Welcome to the Evolution of Medicine podcast! In this episode, James sits down with Lara Salyer, DO, a functional medicine physician and Practice Accelerator alum who is innovating healthcare practice and tackling a major issue affecting physicians across the healthcare spectrum: burnout. Her new book, Right Brain Rescue, teaches clinicians how to access their inner creativity, which she refers to as the “Sixth Vital Sign.” Dr. Salyer’s story is a great example of innovation on the front lines of healthcare, and her insight is invaluable to any practitioner ready to radically transform their career and build a life of purpose. Highlights from this episode include:

  • The “Sixth Vital Sign” and what that means for patient care
  • How the Practice Accelerator can be a catalyst for practice transformation and growth
  • How Dr. Salyer is bringing functional medicine to a growing number of physicians
  • How tapping into creativity helps practitioners build resiliency and improve empathy
  • And so much more!

Resources mentioned in this podcast:

Practice Marketing Series, Episode 6: Living Your Dreams

James Maskell:Hello, and welcome to the podcast. This week, we feature Dr. Lara Salyer. She is a functional medicine physician. She is one of the leaders of our Practice Accelerator, and she has a new book coming out called Right Brain Rescue. In this podcast [episode], we talked about the “Sixth Vital Sign” and what she thinks that is. We talked about her Trojan horse of bringing functional medicine to more and more physicians. And we talked about what you can learn from Lara. She’s got so much to share. She’s such a great example of innovation on the front lines of healthcare. It’s going to be a great half an hour, enjoy.

So a warm welcome back to the podcast, Dr. Lara Salyer. Welcome back, Doc.

Lara Salyer: Hey James, thank you for having me. It’s a pleasure.

James Maskell: Yeah. It’s so great to have you back here and super exciting. And it’s an exciting day because I know what we’re going to talk about here today is Right Brain Rescue, your new book that came out this weekend, which I’m super excited to talk about. But here at the Evolution of Medicine, we’ve just wrapped twice a year where we bring people into the Practice Accelerator and more than almost anyone else, you are to me the perfect example of what the Practice Accelerator was born for, which is we want to take people from conventional medicine, we want to bring them to functional medicine, and we want to give them a starting point for building their own practice and where they take it from there, who knows, who cares? That’s your dream, your vision, but at least you’ll have made that jump. And before we get into sort of like what that vision is and what your dream is and how you’re executing on that dream with this book, maybe let’s just rewind back to employee Lara. And of what she used to be like, and who she is now.

Lara Salyer: Yes, employee Lara was a traditionally trained osteopathic family physician in a rural setting in lovely Wisconsin, home of cheese and beer and cows. And I signed up for a medical career because I wanted to serve. And I thought I enjoyed my career for a while. And unfortunately, they put blinders on you. You’re trapped in a system that is just not giving you that autonomy and freedom to teach and deliver medicine the way you would like. And even though I was taught in a holistic manner, as all osteopaths are, there came a point where it felt like the wheels were grinding to a halt. And in 2016, I knew I was burned out. I didn’t know where to turn. And I had my Google searches, had things like cake decorating, sex ed teacher, all sorts of crazy ideas. I had no idea what I would do next, but I knew that this could not be sustainable.

This was not the kind of physician in a 10-minute visit, just trying to check boxes and move on. So to burn off my remaining CME credit with my employer, I decided to go to a functional medicine conference. I’d never heard of it. And I was hooked and I immediately knew that’s what I wanted to do in my next chapter. And I put in my resignation that I would resign in six months. And I knew that was what I wanted to do. How though? I had no idea how. So, I feel like part of transitions, there is a little bit of a confirmation bias. Like you can look for things that either are going to sabotage and say, “Oh, it won’t work.” Or, if you’re really gritty enough, you can look for things that will confirm that your future will be okay. And so from then on out, I looked for tools.

I looked for a way, how could I make my own practice? Chiropractors were doing this, naturopaths, dentists. They don’t teach you these skills in medicine, in medical school. So there had to be something out there. And that’s when I found Practice Accelerator. And as I was transitioning, that was that playbook I needed to just dive in. And I literally took about three months where I just I dove in, watched the modules, took what I needed from them, played around in the sandbox environment, tried on a few EMRs that were suggested. That’s what I love about Practice Accelerator, is it’s not a dogma. It is basically a kit that you can take little pieces from whatever module you need. And in my case, I needed it all. So I went just from beginning to end and listened on all your functional forum podcasts and took notes and pretty much just made my own world exists. And it was great because I didn’t have to ask word of mouth, like where can I find a good EMR or what should I do with advertising? Or what’s an email sequence, a nurture sequence?

