Practice Patterns of Surgeons Seeking Board Certification in Urogynecology and Reconstructive Pelvic Surgery.

Abstract

Introduction: Physician shortages are expected to worsen, especially in subspecialties like Urogynecology and Reconstructive Pelvic Surgery (URPS). To meet increasing demand, our study compares clinic visits and surgeries/procedures in URPS by reviewing clinical logs to understand practice pattern nuances.

Methods: URPS clinical logs from 2013 to 2021 were obtained from the American Board of Urology. Encounters were organized into URPS diagnostic groups, and the proportion of clinic visits to corresponding procedures was calculated. Multilevel mixed-effects logistic regression evaluated variability between surgeons, accounting for surgeon gender, age, certification status, and patient age.

Results: Three hundred seventy URPS urologists submitted 383 424 clinic and 323 929 procedural encounters, with 49% being URPS-related. Urinary incontinence (UI) was the most common URPS-diagnosis. The overall proportion of clinic visit encounters to procedural/surgical encounters was 3.9:1, ranging from 1.5:1 to 111:1, depending on the diagnosis. The proportion decreases to 1.1:1 when diagnostic procedures are included in surgeries. Multilevel regression identified that 14% of the variance in our proportion was explained by variation between physicians' practice (interclass correlation, clustering of patients under a physician). In regression models we found that female surgeons had greater than 20% increased odds of evaluating patients in the clinic (vs. procedure) for the diagnoses of overactive bladder (OAB; OR = 1.27, 95% CI = 1.09-1.48, p = 0.002), stress UI (OR = 1.29, 95% CI = 1.07-1.56, p = 0.008), UI (OR = 1.32, 95% CI = 1.15-1.54, p < 0.001), and pelvic organ prolapse (POP; OR = 1.94, 95% CI = 1.56-2.41, p < 0.001).

Conclusion: Urologists applying for URPS certification perform 3.9 clinic visits for every 1 surgery, and 1.1:1 clinic visits for every procedure. We found variation was attributed to clustering under physicians (practice patterns) but also found physician gender to influence the odds of performing surgeries with women surgeons seeing more clinic patients and performing less surgeries for OAB, UI, and POP. Taken together our findings show that clinic encounters and diagnostic procedures represent a substantial portion of URPS practice.

Clinical trials: This article is not presenting data from a clinical trial nor does it use human subjects. The data set is a deidentified retrospective log of cases.