Direct Specialty Care Doctor
Meet Dr. Maggie Abraham, a board-certified Obstetrician and Gynecologist holding the prestigious American Board of Obstetrics and Gynecology (ABOG) specialty certification in Pediatric and Adolescent Gynecology. She earned her Doctor of Medicine degree from Trinity College Dublin in Ireland.
Her journey continued with a rigorous obstetrics and gynecology residency at Jacobs School of Medicine and Biomedical Sciences University in Buffalo, New York, followed by a specialized fellowship in pediatric adolescent gynecology at Washington University in St. Louis. Dr. Abraham's commitment to advancing her knowledge led her to obtain a Master of Science in Clinical Investigation from the University of Louisville.
Dr. Abraham is an active member of the American College of Obstetricians and Gynecologists and the North American Society of Pediatric and Adolescent Gynecology. She has contributed significantly to these organizations, serving on various committees, including the ACOG Adolescent Health Committee, for over a decade.
Originally from Ireland, Dr. Abraham relocated to the United States in her early twenties, following her American boyfriend, a decision she considers the best she's ever made. After training in four different states, she and her husband settled in Orlando, Florida, along with their four children and beloved dog, Odin.
Her passion for pediatric and adolescent gynecology blossomed during her tenure as a young attending at the University of Florida. Dr. Abraham witnessed countless teenagers and college students seeking help for gynecological issues that had long been overlooked. This experience shed light on the unfortunate lack of awareness surrounding gynecological conditions in adolescents, leaving them suffering without proper diagnosis or treatment.
Driven by a desire to make a difference, Dr. Abraham dedicated her practice to addressing the unique gynecological needs of young people. Before establishing the GYN space, she enjoyed a fulfilling clinical practice for over 12 years.
Dr. Maggie Abraham is here to provide expert care and support for pediatric and adolescent gynecological concerns, ensuring a brighter and healthier future for young individuals.
LINKS/RECOMMENDED RESOURCES:
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Beyond the Pill: HERE
Learn About Birth Control with Upstream USA: HERE
North American Society for Pediatric and Adolescent Gynecology: HERE
American Academy of Pediatrics: HERE
American College of Obstetrics and Gynecology: HERE
Check out the Sex Education Collaborative: HERE
Period Tracker Apps Mentioned in this Episode:
Period Tracker: HERE
Flo: HERE
Clue Period & Ovulation Tracker: HERE
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Transcript*
Direct primary care is an innovative alternative path to insurance driven health care. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at the time. their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model.
I'm your host, Marielle Concepcion, family physician, DPC owner, and former Fee for Service doctor. I hope you enjoy today's episode and come away feeling inspired about the future of patient care. Direct. Primary care.
The narratives of teenagers and coming of age stories hold a special place in my heart. While I'm an expert in gynecology now, when I was a teenager, I knew embarrassingly little about my body and the answers I received didn't make sense. I started the GYN space to put skilled GYN care in the hands of young people to engage them where they're at.
Impart knowledge in fun and relatable ways and help them develop agency in their gynecological health for now and the years to come. I am Dr. Maggie Ibrahim of the GYN space and this is my direct specialty care story.
Dr. Maggie Abraham is a board certified obstetrician and gynecologist with an American Board of Obstetrics and Gynecology, or ABOG, specialty certification in Pediatric and Adolescent Gynecology. She received her Doctor of Medicine at Trinity College Dublin in Ireland, graduating with honors this year.
She completed an obstetrics and gynecology residency at Jacobs School of Medicine and Biomedical Sciences University in Buffalo, New York, and her fellowship in pediatric adolescent gynecology at Washington University in St. Louis. Next, she earned her Master of Science in Clinical Investigation at the University of Louisville.
Dr. Abraham is a member of the American College of Obstetricians and Gynecologists and the North American Society of Pediatric and Adolescent Gynecology. She has held several committee roles within these organizations over the past 10 plus years, including service on the ACOG Adolescent Health Committee.
Dr. Abraham moved to the U. S. in her early 20s following her American boyfriend stateside, unequivocally the best decision she's ever made. Having lived in and trained in four states, she settled in Orlando, Florida with her husband. Yes, the boyfriend who lured her stateside, their four kids, and dog Odin.
Dr. Abraham discovered the field of pediatric and adolescent gynecology while working as a young attending at the University of Florida. Teenagers and college students alike would come to her practice with a variety of gynecological issues that had been inadequately addressed for many years. Dr. Abraham realized the lack of awareness of gynecological conditions among adolescents often leaves them suffering for years without a diagnosis or appropriate treatment. These encounters inspired her to dedicate her practice to young people and their unique gynecological needs. Dr. Abraham had an immensely satisfying clinical practice for 12 plus years prior to the opening of the GYN space.
Welcome to the podcast, Dr. Abraham.
Thank you, Mariel. Great to be here.
So I unfortunately do not have my Irish pub background change today as I did with Dr. Clodurayan, but I, uh, you can't do that for me. I I'll, I'll try to do that mid mid recording here, but Oh my goodness. I will say that it is so awesome to have learned a little bit about you in preparation for this podcast.
And one of those facts was that you grew up in Ireland. And I love that you're coming from a totally different perspective than someone like myself, who like born and raised in Sacramento, stayed in the States for all of training. And I really am excited to have your perspective, especially given the fact that you are, you have opened the GYN space in Florida.
So let's get started. So for those who, um, for those who are not watching the YouTube, I definitely would recommend it. I changed my background. I'm now in an Irish pub. I love it. Yeah. If you are also someone of Irish background, let me know that before you come on the podcast so that I can make sure that we're chatting in the right space.
So your, your statement though, that's a, if I, if I smell Guinness, it will put me to sleep. So I'm not, I'm a Filipino and Virginia, not a, not an Irish, not an Irish person. Oh my goodness. I love it. Well, I, I love your opening statement and I love when you go onto your website in a time where, you know, we just, the, the movie, Are You There, God, It's Me, Margaret, just finally came out as a movie.
Your statement of you built this practice to put skilled GYN care in the hands of young people. And you're doing it in Florida. So I think it's so awesome what you've done. And I think it's so awesome that you have the space now to do what you need to do because I'm sure that your care was different when you were exclusively doing fee for service medicine.
Yeah. So, gosh, you touched on a bunch of things there, Mariel. Yeah, I'm Irish, born and raised, went to med school there, met my husband, now husband, and he sort of lured me stateside. So I came out here in Gosh, I'm hopeless with dates, but 2006. So I've been here quite a while and it surprises me, you know, I thought I grew up the way I grew up in Catholic Ireland, right?
And I think back about my introduction to, you know, reproductive health as a kid and, and how it is today. And, yeah, putting skilled GYN care in the hands of young people is something. That became important to me over time. Actually, you know, I trained in obstetrics and gynecology and now I'm a subspecialized pediatric and adolescent gynecologist, which is a small subspecialty niche within the larger field of obstetrics and gynecology, but I can talk a little bit about how I got here and try and bridge the gap between, you know, my upbringing and and why.
Putting skilled care, GYN care, in the hands of youth became increasingly important to me as my career progressed, actually.
Yes, please do, especially because, you know, I was texting with one of my girlfriends who, from college, whose kid is now in fifth grade. And they were talking about, um, or she was talking about how, you know, he's going to have his sex ed class this year.
And I'm like, for me, sex ed class was like, girls were separated from boys and literally, like, this was the time in the 90s where always came out with wings. And we were told like, and if you do sports, you have to wear a tampon. And so now we're in 2023. And I would love for you to tell us more about like, when you talk about your introduction to reproductive health, how you growing up in Ireland, fine, but how also, you know, reproductive health was viewed in Ireland compared to the States.
Like, how did you come to this place where you were like. I really love pediatric and adolescent gynecology specifically because you mentioned how, and this is in your, your bio quote on your website, just like you said, you knew embarrassing little about your body and answers received before, you know, you became a subspecialist didn't make sense.
