Future of GI?

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GutOnc has been in the forum longest and gave a sensible answer.
None is going to add anything else, that being said- we all think you are full of ****.
You have been going to different fellowship forums like cards and gi asking about how much you can make...
When the looming cuts to scopes apply, and People like you starts getting Pennies for waddling in human ****, you would be the among the most dissatisfied lot.
From the looks of it you were at a low tier community program in New York and shifted to Arizona,that itself is a testament of your low competitiveness for anything.
So, in short choose something if you have true passion for it, you can always make enough money as a Hospitalist.
If you like something and you think monetary gains are not worth 3 years extra fellowship, go for Hospitalist.

Also please stop annoying us with your humdrum salary questions.

Oh, and if you end up in GI, do a self deimpaction for all that ****.
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Salaries will get a huge cut.

We should consider becoming CEOs in the pharma companies.
 
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Sorry I hope those comments werent directed at me. I havent been here in a whlie- taking a break from studying- but yes I have been interested in a variety of fields in IM for some reasons. Recently I became very interested in surgery as well but not sure if thats for me either. I think asking about this kind of stuff is critical to making informed decisions- preceptors all over tell me to do procedural fields that pay well. To be honest if family medicine paid well and didnt have that paperwork I would do it over all the others. Same with Hospitalist- but burnout and the lesser pay is what turns me off from either. If I'm going to spend my energy on medicine this much then I'd like the respect as well- Hearing oh plastics and derm is where the money is at routinely from nurse and PAs and even doctors definitely has an impact on you- and the reality is if I really only cared about money I'd be going into radiology or anesthesiology and neither are interesting purely on their own merit to me (both are great and fantastic fields and no guarantee I'd even get in but you get my point).
 
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DermViser said:
Are you an IMG by chance?
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Hey man - I like you from all the forums, but the implications here are not really cool IMO, and I've seen you ask this a few times. Yeah, yeah, I know its "a free country/forum"
 
Elixir6 said:
Hey man - I like you from all the forums, but the implications here are not really cool IMO, and I've seen you ask this a few times. Yeah, yeah, I know its "a free country/forum"
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Um, what's your point? Thank you for resurrecting a thread that was dead in July.
 
Hi all,
I have applied for GI fellowship this year. Got 4 IVs and I have a very good chance of matching in my home program (>95%) which is a University affiliated Comm. program, most fellows go for private practice.
However, I have some concerns about pursuing GI fellowship. May be those with more experience can throw some light.
Recently, I spoke to one of GI fellows and he told me that it's difficult to get GI jobs after fellowship because of cost cutting and Obama care. So if anyone is looking to stay in sort after places in CA like LA, San Diego, SF etc then they should reconsider pursuing fellowship as Primary care/hospitalist jobs will be more easily available than GI jobs. Also, 3-4 years from now, things will be tougher as it will be difficult for a private GI doc to sustain himself/herself by private practice alone.
Is that true? Guys, as much as I like GI, I do not want to go out of job after fellowship. This is really confusing. Help!!
 
gut_gal said:
Hi all,
I have applied for GI fellowship this year. Got 4 IVs and I have a very good chance of matching in my home program (>95%) which is a University affiliated Comm. program, most fellows go for private practice.
However, I have some concerns about pursuing GI fellowship. May be those with more experience can throw some light.
Recently, I spoke to one of GI fellows and he told me that it's difficult to get GI jobs after fellowship because of cost cutting and Obama care. So if anyone is looking to stay in sort after places in CA like LA, San Diego, SF etc then they should reconsider pursuing fellowship as Primary care/hospitalist jobs will be more easily available than GI jobs. Also, 3-4 years from now, things will be tougher as it will be difficult for a private GI doc to sustain himself/herself by private practice alone.
Is that true? Guys, as much as I like GI, I do not want to go out of job after fellowship. This is really confusing. Help!!
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johnsmith130077 said:
Any one guys.... How is the job market in gi???
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I am sure many of your peers that are fighting tooth and nail to get a GI spot would love it if you went into primary care instead.
 
