Jobs Applied: Bend Reality

energy stretch

His staff called it the ‘Reality Distortion Field’.  I can almost imagine the super-geek (no offense intended) hallways of Apple ringing with the mythical storytelling that had to surround Steve Jobs as he pushed people to go beyond what they thought they could accomplish.  Steve Jobs would set what I would call BHAGs (Big Hairy Audacious Goals) such as creating the iPad – which was essentially impossible until it came out.

“People that want the future to be different don’t accept the status quo – they push against it” – Steve Jobs

The coming period of transition in healthcare is going to force us to rethink how we do things.  What things do we think are impossible now that we could make happen if we had to?  I think this is a very useful exercise and can help us to position ourselves to adapt to the changes in our own marketplace.  Here are some examples:

– Could you fill a schedule with patients paying $200 cash?

– Could you provide services if the most you could be paid per visit was $55?

– Could you take care of 24 patients in a day if you were the only therapist?

– Could you see 15 new patients every day in a walk-in clinic?

– Could you provide excellent clinical care to 3 patients at the same time?

– Could you base your income on your outcomes?

I don’t know which of these things you will need to be able to do in the future… but I believe they are all possible.  In order to create the future we want, we may need to bend reality.  What do you think of the examples above? What do you think your personal distortion field might need to create in order for you to succeed in the future of physical therapy?  Bring on the discussion below, post it on Facebook on my page or throw it on twitter – use the hashtag #browdering.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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8 thoughts on “Jobs Applied: Bend Reality

  1. I’m curious to see your response regarding providing excellent clinical care to 3 patients at a time. I work part time in a clinic with no use of support staff, and I’ll have 2-4 patients scheduled per hour (clinic manager has 4-6 at times, sometimes with a new evaluation in there). It’s doable to have 3, but in my opinion the quality of care decreases drastically. Much of this also largely depends on the patient population your seeing, what if you have 2 WAD patients and one chronic lower back pain patient grouped together, vs. having three post-op sports med patients grouped? This is largely why I’m not full time in this position

    • Hi Drew,

      I certainly agree. I feel pretty comfortable with 3 patients in clinic in an outpatient orthopedic setting and with help from well trained unlicensed extenders to keep things moving and provide customer service touches. Add in a patient with high fall risk or that has more complex needs and it is more difficult. We use a coding system to avoid scheduling multiple ‘high need’ patients at the same time. I’d be reluctant to try to maintain the pace required to see as many patients as you describe without some help… doesn’t mean its impossible, but I think you correctly identify the risk. Of course if medicare patients are in the mix you’d potentially run into severe inability to bill for your services. Our model (12-16/day productivity) would be ‘bending reality’ for some… just as seeing 6-7 evaluations/day and managing care for about 120 new patients/month utilizing PTAs is the norm in the military. This would require a pretty large paradigm shift for most of my colleagues in private practice.

  2. Interesting thoughts, David.

    I don’t think you’ve bent reality enough. To bend reality, to me, means to completely change the thought of our value – meaning, if we believe our services are impactful, we also need to be considering changing our business models. Why aren’t we changing our business models to offer other service lines or products within our skill set? Why aren’t we seeing sport screenings and sport specific injury reduction classes? I mean, why not? Why aren’t we seeing relationships with various local companies to serve their employees’ needs? Why don’t we have pre-op services where people pay cash to prepare for their upcoming surgery – whether the service is educational sessions or advice on what to do immediately after? Why don’t we have service lines for athletes in the community doing say triathlons or running events? Videoing and offering biomechanical and targeted training advice based on observation of videos? What are we doing with technology? Can we “manage from afar?” Why not? Maybe some would want this and would be willing to pay for telehealth because it fits their life schedule better. The above line of thought bends reality more to me because we take a greater risk and alter our services to such a degree that we aren’t tied to some insurance company.

    • Absolutely right Selena… more than likely those most successful will find ways to innovate regardless of regulation. At least in the current environment that innovation will likely find a hotbed in cash based practices.

  3. Very thought provoking, David. But I have to agree with Selena that I don’t know how much ‘bending’ of reality you are describing or just ‘preparing’ for the reality to come, or that is here already. Both the profession and third party payers are on the attack toward PT extenders, agree or disagree. Patient satisfaction and expectation surveys demonstrate the desire toward knowledgeable therapists, clear instruction, and less wait times, all at risk with multiple people in the clinic. Don’t get me wrong, I can do a 15 patient day with extenders, without difficulty, but I would not call honing this skill bending reality. The cash challenge and offering services in various, non traditional settings (NPs at drug stores….) is getting the profession to think at the edges and not racing toward the bottom.

    I’m late to your site, David. And it is really cool. Thank you for your work.

    • Thanks Jeff. Turbulent times require innovation and we are definitely in turbulent times in the healthcare world. There is a generation of MDs who are rolling over in their graves as they see how primary care has had to adapt, and the expanded roles of NP and PAs in provision of care. I have no doubt that we will see a bifurcation in our healthcare system… the ‘participating providers’ who simply HAVE to be more efficient in order to provide services to the average Joe who utilizes his health insurance. We are already seeing a flurry of niche out of network and cash based practices pop up to service the group that can afford it. I think that as long as we measure outcomes, customer service and patient experience that ingenuity and management skill will allow increased efficiency with good outcomes. I’m not sure HOW we’ll need to bend reality in the future… but I know that an MD that time warped from 20 years ago to today would have had a hard time predicting what primary care looks like right now. Those of us that can “face the brutal reality” (Jim Collins) and adapt, have the opportunity to make sure that Average Joe can still receive better than average care.