- Email: [email protected]
An agenda for the start of the new millennium
J Frakes
An agenda for the start of the new millennium In asking me to write the customary editorial as the incoming president of the American Society for Gastrointestinal Endoscopy (ASGE) for the June issue of Gastrointestinal Endoscopy, Dr. Michael Sivak, the editor, charged me to use this as “... a forum to communicate directly with the members... about challenges, opportunities, assets and the agenda for the Society as seen by the President.” With a due date of January 10, 1999, for a June publication, it became immediately and unsettlingly apparent that my presidential duties had begun 5 months sooner than I had anticipated. This forced me to face my hopes and fears before my esteemed predecessor, Dr. Juergen Nord, had formally removed my president-elect training wheels. I began by doing what we physicians do in our medical practices when faced with a new problem: I reviewed the literature, namely, the inaugural editorials of my estimable seven predecessors, Drs. Bond through Copyright © 1999 by the American Society for Gastrointestinal Endoscopy 0016-5107/99/$8.00 + 0 37/70/97205 806
GASTROINTESTINAL ENDOSCOPY
Editorials
Nord.1-7 This exercise elicited not only ideas, but also feelings: profound respect for my forebears; appreciation for the warm, strong bonds that I have developed with these remarkable individuals; and a simultaneous sense of elation, anticipation and trepidation for the opportunity I have been given as president of the ASGE. Common threads are woven through the fabric of these past presidencies, but each had its own unique pattern. Dr. John Bond stressed intersociety cooperation and collaboration,1 whereas Dr. David Fleischer analyzed the role of the ASGE vis-a-vis its members.2 Dr. Bennett Roth discussed the “trying times” of health care reform and implications for GI endoscopy,3 and Emmet Keeffe harkened back to intersociety cooperation, emphasizing strength in numbers through the newly formed American Digestive Health Foundation (ADHF) and Federated Societies of Gastroenterology and Hepatology (FSGH).4 Dr. Jeffrey Ponsky’s presidential watchword was returning “value to the membership.”5 Years of increasing and sometimes contentious interdependence with other GI societies prompted Dr. Richard Kozarek to reflect on the value of refocusing and reasserting our society’s role as the endoscopic society,6 whereas Juergen Nord gave perspective to our past successes and looked forward to our opporVOLUME 49, NO. 6, 1999
Editorials
tunities at the turn of the century.7 After reviewing the messages of these past presidents, I was struck by the diversity of our leaders, who have come from both academia and private practice and have included a surgeon and a hepatologist! Despite the variety of perspectives and approaches to problem solving, each of these presidents conveyed a deep respect and affection for the ASGE. As I considered the inaugural remarks of the past and tried to commit to paper the current challenges to and assets of the ASGE “as seen by the President,” I began with lists of raw, random problems that I then grouped into categories. In the end, I found that the categories of challenges coincided remarkably with the goals of the Society constructed by the Governing Board to support the mission as approved in 1994: “... to enhance the quality of patient care by fostering excellence in all aspects of GI endoscopy.” To achieve this mission, the Society committed itself to (1) promote the highest standards of training and practice..., (2) foster endoscopic research..., (3) be the foremost resource for education..., (4) advocate responsible positions..., (5) serve the professional needs of the membership, and (6) celebrate excellence and recognize distinguished contributions.... It was with this construct that I chose to “communicate directly with the members... about [my] agenda...” PROMOTE THE HIGHEST STANDARDS OF TRAINING AND PRACTICE The ASGE has a legacy of promoting the highest standards for GI endoscopy through the development and promulgation of guidelines for training and practice, usually through the efforts of the Standards of Practice Committee, chaired most recently by Dr. David Bjorkman. To supplement these guidelines, the ASGE Ad Hoc Committee on Outcomes Research, chaired by Drs. John F. Johanson and Colleen M. Schmitt, is developing quality indicators for GI endoscopy that, when used in conjunction with the ASGE’s Clinical Outcomes Research Initiative (CORI), may enable us to better measure quality in the practice of GI endoscopy and strengthen our longheld commitments to proper training. Some have claimed that the ASGE standards are “unnecessarily high” and that training requirements “add to educational costs and may restrict... physicians from providing these services.”8 With those training minimalists in mind, qualified endoscopists must be vigilant regarding undertrained endoscopists. We must reaffirm that high professional standards in endoscopy must be maintained through appropriate training, regardless of specialty, and challenge indefensible deviations from these VOLUME 49, NO. 6, 1999
