BACKGROUND:The mean wait time for new patient appointments has been growing across specialties, including obstetrics and gynecology, in recent years. This study aimed to assess the impact of insurance type (Medicaid versus commercial insurance) on new patient appointment wait times in general obstetrics and gynecology practices. METHODS:A cross-sectional study used covert mystery calls to general obstetrician gynecologists. Physicians were selected from the American College of Obstetricians and Gynecologists directory and stratified by districts to ensure nationwide representation. Wait times for new patient appointments were collected and analyzed. RESULTS:Regardless of insurance type, the mean wait time for all obstetrician gynecologists was 29.9 business days. Medicaid patients experienced a marginally longer wait time of 4.8% (Ratio: 1.048). While no statistically significant difference in wait times based on insurance type was observed (P=0.39), the data revealed other impactful factors. Younger physicians and those in university-based practices had longer wait times. The gender of the physician also influenced wait times, with female physicians having a mean wait time of 34.7 days compared to 22.7 days for male physicians (P=0.03). Additionally, geographical variations were noted, with physicians in American College of Obstetricians and Gynecologists District I (Atlantic Provinces, CT, ME, MA, NH, RI, VT) having the longest mean wait times and those in District III (DE, NJ, PA) the shortest. CONCLUSIONS:While the type of insurance did not significantly influence the wait times for general obstetrics and gynecology appointments, physician demographic and geographic factors did.

This study surveyed urogynecologists and Advanced Practice Providers (APPs) in the USA to gauge their interest and willingness to embrace customizable pessaries as a viable treatment option. We hypothesize that clinicians might be interested in using customizable pessaries in their practice. A cross-sectional survey was conducted among urogynecologists and their APPs who fit pessaries to gain insights into their experiences with standard pessaries and perspectives on the value and feasibility of customizable devices. The survey was distributed through email lists associated with women’s health and pelvic floor disorders and gathered data on the difficulty in fitting pessaries and the perceived advantages of integrating customizable options into clinical practice. There were 122 participants, including 76 physicians and 46 APPs. Thirty-five percent of clinicians advocated for pessaries as a first-line therapy for pelvic floor disorders. APPs were more inclined to recommend pessaries as a primary therapy than physicians (p < 0.01). Fifty-three percent of providers reported occasional difficulties, and 12

A notable milestone is the performance of Chat-GPT, which has achieved scores at or near the passing threshold on the United States Medical Licensing Exam (USMLE). This development has catalyzed discussions about AI's potential role in medical education and complex decision-making within healthcare environments. The Council on Resident Education in OBGYN (CREOG) administers annual in-service exams to assess the readiness of OBGYN residents for their board examinations at the culmination of their residency training.

Importance Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. Objectives This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. Study Design A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. Results A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). Conclusion The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.

A previous study identified that pelvic floor disorders are common amongst female triathletes, and this population should be screened for these disorders. As opposed to endurance sports, rock climbing is a core-intensive and low-impact exercise that has dramatically increased in popularity over the last decade with more female participants. This population has not been evaluated explicitly for pelvic floor disorders and incontinence.

Obstetrics and gynecology (OB/GYN) residency programs present unique challenges for trainees, such as demanding work schedules, significant financial burdens, and the need to balance professional responsibilities with personal life. These stressors have significant implications for residents' overall health and well-being during residency. Despite the well-documented challenges of residency, the literature lacks a comprehensive evaluation of the fringe benefits offered to support residents during this period, specifically in obstetrics and gynecology.

Pelvic floor disorders, a prevalent issue among women, are conventionally managed using pessaries, mechanical devices available in various standardized sizes. Despite the availability of over fifteen different shapes, the

OBJECTIVE:To investigate potential differences in new patient appointment wait times for otolaryngology care based on insurance types and explore factors influencing these wait times. STUDY DESIGN:A cross-sectional audit study, using a "mystery caller" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors. SETTING:A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included. METHODS:Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model. RESULTS:A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P < .001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03-1.09; P < .001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P = .001) and certain subspecialties, such as pediatric otolaryngology (P < .001) and neurotology (P = .008). Regional differences were also observed, with specific AAO-HNS regions showing shorter wait times. The model achieved a conditional R-squared value of 0.947. CONCLUSION:This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities.

