[INTRODUCTION]
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[EPISODE]
Christopher Habig
Hello everyone, welcome to Healthcare Americana. I am your host Christopher Habig, CEO and co-founder of Freedom Healthworks. Today we're bringing on a very exciting guest and into an exciting growing trend in healthcare for our topic today, the convergence of primary care and health coaching, particularly within the direct primary care model. Today our fabulous guest is Dr. Joshua Fischer of Dr. Fischer MD out in wonderful Marion, Massachusetts, who really, in my opinion, is at the forefront of this movement of physicians reclaiming how to educate their patients on all things daily and long-term health.
Dr. Fischer, welcome to the show. It is a pleasure to have you.
Dr. Joshua Fischer
Pleasure to be here, thank you.
Christopher Habig
Now let's start just a quick background and it's a little bit of a shift from what I usually start off our episodes with and I usually like to give people a reason to continue listening but I think you have a very interesting story from where you had that light bulb moment, that watershed moment of I need to make a switch because the healthcare system at large is not doing my patients or my colleagues any favors.
Dr. Joshua Fischer
You're correct, yes, absolutely.
Christopher Habig
Where was it? Is there any one time where you're like, okay, that was the moment, that was the straw that broke the camel's back, I gotta go do something else.
Dr. Joshua Fischer
Yeah, so it's a little bit of a funny story. So like a lot of primary care doctors, I was getting very burnt out on the system over the last few years for reasons that I'm sure we'll get into. And I was kind of already exploring the idea of setting up a DPC practice. And then just about a year ago, last summer, my wife and I kind of, you know, we realized we really hadn't taken a real vacation since before the pandemic.
So I did something that to a primary care doctor in a corporate practice is just crazy as I took three full weeks off and we took our kids to Spain. We spent three weeks hiking and touring Roman ruins and seeing beautiful cathedrals and drinking wine and eating tapas. We just had a fabulous time. And the thing I really kind of noticed as we were, you know, touring around Spain is just sure it's not perfect there, but people just really seemed a little less stressed and a little more relaxed and I had that very calm Mediterranean vibe. And literally on the flight home to Boston I turned to my wife and I said, I'm out of here. I gotta quit my job. I can't keep working like this. And I pulled out one of those, you know, little cocktail napkins that they give you on the plane and a pen and I sketched out some numbers and I said, I think if I charged this much and we got this many patients, I would make at least what I'm making now and that seems doable. And I'm blessed with a great wife and she says, okay, let's do it. So that was the story.
Christopher Habig
I think all great startups start on the back of a napkin, so you're just joining a very elite crew right there.
Dr. Joshua Fischer
At 37,000 feet on an Airbus, yeah.
Christopher Habig
Now I'm curious, did you save the napkin?
Dr. Joshua Fischer
No, I should have. I should have framed it.
Christopher Habig
You got to frame that, you got to put it right there in the office and say...
Dr. Joshua Fischer
I should have left it to my grandkids in my will, but...
Christopher Habig
So what did you know, you mentioned it a little bit there. What was what was the main thing, you know, from a burnout standpoint? Some people call it moral injury. It's just it's workplace abuse of physicians.
Dr. Joshua Fischer
Nah, I don't like that term.
Christopher Habig
I'm the same way. It's like burnout doesn't do it justice, right? We're really abusing and overusing some of the most talented members of our society. Obviously, empathetic and anybody listening to the show knows where I stand on that one.
Did you feel like you were alone when you're finally like, you know what, I'm out of here. I can't do this anymore. Did you ever look at your colleagues and say, what's it gonna take for the rest of you to not necessarily follow you, but to make that decision that I'm not gonna put up with this crap anymore?
Dr. Joshua Fischer
Actually, most of my colleagues have been asking me how I'm doing and they're obviously getting quite excited about the possibility of maybe recreating something similar for themselves in a few more years when they're ready to make the move. So, no, I really haven't had any pushback from my colleagues. They've been very supportive.
Christopher Habig
That's good. That's good. And again, being a trailblazer, having, you know, somebody to look up to. I think we just obviously we just need more doctors out there doing this type of a model and showing other physicians that it's feasible. Independent practice is alive and well. If you're very smart about what business model you choose…
Dr. Joshua Fischer
I would push back, you don't even need to be that smart about it. Patients are desperate for care. There's a terrible shortage of doctors. I actually think you could be a pretty bad business person and do very well in this model.
