Pioneering Outpatient Neuro with Dr. Mike Studer

[00:00:00] Welcome back to Untold Physio Stories. I'm one of your hosts, Dr. E with Modern Manual Therapy and Edge Mobility System. My co-host is not with me today, but I'm with Dr. Mike Studer. How's it going today, Mike?

[00:00:11] It's going great. And how are you?

[00:00:13] I'm great. Welcome to Untold Physio Stories.

[00:00:15] I'm glad to be here.

[00:00:17] Yeah. So why don't you give a quick intro and then tell us your clinic's origin story, I believe.

[00:00:23] Okay. Quick intro is just that I'm a physical therapist, very passionate about neurogeriatrics, also sports and orthopedics, have been a PT for 33 years and board certified as a neurologic clinical specialist since 95. That's my brief story.

[00:00:43] All right. And then why don't you tell the story that I had you on the podcast for?

[00:00:47] Yeah. So we discussed the fact that back in 2004 and actually still today, it was quite novel at the time for me to consider that I might open my own outpatient freestanding physical therapy clinic that was focused on neurologic physical therapy.

[00:01:08] And I did so in Salem, Oregon, was a great town and still is. And really, it's in a marketplace that shouldn't have supported its own freestanding outpatient neuro clinic because the hospital was already very successful, had no other competition for other hospitals in the area and has and at the time still had a very strong outpatient neuro program.

[00:01:35] So really, it's very novel to consider that you could break off and expect that people were just going to start referring persons that had had a stroke that went through a hospital system and weren't going to be funneled into that hospital's outpatient rehab system.

[00:01:52] But that was the case. And we succeeded from that point.

[00:01:56] So what made you want to do that, though?

[00:01:58] Well, it's very interesting, and I appreciate the question.

[00:02:02] I have had and still have a very deep passion for providing personalized care.

[00:02:09] When I sit down with someone, I know their story.

[00:02:13] I know them.

[00:02:14] I know how to personalize care to their individual diagnosis, their phenotype of that diagnosis, and them as an individual beyond their medical.

[00:02:24] And I wasn't really seeing the opportunity to deliver that level of personalized, consistent care, one practitioner, one patient consistency with that high level of practice that I was familiar with.

[00:02:40] And so I had to step out on my own to deliver that in 2004.

[00:02:46] Yeah.

[00:02:47] It's funny, though.

[00:02:47] My experience, though, at least doing some acute care and some outpatient neuro, but it's always been hospital-based.

[00:02:53] And I only did that when I was in internships, which was a long time ago, maybe like 28 years ago or something.

[00:03:00] My experience was that every inpatient, whether it's acute or outpatient neuro, they're always one-on-one.

[00:03:10] I mean, is it somehow like where you are – is it like a mill where they're saying we're doing like group stroke therapy or something?

[00:03:18] No, not at all.

[00:03:20] And actually, the hospital, like I said, was very proficient, and productivity was not something that was really harped on strongly in an outpatient neuro setting.

[00:03:33] You weren't seeing multiple patients.

[00:03:34] The main point is that to deliver that consistently and keep the relationship where you're seeing your own patients consistently was difficult,

[00:03:46] and to be able to deliver it with an intensity that in 2004 was really questioned.

[00:03:53] And so the intensity of dosage in neurologic physical therapy is not something that really was on the precipice of the profession at that time.

[00:04:06] And I was delivering high intensity with body weight supported, with therapeutic exercise, with reps and resistance,

[00:04:13] challenging people in terms of their stability and balance.

[00:04:17] And I really felt that in an effort to apply the evidence that was emerging at that time from the three-step conference and other compendiums,

[00:04:29] I needed to break out on my own to deliver the type of care that I felt had great fidelity and also had great outcomes.

[00:04:39] Right.

[00:04:39] Yeah, I mean, I would say not only for neuro patients, but the stuff you're talking about,

[00:04:44] it's just not dosed well for patients in general.

[00:04:47] Mm-hmm.

[00:04:48] You know, I think there's a big misunderstanding.

[00:04:51] I would say PTs complain about it on social media all the time, mostly for musculoskeletal,

[00:04:55] because there's not a lot of, like, ortho content creators or, you know,

[00:05:02] or just even talking about ortho patients on something like LinkedIn or X or Instagram.

