AAGL Presidential Address focuses on elevating gynecologic surgery

Dr. Advincula presenting Dr. Einarsson with plaque commemorating his service as presidentSpecialization by “pelvic surgeons” is the future for AAGL, said Jon I. Einarsson, MD, PhD, MPH in his address to an enthusiastic audience at the society’s 46^th AAGL Global Congress. Closing his year as president, Einarsson described five separate initiatives in progress at the society, which are aimed at underscoring that AAGL’s focus has expanded well beyond minimally invasive gynecologic surgery (MIGS).

Described by Arnold Advincula, MD, in his introduction as a “consummate surgeon, researcher, and collaborator,” Einarsson grew up in Iceland, where he earned his MD and PhD degrees. Interested in becoming a doctor even as a child, he nevertheless “thought laparoscopic surgery was nonsensical because it took forever” when he observed early procedures. Watching a total laparoscopic hysterectomy being completed in 30 minutes and attending his first AAGL conference convinced him otherwise.

Founder and director of the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital and recently appointment a Professor of Obstetrics, Gynecology and Reproductive Medicine at Harvard Medical School, Einarsson noted that he had “failed so many times” in his career. “I wanted to pursue a MIGS fellowship and did not match,” he said. “The first time I ran for the AAGL board, I didn’t make it.” To be successful, he advised those in the audience, takes persistence. “Keep working at it, pursue dreams and set goals, and challenge the status quo.”

Reviewing the initiatives that he pursued for the society as president and progress toward realizing them in the last year, Einarsson said AAGL is “close to the finish line” with Essentials in Minimally Invasive Gynecology. Also known as EMIG, it is a validated, high-stakes exam for surgeons that he said will help “weed out bad seeds, set minimum standards for surgery and protect patients.”

AAGL is also developing a prospective surgical outcomes database and he issued a “call to arms” for members to “publish, do research, and stop being modest about what we contribute as MIGS surgeons.”  The third initiative he described was an International Outreach program. The goal is to create a sustainable 6- to 12-month surgical training program in Malawi, with the emphasis on sustainability because having a surgeon “operate up a storm for a week and then leave doesn’t help people.”

Coding and reimbursement also is a key concern for AAGL, according to Einarsson, who said that sometimes the society’s interests in this area don’t align with those of the American College of Obstetricians and Gynecologists (ACOG), which plays a lead role in developing codes. The example he cited was the single code that exists for endometriosis surgery, which covers everything from fulguration to much more complex procedures. AAGL does want to collaborate with ACOG on surgical codes and has recruited a coding expert to assist in developing solutions.

The last initiative and challenge described by Einarsson was residency training. Earlier this year, he attended a meeting at ACOG with stakeholders, all of whom want the best for patients, at which residency training was the focus. ACOG, he said, views ob/gyns as surgeons and also primary care physicians, “but that’s not going to work. Ob/gyns probably have the lowest number of hours of surgical training of any surgical specialty. But it’s very difficult to master today’s surgeries in such a limited amount of time.”

Einarsson predicted that the “pelvic surgeon” is the way of the future in terms of training, defining that surgeon as someone “who is able to take care of any benign condition in the pelvis. To that end, AAGL is seeking focus practice recognition from the American Board of Obstetrics and Gynecology as an interim step to development of a full subspecialty. An AAGL taskforce is evaluating whether the society should pursue the subspecialty designation.

“This is an exciting time to be in AAGL,” Einarsson said. “MIGS is now recognized as the standard of care because past society presidents fought to get it recognized. There are so many dynamic young people in AAGL and we’re positioned for a prosperous future.”