Every time I read this interview, I question my decision not to go into ob/gyn residency. Natalie is wonderful and definitely a light in the world (despite her auburn background - I can not believe I let her saw we on my site!!). She is a real Southern Belle. Below she discuss her premedical/medical/fellowship journey including changing specialties after intern year, how she chose to do a reproductive fellowship, what her day and work look like now, and how she and her husband have balanced it all while growing their family - and or course, the sacrifices this all required.
Leave questions and comments for her below.
Name: Natalie Crawford, MD
Hometown: born in Dallas, Texas. Raised in Peachtree City, GA
Current city: Austin, Tx
Undergraduate with major: Auburn (WDE) – Nutrition Science (magna cum laude)
Medical School: University of Texas Medical Branch (Galveston, TX).
Residency program: ob/gyn, University of Texas Southwestern (Parkland Hospital, Dallas)
Fellowship: Reproductive Endocrinology and Infertility, University of North Carolina
Other training: I matched into Emergency medicine and did my intern year in EM at UT Southwestern. Then I switched to ob/gyn
Take me back a decade, what did you want to be when you grew up? A physician. Always. I am one of those people who just knew. My grandfather was a physician (psychiatrist) and he loved his job. I always admired him and loved the perspective he had. Medicine is the combination of understanding the science behind the body (incredibly complex) and the gift of being able to help others. It was always the right fit for me.
What do you do now? I am finishing up my last month of my fellowship in Reproductive Endocrinology and Infertility! When I knew I wanted to be a doctor, and was premed and in med school, I honestly had no idea this is where I would end up. I LOVE my job and feel so fortunate to be able to do what I do. I love it every day, seriously. For me, this is where I ended up when I was able to keep my mind open, put fear aside, and listen to my heart.
Tell me about your college application process? How did you decide on a school and major? To be honest, I applied to Auburn because my best friend in the whole world (and her entire family) loved Auburn. I didn’t really plan to go there, but when I went to go visit after getting a scholarship, I fell in love with the school. The campus was beautiful, the students were friendly, and the teachers were committed to students succeeding. I just loved it.
As for my major, I was always premed. I started out in biomedical sciences – which was a fine major. But I was getting a little bored in all science all the time. I decided to switch majors to nutrition science – which was amazing! Smaller classes, a big focus on nutrients and how they fuel the body, including the science behind how what we eat impacts our health. It also included all my pre-med classes so it was a win. I loved it.
You were a nutrition major! I have to ask, is there a certain diet plan you recommend? Do you have never foods? I'm a big believer in eating "real" foods. Fruits and veggies top my diet (and that of my family). We eat almost a completely plant-based diet, with no meat and limited dairy. My hubby eats some meat when we go out - but we never cook with it or have it in the house, so that's our compromise. And no soda - ever.
What was the hardest part of your undergraduate studies? How did you get through it? Balance. The hardest part was balance. I think undergrad is where you really begin to learn how to manage your time and how you learn. It took me a while to realize that if I wanted to hang out with my friends at night, I needed to manage my time really well during the day. I also experimented with learning styles – notecards, typing notes, reading chapters, etc. Turns out I learn best from notes in my own handwriting. It takes forever but cements the knowledge in – I still abide my that today. And I hated organic chem (despised it), but didn’t everybody?
Did you take time off between undergrad and medical school? Why or why not? and if you did take time off, how did you spend it? I did not take off – I went right to med school…but this was a big debate for me. Auburn was expanding their international class opportunities and wanted to offer a nutrition class in the Italy program. They asked if I wanted to take a year off to help start this program. It was tempting!!! But my dream was always medicine, and I was in a long distance relationship with my boyfriend (now husband) in Texas. Honestly, I couldn’t imagine postponing something that I had worked so hard for and was so excited to start. So off to med school I went!
How and when did you decide on medical school? I entered college knowing I wanted to go to med school. It simply was what I always, always wanted to do with my life.
What did you do to be a good medical school applicant? I felt like I needed to have really good grades, but also something that set me apart. I really love volunteering and got involved early in undergrad. I was able to volunteer at the Mercy Medical Clinic in Auburn which is a free health clinic run in the evenings by volunteers. This really cultivated a strong belief that healthcare is a right and not a privilege. This by far was an extracurricular that I invested a lot of time in and got to know the physicians well. The lead physician wrote one of my letters for med school, and during interviews his letter was mentioned. I think this helped show my dedication and love for the field.
