The Root Cause - Business of Medicine Podcast

In this episode of The Root Cause Business of Medicine, Brothers Dr. Erik Lundquist and Dr. Davin Lundquist interview naturopathic physician Michelle Leary about how naturopathic training overlaps with—and differs from—MD/DO pathways, especially its outpatient focus and deeper emphasis on nutrition, lifestyle, supplements, and (in some states) pharmaceuticals. Michelle explains key challenges in the ND profession, including limited post-grad residency funding and variable scope of practice by state, while arguing for more collaboration between conventional and naturopathic clinicians to address chronic disease and access gaps. She then details how she helped grow Vita’s functional medicine arm—from an insurance-based model through COVID-driven demand—into a tiered membership program launched in 2023 to reduce burnout, improve access, and fund higher-touch care. The discussion closes with her vision of functional medicine converging with precision/P4 and “Medicine 3.0” prevention—using objective metrics (e.g., VO₂ max, DEXA/body composition) plus better data synthesis (including AI) to prevent the major chronic disease “four horsemen.”

Creators and Guests

Host
Dr. Davin Lundquist
Dr. Davin Lundquist is a board-certified family physician, innovator, and healthcare leader with over 25 years of experience integrating medicine, technology, and holistic wellness. A graduate of the Keck School of Medicine of USC, he has held senior leadership roles at CommonSpirit Health, Dignity Health, and Augmedix, where he advanced the use of technology to enhance patient care. Driven by a passion to move beyond symptom management, Dr. Lundquist founded the Quantum Advantage Method™, a science-based, holistic framework designed to help individuals restore vitality and reverse dysfunction. His approach blends functional medicine, advanced diagnostics, and principles of quantum science to empower patients to achieve optimal health and lasting transformation.
Host
Dr. Erik Lundquist
Dr. Erik Lundquist, MD, ABFM, ABoIM, IFMCP Dr. Erik Lundquist is the founder and medical director of the Temecula Center for Integrative Medicine, where he blends conventional, holistic, and functional approaches to help patients achieve lasting wellness. Board-certified in Family and Integrative Medicine, he specializes in endocrine disorders, chronic fatigue, migraine management, cardiometabolic health, and chronic pain. A graduate of St. Louis University School of Medicine, Dr. Lundquist completed his Family Medicine residency at Naval Hospital Camp Pendleton, where he served as chief resident. He spent eight years on active duty with the U.S. Navy, including service as a battalion surgeon in Iraq and at the Naval Hospital in Naples, Italy. Certified by the Institute for Functional Medicine, Dr. Lundquist is passionate about empowering patients to take charge of their health and teaching fellow clinicians integrative approaches to chronic disease. Outside of medicine, he enjoys the outdoors, singing, dancing, acting, and spending time with his wife and three children.
Guest
Dr. Michelle Leary, ND, IFMCP
Dr. Michelle Leary is the Director of Functional Medicine at Vida Integrated Health and a board-certified Naturopathic and Functional Medicine physician. She specializes in primary care, sexual and hormonal health, fertility, and longevity medicine. Dr. Leary earned her doctorate from Bastyr University and completed a two-year residency in Primary Care and Family Medicine. In 2016, she became the first naturopathic physician to complete the National Multiple Sclerosis Society post-doctoral training program, with clinical training across leading Seattle institutions including the University of Washington, Swedish, Virginia Mason, and Seattle Integrative Medicine. She has pursued advanced education through the Institute for Functional Medicine (IFM), A4M, and the Institute of Women’s Health, with additional focus in sexology, hormone optimization, metabolic weight loss, and anti-aging medicine. A frequent guest lecturer at professional conferences and an active clinical research investigator since 2017, Dr. Leary brings a research-driven, practical approach to helping patients optimize healthspan and overall wellbeing.

What is The Root Cause - Business of Medicine Podcast?

The U.S. healthcare system is at a breaking point—soaring costs, worsening outcomes, and widespread physician burnout. The Root Cause – Business of Medicine podcast, hosted by brothers Dr. Erik Lundquist and Dr. Davin Lundquist, charts a different path: one where healing, fulfillment, and business thrive together.

Each episode shares powerful stories of medical professionals who stepped away from the traditional grind to embrace integrative, functional, and alternative approaches to care. Through candid conversations with practitioners who have redefined success, listeners gain insight into navigating their own transitions, reclaiming a sense of purpose, and reshaping the way they practice medicine.

Erik
Okay, we're back for another episode on the Groot Cause Business of Medicine podcast. And today's special guest is Michelle Leary. And Davin, uh, she was a real tree. You know, uh I I knew a little bit more about naturopathic medicine, but that was kind of a new thing for you today. And what were some key points that you got out of today's podcast?

Davin
They're not so focused on inpatient medicine, but more of an outpatient medicine focus. Um, and I think um broadening their tool set, right, that they have to offer in terms of that natural um, you know, supplement, uh, herbal medicine category, diet, nutrition, all that stuff, I think they're they go a little deeper in in their training, which makes them a really good fit for an outpatient functional medicine uh setup. And so I'm excited for people to hear about that. And then to your point, Um towards the end of the podcast, we got into some really interesting questions and dynamics around, you know, moving from a traditional kind of insurance-based billing model to one that might include memberships and other things.

Erik
Exactly. The other thing I thought was interesting is in her pre-med background She had spent time in a cardiac rehab center and working with the NIH. And that actually, you know, primed her for making the choice to go into naturopathic medicine, which I thought was an interesting uh career choice for her and uh one that was well suited for her. So excited to have you guys listen today and here we go. Welcome to the Root Cause Business of Medicine podcast, where we explore what's broken in healthcare and what we can do about it. I'm Dr. Erik Lundquist and I've been practicing functional medicine for the past 15 to 20 years. I'm excited to co-host this podcast with my brother, Dr.

Davin
Davin Lundquist, who's just beginning his journey into functional medicine. We come from different points on the path. But we do share a common goal. We want to rethink how medicine is practiced and help others do the same.

Erik
The U. S. healthcare system is in crisis, rising costs, declining outcomes. And physician burnout at an all-time high. But you know we found a different way. Another way. A better way

Davin
On this podcast, we dive into real stories from medical professionals who've stepped away from the traditional model, kind of like me, and have found a new purpose in integrative, functional, and alternative approaches to care.

