Surgical Guideline May Help FPs Seeking Privileges

The Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education has called for surgical residents to have a minimum of 50 proctored colonoscopies for entry into practice. The requirement, announced Feb. 1, applies to surgical residents, but family physicians and their proctors may find it helpful as they make the case for FPs' colonoscopy privileges.

Family physicians in practice sometimes meet hurdles in their quest for colonoscopy privileges. Last year, for example, the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy sent U.S. hospital administrators a legal opinion that said hospitals "should extend endoscopic privileges only to board-certified gastroenterologists or general surgeons" or to physicians "with knowledge, training and experience in gastroenterology or gastrointestinal surgery comparable to that required for board certification." The Academy fought that contention in a Dec. 12 letter and legal opinion (Members Only).

Commenting on the new requirement for surgery residents, Perry Pugno, M.D., director of the AAFP Medical Education Division, said, "The threshold of 50 colonoscopies is the same as that suggested by a committee of the American College of Physicians in 1987, and it is close to the average number of procedures that our members with current colonoscopy privileges say was required for their local credentialing. Many of our family medicine residencies require that level of experience for their residents."

At the local level, when gastroenterologists refuse to proctor family physicians who seek colonoscopy privileges, often general surgeons will proctor them, said Pugno. "Surgeons have been helpful to family physicians in privileging disputes. Now, surgeons can say to credentialing committees, 'Even our own RRC does not require more than 50 colonoscopies for our residents in training.'" Previously, the RRC for Surgery had no numerical requirement for colonoscopies.

The Academy itself does not recommend minimum numbers of procedures as thresholds for granting privileges, according to staff in the AAFP Socioeconomics Division. The Academy's Statement on Colonoscopy Privileging asserts, "There is no scientific data correlating the volume of colonoscopies performed with the acquisition of competence. … Hospital credentialing committees, medical executive committees and governing boards should resist pressure to create artificial and arbitrarily high experience requirements as barriers to the privileging of family doctors to perform colonoscopy."

AAFP's statement charts responses from 28 family physicians who sent the Academy documentation on proctored colonoscopies in their residencies or practices. The FPs' colonoscopy experiences ranged from five to 169 colonoscopies, with an average of 52 proctored colonoscopies for FPs in practice.

The AAFP statement notes, "Studies indicate that family physicians who perform colonoscopy compare favorably with gastroenterologists and general surgeons when observable factors (such as the 'reach-the-cecum' rate, the time required to complete the procedure and the rate of complications) are used to determine technical competency in colonoscopy."