Episode 102: The Physician Mom Journey She Never Expected with Dr. Elissa Gartenberg

Building a Concierge Medicine Practice Around Patient Relationships

Dr. Elissa: So I started a private practice about 11 years ago.

I did traditional insurance and saw traditional patients from Medicare to newborns and all between, and it was great for a while, except the last… since the pandemic times, the payments were getting reduced, and I was spending more time with patients. And the way the payment structure was working, I couldn’t keep up with the demands of both, taking care of my patients and having enough financial backing.

So I decided I wanted to continue doing my own style of medicine, which I started this practice doing, giving my all to patients and giving the better care that I saw fit. So I converted to a concierge-type model, like a membership model. And concierge has a weird connotation, but I am a traditional concierge physician.

All my patients have my cell phone number. They call me any time they need something. They usually don’t bother me so much during the nighttime. They understand I’m a single mom with a child that I have other demands going on, so they’re pretty patient and understanding with me. But they do have access to me 24/7.

It helps to identify problems early so that I can help people. I had one lady, for instance, she was in the grocery store And she was having some, neurological symptoms and like dizziness and headache, and she calls me on speed dial and I was walking through, you know, what was going on with her, ended up sending her to the ER and she was having a stroke.

And so it was like so convenient at the time for her to get that care, because she might have just blown it off otherwise or passed out in her car or something, God forbid. So, luckily we were able to take care of her. And so this type of medicine is the type of medicine I like to practice where I’m more hands-on, more involved with the patients, and when they need something, they can reach out to me.

I also do a lot of preventative care, so I designed my own, preventative integrative medical assessment I call it. I’ve always done evidence-based medicine as a Mayo Clinic-trained physician, but then I do, more holistic type medicine too. So I trained in medical acupuncture and Chinese medicine. I dabble with Ayurvedic medicine and functional medicine.

So I created this preventative integrative medical assessment where it personalizes a patient’s history, their evidence-based history, and combines the different holistic types of medical care into an assessment where you can see all how they overlap a lot with the treatments and their identifying issues in the body.

And it’s fascinating to me because you see themes going on, and I can analyze using AI analysis too, a more comprehensive clinical diagnosis. So I do this facial analysis and apply that to this assessment where it identifies early stages of blood sugar issues or little abnormalities that could often get missed when you’re looking at trends in the labs.

So it’s like a microscopic look at those trends. So it’s been really interesting to identify those types of issues, and then we can apply lifestyle changes to the patient’s care so that they can better themselves without medication if possible. But sometimes we start early on medications too, so we have that the whole repertoire available.

Dr. Cindy: Yeah. I love this, that you’re very focused on the preventive side and spending time with your patient and looking at the whole body, the whole picture, to pick up these things before they become an issue. And your patient in the grocery store shopping, wow.

My mind just kept going where that could have gone if she didn’t get care from me right then. I’m so thankful for, that everything turned out okay

Dr. Elissa: Everyone should have a doctor in their pocket, right?

Dr. Cindy: Yes. A doctor in their pocket.

Leaving Traditional Medicine to Build a Practice on Her Own Terms

Dr. Cindy: So what were some of the biggest lessons you learned from starting your own practice like this and with your own structure?

Dr. Elissa: In the beginning, when I first started 11 years ago, I talked about it for years prior, and I never pulled the trigger to just do it. And I had a friend ask me, “Well, why aren’t you doing it? You keep talking about it.”

I had that aha moment, like, “Yeah, I gotta do it.” It was the scariest thing I think I’ve done, almost like jumping off a bridge. But I managed to figure out how I got loans, and I did everything from scratch. So I didn’t want to hire a consultant which was part of my stubbornness.

Financially, I didn’t want to spend the extra money doing that, so I learned it all myself how to do the credentialing with insurance companies and get my Medicare IDs figured out. And I did the build-out for the building. I purchased a building at the SBA loans and the practice loans and did all of the ordering for supplies.

