S1, Ep3: The Residency Episode w/ Dr. Cheryl Burdette

Welcome to by the Roots, the podcast for indies by Indies, where we grab the issues of our medicine by the roots, give them a good shake and see what comes out. Join us for practical and philosophical discussions that can be applied clinically, professionally and personally for the health and well being of our patients, ourselves and our professional community. Please note, this is a learning and exploring platform and is not meant to serve as a replacement for qualified training. Please seek out your own research to support for the modalities, treatments and therapies suggested in today's show. Welcome back to by the Roots the podcast. I am your host, Christy Wild, and I'm so excited to have Dr. Cheryl Burdett today as our guest. I get excited about all my guests. I really love spending time with the folks that I've scheduled, but I'm especially excited to chat with you today, Cheryl. You've got so, so many things in your bio, so many accomplishments. I'm just going to highlight a few of those and then I will let you introduce yourself as well. But I do want to clarify. You graduated from Bastyr and what year was that?

2001.

2001. Okay, so you've been practicing for 23 years. And Dr. Cheryl Burdett is just such an accomplished naturopathic doctor. She's the current director of education at Progressive Medical center and I believe that's in Atlanta, is that correct?

Absolutely. Yeah.

Yeah. That's one of considered one of the largest integrative clinics in the Southeast. Also the co founder of Precision Point Diagnostics Laboratory. She sits on various IRB boards, is on the board of advisors for several different companies. And one of the reasons that we connected is because she is also the curriculum director for a group called Origins Incubator, which is a really awesome concept for helping practitioners transition into a membership model. And I'm just going to point this out, Sheryl, because I get goosebumps even thinking about it. You are sitting in a room with primarily MDs and DOs and you're essentially giving them the, the naturopathic medicine 101 training. And I just think that is so fascinating and so awesome because it's, it's really indirect. It's a direct contradiction from what I hear folks talking about in a lot of places, authority in my life as a student where the MD and DO world is mostly antagonistic. And that's not your experience, is it?

No. In fact, right off the bat, I myself did a residency program for naturopathic dogs. And so I did my residency at Cancer Treatment Centers of America. And so in that environment, you enter into an integrative setting where there are certainly fewer NDs than other practitioners. So largely MDs, the various oncologists there, and of course the psychiatrists and the counselors and that kind of bent of things. And so from the get go, it became very important to me and obvious to me that there needed to be a dialogue across both sides of the aisle, because at the end of the day, everybody's interest is making sure a patient has the tools they need to get better and to succeed and that we're all working towards helping somebody and their journey of health and optimal wellness.

Yeah, that's. That's just incredible. What did that look like? Um, I know it wasn't completely smooth or I'm assuming it wasn't. What about the bumps in the road for that journey?

Yeah, I think it is. Naturopathic medicine speaks for itself. You know, it certainly has a place in this conversation. And as we use naturopathic therapies, they tend to be less invasive. They build a foundation for more things that we might want to do that could be more invasive. They help to manage side effects, they increase the efficacy of what you're doing. And so really the medicine speaks for itself. So while anybody has a tendency to feel if we're going to bring new cooks into the kitchen, you know, that's, that's, well, that's the saying, right? Too many cooks in the kitchen. And so that can always be a bit of a human tendency, especially something new, a different discipline. And I did my residency right at the beginning when naturopathic dots were being established there. And so people, of course, human beings have a normal pushback to something that's different. And so the concerns about how will this integrate and will it undermine what we're doing, but the reality is, is that the medicine speaks for itself. So in these patients that had more routinely been getting, for example, lots of mouth sores or mucositis, then that would contribute to them not being able to eat as well, which contributes to cachexia, which is something that happens at end stage cancer. So one of the things that we, and that we're responsible for bringing on board were some things that were just as simple as, for example, swish and swallows that had various elements, aloe deglycerized, licorice, glutamine, when appropriate, little bit of vitamin A and folates in there. And what was found was that the patients did not have the same level of mucositis, so they were able to eat, so they were able to continue therapy because they weren't cachexic and the outcomes were better. So while initially, of course, anybody has reservations about something new or different, we found that there was a place and an acceptance because ultimately, if you could see patients getting better in a way where they also had more quality of life, everybody wants to see that happen.

Yeah, yeah, absolutely. I'm actually on an oncology shift this quarter with Seattle Integrative Oncology, and it was really beautiful to see how naturally our medicine just comes alongside and helps patients with, I mean, especially doserae, helping them understand why their treatments are really necessary. And with the variety, the spectrum of misinformation that's out there around natural or alternative medicine and really just improving quality of life, it's. It's really incredible how simple it seems, but it's not being discussed in their other appointments. And so relationships with naturopaths become really important during their treatment.

