Practice Update and Future Directions | Chris Kresser

Practice Update and Future Directions

by Chris Kresser

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I thought I’d take a moment to give you an update on what my plans are for the next couple of years, especially in relation to my private practice, which I’ve received a number of questions about recently.

The practice

As some of you know, I closed my practice to new patients about six months ago. I did this because my patient base had grown so quickly that established patients in my practice had to wait up to five or six weeks to schedule a follow-up appointment. That obviously doesn’t work; when a patient is on a treatment plan, and something comes up that requires attention, they can’t wait six weeks for guidance.

The good news is that within a couple of months the wait list for existing patients was significantly reduced. They can now get a follow-up appointment within a week, and sometimes even within a couple of days. As a result, I’ve been gradually working through the 80 people that were on my wait list for new patients.

The bad news (at least for those of you waiting to become a patient), is that I’ve decided to scale back on my private practice, reducing the number of days I see patients from four to two. There are several reasons for this, but I describe two of the main ones below: I want to free up time to write a book and develop a clinician training program.

Now that I’m down to two days a week in the clinic, I’m going to see how things go with my current patient load over the remaining two months of 2012. When it’s clear that I can accommodate new patients again without creating a long wait for established patients, I will open my doors again – albeit on a limited basis because of my reduced clinical hours. I expect this to happen in early 2013.

The decision to go down to two days a week in the clinic was a difficult one. I enjoy working with patients and I know there are a lot of people who need help. But working directly with patients is only one of the ways I help people (there’s also the blog, radio show, educational programs, public talks, etc.), and there’s a definite limit to how many people I can help in this way. Which leads me to…

The book

I’ve been thinking for quite some time about writing a book, but I knew that I’d have to free up some time in my schedule in order to make that happen. With the changes I’ve made in my private practice, a book finally seems possible.

The topic? The real causes (and solutions) of gut problems. Have you ever noticed that most diagnoses of digestive problems are simply fancy descriptions of symptoms? If you go to the doctor and tell her you have gas, bloating and pain, she might diagnose you with “irritable bowel syndrome”. (Of course you might be thinking, “Didn’t I just tell you that?”) If you have acid refluxing into your throat, you have gastroesophageal reflux disease (GERD). If your colon is inflamed, you have Ulcerative Colitis. I could go on but you get the idea.

None of these diagnoses tell you anything about the underlying mechanisms that are causing these symptoms, or what to do about them. For example, many (if not most) people with IBS have either small intestine bacterial overgrowth (SIBO), dysbiosis, a gut infection, a gut-brain axis problem, or some combination of all of these issues. People with GERD often have low stomach acid, an h. pylori infection and/or SIBO. People with Ulcerative Colitis have a dysregulated immune system causing their body to attack itself, as well as SIBO, a gut infection and a gut-brain axis issue. In order to truly heal IBS, GERD, Ulcerative Colitis or any other gut problem, these underlying causes must be addressed. That’s exactly what my book will be about.

The book will help me reach an even wider audience with this important message. I’ve already started planning and outlining, and am tentatively planning to publish at the end of next year or early 2014. Stay tuned for some exciting announcements related to the book in the near future.

The training program

Almost every day I get an email or Facebook message from someone asking me what I’d recommend in terms of education for someone who wants to start a functional medicine practice. Unfortunately, I don’t have a good answer for these folks.

Of course there are several options for learning the basics of treating patients: you can study to become a medical doctor, naturopath, acupuncturist, chiropractor, registered dietician, etc. However, while there are excellent programs in all of these disciplines, and many of them provide a solid foundation, they don’t teach you much in the way of the clinical skills you need to have a successful functional medicine practice.

If a medical doctor wants to specialize in a certain area, such as cardiology, he or she will first get a medical degree, and then do a residency in that  particular field. We need a similar opportunity for those wishing to specialize in functional medicine. This is exactly what I plan to create.

