Laura Schoenfeld: The way that Kelsey and I work with CCFM is that we are actually 100 percent independent. Chris and Dr. Schweig and Dr. Nett do not pay us anything to see patients from them. The patients that I’ve worked with that were, at the same time, working with Dr. Nett or Dr. Schweig—as far as I’m aware because, again, we don’t really have any sort of financial tie with CCFM at all—I get people that tell me that they’ve been referred by Dr. Nett or Dr. Schweig. So what I’m assuming is happening is that Amy or Dr. Schweig is recognizing that this patient has a lot of issues with food. A lot of the people that I work with from those two practitioners are people that have, I’d say, eating disorder tendencies or maybe we just call it disordered eating tendencies, where they have a lot of fear around food, that they’re being very restrictive, that they feel very confused about the diet, and from a cost and also just an expertise perspective, it’s easier for the person to come work with me or Kelsey if they’re having a lot of problems with diet because really that’s not Dr. Nett and Dr. Schweig’s, I guess, specialty, and it doesn’t really make sense for a person to be paying those two doctors to do something that Kelsey and I can do for a lot less money, to be honest. Also that’s what we specialize in, so we’re probably better at it because we do it all the time and that’s what we’re trained in, and then also we don’t charge as much, so really it makes sense for the patient to come work with one of us instead of trying to get that information from any of the doctors at CCFM.
I can’t speak to any sort of fee splitting or having there be a charge that CCFM would take and then pay us to see that person because we don’t do that and I’ve never done that, even when I have collaborated with the naturopathic doctor that I share an office with in Raleigh. She doesn’t pay me. I don’t work through her system at all. I’m totally independent, and personally I really like that setup. I think when you’re in private practice, you don’t want to necessarily be financially tied to anybody else’s business. It can get a little bit hairy, you know, if I charge a certain amount for my one-on-one client time and then I want to collaborate with someone and they want me to charge less. I’ve actually had that problem, where one of the doctors I used to do some collaboration with, he said that if he was going to pay me, it would be X number of dollars, and it just wasn’t anywhere near the amount of money I can get from working with my own clients, and so that wasn’t great for me. Then it was a little bit awkward for him because then it’s like, does he refer someone to me and then he has to pay me? It was just not a good situation.
If you are looking to have an RD work with you, I would strongly suggest finding someone, first of all, that you trust. Kelsey and I have been working for Chris since, I guess, January 2012, so a little over four years at this point. We have done so much work with him that I’m pretty confident that he trusts our judgment when it comes to patients. We don’t have any sort of conflict of recommendations that happen with us and either Amy or Chris or Dr. Schweig. I’ve never had a problem where I disagreed with what they were doing or they disagreed with what I was doing. I have had that experience with that other doctor that I was talking about, and it was really uncomfortable. You want to make sure that if you’re going to partner with someone in a more official way, that you really vet them out, that they’re going to have very similar recommendations to what you would recommend.
Obviously everyone has a little bit of a different set of opinions, and you can’t always guarantee that someone is going to say exactly what you would say. Certainly I have a different level of expertise than what Chris has and things that Chris knows what to do and in certain situations I’m not necessarily trained in, so I wouldn’t have the same approach 100 percent of the time, but it works really well for us—Kelsey and me—and the doctors at CCFM because we all know that generally we’re all on the same page, and we have a really good communication. If I’m working with a patient that is seeing Dr. Nett, a lot of times before I even see the patient, I’ll email Amy and I’ll ask her, “What are you guys doing? Is there anything I should know? Is there anything you’d like me to focus on?” We have a really good system where not only do I talk to her before I see the patient—the same goes with Dr. Schweig—but after I see the patient, if I have any concerns or if I want to just update them on anything, I will email them and let them know what we talked about, so there’s a lot of open communication, which is really important.
I think Amy and Dr. Schweig are really good at getting back to me very quickly about any issues that a patient is having. That’s been another issue that I’ve had with another doctor, where I would email them about a patient and I wouldn’t hear back from there for, like, two weeks or something. In that meantime, I have to make a decision about what I’m going to do, so that ended up leaving a lot of opportunity for disagreement or conflict of opinion when it came to how to treat that patient. So you want to make sure that you have a really good communication system with whatever practitioner you’re collaborating with. You don’t want to leave that RD to basically just make decisions on their own without corresponding with you.
I’d also be very clear about what you want the RD to help you with. Again, I’m just telling you my own experience. That was another thing with this particular doctor that I didn’t work out well with. He wasn’t very clear about what my role was. He would send people to me, and I would do what I would normally do with anyone. I’m obviously going to give them the best recommendations that I can, and there were a couple of times where I made a suggestion that was not aligned with what he was recommending, and he was not happy about that. Let’s just leave it at that. It came down to things like I was suggesting to change a supplement because, for example, a patient had an MTHFR mutation that I didn’t think would work well with a particular multi that she was taking, and she was having a lot of symptoms that I’ve seen in other clients, so I recommended that she change that multi, and this doctor was not happy that I had recommended that without apparently running that by him. So if you don’t want this RD to be doing any changes to the supplement protocol, then talk to them about it. Make sure they know what your expectations are.
Again, this is all coming down to communication. If they don’t know that you don’t want them changing your supplement recommendations at all, then you need to be very clear about that. I think what helps is when you’re on the same page like we are with Dr. Nett and Dr. Schweig and Chris is that I don’t think I’ve ever had a situation where I had to change or even thought to change what they were doing. There might be some additions that I’ve recommended and they’ve worked out fine. It was just kind of like, “Oh, we should add in vitamin A because they’re not eating liver or egg yolks, so we want to make sure they’re getting vitamin A,” things like that. Make sure that you’re not expecting the RD to only do nutrition and lifestyle stuff and then they think, “Oh, well, normally I cover supplements. Normally I cover testing.” Just be very clear about what you want them to help you with if you are doing more of a partnership opportunity.
I guess I’m just giving you guys some of my experiences when I’ve worked with other doctors as an RD. We’ve been working alongside CCFM for a couple of years at this point. I’ve never had a problem with any of the patients we’ve collaborated on where there was any sort of miscommunication or anything where I did something that one of the doctors didn’t want me to do or that I wasn’t even clear on what they were doing as far as what their approach was, and I was always very confident that if I needed some guidance or if I needed some input from Amy or Dr. Schweig about a patient, they were very good at getting back to me. Again, I’m just trying to drive that point home that if you are going to work with an RD in a partnership, you really need to be very open and very clear about what your expectations are.
Now, as far as posting an interest to see if there’s a Paleo RD that you’d want to collaborate with, I would just share that in the Facebook group. When I say “Facebook group,” I mean the ADAPT Facebook group. If you want to ask Kelsey or me to put something out to the Paleo RDs on that Facebook group that we’re in, we would be more than happy to share any sort of job opportunities if you have them. I don’t think Kelsey and I are necessarily looking to partner with anyone else on top of CCFM, but we’re certainly happy to help you guys find someone who would be a good fit for you. I think there are a couple hundred RDs in this group that you could choose from, and if you want to put out an application, we’d be more than happy to share that in that particular group.