New Practice

In a moment, the situation escalated from fine to frightening. The room grew stifling. Dr. Sandra Sobel’s pulse raced and the tension in her body ratcheted up.

“I felt this wave of intense pressure and difficulty breathing,” Dr. Sobel recalls. “Then I recognized it: This is panic.”

Like too many of her peers, Dr. Sobel was burning out. Every new initiative that her academic institution threw at her, every patient encounter that was cut short, every lunch break she was forced to skip had been “a drop in the bucket.” While responding to an innocuous prescription request, the bucket overflowed.

Dr. Sobel, an endocrinologist, became a physician to build relationships with patients and collaborate to solve complex health problems, which she sees as puzzles. But the frenetic pace and competing demands of fee-for-service healthcare had blotted out the joy of medicine.

“I never wanted medicine to be just a job,” Dr. Sobel says. “I knew that there was something that had to change.”

Going direct

To rekindle her passion, Dr. Sobel embarked on a personal and professional transformation. She began a meditation practice, which dissipated the tension. She also hit the books, earning two nutrition certificates and board certifications in lifestyle medicine and obesity medicine. Once Dr. Sobel had the skills, she just needed the right practice model to bring them to life.

Fee-for service medicine wasn’t it. For years, she had been frustrated by the time limits it imposed on patient encounters. Meaningful health outcomes for endocrinology patients require traditional elements, such as medication and health technologies, she explains, but also nutritional counseling, exercise coaching, and mental health support. 

“Good luck covering that in 15 minutes,” she says.

Now, she doesn’t have to. Her direct endocrinology practice, Pittsburgh-based Summon Health, combines the essentials of endocrinology with cutting-edge technology and the high-touch approach to care that her patients demand — in as much time as they need.

Dr. Sobel’s patients get nutritional counseling, physical activity prescriptions, and even meditation instruction, too. Don’t know how to cook? Dr. Sobel will teach you to make simple, healthy meals in her practice’s teaching kitchen. Unsure whether meditation is right for you? She’ll guide you through a session in her practice’s meditation room. Never exercised? Dr. Sobel will build a tailored balance of cardiovascular and resistance training, just for you. 

But perhaps most important, at every step of their journeys, her patients have a friend and ally.

“There are few professions where complete strangers immediately confide so much in you,” Dr. Sobel says. “That’s not something I take for granted.”

Getting results

Those relationships have led to some remarkable transformations. 

“If we can keep doses down or avoid having to add multiple medications, that’s amazing – and that’s my goal,” Dr. Sobel says

One patient visited after having a heart attack, which revealed his unmanaged diabetes. After leaving the hospital, he went from taking no medications to a regimen that included a statin, an anti-hypertensive, an anticoagulant, and 42 units of insulin. 

The patient had low blood sugar and was clammy. None of the clinicians he saw at the hospital — who told him he’d have to wait six weeks for a virtual visit — had bothered to explain to him what low blood sugar felt like.

Dr. Sobel intervened, taking him off the insulin and giving him a continuous glucose monitor. This patient was highly motivated, she says, and already interested in a plant-based diet to lower his cholesterol. He reverently followed her exercise and nutrition guidance. In three months, he was off all of his medications, having lowered his A1C from 12.6% at the time of the heart attack to under 6.5%. His type 2 diabetes remains in remission.

“He will frequently tell me, ‘I felt like I was living half awake and now I’m fully awake. If only I had known the importance of my lifestyle in my health,’” Dr. Sobel says.

Making direct care work

For Dr. Sobel, that patient’s awakening is another puzzle solved by a profound doctor-patient relationship.

“There is very little that’s a better feeling than that – being able to solve that piece of the puzzle,” she says. “That’s why we go into this field.”

For doctors looking to rekindle the passion that brought them into medicine, Dr. Sobel recommends direct care. For specialists, she suggests consulting with other direct care physicians to determine how they established their practices. Business models can differ greatly from one direct care office to the next.

But many of the basics are similar, Dr. Sobel says. You’re going to need a polished website, a partnership with a reliable laboratory, and an EMR that won’t make your head spin. 

While striking out on your own may provoke some anxiety, Dr. Sobel says that providing transformative care on your own terms will more than make up for it.

“It’s a different stressor, but it’s one I chose and one that I like,” she says. “It’s been a wild ride and I’m so happy I did it.”