January 26, 2021

Achieving Fulfillment And Avoiding Burnout With Phil Plisky, PT

PTO 129 | Professional Rebellion


Whether you’re an owner or employee, you’ve probably experienced burnout in your job – that state of emotional exhaustion, depersonalization, lack of accomplishment or growth that hits even the best among us. In this episode, Nathan Shields is joined by Professional Rebellion cofounder, Phil Plisky to discuss why we tend to feel that way and what can be done if and when we're at that point. Phil is also physical therapist himself. His passion for solving the problem of burnout in the PT industry is part of the reason for developing the company. This discussion is important for PT owners, but it is also important for owners to recognize when their team members are at that point and how they can help them get through it. Listen in and learn, among a lot of other things, how burnout can be a good thing even though it sucks.


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Achieving Fulfillment And Avoiding Burnout With Phil Plisky, PT

In this episode, I've got Phil Plisky. Phil Plisky is a Physical Therapist and Cofounder of Professional Rebellion. He's also a faculty at the University of Evansville in Indiana. He is a consultant for professional athletes and the military. He has a cash-based private practice in Indiana as well. He's run the gamut. He's doing a ton of great stuff. We want to talk a little bit about something that he's been passionate about and one of the reasons behind developing Professional Rebellion and that is burnout in the physical therapy industry. Before I get too far into that, Phil, thanks for coming on.

Thanks. It's great to be here. I'm excited to talk to you.

I'm looking forward to the conversation. I first learned about you because you co-authored an article in Impact Magazine in August of 2020 with Jenna Gourlay. I plan on having her on the podcast later on. You guys talked about navigating difficult conversations and I thought, “What a great article because many PT owners have to have these difficult conversations. They don't know how to where to start.” We didn't have that training. I recommend owners to go back and read the article because there's a lot of great information on there. I'm also going to do an episode with Jenna specific to that article at another time. Phil, we're going to talk a little about something different. Before we get into that, do you mind sharing with us a little bit about your professional history and what got you to this point?

I always tell people I graduated from PT school in the last century. It provides a little bit of context there. I've gone through the standard gamut of being a staff PT, going back to get my Doctor of Science degree, changing jobs every eighteen months to three years. I would love a job for a year and then start to hate a job. I’m always trying to get something new. I opened clinics for hospitals. I've been Vice President of different private practices. I did a lot of different things in search of that great career. I can't tell you how many times I was burnt out. I didn't like what I was doing.

You're not talking about the patient care aspect. You're talking about the responsibilities that were peripheral to them.

PTO 129 | Professional Rebellion
Professional Rebellion: Physical therapy is an emotionally and physically taxing job. It can start to feel like factory work after a while.

The amazing thing is it didn't matter what it was. If I were in patient care, I would get tired of the patients and I'd go, “I want to do management.” If I got into management, I would get tired of approving time-off requests and dealing with the paperwork and the staff training and all stuff. I'm like, “I'll go back to be a staff therapist again.” I did that and I loved it for 12 to 18 months and then I got bored. I developed the Y balance test and did research and did a lot of different things that way. Every single time, no matter what it was, I would get tired of what I was doing. Being in my ideal career, I recognize that people don't have a lot of help and I wish I would have had that help to know what I should be doing and how to get there.

You and I sound like we're about the same age. I graduated from PT school in ‘99. Maybe we still have a little bit of that mentality of growing up and you join on with the corporation and you build and grow within it. We're on that cusp where people are not doing that as much. Our parents have that mentality. It was awkward to get into a job and be switching it after eighteen months, like in my personal career, and not be with them for a long time and not envision myself going up the ladder in leadership and stuff like that. I'm assuming that you found that what you were experiencing wasn't unique to you. Maybe you came across other physical therapists that were having the same issues.

I did. What was interesting about it is I looked at some of my mentors and one of them is still practicing and doing patient care 8:00 to 5:00 every single day, Monday through Friday, and that wasn't me. I felt guilty about it. I felt like I was a bad physical therapist, a bad person. 8:00 to 5:00 patient care got old. I never had anybody tell me that was okay. Not all are cut out for that. It's probably rarer that we're cut out for patient care for 40 years, 8:00 to 5:00 only.

You don't see a physical therapist doing that.

They don't. It's an emotionally and physically taxing job. It can start to feel like factory work after a while.

Consider some of the geographical issues that you have when reimbursement rates are low in some cases. It's hard to provide that one-on-one dedicated care for 30, 45, 60 minutes. You’ve got to do what you’ve got to do. You’ve got to be profitable to sustain.

