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Welcome to the Healthy Brain Toolbox. I'm Dr. Ken Sharlin, neurologist, speaker, author, and host for this show. In each episode, I interview influential people whose work impacts how we live and how we think. My guests are leaders in the health and fitness industry, physicians, scientists. Here, you'll find conversations that break down barriers, expand your horizons, and give you the tools you need to protect your health and nourish your aging brain.

Dr. Ken Sharlin: 0:30

Welcome to the Healthy Brain Toolbox podcast. I'm your host, Dr. Ken Sharlin. Today's guest is Dr. Clint Carter, board-certified family physician, former emergency medicine doctor, and founder and CEO of MyMD Select. This is a direct primary care practice based in East Texas. After more than a decade of frontline medicine and experiencing firsthand the limitations and burnout of traditional healthcare, Dr. Carter chose a different path, creating a model of care that puts the patient first, not insurance, not the middleman, at My MD Select, Dr. Carter has built an innovative membership-based primary care practice that delivers personalized. Unhurried Healthcare with unlimited access, transparent pricing, and proactive wellness strategies? His mission is to restore the human connection and medicine, prioritizing long-term health, preventative care, and true physician patient relationships beyond clinical care. Dr. Carter hosts the MyMD unscripted podcast, where he explores how to fix what's broken in healthcare through real conversations, practical solutions, and patient-centered perspectives. Dr. Carter, welcome to the Healthy Brain Toolbox.

Dr. Clint Carter: 2:01

Man, thank you. That was a great introduction. We're good.

Dr. Ken Sharlin: 2:04

I'm sitting here in my neurology clinic, and that intro that I put together, I just feel the pain when I read that intro. I do have a hybrid practice here. It's not exactly a membership model. But I really try to step outside of the traditional experience

Dr. Clint Carter: 2:22

Yeah.

Dr. Ken Sharlin: 2:22

And I don't want to steal the stage, so we'll talk more about it. But it is so challenging on one hand to really connect with our patients and spend the time and looking in the eye and not at the computer screen and yet. We have to balance that against certain expectations of what happens when you go to the doctor. Why am I not being seen on time? How long do I have to wait? We could be five minutes in, five minutes out, we could spend a little time and know that it's when your turn, you know you're gonna get the time and the goal.

Dr. Clint Carter: 2:51

It's hard, man. It my deal, I did family medicine residency and got out and started interviewing at these family medicine practice jobs in town. There's two big hospital systems in our area. Most of the jobs were hospital system based, and I interviewed with both. And you just walk in the waiting room.'Cause you walk in the front door for your interview and you're in a waiting room full of unhappy people that the front desk is manned by unhappy people. And then when I get to the back to meet the doctors, they were all just pretending like it was, you could tell they were just like, dead inside. They really wanted me to come help'em out. And, fresh outta residency, I said I knew enough to go, I don't think I wanna do this like this. This business model, this clinic, this insurance-based strategy doesn't provide job satisfaction that I'm looking for. And we did a ton of ER in my residency, so I'll go be an ER doctor. I don't have a staff to manage. I'm off on a random Tuesday. It's all good. And it was fun until it wasn't. And I found myself at the end of the better part of a year career just coming home and asking my wife is it a job if it steals your soul every shift? Like it's just soul sucking. It's just this endless volume of people who are not having emergencies but just can't get to see their doctor because their doctor has to book their time to keep the lights on. And so they don't have time for these urgencies and minor emergencies. And then when a real emergency comes in, I don't have time for that. I've got all this primary care I'm trying to move. None of it was fun. And I told her, I was like, Hey, guess what? I know I don't wanna be a clinic doctor, and now I know I don't wanna be an ER doctor, so I guess I'm gonna quit being a doctor. I'm just gonna go find something else to do. Smart Guy was in my mid thirties, and then I was watching I like the Treehouse Masters TV show. And I was like, you know what, babe? We built our house as we acted as the builder. And I did the electrical and we did a lot of the unskilled labor. I was like, I'm gonna start a tree house building company. Let's do it. Let's just go. And she was like you are a doctor and so we ended up at a concierge medicine conference in California and came home and we were like, you know what? Let's try it. Worst case scenario, it goes outta business and we build tree houses, right? A buddy of mine had started MyMD Select in a small town to the south of us. He had been in my residency program. And so I went to him for some tips and he was like, dude, join me. Let's do this thing. So I started the MyMD Select branch and Tyler, and we've just taken off together on this journey, and it's been another 10 years now of direct primary care. Of course, when we started, it wasn't called that, it was just that concierge thing. And the journey has been so much fun because we've found that once you get insurance out of the way, anything is possible. We can go wherever the patient needs to go. I'm the pilot. They're the co-pilot. Hour long visit, no wait, no waiting room. My time, my overhead, my staff, they've all been covered by the membership in theory, everything's, I don't need, if you cancel your appointment, I'm not like mad that I lost money. I'll go do some catch up work or, go administrate this thing. I'm not, I don't trade time for money. With that membership, you get full access and that whole it's not, rocket science. It's just a different business model that I was to the point where I was like hell, it's either don't be a doctor or try this. So the risk ratio was fine. It was like, I don't know, let's go, let's try it.

