How to build a better health system: 8 expert essays

The Factors Fueling The Gastroenterologist Staffing Fire

Ongoing shortages of medical professionals have led to persistent problems across the care continuum for providers of all specialties — and gastroenterologists have not been spared.

As the U.S. Faces a potential shortage of ​​124,000 physicians by 2034, physicians have been forced to shift their strategies and innovate in order to keep up with increasing demand for care: the U.S. Population is expected to increase by nearly 100 million by 2050, according to a report by AMN Healthcare. Not only that, but by 2034, it is projected that there will be more individuals in the U.S. Who are older than 65 than children younger than 17 for the first time — leading to an older patient population with more complex medical needs. 

Adding fuel to the fire is the fact that the average age of all practicing physicians in the U.S. Is 53.9 — more than 10 years older than the U.S. Labor force median age of 41.8, according to a 2023 report from Definitive Healthcare. Further, a recent Medscape survey of physicians found that 41% of respondents in their 50s said they plan to retire in their early 60s. 

The ramifications of these findings are a looming concern to all those in healthcare — and there is more gastroenterologists have to worry about: The number of younger people with colon cancer diagnoses is on the rise. A report from the American Cancer Society found that diagnoses among people younger than 55 increased from 11% in 1995 to 20% in 2019, and a growing number of young people are being identified with more advanced stages of the disease. 

Further, in 2021, the U.S. Preventive Services Task Force updated its recommended age for colorectal cancer screenings to age 45 rather than 50, increasing the demand for care among an already strained workforce. 

In a recent survey by Medscape, 50% of gastroenterologists said they felt burned out or both burned out and depressed — the fourth-highest percentage among 29 specialties. 

Considering all this, gastroenterologists have been forced to innovate, with many taking advantage of new technologies and treatment options, such as EMRs and telehealth services, Shaibal Mazumdar, MD, a gastroenterologist at Charlotte, N.C.-based Advocate Health, told Becker's.

"With strained resources, it's important to tweak the process," Dr. Mazumdar said. "Physicians and nurse practitioners are collective resources, and we strive to work at the top of our license with good communication. It is also important to innovate with newer technologies related to artificial intelligence in order to get rid of excessive added activities — to do more with less.

"Curbside consults with referring physicians when you are connected through EMR also helps to make sure patients get timely access to good care."

Other tactics to tackle strain caused by staffing issues have been focused on increasing current employee happiness and job satisfaction, according to Stephen Amann, MD, of Digestive Health Specialists in Tupelo, Miss.

"For the past year or so, this has included pay improvements for all staff, multiple times, despite our overall decreases in revenue from Medicare," Dr. Amann told Becker's. "We have also tried to improve employee "team building" within the organization and open dialogue for ideas and improvements, which help with employee satisfaction."

These changes have upped employee satisfaction at Dr. Amann's practice, and he said he is hopeful about other strategy shifts going forward.

"​​Long term, we are looking at ways to improve efficiencies and service with technology and try to lessen burdens on staff," Dr. Amann continued. "We are looking at ways to help staff acquire practical knowledge, training and experience so that new opportunities for growth and advancement will be available to them in the practice."

University Gastroenterology

March is Colorectal Cancer Awareness Month. Dr. Breton Roussel, a gastroenterologist with University Gastroenterology and University Endoscopy Group, joined The Rhode Show.

University Gastroenterology is the largest GI practice in the area with four main offices, including two in Providence, one in East Greenwich and one in Newport along with other satellite offices around the state. There are 4 endoscopy centers at each of the main office locations making access to care convenient for patients in Massachusetts, eastern Connecticut and RI. In addition to providing colon cancer screening at endoscopy centers and local hospitals, a team cares for patients with all GI conditions including liver disease and inflammatory bowel disease.

It's important to spread the message about colorectal cancer awareness because The American Cancer Society predicts that 150,000 Americans will be diagnosed with colon or rectal cancer in 2024. Colorectal cancer remains the second deadliest cancer in America, but it doesn't have to be. With expanded screening, the mortality rate of colon cancer has gone down over the last several decades. This being true, the medical community can always improve in expanding access to screening for all patients.

