Reflections. As I reflect on the last two years since I became President of the PSG, I simply cannot believe that the time has gone by so quickly. I often ponder on the saying, “the days are long, but the years are short”. Personally, my oldest daughter now drives and is entering her senior year. My youngest daughter is in high school – no more middle schoolers for me. I have had fun trips both in and outside of the US! It makes me stop and wonder what will life be like in 2 years for me?
The PSG is launching a mentorship program for GI Fellows and early career GI physicians. We will be reaching out to those of you who would like to participate in this project.
attending physicians at one’s own training program work very hard to train GI fellows, but this is generally different from a mentoring relationship.
For the PSG, I am very proud of our continued efforts to provide educational opportunities for our GI fellows. They are clearly the future of GI and of course at some point, the rest of us will retire. There is certainly a need for more gastroenterologists in Pennsylvania and West Viriginia. A study published this June in Gastroenterology by Ying and colleagues showed that “nearly 50 million Americans must travel at least 25 miles to see a gastroenterologist…and another 7 million people lived more than 50 miles away” with more disparities in access to care in rural areas. The researchers also found that “of 3,149 [United States] counties, more than two-thirds (69.3%) had no gastroenterologists, and 17% had fewer than 5 gastroenterologists.”
Many of us have benefitted from mentors. Perhaps some of us have suffered for the lack of a mentor during our education or training. Mentors can have a lifelong impact on their trainees, but the relationship does not go in only one direction. Mentors can get as much benefit and satisfaction as their mentees can.
Gastroenterology, like other areas of medical training is akin to a “guild”, where the experienced take the novice under their wing to train them in the arts of their chosen field. All GI fellows, including us way back when, had trainers and coaches that typically were staff gastroenterologists at our program. Many medical schools provide for mentor relationships, but this is less common in GI training. Certainly,
I have been lucky enough to have some important mentors in my medical career. The first was assigned to me when I was a firstyear medical student. His name was Eugene “Skip” Felmar, MD and he was a Family Practice attending in the San Fernando Valley area of Southern California. I enjoyed going out to his office and shadowing him closely while he saw outpatients, rounded on inpatients, and did office procedures. Beyond gaining valuable insight into the practice of medicine, I found out why his nickname was “Skip” after he took me out on his sailboat which he kept docked at the Los Angeles harbor. Skip Felmar became a role model for me, and the mentor-mentee relationship was mutually rewarding.
I remember times in the last two years when we had patients being transferred to our institution from hospitals up to 200 miles away. When I asked the referring team why they are looking so far away, they stated that they tried other hospitals that were closer but were routinely told that there was no GI coverage at the hospitals. We need to do better for our patients! We should be working to recruit these amazing fellows that we train to stay local if that fits their goals.
The PSG has worked actively to engage the Pennsylvania fellows through many opportunities. For example, we have 9 fellows on the PSG board, giving them the opportunity to understand the workings of a statewide organization. All GI fellows get free membership to the PSG (and free admission to the annual meeting) and we have now extended to this their first 6 months as an attending as well! Our annual conference has opportunities to show their research, and the 20 trainees selected for this receive a generous travel and housing stipend. We are hosting our second capsule course in conjunction with Geisinger Medical Center. Also, we have had a very successful virtual discussion with fellows about different
Another highly impactful mentor that I had was someone that I chose myself. Dick Kozarek, MD was (and
continued on page 2
President’s Message
continued from page 1
career opportunities, under the direction of one of our Board Members – Dr. Stokes. We look forward to having more of these opportunities in the future.
Regarding challenging social situations both internationally and nationally, where will we be in 2 years? I hope that we continue to listen to the science and the data , but it is getting harder to find the truth amongst the massive number of social media posts from often questionable sources. We need to keep advocating for our patients - to get their important vaccines, get their
colonoscopies, get treatments for their diseases – to help to improve the overall health of our region!
I am looking forward to our annual meeting which will be in Philadelphia from September 20th to 21st. As always, we will have an amazing line up of speakers reviewing updated guidelines on EoE, IBS and IBD, discussing newer treatments for PBC, novel techniques in AI and endoscopy, management of GI bleeds, management of IBD in pregnancy, BE and difficult colonoscopies, and management of anal fissures and
hemorrhoids. Dr. Octavia Pickett-Blakely from the University of Pennsylvania will be giving our keynote address on “Tackling the Obesity Epidemic”. And we are planning a hands-on course Sunday! Thank you to Dr. Kristle Lynch from the University of Pennsylvania for putting together such a wonderful program. I hope to see you all in September at our annual meeting!
