Functional medicine providers are becoming increasingly sought after. However, people also have concerns about working with a functional medicine provider – mainly cost and excessive treatment. Let’s discuss some tips for finding a good functional medicine provider.
Dr. Michael Ruscio, DC: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio, flying solo today but wanting to speak with you about something that will hopefully be a practical conversation that can help a lot of people, which is how to find a good functional medicine provider.
So I have some notes and some things that I think are pretty important regarding finding a good functional medicine doctor. So we can, I guess, jump in here.
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Dr. R’s Fast Facts Summary
Here is what we cover in today’s episode
- What is functional medicine?
- How does a functional medicine doctor differ from a conventional doctor?
- Why would you see a functional medicine provider?
- Who can practice functional medicine?
- What type of functional medicine provider might be best for you?
- Are there specialties within functional medicine?
- Red flags
And I should also maybe mention—because we get a fair amount of questions about this off and on, which is, is our office still accepting patients? And we are right now. For quite a few months, there was a pretty decent wait to get in. But right now, maybe because as per the usual, there’s a little bit of a holiday slow down. It’s only probably about a month to get in as a new patient.
So if you’re someone who has been following the podcast and been thinking about pulling the trigger, I would say doing that sooner rather than later would be a good idea because I think when the book launches next year, the wait is probably going to go up pretty swiftly. I’m always going to work to make my schedule available. And if it becomes too long of a wait, I will train another clinician and bring them in to the clinic.
But just for people, if you’re listening and you’ve been thinking about it, I’d say now would be a good time. Come March next year, it’s probably going to get a little bit more hairy.
So anyway, let’s talk about how to find a good functional medicine doctor. So first of all, let’s define functional medicine.
What is functional medicine?
The way I define functional medicine is a healthcare practice that attempts to treat the underlying cause of disease using natural remedies as much as possible, like supplements, dietary and lifestyle changes, and using lab testing to guide the treatment and determine what the underlying cause of illness might be with the goal of establishing a healthy equilibrium in the body so that one can maintain well-being by adhering only to healthy diet and lifestyle practices. So that’s what I think a reasonable definition of functional medicine is.
And I think a key component of that is reestablishing equilibrium so the body can maintain on its own with only diet and lifestyle and not being dependent upon crazy supplement programs or even crazy diets. And maybe we could even amend that to a reasonable healthy diet and not an excessive diet. So that’s how I define functional medicine.
How does a functional medicine doctor differ from a conventional doctor?
Now, another question that comes up is, how does a functional medicine provider differ from your conventional doctor? And one thing that I think is important to mention, in my opinion—and I think this is pretty darn reasonable—is that functional medicine is not a replacement for conventional medicine.
And you should have one doctor on each side of the fence for a given issue. So if you have IBS or IBD, you should have a functional medicine doctor. And you should continue following up with whoever is monitoring that. If it’s your gastroenterologist, great. If it’s your GP, great. If you have thyroid autoimmunity, you should have a functional medicine provider that’s well versed in thyroid and also continue your routine follow ups with your conventional provider.
And the reason for this is, while, yes, there is overlap, there are also some key differences. And looking at the example of thyroid autoimmunity, people with thyroid autoimmunity have a small chance of developing thyroid cancer. And most functional medicine providers are not going to be providing routine screenings for thyroid cancer. And so to think that you can just see your functional medicine doctor and work with them and totally negate the follow ups that your conventional provider, most likely your endocrinologist might be advising, it’s only putting yourself at undue risk.
Now, the goal of the functional medicine provider is to help mitigate any findings in conventional medicine. But to be a little bit realistic and not be overly idealistic, even for people that are doing everything right, sometimes something breaks, and something fails. And they need a conventional medicine intervention.
So it’s not that we should turn a blind eye to it or make a one or the other sort of endeavor. We want to use both of these so that you have the most opinions, the most intelligent minds looking at an issues, and getting a good, broad array of opinions so that you can make the most informed and educated decision.
Why would you see a functional medicine provider?
So a few additional examples of why one might see a functional medicine provider just to try to make this more real life. If you have symptoms and your conventional doctor says everything is normal, like fatigue, weight gain, depression, then you may want to go see a functional medicine provider.
