Real Work, Real Life

Physician, OB-GYN

November 15, 2023 Episode 38
Real Work, Real Life
Physician, OB-GYN
Show Notes Transcript

Welcome to Real Work, Real Life where I talk to real people about what they do for work and what that means for their lives. Today I’m talking with Sabrina, an Obstetrician-Gynecologist finishing up her residency before continuing into a fellowship in urogynecology. If you’re considering a career in medicine, this will be such a great episode for you. And if you aren’t, this will give you a whole new appreciation for the physicians that care for you over the course of your lives, and the sacrifices they have made to pursue this career. Obstetricians and gynecologists have a special place in medicine I believe. I can’t think of another field of medicine that cares for people during some of the most joyful moments of their lives and also in some of their most challenging and heart-wrenching moments. Guiding people through such personal, private healthcare decisions takes a special person, and I know I left this interview feeling like Sabrina’s patients will be lucky to have her. 

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Sabrina OB-GYN

[00:00:00] Welcome to real work real life, where I talked to real people about what they do for work and what that means for their lives. Today. I'm talking with Sabrina and obstetrician gynecologist finishing up her residency before continuing. Into a fellowship in Euro gynecology. If you're considering a career in medicine, this will be such a great episode for you. And if you aren't, this will give you a whole new appreciation for the physicians that care for you over the course of your life. And the sacrifices they've made to pursue this career. Obstetricians and gynecologists have a special place in medicine. 

I think. I cannot think of another field of medicine that cares for people both during some of the most joyful moments of their lives and also in their most challenging and heart-wrenching moments. Guiding people through such personal private healthcare decisions takes a special person. And I know I left this interview feeling like Sabrina's patients will be lucky to have her. I can't wait to share this episode with you, so let's get into it.

Emily: Thank you so much for being here, [00:01:00] Sabrina.

Sabrina: Oh, I'm happy to be here.

Emily: So what do you do for work?

Sabrina: I am an OBGYN, so I am currently in the last part of my training where I'm in residency, which is basically an apprenticeship for obstetricians and gynecologists. And literally every other medical specialty. They last varying amounts of time depending on which specialty that you have chosen.

So I am practicing to learn both obstetrics and gynecology, but I always have a supervising doctor that is kind of watching over me, giving me feedback, that sort of thing. And then after this my program is four years. After this year, I'm actually starting fellowship, which is like another apprenticeship.

Where I'm going to be focusing on urogynecology, which is doing kind of female incontinence and prolapse surgery and complex vaginal surgery.

What drew me to the OBGYN field was actually obstetrics which is, as I think more people are familiar with that. It's like. Getting [00:02:00] pregnant, helping people through their pregnancies and their deliveries and in the postpartum period. And that is probably about, about half of what I've spent my time doing so far in my training.

But I actually have come to really love gynecology, which is. All of the care for the reproductive system outside of that pregnancy window and postpartum window. And I've come to love that a lot. And I actually realized that I like surgery a lot more, which is how I ended up choosing my fellowship.

Emily: it. That is so cool. So can we step back a little bit and talk

about, I know there's a very long path to become a doctor. So how did you get there? Can you kind of talk about your path after high school to where you are today?

Sabrina: After high school, I went to college and going into college, I knew that I was interested in something human sciences related, but I also knew that I really liked the human in it, not just their cells. And I also had this little.[00:03:00] part of me that really loved learning languages and I had studied French in high school and thought that I really wanted to have the chance to study abroad and, get much better at French.

And so those were the things that I was thinking through as I was navigating my early years in college. And my freshman year academic advisor was a graduate student at my university and was in the MD PhD program. And I had never heard of such a program. And I thought that it was only for people that did basic science.

And so I was kind of like, Oh, cool. But then I learned that she had actually done her PhD in public health and I didn't have a great idea of what public health was either aside from very broad strokes. not just health for one person, but for the community and for populations. But again, didn't really pursue it that much because I was focused on other things at the time.

I ended up majoring in anthropology after I took a course to fulfill one of our [00:04:00] academic credits and fell in love with it. So I switched from being a biology major to an anthropology major, but still focused on the biologic version of anthropology. And then reconnected with this mentor and after I had kind of come to learn what public health was and epidemiology and I think this might be what I want to do, but I, like, there's not enough time for me to figure this out totally before I graduate.

So, I guess I kind of had the seeds planted that I wanted to do something. I wanted to go to medical school. By that point, I knew that, but I also had come to really like the research that I had been exposed to. And I ended up getting an opportunity to work with this person during her postdoc. After she had finished her MD PhD program, and I got to move to Tanzania and work on a women's health project that was so formative and so fun where we were talking with women about pregnancies and how they had made decisions about them, whether they were pregnancies that they [00:05:00] continued pregnancies that ended up in miscarriages or those that they ended up Terminating because it wasn't the right time for them to be pregnant or a variety of other reasons.

And I think living and working in Tanzania that year, I also, even though it wasn't French, I got to learn Swahili, which was very cool and a skill that had you asked me leaving high school when I get to learn Swahili, I would have been like. No, I, I don't know when that would fit into my career plans.

