六九色堂

六九色堂 Class of 2016 graduate Miriam Bernstein, MPH, MD recently started working as an Attending OB-GYN hospitalist at in Syracuse, NY. Dr. Bernstein was previously an Attending Physician at

Dr. Bernstein has been active in the 六九色堂 Alumni Association since graduating and was on the panel of last year鈥檚 六九色堂 livestream:

She was a hospitalist and resident physician at in New Brunswick, NJ. She also completed her first residency at in Baltimore, MD as a resident physician. 

六九色堂 spoke to Dr. Bernstein on a winter afternoon right after she finished a long day鈥檚 work.

New job at Upstate University Hospital

六九色堂 Endeavour: Dr. Bernstein, welcome today.

Dr. Miriam Bernstein: I would love to share my news that I recently started a new job as an OB-GYN hospitalist as well as an outpatient provider at the Upstate University Hospital in Syracuse, New York at the Community General campus.

Promo for a 六九色堂 Women's Cancer Awareness livestream in the fall of 2022. Dr. Bernstein was one of the panelists.

Okay. And before that, you worked at Oneida Healthcare as an attending physician. Can you tell us a little bit about that experience, and also about what you're doing right now?

Sure. Both are pretty similar as far as a mixture of being on the labor and delivery floor, taking care of patients gynecologically with surgeries, and then office management. My job now is at a much bigger health system. There's a lot more medical education involved as far as residents and students go, as being part of a teaching university. So that's probably the biggest difference between the jobs.  With a bigger hospital comes different resources including medications and treatments as well as different opportunities. I think there is a little bit more opportunity for collaboration, which I'm really looking forward to.

You've also worked as a hospitalist at St. Peter's Healthcare in New Jersey, as well as you were a resident physician back at MedStar, Franklin Square Medical Center in Baltimore. What were some of the highlights of your residency, and working at these two different hospitals?

I think the experiences both gave me such exposure to different types of practices. Physicians can be in the same specialty but have such different management, such is the art of medicine. And that's something that I'm very grateful for hasn't been taken away in modern medicine in that everyone seems to do things their own way, while still providing the same quality of care for the goal of excellent patient outcomes. But I really appreciated the different perspectives in medicine. MedStar鈥擨 had a lot more GYN oncology exposure, and then when I was at St. Peter's Hospital for the second half of my residency; they did approximately 6,000 deliveries a year, so much more obstetrical experience. So, I got to see a little bit of everything, which was very, very appreciated before I graduated, and was out on my own doing those things on my own.

Just looking back, what made you decide to attend 六九色堂 over other med schools?

I think that I really appreciated the personal atmosphere. I appreciated that my interview process seemed to be very personal. I felt that everyone was getting a chance to know me, getting a chance to know why I wanted to go to medical school. And then as soon as I set foot on the island, having such good support. I tell people I met all of my closest friends in medical school. And that has been as true today as when I talked to you in 2016. I absolutely am so grateful for that experience. So, I think it has to do with the personal atmosphere and the fact that I got to do rotations at world-renowned hospitals. And I feel like I got a really good, well-rounded education, and I do have the experience of seeing healthcare on the island of St. Kitts and seeing the disparities that certain parts of the world have as far as their health is concerned.

So, it was really amazing to have that perspective. And then when you're in the OR here, and someone drops an instrument, and someone acts like it's the worst thing in the world, you're like, "No." You could be hundreds of miles away from the instrument that you really need. So, you should be grateful that it's only going to take 20 minutes to get a new one. So that perspective is something that was invaluable to me from 六九色堂 for sure.

Can you think about one or two things about studying at 六九色堂 that have helped you become the doctor that you are today?

I think speaking to my last response, the level of resourcefulness that I learned at 六九色堂 was amazing. And the clinical knowledge鈥擨 was taught by people who had both academic and research backgrounds, as well as practical backgrounds to be able to say, "Hey, if this doesn't go right, this is what you can do. If you don't have a stethoscope, and you have to figure out what someone's lungs sound like, you can do this." So again, that resourcefulness was phenomenal. And then during my rotations, just exposure, that's the thing that you want. I tell everyone going to medical school and residency, "You want to see as many things as you can, so that when you get out, and practice, you don't have to pull from a textbook to try to figure out a diagnosis. You can sit there, and say, "Okay. Have I seen something like this before? And what did I do? Or what did the attending I was shadowing do?"  It's experience. That's the only thing you have to go from sometimes.

