TMD’s Podcast | Golden Nuggets: Episode 4 – Dr. Mark Kargela – Where do we go from here?

by | Jan 22, 2021 | 0 comments

Drs. Joe and CJ have a round table discussion with Dr. Mark Kargela about the PT career field, how to salvage the PT world, what sort of things stand in the way of good patient care and the logistics of owning chickens in Arizona.

Dr. Mark Kargela is the CEO of Modern Pain Care, a company successfully shifting the direction of clinical care in the rehab world for the better. You can subscribe to his groundbreaking material in all of the following locations:

Instagram: @modernpaincare and/or @mkargeladpt
Facebook: Modern Pain Care
Youtube: The Complete Clinician
Twitter: @modernpaincare


Training Through Pain

Additional resources:
Pain and Injury Consults

Dr. Joe Camoratto (00:00:00):
Hey, uh, this is Dr. Joe Camoratto with golden nuggets podcast. I’m here with Dr. CJ DePalma and Dr. Mark Kargela. Um, CJ, what’s up, man. 

Dr. CJ DePalma (00:00:11):
 Hey, what’s going on? I, uh, I can’t help, but smile. Every time I hear the name of this podcast, it gives me butterflies. It makes me happy. 

Dr. Joe Camoratto (00:00:19): 

Um, we’re really excited. We have, uh, one of our friends, Mark Kargela here. He, um, is going to talk to us about, uh, the physical therapy career, um, and kind of what happens as you get out of school, um, start seeing people and then realize that, um, things might be a little bit different than you had originally thought. Um, and wherever we kind of end up going with that conversation. So Mark, uh, happy to have you, 

Dr. Mark Kargela (00:00:42): 

I am just a, feel privileged to be on the golden nuggets podcast, you know, it’s, uh, I’ve seen you guys kind of bring this thing out recently and I’ve got good respect for both you guys and what you do. So I’m looking forward to the conversation 

Dr. Joe Camoratto (00:00:57): 

We are too. Um, so CJ, you and I both have, um, a similar, well, I guess you kind of dove into this world a little earlier than I did, because you were in a clinical rotation and then worked in a clinic for like what, like three months, and then you were like F this I’m out and started The Movement Doctor, right? 

Dr. CJ DePalma (00:01:17): 

Yeah. Uh, yes, three weeks. Um, and it might not even be, cause it wasn’t full-time either. So, um, yeah, so I think my, um, me and you are for sure, me even more so are a little biased, like on like the direction of like how I viewed like the profession as a whole and, and kind of like foreshadowing what I did and didn’t want to do. And I was fortunate enough to be able to take the leap really, really early, but the majority of people that are shifting to the cash pay thing and, and getting from, you know, from traditional, uh, like the traditional trajectory is just like becoming less and less common. Um, or at least it’s becoming more and more daunting of a task that envisioned doing whatever these new grads are doing every day, 2000 hours a year for 35 years. Right. 

Dr. CJ DePalma (00:02:09): 

And so, um, so, you know, we want it to have a Mark on who’s, uh, who’s been in the trenches much longer than we have, maybe not that much longer, just a little bit longer. Um, and, uh, and his is in academia and, uh, me and him had been talking a lot over the last six months to a year about, about, you know, transitioning out. And so I wanted to kind of pick his brain on, on why and, and some of the reasonings of, um, you know, he’s experiencing like the academia side of the pre-grad right. And then, and the new grad, um, with getting a lot of interns and things like that. And obviously it puts out on some of the best content out there, um, uh, evidence driven. And so, so I think he’d be a really good person to, uh, to chat about why, um, why this is happening, why it’s driving him, uh, maybe what we could do to potentially change it. Um, and then, uh, since we’re all out of it now not worry about it after we talked about it and talked about like what the direction is and why, you know, like what his goal is with, with doing something on his own. Um, uh, Mark, can you give us your background a little bit? 

Dr. Mark Kargela (00:03:14): 

Happy to do that. Uh, I am a little bit, uh, more seasoned as far as 18 years into my career. Um, and I’ve kinda toiled in outpatient ortho pretty much for, um, yeah, pretty much for that 18 years. I’ve kind of dabbled a little bit in some side gigs with acute care to help paid on loans and all that stuff, but, um, yeah, I’ve, it’s, it’s been a kind of a journey of, uh, pretty much your typical. When I came, when I was in school, it was very much, uh, you know, heavy, heavy biomedical. I don’t think I remember much about any bio-psycho-social or kind of more rounded, uh, kind of education in my training. There was like a psycho disabilities class I faintly remember, but you know, when you’re going through school and you want the sexy stuff, you want the manual therapy, you want the sports med stuff. 

Dr. Mark Kargela (00:04:00): 

I mean, that’s where I think a lot of, some of the biases, but we had a lot of folks do neuro related, um, you know, colleagues and classmates and stuff. Um, and then just kind of, as I’ve progressed in my career, I’ve, uh, been able to go through, you know, fellowship training, which has been great. I mean, there’s definitely things I think are good and bad about it. I think the overall critical thinking clinical reasoning, amazing being founded strictly on defining yourself as a manual therapy, not as amazing. I think that’s something as a profession we need to move past and move beyond, especially when science tells us that you ain’t fixing people like cars, you’re treating unique human beings, but that’s probably for later parts of this conversation. And then, um, I, I transitioned to Midwestern university here in Phoenix, Arizona. That’s where I’m home-based at, uh, had practiced in Michigan for a good period of my life, but, uh, moved down here and, uh, ended up, uh, at the Mayo clinic for a period of time and then had an opportunity to get into a clinical assistant professor position here at Midwestern university where I’m, I’m basically in clinic seeing patients 95% of the time. 

Dr. Mark Kargela (00:04:59): 

And, uh, cause that’s where I really feel like the teaching I want to do takes place as far as taking power points and bullet points and saying, well, how do I take that? And put it in front of, and apply to a real breathing human being that doesn’t always fit that nice little neat PowerPoint that, you know, you need to know for your board exams and stuff. And I mean, it’s not obviously not important. It’s just, man, it’s just a scrape of the iceberg. And, uh, as you guys alluded to you get out in that first, even your clinicals and you start stepping out, especially independently on your own after you graduate. And then, you know, clinic just gives you a big kick in the gut of like, man, this doesn’t work as black and white, or it’s not nearly as black and white as it gets portrayed in my pathology class or in my kinesiology class or all these things that, and again, it’s not that that’s wrong. 

Dr. Mark Kargela (00:05:44): 

And we can definitely talk about where some of that stuff probably necessary components of understanding the human pain experience, but man woefully inefficient, doesn’t prepare students to be good for a person to be safe, um, when you come into the clinic, but it’s, uh, something, if you want to be good and get to be a great therapist, you need to develop a process. And that’s kind of, obviously I know you guys do a bit of that and that’s what we do at modern pain care is try to create that for people because it’s just, you’re not going to feel. I mean, if, if you come out of school and you feel like you got it figured out, that’s somebody who’s, I feel like a dangerous PT who I like either needs an ego check, a slice of humble pie or, um, somebody who is probably not going to fit in our ecosystem. 

Dr. Mark Kargela (00:06:24): 

Well, cause we’re, you know, as you guys are, it’s a lifelong learning process, man, sience isn’t sitting still it’s changing. And I know you guys can probably relate to things you get taught in school about good chunk of it has been proven to be not the way the world works. As far as science tells us, it’s not true. And then we’re still teaching stuff in an I, I have to be held to CAPTE standards sometimes when I lecture and do things, which, uh, you know, we can talk about that as well. That kind of holds programs to teach a curriculum that may not be caught up yet with science. So yeah, that’s I guess a, a view of where I’m at. 

Dr. Joe Camoratto (00:07:00): 

Yeah. It’s definitely an interesting, um, point of view as somebody who is currently teaching and has to stick to those guidelines. When I think about my time at Duquesne university, out in Pittsburgh, we had a couple of professors who I recognize their names on, you know, like APTA, like, um, uh, uh, guidelines for treatment. And I’m just like, man, if you’re sitting up on this like giant tower where you’re able to communicate all this evidence-based information in, um, uh, a clinical practice guideline, but you’re, you don’t seem to be updating with, you know, the BPS model or the, uh, the things that we know now, as far as trying to improve, then not to talk that talk down then of course the clinical practice guidelines are supposed to be an amalgamation of everything that we have for a topic, but it’s just kind of tough to get behind when we’re looking back. And they’re probably doing the very same things that they went and did when we were going through school, you know? 

