Scientific paper

Who are we and what do we think?

Peter D. Beitsch, M.D.a,*, Arthur G. Lerner, M.D.b, Allison L. Laidley, M.D.c,Lorraine Tafra, M.D.d, Michael J. Edwards, M.D.e

aSt. Paul University Hospital, 5920 Forest Park Rd., Suite 500, Dallas, TX 75235, USAbWhite Plains, NY, USA

cMedical City Dallas, Dallas, TX, USAdAnn Arundel Medical Center, Annapolis, MD, USA

eDepartment of Surgery, University of Arkansas, Little Rock, AR, USA

Manuscript received June 3, 2003; revised manuscript June 21, 2003

Presented at the Fourth Annual Meeting of the American Society of Breast Surgeons, Atlanta, Georgia, April 30–May 4, 2003

Abstract

Background: The American Society of Breast Surgeons was founded on the principal of professional and practical development of itsmembers. The Society undertook a survey of its members to identify issues and concerns and to guide future action.Methods: The survey was prepared by the membership committee and a website was created for responses and analysis. The survey wasposted on the website and mailed to 1,530 members. Overall there was a 31% response.Results: Demographic data regarding practice patterns, technology utilization, and current problems showed a diverse Society with varyingneeds and problems.Conclusions: The Society will pursue professional development in ultrasonography training, coding and reimbursement, and emergingtechnologies. The Society is committed to providing regional training programs, certification, and professional interaction. The Society willcontinue to look to the members for feedback and guidance. © 2003 Excerpta Medica, Inc. All rights reserved.

Keywords: Breast surgeons; Membership survey

The American Society of Breast Surgeons (the Society)recently decided to undertake a comprehensive survey ofthe membership. The purpose of this survey was to identifythe needs and concerns of the members and to discern whatissues the members want the Society to address. The Societycontracted with Levy and Associates to assist in the prepa-ration and analysis of the survey.

The survey included questions about demographics,board certification, breast imaging, image-guided biopsy,research, coding and reimbursement, professional develop-ment, and advocacy. The survey was sent to 1,530 memberswho could respond by mail, fax, or online; 470 (31%)responded. We interpret this as a strong indication of howinvolved and interested members are in the Society. This

report summarizes the results and highlights the issues ofmajor interest and concern to the responding members.

Demographics

Most of the respondents are in private practice (88%)with solo practice being most commonly reported (34%).Twelve percent are in academic practice. Most respondents(74%) devote at least 50% of their practice to breast carewhile 30% devoted their practice solely to breast care. Morethan half of the respondents do not plan to limit theirpractice to breast care (56%). Regarding patient insuranceplans, 95% of respondents are Medicare providers and 76%are Medicaid providers. Interestingly, almost one quarter(22%) of members do not accept any managed care healthinsurance.

Although this survey did not directly address cancertreatment, members responded that breast conservation wasthe preferred treatment for stage I and II disease (82% and

* Corresponding author. Tel.: �1-214-956-6802; fax: �1-214-352-9449.

E-mail address: Beitsch@aol.com

The American Journal of Surgery 186 (2003) 321–323

0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved.doi:10.1016/S0002-9610(03)00270-8

69%, respectively). The SEER data show that the rate ofbreast conservation for early stage breast cancer in theUnited States is, on average, 50%, with significant regionalvariations.

Board certification

Almost all (95%) of the respondents are board certifiedin General Surgery and more than 75% hold a strong com-mitment to maintain board certification even in “breast-only” practices. Members also generally believe that boardcertification should be a requirement for initial membershipto the Society. However, if breast subspecialty certificationwere established, 73% would be interested in obtaining it.

Breast imaging and image-guided biopsy

Approximately 66% of the respondents report usingbreast ultrasonography in the office while 40% report usingbreast ultrasonography in the operating room, primarily forlocalization purposes. Ultrasound-guided procedures in-clude cyst aspiration, fine-needle aspiration, and core-nee-dle biopsy with vacuum-assisted or rotational devices. Re-imbursement for breast ultrasonography procedures is aproblem according to almost half of the respondents and35% are not reimbursed at all for office based breast ultra-sonography.

Stereotactic core biopsies are performed by 46% of themembers, 95% of whom have privileges to do so either inthe hospital (56%) or outpatient breast center (33%). Theprocedures are done in collaboration with radiologists by44% of the respondents. Just over one third (34%) of re-spondents are prevented by their hospitals from performingstereotactic biopsies. Most cite political reasons, hospitalcredentialing, and training issues as reasons for their beingbarred from performing this procedure.

