055 - Thriving In Medical Practice Today As Physicians - Lessons from Independent Medical Practice Owner Stacey Robinson, MD

In this episode, Coach JPMD is joined by Dr. Stacey Robinson at our Tampa studio.  Dr. Robinson is the founder of a successful independent practice in St. Petersburg, Florida.  She is also the best selling author of "Road Map to Health”. She attended Tulane University School of Medicine, New Orleans, LA  and did her residency in Family Medicine at David Grant Medical Center, Travis AFB.  Dr. Robinson is also trained in functional and integrative medicine and is passionate about making health easy.

Dr. Robinson is gifted in identifying and treating root causes of disease. Her medical practice journey has been filled with many experiences that led her to be fulfilled in her current practice. If you're a physician looking to understand how to treat the root causes of disease and target mineral, hormone and vitamin deficiencies while practicing independent of large corporate control, then you should tune in to this enlightening episode. Physician burnout is less likely to happen if you are in control of your practice.

Show Notes

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Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

Transcript

Coach JPMD (00:01.163)
Welcome to the practice of possible podcasts with your host coach JPMD. Thanks for sharing. Thanks for listening. Thanks for watching our podcast. We're now on all major platforms and we're hoping to continue to share the word or spread the word about the business of medicine and how to care for your patients in a powerful way. Today we have Dr. Stacy Robinson joining us and she's going to teach us about

integrative medicine. Some call it functional medicine, others call it concierge medicine. But it's a something that she

morphed into as she grew in her career as a family medicine doc. She'll explain her story, what she went through, how she started off in the military, how she came out of medical school without debt, she repaid that service or the repay that debt through service.

at McDill Air Force Base. We hear about her COVID experience. We hear about sauna and so many different things. We even talked about the food industry and how foods can affect your health. So we're so excited to have Dr. Stacy Robinson on the podcast and we know that you're gonna enjoy this episode. So here we go. So welcome to the Practice Impossible Podcast with your host, Coach JPMD. That's me. And today we're with Stacy Robinson, Dr. Stacy Robinson.

And this episode is really to help us understand an aspect of the business of medicine that most of us don't understand. And that includes myself and Dr. Robinson practices and has a concierge practice in St. Pete. And before we get into the episode, I want to make sure that you guys remember to share the podcast. We're on video now we're on YouTube, we're on Spotify and there's something I'm wondering if I should do.

Coach JPMD (01:58.158)
I know that there's some people that are getting canceled these days on YouTube for saying things that they shouldn't say and I just don't understand that. So I know that there's some people moving over to rumble. So maybe I'll leave a poll and see if I should be on rumble as well. So I am on Instagram, trying to get some followers there at coachjpmd .coachjpmd on Instagram. And we offer a free course on marketing.

We have a healthcare credentialing course as well. But that's enough about me. Dr. Robinson, welcome to the Practice Impossible podcast. Thank you for coming to the home and it's a pleasure to have you. Thank you for having me. So tell us about yourself. Tell us what you do and how long you've been practicing. So let me start from the beginning so I can kind of tell you how I got here. So I grew up in Northern California, very small town.

And I was the first of my family to go to a four -year college. So I really wanted to get to a more city kind of feel. I had enough of the small town. So I moved to Southern California and I went to Santa Barbara City College, wanted to get to the beach and spend a year there trying to figure out what I wanted to do, general ed. And I thought, you know, I want to be a physical therapist.

I was an athlete, you know, all growing up and had some injuries and thought that would be a good field. So Long Beach State University had an excellent physical therapy program. It was a master's program. So I transferred there. And my junior year, I went and shadowed with a physical therapist. I was like, I don't really like this. And then I panicked because I was a junior and I didn't know what the heck I was going to do. So I went and talked to my counselor and he said, well, had you thought about medical school?

No, I'd never imagined that. And he said, you know, you have good enough grades if you want to help people. So that's what I decided to do. Got busy taking the MCAT courses and got into Tulane Medical School in New Orleans. Then I called my dad and I said, how am going to pay for this? And he was like, I don't know.

Coach JPMD (04:19.63)
because we couldn't afford it. And he was in the Air Force. So he said, you know, look into Air Force scholarship program. So I did that and I got accepted and joined the Air Force and went to Tulane, paid for by the Air Force, which I'm blessed to have had that because Tulane, very expensive school.

