Tommy Wyatt: Welcome, welcome. I'd like to welcome everybody to the MSKQB podcast. I'm your host, Tommy Wyatt, and if you're listening to this, you know that this has been a long time coming for me. I heavily contemplated doing a podcast for a very long time now, and went back and forth on whether or not I should do one. But at the request and the motivation of all the people around me, here it is. so to introduce myself again, I am Tommy Wyatt. I'm a sports physical therapist by training. And I'm also a researcher. I serve as an assistant professor at High Point University as well as the director of rehab for High Point University Athletics. But more about what you guys came to hear about today. I serve as the musculoskeletal quarterback, I like to call it, for approximately 300 professional and division and athletes. And I get quite a few questions about this model and how I get into it, how it works, etc. Recent recently made a post on. LinkedIn that this model has allowed me to financially succeed in much greater numbers than the traditional physical therapy path. And so I wanted to create a platform to kind of talk about you know how this works, how this is possible, my journey throughout it, because it is not super refined. I have been doing it for a while though. this is actually as of last month, June twenty twenty six, it has been two full years. so I've been doing this for for a little bit of time. and so now I just want to speak publicly about it given the the current state of physical therapy with declining reimbursement and people not practicing at the top of their scope and feeling limited in autonomy, things of that sort. Those are things that those are challenges I do not have in my day-to-day. And so I'd like to share this knowledge to hopefully get other physical therapists who want to practice in this setting. it's a rare niche between primary care, PC and sports. So again, I refer to myself as a primary care sports physical therapist, both in the fact that I do only treat athletes, but I also serve as the first point of contact or primary contact for all of their musculoskeletal health concerns as you would in traditional primary care. So before we start the podcast, I think this podcast is going to be really essential to current physical therapists who want to practice this model, PT students who may be interested in this model. We'll have athletic trainers, we'll have physicians, we'll have strength coaches, we'll have athletes themselves, and a whole bunch of different stakeholders who involved our musculoskeletal health care with with the mission of elevating musculoskeletal health care by helping clinicians and athletes make better decisions, right? And so a little bit about my story. I grew up playing sports. I grew up playing predominantly football, but I was a multi sport athlete. went on to have a good amount of success in high school and had the opportunity to go on and play at Temple and Rutgers University, originally starting at quarterback and moving on to tight end. and then after football kind of wrapped up between between some of my years I actually joined the Army National Guard and so I did also serve in the Army National Guard for six years from twenty eighteen to twenty twenty four. and that was that took me through PT school as well. I graduated from PT school in twenty twenty three and then within a couple of months went on to do the sports residency at HR Mount in Charlotte, North Carolina. it was at the tail end of that residency where I started treating in this MSK quarterback model. and again it's been two years since then and then I recently a little less than a year ago, got the faculty appointment at High Point University. and I I've been balancing the two ever since. I really grew angry at the reactive model of healthcare, especially in musculoskeletal health. It's always wait for something to get injured and then when we do when they do get injured we have limited data and limited help on how to make better clinical decisions. and in America right now, you know, Go America, great health care. You know, somebody develops a pain, they wait for it to get bad enough for them to actually see someone. The first person they see is probably a primary care physician, maybe urgent care, maybe ED. they go on to get a referral to a sports medicine physician, and then maybe get a referral to an ortho, and then maybe go back to a sports medicine physician, and they finally get referred to PT. and then when they go to PT, This isn't not to knock on any provider, but typically when they get referred to PT, I have experience in my personal clinical practice and physical therapists will probably attest to this. a good forty to fifty percent of the time the diagnosis doesn't seem too accurate and or is just unhelpful. so they're they're getting an evaluation by us, physical therapists. They may or may not be rerouted to a different diagnosis. They get treated. At this point, instead of it being an acute injury, it's now maybe a a six to ten week thing. so and then we have to battle insurance companies over visits and there's a lot of things that happen there. but at the end of every plan of care that I had during practice, the patient would just say, Man, I wish I could have just came to you first. that got me thinking because as a physical therapist in the United