ISGE VIDEOS

1. Decreased emphasis in gynecologic surgery by many Program
    Directors.  This could be a reflection of their training and area of interest.
 
2. Training programs require the residents to spend significant amount
     of time learning about geriatric patients and the treatment of medical
    diseases.  Arguably important aspects of training. However, they decrease the
    exposure of the trainee to surgery.
 
3. Many residency programs lack properly trained and experienced
    faculty in the field of minimally invasive surgery, gynecology and especially
    vaginal surgery. We should ensure that our current residents are properly
    trained because they will be the faculty in the future.
 
4. Reimbursement. Most insurance companies reimburse the same rate for a hysterectomy performed by the abdominal,     vaginal, or laparoscopic route. Practitioners faced with shrinking reimbursement and rising costs need more office         patient volume and for more efficient time management. Thus an abdominal hysterectomy is the preferred method of     treatment based on training and economics. This poses an ethical dilemma.
    Are we offering the best choices to our patients? We as a specialty need
    to answer this question. The lack of reimbursement has curbed the
    enthusiasm for training in minimally invasive surgery in our specialty in the United States. Why would             

    physicians  take time to learn a new technique that they are not going to be adequately reimbursed for? 

    (It took 5 years for  laparoscopic cholecystectomy to be universally adopted!)  
   
5. Many residency programs rely heavily on the availability of private
    patients for training in gynecologic surgery. If the pendulum is
    swinging back towards abdominal surgery, how are we going to train the
    specialists of tomorrow in minimally invasive and vaginal surgery?
    Unfortunately the answer has a strong financial component. 
  
 Expert gynecologic surgeons need to be appropriately reimbursed. Then, more surgical options will become readily     available to women.Our colleagues are not getting it. They are fixated with tort reform issues, credentialing, and others while ignoring the issue of adequate and fair reimbursement for surgical procedures. Unfortunately money is the great motivator. It drives education, advances in new surgical procedures/ techniques, and progress in general. We are witnessing a specialty that is rapidly changing to a strange form dominated by cosmetic surgery, skin care, vitamin sales, and other enterprises that are associated with a higher reimbursement.


Cristo Papasakelariou, M.D. FACOG, FACS
Director Gynecologic Surgery
St Joseph Hospital Medical Center
Houston TX