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BridgeWell Brief #8: Do You Need Your Own Practice to Practice Integratively? · The Integrative Clinician by BridgeWell

• 0:00
  Speaker: I would love to practice integrative medicine, but I can't open my own practice right now.
• 0:05
  Speaker: I hear some version of this from nurse practitioners all the time.
• 0:10
  Speaker: Maybe you need the stability of your current job.
• 0:13
  Speaker: Maybe you're not interested in entrepreneurship.
• 0:16
  Speaker: Maybe you're working in primary care, women's health, obesity medicine, specialty care, or telehealth.
• 0:23
  Speaker: So does that mean you can't practice integratively?
• 0:27
  Speaker: No.
• 0:28
  Speaker: But it does mean we need to separate integrative practice from practice ownership.
• 0:35
  Speaker: This is a Bridgewell brief, and today I want to challenge an assumption I see and hear frequently that becoming an integrative nurse practitioner means eventually opening a cash-pay functional medicine practice.
• 1:02
  Speaker: That is not true.
• 1:03
  Speaker: Integrative is how you think.
• 1:06
  Speaker: Suppose you're seeing a patient with fatigue.
• 1:09
  Speaker: You have 15 or 20 minutes.
• 1:11
  Speaker: You probably aren't ordering every functional test you've learned about, but you can look beyond just the CBC or a normal TSH and saying you're just fine because you're within standard limits.
• 1:25
  Speaker: You can go beyond that.
• 1:27
  Speaker: You can ask about sleep, menstrual bleeding, nutrition, medication, depression, sleep apnea risks, exercise tolerance, menopause symptoms, dietary restrictions.
• 1:39
  Speaker: You can decide whether iron studies are appropriate.
• 1:43
  Speaker: You can think differently even when the visit structure doesn't change.
• 1:48
  Speaker: And that matters.
• 1:49
  Speaker: Many clinicians learning integrative and functional medicine may never leave their primary care practices, may never leave their specialty practices, may never open their own practice.
• 2:00
  Speaker: But this is still extremely beneficial to them and their patients.
• 2:05
  Speaker: Your environment will create boundaries.
• 2:08
  Speaker: Let's also be realistic.
• 2:10
  Speaker: Your employer may restrict specialty testing.
• 2:13
  Speaker: Your formulary may limit options.
• 2:16
  Speaker: You may have productivity requirements.
• 2:19
  Speaker: RVUs are very common now.
• 2:22
  Speaker: You may not have an hour with every patient.
• 2:25
  Speaker: Some organizations may have policies about supplements, hormone prescribing, especially if you're looking at compounded hormones, or outside laboratories that are not the standard laboratories that we use in primary care or specialty care.
• 2:42
  Speaker: Those are real constraints.
• 2:44
  Speaker: Integrated practice does not mean ignoring them.
• 2:47
  Speaker: It means asking, what can I do within the environment that improves the way I understand and manage this patient?
• 2:55
  Speaker: Sometimes the answer is surprisingly substantial.
• 2:59
  Speaker: Start with the part nobody can take away from you, your clinical reasoning.
• 3:04
  Speaker: Nobody has to authorize you to build a better differential.
• 3:08
  Speaker: You don't need a functional lab company to ask a better history.
• 3:12
  Speaker: You don't need your own LLC to recognize that a patient's bloating may be driven by something other than just constipation.
• 3:21
  Speaker: You don't need a cash pay practice to recognize possible iron deficiency before anemia develops.
• 3:29
  Speaker: And you don't need a supplement dispensary to discuss protein, resistance training, sleep, and metabolic health.
• 3:37
  Speaker: And you certainly don't need your own building to stop treating every symptom as an isolated diagnosis.
• 3:44
  Speaker: That is foundational.
• 3:45
  Speaker: Then decide what kind of independence you actually want.
• 3:48
  Speaker: Some nurse practitioners eventually do want their own practice, and that is phenomenal.
• 3:54
  Speaker: Others want to bring integrative thinking into their existing role.
• 3:58
  Speaker: And that is also wonderful.
• 4:00
  Speaker: Some want a hybrid, some want to be educators, they want to do telemedicine, they want to focus on women's health, maybe metabolic medicine.
• 4:09
  Speaker: There isn't one correct destination.
• 4:12
  Speaker: The important question is what kind of clinician are you trying to become?
• 4:17
  Speaker: Because practice ownership and clinical competence are two separate things.
• 4:22
  Speaker: Owning the practice gives you control over the environment.
• 4:26
  Speaker: It does not automatically give you clinical judgment, and working for someone else may limit some of your tools.
• 4:33
  Speaker: It does not prevent you from becoming a better clinician.
• 4:37
  Speaker: On Monday, I ask you to do this.
• 4:40
  Speaker: Instead of asking, what can't I do in my current job?
• 4:45
  Speaker: I want you to ask, what is the one thing I could do differently with my next patient because I'm learning to think integratively?
• 4:55
  Speaker: Maybe it's rebuilding the timeline.
• 4:58
  Speaker: Maybe it's asking about sleep.
• 5:00
  Speaker: Maybe it's looking more carefully at their nutritional status.
• 5:05
  Speaker: Maybe it's recognizing and looking further into their medications or the effects of those medications, not just the side effects or the interactions, but how does it affect their physiology?
• 5:17
  Speaker: Maybe it's broadening the differential.
• 5:20
  Speaker: Start there.
• 5:21
  Speaker: You don't need to wait until you have a perfect practice.
• 5:25
  Speaker: You can start becoming the clinician you want to be in your practice you're already in.
• 5:30
  Speaker: You don't have to leave that practice.
• 5:32
  Speaker: That is not a requirement to become an integrator or functional clinician.
• 5:36
  Speaker: And if you're building those skills, that's exactly the process you want to go through.
• 5:42
  Speaker: Looking at how can I integrate this into what I'm doing?
• 5:45
  Speaker: How can I integrate this into what I want to do and build from there?
• 5:50
  Speaker: We help you at Bridgewell Integrative Education with the clinical skills, the mentorship, and even practice development.
• 5:57
  Speaker: You can explore the current offerings on our website at bridgewelled.com.
• 6:01
  Speaker: I'm Dr.
• 6:02
  Speaker: Sheri Erwin, and this is Integrative Clinician.
• 6:05
  Speaker: You don't need to own your own practice to own your own clinical reasoning.