The field of gastroenterology is changing and practitioners must embrace the advances and new technology to ensure their practice evolves with the field, according to a report released by the American Gastroenterological Association (AGA) Institute's Future Trends Committee. The report, "The Disappearance of Screening Colonoscopy and the Transformation of Gastroenterology Practice," was developed from a consensus conference held in April 2006 and published in the October issue of Gastroenterology.
As a leader in gastroenterology, the AGA Institute convened the consensus conference to study possible impending changes to the field and guide development of a strategy to help gastroenterologists better prepare their practices and careers for the future.
Despite the diversity of current gastroenterological practices – ranging from physicians in small private practices to those in larger groups and academic medical centers – all practitioners face similar challenges in the future: the forces of increasing demands for services, the pressure to limit or curtail healthcare expenditures, and technological advances. The changes may create stress for gastroenterologists; however, by preparing now for the future, the AGA Institute works to ensure that the science and practice of gastroenterology will continue to thrive and flourish.
"As in all fields of science, change is inevitable as practitioners and researchers become more knowledgeable about disease. These changes will continue to alter current practice and how gastroenterologists are trained, as well as the economics and organization of gastroenterology practices in all settings – both private and academic medical centers," according to Robert S. Sandler, MD, MPH, Vice President, AGA Institute, and Chief, Division of Gastroenterology and Hepatology, University of North Carolina.
Based on presentations at the conference, the Committee developed several conclusions to help guide gastroenterologists in their practices:
- Gastroenterologists need to be aware that technological developments in the area of gastroenterological imaging and testing, especially related to colorectal cancer (CRC) screening, are liable to make some common endoscopic procedures currently performed by trained gastroenterologists obsolete.
- Given that such procedures – especially CRC screening – constitute a large portion of gastroenterology practice revenues, if this happens the economic consequences would be considerable for both community and academic practice, which would be further exacerbated by continuing downward pressures on reimbursement.
- To maintain their practices, gastroenterologists may need to look into offering other services such as obesity treatment, Natural Orifice Translumenal Endoscopic Surgery (NOTES; which uses a natural orifice approach to intra-abdominal surgery) and gastroenterological cancer chemotherapy among others. Furthermore, increased utilization of nurse practitioners and physician's assistants will be necessary.
- Philosophically, gastroenterologists may need to position themselves as the coordinator or manager of all digestive health care a gastroenterology patient needs.
- AGA should continue advocacy and public policy efforts to work toward increased reimbursement for nonprocedural services.
- Gastroenterological training, through gastrointestinal fellowship programs and continuing medical education for those already in practice, will need to be revised to reflect the new directions in practice.
On many of these fronts, the AGA Institute is already taking steps to help better prepare our members and the field for these impending changes. The recommendations made by the Future Trends Committee will help inform the strategic planning process which guides the association in training, education and policy programs as well as domestic and international collaboration with other medical societies.
According to Timothy C. Wang, MD, Future Trends Committee Chair and Chief, Division of Digestive and Liver Diseases, Columbia University, New York, "By convening the Future Trends Committee, the AGA Institute is taking a leadership role in ensuring gastroenterologists are prepared for the future. It is vital that gastroenterologists, both in academic and community practice settings, not be complacent. They should use this report to help ensure their practices are poised to change in order to meet these challenges and the growing needs of Americans."
The AGA Institute Future Trends Committee developed the report based on a consensus conference it convened on April 1 – 2, 2006, "If endoscopy disappears, then what?" The purpose of the conference was to develop a report based on expert opinions from both community and academic gastroenterology practices that:
- Describes the specific technological and economic challenges to the gastroenterology practice status quo;
- Assesses the potential impact and timing of these changes;
- Presents strategies for coping with these changes; and
- Makes recommendations to the AGA/AGA Institute for programs and actions to enable its members and the specialty manage these potential changes.
The report reflects the panel's assessment of the data available at the time of the conference. The Future Trends Committee is wholly funded by the AGA Institute.
About the AGA Institute
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is one of the oldest medical-specialty societies in the United States. Comprised of two non-profit organizations--the AGA and the AGA Institute--our more than 15,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization's practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. For more information, please visit www.gastro.org.
About Gastroenterology
Gastroenterology, the official journal of the AGA Institute, is the most prominent journal in the subspecialty and is in the top one percent of indexed medical journals internationally. The journal publishes clinical and basic science studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, CABS, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit www.gastrojournal.org.
Journal
GASTROENTEROLOGY