Building a Center of Clinical Excellence with Zach Baker - Episode 14

It's easy to burn out in an insurance-based physical therapy model. I think one of the keys to avoiding this is to assure you are always building a center of clinical excellence. In fact, that's one of our core principles at Champion.

Zach Baker and Rehab 2 Perform in Maryland are doing a great job with this, so I wanted to get him on the podcast to share some of their model.

Full show notes: https://mikereinold.com/building-a-center-of-clinical-excellence-with-zach-baker

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Transcript

Introduction: 0:34

On this episode of the sports physical therapy podcast, I'm joined by Zach baker. So that's the chief clinical officer and program director for the sports residency program at rehab to perform in Maryland. And this episode, we're going to talk about a ton of great career advice for early career professionals, trying to figure out how to balance personal growth, mentorship, and quality clinical care.

Mike: 1:04

Hey Zach, how's it going? Welcome to the podcast.

Zach: 1:07

you, uh, having me on. Uh,

Mike: 1:09

Awesome. Yeah, man, uh, super excited again. I mean, I'm excited about all the episodes, so I, I, people are gonna get sick of me saying I'm super excited every week, but, uh, I, I'm super excited because, you know, Zach is someone I've been admiring online and really your whole group at rehab to perform, uh, is a, a great place in Maryland. How many clinics do you guys have?

Zach: 1:29

we're currently at seven.

Mike: 1:31

that's awesome. I mean, amazing to watch, cuz I feel like, uh, I I've actually witnessed at least half of that grow just by following you guys on social media. Uh, really cool to see that, but Zach's the guy that when, whenever you put out content that's on there, um, and I wonder if this comes down to your title, you know, Zach's what, what, uh, your. The chief clinical officer. And I love that. I love the sound of that. I love, I feel like that would be the exact position I'd want to be in that, that type of environment, but Zach's always putting out some great content about mentorship and helping people grow and all the neat things that they're doing at R TWOP. So I, I think that's all, all really, uh, exciting things that you're doing. So why don't we start with that, Zach? Why don't you tell everybody, what, what does it mean to be a chief clinical officer? I know you have so many offerings at R two P, but what's that mean exactly for you?

Zach: 2:21

Yeah, I think it's a, uh, a pretty clever way to give myself a, a way more qualified and, uh, important title than probably what I deserve. But, um, you talked about our growth as a company. Um, Josh's the owner I've been with him since day one and we opened in 2014. It was just the two of us. And now, as you mentioned, we're seven, eight years into this. We've got seven locations. We have multiple PTs at locations. So, uh, we really, we reached a point where we thought it was within our best interest to have somebody who essentially what we term this title is like the quality control guy for our clinical care and our clinical operations. So, um, to touch on that, like just superficially, uh, I treat about 30 hours a week currently. And then my roles as the chief clinical officer are geared towards overseeing, um, and really executing the sports residency, onboarding and mentoring our new hires, uh, from a clinical standpoint. And then also just the continuing education of the current staff that we have. On a weekly in-service basis. So just figuring out, um, what is the content that we're gonna go over on a weekly basis? Um, and what does the structure of that content look like in regards to how it'll influence our clinical care? Um, and then really just helping triage within our staff. Like where do people want to go within their careers? Um, and that's something where. I think Josh is a tremendous job of providing opportunities to, for people to grow within the company. Um, and then he kind of leans on me a little bit to help put people into the right tracks, whether it's getting him in, in front of the right people or networking with the right people, maybe hooking them up with, uh, facilitating the path to OCS or SCS, um, or really just making sure that they're, you know, they're happy with what their role is within the company. And they have the resources at hand to do their job.

Mike: 4:04

And that that is really unbelievable because I think if you were to ask. Early career professionals that just get thrown into an outpatient orthopedic environment. Most of the things that probably frustrate them the most are things that you could argue your role is designed to eliminate. Right? So onboarding, right? How many, how many. People that are listening right now have had a clinical onboarding where they actually learned like, you know, the concepts and philosophies of the company. They're about to go, uh, work with probably very few, right? How many people have, uh, you know, mentoring, uh, abilities, how many people have, uh, you know, internal con ed that systemized like, like you've gone through how many people have robust. Clinical rotation and residency programs like nobody. Right? So I feel like you guys almost reverse hacked all like the real frustrations of getting started in out outpatient orthopedics and made that a, a really less daunting environment for new people.

