Breaking Ground: The First NP in TX to Open a Pediatric Functional Medicine Practice
Dr. Emily Gutierrez, DNP, CPNP, PMHS, IFM-CP
From the beginning, Emily Gutierrez’s journey in nursing has been one of discovery. After becoming an R.N. in 1999, Emily got her start in the E.R. and then spent time as a school nurse. When she went on to become a pediatric nurse practitioner, she was well prepared to work in primary care.
However, it wasn’t long before that yearning for discovery had returned.
“I realized I needed more again. I needed to feel like I was enriching my practice, so I went to Johns Hopkins and got my Doctor of Nursing Practice. I got to go onsite for several weeks at a time. It was such a wonderful experience.”
It was in that program that Emily discovered integrative medicine.
“The first six months we focused on our clinical problem, which for me was figuring out how to treat these hippie Austinites that didn’t want to vaccinate. I didn’t know how to provide care for them and I really wanted to, no matter what it was called, as long as it was the best for the child or the family. That’s when I started to study integrative medicine and how we bridge the gap between our allopathic education and providing that in a primary care setting.”
Finding her passion
Once she graduated her DNP, Emily struggled to find the right direction for her career. It wasn’t until she discovered functional medicine that things clicked into place both professionally and with her personal life.
“Functional medicine is looking deeper at the underlying causes of illness. Once I started studying functional medicine, it helped me with struggles I’d been having with anxiety and severe postpartum depression after my first child was born. No matter how much counseling I got or how much therapy I did, I never really felt good.”
Learning about functional medicine opened new doors for Emily, but it was when she applied those principles to her life that things really began to change.
“Once I understood how all our systems are connected, how our genes affect everything from the neurotransmitters in our brain to our gut bacteria, and applied those principles to my own life, I felt healthier than I’d ever been. I decided that if I could help somebody else change their life the way mine was changed, I had to do it.”
A new model of care
Emily wanted to find a place where she could practice functional medicine, but as she surveyed the landscape in Austin, she didn’t see any practices that seemed like a natural fit. Along with her colleague Jana Roso, whom she’d met at UT Austin in the master’s program and been working alongside, Emily faced a choice: join an existing practice and potentially face a “square peg in a round hole” situation, or start her own practice with Jana where functional medicine would be the cornerstone.
“Jana and I couldn’t go back to primary care. If we wanted to do what we’re passionate about, we knew we had to do it on our own. We saw a growing need and jumped in together as partners. In Texas, we were one of the first, if not the first, clinic that specialized in pediatric functional medicine.”
Their practice, Neuronutrition Associates, is committed to helping heal children and prevent disease by focusing on the whole child instead of just the symptoms. Emily is a certified practitioner of functional medicine by the Institute of Functional Medicine, and Jana will soon be a fellow of the Medical Academy of Pediatric Special Needs.
“We see a lot of kids on the spectrum, or with depression, anxiety, or OCD. We see a lot of chronic childhood illnesses like bowel issues and eczema.”
Learning your value
One of the toughest decisions Emily and Jana made with their practice was to be private pay only. They didn’t want to limit access to their services, but they also didn’t want to tie their fate to a system that doesn’t appropriately value the type of care they provide.
“When we started the practice, we looked at other people who were in functional medicine and had the type of structure and practice that we wanted. They said, ‘You will not succeed if you take insurance. You’ll have to hire someone just to chase the insurance for you. It’s also not feasible to provide the time allotment you need with these patients.’ We were scared at first. Why would anybody pay out of pocket when they could just use their insurance to go and see a provider?”
Despite their concerns, Emily and Jana were optimistic that things would work, and they have. She admits it is challenging for some families to get in because of insurance, and that she can’t take Medicaid patients anymore, which breaks her heart.
But their practice has grown and thrived to the point that Emily and Jana recently had to make some decisions to throttle that growth in order to safeguard their own health.
