HCDM 40 | OB GYN Sub Specializations

 

What makes it rewarding to be a part of the medical industry is the opportunity for practitioners and professionals to showcase their flexibility and venture out of their current specializations. Anna Barbieri understands this well, and therefore she eventually decided to pursue two OB-GYN sub-specializations. She sits down with Richard Marn, MD to share how she transcended into integrative medicine and minimally invasive gynecologic surgery to help women with more severe conditions and go beyond just delivering babies. She also gives a peek at the life of an OB-GYN before and during the pandemic and her expectations for the future of her profession, which hopefully will give more attention to even more sub-specializations.

Listen to the podcast here:

Anna Barbieri: Delving Into Various OB-GYN Sub-Specializations

We’re going to talk to someone in a profession that most likely you have met, whether you know it or not. That profession is an OB-GYN, an Obstetrician and Gynecologist. Maybe your mom, grandmother, sister or cousin may have dealt with them but there’s a good chance that you were probably handled by an OB-GYN or an obstetrician when you were born. Not everybody is but there’s a good chance. Whether you know or not, they may have taken care of you. We’re going to talk about that profession and the person that I’m bringing on is Dr. Anna Barbieri.

Anna is a fantastic person. Anna is super intelligent, bright, hardworking, passionate, always tries to find ways to improve herself and improve the care for patients and empathetic to patients and what they go through, her female gynecologic and obstetric patients. We know this for a fact because my wife was a patient of the Anna’s, who you got to hear in Episode 34, when she talked about her life and career as a pediatric dentist. My wife and I have a daughter and Anna had delivered her. We are blessed that process, that experience was memorably positive for us. We’re blessed to have Anna in our life not only as a professional but also as a dear friend. If you want to get a sense of what it’s like to be an OB-GYN, living that type of life and the excitement that comes with taking care of women, female patients as well as helping deliver babies, then this show is for you.

Anna, thank you for coming on board. I appreciate you joining me on this episode.

Thank you, Rich. I’m glad to be here.

A short bio in chronological order as if we’re in an elevator about you.

My name is Anna Barbieri. I am a physician in the field of Obstetrics and Gynecology. I went to Colgate University for my undergraduate education. I knew I was going to go either into Medicine or Archeology. I finished college a semester early in order to work a bit and make enough money to buy myself a summer in Europe for three months, and I went on a dig in Ancient Corinth at that time. That experience taught me that I did not want to be an archeologist. I checked out the field, I was in the trenches for a while there. I began medical school in August after graduating from college. I got my MD Degree from SUNY Upstate Medical University in Syracuse, New York.

I fell in love with Obstetrics and Gynecology while I was there, and then proceeded to do my residency at Mount Sinai School of Medicine in New York. I stayed on as a member of the faculty practice and General OB-GYN there. Along the way, I did a fellowship in minimally invasive surgery. I then did private practice for about ten years. As my career evolved, I fell in love with something called integrative medicine. I did some additional training in that, and because of the nature of my field where you can evolve with it, I evolved too. I left my previous practice and I’m launching a new practice in integrative gynecology, which is going to launch, so I’m preparing for that. I have also gotten involved in a startup that has to do with education in the area of women’s health. I had a number of different hats over the years. It’s been an exciting and rewarding ride far.

What exactly is your job title? What do you do? You’re an OB-GYN, which stands for what?

OB-GYN stands for Obstetrics and Gynecology. Obstetrics is having to do with the care of pregnant women and delivering babies. Gynecology has to do with reproductive women’s health. I do everything from contraception and preventive care to anything having to do with women’s hormones and as far as how they pertain to women’s menstrual cycles and issues that arise from that.

In one sentence, what’s the best part of your profession?

It’s knowing my patients long-term and being able to help them in many different ways.

What’s your least favorite part of your profession?

Being up all night.

The final quick question here, if you can put in one sentence, what are the misconceptions people have about your profession?

It’s thinking that being an OB-GYN physician involves doing one thing, and that is delivering babies. It’s a much wider field than that.

You talked about some of the details about what you do as an OB-GYN. In simple terms, what kind of patients do you work with?

HCDM 40 | OB GYN Sub Specializations

OB GYN Sub Specializations: Just because you finished your medical schooling or training doesn’t necessarily mean that you will be stuck in the same job forever.

