When it comes to women’s healthcare, despite significant advancements in fertility and cancer care, women remain woefully underserved, especially in midlife.
Dr. Alexa Fiffick wants to change this.
“Before I die, I want to make an impact,” she says, “and I want to see women get treated better—not only in healthcare but across every span.”
Fiffick’s new primary care practice, Concierge Medicine of Westlake, opened on September 5 and aims to provide a start to improved women’s healthcare, with individualized primary care and an emphasis on menopause.
Located across from University Hospitals St. John Medical Center at 28885 Center Ridge Road, Fiffick's practice is part of Ms. Medicine, a network of female-owned medical providers who aim to transform women's healthcare using the concierge model—a model in which patients pay their doctors a regular retainer fee for personalized, direct care.
Concierge Medicine of WestlakeNot just for the wealthy anymore
While some argue that concierge medicine is only for the wealthy, the yearly fees average out to $3 to $4 a day—affordable for many.
Fiffick expresses frustration with the current insurance healthcare model, which she says resembles an assembly line that is designed for doctors to see the most patients possible in the least amount of time.
“What ends up happening is the patient is distraught, not getting their needs met, not getting the care they need, frustrated,” Fiffick says. “And the doctors are cranky and burnt out because they can't even do what they're trying to do without getting punished for it.”
Fiffick says the United States’ current medical model creates gender bias, gaps in knowledge, and a lack of training in women’s health.
Female patients are less likely to be taken seriously in a medical setting. A 2007 study published in the Academic Emergency Medicine Journal found that women who went to the ER with severe stomach pain had to wait for almost 33% longer than men with the same symptoms.
Fiffick says she thinks the concierge model is a good alternative that will provide more individualized healthcare, “It allows you to actually act like a doctor and think through things and have a conversation,” she says.
More than an OB/GYN
Fiffick grew up in Hinkley, in a house that her parents built right before she was born and attended Case Western Reserve University for her undergraduate degree.
She says she has always been interested in the science of women’s health and became fascinated with how female hormones work on a molecular level while in medical school—first at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania for her master's degree and then Alabama College of Osteopathic Medicine for her doctorate
“Pregnancy is cool, the science is cool,” Fiffick says. “But ironically, my favorite section in the part of medical school where you're just learning the flow charts and the way that hormones and chemicals interact—my favorite thing was female hormones.”
As Fiffick leaned towards the gynecology specialty, she became frustrated that it wasn’t more inclusive.
“It turns out to be literally just catching babies and doing some surgeries and moving on—even going through medical school and residency,” she says. “Women are more than just their reproductive capacity, right? And our society does not agree to acknowledge that yet…. It really agitated me that all you were relegated to was your reproductive potential, and there was nothing else that you call women's health.”
Alexa Fiffick, DO of Concierge Medicine of WestlakeFrom family medicine to women’s health
Fiffick wanted to learn how to treat the whole person, so she switched her studies to family medicine during her residency at Ohio Health based out of Doctors Hospital in Columbus. Yet, she was frustrated to learn how little training there was in women’s health.
As she searched for a fellowship in women’s health, there were only a few institutions that didn’t require work on labor and delivery and Cesarian sections.
“Everyone's understanding of women's health is gynecology,” Fiffick complains. “Get your PAP, get your breast exam, get your mammogram if you're a breast cancer previvor or survivor. And that's like that's it.”
Fiffick’s fellowship in Specialized Women’s Health with Holly Thacker brought her back to Northeast Ohio at Cleveland Clinic, where she had always hoped to settle.
Most of all, the fellowship opened her eyes as she began to learn about the whole woman and how to treat her—the health risks of menopause, problems of sexual dysfunction, and hormone therapy as a preventative aid.
Fiffick says she was shocked by how much she hadn’t learned in medical school or during her residency.
For instance, estrogen in pill form is only active for 12 hours, yet very few doctors who prescribe the medication know this, or let their patients know that they should take the medication twice a day. “Literally, everything is shocking,” she recalls. “How am I a whole, fully board-certified family physician and I did not know?”