Dr. Mark Kargela (00:07:55): 

Yeah. You know, and I think you got to step back and look at those clinical guidelines. You got to look at like academia, your job in academia, oftentimes depending on your institution, if you’re our level one where you’re, you’re really your job performance and your ability to maintain your track towards tenure is on publishing. You want, you need to get involved in the APTA and these clinical practice, guideline committees and stuff. But the unfortunate piece of that is you’re often those folks aren’t seeing many, if any patients, you know, they’re not seeing any humans with this stuff. So they, it’s kind of maybe a weakness because the folks that are on the front lines grinding, especially know new grads who are getting grinded to smithereens with burnout and all that stuff. But, um, it’s just, they don’t have time to maybe do this. 

Dr. Mark Kargela (00:08:35): 

Now, there are some folks, I got some colleagues who are still, you know, doing clinical practice and contributing those guidelines. I think that’s great. I think we need to involve clinicians. We need to involve patients into those guidelines too. We got some patient advocacy movements in JOSPT with like Joel Belton and some other folks that are kind of kicking us in the rear as far as not just having academics who arent seeing patients. And again, I’m not saying it’s wrong to have academics, you know, compiling knowledge and, and running studies and stuff. But I think we have to recognize that that’s, uh, you know, missing, that’s just a kind of a narrow kind of perspective that sometimes gets brought into and a biased perspective into research, which, um, and our clinical practice guidelines. I don’t, I think we put these on, I mean, they’re necessarily, and we need them and we need to have some sort of, kind of thought process of like, you know, you can’t just go out and do whatever the heck you want, but we also recognize that it’s often a conglomeration of data by faulty human beings who might have a bias or, or may not be seeing patients and maybe not really con you know, consolidate and in a manner that says clinically applicable. 

Dr. Mark Kargela (00:09:36): 

I mean, you look at some of the guidelines and different guidelines across professions and things for the very same condition, because they’re taking well different views and, and, uh, snippets of the literature that maybe fits their profession’s worldview and things. It’s, it’s, uh, you can see how a human bias can kind of figure into that stuff. 

Dr. Joe Camoratto (00:09:53): 

Yeah. It’s, it’s funny. Cause when I’ve spoken with like clinical, um, social workers that have been, uh, providers and friends before they said that they have like this body that kind of regulates what it is they can, and can’t practice regarding how the evidence-based research kind of reflects that. And I think that that would probably be a really good thing to implement because what you’re kind of saying is that people can just really do whatever they want, as long as the patient gets better. And the three of us know that there’s a significant amount of factors that come into play out like if we, even, if we exclude everything that happens in the clinic, there’s still a significant amount of factors that come into play to get people over that line. And so I think, uh, yeah, it’s, there, there needs to be some sort of communication between the people who are seeing the patients, but, but then there’s this problem with like, while you’re seeing patients, you don’t know really the stuff that we know now that we’re a few years out and now we know this stuff, we know we’re kind of making our way out so that we’re not really affecting the career field anymore. 

Dr. Joe Camoratto (00:10:56):
Right. And so it’s, it seems this whole big broken loop. 

Dr. Mark Kargela (00:11:01): 

Yeah. I mean, it’s tough to navigate into the profession as a new grad these days. I mean, I, I can’t even imagine like coming out with some of the, you know, saddled with the debt and I feel at times and part of the issue, cause I work for a university and I’m part of the, the tuition fees that are being straddled upon people. I feel dirty at times. I’m not gonna lie to you. I, I don’t like the fact that that’s what we’re doing to students at all. Um, I just don’t think that positions any human is. I mean, if our job market paid for what the debt load were, um, comfortably pays for that debt load that we’re putting on students and, you know, I guess I could be better. Okay. Or more okay with, I guess, but yeah. And it, it’s tough. And then you get out of school and you’re, you’re seeing that, you know, this algorithm and kinda black and white way of working with people doesn’t work as well as it’s been portrayed. 

Dr. Mark Kargela (00:11:49): 

I’m not saying it doesn’t work at times are definitely textbook cases that are out there. But, um, I think they’re fewer and farther between than we’re led to believe in school. And it’s a de-stabilizing experience, man, when you come out of school and you feel like you got to at least somewhat figured out, and then it’s just like, there’s days where you feel like I absolutely fricken suck. I have no idea what the heck’s going on with half of these people and what the hell do I do? And then, Hey, on top of that, you’re going to see four of those people an hour and feel like a complete fricken failure for four times an hour. And it just, I can’t even imagine getting into that situation and trying to, I honestly don’t think I would have survived the profession. I had my moments where I was ready to quit and I just didn’t feel like I was worth like crap. 

Dr. Mark Kargela (00:12:28): 

I was a PT just because I was trying to treat humans like cars and, you know, with the latest, uh, you know, mechanics skill that I was learning just wasn’t cutting the mustard. It was, you know, I was, you know, sucking basically. So yeah, it’s, it’s a tough, it’s a tough game man to come out to a profession. That’s um, and I think that doesn’t just exist in PT too, because I think, you know, biomedical education and stuff, I think we got to do better in education too, to round folks out. But, um, yeah, it’s, it’s tough. 

Dr. CJ DePalma (00:12:55): 

Yeah. Um, so I had some, uh, uh, some things that I wanted to kind of chat before we shifted away. Um, one of my, like my biggest, I guess, quarrels of, of, um, school and probably what drove me to do my own thing really really early was the concept of like having a 200 PowerPoint slide on the thumb. Right. That like, like legit, like there’s just so much, right. There’s all these directions motion on this thing. And then like the end of the slide would be like two, two page, like you go through all these pathologies and, and, and pathophys and, and diagnostic measures and, and, uh, and testing. And then it’ll be like two slides on treatment. And I feel, you know, and, and I think you, you said it as soon as we started on this call and you were like, you feel the most, you’re like, you’re mostly in the clinic teaching. 

Dr. CJ DePalma (00:13:46): 

Right. And I think that’s super important of like how to actually apply, but why do you think, like, if we’re just talking specifically academia, why, why is it set up like that? Like, why is the, you know, does, does that set us up to be like, like more ill-prepared to be a treating clinician as like this, um, uh, entry-level DPC or, uh, is it required because of the way the test is structured? Um, I don’t know. And I never understood it and that’s like, what led me to come out really? I’m like, Oh, okay. So we have this like all these diagnostic procedures and measures for the shoulder for all these different pathologies, but then you look and it’s like, it’s a, it’s a copy and paste the PowerPoint slide of how to treat seven different pathologies. And I’m like, well then why do I, why do I need to know the ins and outs of all of that? If I’m going to treat it the exact same way every single time based on what their symptoms are. 

Dr. Mark Kargela (00:14:38): 

Yeah, no, I think it’s a, it’s a big problem. I think, you know, we got, uh, you know, all these things about pathology, kinesiology, biomechanics, and all these things that supposedly should give us some like nice, clear black and white, Oh, this is the intervention I should. And then the interventions tend to be these canned, basic things that aren’t really individualized. They’re very kind of standardized ways of looking at it yet. There’s so much variability we see in clinic. And there’s so much of a, of a supposedly similar, you know, tissue issue to that, that kind of presents itself differently. I think a big problem is, this clinical reasoning just isn’t taught. And I think there’s a partly, because it’s hard to teach clinical reasoning when you’re not seeing patients when you’re in a classroom, that’s just something you need to have. And then clinical education. 

Dr. Mark Kargela (00:15:21): 

I mean, God love the CIs out there, but there’s a conglomeration of what students are being told is the way to do it. Uh, you know, and we’ve got clinicians out there who are doing it diametrically opposite and foofooin this system, this system is better the way I do, it’s better than yours and all this crap that if  you look at the research on what system gets superior results, none of them, they all do pretty equally. Well, as far as you get somebody who can navigate natural history, you come alongside anybody promises, you know, we want to make it about our system and not about the human in front of us, but it it’s, it’s, it’s tough to, um, you know, uh, really, you know, produce a situation in an undergraduate setting to really get folks, um, to that clinical reasoning points, to where they can see, okay, there’s not an algorithm or a cookbook for a human being. 

