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A rising population of cancer survivors is accompanied by a shortage of oncologists for continuity of care. This study examined the physicians who provided most of the care for cancer survivors, along with written information provided to the survivors before transfer of care.Data were collected through the CDC-sponsored Behavioral Risk Factor Surveillance System. Our analysis involved states whose respondents completed a cancer survivorship module from 2016 to 2020. Primary measures were the proportions of physician specialists who provided most of their subsequent health care and the proportions of survivors who received written summaries of their care and instructions.The 36,737 cancer survivor respondents came from 33 states. Most of their health care came from primary care physicians [family physicians (42.3%, 95% CI: 41.3-43.2%) and general internists (26.0%, 95% CI: 25.2-26.9%)]. When seen by primary care physicians rather than subspecialists, a lower proportion of patients recalled receiving summaries of either their cancer treatments (44.3%, 95% CI: 42.5 to 46.2 vs 50.5%, 95% CI: 49.4 to 51.7%) or follow-up instructions (69.9%, 95% CI: 68.8 to 71.0% vs 78.7%, 95%CI 77.1 to 80.2%), regardless of their cancer type.Regardless of their cancer type, two-thirds of survivors received most of their health care from primary care physicians. Collaborative community-based care within a shared decision-making framework is essential to prioritize and individualize patients' understandings and needs in this growing population.

As the world clamored to respond to the rapidly evolving coronavirus 2019 (COVID-19) pandemic, health care systems reacted swiftly to provide uninterrupted care for patients. Within obstetrics and gynecology, nearly every facet of care was influenced. Rescheduling of office visits, safety of labor and delivery and in the operating room, and implementation of telemedicine are examples. Social distancing has impacted academic centers in the education of trainees. COVID-19 vaccine trials have increased awareness of including pregnant and lactating women. Last, the pandemic has reminded us of issues related to ethics, diversity and inclusiveness, marginalized communities, and the women's health workforce.

The growth in the number of obstetrics and gynecology resident graduates pursuing fellowships has exceeded growth in the number of resident graduates, because more fellowship programs are being developed in more subspecialties rather than additional residency programs. Approximately 1 in 4 residents pursues subspecialty training, compared with 1 in 12 in 2001. The number of fellowships remains competitive, because nearly all programs fill their match and the number of applicants exceeds the number of positions. Graduating residents who serve as frontline women's health specialists need to serve as leaders of interprofessional teams to better serve their patients, especially in underserved areas.

Interprofessional collaboration has the potential to impact our complex, dynamic health care system through team-led or collective core competencies (professionalism, communication, teamwork, interprofessional education) that promote system improvements for quality care and patient safety. Strategies to reduce errors and subsequent adverse outcomes focus on interactive training; simulations and drills; development of protocols, guidelines, and checklists; use of information technology; and relevant interactive educational activities in the workplace. When sustained with a shared vision, good communication, and enthusiasm for the work being done, interprofessional collaboration can lead to measurable improvements in delivery of women's health care.

Studies indicate that burnout rates among obstetricians-gynecologists range from 40% to more than 75%, which is in the middle to upper one-third of medical specialties. Symptoms range from feelings of underappreciation and unresolved fatigue, to cynicism, depression, physical symptoms, and illness. Burnout is associated with poor job satisfaction, questioning career choices, and dropping out of practice, impacting workforce concerns and patient access. Awareness of the symptoms and some simple stress and fatigue reduction techniques can decrease the risk of being trapped in the downward spiral of burnout. Successful interventions range from more sleep, to hobbies and vacations, to skilled counseling.

Objective: About one-half of all U.S. counties lack obstetrician–gynecologist (ob-gyns) physicians especially in rural areas. The objective of this study was to use experience in our state to identify demographic and practice characteristics distinguishing ob-gyns in general practice (general ob-gyns) in rural and metropolitan settings. Materials and Methods: This retrospective observational study used self-reported responses by physicians to a mandated survey about demographics and practice patterns at the time of New Mexico medical relicensing. Included in the study were all general ob-gyns in 2016 and 2017. Information about subspecialist ob-gyns and residents who graduated that year was obtained from the American College of Obstetricians and Gynecologists and the Accreditation Council for Graduate Medical Education from 2016 to 2019. Results: Nearly 1 in 3 (84 of 273, 30.8%) general ob-gyns practiced in a rural county. Those in rural settings tended to be older (p = 0.02) and male (p = 0.04). Most had practices in both obstetrics and gynecology. Compared with those in metropolitan counties, general ob-gyns in rural counties practiced in smaller groups (p = 0.0003) and worked 40 hours or more weekly (p = 0.0003). All subspecialists practiced in the most populous metropolitan county. No recent residency graduate practiced rurally in New Mexico. Conclusions: General ob-gyns in New Mexico's rural counties practiced in smaller groups and for longer work hours. Rural ob-gyns tended to be older and male.

