Transcript
Marla: Welcome to the Practice Growth Podcast. Today I have a very special guest, one that is not only an industry leader and icon, but also my mentor. So someone I have known very long time and started my career out, um, back in 2009, the Hospital for Special Surgery with Jeannie Moscow. So, such a pleasure to have you today.
JeMe: Thank you so much, Marla. I am so honored to be here.
Marla: So Jamie, you are also the Senior Vice President of Rehabilitation and Performance at the hospital for special surgery where you have been for over 33 years.
JeMe: Yes.
Marla: And have really helped develop and create such a culture, such an excellence where therapists not only come to learn and grow, but also stay for years and years on end.
And part of that, I feel, is really also, um, the career ladder that you've created mm-hmm. At the hospital for special surgery. And today I'm gonna dive in and ask a lot of questions about how you did that. Okay. How you created the culture, the evolution, everything that is there today. Um, so I wanna start by asking you, uh, just your background, tell us how you got to be where you are.
Yeah. Um, from a physical therapist to the Senior Vice president at HSS. Yeah.
JeMe: Uh, well, Marla, thank you for that lovely introduction. Um, for everybody listening, I actually started HSS when I was five. I've been there for a really long time. Um, and I was an orthopedic, um, physical therapist, adult orthopedic physical therapist.
And to be honest, very early on in my career, I got my MBA. Uh, which was a recommendation at the time of the CEO of the hospital I was working at, ended up being the most awesome advice ever. And truth be told, um, I got a cold call from HSS because they were looking for a. Therapist or a clinician who also had a business background.
And it just so happened how they found my name. To this day, I still have no idea, but it was probably one of the best things that ever happened to me and I went down for the interview. And interestingly, uh, probably life lesson number one was never say never, because I was never gonna work in New York City and I was never gonna commute.
Fast forward all these decades. Um, I'm still working in Manhattan and I'm still commuting. Um, and it was unequivocally the best decision I ever made. So I started at HSS as the assistant director. So I came in as part of the management team and I think like everybody right through hard work and getting involved and figuring out.
Where things were going. You know, when I got to HSS, there were 59 FTEs and 19 vacancies, so it wasn't what I would call a place you really wanted to work. But what was inspiring was at the time there were 29 HBO docs and the, those were, um, house based orthopedic surgeons. And I had never worked so closely with orthopedic surgeons in my life, and I had never seen that level of clinical excellence.
And it was really their inspiration that. Is where I got the HSS bug and thought to myself as a very young, uh, professional, like, oh my goodness, wouldn't it be amazing if we could have a rehabilitation department that is anywhere near and create the accolades that HSS orthopedics has? Um, and I say rehabilitation because we didn't have performance till 2006.
So that was something that, that we added. And, um, I think that. The other thing that totally influenced my career, to be honest, was the birth of my two boys. So when I got to HSS, I was the first woman on the manage, second woman on the management team to have a baby. I was the first to have two, and I thought to myself, if I'm not gonna be home.
Then where do I wanna be and, and what's important to me? And I realized that for me, right, it's a very individual decision. Um, being a mom and being a wife was awesome, but I also wanted to be Jeanie Mosca, and I could do that at HSS and I needed like, my own identity. Um, so making that decision, this big light bulb went off in my head in 1992 about culture.
Um, I can't say I used the word at that time. I didn't a probably work environment, but if you're going to be spending time, you really need to be spending time where you're learning and growing and you feel value added and you're surrounded with people that you actually want to be. And fast forward now being a lady, um, I think that's a big important life lesson.
Because time is your most valuable asset and it's depreciating and we never know when it's up and where you choose to spend it. Whether it's work, family, relationships, social. Um, religious affiliations, whatever is important to you. I feel so strongly that you need to be someplace that's positive and not negative, and not with toxic people.
And you should be getting something out. You should be contributing, of course. And also it should be value added and enriching your life and not the other way around. So that's kind of how HSS rehab and performance got created, which is this mix of. Your career, your education, your academics, the people you work with, your personal life kind of all melding into this.
Crazy thing that we call HSS Rehab and Performance.
Marla: Yes, and, and I can say firsthand, you know, you, you look at it and it's number one in orthopedics on paper, but that doesn't explain the experience you have when you go there. It really truly is number one in culture, in education and growth and. Like I said, people stay there for 15 to 20 years.
It's, it's impressive to see the retention you have with your provider, your clinicians, your doctors, and all of the above.
JeMe: Yeah, and I think in fairness to the institution, it's Hallmark is really excellence in patient care and whoever is part of that journey, whether you're behind the scenes or on the front line, create.
This environment there. Um, and as you know, it's an academic teaching institution, so that is a little different. Like if you've ever worked in an academic environment, it's different than private practice and different than a community-based hospital. Not necessarily better, but different. And, um, there is a tenor that is really, um, I know what the right word to say, but is really.
Encouraged to continue to learn and grow and be at the top of your game. And not that that's not other places, but when you're constantly teaching. Right. HSS also has the number one orthopedic residency program in the country. I think it's over a hundred years old. Um, that's something that has to be instilled because the mentors and the professors are the clinicians at the institution.
