BackTable OBGYN

What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline07:32 - Patient Experience with OAB11:59 - Beta-3 Agonists vs Anticholinergics15:15 - Botox Counseling and Dosing18:11 - Tibial Nerve Stimulation25:47 - Sacral Neuromodulation32:09 - Cost Burden of OAB39:38 - Evolution of OAB Care41:39 - Future Research Directions --- More about this episode The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently. --- Resources The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder Anticholinergic Drug Exposure and the Risk of Dementiahttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353 Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial https://pubmed.ncbi.nlm.nih.gov/20171677/ Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registryhttps://www.auajournals.org/doi/10.1097/UPJ.0000000000000916 A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?https://pubmed.ncbi.nlm.nih.gov/33197059/ --- BackTable OBGYN is is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Are your patients looking for a nonhormonal option? Digital contraception could be the answer. In this episode of the BackTable Podcast, urologist Dr. Ruchika Talwar sits down with Dr. Kerry Krauss, an OBGYN and Senior Medical Advisor at Natural Cycles, to discuss the evolving landscape of digital health tools in women's reproductive care. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Natural Cycleshttps://www.naturalcycles.com/ --- Timestamps 01:29 - Introduction03:02 - Contraception Pain Points06:16 - Natural Cycles Origin09:46 - How The App Works12:44 - Effectiveness And Variability15:18 - Ideal Users And Red Days17:34 - Modes Beyond Birth Control19:19 - Clinical Insights From Data22:04 - Future And Privacy24:31 - Counseling And Adoption Tips27:19 - Conclusion --- More about this episode Dr. Krauss shares her journey into tech and wearables and provides insights into the functionality, effectiveness, and future prospects of Natural Cycles, a digital contraceptive app. The discussion covers the utility of basal body temperature tracking, the unique features of the Natural Cycles algorithm, and real-world applications and user experiences. They also explore the broader implications and potential surrounding the integration of digital health tools into patient care, emphasizing the importance of meeting patients where they are.

What happens when a fully integrated healthcare system aligns training, data, and access to improve surgical outcomes? In this BackTable OBGYN episode, Dr. Eve Zaritsky joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss how Kaiser’s integrated health system enables rapid care coordination, large-scale quality improvement, and population-level research using one of the largest US datasets. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 01:17 - Introduction 03:35 - How Kaiser Works07:24 - Research Using Big Data09:19 - Changing Hysterectomy Culture13:36 - Ending Racial Disparities15:22 - Handling Large Uteri17:52 - Vaginal Hysterectomy Trends20:38 - Myomectomy Reintervention Rates24:23 - Shared Decision Making26:30 - Mini Lap Versus Robotic27:41 - Hybrid Extraction Strategy29:08 - Credentialing Robotic Myomectomy30:19 - MIG Referral Pathways32:03 - Fibroids Across Asian Subgroups34:55 - Mentoring Research Pipeline36:44 - Funding Analysts Through GME40:49 - Endometriosis Disparities Findings43:59 - Mentorship Mindset --- More about this episode Dr. Zaritsky describes how a coordinated, system-wide effort transformed hysterectomy care, shifting from 80% open procedures to nearly 90% minimally invasive within five to eight years through focused training, reducing low-volume practice, and tracking system metrics, ultimately decreasing racial disparities once minimally invasive rates exceeded 90%. She also highlights Kaiser-based research on variation in vaginal hysterectomy by service area and surgeon volume, long-term reintervention rates for fibroids across procedures, increasing use of minimally invasive myomectomy, and a JAMA analysis showing differences in fibroid diagnosis among Asian subgroups with the highest rates in South Asians. The episode concludes with Dr. Zaritsky calling attention to how Kaiser’s research infrastructure creates robust opportunities for meaningful mentorship across all levels of training, supporting the development of physicians, residents, and medical students. --- Resources Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast Integrated Health System https://pubmed.ncbi.nlm.nih.gov/28486359/ Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System https://pubmed.ncbi.nlm.nih.gov/40839882/ Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care Systemhttps://pubmed.ncbi.nlm.nih.gov/40172885/