And so what experiences did you have that you're comfortable sharing when it comes to, yeah, when it comes to why, how did you even come to be being the doctor you are today? Yeah,
so we've had no formal sex ed, at least not in my remembrance, you know, and, but I, I definitely remember. Figuring out about what a period is.
I remember, you know, being in the car with my dad and listening to the radio and something came up about periods. And, you know, I don't know how old I was, but I remember saying to him. A period is a punctuation mark at the end of a sentence. None of this makes any sense to me. And I mean, I was that kind of a kid.
But my dad was a vet, so interestingly enough, he took it upon himself to have the conversation with me and, you know, he related it to anatomy and the reproductive system of maybe a dog, maybe a cat was thrown in there and there was very little eye contact because he was driving watching the road. And I just felt in the back seat, I went from, you know, leaning out kind of in between, you know, the, the car seats to really reclining pretty far back and being like, and, you know, in my head, trying to, you know, make sense of it and how it might apply to me and, you know, God bless them.
He did. He did a good job, but still like many gaps. And I think, I thought, you know, the gaps that I had growing up were unique to me, right? And or maybe like partly cultural and different things, but as I stepped into being an obstetrician and gynecologist, I realize that no gaps exist and I think, you know, as parents, it's hard to parent out of a lack, right?
So when we haven't been taught it ourselves, it's hard to turn around and teach it to your to your children. And then, you know, we live in an era where in Florida, sex education is, you know, largely been taken out of the schools. Right? And many people consider sex education to boost still people don't feel comfortable talking about menstruation, talking about reproductive health, talking about sexual health.
And I think as doctors. We believe that sex education and sexual health is health care, right? But I still think that that gap exists and where the gap exists, you know, our teams are looking to social media and I think porn and all those things to educate and their experiences and their understanding fundamentally flawed in many cases.
And so I think, you know, when I trained in obstetrics and gynecology, you know, my experience was largely in the adult world, right? But in my 1st position out of residency as an assistant professor at UF, I was new junior faculty. And so they had me staff the student health center at UF and put any. Young reproductive aged, you know, the teenager would come to the practice with an issue.
I was sort of the default person. And so I discovered, oh, my gosh, like, people don't know about their bodies teenagers struggling with things for years and not getting them addressed or inadequately addressed. And I realized there's a whole space here and then I discovered there was a whole field called pediatric and adolescent gynecology.
And so, yeah, I just kind of went from there. I started, you know, those textbooks. There's a whole organization, there's an annual clinical meeting. And so I just devoured that knowledge. And then I still felt like, so I quickly kind of became the point person within our division within our department that wasn't a division of PD adolescent kind, but within our department.
And within the division of gynecology to see these young women and adolescents, so I, I, I restricted it, you know, based on my, my experience, I felt comfortable seeing adolescence, but not necessarily the pediatric age group. And then ultimately, I felt a bit of a fraud, you know, because there's this whole field and there's a fellowship you can do.
There's all this additional training and I didn't have that training. So I went back to kind of legitimize and get credentialed and do my fellowship. And so four years after residency, I went back and did a fellowship in Piedad Lasungain. And then, and then just my love for the field solidified because I discovered, you know, the breadth of the field.
And yeah.
When you talk about how in places like Florida, sex ed is basically taboo, and people all over this country are not having equal access to learning about their bodies, learning about, you know, what's normal, learning about that normal is a huge spectrum, like Uh, you put on your website, you know, people get their period starting before they're 10.
Like, I'm going to raise my hand, hashtag nine years old. And then, you know, to people who are in high school and there's so much, especially on social media, when you're talking about how people are like, Oh, well, is there something wrong with you? Because you don't have your period yet. I mean, little things like that really impact a person's A whole life.
I mean, there's self esteem. There's so many issues, but the fact that you had extra years of training to do what you're doing today to be the subspecialist that you are, it's just insane to have, you know, people argue like we're not going to learn about it.
We're just not going to, I mean, that's my personal opinion, but to, to not be able to talk about something where you as a physician and already, you know, practicing physician needed to go back for four extra years to be able to learn. All of the things out there, like they're, you know, this is not a benign thing, like magically, you know, this is probably going to ruffle some feathers, but it's like, it's not like magically you go from being a kid to, you know, in college and you're super confident with your body, like some people are great, but it's like.
This is crazy that we're in a time when I'm here in California where women's rights are constitutionally protected as of November of 22. And having sex ed is something that like every fifth grader goes through in, in public schools at least. But I want to ask now because you mentioned how you were becoming the point person.
At your clinic in your department before you went to fellowship, were you able to contribute to how your schedule is set up so that you were seeing specifically adolescents and then pediatrics and adolescent patients rather than, oh, well, Dr. Abraham has some space. We're going to throw some adults on her schedule.
Oh, I was still largely an adult generalist practice. I staff the student health center at the University of Florida. One half day a week. I'm going back in time now. So I'm trying to be accurate. And then, yes, no, I was just working like the teen patients in on my panel that was predominantly adult. And so they were coming to an adult space.
Sitting in waiting rooms with, you know. Adults who pregnant, maybe sometimes all ages, right? And it just wasn't a space that was catered. To their needs, and the resources to were different, right? So it wasn't an ideal situation, but at that point, it wasn't a subspecialty that was high priority either.
Right? And so it was, like, within the larger scheme of, of. Adult, so then when I went back to do fellowship, that was when I truly discovered the breadth of the field and the opportunities within it. And that's when I 1st started working and designated. Pediatric lessons spaces and spaces that were were designed with them in mind and resourced accordingly.
Right? So social work is often important. And then you're straddling sort of the world of. Pediatric subspecialists, as well as adult subspecialists, right? And you're harnessing the resources from both. And then when I actually left my position at UF to go back and do fellowships, a fellowship is 1 to 2 years in pediatrics and kind.
We're like, well, you know, we'll hold your spot when you're done, come back and build it here. But so much happened during fellowship that I wanted to remain in that PD adolescent space. So as opposed to going back to being a generalist and having like a smaller PD adolescent kind of practice, I wanted a large PD adolescent kind of practice.
And maybe my generalist will be kind to be more of a smaller. Part of what I did, and I just wanted to toggle back a little bit. I guess I just wanted to say that. Oh, the piece about Florida and the whole sex education, they're still required to do health education. And as part of that include some abstinence and unplanned pregnancy education.
Which is very different from sex education, right?
It'll be interesting to see how states that are similar to Florida in that respect, how the mental health of teenagers will be as these kids who would usually be learning about sex ed are not necessarily going to have the same access as other places in the country as they grow older, you know, adding social media to the mix, adding all the sports and things that people are doing at those ages, um, it, it will be interesting to see.
I definitely, so grateful though that you and your clinic exist because I hope that, you know, this podcast gets the word out there. I do, I'm just going to put a plug in here on behalf of Dr. Deanna Barry and the whole pediatric DPC mastermind crew. I definitely hope that you will think about doing a talk at the mastermind specifically about DPC and pediatrics in February of 24 because, you know, this is something that If we're able, you know, there's other doctors in Florida, but if we're able to learn from your experience and not that we're going to become magically subspecialists overnight, but just, just the way that you approach things like, oh my gosh, it was very moving for me to see your one reel about.
Period packets, period. What did you call them?
Oh, a period kit. Yeah. About period kits. Yeah. Young women, teens. Sorry. You, you mentioned you got your period at 10. You know, there's a big difference developmentally with getting your period at 10 and getting it at 12. Right. And so many tweens and teens get their period at school.
Or when they're, you know, out with a friend somewhere, or in the middle of an activity. And yeah, a period kit's a great way to start the conversation and give them the tools just to be a little more prepared, right? For some of these challenges. That the come along with puberty and menstruation, even if everything's developing normally, and then you take, you know, you take that teenager where things are not happening normally and you just think about all that they have to deal with.
Right? And so many suffer in silence because they don't want to bring bring it up. If they do bring it up, you know, they feel like they're complaining about pain or. Not being able to kind of keep up with activities and schoolwork because they're having, you know, period issues that, you know, they're going to be ridiculed or considered weak or wimpy, or that their parents are going to worry about them too.