Zach: 5:00

Yeah. And I think a lot of that just comes from what we try to have is like a very open and approachable leadership staff within our company. And a lot of what we've implemented has been direct input from either. Students going through our D P T internship program and expressing their concerns going into the working world, um, or people within our company, just, you know, after they've spent a month, three months, six months, a year, five years, uh, when they look back, what do they wish were things that would've been handled a little bit more efficiently, or what are things that maybe we did in person that they're like, Hey, just make this an, an online platform that I can go at my own speed. Give it to us before we even start working so we can hit the ground running from there. So, um, it's something that this year has been a focal point for us. Um, and what used to happen pretty intuitively when Josh and I were treating in the same clinic under the same roof. Um, the touchpoints that you have with the staff, isn't the same when you have seven clinics and you can't be there every day, 40 hours a week. So that was really what necessitated this role within the company. Um, and just trying to figure out, you know, what can we provide for people from an internal educational standpoint? Via online resources, what requires direct mentorship with another member of their staff. So like their site director on a weekly basis. Um, and then how do I come in on a monthly basis to reiterate some of those things as they're getting the reps under their belt, um, and kind of triaging things in real time with them, because you can prepare all you want. To get into the clinic and some questions you just don't have until you get a month or three months or six months into it. And I think that's what we, uh, that we're really trying to evolve with that ongoing mentorship. So to say,

Mike: 6:42

And again though, you're reverse hacking it though, because not only have you been through it, right. And Josh has been through it, but you you've had enough people that you've brought up through the ranks in your company to know probably where those speed bumps are, like where, where those friction points with, you know, the three month mark, the six month mark, like where that. People stall their ConEd progress or something like that. And you can almost reverse Hacke to make sure that everybody's progressing together. So it, it just sounds like a really neat place to work because you're so supportive of the development of your staff, which not many companies are nowadays. Right. So, so, so you guys, you, you take clinical students, right? Uh, how many D P two students a year do you think you take

Zach: 7:23

That's a great question. And, uh, the, the clinical internship program, uh, was something. Josh and myself and some of other, our senior staff members had implemented early on. And, uh, Jamie Schindler, uh, actually runs lead with that now. So she does all of the, uh, the applications, the placements, the interviews. So she would have those numbers a little bit more intimately, but, um, we take students at all seven locations. We have at least two clinicians at every location that take students. And we have students throughout the entire year. So, um, I don't know what the exact number is, but it's a, it's a pretty big number. Um, I know personally I'm one of the CIS and, uh, there's not a week within the calendar year where I do not have a PT student. So you can kind of, you know, scale that, um, when you run the numbers on your own.

Mike: 8:11

For sure. Yeah. And, and I'm the same way a champion with Lenny. Like Lenny's the one that, that runs it as he, he runs all our PT department stuff and, and it's the same thing. And, you know, sometimes I walk into work and there there's two new students and I feel like it's like that every week. Right. There's just new students everywhere. But, um, I there's, there's something that's just. Priceless about that, though. Right? Where you, you just have such a great environment of learning when you surround yourself with PT students that are always trying to kind of grow and push the envelope themselves and have great discussions. Uh, it's a really neat experience. So, you know, I really look up to you guys, R two P with all these things that you do. So for me, I'm kind of curious how that runs for you. Do you guys have like a set curriculum or like, how do you run your clinicals that, that you make sure that you're getting the most out of the student, but also providing a really great opportunity for them.

Zach: 9:32

So I think the, the biggest thing you have to do is you have to filter who's even getting into your program. Um, and I think that. How you set those standards, whether you have certain cutoffs or whether you just, you know, interview and get to know people and really what their interests are, uh, getting the right people in there for the right reasons makes your job that much easier as a CI. Um, and then we do have a pretty extensive, uh, curriculum, and pre-reading not like saying pre-reading material, but. Things that we value as a company from a thought process standpoint, um, from continuing ed courses that we've taken in the past that we implement a lot in our evaluation or intervention techniques. Um, and Jamie's compiled an amazing email that has all that packaged into one, um, that the individual gets prior to starting in addition to who their CI's gonna be, what their schedule's gonna be, what are dress code expectations? Hey, when you're not working with somebody. This is how you should be spending time, because there's a lot of valuable things that you can do in an internship that don't involve just direct patient care. Um, and I think setting those expectations early, uh, that really answers a lot of the questions that most people have or fills the dead time that I think often accompanies most internship programs. And then we do have kind of a, a default curriculum that we can refer back to in regards to. Week one, here's some readings that you can go through week two. Here's some readings you can go through. Um, and we have a little bit of leniency with that. Where if it's something the PT student hasn't been exposed to you go over that with your CI. If it's something you have been exposed to awesome. Go own that material and go teach our undergrad. People who want to be PTs about that concept are high school interns who are in here that obviously have less autonomy with what they. Legally do, and honestly what they should be doing in the clinic, um, have them be more interactive with you. And I think from a PT standpoint, it allows them to kind of own their voice in how they can relay material to either colleagues or maybe more of the general population. They can start to figure out what verbiage they use and really become more confident with that.

