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Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities

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Abstract

Objective

Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access.

Methods

Qualitative interviews about newborn circumcision care were conducted from April–June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care.

Results

The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5–38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision.

Conclusions

Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions.

Significance

What is already known on this subject?  Access to desired newborn circumcision is inconsistent in the United States. Boys who are publicly insured, or Black/African American typically have less access, resulting in higher rates of riskier elective, operative circumcision procedures in these groups.

What this study adds?  Reasons for observed differences in access to desired newborn circumcision include hospital-level operational and logistical challenges, and an insurance reimbursement structure that often disincentivizes newborn circumcision.

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Data Availability

A de-identified dataset will be made available upon request.

Code Availability

Qualitative code book will be made available upon request.

References

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Acknowledgements

The authors would like to acknowledge the study participants for sharing their time and experiences with our team.

Funding

All phases of this study were supported by the Urology Care Foundation 2019–2021 Societies for Pediatric Urology Sushil Lacy, MD Research Scholar Award. The American Urological Association and Societies for Pediatric Urology had no role in the design and conduct of the study.

Author information

Authors and Affiliations

Authors

Contributions

Dr. EKJ conceptualized and designed the study, coordinated and conducted the interviews (including participant recruitment), analyzed and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. Ms. IR, conceptualized and designed the study, analyzed and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. Mr. FW built and managed the study database, analyzed quantitative data, contributed to data interpretation, and critically reviewed and revised the manuscript. Dr. DJM provided input into study design and data collection instruments, assisted with participant recruitment, contributed to the analysis and interpretation of data, and critically reviewed and revised the manuscript. Dr. CMS contributed to the analysis and interpretation of data, and critically reviewed and revised the manuscript. Dr. JLH conceptualized and designed the study, contributed to analysis and interpretation of data, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Emilie K. Johnson.

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Conflict of interest

The author declares that they have no conflict of interest.

Ethical Approval

The study was reviewed and approved by the Ann & Robert H. Lurie Children’s Hospital of Chicago Institutional Review Board (IRB # 2020-3508).

Consent to Participate

Verbal informed consent was obtained from all study participants.

Consent for Publication

Not applicable.

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Johnson, E.K., Rosoklija, I., Walton, R.F. et al. Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities. Matern Child Health J 28, 144–154 (2024). https://doi.org/10.1007/s10995-023-03822-1

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  • DOI: https://doi.org/10.1007/s10995-023-03822-1

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