Erik
These are authentic conversations with practitioners and friends who've redefined success not just for themselves but for their patients and communities. Whether you're a clinician feeling stuck, a student seeking direction, or just curious about what is possible, you're in the right place. This is the Root Cause Business of Medicine Podcast. Welcome back to another episode of the Root Cause Business of Medicine podcast. And today we have a very special guest, Michelle Leary. Uh who is a doctor of naturopathic medicine, our first naturopath on the show, and we're super excited to have Michelle here Interesting fact about Michelle 2 is that she did her undergraduate in kinesiology at Boston, I was gonna say Boston College No, at British Columbia, University of British Columbia in Canada. She's a U. S. citizen, but went up to a further north to get her degree, and both Davin and I have our bachelor's degree in kinesiology as well. So kind of fun. There she spent some after that she spent some time in a cardiac rehab. And then off to Naturopathic School of Bastier in Seattle, Washington, where she became affiliated with uh IFM, the Institute for Functional Medicine, and really started to sink her roots deep into functional medicine and see the the power and the impact and the comprehensiveness of functional medicine. And then later was a founder of uh Vera Health? No.

Michelle
Vita?

Erik
Vita. Why not uh uh Vera is true. Um Vita Health, which is life in in in Latin or in the Latin languages, Vita Health and um has a very successful uh multiple sites now. You have three sites?

Michelle
We have three sites for functional medicine, six in total.

Erik
That's awesome. And she's going to tell us a lot more about how they got that up and growing, how they were able to um branch it out and and uh their whole model and things like that. So we're super excited to have Michelle on today. So thank you for joining us, Michelle.

Michelle
Yeah, thank you for having me. Excited to be here.

Erik
So let's let's talk a little bit about your background first. Um, you know, there may be a a lot of the listeners who are from a more allopathic or osteopathic background. Tell us a little bit about uh, you know, kind of what led you into choosing naturopathy as your the form of medicine And and and maybe just a little bit of what distinguishes uh naturopathy from allo allopathy, allopathy? Allopathy. Allopathy and osteopat osteopathy. Boy, I'm just really fumbling with my words today, so

Michelle
Yeah, it's a question that I've gotten my entire career, so I hope I have this uh well rehearsed here. So I uh spent some time following completion of my undergrad, as you said, in cardiac rehab. So for those who are familiar, this is typically when people who have had a heart attack or other event are sent to get well again in order to kind of do exercise rehab. And I had full plans on going to DO school or MD school and took the MCAT and was kind of planning in that realm. But because of the field that I was in and seeing so much of the benefit around exercise and wellness and Really seeing how people were thriving and making lifestyle changes, dietary changes. I really wanted to lean into some of those passions. So I spent some time at the National Institute of Health in Bethesda, Maryland, in actually a completely different field, which was pain and palliative medicine, just as kind of a pre-med observer uh and had a really interesting, I would say, pivotal conversation with the director who I was shadowing at that time And I was I loved biochemistry in undergrad, and I loved the molecular biology side of science But I was really passionate about nutrition and exercise, and I had also taught Pilates in my college career. I'd been a Pilates instructor. And so kind of sharing this with her over lunch, which was a unique opportunity for somebody to have, you know, lunch with this um really profound uh medical researcher. She's like, you know, I I don't know if you've considered this, but there's this school in Washington where you're from called Bastier. And of course I was familiar with Bastier and uh and knew and I actually had an an N D as my primary care at the time. And, you know, she said, I think you would probably be really well suited. to check that out. And it was so interesting coming from this biomedical uh you know professional at the time So following that, I had spent also, again, just a handful of weeks at um New York Presbyterian Hospital in New York City, where I got to do some additional shadowing. I happened to have kind of come from the um allopathic medical family. So I had some insides to get um some shadowing there. And I I don't wanna say I was dismayed, but I was um really uh uh disheartened in some ways to kind of see the level of satisfaction that um those individuals were experiencing in mid-career. Like these are people who And I was, you know, shattering urology and radiology and all these different specialties, family medicine. And and people were just generally unhappy with their jobs and not to say anything about New York Presbyterian at that time. But uh they they just didn't have a high level of job satisfaction. So those kind of critical experiences at that time in my life in my mid-20s uh really made me rethink. Where did I want to go? And here I had, you know, a and all the workings to be able to get into, you know, medical school in its traditional fashion. But I just kind of had to follow my heart in that way. Um, it was definitely a gamble. I tell people who are interested in Naturopathic medicine when they come to me now, that you really have to make sure that you understand that this is a field that doesn't have nearly as much structure in the postgraduate realm as allopathic or osteopathic medicine does. And so you really have to be aware of um of that shortcoming, because it is a shortcoming But there are ways that you can be wildly successful, help a lot of people, but you have to understand both sides. So In a nutshell, that is some of the the big influences that took me to this uh direction of training.

Erik
Yeah, I think that's really, really interesting. Um I, you know, I had a very similar um kind of disenchantment with medicine happening after my second year of medical school. uh as you mentioned, you know, and I it sounds like our our undergraduate programs were fairly similar uh in our kinesiology programs, right? I mean there was there was Focus on nutrition. And it was it it was basically about human performance. How can we optimize human performance, right? And so we had these anatomy physiology classes and we were talking about biomechanics and how we could optimize performance through different leveraging of muscle strengths and exercises and then optimizing nutrition to get, you know, blood levels and mitochondrial function, all of this at the undergraduate level, right? And then get into medical school and it was like the you know, a a whole year on drugs. Like, you know, it's just like and we're gonna give this drug for this symptom. And it it yeah, I was I was pretty disenchanted. as well. And I think that's an interesting perspective. And I think there they're this is why I think functional integrated medicine are becoming so popular, certainly among the patient realm, but I mean even among practitioners. And our hope in actually doing this podcast is exposing people who are in the more conventional allopathic, osteopathic realm. to consider potentially the job satisfaction, the fulfillment, uh that you can be found in practicing um integrative and functional medicine. It doesn't mean they have to throw away what they've learned. They just come with what they've already learned and add to it in a way that strengthens their knowledge and experience and expertise in a way that can really enhance overall patient care.

Michelle
Yeah, patient care and outcomes and toolbox and all of it. So yeah, agree.

Davin
Yeah, I think um for me, you know, being more recently uh moving into like more of a functional medicine space, uh, I think the nat you know, naturopathic medicine isn't something I have a ton of exposure to. um other than, you know, conceptually kind of thinking about it, you know, with my patients, hey, I'd let's find something, some alternative to medicine to like drugs, like pharmaceutical medicine, which was the 20 plus years as a primary care doctor in a traditional setting, that was mostly what we had at our in in our toolbox to your point. So Um and and I think this idea, you know, of functional medicine getting to the root cause is something that we all share, right? Like your ability to get to the root cause is not diminished in any way, right? By you know, being a a a naturopath versus um, you know, an MD. So maybe just talk about that and and um and you know w How I don't know, just like helping people, maybe the fact that you don't have you didn't have that bias, right? Of even being able to turn to a a pharmaceutical in any in any way. uh broadened your search or I don't know. May I'm just kind of curious how that maybe influences you.

