PE GI Journal March 2021 Issue

GI A publication dedicated to advancing GI practices and ASCs

Expanding Solutions | pg. 6

Single vs. Multi-specialty ASC Models | pg. 8 Bridging the Gender Gap in GI | pg. 12 Advancing Colon Cancer Awareness | pg. 18

MARCH 2021

WHAT WE DO We partner with gastroenterologists in private practice, providing resources to improve operations, drive growth, and enhance patient, physician, and staff experiences—all while maintaining their independence.

Our strategy is aligned with your interests in tackling the following challenges: • Career security and stability • Succession and recruitment strategies • Growing administrative costs and burdens • Shifting regulatory and reporting requirements • Preparation to move from fee-for-service to value-based care • Competition from hospital and other physician practice models • Declining reimbursements paired with a need to invest in technology, security, marketing, and patient engagement

GET IN TOUCH We’d love to share more details about how we can help you stay independent and thrive in the changing healthcare environment.

Kevin Harlen, President kevin.harlen@capitaldigestivecare.com 240-485-5201

GI Editorial Staff Suzette Sison Editor in Chief ssison@pegisolutions.com

Contents MARCH 2021

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8

Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.com Julia Pinter Contributing Editor jpinter@pegisolutions.com

Publishing services are provided by GLC, 9855 Woods Drive, Skokie, IL 60077, (847) 205.3000, glcdelivers.com.

Letter

Strategies

2 Message from the President

6 Expanding Solutions

Noteworthy 4 New PE partnerships, David Greenwald named president of ACG, and more

10 Screening Time

PE GI Journal™, a free publication, is published

by PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929.

The views expressed in this publication are not necessarily those of PE GI Solutions, PE GI Journal or the editorial staff.

POSTMASTER: Send address changes to: PE GI Solutions, Attn: PE GI Journal, 2500 York Road, Suite 300, Jamison, PA 18929.

While every effort has been made to ensure the accuracy of PE GI Journal contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it.

Advertisers assume liability and responsibility for all content (including text, illustrations, and representations) of their advertisements published.

Cover image: iStock.com/Akarawut Lohacharoenvanich

Printed in the U.S.A. Copyright © 2021 by PE GI Solutions All rights reserved.

8 Finding the Right Fit

16

18

Excellence

Spotlight

12 A Growing Field

18 The Year in Review Making the Most of a Difficult Year

Insights 16 Clinical Compassionate Care

PE Opportunities 20 GI physician opportunities at partnered practices

All copyright for material appearing in PE GI Journal belongs to PE GI Solutions, and/or the individual contributor/clients, and may not be reproduced without the written consent of PE GI Solutions.

Reproduction in whole or in part of the contents without expressed permission is prohibited.

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1 PE GI Journal pegisolutions.com

Letter | Message From the President |

Momentum Positive As we move forward, the GI industry is well-positioned for success

W

e enter spring with optimism. Thanks to the development and rollout of vaccines, the end of the pandemic seems like it’s in sight. But that conclusion is months away, and those months are likely to be some of the more taxing for the country.

At the beginning of the pandemic, GI practices and ASCs weathered the shutdown and emerged with an acute focus on safety while ensuring patients received critical care. Working in this “new normal” presented obstacles, but the GI industry overcame them. While we move forward toward the finish line for this health crisis, we must be cognizant of the speed bumps that will make the last leg of this journey difficult.

On a national level, challenges may include personal protective equipment shortages and confusion concerning the vaccine rollout. On a local level, organizations may find themselves in hot spots, which bring elevated exposure risk and potential restrictions.

Despite our desire to return to normalcy quickly, we cannot let our guard down. We must remain nimble and adaptable, prepared to assess and respond to developments.

We must also be diligent and vigilant concerning steps taken to maintain a safe environment and efficient operations, so we can continue serving patients.

Among the questions to ask yourself: If you’re in an area of heightened risk, do you implement increased testing requirements? Do you need to contact your local health system to understand its protocols and ways your organization can provide support? If you’re in an area with a lower COVID rate, do you implement rules concerning travel to areas with elevated rates?

In addition, apply lessons learned from your experiences.

Are you prepared to effectively reduce operations if your

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area enters into a lockdown? Are crisis communication protocols adequate to support rapid changes? Do you have a plan if staff members test positive or are exposed to COVID? Answering these and other questions while maintaining strong lines of communication with stakeholders (e.g., patients, staff, vendors) will be essential to navigating the remainder of the crisis. At the same time, we must begin to understand how our healthcare system will look following the pandemic.

Despite our desire to The good news is that the return to normalcy GI industry is positioned to emerge with positive quickly, we cannot let momentum. That’s why PE our guard down. is committed to supporting the GI community through these difficult months ahead while taking steps to come out of this period strong.

We continue to pursue diversification of services that will permit us to further support all aspects of GI and help organizations looking to grow. This diversification is a motivating factor in our decision to rebrand Physicians Endoscopy to PE GI Solutions. I invite you to learn more about the expansion by turning David Young, President & CEO, PE GI Solutions to page 6.

Noteworthy | News and events | Working Together

New PE partnership creates the Fredericksburg Endoscopy Center executed to ensure the overall goal of providing quality patient care at the ASC level,” says Nicole Romero, VP of Operations at PE GI Solutions. “Through an established trust in the partnership, all three parties bring specific value to the relationship, which has been the driving force and success of opening the Fredericksburg Endoscopy Center.”

As a GI Medicare certified center, the physician owners, Mary Washington Healthcare, and PE are excited to leverage this strategic partnership, with their focus being successful patient outcomes and providing quality GI care to their community.

Source: Google Maps

PE GI Solutions (PE), along with physicians of Gastroenterology Associates of Fredericksburg and Mary Washington Healthcare, are excited to announce their three-way joint venture partnership and opening of Fredericksburg Endoscopy Center, LLC, in Fredericksburg, Virginia.

Fredericksburg Endoscopy Center, LLC, includes 9,000 square feet and four procedure rooms, allowing for the endoscopic ambulatory surgery center to provide a high volume of procedures—an expected 14,000 annually. In addition to the six physicians included in the three-way joint venture, all practicing physicians at Gastroenterology Associates of Fredericksburg will also perform their procedures at the center. The six physicians involved in the partnership to open the center are Chet Pai, DO; Frank DeTrane, MD; Dong Lee, MD; Narayan Dharel, MD; Peter Wong, MD; and Akash Ajmera, MD. Both the physicians of Gastroenterology Associates of Fredericksburg and Mary Washington Healthcare chose to enter into the three-way joint venture partnership with PE as their strategic corporate partner to leverage their expertise in management services.

