Offer Functional And Family Medicine for a Great Career – A PNC Classic from 2019

John: Dr. Lara Salyer, welcome to the PNC podcast.

Lara: Thank you Dr. John. Thanks for having me.

John: I'm so glad to have you here today. It's been a while. We actually met in the past through Heather Fork. You were into a lot of interesting things then, but I think you were just getting started. But now you're really doing new things and I want to hear all about it.

Lara: I met Heather, gosh, 2016. So a while back. I guess you could call that the pre-contemplative stage. I knew that I wanted to do something different and she is a wonderful physician life coach that helps people transition. I didn't meet her very long, because she just helped me out and nudged me in the right way, and off I went. I think that's the only thing really that's been shown statistically to help with burnout is getting a physician life coach, because they can help you in a way that no other person can to help you untangle your thoughts.

John: She certainly helped a lot of people. I've had a chance to run into her at several different meetings and we keep in touch. I would recommend anyone out there who is looking for a coach to check in with Heather, although I know she's extremely busy. She got a nice blog that she sends out. That's good too. Lara though, you're going to have to tell me though a little bit about your background. Tell us and the listeners. There's really interesting things we're going to talk about, so we need to know a little bit about your background first.

Lara: Sure. Well, I'm a conventionally board certified family physician, settled in a town in rural Wisconsin, Monroe, 10,000 people with my husband and three kids. He's also an FP. We had been here for almost 10 years, graduated in 2000, so that put me at about 12 years into, or 15 at the time, into a family practice. It's like getting picked to play Monopoly when you're a kid, and suddenly you're playing Chutes and Ladders. I felt like that landscape of medicine had changed. Despite my love for rural medicine, I would climb ladders and still end up down at the chute with tons of EMR work. It felt like I was just checking boxes and just complying with metrics that didn't translate to what I thought was a valuable career in family medicine.

I was quite shocked and did not identify as burned out, didn't know what that was. We're a hardy bunch, us physicians, so I think that's hard for us to swallow that pill. It led me down many pathways where I went to a conference. It was by Dr. Debra Lathrop and she does a lot of burnout outreach. When I went to this conference with a bunch of other physicians, we all looked at each other and recognized that that's what it was. As you know, not one solution to burnout, but many different ways we can tackle that problem. That led my thoughts to start looking and my Google searches were filled with anything from cake decorating, to Uber driver, to anything. I wanted desperately to get out of the pain I was in.

I didn't know what that looked like, so I hired Heather, and just a few little talks and I started really contemplating what I wanted to do. That led me to functional medicine actually, which is a deep dive in biochemistry. It's like learning the Krebs cycle all over again, and learning different tools that just aren't available in a conventional setting. Lots of MDs and DOs, we're learning different tests and interpretations of labs, just with the goal to get patients off prescriptions, and more on to a natural alternative.

I fell in love with that, really. It held space for energy and things that I wanted to do with patients. I love teaching and so I thought, "You know, I'm going to go for it and I'm just going to open a private practice." That's what I did in 2017.

John: A couple of things there I want to follow up on. First, I'll need you to maybe provide your definition of functional medicine. I've talked to several people in the past. In my mind, it's not really gelled. It's like, "What is that?"

Lara: Right. You're not alone, Dr. John, because the word functional, it's like a wild west. What does that even mean? I was almost offended when I first heard that word. I thought, "Well, functional? Mind, body, spirit. I do that. I'm a DO. How am I not doing that?" I was offended like, "Well, of course I'm doing this." Well, it's been around for 20 years. Cleveland Clinic, Dr. Mark Hyman, these are names you may have heard of or may not, but what functional is, is really integrating. It's a different lens through which we look at patients. We integrate the mind, body, spirit, but in a different way, where we recognize the impact that trauma can have on your DNA, on the cellular level.

