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
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.