Episode 41: Workforce Shortages

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Richard: Welcome back to Agile and Me Physical Therapy Leadership Podcast series. Again, I'm really excited to welcome Meredith Castin, an expert when it comes to the Non Clinical PT. Welcome back, Meredith.

Meredith: Thank you. Excited to be here.

Richard: Yeah. I think the listeners will have probably or hopefully listened to prior podcasts with you. But just in case they didn't, would you like to just briefly introduce sure, sure.

Meredith: I'm Meredith Caston. I run the non clinical PT. It's a website designed to help Ptot and SLP professionals explore and pursue non clinical careers.

Richard: Great. So today I wanted to talk about workforce shortages and the causes primarily, I think, but I was struck with some statistics that really resonated and concerned me. Back in 2021, the Washington Kaiser Family Foundation survey found that nearly 30% of healthcare workers are considering leaving their professional together, and nearly 60% reported impacts to their mental health stemming from their work during the COVID pandemic. I know you do a lot with clinicians that are leaving clinical care. Does that statistic? And it's shocking how that has deteriorated, particularly over the last few years. I don't mean to get politically in any way, but certainly that issue of civility, how we treat each other generally seems to have deteriorated, I think, here 100%.

Meredith: And I don't even think it needs to be a political issue. I think it's just this is where we are now, right? We can have all of our theories for the reasons behind this. I'm sure we could talk for hours on that, but this is where we are today, and we've got to fix it. And people, like you said, there's a lack of civility and people are just straight up mean. They're mean on the road, they're mean at work, it seems like. As much as I know we really needed to lock down and protect people during COVID something about that era really did give people permission to become just cruel behind the keyboard. And I think that, combined with other factors, has really given people a lot of license to just be really mean to each other.

Richard: Yeah. Not only does the kind of Kaiser Foundation survey show that people are thinking of leaving and it's impacting their mental health, but it was stated that America faced a shortage of up to 124,000 physicians by 2030, and we'll need to hire at least 200,000 nurses per year to meet increased demand and replace retiring nurses. So we kind of got this demographic cliff as well with baby boomers, so we're not getting enough in and the input output mismatch. And also notes that there's critical shortages of allied health professionals, behavioral health professionals, particularly in marginalized communities and also rural communities. And that's a kind of a podcast in itself with regards to looking at those care for those communities, both geography and demographic or proportion of the population. Not only we've got those issues, but we've also got aging, population rising, chronic diseases, creasing comorbidities, behavioral health conditions. And they all contribute to the need for supportive policies, don't they, really? So that the workforce, particularly a healthcare workforce, can continue to ensure access. Do you feel that sense of urgency? Do you believe that there is this sense of urgency to try and address these shortages and these issues that are coming? Whether we like it or not, we know they're occurring. We're seeing the baby boomer effect now, the aging population effect and the impact of the shortages quite profoundly. But do you think that we are in any way as a society or as a profession addressing those, or do you think that we've kind of still got our head in the sand, perhaps?

