I created my practice model NOT to make money.  Some previous patients I cared for while employed by “big hospital” have stated the annual retainer is too expensive for them to continue with my collaboration. Others have congratulated on my success in this new lucrative business model. I am not ashamed to admit, the cash is not flowing in…In fact its costing me money to spend the time with my patient/athletes (I’ll explain the term later) and synthesize steps to course correct to a disease free lifestyle. I believe if you spend enough time with another human, ask the appropriate questions and have a wide fund of knowledge, any life can be improved with less suffering. NOTE: even with the liberty afforded of longer patient visits (60-90 minutes vs 14.1-24.6 minutes) the virtual collaborations must be guided effectively with the correct questions, suggestions and personal goal setting.  To just have a bullshit session is the job of a confidant, therapist or relative. No doubt that talking about a stressor and vomiting up feelings is therapeutic for a certain time BUT implementation of change will always be the final goal for modifying seen or invisible disease.

The doctor visit has always been the cornerstone of getting healthy. An annual wellness exam has boiled down to yearly scolding to declare metrics that have changed and the medicines that need to be started. Western medicine has boiled down to a pharmaceutical based practice that focuses on a symptom and deploys an algorithm based on prescription rescues. Every human knows if you do not address the root cause of a problem, it will escalate and grow in complexity always ending up with the same outcome. Think of the movie franchise Final Destination. A bunch of kids try to alter future outcomes witnessed by a visionary and they all end up dying at the movie climax. (But it’s kinda addictive to predict how the end will happen!) Now apply that script to a heart attack, cancer or dementia and you have recreated the standard medical practice. (FRIGHTENING!)

Take this business owner of a landscaping company I saw in the immediate care. He came in for back pain and knew he needed a muscle relaxer, an antiinflammatory and some pain medicine. (Had same issue the year before) but when I engaged him to find out about core strength, sleep habit, current weight previous interventions, he said;

-“I eat clean”

-“I walk alot and lift weights”

-“I sleep well”

Upon further elaboration:

-he eats TOO MUCH clean food

-he does no exercises to prevent back spasm

-his sleep is fragmented from urinating 3x a night

Perception of self is skewed to allow bad behavior to continue because the rescue is always implemented with a visit to the doctor. Medicines are great short cuts but you can’t

-outexercise a bad diet

-apply what you did at 20 and expect it to work at 60

-cut out a cancer but still continue smoking.

How do you impart awareness on the trajectory of life and synthesis of the data to form a personal plan? Experience will help, (“I’ve been doing this for 30 years”…is a something I HATE to hear from docs) but constant reviewing learning and implementation is mandatory with any healthcare coach/guide. I am constantly modifying/improving my business model and at age 62, I was supposed to be preparing for retirement…but I don’t have time.  Data available to humanity is accelerating to a speed that had been unfathomable and if you don’t keep up with the new information you can give outdated advise as of tomorrow. Required investment in learning is not just taking a Continuing Medical Education course….it’s being open to admit all humans are individual and you cannot apply general concepts to the person in the room and expect the same outcome.

Which brings me back to my practice. I love seeing success in people. It can look like the expression of joy on a hikers face when we summit 14000 feet. It can be the discussion of your “we got your cholesterol down without a statin”. Or a fibromyalgia patient is suddenly exercising with NO trigger points!

General Patton: It is the spirit of the men who follow and of the man who leads that gains the victory.

I call my patient appointments a collaboration between the person who ‘follows’ and the person who ‘leads’. My time is best spent providing resources to achieve the victory over suffering and disease. Knowledge can provide you with a map but it must be created with waypoints specific to the map-reader. If your doctor is creating a map in 14.1-24.6 minutes ….IT WILL NOT BE PERSONALIZED!

The reason I charge an annual fee is to allow for more time with designing, applying and redesigning lifestyle change. Even after the 60-90minute visit I am still reconvening to envision the next collaboration in a few months so see if we made progress. The only reason I would prescribe rescue prescriptions is to get off the rescue prescription (using nutrition, exercise, calming practice and sleep/recovery)

Membership Based Medicine Details

The annual fee is paid when a new patient is ready to commit. Since there are patients who have never paid a retainer fee for personalized care, I allow for a…

-Test Drive Visit

A non commitment investment in personalized primary care. The visit will entail review of life achievements and setbacks, prior treatments, current baseline testing discussion and a…

-Narrative

I put together after the meeting to be implemented until next collaboration with a count down timeline. After the Test Drive a patient is offered application of the fee to the total Annual Membership Amount. If not satisfied, we part ways and you can continue my plan with your own coaches/doctors/therapists but no further Test Drive Visits will be allowed. Only full purchase price of the retainer fee for the current year.  As I build on the perfect practice, I will undoubtably be required to increase fees based on the commitments I provide to the successful…

-Patient/Athletes

I don’t expect perfection from anyone that joins the practice BUT I do expect implementation of the ideas I create for the other person in the collaboration.  If initial suggestions don’t work, then we re-design and re-apply. The answer to the particular problem will always be in the individual…it just has to be revealed with the right collaboration. I do expect members to meet with me AT LEAST 3 x annually and in some patient/athletes we need every 2 months since perfection needs to be chiseled out of marble. Every month visits are saved for the worst diagnoses but at that point I am calling in my colleagues for specialty suggestions (ie oncology or cardiology) BUT I still find myself being the translator and the chef to engage the specialized recipe.

Moving forward with the 60-90 minutes of collaboration, I will use a medical insurance billing company to request reimbursement from medicare or personal insurance. The reimbursement the office receives varies widely and this is the biggest reason for the Membership Fee in making sure I do not end up bankrupt for the sake of making my community healthy. I do not believe it is ethical to become rich from the suffering of others (more correctly- the reversal of suffering) I will never be a great businessman as my heart is that of a healer and I will never reason that the two titles can exist in the same entity.

I honestly feel if I can change the course of a single person’s suffering, we not only save a life but we course correct all the generations to follow.

I am altruistic with my top priority to improve outcome of the individual BUT I will not invest in you if you don’t invest in yourself.

DrRic

12 17 2024