Future of GI?

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sanj238

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I've been doing a search on GI and not much info on its future is available...

What is everyone's take on colonoscopies- the dependence on them and changes to this dependence (increase or decrease likelihood- and to what?), the changes by governing bodies when scopes should be done - will the age change?

What kind of impact will Obamacare have on it- obviously decrease- if so, with regards to scopes only? Are there other areas to take a hit? How does a physician protect himself?

Is the impact on GI going to be more or less severe than on Cards?

Will we expect to see a reversal in trends- say Cards improves with time? If not why?

http://www.beckersasc.com/gastroent...the-present-a-future-of-gastroenterology.html

I found this article to be relevant- but weak on details

http://forums.studentdoctor.net/showthread.php?t=815287

I found this as well- but again, low on details...I figured an update would be nice
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sanj238 said:
I've been doing a search on GI and not much info on its future is available...

What is everyone's take on colonoscopies- the dependence on them and changes to this dependence (increase or decrease likelihood- and to what?), the changes by governing bodies when scopes should be done - will the age change?

What kind of impact will Obamacare have on it- obviously decrease- if so, with regards to scopes only? Are there other areas to take a hit? How does a physician protect himself?

Is the impact on GI going to be more or less severe than on Cards?

Will we expect to see a reversal in trends- say Cards improves with time? If not why?

http://www.beckersasc.com/gastroent...the-present-a-future-of-gastroenterology.html

I found this article to be relevant- but weak on details

http://forums.studentdoctor.net/showthread.php?t=815287

I found this as well- but again, low on details...I figured an update would be nice
Click to expand...

I am a cardiology fellow so I'm not to up to date on GI but from what I read all specialties will take a cut. They already hit stents and PCI pretty hard. I don't see them going to much lower. Personally, I have been reading so much about colonoscopies and how expensive they are that I think GI is up next for the slaughter. Either way tho, GI and cards will continue to make money.
 
GI is going to get gutted. All good things come to an end. But the new norm for highest paid specialties will go down by a 100K + across the board.

Radiology and cardiology have been destroyed already. GI is up next...

The writing is on the wall for colonoscopy to take a big hit.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643440/
 
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If a GI physician does non-scope work can they still make decent pay or is the primary salary derived mainly from scoping?

Furthermore, are there procedures by Cards that can be done by mid-levels?

Do you believe that Cards has been gutted and won't go any further?

I understand that many single specialty practices in cards are closing and moving to hospitals...is this true? If so- what kind of changes are taking place at income?

Is this type of gutting happening to surgery- say in Orthopedics, ENT, retina?

Why isn't derm affected? Is it because its mostly out of pocket (non insurance)?
 
sanj238 said:
If a GI physician does non-scope work can they still make decent pay or is the primary salary derived mainly from scoping?

Furthermore, are there procedures by Cards that can be done by mid-levels?

Do you believe that Cards has been gutted and won't go any further?

I understand that many single specialty practices in cards are closing and moving to hospitals...is this true? If so- what kind of changes are taking place at income?

Is this type of gutting happening to surgery- say in Orthopedics, ENT, retina?

Why isn't derm affected? Is it because its mostly out of pocket (non insurance)?
Click to expand...

Cardiology will see some more hits but I think the worst is over. In regards to moving towards hospital based practice, most physicians see a rise in income because hospitals get paid more than private physicians. With that being said, that can change as well. What I love about cardiology is that it is always expanding. There are always new procedures and imaging modalities. Interventional cardiology is now replacing valves, PFO closures, and a new procedure closing the left atrial appendage. They are also doing peripheral stenting and carotid stenting. I can't comment on GI but based on reimbursement cuts they seem to be up next.

GI makes money off scopes.
 
IMDoc607 said:
Cardiology will see some more hits but I think the worst is over. In regards to moving towards hospital based practice, most physicians see a rise in income because hospitals get paid more than private physicians. With that being said, that can change as well. What I love about cardiology is that it is always expanding. There are always new procedures and imaging modalities. Interventional cardiology is now replacing valves, PFO closures, and a new procedure closing the left atrial appendage. They are also doing peripheral stenting and carotid stenting. I can't comment on GI but based on reimbursement cuts they seem to be up next.

GI makes money off scopes.
Click to expand...

Just because hospitals get paid more for the same thing doesn't mean the hospital will pay YOU more. Once you get bought out, you are salaried, which means that your compensation will rely more on the supply and demand of cardiologists than it does the actual rate of reimbursement. A lowly reimbursed field may see big salary increases if there is a short supply of those providers.
 
sanj238 said:
If a GI physician does non-scope work can they still make decent pay or is the primary salary derived mainly from scoping?

