Breaking Barriers: Dr. Jenn Jaggi’s Path from Practicing OB/GYN to Endometriosis Fellow

Speaker 1:
0:03

Welcome to Indobattery, where I share about my endometriosis and adenomyosis story and continue learning along the way. This podcast is not a substitute for professional medical advice or diagnosis, but a place to equip you with information and a sense of community, ensuring you never have to face this journey alone. Join me as I navigate the ups and downs and share stories of strength, resilience and hope. While navigating the world of endometriosis and adenomyosis, from personal experience to expert insights, I'm your host, elana, and this is Indobattery charging our lives when endometriosis drains us. Welcome back to Indobattery. Grab your cup of coffee or your cup of tea and join my guest tonight, dr Jen Yaggy, at the table.

Speaker 1:
0:49

Dr Jen is a board-certified OBGYN that practiced as a general OBGYN for nearly 10 years, but recently started her fellowship for advanced endometriosis and pelvic surgery with Dr Cindy Mossberger at Pacific Endometriosis and Pelvic Surgery in Gig Harbor, washington. Thank you, jen, so much for joining me today. I'm excited to have you on. Thanks for taking the time to do that. Oh, good morning. Thanks for having me here.

Speaker 1:
1:14

Yes, I'm excited to have you join me today for a couple different reasons. One of the reasons is that you have a unique perspective to give to those of us within the endometriosis community, but also, I just think that you have a great way of giving us insight to something that maybe we have become blind to as far as when it comes to doctors wanting to have the best for their patients but not equipped properly to do so and doing something about that, and I think I'm excited to hear more about your story. And so, without further ado, if you wouldn't mind sharing just a little bit of who you are and what your background is, Of course, and yeah, thank you again for having me.

Speaker 2:
1:58

I was surprised to hear that you would want to have a fellow who's early in training in endometriosis on your podcast. But I guess there's one thing that I can offer. I guess my story to getting where I am is probably unique, though I realize everyone's story in one way or another is unique in terms of how they get to where they are. Say, for a long time I knew I wanted to be a physician. I think during med school itself. I for a while was kind of struggling with what my niche or my specialty would be. I think I've always been drawn to anatomy and sort of the more concrete where you have a visual problem in front of you and a concrete solution. So I think I was always more drawn to the surgical specialties. And yet on some of my surgery rotations I did a rotation in ENT and plastic surgery.

Speaker 2:
2:49

While I loved the hands-on time in the OR, I felt like maybe in terms of the personalities, I hadn't quite found my people, in the sense that I also really liked the continuity with patients and I really enjoyed talking to patients about their stories and I know that's a generalization, I'm not saying that general surgeons or orthopedas don't enjoy that too, but I think there are different personalities and the stereotypes of the medical world and so when I did my OBGYN rotation I really did enjoy just the connection that the physicians had and really getting to take care of patients through all ages and seeing teenagers for their meaningful periods and then seeing women during their pregnancies and really all the way through menopause and prolapse. I really did like the breadth of it and just really the continuity that a lot of the OBGYNs had with their patients. So I think that's ultimately what brought me to OBGYN. But I was always from the beginning thinking that I wanted to focus more on the GYN side. I loved my GYN oncology rotations as a medical student and really initially actually thought I would do OBGYN residency to then go on to oncology. I just felt like they were amazing surgeons. And again, the hands-on part, I really loved the OR. And then I think at the time when I was in residency too, my dad was sick with cancer and I think there was this part of the breadth of general OBGYN that I liked and I suddenly found myself not wanting perhaps every patient to be a cancer patient. So, yeah, found myself deciding that I was going to be doing general OBGYN, at least for a bit, with the idea in the back of my head that I would still go on to do a fellowship. I then thought, maybe MIGS or Urogyne.

Speaker 2:
4:45

I was always drawn to working in a more underserved, low resource area. During med school and residency did rotations abroad in Guatemala, uganda, south Africa and I think if it hadn't been for the fact that my dad was sick at the time, I probably would have ventured off to another country after residency. But someone told me no, if you want to do work in a low resource setting, kind of without leaving the country, you should really look at IHS, the Indian Health Service. And just by chance there were two MIGS, which is minimally invasive GYN surgeons who were going out to one of the hospitals in New Mexico on the Navajo Reservation called SHIPRAQ. So I joined them for a week of surgeries. They were doing the more complex surgeries that the GYNs there and kind of saved for that week that they were visiting. The goal of the week, I think, was really to both do the surgeries that maybe otherwise would have had to be referred out and also to bring more knowledge to the GYNs that were practicing there and just through a kind of series of small world connections, met another physician who was at another neighboring Navajo area hospital in Gallup and a few months later found myself taking a job at that hospital called Gallup Indian Medical Center, where I then practice for the next.

