3X4’s new Functional Medicine Practitioner Spotlight series features interviews with practitioners, consultants and functional medicine thought leaders to explore everything functional medicine practitioners need to know about successfully building, managing, and growing their private practice.
The following is an interview we recently had with Dr. Sara Gottfried, MD, Director of Precision Medicine at the Marcus Institute of Integrative Health, Keynote speaker, NYT Bestselling Author, and Clinical Assistant Professor at Thomas Jefferson University Hospitals.
What can you tell us about your practice?
SG: I am a physician who practices precision and functional medicine in Philadelphia, Pennsylvania.
Precision medicine is a way to personalize care based on the integration of genomics, biomarkers, and wearable technology so that we can optimize function, behavior, and performance. I am a Clinical Assistant Professor in the Department of Integrative Medicine and Nutritional Sciences at Sidney Kimmel Medical College, Thomas Jefferson University. I serve as the Director of Precision Medicine at the Marcus Institute of Integrative Health.
I see patients from 11 states, from PA to NY to CA, mostly via telehealth. My practice has evolved over time. Now I see primarily executives, elite athletes, and people seeking personalized care. Some of my patients are women in perimenopause asking whether bioidentical hormones are the right next step, some of my patients are struggling with stress and prediabetes, and other patients are NBA players seeking to improve capacity, explosiveness, and recovery.
My focus is to quantify health with metrics that matter and to build resilience. I track the gene/environment interface as best we can, and together with the patient, we manage complex data streams involving gut function, nutrients, lifestyle, biomarkers, wearables (such as continuous glucose monitoring, sleep and activity trackers), metabolic flexibility, hormones, and biological age. For each patient, I use N-of-1 experiments to personalize the best treatments for the individual. It’s the opposite of one-size-fits-all.
The approach that I’ve been developing over the past few years to adapt a 4-week therapeutic pulse of a well-formulated ketogenic diet for women, combined with detoxification and intermittent fasting, will be published in my new book, called Women, Food, and Hormones. The book is now available for preorder.
The Marcus Institute of Integrative Health was established in 2017 by Thomas Jefferson University and Jefferson Health to expand the research base, educational mission, and clinical care profile of Jefferson’s integrative medicine program, and to set the international standard of excellence in evidence-based, patient-centered integrative care. We are a group of 10 physicians plus several mind-body therapists. We individually practice integrative, functional, and precision medicine. It is the first integrative medicine department in the country, possibly the world, integrated into the medical school and university and on par with the department of medicine or department of surgery.
What surprised you the most when you started your practice?
SG: I was educated to be a mainstream physician, researcher, and educator. However, as I started practicing in the mainstream medical system, I was surprised to see how often conventional medicine falls short of meeting the needs of patients.
While we have one of the best healthcare systems in the world in terms of innovation and scientific advances, we have unacceptably high obesity rates, a tsunami of mood, stress, and anxiety issues, and increasing numbers of people with chronic, preventable diseases such as diabetes, high blood pressure, and stroke.
I discovered from the scientific literature that nutrition and lifestyle approaches tend to be the most effective for disease prevention and reversal, yet most physicians are not educated sufficiently about this. Diabetes and prediabetes are a great example because diet and lifestyle are more effective than pharmaceuticals, yet there is not only a lack of training in how to provide this type of care, there is arrogance and even disdain among mainstream physicians about it.
Fortunately, medicine is changing. Clinicians at the Marcus Institute and elsewhere are leading the way in the leading edge to change the paradigm into something that encompasses true health, rather than simply managing disease or symptoms.
What was the biggest challenge you had to overcome as you built your practice? How did you overcome it?
SG: I thought the main challenge the first 10 years of private practice was operations, management, and administration, but later I realized that the bigger issue was how to take care of patients without overfunctioning and burning myself out. Maybe you were trained to do this too–I say yes too readily to increased workload such as the patient that wants to be crammed in sooner, to saving the day, to pleasing others, to assuming more responsibility than is my share. In other words, an utter lack of boundaries. We are taught to do this in medicine and we are taught to do it as women and mothers.
I assumed the difficulty was that I didn’t have the right operational manager or staff, or that I needed to hire more physicians and colleagues. I tried harder, which almost never works. However, hiring new people and changing the configuration didn’t solve the root cause, my overfunctioning. So I took a sabbatical (highly recommended). I wrote a few books and spent a lot of time with a business coach on how to stop overfunctioning and to structure my practice in a way that could serve me better.
Ultimately, that structure ended up being the Marcus Institute of Integrative Health. It’s a very rare academic environment where there is deep connection between colleagues, tremendous support, and entrepreneurial vision, in part because of our visionary leader, Daniel Monti, MD, MBA.
I see patients 3 days per week and the rest of the time, I perform research and teach. It’s an ideal configuration for me and I don’t have to manage any staff!
What advice would you give to other practitioners considering launching their own practice?
SG: Even though the culture is changing in mainstream medicine, it is slow. Those of us who practice functional, integrative, and/or precision medicine have an opportunity to take advantage of the gaps in conventional medicine and to address the root cause of our patient’s concerns.
Search for the best evidence and robust research out there to quantify and measurably change health for our patients. Understand the complexity of your individual patients, their histories and narratives, and be genuinely curious about the manner in which their phenotype is expressed.
Don’t rely only on questionnaires to collect data from your patients. Take full advantage of the excellent tracking devices and exceptional, easily accessible testing that is available to track your patients’ data to make informed treatment decisions.
What excites you most about the field of functional medicine?
SG: I am very excited about the broader adoption of functional medicine principles throughout the care team. I love seeing more integrative clinicians using functional medicine tools in their practice, such as in the Integrative Psychiatry Institute. I’m thrilled by the growth of IFM and other groups, like the Functional Nutrition Alliance, as well as the role of Functional Medicine coaches to support behavior change. In academic medicine, I am happy to see the collaboration of integrative, functional, and precision medicine clinicians such as we are seeing in our department. Just like silos didn’t work in conventional medicine, they don’t serve us in our work in building a new model. As we come together more across disciplines and across the aisles of integrative, functional, and precision medicine, our ongoing collaboration will allow more personalization of care and presumably, better outcomes and proof of the model. It takes a group of like-minded early adopters to start a revolution, and we finally are getting all of the pieces in place!
Where do you see your practice 5 years from now?
SG: I’m invested in Marcus Institute of Integrative Health and look forward to continuing to grow and evolve my practice. Our research on how people transition from health to prediabetes and reverse it back to health is heating up, so in 5 years I hope that we understand the various subphenotypes and the most important levers that can be addressed with precision and functional medicine. We expect our executive health program with emphasis on cardiometabolic health, biological age, and brain health to become one of the best in the country for benchmarking and improving wellness with a personalized approach. Genomics will continue to be at the core of our work in scientific wellness, and in 5 years, I expect we will be using more algorithms for complex data streams so that we can personalize further and manage our N-of-1 trials with patients.