Christopher Habig
What I meant by being smart about your business model is by being an independent physician and opting for the DPC or even a concierge model. Don't go back and say, hey, I'm going to have a completely insurance dependent practice and go independent because you're going to struggle. So that's what I meant about being smart about your business model for sure. I actually appreciate the clarification there.
As you started your practice, I mentioned in my introduction that you named your practice Dr. Fischer MD, which I absolutely love. And the number one piece of advice when I give to doctors, when we talk to them is either name your practice after yourself or name it after your town or your community. Don't go out there and create some kind of new super creative name because people are going to have a hard time finding you. What was going through your mind when you're like, you know what, I'm going to slap my name on top of this practice and go from there.
Dr. Joshua Fischer
Yeah, my business partner basically is my wife who serves as the office manager. And we debated a bazillion names back and forth. But the thing I really wanted to make clear is I'm trying to do a bit of a more holistic model of care, which we're going to, I think, maybe touch on and bake in some health coaching and not just be a higher level of the sort of standard primary care that people get in the corporate world.
And it was very important to me that people understand that I am an MD because I think, you know, there are a lot of people out there doing holistic medicine and some of it's great. I'm not arguing that there are benefits to it.
But when people think of me, I want them to understand that I am actually a board-certified physician and I bring that expertise and background and knowledge to my holistic approach to patients. And so hopefully I'm able to provide something a little more complete, thorough, thoughtful than you might get at certain clinics. So we eventually just thought, well, let's just call us whatever I am. Dr. Fischer MD really sort of punches both the doctor and the MD part that I'm a, you know, a doctor and that would just be easy enough.
Christopher Habig
Are you having people that, you know, previous patients, did that make it easier for them to reach out to you and find you and figure out where you went when your name is on the building?
Dr. Joshua Fischer
Oh yeah, so part of my story is this. I actually was practicing in Rhode Island for more than a decade. And just due to some family reasons, a few years ago we moved out to Marion. For those of you who don't know this part of the country, it's about a 45-minute drive from Rhode Island. So the last three years I had been commuting from here into Rhode Island to continue my job. Just also a factor in how I ended up doing this. So when I started, obviously it just made sense to start a practice here in this town in Marion, rather than having to keep commuting 45 minutes. I cut my commute down to about three. But I assumed, based on that, that I was gonna be starting completely from scratch, which I largely have, but shockingly, a fair number of patients of mine from Rhode Island have found me and have actually come out this way.
So I now have a little base of people who are commuting 45 minutes an hour to come out here and see me. Which, you know, been a really nice sort of bonus because I assumed I was going to be starting with nobody and I actually did open with some patients on day one, which was obviously financially helpful.
Christopher Habig
Absolutely. What is the reaction? Just curious how your patients with who are driving 45 minutes. What what do they say about the new practice versus how you were seeing them before?
Dr. Joshua Fischer
I've gotten so much positive enthusiasm. People are really impressed with it. Everything from the fact that I'm in a little old, I mean you can't see my whole office here, but a little old Victorian building that just captures a sort of charm to the fact that they don't have to wait to the fact that I personally serve them good coffee when they walk in the door. To the fact that we spend 60 or 90 minutes sitting here chatting. To the fact that I have all this extra equipment to kind of deliver the holistic care. They text me and I get right back to them.
I mean, they're just, it's not, you know, it's not upgrading from like a Toyota to a Lexus or a Chevy to a Cadillac. It's like going from a Chevy to like a space shuttle. I mean, it's absolutely different experience than anything they've ever had in primary care before.
And uniformly these folks come back and say, I can't believe what you're doing. This is incredible. And I actually don't even, I don't even feel like you're charging enough for your services.
Christopher Habig
I love when physicians say, yeah, my patients come and say, this is too cheap. You're not charging enough. You're not realizing your value. How do you react to that when you're like, wow, okay, these people believe in me. These people see the value. How does that kind of square when you hear that? What's your reaction?
Dr. Joshua Fischer
Well it's really gratifying. You know, as a doctor obviously, I mean look I'm a human and I like making a paycheck as much as anybody else and I'm not going to pretend otherwise, but you know I didn't ultimately become a primary care doctor to get rich. If I hadn't done that, that would be about the stupidest decision in the history of trying to get rich.
You know I'm here because I believe in the work I do and I really enjoy the relationships I form with patients. Sort of like being a teacher, I think my biggest paycheck is the gratitude and the appreciation I get when I can help another human being.
