Deborah Reale

In obese women, laparoscopic hysterectomy provided the shortest operating time with minimal blood loss when compared with vaginal hysterectomy, according to a poster presented at the 42nd AAGL Global Congress in Washington, DC, in November 2013.¹

Teresa Tam, MD, Gerald Harkins, MD, and researchers at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, reported on a retrospective cohort study conducted to compare the routes of hysterectomy and surgical outcomes in obese patients.

Of the 1,286 patients who underwent hysterectomy between December 1, 2009, and December 1, 2012, at Hershey Medical Center, 596 met the obese body mass index (BMI) inclusion criteria (BMI >30 kg/m²). Mean (SD) BMI was 36.5 (5.8) kg/m² and the mean (SD) patient age was 45 (10) years. Mean (SD) gravidity was 2.44 (1.85) and mean (SD) parity was 1.97 (1.41).

Reasons for surgery were restricted to benign indications, including leiomyoma (31%); abnormal uterine bleeding (29%); and endometriosis (17%).

The following approaches to hysterectomy were included:

• abdominal hysterectomy [total abdominal and supracervical] (AH; n = 7)
• vaginal hysterectomy (VH; n = 84)  
• laparoscopic-assisted vaginal hysterectomy (LAVH; n = 16)
• total laparoscopic hysterectomy [conventional and robotic] (TLH; n = 295)
• laparoscopic supracervical hysterectomy [conventional and robotic] (LSH; n = 194).

Comparisons to AH were not considered in the results (n = 7). Less than 1% of the hysterectomies were abdominal cases, with majority (5 out of 7 AHs) performed being combined cases, in conjunction with colorectal service for colon or rectal malignancies. Data on preoperative indications, estimated blood loss, operating time, length of stay, and postoperative complications were compared.

The largest differences in median (SD) operating time were between TLH and LAVH (80 min vs 137.5 min, respectively; P <.001) and LSH and LAVH (90 min vs 137.5 min, respectively; P <.001).

The only statistically significant difference with regard to patients’ median (SD) length of stay was between TLH and VH (1.07 days vs 1.12 days, respectively; P = .005), but the researchers did not consider a difference of 0.05 days (1.2 hours) to be clinically relevant.

The odds of estimated blood loss of 200 mL or greater were significantly higher with VH than with TLH (35.0% vs 3.4%, respectively; odds ratio [OR] = 15.3; 95% confidence interval [CI], 7.0–33.4; P <.001). The odds of estimated blood loss also were significantly higher with VH than with LSH (35.0% vs. 8.4%; OR = 5.9; 95% CI, 3.0–11.7; P <.001).

No association was found between high BMI and surgical complications, the authors reported. However, due to the study’s retrospective nature, Tam and Harkins note that surgeon selection bias on the route of hysterectomy could be based on concerns with operative access and outcomes in obese patients. The authors concur that more studies need to be performed comparing robotic with conventional laparoscopic routes of hysterectomy in the obese.

“In this study, laparoscopic hysterectomy offered the shortest operating time with minimal blood loss compared to the vaginal route in the obese patient population,” the authors concluded.

They noted, however, that, “Although performing hysterectomy in obese patients can be challenging, this study reaffirms that a minimally invasive approach to hysterectomy is both safe and effective. Providing either a vaginal or laparoscopic modality to hysterectomy is often requested by patients, and is supported by the American Congress of Obstetricians and Gynecologists (ACOG) and the AAGL.”

WE WANT TO HEAR FROM YOU!
Drop us a line and let us know what you think about current articles, which topics you'd like to see covered in future issues, and what challenges you face in daily practice. Tell us what you think by emailing us at: obg@frontlinemedcom.com

In obese women, laparoscopic hysterectomy provided the shortest operating time with minimal blood loss when compared with vaginal hysterectomy, according to a poster presented at the 42nd AAGL Global Congress in Washington, DC, in November 2013.¹

Teresa Tam, MD, Gerald Harkins, MD, and researchers at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, reported on a retrospective cohort study conducted to compare the routes of hysterectomy and surgical outcomes in obese patients.

Of the 1,286 patients who underwent hysterectomy between December 1, 2009, and December 1, 2012, at Hershey Medical Center, 596 met the obese body mass index (BMI) inclusion criteria (BMI >30 kg/m²). Mean (SD) BMI was 36.5 (5.8) kg/m² and the mean (SD) patient age was 45 (10) years. Mean (SD) gravidity was 2.44 (1.85) and mean (SD) parity was 1.97 (1.41).

Reasons for surgery were restricted to benign indications, including leiomyoma (31%); abnormal uterine bleeding (29%); and endometriosis (17%).

The following approaches to hysterectomy were included:

• abdominal hysterectomy [total abdominal and supracervical] (AH; n = 7)
• vaginal hysterectomy (VH; n = 84)  
• laparoscopic-assisted vaginal hysterectomy (LAVH; n = 16)
• total laparoscopic hysterectomy [conventional and robotic] (TLH; n = 295)
• laparoscopic supracervical hysterectomy [conventional and robotic] (LSH; n = 194).

Comparisons to AH were not considered in the results (n = 7). Less than 1% of the hysterectomies were abdominal cases, with majority (5 out of 7 AHs) performed being combined cases, in conjunction with colorectal service for colon or rectal malignancies. Data on preoperative indications, estimated blood loss, operating time, length of stay, and postoperative complications were compared.