To change directions: the introduction of NP endoscopists would most likely decrease GI pay by increasing supply while suppressing cost (you can't seriously expect NP to be paid 300-400k even if they scope all day), if reimbursement plans stay the way it is. Of course, this might have been what Hopkins had in mind all along. After all, in response to a high-volume, high-cost procedure, the correct response by the powers that be would be to decrease cost/procedure.

So to attendings and fellows in GI: do you expect the nature of GI work to change now that there's the combo threat of NP endoscopists and decreased scope reimbursement looming? For example, would this actually make GI a more diverse practice, forcing GI docs to go into hepatobiliary more or perhaps focus more on IBD? And now that we will become a value-based healthcare system, how would the traditional fee/scope and indeed the entire practice of GI fit in with the "overall health and well-being" of a patient?

To be honest, I got turned off by GI when I learned that in the pursuit of salary, some GI docs turned into "scope monkeys" (I picked this term up from a buddy I ran into and I mean absolutely no offense to GI attendings/fellows and med students).
 
As for finding a job in a desirable location-it's pretty damn hard. Anecdotally I grew up in the SF Bay Area region and out of a high school graduating class of 320 students, 14-15 will be doctors in the next 5 years (our public high school is like low upper-tier in quality). As a measure of comparison, the U.S. population-physician ratio overall is 300:1. And unlike engineers who actually can concentrate in large numbers in one area, we need to be where our patients are (or there lack of). I can only imagine that super-specialized jobs will only be that much harder to obtain.

The best advice someone gave me in finding a job after med school: the pay, the location, and the nature of the practice are the 3 categories to consider for a "perfect" job. You can probably get your top choice in 2/3 of these categories. This applies to any and all specialties, regardless of the overall trend of that specialty.
 
To all that are worried:

I recently signed a contract.

Job market remains extremely healthy at the moment and stands to remain that way given high volume/need for screening procedures/gerd/IBS, etc. With regard to cuts, we will be fine. The question of small private practices surviving is a different issue given sig equipment costs/looming QI measures/expensive EMR mandates/inability to negotiate terms with insurance co compared to most larger groups/hospitals.

Generally speaking, for new graduates:
Saturated large metro areas: starting salary closer to 200-225
Move 30min-1h away and things go way up fast: 275-300
Move 1h-2h away: 400 and up

Hospital employed jobs tend to start with higher salaries but lower "ceilings" whereas private practices vary in their terms but generally with lower starting salaries and partnership tracks with higher potential (however this may change easily and I would be wary of contracts with lengthy partnership tracks) Not surprisingly, I joined a hospital as many other young physicians are choosing given practice uncertainties and lack of interest in administrative/office economic hassles. I will be working in the southeast (1h from large metro) and my starting salary is above the 80th percentile quoted in most surveys. Will also have a generous RVU bonus structure and loan repayment. Offers from comparable private practices were about half the salary with the opportunity to "buy-in" to a lucrative ASC. In many cases this entails taking out a loan to the tune of 200-400k (or pay straight if you have that kind of cash lying around...) in some instances to pay for the privilege of gaining access to endo center returns. Personally, I'm sick of delayed gratification and furthering my debt burden for a potential "slight" upside several years down the road. I'm sure there's some variety out there however thats the PP model I've seen most often.

If anyone has any specific questions, feel free to PM me anytime.
 
GISTar said:
To all that are worried:

I recently signed a contract.

Job market remains extremely healthy at the moment and stands to remain that way given high volume/need for screening procedures/gerd/IBS, etc. With regard to cuts, we will be fine. The question of small private practices surviving is a different issue given sig equipment costs/looming QI measures/expensive EMR mandates/inability to negotiate terms with insurance co compared to most larger groups/hospitals.

