Since You Put It That Way
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Since You Put It That Way
Health Coaching: The Good, The Bad, and the Ugly
Health Coaching is a fast-growing addition to the landscape of modern American healthcare. Hear all about it--what works, what doesn't, what causes more harm than good--in this episode from Mary Louder, DO and Katie Suleta, trained Epidemiologist and Informaticist, as they discuss the forms health coaching takes. From scope creep to the physician shortage to the doctor-patient relationship and accountability, they dive deep into this topic to bring clarity and guidance to a much-debated field.
Intro for "Since you put it that way" podcast.
Outro for "Since you put it that way" podcast
Hi, and welcome to another episode today of Since You Put It That Way, the podcast that causes you to pause and consider perhaps a different perspective. I'm your host, Dr. Mary Louder. Today, our podcast is going to be very interesting, it is going to be on something called health coaching. And another title could be Scope Creep. Maybe we should have done this, you know, maybe around Halloween, Scope-Creepy, but actually what it is, we're going to talk about some different aspects of licensure--different aspects of training, in the medical profession in, in one area in particular, we're going to talk about his health coaching and looking at the good, the bad, and the ugly of that. And I'm going to be in conversation today with Katie Suleta.
Mary Louder:And Katie and I work together back in Denver a few years ago, as we oversaw a number, 10s of 1000s, of Medicaid patients around the community in the state. And she was in health informatics and population health. And I was one of the medical directors. And so our paths crossed as we grappled with data, as we grappled with ways to cut healthcare costs while delivering quality care. And so that caused us to be creative and curious about ways that we could disrupt the system in a positive way and influence change. And I think we saw that it was really a lot to bite off and chew and digest. And so I think you'll hear that in our conversation today. And you'll hear that we've got lots of ways we could go and have more conversations. So as we get to that point of the conversation, I want to share just a little bit about Katie's background, she holds two master's degrees, one in Public Health from DePaul University, and one in science and health informatics from Boston University. And currently, Katie's working on her PhD in health sciences, and clinical practice and leadership. And she holds a position with HCL healthcare, which is the largest hospital system in the nation. So she understands something about systems, about change management, about health care policy, about education, about credentialing. So she's got a wide breadth of knowledge that we're going to draw upon today as we talk. And she currently heads up the research component of graduate medical education for this system, which is an absolutely incredible job. So she's going to have some very good perspectives and thoughts about our topic today. And I want to have a mention, too, that this is, some of the statements may sound as if I'm being critical. And I'll throw that out because there are criticisms involved. But the criticism comes from an objective standpoint, and not from a place of arrogance. And I think that it's very important to talk about that, because as a physician, I literally have over 30,000 hours of training. And I have--that's just the training. And I have over 28, 29, 30 years of practicing. And so, that's an awful lot of time in the trenches. And so, these things that I talk about, relative to credentialing, scope of care, scope of licensing, who's giving you what type of information, they don't come because I feel threatened. They don't come because I feel that I'm the only one who has answers. I know on a daily basis, I don't have all the answers, and I'm still practicing. I know on a daily basis that I have patients that have very complex medical concerns, questions, diagnoses, and I've got to dig into the literature myself. I've got to get assistance from the sciences, from the clinical aspects, from specialists, and also from the patient themselves, listening to them and understanding what their concerns are. I know at the heart of this, a patient always can tell me what's wrong with them. I know if I don't know for sure I go back, re-examine the patient, re-ask questions, to figure out what--what do we need to understand that we haven't yet understood? So looking at this concept of health coaching, figuring out how a health coach fits into the healthcare team, is something that I think is a very important conversation because it's popping up all over the landscape. So as you listen today and hear Katie and I in conversation, know that that's the intention and the heart that it's coming from. What's the best way forward? That's the good part, what's good about health coaching. What do we need to look out for, that's the bad part, and what's happening out there, that shouldn't ought to happen, and that's the ugly part. So that's why I came up
with Health Coaching:The Good, the Bad, and The Ugly. Thank you for listening to Since You Put It That Way. And here we go into the conversation with Katie Suleta. Welcome.