Reflect back on your last two years… what have been some of your biggest challenges, opportunities, and successes? Where will you be in two years?
The Federal Trade Commission’s Non-Compete Ban: What Is It, What Is Its Status Today, and What Is Its Future?
Non-compete agreements (NCAs) in physician contracts, also termed “restrictive covenants” or “covenants not to compete,” have become a hot topic recently because of the Federal Trade Commission’s (FTC’s) April 2024 ruling invalidating almost all NCAs. But in fact, NCAs have long been controversial, and no more so than in the realm of physician NCAs, which involve substantial policy concerns.
Given its intricacies and importance of NCAs, and the fact that up to 45% of physicians currently have contracts containing NCAs, it behooves physicians to understand the foundation of the NCA, how it relates to a physician employment contract currently, and its possible evolution.
What is It?
Generally speaking, an NCA, usually in the form of an employment contract clause, is an agreement between the employer and the employee that the employee will not enter into post-contract competition with that employer within the limitations of a specific duration, scope of practice, and/or geography. NCAs have traditionally been regulated under state statutory law and common law and have been permitted based on policy considerations that attempt to balance competing employee and employer interests. Physicians should understand their states’ statutory treatment of an NCA. NCAs protect important employer business interests, including the protection of proprietary information, safeguarding trade secrets, reducing employee turnover, and protecting patient lists. Employees, though, have limited mobility in changing professional positions, have less
bargaining power with the employer, and may find themselves with limited options for comparable professional positions.
The NCA ostensibly appears to greatly benefit the employer’s interests over the employee’s; however, NCA protection of employer interests may also substantially benefit employees by encouraging substantial employer investment in employees whom the employer recognizes as a stable and likely long-term human resource, ultimately fostering increased employee satisfaction and innovation. Indeed, one concern with the FTC’s non-compete ban is the potential for significant underinvestment in information sharing and employee training, because employers would, without a NCA, be less likely to recoup those employee investments and would have limited ability to keep competitors from free-riding on investments in employees who leave and join competitors. Ultimately, this would lead to decreased market efficiency.
What is Its Status Today?
Regulation of NCAs, including physician NCAs, has traditionally been based on state statutory law and by common law. Perhaps because of the increasing use of the NCA in professional settings, the NCA has been increasingly scrutinized by courts and state legislatures in the last few decades, with an overall increasing focus on NCA reasonableness and appropriate fit in individual employment settings, and with an emphasis on employer demonstration of legitimate and significant business interests for using an NCA.
States have evolved differently in their treatment of NCAs; some states ban NCAs altogether while others allow them with varying interpretation and enforceability, frequently focused upon the NCA’s duration, scope, and geography. Similarly, in common law, courts will frequently invalidate NCAs that are found to be unreasonably overbroad, either geographically, temporally, and/or in regard to scope. On April 23, 2024, however, the FTC altered this existing state of affairs by issuing a rule banning new NCAs in all employment situations after September 3, 2024. The rule also holds that existing NCAs are not enforceable, with a small carve-out for some senior executives. It applies to for-profit businesses, and some, but not all, non-profit organizations. The FTC’s stated intent is to reduce healthcare spending by increasing employee compensation and mobility. The FTC’s ban is likely meant to reduce transaction costs by increasing physician mobility.
There have been several lawsuits regarding the FTC ruling, challenging it on different grounds. The US District Court for the Northern District of Texas in Ryan LLC v. FTC issued first a preliminary injunction, then a final decision overturning the FTC’s rule. The Court held that the FTC had exceeded its statutory authority, and further, that the rule was arbitrary and capricious. It noted that the rule’s “categorical ban” has no equivalent in state law, is “unreasonably overbroad without a reasonable explanation,” “provides no evidence or reasoned basis,” does not “consider the positive benefits of non-compete agreements,” and does not “address alternatives to the Rule.” The Ryan Court reasoned
Timothy Craig Allen, MD, JD
that as an administrative agency, the FTC can only act as Congress authorizes by statute. On Oct. 18, 2024, the FTC appealed the Court’s decision to the Fifth Circuit Court of Appeals, seeking to reverse the holding setting aside its NCA ban. The United States District Court for the Eastern District of Pennsylvania in ATS Tree Services LLC v. FTC denied the plaintiff’s motion to stay enforcement of the rule, refusing to issue a preliminary injunction preventing its implementation. As in Ryan, the ATS Tree Services LLC v. FTC plaintiffs argued that the FTC had exceeded its statutory authority in issuing the rule. However, the Plaintiff did not appeal the holding.