Generally speaking, for new graduates:
Saturated large metro areas: starting salary closer to 200-225
Move 30min-1h away and things go way up fast: 275-300
Move 1h-2h away: 400 and up

Hospital employed jobs tend to start with higher salaries but lower "ceilings" whereas private practices vary in their terms but generally with lower starting salaries and partnership tracks with higher potential (however this may change easily and I would be wary of contracts with lengthy partnership tracks) Not surprisingly, I joined a hospital as many other young physicians are choosing given practice uncertainties and lack of interest in administrative/office economic hassles. I will be working in the southeast (1h from large metro) and my starting salary is above the 80th percentile quoted in most surveys. Will also have a generous RVU bonus structure and loan repayment. Offers from comparable private practices were about half the salary with the opportunity to "buy-in" to a lucrative ASC. In many cases this entails taking out a loan to the tune of 200-400k (or pay straight if you have that kind of cash lying around...) in some instances to pay for the privilege of gaining access to endo center returns. Personally, I'm sick of delayed gratification and furthering my debt burden for a potential "slight" upside several years down the road. I'm sure there's some variety out there however thats the PP model I've seen most often.

If anyone has any specific questions, feel free to PM me anytime.
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Why is it that every GI guy I've ever talked to has had this notion? "We will be fine" like how ID is fine because they all have jobs, or "we will be fine" like cuts won't happen? I'm asking because I'm genuinely curious...
 
bronx43 said:
Why is it that every GI guy I've ever talked to has had this notion? "We will be fine" like how ID is fine because they all have jobs, or "we will be fine" like cuts won't happen? I'm asking because I'm genuinely curious...
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As in we will be fine because we have a lot of procedures to offer. Even when colonoscopy gets cut and it will -- likely in the 1yr--it won't be cut in an extreme way. It is an expensive screening test to be sure however it is very valuable (literature backing up sig drop in CRC mortality over 20years) and labor intensive. I would be shocked if the rates were slashed to be honest. We have a fairly strong lobby that is working hard to mitigate the drop.
 
GISTar said:
As in we will be fine because we have a lot of procedures to offer. Even when colonoscopy gets cut and it will -- likely in the 1yr--it won't be cut in an extreme way. It is an expensive screening test to be sure however it is very valuable (literature backing up sig drop in CRC mortality over 20years) and labor intensive. I would be shocked if the rates were slashed to be honest. We have a fairly strong lobby that is working hard to mitigate the drop.
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Lol, lobbying... gotcha. I wonder if the health care industry lobbyists share the same cigar room as the Goldman and JPMorgan lobbyists at political conventions. Maybe with the next round of bailouts, they can increase reimbursement for pap smears, huh? What was the data for those anyway?
 
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Since the job market is, in large part, determined by the # of trainees is anyone concerned/aware of the recent increase in GI spots?

According to NRMP Fellowship match data there were:
325 spots in 2008
...
383 spots in 2011,
399 in 2012
433 in 2013
461 in 2014
464 in 2015

Is this due to a hidden factor, like previously not all GI fellowship spots were in the NRMP match and now they are? etc? (like how IM spots appeared to increase a couple years back due to the "all-in" change).

Radiology and Cardiology were hit hard by increasing the # of spots. What do you guys think? I am genuinely curious.

For comparison, Cardiology spots increased from 699 to 835 in the same time span.

source: http://www.nrmp.org/wp-content/uploads/2015/02/Results-and-Data-SMS-2015.pdf pg 43
 
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Was shadowing a GI and it's kinda hilarious how they tried to push the scope for almost every patients complaint of abdominal discomfort or gas. For example a patient with a previous positive H.pylori antibody test from a year ago is told to get a repeat blood test and an endoscopy biopsy if positive. Of course it could still be positive if the antibodies are still there! Then the GI is like so we can schedule the endoscope now or after we get the results of the test...lol. Aren't there more noninvasive tests that are better like H.pylori antigen stool test? I feel that a lot of these procedures are not necessary and as better noninvasive tests are created there will be decreasing reimbursement for it.
 
ehwhatsupdoc said:
Was shadowing a GI and it's kinda hilarious how they tried to push the scope for almost every patients complaint of abdominal discomfort or gas. For example a patient with a previous positive H.pylori antibody test from a year ago is told to get a repeat blood test and an endoscopy biopsy if positive. Of course it could still be positive if the antibodies are still there! Then the GI is like so we can schedule the endoscope now or after we get the results of the test...lol. Aren't there more noninvasive tests that are better like H.pylori antigen stool test? I feel that a lot of these procedures are not necessary and as better noninvasive tests are created there will be decreasing reimbursement for it.
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GIs are scope pushers in private practice. This is a similar but much lesser version of cardiology and their previous cath pushing ways. Correct me if I'm wrong, but I believe scopes are already on the books to be cut in the next fiscal year.
 
bronx43 said:
GIs are scope pushers in private practice. This is a similar but much lesser version of cardiology and their previous cath pushing ways. Correct me if I'm wrong, but I believe scopes are already on the books to be cut in the next fiscal year.
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How much is this expected to cut salaries in Private practice?
 