J Frakes
reasonable and appropriate standards.9,10 Using our guidelines and standards and the information coming from outcomes research, we have the opportunity and obligation to play a constructive role with local hospital credentialing and privileging committees, the American Medical Association’s voluntary physician accreditation program (AMAP), and various licensing, certifying and accrediting bodies and in educating the general public. FOSTER ENDOSCOPIC RESEARCH Endoscopic research has lagged behind other areas of basic and clinical GI research in terms of quality, quantity and funding. Recognizing this fact, Dr. Richard Kozarek spearheaded an effort to organize a combined ASGE/National Institutes of Health Conference on Endoscopic Research funded by the ADHF. The conference, held December 1998 and directed by Dr. David Lieberman, raised interest in endoscopic research and identified and prioritized areas that should be targeted for research. Coupled with the increasingly favorable funding atmosphere at National Institute of Health and National Institute of Diabetes and Digestive and Kidney Diseases, this effort should bring endoscopic research activity to a more respectable level in future years. This initiative will be supplemented by the activities of our Research Committee, Ad Hoc Committee on Outcomes Research, and the CORI Project. Our research and faculty development programs will further demonstrate the value of our technology and ensure its continued scientific development and evolution. These programs include the Olympus Advanced Endoscopic Career Enhancement Award, the Wilson-Cook Endoscopic Research Scholar Award, and the Endoscopic Outcomes and Effectiveness Developmental Research Awards. BE THE FOREMOST RESOURCE FOR EDUCATION The ASGE is the preeminent society in the world for endoscopic education. We have formidable assets to offer in our educational mission. Our flagship educational efforts, the Annual Scientific Meeting and Annual Postgraduate Course, serve as cornerstones for Digestive Disease Week (DDW), the world’s largest and most prestigious scientific meeting in digestive diseases, with an attendance nearing 14,000 professional registrants. The year 2000’s annual course, codirected by Drs. Lawrence Friedman and Jacques Van Dam, will present a survey of the state of the art of endoscopic technology and practice at the start of the new millennium. The course, along with symposia, topic forums, state-of-theart lectures, posters and the Video Forum, will showcase the ASGE’s presence at DDW. In addition, the Learning GASTROINTESTINAL ENDOSCOPY
807
J Frakes
Center continues to be one of the most popular DDW offerings, attracting more than 14,000 visits last year. New videotapes and expanded use of innovative technology hold promise for even further enhancement of this superb ASGE program in the future. Beyond DDW, 1999’s new GI Endoscopy SelfAssessment Program (GESAP-IV), developed under the direction of Drs. Michael Kimmey and Mark Topazian, dovetailed our commitment to endoscopic education and our dedication to setting the highest standards of training and practice. This coming year’s Interim Postgraduate Course directed by Dr. Jack Brandabur on March 3-5, 2000, in Chicago will focus on ERCP and should mirror the impact of a similarly focused course in 1996 as one of the most successful Interim Courses the ASGE has ever sponsored. Our Annual and Interim Postgraduate Courses, coupled with new and innovative hands-on tutorials at the Ethicon Institute, are designed to raise the level of knowledge and technical skills of trained endoscopists, a task that has rarely been undertaken as effectively by any other professional society. For our more than 1000 trainee members we have tailored educational events, including regional endoscopic courses for first-year fellows, a national practice management conference for second- and