Important Private Practice Update | Chris Kresser
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Important Private Practice Update

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important update about my practice
An important update about my practice. BrianAJackson/istock/Thinkstock

After a little over a year of not taking new patients, I opened my practice again on a wait-list basis last week. I sent the email and posted the blog at 8:00 AM. By 10:00 AM, 200 people had signed up for the wait list, and by the end of the week, that number had climbed to almost 600. I closed the wait list on Sunday evening.

As I explained in my previous post last week, I have a small private practice and only see patients for two days a week. In order to leave enough time in my schedule for follow-ups for existing patients, I can only see between 4–6 new patients a week. Given my other obligations (speaking at conferences, a book tour when my book is published, etc.) and vacation time the maximum number of new patients I can see in a year is about 200. This means I currently have 3 years worth of new patients on my wait list.

For the last few days I’ve been thinking a lot about how to address this dilemma. It’s clear that as a single, individual clinician I won’t be able to serve all of the people who wish to work with me. Over the long term, my plan is to create a clinician training program to train others in my approach. It would be mostly virtual, with perhaps one or two in-person retreats. I also intend to build a referral network of like-minded practitioners, perhaps organized by focus on specific health conditions. That way both my patients and I will be confident that they’ll get the kind of care they are seeking, even if they can’t see me individually. I’ve also been thinking of developing an advanced “health mastery course” for patients with guided, in-depth training on nutrition, lifestyle and supplementation, as well as modules self-care for specific health conditions like hypothyroidism, digestive problems, adrenal fatigue, skin disorders, etc. These would be similar in scope and format to the Healthy Baby Code and High Cholesterol Action Plan. I’m excited about these solutions, as I think they will both enable me to help an exponentially greater  number of people than I can help working one-on-one in my private practice.

Unfortunately, these programs will take some time to develop. I can’t see either being available before 2015, and that’s assuming I’m able to start working on them relatively soon. This leaves me with the question of how to decide which patients on my wait list to extend an invitation to. It doesn’t seem fair to simply start at the top of the list and work down, because the amount of time that separates, say #1 from #80 on the wait list is literally a few minutes in terms of when they signed up. I considered a pre-screening process, but there are many problems with that idea. It’s not easy to discern who is in the greatest need of help from a simple questionnaire, and adding a competitive element didn’t feel right to me. It’s also adds an enormous amount of administrative work for my staff, which is already maxed out.

So, what I’ve decided upon for now is to use a lottery system. We’ve put all of the people on the wait list on a CSV file. We will use a random number generator to generate an out-of-sequence numbered list, and then cross-reference that with the CSV file to determine each person’s position on the wait list. When spots become available in my practice, my office manager will send an invitation (which include an Informed Consent and Patient Guide that must be signed electronically) via email. Prospective patients will have 3 days to accept the invitation. If they don’t respond, she’ll remove them from the wait list and move on to the next. I’m aware that this is an imperfect solution, but after agonizing over this for days and talking with several colleagues and advisors, I haven’t been able to come up with a better one.

Unfortunately, with my book coming out in December, the situation was likely to get much worse before it got better. This is why I decided to shut the wait list down, even though it was only open for about 6 days. I’m sorry if you missed the chance to join the wait list while it was open, but it just doesn’t make sense to continue adding people to it when there are already 3 years worth of new patients on the list.

In the meantime, if you’re looking for a clinician that is experienced with or at least endorses the Paleo diet, check out the Paleo Physician’s Network or Primal Docs. They’re both free directories with a listing of Paleo-oriented practitioners around the U.S.. I can’t vouch for individual clinicians on this list, but at least you’ll be starting from a shared awareness of Paleo nutrition and lifestyle.

NOTE: the lottery process has been updated above thanks to a suggestion from Alex in the comments section.

  1. Chris, I was planning to have you look me over at some point, and now it looks like the wellness module/mastery course would be the way that could happen. Here is a wrinkle to think about: I have recently found a paleo doc and am now under his care (Rick Henriksen in Salt Lake City UT; you may have met him at AH12). This seems to means you could function as a consultant to both of us, without taking on responsibility for me as a patient. So: maybe a model for extending your help while limiting your burdens, and maybe also one model, at least, for your approach to training others? Live long and prosper, John

    • Thanks for your suggestion, John. I’ve met Rick a couple of times; he’s really sharp and I think you’re in great hands. The training program for clinicians will be oriented in exactly the direction you’re thinking in. Say hello to Rick for me!

  2. Meagan, I am pretty sure that Chris Kresser realizes that “health issues are important” and certainly doesn’t need a hectoring finger-wag. Perhaps you didn’t mean it that way (probably) but that’s how it came across, to me anyway. Patients on a wait list are always free to seek out other practioners. As far as referring to another practioner he trusts; for those of us who have been through gauntlet of modern medicine, with life and death health issues, in search of solutions, only to find none AND having only been helped with the information he provides online, that right there is a relationship of trust. I would rather wait three years to see someone who has alteady helped me immensely because I read and listen to every single thing that he chooses to share BECAUSE IT WORKED. Quite frankly, I would feel “shuffled off” if he solved the wait list problem by referral. One thing you may realize when you are finally a naturopathic doctor and out of “medical school” as you call it, is that as much as caring and compassion are and should be the cornerstone of health care, the hard fact is that private practice is also a business. Who, in their right mind, would send away 600 clamouring customers? I certainly wouldn’t.