Speaker 2:
6:07

You know, I thought it would be a couple years until I went back to fellowship, but two became six, became gosh, almost 10, shortly after getting there no-transcript, two and a half years after getting there we went from being a group of six GYNs to three.

Speaker 2:
6:23

There were several GYNs who just moved on for other reasons, you know, one retired, one went on to an administrative role, someone had a baby and moved closer to family, but we were suddenly in a lurch, having three docs instead of six, and so it just did not feel like the time to move on and I got thrown into a leadership role as well. I ended up taking on the OB chief role just a couple of years after residency, which in hindsight you know was one of those things you look back on. And you know I certainly learned a lot, but I'm not sure I would have chosen that same route. And then, a couple of years later, I had my first baby, and that seemed also not the time to venture back to fellowship. And then, you know, that thing called COVID turned the world upside down.

Speaker 2:
7:14

So, having to kind of lead the department through that, the Navajo Nation got really hardly hit by COVID, which you know would be a whole other podcast on its own. But it took a couple of years to really feel like we were on our feet. And you know it was at that point that I was like, okay, if I really want to go back to further my surgical training, like this would be, I think, the time to do it, or otherwise, you know, I think maybe I will continue down this route of general OB GYN. And it was through another sort of series of small world connections. I was at an AAGL conference in December of 2022 when one of my former residency friends introduced me to Dr Mossbroker, who runs Pacific Endometriosis and Pelvic Surgery, and said that she had prior fellows. You know that she trained in endometriosis surgery and we started talking with her and ended up coming out for a week to see her in practice, both in clinic with patients and in the OR and, yeah, just really got drawn into this world of endometriosis.

Speaker 2:
8:19

I was just so surprised by the stories that I heard when she was in clinic. You know she really took the time with the patients that often, you know, in other settings, you don't see possible, you know, in a 15 minute appointment Just hearing about patients who had seen doctor after doctor and either not been diagnosed or had had surgeries, but they were incomplete surgeries and so we're having, you know, continued pain. So, yeah, I was really drawn in on the clinic days and then, of course, the OR days was almost feeling like, wow, I'm like back on my GYN oncology rotations, you know, in terms of the complexity of these surgeries and just how elegantly she does them. Except that's not. These aren't cancer surgeries, these are benign surgeries and you know, in many ways it is similar, right, with cancer you're trying to get it all out and with endo as well, it just somehow, you know, I feel like there's a whole other discussion too.

Speaker 2:
9:11

But cancer, you know, in terms of the training programs, is just a much more established world than endometriosis training. So, to make a long story short, I went home and told my partner and now my husband, but I felt like this is what I needed to do next. And then, within a few months, we moved up to the, from sunny New Mexico to rainy Washington and I know, six months into my fellowship at Pacific Endometriosis and public surgery with Dr Mossbroker and yeah, learning a lot and do you ever sit back and look back at where you started out as an OBGYN and the stories that you would hear from patients and knowing now what you know?

Speaker 1:
9:57

looking back and saying I wonder if that patient had endo, I wish I would have been able to refer this patient out or help this patient more. What has that looked like from that transition?

Speaker 2:
10:11

I think you know, I do think when you go through OBGYN residency, I think we are well trained to diagnose those classic cases of endometriosis, but it's them, you know, the ones who maybe don't follow the classic story that I, you know. I look back and wonder about, you know, patients where I missed that diagnosis. I was thinking about it as an example, like I think it was just a couple of weeks ago I was seeing a patient for a new consultation and I remember when I was presenting it to Dr Mossbroker I said, you know, on first glance like this didn't seem like a classic story to me, but you know she's been on OCPs this whole time, so you know, I think it was probably suppressed. She was a patient who was having more bowel symptoms and more bladder symptoms and the pain really hadn't become an issue until she stopped birth control. And you know, as I was presenting, I was like, huh, this is the kind of patient that, yeah, I think a couple of years ago I would have more quickly jumped to like, oh, this is probably GI. You know she should be seen for a workup, for IVS or brain or social cystitis and not kind of have put the you know the more subtle things together.

Speaker 2:
11:19

Yeah, I do, and I think about, you know, the patients that I had where I did ablation of endometriosis or, honestly, even the ones you know. I can think of one case where I was planning to do a laparoscopicis directory for fibroids and adenomyosis and got in and it was, you know, a much more complex case of stage four endometriosis and in that case, you know, I recognized that that was above my surgical skill set and we called it a diagnostic laparoscopy. You know she just ended up with one or two small incisions and then referred her on to the closest tertiary care center for what I thought would be, you know, a minimally invasive procedure. She ended up having an open hysterectomy.

