“I think the passion that we have is to be able to help people return as quickly and safely as possible. And in the case of chronic pain, educate them and give them the tools, empower them to get better and give them hope.”

Welcome to the PT Rebels Podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.

Dr. Fick: Welcome back to the podcast everyone. Today I have my good friend, Brad Conder from Focus Physical Therapy in Louisville, Kentucky, and we’re so excited to have you on Brad, and to dive into your practice and learn more about you and what your kind of niches there in Louisville. So tell us a little bit about yourself and your practice.

Brad: I’ve been in practice for seven years. When I started the practice, I did want to do kind of chronic difficult cases. So heavy manual therapy. I’ve had multiple certifications. I love doing dry needling. I do a ton of dry needling. Been doing that for 15 years when I first in the state to do it, just to heavy focus on that type of treatment ’cause of attention. And like I said, I do a lot of chronic pain, so it includes people. I’ve had pain for multiple years. Nerve related cases, difficult cases that are hard to kind of figure out from like a generic point of view. So that’s what I wanted to start my business with. I do a lot of employer based physical therapy as well. People that need to do injury prevention, work comp, trauma cases, those type of things. So that is fantastic.

Dr. Fick: Tell us what drew you to want to serve that niche or market of the chronic pain patients.

Brad: Yeah. Well, partly is because that’s what I was good at. So, you know, everyone has back pain, but I discovered that there’s different types of back pain, right? So you’ve got acute back pain, you’ve got non-complicated back pain, you’ve got complicated back pain. And for me it’s more about, I was really, really good at helping people through the complicated back pains. So a lot of times patients don’t understand what the difference is. And the difference is is like, you know, neural component. So if you have back pain, but also have leg pain or what they call sciatica. So I just happened to be really good at that when I was in school and kind of learning my manual techniques. And so when I opened my business, since I was good at it, I thought that’d be the best way to kind of serve the population because I knew that to find a therapist that was really, really good at doing that. And also just the whole life cycle of the plan of care. So, you know, I find that one of the reasons why people that have a complicated low back pain, for example, or a nerve related case is that they kind of get some relief, but they never really kind of fully return to what they wanna do. That’s ’cause it takes a lot of time and attention to do that. You can’t just come in for a non-complicated case, see somebody for five minutes, not get actual full plan of care. So, as you know, in physical therapy to get the best outcome you have, you have great assessment every single time. Great manual therapy and also great exercise progression. If you don’t have those three components, which we’ve not really given to people in like generic physical therapy or corporate PT ’cause we’re dominating corporate PT, which I used to run clinics for those places and they’re fine. You gotta have a lot of time and attention to do that. And also just to be able to educate the patient on why the life cycle of that plan of care is so long because people don’t understand like, well, I wanna be better in two weeks. That’s not really how it works. You know, there’s a relationship between how long it takes to get better, between how long you’ve had it. And for me, if I’ve seen somebody that’s had sciatica for five years, it’s gonna take 3, 4, 6 months to get better. And it’s a process. Describing that process individually, it takes a lot of time. Sure. And patients typically in my area just never have gotten any time from anybody to learn their individual situation, to learn how to actually get to what they want. And so that’s why I really enjoy it. That’s why I picked that. ’cause I enjoy, I think I’m really good at it and I having a lot of empathy to kind of help them through that. ’cause I’ve actually experienced it myself. I’ve had my own kind of disc problems and nerve problems. I think that really helped me kind go that way too.