Basically, I would like to say I'm like a composer, like a conductor of an orchestra, helping the cells communicate better, get more in tune, so I operate more like a consultant. There's many different kinds of functional providers. You could have a chiropractor, you could have an acupuncturist. For the savvy consumer, they have to look at what tools that person offers. Being a DO that's board certified, I have that hybrid of conventional training with functional training. It's just an interesting time to be a doctor because I think that, I hope in 20 years, this is just called medicine. It really should be incorporated at every level of training.

John: Okay, excellent. I wanted to reflect on something that you said earlier. You recognized some burnout, and you said you decided to start your own private practice with the functional medicine. Were you working in a fairly large group setting employment? That was part of that environment.

Lara: Yep. I was a traditionally employed family physician, and I thought I had vaccinated against burnout so well. I, at the time, was 41 or two, so pretty young of the generation that both straddle the paper and the EMR. I trained myself how to get quick at typing, how to look at somebody in the eye while I'm typing, how to make my templates work. I felt like just the pace kept getting quicker and quicker, with more paperwork. Our ancillary staff was being stripped of a lot of things they could do to help our workflow. They couldn't take verbal orders, all these things that I thought, "Geez, this is not working."

I had four day work week. I continued doing my self-care, like everybody recommends, running or doing yoga. I continued to try and really vaccinate myself against burnout, but with a panel of 1900 patients, it just wasn't looking any better. I sat there and thought, "Do I want to be doing this for another 20 years?" I had signed up to be a rural family doctor. Fracture care, we're talking IUDs and suturing, everything, just like an old country doctor. I loved what I did, but when I signed up, I thought it would be for 40 years and I was looking there at that precipice going, "I don't want to do this for another 20." So that's where I was.

John: I also want to point out for the listeners, they probably noticed that sometimes when people are burned out, we just bail completely, like, "We're getting out of medicine." But there's a big group of physicians who say, "No, I'm just going to practice medicine the way I want to practice it. I'm going to create something." I gather from what you're saying, that that really was the direction you decided to go.

Lara: Yeah, you're right, John. I didn't think that was the direction. I thought it was medicine in general, honestly. Finding functional medicine and doing one conference is what really saved my medical career, because I was ready to be done. I was ready to say, "I am done with medicine. It's not what I thought it would be." I have other skills I could try from writing to maybe even doing deposition work. I mean there's all sorts of alternative ways to use the skill set that we have. I was ready to dump it.

When I came across functional medicine, where I trained at the Institute of Functional Medicine, ifm.org, and I did their just flagship program that introduced you to little elements of it, and I was hooked. I thought, "Okay, maybe I shouldn't give up on this." With the advent of DPC clinics, like direct primary care, I thought, "You know, worst case scenario, if I can't hack it, I could do urgent care." I was realizing that I shouldn't abandon everything. I really enjoyed the element of medicine that drew me to it, which is helping people heal, and understanding biochemistry, and the physiology of it all.

John: Excellent. That's good. We're going to hear more about exactly what you're doing, because I think just from what I could tell, in addition to what you're doing with patients, you have other programs. You have things that are what I would call courses, so to speak, online resources that help extend your reach for patients or help them. Along the way, I did come across something called Right Brain Rescue. I still am not exactly sure what that is, so tell us about that whole thing and how that just fits into what you're doing.

Lara: Absolutely. As I was going through my burnout process, again, having to self-identify was one piece of it. Heather is, and other life coaches are, really good at helping you understand the psychology behind this whole journey. My story is just one of many. As I'm going through the story and my journey, I started running. I'm not an athlete. I'm picked last in PE class for good reason. I was not somebody that was inclined to exercise, but I started doing this. As people understand the brain, that provides bilateral stimulation to your body.

There's whole therapies based on this. EMDR, if you're familiar with desensitizing or movement and reprocessing, is what that does is that hooks across that corpus callosum, our left and right hemispheres, and you provide healing. You provide this connection, lateral connection across the brain. I was starting to have these epiphanies because I would go off on my walk and run, and this is when I'm still employed, and I would have these thoughts of either better diagnoses for patients that I had just seen that morning, or thoughts about my future, or ways that I would tap into my intuition and really dive deeper. It was really neat to see this unfold.