Nurse Practitioners independently perform endoscopy, colonoscopy, etc. at my institution's VA.

As the poster above stated, think twice before electing to waddle in human feces purely for the money.
 
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ehwhatsupdoc said:
Was shadowing a GI and it's kinda hilarious how they tried to push the scope for almost every patients complaint of abdominal discomfort or gas. For example a patient with a previous positive H.pylori antibody test from a year ago is told to get a repeat blood test and an endoscopy biopsy if positive. Of course it could still be positive if the antibodies are still there! Then the GI is like so we can schedule the endoscope now or after we get the results of the test...lol. Aren't there more noninvasive tests that are better like H.pylori antigen stool test? I feel that a lot of these procedures are not necessary and as better noninvasive tests are created there will be decreasing reimbursement for it.
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I'm sure the physician who wasted his time allowing you to shadow is deeply troubled to discover you disagree with his patient management. Endoscopy is indicated for dyspepsia when 1) patients have a red flag sx including age over 55, 2) conservative measures including test and treat for HP and/or empiric PPI have failed. Nearly all of these patients have functional dyspepsia. The GI you shadowed knows that. That patient will keep coming back until she gets an endoscopy, at which point, the gastroenterologist can happily release that patient back to his PCP.

BTW, its crap like this ending up on the internet (or being discussed in other non-private settings) that lead to my primary hospital and group banning shadowing. You lack the basic understanding to have an opinion but that doesn't stop you from sharing it.

Midlevels are not a meaningful threat to gastroenterologists. There is no large scale pipeline to train midlevels in endoscopy and the volume of endoscopy that needs doing is such that plenty of non-GIs already scope.

Medicare cuts may impact income over time but the legislative environment is rather unpredictable.
 
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Gastrapathy said:
I'm sure the physician who wasted his time allowing you to shadow is deeply troubled to discover you disagree with his patient management. Endoscopy is indicated for dyspepsia when 1) patients have a red flag sx including age over 55, 2) conservative measures including test and treat for HP and/or empiric PPI have failed. Nearly all of these patients have functional dyspepsia. The GI you shadowed knows that. That patient will keep coming back until she gets an endoscopy, at which point, the gastroenterologist can happily release that patient back to his PCP.

BTW, its crap like this ending up on the internet (or being discussed in other non-private settings) that lead to my primary hospital and group banning shadowing. You lack the basic understanding to have an opinion but that doesn't stop you from sharing it.

Midlevels are not a meaningful threat to gastroenterologists. There is no large scale pipeline to train midlevels in endoscopy and the volume of endoscopy that needs doing is such that plenty of non-GIs already scope.

Medicare cuts may impact income over time but the legislative environment is rather unpredictable.
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Solid post. Well done.
 
Gastrapathy said:
Midlevels are not a meaningful threat to gastroenterologists. There is no large scale pipeline to train midlevels in endoscopy and the volume of endoscopy that needs doing is such that plenty of non-GIs already scope.
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This is exactly what the anesthesiologists said early on in the face of CRNA encroachment (aside from lots of non-GIs doing it).

I agree with other posters above that the 'what, me worry' attitude coming from most GI docs seems like the calm the proverbial frog must feel while the water temperature is being slowly turned up.
 
dozitgetchahi said:
This is exactly what the anesthesiologists said early on in the face of CRNA encroachment (aside from lots of non-GIs doing it).

I agree with other posters above that the 'what, me worry' attitude coming from most GI docs seems like the calm the proverbial frog must feel while the water temperature is being slowly turned up.
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The major difference between us and anesthesiologists is that patients don't choose their anesthesia provider unless they make a specific effort (which very few patients who are not physicians or our families will do). Patients choose who will provide their endoscopy. The effect is that surgeons do the majority of scopes in places without a major GI presence and we do the vast majority of the rest. There are lots of people posting in this thread who seem to have an ax to grind with GI (and aren't one of us). We aren't worried about midlevels because there is no meaningful threat.