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Dr. Ken Sharlin: 8:09

I kind of had a similar crisis moment experience and just being very frustrated with the traditional medical model. My AHA moment was, ultimately finding out that functional medicine as a discipline existed and I was implementing the principles already in my life. I just didn't know that there was a framework to bring that into the practice. And it was transformative for me to attend my first IFM conference and, training and then ultimately finish that certification and hang a shingle. But it's still, there's so much I'd like to unpack here because I think, at least for the way I've been seeing it is. How to overcome certain belief systems. Meaning that, I'm just gonna call it an economic healthcare delivery model, if traditional model, I'm employed, so my employer offers me health insurance as an option or a benefit, or maybe I go to the marketplace and I purchase a policy. As you probably know, most people do not have that sort of platinum policy, meaning they're gonna have higher deductibles, copays, limitations of? You can go to this doctor, but you can't go to that doctor, or that sort of thing. And yet, I find. That at a certain gut or heartfelt level, it's, I have insurance, so I am assuming that this is covered. It's co this term covered. It's very troublesome because, for example, I just had to do a quick skin punch biopsy before I came, did the podcast here. The individual has suspected Parkinson's disease and there are a couple of tests. There are really three, but one's a spinal flow test, we don't really need to use that. But the other it to, or either to do a skin punch biopsy or send them for a nuclear medicine scan called a DaTscan, a Dopamine Transporter scan. And while the testing is not really required for the diagnosis, a lot of people feel assured, hey, you're, we're clear. This is what's going on. I order the skin punch biopsy. It's very benign. the actual amount of skin's the size of the tip of a ballpoint pen. We biopsy three areas. I use a little lidocaine with epinephrine. Takes 10 minutes. There's no radiation, there's no big hospital cost. But the person's insurance cover skin punch biopsies. They only cover the DaTscan. I said to the family of the patient and her husband, I said, look, I'll do whatever you want, but when, if you think. That just because this insurance says that's what we approve, that's what we cover, that this is gonna be better for you. I want you to think twice because that skin punch biopsy, direct pay, I'm not saying things are cheap. It's about$1,400. Okay? But this person has that high deductible. It's the beginning of the year. You go to the hospital based radiology department, you have a DaTscan for$5,000. Have you met your deductible? No. Is it covered? Yes and no. It goes toward your deductible, but you just spent three times the amount of money. It's a test that has where you can easily get false negatives and you're exposing yourself to a radionucleotide tracer. Or you could have skin punch plant like big picture.

Dr. Clint Carter: 11:42

What's fun at our practice is once you pay me a membership, and this is just talking business model here, the way our business model works is once you pay me a membership I am personally offended by every healthcare dollar outta your pocket. That's my responsibility now. And if most people have a deductible where they'd have to be on their second surgery for the year, let's say appendicitis and say you have to get your appendicitis and your gallbladder out in the same year. That's a bad year, but you're paying for that appendicitis. All cash, right? Most of my folks, I'm looking for the best cash price. MRI the best cash price this best. We do all of our, we're not doing that skin biopsy, we're doing, regular old skin cancer type skin biopsies and that's gonna cost$50 pathology and it's gonna cost me$27 in supplies. So we're gonna charge'em we're gonna do the math, charge'em seven, seven bucks, get'em out the door. Everything is at my cost as much as possible within the. MyClinic, outside MyClinic, I'm like, okay, in our area, the best way to get a x-ray at cash price is with MD Save, which works with that hospital system, not that hospital system. Or you can get a good cash price over here My job is to be the patient's advocate and navigator of this crazy freaking system. And if I want an MRI of their knee, because I'm pretty sure they're gonna need a knee replacement let's run it through your deductible then, because eventually you're gonna hit it.'Cause you're gonna get your knee replaced this year. But if we don't think that's what we're gonna do, we'll get a cash price because in the end, that's gonna save you money. So the hard part is that an insurance-based system like this pays to fix problems. It doesn't pay to prevent problems and anything they can say no to, like a punch biopsy to diagnose Parkinson's because it's not, the main way that it's done in mainstream medicine is they can say, no, we don't cover that. That they save money by saying no. And so it's just really hard for these patients to wrap their brain around this worldview that I have to do what my insurance covers. And you're like, no, you, that is the last thing you want. Sometimes it's the right thing, but you need a navigator. You need someone advocating for you that has a better idea of how the system works.

Dr. Ken Sharlin: 14:14

So true. And it's a culture change. I assume that folks, by the time they're knocking on your door saying, I'd like to be a member. So the conversation's a little bit easier.

Dr. Clint Carter: 14:25

But most of the time they come to me frustrated. They're like, Hey, I feel like crap. I'm looking more and more like my parents who died a terrible, miserable death, two years ago. And I'm obviously down the same path. My doctor says I'm fine because my labs look normal. Help. And then, they've got questions like, but I have insurance, so can I use you? And then what do I do if I need a specialist? And what do I do if you need an x-ray? So they actually don't understand the business model. They just know they want something better. And then we walk'em through the advantages of listen, man, I'm probably gonna save you money. Like I pay more for my, middle school daughter to play club soccer every month than it costs to have me 24/7 as your physician in advocate. Like it's. Crazy affordable. So then at that point, you've you minimize your healthcare out of pocket dollars. And if you need a big surgery or you have a big, you get cancer for God forbid that's what that, that's what it's for. I've got social media videos coming out or it's you go up and you're like, hi, I'm at Jiffy Lube, I want my oil changed. Here's my insurance card. And they're like no, you just, it just gonna cost you, it's gonna cost you 50 bucks. And most of that's the cost of the oil. So just stay in your car. We'll take care of you. And it's what? Why do we think insurance equals access? And it's because over the last 50, 70 years we've been told that's how it works. And then maybe at the beginning, the best of intentions were in place, but the system is just broken under that philosophy. It can't pay for wellness. How do you pay me for preventing diabetes? You don't. They can't prove that I prevented anything. All they know is their patient doesn't have diabetes. So it's a different, it's impossible for the current system to do what we do.

