In this episode, ADJUSTED welcomes Josh Schuette Director of National Workers Compensation Sales and Account Management at Brooks Rehabilitation. Josh discusses FCEs and balance tests and what role they play in recovery.
Season 4 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Mike Gilmartin, Area Vice President, Sales & Distribution, for Key Risk.
Comments and Feedback? Let us know at: https://www.surveymonkey.com/r/F5GCHWH
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
In this episode, ADJUSTED welcomes Josh Schuette Director of National Workers Compensation Sales and Account Management at Brooks Rehabilitation. Josh discusses FCEs and balance tests and what role they play in recovery.
Season 4 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Mike Gilmartin, Area Vice President, Sales & Distribution, for Key Risk.
Comments and Feedback? Let us know at: https://www.surveymonkey.com/r/F5GCHWH
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
Hello everybody and welcome to adjusted. I'm your host Greg Hamlin coming at you from beautiful Birmingham, Alabama, where the skies are so blue and with Berkley industrial comp, of course. And with me is my co host for today, Mike Gilmartin. Michael, let you introduce yourself.
Mike Gilmartin:Yeah, I'm happy to be back, Greg, this is Mike Gilmartin. I'm coming to you from Greensboro, North Carolina, where it is sunny and 70 degrees can't get much better than that
Greg Hamlin:I know absolutely love this time of the year. man. That's my favorite part about the South is I feel like the fall last for like ever. And coming from Michigan and Indiana. It's like you blink your eyes, the leaves change and then you're fully in the season of the sticks and then snow. So anyhow. Well, we've got our special guest today, Josh Schuette who's the Doctor of Physical Therapy and Director of the National workers compensation sales and account management at Brooks rehab. That's quite the title Josh.
Josh Schuette:Yeah, they keep adding to it every year and I can't fit it on the nametag anymore. It's on audio. But yeah, if you see my nametag, even with size six, five, they can't even fit it anymore. It just makes me feel better about myself. So yes,
Greg Hamlin:well, I just like to say Josh is super Superman. So we'll just call you that. But I've met Josh at the National worker's compensation disability conference in Las Vegas and reconnected at WCI. And I was actually hearing him speak on one of the things he was talking about was functional capacity exams and balanced testing. And that really made a little light bulb go on for me. And I thought, you know, we have not done a topic on functional capacity exams and balance testing. And I felt like this is something that is really important piece to a lot of difficult workers compensation claims. So I wanted to have an expert on to talk to us about that today. So your expert, Josh,
Josh Schuette:I can't wait to tell my mom and dad, they'll be proud.
Greg Hamlin:I can promise that I the one person I know that listens is my mom. And she listens as she's getting ready to go to bed. So I only say I put her to sleep, though. We'll try to try to keep her up.
Josh Schuette:All right, I'll try to liven it up this time for your mom. I'll do it.
Greg Hamlin:Thank you, Josh. So I want to start at the beginning. How did you decide to end up in the medical field? Did you know you wanted to enter into physical therapy as a kid? Or where did your interest start with that?
Josh Schuette:Great question there, Greg. Actually, to be honest, if you'd have told me at 18, I was a physical therapist. Now I never would have believed you because I originally went into school to be a strength conditioning coach for like a football team. And that's what I want to do always lifted weights as I was younger, it was kind of a classic story of like, the scrawny puny kid trying to build himself up. So I got into lifting weights competed in powerlifting I go, I would love to make this a career and had a few friends. He used to do that job as strength conditioning coach, you know, just making athletes bigger, faster, stronger. And then what happened was, all my friends that were in that field and Exercise Science were like, I'm gonna go into PT physical therapy, I said no way, I do not want to do that. And kind of a roundabout kind of like eating, you know, how you get in work comp, where it's not what you choose, but you ultimately kind of fall into it. Long story short, is, I was working with athletes, but at the same time, I had to take a class where I helped that kids with disabilities outside. And I really got into that just trying to make those kids rehab them and just showing the joy and the beauty of how you can be included in different physical activities. And I went back and got a master's in exercise therapy. And the next thing you know, I got accepted into the beginnings of the Ph. D. program in special ed, but I was kind of going broke at that time and go, I did a Google search literally one night and said how do I get into helping kids with disabilities and make money I think was my Google search and physical therapy came up, and I applied that night got accepted the next day, and the rest is history.
Greg Hamlin:That's awesome. That's an awesome story. Josh and I remember and you're gonna have to correct me if I'm wrong on this that your was your father that was a football player. collegiate
Josh Schuette:football player. Yes. Okay. Yes. That's my Indiana University connection. He is first team all American and Indiana. He always points out though, that the team was always one in 10 all four seasons, he was there and then they finally went to the Rose Bowl as the season after he left but he did really well. I don't think it was because of him. But first team all American, very proud of and then play 11 years in the Canadian Football League,
Mike Gilmartin:Yes. Interesting story. I don't know that I ever Googled like, how do I make money in insurance before I chose this profession that's just kind of fell into it. But talk to me a little about Brooks rehab. What do you guys do? What are you focus on, you know, give us give us the lowdown on what you guys do.
Josh Schuette:Yes, Brooks rehab, we actually we hit our 50 year anniversary year ago. But a coincidental Of course, it happened during COVID. So then they had to carry it over and make it a two year celebrations that actually meant something to somebody. But right now we've got a bunch of facilities. When I met Greg, the biggest thing I was actually there to talk about was a rehab hospital. And we have to rehab hospitals. Now located here in Jacksonville, Florida, I can't quite celebrate the weather like you guys, it is muggy and hot, like it is 361 days out of the year. But we make the most of it, we basically see catastrophic workup or any kind of injuries from around the country. So major, multiple trauma, spinal cord injury, brain injury, and PTs, those major injuries patients coming from all over. But we've got to rehab hospitals and it's gonna sound like the song, you know, a partridge in a pear tree when I finish up, but to rehab hospitals, to skilled nursing facilities, and assisted living facility 45 Plus outpatient clinics and a home health division with a bunch of specialty programs. But we basically treat you know the worst of the worst injuries and we try to make those patients those injured workers feel whole again. So I'm very fortunate to have this job and help people out every day.
Mike Gilmartin:It sounds like your Google Search paid off from what you just
Josh Schuette:I definitely got to say I'm blessed. I'm even though I don't work so much with kids anymore. I do see a lot of kids every day in the waiting room. And I make great friends with them. And it's awesome. And actually, I get to take them out running, we got a great organization called angels, angels, where you take kids with disabilities and run them in 5k races here locally, and it's a national organization. So I'm loving it just did it over the weekend actually met some great kids that were able to help out. That's all helped me out.
