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. 2018 Mar;34(2):138-147.
doi: 10.1111/jrh.12286. Epub 2017 Nov 16.

Who Performs Colonoscopy? Workforce Trends Over Space and Time

Jan M Eberth  1 , Michele J Josey  1 , Lee R Mobley  2 , Davidson O Nicholas  3   4 , Donna B Jeffe  5 , Cassie Odahowski  1 , Janice C Probst  6 , Mario Schootman  7
Affiliations

Who Performs Colonoscopy? Workforce Trends Over Space and Time

Jan M Eberth et al. J Rural Health. 2018 Mar.

Abstract

Purpose: With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types.

Methods: Using an all-payer outpatient discharge records database from South Carolina, we conducted a retrospective analysis of all colonoscopy procedures performed between 2001 and 2010.

Findings: We identified a major shift in the type of facilities performing colonoscopy in South Carolina since 2001, with substantial gains in ambulatory surgery settings (2001: 15, 2010: 34, +127%) versus hospitals (2001: 58, 2010: 59, +2%), particularly in urban areas (2001: 12, 2010: 27, +125%). The number of internists (2001: 46, 2010: 76) and family physicians (2001: 34, 2010: 106) performing colonoscopies also increased (+65% and +212%, respectively), while their annual procedures volumes stayed fairly constant. Significant variation in annual colonoscopy volume was observed across medical specialties (P < .001), with nongastroenterologists having lower volumes versus gastroenterologists and colon and rectal surgeons.

Conclusions: There have been substantial changes over time in the number of facilities and physicians performing colonoscopy in South Carolina since 2001, particularly in urban counties. Findings suggest nongastroenterologists are meeting a need for colonoscopies in rural areas.

Keywords: ambulatory care; family medicine; health services research; hospitals; physician supply.

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Conflict of interest statement

Disclosures: The manuscript contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders. The authors have no financial conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Linear growth of standardized measures of colonoscopy centers (A) and individual colonoscopy providers (B) in relation to growth in the population aged 50–74, by urban vs. rural location, 2001–2010
Footnote: Provider location is classified as urban or rural based on where the majority of their colonoscopy procedures were performed in a particular year. Each marker (Urban = diamond, Rural = triangle) on the graph represents a particular year of the study period, 2001 to 2010.
Figure 2
Figure 2. Changes in Colonoscopy Centers (A) and Average Procedure Volume (B) Between 2001 and 2010 in South Carolina, by Practice Setting and County Urban/Rural Designation
Footnote: ASC = Ambulatory Surgery Center
Figure 3
Figure 3. Changes in Colonoscopy Providers (A) and Their Average Procedure Volume (B) Between 2001 and 2010 in SC, by Physician Medical Specialty
Footnote: GE = Gastroenterologist; IM = Internal Medicine; GS = General Surgeon; CRS = Colon and Rectal Surgeon; FM = Family Medicine
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