Marc Bernstein, MD, a gastroenterologist at Sarasota-based Florida Digestive Health Specialists, spoke to Becker's ASC Review about the biggest issue in gastroenterology and what the specialty could look like in the future.
Note: Responses were edited for style and content.
Question: What's the biggest issue in gastroenterology, and what would you do to solve it?
Dr. Marc Bernstein: There are multiple issues that exist in the world of medicine. On a macro level, there is a physician shortage. This will need to be addressed from the top by securing funding and increasing more fellowship opportunities at academic institutions. Additionally, there is room for emphasis [to be] placed on educating fellows about the various career paths of a new GI physician. Fellows are provided very little specific information about how their career will be affected by choosing between academics, an employed position and private practice, and are generally left to pursue this information on their own. Burnout and turnover are common if expectations about a chosen path are not met, which ultimately breaks continuity of care for the patient.
[In gastroenterology], a strong patient-doctor relationship can help ease any unnecessary stress, leading to increased trust and boost patient satisfaction levels. While structural changes, reimbursement issues and technology will always be moving targets in medicine, we also must focus on developing informed physicians who have chosen their path wisely and carefully.
Q: What does the future of the specialty look like three to five years from now?
MB: I see changes that will be pervasive throughout all of medicine. With the implementation of bundled payments in the GI field, the future may weigh heavily on personalized medicine and incorporating the risks/benefits of screening and surveillance testing. I believe this will be a beneficial change for gastroenterology practices who have achieved efficiency and incorporated prevention and continued ancillary services into their practice.
Q: What are your thoughts on noninvasive CRC tests?
MB: There is certainly a role for non-invasive testing. However, there is still a wide gap of misunderstanding. For example, primary care physicians use these tests regularly, but when patients have a positive result and are sent for a colonoscopy, they often have not been fully informed that the procedure is considered diagnostic (it would have been classified as a screening test if they had opted not to use the non-invasive option), and they are billed at a higher rate depending on their insurance. Patients are frustrated and feel they were not fully informed of the process of noninvasive CRC testing. As with most areas of medicine, patient communication at every step is crucial.
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