third-year fellows, and the highly successful Young Investigators’ Conference, which will be directed this year by Dr. Dennis Jensen. Completing our educational armamentarium are our publications, most notably Gastrointestinal Endoscopy, our flagship publication and the preeminent endoscopic journal in the world; our guidelines for training, practice, appropriate use and clinical applications; and our Clinical Updates, single topic publications distributed quarterly to ASGE members and to 15,000 primary care physicians. Building on these highly successful efforts, we must also develop new and innovative techniques for education. Use of the Internet, CD-ROM, DVD, and other new technologies will allow us to meet the diverse educational needs of our membership. ADVOCATE RESPONSIBLE POSITIONS We have an obligation to advocate positions on issues related to GI endoscopy for the benefit of our patients, our members, the medical profession, and the general public. Policy positions emanating from the Health and Public Policy, Practice Management, Research, Standards of Practice, Technology, and Training Committees articulate the considered reasoning of the talented and respected members of our organization. Our challenge is to present more effectively and promote aggressively positions that will favorably influence medical practice, public health, legislation and regulation. 808
GASTROINTESTINAL ENDOSCOPY
Editorials
SERVE THE PROFESSIONAL NEEDS OF THE MEMBERSHIP Some of the most challenging issues facing our members are socioeconomic. Declining reimbursement due to legislative, regulatory and managed care constraints, coupled with inexorably rising costs, have prompted numerous letters to the ASGE from members who are dismayed, disgruntled, frustrated, dissatisfied, and even despondent. Legislated or regulated cuts in Medicare reimbursement, accompanied by the inevitable trickle-down effects on private insurance payments, have been economically devastating to our members. These cuts, magnified by frequent denials and delays in payment, have made it extremely difficult to meet the rising costs of running a practice and the expense of regulatory compliance. These and other challenges to the quality of their professional lives have led to doctors’ discontent,11 early retirement, consolidation, and reliance on practice management companies and have even prompted some endoscopists to quit medicine altogether or pursue nonclinical careers. The ASGE will be an aggressive advocate for its embattled members through the Health and Public Policy Committee, the Practice Management Committee, our Washington representatives, and the Medicare Carrier Advisory Committee and will work diligently to counter this trend of shrinking and inadequate reimbursement. In addition, a panoply of tools such as the “Internist’s Guide to Negotiating Managed Care...Gastroenterology Edition”, Capitation Disk, and Coding Hotline developed in collaboration with the American Gastroenterological Association, coding seminars, and the “Development of an Ambulatory Endoscopy Center––A Primer” will continue to help our members deal with the increasing pressures of managing a practice, whether private or academic. The challenges we face and the assets of the ASGE offer us an opportunity to develop new ways of dealing with Congress and regulatory agencies such as the Health Care Financing Administration (HCFA). We must learn to present our messages more effectively and more compellingly while enhancing cooperation with our sister societies to maximize the impact of our pleas on behalf of all GI endoscopists. I believe that we can work with our sister societies for the benefit of our overlapping memberships while at the same time maintaining our unique focus on GI endoscopy. CELEBRATE EXCELLENCE The ASGE has a history of celebrating excellence and recognizing distinguished contributions to GI endoscopy through the Rudolf Schindler Award, Distinguished Lectureships, Distinguished Service Award, and Lifetime Achievement Award. In addition, we continually strive to acknowledge and celeVOLUME 49, NO. 6, 1999
Editorials