When to test, how to prevent, and what you need to know about hereditary gynecologic cancer syndromes. Two USC gynecologic oncologists, Dr. Mona Guo and Dr. Marcia Ciccone, go in-depth in this BackTable OBGYN x Tumor Board crossover episode. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:37 - Why Hereditary Cancer Matters04:51 - Family History Red Flags09:01 - Who Should Order Genetic Testing11:32 - Variants and Counseling Pitfalls13:30 - Access and Remote Testing Options19:27 - BRCA1 Positive Patient Walkthrough24:52 - Risk-Reducing Surgeries29:11 - Prevention and Screening Limits32:38 - Why Ovarian Cancer Is Hard34:04 - Combining Breast and Gyn Surgery35:41 - Preop Ultrasound and CA-12536:27 - BRCA Timing and HRT Nuance42:32 - Nonhormonal Menopause Options47:14 - Lynch Syndrome Screening Basics54:22 - Endometrial Biopsy Debate56:43 - Insurance and Coverage Pitfalls59:00 - Fertility Preservation and REI01:01:41 - Cascade Testing01:02:45 - Conclusion --- More about this episode Dr. Guo and Dr. Ciccone discuss how careful family history can identify patients who may benefit from genetic evaluation and highlight key red flags, including a family history of ovarian cancer, breast cancer at age 50 or younger, and metastatic prostate cancer. They explain the role of genetic counseling, including pre- and post-test discussions and how to approach variants of uncertain significance. They then cover BRCA counseling and risk-reduction strategies, including the timing of risk-reducing bilateral salpingo-oophorectomy, ongoing salpingectomy trials, and considerations for hysterectomy. Additionally, they touch on pathology protocols, breast cancer screening, and the potential protective effect of hormonal contraception. The doctors address the limitations of ovarian cancer screening and outline patterns suggestive of Lynch syndrome, such as endometrial cancer occurring alongside gastrointestinal or urinary tract cancers. They review the Lynch workup, including tumor mismatch repair immunohistochemistry and MLH1 hypermethylation testing. Finally, they discuss practical considerations like barriers to access, Medicare coverage challenges, fertility preservation referrals, menopause management, and cascade testing in families, including the timing of testing in children. --- Resources NCCN Guidelines: Detection, Prevention, and Risk Reductionhttps://www.nccn.org/guidelines/category_2

As our patients' age progresses, so should our definition of“ ‘recovery’. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients. --- SYNPOSIS Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery. --- TIMESTAMPS 00:00 - Introduction02:18 - Dr. Ackenbom’s Journey to Urogynecology04:47 - Research on Brain Fog06:18 - Personal Support and Hobbies09:54 - Age vs Frailty in Surgery13:05 - Procedures with Perioperative Complexity16:11 - Counseling on Operative Risk20:10 - ERAS and Earlier Discharge23:35 - Patient Goals and Tradeoffs27:53 - Surgical Clearance and Preop Consults33:30 - Prehabilitation Basics36:24 - Minimally Invasive Surgery Benefits37:15 - Surgical Cognitive Complications with Age41:42 - Finding the Surgery Window46:05 - Cognitive and Frailty Screening50:01 - Guidelines for Perioperative Care52:52 - Future Research 54:07 - Conclusion --- RESOURCES Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgeryhttps://pubmed.ncbi.nlm.nih.gov/32827107/ ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patienthttps://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf

Trouble with bowel or bladder function? It might be time to partner with a specialist. In this episode of BackTable OBGYN, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Shannon Wallace and Dr. Anna Spivak, experts from the Cleveland Clinic specializing in pelvic floor disorders. They dive into the complex world of combined colorectal and urogynecological issues, discussing the importance of a multidisciplinary approach to treat conditions such as rectal prolapse, constipation, and incontinence. --- SYNPOSIS The conversation covers detailed diagnostic methods like manometry and defecography, various surgical options, and the crucial role of pelvic floor physical therapy in patient recovery. They also provide insights into setting up effective multidisciplinary clinics and emphasize the need for teamwork and administrative support in delivering optimal patient care. This episode is a valuable resource for both specialists and generalists aiming to enhance their understanding and treatment of pelvic floor dysfunctions. --- TIMESTAMPS 01:05 - Introduction05:40 - Multi-Compartment Prolapse & Second Opinions08:14 - Pelvic Floor Compartments Explained10:36 - When Internal Prolapse Becomes Surgical11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage16:55 - Fluoro vs MRI and When to Order It23:47 - Anorectal Manometry26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches34:43 - When (and Why) to Consider Biologics36:46 - Resection Rectopexy38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders42:55 - Pelvic Floor PT After Surgery and Recovery Timelines47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)49:53 - Symptom Improvement vs Retraining the 'New Normal'52:20 - Fecal Incontinence & Sacral Neuromodulation57:08 - Diarrhea-Driven Incontinence58:56 - Building a Multidisciplinary Pelvic Floor Program01:04:04 - Conclusion --- RESOURCES Pelvic Floor Disorders Consortium (American Society of Colon & Rectal Surgeons) https://fascrs.org/Web/Web/My-ASCRS/Education/Pelvic-Floor-Disorders-Consortium.aspx

From diagnosis to treatment, hysteroscopy plays a pivotal role in modern gynecologic care. In this episode of BackTable OBGYN, Dr. Christina Salazar, a minimally invasive gynecologic surgeon and associate professor at Dell Medical School in Austin, Texas, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the value of hysteroscopy in managing complex intrauterine pathology. --- SYNPOSIS Dr. Salazar shares her introduction to hysteroscopy and the mentors who shaped her early training. She discusses her expertise in hysteroscopic surgery and its broad applications, with a focus on the complexities of Asherman syndrome, dysmorphic uteri, and the critical role of endometrial health assessment. The conversation also covers surgical techniques, post-operative care, and emerging technologies in hysteroscopic and reproductive care. Dr. Salazar concludes by emphasizing the need for improved classification systems for Asherman syndrome and future directions in reproductive health innovation. --- TIMESTAMPS 00:00 - Introduction05:34 - Training and Mentorship in Hysteroscopy11:21 - Dr. Salazar's Practice and Techniques14:00 - Challenges and Trends in Surgical Practices18:58 - Referral Practices and Advanced Hysteroscopy21:58 - Understanding Dysmorphic Uterine Population24:08 - T-Shaped Uteri Description26:09 - Hysteroscopic Metroplasty: Methods and Risks29:17 - Innovations in Hysteroscopy32:38 - Value of Ultrasound in Hysteroscopy36:35 - Post-Operative Management and Estrogen Therapy39:23 - Challenges and Future Directions in Hysteroscopy44:23 - Concluding Thoughts --- RESOURCES The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyseshttps://academic.oup.com/humupd/article/31/6/588/8248883 Hysteroscopy Newsletterhttps://hysteroscopynewsletter.com/

Learn how ACOG turns advocacy into action, supports clinicians, and creates community. Plus, get tips on how you can get involved. In this episode of BackTable OBGYN, Dr. Sivani Aluru from Endeavor Health in Chicago shares her journey and involvement with ACOG, from her medical school days to her current role as the national JFCAC Chair. --- SYNPOSIS Dr. Aluru describes her experiences on various task forces, including the ACOG 75th Anniversary Task Force, and emphasizes the importance of education, advocacy, and community within the organization. She offers insights into the challenges and benefits of participating in ACOG, provides tips for getting involved, and highlights the ongoing efforts to address critical issues in women's health. The conversation also touches on adapting to the changes brought by the COVID-19 pandemic and the value of staying organized and connected in a demanding field. Find out what ACOG is working on, how it benefits patient care, how it benefits provider education and resources, how it builds community. Get involved! Go to meetings! There are so many roles. If you don’t get your role on the first go, try again. Showing up is huge! --- TIMESTAMPS 00:00 - Introduction03:41 - Residency and Early Involvement in ACOG07:29 - Advocacy and Government Affairs18:40 - Balancing Professional and Organizational Work24:28 - Listening to Members' Needs26:36 - Challenges and Value of ACOG Membership29:00 - The Importance of In-Person Meetings34:45 - ACOG's Legislative Advocacy and Future Plans35:48 - Advice for Getting Involved with ACOG40:16 - Conclusion --- RESOURCES ACOG (American College of Obstetricians and Gynecologists)https://www.acog.org/ ACOG CAARE Delegation https://www.acog.org/about/diversity-equity-and-inclusive-excellence/collective-action-strategy/caare-delegation ACOG CREOG (Council on Resident Education in Obstetrics and Gynecology) https://www.acog.org/education-and-events/creog/about