Christopher Habig
I'm curious when you talk about teaching and then being able to really call your own shots, you're in control of your practice. What type of services are you providing for your patients that would have been just impossible in an employed hospital setting that you came from?
Dr. Joshua Fischer
I mean, first and foremost, I still do everything that a typical MD does. I just do it in a way that's much more personalized and responsive. So I give people an annual physical. I refer them for their colonoscopies and mammograms. I do their annual blood work. If they're sick and they need an antibiotic, I prescribe that. If they need medicine to control their blood pressure, I prescribe that.
But the difference is they don't wait months to see me. They wait maybe a few days if they have a question off hours and they text me, I get back to them within a few minutes. So I, again, I'm sort of, I've taken the care they were getting and I've bumped it up to this very personalized concierge level service. But the other layer I bring into this is to try to really focus on wellness and prevention, which is something I've always been very passionate about. And that was, that was a big part of my burnout with the system.
In the standard model of care, it's just a drive through. You have to see a patient every few minutes. There's no billing code for a lot of the stuff that actually keeps people healthy. And so, you know, it's best to give lip service to lifestyle.
Here, I have a body composition scanner, which I routinely put my patients on. We take a look inside and say, okay, this is how much lean mass you have versus fat mass versus visceral fat. You know, based on this, sort of here's where you stack up your age group in terms of health. You know, if you're not doing well, then we'll sit down for sometimes an hour or two and discuss diet, sleep, nutrition, stress, exercise. Try to put people on a plan to get healthier.
I have a red-light device in my office. This is another thing. It's like this is in Voodoo. There's hundreds and hundreds of published studies on this technology. NASA helped develop it. You know, there are world famous researchers studying it. It helps treat, you know, things like tendonitis, muscle aches, injuries, wounds. There's evidence for depression, chronic fatigue, I mean, a whole host of things, and it's totally harmless. Never learned about this in medical school. There's no billing code for it. But I know this works. It's worked for me. It's worked for family members of mine. And so I just bought a device and I let my patients use it when they need it.
So I have this all the kind of extra layer of care I can build in. And also ordering certain preventative tests that are not commonly done in medicine because most doctors are just sort of forced to follow the guidelines and the insurance model. I'm free, we can do things that I think have great value to patients, don't even cost very much, and really can give them a lot of insight into their health and help them make better choices.
Christopher Habig
What I hear is a shift in your care philosophy away from reactive medicine of, hey, I'm here when you need me, just call me, reach out, into much more of a proactive mindset that you're actually putting into play for your patients of, let's see where you are right now, let's figure out ways to get healthy. So it lines up incentives, lines up what you want, your goals with the patient goals. And I think that's a big missing component of modern US healthcare is that it's all reactive. And when people react to health needs, that's when they delay care and that's when they, you know, they seek alternatives that really break the bank. But utilizing a trusted physician such as yourself to say, Dr. Fischer, here's the things that are wrong with me. Let's get to a point where I'm healthy and then let's try to stay healthy. I think that's huge.
And that's where I want to bring in the health coaching component that you're doing, because I think this is really, really unique. And again, I'm a big fan of that.
Little bit of backstory and long-time listeners probably pick up on this one, but I have always felt like physicians vacated that responsibility to educate their patients, you know decades ago Now you're coming into it and saying look I want to be that source of expertise for my patients. You're blogging, you're producing content. Like you just said you're sitting down with patients for an hour, hour and a half. How has that shaped your practice as you as you started Fischer MD and then moving forward…talk about how health coaching has really influenced your relationship with your patients and what you're able to offer them.
Dr. Joshua Fischer
Yeah, so maybe just if I could back up for one moment.
One of my big sources of frustration with the system, it wasn't just having to see a patient every few minutes. It was the fact that because of that and because of the financial incentives and because of what you're limited to do in a corporate practice, it felt like we were just throwing pills at problems. And I always say, I am not against pills, pills have their place, but you know, a really good example is type 2 diabetes. It's one of the most common diseases we see in adult primary care. It almost always gets better, massively better, often completely better with lifestyle changes. So to just throw pills at people is crazy and I was so frustrated with that.
And I had patients, even in my old practice, who I was able to just find a few minutes to talk to about making changes. And it was so rewarding to see people who had terrible sugar control on, you know, three, four or five meds. And then a couple of months they were back to non-diabetic numbers on no medication or maybe like one low dose of one medicine. So this stuff works. Right. And patients know, frankly, that for lack of a better term, that the system is bullsh*t.