brate the less publicized contributions to the field of GI endoscopy of our committees and membership. Having catalogued and characterized our challenges, assets and opportunities as enumerated by the goals of our Society, I see one challenge that defies compartmentalization: demonstrating the value of membership in the ASGE to members and to qualified endoscopists who do not yet belong to our organization. By providing services and resources unavailable anywhere else, our Society, working through the Membership, International, and other committees, must communicate effectively the value of membership: the benefits of our publications, scientific and educational meetings, legislative advocacy, clinical and training guidelines, technology assessments, information and tools to improve practice management, and a strong professional endoscopic network. This value must be impressed on members and nonmembers alike so that they know unequivocally that to stay informed about GI endoscopy—the technology whose responsible use distinguishes us from most other physicians and that plays such an important clinical and economic role in our practices—they must belong to the ASGE. With the above goals in mind, my agenda as the 56th president of the ASGE, this society of nearly 7000 gastroenterologists, surgeons, and other medical specialists from more than 55 countries, is as follows: 1. To communicate to licensing, certifying and accrediting organizations, hospital privileging and credentialing bodies, and the general public the high standards of training and practice that should be expected from a GI endoscopist. 2. To capitalize on the recent favorable atmosphere for research funding in general and a burgeoning interest in endoscopic research in particular and to promote the scientific development and evolution of our speciality and validate the value of our technology. 3. To maintain preeminence in endoscopic education while developing new educational methods and technologies commensurate with the new information age. 4. To present ASGE positions on issues related to GI endoscopy more effectively and thereby promote public health and advance the interests of our members. 5. To challenge Congress, regulatory agencies, insurers, and other payors regarding their increasing attacks and abusive tactics toward GI endoscopists and to develop credible cost and expense data to refute current reimbursement policy. 6. To communicate to legislators, regulators, insur-
VOLUME 49, NO. 6, 1999
J Frakes
ers and other payors that physician discontent in the field of GI endoscopy is real, is justified and presents a long-term danger to quality of care. 7. To promote collegial cooperation and respect among our GI sister societies while maintaining our focus and individual identity regarding GI endoscopy. 8. To acknowledge and celebrate the contributions, large and small, of ASGE members to the field of GI endoscopy. 9. To pursue the mission and goals of the Society and demonstrate the value of the ASGE to both our members and potential members. This is an ambitious agenda: to maintain what is good, to enhance effort where more is needed, and to develop new approaches where none currently exist. However, with the help of our greatest asset, the ASGE membership and its representatives on committees and the Governing Board, we have the opportunity to accomplish much. How do I feel as I take on the responsibility of leading the ASGE? Richard Kozarek partially summed it up in his inaugural editorial: “...anticipation...trepidation...hope(fullness).” To this I add that I feel extremely honored to be your president. James T. Frakes, MD, MS President, ASGE Rockford, Illinois REFERENCES 1. Bond JH. Intersociety cooperation [editorial]. Gastrointest Endosc 1992;38:394-5. 2. Fleischer DE. A society of the members, by the members and for the members [editorial]. Gastrointest Endosc 1993;39: 464-5. 3. Roth BE. The golden rule [editorial]. Gastrointest Endosc 1994;40:382-3. 4. Keeffe EB. Gastroenterology in the 21st century—strength in unity: 1996 presidential address [editorial]. Gastrointest Endosc 1996;45:505-9. 5. Ponsky JL. President’s message [editorial]. ASGE News 1996;4:1-2. 6. Kozarek RA. Future tense: ASGE strives toward the millennium [editorial]. Gastrointest Endosc 1997;45:535-6. 7. Nord HJ. The American Society for Gastrointestinal Endoscopy at the turn of the century and beyond [editorial]. Gastrointest Endosc 1998;47:550-2. 8. Carr JW, Worthington JM, Rodney WM, Gentry S, Sellers A, Sizemore J. Advancing from flexible sigmoidoscopy to colonoscopy in rural family practice. Tennessee Medicine 1998; 91:21-6. 9. Frakes JT, Johanson JF. Colonoscopy in rural family practice [letter]. Tennessee Medicine 1998;91:474. 10. Bond JH, Frakes JT. Who should perform colonoscopy? How much training is needed [editorial]? Gastrointest Endosc 1999;49:657-9. 11. Kassirer JP. Doctor discontent [editorial]. N Engl J Med 1998; 339:1543-5.