As for the recent medicare changes, they have been coming for a while (as I wrote before they were announced) and may or may not stand. The SCREEN Act is percolating through Congress. If the reductions stand, it will affect the high earning partners who own endoscopy centers but how much remains to be seen. They will likely seek to maintain their income by squeezing anesthesia and pathology.

I'm not sure if its jealousy or some misplaced righteousness about the fairness of compensation in medicine but there are people posting in this thread who need to get over themselves (and I'm sure those people think its totally fair that they make 50% more than a pediatrician).
 
My only issue with GI is how they are blocking adoption of virtual colonoscopy. The research for it grows every year.
 
Taurus said:
My only issue with GI is how they are blocking adoption of virtual colonoscopy. The research for it grows every year.
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Not really. The research is the same. We don't block it. We don't order it. I don't order any CRC screening tests. Primary care doctors do. And they can order colonoscopy, FIT, flex sig, BE or CTC according to the guidelines. If they send the patient to me, its for a colonoscopy. The USPSTF hasn't supported CTC despite radiologist lobbying. We don't lobby against it (in fact, GIs were a big part of the initial studies). But here's why I think its crap:
1. You have to do a bowel prep anyway. Then you roll around on the CT table awake with a tube up your ass. Its not a "virtual"experience at all.
2. I find polyps around 40% of the time. If CTC is as good as me, then you will have to repeat a prep 40% of the time or leave polyps in place.
3. The guidelines for CTC are completely made up. They started from what would be required to be cost effective and worked backwards rather than the other way around. The guidelines allow for leaving in small polyps for that reason. Of course, other studies show that polyps <1cm can have cancer or HGD as much as 10% of the time.
4. There is no study proving cancer prevention. None. There are surrogate markers but no true cancer prevention end point.
5. People order it when a patient is too sick to get a colonoscopy. That is dumb. These patients are sick enough that screening is wrong.

So, get to the point where you have data showing that you actually save lives and don't require a bowel prep and I'm sure they will take hold. Until then, its the fourth best test behind colonoscopy, FIT and flex sig (all of which have been shown to reduce cancer death). That data is required before it will be count for HEDIS. Without that, its DOA.
 
Lol. The GI societies actively lobby against CMS coverage. It's all politics and we know why GI is scared to death of virtual colonoscopy. I know because I have actually been to DC to lobby for it to congress people myself. I still believe it is only a matter of time. In the meantime, most groups are busy setting up lung cancer screening programs.
 
@Taurus Are you going to get a CTC when the time comes? Are you sure they will find the flat polyp in the right colon? Are you comfortable with your society's guideline to not report <5mm polyps and leave in 6-9mm polyps?

If its equivalent, why hasn't the mortality study been done? Mortality studies for flex sig took 5-7 years before the initial data showed a benefit. CTCs been around that long.

As for your trips to Congress, it doesn't look to have worked. The new USPSTF CRC screening guidelines are in the final draft phase. These statements get reviewed every 5-10 years so its gonna be a while once these come out before they will get looked at again. The recommended tests are colonoscopy, FIT and flex sig plus FIT. Here is what they said about CTC under the Alternative Tests category:

CT Colonography
The USPSTF found no studies that assessed the impact of screening with CT colonography on cancer incidence, morbidity, quality of life, or mortality.3 Although nine studies evaluated the sensitivity and specificity of CT colonography compared with colonoscopy to detect colorectal adenomas, none were designed to determine its diagnostic accuracy to detect colorectal cancer (the overall number of cancer cases in each study was limited).3 Empiric evidence on the optimal screening interval, if any, is lacking. CISNET modeling suggests that screening every 5 years with CT colonography (assuming colonoscopy followup for lesions measuring ≥6 mm) from ages 50 to 75 years could potentially yield approximately the same number of life-years gained, with a similar balance of benefits and harms, as the recommended strategies previously listed.10 However, CT colonography often requires cathartic bowel preparation; this burden is not captured in the primary proxy measure of harms as lifetime number of colonoscopies.