States, we do have direct access and some level of direct access in all 50 states. And so that got me thinking, why don't patients know that they can go directly to a physical therapist? that had me you know, kind of wrap my head around my dissertation process as a PhD candidate into the perceptions and realities of physical therapists as primary care muscle skeletal providers, and then throughout That research, I found more and more compelling evidence that not only should physical therapists be the front line, but we're actually the best trained to do so. looking at studies like clinical diagnostic accuracy studies. the gold standard treatment for most musculoskeletal health concerns is is conservative care or non medical interventions. looking at the efficacy of exercise versus injections or post surgical outcomes with rehab without rehab. and I got frustrated that I was only going to be reimbursed for value for rehab, given that rehab is it's a good chunk of what we learn if as physical therapists, but in my opinion, it's only forty percent of our scope. I and and the other side of our scope is being very strong musculoskeletal diagnosticians. and so I always say that the power of P T is diagnosis and management. And so the MSKQB model allows me to be a really good clinical decision maker and manager. And so the value of what I provide is much more than I would just be a kind of like that technical rehab role. And thus I get financially rewarded for doing so. So let's get into it. So, what is the MSKQB model? So, again, I serve as the primary and often the first contact provider for a lot of my athletes when they get hurt. So, we're doing you know injury assessments, we're triaging them, we're diagnosing them, we're coordinating their care, we're providing the active rehab, or consulting with their rehab providers. we're helping answer questions on return to play, we're doing injury prevention measures, The the thing that I'm interested in the most is this longitudinal musculoskeletal health kind of model. And so what that looks like for me is I have a full suite of all the Vault equipment, so the force frame and the force decks and things of that sort. and shout out to Vault and and all they do. but I do serial testing for my athletes, so I test them quarterly. They get tested four times a year. I take every single range of motion, I take every single strength, I get a power index, I get their coordination, I get their balance you know, etc. I also take clinical measurements like weight-bearing dorsal flexion, past medical histories, things of that sort, just like you wouldn't like kind of like a standard physical exam. And what I'm able to do is when an athlete does pop up with an ache or pain, and let's say they play for an NFL team, I'm able to directly communicate and consult with the team, given that I may have data and information that the team does not have available to them and that could also attract this athlete over multiple years of their career as well. And so given the climate with the transport portal and NIL and the professional climate, these players can be on four to five different teams over the course of four to five years. And so having somebody in their corner who understands longitudinally what their health care look like from a musculoskeletal health standpoint is something that they really value and something that I think is important one of the questions I get all the time is how do you work with the team, right? The team have athletic trainers, they have strength coaches, they have PTs, they have team physicians. I have actually worked very well with the athletes teams given that I'm coming at it from a primary care standpoint of I'm here to provide you information that you again you may not have available to you, but also to help you make decisions. Given that I do have these data points and I have seen this athlete over an extended period of time. And then along with that, sometimes, you know, because I am trained as a sports physical therapist, it's me taking over very exclusive parts of their care. And so an example there may be the team's working on 99.9% of things, and that 0.1% of things is like, hey, he needs to be able to achieve and tolerate terminal knee extension. And so my only job, my role is to join that team and helping this athlete get terminal knee extension. And that's just one of the examples, one thing that goes into being the MSK QB is again practicing at the top of scope for physical therapists, right? So this includes ordering their imaging, coordinating their care with other providers such as sports medicine physicians or orthopedic surgeons, again, doing the return-to-play testing, getting them prepared for return-to-play testing, and just answering a lot of questions, right? Answering questions on why do I feel this? Why do you think this is happening? What should I do if this happens? how do I recover? in season, how do I recover out of season? And and it's a lot of consultation and athlete education more than it is traditional. I'm gonna see you and just just rehab the crap out of you and do everything for you. which I do have those athletes and so I do still very much treat clinically. I would say in my role now I probably see a good five to six of my pro guides each week given that the current panel is a couple hundred, right? So a lot of text, a