Tea Nguyen, DPM (00:54.178)

I have an allergist today and I'm so excited to bring her on to talk with us about how she built her direct specialty care practice. Welcome to the podcast, Dr. Brynn

Brynn Everist, MD (01:02.68)

Thank you so much. I'm Dr. Brynn Everist. I run a direct care practice based in Kansas City. And I opened about three and a half years ago. And I well, I absolutely love it. And my patients do too. It's just it allows us to provide such a different level of care, different quality of care. And it's such a feel good way to practice. So, but thank you thank you, T for all of the work that you've been doing. And

Introducing other physicians to this model of practicing and and opening the doors and and really showing them how to you know, how it can work and how it can be sustainable. So thanks for what you've been doing.

Tea Nguyen, DPM (01:45.432)

I'm always glad to hear that because sometimes I'm here on a monologue talking to myself and I'm like, is anyone listening? Like, does this matter to anybody? And once in a while, you know, I get into an existential crisis and I'm like, do I keep going? Or what am I doing? So it's good to have you here to talk to us about your specialty. My rare experience with an allergist is my daughter's eczema flare-ups. And at first I thought we had to go.

to like the pediatrician. So they guided us a little bit and then to a dermatologist. Luckily I'm, you know, a medical professional and I can just like text people problems and, you know, I get a quick answer. So I had that privilege of access. But eventually it got to the point where we really needed to figure out what was going on beyond slapping on medications, you know. And I was one of those moms that was kind of resistant to having a whole bunch of steroids on my kid. And because she developed it so young, I didn't know what I didn't know, right? So then we got to see an allergist. What I didn't know about an allergist is how efficient they are with all the things they have to do. Like there are so many tests that has to be performed. And one for her was the one where they had to poke her on her back, like multiple pokes, superficial sub Q pokes, to figure out what she's allergic to. And that was probably one of the most traumatizing things I had to watch my daughter go through.

Because she was scared. She couldn't see, you know, what was happening. All she could feel were the pokes. But then I realized in that it took so much time to go through the test to interpret them and then to make sense of what all that means. And that's something you just can't do with, you know, we have AI now where it's like you put something in and you get something out. But there's context involved. And a lot of the questions I had at the time, I bet you get a lot of patients asking as well is, well, what's the one thing that I can remove from her diet, from her environment, so this goes away forever, not realizing there's more to it than that. So I'd love for you to speak to us about how you felt your practice would fit the direct care model and why it was necessary to do this.

Brynn Everist, MD (04:02.422)

So I think that that situation is one that I encountered again and again and again in a traditional model. And I was so frustrated by the fact that I was given 15 minutes to talk about that with a family. In my practice, I usually have about an hour to an hour and a half with every new patient. And I get the full story, right? The whole history and the family history and and what the families tried, what they're reservations are about the different therapies that have been recommended to them to date. And we do, and I love to do allergy testing because it does provide another, another data point for us them as to why that person might be having that particular allergic condition. But at the end of the day, it really does boil down to education. 

And what it sounds like you're missing is that really in-depth educational piece about What is eczema? What causes eczema? What triggers eczema if you do have it at baseline? and then and then to really probably de you know, there's there's well, there's a so much misinformation out there on the internet, everywhere that friends will tell you that, you know, well-intentioned grandmothers will tell you everything about about what is triggering your kids' eczema. And there's a lot of demystification that we do as allergists of really talking about this is what eczema is at its root. It's a genetic thing. It's you know how your genes are uniquely working, interacting with the world around you. And I mean so my families are like, we tried to eliminate this thing from the diet and that thing from the diet. At the end of the day, this poor child's eating like nothing and still has eczema.

And sometimes it comes down to that pointing out to the family, yeah, eczema is a skin condition, you know, it's not something that you're eating. in but even if you feel like there is something your child's eating that makes the eczema flare, if you were to pull that thing out of their diet, that actually sets them up for higher risk of having a food allergy to that thing that you've removed from the diet. And then you're trading this problem that I I know I can treat. I can treat eczema. We have a big old basket of things we can use to treat eczema.

