Massachusetts Chapter of the American College of Surgeons

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National Survey of Transgender Bottom Surgical Workforce: Supply and Demand
Christine O. Kang, MD, MHS, MS.1 Erin Kim, BA.1 Elizabeth Boskey, PhD.2 Alexander Dagi, BA.2 Anamika Veeramani, BS.1 Nicholas Cuccolo, BS.1 Bernard Lee, MD, MPH, MBA.1 Oren Ganor, MD.2
1Division of Plastic and Reconstructive Surgery. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA. 2Department of Plastic and Oral Surgery. Boston Children’s Hospital. Harvard Medical School. Boston, MA.

BACKGROUND There is little literature regarding accessibility of gender affirmation surgery (GAS). Our study is the first to characterize the discrepancy between gender dysphoric patients’ interest in “bottom” GAS and the availability of surgeons trained for these procedures. METHODS Cross-sectional survey assessed the capacity of accommodating patient demand for bottom GAS, demographics of the patients, and credentials of respondents. U.S. practices performing bottom GAS identified by screening eighteen web-based databases. Out of 958 providers in the preliminary search, 688 met inclusion criteria. After removing duplicates and combining providers within the same practice, 87 survey invitations were sent to unique, bottom GAS performing practices. RESULTS 19 responses collected, representing practices in 15 states and 46 surgeons. On average, each practice had 2.4 (SD = 1.3) surgeons and trained 2 (SD = 3.3) residents/fellows annually. Survey captured more academic institutions (n = 12) than private practices (n = 7). Vaginoplasty was the most consistently performed GAS (89% of practices, 31 surgeons), followed by phalloplasty (68.4% of practices, 23 surgeons). Waitlist size was largest for vaginoplasty (average = 96.17 +/- 140.17), followed by phalloplasty (average = 32.67 +/- 32.87). Comparing practice capacities and rate of growth of patient interest, 12.38% of patients seeking vaginoplasty and 49.85% of new patients seeking phalloplasty will experience delays accessing surgery. CONCLUSION Our results demonstrate a need to increase the size of the plastic reconstructive surgery workforce to better provide surgical care for gender dysphoria patients.


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