Some of the biggest advances in women’s health start with a simple question: why hasn’t this been fixed yet? In this episode of BackTable OBGYN, Dr. Tess Kim, a minimally invasive gynecologic surgeon at Massachusetts General Hospital and the founder of Fruits of Labor, a women's health medical device innovation company, joins host Dr. Amy Park. --- SYNPOSIS Dr. Kim’s educational journey began with medical school at Emory, followed by residency at Beth Israel Deaconess Hospital, and fellowship training at MGH. She discusses the founding of Fruits of Labor, which began with the Perry Peach—a warm compress device designed to reduce severe perineal tearing during childbirth and now acquired by Medicines360. Dr. Kim also talks about her creative process, the importance of addressing historically neglected areas in women's health, and the potential impact of her new project, Mellomallows, which aims to reduce discomfort during gynecological procedures such as IUD placement. The conversation concludes with a discussion of the challenges and opportunities in women's health innovation, the significance of supportive networks, and the role of passion and commitment in driving meaningful change. --- TIMESTAMPS 00:00 - Introduction02:03 - The Birth of PeriPeach: Addressing Severe Tearing06:51 - New Medical Devices: Mellomallows08:41 - The Creation and Mechanism of PeriPeach 11:11 - Company Development: Mentorship and Resources17:37 - Pitching Practice and Experience 19:26 - Project Funding and Working with Medicines36021:51 - Advice for Aspiring Innovators23:52 - Concerns About AI in Healthcare26:48 - Innovations in Women's Health29:06 - Challenges in Academic Medicine32:01 - The Importance of Female Innovators34:00 - Forming a Startup in Women's Health36:10 - Parting Advice for Future Innovators37:37 - The Future of Women's Health Innovations40:10 - Conclusion --- RESOURCES Fruits of Labor website:https://www.fruitsoflabormed.com/home PeriPeach website:https://www.peripeach.com/

Fibroid care: how it was, how it’s changing, and where it’s headed next. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome minimally invasive GYN surgeon Dr. Arleen Song to discuss the evolving landscape of fibroid care. --- SYNPOSIS Dr. Song, a veteran in the field with nearly 20 years of experience, shares her journey from Michigan to Duke, current treatments in fibroid management, and the importance of personalized care. The team explores new surgical techniques, the role of medical therapies such as Ella GnRH antagonists, and the importance of patient education. They also address challenges such as access to care, the significance of research funding, and the evolving understanding of fibroid genetics and long-term management. This episode provides a comprehensive overview of the state of fibroid care and the strides being made in this vital aspect of women's health. --- TIMESTAMPS 00:00 - Introduction02:21 - Evolution of Fibroid Treatment05:50 - Advancements in Minimally Invasive Surgery08:47 - Longitudinal Care and Personalized Treatment13:00 - Modern Approaches to Fibroid Treatment21:15 - New Technologies and Procedures27:01 - Preoperative Assessment and Imaging31:15 - Preoperative Counseling and Risk Assessment33:14 - Medications for Fibroid and Endometriosis37:59 - Challenges in Access to Care38:43 - Racial Disparities in Fibroid Research42:35 - The Importance of Specialized Care49:22 - Future Directions in Fibroid Treatment