Katie Suleta:Thanks so much for having me.
Mary Louder:Yeah. So this podcast is called Since You Put It That Way. And the reason why I call it that is, we look at the same topics over and over again, that are commonly in the news, commonly in medicine, a clinical issue, a policy issue, research issues, and then we look at it from a different angle. And so when I came across, one of your--one of your many publications, by the way, in some nice peer-reviewed journals, I said, Ooh, I've got to find Katie, and talk to her about this topic. So, our topic is Health Coaches: The Good, the Bad, and the Ugly. And, you know, as we're talking at this part, our guests will have already heard a bit of an introduction and... I wouldn't say disclaimer, but let's say a kind and friendly way for me to kind of set the stage about some things regarding credentialing, some background about about the different types of physicians, practitioners, providers that we have in America, and what it all means with different types of licensing and credentials. So I gave a bit of an introduction, so it wouldn't be like, Well, how do we anchor this information? So they'll have a little bit of that to go on. So, share with me, Katie, what your interest is about the credentialing issue with various professionals--and today, we're focusing on health coaches, and kind of, what--what you know, piqued your curiosity about this?
Katie Suleta:Sure. Great question. Being in the Denver area, I've started to see a whole lot of health coaches just kind of pop up in seemingly random places, and kind of all over the place. Going into a coffee shop and seeing up on the cork board, you know, an advertisement for somebody who's got a health coaching business, Facebook will pop up with, Hey, you might know this person who's a health coach or Instagram will pop up with Hey, maybe you should become a health coach. So it just kind of started permeating my virtual spaces, and also some of my physical--my physical spaces, in a fairly big way. And Colorado is also, by some metrics, at least one of the healthier states in the country. And so I think also, by some metrics, probably more health-obsessed than some places in--some other places in the country. And so seeing kind of what was going on in this, in this kind of new and burgeoning healthcare profession. And I started kind of just digging into it and seeing--just kind of taking a look around at who was identifying as a health coach and what their backgrounds were, because as the first article that you came across, and that we started talking about, which was in Stat News, health coaching as a profession is completely unregulated. So basically, there's a little bit of a shout out to The Office here, where Michael Scott declares bankruptcy, and he just randomly one day just says, I declare bankruptcy. And that's all you really need to do to become a health coach, you just need to declare that you're a health coach, and that's it. You don't need to tell anybody that you. You don't need to inform any real accrediting bodies or credentialed bodies. Any you know, you don't need to make this like an official thing. You can just start up a Squarespace website. And that's it. You're a health coach, officially. So I started looking into this because I've worked in the healthcare sector for basically my entire career. And I've been surrounded by medical doctors and Doctors of Osteopathic Medicine--medicine, and nurses, and you know, lots and lots of professionals who are in the practice of healthcare, and health coaching has really started to feel like it's supposed to bridge some sort of gap. And if you dive into the literature on this, it's not entirely sure what gap we're trying to bridge here. And it's almost like we've started from the conclusion and are trying to work backwards. There's a whole lot of--not even a whole lot, but there is there is evidence, there's a body of evidence that basically just states like, health coaching works, we know that it works, and the way that we know that it works is patient outcomes look better. But we never stated what health coaching is, who should be--who should be acting as a health coach, and what might be the best practices for health coaching. It really just became a like, well, we--we quote-unquote, coached some of the patients around health topics and things got better. But again, most of the literature on this doesn't say anything about who actually performs that service, what it looks like, what are the guardrails around it, etcetera, and a whole lot of the literature around it also talks about how most of the health coaches in these studies are professional. So they're MDs, DOs. Right? So they're, they're somehow healthcare professionals who are practicing and have some sort of license, right, so even RN, something like that. But I started taking a look around to see what was going on just anecdotally kind of on the ground level to see like, is that actually who is practicing as a health coach? And from what I can see, and from what I can tell, the answer is no. You do have some people who are RNs, or MDs or what-have-you practicing as health coaches, but it does seem as though by, by a fairly large numbers that most people who go into the health coaching realm don't have a background in health or health care. And so that's what really got me interested in this kind of burgeoning field.