[00:05:07] And I always say there's a need for that, really, because everyone's ortho, everyone's sports.

[00:05:12] You know, no one's peds.

[00:05:14] No one's doing neuro.

[00:05:15] But I know there's a big need for it.

[00:05:17] I mean, even when my wife, who's also a PT, when she did a lot of home care, she was still doing, you know,

[00:05:25] using manual therapy and dosing high levels of exercise instead of just, I don't know, whatever, a lot of open chain, easy stuff.

[00:05:34] Right?

[00:05:34] Yes.

[00:05:34] That's kind of like, but I mean, that's, it's a problem with not only ortho.

[00:05:39] It's a problem in every part of the profession, but everyone always just assumes that somehow strength training at a higher intensity

[00:05:47] and balance training at a higher intensity is purely in like an ortho in sports, for an ortho in sports population.

[00:05:53] But what I would always tell my students back when I was an ortho professor, they would tell me, you know, oh, I don't want to do ortho.

[00:05:59] I just want to do neuro.

[00:06:01] And I would just say, everyone's an ortho patient.

[00:06:03] That's right.

[00:06:03] But also, everyone's a neuro patient.

[00:06:06] That's what I say in my manual therapy classes.

[00:06:09] You know, everyone's an ortho patient.

[00:06:10] Everyone's a neuro patient.

[00:06:12] We're seeing that now.

[00:06:13] And that's becoming fully appreciated, obviously, with, you know, the drivers of the nervous system when you have an ortho patient.

[00:06:21] Yeah, absolutely.

[00:06:22] But, you know, that's really kind of my origin story.

[00:06:26] And we started that back in 2004.

[00:06:29] We were successful at that time.

[00:06:32] And then, of course, as you know, people start referring to you patients that you weren't expecting to get, orthopedically inclined patients, impaired patients.

[00:06:42] Now you have the need for, you know, certainly to add other physical therapists, to add occupational, to add speech.

[00:06:49] We grew and grew and grew until the point where, you know, just before the pandemic, we decided to, you know, take this venture that had been going on 17 years at that point.

[00:07:00] And, you know, I was working upwards of 92 hours a week in the last seven years of it and decided to go ahead and transition to make a sale.

[00:07:09] So I transitioned from that in early 2020.

[00:07:13] Okay.

[00:07:13] Well, congrats.

[00:07:14] Yeah.

[00:07:15] That's great.

[00:07:16] So you had everything.

[00:07:18] You had speech, OT, and PT?

[00:07:20] Yeah.

[00:07:21] As a matter of fact, we had speech, OT, PT.

[00:07:24] We had neuro for one building that we built.

[00:07:28] A different building that was 350 feet away was just ortho.

[00:07:32] And then yet another building that was four and a half miles away was just sports and orthopedics in that.

[00:07:38] And that was high level sport performance as well as wellness.

[00:07:42] We had underwater treadmills in every one of the three clinics, two in one clinic, and then one in each of the others.

[00:07:49] Yeah.

[00:07:50] So it was quite a diverse practice, well-equipped, and a wonderful family of individuals to work with as well.

[00:07:57] So I'm curious, how did you initially get patients?

[00:08:02] Because like you said, you know, most people don't even think to go to PT for ortho.

[00:08:06] You know, you see all these questionnaires to the general public, and they're like, who would you go to for spinal pain?

[00:08:10] Who would you go to for muscle injury?

[00:08:12] And, you know, the questionnaire is something like, would you go to PT, chiro, massage therapist, or athletic trainer?

[00:08:18] And the PT should be the answer to all of them, but it's the answer to none of these questions, you know?

[00:08:22] Yeah.

[00:08:22] And that's just for like ortho or MSK type conditions.

[00:08:26] You know, I've been saying that in air quotes.

[00:08:27] So how did you even get referrals or the word out that you were running a freestanding neuro PT clinic?

[00:08:35] Well, I'll tell you, there are many different entities and people that I could give that credit to.

[00:08:41] I'll take none of that myself.

[00:08:42] I'll start off by saying my former employer, Salem Hospital, was gracious enough to keep me on after I told them I'm planning on opening my own clinic.

[00:08:52] I told them in October, I opened my clinic in March.

[00:08:56] They kept me on that whole time and allowed me to continue to work.

