The doctor who finally listened: Dr. David Borenstein on building an integrative medicine practice

0:24Sami Haider A patient walks in after years of being told it's all in their head, bloating, fatigue, nothing on the test, and then one doctor actually listens. Today's guest has built a practice around being that doctor. Welcome to Founders in Practice, where we sit down with the people building America's best private practices. I'm your host, Sami Haider. My guest today is Dr. David Borenstein, founder of Manhattan Integrative Medicine of South Florida. He trained at the Technion in Israel, is board certified in physical medicine and rehabilitation, and has spent his career combining the best of conventional and integrative medicine. His work has been featured in Vogue, Men's Health, and on Fox News, and his patients describe him as the doctor who finally listened. Dr. Borenstein, welcome to the show. It's an honor to have you as one of our very first guests. How are you feeling today?

1:16Dr. David Borenstein I'm good. Thank you for having me.

1:18Sami Haider All right, so let's go back to the beginning. You studied medicine at the Technion in Israel. What made you want to become a doctor in the first place?

1:26Dr. David Borenstein Well, first of all, I've always wanted to become a doctor since I was a little kid. I can't remember not wanting to become a doctor. And everyone knew, all my family, all my friends knew that I wanted to become a doctor. No reason specifically, it's just something I always wanted to be. So that's what I aim for. And after years of hard work, I became a doctor.

1:49Sami Haider Beautiful. So you trained in physical medicine and rehabilitation, which is pretty conventional. Take me back to the moment you realized you wanted to practice medicine differently. What happened? What did you see in the patient that the conventional system was missing?

2:06Dr. David Borenstein Sure. When I was training in physical medicine and rehabilitation, I had a patient that we saw in the clinic for fibromyalgia. Now, fibromyalgia is a syndrome or however you want to describe it that a lot of people don't believe even exist. Now, imagine 20-something years ago when I was doing my residency, people really didn't believe that it exists. They thought it was more of a mental issue than it was a physical issue. So what I did was I did a lot of research into it, and I was very lucky. My chairman of my department was very supportive. And I looked around and tried to do as much research as I can on how to treat fibromyalgia. Now, I graduated the program before I was able to really help this patient. But it did make me look into fibromyalgia and see what I can do to help patients. So I did my research. I was able to work at a functional medical, integrative medical clinic in New York in Manhattan. And with the training that I got in fibromyalgia, information that I received and courses that I took, I started applying these protocols. And voila, the patients got better. Not 100% in many cases, but there was a significant improvement in their function, their ability to work, to enjoy their lives. So then I said to myself, this has to be another way. And this was the other way. And I just got more involved with functional integrative medicine. And I decided to open up a practice for integrative and functional medicine. And the rest is history.

3:42Sami Haider Beautiful. Yeah, that looks like a great journey. So the practice called Manhattan Integrative Medicine. And now you're in Boca Raton, if I'm not wrong. So tell me that story. How did it start and how did you end up in South Florida?

3:57Dr. David Borenstein Sure. Actually, the story is very, very straightforward. I initially opened up a practice in Brooklyn. And then from Brooklyn, I moved to Manhattan. I was in Manhattan for many, many years. Then COVID came. And when COVID came, all of the practices tend to move to over to telehealth. So we were doing telehealth visits, not too many visits in the office. And I said to myself, you know, if we're going to be on telehealth all the time, why do I have to be in New York? And with the urging of my wife who always wanted to move to Florida, we decided, let's just go to Florida, take our chance. I was still able to keep the vast majority of my New York patients. And as COVID slowly recovered and things improved, they opened up an office here in Boca Raton. And since this part of Florida has a significant, and I mean a very significant number of people from New York and New Jersey and the surrounding states, the name Manhattan relate, you know, they were able to relate to that. So open up the practice and thank God it's, I'm building it. I'm building it and building it and getting busier and busier and helping a lot of people who normally wouldn't have been helped.

5:08Sami Haider Beautiful. Yeah, that's great. So every founder has a year that, you know, almost broke them. Like what was yours and what got you through it? Or maybe the hardest lesson about running the business side and all the medicine side.

