As a part of my interview series with prominent medical professionals about “How To Grow Your Private Practice,” I had the pleasure of interviewing Julia Getzelman, M.D. Julia founded GetzWell Personalized Pediatrics in 2008 with a passionate commitment to bring pediatric functional medicine to San Francisco. She is board certified in pediatrics and is a member of the American Academy of Pediatrics. In 2007 she completed the core curriculum of the Institute for Functional Medicine and has additional training in applied nutritional biochemistry/food as medicine as well as in using genetic polymorphisms as a foundation for treating a variety of chronic health problems like ADHD, anxiety, behavior issues, and autoimmunity.
Thank you so much for joining us, Julia! Can you tell our readers a bit about your ‘backstory”?
Over the dozen years since I established GetzWell Personalized Pediatrics in San Francisco, we have developed a highly successful and fundamentally different kind of medical approach, empowering parents with the information necessary to prevent disease — and even cure illness — largely by raising their awareness of food’s powerful impact on their children and its potential to both harm and to heal. But it really all started with a garden in the middle of Los Angeles in the 1970s.
There are so many things my parents said and did during my childhood that I look back at as life-long gifts that have taught me more than I could have ever imagined: insisting on piano lessons starting at age five, teaching me to navigate the LA public transportation system (such as it was), and “strongly suggesting” I spend a fair bit of my precious summer break learning to sew with my great aunt — just to name a few.
I’m immensely grateful for those opportunities. But, in the end, the warp and woof of me were most influenced by my father’s garden and the chickens we raised in the foothills of Los Angeles, in full view of the crowded 134 freeway. I was fortunate to grow up in a family with a fundamental belief in food’s ability to make you sick or keep you well. “You are what you eat,” was the family mantra.
I can still see the coffee tin that sat near the kitchen sink, slightly the worse for wear, overflowing with food scraps and eggshells. At the end of each day, its contents were added to the compost pile — which Dad rigorously tended for use as fertilizer for the vegetable garden and fruit trees — or was offered to our lucky, egg-producing chickens. Most evenings, Mom would ask one of us to go out and pick a head of lettuce — our modest contribution to the night’s fresh, nutritious salad — a dinner staple.
Granted, I just wanted to eat warmed-up Swanson TV-dinners like “normal” families — how I longed for those shiny trays with individual compartments neatly dividing the steaming peas from the breaded chicken pucks and perfectly sculpted mashed potatoes. But, when a teen from our neighborhood was diagnosed with cancer, my mother was convinced it was due to all the preservatives in the processed food and soda the young girl had lived, in particular. Forevermore, we read labels, avoided Red Dye #2 and all other additives that Mom intuited were unnatural and harmful. We shopped mostly at the local “health food” store. This was just how our family did things and, at the time, I had no idea what an indelible mark this would leave on me.
Today, I’m a pediatrician with a unique practice focused on applied nutritional science — aka functional medicine. When I first learned from credible sources that food is more than just calories and that it delivers information able to impact us at the level of our DNA, I just about did cartwheels. The science supported what Mom and Dad had said all along — that the most powerful medicine we had access to was already on our dinner plates!
Take Daniel, a morbidly obese and volatile 3-year-old, who could barely bend over far enough to reach his feet in order to put his shoes on. His former pediatrician had referred him to a hospital dietician with a six-month wait-list who recommended little more than merely counting calories. This yielded no improvement in Daniel’s weight, nor did it reduce his severe tantrums.
Desperate for help, Daniel’s mother and grandmother sought me out for advice. We discussed, among other things, why the number of calories Daniel consumed was only one part of the equation; the carbohydrates and juices (provided with the best of healthful intentions) in his diet, not the fat, were the likely culprits.
When Daniel returned three months later, I was ecstatic to see incredible improvements in his weight and mood. He was lighter and moved with greater ease. And his mother was convinced that he liked his new way of eating. “He feels better because his moods are more stable. He’s happy now,” she told me. Daniel’s life will now likely unfold in a profoundly different way, both physically and social-emotionally.
I’ve enjoyed so many similarly fulfilling experiences with children who have benefited from this “food-as-medicine” approach to their care. Sean was two years old when I met him, the son of a very bright and successful couple. He could only speak three words, a severe delay in speech development. Sean also suffered from chronic nasal congestion, and his worried parents explained, “It just seems like the lights are always on dim.”
Sean’s parents were resistant to the idea that something as simple as food could be both the problem and the solution. It took some time to convince them to commit to significant changes in their way of eating. But, once they did, in the matter of a few short weeks, Sean was speaking in full sentences. “For the first time in his life, his nose isn’t running!” his mother rejoiced. Fast forward three years to one of Sean’s wellness visits, with me trying hard to re-establish a rapport as we now only have annual visits. Sean, now an articulate and funny five-year-old, quipped, “Is this a check-up or a chat-up?” I was barely able to stifle a burst of laughter.