[00:09:01] I had already worked for them for 11 consecutive years and built a very good reputation in the Salem clinic or in the Salem community, I should say.

[00:09:11] So physicians knew me personally from my time in the hospital rounding on patients with them and seeing them in the acute care.

[00:09:20] Back in the day, we're in a primary care physician was seeing their own patients in the hospital.

[00:09:25] They didn't have hospitalists that were dedicated.

[00:09:28] So I knew most of the primary care physicians already for the last 11 years.

[00:09:34] So reputation, generosity of the hospital.

[00:09:38] And then you earn your word of mouth reputation after you open your doors.

[00:09:43] And then that just continued to feed and feed logarithmically.

[00:09:48] Awesome.

[00:09:48] Yeah.

[00:09:48] That's similar to how when I opened my first outpatient clinic, I already had built up good word of mouth with a bunch of patients around the community with a bunch of doctors.

[00:09:57] But I didn't have the support of the company that I left.

[00:10:00] I mean, they told everyone you're not allowed to say if anyone asks where Urson goes, you're not allowed to say anything.

[00:10:06] So that is very gracious.

[00:10:09] That is very gracious.

[00:10:10] Well, that is typical.

[00:10:11] I mean, that is very gracious of a hospital to do that for sure.

[00:10:16] You know, in this era, people still sign non-competes.

[00:10:19] And I'm like, I don't even think these are really ever legally binding, but people are still signing up to this day.

[00:10:24] So that's great.

[00:10:26] So what are you doing now that you sold the practice?

[00:10:28] Okay, so I'm working part-time in Las Vegas for PAM rehab, post-acute medical rehab.

[00:10:37] I do inpatient and outpatient rehab there.

[00:10:40] I'm adjunct faculty at Toro University.

[00:10:43] I'm associate faculty.

[00:10:45] Let's see, I should say I'm a PT instructor.

[00:10:48] They don't use the word adjunct at UNLV.

[00:10:51] So I teach on guest lectures and then do clinical education for the entire cohort of their students go through me.

[00:11:01] I lead research projects.

[00:11:03] I'm an author, and I deliver continuing education lectures around the world.

[00:11:08] And I'm very busy with that part as well.

[00:11:10] The author and continuing education is taking up most of my time right now,

[00:11:15] but I still have the great fortune of seeing patients on a regular basis.

[00:11:19] That's great.

[00:11:19] Yeah, good for you.

[00:11:20] Congrats.

[00:11:21] So tell me more about your book.

[00:11:24] I haven't got a chance to read it yet, but I was excited when I saw it on LinkedIn.

[00:11:28] It jumped on it for sure.

[00:11:30] It is going so well right now.

[00:11:32] It's going better than I expected it would, and it's keeping me a little bit busier than I thought.

[00:11:36] So it's called The Brain That Chooses Itself.

[00:11:40] And basically, it's a lifespan and healthspan-focused book.

[00:11:44] And there are a lot of people talking about lifespan and healthspan right now,

[00:11:48] but what I'm hearing from readers and professionals, including the former U.S. surgeon general who endorsed the book,

[00:11:56] Dr. Richard Carmona, he says,

[00:11:59] This is a unique compendium, a unique collection.

[00:12:02] Yes, many people are talking about physical activity, nutrition, sleep, social connectedness, and a few things that I add on.

[00:12:13] I bring all of those into one book and don't talk about supplements and medications and surgeries and procedures because I don't know about those things.

[00:12:23] But I give people exactly what the title suggests.

[00:12:27] It's the brain that chooses itself.

[00:12:30] I give people a level of education that's consumable, layperson or medical,

[00:12:35] and give them the opportunity that from that educational base,

[00:12:39] you can choose what levers you want to pull to operationalize a better lifespan or healthspan for yourself.

[00:12:47] So the five main chapters, which I've alluded to already, are looking at physical activity, nutrition, sleep, social connection,

[00:12:58] but then also we look at what's called beyond the comfort zone.

[00:13:04] So doing things that are for your own health that push your boundaries.

[00:13:09] So we're beyond the saunas and beyond the hot tubs and beyond the cold immersion, but also those things as well.

[00:13:17] Then we've got a lot of applications, behavioral economics,

[00:13:20] and some real stories of patients that I've worked with that apply these things in Chapter 9 as well.

[00:13:26] Awesome. That's great.

