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On paper, Dr. Randall Evans had it all. But all his clamoring for “success” as a physician just left him exhausted, unfulfilled, and jaded with the healthcare system. That is, until he discovered psychedelic medicine. Now he’s trying to give other docs the same wake-up call.

We spoke to Randall about how the medical model disempowers patients, what doctors need to feel comfortable exploring psychedelics, and how he’d like to see psychedelics integrated into the healthcare system.

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After years of feeling burnt out in your medical practice, you found psychedelics. How did those initial experiences change the way you practiced medicine?

It was like night and day. I had gotten to the point where by any metric, I should've been winning at the game. I had a successful practice, good money, the fancy house, and a healthy family, but it wasn't what I was hoping for. I just felt incredibly old, like the worst Groundhog Day experience imaginable. I dealt with different flavors of the same problems every day. I was on call constantly, running the ICU, with hardly a moment to breathe. Being busy is fine, but I wasn't feeding myself.

I tried all the usual stuff. I got back into exercising and went to therapy, which helped to an extent. But then I put the word out that I needed a teacher who could give me guidance. Next thing I know, I'm doing my first Holotropic Breathwork experience with an aging hippie in Savannah. In the middle of it, I realized, “I don't know where the answers are, but this is where I need to go.”

The Western medical model is incomplete at best. We've done amazing things, but we tend to oversell what we have. We've created this religion where, as the doctor, I'm the high priest wearing funny clothes speaking language commoners can't understand, and the pill is the religious icon. We disempower people and blame patients when they don't get better. Through my psychedelic experiences, I was emboldened to question this system more vocally and start calling it out.

Since you’ve become so vocal about psychedelics, how have your colleagues in the medical community responded?

My story has been surprisingly well received. During the 10-year overlap when I was working deeply with the medicine while still in practice, colleagues would regularly ask, “What's different about you? Why are you always in such a damn good mood?”. I’d take that as my invitation to start sharing.

Many physicians were incredibly curious but had such a hard time overcoming the stigma. Talk about an effective marketing campaign about the evils of psychedelics! At the same time, most physicians I know are innately curious individuals, so there was a lot of support. Sometimes I even noticed a hint of envy, like I had found something they wanted.

That envy has only magnified since I sold my practice two years ago to do this work full-time. I get a lot of “How did you do that?”. I say I just did it; I made a choice and went for it. This blows people away—the idea that you can just do things. “What do you mean?”, they ask. I mean, I just did it. It was the right thing to do.

You're developing frameworks specifically for physicians to work with psychedelics. What unique challenges do doctors face that require a specialized approach?

Doctors are kind of an odd group. We tend to close ourselves off. At hospitals, there's always a doctors' lounge to separate us from the ‘common folk.’ We also have a lot of confidence in how smart we are—sometimes too much. There’s this belief that if I can't figure it out, nobody can. So accepting help is not an easy or common thing for physicians. Many doctors lack the self-awareness even to realize they may need help.

Any hint of mental illness in the physician world is very taboo. There's a big stigma, both personal and institutional. We’re typically required to declare any mental illness when getting state licenses, even though that practice is arguably discriminatory and could discourage physicians from seeking care. I have old friends and colleagues who won't even follow my LinkedIn page because they're afraid of ramifications from some agency.

I was probably a bit optimistic when I thought I could just throw a physician-only retreat in Costa Rica. At first, I couldn't get anybody to sign up. That led to starting PsychedelicMD, just to have a more open conversation with doctors. That choice has been so rewarding. It's become a beautiful, safe container for people to step out and share their experiences or ask questions.

So what does that framework look like? How do you tailor the psychedelic experience to physicians?

The first thing I found is that ‘physician-only’ is very important. We have to create a container where doctors feel safe to leave their whole professional personality at the door and admit, “I don’t know.” You also have to provide enough scientific basis for these folks to buy in initially. It can't be all woo-woo and vague promises.

With psychedelics, I can talk all I want, but until you've experienced it, you don't understand it. That's the hard part. I like starting physicians with breathwork because it's powerful but still preserves that element of control. Physicians love being in control. Ketamine is another great gateway because doctors are familiar with it from medical practice. It's FDA approved for anesthesia; it’s got the stamp of approval.

These days, I offer private retreats for physicians where, depending on the group, we might start with breathwork and then work with ayahuasca or psilocybin. Sometimes we alternate. I like the combination of ayahuasca one night and breathwork the next day. Some folks feel ayahuasca is too big a jump, whereas psilocybin feels more approachable.

Looking ahead, how would you like to see psychedelic medicine integrated into mainstream healthcare, if at all?

In a perfect world, we would get rid of this patriarchal “I'll take care of it” approach. My job is not to tell you how to live your life. My job is to help you find your way and empower you to find your own answers. We have to re-educate and re-empower people. That means admitting we in the medical establishment were wrong and that we're not the only ones with the key to healing.

We also have to protect natural psychedelic medicine from Big Pharma. We can't let it fall into their hands and get turned into another profit center. One thing I do like about the current model is that everyone has equal access to psychedelics, even if that access is limited. The power is with the people. We just need to educate the public and use that power productively, correctly, and ethically.

I firmly believe we have to create a critical mass of folks who can speak to psychedelics from outside the medical system—people like me who understand the system from years of experience but are no longer tied to it. My goal is to ignite enough people's fires who have that same belief so we can make real change.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.