Assessment of the Capacity of Healthcare Workforce to Deliver Gender-Affirming Bottom Surgery (GABS)
Christine O. Kang, MD, MHS, MS1, Erin Kim, BA1, Nicholas Cuccolo, MD1, Lauren Luther, BA2, Alexander Dagi, BA2, Anamika Veeramani, BS1, Elizabeth Boskey, PhD2, Bernard Lee, MD, MBA, MPH, FACS1 , Oren Ganor, MD2
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: Gender affirming surgery critical for transgender patient healthcare, but information about availability is limited. Collected information on U.S. workforce capacity for gender affirming bottom surgery (GABS) delivery. Hypothesized current surgical demand outpaces its supply due to workforce shortages and lack of trained providers.
Methods: Questionnaire administered via email, phone call, or fax from February-May 2020 to 86 practices performing GABS, identified by searching 10 web-based databases with standardized keywords. Assessed current workforce capacity for performing GABS.
Results: 32 of 86 practices responded, 20 met inclusion criteria. Across fifteen states represented, average 2.4 (SD = 1.3) surgeons and 2 (SD = 3.3) residents/fellows performing GABS annually. Greatest number of total providers offering GABS in Illinois (n=14), Texas (n=10), and Massachusetts (n=9). No correlation between number of GABS types offered or providers and geographic population density in practice city (r=-0.40, r=0.19). Among queried procedures, vaginoplasty most frequently performed, with longest waitlists and highest waitlist additions per month. Phalloplasty, second most common procedure, waitlist additions per month exceeded provider capacity to perform procedure. Most surgeons performing GABS were plastic surgeons and urologists, while obstetricians/gynecologists performed majority of hysterectomies.
Conclusion: Study demonstrated discrepancy between patient interest in GABS and procedure availability, likely secondary to provider shortage with requisite training and experience. While more study needed to better characterize relationship between number of patients seeking GABS and available providers, findings may motivate increase in training to better meet needs of this unique population.
Back to 2021 Program