Why Physical Therapists Stay (Or Leave)

Alliance Physical Therapy Partners: 00:03 You’re listening to the PT Leadership Podcast, where outpatient physical therapy leaders come to share their insights with your host, Richard Leaver.

Richard Leaver: 00:17 I am extremely happy to welcome Eric Boss, who is not only a physical therapist, but also um a data guru. And the topic of today’s conversation is why therapists leave organizations, or shall we look at it class half four, why therapists stay in organizations? Perhaps that’s probably be a better, better title, wouldn’t it? Um so Eric, we’d love to perhaps uh have you introduce yourself briefly to our guests.

Eric Boss: 00:47 Yeah, thanks for having me today, Richard. Um, my background, as you stated, is as a physical therapist. I was in physical therapy uh on the south side of Chicago for several years before moving to Michigan. I managed a large outpatient uh division of uh hospital system in Grand Rapids for a while before getting back out to clinical care, and then moved into data about five or six years ago and full-time about four years ago, um, and really was able to apply that domain experience into um aggressively applying things that I think were helpful for uh the experience of clinic directors, answering business questions that perhaps we didn’t have the answer to. And we’ve been working in that direction ever since.

Richard Leaver: 01:35 Yeah, um, you and I share some similarities, which I don’t know that it’s good or a little scary, but one of them is actually you’ve you’ve crossed the divide between uh having your own private practice and working kind of the what I would say is the for-profit world, but also working in the hospital system. So I always feel that we have a fairly uh not unique, but perhaps a little unusual perspective because we can we’ve seen both sides, haven’t we?

Eric Boss: 02:00 Yeah, and I would define both as more than two. It seems like within each of those systems, there are also perspectives that treat the industry completely differently. So yeah, I think that perspective has really helped me rationalize some of those questions. When I was in private practice, I certainly did not consider other aspects.

Richard Leaver: 02:20 And then before we move on to the topic, I think it’s also interesting that you’ve uh gravitated towards a non-clinical role. And there’s a a lot of uh people, a lot of clinicians out there that um want to consider non-clinical roles in the future. And I think it’s um you know, kudos to you, and and uh I think it’s an avenue that uh is available to clinicians data analysis, not the most common avenue, most of them are kind of sales roles or or marketing or other things rather than rather than the numbers, but but you’ve definitely taken that plunge, haven’t you?

Eric Boss: 03:00 Uh I certainly have. Uh it was uh a bit of retooling and um you know uh some circumstances helped steer me back in this direction. And um uh I appreciate alliances being there for me uh as we applied domain experience as I was ramping up. And now it’s exciting because uh the ability to anticipate questions, I feel like, has put me ahead of some of the data analytics curve, where perhaps you you might offload that to someone who’s gonna do data analysis but doesn’t understand the industry or the question. Um, we have a unique experience here where we’re discussing the question as it relates to something that I have uh field experience in. And it’s been super fun to be able to do that, to really streamline what’s the crux of the question and can we get to an answer effectively? So um thanks for the kudos. I appreciate those. But uh yeah, it’s retooling uh for anybody who’s considering it. It’s real hard work. And if you’re willing to do it, it’s it’s very rewarding to be able to apply what you’ve done instead of set it aside.

Richard Leaver: 04:05 Great. Well, great segue. So I I always talk about two key variables or two differentiators in healthcare. Um could be just specific to to PT, but I think I really there they are for healthcare. One is the application of technology, and then the other is the recruitment and retention. And we’ve we’re all struggling with regards to the workforce as it pertains to recruitment, retention, workforce planning, uh, the structural deficit of therapists within certain subspecialties within our profession, et cetera, et cetera. So I thought this episode of really taking a deep dive into why clinicians stay or leave would be invaluable. And um, as an organization, we struggle like anyone else. And as a direct result of that, you did a study earlier this year that really looked at this in a very objective manner. So I’d love to hear a little bit about how what the study was, and then at a high level, um, what did you find?