I think that, you know, oftentimes as PTs, if we’ve experienced a lot, we’ve seen, we kind of know the empathy part of it, which is the gloom and doom of how that feels. So I was working two jobs when I was working in a corporate. Worked two jobs, a lot of people, a lot of PTs moonlight, right? So I was working in a hospital and I kind of reached out and grabbed a patient went to the ground and I lifted him up ’cause I was freaking out, right? So I lift him up and it kind of just blew out my disc, right? Back pain. Started having pain down my left side of my leg. Numbness, tingling. I was, at the time, I was running a clinic for a corporate PT place in a rural area of Kentucky, like probably about an hour outside of Lexington, Kentucky. And every day I walked into a clinic, bent over, pain down my leg, and just massive pain. But I was by myself too, so I couldn’t really go anywhere. So I would do my treatments with my patients. And I remember that day I had a day one time, I sit in my office and I started crying because I was hurting so bad. And what was weird about that? And as you know, chronic pain. It really changes how your brain processes pain. That’s one. The reason is chronic pain, because the brain centers change as far as the output, and I knew that as a PT I wouldn’t have to have surgery, but I thought I was gonna have to have surgery. I thought at that moment I thought I was gonna have surgery, I was gonna lose my job, I was gonna lose my house. All that as a PT. It was not true. Right. But that was the moment where I was, I knew that I was like. You know, I’m okay. But then when I got over it, that’s what I really dove into as far as like that chronic pain, that patient care. ’cause I just love to kind of help people through that moment. I probably, what I like most about it, not necessarily fixing the problem, but just helping through the mental aspect of like the gloom and doom that you think your life is over and there’s no hope and you’re gonna have to have surgery and you’re gonna, and you hear all these horror stories. For me to be able to tell patients my story and know that I can get over it and show them that I can move, even though my MRI shows I have a herniated disc and I’m pain free to give them hope to actually get to a certain point. That’s what I really love about it.

Dr. Fick: Yeah, I love being able to share those stories with patients because I think it really just helps build the trust and they understand that, you know how that feels. Yeah. And you know, at that moment all the fear that rushed inside of you and how scary that was for you. Yeah. And if you hadn’t experienced that. You probably wouldn’t be able to relate on the same level and you wouldn’t be able to tell your story. And I think that communication, and just that experience that you had to be able to communicate that story to patients is really key. Yeah. And developing just those long-term relationships with clients interest. Right? Yeah. It’s one thing, you know, to give patients our knowledge where if we can put a story behind it, like, Hey, I understand how you feel I went through this. Yeah. You know, from, in my own case, you know, when I was a freshman in college playing basketball, I tore my ACL. So when I have an athlete that has a traumatic injury like that, I can say, I know exactly how you feel right now. Yeah. And that emotional piece is, is sometimes just a lot harder to get through than even the physical pain or surgery. Yeah. So I think when patients have an understanding that we get them or we understand and. We’re very motivated to help them. Also, just based on what we’ve experienced in the past, we know how that feels. Yeah. I think that really helps to create a special bond with us and our clients. It can last, you know, a long time. I know your clients are probably the same as ours. A lot of times when patients come in to see us, their patients for life, yeah. They’re, they send their neighbors and their friends and their grandparents or aunts and uncles. And that’s the type of referrals that we really like because you know, we’re serving the community. Sounds like you really found a niche in your community that you saw a need for. You’ve been able to do just, you know, a lot of service, good service in your community. So that’s really awesome.

Brad: Thank you. Yeah, I think chronic pain, you know, we can talk a little bit more about that, but yeah. You know, chronic pain is, can be difficult to treat and I think I’ve seen a lot of clinicians in practice just either shy away from it or be scared to treat patients with chronic pain. Yeah. Or just not really know how to handle those patients appropriately.

Dr. Fick: So can you tell us some of the strategies that you use with patients who come into your clinic maybe for the first time that have been dealing with chronic pain and yeah, maybe they’ve been to 3, 4, 5, 6, different providers haven’t had an answer and not sure what to do. Like how do you start with those patients?

