Keeping Up With the Rapidly Changing Field of Gastroenterology: Q&A With Dr. William Katkov of Saint John's Health Center

Dr. William KatkovWilliam Katkov, MD, is a gastroenterologist affiliated with Saint John's Health Center in Santa Monica, Calif. Here he discusses how the uncertain state of the medical field impacts gastroenterologists, research that is changing the face of the field and the past and future of gastroenterology.

Q: What do you feel is currently having the greatest effect on how you practice?

Dr. William Katkov
: Gastroenterologists in private practice face a daunting number of challenges that are the direct consequence of rapidly evolving changes in the medical marketplace. These changes include consolidation on a large scale, diminishing reimbursement, the emergence of dominant health systems and the central role of hospitals in many communities. Many gastroenterologists are experiencing the anxiety of an uncertain future and the fear of being left behind without access to patients. The new reality, at the very least, jeopardizes the traditional private practice model.

Compounding all of this is the rapid shift in the goals and aspirations of new specialists emerging from GI fellowships. For most new graduates, traditional private practice is not a preferred option given the uncertainties surrounding reimbursement, as well as changing lifestyle goals. Gastroenterologists who own ambulatory surgery or endoscopy centers are faced with the same pressures and issues.

Q: Are there any developments in gastroenterology research you are excited about?

WK: There are a number of exciting developments in gastroenterology research. Steady progress has been made in the treatment of chronic viral hepatitis over the past 25 years. While it has been only two years since triple-drug therapy for chronic hepatitis C was approved by the FDA, interferon-free regimens are in Phase III clinical trials with very promising results. We are now in the era of biologic therapy (e.g. infliximab etc.) for inflammatory bowel disease. The use of these agents continues to be refined and expanded.

Colonoscopy remains the foundation of colon cancer prevention and detection. Large-scale clinical trials have provided irrefutable evidence that colonoscopy prevents colon cancer. Our appreciation of the role of the human microbiome has led to an explosion of very exciting research that will alter our view of a number of disorders. We are in the early stages of our understanding of the role of gut bacteria in health and disease.

Q: How has the field of gastroenterology changed in the past 10 years?

WK: The most significant changes in gastroenterology over the past 10 years have been the assimilation of new research and the ongoing refinement of the use of diagnostic and therapeutic techniques for the maximum benefit of patients. Every research area and advance noted above has affected the practice of gastroenterology. In addition, gastroenterologists, like all physicians, have had to begin the process of adapting to a rapidly changing professional environment. The choices facing mid- and late-career physicians are unprecedented.

Q: What do you foresee for the future of gastroenterology?

WK: The practice of gastroenterology will transform along with medicine in general. To be successful in the future, and to combat the anxiety that accompanies rapid change, it is essential that gastroenterologists think strategically. Strategies will vary depending on a physician's age, the surrounding community and the nature of the dominant health system(s) in a particular area.  Adaptation is the key, and this requires new and sometimes uncomfortable ways of thinking.  Those with whom we traditionally did not cooperate may become partners, including hospitals and competitors.

For many gastroenterologists, endoscopy centers are a key element in planning for the future. While "taking money off the table" may be attractive in the short run, the most important goal is long-term sustainability. The efficient delivery of high-quality care will continue to be rewarded, but alignment with hospitals and health systems is essential.   

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