Latest / Becker’s Healthcare Podcast / Leading Gastroenterology Through Innovation and Growth with Nirav Shah, MD

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Leading Gastroenterology Through Innovation and Growth with Nirav Shah, MD · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
0:04
Becker's sixteenth annual meeting brings more than 3,500
0:07
hospital and health system executives and nearly 800
0:10
speakers to Chicago
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April.
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This year's event includes keynote conversations with Dallas
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Cowboys legend Troy Aikman and former president George
0:20
w Bush. For the agenda and event details,
0:22
visit beckershospitalreview.com
0:25
and click on the events tab in the
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upper right. We're looking forward to hosting you
0:29
in Chicago.
0:31
This is Scott Becker with the Beckers Health
0:34
Care Podcast.
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We're thrilled today to be joined by a
0:37
brilliant physician leader.
0:39
We're joined today by doctor Nirav Shah, and
0:42
doctor Shah is the chief medical officer of
0:44
clinical research at US Digestive Health.
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US Digestive Health is one of the most
0:49
successful gastroenterology
0:52
practices
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of larger platform practices that's been built in
0:56
United States.
0:57
Doctor Shah, can you take a moment and
0:59
introduce yourself and tell us a little bit
1:01
about your background,
1:03
and how you joined US Digestive Health? I
1:05
know you've also served on the board of
1:07
the of the of the company. Just tell
1:09
us a little bit about you and your
1:10
background.
1:11
Yeah. No. I really appreciate the invite and
1:14
the time, Scott.
1:16
And on behalf of all the physicians across
1:18
the country,
1:20
we truly appreciate everything you do for us
1:22
and keep us keeping us informed.
1:25
But, yeah, first and foremost,
1:27
Nirav Shah, I'm a board certified gastroenterologist
1:31
with US Digestive
1:33
Health.
1:33
I do have various roles I play within
1:37
US Digestive
1:38
Health
1:39
and my local,
1:40
group as well.
1:42
As Scott, you mentioned, I'm CMO for clinical
1:45
research
1:46
at US Digestive Health and president of one
1:49
of our larger divisions.
1:51
I also serve as the chair of physician
1:53
committee
1:55
representing
1:56
over 200 some APPs and physicians
1:59
across Delaware and Pennsylvania.
2:02
And I also serve on several endoscopy centers
2:04
as a medical director
2:06
in a hospital endoscopy unit as a medical
2:08
director.
2:10
Take a second, Doctor. Schott. In today's world,
2:13
the changing world of gastroenterology
2:15
and endoscopy,
2:17
what are some of the biggest operational and
2:20
financial challenges
2:21
facing gastroenterology
2:22
practices?
2:24
I mean, I think, you know, you're probably
2:26
hearing this across every single specialty, Scott.
2:29
You know, there's a looming shortage of,
2:32
physicians that are,
2:34
you know, coming out of fellowship
2:37
and training,
2:38
joining the workforce.
2:40
There are more people retiring than joining,
2:43
and number of fellowships residency has remained,
2:46
you know, somewhat stagnant,
2:48
over
2:49
last couple of decades.
2:51
And we continue to have, you know, more
2:52
and more aging population and increased
2:55
population that were taken care of. So one
2:58
of the biggest challenge that's gonna come, you
3:00
know, over next five to ten years within
3:02
gastroenterology,
3:03
and it's already here.
3:05
There's big shortage of, GI physicians.
3:09
Although we've been fortunate enough to recruit
3:11
top notch gastroenterologists
3:14
in this very competitive market over the last
3:16
one to two years
3:18
by being more transparent and open
3:21
as to what our model is. I think
3:23
that's the key, for those of people listening
3:25
online
3:27
trying to figure out how to recruit in
3:28
this very competitive market.
3:30
So that's probably one of the biggest challenge.
3:33
Another operational things you may have heard from
3:36
your other colleagues in ASC,
3:38
anesthesia
3:39
coverage for outpatient procedures
3:42
and surgeries
3:43
is becoming challenging
3:45
as well.
3:46
And same thing there. You know, the number
3:49
of anesthesiologists,
3:50
CRNA is limited,
3:52
and, you know, we're taking care of greater
3:54
population.
3:56
And
3:57
no surprise to everybody,
3:59
reimbursement
4:00
continues to decrease and,
4:02
you know, our expenses continue to rise. So
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all of this is, you know, big challenge,
4:08
but I think as we move forward,
4:11
we need to continue to, you know, think
4:14
outside the box and,
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how to, you know, deal with some of
4:18
these things that are gonna continue to come
4:19
up.
4:21
Thank you. And talk for a second, doctor
4:23
Schott.
4:24
Years ago,
4:26
I served on the board of Physicians Endoscopy,
4:28
which ended up being a very large
4:31
GI company and endoscopy company.
4:34
And and going back a long time ago,
4:36
there was concern
4:37
that colonoscopies,
4:39
which drive so much of the the strength
4:41
of GI practice and endoscopy centers,
4:43
might no longer be the standard of cure,
4:45
that it might move to something different.
4:47
Now twenty years later, it's still the standard
4:49
of cure
4:50
and still the core procedure.
4:53
Any sense of the future of the colonoscopy
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is is sort of the gold standard of
4:57
cure?
4:58
Are there ever concerns that that will change?
5:00
I mean, it seems like there's been concerns
5:02
for twenty years, and it continues to be
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if anything, it's become far more the gold
5:06
standard for checking for colon cancer.
