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    Urology, gynecology collaboration addresses rising demand

    Sarah E. McAchran, MDSarah E. McAchran, MDIn this interview, Sarah E. McAchran, MD, discusses the need for urology-gynecology collaboration, the background behind the ABMS recognizing the female pelvic medicine and reconstructive surgery subspecialty, and how barriers to full integration of providers treating pelvic floor disorders can be overcome. Dr. McAchran is associate professor of urology with a dual appointment in the departments of urology and obstetrics and gynecology at the University of Wisconsin School of Medicine and Public Health, Madison. She is also medical director of Women’s Pelvic Wellness Clinic at the University of Wisconsin. She was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, clinical professor of urology at Stanford University School of Medicine, Stanford, CA.


    In the past, there were tremendous turf battles between gynecology and urology. When one tried to impinge on the other’s territory, it was usually the dean who became involved. What do you think drove the change to cooperation we see now?

    I think one of the main factors was each specialty realizing that neither one could completely “own” this set of clinical problems and that we need each other. Urology would need the OB/GYN expertise, and OB/GYN would need the urology expertise to make any progress in terms of research, patient care, and professional training.

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    At my institution, Dr. Laurel Rice, chair of the OB/GYN department, and Dr. Stephen Y. Nakada, chair of the urology department, have created an atmosphere where we could move forward to create a collaborative rather than a competitive approach. It’s important to have the mindset from the administration that it’s better for everyone to collaborate. It’s better for our medical students, it’s better for our trainees, and it’s better for our patients if we have a collaborative rather than a competitive approach.


    Pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, and fecal incontinence, affect over 20% of adult women. In 2010, an estimated 560,000 women underwent surgical repair of pelvic organ prolapse or stress incontinence. The demand for services is increasing. Do you think this is one of the factors that pushed urology and urogynecology to collaborate?

    Several factors are driving collaboration. I think that demand, the need for research-driven data, the need for patient quality outcomes, and patients themselves are driving collaboration. In the current market, patients view themselves as consumers. Our health care system views them as consumers. Patients are no longer going to be satisfied with trying to seek the answer to their multi-system problem from multiple places; they want easy-to-navigate care for these problems. That’s what we’re trying to do at the University of Wisconsin: create a one-stop shop where we come to the patient rather than sending the patient out to multiple places.

    Next: Is there a need to increase the number of providers to meet demand?

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.


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