The largest differences in median (SD) operating time were between TLH and LAVH (80 min vs 137.5 min, respectively; P <.001) and LSH and LAVH (90 min vs 137.5 min, respectively; P <.001).

The only statistically significant difference with regard to patients’ median (SD) length of stay was between TLH and VH (1.07 days vs 1.12 days, respectively; P = .005), but the researchers did not consider a difference of 0.05 days (1.2 hours) to be clinically relevant.

The odds of estimated blood loss of 200 mL or greater were significantly higher with VH than with TLH (35.0% vs 3.4%, respectively; odds ratio [OR] = 15.3; 95% confidence interval [CI], 7.0–33.4; P <.001). The odds of estimated blood loss also were significantly higher with VH than with LSH (35.0% vs. 8.4%; OR = 5.9; 95% CI, 3.0–11.7; P <.001).

No association was found between high BMI and surgical complications, the authors reported. However, due to the study’s retrospective nature, Tam and Harkins note that surgeon selection bias on the route of hysterectomy could be based on concerns with operative access and outcomes in obese patients. The authors concur that more studies need to be performed comparing robotic with conventional laparoscopic routes of hysterectomy in the obese.

“In this study, laparoscopic hysterectomy offered the shortest operating time with minimal blood loss compared to the vaginal route in the obese patient population,” the authors concluded.

They noted, however, that, “Although performing hysterectomy in obese patients can be challenging, this study reaffirms that a minimally invasive approach to hysterectomy is both safe and effective. Providing either a vaginal or laparoscopic modality to hysterectomy is often requested by patients, and is supported by the American Congress of Obstetricians and Gynecologists (ACOG) and the AAGL.”

WE WANT TO HEAR FROM YOU!
Drop us a line and let us know what you think about current articles, which topics you'd like to see covered in future issues, and what challenges you face in daily practice. Tell us what you think by emailing us at: obg@frontlinemedcom.com

In obese women, laparoscopic hysterectomy provided the shortest operating time with minimal blood loss when compared with vaginal hysterectomy, according to a poster presented at the 42nd AAGL Global Congress in Washington, DC, in November 2013.¹

Teresa Tam, MD, Gerald Harkins, MD, and researchers at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, reported on a retrospective cohort study conducted to compare the routes of hysterectomy and surgical outcomes in obese patients.

Of the 1,286 patients who underwent hysterectomy between December 1, 2009, and December 1, 2012, at Hershey Medical Center, 596 met the obese body mass index (BMI) inclusion criteria (BMI >30 kg/m²). Mean (SD) BMI was 36.5 (5.8) kg/m² and the mean (SD) patient age was 45 (10) years. Mean (SD) gravidity was 2.44 (1.85) and mean (SD) parity was 1.97 (1.41).

Reasons for surgery were restricted to benign indications, including leiomyoma (31%); abnormal uterine bleeding (29%); and endometriosis (17%).

The following approaches to hysterectomy were included:

• abdominal hysterectomy [total abdominal and supracervical] (AH; n = 7)
• vaginal hysterectomy (VH; n = 84)  
• laparoscopic-assisted vaginal hysterectomy (LAVH; n = 16)
• total laparoscopic hysterectomy [conventional and robotic] (TLH; n = 295)
• laparoscopic supracervical hysterectomy [conventional and robotic] (LSH; n = 194).

Comparisons to AH were not considered in the results (n = 7). Less than 1% of the hysterectomies were abdominal cases, with majority (5 out of 7 AHs) performed being combined cases, in conjunction with colorectal service for colon or rectal malignancies. Data on preoperative indications, estimated blood loss, operating time, length of stay, and postoperative complications were compared.

The largest differences in median (SD) operating time were between TLH and LAVH (80 min vs 137.5 min, respectively; P <.001) and LSH and LAVH (90 min vs 137.5 min, respectively; P <.001).

The only statistically significant difference with regard to patients’ median (SD) length of stay was between TLH and VH (1.07 days vs 1.12 days, respectively; P = .005), but the researchers did not consider a difference of 0.05 days (1.2 hours) to be clinically relevant.

The odds of estimated blood loss of 200 mL or greater were significantly higher with VH than with TLH (35.0% vs 3.4%, respectively; odds ratio [OR] = 15.3; 95% confidence interval [CI], 7.0–33.4; P <.001). The odds of estimated blood loss also were significantly higher with VH than with LSH (35.0% vs. 8.4%; OR = 5.9; 95% CI, 3.0–11.7; P <.001).

No association was found between high BMI and surgical complications, the authors reported. However, due to the study’s retrospective nature, Tam and Harkins note that surgeon selection bias on the route of hysterectomy could be based on concerns with operative access and outcomes in obese patients. The authors concur that more studies need to be performed comparing robotic with conventional laparoscopic routes of hysterectomy in the obese.

“In this study, laparoscopic hysterectomy offered the shortest operating time with minimal blood loss compared to the vaginal route in the obese patient population,” the authors concluded.

They noted, however, that, “Although performing hysterectomy in obese patients can be challenging, this study reaffirms that a minimally invasive approach to hysterectomy is both safe and effective. Providing either a vaginal or laparoscopic modality to hysterectomy is often requested by patients, and is supported by the American Congress of Obstetricians and Gynecologists (ACOG) and the AAGL.”

