Creating Practice Models That Work Better for Providers and Patients: Dr. Ginamarie Papia, Founder of Divinely Guided Health

Michael Carrese: Hi everybody. I'm Michael Carrese, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. I'm very happy to do that today with Ginamarie Papia, a doctor of osteopathic medicine and an integrative medicine physician focused on improving women's health through natural, comprehensive, and holistic solutions. 

After completing her internal medicine residency at Yale New Haven Health Greenwich Hospital, she further specialized in integrative medicine through a fellowship with the Osher Collaborative. Dr. Papia has also enhanced her expertise with training from the Andrew Weil Center for Integrative Medicine and the Institute for Functional Medicine. 

She's just launching her own telemedicine integrative medicine practice, so we'll be asking her about that. Also, we'll be touching on physicians as entrepreneurs and how she and some other physicians are using social media. 

But before we go any further, I'd to give a shout out to a previous Raise the Line guest, Dr. Michael Foti, who was kind enough to connect us to Dr. Papia. So thank you so much for being with us today.

Dr. Ginamarie Papia: It is my pleasure. Thank you for having me.

Michael: Great to have you here. We always start with trying to learn more about our guests and their backgrounds and what first got them interested in medicine. So what's your story?

Dr. Papia: So, contrary to many of my colleagues, I didn't start out when I was little wanting to become a doctor. I actually went to college to become an interior designer. The college that I went to -- I went to NYIT for undergrad, which is New York Institute of Technology – and the campus for NYCOM is on the campus there, so after a year of design, I just felt like it wasn't for me. I was looking for other options. I had friends of mine who were in my core classes who were pursuing biology and things like that. I really enjoyed those classes. I said, you know what, let me try this out and see how it goes. One thing led to another, pursued the whole pre -med track. By the grace of God, here I am. Thirteen years later, I did it.

Michael: Wow, that's quite a pivot. 

Dr. Papia: Yeah.

Michael: So I think it might be interesting for people because, you know, interior design suggests a creative-type person versus medicine, which is obviously more scientific. So do you have both inclinations?

Dr. Papia: I say I have both, but I flare on, I would say more on the alternative side. I'm always interested in like total modalities of healing and I think that's what led me to integrative medicine, which is really incorporating all different forms of healing. What's interesting is I found that medicine was similar to design. In osteopathic medical school, we talk about the four tenets of osteopathic medicine. One of them is like structure and function...it talks about the structure of the body informing the function of the body. And as soon as I read that in medical school, I thought, “Wow, I literally read that in an architecture textbook when I was studying design -- how the structure of a building or a home informs the function -- and I was like, that's so interesting. I mean, my dream is one day to be able to kind of marry those two together. Unsure how, but you know, it's kind of interesting just having the different types of experience.

Michael: You mean like designing healing spaces, or something like that? 

Dr. Papia: Possibly, which is a whole field which is kind of cool. 

Michael: Yeah. And it does seem to me, having talked to other Dos, that osteopathic medicine seems to lend itself more readily, let's say, to functional medicine, integrated medicine. A lot of people kind of keep heading in that direction. Would you agree with that? 

Dr. Papia: Yeah, I would agree with that. From literally your first day in medical school, you're learning these tenets that structure and the function is related. You're learning that the body has this innate healing capacity and that just by giving it what it needs or really taking the things away that are inhibiting it from being able to heal itself, the body kind of heals itself and it knows how to do that. And that's very much integral to integrative medicine. We kind of just get rid of all the crap preventing your body from being able to heal itself and let it do its thing. 

Michael: Can you build on that a little bit and also distinguish the differences between integrative medicine and functional medicine?

Dr. Papia: Sure. So my background is I have a fellowship in integrative medicine. Actually, new this week, I just got my diploma. I am board certified in integrative medicine. I passed my boards there. 

Michael: Wow, congrats. 

Dr. Papia: So, very excited. That's the eighth board exam I've taken, which is crazy to even think about that and the last one for a while now, so I'm excited about that. So, my training is in integrative medicine, although I have done some of the functional medicine trainings.

I would say integrative medicine is building on what we've learned as physicians, whether the osteopathic, allopathic and the modern medicine, and then bringing together all different healing modalities. So whether that be considering natural supplements, vitamin supplements, or total healing modalities like traditional Chinese medicine, Ayurveda, we have more training in nutrition and exercise and all these different things.

