Corporate Gastroenterology: Maximizing profits at the expense of actual patient care.
For years, GI has followed a fantastic profitability model:
Patients are evaluated by a Physician Assistant and cleared for a colonoscopy or upper endoscopy or both. The patient returns a couple of weeks later, fully prepped and is lined up on a gurney with others. The gastroenterologist pops in, shakes the patient’s hand with a brief introduction, an anesthesia person pushes some IV meds and the patient wakes up in a recovery area. Yes, it is an assembly line, but this is actually more of a feature. Doing a procedure many times a day usually correlates with good outcomes and low complication rates.
When the model is working, it is also highly profitable. As reported earlier on this blog (https://authenticmedicine.com/2022/05/gastroenterology-going-corporate/), private equity firms have noted this and are taking over. This is, indeed, a model where the future is bright.
There is just one problem. Sometimes, you need a gastroenterologist to manage complex conditions, such as inflammatory bowel disease or other issues where a procedure is not necessarily always the answer.
These are problems that require thought, patient discussion, and assessment, as well as a good knowledge base. The necessary knowledge base typically exceeds the skill level of the tasked Physician Assistant. Worse, the Gastroenterologists themselves have gotten so used to simply scoping people, they have not kept up on their readings and stumble when dealing with an illness that can be more complicated.
Truth be told: They are getting rusty after a few years of practice.
Even though we are in a town with many Gastroenterologists, we have to send our complex GI patients to tertiary care centers fifty miles or more out of town. By complex, I mean relatively common problems you encounter regularly, such as Crohn’s Disease or Ulcerative Colitis. The local doctors make a brave attempt, but the lack of timely follow-up and monitoring is simply missing. The wait times for these University based doctors have grown long as other physicians in the surrounding area also encounter the limitations of their region’s own profit oriented system.
Now that investment firms are involved, the diminishing number of gastroenterologists trying to provide comprehensive GI care will be forced to conform to the more profitable model.
Patients will be crushed.
First, recruit the lemmings. When I was posting on a local McMedical site, I was chewed out by a patient for recommending anaesthesiology for most colonoscopies. When I was asked how often anaesthesiology is needed, I suggested that it would be less than 10% What a blatant rip-off by greedy doctors! offered this fellow, who likely did not have a compromised airway at the time of his outrage.
Suits me. And remember Joan Rivers.?