Welcome to the Evolution of Medicine podcast! This week, we’re talking with Lara Salyer, DO, IFMCP, a family physician based in Monroe, WI whose passion is health education at the micro and macro level. After 15 years as a board-certified family physician, she was unsatisfied with the troubling trend in America: increased dependence on prescriptions yet decreased overall wellness. She enrolled in training courses through the Institute of Functional Medicine and opened her private practice in 2017. Dr. Salyer is one of the key members of our Practice Accelerator and we are thrilled to share her insight in our Group Visit Series.
In this episode, you’ll hear about how Lara has innovated in group visit intake and creating efficiencies in her practice. We talk about her journey with the Practice Accelerator and her YOUniversity program, which she created to educate patients and give them access to functional medicine testing. This is a super-interesting, energizing 30 minutes for anyone ready to be on the cutting edge of functional medicine delivery. Enjoy! Highlights include:
- Dr. Salyer’s journey from conventional medicine to running a thriving functional medicine practice
- How to use group visits to channel efficiency in functional medicine practice
- How group visits give patients the agency they need to take control of their health and achieve positive outcomes
- The value of the Practice Accelerator, and the power of its “collective group creativity”
- How to build a sustainable business model by identifying and targeting your niche audience for group visits
- How to effectively recruit for group visits and maintain consistent attendance
- And so much more!
James Maskell: A warm welcome back to the podcast, Dr. Lara Salyer. Welcome, doctor.
Lara Salyer: Welcome, James. Thanks for having me.
James Maskell: So great to have you here back on the podcast. You know the podcast that we did back in 2017 was one of my favorite of all time because ultimately, what we were doing with the Accelerator and the Evolution of Medicine and my book was really to help practitioners see the light, go leave conventional medicine, start their own practice and start to make an impact in your community. You more than almost anyone else in that community, grabbed that opportunity by the scruff of the neck and really went for it. What’s life like on the other side of it?
Lara Salyer: Oh, it’s all rainbows and unicorns and stars and lucky charms. I love it. I tell people I don’t work anymore since I launched my private practice. I only play, so every day is really a joy.
James Maskell: Amazing. That’s a great start. If you haven’t listened back, go back to that [episode] with Dr. Salyer and you can hear about how she went from being an employee to starting her own practice, and the beginning of that journey. It’s been an honor to watch you in over the last couple of years and really take it to the next level, which is what we’re going to talk about today. This series is part of our Group Visit Series. I want to sort of rewind to something that we talked about in that podcast that you would just starting.
Ultimately, I don’t want to put words in your mouth, but from my recollection, you saw that running a cash practice in Wisconsin was only getting you to a certain percentage of the population that you knew you could help. At that point, you had started off a workshop where you were doing a sort of a group intake, right? Actually getting 18 people together, they’re charging $30 each. getting people through, going to matrix as a group and then giving them one of the six IFM food plans. I really love that because I saw that as innovation in, you know, using groups to get over the most cumbersome parts of the functional medicine process. Let’s just start from that. What was that process like? How did it work and what did it teach you about where you want it to go next?
Lara Salyer: Absolutely, and I think what you’re doing is heralding the efficiency that functional medicine can offer as well. Why I did this is so many reasons and living in rural Midwest, people aren’t exposed to functional principles. I needed a way that was very low hanging fruit that could get them in the door, low cost and give them a taste of what functional medicine perspectives can offer. It has become like replicable in the corporate wellness things that I do, the outreach into communities and even our local residency, I offer, our residents that are in an osteopathic residency who really might not understand functional medicine. The ability to walk them through how to plug in their own matrix and then walk away with a supportive functional food plan. It has really kind of killed a lot of birds with one stone. It’s been very fun and innovative and helped people kind of come in and walk through my doors and see what could be possible.
James Maskell: Beautiful. Okay, so tell us like how did that go and then I know that you kind of rebranded it at one point to just make it even, so tell us about that process.
Lara Salyer: The very beginning was creating your own functional prescription. People like the DIY aspect. They like to be in charge, they want to have agency. Offering them, not a lecture, but actually a participating workshop that they will have actionable things to do. It started off as creating your functional prescription, which was simply filling in the matrix. I took the IFM matrix and had them fill it in as I walked through each of the sections. That worked great but of course, I like to expand and see what else I can make it more visually impacting.