That led me to more creativity, and then I started researching flow state, which is a state in a brain. It's actually a teachable state that we all can access. You have higher alpha brain. We live in our beta frontal cortex, where we're thinking and analyzing and that's our day. If we learn to navigate into that creative space, that flow space, it's healing. You get this alpha brainwave, it feels good, you're in the zone, you lose track of time. Studies have shown that we can reap those benefits. It helps us be happier and less stress. As I'm doing all this and then I journey into my practice, I am basically tying all these elements of eating differently through functional medicine, learning how to fuel my mitochondria and have more energy and not need my sleep aid like I did before.

All these little elements are tied in a program, like a creativity incubator, people that want to learn just a little bit about what functional medicine can offer to increase their energy. They also have some self-reflection on burnout, and then creative things to help stimulate their own right brain. That's Right Brain Rescue.

John: Now, that is something that people can access and it's not necessarily if they're in your practice? Is that something that's out there that-

Lara: Right, it's designed to be ... It lives online. It's like a fifteen day online course, but it's really jump started my outreach, my grassroots mission. I've been public speaking about prescribing creativity at departments, or keynotes, or conferences. It's been this whole other second career that's been really inspirational.

John: That transcends the practice in a way. I'm going to have to hear more about your speaking in a minute. Let me go back and be a little bit practical, because I think some of the people listening are like, "Well, how the heck did you do this?" Give me an outline of the steps you took, from saying okay to your partners or your employers saying, "I'm leaving, I'm going to do my own thing," and did it take a lot of investment of money? How did you set it up?

Lara: Yes. Oh, excellent.

John: You could do that in two minutes, right?

Lara: Yeah, right, right. No, really, I'm very fortunate to have a husband who also is a physician. With that being said, as everyone knows probably who's listening, who a doctor, we still have tons of medical school loans. This is something that I think is a barrier to a lot of people. They are in pain, they don't know what to do. They feel stuck. Having a lot of conversations with my husband, we had saved up a lot while trying to still pay off our loans. There was a bit of a cushion.

I had a plan that I would give myself X amount of time, and if this didn't work, I could do urgent care. There was lots of plan Bs in place. I want people to understand this was not an overnight decision. In fact, leap year in 2016, I told my nurse, "By the next leap year in 2020 I'm not going to be here." I gave myself four years, but as we know, when you make a decision, suddenly it just goes much faster. Within a month of that decision in February, 2016, I approached my administration and said, "I am going to resign at the end of this year," so I have basically eight months� notice. It was interesting how that played out. I don't think they understand how serious you are. There was really no back and forth. I advocated that I wanted monthly meetings so we could plan for the transition of my 1900 patients that I cared for, and there was a lot of resistance to even let people know.

Here's patients calling to make their next year's PAP physical, and my front staff is saying, "You can't do that," and they didn't know why. It was really difficult. I think administrators don't understand how to help physicians that are really serious and were going to leave. They finally let me notify my patients three months before I left in October, September. My last day, I had already leased a building. I'd already started painting. With technology nowadays, you can really operate as a micropractice. I explored a lot of these new savvy business things like online scheduling, and BMRs that are affordable, and direct primary care models that allow a membership base. Those kinds of things would take a while to unfold, but really there's a lot of tools out there if you need them.

John: Now, were you able to leave the insurance world behind, the Medicare, the Medicaid? Do you still have that partly integrated?

Lara: Nope. I completely severed. I just said, "You know, I'm doing this." I was tired, and so I severed it, which is interesting in this town of 10,000 people. They didn't quite understand how could they see me. I have patients that wanted to see me and I explained my different hat. "I'm a consultant now," and thankfully the doctors knew me, so they love what I do and they want their patients to see me, because actually, our incentives are aligned. We want our patients to be better and healthier, so anything I do is only going to help. However, to navigate discrepancy of price, that really was hard for me. I went into family practice to serve all, so I had to really re-evaluate my value system.