Another example, if you have constipation, bloating, or abdominal discomfort and your conventional doctor prescribed a laxative but you feel like this hasn’t fixed the problem and it hasn’t fixed all your symptoms, then you definitely may want to see a functional medicine provider.
If you have chronic heart burn or reflux and your regular doctor prescribed an acid blocker and you read up on the medication and you’re uncomfortable with the long term risks and side effects, then you certainly may want to see a functional medicine provider.
Or if you’ve been diagnosed with hypothyroid and told you need medication, but you’d like to know if there is another option before starting, then you may want to see a functional medicine provider to see if you can reduce or eliminate the need for the thyroid medication.
Something else that’s important to mention—because a lot of what a functional medicine provider might do is natural and they’re things that you have access to like direct-to-consumer lab testing or just buying things like probiotics and supplements online or from a health food store, it can be easy to get misguided and just try to go what I call protocol hopping where you have symptoms of adrenal fatigue so you do adrenal support protocol.
You think you have high heavy metals because you have inflammation and brain fog. You do a urine test. That shows high heavy metals. You look up a high heavy metal detox protocol. And you do that.
And what I can tell you is, for a lot of people, these things do not work. And I think the reason why is because there’s a difference between knowledge and wisdom. Knowledge you can obtain easily on the internet. What is a thyroid support protocol? Boom. You can find one pretty quickly.
But wisdom is only accrued when one has been working with probably at least a few hundred people in a certain area. And they’ve been able to develop a sense of, “This is what works. This is what doesn’t work. This is what works for this type of person. This is an initial response that tells us it is working, and we should keep going. This is a type of initial response that tells us it’s not working, and we should stop.”
These things are really important to keep in mind. And you only acquire these with practice. In fact, something Dr. Allison Siebecker said to me recently that really resonated, and I agree with whole heartedly, is she commented, “I need to be working with a certain condition or treatment at least for a few years—” two to three years I believe she had said—“before I really feel like I have a good handle on it.”
And I think that’s very, very true. And so it’s important to keep that in mind because if you’re just trying to do some experimentation on yourself, it’s very hard to be proficient.
So a good functional medicine provider—emphasis on the term “good”—can really help you save time and money. So that’s very important.
And we’ll come and we’ll talk about, in a few minutes, how specialization in functional medicine is something I think can be very helpful because if you’re treating ten different conditions, how long would it take you if you have to treat every condition for two to three years to become proficient in that condition? It would take you a long time. So this is where I think a bit of specialization can be very helpful in the functional medicine model.
Who can practice functional medicine?
Before we go there, let’s talk about who can practice functional medicine because this is something else that you may be confused by. “Well, Dr. Ruscio practices functional medicine. But my local personal trainer also practices functional medicine. So what am I missing here?”
And so there are goods and bads here. There is no regulation, really, regarding who can say they practice functional medicine. Now, this is good because when there is not regulation, it allows creativity. It allows innovation. And it doesn’t confine people by shackles of a restrictive system.
This is one of the reasons why I think a lot of conventional doctors like to leave the conventional system and practice functional medicine because they can actually be a bit more free to practice medicine as they see fit.
Now, the drawback of the no regulations is you can have people with vastly different levels of training claiming to be doing the same thing.
Now, this doesn’t mean it’s bad. It just means you need to understand who it is you’re dealing with and how to find the right fit for you. So we could paint this as a spectrum. At one end of the spectrum, we’d have a health coach, maybe a personal trainer.
But I don’t think it’s a good idea to take any functional medicine advice from someone who’s only certified as a personal trainer. I don’t say this to offend anybody. But these things are serious. This is people’s health that we’re playing with. And you want to work with someone who has a large depth of experience.
So at one end, we could say health coach, maybe a trainer. At the other end of the spectrum, we have a doctor. Now this might be a D.O. (a doctor of osteopathy). It might be an N.D. (a naturopathic physician). It might be a doctor or chiropractor (a D.C.). It might be a conventional medical doctor (an M.D.).
At one end of the spectrum, we have the doctor. At the other end, we have the health coach or a trainer. In the middle, we have nutritionists.