That was one of my favorite jobs. I was the Vice President of Clinical Excellence. I had always said my role in that position was to uphold the two pillars of the practice. One pillar was clinical excellence, which means delivering that outstanding care that's scientifically-based, research-based, and has great outcomes. The other pillar is making a profit. If you don't have a natural tension between those two pillars, then your practice will not succeed as well as it can. An ideal patient care, without looking at profit, is not going to be as effective or efficient. If you look solely at profit, that's not going to be ideal patient care. There should be this natural tension and that was my responsibility. I enjoyed that role for about eighteen months.

Was this the genesis as you're recognizing that you don't want to be this guy that's treating patients 8:00 to 5:00? Did you start looking outside of your network for a mentor that could guide you on your professional path? What brought along the genesis of Professional Rebellion?

If you can't lead the person, if you can only give them answers, then you’re not being the best coach. Click To Tweet

It was the absence of that mentor that brought it about. It was not until about 12 to 14 years into my career that I truly figured out what I wanted to do. I had no one along the way. I could have easily ended up quitting physical therapy altogether probably anywhere from 3 to 5 years in. Fortunately, I was driven to get my Doctor of Science and do all these other different things and research. Through that, a lot of different doors opened for me and that kept me engaged.

There wasn't anybody there for me. I had great clinical mentors, absolutely amazing. There wasn't anyone to describe the path, describe these feelings of discontentment and what to do with them, and what's the next thing. Even as private practice owners, we get into starting the practice and that's exciting. We start to see some success and that's exciting. Somehow, we start feeling like a rat on a wheel again. It’s like, “This is what I was trying to escape practice before. Now, I suddenly feel the same way.” What is that cause?

As part of the Professional Rebellion, what are you telling? You work not just with PT owners. You're working with what you call staff Physical Therapists as well in helping guide and mentor and help them create the professions that they want to live in. What do you tell them at the beginning? Can you share maybe a couple of nuggets? Where do people start when they're burned out?

My mentor, Gray Cook, who I eventually stumbled on, helped me professionally and clinically. When we're working on projects together, when we're developing the fundamental capacity screen or whatever thing we're developing, we always say, “Let's define what's going on.” I like to start defining burnout. That label was thrown around so much these days and it doesn't matter the profession. We see this in teachers. We see this in police officers. Everybody is talking about burnout, which is also perpetuating it as well.

When you look at burnout, the clinical definition of it is emotional exhaustion, depersonalization and lack of sense of personal or professional accomplishment. That's a pretty severe definition that we say there. Many of us can suffer from that and that becomes a big problem. When we use the word burnout, we're saying, “I don't like what I'm currently doing. I hate going to work. I hate my job. I can't stand X or Y.” We almost then have made burnout synonymous with being overworked. Sometimes it is being overworked, but sometimes it's being underworked or under-challenged. There are a lot of different things that go into that.

If you think about your career or my career, how is it that we can have a job that we love for 12 to 18 months and then suddenly, it becomes the worst job in the world? How does that make any sense? How can we open up our private practice and love it and it's exhilarating and exhausting all at the same time and then start to hate it? That doesn't make a lot of sense. Quite frankly, your duties haven't changed. There's probably no harder time than the first eighteen months of starting a private practice. Every owner will tell you, “There's no other time than five years into practice. There's no other time than ten years into practice.”

I love that you add underchallenged into that definition. As I'm working with some of my PT honors as coaching clients, they've been PTs from 2 to 15 years. The ones that have been around a while, their concern isn't so much necessarily finances as much as it is, “I'm done with this.” They'll use the word burnout. There are a couple of things that come into play. I like the idea that there's a lack of challenge at that point. You've seen a lot of the diagnoses. You have a toolkit in your repertoire of treatment and care. You've made some financial gains. You're pretty safe there. You're seeing a lot of the same people. You'll get a lot of returning patients. You've got a team that's been with you for probably a few years. You have some of the emotional ups and downs with HR. At that stage, more than likely, the burnout is coming from what they call burnout from being under-challenged.

Beyond severe, clinically defined burnout, it comes from either having lack of clarity, challenge, or community. Those are the defining things that I would dare to say might hit 80%, 90% of the root causes of burnout.

Delve into that for me. I have an idea of what you mean by lack of clarity. Tell me what you're talking about there.

Lack of clarity can come in a couple of different ways. One is having a bigger purpose for your life and your career. As private practice owners, you all are familiar with purpose statements, mission, vision, Simon Sinek’s Start with Why, the whole nine yards. We're all aware of that. It's important to have that. If you don't have that, that's going to be a big problem. The second part of clarity is where a lot of private practice owners and physical therapists struggle is, what does actual success in what I'm doing day in and day out look like?