Michelle
Yeah, maybe I should just Take a step back and just kind of define a little bit of the training of naturopathic medicine because I think it does vary pretty dramatically from school to school, unfortunately. And I also think that uh Canada versus the US, the training is different, even though the board exams are are relatively the same. There's a couple different things there. But just to be clear, that the four years of naturopathic medical education, the first two years are grounded in in basic science. So we have, you know, a year of cadaver lab, very similar to any other um professional medical discipline. We're doing all of the physiologies and biochem medical biochemistries and And I actually think when I was in school, it was excellent. I I found, you know, the um level of challenge and education to be absolutely what I was hoping for and and um the basic science piece. The next two years are clinicals. So we rotate. The big difference is going to be that we don't do a lot, we don't have a lot of exposure to inpatient medicine. So we're not doing a lot of hospital rotations. You can do hospital rotations if there is a supervisor who's taking students, but it is not standardized by any stretch of the imagination. So I think it's really important to clarify that I think the big difference is there's all of our, for for all intents and purposes. uh trainings, clinical trainings are going to be in the outpatient setting. Okay. But that I think makes us really, really good in kind of the again, outpatient manageable conditions. Which I think it's really nice to have exposure to those inpatient conditions as well. I did I think there's immense value in that, and I wish there was more opportunity for that. However I think that the vast majority of those primary care oriented conditions that can be managed in a uh physician office. We got we got good exposure to um all of the specialties. Now in Washington State where I trained, uh naturopathic physicians do have full prescriptive scopes minus Opioids and benzodiazepines and ADHD stimulant drugs. So we were trained in all the different pharmaceuticals and how to utilize those in our practice. In addition to the non-pharmaceutical realm. And I think one of the things that naturopathic medicine is best known for, that some people really lean into and others don't is herbal medicine. And herbal medicine is part of the curriculum. It's it's a core part of the curriculum. Although I think it's probably the most intimidating for a lot of non-uh naturopathic physicians to learn after the fact because Number one, the research is more scarce. Number two, herbs can interact with a lot of things. So I think that there's there's some hesitancy in terms of just wide embracing endorsement of that, but that's maybe a different conversation. So our scope, just to be clear, uh does include pharmaceuticals. So when I came out of my training I jumped right into a family medicine practice where it was largely a Medicaid population. And in fact, my medical director at the time was also the medical director for a um a rehab facility and uh so a a drug and rehab substance abuse rehab facility. And so we were managing uh a lot of these folks. I was as the resident was taking on a lot of these folks. And while I can't prescribe Suboxone and I I didn't prescribe and couldn't prescribe methadone and some of those really high needs, it was in that kind of peak of the opioid crisis in Washington. So, you know, from infections to uh STDs to all the things, you need drugs. Like you need pharmaceutical agents in those situations. And if I hadn't had that in my toolbox, I can tell you right now that I don't think I would have been able to help the people in the way that they needed it. I don't think herbal medicine, at least in my opinion would have cut it or supplements would have cut it, for example. So all that to be said is that I did have this toolbox that included non-prescriptive agents that helped me assess, okay, can we start with uh something besides a statin? For example, if somebody has high cholesterol and they're coming in to see me And that has been an opportunity for me to really dive into the lifestyle counseling. Hey, can we think about things that, for example, phytosterols and fiber and red yeast rice, and what else can we do before we reach for a statin that if somebody has chronic fatigue, for example, may aggravate some of those symptoms or if they already have a borderline A1C, it you know, it can raise that A1. So we have to be kind of thoughtful. So I hope that answers your question, Davin, and just kind of expands the

Davin
No, that I made it it not only answered my question, it revealed my ignorance and unfortunately around so that's great. And I I I did not even realize that. You know, that pharmaceutic traditional pharmaceuticals were part of part of that. So then are there scenarios where um I'm guessing that um you know a a a naturopath a naturopathic doctor isn't doing functional medicine. They're kind of more of a traditional diagno diagnostician. And then they just have an expanded, you know, toolkit that includes, you know, herbal medicine in addition to pharmaceuticals.

Michelle
Yeah, so I have several colleagues who did not go the functional medicine route, and I can talk about kind of some of the opinions within the naturopathic community that are not really in favor of quote unquote functional medicine and and explaining a little bit why. Um but a lot of my colleagues and close friends actually went to community health So community health centers, feder federally qualified community health centers, they um hire a lot of NDs in our area. Um and I think part of that is the Honestly, the cost of hiring NDs is cheaper than uh, you know, and they do require uh residency. So somebody has to have done a residency And they then are able to kind of help more rural communities that otherwise wouldn't have access to care. Because as you both know, there's a major shortage of physicians, even mid-levels So a lot of um NDs, I I would I would just say an estimate maybe 20, 25%, at least of my class, uh ended up going that direction into community health. And they Unfortunately, they don't get to use their toolbox very much. As one of my friends said to me, she's like, I'm lucky if my patient has bus fare to get to their cardiologist that I refer them to. They don't have nine dollars for a vitamin D supplement. If I'm gonna recommend a vitamin D supplement, forget about it. So like her and I practice very different medicine at this stage in our careers Whereas I have the privilege of working with a community that can afford the kind of fancier stuff right now. she does it and and and that's um that's really important to to note there's also a wide variety of scope in the naturopathic uh community at from a nationwide perspective. The scope in Washington is um higher than some. Certainly prescriptive rights are not in every state. In California, for example, you do have to have an MD supervisor in order to have prescriptive rights. But in Oregon and Arizona, for example, there are no limitations on prescriptive rights. So those are two states that have a wide variety. We also do do minor office procedures such as like a punch biopsy or draining an abscess or um removing a genital wart as an example. These kind of minor office procedures. And so again, it's sometimes something that not a lot of uh non-endy friendly uh I shouldn't say endy friendly. I should say people who are not as well versed in the scope of practice are unaware. They're like, oh, you can you can drain my abscess if I you know, and it's like, yeah, this is what part of what we're trained in. So Um so yeah, I think it's full spectrum primary care. How I explain it is that, you know, when it comes to outpatient primary care medicine, urgent care, a lot of again, colleagues did choose to go into kind of these I don't know if you guys have Zoom care down in California, but these kind of urgent care centers that are walk-in urgent cares, lots of NDs choose to kind of practice in those, but of course referring out um when appropriate.