“A strategic partnership with these six physicians and Mary Washington Healthcare was carefully

Knowledge Leader

David Greenwald, MD, will focus on education as president of ACG

PE GI Solutions (PE) congratulates David Greenwald, MD, on his recent appointment as the president of the American College of Gastroenterology (ACG). Dr. Greenwald is the Director of Clinical Gastroenterology and Endoscopy at Mount Sinai Hospital in New York City and is a partnering physician of PE at The Endoscopy Center of New York.

With his appointment as President of the College, Dr. Greenwald will lead the college’s programs that are focused on continuing medical education. He will also use his expertise in GI innovation to advance patient-related skills and advocate for the GI specialty at a national and state level. He will remain committed to fostering connections among ACG members and the GI community.

As a partner to PE, Dr. Greenwald is a coveted physician of PE’s network of GI experts. Through his innovative

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advancements in the GI industry and notable leadership roles, he remains a sought-after GI physician at The Endoscopy Center of New York.

“PE is proud to partner with Dr. Greenwald,” says Annie Sariego, Market President of PE GI Solutions. “I am certain that Dr. Greenwald will exceed the ACG’s expectations in his recent appointment as the President, and I have no doubt he will continue to break down barriers in advocating for the GI industry.”

The Endoscopy Center of New York partnered with PE GI Solutions to leverage PE’s Center Solutions platform, which allows physicians to focus on quality patient care while PE provides strategic business management expertise along with clinical and operational excellence to improve digestive health outcomes.

To learn more about PE GI Solutions partnerships, visit pegisolutions.com.

Join the Team

New GI opportunities abound at PE-partnered centers

Coming out of the coronavirus pandemic, the GI industry is well-positioned for growth. Nowhere is that clearer than at our partnered centers that are currently expanding, particularly in the Mid-Atlantic region. Right now, these PE-partnered centers are looking for new gastroenterologists to join their teams: Peninsula Gastroenterology Associates in Delmar, Maryland Peninsula Gastroenterology Associates (PAG), a Capital Digestive Care partner, is seeking a full-time gastroenterologist to join their three-physician practice. In operation for more than 40 years, PAG treats patients throughout Southern Delaware and Southern Maryland. They are also affiliated with the Peninsula Endoscopy Center, a two-room, physician-owned and operated ambulatory surgery center.

iStock.com/VioletaStoimenova

Philadelphia Gastroenterology Consultants in Philadelphia, Pennsylvania Philadelphia Gastroenterology Consultants is seeking a full-time, board-certified or board-eligible gastroenterologist to join their fourphysician and four-physician assistant practice. Additionally, a partnership track is available for ownership in an adjoining three-room endoscopy center.

Learn more about these exciting opportunities on page 20, or submit your CV at pegisolutions.com/ physician-recruitment.

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Strategies | Business strategy and the bottom line |

Expanding Physicians Endoscopy becomes PE GI Solutions

O

By Robert Kurtz

management of freestanding, single-specialty endoscopic ASCs through aligned investments and collaboration with practicing physicians, health systems, and hospitals.

PE Center Solutions presents a number of opportunities for GI physicians and health systems to build, develop, and optimize a new or existing GI-specific ASC. “Whether partnering to create a new ASC from the ground up, acquiring and managing the business operations of an established ASC, or engaging in a joint venture, we are committed to offering options that benefit all parties. With a flexible service model and several different ownership and investment opportunities, our partners can maintain their stake in the business while remaining independent,” Young says.

The PE Practice Solutions platform, formulated with CDC, is the physician-oriented management services platform that specializes in aligning business growth objectives of GIs through investment opportunities to improve and grow practices while maintaining Physicians Endoscopy Is physician independence. “Business and Now PE GI Solutions healthcare should complement each “Business and healthcare other, not stand at odds,” Young says.

With the expansion into practice PE Practice Solutions helps physisolutions, PE positioned itself as the should complement each cians achieve the best of both worlds thought leader in the GI community other, not stand at odds. ” through the resources, infrastructure, and the GI partner. The foundaand management services gastroention of the organization is built on – David Young, President and terologists need to be able to focus improving the lives of patients and CEO of PE GI Solutions on doing what they do best: providing giving physicians the opportunity to quality patient care. maintain their independence while Services delivered via the platform practicing medicine. include full-service management, finance, clinical and “PE GI Solutions is unique in that it is a holistic solution operational excellence, information technology, physician designed solely for the GI physician,” says David Young, recruitment and human resources, revenue cycle management, President and Chief Executive Officer of PE GI Solutions. payor contracting, marketing, policy advocacy, and specialty “Through a series of strategies, it helps GI physicians run and ancillary services. their businesses, remain independent, and gain more time “It’s an all-encompassing offering for GI physicians to spend with, and deliver quality care to, patients.” wherever they practice, supplied by our team of experts,” The expanded offering combines two strategic partnership says Young.

“We’ve been serving GI specialists exclusively opportunities under a shared services model. PE Center for more than two decades, which has made us highly Solutions platform specializes in the development and

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iStock.com/Chris Curry

ver the last 20-plus years, Physicians Endoscopy (PE) has planted roots in the GI landscape. PE has overcome speed bumps, welcomed changes, and most importantly, continued to grow and evolve with the GI community.

In August 2019, Physicians Endoscopy and Capital Digestive Care (CDC), one of the largest GI groups in the country, entered into a strategic joint venture partnership. This led to the formation of a practice solutions platform designed to support and improve the performance of independent GIs and their practices—a solution that enhanced PE’s existing services for GIs and their ambulatory surgery centers (ASCs).

About a year and a half after the launch of the practice solutions platform and 22 years since PE’s founding, the company is undergoing the launch of a brand expansion to reflect its ability to meet all of the needs of GI physicians under an all-encompassing platform.

Solutions specialized and able to develop a single platform that meets all of their service requirements.”

were well-positioned to support the evolving needs of GI physicians.”

Why the Time Was Right

Benefits for the Entire Continuum of Digestive Care

The expansion—and concurrent rebranding and website redesign—is a natural evolution for the company, says Suzette Sison, Senior Director of Marketing for PE GI Solutions.