lot of calls, a lot of emails, a lot of communication So one thing I'm gonna talk about and everybody's interested in is the financial side of being a musculoskeletal quarterback. because I carry a panel Right, and I and I'm not trading my money directly for time. I'm able to be more financially successful than a PCU who just practices rehab and trades their time for money. And so without getting into exactly my my exact financial model and things like that, I will confirm that with a panel of about a little over three hundred, maybe three hundred and twenty five professional athletes that I'm fortunate enough to have a clinical based income in the millions, right? and so it it kinda evens out to somewhere around fifteen to twenty five thousand dollars a year per athlete just to give a ballpark area there. again a little over three hundred athletes so you could probably do some math there. but there's also times where I am getting paid per service and the athlete is traveling to my home base here in Charlotte, North Carolina and we're doing some, you know, traditional PT treatment or I'm flying out typically to New York or Miami area. to do some of the hands-on care myself there. So I do practice with that full autonomy. it's not that I want to gatekeep this player's care, it's that I want to be the quarterback, right? And so what does a quarterback do? A quarterback receives all the information, they provide a leadership role to take charge and take lead of what's going on in that arena. they know where everybody's supposed to be, they know what everybody does, and they as a quarterback, you yourself might not be the one that scores, right? hand off the ball and the running back runs for a touchdown. You might throw a little screen pass to a receiver and they take it ninety yards and they score. but when they score I score and when I score they score, right? It's a team thing. it's about putting them in the right position and getting a team around them with the right information at the right time to make the right clinical decision that's going to help them succeed. in my population, again, I'm not ignorant to the fact that my population has much deeper pockets than the, you know, general orthopedic or general sports population. And so the amount of money that I'm able to make making these decisions is linear to the the value that that I create. And so to give an example there, if you have an athlete who's making two million dollars a year, and they have to make a return to play decision, right? Or maybe it's a ACL reconstruction, ACL rehab, and the team is trying to coordinate, you know, when and where they're gonna return this athlete to play you can imagine that making that decision with data and clinical insight that may not otherwise have may not been available to the team, would command great value and would would this would then translate financially, right? I will say though one of the common things that I get is well, you're able to work with multimillion dollar athletes so it would make sense that you're able to, you know make a couple million dollars off of those guys. But how would that work in the traditional outpatient population? And I love this question because about two years ago before I did start this with the professional athletes, I actually did an experiment myself. and so I rented space out of an Anytime Fitness down here in the Greater Charlotte area. And I believe I paid fifteen hundred dollars a month for the first month as an experiment. And what I did is I offered a monthly membership, just two hundred and fifty dollars a month, and I just didn't really do any marketing, I just set up a sign in a room at any time fitness and told everybody that came into the gym that hey I'm a physical therapist whatever you need you can ask me unlimited questions you'll get text and phone access to me if you just want you know some spinal manipulation or some dry needling or any of the traditional PT services you just come in and see me we'll make an appointment and we'll get it done and don't have to worry about any of the what we would call fee for service. It's all included in your $250 a month. And this was me kind of testing those waters and testing The model on like if people did know about direct access, would they use it right? so in this experiment, which I ran for 30 days, I had 117 people sign up with no marketing, right? So in that month, I was at 29,250, I believe, a little under $30,000 that month. grew that that clientele in 30 days. Now, the issue there would be maybe potential overutilization over time or attention and I didn't run the study long enough. I I kinda cut that experiment off at that 30 day mark so I'm not sure I could responsibly answer any of those questions but I can answer the question that if people understood the value and could see the value that physical therapists provided in a direct access setting they would use our services right and so I'm trying to wrap my head around that people just don't know what a physical therapist is and what a physical therapist does and how we compare to to the other providers that may be offering musculoskeletal health services. and so Part of my my platform I wanna use is to try to educate clinicians on trying to educate the the public, but also educate the public directly on what a physical therapist is and how do