Eric Boss: 05:14 Yeah, sure. Um, the the study was actually um it was an excellent example of the way we looked across uh a variety of factors. We worked with HR and we worked with operations and we worked with clinic leaders to ask the questions about things that may be contributing to attrition. And then we just looked at um uh population statistics of people who had departed the organization. Sometimes um, you know, you may not get the most robust information as people are leaving, but you can certainly look at the situation that they were in at the time that they left. Um, and and we looked at those very objectively across uh a large number of categories. And then we looked at commonalities for the group to say, you know, it did the group that left or the group that stayed have things in common that we need to highlight or that we need to look at that we need to be aware of? And we just raised an awareness of the typical picture of someone who had left the organization uh in comparison to a control group of people who were still in the organization wherever that was possible. And so those common factors led us to uh uh the ability to have a great robust discussion about which of these factors uh are what we believe to be um shapeable so that we can go in and intervene or at least identify someone who is at risk of leaving and say, you know, what can we do here? What’s the situation, or have a better conversation? Um, but while we may not be able to say this is the definitive reason why people left, we can certainly say this is what people who have left the organization over a period of time tend to look like. And I think we did a good job of that in that study.

Richard Leaver: 07:06 A few things um make it sound simple, but actually it was uh very much based off a sample size that would provide us with a degree of reliability and also a depth of statistical and inferential analysis that gives us validity as well, correct? So I don’t want listeners to think that this was just a kind of a crappy questionnaire and uh you know just collated uh set of pie charts. This is absolutely um you know in-depth uh statistical analysis, correct?

Eric Boss: 07:41 Yeah, absolutely. We took we took the the statistics from people who had left over the past two years, and you know, without giving the specific numbers, the population data that we compared it against was all existing employees. So between those two groups, it was uh on the order of a thousand people.

Richard Leaver: 07:57 So it’s fair to say that the design of the study gives us confidence in what we found. Uh doesn’t necessarily, as as as you kind of infer, doesn’t necessarily give us a definitive answer as it pertains to uh perhaps the the level of each variable being in um responsible for why people stay early, but we certainly got a very good idea of the the various reasons, even though the weighting perhaps might not be um as uh as as easily understood.

Eric Boss: 08:32 Correct. Yeah, I think um you know in in analysis of big sets of data like that, it was it’s always interesting because the majority of categories that you look at, the interesting finding is that there’s nothing interesting, that there is no difference in those categories. And and if you found a difference in every category, there’s uh a problem with your your methodology. Um, but we didn’t find differences in all categories, but we we found some in certain categories, and we also found some combinations. So when we look at kind of multivariate kind of situations where there’s a variable involved that’s compounded by another, um, no, those were obvious and interesting.

Richard Leaver: 09:15 So perhaps um tell the listeners perhaps a few categories or data points that were not statistically um impactful as a cause of why people left or why we believe to be a cause why people left. And then you know then we can then talk about perhaps the top three um reasons why little categories you found that were actually uh important.

Eric Boss: 09:48 Yeah, sure. Um as far as not being a an identified commonality, um well, we looked at females being far more likely to leave than males. When I say far more, um if you’re female or male, the people who left were largely female, but also so was our workforce. So the difference between those things as a percentage of the workforce wasn’t really as relevant as being able to say um across our workforce, we are more likely if you’re female to leave because we are more likely to also hire you if you’re female. Is that either here nor there? That’s for discussion. Uh, if you’re identifying risk, I mean probably, but you’re gonna have to look at that section of your workforce. But compared to a normalized population, it it really wasn’t that different. Um, and then um, you know, full-time versus part-time versus per diem, um, you know, full-time and part-time were much closer than you might think. Um, the the short hour per diem was was different. Um, but those groups, as we broke them into smaller categories, there were subcategories that weren’t super different. Um, but but there were a lot of categories where we did find things. So we looked at a tremendous amount of data, you know, everything that everything right down to like um they worked through commute distance from the employee’s address to their work and and found that there was a situation where people work closer to their jobs are more likely to be retained. But there the majority of things did not have an impact.

