The Boring Road to Independence
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[00:00:00] What up folks? Brando, Brando Lakes. Uh, you know, today I want to talk about something that has been on my mind. Uh, this is like, like really just within like the past 30 minutes or so, I just got off the phone with a really, really good friend. Uh, this is someone who, um, we were roommates in grad school, uh, and in New York.
We're both coming from California. He's from the, uh, northern California. I'm from Southern. And we just like jelled, we, we matched really, really well. Um, upon graduating, he went back to Cali. He started his own, uh, PT clinic and, um. I kind of stayed here and I started working at an outpatient clinic, uh, called Orthology.
It's now Optum. And then I, I left there for New York [00:01:00] Presbyterian. I was there for a few years, and then I finally went solo. Uh, he is someone who went to Low very early on. He did not, you know, work there, work there. Um, not until. A little later I'll share it with you. Um, but he like jumped straight into it.
He is like, Nope, I want my own practice. And he went that route. And he has been someone who has been, um, he. He encourages me. He, he, he definitely didn't convert me to like go independent. Like it was something I knew I wanted to do, but I worked out this sort of, uh, deal with my wife that I would, you know, pay off the student loans before I did anything risky, like for our family, right?
So. He's encouraged me the whole time, like, dude, you gotta go independent. You can pay off the student loans, you'll just do it a lot faster. And I'm like, eh, not [00:02:00] exactly what I worked out with the Mrs. So this is the route that I'm taking. Anyway, I just got off the phone with him and, uh, he's doing great.
He did sell his company, but only because, um, he just wanted. Something different, right? Like he, he, he went independent. He made a, a, a lot of money. Um, he would just share, you know, how, how things were going for him, like business wise. And, you know, he, he was doing fine. He really was. But, um, when you're working so hard.
It can be somewhat difficult to, to juggle like work family life now, like as an employee, which I've been, um. You know, like I can clock in and I can clock out and like I'm done with work more or less. Like I'm done with work and I can be home and I can be present. But as a business owner, [00:03:00] not exactly, like there's still some things that you need to do.
You just also know that you might be on the couch or in like the doghouse if, if you don't make it home at a proper time. Right. Or an agreed upon time and. You know, he, he found something where he can find a better work life balance. Um, but my conversation with him has got me thinking about. Why I do this, it is got me thinking about why some PT clinics go out of business, why some PT clinics don't want to go in network.
Um, why some insurances, you know, decide to reimburse less. And I do think that the one thing that everything falls into, if I can put it into a category, is boring. Now it [00:04:00] may seem super duper exciting to, to start one's, one's own business. Um, it may seem, uh, very altruistic, you know, or even, you know, kind, thoughtful, if you will, to like go in network versus out of network.
Some people think that people going out in network, they're, they're off for money and that that's not exactly it. I, but I do think some of it, at least a, a good portion of it has to do with it being boring. Let me explain. So, because I am in network with Cigna United Health, um, as of at the time of this recording, I'm, I'm still in network with Emblem, uh, blue Cross Blue Shield Aetna.
You know, Medicare, there are a lot of forms that I need to fill out. These aren't fun forms, right? Like [00:05:00] they'll, they, they'll ask me. And if you're listening, if you're a client of mine. Even if you've, you've never been a client of mine, but you've gone to pt, right? Like there's like the LEFS form, the lower extremity functional scale, where it's asking, um, how difficult it is for you to walk two blocks versus a mile.
There's a bunch of other questions like that. There's like the dash, the quick dash, you know, all these forms. They, they, it's boring, right? And you as a patient, as a client, me even have or feel like. This questionnaire doesn't even capture how well I'm doing. Right. Or just in some cases how bad I'm doing.
Right. But like, it, it is just not capturing the improvement that I have. Like I'm telling you, it's better. I just, it, it's better in a way that this form doesn't capture it. You know, like, anyway, I, I won't to go too far down that rabbit hole. It is, it is just to show that [00:06:00] these forms need to be filled out.
They need. To be filled out because if they're not, and you are an in-network provider, right? You're so kind, you're not all about the money, right? You, you, you're an in-network provider. You're filling out these forms because the insurance is looking for it, right? And they're, they want to know if this person, this member of their insurance is actually getting better.
And it's not even so much like they're forking out. You know, so much money, you're, you're paying quite a bit in your, your premiums and copays, probably more than you know, what they're reimbursing at, at least for, you know, physical therapy. But like, they're still looking at this stuff and are waving their flag and say, you have been approved or You have not been approved.
Figure it out. Sorry you're in pain, but figure it out. And these forms, they're [00:07:00] boring. Sometimes they're frustrating, but like, this is what needs to be done. It is the same thing with goals. You know, coming up with goals could be, could be boring. Right? Um, especially if it's, you know, well, I want to be able to walk two miles and, uh, or maybe I want to run the New York City Marathon.
