So perhaps my greatest honor this year is the opportunity to present our president, Charlie Raritan, and working closely with Charlie this year provided me with an unanticipated privilege of getting to know him. My image of this articulate surgeon has expanded considerably, so this is my goal this morning to give you a richer view of the man. And we've come to know Charlie through his service to our society. Here we see his dedication as he does a conference call while on vacation. Before entering the presidential line, he's been on the Education Committee, the Informed Consent Task Force, the PR Committee, the Board of Directors. But what are the antecedents to his presidential trajectory? Well Charlie was born in Philadelphia in 1969, the youngest of three boys. His father, Jerry, was a minister and his mother, Sue, a writer and teacher. 1969 was the year of the first moon landing, but also saw a worldwide cultural revolution. The Beatles were at their height, as was political commentary. So perhaps it's not surprising that this era would nurture a young man who would, let's see, who would attend Williams College to pursue English with a minor in music and theater. So you might wonder, how did he get to medicine? Well his maternal grandfather, a physician that pioneered radiofrequency in surgery, might have been an inspiration. But it seems that his first conscious interest in medicine sprang from poor care that he received for influenza at the Student Health Center. So he recognized that he could do better. He was accepted at several medical schools, but not his first choice, the University of Rochester, which he admired for their psychosocial model of medical education. So a more pragmatic soul might have adjusted his plans, but Charlie, with his focus on getting the principles right, decided to relinquish the acceptances and try again. And of course he was successful, but as often happens, this diversion created new influences. He spent the fallow year working at Emory's family planning internship and then at a contract research organization, using his literary skills to write FDA submissions. So he entered medical school with a new interest in women's health and a recognition that he needed more stimulation than a desk job. By the end of medical school, these feelings had grown into interest in OBGYN, and he entered the residency at Beth Israel in Boston, where he met several major influences in his life and career. The first was David Chapin, who introduced Charlie to our subspecialty as he did many other members of our society. He also rotated with Peter Rosenblatt, who helped to solidify his new interest in urogynecology. But by far the most important colleague that he met during residency was Jane Sharp. She was a year ahead of Charlie at the other Harvard OBGYN program at Brigham Mass General, and her influence was much more profound as a matter of the heart. So Charlie decided to ignore the longstanding rivalries between these two programs, and they pursued their relationship and eventually married. And while he never planned to marry a doctor, let alone an OBGYN, this has become the foundation of his life. But more on that in a minute. His next professional stop was Mount Auburn Hospital, where he pursued fellowship training with Peter Rosenblatt and Neeraj Kohli. It was a good combination that gave Charlie a wide spectrum of surgical skills, and these skills led to his recruitment to Brown to open a minimally invasive surgery program. Neil Jackson and Deborah Myers, who were his senior partners, who along with Peter have been lifelong mentors. He rose to the rank of professor at Brown through scholarship, including working with the PFDN, and he remains the director of minimally invasive and robotic surgery, as well as the fellowship program director. Now back to Jane. Charlie and Jane have been married for 19 years, during which they have shared more than careers, but also a vibrant life and family. Charlie is very active. He loves water sports like kayaking, and artistic pursuits like photography and woodworking. Apparently, he is also a life dancer. Jane and Charlie have built a family of three boys, Galvin, Miles, and Sawyer, and I'm sure you're not surprised to learn that Charlie also provides service in this realm. And it seems that Jane and Charlie also support their boys on Halloween and dress appropriately. Of course, we have witnessed his penchant for dress up at karaoke night as well. And so if you had wondered about this night's deed, well, it's a Vespa. This is how he gets to work, and he parks it beside his secretary's Harley there on the right. He's seemingly immune to any resulting derision. So I feel tremendously lucky to have the opportunity to work with Charlie. I'm impressed with the way he uses his broad intelligence to service his principles. I've watched his diligence in understanding the full spectrum of membership of the organization and what are the beliefs and interests, and that has allowed him to really serve our organization well. He's always prepared. He brings diplomacy to all discussions. Charlie, you've represented us very well. Thank you. Thank you, Jeff, for those kind words and all the people who contributed the photographic evidence as well. In 2012, right here in Chicago, Dr. Matt Barber delivered his presidential address entitled The End of the Beginning. In that talk, he reflected on the importance of the long-awaited and hard-fought approval the previous year of the formal subspecialty designation, Female Pelvic