My twin sister and I have an ongoing quip: One day, we’ll live in conjoined apartments, and our respective kids will become as thick as thieves.
For NYC-based dermatologist Julie Karen, MD, that scenario isn’t far from reality. The 43-year-old lives within earshot of her sister, Elizabeth Hale, MD (also a dermatologist — and colleague). “If you open my door, her door is across the hall,” Dr. Karen shares. “It’s priceless.” Even more idyllic is the fact that each sister has three kids — two sons and a daughter on either side. “Our kids are as close as cousins can be. They're the best, best, best of friends.”
Dr. Karen’s impetus for studying medicine came from her mother, an ophthalmologist. “[As a child], I spent my weekends waking early and going on rounds with her,” she recalls. “I saw the satisfaction that came from a career that involved giving back, helping people, and curing people.”
Nevertheless, Dr. Karen’s path to dermatology — and medicine, period — was far from linear. Below, she elaborates on her path to success. Plus, why she’s fascinated with sclerotherapy, how she avoids burnout, and the surprising challenge of working with her sister.
Spotlyte: Tell us about your path to becoming a dermatologist.
Dr. Julie Karen: I knew from a very early age that I wanted to be a physician. I always loved math and science. So I entered college pre-med, and I finished my requirements pretty quickly. As I was about to graduate, I began applying to medical school. My mother had experienced this shift in medicine, where she felt doctors were losing autonomy, and she was getting a little bit frustrated. She was actually starting to discourage me from going into medicine.
Spotlyte: And then?
JK: I figured, if the landscape is going to change so much, why don't I try to equip myself with some information about the business side of medicine beforehand? So, I deferred my acceptance to medical school. I worked in investment banking, briefly, in healthcare, which I thought would be informative. It ended up not being the case at all.
Spotlyte: How so?
JK: When you're an analyst at an investment bank, you're working 120-hour weeks — but you're not learning about the business. You're just doing menial tasks, which is fine — you have to start somewhere. But, since I wasn't going to pursue a career [in business], I realized there was no sense in staying. So, after one year, I left and I went to medical school.
Spotlyte: That’s quite the pivot. How did you decide to pursue dermatology specifically?
JK: My sister was a few years ahead of me, and she was doing her dermatology residency. She loved it. Her passion was palpable for me. My sister encouraged me to check it out, so I did some rotations in dermatology.
Spotlyte: What is the most gratifying part?
JK: First of all, it's a very visible field. Patients are incredibly motivated by their conditions. They want to be helped. Whether it's [an aesthetic] concern, or, much more commonly, a medical concern, they can see their disease and they can also see the benefits of treatment. They're motivated to adhere to your recommendations. They will partner with you.
The medical aspect is often detective work. The skin can be the first manifestation of disease. In the hospital, when you're rounding and you're on the dermatology team, very often, you're contributing very subtle but important details that may help lead to diagnosis. And then the procedural part is skin cancers. It really offers an array of satisfying and extremely gratifying ways to help patients.
Spotlyte: One of your specialties is sclerotherapy. What drew you to veins?
JK: After my dermatology residency, I did a procedural dermatology fellowship. Procedural dermatology encompasses Mohs micrographic surgery (a specialized surgery for the removal of skin cancers), laser therapy, injectables, and the treatment of leg veins for which sclerotherapy is the gold standard.
I remember the first patient I ever treated at Bellevue Hospital℠ [in New York City] as a resident. My co-resident and I, who became my dearest friend in residency, were put in the room and told, "All right, go do sclerotherapy." And I'm like, "You want me to get this [needle] into that tiny spider vein?"
This patient ended up getting poked innumerable times by two first-year residents! Thankfully, I’ve perfected my skills since then. In addition to sclerotherapy, I've expanded my skills and also perform endovenous laser ablation, a minimally invasive, outpatient laser procedure to address varicose veins. If you've ever watched sclerotherapy injections for spider veins...
Spotlyte: It disappears.
JK: A nurse once said, "It's like Etch-A-Sketch®." It’s fun and it's gratifying. [Veins] are an incredibly common problem. [Most] of the population suffers from [some sort of] visible leg veins, and up to 50 percent of [women] have varicose veins, so certainly, there's a need.
Spotlyte: And varicose veins are hereditary too?
JK: Very much so. There are multiple factors, but genetics is the major one. But then pregnancy is a major contributing factor, and multiple pregnancies, trauma, obesity, standing, and occupations that involve prolonged standing all contribute.
Spotlyte: As someone who stands all day, do you ever worry about developing varicose veins?
JK: Both of my parents have varicose veins, so I have the genetic predisposition. I wear compression stockings every single day. It’s nice to practice what I preach; I can show my patients I'm wearing them.
Admittedly, it's easy for me since I wear scrubs every day. My sister and I have an extremely close cohort of colleagues, and we have a wonderful exchange of information. Several of our colleagues wear dresses and heels every day to see patients. We keep it simple and wear scrubs. Then I have no trouble wearing my compression stockings.
Spotlyte: Would you say that you're more of the medical and your sister is more of the aesthetic dermatologist? Or is it sort of split between the two?
