Academic OB/GYN

A few months ago we hit the seven year anniversary of Academic OB/GYN.  And today, I found out that we have been nominated in the AAGL Oscars for “Most Innovated Social Media Platform”.  This nomination was a pleasant surprise – I completely agree that we should compete for that title, but in truth it always a bit of a shock to find out that people in my field actually have seen what I have been doing here and appreciate it.  Most people are afraid  of social media, and seven years ago when I started this most people in medicine thought far more of the risks than any kind of benefits.   Since that time, things have changed, and many doctors have created robust social media presence.  Since I started, the big players have come on the bandwagon.  Now we have podcasts from all the major journals, and several website podcasts as well such as medscape and so forth.  But I am proud to have been one of the first ,and almost certainly the first to have significant presence in the field of OB/GYN.   With that, I thought it would be fun to recall how it started, and how the journey has been for me, and for the brand of Academic OB/GYN.

I started Academic OB/GYN the summer of 2007 at the University of Hawai’i.  The impetus to do so actually came from my fandom of a podcast called Diggnation, hosted by Kevin Rose and Alex Albrecht.  This was a podcast done by two nerds talking about nerd topics for an hour or so, and also doing a fair bit of drinking.  It came to me – wouldn’t it be great to do Diggnation for OB/GYNs?   So the next week I lined up some guests, fired up Garage Band, and published the first episode of the podcast.  It absolutely took off, and in its heyday we were getting over 500 downloads in the first 48 hours of a new podcast being published, and in some cases topping 5,000 downloads in the first month.   In the early years the audio quality was atrocious.  Some of the episodes were almost not worth listening to it was so bad.  But people liked the content, and they seemed to listen anyway.  The audio got better, though never really to a professional level.  But the content kept coming, and listeners kept growing.  I got lots of mail of appreciation and comments. In 2010 at the University of South Carolina I added Dr Paul Browne as a co-host, and it made the podcast even better.   Listenership grew even further.  This year we total over 102,000 downloads, over 50% of which listened to the entire podcast.  Our most popular episode was an early one with Dr Roger Newman, with over 8,000 downloads, still rising today.   Amazingly, new fans still download our old content, and while we haven’t published an episode in three years we still get 20-30 new downloads a day.  While total numbers are very little compared to downloads of wider appeal products, for a product that really only appeals to a very narrow slice of the world, the popularity has been staggering.

Academic OB/GYN has also been a blog.  Sometimes a very active blog.  Sometimes active enough that I have had to shut down comment threads to stop the absolute wars that ensued there.  All through it I tried to be the professional physician blogger, responding to comments  both throughtful and not, and sometimes even trying to find the 5% reasonable idea within the 100% crazy, and responding to that.  That activity has been wonderful, even amongst the flames.

Academic OB/GYN persisted over the years through all the changes in social media.  First a blog and podcast, then twitter, then facebook, and in the future into whatever platforms arise.  The brand persists through all the platforms, as any social media brand should.  We have talked to major experts in our field about their research idea, what its like to be an academic physician, and how we best teach the next generation of physicians.   On the blog we have all had great discussions about what we love about being doctors, what we don’t like about being patients, what’s wrong with birth in America, what’s right about birth and America, and even what you should wear to a medical school school interview.  I always intended the blog and podcast to appeal to doctors, but over the years the audience has been far wider than that, including docs, residents, midwives, and other interested members of the world.  I’ve been honored to be able to provide virtual mentorship to many many medical students and residents who have contacted me along the way, in addition to help all the great residents and students I have had the honor to work with directly. My greatest honor was finding out that medical students sought to interview at programs I was teaching at because they knew me from the blog and podcast.   It was always a bit of a letdown for them when they found out in the highly anticipated interview that the pseudo-celebrity Nicholas “Academic OB/GYN” Fogelson was just a lowly assistant professor with a yen for social media.

We have published many surgical videos, some of which have gone on to be very popular.  As my professional career has drifted from general obstetrics into minimally invasive surgery and endometriosis, the content has shifted this way as well.  To the chagrin of some of my natural birthing followers, I stopped talking so much about that.  I still care about it, but its not what I am doing now, so I write less about it.  Just recently somebody commented “you used to write about things that were so interesting but not any more…”  Sorry.   But in reality, if a blog writes the same thing for 10 years, its is less interesting than something that evolves over time.