Brad: Well, the first thing is, is getting ’em to understand that they are chronic pain. I think sometimes that, that word chronic pain, there’s a negative connotation with it. There’s somebody, it’s a drug seeker or trying to get surgery and that’s certainly not really the case. I think the definition, the true definition of it, people in general don’t know what that means. So what it means is you’ve had pain for longer than a month. It’s ongoing. Even if it kind of comes and goes, there’s still technically chronic pain. And the reason that matters is because that’s the reason why you also haven’t gotten better. ’cause a lot of those strategies when they go to your primary care doctor or specialist, or even chiropractor or PTs, not, they’re not bad. It’s just sometimes if they’re, if they got a approach that they can’t give you the time and attention you need to actually discover your particular situation, that’s not going to help a chronic condition. Everybody’s condition is individual as far as why it keeps coming back and forth. And so a lot of my people don’t even know they are chronic pain. They’re just like, I just know I’ve had a problem for a long time and nobody really helps it and they don’t know why. So the first thing I try to do is just educate ’em like you are chronic pain. It just means that you have a problem that no one’s fixed, and you gotta continue to search for the solution that matches what you need. And a lot of times the generic system of the healthcare system is not gonna really give you those answers because they’re not set up for that. To give you time and attention to kind of investigate your particular situation. So the first thing first is I usually do that. I usually get excited when those patients that come in that have tried other things, because I know that the approach that we have as far as being able to give one-on-one care and also give them the time of 30 minutes to an hour of individual care every single time. I just know that aspect, no matter what else we do as far as actual good physical therapy, that aspect is something they’re never not gonna get anywhere else, and it’s actually gonna get ’em over the hump to actually get their goals met, to figure out what’s going on. I actually get an actual diagnosis because that kind of frustrates me too, is PT that. People think, the MRIs are diagnosis. That’s not your diagnosis. Your PT diagnosis is, yes, you have this pathology, but you also have this deficit. You have this range of motion issue. You have this strength issue and no one’s ever told ’em that as well. So I do love that part as far as being able to describe that whole life cycle of what it takes to get better. ’cause they haven’t heard it anywhere else. They’re not going to as well, even if another practitioner knows that process. If they go to a primary care doctor, they have no experience in orthopedics and they’ve got five minutes with you, they’re not gonna be able to explain it to you. And so they’re not gonna get that understanding that there is a solution that’s natural and long lasting.

Dr. Fick: Yeah. Yeah. I think just being able to provide answers to patients who have been in chronic pain and being been in that cycle, perhaps if they have seen multiple providers, I think one of the best gifts we can give our patients beyond, you know, communication is just time. Yeah. You know, I think. There’s very few providers that you can go see now that you can talk to for more than three to five minutes. Yeah. And for someone who has a lot of questions about why they’re hurting, what they need to be doing about it, why these treatments have failed. They just don’t get the time. They get another prescription thrown at ’em or a or a script for imaging or, oh, try this person now. And it’s kind of this, this really, endless cycle where of frustration honestly. And I think we’ve both seen that in the, in the clinic. And think for us, especially with your model care and the kind of the care model that we have, one of the primary goals is to serve patients better in, I. Been a PT now almost 25 years, and I saw the system just repeatedly failing clients. Yeah. And I thought I myself could have got burned out just because I wasn’t able to get patients to the level or give them a level of care based on the insurance model that we’re working in. Yeah. They weren’t getting better at a higher cancellation rate. We had a no show rate. You know, we’d get fussed at like work about, you know, but it was a failed system. Yeah. It wasn’t, it was the system as a whole and so. System is failing for our patients and so. I think the passion that we have is to be able to help people return as quickly and safely as possible. And in the case of chronic pain, educate them and give them the tools and empower them to get better and give them hope. Yeah, a lot of them don’t have hope. And then, you know, that can be a really life changing. If you don’t have hope, you start maybe making decisions that aren’t healthy or maybe even ruins relationships. There’s all types of, downward spirals you can go when you don’t have help. And so I think. One of the things that we really try to do is just restore that hope and that trust. Yeah. And it’s a good feeling. Yeah, it’s a really, really good feeling for sure.

Brad: Yeah. So, and actually that’s why I name my business Focus Physical Therapy. ’cause I went through that corporate world as well. When you do high volume and you’re trying not able to spend time with people. I’ve always kind of told students or other therapists or myself, if I just focus on my patients, that gets me through the hard times. But even when you don’t have time with people, it’s hard to focus on your patients. But that’s one of the reasons why I named it that is ’cause if I’m having a hard time, if I just focus on my patients and their care and what their needs are. I usually feel good about myself and feel good that I can get ’em into a good spot. So I named it that so that way I can remind myself I’m going through a hard time. I like focus on my patient, focus on them, and that gets me through most of what I’m going through.

Dr. Fick: Yeah. All right. So, yeah, and I think again, that’s, that’s very relatable. Yeah. Right? I mean, we all, all of us have stuff that we go through, stuff we have to process through Life’s hard. So if we can give our patients, that piece that they need, and we’re serving them, I think, the gift of service always in turn helps us as well. Yeah. And so I really enjoy that piece of just being able to, to connect and, and serve our patients well. And, that’s something that people don’t forget, especially in a smaller, tight-knit community. That’s something that probably no one else in your community can bring to that level. And so. Kudos to you for that.