Marla: Yeah, absolutely. And I think all of that goes into play with you started. Quite a while back when it really wasn't grown from the rehab department perspective. Correct. But you knew exactly what you wanted to create there. Mimicking the ortho uh, department and also making sure that you had a process and procedure for your therapist and your clinicians to grow.
Right. And that's where I've seen evolve your career ladder. Yes. Um, and I think it's a very instrumental part of your entire experience, so would love to ask you a little bit more questions about that.
JeMe: Sure.
Marla: In terms of what is the importance of a career ladder for you at HSS and how did you get into developing it and, and making sure that it was the structure that helped develop the culture and the growth and education that you, you have there?
JeMe: Yeah, so when I got to HSS, interestingly, um, it was a flat system. There were two assistant directors and a director, and everybody else was as a staff therapist pretty much. Um, so this has been an iterative process over the last 30 some odd years. Um, so what we have now, um, is a ladder not dissimilar from what I've, we've created with our nursing colleagues.
Really not dissimilar with the way the orthopedic surgeons advance at HSS. Um, and right now there's three levels. And the basis of it is not only clinical excellence, um, and academics, but then behavior and leadership. So you have to have the full compliment of skill sets in order to advance. We, uh, we do it on a rolling year.
Every year we open it up, you're allowed to apply. Uh, the first level is advanced clinician. The next level is specialist and then clinical lead and what we're working on, how interesting with our clinical leads is should there be a level above clinical lead, like the leads of the leads or the rock stars of the leads or whatever.
So we have a team working on that now, right? Because that's the top and there's no place else to go. Um, so it is this combination of not only didactic and clinical skills, but as I said, behavioral and leadership skills, which is clearly outlined. So there's no surprises about what you need to achieve.
There are some benchmarks related to the score you get on your performance appraisal. So it has to be a 3.5 as of now. Um, there are some metrics related to productivity and, and hitting your, um, metrics. 'cause that's important as well. Um, and then as you advance, it becomes tied now to clinical excellence that is.
Substantiated by outside entities. So Tre. So to become a clinical specialist, you cannot become that at HSS unless you're OCS or SCS or NDT or CHT. So in our system, we have two things. We have not only what you need to do in terms of academics and leadership and behavior, but then we have external factors that are important as you advance.
Up the career ladder. So should you choose to keep going, there are some things that are non-negotiable. So for instance, becoming a clinical specialist, you have to have an ATRI certification, O-C-S-S-C-S, you have, or N-D-T-C-H-T or any of the equivalents. And what we've done in addition to the career ladder is we have a tiered system, tier one, tier two, tier three.
Where are certain certifications fall? Tier one being what we, we deem like everyone has to decide what's important. We're orthopedics, right? What is the most important? So those are all the AB tree ones and C-H-T-N-D-T Center. Tier two is more, um, in the middle. So maybe, um, a RT maybe, um. Prompt, um, prompt, which is a speech not prompt, which you're talking about today, but a technique for swallowing and, and speech.
So tier two and then tier one are things that are more of a weekend course. Kinesio taping, um, titleless one, I mean things that are more, and there's a dollar amount associated with each of those tiers. So we can talk about that later with a, which is a $10,000 maximum today as the way we have it ranked.
So in, so in the latter, you don't only get rewarded with a title change, you get rewarded with a salary increase, um, for the latter itself, not a bonus, which I know is a bonus of contention with some places. Um, and then you also get recognized for your certification. So what I mean is if you get OCS. And you say, do not get promoted to the next level at this time.
For clinical specialists, you still get recognized for obtaining that certification. So the recognition for certifications is separate. It's like connected, but separate from the clinical ladder.
Marla: So you can get a, a salary increase for the recognition of getting that certification
JeMe: Correct.
Marla: And if you move up on the clinical ladder and not, or you can get that salary advancement for moving up on the clinical ladder.
JeMe: Correct. You just can't get it twice. So if you got it and recognized and didn't get promoted at that, that time, like some people get promoted kind of at the same time, but probably not as often. But yes, they're two separate tracks.
Marla: Got
JeMe: it. They're two separate tracks.
Marla: I mean, and I love to hear this because you know, it is really, um, right now everybody is trying to decide therapists make the same amount of money for the insurance, let's call it Right.
Reimbursement. Um, but there are definitely therapists that excel in terms of quality care or in terms of their education and potentially. Um, don't necessarily see the difference in salary when they are amongst their peers. Right. So I do think that this is a, a really fantastic way for pushing and, uh, inspiring to continue to level up your clinical care
JeMe: Correct.
Marla: While also being rewarded for Correct. The effort of pushing up your clinical care.
JeMe: Correct. And as you know, I mean, those things go hand in hand and are super important, especially at a facility like HSS South that it is in other places, but clinical excellence, we almost. We probably have an obligation to be better 'cause we do one thing, right?
We do orthopedics, so we should be better. Um, 'cause it's a single focus right on MSK. But I think it's important that therapists are rewarded for their education, um, and their behavior and their leadership. And it also provides a way to. Have people stay and continue to learn and grow and mentor and teach.
