One physician’s journey from burnout to bliss [PODCAST]

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“As a young girl, I’d stand on my tiptoes, craning my neck to watch her sweep cerulean eye shadow across lids and smear foundation on sunken cheeks. While my high school friends resorted to secondhand eye shadow instruction from the pages of Teen magazine, I learned by watching my mom transform the face of a corpse with her skilled makeup application. My mother’s gentle and methodical lipstick application entranced me. Back and forth. Slowly outlining the cupid’s bow of a mouth. Delicately tracing of the arch in a feathery eyebrow. Until, wondrously, the corpse’s vacant mask appeared serenely lifelike.

With her artistry complete, no one could spot the thin line of super glue keeping the embalmed lips from springing open, or the plastic eye caps that gave the appearance of eyeballs peacefully resting in sockets.

As I grew older, I pondered their last moments before this transition. What was the final word they spoke? Who received their last hug? What were they thinking when they realized their mortal roller-coaster ride was coming to a full and complete stop?”

Lara Salyer is a family physician and author of Right Brain Rescue: One physician’s journey from burnout to bliss reveals the creative muse in all of us.

She shares her story and discusses her KevinMD article, “One physician’s journey from burnout to bliss reveals the creative muse in all of us.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Lara Salyer. She is a family physician, and she wrote the book Right Brain Rescue, “One physician’s journey from burnout to bliss reveals the creative muse in all of us.” Lara, welcome to the show.

Lara Salyer: Thank you for having me, Kevin. It’s a pleasure.

Kevin Pho: So we’ll get into your book and excerpt in a little bit, but first off, can you share your story and your journey to where you are today?

Lara Salyer: Absolutely. I am a rural family doctor, or at least I was, and my journey probably started very similar to many of your listeners’. We’re the ones in high school that aim high, go pre-med, go to a public university. I come from a lower-middle-class family and actually grew up around a nursing home, so that might be a little bit of a contrast. But I chose to work with the living, met my husband in medical school, and went through residency.

I felt like I had the epitome of being a poster child of resiliency. I was chief of family practice residency, and I loved the profession that I chose. Unbeknownst to me, I was finding myself in a toxic situation, where I had just adapted to the way the changing landscape of medicine had become. I was practically an Epic super user. I had done zillions of downward dogs and ran miles to try and deal with what, I had no idea, was falling over me, which was burnout.

And it wasn’t until then that I realized how I could help myself, and I started with being creative. I started drawing and painting again. I didn’t know I was getting myself into flow state, and so that’s kind of what helped me pivot and learn more about the idea of burnout and how we can help people.

Kevin Pho: It sounded like your journey started off on a pretty traditional path, and you reached what many would consider the pinnacle of a career. What were some of the aspects of that career that potentially led you to burnout?

Lara Salyer: Yeah. So being a Gen Xer, we’re gritty. I mean, I remember the times we had paper charts, and then I remember electronic charts being unrolled, and I loved that. I loved learning how to adapt to technology, and to me, it was very much a game: “Let’s make this work.” And there was a promise always that it will get better, that it will get easier, that it will become second nature.

And as much as I tried, I felt like it was uneven, this promise. I felt like no matter how fast I became, I still got pushed to see more patients in less time. No matter how quick I could learn how to dictate or type, it just wasn’t meeting the mark. And then my co-workers that were supposed to be helpful and supportive were stripped of some of their duties. They could no longer input orders; it had to come from the physician. So it felt like the game rules were changing constantly, and no matter what I did, I couldn’t get to that easy flow state that I had been promised.

Kevin Pho: So I take it you’re no longer in that position. Tell me about what you did next.

Lara Salyer: So what I did next, after I started exploring creative flow again, it woke up my intuition. I had no idea what I was going to do. I knew I needed to resign. I didn’t know if I would stay in medicine. I blamed my feelings on the idea of medicine altogether.