Lifelong learning is essential for the practicing physician, yet continuing medical education (CME) and continuing professional development (CPD) units at academic medical centers (AMCs) have been historically underappreciated and under-resourced. Their integration into AMC leadership structures continues to vary widely among institutions. Without necessary resources and leadership alignment, many units are less able to focus on advancing CME/CPD to offer and study innovative educational opportunities that may enhance learner and patient outcomes. Using benchmarking data and recommendations from national leaders in the field, a CPD Hierarchy of Needs was created to frame the strategic development of CME/CPD units. This five-level hierarchy includes priorities such as (1) securing investment, (2) building infrastructure, (3) integrating into AMC leadership structures, (4) promoting data-driven interventions, and (5) advancing educational innovation. Recommendations to use the CME/CPD Hierarchy of Needs are described to convey the significance of CME/CPD units to AMCs and to the lifelong learning of practicing physicians.

OBJECTIVE To assess the changing landscape in nontenured faculty, stratified by sex and underrepresented in medicine status, for obstetrician-gynecologists at all U.S. medical schools. METHODS In this retrospective observational study, we used data from the Association of American Medical Colleges Faculty Roster to identify trends in career pathways of full-time faculty at all U.S. MD-granting medical schools from 1978 to 2017. Proportions of nontenured faculty were compared with other clinical departments, according to sex and race-ethnicity. Two-sample t-testing and simple linear regression were used for statistical comparisons. RESULTS The number of full-time obstetrics and gynecology faculty increased from 1,688 to 6,347, with most being nontenured (from 535 to 4,951; 9.3-fold increase) rather than tenured (from 457 to 587; 1.3-fold increase) or tenure-eligible (from 397 to 514; 1.3-fold increase). The proportions of all faculty who were nontenured increased from 29.6% to 72.5% (a 2.5-fold increase; P

Background The need for earlier recognition of children at risk for neurobehavioral problems associated with prenatal ethanol exposure (PAE) has prompted investigations of biomarkers prognostic for altered fetal development. Here, we examined whether PAE alters the expression of angiogenesis-related proteins and cytokines in human placenta in subjects from an Ethanol, Neurodevelopment, Infant and Child Health prospective cohort. Methods PAE was ascertained by screening questionnaires, Time-line Follow-back interviews and a panel of ethanol biomarkers at two study visits. After delivery, placental tissue samples were collected for protein analysis. Results No significant differences in the prevalence of substance use, demographic or medical characteristics were observed between the No PAE and PAE groups. PAE was associated with significant reductions in placental expression of VEGFR2 and annexin-A4, while the levels of VEGFR1 and CCM-3 trended downward. A trend toward higher expression of the cytokines TNF-α and IL-13 was also observed in the PAE group. Receiver operating characteristic analyses of the data demonstrated a moderate-to-high degree of diagnostic accuracy for individual placental proteins. Combinations of proteins substantially increased their ability to differentiate between PAE and No PAE subjects. Conclusions These results establish the feasibility of harvesting placental tissue for protein analyses of PAE in a prospective manner. In addition, given the importance of vascular remodeling in both placenta and developing brain, the role of angiogenic and cytokine proteins in this process warrants further investigation for their utility for predicting alterations in brain development, as well as their mechanistic role in PAE-induced pathology.

Studies indicate that burnout rates among obstetricians-gynecologists range from 40% to more than 75%, which is in the middle to upper one-third of medical specialties. Symptoms range from feelings of underappreciation and unresolved fatigue, to cynicism, depression, physical symptoms, and illness. Burnout is associated with poor job satisfaction, questioning career choices, and dropping out of practice, impacting workforce concerns and patient access. Awareness of the symptoms and some simple stress and fatigue reduction techniques can decrease the risk of being trapped in the downward spiral of burnout. Successful interventions range from more sleep, to hobbies and vacations, to skilled counseling.