Greg Hamlin:That's awesome. So Josh, when it comes to physical therapy, you know, I think we all know that sometimes surgery is needed. And sometimes it's not. But in both cases, sometimes we often see physical therapy ordered, he talked a little bit about the role of physical therapy and inter workers recovery, because one of the things I think I've noticed being in insurance for a while on the workers comp side is that I think we all want instant fixes. Like we all want to be able to push a bat and have a surgery get better, and then move on. Like, we're so used to everything being now and fast. Yes, that sometimes this piece, I think it's under emphasize the role of it. And I would love for you to talk about what you've seen and how it how it plays into people's recovery.
Josh Schuette:It's a great stage. You said there, Greg, I totally agree with you in this day and age. It is it is a tougher sell for a lot of people because it's like, hey, we central physical therapy, why isn't my injured worker why or you know, or even the patients and why am I not better now, and it can be one week and you think about the body's recovery? It's the same thing of going to the gym if you haven't worked out in five years. And then within one week, 10 days go on? Why don't I have the body of an Adonis right now. It takes time. I mean, you get out what you put in and it does take time. So in this day and age of instant gratification, it is much tougher. But to go back to your question, physical therapy can be very appropriate for a lot of injuries. I mean, I've been fortunate to help out, you know, I still treat even today, but mostly on the functional capacity evaluation side. But for neurologic injuries, you know, somebody's had a brain injury, spinal cord injury, those patients, those injured workers need that rehab to be able to, you know what you set the stage for earlier the balance to get that balance, right to even get weight bearing, right. If you got somebody that's been bedridden for weeks or months, sometimes they're not just going to get right up and get up and move out the door, it's going to take step by step safely to get there. And then going back to your part about surgeries. If somebody's had shoulder surgery, if we're talking about an orthopedic condition, they need that shoulder rehab a little bit at a time because they can't go from shoulder surgery, that shoulder immobilized for weeks on end, and all of a sudden be like, hey, now you're ready to throw a football. I mean, you look, that's what happens. I always compare Worldcom to just what you see on the athletic field page, you know, athletes get injured, they go to rehab, they are not back out in the field, typically the very next day, sometimes depending on the injury can take a full season before they come back because you want them to come back right?
Mike Gilmartin:You hit on something really interesting there. And I have to admit, my sister is actually a physical therapist and runs a clinic in Maryland, multiple clinics in Maryland, so ever and I talked about this all the time. But, you know, athletes, they do the therapy, it takes them a while to get back and they're kind of the best of the best in terms of just their physical abilities and everything else. You see all the time on work comp, where somebody might go to one or two visits and they come back to the adjuster or whoever they're like I'm in so much pain, it's not working, I feel worse, you know, all that kind of stuff. How do you as a physical therapists kind of combat that? Right? Because it's, in my opinion, it's kind of common sense. You're gonna go you're working on working out an injury and doing movements that are going to push you a little bit but in the end, you're going to actually make a difference and help how do you how do you manage and coach through that so that it's not to your point why just want to fix now I want to fix now, how do you deal with that? Because it is interesting.
Josh Schuette:Great point there, Mike. That's where communication I think that's gonna be the underlying answer for a lot of the things that we'll probably talk about today communication is key, whether it's me talking to you guys or me talking to the injured worker, which is, you know, I mean, all comes back to the injured worker. Without them, we don't have a job. So when that when that injured worker, that patient, you know, for coming in for commercial insurance comes in and speaks with me. I'm very upfront honest, I tell them, hey, I'm gonna tell you some things you probably don't want to hear. Because sometimes they're like, Hey, I thought you're trying to sell me on this, and I go, Well, the one thing I don't want to do is set your expectations where I can't achieve them. If I come in and go, Hey, it's gonna be I tell them upfront, you are not going to walk, you're not going to walk out here without some pain. I just want to lay that on the table, you know, because I mean, the other thing about is people sometimes stop me in the middle of the conversation when we first start, and they go, Josh, should I stop when I'm hurting? And I go, I'd be lying to you, if I told you Yes. And here's the reason why. Because you're like everybody else that's walked in the building here over the last, you know, three months, three years, you're already hurting to some degree. So I said, stop and you're hurting, we'd already be done at this point. So you're already in pain. And now I'm going to take that body that's already that joint or whatever is hurting. And now I'm going to try to take and move it a little bit farther, there's going to be some pain involved with that. So I'm not gonna lie to you, however, we're going to keep you under that injury threshold. So the one thing I always tell them, I'd be lying to you, if I said, there is no extra pain. However, I'm not here to make you injured. Again, I'm not here to reinjure you. So we're here to keep you safe, we're here to build into it. But the other thing I point out, though, is if they do not exercise that body part, like let's just say right now, all they can do is, you know, pick up their cell phone, and that's the heaviest thing they can lift without hurting. If they quit even doing that, imagine what's going to hurt for them, you know, a month from now, even just simply, you know, just, you know, basically even moving their arm without holding anything is going to hurt. So you got to get in and move the body to some degree, or else even those basic movements are going to start hurting. So I'm just upfront honest with them. I'm like, Hey, you're gonna hurt, some will keep you under the injury threshold, but you gotta move or else it's gonna you think you're hurting now, it'll be even worse in the future.
