Docs Feeling the Pressure of Colonoscopies

Colorectal cancer screening crunch could affect quality

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) With March being Colorectal Cancer Awareness month, the loudest message seems to be that not enough folks are having the screening. Well, a new study is showing another side of the story, and doctors are feeling the pressure.

Performance and quality may suffer as the volume of colonoscopies (screenings for colorectal cancer) continues to rise, according to the doctors who perform them.

It's the old quantity vs. quality dilemma.

"Know who is performing your colonoscopy."

Mount Sinai School of Medicine researchers surveyed 1,000 gastroenterologists and learned that 92 percent of them believe pressures to increase volume adversely affect how well they perform colonoscopies.

Lawrence B. Cohen, M.D., lead study author and associate clinical professor of gastroenterology at Mount Sinai, told dailyRx in a telephone interview, "With all the time and money that's being poured into these screenings, we need to step back to make sure we're delivering on the promise of colonoscopies."

He continues, “The number of colonoscopies has risen dramatically over the past fifteen years, but it is imperative that an increase in volume not occur at the expense of quality and safety.

“Balancing quantity and quality is an issue that needs to be addressed in order to ensure the continued success of colon cancer prevention programs,” Dr. Cohen said.

For this study, researchers distributed surveys to the 5,739 members of the American Society of Gastrointestinal Endoscopy (ASGE) in the United States. The 40-question survey focused on the physician's practice, facilities in which they operate and observation of colleagues.

Here's what was uncovered from  1,073 responses received:

  • 92.3 percent indicated that more demand, rising overhead and declining reimbursement rates resulted in procedures being postponed, aborted or reduced in some way.
  • 13 percent said they didn't have enough time to conduct a thorough pre-procedure patient assessment.
  • 7.7 believed they often had inadequate time to finish the exam.
  • 47.8 said they observed colleagues altering practice patterns because of throughput pressures.
  • 77.8 percent say their workload is excessive.

However, 97 percent of the physicians believe they are providing better medical care than three years earlier.

When asked what's behind this dilemma, Dr. Cohen said several factors are involved. "The number of endoscopists (professionals who perform the actual procedure) is declining. We're training about 700 a year, but more than that are retiring each year," he said.

"Another fact is shrinking reimbursements. Between 1990 and 2005, Medicare reimbursement for colonoscopies has decreased by 50 percent, which means you have to dial up your output," Dr. Cohen said.

The findings, based on responses from members of the American Society for Gastrointestinal Endoscopy (ASGE), are published in the March 2012 issue of Gastrointestinal Endoscopy.

Reviewed by: 
Review Date: 
March 19, 2012
Last Updated:
March 20, 2012