How did you choose a medical schoool? Texas has their own match system for medical school so you ranked programs. I matched to UTMB (in Galveston) and I liked that their curriculum was organ based blocks (for example, would study cardiac physiology, pathology, histology, pharmacology all at the same time). My parents had moved to Texas, and Jason was in Austin in pharmacy school. UTMB also let you complete your clinical years in Austin if you wanted, so….I was sold.
Why and when did you decide on ob/gyn ? What other specialties did you consider? I loved every rotation my 3rd year of medical school. Some were certainly easier than others, but I found things fascinating in each field. I really did not know which specialty to pick. A mentor suggested I consider emergency medicine because you do a little of everything, become a jack of all trades, and think quick on your feet. You also make good money and have time off - so I thought it was perfect. I did a rotation and I thought it was great. So then after interviewing across the country I matched into my #1 EM residency pick at UT Southwestern in Dallas! I was thrilled.
Well, it wasn’t right for me. I loved the people I worked with, and I found the day to day job interesting. But something was missing. The schedule was exhausting (days and nights) and I felt like I knew a little about everything (instead of a lot about one thing). I did a lot of soul searching and realized the main problem was I missed the patient connection. I missed the continuity, the patient experience. I constantly wondered what happened to my patients. Luckily at UTSW we did some ob/gyn rotations as EM interns, and I just loved it. I loved the patient relationships, the combination of medicine and surgery, it was right for me. Looking back, I think I was nervous about ob/gyn as a medical student because of the notorious “difficult” lifestyle. I always knew I wanted a family, and I field that was known as demanding made me really (really) nervous. However, after doing something that I could feel was not right, I felt more committed that I should be spending me time in a field that inspired me. It was an extremely hard decision, but 100% the right one for me.
How did you go about making your rank list for ob/gyn? I decided I would complete my EM intern year and applied into ob/gyn, always knowing I would stay at UTSW. I did interview at a few other programs, but Parkland is this amazing county hospital and it has the biggest ob/gyn residency in the country. It is one of those places where the residents have a lot of autonomy and certainly the focus is on patient care. It is a place where you have a lot of hands on learning and the “see one, do one, teach one” approach is for real. This type of program is not for everybody, I think it is fair to say that. But I loved the idea of training at a place where I could see (and do, and teach) it all. There were long hours. There were crazy days/nights. But it was excellent, excellent training.
Can you touch on the logistics of applying to a second program? When did you tell your program director? Who did you get letters from? How did you arrange time off to go to interviews? This was one of the hardest decisions I have ever made. It was very difficult separating the normal woes of intern year from actual unhappiness in the field I had chosen. After talking to friends and family and mentors about what was important to me - we realized that the lack of continuity in EM was something that I couldn't get over and I needed to switch to a new residency program.
I actually met with my EM PD and told him I was unhappy and thought EM was not right for me. He was really supportive and understanding. I told him I 100% wanted to complete my EM intern year because I committed to it and I felt like it was the right thing to do. In appreciation of this, he did give me any time off I needed for interviews and a research month to end the year on to ease in the transition (which was helpful!)
I also met with the ob/gyn PD at my institution to get advice. He suggested using a letter from my EM PD (to say I was in good standing), an ob who I worked with as an EM intern (we rotated in both the gynecology ER and on L&D as interns), ana tending from the EM program, and from someone from my obgyn rotation in med school. The process was actually much easier than it could have been.
I was really nervous about the whole process to be honest. But it worked out and I am so happy that I followed my gut. Many people questioned my decision - I was going from a "lifestyle" field with a 3 year residency to a "difficult" field with a longer residency (in addition to my one EM year). But it was 100% the right thing for me.
Why and when did you decide to specialize in reproductive endocrinology and infertility (REI)? Due to my EM experience, I knew that taking care of patients and having a bond with them was key to my happiness. I also was very interested in fellowship and being a true “expert” in a field. I decided in my 2nd year I wanted to do REI, for a few different reasons. I love the physiology behind the endocrine system – so complex but it feedbacks so perfectly! I love the procedures. I love the surgeries. I love that infertility treatment are always pushing boundaries and evolving. But really, I love the patients. I love that this field requires a lot of trust and it is a very personal field. Patients are struggling, they often feel isolated, and being able to be there to help them through this time and understand what they are going through – those bonds mean the most.
What are the other fellowship oppurtunites in ob/gyn? When do you apply for ob/gyn fellowship? Is it another match? If so, did your strategy for your fellowship rank list differ from your strategy for your residency rank list? Ob/gyn has a few different fellowship opportunities: REI, maternal fetal medicine (MFM), urogynecology, gyn oncology, family planning, global health, and minimally invasive surgery. Many different opportunities!
