I’ve been receiving quite a few questions from folks reading my blog and Instagram regarding my work in functional medicine. So, I wanted to do a broad-scope post that hopefully answers any questions you may have about what functional medicine is, what it takes to become a provider, and what it’s like to be a patient. As always, please feel free to send me a message, whether by email or as a DM if you’d like chat further!
First things first:
I always like to start with a good, old-fashioned definition.
Functional medicine is a framework in healthcare that looks at the big picture of a patient’s life. This means evaluating symptoms in light of everything else going on, like nutrition, lifestyle, environmental exposures, and stress levels, all of which profoundly affect our health. To do this, healthcare providers conduct a thorough and detailed history, asking far more questions than a typical doctor visit. We also look at blood work, which helps us in two ways: to uncover the cause of symptoms, like food allergies or vitamin deficiencies, and then to monitor progress. For example, we may want to make sure that our treatments are helping inflammation levels to decrease, or see that those vitamin deficiencies are improving.
Treatments in functional medicine focus first on supporting the body’s internal environment with non-invasive methods like nutrition, lifestyle, and supplementation so that we can avoid drugs and surgery as much as possible. The long term goal is to restore your body to its normal, natural, healthy state that is self-regulated without the need for much intervention at all. Functional medicine physicians are licensed healthcare providers who are legally able to diagnose and treat diseases. Even though there are countless credible natural health blogs, websites, and Instagram accounts out there, you should only ever take health advice from your own healthcare provider who knows you and your history.
Becoming a Functional Medicine Physician
There are two routes to becoming a functional medicine provider. The first is what I call the “direct route” in which a person is ready to practice functional medicine upon graduating from their medical program (naturopathic or chiropractic medicine). The second, which I call the “indirect route” requires post-graduate training and certification beyond the degree requirements.
The route that I personally chose was to pursue a degree in Chiropractic Medicine. (You can read more about how I made the decision between an MD and a DC degree here.) The training in this program is very similar to MD schools in that they include courses in both basic medical sciences (Phase I) and clinical sciences (Phase II) followed by a clinical internship. The first year of school was pretty intensive in that we completed a year-long study of anatomy including a full cadaver dissection. We also completed courses in biochemistry, human nutrition, histology, physiology, pathology, and microbiology. Upon completion of Phase I, we then studied it all over again to prepare for Part I of the National Board Exams.
Phase II involved our evaluation and management courses where we learned how to diagnose and treat (and appropriately refer) everything from ulcerative colitis, to COPD, to metastatic cancer. My school’s curriculum in this phase of the program was broken down by bodily system — cardiology, neurology, dermatology, EENT, etc. We also took two semesters each of pharmacology and botanical medicine, learning about pharmaceutical drugs as well as their “natural” alternatives. Throughout the program, we also completed seven courses in radiology, learning to perform, read, and write reports on x-ray, CT, MRI, DEXA, and ultrasound imaging. Once again, we were evaluated in these skills through Parts II, III and IV of the National Board Exams.
The clinical phase of the program is exactly what it sounds like: seeing patients in a clinic or at hospital rotations under the supervision of a licensed physician.
My school also offers a degree in Naturopathic Medicine (ND) which is very similar to Chiropractic Medicine. But unlike chiropractic physicians, NDs can complete surgical residencies in some states. However, NDs are not licensed in all states, which is why I personally chose to pursue a DC degree. I’m from Chicago, and NDs aren’t licensed in Illinois yet.
The indirect route applies to practitioners who pursued “traditional” healthcare degrees, such as MD or DO, as well as nurse practitioners in states where those providers have autonomy. While these practitioners specialize in a vast array of fields, those in family practice, primary care, women’s health or internal medicine often desire to utilize a holistic framework in their practices, and can pursue additional training in functional medicine for this purpose.
I currently only know of two options for this that are accepted in the larger medical community. The first is the Institute of Functional Medicine, a post-graduate program for healthcare providers. The other option is to earn a master’s degree that incorporates the functional medicine curriculum, such as the Human Nutrition and Functional Medicine program at the University of Western States. (Note: these programs offer additional education for individuals who already hold healthcare licenses. They do not qualify someone to practice medicine who is not already legally permitted to do so.)
Functional Medicine in Practice
Another question I commonly receive is about what it’s like to be a patient of functional medicine. My general (and usually unsatisfactory answer) is that it’s different for everybody.
A Closer Look at Patient Health:
In my own experience, there are three different types of patients who walk through the clinic doors. The first group consists of mostly healthy individuals who are simply looking to maximize their well-being. Perhaps they are concerned about a family history of diseases like diabetes, or maybe they’re athletes who would like to take a closer look at their health for the purpose of physical performance. With these patients, I complete a physical exam, run some screening labs, and also test vitamin levels to make sure they are well within the healthy range — not borderline low, or even too high. Once the lab results are in, we have a follow-up visit where we discuss the numbers, put together a treatment plan, and start making changes that we have evidence for making, based off the blood work. Depending on the patient, we follow up again in a few weeks or months, typically re-test to make sure we’re seeing improvement, and continue until the patient’s health is optimized. As with the traditional medical framework, patients usually come in for check-ups every six to twelve months.
(Alternative) Treatment Options:
The second group of patients is pretty similar. These folks already have a health concern, such as high blood pressure or hypothyroidism, but aren’t ready to start taking medication. They’d like to improve their health in the most non-invasive (and least expensive) way possible, with the fewest side effects. This is what I love the most about functional medicine: it offers options for healing that support the body’s natural design. For example, instead of altogether shutting off the bodily system that produces cholesterol, which is what statin drugs do, the functional medicine approach involves identifying what is sending that cholesterol-making system into overdrive. By removing the trigger and supporting the foundation for balance and health, functional medicine allows the body to return to its normal state.
Patients like these follow pretty much the same course as the first group. We run labs, review them, put together a plan, and check in as needed. If new concerns arise, the patients come in for a check-up, just like they would with any other doctor.
But other folks aren’t quite so predictable. The third group of patients I see consists of people who are really sick but have been to specialist after specialist and never found answers. Their symptoms are debilitating and frightening, and they’d try just about anything to find relief. But despite the number of doctors they’ve seen or the experimental drugs they’ve tried, nothing has worked…yet.
Everybody makes mistakes, and doctors are human too – so sometimes things just keep slipping under the radar. But the nice thing for these patients about working with a functional medicine physician is that even if a formal diagnosis cannot be made (such as a food allergy or an autoimmune disease) we have extra tools for supporting health that traditionally-trained physicians do not. Most of the patients I’ve worked with have never had their vitamin D levels tested, never been asked about their eating patterns, and never had their thyroid labs reviewed before seeking my help. Especially with chronic conditions, nutrient, hormone, and inflammation levels are often way outside of the normal range. (I have actually never yet had a patient whose vitamin D level came back normal! All of them have been low, even my own.)
As a functional medicine provider, there is at least something I can do for every patient. While we may not be able to eliminate every single ailment, I can always help them with something. Sometimes it simply means referring them to the appropriate specialist. Unfortunate though it may be, not all clinicians are created equal.
At the end of the day…
The advancements in modern medicine are incredible. As a body of scientists and clinicians, we know so much about the human body, and we are uncovering more and more every day. Every member of the medical team is important, whether a surgeon, a specialist, a primary care provider, or a nurse — and we need everyone in order to make the machine work. I personally find functional medicine to be an extremely exciting field, and I count myself very fortunate to be able to do what I love, helping others and satisfying my own drive to grow and learn.
I mentioned this earlier but if you’d like to learn more, I’m always happy to share from my experience and help you make the best decision for YOU, whether as a patient, a student, or anything else!