Mike Gilmartin:It all goes back. And Greg and I talked about this on multiple podcast setting expectations, man, it's as simple as that same thing for an adjuster when you first call an injured worker and outlining what they can expect, and when they can expect things to happen. And like, it's just funny to hear. It's the same in every profession, like set expectations, and reasonable expectations. And in general, it's gonna set you up better than then you would have
Josh Schuette:So absolutely, yeah. I mean, it's just like, you gotta set everybody up, are you setting yourself up for failure when it's all said and done. So I've just like, I remember even trying to bring on the same lines of it, my patients family member because they, their family member was debating on coming to the hospital, you know, or having their loved one come to the hospital, injured worker, major injury. And I remember meeting that loved one. And I said, Hey, I want to ask you some questions up front, I started like, asking, like, how long do you think your loved ones is going to be here? How long do you think the rehab process is going to take? She literally stopped me, she goes, What are you doing, I go, Well, I want to figure out your expert, I want to find out your expectation, she goes, this is weird. She goes, I've been to three other hospitals, and everybody immediately tried to sell me on the hospital, didn't even give me a chance to speak, they just kept saying they got the best outcomes, or the best or the best of the best. Now you're, you're almost not selling me on and I go, Well, here's the thing, I gotta follow you and your loved one all the way through this episode of care. If I sit, if I if your expectations, if you're thinking one thing, and I know upfront, I can't meet that, you're gonna be hating me, you know, three weeks from now. So I need to lay all that out on the table, find out what you're looking for. Because if you think your loved one is going to be done in two weeks, with a major brain injury, it's not going to happen. So I want you to know, you're probably gonna be sitting here for maybe two months waiting on that recovery that you're expecting in two weeks. So I'd rather lay that out to you. And it was interesting, after an hour long conversation, she actually said, I appreciate what you said, I actually trust you, because everybody else just kind of gave me a guarantee that my loved one be better in two weeks, and you're actually laying it on the line saying it's not that easy. So coming back to the stages of
Greg Hamlin:recovery. I think that that makes a huge difference. And I agree with both of you that, you know, setting the expectations is so important if you're gonna get cooperation, which is to me really important for recovery. So Josh, when you one of the things that and this was me, maybe admitting confessing here, I hurt my shoulder, it's probably been 18 years now. And my primary care doctor sent me to some physical therapy, and they gave me some therapy and that physical therapy, they sent me home with them. They told me what I supposed to do. And I'm gonna be honest, I wasn't very compliant and doing what needed to get done there. And I think it really did impact my recovery. You know, so I know home exercise is an important component. I guess there's two thoughts that I want you to talk about one, how does it play a role because obviously you have the visits where you're going to the physical therapist and you're being worked with with with a physical therapist or technician of some kind. And then you have the home exercise program, which should be happening on on its own erratically. So two things I guess, talk a little bit about home exercise, and then what are your thoughts on just the general compliancy of home exercise from your experience?
Josh Schuette:No, that's, that's kind of it hits the nail on the head is far as you know, somebody recovering, I appreciate your honesty, I think I've got my own story like that, Greg. So we'll just kind of lay it on the table today as far as our backgrounds, but I'm a big fan from the beginning, you'll even when I tell patients, I'm a big fan of what I call a value added care, and this is across the medical spectrum, what I mean by value added is, if you come in to see me, you better be getting something that you couldn't do for yourself at home. So let's just talk about a home exercise program. There are those people that I meet, and you can tell they're just go getters, you know, they could be that that athlete is trying to get back to, you know, or just that busy mom, busy dad, they got 25 kids at home, you know, I got all this other stuff. Josh, tell me what I need to do. And I will do it. And we'll do a little test around there. And they can do it. Oh, you don't need to come in and see me there. Those other ones, though, that are just, you know, you could tell like, they have never really, and I'm not judging on you, Greg, because I don't even know you that well, buddy. But I'm just saying there are those people that I meet where you're just like, I don't know, if they've ever exercised a day in their life. On their job, For you, for you, buddy, I just met you. But I've already trusted you know, there's people we meet and you do like it during that first initial eval. A lot of it's just that interview where you're just trying to find out what makes somebody tick. And that's the I think the coolest part about my job is find out what makes somebody tick. Certain people, you're like, I meet them, I'm like, do what motivates this person, certain people are motivated by money, certain people are motivated by family, certain people, you know, want to look good in front of others, I mean, you got to find out what makes somebody tick. So when I'm talking to somebody, there are certain ones that it's just like, I can't even tap into it, I just feel like the second they leave me they're gonna go home, and you know, what they're motivated by not hurting at all. So they don't want to push, you know, and I want to say not hurting at all, I'm talking even emotional pain, or any kind of psychological pain. So they're the kind of people that are gonna, you know, just totally just go into their cocoon, if they have a problem with their kid, they're not going to confront the kid because they're like, do that's gonna cause like a shift here, it's gonna cause me some psychological, some emotional pain today, I'd rather forego that, and just totally avoid the conversation. And I'll just go lay on the couch, play video games and drink beer tonight, I've had patients literally say that I play video games to escape. You know, I don't want to do the chores, I don't want to take care of my kids, I want to avoid all that. So that person there for value added i the value added might be making them come in and see me so I can make sure they're actually doing it. So the good part is these days, I know there's some technology out there. I know talk to you some of your team, Greg about some of the technology out there that can actually monitor patient compliance when they're not in the clinic, which I think is key because again, for value added, should somebody come in and see me if they can do it all on their own. No, but if again, they're just not motivated at all. But the cool part with the new technologies, least we can track them track that compliance. So that kind of comes in, you know, to the one part there as far as just kind of making sure that the patient's actually compliant. But as far as value added, if there's another reason for a patient, come and see me, Mike, I might go back to like we're talking about surgery. After that shoulder surgery, the only way to really get that injured worker and that patient moving again, is they have to do what's called passive range of motion, which means somebody else a skilled therapist actually has to move that on for the patient. This can't be you know, addition off to the family member, the workers themselves can't be doing it. So that is value added. But once they get past that stage, if they're independent, let them go home and do it if they're motivated. But otherwise, if they're not, they might have to come in and see me. So I'm a big fan of value added.
Mike Gilmartin:So what I guess my big question is, I agree with Greg a little bit, you see a lot of people who, you know, it's the doctor should fix it for me or the PT should fix it for me, why do I have to do stuff on my own? And I guess I mean, I agree with you, those people, you probably want to see them more often. But if you're doing everything you can do as the PT and you're working them out as best you can. And they're still not doing what they need to do at home. How do you I mean is can you then make up for that like in the office? Or is that going to? I guess you see it all the time where people are like, Oh, I'm not getting any better. And the PT will write in there. Well, you're not. You're not doing your home exercise program. You're not doing the things that your point continue to get the motion better and continue to get you feeling better. How do you deal with that? I mean,
Josh Schuette:and first of all to go on record, I heard you say you agree with Greg. So I don't know how often that happens, but we just want that right now.
Mike Gilmartin:Is very rare. Okay.
