David B Rubin, MD

03/21/2026

It's time for me to try to answer some Frequently Asked Questions ( ). Here we go!

1) How come I can't get my "annual physical" every 12 months?
There's a bit of a myth with periodic health reviews (which we often call "annual physicals," and yet aren't always annual, and encompass much more than just a physical exam). Insurers usually will not cover these exams less than 365 days after your last one. As a result, between weekends, vacations, and high demand, these often get pushed out to more than 12 month intervals. These do not need to be every 12 months... BUT if you are being booked out very far, please reach out via MyHealth! Also, please utilize the Wait List, as well as our EXCELLENT nurse practitioners.

2) What about doing blood tests before annual exams?
We have been trying to order lab work before exams, and to notify patients enough in advance to allow tests to be done in time. This is does not always work perfectly. With very few exceptions -- and we'll tell you when it is an exception! -- the labs we are doing BEFORE a visit are ROUTINE (e.g. not urgent), and not likely to impact your care that day. Any new or acute concerns likely cannot be addressed before we see you. We are good, but we can't read minds, and can't predict the future.

3) I contacted your office, and they told me you have no appointments available until [some time very far from now]. How can I get in to see you sooner?
Make sure you are being clear what you are asking for. If you ask for a "checkup," the first available periodic health review (see #1) is usually very far out. If there is a more acute concern, let the person you're e-mailing or speaking to know this. I usually have available appointments within a few days, and sometimes the same day. Also, use the other providers in the office, especially for urgent issues. I also provide telehealth on Thursday afternoons, if that is easier.

4) I haven't heard about my results. When can I expect to?
In most cases, you can see your results on MyHealth, and you may see them before I do. We try to get these to you promptly once ALL the results are available, or sooner if there is anything more urgent going on. You can certainly reach out sooner -- MyHealth is best for this -- if you have questions. Also, sleep study results will NOT be visible in MyHealth, and if you have questions about those, please just send me a message in MyHealth.

Thank you!

01/07/2026

First post in a loooong time, but I am inspired to do a quickie on the -1 receptor agonists for obesity. Many of you know that most insurers are now refusing to pay for these drugs, which drives the cost from typically $25/mo (with insurance coverage) to $200 - $450 a month. Obviously that is a big increase, and it's leading to a lot of frustration for folks who either have seen great success with the medications, or who have been on the fence about starting them for a while.

For the folks looking to start or continue these medications, if your insurance will NOT cover them, your major options are:
- ( ): Associated with ~ 20% of body weight loss on average. Available through LillyDirect.com for $349 - $449 a month. Comes in VIALS (not pens) that you have to draw up and inject yourself.
- ( ): Associated with ~ 15% of body weight loss on average. Available through NovoCare.com, but they (I believe) can ship to your local pharmacy. Cost is $199 - $349 a month, and these come in PENS.
My usual spiel is that Wegovy is currently* cheaper and many people find the pens easier to use. Zepbound is a little pricier and less easy, but gets slightly better results on average.
(*This all can, and likely will, change quite a bit over time.)

For the folks thinking about coming OFF their GLP-1 RAs:
Nobody knows (with certainty, at present) what the best thing is to do here. There are three major options:
1. Cold turkey. I tend to think of this as the least good option. I have seen people regain all the weight they lost. Stopping a medicine that suppresses a hormone all of a sudden is likely not optimal.
2. Tapering down. This is the one I've seen most success with. People often regain a small amount of weight, but not a lot.
3. Tapering the dose interval. For example, dosing every two weeks. The problem with this is twofold. One, many people feel the effects wearing off after even one extra day between doses. (Many don't.) Two, the pharma companies have said they intend to charge more if people don't fill at least every 45 days. (So stretching the dose out beyond that will not save money, though dosing every 11 days and getting a prescription every 44 days would result in 8+ fills per year rather than 13+, and save up to $2,245 a year.) So it's got potential.
We almost certainly will learn a lot more about this in the near future as people off their GLP-1 RAs in higher numbers.

For those who are curious about cost, courtesy of the excellent resource OpenEvidence.com:
- Cost-effectiveness analyses reveal concerning economic realities. Lifetime modeling shows incremental cost-effectiveness ratios of $197,023 per QALY for tirzepatide and $467,676 per QALY for semaglutide—with semaglutide well above the $100,000-150,000 threshold typically considered cost-effective.
- These findings suggest that while GLP-1 RAs produce meaningful clinical benefits, cost offsets may require longer observation periods than currently available in the literature, and continuous medication adherence is essential for maintaining therapeutic effects.

(And keep in mind that as costs of medications come down, the cost per QALY should go down as well.)

As always, talk to your healthcare provider if you have specific questions -- this is meant as general reaction and not patient-specific advice.

01/10/2022

Super cool idea. This tech has been out for a while, but the state is now making it available. Consider downloading for your smart device. [One you get the QR code, take a screen shot, open it in your photo app, and long-press the image to add to your wallet.]

01/04/2022

I sadly think we will be seeing this shortage of tests for a while. There is a high probability of COVID if you have fever and respiratory symptoms, even mild ones. If you’re feeling generally well, seek testing… but keep in mind that there were over 30,000 positive tests reported YESTERDAY alone in (almost 0.5% of the state population, and more than we saw in the first MONTH of the pandemic), and a positive test won’t change management for most people. If you're not sure, assume you are positive. Quarantine for at least five days, take Tylenol if needed, call if you need guidance, and don’t panic.

Provides important information about COVID-19 testing procedures.

12/29/2021

10/28/2021

09/25/2021

If you had a Pfizer COVID vaccine more than 6 months ago, and are 65+ or otherwise at high risk for complications, consider a . If you have other questions, they’re likely answered here. Thanks to NPR for an excellent and thoughtful review.

With the back and forth on boosters from government agencies, many Americans are wondering if they really need an extra shot. Here is what the science says about who needs a booster now — and why.

09/22/2021

Today, we amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least 6 months after completion of the vaccine’s primary series in certain populations. https://bit.ly/3EIJWvb

The EUA allows a booster dose for individuals:
➡️ 65+ years old
➡️ 18-64 years old at high risk of severe COVID-19
➡️ 18-64 years old whose frequent institutional/occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.

The FDA-authorized Pfizer-BioNTech COVID-19 Vaccine is the same formulation as the FDA-approved Comirnaty, and the vaccines may be used interchangeably.

08/11/2021

Good analysis for anyone still on the fence.

Many Americans say they want to “make sure the shot is safe” before getting vaccinated. That data is already in, and it is overwhelming. 

08/05/2021

Another good one, from Virginia. https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/covid-19-cases-by-vaccination-status/
42 breakthrough deaths in 6 months = 7 per month or one every four days.
In a state of 8.5 million…
• 4.6 million are fully vaccinated, with 1,566 cases. (1/30th of a percent.)
• About 4 million are not fully vaccinated, with 203k cases. (About 5%.)

08/05/2021

Good data from https://www.kff.org/policy-watch/covid-19-vaccine-breakthrough-cases-data-from-the-states/?fbclid=IwAR0V7x8VUHBSK6qpPOK81zS-E5ejkzTCmRs-T2NHQmIbPmomPbAH7czr8lg — if you’re still on the fence about vaccinating, look how low your risk of COVID becomes.

03/29/2021

https://www.axios.com/mrna-covid-vaccines-effective-real-world-conditions-492ac016-1220-4276-aacc-967492a4e117.html

The data show how well the vaccine performs in non-clinical trial settings.