Now, the challenge with nutritionists and health coaches and even trainers is there is a great amount of variability into what goes into these credentials because at a superficial glance, a nutritionist might be a four-year degree nutrition at a major college. Or it might be a weekend seminar. So it might be a nutritional coach. Or it might be a registered nutritionist. So some of these things you have to look into a little bit more deeply, into the credentials.
But why is this relevant? Well, it’s relevant because if you know who you’re dealing with, you can try to find the kind of provider who’s going to be the best fit for you.
What type of functional medicine provider might be best for you?
Now, if you’re someone who has a frank disease diagnosis and you’re trying to weigh if you should use a medication or not, especially if this is a condition that’s somewhat severe and you’ve had for maybe a few years and especially if you’ve seen a couple providers or changed your diet a little bit and you’re still not able to get well, then working with a doctor is a great idea because you’re going to need that level of expertise that a doctor is going to bring to the table.
So that’s the pro of being at the doctor end of the spectrum. You’re likely going to have more clinical savvy.
The con is that they’re going to be more expensive. And there may be a little bit less accessibility. And relative to nutritionists, some doctors may not have as much experience with nutritional coaching.
Now, at the other end of the spectrum, what might be a good scenario for a health coach? Well, if you have very mild symptoms, if you have short-lived symptoms, if you haven’t really tried much of anything for your symptoms or your condition yet, then a health coach might be better suited.
And in the middle of the spectrum is the nutritionist. And they’re kind of right in between. Maybe you’ve tried one or two dietary tweaks and haven’t gotten there.
Or maybe you’ve had a condition for a little while. You’ve used the medication for a little bit. It really helped the symptoms, but you didn’t like the side effects. It’s pretty mild. And you’re not sure if you need to go see a doctor yet because you feel like you could do more work with your diet. Then a nutritionist might be a great fit.
So none of these are right or wrong, although I do have reservations about health coaches and personal trainers saying they practice functional medicine because I feel like that’s misleading. But they can all work. You just want to be cognizant of what you have going on and what level of training you need.
The other thing I’d be cognizant of is there are some that practice functional medicine, even some that may be extremely well credentialed like an M.D., Ph.D. that may not know very much about functional medicine. So you want to be cognizant of that.
At the other side of the spectrum, in my opinion—and again, not to offend anybody—but if you’re a personal trainer or a health coach trying to use lab testing, I think you’re getting a bit in over your head. And I say this as someone who used to be a personal trainer and a health coach many, many years ago.
Being honest with myself now and looking back in time, I was just trying to figure out how this stuff all worked. “Ooh, here’s a cool test I just learned about. I’d be curious to run this on some people and see what happens and see if the protocol I got in this booklet actually works.” That’s not exactly the level of expertise we want to be bringing to a sick, suffering person. So I try to remain open to it. But I do have some reservations there.
Are there specialties within functional medicine?
Another question that comes up is, are there specialties within functional medicine? And formerly, no, there are not. Some naturopathic physicians do specialize if they do a residency. But typically, from a functional medicine perspective, there’s not a standard specialty. But I think it’s actually a very good idea.
And the reason for this comes back to partially what Dr. Siebecker had commented and something that I’m finding myself also which is it’s very hard to get proficient in something. And it takes seeing a lot of patients and time to figure a lot of this stuff out because it takes dealing with patients, having numerous follow-up visits with them, reflecting on their experience, contrasting their experience with other patients with the same condition and you’re using the same treatment. So it takes a while to really sort all this stuff out.
And so if you’re treating ten different things, in my opinion, this is maybe why there is so much confusion and ineffectiveness in functional medicine because we’re trying to do too much. And in doing too much, you’re not able to do anything well.
Someone who is a bit of a generalist in functional medicine might be helpful if someone has very, I guess, preliminary sort of presentation. And they only need simple, standard help. But I do think where functional medicine will go and needs to continue to go is a model where people have areas of focus.
My primary area of focus is the gut with a secondary focus on thyroid. And there are other practitioners that focus solely on women’s health or on Lyme disease or on mold and environmental toxins like lead and mercury. There are others that focus on pregnancy. There are others that focus on predominantly cardiovascular.