Erik
Maybe speak a little bit to the residency component. I mean you you touched on a little bit that, you know, there's not as much of the postgraduate education uh exposure for natural paths coming out of And you know, for MDs or DOs, it's almost unheard of for a physician to graduate medical school and just be a GP. I mean that that general practitioner doesn't really exist anymore almost and mostly because insurances will not um actually contract you know contractually let you practice under their agreement if you're not board certified in some kind of specialty, right? So almost everybody in the medical world um ends up with a residency and then doing a specialty board certification of some sort, or even then going on and doing a fellowship and subspecialty, right? So speak maybe a little bit to that. Because you did mention that, you know, there is an aspect of residency. It sounds like you did maybe a residency in family medicine or primary care. So maybe speak to that a little bit

Michelle
Yeah, there is a shortage of residencies in the naturopathic post-grad, uh postdoctoral education, and it's a big issue. I mean I would be lying to say that I think that especially now I I'm a residency director myself and I see you know, these I I want to say kids. It makes me feel old to say that. But um, you know, these new grads coming out, uh, and they just There nobody's ready to come out of a medical training program and not have some level of supervision. Nobody. I don't care if you're fresh out of MD school or PA school or whatever it is. You just don't know what you don't know. And so the big issue is funding. So if you were to ask a hundred percent of the, this is this is what I think they would say, maybe ninety-eight percent of students and uh naturopathic medical administrators, do you want residencies for uh all of your students? Do you want this to be required? Everyone would say yes. Everyone would say, absolutely. The reason it hasn't happened is that we don't have federal funding similar to what traditional or conventional residency programs. So these have to be funded typically by combination of clinics who want to take on a resident, or they have to be funded by a nonprofit. which is uh one of the big nonprofits that doing some great work. Michelle Simon, just a shout out to her. She is the CEO of the Nonprofit Institute for Natural Medicine. uh and is really doing some great things in terms of getting funding for sites to be able to have a residency because Clinics lose money in the first year of having a resident. The resident is not going to be able to be on their own. I know that firsthand from looking at our PL, right? Residents are are actually a class center. for the first year. So it's an issue. Uh I think it's one of the reasons there is so much variability between quality of naturopathic doctors across the country. I don't I would be lying to you to say that I would um Be comfortable with my friends or family going to any ND in this country, I wouldn't, right? But there are some amazing, amazing NDs who have done some incredible work, who are I'm in I'm very proud to be their colleague. But most of these individuals Have done additional trainings, whether it's residencies or sought out other experiences, have trained other uh under other physicians that are are very profound in their field. So it it's less conventional by all stretch, but it's not necessarily something that you can't come out Of your education and be wildly successful, but it is not a standard path and it is not a guaranteed path. And so hence why I said earlier I really caution people who are not go-getters willing to kind of invest the time and energy. And make sure you are at the top of your class because that is how you are going to succeed. I don't remember the statistics uh recently, but something like after five years less than half of NDs are no longer practicing. And I think part of that may be the challenge associated with number one, coming out of school and not having enough mentorship. And number two Business is tough. And that's part of what you guys are are talking to people about. But if you're trying to learn medicine and run a business and try to learn how to help people all at the same time it's just not a good recipe. So I I I'm proud of the profession that I come from. I'm proud to be an atropathic doctor. I also am very proud to be a functional medicine doctor. And I think that my trajectory has been significantly augmented because of my choices early on to seek functional medicine training while I was still in school. And if I had not had that opportunity, uh, it was actually via Jeff Bland that I had that opportunity. I wouldn't be where I am today. And I should just put in asterisk that Jeff Bland was one of the founders of Bastier University. He doesn't get the credit that um but he'll tell you the whole story and him and joseph pozzorno are very very joseph pozzorno being one of the founders that does uh is an ND and Jeff and him are very close and have been for many, many years. And uh and Jeff is really one of the reasons that functional medicine and naturopathic medicine do have a lot of origins that are similar.

Erik
Well, we'll have to we're gonna have Jeff on our podcast here in the not too distant future. We're gonna have to uh dig down a little bit on that and see if we can get him to spill spill the history a little bit of Bastille. I I you know I it's just it's so so interesting and I I I mean there there are some common threads in terms of business preparation Both for naturopaths and for allopaths and osteopaths. I mean, none of us really come out of medical school with any kind of business sense. I I I do remember having some training in RVUs, you know, relative value units, which was supposedly how we were going to determine productivity and, you know, figure out how we could get a better salary. But it was limited and um and it was like I didn't know what it I didn't h have head nor tails of what they were talking about at the time, right? No no real sense for how to venture out into the business world, no entrepreneurial ship uh experience or or mindset coming out of there. And and so for most of us in the conventional uh track we found ourselves, you know, m looking for a hospital program, looking for a, you know, hospital based clinic program, or in the case of Davin and I, because we were in the military, we ended up in a Navy, you know, ambulatory clinic. Uh, but it was all determined for us, right? We were kind of put into this structured program that we we we had some influence over our productivity, but in the Navy we were based i we could have been the worst physician or the best physician and it would not have impacted our pay. whatsoever, right? Um and and so that's it's really, really kind of a shame. I I I'm I'm gonna go back to the residency program and and I hope I don't take too much time on this, but I think I find this fascinating. What do you know? Like I'm thinking so we have a residency program in in Temecula at the at the Temecula Valley Hospital. It's a family medicine residency Seventy-five percent of those residents come from out of the country. Like they're doing out of the they're they're not coming from U. S. medical schools. So why why aren't we filling those seats with naturopaths? Like what what is the barrier? Do you know what the the situation is with that?

Michelle
Well, I think there's a lot of politics. involved as there is in anything. I think there is a lot of similarities to how DOs were incorporated into a more conventional system. I think that was in gosh, nineteen Fourties, something like that, you guys might know.

Erik
I don't know.

Michelle
I don't remember the the history in in terms of the chronological order, but you know, there was a strong history of of DOs kind of leaning in a more um kind of outsider view and and there was a dis Decision at some point that incorporated them into a more mainstream model. And I think that was largely a not a DO and I don't know the details of that decision, but I think that was a largely a good decision for the osteopathic community and they have retained kind of that route of being able to perform osteopathic manual therapy, uh manipulative therapy, which I think is a great tool. Now in terms of the why, I do know that uh the national organization, the ANP, uh American Association of Naturopathic Physicians, spends a lot of money. on this exact thing. And they are wildly trying to advocate for federal inclusion into Medicare. And once we were able to take Medicare, we can then be uh my understanding is we can then have an entryway to more conventional residencies in the community health realm. And that is where the demand is very, very high. And I honestly believe And this is again coming from someone who trains these NDs coming straight out of school, I think would be a massive service to the rural communities that need But there are fifty states and every state has to license NDs in order for federal authorities, however that works, to then include them in this Medicare program. And I I don't even know off the top of my head what number we're at, but I think it's in the high twenties So we're, you know, halfway there. So I think it's gonna be a while, but if you were to uh query The opponents of naturopathic medical um residents, my guess is a lot of them would say, well, the training is not equivocal. Well, you're right. There isn't hospital training, as I said before, and I do think that the standardization needs to be improved, but I also think we get things that the conventional system doesn't, like nutrition, for example. We get a massive amount of training in nutrition. We get a massive amount of training in these realms that would help treat our most fundamental crisis in this country, which is Cardiovascular disease, obesity, diabetes, like we are so well trained in the realm of nutrition coming even straight out of school. This is one thing that a lot of NDs straight out of school do really, really well. And they are able to sit with the patient, do some really good counseling techniques, and they are able to do some motivational interviewing to be able to understand how do we get this person to incorporate lifestyle medicine. And that Is something that I think is maybe just as important, if not more important, than knowing how to manage somebody who is acutely decompensating. in an inpatient situation. I think both are important to be able to be a I think well-rounded physician, but there are pieces that are missing. In the big picture, I think on both sides. And we can learn from each other. We can help each other. We can help grow this kind of new wave of health care. But we can't have this opposition of like you're not as good as me or I'm not as good as you or you know, it has to be where can we help each other? And That's what I'm hoping.

