As a year unlike any other comes to a close, several trends emerged in gastroenterology over the past year that will continue to emerge in 2021. Here, six gastroenterologists share their predictions on the future of the specialty:
Note: Responses were edited for style and content and presented alphabetically.
Fred Askari, MD, PhD, director of the Wilson Disease Program at Ann Arbor-based Michigan Medicine: COVID-19 has accelerated the move toward virtual visits for our clinic. Virtual visits have been favorably received by many patients, particularly those who drive long distances for appointments. I anticipate virtual visits will make up at least 50 percent of office visits going forward based on patient demand.
Caregivers and educators will have to adapt to the pandemic and patient-driven change to virtual practice. There will be more virtual caregiving, teaching and learning for medical students, residents and fellows anticipated in 2021 which was virtually unheard of prior to 2020. 2021 will also bring further cost cutting initiatives with reductions in non-essential support staff and a move toward a seven-day-a-week active outpatient and hospital practice. These management initiatives will likely lead to further unionization of the healthcare workforce in 2021.
Challenges with organ availability will fuel the growth of living-donor liver transplantation in 2021, and sadly, we will likely see greater numbers of people presenting with alcohol-induced liver disease given the well documented uptick in alcohol use in 2020.
Novel treatments driven by advances in biotechnology will lead to clinical trials of artificial intelligence-developed nucleic acid treatments and gene therapies in 2021 for Wilson disease, as well as ongoing studies with novel copper reduction treatments.
Anil Dev, MD, gastroenterologist at New York City-based BronxCare Health System: GI is well poised to maintain strong growth in coming years. New technology and procedural armamentarium will help fuel specialty growth. However, the cost of new technology and accessories is prohibitive in early adaptation. More competitive pricing for scopes and accessories is needed to contain cost curves and retain an edge in care coordination.
Sam Giordano, MD, gastroenterologist at Camden, N.J.-based Cooper University Health Care: It was a tough year for gastroenterology, as it was for many medical specialties, but there is much to look forward to in 2021. It will be refreshing to embrace COVID-19 vaccinations and turn the corner on a return to normalcy following a year of disruption and hardship.
Many patients delayed medical care during a time when elective procedures were put on hold, and this resulted in many diagnoses that may have been made later than ideal. I look forward to getting back to helping patients in a timely-fashion, and I am still trying to unload my patient backlog from that time.
Secondly, I look forward to the implementation of the new U.S. Multi-Society Task Force Guidelines with the recommended screening age being reduced to 45 years of age for all. This is long overdue, and it is certainly a balancing act trying to keep in mind public policy as a population, with an individual experience. I personally have seen too many young persons unfortunately well under 50 fall victim to advanced-stage colon cancer. There is nothing more heartbreaking than to break this news to a young family, and the hope is that this monumental change in policy lowering the screening age to 45 will allow us as clinicians to have less of those conversations.
Lastly, I am looking very much forward to new endoscope technology and the implementation of AI to aid in polyp detection. As someone who takes great pride in my personal adenoma detection rate, I realize that none of us are perfect and the hope is this improved technology will take us a step closer to achieving that goal. Wishing everyone a happy and healthy 2021.
Steve Morris, MD, gastroenterologist at Atlanta Gastroenterology Associates: [This year] was the annus horribilis in GI and healthcare in general. Any view toward 2021 has to take into account what has transpired and longer term implications. It is the first time that physicians have seen societal events dramatically alter their ability to work and earn an income. As a consequence, I believe 2021 will see acceleration of a trend towards perceived safety and stability with employment of GIs by hospital systems and managed care consortiums, and [2020 will see] the continued consolidation of private practices into large GI platforms.
These changes already had momentum and the COVID-19 crisis will prove a tipping point. GIs will continue to expand into the outpatient setting by owning and partnering to provide [care in] an ASC setting for an increasing number of procedures. Insurers will finally resist the much more expensive alternative of doing elective cases in a hospital.
GI physicians will need to offer in-office infusion services for patient cost and convenience as more biologics and biosimilars are available for therapy. Telemedicine will be part of everyday practice as will social distancing in offices and ASCs for years to come.
Finally, I believe we will see GI practices start to take on more risk as part of a value proposition; this was in its nascency but derailed as part of the crisis. GI practices that are truly forward thinking will expand to include colorectal and laparoscopic surgeons, and even GI oncology expertise to be able to fully serve all their patient’s needs as part of a risk sharing model.
Chris Shaver, MD, CEO at Birmingham (Ala.) Gastroenterology Associates: Our medium-sized, single-specialty GI practice experienced the very real challenges and uncertainties characteristic of the coronavirus pandemic. Our general approach to this unprecedented event included staying open for business through consolidating provider schedules in our clinics and hospitals, [offering] telemedicine, [making] appropriate adjustments in office staffing and instituting protocols to protect our patients and employees. Along the way, we learned a lot about our business and our people. This information enabled us to make some positive clinical and operational adjustments that will persist well beyond COVID-19.
Pulling out my crystal ball, here are some projections regarding the GI landscape in 2021:
1. There will be a COVID-19 endpoint. My hope is that societal shutdowns and unbridled fear will die with the virus. In the meantime, it is a privilege to take care of patients afflicted and affected by the infection.
2. Progressive GI practices will value a holistic and personalized patient experience where GI care points are optimized through replete ancillary service lines.
3. Onerous healthcare regulations and downward revenue pressures will continue to consume enormous amounts of valuable practice resources. Unfortunately, this self-perpetuating creep will continue.
4. Consolidation will follow my No. 2 and No. 3 point above. Independent GI practices will search for the best playbook to consolidate their market. If they do not, existing private equity backed platforms will be more than happy to call the plays.
5. There will be amplified understanding of how to effectively market our practices.
6. Recruiting five-star talent will become more important than ever.
7. Telemedicine will continue as a niche customer service line.
8. If the new colonoscopy pill preparation is effective and safe, it will reshape its market.
My practice administrator [Ben Shelton] said it best: "This year has given all of us the inspiration we needed to stay hungry and keep pushing to expand and grow,” and so, we will.
Larry Schiller, MD, program director of gastroenterology at Dallas-based Baylor Scott & White Health: I'm no Nostradamus, but here are a few thoughts:
1. Demand for endoscopic services will continue to rebound from pandemic-induced lows, driven by missed screenings and extension of the age range for colonoscopy screening down to age 45.
2. The number of medical residents opting for a career in GI will remain high. The number of fellowship positions may expand modestly.
3. The number of more senior GIs opting for retirement or employment by academic centers will increase as the large cohort of GIs trained in the 1970s and 1980s age.
4. Telemedicine services in GI will continue to expand and will be supplemented by app-based electronic interfaces and novel home-visiting services by mid-level providers to collect vital signs, physical examination data and conduct laboratory tests.
5. Healthcare systems will continue to expand GI services to access a large volume of procedures with generous margins. In more rural areas, regions with one hospital, one GI practice, this process is well-underway and will go on to completion.
6. Private equity platforms will continue to consolidate GI practices in an attempt to standardize operations and supply chains to maximize margins and try to leverage size to maintain or increase reimbursement.
7. The eight PE platforms will start to merge, leaving three or four surviving entities as national competitors which — in time — will pair up with insurers to create one-stop sources for medical care.
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