The Biological Clock vs. The Medical Clock

I have one topic to discuss today, but I don't know, you're not gonna like it. Uh oh.

Hi everybody and welcome to the podcast. This is Generations md. My name is Stephanie. I'm joined here by my colleague Dr. Sarah Davis, who's also my mother and.

We'Re here in person together.

Yeah. Happy New Year.

Happy New Year. Okay, well, we have a few things to discussed today. One of them is that I now have my own Tik Tok.

Right. So Shameless self plug right here.

Yeah, I have over 100 followers.

Wow. Like 105 last big time.

Yeah, yeah.

What's your handle so people can follow Dr. Davis?

PGY 30. You.

Did you say already what that was on the podcast?

I feel like I explained it. But if just in case anybody didn't hear that, that's because that means postgraduate year. When somebody's an intern, they're a PGY one. When they're a second year resident, they're a PGY two. PGY three. Up to like PGY seven, eight for those things. But my. I'm more than 30 years of postgraduate, so I'm a PGY 30. That's not. People don't usually introduce themselves that way, but it's kind of fun.

Yeah, it's like saying, I don't know.

Like how many months you are. Yes, yes, exactly.

When you stop saying months of a kid.

Well, that's a good question. Question. Because some people drag it on for a long time. Like, you know, obviously before a year, that's fine. And then you still are like 18 months. Because, you know, you're like, you know, you. Some might say a year and a half, but it's like 18 months. But sometimes you get people that are like, oh yeah, she's 30 months. And you're like, wait, wait, what? How old is that? I think it definitely ends at two. Once you are two, now you're like two and a half, three. You can start just going by halves and then at some point you're into the whole numbers.

You know what? This just reminded me of one thing that we learn in school. School that a certain group of people have a lot. A big advantage of is like child milestones and people who. People in my class who have kids.

Oh yeah.

Have a huge. And we. I don't ever remember having a formal lecture about it, but sometimes we'll get a random question on a test. I'd be like, what? Like, what age is this kid? They can do this, this and this.

And you're like, I have.

I'm like, I have no idea. And especially the boys my age who don't have kids, have no idea how old any kid was. Like I was with one of my friends who. And we were working some event and under four, they didn't need a ticket, but above four they did. And he asked like, oh, is anyone here under 4? And it was an 8 year old.

I was like, I don't know what a four year old looks like. Pretty funny. I mean sometimes it's hard to tell ages, but like 4 and 8, that's a big difference.

C just has no idea. No interaction with kids ever. So.

That is true. I still don't. I mean we studied that stuff in residency. I mean that came up on family practice tests and you know, you start to get kind of a feel for it. But then once you have kids, oh man, you just know that stuff like that.

Yeah, yeah.

You know, when they're rolling over. I mean before that you're like, I don't know, when a kid rolls over. Yeah.

How about just like. And also with. I'm just thinking about some of some students who just are not interested in children at all and they have to do a pediatrics rotation. Just like.

Yeah, but I mean that's with lots of things though, right?

Like, true.

You know, still gotta, you gotta, you gotta see all this stuff. It's just awkward.

There's certain people who are just awkward with kids though.

Yeah. Yeah. And they're, they're, they, they've got to go in like, look in their ears.

Yeah. Especially like a 25 year old boy, he just doesn't like, I don't know.

Doesn'T care at all. Yeah, yeah, well, but yeah, the back to my TikTok, right? Yeah, that. It's. I don't know. People tell you, you keep seeing these things that, you know, doctors should, we should all be on these social media platforms because all the other people, you know, all the people that just have a bunch of, you know, misinformation, they all have these big platforms. So we should do the other side. So I don't know, I'm gonna try to do it. I'll see if I can stick with it. You know, I'm, I try to get help from editing from Stephanie, but she's, she's kind of mean about it.

I'm not mean about it. She says in a mean way.

She's just not helpful. No, I just need to take, just do this, this, this.

I just need to set aside some time and I'll, I'll show you. I'll make a video or something and try to show you how to do it.

Okay, well that'd be good. I have watched other people's videos, but I don't know, it just, it doesn't come real naturally for me. But anyway, we'll see. I still don't know if it actually does any good to have all of us on social media because I feel like the algorithm isn't going to take the nut balls to me anyway. Like I feel like I'll just get the people who are also following other doctors.

Yeah, but you never know who's you could land on, you know. Okay, but so you're doing it for the betterment of society, right?

