Dr. Jeffrey Sicat, a licensed obesity medicine specialist, says he takes a team approach in working with people to lose pounds and then maintain the weight loss.
On-the-job stress and burnout are issues often faced by physicians, but overall, they’re where they want to be. A 2019 survey by the American Academy of Family Physicians and CompHealth found that 71% of respondents were happy, and 61% would become physicians again if they had a do-over. But what if there is an even sweeter spot out there? Here are two Richmond physicians who fine-tuned their careers and found greater professional satisfaction in the process.
The Next Step
It’s great to help patients take control of an aspect of life, but what if you can do more?
For Dr. Jeffrey M. Sicat of Virginia Weight & Wellness, success in helping people manage diabetes early on in his career two decades ago meant getting their blood sugar levels down and lowering their blood pressure.
But that approach ignored another number that was just as important, and maybe more so in determining overall health: their weight. “In the past, if I could help someone improve their diabetes numbers, I’d be so excited: 'Your sugars look great, your blood pressure is at goal, you’re this, that and that,' ” Sicat says. “But in the process, they might have gained, you know, 20, 30, 50 pounds, just because when you start insulin on people, it can cause pretty dramatic weight gain.”
But some patients showed amazing weight loss, he says, and with that came multiple benefits. These were obese people who were taking insulin and other medications, who had sleep apnea and other ailments, and when they dropped 30, 50, 70 pounds, “it really just reversed all those things,” he says.
They no longer needed some medications and were generally healthier. Their life-changing experience was an aha moment for Sicat. “It really just opened my eyes. Gosh, if you can really get skilled at this field, oh, the things you can do with our patients.”
Sicat can empathize with his patients: After being active and an athlete through college and early in med school, he gained about 50 pounds over five years in residency and the early years of his practice. Stress, crazy hours and lack of sleep, moonlighting to pay off student loans — all of this contributed to an unhealthy lifestyle that crept up on him. “When you’re living life, you don’t realize how things impact you,” he says. “In retrospect, it’s very clear to me why that happened to me.”
Weight loss and keeping weight off are very different processes. One problem is that when you reach a maximum weight and it stays there long enough, the body perceives that weight as where you are supposed to be, Sicat says.
The human body, conditioned by thousands of years of dealing with periods of starvation and famine, is trying to protect us; it doesn’t register what a good weight is for a particular person, Sicat says.
“[It] doesn’t care if that was your normal adult weight, or if that is your healthy weight. Whatever it is, it just knows that you got somewhere, and it thinks that’s what you’re supposed to be,” he says. “So literally when you’re trying to lose weight below that weight, your body is defending that weight.”
That’s why so many who lose weight gain it back — about 80% to 90% of people who lose substantial weight regain it in one or two years.
There are other factors that impede weight maintenance, such as less positive feedback. When you’re losing weight rapidly, you feel and see the difference, as do people around you, who reward you with compliments. It becomes less noticeable over the long term. “No one is saying, ‘Oh, my gosh, you’ve been maintaining your weight,’ ” Sicat says.
His approach is a team effort, to ensure that people looking to drop weight and then maintain that weight loss know it’s a long battle, a chronic disease that requires a multipronged approach addressing nutrition, physical activity, behavior and medication.
Obesity also compounds the impact of COVID-19. Age and obesity are associated with poorer outcomes, leading to a greater likelihood that a COVID-19 infection will lead to hospitalization, being placed on a ventilator or death. It triples the risk of hospitalization, accounting for a third of COVID-19 patients who required hospital treatment, according to the Centers for Disease Control and Prevention.
Unfortunately, stress is a primary driver of obesity, according to Sicat. “Weight is impacted by a gazillion things, and stress is one of them, and it’s been a very stressful several years for people,” he says.
A licensed obesity medicine specialist, the New Jersey native earned his medical degree and completed a residency in internal medicine in 2002 at Virginia Commonwealth University Medical School, followed with a fellowship in endocrinology, diabetes and metabolism. He was a cofounder of Virginia Endocrinology and Osteoporosis Center in 2004, then went into obesity medicine in 2011.
“It’s been wonderful,” he says. “It’s such a gratifying, satisfying field to be in.”
Dr. Boyd Winslow started Winslow Newborn Circumcisions months into his retirement from a full-time practice.
The Kindest Cut
For 38 years, Dr. Boyd H. Winslow was a go-to specialist for reconstructive pediatric urology. He could make a urethra using a graft taken from the lining of a mouth, or craft a new bladder for a child by transposing some colon and stomach tissue.
“I did really big-deal things,” he says. “I love pediatric surgery because, if you think about a successful operation in a baby, think of the number of good years you’re giving them.”
Over the decades, one procedure showed up more frequently on his schedule, referrals to correct bad circumcisions on infants.
