20 Questions: Lawrence Terra, MD [Reproductive Endocrinology]
Created May 24, 2008 by Michael O'Brien
After starting out as a failed journalism major, Dr. Lawrence Terra wound up graduating Phi Beta Kappa from a prestigious midwestern university with a B.A. in Psychology. He graduated with High Honors from an University of California medical school and now pursues his original dream of journalism through a popular blog.
He completed a four-year OB/GYN Residency and then went on to a Fellowship in Reproductive Endocrinology and Infertility (REI). He has worked with many of the pioneers in the field of In-Vitro Fertilization (IVF). Dr. Terra is currently in full-time private practice as the Medical Director of an IVF program in Southern California. He is a sought-after lecturer, giving educational talks to hundreds of physicians and medical students annually. Dr. Terra is a Board-Certified Fellow of the American College of Obstetrics and Gynecology and an active faculty member at two medical schools.
He recently sat down with SDN to give us a glimpse of life as a Reproductive Endocrinologist.
What mix of clinical/research/teaching work do your position include? How much power do you have to change that mix?
90% clinical / 10% teaching It’s current at the balance I want. I believe it’s easily changeable if I should so choose.
If you had it to do all over again, would you still become a doctor? (Why or why not? What would you have done instead?)
Absolutely. I don’t think I arrived where I am currently by my carefully crafted plan. I am grateful that things fell into place. I attribute a lot of it to befriending the right mentors, being a nice person and having a lot of luck.
Why did you choose your specialty?
I originally wanted to be the greatest Gyn-Onc surgeon in the world, but when I discovered REI, I was excited to discover that it is the field whose features uniquely suit the majority of my goals in life.
Did you plan to enter your current specialty prior to med school?
I went into med school with no clue and no biases on what field to pursue.
Now that you’re in your specialty, do you find that it met your expectations?
Are you satisfied with your income?
I have other business ventures that supplement my income, but even without them, I would be fairly satisfied with my medical income. Bear in mind, I personally don’t require a high-consumption lifestyle to be very fulfilled.
What do you like most and least about your specialty?
What I like least: I am so specialized as to not be a “general doctor” any more. Hypertension? Arthritis? What’s that?
What I like best:
- FAIRNESS. The harder I work, the better job I do for my patients, the more I reap rewards. The more I slack off, the more I am punished financially (therefore I don’t). It is a fair system (something not necessarily true of other areas of medicine)
- GREAT EMOTIONAL REWARD. Everyone loves the ideas of bringing babies into the world (except the global warming fanatics)
- VARIETY and SUSPENSE: An IVF cycle will be successful 30-60%. But there is no way to know for sure which ones will succeed and which won’t. When those pregnancy tests roll off the analyzer, we rush to see the results and either cheer or grieve.
- Relative AUTONOMY and INSULATION from a broken medical system.
If you took out educational loans, is/was paying them back a financial strain?
I went to a California state school with a reasonable tuition. I worked various jobs during medical school.
On average: How many hours a week do you work? How many hours do you sleep each night? How many weeks of vacation do you take?
I work 7 days/week. But Saturday and Sunday consist of 1-2 hours without a lot of stress. I take off all of December each year. If I can find some good help, I might take off June each year as well. I sleep comfortably at home every night, maybe getting a call once or twice a year.
Do you have a family and do you have enough time to spend with them?
I’m pretty happy with my social life and I enjoy many non-medical activities. I am single and live with my two dogs. If I’m not married in the next five years or so, I can always get an egg donor and a surrogate and have a child. (Not entirely kidding!)
In your position now, knowing what you do – what would you say to yourself 10 years ago?
Read a wide variety of non-medical books. Make quality friendships. Actively learn about yourself. Actively learn “life-hacks” to better use your time, hone your body, manage your energy, efficiently use your mental capacity. Explore a variety of non-medical activities. Make every week of your life at least a little different from the previous one.
What information/advice do you wish you had known when you were an undergraduate? (What mistakes or experiences have you encountered that you wished you had known about ahead of time so you could have avoided them?)
Be open-minded and gather your information from a variety of sources. Don’t believe everything that one person says. Don’t believe most of what the mainstream media says. Don’t believe everything that every professor says. On the other hand, don’t reflexively discount everything either. Bottom line: think critically, try and gather information from both sides of an argument and make up your own mind.
From your perspective, what is the biggest problem in health care today?
This would take me two hours to just scratch the surface even with all my Power Point slides. Since you are asking, I can’t really answer without injecting my political viewpoints. We need more freedom to unleash human work ethic, ingenuity and fair competition (just as our country’s forefathers wanted it) and less bulky bloated restrictive inefficient government. In other words, we need the proper rules in place so doctors can do their best without doing inefficient things (spend hours filling out insurance paperwork) ordering unnecessary tests to defend against frivolous lawsuits, the freedom to put out a better level of medical care and be recognized accordingly. In our present system, a doctor who spends more time talking to his patients is punished indirectly through effectively getting intolerably low per-hour compensation, therefore giving incentive to go the high-volume route and rush through more patients in less time.
From your perspective, what is the biggest problem within your own specialty?
While we don’t have to deal with the insurance bureaucracy and medical-legal nonsense as much as other specialties, we still have SOME.
What is the best way to prepare for this specialty?
I don’t know. It depends on your situation.
Where do you see your specialty in 10 years?
Technologically, at the rate we’re advancing it’s hard to imagine the limits! Who would have thought 20 years ago, that 1 out of every 75 babies born in the US would be products of IVF? Success rates which originally were under 5% are now getting close to exceeding 60% in many patients.
What impact do mid-level providers have on your day-to-day practice?
I would love to have a good NP / PA to help me, but in three years, have yet to find one that would be good fit for my practice. I’m still looking.
What types of outreach/volunteer work do you do, if any? Any international work?
Currently, I do many philanthropic activities, made possible in part by the financial resources and social connections afforded by my job. But I participate in a non-medical capacity. Back in med school, I worked in clinics in Mexico; I’d be less useful today, because I know essentially zero primary care medicine.
What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
This question requires another two hour power point presentation. I do motivational speaking about life strategies. I guess if I could just give ONE universal piece of advice, it would be this. If your life is in any way not 100% exactly the way you want it, then EXPERIMENT. Learn a new language. Wake up one hour earlier. Drive a different route to school. Strike up a friendly conversation with someone you would unlikely talk to. Go to the book store and explore something totally new to you. 90% of the time, you’ll find that you don’t like the new thing and you’ll abandon it. However, that 10% now adds to your repertoire of fun new things in life.
Is there anything else you’d like to share that we haven’t covered? Any other advice for student interested in pursuing a career in medicine?
Think of this not as a blatant plug, but as a polite invitation: If you want to know more about what I think, read my blog at http://fertilityfile.com You can also contact me with questions through the site.