It is again, another match, you apply at the end of 3rd year, and interview over the summer before 4th year. Match day is in October. I knew I wanted to do REI and I felt like I had prepared myself to the best I could, I worked in a basic science lab and presented at national meetings. REI is competitive. There were about 40 spots the year I applied. My approach to interviews: go everywhere I could. Seriously, I went to so many places, but I met amazing, inspiring people in the field, and I truly got a sense of what the places had to offer.
Residency programs tend to be similar because there are so many requirements. Fellowship programs really differ. It was really tough making my match list. We knew we wanted to leave Dallas, and Jason could go anywhere, so we had a lot of freedom. Honestly, my top 5 programs I loved and I would have been happy at any of them. I was moving programs on my list on the day it was due (which is crazy!). In the end, UNC was the right fit for me – I love the location (the South…) and I really liked the patient care focus to the program. As compared to some programs that have a lot of shadowing, UNC gives their fellows independent clinics and we practice like any other physician in the practice. It is amazing. I can’t even being to express the learning that happens when you are given the respect and autonomy to function independently.
What does an infertility physician do? What's your "bread and butter?" So officially, the specialty is reproductive endocrinology and infertility. Which means I am trained to see everything from puberty abnormalities, menstrual dysfunction and amenorrhea, mullerian anomalies, menopause, and infertility. But 90% of what I see is infertility. I spend a lot of time talking, patient consults are 45 minutes each, a lot of which is educational -- explaining infertility, or treatment options, etc. It is fun to combine the doctoring with patient education.
Tell me about a case or two that made you think "that's why I do this!" Everyone is aware that as women age, it gets harder to have children. What is really difficult is when younger women have diminished ovarian reserve. Essentially, they are going to run out of eggs at a much, much, much younger age than they were expecting. There is no real warning sign except shortening of the menstrual cycles, which many women don’t notice. And, once this has occurred, overall egg number is low. These situations are uncovered unexpectedly on a new infertility evaluation. And the conversation is tough, really tough. And the success rates are low, really low. Patients are put in a hard position, and they have to be ready to pursue the most aggressive treatments if they want to have biological children.
Every REI has a few of these patients, and they stick with you, and not every outcome is good. But recently, one of my patients like this just got pregnant on her LAST attempt. They’ve had a hard time, and they are the sweetest couple, amazing parent potential. I’ve done surgery on her, we waited while she saved up the money, went through a first IVF cycle which had very few eggs made and only 1 embryo to transfer and not pregnant. And then went through one final IVF cycle, said it would be their last attempt, we had 2 embryos to put back, and they are pregnant. With one perfect, healthy little babe. And it is miraculous. After everything they have been through, and all the heartache, now they are going to be parents. It matters and it is meaningful. And it makes my day (week, month, year, fellowship…). This is what it is all about, growing families. Helping couples who were afraid they would never have that dream come true. It doesn’t always work, but when it does -- beautiful.
What is your typical schedule like? How many hours/day, days/week, clinic vs procedure? My schedule as a fellow really varies based on if I am clinical or research (we do 18 months clinical, 18 months research). In a clinical month, I have clinic 3 days a week (mornings are IVF procedures), 1 day for operating, and 1 day for education (lectures, meetings, and research). A research month is 1 clinic day (IVF procedure in the morning), 3 research days, and 1 education day.
Clinic is 730-430. OR starts at 730. Research starts whenever you want. M-F. Then we cover weekends, right now every 3rd weekend I work 8-12 covering clinic for IVF. A fellow’s schedule is amazing.
What's been the best part of your training so far? The worst? There is some point in medical training where you suddenly realize that you really know what you are doing. There is a point sometime in your final year of residency, where you realize you are a better surgeon than your attendings. Where you realize that you aren’t afraid for when everything goes wrong because you know what to do. Or at the end of fellowship when one of your patients who really means a lot to you gets pregnant and cries because you helped it happen – these are the best parts. Realizing that after all of this training, you can do it. And you can totally rock it.
For me, the worst parts have been the guilt when I couldn’t be there. I missed my best friend’s baby shower, a sorority sister’s wedding, etc.
What's the latest I should start trying to have a kid? I'm turning 27 now and we just aren't ready financially. I wish I knew the answer!