And so when I put in my resignation, I actually just decided, “I’m going to burn up some CME credit. I’ve got six more months left.” I was really grieving the loss of my patient panel and my staff, but I knew it was the right decision. And I went to a functional medicine seminar and realized, “Actually, I really love medicine. I just need to practice it in a different way.” So I extricated myself from that container and put myself into a different setting, and it was the best thing I’d ever done.

Kevin Pho: So I’ve had several physicians talk about functional medicine, but to you, what exactly is functional medicine? And tell me a little about your current practice.

Lara Salyer: Right. So originally, I’ll explain, I’ll admit I was a little skeptical. I thought, “What is this word, functional? I’m a DO. I’m an osteopath. We deal with root cause all the time.” So I honestly went to the conference because it was in Austin, Texas, and it was beautiful, and I live in Wisconsin. And they promised organic meals and yoga. I thought, “This is a great way to end my medical career. Let’s do this.”

So I went there for five days, and what I learned is it’s like a deep dive of biochemistry. It’s like everything we learn in medical school, but it’s exponentially more detailed. So you learn about different tests that are available, how to prescribe vitamins in a smart way, and how to sequence a root-cause investigation. So we deal with a lot of chronic issues, chronic pain, fatigue, and we find ways that patients can actually feel better with a lot of lifestyle changes, but also just very intentionally, smartly prescribed vitamin regimens.

Kevin Pho: So take us through a sample of your day. What are some typical cases that you see, and what are some sample treatments that you would prescribe?

Lara Salyer: Right. So my typical day is gloriously very autonomous, which is what was missing in my old career, but I enjoy it. I have my own hours that I keep. It’s generally when my kids are in school. I have mober duty, which is mom and Uber, at three o’clock every day.

And so I walk into my office, and I typically take an hour for my first patient, and I comb through their case history. I use a lens in my brain of how I look at a patient from a functional standpoint: Are they dealing with mostly gut issues? Is this autoimmune? Is this cardiometabolic? And so we do kind of an extensive review of systems, and we start with simple things like dietary changes and habit building. We have a 5R gut protocol that we put in place, and we just sort of watch how their body responds. That tells me information on what next test I order. So it’s sort of a Sherlock Holmes kind of investigation.

And the way I run my practice now is a membership. So people partner with me for a minimum of three months, because that’s how long it takes to see any symptom results. And then after that, they can decide to graduate or stay on for some more education and support.

Kevin Pho: And what would you say are the most common issues that you see in your practice?

Lara Salyer: Most common are, and I kind of, I think I resonate with these patients, so I like to attract them, but I like to work with the stressed-out, busy mom or the CEO. And so a lot of the problems I tend to see are people that have had extreme fatigue. They may have tried SSRI medication. Maybe they have a low-grade, maybe Hashimoto’s, or even borderline low thyroid, or they just have this kind of disease. They just don’t feel good, and everything has been normal in their conventional labs. And so they’re kind of at their last straw. They don’t know where to go.

And so I love taking those people in and showing them, “Oh, yeah, did you know you have an occult bacterial dysbiosis in your gut that we can rebalance and help you feel better?” Or look at how cortisol has been changing your stress, your sleep patterns. We do some circadian coaching. So there are a lot of cool things we can do to tweak and kind of get people feeling better, checking under the hood and looking at their transmission kind of deal.

Kevin Pho: All right. So let’s now talk about your book and excerpt, and it’s titled Right Brain Rescue, “One physician’s journey from burnout to bliss reveals the creative muse in all of us.” Now, for those who didn’t get a chance to read your excerpt and your book, can you just walk my audience through it and share the story of why you decided to write it?

Lara Salyer: Yeah, actually, you were probably the beginning of the thought process, because when I first reached out to you in 2016, I wrote an op-ed on your website called “Hippocrates, I want a divorce.” That is what began my thought process.

