The Reproductive Endocrine Associates of the Massachusetts General Hospital: fifteen years of integrated clinical practice and investigation.

The Reproductive Endocrine Associates is the clinical practice of the Reproductive Endocrine Unit, a division of the Department of Medicine of Massachusetts General Hospital (MGH). Founded in 1984, the Reproductive Endocrine Associates is focused on providing superior care to patients with a broad range of reproductive disorders. Moreover, because of its setting within a multidisciplinary research unit, the primary goal of this practice is to translate basic and clinical research insights to patient care as quickly as possible. This article aims to explore both facets of this unique practice–both as a reproductive endocrinology practice and as an integral link within an interdisciplinary research unit. The Reproductive Endocrine Associates is composed of seven endocrinologists (six female, one male), all Boardcertified in both internal medicine and endocrinology and metabolism. Patients are also seen by Clinical Fellows precepted by staff physicians in patient care sessions held daily and one evening per week. The physical layout of the clinic (861 ft) includes one consultation room, two examination rooms, an ultrasound suite, and a teaching/coordination area for patients undergoing ovulation induction. The practice space is one floor below the administrative and professional staff offices, conference room, and research laboratory of the Reproductive Endocrine Unit. The close proximity of the clinic practice to the research space provides seamless professional continuity for the seven staff physicians, each of whom directs his/her own clinical research program. Patients are easily introduced to the newest protocols and therapeutic trials being conducted within the Unit. Although out-patient aspects of clinical investigation do take place within the practice space, almost all in-patient protocols are executed in the Mallinkrodt General Clinical Research Center (GCRC) on the MGH campus. The GCRC is a seven-bed, NIH-funded facility that is an invaluable resource for detailed studies of human reproduction. The Reproductive Endocrine Associates has approximately 3200 patient-visits/yr. Over the past 15 yr, the number of patient-visits has increased 10-fold, and the faculty has doubled in size. For this uniquely situated practice, the largest percentage of new referrals comes from primary care physicians (41%). Nine percent are from other endocrinologists within the hospital, the Boston area, or around the world. Thirteen percent of patients are self-referred. The remainder of referrals derive from a variety of subspeciality services. Eighty-nine percent of the patients seen over the past 3 yr are female; 11% are male. The most common diagnostic categories seen within the practice include hyperandrogenic syndromes, hypergonadotropic hypogonadism, and hypogonadotropic hypogonadism (Fig. 1). The percentage of patients carrying specific diagnoses within each of these broad categories is summarized in Table 1. Due to the research interests of the Unit, patients with relatively rare diagnoses, including precocious puberty and virilizing ovarian/adrenal tumors, are also seen on a regular basis.