That change will probably not be spearheaded by ACOG, which is not a consumer advocacy group. Haywood Brown, MD, former chair of CREOG, believes trainees may not be completely comfortable with every major procedure at the end of training, and that those interested in subspecialty training can continue. And although ob-gyns are required to take continuing medical education courses, ACOG’s spokesperson says the group can’t require that members sign up for any particular subject. "If you know most of your physicians are doing open abdominal surgery, how are you going to retain membership if you tell them that has to change?" the AAGL’s Loffer says. No group wants its members to withdraw.
Others say ACOG could still make a difference. "Maybe ACOG can’t enforce anything, but they set standards. Why can’t they call this the Year of Modern Fibroid Management and set it forth as a priority?" Decherney asks.
Numerous physicians in the field say that in the future, change may come as the specialty evolves. Already, ob-gyns are beginning to subspecialize in areas like urogynecology, which deals with disorders such as incontinence. "Within the next 10 years, you’re probably going to see a split. Residents will either train to be an office ob-gyn, doing prenatal care and basic gynecology, or they’ll train to be a hospital ob-gyn and do surgery," Decherney says. That means that if the pills your ob-gyn prescribes to end your bleeding don’t help, you won’t have to leave her for another doctor if you want to consider other options; it will be standard for you to move on to a gynecological surgeon. Others believe the split may separate obstetrics and gynecology into two different fields, which could mean that, at midlife, women would stop seeing an obstetrician — deeply experienced in doing c-sections — and start seeing a dedicated gynecologist, for whom surgery would be only one of many options he considers every day.
But for women suffering right now, 10 years is too long to wait. When it’s time to make a treatment decision, we need to find the doctor who is best qualified to handle our case in the safest, most effective, and least invasive way possible, and that means doing our own research. And we need to start making noise about this outrageous situation. "Only when women began to talk about breast cancer, only when they began to demand research and to call for procedures like lumpectomy, did we begin to have alternatives to radical mastectomy," says the NWHRC’s Cahill. "Men are willing to talk about erectile dysfunction today, and we’ve got to start talking about our reproductive organs. We can’t wait for doctors to start the conversation about alternatives to open abdominal hysterectomy. We have to educate ourselves and start demanding. Just like we’ve done with everything else."
Stand Up to Your Insurance Company
Kathryn Friedman, 53, of California, knew the facts about the dermoid cyst on her ovary. So when her ob-gyn said the only treatment was abdominal surgery to remove her ovary, she said no thanks. "Dr. William Parker told me he could remove just the cyst laparoscopically," Friedman says. The only problem: Like many specialists, Parker didn’t participate in any insurance plan.
If you find yourself in Friedman’s situation, don’t assume that you must work with in-plan practitioners who lack the right qualifications. You may need to fight, but you may win — as Friedman did.
With Parker’s help, she took her case to a state agency, the California Department of Managed Health Care (DMHC), arguing that none of the physicians in her plan were qualified to perform the procedure Parker proposed. She had to pay for the operation up front, but in the end Blue Cross reimbursed her entirely — and paid a price for its cost-consciousness. "The DMHC fined them $85,000 for trying to make me undergo the slice and dice," Friedman says.
If your insurer denies coverage, take these steps.
- Call the insurer’s utilization or case management department and ask to discuss the denial. Take detailed notes of every conversation.