“Prior to our partnership with CDC, if you asked people to describe Physicians Endoscopy, we were a management company for GI ASCs,” Sison says. “We helped so many physicians within our ASCs, but then they would go back to their ‘homes’—their practices—and still need assistance from a clinical and operational perspective.” The practice is where much of the activity for a GI physician begins. The formation of the partnership with CDC extended PE’s capabilities and allowed for the expansion of offering support from the practice side, as well.

Conversations about undergoing a name change began around that same time, which also coincided with Young being named president and CEO of the company. For a while, the ASC and practice service lines essentially operated as separate entities. While unification of the service lines was part of the company’s long-term plan, the COVID-19 pandemic necessitated a change.

“The needs of GI physicians became further apparent during this health crisis,” Young says. “Physicians were reaching out to us and seeking help to determine what they should and should not do in response. That led to our ASC and practice teams collaborating more closely and leveraging each other’s expertise, which refined what we Robert Kurtz were doing for current is Founder and President of partners and could do for Kurtz Creative, prospective clients. This LLC, and inherently accelerated our former editor evolution and the necesin chief of Becker’s ASC Review. sity for us to ensure we

At its core, PE GI Solutions partners with physicians to improve the financial outlook and operations of their practices while allowing them to stay independent and focusing more on providing the best possible patient care.

But PE GI Solutions doesn’t just benefit physicians and their ASCs, practices, and ancillary services. PE GI Solutions also supports hospitals and health systems by improving financial and clinical outcomes. This is achieved through delivering investment guidance for GI service lines and developing and managing first-class GI ASCs. However, it may be patients who stand to benefit most.

PE GI Solutions works with its partners’ healthcare teams to leverage tools and resources to help ASCs and practices run smoother. Such collaboration helps improve and expand access to GI services and ultimately permits physicians to dedicate more time to patient care. When patients seek out PE GI Solutions-partnered organizations, they can expect to receive the most appropriate care at the right time, at the right place, and in the most efficient manner.

“The purpose of PE GI Solutions is to provide patients with access to quality digestive care through strategic physician partnerships, leadership, and advocacy that services the GI community with clinical and operational excellence, resulting in positive health outcomes,” Young says. “The dream for this platform is to improve the lives of GI physicians, healthcare teams, and their patients through positive experiences across the digestive healthcare landscape. I believe we will make this dream a reality.”

Learn more about PE GI Solutions and get GI industry updates at pegisolutions.com.

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Strategies | Business strategy and the bottom line |

Finding the Right Fit The advantages and disadvantages of single- and multi-specialty ASC models

Y

ear over year, graduating GI fellows must choose between practicing independently or hospital employment. More questions arise for those fellows who choose to practice with an independent group and seek ownership in their center.

With the continued popularity of ambulatory surgery centers (ASCs), this question has never been more relevant: Should I pursue a partnership in a single- or multi-specialty ASC? Here are some of the considerations to weigh when answering this question.

Financial Factors If you are buying into an existing center, the initial investment required is important, as well as the overall return on investment. The capital needed to invest in a relatively new

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center operating only a few years may be more attractive for a younger physician who is just starting their career. The financial return and distributions should increase over time as the center continues to grow and mature. On the flip side, the purchase price to buy into an established center that has been operational for several years can be expensive. Still, the financial return should be proportionally attractive.

Suppose you join a group that is building a new center. In that case, the initial investment is also one of the first components to consider and relatively low compared to buying into an established center. In a multi-specialty ASC, there will likely be more physician partners to divide costs between, which can appear to be a good thing. However, it may be a disadvantage for the partners of a specialty, such as gastroenterology, that requires far less expensive equipment. Plus, the overall multi-specialty facility will need to be larger to accommodate

iStock.com/Andrey Shevchuk

By Annie Sariego

operating rooms and the variety and types of procedures performed versus smaller procedure rooms for GI cases.

Single-specialty ASCs may have fewer partners to share in the costs. However, the physicians can be assured they are using the equipment they are buying. And the same case can be made for long-term investments such as technology upgrades, renovations, and expansions.

After considering the expenses associated with building an ASC, the projected revenue should be enough to ensure a long-term, financially viable center. A profitable ASC is highly dependent upon expected procedure volume and the number of doctors supporting the center. GI physicians perform an estimated 1,000–2,000 procedures per year, while other specialties may perform less than 500. Moreover, look at the payor mix for these procedures. Are there more governmental payors, who reimburse less, or a good blend with commercial payors?

Finally, consider overall financial risk. Single-specialty partnership models may offer more individual control over financial operations. Yet multi-specialty partnership models usually allow for more diversification of risk, especially if one specialty has the potential to be hit with reimbursement reductions in the future.

management services should be the operational support system to keep the business running smoothly, allowing the physicians to focus on the patient care that matters most.

Common management services include financial, marketing, IT, payor contracting, revenue cycle management (RCM), human resources, credentialing, and more. These services—some more than others, of course—can be tailored to the needs of your GI specialty with the added benefit of a single-specialty partner that is a thought leader within the industry.

A multi-specialty business partner supporting all physicians may only offer limited solutions that indirectly affect the bottom line. Of course, they too can share general healthcare management industry expertise, but your day-to-day connections with their most personal services like HR and marketing may not be hypersensitive to the needs of a GI physician.

A Clear Choice

While there are pros to the multi-specialty ASC model, the unique benefits to a GI physician in a single-specialty ASC remain unmatched. From cost savings to specialized partner services, the choice is clear.

Carol Stopa, former SVP of Business Development at PE, has worked with gastroenterologists for over 20 years.

Patient Outreach She says that overall, the decision to When evaluating a single- vs. multiselect a business partner often comes specialty model, the center’s location in down to the expertise of what the partrelation to your patient outreach strategy ner can offer and deliver on: can be very significant long-term. Single“Over my years in working with GI physpecialty GI ASCs are attractive in areas sicians, many have asked, ‘Why should with a mature population of adults over I partner with PE?’ I typically respond, the age of 45. In densely populated ‘Why should I see a GI specialist?’” towns with 55-plus neighborhoods, the She continues, “I could have my colonoscopy done by a general surgeon, or I ASCs can hyper-focus their outreach could see my primary care doctor for my efforts. On the other hand, it can be challenging to reach people at the colon stomach ailment—but I would rather see cancer screening age of 45 and over in a physician highly trained and experi– Carol Stopa, former SVP of Business increasingly diverse urban areas that are enced in the GI specialty. That makes me, Development at PE GI Solutions the patient, feel extremely comfortable overwhelmed by younger residents. and confident I am getting the best care Multi-specialty center partners do possible.