Here's an example of that. There's a manager of a PT practice that I know. He's truly a manager. He’s been doing it forever. I looked at him and I said, “How can you do that? You're approving time-off requests, dealing with front desk staff, turnover, and all this miserable stuff.” He's been doing it forever. The reason is he's defined what success looks like for him. Success looks like, “I want to be home and emotionally detached at 5:00 PM. I want to be with my kids. I could climb higher, but I don't want to.” We forget what success looks like or what that definition is. What data are we going to use to know that we're being successful?

As entrepreneurs, we're great at moving the goalpost. It's a constant movement. It's like, “If I have my own practice, doing my own thing, I have that freedom and flexibility.” Suddenly, you get it and you're like, “This isn't freedom and flexibility. What the heck happened? When I add staff, then I'll be able to get freedom and flexibility because they'll be doing all this stuff I don't want.” You're like, “Maybe once I have an office manager, someone who's responsible for all those things,” suddenly you've complicated your life and you're like, “I still have less freedom and flexibility than I had before.”

It's funny that you bring this up because these are the first things that I talk about when I'm with a client. Even before I get a client, I'm asking them, “What are your goals? What do you want to achieve? What's your ideal scene with coaching, with me in the next year or two?” That's a hard question for a lot of them to answer.

Here's the thing. A lot of times, once you're seeking help, you're already drowning. When you start asking goals and stuff like that, and this is what I've done and I continue to make this mistake, I talk about asking the goals which is like shouting at the drowning person like, “Thumb goes into the water first. It’s the proper swim stroke and then it's bobbing up and down.” That’s the wrong thing. Let me show you a life preserver first and then we'll talk about how do we swim better.

A lot of it goes back to clarity on purpose. Many clients will come to me and say, “What's my next step? I've got some freedom. You've coached me to a point where maybe I'm not treating as much or not at all.” They'll say, “What's next?” You tell me. Where do you want to go? What's your purpose for this business? Now that you have some time and freedom, what do you want to do with that time and freedom? That can be a hard question to ask.

It's not only hard. It's scary. We tend to bury ourselves in busyness, which gets us to our second concept of challenge. Private practice owners are particularly susceptible to it, “Once I, fill in the blank, I will be able to and fill in the blank.” You get there and it's not what you thought it would be. It is about that purpose and that challenge. You can't look at your day and go, “I'm not being challenged.” Every private practice owner has way more challenges than they need. It’s like, “Am I growing intentionally?” That's why we seek that new thing and why we're tired of where we're currently at. What skills and abilities am I working on intentionally to do that new next thing? If you can't articulate that, then that is probably also beyond clarity. That's another source of this feeling of burnout.

The way that they articulate it is to use the word burnout. From what I'm gathering from my experience is that when they're getting to the point of burnout, they're like, “Something's got to change.” They can't articulate it. Maybe they'll use the word burnout. To me, from an outside perspective, they're not living their purpose, but they don't know that because they're not clear on that purpose.

To sit down and get some clarity is going to require a lot of attention, soul searching, time and effort. It's not easy. I'd rather go do something and check that off my to-do list than to sit and think about what I want to get out of this life and find a purpose for myself because then I've got to be intentional with my actions. Personally, I might hold myself accountable. What I'm doing now might not be in line with my purpose. That conversation, they can't necessarily articulate it. What it says to me, in no uncertain terms, is they're not living what their ideal scene was in their head even though they can articulate it.

The best times in your life are often the ones when you are the busiest and most challenged. Click To Tweet

Moses has these Ten Commandments written in stone. Your purpose is written in stone. We're taught that in business. When you make your company's why statement and your mission statement, no matter what happens, it should never change. It shouldn't be a moving target on a monthly basis or maybe even an annual basis. Sit back and reflect and go, “What is that?” Fortunately, one of the ways that I did it in my career and it was pure happenstance is every position I took, I always said, “What do I hate about what I'm currently doing? What do I love?” The only way I'm going to move positions is if it has more that I love and less that I hate. I kept iterating that process over and over again to finally start to develop my ideal career.

It would have been way easier if I connected it to that clarity of mission, my not-to-do list. You ask for goals and you can diagnose a lot. One of the things that I love doing, particularly entrepreneurs, is what's on your not-to-do list? They're like, “My to-do list? Did I mishear you?” I'm like, “No. What do you intentionally not do and are okay with it?” If they can't articulate that, that also tells me where they are in their clarity.

It's funny that you brought that up. I had that experience. I was setting some goals and I did a number of personality tests. The Kolbe test that I took for personality came back and told me that I should not work with small engines. It specifically said that.

I like that. That sounds like a great test, something that gets that specifically. When I grew up, I can fix about any engine, but I hate every minute of it.

PTO 129 | Professional Rebellion
Professional Rebellion: It's not that you have to pay a professional for everything. You have to pay a professional for what you're not good at and don't like.