And then after medical school, I decided on family practice. Tulane wasn't a big family practice friendly place. I remember one rotation I was on, I think it was general surgery, and they said, what do you wanna do? And I said, family medicine. And they're like, what a waste, that's a waste. And I'm just like, so I stuck with that thought. I really liked the variety of Why'd they say it was a waste though? They were really into specialties. Okay. And they thought family medicine was for those who

maybe weren't as smart or as skilled. So it just wasn't a very friendly place for even internal medicine, family medicine. So I, but I still decided to do that. I really liked the variety. So I went to family medicine residency in the air force at Travis air force space in Northern California. And I had to do four year payback for the

than paying my way through school. So I got stationed at MacDill here in Tampa. So that is how I ended up here. four years there, and I would say my residency was just such an amazing experience in the military. It was just incredible. When I got out and came to MacDill, was just, they basically said to us in family practice clinic, in the real world,

in the civilian world, doctors take care of 3000 patients. So they said, that's what you're going to do. And we had no support staff. Like I shared a medical assistant with another doctor. I shared an administrative assistant with another doctor and they gave me, I think I had 2 ,500 patients and I was there seven or eight o 'clock at night driving home from Tampa to St. Pete. I had two young children and I was like, this is not what I envisioned.

Coach JPMD (06:41.578)
And so I got out and I thought, you know, I'm just going to open a private practice. when you say you got out, so you gave back your time. So you had to work at MacDill for four years. so who you're taking care of there because they're active military. So you're mostly like the younger, the families of the... I took care of a lot of retirees and family members. The active duty usually went to the flight medicine clinic.

which were family practice docs, but they, we did take care of some active duty. But that's at McDill? Yes. Okay. But it was mostly, I would say the majority was retirees, family members, children, and then some active duty. That's why it had to be family medicine then? Yeah. Because of the children. So at that, at McDill, where do you send patients to the hospitals? Do they go to Tampa General or they? At the time we had inpatient at McDill. okay. Yeah.

This was a while ago. They no longer, I don't think they have an inpatient at MacDill anymore, but they did at the time and they actually had OB. About halfway through my payback time, they stopped doing OB there. But we admitted patients. If they were complicated, they'd go to Tampa General. And we had some specialists there, but we used a lot of the civilian specialists too, in Tampa.

Okay, so you refer them out like you would in regular primary care. So you left McDill, and so once you leave McDill, do you leave the military or how does that work? So you can stay in the reserves or you can resign your commission, which means you get out completely. And I was advised to do that because reservists get deployed. And I had a baby and a toddler at the time.

And I just couldn't see myself being deployed, not being able to take care of my kids. Okay. So they don't care if you have young kids. They're like, okay, no, you're, you're okay. It's interesting. So Air Force versus the Navy. I know that they're, think I thought it was only the Navy that, that you can go through medical school under. Okay. Navy Air Force Army Army. Okay. Not the Marines. Yeah. Cause I had a Marine friend that

Coach JPMD (09:03.65)
had to go into the Navy to go into medical school and he loved it. A Marine going into the Navy. So you left McDill, went and opened up your private practice. What happened then? my, okay. As you know, you don't learn business in medical school. So I was just so naive.

I shared an office with another doctor, just to save on overhead. And I was taking insurance, so I joined all the commercial plans. And yeah, it didn't work out very well because I like to spend time with patients. And I would spend an hour with the patient and I'd get this check and I'd go, And then I had to give part of that to this practice that I was sharing with.

So you were not employed, you were just sharing space. But why would you have to give money back? That's a really good question. They said they were doing some things for me, but it was like a management management fee. Yeah. So I did that for a year and I was like, yeah, I don't think this is going to work out. We ended up moving back to California. I was trying to get back close to my family because they're still there and my, you know, my

Dad wasn't in the greatest health and we wanted to move back there. So we moved to California and I joined a group practice at Sutter in Davis near Sacramento. And it was a great practice. They cared about their doctors. They gave you time to see the patients more so than most. And I shared a panel with another doctor so I could work part time. My kids were very young at the time.

And it was great. I really enjoyed that practice. We hadn't sold our house yet and it was like the worst time in real estate. Was that the 2008 or? Let me think. 2004 maybe. So we had just built this house and we couldn't sell it for what we needed to sell it for. So we ended up coming back after a year.

Coach JPMD (11:28.234)
And then I was off all these insurance plans, all my Florida contracts had expired. And at that time I heard about Concierge Medicine. And I was like, you know, this sounds like something that would fit. I could spend more time with patients, have smaller panel. And I went to a, at the time there was an organization to help doctors start concierge practices. It was called the American Association of Private Physicians, AAPP. They no longer exist.

any longer. And they had a conference where you could go and learn how to open a concierge practice. Actually, and direct care wasn't really... It was a big thing. Yeah, it wasn't... I probably would have gone that route. And we can talk about the difference of views. Like I know you talked with Lee Gross about the difference between concierge and DPC. They're really very similar and there's a lot of overlap. But I decided to do concierge and I found a physician to share an office with.

he had a concierge practice and this was recommended by when I was at the conference. And he actually allowed me to share his office space and just share part of my revenue, which was great because then it allowed me to grow and it takes a long time. If you don't have a practice already to convert to concierge, which many doctors who have, say they have 2000 patients, convert to concierge and a portion of those patients will do that.

