Running a Practice, 3 Common Fears, and You

Daniel Kalish, DC

Challenges of running a medical practice

Over the last 20+ years, I’ve spoken with thousands of practitioners who want to start a Functional Medicine practice and are hovering around the periphery but haven’t fully jumped in. Some dabble here and there with some Functional Medicine. Others have yet to do their first full patient workup. All of them share a common desire to make the shift to Functional Medicine because they believe in it. So what limits us? It always comes back to some variation on the same theme for all of us: fear.

The three main fears I see that keep clinicians from going all-in with Functional Medicine include: (1) lack of new patients; (2) treatments failing to help; and (3) concerns over money.

Fear #1: Scarcity of Patients

Fear number one is obvious—it’s a fear around “lack of.” Lack of, in this case, new patients. This used to be a valid fear when Functional Medicine was not well known, but these days there are literally thousands of patients for each Functional Medicine practitioner. These folks are hitting IFM’s website at a rate of 3,000 a day right now, literally faster than you could count. (That’s 2.08 patients per second, 24 hours a day). They are flooding into IFM Certified Practitioner’s offices faster than these doctors can handle the load, creating wait lists for those with the solid training.

There is no lack. Instead, there is an abundance of patients. The sad reality is people are sick, and at present, there is an overflow of patients desperate for Functional Medicine treatment. People need help, and they are turning to Functional Medicine providers in significant numbers. There aren’t enough trained doctors to meet this volume of patients.

However, full disclosure, I still wake up some days afraid I won’t have enough new patients, even after 25 years of being booked solid. Clearly, for me, this is a deeply ingrained emotional pattern since there is no external reality to it. I’m not sure of the psychology at work here—maybe it’s a fear people won’t show up for me or a lack of self-worth on my part. The fear part is real, but the reality doesn’t match. It’s all in my mind, so I try not to pay attention to it much—or better yet, I use it as fuel for my emotional and spiritual growth.

Fear #2: Patients Will Not Get Better

The second common fear in practitioners is that the treatments they offer may not work. This one takes a little trust to overcome. In these times, it is best to look to long-term practitioners, observe what makes their practices successful, and take comfort in the reality that the Functional Medicine model works. And the key point here is they are doing really simple things. There’s no magic here. It’s just plain old common sense: eat your vegetables, get to sleep early, and use a few key lab tests and supplements to get you started.

It’s amazing what magnesium can do for someone. Or plain old vitamin C. Our patients become sick due to lifestyle-initiated problems, and so, it stands to reason, their way out is with lifestyle medicine. Focusing on diet, exercise, sleep, and meditation combined with lab-based clinical nutrition programs works consistently. Your prescription of digestive enzymes will work as well as mine. Functional Medicine works so well that after your first 500 patients, you’ll be convinced.

Fear #3: Failure to Generate Revenue

The third fear centers around finances. If you are working within a medical group or a hospital system, you’ll have understandable concerns about the transition. If you are adding Functional Medicine to an existing practice, you may worry about losing current income while building up the new. There isn’t much wiggle room if you are supporting your family with your income.

This concern is best addressed with a concerted effort directed toward business planning and sound financial strategies. True for any business start-up or any business in transition, planning is the key to determine how and when you can make this shift. With a solid plan in place, you can de-stress yourself and take the proper steps to move in the right direction. Many practitioners stay stuck and don’t know how to take the first step. There are many resources available now to help practitioners get unstuck and help them move forward. The development of the “My Practice Plan” program is a response to this stuckness many of us fall into. If you’re not ready to sign up for this course yet, I offer free monthly webinars to help you kickstart your own practice implementation program.

We fear a lack of patients in a world with an abundance of people seeking help; we fear our treatments won’t work when in reality they work better than the status quo; and we fear we won’t be able to make enough money even though clinicians prove all the time that their business model works when it is properly planned.

However, there are some reality-based, non-emotional factors that I see undermining successful Functional Medicine practices, which are, in the order of frequency:

  • Syndrome A: The practitioner burns out from overwork.
  • Syndrome B: The practitioner ends up with a super-busy practice, but it’s not really the right group of patients—so they are busy, but they are not working with the right patient population.
  • Syndrome C: The practitioner has built up significant income and they earn a lot of money, but their overhead has grown so much they have lost profitability and don’t keep much of it despite working constantly.

Therefore, My Call to Action Today For All of Us Is:

  • Make self-care your first priority. First thing every morning, meditate, exercise, and prepare healthy food for yourself before you even turn on your phone or check your email.
  • Direct your marketing efforts toward the types of patients you want to work with while shifting your practice to be emotionally and spiritually fulfilling.
  • At the end of every quarter, take a hard look over every expense and keep your overhead low.

Once you work through these all-too-common fears and roadblocks, you’ll join the rest of us—like myself, like the IFM educators and facilitators actively in practice—in helping patients and making a difference.


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