Do the majority of primary care residencies train how to do colonoscopies. Apparently this is one way FPs are increasing salary.
Colonoscopies in Primary Care
- Thread starter JimZflam
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Yes you can learn to do it, but lol think about all the ancillary equipment needed to do it safely (monitoring equipment, sedation, assistant, scope and screen, etc etc). Not necessarily worth it in terms of time used and equipment purchased.
..and why is every post about FM increasing salary? Is $180,000 - $200,000 and 40 hours a week not enough?
..and why is every post about FM increasing salary? Is $180,000 - $200,000 and 40 hours a week not enough?
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lol give the kid a break. Who's to say he won't be practicing in a town of 5,000 who's nearest GI doc is 50-100 miles away? Providing scope service would be an excellent way to better serve his patients.
My answer to your question is.... DEBT, lots and lots of DEBT.
Besides that ,however, I am genuinely interested in GI and if I can do some and do primary care, I think that would be really cool.
Step 1 : Did great
Step 2 : Did really really good
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I am also very interested in getting enough experience with endoscopy to potentially provide this service to patients in the future. If a primary care doctor is able to gain priveleges at a local hospital it seems this would solve the problem of purchasing a lot of extra equipment - as long as the hospital is only a short distance from clinic. I believe many patients would appreciate being able to have screening colonoscopies or even EGDs done by their primary care physician rather than being sent off to a specialist whom they have never met before. Assuming, of course, that the PCP has demonstrated competency in performing the procedure.
In your case, why not do an IM residency and GI fellowship. You will be board certified in IM and gastroenterology. You can do primary care with your IM certification and scopes with your GI training (given you havent signed any non-compete clauses)
Interestingly, insurance companies reimburse more for procedures done at a "procedure center" than for the SAME procedure done at an office. You just have to determine if you will have enough volume to net a profit after you pay your fees to use the procedure center.
-Dr. T.
While there are differences between office/hospital/endoscopy center fees, that really doesn't matter. If this is a genuine interest, then you can get the training and you can find a place to perform the procedures. You should not have to pay fees to use a procedure center. They bill separately for the facility fee (just like you don't pay a fee to admit patients to a hospital). The only up front costs arise if you want to do the procedure in your office (currently unlikely to be realistic). Getting the training can be difficult (I've heard of some residencies where it's common, but it's the exception rather than the rule), but it is out there if you are willing to seek it out and put in the time and effort.
Get your hands on a scope every chance you get. Read Practical Gastrointestinal Endoscopy by Cotton.
However, add endoscopy to your skill set because you like doing it and it will be of benefit to your patients. Who knows what the financials of endoscopy will look like by the time you are done training.
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I am a PGY-2, soon to be PGY-3 in family medicine. When I am done I will have done 100 EGD's, 100 Colonoscopies at least, if not more. I plan to work in a rural hospital where I will be able to provide these services for my patients. Rural training is out there if you want it and are willing to work hard.
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That's not really the point. And perhaps a slippery slope to start suggesting that a certain arbitrary salary is "enough" for someone...... just doesn't sit well with me.
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that's not really the point. secondly.........your numbers are a little off. average hours worked for fm is not 40. they're more like 50-55. just like they are for other specialties.
and also, other specialties are making >300-k working similar hours. the complain about fm is not the money earned, it's about the money earned compared to other specialties...........especially considering the work involved. ie. seeing 25-40 patients a day.........all the paperwork........all the hassles..........
if you got a 260 on your step 1, you probably should of gone for something else......
I went into FM because I LIKED it. Isn't that the way you are SUPPOSED to choose a specialty? Did you choose a specialty based on how much money you would make and how it would sound when you tell other people what you do? Why'd you even go into medicine?
I know how much FM makes in my area, and I know how much we work. I had job offers during my 4th year rotations in med school (for after residency). The numbers I quoted are real...
Best of luck.
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What kind of trollish comment is that?
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I am just getting ready to begin residency, and one of my criteria in picking a a program was the opportunity to learn endoscopy. I was lucky and had the opportunity to get my hands on quite a few scopes during my general surgery and rural family med rotation in med school and realized I really enjoyed it (now if I did it all day like a lot of GI docs I would probably go crazy!). I looked only in the midwest and found that quite a few programs offer training (some easier to get numbers than others). The training varied greatly between programs. Some places you were taught by GI docs or general surgeons (GI docs are very hesistent to teach FM residents at alot of places), and other places had their own endoscopy suite at the clinic and used a combination of hospital and clinic for training. I found the most helpful thing was to talk to the residents at each program and ask how many of their residents went out and did endoscopy. Also what their numbers were like at graduation from residency. I found that in the midwest their are plenty of good programs that offer endoscopy training if you are willing to put forth the extra time to get the numbers.
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What kind of trollish comment is that?
Seriously.
Very impressive scores, 'props to thethom for going with what he/she loves
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No.
What's the magic number?
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$200,001
Tongue in cheek of course. I was prepared to write a long diatribe about how much I am attracted to/would love to be a Family Practice doc, yet the $260,000 bill they will slide across the desk at the end of ms4 kind of makes it almost an un-reasonable, un-fair impossiblity.
I was then going to say that it's encouraging that I read in USA Today that PC specialties saw an increase of 3.something % income over past year.
I was then going to say that in spite of what other specialties might think, I believe that Obama (and maybe now the patients) understand the need for a re-distribution of reimbursement specialist/pcp, etc. One that will hopefully benefit family docs and hope it comes to fruition.
But it's nothing that everyone else doesn't know, so I'll go back to my Tetris.
