Pelvic PT Rising
Pelvic PT Rising
Flying Solo at Your Clinic: An Employee's Guide to Success
There are major challenges to being the only pelvic provider, for both you as the employee and for your practice. Your boss or manager is often initially supportive, but that may not last.
Just think of some of the challenges to an ortho practice or hospital program adding pelvic rehab:
- Having to provide a private (and hopefully well-appointed) treatment room
- Dealing with a very different patient population
- Not working (hopefully) with aides and giving you more time with patients than your coworkers are receiving
- Dealing with complex patients means longer plans of care and more issues with insurance denials and appeals
- They have to change the paperwork for you. And the website. Market to new physicians and in the community. And provide new training to the front desk.
- And somehow give mentoring and training for you, which they can't provide because you're the only one!
So ask yourself two questions.
- What do pelvic patients deserve, and are they getting that?
- And what do I (as the employee) deserve, and am I getting that?
So advocate for yourself, advocate for your patients, and if it's not happening you might have consider taking another position.
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About Us
Nicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.
Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 500+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!
Get in Touch!
Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).
Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!
In the last 10 years, our field has gone from an unknown specialty to a household name. This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve. In order to help others get better, we need to be better. This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way. Join us as we rise together. We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
Speaker 2:Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine. Hello, hello, talking today about when you are the only pelvic health provider where you practice, and this is actually thank you so much to everybody who completed our survey. We had a couple of prize winners from that as well, but 50% of you surveyed said that you were the only public rehab provider in the place where you practiced and we wanted to talk a little bit about this. And then it just so happened coincidentally that Nicole had done an interview on Rick Lau's podcast, had mentioned this, and it kind of came up in conversation where he was talking about how pelvic health is so needed, but he hasn't really been able to see a lot of big ortho places do a good job of adding it and adding it well, and you, nicole, had kind of agreed had a little bit of nuance there, obviously, to that discussion, but we thought we wanted to pull that out, since half of you guys are in that situation wanted to pull that out and talk about it.
Speaker 2:So that's what we're going to talk about today. Before we do one quick announcement we're really excited that a thousand of you a thousand, more than a thousand now have signed up for our practitioner map. That's our totally free resource where you can get found by other practitioners, other patients, physicians who are looking for a great pelvic health provider. If you haven't done that yet, or if you need to go and check and see if you need to find somebody for a patient, you can find that at pelvicptrisingcom. We're really excited about that resource for you guys.
Speaker 1:Totally so. Onward to the topic at hand today. When you find yourself being the only pelvic rehab provider at your place of business, this podcast goal is meant to empower you to push a little bit your employer to make the situation as good as possible. We're going to go into some of the reasons why. This is actually a challenging thing for a non-pelvic health focused clinic to add pelvic health rehab to the practice, and there's also a lot of things that you need to look out for to look out for yourself and your patients. And so when the clip of me talking with Rick Lau on the clinic boss show came out, I did a little story series and I got a lot of DMs back, a lot of agreeing that they were in a situation where they felt very essentially used or not supported in by their employer and they were meant to feel like it was going to be this great thing and then turned into basically like this dumpster fire of an add-on program that ended up not serving the practitioner or the patients very well.
Speaker 1:But then we also got a couple of DMs, which was a little bit one of the reasons why we wanted to push this podcast episode up a little bit in our queue here of people that were like well, this makes me feel really hopeless. I am in a situation like this. I just took on a job that is basically what you described and now I'm scared that I made the wrong decision or this isn't going to work out in the end. And so the too long don't read version of this podcast is that this is not a hopeless situation. Like Jesse said, 50% of you are in this situation, so it can work. It totally can work, but we're going to outline for you a couple of reasons why it's challenging and the problems that you may run into and, honestly, some solutions on how to navigate the situation if you find yourself there. So we hope this is helpful for all of you that are in the situation. And again, the too long don't read version is not hopeless, but it certainly comes with its challenges.
Speaker 2:Yeah, and Nicole, you did this for five years, so you know what you're talking about, having started and run a program at Hogue Hospital when, frankly, you were I mean, if we go back to your story, you really had no business, not even really that much interest, and we're bribed into doing that. So you know exactly what it's like to be a younger therapist, a less seasoned public health therapist, and be kind of thrown into the fire and that ended up being an experience that really served you very well for a lot of years and it served the community well. So, again, this is not saying that it's bad to be in this situation, but we do want you guys to understand a little bit from the higher level view of why these conflicts may be arising between you and your employer and give you the encouragement that you need to push to make this as good as possible for you, for your patients, for the whole practice, for everybody in this. So, if you really think about this, there's really only three reasons that employers add pelvic health to their practice.
