Dr Andrew Greenland: 0:00

So, welcome back to another episode of Voices in Health and Wellness. This is the show where we explore the behind-the-scenes challenges, insights, and real-life experiences of today's leading health practitioners. I'm your host, Dr. Andrew Greenland, and I'm so glad you're here. My guest today is someone I've really been looking forward to speaking with, Dr. Todd Bourne. Todd is a naturopathic doctor and certified nutrition specialist who now runs a fully global telehealth practice, seeing patients across North America, Europe, Australia, and the UK. He's the co-owner and medical director of Bourne Integrated Medical Specialists and brings over a decade of experience in functional and integrated medicine, particularly in working with chronic and complex conditions from autoimmune to neurodegenerative issues to gastrointestinal and hormone dysfunction. So with that, Todd, welcome to the show and thank you very much for coming on.

Dr Todd Born: 0:45

Yeah, thanks, Dr. Greenland. Happy to be here.

Dr Andrew Greenland: 0:48

So let's start with your current setup. So after years of running an in-person clinic, you've transitioned to full-time telehealth. What led you and your wife to make that shift?

Dr Todd Born: 0:57

So yeah, we graduated from Bass University in 2010. We did our residencies in the Seattle area. Then we were in Connecticut for two years, traditional insurance-based practice, seeing 10, 15 people a day, uh working seven days a week. And then I was like, man, I this is definitely I just see why doctors burn out now. I mean, on the weekends I was charting, reviewing labs, ordering labs, you know, the gamut. So then we went to California and practiced in the Bay Area for five years and ran it because we worked for people in Connecticut. Now we decided to have our own practice and tried to make it this utopic integrative medicine clinic. So we wanted, you know, you know, NDs, basically every every specialty you could imagine. So we had, you know, acupuncture, Ayurveda, we had body work specialists, we actually had um some friends and colleagues that I happened to met at the Institute of Functional Medicine who were at Kaiser Permanente and they were pain specialists, but their passion was functional medicine, but conventional medicine was paying the bills. So they might come in precept or want to see patients a day a week in our office. And after five and a half years of that, we could grew it to a moderately sized practice. It wasn't a large practice, I would say it was moderate. Uh, but we just were like, this is you know just too much because what most people don't understand, which we didn't either, you know, when you start a practice, uh, is that it's really two full-time jobs. You're running in a business unlike no, not unlike any other business, but then you're also having full-time patient care. But then we had, you know, a number of colleagues and we had staff and other practitioners, and so then you're dealing with like all these egos and constantly basically doing damage control, been like, okay, what's your beef with her? What's your beef with him? Okay, now we got to get along. And you know, doctors' egos, as you know, can be fairly large, and so they treat some of the staff poorly, or like, you know, I don't care what your credentials are, you don't talk to our office manager like that because she was, you know, really the backbone of that practice. That's who's the front facing of the office, and she was wonderful. And it was just one doctor, particularly we had some problems with. But so after five and a half years of that, so now it's 2018, we decided to leave the San Francisco Bay Area and return back to the Puget Sound where my uh wife's family lives, because we had two kids in California, we knew we were gonna have more, and my wife has an autoimmune disease, so we figured if she's gonna flare, we need some help. So I was like, you know, that's it, we're just gonna sell the practice and we're gonna cut all operating costs, and I'm just gonna go 100% telehealth. So this is before COVID, and the reason that also was I was getting a fair amount in 2015, 16, 17, a fair amount of telehealth uh patients because they were getting referred to me mostly from colleagues in different parts of the United States that uh didn't necessarily see tick-borne illnesses or they didn't do you know neurodegenerative diseases. So they're like, I know a guy does, and then they're like, Can you see them virtually? And I was like, Well, I assume so. Let me call my malpractice, figure all that out. Plus, I was working with a nonprofit group um out of the UK, which is the Neutralink Clinical Education. So that was getting referrals from them out of the UK, so it just made sense, and then also again cutting all my operating costs. So in 2019, early 2019, we sold our practice in California, one of our associates, and then over formed a new entity in Washington State, and then just went to all telehealth, uh, which 70% of my practice is the United States, 30% is global, and it's nice because now I with the telehealth I can reach way more people than I could with just the physical location, or people are like, oh, I mean, I gotta fly out of California or I gotta fly to Seattle. So now I'm it's much more accessible.

Dr Andrew Greenland: 4:25

Amazing. So how has this model um impacted the way that you build relationships with patients? Because obviously it's a different kind of kettle of fish compared to a brick and mortar, you'll see them face to face, in-person, hands-on, as it were. How is it how has it changed?