This year marks the 50th anniversary of The American Congress of Obstetrics and Gynecology and Indian Health Services (IHS) partnership, which encourages physicians to be aware of American Indian and Alaska Natives' healthcare barriers. We aim to evaluate the distance Native American/Alaska Native women travel to access urogynecologic care and to visually demonstrate the geographic distribution of Urogynecology Subspecialists from Indian Health Services hospitals. This study uses geographic analysis to evaluate the driving distance between American Indian/Alaskan Native women, IHS hospitals, and Urogynecology physicians. Twenty-eight IHS or tribal hospital facilities were included in this study as they all provide gynecology services. We used census data to determine the number of American Indian/Alaskan Native women over the age of 45 residing within a 60-minute driving radius from an IHS or tribal hospital. We used the National Provider Index file to determine the number and location of Urogynecologists who provide care within a 60-minute and 240-minute driving distance from an IHS hospital. With geospatial analysis, we determined the mean driving distance from the 28 Indian Health Service hospitals to the nearest Urogynecology clinic and the number of Urogynecology clinics within a 60-minute to a 240-minute driving radius of IHS or tribal hospitals. A total female population of 40,631 American Indians/Alaskan Natives greater than 45 years old reside within a 60-minute drive of an Indian Health Service hospital. Only 5.7% of these women live within a 240-minute drive of a Urogynecology clinic. Seventy-six percent of IHS or tribal hospitals did not have an urogynecology physician within a 60-minute driving radius, and 35.3% lacked an urogynecology surgeon within a 240-minute driving radius. We identified 51 Urogynecologists within a four-hour drive of an Indian Health Service hospital, representing approximately 6.9% (n = 51/743) of the total urogynecology workforce (Figure: https://bit.ly/3U4W9ln). American Indian and Native Alaskan women living near IHS or tribal hospitals face significant barriers to accessing urogynecologic care. Over 35% of IHS hospitals do not have a Urogynecology physician within a 4-hour driving radius. Given that consultation with a Urogynecologist often requires multiple in-person visits, procedures, and oftentimes surgery, this distance is likely to prevent many individuals from accessing adequate care.

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

BACKGROUND: Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial). OBJECTIVE: This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance. STUDY DESIGN: Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility. RESULTS: From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, +/- 18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times. CONCLUSION: Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.

Federally qualified health centers provide comprehensive primary and preventative care services to medically underserved populations regardless of ability to pay or health insurance status. To evaluate the availability of a new patient visit to a federally qualified health center when seeking urogynecology care. Federally qualified health centers were identified using the Health Research and Services Administration patient-facing physician directory. (https://data.hrsa.gov/data/download) We selected permanent and full-time FQHCs serving adults with more than five percent of their population over age 65 and more than 15,000 visits per year to identify sites likely to have urogynecology services. Phone calls were placed during standard working hours (8 a.m.-5 p.m., except for the 12-1 p.m. lunch hour, local time) over one week (Monday-Friday) in April 2022. An appointment was never made to minimize the administrative burden to FQHC clinics, nor were patient names or identifying information provided. The availability of services was analyzed using R version 4.0.1. In total, 362 FQHCs were called in 46 states plus the District of Columbia (Figure, bit.ly/3eDPrmg). The typical FQHC called was established 19.9 (SD +/- 15) years ago, in urban locations, served a mean county population of 28,023 (SD +/-20,240), and in The American College of Obstetricians and Gynecologists District IV. Of the 221 FQHCs successfully contacted, 180 (77%) stated they could care for a patient diagnosed with pelvic organ prolapse. The mean wait time for a urogynecology consultation was 29.1 business days (SD +/-30). Five percent (n=12) of FQHCs offer pelvic floor physical therapy as a treatment. When the caller stated that she was "scared of surgery" and wanted a more conservative option, twice as many FQHCs (n = 26, 11%) fit patients for pessaries in the office. Eight percent (n=19) of FQHCs called provide complex multichannel urodynamic testing. Logistic regression was used to determine the presence or absence of urogynecology consultations at an FQHC after adjusting covariates. The multivariable logistic regression model adjusted for patient race, ethnicity, patients best served in a language other than English, the total yearly volume of patients seen at the FQHC, and the days of the week called. The predictor variables of call time and mean household income were statistically significant (p<= 0.05). This national audit study demonstrated that the availability of pelvic floor disorder treatments at a federally qualified health center was rare. These findings illustrate a potential disparity for Medicaid beneficiaries seeking care with a urogynecologist.