Mike: 11:36

Right. And it takes reps, right? You, you have to, it's almost like you're, you're a comedian, that's trying out new jokes. You have to see what the response is, right. How the crowd appreciates it and then refine it a little bit and try it again. And that time that it clicks and you're like, oh, I saw the patient's eyes light up. When I said that, I think I really got my point of. Across that it almost comes like a, you know, like, uh, something that you'll refer back to over time. So yeah, that's something you can't teach. Right. They just need to experience that. So, um, that's pretty neat that you, you have'em build that way. Um, I, I always tell people that the clinical students keep us on our toes and they, they keep us thinking and growing and even staying current, which I think we do a good enough job on our own anyway, but they still kind of push the envelope with that. Um, Because of that. I think it's, uh, important that we all try to develop these in our clinics. And I know there's still a bunch of clinics out there that haven't done it. If somebody had a clinic and they're not doing PT clinical rotations right now, what, what would you tell them for some advice to get started that maybe we'll take a little of that friction out. So it doesn't seem so daunting to get started. Like how do you even get started with a good clinical.

Zach: 12:44

So I, I think part of it comes down to, do you have anybody already coming in? And before we even took D PT students, we first took high school students and undergrad students, and tried to figure out when you have these, I don't wanna say lower risk populations, but less demanding populations cuz you don't need to satisfy the, the PT. Curriculum with it as a CI can you make meaningful use of their time? And I think, gosh, if you were to look back at like a snapshot of what we've done with our high schoolers, our undergrads N our D P T students. What we're doing now, doesn't look like a year ago and what we did a year ago, doesn't look like two years ago and what we did two years ago, it sure as heck doesn't look like what we started. And, uh, it's funny. I look back the first student we ever took was, um, Anthony I in Reno, he was ended up being one of the first people we hired as well. Um, after we hired, uh, Jared Boyd. And he, uh, he ended up working with us and now he's with the Washington wizards. Um, and it is kind of funny. We always look back and we're like a man, I'm sorry, you had to do an internship with us. Cause we didn't really know what the heck we were doing when you were a student of ours. But, um, uh, it's, uh, it's fun. It's a learning process. I think just developing great relationships and having people who, uh, feel like they can be candid with you, speaks volumes as well. And just, it helps you, um, refine the process as you.

Mike: 14:03

Yeah, for sure. I, I think that's, that's really well said. Um, I, I know through just everything you do at R two P that you deal with, not only a. Students, but early career professionals, even people that you teach through your courses, you have a new online course. That's out now. Um, all these, these people, um, I, I feel like one big area that we're always talking to with people is starting their careers off. Right. And some people maybe they have limited opportunities because of where they live or, or where they're geographically tied. Right. Um, some don't know what they want still, which I, I, I don't, I don't blame them. Right. It's still daunting to try to figure out exactly what you wanna do with the rest of your life. Right. And some just wish that they had their dream job day one. Right. I've had so many students say, when I say like, you know, where do you see yourself in like 1, 2, 3 years? And they're like, well, exactly where you are And I'm like, well, It took me over 20 years to get here. But I mean, if you wanna try to do that in 12 months, congrats. Uh, but like, what are some of the things you recommend because you have so many different, uh, people from, like you said, high school, uh, and now during their PT, clinicals, post-grad residency, so many people you touch, what are some of the things you recommend from your experience to really get your career started off in the right.

Zach: 15:16

I, the thing that I always tell people is your first job, doesn't have to be your dream job, your career job. Job is it's literally that. Um, and it's funny, I was talking with a, uh, a sports resident one time and he said he was going into an application with another residency program. Um, and he said, yeah, I, I pursued a sports residency because I wanna work in sports. And the person doing the interview said, well, have you ever worked in sports? Have you ever been in an athletic training room? Have you ever worked all day and then had to go on the road with a team? And he goes, no, I've never done that. He. How do you really know you wanna work in sports then? Like you like the idea of working in that environment? Um, and same thing here. I think we all go into school and we leave school with an idea of what we think the ideal clinical scenario is. But until you spend time getting reps in it, you don't know. Um, and I think I, before joining R two, I was at another local, um, outpatient orthopedic clinic. It was about 50% traditional orthopedic, about 50% sports. Um, the owner was a great guy, all the staff there was great. Um, But there were just certain things that I didn't really know what I liked or didn't like, and I think you go into your first job and some people don't know if they're gonna like being the only PT in the clinic or one of eight PTs in the clinic. Some people don't know if they want to work for a large organization or if they wanna work for something that's a little bit smaller. And I think both of those have pros and cons. One may have more growth, uh, from an opportunity standpoint. One may have a little bit smaller ceiling with that. One may promote more autonomy that people struggle with. Some people like having that guidance, um, some may be more demanding in regards to what their community outreach, uh, expectations are, your administrative expectations. And I, I think until you really just get your feet wet and, and work with some of those things, you don't have an idea. Um, you know, I. Clinical caseload as well. People have an idea of like eight versus 15 people a day or 30 minute treatments versus an hour treatments. But until you actually treat somebody, I, I see a lot of people are like, I need an hour with a patient. I'm like, I would love to see you consistently and effectively fill 60 minutes of treatment time with somebody before you commit yourself to that.