5:23Dr. David Borenstein Well, it's hard because one of the business problems that we have is is that historically, integrative and functional medicine doctors do not take insurance. So people now are going to have to make more of a commitment. When you have to pay a few dollar co-pay, you'll go to doctor. It's not a big deal. $20, $30 and you're done. But when you're dealing with a functional medicine doctor or an integrative doctor, a doctor who thinks outside the box, that doctor has to spend a lot more time with you and give you a lot more attention. And unfortunately insurance is not really the way to go in that type of practice. The biggest challenge I've had is having people see the value of going to a functional medicine doctor for their problems. I've had patients have been to 20 doctors, $50 co-pays, $40 co-pays at every single practice. They're running all over the place and not getting any answers. And I tell them, pay once and cry once. Think outside the box. Invest in your health. What can be more important than investing in your health? And I think that's the biggest challenge we have, especially when people are expecting most of their medical care to be covered by insurance. There are certain things in America we know that insurance is not going to cover. A plastic surgery procedure, for example, LASIK eye surgery. So people know that already. I think they have to come to the understanding that when you're seeing a functional medicine doctor, integrative medicine doctor, it's not going to be covered by insurance. It's going to be an investment. But chances are you're probably going to get a lot out of that.

6:55Sami Haider Got it. Yeah, I get it. And it brings me to what I really want to ask you about. What are patients walking in with today?

7:05Dr. David Borenstein I have a vast majority. I have a very wide different types of patients that are coming to see me. I have patients with chronic fatigue, fibromyalgia, lately in a lot of issues with IBS and small intestinal bacterial overgrowth, gut issues. People with thyroid disorders like Hashimoto's and adrenal fatigue. There's been also a considerable surge. We have a big problem here in South Florida with mold and mycotoxin. Because South Florida is a very humid place, mold tends to spread fast here. And a lot of people have homes which do have mold, which become toxic. And they're not very aware of that. So that's another big part of my practice these days. I did not have that in New York, by the way. That was less of an issue.

7:51Sami Haider Right. And I feel like everyone is suddenly talking about gut health. What do you think about it?

8:00Dr. David Borenstein Well, I think gut health is extremely important. We know that the gut contains 70% of the immune system. We know that most of your vitamins and nutrients are absorbed there. So there is a connection known as the gut-brain connection. So it's extremely important. And I think slowly the medical community is slowly turning around and accepting that more and more. But it's a challenge. It takes a long time to convince people the importance of gut health. And hopefully in the next decade or so, more and more people will see the importance and start looking and addressing these gut issues that they have.

8:40Sami Haider Got it. And what was the biggest misunderstanding patients have about gut health and before they walk into your office?

8:49Dr. David Borenstein Well, the biggest misunderstanding is just because you may have normal movements and no symptoms. That doesn't necessarily mean your gut's healthy. One of the things I have patients who come in to see me is I look at their vitamin and mineral panel and they have no problems, no complaints with the GI tract. And then all of a sudden I'm looking at their panel and they're low on everything. So clearly they have an absorption issue. So just because you don't have symptoms doesn't mean you don't necessarily have a problem. Now the people who come to me do have a problem. Bloating, burping, flatulence, diarrhea, constipation. So when these patients come in, they know that they have an issue. They want me to help them discover what the problem is and treat it. But just because, and the takeaway message here is just because you don't have symptoms doesn't mean you don't have a problem.

9:38Sami Haider Yeah, it would make a lot of sense. And how are patients finding you now? Like is it Google, Instagram, referrals or are people asking ChatGPT for a doctor?

9:50Dr. David Borenstein Historically, most of my patients came to me from Google. In the last year or so I have a significant increase in patients who are finding me through AI. Some find me through Facebook and word of mouth. So a patient tells their friend or their relative to come see me. So those are the various ways. But more and more of my patients are finding me on AI, you know, and ChatGPT and all the other AI services.

10:20Sami Haider Got it. And integrative medicine has gone mainstream. Vogue is writing about metabolism. Everyone's talking about GLP-1s. What's the trend you are most excited about and which one worries you?