Josh Schuette:I'm defending you, brother. I gotcha. So anyway, that's Indiana, right there. So to go back to that, the one thing, Mike, that's a great point there. And, you know, coming back to that is I always come back to the time equation. And again, I'm just kind of a basic guy come like I said, I like to find out what makes people tick. And another one of my concepts as value added that always go by another concept is the time factor. And that is this. I tell people let's just say you come for a typical physical therapy prescription three times a week, you know, for an hour each each time. So what does that that's three hours total. Look at how many hours we have in a day. 24 hours in the day times seven days. Week. So we're talking over 100 hours. It doesn't. I mean, it doesn't matter what I do in that three hours, it does some to some degree. But if somebody does everything wrong for those other 23 hours in the day, and then other day of the week, it's totally going to undo that. So the patient, the injured worker does have to be compliant. And I was looking at it, they got to start, you got to take care of your body throughout the day anyway, even when you're sleeping, if somebody you know, wakes up and their arms up by their head, you know, after the shoulder surgery, I mean, eight hours on a painful, you know, in a painful position could totally undo whatever I did for an hour that day, eight hours is going to trump one hour any day of the week. So there does have to be some degree. And that's where again, it comes down to communication part and I'll sometimes laid out with the patient, I'm like, I'll literally do that math equation ago. How many how many hours a week Messina three hours, I can try to do everything I will give you all I got for those three hours, I can assure you that that's all I can guarantee. I'll give you all I got for those three hours, call me after hour if you have any questions, but those three you got my time. But look at what if what if you go home, you do everything wrong, the next 23 hours is that one hour, we're going to trump the other 23. And it's not. And when people get that, then I'm like, that's why you got to take care of yourself. You got to I mean, that's why I'm a big fan of a lot of these athletes that are getting older and really taking care of themselves. They realize I mean, look at Tom Brady, you've got to do whether you like him or not. The guy is doing activities outside of the typical realm that he gets just in coaching. He's doing the nutrition, he's doing the sleep. I mean, you never heard athletes talking about sleep 10 years ago, but they realize you got to give all you got for all 24 hours. So you're never going to truly, truly tap the potential that you got.
Greg Hamlin:Great. Great points. Josh. Well, one of the things that you talked about this a little bit, we I know, we've all seen it that's been handling workers compensation injuries is that as you have injured workers that they're in physical therapy a long time, like they've maybe they've either had surgery, or they haven't. And you've already had 36 visits to physical therapy, and now they're recommending 48. And then the 48 get approved, and now they want another 12. And so at a certain point, you're wondering like, Okay, well is a different surgery needed, we're not really seeing gains anymore. Talk a little bit about functional capacity plans and where they fit in the recovery of an injured worker to maybe help diagnose or from a diagnostic standpoint, look at where this patient's at. Because I think that's some of the things that we struggle with. Obviously, our goal is to get people back to work and back to life. And we want that for them. And sometimes there can be psychosocial components that maybe are layered in there, there can be actual misdiagnosis where maybe they need a repeat surgery, or there's something else wrong in this. There's so many different things and figuring that out is sometimes the challenge of trying to help somebody recover. So where does that functional capacity exam sit in? In and all
Josh Schuette:that? Great question. As far as that I mean, I know there's going to be kind of a spectrum there as far as an ideal time. But the one thing, one of the statements he made earlier, one of the words was diagnostic, you know diagnostic diagnosis, the one thing I'll tell you as an MC is not is not to buy the true definition diagnostic as far as an actual physical diagnosis. And that's something else I communicate to the patient up front because they're an injured worker, because a lot of times the injured worker will come in and be like, I've been to three different specialists, five different physical therapists, nobody's telling me what's causing my pain. So I expect you to tell me today and I go, Oh, we're gonna lay this on the table, too. This is not diagnostic in nature. This is not me finishing this test and going, You know what, somebody missed that road, or the slap lesion you got on your shoulder or that torn meniscus, you got an unique, this is not what the test about, it's more diagnostic in the fact of where is that injured worker right now as far as functioning, so it's more diagnostic in terms of functioning. But it can also give some insight in terms of consistency and inconsistency brought forth by the patient or injured worker. And what I mean by that is classic example is an injured worker comes in. And you know, I'm like, Hey, can you bend over for me, and I'm using a bunch of diagnostic tools inclinometers goniometers, I'm trying to measure it to the exact degree because I want to be objective with everything I do. And I'll get some injured workers maybe give me like 20 degrees, which means all they can do is barely touch their thighs, that's as far as they can bend forward. And all of a sudden, we'll finish up the exam. And they'll go out in the waiting room, and they'll talk to somebody else that's coming to pick them up and they'll have a bag on the ground, they will bend all the way over and pick up that bag. So 90 degrees of flexion. They went from 28 120 degrees when I asked him give it all to God, and all of a sudden they're picking up a bag and 90 degrees and they head out. That's an inconsistency. I asked them to give them all like give me all the code when they're back in the room. And now I didn't even say give me all your code when you're on the waiting room and they can you know, triple the range of motion. So it's di it's also helps out as far as online. What are inconsistencies. Now, here's another part about it, though, Greg is I'm not dying. I mean, again, I'm not a psychologist. I'm also not diagnosing why those inconsistencies happen, because sometimes I get I used to get an angry case, man During which were always good friends outside, but she would definitely get angry with me one of those ones I've been doing it for 35 years, you know, that feeling started yelling at me and she goes, How come you never put it? You know, I she has some definitely some great language there. Regarding my anatomy, why don't you have to put your nickel down and say that the pay, you know, the injured worker is Mullingar. And I told her I said do you want me to make this paper this this 20 page report null and void right now. I can right there in Mullingar. And it just made it null and void. Why is that? Because the Mullingar is actually a psychological diagnosis, not me as a physical therapy died, you know, diagnosing that injured worker, because I'm just saying that the patient is inconsistent. The part about malingering is implying intent. I don't know what the intent is why the injured worker was inconsistent. I mean, I had a guy the other day I said walk his past you can 400 yards it took him over two minutes. And this is at the beginning of the exam when he claimed his pain levels lower. At the end of the exam. He claimed his pain levels through the roof and I said, Hey, man test is over, you're free to go. And I had my stopwatch. And then I watched him go all the way out to his vehicle. He could walk 100 yards faster walking out to his car than he did earlier in the test when I said walk as fast as he can. That's an inconsistency. Now I don't know why he walked out to the car because I mean for malingering he literally after Hey, why do you walk faster and him yell back to me? Oh, it's because I want to get a better claim because I want to make more money. That's what I'm thinking out. No, Pete, no injured worker is going to tell me that. So all I can basically do, there's two main things I'm diagnosing as far as their physical functioning, where they're at right now and the overall scheme of things. And I'm also stating if there's consistencies or inconsistencies, that's where if there are inconsistencies, we probably you know, some patient Greg has gone on and received at physical therapy visits, it's probably more involved at that point, you might need to unless you know some other specialists, you know, if you want to find out in 10, you might need to get psychology involved. You know, not everybody's always into that. But you really want to get a few other people involved to really diagnose that because I tell everybody, something's going on a year, it's probably not going to be solved in a day, you probably need a couple people to really look into this if you really want to get a good benefit out of this.
