Academic institutions meet criticism from private practitioners and vice versa

Published Date: January 15th, 2012

Kandarp Shah, M.D., a gastroenterologist practicing in Visalia, California, said that he decided not to renew his membership to the American Gastroenterological Association (AGA) because he did not feel that the organization was representing his opinion. Coming from the point-of-view of private practice, Dr. Shah admitted to feeling disconnected from gastroenterology societies that he said were paid by institutions whose interests differ from his own.

“There’s no right or wrong, but our perspectives are different,” said Shah, speaking about the dissimilarities between his own perspective and that of doctors practicing at larger teaching hospitals with more academic settings.

Dr. Shah studied medicine at M.S. Ramaiah Medical College, Rajiv Gandhi University of Health Sciences in Bangalore, India. He went on to complete Residency training at Wayne State University in Detroit, Michigan and a Gastroenterology Fellowship at William Beaumont Hospital in Royal Oak, Michigan. For a time he taught at the East Virginia Medical School, UCSF Fresno. He now has a private practice called Valley Gastroenterology Group in Visalia, California.

When discussing discrepancies between the quality of patient care available in private practices and the quality of patient care available at large hospitals, several doctors including Dr. Shah mentioned misinformation about how long is appropriate to wait between colon cancer screenings. According to a report published by the AGA in 2008, colonoscopy procedure for the detection of pre-cancerous polyps (adenoma) should be conducted once every 10 years once a low-risk patient turns 50 years old, and once every 5 years in high-risk patients. Dr. Shah said that he believes this rate to be too low to account for adequate screening.

“How can I tell a patient to trust me that he will be okay in 10 years?” said Shah, noting that within this interval 1 to 2 percent of polyps would surely be missed without proper screening.

Other medical professionals, on the other hand, find that the most up-to-date information about the frequency of colonoscopy screening is best found in large teaching hospitals. Rick Shacket, D.O., M.D. said that he actually feels like practitioners at private practices are less inclined to stay current with procedural standards of the field. Dr. Shacket said that he believes the system of private practice is not set up for good collaboration among different physicians.

“It’s been published that screenings [for the presence of adenoma] should happen every 2 years if a patient has had a polyp found in himself or a first-degree relative,” Shacket said. “Half of the private practitioners out there don’t know this.”

Dr. Shacket is a Board-certified proctologist practicing at several locations in Arizona, splitting his time between performing private endoscopy at various surgery centers and practicing at a teaching hospital as a part of the clinical faculty of the Phoenix Baptist Hospital Family Medicine Program. He received a medical degree in Pomona, California, from the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific.

Dr. Shacket cited superior equipment and a more informed doctor-base as the two primary reasons why practicing at the teaching hospital is superior to private practice.

“A big institution is going to make sure that it has state-of-the-art equipment [on-hand], but a private practitioner counting every dime won’t update equipment except for every 10 years,” Shacket said. “It’s very frustrating when I go into an office and the colonoscope is not stiff enough.”

Dr. Shacket said that he believes that the quality of patient care at a large institution is generally better and disagrees that there is any difference between cost-effectiveness of using either type of facility. Dr. Shah, on the other hand, mentioned that the facility fees often associated large institutions, on average, make medical bills of procedures such as colonoscopy unaffordable to some of his own patients on fixed income.

Among medical professionals, one can find much debate over the actual differences between the two systems. According to Dennis Riff, M.D., the type of facility a patient should see ultimately depends on which condition that patient needs treated.

“Usually, a patient is only sent to a university hospital when [a necessary medical procedure] is not being done on a community level,” Riff said. “That’s the way it should be and has been.”

Dr. Riff has been practicing gastroenterology for more than 30 years. He is the author of numerous research papers relating to GI procedure and is the founder of a multi-location private practice called Associated Gastroenterology Medical Group (AGMG) in Southern California.