Maggie McKay (Host): Welcome to the Obstetrics Podcast. I'm your host, Maggie McKay. Today, Dr. Tiffany Tonismae, a.k.a. Dr. T, tele MFM clinician, OB Telecare, and Maternal-Fetal Medicine Fellowship Program Director at University of Louisville, joins us to discuss the future of maternal-fetal medicine, including access, workforce and innovation. So nice to meet you. Thank you for making the time to be with us today.

Tiffany Tonismae, MD: And thank you so much for having me here today.

Host: Absolutely. So Dr. T, you've talked about seeing patients drive hours for care when you were in med school. How did those early experiences shape the way you think about access to maternal-fetal medicine today?

Tiffany Tonismae, MD: I'm from a small state. So when I say people drove hours, people that live in places like Texas, California, they think nothing of that. But being in Kentucky now, having a patient, having to take off an entire day of work, just to go to a one-hour appointment is asking a lot, and especially when you only have nine months of your pregnancy. And now, I say, "I need to see you every week," that can be really detrimental to a family, especially if that job and that salary is one of the most important things keeping their family afloat. So, having access to care has been something that I've been passionate about early on in my career. And this program has given us an opportunity to allow more patients to get seen without having the burden of travel.

Host: That's awesome. From a clinician's perspective, we often think in terms of 20 to 30-minute appointment, what do you think we sometimes miss about what that appointment actually costs patients, especially in those rural communities? I mean, you mentioned having to take a day off from work, but what else?

Tiffany Tonismae, MD: Yeah. So, I'm also saying you need to have childcare because oftentimes we don't allow kids to these appointments. So, I'm adding the cost of childcare, I'm adding the distance and time for driving, the time they're in the waiting room, the time they're filling out paperwork, all of this adds up. So, a 30-minute appointment can really end up being half of a patient's day. And if they're lucky enough to have a job that allows them to only take a half a day, then great. But most of them, you know, if you take off several hours, you're taking off the whole day.

Host: Right. It really is a huge inconvenience. Telehealth hasn't traditionally been part of maternal-fetal medicine. How has tele MFM changed what's possible for patients and for clinicians? And what surprised you most about it?

Tiffany Tonismae, MD: So, I think the hardest part about the MFM world is that there are so few of us and patients are getting sicker and sicker. So, there's not enough MFM doctors in most cities or states to see every patient possible, let alone those cities that, you know, maybe somebody doesn't want to work there or be the only clinician in that area.

So, having this OB telecare has really allowed the opportunity for smaller towns, smaller hospitals, to have the experience and the expertise of a high-risk doctor without having to worry about, you know, paying one person to be there. What happens when they go on vacation? How do I convince somebody to even come to this area as well?

So, I think about that more and more in the rural south areas, especially with all of these changes in abortion care and reproductive rights has really allowed physicians from all over the country to be available for patients in any hospital, any city.

Host: How long has this been offered?

Tiffany Tonismae, MD: So, we really did start just last fall, so we still are new and we started with one hospital. We are rapidly expanding as we are showing that access to care is really important both to patients and to those OB providers that want a backup person to call for additional advice.

Host: There's sometimes a misconception that telemedicine replaces local care. From your experience, how does tele MFM actually change the relationship between MFM specialists and onsite OB teams?

Tiffany Tonismae, MD: So, I really think that we're more of an accessory care to that OB-GYN. So, the OBs are still seeing the patients daily, actively in the hospital or in the clinic perspective. So, we are there to guide them on best practices, guide them on nuances of care for patients that may have riskier issues or need help with medication, some of these things that aren't part of the general OB-GYN knowledge bank that they need to have an MFM to come and assist. And this can be as easy as, you know, "I have a patient with high blood pressure that I'm really having trouble getting her controlled. Can I have some advice?" Or a diabetic who really needs a lot of attention to adjust their insulin. So, it's not always these patients that are actively sick or actively laboring, but sometimes just a little bit of extra help and a physician to see that patient along with the OB.

Host: As a fellowship program director, you're training the next generation of MFMs. What are you seeing in terms of interest in the field? And what excites you most about the future of the MFM workforce?

Tiffany Tonismae, MD: I am very interested to see how this telemedicine can grow, and one of the things we've talked about is. Education and training, especially when we're thinking about the sonographers that we need to work with. And one of the things I'm so excited that OB telecare has started working on is having a sonographer that can go out and teach ultrasound techs in hospitals that don't routinely do these high-risk OB images so that we have people on the ground who not only can get the images for us, but now we can see them and interpret them from afar.

I think that that's going to be really important for a lot of states that are struggling to get OB providers, MFM providers, but also allow a chance, maybe even for some portable ultrasound imaging studios. So if I had a perfect world, I would have a mobile bus that just had a sonographer and a machine that could go around from different towns and allow us to virtually do these appointments without having to worry about a doctor driving back and forth.

So, I really think that that's important for fellows to learn and important for fellows to consider, when they are thinking about their career, because social aspects of healthcare are so important for us to be paying attention to.

Host: Absolutely. For residents considering maternal-fetal medicine, what should they know about how the field is evolving, especially with new models like tele MFM and more flexible ways to practice?

Tiffany Tonismae, MD: Absolutely. I think a lot of it is about the counseling appointments, so we're not getting those appointments that are five, 10-minute time slots. My patient appointments are 30 minutes to an hour because it really takes time to get to know that patient's history, get to understand how their social life and their family life affects their care, and really you're trying to do a lot of work and improve the outcomes in such a short period of time for their pregnancy.

Host: Well, this has been really fascinating. I mean, I learned so much already in this short time. In closing, is there anything else you'd like to add?

Tiffany Tonismae, MD: I think that hospitals are just now getting the tip of the iceberg with what our services can provide. I'm excited to watch this company prosper and grow. And I'm just excited to be able to offer these services to places that wouldn't be able to have us in the past.

Host: Well, thank you so much for your time and sharing your expertise today. So informative.

Tiffany Tonismae, MD: Thank you so much for having me.

Host: Absolutely. Again, that's Dr. Tiffany Tonismae. As Dr. T shared today, improving access to maternal-fetal medicine isn't just about technology. It's about meeting patients where they are, and supporting care teams with the expertise they need when they need it. As maternal care continues to evolve, models like tele MFM are helping expand access, strengthen collaboration, and improve outcomes for high-risk pregnancies across a wide range of communities.

If you'd like to learn more about how OB Telecare partners with hospitals to deliver maternal-fetal medicine through telehealth, visit obtelecare.com. I'm Maggie McKay. Thank you for listening to the Obstetrics Podcast from the OB Hospitalist group.