Should colorectal surgeons and family doctors perform colonoscopy?

Published Date: January 14th, 2012

On colonoscopy teaching days scheduled at the Phoenix Baptist Family Medicine Residency Program, family doctors and other workshop-enrolled physicians may attain training to perform colonoscopy on patients without having completed the same requirements as a certified gastroenterologist. Rick Shacket, D.O., M.D. is Board-certified proctologist certified and a member of the Clinical Faculty for the Phoenix Baptist Hospital program. He alternates between practicing at the teaching hospital and performing surgery and endoscopy procedure such as colonoscopy at local surgery centers. As a proctologist, Dr. Shacket specializes in treatment of colorectal conditions such as constipation and hemorrhoids, though he usually refers chronic cases of irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) to a gastroenterologist.

“There are not enough doctors who perform colonoscopy. I read that if everyone who needed a colonoscopy [scheduled an appointment with a GI doctor], then the waiting list would be 5 years long,” Shacket said.

Dr. Shacket is of the opinion that family doctors, primary care physicians and proctologists or colorectal surgeons, like himself, are just as qualified to perform colonoscopy as any gastroenterologist who has performed hundreds of colonoscopies during their gastroenterology residency training.

“I see [the debate] as a turf war,” Shacket said.

According to past recommendations put forth by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), non-GI trainees are required to perform 50 colonoscopy procedures, 25 flexible sigmoidoscopy procedures and 25 upper endoscopy procedures (EGD or esophagogastroduodenoscopy) before attaining proper credentials. In more recent years, these requirements have migrated away from requiring a minimum number of procedures performed to requiring documentation regarding the proficiency of these performances by qualified supervisors. Currently, the exact numbers of colonoscopy and other endoscopy procedures required is unclear.

Organizations such as the American Society of Gastrointestinal Endoscopy (ASGE), however, have historically relied on specific numbers of procedures for accreditation. The minimum requirements have become stricter over time, increasing from 50 colonoscopies and 50 upper endoscopies two decades ago to 140 colonoscopies and 130 upper endoscopies at minimum after 2001. The numbers published by the ASGE may have spiked in recent years, to numbers more comparable to the requirements of gastroenterology fellows—although other group societies have generally not followed suit.

Regardless, much debate surrounds the topic of what types of doctors are qualified to perform endoscopy. According to Ahmad Cheema, M.D., a private practitioner in Moline, Illinois and a Fellow of the American Gastroenterological Association (AGA)—certified GI doctors have undoubtedly acquired endoscopy experience because they have performed at least 400 to 500 colonoscopies during their Internship and Residency training.

“You can bet that the GI [with a higher number of colonoscopy procedures under his belt] will find more diseases— like a carpenter who has made 500 pieces of wood will be able to craft with more refinement and sophistication,” Cheema said.

Dr. Cheema also said that he understood the discrepancy between endoscopy training requirements for gastroenterologists and surgeons for the sake of medical specialty. According to Amit Kamboj, M.D. in Visalia California, whether a non-GI could perform colonoscopy depends on the level of experience and quality of training received. Nonetheless, he said that having the procedure executed by a certified GI is preferred, except in cases where the proper doctors are not available.

“I think there is a need for [colorectal surgeons and family doctors to perform colonoscopy] in more rural settings, but if there’s a gastroenterologist in the area, I think it’s safer,” said Kamboj, a recent fellowship graduate from the University of California, Davis, who has been practicing gastroenterology at a multi-specialty group called Visalia Medical Clinic.