Erik
I love that.

Davin
Yeah, I I think um I mean a couple different thoughts here. It sounds like you know, insurance reimbursement or, you know, insurance coverage for NDs is maybe not pervasive across the country. Correct. Um maybe certain communities have found ways around that through, you know, federally funded clinics or, you know, Medicaid type, you know, clinics where You're getting paid differently than just typical kind of contracting with an insurance company. Um, but Sort of that aside, um what I'm hearing is almost like you the ND is almost like a champion for outpatient medicine Done better. Right? So and because in reality, like I see myself now as like moving towards you guys, like I want to understand herbal herbs and supplements and how they interact. And I want to understand nutrition and I want to understand lifestyle tools and levers, right? And and so like my inpatient training, you know, the hundred and some babies I delivered at the naval hospital, like it's not helping me that much right now, right? Like it's it was cool. It gave me a broad exposure to to medicine and and an understanding of the life cycle. Um, but it seems like we could make a case for in primary care Do we really need everybody to have that well-rounded, you know, teaching? Or could we bifurcate and those who are interested in inpatient medicine? get that and those who understand that we can have a huge impact on this country's health by doubling down on outpatient medicine Which under this lens of functional medicine and integrative medicine is really lifestyle medicine, right? And and I think that, you know, if we blended the ND with the the an MD who was more outpatient focused, that could be a real win.

Michelle
No, I hundred percent agree. And I think this is part of the reason that I exactly sought out a lot of conventionally trained mentors in my early career. I not to say I don't have some great ND mentors, but I purposely sought out MD mentors because I knew that having that exposure and that uh call, if you will, if I'm in practice and I am worried about um a patient with a elevated PSA, let's say, and I'm trying to decide Whether it's, you know, okay, referral, do I do an MRI? Do I do additional tech? What do I do? Uh I, you know, I consulted a friend of mine who's a urologist who went to IFM's uh AFMCP, their inaugural course with me. And he then would consult me on like, what do I do for chronic kidney stones? And like, hey, what herbs should I use? And we were like, you know, he was 15 years into practice at that point, I was two, but we, you know, found this camaraderie and helping each other. And that's one of many examples, um, including me doing a year-long rotation in my fourth year. with Dr. Arthur Chandra, who's a a well-known functional medicine physician in the Seattle area, teaches for IFM and other organizations and and um and there's others. So my my point being I think You know, David, you're exactly right is that I do feel that we're excellent in the outpatient setting. Again, those who have had the opportunity to get cross-trained in pharmaceutical therapy, because you do need to know when it's appropriate to use drugs, you need to know when it's appropriate to use herbs. You need to know when supplements can be initiated and which supplements interact with what things. And And most importantly, you need to be able to triage a patient, even if it's a not acute situation. When I say triage, you need to assess like what is this patient's willingness to initiate some of these uh non-pharmacotherapies, or are they going to be non-compliant and I'm gonna just lose this patient to follow-up? And so it's it's this dance of of n having both and again I just think there's so much we can learn from each other and if I were to wave my magic wand and design a A perfect system, which I'm sure all of us have different opinions on this, but I would have, you know, a compilation of different trainings under the same roof, which is largely what Vita, my clinic, is trying to achieve and has done a pretty good job. I think we have some room to grow, is we can be better together. It sounds cheesy, but it really is true. And hence why I think It's so fun to like talk shop when I see Erik and and other um colleagues at conferences because we always learn something from each other.

Erik
Yeah, for sure.

Davin
So I think, yeah, I think Maybe if we were to just still down the early conversation we've had, is that there are options for people you know, in in terms of career training, career paths. Um and I think an ND path is a definitely potentially a more modern fit in terms of where things are headed. understanding, you know, this other tool set, right, that includes non-pharmaceutical uh interventions And now kind of bringing it back to the business aspect of saying, okay, well, if someone does want to pursue that path, like that seems to feel authentic to them, right? Yeah. Um can they make a living? Can they can they have a business, you know, pathway? And and I think that's now maybe a good place to shift gears and understand what you guys have done and how you've been able to translate your specific background and and into value creation, you know, so that you can have a a business that that works.

Michelle
Yeah. So I I will just correct one thing that Erik said in the bio, and that is um Vita Integrated Health was founded in 2013, long before I came along. So I am one of the, if you want to call it, founders of Vita functional medicine, which we launched in 2018, but it is a component of the existing Vita Integrated Health, which was founded by Dr. Chris Sasaki, who's a chiropractor. And his vision was right from the get-go. to incorporate functional medicine into a practice that included chiropractic, physical therapy, acupuncture, massage. And he didn't exactly know at the time what how to incorporate it. He just knew he wasn't the right person to do it because His focus had been on musculoskeletal care and and so on. So his uh practice when he launched it in in one clinic in Seattle, Washington, 2013. He uh hired a few naturopaths um and tried to kind of do it in the realm of of naturopathic medicine. And for whatever reason, I wasn't privy to exactly the details. It didn't work. It didn't work. Um there wasn't a good consistency. It wasn't the right person. It wasn't the patient follow-up wasn't there. It just didn't work, although the musculoskeletal practice bloomed So he was growing, growing, growing with more chiropractors, more acupuncturists, more physical therapists. But the the ND realm of functional medicine wasn't working. And so I think when I came along in 2018, I think it was kind of his like, if this doesn't work, uh I I think I've done everything I can do, right? And so here I was, you know, at this point, two years out of school, finished my residency, had a brand new baby I think, was nine weeks old when I started at Vita.

Erik
Amazing.

