The Good, the Bad & the Ugly: The Economics of GI

Two gastroenterologists identify some of the biggest economic opportunities and challenges in the GI field.

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: How can gastroenterologists leverage data to gain access to improved reimbursement rates?

Please submit responses to Carrie Pallardy at by Thursday, July 1, at 5 p.m. CST.

Q: What are some of the biggest economic challenges and opportunities in the GI field?

RichardDwyerMDRichard Dwyer, MD and Chief of Gastroenterology at CHA Hollywood Presbyterian Medical Center (Los Angeles): One big challenge in gastroenterology, and the medical field in general, is trying to anticipate and adapt to the rapidly changing rules in medicine. It is another great challenge to maintain a positive attitude in the face of diminishing respect and revenue. Physicians are no longer respected much anymore by regulatory and governmental agencies, which treat us as though we're employees. Reimbursement rates are going down while rent and salaries are going up. When medical students graduate with a half-million dollars in loans and the ability to earn money severely limited by that same agency that created the debt, it turns physicians into indentured servants.

Opportunities for economic development do exist — the safest route is to become an employed physician by a large organization with good benefits and retirement. But more sustainably, I recommend all young physicians acquire an MBA so they are competent and comfortable running their own division. A background in creating budgets and monitoring expenses is an important opportunity for a physician amidst the changing financial landscape. Lastly, exposure is an important opportunity. Exposure comes with risk, but for a younger physician, getting out there is worth it, from a financial standpoint.

Dr. Eugene YoonEugene Yoon, MD, St. Joseph Health's St. Jude Heritage Medical Group (Fullerton, Calif.): Our biggest economic challenges go hand-in-hand with our biggest opportunities. We're challenged with meeting a growing demand for colonoscopy screenings, the importance of which we've been trying to promote for years. This increased demand is coming at a time when the healthcare system in the United States and the way it operates is undergoing a seismic shift. Coverage of colorectal cancer screening tests is required by the Affordable Care Act and many people who had put everything but exigent health concerns on the backburner are coming in for screenings, which is a good thing.

As GI physicians who focus a lot of our efforts on prevention, we're always looking for new technologies that make detecting colon cancer easier on the patients. Earlier this year, a panel of FDA experts recommended approval of an at-home stool test that screens for colorectal cancer with a high degree of accuracy. Things are changing all the time. One of our biggest opportunities is finding innovative and cost-effective ways to educate patients about the benefits of colonoscopy and other screenings and get beyond the stigma.

It's clear to me that we need to reach people earlier. We are seeing a disturbing shift in the average age of people with colon cancer.  In just the past three or four years, we've diagnosed many more young people — people in their 20s and 30s — with colon cancer. That population perceives colonoscopy and other screenings as tests that only their parents and grandparents have to have; that's simply not true. There's an opportunity here to educate everyone about the symptoms of colorectal cancer.

The good news is that death rates from colorectal cancer have been dropping for the last two decades because we're removing polyps before they become cancerous and finding the disease earlier, which increases survival rates. We need to get people thinking about these tests in the same way they think about going to the dentist — as an investment in their long-term health. You may not look forward to going but you feel better for having done it and getting checked out.

More Articles on Gastroenterology:
ASGE Names Dr. Colleen Schmitt President, Announces New Board Members: 5 Things to Know
Colonoscopy Price Variation in HOPDs vs. Community Settings: 4 Things to Know
Capsule Endoscopy vs. CT Colonography Following Incomplete Colonoscopy: 4 Things to Know

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