Do not have kids before you are ready. It is a life changing event and you need to be financially and personally prepared. However, remember that there is no perfect time to have a kid and it will always be difficult. In addition, you don't know if you will get pregnant ASAP or if it will take you a while after you start trying. This makes planning much more difficult. It took us a lot longer than expected. I say in medicine, once you are ready, if you think there is a good window in your training program - start trying as soon as you can to fit it in there. And then be flexible. research years are great options, or sometimes upper level years in residency programs are easier. But honestly, when you are ready - you will know it.
As far as fertility, at 27 you are still in peak fertility. Studies show fertility begins to decline a small amount after 32, and then more significantly after 37. If you have a history of women with early menopause (normal average is 51-52 years), or premature ovarian failure, then this may be different for you (and we should talk more about this).
OB/gyn residency is tough. What motivated you to keep going on the hard days? How did you stay empathetic? Ob/gyn residency is tough, but it is very humbling. When things are bad, they are bad. The 25 year old who dies from a cervical cancer only diagnosed because it grew as a mass out her Cesarian (c/s) scar, the baby that doesn’t make it after an emergency c/s because of a placental abruption, the mom who dies from an amniotic fluid embolus. Man, those moments really suck. This is what makes it real. Some patients have such bad scenarios. I always remember that as a patient, you can never prepare for your worst day, because in reality, the hardest or worst things in life are the things that you can never imagine happening to you. As a physician, my job is to try to be prepared for those moments. Things in the OR are systematic for a reason – there is a huge trust when a patient allows you to operate on them. It is my job to be prepared. And no patient ever imagines or wants to come see me. I am an infertility physician – nobody ever thinks/expects/wants that to happen. So every patient walks in a door that they never wanting to have set foot in. My job is to educate them, sympathize with them (because infertility sucks), and help them make the plan that is right for them. And hopefully the end result is a healthy baby.
What advice would you give to a freshman premedical student?
Learn how to balance your time. All your friends do not want to be doctors, so you probably have to work harder than they do.
Learn how you study. Figure out what works for you now. This will help you loads in med school.
Do something you love to prove you dedication to med school. This will largely help your applications – volunteer, go on a medical mission, do research, shadow physicians. Do something.
HAVE FUN!! Have a lot of fun. College is fun, it is supposed to be fun. Enjoy it. Things will not always be this fun.
What about a 1st year medical student?
Remember learning is fun, try to enjoy it and not be stressed about every test. Remember the goal is the knowledge and not the test score.
Keep your options open – even if you always thought you would go into one specialty, be open to each rotation when you do it. Take an honest assessment of what you like and what patient population and problems you want to be taking care of. It may be different than you originally thought. I never would have predicted I would be where I am…but it is perfect.
Don’t let fear make your decisions for you. Say you love neurosurgery but are afraid of the (hard) 7 year residency -- who cares. 7 years will pass. You could be an awesome brain surgeon. Go for it. Don’t be afraid of what might be hard, it will all be hard. Might as well work for it and love it in the end. Otherwise, you will not be happy.
life outside of medicine:
The truth is, regardless of how hard the training is – this is your life. In medicine, we too often delay gratification and are always planning/waiting for the next thing. I’ve had to learn to enjoy where I am in the moment.
To be a physician, it invades your soul. It will always be a part of you and it will impact everything you do. Because you know how bad it can be, you know what the worst case scenario could be. Being a physician gives you perspective and it makes you cherish all the moments of your life.
What does work-life balance look like to you and how did you maintain it now compared to residency? Balance. Balance is really hard. It is a constant goal and not always achieved. I think the key is to understand what is important to you and prioritize your life in this way to be present for those things which really matter. The truth is, regardless of how hard the training is – this is your life. In medicine, we too often delay gratification and are always planning/waiting for the next thing. I’ve had to learn to enjoy where I am in the moment.
In residency, it is hard. Your schedule varies rotation to rotation, which can be hard on loved ones to understand. This time was really hard for J and I because I would work long hours, be really tired, and neither of us made our relationship as big of a priority as it should have been. Balance took realizing that I needed to take care of myself and we needed to plan quality time alone into the schedule for when we could. I’m not going to lie, it was hard.
Balance is overall much easier as a fellow, but much harder as a mom. Generally, I try to give myself 100% to my patients when I’m at work, then I leave the first moment I can. I get the kids and we give 100% to the kids while they are home. We play until they go to bed. Then J and I do the dishes, clean, pack lunches, get ready for the next day. Then I’ll finish up any notes if I have to, study, whatever else needs to be done. I cuddle with my babes while they will still let me, and I just know they are growing so fast.