And so I learned every aspect of the IT stuff and how to organize the whole practice. So if anything went wrong, I wasn’t reliant on an individual to just help me. I created my own website. I did everything. So it was challenging, but I learned a lot and it was very hands-on learning. It was rewarding when things were busy and I had the following.

But I didn’t have to call up an IT guy to come in and help and figure things out very often. So that was rewarding in that sense, that I could try to figure out what was going on, like if there were any hiccups along the way.

Dr. Cindy: Yeah. So you’re very self-driven and like to get in there and do things yourself.

But you mentioned several other people that could have helped, so if someone wanted to start up a practice and they really hated one portion of a startup, they could outsource pieces of it but you didn’t need to outsource.

Dr. Elissa: I did try in the beginning to outsource a couple things, like the billing, but I kept running into little snafus with the different billing companies and things weren’t getting done the way at the speed I wanted them done. So I just took the reins and did it myself.

Dr. Cindy: Now, I’d love to transition into your story about choosing to become a foster mom and then adoption.

From Career Goals to the Dream of Becoming a Mother

Dr. Elissa: Sure. So in my career goals, I started medical school. I was a little late in the game. I didn’t go right from college. I actually decided after I graduated to go back to school for medical school, and so I did all my pre-med requirements.

And during that time I was very driven, very focused on going to medical school, and I had relationships here and there but nothing panned out where I was in that married lane to focus on a family. And so I went to medical school, did my residency, and I was so focused on my career during that, those essential years I guess. Like, when you’re meeting a spouse and supposed to start a family and everything. Well, when all my friends were doing that, I was more focused on my career goals.

So I let that aspect of my life slide, and then I woke up one day and said, “Wait, I’m not married. I don’t have kids.”

I really wanted kids. Like, am I too old? I don’t know. So I applied at first for my adoption license, and so I had this adoption license with the state. I explored looking at the Native American side of things also. But if you’re not a Native, they want you to foster and not adopt. And so then you’re pinpointed as a guardian, and you’re never really bonded or officially legally bonded to a child.

I wanted the whole experience. So, I looked into private adoption. I looked into surrogacy, and I decided I wanted to do the fostering and…Or at first I decided I wanted to do the adoption. And so I had my adoption license for two years, and nothing was really happening. They never called me for an eligible match, which was surprising because there’s so many kids that need parents and I felt like it was… It’s dependent on the agency, too, and your caseworker.

There may have been potentially some bias there. I don’t know. But I wasn’t getting anywhere, and so I was having the routine monthly inspections and the follow-ups and everything, but nothing was going anywhere. So I ended up deciding to do my foster license.

So I applied for my foster license, and the caseworker didn’t turn in my paperwork on time, so I had to repeat all this foster care college training and all this other stuff again. Which is an extra task because you’re doing CMEs, and then I’m doing this foster care trauma training and all this other continuing education for that. Finally, I got all the paperwork in.

Everything was submitted, and they were supposed to come and do another inspection to my house and there was this big hole in my kitchen. And so it was right after the pandemic too, where I was stressing out about that, because I really wanted to get this fostering started. But they said they couldn’t pass me because of the hole in the ceiling from the rain, the roof leaked.

And so the contractors were coming in, but it took them longer during that time period because everything was delayed during the pandemic times. And so they finally fixed the ceiling. It took them three months, and the roof. So I went to submit for the next inspection, but you have to wait another time period for the inspection.

So they gave me a date, which I’ll never forget, March 6th. And so they said they’re going to come out on March 6th. And then the week prior, the caseworker said, “Oh, you have to repeat all this other paperwork again. We’re not going to submit it because…” And I said, “Well, I have the inspection on Monday. Like, you gotta, you know, get things going.”

I think it was a Monday. And she said, “No.” She talked to her supervisor. They had to delay it again.

I felt so much pressure then because I really, really wanted this foster license. And so I ended up switching agencies at the last minute.

I hired an attorney too, because I felt like there was some, something wasn’t right with this other agency. Not that I was going to go pursue any legal action or anything against them. But I just didn’t, I needed some support with an attorney to figure out what I should be doing to actually get my license squared away.