Mike: 17:23

right. Exactly. It could be a long time for some people

Zach: 17:27

And then other people say, oh, I don't need more than 30. I'm like, well, great. We have 30 minute treatment slots. Let's see if you can get everything that you want to get done in 30 minutes. And let's see if you can do that when somebody's running five minutes late or when they

Mike: 17:38

right.

Zach: 17:38

up UN you know, with an unexpected thing, uh, influencing that. So, um, I, my biggest advice is just say your, your first job's your first job. You don't need to stay there for 30 years. It doesn't need to be the perfect job, uh, but go into it, figuring out what are your non-negotiables for your next job. What's the type of setting. What's the clientele that you wanna see? Is there a certain timeframe that you want to have with patient? Do you prefer insurance or cash? Do you prefer a smaller, large company? Um, and I think until you actually go through the motions, you cannot honestly answer that questions. And we've had people that have been students of ours that they want to work with us. They get offered at another location. Or another clinic, it may be closer to home or, or they're hesitant about moving down to our state to work with us and we tell them, you know, do what feels right. Do what you want to do. There's nothing to say that you're not allowed to work for somebody else and then transition and work for us later. Um, how do you even know if we're the right fit for you if you've never hadn't experienced somewhere else either. So, um, I, I think just keeping an open mind and, and appreciating, uh, what that first job, um, it's a learning experience as with what the rest of your career will.

Mike: 18:44

And I, I do feel like sometimes people go in with too much of tunnel vision saying that this is exactly what I want and they haven't experienced anything. Right. And like you said, it really makes it challenging because I know tons of therapists that have, for example, you know, Thought they were gonna get into sports, physical therapist and, uh, and then fell in love with like pediatrics, right. Or, or wanted to do home health. Right. Or wanted to be a traveling therapist, for example. I mean, there's so many different avenues that you can take nowadays in this profession that I think that, that, that really, uh, You know, you shouldn't go into anything thinking there's only one way. And we've talked to a lot of students that are interviewing with people while they're on their clinical rotation with us. And they have some very large critiques of their potential future employers. We always say like, Hey, it's, it's, it's just your first job, not your last job like yours. And that everything is a positive learning experience, right? Even a negative one because it teaches you what you don't want in the future. And then you can pivot and make that adjustment.

Zach: 19:44

Yeah, I agree. And I think something that we always talk about, like as a company and whether it's somebody working for us or just following what we do online or just, you know, having interactions with us. I, I think we always talk about raising the floor as a profession and. There are all, I think that's where, like, when you talk about like chief clinical officer, I think that's really like what my role within the company is, is there's a, you can very easily find somebody more intelligent than I am. That's gonna raise the ceiling of the profession within a different specific demographic or injury, but. What I'm hoping to do with our company and hoping to do just with the field in general, collectively with the network of people we have is how do we raise the floor of what the PT, outpatient sports world offers to a point that no matter where you work or what environment you work in, you feel like you can offer a very high quality product to whoever walks in through the door and you have enough checks and balance of systems and processes in place. But it doesn't take such a cognitive demand and physical demand to do so as well. And I think, um, that's where hopefully just spreading good information, creating good mentorship programs, interacting not only with people within your own companies, but other companies. I think we start to realize that there's a lot of synergy that can take place. It's gonna make yourself a better clinician. It'll make the clinic that you work for a better company, and it'll make our outlook as a field that much better as well. And I think once that happens, a lot of things just intuitively fall into place.

Mike: 21:09

For sure. I, I, I would agree with that. And, and again, I think, uh, sometimes you get lucky in your first job and sometimes you don't, right? Sometimes you, you get into a, a, a place where you're getting some good experience, but maybe you yearn for a little bit more mentorship and maybe you're in a clinic by yourself, or maybe you're in it with another new grad or, or you just don't have that network. What would you tell someone that you think has found their way into this job, but they don't feel like they have enough mentorship. What can they do if they're in that.

Zach: 21:41

So I think the first thing you need to do is just be vocal about it. And whoever your point of contact within that company is whether it's the supervisor, whether it's the owner, whether it's just other colleagues on staff, just express that concern to'em, uh, for some people. They may not provide mentorship because they're trying to promote autonomy and they don't wanna feel like they're stepping on your toes. And they may feel like I've had some people say, I, especially colleagues who from other clinics where they say. You know, I felt a little bit reluctant to provide mentorship because I didn't want it to come off as demeaning and I didn't know how it would be received. Um, so I think just speaking up in regards to what you're actually looking for, um, and then on that you need to see what the response is. Does the company provide anything? Um, where did they just say, oh yeah, we'll get around to it. And then it never actually happens.