Yes. Not for the betterment of myself, it's to the worsening of myself. Like, but I, you know, I think that if I just keep doing it, I will improve. Right.

I agree.

And so.

Well, I think that this is an important subject and the point that you are trying to post on social media for the betterment of healthcare because I think in school and especially, I mean just being at a big academic institution and having a lot of people over you, it's really discouraged to post on social media. We've had this conversation multiple times on the podcast. But I just think it's important to talk about how it is important for healthcare providers to post on social media and put good information out there. And it's not unprofessional. This is just the new.

Yeah, it's way being professional.

It's being professional. It's the new way to get information. People don't go read journals, they look on TikTok and there has to be. That's a part of your job as a doctor. Probably the main part of your job is to be able to facilitate that communication between your knowledge and the patient.

Yeah. And you know, it's an already. Well, okay. What's hard for me is that when I'm talking to a particular patient now again, and in my practice, I know all my patients really, really well, so I kind of know how to talk to each one. But still in a practice like you're talking one on one to a patient. Right. So you can kind of tailor your message because you know a little bit how that patient is going to respond to what you're saying. And so you know, rather than I like, I don't have just a spiel that I say which some people do. Dad does. Dad's. Dad's big time spieler. But you know, he has to be. He says the same thing all Day, every day. Mine are all kind of different, but when I'm talking to a patient, I kind of figure out, like, okay, what tactic is gonna really land with this patient? But when you put something out on social media, you don't know who you're talking to. You're just kind of making this announcement. You're trying to, like, say things, and. And sometimes people take it the wrong way.

Yeah. I mean, that's just. You kind of have to figure out you're not talking to one person, you're spreading information.

Yeah, yeah. But it is helpful because you do get comments, and you have to, you know, weed out, like, when people are just being mean and when they are actually giving you legitimate feedback about your messaging. And it's. It is good to get some feedback because, honestly, in my line of work, well, and this happens to lots of doctors, especially, like, a primary care doctor. The people who don't like your style just don't come back to you. And the people who like your style keep coming back to you. And so you're like, oh, wow, my style's great. All these people keep coming back, but you don't really realize the ones that you've lost. And so I just think there's always room for improvement in your communication and, you know, just the things that you're talking to patients about, all of that. So I think it could be good if I can just motivate to do it.

For sure.

Yeah.

Well, I think that it's good. I think that it's good to stay motivated in doing it. I think it's important, and you're doing good. I'm hyping you up.

You are the. And I figure if I just do it, I'll practice. And you know what people do say when they're trying to encourage you to do this? They say, you know, if it flops, nobody knows because nobody sees it flop. So don't worry if, like, it hardly gets any views, because if it hardly gets any views, hardly anybody's gonna see it hardly getting any views, which is an important point. So. But I figure if I just keep doing it, I'll get better or I'll give up one or the other.

Yeah. Once you have a video that does well, then it encourages you to.

Gives you that dopamine hit.

For sure. For sure.

Yeah. Well, you kind of just got to figure out what really. What hits what people, like, find your niche. Yeah, I'm still. I'm still looking for it. We'll see.

Well, just a point to what you're Talking about, about talking to specific patients and communication style. And that the reason that these pseudoscience people get on there and do, do well is because people like to hear just like a general claim of this is bad for you, this is good for you, this causes cancer, this is this. So when you come on there and you say a blanket statement like that, no scientist, no doctor, nobody is ever going to make a claim that this is a definitive thing. Because that's the whole thing of science is we're studying it, research shows. But people don't like nuance.

No, they do not. They do not. That's true. Yeah. I saw, you had reposted a video that I saw as well of a woman really explaining that and she's like, she did good. And if anything ever comes on there and says, here's what doctors don't want you to know. Nothing. There's nothing doctors don't want you to know. We want you to know everything.

Yeah, exactly.

We don't gape. Keep this stuff. That doesn't help us in any way. Yeah, I, I have one topic to discuss today, but I don't know, you're not gonna like it.

Oh, okay.

Well, I just, I say that I want to talk a little bit about infertility.

Why do I not like that?

Because young women hate it when we start talking about this, when we try to talk about infertility and somehow the conversation ends up being that like we're trying to scare people into having babies earlier. Like somehow that's what gets spun off when we're trying to talk about this. And I feel like men can't even really bring this up at all without getting totally bashed, you know, So I kind of, I just, I want to talk about it especially in the context of female physicians because I feel like we don't talk about it enough. It's like this looming cloud that everybody sort of knows is there, but they just want to pretend that it's not. And I just don't think that that's healthy. And I just, I really, I want to kind of discuss the fact that it's not anti feminist to talk about the fact that fertility does decrease with age 35. It's okay.