Then I transferred the matrix to an analogy and metaphor of a home, building your home and it was starting with a foundation like the GI and triggers are things that crack your foundation, et cetera. You can extrapolate what that is and then having them fill in that worksheet with a house really hit home because everybody can relate to the house. That really helped them take that further. It has been great as a wonderful community outreach. I offer it every so often to more of engaging a lead magnet. Now as far as patients that might not be sure if they want to step on the train here, but it’s just been wonderful. It still continues to be one of my favorite things to do.
James Maskell: Amazing, so obviously, in the Accelerator one of the things that you know, you being in there and supporting and we’ve had a chance to see just your creativity as you start to think about solving other problems. Take us on a little journey kind of since then, and once you saw the potential of this group structure, how else did you see that it could be used in your practice?
Lara Salyer: Yes. Well, what I love about Practice Accelerator first, I have to say is that collective group creativity, I think there is no spark of creativity that goes unwasted. The more you share, and what I love about the group is everybody is very sharing. What might come as a spark of innovation to one person that might just sit there, it might cause somebody else to think of something differently. As we’re sharing all of this process to me, is about working more efficiently and working less hard. You know, do things once and not recreate the wheel a million times. Taking the intake was one aspect and then I went further to map out a timeline. I wanted patients to see how a timeline of symptoms will produce leaky gut or produce triggers that cause imbalance. That was my next step, and doing that again, the whole way, crafting these group situations that I could then retrofit or repurpose into an online teachable academy. Every step of the way was building more ability to reach people either in a corporate setting or community-wise.
James Maskell: Beautiful. What did you call the trigger version, because I know you’re always coming up with funny names.
Lara Salyer: Trigger happy.
James Maskell: Okay, trigger happy. Now people are coming into a workshop where they’re mapping out those triggers. I think that’s super exciting. What sort of insights did people come up with in those sessions where I’m particularly interested in the insights where one person’s triggers informed someone else because they were now doing it in a group as opposed to like a one-on-one intake with the doctor?
Lara Salyer: Absolutely. Each time I do this, there is inevitably going to be group sharing and there’s always one person planted in there that show up, and I encourage my active members of my practice to come to these. What’s lovely is they might stop in because they get free access to these workshops and they’ll comment and pipe up at the end saying, “Absolutely, this worked for me, or this is what we found,” and the insight that happens is this group flow, this group “aha” moment when they see the connection that triggers cause disease, but also the hope. We don’t need to keep stuffing down people’s throats that our lifestyle is bad. They know that. They know that they’re making bad food choices, they know that they’re too stressed, they know. They just don’t know how to get out. They don’t know how to help themselves, and so by allowing them this agency and this comparison and people that are further along that journey than they are that are in the community, it really gives them this hope that they’ve never felt in a conventional setting.
James Maskell: I mean, to give a very specific example, I would imagine that there are people in Monroe, Wisconsin who would never have considered that maybe they shouldn’t eat the cheese curds.
Lara Salyer: Absolutely right. That’s sacrilege. I know, I have to watch it or my car will get egged! [laughter]
James Maskell: I was there last year so I know how delicious those are, but like if you have never been in a family situation where no one, when no one in your family has ever even thought of stopping eating cheese curds and then you see someone, you meet someone who has done that and their condition has improved, that could be the difference between like either taking this seriously or not engaging with it at all, right?
Lara Salyer: Well, and you said that exactly James is, it’s about being an outlier and just giving a different view of something that they have already subscribed to. That while this is what I eat, this is how I am, this is our culture. Being a practical Midwest doctor, I also uphold moderation. I explain to families, this is not all or nothing. In some cases it might be depending on their disease states, but for the most part, if they love their cheese and they have to have milk every so often, maybe if they’re coming down with a virus or something that’s already challenging their system with other inflammation, take a break. I’ve had parents call afterwards saying, “You’re right, my kid did not miss school nearly as much when I had them avoid the milk break at school when they had a sniffle and they got better faster.” It’s about moderation and teaching people they can have the say, end say in everything that they do.
