2022 has arrived and I am thankful! This is a year of new birth for me as I move out of the traditional insurance model and family medicine to start my own business in functional medicine consulting. It’s exhilarating and terrifying all at the same time! As a medical student I dreamed of being a family doctor in a small town, preferably in the Appalachian mountains where I grew up. Visions of old timey docs on a horse with medical supplies in a saddlebag filled my mind, exchanging services for goods if needed. Well I now have Leo, my blue eyed paint pony more than willing to carry me anywhere, although he does not carry me to consults now. And, with the flexibility of having my own business, I can make those precious home visits and even barter services! I love my community and care for each patient who has entrusted me with their care as if they were family. I realize now that in order to truly care for them like they deserve, I simply need more time for each visit. I need the flexibility to think outside the “box” of American allopathic medicine and design a custom health plan for each individual.
Doctors who take insurance are told how they must practice, what meds they must prescribe, and prove their patients are healthy or they are slapped with reduced reimbursement or even dropped from an insurance plan. These are called quality measures. For example if a doctor has many patients with uncontrolled diabetes, that doctor is seen by insurance companies as delivering poor quality care and the doctor is blamed for the patient’s poor numbers. What if that doctor cares for the underserved population who cannot afford insulin for their high blood sugar, or inhalers for their asthma? This has led to many doctors requiring new patients to “apply” to be a patient. The sickest and poorest patients then have trouble finding a physician who will take them for fear of insurance reprisal.
Insurance companies choose to make dangerous addictive pain medications such as hydrocodone and oxycodone inexpensive and “first tier” ie easy to afford. Yet the safer medications for pain control are often Tier 3, or very expensive. Want to reduce opioid addiction? Make non opiate pain options cheap and addictive medications expensive unless one has cancer! Have an autoimmune disease? Insurance makes dangerous and often highly toxic drugs such as methotrexate very inexpensive. Patients must try the toxic drug before they can get the safer drug approved. Need an imaging study? Your insurance decides if you need it, NOT your doctor. Often staff members spends over an hour on the phone begging an insurance company to authorize a lifesaving imaging study or medication for a patient (this is called a prior authorization).
We are told that all patients with certain diagnoses should be on certain medications. Take statins for example, a common cholesterol lowering medication. If you have diabetes, your doctor is expected to prescribe a statin for you, regardless of your cholesterol level! This is because allopathic medicine take “evidence based” studies as gospel and assumes that what helps the majority must be good for all. American medical students are not taught the art of medicine, not taught to think for themselves, but rather a rigid code of what to prescribe for what ailment. Each patient is unique and should NEVER be put in a box and labeled as a “diabetic” or “noncompliant” as doctors are so prone to do. It’s difficult to see each patient as a clean slate, and build a care plan from scratch, modeling it on an in depth look at their history, toxin exposures, genetics etc. This is why I love functional medicine so much, I can delve into every aspect of my patient to truly understand how they got to this place and see a way out. It takes time to get to the bottom of illness, a luxury family practitioners in the US simply don’t have. In order to “break even” financially, most family practice offices must see patients every fifteen minutes. By the time you check in and review your meds, get your vitals with the nurse, that leaves maybe five to seven minutes with your doctor. Your doctor is trained to tell you, “we can only address one issue today, please schedule another appointment for your second problem.” This is ludicrous! Most of us come to our doctor with a list of at least three items to address, and no one wants to feel rushed. Doctors are even pressured on where they send you for referrals, especially if they are owned by a hospital system who wants all referrals sent to them. That should be illegal you say, physicians should always choose based on where is best and most convenient for the patient! While a physician cannot be overtly forced to refer to a specific location, they can be fired for not being “loyal” to their employer. Years of rushing through too many patients a day, of being told how to practice medicine by non medical administration and insurance agencies burns physicians out. Gone is the joy of making a patient well, joyful healing replaced by hardened bitterness and sarcasm.
I felt this bitterness ebbing into my thoughts and heart over the past two years. Gradually, my joy in my job disappeared, replaced with frustration and even anger. My family noticed my unhappiness, my daughter commenting that my astrological sign, Cancer the crab, fit me. Ouch! I realized I had to get out, to break free of the “box” and give myself the freedom to practice medicine with joy again. So, while I know growing a new business will have growing pains, I am ready for the challenge! I want my children to remember their mother as kind and happy. I want my patients to feel heard and to feel better! No more drugs to manage the side effects from a different drug, no more referrals to every “ologist” there is. Being a functional medicine consultant is about joining a team of healers to work together to make others well. It’s about modeling that lifestyle to be an example for my patients and family. It’s about weaving a beautiful tapestry of health and healing that is unique for each individual. 2022 is about stepping outside the box to do what’s right.