Mid-pandemic expansion, OB-GYNs in ASCs & more: 6 Qs with Dr. Natalya Danilyants

At the beginning of October, The Center for Innovative GYN Care opened the CIGC Wellness Center in Rockville, Md. Becker's ASC Review spoke to the Wellness Center's founder, Natalya Danilyants, MD — who is also co-founder of Rockville's The Center for Innovative GYN Care — about her vision for the new facility, challenges specific to her specialty and more.

Note: Responses were lightly edited for style and clarity.

Question: Can you tell me about the CIGC Wellness Center and its purpose?

Dr. Natalya Danilyants: Typically, when a patient goes to a center that treats pelvic pain, it is either to someone who focuses on surgery or alternative care centers that focus on nutrition, acupuncture and naturopathic therapies and stay away from traditional Western medicine or surgical therapy. What we're doing at the CIGC Wellness Center is fusing these together to offer services in addition to surgery for women who have pelvic pain, endometriosis, fibroids or are just looking to focus more on their health and wellbeing. Our team of providers found it exciting to be able to collaborate, fuse these very different modalities and provide all these services in the same center.

Q: What was the process of bringing the CIGC Wellness Center to fruition?

ND: We have a very successful surgery center that's been in existence since 2013. In terms of the Wellness Center, we built a gym before the pandemic for surgery center employees to use during lunchtime, before work or after work. We already had this facility, so we were able to incorporate new services into the existing space without spending a significant amount of money on building out a new office. The rest of the expenses, so to speak, are in marketing and informing existing and potential patients about the new center.

Q: How have you been reaching desired volumes at your facilities at a time when so many patients are anxious about catching COVID-19?

ND: A lot of the services we are offering are online — things like nutritional counseling, psychotherapy. Patients, since the COVID-19 pandemic, are much more open to virtual visits. They don't feel like they have to go to the physician's office to receive appropriate care. I agree, because most of the time, patients have recent imaging — an MRI or an ultrasound — so, in most cases, there isn’t a need for a pelvic exam; it won't add anything additional to what we've already proposed to do. So, even for initial consults and surgical preoperative counseling, a lot of visits I do are virtual.

Q: How will the Wellness Center improve operations at your surgery center?

ND: Sometimes, patients may not be specifically seeking surgical care. Maybe they're looking for alternatives, maybe they haven't thought about surgery needing to be done or maybe they're not interested in surgery. But after a thorough consultation, a lot of patients realize surgical care has to be part of treatment. We're able to support them post-surgery with these alternative therapies. It does bring new patients to the center, patients that maybe would not have come otherwise.

Q: What challenges do you face in your specialty that other ASCs might not?

ND: OB-GYNs are typically not very well trained when it comes to performing minimally invasive surgery. Orthopedic specialists go through residency and all they do is orthopedic surgery. Plastic and general surgeons, they're strictly surgeons — they're not doing primary care and surgery. OB-GYN includes a number of things: obstetrics, office-based GYN procedures like a well-woman exam. Surgery traditionally is a very small part of an OB-GYN's practice. There's minimal surgical training during residency, and that continues into practice. Surgery is just like any physical exercise — the more you do, the better you become. If something is done only occasionally, the surgeon is never going to be at the level where they feel comfortable doing procedures in an ASC.

The challenge is finding other GYN surgeons who feel comfortable doing surgery at surgery centers. It's not that there aren't enough patients. It's the lack of skilled surgeons, and because of that, the tendency to treat surgical conditions nonsurgically. If you don’t prefer to do surgery then you may subconsciously offer patients more conservative treatment — and sometimes it's appropriate, but sometimes it's not because these conditions get worse with time. If you don't treat it surgically early on, it later becomes more complicated.

Q: How do you help physicians feel more comfortable performing surgery in an ASC?

ND: Doing surgery in a surgery center is very different from a hospital setting. You can't do a blood transfusion because we don't have a blood bank. You can't spend five hours during surgery because efficiency is very important. We're there for OB-GYNs to help them to any extent they want. If someone is interested in learning and becoming a more independent surgeon, we are more than willing to teach our techniques. Even before we had the center, when going to hospitals, I'd help OB-GYNs do surgery. They're still able to be involved in their patient's care, but they have a specialist there to make sure the surgery goes smoothly and efficiently. We brought that same culture into the surgery center. Any surgeon that comes in, we're there to do surgery with them. It could be simple like removing a cyst, or more complex like removing fibroids or doing a hysterectomy.

We also invite experienced laparoscopic surgeons. If a surgeon feels more than capable of doing these surgeries and only has access to a hospital but wants to offer more personalized surgical care, then they can come in and get block time at our ASC.

Want to have your thoughts featured in a future Q&A? Email Angie Stewart: astewart@beckershealthcare.com.

More articles on surgery centers:
4 surgery center leaders on sterilization technology that drives efficiency
Bridging the divide between disease understanding and treatment approach in gastroenterology
The driving force behind prosperous ASC-hospital partnerships: Q&A with Surgery Partners EVP, Chief Administrative and Development Officer Jennifer Baldock

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