The incidence of complex, chronic disease continues to rise each year, and there simply aren’t enough doctors and other licensed clinicians to reverse the tide. Fortunately, a growing number of skilled and qualified health coaches and nutritionists are poised to fill the gap.
Over the past few years, I’ve become convinced that health coaches, nutritionists, and allied healthcare providers will play just as big a role as doctors and other licensed clinicians—if not a greater one—in ushering in the future of medicine.
This belief evolved out of my experience as the co-director of a large, interdisciplinary functional medicine clinic (California Center for Functional Medicine, or CCFM), my observation of current trends in both conventional and functional medicine, and my research on the growing challenges our healthcare system is facing.
Why we’ve integrated coaches and nutritionists into our model at CCFM
Let’s start with my experience as a clinic co-director. At CCFM we have many patients with chronic, complex disease that are not sick enough for the hospital but are too sick for the standard episodic model of care where they only see a licensed practitioner once every two to three months for half an hour or an hour.
We’ve known for some time that these patients were underserved and that we weren’t providing them with the level of care they needed for optimal treatment and recovery. For example, they might see me for the initial Case Review appointment, where I prescribe a comprehensive protocol involving dietary and lifestyle changes, supplements, and other treatments; then they might not see me again for two to three months.
How health coaches and nutritionists can help save healthcare
Of course, I can answer short questions that they might have about the treatment in our EHR between appointments, but that is often not enough. Patients need more help: they need more detailed questions answered, support sticking with the protocol, and modifications when necessary.
Clinicians are often too busy with other patients to provide this intensive level of care, but it’s the perfect role for a certified health coach or nutritionist with the proper training.
At CCFM we’re redesigning our model to deeply integrate coaches into patient care. For example:
- Health coaches will conduct the initial consultation with the patient and be the primary point of contact for the patient as they navigate through the treatment process
- Patients will be strongly encouraged to schedule check-in appointments every two weeks with their coach while they are on a treatment protocol
- Coaches will be available for standalone consultations with patients to discuss diet, lifestyle, and behavioral change at a deeper level than is often possible in appointments with clinicians (where lab tests/results, diagnoses, and treatment protocols are also discussed)
- Coaches will lead group visits and classes, typically oriented around a particular health condition or goal, such as autoimmune disease, weight loss, or pain management.
Prominent conventional and functional medicine organizations have also embraced coaches
Several prominent conventional and functional medicine organizations have recognized the role that well-trained coaches, nutritionists, and other allied providers can play in improving patient care. For example:
- Duke University now offers an “integrative health coaching program” that prepares people for a career in this field.
- Cleveland Clinic is utilizing health coaches in both their new Center for Functional Medicine and their Wellness Institute.
- Institute for Functional Medicine has allowed coaches and other unlicensed allied providers to take their courses—including Applying Functional Medicine in Clinical Practice—for many years.
- Iora Health and other primary care organizations are using coaches to get dramatic results with type 2 diabetes patients. In these programs, coaches are the primary point of contact with the patient, and diet and lifestyle changes are the core focus. Some estimates suggest that the approach used by groups like Iora can save insurance companies up to $14,000 per year per patient with pre-diabetes. This is a hot trend in medicine right now, and I’ve had meetings with VCs, entrepreneurs, and others that are working on innovative solutions in this area.
Here at Kresser Institute, we’ve also embraced coaches. Although the ADAPT Framework Level One course is primarily oriented toward licensed clinicians, it is also open to allied healthcare providers such as registered nurses and dietitians, certified nutritionists, and certified health coaches that meet certain eligibility criteria.
I recognize the growing role that these providers will play in the “(r)evolution of medicine,” and I want Kresser Institute to contribute to and support a multidisciplinary, team-based approach to patient care.
Why are coaches and nutritionists essential to addressing the healthcare crisis?
The unfortunate reality is that there just aren’t enough licensed clinicians to address the chronic disease epidemic; there aren’t enough medical schools or enough clinicians graduating from them, and that’s not going to change.
This might sound like a catastrophic problem, but as the saying goes, “In every challenge is the seed of opportunity.” Research suggests that up to 90 percent of chronic disease is caused by diet and lifestyle factors. This means that health coaches, nutritionists, and other allied providers that are well trained in these areas can play a significant role—alongside licensed clinicians—in reducing the burden of chronic disease.
If we imagine the healthcare population as a pyramid, it might look like this:
The 5 percent at the top of the pyramid have serious, acute problems that require hospitalization, intensive care, and/or management by a specialist. Although these patients would likely benefit from both functional medicine and ancestral nutrition and lifestyle, they often have urgent issues that must be addressed before they can focus on functional/ancestral medicine.
The 25 percent in the middle of the pyramid are those that will benefit most from being under the care of a licensed clinician practicing functional medicine from an ancestral perspective. They will typically require diagnostic testing, differential diagnosis, and treatment protocols involving supplements, botanicals, and when necessary, medication.
The 70 percent at the bottom of the pyramid may have a mild chronic disease, or they may be people that are essentially well but have one or more minor complaints, such as skin problems, mild insomnia, occasional fatigue, or digestive distress. Although these patients could certainly benefit from a comprehensive functional medicine approach, in many cases diet, lifestyle, and behavioral changes may be all they need to mostly or even completely resolve their complaints. Skilled health coaches, nutritionists, and allied providers are ideally suited to help this group—which comprises the majority of our population—especially when working in conjunction with licensed clinicians.
The integration of coaches into healthcare: A “triple win” scenario
The inclusion of health coaches and other allied providers into a multidisciplinary approach to patient care is truly a “triple win” scenario, as illustrated in the diagram below:
Patients get better outcomes and more support as they navigate through the complex and often challenging process of recovering from chronic illness.
Clinicians provide better care to their patients without burning out and generate more revenue. How much more? In my ADAPT Framework Level One course, I teach clinicians how they can utilize coaches and other allied providers to generate up to $130,000 per year per clinician in additional revenue—while offering a much-needed additional layer of support to their patients and working less. And of course better care means better results, which in turn means more word-of-mouth referrals and an even more robust practice.
Coaches and other allied providers enjoy meaningful, rewarding work in a collaborative environment and an exciting career path that wasn’t widely available before.
The bottom line: “A rising tide lifts all boats”
With every big change comes uncertainty—and a transition period. As clinics incorporate coaches and nutritionists into their care model, questions will inevitably arise:
- How can licensed clinicians work most effectively with allied providers?
- What are the most efficient models for delivering care (i.e., fee for service vs. packages vs. subscription)?
- How can clinics ensure that each professional is maximizing their value according to their training and scope of practice?
These are not insurmountable problems, and with time the solutions will become clear.
What is already clear, however, is that the growing collaboration between licensed clinicians and allied providers is a “rising tide that will lift all boats”—providing better care to patients, a more sustainable and rewarding practice for clinicians, and an exciting career path for coaches, nutritionists, and other healthcare professionals.