What is the future of gastroenterology?

[Jimmer Fredette]

While I realize no one has a crystal ball, there are some people that have a better idea of the general trends gastroenterology might take in the future. I am not one of those people so I was hoping you more experienced folks could give your opinion. I am most interested in finding out the following questions:

1. How will the recent government reform (I realize it is still being worked on) in health care affect gastroenterology with respect to physician autonomy and compensation?

2. Do you believe gastroenterology will become more competitive? I have heard rumors that they are predicting greater increases in IM applicants in coming years than in past years.

3. Anything else you see happening to the field of gastroenterology.

THanks

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[libertarian]

Let me do my best to answer your question.

60% of GI revenue comes from the screening colonoscopy. Medicare currently reimburses a professional fee of around $230 for a diagnostic screening colonoscopy (depending on where you live). Consider that the vast majority of colonoscopies can be completed in 30 minutes or less, you can do quite well if all you do are screening colonoscopies.

Unfortunately, a few of our fellow gastroenterologists have turned to this as their sole source of income. They make ridiculous sums of money, well in excess of 7 figures. All the while, they sacrifice in the cognitive areas of the field.

This has caused CMS to review reimbursements for colonoscopy. They steadily decrease every year, and many other societies are chomping at the bit to get a piece of the lucrative pie. If you think about it, GI is really the only field where we have an endless supply of patients that MUST have a procedure. (Screening colonoscopy is recommended at 50 years old, and surveillance every 3-10 years). This has lead to competing technologies such as CT colonography (virtual colonoscopy), as well as blood and stool tests to detect for colon cancer.

Where do I see GI in 10 years? It's going to be very difficult to replace colonoscopy, as it is currently the least invasive method of removing polyps (precancer growths). But I envision a future where a simple blood test should be able to detect your risk for colon cancer.

However, minimally-invasive is the key phrase here. Everything is headed that way, and GI, given their expertise in endoscopy, is poised to lead the way. Every month, new and exciting technologies emerge, which makes me confident that GI will be in high-demand for years to come.

If you choose to become a gastroenterologist, the most important advice I can give you is to not become hunkered down only doing screening colonoscopies. You'll be a one-trick pony, and will likely become obsolete in the next few years. Who knows, maybe you'll have made enough money to retire by then, but medicine is a rapidly evolving field, and failure to adapt will lead to your extinction.

 

[bronx43]

While I realize no one has a crystal ball, there are some people that have a better idea of the general trends gastroenterology might take in the future. I am not one of those people so I was hoping you more experienced folks could give your opinion. I am most interested in finding out the following questions:

1. How will the recent government reform (I realize it is still being worked on) in health care affect gastroenterology with respect to physician autonomy and compensation?

2. Do you believe gastroenterology will become more competitive? I have heard rumors that they are predicting greater increases in IM applicants in coming years than in past years.

3. Anything else you see happening to the field of gastroenterology.

THanks

Government reform, which is an inevitability at this point, will certainly result in less reimbursement for the colonoscopy, which means less compensation for gastroenterologists. It's impossible to predict future technologies in medicine, therefore, it's highly possible that GI won't even be utilizing colonoscopies as as the definitive screening measure in the future. If that happens, then it depends on what the new procedure/diagnostic modality is, and how well it's reimbursed. But, with the way things are looking, it's almost a certainty that GI docs will be looking at a pretty big pay cut going into the next 5-10 years.
If that's the case, then competitiveness will obviously drop, as money is the greatest driver for the competitiveness/prestige of a specialty. If you love GI as a field and subject matter, then go for it. If you're going into GI for the opportunity to be make bank being a colonoscopy monkey, then you might want to think twice about it.

 

[libertarian]

Oh yeah, and in response to your question #2...

