Female Pelvic Medicine: The Present and the Future

1. Female Pelvic Medicine:The Present and the Future Roger Dmochowski MD, FACS Dept of Urology Vanderbilt University Medical Center Nashville, TN

2. A Newly Recognized Specialty

3. Definitions • Resident: A physician in an accredited graduate medical education program. • Fellow: A physician in a program of graduate medical education accredited by the ACGME • who has completed the requirements for eligibility for first board certification in the specialty. • Such physicians are also termed subspecialty residents. Other uses of the term "fellow" require modifiers for precision and clarity, e.g., research fellow. http://www.acgme.org/acWebsite/about/ab_ACGMEglossary07_05.pdf

4. Definitions • Accreditation: A voluntary process of evaluation and review performed by a non-governmental agency of peers. • Certification: A process to provide assurance to the public that a certified medical specialist has successfully completed an approved educational program and an evaluation, including an examination process designed to assess the knowledge, experience and skills requisite to the provision of high quality care in that specialty. http://www.acgme.org/acWebsite/about/ab_ACGMEglossary07_05.pdf

5. Subspecialty Certification • Intent: ABMS policy that recognition of subspecialty certification should be primarily for individuals who are devoting a major portion of their time and efforts to that restricted special field. • Subspecialty certification should only be granted after education and training in addition to that required for general certification in the discipline. ABMS: 2004 Annual Report and Reference Handbook

6. ABMS Subspecialty Certification • There is no requirement for a diplomate in a recognized specialty to hold a special certification in a subspecialty of that field in order to be considered qualified to include aspects of that subspecialty within a specialty practice. • Ex: a urologist will still be able to perform pediatric circumcisions. • Under no circumstance should a diplomat be considered unqualified to practice within an area of specialty solely because a lack of subspecialty certification. ABMS: 2004 Annual Report and Reference Handbook

7. Urology • The Certification Process • Candidates have five years from the end of residency to successfully complete Parts 1 and 2 of the certification process to become a Diplomate. Candidates who fail to do so may re-enter the process by way of the Preliminary Examination. • Pediatric Urology was the first approved subspeciaty • Certification includes all domains of urology, including Pediatric urology. • Certification is valid for ten years, by which time a physician must recertify to remain a Diplomate. http://www.abu.org/certification.html

8. OB - GYN • CERTIFICATION AND MAINTENANCE OF CERTIFICATION • The ABOG examines and certifies nearly 1,700 obstetrician-gynecologists and subspecialists in maternal-fetal medicine, reproductive endocrinology/ infertility and gynecologic oncology each year. Additionally, more than 5,000 physicians are examined annually for the purpose of maintenance of certification. www.abog.org

9. OB-GYN / Fellowships • APPROVAL OF FELLOWSHIPS • One of the functions of the American Board of Obstetrics and Gynecology is to approve graduate medical education programs (fellowships) in subspecialties of obstetrics and gynecology. CURRENTLY APPROVED SUBSPECIALTY FELLOWSHIP PROGRAMS Female Pelvic Medicine and Reconstructive Surgery Gynecologic Oncology Maternal-Fetal Medicine Reproductive Endocrinology/Infertility www.abog.org

10. Ideal - FPMRS Combined fellowship in Urogynecology, Female Urology and Colo-rectal surgery to mix unique talents that each specialty offers. = most comprehensive approach to female pelvic medicine and reconstructive surgery (FPMRS)

11. CurrentlyAccredited FPMRS fellowships • 48 PROGRAMS (3 YEARS IN LENGTH) • Currently, 8 programs have a Urologist as PD • The 3 year guidelines apply to Gynecologists entering programs www.abog.org

12. ABU-ABOG • Combined accrediting board. • Designed to recognize contributions of urologists and urogynecologists in the treatment of female pelvic disorders. • Idea is to create a combined program under tutelage of female urologists and urogynecologists. • 2 years for urologists • 3 years for gynecologists • Programs are accredited by ABU-ABOG review board, and re-examined on periodic basis. • Much like RRC review of residency programs.

13. New Directions • Starting in 2013 all Fellowships will be ACGME certified. • Individual programs will be assessed by the RRC of either Gynecology or Urology dependent upon the focus of the training program.

14. What does all this mean for you? • Grandfathering • Practice focus • Case logs • Absolute review and percentages to be determined by ABU (urology) or ABOG (gynecology) • Testing to Begin in 2013 (for 3 years) • A surgeon can still perform SUI and prolapse surgery without this certificate

15. Conclusion • Subspecialty confirmation • Critical period for grandfathering • Each specialty will approach as apropos • Practice focus is a component