The US District Court for the Middle District of Florida in Properties of the Villages, Inc. v. FTC held, like Ryan, that the rule exceeds the FTC’s statutory authority, noting the FTC’s prior lack of any NCA enforcement actions; however, its reasoning differed from Ryan. The Florida Court held that the FTC in fact has statutory authority to issue such rules; however, the Court held that the FTC could not enforce its rule because it violates the “major questions doctrine.” The “major questions doctrine” requires an agency such as the FTC to “point to clear congressional authorization” for any rule it issues that has “extraordinary ... economic and political significance,” as the NCA ban rule certainly does.
What is Its Future?
The FTC’s NCA ban remains unsettled. State legislatures, in response to the recent court holdings, are reassessing their statutory law regarding NCAs. The Ryan Court’s holding prevented the FTC’s rule from going into effect on September 4, 2024. The Texas and Florida court decisions are awaiting 5th and 11th Circuit Court of Appeals review, respectively. Assuming affirmation of either of the cases on appeal, a circuit split regarding the NCA ban may occur. The US Supreme Court may be called upon to determine the validity of the FTC rule banning NCAs. The Circuit Court
decisions are likely to occur in 2025, and any Supreme Court decision would not likely occur until 2026. Meanwhile, state statutory law and common law still apply to NCAs, and the FTC may challenge the validity of NCAs on a case-by-case basis.
US antitrust law remains a potential remedy to scrutinize and restrain inappropriate business practices, including NCA-related abuses. The Sherman Act allows federal and state actors and private citizens, to sue for redress. Antitrust cases are typically considered using the “rule of reason” formulated by the Supreme Court in 1911, which requires plaintiffs show that defendant businesses possessing market power did in fact undertake anticompetitive conduct that had or likely had anticompetitive effects. In other words, the court in an antitrust case will require that the plaintiff show that the business actually had a significant controlling market presence in the geographic area; and further, that the plaintiff show that the business’ actions in fact had an anticompetitive effect, or likely had one. The latter can be found by showing an anticompetitive effect such as abusive pricing
The FTC’s ruling is legally and academically controversial and in fact may not withstand court scrutiny. The rule was put forth by the FTC as an ambitious rule to reduce healthcare spending. But businesses survive only if their revenue surpasses their costs, including personnel costs. Further, maximization of capitalization is attained when businesses require NCAs. Businesses invest heavily in recruiting, hiring, and training personnel, and increased personnel turnover increases these expenditures. NCAs arguably provide a collective benefit by ensuring force continuity, mitigating the risk of the loss of highly trained personnel with proprietary knowledge. NCAs also help a business maintain a skilled workforce, helping maximize business valuation. If FTC’s NCA ban rule were ultimately upheld, businesses would likely respond by instituting longer-term employee contracts,
extended termination notice periods, and disincentives for employees who do not fully serve their contract length, including substantial financial disincentives. Business valuation might decrease, reducing investment incentives.
NCAs have long been a method of balancing the interests of employees and employers. They protect businesses’ confidential information, trade secrets, and patient lists, at some cost to employees pursuing new opportunities. The employee, though, is also provided with some benefit from the NCA, albeit indirect. State statutory law and courts have traditionally worked to ensure an appropriate delicate balance between interests, with courts generally finding unbalanced NCAs unenforceable.
For now, physicians should understand the policy considerations of and recognize the uncertainty surrounding NCAs, become familiar with their state’s statutory NCA law, review employment contracts carefully for NCA reasonableness, and seek legal advice if necessary.
Perhaps the FTC’s approach is the correct one for our future. Or perhaps the appropriate future of NCA interpretation and enforcement should continue to rest on state statutory law and common law, where antitrust enforcement is on a case-by-case basis, rather than FTC rulemaking. The results of high court decisions, state statutory law changes in response to the FTC rule, and perhaps US congressional action will provide the final answer.