Dr Todd Born: 4:38

No, that's a good question. So there are some, you know, um some limitations to to telehealth, right? Is that I'm not actually in person, so all the acute care I used to do can't really do anymore. Um I have had patients for more than 10 years, so it's pretty easy to tell from them whether it's a flare-up of their autoimmune disease or whether it's really an acute illness, and then I'm like just going to a walk-in or urgent care or what have you. Because in the United States, you can never get in to see your doctor anyway, so you usually end up having to use urgent care. So, because I can't do physical exam, right? Can't listen to people's lungs, things like that. I can't do physical medicine anymore, so I used to do a lot more of you know, I still do a lot of pain management, but I used to be able to do a lot more osseous manipulation therapy and use physiotherapy, can't do that anymore. Um, so there are some limitations, but and and being on a screen does unfortunately, you know, you you lose some of that kind of in-person rapport a little, right? It's like if someone's has you know a mood disorder, for example, they're seeing me with major depression or anxiety, and then they're crying, it's not like it was before, where I could, you know, hold that space, maybe slide some Kleenex across when I'm just sitting on a screen, which is kind of cold. But you know, um, same with the pediatrics, I see a lot of kids, so you know, they kind of just bounce in and out on the camera anyway. So that that does, you know, unfortunately, you lose a little bit of that, but because of COVID, and then everything shifted to telehealth in general for a lot of things outside of emergency medicine, like what you're seeing, people are so used to it now, it's not that big of an issue. But like before COVID, I had lots of patients that were not really comfortable doing telehealth. They're like, I don't really want to be on the camera, or I don't know how to use this was Skype days, right? Skype doesn't even exist anymore, and uh that wasn't even HIPAA compliant. So, but now people are just like it's secondhand nature. I mean, they'll just sit there on their phone on the video screen and talk to me in their car, um, like on their lunch break. So it it's changed, but it certainly limits to some things, but the the benefits outweigh all that because I can reach way more people. It's we people have complex chronic diseases, which is what I see a lot of. I see a lot of routine things as well, you know, thyroid discs, more of the simple cases, but mostly people refer to me because difficult to treat, refractory cases, things of that short. They don't even have a diagnosis, they just have this constellation of symptoms, syndrome that they go, you know, get lumped into something and then they get referred to me by whomever. So it it's not a big deal because you know, it's not like emergent or uh urgent care where it's a little more life-threatening. This they're there's quite stable. Usually they're just a train wreck and they can't get out of bed and they're on disability because they can't work, because they're just too sick and too tired, and and then it's me to do all the unraveling. But my practice style honestly has not changed any different than when I was in person. I still am doing the same things, we're in the same labs, the same stepwise fashion, the same systematic strategic approach.

Dr Andrew Greenland: 7:34

I mean, do you ever miss the in-person connection or the advantages of doing the telehealth model um significantly outweigh um the disadvantages of doing the other one?

Dr Todd Born: 7:44

The only thing I miss, honestly, is that you know, sometimes with a lot of people, especially in this day and age, you know what they really need, and it sounds corny, but they just need a hug. They really need a hug. And I've had so many patients over the years, and they're just the you know, they're just dumping everything, which is fine. That's that's what we're here for as functional medicine doctors, right? We are lengthening our visits more than seven minutes where the other the conventional doctors aren't even looking at you and they're just typing up their chart notes, and not that they don't care, but they're trying to get to that next patient, that insurance model. Um, so I actually do this a lot like at the end, especially if I didn't know them well, I'd be like, you know, as we're walking them out to the front, I'm like, Can I give you a hug? Would you like a hug? And they'd be like, Yes, you know, and they'd be crying. And that I do miss that. I miss um being able to see kids in person. You know, I have four kids of my own, so you know, and they're all quite young under the age of 11. Um, so it's not the same on the camera when you know I'm trying to establish rapport and the kids like uh and it bounces out. But for the most part, I like the telehealth because I'm actually it's it's more efficient, you know, I um and it's many times it's actually quicker uh than it was with in-person, because you know, people being late, me running late, all these, so that's all been um gotten rid of with my new model that I've been doing for the past six years.

Dr Andrew Greenland: 9:04

And were there any um emotional physical philosophical philosophical shifts that you kind of noticed in yourself when you moved out of brick and mortar? Because it's quite a big deal, isn't it? It's a complete change of model.

Dr Todd Born: 9:14

Uh, not too much. I guess just people um again, they don't that there is a kinesthetic that's lost when you're seeing someone in the room, right? The energetics can can shift when you're on this cold 2D screen versus being in person. And what's nice about the telehealth, right, is that people can now they don't have to take as much time off work, they don't have to um, you know, take half a day off, they can they don't have to drive anywhere, they don't sit in traffic, so it makes it easier. So they're actually somewhat calmer versus being rushed to the appointment because they had to put and then and they had to take a half day off work, uh, and then they they get to be in their own home, so they're a little bit more relaxed and willing to kind of tell me what's going on. And then with kids, it's always kind of fun, and actually gives me an insight, probably um psychosocial aspect, because I can actually see what's going on behind them if they happen to see me at their house. So that can play right into the dynamics of their health if they've got you know, kids are screaming and they're just constantly stressed and they're just like, oh, which you would not see in the exam room. But for me personally, no, I mean I I I don't feel um I feel like it's a little colder because I'm like I'm staring at a screen, but uh, I'm also used to it in AR and and so it hasn't really affected me a whole lot in a negative way.