I had no idea what those things were. And I loved Practice Accelerator because I knew with confidence that the answer was in there. And then I also had a tribe of people to ask in the private group, which was huge for my growth, and we would just share our experiences. And so that was really the nidus for what made my world so much more fun now. And that’s three years later, I launched my private practice in 2017 and haven’t looked back.

James Maskell: Absolutely. And for that, I don’t want to spend all the time today diving into that story, but there’s so much included in that, the time that you took off, getting ready for the big launch and then onboarding people, eventually moving into a membership practice and having people pay every month. And I guess one of the things, the last time that we hung out was TEDMED, which was right before—

Lara Salyer: The world changed. Yeah.

James Maskell: Well, it’s like literally the first weekend in March.

Lara Salyer: Mm-hmm (affirmative).

James Maskell: And I guess the reason why when we spoke then you had been through a journey in the last six to 12 months of shifting the payment model to a membership. And before we get into talking about the book, like having a clinic where you onboard people through the internet and where people pay you monthly, that seems to be the most resilient practice model in a pandemic.

Lara Salyer: Absolutely. I’m just so grateful because as I was building, and this is the thing I tell anybody that I mentor is like, this is your world. And be excited to fail. If something doesn’t work, it doesn’t mean it’s never going to work. You just find what works in your community. So I had done the traditional fee for service and I’d done some packages in my small rural town and I’m sorry, us Midwesterners, they don’t want to sign on for a six or 12-month package. I also didn’t ethically feel aligned with that because it promises that they’re going to be different in six to 12 months. And as you know, functional medicine is not about guarantees. It’s a journey of what do we find, and if we uncover something that might take longer than the package you bought. So here I was thinking, “Okay, I want to tool this a little better.” And you and I have known each other for now three years, you’ve seen me try different things.

So I just went into membership and said, “You know what? I’m going to try this model and see, and explain to my patients, this is what you get. You get my private time, you get some group visits, you get all these things baked into this membership payment every month and you get my support and guidance.” And that was magic. The group visits really sealed the deal because every week they get to meet each other and meet me. And so when the pandemic hit, honestly, I saw no change. In fact, I gained members because people want that human support of feeling like they have their questions answered and they have help. And it was just great.

James Maskell: Yeah. I love that. And well, there’ll be a lot more time that you and I are going to talk about how the cross-section of membership medicine and groups, because I really feel like that there is a movement in America to try and facilitate this direct care revolution, basically with the direct primary care and the direct care movement. And I think that one of the keys to expanding that movement is this group model. And so I think there’s a lot more that we can go in that direction. But I guess, we’ll talk about that another time, because I guess—

Lara Salyer: Okay.

James Maskell: …a year into your transition, you gave a talk called Right Brain Rescue at the event that I put on as part of the bus tour. And I think that was just the beginning of your journey to think like, “Okay, what’s next? I can see that my practice is going to be stable. I could see that I’m going to make enough money and be able to run the practice that I want to run in Wisconsin. But what am I really here for?” And I guess I want to just…I feel like it’s almost like, you kind of create the space in your own mind to work out what you are truly here for.

Lara Salyer: Yes, much like you, James. Absolutely. I forget who the wise person said that you shouldn’t chase two rabbits because you’ll never catch either. But I feel like you can. I feel like there is room for having multiple passions and fueling my local patients brings me joy, but I specifically designed my career to be very minimal in my workdays. So I wanted to really open my mind and allow my schedule to open up for more of my global mission, which is helping burned-out doctors. I was there, I did the transition, I see the broken system and it’s not going to get fixed overnight, but helping physicians tap into this creativity and learn that there are other options, whether they decide to transition into a completely cash-based practice like me or not, there’s answers for everything. And it starts with unlocking your core values, looking deep inside, practicing this intuitive right brain and getting into flow state. Flow state is the most powerful drug in the universe. It’s the only time your brain produces all five neurochemicals of happiness.