Greg Hamlin:Great points. And I'm glad that you you corrected me on the diagnosis piece, because that's important. But the I guess the other thing, maybe for people who don't know what a functional capacity exam is, what are the what are the kinds of tests that you're doing in a functional capacity exam? What's all involved? How long does it take, from beginning to end just to give people a general idea of what that is?
Josh Schuette:Not to go back to it? Yeah, functional path evaluation. It's a detailed, objective physical measure, and I tell the injured worker, the patient, I'm here to see today, what your maximum safe physical abilities are on this given day. So I also emphasize on a given day, this is not dying, you know, it's not prognosticating, either. I mean, people are like, you think this is where I'm going to be two years from now, I don't know. You know, I don't have a crystal ball for that. But on this given day, the exam itself, one on one typically lasts me four to five hours one on one with the patient. That's not including the final write up. The exam literally starts the tech and I see that injured worker, if I see them out in the parking lot, the test starts then if I see them, when they first come in the waiting room, that assessment starts then. Because if the question that, you know, I'm asked is, How long can the patient sit for stand for? And it's amazing how often I'll see an injured worker out there in the waiting room sitting for 3040 minutes filling out their paperwork, no shifting, no signs of pain, but the second I bring them back to hang out with me. They're shifting within the first minute going, do I have to sit here all day you're killing my back. But yet I saw him out there no problem. So the test starts the second I see him the test ends the second they finally get in that vehicle. And the last second I see them because again, a lot of the stuff I can see out and out in the parking lot is very, you know, diagnostic in terms of how they're functioning in nature too. But basically, what I'm here to look at is any kind of physical functioning. So I know in the state of Florida we have a sheet that DWT 25, foreign division and workout form. It says sitting standing, walking, lifting, carrying, pushing, pulling, bending, squatting, kneeling, reaching, grasping, I got to look at all those different physical, physical functions. And then what is that injured worker? What does that patient capable of doing? You know, across the spectrum? So how much can they live? How often that's what I'm here to see.
Mike Gilmartin:I did not realize that take that long. I assume that was like 30 minutes you come in, you do a couple of tests and you move on. But
Josh Schuette:no, that's a great point, like and the reason why it takes so long, I always tell people, you can see. I mean, I've seen a lot of injured workers, you know, and again, I'm looking at consistency across hours. And I get some people that can come in and they can, you know, shift around the whole time for the first half hour hour. But it's amazing, like three hours into it four hours into it, that's when I can really see, you know, because that's when the person starts fatiguing a little bit and kind of gives up you know, any kind of maybe pretense they had before I can actually see what they're capable of at that point. But the other thing about is to my is there are so many different functions I got to look at And they're asking me, how can you do over an eight hour days. So that's why it takes so long. So yeah, four to five hours one on one, the write up usually takes another couple hours. So it's almost a whole day thing. But the absolute record, for the longest SC I've ever done not including the write up was 10 and a half hours, that was the most extreme one that did not include lunch that was straight, Lord. Oh, Mike, Mike, do you know, you know how I knew it was gonna be extreme one. I went to market one day, and I don't do a lot of marketing, because now it's just like, people are used to me, they're like, Hey, we got an injured worker, we'll send them to you. But I remember one time is Brooks says, Hey, we're doing this big thing at a local Orthopedic Group. we'd love if you're there. I said, Sure. I show up. Now, most of the time, you're going to market to somebody they're not like, Oh, love to see you. They're just like, What do you have to offer? Get out of here, give me your food. I didn't know that kind of thing. But that one there. I remember that day I walked in, everybody was welcomed me with open arms. They're like, Oh, my God, you're here, you're gonna be seeing Mr. So and so. And I'm like, what? And I'm like, you're seeing it for an FC. Right. And I go, Yeah, I'm seeing them next week. Oh, my God. And then they go grab people from the back office. And everybody's like, almost like huddled around me. And I go, what's going on here, and they go, we've been dealing with this guy for a year. And he uses up a lot of our resources, we've actually had security escort him out twice in the last two visits. If you do this test, we won't see him anymore. So you're like a hero to us. And I go in, and I go, guys, please don't tell me anymore. You know, I don't want to be bias going in. But they didn't give me one piece of advice, which is this, which I really appreciate. They go, Josh, if you were planning on seeing anybody else during that day, cancel it. You're gonna be there all day, because this guy is gonna He's gonna give it to you. And sure enough, 10 and a half hours later, I finished and he kept calling me for the next three days wanting to make it let go even longer. And I'm like, the test is over. Brother. We are.
Mike Gilmartin:Yeah, the write up was like at least another four hours. So it was like, I mean, we're talking like a 14 half hour day. I was like, I'm done. So when he kept trying to tell me other stuff was like, brother the reports in I'm done. I can't do anymore. It's me with Superman energy. I'm tapped.
Greg Hamlin:I'm done. You push me right over? Yeah. Well, one of the things you mentioned when I was at WCI. At the conference, you talked about balance testing. And this is something I've never really heard of, and wasn't very familiar with. So I wanted you to talk a little bit more about what that involves, when to do it. When when maybe we should ask for that. Yes. And who's qualified to do it?