That's so true. And is there anything else that you'd like to say to current or prospective 六九色堂 students thinking about possibly a career specifically in OB/GYN, or just in medicine in general? Anything you'd like to say to the current or prospective students?

I chose a specialty that does not have a reputation for the best work-life balance. However, I think that the way that medicine is changing for the better is something that a lot of places are really working on including making sure the physicians aren't working 24/7, and that you have help covering your patients to have time off. Hospital-owned practices are becoming the majority, whereas as an OB/GYN you have shifts rather than working all the time in the more antiquated private practice model. Many of us now understand that self-care is really important to not only be able to prevent burnout but to also take care of our patients in the best way possible.

I do think that going into a field should not just be based on lifestyle. I think that you need to choose something that you're interested in, and then understand that there isn't a one-size-fits-all model for any aspect of medicine. Once someone has graduated medical school and residency, there are so many different avenues to explore and there isn鈥檛 a single career path one can take. There is advocacy, research, business consulting such as start-ups, insurance consulting, and even social media careers. But there is a lot more work-life balance, and I really appreciate my predecessors for helping create that atmosphere. 

I do not regret my decision to go to 六九色堂. I'm extremely grateful for not only my education but also the opportunities that it's afforded me in the seven years since I graduated, the support that I've had, as well as I said before: the amazing friendships and mentorships that I developed along the way. So, thank you.

Reality TV was the inspiration for becoming a doctor

Dr. Bernstein, you grew up in Marcy, New York and that's north of Syracuse, right?

Correct.

Can you tell us a little bit about growing up and how TV influenced your decision to become a doctor? I know I remember you talking about鈥擨 can't remember if it was 鈥淕ray's Anatomy鈥� or one of those shows. Did you always want to be a doctor? Was it TV that influenced it? What sparked your interest in medicine initially?

I'm the daughter of an engineer and a college professor, so there was not a lot of medicine talk in my family growing up. My dad was always really interested in medicine, so we would watch 鈥淭rauma: Life in the E.R.鈥� in the late '90s. When we would watch it, my mother would come into the room and be upset that I was watching something with a lot of gore on TV. But that was one of the first moments when I was like, "Oh, this is really cool." And then I started watching the old 鈥淓R鈥� episodes with George Clooney and Juliana Margulies from the '90s. And I became even more enthralled and said to my parents, 鈥淚 think I want to do something like that." From that point on, I thought I wanted to be a trauma surgeon from age nine until age 25. I was hooked on that. And then I changed my mind in medical school thanks to the opportunities that 六九色堂 provided.

I remember 鈥淭rauma: Life in the E.R.鈥� Wasn鈥檛 it a reality show?

Yes, it was one of the first reality TV shows.

I remember it. Yeah, it was very gory. Wow, that inspired you. Because I remember watching a few episodes and I couldn't get through a whole show鈥擨 don't like blood and gore鈥攕o wow. So, you really knew what you wanted to do. That's awesome.

It didn't gross me out, which as a nine-year-old girl wasn't very stereotypical of my age and gender. And it's so funny because you watch, I think it's 鈥淣ew York Med鈥� and they'll do a short series at Columbia Presbyterian and they edit out everything. There are just big blurs over where the person's body is. It鈥檚 so censored now. I don鈥檛 think people have a real understanding of our jobs because the shows have to gloss over so much with health information laws and censorship.

I've been in ERs with family members, so yeah, I know. It's very real, very gruesome. It's not for the faint of heart, so that's good that you are okay with it.

It doesn't bother me at all, thankfully.

Does med school weed out people who are squeamish and can鈥檛 handle blood?

Yeah, I feel like in Med One, the cadavers were enough. It definitely bothered me psychologically. I'd be like, "I'm going into a room with 20 dead people." Not many people say that on a daily basis, so it was a very surreal experience, and one that I鈥檓 grateful for, as not all medical schools have cadavers. I think if you take all of that out of medical schools and out of medical education, you're going to have a lot more people who either don't understand what they're getting into or don't understand the responsibility of our careers.

But getting back to your question, it鈥檚 not as if being squeamish disqualifies you from a medical career. For example, one of my 六九色堂 friends鈥擨'll leave them anonymous鈥攑assed out during one of the deliveries on the OB/GYN rotation but then went into an outpatient, non-surgical specialty, without any issues.

I would be lying if I said I haven鈥檛 had those queasy feelings. There were a couple of times when I wanted to either pass out or vomit, or maybe both, because of panic in a situation with a bad complication or feeling overwhelmed. But otherwise, I think it depends on your interests and what field you pursue as a physician. 