WE WANT TO HEAR FROM YOU!
Drop us a line and let us know what you think about current articles, which topics you'd like to see covered in future issues, and what challenges you face in daily practice. Tell us what you think by emailing us at: obg@frontlinemedcom.com

When the American Board of Obstetrics and Gynecology (ABOG) announced in September that, with a few exceptions, gynecologists could lose their board certification if they treated men, gynecologists were forced to stop treating male patients. This decision has now been altered, and gynecologists are now allowed to treat male patients for sexually transmitted diseases (STDs) and to screen men for anal cancer.¹

Experts in anal cancer and patient advocacy groups lobbied ABOG to revise their position based on gynecologists’ long-standing tradition of treating men and women for STDs. Anal cancer is usually caused by human papillomavirus. Although rare, the incidence of anal cancer is increasing, especially among those infected with human immunodeficiency virus.¹

ABOG’s new statement reads²:

     To remain certified by ABOG the care of male patients is prohibited except in the
     following circumstances:

• active government service
• evaluation of fertility
• genetic counseling and testing of a couple
• evaluation and management of sexually transmitted infections
• administration of immunizations
• management of transgender conditions
• emergency, pandemic, humanitarian or disaster response care
• family planning services, not to include vasectomy
• newborn circumcision  
• completion of ACGME-accredited training and certification in other specialties.   

Mark H. Einstein, MD, professor in the Department of Obstetrics and Gynecology and Women’s Health at Montefiore Medical Center in Bronx, New York, and author of “Update on Cervical Disease” (OBG Management, May 2013), was forced to discontinue seeing male patients. He commented,  “Cool heads have prevailed. This is the best decision for our patients.”¹

We want to hear from you. Tell us what you think!

When the American Board of Obstetrics and Gynecology (ABOG) announced in September that, with a few exceptions, gynecologists could lose their board certification if they treated men, gynecologists were forced to stop treating male patients. This decision has now been altered, and gynecologists are now allowed to treat male patients for sexually transmitted diseases (STDs) and to screen men for anal cancer.¹

Experts in anal cancer and patient advocacy groups lobbied ABOG to revise their position based on gynecologists’ long-standing tradition of treating men and women for STDs. Anal cancer is usually caused by human papillomavirus. Although rare, the incidence of anal cancer is increasing, especially among those infected with human immunodeficiency virus.¹

ABOG’s new statement reads²:

     To remain certified by ABOG the care of male patients is prohibited except in the
     following circumstances:

• active government service
• evaluation of fertility
• genetic counseling and testing of a couple
• evaluation and management of sexually transmitted infections
• administration of immunizations
• management of transgender conditions
• emergency, pandemic, humanitarian or disaster response care
• family planning services, not to include vasectomy
• newborn circumcision  
• completion of ACGME-accredited training and certification in other specialties.   

Mark H. Einstein, MD, professor in the Department of Obstetrics and Gynecology and Women’s Health at Montefiore Medical Center in Bronx, New York, and author of “Update on Cervical Disease” (OBG Management, May 2013), was forced to discontinue seeing male patients. He commented,  “Cool heads have prevailed. This is the best decision for our patients.”¹

We want to hear from you. Tell us what you think!

When the American Board of Obstetrics and Gynecology (ABOG) announced in September that, with a few exceptions, gynecologists could lose their board certification if they treated men, gynecologists were forced to stop treating male patients. This decision has now been altered, and gynecologists are now allowed to treat male patients for sexually transmitted diseases (STDs) and to screen men for anal cancer.¹

Experts in anal cancer and patient advocacy groups lobbied ABOG to revise their position based on gynecologists’ long-standing tradition of treating men and women for STDs. Anal cancer is usually caused by human papillomavirus. Although rare, the incidence of anal cancer is increasing, especially among those infected with human immunodeficiency virus.¹

ABOG’s new statement reads²:

     To remain certified by ABOG the care of male patients is prohibited except in the
     following circumstances:

• active government service
• evaluation of fertility
• genetic counseling and testing of a couple
• evaluation and management of sexually transmitted infections
• administration of immunizations
• management of transgender conditions
• emergency, pandemic, humanitarian or disaster response care
• family planning services, not to include vasectomy
• newborn circumcision  
• completion of ACGME-accredited training and certification in other specialties.   

Mark H. Einstein, MD, professor in the Department of Obstetrics and Gynecology and Women’s Health at Montefiore Medical Center in Bronx, New York, and author of “Update on Cervical Disease” (OBG Management, May 2013), was forced to discontinue seeing male patients. He commented,  “Cool heads have prevailed. This is the best decision for our patients.”¹

We want to hear from you. Tell us what you think!

