Podcast Episode 48 | August 18, 2023
Dr. Robert Luby, Director of Medical Education at IFM and FMCA faculty member, discusses how doctors and health coaches can work together to transform healthcare. With the democratization of healthcare and patients looking to take their health into their own hands, doctors want to go beyond the conventional to improve patient outcomes.
Doctors ask “What is wrong with you,” while health coaches ask “What is strong with you?” Together it equals progress for patients.
Prior to joining IFM in 2015, Dr. Robert Luby spent 26 years as a board-certified family physician serving patients in community health centers, successfully applying the functional medicine model in marginalized communities and under-resourced settings. During the immediate 16 years prior to joining IFM, he served as the director of curriculum and faculty training in an academic family medicine residency program. Past teaching affiliations include Harvard, UMass, Tufts, Boston U, and the University of Vermont medical schools. Dr. Luby holds a bachelor’s degree in biology from Dartmouth, and received his MD degree from Columbia University College of Physicians and Surgeons. He was board certified in holistic medicine in 2002, and in 2013 joined the first class of IFM Certified Practitioners.
Sandi: Welcome to our podcast, everyone. I am so excited because we have a very special guest today, Dr. Robert Luby. He is the director of medical education for the Institute for Functional Medicine, our collaboration partner, and he is a faculty member of FMCA. So, welcome.
Robert: Thank you, Sandi. It is a pleasure to be here.
Sandi: So, let's begin. I'm curious to know what brought you to functional medicine and what do you love about functional medicine?
Robert: Well, like so many good men, there's an exceptional woman behind this story. So, my wife especially, who had chronic health challenges and really wasn't getting answers with her conventional primary care and really had to start looking into things on her own. And she was disappointed, of course, because I couldn't help her. And once she started helping herself and learning some principles that really made a difference, I said I need to start learning this. So, that brought me into functional medicine, a very personal story about a close family member, which is very common in the functional medicine field. And from there, I never looked back. And I have to say I was rather frustrated with my own conventional training and how limited it appeared to be. And I just thrived once I started practicing the expanded model that functional medicine provides.
Sandi: Wow, that's an amazing story. And very, very common. So, what do you see doctors coming into this field, they're beginning their journey of studying functional medicine. What is attracting them? Would they have similar stories?
Robert: I think they do. I think there's a lot of frustration in terms of the conditions that doctors and clinicians work under. And especially, it can be very frustrating if you're really trying to do it alone without team support. And that's the position many doctors are in as well. So, I think they want to go beyond their current arsenal of therapeutic interventions. For one, they just wanna have more effective interventions to feel like they're making a bigger impact on their patient. I think many of them also do wanna work more in collaboration with other healthcare professionals, which includes coaches, and to have that more of a division of labor to do the things that they do well, and not to have to spend time on the things that others can do well. And in this context, there are so many things that health coaches can do quite frankly, better than doctors because they've been more highly trained. So, I think they're looking for that too. And I think they're really looking to extend their career, expand their satisfaction, and improve the outcomes that they get with their patients.
Sandi: And I assume you're seeing more practitioners becoming interested in functional medicine, being attracted to studying at IFM, and then wanting to work with a health coach when they're through with their training.
Robert: Right. We've trained, what is it now? We're up to over 74,000 clinicians since we've started formal training.
Robert: Over 2100 certified practitioners, 3,100 plus more on the way to certification. So, the growth is impressive. And you know, Sandi, historically it used to be mostly solo practitioners who were interested and we're seeing evermore not only larger practices, clinicians and larger practices, but clinicians and doctors in academic health settings. Large healthcare systems, you know, just larger organizations who really wanna bring this. And sometimes it's not even from the clinicians, but it's from the administrative side in those institutions. And almost without exception, they know that their doctors need help. And they're looking for health coaches as much as they're looking for doctors. They're trying to create a new model where, you know, they're concerned from the operational side about turnover and their practitioner satisfaction. And they have heard, I think the research about coaching has gotten out, Sandi, that the inclusion of healthcare coaching into a team can really improve outcomes, improve satisfaction amongst practitioners, decrease staff turnover, etc. So, it's a real appeal for non-clinicians and administrators in decision-making physicians.
