From Hospice to Healthspan: Why I Started A Longevity Internal Medicine Practice

For the past few years, as a hospice medical director, I’ve cared for people at the threshold between life and death. It’s been humbling to be in the presence of so much death. I’ve witnessed grief, pain, heartbreak, loss—and something I didn’t expect: the fierce, almost desperate desire to keep living.

It is rare to meet a patient who has fully accepted death. More often, I encounter the will to live. People in their final days ask for interventions—IV fluids, artificial nutrition, antibiotics, imaging, bloodwork, physical therapy. Anything that might give them hope or reverse their physical condition. Even those who spent years avoiding doctors or making unhealthy choices often find themselves, in the end, urgently reaching for anything that might restore their health—no matter how slim the chance.

I entered hospice believing it would center on comfort, dignity, connection, rituals, and meaning-making. I still believe in that vision. But again and again, I’m asked to provide treatments that offer no clinical benefit in the context of multi-system organ failure. The body is too sick to absorb hydration or nutrition. The infections are too advanced for antibiotics to help. The lab results don’t change the plan—because there is no curative path left. These interventions often introduce more discomfort than relief—and yet they are requested, sometimes demanded. 

These moments have made me wonder: What if we didn’t wait until the end to want to live? What if health wasn’t something we fought for only when we were sick—or already dying? 

These questions have led me to a new chapter in my work: longevity internal medicine.

Longevity medicine is no longer a fringe concept. It’s a fast-growing field targeting the root causes of aging and chronic illness with the aim of extending not just lifespan but healthspan—the number of healthy years lived.

Physicians, researchers, and entrepreneurs are rapidly expanding the field. Doctors like Mark Hyman, Peter Attia, and Elizabeth Yurth are pioneering root-cause, prevention-based care through advanced diagnostics, personalized treatments, and lifestyle interventions. Researchers such as Eric Topol, Andrew Huberman, and David Sinclair are deepening our understanding of aging biology. And entrepreneurs like Max Marchione (Superpower) and Chris Mirabile (Novos) are creating platforms that democratize access to proactive, longevity-focused healthcare diagnostics and therapeutics.

At the same time, a revolution is happening in how doctors want to practice medicine. Increasingly frustrated with rushed visits, bloated bureaucracies, and insurance gatekeeping, many physicians are leaving traditional systems and opening small, membership-based practices. Doctors want to develop a long-term relationship with their patients, and vice versa. Most commonly known as Direct Primary Care (DPC), this cash-based model allows doctors to spend more time with fewer patients—offering longer visits, greater access, more personalized care, and transparent pricing. 

Recently, a major regulatory shift made headlines: the new federal rule known as "One Big Beautiful Bill" now allows patients to use their Health Savings Accounts (HSAs) to pay for DPC memberships. For the first time, patients can use pre-tax dollars to build long-term, preventative relationships with primary care doctors—free from insurance constraints.

Technology is also accelerating this shift. Doctors now have access to lightweight, user-friendly practice management platforms (like Elation, AtlasMD, and SigmaMD) that enable transparent medical records, pricing, messaging, and real-time lab results. Patients are using wearable devices to track sleep, glucose, heart rate variability, and activity—all of which can be shared directly with their physicians. Home diagnostics and self-collected labs make it easier to identify issues early and monitor progress. And asynchronous tools—secure messaging, video updates, remote check-ins—are reshaping the doctor–patient relationship to feel more continuous and human, less transactional.

I’m shifting my focus not because I don’t believe in the value of end-of-life care, but because I want to move upstream. I believe more people deserve the chance to live longer, healthier, fuller lives—and to reach the end with more peace, not panic. More meaning, not medicalization. More trust, less depersonalization. 

I think of longevity medicine not as denying death, but honoring life. It’s about giving people the tools—personalized, evidence-based, and practical—to stay well and in control for as long as possible. It’s about empowering people with interventions that do make a difference, and supporting the body before disease sets in. Although we can’t completely prevent every disease or illness, we should equip people with the best tools and interventions to manage what’s within their control.

My hypothesis—and my hope—is this: If people feel they’ve lived fully, cared for their bodies, nourished their minds, and had a trusting, long-term relationship with their doctor, perhaps they will approach their final chapter not with fear or regret, but with the peace that comes from having lived with intention, vitality, and care.