Um, because that's super important. Because that's how we all grow, right? We all grow because we had great mentors. And if you don't have a mentor, it becomes that much harder. But it also creates an opportunity for people to choose to build their career. And I think without that, I. My, I guess my bias would be like, like why would you stay then if your salary doesn't change?
I mean, sometimes it's convenient and there's lots of things, but I think for people who are learning to continue to grow and really wanna be at the top of their game, um, that's super important. And I think the other thing we added, which we'll talk about in a little bit, is orthopedic residencies and sports residencies and fellowships, which now we can also.
Help people get to those levels. Like we didn't have that before. So now we have not only a track for you to get educated should you want to, and a program where if you don't wanna take a residency, there's a didactic program to help you get your orthopedic exam, you know, uh, pass your orthopedic exam because that's important to HSS, right?
So each entity has to decide like, what are the key things that are important to them? Clearly, like for us, not that neuro isn't important, but we don't do neuro. So if you look at the ab tree list, there are certain ones that you wouldn't get recognized for at HSS 'cause it doesn't help. Not that it doesn't help.
Of course it helps. It's fabulous to get educated, but it's not necessarily front and center population that you see for orthopedics.
Marla: Right. Yeah. Yeah. That, that makes sense. And, and I know that with this ladder that you've developed and created, you've actually seen. Uh, a goal of yours was to see more clinicians specialty certified.
Yes. Um, and over the past, uh, year, year and a half, I think you guys are at about 89% of specialty certifications, um, approved by the um, A BPT, correct?
JeMe: Right, right. Or, or the equivalent like we said. Um. So I think that in this day and age, as therapists are trying to continue to work at the top of their license, which I'm a huge advocate for, I really believe that orthopedic PTs should be the PCP for MSK 'cause they do it better than anybody else, perhaps except an orthopedic surgeon.
Um, and there's data out there that actually supports that. With all the clinicians out there that treat MSK after an orthopedic surgeon, the next best person is a pt. But in order to do that, we have to work at the top of our license, and it's wonderful that we graduate with A DPT, but it's still an entry level degree.
And you still agree when you come out and it's with, I think what's so important is your first five to seven years of practice where you really need to be a sponge and you need to learn and grow, empower, test those skills because like anything in life, the more you see and the more you experience. The better you are at diagnosing or picking up red flags or knowing something's wrong.
Uh, so I think that is also super important. And being at a facility like HSS, we do need to be at the top of our game. So in our field, in physical therapy, I think the national average now might be around 18%. 17, 18% holds a, um, specialty certification. So I am so proud of the team that they're at 89%.
Marla: And I wanted to go back.
You had mentioned PCP, that's primary care provider, and I think that is so invaluable right now. It's a topic that I, you know, I think we can have a whole nother podcast about. Okay. But I do believe that our clinicians should be the first point of contact and the first part in the medical system to help them.
Decrease healthcare utilization and, and expenditure and all that excessive amount that we're doing. So I love that. That's your goal.
JeMe: Yeah.
Marla: And you guys are creating a career ladder that helps achieve that. Correct? Because then we can meet those primary care providers in the system.
JeMe: Correct. And I think it's especially for Ms.
K. Right. Uh, and our primary care physicians are so overwhelmed, um, 'cause there's such a shortage of them that they should be focused on like medical stuff. I'd take. Um, an Ms. Case, really not their sweet spot, and it's gonna take some time, but I think that's the paradigm that we really need to be shifting to, you know, with the proper education.
So, as you know, um, IHSS, not only do you need to be board certified, either OCS or SCS, you need to pass our advanced orthopedic triage ation. Um, and it's because we wanna make sure. That people really know red flags. And it's not so much about the orthopedic piece, it's just when someone's coming into you cold that you haven't seen them and probably no other healthcare provider has.
And I'm not sure in school we do enough about those other diagnostic, um, catches and red flags. So our orthopedic uh, triage certification is designed to help. Educate or reeducate people about how important that is. And so there's like a seven hour didactic program. Uh, there's a practical and then there's actually an exam.
So I think that with it at HSS, that's how we do it. Um, enough that that is the way everybody does it, and that's okay. But we wanted to have that list of protection, I think, and assurance that. The therapists that we're putting out there and we are touting and we are encouraging that we've done everything that we can to make sure that they are ready and equipped to deal.
'cause we're not looking to set anybody up to sale.
Marla: Perfect. Always putting the process and procedures in place Correct. For that successful at their end to be able to be that, that primary care provider. So wanna dig a little deeper into the career ladder For sure. For, especially for anyone listening who maybe is a small practice owner, a mid practice owner and says, oh, how do, I just don't know how to create this career ladder.
What, where to start, what to do? So if you could tell us what do you feel are the most important components?
JeMe: Mm-hmm.
Marla: And walk through just some must haves Yeah. In that career ladder.
JeMe: Yeah.
Marla: Um, and how you recommend setting it up, let's say for maybe a smaller organization that doesn't have. You know, maybe the resources of a big hospital become.