Hopefully, the same feelings can translate to a GI not need to consider location and demographics as closely as doctor who is looking to put his faith and trust in a business single-specialty partners because they offer a variety of propartner who will take care of his business and livelihood. PE cedures to attract a broader patient base. However, whether is a GI specialist—we understand the specialty through and you are considering a single- or multi-specialty center, the through—it’s all we do as an availability of a competing ASC must be part of your overall consideration when deciding on a location. organization each and every Annie Sariego day. While the GI doctor is Market President at is taking care of his or her Corporate Partner Services PE GI Solutions. patients, PE is taking care of She can be When choosing a corporate partner, do you want a jack those same patients. The difreached at of all trades or a subject matter expert? Both have their ference is we are also taking asariego@ benefits. Remember that a corporate partner who provides pegisolutions.com. care of the doctor.”

“Over my years in working with GI physicians, many have asked, ‘Why should I partner with PE?’ I typically respond, ‘Why should I see a GI specialist?’”

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Strategies | Business strategy and the bottom line |

Screening Time

Communicating the need for screenings this Colon Cancer Awareness Month

By Deven Stopa

Why Is There a Decrease in Screenings?

Looking at the numbers, it’s clear that the COVID-19 pandemic had an obvious effect on the reduction in GI procedure volume in 2020. But to increase your procedure volume and get back to pre-pandemic numbers, the solutions are complex.

There are only two ways to have missed so many appointments and procedures: cancellations initiated by physicians in order to adhere to certain guidelines at the time or cancellations initiated by patients. Assuming all physician-initiated cancellations are rescheduled, you’ll

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need to look at the root of patient cancellations—three different types of patient concerns: 1. Fear of COVID-19: Patients and/or their loved ones may be part of a more vulnerable population taking extra precautions.

2. Financial Woes: Patients are experiencing loss of jobs, and in turn health insurance, at staggering rates. In situations where patients have retained health coverage, pocket money for co-pays may be dwindling, meaning their elective appointments and procedures are not a financial priority.

3. Feeling Overwhelmed: Even if patients are not highly affected by health or financial worries, they are certainly feeling overwhelmed generally—who isn’t? Appointments may be lost in the shuffle of a pandemic, remote working and schooling, and life. Regain their attention and emphasize the simplicity and benefits of maintaining GI health.

There are multiple ways to address these patient concerns and get them back in for their appointments and procedures.

TIP #1

Over-Explain

While you and your staff have always explained instructions and managed patient expectations, now is the time to over-explain.

You do not want to leave room for any patient worries that may cause them to think twice about coming in for their visit.

iStock.com/romaset

G

astroenterologists have known since the start of the COVID-19 pandemic that there is a decrease in routine colon cancer screenings and other elective GI appointments. Research by komodohealth, however, has provided striking statistics showing just how serious patients choosing to forgo or delay their preventative care during the height of the pandemic is: • Screenings dropped by roughly 90% • Colorectal cancer diagnoses dropped by over 30% • 18,000-plus people are now at risk of missed or delayed diagnoses for colorectal cancer, the only preventable cancer that has a 90% survival rate when caught early

Over-explain precautions.

Don’t assume that at this point of the pandemic patients will know about all the extra precautions you are taking. Lay out everything for them—from how frequently disinfection occurs to the measures your own staff must follow daily.

Always include language that refers to the authority you are following, like “in compliance with CDC guidelines,” “adhering to all state and local regulations,” and/or “in accordance with ASCA guidelines.”

In addition to explaining these precautions prior to an appointment, show them. A picture is worth a thousand words, and a video is worth over 1 million. If you take the time to put together visual explanations of your adherence to guidelines, maximize their value by leveraging them across different platforms. Post on your website, upload to social media pages, send via email and text. You can even send postcards with your precautions for upcoming patient visits via direct mail.

Over-explain insurance and billing information.

Prepare answers in advance for insurance and billing questions that are coming up more often during the pandemic.

Provide everyone interacting with patients with key talking points to respond to concerns regarding finances and lost insurance. Always refer patients to places they can get their questions answered when insurance and billing questions fall outside the scope of your facility’s expertise. Going above and beyond to ensure patients understand these aspects of their care can have a big impact on their overall experience.

Over-explain the ease of the visit.

In an increasingly stressful world, where marketing and outreach messages are constantly trying to break through the noise, your patients may be overwhelmed. It can go a long way to remind them of how simple their visit and procedure will be. For example, many patients may forget that their total time at your center for a colonoscopy is usually less than three hours, or that their bowel preparation is not the dayslong horror that they’ve heard about. Being able to speak candidly and honestly to reassure patients that they should not delay their care is just as important as developing your formal patient outreach strategies.

TIP #2

Don’t Shy Away from Spending on Patient Outreach

While budgets may be tighter than ever, the marketing budget is not one that can afford to be reduced right now.

Instead, maximize the ROI of your marketing spend with an approach fully focused on patient outreach with both digital and print direct mail campaigns. Now that you’ve curated your over-explained patient messages, spread these on every channel.

90

Drop in screenings

%

Since the pandemic started, screenings have dropped by about 90%.

Source: komodohealth

Even without targeted direct mail or sponsored social campaigns, there are less expensive options available for getting your message to patients. Did you know that your facility’s Google My Business listing now has a place for COVID-related updates? You can post critical updates, including links to longer messages, in the dedicated space on your listing. You can also post organic social media content that engages patients with your facility. Remember to join digital conversations with platforms that have larger followings to boost your visibility—for example, engage with other colon cancer awareness posts that share the importance of screenings amid the pandemic.

Don’t underestimate the impact of digital and offline reputation management. Always reply to any online criticism, especially when it includes criticism of your COVID precautions. Set the record straight, politely and professionally, for future patients to see when they read reviews. Offline, provide patients with your print materials to share with peers.

TIP #3

Lean on a Corporate Partner

If you have a corporate partner that offers marketing services, ask about the tools available to you. PE GI Solutions, for example, built a customizable toolkit for our 60-plus GI physician partners to spread the message of patient safety during COVID-19.

