Why We Don't Sell an Executive Physical in Philadelphia (And What We Do Instead)

The executive physical exists because the standard fifteen-minute primary care visit cannot answer the questions that successful, time-poor people actually want answered. "Am I going to have a heart attack?" "Do I have early cancer?" "How is my biological age tracking?" Those questions need real lab work, real imaging, and real time with a physician. None of that fits in a regular appointment. So a parallel system grew up around it. Penn has one. Jefferson has one. Cooper has one. Cleveland Clinic has a satellite. Princeton Longevity Center, a short drive away, does a particularly deep version. They all charge between $3,000 and $8,000 cash, take a full day or two, and hand you a leather-bound report. For the right patient, in the right moment, it is a great product. For most patients, most of the time, you can get the same medically relevant information for a quarter of the cost and a tenth of the friction, if you know what to ask for.

What is actually in a Philadelphia executive physical

The Penn and Jefferson exec physicals are not identical, but they overlap heavily. A standard one-day Philadelphia executive physical typically includes:

• A long intake (45 to 90 minutes) with a senior internist.
• A focused physical exam.
• A full lab panel: CBC, CMP, comprehensive lipids (often including ApoB), HbA1c, thyroid, vitamin D, hsCRP, sometimes Lp(a), often a urine analysis, often a PSA for men over 50.
• Cardiac evaluation: resting ECG and a stress test (exercise or pharmacological). Sometimes an echocardiogram.
• A CT chest or low-dose CT for lung cancer screening if you have a smoking history. Sometimes a coronary artery calcium (CAC) scan.
• Body composition: usually DEXA or BIA.
• Fitness testing: VO2 max on a treadmill or bike.
• An eye exam and hearing test in some programs.
• A nutrition consult and exercise consult in some programs.
• A written report and a follow-up phone call.

That is a lot of value in one day. The total cost runs $3,000 to $8,000 depending on the institution, and is usually not covered by insurance because there is no specific complaint driving it.

What is worth doing, and what is theater

Honest assessment after running this conversation hundreds of times. Here is the high-yield core of an executive physical, ranked roughly by how much it changes care:

1. A coronary artery calcium (CAC) scan if you are over 40 with any cardiovascular risk factor. Single most underused preventive test in American cardiology. About $100 at most Philadelphia imaging centers if you self-pay. A score of zero rules out significant coronary disease for the next decade with high confidence. A high score reroutes your entire prevention plan toward assertive lipid lowering.
2. ApoB, Lp(a), and fasting insulin. These three biomarkers do more to change cardiovascular and metabolic care than the entire standard panel. ApoB beats LDL for risk prediction. Lp(a) is genetically determined, gets tested once in a lifetime, and reroutes care if it is elevated. Fasting insulin catches insulin resistance years before HbA1c moves.
3. A DEXA scan for body composition and bone density. Body composition is more honest than BMI. Bone density at baseline is useful for anyone over 40, especially women.
4. VO2 max testing. The single best predictor of all-cause mortality after age. If yours is poor for your age, that is the single most actionable data point you will get.
5. A low-dose chest CT if you have any smoking history over the age cutoff. The data on lung cancer screening is strong and the test is fast.

Honestly secondary or skippable for most patients:

• A treadmill stress test in someone with no symptoms is low yield and has a meaningful false-positive rate. A CAC scan is almost always a better first move.
• An echocardiogram in someone with no symptoms or murmur is rarely high yield.
• The nutrition and exercise consults that come with the hospital exec physical are almost always generic and do not change behavior. A good primary care practice can do better with a longer relationship.
• The leather-bound report is nice, but a working PDF with a real follow-up plan is more useful.

The Fishtown Medicine version

We do not run a one-day executive physical. We do something that overlaps in depth but works differently - and, honestly, works better for the outcomes most executives actually want. Membership is what we recommend first, and what most executive-physical-curious patients end up choosing. Membership gives you the same advanced workup a hospital exec physical does - ApoB, Lp(a), fasting insulin, vitamin D, hsCRP, CAC scan if indicated, DEXA, VO2 max - spread across as many visits as it takes to actually understand and act on the data. But the part that delivers results is what you don't get from a one-day program: unlimited access, direct messaging with Dr. Ash, and ongoing preventive follow-up. Found a borderline Lp(a)? Iterate the plan over the next quarter, not in your next $5,000 annual visit. Want to talk through a new symptom on a Tuesday morning? Text him. The first preventive visit is 90 minutes; everything after is shaped by what we're managing together. This is the difference between great care and excellent care - the difference between a written plan and an actual change in your trajectory. The Strategic Roadmap package is the right fit if you want a once-and-done deep workup with no ongoing commitment. Across five 1-hour visits we build the same high-yield workup: full lab panel, ApoB, Lp(a), fasting insulin, vitamin D, hsCRP, plus referrals for CAC scan, DEXA, and VO2 max where indicated. At the end you walk away with a written plan and the option to continue as a member, which is what most patients do. A referral path if you want the full one-day hospital exec physical. We are friendly with the Penn, Jefferson, and Princeton Longevity Center programs. If you want the choreography, the leather binder, and the all-in-one-day experience, we will route you. We just want you to know it is not the only option, and it is not what we think delivers the best long-term result for most people.