Richard Leaver: 11:26 So that’s that’s as important, if not more important, isn’t it, for people when recruiting uh and looking at how they can help with the retention uh of you know what is isn’t important. Because I think as organizations, as private practice owners, I think it’s difficult to we make assumptions and and perhaps we want to make a whole array of changes in the idea that that you know they’ll have an impact, and and the shotgun approach isn’t as effective as what you basically did from an analysis perspective to try and hone in on the key categories, key factors.

Eric Boss: 12:08 And and I would say the two, as I as I reflect on the study, the the two most stunning kind of non-findings were um we we isolated uh atypical schedules. So if people were working 410s, or if they were working a lot of nights, or if anybody worked a weekend or whatever, um, it had no bearing, none. So if they had an atypical schedule, it was not something that that really indicated that they were at risk. And the other thing was across all regions, um, just salary was very equivalent between people who left and people who stayed. Um, you would yeah, the number one default for people’s head is oh, we need to pay them more. Um, there’s probably other factors that go with that. While that may be a dissatisfactor, the uh dissatisfaction component that makes them take their eye off the ball or start looking around. It wasn’t the thing that said, oh, the people who left made significantly less than the people who stayed. It didn’t bear out.

Richard Leaver: 13:06 Yeah, so all things being equal, if somebody says they left for pay, then you’d think, well, everyone would leave for pay if it was the primarily variable, yes. Given the fact there’s equal pay. Okay. Um one of the things that we found was that it was critical for retention was actually tenure, wasn’t it? And I think this was I don’t know if it was the number one thing, but certainly it was extremely important. Uh indicating that um you know majority of attrition actually occurs within the first two, three years. Can you tell me a little bit about this and and then we can talk about perhaps you know what we need to do to address this factor, but but um you’d love to hear a little bit more about this as a variable category.

Eric Boss: 14:03 Sure. And I think this is one of these that has a little bit of a combining factor to it, but um, in general, the the largest group to leave were people who had been with the organization for less than a year, and the second largest was people who had been for less than two years. Those two groups combined for 58% of people who left the organization. Um and so that’s that is a big number because we have people who have been here for 30 years, you know, across the whole thing. The early careerists were certainly the ones who were most likely to leave. And there could be a variety of aspects to that. There was also uh a slight component that went with that that was age. It wasn’t just um early careerists or people who um had an experience to partner with alliance, so they came in from another partner and they’ve been with Alliance for less time, although that was a factor. Um, it it seemed more often than not that it was younger early careerists. And I think in those instances, there are things we need to consider that um it’s really a culture change at that point when they leave school and they have an environment in which they have a professor that will listen to their concerns, in which they have the ability to kind of uh negotiate environment, they have a lot of autonomy, um, and then they come into a new experience in which things are different and there’s a management component. Uh and uh the occasional early careerists now, this is their first job. Um, you know, PT school is an unaffordable proposition in some cases, and so you know, it may make sense that that they start working after school instead of, you know, back in the day when you can work your way through. Those days are gone. And um, you know, I think it it’s interesting to say, like, what have we replicated in terms of the support system that they get that they have been accustomed to to being a high performer? You have to be a high performer to be in PT school, and and the support systems available to high performers are different in the academic setting than they are in the work setting. And how have we made that bridge or that transition? Have we listened to things that they’re looking for? And have we really built those relationships? And I think this study has the opportunity to drive those kind of questions to say, you know, is there an intervention? Is there a path that people can be on? Are there things that we can supply? Can we make better personal connections? Can we have a direction that gives you a structured onboarding after coming out of a structured academic environment so that you don’t start off balance and then decide, oh, because the work environment was an adjustment, is that an alliance problem or is that just an industry problem? Um, you know, the more you can do to make sure that they feel comfortable settling into a place where they feel supported and encouraged, I think will go a long way to build that longer relationship with the organization.

