Ep030: Cost Effective Business Model in Functional Medicine with Dr. Michael Ruscio

Welcome to the Perfect Practice podcast where we share the most innovative strategies to help you build a successful functional medicine business, attract your ideal patients, serve your community, and get paid what you're worth. Each episode is packed with practical steps that you can take to immediately grow your influence and serve more people. Our mission is to share golden nuggets from successful practitioners, technology experts and innovators from around the world. Your host, Sachin Patel, is a functional medicine success coach, international speaker and best selling author. He's calling in all his favors to bring this information to you so you can create your perfect practice.

Hello and welcome to a very special episode of Perfect Practice. Today we have a practitioner who's doing some amazing work in the functional medicine space. What I really love about our special guest today is that he looks at things from a different perspective. So if you think as a functional medicine practitioner, you've got a unique perspective compared to maybe conventional healthcare. Today's guest has a very unconventional, unconventional approach and he gets amazing results. So today I want to welcome Dr. Michael Ruscio.

Hey, thanks for having me.

Well, thanks brother. Thanks for being here today. Today we're actually going to switch gears for you because normally you're used to being on summits and other podcasts talking about functional medicine digestion concepts and health concepts and really you come to the space with a unique paradigm which I love about you, and maybe we can get into that a little bit. But today primarily we're going to switch gears and learn about how you've turned your passion and something that you do and adore on a daily basis, how you've turned that into a sustainable income and business for yourself. And maybe we can even talk about what your future plans hold. We like to interview practitioners who are in the field, doing it right and actually successful instead of just talking about theories. Now, certainly theories and stuff like that are great, but today I want to get really granular and practical with you, if we can, so that, you know, I know your mission and objective is to help practitioners and I certainly know that you know that they've got to be in business to be able to apply the clinical knowledge that you share as well. So thanks for doing this. I appreciate, you know, your contribution to this.

Well, thank you for having me. And you're right, I think the, the business aspect of this, if you will, it does dovetail into my clinical model, which I think is it's more of a business friendly clinical model. I really didn't try to develop a more cost effective iteration of functional medicine with the objective of Having a better business model, I just did it because I treat patients the way I'd want to be treated. And so I'm always looking for the minimal effective test or dose or dietary restriction or whatever it is. And it just so turns out when you do that, you know, it costs less money, it takes less time, and there's less kind of superfluous data that costs money via testing or lab dietary restrictions. And when you do that, you have a more efficacious care model, one that's less expensive. And it turns out that that is very attractive to patients. So they do kind of dovetail in together. And I think it is something that functional medicine could really stand to amend that. And by doing so, I really believe that cutting this excess out of the model is what stands between functional medicine being a niche healthcare offering to something that can be more applicable to the masses. And we've got to become more cost effective, more parsimonious with the recommendations that we make. And that's what's going to allow us to really open up and treat a lot more people. So, yes, I'm really excited to get into this.

Awesome. Well, before we get too far into it, I think it would help practitioners to understand a little bit more about your background, you know, perhaps how you got successful, because I'm sure a lot of it was trial and error, right. And, you know, really figuring out what works and what doesn't work. So I'd love to hear more about, you know, maybe the kind of the beginnings, if you can give us maybe a 30 to 122nd overview of where you started so we can frame all this for practitioners.

Yes, yeah, I'd love to. So when I was in college, essentially I was on par to go into conventional medicine. I ended up acutely feeling pretty terrible and no one could really figure out why. This brought me to alternative medicine. I found an alternative medicine provider, found I had an intestinal parasite treated the intestinal parasite that was cathartically helpful. And so then I went into alternative medicine. Liked a lot of what I saw, was also concerned with a lot of what I saw, a lot of overzealousness, a lot of heretical thinking. And as I got into practice, I was doing the stuff I was programmed to do by the functional medicine educational system, which a lot of it is good. But there was a number of things that I felt were just way overboard. And so I started questioning some of these things, started doing things a little bit differently. And this has led us to performing some clinical research at my office Some of which has been published, some of which we are working on publishing, some of which we're going through IRB approval for and also developing that into a more consolidated functional medicine model where I probably do a fourth, at least a half of the amount of testing that most in functional medicine would recommend. Yet I would argue we get probably better results than most and we do it in a much more cost effective manner. And it just so happens that when I started talking about that, a lot of people agreed with that and we're kind of nodding in agreement. So that's kind of where I am today, which is trying to be progressive, but also a bit conservative and skeptical thinking, finding what works using that and then excising out from the model things that need to be updated and gotten rid of.