Meredith: Oh my gosh, I think we've got our heads in the sand for sure. I think it comes back to what we've discussed in the past by having a conversation and even coming up, at least we're talking about it, at least it's out there, we're admitting it. But I think if you're talking about is anything being done, I think our heads are in the sand. And I don't know if this is correct or not, but my feeling on a lot of this is something we touched on in a previous podcast of who are we attracting to these professions? And this goes beyond who are we attracting to PT. This goes into who are we attracting to medicine? Who are we targeting and trying to pull into these fields and medicine and being a nurse, being a doctor, being a PT, they all had different sort of ideas of what you could say. Like a doctor was the upper echelon of society and so respected and made a high salary and could afford the best. But I know some physicians who drive 2003 Tauruses because their loans are so high and they're also trying to do things that I think a lot of people want to do get married, buy a house, have some kids. And so what I'm finding from a lot of this is that the expectation is not matching the reality. And a lot of that has to do with money. And money, I think, is something that drives our country. It drives America. If we try and lie, that's sticking your head in the sand if you think that anything else drives this country. It drives the health care system, it drives everything. And so just this situation where I think someone used to be able to go to med school for much cheaper or nursing school nursing is a little different because there's a lower barrier to entry. A lot of times you don't even need a bachelor's degree to get your RN. But I think for a physical therapy know, DPT or an MD or a do, you're looking at first of all a bachelor's degree, then a very expensive graduate degree. And even with loans and scholarships and anything else, this is just something that it's no longer a competitive field. When you look at these other ones, like engineering or user experience or all of these really cool tech fields that are out there, and some of them not even tech fields. Some are just fields that don't cost as much to get into and have very stable, nice, lovely professions where you don't have to have the debt hanging over you the whole time. I think that's really what a lot of this boils down to is that we're expecting people to go into these professions and then live a life where they're just shackled by debt the entire time. And then also to your point of the lack of civility that we've discussed, people aren't always kind when you're trying to treat patients. They're not always going to thank you when you give them good care. They're not always going to say nice things about your appearance. They will often insult your appearance or say really cruel things. So what on earth is going on? Yeah, we've got to pay all this money to get into this profession where we're not treated very well. And then you add in the management component in many times, which I know you're a manager, and this is a struggle you face as a manager, but when you've got your bottom line, you have to be aware of gosh, then all of a sudden, we have to see X amount of patients in order to satisfy that. And then these patients are kind of mean to us. Oh, and then we got to go and document. And this documentation is terrible. And so I just think we have a huge problem on our hands. And it's one of those things that, in my opinion, really, the solution starts with figuring out who you want to attract into these professions in the first place, and then if you want to get the best and the brightest, figuring out a way to make sure that they don't live their lives mired in debt because of it. And then make sure that they are respected and treated with basic kindness so that they don't feel so disgusted by humanity that they leave.

Richard: Yeah, the way I see it is everything in life tends to be multifactorial, doesn't it? And this is, I think, a situation workforce wise, the shortages where there's barriers to entry, to even training. There's not enough training places with a lot of healthcare professions. We know that, in fact, for certain types of physicians, subspecialties, they've actually cut back on the number of training places nationally. But certainly for physical therapy, there aren't enough training places. Then when you do get a training place, the cost of education, postgraduate education, is so high, and it's really a profit center for universities. Let's be brutally honest. They make money money. They might offset it against other courses, but from physical therapy, it tends to be a profit center.

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Richard: And then there are barriers to entry for foreign trained therapists, making it extremely difficult for countries that have, I won't say a huge surplus, but countries that have additional trained healthcare workers that would be interested in coming here. Very difficult. I understand you've got to have certain standards and expectations, but when a state asks me to do english as a second language examination because I trained in England, you know that there's some stupidity surrounding a lot of those expectations.

Meredith: Yeah, definitely.

Richard: Hopefully my english is good enough to be understood, and then once you're in the profession, then we've got a lot of challenges like we've discussed before and everyone is well aware of. So that's the challenges within the profession, then obviously there's societal issues. So to me, these workforce challenges are really you have to look at at every level, at the individual level, at the kind of educational level, and really up to the societal level, don't you? We have to address all those levels and all the various stakeholders at each of those levels.

Meredith: Yes. Amen. Yes.

Richard: The other statistic that all the other information I was looking at recently came from a national academy of medicine report, and it suggested between 35 and 54% of us nurses and physicians have symptoms of burnout. I'm not sure how they got 54%. That's pretty accurate, isn't it? Really? Again, I'm sure you probably think that I'm probably surprised that it's actually not more and characterized by high emotional exhaustion, high depersonalization I e. Cynicism, which, again, we've kind of mentioned, and a low sense of personal acculturement at work. So obviously that's one factor I'm sure is very prominent in why people leave. What other reasons have you been told, people telling you as it pertains to leaving clinical care?