The American Cancer Society has changed its guidelines recently recommending screening at 45. For reasons not fully understood, colon cancer is becoming more prevalent in people under the age of 50. Early detection of colon cancer or pre-cancerous polyps saves lives. By starting screening at 45 there is help for people who now may be at risk. For patients who are above average risk, meaning those with a family history of certain colon polyps, colon cancer, or certain medical conditions, screening begins before the age of 45. It's always important to discuss with your provider which risk category applies to you.

When we talk about screening, there are different options, but it's recommended to get a colonoscopy, which is the gold standard. Patients who are at average risk for colon cancer, meaning they have no personal history of polyps, family history of colon polyps or cancer, or other medical conditions can undergo either stool-based testing through a lab or colonoscopy. Colonoscopy remains the gold standard as it allows us to identify a pre-cancerous polyp and remove it during the same procedure. Stool-based testing requires a subsequent colonoscopy if abnormal. Patients who are above average risk for colon cancer are not candidates for stool-based screening.

There is a stigma around the prep for the colonoscopy, but in the last 10-15 years there have been several new bowel preparations that have come to market that are either liquid or pill-based. At its foundation, a bowel prep is designed to cleanse the colon to allow the proceduralist to examine carefully for polyps that may be smaller than 5mm or a pencil eraser. Although cleansing the bowel can be unpleasant at times, the vast majority of patients tolerate the prep quite well. Everyone would agree that taking a bowel preparation is a reasonable cost for preventing a cancer diagnosis or death from cancer.

Most patients require multiple colonoscopies over their lifetime. For this reason, University Gastroenterology and University Endoscopy Group care deeply about optimizing patient safety and comfort on the day of the procedure. They want you to feel cared for, and at the end of the day, they want you to come back for your next colonoscopy!

Rhode Show Content Disclaimer: The information, advice, and answers displayed in The Rhode Show section of WPRI.Com are those of individual sponsors and guests and not WPRI-TV/Nexstar Media Group, Inc. WPRI.Com presents this content on behalf of each participating Rhode Show sponsor. Sponsored content is copyrighted to its respective sponsor unless otherwise indicated.

5 Gastroenterology Practices To Know

Here are five gastroenterology groups that have made headlines recently:

1. Pen Bay Gastroenterology (Rockport, Maine). This practice recently expanded its staff with the additions of gastroenterologist Eric Elton, MD, and nurse practitioner Amber Mastronardi, MSN, RN, which are part of a larger effort by MaineHealth and Pen Bay to increase access to GI care. Since Dr. Elton's addition in January, wait times for routine colonoscopies have been cut in half.  

2. The University of Nebraska Medical Center (Omaha). The medical center added Fedja Rochling, MD, as its division chief of gastroenterology and hepatology after the center's former GI and hepatology chief, Peter Mannon, MD, stepped away from his role to focus on his position as director of the Frederick F. Paustian Inflammatory Bowel Disease Center and other professional endeavors. 

3. Gastroenterology and Nutrition Specialists (Orlando, Fla.). The practice recently finalized a  partnership with Gastro Health, a leading GI group in the U.S. With more than 400 physicians and 150 locations.

4. Midwest Gastrointestinal Associates (Omaha, Neb.). The group recently entered into a partnership with Atlantic, Iowa-based Cass Health that will bring two of Midwest's gastroenterologists to Cass monthly to treat patients with various conditions and perform colonoscopies and EGD procedures. 

5.  Florida Digestive Health Specialists (Bradenton). This practice added ambulatory cloud EHR eClinicalWorks' AI tools and virtual scribe Sunoh.Ai to assist with patient information charting and streamlined workflows. EClinicalWorks tools include generative AI models enabling a conversational EHR and image AI assistants to facilitate document recognition routing for incoming faxes. Sunoh.Ai is designed to accelerate clinical documentation for the system.

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