Dr. Ken Sharlin: 16:17

I'm a huge believer in the model that you're promoting and that you have. And I think there are many reasons, why it's very good, even in the context of the recent argument that, occurred on Capitol Hill in October, November over the big budget and,

Dr. Clint Carter: 16:35

yeah.

Dr. Ken Sharlin: 16:36

Gonna address healthcare? And they ultimately didn't address healthcare. But, and I'm not trying to bring this into the political arena just for folks who know. I try to keep, certainly don't mind stating my opinion here, but I'm not gonna say I am a Democrat or Republican. It, the point I'm making is that. As I read more about what the Democrats wanted, which was more or less to sustain the status quo. The problem is that in order to fund the healthcare marketplace we would actually, we didn't actually have any money to do it, so we had to create a debt to fund that healthcare marketplace for one year And so they were talking about this will increase the national debt in the next 10 years by this number of billions of dollars. And what I think they weren't even saying was, that's just one year, and

Dr. Clint Carter: 17:24

Yeah.

Dr. Ken Sharlin: 17:24

Next year? And so I, and then admittedly, I'm not an economist, certainly not healthcare economist, but I was playing around on chat GPT and saying, okay, what if. The average American got health insurance, but they got a very high deductible, catastrophic care policy, right? For the big emergencies

Dr. Clint Carter: 17:46

Yep.

Dr. Ken Sharlin: 17:47

Truly not gonna be managed in the doctor's office, right? You're covered, you have a heart attack, maybe you have a cancer, something that

Dr. Clint Carter: 17:56

Yep.

Dr. Ken Sharlin: 17:56

Require a lot of intensive, expensive care, right? And then instead of, subsidizing beyond that, you take some dollars, say, I'm going to actually give you maybe a tax credit, something like that, to use toward a direct primary care model. And again, keep me very apolitical. Now there are hallucinations and all that, and maybe

Dr. Clint Carter: 18:19

Yeah.

Dr. Ken Sharlin: 18:19

AI tell you what you want to hear, but said, wow, that's a really interesting way to do it, because that would actually be a win-win on both sides. On one, because the cost as calculated by the Congressional budget office would be dramatically less to fund direct primary care. The quality would be there'cause

Dr. Clint Carter: 18:42

Yeah.

Dr. Ken Sharlin: 18:42

It's not outside of that and it would be the win-win on both sides'cause you still get the catastrophic care policy.

Dr. Clint Carter: 18:49

We've been preaching that so we blend really well with a catastrophic type, high deductible plan and or maybe a health share if you qualify. And just anything that minimizes your out-of-pocket monthly costs and yet protects you on the backside for something big, right? I got plenty of people that choose me instead of insurance. It always makes me a little nervous. I've got some people that are just independently wealthy, and that's probably the smart way to use their money. They've got it invested, making 12.5% or whatever. That's not the average, that's not the average person. I've got self-employed cabinet makers paying me monthly with no insurance. I've bolted onto other people's, so the majority of Americans get their healthcare through their employer, and their employers are like, how are we gonna stay in business because it's 20% increase every year. My employees aren't even grateful. They think their plan sucks, but it's literally the best thing that we could even afford. It's not the worst plan. We're not choosing the worst plan, and yet no one knows how to use it. It's super complicated. They're unhappy with it, and they resent me for it. I'm just like, it's just such a lose lose, right? The patients are frustrated, they're not getting the care they need, the employer's losing money, and the patients aren't even, his or her employees aren't even yes, thank you for what you've provided for me with this benefit, right? So they have built us into some plan. I thought I was getting outta the insurance game altogether, but they found ways to, if you're a big enough company to self-insure where they, you've got insurance and for the big stuff, but otherwise you pay for the little stuff. If you build a direct primary care doctor into that plan where it's free to your employees, so they prefer to use you and all that stuff. I've been doing that for a big company, a thousand plus people. since 2018. And their insurance costs have not gone up since 2018. Like they've got a creative plan design I can't do it by myself, but they've got a creative plan, design and me. In our company, and it's amazing. The employees absolutely love the healthcare plan. They've got, they feel very appreciated and taken care of by their employer. And at the same time, the employer's saving money, like it's a win, right? And then I've got smaller companies that like, okay, I'm going to get a Blue Cross Blue Shield, but I'm gonna make it high deductible and build you on. What's fun about the Capitol Hill discussion is that kind of under the radar, in the midst of all this, they passed a bill that ultimately started January 1, 2026, that you can now use your HSA dollars, your healthcare savings account if you have one, which they basically only put those in high deductible plans. If you have an HSA, you can pay for my membership with your HSA now, there's no reason they couldn't have before other than it wasn't in the bill, it wasn't an approved thing. And they're like, Hey, this will save everybody money. Let's build it into the bill. I'm like, Hey, way to go government. You did something right. I'm proud of you.

