“We Filled a Need”

BY MENISA MARSHALL

LOUISVILLE Rebecca Terry, MD, is flooded with memories and mixed emotions as she reflects on what Women First of Louisville has achieved since its launch in 1988. When she and Sarah Cox, MD, co-founded this unique OB-GYN practice, staffed entirely by women, their aims were twofold. They wanted to meet women’s care needs through every stage of their lives and deliver excellent care built on a foundation of compassion and kindness. By all measures those aims and more have been achieved.

Within ten months of Women

First’s opening, Rebecca Booth, MD, and Mollie Cartwright, MD, joined the practice after completing their residencies at the University of Louisville. Today the practice’s dedicated team includes 11 physicians, 12 nurse practitioners and physician assistants, plus an excellent support staff.

The group’s newest physician is Taylor Hodge Aiken, MD, who happens to share a unique bond with Terry. Early in Terry’s career she delivered the future doctor who would one day join her practice.

Terry’s voice cracks a bit as she talks about the lasting connections she has built with her patients and their families over her years of practice. “I’ve haven’t done OB for 22 years but continue to take care of many patients whose babies I delivered,” she says. “And, now I’m taking care of their daughters as patients too.”

Such long-term relationships are not unusual when you believe that the better you know your patients, the better you can meet their care needs. Terry has had patients tell her before coming to her practice they felt their concerns were sometimes “unheard and unseen.” It was not uncommon for patients to say one benefit of seeing a female OB-GYN specialist was knowing that you and your doctor may have faced similar health concerns.

“I believe women share an important connection as caregivers. There are other roles too, of course but as caregivers we can identify with one another’s experiences,” says Terry.

For instance, she recalls a patient who recently reminded her that during each of her own pregnancies there was always someone in the practice who was also pregnant. “You all always understood what it was like to be pregnant, to be working full-time when your legs are swollen and uncomfortable, or when you’re having Braxton Hicks contractions, or you’re just tired,” the patient said.

Four Decades of GameChanging Care

Throughout her career Terry has been front row and center during a revolution in women’s health care. One of the “biggest gamechangers” she has seen is the advent and progress of minimally invasive surgery.

“It used to be if a woman needed a surgical procedure, it would involve a large abdominal incision that left a big scar and involved significant healing time,” she says. “Now that’s just so rare, thanks to advanced laparoscopic technology and techniques.”

Terry notes that Women First is unusual in the number of the team’s physicians who can perform minimally invasive surgery. Several practice members have had specialized training in a significant variety of procedures. “Patients can come in for a minimally invasive procedure done either laparoscopically or robotically and be able to quickly return to their normal activities instead of having a huge incision to deal with,” she says.

Women First meets patient care needs on a technical level by providing onsite mammography, bone density testing, ultrasound, and other advanced diagnostics. This provides patients with efficient, convenient care and makes it possible to refer them quickly for additional high-risk care or followup as needed.

Another trend the practice embraced was providing patients with holistic care. They focused on meeting their needs beyond the limits of typical standard obstetrical or gynecological medicine.

An Ongoing Women’s Care “Revolution”

One growing trend Terry has seen unfolding is an overall increase in the number of women in medical practice. When she graduated from medical school about one-fourth of her class was women. The ratio of men and women graduates is now equal, and for some specialties women graduates outnumber men, particularly OB-GYN.

At the time she was finishing her residency training in-vitro fertilization was in its infancy. Fast forward to today, and fertility specialists have a wide range of tools and resources they can use to help their patients. “We now have the ability collect much greater and more specific data around in-vitro procedures,” says Terry. “Experts can look at the egg and the sperm and see what genetic material we have in order to make sure an egg does not carry a high-risk genetic component.”

Another emerging and growing subspecialized area of care is maternal fetal medicine and high-risk pregnancies. Women First works closely as needed with a high-risk specialist to develop care plans for patients who meet high risk criteria. Should it become necessary, patients can be readily transferred to the specialist for care.

One development she sees evolving is the growth of more subspecialties. One example of this is gynecologic urology, which had just gotten started around the time she finished her training but has recently become more prevalent. Another emerging subspecialty is menopausal care and medicine based on women helping other women through this major life transition.

She notes there is currently no specific fellowship training for menopausal care but predicts it will be available in the near future. For now, providers can earn certification through the North American Menopausal Society.

Terry feels this development is driven in part by today’s “baby boomer” demographics. She cites a recent New York Times article that reported millions of dollars are lost a year because of hot flashes and the lack of quality sleep women experience, along with mood shifts that can impact work performance.

“Women are looking for care that meets their needs at each transition of their lives, and we need to meet those needs,” she says

Another troubling development being seen is a significant increase in endometrial and uterine cancers. This may be associated with obesity and diabetes, which are both linked to insulin resistance. In response, Terry stresses to patients the importance of eating a healthy diet, watching their carbohydrate intake, and staying active with at least thirty minutes of exercise a day. These recommendations take on even more importance during menopause when hormonal changes can ramp up insulin resistance.

One unfortunate and sad trend Terry has seen is a growing need for specialized obstetrics and gynecology addiction care. She is aware of only one specialist in the Louisville area who is currently delivering this specific type of care in the region. “Dr. Jonathan Weeks is with the Norton Healthcare system. He is doing excellent and important work as medical director of their Maternal Opiate Substance Treatment (MOST) Program,” says Terry.

Change Can Spur Blessings and Banes

A current trend that has affected her work has been a significant decrease in the number of primary care doctors in active practice. This