you treat them effectively, keeping a strong schedule, and favorable productivity. You're a work horse! You will definitely fit the budget.

Now... how do you get along with others? See, this "teamwork" thing job descriptions put on there really isn't about true teamwork. It's about playing nice with others. It's about minimizing the HR headaches that the hiring manager may have to deal with after they hire you... either because you're the problem, or, because other people have problems with you. Therefore.....

Tip #3: Highlight your potential as a good colleague, employee, and coworker.

Now that you've established you know what you're doing, learned from the best, experienced a good breadth of things, are highly productive, AND, know how to be nice in the playground, the hiring manager will now be very interested in you. When you convey, subtly mind you, how much of a team player you are, that you like to help out where you can, and that you know how to respect organizational structure, it is time for you to get the hiring manager truly interested in your personage.

This is a good time to express your interest, angle, and/or investment in your profession.

Tip #4: Highlight your actions in advocacy and extracurriculars.

When I was a director, coming across a resume that demonstrated truly impressive levels of dedication wowed me. It speaks volumes that a student, already struggling financially, is willing to march on political battlegrounds to safeguard the future of the profession. This is what I call a dual equalizer. The types of firms you want to work for will care about your level of professional advocacy and extracurriculars. The firms that you need to run from like the plague couldn't give a hoot.

A student who is willing to be passionate off the job will certainly give full efforts on the job. Speaking of this job, it is a good time to lead into our last tip of the day....

Tip #5: Highlight your career goals.

It is helpful to put down some career goals because some organizations really want to invest in you. They will spend upwards of $20-30k on simply your hiring and training. They want to keep you for at least five years, maybe more. If they like what they see, they may put you on a leadership track. If they couldn't care at all about your future, then you should regard in kind... after all, that isn't the type of place you'd want to work for per se. Knowing career goals helps me understand what I can do for you as a manager, and, helps me understand if we'll be a good fit. If not, its okay. Keep shopping. This, just like Tip #4, is a dual equalizer. Remember, when you're looking for a job, you should be shopping them as much as they are you. As such, Tip #5 could really help seal the deal. If they could care less, why invest your life into such a place of employment?

Just keep in mind, please don't put down "I want your job." or anything to that effect on your career goals. No joke. I seriously had one applicant interview saying that she wanted my job. I had a good laugh. And no, she didn't get the job.

Just to put things in perspective, so far your resume looks like this:
  • Name
  • Graduated from...
  • Licensed / License Applicant
    • Up to this point, that's all the need to know right? Are you graduated? Are you licensed? If they are willing to take PTLAs, great. If not, you may just have to wait. There's no control here on your side, but, it helps them. Helping them, will help you.
  • Clinical Rotation 1: Hospital ABC
    • Rotated with a PT of 15 years specializing in cardiac rehab. Also had experience in oncology, general medicine, ortho/neuro/trauma, and a special focus in wound care.
    • Assisted with scheduling, volunteered to switch schedules to help department needs.
    • Final caseload: 8 patients in an 8 hour shift, average treatment time at 45 minutes
    • Final Productivity: 75% 
  • Clinical Rotation 2: Sports Medicine and Orthopedics, Inc.
    • Rotated with a PT, OCS, SCS, CSCS of 8 years specializing in ACL rehab. Evaluated and treated a range of MSK populations including rotator cuff repair, total joints, chronic pain, and Division 1 college athletes.
    • Final caseload: 11 patients in an 8 hour shift, average treatment time at 30 minutes.
    • Final Productivity: 81%
  • Clinical Rotation 3: Pediatric Super Fun Therapy, Inc.
    • Rotated with PT of 3 years who is the owner in a small town, pediatric practice. Patient variety included X, Y, and Z.
    • Participated in a health fair with the clinic in addition to normal intern hours.
    • Offered to assist in back office duties to learn business aspects of the setting.
    • Final caseload: 7 patients in an 8 hours shift, average treatment time at 1 hour.
    • Final Productivity: 88%
  • Clinical Rotation 4... and so on...
  • Employment History:
    • PT Aide at Therapy Company 1. 
    • Valet at Hotel 2.
    • Tutor at Agency 3.
  • Professional Advocacy and Extracurriculars:
    • Part of this...
    • Part of that...
    • Went here...
    • Went there...
    • Helped raise this...
    • Helped kill this one bill...
    • Volunteered at pro bono clinic...
    • Etc.
  • Career Goals:
    • Get board certified...
    • Do research...
    • Open up practice back in your home town in 5-10 years...
    • Continue with political action...
    • Etc...