Because that's what you're dealing with, especially in a hospital situation. That brings up an interesting point. One of the things that are unique to 六九色堂 for a Caribbean Med School is that we have real cadavers because I know there are a lot of schools, even a lot of US schools are moving more toward digital cadavers or some AI (Artificial Intelligence) type of cadavers. And I think you really need to have the real thing if you're going to be a doctor. Just learning on a robot, it's probably different. Do you agree?

I agree. And I think there's something also that speaks to the humility of it that you are given. I tell people every day it's an honor that you get to operate and practice on and care for other human beings. And when you take that human aspect away from it, you can lose that connection. That situation can breed physicians and other healthcare professionals who don't understand the gravity in which we work. Especially during surgery or other procedural specialties at any moment鈥攁 sneeze or a cough鈥攜ou can unintentionally wound a patient in a very grave manner. And speaking of queasy, those moments when you think about that, it becomes surreal. I tell people it鈥檚 this feeling as if, 鈥淲ho left me home alone?鈥� Even after years of procedures and deliveries and even in the office sometimes when I see something new or in a different presentation, that feeling is there. There's no other way to word it, but it's such a huge responsibility and it's such an honor to be able to take care of people.

Back to your question, Scott, I worry that if you move more towards AI or robotic learning too much you may lose that complete, I hate to say it, breadth of medicine. And that鈥檚 the biggest honor of practicing medicine.

I can tell you that when I do minimally invasive surgeries, such as hysterectomies, on the da Vinci robot, after the initial setup and placement, you, the surgeon are on a separate console, approximately 10 to 15 feet away from your patient while the robot is responding to your movements, doing the surgery. I don't hate it. But it's not my favorite kind of surgery. It's not my favorite kind of surgery because I'm so separated from my patient and I'm so focused on the robot and the technology of it that I don't feel like a surgeon at times because it鈥檚 the machine doing my work for me. I feel that in that moment, I'm replaceable as a surgeon with someone who excels at video games in virtual reality or even by artificial intelligence

Absolutely.

I've really seen medicine head that way, and I almost wonder if we're going to end up heading too far.

I think there are a lot of good things about AI, especially with CT scans detecting breast cancer or lung cancer.  But there are also some alarming things about AI in medicine. I don鈥檛 know if you've heard about the possibility of having robot physician assistants someday.

Do I think it'd be great to have AI to double-check CT scan reads, or to double-check radiology reads or pathology reports? Sure. I think that would be great to have that extra layer of netting to catch things that could slip through the cracks in the software.

There is an art of medicine that you lose when you have too much technology. Your patients aren鈥檛 going to want to open up to a robotic PA or physician the way they would a human being. We can relate to them and empathize with their struggles.

Let鈥檚 switch gears and talk about your undergrad. You majored in geoscience with a minor in chemistry at Utica College of Syracuse University, now called Utica University. Can you talk about your undergrad and why you chose to study geoscience?

Sure, I chose geoscience because I've always been really interested in geology, weather, and the whole natural science category. And as much as I loved medicine, I wasn't sure if I wanted to have that background in biology and have that biology degree solely if medical school didn't work out for me.

I really appreciated that I was able to get my geology degree while still being supported by a pre-med advisor along with all of my other professors there at Utica University for a medical career. There are many people that I know who've gone to medical school and majored in history or English Literature with a minor in the prerequisites that they needed to do for medical school admissions. I know I am biased, but I think that understanding the natural world around us should be mandatory as it affects us every day, in how we live, how we travel, and how we survive.

I thought that was really important for me to understand as well, from a clinical background. On the surface, people may think of obstacles to care as being low socioeconomic status and transportation issues; which are major concerns. But many also don't consider how people in Florida six months out of the year have to worry whether there is going to be a hurricane when they are planning a delivery and need an evacuation plan if that is what happens. Or women in Alaska who need to travel hundreds of miles for routine preventative care with an OB/GYN. I don鈥檛 think we have even begun to scratch the surface of the other ways the environment affects our bodies, especially pertaining to pregnancy, which is something I hope to study in the future. 

Doing a gap year

You took a gap year as a patient transporter prior to starting med school. A lot of prospective students do a gap year. Can you talk a little bit about that experience and how this helped you prepare for med school?