Speaker 2:
12:03

I think had her ovary taken out as well. I think oncology ended up doing the case and I think back, I was like, I mean, even in all of New Mexico I don't think there are many true excision specialists Now I would know, like you know there may have been somewhere in Arizona or you know somewhere where she could have had a truly minimally invasive procedure.

Speaker 2:
12:26

Yeah, but you know you, I guess, do the best that you can with the knowledge that you have at the time. And you know I think at least with that case you know I as a physician you learn first do no harm. You know I didn't go into a surgery that I thought was above my skill set. It's sad to think that even with referring her on, you know she may not have had the most optimal surgery.

Speaker 1:
12:48

Yeah, and that brings us to the other point, too, of what you're learning in med school and even in your continuing education as far as endometriosis is concerned, because you probably hadn't heard much about endometriosis beyond just what text was given to you or what little pieces you've been given in medical school. Was that the case for you?

Speaker 2:
13:10

I mean I spent a lot of time thinking about what exactly did I learn during the med school and residence. Yeah, I mean certainly medical school. I mean there are so many areas that are covered that nothing really gets more than like half day or a day, other than probably the heart and the lungs. I remember there being a lot of emphasis on hormonal treatment of endometriosis, so it's maybe not surprising that the med school teaching on endometriosis wasn't that thorough. But I remember in residency, I honestly think I mean I started residency in 2009,. Finished in 2013.

Speaker 2:
13:45

I think even then, like excision was really just starting to be kind of more commonly done. You know I would recall of endometriosis cases was ablation of, like you know, the stage one in two cases, and then I remember being involved with the more complex like stage three or four cases, but usually it was that the oncologists were getting called in because it was a frozen pelvis or it was. You know some of the MIG surgeons were doing you know the more complex dissections where bowel was scarred to the bladder and you know I remember long, long surgeries. But I don't really remember being taught about excision as like a con concept. I think you know we were taught you should take a biopsy for conformation, but the idea of really trying to remove all visible endometriosis like is not something that I recall being taught as a resident.

Speaker 1:
14:41

Yeah.

Speaker 2:
14:41

And so we're on. Yeah, the hormonal treatment, the teaching that it should get resolved once you go through menopause and you know again the idea that the ovaries are removed. You know that there's no longer the driver of endometriosis.

Speaker 1:
14:56

Yeah, which I think too.

Speaker 1:
14:57

I mean, I think, to put this in perspective for everyone that's listening who has gone through the doctors, like myself, you know I had a great doctor but again, she had that same training to do the ablation, she had the same education as taking the ovaries out and doing hormonal suppressions and things like that, and I don't think she came at it from a malicious standpoint or she had to be right standpoint.

Speaker 1:
15:27

It was she really truly thought she was doing the best she absolutely could for me and she felt like she was adequate in her knowledge of endometriosis and her skill set in endometriosis surgeries.

Speaker 1:
15:39

So, even though and I think that we talk a lot about the medical trauma that we've faced and certainly this is not to bunch every doctor into that category, but by and large I would say most OBGYNs are doing their absolute best with what they've been given, and I think it's just as a testament to you going in an area that really healthcare is hard to come by and maybe isn't always the best in general, because they're.

Speaker 1:
16:11

It's not, it's not going to be your high paying market, you know. It's a different, it's a different area, it's a different way of living, and so I think you did something that was so impactful and you stuck in there. So I know just from talking to you that you truly care about your patients, so you would never want to lead a mustray or hurt them. Or you know, and I and I want to emphasize that for those who have been through that medical trauma too yes, not every doctor's the same, but most of them- want to do the best for you, and the limitations, too, are the system, when I think that you know the average appointment length is 15 minutes.

Speaker 2:
16:49

That doesn't really give the time to sometimes dig into, you know, all of the symptoms or even, you know, do very thorough assessment, like that's one of the luxuries that I, you know I do have. Now we have 45 minutes to an hour with every new patient and you can dig into things a little more deeply. And yeah, it's interesting because I feel like I really was seeking out more surgical training, because I think that's a more obvious you know, you more clearly see, tools in your toolbox are lacking. Like I knew, stage three or four endometriosis cases are not something that I can do after finishing a general OBGYN residency. But I think you know we leave residency feeling like we have the medical, you know knowledge and I think that's the part that, in a way, has almost been more surprising with doing this fellowship. Just that I may not been asking the right questions or just, yeah, again, like you mentioned, thinking about those patients where I may have missed the diagnosis, even though I thought I was being thorough.