Right,
JeMe: right. Okay. Happy to. Um, and let me just say this on the podcast here and speaking with you, I'm happy to speak to anybody. Um, so anybody listening, if you wanted to reach out to Marla or reach out to me, uh, Marla knows as well 'cause we've worked together. Uh, but I'm happy to help you. Uh, so a few things.
I think you have to decide as the owner, what are you trying to achieve and how many ladders do you want, like how big your team is. Like obviously you're not gonna have a career ladder with three levels. Maybe if you have three people. Not really sure. So it depends on what you want. Um, everyone who comes into HSS comes in as a staff, you know, I mean, that's the lower, lowest level, not that everyone comes in at that level.
Right. That's the other thing with recruiting. If you have a ladder, you can hire into specialist or lead or advanced clinician. So I think it helps with recruiting.
Marla: Mm.
JeMe: Uh, especially if you want a seasoned clinician and not just a new grad. Um, but when new grads are great too. But I think you have to decide how many ladder, how many levels you want, and what's important.
So again, remember this is iterative. It wasn't like this when we started 30 years ago, but now what was important was the specialty certification as kind of a benchmark. Like we wanted to encourage people to get them that, and we wanted, and we know that that takes time. So that was how we came up with clinical specialist.
As a requirement for that, um, we decided that advanced clinician was more geared to someone who was a go-getter, like who's been on your team maybe two years, year and a half, two years. They are, they work hard, they've got a great attitude. Um, they help out with community events. They do some other things.
They seem to be interested in growing and as a way to encourage them to continue to
Marla: grow.
JeMe: Um, so that's how we came up with Advanced Clinician. So for us, there were a few key metrics I'm happy to share. As, as I said, they go real, they're really broken down into three clear buckets, clinical excellence and what, what does that look like?
Um, coupled with metrics, practice metrics, which are important. They have a business run. Behaviors, what are we looking for behaviorally, culturally, like if you have core values. What are those core values that's in there? You get right on those. Um, are you an ambassador for the practice or ambassador for HSS Rehab?
So that's clearly delineated in our core values. And then where's your leadership potential? Um, and I'm not talking about having a fancy title. Do you chair a committee? Do, are you the point person if we're running a recovery zone, do you offer to chair a thing? Um. Are you involved in things externally from HSS?
Do you have external facing things in terms of research or in terms of presentations or national presence at CSM or PPS or you know, cerebral Palsy Academy or the Gate Society, like wherever your specialty are, the hand society, wherever your specialty is within HSS. Um, so this is an important point, I think was so, Marla, for those who don't know.
HSS is an orthopedic specialty hospital, so no one's a general orthopedist. Everybody's in the service
Marla: line.
JeMe: So we have a sports service line, a hand service line, a pediatric service line, a full ankle service line, spine service line, et cetera, et cetera. Specialist. For an specialist, correct. So our team at HSS is sub-specialized to support that.
Okay. Um, I forgot arthroplasty, our beta and our arthroplasty service line. So we've done that across, you know, across service lines. So I think that's important, um, for us. But the general criteria is exactly the same. So hand therapist needs to be CHT. If they're O CS two, that's great, but that thing is CHT.
P need to be PCS or NDT, either or is, um, sports need to be SCSI don't CS you need to be SDS. So I think that's important for people to decide and for more of a general practice, maybe it doesn't matter. Any one of those is, you know, you know, is great. I think the other thing, and those criteria are the same, what we've done.
Is, it's not just for the, for PTOT speech, we've created ladders for every job classification in our system.
Marla: That's great.
JeMe: So our patient access team has patient access one, patient access two, and then I think, you know, three and Lee or something. Um, for our engineers, like in our motion lab, there is a ladder.
You're engineer, a senior engineer. Because I think it was important, 'cause we didn't have that for a long time. That's relatively new since COVID, that it was only focused on the clinicians in our organization. And it's not just about the clinicians, it's about everybody on the team that contributes to a successful outcome.
And so we have now subsequently created. Ladders with criteria similar along with those things. Um, like a coding certification for someone at the front desk get you more money. Um, but the, and the process is the exact same. There's an application process. We do it every year in March. It gets reviewed by a committee.
The announcements are made in June and all the salary increases happen in July. Happens every year. You have to though, be in your job classification for two years before you can. Reapply for the next. Yeah.
Marla: Now you also mentioned metrics and KPIs. Yes. And you said it's important too. So you're, you're looking at obviously clinical quality, but also business acumen.
So can you tell us a little bit about what metrics are in there?
JeMe: Yeah, sure. Um, so every therapist has a productivity target based on their schedule or other things they may be doing during the day. So they have to hit that, um, for your performance appraisal. 3.5, you can't apply if you don't get a, we, we have a scale currently of zero to four, so you need to get a 3.5 in order to be able to apply.
Um, and then we have some, uh, what we would call the billing list for people who can't seem to get their billing done in a timely fashion. So if you are, um. Someone who is on that frequently, that may not be looked at as positively because we have to, as clinicians do the whole thing right when we close the deal, which means we need to write our notes in Bill.
