20 Questions: Sara E. Gottfried, MD, OB-GYN
Created June 1, 2016 by Juliet Farmer
Sara E. Gottfried, MD, is a board certified obstetrician and gynecologist; founder and CEO of Gottfried Center for Integrative Medicine, Inc.; and volunteer clinical faculty at University of California at San Francisco Department of Obstetrics and Gynecology. Gottfried received a bachelor’s degree in engineering cum laude from the University of Washington (1988), followed by a Doctorate of Medicine with a focus on public health and integrative medicine from Harvard Medical School and Massachusetts Institute of Technology Physician Scientist Training Program (1994). Dr. Gottfried completed a residency in obstetrics and gynecology at UCSF (1994-98).
From 1998 to 2006, Dr. Gottfried was a staff physician in the Northern California region at The Permanente Medical Group, a Health Maintenance Organization (HMO). Prior to that, she was administrative chief resident at UCSF. She is the New York Times bestselling author of The Hormone Reset Diet (HarperOne, 2015) and The Hormone Cure (Scribner, 2014), and she has been published in numerous journals, including Yoga Journal, Marin Independent Journal, Journal for the Society of Gynecological Investigation, American Journal of Obstetrics & Gynecology, American Journal of Physiology, Journal of Applied Physiology, Biology of Reproduction and Anatomical Record.
When did you first decide to become a physician? Why?
I decided to become a physician later than most people. It was during a graduate program in bioengineering that I felt like I was heading in the wrong direction, toward someone else’s dream. I felt like I was signing up for a career of being alone with the truth, and that nearly every field in science and engineering would be similarly solitary, except medicine. At around the same time, a boyfriend’s father–a physician–took me to task: Why aren’t you going into medicine? I hadn’t considered it mostly because I come from a family of engineers and administrators. I dismissed medicine in high school because I thought I was afraid of blood. In retrospect, it’s amazing to me how decisions about one’s life can often be based on such tenuous, superficial perceptions. A few months after that conversation, I took the MCAT and applied to medical school.
Despite my late arrival in medical school, the calling to help other women has been cultivated in me since childhood. When I was a little girl, my great-grandmother Mud (a family nickname—the abbreviated version of the German word for mother—that stuck) often traveled to visit us. She was a radical whole foodist and yogini, decades before there was a yoga studio on every street corner. She would show up at our home in Annapolis, MD, not with gum or Barbies like my friend’s grandmothers, but with kale and carob/wheatberry cookies. She drank hot water with lemon and extolled the virtues of fish oil to me at the breakfast table when I was five. Needless to say, I thought she was weird. But my embarrassment soon turned to curiosity. Mud looked 25 years younger than her peers, and she moved with a vitality and grace unusual for her years. Her skin glowed. My eccentric great-grandmother captivated me. Through her actions and words, I grew to understand that an entire world of prevention, healing and repair exists. It was she who inspired me to become a physician, and her ideas permeated the way I wanted to practice medicine.
How/why did you choose the medical school you attended?
I was honored to be accepted at Harvard Medical School. I thought about attending other schools that accepted me, such as Columbia, Stanford, and the University of Washington, but Harvard felt like the right first step. I love a rigorous academic challenge, and I felt it was the best medical education one could possibly receive.
What surprised you the most about your medical studies?
While going through my 12 years of medical training, it occurred to me that something was terribly wrong. On one hand, our health care offers unparalleled innovation and scientific advances. On the other, the US has the highest rates of preventable disease in the world. I was most surprised by the way that I was taught to take a person, diagnose a disease, and offer a pill. It’s reductionistic and it’s not working as a model of healthcare. Take obesity. Thirty-six percent of the population is considered obese (and another 34 percent are overweight), which leads to serious, costly and largely preventable diseases such as diabetes, high blood pressure, gallstones, stroke, sleep apnea, heart disease and cancer. Clearly, mainstream choices are not improving our overall health. One of the most surprising things I can remember is that in all my years of medical training, only 30 minutes were devoted to the topic of nutrition. That got me to seek alternatives that address the body in a more systematic, personalized, predictive and preventive manner, and I believe functional medicine delivers on that promise.
Why did you decide to specialize in gynecology?
I decided to specialize in gynecology for many reasons. I loved every field of medicine and appreciated how OB/GYN allows one to practice the full gamut: primary care, surgery, psychiatry, radiology (ultrasound), genetics and hormone balancing. Women’s bodies are still a battleground, and it is meaningful to me to do what I can to shift the old school ideas about women’s bodies and right to choose what to do with them.