Meredith: Oh, I've heard so many different reasons. I would say a lot of times people say I'm burned out, but exactly what you just said, to your point of things are multifactorial. I think it's important to say what's making you feel burned out, because sometimes people feel burned out, because I think you cited one of the factors is lack of professional accomplishment or something along those lines. But that's a huge one. I've noticed from people is they feel like they go to work, and nothing they do is really making much of a difference. At the end of the day, maybe they're giving some good treatments to some patients, sure. But at the end of the day, they get poor performance reviews because their productivity isn't what it should be. Or they're denied a raise because it's just not available. We're not able to give you a raise. And so I think a patient might say thank you and that might be something that someone really thrives on. I love when a patient says thank you. That gives me more joy than pretty much anything else. Just knowing that someone is grateful for the care that I provided, it makes me feel like I gave good care and it makes me feel like I did my job right because they feel grateful for it. And other people couldn't give two hoots about that. But they want that annual raise and they want more money and they want a better title. And so I think just pulling out really what it is that's making someone feel so stuck and depersonalized and all these other kind of symptoms. Do you feel depersonalized because someone's mean to you? Yeah. Who doesn't? I've had things thrown at me. I've had things that people insult my appearance and guess my cultural background by how I look and say oh, I knew it from your nose. Or I knew I've had some people say stuff that's like good Lord, who raised you? That is so mean and so rude. But it's how it is. And so some people are able to really laugh that off and I am not because I think I would think to myself, I remember someone would say something really cruel or mean to me and I was thinking, oh my gosh. And I would start tabulating in my head how much I spent to go to school to get treated like this. And I remember tabulating it and being like oh my gosh. And my shoulder has never been the same since it was over mobilized in class one day. So now I've got a weird shoulder that's just never been the same. So that someone can be mean to me like this. And I think some people that really bothers other people can just laugh it off, but they're like, I never get a raise, this is the worst. So I think you really have to identify what it is that's making someone feel that way. But to your point yeah, I think 100% that those numbers are probably very low. If you look at just simply dissatisfaction, I think symptoms of burnout, sure, that might be an accurate number. But if you're just saying are you frustrated with this profession and feeling like you were promised something that it's not well, yeah, probably more than 50%.

Richard: Yeah. It's interesting when we talk about reasons for leaving. Burnout isn't a reason. Burnout is a symptom of other causes, other factors. Isn't has that doesn't have to be all burnout, does it? It could be financial reason. I just cannot afford to live in Oakland, California, so I'm having to move role position because pure financial. But again, like everything, like we always say, it tends to be more multifactorial, it tends to be reasons ABC doesn't it? And anxiety, stress of the role is one, but there are many others, I would imagine. Money is a key factor. Childcare is another factor. Hours are another factor. On top of those, are there any others that are kind of common themes, common causes, that people come to you and say, hey, I'm moving out of clinical because of x y lack of.

Meredith: Respect, I would say is huge. And that can come from the form of poor management, which we all know they're good managers and they're not so great managers, but it also comes a lot from patients and it comes a lot from other medical professions. I think that's been a big challenge for a lot of DPTs who don't work in outpatient clinics, is when you work in the hospital environment, it can feel very frustrating when someone's like, call therapy, there's the therapist, and someone's going, oh, my gosh. When I graduated with my white coat and was called Dr. XYZ, and now here I am in the hospital, and they're like, someone grab a therapy. Grab a therapist. And I think there are factors like that that really play into this. And it all goes back to what we've discussed in the past about who are we attracting into this field and are we really being honest with them about the realities? Because, yes, we can show up to work and wear a white coat and demand that people call us doctor, but in many clinical environments, that's going to get us laughed at. And so I think that has been a much bigger factor than we really recognized for a lot of this. I think when we moved to the doctorate, it started attracting a certain type of person who's really proud to have that doctor in their title. And then when you get out and realize that most people are like, oh, what are you going to do with your life? So many patients are like, oh, you're a personal trainer, so do you think you're going to go to college at some point? I mean, when you get these comments from people, after all that time and money spent to earn your white coat, and in our little siloed community of Pts get revered and call each other doctor in school, and then you get out and you're kind of slapped with the wet fish of reality of no one really knows what you do, that can be really tough. It's a tough pill to swallow. I wouldn't say that. That's the main reason. I'd say that's just a bigger factor that we haven't yet discussed in this particular call that needs to be worth mentioning. And I don't think that people should feel bad. I think what I should add to this is we are selling them this dream when we sell PT school. So this is our fault as a profession and as the education community, we've created this problem. This isn't something that the individual should necessarily take all of the blame for, for wanting simple respect, for having a doctor that they paid a ton of money to acquire and then get out and realize that people don't really know what it is or respect it. So this is something that we can't just say, oh, you're just being the patients don't care, just however you can get through to them. And, oh, you know, those doctors, they have egos. Just do whatever it takes to make them happy. So I think that that's something that we have to be very honest with people, that this is how it is, or reap what we sow in terms of people getting out there, realizing it's not what we promise, and then leaving.