PE’s toolkit includes: • Patient safety video • Website messaging • Text-alert messaging • Social media messaging • Patient instructions for COVID testing • Patient letter • PPE guidelines for personnel • Information on COVID vaccines Your corporate partner Deven Stopa is Director should be delivering patient of Marketoutreach tools like these so ing at PE GI that you focus on what’s most Solutions. She important—delivering the can be reached preventative colon cancer at dstopa@ pegisolutions.com. care that will save lives.

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Excellence | Success stories |

A Growing Field PE’s women physicians on bridging the gender gap in gastroenterology

By Julia Pinter

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Y

ear over year, more women are entering the gastroenterology specialty, slowly bridging a gender gap that has always existed within the field.

According to the Association of American Medical Colleges, there is still significant room for further female representation among practicing gastroenterologists (see chart below).

At PE GI Solutions, we take pride in the partnership opportunities available for renowned female gastroenterologists. To celebrate National Women’s Month this March, we sat down with three of our physician partners to discuss their varied experiences throughout their careers, how the GI field has shifted in support of more women, and their outlook for the future.

Female Representation Among Gastroenterologists 936,254

1,000,000 859,848 800,000

600,000

Julia Pinter (JP): How did you initially regard choosing the GI specialty, having less female representation than most others—did this affect your considerations?

Elizabeth Rock, MD (ER): In my time of training, women usually headed toward pediatrics, family medicine, or psychiatry, if they became physicians at all. I remember my conversations with my dad, a family doctor, encouraging me to think twice about going to med school as the years of study were long and arduous. Headstrong, I insisted I could do it. I was lucky enough to be accepted to the Medical College of Pennsylvania (formerly the Women’s Medical College of PA) where no specialty was considered “unfit” for a woman to pursue. I was drawn to gastroenterology during a rotation I took at Temple University Hospital.

I was fascinated by liver disease and the many facets of inflammatory Total Active bowel disease. I was also mesmerPhysicians ized by what could be seen in the Male gastrointestinal tract with the use Female of endoscopy. In a word, that rotation had me “hooked.”

63.7%

66% 400,000

36.3%

34%

200,000

0

2015

All specialties

2019

20,000 15,450 15,000

10,000

14,107

81.1%

83.6%

iStock.com/FG Trade

5,000 18.9%

16.4% 0

2015

Source: Association of American Medical Colleges

Gastroenterology

2019

Sonia Godambe, MD (SG): When I was applying to training programs, I had heard rumors of programs taking only a certain number of females, but it didn’t really factor into my decision at all. If anything, I saw the underrepresentation of women as an opportunity. I was interested in women’s issues, and in GI there are many women’s issues, such as inflammatory bowel disease during pregnancy and incontinence.

Kristin Braun, MD (KB): When I was choosing a specialty, I knew I wanted to use advanced technology.

I considered ophthalmology, but after hearing gastroenterologists speak in a series of lectures, I was impressed—they were always very precise and well-spoken. I was also fascinated by the technology of scopes, and after hearing the gastroenterologists speak, I could tell they were very passionate about treating a variety of conditions.

Fewer women in the specialty didn’t sway me from my interest in GI.

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Excellence | Success stories |

ER: When I began my residency, I went from most of my classmates being female to being the only woman in my residency year. Four years after that, I became the first female chief resident in internal medicine at Temple University Hospital. It was definitely a big change, but this did not keep me from pursuing the field I was most interested in. I began my GI fellowship the next year.

SG: Medical school has been split approximately 50/50 men and women for some time. However, when I came to interview for jobs after GI fellowship, being a woman became an advantage, as many practices were looking to add a female partner in their all-male groups. Working in the field has been nothing short of amazing. I am grateful to have worked with a great group of physicians. We support each other and are constantly striving to provide outstanding care to our patients.

I am grateful to have made strong relationships with patients of all walks of life and provide care to them. Patients now come to me for all sorts of reasons and not just because I’m a woman.

At this point, my experiences as a woman and a physician shape the care I provide for my patients today.

KB: When I attended med school, Jefferson was 51% female, but not many women chose gastroenterology. But during the years I was there, my two co-fellows were also female, which was awesome. That gave me women to connect with and look up to. At the end of my fellowship, I realized there was a huge demand for women in GI. Many all-male or majority-male practices were looking to fill their positions with women to attract and retain female patients—many prefer to see female physicians.

JP: How have your experiences as a woman GI physician changed or improved over the course of your career?

ER: This year marks the beginning of my 40th year as a gastroenterologist. I have seen great advancements in work and family life balance, like the restriction of on-call hours.

But there are definitely still improvements that can be made, especially in childcare policies.

SG: My experiences have certainly changed over the last 10 years, especially with motherhood. As the first female partner in my group, we had to create a maternity policy. With the support of my managing partner, I was able to create a parental leave policy for both men and women for all doctors in our group in the future.

I wanted to create a policy that allowed me to keep the practice I had built but also gave me time for my family.

This was the first time I sat at a table and lobbied for myself and for others to follow. This continued as we added nurse practitioners to our practice. I now find myself trying to provide mentorship to them. Most recently, another valuable resource for balancing work and family demands has been telemedicine.

From using patient portals to meeting with patients virtually, technology has given physicians the opportunity to educate our patients with flexibility.

KB: As I have been in practice, I have seen female patients become much more comfortable with seeing a female GI physician for different reasons, whether

14 PE GI Journal March 2021

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JP: How did your experience being a woman in med school differ from your experience once you entered the field?

it’s disclosing symptoms, understanding hormonal changes, or being more comfortable with being asleep for a procedure with a female doctor. So it’s become very rewarding to treat female patients with issues in the GI tract that statistically occur more commonly in female patients for unknown reasons.

JP: Are there any specific steps that you find necessary to continue empowering more women to join the GI field?

ER: I was lucky to have a supportive group of fellows and attendings to work with during my fellowship and an extremely supportive family who helped with raising my children. My husband and I prioritized hiring childcare for my two children, which brings me to what female physicians need—advances in work and family life balance. Some advances in work and family life balance have already been made by implementation of laws that restrict on-call hours. This certainly helps young women who are in training and trying to raise young families. Further steps can still be taken, perhaps passing on a tax credit to employers who either give young parents discounted childcare or vouchers to help defray childcare costs. Larger institutions may even be able to provide on-site childcare.