Medicine and Reconstructive Surgery. So here we are, now seven years into our existence as a subspecialty, gathered once again in Chicago. Dr. Felicia Lane, Chair of the Program Committee, has constructed a program for PFD Week around the theme of reflection. As a city, of course, Chicago has some of the most remarkable moments of reflection in the world, moments where visually exciting objects stand unto themselves but also interact with their surroundings. I also think that six years after the end of the beginning speech, this is a time for us to reflect, to cast our vision inwardly as well as outwardly, to consider where we've been and how that informs where we're going. For this State of the Society address, it's my privilege to provide our members with a snapshot of the health and vitality of our organization as well as some of the highlights of our achievements and our plans. I decided to seize upon Dr. Lane's theme of reflection and make that my own theme for this presidency. So after this update on the well-being of your AUGS organization, I'll take a moment to share some of my personal reflections on this past year and how I believe it has challenged and strengthened us. It will come as no surprise to any of you that AUGS is a busy place with an awful lot of moving parts. Over 200 volunteers serve on 24 committees plus task forces, writing groups, and others that cover a wide array of responsibilities and activities. And I've been truly inspired by the level of dedication and effort that our volunteers bring to AUGS. The energy and commitment is truly what drives the wheels forward. Some of you will have noticed some subtle changes to our call for volunteers process. We will continue to have the annual call where we ask for your involvement in standing committees and such, but you will also see some ad hoc call for volunteers which allows every member the opportunity to engage in a project of interest and size for which they have the skill set and the right bandwidth. So please keep your eyes open for those. As most of you know, we are in the final phases of moving from our previously outsourced association management situation to the current situation of having our own staff. That move has allowed us to have a more direct relationship to all of our staff, particularly those senior staff that represent such critical corporate memory. In addition, now that we do not have to pay the association management company, this has allowed us to function more efficiently. When we left Smith Bucklin, we were, as a proportion of total budget, well higher than the national benchmarks for staff costs. I can now report that without having to pay those association management fees, we're well below national benchmarks for what we pay for our staff. So I'm happy to report that both aims of this bold move to go out on our own have been realized. Several years ago, aware that our expansion and ambitious initiatives had led to a governance system of isolated committees, siloed and largely unaware of each other's activities, we introduced a governance structure built around councils, made up of committees with similar or complementary focuses, where regular crosstalk could not only minimize duplication of effort, but actually promote synergy. I've had this chart pinned to my wall for two years and still report to it regularly. It's not done with its evolution, but it's truly energizing to see the thought and information flow from one of these groups to another, to inform its work, and to help the organization identify and fulfill its needs. So I'm going to use this council structure to present some of the highlights of the AUGS activities and achievements in 2018. AUGS has always prized and prioritized education as one of its core missions, and this was a major focal point of our strategic plan this year. While we continue to develop the richness of the educational opportunities right here at this annual scientific meeting, and have enjoyed continued success in the annual fellows' cadaver courses in surgical reconstructive techniques, as well as the robotics course, we look to broaden the scope of opportunities to more fully reflect the full scope of our membership. AUGS is home to a robust group of advanced practice providers, and the inaugural version of the urogynecology for the advanced practice provider in Minnesota this year was a success by any measure. Again, looking to expand our offerings beyond those currently in training, AUGS launched the Master Class series just last month, and as a participant myself, I can attest that it was a unique and valuable opportunity to brush up some skills and learn some new ones. The update course continues its successful growth as an opportunity for surgical clinicians to hear about the state of the art in a very clinically-oriented format that is video-heavy but always evidence-based. And look for even more new offerings from the Educational Council in the coming year, including self-assessment tools and the newly developed fundamentals and FPMRS online modules, which will be kicking off in an in-person meeting in Nashville 2019. One of the signature components of the Research Council has been the Pelvic Floor Disorders Registry, an enormous undertaking with significant partnership between academics and industry partners. The PFDR is approaching fruition. The AUGS side of the PFDR has completed its enrollment. We are excited to announce that later in this meeting, we will present the first research project study to emerge out of this significant