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The Many Facets of Reproductive Endocrinology

Session 120

Dr. Alex Polotsky, Reproductive Endocrinologist and Infertility (REI) specialist and infertility fellowship director, feels very fortunate to provide fertility care for women and families. Listen to find out why!

If you’re interested in OB/GYN and REI, this is will be a great episode for you. And even if you’re not, hearing from a program director will give you some insight into your future applications for a specialty.

If you haven’t yet, do check out all our other podcasts on Meded Media and please feel free to share our resources to premeds, medical students, or your colleagues.

[01:20] Interest in REI

Alex got interested in REI during the second year of medical school when he got to attend a class in reproductive health, particularly reproductive hormones. The course leader ended up being his mentor. 

What drew him to the field is this unique combination of medical management and surgical procedures, as well as psychological concerns that have to be addressed adequately. 

'It's a unique combination of a variety of factors where you can do highly specialized care, but at the same time, establish a very close and personal relationship with the patient.'Click To Tweet

A lot of times, your preconceived notions going into medical school don’t pan out. He initially thought he was going to be interested in being an internal medicine doctor. But he realized he was much more driven to a field where he could have final authority in a relatively narrow but specialized area. 

When he was doing his clinical rotations, he realized he wanted to be a narrow expert as opposed to having broad expertise.

[04:40] Traits that Lead to Being a Good REI Specialist

You have to be comfortable with the psychological aspect of patient care. Approach it in a way that the patient is in the driver’s seat. Be able to listen to the concerns of the patient. Understand that often enough, they’re frustrated and confused. They will often complain and be unhappy. 

'Make sure you address the psychological underpinning of delivering healthcare.'Click To Tweet

[07:20] Types of Patients and Typical Week

REI specialists deal with complicated medical management and sophisticated surgical interventions. People come from all walks of life. Some may already have an understanding as to why they have infertility issues. Others don’t. 

Alex is involved in academic practice. He sees patients usually about 3-4 days a week. This includes ultrasounds, new patient encounters, follow-ups, office procedures, surgical procedures (either in the IVF lab or the O.R.). 

He also does administrative duties being in charge of their division in the medical school. He does a fair amount of research and directs the fellowship.

[11:17] Academic vs. Community Setting

Alex chose the academic route versus the community setting. He believes you have to provide excellence in clinical care, being attentive to the needs of the patients. But there are also aspects of care amenable to either clinical research trials or attempts to understand the pathology of a condition better. 

[12:15] Taking Calls and Work-Life Balance

Alex shares weekend calls with other faculty members. This could take around 3-4 hours or sometimes longer in the office. They don’t have a lot of emergencies. 

If they do, it would be related to an abnormal pregnancy that requires surgical intervention. Or it could be complications of fertility treatments.

'There's not a lot of house call. But there is a fair amount of weekends.'Click To Tweet

In terms of work-life balance, Alex has five kid and he definitely has a life outside of work. 

[13:45] The Training Path

To become an REI specialist, it requires 4 years of OB/GYN residency and 3 years of subspecialty fellowship. This is a total of 7 years.

The field is competitive. They have one spot for their fellowship. Nationally, there are 35-40 spots available and they typically get 80-100+ applications.

People approach their application in a broad fashion if they don’t have geographic restrictions.

'It is helpful to go around the country and just see what's available.'Click To Tweet

Look to research opportunities to stand out as well as leadership opportunities during residency training. More importantly, make sure you’re a good fit and that you’re ready and happy to get into training.

[15:45] Advice to Osteopathic Students

Alex gives the same advice to osteopathic applicants as he would to allopathic students. They have had great osteopathic candidates who applied to their program. 

Look to research opportunities and be able to show you can complete a project. Show your interest and your ability to interact with colleagues. 

[16:28] Other Specialties They Work the Closest With and Opportunities Outside of Clinical Medicine

Other specialties they work the closest with include reproductive urology, medical endocrinology, psychology, and embryology. 

In terms of opportunities outside of clinical medicine, you can get exposed to clinical research. From the basic science lab, there are a lot of issues that need to be looked into and uncovered. 

[18:05] Most and Least Liked

Alex loves what he’s doing. He sees it as a great privilege to be able to help couples in something they’re struggling with.

Alex also underlines the importance of positivism. Sometimes things don’t work so you just have to be realistic. Use the best judgment in recommending certain procedures. But that said, he doesn’t think he even dislikes any single thing about his specialty.

In having those phone calls with hopeful parents when implantation was not successful, you just have to be comfortable. There are many different ways to appropriately inform the patients about unsuccessful outcomes. And this is part of your challenge.

'You have to be comfortable with having difficult conversations.'Click To Tweet

That being said, if you’re offering a certain treatment, you should be excited about it and you should be comfortable in recommending that. 

[20:35] The Great Myth About REI

Many trainees don’t realize that you tend to spend a lot of time with the patient just making sure they’re comfortable with how things are and how you can outline the options. 

A lot of times, there is not enough certainty to tell where the issue is. Unexplained infertility is one of the hardest diagnoses to deliver to the patient. Most patients struggle with this in figuring out how doctors are still aren’t able to figure out why they’re not successful if everything is normal. A lot of times, you cannot always tell what the problem is but you can still help.

'Many students feel that most of the time, you can pinpoint the problem and that's not necessarily true.'Click To Tweet

[22:05] Final Words of Wisdom

All Alex can say is that the field is rapidly evolving. He finished his fellowship 12 years ago and there are aspects in REI that are different now. If he had to do things all over again, he would still have chosen the same specialty.

Finally, Alex wishes to tell students who might be interested in this field is to shadow physicians. Unless you see it, it’s very hard to conceptualize what life is like on a day-to-day basis. 

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