 

As an OB-GYN, depending on whether you decide to further sub-specialize within this field, you can work with women ranging from young adolescents meaning teenagers, to women who are much older up to 70s, 80s, 90s. If you do end up doing a sub-specialty training program within this field, you can then start focusing on a narrower road. For example, people that have subspecialty training in something called maternal fetal medicine, that is medicine for pregnant women and their babies, so you’re going to be seeing just pregnant ladies. People who specialize in fertility medicine will be working with women who are trying to get pregnant. People who specialize in gynecologic oncology, oncology being the study of cancer, will be working mostly with women who are dealing with certain specific cancers that occur in women.

You did a specific specialty yourself.

I have two subspecialties within this field. I did extra training in something called minimally invasive gynecologic surgery, which means this is performing surgery through more innovative technologies, using smaller instruments and robotic surgery. The latest extra training I did was in this field of integrative medicine, it’s not specific to necessarily obstetrics and gynecology. Integrative medicine is more of a philosophy of medicine that is more holistic. It focuses not just on the super specialty-focused areas but also on things like nutrition, stress and sleep. General things that will influence our specific health concerns but things that are important to all of us, lifestyle for example. I love it because it does help me in understanding the bigger picture for my patients and also enables me to help them, not just through the specific tools of my specialty, but also through this wider lens of things that people can do on their own. I believe in that and that has greatly enriched my career.

You’re an OB-GYN but you’re also now doing this deeper focus on integrative medicine in your OB-GYN practice. If we can separate those at least initially, as an OB-GYN before, what was that like before you started doing integrative medicine? What was a typical day for you? Let’s try to think of it as a bit pre-COVID and post-COVID. What can someone expect if they were interested in being an OB-GYN coming out of training? What is that like?

Let’s have pre-COVID first. I know COVID has been on everyone’s mind and it’s affecting everyone’s life. For sure, for all of us in medicine, our lives got turned upside down by it, but COVID will be over at some point or at least we will learn how to live with it. Let’s talk a bit about what life looked like in general before March of 2020. When you become an Obstetrician-Gynecologist, you have a chance to decide which avenue of the specialty you want to pick. That is one of the best things about this particular field. It doesn’t mean that you will follow a certain predetermined path. You can then decide through your training what you would like to do.

If you become like I did a General OB-GYN, it means that you are going to both take care of women who are pregnant and deliver their babies, and take care of gynecologic patients, women who are not pregnant. For many years, I took care of anyone ranging from teenagers through much older ladies. I also guided women through their pregnancy and delivered their babies. My week would be divided into a few days of seeing patients in my office. I would see a number of pregnant patients, a number of non-pregnant patients.

At some point, we will either get over COVID-19 or learn to live with it. Click To Tweet

What time does your day start at in those situations?

Probably I start seeing patients about 8:00 in the morning and end my office hours sometime around 5:00 or 6:00 in the afternoon. That means that I was up much earlier than that and tried to get some of my own morning things down or get ready for my office hours. After my office hours were finished, I return phone calls or check results. I did that maybe 3, 3.5 days a week. I was usually on-call for a 24-hour period during the week. What that meant is that if any patient from my practice that was in labor was going to have a baby that day, I would take care of them on our labor and delivery floor.

During that time, I worked with a number of my work partners in what’s called a group practice. That is what most OB-GYN practices are like these days. It helps to work with other people in a group because you don’t need to always think that you may get called to go deliver a baby in the middle of the night. That may be fine one night, maybe two nights in a row but when you have to do that all the time, your life can become unpredictable. You do have to sleep at some point. I’ve always worked in a group practice with 4 or 5 other physicians. We rotated our on-call nights. My time was split some days of seeing office patients, some days being on labor and delivery, delivering babies, doing C-sections, maybe being there at night if somebody needed me. I would probably spend about a half a day each week in the operating room doing surgery, and then probably half a day either doing teaching or I was involved in some committees at the hospital.

At that time, I worked at what’s called an Academic Hospital, that means a hospital that has medical students, that has residents, that has fellows, that has people in training. Part of my job was also education. I liked that too where I got to teach students. It’s a great thing. I still continue to do that. It’s nice to be able to explain certain topics in medicine and watch how people learn and see some students get excited about this particular field.

In your career, you’re bringing someone a little child into the world. You’re also dealing with more serious stuff too, women who have cancer, significant pain, anything related to a woman, lot of things going on. There are some misconceptions that people had of an OB-GYN. You don’t do that anymore. Let’s transition to what you’re doing differently now as an integrative medicine and as an OB-GYN.