Richard: Yes, there's definitely a disconnect between the educational establishment's perception and reality. But let's not go down that road, because I'm sure I'll get telephones from many of the universities.

Meredith: It's okay, send them my way.

Richard: I'm very interested in this kind of lack of respect. I was surprised, to be honest, because I always try and as a clinician, I suppose I try and be respectful to everyone that works with me, for me, alongside me. But I think you're right. There is this lack of respect, isn't it? Looking back as a clinician, if I was lineside managing kind of the health and wellness of athletes, kind of be perceived as the guy with the sponge bucket and sponge type of thing years ago, but I won't say that that's showing my age, because now it's all spray and all the rest. But anyway but certainly I agree that there is perhaps a lack of appreciation, perhaps, of the professionalism of therapy and other healthcare workers, not just physical therapy. With regards to the kind of the reasons that we've outlined, do you find that there is when people are coming and chatting to you about leaving clinical care, do you find that there is out of the various causes, do you find that there is a prominent one more than others? Or is it just you've heard everything under the sun?

Meredith: I think I've heard everything under the sun, but the main ones tend to be money. Just the idea of I cannot make it work on this salary for whatever reason, whether it's debt related or not. I think money is a big one. I think lack of respect is a big one. And I think just what do they call it, moral injury, that feeling of you're treating in a system that isn't what you thought it would be, where everything comes down to the almighty dollar and the patients really don't come first. While we were promised in school that the patients come first and that should be our number one consideration. And then you get into a system where they don't, where really just money comes first and then you're not even making that much of the money that comes first. So I think just a kind of expectation versus reality. But that's for younger clinicians. I think for the older clinicians, a lot of it comes down to I knew it when it was in the glory days, as we've discussed, you could comfortably see quite a few patients in a day if you liked that busy schedule, because the documentation just wasn't that bad. Or I've had a lot of older clinicians say the way patients behave has changed. That comes back to the respect thing. But I do get quite a few older clinicians who come through and they say, I've had it 25 years in, I'm throwing the towel in and it's for XYZ reasons. But to your point you made earlier, it almost always is multifactorial. If it were only money, I don't think a lot of people would leave. I think they would find a way to make it work. They would maybe get a second job if they had to. They would move to a cheaper cost of living area and say, you know, it's worth it, I love this job, it's just too expensive to live in this city, so I'm going to move elsewhere. And I don't think money is the only factor. And there's just so much wrong with their experience that they're having in this profession that it's easier and better and more preferable to simply just step away and change careers.

