Future-Proof PT

How value-based payment, integrated care, and AI could expand physical therapy’s role and reward the outcomes that matter to patients.

Find the full transcript and Dr. Pearl's bio here.

Physical therapists help people recover, stay independent, and avoid more costly care. So why doesn’t the healthcare system consistently reward that value? What would it take to change it?

Dr. Robert Pearl, M.D., former CEO of The Permanente Medical Group and author of ChatGPT, MD, joins Dana and Alex to connect three forces that could reshape physical therapy: payment models, integrated care, and artificial intelligence. Drawing on his experience leading within Kaiser Permanente, Dr. Pearl explains how paying to keep people healthy changes the value of prevention, and why physical therapists should be more fully involved in planning and delivering care longitudinally.

He also encourages therapy professionals to consider this: What could you accomplish if you could support every patient at home, every day? We explore how AI could extend therapists’ reach between visits, give clinicians better information, and support recovery while preserving human connection.

From joint-replacement care to specialist incentives and patient trust, this conversation explores how better care and lower costs can work together. Dr. Pearl challenges clinicians like this: we have the expertise to help shape what comes next. We need to participate to we get a healthcare future we believe in. For therapists, there is a very real opportunity to become more central to prevention, recovery, and population health if we actively shape how those pieces come together.

Chapters:

00:00 The Tension in Healthcare: Patient Care vs. Payment Systems

02:13 The Role of Technology in Patient Support and Prevention

02:41 Introduction and Dr. Pearl's background

06:30 Transition from volume-based to value-based care

08:00 Incentives and their influence on healthcare resource utilization

09:53 Controlling chronic diseases through capitation and technology

11:26 Stinting on care and the importance of long-term outcomes

13:19 Cost of healthcare and the potential savings with capitation

14:45 Healthcare spending in the US versus other nations

15:50 Complex systems and delivering care effectively

17:12 The role of modern technology and AI in healthcare

18:39 Using AI to enhance physical therapy and patient outcomes

21:01 The future of AI in healthcare and physical therapy

21:03 Addressing healthcare shortages with technology

24:19 Outpatient care and rapid recovery models

26:37 The exponential growth of AI and its implications

29:47 AI as an agent to fill care gaps and improve outcomes

33:01 Reimagining physical therapy and preventive care

36:08 Incentives for specialists and population-based care

39:41 Empathy in healthcare and the role of AI

42:05 Building trust and showing care through technology

43:14 Dr. Pearl's philanthropic efforts and closing remarks

Find more information about Dr. Pearl on RobertPearlMD.com

*All ideas and opinions are those of the podcast participants only and are not advice. For informational and entertainment purposes only.*

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Finding the physical therapist's moat, and proving our value to patients, employers, payers, and other providers in an AI-enabled healthcare system.

Find the full transcript here.

Your next competitor may never open a clinic down the road.

As employers look for more affordable, convenient healthcare, physical therapists face growing competition from digital-first companies and employer-based services. In this episode, Alex and Dana use KFF’s employer health benefits survey as a starting point to explore what these changes mean for clinicians, practice owners, and the profession.

They discuss direct-to-employer contracts, financial risk, alternatives to visit-driven care, and the infrastructure practices need to serve patients differently. Then they tackle a harder question: What is physical therapy’s “moat”—the expertise and value that others cannot easily replicate?

From movement assessment and triage to a stronger role in primary and urgent care, they challenge

therapists to connect their skills to the outcomes patients and purchasers need, and consider where to start.

Chapters:

0:08 – Why KFF's annual employer survey matters

1:40 – Self-insurance and who carries the financial risk

2:52 – Premiums may rise 5%, while out-of-pocket costs climb further

3:11 – Affordability challenges the fee-for-service treadmill

4:36 – Earlier access, broader primary care, and AI

6:29 – Could direct employer contracts work for PT providers?

9:57 – Employers want providers to control total costs

13:02 – Digital-first competitors are already taking risk

17:30 – Rural innovation funding and the role of e-consults

17:54 – A clinic-readiness ladder for technology and risk

20:54 – Building and proving the profession's value

23:08 – A practical first step: learn more and meet more people

Find KFF's 2026 Employer Health Benefits Survey here.