But it did and I'm so thankful for it. And I think that year was really formative because it really, to me, crystallized that. I really loved the research that I was doing, but I was lacking the quantitative skill set that I wanted to be able to thoughtfully design studies and then, analyze the data that came from them as well as I didn't have the clinical skills at the time to be able to help with some of the.

situations that our participants told us about when they had interacted with the health care facility. And so I think that year was extremely [00:06:00] fun, formative, challenging and really helped me direct my energy going forward. I ended up. Moving to France the next year, actually and was part time teaching, part time taking the MCAT, which is one of the entrance exams for medical school took some dance lessons, worked in a bakery, it was really fun um, yeah, and then I went back to Tanzania, then was in the U.

S. As I was applying for medical school, and then I ended up being lucky enough to get a slot in an MD PhD program for my training, and the program is unique because they are selecting for people that want both sets of skills for the clinical aspect and the research component.

And there aren't that many programs that do allow for PhDs in non basic sciences. Most of them are in things like biology, biochemistry, genetics some sort of, like, wet lab, so to speak. I think it's changing now that more [00:07:00] programs have offerings or agreements with departments that are outside of the, School of medicine, but there's still definitely the minority.

And so there are people apply to MD programs, people apply to PhD. Then there's like a subset that apply to the dual program. And then even within that dual program, there's like an even smaller group of folks that are interested in something in the humanities or public health. how I

Emily: So you weren't pre med 

Sabrina: So I did all the pre med requirements because I had started out as a biology major and so had gotten most of them done and then even though I had been, declared as an anthropology major, I still was able to take care of most of the pre med requirements so that I didn't have to do a post bac or anything like that 

Emily: then, but that is an option for somebody. If somebody was like, doesn't know, they could go do a post bacc or kind of fulfill them some other way and then take their MCAT and apply to med school potentially.

Sabrina: And I have plenty of friends who have done that. And I think for them, they felt like You have to [00:08:00] pursue where your intellectual and, you know, interests are and where your energy is going and throughout life, you make a decision with the information you have at the time and the resources you have at the time.

And so I have 1 friend now who was a political science major and American studies and really loved that. And it wasn't until later in college that she realized that. She had some more clinical exposure, realized she liked it, and she was like, oh my gosh, and had a little mini, like, what am I doing?

And she was like, trying to do the math to see if she could swing all of the pre med requirements before leaving college, and she couldn't, and she also was like, I think I can do both, and that was actually a really freeing feeling for her because she was able to it. Not totally changed course from the momentum she had built up, but she was able to complete that, but also have this dedicated time to honestly knock out the, the pre med.

core courses that they expect you to have under your belt before you start medical school. And it honestly, I think there's a lot of [00:09:00] stress in terms of applications for college alone, but then certainly whenever you're applying for higher education. And any professional school and people are like, oh, they only want people who are biology majors or only want people that are hard science majors.

And it's simply not true. And I think what most of the time people are looking for are folks that have. A thoughtful story for why they're doing what they're doing because a lot of people are like, yeah, sure. It sounds great to want to be a doctor, but. You really have to, like, put aside the admissions committee, but for yourself, make sure it's what you want.

Because it is an incredible amount of time that you have to dedicate to get there and all of the, like, bells and whistles fade away when you're working 80 hours a week.

Emily: Yes. Yeah. So, so let's go back to all of the many years. So you got into an MD PhD program maybe if you can talk a little bit about what typical med school might look like. And then what it looked like for you paired with a PhD program. It's

Sabrina: Typical med school is four years at most places. Some [00:10:00] institutions are now making it three years where they basically have done away with summer breaks and

like, well, I mean, I'm saying I'm being very honest

Emily: I mean, I can see a lot of people, you know, we work year round as adults. So sure. I can see a lot of people saying, yeah, I just want to, I want to get it done. You

Sabrina: Yeah. And so instead of saying you have a summer vacation to do what you want with it, they have some of your core rotations built into that time or core coursework built into that time so that you can graduate a year earlier and start your residency a year earlier. Or if you don't want to go to residency, you know, whatever it is you do want to do, but.

The traditional programs and the majority of programs are still 4 years and that's regardless of whether you do an MD or, an osteopathic like a deal program. They both they have very similar curricula. There's some variations. But both types of schools are typically 4 years. And then from that.

four year program, you would then go on to residency if you want to be able to practice clinical [00:11:00] medicine. And as I said, the residency length of time is anywhere from like three to seven years ish, depending on the subspecialty. Like if you're doing psychiatry or internal medicine, family medicine, OBGYN, general surgery, neurosurgery is notoriously one of the longer ones.

So anywhere between three to seven years, depending on the specialty, specifically for for my program, most MD, PhD programs have operated like a sandwich model where you have your two years of medical school, which is mostly your core coursework, maybe a clinical rotation or two. And then you stop, you do your full PhD, and then at the end of your PhD, you go back and do the majority of your clinical rotations.

Emily: Yeah, you don't want to do that at the beginning and then become 

Sabrina: Yeah. 

Emily: doctor, like, how long did your, did the PhD program take?

Sabrina: mine was four years. But that's a variable. And I know from one of your other people that you interviewed, she also talked [00:12:00] that it really varies on a lot of it depends on what your research interests are and how productive your lab is, or again, some of it truly is like how lucky you are with how things line up.