Dr. Mark Kargela (00:16:08): 

There’s a, you know, there’s some concepts and clinical reasoning and processes I have to say to, Hey, I’m going to take that knowledge of what I learned in school, you know, the pathologies, the biomechanics and see how it, and I have like a filter. And, uh, if it really, you know, Maitland used to call it a semipermeable brick wall, but that’s a nice concept that basically says all that stuff is theory until it fits the clinical scenario in front of you. Um, and I think if you use that kind of filtering approach of, you know, and kind of that goes into test retest and really staging a patient’s symptom behavior and all that stuff, then a lot of us are already in, but yet we don’t teach students that and they don’t get it on their clinical rotations for some, like some students get lucky and they get involved with somebody who is a very critical thinking clinical reasoning therapist, but there are some therapists out there who are still rolling, you know, the ultrasounds and the tapes and scrapes and cups and needles without a lot of thoughtful practice behind it. I don’t really have any issues with any of that stuff is as long as there’s a thinking brain behind it, that’s pushed, that’s tailoring it to the person in front of them and not just tailoring it to what they do every day that makes them have to think the least and just punch the clock and get, get in and out the quickest way possible. 

Dr. Joe Camoratto (00:17:14): 

The, the, the good part about our current, like the last five years or so, um, probably probably more like three or four is that there seems to be a whole host of groups. Uh, I mean, including modern pain care, um, that are just like trying to and succeeding at affecting a large number of, uh, allied health providers, um, in a way that can push this needle forward on a big way. I mean, you have, um, you guys, you have Ben Cormack and Adam Meakins with a better clinician project. You have CALU now, um, the level up, uh, in clinical athlete together, there’s so many things now that just didn’t exist when, you know, CJ and I were probably graduating WOPprep uh, probably graduating when we were, uh, or coming out. And so I do have at least a little bit more hope as much as I really hate social media, um, and the things that it does to me and the people that I love. I really think that if there was ever going to be like a big shift in the way that we catch people, right, as they get out of school or before they get out of school to, to alter that sooner, I think now is that time. And, and it’s exciting. 

Dr. Mark Kargela (00:18:19): 

Yeah, no, I think, you know, traditional coned too, just doesn’t fit the bill. It just, it does. And you go on a weekend, you got some dude on stage or some, I shouldn’t say, dude, there’s plenty of women who are doing an amazing job. Teaching can see education as well, but, and it’s this, you know, the, the subjects on stage, there’s all this interaction effects, you know, it’s all, of course somebody gets an improved thing cause it’s a million ways to make pain feel better, especially in a stage full of people where you’re the subject, but probably another thing. But, and then you’re on your own too. You know, you’ve got two, two days with somebody and then it’s, you’re on your own, figure it out. And then you, you get the initial like, Oh my God, this is the greatest. And then the reality of the clinic continues to stare you in the eye. 

Dr. Mark Kargela (00:18:56): 

If you look at it that there’s still people that ain’t gettin better and it’s not, then no matter which new shiny tool I throw at these people, it ain’t get, you know, they’re not pressed in the hump of getting them back to the life they want to live or getting back to the gym or getting back to lifting their grandkids or stuff because it isn’t about your fricking tool. It’s about being able to fit whatever you have in your box and not just searching for new tools, learn how to use a toolbox, learn how to apply it to the human. And it’s not just throwing passive stuff at people. It’s really getting to know that human in the unique situation that we’re in and thoughts, beliefs, all that stuff, and then pushing them forward. But we still have this biomedical biased education where man, it’s all about, um, you know, the pathologies, and I’m not saying that stuff isn’t important. 

Dr. Mark Kargela (00:19:39): 

Like you guys with wad prep, of course, you guys got to know mechanics and appropriate lifting formula, high load situations. You better believe movement matters in specific specificity of movement. But you know, we still got therapists out there rolling with the TA multifidus brace everything until you’re, you know, you can’t brace anymore your brace. And when you’re picking up a paper clip off the floor, I mean, come on. Um, it gets to be a little bit ridiculous, but yeah, it’s, it’s just a hard scenario for students to succeed. I think that’s why we’ve created programs. And I, you mentioned some great ones with Ben and Adam and CALU’s great. I mean, they’re doing an amazing job with trying to push, push the knowledge forward. You guys are doing great at WODprep and, um, you know, helping folks out as well. But it’s just, you got to have somebody who’s in your practice and having given you a process to start auditing yourself and checking your biases and recognizing that there’s a process that you got to figure out what fits to that unique person in front of you. 

Dr. Mark Kargela (00:20:30): 

Cause you can spend time chasing 15 different courses with 15 different tools and get the initial honeymoon phase of that tool that you’re feeling like everybody’s getting better. And then reality will stare you in the face. Um, I’m waiting for the tool that comes up. That truly is special in like a, you know, in, when we do systematic reviews and we see no, everybody pretty much follows the same course, regardless of what intervention you throw at. It, that’s a hard pill if for ego driven therapist to swallow, but it’s the truth of the matter. So just let’s fricking support people through their process of pain and get them back to life and not have to worry about being trademarked on them. Fricking tool that you wear on a polo shirt, 

Dr. Joe Camoratto (00:21:05): 

If, uh, if he asked the MDT group that that is their, that’s the tool. That’s the second coming, the MDT, the McKenzie stuff. Um, yeah, I mean, I’m talkin shit here. Uh, so I have, I have a kind of related question, um, and this can be at both of you guys. I don’t know where the PT profession is going with coronavirus, um, because there is not a job that be had in the central South New Jersey area, at least for myself. Um, and with the Medicare cuts coming through and with the clinics, that probably shut down or continue to do so because of the current situation, as well as probably, I don’t know if clinics are going to hire more PTA’s or, or less, now that there’s changes in reimbursement. What do you think is going to happen to the PT career field? 

Dr. Mark Kargela (00:21:55): 

I mean, I don’t think we can continue to try to, you know, just scrap for the fight for the scraps of a biomedical system that is just woefully, inefficient, financially completely backwards and how they, you know, front end people with expensive invasive non-effective interventions when it comes to a lot of the musculoskeletal stuff we see. And then, you know, eventually they trickled onto to you where, you know, patients aren’t ones that, I mean, you have to, I think we have to be willing to step outside of that model of care and in non-insurance based ways, I mean, auto network stuff I think is a great way. And we have a fricking product to offer people it’s and it’s better research it’s done. That’s not my biased opinion. There’s plenty of research to say it will save you fricking money. It’ll save a scalpel, often being driven into your body, where you get invasive stuff. 

Dr. Mark Kargela (00:22:43): 

You can’t uncut yourself. Once that happens, it ain’t going back. But, um, there’s, there’s just models where we have to just quit being all pleased physician. I would just want another few referrals. I mean, I’m not saying that’s not something we shouldn’t maintain relationships with, but stop being like the, you know, the, the, the, the little baby that’s just scrapping for, you know, the physician to feed them and like be a fricking adult healthcare practitioner practitioner, own your degree on the top of your license and freaking practice to it. And then put a message out to people where they can choose that versus a needle or a, or an injection or a, or a surgery. But I think we’re still in this. We don’t teach that to students. I mean, students have no idea how to run a business or how to put a marketing message in front of a human that would get them to choose you versus the other practitioner, the more invasive person down the road. 

Dr. Mark Kargela (00:23:30): 

I think that’s a big issue. We also have in our professions. We don’t teach people to learn how to, because you’re selling people in the treatment room every day. Why don’t you sell them on how to fricken get in your clinic in the first place, then you can even sell them more. I got this, I got you to where I’m going to get you better. I’m going to get you. I have no doubt. I’ll be a partner with you on this journey. We’ll get you back to whether it’s, you know, back to CrossFit or back to, you know, playing pickleball for our older pickleball. I haven’t got there, but I got, I’ll tell you in Phoenix, man, it’s, it’s the wave over in the retirement communities. It’s uh, so I’m, I’m probably gonna do it just out of strict. I need to know what my patients are doing. I’ve seen it from a far but not, not, not participated. 

Dr. CJ DePalma (00:24:12): 

So yeah, I, um, uh, I resonate so well with everything that you just said. And, uh, and that’s like, one of the biggest conversations me and Joe have had is like, is there a line from like, like creating their brand and selling? And I’ve said it from day one, like it is, if you are a salesman in the clinic, regardless, and then there’s people that fight against that. Like, you’re not selling you are, you’re a hundred percent selling every time, because if they don’t, if they don’t buy into what you’re saying, right. And I’m not saying you have to be gimmicky, right. You just have to get trust. Right. And gaining trust is about selling. And so I think that’s super important and your right. And it is one of the things that was probably the main thing that we’re not taught. And so that’s, um, uh, a big disservice. 

