BackTable OBGYN

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 - Introduction 05:40 - Multi-Compartment Prolapse & Second Opinions 08:14 - Pelvic Floor Compartments Explained 10:36 - When Internal Prolapse Becomes Surgical 11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage 16:55 - Fluoro vs MRI and When to Order It 23:47 - Anorectal Manometry 26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup 29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches 34:43 - When (and Why) to Consider Biologics 36:46 - Resection Rectopexy 38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders 42:55 - Pelvic Floor PT After Surgery and Recovery Timelines 47:29- Perineal Prolapse Repairs (Altemeier vs Delorme) 49:53 - Symptom Improvement vs Retraining the 'New Normal' 52:20 - Fecal Incontinence & Sacral Neuromodulation 57:08 - Diarrhea-Driven Incontinence 58:56 - Building a Multidisciplinary Pelvic Floor Program 01:04:04 - 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 - Introduction 05:34 - Training and Mentorship in Hysteroscopy 11:21 - Dr. Salazar's Practice and Techniques 14:00 - Challenges and Trends in Surgical Practices 18:58 - Referral Practices and Advanced Hysteroscopy 21:58 - Understanding Dysmorphic Uterine Population 24:08 - T-Shaped Uteri Description 26:09 - Hysteroscopic Metroplasty: Methods and Risks 29:17 - Innovations in Hysteroscopy 32:38 - Value of Ultrasound in Hysteroscopy 36:35 - Post-Operative Management and Estrogen Therapy 39:23 - Challenges and Future Directions in Hysteroscopy 44:23 - 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-analyses https://academic.oup.com/humupd/article/31/6/588/8248883 Hysteroscopy Newsletter https://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 - Introduction 03:41 - Residency and Early Involvement in ACOG 07:29 - Advocacy and Government Affairs 18:40 - Balancing Professional and Organizational Work 24:28 - Listening to Members' Needs 26:36 - Challenges and Value of ACOG Membership 29:00 - The Importance of In-Person Meetings 34:45 - ACOG's Legislative Advocacy and Future Plans 35:48 - Advice for Getting Involved with ACOG 40:16 - 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 - Introduction 02:03 - The Birth of PeriPeach: Addressing Severe Tearing 06:51 - New Medical Devices: Mellomallows 08:41 - The Creation and Mechanism of PeriPeach 11:11 - Company Development: Mentorship and Resources 17:37 - Pitching Practice and Experience 19:26 - Project Funding and Working with Medicines360 21:51 - Advice for Aspiring Innovators 23:52 - Concerns About AI in Healthcare 26:48 - Innovations in Women's Health 29:06 - Challenges in Academic Medicine 32:01 - The Importance of Female Innovators 34:00 - Forming a Startup in Women's Health 36:10 - Parting Advice for Future Innovators 37:37 - The Future of Women's Health Innovations 40:10 - Conclusion --- RESOURCES Fruits of Labor website: https://www.fruitsoflabormed.com/home PeriPeach website: https://www.peripeach.com/