  3. If patient care is your ultimate goal, why don’t you referr these individuals to another practitioner you trust? Health issues are important and shouldn’t be put on the backburner for 3 years because your the only practitioner they’d be comfortable seeing.

  4. Hi Chris
    Keep up the great work. You have approached this with the same thought and consideration that you apply to every other aspect of your practise. Wherever you land with this will be reasoned and as workable as it can possibly be – no one can ask more! Which makes you even more awesome, and even more in demand!
    Nina

  5. Hi Chris,
    Like Diane said, you have a good problem, in a way, on your hands. You talent is recognized and appreciated. Thank you for also including primaldocs.com and the Paleo Physcians Ntwk on your post. I am a “paleo” RD in Chicago and these sites have helped clients find me and other practitioners in the area. Keep up the great work, and best with your projects. Can’t wait to read your book and more.
    -Kelly Schmidt, RD, LDN

  6. Hi Chris!

    I’m in the early throes of my RD program. If you’re willing to take on a newbie (even if I could intern with you), I’d love to learn from you and help your practice! I’m currently working on the core courses (A&P, Chem, etc) and start my RD program at the University of Colorado at Colorado Springs in August. I’m excited to be in the program, but realize that a lot of what I’ll learn will be counter to what I actually believe when it comes to nutrition (the SAD). I’d love to be able to learn about how our bodies REALLY work and how to fine tune them from you! Keep me in mind!

    Heather L

  7. Hello,

    I am also on the waitlist. Unfortunately I can not wait 12mo to see if you can see me or not. It really would be better if you could determine the order of the list and let us know where we stand. thanks.

  8. Chris,

    Any scheme you use is going to spread new patients out over three years. I think most people are more interested to know where they are in line rather than fairness. I suggest you create an ordered list of all new patients and assign each patient a number. Send each patient an email with his/her number and a chart showing roughly when you expect the consultation to occur, for example #1-25 July-Sep 2013, etc. Knowing when their turn will come up will be very helpful to patients. They will be able to decide if they want to wait or seek help elsewhere. Anyone who cancels will shorten the list and benefit those who stay.

    Your current plan leaves everyone on edge, worriedly checking their email daily to make sure they don’t miss out. It would be better to know that the consultation is two years away and be able to relax. From time to time you can send out a revised schedule chart.

    Thank you for all of your wonderful work!

    • This has been suggested above, and I am going to do it this way. Just figuring out logistics. Thanks.

  9. Thanks for the update Chris. I am one of those people who missed the the boat on your wait list. All the programs & trainings you are considering creating sound great, and I have gotten lots of support from your blog, podcasts, etc. However, I think the challenge is that too many of us have really complicated, multi-layered health issues. Although I have made big improvements over the years, I still have serious issues that are unresolved even though I have seen more practitioners than I can count, read all the blogs, researched for years, eat a great diet, etc. So, I think Diane is right, that direct human to human care and support cannot be replaced by machines, or conferences, or articles or books. This is difficult. Obviously so many people (including myself) have gained tremendous benefit from so many various tools that you, Diane, and many, many others have provided. Yet, for the many of us who are struggling with our day to day health, more and more information and research can be overwhelming, often repetitive, exhausting and not actually supportive in finding our path to health. There is such a wonderful wealth of information available out there already, yet 600 of your readers, I’m guessing many of whom are well researched and familiar with your approach, signed up on your wait list within one week.
    So….I’m not sure more information is always the answer.
    And..I’m not sure what is.
    In the meantime, I will continue on my healing journey.
    Thanks for all that you offer.

  10. Yes please, let us know where we are on the list and then give us an option to stay on the wait list or remove ourselves so others can move up on the list.

  11. Chris, another module you might consider is a “Wellness Checkup & Prevention Tuneup.” I seem to be in good health and don’t have any specific issues. But I was planning to have you look me over in a year or so, after I fill in the exercise piece I have been neglecting. On one hand, my need is the least serious, but on the other it is the least demanding on you. Ideally it would not require an extended series of tests and adjustments, could be managed a lot by healthy patients themselves. Maybe the health mastery course could do this, by including a series of recommended tests, along with training in how to interpret them. In that case, perhaps your staff could review the tests to catch serious issues. A health mastery course that included wellness testing might also be monitored by clinicians you train, to give them experience toward a first level certification. Be well and prosper, John

    • This will be the focus of the “health mastery program”, which will cover all of the nutrition, lifestyle and supplement basics for disease prevention and health optimization. I may also include some basic testing and training, and perhaps a monthly or bi-weekly Q&A with myself or someone trained by me to help with interpretation. We’re on the same page!