You know, I totally agree with that. As I've evolved as a practitioner and as our practice has evolved, we find that we're getting better and better at knowing what pieces are gonna really make this, the needle move. And you just get better at listening too, right? You know what, you know how to connect the dots. So some of that probably comes from experience as well, right? That efficiency. So it's great that you're giving back by teaching people so they don't have to go through that same learning curve and they can reach their goal to have their dream practice and serve their community so much more quicker.

Fully agree. And I think this is, it's part of the evolution of anything. As something gets better, it becomes less expensive and you get more for less, essentially. So this, I think it's important for all of us to keep in mind, myself included, that part of functional medicine evolving will involve us admitting some of what we were doing was unnecessary and abandoning those things. So I think we should all look at this as a constructive exercise rather than some kind of criticism. Because certainly this self critical nature I think is very important for growth. If you can't admit you're doing at least one thing wrong, then you're never going to get any better. And it's not to say that you're an idiot or mal intentioned because you're doing something wrong or inefficient. It's just a great opportunity for growth. So I'm hoping to spin perspective on this conversation in a very positive frame.

No, I love that and I love that perspective. It's all about really efficiency so that you can deliver it. And you mentioned more for less. And we all know about Moore's Law, right? This principle is universal in other industries. So healthcare is not Necessarily immune to that. And while conventional healthcare is getting more and more expensive, we can demonstrate how this approach, this holism approach, where we're looking at multiple areas of somebody's life. And I'm sure your patients are also very compliant as well. That's probably something that we'll get into as well, is how you attract compliant patients. Because if you're getting really efficient, then the patient has to even be more effective at what they're doing. Right. Because there's no supplement for a lot of problems that people come in with. So they've got to take charge in their own lives in terms of getting the outcomes that you're looking for.

Yeah, I think there's a real silver lining to that cloud of attracting more patients, some of which will have a different constitution. And what I mean by that is the more expensive it is to be at your office, you're going to start to select for the sickest of the sick and the most motivated. Now, that can be good by one perspective, but it also actually makes your patient population a more recalcitrant population. They're a harder group to get results for because they typically been to a bunch of other doctors. And so now they're coming to you more proximal to desperation on the scale. And that's great from a compliance perspective, but again, it also fills your practice with people who've done three or four diets, seen, you know, half a dozen doctors, and so it's harder to get results for that population. Now, if we can make our model a bit more cost effective with a lower barrier to entry, now you can start attracting people who go, ah, yeah, you know what? I would spend that much, even though I haven't been to 10 doctors and I'm near the point of desperation. You know, I've maybe done one or two things. I'm not feeling totally well. Yeah, you know, that seems like a reasonable fee structure. I'll go see that gentleman. And that's actually really nice. Right. Because if you're entitled and it's not to take anything away from chronically ill patients, I have nothing but the deepest empathy for them. But they're more challenging to work with. Right. So it's like if you were a coach and you only coached the teams with the worst records ever, that would be a tough position as a sports coach to be in. Same thing here. If we can lower the bar a little bit, you open yourself up to a lot more patience, some of which just need a few easy tweaks. And they do awesome. And it's nice to have that mixture of people in your practice, not just the people who are kind of close to chronically ill. Yeah.

One of the things that we talk about with the clients that we coach is they'll tell me, oh, I want to work with Lyme patients, and that's what I want to specialize in. And you can only imagine how draining that is, because by the time the average person finds out they have Lyme, they've probably been to like five doctors before that. They've probably spent thousands of dollars to then come to find out that they have Lyme and now they're coming to you. So I actually challenged one of my practitioners to take online patients for a month, and a month later she's like, you know what, you're right. It's way too exhausting to do that. And yes, us as practitioners should take protective measures. But the best way to protect yourself from this type of burnout, which is real for functional medicine docs too, is that we have to really hold our space sacred and realize that there's an energy exchange that takes place when you work with a patient. And sometimes if your patients are drawing way too much out of you, and then that can be very challenging and difficult. So you're probably also, I would imagine, attracting a wider variety of patients at different levels in their journey, not just people who are in that, as you said, distal state of their chronic health condition.