Brad: Thank you.

Dr. Fick: So just speaking about your clinic model, are you cash based insurance? Like what does that look like and how does that, best serve your clients?

Brad: I’m mostly cash based, so I started cash based only. I’ve kind of morphed a little bit since I do have so much experience doing manufacturing and industrial medicine. I do some work comp now, luckily, where I’m at as far as I’m on the river. So Louisville’s like right Southern Indiana and Kentucky and the work comp laws are. It’s not too bad for us to be able to get reimbursed enough to do our job. And also there, there’s not a ton of red tape. I was talking to a therapist earlier that, you know, work comp in particular red tape can vary from state to state. Not just how much you get paid, but also just the visits and getting it approved and get people in a door. So it’s a little bit easier. I also do auto cases, which kind of fits into kind of chronic pain model because you know, traumatic in Kentucky auto cases say they pay a hundred percent. So it’s easier to do that. It’s different from state to state. So, yeah, so it’s always been a cash based model since I’ve started. I do half hour visit for hour visits, depending what the patient’s needs are, if we have multiple kind of pathologies that we’re working on. So, yeah.

Dr. Fick: Yeah, that’s, I know for me it was a big transition coming from a insurance based practice to the practice that I have now. And I decided early on, this was in, November of 2017. I actually decided a few months prior to that. You know, we were in a corporate meeting, it was really interesting kinda lunch meeting and the clinic manager was going around the room asking everyone what their productivity per, you know, ratios were. Yeah. And what they were doing for marketing the classic like, you know, corporate meeting. And then, you know, we would get either praised or scolded based on what our productivity numbers were. And then at the end, this clinic manager said, alright, you know, in order to get the productivity numbers up, I’d like for everyone to have either ice or heat and stem at the end of every treatment. Yeah. I just didn’t sit well with me. I thought, you know what? I. I remember those meetings that a little wonder for me and I, I just can’t sit through one more of these meetings. I just can’t do it.

Brad: Well, we did, we didn’t do it. We did modalities, but our corporate meeting was like, everyone has to walk on a treadmill for 15 minutes when they get to the clinic. Right. Just for a, for a unit. Right. Or, or be on a, on a bike. Right. You know, just because, yeah, just because, yeah. Yeah. Just because like, yeah.

Dr. Fick: And so I think, you know, you get. Get to the point where you’re like, you know, I’m either gonna find something else to do, or I have to find a different way to do this. And I’m happy to be a rule breaker, especially when, when things don’t make sense. I thought there’s gotta be a better way. So I just decided to open up a small practice and went mobile first, mobile outpatient practice, and decided I’d be a hundred percent cash. And so many people, you know, that was. What, five, six years ago. But, you know, not that long ago really. But even back then, cash pay practices weren’t as prevalent as they are now. Yeah. So many people tell me, Hey, I’m sorry that you think that’s gonna work. I’m actually really worried for the, for you that you think that would work. And I thought, all right, well you know what? Thankfully my husband had a good job and I thought, well, worst case scenario is I can come back to doing this. I, I think, I’m pretty sure I can get a job doing this, you know, next week. But, you know, it works out. And I think one of the keys of why it works out. When you have the drive and the passion and the also coupled with just knowledge and skills of being able to serve that niche that you’ve kind of identified well and just kind of being relentless in the pursuit of that. And I think the key is just treating people really well. Yeah, definitely. I think you treat people really well. You get results. Best referrals, word of mouth, referrals. And I think, yeah, if you can just rely upon, you know, not only referrals results, but just build that buying trust and connection. That’s a feeling that a lot of people don’t get anywhere else. True. So that’s, I think that’s probably why your clinic’s successful and why what we aim for in our practice as well.

