From surgery to systems to access, medicine is shaped as much by barriers to care as it is by innovation and the latest techniques. In this episode of BackTable OBGYN, Dr. Kimberly Kho, a complex benign gynecologic surgeon, joins host Dr. Amy Park to discuss her work expanding access to women’s healthcare, including building a surgical program in Hawaii, studying childcare as a barrier to care, and exploring the diagnosis and management of adenomyosis.

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Timestamps

00:00 - Introduction
08:35 - Faculty Development in Hawaii
12:26 - Childcare as Access Barrier
16:20 - Survey and Trial Findings
18:10 - Annie's Place Childcare Center
24:23 - Childcare Barrier Example
25:43 - Applying Community Solutions
27:04 - What Is Adenomyosis
30:22 - Diagnosis Strategies Beyond Hysterectomy
34:07 - Risk Factors and Age Myths
36:03 - Fertility and Pregnancy Risks
38:02 - Medical and Surgical Treatments
41:20 - Uterine Sparing Procedures
45:59 - Closing Thoughts

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More about this episode

Dr. Kho discusses her recent transition to the University of Hawaii, where she is building a complex benign gynecology program to serve patients across the state and broader Pacific region. Her work emphasizes faculty development through mentorship, strengthening research infrastructure for generalists, fostering inter-island collaboration, and implementing surgical coaching.

She then reflects on her time at Parkland, where she expanded access to minimally invasive gynecologic surgery, demonstrated by a significant reduction in open hysterectomy rates. She also shares how her team identified unmet childcare needs as a major barrier to care, leading to multiple research initiatives, a clinical trial, and ultimately the creation of a five-year, no-cost, onsite childcare center (Annie’s Place) developed through hospital and community partnerships.

The episode concludes with an in-depth discussion of adenomyosis, covering its pathophysiology, imaging-based diagnosis, common symptoms, and fertility implications. In the absence of formal guidelines or FDA-approved therapies, Dr. Kho reviews current management strategies, including medical therapy, uterine artery embolization (UAE), and endometrial ablation techniques.

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Resources

Childcare needs as a barrier to healthcare among women in a safety-net health system
https://pubmed.ncbi.nlm.nih.gov/38886715/

Addressing childcare as a barrier to healthcare access through community partnerships in a large public health system
https://pubmed.ncbi.nlm.nih.gov/36261213/

Adenomyosis Pathophysiology, Diagnostic Advances, and Therapeutic Options
https://pubmed.ncbi.nlm.nih.gov/41926770/

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BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
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