Brynn Everist, MD (06:23.534)

Treating food allergies is tricky. That's hard. That's a, that's another, totally another type of a journey. And so it's a lot of education around what we can do and what we shouldn't be doing for those conditions.

Tea Nguyen, DPM (06:37.496)

So take us back to where you were after, let's say, residency training. You're a trained pediatrician, correct?

Brynn Everist, MD (06:44.104)

Yes, actually. So I did my pediatric residency training at Mayo Clinic in Minnesota. And then we got to go spend a year in San Francisco for my husband's fellowship. He's a musculoskeletal radiologist, so he does bones and joints. and his claim to fame is that he gets he's the the radiologist for the Chiefs and the Royals. So he gets to see those guys sometimes.

But we were in San Francisco for a year and then we moved back to Kansas City, which is where we're both from. And I practiced pediatrics on a very part-time basis, I would say. I was having we're having our family. And so we ended up having three kids. And I was working at a at a clinic in kind of an underserved part of the area. and I liked it, but it wasn't God. I love pediatrics.

But there's something that it just didn't, it didn't always fit with me. And I had this opportunity about seven years after completing my residency to go into an allergy fellowship at our local university, University of Kansas. And I mean my third kid was not even a year old when I was offered this position. And I was just like, my gosh, can I do this? Can I actually go back to fellowship right now? This seems wild. We're like so settled. We have a

like a real adult life. And but I thought, you know, if I don't take this opportunity, I will regret it forever. And I'm so glad that I did because it was one of absolutely the hardest things I've ever done to go back. Because medicine, as you know, it's still such a hierarchical thing still. And so to go from being really a staff attending with physician parking, and then the next day I'm a fellow and I am like demoted in some ways. You know, and

I'm I was older than some of my staff. I had definitely been practicing medicine longer than many of my staff. Though this is so strange, but I have so much to learn from them. And I just dove so far into just craving every piece of knowledge that I could in this fellowship. And I thought, can I can this old dog learn new tricks? And I I did and I loved it. And I learned that the reason that I think pediatrics didn't fit with me is that

Brynn Everist, MD (09:07.106)

Pediatrics is a wonderful field and God bless pediatricians. They have to know so much. The breadth of the knowledge base is so wide, but then it doesn't go very deep, right? Because you can't. You can't know every specialty that is broad and that deep. And it frustrated me in pediatrics that I didn't know everything. And so if there's a problem, I had to send that patient out to a specialist. And in allergy, our our we don't have a breadth of of

material that we cover, right? We're covering the immune system. We're covering it really deep. And so and I love, love, love the fact that I know the immune system, you know, in and out, backwards and forwards, and that I'm kind of the last stop for my patients to go to. So I think by the time they get to see me, they they, you know, they usually have talked to a couple different doctors about their allergic condition and and coming to see me, they get to really dive in and learn all the things they need to and really talk about management strategies for what they're doing. and the other and the thing that I love about being an allergist is our ability to manipulate the immune system and retrain it and drive it to do the things that it should be doing. 

A lot of allergy is the immune system learning the wrong thing and having the wrong reaction to something that shouldn't be a trigger in that person's life. You know, you take a kid with an egg allergy and think, why is the body reacting to egg this way? That's not right. And so the idea of immunotherapy is that you could take the immune system back to school and retrain it for all the things that it should be doing. So that's what I love to do. And make people feel so much better. You know, if they're treating their environmental allergies or or you're making their life safer and treating their food allergy, it's such a joy.

Tea Nguyen, DPM (10:59.0)

There's no doubt that what you do is so meaningful for so many kids and families who stress about their immune problems that can't be answered in short visits. So to me, this makes logical sense that a lot of allergists in private practice could probably succeed in direct care. So you've been in practice for three years now. How did you conceptualize what this would look like for you?