It's not necessarily how hard you worked or how efficient you are, or, Any of it. Like me, I was doing a lot of international work. Some of it was like, well, I would have been ready to do something, but it took so long for the research to get approved by the various approving boards in the US and in the other countries.

And it's like, well, they didn't meet this month. And they don't meet next month. So it's gonna be another three months before we even they even start to look at it. And you're like, Okay, well, I guess I'll just wait.

Um, so, and there are things like that, that happen in research in various ways.

So there are some programs that try and have a little more continuity between the. MD side of things and your research side. And we certainly had some overlap between them, but you do have periods where you're mostly focusing on medical school or [00:13:00] mostly focusing on graduate school, which is honestly nice because sometimes you can only do so many things very well at one time.

And so, in some ways, it was nice to feel like, okay, I've got my core medical school coursework under my belt, and I have some clinical experience now. I'm going to shift gears and focus on this public health and epidemiology training, but I, but I still have like a leg in this other world, even though it's not my like quote unquote day job right now.

And I think the perspective that you have in one certainly informs the other and I think it's a really fun way of even thinking about the same topic, whether you're thinking about it from someone who's seeing a patient one on one versus someone who is thinking about how to design a clinical trial for something or.

You know, taking it up a level, do you work for a ministry of health or, like a public health department or something like that, or an insurance company, you're trying to make decisions about what will we cover for folks and what won't we [00:14:00] and you know, the evidence for something and all of that.

It's. You realize that each person, depending on how they've been either taught or encouraged to think about things, can, you sometimes can come to very different conclusions about what the best answer is, which is fascinating and also humbling.

Emily: Oh my gosh, absolutely. okay. So four years of undergrad, how many years of med school and then PhD is that four plus 

Sabrina: Yeah. Yeah. I know. Like, what grade am I in right now? yeah. So after high school, it's four years of college and then four years of med school. For me, it was four years of grad school, but I think four to six is very typical. And then you have your residency plus or minus fellowship.

So,

it's it's 12 after high school.

Emily: okay,

I have, I have a million questions coming out of this, but I'm going to try to think of this in order. I think people would often think of doctors famously as having really high student loans after they graduated or just high total costs. Would you be open to [00:15:00] talking about, you know, if you have a sense of your total cost of education or Someone who's gone to med school, undergrad and med school might typically be looking at for student loans.

Sabrina: I have no student loans right now, which is amazing. The MD PhD program, not all of them, but most of them are funded. So. I don't have any loans from medical school or graduate school, which is an incredible, incredibly, privileged position to to be

Emily: I think you work pretty hard, so I think I'm personally fine with it.

Sabrina: thanks. Thanks. I know. I remember when I went to an MD, PhD info session when I was in college, 1 of the current MD, PhD students had said, you should absolutely not do the MD, PhD for. that benefit. it's like trying to climb to the top of Everest for one breath of fresh air. Um, I don't know if it's quite that. I've never climbed down for ever, so I can't say, but it is a lot of work and time, but it also has a very real. Perk to it. So for me, I had a [00:16:00] stipend when I was in medical school and graduate school. It kind of shifted over time how it was paid for. Like initially they gave me a stipend when I was in medical school.

But then when I was in graduate school, I worked as a teaching assistant or a research assistant, and eventually was lucky enough to get an N I H grant that funded the rest of my research and medical school time. So, and and I'm really grateful for that, because I would like to stay within academia.

And so that process of learning how to write a grant was incredibly useful. And I got an appreciation for how hard it is. There's just so much time and to be able to write clearly. You know, because you have page limits and word limits and everything is a real skill that nobody's born with.

so I, I feel very lucky that I was able to pay off my student loans from undergrad.

I think at the end for the end of my graduate school slash the beginning of residency. But if you're not doing a dual degree program, or the type of program you're doing is not funded, then your undergrad, obviously, it varies based on kind of where, [00:17:00] what kind of school you've gone to and what financial aid you have access to for medical school.

I went to a. a public university and so a lot of folks there were, you know, citizens of that state or in state residence, I guess. It was an excellent school, but part of the reason they chose it is, you know, compared to other options they had is just because it was.

half the cost of what a private medical school would have been but even so everybody graduated with like at least a hundred thousand dollars worth of debt. And most people, I think it's closer to a quarter million which is like an absurd number to think about when you're in your twenties and you're like, and how much, like there, it's a lot.

Emily: And it puts so much pressure on doing that job afterwards. and of course it's a sunk cost, but it's still a cost that someone's paying the bill on. So

Sabrina: right, right. And there's certainly a lot of discussion about kind of, are the people that were there's, you know, you would understand that there's an incentive to choose a specialty that would have a higher [00:18:00] income or salary on the back end, just because you feel like you're in, so much debt, you want to be able to pay it off and you feel like you've worked hard for it.

But We don't need, you know, 100 percent of the medical school class going into those lucrative specialties like orthopedics or like dermatology or things, basically things that are procedurally based. We need a mix of people. And so we have a lot of primary care needs that are underfilled, especially in rural areas that you and I know very well.

