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State of Gynecologic Oncology

 |  By jcantlupe@healthleadersmedia.com  
   May 27, 2010

In the tiny subspecialty of gynecologist oncologists, the Society of Gynecologic Oncologists conducts an extensive survey of its 1,100 practitioners every five years. This isn't your quick how-are-things-going type poll. It could take an hour for participants to complete, the society leaders say.

Why dwell on that? Well, Jimmy Orr, MD, former chairman of the SGO and current head of the survey task force, dwells on that. Of 900 or so letters that were sent out in the survey, more than 600 responded. "Who has 70% response rate?" he asks. "That's really huge. If it's 50% that's good, but 70%—that's a big deal." To Orr, it reflects the concern and dedication of gynecologic oncologists.

A bigger deal, of course, is what they said in the survey, Gynecologic Oncology 2010: State of the Subspecialty. Compared to five years ago, there were major differences in what was said about the evolving physician practice. And the survey revealed an evolving nature of the SGO itself.

The workforce is getting younger and a larger number of women are entering the field. In addition, there's a shift away from private practice and an increase in group or multi-specialty practices, not unlike other physician practices. In 2005, women represented 20% of practitioners, and now it's 33%. In 2005, the mean age of a practitioner was 51; now it's 47.

Orr, who is medical director of the Florida Gynecologic Oncology & Regional Cancer Center, in Fort Myers, FL, finds these changes significant.

Having younger practitioners will "propel the specialty forward," he says. "The same can be said of having more women in the field. Women have an understanding of women, and rounds out the whole picture of care, the treatment, surveillance, and family dynamics."

The survey revealed a definite move away from private practice, with 35% of the gynecologic oncologists calling themselves primarily private practice physicians, compared to about 51% in 2005. Twenty-five percent of the gynecologic oncologists now work for a multi-specialty practice/clinic, while only 13% are part of an individual practice.

And 77% say they are salaried employees, compared to 56% who classified themselves as salaried employees in 2005. More work in university or hospital-based teaching facilities, 62% compared to 55% in 2005.

The "security of salaried positions" is definitely reflected in the survey, Orr says. "It relates to the overall angst of what is happening in medicine. There's such a burden with the mechanics and paperwork of medicine. We are going to find an increasing number of individuals trying to integrate themselves into a larger group. The model of an integrated system is not fragmented, it's more efficient, and certainly cost reducing; what we have to look forward to in the future."

The survey shows a "continued dedication" to providing chemotherapy services to patients regardless of the changes in reimbursement rates, as well as the continuation of enrollment of patients into clinical studies rather than the more revenue neutral or industry-sponsored trials, Orr says.

According to the survey, there has been no real change in the percentage of gynecologic oncologists who routinely provide chemotherapy services in their practice (79%) in the 2010 survey compared to 80% in 2005.Those in a group practice (82%) and multi-specialty practice/clinic (82%) are much more likely to administer chemotherapy in their practice than those in an individual practice (55%), the survey showed.

Although 51% of gynecologic oncologists earn revenue from chemotherapy in addition to the E&M code, an overwhelming number of gynecologic oncologists (97%) plan to continue administering chemotherapy in the coming year. The majority of gynecologic oncologists also agree to treat new Medicare and Medicaid chemotherapy patients.

"In revenues and reimbursements for chemotherapy, it's been going down the past 3 or 4 years, and will continue to do so, like all medical reimbursements have been," Orr says. "But these physicians are saying we're in it for the long haul, we will continue to deliver excellent care, in a comprehensive approach for women. It's absolutely the right thing to do."

"These people are really attuned into what they are doing and that they want to contribute to the subspecialty," Orr says of his fellow practitioners. "When you look at the response to the survey, the attendance at our meetings, there are these high percentages because people want to deliver state of the art care."

Orr says he's been in practice more than 28 years, and hasn't looked back. "If I was 22 years old, and God said to me, "What are you going to do with your life? I would do exactly the same thing.


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Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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