In today’s fast-paced world, medicine has become very disengaged. It is an assembly line, and building patient relationships seem to no longer be a priority. This is especially true in women’s sexual health, where not only hospital systems but also venture capital companies do not value it. Dr. Rachel Rubin has observed this and made it her mission to create value where no one is. After a career in urology, Dr. Rubin found a space in the healthcare delivery ecosystem to provide different and better care. With a focus on male and female sexual wellness, Dr. Rubin is building different kinds of relationships with her patients and making a difference. She joins us in this episode to discuss how she is reinventing the model by creating a patient-centered model for treating sexual wellness. Tune in to not miss out!
Listen to the podcast here
Why We Need A Patient-Centered Model For Sexual Wellness With Dr. Rachel Rubin
Reinventing The Model
She’s a spitfire. Isn’t she?
I’m blown away by the conversation we had with Dr. Rachel Rubin. First of all, I love when there’s another physician on, and you guys go into this mind meld of all the things you know and speak about with such intelligence. This is a physician who has created a business with a different model for being a doctor, which is fascinating. She has said, “I’m not going to take insurance.” Like that or not, that’s the choice that she made. She’s in the DC area, and she spends an hour with patients.
That is unheard of at least in my neck of the woods. I also find it fascinating how super specialized she is in the sexual health world. This is something that she had to pursue actively because it’s not something that we’re taught in med school or in residency in any sort of volume.
One of the other interesting things she said, which was a new perspective, is we speak to so many people focused on women’s health. Because she’s a specialist in urology, she sees a lot of men and she’s able to see a lot of couples. Having an understanding of both physiology and the emotional pieces, and having enough time to learn about their relationship have enabled her to make an impact on some of these relationships. I think everyone will be blown away by her energy. We could have talked to her for hours. It’s exciting to see someone doing something so different and doing it successfully.
We are so excited to have our guest for this episode, Dr. Rachel Rubin, who is a quadruple threat. She’s a practicing physician, researcher, and business owner. She’s perfect for us on the show, which is the intersection of everything. Welcome, Dr. Rubin.
Thank you. I’m so thrilled to be here. What an honor.
Tell us a little bit about your practice. As somebody who’s been part of a huge multi-specialty group for my whole career, I’m very interested in the structure that you’ve created in your own practice.
Medicine is very broken nowadays. Everyone knows it. We all talk about it quite often, and I can’t fix it myself. The 10-minute visit and the doctors who are seeing 30 patients a day, it is an assembly line. It is McDonald’s. It’s impossible. Even when you care, you know a lot, and your heart is in the right place, you cannot give your all. You feel horrible at the end of the day. When I did my sexual medicine fellowship, the only way I can be successful and do a good job is by getting to know my patients. If I don’t spend time with my patients to find out, “What are your goals? What are you bothered by, and how can we make things better?” I can’t be successful in the work that I do.
I made a decision very early on. I said, “I cannot beg insurance companies to value this work.” Nobody will ever value sexual medicine, let alone women’s sexual health. I treat about 40% men, and so the work that I do is not valued. It’s not valued by venture capital companies and by hospital systems. It’s not valued by anybody. I had no choice but to hang a shingle and say, “Everybody, leave me alone. I’m going to practice medicine my way. Nobody is going to tell me how hard to work and how much time I can spend with a patient. Most importantly, no one is going to tell me my value and how much money they think I deserve to make.
If you build it, they will come. I do mean the pun intentionally there. Patients want time and expertise. They want someone who gives a crap about them, and that’s my thing. I always tell people, “I have two things that make me magical. I have no magic to offer you, but I spend a lot of time getting to know you and I genuinely care about you as human beings. I have to get to know you to figure out how I can help you.” It’s been incredible. People get it and it stinks because I only have so many hours in the day, so I do have a long waiting list. I have two small kids and I’m trying to learn what self-care means. It’s been the best year of my life building this practice.
Prior to building this, what situation were you practicing in?
I was working as an employee at another practice. It’s not quite the same but a similar model. For lots of reasons, I decided I wanted control and learn the business side of things. I wanted to make my own decisions, and approve my own worth to myself to say, “This is what I want to do. This is how much time I want to spend with people, and not have to answer to anyone else.” I always joked, “What do I know about business? I’m a urologist.” It’s very overwhelming but I had this moment of, “Wait a minute. I learned how to do penile implants. How hard can QuickBooks be?”