Richard: Yes. Looking back at psychology classes, social psychology, it was always said that money wasn't a motivator, but it was certainly a disincentive demotivator and I think it's often used as an excuse, isn't it? Because it's very easy just to say, well, it wasn't the money, but there's definitely other factors. Not to say money isn't important, it is. The other thing I think you're extremely astute on is the idea that people will work for salaries a lot less than what therapists earn. For instance, in England, a skilled senior clinician is probably on the equivalent of about $30 to $40,000 a year. Admittedly it's a 36 hours work week and a slightly longer vacation, but essentially it's a similar job and in fact actually higher visits per day as well. So it's not purely money, it's the work environment, it's the bureaucracy, it's the administrative tasks, it's all the other things, isn't it? And I think it's very easy just to say, well, we'd pay our therapists more. Well, one, practically we can't really do that anymore because when hospitals are operating, as I say, on a two 3% margin, you don't really have much wiggle room. It's not as if I don't want to give everyone increased pay raises as a leader, because I know that Cola cost of living is going up significantly, but the margin just isn't there? And to keep doors open, there's only so much expense that one can bear. So I have a lot of empathy. But bottom line is it's more than money, isn't it?

Meredith: Yes. And I think for some people, it really is money. That is the thing. And that's okay to admit that, because I think when I was leaving, even people just would always assume it was only money, and they're like, that's so greedy. And I was thinking, that's a small sliver for me of why I was leaving. It was all these other factors. But there are people who it is the factor. And that's okay, too, because if you've got debt, or even if you don't have debt and you simply just want a lot of money, that's okay. We change, and we change over time. People develop different tastes. They decide that they do want the finer things in life, even though maybe they didn't when they were 20 and signed up for this. So I think it's okay. And I think we have to destigmatize the idea that leaving for more money, we have to just say that it's okay if you leave for more money. You're not a bad person. You just want to survive and thrive in a society that is built around money.

Richard: Yeah. I don't want the audience to think that PT salary is poor salary compared to national averages and compared to minimum wage. We do well. It's just the fact that most majority have significant student loans, majority have sacrificed a number of years of earning to be able to complete the doctoral program, et cetera. So I don't want it to sound like this is kind of an issue or a problem that it's just rich people have. It's not. But it is true, isn't it? Like you've mentioned in the past, with high cost of living, it's not as if they're getting rich. Therapists are. Most therapists are spending pretty much everything they get and more.

Meredith: Yes, and I think a lot of that comes down to interest rates, too, on the loans. There's a lot to unpack with this whole concept of money and money management and financial management. And that's why, as we were saying, it's like, I know doctors who make the same salary of another doctor, but one will be doing extremely well and the other isn't, because we're not necessarily always taught how to invest. We're not taught how to save, we're not taught how to budget. And so those are all factors that play into things, too. But then at the end of the day, I think even if you want to have a yacht or something like that, it wouldn't be in my dream. But for some people, having a yacht is the sign of success. And if that's what you want, you've got to be like, okay, it might not happen on a staff therapist salary. I might have to become a CEO.

Richard: I'm pretty sure it won't happen on a staff therapist.

Meredith: Right?

Richard: We talk about kind of the causes, but let's look at the stakeholders. Who is responsible for these shortages? Again, it's not an individual stakeholder. I think there's multiple stakeholders that really need to understand this. So for instance, to me, the payers by reducing the, in real or relative terms reimbursement over time, that impacts the ability to provide the service. So in some ways, one could argue from a payer perspective, all they're doing is damaging themselves in the long run. That's being very perhaps nice towards payers. But one could argue that but it's not just payers. There are others who are responsible. You mentioned briefly kind of educational system as well. Who else would you say needs to step up and help address these shortages? Not just in therapy, but in healthcare, each healthcare profession as well, would you say?

Meredith: It's a really good question. I don't know that there's an easy answer and I don't want to assign blame to people. And I hope I didn't come off like I'm trying to put all the blame on educational systems because that's just one side of that's one of a multipronged factor, multifactor whatever you would say. But it's just one of many factors that is contributing to this problem, I think.

Richard: So perhaps instead of saying who's to blame and who's responsible, who can help us, who can dig us out of this hole which we obviously have based on these shortages? 124,000 physicians, short therapy? I have no idea, but it's probably tens of thousands of therapists we're short who can help us dig us out of this problem.