  12. Hi Chris. I agree with Alex Wilber. I would not mind waiting three years, as long as I know that I will eventually be able to see you. I feel that most people on the wait list probably feel the same. It would be great for us to know when we might be getting an email, even if it may be three years from now. Thank you so much.

    • We’re going to do what Alex suggested. Just trying to figure out how to notify everyone of their position on the wait list without posting it publicly (violation of privacy) or sending 600 individual emails!

      • Hi Chris. I have a thought on how you could avoid sending 600 e-mails without violating privacy. I filled out the new patient form but don’t remember all the fields. But as an example, you could post the first initial, middle initial, last initial, city, state, and zip, or a similar combination for all 600 individuals in an e-mail or on your site. This prevents folks from identifying others but would likely be unique enough for folks to identify themselves.

        Keep up the good work and hope to hear from ya!

        Chris L.

        (I posted this once already and it didn’t go through. So I apologize if this is a duplicate post.)

  13. I see two practioners/physicians (a cardiologist & an Internal med, respectively) who work in the “The Center for Integrative Medicine” arm of one fairly large medical system. There are certain shortcomings in their approach as it applies to the overall picture, but I think the docs try to stay up on current research. I’ve told them about you, your research/practice, etc.; both went to your website right there in front of me, as they are eager to look stuff up and talk. Man, could they benefit from “The Chris Kresser Approach to Integrative & Functional Medicine”, what have you!

  14. I think the modules idea is fantastic. Most of your “regular readers/followers” will have a pretty good idea of their own individual areas of concern so modules will allow us to custom-tailor further education surrounding our personal health concerns.

    It has always amazed me how much your sharing of info has been of benefit to me and countless others with whom I have shared your articles. Most of this has been for no cost via your website and podcast. With modules, you are able to charge a fair and reasonable fee, which is as it should be. You have to earn a living and as far as I am concerned, there is no price too high that I could put on the help I have received from your approach. I look forward to these modules.

    As the previous commenter mentioned, this is a happy problem to have. Your solutions are a great example of “life balance” in action. The practitioner training program is a great idea too! Wish I lived in Cali. 🙂

    • Thank you, Rosemary. I’m happy to know my blog and other resources have been helpful for you. To clarify on the practitioner training, it will be mostly virtual with one or two in-person retreats. This way, more people will be able to participate.

  15. I think this is a great solution, Chris. No solution pleases everyone, but your logic in going through your options is solid. Good luck.

  16. I didn’t sign up immediately when you sent the initial email reopening your private practice because I was transferring funds to cover it from my IRA. I’m surprised, but also not surprised at how many people signed up to work with you. For those of us who didn’t even get counted in the 600, can you recommend a list of tests we ask our regular doctors to order, similar to what you do at the beginning of treatment with a new patient? Maybe you already have this somewhere on your website, but I haven’t seen it. Thank you.

    • Hey Sarah! If you don’t listen to Chris’ podcasts, I’d recommend searching through the podcast archives. He makes a lot of recommendations for specific tests there in response to people’s questions about different health issues.

      • He also provides links at the bottom of the page for finding a practioner in your area that is also trained in some of his modalities… particularly Paleo Nutrition.. As Diane mentions above i Think it is critical that patients seek a collaborative physician/provider to help them secure proper testing and provide direction for care … at least in the beginning. Self-care is the ultimate goal but just getting started (especially when orthodox medicine doesn’t see things the same way) can be daunting without at least some guidance. After that : Kick off the training wheels and Go!

  17. hi chris! i read up on your blog regularly but this time i wanted to drop you a note. my berkeley acupuncturist is phenomenal; has helped me in countless ways through diet coaching (weston a. price), lifestyle, etc. he’s in berkeley and his name is Sean Michael Hall. definitely someone you’d like to have/know in your network. i’ll let him know about you too and see if he’ll drop you a line himself. i want to be sure you two connect!

    thank you for everything you’re doing!

    ariyele

  18. While this seems stressful and upsetting in a lot of ways, I think the silver lining here is that we realize that people who are struggling with health challenges, even those who take matters into their own hands in large part, will ALWAYS want and need other people to help them. This type of care and support cannot be outsourced or replaced by machines. It’s a lovely problem to have, and I feel a little bit happy that people still want help from other people they trust.

  19. Chris,

    I’m not affected, but I strongly suggest that you do the lottery right now (i.e. place all 600 patients in a random order), and email each person with their place on the list (this could be done automatically; I guess your staff can do this, but if not email me and I can get it done in a few minutes).

    The reason being that the proposed system will leave people in a kind of limbo. They *might* be getting an email from you next week, or they might have to wait three years. It’s hard for people to know whether they should seek help from alternative sources in that situation. I don’t believe there’s any disadvantage to doing the lottery right away.

    • This is a good suggestion—I definitely see your point. Let me think about it a little bit. Thanks for sharing it.