Speaker 1:
17:49

What are some of the things that you have really learned doing this fellowship that maybe we're shocking, but more like wow, this is blowing my mind on this information, you know, because I certainly have learned a lot and I'm obviously not in a fellowship, I'm just, you know, a host for a podcast, but I've learned so much. I can only assume that you have had that same experience of like wow, this, I had no idea. What are some of those things that have been just shocking to you or enlightening?

Speaker 2:
18:21

One thing that I feel like again wasn't on my radar as much and I you spent a lot of time thinking back to it, was like, did I just not know that or was that a just general gap in knowledge? But like, for instance, adenomyosis, where we were kind of taught as something that is more an issue of women who have had multiple pregnancies and can only be diagnosed at time of hysterectomy. But you know, I'm seeing a fair number of patients that have not had any children and are, you know, in their early 20s, even where their symptoms are classic for adenomyosis and then the ultrasound suggests adenomyosis and when you look in at time of surgery, see again. You know the gold standard really still is to only make that diagnosis at time of hysterectomy. But yeah, I've been learning, there's a lot of other ways that you can almost make that diagnosis.

Speaker 2:
19:13

Ultrasound is another thing where you know I was doing quite a bit of ultrasound as a general OBGYN, but usually in the context of, you know, an early pregnancy, ruling out abnormalities there and not really thinking about ultrasound as something that can give you hints that there may be an ametriosis. You know so usually for ultrasounds that I wasn't doing for you know, like someone walking in with abnormal bleeding and a positive pregnancy test. More often if we were wanting to look at the uterus or the ovaries, we would order the ultrasound. It would get done in radiology. So you know, we order it, then the tech takes the images and then it gets sent to the radiologist to look at those static images and then a couple of days later you get the report back and you know often it would say you know just that the uterus was a normal size, there was maybe a physiologic system on the ovary, or you know essentially that it was unremarkable.

Speaker 1:
20:07

Right.

Speaker 2:
20:08

And now you know, with every consult that I'm doing with Dr Mossbrokker, we do have an ultrasound while the patient's there and there's really just so much more that you can see with the ultrasound if you kind of use it as a tool in real time.

Speaker 2:
20:20

You know, you can see if the ovaries are tethered or stuck to the sidewall, if the ovaries are stuck to the uterus, if there is movement between the cervix and the rectum and you know and more subtle signs of adenomyosis you can see as well. And again, that's something that you know. I've been doing ultrasound for years but never really thought of it as a way to look for some of the markers of adenomyosis. You know if everything is stuck together or if patients have pain when you're pushing on the uterus?

Speaker 2:
20:49

sacral ligaments you know, it really is almost an extension of the exam. That is really pretty, you know, simple and can just really help or make you more suspicious that the underlying issue could be adenomyosis, as opposed to just saying, oh, that one, you know, came back unremarkable, you know we don't know why you're having this pain.

Speaker 1:
21:08

Yeah, and I think that's true. I mean, that's more and more a conversation that we've been having within the adenomyosis community. Is imaging right? Because you know, we've been taught for many years the only way that you can truly identify adenomyosis is through a laparoscopic surgery and to 100% diagnosed, yes, that's still the case. However, imaging is doing a great job now with giving doctors a roadmap, but a lot of times, if you just order the images and let someone else read them, you're not seeing the roadmap, you're letting someone else draw it out for you, and I think that that has been a conversation that's really starting to take hold within the last couple years probably. But I think maybe that is a good differentiating factor between a specialist and kind of for lack of a better word but a generalist, because even though OBGYNs are still specialties within what they're doing, they're still not a specialist in GYN, and so I think that is another thing to consider when people are looking to find treatment for this.

Speaker 2:
22:16

So I think having that ultrasound in connection with you know, a thorough history and exam, yeah, I've. Also. In terms of the things you're asking about, things I've learned or been surprised about, you know, I don't feel like I learned very much about, like pelvic floor dysfunction and you know, incorporating that into every exam I do and just the number of patients that are not only dealing with endometriosis but the pelvic floor spasm or who have symptoms of interstitial cystitis, like they're so often all tied together.

Speaker 1:
22:46

Which is what yeah?

Speaker 2:
22:47

Which is not new news to you, but yeah.

Speaker 1:
22:50

But it would be. I mean, I wouldn't have known that in my journey, you know, and I kind of correlate your journey to a lot of us who have gone through this, because we've all started really in the same place, right you on the doctor's side, us on the patient side but we're walking through it and learning more and becoming better advocates for those with endometriosis because of our lived experiences, because of what drives us right. So I think the value in us doing this together and what you're learning I'm right there with you for a lot of it. So it's kind of fun I'm really. That's why I wanted to talk to you, because I was like, wow, this really feels like you're walking with me on this stuff too and learning with me.

