TY - JOUR
T1 - Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists
AU - Delara, Ritchie
AU - Misal, Meenal
AU - Yi, Johnny
AU - Girardo, Marlene
AU - Wasson, Megan
N1 - Publisher Copyright:
© 2020 AAGL
PY - 2021/4
Y1 - 2021/4
N2 - Study Objective: To determine patterns and barriers for referral to fellowship-trained minimally invasive gynecologic surgeons. Design: Questionnaire. Setting: United States and its territories and Canada. Participants: Actively practicing general obstetrician/gynecologists (OB/GYNs). Interventions: Internet-based survey. Measurements and Main Results: Of 157 respondents, 144 (91.7%) general OB/GYNs were included. Subspecialty fellowship training resulted in the exclusion of 13 (8.3%) respondents. A total of 86 respondents (59.7%) considered referral to fellowship-trained minimally invasive gynecologic surgery (MIGS) subspecialists. The top 3 cited reasons for nonreferral were adequate residency training (n = 84, 58.3%), preference for continuity of care (n = 48, 33.3%), and preference for referral to other subspecialists (n = 46, 31.9%). The top 3 cited reasons for referral to MIGS subspecialists were complex pathology (n = 92, 63.9%), complex medical and/or surgical history (n = 76, 52.8%), and out of scope of practice (n = 53, 36.8%). If providers required intraoperative assistance, respondents consulted an OB/GYN colleague with comparable training (n = 50, 34.7%), gynecologic oncologist (n = 48, 33.3%), or non-OB/GYN surgical subspecialist (n = 33, 22.9%). Factors that were not associated with the decision to refer to MIGS subspecialists included years in practice (p = .13), additional training experiences beyond residency (p = .45), and number of hysterectomies performed by laparotomy (p = .69). Self-reported high-volume surgeons (p <.01) were less likely to refer. In contrast, providers who self-reported as low-volume surgeons (p = .02) and were aware of MIGS subspecialists in the community (p <.01) were more likely to consider referral. Respondents reported using a laparoscopic approach to hysterectomy most frequently (n = 79, 54.9%). In contrast, 36.8% preferred the laparoscopic route for themselves or their partner, whereas 48.6% preferred the vaginal approach. Conclusion: Most of the general OB/GYNs would consider referral to fellowship-trained MIGS subspecialists. Providers who reported adequate residency training and those who preferred continuity of care or referral to other surgical subspecialists were less likely to refer to MIGS subspecialists.
AB - Study Objective: To determine patterns and barriers for referral to fellowship-trained minimally invasive gynecologic surgeons. Design: Questionnaire. Setting: United States and its territories and Canada. Participants: Actively practicing general obstetrician/gynecologists (OB/GYNs). Interventions: Internet-based survey. Measurements and Main Results: Of 157 respondents, 144 (91.7%) general OB/GYNs were included. Subspecialty fellowship training resulted in the exclusion of 13 (8.3%) respondents. A total of 86 respondents (59.7%) considered referral to fellowship-trained minimally invasive gynecologic surgery (MIGS) subspecialists. The top 3 cited reasons for nonreferral were adequate residency training (n = 84, 58.3%), preference for continuity of care (n = 48, 33.3%), and preference for referral to other subspecialists (n = 46, 31.9%). The top 3 cited reasons for referral to MIGS subspecialists were complex pathology (n = 92, 63.9%), complex medical and/or surgical history (n = 76, 52.8%), and out of scope of practice (n = 53, 36.8%). If providers required intraoperative assistance, respondents consulted an OB/GYN colleague with comparable training (n = 50, 34.7%), gynecologic oncologist (n = 48, 33.3%), or non-OB/GYN surgical subspecialist (n = 33, 22.9%). Factors that were not associated with the decision to refer to MIGS subspecialists included years in practice (p = .13), additional training experiences beyond residency (p = .45), and number of hysterectomies performed by laparotomy (p = .69). Self-reported high-volume surgeons (p <.01) were less likely to refer. In contrast, providers who self-reported as low-volume surgeons (p = .02) and were aware of MIGS subspecialists in the community (p <.01) were more likely to consider referral. Respondents reported using a laparoscopic approach to hysterectomy most frequently (n = 79, 54.9%). In contrast, 36.8% preferred the laparoscopic route for themselves or their partner, whereas 48.6% preferred the vaginal approach. Conclusion: Most of the general OB/GYNs would consider referral to fellowship-trained MIGS subspecialists. Providers who reported adequate residency training and those who preferred continuity of care or referral to other surgical subspecialists were less likely to refer to MIGS subspecialists.
KW - Continuity of care
KW - Fellowship
KW - General gynecology
KW - Referral barriers
KW - Residency
UR - http://www.scopus.com/inward/record.url?scp=85099609677&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099609677&partnerID=8YFLogxK
U2 - 10.1016/j.jmig.2020.08.002
DO - 10.1016/j.jmig.2020.08.002
M3 - Article
C2 - 32805461
AN - SCOPUS:85099609677
SN - 1553-4650
VL - 28
SP - 872
EP - 880
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 4
ER -