Current trends in the practice of endoscopy among surgeons in the United States

Joshua Tierney, MD, Rebeccah Baucom, MD, MPH, Michael Holzman, MD, Benjamin Poulose, MD, MPH, Richard Pierce, MD, PhD. Vanderbilt University Medical Center

Background: The diagnostic and therapeutic roles for endoscopic intervention are expanding. A number of “surgical diseases” can now be treated endoscopically. To continue emphasis on endoscopy in surgical training, The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), has developed the Fundamentals of Endoscopic Surgery (FES) course to standardize and assess endoscopy training. However, little demographic information exists about the current practice of endoscopy by general surgeons and how to best integrate endoscopic skills into surgical training.

Methods: A survey to collect data regarding the current practice patterns of endoscopy was sent to surgeons with a valid email address in the American Medical Association masterfile. The questionnaire included information regarding the type of training program each surgeon completed (academic vs. community general surgery residency) and their current practice environment (academic medical center vs. community hospital). Additionally, the respondents’ current practice volume of upper endoscopy and colonoscopy over the prior year was stratified into three groups: rare (<1 per month), moderate (1-10 per month), and frequent (>10 per month). Pearson’s Chi-squared test was used to analyze the data from the type of residency training and current practice setting in relation to the number of endoscopic procedures performed per month over the prior year of practice.

Results: The survey was sent to 9,902 general surgeons. There were 767 who provided answers regarding their current practice of endoscopy. Mean time in practice was 18 ± 10 years, 87 % were male, and 83 % practiced in a metropolitan area. Respondents who trained at academic general surgery programs were less likely than those at community programs to frequently perform colonoscopy (17.3% vs. 27.9%,  p<0.05) and upper endoscopy (11.8% vs. 17.1%, p<0.05). Those who currently practice in academic medical centers were also less likely to be frequent performers of colonoscopy than those who practice at community hospitals (5.6% vs. 24.7%, p<0.05). A similar result, though less pronounced, was found comparing current practice patterns for upper endoscopy. There was a smaller proportion of frequent performers of upper endoscopy in academic medical centers (9.8% vs. 14.8%, p<0.05).

Conclusions: The type of residency training and current practice setting of general surgeons has a significant influence on the volume of endoscopic procedures performed. General surgeons in community hospitals more frequently perform endoscopic procedures compared to those in academic centers. This study identifies areas where more emphasis on endoscopic skills training, such as FES, could be applied.

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