What about a cover letter?

This is actually a great place to put Tips 3, 4, and 5. Many times, the hiring manager just wants to see the bare minimum deal maker/breaker section of Tips 1 and 2. The cover letter is a good way to briefly give character to what you may not actually have in true work experience for Tips 3, 4, and 5. Keep the cover letter to something between half a page and two thirds of a page. The more readable the better. This is a good place to brag without getting in too much trouble. But really, this is where you want your personality to shine. Some managers read it. Others don't. It won't hurt to write it, but, depending on the type of organization, I can't promise that it will help.

A quick bit about Linked In and other employment oriented social media constructs:

Make sure everything matches up. Make it clean. Don't worry about how detailed everything is as much as the presentation. Also, realize Linked In will only help hiring managers confirm what they think of you and verify your resume contents. It will not typically tip the scales in your favor. However, if your Linked In profile (or any other profile) is a mess or unfavorable representation, it WILL sink you.

More likely than not, Linked In will be utilized by head hunters and spammers to get your attention. It may be annoying, but its not necessarily a bad thing as it helps you keep a constant eye on the climate of the job market around you. Linked In alerts (as well as Monster and other websites) are quite helpful in supplementing this area of awareness.

It probably goes without saying that EVERYTHING you put out there, public or private, basically is still public. Many companies will reject your application because of something you put online. For many organizations, so be it. For others, it's unfortunate. Either way, just remember that the media constructs circulating on the job front are really more there for your information in regards to the job market at large as much as it is for the recruiters trying to fill their openings' alert.

You need to have it, but its really more of a passive information post than anything else. Just keep it clean, tidy, professional, and up to date... it's a theme ;)

Closing Thought: Your resume is about deal breakers more than deal makers. Keep it simple, clean, and to the point. Make your resume frame you as an attractive candidate, hireable, productive, quick to train, easy to get along with. The relationships you have going into the interview is the deal maker. So very many hiring managers barely even take a look at resumes anymore. Like I said, I think it's becoming a formality than a function. Therefore, just make sure its quick and easy to go through, and, spells you out as a good employee. The real deal is always done in person.

As always, please let me know if there is anything else you'd like me to blog about, or, if there are things I didn't cover that you are still curious about.

Take care!

PS. If you liked this post, you may be interested in taking a look at this very popular post: New Grad Career Strategies as well as the Career Paths and #DPTstudent labels.

Thursday, March 5, 2015

5 Wasteful Management Tasks

This post is inspired by my random pontifications as I'm closing upon the completion of my MBA in April. Being an MBA candidate has been very exciting; the finish line is near and now is the time to keep the momentum up! Well, I was thinking one day about some of the tasks I had to do as a manager and tasks done to me by managers. Some management processes are simply in place as the nature of the organizational beast. Other times, they are implemented by the managers themselves as a personal lever. In either case, I find that there exists (at least!) five management tasks that are truly wasteful and destructive to organizational values.

Here are...!