And there's a lot of discussion about how to shift. The incentives and offload some of those loans and there are some programs like is the the public service loan forgiveness program where if people work in certain sorts of settings where they are mostly providing care to folks that are.

underinsured or uninsured or in an academic setting often then if they work for a certain amount of time, they can get a certain proportion of their loans forgiven, which is a huge weight off people's shoulders, especially if, two people in the, in the [00:19:00] household have debt that they are trying to work through.

Emily: right. Oh, wow. That is so interesting and just so much to think about, but it's nice to know that there are paths ahead if you don't want to, or can't, you know, take on that kind of debt.

Okay. So you get through your medical school and complete your PhD and then. And , do you begin residency right away after that?

Sabrina: I did. Most people, I think, do proceed with residency right away if they're going to do it. Not all. I had a friend who because her spouse was in the military and got deployed, she ended up doing a postdoc for I think it was a year or two before she ended up starting residency.

But I think it's most typical to kind of take your, because you end up usually with it. Your medical school training you know, in the MD PhD program, and most people just kind of take that momentum and run with it so that they can start residency while they still have all of those clinical factoids in their brain.

Emily: Yeah. So what did matching with a residency program look like for you? Did you feel like you had a lot of [00:20:00] say in where you did your residency program or was it kind of a gamble?

Sabrina: It was a gamble. And I also was trying to match where my husband was already 

doing residency, 

Emily: Oh, you wanted to live with your spouse? 

Sabrina: I know, I know, I know, very strange. So we had met in medical school and then he matched a year before me because I actually started med school before him, but because I did the dual program, he started and finished before me.

So I know, I know. But his residency is longer. So now I'm finishing 1st. So I've gotten back,

but then my. But I know, but then my fellowship was longer. So really, he was so I was very geographically restricted to match into residency. It's not like a job interview where you get to send out applications and hear back from places and then you get to pick which one you liked best.

it's called the match is what the whole system is called. And so you submit your application to this [00:21:00] central platform. They distribute it to the programs, programs, then review applications and decide who they want to interview. When I was going through the process, it was still in person, but now everything's virtual, which has a lot of advantages to it.

But you don't get to actually go on campus and kind of 

see how things are. Yeah, which is not unique to medicine in terms of the hiring and recruitment process. But it is, it is tough, I think. And then after the programs have interviewed everybody that they want to, and the applicants have completed all of their interviews, and they both make a rank list of.

Where they would like to be if you're an applicant, or if your program, you would like to land at your program then everybody submits their rank lists to the central platform where you applied and then. The algorithm sorts you into where you're going to go, and it does preference the student or the applicant.

So say,[00:22:00] I don't know if this happened because I don't know what happened behind the curtain, but say there's a person who, three hospital systems wanted that person. They all ranked that person number one. That person, if they had ranked one of those hospitals number one, it would go to the one that they preferenced.

Emily: Nice. 

Sabrina: does try to favor the student or the, the trainee but there are also people that you know, go to a an institution that's a bit lower on their list or sometimes don't match at all. And that can be pretty devastating. There is a mechanism to have people who didn't get a slot on their kind of initial algorithm match to then interview for slots that went unfilled to make sure that, you know, because there are hospitals sometimes that didn't fill their slots either.

So, so there is a mechanism for that. 

Emily: a fight to the death

Sabrina: Yeah, they 

Emily: candidate. 

Sabrina: to kind of, they used to, they used to, they used to call it the scramble that we're not supposed to call it that anymore. It's now called the supplementary [00:23:00] matching something. I forgetting all the 

the title, 

but

yeah, 

no, but it is really intense.

And it's, you know, as you mentioned, like people have invested so much and it's not always folks that had, like, less stellar applications. Sometimes it is really just unlucky or It's unfortunately a numbers game and it costs money to submit to all of these places.

And Yeah, there's a lot of

kind 

Emily: it's like a really high stakes. Yeah. It's like a high stakes, College admissions, right? you can have everything and you still don't get one of the coveted

Sabrina: Yeah. So there is a mechanism for that. But it is a really stressful, but can be very thrilling time on match day when you find out where you go, because you're assigned a program effectively. And obviously, it's one that you interviewed for and that you had ranked. But it's, but it's still stressful.

And it wasn't certain that I was going to land in a place where we Like my husband, I would have been able to live together and currently we live [00:24:00] kind of halfway in between two cities Like I work at one and he works at another and we kind of commute the difference

Emily: Yeah. That's hard 

Sabrina: so 

Emily: I mean,

Sabrina: yeah, I mean, I wish I could spend less time traveling, but

Emily: yeah.

Sabrina: But I'm grateful that we get to live together So it's it's tough

Emily: Yeah. Oh my gosh. Okay. I I've been so interested in people going through the match experience. I've kind of watched it from afar. So it's interesting to hear about the firsthand experience of it.

So what sort of personality do you think makes a good doctor? And I know this is going to be all over the board, so maybe you can kind of speak to your own specialty.

Sabrina: sure. I think for OBGYN, it is a really unique field of medicine because it has elements of almost every other specialty in it. Like, you have a lot of primary care, and I bet all of us can think of people for whom their only doctor that they see is their OBGYN. So 

they're like, 

well, yeah, like, 

Emily: you're having children. I 

Sabrina: [00:25:00] yeah.