So I didn't have that. I had zero patients. So I moved into his office and then maybe nine months into being there, he decided to move. And he said, here, you can take my patients if they'd like to switch to you. And so that helped me grow. So the first five years, it took me five years to bring home a paycheck. And it wasn't a paycheck that a doctor

So at that time you're married you have kids. Yeah, was your husband working? Yes, so he was able to support, know the family while I did this which you know was I Wouldn't have been able to do it if I wasn't in that situation without taking a loan, you know, I could have taken Borrowed money, but I didn't want to do that. That was my goal. I'm not borrowing money because you hadn't borrowed money from medical school so you were correct at free and there and You're now at this point. You're seven years out

Coach JPMD (13:54.602)
Seven, let's see, four, five, six, seven. because while I was getting ready to open the concierge practice, I did urgent care and I worked for Locums for an HMO group. You told me about that. Which I told you about. Yeah. The most scary, worst experience of my life. And we can get into that if you want, we don't have to, but it was not, and it would just solidified.

that I was doing the right thing, which was good, because it pushed me to that even more. Yeah, so it's very interesting story because a lot of people feel like they want to come out and be their own boss and do the things that they need to do to practice concierge medicine or even the direct primary care, it takes, like any business, though.

Right, it takes a while to build a business and I think you have to set your expectations to a point where it's realistic and if you don't have debt, it obviously makes it little bit easier and I think that's the best way to do it because then you can get to the point where you are now, which I don't think you're accepting new patients or are you accepting new No, I'm not. I have a physician's assistant who is accepting patients and I'll probably be hiring a physician.

towards middle of next year. So how long did it take you to, I know, probably fast forward, to be full? let me think. So we just had our 15 year anniversary and I stopped taking patients about, I hired a physician. I did have a physician for a couple years and she decided it wasn't a good fit. And that was two years. So I was probably full about three or four years ago. So maybe 10, 11 years.

and doing what you wanna do. You don't have to have anyone telling you how long to stay with the patients. That's awesome, but we're gonna get there. One of the things I've been trying to think about what I could do to help physicians and the public understand the basics of how we treat patients.

Coach JPMD (16:12.744)
And one of my ideas is to set up a series on the Krebs cycle and the citric acid cycle. And some people are saying, what the heck is that? But it's basic science, it's how the cells work. And I find that a lot of the things that I'm doing now and I think that you've been doing is looking at lab results and looking at conditions.

that may be related to vitamin deficiencies, that may be related to supplement or nutritional deficiency, not necessarily vitamins. And I know that some of the work that you're doing revolves around that because you helped my wife come off of her thyroid medications. And that's how I got introduced to you. And I thought it was fascinating that you did that. And I know there's some other physicians doing that, but it was just your approach to it.

You know, I read all the labs you sent and I'm like, what the heck is this? I want to paddle. the Krebs cycle. Yeah, I want to paddle like that for myself. So I started to look at some of the stuff and, know, had been already doing some vitamin D, some fish oils, some NAC. And then I went back to the Krebs cycle and like, wait a minute, NAD, NAC, all this stuff is what your body needs. How are you not getting it? So can you tell us a little bit about how you do what you do?

We talked about little bit of functional medicine and what that is and whether or not that's the word I should be using. So tell me a little bit about that. I think it would be a good time to talk about how I got to the point of practicing this type of medicine. And we'll just say this type of medicine, we can talk about definitions. So when I had the concierge practice, you know, I already kind

I already had an approach to patients that was a little more holistic, like lifestyle medicine, you know? And that's why I would spend so much time with patients talking about exercise and diet and stress and sleep and all those pillars, you know, that we all know is really the foundation for our health. So I already had that leaning. And when I had the concierge practice, I had a lot of time on my hands. I was learning business. didn't have a lot of patients.

Coach JPMD (18:26.592)
And I had patients come to me wanting to know what supplements to take. They wanted to go on bioidentical hormones. They wanted those things. And so I had to learn it. And you don't learn it in medical school. Maybe you do now a little bit, but certainly when I went to medical school, you didn't. So I started self -teaching, you know, and searching for organizations that taught that. So I stumbled upon

the Institute for Functional Medicine, which has a certification program for functional medicine. So functional medicine simply, in my opinion, is getting to the root cause of disease, fixing it at the root, preventing it before it's a disease. So identifying the dysfunction, the metabolic dysfunction early and fixing it. the person doesn't, we don't wait till they have the disease. And in conventional medicine,

part of it is you don't have time to do that. And Lee Gross said something that just I loved. He said, it takes a minute to write a prescription. It takes 30 minutes to teach somebody to not write a prescription, right? And do the lifestyle part. you know, doctors know that it's important to, but they don't have time. Yeah, we're not incentivized to do it. And patients I feel are being programmed to want the medications.