And now I speak on stages larger than I ever dreamed to try and explain to people when you practice creativity and flow state and your nurture your mitochondria and dive deep into functional health, with gut restoration, it’s magic. And I love that this is working because as I’m teaching other doctors, they come to me and they say, “What is this functional medicine? I’ve never heard of it.” And that’s when I know it struck home because we just aren’t taught that in regular medical school. And that’s all I wanted is for people to learn that this should be like a Sixth Vital Sign. You need to nurture your creativity and it starts with functional medicine.

James Maskell: Yeah. There’s so many great things in that. I love Sixth Vital Sign. Let’s jump into that a bit and then I want to come back to the Trojan horse. So why is it the Sixth Vital Sign?

Lara Salyer: The Sixth Vital Sign because back when I was in medical school in residency JACHO made it mandatory for doctors in 1995, I believe to ask the fifth vital sign, which is pain. And that really confused a lot of clinicians because pain is subjective. It’s not the true vital sign, like temperature, blood pressure, pulse. And here we were asking if they’re hurting and naturally, if somebody asks you a question like that, you’ll find somewhere that’s hurting, right? You might be there for just refills of medications, but yeah. Sure, my hip hurts or my toe hurts or whatever. And suddenly physicians are now mandated to fix that problem. So I feel that’s wrong in two reasons. That’s putting the power, not on the patient, but on the physician, as an external controller in their health. And it’s really maligning these expectations that everything can be fixed with medicine.

And so now why are we surprised we have an opioid epidemic 20 years later, we have people hooked on medications and looking for solutions outside themselves? And there is a time and place for medicine, for surgery, for acute care. Absolutely. But, my pitch is that if we counteract this negative psychology with asking a Sixth Vital Sign, when was the last time you did a hobby? When was the last time your eyes were sparkling with a passion? What lights you up? And just leave that patient with those seeds of thought that maybe in 20 years, we could have more empowered patients, more resilient physicians, more happy citizens across the world that can really understand we’re here to be human beings, not human doings. We’ve heard that phrase. And so that’s kind of my passion is to reignite that as the Sixth Vital Sign.

James Maskell: Inside the Practice Accelerator group, this was very clear. There were other doctors in there who were suddenly getting into painting. You were taking your colored pens and doing all kinds of videos for your patients using like a whiteboard and, and even a blackboard, I think. It’s interesting you said sex ed teacher there at the beginning, because like you basically get to be whatever you want at that point. Right?

Lara Salyer: Right, right. Exactly. That’s what doctors are, Latin is docere, to teach. So what I love is that my brand of creativity is just going to allow someone else to try their own. It’s never to replicate. The word “creative” just means something new and useful. So, you repurpose things in your own signature way. And so no matter what you do, even if it’s a similar style, it’s always your own unique voice, which I think a lot of functional providers starting out get nervous. They think, “Well, what do I have to say? If, if we’ve got Mark Hyman, we’ve got Jeff Bland, we’ve got all these great minds. What does my voice have to add?” Well, of course their voice adds their own unique signature. And that’s what your community needs is just your new voice added to the choir.

James Maskell: Yeah, absolutely. So, from a clinical point of view, what clinical skills do you think gets sharpened in a clinician? Who accesses their right bank consistently?

Lara Salyer: Ah, that’s a wonderful thing. So they’re more observant. They did studies where they took medical students and have them try and create something just for fun. And they found that these skills are transferable. This skill of resiliency, of feedback, of observation, of looking at a piece of art, they become better and more astute observers. They see that patient walk in that has a limp because they have a soloist spasm or they notice the shifty gaze on that patient when they bring up a topic and they become better clinicians and able to palpate things and listen and be more empathetic, but also resiliency. We’re really put under the wire to be correct 100% of the time and that’s not possible.

So when you create in a setting that’s fun and you fail and you see that it’s fun, like Pinterest fails and things that we create. These medical students in that study found that they were more resilient on the outside world with their patients because they’re human. And honestly, if you look at the way physician-patient relationships have changed over the years, even malpractice suits, you can see a higher rate if the patient doesn’t quite like the physician or understand or trust the physician, but when you really bring people together with that creativity and humanity, then there’s more of that wonderful relationship. And I think both sides will win across the desk.