Josh Schuette:Not great point. And this is something I've actually Greg uncovered more and more. This is probably the last few years, and it kind of became out of necessity. With functional capacity evaluation. I'm kind of writing a fine line here, because I'm still a physical therapist through and through. I'm here about patient safety. FCS function past evaluations are great for like orthopedic injuries, maybe. And some neurological just depends. But if somebody's sending me a patient, an injured worker with a question his balance, I don't typically like to, you know, see that injured worker until the balance part is corrected. And the reason for it is this, an injured worker comes in. And let's just say the question is Josh, I want to know how consistent or inconsistent is with his balance. So patient maybe comes in a wheelchair? And you know, and I'm like, okay, so if the patient stands up, the injured worker stands up. And let's just say, I want to, if I get if I keep my hands on him, that's not very concise, I will be able to tell how consistent I am, right? Because a lot of times you can put your hands on somebody, they might just go and drop for you right there, right? Because they feel like, Hey, he's got a hold of me, I'm going to drop. So that kind of goes against the nature of being a physical therapist, I should be safety number one. But now all of a sudden, I'm standing back trying to see what can they do? What can they do? If this patient literally just goes, Hey, you know what, this guy standing back from me, I just want to drop right now just for the heck of it. What can I document at that point, I'm filling out an accident report. I don't know if it was consistent or inconsistent. So I used to tell people, I'm like, please don't send me any more of those patients until you can kind of uncover what is the underlying cause of the bounce? Is it consistent or inconsistent? So of course, good point, people throw it back on me and go, Well, Josh, do you know a test that can actually test that. And what we found is there's a machine called the neural calm balance Master, we got a couple of them here, some of our facilities, not in every facility, it's pretty specific piece of equipment. But just real basic, it's an actual, you kind of step in on these platforms. And they're moving platforms. So it actually measures, you know, their ForcePlates that the patient is standing on. And then it's got like a TV monitor in front of them. And it's got they're kind of boxed in three ways. The only part that's open is behind them. And they're harnessed in to the patient is harnessed. So if they follow it all they're caught right away. But what it does is it actually has some built in consistency measures in that test. So Mike, for instance, I know Greg hurt like when I was given the one part of the speech but Mike, for instance, one of the things we do is when the patient is standing on the ForcePlates initially and we're just hooking them up to the harness, we're actually testing that patient at that point. So because they're already on the ForcePlates we can tell if they're losing their balance or anything. All we're doing is hooking up You know, the harness is at that point, the first test of consistency or inconsistency is the second we say this, sir, ma'am, the test is starting right now. And what you see sometimes is the second we say the test is starting, the patient will literally fall right there. Because all of a sudden, they go, okay, the test is starting. And now it's time for me to fall. But keep in mind for the last minute or two, they were standing on those floors, plates, no signs of imbalance. So again, that's one of the signs of inconsistency built in another test is, as the test gets more challenging, I mean, it's pretty cool. The force plates move underneath the patient as it gets tougher. The holes, you know, basically, the whole platform moves around them. So they're getting, I mean, because your balance comes from three main areas, your body, your eyes, I mean, all you got to do is basically not recommend you guys stand that feel off balance right now. But if you stand there, close your eyes, do you feel a little shift? Yeah, you're relying on your eyesight comes from your inner ears, because you hear about people with an inner ear infection if you guys ever had when you feel off balance, or that and it also comes from your feet, that somatosensory, they call it there's a bottom and deep. So this balance master looks at all three individually. But to test that it maxes out what that patient has to do. So it actually shifts underneath them and moves everything around the vision screwed up. And what you'll see sometimes is a patient that was falling before, when the test was easier, because they're like, Oh, this is easy. The only thing that's happening is the box is moving, I'll just drop right now, all of a sudden, you'll see their balance improve when everything's moving, because now they're legitimately in fear of falling at this point. So they'll actually get better balance as the test gets more difficult, which again, should never happen. If you had problems balancing, then you should have had problems balancing before you should not be terrible, the beginning. And all of a sudden, as we increase that degree of difficulty, you get better. So again, that's another sign of that inconsistency. So I'm a big fan. So you go back to your question, Greg is like when to do it, and everything. I'll be honest with you, if you got a patient with balanced issues, and let's just say you get through, I don't know, 2030 visits, and it comes down to that question up, you know, and you actually have good communication with the therapist, and you ask him that question, what's going on here? Is the patient getting better? You know, Are they consistent? And if they're like, I talked to one of our therapists, the other asked him that to those two questions with a balanced patient, I go, is he getting better objectively? And second of all, do you feel he's consistent objectively? And the answer, I got to both those were, you never want to hear this, when somebody starts off is well, and I'm like, Oh, my God, I'm like, yes or no, yes or no. And then they're like, well, and I'm like, Okay, if you get that kind of answer, that probably a good time to do that balance master assessment. That's why I recommend it to them. Because the cool part about it is, it's safe. It doesn't even cost that much. It's just like a regular PT eval. I mean, it's just like you barely I mean, it's not sad, I'm seeing so many for like, again, 510 hours at a time. So that's obviously going to cost a little bit more, because we're seeing them longer. But that balance master can be done in 30 minutes, it's just part of the regular PT part. So if if a clinic has access to the balance Master, I would suggest doing it right, then, because at least that way, you'll get some kind of context and some kind of idea in regards to the consistency or inconsistency, at least you can help build, because it's not only consistent or inconsistent. It's also can we use this to help treatment going forward? So what is actually going on? Can we actually treat that? And what can we do from here on out?
Greg Hamlin:I mean, I, I'm fascinated by the whole thing. And I, you know, wondering, you know, how you even go about making a referral for that, just because it means it's something that most physical therapists would have, if we were looking at major physical therapy network,
Josh Schuette:I would say, because a lot of clinics now, or at least, like physical therapy, kind of networks are big, physical therapy settings, there's ones that are just pure orthopedic, you know, they're like they're doing your total knees, your shoulder problems, your knee surgeries, elbows, wrists, but then this is more of a neurologic, you know, machine. So obviously cost more, you know, so typically, I would look, if you have one of those big physical therapy settings or, or networks that you're using, find out if they actually have one, I would just ask ahead of time there. I mean, because like I said, it's a good, it doesn't always get used. So it's, it's good there for to help out for diagnosis purposes, and then also treatment purposes in the future, too. So I would just ask, I can send it to you guys, but leave it the company's name. It's neuro calm. It's a neuro calm balance master. And we're actually just to jump into it. That's the one thing about it is that's more for static balancing. But there's static balancing, trying to stay balanced in one position. There's also dynamic balancing, which is trying to keep your balance on the move. And the cool part is with technology. Now, there's actually some treadmills out there that are actually we're looking to see if they can do the same thing with the dynamic balancing somebody walking, and see if there's consistency or inconsistency the same way we do with the balance master when they're staying in one spot. So hopefully, it's something we can report back to you in the future because we're looking to see if we can get one of those treadmills to actually start looking at consistencies.