In 2014, after the book is published, I’m going to shift my focus toward developing a training program for other clinicians and practitioners who want to specialize in functional medicine. We’ll cover interpretation of blood, saliva, urine and stool testing and how to use these tests to diagnose and treat the most common problems seen in a functional medicine practice, ranging from thyroid disorders to gut issues to hormone imbalance. It will likely include some combination of lecture, case studies, group study and individual mentorship. The majority of the training will be offered online to make it accessible to the widest possible audience, but I may have a module or two that is in-person.

I’m excited about training other clinicians, because through these programs I’ll be able to help far more patients than I’d be able to help directly on my own.

Okay, that’s it for now! Back to our regularly scheduled programming…

 

72 Comments

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  1. I’m also interested in any upcoming class, seminar, ceu etc. in functional medicine. I’m a L.Ac. In New York. Please keep me posted.
    Thanks!

  2. Interested in hearing if you have any update on your training program. I’m an NP and so interested in participating once it’s up and running!

  3. Chris,

    I am so excited about your up coming book and training program. I do hope you continue with your plan to NOT limit it to licensed practitioners. There are so many certified health coaches, TCM practitioners and herbalists that would excel with your training. I am so glad it is mostly online but I do hope it includes a week or weekend (or two) of in person training. I think that would be enormously beneficial and well worth the travel expense. For now, your site is my #1 go to reference.

  4. Hello,

    I am an acupuncturist practicing functional medicine type work and thought I’d provide some info on the training I completed, as I found it excellent and would highly recommend it to anyone interesting in learning how to implement functional medicine. The program is called Functional Diagnostic Nutrition and was founded (and currently run by) a guy named Reed Davis. Reed is out of Southern California but his program is a blend of online and telephone lectures, consults, videos, etc. His program covers the adrenal glands, steroidal hormones (estrogen, progesterone, etc.), liver testing, immune testing, and pathogen testing, and food sensitivity testing – all through saliva, urine, stool, and blood work. Very easy to learn and apply and relatively inexpensive compared to some of the other functional medicine programs available.

    I found the program very interesting and easy to follow. I am a practicing acupuncturist and nutritionist but I learned a lot through their nutritional supplement protocols….stuff I wasn’t aware of and was happy to learn about! The website is http://www.fdnmanager.com and everyone is super helpful.

  5. For those of us who would love to participate in your certification program but can’t wait until it is up and going, are there any other programs that you would recommend?

    I will have my BS in psychology and a minor in Chemistry. Are there any classes that you would recommend that I include while I am still completing my BS (that would be useful in a functional med. career)?

    I know that you are busy and may not have time to speak with me directly, so are there any other practitioners that I should contact for career advice?

  6. The book sounds amazing, Chris, but when my gut issues (preprandrial bradygastria + some type of motility disorder) are never mentioned I always feel lost! I look forward to reading it anyway.

  7. Hi Chris! I’m so excited for you and your new adventures. I too so wish I could see you as a patient… I’ve given up on docs in general (there aren’t any functional med docs in my area) and I’m trying to just learn myself so I can hopefully heal myself. So far, so good. Looking forward to your book! Hopefully I’ll learn more and be able to finally get healthy. Thanks for all you are doing! I have learned a ton and may have found a new calling… 🙂

  8. Hi Chris,

    I understand your training program is still at the idea stage – but I was wondering if you could expand on how your program might differ from that of the training offered by the Institute for Functional Medicine? Just interested, because it sounds quite similar. I’m a long term reader of your blog, and often use it as a reference point when reading up on various health issues. Very excited about the prospect of your upcoming book.

    Thanks

    Gail

    • My approach is quite different than the Institute of Functional Medicine’s in many areas (adrenals, cholesterol/heart disease, thyroid, gut, etc.). I use different testing and probably interpret the results differently. So I guess the easiest way to say it is this training is going to reflect my specific approach.

  9. Hi Chris,
    I am a regular reader, though I don’t usually comment. I just wanted to say that as a long-time gut disorder sufferer, I am so thrilled to hear of your upcoming new book. Too many of us have left the doctor’s appointment with a catch-all diagnosis and a bottle of anti-spasmodic medication that does nothing. It gives me hope and joy that you are digging deeper and helping us address the root issues of embarrassing and miserable conditions. I wish more people in the medical field had your wisdom, curiosity, and true desire to help rather than prescribe.