And so I switched agencies. They sped up the process. The inspector came out, I passed, everything was good, and they submitted my paperwork. And so then I had to wait a little over three months for an answer.

On June 21st of 2022, I got my foster license. It was a Tuesday. And then the very next day, they called me from the state and said, “We have three babies. Do you want to take one?”

And I was like, “Um, well, I’ll take all of them,” but it was like- … I wasn’t prepared mentally. I just got my license. I was so excited. And they said, “One of them really wants you. He’s asking for you.” And so I was like, um, How do they know that? But it was the way she said it.

Bringing Home an Eight-Day-Old Baby: A Foster Care Story

Dr. Elissa: I was already convinced that I was going to do it. So I said, “I have to think about it for a second.” So I hung up the phone and I thought, I’m going to call my mom and discuss this with her. But then something told me not to call her because she was going to talk me out of it.

She was always concerned about adopting a foster child who has any substance exposure or anything. She was very nervous about that and about what could happen and what kind of services or what kind of problems that they could have.

I did not call her and I just called them back. I said, “Yes, yes, I’ll take the baby.”

So I literally had 90 minutes to go to Walmart, get all the baby supplies that I could figure out to get, and I didn’t have a list or anything. And I went and picked up the baby and it was like he was the most precious thing. He was eight days old, and he was the cutest thing ever, and he basically was smiling at me.

And so when I got home, I called my mother on FaceTime and said, “Look what I got.” And she was pretty shocked, because she didn’t realize that it would happen that quickly. So I had him.

The other crazy thing was, the caseworker from DCS said that he had just gotten out of the ICU, and they said he was having some withdrawals, and I was scared about some apnic episodes or anything was happening. She had no idea. They didn’t have the hospital notes or anything to give me to identify what was going on. And I said, “Well, what do I do? Does he have an apnea monitor or should he have one? Should I take him to the hospital now to get one?”

And they said, “Well, you’re a doctor. You can figure it out.”

I was watching him all night, and then the next morning I had to go to work. Because I am a solo practitioner, I brought him with me, I did a lot of tele visits during that period of time, so there weren’t a lot of patients in the office, which was nice.

And so for the next couple days I had him, and then all of a sudden they called from DCS and said, “Oh, we have an aunt that wants him.”

And I was totally shocked and I was sleep-deprived. They wanted me to drive him to the aunt’s house, which I thought was kinda strange, too. But it was a good hour away, and I decided I wasn’t going to, in my condition, not sleeping for two nights.

It wasn’t safe to drive that far. And I didn’t know the people, and I didn’t want to accidentally drop him off at the wrong house. That would be on the news. And that was kind of a scary time. So they did, they sent out a caseworker who picked him up, and then I didn’t have him for a while, and so I was crushed.

I was in a state of shock and depression all at once. I didn’t know if I wanted to do this again, because it was soul-crushing. I knew it was fostering. I knew that was going to be part of the story. You know, when you’re fostering children, the goal is reunification. That’s it.

The goal shouldn’t be adoption. It is reunification, and I knew that going in, and I thought I could trust that. But at the same time, I felt like this baby was mine. Like, I had that connection with him so strongly that I didn’t realize that it would happen that quickly too, just after just a couple days.

And so I fell into this, like- I was still out doing things. I wasn’t bedridden in depression, but I just didn’t know if I wanted to do fostering again. And during that time they called me for some other children to see if I could take them, and I just wasn’t ready, like, mentally at that point.

I needed some time. And so then a couple weeks later they called and said there was a disruption with the bio family, could I take him back again? I said, “Well, I’ll take him back again, but you have to guarantee that you’re not going to just disrupt it all over again for someone else coming out of the woodwork.”

Because that baby is a newborn that needs to bond with someone. I knew that at least if they were with somebody that cared and loved them at that vulnerable time, that was good enough. But, I would be happy, thrilled to take him, but I just wanted to make sure that there’s no guarantees in fostering, so I couldn’t trust the system.