You’re catching me during this transition period. I’m already organizing my new practice. The great thing about OB-GYN and medicine in general is that you can change course. Just because you finished your schooling or training and you end up being in a certain position or doing a certain job doesn’t mean that’s going to be your job forever. That would be my first tip for anyone. Being a professional or choosing a certain profession or path, we spend a lot of time working in our fields. We may as well choose something or stick to doing something that makes us happy and passionate about it. That thing may change, when you’re 25, it may look different than when you’re 40 or 50. Medicine and healthcare in general affords us the chance of being able to change course.

I am someone who loves our field. I would never do anything different. After a while, the repetitive schedule and the night commitments became repetitive. I was becoming interested in this concept of integrative medicine and wanted to do things out of the box and not the way that things were always done. I had always wanted to try my hand at doing something on my own and starting a practice and starting a business. Almost twenty years into my career in medicine, I decided that was the time and that’s what I’m doing. My days have been spent developing the new practice, organizing it, hiring the team. I’ve learned a tremendous amount about marketing, business structure and operations.

I’ve become a founding physician of a startup, also I have learned a lot about how startups work and about digital education. It’s been quite a change from clinical care but I’m looking forward to this new practice, that’s going to launch. It’s going to be still a gynecology practice, we won’t be delivering babies but it will be what I’m calling an integrative gynecology practice. In addition to the usual tools of medicine that we have, which are medications and surgery, our practice will also be providing things like nutrition services, acupuncture services and doing some group events once we can get out from underneath the COVID effects here in terms of patient education and maybe even meditation. I’m feeling creative these days and turning my background and experience into this new thing.

To be clear, what you’re doing here with integrative medicine and integrating it with gynecologic medicine, this is different and this is new. This is not something that a lot of people are doing or few people are doing. Is that true?

Yes. Some people are starting to do it. Even when you look at the biggest institutions, if you look at places like Johns Hopkins, UCSF, the Cleveland Clinic and Harvard Medicine, a lot of the big institutions are starting to recognize that integrative medicine helps people. You can help a lot of people with pain with acupuncture, for example. They are starting to offer some centers that provide this type of care. There aren’t a lot of people doing it in the field of gynecology. Somebody has to start it, and if I’m that person, so be it.

One thing that’s interesting is in medicine and healthcare especially if you’re a doctor, everything is outlined for you. You go to undergraduate. You know what you have to do to get into graduate school, you know what you have to do to get into residency and then fellowship. There’s also a template for how you should be in practice after graduating from your training. This is not outlined what you’re doing with integrative medicine. That’s important to highlight is that you’re hitting your stride as we may have talked about before in your career and now you’re like, “I want to do something different with my experience, my expertise, my skillset and my abilities that medicine offers.” This is what you’re doing and still with the idea that you’re impacting and helping people.

This flexibility of path can apply even in the beginning. A lot of people think that in order to become a physician, that path is set in stone. You finish high school, go to college, take your MCATs, go to medical school, go to residency, go through fellowship and then you start working and you work in that job for the next several decades. That’s not the case anymore. I also work with medical students every year now who rotate through my office on their gynecology rotation. There is a trend in the less traditional paths. I see a lot of medical students who have a different background than a straight college degree in the Biological Sciences or maybe people who have worked for a couple of years in a different field.

There is a certain schedule that we can’t get away from. We have to pass our exams, we have to take the MCATs, we have to get into medical school, we have to take our specialty exams and the licensure exams. Those things exist for a reason because we do have to have some standardization of the path to ensure that people meet certain criteria, but I would encourage everyone to exercise a bit of freedom and creativity. No matter what career we enter, if we feel controlled by it, it becomes something that becomes hard to do after many years. We may as well spend our life something that drives us and motivates us, and that we feel passionate about that we can feel a bit creative about.

As an OB-GYN, is there any particular experience or one particular experience that brings to mind of what embodies an OB-GYN and what kind of work you’ve done?

I have a lot of patients that I have known for a long time. That is one of the best things about my field. I have a lot of patient stories and most of them are happy, but we encounter complications and we encounter sad and difficult events also. I have a patient that I’ve known for several years and it was someone who ended up seeing me one day because she saw her primary care doctor and she complained of something. This is someone that this primary care doctor wanted me to see that day. It was the end of my office hours. I saw a lot of patients but I said, “Sure, why not? Let’s see this person.”

HCDM 40 | OB GYN Sub Specializations

OB GYN Sub Specializations: Many huge medical institutions are starting to recognize the benefits of integrative medicine to people.