*All ideas and opinions are those of the podcast participants only and are not advice. For informational and entertainment purposes only.*

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Alex and Dana explore AI, patient behavior, and the gap between technological innovation and meaningful health outcomes.

Technology may transform how care is delivered, but therapists' ability to influence human behavior could be their most enduring value.

Find the full transcript here.

Listen in on the conversation about the forces reshaping healthcare and the therapy professions.

We begin with the upcoming midterm elections, potential shifts in healthcare policy, and the future of Medicare innovation models under changing political leadership.

From there, the conversation turns to a bigger question: Can artificial intelligence, digital health, and robotics fundamentally improve health outcomes, or does meaningful progress still depend on changing human behavior?

Dana and Alex explore patient agency, the slow and often underestimated nature of lasting change, and the possibilities technology creates for expanding access to care and reducing human suffering.

They close with a challenge to physical, occupational, and speech therapists: Are we placing too much value on hands-on techniques and too little on our greatest strengths and value we provide to the healthcare ecosystem and the population: clinical reasoning, patient engagement, and the ability to help people change their behavior?

The episode covers the intersection of policy, technology, and human potential, and what it will take to future-proof the therapy professions.

*All ideas and opinions are those of the podcast participants only and not advice. For informational and entertainment purposes only.*

(subscribe to our YouTube channel here.)

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The momentum behind physical therapists, the payers still holding on to an old picture of PT, and what new grads need to stay in the profession.

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Kyle teaches at Duke, spent years in hospital-based care as a board-certified neurologic specialist, and started PT school in 2001, when direct access and the DPT were the new conversation. He's candid about how hard it is to be a clinician right now, and he's optimistic anyway. Here's what you'll hear:

You're going to see your physical therapist. When Kyle takes his dog in, he's going to see the veterinarian. He says physical therapists put the "sent for PT" language on ourselves, and it's on us to make clear that patients come to see a clinical expert. He ties it to the century of referral-only, incident-to history the profession is still undoing, even with direct access in every state.

Nothing magic happens at minute eight. Dana points out that the eval and re-eval are the only codes for work only a physical therapist can do. The rest of the code set was built for an earlier era of PT education, and it misses the work we do without pay: coordinating care, reassessing, modifying plans, talking with patients between visits, and much more. Kyle's answer is outcomes. The data in your documentation is what moves payment toward value and complexity, and it's why APTA's Value of PT report keeps adding diagnoses as the evidence comes in.

Physicians already want their patients to see us. APTA's report on primary care physicians came back positive: they think their patients need physical therapists. They just don't know how to get patients to us. Dana calls it being "aligned with our primary care colleagues," and Kyle says he's stealing the phrase. After decades of turf battles, his message to the profession is "It's got to be a contribution, not a competition."

Keep PT in your signature. Kyle names the loan debt and housing costs newer clinicians face that he never did, and Dana gets personal about what it costs to be a PT in northern New Jersey. Kyle wants everyone who moves into other roles like insurance, administration, tech, or city council to introduce themselves as a PT first. Nurses and physicians keep their nursing or physician identity in every leadership role they take, and that's how they get advocates at tables where we're missing.

Cash-based practice is evidence. Dana worries that a profession serving only people who can pay out of pocket drifts away from mainstream medicine. Kyle agrees it can't meet society's needs, and he sees something useful in it: proof that people with the means will pay a lot more for what physical therapists do. He wants to use that proof to improve payment in network.

PT For Future Me. APTA's consumer campaign pitches physical therapists as the clinicians who keep you active 20 years from now and able to play with your grandkids. Kyle says the public and lawmakers are coming around. Private payers still picture PT as post-surgical care, and he wants a campaign aimed right at them.

Tech companies are coming to physical therapists. APTA treats AI as an opportunity and has an AI framework report on the way. Kyle points to the CSM exhibit hall as proof that tech now comes looking for us, and he reminds us the profession has adapted before: when polio disappeared, PTs moved with the technology.

Kyle is optimistic, and he backs it up with record years of state advocacy wins, bipartisan standing in Congress, and physicians and tech companies asking for more of us. Keeping that going is everyone's job, member or not.