Furthermore, are there procedures by Cards that can be done by mid-levels?

Do you believe that Cards has been gutted and won't go any further?

I understand that many single specialty practices in cards are closing and moving to hospitals...is this true? If so- what kind of changes are taking place at income?

Is this type of gutting happening to surgery- say in Orthopedics, ENT, retina?

Why isn't derm affected? Is it because its mostly out of pocket (non insurance)?
Click to expand...

Define "decent pay."

Derm isn't affected as much because they are smart about their supply, and there is still big demand for their services. Most of their patients can either pay outta pocket for cosmetic procedures or they have good private insurance which generally pay more than Medicare and are slow to adopt Medicare cuts. You compare this to cardiology patients and you get the idea...
 
bronx43 said:
Just because hospitals get paid more for the same thing doesn't mean the hospital will pay YOU more. Once you get bought out, you are salaried, which means that your compensation will rely more on the supply and demand of cardiologists than it does the actual rate of reimbursement. A lowly reimbursed field may see big salary increases if there is a short supply of those providers.
Click to expand...

I know people personally who have told me this who were recently recruited by hospitals. Their salaries jumped. What would be the purpose behind signing with a hospital then? Granted they'll take care of the administrative stuff and take over those bills but the biggest incentive for the doctor is to secure an income at the higher rates while bringing more money for the hospital. How else do you explain the increase in cardiology salaries in medscapes last report despite cuts? I'm not so sure supply and demand is as big of a factor in medicine as you make it to be. I agree it has some affect when it comes to region. However, a busy cardiologist will always bring in more money than a busy internist. Therefore, the reimbursement on cardiology procedures directly relates to how much the hospital makes off that physician.
 
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johnsmith130077 said:
can someone interpret it? any idea why they cutting it so badly? are similar cuts in cardiology and hematology too?
Click to expand...


Cardiology saw an increase in reimbursement in almost everything except nuclear technical component. Echo went up 20% on technical. STEMI reimbursement also went up. It's all a cycle man. Cardio and radiology were hit big over the last three years. Next is GI and ortho but the AGA seems to be pretty good at lobbying.
 
sanj238 said:
I've been doing a search on GI and not much info on its future is available...

What is everyone's take on colonoscopies- the dependence on them and changes to this dependence (increase or decrease likelihood- and to what?), the changes by governing bodies when scopes should be done - will the age change?

What kind of impact will Obamacare have on it- obviously decrease- if so, with regards to scopes only? Are there other areas to take a hit? How does a physician protect himself?

Is the impact on GI going to be more or less severe than on Cards?

Will we expect to see a reversal in trends- say Cards improves with time? If not why?

http://www.beckersasc.com/gastroent...the-present-a-future-of-gastroenterology.html

I found this article to be relevant- but weak on details

http://forums.studentdoctor.net/showthread.php?t=815287

I found this as well- but again, low on details...I figured an update would be nice
Click to expand...

In the UK, nurses can do endoscopies. Do you know if this is the case in the US?
 
So does this mean that Cards will have a comeback? If GI is taking a hit, will the hit be larger than what was done to cards? I was thinking of doing a cardiology fellowship and going interventional but the doom and gloom on the cards board is very scary.
 
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ChasingMaria said:
So does this mean that Cards will have a comeback? If GI is taking a hit, will the hit be larger than what was done to cards? I was thinking of doing a cardiology fellowship and going interventional but the doom and gloom on the cards board is very scary.
Click to expand...

Listen to the doom and gloom stories with caution. Do what you like!!! I know that sounds so cliche but it really matters. Will you have a harder time finding that great perfect job in cardiology? Yes you will but plenty exist. One day the same thing is going to happen to the every popular specialty. You're also listening to people complain about starting salaries from 250 to 300 when they used to be higher. No field sees that kind of money anymore unless your geographically situated correctly... GI, cardio, or pulm. A positive side for cardiology is that it has plenty of imaging. You can set up gigs on the side reading echos for PCP's in your PJ's. Ever see an experienced cardiologist read an echo? 5 minutes is considered extremely long if it's more or less normal.

They also have ECG reading gigs that will pay you per ECG. It won't be much but as a trained cardiologist it takes 3 seconds to read one. In other words, if you're smart you can supplement your income in many ways.

There are so many things that happen since we all entered medical school in the economy that screwed things up. However, all in all, we are all doing well.

I would say that if you like both equally then do GI but expect the future to be different than what you're hearing now. It will get worse. Will it be larger than cards? No one can answer that but in cardiology you have so much in your training that you're certified in that it allows you to be versatile. (Echo, nuke, MRI, CT, muga, etc) For example, let's say they do to GI what they did to cardiology. They cut reimbursement by 40% EGD's and colons which are the equivalent in money makers to nukes and echos to cardiologists. You're going to see their salaries drop tremendously because it's expensive to run an ASC or hire an anesthesiologist to do your scopes.

