Thriving or Surviving with Dr. Maxime Billick & Dr. Joseph

I once had a professor tell me: “It’s easy to forget to have children.” - Dr. Maxime Billick

In this episode, Radha chats with Dr. Maxime Billick, an Infectious Disease resident physician, and Dr. Joseph, a family physician, about their experiences with egg freezing. In this special episode, we talk about the financial aspects of egg freezing, the psychological challenges of the process and the peer support systems available for medical trainees.

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Contact Information

Dr. Maxime Billick, M.D.
Email: maxime.billick@mail.utoronto.ca
Twitter: @maximebillick

#EmergencyMedicine #FamilyMedicine #InfectiousDisease  #UniversityofToronto #IVF #EggFreezing #Residency #FamilyPlanning

Transcript

Radha Sharma:  Welcome to Season 1, Episode 3 of Family Planning for Docs Thriving or Surviving. This podcast is an extension of our platform at www.familyplanningfordocs.com, a website created for Canadian medical trainees to highlight useful information about family planning in a medical career. Our group has a mission to inform medical trainees about their options regarding family planning while navigating training career and personal life.

Our research has demonstrated that personal stories are highly impactful and we hope to provide access to a diverse number of stories to current trainees. On our podcast, we hope to capture the stories of medical professionals who have navigated this process themselves while planning parenthood, parenting and support along the way. 

Radha Sharma: In this special episode, we have two guests, Dr. Maxime Billick and Dr. Joseph. We are thrilled to have them on our podcast today, and we just wanna give you guys both a thank you on behalf of our entire team. 

Dr. Maxime Billick: Thanks for having us. 

Radha Sharma: The first question for today is, what does a day in the life of Dr. Billick and Dr. Joseph look like? 

Dr. Maxime Billick: So maybe I can jump into this one first. Um, so I am just finishing up my first year of fellowship in infectious diseases and so my days really vary and sometimes they're out of my control and a bit unpredictable, just based on whether I am on service or not. In the first year we have about six months of consult service and about six months of other rotations. And so when you're on service, it usually starts at 8:00 AM. Consults pour in as I'm sure many listeners know and the day, technically the pager stops at five, but really, you know, if you get a few number of consults, you can be out by five. If you get many consults you can be there significantly later. And so, um, it really depends. And then on my non-service based rotations, they're usually a lot lighter. So they can start at eight or at nine, and they're usually not consult based and sometimes they can be more, either research focused, project focused, etc.

And so I say that all because the, um, degree of flexibility really varies depending on the rotation and sometimes feels a bit out of your control. But that's okay. We roll with the punches and, you know, once I'm staff, I'll have hopefully a little more control over my 

Dr. Joseph: So for myself, I'm an early career family physician doing somewhat of a focused practice in ER, but also comprehensive family practice. So the days can look quite different depending on which role in family medicine I'm playing. But if I'm in the family medicine sector, it could be two or three days a week at the family clinic, plus one or two days a week in ER and or hospitalist, depending on the setting that I'm in. So being a staff, I do have that much more flexibility. Thank God, compared to residency. That was one of my biggest priorities when I was looking ahead into my staff life and asking myself, what is it that I want out of my career? And flexibility was high up on the radar. So, um, I was able to kind of create a career within family medicine that has its ebbs and flows, but at least I'm able to keep diversity going of different areas of interest, but also have a more balanced life that is more suitable for wellness. When I'm not doing clinical work, I spend probably about a day or two a week doing some consulting services privately outside of medicine. 

Radha Sharma: Cool. So very different career paths here, even in the realm of medicine itself. So for each of you, how many years of training, I know Maxime, you're still currently in your training. How many years does it take to get to where you are or where you want to be?