It sounds good in theory, but then you start working with some of that ultra compliant subgroup and you realize it's very, very draining. Again, not to take anything away from them. But if you can open your practice up to have more of a variety of patient types, it really does make practice a lot easier. And also I should ment that the assumption that because someone has been to 612 doctors that they're going to need a lot of testing, I think is a 100% flawed assumption. I can tell you that as someone who specializes in GI care, and this is a fair subset of my patient population, people have been to three or four conventional doctors, five or six alternative doctors, and oftentimes it doesn't require much more, if really any more testing to get them better. You just need to have a better handle on the deeper drawers in the therapeutic kit to pull different treatments from. But it's a really flawed assumption that the sicker the person is, the more testing that they need. There may be a minor trend of truth to that, but I think kind of bottom line, one of the most disservicing dictums in circulation is that more testing equals better results. It's absolutely not true, in my opinion.

Yeah. I mean, even when people come in with digestive issues, we change first how they're eating before they freakishly have to remove like all their favorite fruits from their diet. And just that can help move people in the right direction, just making them a little bit more parasympathetic when they're eating. So I totally agree with you. Like we, you know, both are on the same page in terms of unlocking, you know, the potential for the patient to get better, but also teaching them how to unlock their potential by, you know, simple, often inexpensive changes. Right. It doesn't have to. The interventions are often the simplest interventions are going to be the most effective because they're the most practical. And the things that cost the least are going to be effective as well. And usually if it's something like that, lifestyle driven, the family members are benefiting as well, versus if you give somebody another pill without changing anything else, then they're just going to. Only they benefit if they even benefit from it.

And this even extends beyond some of the basic treatments to something like, let's say herbal antimicrobial therapy for dysbiosis. You can make this more complicated if you want to, but if you have enough evidence, even symptomatically to presume dysbiosis, you can just go to work treating that dysbiosis with various herbal cocktails until you obtain the symptomatic response that you're looking for. To say that we need to test for Candida or we need to know, is it Candida or is it Candida plus H. Pylori or Candida, H. Pylori plus Sibo or just Sibo or Sibo and H. Pylori or Blasto. The herbal treatments for that don't really change much. And it's also, I think, a bit arrogant of us to think that we're testing for everything because there are a number of things that we know exist that we can't routinely test yet. Hydrogen sulfide, sibo and small intestinal fungal over small, I'm sorry, hydrogen sulfide, sibo and small intestinal fungal overgrowth are 2. What may be fairly prominent imbalances in the gut that we can't test for routinely. So to think, well, I need all the lab data before I treat again. It's taking one small slice of what's going on in the gut via an objective lab measure and then trying to conform all of your treatments around that one slice where we could start working into Some of these herbal protocols that really don't need labs to use them and get patients well again, without a test. Now, there is a time and a place for the testing, but the point I'm trying to make is, and this is one of the questions I know that you wanted to talk to, how do you handle objections? Well, I can't remember the last time I had an objection in my office because I think we're so reasonable in our asks of patients. And so let's say we want to do, for example, a workup for dysbiosis. What I'll typically do is for a patient list, a sibo breath test and then a stool test. And oftentimes I will list them as optional and I'll tell the patient, based upon everything that I've seen here, I'm fairly confident if we do testing for dysbiosis, we are going to find some type of imbalance. But I can't say that that finding or findings are going to have a measurable impact on how we treat you, meaning we'll probably treat you the same irrespective of a number of different findings. So if you're someone who likes data and you feel better about having objective measures, we can do the testing. If you'd rather be more conservative, save your money. Then we don't have to do the testing. And I tell them, you don't have to let me know. Now you can let Jasmine, one of our admins, you can check out what you want to do. And it's very hard to object to that. It's like, yeah, this guy's being pretty level headed because he's not telling me that I need all this data, but it may be helpful. So he's involving me in the decision making process. And I think when you conform things like that, everyone feels good about it. They're the single mother of two strapped for cash, doesn't feel like she has to cough up 7, $800. Or the tech guy who loves data and numbers and really wants the testing, who has no problem throwing the money in, can now do the testing.

Yeah, that makes sense, man. That makes sense. I can't imagine that, you know, you'd get an objection. It seems so reasonable.