Ep. 103 Contemporary Approaches to Fibroid Management with Dr. Arleen Song

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. --- 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 - Introduction 02:11 - Defining Vaginal Rejuvenation 04:35 - Common Procedures and Misconceptions 10:04 - Insurance and Coverage of Procedures 12:04 - Laser and Radiofrequency Therapies 18:10 - Vaginal Estrogen and Lift of Black Box Warning 19:59 - The Role of Systemic Hormone Therapy 26:56 - Vaginal Rejuvenation Misconceptions 32:21 - Pelvic Floor Physical Therapy and Timing of Procedures 34:24 - Regional Variations in Therapeutic Availability 38:40 - Gender Inequity in Healthcare 40:16 - Final Thoughts --- RESOURCES Joint Report on Terminology for Cosmetic Gynecology https://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 - Introduction 03:34 - Understanding Fertility Preservation 07:56 - Consultation Process for Fertility Preservation 17:36 - Advancements in Egg Freezing Technology 25:55 - Egg Freezing Recommendations 26:34 - Collaboration Between Oncology and REI 26:52 - Pediatric Oncology and Fertility Preservation 28:58 - Ovarian Tissue Transplantation 33:17 - Uterine Transposition Surgery 40:05 - Gene Editing and Fertility Preservation 43:01 - Financial and Emotional Aspects of Fertility Preservation 48:02 - Practical Advice for OBGYNs 51:12 - Resources and Final Thoughts --- RESOURCES Livestrong Fertility https://livestrong.org/how-we-help/livestrong-fertility/ Resolve: The National Infertility Association https://resolve.org/ Society for Assisted Reproductive Technology https://www.sart.org/ American Society for Reproductive Medicine https://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 - Introduction 05:08 - First Experiences in Medical-Legal Work 08:57 - The Role of Education in Legal Cases 11:37 - Challenges and Rewards of Medical-Legal Work 13:58 - Understanding Standard of Care and Malpractice 15:59 - The Importance of Detailed Reports and Depositions 20:02 - The Jury System and Its Challenges 25:45 - Balancing Professional and Personal Life 29:43 - Getting Started in Medical-Legal Work 32:07 - Recognizing Patterns in Medical Litigation 33:51 - Educating Attorneys for Fair Trials 36:33 - Concerns and Improvement of Medical Expert Testimonies 45:54 - The Role of Systems in Reducing Medical Errors 51:52 - Future Challenges and Opportunities in Medical Legal Work 56:07 - Final Thoughts --- RESOURCES ACOG Technical Bulletin 365: Seeking and Giving Consultation https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2007/05/seeking-and-giving-consultation MooreExperts OBGYN Consulting Medical Legal Expert Witness Masterclass https://www.mooreexperts.com/ Bless This Mess: A Picture Story of Healthcare by Dr. Stephen Klasko https://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 Journey 07:37 - The Role of MIG Surgeons in Obstetrical Surgery 16:06 - Building a Collaborative Team 18:38 - Challenges and Best Practices 25:26 - Expanding the Scope of MIG Surgeons 30:19 - The Evolution of Urogynecology and MIGS 31:31 - Leadership and Building Programs 37:54 - Scaling Up and Regionalization of Care 42:53 - Balancing Work and Personal Life 54:37 - Concluding Thoughts --- RESOURCES Canadian Society for Advancement of Gynecologic Excellence https://cansage.org/about/ From Strength to Strength, by Arthur Brooks https://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 Pathways 11:43 - Impact of Reimbursement on Fellowship Applications 15:20 - Workforce Issues and Future of GYN Surgery 28:02 - Advocacy and Leadership in Healthcare 29:27 - Understanding Hospital Revenue and Efficiency 31:54 - The Role of Physician Leadership in Healthcare 35:35 - Navigating Healthcare System Mergers 36:47 - The Future of Healthcare Amidst Financial Cuts 41:40 - Addressing Healthcare Costs and Reimbursement 45:11 - The Importance of Women's Health Services 47:37 - Strategies for Improving Healthcare Systems 53:48 - Concluding Thoughts --- RESOURCES Trends in gynecologic surgery reimbursement and physician pay https://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 Challenges 04:43 - Clinical Management of TOAs 08:06 - Surgical Approaches and Considerations 22:25 - Microbiome and Infection Insights 32:10 - Discussing Patient Reactions and Education 32:47 - Teaching Practices and Medical Education 34:18 - Clinical Observations and Data 36:55 - Surgical Management of Ruptured TOAs 40:50 - Challenges in Treating Infected Endometriomas 50:13 - Exploring the Role of AI in Medical Practice 54:23 - Concluding Remarks --- RESOURCES ACOG Recommends Concurrent Sexual Partner Treatment for Recurrent Bacterial Vaginosis for the First Time https://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 Surgery 08:51 - Hysteroscopy in Reproductive Surgery 16:28 - Endometriosis and Infertility 23:50 - Diagnosing and Treating Adenomyosis 28:10 - Surgical Interventions for Reproductive Health 33:52 - Balancing Endometrioma Removal and Fertility 35:49 - Surgical Approaches and Patient Goals 36:46 - Complexities of Fertility Consultations 42:48 - Impact of Fibroids on Reproductive Health 45:33 - Adhesion Prevention in Myomectomy 48:33 - Innovations in Fibroid Ablation 52:10 - Understanding Isthmoceles and Their Impact 58:11 - Concluding Thoughts --- RESOURCES ReceptivaDx: What does it mean to test positive for high levels of bcl6 https://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. --- SYNPOSIS The 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. --- TIMESTAMPS 00:00 - Introduction 07:35 - Training in Australia and New Zealand 15:05 - Public and Private Healthcare Systems 20:25 - Challenges and Equity in Healthcare 24:39 - Balancing Public and Private Practice 28:48 - Inpatient Services and Day Case Hysterectomy 29:46 - City vs. Rural Practices and Equity Issues 31:55 - Staffing Challenges in New Zealand 33:57 - Living and Working in New Zealand and Australia 35:25 - Navigating Medical Practice Transfers 40:10 - Medical-Legal Environment in Australia and New Zealand 43:31 - Gender-Based Reimbursement and Training Challenges 51:41 - Endometriosis Ultrasound Scanning and Collaboration 52:27 - Final Thoughts --- RESOURCES The 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 countries https://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. --- SYNPOSIS Dr. 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. --- TIMESTAMPS 00:00 - Introduction 01:09 - Dr. Carrubba’s Background and Journey 03:54 - Fellowship Experience and Pelvic Pain Focus 06:44 - Approach to Chronic Pelvic Pain 14:04 - Detailed Pelvic Pain Exam Techniques 17:14 - Trigger Point Injections and Their Role 21:33 - Challenges in Pain Management and Education 26:34 - Role of Central Sensitization in Chronic Pelvic Pain 29:35 - Approach to Central Sensitization and Screening 33:13 - Approaches to Excision Surgery 36:04 - Post-Surgery Management and Hormonal Suppression 38:19 - Teaching and Training in Pelvic Pain Management 41:35 - Pain Rehabilitation Clinic for Central Sensitization 44:59 - Teaching Pelvic Pain Anatomy to Trainees 48:24 - Advancements in AI for Medical Documentation 52:26 - Reflections on Pelvic Pain Training and Education 56:00 - 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. --- SYNPOSIS Dr. 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. --- TIMESTAMPS 00:00 - Introduction 02:03 - Dr. Hathaway's Journey into Coding 04:11 - Understanding the Financial Side of Healthcare 07:10 - The Disconnect in Healthcare Payments 11:26 - The Complexity of Medical Billing 18:11 - The Role of CPT, RVU, and ICD Codes 24:03 - The Process of Approving New Procedures 32:38 - Understanding the Value Update Process 33:47 - Case Study: Cystoscopy in Hysterectomy Codes 35:26 - Survey Participation and Its Impact 36:12 - Roles and Responsibilities in ACOG 38:12 - Challenges of RVU-Based Compensation 42:08 - Specialty-Specific RVU Valuation 48:42 - Comparing OB and GYN Reimbursements 50:02 - Envisioning an Ideal Healthcare System 55:10 - Maximizing Billing Efficiency 59:46 - Final Thoughts

