The number of gender-affirmation surgeries in the U.S. are on the rise and will continue to increase in the years ahead. In fact, the latest research from The American Society of Plastic Surgeons reflects that, from 2015 to 2016, the number of transgender-related surgeries rose nearly 20 percent.

This sudden increase can be directly attributable to two recent developments. The first is related to the positive change in the general public’s attitude toward transgenderism. With this came many progressive companies taking the initiative of offering transgender health coverage — including surgical benefits to their employees — to show inclusion of all in the workplace and retain high-demand skillsets with competitive benefit packages. Over the years, more and more companies followed the lead and are now offering such coverage. Even the latest headlines are reflective of this trend; in June, for example, we saw Starbucks announce an expanded health insurance plan for transgender employees.

[See: 10 Ways to Prepare for Surgery.]

The second development was the Affordable Care Act, which made it illegal for all major health plans to exclude transition-related care from coverage. This made transgender health insurance coverage a reality for so many and created better access to transgender care across the nation. It also included coverage for all care related to gender transitions, like gender-affirmation surgeries. These two developments, working in combination, prompted the sudden influx in demand for such surgeries.

However, this demand collided head-on with the severe lack in the supply of competent, well-trained surgical specialists in the U.S. The result? Transgender patients are now facing extensive surgery wait times — spanning anywhere from two to four years — given there are very few surgeons in this highly specialized field of plastic and reconstructive surgery and urology.

To make matters worse, severely undertrained surgeons have started to enter the specialty to help meet the demand — which, as you can imagine, is an invitation to dire consequences. In a recent letter submitted to the World Professional Association of Transgender Health, red flags were raised by concerned postoperative transgender patients related to this issue.

The letter requested the creation of specific accreditation for surgical membership within the professional organization and the maintenance of a database that accurately tracks surgeon’s applicable experience and training. This request was the result of the observed prevalence of undertrained and inexperienced surgeons, who have claimed to have unsubstantiated and, in many cases, untruthful training and experience in order to enter the provider market. Moreover, this points to the lack of verifiable information that exists in this regard, enabling inexperienced surgeons access to the transgender community without the proper skills required to keep surgical complications to a minimum.

[See: 7 Reasons to Call Off a Surgery.]

As someone who has undergone the extensive training and performs gender-affirmation surgeries daily, I know that these procedures are incredibly complex and require a comprehensive understanding of all the varying components of pre- and post-operative care. This includes everything from having the knowledge of psychotherapy and hormone therapy leading up to the procedure to being trained to manage and treat any potential complications that could arise following the surgery. Without proper training, surgeons are doing more harm than good.

Now, more than ever before, there’s a clear need for better access to credible and experienced transgender surgeons in the U.S. We can do this by developing comprehensive training programs focused specifically on transgender surgery, which, in turn, results in more experts in the highly specialized field of plastic and reconstructive surgery and urology. These trainings need to go beyond the surgical procedures to include all those key aspects of transgender care that I mentioned previously. The goal of these programs is to allow for more access to timely care, prevent inexperienced surgeons from putting patients at risk of complications and ensure patient transitions are successful.

We also must establish a transgender surgery board-certification that can provide the patient community with the validation of surgeons’ training and experience. As of now, no certification exists, making it hard for patients to know if their surgeons are truly credible. Until created, it’s imperative that patients seeking gender-affirmation surgery thoroughly verify their surgeons’ expertise. Knowing how long the surgeon has been performing, and how many of procedures he or she has performed, is key.

The good news is that we’re already making progress on the training front. In the last year, new transgender training programs have launched — including the one at Hahnemann University Hospital — that are aimed at developing highly skilled transgender surgeons to address these issues.

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If we continue on this path, we can ensure better access to highly qualified surgeons who can provide the care that the transgender community deserves. After all, it is the surgeon who plays the biggest role in the defining moment of the patient’s completion in their transition. We owe it to our patients to ensure those transitions are successful.

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Why We Must Train Doctors on Transgender Surgeries originally appeared on usnews.com