What Actually Works—and What Doesn't—When You Build an Integrative Medicine Program at a Health Care System

By Yoon Hang "John" Kim, MD, MPH

Board-Certified in Preventive Medicine | Integrative & Functional Medicine Physician

February 2026

Successful Integrative Medicine in Health Care Systems

What Actually Works—and What Doesn't—When You Build an Integrative Medicine Progr0am at a Rural Hospital

I have built integrative medicine programs inside a nationally ranked cancer center, an academic medical school, one of the largest managed care organizations in the country, the VA system, and a private practice. But the project that taught me the most—the one that stripped away every comfortable assumption I had about how this work gets done—was a 25-bed critical access hospital in a rural county with exactly one supermarket and a poverty rate that would startle most of the physicians reading this.

I went there because I believed integrative medicine belonged in the places that needed it most, not just the places that could most easily afford it. I still believe that. But the experience taught me things that no fellowship, no leadership role, and no conference presentation ever could—about what actually makes an integrative medicine program succeed, what quietly kills one, and what I wish someone had told me twenty years ago.

This is what I learned.

Lesson One: Without C-Suite Alignment, Nothing Else Matters

I need to say this as directly as I can, because it is the single most important thing I know about building integrative medicine programs inside health systems: if your CEO, CFO, CNO, and CMO are not aligned on the same vision, do not take the job.

I do not mean they should be enthusiastic. Enthusiasm is cheap. I mean they must be aligned—willing to commit resources, defend the program publicly, and hold the line when the inevitable organizational pressures arrive. If even one member of the C-suite is pulling in a different direction, the program will be built on a fault line. You may not feel the tremor for months or even years. But it will come.

I have been in systems where the CEO believed in the mission but the CFO considered it a cost center to be tolerated. I have been in systems where the marketing department loved the program but the medical staff resented it. I have watched well-intentioned programs die not from external opposition but from internal misalignment—from leaders who agreed in principle but diverged in practice.

At this particular rural hospital, the conditions were different. The CEO had been preparing for an integrative medicine program for seven years before I arrived. She had already hired a holistic registered dietitian team. She had built a teaching kitchen that was as large as anything I had seen at major academic centers. She had restructured the hospital's food service to source locally and sell meals at cost—turning a $12 salad into a $3 salad—not because it was good marketing, but because she understood that in a food desert, the hospital needed to be the center of health for the entire county. When we sat down together, the first thing we did was co-author a mission statement. That is the order of operations that matters: shared vision first, operations second.

I learned this lesson not because this hospital got it right from day one—no organization does—but because I had spent years in systems that got it wrong, and the contrast was unmistakable. The difference between a program that has a chance and one that doesn't is not the quality of the physician. It is the alignment of the people who control the resources.

Lesson Two: Passion Without a Financial Pathway Is a Guarantee of Failure

There is a particular form of self-deception common among integrative medicine physicians, and I have been guilty of it myself: the belief that if you build something excellent, the financial sustainability will follow. It will not. Not in a health system. Not in rural America. Not anywhere.

Before I accepted the position, I sat down with the CFO and ran the numbers. I did not wait until I was hired. I did not assume someone else had done the analysis. I addressed every financial concern directly, and I made sure that both the CFO and I agreed there was a credible pathway to sustainability before I moved my life to a small rural town.

The mechanism that made it possible was the Rural Health Clinic designation—a federal program that provides an all-inclusive reimbursement rate for qualifying facilities. This meant that my 90-minute initial consultations and 60-minute follow-ups were covered at a rate that made the model viable, regardless of how long I spent with each patient. In a conventional fee-for-service system, those visit lengths would have been financially impossible. In the rural health clinic model, they were not only possible—they were the foundation of the business plan.

We knew we would lose money in the first several months. We projected that the program would cover my salary within the first year and break even shortly after. The numbers bore this out. But the critical point is that we knew this before I started. I did not arrive hoping the finances would work. I arrived knowing the conditions under which they could work and the timeline on which they needed to.

Every integrative medicine physician who is considering a position inside a health system needs to ask for the financial data before they accept the offer. If the organization cannot or will not provide it, that tells you everything you need to know. And if they offer enthusiasm in place of numbers, remember: enthusiasm does not pay salaries. A spreadsheet does.

Lesson Three: Meet the Community Where It Is, Not Where You Think It Should Be

One of the quiet arrogances of integrative medicine—and I say this as someone who has spent his career in the field—is the assumption that we know what a community needs. We arrive with our training, our evidence base, our dietary philosophies, and our clinical frameworks, and we expect the community to adapt to us. It should be the other way around.

In this rural community, plant-based medicine was not going to gain traction. The culture, the agricultural economy, the food traditions—none of it was aligned with the dietary approaches I had seen succeed in urban academic settings. But when I offered low-carb approaches built around eggs, local animal protein, and metabolic principles that made sense within the context of people's actual lives, they responded. They were not resistant to change. They were resistant to being told their way of life was wrong.