Dr Andrew Greenland: 10:29

Thank you. Um obviously working with patients around the world, US, Canada, UK, Australia. How do you navigate the differences in the different healthcare systems, the insurance, the diagnostics across regions? It sounds like a logistical nightmare. Can you shed some light?

Dr Todd Born: 10:43

And that's like the million-dollar question that I'm I'm glad that I got to see, because as you and I were kind of talking last week or a few weeks ago, that I really thought the American healthcare system was very broken and it was the only one. And then I started seeing people in, you know, the Canada, the UK, the EU, Australia, New Zealand, their systems are just as broken, just in different ways. But once you kind of, you know, I go through it once or twice, then I understand navigating logistics. And in the United States, it's actually almost harder because everything is an insurance-based model, and I don't accept insurance anymore because it limits my time. But at least all the labs I order are covered by insurance, and any medications I prescribe, those are all covered by insurance. But then when I get into other countries, certain labs aren't even available. They're just they're not they don't exist. You can't even get them done. And then over time you learn the logistics. So, like for my patients in the EU and UK, there's a lap, there's an aggregate, these lab aggregators are quite popular now where they basically take a whole bunch of high-quality labs and they put them under one umbrella so you can order from one place versus you know going to each lab. So in the UK and the EU, I can use a company called Regenerous Labs, and I can order labs and have the kits drop shipped. Um, in the United States, I could use Rupa Health. The Australia, New Zealand don't work quite like that. So, and what I do a lot of times anyway is I want to mitigate out-of-pocket costs as much as possible. So I write a lot of these co-management letters, and I do it in the United States as well. If they have either their underinsured or no insurance or their Medicare, Medicare is for 65 and older United States, they don't cover anything an ND does, it doesn't matter what it is. That's just the law of the United States. So I write letters to their doctors that you know, this is what I saw, put it all medical lingual, it's all professional, this is what I saw, this is what they came in for, these are their chief concerns. Second paragraph is the sob story where they're gonna have to, I don't know, their insurance won't cover me, or they're gonna have to pay out of pocket, or I'm a licensed physician in the United States. And I would say 99% of the time, the GP or the specialist, I'll ask the patient, I'll say, okay, which one of your doctors is most likely to run the labs and I'm gonna request? And they'll say, Oh, my endocrinologist will, oh, my GP will, or whatever. And then 99% of the time, they'll run about 80, 85% of what I want, and then we can get it done. In some of the socialized healthcare systems, the labs are so cheap that I can literally, I will on my professional letterhead, I write down the labs that I want ordered, and I sign it, I give it to them, they walk into a self-pay hospital or outpatient clinic, and they'll get the labs drawn. You can't do that here. Like if I send someone a lab corp request, they won't accept my like my requisitions, they're not gonna necessarily do that for a medication. They're like, Oh yeah, it's cash, but it's super expensive. That's where the aggregators come in. So, um, and then for to prescribe, say, medications, I can't in a foreign land. So I'm usually like I've had patients where I'm like, you really need this, and then go back to your GP or a walk in and get this, and hopefully they listen. Because here's your lab results, here's your imaging results, here's what is going on, get this. And then it's really just using the right dispensaries for supplements, which can be a little bit of a logistic nightmare. But again, over the last six years, I've I've done it enough where now it's a fine-tuned machine. Um, of being like, because you know, the most of the stuff on Amazon is either fraudulent or contaminated or garbage, either certain brands. I'm very particular about the 25-28 brands I use, what I want, um, you know, even products that I formulate in the supplement industry. So then it's like United States, I got my dispensaries, and then um internationally I have certain ones, so it depends on the country. And then so now I've got all down and fine-tuned also to mitigate costs because if people want to order stuff from the states, by the time they get it, tariffs, shipping, I mean it's a fortune. So I try to keep it local and still have the same brands that are carried by them. But yeah, time zones tend to be a little more challenging than everything else.

Dr Andrew Greenland: 14:31

Yeah, for sure. I mean, especially recovering Australia as well. Um so what does it look like from a patient perspective in terms of let's take a patient in a far distant country with a very um very different big difference in the time zone? How would they have found you and what does the journey look like from their perspective? And you've talked about some of the logistics. I'm trying to get a sense of that patient experience. What does it look like?