Brynn Everist, MD (11:24.472)

Mm-hmm. Great question. And I don't know that I have the answer for it. It was really just taking a chance. It was asking that question, can I do this in allergy? And I tried to find other allergists that were doing it. And I found, how mate, I think there were two others in the country doing it when I started my practice. but neither of them was doing it the way that I wanted to do it.

one of them solely does does sublingual immunotherapy for foods and and environmental. and that's that's really what she does. She specializes in that. And then another in Sacramento, he does allergy shots and doesn't do sublingual immunotherapy. And I I wanted to kind of do everything. And I wanted to introduce this other type of immunotherapy called in photic immunotherapy. And so I really wanted to be able to to to offer lots of different things for my community. And in my community also there was only one other practice that was offering immunotherapy for foods when I started and that was really important to me too, to be able to offer that kind of therapy.

Tea Nguyen, DPM (12:37.72)

Can you tell us a little bit about how you structure the way patients access you? Are they paying per visit? Are you still involved with insurance with all of these things you prescribe and recommend? What does that look like?

Brynn Everist, MD (12:50.322)

I would say it's a little bit of a moving target. And I've actually really valued listening to your podcast to kind of understand the way that other people are thinking about it. I started my very first couple of months, I started as a subscription model entirely, but then I really f quickly felt like that wasn't the right strategy because I would see a patient, they come in for consultation and I would address their concern, but then You know, they didn't really need to come back and see me. I, you know, we talked about it, we had a great strategy, things were looking great, they didn't need to come back and see me. And so I thought, well, that subscription model doesn't quite fit there. It fits my immunotherapy packages that I offer. and those are some higher dollar items, right? So I have a monthly fee when I for my sublingual immunotherapy patients.

And I have a package fee for my intralymphatic immunotherapy patients because that's a higher price point treatment. and otherwise I usually pay a fee for service. my food allergy patients, they're on a subscription model because I when I wasn't doing it that way before I found that

even if they're well controlled, there's still a lot of questions, right? There they're emails that you get, text messages you get, phone calls, and I want to be able to dive in and really take my time and answer their questions and be there for them. But if I'm not gonna get reimbursed, then that means that I'm sacrificing time that I could be seeing another patient and I didn't want to struggle there. So those patients are on subscription as well and then they know that they have full access to me. so it's both. when I see new patients

I have a flat fee for that and that 's it's the whole hour and a half conversation and then at that visit we decide what we want to do moving forward and I give them all the different price points of what we can do. We set a plan.

Tea Nguyen, DPM (14:56.536)

So you're setting the precedence for allergists in direct care. If you're saying that there were a handful, you know, already in existence who are not neighbors to one another. So you get to decide what the future for allergy medicine really looks like. Did you ever think of it that way?

Brynn Everist, MD (15:15.064)

Gosh, no.

Tea Nguyen, DPM (15:16.694)

It's a little scary, right? You get to decide. And I I think we've heard it over and over again that no two direct care practices are the same, even if we're in the same specialty. We get to decide what that looks like. And I think that is exciting for some, but a little bit scary for others who need structure. They need a plan to copy and paste. And I think with you and I sitting here, we are literally paving the way for the future. Maybe we didn't know that in the beginning. We didn't

plan for that, but then suddenly we find ourselves like we're literally doing whatever we want, however we want, pricing it the way we want. And then you just evolve with time as to what that will look like, you know, one year from now, five years from now. So when you opened your practice, what surprised you the most?

Brynn Everist, MD (16:05.544)

What surprised me the most, well, let's see, two things. One, I thought it was really cool that a doctor could literally hang their own shingle and do everything themselves. Every aspect of the practice, you know, ordering supplies, designing the office, receiving phone calls from patients. You know, there was I don't . I didn't have an answering service, you know, I mixed my own therapies for my patients.

that I thought was just really cool that a doctor could still do that today. I didn't have to have a staff of 50 people, you know, half of which were answering phone calls for me. I didn't need any of that. So I to be able to open up a practice without a single employee and do it well, you know, I hope I did it well. I feel pretty decent about it. you know, I thought that was really neat. that that was a learning opportunity for sure.

Tea Nguyen, DPM (17:01.026)

Yeah.