we stack up with other muscle skeletal health providers and how it would be beneficial to have a primary care physical therapist, especially if you are in the active adult and sports population. That needs a little bit more oversight. So another question that I get is well how do you deal with marketing? How do you deal with sales and a lot of the cash pay P T you know, business building companies out there. they like to hold these crazy webinars and and charge you a couple thousand dollars a month to learn, you know, marketing and meta ads and all the other such things, which I've been h historically bad at, right? I've been historically bad at marketing myself, but I I find myself in the position that I am in now, predominantly through word of mouth. And again I'm not ignorant to the fact that I have a niche population and a past experience in in the sport at a high level. but I truly believe that the the hidden skill to practicing at at a high level is one finding an environment that you can practice at the top of your scope which is probably not going to be in an insurance model in and again not to be ignorant that you can for sure practice at the top of your scope an insurance model. It's just there's so many, so many, so many red tape and and the the chances of you being able to do it are very limited again of about the ordering imaging and and being the first contact provider chances are if you're in an insurance based setting you're probably a very strong referral based system they've already seen someone they're coming in you're kind of starting pushing the ball uphill and all those types of things but I don't want to get too in the weeds of like cash versus insurance and all those things. I will just let you know that I'm very heavily biased against insurance and I don't believe that the current state of Health insurance United States allows physical therapists to practice at the top of the scope. Thus I don't accept insurance. and then it's not also just not financially rewarding for a physical therapist, again, with the hidden skill being clinical skill, clinical excellence is what I think separates a clinician's ability to excel in this model versus not. And I say that because In the traditional insurance based model, if I practiced at a clinical skill level that was ten times better than any other therapist in that office, Blue Cross, Blue Shield of North Carolina would reimburse me exactly the same amount. But when I charge my athletes directly, I'm creating the value for them and they're the ones that get to put a financial value on what I offer to them. And so if my fifteen minutes of manual therapy solves a two thousand dollar problem for them, they're going to reward me with two thousand dollars versus Blue Cross Blue Shield telling me it's a you know, a fifteen dollar value of skill. That's just something that I personally cannot you know mold myself into wanting to practice in that model. and I believe again that if we're going to talk about true value-based care, the value should be from the consumer, right? And the consumer should decide how valuable our services are to them. so one exercise that I would like physical therapists to use in their practice is next time you are at your discharge day with a patient, just simply ask them, how much do you think I should make for getting you this outcome? How much do you think this outcome should have cost you? And or how much do you think I make per year providing people these clinical outcomes? and the the answers will completely shock you on how much patients believe that you get reimbursed or that you get paid by your employer and by insurance companies for providing the great service and the clinical outcomes you did to them versus what you actually you know, were provided. and so that was a kind of enough for me to not want to take insurance pretty much ever again. But again, the hidden skill to me is clinical excellence. and you know teaching entry-level PT students a high point has really got me interested in creating continued education opportunities for physical therapists who do want to practice at the top of their scope. And I know there's a ton of great resources out there on the primary care setting. and so I would highly encourage anyone listening to check out all the primary care offerings that are out there. I plan to target this specific niche of primary care sports PT. I found that there's a lot of people that are interested in being sports physical therapists but do not want to work in the traditional sports setting, right? they want to work in more the clinical setting and so I plan to build a hybrid sports residency that the program is dedicated to training that specific type of physical therapist, a physical therapist who wants to be a musculoskeletal quarterback and work in the traditional clinical setting, but still see the high level sports population and practice at the top of their scope and then again hopefully get financially rewarded for doing so. I have a good bit of experience testing out membership models and all these different models of care, which again I will expound on throughout the the course of this this podcast. And so again talk about the future of this podcast. I will also be launching a healthcare technology company and rebranding supercharged to be that in that I want to create some clinical