James Maskell: Absolutely. The beginning of this year, 2019 you know, on January 1st I sent an email out to our whole community announcing that this was going to be the year of the group. Shortly after that, we undertook inside the Practice Accelerator, a real exploration of like, “Hey, what’s the next innovation in groups? Like what can we be learning?” Because I already feel like the Practice Accelerator is a great community. There’s a lot of incredible doctors there. There’s people who really want to be on the cutting edge of innovation and the delivery of functional medicine. We started that conversation and I know that this year, you’ve sort of expanded some of the ideas of where you wanted to take the group. What did that spark in you and what have you ended up creating as sort of another part of your practice?
Lara Salyer: Yes, listening to all the giants ahead of me that have been experimenting with group visits, Dr. Shilpa, Dr. Mote, everybody I learned from, and try to apply it in my own unique way. I think that is the joy of what we do here in functional medicine. What I want all the listeners to take away is that listen to all the pearls and try them out in a sandbox. What I wanted to do is somehow craft a very cohesive group visit experience that allowed people to share, but also gave them the opportunity to access functional testing. That was the key that I found that brought people in the door. They didn’t want to just sit there and have another lecture. They wanted some real data and I’m a data-driven person, so as I experimented it went through several different ways that I did group visits.
I found that I had to relax my view and expectation that this would be as good as a one-on-one visit. It can’t be. It’s like public school versus private school or public school workshops versus tutoring. You know when you’re working one-on-one with somebody, magic happens so much quicker, but there’s a lot to be learned in a public setting. What I did is, is categorized my group visits into three different pillars, whether it was starting with the gut, then balancing hormones and then talking about what I termed invisible medicine, which is cortisol energy, mitochondria and helping patients see that these are the three keys that I feel need to be looked at in their health. My first…I’ve done this now twice, these group visits, I call them YOUniversity, Y-O-U, so learning about yourself and it’s been great. It’s been a wonderful learning experience. I’m happy to share all the tips and the struggles and I don’t know if you just want me to start from the beginning on what my first reiteration was.
James Maskell: Yeah, like because you know, obviously in our series here, when Jeff Geller spoke at the beginning, he said, “There’s different types of groups you could do. You could do closed groups where you have a certain number of people that go through a certain series of educational events.” Typically, he felt like that was really good for sort of an empowered person, right, someone who is not living below the poverty line. Someone who has a car and the social determinants of health are kind of under control and then you know, he was more concerned with the people who don’t have that kind of situation. How do you get them to that situation and deal with that?
There’s different groups that are going to work for different types of people and ultimately what I think you’ve been really good at is looking at your patient base and saying, “Hey, what do these people actually need and how can I provide it in a way that is like profitable for the business but is also accessible and affordable for more people to get more people access to this?” Obviously, a lab is, you know, could be a big moment for people to really understand what’s going on. Yeah, I’d love to hear what you did, what you learned and what you think others can learn from your experience.
Lara Salyer: Yes, and bingo, you nailed it again right on the head that each community has different needs. Of course, I went into family medicine because I want to serve and help everybody. I had to come to terms that I cannot make a sustainable business model that will help every single person. I had to target down my niche even further, and what I’m finding is that only benefits, and I encourage everybody that’s listening to do that. It’s a process. My group visits are structured for people who are more of the academic, it fits my community well. It’s a very hardworking Swiss community full of farmers, full of people that are somewhat tighter with their dollar, but that’s okay. They really know when a good investment happens and they’re willing to do that. What I did is really tailor it so that they would come in and have a 30-page workbook that was like the timeline, you know, things that IFM gives us, things that will help prompt them to reflect, whether it’s journaling or a food diary or things like this.
The first visit is me talking about gut health. When they sit there and start charting and taking notes on the things that they eat and they see the science behind what happens in your body, and they are left with the instructions on how to do an elimination diet and how it can be actually not that hard in Green County, because other patients are sitting there in the audience saying, “I know it sounds hard, but I did it and I felt fantastic and my MSQ dropped by 70%,” so you have this collective energy that happens. They’re left with feeling motivated and they start implementing some of these things. By the time I see them in the second group visit structure, which is about hormones, I walk through some of the common tests and I give case studies of patients and we talk about symptoms that they might have and how would that correlate. All along they’re gathering more information that helps them make sense of their body like a user manual.