It bled over into my family life. I would spend a Saturday working on something and trying to figure it out, watch all the YouTube videos. I'd come in and I'd kick the dog and throw some pans and my wife is like, “Steer clear of dad today, kids.” My goal was to hire out every repair. It's been such a blessing in my life.

We do a lot of coaching and consulting on, “Am I ready to start my private practice?” One of the Litmus tests if you're ready to start your private practice or not is how many professional services besides medical do you pay for? Whether that be the guy that fixes a toilet or a lawnmower, if you don't value the skills of those professionals, you're going to have a hard time convincing your patients to pay you for your professional skill because you have said, “I don't value the skill of that.” If you can get into that idea like, “I value that. I need an assistant.” There's always something in me like, “I don't need it. I could do it myself.” It’s like, “Why?” I hate it. There are people who love it. Why don't we create this great symbiosis that you'll take what I hate off my plate and I'll pay you? That's the whole goal.

There was so much of that in Tim Ferriss’ The 4-Hour Workweek where he talked about virtual assistants. I've got a number of clients that use virtual assistants. In the past, I've used Fiverr to farm out marketing projects and stuff like that. It can make life much easier, opening your mind to the fact that there are people in this world who love doing the stuff that you hate. They're good at it too, so much so that it's worth you not wasting your time and energy and saving your time, energy, emotion, and all the psychological baggage that might come with it. Letting other people do that can be freeing.

We'll give a caution with that. I've got a friend who works a white-collar job. He's in the office in a suit every day. He loves going home and working on his landscaping and building a retaining wall and remodeling his basement and stuff like that. I did that growing up and that sounds like poke-your-eye-out fun to me. He enjoys that. He finds that relaxing. It's not that you have to pay a professional for everything. You have to pay a professional for what you're not good at and don't like.

That can also be tough as small business owners because initially, we wear all the hats. Even if you have the time to do it, it's hard to pay somebody to do it because you're mining your expenses or bootstrapping things. What could you be doing better with that time, even if it was thinking during that time? Your time is that much more valuable to consider the path that you want to take your business, maybe a marketing strategy that could net you more patients, goals for the upcoming year that could stretch you and help you grow further. Even an accountability meeting with a team member could get you so much further than going in there and calling the vendor and telling not to come.

“You're going to buy this or do that.” One of the practice owners that I work with, this was before he started working with me, he takes his Tuesdays and Thursdays off “to work” on the practice back to that work in the business versus on the business type of thing. He takes Tuesdays and Thursdays off and he could be doing patient care. He's a great therapist and does well. Yes, sometimes it is doing the duties of a private practice owner that he does on those Tuesdays and Thursdays. He also has specifically slated time for thinking. We don't do that anymore. That's considered taboo.

That would be considered unproductive time. You can't bill for that.

I don't even know what code that goes under. Medicare is certainly not going to pay for that.

There is that hurdle I have to get over with owners because their thought process is, “I'm exchanging my time in treating this patient because I know I can exchange my time for money with an insurance company by treating this patient.” To get them to the point where they're spending their time working on the business, they don't understand the exchange at that point. I don’t recognize that.

That's exactly right. I found that time and time again. Along with that is a lot of private practice owners are great leaders, which means they feel that they should be in the trenches with everybody. Otherwise, they're not being a good leader, which I love that heart and I love that spirit. That does make an excellent leader. At a certain point in time, you've got to pull out of the trenches and you can't feel guilty about it. Getting over that guilt is probably one of the hardest things. I can almost better make the argument for the finances of it than I can about the guilt of it.

It comes up time and time again. I want to know what you would say to those owners because they feel guilty and they worry that their team members are going to resent them because they're not on the floor with them anymore.

It's about being a good example. We're talking about burnout with private practice owners. Private practice owners have team members that are also burnt out and they burn out quickly and crazily. It's about being a great example for your team members and going, “What do you love to do in your day?” “I love wound care.” “You want wound care? Who loves wound care?” “I do.” “I love working in women's health.” “Whatever it is, let's get you doing more of that. Tell me what you don't like.” Do that with your team members and then be explicit with your team members.

What I love to do is provide an environment that you can thrive and grow in, in such a way that we're paying the bills. We can survive pandemics and still be able to pay you. That's what I think about on Tuesdays and Thursdays. If we let our team know how much we care about providing stability for them and providing growth for them, they'd be like, “Of course, he needs Tuesdays and Thursdays. Maybe he needs Mondays, Wednesdays and Fridays too.” The focus is making sure that I have the opportunity to grow and the opportunity to be paid. I want that guy on that wall the whole time.

