The Modern OB-GYN

How two local doctors approach care, technology, and access

By Anna Faller | March 16, 2024

The field of medicine is in constant flux, and women’s health is no exception. In the last three decades alone, we’ve developed technologies for breast cancer detection, approved emergency contraception, and implemented critical research to decrease deaths from heart disease.

In other words, obstetrician gynecologist (OB-GYN) services aren’t just for pregnant people. They’re part of a comprehensive field that can help keep patients healthy through each stage of life.

Discourse surrounding reproductive health, however, is still largely hush-hush. To kick-start the conversation, Northern Express sat down with two providers from Bay View Obstetrics & Gynecology in Petoskey—Dr. Kara E. Cockfield, M.D. and Dr. Deanna Angers, D.O.—for expert insight on high-tech treatments, modern health concerns, and advice for being proactive in an ever-changing medical landscape.

Advocating & Expanding Access

With more than three decades of experience between them, Drs. Angers and Cockfield are dedicated to representation in healthcare.

“Though we’re learning more things all the time, I feel like women are largely undervalued in society,” Angers notes. “We need people to advocate for us. That really appealed to me.”

According to the Association of American Medical Colleges, 37 percent of “active physicians” in the U.S. are women, as are 47 percent of residents and fellows. Just over half of practicing OB-GYNs are women, with 82 percent of residents in the pipeline. (The office at Bay View, from the front desk to phlebotomy, is entirely female!)

Though both doctors were originally attracted to the nurturing aspects of the field, they stayed for its complexity and the opportunity to make lasting connections with patients.

“I get to see women throughout the different parts of their lifespan,” Cockfield says. “To see patients grow their families or become moms is really empowering, and I feel really privileged that I’m able to do that.”

Over the years, Cockfield and Angers have also seen technological advancements change the healthcare game.

It all starts with preventative basics, like annual exams, as well as baseline imaging, including ultrasounds, hysterosonograms (that’s an image of the entire pelvis), and even 3-D ultrasounds for those who’d like a full view of their growing fetus. Through use of robotic instruments, providers can also perform more complex procedures, including ablations to treat heavy menstrual bleeding, dilation and curettage (D&C) to remove abnormal tissue, hysterectomies, and even Botox to support bladder function.

Other newer gadgets include a colposcopy machine, which Angers describes as a “fancy camera” that creates microscopic maps of the cervix, as well as the MonaLisa Touch laser, which promotes vaginal health and lubrication.

On the horizon, Angers highlights genetic screenings—which can be crucial for catching cancerous genes, like the insidious BRCA or Lynch Syndrome (a common form of colorectal cancer)—as well as implementing genetic testing for babies as a standard of care.

“Just increasing access to [those technologies] has been awesome,” Angers adds.

Menopause & Anxiety

Modern advancements aside, both physicians agree that women’s health deserves more space in the spotlight, and, in a region where a significant percentage of the population is over 50, menopause is a prime example.

Symptoms range from the telltale night sweats, hot flashes, and vaginal dryness (“the big three,” Angers says), to loss of libido, brain fog, and fatigue. Cockfield also notes that as production of estrogen dwindles further, the resulting imbalance can cause other long-term complications, like bladder prolapse, sleep disruption, and even osteoporosis.

At Bay View, treatment for menopausal discomfort starts by determining the patient’s stage. To address early symptoms, like hot flashes, Cockfield recommends considering breathwork and meditation, which help lower heart rate. Certain vitamins and supplements can also mimic the effects of estrogen, while hormone replacement and bioidentical therapies are also available by prescription.

From there, the patient and provider collaborate to choose a course of treatment, all the while adjusting for variables like side effects and existing health conditions. “You want to anticipate and prevent complications. Not every answer is the same for everybody, so we try to make it an all-encompassing conversation,” Cockfield says.

Anxiety is also an undersold issue, especially for younger patients.

According to the National Institutes of Health (NIH), about 31 percent of U.S. adults will experience an anxiety disorder in their lifetime. Though it’s a condition that also affects countless men, hormone fluctuations—in particular those that accompany pregnancy, postpartum, menopause—often play a critical role. Further, Cockfield observes that while mental health awareness is on the upswing, treatment catered to women’s needs largely has yet to enter public discourse.

“I haven’t seen any great push of good ideas to help women deal with [anxiety], so that’s something I deal with every day,” she adds.

Lack of information—or even misinformation—is another biggie, especially when considering complex conditions like polycystic ovarian syndrome (PCOS) or endometriosis.

These disorders are neither new nor novel. In fact, they each affect about 10 percent of people of child-bearing age. But they are tricky to spot, as both come with a long list of symptoms, and can permanently affect fertility.

The problem, says Cockfield, arises when patients fail to collaborate with medical professionals, and instead refer to the internet as their primary source of information. “Google can lead you astray,” she says. “I think just being aware of what’s normal and addressing that with your doctor is important for [care].”

Prevention & Persistence

When it comes to taking charge of your healthcare, both doctors underscore the power of preventative action.

“Not everything is within our control, like our age, genes, and those kinds of things,” Cockfield notes. We can control our habits though—in particular, the basics, like a balanced diet, daily movement, and getting adequate sleep. “I think everyone knows that those factors are important, but you’d be surprised to what extent they can keep you out of the doctor’s office,” she says.

Routine gynecological visits are another key piece of foundational care. Touching base with your gyno not only encourages a healthy lifestyle but also opens the floor to topics we might not know how to approach on our own, like cervical cancer screenings, contraception options, or the best age to start getting mammograms.

“It’s all about setting up an appointment when you’re healthy so that you have a baseline [for your body]. Then, if there is something you’re concerned about, we can be there for you, too,” Angers says.

And if your concerns are being dismissed, both doctors encourage their patients to voice them louder. In other words: don’t take no for an answer, especially if you’re experiencing something that’s changed or is atypical for you.

“If you have a concern, ask about it. There are no wrong or silly questions when it comes to the preservation of your own health,” Angers concludes.

The Challenges of Rural Healthcare

Bay View is one of just a handful of obstetrics and gynecology groups between the West Branch area and the southern U.P. Consequently, many patients travel hours for the care they need, which can be both inconvenient and even dangerous for those with critical conditions.

On the bright side, the rise of telemedicine has also allowed Bay View to reach patients whose local communities lack specialized healthcare resources.

“We’re really just trying to move with the needs of the community and grow with them in whatever ways they need,” Angers says.

But that doesn’t mean everyone can access care. Fewer specialized practices means there are fewer OB-GYN physicians overall in the region. Per Angers, demand for OB-GYN services remains high, as an increasing percentage of the population seeks care outside of their fertile years. Bay View’s partners, for instance, carry full caseloads, which equates to more than 20 patients per day.

But that’s not the only factor contributing to shortage of OB-GYNs; the Association of American Medical Colleges found that OB-GYN applicants in states with strict abortion laws have dropped more than 10 percent following the overturn Roe v. Wade.

Cockfield says that the ruling hasn’t had a significant effect on reproductive care in Michigan—for now. Instead, she highlights lack of professional autonomy, and in some cases, salary cuts, as two primary deterrents for students considering a medical career.

Petoskey, though, is a popular location and historically, hasn’t struggled to fill open positions. “Thankfully, we’ve had enough of a demand of [providers] who’ve decided to pursue a career here that we’ve had the luxury of taking new doctors in as we need them,” Cockfield says.