how do you feel about the future of the specialty with FIT Test trials vs Colonoscopies

[javksmith93]

Fit test trials include things like CONFIRM trial and other factors include Canada not recommending colonoscopies anymore.

Are you worried that if colonoscopies rent the modality of choice for screening that compensation will go down a lot?

I ask as someone considering GI vs Surgery but with boat loads of debt im not sure where the future is headed, and salary is one thing that is important?

How is the job market for advanced endoscope fellows Reddit seems to say its quite good but on here people say its bad?

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[Gastrapathy]

Colonoscopy will remain a mainstay of CRC screening because it is therapeutic. We'll be ok.

GI and surgery are very different paths. Pick the one you can do for a lifetime.

Adv endo is becoming saturated.

 

[siliso]

VA’s been doing FIT for years and the GIs and the endoscopy suite still plenty busy. All the positive tests need scoped, as do all the people with family hx or hx of polyps or symptoms...maybe if your whole business is just doing screening cscopes it would be a minor threat. But I say minor as the uptake on screening colonoscopy is far from universal and getting a larger population to do FIT via primary care may bring more clients to the scope to f/u a positive than would have come before. Time will tell.

 

[GastriqueGraffin]

There is no shortage of indications for GI and if anything these are growing. Some are encroaching into conditions that were entirely surgical managed in the past. Since you’re still very early in your training, I think it’s reasonable to ask that question because what the field looks like today will likely not be the same in 30-40 years from now but I like where we are headed.

 

[1Cor1557]

Fit and fobt are a gold mine for GI. I do repeat colonoscopies because Primary Care docs constantly order another fit that is positive after a clean colon from last year that was not due for a follow-up in 10 years. Now we have actual more data and research suggesting that these cannot be neglected and actually suggest a higher risk of advanced neoplasia in the future and should in fact be scoped thus we have medical evidence to back this up as a practice as well.

 

[downthedrain]

Despite the trials, I've scoped multiple patients with a negative FIT test, but have iron deficiency and found huge polyps in these people. One was actually so big, it had to be surgically resected. I'm not sure if the patients were doing it properly since it was ordered by PCPs, but I honestly tell everyone I know that there is no substitution for a colonoscopy. Unless you have such bad COPD/OSA that I need to intubate you and can't extubate you, there's very few people I won't recommend at least trying a colonoscopy on.

 

[Anicetus]

Fit test trials include things like CONFIRM trial and other factors include Canada not recommending colonoscopies anymore.

Are you worried that if colonoscopies rent the modality of choice for screening that compensation will go down a lot?

I ask as someone considering GI vs Surgery but with boat loads of debt im not sure where the future is headed, and salary is one thing that is important?

How is the job market for advanced endoscope fellows Reddit seems to say its quite good but on here people say its bad?

Maybe it’s my city but I have yet to meet a GI doc who does not think reimbursements will get slashed in the near future. If a single embodying government-run entity takes a role in screening procedures, they will for sure slash screening colonoscopy reimbursements and the “easiest place” to take money for that cut is the pocket of the gastroenterologist.

There is also this “scoping tech” thing on the rise where GI docs may just be reading these screening scopes instead of actually doing them, while only preserving scoping for complex cases. But this is still up in the air.

I wouldn’t hang your hat on salary for decision making but that’s just me. Too much changes too quickly for a job you get stuck with for life.