James Maskell: Absolutely. And so yes, one of the things that’s happening, I know both of you and I are passionate about functional medicine becoming the standard of care, and we’ve had all kinds of conversations over time about that and how it will work. We’re living in a moment right now where functional medicine is in certain ways just becoming the standard of care, like as everyone starts measuring their own their own data. Now they’re kind of becoming little biohackers and functional medicine it’s the only way that makes sense. And so you’ve got huge sways of the population sort of opening up to it. But then on the other end, you’ve got this sort of like resistance where family physicians don’t like it. That’s kind of like this strange moment where it’s both the future and not being accepted in a certain way.

And I know that one of the things that you’ve always said is that you feel that this conversation about creativity is kind of like a Trojan horse to get to doctors who would never come to a functional medicine conference. And I’d love for you to just share that concept too, because I just think it’s such an interesting idea to find ways to engage people in ways that make them realize that the solution is functional medicine without coming to them as that’s the piece.

Lara Salyer: Yes. Yes. So all of us humans on this earth are just big egos in meat skeletons. And so when I have to admit I was right there with them, I was a burned-out family doctor coming across an article for functional medicine. And even just the tagline, I forget the tagline now, but it was something about we, when I looked it up, we treat the root cause and I thought, “Well, I’m a doctor. I treat the root cause.” I was very offended. I thought, “How is this different?” I didn’t ever have heard of it. And I think a lot of doctors have that. We’ve spent millions of dollars in medical school. We’ve sacrificed our fertility. We have been tearing our hair out, staying up all night in ICU is holding pagers, and we’re finally in our career. And now we have functional medicine people saying, “Well, we do the root cause. We do real medicine. ”

So it can feel very much aggravating when you really want to be doing this. So, I call this a Trojan horse because I do think by all of us being physicians, we’re very heart-centered and all of my colleagues outside of functional medicine want to serve their patients. But having a physician who’s been there, who’s been burned out, who’s gone to the other side and seeing functional medicine, we’re all speaking the same language of trying to heal patients. We just have different colors that we’re pulling from to paint on our canvas and we have different timelines. And so hearing these words of biochemistry, gut health, mitochondrial insufficiency, all these wonderful neuroplastic terms, all these cool things that just aren’t taught in modern medical school. I’m hoping that with the newer generation of medical students and residents, if they’re indoctrinated already, and they’ve heard this language, they’re going to grow up wanting to go and learn and incorporate this into their routine care. So, that’s my goal.

James Maskell: Talk about some of the clinical topics you talk to, you said mitochondria.

Lara Salyer: Yes.

James Maskell: How does that act as a bridge across and what did mainstream doctors know about mitochondria? What do they need to know? And why is this the bridge?

Lara Salyer: Right, right. That’s a great question. So mainstream we’re taught like…and let’s think about this. When you go to medical school, you’ve got to put a ton of information in your head everywhere from pharmacology to microbiology. You’re trying to just cram it all in. So mitochondria are just a passing interest. They give you ATP, they make energy, but there are certain disorders of mitochondrial metabolism and they’re all congenital and you just kind of move on. Same with brain you’re taught. Okay. Yeah. Here’s the neurologist and your brain “stops” growing at 25. And here we have pills if you have dementia, it’s too late by then. You’re trying to get all of this information in four years of medical school and three years of residency.

And so now learning that, “Wait a second, there are tests out there that we never were taught, that collect data.” That you can measure, that can show metabolites of mitochondrial health. And that you learn certain things can affect your mitochondria and Dr. Robert Naviaux, who I’ve been in communication with. He talks about the cell danger response in mitochondria, the freeze and flight and all this cutting-edge research that is really the bread and butter of functional medicine. They’re right there. They’re on that cost. Whereas I would like to say that conventional medicine is just playing by a playbook and functional medicine is really in that brave seat of what can we do to maximize longevity and to nourish our brain and really deal with that really root cellular physiologic cause of imbalance and disease. So yeah, that’s where I find this, hopefully, to be more of our general language as we move forward in medicine period.

James Maskell: Beautiful. Well, the world is definitely moving in our direction. Just this morning. I was listening to a keynote from Dr. Marty Makary. He wrote this amazing book called The Price We Pay about costs in American healthcare and reform. And he was talking about environmental toxins causing disease. And he was talking about lifestyle medicine this morning. And I’d never heard him talk about those things before. So—

Lara Salyer: Yes. Yes.

James Maskell: …this is the way things are coming for sure.