Mike: 22:25

that that would be bad.

Zach: 22:27

Yes. And I think, uh, from there, I mean, you have formal ways that you can get mentorship to your company. You have informal ways as well. And I think, um, I've always been blessed to work with very intelligent, very, um, like-minded and just, uh, open, forward thinking colleagues who like to have these conversations, but a lot of stuff that I do in the clinic today, whether it's, uh, different techniques I use or exercise I use, or just how I frame up my own thought process has come from either. Previous, um, online Con-Ed courses that I've taken or just reaching out to other people. I, I think one of the, the biggest disservices you can do is go to a continuing education course and not speak to somebody else in their course, or make a new friend while you're there, or go to CSM and not leave there with 20 to 30 new context, um, in your cell phone. So I think just expanding your network. It is another great way to find mentorship. And then that's also gonna, you know, from there that will open up the doors to so many other things, whether it's formal online mentorships, whether it's other courses that people recommend, or you just get put in touch with other people that can provide more for you.

Mike: 23:34

And there's so many people out there that if you are yearning for more. There's opportunities out there. And I always tell people, you know, follow some people on social media like yourself, right. And try to learn from them on social media. And if you feel like you jive with them, right, that's the type of person that you want to try to surround yourself with. So luckily people like yourselves, you have online courses, you travel around, do some ConEd courses. You can just learn so much just from following you. To me, you can almost make your own mentorship program yourself sometimes by identifying people that you wanna associate yourself with and learn from over, over time. So I, I would love to see more people do that because I just think it's so much easier nowadays with online education. So really, really neat, uh, experience, um, one, uh, so sorry. Yeah. G Zach, sorry.

Zach: 24:24

Yeah, I was gonna say. And just when you do that, when you reach out to other people, it's I remember early in my career reaching out to other people like yourself, like Lenny, like some others in the field and I'll, I'll kind of express a thought to them kind of questioning my own decision making and I'll get an answer right in line with what I was thinking. I'm like, oh, you know, that kind, that's kind of affirmation to me that I'm moving down the right direction with this. Um, or I'll get a response where it's like, holy cow. I didn't even consider that, or I didn't think of that now. Now I need to take this informal conversation and find a more formal way to learn more about that subject.

Mike: 24:59

Uh, and, and again, what you've done, we talk about this a lot with ConEd is you identified maybe some potential areas that you wanted to get better with for yourself. And then, like you said, okay, I'm gonna outline a more formal way for me to learn this. I mean, I, I think that's a great way to approach it is almost like find. Holes, right. Find areas that you think you need to get better at and then build on that. Right. So I, so I gotta ask. So in our past conversations with Lenny and I, did we enlighten you on anything you weren't expecting or were we right in line the whole time?

Zach: 25:31

I think, um, so what I appreciate from what you guys always provide, and I think a lot of it has to do with, um, just your experience either in the athletic training world or with sports teams, or even with people more acutely following surgeries or following injuries. Um, there are certain diagnoses that I'd be. Either reluctant to, I don't wanna say, give people but have in the back of my head, um, or there'd be certain things I'd be afraid to intervene on early on. If I didn't know if it was. You know, with, within my scope or within something that I could even control. Um, I remember I had an individual one time who, you know, was a soccer goalie. He got slide tackled, got hit right above the, and he had an abnormal amount of swelling that was there. And it was, uh, you, I reached out to. To Lenny one time was like, Hey, I've spoken with the orthopedic for this kid. I I'm making some progress, but have you ever seen this amount of swelling? Super patella. And he had talked about some other, um, you know, just inflamed S that he had come across that had maybe presented like that. And it was funny. It was right after I'd saw him post something about using the sweep. For measuring joint effusion within a knee. And it, it was just random that I was watching that video a couple days before, and then I had this person come in. Um, and you know, I played around with doing that test and some other things clinically, and then that made me think like, you know what, maybe I'll maybe I'll follow up and see with this, uh, with this guy who I've never talked to, if you'll make the time for somebody like me to. To speak with them. And we went back and forth for like two or three days on it. And that that's something that I appreciate. And, um, I think it just goes to show that we have a profession where people are very open to lending, helping hand. So don't.