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

In an appeal for increased vaccination against influenza, the Centers for Disease Control and Prevention (CDC) announced that, although vaccination coverage has increased for some groups of the population, the nation needs to do better. Recommendations from the Advisory Committee on Immunization Practices reported seasonal influenza vaccination data in the CDC’s Morbidity and Mortality Weekly Report (MMWR) on September 20, 2013.¹

More children aged 6 months through 17 years received the influenza vaccine during the 2012–2013 season (56.6%), up 5.1% from the 2011–2012 season. Smaller increases were reported for adults aged 18 years and older at 41.5%, up 2.7% from 2011–2012. Overall, 45% of the entire US population aged 6 months and older was vaccinated in 2012–2013. However, this falls short of public health goals.²

Howard K. Koh, MD, Assistant Secretary for Health at the US Department of Health and Human Services, pointed out that, although the increases in number of those who received the influenza vaccine last year is significant, there is more work to do. “Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.”²

What vaccines will be available for the 2013-2014 season?
The 2013-2014 influenza vaccine is detailed in MMWR¹:

Risk of complications from influenza
Mothers. Vaccination to prevent influenza is particularly important for those who are at increased risk for severe complications from influenza. Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy.¹

Increased severity of influenza among pregnant women was reported during pandemics in 1918–1919, 1957–1958, and 2009–2010. Severe infections were also observed among postpartum (within 2 weeks after delivery) women during the 2009–2010 pandemic.¹ 

One study by Cox et al indicated an increase in delivery complications, including fetal distress, preterm labor, and cesarean delivery, for pregnant women with respiratory hospitalizations during the flu season.¹

Vaccination coverage has increased in pregnant women in the last few years, but, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50%.²

Pregnant women who were treated with antivirals more than 4 days after symptoms arose were more likely to be admitted to an ICU (57% vs 9%; 95% confidence interval [CI] 3.5–10.6] than those treated within 2 days on symptom onset.¹

Infants. Pregnant women have protective levels of anti-influenza antibodies after vaccination that are passively transferred to their children. In a randomized controlled trial of vaccinated pregnant women who later breastfed their children, infants of vaccinated women had a 63% reduction in laboratory-confirmed influenza during the first 6 months of life. In addition, authors Zaman et al reported a 29% reduction in respiratory illness with fever among the infants and a 36% reduction in respiratory illness with fever among their mothers during the first 6 months after birth.¹

Another study by Eick et al found that infants aged less than 6 months who were born to women who were given influenza vaccination during pregnancy had significantly reduced risk for influenza virus infection (relative risk [RR]: 0.59; 95% CI = 0.37–0.93) and hospitalization for influenza-like illness (ILI) (RR: 0.61; 95% CI = 0.45–0.84).¹

Infants born to women with laboratory-confirmed flu during pregnancy did not have higher rates of low birthweight, congenital abnormalities, or lower Apgar scores compared with infants born to uninfected women.¹

ACOG recommendations for pregnant and postpartum women

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.³

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.¹

Recommendations for nonpregnant women
The CDC continues to recommend annual influenza vaccination for all persons ages 6 months or older. Among healthy younger adults, seasonal influenza is typically less acute and results less often in hospitalization, as compared with children aged <5 years, adults aged ≥65 years, pregnant women, or persons with chronic medical conditions. The flu is a significant reason for outpatient medical visits and worker absenteeism among healthy adults aged 19 through 49 years.¹

For specific guidelines, visit the CDC’s “Influenza Vaccination: A Summary for Clinicians” at http://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm.

What can you, as a physician, do?
Health-care professionals are critical to the vaccination program and need to lead by example. “If you are around people at high risk for flu complications, you need to get vaccinated,” said Anne Schuchat, MD, Assistant Surgeon General, US Publish Health Service, and Director of the National Center for Immunization and Respiratory Diseases at the CDC.²

The CDC reported that 72% of health-care personal received a vaccination in 2012–2013. Physicians had the highest coverage at 92.3%.²

“Patients also look to you,” said Dr. Schuchat. “Data show that a personal recommendation makes a big difference to patients.”²

For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Dr. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ mean income was $242,000 in 2012, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported similar incomes in 2011 and 2012. In 2012, 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earned less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other findings
Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (9% of orthopedic respondents were female). Response rates also matter: of those who responded to the full Medscape poll, 31% were female; of ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000
• multispecialty (office-based) group practices: $252,000
• hospitals: $216,000
• academic: $212,000
• solo practices (office-based): $208,000
• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other settings at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

Money issues
Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization. In 2012, that jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with potentially reduced Medicare payments in 2012 than in 2011. The new report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review annual payments from insurers and drop those who pay the least or create the most trouble. In 2012, 26% of ObGyns reported that they already follow this practice or are planning to take that advice. However, 29% will keep all insurers; they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes; 19% of all physicians said yes.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns regularly discussed the cost of services with their patients; 48% occasionally discussed cost if the patient brought it up (89% total).
• In 2012, 35% of ObGyns regularly discussed cost with their patients; 41% occasionally discussed cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2 

How you spend your time
How many hours do you work? The number of hours in a workweek remained about the same. In 2012, 11% of ObGyns worked 41 to 45 hours; 13% worked 46 to 50 hours; 4% worked 51 to 55 hours; 9% worked 56 to 60 hours; and 20% reported working less than 30 hours.¹

Time spent with patients? In 2012, most ObGyns spent less than 16 minutes with a patient: 30% reported spending 13 to 16 minutes; another 30% spent less than 13 minutes; and 17% saw patients for 21 minutes or longer.¹

Demographics of the survey
Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1,094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

ObGyns’ 2012 mean income was $242,000, up from a mean of $220,000 in 2011, although almost half (45%) of ObGyns reported their 2012 income to be the same as their 2011 income. In 2012, about 25% of ObGyns reported earnings of $300,000 or more, and 10% said they earn less than $100,000.¹ The newest salary data are based on Medscape’s 2013 Compensation Report, a survey of 21,878 US physicians across 25 specialties.