Greg Hamlin:And then as far as the functional capacity exam goes, is it you know, we talked about balance testing and SCE is this on thing that standardized meaning like is there one, tight the when you do a functional capacity exam, you're gonna get the same sort of thing, no matter where you go? Or is this something that can be very, very from facility to
Josh Schuette:facility. It can vary facility facility and I found this out just even from my referral sources because a lot of them just come back and ask for me because they'll be like I went somewhere else. They didn't do this, they didn't do that. I remember I've done a couple of theirs. I teach the course actually gotta go teach the course one of the universities later today on FCS, but I lay it out there, I'm like, it's still kind of a young science, I believe it started in the early 80s. But they're still trying to look for a gold standard. As far as FCS, if you type in kind of like my earlier Google search there, Mike was trying to type in how to make money, I think I actually went the opposite extreme, because I was buying it for a company where I was like, evidence based FC testing that cost less or something like that. So I went the other extreme, though, because I had to look out for our budget. And I still think I got 30 Different software companies or training companies out there that do FC training. And as we know, with marketing, does any of them say we got the fifth best results or the 18th? Best, you know, it's they're all the best, they're all the gold standard, right? Even though there is no gold standard, I got 30 Different gold standards out there. Because some doctor recommended it, it's all the best. So with that said, what I usually tell people is a couple things to look for, for an FC. You know, these are just some basic questions. Number one, how long has the FC evaluator been doing it, because it ultimately comes down to not only the technology, but the evaluator is somebody who's only been doing I mean, everybody's got to, you know, learn the hard way. And I'm not saying there's anything wrong with somebody who's only been doing a couple of months. But however, if you're looking for somebody to really get that that challenging patient case where nobody knows what's going on, I'd recommend somebody's been doing it a while, because you ultimately want what's called a thinking evaluator. They're not just relying on the data, but they're also relying on thinking it through looking at what they see, because there's so many different things to take into account here. So somebody that's done multiple trainings to, they just didn't go to one of those 30. But they actually probably did a few different trainings to learn kind of what's best for each one. Because if you see, a good training course, will say, Hey, we're not the end all be all, I'd recommend also going to so and so and so and so, and learning from them and combining these techniques. So overall, the other thing I'd say is time to because Mike to go back to it, there are people out there because I know there's certain ones, it's just a diagnostic code form. So they will literally bill like they're doing the full FC. And they're only spending 45 minutes because I've had to do a lot of reduce for people around my area. And I'll see the injured worker, I'm like you had one of these before. And there'll be like, my interview takes longer than their whole eval. Like you spent an hour and a half talking to me. My last eval only lasted 45 minutes. And I'm like, Whoa. So I mean, I would say time experience with the evaluator their training would be, you know, a lot of things coming into play there.
Greg Hamlin:Great points. Great points. So as we kind of wrap things up, you know, looking at one of the one of the questions, and I feel like there's often confusion about this is the difference between work hardening and work conditioning. And I'm not sure that I can even today, in this moment tell you this difference by
Mike Gilmartin:Greg, can you tell us the difference?
Greg Hamlin:I want to ask this question. So it's been explained to me before, I know there's a difference. But I don't want to lead us down the wrong path, Josh. So I'm hoping you can help tell us the difference between these two things.
Josh Schuette:And I'm hoping I'm given the right answer. Maybe somebody who call you know, you're like, send us an update after I'm done. We like that, dude. Josh is way off. But I did go to the American Physical Therapy Association website. And what's interesting is I know in the state of Florida, I know when we're billing, it's nicely the same billing code for work conditioning and work hardening, which also makes things a little bit more nebulous, a little bit more confusing. But the definition of work conditioning, you're almost looking for, you're looking for the similar outcome, right? You're looking to I always tell people get general physical therapy, got general occupational therapy, you know, getting it, you know, one hour a day three to, you know, three times a week, I look at work conditioning, work hardening is like therapy on steroids. You're now seeing that patient every day for multiple hours per day, because it because again, it goes back to the time equation I was talking about earlier, it's very difficult for us to extrapolate, oh, man, I got this patient who's supposed to be a railway worker, you know, he's got to lift the trim train knuckle that weighs 83 pounds. I got this, you know, any kind of hard labor job where somebody needs to be able to do a very heavy physical demand level, it's very tough to extrapolate. And that one hour a day, three days a week after they come off and shoulder surgery to go, Hey, I think this guy's ready to go back to work full duty. How would you know? I mean, they may do really well. Going back to your point there, Mike about, you know, the shorter exam, they do really well like kind of like a highlight reel for that first hour, but who knows that they start really just kind of their endurance is weak, and they just really look bad for hours into it. So we're conditioning when I looked it up in the American Physical Therapy Association. It's basically first of all, it's one discipline. So It's usually just like physical therapy. And it's four hours and go for four hours a day, up to five days a week, still working on work related activities, trying to get that injured worker back to their job. Now work hardening can go up five days a week, and go up to eight hours a day. Okay. And typically, it's more than one discipline in nature, which means, you know, they're getting physical therapy and occupational therapy. But I remember with one of the programs, they used to have it be physical therapy, and they also get psychology to it, because the question was like, things about fear avoidance, and trying to get that, you know, that injured worker over the psycho psychological part over that hump of, hey, you're gonna have to lift more, you're gonna have to get used to this, we got to talk you through it, you know, so a lot of us fear avoidance. So typically, the main difference is, from what I've seen, the max time per day goes longer with work hardening versus work, conditioning, and then also, it's usually multidisciplinary in nature. So more than just PT, they're also getting another discipline.
Greg Hamlin:Perfect. Perfect. I'm gonna whenever I have this question, I'm gonna come back and I'm gonna listen to this little segment right here.
Josh Schuette:I just don't nobody shoots me down there for you, Greg. I feel bad. Like, Wow, that guy was way off. So like, find a new guy to interview next Monday.
Greg Hamlin:Great. Well, one of the things I'm doing this season as I wrap up, this year is the year last year we talked about people's happiest moments. In this this season, I wanted to focus on what's your favorite part of what you do every day, like what? Obviously there's large parts of people's days that can can you know, they have to happen, but they might not be the moment. So what gets you up in the morning with what you do every day, Josh?