Well, raised to 35.

Yeah. Because everything is perfect and then boom, just disappears at 35. That is not true. Actually, Radiolab just did an episode on that and I was listening to it. That. Which kind of what got me thinking about it is this. The reporter was like, that's what she imagined. It was like, everything's perfect. And then you hit 35, and there's just like this cliff. And that is absolutely not true. So, no, there's not a fertility cliff, but. But there is a line that goes down. Okay. Does that mean it's impossible to get pregnant when you're 45? No, that does happen, but that is a little bit skewed in people's minds as well, because they see these celebrities that had this baby at 50, and they're like, oh, well, she just had a baby. Well, no, actually, she used a surrogate to have the baby. There's lots of other things that those people were doing, you know, and so you can't. You can't extrapolate that to every person. So I just. Just kind of talking about that in, you know, so.

Well, pause, pause. I think it's important, like, to. Because this is an important conversation. And it's also the way that we're talking about it now is just different than it was 30, 40, 50 years ago, because now woman. Or have more autonomy whether to choose to have children or not have children, and they're able to be financially stable and don't have to have a family and lives can look different. So I think it's important to acknowledge the fact that we're talking to people who are interested in having children and you don't have to be that person.

Exactly, exactly. And I think that that's what does get, you know, all messed up when, like. Because what happens? Like, so a woman says that she wants to go into surgery, and then people immediately kind of jump in with saying, oh, well, you know, how are you going to be able to have a family if you're going to be a surgeon? And then they. Then they're, you know, understandably, kind of irritated. They're like, you know, you don't ask that to men. Don't ask that to men. And, you know, quite honestly, it's none of your business. Like, I don't. You really don't need to be inserting that. When somebody tells you that they want to go into surgery, they want to go into surgery. Now, if they're asking my advice and say, hey, you know, I want to go into surgery, I also want to have a family. You know, what do you. What do you think about that? Or what do you think about choice of specialty with relating to have a family, okay, then I can give my answer. But just because somebody says they want to do a particular thing, you don't need to jump in with how that's going to affect them having kids or all that. So I think that it's important to kind of take that part out of the picture. But if you are having the conversation, well, then let's have the conversation and let's talk about the reality of all of these things and you know, and really look at the numbers. And I just was doing a little bit of research about this because, okay, what they say is that physicians have twice the infertility rate of non physicians now.

What does that mean?

What does that mean? I think it's a little bit weird because how do you know? I mean, people have to be seeking treatment for infertility in order to know if they have infertility, right? So, you know, probably physicians are a little more likely to seek treatment for infertility because they have money to do that. So I don't think that that's totally fair. But this, this statistic was saying that like the average age for whatever group that they were looking at of non physicians for having their first child was 27, and for doctors it was 32. So that's five year difference for the average of having your first child. Child. And you know, seems pretty direct, directly correlated to these long training that we have to do for residency and all of that. So. But that got me really thinking about like, okay, 32 is still fine. I mean, really, your fertility at 32 is not that much diminished.

When did you have me?

Right before I turned 33. And I had Ryan right before I turned 31. So essentially 31 and 33 now. But if I wanted to have four kids now you're pushing it later and later, which still might have turned out just fine. But it's just important to have this whole conversation to factor all that in, to look at the timeline of how old you are, how you want to space your family again, and if you want to do it at all. And I just think that it's something that, you know, couples should be looking at and thinking about as they're planning their training. I feel like we are scientists. We're all about data and knowledge. And then it comes to things in our personal life and we're like, well, I don't want to hear that, I don't want to talk about that. That's anti feminism to tell me that I have to think about that. I'm like, you don't have to think about it, but there may be a time in the future where you're looking back and you maybe wish you had made some different decisions. And I also had combed through these some of my physician mom groups and people were saying things like, I mean this one woman was like, Well I was 39 and I said, oh, okay, finally, now I'm ready to do this. And she did like five cycles of IVF and it never did work out. And she really wished that she had thought about it, talked about it. She said, all of my mentors, all these celebrities, I just thought work out fine for everybody. So I just figured it was going to work out for me and I wish I had thought about it earlier. So the other thing is like when we were talking to kb. Yeah. Just about how her program had a program for egg freezing, which is great. And they helped financially with it and said like, okay, this is something that we offer, which is great because most programs don't offer that. So I think that that's a good thing to do. But I also think that sometimes people think, oh well, I'll just do egg freezing. So problem solved. Well, it doesn't, egg freezing doesn't mean that you're not going to have infertility. It's just sort of a backup plan so that you've got some of those eggs that you could use in IVF later on. But it's important to realize that like it's not like, it's not like these eggs are frozen and then you just pop them back in and get pregnant the normal way. That means doing a whole IVF cycle. And the only reason to use those frozen eggs is if you are trying to get pregnant and you can't get pregnant. And now you've got this backup plan and maybe those eggs are a little bit better than what you would naturally have at that time. But it's not like, oh yeah, everything's fine, I'll just freeze my eggs and use them whenever I want.

