Transcription:

Dr. Pam Peeke: Greetings and welcome to The Obstetrics podcast. My name is Dr. Pam Peeke and I'm your host. Today's expert is Dr. Nikki Liburd. Dr. Liburd is an obstetric hospitalist and Site Director at USC Verdugo Hills in Glendale, California. She received her medical degree from the University of Texas in 2008 and completed a residency as Cedar Sinai Medical Center.

Welcome, Dr. Liburd.

Dr. Nikki Liburd: Hello.

Dr. Pam Peeke: All right. So why did you want to be an OB? I mean, you had all these choices out there. Why OB?

Dr. Nikki Liburd: Very good question. So let's take it back to medical school. Third year is usually when you do your clerkships and you decide what direction you want to move into. I was at a loss until the end of my clerkship year and that last rotation or last clerkship was actually OB-GYN. And it was great. It was wonderful. I felt like if I went down this role, I would kind of be almost like a family doctor, but just a family doctor for women and women's health. So that was the draw to it. I just felt that I could get so much out of becoming an OB-GYN by going down that route.

Dr. Pam Peeke: Okay. So you became an OB-GYN. What was residency like for you?

Dr. Nikki Liburd: It was good and bad. So basically, after completing my OB-GYN residency, instead of feeling exhilarated to start my new career, I felt extreme burnout.

Dr. Pam Peeke: Okay. Tell us about that.

Dr. Nikki Liburd: Well, I don't know for many people, at least people that I know that went through the residency experience, there are definitely rewarding parts of it, the patients that you get to help, the comradery and the relationships you've developed with your other resident members. However, it's a lot of hard work, sleepless nights and, after a while, it kind of burns you out. So that's kind of my experience, even though I've learned a lot,

Dr. Pam Peeke: Okay. So you learned a lot and, needless to say, it was no walk in the park, but hey, you signed up for this. You knew that mommies have this interesting habit of just sort of surfacing at two in the morning with all kinds of issues, like, "Here's a baby," right? So what was the beginning of your actual career like? Any surprises there?

Dr. Nikki Liburd: You know, when I started my career, like I said, I was a little bit burnt out and I kind of wanted some flexibility or just being able to determine my own schedule, which wasn't a possibility in residency, that I was able to start as an OB-GYN hospitalist immediately after graduating residency. But that position actually evolved into a full scope generalist position. During that time, my work-life balance suffered which, wasn't something that I expected to happen, but it did as a generalist.

So ultimately I moved on from that work opportunity and discovered that a full-time OB-GYN hospitalist role through OBHG offered me the type of career I wanted, which was to serve patients in a hospital setting, but also having that flexible schedule that afforded me quality time with my family.

Dr. Pam Peeke: Okay. You brought up the family thing. Now, you're a mom as well as a physician. I mean, talk about a glutton for punishment, come on now. Tell us about this thing. Come on now, is this whole issue of work-life balance some kind of urban myth? What's going on here?

Dr. Nikki Liburd: So with work-life balance, I think it means something different to each person. And it definitely doesn't mean 50% of my time is devoted to my work and 50% of my time is devoted to my family. It's just an arbitrary balance that makes you kind of feel good about your work-life balance, that makes you actually want to go to work, that makes you actually want to be around your family and have time to commit to them. So it's not a perfect 50/50 thing as it implies. It's a little bit more personal.

Dr. Pam Peeke: I liked the fact that you brought that up. The 50/50 thing is a total myth and I think there's already a great research out there that's made it very clear that aiming for something like that is kind of silly. Everyone's different, they really are. I mean, we're different when it comes to our lives, how we balance out whatever we're doing, whether we're a physician or not. It's just got to work for you and you got to spend enough time doing trial and error. And it sounds like you have. And so, you know, it's interesting when you switched over and you also became a mom. How did that affect the quality of your work now? Now, you're a mom. You lived through that which you have to help other moms with or potential moms with all day long. Tell us about that personal experience.

Dr. Nikki Liburd: Well, you know, after having a baby, I feel like I'm actually more in tune with my patients, especially the pregnant patients, to some of their insecurities and fears. I kind of been through that. So I feel empathetic. Not that I wasn't necessarily before, but you really don't know until you go through something yourself that's similar to the population that you're actually trying to help. So, it made me more attune in that area, which is great.

Dr. Pam Peeke: I'd love to be your OB-GYN. That'd be a nightmare going, "Oh my God, I'm delivering an OB-GYN and she'd probably going to micromanage," like, "Wait a minute. Didn't you want to use this over here instead of that?" Come on, did you give into it a little bit? Come on.