Dr. CJ DePalma (00:24:54): 

And so, uh, Joe, to hit on it, to hit on your question, it’s very clear that, uh, these cuts aren’t going to stop, you know, and, and like, they’re going to keep coming. And so our loan to debt, uh, ratio or our like debt to salary ratio is just going to keep getting worse. I mean, it’s like almost two and a half times currently right now for your average, which is, which is an insane amount for for anyone who knows, like you’re a good, a good, like graduate degree, uh, debt to salary ratio is like anywhere from one two is pushing it. Most PTs are like, well, closer to the three Mark. Um, especially if they have undergrad loans. And so, um, so that’s a huge, that’s a big problem. Right? And so, so people come out and they’re, you’re fighting an uphill battle already, so they feel the need to not be able to fight for what they want. 

Dr. CJ DePalma (00:25:45): 

Right. And then, and so this is kind of going off, off topic, but, um, I think that’s like the issue with like the burnout is because they take what’s given to them right away because they feel like they need money. They need to pay off debt because we have poor financial literacy coming as a doctorate profession. But most physicians do too. They just happen to make a lot more money. A lot of, a lot of people who have gone to a lot of schooling have very poor financial literacy, and that’s a huge problem. Right. And I’m not saying the school needs to teach that, but, but like, you know, you’re spending a lot of money and, you know, that’s when we’re talking, can we start getting into like federal issues of like, just giving away a lot of money to a lot of people, but, um, uh, so I think that’s where like the problem is. And, and so I’ve heard, um, that, uh, to, to hit on what you said, Joe, about this reimbursement rates is that, uh, I think, I think based on what I’ve just kind of heard, like in the vines, I’m pretty removing consistently from like most PT, like social groups. Hold on, am I going to do noise 

Dr. Mark Kargela (00:26:44):
 Cancellation on this must be amazing. I heard no snoring. 

Dr. CJ DePalma (00:26:46): 

You think he was kicking me kicking Duke. Um, and so, uh, what my prediction is based on what I’ve read is that PTA’s are gonna get the axe almost completely as a profession and PTs are going to get their, just their costs of like our, our salaries are going to go down. Um, there, you know, cause we’re pumping out PTs. I mean, Florida, Florida has 13, like 13 PT schools pumping out 40 to 60 students, each school every, um, uh, three times a year, like PLA like it’s crazy. And so, uh, and so, so there there’s an issue there. Right? And, and so I think that to me, that’s where it seems like we’re going, we’re going to overload, we’re going to overload a professional with a higher, higher degree, which the higher degree has had a lot of, um, uh, I think like kickback, but I think for us, it gives us the ability to have these new opportunities. 

Dr. CJ DePalma (00:27:47): 

Right. And that’s how I look at it. So like, yeah, we are a doctorate wasn’t necessary to move the profession forward. No. Was it necessary to move the profession where we want it to go right now, 100% because it has created the ability for us to have that autonomy. Um, uh, I think that answered your question. I think that sort of answered it a little bit. Oh. And coronavirus go online. Do tele-health a, the, the, the training model. I don’t, I don’t want to talk about what we do, but it’s the best, it’s the best way it is the most. It is, it has been looked at as like a very big risk, but the movement doctor and all of remote rehab offerings that were started prior to 2020 were, fine, we were much better off in a better position when this pandemic hit. 

Dr. Mark Kargela (00:28:35): Should have bought stock, man. 

Dr. Mark Kargela (00:28:42): 
You’re right, man. Coronavirus has opened up some like forced, some of us into some markets and some kind of modes of delivery that have proven to be very successful. Um, that’s tough for a lot of folks who feel like the only juju is when the magical hands are being placed upon somebody. But, um, yeah, it’s, I think it’s, it’s definitely shown that that’s a viable model, remote rehab and, and being able to, um, you know, partner with somebody and it fits the lifestyle that most humans we interact with are, it’s hard as hell sometimes to get people into clinic twice a week. Um, but if you can, people will pay for the convenience of having you in their pocket, on the phone, on a message on a wherever you, wherever they are at and they need you, they can kind of call upon you. I mean, obviously you have some formal sessions scheduled and stuff, but yeah, that’s invaluable stuff. And I think, uh, again, we need to position students to enter that market, but I don’t, we’re, we’re improving. I mean, we had, I’ve had students join me on tele-health calls just when they’ve done some of the shadowing that they do in our university. But, um, yeah. Think it’s an emerging thing that, uh, still isn’t quite, uh, at a teaching regular level. 

Dr. Joe Camoratto (00:29:47):
 And now is that the university that you teach at, or you’re your modern pain care university? I don’t think that’s university, right. Okay. 

Dr. Mark Kargela (00:29:53): 

No, we’re not a university of modern pain care. We’re just a continued education. Uh, I guess business, you could say to the, trying to push the needle forward with things, but you know, at the university, we, you know, I was with our patient load. We have some patients, although not as much as of late, I think. Um, but uh, we get patients who will do the tele-health thing. So if I have students who are regularly shadowing, they can join me in on those, uh, consults to kind of see how it goes. 

Dr. Joe Camoratto (00:30:18): 

Uh, so tell us more about the modern pain care, because it’s really, I mean, like I said, I love all of this, this big name stuff. I, you know, full transparency. I dont subscribe to almost any of them because I just can’t afford it. But, um, I would love to get more information about that and how you tell people, like, what is it that you guys do, you and Jarod, right? 

Dr. Mark Kargela (00:30:36): 

Yeah. Jarod hall is our, as my partner and we, um, and I created modern pain care. Gosh, I think it was like, uh, 2015, somewhere in there. It’s been a while more than I’ve realized. But, um, basically out of the frustrations that we talk about on this, as far as like, you know, the coned isn’t figure, you know, a weekend course just aint cutting it, it ain’t going to do it. And, uh, we still teach them, but we try to get folks into more of a lifelong learning process and it can, you know, teach and folks to, to kind of level up a process, not just that’s going to come out of two weekends, but, uh, we just actually recently started a coaching mentorship program where we’re gonna really put that model in the action. It’s going to be a continuous program that we have people coming in and out of. 

Dr. Mark Kargela (00:31:17): 

Um, we’ve, we’re almost finished with our first enrollment right now, but basically we’re, we, uh, deep dive into people’s practice, get them dialed in on a process, figure out where their holes are as far as where they don’t feel they’re having success in their practice, um, and you know, structure a three- month program to get them, you know, leveled up on whatever it is that they’re struggling with. But we do that. We do, we have a membership where we have, we get, you know, experts from around the world, come in and do a masterclass. We just had Jared Paul from Australia, the shoulder physio come in and do one this, uh, last week or this past week, Monday. Um, so yeah, we’ve, we’re fortunate. We’ve been able to get some relationships with some smart people. And we actually just partnered with a group that I can’t say yet, but I will, once I am given a public we’re, but with gives us some great opportunities to kind of push the needle forward. And again, kind of help the process along to get, cause our big mission is just, we kind of do better and help people. And we can’t just create robots therapists who think PowerPoints and bullet points are going to treat unique human beings. We need to do better. So that’s arming people to, to be able to take that into practice and not just talk about it 

Dr. Joe Camoratto (00:32:25): 

Which is really cool because I always have this like idea floating around in my head is, is if this whole like clinical treatment thing or, you know, online programming doesn’t work, I could just create an like a, um, like a consultation business where I just to a clinic and observe and tell them all, all the things that they’re doing wrong, in my opinion, at least. And that sounds kind of like what you’re doing. Like, you just have like your, your mentees sit in front of you. Like, this is what I believe it. Then you just go pfffft 

Dr. Mark Kargela (00:32:52): 

We try to resonate with their journey, man. Cause I mean, I can probably list a laundry list of stuff that, and I think we don’t, we’re, we’re making sure we enroll the right person. If somebody like, dude, I wear this, this logo on my shirt and this is the only way to treat. And if I think otherwise they’re not going to be a good fit for us. We want people that are hungry to do better in our programs. So yeah. And they’re, I, I think the best way to grow is to get some honest criticism. I think if you get people that are just pumping your tires pattin you on the back, you don’t grow, you don’t change. You just get more. And that’s where I get frustrated, like the manual therapy profession, you know, there’s, uh, not everybody cause there’s some very critical thinking, thoughtful people, but it becomes like let’s roll to the latest AAOMPT meeting every, every year and pat each other on the back and get our dose of confirmation bias and not change any of the push that needle forward on it. 