That can be a concern for a lot of. Teenagers, so having the conversation and letting people know that there can be issues and. They need to be addressed, and it's all part of health care. Right? And it's so important in positioning them well for their whole reproductive lives. Right? And I think we're starting to see a lot of, you know, what quite commonly in my practice, I'll have a parent come in and say, hey, you know, I had to deal with infertility because endometriosis and, you know, people told me that.
This is present since my teenage years. So what does this mean for my daughter? What does this mean for my child? You know, so I think parents are wanting better for their children and not wanting them to go through some of the struggles that they had to go through. And I think we're starting to get.
More and more information out there about how common things are and creating pathways for these things to get addressed. Like, the whole menses of the vital sign. My period is a vital sign, right? That the AP, the American Academy of pediatrics and 8 cog American College of obstetricians and gynecologists came out with that recommendation back in 2006.
I believe saying that. Your period is like a vital sign. So in the same way as we check blood pressure and heart rate, we need to be as providers checking in with our tweens and teens about about their periods and talking to them about what is normal and talking to them about what is not normal, right?
What's abnormal and what needs further evaluation? Because. So much of it's being normalized, right?
Absolutely. And, you know, I, I just think back to that time when you said, you know, cause I, I got my period at nine, unfortunately, I remember exactly the day that, that I got it, but this might surprise people.
I was very much an introvert when I was a child, very much like. Super shy introvert and what happened? Yeah, I went to uc Davis and there were 30% of that college was Filipino. And I was like, oh my God. And then I like found my space. So yeah, totally, totally became like a different person. But you know, I think about how, you know, you mentioned like between, you know, 10 and 12 even.
There's a huge difference. Like I remember personally, I'm laughing because how your dad was like, you're your go-to period dude. And he was a veterinarian. My dad was a social worker. And my dad was like, literally, it was like, I couldn't have mirrored the, are you there? God, it's me, Margaret book anymore.
Like he literally like handed the cordless phone through the door and was like, call your mom. And I was like, okay, well, that's great. And then, you know, people at school would be so upset that they didn't have their periods. And I'm sitting here like. Totally quiet thinking in my head like, well, it sort of sucks because like, I, you know, I, I had bad cramps and I had, you know, days where I was like, I couldn't focus in school that I remember as a kid, you know, in elementary school.
So let me ask you there when you were, you're hearing all of these stories, you're working fee for service, you went to fellowship. And then how did you start to, to change your approach to your career and think about how could you be delivering your level of special specialty care differently to the people that you wanted to serve?
Yeah, that's a great question. So there's about 20 new doctors coming out in North America, like through. Canada and the US each year. So we are in short supply. Most of us end up working in academic institutions. And once once we're there, I mean, the floodgates open, you know, we're seeing there's a huge need, right?
There's a huge gap in service. And so, I mean, our clinics are so busy. I think, you know, I think I can speak for all patent providers and, you know, I mean, the extent of what, what we see is, you know, it's the whole reproductive care, whole gynecology. But for the teenage and and pediatric age group, right? So we're seeing, you know, young women with complex medical illnesses.
We're seeing childhood cancer survivors. We're seeing young women with bleeding disorders. We're seeing, I mean, there's just a lot and then you have your normal. Contraception and healthy sexual behavior, um, behavior is component to what we do like it's a lot. And so sometimes it can feel like you're just touching the tip of the iceberg with patients, right?
And hoping that in those. You know, short visits that you're giving them. You know, a starting space, but gosh, it's hard to put it all into words for me and try different things at different times to try and create some margin. So I scale back and worked part time. So, but I would spend my, my time, you know, following up making phone calls outside of clinic time just to make sure that.
You know, all the info I packed into the visit was landing, you know, and then over time, it just became a little bit more as I got more and more aware of the gaps in their understanding and the fear that comes out of those, those gaps, right? That I realized that I wanted to partner in a more meaningful and deeper way with my patients.
And in order to do that. You need more time and you need more autonomy over your schedule. And also, you know, I think 1 of the really hard challenging parts with with being a pediatric adolescent gynecologist in a larger health care system or academic institution. Is that you're staffing the emergency room and inpatient consults to and your bandwidth, you know, straddling clinic and surgeries and hospital consults or ER consults, you're just spread too thin.
And so you have to make peace with how deep you go, right? Because you are spread so thin. And for me, that reached a tension point over time. And I just decided. I wanted to step away and then when I stepped away, it kind of gave me time to really envision my ideal kind of practice. Right? And the other challenging part, I will say is, you know.
Sexual health, there's just so many people are still really uncomfortable with it. And especially as it relates to our younger teenagers and the pediatric age. I think even adult gynecologists, it's outside of their comfort zone in many cases. Not, not all. Right. And I, I don't wanna, there's some wonderful, some people enjoy that space, even if they, you know, if their primary practice is, is in the adult world.
And so at the end of the day, if you are the specialist, You know, it all kind of filters back to you. And so that that can be challenging. I think it's a challenge for many pediatric and adolescent gynecologists who are out there. And when they 1st start their practice, it tends to be less of an issue, but the institution or the organization you work for becomes increasingly reliant on your expertise.
And that's just that higher level of care. I think when we're not there, um, You know, we don't know what we don't know until an expert comes in and shines the light and says, well, actually, we should be considering this and this and this. And so it's great in the sense that there is this higher level of care and a big passion.
I think of most pediatric and adolescent gynecologists is coming alongside our colleagues and educating them to and helping them build capacity to step into this adolescent space. Right? And and provide reproductive care. I love it. I just, you know, I'm nodding my head over here as a primary care physician because I'm like, all of these things that you're talking about, it's so on the level of preventative health because people are understanding their bodies better so that they're able to be preventative when it comes to like, Hey, you know that thing that Dr. Abraham said to look out for like, I think that that's happening to me and so to be able to flag it earlier or to be able to have a space to flag it and then talk with a doctor who knows what they're talking about earlier would definitely make a huge difference in a lot of people's lives. And this is why, again, I'm so glad you're on the podcast because I hope this spreads the word out that you exist.
I hope that, you know, you're thinking about, could you encourage your, and inspire your fellow, and I love how you said PAG physicians and PAG providers. I, I think that's, that's so swanky, like that you guys are PAG doctors. Um, but I hope that your story inspires them to also think about, you know, My level of training, what's being demanded of me, do I have autonomy, do I have the time to be able to talk with my patients the way I need to, you know, your words are ringing similarities in my head to Dr. Minajula Pali, who's a pediatric dermatologist, who was doing, you know, things like how you're, you're saying like you would take time apart from your work time to make sure that your patients were doing okay, they understood what you needed to get them to understand and Dr. Julepali was talking about how she would always try to, to do things to, you know, achieve those same goals in the dermatology space.
So I, I, I love that, you know, you took that time also just to, to take a step back. One of my best friends from college and my old roommate, her husband took some time off from his financial job. And he's like, I, my plan is I don't know what the plan is. And I think that especially for people who have been in a career space for, you know, a few years, and they're feeling like, is this an alignment with my why and my goals for the future?
You'll be in a space where you're going to guide your clinic by how you've, you've spoken on your, on your website, you know, how you're being able to engage with your patients where they're at, impart knowledge and fun and relatable ways and help them develop agency in their gynecological health for now and years to come.
And. When we as physicians are able to do the things that we need to do to be able to be the doctors we need to be, the finances will come. I, I, I say that very, it sounds very Pollyanna ish, but when you're not so focused on, but I have to make the money, I have to make the money, I have to make the money, great, like, you know, beef up what you need to do, work urgent care shifts, whatever, so that you can take that time off if you can.
But I love that you just, you took space for yourself to just figure out what does the future look like for you.
Yeah, there was a lot that, that happened. You know, I feel like I've gotten to do so many great things, you know, just even going back and doing a fellowship in pediater less than guy. I remember making that decision to kind of step out of being a generalist.