Brynn Everist, MD (17:05.516)

And also again, that's the joyous part, right? The flip side is it's also it is really hard. It's hard to figure all that out and how you're gonna do it. And I was the first allergist in my area. I don't even know if they were offering it in St. Louis. I was anywhere that I knew of that was offering sublingual immunotherapy for environmental allergies, you know, and that was also a hard thing because allergists actually are really judgmental about different kinds of immunotherapy.

And every allergy practice offers shots, but it's an evolving thing that some are now offering sublingual. And when I was in fellowship, I remember learning, they do sublingual immunotherapy in Europe, but we don't do it here. The ENTs do it here, but it doesn't work. So that's why we don't do it here. And I was just, I don't know, when I set looking into setting up my practice, I thought,

Is it really true? So I started just doing the research myself and I was floored by the kind of data I was seeing that sublingual droplets work just as well as allergy shots. Why didn't we talk about this in fellowship? So I actually called my program director and I was like, what gives? Am I not seeing something? Am I wrong reading all these different papers? And she goes, No, you're right. They work really well. We just don't do them because it's cash and the FDA doesn't cover it or approve it, so we just don't offer it here. I was like, seriously.

Tea Nguyen, DPM (18:29.11)

Isn't that funny that we're so we don't realize how ingrained our system is in driving our decisions until we leave it and recognize the reason why we have a bunch of data on that is because there was money flowing to support the research.

Brynn Everist, MD (18:43.544)

yes. And that's I think a disappointing thing maybe about what I know now about our medical system is really so much of it goes back to where the money is flowing. And it and that's really really hard because I have so many patients that say, Well, why doesn't insurance cover sublingual droplets? Or do you think insurance will ever cover intralymphatic immunotherapy? And and I have to say I don't think it ever will because

To get FDA approval for these things, you have to have the right kinds of studies, right? And those studies are so expensive to run to get all those patients to do them. And there is no one in my field that has those deep enough pockets to do those studies that would then benefit from those studies in the FDA covering these treatments. The only com only ones that might be able to do it would be the extract companies, the ones that actually make these purivite extracts of.

like you know, oak pollen and dust mites and ultranaria, you know, though the companies that make those purified extracts, they might be able to afford those kinds of studies, but it wouldn't benefit them to do that. They already have the market that they need selling for typical allergy shots. So it's it's odd when you start tracing back of why is this? and that's disappointing, I think.

Tea Nguyen, DPM (20:07.392)

Yeah. I didn't see that until I left it. And I was like, the reason why we don't recommend certain things is because doctors feel uncomfortable talking about the cash prices of those alternative options. And to me, it's wild to just accept that to be and not provide options because we're supposed to be our patients' advocates, but how can we advocate if we don't know how to have those conversations or we're unwilling to look outside of the system?

So yes, that's a whole conversation for another day. And it makes me really upset when I think about all the limitations we have within this structure. Not that it's all bad, but you know, certainly it doesn't really help when we can't have those conversations openly and honestly. So let's get into your practice development over the last three years. Does your practice today look like how you planned it on day one?

Brynn Everist, MD (20:51.584)

Mm-hmm, exactly.

Brynn Everist, MD (21:04.92)

Good question. Yes and no. I think I am delighted by where my practices come. It was a dream of mine to start doing intralymphatic immunotherapy when I started. And it took a year to figure out the kinks of how to do that. Luckily I was able to, and I started offering that about two and a half years ago, and then I was the fourth allergist in the country to do that. So it was

really exciting. and I've and I now train other allergists on how to do it. So I've started a training program which is really cool. I love doing that. I love introducing people to it and I love being able to say, hey, you know, this is still an emerging thing. So I need you to tell me what's working for you with it. How are you changing it? And so we now started a, you know, a actually community of us that that of those of us who are doing it in this country and learning from each other. And

And that kind of collaboration I didn't anticipate when I started my practice. I thought I was, you know, I really thought maybe I'm gonna be alone, you know, a dark horse, you know, if you will, of this allergist that has this weird business model and offering these weird treatments. and the wonderfully delightful thing is that I have built this really, really amazing community of other allergists from around the country that

Have come to me asking for advice on setting up their own direct care practice, or those who have wanted to come and train with me on learning this kind of immunotherapy that I do, the special procedure. And that's been really exciting. And I was definitely an early adopter of the sublingual immunotherapy that we use for allergy for food allergy treatments. I was really inspired by some of the data there and I jumped into it.

