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In Connecticut, colonoscopy training, not privileging, is the roadblock family physicians face in one rural community hospital.
The administration of Day Kimball Hospital in Putnam recently ruled that physicians must obtain additional procedural training at teaching institutions to be credentialed.
At the request of one of its members, the Connecticut AFP jumped into the fray, sending a letter to the hospital "strongly objecting to the hospital's requirement," said Joseph Cremé, M.D., of Putnam, president-elect of the CAFP.
"Where do practicing FPs get the hands-on experience they need to do this procedure if they can't be trained at their community hospital by physician colleagues?" asked Cremé.
The training situation effectively locks some FPs out of performing colonoscopies because Cremé practices in a rural community where access to teaching facilities is difficult.
"In our area of New England -- the dark side of the moon as far as family practice goes -- the Connecticut residency programs I've spoken to have said, ‘Hey, we're having a hard time just getting our residents trained to do colonoscopies.
We can't take docs already out in practice and plug them into a residency program to learn this.' They simply don't have enough preceptors," said Cremé.
"I'll tell you one thing -- no GI guy around here is going to credential an FP to do colonoscopies and then have the FP take some of his business away."
At a staff meeting Sept. 9, the community hospital's board chair explained the hospital's stand on the issue. "He cited mainly malpractice insurance concerns that were brought up by attorneys," said Cremé. After a number of staff physicians spoke against the training requirement decision -- and chided the board for its lack of understanding of medical training -- the board chair agreed to form a committee for further discussion.
"The hospital is saying we can't learn from our colleagues who've been doing this procedure for 10 to 15 years. That's our stumbling block right now," said Cremé.
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