GASTROINTESTINAL ENDOSCOPY
809
An agenda for the start of the new millennium In asking me to write the customary editorial as the incoming president of the American Society for Gastrointestinal Endoscopy (ASGE) for the June issue of Gastrointestinal Endoscopy, Dr. Michael Sivak, the editor, charged me to use this as “... a forum to communicate directly with the members... about challenges, opportunities, assets and the agenda for the Society as seen by the President.” With a due date of January 10, 1999, for a June publication, it became immediately and unsettlingly apparent that my presidential duties had begun 5 months sooner than I had anticipated. This forced me to face my hopes and fears before my esteemed predecessor, Dr. Juergen Nord, had formally removed my president-elect training wheels. I began by doing what we physicians do in our medical practices when faced with a new problem: I reviewed the literature, namely, the inaugural editorials of my estimable seven predecessors, Drs. Bond through Copyright © 1999 by the American Society for Gastrointestinal Endoscopy 0016-5107/99/$8.00 + 0 37/70/97205 806
GASTROINTESTINAL ENDOSCOPY
Editorials
Nord.1-7 This exercise elicited not only ideas, but also feelings: profound respect for my forebears; appreciation for the warm, strong bonds that I have developed with these remarkable individuals; and a simultaneous sense of elation, anticipation and trepidation for the opportunity I have been given as president of the ASGE. Common threads are woven through the fabric of these past presidencies, but each had its own unique pattern. Dr. John Bond stressed intersociety cooperation and collaboration,1 whereas Dr. David Fleischer analyzed the role of the ASGE vis-a-vis its members.2 Dr. Bennett Roth discussed the “trying times” of health care reform and implications for GI endoscopy,3 and Emmet Keeffe harkened back to intersociety cooperation, emphasizing strength in numbers through the newly formed American Digestive Health Foundation (ADHF) and Federated Societies of Gastroenterology and Hepatology (FSGH).4 Dr. Jeffrey Ponsky’s presidential watchword was returning “value to the membership.”5 Years of increasing and sometimes contentious interdependence with other GI societies prompted Dr. Richard Kozarek to reflect on the value of refocusing and reasserting our society’s role as the endoscopic society,6 whereas Juergen Nord gave perspective to our past successes and looked forward to our opporVOLUME 49, NO. 6, 1999
Editorials
tunities at the turn of the century.7 After reviewing the messages of these past presidents, I was struck by the diversity of our leaders, who have come from both academia and private practice and have included a surgeon and a hepatologist! Despite the variety of perspectives and approaches to problem solving, each of these presidents conveyed a deep respect and affection for the ASGE. As I considered the inaugural remarks of the past and tried to commit to paper the current challenges to and assets of the ASGE “as seen by the President,” I began with lists of raw, random problems that I then grouped into categories. In the end, I found that the categories of challenges coincided remarkably with the goals of the Society constructed by the Governing Board to support the mission as approved in 1994: “... to enhance the quality of patient care by fostering excellence in all aspects of GI endoscopy.” To achieve this mission, the Society committed itself to (1) promote the highest standards of training and practice..., (2) foster endoscopic research..., (3) be the foremost resource for education..., (4) advocate responsible positions..., (5) serve the professional needs of the membership, and (6) celebrate excellence and recognize distinguished contributions.... It was with this construct that I chose to “communicate directly with the members... about [my] agenda...” PROMOTE THE HIGHEST STANDARDS OF TRAINING AND PRACTICE The ASGE has a legacy of promoting the highest standards for GI endoscopy through the development and promulgation of guidelines for training and practice, usually through the efforts of the Standards of Practice Committee, chaired most recently by Dr. David Bjorkman. To supplement these guidelines, the ASGE Ad Hoc Committee on Outcomes Research, chaired by Drs. John F. Johanson and Colleen M. Schmitt, is developing quality indicators for GI endoscopy that, when used in conjunction with the ASGE’s Clinical Outcomes Research Initiative (CORI), may enable us to better measure quality in the practice of GI endoscopy and strengthen our longheld commitments to proper training. Some have claimed that the ASGE standards are “unnecessarily high” and that training requirements “add to educational costs and may restrict... physicians from providing these services.”8 With those training minimalists in mind, qualified endoscopists must be vigilant regarding undertrained endoscopists. We must reaffirm that high professional standards in endoscopy must be maintained through appropriate training, regardless of specialty, and challenge indefensible deviations from these VOLUME 49, NO. 6, 1999