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health. --- This podcast was developed in collaboration with: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx --- SYNPOSIS The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function. --- TIMESTAMPS 00:00 - Introduction02:11 - Defining Vaginal Rejuvenation04:35 - Common Procedures and Misconceptions10:04 - Insurance and Coverage of Procedures12:04 - Laser and Radiofrequency Therapies18:10 - Vaginal Estrogen and Lift of Black Box Warning19:59 - The Role of Systemic Hormone Therapy26:56 - Vaginal Rejuvenation Misconceptions32:21 - Pelvic Floor Physical Therapy and Timing of Procedures34:24 - Regional Variations in Therapeutic Availability38:40 - Gender Inequity in Healthcare40:16 - Final Thoughts --- RESOURCES Joint Report on Terminology for Cosmetic Gynecologyhttps://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Who should consider fertility preservation, when is the right time, and what are the risks? In this episode of BackTable OBGYN, Dr. Amy Park interviews Dr. Mindy Christianson, the section head of Reproductive Endocrinology and Infertility at the Cleveland Clinic, who shares how fertility preservation is evolving for patients planning families and those facing fertility-impacting treatments. --- SYNPOSIS Dr. Christianson discusses her journey into the field of fertility preservation, inspired by an early encounter with a breast cancer patient. The conversation covers various aspects of fertility preservation, including the preservation of eggs, embryos, ovarian and testicular tissue, and planned fertility preservation. Dr. Christianson elaborates on the protocols, patient demographics, and the evolving collaboration between oncology and reproductive endocrinology. The discussion also highlights technologies like ovarian tissue transplantation and in vitro maturation, as well as practical tips for healthcare providers on improving patient access to fertility preservation services. --- TIMESTAMPS 00:00 - Introduction03:34 - Understanding Fertility Preservation07:56 - Consultation Process for Fertility Preservation17:36 - Advancements in Egg Freezing Technology25:55 - Egg Freezing Recommendations26:34 - Collaboration Between Oncology and REI26:52 - Pediatric Oncology and Fertility Preservation28:58 - Ovarian Tissue Transplantation33:17 - Uterine Transposition Surgery40:05 - Gene Editing and Fertility Preservation43:01 - Financial and Emotional Aspects of Fertility Preservation48:02 - Practical Advice for OBGYNs51:12 - Resources and Final Thoughts --- RESOURCES Livestrong Fertilityhttps://livestrong.org/how-we-help/livestrong-fertility/ Resolve: The National Infertility Associationhttps://resolve.org/ Society for Assisted Reproductive Technologyhttps://www.sart.org/ American Society for Reproductive Medicinehttps://www.asrm.org/

A physician’s expertise can extend beyond the exam room and into the courtroom. In this episode of BackTable OBGYN, Dr. Elizabeth Moore, a general OBGYN and founder of MooreExperts, joins host Dr. Mark Hoffman to share her expertise on the intricacies of medical-legal work. --- SYNPOSIS They cover Dr. Moore's journey into expert witness work, including how the pandemic shifted her career focus and ultimately led to the creation of a platform to assist OBGYNs in navigating legal cases. They discuss the challenges of managing extensive medical records, the importance of adhering to the standard of care, and the unique nature of obstetrics cases. They also emphasize the need for precise, evidence-based report writing to avoid unnecessary trials and address the emotional and financial toll legal processes can take on physicians. Finally, the episode explores the need for better systems to protect both patients and healthcare providers while offering insight into future challenges, including AI and private equity involvement in legal cases. --- TIMESTAMPS 00:00 - Introduction05:08 - First Experiences in Medical-Legal Work08:57 - The Role of Education in Legal Cases11:37 - Challenges and Rewards of Medical-Legal Work13:58 - Understanding Standard of Care and Malpractice15:59 - The Importance of Detailed Reports and Depositions20:02 - The Jury System and Its Challenges25:45 - Balancing Professional and Personal Life29:43 - Getting Started in Medical-Legal Work32:07 - Recognizing Patterns in Medical Litigation33:51 - Educating Attorneys for Fair Trials36:33 - Concerns and Improvement of Medical Expert Testimonies45:54 - The Role of Systems in Reducing Medical Errors51:52 - Future Challenges and Opportunities in Medical Legal Work56:07 - Final Thoughts --- RESOURCES ACOG Technical Bulletin 365: Seeking and Giving Consultationhttps://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/05/seeking-and-giving-consultation MooreExperts OBGYN Consulting Medical Legal Expert Witness Masterclasshttps://www.mooreexperts.com/ Bless This Mess: A Picture Story of Healthcare by Dr. Stephen Klaskohttps://www.amazon.ae/Bless-This-Mess-Picture-Healthcare/dp/1483479625