What I did to compromise is I would offer a lower cost to group medical visits that would help teach them some of the basics of what I do, not as an intensive way. It allowed me to reach more people that couldn't afford my private services that are more intensive. you have to be pivot and nimble and creative in how you approach it, and every community's different, But this, this is what's worked for mine.

John: More questions about that, the practicalities. do you have to still have malpractice insurance?

Lara: Yes, yes. I do have a malpractice insurance. They cover me at the same rate as a family practitioner.

John: Okay, I thought you would.

Lara: I have an attorney and those are the two things key that I started with. Being in family practice, you get used to covering everything. I didn't want to be without malpractice. I wanted to have an attorney that I've secured that was familiar with Wisconsin state law where I live, and navigating all those.

John: Then, a covenant not to compete, restrictive covenant was not an issue with the employer?

Lara: It was, and I took them to court. I basically had my attorney serve them papers so we didn't have to go to court. They understood that what I'm doing is not any competitor. There's not even a functional provider within, I don't even how many miles. It worked out fine, but it's a little tricky. It's a tricky environment.

John: Yeah. The legal terminology and everything makes a big difference, I guess, in a contract. Being on the other side, I was working for a hospital as an employer. We went for years and never really enforced, and it restricted [crosstalk 00:16:33]-

Lara: Right.

John: More recently, before I left, we were. Just something you have to have your attorney look at and say, "Well, I don't think that this really applies."

Lara: That's what it was.

John: Or, "Let's not really make waves here. I'm not really competing with you." That sounds like that worked out.

Lara: It did.

John: All right. That was really three years ago or so?

Lara: Yeah. July 2017. I had a six month period after I resigned in December, until I opened in July of six months or so. That allowed me to paint the office, get everything ready, but really learn business systems. I had a program called Practice Accelerator, and it's by the Evolution of Medicine. It's this company that helps skim off all the top resources for a private micropractice, and just give it to you and say, "Here, here's how you can advertise. Here is how you can set up an online scheduler. Here is how you can quickly adapt to this environment that you're not trained in." I mean, let's face it, when you go to medical school and residency, you have blinders on. There's no, at least for mine, no independent talk at all of being your own thing. You're just going to be in a factory setting. It was really helpful. I think that was more helpful than the functional medicine training itself.

John: Very helpful. That's nice. In the old days, you weren't taught how to run a business, but at least they mentioned it occasionally. "Oh, you might go into private practice or be in a small group." Now they don't even mention that, because they assume you're going to work for a large corporate hospital system or something.

Lara: Yeah, you're basically out there. Just very vulnerable.

John: Can you give us a sketcher and overview of what your day or week looks like now, in terms of what you're doing on a day to day basis?

Lara: Yeah. Now Mondays and half of Fridays are non-patient days. I use those to write or to do the business part of it. Looking at my systems, my workflow, talking to my virtual assistant who helps with content management. You know, it's a lot of this techie stuff that just takes time, but I enjoy it and I'm writing my book or following up with leads on public speaking and things like that. Things that are interestingly not something I had predicted a couple of years ago, so I have these two businesses.

Then Tuesday through Thursday and then half of Friday morning, I see patients. They are members of my practice. They pay for time and that gives them ... I've built affiliates that help give them discounts for wellness services. I've built this whole infrastructure that they get free services with my online programs that are out there. They sit in my office, we work together, we talk as follow-up phone visits that, I can capture that value in my payment where you couldn't do this in a regular conventional setting. Basically that's my day, is Tuesdays through Thursdays I see patients as they need me. Mondays and Fridays are more of the outwardly invisible work.

John: What would a new patient visit look like?

