BackTable Women's Health

What does it take to design a career in medicine that truly fits your values, your life, and your goals? On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Chitra Akileswaran, board-certified OBGYN and founder of Avaiyar Private Care, for a candid discussion on building a career that breaks the mold. Dr. Akileswaran traces her path from global public health and a joint MD-MBA to leadership in county health systems, digital health startups, and now direct pay practice, sharing how each chapter reflected her changing priorities. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction06:19 - Public Health and Global Work10:33 - Residency and Early Career Choices15:04 - Founding a Digital Health Company19:48 - Ambulatory Operations Leadership24:36 - Leading a County Medical Group29:32 - Physician Needs and Retention34:25 - Physician Compensation Overhaul41:47 - Physician Unionization and Employment46:25 - Pregnancy Loss and Perspective49:09 - Launching a Direct Pay Practice57:10 - Mentorship in Private Practice01:03:28 - Closing Remarks --- More about this episode The conversation explores lessons learned leading hundreds of physicians, overhauling compensation and benefits, and navigating unionization and administrative change. Dr. Akileswaran speaks openly about personal milestones, including pregnancy loss, and how it drove her to redesign her life and practice. Topics include mentorship, apprenticeship, work-life integration, and the practical steps and mindset shifts needed to carve out a fulfilling, sustainable career in medicine. --- Resources Avaiyar Private Care, Dr. Akileswaran's direct pay OBGYN practicehttps://avaiyarprivatecare.com/Cleo, the digital health company she co-foundedhttps://hicleo.com/ ACOG Well-Being and Physician Support Resourceshttps://www.acog.org/career-support/well-being AMA Physician Practice Benchmark Survey: Smaller Share of Doctors in Private Practice Than Ever Beforehttps://www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever MGMA Provider Compensation Data Reports, the benchmarking source referenced on airhttps://www.mgma.com/mgma-data-reports Dr. Chitra Akileswaran, UCSF OBGYN Residency Alumni Profilehttps://obgyn.ucsf.edu/residency-program/chitra-akileswaran-md-mba --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Medtronic Pelvic Healthhttps://urgencyisreal.com/ --- Timestamps 00:00 - Introduction04:00 - Shared Decision-Making06:51 - Clinic Efficiency10:38 - Expanding OAB Therapy Options12:27 - Long-Term OAB Care17:41 - Building an OAB Program18:18 - Staff Training and Follow-Up25:32 - OAB Navigator Implementation27:14 - Navigation Outcomes28:39 - Scaling with Staff and Epic30:35 - Algorithm Resources34:08 - Neuromodulation Advances38:37 - New Tibial and Battery-Free Devices40:56 - Quality of Life in OAB Care46:11 - Access and Adoption51:22 - Streamlining Therapy Discussions52:47 - Closing Remarks --- More about this episode The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey. --- Resources Patient navigation for overactive bladder improves access to carehttps://link.springer.com/article/10.1007/s00192-019-04085-7 --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Advances in endometriosis research are reshaping how clinicians diagnose, understand, and treat this complex multisystem condition. On this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Hugh Taylor for an in-depth discussion of the systemic nature of endometriosis, including its metabolic, psychological, and cardiovascular effects, as well as central pain sensitization and bowel and bladder symptoms. They also explore how animal models and biomarkers like microRNAs are deepening our understanding of these connections. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:26 - Endometriosis Beyond the Pelvis05:17 - Understanding Systemic Symptoms10:35 - Why Diagnosis Takes Years12:54 - Key Clues to Endometriosis14:35 - Emerging Noninvasive Diagnostics18:13 - Pain Versus Disease Stage19:33 - Precision Medicine Approaches24:04 - Treatment Strategies and Follow-Up27:17 - GnRH Antagonists and Add-Back Therapy29:45 - Danazol and Surgical Options34:26 - Future of Immune-Based Therapies37:49 - Fertility Counseling and Egg Freezing40:17 - Wrap-Up and Key Takeaways --- More about this episode Given that many patients wait years for a diagnosis, Dr. Taylor emphasizes the importance of presumptive clinical diagnosis and selective imaging to expedite treatment. He highlights emerging biomarkers that may offer more noninvasive diagnostic options and help clarify pain mechanisms. The conversation reviews current management strategies, including continuous oral contraceptives, the challenge of progestin resistance, and the promise of blood-based tests to predict treatment response. They also discuss GnRH antagonists, Danazol, surgery for refractory cases, and future directions such as immune-based therapies targeting the inflammation and immune