Why You Should Add Functional Medicine to Your Direct Primary Care (DPC) Practice

Author: Jeffrey Wacks, MD

Direct Primary Care (DPC) is Growing, But Generally Requires an Additional Value-Add Proposition for Marketing

Direct Primary Care (DPC) is a healthcare delivery model in which patients generally pay a relatively low-cost monthly membership in lieu of utilizing their insurance for primary care services. Due to the dysfunction of conventional primary care and the numerous advantages of DPC, including increased accessibility, longer appointment times, more dynamic communication, and better overall patient-physician relationship, the growth of DPC practices as well as patient adoption has grown significantly.

But for physicians looking to jump in and create a startup DPC practice, they will invariably face a fundamental marketing problem. In order for patients to find you, they will essentially have to search "direct primary care doctor near me." But this is simply not happening (see Figure 1 below). The DPC movement has not gained enough inertia for this to drive significant numbers of patients to your practice. It is only those who are highly motivated (or perhaps employers) who will have done the work and made the calculation surrounding value and cost who will pro-actively seek out a DPC practice. You are trying to solve a problem that people don't know they have.

When thinking about marketing for any business, we want to look at it from the perspective of the consumer: what is the problem they are trying to solve? The real problem that people are having is that they are unhealthy and do not feel well. People are tired, overweight, not sleeping well, chronically bloated, depressed and anxious. Metabolic dysfunction, manifested by obesity, hyperlipidemia, insulin resistance/diabetes, and fatty liver, is the epidemic of our time. These types of problems are not well treated by allopathic medicine, so instead the term that people are searching for is "functional medicine." In our experience, the number of people who have sought our services for "direct primary care" can be counted on one hand. The reason our phones do not stop ringing with new patient inquiries is due to Functional Medicine.

Figure 1. Google trends for "direct primary care" (blue line) [average score over past 5 years = 8] versus "functional medicine" (red line) [average score over past 5 years = 58]. Note the average scores for interest over time is on a scale from 0 to 100.

What is Functional Medicine and Is It Evidence-Based?

Functional Medicine is a holistic, nutritional biochemistry-based approach to symptomatology and chronic disease that considers health issues in the context of an interconnected body system (see Figure 2). By looking at health from the perspective these foundational imbalances, Functional Medicine is more of a root-cause, health-promoting approach. By contrast, allopathic medicine uses pharmaceutical medications to block disease pathology, thus it is generally better described as a disease management system than something that truly promotes health.

Figure 2. PatriotDirect Functional Medicine matrix demonstrating the core, fundamental imbalances that lead to chronic disease and symptomatology. 

Introspection of our conventional medical training leads us to believe that this is clearly true. For example, it is common sense that nutrition is fundamentally important to one's health. But how much training do we really get in clinical nutrition? Given our lack of knowledge on this critically important subject, are we really in any position to be claiming that we make people healthier? And if not, why would we possibly expect patients to pay more to see us?

"But I don't want to practice 'alternative medicine?' I went to school for a long time to practice what has been proven to be scientifically true." The idea that Functional Medicine is not evidence-based is completely false. Our training program manual contains thousands of references to the peer-reviewed medical literature. In fact, we take tremendous pride in the fact that we only practice evidence-based medicine. Just because something is not part of the establishment-endorsed conventional medicine standard of care, that does not mean there is no evidence for it.

Additionally, it should be clearly stated that to practice Functional Medicine does not mean that one abandons their conventional, allopathic medical training. To the contrary, Functional Medicine should be thought of as something that integrates with conventional medicine, not replaces it.

Factors to Consider When Selecting a Functional Medicine Training Program

1. The nutritional advice has to be practical

YouTube and social media are filled with health and nutrition influencers who advocate for the adoption of aggressive diets at scale out of principle. For example, much of what we see revolves around chronic low-carbohydrate intake and/or the extremes of animal meat intake (e.g., maximization = Carnivore Diet versus minimization = Plant-based Vegetarian/Vegan Diet). But if your goal is to provide healthcare to the general public, it is probably a better idea to have the baseline nutritional advice be more practical. In our training program, our nutritional advice is just that. We advocate for normal macronutrient ratios with normal carbohydrate intake (comprised predominantly of fruits and root vegetables), healthy fat intake with minimization of omega-6 polyunsaturated fats (i.e., "seed oils"), normal but high quality protein intake, and a general emphasis on bioflavonoid/antioxidant consumption. It is not necessary for people to live like a caveman or eat like a bird for them to be healthy. While there is room for being more aggressive with the nutritional advice in certain situations, this baseline level of practicality is more inclusive.

2. The training program has to be cost and time-efficient

You may have already spent a large amount of money and time getting your primary degree. Thus, you may not necessarily be looking to do a 1-3 year long fellowship. This is the problem with much of the Functional Medicine training. It costs tens of thousands of dollars, requires you to fly across the country to attend modules, and takes months to years to complete. If you are looking for a training program that is formal and accredited, then perhaps you don't mind this. However, as a society, if our goal is to scale Functional Medicine and ultimately integrate it into the mainstream, then we need it to be a little easier for providers to get trained. Without sacrificing quality, we wanted to create a training program that is both cost and time-efficient so that providers can quickly obtain the knowledge and skills necessary to integrate Functional Medicine into their practice.

3. You should be able to sample a substantial amount of the training program before committing

Imagine you commit to a training program, put in 100 hours of work, and then come to realize either that the training program is not going to prepare you for clinical practice or that you don't agree with the fundamental principles that have been used to develop the approach. This is also a huge problem because it makes the Functional Medicine training process risky. If Functional Medicine is to scale, then we need to make the training process less risky. It is precisely for this reason that we encourage people to trial Volume 1 before committing to the whole program. We offer a free trial of Volume 1 of the online training manual or a physical copy of the book can be purchased by anyone on Amazon. It is critically important to us that providers know us and trust us before they decide to work with us.

In conclusion, we believe that integrating Functional Medicine into your Direct Primary Care practice adds tremendous value and will drive patient growth to a significantly greater extent. We believe that the synergy of these two ideas will ultimately be the future of primary care.