The Role of Family Physicians in Addressing the Growing Demand for Endoscopy.

The increasing demand for endoscopic procedures, especially colonoscopies for colorectal cancer screening, continues to outpace the availability of trained endoscopists. This shortage has significant implications, with wait times often extending far beyond recommended screening intervals, potentially delaying critical diagnoses. A study conducted by Dr. Michael Kolber and his team provides compelling evidence that family physicians, with the proper training, could help alleviate this burden. Can Fam Physician 2009;55:170-5

Key Findings from the Study

The study, set in rural Peace River, Alberta, evaluated 1,949 endoscopic procedures performed by a family physician trained in gastroenterology. The procedures included gastroscopies, colonoscopies, and sigmoidoscopies over a period of 7.5 years. The family physician's performance was measured against standard endoscopy benchmarks, including complication rates, adenoma detection, and cecal intubation rates.

Some of the notable findings include:

- Procedure Distribution: Of the 1,949 procedures, 1,178 were colonoscopies, 667 were gastroscopies, and 104 were sigmoidoscopies.

- Competency Measures: The family physician's adjusted cecal intubation rate for colonoscopies was 92.3%, which compares favourably with the 90% standard set by the U.S. Multi-Society Task Force on Colorectal Cancers.

- Adenoma Detection: Adenoma detection rates were also consistent with recommended standards, with detection rates of 23.7% for men and 15.4% for women, improving to 29.8% and 18.0%, respectively, for patients over the age of 50.

- Complication Rates: The complication rates were low, with only one case of colonic perforation (0.08%) and one post-polypectomy bleed (0.08%) out of 1,178 colonoscopies. These rates align well with the standards reported in the literature.

Implications for Family Medicine

The findings of this study suggest that family physicians, after undergoing proper endoscopic training, can safely and competently perform colonoscopies and other endoscopic procedures. This opens up new avenues for family physicians to expand their scope of practice, particularly in rural areas where access to specialists may be limited.

In rural settings like Peace River, where the nearest gastroenterologist is 486 km away, family physicians who can perform endoscopy may significantly improve access to timely screenings and diagnoses for conditions such as colorectal cancer. This would not only reduce wait times but also help improve health outcomes by enabling earlier detection and treatment.

Broader Adoption and Training

The study underscores the potential benefits of incorporating endoscopy into family medicine, particularly as the need for colorectal cancer screening grows. Training programs that equip family physicians with endoscopic skills could be an effective way to address the current shortage of endoscopists, particularly in rural or underserved areas. This could also reduce the strain on the healthcare system by allowing family physicians to manage a broader range of procedures within primary care settings.

With the competency demonstrated in this study, family physicians could become a valuable resource in meeting the rising demand for colonoscopies. While further studies and expanded training programs would be necessary, this model offers a promising solution to the current shortage of endoscopy services in Canada and other regions facing similar challenges.

Conclusion

Family physicians, could expanding your practice to include endoscopic procedures like colonoscopies be a way to diversify your career? Dr. Kolber's study shows that, with the right training, family doctors can safely and effectively perform these procedures, particularly in rural or underserved areas. This could improve patient care, address the shortage of endoscopists, and provide you with a rewarding new skill set to enhance your practice. Consider if this opportunity aligns with your goals for broadening your impact.

Read the study here:

Can Fam Physician 2009;55:170-5