Between 2010 and 2014, Julie Foucher made four CrossFit Games appearances, finishing on the podium twice (2nd in 2012 and 3rd in 2014), and never outside the Top 5. Though her Games career started winding down after the 2015 season — when an Achilles tendon at Regionals cut her season short — she’s stayed visible in the CrossFit community through her podcast, Pursuing Health. And in the past five years, Foucher has also been busy finishing medical school, completing her residency, and establishing herself as a practicing physician with a keen eye toward fitness’ impact on wellness.
We sat down with Julie to discuss a variety of topics: What comes next for Pursuing Health, her hopes for CrossFit Health’s potential impact, and why she’s optimistic about a new model for American medicine that creates more direct relationships between physicians and their patients.
BarBend: Do you have plans to continue the Pursuing Health podcast this year?
Julie: Oh yes. It’s such a fun thing to do and I love it. It’s one of the best decisions I ever made to start the podcast in 2015.
BarBend: Who is someone you’d love to have on the podcast, but haven’t yet?
Julie: My ultimate girl crush is on Rhonda Patrick. I would love to have her on the podcast because she’s so smart. I love how she translates all the latest science on nutrition and longevity to make it into something that’s really usable for the general public, but also for a lot of doctors. So I would love to have her on the podcast.
BarBend: You’re still in the early stages of your medical career. You just finished up your residency. What are your next steps or goals in the near future?
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Julie: That’s a big question. I’m in a transition phase and sort of taking things one day at a time, knowing that they will likely change. When I had finished residency, my plan was to start my own practice in a model called Direct Primary Care. For a variety of reasons that got delayed and it actually allowed me to meet the amazing founders of a practice called Wild Health and got to know them really well. They’re based out of Lexington, Kentucky. I got to know them really well. They’re CrossFitters, and I felt very aligned with what they were doing from a practice standpoint. And there was a lot of sort of synergy in the ways that we could work together.
I started doing some part-time work with them in the fall, and now I’m actually working full time with them, but very excited about the ways that we’re going to be able to build out what they’re doing in terms of building more content. They also have a fellowship where they train doctors and health coaches in how to do what’s called precision medicine, or basically learning all the things that you don’t learn in medical school that actually get people healthy. So all of the sort of things about exercise and sleep and recovery, and really trying to live a lifestyle that’s in alignment with the ways that our bodies are meant to live in order to thrive. So I’m really excited about working with them. And then also still working on my own podcast and continuing to produce content.
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They’re focusing again on experts in health and fitness, and also sharing a lot of stories of everyday people who’ve had dramatic changes in their health by doing CrossFit or by changing their lifestyle. Because I think that’s what is often most inspirational for people who need them. They know they need to make a change, but they think, “Gosh, I don’t think I can do CrossFit because it’s too intimidating or it’s only for really fit people.” Getting those stories out there of all the people, all of the different types of people who do CrossFit, it can only help others identify and have the confidence that they can do it too.
BarBend: Do you have any official relationship in the content you produce or the work you do these days with CrossFit HQ?
Julie: Not anything official, no, but I will say that I’ve had a lot of discussions with Eric [Roza] over the past several months more in brainstorming and trying to just better understand what CrossFit Health could do moving forward and how it could have a huge impact. Nothing formal yet, but I’ve been very grateful to be part of those discussions and grateful that Eric seems to be extremely committed to CrossFit Health and realizing that it has huge potential to help a lot of people.
BarBend: You scored the first really good interview with Eric Roza. He kind of opened up to you.
Julie: Oh, thank you. I mean, it helped that we just connected. I had randomly sent an email once he came on and I didn’t really expect him to respond, but someone from his team connected us and then we were both in Cookeville at the same time in July. And so we got to spend some time talking, and he said he would come on the podcast as soon as the deal was final. So as soon as it was final, I said, “Eric let’s do this.” It was great.
BarBend: Is there anything that you could foresee yourself venturing into in the wellness space in the next five years? It could be on the content side, it could be on the practice side.
Julie: That’s a really big question. I don’t know. I’m very excited about the model of Direct Primary Care and how we can use telemedicine to reach more people. I’m just very excited about the idea of us having more data behind what we’re doing in CrossFit and how that impacts people’s health. It’s not something that’s ever really been widely collected before, but we have all these anecdotes, right?
You walk into any gym and you have people who’ve lost a hundred pounds or they’ve come off their diabetes medicine, or now their cholesterol is better. And for us to be able to capture those anecdotes into data that we can use, there’s so much power in that, whether it’s being able to go to insurance companies to say, “Hey, this, this person joined a CrossFit affiliate and look how they turned their health around.” And two, maybe we’ll be able to think about how it could be prescribed in a more conventional sense, or to use it just in talking to patients and people and offering it as an option.