It's really built on this premise of building this patient provider relationship, that you really get to know your patients and you give them all these tools, but from a place where, you know, “I'm here for you on your healing journey and we're gonna find whatever works for you and I'm open-minded and we'll explore and we use evidence-based integrated medicine.” Meaning, I'm looking for the things that have, yes, evidence behind them, but also things with low harm. I'm not gonna recommend something that could be harmful. I'm looking also at the evidence there too. 

Michael: And where does functional medicine differ from that, you think? Or is it kind of the same?

Dr. Papia: Yes, so functional medicine is really root cause medicine. I would say if integrative medicine is like this big umbrella, functional medicine is really like a piece of it. Functional medicine utilizes a lot resources that are these kind of advanced testing -- like microbiome testing and genetic testing and advanced hormone testing -- and uses that and the biochemistry behind things to inform treatment decisions. 

So, let's say you did this specialized testing. It says you're deficient in this particular enzyme or whatever it is that it picked up in that test. It says, okay, if we go back to the biochemistry and we say if we are able to replace B12, B12 feeds into this pathway that populates this next vitamin and that deficiency will be fixed. It kind of relies heavily on biochemistry. So it's very cool, very cutting edge, I will say. And it really gets to a lot of those patients that have all these things going on and on a root level, you feel like this is all connected, but I can't really put it all together. Functional medicine has a nice way of organizing that. 

Michael: Yeah. We actually just did a long series with Mount Sinai on complex and chronic illnesses and this came up -- that functional medicine docs often end up seeing those patients because it's been very difficult for other providers to figure it out and they have all these tools and this orientation that helps them unravel the mysteries.

Dr. Papia: Absolutely, and they've created this thing called a functional medicine matrix where you organize the past events in like a timeline that the patient has gone through, and by doing that and inputting all this different data -- like what's their nutrition like, what's their exercise, all these different things -- you're able to make connections. The patient never realized it, but as we're talking about this, they start to realize, “Wow, all my symptoms actually started after I had that really bad food illness when I was in another country and things kind of started from there.” You start to realize, hmm, you're making connections and then from those connections you’re able to kind of bring healing and offer things. It often ends up being gut related, a lot of microbiome issues. They have this phrase in functional medicine, “if you don't know where to start, start with the gut” because that's probably what is underlying everything else.

Michael: Yeah. And my gosh, there's been just such an explosion of knowledge about the gut microbiome in last few years. 

So, you've been in practice for a while now, but as I mentioned, you're just starting your own virtual practice. Tell us all about that. Why are you making that move?

Dr. Papia: Yes. So I have always had, even before when I was in training, I always wanted to open my own practice, especially with integrative medicine. If you really want to build that relationship with your patients, a model that is based on insurance doesn't lend well to be able to spend enough time with your patients to really build that connection. So I've been thinking about this for a long time and I really wanted to create a practice that allowed me to work from anywhere and as a woman physician, if I want to get married and have children, I would have that flexibility. 

I also like the idea of being a girl boss and owning my own company and building something that's my own. So that makes me very excited. And so everything kind of fell together. To be honest, I joined a coaching program that is not medicine related at all, but just getting around people who are pursuing their dreams in an environment that's encouraging and you go there every week and they're holding you accountable.

One thing kind of led to another and I hired all the right people and I'm literally within the next month gonna launch my virtual practice. So, I’m very excited.

Michael: Wow, and what is going to be your niche? Women's health, but anything beyond that?

Dr. Papia: So the interesting thing -- like you were saying about the difficult patients ending up with integrative medicine doctors -- what I realized when I did my fellowship at Northwestern, is all the different doctors at Northwestern would send us their most difficult patients, right? It's the one that's been worked up for absolutely everything. And there's so many layers and it can be tiring and it can lead to burnout as a physician because it can be exhausting and you want to be able to offer that type of bandwidth for the patients. 

So I realized that if I wanted to do that, I would need to do a combination. So what I'm offering is integrative primary care. So, I will be your primary care doctor, it's for a monthly fee, it'll include what you would get from a primary care doctor, but one -on -one access to me through messaging and one hour appointments unlimited throughout the year. And then if the people or my patients decide they want to do those functional medicine tests or they want to explore health coaching and different things, that would all be included as well. 

Michael: So is it more of a concierge model?

Dr. Papia: Kind of, kind of. They call it “direct to patient” where it's pretty much like a concierge, but it's a little bit more affordable.

Michael: And seeing as you're just starting, how do you get the word out? I mean, it's obviously a crazy crowded world out there for healthcare.

