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Family Practice colonoscopies
Started by sonofva
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You have to make the effort to learn how to do them in residency (I did). Then you have to practice where 1: the admin folks allow you to do it and it's covered by your malpractice 2: There is enough volume to make it worth your while. 3: There is a surgeon or proctor and your employment who is willing to sign you off. 4: You are practicing where you have a general surgeon available to fix your perforation should that happen.
Needless to say I have never practiced where I could fit it into my "practice". Never did one out of residency.
Needless to say I have never practiced where I could fit it into my "practice". Never did one out of residency.
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Not really, I work in super rural places, most don't even own scopes. And if they do, the staff aren't trained and there is no one who does anesthesia anyway and my malpractice doesn't cover conscious sedation. Huge hassle unless you can dedicate one day a week strictly for scopes or are good enough to do 8 in a half day. Not sure if you would get that volume or enough practice for patients to trust you and admin to let you.
First you need to find a program that teaches scopes. The most important question to ask is how many of your graduates from the past few years are doing scopes. You will have to put in some extra work to get the numbers during residency however. The number of scopes needed to get privledges varies by hospital. I practice in the Midwest and it is fairly common for FP's to do scopes in smaller hospitals (not only critical access). If there are GI docs in the hospital it will be harder to do scopes, they don't even like the general surgeons doing them. I did around 100 in residency (my 2 other classmates doing them did around 60 and none of us had problems doing them after residency).
I enjoy doing them as they break up my day. I do about 100 per year and practice in a 110 bed hospital with 3 surgeons (no GI), and the community is about 30,000 population. I think it is a nice service to be able to offer your patients. The extra pay is nice too. They add around 30k to my bonus at the end of the year based on rvu's. I either do one in the morning before clinic, or do a half day and usually do between 3-5. I am only 2 years out of residency so if you have any questions let me know.
What about at Endoscopy Centers run by GI docs... there usually isn't a Surgeon around??
I'm talking about rural places where there is no surgeon IN THE WHOLE TOWN. Endoscopy centers are in the same town as a general surgeon so you would transport the patient to the hospital should you have a perforation.
There are lots of options depending on your dedication to endoscopy. Generally, you need to choose a residency with endoscopy friendly attendings. Then work your butt off to get as many cases as possible during residency. Join the AAPCE. Credentialling will be difficult without a minimum of 50 scopes. Be prepared to seek more training post residency, even though you will likely need 50 to have a chance, more is better. It's good to have a friendly relationship with a surgeon, but you don't really need one in the next room. The complication rate for endoscopy should be very low.
Endoscopy is a great way to break up the day, and I make more money in the endo suite than I do in the office. I love it, but you really must be dedicated to the cause.
Endoscopy is a great way to break up the day, and I make more money in the endo suite than I do in the office. I love it, but you really must be dedicated to the cause.
This seems like a great skill to have if you do geriatrics and want to provide this service to your patients.
My program teaches scopes and a motivated resident could easily graduate with several hundred under their belt (I guess I'm not that motivated as I've only done a few, although we get a couple dedicated procedures months 2nd and 3rd year to get the minimums). I'm very much a geriatrician in the making and have less interest in procedures than I used to...as a PA I did every procedure I could get my hands on and I think I've kinda gotten that bug out of my system as I am much more interested in the cognitive aspects of my job now, but for those who want to do everything, a procedurally strong residency is a very good place to start.
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