Dr. Maxime Billick: So most people could be at the level that I'm at with three years of internal medicine residency and one year of ID fellowship. Of course I made it more complicated. So I first did a year of obstetrics and gynecology and then transferred into internal medicine. And I also did a year as Chief medical resident at Toronto General Hospital. So that was an additional year - leadership, teaching, administration, etc. And that, of course, is on top of however many years of medical school one goes to. So three or four years depending on the school. So I guess: 1, 2, 3, 4, 7, 8 - 9 or 10 years since starting medical school, something like that.

Radha Sharma: Seems about right. The listeners can double check that number.

Dr. Joseph: In total I did 13 years of education. If we are going as far back as undergrad, Uh, but for the medical portion of the journey itself between a four year undergraduate degree and a two year family medicine degree, that's about six years. I chose not to pursue any further fellowships as I was at that point, more ready to start a staff career and start living the staff life.

Dr. Maxime Billick: Smart choice

Radha Sharma: Maxime, and I can't wait. Well, Maxime is much closer than I am, but I mean.

Dr. Maxime Billick: Yeah, there's a Master's somewhere in the future. 

Radha Sharma: So, like I mentioned at the start of the podcast, the goal of today's episode and other episodes is to talk about how yourselves and other people have fit their family planning within a medical career. So my first question is, what has inspired you to want to start a family in the future? What's been kind of your motivation for that?

Dr. Maxime Billick: I think I knew from a pretty early age that I wanted to have kids. Um, I'm the youngest of three siblings, but, and both of my brothers are much older than me - 7 and 10 years older than me. So they have kids. There's often a gaggle of nieces and nephews around, and I love spending time with them. It also highlighted how important it was to me, you know, now about seven or eight years ago when I was with a partner who didn't want kids, and that became a point of contention, and highlighted to me how important it was.

Dr. Maxime Billick: I once had an undergraduate professor say to me that it's really easy to forget to have children.And I didn't know how true those words were gonna ring until I was sort of in the thick of medical training. And it can feel like sometimes you're jumping or leapfrogging from one leap pad to the next sort of chasing the carrot, you know, the proverbial carrot. There never really seemed either A) a right time, and B) you know, just to get kind of personal, I found it quite hard to connect, with people who I went on dates with. You know, either they were outside the medical world and they either completely venerated it or didn't understand what it would mean to be on call one in four, one in five nights. The times that I dated people in medicine, I have a lot of interests outside of medicine, so I don't wanna talk about medicine all day, every day, like in the evening when I'm home. And so that was challenging for its own reason. And so I found myself 34, very single in the middle of the pandemic. And, because of my year in OB I knew that sort of the mark of 35, at the age of 35 was when you want to start thinking about freezing your eggs if you're not gonna have kids, you know, very soon in the future, and, and again, at the time I wasn't partnered and so I spoke to some friends about it and I went down the road, which I'm sure we'll talk about, of freezing my eggs. Part of that was, again, my age, my single status, and also part of it was being in my chief medical resident year where I had a lot more flexibility than I had as a resident and that I thought I was gonna have as a fellow. And so the timing lined up in a very ideal way. 

Dr. Joseph: So for myself, I consider myself a heterosexual female interested in men and I've always kind of known, I don’t know if it's innate, that I wanted to see myself in a relationship and all through my twenties and to this day, unfortunately, similar to what Maxime just said, it was very hard to meet the right person. And I would say it was not due to shortage of putting myself out there or dating and trying all the traditional methods of putting myself out there, including speed dating, getting set up, dating apps, the whole shebang.

And, it's so interesting, particularly as a woman in different stages of training, people have different types of judgment, which I can see more with clarity now than I ever did going through the process. So pre-medicine, I was a poor student and just trying to make it to the next stage. And you know, I would be labeled as, you're not settled enough and you don't have any money and you know you're not free to move. During medicine, of course, my schedule kept coming up as a reason why somebody wouldn't wanna date me or would start and quit. They're like, you're busy. And I'm like, I always emphasize this is a season I need to go through. And, um, you know, at the end of this season, I definitely see flexibility and family as some of the top priorities.