Exactly. Yeah. But I think it's all predicated upon having this philosophy of being a minimalist. And when you're minimalistic, it's really hard to argue against what you're asking for. And that makes practice a lot easier. And also, I'm sorry if I'm just getting too on a tangent Here, but I probably end up talking patients out of testing 30% of the time. And so I think if you can become that voice of reason for your patients, and it's not about me trying to talk someone to doing something, but rather they come to you as the voice of knowledge and reason. But you've really got to be measured and responsible and conservative in your asks if you get there. Like I said, I can't remember the last time that there was an objection. But rather, people usually come to me and they say, well, I read about this, I read about that. My other doctor wants me to do this. What do you think? So if we can get to the point where we're really parsimonious with the things that we ask our patients to do, I think will really change the culture and the vibe of our practice in a positive way.

Do you think that. I'm just trying to think of. I always go into the headspace of where practitioners might be at with this thought process, because this could be a very foreign concept to a lot of practitioners. I know some practitioners, and everyone can rationalize it. Right. So it's really where how they want to approach the patient. And also, I guess people have to realize is that you're gonna price yourself out of helping certain people. Right? That's fair to say. But some practitioners will test a lot and some will test very little. And not to say that one is necessarily more effective than the other. And that's what I like about this is you can get clinical outcomes without, you know, and give access to more people. One thing I will want, I guess I want to ask you on is when somebody wants to get tested.

The.

One thing that they have to take into consideration is also the time. Right. So if you want, if, hey, here's my suspicion, all signs are pointing to this. You haven't tried this. That could be another thing that you use is the history and what they've tried. So you can rule out what's going to work for them versus what's not. And then they can get started today instead of going home, collecting a sample, waiting two weeks, trying to get scheduled in again. So you just bought them a month of time. And if you nail it, which I'm sure you can 80% of the time, just the Pareto principle, then you've got, you know, great clinical outcomes for people. And a month later, when some people are just waiting for their labs to come back, some people are already feeling better.

Exactly. I mean, exactly. You can, again, using the theme of dysbiosis, you can go to work on using some of the available treatments for dysbiosis like probiotics. And by the time they come back a few weeks later, they can be 30, 40, 60% improved compared to. You're just getting their lab results in. And we were talking before about the clinicians newsletter that we published. We published a monthly clinicians newsletter, and in that newsletter we've documented three cases of patients where we had them perform testing. But then while we were waiting for the results to come in, we also had them start either on a probiotic protocol or some other similar type of dysbiosis protocol. And by the time they got to their follow up, all their symptoms were gone. So we found, let's say we found candida and blasto and the patient had bloating, joint pain and fatigue. And then four weeks later, on a well rounded probiotic protocol, they come in, all those symptoms are gone. And so you look at the labs and you say, well, the candida and blastoise are likely no longer an issue given the fact that you're now fully asymptomatic. And so some of those case studies have made me even more.

I guess.

Reserved with how often I'll call for a dysbiosis workup. And this is why I'm now listing them as optional, because I've just seen enough cases where, okay, it doesn't matter what you, you know, there's so many different things that if you come in with these, if you're using broad spectrum herbal cocktail, you can get rid of those. So, you know, again, do we have to spend the three week turnaround time in anywhere from three to six $700 to figure this out? You know, you can make a case for it, but you could also make a case against it. And if the case against it saves you time and saves you money, then I definitely tend to lean in that direction.

Okay, makes perfect sense, man. I love it. So we handle the objections part. There are no objections because it's obviously very, very comfortable to position to the patient. So for practitioners who have a hard time, you know, sometimes practitioners feel like they must charge a case fee, right? Or charge a four figure deal, you know, if you want, if you want to call it that. But it doesn't have to be that way, right? You don't have to. You can get micro commitments from the patient.

Oh, I think those are, instead of.

Getting a macro commitment from them, I.