Um, so those are some of the key, the key metrics. Um, I think over time as we are changing now actually our satisfaction, we are looking at, um, we have the potential to look at individual satisfaction scores. Um, for maybe 2026 or 2027 we're, we're shifting to a new platform, TPD 'cause it's just rolling out now.
So there may be something to actually add, maybe somebody's individual NPS or patient SAT score, which I think is important. Um, and then interesting, as I was mentioning before, the clinical leads of the leads this other entity we're thinking of maybe having you, you have to be recommended. Maybe very few people in the HSS community.
So maybe a physician, a surgeon, a colleague, maybe somebody from research. Uh, not sure, but the team that's flushing it out. It's fascinating. And the goal is to have a few, right? So right now we do not have a set number that also is important. We used to have a number, I can't remember the number, but let's say we could only have.
10 advanced clinicians and five clinical. We don't, we don't have any numbers from that. Uh, if you are qualified and if you do it and you've hit the mark, you, you should continue to grow this new concept we're looking at, which would be the top of the food chain for a clinical a, right? Because if you decide to go into management, let's just say you could be a manager, you can be a director, you can be.
A senior director, an A VPA vp, an SVP, there's more upward mobility, I guess, if we're gonna use comparative words. So this would be the top. And obviously as you grew up like that, there's less or less, right? There's less that, you know, there's one SVP, there's two VPs, right? So this would be something mirrored like that.
There would be a set number, real five seven, but this would be our elite team. That is our resource. But also then driving. What we're doing for clinical excellence and proactively keeping us ahead of the curve.
Marla: They're helping create the clinical excellence. Correct. Any of the knowledge base that you are building your
JeMe: systems.
Correct. I I love that. And where should we be, right? Mm-hmm. And how are they? Um, interacting with industry and how are we staying in touch with what's happening? 'cause sometimes in academic medicine, you can get sucked into your own little world and it's this little cocoon, um, not good. And you need to be paying attention to what's happening, you know, from the outside.
I mean, I think for me, you know, we formed the network, uh, 30 years ago, which is a. Kind of like a PPO for private practices. We have about like 250 of them in the tri-state Florida. It, it was great because we were getting information back from the private practice owners or people who were part of corporate versus academic medicine.
Yeah. And having those partners, I think made us stronger and made our system stronger. So this is important for us moving forward, and especially as you know. Working with you all and talking about AI and talking about where things are heading, um, you really need to be in it because it's changing so fast.
It's so exciting, but it is changing so fast. And, um, I think that that's important for us with people who are clinically excellent, kind of merge in what's happening. Does that make sense? Yes. I dunno how you feel about that, but
Marla: Yeah, no, I, I absolutely agree. And I, I love that you mentioned that you've got this nonclinical path and this clinical path for career letters and growth and you have it for clinicians and your admin.
So it, it's really impressive to know that, um, those clinicians that may leave or even go nonclinical, 'cause they just don't have that path to really grow in. That's why. Something like this is really valuable to see those clinicians stay, grow, learn, continue to, um, inspire curiosity. Um, and they feel like every day, like you said in the beginning, they're at a place where they just love to be.
JeMe: Yeah.
Marla: And they're, they're excelling there, they're stagnant.
JeMe: And I think, you know, from a leadership perspective, if we talk about leadership and as we've gotten bigger, right? Um. In the old days, I could be everywhere. I hired everybody. Like that's just not possible now, right? 22 locations, four states, not possible.
So local leadership is key, and I think the, the, the win is a clinical leader, like a really key clinical leader for excellence and stuff. And then your manager, director, leader, and when they work together in concert, I think it's phenomenal. And you have this. Great, beautiful crescendo of awesomeness happening in the local level because where the team comes every day is in that local clinic.
So what happens in that local clinic is critical. And then the way we cascade information down is critical. But what we were finding was that the clinicians were almost getting stagnated because there wasn't enough room for them to grow if you didn't wanna go on the manager side. And not everybody wants to, and not everyone has the skillset, right?
Yeah. Just 'cause you're an awesome clinician. It doesn't mean you're a good leader in terms of leading a team and leading the business, and like they're not transferable. And in the old days, back before you were born, um, the best therapist got promoted to the director or the best pa or the best, like best nurse.
That's not the way it works anymore. And it, and it shouldn't be because those skills, some, some people have both and, and some people just don't. And you need to know what you're hiring for.
Marla: I, I think you made such a good point. The best clinicians don't necessarily want to or make the best regional directors, clinic directors,
JeMe: correct.
Marla: Business leader. Right. And I do believe that a lot of our mass exodus in PT or in rehab in general is because those clinicians are forced to either go that way, right. Or have to go into. Nonclinical, right. To be able to grow or you have to lead to go into a different field. So I, I think that's phenomenal to, to know that you guys really thought about that in your clinical career ladder and created that clinical path, that nonclinical path and that ability to
JeMe: Yeah.
Marla: Be a leader.
JeMe: Yeah.
Marla: At the same level of a business vp. Correct. In clinical sense.