BarBend: Can you go a little more in depth on the Direct Primary Care model? What is that?
Julie: Totally. Direct Primary Care is something I found out I learned about in residency. So normally when you graduate from residency, most people end up getting a job, working as a primary care doctor for some sort of health system or larger practice where they get paid a salary, and they then have to see a certain number of patients every day in order to be productive enough to keep the practice open. The problem with this is that all of the incentives are really coming from the insurance companies. And so, and it’s really based on how many visits you do per day. Most of the time, you have to be seeing more than 20 patients a day, which leaves very short visits and very minimal amount of time to work with people on the things that really matter, like the lifestyle changes are really getting to understand what the root cause of their problems are.
And so often this results in more prescribing, more referrals, and not really being able to connect and help patients in the way that they most need. And so to me, that was really frustrating when I looked at the landscape of what I was going to do once I finished residency. I knew I wasn’t going to last at all. And I see it also in my colleagues, even people who graduated from residency a couple years before me have now been out in practice for a few years. A lot of them are already saying this isn’t worth it.
People who really care about helping patients are not going to survive in that system for very long. Direct Primary Care is a model that really first started just in the last 10 years, it’s grown from a couple hundred practices to well over a thousand practices across the United States. There’s no insurance involved. The patient pays a monthly membership fee, which may be anywhere from $30 a month to like $150 a month, depending on what services are offered or demographics or things like that. And then as a result, they get all their primary care so they can come schedule visits whenever they want. There are a variety of ways to do it.
Some practices will also charge a per visit fee or fees for different things, but essentially you then have a primary care doctor at your disposal. And because there are fewer patients, you can have longer visits, you can do more creative things. You’re not tied to having a doctor’s visit in the office in order to get paid. So you can do more telemedicine. You can create group visits or workouts or things like that that are different. And so that was a model that was very attractive to me, just because it allowed me to practice medicine in the way that I felt was actually most effective for patients. It was something I started learning about in residency.
Now insurance is already expensive. A lot of times people have very large deductibles. So even before they hit their deductible, they’re paying to go see the doctor, they’re paying for lab tests, they’re paying for imaging, which adds up in a lot of times when you bill through the insurance. So that goes against your deductible. Things are way more expensive than people even realize sometimes. If you go and get standard lab panels, they could be hundreds of dollars if you bill your insurance. But if you paid cash for them, they may be like $10 or $20. And so by cutting out a lot of that overhead healthcare actually gets a lot cheaper. And if you pay for all of your primary care part out of pocket, then you have the option to go to a much higher deductible insurance plan, which has a lower monthly premium, or you may choose to do like a cost sharing plan or something different. So that overall the total amount of money that you’re spending on health care could actually be less.
BarBend: And that’s going to be different for everyone. And obviously every state has its own regulations and costs.
Julie: Totally, totally. And there’s so many different regulations, state by state, and a lot of different ways to implement it. Obviously it depends on the person’s situation. But it’s something that’s becoming a lot more widespread and it’s a lot more popular among primary care doctors. There’s a lot more support for legislation to supports. So making it more accessible, being able to use things like an HSA account to pay membership fees, all that kind of stuff.
BarBend: Anything else you’re particularly excited about these days?
Julie: The idea of getting to the root cause of symptoms. Working out or moving regularly, eating real food, getting enough sleep, finding ways to manage or mitigate stress, spending time with people you care about: Those are going to be the most powerful tools that we have for getting to the root cause of any symptoms. And a lot of times when you get those ingredients that you need, the symptoms fall away, but other times you have to look a little bit deeper and, and just the concept of really looking for the root cause instead of being satisfied by just covering them up with a medication. That’s something I’ve always wanted to strive to do.
And then Wild Health also is focused a lot on, like I said, precision medicine or genomics, and that’s something else that’s really exciting to me, too. There’s so much information out there and there are so many things that are known in the literature, but are not yet incorporated into conventional medicine. Small ways that we can start to better understand how each of us are unique and individual, and then better tailor those lifestyle recommendations to the individual. So instead of starting everybody on a straight elimination diet, or doing keto and then doing vegan or whatever, maybe we can decrease the number of cycles that we have to do on those experiments by starting with your genetics and looking at what has the best probability of working for you or being successful for you. So that’s something else that I think is on the horizon and that’s very exciting.
Featured image: @juliefoucher on Instagram