Originally published February 6, 2025 in GI and Hepatology News
Dr. Allen is based at the University of Oklahoma Health Sciences Center in Oklahoma City. He has declared no conflicts of interest in relation to this article.
12 Months Down, a Lifetime to Go: Lessons Learned from Year 1 of GI Fellowship
The first year of gastroenterology fellowship is a whirlwind of long days that all began with a letter from The Match. It is intense, humbling, and transformative. Starting fellowship, I anticipated a steep learning curve, but the reality was harder than the expectations. The transition from internal medicine to a subspecialty demanded a rapid acquisition of procedural skills, in-depth understanding of complex gastrointestinal diseases, and the ability to communicate nuanced medical decision-making from the role of a consultant rather than as a member of the primary team.
Lesson 1: Procedural habits are developed early, and procedural prowess comes with patient and diligent practice.
The procedural aspect of GI— especially learning endoscopy—was a major source of both excitement and anxiety. It is a major departure from the regular patient care that is demanded of all internists. With endoscopy, the focus is now task oriented: the objective is to complete a safe procedure with diagnostic and/ or therapeutic value. Early attempts at navigating the endoscope felt clumsy, but with guidance from skilled attendings, patience for myself, and consistent hands-on practice, progress became tangible. There’s definitely a quiet satisfaction in gaining technical competency and applying these techniques to impact patient care. At times, learning the skill of endoscopy harkens back to my learning ballet as a child: skills are hard-earned, progress is not linear, and the body will be sore.
Lesson 2: Thinking like a gastroenterologist is different from thinking like an internist.
Equally important to the development of endoscopic technical skills has been understanding when and on whom to use them. Gastroenterology problems run the gamut from acute to chronic and quality of life-affecting to life-limiting. The best treatment for any given problem may be an internal medicine treatment or may well be surgical intervention. Being an effective gastroenterologist requires an understanding of what both approaches can offer. It is important to understand the “what”, “where” and “why” of GI, because the benefit (and burden) of being a sub-specialist is the implicit trust patients often have in us and their expectation that we’ll “get to the bottom of it.”
Lesson 3: The transition from primary team to consultant can be jarring, but collaboration is key
Being a consultant rather than part of the primary care team brings a unique mix of detachment and responsibility. As a consultant, you’re called upon for your specialized knowledge, often during critical decision points, but as a new fellow it is often difficult to have the “right” answer. There’s a sense of being one step removed from the emotional and logistical weight of daily care, but consulting requires balancing advocacy with diplomacy, precision with humility, and often, providing guidance in moments of uncertainty. As a new
fellow, it was difficult at first to strike this balance when feeling unsure of myself, but I quickly realized that discussions with my attendings and colleagues would often lead me to the next best step, and this was the best place to start.
Ultimately, the first year of fellowship is not without its challenges, and I am sure that everyone who has lived through it remembers the fatigue, self-doubt, and the pressure to perform. But these are counterbalanced by moments of triumph, mentorship, and camaraderie as I become the physician I have always wanted to be. There is still much to learn, but I now have a foundation to build on. Ultimately, the days are long, but the months are short, and fellowship is just the beginning.
Cydney Nguyen
PSG Annual Scientific Meeting
Se ptember 19-21, 2025
LOEWS HOTEL, PHILADELPHIA, PA
Nick Noverati, MD
Shannon Tosounian, MD
Gastroenterologists, more than most physicians, are at risk of procedurerelated harms, termed “endoscopyrelated injury” (ERI). Performing GI endoscopy is taxing on the body, particularly if performed without ergonomic best practices in mind. The American Society of Gastrointestinal Endoscopy (ASGE) has placed a focus on evidencebased practices to help prevent ERI. To further this goal, they have published recommendations for best practices which include aiming for a neutral monitor and bed height, use of anti-fatigue mats, scheduled “micro and macro” breaks, and education regarding the ergonomics of endoscopy [ref].
Given that this is an important concept, and that gastroenterology (GI) fellows may be more interested in developing good habits earlier rather than later in their career, the following interview was conducted between a current academic gastroenterologist (S.T.) and GI fellow (N.N.).
What are common mistakes you see new fellows making regarding proper ergonomics (for example, not feeling empowered to ask for the bed to be high enough/no one asking, scope not positioned properly, bad posture, etc)?
