Insights from a rural OB-GYN: A Q&A with Tammie Koehler, DO

Join us for a conversation with Tammie Koehler, DO, an accomplished obstetrician-gynecologist and owner of Miami Women’s Clinic in Miami, Oklahoma. With nearly 20 years of experience, she is highly respected in her community for her expertise, compassion and dedication to her patients.

Dr. Koehler’s path to become a physician did not take the typical route. While many people mourn the end of their 20s, Dr. Koehler blew out the candles on her 30th birthday cake with an ambitious wish: finishing her education and pursuing her dream of becoming a physician. She made her wish a reality, completing her undergraduate degree and taking the MCAT, all while raising five children. Her hard work paid off when she was accepted to Oklahoma State University Center for Health Sciences College of Osteopathic Medicine.

Initially, Dr. Koehler planned to follow in her husband’s footsteps and join his family practice. However, her passion for OB-GYN led her in a different direction. For the past 18 years, she has owned a successful women’s clinic, where she provides osteopathic care for thousands of patients from rural communities in Oklahoma.

As a mother and grandmother, Dr. Koehler understands the challenges of balancing family and a demanding career. Nevertheless, her passion for her work has allowed her to pursue her dream of having it all.

How did you make the decision to pursue a career in medicine?

I am married to a DO who is a family medicine doctor. We met while we were both paramedics prior to beginning medical school. He went on to pursue medical school and graduated from family medicine residency in 1990, and we opened a private practice in a little town in rural Oklahoma called Miami. During that time, we had five children. In 1993, when I turned 30 years old, my husband asked me what I wanted for my birthday, and I told him that I wanted to go back to school. At the time, our kids were in elementary school, junior high and one was even in high school. Despite this, I was determined to pursue my dream, so I went back to school and finished my undergraduate degree in biology and chemistry. After taking my MCAT and applying to medical school, I was accepted!

During my time in medical school, my husband took care of our children and managed his practice. My medical school was 95 miles away, so I would come home on the weekends while my husband took care of the kids all week. Fortunately, we had wonderful friends who provided us with a lot of support, and we managed to make it work. After completing medical school, I decided to specialize in OB-GYN and completed a four-year residency in Tulsa. Following my residency, I returned to Miami and opened a solo practice, which I have proudly run for the past 18 years.

What motivated you to choose OB-GYN as your specialty?

Initially, I went to medical school with the intention of joining my husband’s family medicine practice. However, during my rotations, I discovered a passion for the OB and surgical aspects of medicine. Specifically, I found that I loved performing gynecological surgeries and working on the surgical side of OB-GYN. It was a combination of my interests and what I found I was good at. When you’re choosing a specialty, it’s important to pursue what you’re truly passionate about, because the road ahead is long and challenging. For me, that passion led me to become an OB-GYN.

How has your career evolved over time?

It has been a fantastic career. One of the unique aspects of practicing rural medicine is that I work independently, without other physicians present during procedures. As a result, I gained a lot of experience very quickly after graduating from medical school and residency. While there are other physicians in the area, the staff and hospital colleagues have been invaluable in providing support and assistance when needed.

Although I initially found it terrifying to work alone, it has become more routine over time. When I first started, I delivered around 10-12 babies per month, but in the middle of my career, that number increased to 35 or more. At one point, there was a period of 18 months where I had no help, so I was on call 24/7. In the last 10-15 years, I have been on call around 15-16 days per month since there are only two of us. When one of us is off, the other is on-call. It’s a very demanding schedule, but it’s also very fulfilling. One of the most rewarding aspects of my job is delivering babies, and it’s especially fulfilling to see babies of parents whom I delivered earlier in my practice.

How many babies have you delivered in your career so far?  

I have delivered 3,500 babies so far. However, I have decided to stop delivering babies and focus more on gynecologic surgeries, well-woman exams and office work starting in September. It’s a bittersweet decision because delivering babies has been a passion of mine, but my personal life has been limited for the last 18 years due to the demanding call schedule of being in a rural area. I’m excited to have more flexibility in my schedule, and it’s kind of like a semi-retirement for me.

Besides the demanding call schedule, what would you say are some other challenges you face in your career and how have you approached those challenges?

One of the biggest challenges in my career has been practicing in a rural area where back-up and resources are limited. It’s not always possible to decline a case due to fatigue or other personal commitments. This often means that I must take on cases despite my schedule or commitments, which can be challenging. Additionally, maintaining endurance and being available on call 24/7 can be difficult, especially now that I have grandchildren and want to spend more time with them.

Another challenge is dealing with the emotional toll of cases where things don’t go well. While most cases are positive and rewarding, there are times when things don’t turn out as planned. It’s important to remember that as physicians, we can’t control everything, and we must do our best with the knowledge and experience we have. 

Do you have any advice for future physicians who hope to follow a similar career path?

I think that everyone should truly follow their passion and not just what their personal life is going to be because if you’re not gratified in your job as well as your personal life, then it’s going to be an uphill battle. When you find something that you’re passionate about, then I think you should follow that dream. Find a practice that meets your needs personally and professionally but don’t give up just because malpractice insurance is high or because of the hours because it is just so gratifying to do what I do. Additionally, owning and running your own practice can provide a sense of autonomy and the ability to provide patient care in a way that aligns with your values. While it may require a lot of hard work and business acumen, the reward of serving your patients on your own terms is immeasurable.

What tips do you have for someone who hopes to open a rural private practice?

Taking some business classes would be helpful because when I started my practice, I didn’t have much business knowledge, and it was scary. But I learned that it is possible to do it if you have enough backbone and savvy to run the business. It’s important to hire good people who are loyal to you and care about your practice as much as you do. With their help, managing both the medical and business aspects of the practice become easier. In the end, the rewards of owning and running your own medical practice are immeasurable, and with the right team and the right mindset, it can be a fulfilling and successful venture.

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