I didn't know then where that was actually going to lead me. I just felt like this is what's important to me and I'm going to take a step in that direction and we'll see where it goes. Right. And you're right. There are the financial pieces. And I think most pad providers can't be too financially concerned because it's not one of those lucrative fields.
Right. But then, you know, medicine pays, right. You know, we have a decent. Living and good earning capacity, but there's a lot of differences within the doctor spectrum, right? But yeah, for me, I think.
Understanding what was important to me at each point and being willing to, even if it's uncomfortable still, even if you decide, hey, this matters to me, but this is what I was spending my time reading about, you know, I mean, I'm still keeping up with obstetrics and gynecology, but I was devouring PD adolescent stuff and I was loving.
Seeing those patients on my panel, and I wasn't as strategic about creating importance around what I did on an organizational level. And I think it was a skill set that maybe I developed a little bit more over time. And instead, I kind of found so much joy in it that I. Owned myself on the back end using my own spare time, but on the end, on the same note, like it is work, right?
Yeah. And I, I guess I kind of also felt a little bit of a fraud. Like, I felt like, well, I'm not quite an expert in this, but then when I went back and after I got my fellowship and did those pieces, and I also did a master's in clinical investigation along the way, because I felt really. Passionate about delivering evidence based care to teenagers, right?
That, hey, they deserve a high level of care, right? And, and also, you know, when you're speaking to parents and to teenagers, I mean, they ask great questions and I wanted to be able to provide them the evidence. And education is one part of it. So I think at that part of my career, I was really focused on The knowledge piece.
And then as I've matured in the space, I feel like, okay, I am the expert, but then being a credible expert to a parent and to a teenager requires relatability. And so, like, Partnering with them to impart the knowledge, but then also understand where they're coming from understand their barriers and their challenges and then finding a workable solution.
Right? And all of that. Takes a lot of time and so I felt like the system I worked in was short, changing my patients and short, changing me too, because you can't cheat time. Like, I feel 1 thing. That's always, as I look back, I remember when I 1st came to the U. S. And I remember residency being like. Oh, my gosh.
Like, it was a shock. You know, I came from a system where things started in the hospital early, but not quite as early as the U. S. system. But I remember one day walking into, I don't know, like 5 a. m. or something, walking in to start a shift and being like, I can't do this. Like, and then having that, like, mental moment of no, no, no, you can do this.
But do you want to do this? And realizing that Okay, I want to do this because I want to be in the U. S. I want to be, you know, my, my now husband right was there and all of those reasons. But I had some of those same moments in my positions recently where it was like, I can do this. Like, I can turn out this number of patients a day.
But do I want to do this? And the answer is like, no, like, I want to do it differently. And then I'm fortunate in that my life circumstances allowed me financially to take a step back and to think about things differently. And then it became really clear to me that I wanted to create the space that was tween teen friendly and designed specifically with them in mind, because I think it's a real privilege to enter into this space and provide reproductive care to them.
And I think that they're deserving of it, right?
Absolutely. Absolutely. It makes me that like sends an arrow to my heart because. I think that that speaks to what care you're bringing and what care all direct primary care as a business model physicians are doing. And you know, we all deserve nothing less than a physician who has the time to give you the care that is personalized to you at your level of where you're at.
And that could be, you know, in your case, definitely reproductive health, especially in the formative years. Um, it could be like a new diagnosis of CHF, but when people are treated like their numbers and like you're talking about that feeling like a fraud, I know that there are so many people out there listening, shaking their, or excuse me, nodding their heads.
In agreement, because what is fee for service? It is get as many fees as you can for the corporation to then throw back at you. And now you got to do it again tomorrow. So let me ask you there, as you were taking this time off, as you were, you know, just, just giving yourself the space to envision your, your next career goal.
How did you learn about providing direct specialty care? That's a great question. So I was listening to some podcasts and it came up and it just resonated with me. Same way I, excuse me, probably pediatric adolescent kind resonated with me so many years ago. But, you know, this is the model of care that I'm actually familiar with, because this is how we do it back in my other home, you know, you go see the doctor, you open your handbag and you pay them for the service they provide.
I'll be honest, like, I've had a couple of. Moments, you know, when you go through residency, you're, you're so busy, you know, drinking from the fire hose of knowledge and scrambling to do all the things, right? That you really don't think about the financial pieces and the cost. But I remember sitting in, like, 1 of my 1st faculty meetings as, you know, as a junior attending.
And looking at, you know, the collections of the department and being like, so why does billable and collections? Like, why are there? Why is there such a discrepancy in the numbers? And I said it out loud. And so I remember everybody around the table was kind of like, Oh, that's just the way it is. Like you're Irish, but that's the way it is in America.
But I remember feeling like this is a load of crock. Like you shouldn't have to do like the one thing in life that should make sense is math, right? And so I just remember thinking like, there's something really off here. And then I actually started just ignoring the numbers. I was like, if it doesn't make sense, I'm just not going to look at that sort of stuff.
And then my daughter, my third, I have four kids, but my third daughter, she spent their first few weeks in the ICU. And when her medical bills came in the door, I was like, I turned to my husband, I was like, what is this? Like, how can people afford to pay this, these kind of numbers and it just kind of blew my mind.
And so it kind of opened me up a little bit more to the economics of, and the business of medicine. And I think people think that, you know, as doctors that. We're setting these prices and we're not, but we're complicit in them, aren't we? Like, we're part of this system. And so a lot of those things were sort of brewing in the back of my mind.
And then, when I got to the place of wanting to practice pediatric lesson, going a little bit differently and seeing that. You know, working in academic institutions and other organizations, it has served me well in many, you know, at different time points. But at this point in my life, it just, you know, program development, education, changing culture and management, rolling out protocols for, you know, how kids coming into the ER with heavy menstrual bleeding should be managed, ovarian torsion, all of those things, you know, that's been really a Fun and wonderful, but now I'm in a different space and I want to do things a little differently.
And so that I couldn't take, you know, I couldn't take it in that direction within a traditional earthy. Within working for a larger organization. So, for me, stepping away was really a good thing. I still work as a hospitalist 1 day a week and I love working with the residents and, you know, I, I still really enjoy labor and delivery.
And operating and all of those pieces, so I think there's a role for both. I think we need both. And I think that health care is transitioning. It's going to change. I think DPC is probably just heralding in a new era. And I'm excited. I think there's more and more people looking to do things differently.
And the other thing that I will say is that when I started to explore. You know, starting my own practice, you know, everybody was like, you're going to have to partner with another organization. And the idea of it just made me feel like, no, no, no. Like, I'm not even really sure what it is I want to build. I just need the freedom to build it.
And so if I'm partnering with, you know, this organization, that's going to be requiring things of me. I'm not going to be free to build it. And also, it kind of blew my mind. I can't really reconcile the idea that a doctor provides a service. And it's the same service, but they're compensated or reimbursed differently from each insurance company for that same service.
Like, that just blows my mind. Like, how is that? How is that even normal and acceptable? You know, a service is a service, and I just didn't want the complication of it all. And. Honestly, the restriction of it all in building my practice. And when you talk to doctors who transitioned to taking insurance, you know, back in the 80s and the 90s, it is very interesting because the goal was to have more time with the patients.
The goal was to have the insurance companies help with that. And I think about the whole idea of the lobster in the cold water and slowly that pot is boiling and then now we're at this place where. Everybody's cooked. And so it's interesting when you are talking about the residents. I love that you are, you know, bringing your whole person.
And now this person who has their independent practice into their space because I talked with a ton of residents and medical students last weekend down at the California Academy of Family Practice. They're the annual summit who were like. Saying these things like, you know, is this the only way to practice the medicine is this is not in alignment with my goals of being a doctor and I love that they have that intuition at such a younger age compared to when I, you know, back in 2019 was told you should look into DPC.
It's it's crazy how. How much earlier people are thinking about, you know, could medicine be delivered differently? And we, we are providing examples of how to do it differently. So let me ask you there, when you decided to open the GYN space, how did you envision your practice? And what does it look like today?