Absolutely.

Yeah. How did your residency. Did you do an additional residency or is that your. That was the residency that you did.

That was the residency post graduation.

Yeah, yeah. How did that inform. How did that inform all the years that came after?

Yeah, well, I certainly got a lot out of it. I was able to, right off the bat, see patient after patient after patient after patient. And when we are just getting done with school, that's a time where you'd like to really, really reinforce those concepts that you've just spent so much time shoving into your head. You've just done all that work making sure you pass your boards. So transitioning, for example, maybe into a space where now you are working on putting a shingle up and opening up a business, but it takes away from seeing patients can be a bit scary or daunting. And so I feel like I was really lucky to have that. That space because instead of my brain going to a whole new, brand new thing that I wouldn't have tackled before, and now I could at least just throw myself into our medicine. What I'd spent the last four years really working to learn. And so I felt like that, that was really fundamental to me. And when I got out, in terms of being confident and leading to becoming a successful practitioner in my own space, in my own right, and so very grateful for what I was able to receive there. And then just simply put me in a place where I thought, well, how do we give back?

Yeah. Yeah, that's incredible. When did you step into the role as the. The residency director in your current position?

Yeah, so I started the residency. I had a little bit of trepidation for a while. I figured, who's got any business being a residency director until you're at least five years out? So I think maybe. Did I even. Nope, I don't think I waited that. And I thought maybe I should. But where I was at happened to be an integrative laboratory. And they were really. And this, this, this laboratory had a very close relationship with a clinic nearby. And so I was straddling both worlds. I was working in a lab space where I was exposed to so much data and, and various test results and really being able to trend what was going on in the community and at the same time in practice, seeing patients, honing those skills, seeing what that felt like and the interested in bringing on more people like myself, as was the clinic. And because this was such a huge just play field of resources, like you had labs, it's your exposure. It's a large clinic with 20 practitioners on staff, including acupuncturist, chiropractors, dietitians, MDs, POs, et cetera. That I thought, well, wow, this would be a really great opportunity to establish a residency program. So I did that. And of course from business perspective as well, they saw this as a good use of their resources too, because it means that you're able to bring in new practitioners under somebody's leadership. And so, well, maybe somewhat bluntly, it's a cost effective way for various organizations to bring in something that might not be an absolute certainty at that moment. So I got started and actually had the pleasure of bringing in my first resident, which happens to be Dr. Kira Fitzgerald, who is out and about and a big IFM speaker and published in books and all kinds of wonderful things that she is adding to our community as well. And so it was just, it seemed so natural. I was in a place that had so much to offer in terms of teaching that even despite my own self imposed rule of you should at least be out five years, I was able to rationalize that away. But by thinking about, okay, all these other practitioners that have decades of experience, all these PhDs with decades of experience, let's just get this thing going.

Yeah, it sounds like in that scenario you were creating the program, but you weren't necessarily the only teacher. And so you had all these other folks with so much experience that you got to put your resident underneath the wings. What an awesome opportunity. And I'm glad you bring into the conversation the business efficacy side of things, because is is a part of the conversation when we're thinking about adding a residency to a business model. What are some other considerations you know, business or otherwise that you think like business owners should consider before they start a residency program.

They need to make sure that they are in the right philosophical space for doing that. And so what that means is they need to recognize all of the stipulations of our accredited residency program and what they provide for and what they talk about is not that that person is merely acting like an employee from 8am to 6pm what it stipulates is that you have to have adequate time off from that primary responsibility to rotate with other clinicians to be able to do rounds in other places to have time to process and think about the information. So they have to have the recognition that this is an educational space, that this and, and these educational opportunities must be provided and, and the realization that this isn't just somebody who's quote, unquote, punching a clock from you from morning till evening. I think it's. Again, it was always important for me to think about this because one of the reasons that we as indies will get pushback, you know, as we're licensed in almost half the states, but not all 50. Yet one of the things that will be said is that, well, no, you aren't the same as other primary care physicians because there's not a required residency. And the reason there's not a required residency is no fault of our own. It's because they. There's not enough of them that exist for everybody. So the way it's situated now is I'd have to check these stats exactly. But back, back in my time about 20 years ago and maybe 10 years ago last time I looked. But anyway, there's probably about 10 to 15% of the residency and I might be even that might be strong 10% of the residency slots that we need to cover everybody who graduates every year. So to me it was important to establish residencies to help gain credibility for our discipline. And at the same time that also is something that I think we can let businesses know as well that they are doing things that help to support naturopathic medicine. There are businesses out there that are, that, you know, a lot of their support comes from naturopathic medicine. This was for example, an integrative lab or for example, maybe other supplement companies that are out there. So they have an incentive to bring in NDs and health residencies and health credibility because again, this is a large portion of who is driving this medicine and therefore driving use of many of these tools. So getting them to understand that, that the, the symbiotic nature of these relationships, I think is important not only to them, but to our discipline as well.