What I have realized has been the incredible community that exists around entrepreneurship, which as a surgeon, a urologist, and a woman, I never had any insight into. I joined a couple of communities that have blown my socks off of other incredible humans who want you to succeed. Your successes are their successes. Your failures are their opportunities to help you. Everyone is going to have challenges. There’s no business or no entrepreneurship journey that doesn’t have problems. It’s how you see them as opportunities, how you move forward, and pivot.There are incredible humans who just want you to succeed. Your successes are their successes, and your failures are their opportunities to help you. Click To Tweet
I’m in this because I genuinely want to practice good medicine, and nobody else will allow me to do that. My biggest problem is that I don’t like that I have a waitlist. I want to see people that are suffering sooner. I do have to figure out how to grow, train others, and build bigger what I’m a little afraid to build because I love how small it is and how I have control. I got lots of problems, but they are so much fun. I’ve never been in this space before. This is very new for me.
It sounds like you need to clone yourself a couple of times. Do you take insurance? If not, do you get pushback on that? In my practice, if we don’t take their insurance, they’re not coming. I think that’s what we’ve trained them to do.
I don’t take insurance. As I said, I cannot fix medicine right now. For people who have out-of-network benefits, we give them superbills. I’m in the Washington DC area where there’s a concierge doctor everywhere. It is a little bit more understood in this area. You are a gynecologist who takes care of all things, does annuals, and sees people more regularly. I think of myself as that super specialist where people are like, “I’ve seen twenty doctors. I’ve already done all these things.”
I see challenging things. Challenging patients are different when you have time. It’s challenging for someone who only has ten minutes, but when you have an hour, it’s much easier to be a detective and educate, figure out what’s going on, and get a good diagnosis and plan. I love the challenge. In the DC area, I tell all my referring providers and it’s an incredible community in DC. I always say, “I’m Dr. Rubin. I do the shit you don’t want to do.”
It’s not that you don’t want to do it. It’s that you don’t have time for it. You got twenty people waiting. For that person who has had 30 years of pelvic pain or has that little libido complaint, I genuinely care about the libido complaint. You do too, but you don’t have time for it. You don’t have time to go into it deeply.
It has allowed me to be a trusted referral source because of that. I always joke, “It’s the third person who tells you about me when you finally make the appointment, and then if you have to wait, you’re pretty annoyed.” It takes three people. “What do you mean she doesn’t take insurance? Wait a minute. I can’t do that. I don’t X, Y, and Z.” You then hear the stories. You see the testimonials and you hear people.
I have to remind myself of its value when I see people coming back who said, “You saved my relationship. I feel like myself again.” My favorite is people come back and say, “Dr. Rubin, I came to see you for pain with sex. It doesn’t hurt anymore, but I didn’t think I would like it again. I didn’t think I would want it again. I didn’t ask you for that.” It’s those stories. How could I not do this work? It is so rewarding. It’s so valuable. We got a lot of entrepreneurs here.
My dream is to have a billionaire come in and give me a huge center where we do provide free or discounted care so that I can train people how to do this and do fellowships. In the female sexual medicine space, it’s very challenging to find funding. In the male sexual medicine world, there are a lot more funding opportunities for fellowships. We have 27 fellowships that focus on men’s sexual health and one fellowship in the entire country that even acknowledges women’s sexual health.
I have so many questions. One of them you just answered. I wanted to know from your experience, and certainly in ours from a business and investment perspective, if there’s an enormous difference between what people are interested in. I find it fascinating because you hear the old rub that doctors aren’t good business people historically. Now, people like both of you have figured out how to take those skills and make changes where you can in the system. You are a specialist. I’m curious, with an hour, do you become a therapist, hairdresser, marriage counselor, and fashion consultant? People don’t have those experiences where you have an hour with someone who is so clearly interested in your well-being. Your energy and passion literally leap off the screen.
I’m a nice Jewish gal. We go to church. It is so transformative to see people sitting there. At the end of the visit, you see this moment of, “I’ve never had a conversation like that with somebody. I’ve never gone there with someone. I just told you things because no one has ever asked me the question.” Even personally, I have never had a doctor who has any element of curiosity about my libido, my orgasm, my pain, and my sexual health. They all know what I do for a living because I never stop talking about it. If they’re not asking me anything, it doesn’t happen.
When people come to see me, it is an incredible moment. I had a young man come to see me. He had saved a lot of money. He had a very complex issue. I talked to him about it. We had a great plan together. He looked at me and said, “Is this the other half lens? Is this how people experience life?” I said, “I have patients who are billionaires and patients who are doing GoFundMe who come to see me. I’ve had patients who needed surgical procedures. They have had churches do GoFundMe. That woman is pregnant right now from the old-fashioned way. He’s able to have the marriage, the life, and the things that she wanted to.” It was a very good story.
