What. A. Year.
This isn’t one of my normal posts. In fact, I should warn you that there is graphic content if you continue to read. My post today will be longer than usual. Much longer. I don’t want to bore you, but this is a post of reflection on the last year as a physical therapist in Boise, Idaho.
Jumping right into the profession from Arizona and seeing the different types or inner workings in PT, as well as the medical model, have been different. Some good. Some bad. And that’s why this will take such a long time to get through. There is so much information I’d like to write down. The hardest part is finding where to start in the plethora of events that occurred in 2020. I’ll try not to dive heavily into COVID-19, but I will when it plays a role in the lives of the patients I saw.
I like to start with the bad. It’s juicier. When you’re gossiping with a friend, you always want to hear the juiciest part first, like, “I heard Tammy’s toe was cut off.” And then you end with the good, like, “But then I realized it was just her toenail. Those grow back.”
So what happened in 2020 that was bad for physical therapy in Boise, Idaho? Well….a lot. Some of the bad has been going on for years, but it became worse with a shortage of patients for clinics. There’s a simple scheme many clinics use to get the most financial advantage out of each patient. Every patient, with insurance, will be checked to see how many visits they are allotted per year or per injury. This usually is in the realm of 12-20 visits. Patients could have REALLY good insurance that allows them to attend 60 visits a year (this is handy for post-stroke or neuropathologies). Whatever the specific number of visits may be, quickly becomes the total of visits required to fix the injury in the insurance model. Oh, you just got a total knee replacement? 20 visits. Jammed your finger bowling? 20 visits. Low back pain? 20 visits.
Let me give you a real story of how a patient was being abused worse than other patients on the basis that she had better insurance that she paid more for. In June, a middle-aged woman decided she needed a knee replacement. She was fairly active and was having right knee pain that was slowing her down, especially on hikes. So she did her research and found a great orthopedic surgeon in the Treasure Valley. She had her knee replaced (although I wish I saw her before this) and went to a typical physical therapy clinic in Boise, Idaho.
Here comes the juice.
Sounds really peachy so far, right? Well, here comes the juiciness. After the surgery, she couldn’t bend her knee enough to go a full revolution on a bike. And she loved biking. So her physical therapist would CRANK on her knee to hopefully get range. The therapist would do this 2-3 times a week. FOR 5 MONTHS. Now, I’m not a mathematician, but 2 (times a week) x5 (months) x4 (weeks in a month)= 40 visits. Even worse, is 3x5x4=60 visits of pain and no gains. And the therapist was paid for every visit because the insurance allowed it.
Now, due to a drop of patients during COVID, this therapist pushed for more treatments that were not working. What the patient really needed (after a month out from the surgery) was a manipulation under anesthesia (MUA) and maybe 6 visits max after the MUA (she saw me after for only 4 visits before feeling 100%). My heart goes to the patient because she has tried to reach out to the previous therapist and she will not return any calls. I know this story sounds juicy, but I have one that’s juicier.
*GRAPHIC CONTENT WARNING*
This one is about a medical group that consists of therapists and a surgeon that is hurting the generations ahead of us. You could even call this a “eunuch” situation. A young man came to this group presenting with one-sided groin pain. So after a very POOR examination, they suspect one of his testicles is the pain generator. They cut it off. They cut his testicle off. I really can’t believe I’m telling this story because he didn’t get better after losing one of his testicles. This is not medicine. This is crazy. So now there’s a kid somewhere in the Treasure Valley with groin pain and missing one of his genitals.
So I’ve told you some of the bad, and there are more problems like the FDM method, physical therapists skipping physical therapy for their own issues and going to a surgeon, and surgeons pushing for elective surgeries that aren’t warranted, but I’d rather start talking about the good that I’ve seen here.
I have seen some really good work in Boise. Despite the real and absurd stories you just read, there are good clinicians here. There are some good up and coming therapists too.
A few clinicians I have chatted with have been keeping up with their results to make sure they’re better and faster than the average (Tracking is the only way to know you’re improving or better than the average). We’ve had some students come in and experience a huge paradigm shift. It’s a great feeling to help others see how effective they can be after feeling like they needed 15-20 visits to make someone better.
Our current average visit is 2.3 visits. We take huge pride in these numbers because you can’t find that anywhere else in Boise. We have only found similar results in one other place- Tucson, Arizona. Shout out to Smith Performance Center.
How do we get really fast results? We really focus in on getting a good diagnosis. Seth and I practice everyday to hone our skills. It takes a lot of time and a ton of mind power to intentionally get better. Sometimes it becomes fatiguing to do over a long period of time, but the results are well worth it. There’s nothing quite like the rush of getting someone our of pain that has tried everything else, including another physical therapist.
Did I mention Seth and I started our clinic at the start of 2020? Talk about good planning. It wasn’t our ideal plan to start 3 months before a pandemic hit which turned all of our marketing strategies useless and ineffective.
Luckily, we kept our overhead low (we followed a lean program), changed our marketing, and learned along the way. We try to keep our management style similar to our clinical style- low risk, high reward. On both, we’ve found if something doesn’t work, we scrap it and try something else. It takes some humility to admit to being wrong. Seth and I have been so wrong on many occasions to the point that all we can do is smile, admit our mistake, and get back to finding something that does work. It’s worked out so far being profitable in our first year running, in a pandemic, new to Boise, Idaho, and working with about 120 sq. ft. of space (for the first 6 months). I have loved all the moments. Seth and I have learned so much along the way that only can be learned by taking actual steps.
2020 was crazy, but it was worth it. So much learning. So many mistakes. In turn, we are ready for 2021 and the next 12 months. No Pain, More Gains.