    Thank you from the bottom of my heart,
    Emily in Austin

  10. Chris;
    I’m one of the (I’m sure many) people who have asked you to teach a course or offer some kind of a mentorship program. As a full-time dentist/owner in a very large and busy practice as well as a mom of two my plate is already full, full, full. That said, my staff has come to somewhat dread the health questionnaire because they know, if it says anything about systemic issues, particularly involving thyroid, GERD, cholesterol, diabetes or depression they know a fairly lengthy discussion is likely to ensue. I’ve been trying to figure out a way to increase my knowledge base and practice some kind of functional medicine “on the side” when I’m not already scheduled with dental patients while still attempting to maintain something that resembles balance in my personal life! I’m looking forward to seeing how your plan unfolds as well as discussing my most recent set of labs on my next consult.
    As an aside, my significant other just got his labs back and has some concerns. He’s so disappointed that you’re not taking new patients and asked if I could be his doc… 🙂
    I was thinking about trying to get a naturopathic decree from Bastyr so I could have some credentials but I’m not sure what it would gain given that I’m already pretty swamped with dental continuing education.
    ~Carrying on the proud tradition of Weston A Price~
    Kim Rioux DDS

  11. Re:Have you ever noticed that most diagnoses of digestive problems are simply fancy descriptions of symptoms?

    Yes, almost all modern medicine is like this. Symptoms are also largely what it treats, seldom underlying causes.

  12. Hi Chris!

    I just started a career change – I’m working to become an RD (it’s gonna take a while, since my other degrees are in business and education!)…and I’m really interested in your clinician program! Can’t wait to hear more!

    Heather

  13. Hi Chris,

    I would love to participate in your program. I am a Certified Health Coach. Would that certification be accepted or would I need more training to attend. Thanks!

    Jessica

    • I’m not sure yet, but I think that would probably be enough. I currently don’t plan on limiting enrollment to licensed practitioners, but just want to make it clear that some labs don’t permit non-licensed practitioners to order some of the tests we’ll be discussing.

      • Wonderful! I just checked out directlabs.com as you recommended in a different comment. This is an amazing resource and so wonderful that they allow patients to order from these well recognized labs. Thank you for passing this along!

  14. Oh Chris.. Since you are not going to be taking new patients can you recommend me to someone else? I have been so in need of your help with my daughter (her name is Sylvia!) She is medically fragile and has been battling C DIf bacteria for almost a year after taking antibiotics for strep throat. She he is only 3 years old.. I need support in a diet plan to repopulate her gut. Her C dif presents as constipation and all the med doc’s just want to keep giving her enemas and antibiotics. She is G tube fed and I am blending all her meals so she could have optimum nutrition. HELP!!

  15. Exciting news! I’ve just recently discovered your site and am amazed at how much you’ve shared and the professional quality of your research and practice. I was hoping that a book would surface soon. Keep up the amazing work that you do, and thank you. 🙂

  16. I wish you the best of luck with your future plans! I am really looking forward to your forthcoming book on gut problems. I have had severe Crohn’s disease for 17 years, numerous surgeries (one including a temporary colostomy) and am trying to prevent further damage.

    I read all I can about the different dietary approaches and sometimes it’s all a bit confusing and overwhelming as “everyone is different” and there is no one approach that is suitable for everyone. I am hoping your voice can clarify things.

    Thanks in advance!

  17. Congrats, Chris! I am very excited for you. Your website and podcasts have inspired me greatly.

    I would like to pursue a career in functional medicine, but it is difficult to determine what type of schooling would be best. I’m feeling drawn toward becoming a DO, because my accessibility for future patients is important for me. The years of schooling are daunting, however, especially since–as you said–this would simply provide the foundation for functional medicine. Do you have any advice for someone like me? Do you ever wish you were a doctor who had the ability to prescribe, accept insurance, etc.?