Dr. Nikki Liburd: Just a little, but overall I just told myself, "Nikki, you're in good hands. You know, you picked this person to be your OB-GYN." And a lot of times, I'd actually did just sit back and pretend I was just the patient. I think I probably would kick it in more as far as, "Hey, I have some expertise in this situation if I felt things were going down the wrong path," but that didn't happen.

Dr. Pam Peeke: That's excellent. Okay. Now, let's look at your life as a hospitalist. So take us through an average day as you fulfill your role as a hospitalist. I mean, what happens as you live through that day. And are there any eye-openers there for people who probably may not understand what a hospitalist does?

Dr. Nikki Liburd: Yes, definitely. An average day on the job for me prior to becoming a site director was pretty similar to what it is now, but it did include team huddles, team sign outs, working with different members of the labor and delivery unit, rounding, introducing myself to patients, deliveries, safety discussion drills. It was just a day that was packed full of different things that I could do that would impact patient care.

And also, you know, during that time, as a hospitalist, you provide call coverage for community physicians in clinics. Once I moved though into the leadership role as a site director, now my role as a hospitalist is including collaborating with hospital leaders and administration on a regular basis to maintain a good working relationship. So instead of just the technical skills, being in a leadership position has allowed me to improve my social skills with others to try to make things work.

Dr. Pam Peeke: So tell me about your leadership role. So you kind of evolved over time and you transitioned to leadership. So what do you do as site director and how did that evolve?

Dr. Nikki Liburd: So as site director, you have the opportunity to be in the air or have a better relationship with those C-suite members like your CEO, CMO. And in the past, early in my site director role, I was able to interact with people in the C-suite, but it wasn't on a regular basis as I would have liked. Now I'm at a new hospital and it seems that we are including those conversations and relationship with those people in the C-suite. For instance, I'm now going to have a regular meeting every month with a new CEO at our hospital who used to be the previous CMO. He now wears both hats. So in order to maintain the working relationship we have, because as you know, sometimes when a new CEO comes on board, things can change as far as whether your program will be valued as much. So that's something that I want to just continue to maintain that relationship. So that's where I'm at right now as a site director.

Dr. Pam Peeke: I love it. I love it. And so, you know, when you have OB-GYN residents out there in training and they're looking at this type of evolution in your career, do you have words of wisdom, some advice to them about the fact that there are a lot of interesting opportunities here as you become an OB-GYN?

Dr. Nikki Liburd: Yeah. Actually, my advice is to seek employment opportunities that allow you to attain the best opportunity to maintain a good work-life balance, whether it is through a traditional private practice path or the OB-GYN hospitalist track or even a hybrid model. Because before you know, it'll be time to retire. So it's imperative to have a good balance and minimal regrets when it comes to work-life balance.

Dr. Pam Peeke: I love it. That's fantastic. So let's take a step back for just a moment and think about what happened in medical school and also women's health. And now look forward and say to yourself, "Well now, has OB-GYN changed since you were in medical school?" Let's think about that kind of transformation. What do you think?

Dr. Nikki Liburd: I think that it is definitely has changed in regards to kind of my profession right now as an OB-GYN hospitalists. During my medical school training, as well as residency, I was not exposed to the role of an OB-GYN hospitalist. However, over the years, I've seen that hospitalist role that is now expanding and it's an important part of actually now that I've seen medical school and residency training to have the OB hospitalist there teaching and those medical school and residency folks.

Dr. Pam Peeke: So really at the end of the day, there has been changed, but it's been good change. I mean, there's been a evolution really in the profession as it has in other sectors of medical profession, including internal medicine with the hospitalist and all the rest of it. And you're working with a lot of those folk as part of your team.

And I think all of this has just been keeping pace with appropriate changes that have occurred over the course of the last probably 10, 15 years. So thinking about that then, what do you see on the horizon for women's health? How different do you think it will be potentially in the next, say, three to five years?

Dr. Nikki Liburd: That's a good question. One aspect that I think that will be actually improved and be different in five to ten years, is patients becoming advocates for themselves. The internet, social media has helped in that role. Dr. Google has helped in that role. So I do see more patients being advocates for their own care. And to me, I don't necessarily find it offensive when I encounter patients like that, that are real advocates. It actually makes my job a little easier. And so that's one aspect that I think will change.

Now, the other aspect, I think, that will change is the important role and benefit of an OB-GYN hospitalists will continue to grow in the area of hospital leadership, teaching roles and likely health policy.