Five Wasteful Management Tasks
1. Scheduling
  • Scheduling is perhaps my biggest pet peeve when it comes to the misuse of managerial resources. It doesn't take a manager to schedule. In fact, it is a double waste as this takes away from a manager's productivity and ability to attend to business unit issues on a daily basis and forces them to do something less profitable to the company at large. Scheduling is better performed by an internal call center department. Having a department specifically dedicated to the scheduling, pulling, and pushing of human resources on a day to day and hour by hour basis under request of the managers of each business unit centralizes human resources when it comes to labor hours. It also allow the manager to be a manager, not his/her own secretary per se. The way I see it, managers are paid and tasked as stewards of business units. They add value by their very presence, their ability to maintain healthy operations and optimize them over time. It is their job to develop and cultivate the growth of excellence in their business unit, and, to bear the weighted duty of problem solving when the proverbial fecal matter hits the fan. Companies are far better suited in freeing managers to do their job and not bear down upon them tasks better suited for a separate department which can by itself already create far more value across the organization than an over tasked manager repeated in series throughout the chain of command.
2. Performance Assessment Robbery... Oh, sorry. I mean "reviews."
  • Let's face it, yearly reviews tend to have some element injected into the process where the most deserving employees are typically docked just enough points to rob them from a meritorious raise. WHY is this generally ubiquitous across nearly all organizations? Honestly, I have no good answer. Everyone says this is to cut costs. But, I think not only does it do that, it discourages good staff (possibly decreasing their productivity) and honestly puts them at risk of leaving the organization, lowering the human capital available to the firm. This is truly a stupid process. If employees perform well, reward them! Don't take from them simply because it is the thing to do. If times are tough, say so. People will get it. But, this underhanded way of cutting people off at the knees.... Ugh! Makes me mad.
3. Intra-departmental Politics
  • While maneuvering through external politics is absolutely a critical function and required skill of a manager, making sure everyone is playing nice in the playground is an infantile and rather ridiculous task given to management. I found that one of the most insane and ridiculous tasks I had to do as a manager was playing teacher for kids to play nice with each other. Honestly, if the policies were in place, I'd have a better solution. GO TO HR! That is what HR is for. It is wasteful for managers to play mediator between team members for petty differences. Now, for professional disagreements, there is definitely a duty upon the manager to resolve the issues. However, when things are truly petty... that is when they should go the proverbial principal. Go. To. HR! Deal with it there and don't come back until you do. The workplace is no place for personal drama.
4. "The budget"
  • Corporate accounting is usually in charge of accounting these days. Having managers re-double their efforts on the numbers, in my opinion, is a little redundant and qualitatively backwards. Corporate accountants are highly trained for the very specific purpose of making sure the budget will fit operational goals. The job of the manager is to fit their operations within those parameters, and if unable, to put in a request/report for variance. Nevertheless, I've seen this redundancy occur (typically in larger organizations) by where both accountant and manager go over the same budgetary considerations. Unless the manager needs to serve as an accountant for lack of one, this just seems silly. Wouldn't it be a better use of resources for the manager to dedicate themselves to the operational aspects of their business unit if they have the support elsewhere? I'm not saying for managers to ignore their own budget, I'm simply saying there is no need for two people to do the same job when one is clearly better at it -AND- is going to be the final say anyway. A manager's responsibility over the budget should be operational; the accountant's responsibility should be financial. That is where they should meet and those are the grounds they should work from.
5. Meetings
  • Surely, there are meetings where management level staff need to be present. However, my experience is that the majority of meetings exist because they always have. Some meetings can be attended to by line-staff or senior-staff as a better allocation of resources. Why? Well, first the staff member will feel privileged to go to a management meeting to represent the manager, the team members, and the department at large. Secondly, many "meetings" are merely grumblings on the daily grind of things. Managers tend to know less about this than those who are already in the front line. Who better to represent concerns and bring solutions to issues than front line staff? Also, so very many meetings can and should be done virtually; either through live digital means or through shared online documents. Really, the purpose of meetings is to conglomerate ideas; if this process can be done with more agility, why not do it?

So, those are my top five pet peeve management tasks which I think should simply be erased off the face of the earth if possible. Now, certain firms will require cross-functionality because of size, scale, or leanness. In which case, sure, having a manager schedule because the business unit is the manager and two other team members... that makes perfect sense. In that same situation, the manager should certainly also serve as the accountant if there is no further infrastructure in their firm. However, should the firm be of scale and have the available resources, doesn't it simply make more sense to have value added across two business units than for double the value to be taken from one, by making managers perform tasks outside of their true purpose and cut value to a fraction? I think so! But, that's just me.

Just my thoughts until next time!

Take care,

Wednesday, March 4, 2015

3 Insights From An Industry Analysis

So I was tasked to do an industry analysis on outpatient Physical Therapy a little while ago. I finally got to a point when all the data I mined started to make sense. I'm not privy to share everything, of course. However, I am allowed to share the following insights after hours of tedious data analysis.

3 Insights from An Industry Analysis: Outpatient Physical Therapy

Before I go into the insights to be shared, I want to first share with you a very special data presentation called the Profit Pool Analysis (PPA). This is a rather complicated graph to conjure, however, when done correctly and accurately, it speaks volumes.

