Pediatrician attitudes, experiences mixed on circumcision counseling

from the Division of Health Policy Research

Pediatricians have mixed views on circumcisions, according to a recent AAP Periodic Survey of Fellows. One-fourth of pediatricians recommend to most parents of healthy newborn males that circumcision be performed. Another 12 percent recommend to some parents that circumcision be performed, while 64 percent make thsi recommendation to only a few or no patients.

Fewer than one in 10 (9 percent) recommend to most parents that circumcision not be performed, while 15 percent recommend against circumcision for some patients, and 76 percent so recommend a few to no patients

Half of the pediatricians report they usually make no recommendation regarding circumcision to parents of newborn males. However, the majority of pediatricians (74 percent) discuss the pros and cons of circumcision with all or most parents of healthy newborn males, and 21 percent do so with some. Slightly more than half (52%) say they usually make a recommendation regarding circumcision dependent on discussion with the parents, 27 percent say they sometime do so, while for 21 percent a recommendation is not dependent on such a discussion.

Parents, however, general do not seek their pediatrician's advice regarding circumcision, report most pediatricians: 57 percent say only some parents are uncertain about circumcision and seek their recommendation and 38 percent report few parents do so. Only 5 percent of pediatricians report all or most parents seek their recommendation regarding circumcision.

Pediatricians' specific recommendations regarding circumcision are reflective of their attitude toward the current medical evidence surrounding the circumcision of healthy, stable newborn males. Most pediatricians (56 percent) think the medical indications for circumcision are inconclusive; 34 percent say the potential medical benefits outweight the disadvantages, while 11 percent say the disadvantages and risks outweight the benefits.

Seven out of 10 pediaticians (70 percent) do not perform circumcisions. The main reason for not doing so is that the mother's OB/GYN performs the circumcision (reported by 71 percent of pediatricians). Thirty-two percent state they prefer not to perform this procedure, and 10 percent say their hospital policy does not allow them to perform circumcisions. Seven percent refer circumcisions to another pediatrician, and 7 percent state they do not perform circumcisions because they were not trained in this procedure.

AAP Periodic Survey #37 was conducted between July and November 1997. Surveys were mailed to a random sample of 1,830 AAP members in the United States. In total, 1,165 questionnaires were completed, for a 64 percent response rate; analysis was based on 734 post-residency pediaticians who provide health supervision to newborns up to 2 months of age.

Table: Pediatricians who recommend to:
(in percents)	All/most patients	Some patients	Few/no patients
Recommend circumcision be performed	24.0	12.3	63.7	= 100%
Recommend circumcision be not be performed	9.4	14.6	76.0	= 100%
Make no recommendation regarding circumcision	50.4	15.7	33.9	= 100%