What our patients who came from those programs tell us

A meaningful share of our executive membership cohort came over from one of these hospital programs. They walked in with the binder, the printout, the impressive list of normal values - and still had questions they could not get answered. A borderline lab result they wanted to think through. A symptom that came up three months later. A new training plan that needed a sanity check. The exec physical had given them data. It had not given them a relationship. That is the gap we are built for. The binder is information. Membership is a relationship that turns information into outcomes - because most of medicine is in the follow-through, not the workup. It is also why we deliberately blend the boring head-to-toe primary care work (mental health, sleep, gut, GI, dermatology, the regular annual stuff) with the preventive and proactive work (ApoB, Lp(a), CAC, DEXA, biological age, longevity protocols). An executive-physical-only program treats you like a set of numbers. Real care needs both: the longevity data and the run-of-the-mill primary care that keeps you well in between.

A note on understanding what executives carry

Before clinical medicine, Dr. Ash served as a board-elected partner at a Fortune 5 company. The pace, the responsibility, the burden of decisions that affect thousands of people, the cost of being unavailable at the wrong moment - he has lived all of it. Patients who run companies, lead teams, or carry public-facing roles are not abstract to him. They are familiar. That is part of why the practice is structured the way it is: same-day access, direct messaging, visit lengths that allow for actually solving problems instead of triaging them.

Who an executive physical fits best

• People who have not had a real primary care relationship in years and want a reset.
• High-performance professionals who want a deep baseline before kicking off a training or longevity plan.
• People with a family history of cardiovascular disease, cancer, or sudden cardiac death who want the workup done sooner than guidelines suggest.
• People who do not need ongoing primary care but want a one-time deep look.
• People between primary care relationships (recently moved to Philly, last doctor retired, etc.).

If you already have a primary care doctor you like, you probably do not need a full executive physical. You probably need three specific tests added to your next visit. We can tell you which three.

How it compares: hospital exec physical vs. Fishtown Medicine

Feature	Hospital Executive Physical	FTM Membership (recommended)	FTM Strategic Roadmap
Cost	$3,000 to $8,000 (one-time)	See membership	$975 one-time
Time structure	One day, sometimes two	Ongoing - first visit 90 min, then as needed	Five 1-hour visits over 2-3 months
Lab depth	Full panel including ApoB, Lp(a)	Full panel including ApoB, Lp(a)	Full panel including ApoB, Lp(a)
Cardiac imaging	Stress test, sometimes echo, sometimes CAC	CAC scan referred out (~$100)	CAC scan referred out (~$100)
Body composition	DEXA in-house	DEXA referred out (~$50-100)	DEXA referred out (~$50-100)
VO2 max	In-house	Referred out or home protocol	Referred out or home protocol
Direct messaging with Dr. Ash	No	Unlimited	During engagement only
Follow-up cadence	Written report + one phone call	Ongoing, no extra fees	Through final visit, then optional membership
Best for	Want the binder, the campus, the day-of choreography	Want results from ongoing preventive care	Want a one-time deep look, no commitment
Insurance	Out of pocket	Out of pocket	Out of pocket

Key Takeaways

• An executive physical in Philadelphia is typically $3,000 to $8,000 at a hospital program.
• About 70% of the value comes from five or six specific tests: CAC scan, ApoB, Lp(a), fasting insulin, DEXA, VO2 max.
• The Fishtown Medicine Strategic Roadmap (5 sessions) covers most of the same depth with ongoing follow-up.
• If you want the full one-day hospital experience for the binder, we will refer you.
• Whichever path you choose, the follow-up plan matters more than the report.

Related Services and Reading

• Preventive Care in Philadelphia - the ongoing version of the same workup.
• Direct Primary Care in Philadelphia - the membership model behind the longer relationship.
• The Annual Physical - what a single comprehensive visit covers.
• Healthspan Optimization - the longer-arc framing.
• ApoB and Heart Health - why we use ApoB.
• Lp(a) Cholesterol - the lifetime test most patients have never had.
• Strategic Roadmap Package - the one-time deep engagement.
• Longevity Medicine - Medicine 3.0 applied to your day-to-day care
• Functional Medicine - what functional medicine offers and where it overlaps with internal medicine

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