Michelle
And uh bright eyed and bushy-tailed and ready to work. And you know, I had the um fortunate uh access to people like Jeff Bland and Joe Lamb and Artie Chandra and uh you know, list goes on. Mario Robinson is the urologist I mentioned earlier and all these people that I I leaned on. And so I started to think about how we could build this into a sustainable business side. as well as the practice. And so Chris having already had at that point multiple years in running a business. He really emphasized to me, I want you to just focus on building the functional medicine side of things. And so I, after having worked at IFM, actually had been still working at IFM at that time, up until 2019, I was working part-time for them. Uh, I knew what we needed to do and to get functional medicine off the ground. I felt like, okay. This is what we need to do. We need to use the functional medicine timeline. We need to use the matrix. We need to establish a realm of different types of providers. I brought on Dr. Michael Quarsillis, who's a physician assistant by um training as well as a naturopathic physician. So he kind of has uh both dual training, if you will, in the realm of exposure to the conventional side through his PA. And so we grew with adding him. Um, I think that allowed for a lot of the more uh endy shy patients to kind of feel more comfortable that there is someone who has the training and he was at that point I think 18 years into practice. So we had um someone who who had a lot of experience come in and then my practice just boomed. People were finding me on the IFM website. site they you know I had been doing A4M training I was already IFMCP at that point I um had done additional hormone training at the um uh Women's Institute in Portland, Oregon. I had had done a variety of different things at that point. And so we really wanted to go into the realm of how do we offer functional medicine primary care. Functional medicine primary care. And that was unique because a lot of places, and by the way, we were doing it on an insurance model, exclusively insurance model at this point. There was no cash-based services. We were not doing that. And then COVID hit, right? So practice is booming, all these kind of good things are happening, COVID hit. And we uh I don't know if this is same for you guys, but we stayed open as essential workers. We obviously did a lot of telemed. during that time. So we didn't have people come in who didn't need um to, but we absolutely stayed open and to the point when before there were drive-through uh before they were drive-through COVID um uh yeah, testing sites, we were actually for patients who had high risk, we were actually swabbing them in the parking lot when we could get um when we could get those swaps from LabCore requests early on. So we were kind of doing the full spectrum, how can we help our community people? And that felt really good to our patient population. People, I think, developed a level of trust with us during that time. Uh and we expanded during COVID, meaning the functional medicine department. And what I mean by expanded is we really went into the realm of prevention of how do we reduce the uh risk of the conditions that we know are associated with worse COVID outcomes. How do we early on look at what is long COVID? What does that even mean? What's the pathophysiology? What can we learn from SARS virus in terms of if if there is any association? What botanicals could potentially be utilized in early COVID infection, even though the research is Clearly just not. It wasn't there and is barely there now. We were kind of just doing what we could within a safe realm. And I always like to emphasize So from a business perspective, uh I think the shift that happened during COVID was largely because people became aware of their underlying conditions and how that could influence something in an acute care situation like COVID, right? So The growth that happened following that, we hired additional physicians, we started a residency program. We uh initiated a way of people being able to get in um same day and we, you know, reserved same day appointments as many primary care clinics do We really made it sure that people again felt well taken care of. And the demand became so significant for our docks that we were burning out. Which I know you guys are familiar with, right? And many, many people who potentially are listening to this may be familiar with. So we needed to do something different. And the option to do a membership model presented itself mainly because my wait list at the time was a year for a new patient And I think I was seeing my follow-ups every six weeks that didn't feel super good to me. They could see my resident sooner, but it it was too long to see me. So we launched our um our membership model in twenty twenty-three and we did this a little cautiously because it was difficult and I know um many people who go through this transition can relate It was difficult for us to say, hey, we're gonna charge you to see me uh regardless. You're gonna pay a monthly fee. In whether you see me or not, you're gonna pay this fee. And then the way that the insurance world works in Washington state, we have a model where you're paying for non-insurance covered services. So it includes adjunctive things like a DEXA scan. and preferred scheduling and several other components that are separate than billing for an office visit. So the insurance piece was still on board, but the membership was for non-insurance covered services. And I had to say goodbye to a lot of my patients who said, hey, this model doesn't work for me financially. And that that was hard, but in the long run, um, which I can pause here and ask if you guys have any follow-up questions on that. It was the right decision for the clinic because now we've been able to grow and um expand our reach and we still have a residency program. Which allows patients who do not want to sign up for a membership to still have access to care that residents directly overseen by myself and other uh functional medicine, certified functional medicine physicians. And we we feel really good about still being able to support our community. without um having to not be able to pay our doctors what they're worth, uh having to see so many appointments that everyone was burning out, medical assistants burning out, doctors burning out, nurses burning out. So I'll pause there. I know that was a long scramble.

Davin
I mean a a quick thought is um COVID, right? So do you think I mean obviously you guys were providing a lot of value because Again, you were kinda like going upstream into their conditions a little bit, right? And saying, Hey, let's get ahead of this so you don't end up as one of those people, you know, that you're hearing about on the news, right? In in the ICU or whatever. So There's that aspect, which was a trust factor for you guys. Also maybe what do you think about just you know, COVID as revealing or having people sort of question the traditional model, right? Because I think All the mixed messages, is you know, who who has the truth, who's telling us the truth. I think from my perspective, people began to question a little bit the traditional model where there was this kind of inherent trust. Now maybe people are questioning, is there a better way? I I'm just curious your thoughts on that.

Michelle
Yeah, I think that's true. I think that the patients who were questioning is there a better way? I think there was a lot of fear. Uh Obviously during that time and when people are worried about their families, about their own mortality, about something out of their control, they start to look for things that they can control. And I think functional medicine and doctors uh who were able to offer Support, I I think it it's a fine line between promising something that you really don't know, uh, meaning like none of us knew what was gonna work and what wasn't. We just kind of had some theoretical Okay, we think this is absolutely safe. Is it gonna harm you? No. Okay, well, let's do that because we think that there's plausible uh outcomes that could help. I think that's where people were looking for us. Okay, yeah, there there's a lot of unknowns and what do I do in terms of, you know, how do I protect myself? But this person has at least something to go on this doctor has at least something to go on that's plausible versus the conventional community is just saying There's no Yeah like well come to us

Davin
Good luck good luck if you're really sick.

Erik
Yeah. Come come to us when you're almost dead. And we'll try and revive you uh in the hot cler, right? I mean that was and so it made it really challenging, I think, for individuals to your point, where they felt like they had zero control or influence over that. It was like you were just waiting for, you know, the uh spirit of death to come by and grab a hold of you and you were hoping to shake free before the Grim Reaper finally you know, clocked in. So I I I think to your point though that you you guys seeing that, feeling that within your community and providing that service. uh became a a powerful impact not only on the community, but also on your practice, right? And in things really started we know we noticed something similar. The demand for integrative and functional medicine uh during COVID and after COVID has skyrocketed. And I think that some of this is just to the dissatisfaction of conventional treatments and not being able to get the kind of care and just even being hurt. I mean it's it's one thing to say, okay, there there are no scientifically proven treatments right now that are going to help you. And it's another thing to say, let's do something versus, so just go home and do nothing, right? I mean it just it just was And because of your background in lifestyle medicine, in natural medicine, um, there was a lot of things that were safe, that made sense physiologically. Uh that would allow you to optimize an individual's performance going back to kinesiology. And this was the performance of protection, right? Performance of the immune system being able to fight off these infections or at least resolve or or modulate the the cytokine storm at that time. So I think that's that that's super interesting. I speak to a little bit then to how how the membership program changed the burnout or the culture of your practice um from a business standpoint. I I I I mean I've talked to colleagues and and friends who are struggling with this, trying to transition into a membership program. And they don't want to give up their patience, right? They're like not satisfied with how they're practicing But they're they also are are providing a service that isn't able to be given through a cash based practice. Um, and so it becomes this this tug-of-war between their their compassionate heart and their ability to to to keep a business functioning and their their job satisfaction.

