NY Times on colonoscopies

[bronx43]

http://www.nytimes.com/2013/06/02/h...ditures.html?partner=rss&emc=rss&src=igw&_r=0

Bad news for GI when the Times picks up a scathing article about the broken pricing mechanism and its role in the unsustainable health care system... with colonoscopies as its star culprit.

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[Taurus]

http://www.nytimes.com/2013/06/02/h...ditures.html?partner=rss&emc=rss&src=igw&_r=0

Bad news for GI when the Times picks up a scathing article about the broken pricing mechanism and its role in the unsustainable health care system... with colonoscopies as its star culprit.

Very bad indeed. There's a strong correlation with stories appearing in the major news media and reimbursement cuts that happen soon after.

 

[Gastrapathy]

The anesthesiologist probably was paid more than the endoscopist. We shouldn't be using MAC for colonoscopies. Its a regional thing, nearly 100% in the Northeast and less than 20% in the south.

 

[Osirisx7]

Yet another article from February 2012 touts colonoscopies as the holy grail of cancer screening.

http://www.nytimes.com/2012/02/23/h...r-deaths-study-finds.html?_r=1&pagewanted=all

No doubt that there are cost problems in America, but gunning for GI Docs heads will not turn out to be a beneficial tactic for the screening of cancer in the US. Everyone will complain about the cost of cancer screening, but if I came into the office and gave you the risks associated with not doing it, how many would still refuse?

I will say that anesthesiology is a necessary field in high risk surgical procedures, but they hurt themselves by becoming so good at their trade that it is now automated in most cases. To have a turf war on using MAC for colonoscopies amounts to the same as wanting everyone who flies a plane to buy first class, the cost is there if you need it and not if you don't.

Lastly bronx, NPs and CRNAs are a necessity in our healthcare system at the moment with the baby boomer generation outpacing our doctoral workforce of primary/surgical care physicians. You should hire them if they are good, but agreed on the fact that they should not be called Dr nor have independent rights in hospitals and clinics.

 

[bronx43]

Yet another article from February 2012 touts colonoscopies as the holy grail of cancer screening.

http://www.nytimes.com/2012/02/23/h...r-deaths-study-finds.html?_r=1&pagewanted=all

No doubt that there are cost problems in America, but gunning for GI Docs heads will not turn out to be a beneficial tactic for the screening of cancer in the US. Everyone will complain about the cost of cancer screening, but if I came into the office and gave you the risks associated with not doing it, how many would still refuse?

.

You're conflating issues here. The question isn't whether or not colonoscopies are beneficial for preventing colorectal cancer, because the answer is obvious - they are. The problem is why the procedure, along with many others, is so expensive. Obviously, very few people would still refuse to forgo it if given the risks and benefits, but that's obviously not the point the article was making. You can say that about ANY medical procedure or medication. Would people refuse a cardiac catheterization even if it cost them 100k?

 

[bronx43]

Lastly bronx, NPs and CRNAs are a necessity in our healthcare system at the moment with the baby boomer generation outpacing our doctoral workforce of primary/surgical care physicians. You should hire them if they are good, but agreed on the fact that they should not be called Dr nor have independent rights in hospitals and clinics.

I don't know why you brought this up, as no one in the article or thread addressed midlevels. But, the problem with the surge of NPs and CRNAs is that they don't DIRECTLY help with the real problem of physician shortage, which lies in geographic distribution. There is no shortage of any medical provider in large and even medium sized cities. There are severe shortages in BFE, but needless to say, midlevels don't want to go to those places either so their entire purpose of offsetting shortage of medical care is lost. All CRNAs are doing now to anesthesiology is tightening up the market for the MDs as more groups go to the ACT model. This may eventually indirectly lead to a flow of MD providers to the BFE locations, but it is obviously not ideal.

 

[nephappl]

Very timely and on point although depressing.
Health care costs are outrageous , my wife made the mistake of being sick and had to go to the local ER.
ER doc saw her, orderd CMP and then sent her home. Thats all.....
Bill between ER doc and Hospital $ 1000,00 and they sent us bills every single day and offered us "financial assistance" one week after the visit
Our health system is broken.
Country is bankrupt both financially and morally the latter being the worst.

 

[Gastrapathy]

So you went to the ER without insurance and expected what to happen?

 

[nephappl]

LOL!!!
We have a large private practice and pay an already ex[pensive policy for our > 50 employees (yes we create jobs).
Unfortunately you are missing the point. It does not matter whether you are or are not insured. I am just highlighting how expensive it is to use medical services here; insurance takes the bill down and of course we paid a lot less but still insurance overpaid for this service; they increase the premiums for everybody else to compensate.
Maybe a little bit of research from your part would help the discussion..

 

[Gastrapathy]

So you return all that extra money you bill to the insurers, right?

 

[nephappl]

Dear colleague,
Again it is helpful to learn how medical billing is carried out and insurers insurers pay for services you provide and then you can come to this forum and write your opinions based on your knowledge of the facts.
Our specialty has been one of the hardest hit with cuts in the last 10 years or so.
It seems you are taking this to a personal level leaving ideas aside which SDN is primarily for.
I am not discussing this matter with you anymore so do not even bother to answer.

 

[Gastrapathy]

Ah. So you deserve your money but the emergency physician doesn't. Check.

 

[Silent Cool]

Are there people who go into GI because they legitimately find the GI tract interesting or cool or whatever? My contention is that most people do it because, relative to other IM specialties, it pays well and has a nice lifestyle. Those factors of course are true because of the colonoscopy. What about virtual colonoscopy? Radiologists are going to be all over that. I just don't see the "fascination" with GI. Cardio I could see. Onc I could see. But not GI. Thoughts?

 

[bronx43]

Are there people who go into GI because they legitimately find the GI tract interesting or cool or whatever? My contention is that most people do it because, relative to other IM specialties, it pays well and has a nice lifestyle. Those factors of course are true because of the colonoscopy. What about virtual colonoscopy? Radiologists are going to be all over that. I just don't see the "fascination" with GI. Cardio I could see. Onc I could see. But not GI. Thoughts?

There are people that go into every field for the interest, but let's just put it this way. If every specialty had the same pay, GI would have FAR bigger problems finding applicants than those other two that you mentioned.

 

[Gastrapathy]

I love GI. It's a great mix between young and old, super-sick and not so sick, inpatient and outpatient, clinic and procedures. There is lots of art to GI and yet it's a field focused on developing evidence. You have to be comfortable with uncertainty and not hate functional dyspeptics. There is still the chance to be the first to try something once in a while. Scopes are fun. I've never had a lifestyle practice and most of us are busy.

It's not just the cash. I know very few unhappy gastroenterologists.

 

[johnsmith130077]

how much do GI attendings in private practice make on an average? how many hours a week are put in on an average?

 

[Gastrapathy]

how much do GI attendings in private practice make on an average? how many hours a week are put in on an average?

No one has an "average" practice. There is an incredible variety of academic, semi-private, and private practice jobs. Some people do straight liver, others practically only ever scope. Most of us have a reasonable life style (by my definition) but we take call and do go in at night and on the weekends. I think we are paid well but not as dramatically as people seem to think.