Think those are a thousand fold better. And I understand the reason for wanting the commitment, the financial commitment, is to gauge their actual Commitment. But there are other ways to assess that in your paperwork, your fee structure. If your paperwork is too short and too easy, you're going to get everyone filling it out to come in. So if you have short, simple paperwork and an initial free consultation and a really cheap initial exam, then yeah, I think you're opening the gates a little bit too wide. Now, on the other side, if you have a 30 page questionnaire for your initial paperwork and it's over $1,000, my opinion is you're setting the bar a little bit too high. But if you, I think the sweet spot might be maybe 15 to 25 pages and then a few hundred dollars for them to get started. And that sets the bar high enough, at least in my experience, sets the bar high enough to weed out the people that you don't want, but it also prevents you from only having the people that are the ultra compliant and might be a bit draining. And I would never go to someone who said, I'm going to need $4,000, right? The narrative in my head would be, go f yourself. Honestly, right? If someone pitched that to me, I'd be like, you got to be out of your God darn mind Again, that's just me. But I always ask myself the question, if I was being treated like this, what would my response be? And when I asked myself, that's the knee jerk response in my head. If this guy was asking for three, four thousand dollars, I'd be out of there in a heartbeat. But if he was willing to work with me step by step and build that trust, which you should be earning as a clinician, then what you can end up having is a situation where you never feel like you're on the hook to deliver this $4,000 result and you're just being practical and honest with the person and you're taking them step by step by step. Now, they may end up spending that package amount of money or even more, but you didn't hold the bar so high as to only select for the people who are willing to spend that. And then also put yourself in a situation where now you're being held to the standard of, Well, I spent $4,000, $5,000, this clinician better be really awesome for, for that attached price tag. And for the clinicians, if there's testing that you really want, I would say think about what one or two tests are the most important right now. And then create a hierarchy. Let me, you know, here's all my problems. This is known as a vertical differential diagnosis rather than a horizontal. The Horizontal differential diagnosis, you try to diagnose everything right out of the gate, and I think that's wasteful. But a vertical. You create a hierarchy and you say, well, here are the lists in descending order of likelihood of a different issue being present. So I'm going to start with item one or item one and two and run the testing or whatever interventions are suited for that, give that its due course and then reevaluate. Then we've gone to three and four. And I think using that vertical hierarchy in combination with a per visit fee is you're much more, I think, able to get people in who aren't the ultra motivated. But again, I don't think you should be doing the free consults and like the $125 initial exam either. You want to kind of be in that sweet spot, kind of in between.

Yes, I like that. I was taking notes because this is great information. I think I like that how you visually portrayed that vertical versus horizontal strategy. And you know, my wheels are churning as you're saying all this. And you can even put up magnets. You can have a magnetic board in your office with all the 10 different tests that you probably run that are most common. And even just visually show the patient, here's the order that we're going to do these in. We can start with my intuition and my experience and go there. Or we can start maybe with these one or two tests which are going to give us better picture of what's going on. Maybe some of the things you can't vocalize. And then boom, you have immediate buy in from the patient.

Yep. And another thing that just shoots in my head as you're saying that is under promise and over deliver. I think that's a better way to come at this with the packages. I think what you're doing is you're oftentimes way over promising. And it's very difficult to live up to that promise. And the promise may not even be something that you said, it's just implied that or associated with the level of expense, $4,000 in the patient's mind, or 5 or 6, that's a high promise associated, even if you didn't make the promise. Right. Just the fact that there's that high financial price tag associated with your care kind of hinges you to this high level of promise. So I'd rather be at the other end of the spectrum where I'm cautious, conservative, circumspect, as honest as I can be with the patient. And we take one step at a time. So, you know, we're trying to minimally promise being a little bit conservative in the language and the tone and tenor that we use. And oftentimes we end up exceeding the expectations of the patient. And that obviously has a huge impact. These are people who are happy they refer in friends and family, rather than people who feel like they got burnt because $4,000, two months in, they don't feel much better now they're out of there, they're writing you a nasty review on the Internet or whatever it is.

Yeah, all great points. So can you tell us, starting out, was there any particular marketing strategy that you had or where you invested your time initially to get the ball rolling, or were you kind of busy right out of the gate? How was it working up to where you are now?