[00:13:27] Yeah, I'm totally, I mean, you know, whether it's like time-restricted eating or fasting or cold immersion or saunas,

[00:13:34] I mean, I just try to do every single thing I can to eat the most out of my health, you know?

[00:13:40] And I just figured that like any kind of stressor, right, there's an adaptation from these stressors and things that are tough.

[00:13:48] I just find that like the more I do these things, I get too adapted, you know?

[00:13:52] Like sometimes I'll go a month and I'll eat one meal a day for a month,

[00:13:56] and when I go back to eating more than one meal a day and I'm like, I just gain weight so fast.

[00:14:00] Or now that I'm completely cold adapted, I've been taking cold showers for three years and ice baths regularly.

[00:14:07] I just sweat all the time.

[00:14:08] Like I'm just so hot everywhere, you know?

[00:14:11] You might learn a couple of things from the book because I not only deliver things on a layperson's basis,

[00:14:18] which should be beneath your educational level,

[00:14:21] but every chapter has what's known as the introductory section,

[00:14:25] and then demarcated after that, same chapter has the deeper dive.

[00:14:30] The deeper dive has all the science that you're looking for, all the evidence,

[00:14:34] with well-substantiated and well-methodologized, if you will, studies.

[00:14:42] And it says, here's the deeper dive.

[00:14:44] Here's more information, and here is the science behind it.

[00:14:48] And now, you know, if you're interested and want to actually pursue things,

[00:14:53] you can understand things on that next level to be able to pick and choose.

[00:14:58] Wait a second, maybe I don't need to do that.

[00:15:00] I've heard about this, but it's not as good for me as I thought it might be.

[00:15:04] And so it really speaks to all persons in that regard.

[00:15:11] Great. Awesome.

[00:15:12] Yeah.

[00:15:12] So it's indicated if you're alive.

[00:15:13] That's how I would put it.

[00:15:14] Yeah.

[00:15:15] Yeah.

[00:15:15] Indicated if you're alive and you want to stay that way healthily.

[00:15:19] Awesome.

[00:15:20] All right.

[00:15:21] All right.

[00:15:21] So, all right.

[00:15:22] That's available on Amazon.

[00:15:24] It's the brain that chooses itself.

[00:15:26] And can people find you anywhere else, Mike?

[00:15:29] You know, my website pretty much contains everything else.

[00:15:32] It's just MikeStuder.com.

[00:15:34] If you want to look me up, I mean, you type my name in and you're going to find plenty on the internet.

[00:15:39] TED Talk, MedBridge, ConEd, and et cetera, et cetera.

[00:15:44] It's all up and down.

[00:15:46] All right.

[00:15:46] Hey, thanks.

[00:15:47] Thanks for coming on.

[00:15:48] And if you haven't done it yet, please rate Untold Physio Stories five stars.

[00:15:52] That same thing.

[00:15:53] I would do it.

[00:15:53] Yeah.

[00:15:54] I'm saying that to you, Mike.

[00:15:55] And I'm saying that to you, audience.

[00:15:56] Please rate us five stars wherever you listen to podcasts as that helps our discoverability.

[00:16:01] And make sure to check out Mike's book.

[00:16:03] I'll be excited.

[00:16:05] I'm excited for not only the deep dive but also the lay things.

[00:16:07] You know?

[00:16:08] I mean, like, just sometimes when it's written for a lay person, it's a misconception that every medical provider knows.

[00:16:18] Every single thing about the medical aspect of nutrition or health or sleep, right?

[00:16:23] Yeah.

[00:16:24] So, yeah.

[00:16:25] Yeah.

[00:16:25] And if I have one skill as a clinician, it's a motivator.

[00:16:29] If I have one skill as an author, it's the ability to be able to translate knowledge.

[00:16:34] And that's what I'm hearing from across the world right now.

[00:16:37] Somebody wrote to me from Australia that bought the book recently and just really appreciated how easy of a read this is.

[00:16:44] So, I'm excited for you to dive into it.

[00:16:47] And I'll certainly be rating Untold Physio accordingly.

[00:16:51] And if it's so deserving, please do the same for the book.

[00:16:54] I will for sure.

[00:16:55] All right.

[00:16:56] Thanks for coming on.

[00:16:57] My pleasure.

[00:16:58] Thank you.