That's been my experience. As these owners make that transition, they feel that way initially but that's not the reality that they go through. People don't express resentment. They're looking for them to answer questions but that doesn't mean they necessarily have to be treated on the floor. When they do take the time to improve the business and improve the working environment and have those conversations with team members that they didn't have in the past, that's when the team comes back to them and says, “You need to be doing more of this stuff. Whatever you're doing on Tuesdays and Thursdays, whatever you're doing with your coach, whatever you're learning at the consultant, you need to be doing more of that. How did we ever get by with you treating full-time to begin with?” Those are more of the comments that are coming back to them when they start working on their business and having those conversations and focusing on their team.

If we said that lack of challenge is a responsibility for feelings of burnout, whether you're burnt out or not as we said is a question, but if lack of challenge is there, modeling for our team members that we have a coach and a community is the third secret to combating the feelings of burnout. We need to be challenged. I'm an introvert by nature. I like to sit and think by myself and not talk to others. This pandemic has taught me that I am not. I thrive on working with people.

One of my values is collaborative creation. It's being in a community of people who are challenging me, who are making me better. We’re working on something together to get better. Being a private practice owner is lonely. You can't talk to your staff about the problems you're having because you don't want to burden them with it. It's your responsibility as an owner. You also don't want to share your successes like, “We had a great Q4. This is awesome.” You got to have that community that's causing you to grow and that's asking you the tough questions like you do with your coaching folks saying, “What are your goals? What are you looking for? What does success look like? What does a win look like for you?” If you don't have someone in your life doing that, it's like being the lazy, out-of-shape PT, and trying to get someone else off the couch.

People look at you and go, “Why would I listen to you? You don't have it in order.” It's also about modeling that investment for your teams, like, “What kind of community do we have in our system? What kind of community do I have as a practice owner that people are thriving?” I've had some of the worst jobs. What we did was bad, but I loved every minute of it because I love the people I was with. They were like-minded. Private practice owners, they're running around solitary and it's lonely.

One of my mantras that I talk about on the podcast quite often is to step out, reach out, and network. It goes in line with what you're talking about. For PT owners, specifically, step out of treating full-time so they can spend time working on the business. Reach out and get some support. Get some business acumen, training, consulting, coaching, you name it, and network because it is solitary. Honestly, who is holding you accountable? I work with a number of owners that have been owners for over a decade and they say, “I've got all these goals. If I achieve them or not, no one's asking me. I'm not accountable to anybody.”

Being a private practice owner is lonely. You can't burden your staff with your problems. That is why you need help. Click To Tweet

It goes back to what we were talking about earlier. Are you willing to pay for professional advice and help? I’ve got a financial planner. I love finances, it's a passion of mine. I can't read enough financial information. I could do everything he's doing. When I started working with him, I told him, “You are my personal trainer for finance.” It's not that I don't even have my own abilities to do my own personal training. That's not the case. It's accountability and clarity on data because we're our own worst judge of how we're doing. Think about working with patients, “How are you doing?” “I’m no better.” “When you came into me, you were not walking. You walked in, so you're a little better.” It’s not their fault. It's how we naturally are. We're looking at our current circumstance where we've always been and not where we came from and what we're doing. Having a coach and having a community around you goes such a long way to that satisfaction to avoiding that burnout.

There's so much to be said for being part of an accountability group, a mastermind, an organization of small business owners. It wasn't until I did that, that I recognize a lot of my weaknesses are commonly placed throughout all industries. I can learn from these other guys. I can get questioned by these other guys on maybe some false postulates that I have about, “I can't do this.” They're like, “Why can't you do that?” I give them my answer and they're like, “What?”

Don't you hate when you get that answer? It’s like, “That was obvious. I can't believe I didn't think of that myself.”

If you don't have that network, if you're not collaborating, you don't get pushed. You don't get stretched. You don't get invited. You don't get challenged. That’s where you can get some burnout because you're not getting challenged.

I'm going to say it's okay to say burnout because it's almost like the word love. It means different things to everyone else. Burnout could be actual clinical burnout or it could be, “I'm dissatisfied with where I'm currently at.” Sometimes, that dissatisfaction comes with a huge lack of hope. Nothing can change from that so I stay there. Use that dissatisfaction, use that frustration, as an agent to change something. If you're feeling frustration and dissatisfaction as an owner, you're doing it right because that means you have an area of growth that you need to work on. Go get some help working on that.

The problem is when you get that frustration and then you bury your head in the sand and keep treating patients and keep pushing forward, the frustration, the emotional exhaustion comes into play and, honestly, a lack of accomplishment. You know something's wrong and you're not taking the energy to fix it, “I got these distractions. These patients want to see me and I've got to see them.”

