Effect of physician gender and specialty on utilization of hysterectomy in New York, 2001-2005.
ABSTRACT The purpose of this study was to determine the effect of physician gender and specialty on the utilization of hysterectomy and alternatives to hysterectomy.
The database of Empire Blue Cross Blue Shield was abstracted for all claims relating to a hysterectomy procedure or a hysterectomy-associated diagnosis during the 48 consecutive months May 2001-April 2005. Two hundred ninety-five thousand, one hundred forty-eight claim lines were abstracted and analyzed by CPT and diagnostic grouping codes.
One thousand nine hundred seventy-two hysterectomies were performed during the time analyzed, as well as 5077 hysterectomy alternatives. These 7049 procedures represented 2.4% of all coded physician encounters. Male physicians utilize hysterectomy and hysterectomy alternatives at the same rate as female physicians. Physicians who practice gynecology-only or gynecologic oncology utilize laparoscopically assisted vaginal hysterectomy more often than their counterparts who practice obstetrics as well as gynecology.
Gender does not influence the rate of hysterectomy for similar clinical diagnoses. Subspecialty physicians utilize laparoscopic assisted vaginal hysterectomies more frequently than general obstetricians and gynecologists.
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ABSTRACT: On the basis of consistent published scientific evidence, the American College of Obstetricians and Gynecologists has given uterine artery embolization (UAE) a level A recommendation as a viable alternative treatment for uterine myomas, describing it as a safe and effective option for appropriately selected women who wish to retain their uteri. Despite the growth of favorable clinical outcome information, many gynecologists do not routinely offer UAE as an alternative to abdominal hysterectomy or abdominal myomectomy. The percentage of laparoscopic hysterectomies in the United States remains less than 20%, reflecting the reluctance or inability of gynecologic surgeons to perform other minimally invasive procedures such as hysteroscopic myomectomy, laparoscopic myomectomy, laparoscopic hysterectomy, or even vaginal hysterectomy. Of great significance, many patients do not wish to have any kind of surgery, no matter how "minimally invasive." As a result, patients seeking less invasive treatments may bypass the gynecologist and be referred directly to an interventional radiologist by their primary care physician, or they may self-refer. Little has been published on the referral relationship between gynecologists and the interventional radiologist who performs uterine artery embolization. The absence of a structured routine referral relationship causes some women to undergo treatments that potentially are not aligned with all of her treatment desires. This study was undertaken to gain insight into the interventional radiologist-gynecologist dynamic and the benefit to patients who are informed of all of their options for the treatment of myomas. Investigate the course of myoma treatment in a cohort of patients either self-referred to an interventional radiologist or referred to the interventional radiologist by their gynecologist. Determine the effect of a cooperative referral network of interventional radiologists and gynecologists that informs patients about the options of UAE and minimally invasive surgical alternatives on the choice of myoma treatment. Prospective data acquisition of patient referral source, UAE evaluation, patient decision on treatment options, and continued follow-up with a network gynecologist. Hospital-based interventional radiologist and gynecologist both practicing in a large urban teaching setting. A total of 226 women, representing 73% of women presenting to an interventional radiologist in 2007 seeking UAE for symptomatic myomas. One hundred thirty-eight of these patients were referred to the interventional radiologist by a gynecologist, and 88 were self-referred. Patient outcome relative to referral was traced with 76 patients in the myoma surgery group treated from 2007-2008 by a gynecologist in the referral network. Evaluation for suitability for UAE procedure, followed either by UAE procedure with return to referring gynecologist for follow-up, return to referring gynecologist for treatment, or referral to another gynecologist for minimally invasive surgical management when the primary gynecologist is unable to perform alternative treatment. All patients in the study initially evaluated by the interventional radiologist were referred to a gynecologist. Overall, 62% of patients were candidates for UAE, and 38% underwent the procedure during the study period. Patients who did not receive UAE were returned to the referring gynecologist for further evaluation and treatment. Patients who underwent UAE were referred to a gynecologist for ongoing care. In all, 70% of self-referred patients and 92% of gynecologist-referred patients expressed satisfaction with their original gynecologist and were referred back to that physician. Patients who did not have a gynecologist