Don’t aspire to be the celebrity trainer

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Too many personal trainers decide their industry is only for the upper class. I’m looking at you who charges $100 an hour. You, with your underhand grip, swirling your wine, bragging how aged it is; looking down at me for drinking PBR in a can. [1] You who charges teenagers and their parents close to a thousand dollars a month. You who prices your digital products at $500.

Personal trainers have a unique position in the healthcare world in that, particularly in America’s needing to get better -but slowly getting better- system, they can bridge the gap between the insane costs and those who can’t afford them. [2] As a trainer you likely have little debt; doctors and therapists are hundreds of thousands of dollars in the hole, you often set your own prices (which can be lower because of your lack of debt), you often set your own schedule, you can work with multiple clients at a time driving down each client’s cost (yet keeping your take home pay the same or better), you can negotiate your rent so you only pay rent if you make money, hell, many trainers get by without even using a gym! I’m not sure any other healthcare oriented business can be executed with lower overhead.

Furthermore, and in America this is practically antithetical to how healthcare has operated, if you do a great job with your clients, they often stick around with you. They’ll stay with you for years. What’s even better is if you’re doing a great job that means you’re making money and the client is almost assuredly saving money. Sure, they may be paying you something like a small car payment each month. But that’s nothing compared to the blood pressure meds they no longer have to pay for, the surgery they avoided, the lesser doctor visits, the diabetes they no longer worry about, the money on food they’re saving due to eating less.

This is one of the most perverse aspects of the United States system: Do a shitty job with your patient and you get paid more than if you do a good job. Screw up someone’s surgery? Oh well, guess you get to do another surgery. Forget to wash your hands? Let’s prescribe some not free antibiotics. Screw up someone’s surgical rehab? Guess they’ll have to come back for more sessions. Order a CT scan when you didn’t need to? Pshh, can’t hurt to have it, right? Wait, CT scans increase the risk of a person getting cancer? EVEN BETTER! Ka-Ching, Ka-Ching, Ka – Fucking – Ching.

In personal training, the one giving the services and the one receiving the services are both rewarded when things go well. In most healthcare arenas, not so much.

What’s even more incensing is so much of the healthcare system is a band-aid. It doesn’t get at why things have gotten to the point that your hospital visit costs $50,000.

Putting the above image into simple words: The U.S. overly invests in reacting to severe health issues but underinvests in preventing severe health issues. [3] Personal training is able to help with this. Because those in Washington seem content to manage themselves as if they’re cast members of the upcoming movie “Mean Girls Two,” this spending pattern doesn’t look to be changing anytime soon. So, personal trainers should help with this. I can’t tell you how many clients I’ve had where the first words out of their mouth were, “I had a check up and such and such isn’t looking so great. I’m here to prevent such and such from becoming a serious issue.” It may be bone density, balance, blood pressure, blood sugar, an ailing joint, whatever.

I’ve been picking on doctors, but I can argue the other direction as well: Medicine has a culture that does not turn people away if they can’t afford medicinal services. (Yes, the ER is required by law to treat them as well.) Doctors often take people for too much money, but many doctors do work they’re not compensated for either. Plenty of doctors do not turn people away because they are poor or difficult. Sure, some avoid these populations. Some doctors are even going to cash based practices, completely pricing out anyone but the very wealthy.

My point is can you say the same about trainers? How many trainers are only working to charge more? How many are only trying to be that person profiled on ESPN for training X athlete, or in People Magazine for training Y celebrity? Some doctors are this way, but many go out of their way to work on the other end of the spectrum. Are trainers going out of their way to work on the other end of the spectrum?

Too many personal trainers, people who have the ability to enhance people’s health perhaps more than any other healthcare professional, turn away people because they aren’t wealthy. Too many price people out. Too many don’t want to deal with the really tough clients even though they’re the ones who need it most. Too many say crap like “I only want to work with successful people. People who will pay me what I’m worth.”

Get over yourself.

Amazon’s CEO Jeff Bezos has three guiding business principles, one of which is to be customer focused. Whenever he has a tough decision to make he asks himself, “What’s best for the customer?” Hence, one of my favorite business quotes from him, “There are two types of companies, those that work to charge more and those that work to charge less. We will be the second.”