And so that's been a really fun part of my practice and developing a community with other allergists that are offering that as well. So I think that's been something that I really didn't foresee in this practice. But what I wanted to do was I wanted to offer these different kinds of immunotherapy options, and I'm getting to do that. I didn't know that my first tire was gonna be a physician's assistant. but

Brynn Everist, MD (23:19.37)

a year and a half in, I met her and she was just perfect. She has over twenty years of experience in allergies. I knew I wouldn't have to do a lot of training. And she was looking for something a little different and and I was really excited about having someone in the office that would be kind of a partner, you know, that you could share share experiences with and someone to really help me support the practice to be there if if, you know, I couldn't be physically in the office. so that was I think maybe a surprise.

I thought I might be having an MA or an RN, but I would. I just don't really think I need those roles. You know, I like greeting patients when they walk in the office. I like answering the phone when I'm available to say hi. And I still get the my gosh, wait, is this this this this is the doctor? I'm like, Yes. Hi, nice to meet you.

Tea Nguyen, DPM (24:09.174)

And they're like, I'm so sorry, did I call your cell phone? I'm like, Yes, I gave you my number.

Brynn Everist, MD (24:15.15)

Yeah. So those are delightful things. but then in then I'd say the stresses are probably the same as any business owner. You know, you look at your your you know, your revenue and and your expenses and trying to balance all that and make sure that everything everything is working. and and so far, yeah.

Brynn Everist, MD (24:39.906)

There's no way right now that I would turn around and start taking insurance. So I'm really excited. And I'm excited that there is a way, a path forward of this kind of practice in allergy. Allergy, like many medical specialties, is getting really crunched right now. insurances are reimbursing less and less for office visits and treatments, and even denying things or or down down coding things automatically, like reflexively down coding.

And then everything else is getting more expensive. You know, your MAs are more expensive, your RNs are more expensive, the cost of all the extracts, which are like liquid gold already, those are all going up. So when your reimbursements are coming down and the cost of doing business is coming up, you get pinched in the middle, you know, and medicine's unlike any other business, you can't just raise your prices. It doesn't work like that in medicine if you are contracting with insurance companies.

Tea Nguyen, DPM (25:37.13)

So how do you purchase the stuff that you need for your practice?

Brynn Everist, MD (25:43.976)

directly from the suppliers. That's pretty easy. I just have a

Tea Nguyen, DPM (25:49.422)

I don't know anything about allergy needs. I didn't know if they were expensive. I didn't know if you had to go through a pharmacy or anything like that.

Brynn Everist, MD (25:57.054)

No, there I mean again at different practices we'll do it different ways. The way that I do it is I I contract with one of the four extract manufacturers in our country. and one is owned by the military, I guess. That's it. And then they make some, but then there are three private companies that make extracts and they all do it a little differently. and I prefer one for various reasons. And so I I

I have a contract directly with them and they and so I buy these bottles or fifty ml bottles of of d the different extracts. so you can come to my office and you have this like, you know, extra of these

Tea Nguyen, DPM (26:41.007)

It's an apothecary box. It's so wizardry, you know.

Brynn Everist, MD (26:44.526)

It is. It is like wizardry and because you get to mix your own potions for people depending on what they're allergic to. No, that could be

Tea Nguyen, DPM (26:54.754)

total niche because you're a pediatrician and the kids can just come in and it'll be their little, you know, apothecary wizard recenter. Hey, business idea right there.