Mary Louder:Yeah, that's a great answer. And, you know, it's, it's interesting, because we've got, we--there's some huge assumptions made here that you listed, one that health coaching works. But what does that mean by change in outcome? What are we actually measuring? And so I think that's super important. And that I agree with you any- and everybody could be a health coach. And they can just simply hang a shingle, put up--and now in the virtual world, that means putting up a website, right. And so that's done. And then the other thing is, what are people actually looking for when they're seeking health coaching? And so I've thought about this at multiple levels. I thought about it from a change management level, which has to do with organizational management and change management. I thought about it from a clinical aspect. I thought about it from a, maybe humanitarian and humanities with connection, relative to the doctor-patient relationship. And I've taught--thought about it from a logistics or legal aspect. And so I think that this podcast has been a little challenging for me, because I have lots of opinions about this. I have some biases, that would not be implicit, meaning I don't know they're there, I got some strong biases that I wear on my sleeves, and the sleeves are long. So I admit I have biases. And I also have some very big concerns about this. And yet, I have a health coach in my practice. So I've also embraced it. So, it's a very interesting position to sit in, to then give some thoughts, opinions and guidance from. So let's look at this from maybe the concept of what we would call scope creep. And scope creep, is, it, you know, we take that from a change management, engineering, organizational management world, of where different aspects, when you're bringing change into an organization, scope creep means you just basically expand into different areas where there's a lack of clarity of expectations, there is miscommunication, perhaps a non identification of goals, and perhaps a lack of understanding of outcomes. And if we look at it from exactly that, that kind of summarizes what you shared in the beginning, isn't it? Yeah. And so it's like, yep, this area is ripe for scope creep, because of how it's set up. And so, to that, I say, I'm not sure it's the health coach's fault that they're stuck here. Or that it's really their intent to be here, because I think people are well intended to help others. And I think in medicine it's like saying, well, there's a bunch of bad physicians. Well, I don't think so. I think the system is not a very good system for health care. And we have lots of issues in our country that we need to overcome, and policy, which we'll get to another policy podcast with you down the road. But--but all that doesn't take away from what the intention is, which is to help people be healthier. Right?
Katie Suleta:Absolutely. Yeah, absolutely. And I, I agree with you, I would, I would venture to guess that most people that get into health coaching, it's, it's out of kind of that same instincts that drives people to go to medical school, or drives people to go to nursing school or, you know, insert any other type of health care profession, right? People want to help others. They want to believe that they are doing good, and they want to feel like they're having an impact. And so it's not necessarily their fault that they're in this--in this predicament. And I also certainly sympathize with that, you know, in that first article that we started talking about, I talked about how the average physician visit for a routine physical is really, really short. And so most people are going to be left wanting because they want to talk more about what might be going on with them or questions that they might have. But the way that our system is set up, physicians are extremely pressed for time. And that's not going to change anytime soon, even though we are sort of in the midst of moving from this fee-for-service model to a value-based care model. But physicians are going to continue to be extremely pressed for time, especially as we are also experiencing this physician shortage. And so it is completely understandable and reasonable that other people, or that patients would want to talk to somebody more frequently and, you know, at some length that's longer than roughly 18 minutes, about what might be going on with them, and to get their questions answered. So that's a completely understandable and relatable impulse, right? And so again, people going into the health coaching realm, it's one of those like, they want to help people, some of them just might be trying to sell something, but most people, I would venture to guess, are trying to--they genuinely want to help other people. And then also from the patient perspective, they want to have their questions answered, they hi--health is really confusing. There's just, you know, so much information So like, yeah, people want to talk about it, that's completely about it all over the place. understandable. Not necessarily their, their fault that they're in this position, but there are certainly people that are going to take advantage of this position. Right? And so that's, and I think it's really interesting also, that you brought up policy, because there's--there is this question of what does health coaching do? What are we ultimately trying to accomplish with it? Because if we are trying to have better outcomes for patients, is this the way to do that? We might already have an infrastructure set up for that, but maybe we need to, you know, think about how to better set it up for that or make some changes to it, in which case, is health coaching just a bandaid? Or is this something that we actually want to turn into a long term solution, right? And especially one of the things that I've seen, anecdotally, and you didn't ask about this, but anecdotally, I've seen a lot of health coaches are women, and a lot of their backstory is tend to be around receiving a diagnosis that is very skewed for women as far as something like endometriosis, breast cancer, even Hashimoto's, thyroid disease, right? Stuff like that, and so it's like, well, there's something there. Is it that we just haven't done enough research on these diseases? I think the answer is yes. And it can be "yes, and," right? We have neglected certain segments of the population. And so there's definitely like, people feel like they're desperate for answers. And they, they're desperate for people to talk to them about what might be going on with them. So I completely understand how this is working, but also trying to understand what exactly are we trying to accomplish with the profession of health coaching, because they can't be a bandaid for everything, and they can't, and to get to your scope creep thing, they can't do everything.