PURPOSE To assess the changing diversity of faculty in specific clinical and basic science departments, stratified by sex and underrepresented in medicine (URM) status, at all Liaison Committee on Medical Education (LCME)-accredited medical schools. METHOD In this retrospective, cross-sectional, observational study, the authors used data from the Association of American Medical Colleges Faculty Roster (data pulled in October 2019) to identify trends in clinical department faculty and in basic science department faculty by sex and URM status. They included full-time faculty at all LCME-accredited medical schools from 1979 to 2018. They compared the proportions of faculty across separate departments according to sex and URM status, and they used 2-independent-sample t test and simple linear regressions for statistical comparisons. RESULTS The number of full-time faculty increased from 49,909 in 1979 to 175,326 in 2018. The largest increase occurred in clinical departments, where the number of faculty increased from 38,726 to 155,677 (a fourfold increase). The number of faculty in basic science departments increased from 11,183 to 19,649 (a 1.8-fold increase). The proportions of faculty who were non-URM females (compared with non-URM males, URM females, and URM males) increased the most-from 14.4% (5,595 of 38,726) to 37.6% (58,478 of 155,677) for clinical departments, and from 14.9% (1,669 of 11,183) to 33.0% (6,485 of 19,649) for basic science departments. Growth was steady but slow among URM faculty, especially for Black males; the absolute number of male URM faculty remained low in both basic science and clinical departments. The proportions of females and URM faculty were highest in the departments of obstetrics and gynecology, pediatrics, and family medicine. CONCLUSIONS The substantial increase in faculty, especially in clinical departments, has led to greater diversity, but mostly among non-URM females. The rise of URM male and URM female faculty has been minimal.

Background Prenatal care programs for women with opioid use disorder (OUD) often focus treatment/counseling plans around illicit substances, while concurrent use of alcohol might present an equal or greater risk to the fetus. Methods This study evaluated self-reported prevalence of alcohol use in patients participating in a comprehensive prenatal care program for women with substance use disorder (SUD; n = 295), of which 95% are treated for OUD, and pregnant women being served through general obstetrical clinics at the University of New Mexico (n = 365). During the screening phase of a prospective study, patients were asked to report alcohol use in the periconceptional period, and between the last menstrual period and pregnancy recognition. Results The screening interview was conducted at 22.3 (median = 22; Q1 = 16; Q3 = 29) gestational weeks. Among patients screened at the SUD clinic, 28.8% and 24.1% reported at least one binge drinking episode in the periconceptional period and in early pregnancy, respectively. The prevalence of binge drinking was similar in the general obstetrics population (24.7% and 24.4%, respectively). Among those who reported drinking in early pregnancy, median number of binge drinking episodes was higher among patients screened at the SUD clinic (median = 3; Q1 = 1; Q3 = 10) compared to the general obstetrics group (median = 1; Q1 = 1; Q3 = 3; p Conclusions This study demonstrates a high prevalence of prenatal alcohol use in early pregnancy in both groups, while patients with SUD/OUD consume more alcohol. These findings underscore the need for targeted screening and intervention for alcohol use in all pregnant women, especially those with SUD/OUD.

Early identification of children who experience developmental delays due to prenatal alcohol exposure (PAE) remains a challenge for individuals who do not exhibit facial dysmorphia. It is well-established that children with PAE may still exhibit the cognitive and behavioral difficulties, and individuals without facial dysmorphia make up the majority of individuals affected by PAE. This study employed a prospective cohort design to capture alcohol consumption patterns during pregnancy and then followed the infants to 6 months of age. Infants were assessed using magnetoencephalography to capture neurophysiological indicators of brain development and the Bayley Scales of Infant Development-III to measure behavioral development. To account for socioeconomic and family environmental factors, we employed a two-by-two design with pregnant women who were or were not using opioid maintenance therapy (OMT) and did or did not consume alcohol during pregnancy. Based on prior studies, we hypothesized that infants with PAE would exhibit broad increased spectral amplitude relative to non-PAE infants. We also hypothesized that the developmental shift from low to high frequency spectral amplitude would be delayed in infants with PAE relative to controls. Our results demonstrated broadband increased spectral amplitude, interpreted as hypersynchrony, in PAE infants with no significant interaction with OMT. Unlike prior EEG studies in neonates, our results indicate that this hypersynchrony was highly lateralized to left hemisphere and primarily focused in temporal/lateral frontal regions. Furthermore, there was a significant positive correlation between estimated number of drinks consumed during pregnancy and spectral amplitude revealing a dose-response effect of increased hypersynchrony corresponding to greater alcohol consumption. Contrary to our second hypothesis, we did not see a significant group difference in the contribution of low frequency to high frequency amplitude at 6 months of age. These results provide new evidence that hypersynchrony, previously observed in neonates prenatally exposed to high levels of alcohol, persists until 6 months of age and this measure is detectable with low to moderate exposure of alcohol with a dose-response effect. These results indicate that hypersynchrony may provide a sensitive early marker of prenatal alcohol exposure in infants up to 6 months of age., Highlights • 6 month old infants with prenatal alcohol exposure exhibit broadband hypersynchrony. • Hypersynchrony was positively correlated with number of drinks consumed prenatally. • Distribution of low frequency to high frequency amplitude did not differ by group. • Hypersynchrony may provide an early marker of prenatal alcohol exposure in infants.