Lara: A new patient visit, they get a intake form online that takes them about 30 minutes to fill out, because it's a lot of information we want to know. Then they get immediately at the end of the form, a link they click to schedule their first visit, and the minute that happens I get their intake, I start working on their case. It takes me about 45 minutes. I pull together some things. I have a binder ready for them by the time they hit the door. I see them for about 60 to 75 minutes, doing a full exam. Then we together co-create their goals. It's like being a physician slash life coach, because you're helping them steer the ship. What things are you wanting to work on?

We talk about testing. What tests would make sense at this point, from a functional standpoint? These are home test kits, whether it's stool, urine or saliva. Again, these are things I had to learn. We didn't learn these things in medical school, so I'm still spending a lot of time learning as I go. Patients, we work together I'd say on average three to four months, and if they're really sick, maybe up to eight months of regular membership, and then I graduate them down to a very low tier, $39 a month, just to get access to my content, my ongoing classes and affiliate discounts. That brings value in that way.

John: As you're going along, let's say in the first few months of their interaction with you, is it all live? Do you have things that they're taught that are online or written?

Lara: Right. The only thing that's live is that first visit, that hour long visit. After that, patients' eyes glaze over. I know some functional providers have a three hour initial visit and I am a teacher and I could see that an hour is a long time. That's where I settled on. They get this binder with hard written stuff that's paper, that they can look at and hold because people love that. There is something very neurobiologic about writing down as we go, so they're taking notes.

Then follow up visits are usually done on the phone. We talk on the phone every about 10 days, almost like a little cheerleader. How you doing? What questions do you have? Obviously they have the portal, but I discourage that. I certainly set up boundaries that I will look at my portal at 9:00 and at 3:00 every day, and I will answer, but really our phone conversations are crucial.

What I love most is leveraging technology to do something I wish all family practice practitioners could do is, I get their labs and I record a password protected video interpretation of their labs on the screen, and I send that to them ahead of their phone visit follow-up so that they can look, they can digest, they can understand, they can re-watch it, they can have their husband look at it. Then when we meet on the phone, they have all their questions ready to go, and it's just so much more efficient use of both of our time.

John: Now, just again, so I can understand too, then you're focusing on the functional and holistic medicine and optimizing their physical and mental health through these different techniques that the typical family physician doesn't. Do your patients have other physicians to take care of their diabetes and high blood pressure and all that?

Lara: They do. A lot of my patients tend to get referred to me from neurology or rheumatology. These are the look like very complex patients that have these underlying inflammatory processes. I can detect things like high calprotectin levels in their stool that would have eventually turned into Crohn's, or ulcerative colitis. But their colonoscopies were negative and their biopsies were normal. Once we help them out, they're now no longer counting the toilets at the airport. I've had that happen. The GI doctors are happy because the patients are happy.

Rheumatology is a big one. You get these autoimmune, these smoldering, you know something's there, but as a regular family practitioner, I was trained to wait. Now we just strike while the iron's hot, and I can get them off a few medicines or figure out why maybe they have an occult infection that just wasn't detected.

John: Interesting. I might have someone I want to send to you. Let's see, how far from Milwaukee are you?

Lara: Oh, I was just there the other day watching Hamilton. It's about a one hour and 50 minute drive.

John: All right, well I'm three hours south, but I'll keep that in mind. Awesome. You're bouncing and juggling all these things, but you've got a schedule, you've got a system and you're enjoying it. Tell us what is your feeling these days as, do you regret leaving corporate medicine?

Lara: Not at all. It's not for everybody. I think I thrive on being able to have that element of control, which I think is the highest reason for burnout in a lot of medicine is no agency, no autonomy. You get told what to do, you get all that stuff. I like having the control back, but you have to be okay with that, because along with that is that roller coaster of entrepreneurship where you do control everything, so theoretically you could be working 24/7.

