How AI Documentation Improves Pelvic Health Care Access

Featuring Dr. Travis L. Bullock, fellowship-trained urologist specializing in Female Pelvic Medicine and Reconstructive Surgery at Urology of St. Louis

Ask most physicians what an ambient AI scribe did for them, and you’ll hear that their notes are done faster and they get home earlier. That’s real. But Dr. Travis L. Bullock thinks it misses the bigger story.

Dr. Bullock is a fellowship-trained urologist at Urology of St. Louis specializing in Female Pelvic Medicine and Reconstructive Surgery (FPMRS), also known as urogynecology. He’s one of the few urologists in the St. Louis region with this subspecialty training. On EP 05 of Truly Integrated, he told iScribe CEO Pat Williams that ambient documentation saved him time and also made him a better doctor.

Prefer to listen? Hear Dr. Bullock’s full conversation on Truly Integrated, EP 05: episode page · Apple Podcasts · Spotify

Key Takeaways

• Female pelvic medicine treats quality-of-life conditions, including urinary incontinence, pelvic organ prolapse, overactive bladder, and complex voiding dysfunction, that demand unhurried, detailed conversations.
• Large specialty practices improve patient access when subspecialists can focus on the conditions where their expertise matters most.
• An ambient AI scribe lets physicians slow down, explain their thinking, and include patients more fully in care decisions.
• AI-generated notes capture details that rigid, template-based documentation misses.
• Better notes support referring providers, coding accuracy, and payer workflows, and set the stage for AI-assisted order entry and denial management.
• Many women with bladder symptoms say no provider ever asked about them, so a physician with time to ask is part of improving access.

Pelvic Health Care Runs on Conversation

Dr. Bullock’s practice covers conditions that profoundly affect quality of life, including urinary incontinence, pelvic organ prolapse, overactive bladder, and complex voiding dysfunction. He offers a full range of treatment, from urethral slings and robotic-assisted and vaginal prolapse repairs to sacral and tibial neuromodulation and Botox for urinary incontinence. He’s also principal investigator on multiple clinical trials.

These are not conditions patients discuss easily. Getting an accurate history means building comfort, asking careful follow-up questions, and walking through options that range from behavioral therapy to surgery. That conversation is the care. And when a physician is splitting attention between the patient and a template, the conversation suffers.

In the Study of Women’s Health Across the Nation (SWAN), 814 of 1,339 midlife women with urinary incontinence did not seek treatment, and one of the most common reasons they gave was that a health care provider never asked (55%). A conversation that never starts can’t lead to care.

Access Is a Specialty Problem

Subspecialists like Dr. Bullock are scarce. When their schedules fill with administrative work or visits that could be handled elsewhere, patients with complex pelvic floor conditions wait longer for the expertise they need.

As of 2023, approximately 1,700 physicians had earned subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery, according to the American Board of Obstetrics and Gynecology. And the 2025 AUA Census found that 62% of U.S. counties do not have a practicing urologist.

Dr. Bullock described how large specialty practices improve access by helping physicians focus on the areas where they have the most expertise. Documentation is a key part of that equation. Every hour a subspecialist spends charting after clinic is an hour that isn’t available to the patients who need them most. iScribe providers save roughly two to four hours per day and see 10+ more patients each week. In a specialty with limited supply, that’s access, measured in appointments.

Why So Many Women Never Reach Pelvic Health Care

Pelvic floor disorders are common. In a nationally representative study published in JAMA, 23.7% of U.S. women had at least one symptomatic pelvic floor disorder, and the share rose with age, from 9.7% of women ages 20 to 39 to 49.7% of women 80 and older.

Yet most never reach a specialist. In a population-based study of women 40 and older in the International Urogynecology Journal, 41% of respondents had urinary incontinence, but only 25% of those women sought care and 12% received subspecialty care. The authors called it an iceberg: only a fraction ever see a pelvic floor specialist.

In our view, that’s why Dr. Bullock’s argument matters. Access to pelvic health care is partly a supply problem and partly a conversation problem, and time saved on charting helps with both.

Notes That Are “Something to Be Proud Of”

Here’s where Dr. Bullock’s perspective breaks from the usual time-savings narrative.

“I’ve always been a quick adopter. So, I adopted this ambient scribe probably a year and a half ago, and it’s really changed the way I practice,” he said. “…I’ve talked to a lot of physicians that are using Ambient Scribe, and everyone focuses on the time savings that it’s given them. My notes are done quicker, I get out quicker. They really focus on the time savings… I think it’s actually made me a much better doctor than I was before, because those notes are… something to be proud of.”

Before ambient documentation, Dr. Bullock relied on rigid, templated notes. Templates are fast to fill in, but they flatten the encounter. They capture checkboxes and miss the nuance of a patient’s symptoms, history, goals, and concerns.

With iScribe, his notes reflect the full patient conversation. And because he isn’t racing to document, he can slow down, explain his clinical reasoning out loud, and bring the patient into the decision. The ambient AI scribe captures that reasoning, so the note and the conversation become the same thing.

Why Template Notes Fall Short in Specialty Care

Templated documentation was built for consistency. For a subspecialist, that trade costs precision in three places.