or who were dissatisfied with their original gynecologist were referred to a network gynecologist for continued gynecologic care. In our study 26 self-referred women were sent as new patients to gynecologists in the interventional radiologist's referral network, resulting in a 119% return on the original 138 gynecologist-to-interventional radiologist-referred patients. Among the 8% of gynecologist-referred women who switched to a different gynecologist within the referral network, the primary reasons for dissatisfaction were the gynecologist's failure to fully disclose treatment options or offer desired minimally invasive procedures. On follow-up with a network gynecologist, 8 newly referred patients underwent myoma surgery, and 8 newly referred patients continued to be seen by that gynecologist. Four patients referred to the gynecologist for treatment were originally referred by the gynecologist to the interventional radiologist for UAE evaluation. Ten patients switched from their named gynecologist to a different gynecologist willing to disclose all treatment options for uterine myomas and able to provide minimally invasive surgical treatment as medically indicated. Of the 10 women who switched to this network gynecologist, 8 underwent myoma surgery. Establishing a referral relationship with an interventional radiologist for comprehensive uterine myoma treatment supports a trusting, collaborative, long-term, noncompetitive "win-win" relationship between the gynecologist and radiologist, meets the patient's desire for full disclosure of all myoma treatment options, improves the patient's overall medical care and physician/patient experience, and has been demonstrated to improve patient flow to a gynecologist practice. With the guidelines established in this study, no patients were inappropriately left to the gynecologist for post-UAE care. The authors acknowledge that this dynamic is dependent on the individual interventional radiologist and their relationships and open communication with the gynecologist. Finally, the study revealed that failure to fully disclose alternative treatment options, or offer minimally invasive surgical techniques may result in a loss of patients due to patient dissatisfaction.Journal of Minimally Invasive Gynecology 03/2010; 17(2):214-21. · 1.58 Impact Factor
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ABSTRACT: With continuing development of minimally invasive techniques in gynecology, hysterectomy with laparoscopic assistance is increasingly performed. This study aimed to examine the relationship between the characteristics of gynecologists and the likelihood of performing laparoscopic-assisted hysterectomy (LH) under the case payment system of Taiwan's National Health Insurance. A retrospective population-based study was conducted based on the data from Taiwan's National Health Insurance Research Database. A total of 56,532 female residents aged 20 years and older who underwent total hysterectomy with or without laparoscopic assistance between 2004 and 2006 were included in the study. The gender, age and practice volume of their gynecologists were noted. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses. Of the women selected, 30,478 underwent traditional total hysterectomy (TH) and 26,054 underwent LH. After controlling for clinical and nonclinical factors, male gynecologists (OR 1.65, 95% CI 1.55-1.76) were more likely to perform LH than their female colleagues. Gynecologists aged 60 years and older (OR 0.31, 95% CI 0.29-0.39) had the lowest likelihood of performing LH compared with their counterparts. In addition, surgeons with low-volume practice (OR 0.31, 95% CI 0.29-0.33) also had a significantly lower probability of performing LH compared with other surgeons. A higher likelihood of performing LH was observed among male and younger gynecologists with high-volume practice in Taiwan. This finding suggests that differences in practice patterns and surgical treatment decision may explain the variation in the approaches to laparoscopy-assisted hysterectomies. Differences in practice patterns and surgical treatment decisions may explain the variation in the approaches to laparoscopic-assisted hysterectomies.European journal of obstetrics, gynecology, and reproductive biology 01/2012; 161(2):209-14. · 1.97 Impact Factor
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ABSTRACT: Physicians are increasingly presented with women requesting a labia minora reduction procedure. To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction. Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands. A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physician's personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction. A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal (2-5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the woman's labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01). The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of one's personal predisposition vis-à-vis referral and willingness to operate is needed.Journal of Sexual Medicine 05/2011; 8(8):2377-85. · 3.15 Impact Factor