I have a family friend who's a PCP and he'll tell you the trends over the last 35 years. A specialty will get hit and then make a comeback.

Do what you like.
 
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Medstart108 said:
In the UK, nurses can do endoscopies. Do you know if this is the case in the US?
Click to expand...

Ask Johns Hopkins they have a Nurse Practitioner GI fellowship program (which I think is disgusting, on the part of Hopkins, by the way): http://www.hopkinsmedicine.org/gast...ng/nurse_practitioner_fellowship_program.html

"The fellowship program is administered by the Department of Medicine, Division of Gastroenterology and Hepatology at the Johns Hopkins School of Medicine,"

Meanwhile, medical residents are killing themselves, even doing years of research and chief years, just to get to do GI.
 
whats the future of GI colonoscopies after recent stool tests for detecting cancers published in NEJM?
 
scissors_black_silhouette_clip_art.jpg
 
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So many outsiders with the same opinions.

Did you read the paper? It is a cancer detection test, not an adenoma detection test. FIT is the superior cancer detection test when you factor in cost and use of serial tests. Fecal DNA false positives plus true positives all lead to colonoscopy and there was a high false positive rate. Colonoscopy remains the best adenoma detection test and patients continue to prefer to have adenomas found and removed. The guidelines already endorse both strategies and this changes nothing.

Once again, those predicting the demise of GI sure seem to want it to be true. We will be fine.


Sent from my iPhone using Tapatalk
 
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Gastrapathy said:
So many outsiders with the same opinions.

Did you read the paper? It is a cancer detection test, not an adenoma detection test. FIT is the superior cancer detection test when you factor in cost and use of serial tests. Fecal DNA false positives plus true positives all lead to colonoscopy and there was a high false positive rate. Colonoscopy remains the best adenoma detection test and patients continue to prefer to have adenomas found and removed. The guidelines already endorse both strategies and this changes nothing.

Once again, those predicting the demise of GI sure seem to want it to be true. We will be fine.


Sent from my iPhone using Tapatalk
Click to expand...
When colonoscopy reimbursements get cut drastically, GI will be just fine... fine like endo, ID, neph. Not really unique to GI - just a fact of life for the medical profession since we all live on artificially derived payment models.
 
bronx43 said:
When colonoscopy reimbursements get cut drastically, GI will be just fine... fine like endo, ID, neph. Not really unique to GI - just a fact of life for the medical profession since we all live on artificially derived payment models.
Click to expand...

Why did you pick endo, ID and neph instead of saying "GI will be just fine... like cards is just fine"? They seem more similar in my med student mind.

Seems like the advanced endoscopists are pushing the envelope on new procedures... and im curious as to what people in the know think about GI docs starting to actually treat more abdominal oncology instead of just screening, diagnosing and staging? Is that an option?
 
It's a great test, and will likely replace FIT testing in the armamentarium. It's unlikely to replace colonoscopy as the primary screening tool, in its current iteration anyhow. It is great at detecting full blown cancers, though still not as good as colonoscopy. However it's downfall is only detecting around 40% of precancerous polyps. As a patient, would you rather have a test that can detect once colon cancer is present or one that can prevent it from ever happening by detecting a polyp and removing it? It is also much more cost effective for the healthcare industry to screen and prevent the occurrence of colon cancer, rather than treat it once it has already occurred.

It will definitely be a useful tool. It could even lead to more colonoscopies if used by people who refuse colonoscopy and end up with a positive test, false positive or true positive. However, there needs to be head to head trials with colonoscopy demonstrating at least equal performance before it has any hope of replacing colonoscopy. There are some trials that are currently looking at exactly this, but the just began and are a decade away from finishing. Unless the show some overwhelming superiority (doubtful), enough to effect public policy prior to their conclusion, we'll be waiting at least until then until we can objectively compare the two.
 
johnsmith130077 said:
end of GI..Doom and glooom ,,,,................the end
Click to expand...

GI is going to be just fine just like cardiology will be. I admire GI. They stay under the radar way more effectively than cardiology.
 
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So basically GI salaries are going to go way Down and theres nothing anyone can do about it?
 
wjs010 said:
So basically GI salaries are going to go way Down and theres nothing anyone can do about it?
Click to expand...

No one has a crystal ball, but GI is a one-trick pony. The most likely scenario is that salaries will decrease because the federal gubbmint will slice into them. They tend to target high-volume, procedural-based specialties.
 
boanssi said:
http://www.medscape.com/viewarticle/819615_1

Please comment.
Click to expand...

