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    Urology, gynecology collaboration addresses rising demand

     

    Kirby has estimated that 3,735 pelvic floor disease specialists will be needed, or one per 100,000, in the next 15 years (Am J Obstet Gynecol 2013; 209:584.e1-5). That means adding 2,300 specialists given that in 2013 there were 1,400 members of the American Urogynecologic Society (AUGS). The prevalence of female pelvic disorders is expected to experience 45% growth in the next 20 years. Up to half of U.S. women experience one or more symptoms of pelvic floor disorders during their lives. One in nine will undergo surgery for female pelvic floor dysfunction by age 80. Do you think there’s a need to increase the number of providers—urogynecologists, female urologists, nurse practitioners—to meet this demand?

    There’s clearly a need. The way we’re going to meet that is twofold: by increasing interest and increasing training opportunity. Increasing interest starts at the medical student level. When I was a second-year medical student at Vanderbilt, I went to a panel discussion on women in surgery and Dr. Jenny Franke, Vanderbilt’s female urology specialist at that time, was one of the speakers. I thought everything she said sounded incredibly interesting. So I focused on rotating through urology in my third year, working with Dr. Franke in my fourth year, and ultimately went into urology with the hopes of doing what I’m doing now.

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    At UW, we have a fourth-year rotation for the medical students in urogynecology that satisfies their surgical rotation. We have exposure to urogynecology in the OB/GYN rotation that is done during the third year. Increasing that exposure is really important. That continues on into residency training as well. All of the residents in urology and in OB/GYN have some exposure to female pelvic medicine and reconstructive surgery (FPMRS) at our institution.

    In addition, for institutions that don’t have such a strong faculty presence in that, the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) runs the Resident Preceptorship program every August, which sponsors residents from all of the different urology programs in the country to come to Chicago for a “mini-fellowship” in female urology with specialists from across the country. That’s another way that we can generate interest in pursuing this as a career.

     

    Can you discuss the history of the American Board of Medical Specialties recognizing the subspecialty of female pelvic medicine and reconstructive surgery?

    As I understand it, SUFU and AUGS, which were the urology- and the OB/GYN-based subspecialty societies that were interested in this, wanted to make FPMRS a more formalized training program and so began accrediting postgraduate training programs in that around 1998. That means that the trainees have finished a fellowship but they are neither certified nor examined. To be certified and examined, you have to be recognized by the American Board of Medical Specialties (ABMS). It took until 2011 for that to happen. Once you’re recognized by the ABMS, your fellowships have to be accredited by the Accreditation Council for Graduate Medical Education, which is an entirely separate application process. That was completed in 2011 as well.

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    In 2013, the first certified examination was given; that was a written examination. Both grandfathered and fellowship-completed examinees were allowed to take that exam. Going forward, only those applicants who have completed an accredited fellowship may sit for the exam.

    Next: What do you see as barriers to full integration of all physicians involved with full-time care of patients with pelvic floor disorders?

    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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