What if the key to improving obstetrical surgery outcomes isn’t a new technology, but rethinking who’s in the operating room? In this episode of BackTable OBGYN, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Sony Singh, a prominent figure in the field of minimally invasive gynecologic surgery (MIGS) and obstetrics, to share perspectives on the emerging role of MIG surgeons in obstetrical surgery. --- SYNPOSIS Dr. Singh shares his extensive career journey, from his education in Canada and Australia to his current role as department chair of OBGYN at the Ottawa Hospital. The conversation delves into the integration of MIGS into obstetric surgery, including procedures like laparoscopic cerclages, placenta accreta management, and cesarean scar pregnancies. The hosts and guest discuss the challenges and importance of building a robust team, regionalization of care, maintaining work-life balance, and the eventual transition of leadership roles to sustain the high standards of care. This episode highlights the crucial role of minimally invasive specialists in advancing OBGYN practices while promoting a sustainable work culture. --- TIMESTAMPS 00:00 - Introduction 02:08 - Dr. Singh’s Journey07:37 - The Role of MIG Surgeons in Obstetrical Surgery16:06 - Building a Collaborative Team18:38 - Challenges and Best Practices25:26 - Expanding the Scope of MIG Surgeons30:19 - The Evolution of Urogynecology and MIGS31:31 - Leadership and Building Programs37:54 - Scaling Up and Regionalization of Care42:53 - Balancing Work and Personal Life54:37 - Concluding Thoughts --- RESOURCES Canadian Society for Advancement of Gynecologic Excellencehttps://cansage.org/about/ From Strength to Strength, by Arthur Brookshttps://www.arthurbrooks.com/books

How economically viable is gynecologic surgery today, and what happens if the system keeps pushing the limits? In this episode of BackTable OBGYN, Dr. Marisa Dahlman from Virginia Mason in Seattle sits down with hosts Mark Hoffman and Dr. Amy Park to discuss the evolving landscape of this field and the pressures surrounding reimbursement. --- SYNPOSIS Dr. Dahlman begins by sharing her career path and fellowship experience before the conversation expands to explore the shift from MIGS (Minimally Invasive Gynecologic Surgery) to CBG (Complex Benign Gynecology), current reimbursement challenges, the difficulty of balancing obstetric and gynecological practice, and how these forces influence training and clinical life. They also discuss the stressors new graduates face while building viable practices, broader healthcare system challenges, resource allocation, and potential solutions to improve practice sustainability and patient care. --- TIMESTAMPS 00:00 - Introduction 03:06 - Fellowship Training and Career Pathways11:43 - Impact of Reimbursement on Fellowship Applications15:20 - Workforce Issues and Future of GYN Surgery28:02 - Advocacy and Leadership in Healthcare29:27 - Understanding Hospital Revenue and Efficiency31:54 - The Role of Physician Leadership in Healthcare35:35 - Navigating Healthcare System Mergers36:47 - The Future of Healthcare Amidst Financial Cuts41:40 - Addressing Healthcare Costs and Reimbursement45:11 - The Importance of Women's Health Services47:37 - Strategies for Improving Healthcare Systems53:48 - Concluding Thoughts --- RESOURCES Trends in gynecologic surgery reimbursement and physician payhttps://pubmed.ncbi.nlm.nih.gov/40305043/

