Top 10 Reasons Functional Medicine Practices Fail
By Dr. Daniel Kalish
In my 25 years of practicing functional medicine, I’ve made many mistakes while building three different clinics. I see these same errors being made over and over by other doctors of my generation who have been in practice for twenty to thirty years. In hopes that you won’t make the same mistakes, I’m going to share a “what not to do” list—because in some ways, what NOT to do is just as important as what TO do. Here’s what to avoid:
- Not hiring sufficient support staff. The doctor then overworks in areas that don’t generate income, like doing the billing, opening the mail, answering the phone, and scheduling patients. Everything that I do in my clinic now are things that only I can do; all other tasks are performed by someone else.
- Not hiring the right support staff. Many doctors, instead of hiring based on personality and performance ability, hire someone who is like them or someone interested in natural medicine. I’ve done this so many times: “Let’s hire Maryanne. She’s interested in natural health,” or “Let’s hire Jon. He seems like a nice guy and is easy to be around.” Be sure to hire people who can perform the job, and I’ve found this means they are often quite different from me personality wise.
- Lacking financial planning and financial projections. In my practice, I know if I work x hours, I’ll have y pretax income in my pocket at the end of the year. My practice operates on a 57% margin, meaning if I collect $100,000 this year, I’ll keep $57,000. If I collect $1,000,000 this year, I’ll keep $570,000. Since I know my margins, I understand exactly how much I have to work to generate any given amount of money. I went for years not knowing what a margin was, let alone what my businesses’ margins were. Know your margin, month to month and year to year.
- Trying to do or offer too much. I used to have dozens of lab tests and up to one hundred possible supplements available, and some of these tests and products were utilized by only one or two patients. Only when I streamlined my business did it become profitable. I now carry five or six lab tests and usually use only three. I carry thirty-five supplements, and my big sellers number about twelve.
- Not creating a simple, clear, reproducible model. For years I approached each new case as if everything would be completely unknown and different. It was like running a restaurant where the customers would come in and say what they want to eat and then the chef would have to shop and cook random things. Now my clinic has a menu, and I don’t veer from it: 1) Neuroendocrine, 2) GI, and 3) Detox. That’s it. I offer three menu items and still get great results. In the years when I did so much more, my bottom line suffered and I was stressed out of my mind trying to do everything for everyone.
- Not referring people out enough. I now refer out all patients whose needs fall outside my expertise. I refer out my Lyme patients, SIBO patients, psychiatric patients, and structural patients. I no longer try to do everything for everyone, and guess what? These doctors in turn refer patients to me when they know I am the right person for the job. I used to see a referral out as admission that I couldn’t help the person, but in those days I thought I had to be able to help everyone with everything. No longer.
- Overworking. We all work way too much. This year I’m taking ten weeks off. Ten weeks of sitting on the beach—not. I’m taking ten weeks off from my regular practice to work on projects, from fixing bicycles to writing the next book and patient education program. It’s time away from my day-to-day practice so I can focus on doing the things that 1) help me relax, and 2) help me build the practice by creating new content, programs, and patient materials. It’s hard to build the practice when you are always working long hours in the office.
- Not exercising enough. A lot of doctors believe they just don’t have time to stay fit, but this will sink your practice fast. We all need physical energy and vitality, especially those of us who spend our days around sick and exhausted people. It’s easy to lose energy and be dragged down by our work when we need to be the most vital, energetic, and fit person in the room. I run, bicycle, do yoga, lift weights, and do chi gung every week. In fact, my main problem with exercise is doing too much of it, which doesn’t work so well either.
- Lacking vision about what you want. I see many practices where the doctors conform to the patients they see, meaning the doctors are passively waiting for patients to show up and then adjusting their practice style and lifestyle around the patients who randomly appear. If you have a clear vision of what you want, you can guide the process. A clear vision might be: family practice; geriatric practice; new moms and children; athletes or executives; patients with Hashimoto’s; patients with mood disorders; patients with eating disorders; alcoholics; patients with autoimmune issues; patients with chronic fatigue… The list is endless. I worked hard and built a chronic fatigue practice even though I didn’t plan it; it just happened. In the end, it turned out I didn’t enjoy working with only chronic fatigue patients and I had to switch gears. I would have saved time if I had determined what I wanted first.
- Not having a spiritual connection. This work requires intense levels of energy, and I have burned myself out several times. Divorce, overwork, lack of fun, lack of meditation. Now I’m super careful about my spiritual connection. I meditate two hours every day, keep recharged, and have wonderful relationships with my family and partner.
Functional medicine practices may be prone to failure, but they don’t have to be. I hope these time-tested suggestions will help you avoid the mistakes that I (and so many others) have made.
Want to learn more from Dr. Dan Kalish? Register now for Emerson Ecologics’ IGNITE Conference 2016, taking place October 13-16. Dr. Kalish will be teaching a hands-on track on creating a patient process and a practice model for success!