Dr. Mark Kargela (00:33:41): 

There are some definitely forward thinking people in there, but it’s easy to fall into a career where you don’t grow and you just surround yourself in a world of confirmation bias that in your view of it, that you look like you’re doing the best thing possible in science’s view in best practice, it’s past your long since by you got an opportunity to develop a process, to stay on top of that. Um, which is what we try to ingrain in people. Cause it’s, it’s, uh, I’ve been in my share of, of the, uh, the, uh, polo wearing Kool-Aid drinking set of, uh, uh, different processes and programs. So I’ve, I’ve, I’m trying to prevent folks from going down that same path that probably cost me about five to six years of productive, productive career time. Cause I was so ingrained in and treating humans like cars, like I said, 

Dr. Joe Camoratto (00:34:25): 

Yeah, I try and curate my physical therapy, social media so that I am not just in a bubble, but the other side of that coin is that it makes me nuts when I look at some of this stuff that I see. And I just like, there’s such a drive to just unfollow everything that doesn’t, you know, scratch that itch for me. And I try not to do that. Um, because I know that as soon as that happens, exactly what you’re saying is going to happen. Um, but it is, it is a much better way to take the people that are looking for, uh, further education or for that criticism rather than trying to take those people who are not looking for it and spoonfeed them, whatever you think is your logical reasoning, because surely they have their own logical reasoning. They’re not just pulling these ideas out of thin air, right? 

Dr. Mark Kargela (00:35:11): 

Yeah. I mean, and it’s okay to have your, your way of working with people. Maybe you’ve learned this technique or you’re more of a Maitland or, and I don’t think we’re pretty system agnostic as far as you can do whatever you want to some extent, I guess you just gotta have a thinking process to where you’re validating it in front of the person in front of you, but completely agree with like social media. We purposely keep conflicting opinions in our feeds as much as it can be, unless they’re just jerks. You know, don’t really have time for folks that can have a respectful dialogue with. Um, I can’t even imagine I’ve seen the, like the fitness athlete and power lifting space on like Instagram and, and Facebook. I can’t even imagine like what you guys CJ. And, uh, I know you guys see more than just that space, but good God. Some of the narratives that come out of there and things it’s, it’s, it’s maddening, but I think it’s good to know. We have folks like you and I think hopefully folks look at us the same way of trying to put a more reasoned thoughtful science-based message out there to help people who are consuming this garbage on social media to have a little bit more of a, a nuanced, uh, person centered view on things. 

Dr. Joe Camoratto (00:36:16): 

I think one of the really difficult aspects of trying to curate that information is that there’s information on both sides. And so even if you say, even if you stick to the research, right, if you don’t, if you can’t recognize that this paper is writing from a biomedical like type view or this paper is talking about core, but you know, there’s this whole field of like core research that shows that it’s no better than just regular exercise. You could still be with all this good will and, and blissfully ignorant, but it it’s just, it all depends on the context and the, and the, you know, learned response to the past experience of that person and their background too. 

Dr. Mark Kargela (00:36:54): 

Yeah. I think you’ve got to purposely have a process to like, you know, audit your practice and to continuously expose yourself to opposing views and viewpoints to, to check yourself because it’s easy, you’re humans, we’re biased, you know, it’s, it’s what we do. We grouped together. We tribe up that’s just how we’ve survived over time. It’s still how we attempt to survive. Even in these modern times to where I’m not even touching the chat comment there, but there are definitely people who will assemble entire businesses around a very biased way of, of gathering research to support a viewpoint. And, um, again, whether they’re helpful in dialogue or have any opportunity to have respectful dialogue, you know, and then again, you invest yourself in being a manual therapist or some sort of, uh, you know, online entity, that’s the, you know, charging money. And we try to, you know, we’re not definitely, you know, immune from that. 

Dr. Mark Kargela (00:37:47): 

We, Jared and I are very purposely saying we can not become, what we don’t want, what we preach to not become. So, um, hence why we try to keep our views, uh, diverse and make sure we’re not walling ourselves into narrow ways of thinking, but it’s easy to get people. And then once you get imbibed in it, man, and you get that whole, you know, uh, you get invested in it to the point you just lash out when somebody, you know, uh, criticizes your comfort zone or, or what you’ve invested your, your business upon this model of thinking, you should never invest. If you invest on a model, that’s statically thinking, this is the way the body or human works. Um, your business model will die because that’s just, we’re learning day by day and it will get chiseled away to where there is no foundation and you’re just, you know, selling a pack of lies. But you know, some people have hard time with that. They want to, you know, are more interested in selling then 

Dr. Joe Camoratto (00:38:36):
Kind of moving things forward. Yeah. CJ are we strength therapists then, or you’re very, very variability therapists. 

Dr. CJ DePalma (00:38:43): 

Yeah. Functional therapist. Um, I, uh, um, which is where that’s like an actual thing, isn’t it like in SNFs? Functional? Yeah. Like walk, walk patient anyways. So I wanted to, uh, I wanna, I wanna move the conversation forward, um, to talk about, uh, what Mark is kind of doing and why. Uh, but I, I did want to hit and I just lost my train of thought. Um, Oh, on, on what Mark was just saying about how, like a certain way of thinking that static will ruin the business and I kind of want to counter and say that it, it might not. And, and that’s probably more dangerous because, you know, because of like the people that we see on the internet, they’re very locked in their ways, but they create this guru and this, like this deity mentality of like, they’re the best. Right? So like, there’s the, the practices out there. 

Dr. CJ DePalma (00:39:27): 

Like, so I had, I, you know, I saw someone who was like into ELDOA, which I had no idea what that was. I don’t know if you guys ELDOA, it’s like a breathing thing. It’s like a posture breathing thing. I mean, like, no, it’s, it’s, it’s, it’s really strange. And anyways, but I mean, she was like, well, I’m a level one, something, but like, she was talking about some dude name and it was like, his thing was like Grandmaster level four. And I was like, you can’t be named grand master level, four of a clinician, like a healthcare thing. Right. And so I think that there’s a more dangerous and more, I guess, like, as far as like growing our profession, the static-ness yes, it will. That’s what’s going to hurt the profession. That’s what is hurting it. But I think from a business standpoint, it, it almost ends up being something that’s more viable because you’re so locked in and you become this crazy niche. 

Dr. CJ DePalma (00:40:23): 

And it’s very unfortunate that, uh, it becomes almost like a, like I’ll, I don’t care about calling people out. Like I’ve seen some PRA some PRI like, like patients that have been like super deep into their, into their reins and like, they can speak the lingo, which I still can’t speak to this day of like, whatever that they claim and people just get stuck in there. And the, they, these treatment styles that, that are very much like expert driven and specialists and like levels. And you can see more advanced people, it pulls the patient in man, and it, it just keeps them there for forever. And it as a business model, it’s fantastic. And that’s, what’s scary, right? That’s super nerve wracking. 

Dr. Joe Camoratto (00:41:11):
 You live in that post hoc, you know, mentality where A plus B equals C and this like, was it a survivorship bias where everybody who rates me on Google says, I’m great. You know, it’s uh, 

Dr. Mark Kargela (00:41:24): 

And then you, then you just go to all the Grandmaster meetings every year and get your dose of confirmation bias to where all men were doing it. Right. Everybody else’s wrong, you can insulate into a system 

Dr. Mark Kargela (00:41:35): 

And think it’s the, is the truth of the way it is, because you’re not even seeing anything else and even considering anything else that might be going on in the situation, but that’s a good point. I think it all comes down to your mission and your values and how you message what you’re doing to the public. I think you can probably still do a bit of that with a good, sound mission and values behind it, as opposed to, and some, sound theory behind it and just, you know, staying on cutting edge of treatment versus, you know, static, blowin balloons around and stuff. I’m not trained in PRI I, I know enough and have seen enough of the discussions and science behind it to know it’s kind of another one of folks getting invested in being a certain therapist, which I think again, limits their growth and limits their ability to help patients. 

Dr. Mark Kargela (00:42:16): 

Again, we can trumpet out. Oh, well, this patient, the only thing they got better was was this. You can do that with any fricking system. I’m tired of those stories coming out. Um, again, make it be able to patient not your wonderful system. And, um, if people only can, if you’ve walled them into one way of being able to find relief for pain and stuff, to, um, to me, you just narrow their ability to, to find, you know, good movement in the world. If it’s only through a balloon blow or some sort of needle being poked in the skin or something like that, I think you you’re limiting your patient’s ability to manage life. 

Dr. CJ DePalma (00:42:49): 

Yep. Um, Joe, are you going to reference this or are you going to move conversation forward? Okay. All right. So, um, uh, so we’ve kind of tangented and, uh, and haven’t really discussed our, our general focus. So I kind of want to bring it back to, uh, Mark is making a general shift in, and he’s starting to do his own thing. So I kind of want to talk, um, like where you are with that. Uh, what are you doing? Kind of like, what, what is it, and I really want to talk about why, um, and why you’re making the shift. So floor is yours. 