SG: My hope would be that any woman physician who is interested in GI because it’s the right fit for their medical interest can jump in with both feet and find support and mentorship from those of us here to achieve their goals. I think using a support network is a necessary step. The network can come from many places. I have a local women’s physicians’ group that “Zooms” every month to talk about our experiences. I also sat on a national GI society to help women in GI last year, and the group put out programs and resources to support women in GI. Individually, we must keep pushing to create opportunities for ourselves to achieve our goals. Each person will have to find the right balance of work, research, teaching and administration for them. These perfect opportunities might not exist, but we should try to create them. The networks should also include friends and family as the love and encouragement you get from them is motivating.

KB: I think continuing the progress that has been made in offering work-life balance is important. Gastroenterology is a hot, competitive field for the balance it offers. Ultimately,

Dr. Elizabeth Rock is a board-certified gastroenterologist at PMA Medical Specialists and is a partner at Endoscopy Associates of Valley Forge.

Dr. Sonia Godambe is a board-certified gastroenterologist at the Illinois Gastroenterology Group and is a partner at Elgin Gastroenterology Center.

individual work-life balance depends on a lot of factors, like your family, your hospital affiliation, if you have a supporting corporate partner. You have options within the field to make choices that you feel will be best for your own life balance. When you consider different options within the field, evaluate what the workload and hours will really be like.

Fortunately, with PE, I have found a great balance with my other physician partners. Endoscopy centers are great workplaces because they can be more flexible in scheduling than hospitals, and patients also tend to be happier coming to endoscopy centers rather than hospitals. On the other hand, you’ll still get to see some of the more interesting, acute things you can treat when you are on-call at the hospital, but it does not take up too much of your life balance.

JP: If a young woman in medical school today was considering going into gastroenterology, what would you tell her?

ER: Gastroenterology is a wonderful career for women, particularly within the growing field of nutrition and therapy requiring dietary modification. As the years have passed, I find that I am easily accepted by patients. Patients often comment on the empathy and understanding offered by female physicians. As the senior physician in this group, I am always happy to consider other women for partnership and growth opportunities.

SG: I would tell her to absolutely pursue a career in GI. Like many things in medicine, it’s fascinating, ever-changing, and so rewarding. You can create your own blend of clinical medicine, research, and procedural medicine.

KB: If I could go back, I would choose GI again. This is a competitive field with amazing technology, something that always interested me. You can almost always make real improvements in the lives of patients. It is truly rare that after meeting with a patient, there is nothing we can do to improve their quality of life. In GI, the treatments, procedures, or lifestyle interventions can help patients majorly feel better on a day-to-day basis. Even with colon cancer, it’s highly treatable especially when detected early. Getting involved with colon cancer awareness and increasing screening rates is another fulfilling part of joining the GI field.

Dr. Kristin Braun is a board-certified gastroenterologist at Clinical Gastrointestinal Associates and is a partner at the Endoscopy Center of Bucks County.

Julia Pinter is a Marketing Assistant at PE GI Solutions.

She can be reached at jpinter@ pegisolutions.com

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Insights | Clinical updates |

Compassionate Care

5 ways to support patients through their colon cancer diagnosis

R

eceiving a diagnosis of colon cancer forever changes a patient’s life.

Even patients who had steeled themselves to hear the dreaded news can feel shocked, confused, and frightened—all at a time when they must make important and frequent decisions about their health. For some, just figuring out how to move themselves and their families forward can seem overwhelming, both immediately after receiving the diagnosis and at nearly every step along their cancer journey. Doctors and other healthcare professionals can provide medical care to stop the progression of colorectal cancer, of course, but they can also offer emotional and logistical support that can shape disease outcomes.

Physician support can also provide hope at a time when patients need it the most. In a 2017 study published in Psycho-Oncology, researchers found that patients receiving higher levels of perceived support, personalized disclosure, and discussion of medical treatment plans from their doctors were more likely to have higher levels of trust in physicians.

Furthermore, the perceived emotional support they received from their doctors predicted the patients’ levels of hope.

Feelings of trust and hope can help patients continue treatment, even when all seems lost.

These are some of the important ways you can support your patients through a colon cancer diagnosis.

Carefully communicate the diagnosis.

Patients often remember with immense clarity the moment they heard the words, “You have colorectal cancer.” Many also

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recall how the doctor delivered their diagnosis, particularly if the physician does a poor job of communicating the news.

It is never gratifying to hear bad news, of course, but the way a practitioner delivers it can make the experience more satisfying. Research published in the Annals of Medicine shows that patients were more satisfied with the way a doctor communicated the news when the clinician delivers it in an “unhurried, honest, balanced, and empathic fashion.”

Carefully choose the location for disclosure. The environment should be private, so that the patients can express their feelings freely and without fear of being overheard.

Disclosure should never occur in a public place, for example.

While it is best practice to deliver a cancer diagnosis in person rather than over the phone, the pandemic has forced many practitioners to disclose the diagnosis virtually. In these cases, doctors should engage in a face-to-face video conference rather than in a phone call whenever possible.

In all cases, physicians should provide enough time for the patient to absorb the implications of the diagnosis and ask questions.

Never bombard the patient with facts, medical jargon, and statistics, particularly when first disclosing the diagnosis.

However, be prepared to answer questions and provide the most accurate information possible. Avoid explaining all the details in one appointment. Instead, schedule several interviews to discuss the diagnosis, treatment plan, and available supportive services.

Consider contacting the patient again by telephone on the day of disclosure—this can help reinforce the message of support.

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By Amiee Mingus

Monitor patients for signs of depression or anxiety.

Help the patient build a cancer support team.

It is normal for cancer patients to experience sadness or distress immediately after disclosure and throughout the course of treatment, as they cope with an uncertain future.

Grief and apprehension can evolve into depression and anxiety, which can interfere with the patient’s ability to carry out day-to-day activities and undergo treatment. Depression is common among cancer patients. In fact, one out of four people diagnosed with cancer also suffer from depression.

Physicians should monitor cancer patients for signs and symptoms of depression or anxiety, but detecting depression in colon cancer patients can be challenging—the disease and its treatment may mimic certain signs and symptoms of depression, such as major unintended weight loss, extreme fatigue or lethargy, and trouble focusing (chemo brain).

Research published in JAMA found that sleep disturbance, losing interest or pleasure in doing things they once loved (anhedonia), low self-esteem, and decreased appetite were the most common symptoms of major depression in patients.

The researchers in that study suggested asking patients if they have been bothered by anhedonia and have been feeling down, depressed, or hopeless (depressed mood) within the past month. Ongoing assessment for these symptoms of depression, as well as insomnia, fatigue, anorexia, nausea, weakness, or palpitations, can help clinicians provide full support for patients with colon cancer.