Forty-three percent of ObGyns were satisfied with their 2012 compensation levels; 48% of all physicians were satisfied.^1,2

Other Findings

Men still make more than women. In 2012, male ObGyns reported earning 14% more than female ObGyns. This pay gap is smaller for ObGyns than for all physicians, however; overall, male physicians earn 30% more than females. One contributing factor to the closer pay gap for ObGyns is that there are fewer women in the higher-paying specialties, such as orthopedics (only 9% of orthopedic respondents were female). Response rates also matter: of those who responded to the overall Medscape poll, 31% were female; of the ObGyn respondents, 43% were female.^1,2

ObGyn compensation varies by region. Highest earnings were found in the South Central region (mean: $250,000 in 2012); lowest earnings were found in the Northeast (mean: $213,000).¹

Work setting counts. When ranked by job setting, in 2012, ObGyns employed by health-care organizations were the top earners (mean income: $272,000). This figure rose considerably from the 2011 mean of $239,000. Additional mean earnings of ObGyns ranked by work setting in 2012 were¹:

• single-specialty (office-based) group practices: $264,000

• multispecialty (office-based) group practices: $252,000

• hospitals: $216,000

• academic: $212,000

• solo practices (office-based): $208,000

• outpatient clinics: $206,000.

When ranked by work situation, partners beat all other situations at $268,000 (mean). Employed ObGyns earned more than owners of solo practices (mean: $241,000 vs $204,000, respectively). Independent contractors came in the lowest at $198,000 (mean).¹

Satisfaction with career choice and practice setting showed a slight dip from 2011. When all physicians were asked if they would choose medicine again, 53% would do so in 2012, versus 55% in 2011. Among the ObGyns who said they would choose medicine again, 37% said they would choose the same specialty (the same as in 2011). In 2012, 18% of ObGyns said they would choose the same practice setting, compared with 23% in 2011.^1,2

What’s most rewarding? In 2012, 42% of ObGyns ranked their relationships with patients as the most satisfying part of their job, compared with 31% of all physicians. While 34% of all physicians said that being good at the practice of medicine was their primary reward, 28% of ObGyns listed that first.^1,2

FINDINGS ON HOW YOU MAKE AND DISCUSS MONEY

Where does your income come from? In the 2011 report, only 4% of ObGyns either participated in or planned to join an accountable care organization (ACO). In 2012, that figure jumped to 25%. Only 1% of ObGyns opted for concierge medical practices in 2012 and 2011, and only 3% chose cash-only practices in 2012 and 2011.^1,2

What about Medicare and Medicaid? More physicians were concerned with the potential for reduced Medicare reimbursement in 2012 than in 2011. The current report indicated that 15% of ObGyns plan to stop taking new Medicare or Medicaid patients, 3% plan to stop seeing current Medicare or Medicaid patients, and 28% are undecided. However, 53% of ObGyns are not conflicted and will continue to see current patients and take on new Medicare and Medicaid patients. In 2012, 59% of all physicians planned to treat new Medicare and Medicaid patients.^1,2

What about insurance company payments? Practice management experts often recommend that physicians review their annual payments from insurers and drop those who pay the worst or create the most trouble. In 2012, 26% of ObGyns reported that they already do that or are planning to take that advice. However, 29% will keep all insurers because they feel that even poor payers still represent income. About 15% felt that dropping insurers was inappropriate behavior.¹

Do you provide ancillary services? When asked if they would offer additional medical services to increase income, 21% of ObGyns said yes. Nineteen percent of all physicians said they had begun to do that.^1,2

Do you discuss cost with your patients? In larger practices and hospital settings, treatment costs are often discussed by a staff member responsible for billing and payment, rather than by the physician. As physicians move toward these larger organizations, the trend is becoming more apparent¹:

• In 2011, 41% of ObGyns reported that they regularly discuss the cost of services with their patients; 48% said they occasionally discuss cost if the patient brings it up (89% total).

• In 2012, 35% of ObGyns said they regularly discuss cost with their patients; 41% said they occasionally discuss cost (76% total).

In 2011, 84% of all physicians either regularly or occasionally discussed the cost of treatment with patients. In 2012, 68% of all physicians regularly discussed cost of treatment (30%) or did so if the patient asked (38%), and 6% reported that it was inappropriate to discuss cost with patients.^1,2

Findings on how you spend your time

How many hours do you work? The number of hours in a workweek remained approximately the same for the last 2 years: in 2012, 11% of ObGyns worked 41–45 h/w; 13% worked 46–50 h/w; 4% worked 51–55 h/w; and 9% worked 56–60 h/w. Approximately 20% of ObGyns reported working less than 30 h/w.¹

How much time do you spend with patients? In 2012, most ObGyns spent 16 minutes or less per patient visit. Thirty percent of ObGyns spent 13–16 minutes with a patient, and another 30% spent less than 13 minutes. Some indicated longer patient visits—17% saw patients for 21 minutes or more.¹

Demographics of the survey

Respondents to the Medscape survey totaled 21,878 US physicians and ranged in age from 28 years to older than 70; 66% were aged 40 to 64 years; 31% were female; 69% were male; and 89% were board certified.

