Twenty-Two Years of Minimally Invasive Gynecologic Surgery Fellowship Graduates in the United States and Canada:...

To describe the geographic distribution, practice characteristics, and academic appointments of graduates of the fellowship in Minimally Invasive Gynecologic Surgery (FMIGS), and to map their practice locations relative to the general population and broader obstetrics and gynecology (OB/GYN) workforce.

Retrospective cross-sectional cohort study.

FMIGS programs in the U.S. and Canada.

Graduates from FMIGS-accredited fellowships (2002-2024) were identified from AAGL administration and graduation records. Practice locations and settings (academic, private, or military) were manually abstracted from clinic/university websites in September to October 2024. FMIGS subspecialist counts were tabulated by hospital referral regions (HRRs)-geographic areas with population ≥120,000 containing a major tertiary center. Number and locations of all OB/GYNs were identified through the National Plan and Provider Enumeration System using specialty taxonomy and zip codes. ArcGIS software was used to generate an interactive map of FMIGS locations.

None.

657 FMIGS subspecialists graduated from 78 programs from 2002-2024. FMIGS subspecialists exhibited very low clinical attrition rates, with 99.7% actively practicing as of 2024. Recent graduates had higher female representation and higher likelihood of working in academic medicine. Geographic analysis revealed clustering of FMIGS subspecialists in major metropolitan regions (New York, Los Angeles, Washington DC), yet many U.S. regions lacked access to any fellowship-trained MIGS subspecialists. While the number of OB/GYNs per HRR was highly correlated with population size (R = 0.96), the number of FMIGS subspecialists per HRR showed a weaker correlation (R = 0.77), with more variability in their distribution across populous regions. The ArcGIS geospatial map illustrated these regional differences.

Most FMIGS subspecialists practice in urban areas and increasingly at academic centers with fellowship programs. However, many regions remain underserved by FMIGS-trained subspecialists. The FMIGS map is a valuable resource for assessing regional variation in MIGS fellowship training and facilitating strategic planning and research within the subspecialty.