When you’re going from internal medicine to I, we’re just not very good at the basics of moving beds. That’s just not something that we do in internal medicine! I try to move it to where I think would be best for the GI fellow and I walk them through the rationale. You should be at eye level with the screen, your shoulders
Head, Shoulders, Scope— No Woes!
A Conversation About Ergonomic Best Practices
should be relaxed, the bed should be close to the hip—just so you have a starting point and they can make adjustments from there.
The other big mistake I see often is that the grip in the right hand is tense. There’s a lot of concerns about losing your spot in the lumen and not wanting to fall back and really wanting to hold that really tight tension. A thumb injury on the right hand is a type of injury that can happen from this.
What do you think is one of the biggest barriers to proper ergonomics and how can an endoscopist correct this?
Depending on where you work, the degree of personalization in a scope room may not be optimal. For example, a room may have screens in a fixed position, or an older building may be less accommodating. Advocating for what you would like, like a foot mat or for a better location of the video screen, for example, are good ways to help prevent injury.
Another problem is not knowing about mistakes in ergonomics until an injury has already happened. A lot of people view it as one more thing to worry about and so it is put on the back burner until it becomes a major issue. So, until it becomes a collective priority for prevention, it can be a barrier to proper ergonomics.
Do you do anything between cases to prevent injury, such as stretching or anything else?
I often am stretching my wrists, stretching my hands, doing a few stretches for my back in between cases and while writing notes.
Is there anything you do outside of the workplace to help prevent injury or physical fatigue from endoscopy (yoga, stretching, strength training, etc) that you would recommend to a trainee to incorporate into practice?
I do a ton of yoga! And strength training is really important for me. I think I was very humbled as a new fellow of exactly how much hand strength would be good.
Incorporating upper body weightlifting has also helped that a bit. To be honest, I was very humbled by how much actual strength and endurance you need in the upper extremities for scoping.
Have you observed or noticed any perceived disparities between level of training/status, gender, or other characteristics in optimizing ergonomics?
Yes! It is more common that women are going to get injured scoping, and that may be related to smaller hands and perhaps slightly lower strength in general. Hand size in general is a big predictor of injury and I’ve met a few other physicians who happen to be women who have very small hands, who have really struggled with more pain or fatigue after scoping.
Are there other tools or tips that one can use to prevent injury?
Shoe choice is a big one. A certain type of running shoe or whatever, was fine when you’re walking around the hospital, but it’s very common that people notice a difference in low back pain and leg discomfort when they’re standing all the time. There’s no one
specific shoe to recommend, but just good support and ones that aren’t making you feel sore at the end of the day.
Scope choice may be a factor. Some people will, across the board, only use pediatric colonoscopes. For me, I don’t do that because I think adult colonoscopes will get me to cecum faster, and increased procedure time is also a risk factor in ERI. Maybe if my hands were smaller, I would definitely make an adjustment.”
I know one attending that uses wheel extenders for the knobs of the endoscope and it has made a big difference in injury. She loves them. She uses them all the time, mostly for colonoscopies, just because they’re longer cases, and says it’s made a huge difference.
They can be an added cost and need to be cleaned, but it’s worth it for some endoscopists. More endoscopists should be aware of this.
What do you think are ways that a workplace could support endoscopists better to achieve physical wellbeing?
I do think that a personalized evaluation from either an occupational or physical therapist is so reasonable for any procedural specialty, because everyone’s needs are going to be different. It could be helpful to point out the pitfalls in someone’s posture during scoping or positioning of the bed, for example. I think that would be a great initiative for people onboarding to a new fellowship or a new job.”
Do you have any tips of how to be more cognizant of what your body is doing while scoping?
I do a brief “ergonomic time out” before starting the procedure. I make sure that the screen and bed are at a good height, and check that I’m holding the scope in a position that I know is the most comfortable for my body. If I’m noticing a pattern of bad behavior, I’ll ask one of the nurses or techs in the room to call me out on it.
Do you have any other parting advice or words of wisdom?
Especially for new fellows, awareness of proper ergonomics during endoscopy must be a priority. The earlier you start these habits, the better. Once you start to scope a certain way, bad habits can be incredibly hard to break. Although there’s a million things flying at you when you’re a new fellow, if you make this a priority, the likelihood that you’re going to be comfortable scoping for decades is so much higher than you never pay attention to it.