It helps though.

It helps, right? It does help. And I, and again, when you talk about these things with nuance, I definitely don't want to disparage anything about having an egg freezing program. I think it's good. But thinking that that is going to solve the problem is not logical. You have to attack the problem from a lot of different angles. And I think just saying like, oh, they're sacrificing. So now, now women, don't worry. Just, you know, you can go and do a 10 year residency and it'll be totally fine because your eggs are just sitting there in the freezer.

Yeah, I guess just pausing there. I think just, yeah, I, as a young woman having this conversation, it's just so frustrating that like men don't have to think about it. And it's just like men have always been able to go have a high paying, successful career and think about kids later. And that just happens. And I don't think that, I mean, maybe I'm wrong, but with the people that I talk to, my friends and everything, people are thinking about having kids, but no one wants to sacrifice anything. And also see people who are doing it all and, and are surgeons and have children and all of these things, it's just, it does seem anti feminist to not choose a career path because you want to have a family.

Yeah. And that's where I think you get into a little bit of the trouble with the name calling and any of that. And I agree it is very frustrating that the men don't have this, but it is what it is. And so I think it doesn't serve us to kind of focus on the fact that that's frustrating. It just is. But as more and more women, I mean, women are now the majority in medical schools. And it didn't used to be that way like we talked about. I mean, in my med school class, we were one third of the class, and before that it was much less. And I just don't think that the training programs have kept up with this change in the demographics.

Yeah, I think that that's an important point. And I think that, yeah, just understanding the age of when women go to residency and trying to change how we're taking care of pregnant women and people who had just, who have just had babies. And I think that's important.

Yeah, yeah. And I think it's just like sticking our heads in the sand and just saying, oh, yeah, freeze those eggs and move on. I just don't think it's a. I don't think it's a viable strategy. I think it's something that everybody in medicine has to really be thinking about. Like how. What are some ways that we can make this easier or make it just make it all more manageable so that we can keep these women in medicine. Because as we Talked about before, 40% of women physicians will go part time or quit all together within five years of completing their residency.

Yeah.

Which is a staggering statistic. I mean, that's, we really should be doing things to, you know, to help that. And I don't know exactly what part time means, but so, you know, I just say that is it. This is. It's not a female problem, it's a society problem. And so, like, just looking at it a lot of different angles and just coming up with Solutions is important. And that's why I just think like, talking about it, acknowledging it, thinking about it is good. And I just don't think we just don't want to be shutting down when we start bringing it up, when we're bringing it up in the right context. Yeah.

And I think that that's, I mean, talking about like equity and stuff with male and female, the. That doesn't come from me as a woman choosing to either do a career path or not. That comes from a system level.

Exactly.

Of being able to change things so that I'm able to do the same career path as a man and not have to sacrifice more just because I'm a woman.