Yeah. And you're kind of. You're mentioning these folks as like, they're essentially sitting in that kind of sponsorship role, is that right?

Yeah.

And kind of. Kind of a little bit of financial support around getting the residencies established and keeping them running. Yeah, yeah. I think that's. It's a complex relationship, but it's really important to, I think, keep that in mind as well. Thank you for mentioning that. Going along with that. That credibility piece, and it is such a huge residency is such a huge part of what brings credibility to our profession. I wholeheartedly agree with that. And it is. It is hard to access. So we have this tension for those who are coming out into the professional world with lack of availability, lack of that ethos that you described. I would love to say that is the ideal that we run into as students, but that's not always the case, is not always finding residencies that are focused on continued learning. And this was a conversation we had with another. With another guest who is. Who's currently in residency. Their residency is very supportive and affirming and having that element included as well, recognizing that new doctors are very vulnerable and they do need encouragement and support to step into these roles that previously they were doing under, you know, someone else's licensure or directorship or direction. Now they're stepping into that and doing that alone. And high volume, high volumes of patients with that kind of like. It reminds me of like, bird wings when they're, like, still wet, you know, and they. They're like, resting and waiting for things to dry so they can actually fly. And a lot of pressure in. In certain circumstances where a lot of pressure gets put on new residents, unfortunately, I've just seen that be really negative experience. So. Yeah, I'm just. I'm grateful that you're bringing up all these pieces because I think they are really important and lead for a more. It's a complex picture.

Absolutely.

Yeah. Yeah. What. So we've got some. You've had. You've offered some suggestions for people who. Who are directors or who are creating residency programs. What about for the folks who are applying? We're kind of in that season now. This episode is coming out when we're in the season of application and match and all of that. What are some suggestions for folks who are applying for residency? What should they be asking in their interviews and what should they be considering or looking out for?

Yeah, well, I think the major thing is where is your passion? What lights Your fire. And that's going to give you, you know, your best direction. So I can remember being interviewed for residency by Yale, the integrative center there, and by Dr. Katz, who's pretty well known in the integrative space, and, you know, very excited about the pedigree of that residency and whatnot. And so he was the one that asked me that clarifying question, what's your passion in terms of who you want to treat? And so while I was offered that residency, it was at that moment in the interview that I, you know, that I realized my passion is really cancer. So I was in a very lucky situation of getting to choose between the two. And as much as I was so impressed with Yale and Dr. Katz and all of the facility, he was really the one that asked that clarifying question that moved me and the direction and the space that made the most sense for my heart. So that's really what you want to look for. What's going to facilitate your passion? Where do you want to be? Is it going to facilitate those goals? I think, second of all, then look for people who have gone through that residency program and talk to them about what opportunity it provided. Again, I think some of the nice thing about, for example, the residency that we do at Progressive Medical is that it does provide some logical stepping stones after the fact. Many of our residencies are just that they're for a year or two years. At Progressive, our residency, we request two years. There's no mandatory anything for anybody on the planet. Anyone can do anything they want. But so, but that, that. That's our. That's our preferred. And so understanding those goals and then as we move through something like the Progressive residency, you know, one of the reasons, again, I feel like it's such a good place to have one, is because there's some logical next steps. So many times you're just there for a year or two years and then that's that. Then it's then your time with that practice is over. Sometimes they need another permanent practitioner on board, but. But generally that's not a guaranteed element of any residency. It's like you're here and then you cycle out. Now at Progressive, because we have such a strong relationship in that laboratory space as well. Precision Point Diagnostics, which I am co founder of, it means that I have a network of clinicians all over the country, even internationally, that up less, but all over the country in terms of people that are using a lot of the testing that they will have previously experienced at the clinic. And so it gives me a Natural network to talk to people around the country about, do they need to add somebody to their practice? In addition to that, I am the educational director for a large physician supplement line. And so, again, because there is a use of those things at this clinic and we have a good relationship, it means that I can talk to them about what other, you know, practitioners out there are using these similar tools. I've got a resident that's very familiar with these. What can we do in terms of slotting somebody out there in the space? So looking for ways that the residency is going to move you into your next steps, because you know that this is, you know, a year or two years. So does this facilitate where you want to be after that? So I think those are some of the things to be thinking about and looking for. Does it facilitate your passion? Does it provide more of a skill that you need? And then is it going to provide a next step for you for that, a more permanent place in terms of what you're going to do next in your career?