For Winslow, it was a burden on his caseload, but for the families of these boys, it was an emotional, traumatic experience, something that he wanted to allay in some way. He put together a visual presentation, descriptions and photos that documented what he’d seen over 25 to 30 years and how he fixed the problem, then he made presentations to various health care facilities and practices.
He had hoped that would result in some positive change, which it did, but in an unexpected way — a sentiment that he describes as, "Hey, he knows this, let's [refer patients] to him."
Now, the semiretired Winslow has a part-time practice, Winslow Newborn Circumcisions.
The practice of circumcision is ancient. The procedure is often performed in the first month after birth, frequently in the hospital within two days after delivery. About 60% of newborn boys in the United States are circumcised, according to the National Center for Health Statistics.
It is an elective procedure. The driving force behind circumcision decisions are cultural, Winslow says. Many families of Jewish, Muslim or Christian backgrounds prefer to have the procedures performed on or as close as possible to the eighth day following birth, as prescribed in the Book of Genesis.
Some of the standards for the procedure in American medicine may lead to complications, according to Winslow. For starters, circumcisions are often performed in the hospital, soon after delivery by the obstetrician/gynecologist. They are specialists most familiar with “female reproductive parts,” Winslow says, “but somehow, by default, they got to do newborn boys’ circumcisions.”
He educates parents on some of the benefits of the procedure (such as reduced risk of urinary tract infections in infancy and reduced risk of sexually transmitted diseases later in life) and potential cons (such as bleeding, pain, discomfort, yeast infections).
Winslow limits his work to the first 41-44 weeks after conception (the average birth date is 38 weeks after conception). Any later, and general anesthesia may be required because of the risk of movement on the part of the child.
He also contends that there are health benefits to that time window. The sucking reflex in infants releases endorphins, which soothes the child. The reflex has generally kicked in by then but is often not there in the first couple days after birth, when many circumcisions are performed in-hospital, according to Winslow. That time frame also brings distance from the stresses on mom and infant from childbirth. The infant is better able to heal and there’s less bleeding, he says.
Winslow performs the procedure with parents present, with the mom sitting beside the child to comfort the baby. “I want this to be as emotionally calm, lacking in turbulence, as it can possibly happen,” he says.
Winslow says he listens to the parents, provides exhaustive answers to their questions and allays their concerns. The emphasis for him is on investing time in working with the family and in the procedure itself.
It’s the least he can do for the family, and for the child, he says. “I’m working on the only penis that that little boy is going to get, and it deserves a few extra minutes of care and making it pain free and making the outcome aesthetically acceptable. There’s no need to hurry for a medical procedure on something that’s that small and delicate,” he says.
The New England native earned his medical degree from Harvard Medical School in 1974, then he served residencies and fellowships at Massachusetts General Hospital, receiving training in surgery, urology, renal transplantation and pediatric urology. He began a 14-year service with the Children’s Hospital of the King’s Daughters in Norfolk in 1981, where he worked with noted Drs. Charles Devine and Charles Horton, developing his interest and honing his skills in genital reconstructive surgery. He also became the hospital’s chief of urology and a urology professor for Eastern Virginia Medical School. Winslow and his family became Richmond residents in 1995. His practice became part of Virginia Urology, then morphed into Children’s Urology of Virginia.
Several months into his retirement in 2016, friends called and encouraged Winslow to continue with the circumcisions, and he returned to practice, working part time. “[I] went back to work on my terms and not as an employee of anybody,” he says.
Now, he works a couple mornings each week. “It’s not terribly taxing on me,” he says.
“I think I’m practicing medicine the way every doctor would like to practice, but they can’t.” —Dr. Boyd Winslow
He also is in demand from other urologists who want advice on how to create a similar business. His advice: Start helping families and obstetrics doctors early on, “so they connect your name with a careful, deliberate, complication-free circumcision.”
He’s at a stage in life where he can do what he wants professionally. “I sleep well at night because in good conscience [I] delivered my very best care. I just wish I never had to hurry through anything.”
This practice has provided great satisfaction to Winslow. “I think I’m practicing medicine the way every doctor would like to practice, but they can’t,” he says. He and his wife have five grown children, so there’s no longer the financial burden of caring and feeding and educating kids to worry about. “I would be petrified if this is all I did when they were young,” he says.
Health care professionals are being squeezed by a system that emphasizes speed, quantity of care and profits, he contends. Doctors are perceived as akin to laboratory equipment, a useful cog in the profit machine.
There’s also a perception that doctors are mostly motivated to enrich themselves, but Winslow says that’s just not true.
“Doctors are being squeezed from every angle,” he says. “To me, it’s still remarkable that so many good people choose the profession, and it truly is out of humanitarian purposes. It’s a wonderful profession because people put into your hands their well-being.
“Each day, it’s not for me, this is for them.”