Mike: 27:13

Yeah. And, and that's great advice too, is I, I don't think if, if somebody's putting themself out there on social media, they're probably willing to chat a little bit. Right. And I think that's the important part. I mean, I, I get a ton of DMS. I try to go through each one. Right. There's a lot of people that are in like shoulder pain that are asking for questions that I'm just, I skip, right. Because I'm not, I'm not here to give medical advice, but if, if somebody were to DM me. A clinical type question. I'm always trying to help because I, you know, I think we're, we're a service based industry, right. We're here to serve. So I think we, we carry that forth with each other as well as if there's something we can do to help you, you know, I think that's, that's pretty neat. So, uh, next thing I wanted to talk to you about kind of last big question for the podcast for me on this is R two P is, is. It's a different place. Right. And I think a lot of people see it online and I think they really appreciate it. There are a ton of PT mills out there, right. That are just churning out patients. It almost like looks like they care more about revenue than outcomes. Like these are the types of, of clinics that are everywhere. Right. They're that are just, they're just a common thing. R two P is different. You still take insurance though, right? And there's tons of limitations with insurance, but you're still providing a great job. How do you handle that? How do you reconcile that kind of, that blend between having to pay your rent, but giving the best outcomes you can in an insurance based model? Because I think a lot of people are nervous about that. And a lot of people think that you have to just do it poorly if you're gonna be an insurance based model, but then people like you are just absolutely kicking butt. What's your.

Zach: 28:48

Sure. So I think part of this comes down to really figuring out, like, if you're concerned about an insurance based model, what are your concerns with that? You know, is it, is it the reimbursement that you get? Is it the number of people that you may need to see in a day to make up for that lack of reimbursement? If you feel like you could get more from a cash based standpoint? Um, is it just maybe in the hassle of dealing with insurance and the personnel needed for that? So I think. One thing that we do really well is behind the scenes. We have a phenomenal, uh, just billing and admin staff that knows insurance inside out. And they give us a heads up of like, Hey, these are the types of patients that you may run into hiccups with with the total number of visits you're gonna have with somebody. So if you recognize this insurance and you're forecasting a certain number of visits, be proactive in regards to how you're spending your time with that person, or be proactive with the conversation that is, Hey, you have insurance. But in order for us to get done, everything that we need to, there may be a point in time where we have to transition to a self-pay model. Um, so we are predominantly insurance based, but we do have a small percentage of people that will do self-pay just because of insurance limitations with that. Um, but I think the, the biggest thing is just. Maximizing time with individuals and how we, how we structure. We have hour long evals. We have 30 minute, uh, one on one follow ups with individuals. So we're actually seeing less than what the state of Maryland, um, dictates as like the maximal number of people you could see within an hour. So, um, I think that's one thing that we do is find that balance of, you know, how do we see enough people? So that we can drive enough revenue to do what we need to as a company, you know, have a facility that is enjoyable to work in for our employees, um, and is also enjoyable for the, um, patients to come in, have enough money so that we can attract talent, but then also retain talent because we're, we're compensating them in ways, um, that they think that they can make a long term career out of. They're not just leaving after a couple, a couple of years and moving on to greener pastors. Um, and I think what one thing that we tried to figure out was like, what was that amount of time that we felt like we could give high quality care to patients, um, and maximize our direct one on one time with them. But appreciate they're gonna be in our clinic longer than 30 minutes. So how can we still supplement and keep them in the clinic and keep them guided and structured in doing meaningful tasks that just doesn't require that direct one on one supervision. I think we often go back to the two current, uh, terms of, uh, competency versus capacity based activities and things that are more competency driven, maybe more skill acquisition, or patient education. Or just maybe a less safe to fail activity because of where they're at from a healing standpoint, that's what we're driving home with them in those 30 minutes of one, on one time we have with them. And then maybe they have other things within their care that are addressing impairments that they have. So maybe we need to work on mobility. We need to work on strength. We need to work on, uh, energy system development, but I don't need to watch them ride a bike. I don't need to watch them hammer out, repetitions on something. I've already taught them in a previous session. Those would be more of your capacity activities. You're, you're more safe to fail activities and hopefully nobody's failing. Um, but the, the ones that don't require that direct one on one supervision that, that keeps them in the clinic allows you to work with your next patient and still supervise what they're doing. Um, but it's still meaningful and worthwhile time for that individual. And I think really just figuring out and conveying that to the patient is the most important thing. And, and letting them know like, Hey, when you come in for a session, these are your issues. You're having. This is what you need to do to address it. This is what you need our direct attention with and how we're gonna spend our time with you. And these are the things that you don't need our direct attention with, but I can guarantee if you don't do them and you just walk out the door, you're probably not gonna get the same outcomes that, uh, that you want. So I, I think it's, uh, you know, it's, it's kind of finding that balance of, you know, how do we, uh, how do we. Be definitive in what we offer as a company and make sure that we're extremely transparent to the patient in regards to what they're getting and what their expectations are, so that they're not expecting 60 to 90 minutes of undivided attention. And then they're disappointed when they don't get that. Um, but more importantly too, like from a, an employer standpoint, being extremely transparent with prospective hires. This is how we do things. If you are working at our company, this is what your logistical demands are gonna be. This is what your caseload's gonna look like. We strongly encourage you to spend a day in the clinic with us and see if you feel like you could comfortably and efficiently, uh, operate here. Um, because we don't want any surprises for either the patient or the clinical staff on hand.