Mary Louder:Right.
Katie Suleta:And so we really need to start thinking about answers to those questions.
Mary Louder:Yeah. So to that end, what a health coach actually does, and I've gotten some definitions from the National Health Coaching organization. So I went right to the top, some of the credentialing and certifying bodies that that are actually there and legitimate and have some, I would say, skin in the game and have some, you know, boots on the ground in terms of how they're training people. So here's a definition of what health coaches actually do. They're trained in behavior change and motivational techniques. Rather than acting as the expert and giving advice, the coach creates an environment that gives the client permission to take the lead, I would see that as like empowerment, and I would see that as maybe, you know, motivational interviewing, and they adhere to what the client wants, not what the coach thinks they should want. And the client determines their unique goals through a process of self-discovery, accountability, and the coach then facilitates a change at a pace that is set by the client. I think--yeah. Now how I see that is I see that as someone who's on my team, who picks up some of the pieces that are very, very important, and uses skills in motivational interviewing, for example, if I have a, I agree, a diagnosis that has many steps to it, or many challenges, and we've got some things to do, whether it's go to a specialist, have some imaging, get ready for labs, or there's a new medication, or perhaps a supplement, or, even if we just stay in the lifestyle area where we need to increase activity levels or find some mindfulness techniques. I assume as a physician, when the patient and I are working together and they say Yes, Doc, I want to do that, thank you very much send the the information, and it goes out in the clinical summary to them from the the visit summary. I assume they're going to do that. Now, I've been a physician 30 years, and I still assume they're gonna do that. I haven't changed. I don't know if I'm slow or naive, or, you know, optimistic, I'm not sure. But-- An eternal optimist, I can relate, yes. But I'm, I'm assuming that they're doing this, and then you circle back around and find out that they aren't. And so that's that, accountability. But it's not that you're trying to hold their toes to the fire, what you're trying to do is all--is to help them transform, to help them grow, to help them change. And definitely we need people in the trenches helping the physicians do that with the patients or with their clients. Would you not agree with that?
Katie Suleta:Potentially, yeah. I don't disagree with it. And I Because as you started off by talking about scope creep, one guess my only hesitation around it is really kind of that policy of the--I actually just published an article today on piece of, what exactly are we trying to accomplish with health coaching? Because, yes, I do agree that especially in our current system, and the way that we have things set up, yes, it would be great to have basically somebody that could help hold sort of that scope creep piece, which is, you know, health people accountable, and/or just make people feel like they have somebody else on their team kind of rooting for them and rooting for them to make whatever changes they need to change from a lifestyle medicine perspective, or, you know, develop new habits, whatever it might be. So yes. But again, thinking about it from that policy piece, really, I just keep going back to what what is the ultimate goal? And how do health--how does a health coach kind of fit into the larger ecosystem of healthcare? Because I do think that there is a place for them. The question just then becomes, what is that place? coaches who are interpreting lab results. That's not something that they are trained to do. And that's not something that was included in that definition that you read, that is not something that, you know, I I do not want them doing, ultimately, like if they are an MD or something to that effect. And they've been trained to do that, that, that--that is one thing, right? But just a health coach as kind of a profession, especially as one--as a person who doesn't have a clinical background, I have a lot of concerns about that. And so we're starting to kind of see, the wellness industry is starting to sort of start that scope creep with health coaching of like, you know, starting to starting to, I guess, offer those services that it's like, well, you can make more money this way, which might be true, but also doesn't mean that they are helping you and they're not necessarily helping patients in any sort of real meaningful way by offering the service.