Dr Todd Born: 14:54

Yeah. So it's similar to the United States, is that in the United States, most of my patients are referred to me by another a friend, family member, or another clinician. Um, or they see hear me on a podcast or see me at, you know, um, there's you know, I might do a webinar that then then even if it's a um CME webinar that gets dumped onto YouTube or an article I wrote. I mean, I I wrote an article on allergies in 2016 that I forgot about, and I still get patients that will be Googling around and be like, oh, I read this thing on allergies and sublingual immunotherapy. Can you do that? I'm like, what article is that? I forgot. So um the the other time zones, so when people go to my website, it's an online scheduling program, and once they fill out the information, it changes to their local time zone, and then a window pops up, it's a scheduler, and it matches my openings. So they will be able to see what coincides with them. I do get some people that are outside, so they usually end up emailing me, and I'll say, just we coordinate an internally on a via basically email, and then I go into the admin panel and I just book them outside of my normal hours, which sometimes tends to be like nine o'clock their night, or maybe it's 7 a.m. the next day for them really early, and it's four o'clock my time. So we kind of make it work, but those people usually sometimes refer to me, but usually it's um these health summits that you may have even been part of, right? These like monster, you know, marathon four days on a health topic. They got 60 experts around the world on and maybe the whole thing is on fatigue, chronic fatigue, or tick porn illness or whatever it is. So, um, and I also do a lot of pre presentations for Health Masters Live, which um is based out of New Zealand but covers a lot of Europe. Uh, most of the practitioners who listen to it so I get a lot of referrals from them. So people are kind of know what they're getting into more or less when they refer to me or they heard me. Um, I don't think globally I can think of anybody who just happened to be like Googling around and an SEO picked me up, unless it was something specific, like an article. And then I just send them the paperwork, and and they're so the people who are you seeing me in um foreign countries, they're usually some of my sickest patients. So they're just so happy that somebody knows what they're doing, knows what they're talking about, has some compassion. Because like the United States, they're like, I have chronic fatigue syndrome, I've had this for 20 years, they're talking to me from their phone in their bed, and they're like, I've seen this person, I'm in this system where the GP now, you know, I got six months' wait to even get in to see a doctor. And I'm like, Oh wow, I thought the United States was bad. They're like, oh, it's terrible here, and there's no specialists, or they don't believe in functional medicine and pills, and so um their journeys, they're usually very happy that somebody like me can listen and knows what I'm doing. And there are some times where the time zones are it's too over, it's it's too much to overcome after a couple visits. So if they're in an area where I know someone um like the UK, there's a couple of practitioners I trust, and I refer them to them, and they usually end up seeing them for part or most of their care, and I just maybe come in as like the fixer on a couple things.

Dr Andrew Greenland: 18:05

Amazing. I mean, you've really really sussed this. I mean, what does it what's your operation like? So it's obviously you, who's behind the scenes and who's kind of navigating all these logistics?

Dr Todd Born: 18:14

Me. It's me, myself, and I. So, yeah, after you know, running a moderately sized practice with I think at our height, we had three practitioners, three NDs, we had an acupuncturist, an Aur Vedic practitioner, a bodywork specialist. Uh, we were treating a bunch of um professional sports players, we were uh there, we would treat all the Oakland Raiders, most of the um, you know, the Golden State Warriors players, and a bunch of other lead athletes. And so I had more personnel to help, but that also then comes with its own issues. And I wouldn't say I'm a control freak, but I just like to move at my pace and like to do things my way. Um, and so my wife, you know, we have four kids under the age 11 and under. So she went to the stay-at-home mom aspect while she's, you know, we're raising young children, and so she's really helpful because she's much more the creative side, I'm much more the analytical side, so we have a good kind of yin and yang balance where uh she does it. But I mean, I have a web designer and I have an SEO person, so you know, because people more and more over the years have been like, you need to be more on social media, you need to kind of dispel and debunk the medical myths from all these, you know, influencers with no health training and you know, just espousing all sorts of garbage. And yeah, but I despise social media and I don't want to deal with it, and I don't even have time. And then the universe threw me this guy that was like, he literally, he's like me, but so he's a solo guy, and he will handle everything. So all I have to do is provide content uh or edit what he's doing, and then he goes and he created all the social media channels, he does all the posting. Um, I am getting to the point because I divide my time between consulting and advising the dietary supplement industry, a pharmaceutical group, a medical group, my own private practice. I got four little kids. Where um I am gonna probably fairly soon need to bring on like a virtual assistant to help with some of these more like routine, um tedious tasks, so then I can be freed up to do all these other things, the higher level tasks, versus you know, trying to answer a whole bunch of really simple emails or um chase labs to be like where you guys lost the SIBO kit, you know, and I'm spending an hour trying to deal with Genova because they lost the patient stuff. I would need someone to do that. But yeah, for me, um, it's all about speed and efficiency.

Dr Andrew Greenland: 20:37

Brilliant. Um you've navigated the healthcare systems of a number of different countries and you've seen the good, the bad, and the ugly. What do you think is truly good health care, in your opinion?