Richard Leaver: 17:10 A lot of interesting points there. What I feel from what you’re talking about is the new graduates or early careerists that are younger, they’re bringing with them the issues or the um the factors that will likely contribute towards them leaving within a short period of time. So it’s so it’s not as if the organization specific organization has all these issues that are causing the person to leave or consider leaving. It’s the fact that the the new graduates and early careerists and younger people are coming with their own set of issues and the organization, or then and the organization’s inheriting those issues and then having to, like you say, develop lots of tactics, support systems, um, processes to try and support them with the issues that they come with. Does that make sense? Uh absolutely.

Eric Boss: 18:17 And I think you know, it’s interesting because you and I both come with our own set of issues as well. We’ve just had enough time to adapt to Gen X’s issues. You know, it’s uh the industry as a whole understands how to deal with people like me and people like you. But, you know, there may be an instance in which we have a learning opportunity here to say, what does that mean? Instead of applying the same things that would make me happy at work, maybe different. And, you know, identifying them as someone to ask, I think is one of the great results of this study.

Richard Leaver: 18:53 Perhaps they used the word issues in a negative content. It’s just essentially it’s a it’s a misalignment, isn’t it? Misalignment of the values, expectations, and experience of younger people, early careerists, or new new graduates versus the reality of certainly outpatient therapy. And I would be honest, I think, I think general work, uh full-time work nowadays. But um uh so with this this kind of um mismatch between needs, expectations, and wants of the early careerists, new uh younger therapist with the kind of the structure organization of the company, what what does really the funk company need to focus on to try and um you know help reduce their um anxiety, uh willing wanting to perhaps leave after a relatively short period of time in a practical basis. How can we better support these people to try and reduce attrition? So I think you mentioned uh mentorship as one thing already, but I’m sure there’s some other things as well, yes.

Eric Boss: 20:07 Yeah, I think in any era of instability, everyone likes to be on a structured path that you need to be able to see where you’re going and you need to have attainable goals along the way. Um, you know, I think move moving goalposts are very, very hard for people who have been in an academic environment where they get a syllabus with with you know a set of parameters. And if you do these things, you will get these grades. There are rubrics, you know, and then you come out and and maybe your schedule fluxes in a way that’s out of your control, and nothing has been out of your control yet. Um, there are things that we need to understand in terms of moving from one environment to another um as typical high performers, but also that that level of communication and and respect that goes with understanding the conversation about what’s important to you is, you know, we can make a lot of assumptions about what’s important to people, but in most cases, what’s important to me will not be what’s most important to them. And it could be that perhaps that is more schedule flexibility, but without you know, making a sacrifice for squad schedule quantity, right? And so we need to have that discussion to meet in the middle. Um uh I’d love to hear your thoughts on it. What do you think? Uh, you know, leadership is identified.

Richard Leaver: 21:38 I think uh it would be nice if life was a simple rubrics, wasn’t it? But uh having said that, with no challenges in life, I don’t know if it’d be half as fun either. Um I think with regards to this category or variable, it really you have to really take it in context of generational. Differences, I think. And you talked about kind of structure, and that is definitely something that my generation, I think our generation, although you’re weathering it much better than me, but my generation would would consider perhaps as micromanagement. But whereas younger other generations, I think, expect that level of structure to be in place because they’re comfortable and that’s what they’re used to. Whereas we were told just to go out and don’t want to be seen until it gets dark and here’s a football, you know, that they never had that unstructured kind of um experience. I think what goes along with structure, which I think we need to do better as organizations to help with retention, I think sometimes you we’re actually fearful of this, is actually setting very clear, specific expectations and providing feedback to those clear expectations. I think with expectations, sometimes it’s seen as a dirty word, and sometimes we’re fearful that it will create a constraint on individuals. But the reality is, I think uh people are craving for expectations as long as they’re reasonable. And I believe that we’re in part failing on not only providing expectations, but really uh making sure that they’re clear, uh, measurable, um, you know, uh reinforced, uh, et cetera, et cetera.

