Cardiometabolic
Lipids, blood pressure, prediabetes, MASLD. Continuous glucose monitors when they earn their keep; statins when the math says yes; food before pharmacology where the math says maybe.
Musculoskeletal
Tendinopathy, low back, knee, shoulder. Office-based ultrasound, dry needling on Wednesdays, a working relationship with two physical therapists who actually return calls.
Mental health
SSRIs, SNRIs, the rest of the alphabet. Buprenorphine without theater. Half-hour visits as standard, not as concession; warm handoffs to therapy that we don't outsource to a portal.
Reproductive
Contraception across the board including IUDs and implants. Cycle troubleshooting. Pre-pregnancy planning. Miscarriage care without a chaperone of strangers.
Pediatric & young adult
Well-child from age 5; transition-of-care visits at 18 and 22. Sports physicals, ADHD continuation, the conversations young adults dread but need once.
Perimenopause
Tracking, sleep, vasomotor, mood. Hormone therapy when indicated, against the 2022 Menopause Society position statement. Honest about what we don't yet know.
Sports & performance
Grandma's Marathon training panels, hockey concussion follow-up, Birkie skiers, North Shore trail-runners. Lactate testing once a season; gait video when it earns its scroll.
End of life
Palliative coordination with St. Croix Hospice and Solvay; advance directives written in plain English; house calls within Duluth city limits during the last fortnight.
A note on what's missing
You will notice we don't list dermatology, OB obstetrics, allergy, or oncology. Those lanes exist; we are not the people for them. For most of them we keep a short list of clinicians who have earned our trust over a decade — Essentia dermatology in the Lake Avenue building, Dr. Margaret Lekander for prenatal care at Duluth Clinic, the allergy group at Aspirus St. Luke's. We refer with a phone call, a one-page summary, and a follow-up. The split-board tracks every referral until it closes.
If you came here looking for hormone optimization, peptide therapy, ozone therapy, IV vitamin drips, stem-cell injections, or any service whose Wikipedia article begins with the sentence "concerns about the evidence base have been raised," we are not the practice for you, and we will tell you so politely on the first visit so we don't waste each other's time.
Cross-references
How a protocol meets a person.
Most members spend most of their care in two of eight lanes. The lane assignments are not specialties; they are a way for us to remember who has read the most recent paper on the subject. A 52-year-old member running a Birkie cycle while taking sertraline and managing perimenopausal sleep is in 07, 03, and 06 at once; the medication list is reconciled in 01 at the annual visit; the lab schedule lives on the splits board. None of this is a referral. It is one panel.