Brad: I think there’s a lot of negative things you look at with our healthcare system. You know, I hate that we kind of loom. Health insurance into our system. I tell patients all the time, healthcare is the relationship between me and my patient. That’s it. Right? That’s healthcare. Everything else may have a label of healthcare, but it’s not. But some positive things that’s come out that changes is that I think that it’s, it’s forcing people to make better decisions, right? To looking at where they’re spending their money. Especially when we offer our, so that’s when Obamacare kinda came into play and that went sky high for a lot of reasons that we don’t wanna get into. On this ’cause it’d be an hour to talk about why that happened. But people started to make better decisions. They’re like, okay, I’m spending a lot of money anywhere. Let’s make sure that we’re got a good, good outcomes. We have a good relationship, and let’s be educated. Consumer of healthcare, which is what I promote a lot of. It’s like, just, I may not be good fit for you. That’s okay. I, I’m, I’m okay with that too. This look at your money. This is what it’s gonna cost. This is where we want to be. This is your goals. Make a good decision. We wanna make sure it’s right. So you’re, if you’re a health-minded person, you wanna make a good decision and we’re a good fit. That’s where we want social positives come out of it. You know, a lot of times people in the news might say it’s negative as far as our healthcare outcomes, but that’s just the news. But there can some be positives too.

Dr. Fick: Absolutely. Absolutely. Yeah. I think as looking back to Obamacare, I think everyone’s pretty concerned about how that would affect our practice. Yeah. I think for the cash model, that really helped us.

Brad: Oh, it helped a ton. Yeah. Helped a ton. It sounds weird, but people don’t, they’re not educated why that happened. Right. You know, I mean, it’s because. I dunno, we don’t wanna get it that it’s in Kentucky was a good example because, okay, if I can get it to it for a little bit, it works for me. So, okay. Obamacare, people don’t really understand when, the only things that really happened is you took, you know, the bare minimum from Medicaid moved it from 30 grand to like 50. Right? In Kentucky in particular, especially in rural areas, you had about 150,000 people in Kentucky that were on Medicaid. Then there’s different points of Medicaid, like Care Source or WellCare or whatever. So you took that, the bare minimum Medicaid and you moved it from there to 50 grand. Right? So you put. Almost, it went from 150 lives in Kentucky on that system to almost 500,000 almost overnight. Wow. Right. And so, and Humana’s actually based in Louisville and so Humana, so to take all these lives in into the system. So we didn’t have, so we had Passport, you had Medicaid, you had WellCare and Care Source. And Care Source is a big one in Kentucky. So if Humana’s gonna take on Care Source, Medicaid, which is a bad payer. Where’s the cost gonna go? So it’s gonna go to the other people that are paying their premiums. That’s why these insurance companies, they had to take on all this load, and so they’re gonna make money. So the way they made money was to jack up, premiums and also increase deductibles. So, and then also decrease reimbursements. But that’s what basically what Obamacare did. So in, in a nutshell, especially in Kentucky, I mean, I was at a clinic that we were about, it was corporate. We all bought out by another corporate place, and then we didn’t take Medicaid at the time, but that county we were in. They had about 15% Medicaid. They went from 15% to 60%. Holy cow. Oh, one in one month, basically. Right. And so they about went out of business because that happened. Most Medicaid recipients or providers that provided it, they weren’t getting paid for almost a year. And so that’s, that’s where, how all that went down, especially in Kentucky. So to your point, because that happened. And it all happened overnight. People didn’t know what to do about deductibles. So if I got people in and I started to have that conversation with them as far as like, your deductible is this, because of that. This is where, how much you’re gonna spend. So I knew all the numbers of how much they would spend on deductibles. It’s much easier decision for them right now. It doesn’t always work still, but at least they were educated on the financials of why it happened and what, how they can choose the best option for them, for their particular case, especially for chronic pain. Even with insurance, you might be limited on your visits. So my chronic pain people, you might come for 10 or 15 visits, but we do maintenance as well, right? To where, okay, now we’re to a certain point, but let’s keep you there and keep you happy and keep you active.

Dr. Fick: Yeah. I think that’s really important for people to understand and they have a better understanding of the trajectory of how this all has happened and evolved. This a constantly changing, evolving process today. Yeah. So I think the key in all of that is for, you know, educating our patients of how they can be better consumers in their healthcare. Yeah. If you had choices where a lot of patients didn’t understand that you, you don’t have to go where your doctor says you don’t have to go down the street to this clinic. You have a choice. Yeah. And we’re one of those choices. And here’s why we think we’re a good choice. Best choice.

Brad: Yeah. Well, thank you for talking with me today. It’s really

Dr. Fick: Thank you too. Great to have you on the podcast and, we look forward to more talks with you and, best of luck in your clinic.