Dr Andrew Greenland: 0:00

So, welcome back to another episode of Voices in Health and Wellness. This is the show where we dive into the real stories and strategies behind the people shaping the future of care, from wellness innovators to frontline physicians. Today's guest is someone who truly embodies the balance between clinical excellence and entrepreneurial leadership in healthcare. I'm thrilled to welcome Dr. Loren, the founder of North Star Allergy, Asthma and Immunology, based in Florida. As a board certified allergist and immunologist, Loren leads a practice that's not only providing high-quality care, but also deeply rooted in education, accessibility, and patient-first values. So, Lauren, welcome to the show and thank you very much for joining us this afternoon.

Dr Loren Isakson: 0:37

Thank you so much. I appreciate you having me.

Dr Andrew Greenland: 0:40

So maybe we could just start at the top. Could you give us a sort of a little sense of your journey and how you've ended up doing the work that you do at North Star?

Dr Loren Isakson: 0:48

Oh, sure. Well, my journey's been uh quite a long one, actually. Um I went back to my days in my undergraduate, I studied physiology for my bachelor's of science. And uh I was sort of on the typical uh pre-medical track, thinking maybe I would go into medicine straight out of that undergrad. And I found that in my fourth year, I was taking a class called uh, I think it was called artificial internal organs or artificial cells, something like that. And I became quite fascinated with how it was that they did the experiments rather than the result itself. So the the process really uh intrigued me. So I decided, well, you know, maybe I shouldn't go into medicine just yet. Um, but I was smart enough to know to take my medical college's mission admissions test. I knew that all that information was stored in my head. Um, so I did that and I let those sit for a while, and then I went to do a master's of science and biotechnology. And uh throughout that time I did a bunch of research. I was able to spend a little bit of time down at the National Cancer Institute. And uh during that time I found that I really enjoyed my time there, but I did miss some of what I thought medicine would be like in terms of patient interaction. So I had learned that you could do some research throughout medicine, and I decided to apply to medical school, um, which I did and had a great time there. Um, I always knew I had an interest in in immunology and allergy. It's a bit of a puzzle, uh, it's very intriguing to me as well. So uh as I did my rotations, I kept an eye on those kind of things. Um, I of course you do a number of different fields that you get exposure to, and uh I felt that pediatrics uh was something that I gravitated towards. And before you can be uh in a fellowship for allergy and immunology, you either have to do residency in internal medicine or pediatrics or medPeds. So I enjoyed the pediatric side. So I did my my residency and pediatrics first, and then I did my fellowship in allergy and immunology afterwards. And um I enjoyed doing that. I like the academic environment. I did think perhaps I would run a lab at some point, but I I found academics was a little bit challenging to do the kind of esoteric work that I wanted to do. Um, so I I ended up sort of going my own route. I I actually worked uh as the medical director for allergy and immunology services at Mickhill Air Force Base. I myself was not in the military, but I helped them out. And as I grew over time there, I decided that I'd like to eventually open my own clinic. And I did a master's of science and entrepreneurship in the midst of working at the Air Force base and then sort of transitioned into my own practice because I didn't really know anything about running a business. They don't teach you much of that in medical school. Um so I figured rather than start on something that's completely far afield for me, I've at least have a pretty good understanding of medicine, though there's lots to learn. And then I'll learn about how to run a business, and then those two will kind of come together and we'll look at other things in the future. So it's a bit of a long-winded answer, but that's how I got here.

Dr Andrew Greenland: 3:48

Amazing, amazing journey. And so, in terms of where you've ended up with North Star, tell us a little bit about the setup and what you do uh for your patients there.

