Chris Kresser: Good question. I know that that’s a model that’s being taught by some practice management training organizations out there in functional medicine. I can certainly see some merits to that approach. It would generate more consistent cash flow for the clinic, make it easier to predict revenue and in some ways when a patient makes a commitment like that, they may be more likely to follow through with the treatment and stick around until they get results because they’ve already made the financial commitment. The downside is just less flexibility for patients.
I have some patients who I only see once a year these days. And some people need much more intensive treatment, some people need less intensive treatment, there’s just less flexibility overall. I don’t feel strongly about it. I mean we’ve actually considered doing some kind of a hybrid. I think I mentioned this in another Q&A or webinar. We are currently evaluating having some kind of monthly membership fee to new patients coming into the practice to pay. But it would be a low fee and it would be something that would support appointments with either a nurse practitioner or physician assistant or a health coach or our DE between appointments with clinicians.
Because as I mentioned, I think I’ve said this a few times in different context, but I think there’s a big gap in patient care right now between patients who are too sick for the standard outpatient healthcare model that we have, even in functional medicine where they might see a clinician once every two or three months, and not sick enough to be in a hospital or just can’t get the care. Maybe they are sick enough to be in the hospital, but they can’t get the care that they need in the hospital because the hospital is set up for acute care situations.
So the question is how do we serve those patients without completely burning ourselves out? And there’s a hard limit to how much time we have as clinicians and that’s especially true if you’re doing other things, like I am for example, with the blog and a podcast and a training program and public speaking, etc., family, of course, and personal life. So there’s a limit to the number of patients that you’re ever going to be able to help on a one-on-one basis. And I know that my patients would often like to able to see me more frequently or see someone more frequently. And I recently hired Dr. Nett, not so recently now, and she’s now full and she was able to see my patients in between their appointments with me sometimes if they wanted extra support. But that’s not even possible anymore and that happened really quickly.
So there is some kind of hybrid I think that would make the most sense, at least for me. And so I’m not sure what that monthly fee would be. We haven’t gotten to that level of detail yet, but the idea would be that patients pay a monthly fee and whether or not they use those services, it’s kind of like a community-supported agriculture model applied to healthcare. So everyone pays the fee, let’s say it’s $25 a month, and that enables access to appointments with a health coach or nutritionist in between appointments with the clinician, and there may be some other benefits that come with that kind of membership as well. And then that generates, if you have a substantial number of patients in the practice, that generates enough revenue to pay for the nutritionist or health coaches and maybe a little extra revenue to cover the additional administrative costs, of course, that would be involved with having those people on staff.
So I think there are a lot of different ways to do this. It depends to some extent on who you are and what kind of patients you want to serve and what your comfort level is. I don’t think there’s a right or a wrong way. But for us, we’re moving towards more of a hybrid. Not an exclusive membership model, but a fee for service that might have a membership aspect to it