 

I ended up seeing this person and it turned out that she had not seen a gynecologist for many years before. She was there for a specific thing that had nothing to do with her preventive care. I had asked her if she had a breast exam and she had not had one for many years, she never saw a gynecologist. Despite the fact that it was late in the day and she wanted to go home, I wanted to go home, we ended up doing the full exam. I discovered an abnormality, I sent her for her mammogram which is like an X-ray of a woman’s breast. It turned out she had advanced breast cancer. She ended up having treatment within a week of that. To this day, she and I talk about it of how a single interaction with a doctor can change the course of someone’s life. That is a powerful thing.

We can’t forget that in all these lines of healthcare, we have the privilege of changing the course of someone’s life. That’s important because there are a lot of other aspects of medicine that feel mundane, all those phone calls, all those results, all the paperwork that we do sometimes can feel tedious but at the end of the day, we can’t lose sight of how important our work can be. Every year I see her, every time she sends me an email or we do something, I’m reminded of that and it makes me want to go on. That exemplifies how meaningful we can be.

What do you think the future outlook is like for your profession overall? Not you specifically but overall as an OB-GYN.

The outlook is positive but OB-GYN is going to change over the next few decades. There’s so much more to this field than what was thought previously. That’s true of a lot of fields in medicine, there are constantly more and more information coming out and more to know. Genetics is that example, and in OB-GYN, we deal with pregnant ladies and we deal a lot with genetic or inherited issues that can arise in the course of a pregnancy or with a new baby. The science of genetics has advanced rapidly over the last couple of decades. We now need specialists in medical genetics and specialty counselors in that because the regular field is unable to keep up with everything. Over the next several years, OB-GYN may become even more sub-specialized. Some people will work in the hospital. We’re seeing that now even already, some people will work in the hospital delivering babies. It can be a strenuous, busy job. Some people will work in the office setting seeing regular patients, and some people already specialize in surgery related to gynecology. We’re going to see more of a specialization within the field.

You talked about your bio initially. What were you like as a student in high school and college? Are you the studious type, straight A’s?

Like everyone, I had my challenges. I was not born in the US. I came to this country when I was fourteen years old. I was in ninth grade. I was born in Poland, then my family moved here at that time. I entered high school in ninth grade. Most of my ninth grade was spent learning English because I did not even speak English at that time.

Nothing?

I spoke the equivalent of studying a foreign language in your seventh grade for that one year. I had no speaking ability but whenever you get immersed in something, you end up learning it quickly, so I did. In high school, I was a well-rounded student. I did a lot of things. I was on a ski team, track team. I had a lot of interests in more humanities but I always liked the sciences also. I was lucky that high school academics came to me relatively easily. In college, I loved Ancient History and Archeology, so I was going to try it. I made that my goal. I bunched up all my courses together. I had taken a bunch of AP classes so that helped me satisfy some of my college requirements. I was able to take the last semester off of school and then earn enough money for my big European trip. It was great. It was one of the adventure highlights of my life. I’m glad I did it and I don’t regret it.

No matter what career you are in, it will not hurt if you allow yourself to exercise a little bit of freedom and creativity now and then. Click To Tweet

With medical school, those academic requirements got harder and there were some bumps in the road. Biochemistry is not the easiest class at all but it was okay. The key is structure, knowing when to sit, knowing when to study, being able to train your focus on something and then making sure that you can live a life outside of all that studying. Medical school was a combination of intense experiences, intense studying and academic focus but I also made some great friends. I met my husband in medical school. Residency was the same, we worked hard. That was the time of those 90-hour weeks but I’ve made some great friends. I’ve had some great social experiences. Life is not just one thing. The key is to figure out where your balance is and how to live life on all these multiple levels.

In college, you were thinking about Archeology and healthcare or medicine, what was the decision-making process for you in helping you decide that?

I couldn’t choose between the two because Archeology to me represented this hobby, dream, this more artistic line of work, but I couldn’t picture what that would be. That is why I wanted to go on a dig to find out what that work entailed because it’s one thing to think of something or read about it, but it’s another thing to try it. As much of a dreamer as I sound to be, I’m also pragmatic. I like to test things out. I’m analytical, I wanted to try it. Medicine was something I knew a bit about. My father is a general surgeon. My mom was a neurologist. I knew medicine because I knew it from my home experience of it. I saw the good and the bad of it. Until college, I didn’t think I was going to go to medical school.

I had some experiences in terms of my extracurriculars and working with people in college that opened my eyes to it a bit. I knew that with medicine, I could carve my own path within it but have a bit more of a long-term plan. When I went on my archeology adventure, it was great while it lasted, but there was no way no how I was going to do that for the rest of my life. That was not the life I wanted to have. I did the same things even in medical school. I initially thought I was going to do what’s called general internal medicine, being a primary care doctor, an internist. I wanted to practice being that. I did a special rotation in that specifically where I worked with somebody to see what their day was like. That taught me that I did not want to be an internist. I’m glad I did that because you don’t want to commit to something long-term without trying it first.