Yeah, I wasn't busy right out of the gate. It took a little while for me to kind of figure out what I fully wanted to do. So I was doing things like local free lectures and workshops. We did some ads in the local paper for these little lectures and workshops. And when I really saw things start to take off more fully was when I started doing various podcast interviews with people. But the thing is, those opportunities only extend themselves, in my opinion, to the people who've worked hard to have something novel to say. So it turned out that I was working really hard in trying to get to the truth. As I mentioned earlier, when I said I first got into practice and I felt like there were some things that were good and some things that I felt like were just way overzealous. Well, it was trying to expose those things. I don't mean expose these things in, like, a debunker way, but just trying to find the truth from the fact and. And doing this so I could feel as good as I could about care with patients. Because I think if we're all honest, we're all probably doing things, or in the back of our head, we're like, do I really need. Do I really have to put someone on all the way to autoimmune paleo diet, or do I really need to do this full allergen test or do it right? So those things, to me, I started doing. I think your intuition is really powerful. And so I started to investigate those things. And it turns out that most of the things that you don't feel good about doing oftentimes don't need to be done. And so as I started looking into those things and then talking about it, it turns out that a lot of people appreciated that. And so I think having a well Developed message was the most important thing in helping me go from just starting out to scaling upward. But you know, initially kind of your guerrilla marketing, you know, wherever I could, trying to get in front of people, speak, share my knowledge. And then there hit this tipping point where I think I had acquired enough interesting and novel thoughts and points to where people who had built up big platforms were curious to have me on and discuss some of my thoughts. So I don't know how much that helps all practitioners, but I think if you follow that thread of trying to stay true to your intuition and not just fall into the same thing everyone else in functional medicine is doing, then you give yourself something new to do. And I should mention really quick that with the clinicians newsletter that's been in existence now for almost two years, we've had a few doctors actually who are saying we're building our practice based upon your cost effective model and it's actually a really marketable strategy. We actually interviewed Joe Mather, who's an MD and he's just out of residency and in the past two years he was claiming that he's really built up his practice because he's cut out a lot of the expense from following our newsletter and kind of seeing the case studies and figuring out, okay, here's all the things that he's not doing, here's the things that he is doing. And he's marketing himself as a conservative, cost effective functional medicine doctor. And it turns out that people go on the Internet and they read and one of the first things they see in terms of objections posted is the cost. And so if you can leverage that to make yourself, you know, in possession of that market differentiating point, then that may be something really salient for today's practitioner who's just starting out.

Yeah, actually you, you hit exactly what I was going to say is that that's your unique ability, right, Is to, you know, cut through the bs, cut through the fat and get right to what's going on with the patient. You know, the efficiency in your practice is going to show up with the efficiency in the case and you know, you're starting to immediately move the needle in the right direction for the patient. And you know, you know, the one thing you also said that I wanted to bring up is that if you can't test everything right, then why test anything? Right? So this is like something that I've been toying with with quite some time. And over the years we've certainly reduced the number of labs that we do. Like we'll do a GI map on every patient and an organix on every patient. And that's where we start. Right. But for people who are just starting out in clinical practice, I think that this is an important point because if you're not comfortable with reading the labs, then that's another challenge. Right? If you haven't read a couple hundred of them, then the lab itself might not have as much value. So you're ordering a lab and not knowing how to interpret it could also be taking value away from the whole proposition. So the fact that, you know, you can listen carefully with a really good intake form, with a, you know, a good heart and a good set of ears, you can really pick up a lot from the patient.