Chapters:

00:00 Welcome, APTA President Kyle Covington

01:22 Where direct access stands now

07:39 The eval, the re-eval, and the work we don't get paid for

11:37 "Sent for PT" and the veterinarian test

12:55 Nothing magic happens at minute eight

16:15 Downstream spend and aligning with primary care

21:13 Burnout, loan debt, and what new grads face

26:23 Why PTs are leaving the clinic

28:20 Cash-based practice and keeping PT in your signature

31:20 PTs as experts in behavior change

33:08 PT For Future Me and public health

34:45 AI and technology

37:23 PT first and the case to private payers

39:27 Bipartisan support and record state wins

41:26 Wrap-up

A few quotes from Kyle to listen for:

"We've known for a long time that nothing magic happens between minute eight and minute nine, or minute fifteen and minute sixteen. The magic that happens is the exercise prescription and the clinical expertise that we apply."

"We need to own that you are coming to the expertise of this clinical expert. You're going to see your physical therapist."

"They all think that their patients need us. The misdirect is they don't know how to get their patients to us."

"It can't be a competition anymore. It's got to be a contribution."

"They face a world outside of PT from a loan burden standpoint, from a cost of buying a house standpoint that I didn't face when I was coming out of PT."

"What it is doing in a way that we've never had before is showing that society is willing to pay a lot more for our services."

"PT is in my signature. PT is what I was trained to do. And it's because of my PT training that I'm so good at this other role."

"We're your provider that's going to keep you active two decades from now. We're your provider that's going to make sure you can play with your grandkids."

"It's technology saying, you know what we need? We need physical therapists."

"You chose this profession, and it's all of our collective responsibility to grow that fire."

Find the full transcript and Kyle's bio here.

Follow Kyle on LinkedIn here.

Download the APTA's Report "The Economic Value of Physical Therapy in the United States." Linked here.

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

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Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: How OTs and PTs Get Paid and Therapy and Value-Based Care Models.

Chris Hoekstra watched PT's AI panic flip in twelve months at the same annual meeting, and he explains what that reversal says about how this profession actually changes.

Chris has been a PT for about 25 years. He also holds a PhD in clinical informatics, teaches organizational behavior at Oregon Health & Science University, and leads clinical transformation work at Therapeutic Associates. He calls himself a sociotechnologist, and that turned out to be the right word for this conversation.

We got into why PT has been slow to adopt technology, why most therapists can't tell you what an RVU is when every physician can, the difference between quality and value, and what Chris thinks leadership actually requires. He also tells the story of a quality dashboard rollout that made therapists call in sick.

What we cover:

→ Why the HITECH Act money went to medicine and PT paid its own way → The four levers that decide whether anybody changes anything → The gap between the scope therapists have and the codes they can bill → Quality and value, and why treating them as the same word keeps us stuck → What $800 a day buys in a skilled nursing facility → Why a quality number feels like a verdict on your character → What CMS is signaling in this year's requests for information → The three ingredients that put a clinician in flow

Chapters:

00:00 Meet Chris Hoekstra

02:15 Why PT lagged on technology

04:05 What actually forces change

07:13 When patients start acting like consumers

10:29 The four levers behind every decision

12:45 The scope we have and the codes we don't

15:41 "I want an hour with my patients"

16:55 Quality and value are not the same

19:16 $800 a day to walk down the hall

22:09 The patient who wants the ultrasound

24:34 The 10 percent echo chamber

25:30 A failure of leadership

29:26 They have to feel it

31:12 Confident humility and one percent better

32:26 Every physician knows what an RVU is

35:06 AI, second brains, and what it's for

37:45 When AI alone outperformed the doctor

38:28 From boogeyman to ChatGPT in one year

41:56 The dashboard that made PTs call in sick

43:46 What quality even means anymore

46:06 What CMS is signaling in the RFIs

48:31 PT as prevention

50:40 Part of the primary care team

53:29 The recipe for flow

54:36 What every PT should understand

A few quotes from Chris during in this episode. Listen for them:

"I had more than one PT, the first day we rolled it out, call in sick, because they thought maybe they would be the lowest performing person on that dashboard. That's the amount of fear we have with people when you start to show these."

"Historically we've dumbed down PT to say it's visits plus units."