Speaker 2:If it's an ortho clinic, if it's a big hospital program, whatever it is, there's really only three reasons because they've got an employee who's super passionate and pushing for it, and if you guys are listening, it sounds like a lot of that might be. You guys, right, who wanted to do this but didn't want to leave your current place, and you got really excited about public health and said, hey, can we add this? And your boss basically shrugged and says, yeah, sure, right, go for it, go for it, and maybe they'll probably be a little bit nicer about it than that, right, they'll be talking about being supportive. The next reason, though, is for them to make more money. They see it as a niche that's growing which is certainly true and saying, hey, I want a piece of that growing pie. Nothing wrong with that, by the way.
Speaker 1:Totally nothing wrong with that. And also in the world of shrinking insurance reimbursements, like a lot of clinic entrepreneurs and a lot of clinic owners are looking, how can I increase cash based revenue to an already existing orthopedic practice? Which essentially is how do I diversify my clientele so that I'm not beholden to 100% to what insurances are doing? How can we add this service? They see this niche, they hear about it on Instagram, they look on their personal TikTok and they're like, wow, this is a big deal, Everybody's talking about it, and so they want to add that to their current, essentially revenue stream.
Speaker 2:Right. And then the third reason is because they really do genuinely see a need in the community. They're passionate about it. Maybe that's a boss who had a child themselves and is now passionate about providing that kind of care to their local community, or they just see the need.
Speaker 1:And I would say that some hospital based services will fall into this. There is a desire for the hospital based program to serve all different types of people, so they will be like oh, we need to add pelvic health, which is essentially what I ran into way back in the day actually with the hospital based program that I started, but a lot of that is a little bit of a also to make money or to expand their services and also reach a community need.
Speaker 2:Right, so they're not having to continue to refer out, for example, every time they do a post prostate or prostatectomy surgery or something like that. So, if you really think about it, though those three reasons, the employee really pushes for it to make money or to fill a need in the community. For two of those three, your employer has no real desire to do this. That well Right. They just want it to either bring in funds or they want to make you, as the employee, happy enough to stay that you're not going to go off and do your own thing or go and work for somebody else. So they don't have that passion for pelvic health. And that's really important, because if you haven't found it out already, you certainly will if you're in this situation.
Speaker 2:A pelvic program gets hard. It creates inherent conflict between, usually, the way things are done for everybody else and the way things are done for you, and Nicole has shared like a really just simple example that you don't even really think about. But, nicole, at Hogue you were demonstrating to your bosses that you had almost three times as much paperwork as your colleagues because you were spacing out visits. You couldn't get people in yet a larger caseload, they had more reauthorizations. And so all of a sudden you were in this different boat where you were doing three hours of paperwork a day, and originally they were expecting you to do that on your own time.
Speaker 1:Right. So I was under the same expectations as everybody else, even though I had three times the caseload. And you know me being a young therapist, I was like when they kept being like, oh you know, this note isn't done. What's going on? I was just like gosh, am I not efficient enough? What's the problem with me?
Speaker 1:And suddenly I was like wait a second two of my other colleagues over here seeing patients three times a week. That's one person that they have. I have somebody that I'm seeing once every week, like that's, you know, a third less, a third more charts that we have, or three times more. So it was just like oh, I have the patient volume, even though I'm being held to the regular standards of everybody else.
Speaker 2:Right, and you eventually went back to your employer with that and said, hey, I'm going to need more paperwork time or I'm going to need to stay late and do this on the clock. I'm not going to continue to do this in my off hours, which they agreed to, which was a great thing. But you can just see we're going to give you some more examples. I just wanted to give you one real life, one from Nicole's experience of how this gets hard, or how the rules have to start to bend for you guys as pelvic rehab. So a couple of just. I'm just going to list these off, nicole, and if you have thoughts on anything, just jump in. But you have to have a private treatment room that is thoughtfully designed. It can't just be a broom closet.
Speaker 1:Yeah, I mean, I feel like this is one of the other things. Right, if a person that's not looking at pelvic health as a passion looks at, like the specs that they need in order to do this, they look hey, do you have a treatment room? They've like checked the box and it's like, sure, but then are they thinking about where that treatment room is? What's just outside of that treatment room? How big is it actually understanding that people are going to be undressed in there? Is it a door that you know is easily accessed or accidentally gone into by somebody there? You know, are we going to put a lock on it? Is that even allowed? Like there are so many things to think about, even just in the layout of the clinic, where this space is, that you're going to have, not to mention the how you decorate it. And you know we're getting table warmers and real linens and essential oils going and the music needs to be different. It can't be, you know Justin Bieber bumping in the outside where the football team is.