Eric Boss: 23:41 Sure. And I do like uh the notion that high performers do just want clear expectations and then clear measurement against those expectations. So if you’re going down the path and someone doesn’t know where they stand, I feel like that has also been a factor, kind of a non-measured factor in this. But um, you know, we did look at performance reviews uh against perceived performance. So we asked their upline about like what that looks like in terms of people who left. And sometimes there was a match and sometimes there was a mismatch, and it there it they didn’t always necessarily have a performance review that matched the KPIs of the time in which they left. And so that disconnect between knowing where you stand versus how you perform I think is very, very difficult for some people to reconcile. If you’re if you’re not on steady footing, if you feel that you’re being assessed in a way that’s different than the expectations that you think you understand, that’s not a safe place anymore. And I think there’s a tendency to lean out at that point.

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Richard Leaver: 25:37 When you read the books, the the they infer that organizational leadership is a variable, and I think along with that is perhaps culture of the organization. And uh, you know, as a as a senior leader, I always felt that it was incumbent upon me, or I was somehow directly responsible for a degree of turnover attrition because of this perception that senior leadership um kind of sets a tone and can contribute towards um you know dissatisfaction or people leaving. But in the study, whilst it was perhaps leadership, what level of leadership perhaps had the most impact on uh whether people were were likely to perhaps leave an organization?

Eric Boss: 26:36 Yeah, so in specific mention, um the local aspect is the biggest factor in retention. So uh on follow-up, we look more at retention than attrition, and uh so many people mentioned their local unit. So if you’re in a clinic, one clinic, their clinic are the people that keep them at work. And people will unabashedly repeatedly say that. Um in terms of upline leadership and attrition, it it wasn’t necessarily clustered to one person in an obvious way up the chain of command, other than if someone had left one clinic, you were more likely to experience attrition at that same clinic. So if one person leaves a place, you’re more likely to lose two than another facility is to lose one. So I don’t know if that tracked on the math, but that’s it. As soon as someone leaves a place, um, it it’s more likely that they will lose a second person than it is for a place who has never lost an employee to lose their first. And I thought that was an interesting dynamic.

Richard Leaver: 27:50 This is really critical, I think, for listeners. So let me kind of reiterate it’s more of a local leadership, even possibly down to the clinic director, that has an impact than you know, the person sat at the top desk. Now, it’s not to say culture isn’t important of the organization generally, but I always felt that the local leaders can act as a buffer as well, so they can balance the organizational expectations, culture, perspective, values with the local nuances and needs of the team. And I feel that when that local leader is unable to do that for whatever reason, be that uh you know, their skill set or be that just from other factors, that’s when there’s that kind of disconnect and somebody leaves. So kind of reminds me of the, I think it’s Studer, isn’t it? I could be wrong with regards to the idea of the question, do you have a best friend at work? And um, you know, this the second point is if one person leaves from a location, there is a high probability that others will follow. I would imagine feeds into this concept as well of a local team or a local you know group and the dynamic associated with that. Once you disrupt that that dynamic at a local level, then uh it can have a profound impact and a lasting impact, can’t it?

Eric Boss: 29:21 Absolutely. And I think I don’t have a mathematical basis to back this up, but it’s anecdotal in the evidence that we had is uh occasionally there is an us versus them component in management, and wherever that falls in the chain will spread downward in the chain. If people feel like their manager is fighting for them, you have to really look into that because who would your manager fight? Your manager would be fighting Alliance or whoever is uply. We’re not fighting, we are all on the same team. But if the perception exists that an individual is fighting for you, that’s really a management communication personality problem that will feed down the chain because there is this feeling like it’s us against the world instead of we are all uh here together. So um you can see that anecdotally through that there was a flow through the chain in spots that I think were um you know uh enough to give you pause to say what’s the message that’s making it through? Are we working on this together with leadership or are we working against leadership to preserve our small room?

