title: Discrepancies in the female pelvic medicine and reconstructive surgeon workforce.
abstract: BACKGROUND
  It is unclear whether the current distribution of surgeons practicing female pelvic medicine and reconstructive surgery in the United States is adequate to meet the needs of a growing and aging population. We assessed the geographic distribution of female pelvic surgeons as represented by members of the American Urogynecologic Society (AUGS) throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels.
  
  
  METHODS
  County-level data from the AUGS, American Congress of Obstetricians and Gynecologists, and the United States Census were analyzed in this observational study. State and national patterns of female pelvic surgeon density were mapped graphically using ArcGIS software and 2010 US Census demographic data.
  
  
  RESULTS
  In 2013, the 1058 AUGS practicing physicians represented 0.13% of the total physician workforce. There were 6.7 AUGS members available for every 1 million women and 20 AUGS members for every 1 million postreproductive-aged women in the United States. The density of female pelvic surgeons was highest in metropolitan areas. Overall, 88% of the counties in the United States lacked female pelvic surgeons. Nationwide, there was a mean of 1 AUGS member for every 31 practicing general obstetrician-gynecologists.
  
  
  CONCLUSIONS
  These findings have implications for training, recruiting, and retaining female pelvic surgeons. The uneven distribution of female pelvic surgeons throughout the United States is likely to worsen as graduating female pelvic medicine and reconstructive surgery fellows continue to cluster in urban areas.
authors.affiliation: From the *Division of Female Pelvic Medicine & Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; †Department of Natural Resources and Environment, Naresuan University, Muang, Thailand; ‡Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH; and §Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, Hartford, CT.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Muffly
authors.forename: Robbie
authors.initials: R
authors.lastname: Weterings
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Barber
authors.forename: Adam C
authors.initials: AC
authors.lastname: Steinberg
mesh_terms: D003430:Cross-Sectional Studies / Q000379:methods; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006176:Gynecology; D006801:Humans; D010820:Physicians / Q000600:supply & distribution*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D019035:Rural Health Services; D012952:Societies / Q000706:statistics & numerical data; D016008:Statistical Distributions; D014481:United States; D019037:Urban Health Services; D014572:Urology; D000078329:Workforce