Executive Physical in Philadelphia, PA: What's Actually In It, and What's Theater

The executive physical exists because the standard fifteen-minute primary care visit cannot answer the questions that successful, time-poor people actually want answered. "Am I going to have a heart attack?" "Do I have early cancer?" "How is my biological age tracking?" Those questions need real lab work, real imaging, and real time with a physician. None of that fits in a regular appointment. So a parallel system grew up around it. Penn has one. Jefferson has one. Cooper has one. Cleveland Clinic has a satellite. They all charge between $3,000 and $8,000 cash, take a full day or two, and hand you a leather-bound report. For the right patient, in the right moment, it is a great product. For most patients, most of the time, you can get the same medically relevant information for a quarter of the cost and a tenth of the friction, if you know what to ask for.

What is actually in a Philadelphia executive physical

The Penn and Jefferson exec physicals are not identical, but they overlap heavily. A standard one-day Philadelphia executive physical typically includes:

• A long intake (45 to 90 minutes) with a senior internist.
• A focused physical exam.
• A full lab panel: CBC, CMP, comprehensive lipids (often including ApoB), HbA1c, thyroid, vitamin D, hsCRP, sometimes Lp(a), often a urine analysis, often a PSA for men over 50.
• Cardiac evaluation: resting ECG and a stress test (exercise or pharmacological). Sometimes an echocardiogram.
• A CT chest or low-dose CT for lung cancer screening if you have a smoking history. Sometimes a coronary artery calcium (CAC) scan.
• Body composition: usually DEXA or BIA.
• Fitness testing: VO2 max on a treadmill or bike.
• An eye exam and hearing test in some programs.
• A nutrition consult and exercise consult in some programs.
• A written report and a follow-up phone call.

That is a lot of value in one day. The total cost runs $3,000 to $8,000 depending on the institution, and is usually not covered by insurance because there is no specific complaint driving it.

What is worth doing, and what is theater

Honest assessment after running this conversation hundreds of times. Here is the high-yield core of an executive physical, ranked roughly by how much it changes care:

1. A coronary artery calcium (CAC) scan if you are over 40 with any cardiovascular risk factor. Single most underused preventive test in American cardiology. About $100 at most Philadelphia imaging centers if you self-pay. A score of zero rules out significant coronary disease for the next decade with high confidence. A high score reroutes your entire prevention plan toward aggressive lipid lowering.
2. ApoB, Lp(a), and fasting insulin. These three biomarkers do more to change cardiovascular and metabolic care than the entire standard panel. ApoB beats LDL for risk prediction. Lp(a) is genetically determined, gets tested once in a lifetime, and reroutes care if it is elevated. Fasting insulin catches insulin resistance years before HbA1c moves.
3. A DEXA scan for body composition and bone density. Body composition is more honest than BMI. Bone density at baseline is useful for anyone over 40, especially women.
4. VO2 max testing. The single best predictor of all-cause mortality after age. If yours is poor for your age, that is the single most actionable data point you will get.
5. A low-dose chest CT if you have any smoking history over the age cutoff. The data on lung cancer screening is strong and the test is fast.

Honestly secondary or skippable for most patients:

• A treadmill stress test in someone with no symptoms is low yield and has a meaningful false-positive rate. A CAC scan is almost always a better first move.
• An echocardiogram in someone with no symptoms or murmur is rarely high yield.
• The nutrition and exercise consults that come with the hospital exec physical are almost always generic and do not change behavior. A good primary care practice can do better with a longer relationship.
• The leather-bound report is nice, but a working PDF with a real follow-up plan is more useful.

The Fishtown Medicine version

We do not run a one-day executive physical. We do something that overlaps in depth but works differently. The Strategic Roadmap package ($975, five sessions, no membership required). Across these visits we build the same high-yield workup: the full lab panel, ApoB, Lp(a), fasting insulin, vitamin D, hsCRP. We refer you out for a CAC scan if indicated (with the cheapest Philadelphia option), a DEXA scan if you want one, and a VO2 max if you are training-oriented. Each visit is an hour. Between visits, we coordinate. At the end you walk away with a written plan and the option to continue as a member, which is what most patients do. Membership ($250 per month, $685 per quarter, $2,500 per year). If you join, the first preventive visit is 90 minutes and covers most of the same ground as a hospital exec physical, just spread over several conversations. You get ongoing direct messaging access, follow-up at whatever cadence makes sense for what we are managing, and a permanent record that does not live inside Epic. A referral path if you want the full one-day hospital exec physical. We are friendly with the Penn and Jefferson programs. If you want the choreography, the leather binder, and the all-in-one-day experience, we will route you. We just want you to know it is not the only option.

Who an executive physical fits best

• People who have not had a real primary care relationship in years and want a reset.
• High-performance professionals who want a deep baseline before kicking off a training or longevity plan.
• People with a family history of cardiovascular disease, cancer, or sudden cardiac death who want the workup done sooner than guidelines suggest.
• People who do not need ongoing primary care but want a one-time deep look.
• People between primary care relationships (recently moved to Philly, last doctor retired, etc.).

If you already have a primary care doctor you like, you probably do not need a full executive physical. You probably need three specific tests added to your next visit. We can tell you which three.

How it compares: hospital exec physical vs. Fishtown Medicine Strategic Roadmap

Feature	Hospital Executive Physical	FTM Strategic Roadmap
Cost	$3,000 to $8,000	$975
Time structure	One day, sometimes two	Five 1-hour visits over 2-3 months
Lab depth	Full panel including ApoB, Lp(a)	Full panel including ApoB, Lp(a)
Cardiac imaging	Stress test, sometimes echo, sometimes CAC	CAC scan referred out (~$100)
Body composition	DEXA in-house	DEXA referred out (~$50-100)
VO2 max	In-house	Referred out or home protocol
Follow-up	Written report + one phone call	Ongoing, with optional membership conversion
Insurance	Out of pocket	Out of pocket (membership is also OOP)

Key Takeaways

• An executive physical in Philadelphia is typically $3,000 to $8,000 at a hospital program.
• About 70% of the value comes from five or six specific tests: CAC scan, ApoB, Lp(a), fasting insulin, DEXA, VO2 max.
• The Fishtown Medicine Strategic Roadmap ($975, 5 sessions) covers most of the same depth with ongoing follow-up.
• If you want the full one-day hospital experience for the binder, we will refer you.
• Whichever path you choose, the follow-up plan matters more than the report.

Related Services and Reading

• Preventive Care in Philadelphia - the ongoing version of the same workup.
• Direct Primary Care in Philadelphia - the membership model behind the longer relationship.
• The Annual Physical - what a single comprehensive visit covers.
• Healthspan Optimization - the longer-arc framing.
• ApoB and Heart Health - why we use ApoB.
• Lp(a) Cholesterol - the lifetime test most patients have never had.
• Strategic Roadmap Package - the one-time deep engagement.

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