J Frakes
reasonable and appropriate standards.9,10 Using our guidelines and standards and the information coming from outcomes research, we have the opportunity and obligation to play a constructive role with local hospital credentialing and privileging committees, the American Medical Association’s voluntary physician accreditation program (AMAP), and various licensing, certifying and accrediting bodies and in educating the general public. FOSTER ENDOSCOPIC RESEARCH Endoscopic research has lagged behind other areas of basic and clinical GI research in terms of quality, quantity and funding. Recognizing this fact, Dr. Richard Kozarek spearheaded an effort to organize a combined ASGE/National Institutes of Health Conference on Endoscopic Research funded by the ADHF. The conference, held December 1998 and directed by Dr. David Lieberman, raised interest in endoscopic research and identified and prioritized areas that should be targeted for research. Coupled with the increasingly favorable funding atmosphere at National Institute of Health and National Institute of Diabetes and Digestive and Kidney Diseases, this effort should bring endoscopic research activity to a more respectable level in future years. This initiative will be supplemented by the activities of our Research Committee, Ad Hoc Committee on Outcomes Research, and the CORI Project. Our research and faculty development programs will further demonstrate the value of our technology and ensure its continued scientific development and evolution. These programs include the Olympus Advanced Endoscopic Career Enhancement Award, the Wilson-Cook Endoscopic Research Scholar Award, and the Endoscopic Outcomes and Effectiveness Developmental Research Awards. BE THE FOREMOST RESOURCE FOR EDUCATION The ASGE is the preeminent society in the world for endoscopic education. We have formidable assets to offer in our educational mission. Our flagship educational efforts, the Annual Scientific Meeting and Annual Postgraduate Course, serve as cornerstones for Digestive Disease Week (DDW), the world’s largest and most prestigious scientific meeting in digestive diseases, with an attendance nearing 14,000 professional registrants. The year 2000’s annual course, codirected by Drs. Lawrence Friedman and Jacques Van Dam, will present a survey of the state of the art of endoscopic technology and practice at the start of the new millennium. The course, along with symposia, topic forums, state-of-theart lectures, posters and the Video Forum, will showcase the ASGE’s presence at DDW. In addition, the Learning GASTROINTESTINAL ENDOSCOPY
807
J Frakes
Center continues to be one of the most popular DDW offerings, attracting more than 14,000 visits last year. New videotapes and expanded use of innovative technology hold promise for even further enhancement of this superb ASGE program in the future. Beyond DDW, 1999’s new GI Endoscopy SelfAssessment Program (GESAP-IV), developed under the direction of Drs. Michael Kimmey and Mark Topazian, dovetailed our commitment to endoscopic education and our dedication to setting the highest standards of training and practice. This coming year’s Interim Postgraduate Course directed by Dr. Jack Brandabur on March 3-5, 2000, in Chicago will focus on ERCP and should mirror the impact of a similarly focused course in 1996 as one of the most successful Interim Courses the ASGE has ever sponsored. Our Annual and Interim Postgraduate Courses, coupled with new and innovative hands-on tutorials at the Ethicon Institute, are designed to raise the level of knowledge and technical skills of trained endoscopists, a task that has rarely been undertaken as effectively by any other professional society. For our more than 1000 trainee members we have tailored educational events, including regional endoscopic courses for first-year fellows, a national practice management conference for second- and third-year fellows, and the highly successful