Extracolonic findings on CT colonography are common, occurring in approximately 40% to 70% of screening examinations.3 About 5% to 37% of these extracolonic findings require diagnostic followup, and about 3% need definitive treatment.3 These findings have the potential for both benefit and harm. Potential harms include additional diagnostic testing to determine that an abnormality is of no clinical importance, as well as treatment of findings that may never pose a threat to a patient’s health or even become apparent without screening (i.e., overdiagnosis and overtreatment). Radiation-induced cancer is a potential long-term concern with repeated use of CT colonography. No studies directly measured this risk, but radiation exposure during the procedure appears to be low, with a maximum of about 7 mSv per examination.3 In comparison, annual background radiation exposure in the United States is 3 mSv per year per person. Although seven new studies have examined the potential harms associated with CT colonography since the prior USPSTF review,3 high-quality evidence remains lacking to draw clear conclusions about the ultimate clinical impact associated with the detection and subsequent workup of extracolonic findings. Given the frequency with which these incidental findings occur, it is difficult to accurately bound the potential net benefit of this screening test without this information.
 
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I would personally get it. I think finding extracolonic stuff is important, as someone who reads lots of body studies. We can argue about the data ad nauseum but I'll let the research people hash it out. We all know that payment approval decision depend not only in the science but the economics and politics.

I think that it should be offered as an option. People should decide whether they want VC or optical. It should be like screening mammo. You don't need a doctor's script to get one. I definitely would not want VC to be dependent on the referral of GI. That is why cardiac CT has not taken off because it is mostly ordered by cards even though the research has shown it to be as good and more cost effective than stress test, etc.

I believe that VC will get approval eventually. May take another 5 years or so. Some insurances already pay for it. In the meantime, I have my plate full with other stuff. Once it is approved, it will be a new frontier and opportunity like lung cancer screening is today.
 
Taurus said:
I would personally get it. I think finding extracolonic stuff is important, as someone who reads lots of body studies. We can argue about the data ad nauseum but I'll let the research people hash it out. We all know that payment approval decision depend not only in the science but the economics and politics.

I think that it should be offered as an option. People should decide whether they want VC or optical. It should be like screening mammo. You don't need a doctor's script to get one. I definitely would not want VC to be dependent on the referral of GI. That is why cardiac CT has not taken off because it is mostly ordered by cards even though the research has shown it to be as good and more cost effective than stress test, etc.

I believe that VC will get approval eventually. May take another 5 years or so. Some insurances already pay for it. In the meantime, I have my plate full with other stuff. Once it is approved, it will be a new frontier and opportunity like lung cancer screening is today.
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VC is also only as good as the radiologist reading it, no? Someone in the community who only does a handful a year is not as competent as the one at the academic center who reads hundreds. This will also be a rate limiting step for the mass deployment of this option for screening. Although you could also argue this point for the surgeon who only needs 50 colonoscopies to graduate and may do even less than that each year once practicing.
 
You need to watch colonoscopies for a day and see all the right sided flat ssps we find. The "research people" haven't proven CTC saves lives and you can't possibly see these lesions.

The extra colonic findings are a huge PITA. If I order it, I have to ensure they are followed up (you aren't going to ever do that for me). Huge waste of PCPs time with no proof of benefit.

Its not a good test. Look I practiced in the Navy for years and saw CTC up close and personal since we were part of the original studies. My experience was not positive.

It is inevitable that a noninvasive test will disrupt average risk screening in the future. It's very likely to be an imaging test. As long as it improves screening rates, there will still be lots of colonoscopies to do. CTC isn't that test for all the reasons I listed at the start and the ones written by the USPSTF.
 
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http://www.ncbi.nlm.nih.gov/m/pubmed/26280354

Colorectal Polyps Missed with Optical Colonoscopy Despite Previous Detection and Localization with CT Colonography.

Blah, blah. Like I said, I'll let the research guys hash it out. I'm just waiting for reimbursement approval which is coming. Obama got a virtual colonoscopy.

