Physician Perspectives on Newborn Circumcision Care in Chicago: A Qualitative Analysis of Barriers and Opportunities
Emilie K. Johnson, MD, MPH1, Ilina Rosoklija, MPH1, Ryan F. Walton, BS1, Derek J. Matoka, MD1, Catherine M. Seager, MD1, Jane L. Holl, MD, MPH2.
1Lurie Children's, Chicago, IL, USA, 2University of Chicago, Chicago, IL, USA.
BACKGROUND: Circumcision is the most common pediatric surgical procedure performed in the United States (US) and has the greatest health benefits and lowest risks when carried out within the first several months of life under local anesthesia. While over half of US infant boys undergo newborn circumcision (~1 million procedures/year), available data indicate that access to desired newborn circumcision is inequitable, with Black/African American and/or publicly insured infant boys having less access. This study aimed to ascertain the perspectives of perinatal physicians about providing newborn circumcision care, with the goal of informing solutions to reduce the disparities in access to desired newborn circumcision. METHODS: Physicians who provide perinatal care at hospitals in Greater Chicago participated in semi-structured qualitative interviews about barriers and facilitators to providing newborn circumcision. Participating physicians also completed a brief demographic survey immediately after their interview. Interviews were transcribed verbatim, and inductive and deductive qualitative coding was performed. Codes were summarized into themes, with representative quotes. Survey responses were summarized using descriptive statistics. RESULTS: Twenty-three physicians from 11 hospitals in Chicago (city and suburbs; 78% female; 43% family medicine, 35% pediatrics, 22% obstetrics; 78% currently perform circumcision; 78% from primarily minority-serving hospitals) participated. Physicians reported multiple barriers to providing newborn circumcision, particularly, difficulties with procedural logistics and inconsistent clinician availability and training. Figure 1 shows the most commonly identified barriers and recommended strategies. Regarding newborn circumcision insurance coverage and reimbursement, many physicians reported limited knowledge and several mentioned that some insurance reimbursement policies financially dis-incentivize clinicians and hospitals from offering inpatient newborn circumcision (Table 1: Insurance Coverage/Reimbursement Themes). CONCLUSIONS: Physicians in Greater Chicago identified multiple barriers to providing newborn circumcision, including both logistical/operational, and reimbursement challenges. Future studies and advocacy work should focus on developing strategies and policy to equalize access and incentivize clinicians and hospitals to perform newborn circumcisions. 
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