But the caseworker said, “Yeah, we’ll do our best not to actively find someone else at least.” So they allowed me to take him back, and I was protective at that point too. We had to go through some hell for a while too. It wasn’t as easy of a process as, you know, some people have to go through fertility treatments and others, you know, struggle getting pregnant and losing pregnancies and that kinda thing. But I feel like my story was comparable in that drama and it was traumatic. Now I can laugh about it, and I always knew during that time, one day I’m going to laugh about this.

The Emotional Reality of Foster Parenting and the Adoption Process

Dr. Elissa: But at the time you’re going through a rollercoaster of bio parent visits and them not showing up, and then court hearings where the judge is just, you know, reactivating the case to wait for the parents to show up at the next hearing, which is three months down the road.

And meanwhile, this little baby’s growing, and he has no other caregiver, and I’m bonding stronger with him. And it’s like any second they could do all the right things and then get him back. And so, I felt, even though that’s the goal. Like, I knew that’s the goal and you want the bio parents to be ready, but in his case- It would’ve been really bad if the bio parents took him back.

There were a lot of drugs involved, and the bio mother had lost multiple children in the past, and the bio father wasn’t stable, and the grandparents were not, um… They were really bad people. And so I knew it was not in his best interest to be reunified with that family, even though they’re bio blood and that they’re part of them.

But it wasn’t a safe situation for anybody, even the parents. So I wanted to do my best to protect him. So I hired an attorney who was helping me through the ordeal, and she was… she couldn’t do anything. She had no legal rights. She couldn’t even speak for me, basically.

But she could at least listen to the hearings and give me some advice on how to proceed next or what I should do because as a foster parent, you have no legal rights either. The judge could decide, “Well, I don’t like the school he’s at. Why don’t we switch schools?” Or, “Why don’t we, you know, get rid of the foster parents, assign him to someone else perhaps?”

You never know, but I mean, that’s probably extreme. But there are a lot of vulnerabilities when you’re a foster parent. So it wasn’t an easy process to say, but it was part of going through the hurdles to get there.

My patients were so supportive during that time. I had one of my older patients, she was really depressed. And I said, “Well, if you want, you can come and hold the baby.” Because for three months I brought him to the office, and he was just sleeping in his little bassinet, and I would change him between patients.

And so she came, and she would sit with him and sing to him. And like he would just sleep on her shoulder. She still comes by over the years. She’s brought him little gifts and has a good grandma type bond with him.

So it was really special that he could help people. I think it really helped her out of her depression, too.

And the other patients have always asked about him. He was like my little mascot in the office, so I joke that he’s been working since he was nine days old. So he has a good work ethic.

Dr. Cindy: Oh, that’s a beautiful story. It sounds like you have a family at your office. It’s your patients.

Dr. Elissa: Yes. They are family, yes.

Dr. Cindy: So at this point in your story you’re still his foster mom.

Dr. Elissa: Yes.

Dr. Cindy: And at what point did you switch over to adopting?

Dr. Elissa: It took a while. We had a judge that basically didn’t want to make any decisions either way. He never wanted to sever the rights. There is a law in Arizona that after, I think it’s six months, that the child needs to have a permanent home plan in place. And so it lasted much longer than that. It was like 20 months before I adopted him.

Dr. Cindy: Oh.

Dr. Elissa: It was a hard time. We’re all dependent on what the judges said. But during that course, the judges rotate, so we had a new judge, and then the new judge looked over the whole case and was like, “Wait, why is this not following the way it should be?” And then during that time, I also had a CASA. A CASA is a court appointed, um, I forgot what it stands for, but it’s a court appointed volunteer who helps advocate for children.

And so they don’t usually assign them to an infant because it’s more for older children who have a voice in where they live and what their goals are. And so I wanted somebody to help me make sure he had a voice in the system too. So the goal was to eventually adopt.