Josh Schuette:Not love it. And I hope you guys don't mind, I want to hear a little bit from you, too, to get me fired up for the day. But I'll go and start here. But the biggest thing for me is I get to do a couple different things with my job, I get to sometimes treated Functional Capacity Evaluations as physical therapist, I do the sales role, which you know, again, helping injured workers come in. And then also I also get help out program development, creating new programs. But then I also get to help out sometimes a case management as an injured worker goes through different settings, I sometimes help out with the touch points, they're getting set up from inpatient to another clinic. So maybe setting up where conditioning saw actually is this one that has everything involved. So my happy moment, generally is this to be able to see an injured worker that I mean, sometimes could literally be on death's door when I first get the call. And we you know, we're not even sure if we get in the hospital because we're not even sure if that injured worker is going to live. But they stabilize, we get them into our hospital. And then seeing them six months a year later, I do the FC on them, and they return to work. And that is probably the thing because it's like that's why we do what we do. So real quick one, if you guys don't mind, just for about one minute here. One time, I did get a call. I was doing an FC on another injured worker at another clinic and they call me and they go we got a guy. He literally had like a tree fall on, we're not even sure if he's gonna live. I mean, this is how bad it was. And they go, if you bring them in, do you think you could handle this, I make a bunch of calls, go back and see my injured worker here. About a week later, we bring them in, and he finishes up. And it's three months of intensive rehab this guy's got to get but by the time he after the Tree Fallen on, everything's kind of shattered for him to get up and move again. This guy was so the endurance just wasn't there. So you start off a basic therapy, and he's having trouble with that. And then they go Josh, can you train us at this other clinic how to do work conditioning, so I showed him how to do work conditioning. And I kind of forgot about things. But then about three months after we started the word conditioning, or probably you know, two months they go, Josh, can you see him for his FC? And I'm like, Alright, I didn't know what to expect. I hadn't seen him in months. I think it was basically six, seven months to the day from the time I got that call to do in the SEC, the guy did the FCC and he actually aced it, he could return to full duty work. So I mean, it was amazing. And I told him that I said, I you know, because I'm pretty much just tucked away I talk I was like Brother, you know, because I'm here I'm sounding like Hulk Hogan only brother. I can't believe how well you did man. I was like, I remember you barely live seven months ago talking to your wife and family and we weren't sure if you're gonna make it. And you just did everything to return the word. This is amazing. He goes yeah, man. I was like he goes it's kind of sent him with me too. So I think that is like one of the highlights. It's like why we do what we do. Because to be able to see that that comeback that epic comeback? I mean that's what we're all here for. Right? It's like, that's what you want to see. That's what gets you up in the morning. That's why I feel like WWE wrestling right to throw my laptop off here. But anyone here make finished guys. So that one and I had another guy recently who I saw for his FC non it's actually a couple years ago, software's FC, but he decided to switch careers. And he got so inspired by the therapy got he's actually he I mean talking about a leap of faith. He didn't have the money didn't have the resources because he hadn't settled yet. He put everything on his credit card and had to actually even take food from his food bank at his church. He is now a therapist with us. He's totally switched careers and he's now helping out other people started working with us two months ago, so that's why I do what I do is awesome comebacks like that. But guys, tell me what gets you up in the mornings. Hot. Hire me.
Mike Gilmartin:That was Greg, you first met my following that,
Greg Hamlin:uh, you know, for me, I love feeling like I'm making a difference. And so when it comes to workers compensation, you know, when I know that one, we're doing the right thing for people, and we're helping people get back to work and we're helping businesses be able to stay in business that and then watching my own staff grow from when I came to where I am now, you know, those little steps and then watching their lives change, you know, I can think of a couple people that I recruited brought in, that did not have workers compensation backgrounds, you know, one instance of customer service working at a Publix, and, you know, he made the transition to workers comp, watching him get his insurance license, watching him develop, and then seeing him be able to have the freedom because of working more normal hours to be able to do what he loves, you know, he's leading price sessions at his church, it's great that he's able to give back to other people, because he has freed up a little bit more freedom in his work schedule to do what he does. So those things and then of course, seeing our injured workers succeed, for me is what it's all about. And, you know, I want to what I've done here and hang it up feel like not only did we do the right things, but we also changed the way people think about workers comp. And so hopefully, between the podcast and the other things that we're trying out with our empathetic resolution model, you get to a point where we help people see worker's comp, a little different. And if I've achieved that, at the end of all this, it'll be worth it. So there's
Josh Schuette:definitely, definitely you could Greg, I definitely think you guys will help change. Just quick shout out to you know, I had a call with you some of your teammates there recently. And it was definitely a breath of fresh air. I mean, they were trying to go above and beyond to help out one injured worker, just from every which way you know, bio psychosocial, they are truly live in the model. And they didn't have to do that. And it was just amazing. Because it ultimately we're about we're in the business of people helping people and it was just a breath of fresh air. So I definitely feel like you guys are on the right track and can definitely you know, that's how we make a change one person at a time. So I really appreciate your vibe. But of course, Mike, you got to follow that up, brother, you got to take it, you got to finish us up strong, man, I got faith in you.
Mike Gilmartin:I'm gonna go a completely different direction. Because you guys have basically taken all the work stuff I could have said, I'm gonna go completely outside of work. I'll be 100% Honest, I think my biggest thing that gets me up every day. And it makes me feel maybe a combo, I don't know what you would say is watching. I have a very young daughter's four years old watching her develop. Like every day, she learned something new every day, she says something different every day. She's like to say something you're like, where did you How do you know that? I think I say how do you know that like 17 times a day. And so I mean, it goes back to the stuff you guys were talking about, though, it's helping them figure out their potential and helping them figure out the things that they know and don't know. And I don't know that to me, because my answer for work would have been the same as your guys. Honestly. I'm like Greg, watching people develop, working with newer people figuring out what makes them tick. figuring out what's gonna make them grow in their work is is big for me. But I think that probably takes the cake is watching such a young person. Figure out how to live life is kind of wild. And it's what keeps me going every day for sure. Awesome. Is
Josh Schuette:that your only? Yeah, we got one four years old. Her name is Ellie. So congratulations are my that's all. Thank
Mike Gilmartin:you appreciate it. I don't have six like Greg's
Josh Schuette:got multiple kids, right? Do
Greg Hamlin:I Do we just wrapped up homecoming and I had three in high school and they all went together as siblings with their dates, which is really cool. Awesome. Drum. Yeah, so life is good. Life is good. And
Josh Schuette:I'm very fortunate to I got my son's gonna turn 13 this week. And yeah, we it's like I said, this past weekend, we all went out ran with the kids together. And it was just great vibe. So I'm in total agreement with you too. I realized the question usually is works on on sound fellow and I was just, yeah, it's a combo package. I mean, you gotta love what you do. But definitely family. You know, I mean, without that, dude, I mean, so it's definitely what helps get me up in the morning. But, guys, I really appreciate the opportunity, guys, both awesome. And actually the whole team on here, but I know we got some people you know, right now back there, you know, just helping us out. So thanks so much.
Greg Hamlin:Thank you, Josh. It was great chatting with you. It's always good to see you know, our paths will cross again, different conferences and hopefully with some recovery, some patients down the road. And I just remind all our listeners our motto to do write think differently. And don't forget to care and catch us every other week as we release on Monday. So the reminder that on the off weeks, we do have a blog. So if you prefer to read your CDR rather than listen, that's an option as well. So thanks again to everybody and we'll see you next week. Thanks, guys.