Dr Loren Isakson: 3:56

Sure. Yeah, I I would say um interestingly, my intent was to launch with telemedicine, which is exactly what I did. Um, and I had a lot of advice from people to sort of just open the floodgates, if you will, and and build your traditional bread and uh butter brick and mortar practice. But this was uh, I mean, going back to 2019-2020, and my inclination was to sort of build things slowly. I I guess it probably has the terminology lean startup, which wasn't what I was aware of at the time, but that was my inclination. And so after I launched with telemedicine, um, with a little bit of an in-person presence, um, COVID came. And a lot of those same people who gave me the advice about going big and so forth, they were suddenly very concerned with how are they gonna pay their staff. And I douged all of those headaches. Um, but accordingly, as time went on, we have started to make more of a shift from telemedicine uh to a traditional uh in-person presence, much like what I did at the Air Force Base. So on the day-to-day clinical, um, there's a lot of standard things that we do, uh, you know, skin testing, allergy shots, all that kind of stuff. But I think what sets us apart is is my fellowship was very, very heavy in immune deficiencies. Um, I have an enjoyment for it, whereas it's uh can be a burden for some practices in terms of efficiencies, but it's sort of how I look at things. And we did a lot of work with the bone marrow transplant team during fellowships. So it's something that I think you don't see in most practices, but I'm able to look at allergy through the lens of an immunologist. And we see kids and we see adults, I'm very comfortable with all of them. Um, I'm not a rheumatologist, but we did have a lot of rheumatology training in our uh in our program. So I I have a fair bit of experience with rheumatology patients as well. So that's sort of what we're doing right now.

Dr Andrew Greenland: 5:45

Great setup. And but what does a typical day look like for you at the moment? So between seeing patients managing the practice and maybe everything else that you do and balance?

Dr Loren Isakson: 5:54

Yeah, so so a typical day is all of those things. Um it can be going from somebody who sneezes near cats to somebody who desperately needs um antibody replacement therapy, to the website not being optimized and crashing, perhaps, although that's pretty rare to billing headaches and dealing with the insurance companies. So uh as I've started to hire some more uh team members, as we continue to grow, I'm able to uh delegate a lot of those responsibilities that are non-clinical, which I happen to actually enjoy, but at some point you realize you only have so much bandwidth and uh you're never gonna grow in the direction that you want to unless you get some help, which has uh been a challenge for me. I'm somebody who likes to roll up my sleeves and get involved in everything, but uh I've realized that uh sometimes less is more in terms of getting where you need to.

Dr Andrew Greenland: 6:45

Um you've been in the specialty, sorry, being in the trenches of specialty care. What keeps you passionate about this work?

Dr Loren Isakson: 6:52

Well, I would say the immediate impact, honestly. Um, I remember during uh residency, we did some things perhaps in neurology or or other areas where we did extensive workups, but the state of the art of medicine there was a little bit challenging in terms of being able to help people, um medicines and just some limitations that our medical technology has. But in allergy and immunology, we can actually make an immediate impact in our patients' lives, be it that day with just medicines, or again, like I said, giving back antibodies to somebody whose immune system is deficient in those, but also with an eye towards clinical trials. And those clinical trials are exciting because they're not just about big pharma these days. Uh, there's a lot going on with wearables and med tech that you can make into meaningful uh data points that you can extract uh valuable insights from. So I think that's nice in terms of uh tying together my entrepreneurial interests, um, but tying it to really sound, good, solid medical uh studies.

Dr Andrew Greenland: 7:51

Fantastic. And what shifts are you noticing in terms of patient needs or expectations? And has that changed um since the pandemic? Pandemic being quite a landmark for us all.

Dr Loren Isakson: 8:01

Well, you know, I I would say I'm probably the wrong person to ask uh on that question. And the reason being is my expectations of what should come out of a visit are far often exceed perhaps what a patient's expectations are. And that's not meant to sound arrogant, it's just that allergy immunology is a very, very, very detailed um type of uh uh field. And I think that uh I think we generally answer just about the vast majority of the questions that we need to. So if I had to say from a consumer perspective, maybe rather than a medical perspective, it's sort of that instant access, if you will, um, almost like the Amazon experience of customer care and messaging and artificial intelligence. So there's a little bit of a shift there, but I I've tend to embrace those things early. So they're things that I would want as a patient. And I often try to think for my clinic, what would I want if I'm seeing another specialist? And often that aligns, I think, with the patient sentiment and the broader public.

Dr Andrew Greenland: 8:57

Interesting. And there's also a lot of talk about burnout in healthcare. Have you seen this manifest in your experience or the people around you in the work that you do?