But again, some people are just not interested in waiting or you know, had stereotypes about female doctors, which really makes me sad to say this, but if you're a male physician, you're a very good catch, you have high status, and everyone looks up to you. If you're a female physician, you're a threat, you're intimidating, you're not gonna be a good spouse, you're not never gonna be good with kids, and you're never gonna be home. That is generally the stereotype that's out there, which really was quite damaging in the dating process because in more recent years, if I said I was a doctor, there were people who just stopped talking to me.

Dr. Joseph: So I realized, you know, dating was not gonna be easy. I've had some, some good relationships but not one that, you know, made it as far to the point of having kids. Um, and so kind of when I hit 34, I decided, after talking to a lot of people to do egg freezing myself. So I wish I had more information and support and guidance to make that decision earlier in hindsight.

I did that at 34 and a second round at 36, and I never felt more empowered. I still hope to have a family one day and. At this stage though, I'm quite open to seeing how that idea, feeling and desire evolves. It may not look as traditional as I may have hoped it to be, but I think my journey has also taught me to be open-minded and even just my own journey of freezing eggs taught me just, just how many options could be out there and allowed me to just consider them and learn more about it.

Radha Sharma: Thank you both for sharing your own journeys. I know it's such a personal question and something that trainees, like you mentioned, it doesn't seem like there's very open dialogue about this, this episode. Maybe the first time someone's hearing about egg freezing, for example. Um, so again, thank you both for sharing that. It's very empowering to hear both of you on that journey. 

Radha Sharma: I can imagine that it was probably very taxing. It sounds like there's a kind of scheduled time that you need to not only give the injections to yourself or have someone do it for you, and then also be visiting your fertility doctor with. Can you talk a little bit about how, you know, how you felt during the process yourself 

Dr. Joseph: Before the process itself - maybe we'll talk about this again. You know, first of all is getting that adequate education and information about this technology, what it entails, just not, biologically and physically and schedule-wise, but also the psychosocial aspect of it, which is never talked about enough. Because usually when you're hitting that stage of like, I'm going to freeze my eggs, I say, there is a bit of a grief around the desire of having had a traditional way of having a baby. I will also add a layer of culture and religion as possible factors that can impact one's decision to go through with this process. Certain cultures around the globe, ethnic cultures, I'm referring to particularly eastern cultures where a more traditional model of family planning is extremely valued and held high in society. Artificial reproductive technology may not be acceptable. From an ethics perspective, it is also something that I personally had to wrestle with. Ethically is this okay to go forward with? What is gonna happen to my eggs if I don't use it? Is the egg, you know, a full human potential? And if I don't use it and destroy it, am I destroying a human? There were so many ethical questions also to grapple with in this journey. So that's just kind of leading up to the egg, um, egg freezing process, for myself. 

Dr. Maxime Billick: It's really interesting to hear, you described some of the things you wrestled with and, um, coming from what I imagine as a, at least a different religious or potentially cultural background as well, how many things were similar and lined up. Something you said earlier that it felt really empowering to freeze your eggs and making the decision to go forth with. Freezing my eggs felt so empowering. It felt like I was taking control of my fertility, even though I knew it was not a guarantee. Um, and just more like an insurance policy that wasn't quite a hundred percent. It felt empowering. It felt like I was taking control of my fertility. It felt like I suddenly had to grapple with what it would mean to potentially use these eggs to have a kid on my own, what my life could or would look like, and to sort of, face my singleness in a way that I hadn't really taken the time to before and to be okay with myself.

Dr. Maxime Billick: That said, when I was going through the process, I never felt more single than when I froze my eggs, like in the days leading up to it and getting myself the injections. It was also mid COVID and I felt really alone throughout the process, even though I had wonderful, supportive friends, and family. I knew that a lot of people had gone through this process to pursue IVF, you know, so had done it with a partner, helping them with the injections or what not. I say that because there was a lot of duality in my feelings throughout the process, causing me to think about myself as a person in a way that I hadn't really expected to. I just kind of thought I was freezing my eggs and putting money into an insurance policy, and it ended up being much more self-reflective than I had anticipated.

