Physician Perspectives on Performing Newborn Circumcisions: Barriers and Opportunities.

EDUCATION of physicians; HOSPITALS; MATERNAL health services; HEALTH services accessibility; PROFESSIONS; MINORITIES; INFANT care; CIRCUMCISION; LEADERSHIP; MOTIVATION (Psychology); RESEARCH methodology; TELEPHONES; APPLICATION software; HUMAN comfort; PHYSICIANS' attitudes; INTERVIEWING; PLEASURE; HEALTH insurance reimbursement; QUALITATIVE research; SURVEYS; DOCUMENTATION; GOVERNMENT policy; DESCRIPTIVE statistics; RESEARCH funding; HEALTH equity; STATISTICAL sampling; JUDGMENT sampling; CONTENT analysis; DATA analysis software; FINANCIAL management; PSYCHOLOGY of physicians; INSURANCE; EMAIL; WORLD Wide Web

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. [ABSTRACT FROM AUTHOR]