Dr. Pam Peeke: Why do you say that?

Dr. Nikki Liburd: Well, I say that because as hospitalists, we are always there at the hospital, seeing how things go day in and day out versus a traditional model of a physician. You know, your time is split between different places, your office or clinic versus the hospital. And having a hospitalist there for you, it's been actually me working with a community of physicians it's been a plus. They love having us there, not only for safety, but also offering call coverages to make sure that they have a better work-life balance too.

In the area of hospital leadership, I have a couple of the site directors that I've worked for in the past became chairs of their department as well as serving as assistant professors, if residents or medical students come through. As far as health policy, ACOG, which is one of the professional organizations for OB-GYN, there seems to be some communications regarding the importance of our role in the hospital as hospitalists. So I think it's all going in the right direction.

Dr. Pam Peeke: I love it. Okay. Now, the acid question. Here you are, a busy leader, a hospitalist, site director. And at the end of the day, literally, how do you decompress? How do you take care of your own health and wellness? Because, you know, sometimes we as physicians are the worst, right? So how do you do that?

Dr. Nikki Liburd: So for me, it's evolved over the past few years. Even though I wanted to have a work-life balance, sometimes I still bring home a lot of my work as far as in my head and thinking about it obsessively. That has waned over the past couple of years. For instance in 2019, I was actually diagnosed with breast cancer and done with treatment, but that made that whole work-life balance system actually mean something way more important to me than it has even in the past.

So in addition to spending quality time with my family as I did before, I'm incorporating more exercise, audio books, even reading the Bible have been valuable to me in the area of physical and mental health and wellness. So that's how I decompress.

Dr. Pam Peeke: Wow. I mean, that's really rich. And now there's another nuance to your wonderful career and that is you were a patient.

Dr. Nikki Liburd: Yes. Yeah.

Dr. Pam Peeke: Tell me how that enriched your experience as a physician.

Dr. Nikki Liburd: So, you know, during that process, going through the treatment for breast cancer, I kind of allowed myself to be more of a patient during those endeavors and not try to micromanage my care or pretend like I was the physician. I just totally just let go and let others take care of me. And that was eye opening to me, just being in that role as just the patient. Like I said earlier, it makes me more attuned to my patients, who a lot of them are not necessarily trying to micromanage their care. They just want to be taken care of and they just want to be a patient. So I'm more cognizant of that.

Dr. Pam Peeke: Wow. Okay. So you were patient and that really put you in a very different perspective. I know as a physician, I would probably be a real superb pain if I were a patient. At the same time, I'm so humbled, just doing something simple like mammography. I wear the same little, silly-looking gown thing. I have to go into the same room everyone else does. And even though I'm a smarty pants doctor, at the end of the day, I'm very humbled by the fact that this is a shared experience. And I know that's got to be the way you feel too, right?

Dr. Nikki Liburd: Definitely. That's a good way to put it. It is a shared experience. Yes.

Dr. Pam Peeke: Absolutely. And meanwhile, the same time you became a mom and that puts you in a different place. So now, you really understand what it's like when you're dealing with women as a hospitalist. So you've got an extraordinary background and I have to say that you must have really robust feelings of compassion, self-compassion and empathy that help inform your decision-making. Would you agree?

Dr. Nikki Liburd: Definitely. I definitely agree with that. For instance, going through the process with cancer and cancer treatment, it was hard, but there also were a lot of blessings during that process, you know, and just overjoyed though, too, that, you know, I had a lot of support through OBHG with getting through this and supportive family. So definitely, I agree.

Dr. Pam Peeke: Awesome. Fantastic. Okay. How about a final word of wisdom to OB-GYN residents and maybe physicians out there who might be interested in becoming a hospitalist?

Dr. Nikki Liburd: Yeah. So words of wisdom is if you're thinking about it, just jump in and do it. You won't regret it. There's always an opportunity to go do something else after or go back to what you were doing before you became a hospitalist, but you'll never know until you try it. And there are wonderful rewards that can be gained doing inpatient medicine. So I would just do it if you're already thinking about it.

Dr. Pam Peeke: I love it and fantastic. And I know that if people are interested in learning more about the hospitalist's life and work, they can go to OBHG.com/clinicians to read more about the hospitalist's life and work and the variety of roles available to OB-GYN physicians. I want to thank you, Dr. Liburd, for being our guest on the Obstetrics Podcast today. And we really appreciate, again, your words of wisdom and sharing your professional and personal experience. Thank you very much.