I Was a PT Before I Was an Operator

Flexibility. Creativity. Travel. Autonomy. The prestige of a “doctor” title without a decade in med school. As a high schooler, I picked physical therapy for none of the reasons guidance counselors expect to hear. I had a nomadic, independent streak that needed a career built around it—and PT was the one that fit.

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If you’ve met me more recently, you probably know a different list of traits: bold, action-focused, quick to have a hard conversation, happy with a spreadsheet of data in front of me and intent on building teams that are empowered to act. That version of me is real. But it’s not where this starts. Underneath it is the part most people don’t see—the part that shaped this journey and made me fall for this profession in the first place. Let me show you instead of telling you.

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Before I managed more than 50 locations across three states, and before “patient access” had a title attached to it, I was a physical therapist. It started with treating people with substance use disorders and psychiatric conditions in skilled nursing and long-term care. I spent about five years in patient care—the part that never makes it onto my résumé because it’s the kind of work that doesn’t photograph well for LinkedIn.

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That experience built everything else, including the closest thing I have to a professional mission.

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Let me tell you about Richie.

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Richie

Richie is a composite built from patterns I saw again and again over years of practice. The details have been shaped to protect patient privacy, but the lesson underneath them is real.

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I met Richie about two and a half years into my long-term care work. He came to my facility following a total knee replacement that had not given him the outcome he hoped for—not two weeks after surgery, but two years later.

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Before that, Richie had built something big. He’d opened and run two restaurants, building them from nothing. He was the kind of guy people still talked about years after he retired. Heck, they still brought him pasta and steak despite my recommendation that he follow a strict diet.

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We hit it off instantly—both foodies, both a little obsessed with how a kitchen actually runs. He spent our time together handing me leadership lessons whether I asked for them or not. He taught me the way he ran a kitchen: direct, a little blunt and with quite a few cuss words. I liked him immediately for it.

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He had an eye for process improvement before I had a word for it, along with a gift for recognizing what made someone good at their job. He gave me some of that gift, too, back when I had none of my own yet.

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When he retired, his insurance coverage was limited. After the knee replacement, his access to rehabilitation was shaped by what the policy would cover. He did not fully understand the consequences of going without therapy, and he was not in a position to advocate for more. Too much rehabilitation was missed, and medication became the primary way his pain was managed.

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When that medication was no longer available, Richie turned to street drugs to manage his pain. His ability to care for himself declined. Without the rehabilitation he needed, his mobility continued to worsen until he was using a wheelchair. His cardiac health declined, too.

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Two years after a surgery that was meant to give him his life back, he came through our doors unable to walk. Not long after, a cardiac complication took him from the world.

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I spent time with him that had nothing to do with a treatment plan—on my own time, because by then he wasn’t a caseload number to me. He was someone who had taught me things nobody else had bothered to. Losing him is still one of the few professional losses I have never forgotten, and I don’t think I’m supposed to.

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Richie didn’t end up in long-term care because of one bad diagnosis. He ended up there after too many opportunities to intervene had passed. Every year made the next option smaller.

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What Richie—and So Many Like Him—Taught Me

I think about Richie more than I let on, usually while staring at an access metric that someone on my team thinks is just a number on a slide.

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It never is to me.

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By the time someone lands in long-term care, too many of their options may already be gone. It is rarely one dramatic failure. It can be a skipped rehabilitation appointment, a prescription that solves pain and quietly creates a new problem, or a policy that never covered what the next ten years would actually require.

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It compounds.

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Nobody plans to end up in a wheelchair. They get there one missed opportunity at a time, and often no one sees the full pattern until it is difficult to reverse.

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Pain and mobility aren’t the “soft” part of healthcare. They’re where someone’s whole life either holds together or doesn’t. Many patients I treated in that population had some version of a Richie story underneath it—a joint that never received the right rehabilitation, a pain plan that addressed one problem while creating others, or a system built to catch people after the fall instead of before it.

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I learned to see the person before the diagnosis because the diagnosis was rarely where the real story started.

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Access isn’t a nice-to-have. It’s the mercy we don’t call mercy.

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This is one of the central promises of outpatient PT—the work we do at CORA every day. We get to be the early intervention Richie never had. We get to manage pain, protect mobility and help keep someone’s quality of life intact before any of it compounds into something nobody can walk back.

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That’s not a business line to me. That’s the closest thing I have to a calling.

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Going Back to Outpatient PT, I Learned Access Isn’t Just a Front-Office Job

When I returned to outpatient PT, I expected to feel like I was starting over.

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I didn’t expect to find that the same lesson from long-term care was waiting for me at the treatment table—just earlier in the timeline, where it could still do some good.

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We talk about access a lot in terms of the front office: scheduling speed, intake forms and how many rings it takes before someone answers the phone. That’s real, and it matters. But clinicians build access too, every day, usually without realizing that’s what they’re doing.

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You’re the one who catches it first. A patient mentions they’ve been “managing” knee pain for three years with over-the-counter medication and a limp they’ve gotten used to. That offhand comment may be an access failure already in progress, and you’re the first person positioned to interrupt it before it becomes someone’s Richie story.

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How you educate a patient is access. A patient who understands why they’re doing an exercise—and what may happen if they stop—is more likely to return. A patient who leaves confused may return less consistently, or not at all. That’s access, even if nobody calls it that on a dashboard.

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Your referral instincts are access. Flagging a patient who needs a conversation about pain management before it becomes a prescription problem can close an important gap. So can recognizing when transportation or another obstacle may keep someone from returning.

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Your flexibility is access. Looking for a way to help a patient who is clearly struggling, even when the schedule seems full, can have effects you may never see.

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I didn’t see Richie’s turning point happen. I saw where it ended up. Somewhere along his timeline, there may have been an opportunity to change his trajectory. I think about who that could have been more than I think about blame.

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You don’t need a title with “access” in it to protect someone from ending up where Richie did. You need to recognize that the small, unglamorous decisions you make during a treatment session may be the only early intervention a patient is going to get.

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I didn’t understand that when I was treating in long-term care. I understood it instantly when I came back to outpatient care and realized I was now standing at the point in someone’s story where Richie’s version could have gone differently.

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Why This Is the Job Now

I went back to outpatient PT because I wanted to work on the other side of that timeline—the side where there was still time to change the outcome.

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Clinic management came next, followed by regional leadership and operations. None of it was a departure from what I learned in long-term care. It was the same care, just further upstream, with more people affected by whether I got it right.

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Now, as Senior Vice President of Operations and Director of Patient Access, every access decision I make—how quickly someone gets seen, how far they have to drive or whether intake makes care easier to enter—is a decision about whether the next Richie gets caught early enough to matter.

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Every operations decision can affect clinical care.

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I was a PT first. That is why I think about him when I’m staring at a wait-time report. I think about him every time I see CORA expand care into a community where people need it. I think about him when someone asks why I spend so much time on access while so many other priorities demand attention.

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I’ll give you the blunt version and the honest one, because they’re the same thing: access isn’t the metric I report. It’s the person I couldn’t help in time and the ones I still can.

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That includes the people being treated in our clinics right now, often in ways that are easy to miss.