The gastroenterologist: physician or technician?

Concern exists about perceived overuse of gastrointestinal endoscopic procedures. To determine the portion of the current practice of gastroenterology that is procedure related or purely cognitive, we compared 303 consultations from two practices. One-hundred and eighty-seven patients were in a Veterans Affairs Medical Center and 116 in a private group practice. Sixty-five percent of the consultations resulted in an endoscopic procedure. Patients referred for abnormal barium studies (100%), percutaneous endoscopic gastrostomy placement (97%), and gastrointestinal bleeding (83%) were most likely to have a procedure. Sixty-nine percent of consultations from medical specialties had endoscopy compared with 44% from surgical specialties and 45% from other specialties. There were no differences noted between the two practices. We conclude that gastroenterology is predominantly a procedure-oriented subspecialty. Procedures are performed most commonly on patients referred for conditions that are likely to require endoscopic biopsy or therapeutics and on patients referred from medical specialists.