What this graph speaks if not shouts, is of the profit found in outpatient PT through billing for Therapeutic Exercise. It receives the highest pay and lowest rate of denial compared to the runners up; the overwhelmingly common Therapeutic Activities and Manual Therapy. Also, to be noted, the last two or three years had an industry trend of commonly billing for Neuromuscular Re-education. Guess what? It wasn't the most profitable of all codes as much because of claims being rejected. There is actually far more discussion to be had on this PPA, but, I promised earlier on Twitter to keep this succinct.

So what were my three insights? Well based on this analysis and some other results...

1. We're branding wrong.
While the PPA tells us only the financial perspective of where our market dominance is, it should also tell us a little bit about not just the payer but the end using consumer, the patient desires. As much as we'd like to think people come to us for manual therapy, dry needling, functional movement training, or whatever... the fact is people actually come AND PAY for exercise.

Honestly, when I saw this, I nearly hit the floor. It was mind blowing. How could this be possible? With all the branding we're doing about movement, manual therapy, human touch, and improving the human experience... we missed the boat.

Exercise is a 100% reliable prescription that can be self-administered at supremely cost effective operational margins. And think about it, what do people do when they come up to an outpatient orthopedic PT on the casual conversation?

"Hey, I got this thing about my knee.... anything I can do about it? Any stretches? Exercises?"

RIGHT?! They don't go up to us and say, "Hey... could you mob my knee?" Consumers ALREADY value us for our expertise in prescribing exercise a medicine, so to speak. It's something to think about, and, it leads to insight #2.

2. Exercise is our unique value proposition.
I know, I know... there are half a dozen armies and brands of personal trainers who can delve out exercise content for a fraction of our cost.

The thing is, they don't prescribe exercise as a healthcare solution. Sure, it's fitness and what not. But, what outpatient PTs do that personal trainers cannot is they cannot prescribe exercise as a solution to musculoskeletal disease management.

As such, we need to be WAY better in our DPT didactics about exercise physiology, strength and conditioning, psychology of exercise, and keeping a keen market eye out for trends of exercises.

3. We're driving profit from the wrong place.
I alluded to this above, there has been so much billing as of late for 97112 because it is priced well. However, we're just not driving enough profits from it as an industry. Certainly, your clinic or your business may be gleaning quite a great amount of revenue from providing and billing for Neuromuscular Re-education. However, as an INDUSTRY AT LARGE... we're actually losing that battle. Plenty of payers have noticed that everyone seems to be doing it (billing for neuro-re-ed). Obviously, every patient can't be "appropriate" for 97112, at least in their eyes. That's why they are declining to reimburse a good portion of the industry's claims, leading to a lower operational margin for that service.

Instead, I would suggest that as an industry, we take a careful look at driving profit from Therapeutic Exercise. There may very well be something to it. Instead of lobbying to protect manipulation, or dry needling, or this or that or anything else. Why not lobby to protect the prescription of exercise for healthcare and disease management as something truly unique, only to be given by the physical therapist? It may not be the popular thing within our profession, but boy, it seems quite popular to our consumers and stakeholders across the value chain. Again, something to think about.

That's probably all I can share while holding to my commitments. I know for some of you, it may not seem like much of a share. For some of you, this may be as earth shattering as it was to me when I finally put the pieces together.

I'm not saying we abandon Neuromuscular Re-ed as a mainstay and specialty; I mean, all of our neuro patients need it! I'm also not saying let's abandon Manual Therapy. If anything, I think the combination of Manual Therapy with Therapeutic Exercise is what makes the Physical Therapy experience under the care of a physical therapist so unique in the spectrum of healthcare.

Instead, I'm humbling suggesting we take a look at the facts of this analysis. The market values our ability to prescribe, provide, and progress exercise as "medicine" -- as a solution to rehabilitation, recovery, and the management of musculoskeletal disease in the outpatient environment. As such, we can also use it to optimize health, and perhaps, improve markers in population health through proactive measures and prevention initiatives.

The market demands us for exercise; we'd be wise to consider not only giving it to them, but finding new ways of positioning and promoting our expertise on the strategic level, the political forefront, and, through legislative avenues.

PS. Keep your eye out for two up-and-coming posts:
"5 Wasteful Management Tasks" and "5 Thoughts, 5 Years Later"