There's been this explosion of popular health stuff out there in the past few years, like podcasts. You may know somebody who's names Peter Attia, Gabrielle Lyon, Ken Barry, Ben Bikman…I could go on and on and on. And people listen to this stuff, they read this stuff.
And so I find a lot of times the patients who were willing to explore just life other than just taking a pill, they would often know more than some of the doctors. I mean, it's, you know, it's just, it's ridiculous. So I was always following that sort of space and getting more and more frustrated with the fact that I knew about all this stuff like red light and saunas and better techniques for better sleep and better nutrition. But I was only able to be like, here's some metformin and lysine pill, come back in three months.
So a big part of my break from the system was really about getting away from that. And here, I mean, it's probably a bit of a self-selected population, right? The person who just wants a pill for every problem is probably not going to find the value in paying me for my care. But I think a lot of patients are so frustrated with just getting a pill for every problem and never getting to the root of things and never feeling anyone really listens to them. That they're coming in in droves here and people are really seeking this type of care. So I'm not sure if I answered the question you asked, but.
Christopher Habig
Yeah, it's almost this fact that you get to use your brain and your expertise and yeah, there is a little bit of self-selection and it's not the typical, what I'm gonna say, like challenges to this type of a business model where there's going to say, critics say, it's just going to be rich people or it's just going to be the really healthy people and that's who you want to see. It's almost the complete opposite.
Dr. Joshua Fischer
I have a very broad spectrum of patients, socioeconomically, age-wise, ethnically. I mean, there is not one stereotypical type of person who comes in here. I have young people who just really are very invested in their health and they want to be very preventative and forward-looking. I literally just, before we recorded this podcast, came from doing a house call on an elderly patient of mine who has severe dementia and really can't get out of his house. So I just do house calls on him when he needs to be seen.
There are people from all walks of life who want something different than what the corporate system is offering them.
Christopher Habig
Do you feel like being able to offer nutrition advice? And you mentioned Peter Attia, who's big on this movement, health span, live better, live longer type of thing. So not just live longer and be crippled when you're 60 or too obese to move or anything along those lines, but let's...
Dr. Joshua Fischer
His quip is a long life and a quick death. And I think that's the best goal any of us could hope for health-wise.
Christopher Habig
Being able to use a longer life and be able to actually enjoy it, right? It's kind of the two sides of the same coin there. So very familiar with that mindset.
Again, going back into this concept of health coaching, do you ever look around and say, you know, why aren't more physicians talking about these things with their patients? And again, I know you touched upon incentives from the fact that once you cure somebody of diabetes, if you're in a hospital, you lose money on that patient, or you don't earn any more money on that patient where your practice is incentivized to cure diabetes, especially, you know, specifically Type 2, if and when possible.
It's just this mashup of incentives just continues to just blow my mind. Do you ever look at this and say, more doctors should be talking about nutrition, more doctors should be talking about exercise if they had the time to do that?
Dr. Joshua Fischer
Of course they should because outside of luck, the biggest determinants of whether you're going to live a long healthy life is whether or not you smoke, whether or not you abuse toxic substances like drugs and alcohol, whether or not you exercise, whether or not you eat a proper diet, which very long conversation about what a proper diet is that we probably don't want to get into, but, whether or not you get good sleep most nights, whether or not you have friends and family and social connections. Those things are exponentially more important to your health and longevity than most medical treatments.
So this should be the centerpiece of medical care, but the whole system, from the way doctors are trained to think, to the way doctors are paid, to the tools doctors are given to use, just doesn't do anything other than lip service for these pieces.
Christopher Habig
When you look at what you're talking and educating your patients in your practice and then you realize that health coaching is a standalone, multi-billion-dollar industry out there. How do you react to that when you're looking out and saying, wow, why is this person a health coach when they don't have a medical degree or anything along those lines? Is there a little bit of competitive rivalry there?
Dr. Joshua Fischer
No, not at all. You know, the truth is, unfortunately, my profession, which I love and feel a strong allegiance to, is also not exactly known for humility. And we've gotten a lot of things wrong. A lot of doctors are not particularly interested in anything other than the pills and the lab results. And patients are going to seek these solutions out from somebody.
