The Preventive Medicine Podcast

Dr. Katie Dabrowski, PT, DPT, CSCS is a physical therapist, strength coach, and co-founder of Old Bull Athletics — a private practice in Miami, Florida built around treating movement as medicine and blending the worlds of strength training, performance, and rehabilitation. Her undergraduate work in psychology and neuroscience at Nova Southeastern University included a Divisional Honors Thesis comparing the effects of brain training and physical exercise on executive function, and she went on to earn her Doctorate of Physical Therapy from the University of Miami. She currently serves as an adjunct neuroscience faculty member at NSU and is an Advisory Board Member for the Society of Neurosports.

In this episode of The Preventive Medicine Podcast, Dr. Dabrowski breaks down why she left the traditional PT model behind, how Old Bull Athletics was built to meet patients across the full spectrum of health — not just after injury — and what it actually looks like to use neuroscience and strength training together to build lasting resilience. This is a must-listen for anyone who wants to understand where the future of musculoskeletal care is heading.

Topics Covered:

What happens when a physician with 24 years of military service, experience deploying to Baghdad, and a front-row seat to America’s most devastating hurricanes decides the exam room isn’t enough — and runs for Congress?

In this episode of The Preventive Medicine Podcast, we sit down with Dr. Darren, founding chair of the Department of Osteopathic Medicine at Orlando College of Osteopathic Medicine, Florida’s State Air Surgeon, and Democratic candidate for Florida’s 15th Congressional District. Dr. Darren has cared for soldiers in combat, coordinated medical responses after catastrophic storms, and trained the next generation of physicians — and now he’s bringing that lens into the political arena.

This conversation goes deep on what it actually takes to fix American healthcare — not from a policy wonk’s perspective, but from someone who has lived it on the ground, in uniform, and in the clinic. If you’ve ever wondered why healthcare got so political, who’s really blocking reform, and what a physician-legislator could do differently, this episode is for you.

Disclaimer: This podcast is not a political endorsement.

Topics Covered:

What does it actually take to build a private practice from scratch — and keep it alive?

In this episode, Dr. Sharma sits down with a physician who has done exactly that. A Northwestern-trained physiatrist and fellowship-trained spine and sports medicine specialist, today’s guest founded Desert Spine and Sports Physicians and has led it as CEO since its inception — earning Top Doc recognition in Phoenix every year since 2009.

The conversation goes deep on the philosophy behind function-first MSK care, the operational realities of private practice ownership, and why the current healthcare system is structurally built against the kind of preventive, patient-centered medicine both physicians believe in. This isn’t a polished origin story — it’s an honest, unfiltered look at the business of medicine, the ethics of care delivery, and what it takes to build something that lasts.

If you’re a physician thinking about private practice, a patient trying to understand why the system feels broken, or simply someone who wants to know how to actually get and stay healthy — this episode is for you.

What Preventive Medicine Actually Means — How today’s guest defines preventive medicine in the context of spine and MSK care, and why the word gets misused in modern healthcare.

Function-First Philosophy — The origin of Desert Spine’s approach to MSK care centered on restoring and maintaining function rather than chasing symptom relief. What shaped this perspective and why it diverges from conventional practice.

Starting a Practice from Scratch — The decision to build rather than join. What the early operational phase actually looked like, which systems and decisions made the biggest difference in getting to sustainability, and what most physicians underestimate going in.

Why Private Practices Fail in Years 1–5 — The most common reasons practices don’t survive their first few years: financial miscalculation, operational blind spots, physician burnout, and loss of clinical identity under business pressure.

How Reimbursement Models Work Against Prevention — A frank breakdown of how current fee-for-service and value-based payment structures disincentivize the kind of care that actually keeps patients healthy long-term.

Navigating the Insurance Landscape — The practical reality of getting paid as a private practice. Credentialing, contracting, billing infrastructure, and how to build a system that doesn’t hemorrhage revenue.

When Patient Care and Business Reality Conflict — Real talk on the moments every practice owner faces: when doing right by the patient costs the practice money. How to build systems and a culture that protect clinical quality even under financial pressure.

Two-Minute Health Advice — If someone walks up and asks how to get healthy, what does a Top Doc physiatrist actually tell them?

Honest Advice for Physicians Considering Private Practice — What today’s guest wishes someone had told them. What the business schools don’t cover, what the idealism misses, and what the rewards actually look like on the other side.