It's like you only have so much time to, to make, doctor's appointments period. And so you're like, well, this person's kind of monitoring my, you know, X, Y, and Z. Like, am I up to date on my vaccines? I

hope so. You know, all of that stuff. So you have some primary care, you have like obstetrics of course, in, in terms of the, the care during the preconception, pregnancy and postpartum time.

There's a lot of procedures involved. There's surgery, like, whether it's a, you know, a cesarean section, which is kind of wild that we do a major abdominal surgery and get in and out in less than an hour. It's wild. Um, Yeah, and you're like, here you go. I know. I know. Or if you're, doing smaller office based procedures or inserting an ID or, you know, for contraception or if someone doesn't want their uterus anymore, there's a reason why medically it should come out doing hysterectomies and all of that.

There's a lot of variety in it. And we look at a lot of our. Own imaging, whether it's an ultrasound or an MRI or a CT scan. [00:26:00] And so you get a little bit of radiology training. And I think a huge part of it, too, is counseling. As we all know, there's a lot of very. really fascinating ethical dilemmas that come up, not just an OBGYN in all parts of medicine, but I think an OBGYN especially, it's you can sometimes find yourselves with scenarios that you couldn't have imagined, and there's not a clear answer, and it really depends on What the patient's priorities are and what what their goals are what sort of risks are we trying to minimize and for whom?

And it can be really challenging, but it's also one of the parts of my job that I love the most Even though I didn't anticipate landing in fellowship that I am now going to pursue. I thought I really was going to land in high risk but I really have enjoyed throughout my time in undergrad and my time doing research, my time in grad school and now being able to talk with folks about things that they don't really talk to anybody else about.

 and not in a [00:27:00] voyeuristic way, but let's work through this together and figure out, what would success look like for you? And how can we get there? And I think that's something I, I really enjoy and, kind of came up. You know, in my undergrad in a variety of ways.

And then in Tanzania, talking with folks about their pregnancies and kind of what became of them. And then when I was in grad school, I focused a lot on HIV and mental health. And now, you know, I'll be focusing on kind of symptoms that people usually kind of hush, hush about. And they're like, Oh, it's embarrassing.

It's just aging. And, or they don't know that there's And it just happened because I had kids and like they don't know that there are actually really great treatments available and not all of them are surgery. So I'm excited to, to keep doing that.

Emily: Oh, that sounds so amazing. And yeah, I feel like so much of, women's health. Once you kind of have the children, it's like, Oh, we're done. You're fine. Yeah. Carry on.

So it's just, it sounds amazing to get to work on that for your career. So that's 

Sabrina: Yeah. I think, and I don't know if I really answered your question, but the type of person that would do well in this [00:28:00] career as I was reading, I was

Emily: Well, you did, I mean, someone who can manage that and see how, I mean, I think all of American society is currently realizing how gray. A topic this can be and how you have to be someone who has the empathy and the ability to see a really complicated set of issues and make the best decision with all of your expertise and training for, your patients.

Sabrina: yeah, even though people often. Think that, oh, you have to be excellent at science to be a physician. It's like, yes, that's part of it. But I think the communication skills are something that are harder to teach, but crucial to. just about every part of my job.

and, it also makes it a lot more fun when you feel like you can, even if you see something in a different way than someone else if you're able to identify that and still find a way forward, that's incredibly useful and, satisfying and [00:29:00] helpful.

So that's part of it.

Emily: That's amazing. now we're going to get right down to brass tacks, but what do you make as a resident and, what do your benefits look like? 

Sabrina: So during, I know you talked with Shannon about this with postdocs and residencies, as a resident it varies a little bit geographically. There's some adjustment for cost of living, but it's very standardized that everybody gets a base salary. That's something in the like upper fifties to lower sixties in terms of thousand dollars.

Emily: Yeah. 

Sabrina: Especially when you're working 80 hours a week, you're like, well, that

comes out to like 12 an hour, maybe not always. Yeah, it's not great. So in terms of like, obviously that's not that way forever. once you are a practicing physician, it really ranges. If you are someone that is in an academic setting, you typically make less, but you.

In theory, get more flexibility with your work and maybe have a lower patient volume. You also have, a [00:30:00] salary rather than compensation based on how many patients you see, or how many procedures you do. and I think for OBGYNs, if you're a generalist, meaning you aren't focusing on GYN cancers, you're not focusing on high risk obstetrics or like urogynecology, like what I'm going to do you kind of see a bit of everything, then I think for some folks starting out, it might be in like the upper hundred thousands to You know, 200, 300, 000 per year.

For other folks that are in private practice, you can make a lot more money, like more solidly into like two, threes, 500, 000, which is a lot of money. But you're also paid based on how productive you are. So like most things in life, if you take a bigger risk, there may be a bigger reward. And so some folks really like that.

Other people feel like I. Would rather have a set salary and then see the patients that are on my docket, but it doesn't matter if I see 5 people in a day, or if I see 25 people in a day, I'm [00:31:00] still going to, you know, get paid the same amount. It really depends again on what your what your priorities are and also, like, what is most important to you for.

