Rely on team approach, creativity to meet GI patient demands
The gastroenterologist workforce shortage has gotten worse, especially with the increased demand for GIs.
There is a combination of fewer doctors but an increasing need for services.
The age for colorectal cancer screening has dropped from 50 years to 45 years, so there is a wave of patients who need to be screened and should be screened. In the U.S., the general population is getting older and the burden of gastrointestinal illnesses is increasing along with demand for GI services.
Further, the average GI practitioner across the U.S. is older than 55 years and many are nearing retirement age. However, there is only a fixed number of GI fellows that are graduating each year to fill this demand.
‘Difficult Market’ to Hire GI Physicians
In the Northeast region of the U.S, especially in Rhode Island where I am, we have trouble attracting new graduates because salaries are lower. Reimbursement is lower in New England than other parts of the country and that translates to lower salaries compared with elsewhere.
If we want to hire someone, they must be willing to take a “hometown” discount, whether they are joining a private practice or taking a full-time academic position.
In the last 5 years, we have had difficulty in hiring a physician at our practice. We have tried and are still trying but have lost candidates to neighboring states. It is a very difficult market to hire physicians and it has been similar for our colleagues who are full-time at academic centers, hospitals and other private practices.
One issue is that most physicians have significant debt from college, medical school, residency and fellowship, and need to be able to service that debt while trying to purchase a house in addition to family expenses (childcare, saving for college, etc.). Thus, the initial salary and long-term earning potential are major factors in choosing a job for most new graduates. Individuals coming out of fellowship often end up going to institutions or practices that are willing to offer them more money.
We are not unique. There is not only a crisis in GI but also in primary care and several other specialties. It is very difficult to get primary care providers in our area and this is happening more and more across the country.
‘There is Not a Perfect Solution’
We were originally a nine-person physician group, but in January 2023 we joined GI Alliance, which has about 900 physicians. We anticipate that as part of their large network, they can help us to recruit and retain both physicians and advanced practice providers (APPs), so that we can better serve our community.
We need to evolve to a team approach with APPs to help us meet the increasing demand for GI services and concurrently try to get more people trained in the field. There are conversations about reducing the length of training and/or increasing the number of training programs available. The government has started to take notice, so they have increased funding for residency programs.
In addition, we are going to need to be creative in terms of enticing people who are considering retiring to continue to work full or part time. However, in our field it can be very difficult due to onerous on-call responsibilities. It is one thing to be called in the middle of the night and have to go into the hospital when you are in your 30s or 40s, but when you are aged 60 years or older, it starts to get a lot harder to work at that pace. While eliminating calls for older physicians might increase retention, that leaves younger physicians to take more calls.
There is not a perfect solution, but we will all need to be creative in order to maximize our ability to provide high quality accessible care while avoiding physician burnout.
- For more information:
- Samir A. Shah, MD, FACG, is clinical professor of medicine at Brown University’s Alpert Medical School and a partner at Gastroenterology Associates Inc., powered by GI Alliance. He can be reached at samir_shah_md@brown.edu.
Collapse
Read more about