DAY 1 - Challenges and Innovations in Gastroenterology: Screening Barriers, Gender Disparities, Financial Trends, and AI-Driven Patient Education

Kanya Hirunrattanaporn, MD, of King Chulalongkorn Memorial Hospital in Bangkok, Thailand, described her study of the barriers to participation in a national CRC screening program. Typically patients meet with an endoscopist prior to colonoscopy to reduce anxiety and discomfort, but long wait times and rotating fellows make it difficult to assign the same endoscopist for the consult and the procedure, and any preferences based on endoscopist gender cannot be guaranteed. In a prospective study of 311 patients scheduled for colonoscopy, patients were asked if they had a gender preference for the endoscopist, and if so, about the factors influencing their decision. Most patients preferred same-gender endoscopists, with women more likely to than men to request an endoscopist of the same gender. Women cited a desire for empathy and understanding as the primary driver of gender preference, whereas men chose an endoscopist based on familiarity. Approximately 10% of patients indicated they would be willing to reschedule their procedure if the gender preference could not be met, which would delay screening. Dr. Hirunrattanaporn emphasized the importance of providing emotional support, trust, and comfort to patients, particularly when gender preferences cannot be met, and that gender sensitivities should be raised at the time of scheduling. In addition, it is essential to encourage greater gender diversity among endoscopists to better meet patient preferences, improve screening uptake and adherence to care, and increase patient satisfaction.

Alexandra Rea Markley, MD, from Mount Sinai West Medical Center in New York, New York, described the geographical and institutional distribution of women in gastroenterology fellowship, faculty, and leadership positions across US academic institutions. She conducted a cross-sectional analysis of publicly available data for 217 programs across the US in 2023, 88% of which were university based. Only 30% of gastroenterology faculty were women, and only 15% of institutions had more than 50% women gastroenterologists on faculty. Some programs had no women gastroenterology faculty or fellows; these were primarily located in the South. Women comprised 19% of division chiefs, 12% of endoscopy directors, and 32% of program directors nationwide. Dr. Markley also found that institutions with a woman division chief had higher proportions of women in leadership positions and on faculty. She suggested that women leaders may create a more equitable institutional environment with greater numbers of women mentors. More quantitative and qualitative studies that also include data on gender disparities among department chairs are needed to understand the barriers and facilitators of gender parity in gastroenterology, with targeted approaches based on geographical variations. Ultimately, achieving a gender balance that matches that of the patient population served may improve care.

Jonathan A. Busam, MD, from Cedars-Sinai Medical Center in Los Angeles, California, examined the trends in revenue erosion felt by independent gastroenterologists in the US. He noted that more patients are going to academic centers for gastroenterology care as community based doctors move to larger group practices and systems. Between 2012 and 2020, there was a 35% drop in practices of fewer than 10 providers. At the same time, the number of physicians affiliated with private equity owned clinics increased from 2016 to 2020. Most physicians cite financial factors as the key drivers in these shifts, in particular, the need to maintain organizational and financial stability in the face of increasing costs. Dr. Busam specifically examined changes in hourly reimbursement rates for GI procedures and the effect on practice revenue between 2014 and 2024. He found that mean reimbursement declined by 38% per procedure and the mean procedural time decreased by 24% per procedure; however, the improved efficiency was insufficient to gain back lost revenue, as the hourly reimbursement rate also decreased 21% per minute. At the same time, healthcare capital was increasingly flowing to non-physicians: physician benefit manager profits increased 81% and drug prices increased 63%, while individual physician revenue decreased by 15%. There are real concerns that the drive to achieve efficiency and recoup revenue losses and keep independent gastroenterology practices sustainable will be done at the expense of quality.

Todd A. Brenner, MD, from of Beth Israel Deaconess Medical Center in Boston, Massachusetts, described the trends in private equity acquisitions of gastroenterology practices in the US from 2013 to 2023. While private equity acquisitions in other specialties are well known, for example, in dermatology and cardiac imaging, gastroenterology practices have become attractive to investors because they are procedure based and are expected to experience increased demand with the aging population. Using data from the Irving Levin Associates Healthcare M&A database, Dr. Brenner found that the number of gastroenterology practice acquisitions  skyrocketed between 2020 to 2021, then slowed thereafter. A total of 114 GI practices, 1169 practice sites, 854 clinical sites, 266 endoscopy centers, 49 infusion centers, and 2,675 providers came under private equity ownership in the decade examined, representing about 14% of the total gastroenterology market. Hotspots were seen around major cities nationwide, but most acquisitions were seen in the South region, with the least in the Midwest. Acquisitions were made in areas with high education and income levels and non-white populations. More research is needed to understand the effect of private equity acquisition of gastroenterology practices on the quality of care and patient outcomes.

Regis Lee, DO, from Riverside Community Hospital in Riverside, California, described his efforts in harnessing ChatGTP to develop language-specific patient education materials. He noted that 26 million patients in the US have limited English proficiency and face language barriers when seeking healthcare, scheduling appointments, asking questions, and understanding their providers’ instructions, all of which can decrease health care quality and impact outcomes. AI is increasingly being used in gastroenterology for detection of lesions, monitoring MASLD, improving liver transplant waiting list outcomes, and enhancing patient and medical education. In his study, Dr. Lee used ChatGPT to deliver information from the American College of Gastroenterology practice guidelines in 10 different languages, prioritizing compassion, friendliness, and professionalism in the tone of the content. Native speaking physicians were asked to evaluate the content in terms of understandability, actionability, accuracy, cultural relevance, sensitivity, tone, and engagement. While most of the content was considered high quality in each of these areas, improvements are needed in using common everyday language, ensuring clarity in numbers, and inclusion of visual summaries and audio and video to video to improve educational value to patients.

Loren Rabinowitz, MD, of Beth Israel Deaconess Medical Center in Boston, Massachusetts, described her study on the gender pay gap among academic gastroenterologists. The study utilized data from the AAMC Faculty Salary Reports from 2020 to 2024 for 8,306 gastroenterologists at 155 medical schools in the US. She found that women were better represented within junior ranks and earned only $0.85 per dollar, with the disparity worsening as rank increased. Women division chiefs were paid on average $100,000 less than men. The lifetime gender pay gap among gastroenterologists was estimated at $1.1 million. While the study was limited by the number of covariate adjustments that could be made with aggregate data, variability in data reporting, and lack of data beyond academic institutions. Dr. Rabinowitz recommended that women gastroenterologists investigate their institutional compensation structure, recognize their personal value, and engage in self-advocacy; academic institutions need to explore and promote policies that promote gender pay equity among gastroenterologists.