The future of gynecologic surgery is less invasive, more precise, and closer than you think. In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman welcomes Dr. Noam Smorgick, Director of Minimally Invasive Gynecologic Surgery at Shamir Hospital in Israel. They discuss Dr. Smorgick’s journey into the field of OBGYN and her innovative approaches to intrauterine adhesion management and hysteroscopic surgery for complex pathologies. --- SYNPOSIS Topics include the advantages of hysteroscopic management over traditional methods, the importance of maintaining fertility, the nuances of the Israeli healthcare system, and the development of new surgical instruments and procedures. The episode also highlights shared decision-making in patient care and looks ahead to the future direction of gynecologic surgery. Dr. Smorgick shares insights from recent studies and her experiences, making it a valuable listen for practitioners and anyone interested in gynecologic surgery advancements. --- TIMESTAMPS 00:00 - Introduction 02:05 - Dr. Smorgick’s Journey to Medicine 05:01 - Insights into Israeli Healthcare System 10:20 - Intrauterine Adhesions and Hysteroscopic Management 11:28 - Research on Retained Products of Conception 15:07 - Comparing Management of Pregnancy Loss 22:02 - Future Directions in Hysteroscopic Surgery 23:46 - Infertility Treatments in Israel 25:50 - Managing Uterine Septums and Adhesions 28:03 - Shared Decision Making in Surgery 32:03 - Techniques and Tools for Metroplasty 33:08 - Adhesion Prevention Strategies 35:35 - Postoperative Care and Follow-Up 36:59 - Office Hysteroscopy Procedures 38:05 - Reusable vs. Disposable Instruments 45:51 - Future of Hysteroscopy --- RESOURCES Netherlands Publication: Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/28390688/ Dr. Smorgick’s Publications: A comparison of reproductive outcomes following hysteroscopic management versus dilatation and curettage of retained products of conception: https://pubmed.ncbi.nlm.nih.gov/24997472/ Hysteroscopy-assisted suction curettage for early pregnancy loss: does it reduce retained products of conception and postoperative intrauterine adhesions?: https://pubmed.ncbi.nlm.nih.gov/37782418/

