General Surgery Department, Cleveland Clinic, OH.
General Surgery Department, Cleveland Clinic, OH. Electronic address: https://twitter.com/AyatElSherifMD.
Surgery. 2022 Aug;172(2):494-499. doi: 10.1016/j.surg.2022.04.007. Epub 2022 May 14.
Historically, surgeons have provided subspecialty breast care. The development of a robust medical breast program in a large academic center staffed by trained primary care providers initially showed a shift in care of benign breast disease away from surgeons. In this review, we aim to revisit the practice after 20 years. Medical patients are defined as patients with symptomatic issues (eg, pain or lump), those at increased risk (due to family history, genetic mutations, or benign atypical lesions), or survivors in need of long-term care.
Data for this review were collected retrospectively from an internal outpatient appointment dataset. The sample included data for 3 staff breast surgeons (2.6 clinical full-time employees [FTEs]), 3 staff medical breast physicians (2.4 clinical FTEs), and 2 medical breast advanced practice providers (2.0 clinical FTEs). Provider visit types were grouped into 1 of 4 categories (new medical, established medical, new surgical, and established surgical) in order to review the percentages of outpatient visits by provider group.
Before the institution of the Medical Breast Service, 75% of breast surgeons' outpatient visits were for either new or established medical issues. Our most recent analyses show that between 2013 and 2017 breast surgeons averaged 19% of surgical outpatient visits for medical issues. Higher surgical outpatient visits have resulted in higher surgical volume, increased surgical productivity and time spent in the operating room, and decreased time to treatment at our institution. Both surgical and medical breast providers can be added and become rapidly productive with focus on their respective areas of expertise.
The Medical Breast Service has met its expectations in providing access for symptomatic patients, personalized care for those at risk, and attentive care to long-term survivors. The program has allowed for surgeons to focus on surgical outpatient visits, driving surgical volume and productivity, and streamlining care.
历史上，外科医生提供专业的乳房护理。在一个拥有训练有素的初级保健提供者的大型学术中心中，建立一个强大的医学乳房项目，最初显示出良性乳房疾病的护理从外科医生转移。在这篇综述中，我们旨在 20 年后重新审视这种做法。 医疗患者定义为有症状问题（例如疼痛或肿块）的患者、有风险增加的患者（由于家族史、基因突变或良性非典型病变）或需要长期护理的幸存者。
本研究的数据是从内部门诊预约数据集回顾性收集的。样本包括 3 名乳腺外科医生（2.6 名临床全职员工[FTE]）、3 名乳腺内科医生（2.4 名临床 FTE）和 2 名内科乳腺高级实践提供者（2.0 名临床 FTE）的数据。为了审查按提供者群体分类的门诊就诊类型的百分比，将就诊类型分为 4 个类别之一（新医疗、既定医疗、新外科和既定外科）。
在医学乳腺服务机构成立之前，75%的乳腺外科医生的门诊就诊是新的或既定的医疗问题。我们最近的分析表明，在 2013 年至 2017 年间，乳腺外科医生的外科门诊就诊中有 19%是医疗问题。较高的外科门诊就诊率导致了更高的手术量、增加了手术效率和手术室时间、以及缩短了我们机构的治疗时间。 外科和内科乳腺提供者都可以加入并迅速发挥作用，专注于各自的专业领域。
医学乳腺服务满足了其为有症状患者提供服务、为高危患者提供个性化护理以及为长期幸存者提供周到护理的期望。该计划使外科医生能够专注于外科门诊就诊，推动手术量和效率，并简化护理。