Let’s go back to dealing with difficult clients. These are the clients where you can make the most impact. On the individual level, they have the most to gain. But it’s not only the individual level; on the societal level this is where most impact can be made as well. The tough clients are those who either cost or will cost the system -that’s all of us- the most. Helping that older person with their balance goes a lot further than helping a fifteen year old jump higher. Preventing joint replacements, diabetes, cardiac surgery, all make more of an impact than helping a celebrity see an extra ab.

There’s a misperception though. That the tough clients are that way strictly due to their own fault. “They’re lazy, they should have made better choices.” This is disturbing because too many people involved in healthcare, a science oriented profession, don’t know the science behind tough clients!

This recent study, “Almost half of homeless men had traumatic brain injury in their lifetime,” floored me. If there’s any group I’ve had little sympathy for, it’s been homeless people. This study has made me feel pretty silly for thinking that way.

“87 percent of those injuries occurred before the men lost their homes. While assaults were a major cause of those traumatic brain injuries, or TBIs, (60 per cent) many were caused by potentially non-violent mechanisms such as sports and recreation (44 per cent) and motor vehicle collisions and falls (42 per cent).”

That is an incredible percentage. As anyone who’s been around head trauma knows, a lot of people have no recollection of their trauma, meaning there is a significant chance these percentages could be higher. (e.g. those who suffered trauma responded they didn’t due to not remembering.) Or the trauma could have been from when they were a child. Also where the person might not remember.

I shared this study with a client who’s a paramedic and she was also stunned. She mentioned how this certainly changes how she approaches all the homeless people she has to take care of on calls. (More patience; hopefully more empathy.)

One of the biggest gifts I think scientific research will give us in the coming years is scientific evidence of how much the less fortunate are less fortunate for biological reasons. So much has already come out that I should have expected to see something like what was found in the homeless study. The impact of head trauma, childhood trauma, mental illness, maybe even parasites, discovery of things like genetic predispostion for alcohol, studies illustrating how much growing up poor negatively effects one’s health. (PDF here.)

“So what causes this correlation between SES [socioeconomic status] and health? Lower SES may give rise to poorer health, but conversely, poorer health could also give rise to lower SES. After all, chronic illness can compromise one’s education and work productivity, in addition to generating enormous expenses.

Nevertheless, the bulk of the facts suggests that the arrow goes from economic status to health–that SES at some point in life predicts health measures later on. Among the many demonstrations of this point is a remarkable study of elderly American nuns. All had taken their vows as young adults and had spent many years thereafter sharing diet, health care and housing, thereby controlling for those lifestyle factors. Yet in their old age, patterns of disease, incidence of dementia and longevity were still significantly predicted by their SES status from when they became nuns, at least half a century before.”

In the U.S., economics has already shown us how hard it is to move up the ladder nowadays. We should have a greater appreciation for how it’s even harder for those with these conditions. Conditions I guarantee will only grow in number as research progresses.

We all know some get to start life on third base. We should also appreciate some start at home plate, some start in the stands…and some start in the parking lot.

This is why when I hear people exclaim, “such and such group is only that way because they’re lazy, they don’t work hard enough, they have no will power,” I want to scream. Hard work? There’s a genetic component to that. Ability to push through pain? Genetic component to that. Ability to work in the financial industry? We’re pretty sure there’s a genetic aspect to that. 

Or how about “black people are where they are because of what they name their kids.” Beyond being one of the most ignorant statements I’ve ever heard -this was actually said to me in person- as well as the irony of this statement -if a person is being judged for having a “black” name then you are arguing racism exists in the same statement you just said it’s black people’s fault- even this has been studied…over a decade ago [4]:

…We find, however, no negative causal impact of having a distinctively Black name on life outcomes.

Not only is biology, economics, genetics, and more, proving these people wrong, but even if the down and out do get help -they do what they’re told they should do- the help isn’t adequate. Fields like psychiatry are struggling to make an impact.