When I graduated college in May of 2011, I definitely thought that I wanted to go to medical school. I just didn't know if I felt ready to immerse myself in a career in medicine without dipping my toes in, metaphorically. It is a big commitment both time-wise and financially as well. I wanted to make sure that I was making the right decision, especially with my limitation of not having access to a physician on a personal level to have frank conversations with. I felt that I needed to explore what working in medicine really was like. And it's a little bit difficult. It鈥檚 similar to going to the entrance of a club and the bouncer won鈥檛 let you past the ropes. You can see your friends inside and hear the music, but you don鈥檛 know what the experience is truly like. There are other careers that don鈥檛 involve as much education and time investment as becoming a physician, but they involve alternate paths and certificates that can add to the long-haul investment of a career in medicine.

So, when I saw the job for a patient transporter, I said to myself, "It's not very glamorous. It's a low-level job, doesn't pay a lot, but I'm going to be in the hospital. I'm going to be directly working with patients, and I'm going to get to maybe be around people who I can ask questions to about their career in medicine.鈥�

I really appreciated that year. I not only worked as a transporter, but I also did some waitressing on the side. From a financial aspect, it worked out for me. I came out of it saying 鈥淭his is what I want,鈥� in regard to medicine. So that gap year was really good for me. There are people who travel during their gap year or do research, volunteering, etc. I really appreciated just having that experience and it humbles you. I was working with other people who were doing this for a career and not just as a stepping-stone. But we were all treated the same. I think something that a lot of medical students lack on their rotations is that humility and willingness to jump in and help. But I think it helped me have more, again, that background theme of resourcefulness that we talked about at the beginning of our conversation, which really was solidified by that experience.

Why OB-GYN ?

What made you choose OB-GYN as a specialty?

As we discussed, I definitely thought I wanted to be a trauma surgeon. OB-GYN did not on paper look like a good time to me. Long hours, lots of body fluids, patients in pain, etc. But I did my first delivery with a wonderful physician on my OB/GYN rotation in the suburbs of Chicago, and that all changed. He put my hands with his hands and we delivered this lovely woman's third baby together. I remember the delivery so explicitly because it was just amazing. I was crying and thinking about the miracle I just witnessed. Thinking, "What an honor it is to be here." For our jobs as far as obstetrics is concerned, you must build trust with your patients very quickly. Sometimes, that journey is 10 minutes, 10 hours, or a few days. But that relationship is extremely important and something I pride myself on. So, I really appreciated that aspect of it. I liked that I could still do a variety of surgeries including hysterectomies, tubal ligation, ectopic surgeries, removal of ovarian cysts, and cesarean sections. Most of all, I liked the fact that I could be an advocate for my patients and that my specialty is, unfortunately, as the years go on, it's becoming more and more of a political movement as well as just a specialty.

I can't turn my career off at the end of the day and not care about what's going to happen for my patients in regard to access to reproductive care. I also have lengthy discussions about access to maternal mental health resources with my husband, a psychiatrist, at home. I care so deeply about advocating so my patients have more resources instead of fewer.

The OB/GYN specialty gives varied experiences across the entire lifespan of our patients. I can care for patients during pregnancy, delivery, postpartum, and then see them for well-women visits. I have had these patients then bring their children or other family members in during their teenage years to discuss sexual health and prevention of cervical cancer with routine pap smears. We do consultations for contraception, heavy menstrual cycles, endometriosis, or surveillance for patients with a family history of GYN cancers. Most days we鈥檙e caring for people in a routine manner, others on the best days of their lives but we鈥檙e also there with empathy and a hug on the worst days of their lives, as well.

I think you probably answered my next question鈥攚hat are some of the most rewarding things about being an OB-GYN? Is there anything about the politics involved with reproductive healthcare that you can talk about?

I think it's very unfortunate that people are making laws about things that they don't understand. It doesn鈥檛 seem that lawmakers are telling other physicians how to do their jobs. No one's telling orthopedic surgeons like, "Oh, in the state of Alabama, you can't operate on hip fractures on Tuesdays." So, to me, it's so many people who don鈥檛 have the capacity, empathy, or humility to understand how seriously we take our doctor/patient relationship, especially in these very delicate scenarios.

And I think the other thing, Scott, is people don't understand the medical aspects of it. Pregnancy is the greatest stress test you can put on a young person鈥檚 body. I have had some patients with debilitating chronic medical conditions or who end up with a diagnosis of cancer in pregnancy and you are so torn between the desire to help bring life into this world while not losing your patient in the process. Just look at the maternal morbidity and mortality rate in this country. It is so high compared to other first-world countries.