Objective: The objective of this study was to quantify the subspecialist workforce involved in the clinical education of Obstetrics and Gynecology (OBGYN) residents and to provide an overview of the subspecialist faculty workforce geographic distribution and demographics.Methods: This cross-sectional, observational study used public data collected from July 1, 2022, through August 31, 2022.A list of Obstetrics and Gynecology residency programs, their sponsoring institutions/locations, and affiliated locations was compiled from the American Medical Association's Fellowship and Residency Electronic Interactive Database.Faculty subspecialists' names were collected by manually searching each program's website.Demographics were collected from the National Plan and Provider Enumeration System.Subspecialty faculty who had completed an Obstetrics and Gynecology residency, were fellowship trained, and/or had board certification in the subspecialty were included in the study.Results: A total of 4,659 subspecialist faculty were identified from 278 residency programs, representing 81.5% of the total subspecialist workforce in Obstetrics and Gynecology (n=5,716).Of the subspecialists identified, 2,838 were faculty at sponsoring institutions, representing 49.7% of the entire subspecialist workforce; the remainder worked with residents at affiliate locations.Our results showed 59.9% of subspecialists were female and 40.1% were male; 97.0% were allopathic subspecialists.The largest proportion of subspecialists were in the age group of 40-49 years (36.6%).Subspecialists were present in 45 states, with the exception of Alaska, Idaho, Montana, North Dakota, South Dakota, and Wyoming.Conclusion: Most of the Obstetrics and Gynecology subspecialty workforce is involved in the clinical education of OBGYN residents, with half of the workforce on faculty at the residency program sponsor site.The subspecialty faculty workforce is primarily female, has an allopathic degree, is mid-career, and is geographically diverse.

This cross-sectional, observational study aims to quantify Obstetrics and Gynecology resident exposure to subspecialty gynecology training by describing the program subspecialty curriculum and interaction with subspecialist faculty. Additionally, this study will provide a broad overview of the breadth to which the Obstetric and Gynecologic subspecialty workforce is involved in academic medicine and the education of residents. Using the American Medical Association Fellowship and Residency Electronic Interactive Database website, a list of all Accreditation Council for Graduate Medical Education (ACGME) accredited Obstetrics and Gynecology residencies demographics were compiled. ACGME-accredited fellowships included: Complex Family Planning, Urogynecology, Gynecologic Oncology, Maternal-Fetal Medicine, and Reproductive Endocrinology and Infertility. The American Association of Gynecologic Laparoscopists website was used to identify Minimally Invasive Gynecologic Surgery programs. The North American Society for Pediatric and Adolescent Gynecology website was used to identify Pediatric and Adolescent Gynecologic programs. Each residency program's website was hand-searched to identify and record the program curriculum/rotation schedule, and the number and names of faculty subspecialists in each subspecialty division. The Gynecology subspecialty teaching faculty is 81% (n = 3,877) of the total gynecology subspecialty workforce (n=4,784) practicing in the USA. University and community-based university-affiliated employed significantly more subspecialists than community-based residency programs (p<0.01). The largest subspecialty in a teaching institution was maternal-fetal medicine physicians, followed by gynecologic oncologists (p<0.01). On a proportional basis, gynecologic oncologists were most likely to be associated with an OBGYN residency program (91%, n=787/868). In contrast, reproductive endocrinologists were less likely to be associated with a residency program (65%, n = 573/885) than all other subspecialists. Over one quarter (27%, n=85/311) of residency programs did not have a fellowship-trained PAG and MIGS on faculty. This was partly explained by the region where ACOG District I had the highest number of subspecialists (35.1) in academia versus more than half that in District XII (15.6, p<0.01). OBGYN subspecialists are geographically mismatched demand and supply characterize the current OBGYN subspecialty workforce. Fortunately, this group is well represented within most OBGYN residency training programs.