That's such a powerful point, too, for residency directors and clinic owners as well, is to implement some way of connecting your residents into your networks. And I think that's a really important piece that often gets neglected is how you're going to help them transition out of the residency once they're finished. How are you empowering them? What doors are you helping open for them to connect them with the greater community, professional community. That's awesome. Yeah. Thank you for sharing that.

Yeah, yeah. And to any clinic that somebody were to end up at, that's a good way of looking at it. Look to see, you know, what are the procedures and what are the relationships that that clinic has? Do you do a lot of IVs? Therefore, they're going to have a relationship with places with different Internet, you know, national pharmacies, wellness infuserve, et cetera, and then talk to those organizations about other clinicians and ask them, do they know people that are hiring, or maybe they use a lot of a particular, you know, supplement, supplement line or a lot of various, you know, botanicals in terms of tcm, and then reaching out to those organizations. And that's a good way to establish a network when we are so small, because internally, our own ability to network in terms of NDS, you know, for example, I think that about 400 to 600 of US graduate every year, compared to 25,000 MDs that graduate every year. So they have a much stronger natural network just because of numbers themselves. So we have to figure out, you Know, what are those ripples in the pond that are being affected by what we do? And use those to help take your next steps.

Yeah, absolutely. Honestly, that's one of the primary driving forces for this podcast, because what I've been finding is a lot of those resources tend to stay pretty siloed into where you went to school or what region of a country you're practicing in. And we don't get to hear, really, from resources across the board, across, you know, all of. All of our North American practitioners. And really, we're all working towards the same goal, but we're not really sure how we're connecting and doing that. So it's like all these little puzzle pieces that are moving within their own confines. And I think it's so important to remember is like, the networking piece is we have so many resources across the profession, and networking and connecting with those, even if they're not really your passion, you know, they're not in your area of fertility wellness or oncology treatment. Like, being able to have colleagues and connections across the profession is really powerful.

Absolutely. And, of course, stay connected with your professional organizations on national levels and state levels. That can be quite helpful, too.

Absolutely. 100% agree. How many residents do you have currently or how do you off. Do you have on a regular basis?

Yeah. So we have had different numbers at different times. In general, we add somebody every year, but then there's a second resident. So two. You generally two at a time. We've had some moments where we've brought on five at a time, so it fluctuates. But that's our general model. And I have been doing residency programs. Wow. Since I. I was back at that lab. So that's probably 2003 or so, at least. So a long history in terms of doing this and. And being in the teaching space, because teaching is different than doing so that that's a skill as well. So, like I said, nervous about it until I felt like no one should be doing any of that until they had at least five years of experience. So I'm well past that at this point. You.

I mean, you're such a natural teacher. It doesn't surprise me at all that that was something that pulled at you, like, right out. But I'm just curious, kind of how you.

Not really. It was terrifying.

No.

Well, that's what I was gonna ask.

How did it feel in the moment?

Terrifying. And, you know, people often say to me, wait a minute, weren't you the quiet one in the back of the room? That's at Bestiar. And I'm like, yeah, because that happened, it scared the pants off of me. And I think that that's a natural thing that we all feel as we're graduating and going out there. So that's normal if you're feel, but then still go do it anyway. And not just because of the loans, but again, because of your passion and because we know more than we think we do. And you know, anytime that self doubt creeps in, I just encourage anyone to just go to a standard grocery store and watch what people are putting in their carts and then decide, do you really not know enough to help somebody? And I think you'll quickly realize no, that's not the case. And you know, I had the one thing that was nice in terms of that integration at cancer treatment centers. Not only were there indie residents, but they were medical residents as well. And so I got the unique opportunity to kind of see how our education stacked up. And I was like, wow. I mean, you know, I did not feel like our education was lagging behind in any shape or form. And I think that that's something that we all feel as we're getting to the end. I should have learned more of this, they should have taught me more of this. And that is a natural part of it. But again, I would be assured that really our education is quite strong, our medicine is quite strong. And if we follow that medicine, it comes with an inherent wisdom that we're able to impart to others. So just do it. Anyway, so I got started in this space again because I saw that the lab around me and the clinic around me needed more people, they were growing. And so I thought, well, here's a way to give back. And then in terms of the teaching part, that more got started because, well, there was somebody else out there that was supposed to do a whole bunch of lecturing and teaching and he had an issue where he got very sick. And they said, oh well, you've been working in the office next door, so you must know all of this too. And again, he was probably two decades in at this point and had written books and I was like, maybe, but you know, went out there and just did it because again, our medicine is wise. And what we learn, we do learn, you know, a ton and a ton. And, and, and it, it does stack up against other education programs out there.

