Practice Spotlight: Wes Youngberg,  DrPH, MPH, CNS

Rancho Family Medical Group

www.myranchowellness.com

It was on a fall day in Michigan, at age thirteen, that Wes Youngberg’s passion for lifestyle medicine was born. “Why did Mom die of brain cancer?,” he asked his Dad as they walked amidst the autumn leaves. “I wish I knew, Son.” After contemplating his father’s response, Wes said, “I wish I knew what my future health risk would be so I can start addressing it right now.”

Wes may have already been destined for a healthcare profession due to the influence of his aunts, uncles and cousins, over 15 of which are physicians. But that heart to heart with his father, and those two compelling words “health risk,” set him on the particular path of Lifestyle Medicine.

After fourteen years at a medical mission in Guam, Dr. Youngberg returned to southern California last January to join Rancho Family Medical Group, a large family practice group which incorporates four specialty practices: Cardiology, Internal Medicine, OB/GYN, and Lifestyle Medicine (LM).

Wes develops and conducts HMO and PPO based disease state management programs designed for optimal health improvement in high medical risk patients. The medical group serves 4,000 patients per month, with over 300 patients taking advantage of various LM clinics and seminars each month. Individual consultations are set for 30 minutes and group sessions are two hours. Patient referrals to the Lifestyle Medicine Clinic come from the primary care doctors and other specialists. Patients may also self refer depending on their health plan. All HMO patients attached to the group practice have open access to group and individual services.

Their current volume is so large that they need more LM specialists. They have had to limit individual visits to give priority to those participating in the 10 week group programs. Individual appointments for those not in a group program are booked four months out. Typically between 15 and 30 patients attend any given session.

Marketing is paramount and currently happens by word of mouth from patient satisfaction and physician referrals, mainly from 4-5 primary care providers that are especially excited to have LM services available to their patients.

Clinical Group Seminars include:

-Optimizing Emotional and Brain Wellness  to provide a more comprehensive approach option for dealing 

 with depression, anxiety, headaches, fatigue, poor memory, Alzheimer’s risk, and other neurological

 conditions.

-Optimizing Metabolism and Heart  Health to increase energy, circulatory health and learning a system of

 nutritional excellence that allows the body to naturally reduce excess fat weight without risky drugs or

 dangerous procedures.

-Diabetes Management Clinic to learn how to effectively manage and possibly reverse diabetes, pre-diabetes

 and problems with hypoglycemia. One does not need to be a diabetic to benefit from this program. For many,

 their most significant cardiovascular health risk is an undiagnosed pre-diabetic blood sugar imbalance.

Insurance Reimbursement is vital. Office visits are based on established intermediate or extended visits. Group visits incorporate the screening and laboratory/progress evaluation of intermediate or extended visits and adds the educational/counseling function that lasts a total of 2 hours. As part of the established guidelines for group visits, lab and chart reviews are conducted prior to the group session.

Measures for success are multi-faceted. Given the availability of the 10 weekly sessions and follow-up office visits, patients have every opportunity to learn and practice effective LM strategies that are sufficient to achieve their goal. The group sessions are designed with a comprehensive laboratory pretest during week one and is followed by a retest of appropriate labs two weeks prior to the end of their weekly sessions. Individual consults are recommended at baseline, two-weeks and two months with either monthly or quarterly follow-ups depending on the risk level of the patient and the number of co-morbid conditions to address.

What labs are measured and how much do patients typically improve? 

Dr. Youngberg explained: “Prior to ordering labs, we do a 45 minute consult with the patients with a complete medical history, family history, chart and lab review, and evaluation of patient goals. Labs are then ordered based on findings and often include: 2 hr GTT with fasting and 2 hr insulin (to pick up undiagnosed diabetes, pre- diabetes and insulin resistance), if adrenal fatigue or reactive hypoglycemia I will order a 4 hr GTT and include cortisol measures at fasting, two and four hours; A1c, TSH and Free T4 & T3; homocysteine, ferritin, Fe/TIBC, 25-hydroxy vitamin D, VAP cholesterol profile with Lp(a); hs CRP; CBC and comprehensive metabolic panel. For selected patients we will add DHEA-S, testosterone, estradiol, progesterone, lead, mercury, H pylori ab. Our programs specifically discuss each abnormal lab and multiple LM strategies to optimize them. Most patients get significant benefit.”

Are the Lifestyle Medicine services/programs running in the black?

Yes, we are generating double the revenue compared to expenses. Of importance is the fact that running a LM Clinic is far more cost effective than running a fitness or wellness center that includes exercise facilities. Our model of a LM clinic essentially only needs shared intake (BP, weight, etc.) area with any medical practice, a consultation room and access to a conference room that seats at least 20 patients.

What challenges have you had to deal with?  What successes?  What advice would you have for other LM practitioners?

The key is to stay on the forefront of the medical research and to wisely apply it to current LM strategies. We cannot wait for a medical society to come out with a consensus statement before we apply the information clinically. Most critical to LM success is to focus on the power of hope and to re-educate our patients regarding misguided medical adages of the past. "Once a diabetic, always a diabetic", or "You'll have this disease for the rest of your life, all we can do is help you manage it" are statements which destroy hope and the resolve to change. As Normal Cousin put it, "Don't deny the diagnosis, defy the verdict!”

WIN! Wellness Six years ago Dr. Youngberg teamed up with his parents, Drs. John and Millie Youngberg, both retried professors of education, to develop a new wellness model integrating physical, emotional, and spiritual well-being. They are currently filming 21 presentations to be made available in DVD for use in medical groups, wellness centers, churches and self-care groups. See www.winwellness.org

“How we think, how we perceive life around us is integral to our overall well-being."

WIN! consists of twenty-one exciting lectures blending mental, physical, spiritual and relational dimensions for balanced living and can be utilized by individuals or groups.” Dr. Youngberg’s passion for helping others identify factors influencing health risks and healthy habits has not wavered since that walk in the woods with his father. Commitment, creativity and collaborations have, and will continue to be, life-giving.

ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice. We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended to imply official endorsement of individuals or practices.