Young Investigators’ Conference, which will be directed this year by Dr. Dennis Jensen. Completing our educational armamentarium are our publications, most notably Gastrointestinal Endoscopy, our flagship publication and the preeminent endoscopic journal in the world; our guidelines for training, practice, appropriate use and clinical applications; and our Clinical Updates, single topic publications distributed quarterly to ASGE members and to 15,000 primary care physicians. Building on these highly successful efforts, we must also develop new and innovative techniques for education. Use of the Internet, CD-ROM, DVD, and other new technologies will allow us to meet the diverse educational needs of our membership. ADVOCATE RESPONSIBLE POSITIONS We have an obligation to advocate positions on issues related to GI endoscopy for the benefit of our patients, our members, the medical profession, and the general public. Policy positions emanating from the Health and Public Policy, Practice Management, Research, Standards of Practice, Technology, and Training Committees articulate the considered reasoning of the talented and respected members of our organization. Our challenge is to present more effectively and promote aggressively positions that will favorably influence medical practice, public health, legislation and regulation. 808
GASTROINTESTINAL ENDOSCOPY
Editorials
SERVE THE PROFESSIONAL NEEDS OF THE MEMBERSHIP Some of the most challenging issues facing our members are socioeconomic. Declining reimbursement due to legislative, regulatory and managed care constraints, coupled with inexorably rising costs, have prompted numerous letters to the ASGE from members who are dismayed, disgruntled, frustrated, dissatisfied, and even despondent. Legislated or regulated cuts in Medicare reimbursement, accompanied by the inevitable trickle-down effects on private insurance payments, have been economically devastating to our members. These cuts, magnified by frequent denials and delays in payment, have made it extremely difficult to meet the rising costs of running a practice and the expense of regulatory compliance. These and other challenges to the quality of their professional lives have led to doctors’ discontent,11 early retirement, consolidation, and reliance on practice management companies and have even prompted some endoscopists to quit medicine altogether or pursue nonclinical careers. The ASGE will be an aggressive advocate for its embattled members through the Health and Public Policy Committee, the Practice Management Committee, our Washington representatives, and the Medicare Carrier Advisory Committee and will work diligently to counter this trend of shrinking and inadequate reimbursement. In addition, a panoply of tools such as the “Internist’s Guide to Negotiating Managed Care...Gastroenterology Edition”, Capitation Disk, and Coding Hotline developed in collaboration with the American Gastroenterological Association, coding seminars, and the “Development of an Ambulatory Endoscopy Center––A Primer” will continue to help our members deal with the increasing pressures of managing a practice, whether private or academic. The challenges we face and the assets of the ASGE offer us an opportunity to develop new ways of dealing with Congress and regulatory agencies such as the Health Care Financing Administration (HCFA). We must learn to present our messages more effectively and more compellingly while enhancing cooperation with our sister societies to maximize the impact of our pleas on behalf of all GI endoscopists. I believe that we can work with our sister societies for the benefit of our overlapping memberships while at the same time maintaining our unique focus on GI endoscopy. CELEBRATE EXCELLENCE The ASGE has a history of celebrating excellence and recognizing distinguished contributions to GI endoscopy through the Rudolf Schindler Award, Distinguished Lectureships, Distinguished Service Award, and Lifetime Achievement Award. In addition, we continually strive to acknowledge and celeVOLUME 49, NO. 6, 1999
Editorials