The problem is even when you have a lot of money, the training is not there for doctors to give you that good care. That’s what I’m trying to change. That’s why I speak so loudly. That’s why I’m involved with societies that are focused on the evidence because there are a lot of people who are willing to take your money but aren’t necessarily backed by a lot of evidence and high-quality care. Women are accepting of that as opposed to pushing to say, “Why don’t we have more evidence? Why aren’t we holding medicine and science to a higher standard?”Many people are willing to take your money but aren't necessarily backed by a lot of evidence and high-quality care. Click To Tweet
It must be hard to juggle female sexual health and male sexual health. It almost sounds like it’s a little bit of a 50-50. Do you find that difficult? They both are large fields with lots of complexity.
I love it because I take what I know from men’s sexual health and urology. It’s all homologs. The head of the penis and the head of the clitoris are exactly the same. The vulva or labia majora and the scrotal skin are exactly the same things. All the pathology overlap, and we can take what we know from one and work with the other. I’ll give you a perfect example. Low libido. We think of men as having all the opportunities in sexual medicine, but we don’t have FDA-approved products other than testosterone for men with low libido.
We got two FDA-approved products for women that work with about 60% of women who take them. They are wonderful and fabulous. Guess what? They work in 60% of my male patients who take them. They work fabulously in men. We do borrow a lot. Because I see all genders, I can help navigate any love triangle that comes into my office. This is the problem with the world. All my colleagues fix all the erections. They get them bigger, harder, straighter, and stronger. There’s no place for them to go. If I help one side, it’s hurting the couple. If it is a couple, it’s hurting people. I see many couples. I see many patients and I see both of them.
It’s lovely to have that insider information to say, “She doesn’t get pleasure from X, Y, and Z, and that’s what gives you pleasure. Can we come up with a compromise?” I do a lot of counseling. I do a lot of psychology. It’s not really psychology. I’m not a trained therapist, but because I talk to people and I genuinely care about people, I’m a little bit of a psycho-urologist. I’m going to do a little bit of therapy, but it’s also getting people to talk about things from a biological perspective that they’re not so comfortable talking about. Devices like sex toys, I make them medicine. To anyone in the sex tech industry, thank you for what you do. You’re doing incredible work. Sex tech nowadays is amazing.
It’s introducing octogenarians into sex tech and saying, “You want oral sex. Your 80-year-old wife does not want to give you oral sex anymore. What about this device that feels like oral sex? It’s a win-win. Here’s what it looks like. You don’t have to worry about your arthritis anymore.” It’s bringing that into the conversation as though, “Your diabetes makes it harder for you to orgasm. How can we get you to have more pleasure?” “I make sex boring. It sounds like diabetes and high blood pressure.” It gets people able to talk about it with their partners in ways that they’re shocked that they’ve ever been able to do that before.
Here’s the top flash. The US concierge medicine market is expected to reach 13.3 billion by 2030. Concierge medicine being a subscription-based model rather than an insurance model.
Here’s what I want to do. When I started in this space, my kids were 9 and 12 on the business side and talking about vaginas and sexual pleasure. Now, they’re adults. I would love your kids to sit with my kids, and they could tell them what they’re in for in terms of people stopping you. I’m not a physician. I don’t even play one on TV, yet the questions people asked you. I think your point is so well taken. I see this every time. Anytime someone gets to speak with Alyssa and see how she listens, she’s clearly a different and better kind of physician than most people have had the benefit of going to. It’s the same with you. They feel like it’s manna from heaven. They want to ask all kinds of questions.
When I was in my first sexual health business, we were like at The Who concert. We are going to be trampled because even though we just had information on the business side and enough physiology to be dangerous, the pent-up desire to have someone to talk to about these complex issues is overwhelming. Besides those I could see who wouldn’t want to go to you, I want to move to Maryland so I could be your patient in terms of energy. There’s also a feeling in medicine and you just described it, Rachel. I’m curious for you, Alyssa, have you seen this weariness that physicians have had or are experiencing through COVID, having been on the front lines, having been understaffed, people are not coming back to work, and doctors are retiring? This is also a pandemic for our medical care.
I couldn’t agree more. I see people feel burnt out and you can see it in their day-to-day behaviors. I think that our staff is limited because so many people just left or don’t want to work any further. That was why I was honing in on Rachel. What was your impetus to start your own practice? In part, it’s probably because you wanted to take control of what turned out to be a pretty rough situation for a lot of us in healthcare. I wanted to back up a little bit because in med school maybe we get 30 minutes in sexual health. Maybe 15 of that is for contraception, and the other 15 is for STIs. Tell us about your training. What extra training did you do to have such expertise in this field?
