Is a turf war brewing? It seems so. Radiologists want to get a piece of the colonoscopy pie by slanting recent study, making virtual colonoscopy look good:
The paper, published Monday in the journal Cancer, used data from earlier studies to compare costs and benefits of CT scans with two more common screening techniques “” optical colonoscopy and flexible sigmoidoscopy. CT scans came out on top. The first author, Perry Pickhardt, is a radiologist and a leading expert in virtual colonoscopy.Polyps are small growths that can become cancerous. Pickhardt’s analysis makes a key assumption “” that patients with small polyps (less than 6 millimeters across) won’t be referred for follow-up colonoscopies. He cites “consensus guidelines” as the basis for that assumption. But while it’s true that small polyps don’t pose an immediate cancer threat, the “consensus” doesn’t necessarily reflect the view of gastroenterologists.
The problem with virtual colonoscopy is that whenever there is a suspicious lesion, a traditional colonoscopy would be needed anyways to perform the biopsy.
Related posts:
- Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare
- Virtual colonoscopy
- Should Medicare cover a virtual colonoscopy?
- My take: CME, virtual colonoscopy, Google
- Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief
- How accurate is a colonoscopy to screen for colon cancer?
- Questions to ask before your colonoscopy
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{ 9 comments }
This is because radiologists see the writing on the wall. As their jobs are being ourtourced to India, they realize that they have to act like clinicians to survive. The problem is that they’ll act like gatekeepers for the gastroenterologists and not like treating physicians.
Non-physician here with a question. Don’t colonoscopies have a small (but real risk) of tearing of the colon. CTs don’t have that risk–and I expect the added radiation risk is smaller–or at least further off.
Thus, from a patient’s perspective a virtual colonoscopy is much better–plus you avoid medical anal rape.
Agreed:
It is only a matter of time before most radiology reads are farmed out overseas. If you are not an interventional rad than you are going to be in deep s%&t in 5 years. Medicare is going to jump all overthis bandwagon. Why pay for an American radiologist when you can pay an Indian or Bulgarian radiologist 10-20% the amount. The only thing stopping it from happening now is malpractice issues (who to sue). I would not want to be a radiologist right now.
I certainly sense professional envy on the part of the two anons above. Radiologists are not responsible for your career choice errors. In any case, we will see in 5, 10, and 20 years that there will be a continued and growing need for US radiologists, if nothing more than hand-holding for PCPs who in most cases are no better than triage nurses. And we will still make a lot more money than you!
I have no particular love or hatred for radiologists (or gastroenterologists). I’m merely stating the obvious. Other medical and surgical specialists have morphed considerably over time as any of us who trained in the ’70’s can attest. The changing market will force those metamorphoses whether you like it or not- and whether or not you continue to brag about your high earnings and stick out your virtual tongue at our primary care colleagues.
Anon 8:09
“continued and growing need for US radiologists, if nothing more than hand-holding for PCPs who in most cases are no better than triage nurses”
I agree that there are some PCPs who leave something to be desired.
But I see more and more xray & ct’s with “hedging” readings that do nobody any good. Perhaps radiology services should be capitated- at least that’d avoid the blatant overuse of mri, ct, pet scans (i don’t know how some radiologists get around stark laws disallowing self-referral).
Anon 9:53:
As the above poster, I have nothing for/against radiologists per se (though the increasing hedge reads are frustrating and at times worthless). As far as my own career choice (I am not a PCP), falling a sleep in the reading room during med school precluded radiology. I am also just stating the obvious. Your earnings that you brag about (compared to the rest of medicine) are a good example why non-interventional rad will be farmed out overseas. Laugh now…but watch.
Enough studies point to the fact that with current screening recommendations where they are now, there are nowhere NEAR enough colonoscopists to screen all the patients. So virtual colonoscopy would probably be a boon, not a detriment, to GI specialists and Medicare.
I also don’t think radiology will be completely outsourced, probably just in more remote areas with fewer specialists.
Perhaps virtual colonoscopy could be done by mail, like fobt testing:
1-pcp prescribes test and gives patient capsule to swallow
2-pt swallows, then collects capsule, and mails away to a centralized reading center, perhaps outsourced overseas
3-if test shows pathology patient is referred to GI
this would save medicare/taxpayers the cost of the 70% (or whatever) negative colonoscopies done now.
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