Back then, I didn’t know what was happening. I knew I was hurting. I was in pain. And as I sifted through the emotions that I was feeling, of grief and anger and betrayal, it felt very much like a divorce would feel. Now, I’m happily married to another family practice doctor. We have three kids. But we all can understand what that feels like when you have put your trust in a whole system or relationship.

So as I’m sifting through this, I’m realizing that this is a love letter to the universe of all physicians that have been betrayed by this system that we were promised would take care of us and lead us to a career that is fruitful and creative and enjoyable. And so as I wrote that, I decided I needed to write a book.

And I basically wrote a book that is a true story of how I grew up and then went through my childhood, and I had a near-death experience, actually, a few years before my burnout that shifted my perspective. And when I returned to work, I realized, “This is not the career. It’s not getting better. It’s not getting easier.” And I needed to make a decision.

And so you go hand in hand with my thought process of leaving a conventional practice and breaking up when there’s really nothing wrong, but there’s everything wrong. It’s irreconcilable differences. And so, leaving that practice and then launching a private membership practice in holistic medicine, you get to hear how that feels, my entrepreneurial brain, all the indecision there, but then watch how flow state and creativity help keep me on track. I’d like to say it’s pretty inspirational, so people don’t feel so alone.

Kevin Pho: So tell me a little bit more about that transition. I know there are a lot of physicians in conventional practices, and they’re burned out like you described, and they’re dealing with a lot of electronic medical record issues. They’re forced to see more patients in less time. And I’m sure there are a lot of physicians who want to either cut back or leave conventional medicine entirely. Tell me a little about your process. How long did it take, and what were some of the potential obstacles in making that transition?

Lara Salyer: Yes, that’s a great question. So when you think of it also like a relationship, it’s a dance of energy and communication. And when we have boundaries with our friends or our spouses, you know, we don’t have boundaries in medicine. That’s the key thing. That’s what you realize: “I don’t have autonomy. I can’t say, ‘No more patients, please.'”

And so part of this transition is a very big mindset shift, that you deserve to have these boundaries, that you want to take on a different flavor of stress than you do now, because there’s always going to be stress in any job. So for me, it was much more favorable to say, “I want to go on my own, and if I fail, I fail, but I’m going to do it.” And having that kind of good stress for me, of putting out business systems, figuring out payroll or anything like that, was fun for me. Marketing, not everybody likes that idea.

But looking inside yourself, seeing what parts of your job you really do like currently and what parts you do not like, and seeing if you can find a shift, that’s why physician coaches can be very helpful in that process. I did use one for a few months, and it was really clarifying.

Kevin Pho: Now, was there a singular event that made you decide to quit your conventional job and start this new practice?

Lara Salyer: Yes, there was. I’m sure it was a series of events leading up to it, but it was this one event when my nurse came into my office. This is after a morning of seeing that bread-and-butter family practice: diabetes, setting a fracture, taking an IUD out, suturing a laceration. I live in a rural area, so there are lots of cow accidents. And I felt like it was a very great morning.

But I had just come back from a meeting, a typical lunch meeting, where, you know, “Not all your patients have all their tetanus shots now.” And I felt like the love languages that we were speaking as a physician and as an employer were completely different. What I felt I valued, I just talked to a college kid and got him help for suicidal thoughts. I mean, I’d done some great work that morning. And to hear my employers say, “Nope, still got to get more mammograms, more of this, we got all these other things,” that just didn’t actually make my job any better, I felt really awful.

So I’m sitting in my office getting ready for an afternoon, feeling downtrodden, and my nurse comes in and innocently puts a little newspaper clipping on the corner of my desk, which is an obituary of a lovely patient that I had had for years. She was elderly, 82, had had a great life. This was not unexpected. She’d been battling cancer. And so normally, that would trigger me to open my desk drawer and write a short little note to her family, saying, “It was an honor to be part of her care team. I remember when she would show me her knitting and her grandchildren pictures.”