Dr Todd Born: 20:49

Oh well, that's that's the utopic world, right? I would say that in theory, the utopic version, it depends on the patient, right? Um, the United States, generally speaking, is extremely deft at urgent and emergent care. I mean, you can't really get better than here when those things like you have a heart attack, you have a stroke, you know, you have a you have a gunshot wound. America is about as good as it gets. But the majority of people, you know, the way you're an emergency room physician, you know these things. It's like if you have an acute illness or urgent emergency, you either survive or you die. There's really not much of a gray area. Well, what do most people in the industrialized world suffer from? They suffer from chronic disease. The United States healthcare model, and I would say now, given that I've seen people in a whole lot of countries, industrialized countries, their system is just as messed up as ours, just again in different ways, is that it's not well equipped to handle complex chronic disease. There is no way from you know, I don't care how smart you are, how efficient you are, if someone comes in, they got 15 chief complaints, and they've got a myriad of health issues, that you can cure them in the 10 minutes, right? It's just not going to happen. That's the average visit with you know, not a first but a follow-up visit, right? In the United States, it's running between seven and like 12 minutes, depending on your whether you're seeing a specialist. There's just no way. So the medical model, and lots of my conventionally trained colleagues who are now into functional medicine, they all agree the same thing. That's why they left that system medicine. They're like, I can't help people, I'm just keeping them alive until the next visit, just palliating, tweaking meds, and you're on the next. I'm not actually treating root cause health. So there's just no way. So, in theory, integrative medicine or even functional medicine, atrial palliative medicine, for these kinds of patients, if it was truly a model, the way it was built, right? Where you have someone who's very complicated and they have specialists, if all the specialists would talk to each other, the GP would coordinate like it used to, like they used to, but they don't anymore. Now it's more like it's all compartmentalized. Oh, that's your thyroid, go to endo. That's your gut, go to gastro. Oh, shoulder pain, go see PT. If PT doesn't help, you're off to ortho. It's like outside of sprains, strains, and coughs and UTIs, what is the GP doing nowadays? And well, child's and annual exams. Not not much, unfortunately. And they're just seeing 30 people a day and just run ragged and no one wants to be a GP because you don't make any money compared to your you know, your your brethren, because the United States healthcare model um insurance model pays well by procedures, not by time. So it's it's in your best interest to do procedures. So I digress. But what will really be the utopic model is basically what functional medicine, naturopathic medicine, you know, all these or atriopathic medicine was kind of first, and then these other ones were were branched out from them, but they're all essentially the same thing. Uh that model where you can be, and I try to be that model. I'm like, I want to be the one-stop shop. It doesn't mean I don't use specialists, I refer to specialists all the time for their diagnostic prowess. I'm like, you know, I think you have this, but I really need you to see rheumatology, or I to to really solidify this. Or I had a guy the other week that was coming to me and he had a DBT 10 years ago, and he's been put on blood thinners since, and he's like, I don't even know if I still need these. I was like, Well, what did your internist say? He's like, and who why is an internist managing your Zorelto and all these other meds? I mean, you really should be cardiology and hematology. He's like, I don't know. He's retiring, so now I'm in limbo and I'm almost out of medication. And I was like, Well, I need you to go to hematology, just have them do their evaluation. Because have you ever been worked up for a bleeding disorder or coagulation disorder? He was like, No, they just put me on this med in the hospital and I've been on ever since. Like, all right, you know, and you can see where this is going, pretty typical model, right? Where someone just gets lost and the left hand is in the right hand's doing. So in a utopic model, it would really be the specialists working together, all and the the GP, everybody or the functional medicine doc in the best interests of the patient. But either there's too many turf wars now. Um, in socialized medicine, what I've noticed a lot is the refusal to do anything. Right? I'll have patients, I have one in the UK. And I was like, you know, she's had 20-year history of chronic UTIs. I was like, well, have you ever had a urinalysis with a macro, micro, and a culture and sensitivity? No. I was like, Have you ever been worked up for interstitial cystitis? No. Have you ever seen a urologist? No, jeep, they won't refer me. And I was like, see, this is what we're talking about. And this I was like, she's like, I've been asking, and I was like, well, that's okay. I think maybe it's time for a new GP. She's like, it doesn't work like that. I can't just get a new GP. I'm stuck. I I don't shift out. And I was like, oh, you know, that's kind of like here. If you're in an HMO insurance-based model, health management organization, you don't get to refer yourself, you don't get to pick who you want, and so but it's cheaper health insurance. If you choose a PPO, then you can say, I I don't like, I don't get along well, and I don't jive with my primary care provider, I want a new one. But now there's no primary care providers are so booked up you can't even get a new one. So I would love to see a model that works more like the functional medicine, you know, naturopathic model where you have one individual who's really skilled, controls a lot of things, and then using the specialists, but the specialists all need to talk and being able to actually see someone that that has that clinical skill set, the specialist. I mean, look at the guy here, he's 10 years later after the hospital. I said, Well, did you never seen anybody besides the internus? He's like, No. I said, Did you ask? He said, Yes. And they said, I don't need to. I was like, Oh man. So now I just referred him to this was literally two weeks ago. So I just referred him to hematology, cardiology. I said, You want to see my people? You know, the ones that I like and trust, and we work well together and they like NDs. And he was like, Yes, that would be awesome. I do not want to be on these forever. Uh he's like, I'm young, I don't want to bleed out someday, you know, have a hemorrhagic stroke or something.