Yeah, I have to agree. You know, I'm, I'm more current in the educational spaces and at University of Washington actually has like a program within their medical program where they, the students can choose, like, different things to explore. And one of them is, like, natural. They actually come and do a week in our clinic of different shifts. And it's really fascinating to be on a primary care shift with one of those students. And we're just like rattling off treatment plans and we are rattling off, you know, DDX and all these other considerations. And I've seen some of them just like their eyes glaze over because they're not there yet in terms of that level of patient care. And, and I think it's really, it's really cool to see, not that I'm trying to criticize their methods or their. That we are very capable and we don't often get to see that comparison that can. That compare and contrast with, with people in the allopathic fields.

And I think it is why the field keeps us intellectually curious. And as you were mentioning, we're both a part of Origins Incubator, which is predominantly MDs and DOs. But again, they come over because they say the medicine wasn't allowing me that intellectual curiosity. It wasn't allowing me to think about the patient as an individual. And we start off needing to think about each patient as an individual. And if you're going to do that, it can't be protocol driven. It can't be for this, you give this. It has to be thinking about those pathways, thinking about those intersections. And how's that all coming to play in this patient? So inherent in the medicine is the idea that you've got to be moving through the logical system. Not just as you can't be like the kid who just writes down an answer on their math test. Right? You've got to move through it and show your work and kind of get to how each step leads to the next thing. And so when you do that, it means that all that biochemistry stays fresh in your mind for the rest of your life because you're using it every day. I mean, I'll talk to colleagues at MDS dos and they're like, how do you know all this biochemistry? Like, we were never taught this. And so when they, you know, when they are learning the citric acid cycle, there was not an inclusion of those B vitamin co factors and the amino acids flexing in and CoQ10 from Succinate to malate. And so, but for us, it was a natural part of how we learned medicine and how we learned patient care. That individualization means that you've got to think pathways and think individually, which means that you. And the nice thing is that it really invokes that curiosity.

Yeah. Are you, were you a student of Dr. Littleton? Was he at Bastyr when you were. Yeah, that's just what it reminds me of immediately. He was always very concerned with us knowing those cofactors and, and they were on every exam because of this very reason. He knew down the road you're going to need to know these things and why people are taking these supplements. And so just a shout out to Dr. Littleton because he finally officially retired and we just love him and want to show our gratitude to all the folks who are teaching in the basic sciences. Is in our.

Not only was he a biochemist, but an ND as well, right?

Yeah. He put himself through the program, right?

Yeah, my year. So he wasn't actually teaching. He was a classmate at that point.

Oh, okay. Okay. Wow. Wow, that's. That's incredible. Well, thank you so much for this today. What a rich and vibrant conversation. Anything we left out is that feels like it's still kind of burning at the edges.

Just that people are always welcome to reach out to me if they have questions about residencies. I do have a residency in Atlanta, Georgia, so it's one of the few sunny spots. It's also one of the few accredited residencies outside on the school system. So if you're looking for a different perspective, you know, call me up, email me, we can talk about what's going on, but just in general as well. And as people get out there, just be thinking about what you valued as you're going through your training and be thinking about how you're going to give that back.

Yeah, that's wonderful. Thank you so much, Cheryl. And we will include all of Dr. Burdette's information in the show notes today so that you can reach out to her if you feel like you want to connect. And thank you again so much for joining us today. Thank you listeners for following along. If you are you have any questions or want to reach out, please leave a comment. Make sure you like and share and we will talk to you again soon. Thank you for joining today's discussion on by the Roots. Please share any questions or comments you have on this episode or join the discussion on our Instagram page, ytheroots. The podcast like follow and share for the most up to date content. We look forward to sharing again with you soon.