Speaker 2:
23:33

Yeah, I'd say like the part yeah, that the end of the day leaves me so sad. On many days it's just how many doctors patients have already seen and you know how long it's been until they get that you know appointment where they feel like someone is kind of putting it all together.

Speaker 2:
23:49

Or you know then they have the surgery, which then the large majority of the time kind of shows what we were suspecting, and I can't tell you how many times there's patients in tears at their consults, just feeling like they're finally validated, and as a patient who has felt that way.

Speaker 1:
24:05

again, I don't blame my doctor for not knowing what she didn't know. It's just not well known outside of the specialty, really. But I'm excited to see where you're going with this. So you are doing a fellowship now. Can you explain what a fellowship is? Because I think that a lot of us hear about excision specialists and they hear about these specialists, but there's a step to getting to that point of being a specialist and that's the fellowship. Can you explain what the fellowship is and what the different kind of fellowships there are?

Speaker 2:
24:37

I guess to start very basically, you know there's four years of OBGYN residency that all OBGYNs do, and then afterwards there's the option to do a fellowship. There are certain fellowships that are like ACGME, approved fellowships. So for instance, high risk obstetrics, that's called an MFM fellowship, infertility, called REI, reproductive anachronology and infertility, and then neurogyne and MIGs minimally invasive GYN surgery is the other one that some of your listeners may have heard of and that there are MIGs fellowships through AGL and through SLS and essentially it's typically two years of additional training and with MIGs it's usually pretty broad. It's all of the more complex parts of GYN surgery, fibroids and ametriosis, and it's interesting because MIGs it's really, you know, minimally invasive GYN surgery is talking more about, in a way, the approach, laparoscopic and robotic, versus, you know, with high risk OB or with infertility. It's more the subject matter, but I would say overall with MIGs it tends to be again an ametriosis, fibroids, all of the things that make GYN surgeries more complex. And so you know, migs is not a fellowship through gosh I'm going to mix up my acronyms through KBug that, like MFM and REI are, though I'm guessing in the next few years it may be going that route as well and a lot of the people who are, you know, experts in their fields now did more informal fellowships in the past, like, for instance, dr Mossbrook, who I'm working with now, did a fellowship with Dr Redwine.

Speaker 2:
26:13

You know, in the past people really did fellowships more informally and now they're getting more formalized.

Speaker 2:
26:19

So what I'm doing is two years working with Dr Mossbrook, both in the clinic and the OR and essentially, you know, learning from her expertise and her skill set. It's a little different than people who are doing a fellowship like MIGs, where it may be kind of a broader scope in terms of laparoscopy and robotic surgery, fibroids, ametriosis. This with Dr Mossbrook is really focused specifically on endometriosis. So I think the word fellow, depending on you know a person's specific background they may have done a fellowship with a specific physician or, you know, nowadays fellowship could mean again doing a AGL MIGs fellowship where you're at typically at an academic center. And again, I think it really varies, some MIGs fellowships having more emphasis on endometriosis and others having less emphasis on endometriosis, just depending on who the faculty are. And I think in general, you know, for patients, someone who is MIG-strained means they're generally focusing on the GYN portion only and not the obstetric side. So someone who's MIG-strained is going to be better at approaching endometriosis surgeries, but it doesn't necessarily mean that they, for instance, are an excision expert.

Speaker 1:
27:41

I think it's important to note, too, that just because they've done a MIGs program doesn't make them a specialist in endometriosis.

Speaker 2:
27:50

Yeah, I mean, I guess the word specialist it's so hard Like what defines a specialist? Yeah, it's hard. Certainly Dr Mossbrook is an endometriosis specialist. I think again, people who have done a MIGs fellowship certainly have a lot more endometriosis training than someone who did general OB-GYN residency. But I think there's just a lot of variation, you know, from program to program and in a way, you know, I think about my fellowship with Dr Mossbrook or it's almost like an apprenticeship you're learning, in this case from a specific physician and in this case it is very, I would say, disease-focused with endometriosis. And in other programs, again with MIGs, if you think about even the title Minimally Invasive GYN Surgery the focus is on laparoscopic and robotic approaches, again generally to complex GYN problems.

Speaker 1:
28:43

Yeah, what was I mean? I know that you wanted to do the surgical side of things more, but what was it that pulled you more into the endometriosis side of doing a fellowship?

Speaker 2:
28:56

Yeah, it's interesting, I was thinking about this this morning like, in a way, it was really the surgery part, you know, that I was looking for and that I knew was, you know, an area that I felt like I wanted more, you know, to advance or to refine. But it was really kind of everything else that drew me in in the sense of, you know, even going back to what I said early on, you know, being on my surgery, rotations and like plastic surgery and ENT, and feeling like I love the, you know, the anatomy part of it, but felt like it wasn't my people. I feel like in this endometriosis world, like they're really you have to kind of consider the whole, the whole body, and be a little more holistic about the approach, and I think that's always, you know, been an interest of mine. And there is also this continuity with patients too, like through their journey, and so for me, yeah, it really is this just unique meld of kind of everything that I feel like I've been interested in and been good at kind of coming together in one disease.