Surveys required of licensed medical practitioners under the 2011 New Mexico Health Care Work Force Data Collection, Analysis and Policy Act produce knowledge useful for state health care workforce planning. As a case example, we examined responses to the mandatory survey from all obstetricians-gynecologists (ob-gyns) licensed and actively practicing in New Mexico between 2013 and 2015. In 2015, there were 389 licensed ob-gyns in New Mexico; two-thirds (254, 65.3%) practiced in the state. Eleven of 33 counties had no ob-gyn and no inpatient maternity services. More than half of all ob-gyns were female (54.1%), and females were younger than males (median age: 48.2 versus 61.4 years). Very few providers stated that their practice was too full to accept new patients. Most ob-gyns were employed (rather than practice owner-operators), and few worked in independent practices. The 28.7% of all ob-gyns who worked in non-metropolitan counties were more likely to be male, white, older, and work more hours. In conclusion, mandated self-reporting of workforce data provided a rich information source for use in evaluating medical specialty trends in New Mexico. Longitudinal observations will identify trends, along with an ability to isolate factors that either determine or are determined by these trends.

The scope of change required by academic medical centers (AMCs) to maintain their viability and achieve their tripartite mission in the future is large; such reform is affected by numerous global, national, and local forces. Most AMCs focus their transformational efforts on organizational infrastructure (e.g., undertaking payment reform, developing new organizational structures, investing in information technology) and educational programs (with subsequent changes in undergraduate and graduate medical education curricula). Although useful, these efforts have failed to produce the kind of change required for AMCs to succeed in the future.The authors of this Invited Commentary describe a key element missing from most of these reform efforts-the preparation of faculty for new models of health care and educational practice. To address this issue, they call for the effective, system-aligned presence of continuing professional development (CPD) programs. CPD combines continuing medical education, with its focus on content knowledge, and faculty development, with its focus on evidence-based learning methodologies, across the institution to produce a more robust, system- and outcomes-oriented program to facilitate both individual and organizational learning. If sufficiently supported, CPD programs can provide a platform for the human changes necessary to ensure the smooth transition of AMCs to new models of education, clinical research, and ultimately patient care.

Purpose To describe a long-term overview of accredited continuing medical education (CME) at M.D.-granting medical schools in the United States. Method Self-reported data about type, duration, and numbers of learner participants of accredited CME activities and income for CME units from each medical school were compiled annually by the Accreditation Council for Continuing Medical Education (ACCME) between 1998 and 2017. Comparisons were made with data from all other ACCME-accredited organizations. Results Between 1998 and 2017, medical schools represented 18%-19% of all ACCME-accredited organizations. CME activities, hours of instruction, learner participants, and income increased gradually until reaching the highest levels between 2008 and 2011 before remaining constant. In 2017, each school generated a median of 132 activities (interquartile range [IQR]: 66-266), of which 44% were courses and 31% were regularly scheduled series (RSS), and a median of 29,824 learner interactions (IQR: 8,464-46,255). Total income rose gradually until 2010 before declining. In 2017, each school reported a median annual income of $1.0 million (IQR: $0.2 million - $2.9 million) from CME activities, comprising 44% from registration fees, 39% from commercial support, and 14% from advertising and exhibits. Compared with other accredited organization types, medical schools generally developed more RSS activities and proportionally fewer interprofessional and online activities. Conclusions While medical schools represent less than 20% of all ACCME-accredited organizations, their role is pivotal and their influence far-reaching. For medical schools to fulfill their responsibility as education leaders, they need to prioritize support for CME offices and faculty development and implement new approaches to teaching and learning.

Objectives Retirement of “baby boomer” physicians is a matter of growing concern in light of the shortage of certain physician groups. The objectives of this investigation were to define what constitutes a customary retirement age range of maternal–fetal medicine (MFM) physicians and examine how that compares with other obstetrician–gynecologist (ob-gyn) specialists. Study Design This descriptive study was based on American Medical Association Masterfile survey data from 2010 to 2014. Data from the National Provider Identifier were used to correct for upward bias in reporting retirement ages. Only physicians engaged in direct patient care between ages 55 and 80 years were included. Primary outcomes involved comparisons of retirement ages of male and female physicians with other ob-gyn specialties. Results Interquartile ranges of retirement ages were similar between specialists in MFM (64.1–71.1), gynecologic oncology (62.1–68.9), reproductive endocrinology and infertility (64.1–71.7), and general ob-gyn (61.5–67.9). In every specialty, women retired earlier, while males in MFM were most likely to retire at the oldest age (median 70.0). Conclusion MFM physicians usually retired from clinical practice between ages 64 and 71 years, which is similar to other ob-gyn specialists. Females retired earlier, however, which may impact the overall supply as more females pursue MFM careers.