enterprise. The Fellows Pelvic Research Network for Pelvic Floor Disorders, a joint venture between AUGS and SGS, continues its success as an opportunity for fellows to design, propose, conduct, and present high-level research with senior mentorship and multiple advisory opportunities. The FPRN had its meeting here yesterday, and no fewer than 10 projects from this group are being presented and or updated here at PFD Week. Another example of AUGS' commitment to supporting its members, its academic research, not just during but in years following fellowship training, the Junior Faculty Research Network was launched in 2015. In a sign of its success, they've successfully obtained external funding and a subcontract from the NIDDK of $100,000 to continue their work on the microbiome. Later in this meeting, you'll hear an update about their findings to date. The ACQUIRE Registry received its approval as a QCDR registry. In short, that means that it serves the function of reporting for those who need to do so to CMS as part of their MIPS program. It's beyond the scope of this talk to review the alphabet soup of the macro-related programs, but suffice to say, this is another example of a membership benefit that has real-world value for many members, especially those in private practice settings. Beyond reporting functionality, ACQUIRE is serving true quality needs. As of today, 3,019 patients are enrolled in ACQUIRE, 42 practices are currently enrolling, and another 85 are poised to begin. Participants have successfully reported to the MIPS program using ACQUIRE, and more and more individuals are seeing the value of a designation as a Urugine Quality Champion program. The SUI module of their ACQUIRE Registry was developed out of the recognition that traditional academic literature was somehow not getting the story of the majority of our patients who are satisfied with their SUI treatments out into the public and into the courts. Currently, as you may know, in New Zealand and Australia, single-incision slings and transvaginal mesh for prolapse are essentially unavailable, and in the U.K., there is a complete pause on all mesh for use in the pelvis. The SUI module represents our earnest efforts to tell the story of the outcomes of all of our surgical treatments for SUI. We have the ambitious goal of 2,000 enrolled patients, but we're confident. Not only do we have a network of centers enrolling patients, but we also design this to be a grassroots endeavor. Any surgeon can participate, and ACQUIRE fees are included in your AUGS membership. You'll receive benchmarking and quality information about your own practice compared to regional and national data, and we'll be contributing with an absolute minimum of inconvenience and effort to this important project. Other projects, including a prolapse module, are also forthcoming. My thanks to those who have already enrolled or expressed interest. In the Practice Management Council, the Payment Reform Committee has obtained funding to access Medicare databases that will allow them to continue their work in developing an alternative payment model, or APM, for stress urinary incontinence. The goal is to develop an episode-of-care payment model that AUGS members can use to obtain additional reimbursement incentives through Medicare's Quality Payment Program and to work with their commercial payers. The Coding Committee remains hard at work for members of AUGS. AUGS coding fact sheets have been recognized as standards in the industry, and 12 fact sheets were released or updated. In addition, 27 coding questions from members were answered. The committee was instrumental in protecting Medicare reimbursement for the pessary and irrigation CPT codes. The Biofeedback CPT code was flagged in a Misvalued Services Review. ACOG, AUGS, and AUA worked together to submit a CPT application which will lead to a RUC survey, likely in late October, to members of those organizations. Please be on the lookout for an email from ACOG and AUGS regarding this survey. And as always, please make every effort to provide your honest and complete information in these surveys. They are critically important in the determinations of reimbursement levels. Many of you are aware that the 2019 Medicare Physician Fee Schedule Rule will likely include changes to E&M documentation and possibly decreases in payments starting calendar year 2019. AUGS members were provided a comment letter toolkit for the E&M visit proposals. The Coding Committee provided comments to CMS and will be hosting a webinar on December 5th to go over coding changes that will impact the 2019 Medicare reimbursements. The Membership Committee released its findings of the 2017 AUGS Practice and Salary Survey. Now planned as a biennial product, this survey is designed to provide credible industry data that will help physicians prepare, plan, and forecast to meet the challenges of an evolving healthcare landscape. Always focused on the needs of trainees and those newly in practice, the Committee has scheduled a number of Member of the Future discussions for PFD Week. A set of questions will be used to guide the discussion aimed at identifying the unmet needs in our younger or newer population of members. The Public Education Committee remains engaged in equipping providers with our popular patient fact sheets as well as equipping our members to address primary care providers in the Phase B3 initiatives designed to increase awareness of pelvic floor disorders and exposure of FPMRS providers in those spaces. We