Maldistribution of manpower in GI ‘happening so rapidly,’ limits patient access to care
Literature has shown that the workforce shortage in gastroenterology may be approximately 12% to 15% by 2025.
The estimates being calculated are based on the COVID-19 pandemic, which really spawned this shortage and accelerated retirement among several physicians who were close to retirement age.
The workforce shortage is very underestimated and there are a couple of phenomena that are occurring besides the early retirement that COVID-19 caused.
Private Practices Becoming ‘Anachronistic’
The pandemic has greatly impacted the economics of GI practices. GI practices have been negatively affected economically based on the increased cost of drugs, equipment and staffing brought on by the pandemic, which has added a 25% to 30% added inflationary cost in addition to the proposed 3% to 4% Medicare reimbursement cuts.
This is happening in all practices, from community hospitals to academic centers, but it is particularly distressing private practices.
Private practices depend on self-capitalization and being able to afford the cost of providing quality and more affordable community patient care. This phenomenon along with the added administrative burden of insurance preauthorizations have caused approximately 30% of practices to consolidate with larger groups. We are also seeing a rapid uptick in private equity subsidizing private practices and consolidating groups.
We are also seeing hospital systems vertically and horizontally integrating to control markets. They want to buy practices so they can control the flow of patients, resulting in increased cost of care.
Another aspect is that approximately 60% or more of GIs are either staying in academics or being employed by hospital systems. The consequence is small private practices are becoming anachronistic.
The private practices with one to five GIs are having difficulty financially making ends meet and as a result they are looking for other practice models. Private practice is a dying entity.
Increase in Locum Positions Impacts ‘Quality, Access to Care’
Another growing issue is new trainees are entering the job market with an unprecedented financial burden of loan repayments.
As a result, they do not want to invest in a practice because of the lead in time before they become full partners. Therefore, GIs coming out of training are looking for locum positions. The hospital systems want to hire locum physicians, so they do not have to have to commit to service agreements or pay for call with community practices. Hospitals are willing to pay higher locum salaries and young physicians are gravitating to this opportunity.
This impacts quality and access to care. It also increases cost of care because patients are having difficulty getting longitudinal care, so they end up in emergency rooms.
In addition, screening for colon cancer is becoming more difficult because of the lack of physicians in the community.
As an example, in Charlottesville where I practice, Sentara Martha Jefferson Hospital has been cutting back on nonprofitable service lines and no longer offers advanced GI services or allows community GIs to do diagnostic or advanced procedures.
The University of Virginia Medical Center in the last several months has announced it is no longer accepting patient referrals directly from primary care providers or specialists because it does not have the manpower to see patients. The center also sent letters to patients with complicated inflammatory bowel disease saying they need to seek further care elsewhere.
Since two large nonprofit institutions are limiting access to care, patients are waiting months for appointments and could wait up to 1 year to have a surveillance colonoscopy. In addition, access to interventional endoscopists who perform procedures that prevent patients from needing surgery is being delayed.
Hiring Allied Health Professionals is Just a ‘Band Aid’
Prior to the COVID-19 pandemic, we were working toward increasing access to care. We were trying to get the colon cancer screening rate up to 80% across the U.S., including in minority communities. The pandemic created a setback in that process.
There was a period after the pandemic during which the incidence of colon cancer was increasing because of the lack of screening and access to interventional procedures.
We are trying to increase access to care by utilizing more allied health care professionals. Training programs for allied health care professionals, nurse practitioners and physician assistants are increasing across the country, but that can make up for only so much of this deficit.
This solution is only partially beneficial because allied health care professionals cannot provide interventional care and perform procedures such as colonoscopies or remove polyps. This is a band aid on the larger issue.
Maldistribution of Care
There is not only a decrease in manpower but also a compounding maldistribution of care in GI. Fellows coming out of training who just want to do locum work and perform endoscopies will not be fulfilling the needs of the community. The value of independent or community practice is being lost by the changes noted above. Private practitioners are part of the fabric of the community; they know their patients’ and community’s needs and are the best investment to advance quality, personalized and preventative care.
No one is addressing this specifically, because it is happening so rapidly. No one is appreciating the whole picture and how it should be approached.
- For more information:
- Daniel J. Pambianco, MD, FACG, FASGE, FAPCR, is a gastroenterologist and managing partner at GastroHealth in Virginia. He can be reached at dpambianco@gastrohealth.com.
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