Brynn Everist, MD (27:05.518)

There you go. There you go. Yes, I know. So yeah, then that's how we do it. And we and and and I mix my own formulations for their immunotherapy. If it's sublingual and good, we're doing little droplets under the tongue, or what we call subcutaneous, which is where an allergy shots, or my intralymphatic therapy that I do that that we actually do a it's an ultrasound guided lymph node injection is the way we do that. And the cool thing about that, some people call it eyelet, I call it quickly in my practice.

and the really cool thing about that is that we take five years of three to five years that someone would typically be on allergy shots and you get to condense that therapy into three monthly injections. So it is really exciting.

Tea Nguyen, DPM (27:48.916)

It's really, really cool. I also wanted to talk a little bit about Amuse Drops. You don't have just one company. You have a product company. And that's a totally different funnel. And I wanted to know a little bit about well, before we get there, I want to know how do patients even find your practice? Like how did you grow it? And then we'll get into your product.

Brynn Everist, MD (28:11.382)

I grew it entirely by word of mouth at first. So my I I think I'm lucky because my kids were in school are in school still. And so they are we have a really great community right with the school. And so people knew that I was starting my own practice and then I was gonna be offering something a little bit different. And and they were really, really supportive of me. And so I grew that way at first. And I tried to go around to some pediatric offices at first and some family medicine offices.

But again, right, I was opening an allergy practice with a completely different business model, offering completely different immunotherapy options than any other allergist in the city. And so it took time for referring physicians to understand what I was doing and to understand the value of what I was doing. It took patience of mind to go back and say, Hey, this person's doing this thing, and it was a great experience. You need to send more patients her way.

So it took some time, but like I said, I opened up without a single employee. And so starting small was good. And then growing slowly and then, you know, and then hiring my PA. so and we still have a really lovely, steady, steady growth. and now I do get referrals from other physicians that have heard my name often enough that they understand the value of what I'm doing. So much so that because I

I understand it. You know, I've been in their shoes where they don't have much time with their patients. And so to tell somebody, hey, I'm going to send you to this allergist that she doesn't take your insurance. And so you're going to have to pay cash. And but there's going to be a value to you in doing that because the quality of care is going to be different or the kind of treatment that she offers is different. That that's going to be a five-minute conversation, you know. And so I am really grateful for it.

for any physicians that send patients to me because I know that they're taking extra time because I'm not the click button in their EMR, you know? I'm an e I'm I'm a five minute conversation and I really value that. So thank you to anyone out there that's referred patients to me. I appreciate it.

Tea Nguyen, DPM (30:22.478)

No, I agree. It does take so much time to quote unquote convince a patient that you should see this person and it is out of pocket and then the pushback and all the things. But the most valuable patients I've received are the ones who come from other doctors because that's the biggest trust point. If my doctor referred me to you, I'm gonna go see that specialist, you know. And it's just so much more powerful and it does take a little bit more effort, of course.

So let's get into you've got a product line now, which is really cool because you have the freedom to do so. You don't have a business, you know, employee contract that says you can't make money outside of this or we're gonna take a profit because you did this under the, you know, our contract or whatever. So tell us a little bit about what this is.

Brynn Everist, MD (31:10.388)

Yeah, so I so Amuse, we launched Amuse three months ago now, so it's brand new. I was working on developing the concept for about two years before that. I laughed though, you had somebody else on your podcast that also was a direct care doctor who also started another business. And you guys both laughed about, isn't that just classic for what we do? We had this one great idea that leads to another great idea. And we just think, I've all the energy to do these things. And and I I think I was really naive when I first started the concept of Amuse because I really thought I was make gonna make this thing that I would sell through maybe just through my office, just really low key. And a friend looked at me and he was like, no, that's not good

No, it's not gonna be low-key. You know, this is this is a whole business that you're starting and it's gonna it it's you know, you're gonna end up running it like a real business. And it's like and I was like, no, surely it's just gonna be something easy I do. but let's get into it because I'm really passionate about this. So one of the ways that I treat food allergy is called sublingual immunotherapy. They're these droplets of food proteins that you put under the mouth. And it's amazing that in a micro-dose set setting,

Tea Nguyen, DPM (32:01.195)

You know you're not low key.

