Physician shortages won't make med school shorter, says ASC CEO

Gastroenterologists are an aging specialty, and training a new one still takes over a decade despite shortages across healthcare.

Michael Weinstein, MD, president and CEO at Silver Spring, Md.-based Capital Digestive Care, told "Becker's ASC Review Podcast" that even though other countries train capable physicians more quickly, the U.S. will likely use other strategies to address shortages.

Note: This is an edited excerpt. Listen to the full podcast episode here.

Question: It takes 13 years to train a GI in the United States, but look at India. They almost start their medical school out of high school, and they're done earlier. Don't we need to make it a little bit easier to become a doctor in this country if we're going to meet the needs we have?

Dr. Michael Weinstein: You are bucking up against 150 years of tradition. I'm not sure we're going to be able to do that. I think we're going to look at alternative providers who can be more focused on certain types of care, like using nurse practitioners who are trained in gastroenterology. So maybe it takes three years or four years to train people who are very competent, particularly if they have the backdrop of a more trained gastroenterologist. So as a gastroenterologist, I can probably oversee three or four nurse practitioners who are working and multiply [our] work through the use of the [advanced practice providers]s.

Q: Is there a limit to that leverage? If you look at specialties like neurosurgery, are there limits to that? We could train enough advanced practitioners like we've done for nurse anesthetists to really leverage gastroenterologists like we have anesthesiologists. Are there other places where that's less likely? 

MW: I think the only way is if we find out that a lot of the services that have been provided historically can be replaced with non-interventional services. Maybe we don't need surgeons for everything. Will there be better medications? Will we fine tune that? Will we change the healthcare delivery system to incentivize long-term outcomes and value-based care as opposed to more care, which is the incentive in a fee-for-service system? 

That may decrease the need for physicians. We're going to develop alternative treatments that won't require physicians and can be administered by APPs. Routine screening colonoscopy, which has been the boon of gastroenterology practice for the last 30 years, may be supplanted by non-interventional means of screening for colon cancer, allowing the gastroenterologists to focus on interventional care, and we will give up all of the routine screening. So maybe the supply will meet the demand as we go forward.

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