decision support tools to help us make more standardized and better decisions on return to play, but then also create some type of AI triage agent to allow athletes and other patients to appropriately find the right person at the right time, right? So having a bump or a bruise or an ache or a pain, how can we get these people to physical therapists, to the right physical therapist at the right time? as we all know the crazy statistic of only 10% of people with musculoskeletal complaints see a physical therapist, I am targeting that 90 and I want to make sure that 90 gets to the right person at the right time for the right cost. Right. And that's what value-based care and population health should look like. We'll also talk about again a lot of technology, a lot of wearables and data and and why PT should embrace technology. There's gonna be a lot of stuff coming through here. We're gonna have a lot of guests. We're gonna talk to athletic trainers, we're gonna talk to physicians, we're to talk about how being a primary care physical therapist or being an MSK quarterback is actually beneficial to all parties. It's not like we're trying to take over another profession or take on a role that we're not properly trained to do. It's about fulfilling the role that we're properly trained to do and thus creating very positive downstream effects for all the other stakeholders, including the health and well-being of the athlete. so again, just to talk about the educational mission, I do plan to have CEU courses, hybrid sports residency, some type of clinical mentorship and research translation to help PTs become musculoskeletal quarterbacks. if you know me, like I said in the beginning, I contemplated doing this for a very long time given that I did not want to come across as this guru and I'm gonna show you how to make $300,000 a month and you should take all my courses for $10,000 a month and everything like that. I'm gonna stay as far away from that as possible and so that I hope that I can pack in as much education into podcasts and these other free streams as I can and then where I really want to push PT into upgrading the individual clinical skill of physical therapists to be able to confidently take on the roles MSKQB I want to deliberately do that through continuing education you know have peer reviewed courses and peer-reviewed sources of information and and have a variety of faculty members come on and really train physical therapists to do this. I really hope to do it in the right way and not make it a like a money grab and promise everybody the same financial return that I get from my very niche population of professional athletes. And so My goal is to really improve overall the musculoskeletal health care that's in the United States. And I really hope you guys enjoy the podcast and the other concept that I put out and and how we move forward. so to wrap up the show in the next couple minutes I just want to answer the most common questions I usually get And so the first question is what exactly is an MSK quarterback? How is it different than a traditional physical therapist? Again, I touched on this, but the traditional physical therapist is predominantly a rehab provider, and they're going to practice in the model where you're gonna come in two times a week for eight weeks and you're gonna make this plan of care and all that type of things where the MSK quarterback is going to effectively evaluate and diagnose. and you may not actually be the person providing the care, right? I may coordinate the care. you may get drained link with this practitioner, you may have exercise with this practitioner, you may delegate to a strength conditioning coach for this portion of the care. So it's really more about that coordination and I'm a really big proponent of having physical therapists do what a what a DPT is required to do, right? And a lot of these other things that may fall into a plan of care can be delegated to other professionals who are also highly trained at carrying out these tasks. Again, so being a quarterback is all about putting people in the right spot. why do you believe this model is the future of musculoskeletal health care? Again, this is not to poo-poo on any of the other professions, but musculoskeletal health care, in my opinion, has been very over medicalized. the evaluations are done by medical professionals, the primary interventions are typically medical interventions, and we have a plethora of research and literature to show that the non-medical route is as effective or more effective for musculoskeletal. complaints, conditions, etc. I would also say that physical therapists are probably one of the only providers that are capable of taking care of muscular cells complaints long term, right? And so if you have a shoulder pain and you get a steroid injection or a PRP injection or things of the sort, those are all the medical interventions that we have to date are short term and they don't manage anything long term. But one thing that we can manage as physical therapists is their function over time, right? And we understand That every day as we age, the musculoskeletal system gets less efficient at fixing itself and upkeeping itself. And so taking care of this person longitudinally is almost as important as taking care of them in that acute cycle. and so again, part of being a primary