‘Think outside the box’: ACG president aims to address workforce of the future
At last year’s ACG Annual Scientific Meeting, as president-elect, I sat in at the Board of Governors meeting, where the recurrent theme was workforce shortages in gastroenterology and how we were to address the workforce needs of the future.
However, it was not just a shortage of gastroenterologists; it became apparent that this was a multipronged issue, which requires a multipronged approach. It came down to shortages in GIs, anesthesiologists, certified registered nurse anesthetists (CRNAs) and additional care team members, such as endoscopy technicians, nursing staff and other allied staff members. It also comes down to the question: What is needed for the future?
Going into this year as ACG president, I have used this information to shape what this year’s focus will be for ACG. We have created a “workforce of the future” task force to address three work groups: gastroenterologists, anesthetizing needs and advanced practice providers (APPs). Each work group will be led by a physician.
Senior, Retiring GIs May Help Address Shortfalls
In the GI physician workforce, there are many who are aged 55 years and older who are looking ahead to retirement. Others still work, while exceeding the typical retirement age. And yet there has been an enormous dropout in our workforce due to the pandemic, burnout and other systemic drivers.
The more junior physicians were trained in a different environment where duty hours and promoting wellness were paramount. They work hard, but also set boundaries on their work life and personal life. They are looking for jobs that allow flexibility when at key milestones, such as raising children.
Between senior clinicians who have worked beyond typical years in practice and junior colleagues setting new priorities, there is sure to be an impact in the workforce. Senior and retiring clinicians have a wealth of experience and knowledge, so is there a way to utilize their talents to help address some of the shortfalls in clinical practice?
There are health care deserts around the country and world, with big swaths of areas that do not have practicing GIs or they are unable to recruit or retain physicians.
We must figure out how to solve this issue. How can we provide patients in those areas the GI care that they need without having to travel such significant lengths?
I do not think that the solution is necessarily just to train more GIs. There are lots of opportunities, and that is what the ACG work groups will look at.
‘Recruiting, Training and Retaining’ to Ensure Best Patient Care
Over the years, there has been a transformation of the type of anesthesia and anesthetic support for gastroenterology procedures. There has been a shift from GI-administered conscious sedation to a CRNA-directed propofol-based one.
Since this is becoming a competitive market, we are now seeing movement among anesthesiologists and CRNAs because they have new options, leaving some endoscopy centers without the ability to support the level of sedation needed.
Both private practices and large academic institutions alike have had to reduce their endoscopy capacity at times, such as closing endoscopy for a day if not longer, because they do not have the level of anesthesia support needed for patients scheduled for endoscopic procedures. Another issue is that more and more advanced endoscopic procedures are requiring anesthesia due to both patient and procedure complexity. This poses a real problem that may continue to grow.
As GIs, we have not been historically trained in providing anything other than conscious sedation and are reliant on forces outside our control.
We need to think outside the box and determine whether there is a future in which GIs need to be trained in higher level anesthetic support. It may change how we are trained but we need to help solve and address the issue at hand.
With the COVID-19 pandemic, we had a loss of technicians across all specialties, including endoscopy. The same could be said about nursing, dietetics, administration and other care team members. Trying to make sure that we retain talented individuals is key. Everyone is looking for ways to be promoted in their career and profession.
Advanced practice providers (APPs) are essential to the care team, both in the outpatient and inpatient settings. APPs are being increasingly asked to provide higher level of care to complex patients, and yet also have the flexibility to find the right specialty and practice that meets their personal and professional needs.
We need to ensure we are recruiting, training and retaining those who allow us to provide the best care for patients.
‘Anticipate Workforce Needs of the Future’
Whether it is physicians, anesthesia support or other health care team members, we need to look at how to best recruit individuals in all three categories. How do we train them effectively and how can we accelerate training paradigms to get them into the workforce quicker? More importantly, how do we retain them?
Every time we lose someone from our workforce, the cost of replacing them is incrementally much more than the cost of retaining them and offering them a package to stay in the practice.
This year, we are not going be able to solve all these issues, but I think we should start to think of outside of the box for ideas we could put into place very quickly. Some ideas will require more thought and a long-term plan. None of us can predict what endoscopic practice may look like 10 years from now. We need to be flexible and be able to modify when looking at projections.
With the health care transformation, we have to be able to anticipate the workforce needs of the future. Even though we know what our current workforce needs are today, we also must project what they will be in 5 to 15 years and start planning accordingly.
- For more information:
- Amy S. Oxentenko, MD, FACP, AGAF, FACG, is ACG president and professor of medicine and vice dean of practice at the Mayo Clinic. She can be reached at oxentenko.amy@mayo.edu.
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