Parenting Through Uncertainty: Daycare Challenges and Advocacy

And the other struggles that I experienced during that time were with the schools. He was at a great daycare in the beginning. After three months I sent him to a daycare, and I have a doctorate degree, and the whole system is confusing to me how they operate with these vouchers or the aid that they give through the state.

I was surprised. If I can’t figure it out I’m sure I’m not the only one.

So I had sent him to this one daycare, and there, in Scottsdale there’s not many daycares that took the DES payments. He was eligible as a foster child to get a deduction on the daycare rate. And so I had to pay out of pocket the full amount for his schooling.

But the first daycare gave me a discount, and they were really good. They were supportive. The director, she was also a foster mom. We had this kindred spirit where we could bounce ideas off of each other, which was really, I felt, supportive.

And the teachers were phenomenal there. And so he was there for 15 months I should say. And then there was an opening. I had been on this waiting list for this other school that was much bigger, and they took the subsidy, and they had a really great reputation.

So I switched him over there, and I don’t want to disclose the name of the place, but you’re not technically allowed to sit and watch the kids when you’re there. But I came in a couple weeks later. The door was open, and I went to pick up my son, and he was sitting in a chair with a seatbelt in the middle of the room.

And I snapped a picture because I thought nobody’s going to believe me that he’s like, you know, sitting in the seat belted chair. So I had asked the director and the teachers, “What’s going on?”

And they said, “Well, he wanted to play with the toys instead of sitting with the circle time, and he had his own agenda.”

But I felt like he was prejudiced against because they knew his history and his story, and that he was in foster care, and I had to report it to DCS that this happened, and they were like I mean, that wasn’t that bad. To them, they didn’t think that was a problem.

But I was so upset. I wanted to pull him out of that school right then, but I was waiting on the adoption, and couldn’t disrupt too much at the time, so he stayed there. And then a few months later, he went to another school. There was some biting going on in the room, and I was observing he was not happy there.

The teachers that he had after that were really sweet and really great, but they didn’t really know how to handle that age group, I felt, because they were all biting and hitting, and they were in that stage of life that they’re all messing with each other. I felt that he wasn’t thriving there, so I pulled him out and sent him to another school, and they were awesome. He was doing wonderfully, and he was learning language there, too. It was a language immersion school. And so he was there for about a year and a half, and then, it came to potty time, potty training time.

When he started back at the school I had worked on the potty training all last summer we were doing it, and then I brought him the first day, and they said he pooped his pants in the room and put a Pull-Up on him, and then he regressed.

I took him to the pediatrician, and the pediatrician said he should be in underwear. But he was in a room with three to five-year-olds. And so I felt like they were kinda catering towards his development should be more like a five-year-old instead of a fresh three-year-old. And so he got kicked out of the school.

They knew his story, too. His needs were a little bit more than compared to the other children. And so, they didn’t accommodate him with any special treatment to give him some extra support there. So I was personally hurt by all that myself. But I really feel like there’s some discrimination going on so I’ve been careful telling his history to anyone right now.

Dr. Cindy: Of course, yeah. And so this, from the very start, this sounds like an emotional toll.

Dr. Elissa: Yeah.

What Physicians Should Know About Foster Care, Resilience, and Support

Dr. Cindy: Because there’s a lot of what ifs, and there’s a lot of you don’t know what’s around the corner and still all the way up until the adoption you still didn’t have control over his life. I mean, that was a legal right. So I’m hearing you, you did get support from a lawyer and people you met along the way supported you, like the lady with the kindred spirit.

What would you advise for someone listening today about seeking support to work through such a rollercoaster?

Dr. Elissa: I think if it’s your frame of mind how you look at it. If you know your goals and if you have more of a letting go of the outcome and knowing that as long as a child’s safe and cared for. Like, I would foster again in a heartbeat, but right now I’m nursing a broken shoulder, so I’m not in that frame of mind at the moment, but I suppose if they called me and said they had someone, I would probably just take them with my broken shoulder,

I feel like these foster children, I mean, if you imagine they’re yanked from whatever they know about life.