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Meredith: Well, I think given that so much of the problem is related to money, I think if we can somehow remove the burden of expense, like the barrier of expense to enter these fields, that is a good starting point. More scholarships, more opportunities to have loan repayments that maybe are a little bit easier for people to understand. Without getting too political, it would be really nice if there were some factors worked into the way our government works so that if someone chooses to go into a public servant type of role like healthcare, then they have some degree of loans forgiven. And I think if you're going to get your loans forgiven sure, you should probably have to work for a certain type of organization or for a certain length. Of time. There need to be checks and balances rather than just, like, having everything wiped out. And I know I also want to say I respect people who have worked really hard and scrimmed and saved to pay off their loans, and I respect and understand their frustration when someone else's is just completely wiped out. I really do. I understand and respect that. And that's why it's such a complex topic. And I hesitate to really weigh in heavily on this because I can see people's frustrations. But I think the fact that this is happening shows that we need to fix it. There shouldn't be this competition of like, well, I paid off my loans and I was responsible and you didn't, because that's not helping us either. And so we just need to make it so that it's affordable to go to school in the first place. And then maybe there are more scholarship options, and maybe we figure out ways where there are tax incentives for CEOs of big therapy companies or hospital systems to fund these scholarships. And these scholarships do go to people who will then serve their communities, the underserved communities, the ones that are seeing the mass exoduses. And I'm afraid a lot of this is beyond my wheelhouse. Honestly, I don't really know how managing a huge corporation is. But I think the point of all of this is we just have to get extremely creative and think about ways to give. I think incentives go a long way. And so if we can incentivize we can incentivize the schools to cost less. However, that would be I don't know about the details. We can incentivize the government to help providers stay in or join the workforce. That would be great. Again, I don't know the details, but at least just having these conversations of going, okay, this isn't working, what are some thoughts of things that might work? And I also want to say I would love to see more clinicians at the decision table, the decision making table. And you were saying we can blame these reimbursement cuts. That is one of the biggest murkiest puddles of how the heck does this work? And every time I have tried to find good jobs for clinicians to go into with the CMS, it is so freaking hard to understand what they even want you to have. And it almost always goes to nurses. It's always a nursing background or clinical physician background. So there's just so much work we can do to get people from rehab backgrounds working at CMS in the first place and working we have people working as utilization reviewers in the insurance companies, but that has its own set of problems, as we've noted. And so I just think we've got to just get very creative with solutions and have more of these conversations.

Richard: Yes, rehab, I think, is often considered just collateral damage because we aren't a strong voice. We're not a united voice. Just by the nature of the profession, it's fragmented, which has its advantages, but also has some disadvantages associated when we try and have a unified voice. But we have to do that and we have to have increased self advocacy as well. So I think we can blame other people, other stakeholders and point fingers. But I think the biggest finger has to kind of be at ourselves, doesn't it? In some way I need to be part of the solution and not just complain. The other thing I think is one small part is attracting, when we talk about attracting people to the profession, is and this again was raised by other industry leaders, is we do a terrible job with attracting minority groups to the profession.

Meredith: Yes.

Richard: And we've got to do a better job. And I think you're also right with regards to saying that you can't really manage the problem or address the problem through disincentives. You really have to provide incentives of some manner. So, for instance, when I trained in England a few years ago, training for a healthcare degree was actually free.

Meredith: Oh, wow.

Richard: Because the society understood that they needed to promote, they understood the importance of allied professionals and they understood that in order to have sufficiently number of trained healthcare professionals, they would have to incentivize people to do the training, particularly when the starting salary was equivalent to $15,000 a year. But regardless, certainly that had a profound impact on people what degree they chose to do.

Meredith: Yes.

Richard: Over time, do you see more people coming to the non clinical PT world and think of moving on, leaving, or is it kind of a steady state or since COVID has passed, is there less people approaching you as it pertains to kind of leaving the clinical workforce? What's happening? What do you see now and then? What do you see in the long run?