The fellowship in Cleveland provided her with the education she’d been seeking. Fiffick learned about the cutting-edge research in Hormone Replacement Therapy (HRT) and women’s health that doctors like Thacker, Rebecca Thurston with the University of Pittsburgh, and Heather Hirsch have been conducting over the last 20 years.
Fiffick learned that HRT can help women in midlife decrease their risk of diabetes and improve insulin sensitivity and she learned that going through menopause increases the risk of cognitive decline and brain matter lesions as well as heart disease.
“Hot flashes actually cause white matter damage to the brain, equivalent to having vascular dementia.” Fiffick explains, “So they do MRI scans, and they see actual areas of the brain that are lacking blood flow because the vasomotor symptoms were that severe.”
Alexa Fiffick, DO of Concierge Medicine of WestlakeHRT and ‘that’ study
In 2002, the Women’s Health Initiative (WHI) conducted the first randomized controlled trial of hormone replacement therapy (HRT) and abruptly halted the study because of the risk of breast cancer, heart attacks, stroke, and blood clots.
The use of HRT in the United States plummeted by more than 80%, even though the study only enrolled women over age 70 who had gone through menopause and had never taken HRT. Ironically what was supposed to be a definitive study in support of women’s health, decimated the fledgling field, and they’ve been playing catch up ever since.
“Before the 2002 study, about 40% of menopausal and perimenopausal women were on HRT,”
Fiffick explains. “Now we’re at 10% of the population. That qualifies as a ‘Holy Cow!’”
In truth, HRT for younger women who have just started getting perimenopause symptoms doesn’t have the same risks and can prevent the same diseases that it might cause in women who have already gone through menopause.
“We know for a fact that menopause in and of itself is an independent risk factor for heart disease, as well as all the other stuff like osteoporosis fractures, recurrent UTIs, like genital urinary syndrome of menopause, which can lead to UTIs that cause sepsis and death,” Fiffick explains. “It's a whole spectrum of things where we're just like, yeah, whatever, that's not important—[it’s] how that feels to me and a lot of our patients.”
The Ms. Medicine network
During her fellowship, Fiffick became a menopause practitioner in the North American Menopause Society and she began to think about her next moves.
She originally planned to stay in academia, but her passion for patients and their struggles within the healthcare system had her looking for something else. “With this population of people that I'm so passionate about, there's so much to unpack and to learn about patients that I can't do what I do in 20 minutes,” she says.
Luckily, Fiffick’s fellowship acquainted her with Dr. Lisa Larkin, an internist based in Cincinnati who had worked for many of the big health conglomerates and become disillusioned by the healthcare industry.
Larkin started her own concierge practice a few years ago and realized how happy it made her patients, how happy it made her, and she realized she needed to help other people—specifically, other physicians who are passionate about women's health.
“My first year going in my second year [of practice], I was getting a little bit more frustrated with my ability—or inability—to care for people, specifically women, the way I wanted to, and then I started really looking at working and partnering with Ms. Medicine,” Larkin recalls.
Fiffick partnered with Larkin’s Ms. Medicine network, which helps members with the marketing and business side of creating and building a medical practice. “Right now, we're basically trailblazing a market that barely exists and that comes with a fee,” Fiffick says. “But in the long run, the goal is the same -- get care to people who are getting forgotten.”
Creating a new army of female health advocates
As she looks toward the future, Fiffick is hopeful for real change in women’s healthcare.
“I think physicians nowadays need to be stronger advocates than they ever had been before,” she says. “And luckily, that's something I've learned from people like Holly Thacker and Lisa Larkin and Heather Hirsch—getting out and teaching patients and other people the information that they need helps our message become stronger.”
Fiffick is proud to be involved with the Menopause Mandate, an organization championed by actress Naomi Watts that is creating a coalition of women, activists, medical experts, celebrities, and journalists who aim to transform the support women receive from healthcare and society at large.
Fiffick envisions “an army of women who can go to their physicians, who can go to their politicians, who can go to their employers and advocate for themselves because they're armed with information.”
Fiffick says she is honored to be a part of the movement, “It's with that power of people coming together that will make the difference.”