I tell people I don't work anymore. I play every day, and I do enjoy. I really don't feel like I have a job. I enjoy the ups and downs. I enjoy looking and how could I make this a more impactful visit? Or how could I change it to get more people interested, or see the value, or reach more people, talk about burnout? It fits for my personality. Of course it's not for everybody.

John: I think a certain person, when they go out on their own, they have to have that entrepreneurial spirit and they have to want to learn a lot and keep learning, and you have to learn marketing, and business, and all those kinds of things. I'm sure there are people that are thinking, "Well, whenever you have a startup there's going to be, from a financial standpoint, there's costs and there's no revenue, and then the revenue starts to kick up." Looking back now, you feel satisfied, in terms of even the financial side, like, "Yeah, it's worth my time. I enjoy what I'm doing, I'm getting paid. reasonably for it, and I'm happy."

Lara: Right. It feels like honest work. I come back to that feeling. As an employed family doctor, it never felt honest to me because I'm rushing. I'm trying to comply. I am not even giving them the full part of me that I know I could get. It felt like I was just a robot, flipping patients like burgers every 10 minutes. It just did not feel like what I signed up for, or the potential that I could impact lives. Now, I feel valued. I feel like I'm giving honest, good quality care in a way that I never could. Being able to sustain that, of course everyone should have that cushion of financial ... It's going to be lean, and you have to take care of yourself.

I've learned to optimize my own body with sleep habits, exercise, energy, all that stuff to keep yourself at tip top shape and in sparkle mode, because you want to be your best self. Then everybody learns and stands on the shoulders of giants. There's people out there that have done it that are five steps ahead of you. I have learned from people. I now mentor other physicians across the world that want to learn how to set up their own micro practice. We're all there, we're all out there doing it our own way. Even if the mentor you learned from might not have the exact community you live in, or the exact template, you can pick and choose some things, try it out and craft your own method that works.

John: What do you find right now that are the most challenging parts? You've left some things behind. Are there new challenges that are ... I mean they may not seem, they may just be, little new challenges that you ...

Lara: I think the whole challenge as a whole is the disconnect that I think the public has about what insurance does not and does do for them. I think they expect, "Well, I'm paying these super high premiums, and why aren't you covered?" They don't understand that even with these premiums, you're not getting any good quality care either. You know, even in the well-meaning primary care doctor, and I really hate the us versus them mentality. I try to explain to my patients I am not anti-conventional medicine at all. I'm just saying that this is the choice that works for me. It helps you get better, and I think it's the disconnect with that very toxic environment that insurance has created.

John: You were talking earlier about how it feels like, just corporate medicine, you're on this spinning wheel all the time. I just think occasionally about how it is to the patients. It's really unrewarding to the patients, too. They come in, they're like, "Okay, I have this problem. I'm worried. I get seven minutes of your time? Because you're going to be moving to the next and doing the EMR." It's really unrewarding. To me, it seems like we're setting it up to collapse at some point.

Lara: No, I agree, I agree. It's just not set up well, and there is no one answer, like you said. You have the door knob question, right? You know, people-

John: Every time.

Lara: ... They don't want to tell the front staff that they're really there because they have something that they're concerned about that's embarrassing, or maybe even fearful. They've had crushing chest pain for 48 hours and they don't want to say anything. You think you've got it all tied down and then you go to leave and there's that door knob question that is the most important thing. That is where I wish that people could trust. But it takes a while to trust your physician and have that relationship. Until that's there, how can you do it in seven minutes? It's a tough world.

John: All right. I want to hear a little bit about some of the other things, like particularly the speaking. It sounds like you're focusing, so we're going to shift gears to that, if we can. Tell us about your speaking. Are there certain topics you typically speak about? Are you actually actively promoting that side of your activity in business, so to speak?

