Can FM physicians do colonoscopies? How so?

[blueskyguy]

Hi all,

I heard that Canadian FM physicians can do "colonoscopies" and other procedures. What is the route to be able to do something like this? Is this part of a "+1 year" program?

Also, can someone list all of the "subspecialties" or "additional programs" that FM physicians can do to add to their practice? Are they all "+1 year" programs, or can they be longer, etc.?

(I read online about "Certificates of Added Competence". Are these the same as "+1 year" programs? Here is where I read about this: https://www.cfpc.ca/CAC/) (Is it possible to do any of these kind of programs in the U.S., and then come back to Canada? Or no?)

Also, can anyone outline the positives/negatives of doing these extra training programs? How commonly are they done? Are they more lucrative? How much so? Are they competitive? Ultimately, are they worth it?

Thanks for the clarification!

 

[freewheeler]

You can do colonoscopies if you have the training, work rurally, and have the hospital privileges to do so.

For this specifically, either American trained FM doc with experience during residency or somehow access training as a Canadian FM in rural practice where there is a service gap.

Not common.

I don't think this is part of the +1 in surgery.

You can do almost anything you want as a family doc with regards to having a niche practice. Really depends on your interests.

[Wachaa]

It's possible to get the training and do it, but the FPs who do colonoscopies would then typically work in a remote area that HAS an operating room but does NOT have a surgeon practicing in the city. Not many desirable places to live in which fit that description.

[ZBL]

“Can” and “should” are two very different things. 

[Snowmen]

You need a ton of experience to be comfortable doing endoscopies and I doubt you could get the volume to achieve that. There's also the issue of referrals since you probably couldn't get enough volume from just your patients. No one will refer to a GP if they can refer to a surgeon/GI.

[NLengr]

Those things are money makers for IM and general surgery so I would imagine it's very rare to find an area where you could do them as a family doc.

[shimshim]

If rural and no Gastroenterologist are there (like northern remote Manitoba) 

 

I know in Maritime provinces you wont get the privilege at the hospital. In PEI I think currently there is 1 GI, and still no surgeons or FM have the privilege.

Now in the USA (FM and Surgery can do colonoscopy if trained but those are for over night calls, so just imagine). 

I signed a contract in a hospital, and I have it in my contract that if anyone other than a GI does any procedure from my pool of patients or in the hospital, I can terminate my contract with the hospital at my will and the hospital owes me (XXX amount of money), and if  me and my group allows, they can take the 10 PM - 7 AM cases only with our approval and not under our umbrella or malpractice. 

 

 

[ploughboy]

On 7/13/2019 at 5:56 PM, shimshim said:

I signed a contract in a hospital, and I have it in my contract that if anyone other than a GI does any procedure from my pool of patients or in the hospital, I can terminate my contract with the hospital at my will and the hospital owes me (XXX amount of money), and if  me and my group allows, they can take the 10 PM - 7 AM cases only with our approval and not under our umbrella or malpractice. 

 

 

Smart.  Did they offer that, or did you have to negotiate it?  Just curious, as I don't stick scopes into people for a living.

[medigeek]

On 7/13/2019 at 5:56 PM, shimshim said:

If rural and no Gastroenterologist are there (like northern remote Manitoba) 

 

I know in Maritime provinces you wont get the privilege at the hospital. In PEI I think currently there is 1 GI, and still no surgeons or FM have the privilege.

Now in the USA (FM and Surgery can do colonoscopy if trained but those are for over night calls, so just imagine). 

I signed a contract in a hospital, and I have it in my contract that if anyone other than a GI does any procedure from my pool of patients or in the hospital, I can terminate my contract with the hospital at my will and the hospital owes me (XXX amount of money), and if  me and my group allows, they can take the 10 PM - 7 AM cases only with our approval and not under our umbrella or malpractice. 

 

 

Correct me if im wrong but restricting scopes is because of  the lack of resources ultimately?

[NLengr]

On 7/13/2019 at 7:26 PM, shimshim said:

If rural and no Gastroenterologist are there (like northern remote Manitoba) 

 

I know in Maritime provinces you wont get the privilege at the hospital. In PEI I think currently there is 1 GI, and still no surgeons or FM have the privilege.

Now in the USA (FM and Surgery can do colonoscopy if trained but those are for over night calls, so just imagine). 

I signed a contract in a hospital, and I have it in my contract that if anyone other than a GI does any procedure from my pool of patients or in the hospital, I can terminate my contract with the hospital at my will and the hospital owes me (XXX amount of money), and if  me and my group allows, they can take the 10 PM - 7 AM cases only with our approval and not under our umbrella or malpractice. 

 

 

Are you in Canada or the US?

[futureGP]

As an MD you can do whatever you are trained in if it meets the needs of the community.

 

Typically the more rural you go, the more FM will be doing. Samething applies to specialties. If no subspecialists around, you are it (IM, general peds, general surg). Mind you, you would have to be quite a distance away from civilization to find gigs like this.

[rmorelan]

7 hours ago, futureGP said:

As an MD you can do whatever you are trained in if it meets the needs of the community.

 

Typically the more rural you go, the more FM will be doing. Samething applies to specialties. If no subspecialists around, you are it (IM, general peds, general surg). Mind you, you would have to be quite a distance away from civilization to find gigs like this.

How to you get the training? I have always been curious about that - you would think they would be pretty protective around something like that. 

Have to be able to handle the complications to no? I don't mean actually doing the surgery of course for bowel perf but if it happens as a predictable complication you have to be able to deal with that I suppose. 

Ha the problem is I would think you better be able to really prove you are trained etc, just because if you do get sued they are really going to go after your qualifications (and stuff happens no matter how good you are). 

[LittleDaisy]

8 hours ago, futureGP said:

As an MD you can do whatever you are trained in if it meets the needs of the community.

 

Typically the more rural you go, the more FM will be doing. Samething applies to specialties. If no subspecialists around, you are it (IM, general peds, general surg). Mind you, you would have to be quite a distance away from civilization to find gigs like this.

I've heard some GPs doing colonoscopies in Manitoba, I would assume that they do simple colonscopies in uncomplicated patients, and some even do C-section!. I am not sure how the medico-legal aspect involves. As a GP, your scope of practice is very broad. You just have to get some extra training during residency or when you become a staff, and feel comfortable doing your own niche. 

In urban areas, it's rare GP do colonscopies or do C-section ( I would imagine that they assist) since there are a lot of specialists. Those scenarios only exist in remote areas.