Our national medical model is still two generations behind the science. So many chronic illnesses that fundamentally impact the quality of life of millions go unaided — in fact, are exacerbated — by our “one-ill-one-pill” construct of care, dictated largely by pharmaceutical and insurance companies. Fatigue, joint pains, headaches/migraines, ADHD, anxiety and skin rashes — these are all examples of ailments that most people (and their doctors) would never imagine have anything to do with what they put in their mouths.
What made you want to start your own practice?
After getting my medical degree from Yale and training at one of the highest-ranking clinical residency programs in the West, I was an idealistic pediatrician determined to help children and their families achieve optimal health. However, what I encountered after finishing my training was a fractured system necessitating “15-minute-medicine” and an approach that was so rote it seemed like it could have been carried out by an intelligent primate.
Before opening GetzWell Personalized Pediatrics, I worked in several poorly managed outpatient settings where I had no say in how things were run. In most of the group practices I encountered, the doctors worked under one roof but there was no cohesion, little communication, and sometimes the physicians didn’t even like each other. During medical school I’d decided on a career in pediatrics, in part, because I felt a synergy with pediatricians. But in the “real world” that didn’t necessarily bear out. Ultimately, I felt like I was a cog in a system that needing major fixing. I was authentically invested in helping families achieve true wellness, but there was little support or reward for my investment–it felt like it didn’t really matter if it was me or another warm body putting in the hours.
Furthermore, I became bored and deeply disappointed by the kind of medicine I was practicing. The one-ill-one-pill paradigm and poor insurance reimbursement in pediatrics — -the lowest among the medical specialties — -left little room for critical thinking, adequate time, or treating each patient as a unique human being with unique health needs. I became determined to create a practice where I could deliver the kind of care I wanted for myself and my family. Founding GetzWell was the best decision I ever made.
Managing being a provider and a business owner can often be exhausting. Can you elaborate on how you manage(d) both roles?
This is a tough one — -I enjoy both roles equally. It’s a constant balancing act between managing the practice and caring for patients. It’s as though I gave birth to GetzWell 12 years ago — -the practice, like a child, requires a significant amount of time, patience, and energy to nurture, but the rewards make it all worthwhile.
I also continue to expand my knowledge of the latest studies in functional medicine — which is shifting the paradigm of what we understand about health — -allowing me to get to the root causes of illness instead of focusing solely on symptom suppression with pharmaceuticals, which is typical in mainstream medicine. I’m personally seeing fewer primary care patients now–-the rest of my amazing team does that — -and instead I am focusing on patients with complex health challenges whom I have a set of unique skills to help.
For example, I’m now seeing kids and adults with ADHD, anxiety, autoimmunity, etc. who want to address the underlying causes of these health issues in order to fundamentally heal. My clinical toolbox has grown by leaps and bounds in the last decade, and I’m using resources like 23andMe which provides individual genetic data enabling me to personalize treatment plans like never before.
As a business owner, how do you know when to stop working IN your business (maybe see a full patient load) and shift to working ON your business?
Successful business owners need to be hands-on and able to respond quickly to what’s happening. One impetus for founding GetzWell was the dysfunctional settings I’d worked in prior. I will never forget the time front office staff of a practice where I was filling in yelled at the owner — -the whole scene was so wrong. This experience, as well as the pervasive lack of respect and tension in other offices in which I’d been employed, made me determined to foster a positive environment for the GetzWell team. As GetzWell’s CEO I’m present and observant, have an open-door policy with my staff, and nurture a culture of teamwork and respect that I know translates to the care of our patients.
From completing your degree to opening a clinic and becoming a business owner, the path was obviously full of many hurdles. How did you build up resilience to rebound from failures? Is there a specific hurdle that sticks out to you?
There are always hurdles, and frankly, it’s the challenges along the way that have made me stronger and more resilient. I think opening one’s own medical practice in the current managed care dominant environment requires a lot of grit and commitment. Hanging out your shingle just doesn’t happen that often anymore, particularly in primary care, because of the insurance reimbursement structure and other factors. So rebounding is kind of already in the DNA of those who actually take the leap.
What are your “5 Things You Need to Know To Grow Your Private Practice” and why. (Please share a story or example for each.)
- Keep overhead low.
This sounds obvious, but many make the mistake of aiming too high with fancy office space, large staffs, and expensive electronic health records systems. It’s essential to see how the practice evolves, how quickly it grows. Start small and expand from there. I had a friend who tried to get a practice off the ground in another city and failed because of having made too significant an investment upfront.