Speaker 2:Well, I'm going to disagree with you there, Nicole, because it can always be Justin Bieber it can always be Justin Bieber.
Speaker 1:In fact, we have Justin Bieber sometimes at the clinic in Justin Bieber days.
Speaker 2:Yes, right, it's not Eminem Right, it's not Eminem Right.
Speaker 1:Right, right, right, not. No, lose yourself is coming into the thing where you know your lose your pants in the no it's not going to work. It's not going to work Guys.
Speaker 2:So, but even linens, right, that's maybe going get patient gowns that they haven't been getting before. You don't necessarily think about that equipment they're going to have to order. Just having gloves and slippery stuff and free up that. That's all a headache for your boss. Things like the patient population being different, right, nicole just mentioned you know, maybe if you're an ortho place you're getting in a whole lot of like high school kids and now this young mom with a six week old baby has to walk through these guys throwing weight around and the baby's crying in the room. The high school kids are thinking that's crazy. Right, that's just a weird dynamic sometimes.
Speaker 1:Yeah, and not even to mention too, like public health population is are sometimes are more sensitive to things, right? So now, all of a sudden, your equipment needs are different, you're? You know, Jesse mentioned slippery stuff. You know what if somebody thinks that they're allergic to slippery stuff, which, by the way, is not very common? However, you need to have options for folks, and now we're trying to get samples and who's going to call those people? And you know, someone might not like free up. We want coconut oil instead.
Speaker 1:And now, all of a sudden, we're having to have a lot of different options for folks, which you know, objectively is not that big of a deal. But to somebody who doesn't understand the population, it can seem like you're asking for a lot of little stuff and it's basically like a nuisance, right? And so you can kind of see where all these things are going to start adding up with your asks and you can see where some of this conflict is going to start to happen, because they're not going to really understand. Wait, what, what the hell do we have to do for the one person who might need it? And it's like, yeah, for the one person who might need it, because that person's really important and just as important as someone else walking into this clinic. That just has different needs.
Speaker 2:Right. So a couple other things right. It doesn't really work with AIDS. That throws the whole model of care off. And if you guys are listening, I'm assuming you're passionate pelvic rehab providers. You're probably pushing for hour long sessions that are all hands on and one on one with your patient. Well, that might not be the way that the whole rest of the clinic runs. Now that employer is looking at you getting special treatment, other people are looking over there and saying, hey, why does Katie not have to see somebody on the half hour every time? It's just creating this inequity within the practice that a lot of times employers don't really love.
Speaker 1:Yeah, and you know what, and being like, well gosh, I use AIDS and I kind of think that that's really great.
Speaker 1:It works well for me right In my constrained situation and it can.
Speaker 1:We're not saying that this is terrible.
Speaker 1:However, if given the opportunity to work one on one with your patient and see if the exercise the squat jump thing off of a step is creating incontinence, that might be much better completed with you being able to talk about that, versus to a 16 year old kid who's an aide, who thinks they might want to go to PT school, thought they were going to get into being an aide to watch people do zigzag drills and ACL rehab and now all of a sudden they're watching a 30 something mom and they're not really sure why she's doing the squat jump thing and they don't really know, oh, are your symptoms there? And the moms are going to be like well, I leaked a little bit with that. It's just different. It's just different. So again, is that the optimal way we want to be doing exercise with our patients? It certainly can work if that's the constraint that you have. However, if again given the other opportunity to work one on one with your person through all the exercise stuff. It's going to be better without the use of AIDS.
Speaker 2:Right, once you come to the light side, you won't go back. So we've actually hired folks who didn't really think it was a big deal, that they could only work with people for 30 minutes or that they were using AIDS, and they're like, oh, it was kind of fine. And then after like a week working at pelvic sanity, they were like, oh my gosh, how was I even doing that?
Speaker 1:How was I doing that before?
Speaker 2:I feel like I'm running over on my hour session now because there's so much to do with our folks. So a few other things that are just challenges here. Complex patients mean they're going to be seen longer, which means more insurance issues, which means your employer might have a biller who's barking at them and saying, why can't Nicole ever discharge anybody? And right, and if you listen to this podcast, you know what Nicole thinks about that word. So that's going to be a bigger challenge.