Respondents who are trained in stereotactic-image–guided biopsies have been educated through national (53%)and regional (31%) courses. Additionally, there is a stronginterest in the Society providing the appropriate educationalcourses to maintain competency in this procedure.

Research

Despite the high percentage of private practitioners in theSociety, more than half of the members (54%) participate inclinical trials through affiliations with NSABP (60%),ACOSOG (60%), CALGB (16%), and NAFTA (15%).Most (68%) do not have a research assistant. The mostcommon impediments to performing research are lack oftime (84%), additional expense (42%), fear of paperwork(36%), Insitutional Review Board submission (31%), andlack of training (26%). A small but significant number of

respondents (14%) believe that research is inappropriate forprivate practitioners. There is a strong interest in regionaltraining courses on participation in clinical trials.

Coding and reimbursement

The development of new CPT codes is of strong interestto the respondents and 87% believe the Society shoulddirect more resources to this effort. Responses vary but mostrespondents agreed on the need for new CPT codes forductal lavage, brachytherapy and sentinel node biopsy.There is also strong interest in regional training courses oncoding (62%). The current system of coding and reimburse-ment was thought to affect patient care (59%) and the typesof services offered to patients (43%). Despite these con-cerns, 72% of members do not think this problem affects thequality of care they provided to their patients.

Professional development and advocacy

Professional development is cited as the most commonreason for membership in the Society (93%). Advocacy(63%), research (35%), and certification (30%) are otherreasons cited by respondents for membership in the Society.More than half (54%) of the respondents had attended anAmerican Society of Breast Surgeons annual meeting, butthere is also a very strong interest in having the continuingmedical education (CME) program available on-line in theSociety website. As mentioned in other sections of thispaper, there is a strong interest in Society sponsored re-gional training programs in breast ultrasonography, stereo-tactic breast biopsy, sentinel node biopsy, medical coding,and clinical trials. The highest interest (91%) is in emergingnew technologies.

Members are also interested in the development of ahotline (86%), an online chat room (53%), and the ability toshare databases for patient outcome and management data.There is also interest in developing practice guidelines,online CME, and online recertification.

Members want the Society to be an advocate in severalcritical areas: malpractice insurance reform (92%), reim-bursement (92%), and coding (87%). Most of the members(80%) do not have difficulties obtaining malpractice insur-ance coverage, but 20% stated that they do. Additionallayers of coverage are available to 61% of members. De-spite concerns about the present system, most members donot believe it affects the quality of care they deliver to theirbreast patients.

Comments

This survey was undertaken to obtain a snapshot of theSociety and the directions in which we should proceed. The

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Society was founded on the principles of helping membersboth professionally through collegial relationships at meet-ings and also practically with mentoring in new technology(ultrasonography, sentinel node biopsy, stereotactic biopsy,ductal lavage, and so forth), coding/reimbursement (semi-nars in coding, new CPT codes), and national advocacy forprivate practitioners and academic surgeons. The Society iscomposed of general surgeons, the vast majority of whomare board certified and Fellows of the American College ofSurgeons. This bond with the ACS will only grow strongeras the Society becomes more involved with the researchactivities of the ACS Oncology Group. With the resultsfrom our first comprehensive survey, we now have a clearerpicture of the composition of our Society, our problems andneeds. The Society will respond with the following:

1. Professional development is important to the membersof the Society. This is a service that the Society is commit-ted to through providing regional training programs. The

Society will evaluate the feasibility of online CME educa-tional programs and online certification programs.

2. Professional interaction with rapid response to impor-tant issues is critical. The members want to have access toeach other through hotlines and online chat rooms and wantto develop the ability to share information for research andpractice guidelines.

3. Members of the Society strongly support action inareas that need reform. The Society will continue to focusefforts toward equitable reimbursement for breast proce-dures. The Society will address the feasibility of politicalinvolvement with medical malpractice issues and tort re-form.

The American Society of Breast Surgeons will continueto ask the membership for direction, and we look forward tobuilding an even stronger and more receptive Society for thebetterment of our members and, more importantly, of theirpatients.

323P.D. Beitsch et al. / The American Journal of Surgery 186 (2003) 321–323