The Cancerous PPS Juxtaposition


The perfect storm of wild destruction and perfect rebuilding.

By Kristen Wilson, PT, DPT

This issue’s theme of work-life balance poses interesting perspectives on managing the challenges that result as a private practice owner who must continually balance the demands of home and work life.

But as members of the Private Practice Section (PPS), we must also balance the demands that participation in our professional organization pose. This article is a transcript of my Graham Session What I Believe speech, which highlights my individual thoughts on managing that balance. For those who are not familiar with the Graham Sessions, the What I Believe speeches are meant to be provocative, even controversial, offering an opportunity for the speaker to convey a personal message relating to perspectives on his or her relationship with physical therapy. With that being said, please understand that the message shared in this article is reflective of my personal perspectives and not meant to offend or influence others.

I believe that being involved in PPS is a cancerous experience.

Yes, you heard me correctly, cancerous. The exact evil malignancy that spreads destruction through the body, breaks down defenses, and forces one to take a hard look at what matters most in one’s life. And while most of you are bristling right now at the mere mention of such an offensive comparison, please indulge me as I highlight how many of you also experience the side effects of PPS affliction in your own life.

I attended my first PPS event in April of 2015 as a member of the pilot program for the Peer2Peer network. Literally 30 minutes before I was to leave for the weekend, I walked into my house and found it flooded under 6 inches of water and concurrently learned that my next door neighbor was housing a sexual predator next to my three young kids. In hysterics, I called my husband who came home from work to help me triage the situation. Knowing that I had been granted the honor of participating in the pilot group, my husband packed me up and pushed me out the door to D.C. While I spent the next three days engaged in scintillating conversation and cocktail parties, he picked up the pieces of our life and restored order to our home. This was my first experience with understanding PPS guilt, the initial symptom that comes from being part of this organization—the guilt of leaving my family, my clinic, my business partner, numerous times throughout the year so that I can participate in events intended to improve my health, the health of my business, my professional career, and my future. I know many of you have experienced this guilt, and understand how detrimental this can be to relationships and psyche. It’s a matter of trying to balance the guilt continually. Guilt from leaving, guilt from having obligations that you inherently enjoy, guilt from having meaningful relationships separate from your home life, and then the guilt of returning home after a PPS experience and not being able to share the events with those you love. How can they understand the meaningful conversations, the comfort of being in a room with people just like me, the fun?—they just weren’t there. Like coping with an illness, PPS is an experience unique to me. After PPS events like annual conference, this guilt manifests itself in what I affectionately call the PPS hangover, the week it takes to recover mentally, physically, and emotionally from being in such a stimulating environment. It’s the recovery period from the intensity of treatment—the rebuilding phase of taking the experience you just had and translating it into real life, with the intent to make you better, healthier. And while it would be manageable if PPS guilt went unnoticed, it doesn’t. Spouses ruffle, kids sense detachment, staff see the change in your demeanor. Many question if it’s for the better because they see the struggle, the guilt, the internal wrestling match. But with time, things return to normal, or so you think until next time.

Guilt isn’t the only form of destruction associated with PPS. Let’s not forget the debauchery. PPS events evoke a YOLO—you only live once—mentality of sleepless nights, endless parties, and an opportunity to, for once, blow off some steam. Throw a bunch of high-energy overachievers who touch people for a living into a room with music, sprinkle in alcohol, and watch the fireworks ignite. Questionable decisions, temptation, and uninhibited behaviors grow as the hours of the night recede. Isn’t this the behavior of one infected with the desire to prove that life is too short to pass up opportunities to truly be alive? And we all justify it by referencing how hard we work, how people just don’t understand our struggles, and how we too deserve a chance to play. And maybe you are in the camp that withdraws from the wild nights, but by mere association, you too have indulged in the opulence of unrestricted pleasure. Nights at the Broadmoor, dinners in Vegas, rented costumes for the sake of playing a role—PPS gives an opportunity to gratify every sense, to feel alive, to embrace YOLO. And at what expense? Business funds pay, but is there a price for possible moral compromise? In a conversation with a dear friend at the culmination of Colorado Springs, it was suggested that maybe as an organization we should take steps to reduce the opulence and debauchery, but can you truly restrict the behaviors of those already infected with the cancer of PPS? I forecast that efforts at restricting behavior will only exacerbate the outcome. So we’re left with quite the conundrum.

And lastly, being in PPS creates an unprecedented sense of self-doubt. Surrounded entirely by successful, driven entrepreneurs, you find yourself constantly reflecting and weighing your own value against your peers. At any PPS happy hour event, you can easily become unraveled in conversation when you realize that the person you’re speaking with is constantly looking over his shoulder to see who else just walked into the room. No matter the size of your practice, the number of years in business, the percent of profit margin you attain, there’s someone sitting next to you whose performance exceeds yours and leaves you wondering how you ever managed to earn a seat at any table. Even the most confident and seasoned of players has moments of doubt, wondering if they’ve done enough, created enough of an impact, made enough of a difference. That doubt eats away at the soul and in the quiet moments at the end of the night continues to whisper in your ear: Is my practice good enough? Am I going to make it in this industry? Am I a good leader? Am I enough?