And my son’s story’s a little different. He was abandoned at birth, so it’s still a trauma, and even though he may not remember it or even have any understanding of it, it’s still traumatic. Birth, I guess it could be traumatic to anyone, going through a birth canal. But yanked from whatever they know, even if it’s not safe, even if there’s abuse and other things, it’s like that’s their world that they understand at that time, and so there’s a big transition and change that they have to make.

So any love and support that someone can give them during all this process can be so rewarding in the end because at least they know what that feels like. They can understand some concepts. Maybe not verbally communicate it so well, but giving that love and nurturing to a child who is in a vulnerable place like that is rewarding.

So I think the mindset of somebody who is a caregiver. Doctors are, like, the perfect people, I feel, because it’s like we understand where their developmental things could be a little bit off or if there’s something to be concerned about looking into, you know, their cognition or, their behaviors or what have you.

We find the resources. We’re very resourceful in that respect. So I think doctors are the perfect people to do something like that. And also, I think you need a strong sense of self, understanding who you are, where you’re coming from, what your background is, how you respond to you know, anger, other issues. And then understanding how you’d want to raise your children.

But there are legal things you have to follow, too. I feel like the way the system is made right now, they want a special type of person, which is extremely rare, to have somebody who’s nurturing and loving, willing to spend their money and willing to give their all to a child, yet they can be removed at any point, without much notice.

And then where does it leave the caregiver? I’ve only dealt with it for a couple weeks, but I can’t imagine having somebody for years, having a good relationship with that child, having that bond and having it just yanked away from you all of a sudden.

That could be devastating. I’ve heard stories like that. So resilience is another big motive that you should have when you’re fostering.

I think, too, to understand, like okay, I can get through this. You get through other things, but not that you’re asking for something like that to happen, but it’s like, or understanding you want a relationship with the family, the bio family or whoever they’re being reunited with.

Dr. Cindy: Well, thankfully doctors are very resilient to begin with. And I like your point that a foster child would be in a unique position if they were placed in a physician’s home because they would get those specialty eyes on them, maybe catch things a little sooner.

But I’m just curious if people want to talk to you further. You have learned a wealth of information about how to be a single mom and physician fostering and adopting, and I know there’s a lot more depth to your story. Are you open to speaking with people or do you…

Dr. Elissa: yeah

Dr. Cindy: How do you connect with people to talk about this?

Dr. Elissa: Well, I have an Instagram. I guess that’s the modern way to communicate. It’s Dr. Gartenberg. It is D-R Gartenberg. I’m also on LinkedIn and Facebook.

Dr. Cindy: Wonderful. because I’m sure there are 100 questions that people are thinking about right now.

And we just unfortunately don’t have the bandwidth to get to everything, but my goodness, there is so much to learn about this. But the best part of the story today is that your son is with you.

Dr. Elissa: Yeah.

Dr. Cindy: And you are his mom, and that it worked out, and just I’m so happy for you that this has worked out.

Dr. Elissa: Thanks. I know, it’s hard to get too mad at him. Like, this morning- … I was running late. I’m like, “I have this podcast to do,” and he was hiding under the bed with my phone playing games. And I couldn’t reach him. And I was like, “Okay, I’ll just tell the story on the podcast.”

Dr. Cindy: Yep. This is reality …

Dr. Elissa: That’s what I was thinking.

Dr. Cindy: It’s life. Oh, he sounds like a beautiful soul. Yes. Beautiful spirit.

Dr. Elissa: He’s smart. He’s talented. He’s a little musician, and he loves music, and he taught himself how to play piano. And he’s speaking Spanish now, and he’s so appreciative, too.

It was his birthday, and he was thanking me all day for all of his gifts, and he got a new bed.

Dr. Cindy: Well, happy birthday to the little guy.

Dr. Elissa: Thank you.

Dr. Cindy: Thank you for carving out the time today to talk to us about this.

Dr. Elissa: Oh, of course. I really appreciate it. Thanks for having me.

Dr. Cindy: Of course.

Dr. Elissa: Or us, I should say.