Who Is Warning Us About a Shortage of Gastroenterologists?

We have frequently discussed the worsening shortage of primary care physicians and the current crisis in primary care. Now, in the NY Times is a story of a different kind of physician shortage:

The United States will face a severe shortage of gastroenterologists as the population ages and the demand for colorectal cancer screening increases, a health care consulting firm has projected.

At current rates of cancer screening, the United States will need an additional 1,050 gastroenterologists by 2020, according to the study by The Lewin Group.

Note that this isn't the proclamation of a current shortage, but the forecast of one to come. The Times did not provide a link to the report, nor explain the rationale for its prediction. Given that gastroenterologists are remunerated much better for their time spent doing colonscopies than primary care physicians are spend for their time spent taking care of patients sans procedures (see: Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306. Link here. ) , it is a little hard to believe that we will not be able to recruit sufficient gastroenterologists in the future, barring any radical change in how physicians are paid.

However, the NY Times article did note:

The projections were reviewed by outside experts and commissioned by Olympus Corporation of the Americas, which manufactures cameras used to screen for colorectal cancer.

Actually, Olympus manufactures not just the cameras, but the colonoscopes themselves (see their web-site, which states the company manufactures "a full line of diagnostic, therapeutic, slim and adult colonoscopes with the highest resolution available.")

Moreover the study was done by the Lewin Group, which was not further characterized in the NY Times article, but does often seem to be a source of authoritative pronouncements on health care policy. So what is the Lewin Group?

It's web-site says it is "a premier national health care and human services consulting firm." It also claims:

The Lewin Group is committed to independence and integrity in our work. We combine professional expertise with extensive knowledge and a rigorous approach to analyzing and solving problems to deliver value to each of our clients and to the larger community as well.

That's a somewhat self-contradictory assertion. It seems that delivering "value" to specific clients might be hard to do while maintaining "independence."

Who are Lewin's clients? We already know that Olympus, a company that makes more money if it sells more colonoscopes, sponsored this study of demand for colonoscopy. The Lewin Group says its clients include "hospitals, health systems and providers;" "payers / insurers;" and "pharma/bio/device." Furthermore, its explanation of its services to the latter group includes:

We provide analysis and results-focused strategies demonstrating the value of medical products to public and private sectors payers, clinicians, health care facilities, patients, and policymakers. We also provide policy insight and guidance to industry clients on evolving trends and their impacts.

"Results-focused strategies demonstrating the value of medical products" somehow seems more akin to marketing than objective policy analysis.

Finally, who owns the Lewin Group? It is not a not-for-profit, and it is not even an independent for-profit corporation. In fact, per the web-site,

The Lewin Group is an Ingenix company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities.

So, the Lewin Group is in fact part of UnitedHealth, a corporation that was until recently run by a CEO who became known for the more than a million of apparently back-dated stock options he received (see our post here).

For balance, I must note that the same web-page asserts:

The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services.

But again, note that the focus is on making clients happy, not providing the public with unbiased knowledge.

One might further argue that it is not in the interests of UnitedHealth, as a commercial managed care organization, to pay for more and more colonoscopies. However, in the current US health care system, in which there have been more and more procedures, UnitedHealth has prospered, perhaps because it has been easy for it to simply past the costs of these procedures along.

At any rate, once again it's hard to tell who the players are in health care policy without a scorecard. As the health reform debate heats up, expect to see more authoritative proclamations coming from groups with vested interests other than simply providing unbiased expertise. Such groups, of course, have the right to make their views known. But it would be a more honest discussion if everyone were willing to put their vested interests on the table.

Thanks to one of our scouts for a tip on the ownership of the Lewin Group, and hat tip to KevinMD.