Increase In Percentage Of Women Research Articles

What are Women Being Advised by Mentors When Applying to Surgery?

Despite an increase in percentage of women entering the surgical field, women tend to favor certain surgical subspecialties. The purpose of this study was to investigate how surgeons advise trainees in pursuit of a surgical career. An 18-question survey was administered to members of the American College of Surgeons through their monthly newsletter NewScope. Respondents were asked to identify subspecialties that they would consider to be most receptive to men or women and how they would advise men and women pursuing a surgical specialty. There were 663 respondents, of which the majority (n = 465, 70.99%) were male. When asked if participants had a role model in medical school, 61.10 per cent had male role models/mentors, whereas only 7.96 per cent had female role models/mentors. Among the 23 surgical subspecialties listed, the top five specialties viewed as receptive for women were breast surgery, obstetrics and gynecology, plastic surgery, ophthalmology, and GS. Surgical specialty and gender of the respondent played a role in how surgeons advised men and women trainees, especially in specialties that traditionally have less female representation. There is inherent gender-based bias in advisement of trainees that may affect surgical specialty choice. Surgeon gender, age, and surgical specialty could be predictors as to how trainees are advised.

Abstract 31: The Impact of the 2010 NY State Breast Cancer Provider Discussion Law on Breast Reconstruction Rates: An Analysis of 42,137 Patients From the NY SPARCS Database

PURPOSE: The percentage of women seeking breast reconstruction remains low despite rising mastectomy rates and federal laws mandating insurance coverage. The New York State (NYS) Breast Cancer Provider Discussion Law, effective January 2011, mandates provider discussion of breast reconstruction in order to improve patient awareness of post-mastectomy reconstructive options. This study examines the law’s impact on reconstruction rates. METHODS: We used the NYS Planning and Research Cooperative System (SPARCS) database and the US Census Bureau American Community Survey to examine breast reconstruction rates three years before (2008–2010) and four years after (2011–2014) law enactment, stratifying by socieoeconomic status (SES), median income bracket (MIB), age, insurance type, and race. RESULTS: We examined 42,137 patients. There was a decline in the absolute volume of mastectomies from 6479 in 2008 to 4488 in 2014, with an increase in percentage of women seeking reconstruction from 49% in 2008 to 60% in 2014. These reconstruction rates in NYS overall were significantly higher than the national average of 32.3% (p<0.01). This rise was seen across all SES, MIB, races, age groups, and insurance types. A significantly higher percentage of Caucasians chose reconstruction when compared to other races for any given year (p<0.01). African Americans (AA) experienced the biggest change in breast reconstruction rate, from 41% of AAs seeking reconstruction before law passage to 51% after law passage, and increase of 25% (p<0.01). This was followed closely by Asians (18% increase, p<0.01) and Caucasians (12% increase, p<0.01). High SES and MIB were associated with higher rates of breast reconstruction. Patients with low SES however, experienced the greatest change in breast reconstruction rates, increasing 35%, from 37% pre- to 50% post-law enactment of patients choosing breast reconstruction (p<0.01). Medium and high SES also had lower but still significant increases of 24% and 11% respectively (p<0.01). This finding was paralleled in the analysis of MIB, where the highest increase occurred in those with the lowest MIB ($0-$36,580) experiencing a 30% surge in rate of breast reconstruction (p<0.01). Those with lower MIB ($36–580-$49,567), higher MIB ($49,567-$65–885), and highest MIB ($65,885-$200,000) had increases of 15%, 13% and 9% respectively in breast reconstruction rates after law passage. CONCLUSIONS: The aim of the Breast Cancer Provider Discussion Law is to improve breast reconstructive rates through provider-driven patient education. Our data shows a significant change in reconstructive rates following law passage. This change, seen most acutely in minority populations, those with lower MIB, and low SES suggests effectiveness of the law in improving awareness of both the reconstructive options and the federal mandate for insurance coverage. Further examination of public and provider awareness of this law may further clarify its role on this observed trend in breast reconstruction. The NYS Provider Discussion Law may potentially provide a template for other states to model legislation geared towards patient-centered improvement of health outcomes.

Assessment of Follow-Up for Low-Grade Cytological Abnormalities in the National Breast and Cervical Cancer Early Detection Program, 2000—2005

OBJECTIVE To assess the management of women in the National Breast and Cervical Cancer Early Detection Program with low-grade squamous intraepithelial lesions (LSIL) before and after the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for management of abnormal cytology were published in 2002. MATERIALS AND METHODS We examined the follow-up for 22,342 women with LSIL during 2 periods: 2000-2002 and 2003-2005. RESULTS The percentage of providers who followed the recommended guidelines with colposcopy for an LSIL Pap test result increased by 9% from the pre-ASCCP to the post-ASCCP period. An increase was seen in every age and racial/ethnic group. Younger women (<30 years) and white women were more likely than comparison groups to be followed by colposcopy rather than a repeat Pap test. CONCLUSIONS The increase in percentage of women having colposcopy in 2003, 1 year after the new guidelines were published, suggests a change in provider practices consistent with those guidelines.

Assessment of Follow-Up for Low-Grade Cytological Abnormalities in the National Breast and Cervical Cancer Early Detection Program, 2000-2005

To assess the management of women in the National Breast and Cervical Cancer Early Detection Program with low-grade squamous intraepithelial lesions (LSIL) before and after the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for management of abnormal cytology were published in 2002. We examined the follow-up for 22,342 women with LSIL during 2 periods: 2000-2002 and 2003-2005. The percentage of providers who followed the recommended guidelines with colposcopy for an LSIL Pap test result increased by 9% from the pre-ASCCP to the post-ASCCP period. An increase was seen in every age and racial/ethnic group. Younger women (<30 years) and white women were more likely than comparison groups to be followed by colposcopy rather than a repeat Pap test. The increase in percentage of women having colposcopy in 2003, 1 year after the new guidelines were published, suggests a change in provider practices consistent with those guidelines.

Survey of maternal-fetal medicine subspecialists: professional activities, job setting, satisfaction, and trends over time.

The purpose of this survey was to describe the job setting, professional activities, and satisfaction of maternal-fetal medicine (MFM) subspecialists and to compare these with previous surveys. A questionnaire was mailed to members of the Society of Perinatal Obstetricians (SPO). The results were compared to a similar survey in 1986. Of 1,352 members, 58% responded. In comparison to 1986, there was an increase in percentage of women (25%); a decrease in university hospital-based faculty (55%); and an increase in community hospital-based salaried physicians (23%) and private practice (15%). The distribution of professional time changes with an increase in clinical care, a decrease in teaching and research. The annual number of procedures increased for ultrasound and genetics and decreased for gynecologic procedures. Since 1986, there have been significant changes among MFM subspecialists in job setting, allocation of professional time, and number and types of procedures. Job satisfaction remains high.