Meredith: Yeah, I haven't seen things fall off. I will say it kind of I would say kind of spiked incidentally before COVID when PDPM and PDGM resulted in all of those restructuring and sniff environments and home health, there were quite a few layoffs. There were rifts. Reductions in force. There were some pay cuts and just a lot of frustrations with people moving more to group settings that they didn't always feel were the best for the patient or necessarily safe. So that's when things around 2019 and the beginning of 2020 really felt like they were picking up quite a bit. Where I went from being a blog with some services and a course available for people who wanted to be, I always looked at us as the black sheep who just wanted a change. This wasn't right for us to oh goodness, there are a lot of people who want this. And so that was the beginning of it. COVID then further amplified things, but it hasn't slowed down since then. I'd say, if anything, it's kind of plateaued and I think some of the big factors though, that make the difference is that now those early adopters, if you want to call them, who did leave patient care, are really growing in their careers. They're having advancements, they're having salary increases, they're getting better titles, they're enjoying flexibility, they're getting to work from home. So a lot of those things that were frustrating them acutely at the beginning, especially during COVID oh my gosh, I really want to work from home because I am freaking terrified of this virus now. We're not freaking terrified of COVID anymore. It's pretty managed, but people love working from home. You don't have to pay as much money in commutes. You get to wear your pajama bottoms and a nice top. There are a lot of really nice things about working from home. And so I think it's not me having to convince I've never felt like I've had to convince anybody that they should leave. It's more just people wanting it for their own reasons, for some different way or whatnot. But now I just feel like I'm almost removed from the equation in many ways because we've got all these people who've been there, done that, and they're on LinkedIn just saying, oh my gosh. The reality is it's pretty nice on the other side. And so I think that's doing a lot of the work for me, in a sense, as a business owner, I don't have to sit and be like, hey guys, you can do this. It's possible, I promise. I've done it. You can do it too. Give it a chance. Now there are all these people being like, yeah, it's doable, I love it. And then they want guidance and they come to me in many cases, although I will say there are probably seven or eight different people out there now offering very similar services to me. Because what started as this weird little niche business that was trying to help a small group of black sheep type of people is now I mean, it's its own industry, which is insane to think about that now. There's a non clinical wing of our profession, but there is and it's been kind of cool to see different people go, okay, well, I'm the user Experience Guru, or I am the well, I hate to use the word guru because that's pretty negative, but you know what I'm saying? It's like the person who went into customer success and really killed it and did so well, and now they're going to help other people with that specific career track. So it has been really cool to see it develop the way PT has where there subspecialties.

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Richard: Well, perhaps you might head up the subspecialty for non clinical within the APTA in years to come. Who knows? Joking aside, this is perhaps a little unfair question, but let's say you had a magic lamp and in that magic lamp was a genie that could give you three wishes, or shall I say could implement three changes to reduce perhaps or tackle the number of healthcare workers leaving. What would perhaps those three wishes be, do you think would have an impact? And let's narrow it down a little bit. Hopefully those wishes is something that perhaps is possible to be done. I don't know if they can or can't, but what would be the three wishes?

