Here’s to the Crazy Ones


The ones who think outside the box.

By Brett Roberts, PT, DPT

The following is an excerpt from a speech delivered at the 2014 Graham Sessions, Salt Lake City, Utah, January 2014.

“Here’s to the crazy ones….because the people who are crazy enough to think they can change the world, are the ones who do.” – Steve Jobs1

Today, many practice owners feel that the large consolidation of health care entities and the ramifications of the Affordable Care Act (ACA) will result in a negative effect for their business. This may indeed be one of the most frightening times our profession has ever faced. Maybe I’m the crazy one, but I believe that we are also heading into the single most exciting growth period our profession has ever or will ever know.

There are three topics I would like to address: 1) whether or not we should strive toward standardization of physical therapy care, 2) divergent reimbursement models, and 3) deficiencies in our education process.

Is the variation that currently exists in physical therapy treatments responsible for holding our profession back? Some in our field feel that we will only experience growth with standardization of treatment models. Conversely, I believe that continuing to overregulate our profession by forcing this issue will not only negatively reflect on our profession’s growth potential, but could ultimately lead to its demise. Will this eventually lead us down the road of Henry Ford, in which we say to our patients, “You can have any color of car you want as long as it’s black?” A simple counter strategy to upset this business model becomes as simple as offering different colors.

The second topic pertains to the creation of divergent reimbursement models. I believe that in the future our profession will have two very distinct business models, with one model being very strategically financially disadvantaged. I like to refer to these models at the Model A and the Tesla Model. Model A will be the current 3rd party payer model. The Tesla Model will be a hybrid model of a brick and mortar cash pay clinic, potentially offering cloud-based care and may or may not accept insurance. Model A is unsustainable due to the significant overhead expenses that are created for both the provider and payer. Financially, the Tesla Model will allow for less expense to the patient and faster, real time access to care. It will offer greater overall profit to the provider due to increased access to patients, less overhead, and greater freedom to create a true patient-centered experience. In short, that will remove the financial access barrier that a 3rd party payer continues to create. We have already seen this philosophical shift in which consumers are willing to pay more for a product or service that was previously relatively inexpensive. Admit it…how many of you expected in 1981 that you would not only be willing to stand in line for a cup of coffee, but that you would be willing to pay $5 for it?

In order to continue our profession’s upward trajectory, I also believe two deficiencies need to be addressed when training our future doctors of physical therapy. First, I believe there needs to be an increased emphasis on fundamental business concepts within our entry-level curriculum. The lack of understanding of what is required to run an efficient and effective practice will and has always held back our profession. We will never be able to take control of our financial future without the most basic understanding of the factors that dictate it. Next, I believe our profession should attempt to identify candidates who excel at using effectual reasoning versus causal reasoning. An effectual reasoner doesn’t start out with concrete goals. Instead, they constantly assess how to use their personal strengths and resources to develop goals on the fly, while creatively reacting to contingencies. In opposition, those who use causal reasoning set a goal and diligently seek the best ways to achieve it. Health care providers tend to utilize causal reasoning…i.e., your shoulder hurts because of the impingement syndrome. Is this the best type of person for an ever-evolving health care market? Is it better to create a solid plan of attack if your target is constantly moving and changing? Effectual reasoning allows one to see and adapt to new emerging opportunities that were initially unknown. Their course of action is determined by the results of each step. If the future of our profession rests in being able to see and adapt to new opportunities as they appear, we need to find DPTs that are effectual reasoners. Failing to meet these demands may relinquish our profession to the ranks of farriers or operators.

In closing, I believe we are standing at the edge of a great growth potential for our profession. However, in order to capitalize on these advantages, our profession needs to identify and cultivate a business savvy therapist who is able to adapt to the ever-evolving health care marketplace, yet never loses focus on the patient.

Brett Roberts, PT, DPT, is the president of Roberts & Associates Physical Therapy, SC, Wisconsin Rapids, Wisconsin. He can be reached at


1. Here’s to the Crazy Ones. Published 1997. Accessed March 2, 2014.

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