How does being a mother affect your role as a physician? How does being a physician impact your role of being a mother? Has being a mom changed me as a physician - YES. 100% YES. I know that my field is special and unique and I have always loved helping couples achieve their dreams of starting a family. But going through it all myself - the uncertainty and fear with infertility, the craziness of pregnancy, and the pure joy (and exhaustion) of being a mom, makes me view this process completely different. My littles have brought so much love and endless happiness to my life, more than I honestly knew possible. And I want this so much for each of my patients. I want each patient struggling with infertility to be able to see the lines on positive pregnancy test, tell their partner and jump up and down with excitement, experience the first kicks, see your little peanut waving on ultrasound, pick out the perfect baby name, experience the emotional roller coaster of birth, hold that sweet, sweet baby in your arms, and watch them turn into their own little person (which happens way too fast). I know how precious it all is. And it makes me want to work so hard, and do everything I can, to help every woman experience this. Being a mom has 100% changed me as a physician.
On the other hand, being a doctor mom is hard. When a patient of mine was trying to get pregnant at 40, who never thought she would want another child because she had 2 amazing kids. But her youngest died at 4 years old of cancer… man. hard. I certainly went home and held my kids really, really, really tight. And when my daughter had pneumonia, you can bet I sat by her bed and watched her sleep, listening to her lungs and counting her respiratory rate. The truth is, being a physician and a mom are not just titles. They become who you are. People who say you can separate the work and home are crazy in my opinion. To be a physician, it invades your soul. It will always be a part of you and it will impact everything you do. Because you know how bad it can be, you know what the worst case scenario could be. Being a physician gives you perspective and it makes you cherish all the moments of your life.
Is your husband in medicine? J is a pharmacist. Which is great, he is in the medical field and understands my crazy stories, my bad days. But he has a normal schedule. He works 8-5, no weekends. He really plays a huge role in our house and helping things run smoothly. I should say this 100 times. I could not do this without him. It hasn’t always been easy. He has been the primary breadwinner throughout my training, yet my job always takes priority…OR cases or clinic will run late, boards to study for, it can be tough. Communication is key.
Do you have any tips or rules to keep you healthy during residency?
Water. I had water with me all the time. A big water bottle, filled it up all the time.
Pack a lunch. Just do it. Otherwise you will get hungry, cranky, and buy crappy food. Do it the night before, pack your lunch.
J and I frequently say we’ve laughed more in the past 2 years than ever before. It is (crazy) busy – but man it is fun.
The long term plan would be to start a foundation to help aid these couples in achieving this dream.
What does your ideal career look like? Hopefully the job that I start in August! I’ll be working at a private practice in Austin. I always thought I wanted to go into academic medicine, but sometime in my fellowship I realized that what I love most is the patients. And I enjoy the education, the research – but an academic job would just pull me away from patients. I’m excited to be joining a successful practice where I can provide wonderful care to my patients. As the new medical school opens in Austin, I hope that in the future some educational opportunities can present themselves to have medical students or residents become more engaged in our practice.
What does you ideal life outside of medicine look like? Right now, everything is about the kids. Everything. But that is just how it is with kids. Our littles are young (2 years and 6 months) so we juggle fun outings with nap times. Kids at this age are fun and silly and make you smile constantly. J and I frequently say we’ve laughed more in the past 2 years than ever before. It is (crazy) busy – but man it is fun.
Where do you see yourself in five years? Hopefully I’m partner in my practice, my kids will be thriving in elementary school, and I’ll be working on starting a nonprofit. I really, really hate to see couples who desperately want to be parents, and who would make amazing parents, not be able to afford infertility treatments or adoption. So the long term plan would be to start a foundation to help aid these couples in achieving this dream. My husband thinks I’m slightly crazy with this plan, but he is 100% supportive.
What sacrifices have you made for your career? Time. Anyone in medicine will sacrifice time. Time away from your friends/family, weddings you miss, baby showers you can’t attend, holidays at work, quality time with your partner, and tucking the kids in bed at night. You will miss things, it is a sacrifice, and at times it will hurt. But to be able to care for patients is a huge honor. And with it comes tremendous responsibility. Patients trust you to help them. The training is hard and demanding because there is a lot to learn. If the training were easier, you wouldn’t end up as such a great physician. There are fewer compromises as your progress through the training and into your career, but the sacrifices are real. Surround yourself with supportive people who love you. Shower them with your love and lean heavy on them. You can 100% do it all, you just can’t do it alone. Find your tribe.
I know. I know. She's amazing.
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