Dr. Mark Kargela (00:43:21): 

Yes. Uh, you know, my shift is eventually modern pain care will be, uh, you know, uh, again, we will practice what we preach and there’ll be some clinical, you know, foundations to it where we’re, um, you know, you’re going to start seeing clinicians maybe, or seeing patients. And then that will be your classroom. Having clinicians come in and see what we do and how we put into action, what we bother them about doing as far as the process and person centered care and that stuff. Um, right now I’m in the university setting. And, uh, you know, I, I have no complaints as far as it’s a very good job, all that stuff, but it’s just, you’re still, I’m still in the belly of healthcare and it’s frustrating. And, uh, um, the university part of the academics part, I think obviously love interacting with students and it’s been great. 

Dr. Mark Kargela (00:44:00): 

I mean, there’s good and bad things of anything. And I, I can’t say anything bad about Midwestern that’s any different than some of the struggles that any academic setting has as far as translating current research to what hits them in a PowerPoint. But, um, yeah, eventually going to be looking to do some more type models that bust out of this kind of healthcare system, where you’re scrapping for a neurosurgeons after they’ve been this, patient’s been through a dumpster fire of horrible messaging, horrible beliefs around their body, immobility fear, avoidance, the whole nine, that oftentimes healthcare brings people in. Um, I think we can step out of that and getting on the front get that on the front page of Google, when somebody’s searching their back or on the front page of whatever and get our messages out to people, I think there’s a lot to be done. 

Dr. Mark Kargela (00:44:44): 

I’ve actually been purposely studying a lot of marketing sales. It’s helped me in my clinical practice because I’m better at selling my plans of care to people and things, but it’s also going to help me, um, in, in business when I eventually put a shingle up and, uh, you know, start, you know, putting a founding site of modern pain cares clinical practice out there that, um, we want to be, uh, affect the healthcare system and it’s not going to happen trying to work on the, in the belly of the beast. We’re trying to step outside it and, and, uh, create a different Avenue for clinicians to not get burned out on 30 patients a day to where they can fricking love coming to work each day, they get a learning environment that’s going to push their growth constantly. And they’re going to, they’re going to help people in, in a very non nocebic invasive cost-effective way. 

Dr. Mark Kargela (00:45:30): 

And it’s going to be probably outside of, um, some of the in network stuff that, you know, has our profession piling in, you know, 30 patients on a schedule and giving no individualized care and, and, and riding natural history, uh, charging natural history. Cause they’re getting patients getting entertained for 10 to 20 minutes in a therapy setting. I guess it’s better than an neurosurgery clinic getting scalpel. You know, not that that doesn’t occasionally have its place, but yeah, I think there’s ways we can do better. And I think I’m tired of talking about it and being frustrated with it. I’m at the point where it’s time to take action. 

Dr. Joe Camoratto (00:46:04): 

HEll yeah. I love it. Go CJ. No, go ahead. Um, I don’t really have a question. I guess I’m more have like a thought. Um, but I don’t know if it has to do with Mark opening his, his modern pain care business. Wait, here’s a question. Is it going to be a brick and mortar spot? Are you guys going to stay online? Um, with that, 

Dr. Mark Kargela (00:46:29): 

You know, I’d like to get, uh, eventually a brick and mortar, um, uh, thought I’m actually in process of, I I’m a member, although it’s been on hold since coronavirus and things that a CrossFit blade here in Phoenix, I’ll be kicking that back up in March 1st. Cause they’re, they’re probably, I mean, they’re closest to me, but honestly, a great box. So I’m looking to start working a little bit with, uh, CrossFit athletes. I think there’s this misnomer that, you know, some of the issues we see in just general ortho practice don’t exist in the, in the CrossFit population. There’s some, some significant challenges there, but, uh, looking to start working, uh, you know, with, uh, the CrossFit box I’ve been in discussions with nothing’s been agreed upon or anything like that. But I think there’s just huge opportunity to kind of put that fitness facing, um, kind of mode of healthcare instead of just like, wait until the wheels fall off the car. 

Dr. Mark Kargela (00:47:19): 

Can you start creating systems and settings where we start, uh, proactively keeping people healthy and out of doctor’s offices out of the pain physicians, offices. I mean, granted, we’re still gonna have to, to work in and help the people that are too far down that path of, of, of, uh, healthcare maybe doing what it does, but I think there’s different ways we can go about it versus just again scrapping for what biomedicine spits out the other side and get in front of biomedicine, use it when it’s needed, because it’s an absolute necessary part. I’m the last thing I checked PT doesn’t help Corona virus or anything like that. I mean maybe the side effects and stuff, but like when we, we aren’t going to change a virus, we, you know, that takes biomedical skills to identify, develop vaccines, all that stuff. So it has its place. I people often times say, well, you think biomedicine’s, the devil, no, it’s just can be very limiting and disabling, especially when it comes to musculoskeletal conditions. So, um, we need to do better. And I think again, stop talking about it, started doing things about it. 

Dr. Joe Camoratto (00:48:15):
 Shout out to your snatch PR by the way, really great. 

Dr. Mark Kargela (00:48:19): 

Yeah, dude, it was ugly. I, you know, I’m staring at the floor of all rounded. My butt comes up early. I mean, I, I pretty much, you know, I like the wad prep group I get in there. Um, oftentimes lurk, but I like getting, uh, you know, it’s good community there. I mean, that’s been one of the best things that’s got me through coronavirus as far as, and my wife being so nice to allow me to spend some money on our garage gym. I’m hoping that I’ll be part of modern pain care’s, uh, initial brick and mortar, uh, bots. So there’s that investment. 

Dr. Joe Camoratto (00:48:49):
 Yeah. I’m glad you were able to find some, uh, weights. I remember sending you a link to some hundred pound plates, uh, and you were like, yeah, thanks a lot 

Dr. Mark Kargela (00:48:55): 

Sure. Shortly after I was on the fence of like, should I pull the trigger on those? And then all of a sudden rogue, I was on like every, like, you know, list of alerts when products became available. And like, I remember I would be like walking with my wife and kid and bumper plates would come available. I get the alert on my phone. I’m like stop. But I had to friggin like jump and get the credit card out, so, or, and get and pay for it because you know, those things lasted for like literally 10 minutes and then they were already sold out again. So it’s still that way. For some things, if you guys have some change plates, I’m looking for two and a half, some fives, if you can help a guy out all, even one, two and a half, I could send you that had other, 

Dr. CJ DePalma (00:49:36): 

If you follow, uh, as many reviews as possible on Instagram, uh, it’s this guy, all he does is do reviews and just turn your notifications on. Um, he gets the first notice like rogue legit contacts him when, or at least it seems like that. I don’t know how he gets it so fast, but he’ll basically make a post and it’ll be like iron plates available. And so you’ll get it that, it’s all I got all my stuff during that time, which was only like a bike. 

Dr. Joe Camoratto (00:50:03): 

So let’s go back to talking about the brick and mortar thing, because I know that there that the three of us, or at least CJ and myself are like really biased towards exercise. Right. But, you know, we know that with the recent stuff, that’s come out, that exercise modes as a general, don’t like, it, it doesn’t really matter what it is that you do. And I know that Ben Cormack kind of hits on this a lot. It’s like, it doesn’t matter what you do as long as you do some sort of value based, um, uh, sort of exercise. But I think that, um, we can at least attest to the type of, uh, exercise that CJ and I prescribe, um, or, or give to our lifters is that it’s a moderate to high intensity. And it has a secondary effect that is listed by like, you know, the, uh, uh, shoot the activity guidelines for all Americans, right? You need to do this stuff to be healthy. And, and, uh, I at least sleep soundly at night knowing that even if the stuff that, that we give out to our people to try and, um, help them while they’re following that natural history, they’re at least getting healthier if there is no, you know, sort of efficacious, uh, side effect from that stuff. 

Dr. Mark Kargela (00:51:08): 

Yeah, no, I think we just had Jared Paul, like I said, last this Monday, this past Monday, talk about how it really strengthening for shoulder pain. We don’t really have any good evidence that pain and disability gets better, but I it’s hard to argue. I agree. Like the secondary health benefits of exercising from a metabolic cardiovascular, I mean, yeah. I mean, you’re not going to get that from a needle being poked in you or, uh, somebody jumping on you for a whack and crack on your neck or back. I mean, it’s not to say those things can help pain, but again, they haven’t shown any real efficacy. I think exercise is probably the best choice as far as when, when you think about those secondary health benefits, does it confer special superior benefits from a pain and disability? Uh, I don’t think we have a ton of data to support that, but again, I think in the CrossFit population, you got a lot of folks where valued living is involved in exercise and loading their bodies and participating in CrossFit. 