“I'm the only person that can see them.” That was a hard point in my career. I was like, “They want to see me.” Once I found out that they sometimes did better with other people, that bite of humility launched my career.

I have to broach the subject and it's hard for people to swallow it because I had to overcome it myself. It sounds like you did as well. There's an element of pride that keeps us from growing when it comes to pulling away from patient treatment to address the things that need to be treated. We get to that point where I've built this practice because of the way I've treated and interacted with patients. I can't trust someone else to do this job like I can.

The thing that we've got to keep in mind is if you love patient care and 100% can't see yourself doing it 40 hours a week, then you should be in patient care and you should be hiring a great chief operating officer to do the business stuff that you don't like. I don't think that's who we're talking about. We're talking about people who are hiding inpatient care. Business stuff is hard sometimes. It's awkward. We don't want to look at it. We don't want to deal with it. We don't want to deal with staff development and knowing that staff development is the secret sauce to their happiness. Remember, it's about your staff having clarity, challenge and community. It doesn't matter whether it’s your staff or not. Having those three C's there are critical.

You're talking about owners reaching out and getting some coaching. I've talked to a client to help him recognize that as you start moving up the leadership ladder and handing off some of your responsibilities and hats to other people, you are becoming their coach. You're helping them gain clarity. Help them feel fulfilled and accomplished. This helps them then avoid burnout, if you will, and also buy in to your culture. You're starting to develop a culture because you're becoming a coach to them and guiding them. It happens on different levels. We might reach out to the coach because where we're at is owners. We can be then seen as coaches to those who we are working with, especially our leadership teams.

Who’s coaching the owners on how to be coaches? One of the things I love that you do is like, “This is what staff development looks like. This is what handoff looks like.” When you're looking at what you're doing, you need to be spending a lot of time in coaching the people who are now your coaches and then approaching the people downstream from you. That's important.

Summarize for us your three things that you focused on. I remember community at the end. Remind us of the first two.

PTO 129 | Professional Rebellion
Professional Rebellion: If you're feeling frustration and dissatisfaction as an owner, you're doing it right because that means you have an area of growth that you need to work on.

We're looking at clarity and that clarity is, do we have clarity of overall purpose, business purpose, and things like that? Also, do we have clarity on what winning looks like in our private practice or as a staff therapist or whatever? What is that clarity? Otherwise, we're going to keep moving the goal line. We're going to keep moving the goalposts. We're looking for clarity there. We're looking for challenge. How am I being challenged intentionally by other people to grow? What does that look like? It feels a little awkward but yet exhilarating. Think about all the different and hard things. This is why burnout isn't about being overworked. If you look at the best times in your life and go back and look at them, a lot of times, they were when you were the busiest and most challenged. It's not about doing too much. It's about not doing the right things.

We have clarity, challenge and then community. Who are you doing this with? Who are you gaining your clarity with? Who are you being challenged by so that you're enjoying the process of that? That may be your team that you're with in your private practice or it may be a combination of both, your team and your private practice and the group that challenges you, the people that challenge you, your coach that challenges you. If I look back at my career, my favorite thing was when I was working on a team with people doing something that no one ever thought we could do. That's been the most fun part. It was fun because we accomplished it. When we accomplished it, we're like, “What's next?” I sold the business and my partner said, “I know we've sold and you're disbanding people. We've enjoyed our time together. Whatever the next thing is, let me know. I'm on board.” Did you hear that? It doesn't even matter what the thing is. We had so much fun together.

I experienced the same thing with my partner. We work well together and we sold our practices. There are plenty of reasons why we communicate now because we've collaborated and we enjoy each other's company and we are aligned in our values and many of our purposes are similar. That makes it a lot more fun to work in that environment. I'll ask you a quick question and then we'll see if you have any more that you want to share. What would you recommend an owner say when a provider, maybe not even a provider but a front office person, a biller and they come to you and they say, “I feel like I'm overworked, I'm too stressed out?” Would you have any advice for an owner in that situation on how to deal with that conversation?

I can tell you what not to do because I've made these mistakes and it does not go well. Remember our analogy of the person drowning and then you're going to tell them about the swimming strokes that they need to do and how they’re whipping their legs exactly right and the breaststroke that they're trying to do. It's a horrible idea. Our natural tendency as entrepreneurs, as learners, and things like that is to throw information at the person and be like, “You’ve got to read this book. You’ve got to do this thing.” Those are important.

Don't get me wrong. There are a lot of books that I have that I recommend, but that's the worst thing to do when someone comes to you and has that burnout. The first thing to do is to be compassionate and to talk to them about the time that you were burnt out too and how bad it sucks. We tend to offer solutions way too early. We do this in relationships a lot too. It’s like, “This is my problem.” You're like, “This is how you fix it.” “Let me know that you're okay with me being burnt out.” That's the first message. It’s like, “It's okay. It's normal. It's common. Let's explore together how we can help that.” You have to be committed as a practice owner to truly doing that.