Currently, GI is the most competitive fellowship to get into when you look at number of applicants and the number of available spots. This probably has to do with 1) Income potential, and 2) lifestyle... not a whole lot of GI emergencies that require you to wake up at 2am and get yourself to the hospital, unlike cardiologists =)

I see this trend continuing into the future. You stand a better chance if you have graduated from an allopathic medical school in the United States, have quality GI research (start early, like in medical school), good board scores, and generally aren't regarded as a prick.

 

[Matt Schreiber]

The next few years are likely to be tumultuous ones for the practice of gastroenterology. With health reform's key provisions kicking in, Accountable Care Organizations forming, ICD-10 coding becoming a requirement, meaningful EHR use a reality for medical practices across the board, and the growing importance of exporting data to registries, physicians have a tremendous amount to address.

I suggest you request the white paper here: www.gmed.com

The rollout of healthcare reform will have a dramatic effect on many gastroenterologists during the next three years. Some will be prepared, but others will end up facing challenges that could threaten their practice. We at gMed, the only gastroenterology specific EHR have many solutions to the ever-changing environment.

 

[Silent Cool]

GI is primarily a high-volume, procedural specialty.
High-volume procedural specialties will always be the target of gov't cuts.

 

[ruralsurg4now]

Unfortunately, a few of our fellow gastroenterologists have turned to this as their sole source of income. They make ridiculous sums of money, well in excess of 7 figures. All the while, they sacrifice in the cognitive areas of the field.

He's not kidding, by the way. I don't know about the income, but a lot of GI guys you run into are basically ONLY doing scopes, where their entire day is just scoping people mechanically. If you ask them about anything, the answer is "they need a scope." Literally, you imagine that the entire field of gastroenterology could be summarized with a one-sentence response of "whatever the complaint is, scope the patient." The worst part is that if the scope has no abnormalities, they just sign off like "well, that was all I have to offer." And you're like "man, you're totally useless. What the h**l did you train for?"

 

[Silent Cool]

He's not kidding, by the way. I don't know about the income, but a lot of GI guys you run into are basically ONLY doing scopes, where their entire day is just scoping people mechanically. If you ask them about anything, the answer is "they need a scope." Literally, you imagine that the entire field of gastroenterology could be summarized with a one-sentence response of "whatever the complaint is, scope the patient." The worst part is that if the scope has no abnormalities, they just sign off like "well, that was all I have to offer." And you're like "man, you're totally useless. What the h**l did you train for?"

And that's the reason that nurse endoscopists are coming about. Many GI docs have effectively become technicians.

 

[ruralsurg4now]

And that's the reason that nurse endoscopists are coming about. Many GI docs have effectively become technicians.

That's the problem. I'm not trying to put down the field of gastroenterology. There's a lot to know, obviously. But like I said, you wouldn't know it from talking to a lot of GI docs these days. It's like "I scope ...I no scope ...I scope ...I no scope ..." I often get the feeling that if I removed "scope" as an option for consultation, they'd just look bewildered at me and go "what I do now???"

 

[Silent Cool]

That's the problem. I'm not trying to put down the field of gastroenterology. There's a lot to know, obviously. But like I said, you wouldn't know it from talking to a lot of GI docs these days. It's like "I scope ...I no scope ...I scope ...I no scope ..." I often get the feeling that if I removed "scope" as an option for consultation, they'd just look bewildered at me and go "what I do now???"

Yup. GI is a one-trick pony. When reimbursement falls through the floor (which it will), watch competition for GI spots plummet.

 

[ruralsurg4now]

By the way, any time you make a field where there are no emergencies, your primary intervention is relatively easy to perform after a fairly short period of training, and you don't really need to do much critical thinking at the physician level, you can be assured that within a decade you're going to be replaced by a nurse. But for now it's very lucrative.

 

[Taurus]

It's only a matter of time before virtual colonoscopy gets approved. The GI's have been fighting it but it's inevitable.

 

[IMDoc607]

It's starting for GI. They took some big cuts this year.

http://www.gastro.org//advocacy-reg...lendar-year-2014-final-payment-rules-released