Lara Salyer: And it’s funny, even in medical school, I remember a few people saying environmental medicine and that was just a foreign concept. Now we’re learning about the body burden, the toxic body burden. And it’s becoming…it’s kind of like asking your mom or dad, they tell you to put a sweater on and you don’t want to, then your boyfriend says something, you’re like, “All right, I’ll put a sweater on.” And you hear it from so many people. And I feel like eventually doctors are going to have to listen. So many people are talking about all these things that eventually modern medicine is going to have to catch up.

James Maskell: Awesome. Well, look, your book is out. I know it’s been a journey to get here. I know what it’s like to write a book and I’ve [shared that] for our listeners. Share with us, why they should read Right Brain Rescue and why they should tell all the doctor and the health professional friends why they should read it, too?

Lara Salyer: Oh, absolutely. It is a labor of love. It’s just like delivering a baby. It’s been growing and gestating for months and it’s out and I can’t be more proud because it’s a story and who wouldn’t want a story. It’s a story that is told very candidly and honest about my journey of being a working mom of three, burned out and trying to figure out what that feeling is and learning how to self-identify and transitioning. And really it wasn’t until a pivotal moment where I had several and I don’t want to give the book away, but things like a near-death experience that made me refocus and come back to work and see all the little things that are glaringly wrong in what I was doing and not fitting with the reason I went into medicine. And then, you are right there in my journey as I’m trying to figure this out, should I leave? Should I stay? All the little thought processes, and then the transition.

So I talk about Practice Accelerator. I talk about how there are tools out there for all of us if we just look for it. And then you learn about the key ways that I feel my right brain, nourishing my mitochondria, practicing integrative brain patterns, and the creative flexible thinking. And it’s really inspirational because it’s just full of lots of good snarky humor. And it’s written as if I was talking to my best friend and that’s been the best thing I think I can share with people is that has resonated with a lot of physicians and non-physicians. It’s written for any level where they can just want to laugh and cry and see how heartbreaking it can be to be in a career where you’re just not aligned anymore. So you search for a new purpose.

James Maskell: Well, I’m really looking forward to it myself. And I know this has been a great journey to come all this way. And I know you’re only just getting started. Look, there’s a lot that needs to change. And I think that in the functional medicine world will this whole thing to happen a lot more quickly, but the kind of transformation that we’re really talking about is so massive. And so it has to be all the way through the system and patient care that we know that it’s going to be a long ride and we all know that we all have a different role to play in the transformation. It’s really cool to see so many people stepping up into leadership and all different areas. And I know that already, I know that there are many physicians that are following this path and coming across you, and this is the right information at the right time.

And as an example of someone who pivoted, created a new type of practice who innovated on the front lines and then got themselves in a position where they wanted to…what they wanted to do, that’s a huge story. And I think that it’ll resonate with the minds of so many practitioners out there. So yeah, thank you for doing what you do. And it’s been great to do it here together.

Lara Salyer: Yeah.

James Maskell: I think back very positively on my time at the cheese festival, which I think actually would have been about this time had it not been for COVID.

Lara Salyer: It was supposed to be…yes, you came to our little town last two years ago and it was an awesome time and we were supposed to have our Cheese Days this year, last weekend, but it was postponed till next year, 2021. So it’ll be just as good.

James Maskell: I got a pretty severe attack of gout after that cheese fest because I ate that much cheese, but it was very fun. So, Doc, thanks so much for being part of the Evolution of Medicine podcast and being part of the Accelerator. Truly, our goal with the Accelerator at the beginning was to create community and to have people learn from each other. We knew that was the core piece has been the through line to all of our work, whether it be the group visits, the meetup groups and the Practice Accelerator. And part of being a good community is that you have to have go-givers and your generosity inside the group is incredible. The inspiration, the way that you use Loom…for those people who don’t know Loom is like a screen-sharing technology, and Lara is amazing at making Looms, sticking them in the group and people get so much value from that.

And I really appreciate everything that you bring to it. If you guys are listening to this, you want to find out more about the Practice Accelerator, go to goevomed.com/accelerator. You can have a chat with someone on our team. If you join us, you will find Lara in there and she’ll be on her path towards the transformation of healthcare, around creativity as medicine. This has been the Evolution of Medicine podcast. I’m your host James Maskell. We’re here with Dr. Lara Salyer. Check out Right Brain Rescue, it’s available as from this weekend at everywhere where books are sold. And so thanks so much for listening and we’ll see you next time.

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