Abandoning the Traditional Medical Model
If I had asked Stanford Owen what kept him up at night instead of asking what compelled him to change his practice model, it would have elicited the same response. His answer? “Insurance companies.”
Dr. Owen remembers vividly the night he had this realization. Up at two in the morning and unable to stop calculating and recalculating the hours he spent trying to get paid for services he had already provided, he came to the conclusion that he couldn’t continue practicing medicine this way. “In that moment and in every moment that followed, I committed myself to making the jump—to abandoning insurance completely.”
This is not to say that his full-speed-ahead mentality precluded all fears. Dr. Owen will be the first to admit that his decision triggered a number of them. “My willingness to make the jump didn’t necessarily guarantee that my patients would be willing to make it with me. I doubted my capacity to garner interest in a model that most people in my community were unfamiliar with. I doubted my capacity to build a sustainable patient load out of my existing patient pool. I desperately wanted advice about how to price my services or some assurance that people would pay what I ultimately chose to charge, but I didn’t get either of those things. I jumped anyways.”
Dr. Owen made his decision in the immediate aftermath of Hurricane Katrina. Gulfport, the city of 70,000 in the Mississippi Gulf Coast where he practiced, had suffered near complete devastation from the storm. Dr. Owen knew that efforts to rebuild the community would prove long and arduous no matter what he chose to do. “All of us had to start from scratch in every aspect of our lives. I thought, ‘If I want to practice medicine differently, I have to start right now.”
To provide himself with a dependable practice base and a steady income during what he predicted would be a rocky transition, Dr. Owen moonlighted at an emergency room. Around that time, he began sitting down with patients from his traditional practice to explain how primary care could work without insurance and how both parties would benefit. Dr. Owen recalls being shocked by his patients' ambivalence.. “Most just said, ‘Okay,’ and continued being part of my practice, despite the change of model.”
Since making the transition to Direct Primary Care, Dr. Owen has raised his prices twice and added a co-pay. Each time, his initial fear that patients won’t stay resurfaces. “My patients have proved me wrong time and time again. They stayed when I first stopped taking insurance and they stayed a few weeks ago when I raised my membership fees. It’s loyal patients that make this model possible, it’s the model that makes personalized care possible, and it’s personalized care that makes patients loyal.” Witnessing that cycle has reinforced Dr. Owen’s belief that non-traditional models can and will survive, no matter what changes physicians make to their Direct Primary Care practices along the way.
Rethinking the Traditional Wellness Model
Dr. Owen’s trust in alternative methods of delivering care not only determined his choice of practice model, but also informed the way he thinks about wellness and making wellness possible for his patients. Unlike many professionals in the medical field, Dr. Owen sees nutrition and exercise as a means of treating existing conditions--not just preventing future ones. “I find that patients don’t resist making lifestyle changes when those changes are presented as a treatment whose results can be measured within seven to ten days, like any other.” Dr. Owen thinks defining wellness strategies as solely preventative measures disservices patients who could immediately benefit from them and decreases the likelihood that patients will comply with guidelines for nutrition and exercise. “The traditional wellness model relies on the notion that either fear or knowledge will drive people to action, but I haven’t found that to be the case. Neither anxiety about the future nor cognitive understanding of risk drives patients to make meaningful change. They don’t care if they’ll feel bad far in the future. They care that they feel bad now, and they want to feel better. That’s why they’re in the doctor’s office. If a doctor can offer a solution that’s low cost, has no side effects, and provides immediate relief, patients will take that option.”
Dr. Owen’s experience suggests that medical nutrition therapy (MNT) is that solution. When he started offering it to his patients in the 1980s, most of the available programs focused on weight loss—not treatment of diseases. “No one had ever quantified how quickly the human body could respond to nutrition intervention, so I decided to find out. I dedicated a significant amount of time, energy, and resources looking at how nutrition therapy affected not just diabetes, but also related conditions like hypertension, liver disorders, sleep apnea, and acid reflux. I also quantified if and how quickly it reduced the eight most common symptoms of these conditions: fatigue, restlessness, heartburn, back pain, joint pain, headache, and insomnia. When I finished, I was determined to develop my own empiric nutrition therapy model for disease treatment that made weight loss irrelevant.”
His efforts led to the creation of PrescriptFit, a medical nutrition therapy program that he has since distributed to nearly one hundred clinics, predominantly located in the South. Dr. Owen sees PrescriptFit as separate business that operates as an arm of his clinic, just as it does for the many other physicians whose clinics they service. “PrescriptFit benefits my practice twofold: it brings in nearly as much revenue as I make from treating my patients, and more importantly, it makes it possible for me to treat patients who suffer from chronic diseases. Most textbooks and medical institutions recommend MNT as the first and primary treatment, yet it is rarely offered because the doctors regularly interacting with these patients—family physicians—never learned about MNT. Instead, it was delegated to dietitians who don’t treat chronic illness.”
In part, PrescriptFit is Dr. Owen’s attempt to make MNT more accessible to primary care physicians. Contrary to popular opinion in the medical community, Dr. Owen doesn’t think that getting patients on board with a nutrition strategy has to be a constant battle. “It requires an understanding of the patient and an understanding of the goal. We all know that losing weight is incredibly difficult, but slightly changing a diet can be very easy. Patients are more receptive once they understand that, unlike with long-term weight loss programs, the benefits will be immediate.” Dr. Owen has his patients measure results themselves to encourage engagement with the process. “They regularly rate their symptoms on a scale of one to ten, so they notice improved energy or easier breathing after the first or second week. That information tends to motivate much more effectively than a convoluted chart showing improved cholesterol levels.”
Thirty-five years of experience in medicine has provided Dr. Owen with a sense for what attitudes exist among patient populations about health and what kinds of interventions each cohort responds to best. This knowledge informs if and how and Dr. Owen approaches a conversation about MNT. “In a given practice, twenty percent of the population will be health nuts seeking preventative measures. Most of them have already done their research; there is not much a physician can tell them that they don’t already know. Then, there’s a slightly higher percentage that I call rebels. These folks won’t listen to most of the advice a physician tells them, unless they’re already experiencing symptoms. They gravitate towards treatment that provides them with immediate gratification. The rest of the population falls somewhere in between these two extremes and won’t commit to making a change unless it gives them a results that they can measure.”
Despite these disparities, positive patient experiences with MNT have a common thread: they all spark more conversations between physicians about the potential of nutrition therapy. Dr. Owen uses case studies to illustrate how consistently and dramatically these interventions can improve patient health and quality of life. “I recently gave a lecture to a group of physicians and told the story of one of my diabetic patients who had six episodes of health failure. His surgeon had asked me to clear him for surgery so they could put his dialysis shunt in. They predicted he would die very shortly. I immediately put him on a very rigid MNT program, and the results were stunning. Fourteen years later, not only was he never put on dialysis, but he’s also off three quarters of the medications he used to take. He hasn’t been back in the hospital since.”
Incredible success stories like these motivate Dr. Owen to continue educating others about both alternative models of wellness and alternative models for health care. Much like the DPC community itself, Dr. Owen’s PrescriptFit business has grown immensely through word of mouth—proving once again the undeniable power of physicians networking together to transform the way we provide care.