And I think this is important, again, because it helps you become proficient at what you’re doing. And so there is no specialization. But I think specialization is a good direction to move.
So how that pertains to the listener or the reader of this is if you have a condition or suspect a condition in a certain system of the body, let’s say gastrointestinal, then you’d want to look for a functional provider that has focus in that area. And also, be wary that if you see eight focuses listed, then that person probably doesn’t have a focus in any one of those eight but is probably a generalist in all eight of those eight.
Again, it’s not a good or bad thing. It’s just trying to figure out how to get you to the right person for you.
Who you work with is a calculated decision.
So again, who you work with is a calculated decision. Someone who is a doctor and a specialist is probably going to be a little bit harder to get into to see and be a little bit more expensive. But they’re going to have more clinical expertise and probably be a bit more efficient in getting the problem resolved.
Someone with less clinical training, like a nutritionist, may cost a little bit less, may be a little bit easier to get in to see. And they’ll probably have a better handle and be better suited to help you with dietary aspect of this.
And then going even further on the spectrum, someone who is a health coach is probably going to be the easiest to see and the cheapest and be able to be there for a lot of feedback, encouragement, and hand holding if you need that. But they’re probably going to have less clinical expertise, of course.
So none of these are a bad thing. It’s just you need to figure out what you need and select someone who is in best alignment with what you need.
So there’s also the issue of red flags. And boy! The red flag piece is one I’ve thought a lot about. And I don’t make any of these criticisms to offend anybody or to pick on anybody. Many of these things are things that I did early in my career. And fortunately, through some reflection and some introspection, I have come to do things differently.
There is an exception to any one of these red flags or any one of these rules because they’re generalizations. And there’s always a problem with generalizations. So they’re not meant to be exclusive dictates. But if you see a number of these red flags present, then that may tell you something. One red flag in isolation is probably not a big deal.
When a provider requires you to purchase a ‘package’ to receive care.
So one red flag is when a provider requires you to purchase a package to receive care. Now this might look like needing to sign up for a three-month plan which costs $5,000 and includes all testing and treatment and office visits.
And I want to make a clarification here because I was just speaking with Diana Rogers. And she said, “Hey, I charge packages for my nutritional consulting.”
And it got me thinking that maybe the most accurate way to put this would be it appears that on the clinical end of the spectrum—so if you’re working with a doctor for clinical functional medicine and they want you to do a thyroid package or a gut package or a detox package that involves office visits and testing and treatments, then I squarely consider that a red flag because everyone is different.
And when you get to this level of complexity, people are going to need varying levels of care. Some people may only need two months of a six-month package. Other people may need eight months. And the six-month package is not enough for them. And of course, a package just pigeon holes you into certain testing and treatment that is allocated by the package. So I definitely have some reservations with that.
Now, to Diana’s point, if you’re doing nutritional consulting, someone is probably going to need a number of visits with you to learn everything, to start applying it, to cover questions with you and follow-up visits, to tweak things. So for nutritional coaching, I think this makes a lot more sense especially because the nutritional coaching won’t be factoring in lab testing and personalized treatment based upon the lab testing.
So for nutritional coaching, I think that makes some sense, especially if the nutritionist wanted to make sure someone was invested and was going to take improving their diet seriously and see them once a week for four weeks in a row and charge that for a month-long package. I think that makes sense.
If they appear hard driving, overly opinionated or don’t listen
Another issue—if they appear hard driving, overly opinionated, or they don’t listen. And I think I’ve shared this quote before. But I’ll share it again. My high school history teacher and actually soccer coach, Coach Gary Cook said something I’ve always remembered which is, “He who knows what he does not know is the mark of one who truly knows.”
“He who knows what he does not know is the mark of one who truly knows.” The more I’ve learned, the more I’ve realized the less I know. So if someone is very opinionated or dogmatic, there is probably a lot that they don’t know.
And in my experience, the more someone learns, the less hard driving or opinionated they are and the more thoughtful and conservative and willing to listen they are because the more you learn, the more you realize you don’t know, the more you’ve learned that what you used to think has many things that contradict it. And so you’ve learned to become more open minded, more broad in your approach, and less dogmatic and less hard driving and overly opinionated.