Now I happen to believe as a medical doctor who also obsessively studies things like nutrition and stress management and fitness and so forth, that I am in a uniquely good place to provide health coaching to people. But you know, I've met plenty of average people who've, you know don’t have a specific medical background in training, but through reading and podcasts and such are quite knowledgeable about stuff. And often more knowledgeable than some doctors about some of these topics. So, you know, I think the medical profession needs to a little bit get off of its high horse and reclaim the fact, you know, people are doing some of this stuff.
Let me just give you like one example. Have you ever heard of Dave Feldman?
Christopher Habig
Yes, I have.
Dr. Joshua Fischer
So Dave's an interesting guy. I don't know him personally, but he's an engineer and he went on a keto diet, which many people are doing because it works for some conditions very well. And his cholesterol went through the roof, but everything else about his health got better. You know, he lost weight and his blood pressure came down and his blood sugar came down and et cetera.
Now he's obviously a bright guy, he's an engineer, and to his credit he started sort of just doing a bunch of scientific experiments on why people's cholesterol sometimes goes berserk on a keto diet. And importantly, does that lead to heart disease or not? And you know the punchline is we don't know.
But you know the standard response from the medical community has often been this guy's crazy, this is unethical, he's going to get people killed. And you know I'm sitting here looking at this and saying I've known a lot of patients who've gone on this diet and they've done great on it, and they're not going to come off of it because they feel good. And for the first time in their life they're thin and their diabetes has gone away.
I don't think it's really fair to tell that person, sorry, your cholesterol's high, just stop the diet, let's do the studies. If it's true, and it might be, that this diet is gonna kill them, let's find out and be able to tell them that based on science, not just on conjecture.
See all these people who are outside of the medical system, who are pushing the boundaries. Again, I'm not endorsing or discrediting what Dave Feldman's doing. I'm just saying I think it's great that there's suddenly this kind of democratization of healthcare and there are people who are deciding, you know what, if the doctors aren't going to ask these questions, we will.
Christopher Habig
Absolutely. And I love the fact that you've embraced this educational mindset that you're here to kind of influence your patients, but also here's all the facts. Let's make a decision together, where you think it's gonna go. And I love the fact that if people visit your website at DrFischerMD.com, they'll see that you are a prolific writer. You're writing blogs. You're putting content out there that you can refer people to. And I think that's fantastic.
And I think that, you know, going kind of back what we're talking about, that I think the physician voice in the room on those discussions is very, very important. And I'm very excited that you lend your voice to those discussions. Do your patients interact with your blog? Did they come in and say, hey, I just read that article and here's my thoughts on it? Do you converse about the content you put out?
Dr. Joshua Fischer
I have had patients who've come in here because they read a blog post of mine and decided they wanted, based on that, to meet me and consider signing up to be my patient. I've had patients who come in for a visit and will reference a recent blog post I made and want to talk about it. And I've had a fair number of patients who don't know I have a blog at all.
Christopher Habig
Last question for you. What is your advice to other physicians out there looking at this model, wanting to provide more of that health nutrition, exercise, more of that health coaching expertise might be constrained by the system? What is your advice to them?
Dr. Joshua Fischer
Well, my advice would be that what you're offering or what you what the thing that you want to do and that you're offering to do is very needed. It's very needed because our society is falling apart and we have astronomically high rates of obesity, of depression, of Type 2 diabetes. And this, you know, at a time of whatever other problems are going on in America, this is a time of peace and immense prosperity and immense technological advancement.
So if you looked at humans at any point throughout human history, you know, I think very few would have complained about the opportunity to live in America in the early 21st century. And yet despite that, the health of the average American is falling apart. So we need to dramatically change course.
So I guess what I would say to people who are thinking about making a move is do it for two reasons. Number one, you will not fail because this is so in demand. And number two, I'm not trying to sound corny here, but like your country needs you. Step up and do this because our civilization is going to fall apart if we don't create a grassroots movement to reclaim the health of the people.
Christopher Habig
Dr. Fischer, that was very well said. I want to thank you for joining us here on Healthcare Americana. It has been a pleasure.
Dr. Joshua Fischer
The pleasure's been all mine. Have a great day.
Christopher Habig
Thank you for joining us on this episode of Healthcare Americana. We hope you found today's discussion insightful and inspiring. If you enjoyed the show, please leave us a rating and review on your favorite podcast platform. For more episodes and the latest updates, visit our website at healthcareamericana.com.
I'm Christopher Habig reminding you to stay informed, stay healthy, and stay empowered. Until next time, take care and thanks for listening.
[OUTRO]
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