also have a number of engaged special interest groups, and while their nature they do not carry out charges from the Board, their activities and expertise are a valuable asset and a number of projects and products, including a Global Health Fellowship opportunity, have and will continue to feed back into the society and help focus and advance our efforts. The most recent governance change, the development of the Publications Council, reflects our understanding that the FPMRS journal as well as OGS documents and publications can be some of the most relevant and valuable products and services that we deliver. OGS is committing its resources and efforts to the production of publications that are of high levels of scientific merit and clinical value. Whenever appropriate and to the degree possible, we seek to partner with other organizations so these documents help to provide clarity rather than introduce confusion on the world stage. In addition to our own array of systematic reviews, terminology documents and guidelines in production, we currently have joint projects with IUCAA, the American Society of Colon and Rectal Surgeons, SUNA, the American Institute of Ultrasound in Medicine, to name a few. In addition, we are currently in negotiations to take outright ownership of the FPMRS journal. The financial health of our organization is strong. Our operational budget is positive with annual revenues exceeding $4.5 million. Our organization's investment policy designates funding levels for the rainy day or the long-term fund as well as various endowments including lectureships. I'm happy to report that these mechanisms are fully funded and that your Board of Directors continually seeks innovative ways to reinvest excess revenues into new programs such as the update and APP courses designed to provide direct benefit to the membership. Likewise, the Augs Foundation is on solid financial footing. Having reached our savings goal of between $1.1 and $1.2 million, we're currently able to present a June Allison grant each year and we anticipate the ability to award two such grants as soon as next year. You'll be hearing more from foundation leadership about the results in the form of scientific projects presented here that those grants have produced. Our membership surpassed 2,000 last year and is projected to show additional growth by the end of the calendar year as dues are submitted. Hint, hint. A breakdown of membership by category shows a healthy participation among affiliate members as well as residents and fellows, all of which bodes well for the future of the organization. Annual meeting attendance, depicted here as physician attendance, not the overall numbers, shows good health for this cornerstone of the Augs year. The peak that you see in 2014 was the joint meeting with IUGA and our partnership with them as well as the schedule of future joint meetings allow for synergy and expectation of record attendance in 2019, 2022, and every five years thereafter. So this is just a snapshot of some of the few items. Here Augs volunteers are at work at the moment. We are the voice of a subspecialty and that has come of age. As we continue to mature beyond our subspecialty, we're cognizant of our relationships with the broader specialty and beyond. We're thrilled to observe a growing number of our members who have leadership roles beyond the subspecialty, including chairs at academic institutions, editorships at publications beyond FPMRS and the like. We're also proud of our ongoing partnerships with other organizations, including deepening relationships with IUGA and SUFU, as well as a growing number of others, which will in the end benefit the care of women with pelvic floor disorders. One small note about the maturation of our subspecialty. As proud as I am of FPMRS and as much as I want to shout it from the mountaintops, FPMRS is the name of our subspecialty. It is not a post-nominal honorific. The convention says these letters just don't belong there. Feel very free, though, to point out in other ways the value of your subspecialty certification. HABOG recognizes the clinical content areas in the specialty of GYN and its subspecialties shift and change over time. It's critical that we, practitioners of FPMRS, provide them with the information they need to minimize potential areas of confusion in questions of our clinical content as it relates to the specialty, other subspecialties, and focus practices. Please go back to your email inboxes, check your spam filters that may have landed there, and look for as HABOG focus 2020 to fill out your perspective on the practice of FPMRS. We should not be leaving it to others to determine what the scope of our practice is and how it is evolving. So a few reflections on the year. Scientifically, and science has always been our core strength and value, we continue to wrestle with the means by which we understand and improve our craft. Questions that might once have seemed simple, such as how to measure our success rates, prove ever more nuanced the more we look into them. A year ago, I had some personal experience in the complexity of questions I had once thought to be simple. This is a self-portrait, not really the kind of self-portrait you want. I found myself on the trauma service with three broken ribs, a hemothorax, and a chest tube. I'll be happy to tell you the story sometimes that has to do with a brand new go-kart in a particularly slippery area of the track that I managed to find. You'll be happy to know that the rest of my