Mary Louder:Yeah, I--and I think that's an excellent point, because I got researching into this topic because of something that I was involved with as a physician, and just by business growth. And I had a health coach approached me, and literally say this to me, I can do the same thing you do. Which I said, please say more. I didn't know initially, I said, please say more. I'm curious, what can you do that I can do? And it was in this very area of interpreting tests. Well, I interpret tests just like you do. I said, really? Well say more. Again, I was curious, right? I was trying--and when they finally in, when they finally the conversation was done, I said, Actually, you can't do those things. I said, number one, it's illegal. Number two, you don't have the experience and the credentialing and the license, etc, etc, to which they said they've done just as much as I've done. Again, so they kept holding their ground. Yeah. And I would say, that would be where I come across now, with a bias as long as my sleeves, and understanding I have a strong opinion about this now, based upon what I've seen. And so as I searched out different and read about different coaching programs, there's ones in functional medicine that literally call these folks functional medicine practitioners.
Katie Suleta:Yep, I've seen that.
Mary Louder:And when we use the word practitioner, that is in the Webster's Unabridged Dictionary, a licensed professional who gets paid for professional licensed activities. So the things that I think of is a doctor and a lawyer when I think those two things, right. And so I think we have to be very careful and clear what the definitions are. And I think you're right that you know the scope of practice, and the scope creep, I've got some more things here from one of the, what I found was some better resources for what health coaching is, is that the coaches facilitate and empower clients to develop and achieve health and wellness goals. I think those goals would be set by the clinician, by the physician, by the Nurse Practitioner, by the Physician Assistant. And hopefully that physician is also working with those mid-level providers to provide a whole health care team. And then the coaches assist the clients using their insight, personal strengths, and I would say probably motivational interviewing, to set goals and action steps. And they may offer evidence based resources from a nationally recognized authorities. I would say that would be under the guidance of the clinician as well, because you wouldn't want a health coach giving out data and research that they think should be followed. But what they cannot do, and what is completely out of the scope, is provide diagnosis or treatment recommendations, order or interpret labs, recommend or sell supplements, provide psychotherapy, give nutritional advice, or design exercise plans.
Katie Suleta:Except that they do, especially on those last three points. I mean, I mean, I've seen so many, I've actually been working on a study looking at a small sample of health coaches, and how many of them recommend supplements and sell supplements. Right? And so basically, that's your unregulated treatments right there. They don't have a prescription pad. But that doesn't mean that they can't, they can't prescribe, quote, unquote, prescribe-slash-recommend drugs to you, they just aren't regulated, especially not in the same way that our actual drugs are regulated. And then I've also seen, I--just about, I won't say 100%, but I mean, it's got to be high 90s, how many health coaches provide nutritional plans and diet advice, right, and stuff that normally you would think of as a registered--as the realm of a registered dietitian, but they're not.
Mary Louder:Right? Yes. And in Florida, they cannot do that, for sure. That's like, a hard-and-fast law. So it's interesting, because there's another point that you bring up about accessibility to the physician, and the--the, maybe a challenging diagnosis. And when I hear those things, what I hear as a physician is, does the patient feel heard and seen and understood? So, I also see where there is an opportunity. And they refer a person who takes an opportunity--are they an opportunist? Perhaps--stepping in the realm working with the client, because they're not seen, heard or understood. When that occurs, there's an alliance that forms a relationship, a connection that forms that might not be based in the deepest knowledge, that might not be based in the highest level of licensure. And I have seen communication triangulate. I have seen health coaches, and other professionals, undermine the physician, or say, Well, if they aren't going to help you, we can help you. Or, let us help you find a different relationship. Now, like any relationship, if you don't gel with your physician, you got to figure out why.
Katie Suleta:Yeah.