This is a distinction that matters enormously. Integrative medicine, at its best, is about meeting people where they are and helping them move toward health using the tools and frameworks that fit their reality. If your approach requires a Whole Foods within driving distance and a patient population that already understands the difference between omega-3 and omega-6 fatty acids, you are not practicing integrative medicine. You are practicing boutique medicine with an integrative label.

The hospital understood this instinctively. Operating in a food desert, the leadership leveraged the institution's purchasing power to source fresh food from local suppliers several times a week, bypassing the large food service companies that could not reliably deliver quality produce to the area. The salads and meals in the cafeteria were sold at or near cost. This was not a side project or a wellness initiative. It was a clinical strategy. Access to real food is medicine, and making it affordable in a place where people have limited options is one of the most impactful things a rural hospital can do.

The broader lesson is this: your clinical model has to be culturally literate. Functional medicine testing, integrative oncology protocols, lifestyle medicine interventions—all of these are tools, and tools only work when they fit the hand that holds them. The physician who adapts to the community will build something lasting. The physician who insists the community adapt to them will build something that collapses the moment they leave.

Lesson Four: The "Entre-ployee" Model Is the Sweet Spot

After working in nearly every organizational structure available in American healthcare—large managed care, academic medicine, the VA, private hospitals, nonprofits, and private practice—I have come to believe that the optimal arrangement for an integrative medicine physician inside a health system is what I call the "entre-ployee" model. You are part of the system, but you have the autonomy to design your own institute, create new service lines, build your team, and control the direction of the project.

At this hospital, we created an institute of health and healing. Within that institute, we launched multiple service lines: integrative oncology, integrative pain management, integrative and functional medicine consultations, a diabetes reversal program, and medical weight loss. We also developed the infrastructure for what I envisioned as integrative primary care—a membership-based model embedded within the hospital system that could demonstrate the kind of cost savings that have been documented in case studies showing up to 50% reductions in healthcare costs.

This degree of latitude was not accidental. It was negotiated. It was part of the agreement I reached with leadership before I started. And it is the reason the program was able to develop as rapidly and comprehensively as it did.

The alternative—being hired as a staff physician who sees patients in an integrative medicine clinic but has no authority over the program's direction, staffing, or scope—is a recipe for frustration and eventual departure. You become window dressing. The health system gets to say it offers integrative medicine. But what it actually offers is a conventional clinic with a slightly longer visit time and a physician who happens to know about supplements. That is not a program. It is a marketing asset.

If you are being recruited for a hospital-based integrative medicine position, negotiate for entre-ployee status or something close to it. If the organization is not willing to give you meaningful authority over the program they are asking you to build, they are not serious about the program. They are serious about the optics.

Lesson Five: Know the Red Flags Before You Say Yes

I have accepted positions I should not have accepted. I have ignored warning signs that were visible in retrospect but obscured in the moment by enthusiasm, optimism, and the genuine desire to do meaningful work. I do not want other physicians to make the same mistakes.

Here are the red flags I now watch for.

• A salary significantly below the national or local average is not just a compensation issue. It is an indirect measurement of how much the organization values the service and the provider. If they are offering you substantially less than what your training, experience, and specialty warrant, they are telling you—whether they realize it or not—that integrative medicine is a second-tier priority.

• Inability to commit to a joint mission statement is a serious warning. If leadership cannot sit down with you and articulate a shared vision for the program in writing, the vision does not exist. What exists is a vague aspiration that will be reinterpreted the moment financial pressures arise.

• Recruitment difficulties including long delays, inability to provide written expectations, refusal to share financial data, or withholding the salary range until the final phase of negotiation are all signs of organizational dysfunction. A health system that cannot be transparent during the courtship phase will not become transparent after the wedding.

• Lack of personnel, space, and equipment means the program has been approved in concept but not in practice. You will spend your first year fighting for resources instead of building clinical services.

• Misalignment between what was promised during recruitment and what is delivered upon arrival is perhaps the most common and most damaging red flag. If the job you were offered is not the job you find when you show up, the misalignment will only widen over time.

• Unnecessarily long or punitive contracts deserve close scrutiny. Non-compete clauses, restrictive covenants, and multi-year commitments with unfavorable termination conditions can trap you in a situation that has already failed.

• Every one of these red flags is something I have either experienced personally or witnessed in colleagues. None of them are subtle in retrospect. They only feel subtle when you want the opportunity to work out.

Lesson Six: Mission-Driven Work Solves the Recruitment Problem

One of the persistent complaints I hear from rural health systems is that they cannot recruit quality staff. At this hospital, we did not have this problem—at least not within the integrative medicine program.

We recruited two registered nurses relatively easily while other departments in the hospital struggled with the same positions. When I posted a nurse practitioner position, I had serious inquiries within a week, including one formal application almost immediately. These were not candidates who were settling for a rural position because they had no other options. They were professionals who were drawn to the mission.

This should not be surprising, but it seems to catch administrators off guard. People are desperate for meaningful work. The healthcare workforce crisis is not primarily a supply problem. It is a meaning problem. Clinicians are burned out not because they work too hard but because they work hard at things that do not feel like they matter. When you build a program with a genuine mission—one that is visible in the clinical model, the team culture, and the leadership's behavior—you attract people who want to be part of something real.