Sandi: This is a real turning point because it wasn't always the case, and those people were a very budget conscious and also looking askance at functional medicine. And so, is it your opinion that that's really changed? That's so exciting.
Robert: That's such a good question. I think partly it's because those stakeholders, those decision-makers have recognized that historically physicians have done a lot of things, clinically a lot of tasks, that don't have to be done by clinicians at that pay scale. For example, when you talk about cost-cutting measures, when the division of labor in a collaborative healthcare team is such that everybody's doing what they're best trained in that can really allow for cost-cutting from an institutional perspective. I think the other thing that's organically happening, Sandi, I'd love you to weigh in on this, is, you know, the trend is also the democratization of healthcare. If you step away from institutions, you have patients and consumers stepping away from conventional care, maybe from their conventional primary care clinician, and starting to look for other ways of either prevention or getting solutions to their very difficult health conundrums that they might not be getting from their primary care practitioner. And in many cases, they're turning to coaches because they realize they need to make life changes. And I think this is not lost on decision-makers in large institutions, that with this democratization of healthcare, everybody's recognizing the value of health coaches because patients and consumers have started to recognize the value. I'd love to hear your perspective on that.
Sandi: Well, I agree completely, and thanks for bringing that up. It is such a good point. We are seeing, we're reaching a point where instead of the doctor will see you now, it is the patient will see you now. That was Eric Topol's book a few years back. And with greater access to information, look at what's at our fingertips, the information that you would have to go to a library, to go to a medical journal to find, and, you know, go to the periodical section in a medical school library to get information. You could just Google and in less than five seconds, you've got PubMed. You've got everything accessible, but you've also have a lot of information out there that is increasingly showing you that you can be taking charge of your health. And for example, the tremendous growth of continuous glucose monitor.
So, I am wearing one right now, and that allows me to track my blood sugar real time throughout the day, and it's very insightful. And so, if I'm going to the doctor, I'm prepared. And we're also seeing the rise of direct-to-consumer testing in so many areas. And in both of these ways, I think the health coaches play an important role because we can't rely on Dr. Google. It's unreliable and there's a lot of misinformation that's out there, and people who are going to direct-to-consumer labs, for example, might misinterpret, over-interpret. And so, the coach can be the guide that helps them. They're the bridge of communication back to the practitioner.
Robert: I think that is so important because as you said, you're alluding to the starting point of information, and wherewithal of patients now is much broader spectrum than it used to be in years past because they have access to so much information that will only accelerate with artificial intelligence now. And it puts the health coach in a much more pivotal position of responsibility and quite frankly, ethical responsibility in terms of, often the healthcare coach will be a gatekeeper into the healthcare system or into at least a different way of negotiating one's health concerns with the healthcare system. And the coaches not only have to bring their skill in, you know, patient communication and but also that real ethical moral responsibility to do what's best for the patient.
And so often, I think both you and I agree, that's going to involve bringing the patient into a collaborative care team where they're really reintroduced back into all degrees of healthcare professional, including practitioners who are hopefully more well-trained to deal with their very challenging chronic-health conditions where maybe their prior practitioner was not. So, that's what I see for your audience. You know, the real value of functional medicine, healthcare coaching, and functional medicine clinicians you, your coaches, and we functional medicine practitioners follow the standard of care in all ways, but we add that extra functional medicine perspective, which sometimes is the key missing piece for a patient to really breaking through and changing their health care trajectory, their health outcomes.
Sandi: Oh, absolutely. So, have you seen examples where a doctor goes through IFM and then they put together a collaborative care team with a health coach? Any examples, anything you'd care to share, or what it would look like? What would be that ideal team with the coach's role on the team?