"We went from one year boogeyman to the next year put everything in ChatGPT. It just takes a couple of people getting a good outcome from it. And we're lemmings, so we're gonna follow."

"We teach our PTs to look at the efficacy of their care in a frame of one, always. What we rarely do is roll those up into populations to say, how am I doing en masse?"

"Be confident, but first be humble. Every day step into it saying, I'm not where I need to be. And if I am, I should probably retire."

"MIPS has been a travesty in many respects, with an overfocus on process measures that actually don't change care. Everyone's gonna game the system when you throw money at it."

Find the full transcript and Chris' bio here.

Follow Chris on Linked In here.

Hosts: Alex Bendersky and Dana Strauss

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

Subscribe to the Future Proof PT YouTube Channel.

Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: How OTs and PTs Get Paid and Therapy and Value-Based Care Models.

Net Health's Ben Barron on the 12,000-therapist shortage, what CMS' proposed RTM changes would mean for rural practices, and how to create access to physical therapists' expertise starting today.

The physical therapy profession is 12,000 therapists short, with no catch-up projected until 2037 at the earliest. Demand is climbing. Filling the schedule is not the problem. We should be focused on how to serve more of the community with the therapists we already have.

Ben Barron is a physical therapist, former co-owner of a 23-clinic orthopedic private practice, and an executive at Net Health. He joins Alex and Dana to talk about what therapists can do about capacity right now.

Ben said this perfectly: "We're going to be busy. The question is: How do we want to be busy?"

The through line is more evaluations, hybrid and tech-supported care paths, remote touchpoints between visits, and care segmented by clinical need rather than by who called first. Besides being ways to address access issues, they're the pre-value-based steps that prepare a practice for what's coming and let therapy meet its physician partners where they already are on their own VBC journey. How? By delivering the thing those partners need most, which is prompt, skilled evaluation and reliable access to care for their patients best managed by physical therapists.

In this episode, we cover this and more:

• The workforce math that makes hybrid care a necessity rather than a preference

• Why the 40-minute one-on-one visit came from the 8-minute rule, not the evidence

• Visit frequency dogma, and what the evidence actually supports

• Why a wait list is rationing, and why "we're full" isn't a success metric

• The eval math: why skewing toward evaluations helps finances and patients

• RTM, hybrid visits, and the 166 hours a week you're not with your patient

• Why promising cost savings is the argument that loses regulators

• What primary care and behavioral health figured out about access first

• How to be ready for value-based care before you ever sign a contract

Two other quotes from Ben during the episode that we love (listen to hear the context!):

"We are incrementally making an imperfect system less imperfect."

"We ration care every single day."

Chapters:

00:11 — Music intro and welcome

00:42 — Ben Barron’s background in physical therapy and health tech

03:04 — Are technology tools making therapists’ work easier?

07:37 — Workforce shortages, demand, and access to care

10:51 — RTM: reimbursement changes and remote monitoring

18:59 — Why RTM adoption has been slow

26:06 — Rethinking one-on-one care and embracing hybrid models

39:33 — What prevents practices from changing

44:04 — Access, value-based care, and a more sustainable practice model

52:30 — Building a future focused on lives impacted

54:08 — Closing thoughts and thanks

Find the full transcript and Ben's bio here. Follow Ben on Linked In here.

Hosts: Alex Bendersky and Dana Strauss

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

Subscribe to the Future Proof PT YouTube Channel.

Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

VA Leader Brian Westlake, PT, DPT, Cert MDT on how to impact total cost of care, what it means to control healthcare spending in a fixed budget and how primary care is crucial, outcomes-accountable care, and MSK triage in primary care.

After 25 years leading inside the Veterans Administration, Brian Westlake came away certain that future of the physical therapy profession depends on moving upstream, into the primary care team.

He saw it firsthand. As an executive overseeing a ~$400 million budget in the Bronx, Brian watched primary care teams do what fragmented, downstream care couldn't do. They keep budgets viable and get patients the right care as early as possible. He has a high conviction that this is a better model for PT and that it's the only way the profession secures its future, steps fully into its role in the healthcare system, and has a bigger impact on patients.

He starts off with the story of four patients, all sent to him for evaluations for shoulder pain. Two actually had a neck, not shoulder impairment, and some had already gotten injections and an MRI of the shoulder before anyone screened the spine. It's exactly the wasted downstream spend that earlier PT contact is built to prevent.