Dr Loren Isakson: 9:05

Uh yeah, definitely. I would say burnout is definitely pervasive. Um, I'm certainly not immune to it. Um, but I I think that, first of all, at least I feel that I personally have a strong resilience to myself. And I try to reframe things rather than this is another frustrating day as to sort of this being a puzzle, how can I solve the issues that frustrate me and tire me with the technology at hand or finding the right people to work with? But yes, burnout is definitely pervasive. Um, I know that a lot of people are leaving medicine and trying to go into other jobs and medtech. I would say that um that's certainly an ideal thing for some people, but my hope is that uh you know, some people might actually lean into medicine a little bit more and find out how they can maybe take a part-time role in health tech or advising or some other things that they don't necessarily entirely throw away medicine, but it's certainly understandable if they they don't want to walk that path anymore. I'm sure there'll come a day that that happens for me, but I'm still a ways off from that.

Dr Andrew Greenland: 10:05

Thank you. Um, you've talked a little bit about technology and how you sort of improving the customer client experience, but how else is um technology helping you in the whole world of allergy and immunology at the moment?

Dr Loren Isakson: 10:18

Well, it's certainly helping or at the the infant stages of helping in terms of efficiency, all these things with AI scribes are certainly making documentation easier. They're not quite there for my workflow, at least. I think they certainly help in in some other people's workflows. So from my perspective, we still need a human or maybe a couple of humans in the loop to get things the way that I like them. But I would say it's helping there, it's helping um combat uh you know denied claims. Uh there's a a lot of conversation between AI that's happening. Between AI, I feel that maybe is able to remove doctors and staff. So I I think that that's um very helpful. We're we're not entirely replaced yet. Maybe that day will come. Um, but uh I I think right now maybe what AI hasn't been able to do is quite understand body language and uh a patient maybe telling you something with with their words, but maybe saying something else uh that's quite different that you have to pick up on the nuance of that in person or through a video camera. So there's some opportunities there. Um, but uh I mean you can you can find AI or computers and everything and just have to leave it to your imagination. There's always room for improvement.

Dr Andrew Greenland: 11:30

I'm sure it's only a matter of time before they could pick up the um uh body language and sentiment. I mean they can do it very well on the audios, so I'm sure it's only a matter of time before we can do it in the visuals.

Dr Loren Isakson: 11:39

Yeah, it's coming.

Dr Andrew Greenland: 11:41

It's coming, it's coming. So you mentioned a little bit about your masters in entrepreneurship. What were some of the the big learnings that you took from that in order to set up and run your business?

Dr Loren Isakson: 11:50

Yeah, well, you know, honestly, one of the biggest learnings I took from there is that I'm capable of learning in a different way than I thought I was. I I was very much a person, and learning is is a super important skill to being an entrepreneur. Um, you're not going to know everything, but you have to be adaptable and get yourself up to speed. So, what I really mean by that comment is I attempt to be uh in the past very focused on writing things down, taking detailed notes and refining things. But the scope of the work that I had to uh go through through my program, coupled with my busy schedule as a clinician, because I was taking night classes, I had to learn how to learn through audiobooks uh often when I would listen uh on the car ride from the clinic on the way over to evening classes. And that's something that really surprisingly made me step outside my comfort zone. Um, but I really just didn't have the extra hours to sit and read more textbooks as I'm keeping up with my maintenance of certification readings and exams. So I found that I'm actually much better at that than I thought I was. Of course, I have to go back and read things, but that that was actually a pleasant surprise for me. Um I think in general, uh a lot of the things that we learned in business school is things aren't as scary as as they make them out to be in medical school through the lack of education that we have on business. And at the end of the day, um, you know, if you make a mistake, it's it's it's uh affecting the clinic, but it's it's usually like something's off in your balance sheet. It's not that a patient's gonna have a cardiac arrest. So you could take some comfort in knowing that the risks are there, but they're not as bad as they are in medicine.

Dr Andrew Greenland: 13:28

So with North Star, what's um obviously you've put lots of things into place. It sounds like an incredibly well-run, successful business. But what's working particularly well in your practice that you're most proud of?

Dr Loren Isakson: 13:39

I mean, uh, I think again, the immediacy of the impact that we can make in people's lives, particularly with the advent of biologics. I've been very happy uh by that. And what I mean by that is monoclonal antibodies that were not available to us in many, many years for other diagnoses. Um, if you were to use asthma, for example, many years ago, uh people just went to the ER and got steroids. And I had a patient who had maybe 11 or 14 uh ER visits before we were able to get them in another environment and use some biologic medicines. And at that point, I think under my care and our team's care, it's not just me, but we use biologics and they had uh one ER visit in a couple years. So that's really a testament to research and development, not just our approach, but um I think those are some of the things that I really enjoy and also making differences on the business side of medicine as well.

