Shifting the Course of Gastroenterology
The following is adapted from Scope Forward by Praveen Suthrum.
Ninety-five percent of private practices in the region were gone. There were hardly any independent physicians left to refer patients around. Two health systems dominated the landscape by buying up practices. People who showed up at the remaining independent facilities usually had low-paying insurance plans. Then there were those willing to pay cash for opioids.
I was visiting a private medical practice in the area to understand why they were bleeding money. The physician owner had returned from retirement to manage the practice. The administrator of the facility said she was “stuck in this job.” The owner’s son, also a physician, gave up on medicine to work on the business. Wasn’t it just a matter of time before they would spin out of control?
That experience served as a poignant reminder of what healthcare would become if we let industry forces dominate us. Out of respect for the region and the facility, I won’t tell you where it is. But doesn’t some of it already sound familiar to you? In truth, couldn’t it be Anytown, America? Couldn’t at least some aspect of it be Yourtown, America?
You know it already.
Gastroenterology is in the midst of massive structural disruption. Stool DNA tests for colon cancer are disrupting screening colonoscopy. If that technology fails, then there are many companies working on liquid biopsy. These are blood tests that look for not one but many cancers at the same time. If that doesn’t disrupt, then there’s artificial intelligence (AI). AI has the potential to classify cancerous polyps and spot what endoscopists might miss.
Most gastroenterology (GI) practices are too busy to worry about technology. They’ve been more concerned about business consolidation led by private equity. In 2019, there were at least 16 private equity transactions in gastroenterology. Compare that to two deals in 2018. There’s a race to get bigger faster.
Taking Private Equity for the Wrong Reasons Is Like Playing With Fire.
In the 1990s, Physician Practice Management companies (PPMs) burnt billions of dollars. They tried to merge practices and went bust. In the end, doctors and PPMs sued each other.
Leaving that aside for a moment, look at Big Brothers who want a piece of gastroenterology. Hospitals want to hire you. Big insurance companies are acquiring medical practices. Big Tech wants to lead healthcare using algorithms. Even Walmart is entering the game of healthcare.
Meanwhile, patients are changing their expectations from GI. Some are biohacking their way into the microbiome. Some others want their colon cleansed to showcase a flatter belly. Not exactly reasons doctors went to medical school.
When I talked about these emerging trends, gastroenterologists had these responses: Some felt threatened. Some brushed them away. Some got excited. But many were in a state of confusion.
Now, that’s a problem.
When we take action in a state of fear or confusion, we regret those decisions later. In such a state, we tend to be reactive, we follow the trend of the herd for safety, or we simply go where others want us to go out of our own indecision.
When a large cohort like GI takes action in a state of disarray, the industry risks implosion. Hospitals laying off doctors with limited notice. Private equity (PE) deals going bust. Technology changes catching the industry off guard. At its worst, implosion can mean doctors rebuilding their practices from scratch. That would put countless people at risk, including patients. Once, a doctor told me, “Distracted doctors do more harm than good.”
To make more empowered choices, we must first understand the future with an open and curious mind.
We must be willing to look at every area — be it clinical, technological, or business — without judgment. We must take stock of our own situation. And then we must take action in defined timelines.
I began writing my book as a way of inviting gastroenterologists to peek into the future. I conducted over 30 interviews in various parts of the country. From Minnesota to Mississippi and from California to New York. Gastroenterologists in various phases of their journey generously shared their time and perspective. More importantly, they shared their views so candidly. Their concerns about PE or hospital consolidation or DNA testing. Their dreams about a better future for healthcare. The challenge for me was to reflect and connect the dots as objectively as possible.
You can say my book will serve as your tour guide to the future of gastroenterology, but I have to caution that my aim isn’t to be exhaustive. For example, I’m not covering several important topics, such as the pharmaceutical industry, policy, or the mounting costs of healthcare. Instead of talking about all the sights on this tour, I wish to give you a decent slice to help you develop your perspective across technology and business. Also, if you are a hospital or insurer, you’ll find I’m unabashedly biased toward doctors. Doctors come first and the rest of the industry after. In their success lies the success of healthcare. Their failure risks a total collapse of the system.
If there’s any cohort of medicine I understand, it would be gastroenterology.
Through NextServices, the company I co-founded, I have worked with GI doctors since 2005. We help gastroenterologists with billing, technology, compliance, and more recently, private equity. My team and I built a cloud-based software platform called enki.
Once, a gastroenterologist asked me, “How do you know the inside stories? Do you have any family members who are gastroenterologists?”
I said, “No, but I have friends who are.”
Then he mused, “Oh, then in your past life, you must’ve been a gastroenterologist!”
I’ll take that.
I contributed to two books by C. K. Prahalad, a management guru and my teacher at the University of Michigan. The Fortune at the Bottom of the Pyramid and The New Age of Innovation (coauthored with M. S. Krishnan) both became management best sellers. That experience provided a method for me to not only see the future but to connect the dots for others.
More recently, I wrote Private Equity in Gastroenterology: Navigating the Next Wave (Amazon #1 New Release in Private Equity and Gastroenterology). The book offered much-needed clarity on the subject.
They say writers use writing as a way to work out topics they wish to understand. You can say that’s what happened to me through this book. I learned a lot through the interviews and research.
Reading Scope Forward will give you enough depth to develop your own point of view of the future. By the end of these pages, you will come away excited about the way forward because you’ll develop a clearer vision. You’ll have a sense of what to do next and how to direct not only yourself but others.
My vision is for the GI industry to use my book to shift the course of gastroenterology. We must come together and align. We must change the space for good. To not only help us thrive in our professional lives but to sleep well at night, knowing we’ve made healthcare better for those who need it the most.
By picking up my book, you’ve set something into motion for yourself and the industry. That something is to take the future head-on and be willing to shape what’s to follow in the next decade.
Let’s scope forward.
To learn more about shifting the course of gastroenterology you can find Scope Forward on Amazon.
Praveen Suthrum is the co-founder and president of NextServices. The company provides a platform that medical practices need to thrive while facing tougher reimbursements, higher operating costs, and increased regulation.
Scope Forward is Praveen’s second book and his follow-up to the Amazon #1 new release Private Equity in Gastroenterology.