Dr Andrew Greenland: 26:44

So here we are. You've really um got this model working very well. What are you most proud of about what you've managed to create?

Dr Todd Born: 26:54

I would say most proud of is um one, and it's not to glorify my own ego, I really enjoy you know, medicine. I like to see people who've been really sick for a long time get better, get their life back, and then you know, um, and then they send me these lovely, I don't ever, I never request testimonials because it just seems weird and you know, but can you say what a good job I did? So they just go ahead and we'll sometimes say these, and then they might send me an email thinking, or they'll tell me verbally, and I'll say, Can I do you mind if I put that on the website or something? But I think that one of the reasons I'm asked to speak at medical conferences about 10 times a year, and then a bunch of podcasts and webinars is one of the things that I'm asked to speak on is my system and model. Like I'll get people, I might present on complex cases or your factory diseases or autoimmune disease or IBD or whatever, and people will say, attendees in the audience, they've asked me enough now where I put in a slide of so it's all theory, science-based, evidence-based, you know, here's what it says, here's what all the science says, here's what I'm doing, and here's my system, my approach in a systematic way, with and it's all you know, referenced with scientific, you know, are because it's a CME, it has to have scientific references. And now I have a slide where I talk about peeling away the layers of the onion, and because a lot of times when someone sees someone like us, we want to do everything all at once. You know, I want to treat everything. And then it's it's first of all, it's like what I try to tell people in clinicians is like your patient can barely get out of bed in the morning. They got a 10 out of 10 pain on average. They've got an autoimmune disease that's on fire with a grill that's already pushed the bus down the hill, and you're trying to have them take all these supplements and do an allergy elimination diet, and etc. etc. Do you ever see them again? They're like, well, no, no, usually it's like it's too much. You know, it's just you gotta stepwise it in and triage, but that also takes a lot of you know years of experience to know like when to intervene with what at what level. Um, so I think that the model has worked well, and I'm proud that I'm able to go to I'm asked to go to conferences, teach other physicians, you know, it doesn't mean you have to practice just like me, but what resonates with you, adopt that to your style. And I've had many clinicians over the years um precept with me, shadow me, more when it was on site. Now it's really hard to shadow me because it's all telehealth, and I gotta tell a patient I'm gonna enter a doctor in another room, and they'd be like, Well, who's coming on? Why are they coming on? So I don't do it much. But I used to have a lot of medical students and other doctors who were interested in functional medicine come and shadow me, and they're like, This is amazing, you know. So that always was good to know that okay, it is working. And then I also know the proofs in the pudding, right? Because people are getting better. I see the labs get better, I get them off their medications, or at least maybe down to one med. So that's always been very, you know, gratifying to see that um something that's in my head has actually worked out pretty well.

Dr Andrew Greenland: 29:42

And on the other side of the coin, are there any particular bottlenecks or challenges that you've not managed to crack yet that still keep you up at night?