It’s sort of like taking your car in for having your whole transmission checked. You’re checking each line and you’re, you’re going over each little facet and then by the time the last group as it happens, it’s about energy and about mitochondria. It’s kind of the icing on the cake and tapping into their fatigue and saying it’s not always that you’re Prozac deficient. It’s not always that just sleep more and eat more protein. There’s a lot of nuances and having them see again, those case studies and learning and reflecting on what has helped them and hearing other patients in the room say, “Yeah, this is what I found on my OAT test or my GI tests,” and to encapsulate these group visits, what I have to do is really simplify my approach.
Like I said, it’s three visits, one was GI, and then I also included the GI map testing as an explanation. I would run through a typical GI map test. The second group visit was hormones. Then I ran through a typical ZRT test where I went through salivary and blood spot hormones. Then the last one, energy, and then I went through an OAT test, a urine organic acid test, so I had to simplify, even though I use a lot more testing than that, I wanted to make this understandable for people and it’s been wonderful because then they can go home and learn more about the testing on their own time and they can come back and see if they would like to order one.
The group visit structure that I offer, I scheduled this on Eventbrite and it is $199 for the three sessions. It includes the workbook and it includes the ability to order the test. It does not include the cost of the test, so they are upfront, they get a sheet with QR codes that they can scan and learn about each test and how to collect the sample and what each test costs so that they know what they’re up against and if they choose to order it, it results in a video interpretation of the lab test personalized to them and that’s kind of the whole encapsulation of the group visit. What I’m finding is, people enjoy the data collection and then they also realize the tip of the iceberg, that if they need more help, they need to come in office. It actually helps people get better without needing me to, so win-win.
James Maskell: Yeah, that’s beautiful. I guess a lot of people would probably be thinking like, “Oh, okay,” let me ask you how to…How is this delivered? Is it like you in front of a group or is it you sitting in a circle? Secondly, how did you recruit these people and how many people did you recruit and what did you find during the recruiting process?
Lara Salyer: Yes. Great, so initially the recruiting process, I vetted, I used Wufoo for intake where they would apply to be the beta testers of my university program and they knew up front that the cost was going to be $199, that this is a trial and I want their feedback. I recruited about 15 students and they sat here and it was me in this waiting room here. Behind me is a smart TV, so I would upload my slide set and very informal. I would sit here, we would talk, it’s a cozy waiting room. They’d bring their clipboard and we talked for an hour. As they walked through the process, I was very adamant about feedback, good and bad, please let me know. They had SurveyMonkeys that they would be sent, and they were generous. Feedback really helped me shape the program for the second reiteration.
The second reiteration was very similar. Same thing, waiting room, me here, very informal and again, more students where they’re learning and they’re actually telling their friends. I am about to re-enroll people for the fall session. One thing I learned is that they want it spaced out. I assumed erroneously that patients want to be committed for a short amount of time, right? They want action, they want it short. I did my university in three weeks. Each Sunday they came in and we had an hour lecture and then they were done. A lot of the students said, “This was fantastic, but I want more time in between lectures to digest,” and so that needs to be respected as everyone needs a little space. Now this fall session, I’m going to experiment with once a month for three months and see how that goes and I’ll let you know.
James Maskell: That’s great. Yeah, super-exciting. They’re getting an education. They’re also learning sort of the fundamentals of functional testing. I mean this, just thinking about it, this is why these appointments are so long, right, in regular functional medicine is because there’s so much to talk about. What is this test? Why is it not covered by insurance? Like what are we going to find out that you wouldn’t find out from another kind of a test? You know, and I know that practitioners are struggling with this because they’re having to do so much in a short period of time. That time gets extended, and it leads to kind of all the inefficiencies that have meant that the average functional medicine doctor doesn’t make as much money. They can’t take insurance even though they want to be able to help lots more people.