That's a great question. So isn't it funny that we get no education? You know, through med school, or at least I didn't about, you know, how are you going to build your practice or what is it going to look like? You just feel like there's. 2 buckets, you either go down academic route, or you go down the private practice route.
Right? And I think it's changed so much that I'm not surprised that. Are the residents and medical students coming through today are evaluating these things. And I think we have a role in, in sort of. Innovating within that space, right? And finding ways to keep our patients front and center. I meant to actually mention that, that I found myself feeling like I needed to satisfy.
Management. You know what I mean? And it's, it's quite a stressor and they are insatiable. You know, you jump through your metrics every year and they just increase and increase. So to circle back to what you asked me, my practice just opened in the middle of August. So it's new. I mean, there's aspects of it that I love.
I love the fact that I've gotten to create this space. And then there's aspects of it that are so far outside my comfort zone. And I mean, I think that's the thing though, like we're constantly evolving. And that's why I love working with teenagers because they're not afraid to grow, try on new things, think differently about things and do things differently.
And so I feel like I'm channeling a little of them in doing this. Um, so thank you to all my patients out there. Yeah. Like, I think I, I told you this, that I feel like when it comes to social media and different things, I feel like I'm a dinosaur who's had my head under the rock. However long, but I am having to emerge in that space because when I worked for a larger institution, my patients came from all over Florida.
And so it was really important to me to have a wide reach and to be accessible. And so I decided to start with a virtual practice. It may evolve over time into something else. I feel like it's still just a big experiment. I'm trying to figure out what's going to work. What do they want? How can I be accessible?
How can I meet their needs? So right now it's a virtual, I can do a house call if you're in, you know, a certain area, but largely I see it being a virtual practice and just partnering tagline was, you know.
GYN expertise at their fingertips. And so, you know, when you come to my website, the idea was to create a warm and friendly space that is welcoming to all adolescents, as well as those that care for them, right? Their parents and guardians. And. to be kind of like a GYN home for them. I hope to build out other aspects of it, community, meeting spaces, and different things over time.
We'll add those pieces in. But the website is a, is the front. And then when you become a patient, a patient of the practice, then you enter into my electronic medical record and the virtual space. And then, you know, I've been thoughtful. In making sure that, you know, their privacy is protected and in so far as technology, you know, nothing's 100 percent perfect.
Right? But taking steps to make sure that they're sensitive information confidentiality. Is is being protected and safeguarded right? And so that they can enter into the space with confidence and seek gynecological care.
I love it, and it's so needed in this day and age. I have linked to your blog, uh, Yale Law Journal article about, specifically, they're talking about abortion and the interoperability trap because when we're talking about, you know, EMRs like Epic being shared across state lines, there's A lot of issues that we did not necessarily have to think about or that we were not thinking about pre row falling.
And so let me ask you there when it comes to privacy. That's a huge question I wanted to ask you because of you being in Florida and because you are a doctor working in reproductive health with people who are not adults. When it comes to things like you have A period tracker that you've developed when it comes to, you know, safeguarding privacy.
What questions have you heard from people who are worried about their reproductive health privacy? And how have you addressed that specifically?
Yeah, I mean, we talk to teenagers a lot about the digital imprint. That they are leaving, right? Whatever they engage in is being tracked. And so social media and any information that they're sharing in a digital space is, you know, they really have to read when they're engaging in an app.
Kind of the disclosure information, and they have to understand that what they're putting out there is creating an imprint. Right? And so, you know, menstrual tracking apps are quite I mean, they're great. In many respects, but you also have to be aware of some of the downsides. I generally tend to favor good old period diaries, like pen and paper, especially for your 9, 10, 11, 12.
13 year olds, you know, and as they get older, yes. You know, maybe with a parent looking at an app and deciding if that's a better fit. I mean, there's been controversy about what's getting shared. Even if it's collated data that's being shared, that's still your private health information. And so it does fuel knowledge and research and development on one end.
But also, you know, we're talking about minors here and their information and also their understanding of what it is that they're sharing. And then, you know, the ads and all the other things that they are getting fed as a result of information that they put out there. So, you know, there is a privacy mode and so making sure that as a parent, that if your child is using an app using those, making sure that they're putting those on and then.
Thank you. You know, certain apps are better than others. I can recommend some if you like, but having those conversations about responsible use of technology, but then technology, you know, has also afforded us so much, right? And so I think it's just mindful engagement, cautious and mindful engagement. And so, yes, when my patients come to see me, it is on a virtual platform through an electronic health.
System, and then they have a secure messaging app, too. So everything, the messages they send me is encrypted. What I communicate back to them is encrypted. They do have capacity to send me a picture, different things, but it is all encrypted. But nothing, you know, it's still, it's the era we live in, right?
And so it's moving with that, but also being cautious and mindful and using technology to help us live. Better and healthier lives. Right.
And, you know, another thing that I've found works for a lot of people in regards to efforts to protect privacy is a VPN or a virtual private network. When I was in another country, when I had to check into my charts, I was technically logged in in the United States.
And then so I could access my what I needed to do for work through my VPN. But it looked like I was stateside because there's some institutions that won't allow you to work if you're outside of the US. Um, so I think that that's, it, it definitely works on cell phones. It works on laptops, computers, all of these things.
And you know, there's, they're not expensive, but I think that's also another layer that of privacy that people can look into. But you mentioned Maggie apps. Um, what, what apps do you recommend to your patients?
So period tracker is a good one. It's an oldie, but a goodie. Clue flow got into trouble because of their privacy and so think they weren't alone in this space.
But since then, they've been very mindful about privacy. And they've implemented some new pieces in their software. So I think they are worth checking out. I mean, the thing is, most of these apps are designed for adult menstrual cycle. So they don't always directly. Translate into teen use, so turning off some of the fertility tracking pieces and some of the other pieces are also a good idea.
I'm just thinking back here to my 3 by 5 card situation that I was given by my female physician when I was younger. And the, the red felt pen that I would work my, my cycles on. So, oh my gosh, it's just, it's sick.
It also just mark it on the calendar and their phone and use their own, you know, code. So there's lots of different workarounds too, but these apps can be helpful if used responsibly.
And just to understand what it is that you're sharing and understand if you're comfortable with that knowledge being out there. And then I think just the piece of. The ads and the other things that you get fed in response to what you're putting in is a consideration too, right?
Absolutely. So let me ask you there.
Now, when you are treating pediatric patients and adolescents and Your clinic is, is the next step that a family is going to go to. How does it work when like on online, you have a place for people to make their meet and greet appointment with you, but how does it work with consent by parents, especially if they're under age?
Um, I was wondering that because you know, your patient is the person having the reproductive health questions, but it's definitely, you know, in a space where the adults are going to be involved.
So, for gynecological issues, you know, my patients, yeah, many of them are, are minors, right? So they're coming with a parent.
Obviously, birth control, contraception, STD testing that is, um, minors can independently access that piece. Right? And so important to know, but parental involvement is always desirable. And in most cases. A parent or guardian is coming with minor and so there are. Forms. So there's a patient agreement form.
There's a consent to treatment for a minor form. There is my HEPA forms. All of those go out electronically for signature and come back in before the patient establishes care in the process.
Love it. And you have a picture of that on your website where there's a mom and her daughter sitting there together on the screen.
Forms. Yeah. Yeah. Love it. Now, when it comes to... And they also have like an intake form, you know, their medical history and all of those pieces too.
Gotcha. Now, when a person is coming into you about reproductive health and the talk shifts to, you know, could a birth control option, um, an OCP, a LARC, another form of, um, helping control the periods or, you know, whatever the reason.
Yeah.
You know, for whatever the diagnosis is. And medical management. Mm
hmm. Yeah. So when it comes to medical management of, you know, say a birth control option, how do you go about making sure that a person has a negative pregnancy test before prescribing? Is that done like they go do it while you're on the call and they just go to the bathroom and do it?
How, how does that work?