Remember that USPTF dragged its feet on lung cancer screening too. The case for VC grows every year with more research and better techniques.
 
Totally anecdotal but I have been shocked by the number of polyps > 5 mm (even a few 1 cm or more, esp flat polyps) that I have found scoping someone who had a single polyp visualized on CTC. Not impressed. One patient had 7 more polyps than the one identified on CTC, a few of which were well above the 5 mm CTC limitation. Again anecdotal but I've heard the same from others.
 
whichever test goes second will always find missed lesions. No one claims colonoscopy is perfect. Colonoscopy after colonoscopy finds missed lesions too. It's the gold standard but not perfect. Colonoscopy decreases the rate of colon cancer by 70%. Again, that study doesn't exist for CTC. Instead they keep publishing this sort of drivel.

I was waiting for the Obama argument. His version of CTC included an immediate read and plan for immediate colonoscopy obviating the need for a repeat prep. VIP medicine not in any way applicable to population screening.

It may well get approved someday. PCPs will still hate it because of all the extra work due to the incidentalomas, patients will hate getting repeat colonoscopies and the actual procedure being unpleasant, payers will hate it because of the unclear/short screening intervals and GIs won't order it.
 
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For PCPs, if they order a CTC, they will have to work up an extra colonic finding in 40% and refer for colonoscopy in 25+%. Refer for colonoscopy and they are done.
 
Gastrapathy said:
For PCPs, if they order a CTC, they will have to work up an extra colonic finding in 40% and refer for colonoscopy in 25+%. Refer for colonoscopy and they are done.
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And you won't know you have a 3 cm mass in your liver if you just get optical colonoscopy. But who cares about that. :D
 
Taurus said:
And you won't know you have a 3 cm mass in your liver if you just get optical colonoscopy. But who cares about that. :D
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That is a great example. In a patient without risk factors, the vast majority of these will be hemangiomas, FNH or focal fatty sparing. But, we'll have to get an MR to prove it. The patient will spend a month knowing she has a "liver tumor" and someone has to order, pay for and followup the MR result. Fantastic.
 
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http://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&ItemID=113072

CTC excels in matchup with FIT, colonoscopy
By Eric Barnes, AuntMinnie.com staff writer

December 30, 2015 -- In the first randomized trial to pit CT colonography (CTC) against the fecal immunochemical test (FIT) and conventional optical colonoscopy, FIT yielded a higher participation rate than CTC but found fewer cancers and advanced lesions, according to results published in the Journal of the National Cancer Institute.

Meanwhile, reduced-prep CTC attracted more participants than full-prep CTC, without a significant difference in detection sensitivity between the two -- and both forms of CTC yielded more participants than optical colonoscopy, said investigators from the University of Florence in Italy. CTC detected more cancers and advanced adenomas per participant and per trial invitee, wrote lead author Dr. Lapo Sali, PhD, and colleagues (JNCI, December 30, 2015).

Dr. Lapo Sali, PhD, from the University of Florence.
"Our study confirmed the high detection rate of screening CTC for cancer and advanced adenoma, which was threefold greater than that of one FIT round and was not statistically significantly different from that of colonoscopy," Sali wrote in an email to AuntMinnie.com. "These data support the potential of CTC for population screening of colorectal cancer."

Notably, almost one-third of the people invited to undergo the exam responded, despite a general lack of knowledge about CTC, he added. Sali is an assistant professor of experimental and clinical biomedical science at the University of Florence.
 
Like I said, the scientific evidence for VC grows every year. It's only a matter of time before it's approved for reimbursement and widely adopted.

Don't hate the playa, hate the game, eh? ;)

I'm sure there is enough work to go around for everyone. I'm just excited about new growth area.
 
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Gastrapathy said:
That is a great example. In a patient without risk factors, the vast majority of these will be hemangiomas, FNH or focal fatty sparing. But, we'll have to get an MR to prove it. The patient will spend a month knowing she has a "liver tumor" and someone has to order, pay for and followup the MR result. Fantastic.
Click to expand...

I find lots of clinically significant stuff on body studies that are not part of original indication. Day to day, there is more pathology in body studies than in any other body part.
 
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