JeMe: Right. So it's in process. So that, so we're getting there, but the aspirations there, the vision is there, hoping to launch it next year in, in, in 2026. Awesome. Um, 'cause I, it's, it, it really is so, so important. Um, so, so I would agree with you.
Marla: Yeah. And just for the small clinics, this is. Making the foundation for as they grow. 'cause I know a lot of prom clinics, that's all they wanna do is grow and they really are. They, they've got all the tools to do so. Um, and for the large clinics, it's a great way to look back and say, okay, what is my retention?
What am I spending on the amount of new hiring and people just coming in and going and how, how can I emulate this to get that retention to be greater and to have leaders that have been here for 20 years. And continue to be by mini Me and expanding it in that region, in that area.
JeMe: You know, I think what's hard to sell sometimes is the ROI.
Yes. Or the clinical ladder. 'cause it is an investment. Um, and every clinic is different and every leadership and management team is different. But I think, um, speaking about how important education is and speaking about, um. The specialty certification and what that means perhaps for a brand awareness for that clinic or a brand awareness for that facility is important.
Um, speaking about retention and the cost of retention, right? So every time a therapist leaves and you have to recruit, sometimes you lose patient volume, uh, or you can't just absorb everything or there's not attempt to hire, and then you need to spend money recruiting and then you need to take time. To interview instead of maybe doing other things you'd rather be doing for business development or marketing.
Like those all have a price tag. My, if I had guess it's probably a hundred thousand dollars per clinician, at least. Right? Just us. Um, when they leave, that's the cost. Um, again, we can talk about having a bullpen and having per diems on, I mean, there's lots of strategies to help to mitigate that, but. If you have people, and this is where your hiring process is important, that you want to stay and grow, right?
So you need to make sure you're hiring the right people to start with them. My opinion, that are bought into your culture and bought into your clinical excellence or core values or whatever's important to the clinical owner or the director, whatever. Whatever those teeth things are, you wanna hire for that.
So we don't hire for talents. We hire for culture, not that you obviously have to be licensed and are there times we, we need somebody special? Yes, of course, but for the most part we hire for culture. Um, 'cause we're blessed with a team that can train and there's a system in place that you can learn and grow and get educated and do almost anything that you want to do.
And it is supported internally and or supported externally with money. Of course could always
Marla: need more money
JeMe: end dates. Like we really invest in that. That's a decision. That's a decision people make, right? So maybe instead of buying a ton of swag, you put more money into education. I mean, there's a bucket of money.
You just need to decide. And I'm not, I'm all for swag. I love swag, swag, cost, money. Um, and maybe you wanna take some of that money and put it back into education or supporting continuing ed or supporting a residency or supporting. Uh, studying for an OCS exam. So I think it's also a choice. People have to decide to make.
Marla: Yep. And I assume that mentorship and mentors are on the career ladder, so you actually have to be a mentor and give back.
JeMe: Yes. '
Marla: cause you just said a lot of your ability to grow your leaders are through, is through mentorship. So I assume that's a big part of the career ladder too.
JeMe: Correct? Correct.
Teaching is a bit teaching. Teaching in general. Yeah. Mentoring and teaching and, and then what other roles have we played being a faculty member in a residency or a fellowship? So there's a whole bunch of. You know, happy to share. Um, and they're broken down. So it's super specific, even related to under a behavior like communication, do you bring positive energy into the clinic?
Um, how influential are you? Um, how do you handle stress? How flexible are you? Like there are, are you really a team player? I mean, there are some very specific phase, um, and some people get caught up because. They have amazing clinical skills and they may have every certification, but they don't have the right leadership or the right, um, gravitas, if you will, for what they're looking for for the next step for leaders and the, the behaviors and what people bring to the clinic, which, you know, is so, it's tangential and it's small, but it's so important.
So one toxic person, it takes four to six positive people to. Deflect the toxicity of one toxic person. So the goal is not to hire toxicity and if you have toxicity to try to exit it from your clinic. Um, but you know, it's tough. And you know, we were talking earlier, I think you, uh, have had some podcasts on burnout, um, as you know, not my favorite word 'cause it's negative, but it's real.
Um, stuff like that kills the clinic. Like there are some things that are controlling and some things not. And. Helping people with wellness and resiliency and understanding what's in their control, what's not, but working every day to create an environment where you come to work that's positive, not perfect.
Everyone has a bad pay positive and people are there to be team players, like that's key. To an underlying foundation of a decent culture. Yeah. Decent to good culture, right?
Marla: Yeah. Excellence breeds excellence. I know when I was at HSS and you know, you, they'd say, we have this. Summit or symposium coming up, who wants to give me a presenter at it?
You would have everybody raise their parents. They would all be there wanting to be the one and would, you would be an honor to get picked. Sometimes if you don't have that culture again or rewarding the culture, like you said, it's on your career ladder, um, then, then nobody wants to do that. And, and that's one example.
Not everyone's gonna have a symposium that they're giving, but let's say it's like, who wants to go to the local university and get a talk? Who wants to go to our, um. Our local, uh, YMCA and do a presentation. Like it's actually having everybody want to be the one to get picked, not just, oh, how am I gonna get a volunteer?