“The astonishing truth is that despite millions of dollars and hundreds of academic careers psychiatry has made no progress in almost 20 years, let alone ten, a claim no other medical specialty can make, and the truth which cannot be spoken out loud.”

(From The Last Psychiatrist, here.)

This post is not to persuade professionals like personal trainers to only work with poor people. It’s to persuade trainers to not only work with rich people. [5] To hopefully give at least one person more patience when they’re working with their clientele. Maybe a greater level of empathy with your toughest clients. More desire to take on that hard client the others don’t want to deal with. More desire to figure out how to help the toughest clients. Hopefully, the next time someone asks you what you charge, you ask yourself if you really only want to work with winners of the ovarian lottery. Because it does exist. [6]

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[1] One of the reasons I make fun of wine connoisseurs is because of how easily they’re tricked. The price tag of the wine affects their perception of its taste. Two buck chuck taste just as great to them as all the expensive crap, as long as they don’t know it’s two buck chuck. 

[2] The recent changes to the U.S. system have done great things in terms of coverage, but not in terms of cost. I’ll use myself as an example. Because I had a knee surgery I had significant issues getting health insurance last year (2013). This year, I was able to qualify for coverage in about two minutes. The difference was astounding. (Any issues you have with the ACA should be at least mitigated due to this.)

That said, I have a plan that’s $150 a month (I don’t qualify for subsidization), and basically doesn’t do anything until my deductible of $6,000 kicks in. If something major happened to me, we’re talking ~$8,000 out of my pocket in one year. Some research has found most Americans couldn’t come up with $2,000 if pressed. 

[3] For more on America’s spending on medical versus social services, check out the book “The American Health Care Paradox: Why Spending More is Getting Us Less” It’s a testament to the fact Americans need to stop arguing over health care moralistically. As we’ve been doing that for a century and all it’s done is proven how a developed country should not operate health care. Economically, the solutions to health care are apparent. If nothing else, plenty of countries have shown a better way.

[4] Figuring out the reasons for the differences between blacks and whites, particularly with respect to education, has proven to be very hard. (Look up Roland Fryer if interested.) Suffice to say, the answer to this is at least partially: where you start dictates a lot in where you end up. (Similar to the nuns.) When you start out poor it’s really, really hard to become not poor. Contrary to some opinions, racism still exists. And that whole American history and how we’ve treated certain groups may have something to do with it too. MLK was killed less than 50 years ago. Racism was explicitly legal until 50 years ago. (It’s still implicitly legal. See the War on Drugs and how we prosecute crack versus cocaine.) It’s hard to reverse centuries of something in less than 50 years.

Speaking of racism, just because you have a minority friend doesn’t mean you can say whatever you want about that minority. Or that you’re absolved from being racist. That’d be like me saying, “Men who have a wife can’t be misogynist.”

[5] For the person thinking, “How am I supposed to make a living?” It’s worth mentioning, compared to young people, those over 50, where you often find your toughest clients, make considerably more money, have considerably more money, and spend considerably more money! How beautiful is that? In personal training you not only can have the biggest impact by taking on some of the hardest clients, it’s also how you can make the most money!

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[6] Michael Lewis has one of my favorite interpretations of how luck manifests in life:

“Then they put these teams of three into a room, and arbitrarily assigned one of the three to act as leader. Then they gave them some complicated moral problem to solve: say what should be done about academic cheating, or how to regulate drinking on campus.

Exactly 30 minutes into the problem-solving the researchers interrupted each group. They entered the room bearing a plate of cookies. Four cookies. The team consisted of three people, but there were these four cookies. Every team member obviously got one cookie, but that left a fourth cookie, just sitting there. It should have been awkward. But it wasn’t. With incredible consistency the person arbitrarily appointed leader of the group grabbed the fourth cookie, and ate it. Not only ate it, but ate it with gusto: lips smacking, mouth open, drool at the corners of their mouths. In the end all that was left of the extra cookie were crumbs on the leader’s shirt.

This leader had performed no special task. He had no special virtue. He’d been chosen at random, 30 minutes earlier. His status was nothing but luck. But it still left him with the sense that the cookie should be his.”

Pass the cookie man.

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