Brynn Everist, MD (32:30.07)

you can actually trigger immune tolerance. So you take a patient that's allergic to a food, you give them tiny, tiny, tiny little amounts of that food protein under their tongue, they swish around their oral mucosa, and that drives immune tolerance. The studies looking at that show that the earlier you start between ages like one and two, one and three years of age, are actually have a more profound effect for treatment.

You know, we don't really like to use the word cure in allergy. It's a hard word for us. But we get results that lead to cure. And so I looked at this data and I thought, well, this is this is and I had this experience treating patients in this way and they loved it. It was easy. It was safe. and and and I just thought, well, gosh, you know, the immune system's gonna work the same way whether or not we introduce foods

later when you have the allergy or if you don't have the allergy yet. And I thought, well, wouldn't this approach, the sublingual immunotherapy approach, be the same concept as the early allergen introduction that we're already recommending? And so I I had this question, you know, could I put these, you know, I wanted to put six different foods into a single bottle to use as an early allergen introduction. and

And I was mixing in my office and and I figured out how to do it. Okay, I had the right right thing and trying to find a manufacturer for it then. And that was a r a huge headache to find the right person to do it. And it it took a year over a year to find the right manufacturer. but I did. And now so in actually instead of mixing whole foods, my manufacturer makes these purified protein extracts, which is great because they are totally shell stable. They

The expiration date is about two or three years. So they're really fabulous. and they and and it's a microdose system. So the idea though is that you know, when the quote, early allergen introduction should start around ages four to six months of age, that's really because that's when it's developmentally appropriate to be introducing foods, right? You're not gonna be putting, you know, peanut butter and in a two months old's mouth, right? That

Brynn Everist, MD (34:52.514)

That doesn't sound very safe. But proteins themselves are very safe. You know, there's a lot of protein that babies are putting in their mouths. Bacteria is, you know, one of them. Think about every time a kid sucks their thumb, you 're putting real things. Yeah, yeah. So proteins are very safe. So the idea is that we started even earlier than solids because it's developmentally appropriate as little droplets and you and you instill these little droplets under your baby's tongue starting around two months of age and start driving that immune tolerance so that when your baby is ready to start solids, it'll be really successful.

Tea Nguyen, DPM (35:31.16)

Does this product exist?

Brynn Everist, MD (35:34.08)

I launched it three months ago. It does. It does. Yes. My product exists. Yes. Yes.

Tea Nguyen, DPM (35:36.344)

So now it does your product.

Tea Nguyen, DPM (35:42.144)

It's a beautiful website. So I'll put all of your information down in the show notes to inspire doctors to like to do the thing. Whatever you're good at, just do the thing. Yeah.

Brynn Everist, MD (35:51.318)

No, well, you know, especially these babies that have eczema or their family history of food allergy, these are our really, really high risk infants. And what we found is that at four months of age, nearly twenty percent of our food allergic kids are already allergic to that food. So that means that even with early introduction of solids and allergenic solids, we still miss the mark. So many of these kids are already allergic. And so that also is like, well, we just need to start sooner, right?

Because early introduction of allergenic foods is currently the only way we know of that can prevent a food allergy. So it's a powerful metric, and it's not going to work in 100% of kids. No, but it really is shown to be very powerful, especially in those really high-risk infants. So I would encourage anyone who cares for young infants to really consider this because it's because I it's a great, it's a great product. and so

And if you ever have questions about it, please let me know. On our website, there is a contact me box. I get those emails directly. I'm happy to talk to anyone about it. I'm really enthusiastic about it. I love it. And I hope it takes off because I really stand behind it.

Tea Nguyen, DPM (37:03.906)

You guys have to check out the website. It's so cute. It's such a gentle green sage color in the design. I'm so into it. So thanks for sharing. Thanks.

Brynn Everist, MD (37:13.022)

Can I tell you about the name? Yes. Why did we named it that? So my company is called Amuse Drops, drops because it's a little droplet, right? And Amuse comes from inspired by a French term Amuse Bouche. If you know what an Amuse Bouche is, it's a little primer, a little taste that a chef will give you before your meal. And it's to prime or prepare your palate to enjoy the meal to come, right? And so Amuse is

And the way that I'm using it is that little primer for your immune system to prepare it for joyful eating to come.