Like, your satisfaction in a career and the type of care that you want to deliver and which patient population all of that.

Emily: does an OBGYN see 25 patients a day sometimes?

Sabrina: Oh, yeah, easily.

Emily: Oh my. 

Sabrina: Yeah. No, that's why it's kind of wild when 

you think like like people are booked for like 15 to 20. Yeah. Yeah. Like for me right now as a resident for an annual exam, they're usually slotted for like 20 to 30 minutes. And for, a follow up, say, someone was seen in the ED recently, or in the emergency room recently and they just need, like, a quick follow up, it's, like, 15 minutes.

It's so fast. And so, if you have, eight to nine hours of clinic a day, you know, you're, you'll see however many patients it is divided by. 

You know, 15 to 30 minutes. Yeah. So, yeah, you can easily see a lot of people. And, you know, for some of the visits, like [00:32:00] for some of the more routine obstetric visits, like 15 minutes actually might be more than what you need.

But if you have patients that have a lot of issues that come up, or have several comorbidities you can easily go through all that time and then get behind for your next patients and feel really bad. So if your doctors are running late, I almost. It's not because they're taking a long lunch break.

I can 

Emily: Yeah. So this is kind of pay adjacent. Do most doctors pay malpractice insurance or if you are like working for a hospital, is that covered through the hospital? Yeah.

Sabrina: Yes. So if you're in private practice, it depends on how big of a practice you're in, It kind of how it is paid for, but everyone has to pay it if you're working for an academic institution, typically it is, it is paid for you. And there's, if you drill down into the nuts and bolts, like, if you're changing jobs, there's lots of variations on a theme for what is covered versus what is not.

Emily: Wow. Right.

Sabrina: If you work [00:33:00] for a federally qualified health center and FQHC you may not have to pay malpractice in the same way. But there's a lot of variety, but one of the reasons why we GYN is one of the more like specialties with the higher burnout rates is because of how litigious our field is.

 I don't know the exact statistic, but it's the majority of that will get sued at some point in their career. And most of them several times not always like these big catastrophic cases, but. We can get sued for up to 18 plus years after a delivery for something that, you know, happened at the time of labor and delivery and they say, well, you know, we think that this was.

Something you could have done differently which is, I think, one thing that I, has been hard in terms of practicing because sometimes you feel, and people interpret things differently and practice more defensively versus [00:34:00] not but it also depends on your state that you're in Like Texas, there's, it's like, not as litigious, but like in the Northeast it is very so it's, it's tough and it is always hard when you feel like you're making a decision that you don't never make it ex like totally because you're worried you're gonna get sued.

But it's always in the back of my mind Like, what am I documenting? And How might this look 10 years down the road? It's tough. That happens in any field, not just in OBGYN, but I think especially with some of the situations that are specific to OBGYN there's a lot on the line.

Emily: That's exactly the right way to put it. Right. There's a lot on the line. Yeah. oh, my gosh. So do you have a sense of how much malpractice insurance like might cost just because ballpark or does it really vary?

Sabrina: I wish I knew. I have to say, I actually reached out to a couple of friends who are further along in their, careers than I am, just because I feel like as a trainee, I don't get to negotiate anything. Like my salary is told to [00:35:00] me, my benefits are told to me. I don't have malpractice insurance because I'm practicing under my supervising doctors.

I don't actually know, but I can try and find out and let you, let you know after the, the podcast, 

Emily: Nerd, nerd wallet tells me that it depends, but obstetrics and gynecology, annual medical malpractice insurance premiums between, can this be right? Like 50, 000. Can that be right?

Sabrina: Oh, yeah, I was gonna say it. Yeah. 

Emily: This, so This, is. 

Sabrina: per patient, but like per person in your

Emily: Per person. This is saying between 50, 000 and 205,

Sabrina: I know that sounds like a very wide range, but that sounds about right. I was gonna say it's at least tens of thousands, if not like a 

hundred grand 

Emily: Yeah. And so something like internal medicine is between 8, 000 and 50, 000 is what it's saying. 

Goodness gracious. 

Sabrina: Yeah. So it sounds like you have a big healthy salary, but say you're a solo practitioner, which is Really [00:36:00] going away with how consolidated many health care systems are becoming but it might seem like you make a lot of money, but it gets shelled out very quickly when you account for, malpractice for, your office supplies for paying all your office staff, because if you're.

The only person providing clinical care, or one of a small number of people providing clinical care, there is so much that goes into, keeping up to date with all the regulations of providing clinical care and, all the billing, the insurance negotiations, the denials, the prior authorizations, the scheduling, the rescheduling that, like, a lot to deliver good care,

Emily: Yes.

Sabrina: which is crazy, but

Emily: Oh my gosh. So what are your hours like? now and kind of what do you anticipate your hours to be like once you're sort of fully qualified, done with fellowship, working in your field? 

Sabrina: Yeah. During residency, it is hard. I mean, you're [00:37:00] not allowed to work more than 80 hours a week. But I think, most consistently, I'm in the, like, 60 to 80 range on the upper end of that. So that averages out to, I'd say solidly 12 to 15 hour shifts.