Lara: Yeah, it's been a wonderful surprise. With the Right Brain Rescue launch last year, about November, so exactly a year ago, I started really actively looking at going to residencies and just saying, "Listen, let's play with your creativity." We have lost the innovation in medicine, and I think being a doctor is one of the most creative careers, because you are observing someone's body language. You're taking in their narrative. You're weaving that past, present, and future. You're using those creative, divergent thoughts to look at what diagnoses you have. You're trying to use your own personal skills to get them to adhere. You're using your hands to palpitate. As a DO, all these things are so creative and yet we're kind of robotic.

I wanted to start with residents and medical students, and I actively campaign to go in there and start working with them, giving them talks on using creativity and how to tap in and reflect. But this is important. It's like a vital sign. I don't know if you remember, John, what happened in 2001, what they started doing 2001? They made us measure pain.

John: Oh, yeah. Right. That was a great, great idea [mockingly].

Lara: Right? Wasn't it great? Right, right, right. We have vital signs like heart rate, temperature, blood pressure. Now these make sense, because they keep you alive. Pain, pain is existential. Life is painful, and everybody has pain, and yet now we're asking that? That's not really keeping us alive. What does keep us alive is creativity. It's the human touch, it's innovation, it's authenticity and transparency, and that's what both patient and physician crave.

That's what I speak about, is that intersection of creativity and medicine, and helping people see that they can practice this daily like a vital sign that they should ask themselves, "When's the last time I did something joyful?" Ask their patients, really stimulate this grassroots movement to level that up and make it more of a conversation on a daily basis.

John: Is your way of expanding that part of your activities in work, is that just reaching out directly? Are you using some kind of, have you got a blog and a website that has your branding on there?

Lara: Yes, I do have a blog on my website, DrLaraSalyer.com. I have a YouTube channel that I occasionally go ahead and put stuff in there when I'm excited to, like time-lapse videos of myself drawing different mechanisms. But really, most of the outreach has been just myself speaking. Once I speak at one conference, then it feels like I get five more people saying, "Hey, I would love for you to come to my residency or my hospital and could you do that same thing?" It's really grown. As I peel back each layer of the onion, the talk and the education gets better and better.

I continue to keep reading research on neurobiology and creativity, so it's perfect because it's melding my passions with what I like to do. I'm keynoting in the March AAO convocation across in Colorado. It just is growing organically without really any effort, which is beautiful.

John: It's just, keep your options open, and network, and do that sort of thing. Now, I'm kind of making the assumption that when you began speaking pretty much, it was just a mission for you, but that if you're doing a key note, you're probably getting paid at this point. Has that evolved?

Lara: Yeah, it's evolved quickly. I only started speaking this year, in the beginning of this year. I approached local residencies like University of Chicago and Rockford or the one here, basically Monroe Clinic, and just said, "Hey, can I talk to your residents? Let's do this. I want to teach them a little bit about Right Brain Rescue and how that melds functional medicine with neuro-plasticity and creativity. Let's do this." Then a Mayo Clinic family practice residency contacted me. They saw my social feed on Instagram. They were following me. One of the residents said, "We would love to have you do one of our residency retreats." Then I did that, and then it just cascaded on different residents, permeated another conference, and then I was suddenly speaking in Washington, D.C.

Now, a lot of these aren't paid. In the beginning, you're not getting paid. It really wasn't. Eventually I wanted to get paid, but I was just having so much fun, and I knew that that's a foundation I needed to get my outreach in the public. My speaking gets better now I have a public speaking coach and the keynote has finally ... As I go, I'm speaking to the Illinois Osteopathic Convention in Chicago in December. Finally, that's starting to see some profit. I'm starting to get paid to do more of that, which is really exciting in the span of less than a year. It's something that, people don't realize they might have skills that never were tapped into because they're in factory medicine.

John: Right. No, that's awesome. I guess what I've seen is, like you said, you volunteer something local, then people start seeing you. They might want you to come, they may not have a stipend, but they're going to pay your travel, they're going to pay your hotel. Now we're getting somewhere. Then it's just, you go to the next one. It's like, "Oh, by the way, do you have a budget for speakers? What's your budget?"