GI has something no other field has and that is screening guidelines. For example, no guidelines exist for the screening of ischemic heart disease.
Where I think this article might be missing is that no one doubts GI is a good field. However just like they did to cardiology high volume procedures attract cuts. Once or if they cut reimbursement, that's when you'll see the landscape change. They already cut upper GI scopes and next year is lower. What happens when GI is forced into joining hospitals? (If that even occurs) the reason why cards got hit hard is because it's high volume and the equipment is so expensive (echo, nuke, etc). I'm not sure that exists in GI. Honestly who cares....all those specialties will make good money in the future. Instead of 500K at your Peak you'll make 350 to 400....what's so horrible? It's all about how you use that 400 or 500. You can make 1 mil and spend it all while the guy make 590 saves most of it.....at the end of the day the person who is wise with his or her money will have more in the bank.
 
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IMDoc607 said:
GI has something no other field has and that is screening guidelines. For example, no guidelines exist for the screening of ischemic heart disease.
Where I think this article might be missing is that no one doubts GI is a good field. However just like they did to cardiology high volume procedures attract cuts. Once or if they cut reimbursement, that's when you'll see the landscape change. They already cut upper GI scopes and next year is lower. What happens when GI is forced into joining hospitals? (If that even occurs) the reason why cards got hit hard is because it's high volume and the equipment is so expensive (echo, nuke, etc). I'm not sure that exists in GI. Honestly who cares....all those specialties will make good money in the future. Instead of 500K at your Peak you'll make 350 to 400....what's so horrible?
Click to expand...
 

that 100-150k is a huge difference. its the difference between me donating 1000$ to save dying children in 3rd world countries vs donating 30000$.
 
anbuitachi said:
that 100-150k is a huge difference. its the difference between me donating 1000$ to save dying children in 3rd world countries vs donating 30000$.
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Is that a serious response? If so don't go into, it's heading down the path of cards. Will already be well reimbursed but if 300 to 400k at your peaked dint enough you better find another field. Until I see a contract, this 350 to 500 depending on location isn't realistic.
 
IMDoc607 said:
Is that a serious response? If so don't go into, it's heading down the path of cards. Will already be well reimbursed but if 300 to 400k at your peaked dint enough you better find another field. Until I see a contract, this 350 to 500 depending on location isn't realistic.
Click to expand...

Half serious. But it's more about the attitude, and I believe that's something that will eventually have to change in general or doctors will just keep getting taken advantage of. What will you do if you cut nurses salary by like... 25%? they will probably punch you in the face... but doctors should just be like.. 100k gone but 300k is still good, if you dont like it go into something else? thats awful. There wont be any unity since someone else might be like anything over 50k is enough. We should be tougher like the nurses union where going down/backwards = bad, forward/up = good, simple as that.
 
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anbuitachi said:
Half serious. But it's more about the attitude, and I believe that's something that will eventually have to change in general or doctors will just keep getting taken advantage of. What will you do if you cut nurses salary by like... 25%? they will probably punch you in the face... but doctors should just be like.. 100k gone but 300k is still good, if you dont like it go into something else? thats awful. There wont be any unity since someone else might be like anything over 50k is enough. We should be tougher like the nurses union where going down/backwards = bad, forward/up = good, simple as that.
Click to expand...
That would require doctors with more time... They are too busy working right? And more docs with balls. Why doesn't this piss enough docs off to do something about it. Have docs been brainwashed into feeling guilty about their "high salaries"... Enough to become complacent?
 
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Good point....I am not saying it should continue on a downward spiral but if I make 400K at peak instead of 700K I won't mind. However, there comes a time when we need to stand up and say enoughs enough.
 
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johnsmith130077 said:
is Cologuard test the end of GI as a lucrative test?
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No. Even if stool DNA testing becomes the standard for CRC screening in the future (and no gastroenterologist will deny that this is possible, if not likely), colonoscopy is still needed. For practices that depend on a large number of screening and surveillance colonoscopies, what will likely happen (as has been demonstrated on a smaller scale from Kaiser Permanente) is that the overall compliance rates of CRC screening will increase because there is a new, reliable, non-invasive test available. Larger number of people being screened, means a larger number of positive DNA tests that will prompt a diagnostic colonoscopy to look for adenomas and CRC. When Kaiser instituted wide use of FIT testing, their colonoscopy rates actually increased as a result because their population was more compliant overall with screening guidelines.

As Gastrapathy has reiterated numerous times on this board, GI as a profession is and will be fine.
 
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how much are fresh gi grads and advanced endoscopy grads being offered in private practice?
 
1000% depends on the location, from what I understand. Urban vs. rural, and what part of the country. Demand and payor mix both play a part.
 
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