Mary Louder:You know, it's when--and I, as a physician, personally, I--and professionally, I hold the doctor-patient relationship as the most sacred thing. And I always have. And I know that if I listen to a patient, they're going to tell me what's wrong with them. When in doubt, when in doubt, I go back and re-examine the patient and re-ask the same questions. Because there's something I'm not understanding, there's something I'm not seeing. There's something that just hasn't made itself known yet. And no matter what, and even have I ever made mistakes as a physician, yes. Have I owned up to them? Yes. I've never been sued in my entire career. I've never been named in a suit. Never had a board complaint in 30 years. So I think that means I kind of have something that I understand about communication, and connection with patients. So I don't take this topic lightly, and I don't dismiss people from wanting to help, you know, just because I'm the doctor and I'm all knowing because I'm not because if I don't know something, I'll also tell the patient, I don't know, but I'm here to figure it out and help you. Right? So, and I haven't seen that in the health coaches, especially in this--let's take this one little vein, see what you you know what your thoughts are about the functional medicine health coaches, what do you have you had experience in that realm and the exposure there?
Katie Suleta:Yeah. And I, the Functional Medicine Practitioner title concerns me a whole lot. And it is I think it is specifically designed to confuse people and make them feel as though they are getting, they're basically seeing a doctor. And I've also seen people who have who hold the functional--Functional Medicine Practitioner title, whatever that actually means, call themselves doctors, I've seen it in social media, I've seen it in influencers, right. And part of this conversation does actually need to involve social media and influencers, because a whole lot of people who are identifying as health coaches are influencers. And then a whole bunch of people who are influencers may not totally identify as health coaches, but that's 100% what they're doing, and they're playing in that realm. And so I think it's important to acknowledge those things, because there's a lot of money to be made here. And I think that Functional Medicine Practitioner title specifically exists for people to make money off of it, and not to actually understand and help plug a hole in the healthcare system, or like, you know, help with--help bolster the health care system in some way. I think it's just there to take people's money. And I don't think that it is the fault of the people who obtain that title necessarily, that they kind of fell into that. But there is an important conversation to be had about when people are feeling frustrated and not heard, right, by their physician, by the healthcare system, whatever it might be. There's a gap there that people can fill. And a whole lot of different types of people will try to fill it, you'll have do-gooders and people who are well intentioned, but you'll also have other people who are out there trying to make money. And I think that's a big part of what's going on with that Functional Medicine Practitioner title. And it's there to confuse people, and not just patients, but also the people that hold the title, right? Make them feel more important and more trained than they actually are so that people then have the audacity to walk up to somebody who is a trained physician and say, I can do what you do. And no, no, actually, that's not the case. Right? And is it their fault that they think this? Yes, and no. Trying to understand exactly what goes into functional medicine practitioner training versus physician training. But also, is it their fault that this thing is being offered and that they fell into it thinking that like, they could do good with it? Maybe not so much on that part. But that's why I think it's been important and so interesting for me to kind of journey down this road talking about, what is health coaching? What is it trying to accomplish? What do we ultimately need it to do? Because there are a lot of opportunities in our system to make good changes for patients and for physicians and for our teams, right? There are a lot of opportunities there. But I don't--I want us to be more thoughtful and mindful about how we are trying to address those things, instead of just kind of allowing the market to determine who goes where. That's not quite--and how those things are actually--how those things are actually addressed. Right. We want to be more thoughtful from a policy perspective and also from a profession. From like a, from a professional standpoint, you want to be more thoughtful about this, because if we do want health coaches to become a part of our ecosystem, we want to start talking about what their training should be, standardizing it in some way so that we make sure that people are getting decent advice, right? And that they're--and trying to make trying to limit that scope creep, so that you don't have as many people who are like, Well, I'm health coach, but I can totally interpret your lab results for you. Or, have you thought about going in and buying X, Y, & Z supplements, by the way I sell them, here you go, and don't--you don't need to worry about going to your doctor for that. Because like I can just, I can just, you know, recommend the supplement for you and you can buy it. And just making sure that that kind of stuff is not happening.
