BY: LISA MUNGER
If REI fellowships and physicians with this expertise are limited, there are several consequences, some of which can be seen in evaluating patient care today. Without enough fellowship programs, qualified REI specialists may be unable to care for patients with infertility and other reproductive health issues. Without enough fellowship programs, there may be reduced research on infertility and other reproductive health issues, limiting progress in the field, according to the NIH.
Escalating Need
Rachel Weinerman, M.D. and REI specialist, credited as a nationally-recognized educator in the field, said REI fellowships and specialists are needed now more than ever. REI services demand has experienced a precipitous uptick in recent years, even as the number of fellowships haven’t increased properly to meet the demand.
Increased coverage for IVF among employer-sponsored insurance and more states requiring coverage accounts for part of the equation.
The International Foundation of Employee Benefit Plans has tracked fertility benefits over the past since 2016. According to their most recent survey in 2022, 40% of overall U.S. employers currently offer fertility benefits (an increase from 30% in 2020).
28% cover fertility medications (8% covered in 2016, 14% in 2018, 24% in 2020)
30% cover in vitro fertilization (IVF) treatments (13% in 2016, 17% in 2018, 24% in 2020)
16% cover genetic testing to determine infertility issues (11% in 2018, 12% in 2020)
17% cover non-IVF fertility treatments (6% in 2016, 11% in 2018, 11% in 2020)
“People are accessing IVF services for fertility and fertility preservation, " Weinerman said. “There is a much wider population of people accessing services, including members of the LGBTQ community, who are increasingly seeking IVF services.”
REI Fellowships
There are 49 accredited fellowship programs, as of the Accreditation Council for Graduate Medical Education most recent data from the full 2021-2022 academic year. The National Resident Matching Program’s (NRMP)’s April 2023 The Match report says that there were 41 REI Fellowship programs in 2022. ReportingWhen ACGME assumed accreditation responsibilities for the first year in 2016 from the American Board of Obstetrics and Gynecology; 41 REI fellowships existed.
The University of Miami/Jackson Health System Program and the University of Washington Program received ACGME approval in September 2022, making them the latest programs to receive approval.
The University of Miami/Jackson Health System Program and the University of Washington Program received ACGME accreditation in September 2022, making them the latest programs to get the nod.
ACGME cannot estimate new programs coming in the pipeline.
“It depends on receiving and approving new program applications,” said Susan Holub, director of communications at ACGME.
The National Resident Matching Program matched 49 out of 49 open fellowship positions in 2022.There were 78 individual applicants for REI fellowship program positions for the 2021-2022 academic year in the most recent available data.
Creating an REI Fellowship: Obstacles
Potential programs must meet the ACGME requirements for the REI specialty and the Common Program Requirements to be accredited.
The organization is solely responsible for accrediting new programs, said Susan Holub, vice president of communications for ACGME.
Obstacles are inherent in beginning an REI program, as doing so requires significant resources, expertise and infrastructure.
Securing funding to developing and sustaining a fellowship program can be difficult, Weinerman said.
Besides the dollars required to pay staff, upstart also needs to include the resources for educational resources and materials, equipment and technology, according to the American Society for Reproductive Medicine.
Programs must undergo accreditation by ACGME, which is sometimes a time-consuming and complex process. Further, new programs require many resources, including access to clinical facilities (reproductive surgery spaces, labs for testing and access to assisted reproductive technologies like IVF and IUI.
Since ACGME took over accreditation from the American Board of Obstetrics and Gynecology in 2016, guidelines for establishing a new fellowship are more stringent and often more complex, which often translates into cost in actual dollars and time.
“There are very specific guidelines and an intense application process. There's the review, so establishing a new program can take up to a year,” she said.
A Field, Underserved
While training obstetricians and gynecologists in a private setting can provide valuable experience in diagnosing and managing REI issues, it’s not necessarily a sufficient substitute for an REI fellowship, said Ruth Lathi, M.D., program director of the REI Fellowship at Stanford Health Care.
“This requires access to complex patients and advanced specialists, which are rarely encountered in private clinics,” she said. “While many providers do not care for all aspects of reproductive life, this knowledge is used in managing complex patients with infertility.”
Nonetheless, she said REI fellowships are needed to further the industry.
“Without sufficient REI fellowships, there may not be a sufficient pipeline of providers and research to serve the future men, women and people who require reproductive care.”
Weinerman concurred.
“We have a lot more use of advanced practice providers like NPs, PAs and general OBGYNs to fill those roles because of demands, she said. “There are a lot of practices that have very long waitlist practices because it’s hard to hire REIs … That may change overall the field provides patient care.”
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