In many cases, a pregnancy test is not needed or indicated, right? So if a patient is not sexually active. They're not going to need a pregnancy test done. Our mind goes very quickly to needing pregnancy test, but if they need a pregnancy test, because they're sexually active and they've and they've missed their period, or it's delayed.
Then they can go take 1 and pick 1 up and call me and let me know the result. And we can kind of go from there. But you can reliably exclude pregnancy if they've had a recent period and they're not sexually active. Of course, you know, we require mutual trust and engagement and we want to provide a safe space to have those conversations and 1 on 1 time is really important when you're taking care of.
Yeah. Teenagers so that they can ask questions that they need to ask and answer questions comfortably.
Absolutely. And it's like, I don't care if you're 10, like you got to go pee in the clinic bathroom and then leave us a urine sample.
And they're like. I just peed all over my hands or whatever it is in a clinic that is not home and like the, the total difference of how you're doing it. I mean, even just having the discussion about you're not sexually active, your period has happened at this point, you know, all of the things you just said.
Yeah. I, I appreciate you mentioning that because I think Those are also things that come down the pipeline from non physicians who create these, you must do these things. So I appreciate you mentioning.
And also just to think about, you know, birth control, we think it's just for people who are sexually active, but we use it.
Commonly to treat abnormal periods and other period issues. Right? And so it's like, making that distinction. That's really important too, because birth control can get stigmatized and some teenagers are really uncomfortable because. They feel like, well, are people going to think that I'm sexually active because I'm taking a pill?
And you're talking to them about, well, your hemoglobin is 6, and we need to, you know, prevent your period so your anemia can resolve. And, and I, I just wanted to tag back to one other thing you had brought up. So accessing birth control pills. Certain brands are challenging based on insurance coverages and the out of pocket costs for certain ones.
But the only difficulty I've encountered from a coverage standpoint beyond that is, you know, a 9, 10, 11 year old who may need 1, you know, under the age of 12. They'll often require prior authorization, but you can cash pay for certain pills for less than 10 a month. And when you have that conversation with a parent, or, you know, sometimes a pharmacist may feel uncomfortable.
So calling and providing that, that educational piece and so with understanding, I think you can get around some of those barriers. But they're not state specific.
You know, we're, we're talking at a time where literally just within months, the FDA has approved the first non prescription daily oral contraceptive.
Yes. So, yes. So, yes. Talk to us about that yeah, I mean, we're all super excited about the opal being available. I think early next year, it should be coming out. Over the counter birth control has been available in many countries for many years. So it's great, especially because people do not have access to gynecologists or other doctors who will prescribe these birth control.
Um, there's contraception deserts all throughout the U. S. and so this is basic health care. And so we're excited to see that this is coming coming. It's been long overdue and awaited for, but I did want to make 1 other comment. Yeah. And in the absence of contraception being available, especially to teenagers, they're relying on things like natural cycles and in the absence of having good understanding of their reproduction and their reproductive cycles.
These. Methods are going to feel them, right? And so we're not doing as good a job at taking care of their health care needs as we could be doing. And I really do hope that the opal will be affordable and widely available, especially in areas where access to contraception is. It's harder definitely in the rural settings.
And I mean, we see it with emergency contraception. I can't tell you the number of phone calls I've made to pharmacies and they've not had it available and they've run out and not gotten restocked and different things, right? These things need to be available, especially in this post row era when there are so many reproductive challenges, right?
Absolutely. And, you know, I cannot even imagine how it must be to be an obstetrician gynecologist. Who is wanting to go from residency to practicing in their home state that is now a restrictive state. It really truly makes a difference. And even just as you said earlier, you know, when you're talking about natural family planning, absolutely a way, a way that a person can be successful.
Dr. Marguerite Duane shared on her podcast that she loves talking to people, but she has the time to talk to people about natural family planning. I went to Creighton. That's a huge thing at Creighton. Yeah, it doesn't work great for teenagers. Yeah, it doesn't work for everybody. Especially if their cycles are wackadoodle.
So, you know, we have to be, be aware of limitations. And, like how you said earlier, like, we're talking only abstinence and not even mentioning. The natural family planning is a thing. That there are abnormal, abnormalities in periods that are an abnormal vital sign. No matter how young you are or old you are, when you get your period, it is doing a disservice to just the education of our, of our younger generation.
And that's definitely the opinion, the opinion that I hold. And I am hopeful for the states. Like, I really do hope that with more, you know, more advocacy and more people talking about their Reproductive health care needs across the spectrum. I mean, the menopause space is blown up and we're just on the other end of that extreme, or we want to, you know, really amplify the voice of of teenagers and their reproductive needs.
And so I'm really hopeful that in this. Post row era that we're gonna, you know, go back to the drawing board and create policies and a system that works for everyone. Right? Maybe it's a little idealistic, but hopefully the pendulum can shift slowly. But I think there's enough people talking about about what needs are and.
Fighting back against policies that don't work boots on the ground for people. And there's enough of active in the space that I am hopeful that that will translate and enough health care providers, right? In that space. So I am hopeful that. Things will actually in sort of dismantling that as we reassemble, we'll have actually better policy.
And, you know, I always feel like a big role of health care is to protect minorities, right? And those that are disadvantaged. And we have to be creating the policies around that patient population. Right? And then that'll translate into wellness for all. Right? So here's hoping. Right feel like right now it's like, you know, as a gynecologist, most of us are really discouraged with this current state of affairs, but things.
Will hopefully evolve for the good, right?
Absolutely. I'm with you in terms of, like, we had such a temperamental position of women's reproductive rights being protected because we were all reliant on Roe. Yes. And the Supreme Court is a bunch of people who have their own opinions and they're supposed to be working in the law.
Over time, those people have changed, America has changed, and so when we codify in law the protections that women, you know, had for generations, it's a very different place, and it could put us in potentially a better place to protect all women, no matter if they're rural or they're, they're, you know, they have skin of color, whatever, it does not matter the background, and again, I love that you're on this podcast because when I remember seeing your LinkedIn post when you were opening your clinic, I'm like, Thank you She's in Florida?
I have to get on this podcast. So I really appreciate, you know, you talking about that. And I will just put in a little plug here. The New York Times had done a podcast specifically about how the Opel came to be. It was serendipitous that it came so close to the fall of Roe. But if you're interested in learning more about the history, I definitely would check it out.
It's, it was an awesome episode. Yeah.
I will for sure. Yeah. Yeah, absolutely. So when you talk about access to OCPs and, you know, you talked about the, the opal coming out, having, you know, pretty much we can find a lot of options on our wholesale pharmacies in DPC. What about LARCs? How do you handle LARCs?
So in the virtual space, clearly I'm not gonna place a larc, right? And so, you know, there's a lot of providers that will place LARCs. So I, I think if somebody wants a larc, it's easy to connect them with, with those providers. I mean, I've done a lot of work in the LARC space, especially as it relates to debunking myths about adolescent utilization.
So, Jeremiah Fellowship, I worked on some of the choice data, which is a great opportunity and, you know, we were able to show adolescents are just as likely as older reproductive age women to keep their larks and use them with excellent 12 and 24 month continuation rates. So big win there. So I feel like choice is a really great thing.
And I think that the contraceptive stories of teenagers are going to. Thank you. continue to evolve. And at some point, I think educating them about LARCs is super important. But at this point, I'm not going to provide them. And if the demand is there, I may look in to how to access them and decide over time if it's a service I will provide.
But counseling them about them and recommending them if that's going to be the best method for them, and then connecting them With somebody who can actually put it in for them be that I'm, I'm assuming by large, you're talking about. And plans and next plans and, um. And I, and they're wonderful. I'm so glad that we have them in our toolbox and that.
Teenagers can can utilize them. Most teenagers do still utilize. The pill and different things, but it's great choices and options are key. And I will say that if you're a Florida, you know, DPC doctor who is around the Orlando area or who will connect with me. Yes. Um, and there is some nuance to, to putting them in and, you know, young women who have a bleeding disorder or young women who, you know, in teenagers as compared to older reproductive age women.