Speaker 2:
29:59

And it's funny because I always, you know, thought of myself initially just, you know, having this kind of broad approach. I would have never thought that I would, at the end of the day, want to have, you know, focus on just one disease. But I feel like, with endometriosis, you're bringing so many different things together and also, again, it's like, if you think of one in 10 women having endometriosis, that is a large subset of women, and so we do need more people who are focusing on this. But yeah, I think it's just been really interesting how I wasn't it's almost like I wasn't seeking endometriosis out, but it kind of sound me, you know.

Speaker 1:
30:40

Yeah, I feel like that's true with a lot of doctors who have done that and they've, you know, talked about it.

Speaker 1:
30:45

It's just the intrigue of it and the whole body approach to it and really seeing how unjustly it was treated within the healthcare system and I think that's been probably one of the most shocking things for a lot of doctors who get into it is just, you know, not only from the excision standpoint but as being recognized as something that is more harmful than just a painful period and seeing the effects that it has on the patients and how it's treated when it comes to medical billing and how it's treated when it comes to people calling you crazy because of the pain you know and not recognizing that it's such a big pain, contributor to different parts of your body beyond just your uterus or ovaries. And I think the fact that you've done this and you've seen two different sides of the coin, so to speak you've seen it with the more marginalized community, as an OB-GYN, and now you're seeing it as a fellow in endometriosis Just the healthcare discrepancies in women's health is large discrepancy.

Speaker 2:
31:59

I don't know how else to say that. Yeah, I mean, I think that's the other part. You know, in a way that has been hard, like I you know, as I was saying, as far back as residency was really interested in working in an underserved area. The first what? Almost 10 years of my life I worked at a Navajo Reservation Hospital and so really was taking care of patients I mean again, not all, but for the most part with much fewer resources. And now I'm sort of at the other end of the spectrum, working in a practice that is out of network, with insurance and just very different patient population, and in some ways that has been hard.

Speaker 2:
32:35

I come back to the fact that for these two years I really am learning how to do these surgeries well and how to take care of patients with endometriosis well.

Speaker 2:
32:45

And then I think you know, the next battle that I feel like I want to put my energy into is, yeah, how do we make this more accessible for the average patient and make it so that you know, right now I feel like a lot of the patients that I'm seeing have in a way, found us, like they have come from sites like Nancy's Nook, or their physical therapist suggested that they may have that dough and come to us.

Speaker 2:
33:10

But I think back to, you know, the patients that I was taking care of and my prior practice setting and you know they were really relying on what the what the GYN was telling them in the in the office and I think, like, how do we get to that point that patients are getting the info and the diagnosis from the person they're seeing, you know, for their appointment and don't need to come to it from this you know roundabout way?

Speaker 2:
33:36

I mean, I think it's amazing all the advocacy that patients are doing for other patients and trying to get the word out, but in the long run, yeah, I just feel like there are so many, so many battles still to be fought, you know, or how can we get to the place where insurance reimburses these procedures appropriately and sees, you know, not only that they're effective for the patient, but I can't imagine that it's not cost effective to do the you know surgery the right way the first time, as opposed to having, what do they say, the average patient it's seven years or eight years until they get the diagnosis and if you think that during that time, you know, the average patient has seen so many different providers, perhaps like had one or two surgeries. You know, it just seems to me like it has to be cost effective to do the right thing first. And you know how do we get to that place with the insurance companies and yeah, I mean I'm going to focus on surgeries, but yeah, all of those other battles I feel like are the other driver.

Speaker 1:
34:41

Were you aware of that? Going into the fellowship of just?

Speaker 2:
34:44

how I was like when I was at the AA GL conference. I remember my residency colleague tell me that, yeah, the Jardee of Excision Surgeons being out of network, and I think you know, coming from a very low resource place, I would admit my first like reaction to that was like well, that's not, that's not right, or you know how can that be? I think I had a very limited understanding of you know why it is that they're out of network and now I understand that much better and realize how complicated the issue is. You know, in terms of you know if an insurance company reimburses the same way for a ablation as for a long, complex surgery. You know, obviously that is part of the issue and I was, I would say, more peripherally aware of the issue and I think I had my biases about sort of being out of network. Now understand that better and, of course, hope that we get to a place where this is something that every patient has access to.