Mike: 33:28

I love that too. And to be able to experience that, I think would probably be eye opening for people. Because again, it's not that complicated when you lay it out as, as nicely as you just did, but I think a lot of people don't. Maybe see that structure as well. Right. And maybe they're trying to bounce back and forth between hands on and supervised and they don't quite see how to best structure, but I really like how you break it down. And I'm sure you did that from learning from experience of, okay, I'm gonna really jam pack these 30 minutes of me time with the things that you need me in the most. Right. And then I'm gonna help set you up with these other things that I can just observe while I'm working with the next person. That, that is a great model that I think is sometimes underutilized. And I think it just takes a little creativity on your part, but once you get going, man, it, it flows, right? Like that's not challenging anymore. It's just second nature for you now. Right?

Zach: 34:18

And I think that's something where, when we talk about like, what's our onboarding and our mentorship look like it, it's less about like the Xs and OS of like, how do you evaluate somebody? How do you treat somebody it's for our new employees and our new hires and our D P T students coming in, like the, the theme that I always come down to is session flow. And how can we, how can we design this session so that we get everything done that we needed to. But in the most, uh, logical order and the one that's gonna give us our most bang for our buck. And I think that's where you can take. I was like harp on this with early post-op patients. Like how can we get energy system development by sequencing, lower intensity tasks at a work rate and a workload that mimics aerobic exercise. And then we can, we can, uh, we can find, but you can find cool ways. Like how can I work on terminal, knee extension, other than just doing. You know, TKA and quad sets. Maybe we throw'em in a front plank and then maybe we superset that with marching on the turf for active knee flex. And I think when you really just lay all this out on paper, you can do some really cool things in the clinic that can make some remedial exercises, more challenging and more stimulating and entertaining. Um, and I think you start to realize, like I've been making this a lot harder for myself than I really needed to. And a lot of these different things within that session flow are gonna compliment one another. If you can package it really, really well.

Mike: 35:42

That's great. That's great. And I, I think that's a part of what makes you guys special again too, is, is, is that you have that and it, it's funny, not everybody sees it as clearly as you just laid out too. And I, I, I just had a recent conversation with somebody in my inner circle and we had a similar conversation. They were asking about flow. And I, I like how you said that, like, uh, session flow or visit flow. Right. And they, I was like, well, how many people do you see an hour? And they're like, I see two people an hour. I'm like, Do you schedule'em on the top of the hour or one, every 30 minutes. Like we have two new people come in every hour. I'm like, great. Just have'em come every 30 minutes. right. And for, and for that person, they were like, that was like, well, that's not what we do. Right. I'm like, well, but maybe you could, right. There's, there's, there's like a way around that. But again, I, I think it's just, it's taken people outside of what they're used to sometimes. And as, as much as that's not a rocket science concept, what you outlined right there, it's. Pretty dang effective. And I think people would be more satisfied on both ends both the, the patient and the therapist. Right? I mean, this, this is a good environment for your as good as environment for your therapist as it is for your patients.

Zach: 36:49

we harp on with all of our patients as well is. The first thing they do when they walk into the door, after you greet them is set the expectations for what you're gonna accomplish that day. And what I've found with a lot of patients is they get less hung up on the amount of physical time that it takes to accomplish that task. But whether or not they leave that day, knowing that they either accomplish it or move closer to towards accomplishing that task. And then the last thing that should be done when they leave the, uh, session. Catch back up with them and let them know what you are going to be expecting of them before you see them again. So, Hey, if they have a home program, these are the three things I'm gonna be asking you about next time, or you're laying the foundation for, we accomplished this today. The next time you come in, I want to get this done. And then they already come into the session. It's almost like they're coming in on like an ongoing consultative basis. As opposed to just showing up and meaningly going through like six to eight sessions of PT, every session has a theme. Every theme has measurable and objective things that you can do to monitor. Um, and then your job as a clinician is just painting that picture in a manner and communicating it in a way. That they can understand and they can relate to. And that you're not just justifying things from an insurance standpoint or checking off boxes, um, from your impairments list that you created at the eval. And I think that's where we talk about like blending the art and the science, um, of PT. And I think what really separates very, very good clinicians are the ones that can do that effectively, um, and communicate it effectively as.