It's important to hear that. And for me, I was very grateful UCSF has Beyond the Pill. It's a huge platform where they, you know, empower physicians and other non physician providers to be able to provide reproductive health access through LARC placement. And, you know, they
And Upstream as well.
Yes. Yes. Are doing great work in that space. I think, yeah, it's wonderful. Awesome. But I think sometimes getting a teenager to that space of understanding or or their parent, you know, why this method might be a preferred method for them. You know, there's a lot of important education there. I love, though, that you mentioned how you have the time to do the counseling because.
Already, if somebody has, I want to get to this next year, your pricing point, but you have a membership option. And when it comes to having a relationship with a person over time, and it doesn't take like eight minutes to like sell somebody on the, like the reason LARCs exist and how it would be a great option for them and whatever.
It's one thing to, I think about my own. Place as a family physician and fee for service, it would be like, okay, so this is like a 30 minute visit and we're going to talk about all of your options, including larks. And then here's a handout that I had from UCSF, the beyond the pill, where it showed like the efficacy of each method and you know, how many the different what they look like a graphic of each.
It was, like, when you talk about how, like, you think in your fee for service job, like, this is not the ideal way of, of talking to someone about the reproductive health, like, I totally had those same thoughts when I was, Physically handing the handout so they could, you know, off the tear pad so they could take it home with them and then get back to me as to if they wanted it or not.
It's uh, the counseling, the having the time to talk with a physician who knows you, that is so important when it comes to Especially talking about larks. Yeah. And understanding their goals, like what is it that they want this method to do for them? Because many people use it for menstrual control as well as for plus or minus contraception.
Right. But then also troubleshooting some of the, you know, concerns on the backend when they're not happy with their bleeding profile or other issues. So some of, some of those pieces like adding in adjuvant therapies to. Manage and offset some of the bothersome bleeding or different issues they may be having with it.
And then also, you know, teenagers, I think I said this before. They're very willing to try different things. And so educating them about how long to give it to stick with the method for it. And also when to abandon it and try to pivot to something else and and partnering with them in that. Journey is is super important and like giving them a space to voice kind of the issues that they might be having and provide some context for it.
Yeah, there's a lot that goes into into all of that, right? Um, so it's not just putting it in and sending them back out into the world. Sometimes that can be the easy part.
Well, you know, in our community, the non physician model of clinic that are my old clinic has gone to. There is no access to, you know, placement of LARCs and so a person will go from their primary non physician provider to the OB just for placement, and then there's no follow up regularly with that OB, and the OB is In a different county, um, my husband and I are the only physicians providing obstetrical care of any sort in Calaveras County.
And so when it comes to all of these things that you're saying about access in choice, it's like I absolutely in agreement with everything that you're saying when it comes to your pricing. Now, we want to ask you this because I've asked other specialists about pricing, particularly because some subspecialties, some general specialties.
They are not seeing a membership model, like a primary care physician practicing under the DPC model, working the same for their specialty. So how did you approach pricing when it came to the GYN space?
Yeah, I'm glad you asked me that. That was really hard, like trying to figure out what's a reasonable price and then, you know, understanding that I wanted to be accessible to teenagers and the pediatric age population, too, that come from a variety of socioeconomic backgrounds.
Right? And so I created 2 tracks. So the gynecology. Track and the contraception track. And so if a teenager is purely coming to see me for birth control and, uh, counseling around healthy sexual relationships and that sort of piece, that's 1 track and that's priced at a lower. Lower price point versus if they have a gynecological issue that might require, you know, testing investigations and some figuring out.
Right? So that's price differently. And then I foresee I'm still really early in this, right? So I'm still figuring out some of these pieces, but I didn't want to set a price and then adjust it. So I found a price that I was comfortable with and, you know. Hold some people to see if they thought it was reasonable.
And then, you know, you have to factor in that there is the visit cost, but then on the back end, you still are going to be doing some pieces too, right? So your time and putting a price on your time and a value on your time, right? So that, that was some of my homework. And then the membership piece, I guess, in DPC tends to be the revenue that you can kind of count on.
And so that part was harder for me. Because, you know, I want to provide a service for as long as I'm useful for and then my greatest joy is then feeling like, okay, I've got this. I'm good to go. So, I foresee that. A lot of my patients will see me on a consultation basis and then go back to their family practitioner for their ongoing care, right?
Or partnering with their primary care to. Provide the guidance and then if they feel comfortable, they can take it from there. So, adding in that piece of expertise that I might be able to lend to the situation, but I did offer a membership option because, you know, for example. A young child with developmental issues and limited capacity for menstrual hygiene who needs some suppression.
And so we may start out with the method and they might need to touch base with me to change that method or pivot to something else. So they can enroll in a membership where I can, you know, be a constant touch point for them until they get to a place where things have stabilized. And then they can either find their transition back to their.
Primary care, or they can see me on an ongoing annual basis for a reevaluation, a tune up, or maybe a change, right? Similarly, I think with a kiddo who has maybe an underlying issue triggering heavy periods and is anemic, that might take a little bit of time to get them stabilized so they can enroll in a membership for.
3 months or so, or, or somebody with PCOS, right? We're going to be adding in and titrating different medications and checking different labs. So people have options to utilize my services as they find value. Right. And then I created an accessibility membership option where I can determine my own cost based on, you know.
What the family can reasonably afford, and then they have an option if they want to use their insurance for any labs or medications they can, but then I can also provide cash pay options for those and ultrasounds and different things too. And for your patients specifically, have you worked with different GPOs or lab or imaging centers to be able to offer wholesale pricing or transparent pricing to your patients for those things?
Yes. Love it. And I, you know, again, if you're too early to say how it's going to work
out. Well, I, I just, I would say I've contracted with them. Yeah.
Love it. And I would say if you're in Florida and you're, you're wondering, like, how does my patient get access to, you know, XYZ and it deals with their reproductive health?
Like, here you go. Here, Dr. Maggie Abraham is open and ready for business. So that's awesome. Now. When it comes to you being at where your patients are, like, I will also dispel the the belief that you have in the back of your head where you like, you think you're a dinosaur. I don't, I don't think you're a dinosaur at all.
I thought your other real, um, where you were like in the car talking about when a teenager, when, when is a great time to talk with your teen and you were, you were saying in your real how You know, like sometimes being in the car is a great place to have a conversation because then the teen is like, I know it only takes five minutes to get to the next location.
So like, I can survive. Yeah, I can survive talking. Oh my gosh. And I love that. It's so relatable. And so I think that that will do very well for people understanding you through your social media presence. You know, what kind of doctor you are. And like, you don't hear people talking about the teenage angst.
From that perspective all the time. And so I thought it was very well done. And I just, again, put that out. Cause I don't believe you're a dinosaur at all.
Well, I'm a big fan of having like a hundred one minute conversations with your kid, as opposed to one, 100 minute one, right? It's like small, constant little touch points that, and they don't have to be perfect, but just let them know that.
You care and you're there, right? And I think it's invaluable. I think there are so many teenagers that go around with so much fear and unanswered questions and they're just holding them all inside, right? Until they find that safe space where they can get the knowledge that they need. And, and I also feel like, you know, the knowledge that I need to help them engage and, and, and deal with some of these things.
And I also just. Feel that there's so much that they just shut down and ignore because they don't have access to the care and the answers. Right. And so that whole ignoring things can really affect them adversely in the long run. And So I, I feel, yeah, I really feel like I want to, to try and meet them in some of those places and that's kind of my goal.
And hopefully it works out and we'll see, you'll have to have me back to talk more. And I guess I also wanted to say that I've been in the community. Along, like, since 2019 and before me, my Judy Sims was here. Then built a pediatric and adolescent kind practice. So we have been in this community building relationships and capacity to take care of teenagers for quite a long time.
So I feel like I built this and started this practice. But I have like connections and people that I trust to also help me take care of this patient population, like people I trust to put in larks and manage them in this patient population. And I'm just there to continue to provide the. Added expertise as it's needed.