Mary Louder:Yeah, I think that's a really, those are really good points. And so it even looking at scope creep if we look between MDs and DOs, which are the top of the, you know, licensing in terms of unrestricted licensing. And then if we look at mid-level providers, such as a Nurse Practitioner, or a Physician Assistant. I mean, there's even a lot of confusion there in terms of scope creep, and I hear it in the following way. I hear it, Well, I'm seeing Dr. Smith, he works at this practice da ta da ta da, you know, whatever, Tree Trim Lane, whatever. And then you look up Dr. Smith, you really Dr. Smith is actually a Physician Assistant, and his name is Dr. Jim, but they--he's not a doctor, he's a Physician Assistant. And he's never really clearly identified that. And then I found that also with Nurse Practitioners, and when we look within practices and even when I practice in Colorado, the way the, the laws are, when I was medical director over a number of urgent cares, the mid-level providers practice independently. And now, they were under my license in terms of the responsibility I had to them and the State Medical Board. But they also practice independently at a facility. And I had certain criteria. I had to be there, I had to credential them, they had to be credentialed. But that still was, in my mind, that took me, Oh, I don't know if I would say I was never really quite used to it, but it was nerve wracking at times, knowing what can come in through an urgent care. And so you really have to have people that you can trust that understand their own scope. But you know, it's interesting, because as a physician, I have a scope of care. I'm a licensed physician, unrestricted and I have--hold licenses in multiple states. I still can't take your tonsils out. You know why? Because I'm primary care. Right? So I have a scope that I have to practice in, right? I can't put a pacemaker in you. Now, can I put a temporary pacemaker on you? Yes, if I'm ACLS certified, right, which I have done that in emergency room setting. But I still have a scope that I practice in, and a community standard as well. So it's not like, I'm certainly not sitting here pointing the finger at everyone else saying, well, the physicians are the only ones who can do absolutely everything all the time. Because that's not true.
Katie Suleta:Well, it's not--it's not only not true, I think it's also not fair to everybody, right, including physicians. I mean, we are experiencing a physician shortage. Physicians are saddled with increasingly more responsibility, because they are expected to take on more patients at this point, because we're experiencing a physician shortage. And so if we can kind of help lighten the load, that's not a bad thing, especially if we're, especially if we're actually taking the time to consider where different types of duties and responsibilities to a patient might actually be best placed, right? That might not always be with a physician. But that doesn't mean that you can just have people walk in declaring, but now they work in health care with no background in it whatsoever, and then start quote-unquote, treating patients, that's just not, like, that's not how our system works. That's not how anybody wants it to work, nor should it. That's how people die. That's, that's how people get hurt. That's just not what we need. And so I think, again, it really does come down to if health coaching is here to stay as a part of our healthcare ecosystem, what purpose is it serving? What ends do we, I guess, what are the outcomes that we're looking for here? How does it actually fit in? To, you know, for all of these things? Because again, I do think that there could absolutely be space for this. It just depends on how we want to kind of address the issues that people are reporting going into health coaching, because of, right?
Mary Louder:Yeah, so two things here, as we kind of wrap up one, the physician shortage--very real. Very, very real. And that is a limitation based upon residency positions coming out of medical school. Annually, 9000-plus medical students who graduate cannot get their postdoctoral training. Because these positions don't exist, because Medicare has limited them, they haven't expanded. Now, what I see in the Medicare and this is a whole different topic, we have to not open this can of worms, but at least point to it, the Medicare--companies running Medicare have made billions of dollars in profit margins. And it's on the backs of taxpayer dollars. And it's at the cost of care to the individuals and limiting of residency slots, which I have huge ethical issues with. So I'm going to leave that there as a can to point to that we get to come back to, because I think we'd be going on for hours. But I want to just touch base about that. Speaking of hours, I want to touch base about an MD and a DO, 20,000 plus hours of graduate level training 15,000 hours plus of clinical experience 35,000 hours. 35,000. Thousand, right. I feel like Dr. Evil here, 35 Thousand. For a nurse practitioner, it's 3000 to 50, or correction, yeah, 3000 to 5500, and then 500 to 1500 of clinical. And that's about the same for a Physician Assistant, maybe even a little bit less. So we've got a differential here of time and experience and just that's training, let alone, I still say I'm practicing 30 years later, because I don't--because I'm still learning and growing. So If we want someone to find a health coach, and we want someone to know the credentials of the individual, I'm going to say what I recommend. And then I want to hear what your thoughts are about this. Number one, if you're looking at a website, always look for the About page. What is that practitioner, that person that professional about? What is their license, their certification, their credentials? Are they in plain sight? Are they listed clear? Is there no ambiguity? That they're not calling themselves doctor and then a first name after it or just doctor with the last name without any thing like MD, DO, PhD, DC, licensed acupuncturist, things like that, you need to literally have things that identify a license and a credential. And then in their services offered, literally listing very clear what they can do. And same thing in looking at an informed consent, understanding what you're getting, who you're seeing, who's delivering services, and the risks, benefits, side effects, outcomes, and alternatives. Tell me where I'm wrong here.