Richard Leaver: 30:31 So ultimately, you know, every level of the organization, there has to be alignment, doesn’t there? Um so uh yeah, we prevent that problem. Yeah. Moving on. Um, you mentioned interestingly that compensation, those that leave the organization, their compensation rate is the same as those that stay. But there were some factors associated with turnover uh when we talk about um you know compensation and feedback um and paths for financial and professional growth, weren’t there? So the data actually did show that there was a difference with regards to um when feedback was given, how you know what the feedback was, etc. And then also interestingly, there’s some information about um compensation raises as well, wasn’t there? Can you can you kind of provide the distance with a little bit of information on those things?

Eric Boss: 31:26 Sure. There was an actual um noticeable split for people who had not had an increase in their compensation over an extended period of time, between 12 and 18 months. The the people that were retained on average because of the cycle, you know, were closer between six and 12 months. So even if they got a larger increase, but the there was more time in between increases, those people were more likely to leave. And I think that does say something about positive feedback from an organization. To a certain extent, you know, everyone gets a thank you note from the organization every other Friday. And if if every other Friday that thank you note just says the same thing for 18 months, the message gets a little old, like no matter what the message is. So it may not be the whole amount, but are we moving the bar on that? You know, would it, I think it’s worth examining our, you know, infrequent um, you know, incentive kind of payment things or infrequent thank yous, or, you know, uh not on a predictable schedule, but something that’s additional, but also looking at maybe like mid-year increases instead of annual increases, or, you know, just a different something to say, here’s where we are along the way. That may not fit a beautiful budget picture, but I think in terms of human nature, if you stretch out the longer time where your base remains the same, then everything is just kind of like, well, how is it different? Even if you’ve been appreciated along the way in other ways, that hasn’t really moved. And it’s the most frequent interaction in terms of financial transaction any employee is gonna have with an organization is their paycheck.

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Richard Leaver: 33:35 What I thought when I read about this, the fact that the duration of any type of pay increase was longer for those that left compared to those that stayed. I first off thought, based on my cynicism, well, they’ve just got to be bad, their jobs would observe a pay raise. But that’s probably not true. What’s probably more likely and kind of fits in with your narrative is really the fact that that perhaps that group wasn’t given sufficient feedback with sufficient frequency. So that their level of engagement perhaps was less, and also perhaps it was a reflection of the local leadership’s engagement with their team members was less overall, which could could have contributed to it. Um, so it wasn’t so much the dollars involved, it was the fact that the the leadership and managerial uh style and um uh actions that were taken were were different than those that stayed, and and they did have uh you know just basically fewer and less effective conversations with regards to accountability expectations, performance, et cetera, et cetera. Yes.

Eric Boss: 34:52 I would agree with that sentiment for sure.

Richard Leaver: 34:57 You did in the beginning um make a note with regards to type of uh employment status, so part-time, PRN, and full-time, and you’re saying that that full-time and part-time perhaps there wasn’t very much variance, but for PRN there actually was, wasn’t there?

Eric Boss: 35:16 There was. Um you know, about a third of the people who left uh were working in a PRN schedule. And it’s it’s interesting that that there is an amount of flexibility and there’s also an amount of reward with that. Um, I I think the PRN space right now is extraordinarily competitive. Um again, that’s anecdotal. We didn’t look at saying, you know, people who left here, did they go take a different offer or they just work in PRN somewhere else? Um, but you know, if if you look at the meme gradient, you know, if you look on Instagram on the physical therapy posts, it’s always going to be a contractor or two saying, well, I don’t I don’t know why I ever worked full time because look at um, you know, I set my hours, I I I get an incredible amount of money compared to my other rate, you know, and it you wind up trading that stability for for pay. That’s going to be a personal preference, but I also think that that space is wildly competitive, particularly locally, but um, I’m sure nationwide. And they’re just fighting with more attractive offers, I think. And so the the attrition in that space is somewhat expected because if they work for you and then decide to do anything else, they have the flexibility to do that. It’s not that they need to go commit to something that’s very similar to what they’re doing. Um, they can literally just not come back.