COMMERCIAL BREAK: 21:44

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Dr. Ken Sharlin: 23:45

There is maybe one problem here and I'm looking forward to hearing your thoughts and I don't think this is created by Direct Primary Care at all. I think it's just a systemic issue. I know in the state of Missouri alone where I'm located, they said, I heard a statistic, something like a 2,100 or 2,400 physician shortage, not enough doctors. I don't necessarily think the solution is just crank'em out, see as many people as you can in one day, but are we. Creating more of a divide with direct primary care. Is there a yes, train more doctors. Train more doctors. We're cutting back on residencies and all that but is direct primary care inadvertently creating a have and have not situation?

Dr. Clint Carter: 24:35

It is certainly not the solution to the countrywide, if not worldwide medical problem, right? The insurance-based system is broken. However, the average primary care physician is gonna have 3000, some of'em, like 5,000 people on their census that they take care of officially. A good direct primary care doctor has 300 to 500 that can be taken care of this way, this high touch, this high attention, no waiting room, I can only do that for so many people at a time. So if everyone immediately switched to direct primary care, there would be a 10 X worse shortage of physicians. So it is not the solution. What I like about it is that it's a disruptive industry. It points to a better way. We are a information age. We have the most educated consumers in the history of the world. They know they're getting a crappy product. They also know it's getting more and more expensive, not because they had a claim, but because the claims that the company had are so freaking expensive. The cost of healthcare is outta control. And the health insurance companies can't lose money. They go outta business. And so in order for them to make money, they gotta keep raising the bar. And in order to do that the cost of healthcare always trickles down to the consumer. And so what we do. We simplify that and say, Hey, you know what the system does is when you want a blood count, a CBC, a complete blood count, it's cost me$5. The system co cost charges you$25 for that same, and it's only one of your 10 labs you got that day. So my, biggest lab panel that I almost know how to interpret is like a hundred dollars. And that's'cause vitamin D for some reason is like$25. If it wasn't for that, I could get it all for, hormones, the whole thing. I can get it all for a hundred bucks. And so I charge the patient a hundred bucks, right? And then everything else is cheaper. it costs me$45 to sew somebody up. One of my members cuts their finger cooking dinner at night. They call me at home. I say, all right, I'll meet you up at the office. I get it sewn up. They're back home before dinner's cold. I charge'em$45. It's simple. All we did was we just take, and like Dr. Smith did, when he started this for the same reason he was on the clinic side. I was on the ER side, and he was like, I can't handle this anymore. And the idea is it's doctor patient and only what we need nothing else between us. Whereas the insurance world, you've got 16 middlemen and they all have to make a living and it's all how the system's built. And so it's just broken. But direct primary care is a disruptive industry that points to a better way. Functional medicine, one of the main things that I've learned over the last 10 years is that my residency trained in the box quote unquote, what insurance pays for training wasn't fixing people, right? Like I would have these 45-year-old fit, beautiful, women in just professionals or professional housewives that are working out like four times a day, they look great and they feel like trash. And they come to me and go, Hey, my labs look good. My doctors says I'm fine. I feel terrible. Fix me. And I'm like, I got this an hour as often as you need. We got this. And I would just find that there was some pop, there was some sub segment of that population. I didn't, my toolbox did not have what they needed. And then I learned, oh, bioidentical hormone replacement. Oh, okay. We've also got, what I thought was a healthy diet isn't a healthy diet. Turns out gut health is super complicated and we know way more than I was taught. I was taught literally nothing about nutrition. Literally nothing really in med school about nutrition. It is assumed you get some carbs, you get some protein, you get some fat, you'll be fine if if your cholesterol's high, eat a low fat diet. Doesn't work. But I've been, they've been saying that for freaking 40 years. So as I've gone what's happened is I've done more and more functional medicine because that's what the patients need and we don't care what insurance says. They're paying me directly. I'm just now getting MyClinic up to functional medicine trained level like you are. And you don't need a membership to do that. You can pay your functional medicine doctor by the visit. there's ways to do it, but the answer is not continuing to pay insurance to try to hold this together and pay to fix the fruit on the tree, one apple at a time instead of getting to the root of the problem and having a freaking healthy tree that makes healthy fruit.

Dr. Ken Sharlin: 29:26

Our system generally, I'll use the term rewards, procedures over intellect. We spent listening to our patients and then, okay, if we're not doing a procedure, in my case, an EMG, lumbar puncture, a skin punch biopsy, okay? Maybe my next tier is, a regular visit that ends with a working diagnosis and a prescription, and you're out the door. Do you know. What we, if we went to average Joe or Jane, primary care doctor and said, what does prevention mean to you? I would venture to guess. My patients are taking their blood pressure medicine. My patients are taking their cholesterol lowering drug. My patients are taking their diabetes medicines and I love to explain to my patients that look. I understand these meds, but you also have to understand that the use of blood pressure medicine, the use of a statin or similar, the use of diabetes medicines are really big public health experiments. They will not necessarily help you as an individual. And I go through the whole number needed to treat. You're the mayor, the governor, the president, you can say, I saved a hundred thousand people from having a heart attack this year by insuring that a million people took their blood pressure medicine. But what they don't say is, yeah, but 900,000 went on to have that heart attack by taking the pill. And so the discussion even about prevention really has to change, and I love your comment about how little, nutrition education we get as doctors, but another dimension of it, I think, and I'm curious how you've approached it really is that as more nuanced providers who are interested in prevention, in my case brain health, how we communicate to our patients, rather than saying, take your pills change your diet, which is like barking orders, right? Versus getting in someone's inside, someone's heart, their mind, their value system

Dr. Clint Carter: 31:32

Correct.