Dr Todd Born: 29:51

Yeah, um, you those are like patients where um so the way medicine works, right, and you've been doing this a long time, you could probably walk into an exam room and know what someone has pretty quickly by just especially with just looking at them, a couple questions, and then your differential, and then you narrow it down. So for me, I'm kind of in that same boat where I've got a pretty good idea of what's going on. So um, if I'm doing an intervention, I got a pretty good working diagnosis, I'm doing an intervention or interventions, the patient is adherent to those interventions and they're not responding, then a couple things went wrong. My my my working diagnosis was incorrect. They're they're they're you'll they're lying, they're you know malingering that they didn't take the stuff, but usually that that's not the case anymore because that's homeopathy and things I know that will do it. Um, or I'm missing something. So, but I will work with them. What I I like to get results quickly. So if I've worked with someone for like three months and I'm throwing everything at them and they're doing everything I'm saying, and they're still not really getting that everybody will get better, just maybe not to where they should be. Maybe they're only 20% better in those three months. That's that's not good enough. I'm missing something, so I'm gonna refer them out. Um, and that that doesn't bother me. I would say the bottlenecks that bother me um the most that keep me up and I would say get me the most frustrated is that when I know I can help someone, whether it's a child or not, and it usually tends to happen to children because the parents, you know, is that they won't do the things that I'm telling them that they need to do to get better, right? And then they just keep and then they either get frustrated with me that they're not better. I'm like, but you didn't do any of the things. Or they want to pick and choose, which is fine, right? Because we're it's a collaboration, you're healthcare. But I I see this a lot in children. Like, I get a really sick child, they've got asthma, right? They've got gastroparesis, they've got, you know, behavioral disorders, they got ADHD. They I mean this is the same child, right? They got all they got atopic disease, and then the parent wants to research every single little thing that I told them to do, and then they'll pick like two of them, and then they won't even follow them in the right order, and then the child's not getting better, and this may go on for like a year. And that's frustrating to me because I'm like, oh, if you were just listen, and I'm not saying you gotta do every single thing, we it's a collaboration, but don't pick two of them, and then you only like don't even see it through. You're like, Well, I gave it to them once. Well, that's it. That's not gonna work. It's not like I just gave it and you get a penicillin shot, it's it's not the same thing. Those definitely keep me up at night. Um, or pages I know that could help, but they don't want they don't you've you studied this in med school, right? The stages of change when they're in like that, maybe they're even in the contemplative phase, and they're like, Yeah, you know, I know I should quit smoking and quit drinking and eat quit eating gluten because it's you know, I I have non-celia gluten sensitivity, but I know it does this and this to me, but I'm still gonna do that. It's like Well, you know, you you're bringing a garden hose to a fiber alarm fire. Those definitely, those two, the people that won't do the things they should really be doing, seeing it to the end, and then the people that just don't want to, um, which I don't see as much anymore because you know, I I charge like an attorney and um they usually don't stick with very long versus an insurance model, they're like, what do they care? They're paying a ten dollar copay, they'll just keep coming in, spinning each other's wheels with the same complaints over and over, and yet they're not doing anything. And they know they should be doing these things, right? It's like, you know, I can help you. Did you get your labs done? No, I just haven't gotten around to doing it. Well, you've had that lab requisition for six months. If you really want me to know what's going on, I need those test results. I'll do it, I'll do it. I'm like, come on, those keep me up at night out of frustration, probably.

Dr Andrew Greenland: 33:40

I'm smiling because so many of your anecdotes resonate because patients are patients at the end of the day, and I've had a fair share of the kind of things that you've just reported. So I'm I'm smiling from that perspective. Um so if you had a magic wand, then you could fix one part of your business tomorrow. What would that be, if anything?

Dr Todd Born: 33:57

Uh magic wand would be um I guess uh more time, right? If I had more time in a day, I'd be able to just you know get more, I wouldn't say more done. I mean, I already feel like I get a lot done. But I would say also knowing that in the United States it's an insurance-based model. And so one of the frustrating things about being a physician is, and and I get it, right, because that's the way we we we're we're conditioned to think, every tradesman charges by the hour. Attorneys charge by the hour, plumbers charge by the hour, electricians, people who do your yard, they all charge by the hour. But if a doctor charges by the hour, that's like heresy. They're like, what do you mean I'm getting charged by the hour? And it's like, well, you know, especially root-cause medicine takes a long time. You know, acute care, even root-caused medicine, that's easy. I can see someone in 15, 20 minutes with an acute case. But complex chronic disease takes, especially if you've had psoriatic arthritis for 20 years, I know you want it fixed yesterday, but it's gonna take me a little time to undo some things. And it would be nice if people were more like I don't really have this issue in um other countries. People are kind of used to um they're all they're a little not accustomed because they have socialized health care and it comes out of their taxes and whatnot, but they don't mind paying out of pocket because they know that's kind of where they've they have to, and they may have had to do it with a functional medicine doctor in their country. They're like they don't and they're they don't they're not part of the socialized health care, so they're kind of used to it. But it would be nicer if the United States um mentality understood two things. One, the benefit of naturopathic and functional medicine, and two, that you know, it's okay to charge by time. You know, you know, we go through a lot of schooling and a lot of you know a lot of hours and a lot of sacrifices and come out with a large medical school that it's okay to be able to bill by the hour. And I get people super bill and they'd submit it to insurance reimbursement, but even then they're like, oh you know. But not insurance is accepted in every state. So I most of my patients aren't even in Washington. Was Washington does accept insurance. I get patients, new patients all the time. They're like, you don't accept insurance? I say no, and I get it. Why pay me $500 an hour when you can see the doctor up the street for $20 as a copay, and then insurance pays the rest? And and I get it. But the the um we need the model fixed, and it's I don't think it's ever gonna happen, not in my lifetime.

Dr Andrew Greenland: 36:30

Um, so you're basically you you yourself and you, as you said earlier. So, what would happen if 50 new patients tried to book in next week? I mean, it's sometimes it's a nice problem to have, but maybe not. I just wondered how you'd handle it.