Speaker 1:
35:44

Yeah, absolutely, and I think when you have a heart for the communities that are underserved and you want to be able to help those patients who can't pay out a pocket, you know, I think that's always got to be kind of on your mind. I know, for me as a patient, it's always on my mind Well, is insurance going to cover this? Is am I going to be able to see the person that I want it or that I need to see? It's not even I want to see, it's that I kind of need to see to get the proper care right. That's a challenge and that's what I think sometimes can add to the trauma of the medical trauma. Right, so it's not always necessarily that it's the doctors that are doing these things and the patients have bad outcomes. It's really that the medical system isn't set up for the patient to have long term quality of life and that's a little frustrating from the patient standpoint and the doctor standpoint and it's a complex thing that we don't have enough time to talk about, right? I?

Speaker 2:
36:40

think it has to come from both ends, in terms of patient advocacy and then positions, to change the current system. Yeah absolutely, there's more education during residency, making sure that even some of the ongoing maintenance of certification involves more education about endometriosis. And then, yeah, unfortunately I don't think without addressing the reimbursement side of it, the issue will get solved.

Speaker 1:
37:10

Yeah, was it? I think this is an interesting thing to think about. Were you aware of the one in 10 number prior to doing your fellowship?

Speaker 2:
37:20

No, no Interesting. I knew it was relatively common, but I feel like that's a statistic that I more recently learned.

Speaker 1:
37:29

Was that a shock to you, or was it? Oh, that aligns, that checks out.

Speaker 2:
37:36

Of course, now, since I'm primarily seeing patients with endometriosis, it seems like it should be even higher, but I think it does make sense.

Speaker 1:
37:46

Yeah, I think that's something that we, as people who have been in the endometriosis community, oftentimes forget is just how many doctors don't have the knowledge of endometriosis, because it's not the first thing that would pop into someone's head if they're not infiltrated with it, right, like you said, irritable bowel syndrome and other things that could contribute to pain factors, urination issues, whatever To think one in 10, you're not thinking oh, that's this patient. They just don't know. That's unfortunate and something that I hope that we can get better at.

Speaker 2:
38:22

We've decided that a system or an issue with our medical system as a whole, right, you kind of get referred from one specialist to see another specialist and they refer on and it's like who is the person putting it all together? So I think, yeah, even separate from GYNs needing more knowledge about endometriosis, it's probably also family practice doctors and therapists and it's so nuanced, isn't it?

Speaker 1:
38:50

This disease is just a very tricky disease and I think something I admire about what you're doing is that you took yourself out of a I don't know if it was comfort zone of knowing what you knew to get better. I think that's promising, for a lot of us who have dealt with this disease for a long time is to be able to see someone say I want to get better at my skill and my craft and I'm going to step out of that comfort zone. Do you think more and more doctors are going to start doing that to understand their patients better, or is that something that's not really that common?

Speaker 2:
39:25

That's a good question. I mean, I think in some ways it's both, yeah, certainly stepping out of comfort zone in the sense that I was the department supervisor and now I'm going back to a learning role and being at the bottom of the totem pole, to speak. But I think in other ways it was also that I recognize there were certainly for a large majority of GYN surgeries felt very comfortable but also just like feeling that there were these more complex cases that I wanted to be able to do and not need to rely on referring to someone else. So in a way it was almost like my discomfort with that that drew me to wanting to learn more. Yeah, I think it's complicated.

Speaker 2:
40:07

I think it's also complicated by the fact that OB and GYN are tied together as one specialty and I think for a lot of general OB GYNs the bulk of their practice is the OB side.

Speaker 2:
40:19

I think, again, obstetrics is such a bulk of our residency training and then just the logistics of the average OB GYNs practice I think is heavily OB and so I think everyone ideally would like to further their surgical skillset. But it is hard to do it unless you and I mean I consider myself myself lucky that I was able to say okay, I'm going to take a two-year pause or I'm going to go back to learning. I think in many cases it may not be an option for people. There's loans to pay back, there's family responsibilities or you're in a practice where that's not an option. So I consider myself lucky to have this opportunity and a supportive partner who was like encouraging me to go back and learn more. So I think it's one of those things where probably a lot of physicians would like to do something similar, but there's also the reality of how do you make that happen when you're already 10 years into practice.

Speaker 1:
41:25

What's something that you wish that they would put into medical school and residency programs that you think would help just the general GYN be able to identify endometriosis better and even refer out appropriately?

Speaker 2:
41:40

Yeah, I mean, I think in a way medical school is where it all starts, and I think if more people can become aware or can be taught that endometriosis isn't just pain during your periods and people see it as more of a multi-system there may be bladder involvement, bowel involvement, almost IBS.

