Internists performing endoscopy

[Firebird]

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Hi,

I'm about to start PGY3 and was wondering if anyone has any experience with your program training general internal medicine residents to perform screening colonoscopy or any other endoscopic procedure. The increasing demand for screening endoscopic procedures may increase at a rate greater than surgeons and gastroenterologists can keep up with, and so I suspect that generalists, who used to do screening flex sigs all the time, would have at least the possibility to fill this void. Any thoughts?

 

[Jccripe]

I cannot see that as a reality. Endoscopic procedures take a while before anyone can get good at them. And they are a cash cow, so i doubt GI and CRS will ever let anyone else do them.

 

[Gastrapathy]

I'll train anyone who can devote the time. The ASGE website has a guideline for training non-gastroenterologists in endoscopic procedures. I tell the FPs who want to learn that I will follow the ASGE's recommendations but that, if they can find the time, I'm game. Once they read it, they usually look elsewhere.

Internists...haven't seen it. After all, you can do the dang fellowship.

 

[dragonfly99]

When I was a med student there was a family practice doc (pretty much rural area) I know of who was doing colonoscopies for his patients. I don't know who trained him.

 

[Pkboi24]

When I was a med student there was a family practice doc (pretty much rural area) I know of who was doing colonoscopies for his patients. I don't know who trained him.

Yeah, more and more family docs are training in screening colonoscopies. I went to this FM residency dinner where they try to recruit you and it was all the guy next to me could talk about. It seemed like he was one of those guys who prided himself on being "a real doctor" who could "do anything". I kept quiet and ate my chicken.

 

[berkshire]

If I remember correctly, a number of studies have found similar results when comparing trained FM docs vs. GI docs when performing EGD. I think the data shows better colonoscopy results with GI, but I could be wrong.

I've heard from FM friends that there are a number of significant barriers to increased adoption of endoscopy. The investment is huge--equipment is very expensive, need to hire or re-train nurses, training takes away from clinic time--but also the reward is poor. Re-imbursement for FM EGD is less than GI EGD, and to compound this, FM docs have less patients per week or month who need endoscopy. If you only see 3-4 patients a month who need an EGD it doesn't justify the investment.

So even though there are definitely FM practitioners who perform EGD, for example, the numbers are small.

 

[Firebird]

I'll train anyone who can devote the time. The ASGE website has a guideline for training non-gastroenterologists in endoscopic procedures. I tell the FPs who want to learn that I will follow the ASGE's recommendations but that, if they can find the time, I'm game. Once they read it, they usually look elsewhere.

Internists...haven't seen it. After all, you can do the dang fellowship.

Thanks very much for the reply. I could very well do the fellowship. The problem is, I like doing general medicine. I like dealing with the variety that a general internist sees.

When I was first exposed to primary care as a student, the FP doctor that trained me was able to do a number of obstetric and gynecologic procedures, including c-sections and colposcopy. At that time, I developed an interest in carving out a unique niche for myself, much like that physician had done for himself. I have evaluated a number of ways to do this, including learning aesthetic procedures, doing additional critical care than what is typically afforded to generalists in my town, or performing stress tests (which is not that out of the ordinary for a PCP). Endoscopy is more interesting to me than any of these others, but I do recognize the roadblocks associated with doing something like this.

I looked at the website for the ASGE and I could not with 100% confidence find what I thought were the guidelines you mentioned. Do you have a direct link? Also, in your opinion, how many procedures does it take to be "qualified" to be privileged to perform endoscopy?

Thanks so much.

 

[Gastrapathy]

Thanks very much for the reply. I could very well do the fellowship. The problem is, I like doing general medicine. I like dealing with the variety that a general internist sees.

When I was first exposed to primary care as a student, the FP doctor that trained me was able to do a number of obstetric and gynecologic procedures, including c-sections and colposcopy. At that time, I developed an interest in carving out a unique niche for myself, much like that physician had done for himself. I have evaluated a number of ways to do this, including learning aesthetic procedures, doing additional critical care than what is typically afforded to generalists in my town, or performing stress tests (which is not that out of the ordinary for a PCP). Endoscopy is more interesting to me than any of these others, but I do recognize the roadblocks associated with doing something like this.

I looked at the website for the ASGE and I could not with 100% confidence find what I thought were the guidelines you mentioned. Do you have a direct link? Also, in your opinion, how many procedures does it take to be "qualified" to be privileged to perform endoscopy?

Thanks so much.

http://www.asge.org/WorkArea/showcontent.aspx?id=3572

This is an old document when the minimum numbers were lower but the concept is explained. The current minimum numbers are 130 EGDs and 140 colos.

 

[mig26x]

in some places nurses do colonoscopies, why not let an IM trained physician do it?

 

[Daniel565]

My uncle's a GI, he told me that he would perform endoscopies & colonoscopies before his GI fellowship while working in a rural area.
He also explained that if there is a GI around then he should always do it, if there isn't a GI around then a trained internist can often do it.
That was ~7 yrs ago in NC. Is this reasonable or did I just misunderstand something?

 

[Ash MD]

Reasonable.

Remember when FP's used to do appy's?

 

[dubmaster123]

The place where I did my 4'th year fp elective had attendings doing appys and other gen surgeries as well as anaesthesia, one of them was also head of the OB/GYN dept in the hospital. This was in a pretty well developed area in the mid-west...

kinda cool...

 

[sevo85288]

FPs did C sections. OBs did there own anesthesia. Peds do circs.

FPs should get further training and gain skills like endoscopy, TTEs, hysteroscopy/biopsies, basic suturing of wounds/urgent care; etc. Perhaps an additional year of practice to make them more well rounded/marketable.