(56) Fertile Ground for Collaboration

Background: The clinical scope of Pediatric Adolescent Gynecology (PAG) is extensive and overlaps with other providers who participate in female reproductive health including Pediatric General Surgery and Pediatric Urology. PAG took decades to differentiate from their adult counterparts into a now organized subspecialty. We sought to understand the perception of PAG provider availability as well as case coverage given the field’s expansion.

Methods: A national 8-question survey was sent out to the American Academy of Pediatrics (AAP) Section on Surgery (SOSu) and Urology (SOU) members with questions focused on practice patterns and inquiry on the availability of PAG specialists in their hospitals. The survey was sent to members twice over a period of 3 months to maximize response. Qualitative data was collected.

Results: Of the total of 701 members surveyed, there were 136 responses (19.4%). Of the responders, 63% indicated that PAG providers were currently available in their hospital. PAG providers offered consultations (96%), multidisciplinary team participation (58%), interdisciplinary education (38.5%) and participated in research (30%). Half of respondents viewed PAG as accessible, with 24/7 call coverage, and a majority reported perceived availability as an ambulatory consultant. Respondents could select one or more subspecialty for each response and reported that pediatric surgeons were primarily managing ovarian torsion, GU trauma, adnexal masses, and Mullerian anomalies. PAG was perceived as being primarily responsible for cases of endometriosis, ectopic pregnancies, and miscarriages. There was equipoise regarding care for patients with fertility preservation and TOA/PID. Free text comments regarding the value PAG adds to the care team were categorized as positive vs negative leaning. Positive themes included value in dedicated field of focus, aid in multidisciplinary teams, and longitudinal follow up. Negative themes centered around limited availability and perceived lack of value as a separate practice.

Conclusions: The survey shows the current opinions for which gynecologic disease entities are being cared for by specific services. While pediatric surgeons provide care for many of these patients, PAG providers interact with pediatric care teams as consultants, participate in multidisciplinary clinics, and provide expertise in the surgical management of the reproductive tract. Enthusiasm for increased interdisciplinary collaboration among AAP SOSu members may be based on PAG provider availability and could be aided by the expansion of PAG providers.