So I'm gonna ask you a question about how you got to patients who are asking you for vitamins, but I know that there's a push even when we're watching TV, Hallmark channel, every other commercial is about a biologic and about a drug that costs $2 ,000 a month. It's crazy, but then when patients ask for that, of course, physicians are gonna wanna cater to their patients and like Dr. said, takes a

couple seconds to write a prescription for these medicines that they actually really want, the ozempics, all the medicines that we don't even know what the long -term side effects are on these things. But yet people are still prescribing them. So how did you find the patients or how did the patients find you that were willing to have you prescribe those vitamins and those supplements? Yeah, I think a good portion of patients who are looking for concierge medicine are already

Coach JPMD (20:51.106)
health conscious, they don't want to go down the drug route. I wouldn't say all of them. Some patients come to me because they are very, they have so many comorbid conditions, they're on a lot of meds, and they need somebody to spend more time with them. But interestingly, a lot of those patients turn into the other, because they start, I start, you know, slowly kinda, you know, giving them some things they can do. But I didn't have,

have to go looking for those patients. They found me and then I had to learn how to practice that way. And then when I found Institute for Functional Medicine, went to their, they have a five day conference, it's like an intro conference. I was blown away by how evidence -based it was. I'm looking at these studies they're presenting, going why have I never heard of these things? It's because doctors are presented with

drug studies and we aren't presented with nutrition studies and things like that. So I went down the road of certification with Institute for Functional Medicine. Then there is now a board certification for integrative medicine through the American Board of Medical Specialties. It's just like any other specialty. And I got board certified with them, which required an exam and I...

I didn't have to do, they have a fellowship now and they didn't, at the time they knew a lot of doctors were practicing integrative. So they allowed us to provide proof that we're practicing letters of recommendation and then take the exam. I didn't know. So there is a prerequisite. So you didn't have to go to the residency training of sorts. no, they no longer allow that. They just did for a short window of Now you have to do the fellowship. So I did that and I'll tell you once you're

Once you're doing that, you'll never go back. It's just... It's back to basic science. I think it's back to basic science and helping prevention. And, you know, of course they tell you lifestyle modifications for blood pressure, cholesterol, and all that, but we don't have the time, like you said, to coach patients on understanding the importance of doing certain things. you know, the meats that we eat, the foods that we eat, you know, I don't know what your experience is with regenerative farming.

Coach JPMD (23:15.258)
Eggs, organic eggs versus non -organic eggs. saw some research that said that organic, inorganic eggs or GMO or whatever, GMO fed chickens, their eggs don't have as much omega fatty acids as do the grass fed or the free range. What's your experience around that and is that something that you also learn in integrative medicine? my gosh, yes. Nutrition is so, so important.

and not just getting the right nutrients, avoiding things that you don't want to get in food like pesticides and artificial sweeteners and chemicals and preservatives and things that, you know, it's not food. So nutrition is a huge part of what I do in my practice. Rewinding a little bit back to the Krebs cycle. so one of the lab tests I do is called a nutrival.

by Genova Diagnostics and it's a functional medicine lab to look at what the patient might be deficient or in need of to make the Krebs cycle work better. And for those who may not know the Krebs cycle is how we take food and turn it into energy for ourselves. And I believe that one of the reasons we have those

higher nutrient needs and I don't say deficiencies because it's really, I think, a higher need for nutrients because we have so much toxic burden from the foods that we eat, air pollution, personal care products, like all the chemicals that are introduced in the environment that haven't been tested for safety. And it's putting a burden on our crop cycle.

Right? So we need more nutrients. And I think looking at the Krebs cycle and trying to figure out which nutrients you need more of, what your glutathione levels are, because glutathione is one of the most important antioxidants and it helps regenerate ATP. So we are seeing a lot of mineral deficiencies because minerals are used for all those oxidative stress pathways. And I truly believe it's

Coach JPMD (25:34.614)
our toxic burden that's driving a chronic disease. And there's, it's not just my belief, there's evidence that that is the case. So just as important as eating the right foods, it's decreasing your toxic burden by eating clean, you know, foods that don't have all of those things. like the eggs, you know, that are higher in omega -3, it's because of what we feed the chickens and the cows.

you know, cows that we don't feed the right foods to, they don't have as much omega -3 and they have more omega -6s in their flesh. So we are sorely low in omega -3s and high in the omega -6 -3 ratio. that's, I think, so this is, I want to talk about the resistance of conventional medicine to what we're, what we're doing in functional medicine.

And the example I like to use is that, so I think everybody should be either taking fish oil or getting enough omega -3 in their diet and reducing omega -6s. And so I prescribe a lot of high quality fish oil because a lot of people don't even like to eat fish. So that's where we're getting the majority of it. And a couple of years ago, there was like a headline, fish oil is a waste of money. It has no benefit. All of my patients like stop their fish oil.