Speaker 2:You, as a pelvic rehab provider, are going to want training and mentorship that your employer cannot provide. That is probably one of the biggest things as we talk about all this. Like they literally don't have the personnel, by definition, for those 50% of you to do this, and so how are they making up for that and how are they making sure that you feel supported and competent? And a lot of times this is where the good intentions start. It's like, cool, we'll send you to Herman Wallace one. And then you come back and then say, cool, where's my next training? And they're like what do you mean? I just got you pelvic certified or whatever. Like, just go see people, why do I need to spend $2,000 to train you?
Speaker 1:Right, and then you're trying to explain to them like well, two ways, like bowel and other concerns, and like does actually treats, rectal treatment and that kind of stuff, and you're just like, right, so that's really important, and unless and you don't have anybody here to teach me how to do that, so now where are we at? Now you again, you can start to see how you start to become a nuisance, that you're asking for more stuff and you're not a nuisance. All you're doing is advocating for yourself and your patients. But we can hopefully start to see, like, why this is challenging, because now you are needing things that make it more difficult for it to be equitable across all other people at the practice.
Speaker 2:Yep, and I'm going to blow through these last challenges here. But somebody has to train the front desk. They can't call in and say I have vulva. Denia on your front desk says vulva. What could you spell that for me? Right, somebody's got to do that. They've got to add stuff to the website. For some people that's a real pain in the butt If they don't know how to do that. They've got to do paperwork and have all of the questions about sexual health and bowel health and gynecological history all of that stuff on their things.
Speaker 2:And is that going to go to everybody or just the public health people? Well, now, that complicates things. In your EMR you've got different equipment. You have a new marketing challenge. You have to go to different doctors in different places to do that. They're not really passionate about the program in the beginning, and so this is one of the reasons.
Speaker 2:So we just wanted you to see all of those different potential areas of conflict, and that doesn't mean that all of them are going to be a problem.
Speaker 2:It doesn't even mean that most of them are going to be a problem.
Speaker 2:But if you are in a situation and this is going perfectly, you are definitely in the minority here, because there's a lot of moving pieces with this and I think this is one of those areas where sometimes we see the Pelvic Rehab Provider especially if it was that employee who really pushed for the program being so gung-ho and so wanting to make this thing work that now they're putting themselves in a position of taking on extra work often unpaid extra work to go and market to that doctor to get people in the door because they started this program. So if you're listening and that resonates, you're definitely not alone. Or the person who has to go and actually train the front desk because who else is going to do it, who else knows enough to actually go to your front desk and teach them about the different conditions and how to answer the questions? Well, that might be you as the practitioner, but is that part of your job responsibility? Is that causing resentment between you and the front desk? Are you being paid for that time?
Speaker 1:Yeah, and I'll tell you just a real quick story about what I had to do. And I ended up doing this at the hospital program. I ended up taking the front desk people out to lunch sometimes because I was like, well, can we just go get lunch? Like I'll buy you lunch, and let's just talk about these conditions, because if somebody calls, I want you to be able to route them the correct way and make sure they get the correct paperwork and all of that stuff.
Speaker 1:And, to be honest, one of the people was really resistant. She didn't want to do more work because it was causing her a bigger problem. No one asked her if they were going to add a pelvic health program. Now, all of a sudden, she's trying I'm trying to get her to do something and I'm not her boss, right? And so I remember one of the times when she was acting all nice at the beginning and then started to kind of be a little bit bitchy towards me.
Speaker 1:And I can look back now and be like, oh, I understand why she was a bitch. That was not a good position that she was put in by our management team, like that was a mismanaged situation. I can see that now. But all I'm thinking about are the people that are calling and I'm just trying to get my job done and it just causes like so much friction. And so then I go to my manager and I'm like she's being a bitch and she's not doing her job, like can you tell her to do this? And they're like well, I think it's fine that we just use the paperwork, and now all of a sudden it becomes something that we're just trying to bandaid over versus actually changing the system. And, as you all know, if you are in a hospital-based program, changing anything that has to do with paperwork requires lawyers and the forms committee and all this bullshit. That I didn't realize when I was first saying yes to this.
Speaker 2:So we want you guys to think about and ask two questions really what do patients deserve and are they getting that? And then what do you as the employee deserve and are you getting that Right? Is it working for the patient and is it working for you? And a lot of times there's a little bit of a dynamic tension there where it's really hard for both of those to happen. So maybe you're the one running around and making it work for patients, kind of like Nicole was trying to do, taking the person out to lunch, doing all the extra stuff, going the extra mile in order for patients to get what they deserve. But then are you actually getting what you need out of the situation? Are you getting ongoing mentorship, training? Are they ponying up for more con-ed and maybe more con-ed than your coworkers are getting?