Reference:
Pawa S, Kwon RS, Fishman DS, Thosani NC, Shergill A, Grover SC, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, Chalhoub JM. American Society for Gastrointestinal Endoscopy guideline on the role of ergonomics for prevention of endoscopy-related injury: summary and recommendations. Gastrointestinal Endoscopy. 2023 Oct 1;98(4):482-91.
Adam C. Ehrlich, MD, MPH, FACG ACG Governor for Eastern Pennsylvania
American College of Gastroenterology Update
Advocacy Update
On April 3, 2025, the ACG Governors had the distinct pleasure of representing our field of gastroenterology in meetings with Congress during the annual legislative fly-in. We were joined by members of the Board of Trustees, the Legislative and Public Policy Council, and the College’s Early Career Leadership Program.
In our discussions, we emphasized how Congress is essential in protecting us from many harmful forces at play – from insurers and their burdensome utilization management requirements to ever-decreasing Medicare physician reimbursement.
Specifically, we asked our House Representatives and Senators to:
1. Support prior authorization reform, including the Reducing Medically Unnecessary Delays in Care Act, a physician-led, bipartisan legislation from Rep. Mark Green, MD (R-TN), Rep. Greg Murphy, MD (R-NC), and Rep. Kim Schrier, MD (D-WA). The bill would require all Medicare plans to have only medically necessary prior authorization policies for both prescription drugs and services. It also requires all appeals and peerto-peer reviews be conducted by a doctor in the same specialty as the patient’s condition.
2. Cover surveillance colonoscopy as a preventative service, through Appropriations language that would urge the Department of Health and Human Services to provide updated guidance to private insurers. We have heard your concerns about
this issue and continue to push for federal action through multiple avenues.
3. Advance both short and long-term improvements to the Medicare physician reimbursement system, including the Medicare Patient Access and Practice Stabilization Act (HR 879) and reforms that center patient access to care, while ensuring pay keeps up with inflation and the cost of providing services.
Finally, we reminded legislators that ACG members are happy to serve as a resource on local issues. We discussed how ACG can be a resource for congressional offices in our states and communities because firsthand experience can help assess how healthcare policies will uniquely impact their constituents—our patients.
Programming Update
In early June 2025, the ACG and the ACG Institute arranged several leadership and career development programs to foster the growth and skills of its members. These opportunities included:
1. Chief Fellows’ Course—Designed to teach important skills for incoming chief GI fellows that will help them navigate the unique challenge of leading while still in fellowship training.
2. Emerging Leadership Program Designed to teach senior fellows skills including time and change management, communication skills and negotiation.
3. Early Career Leadership Program— Designed for those 1-5 years after fellowship to enhance advocacy, communication, and mentorship skills.
4. Advanced Leadership Program Designed for those 10-20 years after fellowship and who have already demonstrated leadership to take the next steps in their leadership journey including in the ACG.
5. Clinical Research Leadership Program —Designed for those who have already received Primary Investigator/ Co-PI funding to enhance their understanding of funding mechanisms and research skills.
Most of these programs have applications that are open in the fall. If you are interested, we encourage you seek out more information on the ACG website and consider applying! Upcoming ACG educational meetings and courses:
• Functional GI and Motility Disorders School and Midwest Regional Postgraduate Course Indianapolis, IN—August 22-24, 2025
• Esophagus School and Regional Postgraduate Course Williamsburg, VA—September 5-7, 2025
• Hepatology School and Southern Regional Postgraduate Course Nashville, TN—December 5-7, 2025
We look forward to seeing you at any of the regional meetings and of course at the annual meeting in Phoenix!
Sidney J. Winawer, MD, DSc (Hon), MACG
“80% of success in life is showing up.”
Woody Allen
As a young boy, my parents took me to Winawer Family Circle festive gatherings. Aunts, uncles, cousins, etc., all “showed up.” As immigrants, social life was with family. When I married and had my own children, we all showed up at every wedding, birthday, funeral, etc. As a result, the next generation became very close with each other – a blessing for parents. The concept of showing up became part of my DNA—professionally as well as personally.