So yeah, and that's really a key point, what you said, which is listening. One of the things that I found, and we talk about this in the newsletter also, is there seems to be, at least loosely, this inverse relationship between the amount of testing that you order and your ability to listen to the patient and gauge their response to treatments. Right. The more testing you do, you're just kind of trying to make heads and tails of all of it. Right. You have all these different things that you found, now you're trying to treat all these different findings. So you have multiple things on your radar, multiple things that you're treating, multiple responses to treatment you're trying to weigh. And it gets very convoluted very quickly where it makes it very difficult to actually, and this is crucially important, learn from the cases you have right in front of you. One of the things I advocate strongly, and we lay this out in the case studies again in the newsletter, is doing one thing at a time. Because if you can do one thing at a time, you understand A what you're treating, B what the response should look like in terms of severity of improvement, time to that improvement, what the typical reactions are, how to circumvent those reactions, and then when someone's not fitting the optimal response curve and when you need to shift to something else, it also helps you in not over treating the patient. Because if you give someone a diet, some basic nutritional support, some anti inflammatory support, some digestive support and some adrenal support, and they come in 30, 40 days later and they say, I'm 70% improved, you don't know where the majority of that improvement came from, but rather if you can stagger the initiation of these therapies, you can get a sense for, wow, this person jumped, let's say their GI improved 40%, roughly, subjectively speaking, from going on the low FODMAP diet. That's awesome. Now we gave them a probiotic and in this case they only saw a needle movement of 10%. So that taught me that this anti fermentative diet, hugely helpful. Probiotics, not that helpful. So maybe the next thing that we do is go into a more restrictive iteration of that diet for a short term or try another therapy like antimicrobials that may push someone more in this anti fermentative direction. But the only way that you can learn those things is if you're slowing down and trying to do minimal treatment at one time. So I've learned so much from just slowing down and rather than having this horizontal differential diagnosis and treatment strategy, moving to a vertical model and working through one thing at a time. And patients also appreciate that because instead of them having to take 15 supplements, they're able to take one or two or maybe three. They feel a lot better about it. They feel like they're learning from their body. I'm making very meticulous chart notes. So we're documenting in their chart what works and what doesn't work. So this fast forward. So if someone is doing well and then a year or two later, they regress, oftentimes they've forgotten fully what worked and what didn't work for them. So they want to come back and see you. Because now you have all of the mapping done for what's worked and what hasn't worked. And oftentimes all you have to do to get someone out of a regression is simply revisit what worked for them in the past. So there's a lot that you can get out of slowing down and doing less, all the way from a cost effective position all the way through actually better honing and being able to learn from the cases that are right in front of you.

So quick question then, regarding your treatment plans. How often would the patient see you? I mean, are they phone follow ups? Are they in person follow ups? How long are your appointments typically?

So we have a hybrid of in person and phone even. Kind of funny even for some of the people who only live 20 minutes away. If it's a time in the day that's really imbued with traffic, then they may elect to do a phone follow up. So we do a hybrid. It's the same price whether you're in person or over the phone. I just wanted to make things simple. It didn't make any difference. You know, you're not getting a different experience really if you're over the phone. Or in person. It's not like we're doing heavy physical exam or anything like that. And the timing piece is one that we've had to actually learn better to under promise and over deliver because we block 30 minutes for a visit. But oftentimes I don't need that 30 minutes. Oftentimes I only need 10, maybe 15 minutes. Part of that is because I spend time before and after the visit reflecting on their experience and taking notes. So a lot of what has to be done is done before and after. I'm actually seeing the patient. And I don't think all patients understand that. They're used to kind of the traditional medical model where all the notes and everything's being done right there and then you're off to the next person. But we had to change our labeling on our visits to 10 to 15 minute follow up because people were seeing 30 minutes in the calendar and occasionally they would say, well, I didn't get my full 30 minutes. And you know, we. And so I look at complaints in your office as learning opportunities to where you don't have the appropriate systems in place. And so instead of getting frustrated by that, I said, well, okay, we need to think about where this problem is coming from. It's coming from the fact that they're one, associating to more time to better results, which is incorrect. And so we had to educate our patients that I spend time before and after each visit going through your notes and fitting everything together so that we can be as efficient with your time as a patient as possible. So please don't think that the longer you spend in the office, the better results you're going to get. And then two, we changed the way we labeled the office visit from 30 minute to a 10 to 15 minute follow up. And then the pricing, did you ask about the pricing also?

Certainly you can share.

And that's all available on our website. We just changed this. I believe my initial exam is 425 and follow ups I think are 197. And this is something that may be people will appreciate, which is I was looking at our monthly numbers and our amount of collections over the past year had been going down. And that knee jerk reaction, I was kind of irritated, like someone was dropping the ball in my office. When I met with our accountant and we dug into the numbers, we realized that we were collecting less, but we were actually making more. Because what's the margin on lab tests? Very, very poor. Right? If anything, maybe 15, 20, 30% for some of the time. And you know, processing that goes behind it, and then for supplements, maybe a 50% margin. So we're doing, we're asking for less of the items that have the lowest margin and more of the items like follow up visits that have the highest margin. So none of this was my intention. Right. I don't make any of these decisions with profit.

First.

This was just me becoming more skilled at functional medicine, ordering less tests, using less supplements. But people wanted to have more routine follow ups to kind of guide them along the way. And it just so happens that we collected less, but our profit margin went up, so we actually ended up making more.