Dr Andrew Greenland: 14:29

Thank you. And certainly on the other side of the coin, what are some of the most frustrating challenges that you've had most recently, either whether that be operationally or in delivering care?

Dr Loren Isakson: 14:40

Yeah, I would say uh they're tied together uh somewhat, and uh it's a common complaint I'm sure you'll find is uh is often working with uh insurance companies is certainly a challenge. Um, we're quite happy to try to do that. Uh I think that as a solo independent clinic, that can be a little bit more challenging. But there's some really great people and some services out there that can help take some of that weight off of us. Um, I can't claim to understand some of these bills that come out from hospital systems and insurance companies, and they're very, very inflated, and then some sort of magic happens in between, and then you're paying a very reasonable out of cost, uh out-of-pocket cost if you have the right insurance. But if you don't, that's an issue. So I would say that's probably common to uh almost every practice and and also a driver of burnout as well. Um, but using technology to help alleviate some of those concerns has been a refresher.

Dr Andrew Greenland: 15:32

It's interesting. And we've done a lot of these conversations, uh, all that you know, this has been a global podcast, but most of them have been within North America, and I don't think there has been a single practice that hasn't referenced the whole insurance and the billing thing. So it's uh interesting that yes, you are another person that vouches for this and you've obviously found ways around it, but a lot of them do struggle. Um, maybe there's an AI solution out there for somebody to get their teeth into. Who knows?

Dr Loren Isakson: 15:54

I'll also I'll I'll touch back on a point um that you asked earlier about in terms of um a positive, and I think it does go to burnout uh as well. Um I really enjoy, for the time being, being a solo independent private practitioner. I I have complete autonomy over my schedule. Um, and that's really important. I think that a lot of doctors feel perhaps undervalued in a large healthcare system and they don't have control over their schedule and their template. Um for me, I I view some of those things as sacred ground. And if if sometimes one of my family members says, Hey, I really want to do something this weekend, uh, you know, I'll take a look. I think it's important sometimes to shut down the clinic um early on a Friday or maybe for the whole Friday and get a three-day weekend to spend time with family members and sort of recharge. And that's not somebody I I don't have to ask permission to do that. I'm I'm the boss, so I can do that. Um, so you know, we want to still deliver good care. We're certainly not limiting access and we're available remotely, but uh I I think that's uh really one of my refreshing positives of this experience so far.

Dr Andrew Greenland: 16:56

Is there a particularly big challenge that you've recently had to overcome that you're particularly proud of in the work you do?

Dr Loren Isakson: 17:02

Yeah, I I mean I I think it's little operational things, but they they have big impacts. Um you know, one example is we're trying to get a penicillin skin testing uh and allergy delabeling program up and running, and we have just about everything done. It's just it's just really hard to actually get the the penicillin G in our clinics so we're right at the finish line, but all the steps that led up to that, and then it's something I used to do in the past. So I won't say it's complete, but it's like 99.9% complete, and even getting through all the hoops and barriers for that has been uh you know a big positive for us uh in terms of growing on the other things that we've done before. So uh almost to be revealed, but yes, we're we're just about there. And that that's a sort of, I don't know, what do they say, a feather in your cap to be.

Dr Andrew Greenland: 17:45

Thank you. Where are you looking to go in the next say six to 12 months? Or do you have any kind of longer-term objectives for North Star?

Dr Loren Isakson: 17:52

Yeah, I have uh I have both short-term and longer-term objectives. Uh, I would say in the next six to 12 months, it's continuing to grow our in-person presence as we transition over from our telemedicine focus, adding on the typical um bread and butter services, but then expanding beyond that. Um, a lot of people have talked to me and said, wow, we really appreciate your functional medicine or holistic approach. And it's not something that I really thought of that I was doing. I just thought it was sort of good medicine. But uh apparently there's some other integrative type of things out there that I have yet to learn about and build upon what I'm already doing. So I think those are maybe some some medium-term things. And then I think in the long term, I would be interested in in clinical trials, um both in terms of using pharmaceuticals, but also in terms of technology, just wait is to improve people's lives. I don't think everything needs to be a complicated, um, fancy biologic or or pharmaceutical to fix people. Sometimes it's it's just healthy diets, good habits, that kind of stuff. So I'd like to really build out on that and see if there's some good evidence-based medicine to further my um my penchant for that.