care physical therapist is not all not always being the one who is the interventionalist and being the one who's giving the intervention. But keeping track of the injury history over a period of time and trying to prevent negative downstream effects of of things that pop up throughout somebody's course of life. how do you personally manage the care of professional athletes differently than traditional outpatient setting? Again, I do serial sports science testing with them through Vauled. I collect a whole lot of data on them. They're getting an annual MSK physical from me. and again a lot of the management is care coordination, is diagnosing, is evaluating, is ordering of imaging, coordinating with the different physicians and athletic trainers and things like that. Which is so awesome. I get to meet somebody Awesome people, it's so cool. what clinical skills separate average clinicians from elite clinicians? Again, I think the power of PT is diagnosis and management. the skills that take you from being a good to great to elite clinician is your ability to make very high level clinical decisions as fast and efficiently as possible. Right. And getting that person from A to B as fast as efficiently as possible is gonna be what separates a a great clinician from elite. how can physical therapists become more financially successful while improving patient care? Again practicing at the top of your license and letting the person that you're taking care of choose the value of your services, it's what's gonna financially reward you over pretty much anything else, at least until insurance companies in the United States get the head on their shoulders, which I highly doubt will be any time soon. what role will AI, objective testing, and technology play into the future of physical therapy? I I personally think that AI will help us make better clinical decisions down the lines by synthesizing information just much quicker than we can as humans. but I do think that with advances in technology it's gonna be even more important to keep up on your clinical skills in terms of manual therapy, exercise progressions, and helping with clinical context, right? A lot of technology right now is really good at describing data, collecting data, analyzing data, but it completely sucks right now at providing clinical context. and so I think again Technology will weed out the elite clinicians from the weak clinicians and the weak clinicians, their care and practice will look very similar to some of the advanced technology, but the elite clinicians will still be able to stand out against a lot of these technological advances given that even with AI, the input is the output, right? And so the more of a subject matter expert you are and your ability to put in great clinical context in the input, you're gonna get better output from the systems. what changes need to happen to physical therapy education to prepare clinicians for this future? again, this is what I hope to build with a great group of people around me. but I think it's again honing your skills in diagnosis and management, honing your skills into knowing that our interventions of physical therapists are not the end all be all and patients will get better and should get better with medical interventions. There are also other professionals like athletic trainers that are super highly trained into taking care of these populations and musculoskeletal health and we need to rise all the different professions as a whole if we want to improve muscular skeletal health care and not completely fight against each other. what misconceptions do physicians, athletic trainers, coaches and patients have about physical therapists today? I think the number one one of the one of the largest misconceptions that I see is that again we're rehab providers only. and there seems to be a lack of knowledge about our clinical diagnostic accuracy. Again, this will be a future episode, in itself, but I think the misconception is that you know, physicians diagnose and PT's rehab, right? And you get hurt, you go see a PT after you already got a diagnosis. And again, not to ruin future episodes, but there's interesting studies about the clinical diagnostic accuracy between physicians and physical therapists that I really think are gonna shock a lot of people. How should someone, start adopting the MSK quarterback mindset? Again, go find resources like this podcast on how to change your mindset and actually clinically prepare to fulfill this role because it is a different level of responsibility than maybe some physical therapists are either ready for or capable of And so seek out the resources the people that are doing it, because there's there's gonna be more and more resources out there to do so. and again the hidden skill is to be very clinically strong, right? So yeah, that looks like all of our questions for today. I appreciate you guys sending in those questions. this has been fun. This is super new to me, so I look forward to future episodes and interviewing great guests. and so if you have any other questions for any other episodes, please find me on Instagram, TommyWyatt DPT. find me on LinkedIn, Tommy Wyatt DPT. please feel free to share your thoughts and other questions that you may want answered. but I really appreciate you listening to our first episode and we look forward to seeing you soon.