Depending on their individual needs, people with cancer need a wide variety of support services.

Some need the help of a nutritionist to avoid treatment-related nausea and unintentional weight loss, for example, while others benefit from psychiatric care to help them deal with depression and anxiety. Others benefit from joining a cancer support group or need assistance with rides to treatment or lodging when they travel for treatment. The American Cancer Society offers a collection of invaluable resources intended to help cancer patients. Doctors can also provide local information about any supportive care options the patient may need throughout treatment, such as psychiatric care or consultation with a dietician.

Develop a personalized approach for each patient.

Every patient is an individual, and every person with colon cancer has a unique experience throughout the course of his or her disease. To provide full support, physicians should develop a personalized approach for each patient.

Clinicians can observe the way in which the patient communicates, for example, and develop a line of communication that facilitates the patient’s preferred approach. Some patients have trouble expressing their feelings or asking questions, for example, and will simply do as the doctor tells them. Others openly express their thoughts and feelings, and will freely express concerns and questions, both during disclosure and throughout treatment. Many feel more comfortable talking to nurses about their diagnosis. For these patients, create an environment that gives them a few uninterrupted minutes with a trusted nurse before or after meeting with the physician.

Doctors may want to collaborate with families to help find ways to personalize the disclosure. Personalization can also help doctors present individual patients with multiple treatment options, and discuss the potential benefits and side effects of each treatment.

Offer continued patient support.

Taking charge of the patient’s care from the initial contact as far into the definitive treatment as possible gives the practitioner more time to develop a supportive relationship with the patient. Offering continuing care also helps the patient calmly explore the available treatment options with someone they know and trust. The doctor should also offer continuing support in cases where the physician in charge changes.

Disclosing a cancer diagnosis is one of the hardest things a clinician will ever have to do, yet most doctors receive little formal training in being the bearer of bad news. Inexperience and lack of training in delivering a cancer diagnosis can lead to discomfort and uncertainty for both practitioner and patient. Many clinicians improve diagnosis disclosure techniques over the course of their professional careers, but doctors at every stage in their careers can improve their approach.

Colorectal Cancer Awareness Month provides a great opportunity for clinicians to learn new ways to support their patients. Listening to the personal stories told by cancer patients, survivors, caretakers, and other Amiee Mingus healthcare professionals is Vice President of Clinical can help physicians Operations at understand how receiving the diagnosis changes lives. PE GI Solutions.

She can be It can also help doctors reached at learn new ways to support amingus@ pegisolutions.com. their patients.

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Spotlight | The Year in Review |

Making the Celebrating the GI industry successes and lessons learned from 2020

W

hile coverage of COVID-19 dominated the public health news in 2020, there were also significant advances in Colon Cancer Awareness. And it may be just the momentum the GI community needs to push forward this year to increase screening numbers. Journey with PE GI Solutions through 2020 in the advancement of Colon Cancer Awareness and lessons learned.

Most

Advancement of Colon Cancer Awareness Highlights in 2020 FEBRUARY

MARCH

Colon Cancer Awareness Month Cut Short by COVID-19 Events marking Colon Cancer Awareness Month kicked off as usual in March 2020. PE employees joined advocates for colon cancer awareness nationally in celebrating Dress in Blue day on Friday, March 6. Just one week later, areas began to shut down and cancel most of the exciting events that usually bring together survivors and supporters to fundraise for colorectal cancer research and care.

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APRIL

MAY

JUNE

Reopening Centers & Regaining Trust After widespread closures of facilities and cancellations of elective procedures due to COVID-19, re-openings and re-organizing facilities in adherence to new protocols occurred on a state-by-state basis. On April 17, the Ambulatory Surgery Center Association (ASCA) put their support behind following regional guidelines to reopen, reiterating that the safety of staff and patients alike remained a top priority. Immediately, centers began to do the extraordinary—modify their setup for social distancing, rework processes for fewer touch points, and bring in the extensive PPE and cleaning resources they needed. Regaining trust of patients in the importance of coming in for their preventative screenings began last spring but remains a priority in the year ahead.

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JANUARY

of a Difficult Year Virtual Get Your Rear in Gear Is a Success

A Reminder to Share Family History Just two short months after his brother Chadwick Boseman’s passing, NYCbased choreographer and performer Kevin Boseman revealed in October that he, too, had battled colorectal cancer. His news was much more positive—he was celebrating two years in remission! This news quickly sparked an important discussion on the increased risk of colon cancer that runs in families. PE joined the conversation with insights on the importance of sharing your family health histories.

PE joined the Colon Cancer Coalition in fundraising efforts during the first-ever virtual Get Your Rear in Gear Event for the Philadelphia region.

The PE team was the top fundraising team, raising over $15,000. The event brought in over $140,000 to increase screenings and prevention of colorectal cancer.

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Source: facebook.com/ColorectalCancerAlliance

JULY

AUGUST

SEPTEMBER

Chadwick Boseman’s Battle with Colon Cancer Perhaps the most memorable event bringing colon cancer to the forefront of so many Americans’ minds was the death of actor Chadwick Boseman.

Known best for his role in Black Panther and as Jackie Robinson in 42, Chadwick Boseman secretly battled colorectal cancer from 2016–2020, leaving fans in awe at the news of his passing.

Boseman’s death also brought to light the specific prevalence of colon cancer risk in Black men.

Moving Forward

OCTOBER

NOVEMBER

DECEMBER

Legislative Wins for Patients The end of 2020 was a busy time for Congress, passing COVID-19 relief. But did you know that within the relief package passed on December 22 were two acts that will benefit colorectal cancer patients? Fight Colorectal Cancer advocated for these bills, among their breadth of work in patient advocacy, research, and prevention awareness, since 2012. The Henrietta Lacks Enhancing Cancer Research Act directs the federal government to research and report on increasing the participation of traditionally underrepresented communities in clinical trials for cancer treatment options.

The Removing Barriers to Colorectal Screening Act, nicknamed the “Medicare Loophole act,” will correct a Medicare loophole that unexpectedly billed patients for polyp removal occurring during a routine colonoscopy.

While this Colorectal Cancer Awareness Month may look different, PE GI Solutions is inspired by the advancement of colorectal cancer awareness over the past year. We will continue the necessary conversations to advance colorectal cancer awareness through physician resources, patient advocacy, and research and treatment fundraising.

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Opportunities Submit your CV online at pegisolutions.com/physician-recruitment.