So if you’re getting a sense that someone is very firm on something and it’s got to be this way and they don’t listen to you, that’s definitely a red flag.
If they require excessive testing out of the gate
Another red flag—if they require excessive testing right out of the gate. So for example, if a provider requires you to perform $4000, $5000, $6000 of testing right out of the gate or before getting started, then this definitely might be a red flag.
Now, there can be exceptions to this. If someone has a chronic illness practice where they’re accustomed to seeing very ill people, very progressed people and they know that the people coming to see them are going to need some in depth testing to figure out a more chronic and complex case, then I’m open to it.
But be cognizant of the fact that a lot of testing, in my opinion, is oftentimes wasteful. It’s not to say that a lot of testing may not be needed.
But I think the best practice is to organize the potentially needed tests into a hierarchy. So let’s say there are maybe eight tests that you could do. Organize that into a hierarchy where you’re going to start with the three tests that seem to be the most clinical relevant. Treatment those test results through to completion. And then reevaluate.
And if you’ve done a good job with picking those first three, then you will likely see all the other symptoms go away. And so now what you’ve done is you’ve gotten rid of five unneeded tests.
Now, if after going through those three tests and seeing their results through to completion there are still symptoms, you move on to item four, five, and what-have-you. But by organizing into a hierarchy of the most impactful or the most fundamental or the most suggested system first, you mitigate unneeded testing. And this has a sizeable impact on the cost.
So those are the red flags. And again, none of those red flags in isolation are a problem. But they’re things that you have to be cognizant of. And you want to compare and contrast with each provider.
And so these are some of the things that I think can be helpful for you to find the right provider for you. Remember that there is no right or wrong. But there are different options out there, all the way from a health coach that can give you some good, general diet and exercise tips to the clinical specialist who can really hone in and figure out a problem.
And be careful for the doctor who is just trying to put everything into a cookie cutter approach. But also be careful for the health coach that’s trying to be a doctor and order a bunch of testing. Not to say any one of these is bad, but in my experience when someone gets too far off where they belong on the spectrum, quality suffers. Efficiency suffers. And then you really, ultimately, are the only one that suffers.
So these are some pretty, I think, important and salient things in terms of how to find a good functional medicine provider. And something else just to keep in mind—I think we’ve covered this before. But it’s embedded in this conversation. More testing and treatment does not mean better results.
And this is tough for both patient and clinician alike because a sick patient, me, myself being one several years ago, just wants to get better. And they’re willing to do anything. And I have lots of patients that tell me, “Doc, I’ll do more testing if you want me to. I’m ready to get better” as if doing the more testing was going to somehow make me able to get them better more quickly.
And from the end of being the clinician, it’s tempting. It’s almost like having a security blanket. “Let me do a lot of testing so I make sure to catch the problem.” But I really have not found this to be the case.
I have found that when we do too much testing it can actually cripple our ability to think because there are too many things to distract you. It’s kind of like a computer. If you have too many programs open and too many things running at the same time, the computer slows down. It can crash because you can only process so much data at a time.
So trying to be a little bit more selective in what you look at will enable you to, as the patient, not have to do as much and to isolate the responses that you’re trying to gauge, “Am I feeling better from X, Y, or Z?”
And also, as a clinician, you’ll be better able to read those responses and start to hone your clinical skills as to what a response should look like, what it looks like when something is not going the way that it should, and so on and so forth.
So those are all some tips for how to find a good functional medicine practitioner. There are a lot of options out there. With using some of these tips and doing some research and being cognizant of the red flags, I think you have a high probability of coming out on top and finding a good practitioner who will be a great person in your corner to give you a very valuable perspective on your healthcare.
And also remember that this does not mean you should just run away from your conventional medicine provider and not do the follow ups. You want a good person on each side of the fence for a given condition. And if you do that, you’ll have a really good probability of a great outcome and hopefully do so with minimum cost and maximum efficiency.
So this is Dr. Ruscio. And I will talk to you guys next time. Okay. Thanks! Bye.
What do you think? I would like to hear your thoughts or experience with this.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.