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

Blind biopsies leave questions unanswered. In this episode of BackTable OBGYN, host Dr. Mark Hoffman welcomes back Dr. Linda Bradley, an expert in obstetrics, gynecology, and hysteroscopy from the Cleveland Clinic, to discuss the benefits and advancements of direct visualized endometrial sampling over traditional blind biopsy techniques. --- This podcast is supported by: Medtronic https://www.medtronic.com/en-us/healthcare-professionals/specialties/gynecology/product-portfolio.html --- SYNPOSIS Dr. Bradley emphasizes the importance of hysteroscopy for accurate diagnosis and treatment of various gynecological issues, including abnormal uterine bleeding. They explore the limitations of blind biopsies and the advantages of hysteroscopy in detecting focal lesions, avoiding unnecessary hysterectomies, and ensuring patient safety. The discussion also touches on the economic and procedural challenges in adopting hysteroscopy more widely in clinical practice. --- TIMESTAMPS 00:00 - Introduction 03:30 - The Evolution of Hysteroscopy at Cleveland Clinic 04:49 - Challenges and Innovations in Hysteroscopy 06:30 - Clinical Insights: Direct Visualized Endometrial Sampling 12:03 - Case Studies and Practical Applications 15:46 - The Importance of Visual Examination in Gynecology 20:03 - Advocating for Hysteroscopy in Medical Practice 31:07 - Patient History and Trauma Considerations 31:34 - Cancer Detection and Missed Diagnoses 32:14 - Challenges with Unscheduled Bleeding 32:56 - Case Study: Blood Transfusions and Hysterectomy 33:38 - Importance of Hysteroscopy 34:43 - Hysteroscopy Techniques and Best Practices 37:41 - Ultrasound and SIS (Saline Infusion Sonohysterography) for Imaging 38:45 - Post-Operative Care and Follow-Up 47:41 - Environmental and Economic Considerations in Healthcare 52:51 - Final Thoughts and Patient Advocacy

When radiology meets surgery, endometriosis care becomes more precise, personalized, and proactive. In this BackTable OBGYN Brief, host Dr. Mark Hoffman is joined by Dr. Wendaline VanBuren, an associate professor of radiology at Mayo Clinic, and Dr. Tatnai Burnett, a minimally invasive GYN surgeon at Mayo Clinic, to discuss the complexities of diagnosing and managing endometriosis. The discussion covers the roles of advanced imaging techniques like MRI and ultrasound, the importance of pre-surgical planning, and the need for multidisciplinary collaboration. They share their approach to managing symptomatic and asymptomatic patients, the use of hormonal treatments, and the significance of monitoring potential malignant transformations in endometrioma cases. The episode underscores the critical role of imaging in planning effective surgical interventions for patients while highlighting the progression of endometriosis management protocols. TIMESTAMPS 00:00 - Introduction  01:07 - Discussing Endometriosis Management 02:18 - Imaging Techniques and Their Importance 04:24 - Interdisciplinary Collaboration 05:40 - Advanced Imaging Protocols 08:12 - Monitoring and Follow-Up Strategies 08:50 - Concerns About Malignancy 11:04 - Future Directions CHECK OUT THE FULL EPISODE OBGYN Ep. 69 https://www.backtable.com/shows/obgyn/podcasts/69/imaging-protocols-to-guide-endometriosis-treatment

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women. --- SYNPOSIS Dr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health. --- TIMESTAMPS 00:00 - Introduction 03:41 - Challenges in Menopause Medicine 07:21 - Misconceptions and Risks of HRT 15:35 - Understanding Bioidentical Hormones 18:48 - WHI Studies and Their Impact 23:21 - Practical Guide to Prescribing HRT 33:47 - Understanding Estrogen Levels and Risks 36:04 - Debating Gels vs. Patches 37:51 - Concerns with Compounded Products and Pellets 38:50 - Patient Education and Meeting Them Where They Are 42:12 - Progesterone Benefits and Sensitivities 46:38 - Testosterone Therapy for Women 51:36 - The Importance of Lab Tests 55:39 - DHEA and Vaginal Health 57:14 - Advocacy for Accurate Hormone Therapy Information 01:00:05 - Conclusion and Final Thoughts --- RESOURCES The Peter Attia Drive episode with Dr. Rachel Rubin: https://peterattiamd.com/rachelrubin/ FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women: https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4m Dr. Rachel Rubin’s Hormone Therapy for Early Adopters Course: https://rachelrubinmd.thinkific.com/courses/MHTCME