Alex and Dana met on LinkedIn, started a podcast, and only met in person in October of 2025. They use their milestone 20th episode to issue an urgent call: 270,000 physical therapists must each become agents of change, starting today. They cover these topics and more:

-The economic reality is unsustainable. Therapists graduate with up to $200K debt (three-quarters of medical school) to earn a $120K salary ceiling. Compare that to nurse practitioners makin $150K with two years of training.

-The fee-for-service model traps therapy professionals. Many now leave between years 3-5, before their investment even pays off. But everything needed to transform exists right now.

-Physical therapists aren't physician extenders—they're doctoring professionals with their own licensed and supportive extenders (PTAs, health coaches, PT aides, etc.). The solution mirrors how surgeons often collaborate with physician associates: PTs should evaluate, plan care, and intervene when expertise is required, while delegating execution to skilled and/or trained team members.

-Time directly providing one-on-one patient care doesn't equal quality.

-High-quality clinicians redirect inappropriate referrals instead of accepting them like "manna from heaven."

-Setting realistic patient expectations based on prognosis and comorbidities IS the professional expertise that defines doctoring professionals. Yet the profession never fully claimed the direct access promise.

-Alex's recent experience with his father's hospitalization exposed for him healthcare's fractured reality: disciplines that don't communicate, 10+ daily errors, and systems where only patients with physician quarterbacks receive optimal care. Despite seamless technology enabling collaboration, hospitals remain unsafe places.

-Fee-for-service creates no incentive for safety or communication—but value-based models like TEAM (hitting 25% of hospitals in January) are shifting the landscape by making hospitals accountable for 30-day spending and outcomes. Therapists--this creates massive opportunity. For example, therapists can help ensure anyone who may be able to return directly home actually CAN go home, and can advocate for that on behalf of patients in collaborating with the multidisciplinary team.

-Complaints aren't actionable—they're just "the what." Action emerges when individuals realize they can move the needle in their own clinical settings, with their own patients, and with their own teams.

-Value-based care is the path to sustainable, higher PT and OT incomes in clinical roles.

-What Alex is excited about for the APTA PPS event this week!

And more!

Join them for Episode 20. Like it? Please give them a thumbs up and subscribe!

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Alex and I recently talked about the physical therapist income floor and ceiling. And in this episode, we talk with Dr. Marc Gruner, who offers a framework for a solution to that seemingly impenetrable ceiling.

Here's the punchline. The income ceiling in PT isn't about reimbursement rates. It's about your practice model.

Dr. Gruner created the RTM codes, which are the first new codes for PT in 20 years. Now we can absolutely make the strong argument that the PT billing codes don't adequately reimburse therapists for the value we create, and that the income ceiling should not be tens of thousands below providers who don't have doctoral degrees as the required minimum educational level.

But in this episode, Dr. Gruner explains why team-based care and value-based arrangements are the only path to sustainable income growth while providing access to care to our communities.

We talk about RTM in this episode, and about how RTM wasn't designed as simply another billing code. It's infrastructure for the glide path to value-based care for physical therapists.

So tune in to hear much more from Dr. Gruner, a true physician champion for the physical therapy profession. Learn how to stop top playing every position and start calling the plays.

RTM Strategic Deep Dive: Subscribe below for the full article on how remote therapeutic monitoring serves as a facilitator for value-based success, and why we make the argument that it is crucial for therapists to think of it that way. When you subscribe, you have access to the full archive of newsletter articles and to exclusive access to a supplemental set of resources that will hit your inbox after you subscribe (for free!).

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Drowning in student debt? Feeling undervalued as a PT? Here's why: You're trapped between an artificial floor and a glass ceiling. The floor? PT school costs more than an MBA at MIT—that's your barrier to entry. The ceiling? The AMA's physician-dominated board literally decides what you're worth. And between those two forces, you're stuck. Today we break down the economic trap keeping PTs fragmented, underpaid, and powerless—and what you can actually do about it. You're not alone, and the problem runs way deeper than you may think.

What You'll Learn:

• Why PTs earn less than other providers for the same skills - Discover how the American Medical Association controls your reimbursement rates
• The hidden economic barriers keeping PTs fragmented - Learn why our 400,000-strong profession has less influence than professionals with a smaller number of providers
• Why your PT school education failed you - The critical finance and regulatory knowledge gaps that leave new grads unprepared (and how to fix them yourself)
• The private practice opportunity - Understanding debt structures, consulting fees, and why smaller clinics actually have MORE freedom to innovate
• Your path out of fee-for-service dependence - Practical strategies for recouping your investment beyond insurance reimbursement
• Why certifications actually DO matter (despite what cynical colleagues say) - How specialization opens doors beyond your clinic job

Our guest today is Jon Lee, PT, DPT, MBA, the co-founder of Pickle, former pro sports PT, and someone who's navigated from clinical practice to Oxford MBA to vaccine development to healthcare tech

It's a conversation about the structural economic problems facing PTs—and actionable knowledge you won't get in school. You will enjoy how the three of us challenge each other throughout this hour-long conversation. We keep it real and it's ultimately optimistic.

This episode is great for new grads struggling with debt, mid-career PTs feeling stuck, clinic owners questioning their business model, and anyone wondering if they made a mistake choosing their healthcare profession.

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