Everything you need to know about tubo-ovarian abscesses (TOAs): breaking the stigma, safer treatment, fertility preservation, and better outcomes. This episode of BackTable OBGYN features Dr. Katherine Smith, an assistant professor and MIGS Fellowship Program director at UT Southwestern. With hosts Dr. Amy Park and Dr. Mark Hoffman, Dr. Smith provides an extensive overview of contemporary TOA management, emphasizing the significance of early intervention and the evolving understanding of TOAs beyond traditional STI etiologies. --- SYNPOSIS The conversation delves into the management of TOAs, both non-ruptured and ruptured, and the underexplored connection to the female reproductive tract microbiome. They also touch on the integration of AI in clinical practice, particularly in streamlining administrative tasks. The episode underscores the need for updated guidelines and more research into the microbiological aspects of TOAs to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 02:20 - Understanding TOAs: Early Interventions and Challenges04:43 - Clinical Management of TOAs08:06 - Surgical Approaches and Considerations22:25 - Microbiome and Infection Insights32:10 - Discussing Patient Reactions and Education32:47 - Teaching Practices and Medical Education34:18 - Clinical Observations and Data36:55 - Surgical Management of Ruptured TOAs40:50 - Challenges in Treating Infected Endometriomas50:13 - Exploring the Role of AI in Medical Practice54:23 - Concluding Remarks --- RESOURCES ACOG Recommends Concurrent Sexual Partner Treatment for Recurrent Bacterial Vaginosis for the First Timehttps://www.acog.org/news/news-releases/2025/10/acog-recommends-concurrent-sexual-partner-treatment-recurrent-bacterial-vaginosis-first-time Strange Bedfellows, Ina Park MD, MS https://www.inapark.net/the-book

Endometriosis and fibroids don't have to block your patient’s path to pregnancy. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Jim Robinson, Director of Reproductive Surgery at Shady Grove Fertility in Maryland, to share his guidance on reproductive surgery applications and reproductive health. --- SYNPOSIS The conversation explores the management of endometriosis and fibroids, the use of office hysteroscopy, and the intricacies of hysteroscopic and laparoscopic procedures. Dr. Robinson covers the importance of individualized patient care, the latest advancements in reproductive technology, and insights from his unique career blending academic medicine with a focus on enhancing fertility outcomes. Listeners will gain a comprehensive understanding of the critical role surgical interventions play in reproductive endocrinology and the nuanced approach required to optimize patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:17 - Understanding Reproductive Surgery08:51 - Hysteroscopy in Reproductive Surgery16:28 - Endometriosis and Infertility23:50 - Diagnosing and Treating Adenomyosis28:10 - Surgical Interventions for Reproductive Health33:52 - Balancing Endometrioma Removal and Fertility35:49 - Surgical Approaches and Patient Goals36:46 - Complexities of Fertility Consultations42:48 - Impact of Fibroids on Reproductive Health45:33 - Adhesion Prevention in Myomectomy48:33 - Innovations in Fibroid Ablation52:10 - Understanding Isthmoceles and Their Impact58:11 - Concluding Thoughts --- RESOURCES ReceptivaDx: What does it mean to test positive for high levels of bcl6https://receptivadx.com/what-does-it-mean-to-test-positive-for-high-levels-of-bcl6/ Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome: https://pubmed.ncbi.nlm.nih.gov/28892298/

Ever wondered what it’s like to train and practice obstetrics and gynecology across New Zealand and Australia? In this episode of BackTable OBGYN, Dr. Amy Park sits down with Dr. Michael Wynn-Williams, a renowned gynecologist and endometriosis specialist. Dr. Wynn-Williams discusses his extensive training across New Zealand, Australia, the UK, and Scotland, emphasizing his role in minimally invasive gynecology.---SYNPOSISThe conversation covers the nuances of gynecology and obstetrics training in Australia and New Zealand, the balance between public and private healthcare systems, and the cultural differences in medical practice. Dr. Wynn-Williams also sheds light on issues like medical-legal environments, insurance, the impact of geography on healthcare delivery, and the integration of advanced ultrasound practices in endometriosis care. The episode provides valuable insights for those considering a career in gynecology in these regions.---TIMESTAMPS00:00 - Introduction07:35 - Training in Australia and New Zealand15:05 - Public and Private Healthcare Systems20:25 - Challenges and Equity in Healthcare24:39 - Balancing Public and Private Practice28:48 - Inpatient Services and Day Case Hysterectomy29:46 - City vs. Rural Practices and Equity Issues31:55 - Staffing Challenges in New Zealand33:57 - Living and Working in New Zealand and Australia35:25 - Navigating Medical Practice Transfers40:10 - Medical-Legal Environment in Australia and New Zealand43:31 - Gender-Based Reimbursement and Training Challenges51:41 - Endometriosis Ultrasound Scanning and Collaboration52:27 - Final Thoughts---RESOURCESThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the professional body responsible for training, accreditation, and standards in obstetrics and gynecology in both countrieshttps://ranzcog.edu.au/