Dana, Alex, and Brian get into:

– Why PTs belong at the front of the system as the MSK triage point of contact

– The VA's PACT model, and why MSK should follow behavioral health into primary care

– Outcomes-accountable care and the IMC model (25% MSK cost reduction, at risk)

– The Choice Act and Mission Act, and how community-care spend exploded

– Telehealth that actually scales: e-consults, store-and-forward, video-to-home

– Why weak outcomes collection is the thing holding PT back

– Speaking the language payers reward: total cost of care and "days at home"

Brian's message to the profession: We've earned a seat in the broader healthcare arena, we underestimate our own impact, and we can't afford to wait. We have to demonstrate the impact we can have so it becomes the norm for primary care providers and patients alike.

Tune in for the rest of the conversation!

Chapters

• 00:09 — Introduction: Brian Westlake’s VA career and virtual PT practice
• 03:35 — What it means for physical therapy to move “upstream”
• 10:47 — The value of early MSK assessment in primary care
• 13:37 — Building primary-care teams with embedded PT support
• 17:23 — The need for standardized, outcomes-driven PT care
• 18:42 — Integrated MSK Care: accountability, outcomes, and lower downstream costs
• 23:17 — How the VA evolved: outpatient care, the Choice Act, and the Mission Act
• 29:56 — E-consults and telehealth as tools for access and triage
• 36:25 — Why outcomes data matters for PT’s future and AI
• 39:09 — Proving value through total cost of care
• 44:41 — The practical barriers facing independent practices
• 47:28 — Primary care as the path to innovation and scale
• 48:46 — Advocacy, interoperability, and avoiding professional stagnation
• 51:06 — Why Brian is optimistic about PT’s future
• 54:54 — Closing: start small, pilot partnerships, and move forward

Find the full transcript and Brian's Bio here. Follow Brian on Linked In.

About the show: Future Proof PT is a podcast for physical therapists, physical therapists assistants, and others who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.

Hosts: Alex Bendersky and Dana Strauss

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

Subscribe to the Future Proof PT YouTube Channel.

Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Plus, Ray Dalio's framework for how systems break, applied to the profession's financial reckoning and its AI future

(note: this episode was published before the CMS 2027 Physician Fee Schedule Proposed Rule was published)

Is physical therapy heading toward its own financial reckoning?

In Episode 32, Dana and Alex run MSK care through the same systems logic Ray Dalio uses to explain how countries go broke. Here's what you'll hear:

• How physical therapy goes broke. Large systems are already taking write-offs and defaulting as payers stop feeding operations that don't return what they promised. Alex makes the case that these are the first signs of a two-to-three year restructuring, and that it's predictable if you know the cycle.
• Your evaluation pays $90. Your treatment pays $30. The system is already telling you where your value is. We get into why that gap exists and what it should change about how you design your day, your team, and your top-of-license time.
• Your patients are already grading your plan of care with ChatGPT. A time-constrained patient can drop their symptoms and your plan into AI and ask "is this any good?" in thirty seconds. We talk through what that means for how defensible your plans need to be, starting now.
• The money is moving to primary care (even in fee-for-service), and PT is sitting in the specialty bucket. Advanced Primary Care Management codes, capitation tests in ACO models, and a closed-system reality where dollars flowing to primary care flow away from the rest of us. Dana lays out a four-to-six year forecast and why PTs need to fight into that definition before it hardens.
• Your discharges might be creating your own return visits. Tissue remodels over months and years. An episode of care runs days and weeks. We unpack that mismatch and why treating to symptom relief (often with unnecessarily high visit frequency) keeps sending patients back through the door.
• AI is safer than your intuition wants to believe. Iatrogenesis is one of the largest preventable costs in medicine. Bring in the Waymo that has never had a fatality, add the difference between training and tuning these models, and you get a real role for clinicians as the people who tune them.
• The optimistic close. Done right, AI plus interoperability finally plugs PT into the rest of the medical system and makes the work more individualized, more rewarding, and more visible. Or you can keep your paper charts and your goniometer.