Dr. Ken Sharlin: 31:33

connecting at a level where they're like, man, this is me and this is what I want, and I am ready for these changes. And then helping them to not only execute those changes, but then maintain them over time. That's a whole other area that doctors don't really learn.

Dr. Clint Carter: 31:54

No, I love the value system. Point is because if you have a eight minute visit with someone as a physician, it's not your fault that you don't go into a bunch of detail about their, let's say that we were trained on what an actual healthy diet looks like. Don't have time to address it. Literally don't have time to address it. Like in primary care training in the residency programs that we all go to lifestyle modification is somewhat of a punchline, right? If we could get'em to eat better and exercise more, but no one's gonna do that. Everybody, they're getting fatter, not thinner. They just, here's the new diabetes meds. Start it sooner. Don't wait till they have diabetes, start their diabetes meds when they have pre-diabetes.'cause they're headed that way. It's inevitable. The momentum, the inertia is too strong to reverse. I guess if you don't know what's important to the person, you don't know what their true fears and motivations are and it's never the weight loss. Someone comes to me, they don't wanna lose weight. It's not the weight, it's the wedding they got coming up. It's the knee pain that they're getting because they're getting heavier and heavier. It's the fact that their mom and dad, mom or dad or brother just had a heart attack and they understand they're on that path. It's not the weight. There are very few. Professional models coming to doctors for weight loss. what we're talking about is average Joe, this is important to me but you don't have time to get to that. And you, if you had someone who's, you had an hour with them, we get way past The usual greeting. Hey, how are you? Oh, I'm good. How are you? Oh, I'm good. Yeah, great. I'm fine. Okay, great. Your labs look good. Okay. And seven minutes later they're out the door with a blood pressure medicine and metformin for their, pre-diabetic A1C. And I'll see you in three to six months, watch your carbs move around a little more. Good luck. So many, I will say that in my area we have some really good doctors. We stuck in a really bad system doing a kind of a remarkably good job at what they're doing with what they've got. They're asked, it's not a fair fight. They're asked to build the same house with a wooden hammer and, super glue, right? And I've got time and energy and tools and teams and it's just it's not a fair fight, man. You can't get the same result, but insurance can only pay for what they see. You have an A1C of X, Y, Z, so therefore you're now pre-diabetic. Insurance will help cover this generic version of this medication. Or maybe we'll even eventually start getting these name brand versions of the medication, which is gonna cost you more. The cost of medicine's going up because. They just keep piling on. They're treating the fruit of the tree, obviously that analogy of the blood pressures over here and the cognitive decline. But really, we'll treat that separate from the diabetes and the blood pressure and the obesity. That's a separate problem. No, it's not, it's the same problem. Get to the bottom of it. Let's find out their value system. Are they, there are some people that are like, listen, I like my couch. I don't care what I look like. I want more medicines to control my high sugar. And I'm done trying. And you're like, that's great. You should probably go see somebody about that. We sell, you and I, we self-select for the people that are like, I wanna be healthy. I am not gonna let my brain slip. I'm not gonna let my my, my health go. I'm not going to die a painful, miserable death at age 70. I'm not doing it. So let's go. What do I need to do? What does eating healthy look like? Man, every time I eat, I get bloated And I feel like crap. And, it's okay, let's talk about what's in your food. Let's talk about diet and then let's talk about what exercise looks like for you. You've got a bad knee already. You need to lose 50 pounds in order to meet your own healthcare goals that you just spent the last 30 minutes describing to me. Let's get there. But you're limited on your exercise, You have to get into their real life, their real values and talk about what is gonna work, potentially work for them. And then you have to circle back. You have to be able to communicate with them. You can't wait six months to find out how it went. They gave up two weeks in.

Dr. Ken Sharlin: 36:05

Most direct primary care, I would venture to guess they might use the term prevention, but they're still stuck in the paradigm of, I'm making sure my patients are taking their blood pressure medicines. How do you incorporate coaching or dietician or any, or are you doing it yourself? How have you framed MyMD Select so that if this is a scalable reproducible model that other providers are learning these principles or have the tools to integrate these principles into their practices?