Michelle
Yeah, I think the membership model was a a must for us because we weren't going to be able to keep our doctors. Uh in from a financial perspective, you can see 20 plus patients in a day. uh and the reimbursement, you know, in order to have a medical assistant for all the providers, in order to have, you know, a um a at least break even PL at that point with all the supplies that are required for primary care and things expire and and just managing the business side, we had to do something because insurance was not adequate. Insurance reimbursement was not adequate. And largely functional medicine is consultative, right? It's not typically a a very procedure heavy you know, there's some notable things that we do like trigger point injections and as I mentioned earlier, um, you know, some Some uh office procedures, but largely were not a procedure heavy uh practice. And so the reimbursement was just not adequate for basic ENM codes, 213s, 214s, even 215s. And the challenge was how do we do this? And Number one, make it so the doctors don't burn out. And so when we transitioned, we made a decision to have a tiered model. So we had a resident, actually two at that time. We had two residents, and we had uh other associate physicians, Dr. Corsillis being one of them And then myself, who's the director of the program and just has uh more administrative responsibilities. So my panel size was going to be lower. So we have three tiers of cost. And uh patients were given the option of one of these three tiers, essentially And if they chose not to engage in one of these tiers, they could see a first-year resident under the supervision of one of the attendees. And that uh resident would only have limited appointments. So it really um It really encouraged people to go with the physician they had already been seeing for at that point, usually a few years, several years. And I think that people understood it. I think patients understood it. They got it, because this is not a secret that there is a lot of change in the medical reimbursement. model over the years, even in the last ten years. And they felt like it was valuable to them, patients. felt it was valuable to them to be able to get a longer appointment with their doctor. They felt like it was valuable to get some of the preventative services that we were offering, such as a VO2 Max. and a DEXA scan and there's you know discounts on things again, those non-insurance covered services. So The transition was not as difficult as we thought it was going to be for patients. Of course, there was some pushback and some disappointed individuals But uh the conversations were essentially we will work with you until you find another provider. We're not going to do any abandonment here. If you aren't able to get your blood pressure medication filled, don't hesitate to reach back out to us. We will help you. We had a list of non-concier or non-membership providers we were referring out to. We we made sure that this was a hand-holdy process for um our patients in the transition. And I think people felt really good about that, that we weren't just like, okay, figure it out. You're on their on your own. Our resident, interestingly, our second-year resident at the time who had a a membership fee of uh I think it was $79, she filled it up first. So her panel, I think, filled up in 30 days. And so I think that was the sweet spot of the pricing, but also she wasn't brand new. She filled up right away, which was a surprise to us. We did not think that the that was going to be the case. Um, I think it was then me, because again, my panel that I was taking Then it was Dr. Corsillis, who had a much larger panel that he was taking because of his um uh clinical hours. And then I think it was the non-uh concierge individual that then was getting a trickle-down effect.

Erik
And do you mind Michelle, do you mind sharing what prices you had for your different tiers?

Michelle
Yeah, so this is when we started in 2023. They have since gone up, but in 2023 it was uh $79 for our second-year resident Um at the time we did $189 for our associate physicians and I was $249 uh per month. at this time. And we did do an annual membership uh discount. So they got essentially one month free. if they uh decided to pay in full. And, you know, we weren't gonna force anybody to stay if they really didn't like, you know, we were gonna refund them pro rated, but they did get a discount if they paid in full.

Erik
Yeah, and one of the things that uh I I've heard about the membership program versus you know, doing paying an annual versus uh membership is that uh you need to get an escrow account to put that money in uh so that you have that available so if somebody cancels a membership you can prorate it back. Is that is is that what you guys did?

Michelle
You know, I I honestly am not that in depth on the accounting side. We have kind of a big Team, I do know that there were conversations in that realm, but uh I I wouldn't be able to tell you the exact details, but I do know that um we've always been able to accommodate if somebody's had that request. So yeah. And we were lucky just to add to this, you know, I call it kind of big Vita and little Vita, meaning the Vita that was more the musculoskeletal medicine side that was, you know, established well before the functional medicine side. Functional medicine was kind of like a startup within Big Vita. And so we had funding, I would call it. Um that cushioned us. And that was a huge benefit which I recognize a lot of Medical only practices don't have that luxury per se, but it surprised us how uh quickly the program grew from the twenty twenty thought and people people understood it. They got it.

Erik
How long from the time you made the decision? Okay, we're gonna go to membership to rollout. Like, okay, now we're now this is day number one of the membership.

Michelle
It was around six months. It was around six months, and we had sent out multiple letters, emails, communications. If we didn't hear back from somebody, we had our team call them. We just made sure that everybody was aware of this change again because there's laws against patient abandonment, number one, and number two It's just the right thing to do. You know, we we had a whole bunch of people in our system that we were responsible for. Our you know, we were there primary. So we wanted people to be really clear.

Erik
So were you able to keep track then? You kept track of people who at least responded yay or nay, right? You wanted you wanted an RSVP Um every single patient. So that you knew that you were taking care of them. And if they said, no, we're opting out, um, we're not going to participate in your membership program. um then you you walk them through then what that transition would look like, you know, in terms of, okay, we'll see you for a little bit until we're filling up and we can get you referred to a non-member, you know, referral out. We're not going to leave you hang high and dry, but we we we do want you to participate in the membership if you're gonna be our patient.

Michelle
That's exactly it. And we made sure that if we didn't hear back from them, we made multiple attempts and we documented those attempts in in a formal way. because we do want people. And people move. They change their phone numbers. I mean it wasn't always easy, but vast majority. And if somebody did call a month after we launched, I I I remember multiple times people are like, oh I didn't know Yeah, we took care of them until they could find someone someone else.

Davin
Oh well I I just think that this topic will be really fat really interesting to our our listeners. Um, because I think there's a lot of people out there probably, you know, wondering how to make this move if they're already in practice. And um you've obviously you guys navigated it successfully And it seemed like it it's helped your uh business one, you know, financially, but also like from a quality of life for your practitioners, you would say that you kinda Like the goal of this transition were met? Is it is that your impression or is it not all good?

