As someone who just finished GI fellowship (and residency) in Texas (and medical school in Kentucky), and is doing a 4th year, I'll add fuel to the fire.
In Kentucky, I heard from a practicing GI in the Commonwealth that 50% of digestive endoscopy there is done by surgeons. This is a combination of factors -- rural state (so not enough GIs in the boonies), and the main/largest GS program in the state (University of Louisville) imbues in their surgeons the idea that they are the complete/ultimate physician -- which isn't a bad way to train, but should be tempered by the reality that there is just too much to do for one person to be good at all of it.
Texas is obviously going to vary more depending on an urban versus rural setting. Where I did my residency and fellowship, Parkland (UTSW), we had the R4 surgeons rotate with us for a month to get their GI endoscopy #s. In general, unless it was the CRS service or a Trauma case (for an upper), surgeons just did not do any significant amount of GI endoscopy at this institution. Unless is was a surgeon planning on a laparoscopic/bariatric or CRS fellowship (or going straight into Gen Surg, but there are none of those any more
), every surgeon that rotated on our service used the month as a blow off/vacation/interview for fellowship/go to an out of town conference, get by with the bare minimum experience for #s. These are good surgeons, some of the best trainees in the country, but they obviously had no interest.
Now, the ones who where planning on fellowships I mentioned above, they took the time somewhat more seriously, but they also QUICKLY realized that GI endoscopy is more than just inserting a scope into an orifice and pushing it in then pulling out. Most (not the CRS ones, of course) unequivocally stated they planned to do minimal to no flexible endoscopy in their future practice, and certainly not for screening or investigating GI complaints.
Frankly, I shudder to think about many of the screening/surveillance colons I've seen/heard of done by boarded CRSs. Don't get me wrong -- there are CRSs who are excellent colonoscopists. But, and this is a big but, there are a lot more, not to mention all the GSs out there, who don't have any idea what they are doing or what they are looking at. This last point is key -- for the most part, the dextrous parts of endoscopy (or surgery, I would venture to guess as well) can be taught to anyone with two hands, no movement impediment/disorder, and who has the desire/intention. IT IS what you do before a procedure, during a procedure (managing the findings), and with the results afterwards, that makes the real difference.
There is a big difference between dropping a flexible endoscope into someone to study your anastamosis or area of planned resection versus looking for AVMs, SUBTLE sessile carpet like polyps spanning multiple folds, inflammatory changes and the distribution of said changes, and then knowing what to do with those and a myriad of other findings. You learn these things in a GI fellowship, not in General Surgery residency or CRS fellowship. Society guidelines for polyp f/u based on size and histologic criteria are BARELY followed in the real world by boarded GIs, so when you hear of these people getting yearly colons by a CRS for hyperplastic polyps.....really, are you that surprised? And this is just colons -- don't forget EGDs and other endoscopic procedures. ERCP may be a little different, but I still believe that there is a difference in the approach that people trained as Endoscopists take compared to those who are trained as Surgeons and then learn endoscopic techniques, when it comes to the endoscopic management of patients.
For the time spent, colons (and EGDs) pay well compared to many bread and butter Gen Surg procedures (or compared to most things in Medicine and Surgery, for that matter), and better than ERCP/EUS (unless you learn to do those procedures well and can do them efficiently, for the most part). This is why GI has become one of the most competitive specialties to get a fellowship spot in. Most hospital GI labs with a busy endoscopy service have decent turnover and even without an ASC as part of your practice, GIs who only do cases in the hospital do pretty well. Not to say, that ASCs aren't a desired component for any practice (for the time being
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As for PAs/NP doing colons and EGDs, this is also a manpower distribution issue. But there is a big difference between doing screening colon for someone who has no symptoms and doing a colon as part of a diarrhea or anemia work-up. Hopefully, patient distribution will reflect that.
Bottom line -- people train to do certain things and there's a reason why there's a GI fellowship after IM or why you can fast-track Gen Surg to do Vascular Surgery. But it's all about being trained the right way, and then doing things the right way.
To speak to the original point, no Gastroenterologist I know is exactly going hungry. What does piss us off is the referral from a surgeon for a patient with diarrhea or anemia who has already had a colon done by the surgeon, and so that part of the work-up (which is the most $$$ lucrative part) is denied to the Gastroenterologist. Furthermore, you have no idea if the colon was done correctly (were random biopsies of the colon taken? Was the terminal ileum intubated and visualized?). So then you repeat the colon and hope that insurance doesn't stick your patient with the bill, denying a repeat colon so soon. This isn't right for the patient.