Radha Sharma: I know Dr. Joseph, you actually talked a little bit about this already, about how you wish there were more resources available to you when you were going through egg freezing yourself. I'm wondering if either of you had any mentors or access to resources about egg freezing and what the support system sort of looked like, uh, when you were going through the process?

Dr. Maxime Billick: I didn't know of that many people who had frozen their eggs or who had even gone through IVF openly when I was going into this. I had a good friend who was an OB resident and she provided a lot of information and a lot of support, even just in terms of what the process might look like, what the procedure itself was like, and then of course, as a friend, you know, provided the emotional support. I had a couple of close friends who did that. It was interesting when I started talking about the fact that I was gonna do it, ‘cause I had to tell some people at work and there were some slightly more senior people within my department or within my hospital. Many people came out of the woodwork saying, oh, by the way I did IVF If you ever wanna talk about what the process is like you can reach out. But I'd never known before that or someone else who had kind of vented in terms of being like, Oh, the mornings were so tough, you know, and I was running in late because of X, Y, and Z. It was really interesting because it wasn't only, um, cisgender women who reached out to me. There were a lot of cis men who were also extremely supportive. Either their partners had gone through it, um, or they were just very understanding and recognized that as physicians, our peak fertility years also overlap with our peak career years. So I wasn't expecting to find resources and support everywhere that I found it. And I think that what you're doing here is wonderful because it provides sort of a single location or at least a beginning point where people can reach out to. 

Dr. Joseph: Yeah. Again, at the time, I was considering the process, I did not know anyone who had done it, to be honest, and somebody that I know, shared with a famous person, a woman of color who was doing it somewhere in the states and I'm like, wow, okay. There's one other human being who is a person of colour and had the guts to do it and is clearly talking about it and she's someone famous. So that was kind of empowering. I think I tried to talk to many women who went through IVF and it's interesting to get mixed reviews because I also think those who went through IVF that I encountered were not able to have kids biologically and hence they had to pursue this process. It wasn't an insurance plan or anything like that.

So they were already emotionally kind of went through some emotional suffering in the process and may have had multiple miscarriages. So it was a very emotionally heavy time for them to go through this. Also, like, you know, just within Canada we have Facebook groups and other social forums where we can connect by just asking an open-ended question and actually find people who can respond to you, which again, maybe at a certain time that wasn't as easily accessible. 

Radha Sharma: There is actually a section on our website about IVF and also ART, so we'll also link that in today's show notes and a couple of articles that listeners might also find helpful.

Radha Sharma: If someone were to be researching how much egg freezing costs, um, the process itself, uh, what would an estimate for someone living in Ontario be based on your personal experiences or maybe something that you've read online? 

Dr. Maxime Billick: Maybe I can speak to the trainee experience specifically because with PARO insurance, we actually, we actually get a fair amount of coverage. So when you pay for the process of cryopreservation or egg freezing, most of the initial tests, including many of the blood tests and the initial ultrasound are all covered by OHIP. There are several blood tests that are not specifically your AMH and sometimes certain hormone levels. So that is usually somewhere between $100-$200 out of pocket, depending on how many times they need to do it, the medications themselves can cost anywhere from what I've been told to, you know, $2000 to about, you know, maximum, maybe around $6,000 per cycle. The majority of this, almost a hundred percent, is covered by your PARO insurance. If you're still a resident or a fellow under the PARO umbrella, I think for me it was something like 90% covered. So I had about a $100-$150, uh, copay. My meds cost several thousand dollars. But again, that was all covered. The procedure itself is not, and again, when I researched it in the city, I found quotes as low as about - and keep in mind this was a year and a half ago as low as about $5,500 with sort of a resident discount and as high as about $10,000. So it can vary. There's pros and cons to different clinics. You know, I think people should speak to their friends and can always reach out to me individually. But those were the ranges that I found. And then keeping the eggs frozen each year, usually, depending on the clinic, is somewhere between $400 and $500. That again, is just for the process of freezing your eggs if you were to use them. You actually have to go through IVF, which in and of itself, I've been told is somewhere around $10,000. And you specifically have to do something called ICSI, because there's not the fluffy clouds around the eggs themselves, they have to inject the sperm into the ovum, which is a more detailed or nuanced process.