And then you take some, 24 hour shifts that. end up being like 28 hours. They're long. It's, I know it's inhumane. 

Emily: The faces I'm making are because I'm feeling very lazy right now.

Sabrina: no, no, no, no, no. On the contrary, you should be like, that's gross. That should not exist. Because it doesn't, it doesn't feel good. And I remember when I was a medical student, even I was like, Oh, 80 hours a week.

Well, there's still like another 88 hours in the week. So like, I would be fine.

Um, 

And because I'm like, 168 hours a week, like,

yeah, I'm gonna be 

fine. I'm still working like, less than 50 percent of the hours of the week. Like, this is, this is no big deal. And then I became a resident. I'm like, oh my gosh, this is a lot.

Like, even the weeks I'm working, I'm working 60 hours. I'm still so tired from the ones where I worked 80 

or [00:38:00] 

it's, it's, It's, yeah, and it's like on average you work you can't work more than 80, but like there's some weeks where I work a hundred and then other weeks where I work fewer. And so it's a lot, that's not, you can't do that forever.

And I think that's one thing I learned in residency is that I have a limit on what my body can sustain and what my mind can sustain happily. But I think it's probably typical to work 50 to 60 hours. When you're out, you can work part time. And I think there are more and more people that I've talked to that have done that.

It is harder to do it in academia. If you want to stay, like, doing a combination of research and clinical care, which is ideally what I would like to do. And as part of why I wanted to do the MD PhD program and to begin with, so it's something that I think I'll have to really negotiate and also, you know, try and figure out ways that you can still provide excellent care and do excellent research, but also.

Identify where you can be really efficient and outsource some things. So it is unfortunately uncommon for people to work only 40 hours a [00:39:00] week as a position. But there's a lot of variety in that. And it really depends on what you negotiate and what kind of practice. Pattern you have and who else is in your your group and you know, some of it too is like how much money do you want to get paid?

For people that are in a setup where they're paid by how many people they see or how many procedures they do, that sort of thing.

Emily: Yeah. What are some things you love about your job, especially if you think people might find it surprising?

Sabrina: , within OB GYN, I really like the mix of the surgeries and the procedures. And the counseling and, hearing the stories of how people came to your office and what, what are they looking for? And I think Using that, story to identify what it is that people are seeking.

And then you can draw on all of the science background and the, physiology background that you know, is this someone who needs a medication, and you can draw on on that and offer them those options. Is [00:40:00] there a small procedure you can do or is it a bigger surgery that you can offer?

And talking through those options, I think it's really fun. And. It's really satisfying when you, of course, see someone who's like, hey, you helped me. And it's also, really gratifying the craft, I think, especially if you're going into a procedurally based field the craft of the surgeries is really.

Remarkable and it's something that requires a lot of your attention and care and it's a lot of creativity to where's like, you know, you think, oh, it's a surgery. You do the same thing every time, but it is so far from the truth. person's anatomy is a little bit different.

Like the tissue. It is every source. It's different. Um, and the tissue quality can be different even in the same person over, different times can be different. And using that more creative side of your brain is really fun. I find. And I think, as I had said before, having this space where people can talk about things that [00:41:00] they don't often talk about but still really are bothering them is it's such a privilege and it's, it's so rewarding to get to hear those stories so that you can try and figure out, okay, what, what can we offer you to get you closer to what, what you're looking for.

So I think it's kind of, kind of that mix of, why I ended up choosing anthropology and, and, you know, to begin with, it's like the human piece, but still having the science underpinning is what I really love. And I think. In terms of the, like, the language piece that, you know, I really liked was French, and then Swahili, and then I learned, you know, some Chochebo, and I was living in Malawi in grad school, it's like, medicine has its own vocabulary, too, and so you, in some ways, you're an interpreter, too, when you're a physician, because people will hear about things, and you have to figure out, how can I phrase things in a way that will Make sense for this person cause everybody comes in with a different set of ideas and things they've read about, heard about, experienced.

And also some people want to know a lot more than others. [00:42:00] And some people are fine with, all right, if that's what you recommend, I'll do it. And other people are like. But wait a minute, like, tell me exactly, like, which receptor does that work on? And you have to be able to explain it to all of them.

So I think it kind of works all sides of your brain which I find really fun.

Emily: I love that. So on the other hand, is there anything that is tough about it that either you didn't expect or you just didn't anticipate how challenging it would be?

Sabrina: the hours are hard. I know they're not forever and I I wish the medical training system were different because I don't think anybody can pretend that they're at their best when they're at hour 28 of being awake. I think that has been, I think one of the things that has been, like, personally hardest for me is feeling like I'm not, giving my absolute best at all times.

And it's not because I don't want to, it's just that, like,

I don't have enough in the tank. I think it also, you know, if you've. Spin everything as an opportunity. It's like, okay. Well, what are the things that are the non negotiables that I need to provide for this [00:43:00] patient? And what are the things that I either need to ask someone else to do whether it's now or something that's like, okay Later today when we have more people on board because we usually have fewer people on overnight Like during the day shift when you have some more people around can someone come back and like give you you know Some more information about that it's Comes down to time and, energy, back when I was a medical student, I didn't appreciate what that would feel like Doing it for years on years but I'm very grateful for the training. And I'm very hopeful going forward that.