Of the overall survey respondents, 5% (n = 1094) were ObGyns. Of these respondents, 71% were aged 40 to 64; 43% were female; 57% were male; and 92% were board certified.^1,2

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

Although it’s not a new trend, ObGyns are changing how they practice medicine as a direct result of the high cost or availability of liability insurance. From 2009 through 2011 about 18% of practicing obstetricians decreased the number of high-risk patients they were treating, 15% increased the number of cesarean deliveries they performed, 13.5% stopped offering vaginal birth after cesarean, and 5% stopped practicing obstetrics altogether, according to the American Congress of Obstetrics and Gynecology.¹ Liability exposure, in part, also has resulted in fewer hospitals across the United States offering birthing services.²

The Premier Perinatal Safety Initiative (PPSI) is a national endeavor, involving 14 hospitals, designed to 1) lower the incidence of preventable adverse birth events, such as birth asphyxia and neonatal neurologic disability, 2) better define preventable perinatal harm, 3) identify measures to improve outcomes, and 4) evaluate the effect of harm reductions on liability claims and pay-outs.²

Reduced adverse events

In 2 years, PPSI hospitals reduced, on average²:

• birth hypoxia and asphyxia by 25%
• neonatal birth trauma by 22%
• complications from administering anesthesia during labor and delivery by 15%
• postpartum hemorrhage by 5.4%.

The adverse outcome index rate, which measures the number of patients with one or more of the identified adverse events as a proportion of total deliveries, was reduced by 7.5%, or 144 fewer adverse events from 2008 to 2010. All hospitals scored below the 2008 Agency for Healthcare Research and Quality (AHRQ) Provider Rate, a national comparative rate measuring perinatal harm.²

Reduced liability claims

In addition, liability claims and payouts decreased by 39% from 2006 to 2010, versus 10% at nonparticipating hospitals. All PPSI hospitals averaged 18 liability claims per year at baseline, but that number dropped to 10 in 2009 and is trending to 8 in 2010 (final claims losses are not yet available because it typically takes 2 years or longer for a claim to be filed).²

Strategies to achieve best outcomes

The best outcomes were achieved with two factors: An increased adherence to evidence-based care bundles in participating hospitals, and enhanced communication and teamwork among hospital staff.²

Increased adherence to evidence-based care bundles. Grouping essential processes together in care bundles helped clinical staff remember to take all of the necessary steps to provide optimal care. For a care bundle to be considered adhered to, staff were scored as “all or none,” meaning that all elements of the care bundle must have been observed for credit to have been given. For instance, the augmenting care bundle included four essential steps. If fetal weight was not calculated before oxytocin was administered, no credit was given for the care provided.²

PPSI hospitals significantly improved compliance with care bundles from 2008 to 2010. On average²:

• Elective induction bundle compliance increased from 58% to 88%.
• Augmentation bundle compliance increased from 33% to 72%.
• Vacuum bundle compliance increased from 9% to 51%.

High-reliability teams. PPSI hospitals implemented proven strategies for certain high-risk protocols known to enhance communication and teamwork, including²:

• TeamSTEPPS^®. Developed by AHRQ, TeamSTEPPS produces highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.
• Situation Background Assessment Recommendation (SBAR). An effective situational briefing strategy used by the US Navy helps people communicate relevant case facts in a respectful, focused, and effective manner.
• Simulation drills. Practice exercises feature actresses and mannequins reacting as real patients during the birthing process.

Data regarding outcomes for these communication and teamwork strategies in the PPSI hospitals continues to be evaluated, and will be available in fall 2013.

Study information

Baseline data was completed in a retrospective study of harm outcome data from 2006 and 2007. During Phase 1, health-care teams implemented interventions and worked on improving performance and perinatal safety improvement across approximately 145,000 births. Phase 2 began in January 2011 and will be completed in December 2012.²

The 14 participating hospitals include 4 with small birth volume (1,000 to 2,499 births per year), 8 with medium birth volume (2,500 to 5,000 births per year), and 2 with large birth volume (5,000 or more births per year) in 10 states: Illinois, Kentucky, Massachusetts, Minnesota, New Mexico, Ohio, Tennessee, Texas, Washington, and Wisconsin. Six of 14 hospitals have academic teaching status.²

We want to hear from you! Tell us what you think.

The American Board of Medical Specialties (ABMS) sets the standards for physician Board Certification. ABMS has begun to publicly report on its Web site (www.CertificationMatters.org) the status of whether ObGyns meet the ABMS Maintenance of Certification^® (ABMS MOC^®) program requirements established by the American Board of Obstetrics and Gynecology (ABOG).

There are 24 ABMS Member Boards; 7 began reporting MOC status of the physicians they certify in August 2011, and ABOG is one of 11 boards that began to report MOC status in August 2012. The remaining six ABMS Member Boards expect to make MOC status available by 2014.

The results of a search show the physician’s name, the name of the ABMS Member Board(s) that certify the physician, and a “Yes”, “No,” or “Not Required” response to whether the physician is meeting the MOC requirements of that Member Board. In addition, the physician’s profile contains these features:

• His or her status of all specialty and subspecialty certificates. For example, a physician can be Board Certified in General Obstetrics and Gynecology and the subspecialty of Maternal-Fetal Medicine.
• If a physician became Board Certified before his or her Member Board(s) established their MOC program, and he or she is exempt from participating in MOC, a “Not Required” option is provided. If that physician voluntarily meets the MOC requirements of his or her Member Board(s), the profile will show a “Yes.”