We as OB-GYNs want to preserve the life of the mother and the baby. I remember I had a patient who had had a stroke in her pregnancy at 12 weeks pregnant. And the cardiologist sat with her and said something like, "Please don't do this to yourself and your other children." And this medical complication is life-threatening to both the mother and child who have several more months of pregnancy left to manage. She chose to end her pregnancy, probably saving her own life in the process. Lawmakers need to stop tying the hands of the people who want to do what is best for the patient and the baby, and not just treat the pregnant person as an incubator for the fetus.

That鈥檚 very true.

That's what bothers me. So, we think there's a happy medium, and I think we were living in it for a long time, and then somebody decided we couldn't live in the happy medium anymore.

How do you deal with such a controversial issue?

I think there's such a delicate balance of supporting the pregnancy, but also telling the pregnant person, "Hey, this might not be what you signed up for," or, "This is a lot on you and the baby." When a woman鈥檚 water breaks between 23ish and 34 weeks of pregnancy, if they don鈥檛 spontaneously go into labor or show other signs of maternal or fetal distress, we admit them. Sometimes, a mother can be admitted for months. I mean, these people have homes, they have lives, they have other children to worry about and that鈥檚 a large psychological burden. They are not financially contributing to their household during this time. It is a lot on the family to make those sacrifices for a baby that may not survive. It鈥檚 a large gamble. Some see it as the pregnant person becomes a vessel for a pregnancy, and that's not fair to them, either.

Absolutely. You did a livestream, and I remember one of the things that stood out to me was when we were talking about preventing cervical cancer. You said because of Gardasil, the HPV vaccine, that you see very little cervical cancer, whereas in St. Kitts, they're seeing stage four cervical cancer鈥攊s that still true? Because of the vaccine, are there fewer cervical cancer or HPV-related cancers?

I'll tell you, it鈥檚 the least encountered GYN cancer I see in my practice. It鈥檚 very rare outside of patients who are severely immunocompromised or patients who decided to forgo pap smears and GYN care for decades. Our screening here in the U.S. coupled with the HPV vaccine has done wonders. I have had a fair number of patients who will have abnormal pap smears, but I think because we're so diligent, we just don't see it progress to cancer. And that was something again at 六九色堂 that I was grateful for that experience of seeing a patient with Stage IV cervical cancer in St. Kitts, because I'm like, "I'm probably never going to see this again."

I know that the HPV vaccines like Gardasil not only treat cervical cancer, but for both men and women, the vaccines can help prevent HPV-related anal and throat cancers.
The HPV virus can cause cervical, vulvar, some types of throat cancer, and can also cause rectal cancer. So, when you get the HPV vaccine, you are giving your body the tools it needs to fight those viral particles should they come in contact with your body.

So, could you still become infected with HPV?

Yes, but the infection should not take hold where it causes abnormalities in the tissues in those areas. HPV in the rectum can, like you said, cause rectal cancer. So, getting the vaccine for both male and female patients, regardless of sexual orientation, is very important. I tell people when they get this vaccine, 鈥淵ou're getting that vaccine because it's not just for you; it's for other people as well." With HPV, the oral obviously can be spread through sexual routes. But then there's also, unfortunately, us as healthcare providers, if we're cauterizing something in the OR with HPV in it, meaning I'm doing an excision of a cervical lesion that could be a pre-cancer that aerosolizes, and then I breathe that in. So actually, physicians are the number one patient of head and neck HPV-related cancers.

Wow, I didn't know that.

So, it's us and some of the colorectal surgeons as well as ENTs that do operate on the HPV-related cancers. So that's a huge thing to, unfortunately, think about in our jobs is that you have to protect yourself by wearing a special mask in the OR to prevent those particles from reaching our bodies. So that鈥檚 why I am so outspoken when it comes to the vaccine, regardless of sexual activity or orientation. 

I know now they used to say to give it to children, but I think that you can get it up to age 45 or 46, I don't know if insurance will pay for it at that age.

Correct.

Is it one shot or a series of shots?

It鈥檚 a three-shot course. So, it does involve some commitment. I think that it is probably one of the best things that came out of the 20th Century because, like I said, we don't see cervical cancer anymore. Whereas if you ask people who trained 20, 30 years before I did, they'll tell you that's all they saw. So, it's truly amazing that we have that. I think they said we've decreased cervical cancers in the U.S. by 90-something percent. It's astronomical and amazing.