Speaker 1:And are they paying you for your time in order to do these other types of tasks that aren't technically, at that point, patient-focused and revenue-generating? They could see, right, we all know that marketing is essentially revenue-generating, but that's not what you were hired to do. You were hired to see patients, and now when things are getting taken away from that that time, then that becomes very difficult. So are you getting paid for that, or is there some sort of compensation structure to allow for you to do these other non-patient-related tasks?
Speaker 2:And are patients getting the kind of care that they deserve, or is that a kind of? We did a podcast a long time ago in Nicole about would you be proud to have a family member come to your clinic, or a close friend? Would that be an experience that you would want for them? And I hope the answer is yes. So those are the two things to ask yourself Are the patients getting what are they deserve and what are you as the employee getting what you deserve? And we wanted to again.
Speaker 2:I know we've listed all of those challenges kind of in the middle of this podcast. It is not hopeless to make this situation work and have a good experience with it, but you need to make it as good as possible. You are likely going to have to push for the things that you really need to advocate for. So longer treatment sessions, if that's what you believe that you need, getting more con head or being able to do that, or finding somebody who's a mentor like being able to make this thing work for you, and then at some point you just have to decide is this working? Because one of the cool things about the way that our field is going with the rise of cash-based physical therapy practices is that there's options out there, that you don't have to be almost swimming upstream against all of this stuff, All of those different challenges.
Speaker 2:That's a lot of work and effort and friction sometimes and if that's not going well or you're feeling burned out or it's not providing the kind of environment that you really want. I know so many of you guys are so loyal and amazing people and wanting to make stuff work, but to remember, there's also more and more options out there than there have ever been, and that's one of the things. We've got a whole hiring directory on the practitioner map. But if you're in a position that's not working and you've pushed for what you need and you're not getting it, you might want to explore another option.
Speaker 1:Absolutely. And then the other thing I'm going to say about that is that I got a really interesting DM from somebody that was in response to that little clip that we alluded to at the beginning of the podcast and she was basically describing hey, I just started, I just took this job and so far, so good, like everything's great, and I was like great. Then all of those problems that we listed aren't happening. That's wonderful. And also it's a little bit can be a little bit of the honeymoon period right now where everybody's excited. Everybody said yes to the opportunity. You said, yes, you want to do pelvic health. Your employer said, yes, we can do the program, and at the end of the day, that's great at the beginning and then, when some of these, the rubber really does meet the road, is there still that same amount of support and the same amount of things that you thought you were going to get? Are you actually getting those things down the road a little bit? I want you to also think about that. And it's not necessarily anyone's fault quote unquote If it's not working out. What you do need to do is make sure that you're communicating well with your employer if it's not really stating hey, this is what we set out to do. This is what the expectation was. This is where it's not being met, and what are we going to do about it?
Speaker 1:Knowing that not every single job is ever going to be perfect, you're not going to fix every single problem. But then for you to take a step back personally and say what are my non-negotiables? If it's treatment time, then push for treatment time. You might have to give and take a little bit on something else, but ultimately I love going back to those two things that Jesse mentioned what do patients deserve and are they getting that? And what do you deserve working at this place? Are you getting that? And if you can go back to those things and really work that, whatever system you're in, to make that advantageous for both parties, then that's great. And if we can't, then to Jesse's point there are more opportunities with cash-based practices on the rise for job opportunities where you don't just have to open your own practice in order to have all of those things met very easily.
Speaker 2:Absolutely. So I hope this has been helpful for you guys. We'd love to hear your experiences. This whole podcast was generated because of quite a few DMs that Nicole got. We love hearing from you. So if you're in this situation, if you're one of the 50% of pelvic rehab practitioners who are the solo pelvic rehab person in the place that they practice, please reach out, let us know. Does this resonate at all? Have you seen these challenges? Have you seen other challenges that we didn't list on that grand old list of the ones we laid out? Or is it going great and you're feeling really excited about it, and either way, that is fantastic. We just want you to be in a position that you feel good about the care you're providing for others and that you're being taken care of yourself, and that's what we want for every single person who's out there. So I hope this has been helpful for you guys. As always, we'd love to hear from you and keep this conversation going.
Speaker 1:And let's continue to rise.