And instead, I felt like celebrating inside. I felt relief. I felt like I was celebrating someone’s death, and that caused immediate shame. I felt immediate shame, so much so that that afternoon, I closed early. I just wanted to get out of there. I didn’t know what was going on. I felt like there’s something wrong: “I’m not the physician that I want to be.” I no longer am feeling like that is who I want to become. So that was a key mirror point, where I had to really look at myself and ask, “Do I want to do this in five years, in 10 years?” And that was big for me.

Kevin Pho: We’re talking to Lara Salyer. She is a family physician, and she wrote the book Right Brain Rescue, “One physician’s journey from burnout to bliss reveals the creative muse in all of us.” Now, for those physicians who are burnt out but may not be quite ready to branch out and start their own practice, what kind of tips do you have for these physicians? And more importantly, what kind of advice do you have for the administrators who may be running these primary care clinics?

Lara Salyer: Oh, my goodness. So I keynote and talk all across the nation, all across the world, for this purpose: to help people understand the conversation of burnout using a slightly different perspective. And I firmly believe that allowing our physicians to tap into this creative flow state and nurturing this in them will awaken better communication skills, more happiness, less stress, etc., because we can’t fix the system overnight.

So to administrators, I always challenge them to invite speakers like me that are going to give an interesting and fresh approach to burnout, because let’s face it, everybody’s burned out. I speak for even other institutions: interior designers, police, firefighters. Everybody’s burned out. And there’s a chance to have this conversation in a way that is non-confrontational, that is safe, and allows people to look inside themselves so we can get some solutions.

And then to the physicians listening: Use a therapist, seek out support, dive in, and ask yourself, even if you’re thinking, “I am not creative. I don’t have anything in my body that I can think of that would make me go into flow state,” ask yourself, “What did you do as a child? When was the last time you lost track of time?”

Flow state is very medicinal. It actually will help your brain produce five neural chemicals of happiness, and that effect lasts longer than the event itself. So I ask all my physicians to just think about what brought you joy. If it was as simple as jump roping, playing with dolls, or Legos, there is an adult variation of this. So explore that inner joy, start practicing that and incorporating some kind of creative flow state into your routine, so that you can unlock some of this vitality and kind of reignite your own reason for doing what you’re doing.

Kevin Pho: For those physicians who are interested in either cutting down on conventional practice or breaking off, or not necessarily doing a functional medicine practice but doing something nontraditional, what kind of advice can you give them through your own journey?

Lara Salyer: Yes, I would seek out a lot of these second career opportunities. My Google search when I was in my burnout phase had all sorts of ideas in there: cake decorating, medical deposition. I was searching for anything. And believe it or not, there are a lot of ways that physicians can use their skills. And that is another thing I would love to see medical schools incorporate, just some training on other avenues where you can use your skills if you decide that you may want to leave medicine.

I want everyone to know there’s not one way to be a doctor. There’s also not one way to help patients heal. You might leave this current occupation. Start exploring neighboring colleges or universities. Would they need an adjunct professor? Look at medical deposition or medical writing. Look at conferences like SEAK, S-E-A-K, and they have a lot of opportunities, so that you can start opening those doors. And I think what it is, is we’re too scared. We don’t know what’s on the other side. But unless you look and open these doors, you’re never going to find. So just start exploring.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Lara Salyer: Oh, my take-home message is don’t stop at the fifth vital sign of pain. I was around when they started making that mandatory, and now look what happened. We’re asking everybody if they have pain, and now we have an epidemic of opioid overdoses and deaths and addiction.

I’d encourage everyone to add on a sixth vital sign, which is creativity, and just ask yourself or your patients, “What brings you joy? When’s the last time you played with a hobby? And what are you really passionate about?” And even if they don’t have an answer, and maybe you don’t have an answer, you’re putting that seed in their brain and reminding them that they can feel empowered, and so can you. And really, that is what it’s all about: launching up into our sparkliest self and really enjoying what we do every day.

Kevin Pho: Well, thank you so much for sharing your story and insight, and thanks again for being on the show.

Lara Salyer: Thank you.

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