If you've developed a system that the only person that can thrive is the person that works 8:00 to 5:00, seeing X number of patients and billing X number of units, you might as well accept burnout and consider it like, “I know the guys at Toyota are going to develop lateral epicondylitis. We're going to have our lateral epicondylitis program. There's nothing to do about it because their freaking job sucks.” If you're not committed to being truly open to like, “What do you love? What do you want to do?” If you can do that and also either keep your minimums like, “I'm transparent with you in our books. This is what I pay you. This is what we make.”

If you want to decrease your hours, that's great. This is what it looks like. When you decrease your hours, I know that your margin goes down. While it may seem a one-to-one ratio to you, it's not a one-to-one ratio to the practice. If we're both okay with that, let's go down that road. This is the margin we need to make. Do you think you can make that margin in that specialty area that you want to go to? If you think you can, I'm going to give you some free time. We said that free time as an owner sucks. What about the free time as a staff therapist to go develop and go, “I'm going to give you this free time?” Like in my coaching group, they hold me accountable. I'm going to hold you accountable to that too.

If you're going to be given that 20% time to go develop, at three months and six months, I’d better see what has developed. We're going to make a decision every 3 to 6 months whether we're going to continue developing. The solution is helping the person gain clarity, help the person gain challenge, and help the person in the community. If you're not willing to do that, you pat them on the back and shove a book down their throat and it’s fine. Go buy them lunch because that's going to solve this problem.

We go to the solution partially because we are males. As you and I are talking, the first thing our wives don't want to hear is the solution to their problem because that's where we tend to come from. I agree, some of those solutions come best even though you might have the answer in your head like, “I know what you got to do.” It comes from them. If you can have that communication, “What do you need and how can I help you at this point?” your job as a leader is to create a foundation for them to succeed.

You've described the ideal coach which you have to be as a practice owner. The answer to burnout and all that, there are books on that. You don't even need me. You don't need Professional Rebellion. You don't need you. I hate to downplay your consulting service. You don't need it if it's all about knowledge. It's not all about knowledge. It's about relationships, community, and discovery. If you can't lead the person, if you can only give the answers, that's not the best coach.

They're not going to grow. Also, they're not going to gain from inner wisdom and experience. Sometimes you have to let them, “Go ahead and do that. Tell me how it turns out.” They might fall flat on their face.

We tend to think of burnout as synonymous to being overworked, but it can also mean being underworked or under-challenged. Click To Tweet

If you know the idea is bad, it's going to be a little shorter leash. It's like, “We're going to follow up in a month with how that's going. If it's not going, then let’s maybe explore. Here's the deal. Let's look at that in a month. Where do you think you can be?” Gain that clarity, “I can be here.” “Let's follow up in a month and see where you're at.”

People can set up their own challenges. They know where their weaknesses are, most of the time. Even though they might not be able to iterate them, they can come to a conclusion pretty quickly. It’s like, “This is where my challenges are and this is what I need to focus on.” If they have that willing leader to sit down and talk to them and ask them those hard questions, that's when they can start seeing growth and then that leader holds them accountable. They're being challenged. They're getting some clarity like you're talking about. They’re collaborating and have a community in which to grow and accomplish and get all the fulfillment that they need.

I’ve seen some great practices built on the concept of community because community begets passion, begets expertise. People like being asked for. If you become the running guy or the running gal in the runners' community and you're a runner yourself, that's an awesome place to be.

You're serving and you're living out your purpose at that point and that's cool. Anything else you want to share with us? Anything that popped into your mind and you’re like, “I’ve got to get this off my chest.”

The key thing is to understand that the feelings of burnout are completely normal and you should look at them as a positive thing even though it sucks. That positive thing means that if you do it right, you're about to grow and get on to the other side of it and you'll be thankful. If you grow in the right process, getting that clarity, getting that challenge and getting that community, everything will go well. If you don't, rather rinse and repeat, you're going to be putting Band-aids on burnout as I did.

I love our conversation. I loved your definition of burnout, which was emotional exhaustion, depersonalization, and lack of accomplishment. You wrapped it up well. Once you're feeling those sensations, those struggles, you name it, if you look at them as opportunities for growth, then you got a cool future ahead of you because you're willing to take on that challenge.

This has been a lot of fun. I've enjoyed it. This is great.

If people want to get in touch with you, how would they do that?