In this episode, we sit down with a leading expert in Physical Medicine & Rehabilitation (PM&R) who brings a rare combination of clinical depth and academic leadership. With training from the University of Oklahoma College of Medicine, a PM&R residency and SCI Fellowship at the Medical College of Wisconsin, and experience as both a former SCI Fellowship Program Director and current Program Chair of PM&R at MCW, our guest offers a masterclass in spinal cord injury care, preventive medicine, and the future of healthcare delivery.

Whether you’re a patient, caregiver, clinician, or simply someone curious about how medicine is evolving — this episode is packed with insight you won’t want to miss.

What We Cover in This Episode:

In this episode, we break down the surprising and often overlooked history of how the U.S. healthcare system came to be—not through strategy or design, but through a series of accidents, policy compromises, and economic incentives that spiraled into today’s crisis.

We explore the roots of employer-based insurance, the rise of fee-for-service reimbursement, the unintended consequences of Medicare and the Affordable Care Act, and how hospitals, insurers, and physicians evolved into the fragmented landscape we live with today. From the explosive growth of consolidation to the misaligned incentives driving costs, access issues, and burnout, this episode explains why American healthcare works exactly as it does—and why fixing it requires understanding its origins.

Whether you’re a clinician, policymaker, administrator, or simply a curious listener trying to understand why U.S. healthcare is so complex and costly, this deep dive uncovers the structural forces that still shape the system. You’ll learn how major policy decisions, market power, and historical quirks created the misaligned incentives that fuel skyrocketing prices, consolidation, administrative waste, and persistent inequities.

How employer-based insurance began by accident during WWII wage freezes

The rise of fee-for-service and how early insurance models locked in volume-based payment

Medicare and Medicaid’s structural influence on cost and system design

How technology and specialization shifted the system toward high-cost acute care

Why the ACA unintentionally accelerated consolidation among insurers and hospital systems

How misaligned incentives across hospitals, payers, physicians, and patients drive today’s dysfunction

Why U.S. healthcare prioritizes volume, pricing power, and market share over actual health outcomes

Why the system behaves exactly the way it does

How economic incentives—not clinical priorities—shaped U.S. healthcare

Why costs continue to rise regardless of reform efforts

Why consolidation amplifies prices and reduces competition

The historical context needed to understand meaningful solutions

Clinicians

Health policy professionals

Students in medicine, public health, or health economics

Anyone trying to understand why U.S. healthcare feels so broken

Ragav Sharma, DO is a Physical Medicine and Rehabilitation (PM&R) physician with training in interventional spine and musculoskeletal medicine. He formerly set powerlifting records and has also completed several races including ultramarathons. He is an avid proponent of resistance training and has coached others, obtaining a Certified Strength and Conditioning Specialist (CSCS) certification, for both general health and powerlifting goals. 

In this episode, Dr. Ragav Sharma breaks down the science and strategy behind resistance training — one of the most powerful tools for improving long-term health, performance, and longevity. We explore what the evidence says about strength training for muscle growth, fat loss, metabolic health, injury prevention, and healthy aging. If you’ve ever wondered how often to lift, what exercises actually matter, or whether resistance training is “safe,” this episode gives you the no-nonsense, research-driven answers.

Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:

Bodyweight exercises

Free weights (dumbbells, barbells, kettlebells)

Resistance bands

Machines

Household objects (backpacks, water jugs, cinder blocks)

Strength training is not just for athletes or bodybuilders. It is one of the most potent therapeutic tools we have for improving overall function, mobility, and longevity — and it should be accessible to everyone.

Resistance training:

Increases fat-free mass (muscle)

Reduces overall and visceral fat

Helps preserve muscle during weight loss or GLP-1/GIP therapy

Predicts lower mortality independent of BMI

Muscle is metabolically protective. Higher muscle mass is associated with a lower risk of chronic disease and death, even in those with a high BMI.

Bone density peaks around age 25–30 and declines after 40, especially in women. Walking alone does little for bone mineral density.

Mechanical loading — squats, deadlifts, step-ups, weighted carries — is essential for:

Increasing bone density

Slowing osteopenia and osteoporosis

Reducing fracture risk

Maintaining physical function later in life

One of the strongest demonstrations is the Lift More Trial, where women 60+ with diagnosed osteoporosis safely performed heavy squats and deadlifts twice per week. They improved bone density significantly, with only one mild strain in over 2,600 sessions.