family, including my 80-year-old mother-in-law, did just fine. But when my nurse would come in and dutifully ask for my pain level, I thought to myself, well, right now it's a three, but if I take a deep breath, it's a six, and if I cough, it's a nine, and I honestly do not know how to answer your question. The little faces didn't help much because it's a trickier question than I thought. Similarly, as we look at our surgical outcomes, we come to realize that perhaps the traditional Kaplan-Meier survival curve, with a dichotomous and readily measured outcome, may be an inadequate tool to understand the conditions we treat. In this sort of simplified version, a chart showing high levels of badness, however you want to define that, before an intervention, and then better levels after that, that fall below a threshold, we'll call success, all right? So that's one way to understand it. But as Dr. Nager was pointing out, as we develop composite outcomes and take many measurements at many time points, a more complex picture emerges as individuals wander into failure and then back into success. I give much credit to our colleagues in the Pelvic Floor Disorders Network and others who are applying their wisdom to these questions. I take encouragement from the groups like the Scientific Committee's Prolapse Consensus Conference and the Basic Science Special Interest Group and their efforts to provide guidance in the areas where gaps in our evidence are most crucial. As some of you who've heard experts like John Gleason, who lent me the following slide and a little tiny fraction of his knowledge, have described it, development in informatics are changing our relationship with the data and with the healthcare that data represents. Previous paradigms of expert opinions, then chart review cohorts, then some rudimentary databases, are changing the way that we record and improve medicine. There may come a time when the scientific process of making an observation and then developing a hypothesis and then collecting a predetermined sample of a population designed to represent the data that is out there is obsolete. Imagine a time when confidence intervals were a thing of the past. Presumably with some form of big data, we won't need to sample the data. We will simply have it all in front of us and we can just observe the truth of its story as it unfolds in front of us in real time. Although we have some way to go before this science fiction reality, Oggs is not simply sitting and waiting for it to arrive. Our registry products, including the Acquire SUI module and the Prolapse module currently in development, are already being integrated with an array of coordinated registry networks. This busy slide shows how informatics interfaces with the National Library of Medicine, the Office of the National Coordinator of Health for Informatics, the FDA, and other governmental organizations are already being organized around a Women's Health Alliance Coordinated Registry Network, including Oggs at the center. These organizations have learned that the old system, building a process of research from the ground up for each clinical scenario, and then reinventing the wheel the next time, is a terribly ineffective and inefficient system. The future lies in data harmonization, interoperability, and core minimum dataset development. Oggs is pleased to be an integral partner in this exciting frontier, playing our part in moving to a time when the data can tell its own story. This year also began with some opportunity to reflect on ourselves as humans and as colleagues. The discussion around J. Marion Sims and his work with patients who were slaves was earnest, honest, both academic and visceral, and it was painful. I know full well that many of you were not in agreement with the board's decision to retire the named lectureship, and I accept and understand that. As I've said before, it's my hope that you will all go and continue to teach the story of Sims as you understand it. I also hope you will not lose the opportunity to tell the story of the women through whose suffering our science was advanced. But it became clear that this story was simply inextricable from the power dynamics, the explicit and implicit bias that continues to pervade our society, and that it served to divide us rather than to bring us together. Surely, in recent days and months, we have all had our fill of rancor and divisiveness. We can probably never know precisely what was in the hearts and the minds of all the players in this scene, but I do not believe that anyone who finds in the story elements of racism and prejudice is mistaken to feel that way. The board felt clearly that whatever debt of honor we might owe to an individual in our history, it is far outweighed by our responsibility to provide a safe and respectful place for every one of our members today. We have spent some real time and effort examining expectations for our own activities and behaviors as individuals, as members of AUGS, and as a board of directors. We spent part of our strategic planning meeting diving into what we thought our culture as a board was and what it should be. We drafted a board culture statement which outlines the characteristics to which we aspire, including things like diversity, openness, conflict resolution, board-staff partnership, and the like. I have often said that AUGS is a place where committed individuals can disagree, but they can do so productively. With a bit of tongue in our cheek, at each board meeting, the individual board member who