Katie Suleta:Yeah, the About Me page is going to be really important. And if you don't see a list of, this is where I went to school, this is what my degree is in, etc, that should be a red flag, because if they don't have that listed, it either means they didn't go to school, or they didn't go to school for something relevant. So having a theater degree, I think is totally fine, as a lot of people do, and the world is a better place for it. But like, that is not who you should be going to as a health coach, right? So having kind of making sure that there's that transparency. And then I also hate to say this, but making sure that--checking up on certificates, any certifications that people might say that they have, and or where they went to school. Is it real? Is it accredited? I, you know, in this age of, you know, everything is real on the internet until it's not, or until, kind of, we all collectively decide that it's not, it's really important to make sure that people actually went to school and went to a school for a plate--at a place that's real and credentialed, and is not just kind of Groucho Marx's school of hard knocks, or whatever it might be, I mean, we want to make sure that people are actually going to accredited institutions. And then also kind of digging into that About Me page a little bit more to see if there's information on what their kind of ethos is, right? So in the way that people kind of look for a therapist, I would recommend the exact same thing for a health coach. Figure out what their ethos is. And honestly, if they recommend supplements, and they're selling supplements, red flag. Do not go to that person. They are not qualified to be doing that, and they are just trying to make money. And that's a red flag, you don't want to be working with somebody like that, right? Ditto if they're hawking random other wellness products at you that they have no real understanding of. And so I think, really just kind of doing your own homework and understanding who it is that you might be dealing with is really important. And oftentimes, too, they do offer, many of the health coaches that I've seen, offer a free 15 minute consult, free 45 minute consult. If you're really interested in somebody take that consult and ask them questions. Yes. Ask them questions about what the process looks like, you know, how it works, and really kind of start to dig into it with them, because that's the only way that you're going to get some of those questions answered. The website stuff is pretty easy. And you can usually get it answered within two minutes. But if you're actually interested in going into business with somebody and paying them for the--their services, then I would hop on a free call and really start asking them questions.
Mary Louder:That's a really good idea. And all those things are on my website as a physician, building a virtual practice. But in addition, there's a get acquainted call, Membership Exploration, because we do value-based care for lifestyle medicine. So it's like, is this the fit? Is this where you want to invest your dollars for your health? But make sure you know, clearly what their licensing is, what their experience is, and go from there. So I think there's--I agree with you Katie, I think we've maybe come around to say there's great potential. I think we need to identify the goals. We need to identify the scope, we need to identify the objectives, and then how we can measure whether these outcomes are good. And I think it's--I think it's a wide-open field. Depends upon your part of the nation. It might be the Wild West, might be the Midwest. Might be the last frontier, I don't know. But I think there's lots of opportunity here for us to do the right things with our good ethics and licensing and credentialing in place. So, thank you for coming on and talking about this important topic. I think we're probably you know, we'll, we'll get together down the road and do some more policy discussions and I think maybe do some up--updating on the scopes and credentialing because I think there's a lot more to talk about with credentialing as well. And what--where we're going in healthcare. So thank you, Katie, for being a part of our podcast Since You Put It That Way.
Katie Suleta:Thanks so much for having me.