Dr. Mark Kargela (00:51:58): 

So getting that, especially that population and the powerlifting population and folks that are just trying to get well, I think especially right now in coronavirus, we’re seeing that, you know, a good, healthy immune system has a protective role. Exercise can definitely build you up. And I think right now we have a unique opportunity in PT. If we can capitalize on that message, like we are probably the best position profession. If we just put away fricking shiny tools and get to the basics of being good prescribers of exercise, which again, we’re not maybe as good as we need to improve our strength and conditioning components and all that stuff, but get great healthy humans. And if manual therapy needs to get something where they can start engaging in a, in a healthy lifestyle then great. And if a needle needs to be there, fine, if a cup good, but it shouldn’t be the fricking center stage of, of how people get well. 

Dr. Joe Camoratto (00:52:46): 

So you kind of follow like kind of what PT Inquest Eric Meira says. Whereas I don’t care what it is that you’re doing. I care what it’s, you’re not doing, which is like all of that stuff that, you know, would be, uh, the main, like the, the meat of the potatoes of the treatment world. 

Dr. Mark Kargela (00:53:04): 

Yeah. I mean, I don’t get, I mean, I used to be somebody who, I mean, I’m not a, I’ve been a vocal critic of needling. I don’t honestly care. Honestly, if people want to get needles certified or cup certified or tape certified go to it. But again, if you’re thinking that that confers some unique superior benefits, yes. If you go talk to people on Facebook and Instagram and go to the monthly comp or yearly conference that pumps you full of that bias, you’re good. Of course, you’re gonna believe that I would too. And I’ve been that person with certain parts of my intervention, development and treatments I’ve learned over time, but we need to look past that stuff, man, if we’re going to compete in the healthcare space and have a message, because I think we have the data on, on getting people, you know, lifestyle and getting them getting while human beings and being more upstream in healthcare versus the downstream dumping grounds that we get sent to us often from biomedicine. I think w jump on that, man. And I think don’t worry about the frickin physician being happy about it, make the person happy. They’ll be, there’ll be not in the physicians. And the physicians will take notice if we do what we can do and stop trying to like beg for their, you know, scraps of a referral here and there. Not saying we can’t still work that if you have those relationships, but man, it’s just, I think we limit ourselves by being kind of stuck under that system. 

Dr. CJ DePalma (00:54:20): 

Yeah, I agree. I think, um, the one thing that would never say that my like in-person practice was like a raging success, but we were, we were like, we were comfortable and we did well. And then, and, and I was, I would never consider myself a great clinician from like the normal standards of, of like the things we talk about in school. But what I did well was communicate with people and like create a relationship and, and the soft skills. And like I talked about earlier, like the sales concept. And so, you know, people come in and we just have this like relationship with us in the private practice or the cash pay or whatever, whatever you want to call it, you know, the ability to have one-on-one care has like, given me that opportunity as a clinician to, to really hone in and focus on that more right. 

Dr. CJ DePalma (00:55:08): 

To like elaborate and like not elaborate. So elongate and really dive into the educational process there. And, and we set ourself up as a profession to not be able to effectively do that. Right. To try and educate someone on like, even just like rudimentary, um, uh, concepts of pain in 10 minutes during, during an eval when they’re trying to subjectively give you their story and then you’re trying to give them feedback on it. Um, I think we’ve really just created a, uh, a big problem there and some people do it well, like, and, and so, and then we have this like other, probably a problem with, you know, a postdoc issues of like, you know, Oh, well, I see three people by outcome rates are really good. And it’s like, I mean, are your outcome rates really good? Or just people getting better. Right. It’s like what? 

Dr. CJ DePalma (00:55:58): 

And so there’s so many issues there and that’s okay. Right. And that’s totally fine. There’s nothing wrong with that. But again, it creates this biasness that like what’s, you’re doing is really good. It it’s just, it’s just so tough. And so some people are in this traditional model and they feel very successful and they probably are, if you’re looking at numbers. And so I don’t want to knock that. I don’t, I think one-on-one is the only way to see him, but for me, it, the only way I felt I was going to be effective as a clinician. And, um, and, and so, and I think that’s a lot of people moving to the one-on-one or to the one-on-one model. I hope that’s their goal. Right. You know, it’s, you know, obviously you can be being your own boss, like, you know, you have like financial opportunity there, but, you know, I think it’s, I think it really does give you an opportunity to like, communicate and be a person with the person in front of you. Yeah. 

Dr. Mark Kargela (00:56:50): 

When you look at the trends of late that you guys talked about already with healthcare reimbursement and stuff, businesses, aren’t going to be staying afloat unless they divide you up more to where you’re seeing more people at once. It’s just, it is the way it is. And if you want to keep it on that path, I mean, I just don’t see how it’s sustainable from a just sanity standpoint, to be able to see so many patients not there are probably clinicians and I’ve, I know there’s clinicians who can see people, you know, double booked. And I think there’s some reasonable times where that can be done. Well, there’s probably some strength that some group settings where you’ve got people who are kind of pushing each other along and, and different things, but, um, I’m with you, man. I think if you want to try to provide the best top of our license best care to really tailor to human, I think one-on-one is the best place to provide that. 

Dr. Mark Kargela (00:57:30): 

And I think it’s becoming increasingly hard and not to say there are settings out there that do it. I mean, that would be my big thing. If I’m looking to come out of school and find my setting, that would be the number one thing. I mean, mentorship and stuff gets bandied around and then you like cut your salary. And then the mentorship ends up being like a half-ass you’re there confirmation bias Fest. That’s not necessarily, you know, upping your game as a clinician. I’ve seen that’s all. Cause there’s some clinics that do a great, but yeah, I think, you know, it’s, it’s, uh, there’s, there’s opportunities for PTs, but you just gotta, um, find settings that, uh, uh, you know, allow you to grow the way that and give you the opportunity to form those relationships that you talked about. 

Dr. Joe Camoratto (00:58:12):
 Uh, Mark is modern pain care on tik tok? 

Dr. Mark Kargela (00:58:16):
 We’re not on tik tok, you know, I’ve dabbled, 

Dr. Mark Kargela (00:58:18): 

I’ve got a Tik TOK account, dude. I am just not, uh, I, I’m still trying to figure the platform out. I actually, it’s been a while since I’ve been on there, but, um, you know, we, we definitely are sensitive to the fact of where our audience is and, uh, Instagram definitely seems to be where folks are at. I am not wanting to be out there shaking and dancing on social media too much. Uh, my wife already is appalled by, you know, if I have too many beverages at weddings, I, I don’t, I let loose be ugly, but, uh, it’s all good. But, um, yeah, it’s uh, yeah, we’ll, we’ll check it out. Maybe who knows, maybe we’ll have a tik tok page before, you know it. 

Dr. Joe Camoratto (00:58:53): 

Um, now what are your thoughts on clinicians who are on Tik TOK or on reels on Instagram, their ability to communicate complex topics in a very short period of time, because that’s been something that’s been chappin my buns quite a lot lately. 

Dr. Mark Kargela (00:59:05): 

Yeah. I think, you know, the, the headline based stuff, that’s a clickbait worthy that has, you know, minimal, you know, foundings in any reality of the world. I struggle with that. I think there’s ways you can be thoughtful and still do that because I think we also have to be sensitive to the fact that that is the world we’re living in media. And if you want to get your messages out to the consumer consumer, you can be as mad about it. And as grumpy about marketing and sales, and then just don’t, you know, I I’ve been that person to then, then don’t bitch When people don’t come to your door, you’re not putting your message out there to bring people to your door. They’re not going to like, you know, I mean, I guess you can put blog posts out there and stuff, but we live in a world where if you want to get your message in front of people and do the upstream approach and get one-on-one and build your own practice, then you need to be able to put your message out there and compete with the garbage that’s out there. And in social media worlds, even if it’s painful. Um, and I I’m with you, uh, Joe, I’m not a huge fan of social media. I only do it strictly from how do we move our mission at modern pain care forward. I could care. And I like dogs and puppies and, and seeing people’s kids do cool stuff. Um, you know, obviously I could definitely do it without the politics and all that other crud with it, but 

Dr. CJ DePalma (01:00:13):
 We almost made it a whole conversation to not even use the word. It was so close. All right. Continue. 