I’m really excited when there’s innovation that’s happening and it’s been great to put it together. Yeah, that kind of gets us up to today. Let’s just talk for…I’d love to just know about a little bit some of the other stuff that you’re getting on, but we are relaunching the Accelerator this month. We’re starting to do two intakes a year. It has been one of the greatest pleasures for me over the last three years to interact with you in the Accelerator and see not just the innovation that you brought to your own practice, but the leadership that you brought to other people and support that you provided. It just really feels like we’d been sort of in this melting pot of the future of chronic disease care. I’d love to just get your thoughts on the experience from your point of view.
Lara Salyer: Yes, absolutely. Before I launch into the value that Practice Accelerator has given to me, I want to touch back on the value that group visits have offered my community. When we do these group visits, I encourage people to record each session and what I do for my active patients in my membership that are already getting the private care that they need, it helps increase their value by saying, “Guess what, you have access to these classes.” It’s like a double dip. It’s a reciprocal, wonderful way to add value to the people that are already invested in paying you one-on-one for help. That is the value I think that we all need to remember to give back to our patients and try to continue to increase the value because they’ve trusted you with their health and that’s what you do very well in the Practice Accelerator.
It’s not just purchasing the program and getting access to the modules and the lectures and a fount of resources that you can rearrange and stack like Legos to build your best business model, but the value that I found is in the groups that you offer on the Facebook group is hearing everyone else’s feedback. Watching their growth as a practitioner in their community, and then the synergy that happens with us sharing, it really does feel like we are on the cutting edge of the precipice of the future of medicine. It’s very exciting, so that is what I found most helpful with the Practice Accelerator, is the value that happens after you watch the modules, it’s what you apply.
James Maskell: Beautiful. Yeah, no, I definitely feel like that and it’s been super exciting that even doing the future of group visit session that we did at the beginning of this year and seeing people starting to think about using Zoom and doing hybrid models of in-person and online. There’s a lot of clinicians like yourself that draw from a wide area geographically and so forth. That’s been just super, super valuable to hear.
I know that the bounds of the Practice Accelerator is not the end of your innovation, and I know that you have some pretty exciting opportunities that are coming your way. You created a program called Right Brain Rescue, and I’d love to just share with our community because ultimately, it just feels like one of the most exciting things is seeing someone who comes into practice and has all of their creative juices to be able to create a practice that works for them and their community, but those creative juices don’t just stop there, right, and I know that you’re really passionate about helping your fellow physician to reclaim something that you feel like they may have lost, so can you get us up to date?
Lara Salyer: No, absolutely, and I wish that there was a way to track where all this creativity begins, but I really feel it’s just that synergy of people in the same room, you never know. It’s leading back to everything, Precious Accelerator, my own journey through typical family practice, feeling burned out, launching a new career in functional medicine, falling in love with the ideas that functional medicine upholds and seeing my own growth in both medical and biochemical and you know, emotional and creativity. Right Brain Rescue is like my ultimate group visit for physicians. It’s like the Trojan horse of functional medicine. What I love about it, is I spent a year just researching all the clinical references behind neurosculpting, I guess would be a great word, or neuroplasticity and how beneficial creativity can feel in your brain and how it helps promote the lateral thinking and insights, and it makes you a better clinician. It makes you fall in love with medicine again.
My goal is to help physicians infuse creativity in their careers. It can be at whatever level is apropos for them, but to understand how they can optimize their own energy levels in mitochondria. It’s been great because I’m just traveling to different residencies, various national conferences giving keynote speaking, and it’s well-received and people are waking up, and I love that. I want to be that lightning rod for functional medicine and all the different worlds of medicine, so it’s wonderful.
James Maskell: Yeah, it’s amazing. I know you gave probably one of the first talks last year on the New Vision Tour in Chicago about it and I’ve just…What I saw that predated the program was just as simple as being physically creative with the educational videos. You’re obviously like an artist with how you draw on a whiteboard very clearly. I could see even in the Practice Accelerator, other doctors were starting to paint on the weekends because they saw just how much joy you were having in expressing yourself in that way.
Lara Salyer: Yes it is. Albert Einstein said that creativity is contagious. He also talks about intuition is really the wise decision-maker of our mind, and so creativity is like the conduit to your intuitive thoughts. What I’ve loved is hearing from people that I’ve never even met, you know, just whether it’s on the lovely social media aspect of Instagram or Facebook getting messages from other physicians saying that they’ve picked up their paintbrushes again or they started knitting again or they took up a hip hop class or whatever it is. I mean, awesome. That is what I want. I want to prescribe creativity to as many doctors as I can.