Some of them called me and said, hey, what do you think? A lot of them just stopped it. And the way they do the studies is they, lot of these nutritional studies, they'll ask a group of people, do you take fish oil? And then they'll look at their, for example, heart attack risk over time. And they'll say, well, there was no reduction, so it was useless. Well, were they taking enough omega -3? Were they having their omega -3 levels checked? And

It just drives me crazy that conventional medicine often is so quick to say vitamin D gets the same thing. They can go with that. Yeah. They give vitamin D and look at fracture risk, but they don't check vitamin D levels and they don't control the dosage. They just look at, it's too low of a dose. a thousand IUs of D. It did not have a benefit. Well, that's because most people need at least 5 ,000.

Coach JPMD (28:02.222)
Yeah, yeah, and even in eggs. mean, your vitamin D levels will actually decrease in the non -organic eggs and the grass -fed, non -grass -fed or grain -fed eggs. so, and that comes to the COVID experience, right? Because in COVID, had patients who had a low vitamin D level, particularly nursing home patients and patients who were chronically ill.

obese patients, had a lower vitamin D level and their complication rates were much higher. So I've been, you know, prescribing that for years now. So what's your COVID experience? What have you seen? Did you see a lot of COVID in your practice? Yes. I mean, who didn't, right? So, however, I only had three patients since COVID started in the hospital from COVID and

I mean, every single patient of mine, I had checked their vitamin D. Now they all don't, aren't complaining about taking it, but most of them have vitamin D levels between 50 and 70. So I don't have proof that that's why, because my patients are probably more healthier overall than the typical practice. But I do think the obesity, inflammation, you know,

just chronic disease in general, not just vitamin D, we all know that that increases risk for COVID mortality and hospitalizations. So why were we not promoting that? Why were we not blasting that on the airwaves? There's no money in it. I do think, mean, Institute for Functional Medicine really tried. They had free webinars for the general public on

how to prevent COVID with nutraceuticals, lifestyle, how to, what to do. They actually had a whole protocol of if you get COVID, this is what you can take, nutraceuticals. But you know, it just, I don't think the marketing was there. And Paxlivid, you know, that's a big moneymaker.

Coach JPMD (30:21.142)
And they have a lot of money to promote that. They're still promoting it. I saw that and I'm like, what happened here? you know, none of my patients that didn't, you know, go the conventional route, I'm just going to say that.

had rebound COVID. That's another thing I heard a lot of patients getting is that they get this new drug, Paxilid, and they get COVID five days later. I'm like, huh? The rebound effect. Yeah, it doesn't make sense because your body's supposed to clear this, produce antibodies, and then you're one and done. So, I mean, even my experience with COVID, I had COVID in 2022, January 2022, and I took the things that I thought were important to take and...

My wife took him, my best friend took him, his wife, and I have not had a cold, and I should not probably say this right now, but I haven't had a serious cold in over a year and a half. Just taking the things that, I mean, obviously I take care myself, I work out, so I'm just trying to understand, and maybe I'll never understand why we were not promoting certain things, but.

What is your take on saunas and cold water exposure? Cause I know that you've had some experience with saunas and what are you, I forgot the name of the cold water exposure or heat exposure or extreme temperatures. I am a believer in a sauna. I think there's a lot of studies supporting that sauna decreases risk for sudden death from heart disease.

I didn't know that. I didn't know that. Yeah, there's actually study of, and it actually breaks down how frequent you have to do it to get a specific reduction. And I can't, I can send that to you though. So I'm a believer in sauna. I think it's a good tool to promote your body's detox, pushing your body to a clean house. And we have two saunas in our office. Infrared, infrared saunas or? Infrared. Yeah.

Coach JPMD (32:30.254)
What temperature are you getting it at? You know, if I had to go back and do it again, I would have probably purchased a sauna that went higher because ours goes to about 140. And some of the studies show benefit with higher temperatures. So in ours, it doesn't go that high, but I don't think it's without benefit. just think if you can tolerate a higher heat and have a sauna that produces higher heat, might have more benefit. And how long, how long you've?

What are you gonna in for? You know, what they can tolerate. Some people can only stay in 10 minutes, others will stay in 30 minutes, 40 minutes. I have heard that there's not a benefit over 30 minutes, but again, there's not, we only have limited studies to look at, so we don't know as much as we will in the future, I'm sure, about heat therapy. Cold therapy, even less, I think, that we know about the benefits, but. Yeah, it's interesting how we don't know, but yet,

The Danish and the Swedes have been doing this for eons, yet we're not listening to their studies or we're not seeing what they're doing. They're living longer than we are. So why do you think that we're not? You know, I don't know if we're just so dependent upon the randomized control trial. a lot of doctors won't do anything until there's a randomized control trial, placebo controlled trial. there's no money for that in the

natural product industry, right? You can't brand vitamin D.

So the things I'm sure if they tried hard enough, they probably figured out a way. They did that with the fish oil, Yes, Icosapent, Vespa, and what's the other one? I'm blanking on it. But the funny thing is the insurance will say, yeah, we'll cover that. Your copay is X dollars and it's the same price as you would buy a high quality fish oil. But it's not as high quality though. It's higher quality if it's prescription.