Tea Nguyen, DPM (37:51.36)

Amazing. I love that. Yes. Yes to all of that. It's gonna be so successful. We'll tell Oprah. We'll tell all the people. I think it's wonderful what you're doing. And just, you know, you're doing it from a place of joy and satisfaction and just pleasant, just pleasantly fun, you know. And I I love being with doctors who just love what they do. And I feel like a lot of us love what we do, but we're in a system that doesn't allow us to do that.

We're shoved in a box. It's like, what is the analogy? We're like a square pig in a circle. Like it just doesn't fit for us to be stuck in a situation where we we dislike. We love the medicine, but we don't like the way it's being delivered. And when you're thriving in a you know direct care practice where the rules are truly yours, you suddenly develop product lines and you suddenly are, you know, all over news channels and you're doing stuff that is really meaningful, where it's literally changing lives.

And I appreciate that so much.Thank you. 

Brynn Everist, MD (38:51.96)

Thank you. It is a privilege to get to be so joyous in your profession. Right. It is totally a privilege. So I'm enjoying living in that and enjoying it.

Tea Nguyen, DPM (39:04.674)

I'm wondering if the doctor's listening. Maybe they've thought about direct care. Maybe they're kind of in it in the beginning. They still have doubts and fears show up. What would you say to that doctor about this path?

Brynn Everist, MD (39:18.578)

yeah, it is it is terrifying doing something different. I think that this path if if you're looking to do the thing that you're trained to do, because you at the end of the day, you really enjoy that thing. It's just the system that's holding you back. There is an opportunity for you. It it may be challenging if you have a non-compete or you work for a big hospital setting and you don't know how to get out of that. But there are ways and there are now plenty of us out there that can help.

We all love what we're doing. And as far as I know, we're all really eager to talk about it. So look on, you know, there are different Facebook groups. IT, you have a fantastic training program that you offer, consultation service. there are so many of us out there that are eager to talk to you about it. So if you're having hesitations or you wonder how do they figure out this part of the of this situation, how do I navigate that? Then ask somebody. We're all all here happy to help.

And I think though too, I think you do need to be prepared for that, you know, maybe you won't make as much that first year that you're out. There are some wildly successful stories and there's some that are like, well, you know, that first year was fine. I didn't go into debt. But that's the start of it. And then you get to roll from there and you really will make a nice income if that's kind of the mental hurdle that you're after. I don't know. It's you never worthwhile, I think, in life to take risks, right?

risks for your own happiness are so they end up being so worthwhile, right? They are just they are your life. So do it. Live your life.

Tea Nguyen, DPM (40:58.894)

I like it. Do it. Live your life. Not theirs. Right.

Brynn Everist, MD (41:03.956)

And honestly, we are taking big risks to do our best, right? Because the path that you've that you chose, the path that I chose, we are suddenly off the train tracks, right? I mean, the amazing thing about a medical career in some ways is that there is a straight shot. You know, you you hop on that freeway and you're gonna get to your destination as long as you pass your exams, right? And stepping off of that.

That freeway, those train tracks, whatever you want to call it, it is so scary. And yet that is that there's something inside of it that says, but that's the only way that I'm gonna get to do this and do it really well. Right. So that's that's I think what what my my thing was. I I wasn't doing what I wanted to do as well as I wanted to do it. And I had to figure out how to forge my own path in in order to be the best doctor.

And be the best provider and be there for my patients as I could be.

Tea Nguyen, DPM (42:07.566)

That's such a perfect way to end this. This is so wonderful. So great to have you. I'm excited to share this with the world. Forward to hearing about your success with your Amuse, which is a really cool name.

Brynn Everist, MD (42:14.07)

big clear.

Brynn Everist, MD (42:18.636)

Yes. Yes. Thank you so much, T. I really appreciate this opportunity. So thank you.