“We used to see eight or nine patients a day. In a functional medicine practice where you see primarily very sick children, the stress accumulates over time. When we talked about raising our prices, we both felt sick to our stomachs about it, but we were getting to the point where we’d end up burning out, quitting, and closing the practice. So, we raised our prices a little bit, which was not popular. But to manage our stress, we had to see fewer patients, so now we see about six a day.”
For Emily, that decision speaks to one of the biggest challenges nurses face when they open their own practice: valuing your time and charging what you’re worth. When they opened Neuronutrition Associates, Emily and Jana weren’t stressed about the startup costs, which they paid for mainly out of pocket and recouped within a year. There were no worries about paying themselves a salary, as they took a 50% salary from day one.
Their biggest challenge was the perceived gap between physicians and nurses.
“If I don’t value me, how are other people going to value me? Just because I’m not a physician doesn’t mean I’m not worth it. I hear it often said, ‘Well, I’m not a physician, can I really charge that much, or can I really do this because I’m not a physician?’ But the truth is, yes we can, and we can do it really, really well.”
Emily says it doesn’t bother her anymore when people bristle at the fact she calls herself a doctor. Any doubters need only look at the degree hanging on her wall.
“The perception is that if you’re called doctor then you must be a DO or an MD, but nurses can be doctors too. Nurses have to be okay with somebody not liking that we’re going to call ourselves the degreed person that we are. I don’t ever pretend to be a physician. I have my degree on the wall and it says Emily Gutierrez, DNP.”
Layered on top of this challenge was the ever-present question as a business owner of being good enough to not only open a practice, but be private pay only.
“I empathize with that question: am I good enough? Is what I’m putting out good enough? I think that we’ve answered that question definitively. Yes, absolutely, we are good enough. We’re good at what we do. We don’t advertise at all and we have a six-month waiting list for any new patient visit. We have one satisfied patient after the other walk through our doors and it’s all from word of mouth, which is so powerful.”
Results that speak for themselves
Also powerful are the results Emily and Jana get for their patients.
“We’ve had kids on the spectrum start talking that have never talked before. We’ve had people with irritable bowels and Crohn’s go into complete remission. We’ve had skin clear in eczema cases where steroids were being used three times a day. These transformational stories come from families that are congruent with our plan of care. They are willing to change their diet and put in the work that it takes.”
Selecting the right patients has been a big part of Emily and Jana’s success. Functional medicine, as she explains, is a holistic approach. It’s not just about taking a pill. For practitioners, this means finding patients who are willing to put in the work.
“We actually call people back now and vet them to see if they’re a good fit for us before we take them on as a client, because we want somebody who’s motivated and ready to work. Those patients are the ones who see tremendous outcomes.”
Those life-changing outcomes keep Emily going when the stresses of the job begin to mount. It reminds her of the way functional medicine changed her life for the better.
“I feel like my patients have made me a better person. To see somebody and to really dive in with them with their struggles and be a partner with them has changed how I view everything about my life. So, I think it’s given me a deeper sense of empathy and I think it’s matured me in a way that I didn’t expect to be matured.”
Advice for Nurse Owners Today
In addition to learning about herself, Emily has learned how to be a business owner in the four years her practice has been open. One of the most important things she’s discovered has been the importance of setting boundaries.
“For anybody with a practice, there needs to be a layer between you and your patients in how they can reach you. You know what is appropriate and those boundaries need to be established upfront so there’s no confusion later.”
For any nurses who are considering opening their own practice, Emily emphasizes the importance of trusting your gut. A yearning for discovery led Emily to the precipice of starting her own practice, but ultimately she had to trust herself enough to leap.
“When you have a feeling in your gut and you want to make a change, don’t be afraid to do it. If you protect yourself, manage your stress, and have those healthy boundaries, it’ll be beneficial for everyone. Just remember, as a healthcare provider, you also have to care for your own health. A lot of people forget to do that.”