brate the less publicized contributions to the field of GI endoscopy of our committees and membership. Having catalogued and characterized our challenges, assets and opportunities as enumerated by the goals of our Society, I see one challenge that defies compartmentalization: demonstrating the value of membership in the ASGE to members and to qualified endoscopists who do not yet belong to our organization. By providing services and resources unavailable anywhere else, our Society, working through the Membership, International, and other committees, must communicate effectively the value of membership: the benefits of our publications, scientific and educational meetings, legislative advocacy, clinical and training guidelines, technology assessments, information and tools to improve practice management, and a strong professional endoscopic network. This value must be impressed on members and nonmembers alike so that they know unequivocally that to stay informed about GI endoscopy—the technology whose responsible use distinguishes us from most other physicians and that plays such an important clinical and economic role in our practices—they must belong to the ASGE. With the above goals in mind, my agenda as the 56th president of the ASGE, this society of nearly 7000 gastroenterologists, surgeons, and other medical specialists from more than 55 countries, is as follows: 1. To communicate to licensing, certifying and accrediting organizations, hospital privileging and credentialing bodies, and the general public the high standards of training and practice that should be expected from a GI endoscopist. 2. To capitalize on the recent favorable atmosphere for research funding in general and a burgeoning interest in endoscopic research in particular and to promote the scientific development and evolution of our speciality and validate the value of our technology. 3. To maintain preeminence in endoscopic education while developing new educational methods and technologies commensurate with the new information age. 4. To present ASGE positions on issues related to GI endoscopy more effectively and thereby promote public health and advance the interests of our members. 5. To challenge Congress, regulatory agencies, insurers, and other payors regarding their increasing attacks and abusive tactics toward GI endoscopists and to develop credible cost and expense data to refute current reimbursement policy. 6. To communicate to legislators, regulators, insur-
VOLUME 49, NO. 6, 1999
J Frakes
ers and other payors that physician discontent in the field of GI endoscopy is real, is justified and presents a long-term danger to quality of care. 7. To promote collegial cooperation and respect among our GI sister societies while maintaining our focus and individual identity regarding GI endoscopy. 8. To acknowledge and celebrate the contributions, large and small, of ASGE members to the field of GI endoscopy. 9. To pursue the mission and goals of the Society and demonstrate the value of the ASGE to both our members and potential members. This is an ambitious agenda: to maintain what is good, to enhance effort where more is needed, and to develop new approaches where none currently exist. However, with the help of our greatest asset, the ASGE membership and its representatives on committees and the Governing Board, we have the opportunity to accomplish much. How do I feel as I take on the responsibility of leading the ASGE? Richard Kozarek partially summed it up in his inaugural editorial: “...anticipation...trepidation...hope(fullness).” To this I add that I feel extremely honored to be your president. James T. Frakes, MD, MS President, ASGE Rockford, Illinois REFERENCES 1. Bond JH. Intersociety cooperation [editorial]. Gastrointest Endosc 1992;38:394-5. 2. Fleischer DE. A society of the members, by the members and for the members [editorial]. Gastrointest Endosc 1993;39: 464-5. 3. Roth BE. The golden rule [editorial]. Gastrointest Endosc 1994;40:382-3. 4. Keeffe EB. Gastroenterology in the 21st century—strength in unity: 1996 presidential address [editorial]. Gastrointest Endosc 1996;45:505-9. 5. Ponsky JL. President’s message [editorial]. ASGE News 1996;4:1-2. 6. Kozarek RA. Future tense: ASGE strives toward the millennium [editorial]. Gastrointest Endosc 1997;45:535-6. 7. Nord HJ. The American Society for Gastrointestinal Endoscopy at the turn of the century and beyond [editorial]. Gastrointest Endosc 1998;47:550-2. 8. Carr JW, Worthington JM, Rodney WM, Gentry S, Sellers A, Sizemore J. Advancing from flexible sigmoidoscopy to colonoscopy in rural family practice. Tennessee Medicine 1998; 91:21-6. 9. Frakes JT, Johanson JF. Colonoscopy in rural family practice [letter]. Tennessee Medicine 1998;91:474. 10. Bond JH, Frakes JT. Who should perform colonoscopy? How much training is needed [editorial]? Gastrointest Endosc 1999;49:657-9. 11. Kassirer JP. Doctor discontent [editorial]. N Engl J Med 1998; 339:1543-5.
GASTROINTESTINAL ENDOSCOPY
809