Dr. Papia: Yes, 100%. I was actually just thinking about that this last weekend because today is my last day at my office job. And obviously when you make these big changes, it's so normal to have all the, you know, the anxiety and the nervous feelings and all these things come up. Is this the right thing? All these feelings. I was like, how am going to find patients? Like, am I going to be able to support myself doing this? I had a lot of anxiety around it over the last few days,

I've had interactions with one dietitian I'm friends with and somebody else we had actually had on the podcast with Michael, and I was telling them about what I'm doing. They're like, “I have so many patients who would benefit from what you're offering and how can we get them connected to you? How do we get them signed up? This is amazing.” I was like, okay, all right, I’m doing the right thing in the right place. One of the other things that somebody said was, “Whenever I find a great integrated medicine doctor, I connect them with my patients and then all of sudden they're all booked up and now they're not available anymore.” And I'm like, I think we're gonna be okay. I think we're gonna have plenty of people. I think it's gonna be great. I'm excited.

Michael: Yeah, if you get a referral network going, you'll be okay. I do want to spend some time talking about women's health which is, as I mentioned, a focus of yours. Particularly, I'm interested in your perspective on hormones and how you work with that dimension in women's healthcare.

Dr. Papia: Yes. Women's health is a fun topic for me because I've seen so many women who have come to me and I get a combination. We get the younger population and then we get a lot of women who come with like menopausal type symptoms. What I love about the women going through these hormone changes as they transition to menopause, it's becoming common where everybody is talking about it. I think in the past, nobody was talking about menopause. Women kind of suffered in silence. Now there's so much education out there and so many doctors who are doing bioidentical hormone replacement, and I will say, you know, I went through training and they said hormones are bad, estrogen gives women breast cancer. 

Michael: And that goes all the way back to the early 2000s, right? 

Dr. Papia: Yes. And the study that came out, that study, what's interesting is that's the study where everybody stopped giving hormones because they were giving hormones before. They looked at that same study again very recently and from the same data, turned around and said, ‘women should have hormones.’ The issue was with the type of hormones that they were giving. It makes you wonder, were we missing an opportunity to prevent cardiovascular disease, metabolic issues, all these different things by getting women connected to the right type of hormones? That’s a different discussion. 

I probably won't be doing a lot of bioidentical hormone replacement because it won't be my niche in my practice, but the doctor that I worked with at Northwestern, Dr. Melinda Ring, she's one of the pioneers. She's been in this field prescribing hormones for very long time. And if you find the right doctor that can prescribe bioidentical hormones that come from pharmaceutical companies, it's the same molecular structure as the hormones your body makes. It's not equine estrogen coming from horses or anything like that. It can be life -changing for women. One hundred percent. So I think it's very important. 

What I like to focus on, and the niche that I found, is dealing with younger women with hormone issues or period issues. I find a lot of young women go to their gynecologist and they have all these different issues like my period is crazy, or I'm having terrible mood swings left and right, and the doctors are like, “The only thing we have to offer you is birth control.” And everybody's put on birth control, and I just don't think it's a good permanent solution. I think it's a band -aid. 

I've also seen the women that come to me later on and they're like, “I want to get off this birth control. I want to start having a family” The effects of trying to get their body regulated after coming off of the birth control...that's something else that they don't really talk to you about when they give you pills. They're sometimes putting girls as young as eleven, twelve years old on birth control. And so that's my kind of area of interest.

Michael: How do you manage it without medication?

Dr. Papia: It's a great question. It's not always easy. Basically, what I'm looking for is number one, I want to know are there vitamin or other deficiencies that are causing your symptoms to be worse? That's what I look at first. Then I want to know how your cycles are, maybe there are natural supplements and things that we can use to help regulate those cycles and make them better. But I also look at what's going on with your nutrition because a lot of women start to realize, if I eat certain things during my cycle, it's better or worse. Really dial in nutrition, really dial in exercise because that's another piece that can be kind of modulated to get certain outcomes. 

Then the last piece is stress. A lot of women have so much stress and they're like, “I'm good. I feel good. I don't feel stressed. I love stress.” But stress wreaks havoc on our endocrine systems. We know this. Even if you're in a high stress profession, if we can get you the tools to be able to manage that stress and channel it into your work or whatever you want to channel it into, that can be life changing. But it takes a partnership. It's not a ten minute appointment. 