Meredith: Oh my gosh. Well, the first one would have to do with people's behavior as patients. It would be nice if during an intake session, someone would have to sign a form committing to respecting their healthcare provider and not being cruel to them and not calling them names and not throwing things at them. And that would be part of their contract of care. I realize sometimes people come in and they're barely coherent in the hospital. So we got to workshop this. You've probably picked up I'm not a details person, I'm an idea person, but I think even just a sign on the wall of a hospital, your healthcare providers are here to help you, help them help you by being kind. Something along those lines where it's just a friendly reminder that people work really hard and they deserve your respect. And we understand that you're in pain, but you can show some human decency. I've had some really painful surgeries and recoveries and can tell you that it's still possible to be kind to your providers when you're in immense pain. That's just what happens. You can overcome the pain and still show kindness. It is possible. So I think something along the lines of contractual obligation of patients to be kind would be wonderful, I think, if there were some way to fix I mean, we're talking genie magic lamp here, so I'm just dreaming really big. But I think if there was some way to create a culture in our profession of go, take however much time off you need and we will fill things. I don't know if that looks like a national registry of clinicians who can fill in again, details not my thing, but let's give people the flexibility that we were promised going into PT. I was promised it's funny because I don't have children and I chose not to have children. But back when I chose the PT profession, I was in my early twenty s and I figured I was going to have them. That's what you do as a woman, right? You have some kids. And so I was like, PT is really flexible. That's cool, because I always used to think, man, it looks hard to work full time and have kids. That looks like a lot of work. Well, PT keeps selling me on the idea that you can work part time and do it and so that's fine. But I think the part that I didn't really consider is how expensive it is to become a PT. And so if you only work part time, that's not going to pay off your loans. It's not going to pay off any debt. If you acquire debt, it's also just not going to make you any money. Even if you don't have debt, it's not going to be very lucrative profession. So I think if there's a way to figure out how to really give us that flexibility so that people who, whether or not finances are an issue, can choose to go and work at other jobs and take breaks and rest their hands and rest their backs and rest their emotional centers and go work as a bartender, as we've discussed in other cases. Or go work as a substitute teacher. Or go be an author and try and write that book, whatever they want to do, and then come back after that. Sabbatical, refreshed and ready to be a good clinician and excited about their work again. How cool would that be if that could be the culture of our profession? It's celebrated when someone takes the sabbatical. And then my third wish, I think, would be to take money out of the equation of health care altogether. I don't know what that looks like. Details, not my thing. But how wonderful if someone wants to be a healthcare provider and they didn't have to worry about whether they had to choose to have a house or a marriage or children or all of these things that cost a lot of money in our society, or childcare. How nice if someone could have a situation like you did where they got some free education to become a provider with the understanding that, okay, if you do this, you treat in XYZ situations because I agree with you. Shout out to Rising Tide. And what Heidi Janenga is doing with getting more minorities into our profession, that's awesome. We just need more minorities coming in. But we can't expect for someone who's coming in. And maybe it's someone who is coming from a family who doesn't have the means to pay for their entire education, which I think a lot of kids do have that and have been very lucky and that's great. That's great. But if we're trying to attract more minorities and I'm not just talking about skin tones, I'm talking about different socioeconomic backgrounds, I'm talking about different religions, I'm talking about different who they love, right? Like gender identities, all of these things. If someone's coming from a background that isn't necessarily that kind of traditional, well off, nuclear family, white people who can just save up and send their kids to college, I hope I'm not making any offensive assumptions here.

Richard: I think you've included everyone.

Meredith: I'm just trying to say if you want to attract someone from a nontraditional background, we also have to recognize that that nontraditional background might also come with some things. Like, well, this might be the first person in their family to go to college, or they might be having to pay for this all on their own because they might not have family support, or they might not have financial education. So I would love to be able to attract people who are going to have a much better breadth of care and relationship to the patients that we serve and not have them then have to be like, sorry, sucker, you are in debt for the rest of your lives because you chose this profession. That's what I want to avoid. I want people to be able to come in and then treat just the way so many other people do, and if they find it's not for them, okay, maybe there's something else I can do in healthcare still. Maybe I can take a non clinical route if I want to, but I don't want them to feel shackled to a broken health care system because they came in trying to fix this weird whitewashed issue we have in our profession. It's not their job to solve the problem. It's not some minority's job to solve this problem we have and then suffer and be stuck in debt for the rest of their lives because we were like, Come on, we need more people of your type coming in here. We need more of you. Come in, pay a ton of money, and then hope things work out for you. Dude, I would love to fix that. So that's my third wish. I hope these were dreaming big enough.

Richard: Absolutely. Well, thank you so much for your time today. As always. If people want to reach out, how would they contact you?

Meredith: I always recommend people visit themonclinicalpt.com because we've got a great start Here page where you can find answers to a lot of your common questions about the nonclinical world. We've got a great networking group. I hang out in there sometimes and answer questions, and there are just a lot of ways to get in touch. We've got a great team here that's able to answer your questions, so you're welcome to reach out to support@thept.com.

Richard: Thank you so much. It's a pleasure talking to you, as always. Thank you, Meredith.

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