Right, right. And again, I'm not saying that men don't sacrifice in, in various ways as well. Like I. So again, I might, when I read these various posts from women, I'm not, I'm not reading a bunch of these posts from men, so I'm not getting all of their story. But like I was reading this one post of this woman saying, you know, I'm so devastated. I did not match into the fellowship that I wanted. She had done a psychiatry residency and she wanted to do a child psych fellowship, but she only applied to like really one or two programs that were local to her because she already had a family and her kids were in school, her husband had a great job where they were, and that was the only, those were the only programs where she wouldn't have to either move her family or live apart from her family during, I think it's like a three year fellowship. And so she didn't match. And she was really just, she's like, I'm devastated. This was what I wanted to do, but I guess I will just do general psychiatry so that I can stay here with my family. And lots of people were chiming in with different things of like, well, maybe you could do a fellowship in a few years or who knows, maybe a spot will open up in this fellowship that you didn't match in. And then several other people said, yeah, you know, those are some of the choices that I made. I did this or that or something different so that I could be with my family. And then lots of people chiming in saying, you know, I lived apart from my family for three or four years while I was doing more training and went back and forth, which I just can't imagine. I just can't imagine doing that. But you know, men do that sometimes too, you know, and sometimes have jobs that travel all the time or I mean, Think about people in the military who go and, you know, have to for six months at a time, don't see their families at all. So I think that it, you know, it's not like we're the only ones that are having to go through this, but, but just kind of like watching that, that person just kind of saying that in real time, like, okay, I'm, I'm literally making this choice right now to choose my family over doing this fellowship that I really, really wanted to do. I, it's just kind of heartbreaking. Yeah.

But it doesn't seem like it's, I mean, there's, there's always going to be decisions and sacrifices you have to make in life. Right. Like, I don't know if that is necessarily, necessarily. And in any career path too. Sometimes it's like, okay, you want to go into this other hard job and want to do this other thing, but no, you're not going to do that because you want to stay there for your family. Like, you're not going to take that promotion and go that place. So. I don't know.

Yeah, I, yeah, I think that stuff does happen. It does, it happens all the time. Sometimes with big decisions, sometimes with smaller decisions. But. Yeah, and I guess I'm just kind of saying like, so the, the future is full of lots of those different things. And so coming with like choice of residency, choice of specialty. I mean, it's, it's starting with that even, even when your family is imaginary.

Yeah. Yeah. Well, how about like, did you look into how other countries do it in difference other places or not?

Not that much because they are, all their, their programs are so different and because they start this whole process so much earlier than we do.

Yeah.

That is what is just really frustrating to me. I think it's ridiculous. I don't think we need to do four years of college before doing four years of med school. You easily could combine those two into a six year program, which they have done. Or, you know, I think there's lots of ways that we could make this whole process shorter. But you know, we've sort of, we've gotten into, we've gone down this path and here we are. But I think that there are ways to make it more efficient and, and you know, and those are some of the different solutions. I think you got to look at solutions on all kinds of different, you know, lots of different areas, but that's definitely a place. And you know, then of course, as I've talked about before, this doing a bunch of gap year thing, it does not help the problem.

Yeah.

So all of those things are ways to look at it. But I think that just like anything, it's very hard to do change, systematic change. Everybody's so used to, this is the way it is. This is how it's worked. But we just have to remember that the system was not created for us. And so now we're kind of trying to go into a system that was not created for us. And it's, it's, it's not all. I mean, not that it doesn't work. It works at times, but there are, there are certainly problems. And certainly had women been the ones who had always been doctors, the training program would look a lot different.

Yeah. And be better.

And be better. Way better. So. Yeah. What, what, what are your thoughts?

No, yeah, I mean, I think it's important. I think. Yeah. Talking about it on a systems level is, I think, better than necessarily talking about it on an individual decision level, because it is just hard. As a young woman, it's like, I don't. I don't know. In a couple years, even if I, you know, maybe I don't want a family, maybe I'm still trying to decide, but I do know I really want this career path, so I want to be able to do it. I don't want somebody telling me, no, I can't do that because of this.

Potential future family that you don't even know.

Yeah, exactly.

You don't even know if you're going to like those kids.

Exactly.

What do I care about them? Yeah, I care about them. I love my grandchildren. I love my imaginary grandchildren.

Well, only if you behave. You're getting some.

Okay. That's right.

If you misbehave, no grandchildren for you.

Yeah, that's a good way to make decisions about having a family if you want to spite your mother. Yes, exactly. Make that out of spite.

That's what we recommend on this podcast, fighting your mother. But, yeah, it's important. And I, I think it's important to talk about, and it's nuanced and complicated, but things are changing. And even your point of more women are in higher education than men now. So it's like, I'd like to see some systematic changes now that we have all these educated women, but I don't know.

Yeah, I don't know either.

All right, well, good combo. Thanks for chatting with us. You guys know where to find us.

Mom, Plug your tick tock, Dr. Davis. PGY 30 on tick tock and enerations.

MD on tick tock and Instagram. And you can email us@askgenerations mdmail.com and we'll talk to you soon. Bye, guys.

Bye, Sam.