Many people assume aerobics is the only way to protect the heart. The data tells a different story:

Any resistance training → 19% lower cardiovascular mortality

Improves LDL, HDL, triglycerides, blood pressure

Enhances functional capacity in heart failure patients

The best results come from combining aerobic exercise with strength training — but strength training alone has a meaningful impact.

Strength training increases insulin sensitivity through GLUT4 upregulation and:

Lowers HbA1c in both type 1 and type 2 diabetes

Reduces visceral fat, a major driver of insulin resistance

Improves metabolic flexibility

For people unable to tolerate high-impact cardio, resistance training becomes even more important.

The psychological benefits are just as powerful:

Significantly reduces anxiety symptoms

Lowers depressive symptoms in adolescents and adults

Benefits occur regardless of strength gains

Simply engaging in resistance training reliably improves mood and mental well-being.

Movement is medicine — and resistance training consistently reduces pain:

Decreases chronic low back pain

Improves pain and function in knee osteoarthritis

Helps patients with fibromyalgia reduce fatigue and tender points

For general musculoskeletal pain (3–7/10), strength training should not be avoided — it is often one of the most effective treatments.

Inactive adults lose 3–8% of muscle per decade, accelerating after age 50. Resistance training:

Rebuilds strength and muscle

Improves gait speed, grip strength, and mobility

Reduces fall risk

Lowers frailty and functional decline

Most importantly:

This is one of the strongest arguments for making resistance training a standard part of preventive medicine.

Despite overwhelming evidence, only about 10% of adults meet strength training guidelines. Common barriers include:

Fear of injury

Lack of knowledge

Lack of time

Misconceptions about “proper form”

Intimidation around gyms

Poor clinician guidance

Social stigma

Limited access to equipment or facilities

But most barriers are built on incorrect assumptions — and many can be addressed effectively.

Weight training has one of the lowest injury rates of any physical activity:

0.05–0.31 injuries per 1,000 hours
Compare that to:

Running: 2.5–33

Basketball: ~8

Tennis: 27–62

Golf: 3–8

Strength training is far safer than most sports.

Data shows:

Powerlifters report no major back injuries in squat/deadlift reviews

Only 6.5% of disc herniations are related to heavy lifting

Most herniations occur during daily tasks like mopping or twisting

A well-dosed program protects your back — it doesn’t harm it.

People with knee osteoarthritis benefit from resistance training:

Reduced pain

Improved strength

Better function

Lower disability

Even common “faults” like knee valgus are not inherently dangerous.

Strength training is safe and effective at any age — including people with:

Osteoporosis

Arthritis

Chronic pain

Frailty

The Lift More Trial proved heavy lifts can be safe even in 60+ adults with fragile bones.

The research shows:

60 minutes per week → maximum longevity benefit

15–20 minutes per week → effective for muscle and strength

“Exercise snacking” (5 minutes) → still beneficial

Time is not the barrier — expectations are.

Form matters, but not the way most people think.

CrossFit (irregular form) has injury rates similar to powerlifting

Machines and free weights produce similar strength gains

“Good form” is often just what feels natural and safe for the individual

The real risk factor isn’t form — it’s doing too much, too soon.

Here is a simple evidence-based template:

Push (push-ups, machine press, overhead press)

Pull (rows, pulldowns)

Squat (goblet squat, leg press)

Hinge (deadlift variation, hip thrust)

Carry (farmer carry, loaded hold)

3 sets

8 repetitions

Twice per week

That’s it. This template is enough to significantly improve strength, function, and metabolic health.

Avoid nocebo language (“deadlifts will hurt your back”).

Focus on function, not weight loss.

Give general guidance — not detailed workout plans.

Celebrate adherence to ACSM guidelines.

Identify the patient’s stage of readiness to change.

Provide reassurance, clarify myths, and help them feel capable.

A simple conversation can dramatically shift a patient’s willingness to exercise.

Resistance training isn’t just a fitness trend — it’s one of the most powerful interventions for:

Chronic disease prevention

Pain reduction

Bone health

Metabolic health

Mental well-being

Mobility and independence

Longevity

And best of all, the maximum health benefit requires only one total hour per week.