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Doing endoscopy when you get done is very doable. I do screening colonoscopies and there are two GI doctors in my area, so it's not like I'm the only guy available. I give my patients the option to let me do the procedure or I will send them to the GI docs if they prefer. By enlarge they choose for me to do the procedure, even new patients who I have never seen before their first visits. A lot of people, especially with the economy the way it is don't want to deal with having to go to more doctor's appointments. I do my scopes at the hospital where I have privileges. You definitely have to do your homework when choosing residency programs. Don't expect to get the training when you get out and you need to get exact numbers of procedures that residents are available to get. Don't fall for the "if you're really aggressive" numbers. You will need at least fifty to have any chance of getting privileges at most hospitals and this may require a period where your scopes are precepted. Most hospitals have picked a number out of a hat that you are required to have 50, 100, 140 are all numbers that I have heard. The majority I researched are closer to 100.
A resource: The American Association for Primary Care Endoscopy. The founding president is former AAFP and AAFP Foundation president and long-time family medicine endoscopist William Coleman.
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This is exactly what I am doing. I took a bunch of GI electives as a resident and now am in a rural part of the country. I still need to be proctored here at the hospital but will eventually be up an running on my own with scopes. The nearest GI doc here is 100 miles away and a semi-retired doc comes twice a month. I am looking to fill the void as soon as I can get in a formal course and be proctored. You can pretty much do what you want in FP as long as you put it in your contract and be saavy about your location. Just like I don't do OB and am not expected to.
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Good advice on choosing residency training carefully if you're sure this is something you want to do. I tried early in my training to get involved with scopes and got such a smack-down by the main GI in the hospital that I just gave up.
Now hearing that people are getting training and actually have priv's to do them at their hospitals makes me a little jealous. It's a HUGE adjunct to your salary and also just a fun way to break up the monotony of clinic every day.
Even if procedures get more sensible reimbursement under The New World Order of Obama The Great, they're still a great part of family medicine. Most of the job these days is comprised of charting and admin stuff. So, if you can break out of the routine occasionally and actually DO something, its great. But our residency turned out to be pretty weak in procedures, and the hospital is irrational and stingy with priv's, so choose your training site wisely.
Now hearing that people are getting training and actually have priv's to do them at their hospitals makes me a little jealous. It's a HUGE adjunct to your salary and also just a fun way to break up the monotony of clinic every day.
Even if procedures get more sensible reimbursement under The New World Order of Obama The Great, they're still a great part of family medicine. Most of the job these days is comprised of charting and admin stuff. So, if you can break out of the routine occasionally and actually DO something, its great. But our residency turned out to be pretty weak in procedures, and the hospital is irrational and stingy with priv's, so choose your training site wisely.
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and average salary for fm is not 180-200k. it's more like 170-k. and that's with 50-55 hours worked.
I seriously can't believe how rude some people are on this forum. Dr. T, thanks for being so professional in the face of such utter disrespect. For the record, I know a FM doctor who works ~40-60hrs a week and pulls in 500K...Work smart, not hard...and if you work smart and hard, that's another story...
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How does one get creditionaled to do Colonoscopy if they get sufficient volume during residency?
Do hospital administrators looks at volume? Is there a formal process for certification if you have achieved the number of colonoscopy studies during residency.
Do hospital administrators looks at volume? Is there a formal process for certification if you have achieved the number of colonoscopy studies during residency.
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All hospital-based procedures must be granted by a credentialing committee at the hospital. This committee is, in some ways, a risk-management/turf-protection cluster with very little basis in actual reality.
Hospital admin and various specialists tend to sit on the board, and their whims determine policy. There's no national standard (that I'm aware of). So, some places say, "GI's only, and a minimum of 100 scopes." Others (usually ones with an FP on the board) may say "Adaquately-trained FP's and GI's but they need 150 and a LOR from a GI." Just depends.
When in training, your only goal for procedures is to do as many as you can and to get very comfortable with as many as you are interested in. Then, when you approach graduation, you can look into the hospitals where you intend to practice and see the "climate" for FP's doing the procedures you want to do.
Also, realize that many procedures don't HAVE to be hospital-based, even though they may be at this time. Some docs do scopes out of their office. But C-sections, appys, etc generally NEED the hospital.
But for now, just learn the procedures.
Hospital admin and various specialists tend to sit on the board, and their whims determine policy. There's no national standard (that I'm aware of). So, some places say, "GI's only, and a minimum of 100 scopes." Others (usually ones with an FP on the board) may say "Adaquately-trained FP's and GI's but they need 150 and a LOR from a GI." Just depends.
When in training, your only goal for procedures is to do as many as you can and to get very comfortable with as many as you are interested in. Then, when you approach graduation, you can look into the hospitals where you intend to practice and see the "climate" for FP's doing the procedures you want to do.
Also, realize that many procedures don't HAVE to be hospital-based, even though they may be at this time. Some docs do scopes out of their office. But C-sections, appys, etc generally NEED the hospital.
But for now, just learn the procedures.
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How many FPs are actually doing appys? Is that common at all?
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For gastroenterologists to be credentialed out of fellowship, we need 140 colonoscopies and 130 EGDs. Honestly, in my anecdotal experience, my biggest problem with primary care endoscopy isn't the technical skill to do the procedure, its the failure to know what you are looking at. Of course, I can say the same thing about surgeons (hey GI fellow friend of mine walking by as I scope in the ICU, would you biopsy that thickened fold?...No thats a gastric varix).
If you are going to do colonoscopy, I would strongly urge you to keep track of the quality measures proposed by the ASGE, specifically adenoma detection rate, cecal intubation (with pics to prove it each time) and withdrawal time. If you can show that your detection rate meets the community standard, there is no argument that can be made that you shouldn't be doing colonoscopy (assuming you don't perforate people).
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