Thursday, March 06, 2008

A bad day for Gastroenterologists

The (very high) income of the Gastroenterologist just took a significant hit.

The cause? We've now learned that half of all colon cancers arise from hard-to-see "flat lesions" in the colon:

Easily Overlooked Lesions Tied to Colon Cancer - New York Times

Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States.

The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise.

Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them...

...The study, of 1,819 military veterans, mostly men, found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to contain cancerous or precancerous tissue. Depressed or indented lesions were the least common but the most risky. Together, the flat or depressed lesions accounted for only 15 percent of the potentially cancerous growths found in the study, but were involved in half of the cancers. Once the doctors spotted the flat lesions, they sprayed a bluish dye on them to see their outlines better and remove them completely...

These suckers are hard to see. Looking for them may double the duration of a colonoscopy.

Problem is, Gastroenterologists are paid by the procedure, not by the minute. If a colonoscopy takes twice as long, then colonoscopy earnings fall by 50%. That probably translates to at least a 10-15% overall income cut.

Or, they could do what studies have shown many already do -- believe they're so incredibly skilled they can go really fast and still do a good job. Not true of course, but wishful thinking is strong when the money is right.

Either way, not a good day.

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