Continence Coach: New Subspecialty Certifies Expertise in Female Pelvic Reconstructive Surgery

  At its March meeting, the American Board of Medical Specialties (ABMS) formally established a new subspecialty: Female Pelvic Medicine and Reconstructive Surgery.¹ The new subspecialty will be administered jointly by the American Board of Obstetrics and Gynecology (ABOG) and the American Board of Urology (ABU).

  What does this administrative decision have to do with continence care for women? The answer, frankly, is everything. Above all, subspecialty recognition will help ensure standardization and consistency that has been lacking among programs across the country. Until now, gynecologists and, to a lesser extent, urologists could call themselves urogynecologists or female urology “specialists” without completing fellowship training beyond their basic residency in obstetrics and gynecology or urology. Even more troubling, some clinicians who lack specific training in those procedures and have little or no experience in female pelvic medicine and reconstructive surgery research have been performing surgical procedures on women for incontinence or pelvic organ prolapse; as such, they achieve suboptimal outcomes, including high rates of patient complications such as infections, postoperative pelvic pain, and mesh erosion.

 This recent ABMS decision intends to reduce the number of undesirable outliers and lower the risk of unfavorable results from surgery, especially if the female patient and her referring provider are made aware of the importance of demanding surgical intervention provided only by a Board-certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery. Patients can visit www. CertificationMatters.org or call (866) ASK-ABMS to see if their physician is Board Certified by an ABMS Member Board.

  Young doctors pursuing fellowship training now can be assured that any program in this subspecialty will follow a structured and comprehensive curriculum, receive formal training in how to use and interpret biostatistics, and rotate through colorectal surgery. They will have dedicated time to engage in research and learn how to review the literature, how to best structure a study, and how to analyze and interpret results. This will help to advance the science and the discipline of the subspecialty. A self-policing mechanism will help protect the integrity of the subspecialty’s certification through site visits with program heads at teaching hospitals and academic medical centers, required documentation, and periodic reviews by the ABOG and the ABU.

  For the immediate future, there may be a shortage of properly credentialed physicians, making it difficult for some women to access to a qualified local provider. But ultimately, the value of a Board-certified physician in this established subspecialty should help insulate reimbursement fees by public and private payors, encouraging future physicians to enter the field.

  It is estimated that at least 25 million adult Americans experience loss of bladder or bowel control. Each day, another 10,000 Americans turn 65 years of age. Because age is a risk factor for health problems, the prevalence of those having health issues is likely to grow. Until we understand more about prevention and how to circumvent risk factors other than age itself, the aging baby boomer generation will seek interventions and remedies. A primary objective of the NAFC’s mission is to help consumers seeking solutions to their bladder and bowel control problems and related pelvic floor dysfunction find a reliable, trustworthy, experienced, fully trained, credentialed expert. As an organization, the NAFC celebrates the announced decision by the ABMS and ABU’s and ABOG’s navigation of the rocky road leading up to it.

  Of course, there continues to be room on the interdisciplinary team of providers in continence care for other experienced clinicians — nurse practitioners who fit pessaries in women with prolapse who wish to avoid surgery and who offer guidance and instruction in bladder retraining for men and women with overactive bladder; physical therapists, occupational therapists, and specialty nurses who are using biofeedback and electrical stimulation to help teach patients how to strengthen pelvic floor muscles for improved bladder and bowel control; and family practice physicians who isolate symptoms and prescribe medications for urgency and frequency. As each of you advises your female patients and their families and refers them for possible surgery, teach them to look for this newest Board-certified expert on the continence care team.

 The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Management peer-review process.

1. ABMS Announces Certification in Three New Physician Subspecialties: Pediatric Anesthesiology, Female Pelvic Medicine and Reconstructive Surgery and Complex General Surgical Oncology, April 18, 2011. Available at: www.abms.org/News_and_Events/Media_Newsroom/Releases/release_ThreeNewSubspecialties04112011.aspx. Accessed April 20, 2011.