If you had to do it all over again, would you still specialize in gynecology? Why or why not?
I’m grateful that I have been able to work with so many women and help them transform and reclaim their lives. I’m not sure that there’s any other way to get the type of rigorous education that I received. I considered internal medicine, and then a focus on women’s health, but if I chose that path, I wouldn’t be as confident about the inner workings of the female body and how to activate innate healing.
Has being a gynecologist met your expectations? Please explain.
In my 30s, after finishing my training, my day job was as a doctor at an HMO, which I regard as my years in “McMedicine.” It meant seeing dozens of patients every day, never stopping for a lunch break and squeezing extra hours of paperwork into the week whenever possible. I felt like I worked on an assembly line, and rarely had the luxury of connecting with my patients the way I most wanted. I was often stressed out, angry and resentful. It was only once I opened my boutique integrative practice of natural hormone balancing that I felt I was able to spend quality time with my patients and treat them with integrity and become the doctor I wanted to be. So yes, being a gynecologist has met my expectations, but not in the factory model. It was only when I created a practice that reflected me as a person—my values and commitment to healing—that I fell in love with my work. And my work as an author and speaker has been at the center of my career.
What do you like most about being a gynecologist?
I love helping women feel sexy, vital and balanced from their cells to their souls. Rather than treating problems or symptoms, I treat people. I treat women. And it’s so rewarding to go on a journey with each and every one of my patients as they transform their health. With every patient I see, I consider her unique context, physiology and preferences…and then invent a treatment plan to promote maximum health and happiness. It’s not one method fits all. It’s not fix-’em-up-and-send-’em-home. It’s a mission.
What do you like least about being a gynecologist?
When I was in the HMO, I hated the time constraints and the expectation that I should do less for my patients—order fewer lab tests, perform fewer ultrasounds and delay surgeries. It’s heartbreaking to see the corporatization of American medicine. I tried to change the system from within, but I gave up after a few years and created my own practice outside of the mainstream system.
Describe a typical day at work—walk me through a day in your shoes.
I’ve just completed my third book about the proven ways to turn on good genes and turn off bad genes, i.e., ways to leverage epigenetics. These days, I’m on sabbatical from my clinical practice but I work with women in my online courses—I have a detox; a hormone balancing beginner course; a natural hormone balancing training for practitioners; a course on how to improve skin, sleep and digestion; and we’re just launching a test of the new epigenetic protocol. A typical day is as follows (when I’m not writing): 8 a.m. take kids to school; 8:30 to 9 a.m. work/answer emails (usually on my treadmill desk); 9 to 11 a.m. yoga; 11 a.m. to 12 p.m. work; 12 to 1 p.m. lunch; 1 to 6 p.m. work—this is when I record interviews, podcasts, videos and radio shows. When I’m writing, I don’t go to yoga because the morning is my most creative time and I need my full capacity for synthesis and creating protocols.
On average, how many hours a week do you work? How many hours of sleep do you get per night? How many weeks of vacation do you take annually?
I work about 30 to 40 hours per week, more when I have to record a TV show or I’ve got a writing deadline. After a few decades of working 50 to 100 hours per week, I now know it’s not a good idea to push so hard. My health suffers, my adrenal function burns out and my body breaks down. I sleep seven to eight hours a night. I vacation about eight to 12 weeks per year. I’m the boss, and it means a lot to me to enjoy my family and friends while I’m young, and not work like a dog until I’m 65 or 70 and then [be] too old to enjoy more free time.
If you have family, do you feel you have enough time to spend with them? Why or why not?
I’ve been guilty of neglecting my family and the parts of myself and my life that are most important to me for my work. It got to a point where I felt like I was starting to betray myself, to live in a way that wasn’t in integrity. It’s taken a long time to learn how to keep boundaries on the time my work requires, and to scale back on travel and to say “no” to more opportunities. It was tough work to craft the lifestyle I have now, and I went through my fair share of research and self-discovery before I found it. Now I get up about an hour before my kids, make tea and meditate, and then spend time with them over breakfast and again at dinner. Our meal times and vacations together are sacred. I remember in residency when I was trying to decide between academic medicine and working at an HMO, one of my professors told me that she had a day nanny and a night nanny. It felt like she consigned parenting to someone else. I knew I couldn’t do that, so it helped me decide not to go into academic medicine, to choose lifestyle over academic achievement.