West Scottsdale, AZ Digestive Health Specialists Arizona Full-time gastroenterologist with partnership potential needed for small practice of four MDs, NP, and PA. Outpatient-based with low inpatient volume and only one hospital round. No ERCP or EUS training needed. Physician office includes an infusion center, pathology lab, and state-of-the-art endoscopy center, all within the same building.

West

Bellingham, WA Northwest Gastroenterology Exciting opportunity for BC/BE gastroenterologists, preferably with advanced therapeutic, ERCP and/or EUS skills, to join a growing physicianowned single-specialty GI practice in beautiful Bellingham, Washington.

Established in 1979 and growing, with nine physicians and four advanced practice providers, multiple ancillary service lines, and a new five-room endoscopy center. Offering a two-year partnership track, equal limited call rotation, competitive salary with excellent benefits, and work-life balance in a progressive community close to both Seattle and Vancouver.

Midwest Bloomington-Normal, IL Digestive Disease Consultants Reputable single-specialty practice for more than 30 years seeks physician.

Multiple revenue sources including endoscopy center, strong support from local hospital, and guaranteed salary for two years. Low turnover and high retention rate.

Bronson, MI Bronson Gastroenterology Practice Seeking a BC/BE gastroenterologist to join a well-established and respected group of outpatient and hospitalist gastroenterologists, and mid-levels.

Employed position includes competitive salary, paid malpractice, and full benefits. Kalamazoo, located midway between Detroit and Chicago, offers highly rated public schools, affordable real estate, and many activities for the whole family. Lake Michigan is less than an hour’s drive away.

Lima, OH Gastro-Intestinal Associates, Inc. Seeking a board-certified full-time gastroenterologist to join a six-physician, seven-CNP practice—the northwest Ohio area’s largest gastroenterology practice of more than 30 years. ERCP experience is preferred. Partnership track in 18,000 sq. foot practice-owned office and ASC after one year.

Competitive salary and benefits with paid malpractice, productivity bonus, and 1:7 call rotation. Signing, relocation, and loan forgiveness packages available.

Mid-Atlantic Delmar, MD Peninsula Gastroenterology Associates

Rochester, MI Troy Gastroenterology Two gastroenterologists skilled in general endoscopy and ERCP needed for private practice with two state-of-the-art, AAAHC-accredited ASCs. Competitive base salary with productivity incentive, retirement plan, discretionary allowance, insurance, and eligibility for member status after two years.

20 PE GI Journal March 2021

Seeking full-time gastroenterologist to join a three-physician practice.

Well-established practice of more than 40 years, treating the digestive health conditions of patients in Southern Delaware and Southern Maryland.

Located adjacent to the affiliated Peninsula Endoscopy Center, a two-room ASC that is physician-owned and operated. Offering a partnership track, flexible schedule, and limited call rotation.

Northeast Midwest Mid-Atlantic

Philadelphia, PA Philadelphia Gastroenterology Consultants Immediate opening for a full-time board-certified or board-eligible gastroenterologist to join four-physician and four-physician assistant Philadelphia Gastroenterology Consultants in Northeast Philadelphia. Partnership track available for ownership in adjoining three-room endoscopy center, Philadelphia Gastroenterology Endoscopy Center for Excellence. Competitive salary—first-year guaranteed, productivity bonuses, benefits, PTO match, ½ day off per week, paid malpractice, flexible schedule with limited equal call rotation. EUS and/or ERCP skills helpful but not required.

Northeast Stoneham, MA Digestive Health Associates, PC

South

Seeking full-time gastroenterologist to join well-established, seven-physician, single-specialty practice group with an ASC in the Boston area. 1:9 call schedule. Competitive salary and benefits. Full partner track at two years.

Central NJ Garden State Digestive Disease Specialists, LLC Seeking full-time BC/BE gastroenterologist to join three-physician practice. The job offers an excellent salary, competitive benefits package, reasonable call schedule (which includes other gastroenterology colleagues in the rotation), and an opportunity for full partnership track in 2–3 years. EUS/ERCP training preferred.

Hillsborough, NJ Digestive Healthcare Center PA

Hagerstown, MD Gastroenterology Associates Immediate opening for a gastroenterologist to join a well-established practice. Weekend call 1:8. One-year partnership track for ownership in practice and endoscopy center. Multiple revenue sources including endoscopy center and ancillary services. One hospital with endoscopy suite next to the office in the same complex as the hospital. Live in Frederick—one hour from Washington, D.C. and Baltimore.

Limerick, PA

Seeking a BE/BC gastroenterologist skilled in general endoscopy and ECRP to join busy, seven-person, single-specialty, 30-year established practice located in central New Jersey. Excellent salary, competitive benefits package.

North Bergen, NJ Advanced Center for Endoscopy GI physician needed to join a single-specialty, nine-physician GI center.

The center can help the physician drive patient volume through the ASC, allowing the physician to increase procedure volume in an environment that is more convenient. Ideally located in North Bergen, the “gold coast” of Northern New Jersey, with a spectacular view of the NYC skyline.

Endoscopy Associates of Valley Forge Opening for a full-time board-certified gastroenterologist to join a practice one hour outside Philadelphia. Partnership track available for ownership in adjoining ASC, Endoscopy Associates of Valley Forge. Competitive salary— first-year guaranteed, productivity bonuses, benefits, PTO match, ½ day off per week, paid malpractice, flexible schedule with limited call rotation. Any experience with EUS and/or ERCP would be a plus.

Uniondale, NY Gastroenterology Associates PC Seeking a full-time/part-time, board-certified/board-eligible GI physician to join large single-specialty gastroenterology group. Compensation package includes an option for partnership in practice and ownership in affiliated ambulatory surgery center.

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HELPING PHYSICIAN PARTNERS GROW AND THRIVE PE Practice Solutions is a unique, physician-oriented management service organization aligned with the interests of gastroenterologists in independent practice.

A collaboration between PE and Capital Digestive Care, we are committed to preserving the independence of gastroenterologists and advancing digestive healthcare.

LET’S WORK TOGETHER TO ACHIEVE YOUR PRACTICE MANAGEMENT GOALS: Strategic Guidance Financial Revenue Cycle Management Clinical & Operations Payor Contracting Human Resources Information Technology Marketing Kevin Harlen, President kevin.harlen@capitaldigestivecare.com 240-485-5201 capitaldigestivecare.com/joinus