The best thing is probably at PhysioRebellion.com. The Professional Rebellion is a parent company. There's the Physio Rebellion, which works with physical therapists. There's Private Practice Rebellion, which works with private practice owners. We're adding in the fitness or personal training around. My goal is that we would have both a teacher rebellion, a student rebellion. What we're teaching at the DPT program, I feel bad for these students. They are beyond burnt out and they are beyond hopeless.

Part of my goal as a faculty member is to re-instill that hope. I feel somewhat badly for maybe some other universities that don't have classes with dealing with this and developing more than your specialization. It’s like, “What is your career path look like?” It's okay to talk about how that involves your life and your vacations and your significant other and your dog. I love doing that. PhysioRebellion.com is specific for physical therapists. You contact me through there. You're going to have Jenna on. She's one of the cofounders as well. You can get ahold of her. One thing we look at as far as the coaching community is like with physical therapists, there's a right fit for certain people. I'm not the right fit for certain people. I'm willing to admit that there's sometimes way better people that can be your coach, can be your mentor.

I've had the same thing. I've had people come to me and I'm like, “You might want to try this other coach over here.” At least talk to 2 or 3 different ones before you land on someone. If someone was interested in doing what you're doing and talking to students and wanted to be adjunct professors at a local university because they have some time on their hands and maybe that fulfills something for them and their purpose, how do you go about doing that? Do you talk to someone in the local PT program?

First of all, that is a huge common fulfillment. I’ve always said that I never wanted to be a teacher growing up. The irony that I'm a full-time faculty member is not lost on me. That does fulfill a lot of different aspects of that challenge, of that community, and that type of thing for people. Here's the advice on that. You've got to reach out. You have to reach out multiple times and in multiple different ways and multiple venues. Most faculty are interested in having guest speakers, adjunct faculty, because it does bring variety, it brings interest. Quite frankly, sometimes it can lighten the load a little bit.

You have to realize that faculty, like a private practice owner, might get 75, 100-plus emails in a day. If you happen to email at the wrong time of day, a wrong time of the semester, they're either engaged in and immersed and it's like, “That's a great idea. I can't deal with that now.” It's then off the radar or they're like, “This is my two-week break here. I'm shutting down. These emails are going to accumulate and I may or may not get back to them.” I would be persistent in it and keep asking because a lot of times that one ask doesn't get heard. Sometimes it may take five, ten asks of different people.

What I found in my coaching too is the emails that people send are not good because it's not clear. Think about it. You say, “I'm interested in teaching and helping out. Do you have anything?” It’s like, “If I have to think of what problem you're solving for me, I'm not going to think long and hard about that because I don't know what your skillset or expertise is.” If I were to go to a PT program, “I'm passionate about student burnout and student anxiety and things like that. I was wondering if there's a place in your program that I can give a 45-minute presentation to help them with that and that can either be part of a course or not. Let me know if I can help out in any way.” We should know that from business. That's Sales 101. Be clear on what you're offering.

Come with a product.

PTO 129 | Professional Rebellion
Professional Rebellion: The first thing to do to help someone who is experiencing burnout is to be compassionate and talk to them about the time you were burnt out too and how bad it was.

It’s like, “Do you like me? That's great. Let's go a little more than that.”

Thank you so much for sharing that. I'm sure there are plenty out there that have gotten to a point where they want to give back and they want to do more.

Being called a Professional Rebellion was not a light name choice. It was not something we came up with within a day. That’s the whole goal. I teach the leadership and practice administration course at the university. My goal is for us to have this revolution in physical therapy where private practice is something you go into. It's a plan and this is how I do it. There are many practice owners that could help university faculty who have never owned a practice who are teaching these courses that are laying and don't have any real world.

Don't get me wrong. My students might say, “Dr. Plisky is the lamest professor there is.” Go out there and share what advice you have for students. What is cool is it also develops your business because if you're sincerely giving back and you're likable, those students are going to want to do clinical with you. Those students are going to want to work for you. When you're making choices on staff hires, you're choosing from the best of the best who already matched your culture because they already know you and you already know them. It's a win-win. Your personnel problems go down, your attrition goes down.

Thanks so much for sharing your expertise, your wisdom and your knowledge. It was awesome to have you on the podcast.

It's been a lot of fun. I look forward to doing it again.

We will do it again. Thanks, Phil.


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About Phil Plisky

PTO 129 | Professional RebellionPhil Plisky, PT, DSc, OCS, ATC, CSCS, is the co-founder of the Professional Rebellion, a community dedicated to helping physical therapists create the career of their dreams. His mission is to advance the profession by inspiring those with the power to change it. He does this as an Associate Professor at the University of Evansville, Director of Residency Programs, co-developer in Functional Movement Systems, entrepreneur, and consultant in professional sports. He believes that everyone can design their ideal career and part of his is helping others create theirs.

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