Dr. Maxime Billick: So, you know that, like I said, from what I've been told is somewhere around $10,000. In Ontario, your first cycle is covered, but beyond that, it's not. So, you know, the costs add up quickly. I have had a friend who has done it with OMA insurance and her meds were covered, although not as high a percentage. I think it depends how they're prescribed to be totally honest and for what indication. So that's a general sense. I also imagine that as demand goes up, prices will probably go up with inflation. 

Dr. Joseph: I would speak from a staff physician perspective. Uh, my biggest regret is not doing egg freezing when I was a resident because I only found out again after that - big chunk of the drug costs are covered in the process. And, you know, I did not benefit from that. In Ontario I have the OMA, OPIP insurance, which, thankfully it used to be $2,500 of, for fertility drugs, they have increased it to $7,000, which is a huge jump, which just happened in the last year. So for those of us who did the process before that, there was a lot of out-of-pocket pay.

Dr. Joseph: So generally speaking, for the egg freezing process, not publicly funded, you have to kind of save up about, I would say on average $9000 - $12,000, and to go through a full IVF cycle, it's on average anywhere between $20,000 to $25,000. So just the ballpark, the numbers. In terms of egg freezing process as a staff, again, the cost varies clinic to clinic. And I found, frankly, doing the research to compare costs to be tough, because a lot of the clinics would not release their cost list without you getting a referral and talking to a physician, I'm like, there's only so many referrals I can get and there's so many, so many appointments I can attend. So I found it very frustrating. So if you can find someone who has been through the process and who has done the research, it can save you a lot of time just to even get ahold of that information. So there's a cost for the actual procedure of going through the egg freezing process, and then there's a cost of the drugs. The drugs can be anywhere between $3000 - $8,000 per cycle of drugs you do. So again, most insurance plans don't fully cover it. 

Radha Sharma: If you both had a magic wand, let's just say this land of magic is here and you could go back in time and change anything, If anything, would you and why? 

Dr. Joseph: For myself, if I could go back in time, I would've probably done egg freezing while I was a resident. I understand and appreciate that it comes with more challenges, both financially and also schedule-wise. But if I could have learned about this technology in advance and been empowered to consider it in advance and had a consult in advance, which is covered in the public system, I think I could have tried to schedule it in a rotation that has better schedule, maybe more clinic-based rotation than one where I'm on call, one and every four or something like that, and where I have understanding supervisors and program directors that would give me that morning windows off.

Dr. Maxime Billick: From my perspective, when you said that question, the first thing that came to mind was I would've spent a year or two traveling or backpacking before med school. Like it was like completely unrelated.

Radha Sharma: But that's totally fine! 

Dr. Maxime Billick: I did, I did live abroad. That's what I would've done. I would've taken a little bit more time to, you know, maybe not be quite as serious right away. And again, to be fair, I wasn't serious right away, I did work in various fields and, and lived abroad, but the timing was right for me when I did it. But I was very lucky that I had the support from supervisors and from family and friends. I had the medical knowledge or acumen to even know, to start thinking about it because of my year as an obstetrics and gynecologist resident. And had the flexibility in my schedule that year to pursue it.

Radha Sharma: You guys have shared a lot of wisdom about your own journeys and I'm sure there's a lot of medical trainees, probably medical students and residents that you know, may access this website and are looking at you know, advice. So, do you have any advice for medical trainees, not necessarily about egg freezing - it could be - but just about really anything with family planning, medicine, any kind of final advice? 