10:37Dr. David Borenstein Well, there's a couple of trends. The problem is that you're correct. More and more people are accepting integrative medicine. The concern I have is the people who are practicing it are not really as experienced or trained to do it. They look at it as a way of, you know what, let me try to have another revenue stream. So let me just do this integrative medicine thing and see how well that works. The problem is integrative medicine is like any sort of field of medicine. You need experience. You need training. You need to keep up with the latest podcasts and CMEs and updates. And I think that's lacking. Also, I'm also finding that a lot of non-MDs or non-DOs are also doing that. And I think that in order to get the maximal benefit from functional and integrative medicine, the provider should be either an MD or a DO.

11:35Sami Haider Got it. Yeah, makes sense. And your reviews keep saying the same thing. I actually have seen that myself. Like they say, like you explained, you know, really well. You listened really well. You follow up. So why does that matter so much to patients today?

11:57Dr. David Borenstein Well, because patients go to their conventional primary care doctor and the doctor either doesn't listen or doesn't have time to listen. Remember, this is a corporate medical system that has changed significantly in the last 20 years. Your doctor has X amount of time to see you get you out of the office next patient. The doctor doesn't work for himself. The doctor works for a corporation. The doctor has a boss. Doctors don't make the rules. This is a very different situation in 20, 25 years ago when doctors were more independent. They usually had their own practices. So they can make the rules. They can spend a little more extra time with you. But today in American medicine, that situation has completely changed. Your doctor is maybe not trained enough to understand functional integrative medicine. But a lot of the times that I'm finding that a lot of doctors tend to poo poo or dismiss a patient's symptoms. And that's the difference. When you're in a functional medicine practice, like I have, I have a lot more time to listen to you, to understand you. And I've seen this before. Most of the patients that come in, it's very rare that people come in with a new sort of condition. It's the same issues over and over again. And many of these patients are refugees from either primary care practices or other people who have not listened to them and don't know where to turn and don't know what to do. A primary care doctor has no idea how to treat fibromyalgia. And they certainly may not have an idea how to treat chronic fatigue. And they may not have an idea how to treat mold or mycotoxin or irritable bowel syndrome. It may give you some fiber or some medication and have a nice day. So that's the difference. You know, patients want to be heard. Patients want to understand what's going on in their health. And they want to understand it from their level. You don't have to talk down. You want to be on their level and there and speak to them in a respectful, equal sort of way. And then they'll be more willing to work with you and to listen to you and try to do what you ask them to do with them. Yeah.

14:13Sami Haider Now, this is really important. Absolutely makes sense. Okay. So I could talk about this all day, but now it's time for my favorite part that we call it quick fire round. I will give you two options. You pick a side and tell me why. All right. So let's start with this. So GLP-1 medications, game changer or overused.

14:35Dr. David Borenstein GLP-1 medications certainly have an indication in medicine. My 300-pound patient who has significant high blood pressure, high cholesterol, diabetes, maybe developing peripheral neuropathy. I mean, this is the type of patient where the benefits of the GLP-1 are going to be significantly greater than the risks. Because now you're going to help these people lower their blood pressure, lower their cholesterol, probably lower their triglycerides, keep their hemoglobin A1Cs down by having them lose the weight and control the insulin better. So those subset of patients, game changer, breakthrough. The problem I'm seeing here, especially, and I see it a lot here in South Florida, is the housewife that wants to lose five or six pounds because she has to go to a wedding in three weeks. That's where I think where the GLP-1 is a little bit overused. What I do in my practice is, and I do sometimes do prescribe GLP-1s when they're indicated, my goal is when I see a patient, I want to maximize their metabolic potential. I want to make sure that their insulin is low, their leptin is low, their thyroid is optimized, their diet is optimized, their vitamin and mineral levels are optimized. If I don't see movement after improving all those, we may want to consider a GLP-1 in low doses. But unfortunately, I'm seeing way too many people use this more and more, more for cosmetic reasons than for actual health reasons. It's a shame because there are a lot of other things you can do to improve your health to lower your weight, improve your insulin, improve the cholesterol without having to take a GLP-1. But the short answer is it's great for those who have the proper indication, like the patient I just spoke about a minute or two ago. But unfortunately, I think it's quite overused and it's used mainly for someone who is a suburban housewife who wants to lose a few pounds and want to do it quickly.