I guess the healthcare system model that we work in lends nicely to just prescribe, here you go, here you go. But that's why I went into integrated medicine is I want to build that relationship.

Michael: You know, you've spoken about that relationship piece several times now, and I'm just wondering, because you are virtually based, what your strategy is for that not getting in the way of developing a relationship or vice versa. How do you use it to build a better relationship?

Dr. Papia: That's a great question. I've thought about this and I do believe that, as we've seen with COVID, even if you’re in a virtual call with someone, if you're 100 % present and you can really listen to them and really be there for them 100 % in that moment, you can build that relationship, even if it's virtually. 

Yes, I may not be there in person to like, hold your hand if you cry or things like that. But if I can be there for you when we have those appointments and then also be available if you call me and you're like, “I need to talk. I need an appointment today,” I'm gonna respond to you. You're not gonna have to deal with four different secretaries who say they’ll call you back in three days or you don't hear from them. I'm a one woman show at this point -- maybe in the future that'll change -- but I think there's something beautiful to that. Kind of goes back to like doctors hanging a shingle.

Michael: Well, you referenced before that, unfortunately, lot of physicians have to have their eye on the clock because their appointment is thirteen minutes or fifteen minutes or ten minutes or whatever, and you have a model where that wouldn't be the case.

Dr. Papia: Right. And we've all been there where you have so many patients you need to see in a day and you know that you're five, ten patients behind and the clock is running down and your brain is there instead of being in room with the patient. You're thinking, “Oh my gosh, I have so many notes I have to finish. I have all the stuff I need to do.” What I'm looking forward to most is being the owner of my own time, which I don't think a lot of doctors think about when they go into medicine. If I could share one thing with my younger self or anybody going into med school: you get to make medicine how you want it. You get to make your career how you want it to be. 

If you end up in a job somewhere in a hospital system or whatever it is and you're not happy, there are so many different options for physicians. You don't need to get discouraged. There are so many different options and so many cool physicians and providers doing really cool work on a grassroots level to get the system to change. So, change is coming. There's so many options and I'm just excited for the future.

Michael: Yeah, I can tell. Is there anything else about women's health that's really interesting to you trend wise or otherwise?

Dr. Papia: Like I was saying, what I find the most interesting and exciting is how mainstream this is becoming. Everyone is talking about hormones. Everyone is talking about this diet, this supplement, all these different things. I do think you need to be a little bit wary about all the stuff you find on TikTok, right? You got to be careful when you're scrolling that you're not getting your medical advice from TikTok. The beautiful thing about having a provider like myself that learns about all these different things is I can help you piece it together, which is really what you want. You want somebody to kind of filter out all the noise and say, “Listen, this is what's been studied.” There are cool things happening, like the American College of Gynecology has on their website four PMS symptoms and they recommend calcium, they recommend magnesium. It's pretty cool. You might think, wow, I thought all these associations were so against natural supplements and vitamins and things like that. But there's a lot of evidence to support these things. So if you can just get the right resources, there's a lot of great stuff out there.

Michael: You mentioned TikTok, so of course that's perfect segue to one of the questions I want to ask you about. You have a presence already on social media. Talk about that and particularly, who's your audience? Who are you trying to reach with that and what works, do you think? 

Dr. Papia: Yes. It's fun. I had insight that social media was going to be important for doctors, even when I was in my residency. At that point -- it was right before COVID -- I set up my website and I set up all these different things. But when COVID hit, the hospital became a war zone. It was crazy. So that kind of fell to the wayside, but I started it then and I picked it up recently.

I feel like there's so many people talking about health on social media and all these different outlets. We need voices of people who are educated and credible to spread the word about the evidence -based things. Like, who is talking that has actual background on all these different things so I can be informed? So that's why knew that was important. 

I will say from like generational thing, I probably feel more comfortable on Instagram than I do on TikTok. But now that I'm like leaving my nine to five job, I'm going to try to dabble more with TikTok because I feel like you do reach a different kind of clientele and different things with TikTok. I think there are a lot of opportunities on there. 

You were asking, who am I trying to reach? 

Michael: Yeah, like who can you reach on those platforms? I mean, it's sort of an obvious answer -- you can reach younger people with social media than older people -- but is there any other sort of insight into audience and the effectiveness of that type of content?

Dr. Papia: I haven't thought too much about this and I guess I should because from a marketing perspective, I've had people ask me like, “Who's your target audience?” What's the age range?” I think what I'm trying to do is really be that credible voice for integrative medicine. People are talking about natural supplements and things like that. I want to reach the people that didn't know that these things were options or didn't feel like there were connections between what's going on with their mental health and their physical health. I want to be able to provide some kind of insight for different people. 