JK: We both do very much the same thing. We don't practice a great deal of medical dermatology anymore, though we do a lot of skin cancer diagnosis and treatment. But we don’t do more general [medical] dermatology. My practice is about 50 percent skin cancer, 50 percent aesthetic. We do a lot of injectables, a lot of lasers, and we are both Mohs surgeons.
Injectable wrinkle reducers are used to temporarily smooth the look of moderate to severe wrinkles in certain areas of the face such as the forehead, frown lines, and crow’s feet. They should not be used more frequently than every three months. Like any medical treatment, they have potential risks and side effects. Be sure to talk to a licensed provider to see if they’re right for you.
Spotlyte: What's your favorite part about working with your sister?
JK: I feel so fortunate. Every single day we just look at each other and we think, “We are so lucky.” Working together, it's knowing that you are so aligned with someone. My success is her success, and anything that goes wrong is going to impact us both. And I truly care as much, if not more, about her wellbeing than my own. I mean, I always have; as a sister, that's the way you are.
Our lives are crazy. Our practice days are crazy. Literally, I sent her three emails this morning with things I need to tell her, because even when you spend time together, you don't get to get it all in.
Spotlyte: Any challenges?
JK: I guess one challenge is that you really, really care. You don't want to mess up — whether it's in a small way or big way, because I don't want to let her down.
Spotlyte: As a mom to three kids and a dermatologist with a busy practice, what's your key to maintaining work-life balance?
JK: That's an ongoing challenge. You never feel like you have a perfect balance. Sometimes, you feel like if you try to do everything, that you're doing everything okay, but not maybe the best.
I have three children whom I adore and live for; I also love to exercise. My sister and I run marathons together — so we have a lot of demands on our time.
Spotlyte: How do your children feel about the demands on your time?
JK: My children see that I have a lot of satisfaction and tremendous gratitude for the opportunity to go to work, and that makes it okay. They may still lament, "Oh, why weren't you there?” When it comes down to it, they respect what I do. I rarely miss a sports game, but can't make every single field trip, for example.
It also does help being my sister's partner. While we were building the practice almost six years ago, we were working full-time. We had these family dinners, and they'd be working dinners. The kids didn't mind much because we were present. It's not a perfect balance, but it's a very good one.
Spotlyte: You mentioned gratitude. Do you think an optimistic attitude helps to keep you from burning out?
JK: Yes. Physician burnout is a big problem. And you know what? There are days when I feel burnt out. But I really give 100 percent of myself to every single patient.
I try to remember that each patient is coming to you and this is their experience. So, it's not okay to have an off minute. You can't be off for a moment, because yeah, you might be good for the next patient, but that [moment has] the one who just walked out the door unsatisfied, unhelped. So you really give your all. It makes the days go by quickly, but it's exhausting.
Spotlyte: What's your favorite way to unwind at the end of a very long day? Do you watch TV? Do you read?
JK: I don't watch any TV. I wish I did, but I don't. I don't really unwind ever, to be honest. I'm not proud of it. It will be like 10:30 p.m. at night sometimes and I realize that I have not sat down since I got home. Even the way my kitchen is setup, we have this countertop [that’s] my standing height. So all my kids are used to sitting at their stools, but I'll be eating with them, standing, talking to them. I literally don't sit down.
On the way home, I unwind by listening to podcasts or music. The thing that relaxes me is getting things done. I feel relaxed if my house is clean, my kids are happy, their homework is [done], their bags are packed. Also, my kids are at ages where they have tremendous, robust activity after school. So I don't ever go straight home from work. I either go to gymnastics, or basketball, or football to pick up the kids, and [we] don't get home until 8 or 9 p.m. every night.
Spotlyte: Do you have a stringent skincare routine?
JK: Yes and no. I'm stringent about the categories of products that I use. I am a firm believer that there are a few things that are essential, and everything else is icing on the cake.
JK: An antioxidant serum in the morning, sunscreen, a zinc-containing sunscreen applied on top. And then, at night, a gentle wash, a retinoid (I use a prescription one now). Then a moisturizer, ideally one with growth factors and peptides. [The] icing on the cake includes tone correctors and pigment correctors, which I use after the summer.
Retinol shouldn't be used by women who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.
I'll be honest with you — if I was not in my field, I would just stick with the antioxidant, the sunscreen, the retinoid, and the moisturizer. Even that's a lot, but it really doesn't take long. It’s five seconds in the morning and five seconds at night, which is all we all have. But I do have the opportunity to play around.
My sister and I have always been fervent leaders in transparency, and [we do] not necessarily like [to have] one brand allegiance, because there are a lot of good products out there from different companies. And that's partly why we haven't, to date, started our own skincare line.
Spotlyte: Have you considered starting your own line?
JK: [My sister and I have] been approached multiple times. Maybe it would be great — but there are so many wonderful products out there. I use things from SkinBetter®, SkinMedica®, SkinCeuticals®, and Environ®.
My favorite, if I had to say, would be a plug for one of my best friends and closest colleagues. Her name is Heather Rogers and she has a product called Doctor Rogers RESTORE®. It basically is all-healing: it's for dry lips, chapped lips, and dry eyes. I use that every night on my lips and sometimes under my eyes for extra hydration.
SkinMedica® is an Allergan®-owned skincare line.