And so I feel like they're also kind of championing this, this practice to like, we're never an isolated entity, right? And so just the residents in the community have all gone out now and started their own practices. And some of them stayed in the area. They still call, call us up and go, Hey, I know a team's just in my clinic.
And like, do I do this, this and this, you know, and it's great. It's great to hear them. Doing it, you know, because I think just ACOG and AAP have done a ton to promote GYN care in our younger populations, and we're starting to see some of those benefits.
Absolutely. And one of the things that you're bringing to make those things of AAP and ACOG and your fellowship training.
Has taught you and you know what most physicians will argue is the right of an adolescent to know about you have period parties. So tell us how you're all of your training and all of what you're bringing to the table is manifesting in a place where you know kids and adolescents are feeling like. Whoa, this is totally a safe space that I can engage in.
Yeah, so we're gonna throw a little period party. Just a virtual event really, just honestly to bring a little bit of awareness to the practice, but also to, you know, Put education in the hands of parents who might be concerned, you know, about how to parent their child. Well, through puberty and menstruation and beyond.
So, yeah, we're going to talk about reproductive anatomy. Puberty stages, a period, what it is, how to, you know, talk to your daughter, your child about their period and about menstrual hygiene. And, you know, that space has evolved a ton over the past 10 years. So, sometimes I think the tide's always changing and parents are going to want to equip their, their child well, and be up to date with what's out there.
And what's safe to use and what the options are. I mean, I still get, I still get questions about hymens as a virginity checker. You know, it's funny how these myths kind of stay with us. There's like a part of us that's like, no, well, that doesn't make sense anymore, but we still want a doctor to tell us.
Yeah, that's not, that's not true. But, uh, yeah, just to partner with them and give them those reassurances of, or some guidances and some suggestions of things that they want to, that they might want to incorporate, you know, not every kid is going to be like my period, but it's just this idea of framing it in a positive way, even though it may be uncomfortable and it may be challenging too.
Right? So being realistic. But also it's a milestone, right? And we celebrate developmental milestones. So I think it's like putting it in that sort of framework and then finding, you know, just a way to connect with your daughter around this milestone. So it doesn't have to be all balloons and whatever, whatever it can be.
An ice cream date or something, it's going to be different for each child. And, you know, only the parents going to know what's going to, what's going to be the thing that's going to be a meaningful connection. But it's a way of calling it out, giving it the attention it deserves and letting your child know that.
This is a change and changes are stressful, right? Stress is normal. Changes are stressful. And it's like, but embarking on it and bringing it out into the open, like not keeping it as a taboo thing, giving language. To it all so that, you know, mom and parent are not internalizing it, right, that instead it's creating a framework to continue the conversation.
So, if other people are wanting to expand their knowledge on pediatric and adolescent gynecologic health, you mentioned ACOG, AAP, you also are asking ourselves, the North American Society for Pediatric and Adolescent Gynecology.
I haven't shouted out NASPAG enough. NASPAG and the people in it are just.
Wonderful people. Wonderful. It just, they're a championing the care of pediatric and the reproductive care of pediatric and adolescence. So NASBAG is the North American Society of Pediatric and Adolescent Gynecology. It started in the late 80s. Gosh, so it's been around a long time and they've really pushed into this space advocating for our youth and also, you know, created a curriculum Um...
For training in pediatric and adolescent gynecology and making that part of core residency requirements in the past few years, and they've also formalized fellowship training and making sure that. Key areas of pad care are covered within fellowship training and then providing tons of resources for parents, other providers, like pediatric and adolescent gynecologists.
Like, we know that we live in that space. Between the adult, like, we straddle the adult world, and we straddle the pediatric world. And, you know, you mentioned your pediatric dermatologist. Like, I commonly interacted with the pediatric dermatologist about, you know, lichen sclerosis in the pediatric age.
Population and, you know, we work together with a host of subspecialists, so I think we have that unique platform where we can kind of speak across the lines. And that's a wonderful organization. Check it out. If you're looking for a pack provider, you go in your state. If you're listening to this, or you're another position and being like, oh, so she's in Florida.
Is there 1 in my state? You know, you can find us. on the NASPAG website, you can go to find a provider and find one in your state and get to know them. They'll be glad you reached out and they'll be happy to help collaborate in managing your patient. Yeah. So good. So good. Now in closing, I want to ask, I know you just opened your clinic in August, but given that You know, you've had over a decade of experience in training and practicing and learning from your patients and learning how to deliver your care best for your patients.
When you speak to those who are interested and inspired by what you're doing and are interested in opening their own practice, no matter if they're in a restrictive state or a non restrictive state, What guidance would you have to them after listening to your podcast today? Oh, that's
a loaded one. I think understand your why, uh, like what you're here to do, and then give yourself space to be creative.
Find some margin to allow yourself to dream, right? And to your ideal space. And then stay aware of those places where you're finding yourself. You know, drawn to the things that you're spent your time looking up and the patients, the patient interactions that you, you enjoy, let that inform like some of your decisions.
And, you know, when you step away from things, it's, it's always uncomfortable, right? Letting go is hard. And so it's not necessarily gonna feel easy and don't expect it to. But there's always like challenges and areas that you're going to feel uncomfortable in, right? Change is stressful. So keeping that in mind.
And then, you know, I couldn't be where I am today without, you know, the people championing me along. I think we all kind of worry like, am I good enough to do this? And just because it's important to me, is it going to be important to other people? And I think it is. You know, you can lean back on your training and be like, okay, well, I Practiced fellowship, like, I'm not an imposter. So having those, those credentialing pieces are important. But then you also have to have just the belief in yourself and then knowledge of kind of what's important to you. And then people are recreating things all the time. So you can find the how to. Out there, you know, I think, you know, once I realized what was important to me hearing.
The DPC, your DPC podcast and hearing all these other people doing things. And then, like, reaching out, like, you mentioned Deanna Barry, like, I reached out to her and she responded and it kind of blew my mind. And she was so positive and so encouraging. And, you know, I wanted to say, if I can do this, anybody can do this, but I was like, you know, people see those things, but she was like, no, really.
And so there's a community out there that you may not interact with face to face, but there's going to be a lot of a lot of people who are. Building and creating, and you're going to be able to come alongside them and learn from. They're the people are very willing to share share, especially in this world, which is helpful and then you're going to take those and and apply them to your own situation.
And so maybe I don't know in there. I hope there's some advice. Feel free to reach out to me. I'm happy to share and try to answer any any questions. I don't feel like I'm necessarily you're not going to want to see my. I don't want to see my bank balance right now, but you're not going to feel encouraged about because I've just started, but it feels good to be in this space for sure.
It feels worth it to me. And then I don't know how I'm going to measure my success. I'm really not concerned about some of those pieces right now and just enjoying it. And I still think I'm innovating and creating and trying to understand kind of how best to meet. My patients where they're at and provide what I, the services that I care about providing and then continuing to build my network where I am here in Florida, because.
You know, the scope of what I do is different now, right? And I'm going to probably evolve, depending on kind of what my, my patients needs are. And so you have to. Be willing, I think, to be kind of flexible and fluid with some of those things too.
Just awesome. So be sure to check out Dr. Abraham's accompanying blog where you'll find links that she mentioned as well as her video of what she recommends to put in a period kit.
It's awesome. You don't want to miss it. Thank you so much Dr. Abraham for joining us today.
Oh, it's been a pleasure. I really appreciate you having me on. Uh, it's bizarre to be here because I've listened to your show and now here I am talking to you. I appreciate it. Thank you.
Next, we look forward to hearing from Dr. Stephanie Phillips of Front Porch Family Medicine in Royston, Georgia. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about DPC. Leave a five star review on Apple Spotify now as well, as it helps others to find all these DPC stories.
Lastly, be sure to follow us on social media. If you're wanting to continue learning more about DPC in the meantime, check out dpcnews. com. Until next week, this is Mariel Concepcion.
*Transcript generated by AI so please forgive errors.