Is starting a weight loss clinic while in residency possible?

[EMTAB]

During medical school I became interested in weight loss and got heavily involved in research. I've started working through the requirements for the American Board of Obesity Medicine CME pathway and should be done in a couple weeks. Part of the requirement to state that you are ABOM certified (even though it's not a recognized ABMS specialty) is to have completed a residency program and be board certified within that specialty. I'd have the information, and feel like I know more of it already, and have floated the idea of opening a weight loss clinic as a moonlighting opportunity and perhaps attach a gym to it with a friend who is a personal trainer and wants to open a gym as a separate business. Is this feasible while as a resident? It wouldn't be open likely until July, and I would be a PGY3 at that time and my schedule gets closer to 40-50 hrs a week at that time so I wouldn't be violating duty hours. Curious if anyone has experience with weight loss clinics or any other thoughts on this idea.

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[auburnHCP]

I’d say go for it!

 

[VA Hopeful Dr]

Yes, you can do it.

That said, the majority of weight loss clinics that I've ever seen are basically phentermine/hcg/b12 vending machines. People go to weight loss clinics for the easy fix. If you're OK with that, have at it.

 

[hallowmann]

Yes, you can do it.

That said, the majority of weight loss clinics that I've ever seen are basically phentermine/hcg/b12 vending machines. People go to weight loss clinics for the easy fix. If you're OK with that, have at it.

But hey, OP can be the one that gives them bupropion, naltrexone, topiramate, and semaglutide instead so they don't have to worry about the DEA license.

 

[NeuroticByN8ure]

Agree with the above. Marketing yourself as a weight loss physician sets the expectation that you will prescribe them something-- most people who are highly motivated to make lifestyle changes on their own aren't seeking someone to prescribe them medication. And then, in practice, you find that you can't get anything covered, so the only affordable option is phentermine w/ a good Rx coupon at Walmart.

The patients I have successfully helped with medication-directed weight loss have been diabetic--- some people will come to me on Lantus + TID Humalog and metformin. Maximizing a GLP1a and getting them off of insulin w/ this, and having them stop sugary beverages can yield impressive results.

90% of my patients are overweight, so you won't have any trouble finding obesity to treat within your FM/IM patient panel.

 

[NeuroticByN8ure]

Has anyone had success with getting Wegovy covered for their patients?

 

[VA Hopeful Dr]

Has anyone had success with getting Wegovy covered for their patients?

Sadly no

 

[hallowmann]

Has anyone had success with getting Wegovy covered for their patients?

Prescribe semaglutide sometimes with variable coverage. For diabetics it (or other GLP-1s), almost never an issue. For prediabetes and obesity or NAFLD/NASH and obesity, its variable. A lot of people with private insurance can get the Ozempic coupon card and they pay <$30 a month. If I have time, I walk them through the application and print the coupon during the visit, but mostly I don't have time and many never end up doing it. Sometimes I have them come back for a 15 min visit and spend much of the time doing just that (usually takes <5 min) and med counseling.

 

[betamale]

You can prescribe Wegovy too. very effective. Ozempic is similar chemically but covered by insurance for prediabetics but still causes weight loss but at a lower cost. You can request samples from Novo Nordisk and give them away as starter packs.

 

[EMTAB]

You can prescribe Wegovy too. very effective. Ozempic is similar chemically but covered by insurance for prediabetics but still causes weight loss but at a lower cost. You can request samples from Novo Nordisk and give them away as starter packs.

I heard that about wegovy, but it seemed like the insurance coverage was the real problem. I didn't know that about the Nordic, I'll have to look into that!

 

[FrustratedFamDoc]

I've never done it or even thought about it, but I could see it as such:

seeing >40 patients in a day, majority on adipex, 75% have plateaued with modest results and are begging you to continue adipex, despite your best judgement. If you don't, you'll essentially lose them as a patient as there is really no reason for them to continue to see you. Wash, rinse repeat until the next year when they come back, even heavier promising that they'll do better this time around. You'll be signing off for 1+ mid levels also at the clinic.

I've tried almost every conservative tool at my disposal and I consider myself a pretty good motivator, and over a 13 year period, my results are abysmal. I've had a few standouts, but it is always from their efforts, not mine. People suck at making changes unless forced to.

I've referred MANY patients for bariatric surgery and they come back kicking ass. They are now forced to eat right or pay the price. Only a few have gained the weight back. None have had regrets. In the 13 years of referrals, I have not once seen a bad outcome from him in one of my patients. We have an awesome dude in my town doing them... and they won't be coming back in 6 months begging for more adipex.

A log home created with axe hewn timber that took a frustrating 3 years to build sure feels the same as one made over 3 months with the assistance of a chainsaw... and needs far more continuing maintenance.

 

[futuredoc331]

It's actually possible to start your own clinic while in residency? So long as you don't go past duty hours, of course? And have the approval of your program?

 

[hallowmann]

It's actually possible to start your own clinic while in residency? So long as you don't go past duty hours, of course? And have the approval of your program?

Do not exceed duty hours, get program approval (often this means in writing with a moonlighting agreement form), have an unrestricted medical license (i.e. not a training license - varies by state how much training you need to have to do this, usually between 1-3 yrs of GME), have malpractice insurance that you will most likely need to pay for as your training malpractice is usually restricted to training duties, and be sure there are no conflicts of interest/non-competes with your training program.

 

[futuredoc331]

I wonder how much more difficult it is to get your program's approval if you're wanting to run your own clinic rather than moonlight for someone else.

 

[ObsequiousAplomb]

I wonder how much more difficult it is to get your program's approval if you're wanting to run your own clinic rather than moonlight for someone else.

Some programs require a form signed by the medical director of the place you want to moonlight. Residency director specific on how they would want to handle someone being their own medical director.

 

[VA Hopeful Dr]

Your biggest challenge will be your attendings and co-residents, who constantly create excuses for not working out or eating healthily.

Umm, what?