best and most openly addresses the conflicts of interest we all have, not just the financial ones, but the many hats that we wear and the interests we carry, is given the Transparency Champion Award. To date, Jeff Cundiff, Chris Tarney, and now Jen Wu are the vaunted awardees of this ad hoc award. We also took the opportunity to revisit our member code of conduct, enhancing it in the areas of discrimination, harassment, and retaliation. We added the AUGS meeting code of conduct, making it crystal clear our expectation that any member or guest of AUGS will find it a welcoming, collegial, professional, and a safe experience. This policy, as well as clear instructions for anyone who might have an experience of the contrary, will be printed and readily available at all AUGS in-person events. So this happened, during which I became educated that exposure to oxygen eats plastic, causing it to degrade and to last only for a few months. And while I admit I did not know this, it strikes me as spectacularly good news for the oceans of the world. But setting aside jokes and the vagaries of some journalism, it was an opportunity to reflect on the critically important role that any one of us may be asked to play in presenting the science and the state of our art of our subspecialty to the public, including to juries of our peers. I offer that you might be shocked to know some of the things that have passed for truth in a court of law from someone titled an expert witness. I do not think that AUGS members should shy away from providing opinion or testimony in courts of law or in courts of public opinion. Indeed, who is better positioned to provide guidance in some of the complex and nuanced realities of caring for women with pelvic floor disorders and the outcomes of their treatments? Please understand, this is not about mesh. This is not about being pro-mesh or anti-mesh. This is about upholding the critically important responsibilities of an expert witness. We've convened a task force composed of individuals with experience on behalf of both plaintiff and defense, as well as those with expertise in ethics, to develop the AUGS Code of Conduct for Expert Witnesses. This code will have two components. One is a policy statement clarifying what we expect of our members as they provide expert testimony or services. The second is an affidavit. We will be asking each and every AUGS member involved in these services to sign and send in for AUGS to retain on file. A few bullet points are brought up for your observation. In it, we make clear that we consider the activities of an expert witness fall within the scope of your medical practice and therefore is subject to peer review in the same way. We must fiercely preserve and protect the integrity and credibility of the science that we present to the outside world. We must work hard to resist the forces that would convince women with successful surgeries that their, quote, defective and, quote, recall devices must be urgently removed by surgeons they may not know and at significant risk and cost. AUGS well recognizes that complications can occur during any surgery, including those based on mesh implants. Who better to care for those women than FPMRS subspecialists? But we should not stand by while our patients who have no adverse events fall victim to profiteers. We need to resist losing control of our own story. In addition to these codes and expectations of conduct, AUGS should reflect on the strength and numbers of our greatest asset, the membership itself. It is difficult to read the tea leaves of the future. On one hand, with the aging of our population, the prevalence of pelvic floor disorders is projected to increase significantly over time. Increased awareness of pelvic floor disorders and the growing number of medical staff offices that are looking for FPMRS certification before they grant privileges for surgical care of prolapse and incontinence, thereby reducing the number of available surgeons and the retirement of the, quote, grandmothers and grandfathers of FPMRS would all seem to indicate that there is unmet need. On the other hand, we begin to observe some of our fellowship graduates having some degree of difficulty in obtaining the jobs of their choice. According to ABOG, there are 1,064 diplomates of FPMRS. May surprise you to know that this is higher than the number of gynecologic oncologists. And it does not include our urology-based FPMRS providers who are certified through a separate single-step system through the American Board of Urology. We are graduating between 45 and 55 new FPMRS providers each year. This is a larger number of individuals entering the workforce than in any other GYN subspecialty and again does not include the graduates of urology-based fellowship programs. We also recognize that many women are obtaining their care from non-FPMRS providers. All of these forces might suggest that we may be nearing the right number of providers. This map represents the current distributions of AUGS member providers across the country. California is home to 142 of us, while Wyoming still awaits its first. In terms of relative population, this map represents the number of women in each state for each one AUGS member. Note that the ratio ranges from one provider per 50,000 in D.C. and Virginia to one in 500,000 to a million in other parts of the country, demonstrating a tenfold variation in FPMRS provider density. What's the right number? How do we determine the need and right size the supply? I don't know the answer, but