dysfunction at the root of endometriosis. --- ResourcesClinical evaluation of the oral gonadotropin-releasing hormone-antagonist elagolix for the management of endometriosis-associated pain: https://pubmed.ncbi.nlm.nih.gov/31434540/ Circulating microRNAs as potential biomarkers for endometriosis: https://pubmed.ncbi.nlm.nih.gov/25772772/ ---BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Does catching cancer earlier with surveillance always translate to better outcomes for gynecologic cancer patients? On this episode of BackTable Women’s Health, hosts Dr. Mona Guo and Dr. Marcia Ciccone interview Dr. Ritu Salani, Professor of OBGYN at UCLA and lead author of the updated SGO surveillance clinical practice statements. They discuss how post–curative-intent surveillance has evolved amid limited prospective evidence, review the latest guidelines, and highlight the real-world challenges of balancing early detection, patient safety, and cost. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:05 - Evolving Guidelines and Consensus10:02 - Lead-Time Bias and Cost Considerations12:05 - Maintenance Therapy and Surveillance Nuances14:44 - Ovarian and Endometrial Cancer: Imaging vs Exam20:24 - Key Takeaways from the TOTEM Trial24:04 - Future Tools, Lifestyle Counseling, and Shared Care27:21 - Cytology, HPV Testing, and Post-Radiation Surveillance31:13 - Hormone Therapy Considerations34:37 - ctDNA and MRD Testing37:39 - Emerging Technologies and Limitations43:22 - Rapid Fire Takeaways45:33 - Closing Thoughts --- More about this episode The conversation explores practice variability, the lack of clear survival benefits from routine imaging and tumor markers, and the risks of cascade testing and lead-time bias. Dr. Salani reviews the TOTEM trial data for endometrial cancer, the importance of symptom review and pelvic exams (especially for lower genital tract cancers), and the reduced role of cytology, even in cervical cancer after radiation. They also discuss shared-care models, lifestyle counseling, hormone therapy considerations, and the promise and limitations of emerging technologies like ctDNA and MRD testing during maintenance therapy. --- Resources TOTEM Trialhttps://ascopubs.org/doi/abs/10.1200/jco.22.00471 2010 Ovarian Cancer CA-125 Trialhttps://pubmed.ncbi.nlm.nih.gov/20888993/ Society of Gynecologic Oncology Clinical Practice Statement on Surveillancehttps://pubmed.ncbi.nlm.nih.gov/41308226/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Are we addressing sexual health in clinical practice? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner is joined by Dr. Christine Vaccaro, a double board-certified urogynecologist and sexual medicine specialist, to discuss the evaluation and care of women’s sexual health concerns. They highlight the importance of open conversations, patient empowerment, and a multidisciplinary approach to support well-being and improve quality of life. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:01 - What Is Sexual Medicine07:58 - Understanding Libido, Arousal, and GSM15:54 - Clinic Visit Structure and Patient Counseling19:17 - Clitoral Exam, Adhesions, and Anatomy Education28:17 - Addressing Stigma, Patient Education, and Myths32:03 - Tools for Patient Empowerment: Apps and Self-Examination39:55 - In-Office Procedures, Pain Mapping, and Hormonal Considerations46:37 - Managing Complex Cases and Multidisciplinary Collaboration53:47 - Closing Remarks --- More about this episode The conversation explores practical strategies for evaluating and managing issues such as libido, arousal, orgasm, and sexual pain, with a focus on genitourinary syndrome of menopause (GSM) and clitoral anatomy. Dr. Vaccaro shares her approach to assessing clitoral adhesions, pelvic pain, and hormonal changes, as well as effective ways to educate patients about anatomy and self-examination. They discuss the importance of reducing stigma, addressing misconceptions, and using a multidisciplinary approach to improve patient outcomes. The episode also highlights the role of clinician training, patient-centered counseling, and collaborative care in supporting women’s sexual health across the lifespan. --- Resources International Society for the Study of Women’s Sexual Health: https://www.isswsh.org/ Female Orgasmic Disorder: Current Understanding and Clinical Management: https://pubmed.ncbi.nlm.nih.gov/42314165/ OMGyes: https://www.omgyes.com/join You Are Not Broken by Dr. Kelly Casperson: https://kellycaspersonmd.com/you-are-not-broken-book/ Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris - https://academic.oup.com/smoa/article/6/2/115/6956478?login=false Clitoral Adhesiolysis: Technique and Patient Selection - https://www.vjsm.info/videos/all/clitoral-adhesiolysis-technique-and-patient-selection Female Orgasmic Disorder: Current Understanding and Clinical Management - https://pubmed.ncbi.nlm.nih.gov/42314165/ --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app