Dr. Clint Carter: 36:37

We've never had levels of membership. We're getting to the point where we're just gonna have to introduce that because there are people that would love. If I had a level of membership that included, like personal coaching and dietary instruction and like a more detailed hands-on, I spend my hour as often as they need. Getting at the 30,000 foot view this group of foods is bad for you. This group of foods is literally killing you. You seem to respond well to this dietary model. And it's usually because of this. And, it's protein first, all the things. But you can also say what's worked for you in the past? Okay keto diet worked really well, when I went vegetarian, I went, it's oh, that's good, just watch your carbs. But okay. And so what we do is we just personalize it and we coach and then we have, our patients have 24/7 access to us on an app. If you 10 o'clock at night, you're like. My toe hurts. You text the app, we call you the next day and we get you in and we figure it out, or, some dietary question or some exercise concern or whatever. If you have a real urgent question, you just push the little phone icon on the app and it calls me directly at 10 o'clock at night and I'm like, oh gosh, yeah, let's handle that. Or yeah, I like that. Tough for that take, let's get that handle first thing in the morning, whatever's appropriate. But the point is that we can just have this conversation ongoing. So it's not just when they're in front of me. I've got, six providers, big picture, I've got 25 employees. I got people watching that app, like a machine answering questions, getting to the, sending it to the provider, if it goes to the provider. But the point is it takes work to give this level of personalized care. And there is direct primary care doctors that are much there.$50 a month working out of the back of a doc of a chiropractor's office and all you get is them, but you get them, a crazy access to just a doctor and that is something. And chances are those guys and gals have decided that my toolbox was incomplete. And I think that once most direct primary care doctors, while they may not all be functionally medicine trained, they are doing much more education. They've had to educate themselves on what healthy diet and exercise and all that really looks like.'cause the information's out there. But doctors don't educate themselves on it'cause they don't have time to use it.

Dr. Ken Sharlin: 39:01

I actually found early on when I tried to bring these principles into my practice that using the word healthy was not extremely productive...

Dr. Clint Carter: 39:13

correct.

Dr. Ken Sharlin: 39:14

I was talking to a colleague, Austin Perlmutter. We were at a meeting in Orlando a couple weeks ago and talking about behavioral change and maintaining these behavioral changes and he linked very perceptibly to self-identity, right? When you challenge these, eat healthy, right? You're really challenging that person's whole identity. So there's a pushback

Dr. Clint Carter: 39:39

Yeah.

Dr. Ken Sharlin: 39:39

And I know that at times I probably am guilty of unintentionally talking over my patient's heads, even though I think I'm not. But I do find that, say for example if I engage them in, let's talk about an anti-inflammatory diet, and they may not

Dr. Clint Carter: 39:55

Yeah.

Dr. Ken Sharlin: 39:56

appreciate the word inflammation. They're like what's that? What's that? Oh did you know that this thing called chronic inflammation really is the main driver pretty much every chronic disease you can possibly think of. And then it starts a conversation as outside of, my husband and I eat healthy. We eat healthy. But when I start to look at that stuff, we're folks, we're talking about essentially taking a microscope to your diet, right? Really looking at is the food that you choose to eat every day actually delivering the nutrients your body needs to function properly, right? It's the same as a car. You gotta check your fluid levels, you gotta change your oil, all that other stuff. You can't just drive your car and forget that you have to change the oil, right? Or eventually these systems start breaking

Dr. Clint Carter: 40:43

Yep

Dr. Ken Sharlin: 40:44

down and we get the big picture quote, you have Parkinson's disease. Then when I start looking at the drivers-

Dr. Clint Carter: 40:53

Yeah.

Dr. Ken Sharlin: 40:53

their Parkinson's disease, sometimes I just, in my mind, in a fantasy sort of way, I'm going to, I'm gonna just put my hands over my face and say, oh my gosh, how is this person even alive? What have they been eating all of these years?

Dr. Clint Carter: 41:09

Yeah.

Dr. Ken Sharlin: 41:10

and I don't mean to be critical'cause I think we do go through life so blindly of what's for dinner. That looks good. That sounds good. Somebody hands you a menu. I think I want to have that today. And I don't know if you got to see it. There is a Medtronic commercial on TV that should be shut down and I really, I like this company, medtronic should be slapped on the wrist for this. They make an insulin pump. Now they do say it's for type one diabetics. but there's certainly plenty of type two diabetics who get to the point where their diet is so outta control. Their insulin resistance is so outta control that their doctors are putting'em on insulin, which is not solving the problem. The context of the commercial is the guy goes into a pizzeria and there's many versions of him in this sort of fantasy commercial and is basically saying, come on. You can't just eat one slice of pizza. you are right. You are right. And so I, but fortunately I have an insulin pump, so I'll just turn it up. And I listened to that the first time I saw it. I almost fell outta my chair. I believe that they were just saying, did you just say that? That person basically you're diabetic, but eat whatever you want.'cause you can always turn up the insulin pump. Did you just say that?