Not all pain is visible and not all solutions are obvious, especially in chronic pelvic pain. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes Dr. Aakriti Carrubba, an expert in minimally invasive gynecological surgery and pelvic pain from the Mayo Clinic, to talk through the evaluation and treatment of chronic pelvic pain.---SYNPOSISDr. Carrubba shares her journey from Kentucky to Florida, detailing her extensive training and interest in managing pelvic pain. The discussion covers the evaluation of pelvic pain, the significance of a thorough patient history and systematic pelvic exams, and the role of interdisciplinary approaches, including physical therapy and pain management. Dr. Carrubba emphasizes the importance of addressing central sensitization and chronic pain syndromes, explaining that not all pain can be attributed solely to structural abnormalities. The episode also touches on the integration of advanced AI tools in medical practice to enhance patient documentation and overall care.---TIMESTAMPS00:00 - Introduction01:09 - Dr. Carrubba’s Background and Journey03:54 - Fellowship Experience and Pelvic Pain Focus06:44 - Approach to Chronic Pelvic Pain14:04 - Detailed Pelvic Pain Exam Techniques17:14 - Trigger Point Injections and Their Role21:33 - Challenges in Pain Management and Education26:34 - Role of Central Sensitization in Chronic Pelvic Pain29:35 - Approach to Central Sensitization and Screening33:13 - Approaches to Excision Surgery36:04 - Post-Surgery Management and Hormonal Suppression38:19 - Teaching and Training in Pelvic Pain Management41:35 - Pain Rehabilitation Clinic for Central Sensitization44:59 - Teaching Pelvic Pain Anatomy to Trainees48:24 - Advancements in AI for Medical Documentation52:26 - Reflections on Pelvic Pain Training and Education56:00 - Final Thoughts

No money, no mission. Understanding coding is the key to funding care and making your practice sustainable. In this episode of BackTable OBGYN, host, Dr. Mark Hoffman, chats with Dr. Jon Hathaway, associate professor at IU School of Medicine and coding specialist. They discuss the intricacies of medical billing, the impact of coding knowledge on revenue, and the systemic gaps in residency training regarding financial literacy. ---SYNPOSISDr. Hathaway shares his journey from mastering coding to becoming a national expert, providing a crash course on CPT, RVU, and ICD codes, and emphasizing the importance of accurate billing for the sustainability of healthcare practices. The episode offers valuable insights into the challenges and opportunities in medical coding and the broader financial aspects of healthcare.---TIMESTAMPS00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding04:11 - Understanding the Financial Side of Healthcare07:10 - The Disconnect in Healthcare Payments11:26 - The Complexity of Medical Billing18:11 - The Role of CPT, RVU, and ICD Codes24:03 - The Process of Approving New Procedures32:38 - Understanding the Value Update Process33:47 - Case Study: Cystoscopy in Hysterectomy Codes35:26 - Survey Participation and Its Impact36:12 - Roles and Responsibilities in ACOG38:12 - Challenges of RVU-Based Compensation42:08 - Specialty-Specific RVU Valuation48:42 - Comparing OB and GYN Reimbursements50:02 - Envisioning an Ideal Healthcare System55:10 - Maximizing Billing Efficiency59:46 - Final Thoughts