    Thanks for any insight you can provide!

    • It’s a tough decision and depends a lot on your ultimate goals. I do sometimes wish I had the ability to prescribe the few medications I think are useful, but I have colleagues I work closely with that I can refer out to for that. Ultimately I feel like the path I chose allowed me the time and space I needed to pursue my research and clinical development in functional medicine. Had I chosen an M.D. or D.O., I think it would have taken me an extra 6-8 years to get to where I am now. I wasn’t willing to wait that long.

  18. So excited about your future! You are doing such important work and this book is going to be just invaluable since so many of our modern ailments originate in the gut. Thank you for all you do and for undertaking these initiatives to help widen the network of informed people!

  19. I’m just one of the many who are super excited about your book. Really shocked that you are even writing one considering how full your plate is presently, but inspired that you are creating the space in your life to do your best work even if it means making some sacrifices and not apologizing for for doing what you must. This is growth and as a long-time reader, it’s always nice to see things aren’t stagnating. Best wishes-

  20. Hi Chris,

    I can’t tell you how excited I am to see another DOM who practices the way I do. Too bad we’re on opposite coasts!

    I end up treating gut problems (same thing you see – SIBO, dysbiosis, etc) on almost every single patient I see. There is so much patient education needed (and clinician training) – I *know* you’ve spent hundreds and hundreds of extra hours on research and training, because that’s what I’ve had to do. This stuff isn’t taught to us in Acup. College.

    Congratulations on your practice growth, it’s obviously well deserved. I look forward to the book.

  21. this training course is what 21st century medicine is crying out for
    having trained for 5 years full time to become a practising osteopath for the last 8 years, this stuff has only become known to me through years of trial and error and self investigation, which is obviously very time consuming
    a course to fast track functional medicine interpretations is just the ticket
    congratulations chris, you are not only helping a lot of people yourself, but soon indirectly through mentoring and training other practitioners

    keep up the good work

    josh lamaro

  22. Chris – congratulations on the book, that’s fantastic.

    Just curious if you will be covering non-digestive complaints that are caused by gut issues? You mention autoimmune disease, how about the strong mental health connection between gut and brain? I have personal experience of this, so am always interested to hear of new information coming to light and new avenues for this area being publicised, especially considering the skyrocketing rates of mental health concerns. I am absolutely biased in asking this question 🙂

    • Yes, to some degree. I’m speaking at the Wise Traditions conference in November on the gut-brain-skin axis, so I’m sure I’ll include at least some of that research. One of my goals with the book is to show how crucial the gut is to all aspects of health, so I’ll be touching on its relationships to other organ systems and health/disease states.

  23. Chris – I’m excited for these new developments. I will be the first to order your book and as a chiropractor I would also be very interested in your functional health training. Keep us updated on the progress.

    Kevin

  24. Chris – will your new book cover autoimmune disease? I am assuming so, since it is so linked to the gut…

    Thanks for the update, its great to know what you are up to. I am very excited for the book as your work has had a huge impact on making me feel better 🙂

    Mickey

    • I know Dr. Kalish and have seen is program and it’s fantastic. Where mine will differ is that I will cover blood work and how to interpret it from a functional perspective, and I’ll probably go into quite a lot of detail on thyroid issues. Of course he and I are different people with different backgrounds and experience, so there’s that as well.

  25. I think you are definitely doing the right thing. I’ve never been one of your patients, but the information that you share on the blog, Facebook, the radio show, and the Healthy Baby Code has not only dramatically improved my health, but also taught me a much more effective approach to dealing with my own and my family’s health issues. The more people you can reach, the better.

  26. I’m looking forward to more info on your training program. I’m a nurse practitioner that’s looking for a new direction. I have found so much information on your website ( and within the paleo community) that was life changing for me. I’d love to be know more so I too can help others. Best of luck of your book endeavor.

  27. Chris, I am very glad to hear that you will be writing about “gut problems.” My entire life seems to have revolved around those, and I have so far found dietary changes to only be partially helpful. I’m eager to read what else you have to say about this.