Nearly 800,000 Board Certified physicians voluntarily meet specialty-specific standards beyond what is required for state licensing. Board Certification involves rigorous testing and peer evaluation designed and administered by specialists in a specific medical field. The ABMS MOC program promotes career-long learning, quality improvement activities, and self-assessment. Insurers, hospitals, quality and credentialing organizations, and the federal government recognize ABMS MOC as an important quality marker.

“As the organization that has set the gold standard in physician specialty certification for more than 75 years, this effort further demonstrates ABMS’ commitment to advance quality health care for patients,” said Lois Margaret Nora, MD, JD, MBA, ABMS President and Chief Executive Officer.

Anyone can visit www.CertificationMatters.org to see if a physician is Board Certified by an ABMS Member Board.

We want to hear from you! Tell us what you think.

The American Board of Medical Specialties (ABMS) sets the standards for physician Board Certification. ABMS has begun to publicly report on its Web site (www.CertificationMatters.org) the status of whether ObGyns meet the ABMS Maintenance of Certification^® (ABMS MOC^®) program requirements established by the American Board of Obstetrics and Gynecology (ABOG).

There are 24 ABMS Member Boards; 7 began reporting MOC status of the physicians they certify in August 2011, and ABOG is one of 11 boards that began to report MOC status in August 2012. The remaining six ABMS Member Boards expect to make MOC status available by 2014.

The results of a search show the physician’s name, the name of the ABMS Member Board(s) that certify the physician, and a “Yes”, “No,” or “Not Required” response to whether the physician is meeting the MOC requirements of that Member Board. In addition, the physician’s profile contains these features:

• His or her status of all specialty and subspecialty certificates. For example, a physician can be Board Certified in General Obstetrics and Gynecology and the subspecialty of Maternal-Fetal Medicine.
• If a physician became Board Certified before his or her Member Board(s) established their MOC program, and he or she is exempt from participating in MOC, a “Not Required” option is provided. If that physician voluntarily meets the MOC requirements of his or her Member Board(s), the profile will show a “Yes.”

Nearly 800,000 Board Certified physicians voluntarily meet specialty-specific standards beyond what is required for state licensing. Board Certification involves rigorous testing and peer evaluation designed and administered by specialists in a specific medical field. The ABMS MOC program promotes career-long learning, quality improvement activities, and self-assessment. Insurers, hospitals, quality and credentialing organizations, and the federal government recognize ABMS MOC as an important quality marker.

“As the organization that has set the gold standard in physician specialty certification for more than 75 years, this effort further demonstrates ABMS’ commitment to advance quality health care for patients,” said Lois Margaret Nora, MD, JD, MBA, ABMS President and Chief Executive Officer.

Anyone can visit www.CertificationMatters.org to see if a physician is Board Certified by an ABMS Member Board.

We want to hear from you! Tell us what you think.

The American Board of Medical Specialties (ABMS) sets the standards for physician Board Certification. ABMS has begun to publicly report on its Web site (www.CertificationMatters.org) the status of whether ObGyns meet the ABMS Maintenance of Certification^® (ABMS MOC^®) program requirements established by the American Board of Obstetrics and Gynecology (ABOG).

There are 24 ABMS Member Boards; 7 began reporting MOC status of the physicians they certify in August 2011, and ABOG is one of 11 boards that began to report MOC status in August 2012. The remaining six ABMS Member Boards expect to make MOC status available by 2014.

The results of a search show the physician’s name, the name of the ABMS Member Board(s) that certify the physician, and a “Yes”, “No,” or “Not Required” response to whether the physician is meeting the MOC requirements of that Member Board. In addition, the physician’s profile contains these features:

• His or her status of all specialty and subspecialty certificates. For example, a physician can be Board Certified in General Obstetrics and Gynecology and the subspecialty of Maternal-Fetal Medicine.
• If a physician became Board Certified before his or her Member Board(s) established their MOC program, and he or she is exempt from participating in MOC, a “Not Required” option is provided. If that physician voluntarily meets the MOC requirements of his or her Member Board(s), the profile will show a “Yes.”

Nearly 800,000 Board Certified physicians voluntarily meet specialty-specific standards beyond what is required for state licensing. Board Certification involves rigorous testing and peer evaluation designed and administered by specialists in a specific medical field. The ABMS MOC program promotes career-long learning, quality improvement activities, and self-assessment. Insurers, hospitals, quality and credentialing organizations, and the federal government recognize ABMS MOC as an important quality marker.

“As the organization that has set the gold standard in physician specialty certification for more than 75 years, this effort further demonstrates ABMS’ commitment to advance quality health care for patients,” said Lois Margaret Nora, MD, JD, MBA, ABMS President and Chief Executive Officer.

Anyone can visit www.CertificationMatters.org to see if a physician is Board Certified by an ABMS Member Board.

We want to hear from you! Tell us what you think.

The TERC test, a new molecular assay, examines abnormalities of the telomerase RNA component (TERC) gene based on knowledge about which molecular changes turn cervical dysplasia into malignancy. This knowledge comes from National Institutes of Health (NIH) research demonstrating that the TERC gene is amplified in the precursor cells of cervical cancer.^1,2

What does this test mean for your practice?

