Scope of Practice

Fishtown Medicine focuses on adult internal medicine through a longevity and prevention lens. Clear scope keeps care safe, deep, and truthful. This page explains what we do, what we do not do, and why those boundaries make care better.

What does Fishtown Medicine specialize in?

Fishtown Medicine specializes in adult internal medicine with a focus on:

• Preventive Medicine & Healthspan Optimization
• Metabolic Health (insulin resistance, weight management, diabetes prevention)
• Hormone Optimization (testosterone, thyroid, menopause and andropause)
• Cardiovascular Risk Management (lipids, blood pressure, inflammation)
• Complex Diagnostic Work (unexplained fatigue, brain fog, chronic symptoms)
• Longevity Medicine (VO2 Max, muscle health, sleep, recovery)
• Acute Care (infections, injuries, urgent medical needs)

We practice relationship-based medicine with deep continuity. We do not dabble; we go deep in areas where we have expertise.

What does Fishtown Medicine not do, and why is that a good thing?

Clear boundaries are not limitations; they are a commitment to excellence. We refer out when you need specialized care, and we coordinate that care as your quarterback.

Out of Scope: Medical Conditions

We do not provide primary care for:

• Active cancer treatment (we coordinate with oncology)
• Organ transplant recipients (requires specialized transplant medicine)
• Continuous opioid use (requires pain management specialists)
• Continuous benzodiazepine use (requires addiction medicine or psychiatry)
• Unstable psychiatric illness (requires psychiatry): active psychosis, mania, suicidal or homicidal intent, a recent psychiatric hospitalization, or any picture needing crisis stabilization or intensive medication monitoring
• Pregnancy, obstetrics, and delivery (requires OB/GYN)
• Pediatrics (under 18 years old, requires a pediatrician)

Note for Member Families: While we cannot serve as the primary physician for minors, we are happy to act as a sounding board and collaborate with your pediatrician on complex family health questions.

Mental health is part of primary care here. Mental, physical, and sexual health get pulled apart and handed to different people, and things fall through the gaps between them. We treat them as one picture. Depression, anxiety, ADHD, sleep, stress, and the medications that go with them are ordinary primary care work, and asking about them is not asking for a referral elsewhere. The exclusion above is narrow and it is about acuity rather than diagnosis: an illness that is unstable enough to need crisis care or close psychiatric monitoring belongs with a psychiatrist, and we will help you get there. Anyone in immediate danger should call or text 988 or go to an emergency room, and we will still help you land somewhere safe.

Out of Scope: Insurance Types

We do not accept:

• Medicare
• Medicaid

Our membership model is designed to work with or without insurance. We are out-of-network for all insurance plans, which lets us remove the barriers (copays, denials, 12-minute quotas) that get in the way of good care.

Your membership is generally HSA/FSA eligible.

Where We Practice

Dr. Ash is licensed to provide medical management in 40 states. Patients in licensed states get the full clinical experience: prescriptions, labs, imaging orders, specialist referrals, and ongoing care.

Licensed for medical management in:

Alabama, Arizona, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Guam, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming.

International and out-of-state guidance. If you live outside our licensed states (or outside the U.S.), we can still work with you in a non-clinical, educational capacity, including health strategy consultations, lab interpretation, and longevity planning. We cannot prescribe, order labs, or provide direct medical management across state or national lines, but we can be a thinking partner for your existing care team.

Why do we set boundaries?

1. Depth Over Breadth

We would rather be exceptional at what we do than mediocre at everything. Our focus areas (metabolic health, hormones, cardiovascular risk, longevity) require deep expertise and continuous learning.

2. Safety First

Conditions like active cancer, organ transplants, and chronic opioid or benzodiazepine use require specialized monitoring and expertise we do not maintain. Referring you to the right specialist is the safest, most responsible choice.

3. Regulatory Compliance

Medicare and Medicaid have specific billing and documentation requirements that are not compatible with our membership model. We cannot deliver the level of access and continuity we promise while managing those systems.

4. Straight Answers

If your needs are outside our scope, we will tell you immediately during your complimentary introductory call. We will not waste your time or take your money if we are not the right fit.

What happens if you need a specialist?

We act as your quarterback:

1. We coordinate your care and send your records ahead of you.
2. We curbside specialists for you, getting expert opinions without you needing to book a separate appointment unless a procedure is required.
3. We debrief with you afterwards to translate the jargon and integrate their recommendations into your overall health plan.

You do not lose us when you see a specialist. We remain your primary physician and advocate.

Questions About Scope?

If you are not sure whether your needs fall within our scope, schedule a complimentary introductory call with Dr. Ash. The call is a no-obligation chemistry check to make sure we are the right partners for your goals.

Tell Dr. Ash what's going on