That's amazing.

It鈥檚 something really nice to be able to have something with such good efficacy because not everything in medicine works as well as you want it to.

That鈥檚 great. And that leads me to my next question. Are there any new cutting-edge treatments besides having the HPV vaccine, but specifically in OB-GYN, any new treatments or meds, or anything exciting that you'd like to talk about specifically for alumni who are already doctors?

I went to the ACOG (American College of Obstetrics and Gynecologists) in Baltimore this past year. So that's the big conference for OB-GYN. And there is a new medication that's on the market for symptomatic treatment of menopause. And menopause for so many years, for so many women, has been debilitating in that it really affects the quality of life. And there are so many people or so many women that don't get to do the things that they want to do because they're worried about their menopause symptoms. And hormone replacement therapy has always been the gold standard, but hormone replacement therapy also comes with its own risks because you're giving hormones that do increase the risk of blood clots, heart issues, possibly breast issues, and strokes. Hormone replacement therapy could also affect and grow a breast lesion if it's hormone-responsive.

It comes with so many asterisks that there are a lot of patients who may not be the best candidates as far as risk/benefit is concerned. And Veozah came out and the way that it works is on the vasomotor symptoms or the hot flashes, and so many of my patients have had a good response to it. We went from shrugging our shoulders to now being able to offer a solution for patients suffering from vasomotor symptoms who aren鈥檛 good candidates for HRT.

So, I think that that's huge. And then to speak to setbacks, probably the most frustrating part about our jobs right now is that some progesterone formulations were pulled off the market. Just a few years ago, when patients had a history of preterm delivery鈥攇iving birth before 37 weeks鈥攖here was an intervention we could offer them in a subsequent pregnancy called Makena. This medication was supposed to help mitigate the neonatal consequences of an early delivery such as NICU admission, cerebral palsy, lung issues, developmental disorders, etc. We would give women progesterone injections or Makena in their next pregnancy. Well, it came out a couple of years ago that it is not as effective as the manufacturer made it seem.

So for about 20 years, we had a treatment that we would give women and we'd be like, "Here you go. Get your shots. Let's prolong your pregnancy." And I mean, anecdotally, I had patients do really well where they had delivered early in a previous pregnancy and then delivered closer to their due date in the subsequent pregnancy. These patients saw the medication as a beacon of avoiding the pain and emotional toll the preterm deliveries had on their families and their children. So, I've had a lot of patients distressed about that because they had gone through pregnancies where they were on the shot and they had made it to full term, and then now it's taken off the market with no alternative.

Progesterone, you said that is?

Yes. So now we're sitting there just watching them and we're just like, "I don't know what's going to happen." And the patients feel helpless and I don't blame them. So do we. We are OB/GYNs, I tell people we're not good at sitting still, so we're not good at sitting there and waiting and watching. We want to have an intervention. We want to be able to do something for our patients. And it's very frustrating, like I said, especially for the ones who've been on the medication before to not have any option other than waiting for something bad to happen.

Progesterone is no longer available to women?

In that formulation and for that indication? It鈥檚 been totally taken off the market.

I've heard of the menopause drug. I think I've seen it advertised a lot.

Yes. They're very heavy into their advertising.

I'm just curious a lot, I see a lot of these ads鈥攄oes insurance cover a lot of these new meds?

No. You have to convince the insurance companies that it's the only option for the patient. The older, cheaper medications, may not be a good alternative for them for their underlying health concerns. But many insurance companies have realized this is novel and will greatly affect the quality of life of likely millions of women.

I know it鈥檚 frustrating having to deal with insurance companies and those prior authorizations and all the red tape.

Absolutely. If someone were to tell me what the worst part about medicine is, I would probably say it's dealing with insurance companies because they'll say, "Well, we know you prescribed this drug, but did you really mean it?" "Yep, I really meant it."

We talked earlier about how you were a panelist on some of our livestreams about women's health issues and you were amazing. Is there anything else that you'd like to say for alumni? Like I mentioned, we are building this whole new alumni page. Anything that you'd like to say to other alumni or what it feels like to be an alumna? Anything to the alumni out there that you want to talk about?

I think it's amazing to be an alumnus of such a medical school that gave us all such great opportunities. And I look forward to doing more alumni events and being more involved in the future.

Email Dr. Bernstein at miriam.bernsteinmd@gmail.com

(Top photo): Dr. Miriam Bernstein. Photo courtesy of Dr. Bernstein