Mike: 38:21

And it's super powerful for the person to know that you have a plan. You're not just making it up on the fly that day. It's a plan and they get to see how. Interacts and they get to see how it builds from session to session. Uh, I think articulating that gets so much more compliance that that's, that's a big reason why you guys are, are kicking some butt over there. So. Awesome. So Zach great stuff. I'd like to end with our high five. So BA basically five quick questions. Five quick questions, five quick answers, hopefully. But again, I think this is where the gold is. So hopefully people start to like this section, but five quick questions. First one is what are, what are you. Currently reading or working on for your own personal development

Zach: 39:02

gosh, ConEd. Uh, I usually follow something along the themes of what our sports residency, uh, is for that month. And admittedly, what I'm reading mostly outside of the clinic is like, Nonclinical stuff, personal finance, I'm a big personal finance nerd. So I always like to, uh, to go down that rabbit hole, uh, most of my, um, in clinic stuff is geared towards whatever the theme of the sports residency month is.

Mike: 39:25

that's great. That's great. Lenny and I are the same. We, we, uh, we harp all our students and, and young, young, uh, clinicians with personal finance and golf swing lessons. Those are the two big things

Zach: 39:35

There you go.

Mike: 39:37

I like that. That's great. But, uh, awesome. All right. Second question. What's one thing that you've recently changed your mind or evolved your thoughts on.

Zach: 39:44

Oh, gosh, it it's a common theme at our, at our clinic. And one of our core values control the controllables. And I think, uh, as a parent of three kids, And also, as you know, now being a decade into, uh, uh, clinical care, you can only convey what, uh, the message you want to convey. Um, and you can only train and educate people so much, uh, and you can't get as emotionally attached on what that outcome is. If you've known, you've put everything into it, had a, a logical thought process. So, uh, it helps me get less frustrated when my kids see something goofy. Um, and it also makes me, uh, a little bit even keeled. Um, when I don't get a, a desired outcome I wanted to with the patient.

Mike: 40:23

I like, but that's wisdom that takes, that takes experience to feel comfortable with that concept. I like. All right. Awesome. Next question is what is the best piece of advice that you'd give a student or early career professional? What's your number? One thing you like to tell people

Zach: 40:39

Ask questions, uh, but be respectful of the answer as well. Even if it's an answer, you, if it's an answer you don't want, just, you know, appreciate the honesty and the answer that you got, um, and continue to ask more questions. Um, and you know, don't, don't be afraid to communicate.

Mike: 40:54

I like that. I like that. And then fourth question,

Zach: 41:00

So we've got, uh, the sports residency is, uh, we got through applications for our next, uh, cohorts, and now I'm able to shift gears a little bit more towards my teaching with R P academy. Um, I just wrapped up a course in Boston with our blueprints course. And our foundations course, uh, finally went live that's our online version, uh, you know, the foundation or kind of the beginning principles to our blueprints course, which is our live in person two day course, which is a much larger, deep dive into, uh, case studies and lab breakouts predominantly with criteria based testing, locomotive strength and power progressions, and how that fits into that whole. Rehab to performance continuum from acute care to end stage rehab.

Mike: 41:48

That sounds like a great course. I, I gotta get to that. Um, I did sign up for your online course, so I am a, I'm a student in your course. I don't even know if you. But, uh, I'm still on the first section. I just recently signed up and, and had to go to spring training. So I'm a bit behind, but I can't wait to dig in and learn more from you guys, because like I said, I've been looking up to you online with all your social media, uh, educational things, uh, of late. So really appreciate that. And looking forward to that. Uh, and then lastly, how do we learn more about you Zach what's, uh, some places where people can find you.

Zach: 42:20

Yeah. So easiest thing for R rehab to perform an RCP P academy is always just either going onto our website R to perform.com and, uh, R rehab to perform.com/academy. Uh, both of those also have active social media footprints on Facebook and Instagram. For me personally, if you're looking for more of the professional side of things, I do that on Instagram, uh, at ZD baker 30. Um, and then my Facebook account, that's kind of a mix of more, uh, family and professional. So more than welcome to check either out, but the content will be a little bit different. The, uh, the Facebook, while I'm more pictures of my kids and dogs and whatever sports they're playing, uh, the Instagram stuff will have more things that are clinically. Mike, thank

Mike: 43:02

That's that's great. And I can't honestly recommend it enough so far from what I've seen of the online course and, and hopefully, uh, you know, the live ones too, but from what I've seen in the online course, It's, uh, it's really well set up and I'm super excited to go through it. So why don't you take it with me? Uh, if you're listening to this, you can be a student alongside with me. We'll both learn from Zach and the crew from R two P. So Zach, thank you so much for joining us and sharing all this great knowledge with everybody. We really appreciate you taking the time.

Zach: 43:30

you for having me. To you and your crew for, uh, you know, setting the bar very high for our field. Uh, and continuing just to be a good group of people for people to reach out, to, and really strive to, uh, to have their career, uh, project towards.