Our Interview With Dr. Janet Chene

Dr. Janet Chene is the owner of dr.chene.com, an integrative nutrition TeleHealth clinic. She has 21 years of Integrative and Functional Medicine practice experience and is committed to empowering people to attain their optimal health by integrating the best natural options with conventional modern medicine.

What motivated you to pursue a career in medicine?

I really love to help people because I care about them. And that's the only reason I'd recommend getting into medicine. If someone is after money, I would really suggest doing something else, like business.

This career, in order to be successful, demands a lot of your life and energy, more than I anticipated in terms of time. If you really don't care about people much, you'll end up resenting it. You'll feel it as an imposition on your life.

And the patients will sense that and that's not really good care.

What do you wish you had known about the medical school application process before you applied?

I never applied in this country. But what I didn't know about medical school is that I'd spend almost two years dissecting cadavers, which was totally unpleasant for me. However, we had to do it in order to learn anatomy thoroughly, including neuroanatomy. So, I don't think I would have applied if I had known.

What was the biggest challenge that caught you off guard when you sat down to write the MCAT?

Yes, I didn't write the MCAT. The only American tests I took were the ACT, for which I received a full competitive scholarship for undergraduate. But since it was the early 80s, I had no one to help me, and it was very difficult to even get a credit card, despite having been responsible for paying all my bills.

Then, I went to a foreign medical school, which was in the Dominican Republic. It happens to have the oldest university (opened in 1500) and oldest medical school (opened in 1540) in the New World. They also have the oldest hospital, Padre Billini, where I did my geriatric rotation. So, I didn't apply to medical school in the U.S.; I really wasn't prepared for the debt load, even if I could have gotten credit.

I wanted to experience life in a Latin country, and since I spoke decent Spanish, I thought it would be a good opportunity. At that time, there was a test called ECFMG with a 49% pass rate, and I thought, "No problem." I had always been in the top 10% of my class. But then they changed it to something called FMGEMS, and I didn't realize the pass rate would drop to 4.9%. It went from 24% to 12.9% or 11.9%, then 6.7%, and eventually to 4.9%. But I still passed it. Afterward, I took the federal licensing exam, which I believe the USMLE has replaced, but the federal licensing exam applied to all states.

Afterwards I took the FLEX exam, which the USMLE has now replaced (must pass by the end of residency), and without further preparation or any residency training yet, I passed it with high scores easily. It was much easier than the foreign doctor exam, FMGEMS, that I had to take to apply for residency.

How much work experience did you gain before applying to medical school? What opportunities did you pursue, and what helped you the most during the application process?

During undergraduate, I worked full time and went to school full time. It was pretty exhausting. I worked as a medical transcriptionist, at least from 3 to 8 in the morning when I could.

I also learned to be a paramedic in Detroit. I worked nights, weekends, 24 hours on Friday, and 24 hours on Sunday. That gave me a lot of experience.

It's helpful to have that.

What led you to specialize in Family Medicine? What advice would you give to someone looking to pursue your specialty? 

I wasn't sure which country I would end up in, so I took family medicine, which always interested me because you can take care of most people—old, young, you can deliver babies, perform a little surgery, remove worrisome skin lesions, stitch wounds, and set bones or dislocations. You could also handle emergencies, because at that time, residency programs required a lot of hours, including time in both pediatric and adult emergency rooms.

I really love the full spectrum of being able to care for people from birth to death, essentially. I also enjoy the continuity of care. As for integrative and functional medicine, I spent about a hundred thousand dollars traveling around the world, learning from those I could identify as the best in the field. These meetings taught me how to view physiology in a way that helps you understand how disease develops. When you listen to a patient’s history and possibly conduct some tests, you begin to form a picture—like assembling a puzzle—of what happened to that person to make them ill and how they overcame all the incredible defenses we have in place to prevent illness.

But when those defenses are overcome, illness occurs. This teaching helps you understand how to support healthy physiology. Even in cancer cases, it shows you how to create a different environment from the one in which the cancer developed. There are factors that overcome the immune system and contribute to the creation of cancer. Unfortunately, modern life includes many factors that facilitate this, and most people are unaware of them. I really appreciate the integrative and functional medicine approach.

The reason I did not want to go into Internal Medicine initially is because it often feels like you’re just writing prescriptions all day, without really fixing anything, except when you write a prescription for antibiotics. Other than that, most prescriptions are just refills, and you end up becoming a pill mill—"a pill for an ill," just adding more and more. It’s great for big pharma, but it’s not great for our health because we’re not addressing what went wrong or identifying the root cause of a problem.

That can't always be done 100% of the time, and so I am happy to have pharmaceuticals in my armamentarium especially in the Emergency Department and the ICU where we need to have a direct an immediate effect.

If someone wants to start their own practice, what does that path look like after finishing medical school?

I am a strong advocate of private practice. I practiced privately my entire career, except the years I served as teaching faculty for medical residents in the hospital and large clinic with faculty doctors and many residents, and the years that I was an Emergency Department physician full-time. However, in corporate practice, you have to support the administration above you, which diminishes the personal aspect of care.

The patient's outcome tends to be better in a small practice, where one or two practitioners are familiar with their patients. Having consistent doctors and staff allows patients to be more open and comfortable.

In private practice, you can practice medicine the way you want, without being pressured to double-book every 15-minute slot or adhere to billing codes set by Medicare. I am an idealist. I have been fortunate in not having to compromise my principles. My conscience does not have a price, and I’ve never had to compromise my integrity throughout my career.

I wish more physicians who feel time-pressured and constrained by the economic interests of their employers could have the opportunity to own their practice. While you may earn less initially as you learn to manage your own practice, there are other benefits. I have acquired many tools in my practice to help my patients, some of which involved buying inexpensive equipment. Not all of these tools worked as expected, but they did help with pain management, energy levels, and immune system support.

Using tools like infrared therapy and e-stim did not always require my direct time but benefited the patients and the practice. Ultimately, these tools allowed me to spend more time with my patients. While I didn’t make these decisions for financial reasons, collectively, they improved the office's efficiency and patient outcomes.

I am a strong proponent of private practice. On my website, I offer mentoring for those interested in becoming integrative and functional medicine physicians. When setting up a practice, you will need certain essentials: a list of supplies, reasonable rent space, someone to assist with billing issues, and a reliable EMR (electronic medical record) system.

I recommend starting small, perhaps as a solo practitioner, with patients scheduling online or by phone. If necessary, consider adding a nurse practitioner to handle routine tasks or follow-ups, who can refer patients back to you if issues arise or if they are not improving. This model allows for flexibility, so you can take breaks or attend educational opportunities without risking burnout.

What advice would you give to someone who’s looking to start their practice today?

It feels much better to me, and I think to most people, to work for yourself. When you get up to go to work in your own practice, you can choose the people you hire, which is important. Hopefully, they share the same spirit you do. When your practice succeeds, you can offer them a little more than they would typically earn and try to help them with a retirement program if possible.

This way, the doctor isn’t the only one able to retire. Medicine is a team effort, both in the office and in the ER or surgery. It’s beneficial to choose the people you work with, rather than having someone else assign staff to help with your patients and hopefully genuinely care for them as well.

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