Michelle
It's a it's a really good question. I think that we still run into Challenges with physician burnout. I'd be lying to you to tell you that that doesn't still happen because people are still with patients eight hours a day, many days. The difference is they're seeing far less patients So, you know, you might see ten people in an eight-hour day as opposed to twenty-five, right? And that makes a big difference in terms of uh, you know, what you're needing to do, but the complexity of those visits is typically deferred. You're often going into more complex Laboratory testing and you're spending that 45 minutes, or follow-ups are 45 minutes, or new patients are an hour, you're spending that time reviewing really in-depth data that you know, requires a lot of mental energy. And um and so I wouldn't say that we have accomplished the goal of everyone just coming to work, singing and, you know, skipping and I I I don't think that is true. I think our providers are largely very happy with the structure. I think they feel supported. I, you know, can't speak for them specifically, but I I what I'm told is they feel really supported. We make sure that they have an AI scribe. They all have a paired virtual nurse And they have an in-house MA or uh LPN nurse. So there's a lot of support staff. And part of that model, that paired nurse, is the portal, our physician portal or our EMR portal Patients are typically able to get a response about a question within hours, if not within 24 hours of sending that message. And the responsiveness, I think. is one of the biggest uh retention aspects of our program, in addition to my bias around I think our doctors are amazing. Uh I I truly believe that But I do think that having quick responsiveness is so different than what conventional medicine offers. And the customer service forward approach that people are wowed by that. They call they have a sore throat. They call the front desk. The front desk immediately transfers them to the paired nurse of their provider. That paired nurse RN She will, she or he will triage the patient. So, okay, you have a sore throat, do you have any trouble breathing? Have you done a COVID test at home? Do you have a fever? Blah, blah, blah, blah, blah. They just kind of get you know, obviously a triage. If they assess that the patient does not need to go immediately to the emergency room, they're typically able to schedule them same day, if not with their provider, but with a provider same day. It's most of the time their provider. And then they are able to be seen and et cetera, et cetera, and taken care of. And that I think has been, if I can speak to the secret sauce, it has been The number one thing that when people talk to me about what keeps them at Vita, it is because they feel so taken care of and responded to And we have so many different avenues that we try to achieve that on a daily basis.

Davin
That's great. I I so it it almost sounds like There's two aspects to this, right? Like the the concierge nature, right? If if that's the word that we that we need to use, right, is is that convenience, ultra convenience access is is, you know, top notch and responsiveness. I I think that's really interesting because I think that's more on the concierge side whether you're functional medicine or traditional primary care, people like that. People like that convenience and and access. So Um, but the fact that you also have in you know that deeper functional medicine uh breadth to the practice, right? So You know, you may have people that just are pretty healthy and they just love that convenience. And then you have others that really need that deep, complex uh understanding. So it's almost like a great combination that's complementary.

Erik
Well, I I I probably have another three hours of questions for you, but we only have about one more minute of uh recording time today. So I we're definitely gonna have to have a part two, Michelle, if you're up for that.

Michelle
Yeah.

Erik
Um But you know, we we uh we'll we'll give you the the last question here that you can kind of shout out and uh it'll be interesting to get your perspective on this. But uh what do you see the future of meta few functional medicine being? over the course of say maybe the next five to ten years.

Michelle
Yeah, I I think that we really have to look at what Lee Hood and Jeff Bland both developed kind of simultaneously separately but simultaneously and that is functional medicine meets precision or P four medicine. And that to me uh is and I'm a little bit of a a groupie of Peter Atia, if I can just Say that, Peter, if you're listening to Erik and David's podcast, I'm a big fan. Uh, is what he calls uh medicine 3. 0, right? And how we can look at these four horsemen, which are described as cardiovascular disease. diabetes or metabolic disease, Alzheimer's disease or other types of dementia, neurodegeneration, and then cancer. If we can look at these four areas from a preventative lens, and we can develop or use tools that we already know are evidence-based, such as BO2 max assessment using grip strength. Basic things that we DEXAS can basic things that we can get data on to predict is this person on a trajectory for health, right? And visceral adiposity being one of the big markers we look at on a DEXA scan. I'm not just using it for bone density. We're looking at it from a full body composition perspective. Those types of things really matter. And so medicine, you know, when you call it 3. 0 or you call it P4 medicine or you call it functional medicine is looking at How do we put all of these assessment tools in addition to laboratory data, standard laboratory data, but also potentially genomic data? Use AI to help us understand it. So you're not spending three to four hours prepping for every patient chart, because that's really what it would take to assimilate all of this. And then coming up with a plan, right? What is the plan for the patient in time six weeks? What is the plan at three months? What does the plan look like at six months? So people see, okay, this is what we need to do. And lifestyle, just like functional medicine has the bottom of the matrix, is movement, nutrition, meaningful relationships, sleep. What am I missing here, guys?

Erik
I feel like stress.

Michelle
Thank you. You know, the bottom of the matrix is where it has to start, but the tools that we have in functional medicine, naturopathic medicine, the combination of allopathic plus functional medicine, however you want to call it. That is what is going to allow us to get there. So that's my that's my vision.

Erik
That's awesome. And You know, you you've inspired me. I'm gonna do what I can to get a naturopath on staff at the residency in Temecula. Because I think that I just can't imagine what my education would have been like doing rounds in the hospital if we had had a naturopath instead of a registered dietitian. Now, nothing against registered dietitians, but they're trained very specifically in a a myopic view of nutrition, and it's not their fault, it's just the way the training is. But having somebody who understands how to use food as medicine and understand the interactions Wow, that I just I I can't underestimate how impactful that would be for hospital stays for readmissions, I just think it would be super, super valuable. So thank you so much, Michelle. This was so much fun. And I we're definitely going to have to have you back on for membership program part two, uh, where we can get into maybe a little more of the details of, you know. Who you know what systems you used, what companies maybe you you have has helped have helped you out from a billing standpoint, uh, you know, how How you structure that and and I I think even from a mentorship residency training, right? Because one of the challenges in any functional medicine practice is finding a provider You you you can't find a provider who's already trained that's willing to uproot and come join your practice unless you have a lot of deep pockets and you can lure them away with money. Do you have to train new ones, right? And so I think a part of what I I would love to dive in a little deeper is just your system of residency or mentorship because there's a lot of conventional medicine doctors and nurse practitioners, physician assistants who want to get into this field. They're doing some of the training, but Still, practicing functional medicine in a clinical setting, in an insurance-based model, is really heavy lifting. And so to your point of still despite the membership, there's some burnout because it is hard work, right? So having some mentorship, having somebody you can go to To help offset that would be really powerful.

Michelle
Pitch out there for uh anyone who is interested in exploring having a naturopathic residency at their clinic and understanding all the details of that, Michelle Simon uh who's an ND uh PhD Institute for Natural Medicine. She she runs a nonprofit. She's a great uh resource.

Erik
Davin, any final words?

Davin
Well, I'm I I'm a Peter Atia fan as well, so maybe if we say his name enough it'll come up in the search and and his people will reach out to our people. Who knows?

Erik
Yeah our people being two, right? You and me. That's our people, right? All right, well thanks Michelle.

Michelle
I appreciate it.