Neal M. Lonky, MD, MPH

This is the evolution from interpreting anatomical microscopic features to molecular markers associated with cellular proliferation that move our paradigm from “snapshot” diagnosis to a “movie preview” of the prognostic significance of the lesions of the cervix. Like other molecular markers, it will help us assess risk more accurately, preventing unnecessary visits and treatment in the lower risk cohort (with the associated stress and complications), while moving those positive for the markers to appropriate care.

Dr. Lonky is clinical professor of obstetrics and gynecology at the University of California–Irvine and a member of the board of directors of Southern California Permanente Medical Group. Dr. Lonky is an OBG Management contributing editor.

When standard screening like the Pap smear and human papillomavirus (HPV) test do not provide clear results about a patient’s cervical cancer risk, the TERC test will enable detection of specific cancerous characteristics.

Following TERC and HPV testing, women at high risk can undergo additional cervical biopsy under colposcopy and benefit from more aggressive observation and treatment. Women found to be at low risk may not have to undergo extensive follow-up.

It is estimated that almost 12,000 new cases of HPV-associated cervical cancer are diagnosed in the United States each year.³ It is estimated that this test could help detect cervical cancer in more than 1.5 million women with ambiguous Pap test results.²

One of NIH’s goals is to evolve their scientific discoveries into clinically valuable technologies through collaboration with commercial organizations, which is how Quest Diagnostics acquired a nonexclusive patent license for the human TERC gene marker.²

We want to hear from you! Tell us what you think.

The TERC test, a new molecular assay, examines abnormalities of the telomerase RNA component (TERC) gene based on knowledge about which molecular changes turn cervical dysplasia into malignancy. This knowledge comes from National Institutes of Health (NIH) research demonstrating that the TERC gene is amplified in the precursor cells of cervical cancer.^1,2

What does this test mean for your practice?

Neal M. Lonky, MD, MPH

This is the evolution from interpreting anatomical microscopic features to molecular markers associated with cellular proliferation that move our paradigm from “snapshot” diagnosis to a “movie preview” of the prognostic significance of the lesions of the cervix. Like other molecular markers, it will help us assess risk more accurately, preventing unnecessary visits and treatment in the lower risk cohort (with the associated stress and complications), while moving those positive for the markers to appropriate care.

Dr. Lonky is clinical professor of obstetrics and gynecology at the University of California–Irvine and a member of the board of directors of Southern California Permanente Medical Group. Dr. Lonky is an OBG Management contributing editor.

When standard screening like the Pap smear and human papillomavirus (HPV) test do not provide clear results about a patient’s cervical cancer risk, the TERC test will enable detection of specific cancerous characteristics.

Following TERC and HPV testing, women at high risk can undergo additional cervical biopsy under colposcopy and benefit from more aggressive observation and treatment. Women found to be at low risk may not have to undergo extensive follow-up.

It is estimated that almost 12,000 new cases of HPV-associated cervical cancer are diagnosed in the United States each year.³ It is estimated that this test could help detect cervical cancer in more than 1.5 million women with ambiguous Pap test results.²

One of NIH’s goals is to evolve their scientific discoveries into clinically valuable technologies through collaboration with commercial organizations, which is how Quest Diagnostics acquired a nonexclusive patent license for the human TERC gene marker.²

We want to hear from you! Tell us what you think.

The TERC test, a new molecular assay, examines abnormalities of the telomerase RNA component (TERC) gene based on knowledge about which molecular changes turn cervical dysplasia into malignancy. This knowledge comes from National Institutes of Health (NIH) research demonstrating that the TERC gene is amplified in the precursor cells of cervical cancer.^1,2

What does this test mean for your practice?

Neal M. Lonky, MD, MPH

This is the evolution from interpreting anatomical microscopic features to molecular markers associated with cellular proliferation that move our paradigm from “snapshot” diagnosis to a “movie preview” of the prognostic significance of the lesions of the cervix. Like other molecular markers, it will help us assess risk more accurately, preventing unnecessary visits and treatment in the lower risk cohort (with the associated stress and complications), while moving those positive for the markers to appropriate care.

Dr. Lonky is clinical professor of obstetrics and gynecology at the University of California–Irvine and a member of the board of directors of Southern California Permanente Medical Group. Dr. Lonky is an OBG Management contributing editor.

When standard screening like the Pap smear and human papillomavirus (HPV) test do not provide clear results about a patient’s cervical cancer risk, the TERC test will enable detection of specific cancerous characteristics.

Following TERC and HPV testing, women at high risk can undergo additional cervical biopsy under colposcopy and benefit from more aggressive observation and treatment. Women found to be at low risk may not have to undergo extensive follow-up.

It is estimated that almost 12,000 new cases of HPV-associated cervical cancer are diagnosed in the United States each year.³ It is estimated that this test could help detect cervical cancer in more than 1.5 million women with ambiguous Pap test results.²

One of NIH’s goals is to evolve their scientific discoveries into clinically valuable technologies through collaboration with commercial organizations, which is how Quest Diagnostics acquired a nonexclusive patent license for the human TERC gene marker.²

We want to hear from you! Tell us what you think.