Dr. Clint Carter: 42:25

The problem with, like you said, like challenging their identity and trying and you end up shaming their diet if you're not careful, is because people aren't, it's a funny way to say it. They're not actively trying to hurt themselves. They are doing what everyone else is doing that has the same information as them and as far as they know, diabetes is an inability to secrete enough insulin and your sugars get high. Yeah, eventually, but the problem is that the insulin you have doesn't work'cause your insulin resistance and you go down that let's fix the problem. But the they're doing the best they can with what they got. Our job is, and when you have enough time with your patient, like just when I'm meeting people the first time, I'm like, okay, do you have any dietary, do you have a dietary strategy? Do you avoid certain foods? Do you concentrate on certain foods? Do you like we eat pretty healthy. We cook most of our meals at home. We're in the south man. That could be chicken fried steak and gravy every night. There is no telling. So we do have to, the problem is that to be a proper primary care physician, I'm a primarily an educator and that takes time, and the insurance. It does not reimburse for that. You're gonna get paid. Primary care doctor may get paid$77 for seeing someone, whether they spend 10 minutes with'em or 30 minutes with'em, and to keep the lights on, you need lots of 77s to pay that staff and all those things. So why don't we make it, 15 minutes slots, try to get in and out in about eight minutes'cause you gotta check'em in and check'em out and let's you know they're gonna be a 30, 45 minute wait just to get back because you can't keep up that pace'cause you actually cared about your patient and you spent a couple minutes with'em. And it's not a lack of caring, it's a math problem. It's a business model problem. And eventually we're gonna need to educate our doctors differently because if we do create a system where they have time to educate their people, they're gonna need to know what they're talking about. And really the only education system that does that right now is the functional medicine educational system. That is after you're a doctor, then you go pay extra money and you do extra time to go learn. The truth, if you will the root cause way to address stuff instead of just painting fruit. Let's fix the root. All right, you just spent hundreds of thousands of dollars and, a decade of your life in school.

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Dr. Clint Carter: 46:29

Now let's go start IFM training. It's people don't wanna do that, and for the most part, functional medicine and identical hormones and all that was punchline. Now, all that was a punchline in residency because we knew the truth. People aren't going to, people don't, you just give'em their metformin and their lisinopril and they're fine.

Dr. Ken Sharlin: 46:46

And the reality is that even within what we call functional medicine, unfortunately the education is not standardized. Most of us do generally think of IFM as the standard bearer but I work a lot with A4M, the anti-Aging fellowship track and their own curriculum and they're wonderful. But my point is, the parts are not necessarily communicating. This is the basic of education that if you're gonna say you're trained in certified in functional medicine, you like take international boards, I went to Emory Medical School, maybe you went to UT, University of Texas and but we ultimately are held to the same standard, have to take the same, they're family medicine, emergency medicine, neurology boards. We have to pass our, in medical school to national exams so we can go on even residency. So these I'm seeing and it's really a part of the question that I have on my list to ask about really going back and redesigning the US healthcare system. What would be those core principles? Is the core principle prevention? Is the core principle systems biology, that really underlies functional medicine, really changing. As a whole so that it makes sense.

Dr. Clint Carter: 48:02

When I went from doctor to business owner, I had to get another education on how to lead people and run a business, right? So that I got a lot of, it was school of hard knocks. And then I started really educating myself on it. And one of the things I learned was. Every system is perfectly designed to give the output that you get. So the current system is perfectly designed to put physicians in offices with short visits, insurance reimbursements, and no time to educate your patient. If you don't have time to educate your patient, then what is the point in learning All of that stuff that you should be sharing with them, right? So the education that physicians should have in standardizing, that can't happen until you have a system to put them in where that's the natural result you're gonna get. So it's almost like we can back into this problem. We don't have to know ahead of time what the standard is. We need to start chipping away at this broken system. I think,'cause the other thing is a total overhaul. If you were to be honest, the easiest solution to what the government's problem is Medicare for all. That's the easiest thing. Just standardize it to Medicare standards. And my job would be really easy at that point, My numbers are gonna quadruple overnight because the government's not good at governing much less medicine. But the point being is that's the easiest solution. It's the wrong one. So then we're like, okay, can we chip away at this thing? Is it so broken? It's irreparable and we have to start over with something else. What do we do? So we have to start chipping away, start at least exposing the underbelly of where the problem is. With these different business models like cash pay per visit, or membership based practices or, concierge medicine's, technically a kind of a insurance plus model or, I direct primary care isn't it's pure membership, you've got all these different little ways to, to work on it. And what you find is you're gonna get better outcomes. Patients are gonna be, they're gonna feel educated, more bought in, you're gonna get lifestyle modification, we're gonna prove that's possible, all these things. And eventually the customers get demand, the change, right? we have a highly educated customer base that wants better service, better health, more truth. They wanna know, can I heat my stuff up in a plastic bowl or not? What the hell, I shouldn't do it. But then they, it's all sensationalism. I don't know what to do. So they know what they need and when they start demanding it is the only time that they're gonna get changed. You can't stop drugs coming into this country, you ultimately you stop the drug dealers from, let's say Central America or something. You stop that train of drug dealing coming up when you take away the demand. Otherwise, they'll find a way to meet the demand. So what we need to do is change the demand for healthcare to the people. They're like, Nope, I want more time with my doctor. I gotta get healthier. This is, I'm demanding it. And then direct primary care is a fun way. The other thing I like about Direct primary care is the other option for me was to quit being a doctor. One way to look at it is if you go, everybody goes direct primary care we're gonna have a tenfold shortage. The other answer is. The fact that there is direct primary care. there's 300 to 500 people that get taken care of by me, that would not be getting taken care of. It's saving the physician burnout issue a little bit as well. And so does functional medicine. It's so fun to watch people change for the healthier, and it's so fun for them to be so grateful for it.

Dr. Ken Sharlin: 51:41

The magnet for you in terms of if you're communicating your message, you are communicating your message to other doctors or having the same feelings Frustration, burnout.

