Delaying the Fellowship Start Date in Obstetrics and Gynecology.

OBJECTIVE: To evaluate residents planning fellowship, their preferences for fellowship start date, and the acceptability of resultant gaps in pay and insurance coverage. METHODS: A survey was conducted during the 2022 in-service training examination querying obstetrics and gynecology residents about their desire to pursue fellowship, their preferred fellowship start date (understanding the salary gap), and the acceptability of a medical insurance gap. RESULTS: Survey analysis of respondents planning to pursue fellowship demonstrated that, acknowledging the pay gap that would occur, 93.9% preferred a fellowship start date after July 1, with the majority (65.1%, 593/911) preferring an August 1 fellowship start date. Most respondents (87.7%, 798/910) found the potential resultant gap in medical insurance coverage acceptable. Survey data showed that racial and ethnic identity was not a determining factor in either of these issues. CONCLUSION: The majority of current residents planning to pursue fellowship prefer a delayed fellowship start date, even if it means a gap in salary and insurance coverage. The results of this study, requested by a specialty-wide, consensus-building workgroup, informed a statement signed by the majority (88.9%) of workgroup constituents supporting an August 1 clinical fellowship start date.

Workforce Analysis of Female Pelvic Medicine and Reconstructive Surgery, 2015 to 2045.

OBJECTIVES: The aim of this study was to assess how the projected increase in prevalence of pelvic floor disorders (PFDs) will impact the number of patients per female pelvic medicine and reconstructive surgery (FPMRS) subspecialist between 2015 and 2045. METHODS: We performed a workforce analysis of FPMRS subspecialists in the United States by developing a model to predict the number of FPMRS subspecialists in 5-year increments from 2015 to 2045. Our model allowed for selection of the number of current FPMRS subspecialists, the number and sex of new FPMRS subspecialists added per year, and retirement age of FPMRS subspecialists. The number of women with PFDs from 2015 to 2045 was then predicted by applying published, age-specific prevalence rates to the 2012 US Census Projections for women aged 20 years or older. For our primary outcome, we divided the projected number of patients by the projected number of FPMRS subspecialists every 5 years from 2015 to 2045. RESULTS: The model predicts the number of FPMRS subspecialists will increase from 1133 to 1514 with a sex shift from 46% female to 81% female between 2015 and 2045. The number of women with ≥1 PFD is predicted to increase from 31.4 million in 2015 to 41.9 million in 2045. For our primary outcome, the number of patients per FPMRS subspecialist is projected to range from 27,870 in 2015 to 27,650 in 2045. CONCLUSIONS: The current ratio of patients per FPMRS subspecialist appears high and is predicted to remain near current levels over the next 30 years. These projections support the need for continued training of physicians skilled in treating PFDs.

Internet Use Among Urogynecology Patients in North Carolina.

OBJECTIVES: Given limited information regarding digital technology use among patients, we sought to evaluate Internet use among younger (<65 years) as compared to older (≥65 years) women and to assess factors associated with Internet use. METHODS: We administered an anonymous questionnaire on digital technology use to English-speaking women who presented to our Urogynecology practice during a 1-month period. The questionnaire assessed the following sociodemographics: age, race, education, income, and insurance status. For our primary outcome, we assessed Internet use among younger versus older women. We also conducted a logistic regression analysis to evaluate the association of age with Internet use, while adjusting for potential confounders. RESULTS: A total of 556 women presented during the study period. Among these women, 506 completed the survey, for a 91% response rate. There were 282 (55.7%) younger women and 222 (43.9%) older women. Most of the younger and older cohorts were white (77% vs 86.5%, P = 0.02). Younger women were more educated (79.8% vs 59.5% ≥ college education; P < 0.0001) and had a higher income (58.3% vs 39.8% ≥ $50,000; P < 0.0001). For our primary outcome, younger women were significantly more likely to use the Internet (93.8% vs 66.3%, P < 0.001). In a logistic regression model which adjusted for age, race, education, and income, younger women remained significantly more likely to use the Internet (odds ratio, 6.6; 95% CI, 3.4-13.0). CONCLUSIONS: Although women younger than 65 years reported greater Internet use when compared to women 65 years or older, most of older women also used the Internet.

Adequacy of urine cytology specimens: an assessment of collection techniques.

The objective of this study was to determine whether the method of urine collection impacts the adequacy and cell counts of cytology specimens in a low-risk population. Voided, post-cystometrogram (CMG), and bladder irrigant specimens were collected and evaluated for cytologic adequacy and average cell count by a single cytopathologist masked to the source of each sample. Data were analyzed to detect differences in specimen adequacy and cell counts based on method of collection. Both the voided and post-CMG specimens (97.3%, 93.7% respectively) were significantly more likely to be adequate compared to the bladder irrigant specimen (11.7%, p < 0.0001). The spontaneously voided specimen (211.4 +/- 100.1) had significantly higher cell counts than both the post-CMG specimen (85.9 +/- 86.6) and the cystoscopy specimen (6.4 +/- 19.6, p < 0.0001). In a multivariate linear model, collection method and specimen adequacy were associated with increased cell count/hpf (p < 0.001), as was the presence of hematuria on urine dipstick (p = 0.03). No cytologic abnormalities were diagnosed. Whereas both spontaneously voided and post-CMG specimens were consistently adequate for interpretation, spontaneous voided specimens were optimal with regard to maximizing cell count/hpf.