Coach JPMD (34:35.406)
It's even higher quality than the salmon that you can eat. It has fish oil in it, right? Well, the fish, have to worry about, you know, mercury. So, yeah, I was going to ask you about that. it true that you're getting wild caught fish that are going to have that much mercury? Should we be concerned no question. So, big fish that eat little fish and live a long time have high amounts of mercury in their flesh. Tuna, shark, swordfish.

some snapper salmon caught in the US versus Alaska. Wild Alaskan salmon is low in mercury. But you have to know you're getting where it's caught. Like it'll say wild salmon, well it was caught. How about Thailand or Asia? I'm not sure. So I test my patients for mercury and every fish eater has

some very high mercury levels. Like normal mercury level optimal would be below five. We get in a fish eater 25 to 35 serum levels of mercury. Okay. So I should be afraid because that's all I, I don't eat meat and I only eat fish. if you avoid the high mercury fish, which you go to the, the EDF environmental defense fund has a seafood selector.

and they have categories and they show which ones have high mercury. And grouper, which our Floridians love, their grouper is very high in mercury. So it... So what does mercury do for those that are non -medical? I know that it has some toxicity in the brain. Yeah, the biggest concern is neurotoxicity over chronic exposure over time. So...

know, mercury can be stored in the tissues and the brain. And if you have a chronic exposure, there's, I mean, some people actually have genetic variations or SNPs that affect their ability to clear mercury. And those patients are the ones that tend to have a lot higher levels. So who should typically get mercury levels? I mean, I test everybody. Most people, like if a patient told me I never eat fish.

Coach JPMD (37:00.664)
They're probably not going to have a high mercury, but any fish eater, you know, you could tell them, stop your high mercury fish for three months and then we'll test you. Because if you test them, it's, you know, most likely going to be high. So, you know, I think it's a concern, you know, and, and fish have other PCBs and other toxins forever chemicals in their flesh because our water is polluted and.

So, you know, I know some integrative functional medicine doctors who are very, very smart, who say, I just don't eat fish anymore because of the concern for other things other than mercury that they're being exposed to. Now, can saunas help detox that? Because I know that not infrared, but steam, steam showers or steam rooms can, I know, help.

Yeah, it can help. But not enough to say, okay, we're gonna eat fish and just detox. I guess we have to look at, test that out. That's a study we need to We'll do a study. We'll get ARB, what is it? Spend millions of dollars to study it? See, that's why these studies aren't done because again, it takes a lot of money to do a very well quality, good design study. And you have to have...

You know, doctors don't have money to do that. And there's no incentive too, because you do the study, you find the information, and then what? Yeah. Okay, then there's no glory, there's no fame from that, I guess. I don't know. So tell me about the business model, because some people are wondering, so how do we make money in concierge medicine, and is it...

Is it unaffordable for some? What would you say to some that say, you're pricing the general population out by having a concierge practice? Yeah, that's definitely an argument. And that is one of the things that differentiates direct practice, DPC, from concierge is that in general, concierge is a higher price point and caters to a population that has more disposable income because of the price point.

Coach JPMD (39:17.358)
Right and concierge practices generally offer more service services, which is more costly DPC is in my experience most DPC doctors are more conventional based and have a more traditional practice and they have say six to seven hundred patients Whereas my practice 250 is probably the average for concierge practice

So 250 patients total in your practice and then you're capped in your... It varies. It varies. But again, a DPC model, you're gonna see more patients per day. We only have so much time in a day, so we're gonna spend less time with the patient. And you just have to, I think, if you're a physician thinking about, wanna do this, what model do I do? You have to think about what your practice style is. How many patients do you wanna see a day comfortably?

Because that's going to determine how many patients you can have in your panel. You only have so many appointments, right? So I think thinking about that ahead of time Before you decide what your model will look like Is important. Yeah, I think also what's important is is figuring out how much you need Because some physicians, know, they feel like they need a million dollars to live but do we really need a million dollars?

to live a comfortable life. Depends on how much you're spending. So I'd like to be able to make less and have more time with family and have more time to do things. But at least make it such that we can retire and we can have some savings at retirement.

So I think that's something that I try to help physicians understand, how much do you need versus how much do you want? And if you need this, then let's get to that magic number, the 250, 300, 400. And so from that model, do you then back in the pricing to determine, okay, I only want to see five patients a day? So then do you just, how do you model that out? You know, it is difficult because you tend to underestimate your overhead.