Perhaps the biggest change in Academic OB/GYN is that the man behind the machine is no longer an academic.  In the fall of 2015 I left my most recent post at Emory University to enter private practice in Portland, OR at Pearl Womens’ Center.  Its a great practice.  We have our own operating rooms and our own staff, and a financial mechanism to capitalize on the skills we have while also providing great subspecialty surgical care at a cost that can beat any hospital.   While I loved teaching, it seemed like my academic life had run its course.  I know I will never be a person that writes two hundred peer reviewed articles, yet that seemed to be what was required to ascend in academia.  At Emory, for the first time, I entered into the leadership of a great department.  It was a great honor and I got a lot done.  But I also found out that it took a lot of time and involved a lot of meetings with big groups of people, which in the end wasn’t for me.  It seemed like the larger the meetings were, the more time it took and the less was actually accomplished.  And those meetings were large.  I spent a lot of hours away from my wife and young child, and it didn’t look like that would ever change.  But that is what is required to be a successful academic.   Furthermore, the social media rules of my employer really prevented me from continuing my online presence in the way I had in the past.  It wasn’t entirely clear what I could or couldn’t do, but there seemed to be a lot of concern about people having brand outside of the mothership.  Everything I did was owned by Emory and had to be run through their people, and by and large their people were more worried about risk than they were about innovation. I had lot of ideas for social media for the department, but there never seemed to be much interest, and whatever interest there was was stymied by traditional media people who had no idea how to use social media effectively, or people that found small technical challenges to be unsurmountable obstacles.  This had never been the case at the smaller institutions I had been at, but in truth in the smaller institutions I never asked anyone’s permission to do anything.  I just did it, and people liked it.  The last straw at Emory was that I used my social media presence to raise money for a patient that really needed help.  She had a terrible surgical issue but wasn’t able to be out of work long enough to recover from the major surgery.  I knew we could help her, but her near-destitute social situation made it impossible.  So I harnessed my social media brand to raise a few thousand dollars for her.  It was quite easy, and in 24 hours I had the money we needed.  People were happy to give and were inspired by my effort as well.  It was probably the greatest thing I ever did as a physician.  But at a departmental level it was a big problem.  Instead of praise, I was almost fired for it.  So many questions were asked.  “if you do it for this patient what about other patients?” (since when did spontaneous charitable acts have to be equally distributed across the entire universe?) “you can’t use a patient’s story without her consent” (uh.. I had her consent, so much so she cried when I offered help her) “you are setting a bad example for the residents” (actually I am setting an awesome example for the residents).  For all these years of doing Academic OB/GYN I had gotten little back in return for all the effort.  But in that moment I realized I had developed a certain power from it, and I did not hesitate to use that power for the benefit of my patient.  I broke all kinds of institutional rules, but they were rules intended for entirely different purposes, completely out of context to the actual matter at hand.  And sometimes a person just has to break a rule to get something done.  So while an entire residency was inspired by a truly great act by one of their attendings, institutional leadership was concerned about a rebel attending that was willing to break rules to help a patient.  Perhaps worse, they had great concern that I was fanning the flames of a budding uprising among the residents, as they started to take my side over theirs.  In the end, they did what they had to do, but it left me feeling like maybe it wasn’t my place anymore.

The other problem was academic promotion.  In Academic OB/GYN I had created  tremendous body of work, with hundreds of published elements in text, audio, and video, some of which had thousands of viewers each.  I had readers and viewers in over 100 countries.  But in the traditional academic sense, I had only a handful of peer reviewed publications and articles.  After ten years in academia I had very little to show that would ever get me promoted, even though I feel that in many ways I had made more national and international impact than many of my colleagues.  In the end, I don’t think academia really knows how to value something like Academic OB/GYN.  It is unquestionably my greatest body of work, but in the world of academic resumes and CVs, its worth exactly nothing.  I was told that after ten years my academic career was still just getting started and there wasn’t enough to justify me being promoted.  And I looked at what I would have to do to get promoted, and realized that it just wasn’t something that interested me enough to pursue.  And so after thinking about this and a lot of other personal reasons, my wife and I decided we would leave and move to Portland, where I grew up and where my extended family resides.

The great thing about me leaving is that now I am again free to do whatever I like with Academic OB/GYN.  It was very dormant during my Emory years, but now it is free to grow again, and it will.  I have contacted Paul Browne and he is ready to fire up the podcast again, and we will be doing so.  At the same time, my new partner Rick Rosenfield and I have started Ask The Pearl, a video podcast about important topics for patients in OB/GYN.  Where Academic OB/GYN podcast was clearly directed at doctors and the highly educated public, Ask the Pearl is for all patients to get basic women’s health information in a fun and informative way.  We are only a few episodes in but it is growing already!

Thank you all for being fans, readers, and listeners of the blog and podcast.  It has been a great 7 years so far, and hopefully the future will be even better.

And if you are going to AAGL this year and have appreciated my work over the last eight years, please go to the Tuesday evening Hologic function and vote for Academic OB/GYN in the AAGL Oscars.   Its great to be nominated, but even better to win.