Why Your Fee-for-Service “Provider” Won’t Recommend a Self-Pap

As a male physician, whenever I have a meet and greet with a female patient, I try to address the elephant in the room regarding women’s health. I share that I’m married, have four children, now one granddaughter, delivered babies for a decade and a half, and feel quite comfortable with gynecologic concerns. Nonetheless, I’m cognizant that many women have concerns about a male physician in our hypersexual culture. Statistics demonstrate up to 25% of women have had some form of sexual assault from being flashed to raped in their past. For all those reasons, I let those patients know that I am happy to refer to a female physician for any breast or gynecologic concerns they may have, if that would be their preference.

For quite some time, our epidemiology colleagues have shown that there is no benefit in performing a routine pelvic exam on a woman with no gynecologic concerns and a normal menstrual pattern. In fact, there’s a slight uptick in harm from anxiety, additional testing and sometimes unnecessary procedures and surgeries for a perceived uterine or ovarian abnormality on a screening pelvic exam! Really, the only benefit in an asymptomatic woman is to screen for cervical cancer.

About a year ago, the FDA approved a self Pap test for the identification of high-risk HPV types. They knew a significant number of women avoid having a Pap smear performed, and this new option eliminates a lot of the barriers. Now there are websites that allow women to order a self Pap kit sent to their home, they collect the specimen and mail it back for processing. If there’s an abnormality, these groups will connect them with a local gynecologic clinic.

We were quick to adopt the self Pap test, as this is clearly preferred by our female patients. So many of them comment that they will be telling their other female friends and family members about this option because they find it so much more convenient, less stressful, and, frankly, more dignified. I’m quick to warn them that their friends who may be seeing a “provider” in the system will be unlikely to have this offered. Why? 

“Providers” in the system don’t make wRVUs for a woman to stop in and do a self Pap and then move on. Reimbursement for a “well woman exam” is built on examining multiple private body parts. If those are not documented in a note, then a well woman exam was not performed, and a provider in the system will not be reimbursed. They’ll continue to gaslight asymptomatic women that they need to be examined at least every 3-5 years (and some still recommend annually despite updated guidelines years ago)! These truly well woman that go to these exams are the “strep throat” visit for our FFS colleagues that provide them (i.e. simple, quick, easy).

The self Pap is a win for women (and for male DPC physicians). This option allows women to get screening done easily and comfortably and not spend extra to get a “well woman exam” at the local gyn clinic just so they have a female “provider”. It’s also a win for DPC. It’s another opportunity to streamline care while reducing expense and embarrassment for our patients.