  28. Hi Chris, I’ve been studying independently for a couple years now and I eager to begin my schooling to become a functional practitioner. I certainly hope to take your training program when it becomes available but I wonder if you have any suggestions for schools to pursue in the meantime. I’m curious what thoughts you have, if any, about Reed Davis’s Functional Diagnostic Nutrition course? As well as how your program may differ from it once it becomes available? Any kind of insights would be most appreciated to help me begin the next stage of this journey. While there are countless people doing great work out there, I’ve found that you are a truly exceptional thinker and doer and thus regard highly whatever knowledge you are able to share! =)

    • Hey Ryan: I don’t know much about Reed’s course. I haven’t seen it myself, and I haven’t had much exposure to him, so I’m not really a great person to ask about that. Sorry I can’t be more helpful.

  29. Chris, this is great news for your business. It is, however, disappointing for potential patients like me who really need your help. I can read and read and read as much as I can on your website, but I still need the guidance. Is there anywhere you can recommend for guidance and treatment? I look forward to hopefully working with you someday!

    • I understand your dilemma, Lindsey, and that’s why this was a difficult decision for me. That said, I have to consider how I can help the largest number of people in the most effective way. Training other clinicians to work in a similar manner is by far the best way of accomplishing this goal, because each clinician I train will see thousands of patients over a career.

      If you need help immediately, and can’t wait until the new year when I re-open my practice, you might consider checking the Paleo Physician’s Network if you haven’t already.

      • That absolutely makes sense! And I’m so thankful for all of the information I have come across on your website. Thanks for your help!

  30. chris, I cannot tell you what an impact you’ve had on me. I went thru the NTA’s program and am a Nutritional Therapy Practitioner. I was listening to you and reading your work WAY before getting this cert. but I am just blown away by your knowledge, your perseverance. it reminds me of myself when i first started digging into everything paleo, primal, WAP, etc. I could find. but you’re on another level. you’re from another solar system. thank you so much for what you do, thank you so much for seeking truth, for REALLY seeking truth and sharing it. I look so forward to learning from you about how to be a better practitioner. all i want to do is help others, and I truly feel I couldn’t do it without you as a resource.

    • Thanks so much for your kind words. I really appreciate your feedback. This is what makes all of the hard work worthwhile!

  31. I’ll be excited for the training program! I’ll be a licensed acupuncturist by then. I hope it will be approved for NCCAOM CEUs and Florida CEUs.

    • Unfortunately, this isn’t likely. I looked into CEU certification and it’s incredibly expensive. Like $20-$25k expensive. We’ll see.

      • just get the practical info out there, get others to produce favorable results – all that certification bs can come later or never imo

  32. I am very excited to hear that you are going to be offering a training program, Chris! Are there any prerequisites for this program? I am currently a strength coach and have been looking into nutrition certs because I would like to transition into handling more nutrition clients. Also, do you have a recommended reading list for people who want to prepare for the course?

    Thanks for all your material!

    • Zach: I haven’t decided on this yet, but I’ll keep you all updated regularly as it evolves. In general, having some kind of license (naturopath, acupuncturist, chiropractor, RD, etc.) makes it easier to order the tests we’ll be discussing, but nowadays patients can often order them directly through directlabs.com and other sources.

    • Zach, check out the Nutritional Therapy Association’s Nutritional Therapist Training Program. I completed it about a year and a half ago and am building a successful practice helping people get healthy with real food. Feel free to use my name as you referral source if you go ahead and let me know if you have any questions.

      • Thanks a lot, Debra! That is the cert currently at the top of my list. What was your background before going through the NTP program? Also, did you consider any other programs? I am also looking at Bauman College and Hawthorne University. Do you have any opinions on those?

        Thanks again!

        • Hi Zach,
          What did you decide on your program? I was looking at Bauman and am curious what you figured out. Also, I wonder if the programs NTP etc. qualify you to order the functional medicine tests (or do you need to be a Registered Dietician)? Thanks!

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