Background A significant disparity exists for American Indian and Alaska Native populations in accessing obstetric and gynecology (OBGYN) subspecialty care, as nearly 43% of individuals do not reside in areas where the Indian Health Service (IHS) provides care. Geographical separation from IHS facilities exacerbates healthcare disparities, particularly regarding access to specialized services. This study aims to create a map illustrating the average driving time from an IHS clinic to OBGYN subspecialists (e.g., gynecologic oncology, maternalfetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility [REI]) and determine the average wait time for appointments with these specialists. Study design A cross-sectional and mystery caller study was conducted using hospital -level data from the IHS and data on women from the 2010 United States Census provided by the US Census Bureau. All US OBGYN subspecialists were identified and mapped. The local distribution of clinics near IHS hospitals was determined, and the nearest OBGYN subspecialist was mapped to IHS hospitals providing women's care services. Thirty-seven OBGYN subspecialists closest to IHS hospitals were contacted to calculate the mean wait time for subspecialty care appointments. Results The median driving time to the closest gynecologic oncology, maternal-fetal medicine, family planning, urogynecology, pediatric and adolescent gynecology, and reproductive endocrinology and infertility OBGYN subspecialist was 214 minutes (interquartile range [IQR] 107-290). The longest drive to see a subspecialist for urogynecology services was over 240 minutes. From the 2010 US Census, we identified 583,574 American Indian and Alaska Native (AI/AN) pediatric, adolescent, and women within a 60 -minute drive of an IHS hospital. The mean wait time for a new patient appointment was 13.6 business days (SD +/- 2). Conclusions Geographical disparities significantly impact the ability of American Indian and Alaska Native populations to access OBGYN subspecialty care. There was no difference in wait times compared to the national average, though there were significantly longer drive times.

We assessed the geographic distribution of MIGS surgeons as represented by board-certified minimally invasive gynecologic surgeons throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels. American Congress of Obstetricians and Gynecologists and the United States Census were analyzed in this cross-sectional, observational study. State and national patterns of American Board of Obstetrics and Gynecology, Inc. board-certified MIGS surgeon density were mapped graphically using R 4.0.1 software and 2020 US Census demographic data. In total, 308 MIGS surgeons were board-certified during the study period in August 2022 and were included. The typical board-certified MIGS surgeon is less than 50 years old (n=266, 87%), female (n = 186, 60%) who trained at a US allopathic medical school (Table). In 2022, the 308 board-certified MIGS physicians represented 0.001% of the total physician workforce. Nationwide, there was a mean of one MIGS surgeon for every 90-practicing general obstetrician-gynecologists. These findings have implications for training, recruiting, and minimally invasive gynecologic surgeons. The uneven distribution of MIGS throughout the United States is likely to worsen as graduating MIGS fellows continue to cluster in urban areas.

To examine the magnitude of industry payments to obstetrics and gynecology and urology residency directors and department chairs between 2013 and 2020. For this cross-sectional study, non-research payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OBGYN and urology residencies were compiled from the Centers for Medicare and Medicaid Services Open Payments Database. This data was cross-referenced with the Accreditation Council of Graduate Medical Education. Department chairs were identified by internet search or direct program contact. Data was analyzed using nonparametric and multiple linear regression models. A total of 28,764 payments were accepted by 599 physicians, summing $8,467,051. Urologists averaged more payments and higher amounts per engagement than OBGYNs (p<0.1 for both). Similarly, department chairs received a higher number of payments and greater compensation per engagement than program directors (p<0.1 for both). California accounted for the highest sum total amongst the states at $1,676,221. Male gender, regardless of specialty, was another significant variable for higher average payment compared to female counterparts (p<0.01). The association between non-research payments and department chairs remained significant after adjusting for covariates (unstandardized β=171.5; 95% CI 63, 279; p<0.01). Four variables were predictive of the magnitude of industry payments received: male gender, department chair, urology, and practicing in California. Non-research payments to leadership positions in OBGYN and urology residency programs can impact trainees and should be disclosed.