Lara: Right, right.

John: You just gently move into the ...

Lara: This goes to the whole being nimble, and I guess you could say just thirsty for knowledge. There's podcasts out there that tell you how to do this. The Speaker Lab is a podcast I listen to about negotiating prices. All these things, there's information out there. Granted, we could have information overload, but if you wait and listen, "Okay, what is the next step that I need to take right now to level up my game and see where I need to be?" Find a podcast that, you can find it and like yours. You never know what you learn and what can spark your mind.

John: Then meanwhile, you're also writing a book. Did you mention that earlier?

Lara: Yes, yes. I'm writing a book, yes.

John: Want to talk about that?

Lara: Yes. It's just my journey. My journey from regular FP to burnout to, I would say just expansion. It doesn't have a title yet, but it's Right Brain Rescue in a narrative form. It's a memoir that will be educational. You'll laugh, you'll cry. It'll be good. I'm hoping for publication in 2020, and I'm a student of the self-publishing school, so I have a writing coach. It's been a fun journey.

John: Okay, good. Is it going to be geared for any particular audience? A general audience? Medical?

Lara: It's going to be geared towards doctors, but anybody can understand it. It's not going to be heavily science. Each chapter will have a takeaway science portion, if you wanted to skip that. I will talk about my journey, and then at the end of each chapter, explain what's going on at the cellular level in this part of my journey. What cognitive psychology am I doing to myself by not identifying as burned out? What am I doing differently that makes me change and evolve? It's basically a transformational character arc. It's a hero's journey that inspires people to think about creativity a lot differently.

John: You'll have to let me know when that's coming out.

Lara: Definitely.

John: We can have you back here to talk about it, or at least get the word out when it's coming out.

Lara: Definitely, thank you.

John: We'll definitely do that.

Lara: Awesome.

John: Well, let's see. I think we're getting to the end now. I probably overstayed my welcome maybe with my listeners more than you, because they tell me they don't like more than 30 minutes and I go over every time, but that's okay. They can always turn me off, you know? Turn us both off. All right, so tell us the best way to find everything that you're up to, and even if we live within, let's say, driving distance, when I come for functional medicine. Where do we find you? Website?

Lara: Yes, the easiest way is my website, drlarasalyer.com. You can follow me on Instagram, @DrLaraSalyer, Facebook, Dr. Lara Salyer's Professional Services. If you're interested, I'm doing a 10 day creativity challenge. What it is, is a free 10 day challenge. We're launching it on Black Friday, and it's going to be just 10 days of fun things, a little elements from Right Brain Rescue that you can try and play with, and inspire your own little creative journey.

John: The link to that or the notes on that is-

Lara: That will be on RightBrainRescue.com, if you're interested in that.

John: Because I did think I had seen that the Right Brain Rescue was there, standing on its own. RightBrainRescue.com. All right, I've got that. We'll put all the show notes.

Lara: Awesome.

John: We'll have all those links and everything.

Lara: Thank you.

John: Well, any last words of wisdom you'd like to impart on us before I let you go? It's all physicians here listening for the most part. Some of them are burned out, like I was, and you were.

Lara: Yeah, yeah. Color outside the lines. That's my standard news for anybody who is just not sure where to go. Color outside the lines. Look, keep looking and listen to that little intuition, because we are taught as physicians to analyze every pro and con and make logical decisions. But guess what? I think our intuition is wiser than we give it credit to. Make sure you check in with yourself routinely, and do what your heart is telling you to do.

John: That is excellent advice, definitely. Listen to your intuition. Listen to your gut, if that's where it is. Okay, Lara, I really appreciate you coming on the show today. It's been fun speaking and I'm sure we'll have a chance in the future to follow up. Thanks again for joining us.

Lara: Thank you, John. Thank you for having me. Have a great day.

John: Okay, you too. Bye. Bye.

Lara: Bye.