Report On The Future Of Gastroenterology

The field of gastroenterology is changing and practitioners must embrace the advances and new technology to ensure their practice evolves with the field, as per 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 reported in the recent 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 scientists 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," as per 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, particularly correlation to colorectal cancer (CRC) screening, are liable to make some common endoscopic procedures currently performed by trained gastroenterologists obsolete.

• Given that such procedures particularly 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 therapy, 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 a number of 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.

As per 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".


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