Dr Todd Born: 36:44

So the way my scheduling is done, so again, it that that is a little bit of a difficulty because it's charged by the hour. So I don't know how long someone's gonna take. So, what the way I have the scheduling program built is um so someone books in a new appointment, and I've been doing it long enough that it's between 60 and 90 minutes. You know, 60 minutes usually is our children, or if it's a simple case, it might not even need to be that long. I might see someone at 45 for the first visit. So I automatically have a buffer built into that first visit, and it usually rarely goes past 90. It's not that people aren't more complicated, it's most people are pretty fatigued out after 90 minutes, right, of talking and telling their story and you know, answering all my questions and stuff. So they've kind of usually petered out by about that 75 minute 90 mark. Plus, um, the reason also I changed my model by the hour um is that so I've been in the insurance model, which is is no fun because you just you got to get them in and get them out, and then I've been in a model which was time of service that was structured like the insurance industry. And after two years into that, my wife and I were like, This is not a viable model, but it was too late. We had too many patients. We had 3,000 patients, we couldn't all of a sudden change the model, it would make a lot of people very unhappy, so we just kept it. But the way we were doing it there was I would see someone for 30 minutes, you know, or they were loquacious and they just like to monopolize your time, and they would just keep talking. Even my office manager would knock on the door, give the two-minute warning. I'm doing all the cues, right? I'm standing up, I've got their chart, they're still talking and talking, and then I'm walking them out, they're still talking, I drop them off, they're still talking, and now I'm like two patients behind. We were charging the same as if we saw someone for 30 minutes. Okay, and so I was like, this that's how I restructure here. So my time structure is also to keep people on point because they know that I'm charging in 15-minute increments, so they don't want to keep me on forever. So that was another strategy, and it's worked out well for that. And then I then I have a buffer between visits, so I that allows me to time to you know regroup, catch my breath, you know, shut my AI scribing program down, let it think, chart, you know, and then I save it so I can review later, and then I go on to the next patient. Um, and say, and then once I've seen someone a maybe three times, I know how long they're gonna take with follow-up visits. So I will get people that will book the follow-ups, and they're always booked for 45 minutes, even if they need 30. Again, that buffer, so I'm not running super over. I know they're long-winded or they're really complicated, or maybe they contacted me and said they had some regression in their disease. I will actually go into my schedule if I don't have another patient and block another 20 minutes. If I do have a patient after, I contact them and say, Hey, look, I have a patient for you, they tend to run long, don't want you waiting forever. Can I move you 15 minutes? And they're always like, Yes, thank you, right? Because they don't want to just sit in the virtual waiting room until I undock them. So um, yeah, it's a pretty well oiled machine, and then I try to block my schedule accordingly, and then when um sometimes I forget, and then I get things doubled up, or is my software sometimes gets. It's messed up and it will allow people to double book. That's not that common, but it does happen. Then I'm like, oh, gotta flip a coin. Who's willing to take a different time slot? So yeah, it's it's I got it down pretty well to where those kind of things don't happen. If I get inundated with a bunch of people, they're spread out in a way where it's manageable, they get seen and heard, and I'm not spilling over and now I'm 25 minutes behind. I mean, I might get 10. I don't usually go 10 or 15 minutes late.

Dr Andrew Greenland: 40:31

And finally, what's what's on the cards for you in the next year or so? Do you have any particular goals for your work going forward?

Dr Todd Born: 40:37

The goal for the work is um, like I said, I finally acquiesced and did the social media thing, which it's all gonna be educational. So we have um like two, three days a week, and like it's just a nothing's meant, you know, nobody has any attention span nowadays. So nothing's meant to be longer than a five-minute read. It'll be on a health topic, you know, um, cold and flu or what have you, um a disease, children, and then two days a week, I'm gonna record like a three to ten, twelve minute video on a particular topic. Uh, and I'm also welcoming people to send me things they want me to speak about if that's an area of my expertise and I know something about it, where I'm kind of dispelling the miss, the misconceptions, the disillusionment, you know, setting the record straight kind of deal, because I'm a pretty candid person, and you know, uh, and then I'll send those to the SEO guy, and then he clips them up and hit we have a YouTube channel. And I just want more people around the world to know that there are options, right, to your healthcare. You're not just stuck. And again, I'm not anti-medication, there's a time and place for meds, I prescribe them all the time. But there's you know, the polypharmacy that happens when you know they're on this much, and then they have no quality of life, they're 60 years old, they're you know, and they've just like, I'm tired all the time, I'm always pain, my gut's erect, I've got eight bowel movements today, and you know, I go see my doc and they're just giving me a modium and they're just giving me this, the pill ill to the pill. I like people to know that there are solutions that can cure you that are relatively non-invasive. So that's kind of my next year goal. And and I can help one people, one person at a time, but that's one reason why I speak at the conference. Is also if I can train a room of 300 doctors on a health condition and they can take some of that back to their practice to improve outcomes, you can help way more people.

Dr Andrew Greenland: 42:25

And with that taught, I'd like to thank you so much for your time today. It's been such a fantastic conversation. Really good to hear your insights and for your open, honest uh thoughts on the telehealth model and everything that you see. It's been fantastic. Thank you so much.

Dr Todd Born: 42:38

Great. Thanks for having me. Great questions.