I did four years of medical school. I did urology training, which is five years of surgical training to become a urologist. We’re penis doctors, but we do kidneys, bladders, urethras, prostates, and things like that. I would say I got some men’s sexual health knowledge in that work. I was at a conference presenting on prostate cancer research, and went to a course on female sexual medicine that my mentor, Irwin Goldstein, was teaching. I was an early resident and had sat in his course. I had this moment of, “This is my people. This is what I want to do with the rest of my life.”
I ended up doing that fellowship with Dr. Irwin Goldstein. After five years of urology training, I spent a year out in San Diego, training, learning, doing research, and doing incredible work in both male and female sexual medicine. From there, it has been a passion of mine. I’m very involved in the ISSWSH, The International Society for the Study of Women’s Sexual Health. I’m the Education Chair. It’s all things evidence-based, advocacy, and education. That course that I went to as a young resident, I’ve been teaching it every year with Dr. Goldstein since I graduated.
It’s so incredible to be this early in my career, and to be able to be a voice, to be loud, and to make real change. It’s sad because it’s a wide open space. There’s room for all of us because there are so few people who make this work something that they’re passionate about. I do see male patients. My social media presence ends up being very female-focused because there aren’t that many people with megaphones in this. There are a few, but not enough.There is room for all of us because there are so few people who make this work. Click To Tweet
I bet you couldn’t imagine when you were in medical school with the 62 seconds that you both got on sexual medicine saying, “My social media platform is very feminine.” It’s a whole brave new world from probably how you were trained to do this and what you’ve built. How do you interact with the industry? You talked about you’re involved in some of these societies that I know Alyssa is also involved with. Are you finding that in your field, given your platform and how clear you are, you’re getting inquiries from large companies who want to figure out how to take some of your knowledge into their product development?
I’m starting to get a lot more of that. I’ve gotten a lot more exposure than I ever had before. There was a big New York Times article that had a picture of us talking about the work that we were doing. I don’t recommend that if you like your email to be organized. That did see a big increase. I have seen more of an increased interest in certain industries. It’s very interesting because we need the industry to care about this. We need the industry to invest in good high-quality research and products. It’s not that beneficial for them to do that all the time because you can make a lot of money without doing that work, evidence, and research.
There are so many opportunities to do high-level research and get a better understanding of these supplements, medicines, devices, apps, and telemedicine, but we don’t often put them to the test to say, “Let’s research this. Let’s look at this.” I’m particular with who I do work with. Every once in a while, companies want to design a study. We have a couple of research projects that we’re working on. To give you an idea, during the pandemic, we’re doing a pelvic floor botulinum toxin study. There are a lot of companies that stopped the study early because they said, “We had a change of leadership, and we decided women’s health was not a priority.”
They said it on the phone out loud. I heard it and my colleagues heard it. It was a magnificent study that showed many of the few things that have changed my practice fundamentally. It is a pelvic floor botulinum toxin. There are different brands, but botulinum toxin into the pelvic floor for the correct patient. Not everybody would do well. It has changed my practice. It’s things like that that I try not to get too excited about the industry because what I have seen, the venture capital industry will flip on you real quick. You’re the golden child until you’re not the golden child. That’s why building my own business has been so rewarding. I don’t know what it’s going to look like at the next stage of it all, but we want more industry to care about this. We want to encourage them to do more research.
There has always been this thought of, do you sell products in your office or not? Is there any conflict? What’s your feeling about that? If you do, do you have any favorite go-tos?
I have. I just got started a year ago and I’m doing it all myself. I do payroll. I do everything. I do order supplies.
We used to joke. I had a Costco card, so I was VP of Operations and Supplies.
I am also VP of Operations, and Costco gloves are awesome. I use the Chux puppy pads. They have many uses. I’m doing it all. I don’t know what it’s going to look like a couple of years from now. I don’t sell products in my office. I do have a lot of products of things that I’ve learned that patients love over the years. I have curated all tips and tricks and things that I have known. I love devices because I love learning about them.
Strangers will email me and say, “Rubin, we found this device. My husband had prostate cancer, and this device was life-changing for us.” They know they can email me those things because they can’t tell their girlfriend. I do have a lot of things that I love. The other thing is if I am in with a product specifically, it’s a little bit challenging because you want to have some ability to use whatever or change your mind. I don’t have any Rubin-branded sex toys. Who knows? Maybe in the next decade or something.
