What Membership Does for You

Some people come to Fishtown Medicine for the integrative and functional side: a root-cause workup that goes past the standard panel into the systems that have been driving their symptoms. Some come for the preventive and proactive side: long-range planning for the health of their heart, metabolism, bones, and memory. Everyone stays for the same reason. Personalized, direct care, with the same physician.

Membership is how I take care of people. I get to know your whole story, look for the early signs that a standard visit has no room to catch, and stay with you through every next step, from your first text to the specialist's answer, so you always know who has your back.

What does membership do for your health?

It finds problems early, gets you to answers you can act on, puts your doctor a text away, and brings care to your home when that is where it works best.

Problems found early

Most of the conditions that shape the next 20 years of your health start long before they cause a symptom. Plaque builds in the arteries for decades, and insulin resistance, where the body needs more and more insulin to keep blood sugar steady, shows up years before a diabetes diagnosis would. You want to know about these while there is still the most room to change them.

So the labs here go further than a standard physical. The usual starting panel includes ApoB (the count of the particles that build plaque), Lp(a) (an inherited cholesterol particle), fasting insulin (an early read on insulin resistance), hs-CRP (a marker of inflammation), full thyroid, A1c (your average blood sugar over about 3 months), vitamin D, ferritin (your iron stores), B12, a complete blood count, and a metabolic panel, with more or fewer depending on your history and goals. A result can fall inside a lab's normal range and still say something about you, which is why we read every number together.

Your annual physical runs 90 minutes and covers your history, an exam, your labs, wearable data, family risk, and the plan for the year ahead. Longer visits are linked to more careful prescribing and higher satisfaction. I also keep watching between appointments. When new labs come back or you send me your wearable data, I review them then, so a number heading in the wrong direction becomes a conversation long before next year's physical.

Visits here have no timer. The records review and the lab review each typically run 60 to 120 minutes, and some run longer, because we keep going until you and I are on the same page about what has been done, what was found, and what we are looking at now. This is usually where a year of vague symptoms starts to make sense as 2 or 3 specific, treatable things.

One physician covers the areas that usually take several clinics: cardiovascular prevention, metabolic health, hormone care including testosterone and menopause, the medication side of mental health, and sexual health. Those systems affect each other, and one doctor reading all of them together can see how.

When something needs a specialist, I stay on it. I find someone I trust in Philadelphia, send them a clinical briefing on your behalf, and bring their opinion back into your plan, often without you needing another appointment. If you are ever admitted to a hospital, I help you through that too. You never have to carry messages between your own doctors.

Your doctor, a text away

You text me directly, as often as you need to, and I am the one who answers. When something new comes up, we can usually meet by video the same day or the next. Refills come straight to me, and there are no copays or visit fees for our care, so nothing about the relationship is metered. Most urgent questions are handled by text or a quick video, often within hours. For an emergency, such as chest pain, trouble breathing, or signs of a stroke, call 911.

Care that comes to you

When you need to be seen in person, I come to you. Home visits across the Greater Philadelphia Metro are part of membership, with no separate charge. Fixed imaging like an MRI or CT, and surgery, still happen at a dedicated facility, and I help arrange those. Sometimes getting to an appointment is the hard part, and sometimes seeing where you live tells me more than an exam room would.

Who is the membership for?

The membership is for adults 18 and up who want to stay ahead of their health, and it welcomes people living with complex chronic illness. It works best for people who want to be part of the plan, because the plan is built with you.

A few situations need a practice built for them. If yours is one of these, I will tell you plainly and point you somewhere good:

• Leading active cancer treatment (I co-manage alongside your oncologist).
• Transplant management.
• Active labor and delivery. Pregnancy itself is not on this list: I keep caring for you through it, working alongside your OB/GYN, who leads the obstetric care and the delivery.
• Chronic opioid or benzodiazepine maintenance prescribing.
• Patients on Medicare or Medicaid, because the federal billing rules are not compatible with a flat-fee model.

What do the first 90 days look like?

In the first 90 days we gather your history, read your labs together, and build your plan, in 4 steps.

Week 1, getting your history in one place. Send whatever records you have through your member page or by email. If gathering them feels like a chore, or you are tired of retelling the same story, we can request them from your past doctors for you. We also go over when to text, when to call, and what counts as urgent.

Weeks 2 to 3, the records visit. We read your history, prior labs, and specialist notes together, usually for 60 to 120 minutes. Many members say it is the first time a physician has read their whole story start to finish.

Weeks 3 to 6, labs and the deep dive. I order labs chosen for your history and goals, including advanced markers like ApoB and fasting insulin. When they return, usually in 7 to 10 days, we sit down again and read them, and the plan from that conversation guides the year ahead.

Weeks 7 to 12, putting the plan to work. This is when specialist referrals happen if you need them, along with medication adjustments, follow-up labs, and check-ins on the rhythm you choose. Some members stay close every 2 to 3 weeks while we work something out, and others settle into every 4 to 6 weeks once the picture is clear.

How does membership work with my insurance?

Membership is not health insurance, and it does not replace it. It is for your care with me, and your insurance keeps covering the care billed outside it: the hospital, emergency care, specialists, imaging, lab draws, and prescriptions. You keep your insurance, and the two work side by side.

Lab draws can also go through our cash pricing, passed through to you with no markup, whenever that costs you less than your insurance would. Your insurance covers the big, billable events. Membership is for your ongoing care with me: the unhurried visits, the texts, and the follow-through between appointments.

What does the membership cost?

On the annual plan, membership is $5,000 a year, which works out to about $13.70 a day, and that covers all of your care with me, without copays or visit fees. You can also pay quarterly or month to month. Either option is fine, and the annual plan saves the most.

The membership is HSA and FSA eligible, so pre-tax dollars can usually pay for it, as your plan allows.

If more than one of you is joining, each person has their own membership with the same direct access. Knowing both of you helps me, because I see the shared history, the shared stress, and the shared kitchen, and I can say so out loud. Adult children living at home, and parents or in-laws under the same roof, can each join the same way. Each membership is priced the same way, on the plans above.

Bought separately, the care inside membership would mean a hormone clinic, a metabolic program, a preventive cardiology consult, a mental health prescriber, and someone to coordinate all of them, each with its own intake and portal. Here it is one physician who already knows your history when you text.

How do I start?

Start with the intake and let me know what is going on, in whatever words you have. If your history is long, share what matters most and upload what you already have. Once you join and sign the consent to coordinate your care, let us know where your records live and my team requests the rest. I read every intake myself, and the free 20-minute call comes after I have read your story. If membership is the right fit, you join and we schedule the records visit. If it is not, I will say so and point you to a practice that fits better.