Is this acceptance of guilt, indulgence, and self-doubt akin to selfishness, the type of selfishness that results in a sense of self-importance? We claim we are needed to make PPS succeed. “Yes, I have to go, I’m on a committee.” “Yes, it’s necessary, I’m part of the pilot group.” “You want me to be successful, right?” How can we justify to ourselves and those we love the necessity of something that quite possibly really isn’t. How do we reconcile this evil destruction spreading wildly through our veins wreaking havoc on our psyches and relationships? As one colleague wondered after Colorado, “I’m not sure PPS is a net positive.” And if we stop our analysis here, most would likely agree it is not.

But I can’t stop here, I won’t. As a lover of the English language I know that in many cases a word can have two meanings, a double entendre. And a quick review of Merriam-Webster reveals that to be the case in this situation.


  1. Malignant destruction that spreads wildly through the body.
  2. A change of position, state or form; unlimited growth that occurs systemically.

And with #2, I begin to understand.

A change of position, state and form, happened to me that day in April of 2015. I left my family and walked into a roomful of strangers. Through gritted teeth and pouring tears I shared my story and let myself feel vulnerable. I let go of my traditionally guarded self and changed. And in that moment of change, I found a support system to help me through my time of destruction. A support system of people like me, who understood me, my struggles. People who know and understand my guilt, my need to blow off steam and indulge. People who struggle daily to balance the challenges of growing a family with running a private practice in an environment of consolidating health care, declining payments, and increased competition. And that group is constantly changing state, continually growing with each PPS encounter. As I meet new faces, I add to my support system. I chose then, and choose now, to surround myself with people who lift me up, improve my outlook, encourage me. Those relationships continually change me and are invaluable; they alone make PPS a net gain. But then a closer look reveals much more.

PPS, like any experience with a life-altering situation, teaches me to prioritize and recognize the greater purpose. It’s easy to get bogged down with the day to day of life, the mundane, the frustrations, the stress. It’s also easy to get wrapped up in focusing on my life and my practice. But knowing that my efforts both in and out of the organization contribute to a greater good for the profession of physical therapy, creates a quieting of that day-to-day noise. We have an obligation in this organization to move the profession forward, to act as leaders who abandon the struggles that detract energy, and instead, shift our focus to ways that we can grow and excel. Think of the positive that could result if we spent less time worrying about whether to call each other “Doctor” or complaining about decreasing reimbursement, and more on reducing the cost of a PT education or preparing our PT colleagues to succeed in business. As active members of PPS, we have a greater purpose. At the sacrifice sometimes of my own well-being, PPS allows me to recognize the priorities in my professional life that are worth investing time. And as a result, this discipline of focus translates into a personal life with solid priorities and foundation.

Finally, how do we leave the definition of cancer without acknowledging unlimited systemic growth? Cancer spreads through the body through the abnormal division of cells, beginning locally, then occurring at rapid rates until you can no longer differentiate between afflicted and unaffected cells. Systemic infiltration. For anyone who has had cancer or who has watched someone battle cancer, you know that when diagnosed, two options remain. To fight and grow, or to succumb. The fear and negativity, the side effects, of any new situation can often be too much to handle. But electing to fight opens opportunities to grow, learn, and experience. People ask me all the time how I find the time to devote to PPS when I’m already spread so thin building a family and a business. But like many of you, I recognize the potential that PPS offers me for growth. I don’t mean growth for my practice, my network, my finances, or my career. I mean an opportunity to grow myself. Annual conference programming, website resources, networking events, all offer opportunities to learn, but growth happens in the quiet conversations in hallways between sessions, during late night dinners over well-planned agendas, through text chains with trusted confidantes. It’s having the confidence to have a colleague challenge you in your Peer2Peer group. It’s standing in front of an intimidating crowd of the brightest minds at the Graham Sessions and spewing emotion. Growth is asking yourself the hard questions, reconciling your guilt, trusting others to help you embrace your vulnerabilities. It’s letting people into your vault and listening to what they have to say whether you want to or not. It’s looking hard in the mirror and learning to love your true self. And the experiences I’ve had in PPS have resulted in unprecedented growth in my short tenure. PPS’s systemic influence on my behavior lifts me up and as a result I am a better mother, wife, friend, PT, and business owner. PPS builds an edifice out of the destruction. It heals. And as a result of the support I have found here, I have the confidence to face my challenges, look inward, take risks, and most importantly, grab my thread, my unique woven pattern, and hold tightly.

So perhaps now you understand the cancerous PPS juxtaposition. The perfect storm of wild destruction and perfect rebuilding. There are some of you who will not relate to this speech. You’ll find it too intense, too self-indulgent, offensive, or too emotional. And others will feel like I’ve articulated your PPS relationship eloquently. Like any disease, every person responds in a unique manner. PPS has created an unsettling destruction in my life, one that if left alone to its defenses, would push me away from wanting to continue to be a part of this great organization. But rather than choose to succumb, I choose to embrace the destruction for the greater inherent benefits, the net positive. Benefits that require effort and work, but nonetheless, tools that give me a greater purpose, solidify my intent, and contribute to my true self. And maybe PPS isn’t your cancer, but undoubtedly there is something in your life that creates the same contradictory sensations I have described. I encourage you to embrace that cancer and explore what it means to you, in both negative and positive ways. Determine your net positive. I’m grateful every day for the journey that PPS contributes to, my journey. And while I’m very aware that it might not be what you believe, I believe I have the PPS cancer. And I’ll fight until someone finds a cure.

Kristen Wilson

Kristen Wilson, PT, DPT, is a PPS member, Impact assistant editor, and owner of Action Potential in Glen Mills, Pennsylvania. She can be reached at

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