Speaker 2:
42:03

If you're considering a diagnosis of IBS, you should also be thinking about possible endometriosis. I think if that can be incorporated into medical training, that would probably be the most helpful. The reality is, I don't think we will be able to train every general OBGYN to do these complex cases, and I think it is a matter of recognizing which cases need to be referred out. But having it on your differential when it should be is probably a better goal. And then the other, I guess big question is how do we increase the number of people who are doing this type of surgery? Because I think if once there is more awareness, there's going to be more of a demand for excision surgery, and then it's not like you'll be able to create the excision surgeons overnight preparing for that as well. I think it's a two-pronged approach, like creating awareness but then also having if that's going to create more demand for these types of surgeries and then also having more GYN physicians who are able to do them.

Speaker 1:
43:09

Yeah, you give us hope, though that's what I'm saying, right, you give us hope. Looking at your future. What are you excited for in where you're going with your fellowship and potential practice later down the line? What is exciting for you moving forward?

Speaker 2:
43:28

Yeah, I mean, I think again, right now, one of the things that is really the most exciting is sort of seeing the whole process through getting to see a patient in clinic and doing an initial consult, being there for the surgery, seeing them through the recovery period as well.

Speaker 2:
43:46

Yeah, I think now that's one of the things that is really them and it's really part of how I'm learning to right.

Speaker 2:
43:51

Thinking back to what were the symptoms they talked about during the consult and then seeing the anatomy at the time of surgery I think is one of the best ways to learn is to have that continuity.

Speaker 2:
44:03

Yeah, and then, yeah, I mean I really I don't know exactly where I will be when this fellowship concludes and still thinking about bigger picture questions of whether I'll be able to make this entirely my focus, or whether I will be a GYN physician that is much better burst in endometriosis and doing some of the perhaps simpler endometriosis cases and still seeing some other GYN types of problems, or being able to be like Dr Mass Brooker, who is really an excision expert. You know, all of that, I think, still remains to be seen, but I'm just excited to learn more and then, yeah, hopefully at some point in the future, be able to collaborate with other people who are focusing on this as well, to address some of these bigger picture issues, like I'm looking forward to the conference in April that I'll be going to in Geneva focusing on endometriosis, and just getting to talk with other people who have made this their life's focus.

Speaker 1:
45:07

Yeah, it's always exciting and inspiring and yeah, oh, it's a breath of fresh air to hear you talk about it and just your journey and I and I and, like I said, I just really feel like you are on this journey with a lot of us. It feels like you're right there with us from the other perspective, and I think that's impactful for a lot of people to understand, because we can often feel like the doctors don't get it, they don't understand, but they do. It's just from a different standpoint, right, it's from a different perspective. And so to see it from this perspective and to see someone that has practiced for quite some time to be able to step back and and learn some more and grow some more in their skills, that is just refreshing for a lot of people. It is for me at least, and I knew that when Nancy Peterson said you've got to meet this gal, I said okay, nancy, I'll meet her. And she said, no, I want you to talk to her. I said, okay, nancy, what you want you get. So you made an impact.

Speaker 2:
46:08

I appreciate it. I had a chance to when I first heard about the podcast. I got to listen to to your story as one of the early episodes and I felt like you were so thoughtful when you were talking about, you know, the physician you had initially seen. When you talk, I felt like you even sort of beat yourselves up about not having done you know the research yourselves about endometriosis. You know, in the sense of kind of those early decisions and, yeah, I just appreciated your thoughtful approach to that Cause in many ways. You know I was identifying with that GYN that you initially saw. You know, in terms of the, the steps, yeah.

Speaker 2:
46:46

And the through. So, yeah, I appreciate all that you're doing to bring more information to other patients on their journey and I appreciate you tying me in Cause. Yes, I'm on a similar journey myself.

Speaker 1:
46:58

Yeah, yeah and it's. It's kind of just kind of fun to see that journey happen. I'm excited to see what the future brings for you. I'm excited to see the change that you will elicit, because I really truly feel like having a broad picture of this is going to be impactful longterm for many, many people. So I'm excited. Plus, you really have a just a sweetheart for those patients and the underserved communities and the ones that are often overlooked. So thank you, thank you for doing the work that you're doing.

Speaker 2:
47:32

Shout again when I'm closer to the end of my fellowship, but I've learned a few more things along the way.

Speaker 1:
47:37

Oh, I'd love that. That would be so good, and then hopefully, we'll get to meet in person one of these days and have those conversations. Well, thank you so much for joining me today and sharing your story and your heart, and I'm sure that people will be able to resonate with us. So thank you so much for taking the time.

Speaker 2:
47:54

Thank you, lana, oh my gosh.

Speaker 1:
47:56

You're so welcome and until next time, everyone continue advocating for you and for those that you love.