Richard Leaver: 36:43 I think the other thing is PRNs can feel like second-class citizens and not intentionally, but I think you’re just by the nature of their flex, you know, the their uh flexibility, the ability, you know, they’ve paid a higher rate because then we have the ability to flex their hours and we know and um you know the the amount of loyalty uh I think is generally less because you know the benefits are are different. You know, they yes, to your point, they take a much higher hourly rate, but they don’t have many of the other benefits. Well, they don’t have really any of the benefits that really I think uh tie people to to an organization, perhaps. And I would feel that I would believe that many of them feel almost as kind of outsiders um and inadvertently not included very often because they’re after sight, after mind, isn’t it really?

Eric Boss: 37:43 And yeah, we did discuss that like in the very beginning, that one of the main factors of retention as opposed to attrition was that camaraderie at your local level. Yeah, and so unless you are you know part of that team, you don’t have that retaining factor. There’s that cohesiveness is not grabbing you and pulling you into the center. So I agree exactly with what you’re saying, yeah.

Richard Leaver: 38:10 So the study definitely identified various factors that we’ve talked about on a practical basis. What behaviors or what does the organization or private practice really need to do to get ahead of this? Or or let’s even backtrack a little bit. Are there any warning signs that are evident? Is there anything that is kind of a uh an indicator, a leading indicator perhaps of those people that may well leave relative to others? Because if we can pr anticipate and predict, then I think the the obviously the local leaders can take actions. Um still reactive to a certain extent, but at least they haven’t handed in their notice at this point. Um, and I would say that probably good leaders should be doing all the things you’re just about to say anyway. But um you know what uh what from a practical basis do you believe that could be focused on with this group? And what are the what are the the leading indicators, perhaps?

Eric Boss: 39:22 Yeah, um, that’s a great question. And we did look at that in the study for certain metrics for those people who left and what those metrics looked like in terms of typical KPI or work performance before their attrition. And there were indicators in cancellation rate, there were indicators in visits per day that maybe they weren’t as engaged or trying to get as many people rescheduled back into their schedule. Um, and you know, those type of typical KPI metrics did slip prior to attrition in a leading indicator type of way. And it wasn’t way out in front. It’s not like you could see it six months before, but in the four to six weeks before someone was ready to leave. Um, those indicators consistently slipped across people who were leaving. And so the ability to go back and look at the trend, and there isn’t a benchmark to say, like somebody, well, I take that back to a certain extent. Uh the people who left the organization across the board had a general lower productivity in terms of visits that they were seeing per day. Um but besides that, in terms of the slips in an increased cancellation rate um uh or other factors, it it seems like you would be able to track that out um and then look at their particular trend as opposed to a particular number. If you’re looking for a 10% cancellation rate, you couldn’t say anyone with a 12% cancellation rate is trying to leave. But if someone had a cancellation of 4% their whole life and now it’s 10%, I would certainly be having a conversation with that person. How about you?

Richard Leaver: 41:09 Yeah, so I I think it’s uh as a locally I remember, yeah, I you have to look at things in a holistic manner. And um it’s definitely a case, isn’t there? The reality is if somebody is looking to to leave, they check out to a certain degree. Now everyone has has variable levels of engagement um uh as a result of both internal and external factors involved. You know, home life can could equally have an in uh same amount, if not more of a profound impact on performance. And but it’s it’s essentially it’s change of change of normal, whatever that normal is, isn’t it? So as you say, it’s not the fact that they hit a certain number and then that triggers uh a definitive um uh kind of expectation or idea that somebody will leave. It’s just a change from that individual’s normal. And I think as organizations, as local leaders, it’s if you are actively managing your team, you don’t need a spreadsheet to show that change in in behavior. You can see it. Um and then you know the final piece of that is the local leader, I believe, is wanting talking to the person about that change uh and not in a judgmental way. Um because I would imagine that whatever’s contributed to that change in behavior uh is weighing heavily on them. And uh I think the conversation has to be a supportive one in nature, doesn’t it?

