BY SHERI PORTER
"We were simply the spark that started the fire," said family physician Mark Goedken, M.D., of Cedar Rapids, Iowa, referring to AAFP's efforts to equip members with tools to fight colonoscopy privileging battles.
Goedken and FP
David Kresnicka, M.D., of Marion, Iowa, became entangled in a colonoscopy
controversy in March 2000 when both completed the National Procedures Institute
colonoscopy training course -- but were subsequently excluded from performing
the procedure by their local hospitals.
The pair turned to the Iowa AFP for help. Eventually, the 2001 AAFP Congress of Delegates passed Substitute Resolution No. 604 that led to the AAFP's Colonoscopy Pilot Project.
The project churned into motion in fall 2002 when the Academy surveyed members who have been granted colonoscopy privileges in U.S. hospitals. Survey data indicate that hospitals have granted privileges to FPs whose experience with the procedure ranges from having performed five colonoscopies to having performed more than 150. Of those surveyed, 61 percent had received hospital privileges after performing fewer than 55 colonoscopies.
Go to http://www.aafp.org/x23483.xml to read three documents related to this topic, including a position paper and the colonoscopy privileging statement that refers to data from the Colonoscopy Pilot Project.
"We believe that these new data will improve the ability of family physicians to obtain privileges in colonoscopy at their local medical centers," said Goedken. "Family physicians should be encouraged by AAFP's strong position." He suggested FPs can use the AAFP materials to gain support from their credentials committees and general medical staffs.
Goedken gave credit to the Iowa AFP; Iowa AFP EVP Janet Wee; and AAFP EVP Douglas Henley, M.D., calling their support and assistance the "fuel" that kept the issue front and center.
Kresnicka, who lives in an urban area but has his patients come to a nearby rural hospital for the procedure, said he was happy to see momentum for the issue building. "I plan to reapply for colonoscopy privileges at both of our local hospitals again in the near future," he said. "I will use the new AAFP data on colonoscopy along with my record of more than 300 completed cases without complications to convince the credentials committees to allow qualified family physicians to perform this procedure in their hospitals."
Family physicians have always been responsive to the needs of their patients and their communities, said Norman Kahn, M.D., AAFP vice president for science and education. He said the Academy has been keeping FPs current on the appropriate screening guidelines for colorectal cancer and how to reduce morbidity and mortality related to the disease.
"One way to do this is to get more patients screened, and one screening tool is colonoscopy," said Kahn, who added the Academy wanted to recognize the small but growing number of members incorporating colonoscopy into their practices.
"Most physicians involved with endoscopy believe that as more FPs decide to incorporate colonoscopy into their practices, fewer hospitals will be able to deny (colonoscopy) privileges to FPs as a whole," said Goedken. "There is power in numbers."
According to the AAFP's 2003 Practice Profile Survey, colonoscopy is the second most contested privilege in the specialty (3.2 percent of respondents said their request for the privilege was denied). However, according to the same survey, more than 82 percent of members said they don't want to perform the procedure.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
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Copyright © 2003 by
American Academy of Family Physicians.