How do you balance work and your life outside of work?
Mostly through the targeted lifestyle choices and self care that we all know is a good idea. I create a spiritual practice throughout my day of green tea, meditation, nutrient-dense food (including the preparation and eating it slowly with family), exercise, yoga, walks in nature, walks on my treadmill desk and time for connection with family and friends. When I worked 120 hours a week in residency, I didn’t have any of this. I barely felt like I had time to go to the bathroom. That level of self-denial isn’t good for anyone, and even though it has a whiff of being noble, it is a recipe for burn out.
Do you feel you are adequately compensated in your field? Please explain.
Yes. Publishing two New York Times bestselling books has been very rewarding. I’m grateful that people want to hear the message and want to help me spread it. But I also live beneath my means.
If you took out educational loans, is/was paying them back a strain? Please explain.
Ha! Yes, I put myself through school with very little help from my parents, so it’s only been in the past year, at age 48, that I paid them all off. It’s a big burden and sometimes pushes career choices you wouldn’t otherwise make. I urge you to stay true to your dream, and the loans will take care of themselves, even if it feels like it will take forever.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
Make sure you’re living your dream. Don’t make choices about your career to satisfy anyone but yourself. It may sound like a cliche, but I see a lot of people in medicine trying to live a life that doesn’t belong to them, with their head and heart misaligned. Get aligned. Learn to know your truth, which will help you be in love with the life you create. Now my life is defined by loving what I have, and I really feel the difference. I have so much more energy and sense of service.
What information/advice do you wish you had known prior to beginning medical school?
I wish I would have known that true healing doesn’t come from treating or masking symptoms. The greatest health transformations are triggered when you address the root cause, not the signs. And it’s an inside job, not something that can be accessed in the average appointment of seven minutes with a physician. I wish I would have been aware that prevention, healing and repair exists through nutrition and lifestyle, and that the answers to health challenges cannot be found solely in a bottle of prescription pills. Eating whole foods is the foundation of robust health and regular exercise and contemplative practice can keep your body humming.
From your perspective, what is the biggest problem in health care today? Please explain.
As medical practices have become increasingly technical and specialized, the time available to devote to more complex issues including women’s health, lifestyle choices and root cause analysis has become increasingly scarce. In fact, the average appointment with a doctor in this country lasts seven minutes! I strongly believe that longer appointments can allow for a dialogue between practitioner and patient and create a collaborative partnership, with the patient playing an active role in their own health.
Additionally, conventional medical practices focus heavily on identifying and treating symptoms – doctors have been trained to fix what is broken in the body. Practitioners should be encouraged and trained to offer a lifestyle-based approach to their patients. Better lifestyle choices can prevent many diagnostic procedures and treatments and save an enormous amount of money, which can be invested in other areas, such as personalized lifestyle medicine. A more integrative and functional approach has been shown to be extremely effective when applied to hormones, mood, longevity, stress related problems and disease prevention.
Where do you see gynecological medicine in five years?
I believe that the modern health care environment in general is heading towards more personalized lifestyle medicine and DNA-based functional medicine protocols that address genetic variations and the exposome, or the aggregate non-genetic exposures from conception onward. The cost of genetic testing has rapidly decreased and testing has become more mainstream and available. There are a wide array of personalized medicine tools and DNA-based protocols that healthy practitioners should start using in their practice to ensure that they thrive in this environment. If you want to learn more about mine, click here: SaraGottfriedMD.com/DNA.
What types of outreach/volunteer work do you do, if any?
I’m involved in outreach work focused on the abolition of sex trafficking. I live on the Berkeley/Oakland border here in Northern California, and Oakland is a major hub for trafficking girls. We donate a portion of our net profit to support several nonprofits that fight sex trafficking of girls.
What’s your final piece of advice for students interested in pursuing a career in gynecology?
First, take care of yourself and heal your wounds – most practitioners have some degree of adrenal dysregulation, hormone imbalance and gut problems. Deal with those first so that you come from a place of fullness and experience when helping patients.
Second, create your vision of what sort of doctor you want to be and what sort of practice you’d like to have. For me, it took 18 months to build a bridge from my “McMedicine” job at the local HMO to my boutique practice of natural hormone balancing. Keep iterating until you have the right fit between your nature, your vulnerabilities and your practice.
Stay open and curious. When things become rote or you feel burned out, that’s a sure sign that some part of you is not integrated into your experience. It’s your sacred duty to integrate.