Eric Boss: 42:53 Yeah, I believe that firmly. I think some of the I’ve ever had, uh the one leading up to my own attrition when I stopped being a physical therapist, the conversation wasn’t Eric, you’re not seeing 12 people per day or your patients aren’t coming 12 visits per evaluation. We sat down and he said, Are you doing okay? That was literally what he asked me, and I said, No, I was not doing okay. And it was the conversation I needed to have to move into a role in which I could excel. I was to a point where I could not perform that role there because I was not engaged, and so that’s the the question managers need to ask. They need to be able to say, are you okay? Because it may be something that we can help with. You know, if you do need more flexibility for something that’s happening at home, if you do need a different schedule because something’s happening that that requires you to be somewhere for your kids, we should do that. And let’s let’s make that right instead of you struggling through it. But also let’s identify, let’s collectively air out the fact that you’re not performing the way you were. And there’s there’s a reality to that that’s refreshing.

Richard Leaver: 44:05 Yeah. I think you know, we’re all afraid of sitting down with people and and uh calling in them out is not the right word, but sitting down with them and and saying, Hey, are you okay? Um, you know, it’s not often it’s not often enough people have that conversation. And I’m constantly amazed that you know it is variables that indirectly impact work rather than work itself. You know, I always say that people tend to leave as a culmination of, or usually a culmination of various frustrations, be they work or non-work related, or combination thereof, and then they reach a certain tipping point with kind of catastrophe theory associated with well, I’m done. You know, but it was usually a number of factors, and I I believe a good manager should can and will and should have the conversation very early on to uh to make sure that the the level of frustration doesn’t reach the point where they eventually say, I’m done. And you know, to your point, um just very recently, there’s an example of a person who just needed to change their their schedules or change clinic even. Um and uh you know those are very simple ones, but it’s also being cognizant as a leader that the majority of people actually are living paycheck to paycheck, and a lot of new graduates uh aren’t earning enough to really have any what I believe similar standard of living that we had as new graduates, not to say we were paid well, it was the fact that the costs are exponentially increased with student loans, housing, you know, and general living expenses. Um and uh even just as a leader, just acknowledging those factors in themselves can reduce anxiety and frustrations. I think I think as a leader, I think we feel sometimes we’ve got to fix everything. But that’s not the conversation, is it, very often? It’s just listening. Absolutely. Any final thoughts on the data or on the findings or on from a practical perspective for our leaders with regards to to helping with with um you know uh retention?

Eric Boss: 46:22 Yeah, from a data perspective, I just love the fact that we took a look at it. Um the data was imperfect, it was a tragically messy data set, and the results aren’t gonna be published in any, you know, journal. They’re not they’re they’re not gonna pass muster in terms of is there statistical significance for everything we’ve talked about? Um, but we made a best effort to look at, you know, a problem and then try to wrap our arms around that is it the the amount of relevance that’s there. We landed on some things that were very actionable. And I just commend the study of those things. If you have something that is, you know, an issue, let’s wrap some objective data around it and try to act in a way that it says, okay, we’re supported by this in most cases. Taking that step um that’s better instead of waiting for a perfect analysis by, you know, whoever for whatever, uh, you can do that at any level in the organization. You can you can look at things and you can really assess them and just try to move one notch closer, even if it’s not perfect. And um, you know, I think there’s a mistake that data always has to be finance level to the penny data. And I think a lot of times we can gather, collect, and process enough information to do good things.

Richard Leaver: 47:44 Well, thank you, Eric. Um I’ve learned a lot, and I think uh you know your assistance has been invaluable, certainly for Alliance physical therapy partners in helping us understand the various variables that we need to to um do a better job as leaders, operational leaders in managing and and looking at and and being aware of. So uh appreciate everything you do and uh hopefully uh you had a good experience as well on the podcast. Uh thank you, Richard. Appreciate the time.

Eric Boss: 48:15 Take care.

Alliance Physical Therapy Partners: 48:19 This has been another episode of the PT Leadership Podcast, brought to you by Alliance Physical Therapy Partners. Learn more about our team and find more episodes online at allianceptp.comslash podcasts.