This article summarizes results of a unique, 10-year collaboration between the New Mexico Medical Board and the University of New Mexico School of Medicine's mini-sabbatical program for physicians considering relicensure and reentry into practice. The Board assesses all physicians wishing to reenter active practice to determine their background and needs, and the medical school's office of continuing medical education then evaluates candidates for their retraining goals, coursework, and faculty involvement. Progress is measured weekly, at course completion, and three months thereafter. Of the 27 physicians referred from the Board between 2004 and 2014, five were judged to require more extensive residency retraining and four received administrative medical licenses. Twelve of the 18 eligible candidates elected to enter the medical school's mini-sabbatical program. The median training was four weeks (160 AMA PRA Category 1 Credits™). Their education did not interfere with the learning of medical students and residents. All except one demonstrated acceptable core clinical skills to permit granting of an unrestricted medical license. Eleven completed the program and were successful in attaining employment in New Mexico. This collaboration permitted a determination for a physician about the extent of retraining before relicensure. The mini-sabbatical program was successful in returning eligible physicians to practice in our state.

PURPOSE Retirement of primary care physicians is a matter of increasing concern in light of physician shortages. The joint purposes of this investigation were to identify the ages when the majority of primary care physicians retire and to compare this with the retirement ages of practitioners in other specialties. METHODS This descriptive study was based on AMA Physician Masterfile data from the most recent 5 years (2010–2014). We also compared 2008 Masterfile data with data from the National Plan and Provider Enumeration System to calculate an adjustment for upward bias in retirement ages when using the Masterfile alone. The main analysis defined retirement as leaving clinical practice. The primary outcome was construction of a retirement curve. Secondary outcomes involved comparisons of retirement interquartile ranges (IQRs) by sex and practice location across specialties. RESULTS The 2014 Masterfile included 77,987 clinically active primary care physicians between ages 55 and 80 years. The median age of retirement from clinical activity of all primary care physicians who retired in the period from 2010 to 2014 was 64.9 years, (IQR, 61.4–68.3); the median age of retirement from any activity was 66.1 years (IQR, 62.6–69.5). However measured, retirement ages were generally similar across primary care specialties. Females had a median retirement about 1 year earlier than males. There were no substantive differences in retirement ages between rural and urban primary care physicians. CONCLUSIONS Primary care physicians in our data tended to retire in their mid-60s. Relatively small differences across sex, practice location, and time suggest that changes in the composition of the primary care workforce will not have a remarkable impact on overall retirement rates in the near future.

Widespread use of home pregnancy tests and the availability of first trimester genetic screening many ultrasound imaging studies being performed before 14 weeks gestation. While these scans are believed to be safe, the additional time and expense has led to questioning about its value unless indicated by vaginal bleeding, persistent nausea, potential teratogen exposure, medical complications associated with early reproductive loss or an congenital anomalies, repetitive early pregnancy loss, or desire for genetic testing. A scan at or beyond 7 weeks allows for confirmation of viability and accuracy of gestational dating by crown rump measurement. The observation of either a subchorionic hematoma or an abnormal configuration of the uterine cavity alerts the provider to the greater risk of a spontaneous abortion, placental abruption, preterm delivery, or fetal growth restriction. Gestational trophoblastic disease can be diagnosed earlier with subsequent performance of an ultrasound-directed suction curettage before morbid conditions worsen. Certain congenital anomalies can be diagnosed as early as the 11 to 14th week. Multifetal gestations can be diagnosed early with chorionicity determined between the 6th and 12th week. Nearly all maternal adnexal masses are small and require no follow-up imaging by the 15th week unless large (> 5 cm), complex, or discomfort ensues. Experience of the sonographer, resolution capabilities of the imaging machinery, maternal obesity, and fetal positioning limit interpretation capabilities. Technological refinements with three-dimensional (3D) imaging and higher definition resolution hold promise for improved accuracy in anatomic and blood flow studies. How to cite this article Rayburn WF, Izquierdo LA. Benefits and Limitations with Ultrasound Imaging in the First Trimester. Donald School J Ultrasound Obstet Gynecol 2016;10(1):9-13.