Dr. Clint Carter: 51:50

The system is not built for doctor satisfaction. I heard the analogy recently and I love it that most doctors are like a craftsman that could like hand build the best rocking chair you've ever seen. Like most doctors that care, that haven't completely mailed it in. could be really good at their job, but the reality of their job is they're on assembly line, putting the same screw in the same crappy chair every day over and over again, when what would really give them life and fill their cup would be handcrafting a real work of art but they're not, they're putting like Ikea furniture together. One screw, the same screw and the same piece of furniture, one of three or four screws and similar looking furniture all day long. Who the hell wants to do that? That's not what you went to school for. You went to school for, to help people and for them to love you for it, to be honest with you. We all wanna be appreciated and excited to get up and go to work. But it's not sustainable, and I don't think anyone thinks it is sustainable. The reason government didn't come up with a solution is because it doesn't need a tweak. It needs an overhaul. And those are two very different things.

Dr. Ken Sharlin: 53:07

I'm in Southwest Missouri. It abuts Northwest Arkansas. A lot of people from outside this area. Not aware that Northwest Arkansas is a mecca of sorts driven by Walmart. Walmart's national headquarters is in Bentonville Arkansas, and the corridor between Bella Vista down to Fayetteville, where University of Arkansas is.

Dr. Clint Carter: 53:31

Yep.

Dr. Ken Sharlin: 53:32

Would attract anyone who's looking for that combination of culture, outdoor activity, the best restaurants, the best theaters, the best music, And Alice Walton one of the Walton heirs. She's certainly put her mark on Northwest Arkansas when she created the crystal Bridges Museum of American Art and the art world by bringing these, priceless masterpieces to Arkansas. Not to New York City or Chicago or LA. And now she has turned her attention, not that it's turned away from Crystal Bridges, which continues to evolve, but to what she called the Whole Health Institute, and now the Alice M. Walton School of Medicine. That has its first year, its freshman year this year. And really integrating functional medicine, root cause systems, biology, mind, body, spirit, so to speak. She had, Deepak Chopra on her initial board of directors, doctors about coaching and behavioral change. It's gonna have a very small impact. But, you gotta start somewhere and certainly I would love to be involved with it. I've reached out to them and it's been challenging to connect, but hopefully I will. But yeah, there's a little bit of a revolution happening at that level too.

Dr. Clint Carter: 54:55

I absolutely, and you know what it's gonna happen is, you know why other schools are gonna move that way. It's not because we need more. Rich founder visionaries to make it happen, the best and the brightest are gonna stop going to Harvard or New York City. They're gonna start going to northwest Arkansas, because that's where medicine is done, right? And that's where doctors come out, badass at making people better and loving their jobs, and they're gonna be the most sought after physicians in all the land. Now, if you take those same people and you plug them in a job where they get eight minutes with everybody and you don't change, the system doesn't reciprocate, then they're gonna quit and go do something else. Hopefully hang a shingle. Charge cash, start a membership, something. But the other option is they quit because these are smart people to start with and they go do something else altogether outside of medicine. And we don't want that. We need the people that are called by their creator to go help mankind and have been equipped with the brains and the care and the want to we need to maximize that. And a school that creates that kind of product is gonna attract the best and the brightest and they're gonna demand that the job they go to allow them to use their skillsets, There's lots of ways to break into this cycle of failure. You can break in at the payer place, you can break in at the physician spot. I just will not go back into the system. If the government outlaws direct primary care, I guess I'll go build tree houses. I don't know. I know what I'm not doing. I'm not going back. I would be a terrible doctor in the system at this point. I'd be the worst employee of all time.

Dr. Ken Sharlin: 56:46

Folks, you've been listening to the Healthy Brain Toolbox podcast. This week's guest is Dr. Clint Carter. He is a family practice doctor, emergency room doctor who's transformed his career in the lives of his patients through a direct primary care model, MyMD Select. Carter, it has been a real pleasure to visit with you over this hour. And if folks do wanna learn more about what you're doing, providers wanna learn more about what or connect, can you tell us where to go, what to do?

Dr. Clint Carter: 57:23

my email is dr.carter@mymdselect.com. We'll put as much of this we can in the show notes. If you reach out on social media at my MD select someone will get it to me. But the point being is that I have a podcast my MD unscripted. That will be another eyeopening functional neurologic conversation. And, we'll probably get back into this a bit. but please reach out to me. I would love to mentor and or advise and or encourage and or, just bolster patients and providers alike that there is a better way. There is a better way.

Dr. Ken Sharlin: 58:01

I love it. Dr. Clint Carter, thank you so much again for being on the Healthy Brain Toolbox.

COMMERCIAL BREAK: 58:07

Hi everyone. Dr. Ken Sharlin here with the Healthy Brain Toolbox. I'd love to hear from you. If you have general questions about brain health, neurology, or the science of keeping your brain sharp. Send them to questions@healthybraintoolbox.com. I'll be reading your questions on the upcoming episodes. Please remember, these need to be general questions, can't answer personal medical questions, or provide individual medical advice. So if you've ever wondered about brain health strategies, lifestyle tips, new research, or the future of neuroscience, send those questions in. I look forward to hearing from you and who knows? You might even hear your question featured on the show. Thank you for tuning into the Healthy Brain Toolbox podcast. I hope today's conversation gave you new insights to protect and nourish your brain. Be sure to subscribe, leave a review and share this episode with anyone looking to take control of their health. Until next time, stay sharp and keep learning.