I can have a more balanced, divide, or not divide, but kind of set up between my time at work, my time, hopefully, with research. I still would really like to, incorporate my global health work and, you know, then time with my, my family too. And for other things that I like to do, and so I'm 

hopeful that I'll be able to yeah, other things.

Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. So I think it's, it's tough. It's it's [00:44:00] doable. But anytime you are forced to really count down your hours during the day, so discreetly, it makes you think very hard about how you are spending your time and. Who you're spending it with. And when you have a, vacation or whatever, you're like, how exactly do, where do I want to go?

And you know, what, to do? So it can be clarifying in many ways. So I guess that's the, that's the good in it because it makes you really take a hard look at what, you need to keep yourself going.

Emily: Yeah. My gosh. Well, thank you for using one of your precious hours

with me. 

Sabrina: Oh, no, this has been fun.

Emily: So this is the last question I have for you. So I usually ask, you know, what's one piece of advice generally about work that you would give your younger self. But I would say in your case, if you were thinking about someone who's like, I think I want to go to medical school.

Do you have any kind of general advice you might give that person?

Sabrina: I hope none of this has scared anybody away from medical school, if they're really interested in it. Because it can be such a wonderful [00:45:00] experience, and it can also be really hard. It's challenging, it's inspiring, it's a lot of dualities it's not the, either or, it's...

And I think for someone who's interested in a career that combines clinical care, you know, especially if you're interested in, like an MD, PhD program and, doing both clinical care and research, it's so rewarding and such a fun journey. And so I think if you're interested in it, I think definitely, go for it.

 A piece of advice I was given is that if you're interested in medical school or you're interested in research or, you know, especially this dual degree program, it's not a black box. Your life doesn't stop when you are pursuing a program like this. There are plenty of people who have met partners, gotten married, started families, had multiple kids.

Or even if someone, you know, isn't interested in having kids, you know, they've started new hobbies even admits all this like [00:46:00] crazy, hours and different that that people have been doing. So it's not a black box in life and it is it's not where everything else is just on pause.

You have to be very strategic about how you spend your time, but it is doable. And I think it's also easy to think about all of the hard aspects of. This career path, but it also doesn't take very long if you think about, like, what was I able to do today that I wasn't able to do last year, or I wasn't able to do 5 years ago or 10 years ago and there's so many things and.

When I think about, would I have predicted where I am now when I was leaving high school? The answer is no, but I'm grateful for that and. It's really cool. I think one theme for me has been to really latch onto mentors that you mesh with, and it's probably not going to be just one person.

It's going to be a suite of mentors that kind of help you with different things. one person might be a really good mentor for research and another might [00:47:00] be really good for kind of overall life stuff. But I think ask your mentors you know, what is it that they are thinking about and not just what are the decisions they made, but how did they make those decisions, which I think a lot is a lot of what you have been trying to get out from the interviews that you've been doing with those podcasts is like, not just where did you land, but how did you get there and why, and you know, most people look at someone and assume that they had a linear career path to get there, and it's so often not the case at all.

You know, like, I zigzag from biology to anthropology to public health to research to, like, a year in France, and then, I thought I was going to do high risk obstetrics and had focused on, HIV and mental health and thought that was going to be what I focused on, and, you know, now I'm actually focusing on, A more surgical based specialty and it's not because I haven't been able to commit to anything quite on the contrary.

It's like a committed and through that commitment, I learned something new that helped me make the next decision, even if it wasn't quite what I thought it was going to be from the [00:48:00] outset. I guess one piece of advice is not being afraid to try something new and also not being afraid to change your mind.

I had a lot of heartache about my decision, not in a bad way, but just because it just wasn't what I thought I was going to do. And I had kind of set up everything, assuming one thing. And then I found when I was, Through part of my training that actually what aligned better with my interests what I wanted to prioritize how I wanted to spend my time how my brain works what I like for my workflow.

I found it to be very different between the obstetrics side and the gynecology side and I found that. Gynecology was much more My speed I don't even speed, but just mesh better. and my husband actually, he said, you know, you more often looking back, said you had like a great day when you were on this sort of rotation rather than this one.

And so I think having people in your close circle that are good sounding boards and pick up on those. Those themes for you can be really helpful [00:49:00] not to say that they should make your decisions for you, but it can be a 

Emily: Well, what a reflecting, what a reflection. that's someone that knows you probably the best of all that it's like, yeah, that's helpful in making a

Sabrina: Yeah. I think, don't be afraid to try new things, commit to things when you do them, but also don't be afraid to change your mind.

Emily: Yes. That is great advice. Well thank you so, so much for taking the time out of your very busy schedule to talk. And I just really enjoyed this discussion.

Sabrina: Oh, this was super fun. Thanks so much for asking me to be interviewed.

 Thanks for joining me. If you liked the show, please rate and review on iTunes and Spotify. And please share with a friend. You can also follow the podcast on Instagram, LinkedIn, Facebook, or ticktock. And if you'd like to be interviewed here or there's a particular job you'd like to learn about, please reach [00:50:00] out@realworkreallifeatgmail.com.