Putting, taking time outta Wednesday to, to put it on paper. Relatively speaking, it, it is kind of boring. You'd much rather just be out there walking. You'd much rather be out there running right, in regards to, to those goals. You, you just much rather be on your feet, not sitting down. Definitely not sitting down with someone else.
Trying to figure out what is the perfect, specific goal. And it's, to me, the same. It's the same with insurance where. You know, insurance is saying, Hey, provider, [00:08:00] um, we know you might have a good relationship with this patient. Uh, we know that, uh, this condition. Might take longer than what you think or what you feel or whatever you're putting in your protocol.
Um, and by the way, the protocol is like, as the doctor prescribes, it could be like two times a week for like six to eight weeks. Um, but the insurance, I have contracts with the insurance, right? Because I'm in network. And they'll say, they'll say, Brando, you are tier three. You are in contract with, contract with us, but you are a tier three provider, and what that basically means is we're only going to reimburse you at like a certain amount now because, well, this is how I feed my family.
I'm gonna want a higher amount, right? Like logically speaking, I want my business to grow. I want to be able to [00:09:00] hire employees. I'd like to hire admin. Right to, to take some work off of my plate. So I like to employ people. Um, and all that requires, well, uh, higher reimbursement. I can't pay them if I can, if I'm not getting enough money myself, right?
So they'll say, Hey, we know you want to see this person, you know, two times a week for six weeks, and we know what the prescription says, but if you could instead see them four times. Over the next, I don't know, six weeks. That will be great. And if you do that, we will reimburse you more. You can go from a tier three to a tier two.
All you have to do is see them, uh, heck of a lot less than what the doctor is saying or even like, what, what you would like to do with this per person. And this could be someone who just got outta the [00:10:00] surgery. This could be someone with a, like a fairly acute, uh, condition. It could be like a, like a ACL tear.
Uh, it could be a full thickness tear, the rotator cuff. It could be, you know, like super acute, very intense, low back pain. They don't care about any of that. What's in black and white on the forms that I receive from from these insurances is you see them less, we give you more money.
How does that fit in the category of boring? Well, I have patients, and there's a lot of research on this that the sort of connection, the sort of bond that you may have, like with a patient, the better off they are. Um, so let's say I, I may be explaining something that, that's so obvious, but if you're a patient.
And you go inside [00:11:00] a PT clinic, hell, even if it's like a, like a doctor's office and, excuse me, sorry, I'm yawning. See, this is boring. I'm doing the boring work of a podcasting, of, of recording, of recording my thoughts where I, I, I don't know, one could argue do I actually need to, um, but I am doing this boring work.
Anyway, I'm with you guys, so it, it, it is somewhat fun to me anyway. You go into a doctor's office and, uh, this doctor is like rude. You know, they're just rude. They're standoffish. Uh, bedside table or bedside manner is terrible. I don't know about you. Yeah, but I personally have this experience where I'm at Columbia.
Oh, I probably shouldn't have shared the hospital. Anyway. I'm, I'm at a facility. I won't tell you what hospital it is, but I'm at a facility and [00:12:00] I'm in the room, left in a room for about 40 minutes now. You could ask yourself, well, Brenda, 40 minutes. Like, why didn't you just like step outside? Well. I could have and I didn't because, because I, I was somewhat in some way, uh, content with being bored.
I, at this time, my, my son was probably like, like two or three months old and I hadn't gotten any sleep. So I might have, I might have snoozed off. I might. Anyway, I checked my phone, 40 minutes have, have, have elapsed and my wife is asking, Hey, are you almost done with with this appointment? And I said, no, I haven't even been seen.
She says, what? That's crazy. You used to step out and see what's going on. So I step out of the, out of the room and the doctor is, is fraternizing. He is talking with a nurse or some other students. I don't know. Who exactly they were or what their roles were. But he's like sitting, talking, we're standing [00:13:00] talking and I'm like, Hey, um, you're still seeing me, right?
He's, oh, yeah, yeah, yeah. And you know, of course he like comes in and he is checking me and whatnot, and I told myself, like, before I left, like at that point it didn't matter, like what he said, I'm not letting this guy. Operate on my ear. I was going there because I have a hole in my eardrum. I still do. And I'm like, I'm, I'm not letting this guy touch my ear like he forgot about me.
You know? Like, yeah, I was a parent, like going there to get my ear checked out. I wasn't going there for a nap. But he didn't know, right? So like he left me in that room, like, why would I continue my care with this person? And I feel, especially with. You know, having someone you know, sort of educate you on how your body works or should work, um, placing their hands on you, [00:14:00] you know, to, to loosen up like any sort of like muscle tissues or whatnot.
Um, was it Take your body through different exercises. Touching. And you know, sometimes there's, there's context to it. Like in a setting where, you know, there might be like guiding your hips or like raising your arms over, over your shoulder. Like, you know, like it could be, it could be, um, what's the word?
Um. You, you guys are probably thinking it, and if we were playing Jeopardy, you'd probably say what is and whatever the word is, but I can't think of it right now. But, you know, it could, it could be, uh, sensitive. Right? You, you're in a very sensitive place. So is that, is that someone or a setting you want to go into, like sporadically, right?