I'd prefer to consider this ahead of time rather than respond reactively after some sort of crisis as some other specialties have observed and endured. The board has charged the membership committee to carry out a workforce needs assessment, as other organizations have done, to get a more comprehensive picture of where we are now, where we're heading, in order to better serve both the population of women with pelvic floor disorders as well as our own AUGS members themselves. So a moment to reflect on gender disparities. Our own salary survey afforded an excellent opportunity for self-reflection as an organization. It's interesting to note that, as is the case in medicine in general and OB-GYN specifically, the demographic evidence demonstrates that our membership is becoming increasingly female with the passage of time. Many of you picked up what appears to be a significant discrepancy in income between male and female providers. This discrepancy holds true irrespective of years in practice and percentage of practice dedicated to FPMRS. On the one hand, perhaps you might say gender disparities in income are pervasive throughout our society, and maybe we ought not to be surprised when we encounter them in our own world. But many of us felt this was really jarring because this is our own home and we are seeing these discriminatory forces right in our own backyard. I asked Dobie Giles and Leslie Suback, as well as AUGS staff, to join me in probing this data set a little bit more. It turns out that women in FPMRS are more likely than men to be employed in academic centers and to be more engaged in research, and perhaps this goes some way to explaining this disparity as being something other than outright discrimination. The task force will be going back to the data set to create a multivariate analysis, controlling for as many of these features as we can to try to glean a clearer picture. But there are a few caveats here. Despite the importance of this survey, only 16% of our memberships responded. Secondly, some data, including reimbursement per RVU and RVU totals, showed a variability that suggested that people just weren't recalling very well or didn't have the information at hand when they were filling out the survey. All this is to say two things. One, this is important, and it is critical that we have a good understanding of our own field and of the discriminatory forces within it. Two, as is true in any science, the quality of the data determines the value of its results. So I plead, you'll be receiving the next version of the survey in early 2019 to reflect on this 2018 calendar year. Please be prepared and motivated to respond. Keep year-end summaries, RVU reportings, et cetera, at hand so we can try to get a better handle on this. In closing, I encourage all of you to consider not just the way that AUGS can continue to improve, but to envision how you yourself would make it better. A tiny example, in 2003, at the AUGS annual meeting in Hollywood, Florida, after the formal passing of the GAVL, from Linda Brubaker to Mike Aronson, I happened to notice that the GAVL then went into a paper bag, where it was kept until the next year. I found myself thinking, I think we can do better than that. Some of you may know that woodworking is my backup career, just in case this medicine thing doesn't work out. So over the next several months, I made a box, spalted maple, black cherry, American walnut with brass barrel hinges to house the GAVL. In 2004, I presented the box to President Aronson, who graciously accepted it on AUGS behalf. This coming Saturday morning, I have the honor to present it to yet another distinguished AUGS president, your incoming president, Jeff Cundiff, in whose extraordinarily capable hands I will leave you. I have deep confidence in Sean Menefee, the president-elect, and the rest of the women and men of the Board of Directors, for whose dedication, commitment, and skills I have tremendous respect and gratitude. And I would like to thank Michelle Zinnert, our CEO, along with all of her staff, for their own earnest and diligent work in self-reflection over this year, and for the ongoing stewardship of our great organization. To my partners and colleagues at Brown, thank you for your support. I think I contributed about 17 RVUs to the collective goal this year. To my boys, Gavin, Miles, and Sawyer, thank you for your enthusiasm in this project of mine, for your rapid development and skills, and sneaking in for a stealthy goodnight hug during conference calls. I truly believe that as a father, demonstrating engagement and enjoyment in a career that I love and that is worth the effort is one of the best lessons I can give them. To my wife, Jane, thank you for this. Thank you for coming. I'd say I love you like I did when we married 19 years and one month ago, but that's not quite true. My appreciation of you is better, and my gratitude more profound. The state of our society is strong, and I think it's a little stronger for having done a little self-reflection. Thank you for the honor and opportunity to serve Augs in this way. It has been, in chronologic order, bewildering, humbling, powerfully educational, and in the end, transformative. Thank you. It seems that you all appreciate Charlie as much as I do. We do have a small token to acknowledge the service that he's provided, and, Charlie? Thank you so much. Thank you, man. Well done. Thank you.

AUGS

education

research

urogynecology

interoperability

collaboration

gender disparities

acknowledgments