Robert: Right. You have to start with what is the context of the practitioner, just as we start with what is the context of the patient. You do need to know the context. Are they practicing solo? Are they practicing in a small practice, a large practice, academic setting, healthcare system? How much control do they have over their employment conditions, let's call them, and what other professionals do they have access to? You know, in my setting, community health clinics not a lot of resources, not a lot of other collaborating practitioners upon whom I could rely. So, that's the one extreme. And then the other extreme is there are places where there's already health coaches or nutrition professionals or clinical pharmacists. So, it really depends on finding out what the baseline is. But in almost every case, the addition of a health coach is going to enhance that collaborative care team.
And then to answer your questions, I've seen so many different examples of this. You know, at our advanced practice modules in our applying functional medicine and certification trainings, we always have a presentation early in the morning on day two, where we talk about the process of getting certified. And questions always come up about how do I incorporate a healthcare coach into my practice. And we recommend everything from, if you start talking on the chat to the other people who are attending and pose this question, "Are there other practitioners out there who will tell you how they started with a coach?" I also recommend using IFM's website, the find a practitioner link there where you can find practitioners in your area who are practicing functional medicine. There's also the integrated connections service where they're often, you can find practices looking for coaches and coaches looking for practices.
But there's just been such a variety. But so often the stories I've heard is I connected with another practitioner in my locality who was working with a coach. They kind of guided me through what they did and they customized that approach to their own practice. But Sandi, I would have to say, you've created a lot of resources around this of exactly how to introduce a coach into one's practice. So, maybe you should put a plug-in here for yourself and the assets you've created. Because I've been very impressed with how practical they are. And I do guide practitioners looking for coaches there too.
Sandi: Well, it's my mission to see a health coach in every practitioner's office. And we wanna make it easy for them to give them examples of how to successfully integrate a coach. And so, I do speak at those advanced practice modules and other IFM events, and I am also in that chat that you referred to. And there's a lot of people there who are in training and they're reaching out and saying, "Help me get a coach." And so we accommodate them. And for the beauty of training with us and then working in a functional medicine practice is that everyone speaks the same language so that when we refer to the tools of the functional medicine practitioner, the matrix, the timeline, etc., the food plans, the coaches know what it is. And so that's been really, really crucial.
So, you gave a very important talk at the last module of our 12-month training program, and you tied it all together so beautifully where you talked about the functional medicine model, the principles of functional medicine, and tied it in with the principles of coaching, and specifically the role of character strikes. And I love what you said, and that is because doctors tend to think of, "What's wrong with you?" And coaches, we train them to think, "What's strong with you?" So, I'd love for you to comment on that.
Robert: Right. When I recall a few years ago when I first started to engage with FMCA, Sandi, that I got to thinking about...you know, I was learning about what it really is that health coaches do. I really wasn't that familiar with it when we first started having conversations together. And the more I thought about... Well, first of all, there was so much joy amongst the health coaches in what they were doing and what they were learning. And I said, I gotta, you know, catch the coattails of this and really understand what's happening. And as I did, I understood what that joy was about. And these were largely professional individuals who had successful careers who turned to, you know, pivot in their career and go into coaching. That seemed to be the story of a lot of them.
And what I started it caused me to reflect on my own career. And I realized what the coaches are doing day in and day out is eliciting these character strengths that you talked about. And my wife, who's been through this now, been through the training, had me take the character strengths test, and I learned so much from it, and it helped me in my practice, helped me with my patients. But it also made me realize why there's so much job satisfaction and meaning and purpose in health coaching that these individuals find. And I've reflected on my own practice, and I realized, you know, my unstated task day-in and day-out with patient after patient is to find out, what's wrong with you? And what I really realized then is when we work with a health coach, it is my job to find out what's wrong with you physiologically, you know, where are your physiological dysfunctions, the pathology, all of that, that is my job, of course.