Dr. Joe Camoratto (01:00:20):
 Well, I’m looking forward to watching you like, mm, mm, mm. 

Dr. Mark Kargela (01:00:25):
 I always like CJ’s post, like when he’s in the gym doing the electro techno beats going in the background. I mean, I’m 

Dr. Joe Camoratto (01:00:34): That dadbod playlist. 

Dr. Mark Kargela (01:00:38):
 I’m, uh, I’m looking, I mean, I’m taking, taking pointers and then I’m gonna see if I can have CJ. Maybe he’ll sell me his playlist. He could probably make some money on the no jams or something like that. 

Dr. Joe Camoratto (01:00:49): 

I do have one more question. Uh, when, when can we expect the next clinical thinker podcast episode come out because I subscribed and I I’m left hanging here, man. I’m looking for episode 12. What’s going on? 

Dr. Mark Kargela (01:01:01): 

Yeah, no, unfortunately that podcast was dissolved. I enjoyed it. It was just tough logistically with Ben, Jared, and myself to get on all three of us. Yeah. I’m sure you guys can relate to it. Just trying to get you guys on a podcast together and us three on it. But yeah, I had a great time. I always enjoy, uh, Ben’s perspective. I’ve learned a great deal from, from Ben Cormack and all he’s doing with, uh, his own, uh, core kinetic PR uh, you know, brand and what also he’s doing at a better clinician product or project with, uh, Adam Meakins. So, you know, 

Dr. Joe Camoratto (01:01:33):
 I have the, um, modern pain care podcast, right? Yeah. 

Dr. Mark Kargela (01:01:36): 

Yes. We have the modern pain podcast. I don’t know if we’ll be, you know, hit the, uh, the levels of the golden nuggets, but, you know, we ascribe to, to, we don’t have the brand appeal and the name just, you know, obviously crushes it with the, and the, the, the picture. I always also enjoyed it its guys run a good footing. How many podcasts are you guys in, by the way? How many is it? 

Dr. Joe Camoratto (01:01:56):
 This is number four, four. I’m just, you know, top 10 bottom floor level, man. 

Dr. Mark Kargela (01:02:03): Um, but yeah, no, I think, yeah, 

Dr. Mark Kargela (01:02:04): 

We were, we’re trying to hit the appropriate channels to push our message out there and, um, getting the world to people to where we can start, you know, getting in their practices and helping them, whether it’s through a membership through our online course or through our deep dive, on coaching stuff where we, you know, kick in the brain hard and get you thinking and moving your, your profession and your community forward of patients. That’s what we’re after. So 

Dr. Joe Camoratto (01:02:28):
 Can I, can I just tell you that when I listened to the clinical thinker podcasts, what was it two years ago now? I thought you were the British one. No joke. 

Dr. Mark Kargela (01:02:37): 

You know, I think I’ve had a few other people think the same thing like that. Uh, I was the, the Brit, maybe I have a British look. I mean, I always tell people I have a face for podcasts, so I, um, I’m not, uh didn’t but yeah, I, I don’t know why that the brit thing gets confused, but it’s, you’re not the first person. 

Dr. Joe Camoratto (01:02:54):
 And then I remember commenting on one of Ben’s videos. I was like, Oh, shit you’re the one he’s like, what are you talking about? I was like, ah, nothing. 

Dr. Mark Kargela (01:03:07):
 I’ve had that before too. But you hear somebody’s voice and what you picture them to look like is completely opposite of what they end up looking like. Um, yeah, no it’s 

Dr. Joe Camoratto (01:03:16):
 Any chance, any chance we could hear your best British accent on the pod or? No, 

Dr. Mark Kargela (01:03:21): 

I don’t want to drop your ratings right out of the gate. I mean, this is really high. Let’s keep, let’s keep the, uh, the trajectory of heading and up and up. Um, yeah, I’m definitely going to be sharing this episode to our, to our followers and listeners too, so they can, be fully indoctrinated by the world of Mark Kargela, um, again, hopefully they see that we have a pretty nuanced, uh, open approach to focusing on the person not on, on strictly, you know, your, your brand identity and stuff like that. Of course, those need to best. But, um, if it’s all aligned with pushing best practice for where we’re game, 

Dr. Joe Camoratto (01:03:56):
 CJ got any other, uh, things you want them to know. 

Dr. CJ DePalma (01:03:59): 

Yeah. Well, not really. It was more of like question of the day kind of thing. Just like end on something like Joe, you come up with some really good questions, sometimes nothing, nothing end of the world related or related to the last podcast. Uh, no, I haven’t asked about the end of the world. Oh, okay. We can’t do that on the episode. All right. Something less turmoil. 

Dr. Joe Camoratto (01:04:21):
 Um, have you ever owned or will you own, uh, some chickens in your, in your, uh, lawn yard, 

Dr. Mark Kargela (01:04:27): 

You know, are in Phoenix, man, the yards are like at a premium, like it’s hard to find like any significant square footage or square acreage. Um, but although you can, it’s just, you gotta pay like 750 grand to make that happen. Um, but I actually do know some people, like at our CrossFit box, we’ve got somebody who brings in like a, you know, uh, eggs every once in a while from the chickens they raised. So it’s not uncommon. I think, you know, if the end of times come, as I know, you’re, you’re mindful of, I think it’ll be good to have your own ability to produce, uh, eggs and, and such survival assisting, um, of foods. Yeah. And nicely work. And I don’t know if you guys were like digging the old bunkers in the backyard yet, but, uh, you know, it’s, it’s good to be prepared if chickens are part of it. Uh, I think that’s, you know, props to you, boys. 

Dr. Joe Camoratto (01:05:14):
 Well, we’re not going to advertise what we are or are not to do for you in the world. Cause then everybody’s going to want to join in. But yeah, 

Dr. Mark Kargela (01:05:20):
 That’s right. You don’t want to anybody to come into your world survival camp. 

Dr. Joe Camoratto (01:05:24):
 I don’t have that much or won’t have that much food for them, you know? Um, cool. 

Dr. Mark Kargela (01:05:31): 

Yeah. I’m actually taking a lot of that financial planning class and it’s kind of talking about doing some preparatory stuff with food and water and stuff in case the, you know, things get off the rails in the world and you know, who knows, I would have never considered it maybe two years back, but as things have transpired in the world over the last few years, I’m a lot, I’m considering that a lot more seriously than I have for sure. 

Dr. Joe Camoratto (01:05:52):
 Today’s inauguration day there might be a big pivot. Um, all right, cool Mark. Where can people find you? 

Dr. Mark Kargela (01:05:58): 

Well, you can find mkargeladpt is my handle on Twitter, Instagram, Facebook, if you want modern pain care is the handle on, uh, Facebook and Instagram as well. A is our website, uh, check them out. We just actually launched our website onto back onto, uh, a new platform, which is going to give us a lot more opportunities to produce some higher quality content. And we have a membership and all that stuff too, but people can check that out. If you want to see what we’re up to and see if you guys can, if there’s a good fit for where folks are looking to move their careers and what they’re up to, 

Dr. Joe Camoratto (01:06:34):
 Hopefully they’ll have a CrossFit course someday. 

Dr. Mark Kargela (01:06:36): 

Well, you know, I we were in discussions with a few gentlemen, uh, who I’ll leave unnamed, um, as far as maybe seeing if we can, um, collaborate on such activities to see if we can cause apparently CrossFit people have pain too, and they have thoughts and feelings and beliefs around their pain. Often probably sometimes a little bit more off the beaten path than some of our, uh, other folks who we automatically think, Oh, it’s chronic pain. So you’re only seeing persistent painers. I’d say I deal with a lot of this stuff with my athletic populations as well. So, um, yeah, be on the lookout. You never know what happens down the future as far as what offerings we have. 

Dr. Joe Camoratto (01:07:13):
 Very cool. Well, thanks for coming on. We really appreciate the time. Um, especially the short notice, uh, scheduling, uh, that’s the beauty of not being in the clinic 24/7. 

Dr. Mark Kargela (01:07:24): 

Yeah, no, it’s always a pleasure to chat with you, gentlemen. I mean, obviously I get a good dose of confirmation bias with you guys, but I hope that, you know, we see that we actually think that we might be living in a world of confirmation bias and, and seek to, you know, uh, remedy that as much as we can by keeping our minds open with other views. So great time today. 

Dr. Joe Camoratto (01:07:43):
 Yes. Uh, cool. Thanks everybody for coming out. CJ anything uh, to the people. 

Dr. CJ DePalma (01:07:47):
 Nope. Thanks for joining the golden nuggets podcast. We’ll see. 

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