Dr Andrew Greenland: 18:58

And from your understanding of the specialty and your academic interest in the literature, can you see anything, any exciting developments that will be coming online in the next couple of years that you're looking forward to being a part of?

Dr Loren Isakson: 19:09

Um, well, there's things that I'm looking forward to being a part of, but I don't think are really practical for an outpatient clinic. So I know there's a lot of work in these CAR T cell therapies and other therapies where they extract your body cells and kind of uh treat them or condition them and re-implement them to harness the immune system to do what you want it to do. Uh, I think that's something I'd probably need to have a hospital affiliation with or work with a pharmaceutical company perhaps to do that. So I find that very intriguing. I think there's a lot of things to do to harness the immune system and try to redirect it, either for cancers, immunobiology, other things, but it's gonna be a little bit difficult to do as a regular bread and butter practice, but there's certainly room to growth and partner with clinical trials companies on that. So that I do have my eye on that kind of stuff.

Dr Andrew Greenland: 19:55

Interesting. And from a business point of view, if your clinic suddenly had an influx of 50 patients next week or next month, uh, what part of your operation would break first? And hopefully it's not you.

Dr Loren Isakson: 20:06

Uh it probably would be me because I'm doing a lot of other things. Yeah, actually, I find that sometimes when the more I have to do, the the more I actually get done. Um, so I I'm not sure things would uh would break, but it would put some strain on our digital intake system, which has needs to be optimized. Um, I've had a lot of conversations with a lot of um companies, not just digital intake. I think there's really a lost opportunity with companies that collect data and put things as uh PDFs and so forth into the electronic medical record. And they're not doing a an ideal job of taking the information from digital intake and putting it in structured um information. So I think that that there would be some opportunities that we're not quite there yet with um where that data could be turned into part of the note be written being written for us ahead of time and uh making summaries for us. So some of those technologies exist and some of them are getting optimized. They're not always economical for a small practice like ours. So I think digital intake and and uh you know the initials of documentation would would probably suffer a little bit in the beginning, but we could always add on additional scribes and and other types of technologies to accommodate that.

Dr Andrew Greenland: 21:20

Brilliant. And if you were starting your practice all over again tomorrow with everything that you know now, would you do anything differently?

Dr Loren Isakson: 21:27

Oh yeah, I would definitely do some things differently. Um, I I wouldn't say during the pandemic I would have been more aggressive about hiring, but maybe, excuse me, coming off of the pandemic, I probably would have looked into doing less of the administrative stuff that I really enjoy and focus more on the clinical stuff. Um, I think it's important, first of all, just to work with people collegially and have an enjoyable day and not be quote unquote the lonely entrepreneur. Um, but also looking at people as an investment in in their life and in your life and getting to the place that you want to get to faster. Um it's not to say that I didn't look for some of those, but I had some pretty unique characteristics and I was growing the clinic in a less traditional manner uh and sort of matching things with my patient flows and and cash projections. But I I think it's important, uh, especially to the people who gave me advice not to do that, um, to understand that investing in good staff is really, I don't want to be sort of mercenary about it, but you know, like an asset, like a like a thing that is gonna return value on your clinic. And it's it can be dollars value, but it can be also personal value, emotional value, time value, and stress value that you're you're making some advancements in. So I think I would have hired or made a more aggressive approach to hire the right people earlier. But to be a bit empathetic to myself, I did make that effort. It's it is challenging to find the right people, and I think that's actually the hardest thing about running a business is finding the right people to partner with. Um, once you do, you should hold on to them.

Dr Andrew Greenland: 22:58

Totally agree. It's all about the team. Loren, thank you so much for your conversation this afternoon. It's been really interesting hearing about what you do at North Star, your thoughts for the future, how you've overcome certain challenges. Um, I'm sure this will resonate with a lot of people listening. Uh, we're very happy to put your contact details on the um bio page of the podcast, should anybody want to reach out. But thank you once again very much for your time. Really do appreciate it.

Dr Loren Isakson: 23:20

All right, thank you so much for having me. I appreciate it.