Um, having that culture where they, they, they wanna continue to grow is what I think a career ladder helps.
JeMe: Right? And, and as we, you know, it's so iterative, right? They're so intertwined. It's not having one without the other. And either way, it's something everybody has to work on every day. Okay. I think when we talk about culture, right, we should be bringing up the best version to our of ourselves every day.
To where everyone oh, um, to the best of our ability. And I think that that's, you know, that's super important. But yes, I think the career ladder provides a framework that's very clear. It's as objective as it can be, right? Like everything in life. And definitely has some, as we were talking, some really clear, if, if you don't have this key answer, no, like it's not well.
They're really good or they've taken so much continu with no, there's some black and white stocks for sure. Um, but then you have to have some other pieces related to behavior and leadership. If those are important to you, like that may not be something that other people think are important, that's fine.
They just wanna do it clinically. Um, so you do ev everyone has the freedom to put in what they think are best and, but that's how we started what is most important to us in big buckets. And then how do we. Do like the dropdown into, so what does that look like when, when we talk about behavior or we talk about leadership and what examples are we looking for so you can see, and then who's ever selected we meet with.
And if you're not selected at that time, we meet with and we go through and highlight exactly where you are missing. Right? Because the goal is to have people succeed. It's not supposed to be punitive. Like the goal is to continue to work, to have everybody grow. Um, but you need to make, and of course it gets harder, like everything in life, right?
It gets a little more challenging as you move up the ladder. Not impossible, but more challenging. And this now, this upper, upper tier. Um, but that's, I think that's important. And not everybody wants to take it the next level, right? Like people might wanna get their OCS or SCS and they don't really have an interest in presenting at a national meeting.
Well, then you're gonna stop there and that's okay. That you don't, not, not everyone will be at the top. And, and that's okay. We want people to be comfortable with where they are and also if they wanna go and do some different things, they know what it will take to get to the next level. Not everybody wants to put in that much effort.
And sometimes, as we all know with our lives, you know, life ebbs and flows right? Where we have more time or less time, our personal life. You have kids, you're moving, you're getting married. I mean, there's only so many things a person can't focus on at one time. Um, so that's why it's there. And, and it's dynamic and that's why we do it every, we, we chose to do it every year at the same time.
That makes
Marla: sense. It does. And you really are, as you just said, you're, you're choosing exactly who you, what you want to create
JeMe: for your
Marla: organization. Mm-hmm. Then you're creating that career ladder, almost like a resume going backwards. Like, this is what you want, this is all the pieces you should have to get hired production.
JeMe: Correct. And that's a great way to look at it. Yeah.
Marla: And then you're molding those individuals to that
JeMe: and it's totally transparent.
Marla: Yeah.
JeMe: There's no hidden secrets. Yeah. It,
Marla: and your big ROI, like you said, is really retention, culture, branding, and. I know important to HSS is being the educational leaders in the right
JeMe: and and clinic.
Yeah. Clinical access is probably being number one, but yes. All, all of the above it breeds. Maybe they're all together in the number one, right? It breeds all of those things.
Marla: And outcomes
assumed
Marla: too
JeMe: are so, yeah, so popular. Um, and so not popular. Sorry for all those things that are so important. To, to HSS and, and probably to everybody, right.
But again, people have to choose what's best for them, right? Just like different organizations have a different culture. One isn't necessarily better than the other, it's just some people fit better in one place than another. Right. Or some key players do better for one coach versus another coach. My guess is the player's skills are pretty much the same, but one coach can draw somebody out better.
I mean, that's kind of just life and then that crazy connection or whatever that, that, that people have.
Marla: Yeah. Perfect. Yep. I, I think that makes perfect sense. Yeah. And I love, you know, being able to lay out that foundation and how people can help create it themselves. Um, important question that I know a lot of people are gonna ask is how do you track it?
Yeah. And I know you're very large, so can you tell us how you tracked it when you were small versus making now at scale, how you track it?
JeMe: Yeah, so probably like everybody, we tracked it on paper at first, and then we went to Excel. Okay. And now we, we use a system called Workday, but there's a lot of HR based systems.
Um, it just launched at HSS about a year ago, but it does have the ability by person to put in the system what certifications you have. What's your title? Like, what's the range of pay for that title? Like, so the individual employee can see it of kind of where they are and they can own. Kind of what, what they put in.
And then there are certain people that obviously have administrative rights. Uh, so we review it and make sure it's accurate and then you can query it. So you can pull information out, like how many people have a CHT, how many people are in dt? Big store wants to put into the system. So I think for larger organizations, that's really important.
Um, what we're working on now is what do you do with Recertifications? Um, and how do you track that? Like, and if you got it and you're supposed to recertify and you didn't, what do you do? So our decision right now has been for the really big ones, OCS, you need to recert in order to use those letters.
