Endoscopic Services in the United States: By Whom, for What, and Why?

The Peterson et al1 article in the Journal examines the declining volume of endoscopic procedures performed by family physicians (FPs) in both urban and rural settings. In a relatively short, 3-year time period, the percentage of colonoscopies, sigmoidoscopies, and upper endoscopies performed by rural FPs declined by half. Urban FPs performed fewer endoscopic procedures overall in comparison to their rural counterparts; however, they also experienced a statistically significant decline in sigmoidoscopies and endoscopies over the study interval. This commentary will focus on the relevance of this issue from the standpoint of health care delivery with particular reference to colorectal cancer (CRC) screening, assessments of endoscopic quality, and potential solutions, including training paradigms in flexible endoscopy.