Yeah, my funny story, I won't name the company, but my rep came to me and he said, hey, your supplement numbers are down. And he was trying to poke at me, but I actually got happy and I gave him a high five, which he was not expecting because that's one of our objectives as well, is to minimize that for our patients. So it's great to see we're on the same page there.

Yeah, absolutely. And again, patients really appreciate that. I can't tell you how much patients appreciate minimal testing and minimal treatment.

Yeah. So, Michael, I want to be courteous of your time as well. I know you've got another interview after this. So, you know, you did talk about your newsletter. I'd love to learn a little bit more about that. I really enjoyed your practice philosophy and a lot of the practitioners listening to this will want to learn more about how they can get their hands on that newsletter and learn more about the case studies and the outcomes that you're getting. I think that would be pretty cool. So maybe you can talk about that and any words of advice that you have for us to share would also be appreciated.

Sure. Well, thank you. So the newsletter is entitled the Future of Functional Medicine Review Clinical Newsletter. It's a monthly publication that we release where we have one case study and usually about three to five research study summaries. And then also a practice tip where we may be talking about hiring or paperwork or strategies for better office systems. And then also we answer one practitioner question of the month. You know that that's been really helpful to give people a well rounded perspective on a case study that we detail all the way through. And then also some research studies, for example, thyroid antibodies. The appropriate levels of thyroid antibodies is something that is a very contentious issue. And we've been chronicling what I think to be a much more conservative and patient centered perspective on interpreting most, namely TPO antibodies. And this has very strong implications for clinical practice. So the Research studies aren't just this academic fluff. They are research studies that have a lot of clinical translation into what you're doing in your practice. So we release that once a month. And it's my way of trying to provide practitioners with a constant drip of well thought out information that articulates this cost effective model of functional medicine. Not only showing the science behind it, but also how it translates into case studies. And I'd invite anyone to have a look. And we have a following that's been growing quite nicely and it's really nice to see, like I was mentioning before, some new doctors who've been following that and just saying, God, this has been such a great lifeline because I've gone to, and I won't name any specifics but I've gone to these different conferences and it just seems so academic and so overblown and I just have a hard time translating what they're recommending there into my clinic. And you know, your newsletter has given me a way of just consolidating to what is the, you know, the most important. And I should mention that the focus is GI and thyroid. So if you're looking for deep into Lyme or Sears or mcas, we touch on those things from time to time. And we did actually release one MCAS questionnaire that's been research validated, but the main focus is really gut and thyroid. But you'd be surprised how far you can get, especially if you master the fundamentals in the gut.

I mean, who doesn't have GI issues, right?

Yeah.

So how can people get access to that then?

So if they go to our website DrRushow.com, it'S-R-S-CIO.com and they can find it there. Or if they just type review, that'll take them right to the page specifically on the review. So DrRuescio.com review awesome.

I'll be sure to share this in the show. Notes and big shout out to you man. Thank you so much for dropping these gems of truth and kind of opening up your practice model for everyone to take a peek in. I think people are going to, I know people are going to get a ton of value out of this. I certainly took some notes and thinking of ways to restructure even my brand and business a little bit. So thank you. This has been super awesome. And for those of you that are listening, please check out the newsletter. I'm going to sign up for it as soon as we get off here. I haven't been on it so thank you for sharing that. And, you know, just learn how to practice this efficient model. And what I loved about what Dr. Ruscio said is that he talked about taking some of that pressure off of yourself, because especially the majority of functional medicine practitioners are just starting out, right? Like people like yourself and myself who've been in the game for, you know, maybe close to 10 years, that, you know, that's not the majority of people. Right. That tidal wave of practitioners is coming. And, you know, by the time they get confident and proficient at charging large case fees, not to say that that's necessary, but when right off the bat, they can take that pressure off of themselves and get their hands on people and start helping people and learning through that experience so much sooner and gaining their clinical confidence. So I love it, man. Thank you.

Thank you. I mean, it's been a pleasure to talk about this. I don't often, like you open with talk about the back end of practice. It's usually the science and the studies and the treatment model and what have you. But this is important. This, I think the difference between someone really thriving in a practice and. And being able to access a lot of people or just struggling because they're painting the bar of entry way too high, and it's limiting their ability to see people, to help people, to learn, to build up a name in their community. So I am grateful for the opportunity to share this.

Thank you, brother. I appreciate it. Have an amazing evening.

You too.

Bye.