James Maskell: Absolutely. Yeah. Super, super exciting. Check out Right Brain Rescue if you’re listening to this, you can just…We’ll put the details in the show notes. I guess, this is a series on group visits and ultimately, later this year, early next year I’m going to be going hard to really try and think about group visits as a sort of a Trojan horse to bring functional and integrative medicine concepts to a wider audience. I’d love to just like take a step back and just get your thoughts as to how do you see, as someone who’s on the cutting edge and is innovating and is creative, what is it going to take for a lifestyle first root cause approach to become the standard of care and how can we all work together as a functional medicine community to be able to make that a reality?
Lara Salyer: Yeah, I can’t underscore it enough that what it’s going to take is group visits, quite honestly. Not everybody has the capital to invest in what it takes for a private practitioner to dig down to root cause. It is labor intensive. It can be exhausting. I’ve met practitioners in the functional world who are burning out, right? It can be very tiring. However, when you start to expand and look at possibilities of delivering content in a group setting and you divorce yourself from the idea that it has to be completely comprehensive, even the littlest that seems basic to your mind as a functional practitioner, can be something that the community has never heard of before or hasn’t ever entertained the thought. It can send a ripple effect that will plant seeds in your community that you may not even bear the fruit for generations, but you’re changing the moms, you’re changing the kids, you’re doing all this in a group structure. I can’t emphasize enough that I really believe the key to changing the landscape of medicine and allowing functional medicine to reach more is the group visit structure.
James Maskell: I’m glad we’re in agreement on that. I guess one more thing just to throw in there is, part of the thesis of the book and what I’ve seen through this is that ultimately, we’re embarking on treating the root cause of the root cause, which is a lot of times loneliness, right, and a lack of social support. From your experience of bringing patients together, people who want to get healthy and introducing them to each other, what’s been the most sort of satisfying part and would you agree with that thesis that ultimately that by treating loneliness, we’re really doing the true root cause medicine?
Lara Salyer: Amen. Yes. Loneliness. We need a tribe. As much as we’re independent, we’re driven, we’re all separate egos walking around. We’re really a collective universe of energy. When we tap into that energy in a tribe format, magic happens. In my own group visits, I’ve had patients that met each other, didn’t know they were neighbors, you know, and then they went for a walk after the group visit and decided to rekindle a friendship. Even among practitioners, that’s why the Practice Accelerator works so well. It’s a tribe. We are vulnerable, but we’re also stronger together. We’re able to grow in ways that you can’t do alone. Medicine can feel isolating because you’re slapped with a diagnosis and a patient feels like they’re the only one there, but when you provide that vessel and that space that allows them to come in and meet others, it’s just going to change the world, I believe.
James Maskell: Well, that’s what we’re going for. Look, Dr. Salyer, thank you so much for being part of the Practice Accelerator community. Thank you for taking action. In the first iteration of what we set up with the book and the Accelerator and the functional forum and for being such an incredible advocate inside the Accelerator and just with all the work that you’re doing. I’m super thrilled to be going on this journey side-by-side because ultimately, whether it’s introducing doctors to functional medicine through re-examination of the importance of creativity or whether it’s actually innovating on how we deliver this to patients and how we make this more accessible. It’s been an unbelievably interesting and fun ride so far. I know that’s just like me, I know that you’re just getting started, right?
Lara Salyer: Likewise, it’s been a pleasure and I can’t wait to see what the future holds.
James Maskell: Amazing, so check out Dr. Lara Salyer, Right Brain Rescue. You can find out more about her practice. What’s the best website to find out about your practice?
Lara Salyer: Thanks. My website is DrLauraSalyer, that’s L-A-R-A-S-A-L-Y-E-R.com.
James Maskell: Amazing. All right, so this is been the Evolution of Medicine podcast. We’ve been with Dr. Lara Salyer, we have been talking about group visits. I hope that you have learned something here today and please share this with a practitioner that needs to hear it. This is the Evolution of Medicine podcast. I’m your host James Maskell and we’ll see you next time.
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