Chapters:

00:10 Introduction to Payment Stressors in Healthcare

01:43 The Evolution of Physical Therapy and Payment Reform

05:30 The Impact of AI on Healthcare Delivery

09:53 Revolution vs. Evolution in Healthcare Systems

14:01 The Future of Payment Models and AI Integration

19:30 AI's Role in Healthcare Precision and Transparency

21:05 Access Challenges in Urban vs. Rural Healthcare

22:52 Understanding Access Problems in Healthcare

25:02 AI's Impact on Healthcare Access

26:51 Network Adequacy and AI's Potential

29:08 AI Safety and Bias in Healthcare

31:16 The Future of Physical Therapy with AI

33:48 Embracing Change in Healthcare Delivery

Find the full transcript here.

Referenced in the episode:

Dr. Chad Cook

Dr. Trevor Lentz

Ray Dalio's books

CMS Physician Fee Schedule home page

Medicare Shared Savings Program

ACO REACH Model

LEAD Model

ACCESS Model

ACCESS Model: landing page for referring and co-managing clinicians (including PTs and OTs)

Advanced Primary Care Management services and codes under the Physical Fee Schedule

Duke research finding removing financial barriers to physical therapy led to more evidence-based care and cut unnecessary healthcare utilization.

"Healthcare Dive's" coverage of the Hinge Health IPO

Waymo's March 2026 landing page covering their safety data

About the show: Future Proof PT is a podcast for physical therapists, physical therapists assistants, and others who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.

Hosts: Alex Bendersky and Dana Strauss

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

Subscribe to the Future Proof PT YouTube Channel.

Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

Duke's Dr. Chad Cook on the 5 things MSK therapists obsess over, and what we should be doing instead

A VA physician once told a colleague of Dr. Chad Cook's that physical therapy isn't really the movement profession, it's the Swiss Army knife profession, because PTs do a little bit of everything. Whenever no one else knows what to do, the patient gets sent to PT to "get it sorted out."

Chad isn't sure he disagrees. In this episode, Chad joins Alex and Dana to walk through five sacred cows in MSK physical therapy. These are the things clinicians treat as essential that, in his view, matter far less than the profession believes, and the skills we should be leaning into instead. Chad is a tenured professor at Duke University with appointments in Orthopaedics, Population Health Sciences, and the Duke Clinical Research Institute. He's been a PT for 36 years, a health services researcher for 27, and is one of the most cited voices in our field.

What we cover:

• Why the "movement expert" identity has limited what PT can become, and the cost of letting ourselves be bucketed as specialists when so much of what we do is primary care
• Where tissue-specific diagnosis still matters (red-flag screening) and where it really doesn't (the 56 SIJ tests, the rotator cuff special-test rabbit hole)
• Why treatment specificity often doesn't drive outcomes, and what therapeutic ritual, contextual packaging, and alliance actually do
• How the top 10% of clinicians handle session-by-session symptom fluctuation without losing the long-term trajectory
• Why social media arguments about exercise intensity and volume miss the point, and what behavior change should look like instead

Plus three threads that emerged outside the five-things framework:

• The case for training prognosis communication with the same rigor as diagnosis, and why patients are really looking for someone who can tell them what to expect
• What top US psychologists told Chad about the power of physical touch: "You're lucky. You can put your hands on your patients. We don't have that." — and why it's a privilege PTs underuse
• The phrase from one of Chad's fibromyalgia patients that frames what he thinks PT actually is: "negotiated behavior change"

Dr. Cook shares some uncomfortable numbers that we need to face to address.

-75% of PT referrals never initiate,

-30% drop off after the first visit,

-and MSK patient outcomes have actually gotten worse over the last two decades

Plus, where Chad sees AI, digital-first care, and lifestyle medicine fitting in.

Chapters

00:00 Introduction to Dr. Chad Cook

02:56 The Identity Crisis in Physical Therapy

05:47 The Role of Physical Therapists in Primary Care

08:33 The Precision Paradox in Treatment

10:51 The Emotional Aspect of Diagnosis

13:29 The Transition to Self-Management

15:41 The Impact of Digital Health Solutions

18:20 The Future of Physical Therapy

28:45 Navigating Uncertainty in Healthcare

30:45 The Digital Transformation of Health Systems

32:08 The Role of AI in Patient Care

36:51 Understanding Patient Recovery Trajectories

39:36 The Importance of Prognosis in Therapy

46:04 Redefining Exercise and Patient Engagement

50:48 The Power of Touch in Therapy

55:22 Negotiating Behavioral Change in Healthcare

59:09 The Future of Physical Therapy

Find the full transcript here.