If we could package resistance training into a prescription pill, it would be the most effective blockbuster drug in modern medicine.

Join us for an inspiring conversation with Dr. Shounuck Patel, a leader at the forefront of interventional orthobiologics and musculoskeletal ultrasound. A proud alumnus of the Chicago College of Osteopathic Medicine (CCOM), Dr. Patel completed his residency at the prestigious Kessler Institute, followed by world-renowned fellowship training at the Orthopedic and Spine Specialists (OSS).

Dr. Patel is a master instructor for the Interventional Orthobiologics Foundation, where he trains physicians globally in cutting-edge regenerative techniques. As the founder of the Patel Center for Functional Regeneration in Newport Beach, he has established a premier destination for patients seeking advanced, evidence-based musculoskeletal care.

Internationally recognized for his expertise, Dr. Patel is a sought-after speaker on orthobiologics and ultrasound, sharing his knowledge at conferences and workshops around the world. He also serves as an associate clinical professor, mentoring the next generation of physicians at Western University and Touro College of Osteopathic Medicine.

Passionate about education, Dr. Patel regularly shares practical insights and procedural pearls on Instagram and YouTube (@Regendrpatel), making high-level regenerative medicine accessible to clinicians and patients alike.

Tune in to hear Dr. Patel’s journey, his approach to innovation in musculoskeletal medicine, and his commitment to teaching and advancing the field.

Dr. John Whyte is a nationally recognized physician leader, public health communicator, and healthcare innovator. He currently serves as the Chief Executive Officer and Executive Vice President of the American Medical Association (AMA), where he leads the organization’s mission to advance the art and science of medicine and improve the health of the nation.

A board-certified internist, Dr. Whyte earned his MD from the University of Pennsylvania and his Master of Public Health from Harvard University. His distinguished career spans leadership roles across some of the most influential healthcare institutions in the United States. He has served as a Director at the U.S. Food and Drug Administration (FDA), as well as positions at the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS).

Prior to his role at the AMA, Dr. Whyte was the Chief Medical Officer at WebMD, where he became a trusted voice for evidence-based health information and patient education, reaching millions through his accessible communication style and media presence.

Known for his ability to bridge clinical medicine, public policy, and health communication, Dr. Whyte has dedicated his career to helping people make informed decisions about their health — embodying the rare combination of leadership, compassion, and clarity that defines the very best of medicine.

Dr. Boyd Burns is a distinguished leader in academic medicine and healthcare administration, currently serving as the Interim Dean of the Oklahoma University School of Medicine. He also holds dual leadership roles as Chair of the Department of Emergency Medicine and Chief of Staff at Hillcrest Healthcare System, where he plays a pivotal role in shaping clinical excellence and medical education across the region.

A former residency program director, Dr. Burns has trained and mentored countless physicians, emphasizing clinical rigor, leadership, and service to the community. Beyond his institutional roles, he remains deeply engaged in the broader landscape of emergency medicine, contributing to the leadership and governance of multiple professional organizations.

Dr. Burns’ career reflects a lifelong commitment to advancing patient care, medical education, and healthcare systems through innovation, collaboration, and evidence-based leadership.

Dr. Boyd Burns is a distinguished leader in academic medicine and healthcare administration, currently serving as the Interim Dean of the Oklahoma University School of Medicine. He also holds dual leadership roles as Chair of the Department of Emergency Medicine and Chief of Staff at Hillcrest Healthcare System, where he plays a pivotal role in shaping clinical excellence and medical education across the region.

A former residency program director, Dr. Burns has trained and mentored countless physicians, emphasizing clinical rigor, leadership, and service to the community. Beyond his institutional roles, he remains deeply engaged in the broader landscape of emergency medicine, contributing to the leadership and governance of multiple professional organizations.

Dr. Burns’ career reflects a lifelong commitment to advancing patient care, medical education, and healthcare systems through innovation, collaboration, and evidence-based leadership.

The podcast is back! I took time off of the podcast during residency to focus on really mastering my craft, and now that I am a fellow physician, feel it is the right time to start bringing back the message of prevention!

In this episode, I go over the history of the show, re-introduce myself, talk about current big topics in preventive medicine, things I find interesting in the world of preventive medicine right now, and talk about what to look forward to.