My GI fellowship was Harvard-affiliated but located in the Boston University Mallory Institute of Pathology. The BU pathologists held a conference every morning. I showed up. It was there that I first learned about the work published in 1927 from St. Mark’s Hospital in London on the adenoma-colorectal cancer (CRC) link. The concept took root in the back of my mind. Our cytologist had a program of early cancer detection in Pernicious Anemia (PA) patients through gastric washings. I showed up at her morning lavages and was introduced to the approach of early curable cancer detection before its clinical appearance. The Nobel Prize Foundation honored William B. Castle in 1938 for the B12 cure of PA. He had a PA Clinic where patients were encouraged to bring in stool specimens for occult blood detection of early gastric cancer. I showed up and, having been converted by our cytologist’s concept, joined in the effort. The occult blood method intrigued me.
Showing Up
Boston City Hospital and the BU University Hospital across the street were treasure troves of talent in GI. I had applied and was rejected by Franz Ingelfinger at BU who had one of the country’s GI “Meccas.” Nevertheless, I showed up at his rounds, presented cases, and secured an invitation to his journal club and casual dinners with his fellows. I even showed up at a BU medical Grand Rounds that he conducted. He was stunned! No Harvard fellow had ever done that. We developed a close relationship, and I learned a lot from him. He offered me a faculty position. This time it was my turn to reject. I accepted an offer at Cornell.
I arrived back in my hometown of New York City with appointments at three Cornell hospitals. My lab was at Bellevue, but I began to take an interest in Memorial Sloan Kettering Cancer Center (MSKCC) because of its focus on cancer. I showed up at rounds and conferences organized by Paul Sherlock, the only gastroenterologist there. We became friends and colleagues. When MSKCC transformed into a full-time academic center, GI was the first designated service, and Paul invited me to join him as Director of the Endoscopy Unit. Showing up gave me the entry.
As I began to consider a research program, experience with countless advanced CRC patients coupled with my various Boston episodes of showing up crystallized into a focus on cancer prevention. Screening, surveillance, and interruption of the adenoma-CRC progression became my crusade. Showing up in the NCI cafeteria as an AGA representative to the National Cancer Advisory Board led
to a wonderful friendship with board member and chair of Howard University Department of Surgery, LaSalle Leffall. He became helpful with the National Polyp Study review by the board. There were many other situations when showing up led to interesting outcomes – e.g., an invitation to Yale Club dinners by my friend and colleague Dick McCray resulted in our organizing the New York Society for GI Endoscopy.
Many things have changed in the practice of medicine since I went to medical school, and surely, they will continue to change in the decades ahead. But looking back, there is one lesson that I learned that is as meaningful now as it was then: the value of showing up, both professionally and personally.
Dr. Winawer is Emeritus Chief, Gastroenterology and Nutrition Service, Chair, Cancer Prevention Program, Memorial Sloan Kettering. He has been a member of the American College of Gastroenterology since 1971 and served as ACG President, 1979-1980.
Reprinted from ACG Magazine with permission from the American College of Gastroenterology.
“Looking back, there is one lesson that I learned that is as meaningful now as it was then: the value of showing up, both professionally and personally.”
BOARD&STAFF
BOARD&STAFF
PRESIDENT
PRESIDENT
David L. Diehl, MD
Geisinger Medical Center Gastroenterology/Nutrition 570-271-6856 dldiehl@geisinger.edu
Karen Krok, MD, FAASLD, FACG Penn State Hershey Gastroenterology 717-531-1017 kkrok@pennstatehealth.psu.edu @klkrok
@DavidDiehlMD
President-Elect
1st Vice-President
Manish Thapar, MD Jefferson Einstein Philadelphia (215) 456-8242 manish.thapar@Jefferson.edu
Karen Krok, MD Penn State Hershey Gastroenterology (717) 531-4950 kkrok@pennstatehealth.psu.edu @klkrok
SECRETARY
SECRETARY
Neilanjan Nandi, MD, FACP University of Pennsylvania 215-662-8900
TREASURER
Kim Chaput, DO St. Luke’s Gastroenterology 484-526-6545 kimberly.chaput@sluhn.org
EDITOR
David L. Diehl, MD Geisinger Medical Center Gastroenterology/Nutrition 570-271-6856 dldiehl@geisinger.edu @DavidDiehlMD
ADMINISTRATIVE OFFICE ASSOCIATION EXECUTIVE
STAFF Jessica Winger Meeting Manager
Tom Notarangelo Design Manager
Neilanjan.Nandi@pennmedicine.upenn.edu @fitwitmd
Manish Thapar, MD Thomas Jefferson University Hospital (215) 955-8900 manishthapar@yahoo.com