Right? Some of the others are a little more bright, right? Um, but I think that one's now 10 years. Um, so we're trying to figure out how you track research. Uh, so that's number one. So not figured that out yet. Let me do the thing, you know, and, and make sure that's happening. Second thing is, if you lose it, you take away money or not.
Don't know the answer to that. Interesting. You got it for having it now. You don't, not sure the answers to that. Um, and then, uh, the third thing, which I lost my train of thought. Was reevaluating your clinical ladder and your certifications on a normal ongoing basis. So we do it every two years. That's actually, we get the ladder and we look at the cer, 'cause things change, things come in, things we put on that nobody has, like, we took off other things that may have come up in some, some other disciplines or things that people are doing.
Um, so, so we just look at it for accuracy, to tighten, uh, to make sure we have the right. The right ones are, is it still applicable? Um, so we have a team that looks at that, or, uh, we look at the clinical ladder. So it's on a biannual basis. One year is the ladder, one year the certifications. And then if there are certifications that have been put out there that are new, perhaps, um, people can apply or, or put a recommendation in to get that certification.
On the tier certification list. Does that make sense?
Marla: Yes.
JeMe: Um, and then the team will look at that and we have, we've put things on, we've taken things off, um, because it's dynamic and we've probably had this clinical ladder now, probably, probably since COVID, so it's five years.
Marla: Yeah. That, and that makes total sense because the industry is always changing and skills and certifications and what we want.
JeMe: Right.
Marla: Probably your primary care provider certification is new and very important.
JeMe: Right? Right, exactly. And, and who knows what's gonna happen with ai.
Marla: Yes.
JeMe: You know? Yes. Like is there gonna be an AI certification for healthcare or you know, we're, you know, we're moving into the whole AI and ambient listening world for documentation and.
I mean, listen, I, I don't know the answers to these things, but certainly I could see that coming.
Marla: Well, I, I think that's a great point. Like you said, you have to decide what's important in your organization that you're trying to create.
JeMe: Mm-hmm.
Marla: And put that on there. So maybe it is innovation in AI and you want that lead, so that's at the top of your rung and you've got some kind of certification that they have to achieve or skillset that they've given to get to that level.
JeMe: Right, exactly.
Marla: Great. Um, so I mean, this has been so instrumental, so helpful. I would say, just in closing, if you wanted to recommend to anyone listening of a, why they should have a career ladder in place B, you know, just
JeMe: the,
Marla: the way to sort of start that and, and get there. Uh, and c how, how to reach out to you if they have any questions.
JeMe: Yeah, sure. So we can't forget that people are our greatest asset and if you don't have the right people on your team, you don't have the business. So. Okay. There's no better reason why piece, and you wanna attract people, I would think, that wanna learn and grow. And for your business, retention is very costly.
And having to hire and train and hire and train and you build more continuity and it really hurts your brand. So for me, that would be the big, big.
Marla: Another one,
JeMe: how I would start is as the leader, I would put some things down that I think are important. And then I would get a group from your team to put down what they think are important.
Um, and then I would compare them and then start to create how many levels. Um, I would help, depending on how big your team is, uh, what's important. Um, and then put, you have some key metrics. I do think we need things that are black and white. We have to, our previous ladders were much more gray and much more subjective.
So I think we need some. Uh, things that are pretty black and white. That's just my opinion. Um, and that's, and that's how you start. And then you decide, are you rewarding it for money? We're gonna do a bonus, you're gonna do a salary. I'm not for the bonus, because that's one time. And I think bonuses need to be associated with other things.
Maybe productivity, maybe the success of the business. That's a thank you at the end of the year. Um, but not for something that you get benefit for, for forever. So when sometimes they're OCS, you don't get a benefit just 'cause they got it in July. You, you, you've gotten that knowledge and that knowledge is gonna go with them for years.
And I think you need to be paying for that because that's super important and salaries. For therapists will never rise if the people who are controlling the perpetrator don't invest in that. Sure. So I think it's super important to continue to support our profession. And if I may, when you think about many, many people coming out of school with six figures of debt, which I learned about a few years ago, that's staggering.
And we need to help. Like why would people go in now? It wasn't like that when I went in, you know, the year of the dinosaur, but that's nuts. And that's the reality of people that we're hiring and now they need to live and they need to pay rent. And I think we have an obligation as leaders in the field to help support that and to help support financially, the knowledge DPTs and other.
An occupational therapist and speak to language pathologists and exercise physiologists, and they have amazing knowledge and we need to support that. And I think that's our part of our mission as leaders in the field. Um, those are some things we can do to help our teams and help people grow and, and perhaps help them to choose to stay.
So that's, that would be my closing thoughts. I mean, anyone is free to reach out to me, Morela. I don't know how people get information or if you're going to share it, but people can email me or they can call me at HSS. Um, I would be happy to help you have a team of people who work on this, but happy to take any calls.
I feel very passionately about staff growth and development and, um, helping people be the best they can be.
Marla: Thank you Jamie. This was fantastic. Uh, such a pleasure to have you and to share your knowledge with everyone. We really appreciate it and um, just can't make you enough for being here.
JeMe: Well, thank you for inviting me and always a pleasure to be with you.