Speaking of the next decade, when you look forward, you were shot out of a rocket ship in the past. You’ve built this, and they are coming more than you can handle. Where do you see yourself being five years from now? Have you cloned yourself as Alyssa said? Have you changed how people are trained when they’re doing urology fellowships?
I’ve learned a lot about limiting beliefs. I’ve never thought of myself as a dreamer. I’ve never thought past now or even seen the vision of what it looks like. I have been trying to push myself because I’ve already succeeded past my wildest dreams that I didn’t even have. I didn’t think I was smart enough to go to med school, and now I’m a doctor. I didn’t think I could be a surgeon. I never thought I would match into urology and here I am, a urologist. It’s a wild world to think you can’t do something and then do it well. I got to work on my own mental issues. Self-care and mental healthcare are all good.
In terms of the future, my dream is to have a place where I can train people how to do this at a high level, and where I can have a research center. I can tell you about the thing I’m most proud of. The thing I am most proud of is that a year ago, I made an announcement that I wanted to mentor and support as many medical students as I could humanly find and cultivate. Every month I have a mentorship research group. We call it the Sexual Medicine Research Team or SMRT. We meet once a month. It is a research and mentorship group.
I have over 100 students that are involved. It is growing like wildfire to the point where they have now created a board. We have two presidents, a vice president, and a research coordinator. We have no funding. We have nothing. These are medical students who give a crap about this stuff. We’re going to do projects together. We’re going to do advocacy and education projects. The sky is the limit. I’m going to make them write books so that we can get funding and pay for their travel to go to conferences and speak.
My dream is to replace myself with people. It’s not about me. It’s about the fact that this field needs to be legitimate. It needs to be infiltrating every department and every practice to say this matters. Sexual medicine matters, and we believe that we can practice good medicine. For all you billionaires, thank you for being billionaires. That is the thing. I need to learn how to be a better mentor, how to manage people, and how to manage big projects.
I am making it up as I go along. It’s so fun to let these medical students know that it doesn’t have to look the way that they think it has to look. It doesn’t have to look in the broken system. They see. They’re watching me. They’re watching my colleagues and my friends. I have a lot of friends on the cause too. It is infectious, and they want to do this. That’s the thing that gives me the biggest pride and dopamine.
The good kind of infectious. It’s amazing. One of the things you said earlier is when you think of all the quotes, and I’m sure Alyssa had crazy things said to her too. When I started this business, I was doing customer service. I’d pick up the phone and I was working for a particular product, and someone said, “This stuff really works. Thank you, God.” When I had to travel when my kids were little, I would say, “Mommy is going out to do God’s work.”
You use what you can, but just the enthusiasm and the passion. One of the reasons I love being in this space as a business person and doing this show with Alyssa is because we meet people like you who have this energy and passion that could bull you over in the most positive way, and make you feel hopeful about a future that looks better and different than where we are right now.
Best of luck to you, Rachel. Your energy is literally contagious.
You have so much work to do that you could cry every single day. We had a full-page spread article in the New York Times in 2022. It’s the basic level. It was a full page in the science section. The magic that it said was, “We give women a mirror and we teach them about their own bodies.” That was a full page in the science section in 2022. Am I grateful for the exposure? Of course. It was so kind and lovely. It’s a wonderful article. That’s what makes full-page science. It’s women looking at their own bodies and learning about their own tissue.
If you distill down to what I love so much about my job, it’s that I take brilliant, educated, and incredible humans. I teach them the basic anatomy and physiology of how it works and how we can make it work better. How can hormones, dopamine boosters, and pelvic floor physical therapy help to make you have more fun? Sex is supposed to be about fun unless you’re trying to make babies, which I don’t recommend. I have two. It’s a challenging thing during a pandemic to have babies.Sex is supposed to be about fun. Click To Tweet
That’s a whole other segment.
That’s a whole other show, the fun parts.
Thank you so much. We appreciate you spending some time with us.
Thanks for having me.
About Dr. Rachel Rubin
Dr. Rachel S. Rubin is a board-certified urologist and sexual medicine specialist. She is one of only a handful of physicians with fellowship training in sexual medicine for all genders. Dr. Rubin is a clinician, researcher, and passionate educator. In addition to being education chair for the International Society for the Study of Women’s Sexual Health (ISSWSH), she serves as associate editor for the journal Sexual Medicine Reviews. Dr. Rubin completed her medical education at Tufts University, her urology training at Georgetown University, and her sexual medicine fellowship training with Dr. Irwin Goldstein in San Diego.