I think it's going to be, yes, maybe into a younger kind of population, but especially from a virtual practice, I think we do have a generation on our hands that do feel more comfortable in a virtual setting and I think where medicine is heading is it's going to be a lot of virtual telemedicine practices. 

Michael: I'm just curious what your insights are, though, into what works. Like, what persona do you think is effective? You’re not doing dance routines -- or maybe you are, I don't know -- but in terms of presentation, that's important obviously because people are zipping through all kinds of stuff. Why are they going to stop on Dr. Ginamarie?

Dr. Papia: On my video? 

Michael: Yes, and what works in terms of getting the information across?

Dr. Papia: So I've been playing around with this a lot because I was doing videos where I would just be talking for a few minutes and I got a little bit of traction, but not much. I've gotten input from people who run social media pages, from my cousin who's like a TikTok expert, and all these different people giving me feedback. What I find is you have to have the right combination. There are things like using the tools that are on the platforms such as the right music, the right hook to get people's attention because you only have a few seconds to grab their attention. I don't want to think of it as manipulating people's attention, but if I can grab your attention to give you really valuable information, if I don't do that, I'm doing you a disservice. So that's how I look at it. 

So I'm presenting the information in a way that's authentic to me, but I also want to be able to get your attention and provide value there.

Michael: Yeah. Well, and authenticity is everything in communication. So we are, as you may know, an education company. One of our favorite questions for guests is to have them provide us with some direction about a gap in knowledge or a myth or something where they're like, “You know, I just wish people understood more about that.” What would you say, “Hey, Osmosis, make a video about that.” 

Dr. Papia: Okay, here we go. Game on, challenge on. I would say what's lacking in medical education is what I've learned through all my training in integrative medicine: there is evidence for a lot of the natural things your patients come to ask you about, but the doctors and medical students are not trained on how to find that information, and there are resources out there. I think that's so important because we've all had those patients who come to your office with a big bag of supplements, right? And they're like, “You wanna look at these?” And you're like, “I don't know any better than you do what these things are.” There are different like databases and tools. One of them -- and you probably have access to this through either your institution or your hospital system -- is called Natural Medicines. This is a platform a lot of hospitals pay for. You can look up absolutely any natural supplements. So let's say you want to see magnesium. You type in magnesium and a monograph will come up and it'll give you a lot of the different studies that were done on magnesium, the right dosages, what there's evidence for, and it'll give you the effectiveness of it. So, there's data out there. 

A lot of people think that with integrative medicine and incorporating all these things, we're kind of working with fluff, right? And we're like, come here and we'll give you this honey wax or whatever it is. There's a lot of evidence for it if we look for it. Yes, the studies may not be as big because, you know, you don't have big pharma funding studies for chamomile. But at the end of the day, there are studies and the harm is low on something like chamomile. The studies may not be overwhelming, but what's the risk in really having patients try things like that before we put them on medications? 

Michael: Right, right, makes sense. So, I'm afraid to say we're running out of time, but we mentioned Dr. Michael Foti, and I do want to give you a chance to plug the podcast that you guys just launched. What's that all about?

Dr. Papia: So Dr. Foti and I met in residency. Dr. Foti has had an incredible journey that he is so courageous to share with his mental health journey. He actually wrote a book called Grief that's available on Amazon, and I think Barnes & Noble. Dr. Foti and I have started a podcast called The Upward Spiral, where we're talking to all different providers, different people, interesting people to really help raise the tide and spread awareness about physician mental health and different cool topics that we find interesting.

Michael: That's great. Very, very important subject. It’s something that's come up just constantly on Raise the Line, so I'm glad you're focusing on that. The Upward Spiral, look for it wherever you get your podcasts. There, I did the plug for you!

Dr. Papia: Thank you, thank you. 

Michael: Well, listen, this has really been so interesting and I want to thank you very much for your time today and wish you all the best of luck with your new practice.

Dr. Papia: Thank you for having me. It's been a pleasure.

Michael: And how would people find you on social media? What are your handles?

Dr. Papia: So they can find me on TikTok and Instagram, it’s @doctor.ginamarie. And my website is the same without the period, so DoctorGinaMarie.com. 

Michael: Excellent and we'll put that in the show notes as well. With that, I'm Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.