A new study suggests that the aging U.S. population and the increased colorectal cancer (CRC) screening rates will overwhelm the supply of gasteroenterologists (GIs), impacting the country's ability to provide adequate screening and treatment of colorectal cancer.
The study, from Olympus America (Center Valley, Pennsylvania) and The Lewin Group (Washington), found the U.S. is facing a shortage of GIs that will total at least 1,050 of these specialty physicians by 2020. Olympus says it plans to advocate for additional federally funded GI fellowships to help close the GI gap.
Tim Dall, VP at The Lewin Group and the study's author, told Medical Device Daily that to do the study, the group combined parts of two proprietary simulation models it had developed – a national colorectal screening model and a physician supply and demand model – to arrive at its GI workforce and CRC screening projections.
The researchers projected that if current age and gender screening rates remain constant, the aging population alone will create a shortage of 1,050 gastroenterologists by 2020. Under a scenario where national CRC screening rates increase by 10%, the shortage of GIs rises to about 1,550 over the same timeframe, the researchers found.
The findings also suggest that if the U.S. sees a 10% increase in CRC screening rates over the next decade, the total annual number of screenings (beyond the anticipated growth associated with an aging population) increases by roughly 600,000 in the short term and by almost 1.5 million by 2020.
"This study finds that the projected demand for gastroenterologists is growing at nearly double the rate of supply," Dall said. "The shortfall of gastroenterologists could limit the nation's ability to implement national guidelines for CRC screening, particularly in traditionally underserved communities."
Bob Reinhardt, VP and chief of strategy at Olympus America, told MDD that the company was motivated to have this study done by its philosophy to become a more socially aware company and return to society some of the benefits it has received.
Because Olympus realized the importance of getting people screened for CRC and recognized that the number of people getting screened is lower than it should be, the company began working with advocacy groups to promote screening. That advocacy blossomed into the realization that if the awareness of CRC screening got any stronger the demand couldn't be met, so the company then began to look at ways it could help boost the number of GI physicians in the U.S.
"The main idea behind what we're going to do is what we've called the 'GI Bill for GIs', the idea there is to work with the federal government to create additional federally funded fellowships for gastroenterology," Reinhardt said. "It's a long-term solution, it takes three years to complete the fellowship, so we're looking ahead ... in addition we'll continue to work with the advocacy groups and societies to try to keep up the level of awareness."
Dall said the one surprising finding in the study was that the demand projections were fairly stable even if a larger portion of the CRC screenings are performed by general physicians or physicians of other specialties, as virtual colonoscopies become popular, for example. "If you have more people getting virtual colonoscopy they still have to be referred to a GI if polyps are found, their follow-up visits would be with a GI, so the demand projections tended to be fairly stable," he said.
Actually, Dall said, the supply of GI doctors is projected to be very stable as well. It was growing for a number of years, he said, but in recent years (meaning the late 1990s and the early part of this decade) the government cut the number of fellows going into GI. Dall noted that the current GI workforce also is aging, so they are getting to the point where the number entering the field is simply offsetting the number retiring.
"In the late 1990s-early 2000 timeframe, there was a renewed interest in primary care physicians rather than specialists ... then in the early 2000s we started seeing a reversal in that more people were going into specialty fields, but by then a lot of the fellowship positions had already been cut," Dall said. "That is contributing to the shortfall."
According to Olympus, the estimated cost of new CRC cases was $8.3 billion in 2007, with Medicare paying at least $2.4 billion of this total. A federal investment in GI fellowships today can not only overcome the physician shortage, it can yield significant healthcare cost savings in the near term by making preventable screening more widely available, the company argued.
What sets colonoscopy apart from screening procedures for other diseases and cancer types is that it doesn't just screen for cancer that is already there, Reinhardt said. "What's unique about it is with colonoscopy you can go in and see that they might get cancer ... then, by removing the polyps, you are essentially preventing them from getting cancer," he said. "It does find some cancers that have developed, but its main drive is finding cancers that haven't developed and preventing them."