But to be able to turn to a health coach, and really, you don't say this in the referral, but you're saying, "I want you to work with the health coach in our practice now." And under your breath, you're saying, "Because the health coach is gonna find out what's strong with you." And that's where we can really make progress. Because once we combine, you know, my functional medicine thinking, working around the matrix with you and understanding what's wrong physiologically, when the health coach understands what's strong character-wise with you, we're gonna make some progress. And I've been really confident about that ever since. So, I appreciate you calling that out. It's a good bumper sticker. What's wrong with you?
Sandi: Yes. I love it. And I might also add, so not only did your wife go through our program and is now a graduate, but your sister as well who specializes in working with people with cognitive decline. And so even there, you can use that message, what's strong with you, what's wrong with your caretakers as well.
Robert: Absolutely. Can you imagine the pressure I'm under with a wife and a sister who are coaches? I mean, I've gotta watch my behavior all the time.
Sandi: Can you tell us a bit more about your practice, about your work as a physician, what your specialty is?
Robert: Yeah. I was trained as a family medicine physician and, I mean, currently, my full-time job is a director of medical education with IFM. So I'm doing a lot more education than clinical work. But my entire career has been in federally qualified community health centers. The majority of that within academic medicine at family medicine residency programs where I was in charge of the curriculum, especially the outpatient curriculum, which involved a lot of behavioral health, I will say faculty training, faculty development as well. And we did not have the benefit of coaches at that point. We had very scarce nutrition, professional support, and occasionally pharmacy professional support. But it was really trying to figure it out on our own. So, after decades of this, you know, to really be able to learn after starting my work with IFM about the possibility of collaborative care teams and especially the possibility of health coaches. And like we said, with these new trends now with patient empowerment and the democratization of medicine, the possibilities right now that were not there in my career in the circumstances where I was practicing, are just so exciting to me that, you know, the prospects for our patients and the consumers of healthcare, it's just so much more positive than it was. So, I think the future is so bright for patients and in part because of health coaches.
Sandi: That is so beautifully said, and I could not agree more. The future is bright and health coaches have a calling to serve. And you've mentioned the community health centers. And one of the things I really appreciate about the field of health coaching is the barriers to entry are pretty low. You don't need a college degree, you don't need training in healthcare, which means it's very accessible. The training is so much more affordable than if someone were to say, I want to go into nutrition or another area of healthcare, which might involve going to school and get an advanced degree, which is often out of reach financially as well as time investment. And so, we have so many people coming to become health coaches and seeking that certification from all walks of life. A lot of physicians, we were talking earlier about physicians being attracted to coaching as well.
Robert: Yeah. I think it's that phenomenon of when one has mastered a career, perhaps plateaued in their career and it's time for a change, it's time for, you know, personal growth to continue, and maybe that needs to occur outside the original profession that you chose, health coaching is a wonderful opportunity. I have to say you mentioned the word, mission, Sandi, and it just caused me to reflect almost without exception, the individuals I have met who are in coaching do have that personal mission of service. And I almost feel that kindred spirit aspect in every conversation I have with health coaches, even when they're perfect strangers to me. And then on that personal experience in my family, I can call out my sister if she doesn't mind me calling her out. You know, she went through extensive training and, you know, postgraduate training to do what she did in her career. And I can tell you she is just thrilled to be a health coach now and finding more satisfaction and more pleasure in this than I ever perceived in her other career. If she doesn't mind me saying that. So, she's an example of what I continue to hear from health coaches is that they're so glad they made that pivot. You know, they aren't looking back and they're really, really feeling fulfilled and feeling a sense of meaning and purpose.
Sandi: Wow. This has been just a fascinating conversation, talking about the future of functional medicine, future of health coaching. And we are just honored that you are part of our faculty and that we have this very special collaboration as an institution with IFM. So, the two institutions work very closely together and have the same mission to transform healthcare. So, this has been delightful. Thank you so much for being here today.
Robert: You're so welcome, Sandi. And thank you for the invitation. It's been a pleasure and an honor.
Sandi: Thank you. Bye now.