You were thinking about internal medicine. What else were you thinking about in medical school?

Oncology because I had an amazing mentor. Sometimes we want to do the things that people that we look up to do, which is understandable, but that doesn’t necessarily mean that we should be doing those things. We may be inspired by their character, their person, their attitude, that’s what happened to me but I confused that with being inspired by their field. I did a little rotation in that also and that taught me that I didn’t want to do that. Whereas in medical school, you get to try lots of different subspecialties and specialties. When I did OB-GYN, this was my last rotation of my third year, which was the year when you try different things. I was getting down a bit because this whole internal medicine thing and the oncology thing didn’t seem to jive. I was like, “What am I going to do?” I did OB-GYN. By the end of the second day, it felt right. I came home and I was like, “This is what I’m going to do. I can’t do anything else.”

You’ve got to live those experiences even for a few moments to get a feel for what that’s like. Like you, you get inspired by certain people you come across. It’s not necessarily inspired by the field but whether it’s their character or their skillset, maybe they’re good at that skill like, “I want to be like that,” or the way they approach their life or their profession. It can be inspiring for someone that’s looking for directions sometimes.

I would encourage anybody that’s looking at any healthcare field, if you think you like something in particular, spend some time with somebody who is living that life. Take a look not just at them but see the work they do. How does that work affect their lives? I’ve had medical students that come and work with me sometimes for a week or two. I’ve had some students who say, “I cannot do this. This is not for me.” I’ve had students who fall in love with this work and where that decision gets solidified. Both experiences are valuable. The goal is to try to figure out what you don’t want to do and hopefully find something that you’re going to love.

Would you have done anything differently?

Yes. Despite my not such a straight and narrow path, in the end, I did. I went on my adventure trip but then I went straight to medical school. I did my residency and then I went straight into my first job position. At the time, things are changing here a bit. When I finished medical school, I graduated quite a bit of educational debt, and I had the opportunity to go and work in one of the programs that would have allowed me to repay that debt faster by working in an underserved area, which could be a remote part of the country like Alaska, North Dakota, an Indian reservation or you work up in an underserved area in a big city.

At the time, for some reason, it’s such a hurry to be done with school and get on with my life, do things like get married, have the kids and have a house. Looking back, spending a year or two working in a different environment and getting exposed to that would have been a good choice at the time. What I learned from that is take the time to see what’s around. It’s like how that saying goes, it’s about the journey, not the destination. I was in a hurry to get to a destination only to find myself several years later, finally enjoying the journey that’s going to take me to the next place.

HCDM 40 | OB GYN Sub Specializations

OB GYN Sub Specializations: It is incredible how a single interaction with a doctor can change the course of someone’s life.

 

Making your own road. I want to switch gears now to what I call my rapid-fire questions. This is a little lighthearted, playful and sometimes revealing but it doesn’t have to be. What’s your favorite candy to eat?

Any dark chocolate.

What’s your favorite ice cream flavor?

Coffee.

What’s your favorite type of books to read?

Historical fiction.

Beaches or snow?

Snow.

On a scale of 1 to 10, how strict were your parents? Ten being very strict.

Eight.

Would you rather not brush your hair ever or your teeth?

Hair. I have to brush my teeth.

Don't ever commit to something long-term without giving it a try first. Click To Tweet

I know you live in New Jersey. If you have to live in a different state, what would it be? You can’t say New York.

I would live in Maine. I love Maine.

Place you would most want to travel especially now in December of 2020?

I would like to go to Northern Italy.

How many days do you wear the same pants in a row before it becomes a problem?

Two or three.

If you could get a yacht, what would you call it?

A yacht would be a huge headache to have. I would call it Headache probably. That would be a major headache.

If you were stranded on a tropical island, what two things would you want with you?

HCDM 40 | OB GYN Sub Specializations

OB GYN Sub Specializations: Never hurry to get to a destination. Take the time to process everything around you during the journey.

 

I would want a knife. I should have a practical tool. I would get a water purifier with me.

Practical thinking.

My family loves to watch all those Survivor shows. We watch a lot of those. Bug spray, that would be the best too.

That’s it. I appreciate you coming on this episode.

Thank you. I enjoyed it and all the best to everyone. Take care.

That’s our show. Thanks for tuning in. To learn more about our guest or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. You can also find me on Instagram, @DrRichardMarn.

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