16:48Sami Haider Got it. And should patients Google their symptoms before they see you? Yes or no?

16:57Dr. David Borenstein That's a big double-edged sword. Let me tell you why. I think it's good that a patient is educated and they know about their condition. In that case, it's a good thing. The problem is sometimes half information is worse than no information at all. And they'll say something and they'll take things, read them out of context. It's a very big double-edged sword. So I think there is definitely indication for people Googling their symptoms. But I think that maybe for a general understanding of what they have, it may be a good idea. But they should ask their doctor and ask the doctor the questions they need to ask in order to better understand their condition. So for general things, yes, but more specific issues, definitely speak with your doctor.

17:44Sami Haider Beautiful. All right. So would you let AI answer your patient's messages at 9 p.m.?

17:52Dr. David Borenstein I usually am the type of person who likes to be more hands-on. So I've had people call my office at 9 p.m. and I've called them at 9 o'clock. And because I don't want them to lose sleep over their issue. So I think there's a great tool for AI. I am probably going to get an AI system in my office sometime in the near future. But I think AI is a great substitute when I'm not there. I can't help or I can answer. But I think it's a great backup system. And I think the potential for AI is tremendous. And I'm hoping to see more and more improvements in that. But until then, I'd rather try to do as much as I can myself. But it's a great adjuvant, as we call it, a great addition to health care. And I'm hoping to see some more advancements in AI in a good way.

18:50Sami Haider Yeah. You know, I 100% agree with that. A super quick one now. One thing you wish every patient knew before their first visit.

18:59Dr. David Borenstein I think I wish that patients understood that functional integrative medicine is a process. It is not instant gratification. And I wish they came into the office knowing that this is going to be a process. I'm going to have to do a little bit of work on my end to get better. And not everything is spoon fed from the doctor to the patient. I think the patient came in with that understanding that they're going to have to invest in their health. I'm going to guide them. I'm going to show them what they need to do and I'm going to answer their questions. But the health, the burden of the health is going to be on them. And if they can understand that, I think that would be great and would make the process much smoother and easier.

19:45Sami Haider Beautiful. And last question, and I ask every guest about this. If a young doctor watching this wants to build a practice like yours, what's the one thing you would tell them?

19:56Dr. David Borenstein That's a hard question. I think 20 or 30 years ago it was much easier to do this. You had a lot better support. I always tell my patients, I always tell doctors who... I always tell doctors who want to do integrative functional medicine, don't give up your day job. Do it slowly. And if it means you have to take insurance for those patients, you do it and you build it up. And once you get to a critical number, you start cutting back on the insurance plans and see how well you maintain until you're completely off the insurance plans. That's how I did it. So I started taking insurance, but unfortunately when you take insurance you really can't spend as much time. But I did the best I could and then I just cut back until I was finally off of the insurance. I think that's going to be your main challenge. I don't think it's a bigger challenge today than it was a decade or two ago. Definitely do it. But if that's your passion and you want to do it, certainly look into it. But understand it's a process. It's not going to happen overnight. Things do take time to happen.

21:00Sami Haider Yeah. Yeah, I agree with that. Where can people find you and learn more about the practice?

21:08Dr. David Borenstein Sure. You can go to my website, www.DavidBorensteinMD.com. You can also look up Manhattan Integrative Medicine on my Facebook page as well as my YouTube channel, David BorensteinMD.

21:25Sami Haider Beautiful. Dr. Borenstein, thank you so much. This was genuinely one of my favorite conversations and a lot of founders and patients are going to get real value from it. And to everyone watching, if this was useful, share it with the founder who needs to hear it. I'm Sami Haider. This has been Founders in Practice and I will see you in the next one.

21:46Dr. David Borenstein Great. Thank you for having me today.