The ripple effects extend beyond recruitment. We began drawing patients from more than 75 miles away. People drove over an hour to see us. We had patients fly in from out of state because we accepted insurance and offered services they could not find closer to home—90-minute integrative medicine consultations, functional medicine testing, lifestyle medicine interventions, all within a single visit. This did not happen because of our marketing. It happened because the program was real, and people can tell the difference.

For health system leaders, the implication is straightforward: if you are struggling to recruit, look at your mission before you look at your compensation packages. A meaningful mission with adequate compensation will outperform a generous salary with no purpose every time.

Lesson Seven: Take Care of Yourself First, or the Program Dies With You

This is the lesson I learned last and value most.

Building an integrative medicine program in a rural setting—or in any setting, frankly—is extraordinarily isolating. You are often the only integrative medicine physician in the building, the only person who fully understands both the clinical model and the organizational challenges, and the only one who carries the weight of the program's survival on a daily basis. There is no department of colleagues to share the burden. No institutional precedent to lean on. No playbook.

I spend several hours each day on personal practices that keep me grounded, mindful, and resilient. Meditation, movement, reflection, connection with people I trust. This is not optional. It is not a luxury. It is the infrastructure that makes everything else possible.

The other dimension of self-care that I learned is relational: communicate through difficult times, not around them. Ask for help sooner rather than later. Be honest and direct, even when honesty is uncomfortable. Work on yourself first before you try to change the system. These are not soft skills. They are survival skills.

I have seen integrative medicine programs fail because the founding physician burned out. Not because the clinical model was wrong, not because the patients were not responding, not because the financial projections were off—but because the human being at the center of it all ran out of fuel. The program did not survive their departure because the program was them, and no one had built the resilience infrastructure necessary to sustain it independently.

If you are building something, build yourself first. The program can only be as durable as the person holding it together.

The Bigger Picture: Why Rural Matters

The Academic Consortium for Integrative Medicine and Health has member institutions at many of the country's leading academic medical centers. What it does not have—or did not have when we began this work—is representation from small rural hospitals. The disparity is telling. Integrative medicine has been built primarily in places where patients already have options: urban centers, academic campuses, affluent communities. The places where people have the fewest options—the places where chronic disease, food insecurity, and provider shortages are most severe—are precisely the places where integrative medicine could make the greatest impact.

Membership-based integrative primary care in rural settings has the potential to reduce healthcare costs by as much as 50%, based on existing case studies. If a rural hospital can demonstrate those savings for its own employees, every business in the county has an incentive to adopt the model. When businesses save on healthcare costs, they can hire more people. When more people are employed, the health of the entire community improves. The economics of rural integrative medicine are not just about the hospital's bottom line. They are about the economic vitality of an entire region.

This is not idealism. It is arithmetic.

What I Would Tell Someone Starting This Work Today

If a physician called me today and said they were considering building an integrative medicine program at a rural hospital, here is what I would tell them.

First, verify C-suite alignment before you accept the position. Not enthusiasm—alignment. Ask for a joint meeting with the CEO, CFO, CNO, and CMO. If they cannot all be in the same room at the same time to discuss the program's vision and financial framework, reconsider.

Second, run the numbers yourself. Do not rely on the organization's projections alone. Understand the reimbursement model, the break-even timeline, and the revenue streams that will sustain the program beyond the initial investment period.

Third, negotiate for autonomy. The entre-ployee model—where you are part of the system but have authority over your institute and service lines—is the arrangement most likely to produce a program that is both clinically excellent and organizationally sustainable.

Fourth, study the community before you design the clinical model. What do people eat? What do they believe? What are their actual barriers to health? Build your program around their reality, not your training.

Fifth, watch for the red flags. If the recruitment process feels opaque, the promises feel vague, or the financial data is withheld, trust your instincts. The job that feels too good to be true during the interview will feel entirely different six months in.

Sixth, build a team early. The loneliness of being a department of one is not sustainable. Hire mission-driven people, create a culture of shared purpose, and invest in your team's wellbeing as deliberately as you invest in patient care.

Seventh, and most importantly, take care of yourself. You cannot build something durable if you are depleted. The personal practices that sustain your resilience are not ancillary to the work. They are the foundation of it.

And one last thing: reach out. The physicians doing this work in rural and underserved settings are scattered and often isolated. But we exist. And the conversation between us—the sharing of what worked, what failed, what we wish we had known—is one of the most valuable resources any of us has. I am always willing to talk. The road is lonely until it isn't.

This article draws on my experience building an integrative medicine institute at a rural critical access hospital, as well as two features published by Integrative Practitioner—a podcast interview on bringing integrative medicine to rural communities and a follow-up article on lessons learned.

About the Author

Yoon Hang "John" Kim, MD, MPH is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. He is the founder of www.directintegrativecare.com, a membership-based telemedicine practice, and the author of three books on Low-Dose Naltrexone therapy. He leads an LDN Support Group with over 8,000 members. He provides 1:1 physician and independent practice NP mentorship in developing integrative & functional medicine practice through www.yoonhangkim.com.