• Details get dropped. A template can record that a patient has stress urinary incontinence. It rarely captures the specifics that shaped the treatment plan.
• Referring providers get less. A detailed note gives the referring physician real insight into the plan and the reasoning behind it.
• Coding gets harder to defend. The level of medical decision-making in a complex pelvic health visit needs to be visible in the note to support the code.

iScribe addresses all three with provider-specific macros, specialty-tuned to each physician’s preferences and requirements. It’s the opposite of an off-the-shelf template.

Here’s how a templated note and an ambient AI note compare on the points Dr. Bullock raised.

Templated note

• Patient’s symptoms and goals → Traditional documentation: Reduced to checkboxes → Ambient AI note: Captured from the conversation.
• Clinical reasoning → Traditional documentation: Rarely recorded → Ambient AI note: Captured as the physician explains it.
• What the referring provider sees → Traditional documentation: Diagnosis and plan → Ambient AI note: The plan and the reasoning behind it.
• Support for the coded visit level → Traditional documentation: Limited to what the template holds → Ambient AI note: Decision-making visible in the note.
• Physician’s attention during the visit → Traditional documentation: Split with the template → Ambient AI note: On the patient.

From Notes to Coding, Orders, and Denials

Dr. Bullock also looked ahead to ambient AI supporting order entry, billing suggestions, and denial management, reducing the administrative burden across both clinical and back-office teams.

Part of that is already here for urology. iScribe Code Intelligence delivers E&M code recommendations with 95% audited accuracy, supported by detailed analysis of AMA MDM guidelines, for urology and orthopedic practices on athenahealth or NextGen. And real-time denial prevention capabilities are in development, in service of iScribe’s mission to end documentation-related denials, which we see as a fundamental flaw of modern medicine.

What to Look for in an Ambient AI Scribe

If you’re a urologist or urogynecologist evaluating ambient clinical documentation, Dr. Bullock’s experience points to better questions than “how much time will I save?”

• Does the note reflect the whole conversation, or just the parts a template can hold?
• Is it tuned to my subspecialty and my documentation preferences?
• Does it support coding and orders, along with the narrative?
• Can I reach a person when I need support? (With iScribe, you always reach a person, never a chatbot.)
• Can I trial it without losing clinic time? iScribe’s complimentary 14-day trial comes with zero schedule reduction.

Faster Notes Were Only the Start

Time savings got ambient AI in the door. Dr. Bullock’s point is that the lasting value is quality, in notes worth being proud of, conversations patients feel part of, and subspecialists available to the patients who need them. We think he’s right, and if your experience with ambient documentation has been different, we’d like to hear it.

Frequently Asked Questions

What is an ambient AI scribe?

An ambient AI scribe captures the natural conversation between a physician and patient and converts it into a structured clinical note in real time, without dictation or manual typing during the visit.

How does ambient clinical documentation help urologists?

It captures detailed, specialty-specific notes, supports referring providers and coding accuracy, and frees time that subspecialists can return to patient access. iScribe Code Intelligence is available for urology practices on athenahealth or NextGen.

What does a urogynecologist treat?

Urogynecologists (FPMRS specialists) treat female pelvic floor conditions, including urinary incontinence, pelvic organ prolapse, overactive bladder, and complex voiding dysfunction.

How does ambient documentation improve access to pelvic health care?

It gives subspecialists back time they would otherwise spend charting, time that can become appointments for the patients who need them most.

Why don’t more women seek treatment for urinary incontinence?

In the SWAN study, the most common reasons were that their incontinence was not bad enough (73%) and that it is a normal part of aging (53%), alongside a provider never asking. The authors concluded that over half of those women gave reasons that public health and clinical efforts could address.

What is FPMRS?

FPMRS stands for Female Pelvic Medicine and Reconstructive Surgery, a subspecialty jointly sponsored by the American Board of Obstetrics and Gynecology and the American Board of Urology. Effective January 1, 2024, the boards renamed it Urogynecology and Reconstructive Pelvic Surgery (URPS). Its subspecialists must also be specialists in obstetrics and gynecology or urology.

Is ambient AI a good fit for sensitive pelvic health visits?

We think it can be, as long as patients know the visit is being recorded, have a real chance to decline, and the physician reviews every note before signing. Patients often notice the difference: in The Permanente Medical Group’s rollout, 47% of patients said their doctor spent less time looking at the computer, and no patients reported a negative effect on their visit, according to the AMA. For more on privacy and safeguards, see our guide to ambient listening technology.

About Dr. Travis L. Bullock

Dr. Travis L. Bullock is a fellowship-trained urologist at Urology of St. Louis, specializing in Female Pelvic Medicine and Reconstructive Surgery (urogynecology). He earned his medical degree at Eastern Virginia Medical School, completed his urologic surgery residency at Washington University School of Medicine in St. Louis, and completed a fellowship in female urology, neurourology, and pelvic floor reconstruction at Metropolitan Urologic Specialists in Minneapolis. He is board certified by the American Board of Urology and in Female Pelvic Medicine and Reconstructive Surgery and received the Castle Connolly Top Doctors Award in 2021, 2022, 2023, and 2024.

Hear the Full Conversation

Listen to Dr. Travis L. Bullock on Truly Integrated, EP 05, “How Ambient AI Is Improving Access in Pelvic Health Care.”

Built for urologists, tuned to you. Start a complimentary 14-day trial of iScribe AI, fully set up before go-live with zero schedule reduction.