Dr. Maxime Billick: I think the first thing that I would say, which is a little bit unrelated, is make sure to maintain some of your interests outside of medicine. I think that those can be reinvigorating and sometimes when it feels like things are tough in the medical world or in your personal life with regards to fertility or other things, it's really important to have another outlet. And I think it's easy to let those things fall by the wayside in medical school, in residency, or even as a staff. I think the other thing is that it's really easy, like I said, to forget to have children or to forget to even think about it. So I think that as people start hitting around the age of 32 to 35, to think about if this might be something that is up their alley, something that's appealing, something that's feasible, something that they want to do. I have lots of wisdom I feel like I could share and impart, but I think part of it is about going through this journey on your own, like for yourself, not on your own, but certainly for yourself. Because freezing eggs for one person might not be the right answer for someone else, but I did find it a particularly empowering experience and kind of a freeing experience. Like I felt a significant decrease in my own anxiety after doing it. And I didn't realize how much of the pressure to meet someone was self-imposed and was dictated by my fertility. And not to say that completely went away afterwards, but it definitely decreased in its intensity. 

Dr. Joseph: I have so many thoughts flying through my head, and as a side note, I do some life coaching and relationship coaching and it’s quite interesting to wear that hat for a moment in giving this, what I'm about to say. Specifically from a family planning perspective, I would say that knowledge is empowering and the more you can learn while earlier you're in a training position, even just being educated about what technology is out there, what are the options and who tends to choose it and is it gonna work for me? Just even just having the knowledge, forget doing the procedures or going through the process. Once you have that knowledge, as you proceed through your training, you can see and tell, this may not work for me. This is right for me. This is something I should maybe talk to an expert about. So if you have that knowledge, you can go through the process much more informed, much better, and even seek much more support in the process. 

Dr. Joseph: I would encourage you to think, let people think about, um, you know, different milestones and what you want in life to start being in parallel. I'm not saying that it should take up a whole lane as it's going in parallel, but you know, from a relationship perspective, you know, instead of saying, I will only wait ‘till I graduate before I can even consider dating because I don't have time. You know what, if you had your heart a little bit open to someone good that might be crossing your path. So not to close your heart you know, romantically, for example, in the journey as well, just because you have a very busy professional life ahead. 

Radha Sharma: We really appreciate all this wisdom that's coming our way. I think I can speak for myself. Um, I'm very early on in my medical training, so I think even through these podcasts and listening to the advice that's being given, it's shifted my perspective. You have to kind of take control of what your own journey's gonna look like, and that might not look like your friends or your colleagues, but, um, accepting that uncertainty and accepting your own journey 

Radha Sharma: In the name of the podcast, Maxime, Dr. Joseph, are you thriving or surviving? 

Dr. Maxime Billick: I think if you had asked me like eight months ago, I would've been surviving. But right now it's, you know, the beginning of the summer. I'm on a more relaxed rotation. My egg frozen eggs are tucked away. I think I'm thriving. 

Radha Sharma: Love to hear it. 

Dr. Joseph: Yeah, I think again, about eight months ago or a year ago, I was very much in the survival stage coming out of COCIVD, coming out of being an ER physician in COVID, ground zero hospitals and the isolation, lockdown, all of that. But today I can safely say I'm definitely more on the thriving end of the spectrum. Just finding balance in clinical career, finding more balance in personal life, coming to terms with singleness, but that is still not stopping me from pursuing relationships and loving people in my life more than ever, and just surrounding myself with wonderful people who are my cheerleaders. So I couldn't ask for more. 

Radha Sharma: Amazing. I'm really, really happy to hear both of you are on that, on the up and up as they say. We just wanna give another huge, huge, huge thank you to our lovely guests. It was so amazing to just sit down and talk to you both so openly today, and hearing your journeys.

Radha Sharma: You can find additional information about some of the subject matter that we discussed today, both on our website and also we will link some articles related to what was talked about. 

Radha Sharma: This is Radha, Dr. Joseph and Maxime signing off.