Integrative and Functional Medicine Practice Focus

I&FM practices tend to be organized around one or more common practice focuses: Wellness, Disease, Symptom or Treatment. Some practices may check the box of each focus. Other practices may only touch one focus. Some of the comments in the following descriptions may seem obvious, but the distinctions are significant. Please also note that these different practice focuses can exist within traditional practices.

Wellness Focus

Practices that focus on wellness offer spa-type services targeted at general wellbeing or optimal health, such as massage therapy, biofeedback devices, meditation, yoga, qigong, etc. While all of these offerings may provide benefit to patients suffering from a specific disease or symptoms, a wellness practice focuses on the general benefits these offerings can have for the general population, i.e., the offerings are not targeted to treat specific diseases or symptoms as part of a broader approach to patient care.

Disease Focus

Practices that focus on disease target their offerings to patients suffering from specific diseases, such as fibromyalgia, chronic fatigue, Lyme, IBS, etc. A disease focused practice doesn’t treat anyone who doesn’t suffer from one of the diseases treated at the practice. A disease focused practice may focus on a group of related diseases. One of my first experiences in I&FM practice management was trying to help a group of doctors who worked for a fibromyalgia and chronic fatigue clinic that closed.

Symptom Focus

Symptom focused practices focus on symptoms, such as pain, fatigue, erectile dysfunction, etc. Like a disease focused practice, a symptom focused practice doesn’t treat anyone who doesn’t suffer from one of the symptoms they treat and a symptom focused practice may focus on a group of related symptoms, like anxiety and insomnia. For some symptoms like fatigue, a symptom focused practice could be the same as a disease focused practice, (chronic fatigue).

Treatment Focus

Practices that focus on treatment offer specific treatments for diseases or symptoms, such as IV chelation, defined treatment protocols, ozone therapy, stem cells, etc. Treatment focused practices are like wellness focused practices except they provide services to patients whose motivation is to treat a disease or symptom rather than be “well.” In some instances, the distinction between a wellness focus and treatment focus will be nominal. IV therapy, for instance, is used by some patients to maintain wellness while other patients seek it to address toxic exposure and its symptoms.

This schema for practice focus may not seem significant, but it is useful in planning, marketing and analyzing practices. The subtle differences between the focuses are important, especially for a provider considering practicing I&FM by either joining a practice or starting a practice. Two obvious statements made for example are that “a disease focused practice doesn’t treat anyone who doesn’t suffer from one of the diseases treated at the practice,” and “a symptom focused practice doesn’t treat anyone who doesn’t suffer from one of the symptoms they treat.”

The impact of these statements is very significant, however, because it means that the providers of each practice will treat the same symptoms or diseases over and over again. This isn’t necessarily a negative. Many I&FM providers I’ve encountered want to focus on a set of diseases or symptoms. They can focus their training, build expertise and avoid becoming a “jack of all trades, master of none.”

Other providers I’ve encountered would find focusing on just one set of diseases or symptoms to be monotonous. They wouldn’t want to limit the kinds of patients they treat and would welcome a much broader spectrum of patient care. Another consideration is that they wouldn’t want any of their skills or knowledge to atrophy.

Consider a family practice physician we hired at Sparks Family Medicine years ago. Prior to joining, she had worked in a cash practice exclusively managing hormones. As the management of hormones went more main stream, her business dried up. When she joined us, we quickly discovered that she was out of touch with many of the standards for traditional primary care. While focusing on managing hormones had been a boon for her for years, the downside is that her other skills were significantly neglected.

A provider can take steps to maintain the skills and knowledge they aren’t applying every day, of course. If the hormone doctor we hired had continued to attend CME in general practice, she would have been better prepared to return to general practice. The catch is that when she was exclusively managing hormones, she never believed that she would return to general practice. When the market changed, she was unprepared to navigate the shift.

I would recommend that it is important to remember the old adage, “What will make you laugh will make you cry” when considering practice focuses. They each have advantages and disadvantages. Embracing just one focus may leave a practice overly dependent on one market segment. Embracing all four focuses may spread a practice’s resources thin. I am not recommending the formerly or the latter. I just think it is important for providers to understand the pro and cons of each focus.

Wellness and treatment focuses rely on staff and equipment. This comes at additional cost, but it creates revenue streams that are not directly dependent on the provider. Practices focused only on wellness often utilize a medical director relationship with a provider because their presence isn’t required, (only their supervision). Some wellness practices may be run entirely by lay people without medical provider involvement.

While treatment practices provide services that do not directly require a provider, they tend to have providers present because of the health of their clientele and, in some cases, the complexity of the treatments. (Starting an IV on someone is more medically complex than a massage.) In some cases, providers still may be providing the treatments. This is definitely the case if a practice is focused on providing a specific medical protocol that third parties have marketed to patients.

Types of Practices in Practice 

To see how the different practice focuses are used by different practices, let’s look at sample practices.

Tom’s Best Spa

Tom’s Best Spa has four massage rooms and contracts with licensed massage therapists for individual massage sessions. Tom’s also has two salt rooms that its clientele pay to use. Several afternoons a week, various instructors offer yoga and meditation classes in a large therapy room at Tom’s. State law doesn’t require Tom’s to have a medical license for any of the services it offers, so Tom’s doesn’t have a formal relationship with any medical provider.

I&FM Focus: Wellness

Best Family Medicine

Dr. Johnson is a primary care physician who started Best Family Medicine ten years ago. He provides traditional primary care, but on Fridays, he performs cranial sacral therapy on some of his sick patients who find it beneficial.

I&FM Focus: Treatment

Men’s Wellness Clinic

Dr. Smith sees only male patients with issues in sexual health. Many of these patients get testosterone shots. Men’s Wellness also offers patients a therapist to address anxiety and mental wellness.

I&FM Focus: Disease (and possibly Treatment for testosterone shots and therapist)

Jones Integrative Center

Dr. Jones sees patients for integrative and functional concerns. She has several rooms where she provides complementary services to patients, such as biofeedback, massage therapy and nutritional counseling. Patients come to the Integrative Center for a wide range of diseases and symptoms.

I&FM Focus: Disease, Symptom, Treatment, (and possibly Wellness if “healthy” patients utilize the treatments)

Notice that there isn’t always a right answer for the practice focus—but that isn’t really necessary. With I&FM being such a hard elephant to define, the practice focus schema is a tool to promote consideration of what kind of I&FM we are talking about, including how the practice is marketing their services and their target population.