2. Be humble and nimble.
Like I’ve said, you need to respond quickly to demands, make changes and be in an
almost constant evolution mode. As the owner, I am always prepared to wear many
hats and am never too proud to wipe down dirty doorknobs or pick up a phone that’s
3. Hire well, but when you make a mistake, cut your losses quickly.
I’ve had to learn this the hard way and on occasion have made the error of keeping employees around too long. This in one case led to a drag on morale that resulted significant staffing issues in the practice. This was a stressful time and I learned a lot about myself and what’s important to me and GetzWell.
4. Have a strong website.
In today’s world this seems obvious, but there are a lot of terrible websites out there. I have actually had people tell me they joined the practice because they loved GetzWell’s website!
5. Don’t take insurance.
Being out of network has allowed me to realize my dream and to practice medicine utilizing the latest science in real time. I don’t have bean counters from the for-profit insurance world telling me how much or little time I can spend with patients, which procedures I can or can’t do, or whether house calls for newborns are cost-effective. Additionally, I don’t have a team of people dealing with insurance claims submissions, denials, and all the attendant hassles of being in network. To quote Chris Hayes from MSNBC, “Every last thing about medical billing absolutely sucks even if you have good insurance. My god.”
Many healthcare providers struggle with the idea of “monetization.” How did you overcome that mental block?
My father was a medical professional and small business owner, and he influenced me more than I could have known at the time. As a result, I’m fortunate to be able to say that I rarely experience that kind of a block. I agree, however, that it isn’t something that comes naturally to most physicians.
What do you do when you feel unfocused or overwhelmed?
Physical exercise has always been one of my best forms of therapy. I used to be a runner, but not any longer — -I’m a walker! A brisk walk usually helps tremendously. Sometimes at the end of a particularly challenging day, I’ll take 15 minutes and lie on one of the exam tables and meditate. That also allows me to reset, focus, and increase my productivity.
I’m a huge fan of mentorship throughout one’s career — None of us is able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?
I’ve had the opportunity to learn from several outstanding individuals who supported me through many of the ups and downs associated with running a growing pediatrics practice.
One in particular: a man with whom I’ve developed a lifelong bond, is a successful OB/GYN and entrepreneur himself. Time constraints aside, he is always available to share experiences, voice concerns, and help negotiate resolutions in a transparent and encouraging manner. Integrity, sensitivity, and clear communication — -these describe this exceptional individual and qualities I strive to possess in my role as CEO of GetzWell Personalized Pediatrics.
What resources did you use (Blogs, webinars, conferences, coaching, etc.) that helped jumpstart you in the beginning of your business?
- The Institute for Functional Medicine
- Center for Mind-Body Medicine
What’s the worst piece of advice or recommendation you’ve ever received? Can you share a story about that?
I was a one-woman show. I started my practice from scratch and was motivated to try new — and sometimes unorthodox — ways of doing things. I was inspired by the appealing promises of the new “share economy.” I had this grand idea that I could be environmentally conscious and save some money by using City Car Share for everything from getting office supplies to doing house calls. So, I sold my car.
At the same time, I had committed that every newborn entering my practice would have their first visit at home. What started as a great idea ended up with me schlepping a baby scale and other necessities for newborn house calls to the nearest City Car. But it turned out that cars which seemed so close on my phone’s tiny screen weren’t that close after all (especially with all the stuff I had to carry).
Sweaty and harried, I would finally arrive at the often-dirty car, running late and needing to race off to the next appointment. I suffered through this self-inflicted hellscape for a couple of months until it became clear that, in addition to the severe inconvenience, it would have cost me far less to lease my own luxury auto! I drive my own car now and take a Lyft in a pinch.
Please recommend one book that’s made the biggest impact on you?
In God’s Hotel, Dr. Victoria Sweet discusses her experiences at Laguna Honda Hospital in San Francisco back when it functioned much like an almshouse for those who had fallen on hard times. She describes practicing a kind of “slow medicine” that has basically vanished in today’s version of medical care.
Slow medicine. That’s what I decided I wanted to be able to provide for families and especially for kids. I tell people GetzWell Pediatrics is like your old-fashioned neighborhood doctor armed with all the best modern tools. We provide newborn house calls, support for breastfeeding, and hour-long wellness visits. In short, we really get to know our families. The national average for a pediatric visit is twelve minutes — this results in a lot of doctor burn-out and even more unhappy patients. Sharing critical and often complex information takes time. At GetzWell, nobody is rushed.
How can our readers reach on you on social media?
Facebook: @ GetzWell Personalized Pediatrics
Pinterest: @GetzWell Personalized Pediatrics
Thank you for all of these great insights!