Coach JPMD (41:28.462)
You really have to come up with an entire, you know, what is my rent going to be? Where am I going to practice? I'm in downtown St. Pete. Like my rent is really, really high. So to have a DPC practice, I probably couldn't be in downtown St. Pete. So I think, you know, you have to think about all of those things and then write down how many staff you're going to have and how much you're going to pay them.

you can come up with estimates on business expenses, medical supplies. But I think the most important thing is how many patients I'm gonna see in a day, how much money do I need to make, and get the big cost written down. How much is my malpractice insurance? Everybody, depending on your specialty, may be a little bit different. And so then you start looking for providers when you...

are looking to grow, what are some of the criteria that you look for in providers? Because do you look for them to be certified in integrative medicine or would you teach them? For me, really want an experienced person because I hired a physician and when she left, I had to take on her patients. So I have more than I can handle.

And a lot of those patients are very complex. We didn't really talk about integrative slash functional medicine. You will attract very complex patients who have mystery illnesses. And when I say mystery illnesses, I don't mean it's all in their head. mean like serious things that they have that I had to learn about. Lyme and tick -borne illness, exposure to mycotoxins from mold is

is a real health problem for certain people that are susceptible to that. Hypermobility syndromes that predispose to POTS, mast cell disorders. There's a whole chronic GI issues like small intestinal bacterial overgrowth, inflammatory bowel disease, autoimmunity is becoming very much more common. And I think because of our toxic burden,

Coach JPMD (43:55.286)
So I had to learn all of that. And that meant going to conferences with doctors who actually specialize in those more difficult areas. So my panel is made up of lot of patients who have chronic complex illnesses like that. And I need somebody who can come in and take those patients. So what about specialists? then you're a family doc and

These are complex patients that may need procedures, that may need things. So they're paying you, but do they have also insurance that will also pay for the specialists that they see? Do you send them to? 95 % probably my patients have insurance. Medicare, commercial insurance. We do have a few patients who don't have insurance, but you know, we refer to specialists when needed. As a family doc, I'm sure you know that you can take care of probably 90 % of what you see. So,

We do, but we do refer out and have our handful of specialists who we have good relationships with. And you've opted out of insurance. I'm opted out of Medicare and yeah, I'm not on any insurance plans. So when I have an insurance plan and they say they will cover an out of network physician, you're not even out of network, you're not even accepting it. You're not building it. We're out of network. We don't bill for the patient. Gotcha. We provide claim forms. So our patients,

I don't know what percentage of our patients get claim forms, because I don't do that part. However, a large percentage of our patients get claim forms and submit them. Some of them get reimbursed in full. It just depends on their out of network benefits. I gotcha. So they don't necessarily have to pay 100 % out of pocket if they have insurance, if they have a PPO that's going to cover 80 % of an out of network provider. That's interesting. I'm not sure if we're doing that. I have to talk to Karina about that. Many insurance plans, I believe I'm not an insurance specialist, but I think

Some insurance plans actually have separate out of network deductibles and in network. And that can be a hurdle because if they're seeing all in network except you, everything is gonna go to the deductible. Yeah, but the cost of the labs and the cost of some of the supplements. the labs go through insurance. Like we draw the labs in the office and send it to Quest with the insurance card. Gotcha. So they don't pay for labs. Radiology, same thing.

Coach JPMD (46:14.798)
Supplements obviously. just the things that you do, you're not billing those insurance plans. Correct. Didn't know that, okay. So the same, the network, specialist network is gonna have cash versus insurance as well. Right, so the specialists, you know, we actually will call often and make sure that the specialist takes their insurance so that we're sending them to somebody that it can be covered. Health savings accounts. Yeah. know, patients often pay out of their HSA for our services.

That's what we did. That's how we were able to afford it. Because then it's tax deductible, I think. So what do think the future is of concierge medicine versus direct private care? Is it gonna be like England or some other country, socialist countries, you have private doctors and then you have the rest of the masses seeing generalists? I don't know. I mean, right now,

so many people are paying, having high deductibles and paying out of pocket, even though they have insurance. So if that trend continues, think concierge and DPCs are going to be the future. Now, if that changes depending on, you know, our politics and who gets into office and what happens with healthcare reform, if it happens, so who knows? But I do think integrative and functional medicine is

the future, mean personally. Cleveland Clinic has an integrative, has a functional medicine clinic now. More and more doctors are going that route. And so I think that is really where the future lies. How do we get courses in every medical school in the country? I don't know. I think the Institute for Functional Medicine needs to use their power because they have some.

really amazing physicians teaching. I mean, you look at their bios and it's like... But are they lobbying? Are they spending the money that big pharma has spent? Well, don't have the money. they could raise their membership and I can pay more. So they could do that. What would you tell a younger physician coming out, one to five years out,

Coach JPMD (48:39.094)
You've gone through your trials and tribulations. What would you tell them that they should look at doing before they...

Go the wrong route. Yeah. If I were to do it again, I would go down the integrated medicine route like square one. So I would say, if you're interested in root cause medicine, integrative holistic approach, then I would do that out of the gate, you know, if you can. that's what, you know, I took a long torturous route to it and was older when I finally got there. And I wish

I was 20 years younger and where I am now with regards to my knowledge of that area. So in all the things that you've been doing, I realized later on in doing some research that you wrote a book as well. When did you write that? In between the Before COVID. No, yeah, before COVID. I don't remember what year I published it, but I wrote hundreds of patient handouts on every topic.