Related: Episode 30 with Dr. Trevor Lentz

About our Guest:

Dr. Chad Cook is a tenured professor at Duke University with appointments in the Department of Orthopaedics, the Duke Clinical Research Institute, and the Department of Population Health Sciences. He is a physical therapist with more than 36 years of clinical experience, an active health services researcher, and a clinical board member for multiple healthcare organizations. Dr. Cook has been involved in securing over $16 million in external funding and has authored more than 450 peer reviewed manuscripts, 46 book chapters, and four textbooks. He has delivered over 100 keynote lectures across 40 countries.

Chad’s recent article in Journal of Orthopaedic and Sports Physical Therapy: Many Paths to Recovery: The Case for Treatment Pluralism.

About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.

Hosts: Alex Bendersky and Dana Strauss

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."

Follow Dana Strauss on Linked In.

Follow Alex Bendersky on Linked In.

Subscribe to the Future Proof PT Linked In page.

Subscribe to the Future Proof PT YouTube Channel.

Subscribe to our newsletter and email list.

Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.

And the active ingredients in PT often aren't even physical

"We have the capacity to provide a level of care that nobody else in the healthcare system does. But we're being hamstrung by the payment models." — Dr. Trevor Lentz

Dr. Trevor Lentz of Duke University on why patients write off physical therapy after one failed attempt, what the profession is actually selling, and the payment models keeping PT from delivering its real value.

In this episode, Alex Bendersky and Dana Strauss sit down with Dr. Trevor Lentz, physical therapist, researcher, and faculty at Duke University, to unpack the structural and identity challenges facing the profession.

The conversation moves across patient defection, language and labeling, payment reform, phenotyping, and what it would take to build longitudinal care models that finally pay therapists for outcomes rather than volume.

What you'll hear:

• Why a single bad round of PT loses patients for life, and why the same isn't true for dentistry or primary care.
• The challenge of fostering critical thinking and comfort with uncertainty in clinical education.
• Trevor's research on removing copays, what it actually did to costs, and what payers misunderstand about long-term value.
• The case that PT's active ingredients aren't physical, and why the language we use, from "assistant" to "exercise" to "blown disc," is quietly damaging the profession.
• How Duke's Joint Health Program built a longitudinal care model before the payment model existed.
• Phenotyping, tiered care, and what it means for therapists to be the quarterback of a patient's care journey.
• The AIM-Back trial and the Pain Navigator program, recently published in JAMA Network Open, and what it teaches about scaling non-pharmacologic care.

Find the complete transcript and outline here.

Chapters:

00:00 Introduction

00:23 Trevor's background and path to research

03:00 Day-to-day at Duke

03:54 Inductive vs. deductive reasoning in clinical practice

05:39 The No-Copay Revolution study

09:30 Horizontal vs. vertical value and the time-horizon problem

12:44 Rethinking incentives and longitudinal care

17:28 Why one bad PT experience ends the relationship forever

20:53 The identity crisis and language problem

26:57 Phenotyping and tiered, personalized care

39:32 The Pain Navigator program and AIMBAC trial

46:23 Navigators in the commercial space

48:14 Closing: the whole-person argument

About the guest:

Trevor Lentz, PT, PhD, MPH is an Associate Professor in Orthopaedic Surgery at Duke University and a licensed physical therapist. His work focuses on improving outcomes in musculoskeletal care by integrating behavioral and psychological factors, patient-reported outcomes, and real-world data into clinical decision-making. He leads and collaborates on pragmatic and hybrid effectiveness-implementation studies aimed at translating evidence into routine surgical and non-surgical musculoskeletal care.

About the show: Future Proof PT is a podcast for physical therapists who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.

Hosts: Alex Bendersky and Dana Strauss

Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."

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Subscribe to our sister newsletter, Timeless Autonomy, Dana covers health policy insights and career growth tips for healthcare professionals and sends a weekly newsletter (nearly) every Sunday evening.