Is is that a setting you want to go into? I don't know. Every now and then, especially when you're in pain. No, like you're gonna want to go [00:15:00] there a little more frequent to get to know who the heck is this person that's working with me in the first place. Right? So they want you to do this sort of, uh, boring work.
Sorry, one second.
So, you know, you're doing this boring work and. You are doing this boring work and the insurance want you to keep doing boring work. As a business owner, you're, you're doing the boring, boring work of filling out these tax forms or hiring people and you know, um, making sure you're compliant to every law.
Making sure you're compliant to every policy that the insurance lays out. All this stuff is boring. It really is. It's not coming up with a new and cool and fascinating exercise intervention. It's boring and I choose to [00:16:00] do it because, well, for me, it excites me, right? It excites me in a sense of like, I'm not just a regular physical therapist.
It excites me in that I know how insurance works, I know how our healthcare system works. It excites me in a sense of, I. Playing by the medi, uh, the insurances rules. I know how to get this person better using fewer visits, um, if it comes down to it, um, or figuring out a way to like put the onus like back onto, onto the patient.
So I have fun with it, I really do. Um, but I can imagine how someone, especially like a patient or a client is coming to me and. Well, they're not having fun and doing the boring stuff is still boring and they don't want to do it. [00:17:00] And when I think of it, especially in that context, I can see why people aren't getting better.
I can see why people are, are, you know, having or experiencing sustained pain or consistent persistent pain. Look. It would be great if I could do whatever the heck I wanted to do with my body and not have to suffer any sort of con uh, consequences. Not have to do any sort of stretching or any sort of exercise or, you know, treat my, treat my, I don't know, 80-year-old body as if I'm still like 13.
But like, that's, it's just not reality, you know? And I do think that for those who are having chronic pain, they're looking for this sort of magical, you know, mystical, [00:18:00] mythical, um, sort of intervention. They, they would love to go in and have a PT do this and their pain is gone. They would love to go in and if it's not pt, a chiropractor go in, you know, and it's gone.
Uh, same with acupuncture. Massage therapist just want it gone. And it's not so much of the, the, the, the speed at which we get it as much as we hate doing boring stuff. So if I don't have to do it and I can pay you to do it for me, I mean, you know who, who's gonna turn that down, right? But I, I will still encourage you to.
To lean into doing whatever is boring because it's, it's oftentimes the boring things that, that, that really help our future selves. Um, saving and investing boring, [00:19:00] right? I'd much rather go out, blow that money, have a, have a good time. It's boring to save it. It's boring to invest it. I'm looking out for my future self.
Uh, it's boring to, uh, instead of kicking my feet up on the recliner watching some television, it's boring to do a stretch instead. Um, it's boring to do squats in between, you know, or during the commercial breeze. I'd much rather enjoy my commercial, maybe even get another snack from the fridge. Um, it's born to do exercises when you'd much rather do just about anything else, but.
Again, it's the boring things that we do that get us ahead. So I would encourage you, and you know what, I'm, I'm gonna do something better than just encourage, um, my, my, my friend, you know, we had his practice that, again, I said that he, he never converted me. He, he, uh, encouraged me. Um, but I actually want to.
[00:20:00] Convert you, um, from, uh, doing or being a president who just does everything fun and wants to do things fun, to doing something boring, right? And I guess that does require some encouragement. But anyway, what I want you to do, I want you to find one thing. I want you to, here it is coming up with a goal. I want you to, I want you to find one thing in your life that you just don't.
Want to do, you absolutely despise doing it. You know you need to do it, but you don't like doing it. I want you to write down just three things that you can do to like, make it more fun. It just make it more fun. So let's say it is like saving and investing, um, you know, for, for. Uh, every, every dollar you put into the piggy bank, every, every five bucks you put into your high yield savings account for every time you pick up [00:21:00] a financial literacy book, you know, you, you gift yourself something.
You know, maybe this is like a, like a,
I'm having trouble already coming up with something. Maybe it can be, um, the dessert that you're gonna have anyway for dinner. Right. Make yourself earn it. Right. You can work for it. Right? You say that's boring. Yeah. That's exactly what, what we're looking for. That's exactly what we're looking for. We want to make it boring.
Right? Um, the same thing goes for, for fitness. You know, for every time that you're, you're stretching, you know, then you deserve to zone out. Listen to some music. You deserve to go out for a walk. Um, for every time that you. You know, I'm, I'm spit balling here. I think you guys are a little more creative than me, and especially after I've been looking at, you know, the cameras for, for going on 20 minutes now.
But the gist is find something that [00:22:00] you think is boring that you have to do, but that is boring and make it fun. All right? It could be listening to music while you're doing it, I don't know, but again. I want you to write down three things so you can do to kind of make it fun. All right? All right. Without further ado, I'm gonna sign off, but before I go, I just want to say enjoy doing boring things.
Enjoy doing boring things. Till next time.