And I'm like, and I found myself saying the same thing over and over and then giving the patient the handout. And I thought, I just need to put this in a book. And so that's what I did. And I don't know, it took me a few years to write it. And. Did you have a writer, ghost writer? No, I wrote it myself. And then by the time I wrote it, getting a book deal doesn't, doesn't happen anymore unless you're famous, right? I'm not famous.

So I self -published, I used one of these.

Coach JPMD (50:18.594)
I don't know, I can't remember what you call it. It's someone who helps you publish. then - Agent? No, it's a, I can't think of the term, but I use somebody to help me, because I didn't know how to publish a book. And then I had a really bad experience with that relationship. And then I separated myself from it and just like, now I'm just self -published. And I actually have a publishing company name. I forgot what it is.

Well, you have to remember because we have to put them in the show notes. We have to get that Henry and Aubrey Publishing. And that's the middle name of my two kids. So I published the book and it's really like word of mouth. Like I do a lot of classes where I teach patients what we're talking about. And so they buy it. They tell their friends, you know, I have maybe 30 Amazon reviews. I get good reviews. It's more than me.

I don't have any. I don't even have a book. Yeah. the book is Roadmap to Health, Seven Steps to Alter Your Destination with the, you know, small changes make a big change in your future health. And I wanted to give really simple, easy strategies, you know, not like really difficult things to do. So, yeah, I, I enjoyed writing the book. I'd like to do another. just, you know, finding the time to do that.

That's awesome though. Well you're going to write a book. I hope so. You know, I have to take my boards and do some things before that. But I would like to kind of compile a lot of the things that we've done. I've learned a lot on the podcast and this has been an educational experience for me. So putting all this together would be great. And you know, we're nearing the end and I wanted to do some rapid fire. I don't know if you saw a couple episodes where we asked some quick questions and.

kind of get to know you a little bit better and put you on the spot. Okay. I'll do my best. What's your favorite food? man. I love sushi. However, a lot of it has mercury. So I try not to eat it very often. Okay. Favorite vacation spot? in Florida, Key West. Italy was a favorite spot that I've traveled to.

Coach JPMD (52:44.108)
Last book you read? I don't read for pleasure very often. And I don't remember the name, but I love Dean Koontz and John Grisham. Those are probably my two favorite authors, so whatever the last book. Fiction. Fiction? Yeah. One thing you'd like to tell the current president if you had to meet him?

that's, that is an evil question. I usually say the hard ones for last, but I just threw that one in there. I don't know.

Coach JPMD (53:17.578)
Can I pass? That's a first pass. A rapid fire. Have you ever asked that question? No, I haven't. That's a first. No, I may have. I may have acted a different way. Spiritual habit? Getting out in nature, spending time in nature. do just about every day. Okay. One thing your partner loves about you? That I ride a Harley. Really? Yeah, because he rides, he rides. And so,

We ride together and it's a lot of fun and that is it's a form of meditation riding a motor I don't know you've ever ridden a motorcycle, but it's very meditative. Yeah helmet. full head to toe gear. No, I see guys riding with their shorts shorts I said they've never been in an accident before they've never had road road what a road rash No, a friend of mine her husband went. i'm just gonna take the bike down to the store literally like a quarter of a mile away

he fell off his bike and had his road rash from head to toe. And she called me and said, how do we treat this? If you were not a doctor, what would you do? Probably a photographer. Toughest thing you saw in the military.

You never, I don't think you were in deployed though. I was not deployed.

I would have to say like patients with like Gulf War illness. I mean that is a complex chronic illness that there's really no answer for. It's Bucket list item you want to accomplish. One.

Coach JPMD (55:10.23)
Yeah, I haven't written my bucket list in a while, obviously. Have my own podcast. bucket list. And name a pet peeve of yours. One pet peeve that really irks you.

People who drive and don't use their turn signals. I drove here from St. Pete's, Yeah, I was driving. It actually was not bad. Yeah, I think it's reverse. That was a reverse commute, so everything is flowing the other way. this has been, this has been awesome. I've, I learned a lot today and,

I hope this was fun for you. And you know, I think there's some things that I'd like to touch on again, and maybe you can come back and absolutely delve deeper on the, the Krebs cycle. We'll do a Krebs cycle episode. I'll tell you the first time I saw that Krebs cycle on the lab report, I like had PTSD from medical, from medical school and undergrad. Yeah. Yeah. So that's awesome. Thank you. welcome. you know, share this podcast with your friends. we're on YouTube, and maybe rumble if you want us to be a rumble.

So, but in any case, wherever you listen to your podcast, share it with your friends and we thank you for being part of the practice impossible community. Take care.