5:09
Any sense of what you see in in
5:11
the future?
5:12
Yeah. I mean, I would
5:14
be remiss to not mention this is, you
5:17
know, colon cancer awareness month, so
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I'm a big advocate for colonoscopy.
5:24
You know, I think it like you mentioned
5:26
over the last two decades, even when I
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joined
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about fifteen years ago,
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you know, at that time, CT calligraphy
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was out there.
5:35
I know there are stool based test available.
5:37
There are, blood based test available.
5:40
Remember, there's only one detection
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and prevention
5:45
strategy,
5:45
and that's colonoscopy.
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Whether you do a stool test or a
5:49
blood test, it is not picking up
5:52
early stage polyps that may turn into cancer.
5:56
So colonoscopy
5:57
is truly the only modality
5:59
that's allowing us to remove precancerous polyps,
6:03
which
6:04
is the biggest benefit. And you may have
6:06
heard it in the news too
6:08
that, you know, number one,
6:10
cause of death in patients 50,
6:14
when it comes to cancer related death, it's
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colon cancer.
6:18
In this day and age,
6:20
no one should
6:22
pass away from colon cancer
6:24
because how good technology in colonoscopy
6:27
has become
6:28
in our skills in removing
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bigger, larger polyps that used to even require
6:34
surgery in the past. So So I think
6:36
it still remains the gold standard.
6:38
Yes. The other modalities are gonna be there
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and certain patients that are
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truly apprehensive,
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certainly, that option is available.
6:48
But to me, I think detection and prevention
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should be the strategy
6:52
and not just,
6:54
waiting till colon cancer develop. This is one
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of the only cancers we can pick up
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prior to it turning into anything. And in
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fact, intervene and remove that precancerous growth
7:04
to ever turn into cancer.
7:06
So I truly feel passionate that
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I think colonoscopy
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is a gold standard. And, certainly, if another
7:13
test comes that is able to give us
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a very high sensitivity
7:18
of large polyps, right,
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goal should not be only to detect cancer.
7:23
It should be to detect
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large polyps that may turn into cancer.
7:28
Thank you, Oscar. Two different questions
7:30
up up this sort of avenue.
7:33
First is,
7:35
where does pancreatic cancer fit in? I know
7:37
there's been such growth in cold, rectal cancer,
7:39
colon cancer, and deaths.
7:41
Pancreatic cancer, how closely tied is that to
7:44
the gastroenterologist
7:46
and so forth or or completely really a
7:48
whole different avenue?
7:50
No. So, you know, I'm also an advanced
7:54
endoscopist,
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so
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I've also trained in endoscopic ultrasound
7:59
and ERCP,
8:00
which are the two procedures
8:02
that deal with the bile duct in the
8:04
pancreas,
8:06
among other organs.
8:08
But, you know, gastroenterologists
8:10
play instrumental role
8:11
in, also diagnosing,
8:14
pancreatic cancer.
8:15
And there are some newer guidelines
8:17
that, discusses,
8:19
you know, some high risk patients
8:22
that should be screened for pancreatic cancer as
8:25
well,
8:26
such as BRCA one or BRCA two, which
8:28
are involved with breast cancer.
8:30
So I think in pancreatic cancer, we have
8:33
ways to go
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in order to pick up the cancer at
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an earlier stage
8:38
as it is one of the most difficult
8:40
surgery. And over decades,
8:43
outcomes in pancreatic cancer has not improved greatly.
8:46
Part of it is by the time the
8:48
symptoms come,
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it's too late and,
8:51
you know, and we're intervening
8:53
at a much later stage compared to colon
8:56
cancer.
8:57
Thank you.
8:59
Fascinating. And and and talk about artificial intelligence
9:03
in gastroenterology
9:04
and and colon cancer.
9:06
What are you seeing there? What's helping?
9:09
What are your thoughts?
9:10
Yeah. So I'm happy to say that, you
9:14
know, usually, health care is
9:16
one of the last ones to,
9:18
you know,
9:19
take on any newer technologies.
9:22
And I think artificial
9:23
intelligence as you see across every
9:25
every single,
9:27
specialty within medicine
9:29
is really, you know, getting adopted
9:32
very rapidly.
9:34
In fact, at US Digestive Health, we were
9:36
proud in
9:38
2021.
9:39
We actually deployed
9:41
something,
9:42
that's artificial intelligence,
9:44
which is polyp detection, which enhances your colonoscopy
9:49
system wide, and we were one of the
9:51
first in the country to deploy that across
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the organization
9:55
with help of our physician group and colleagues
9:58
in really getting behind,
10:01
seeing a technology that will
10:03
enhance and improve quality of care,
10:06
which has improved our adenoma rate, which are
10:09
the precancerous polyps
10:11
that we can remove earlier.
10:14
So, you know, from artificial intelligence side, we
10:17
were one of the first in the country
10:19
to widely adopt that technology in the endoscopy
10:22
room. And now our next phase is to,
10:26
you know, deploy that on our practice side
10:28
or our clinic side
10:30
because, you know, as you are aware, there
10:33
are quite a few
10:34
EMRs out there or electronic medical records
10:37
that have artificial intelligence capability,
10:41
which will improve our, you know, front office,
10:44
back office, billing,
10:46
and most importantly,
10:48
during the patient interaction with the physician
10:52
or the APP,
10:53
where ambient listening is going to do majority
10:56
of the writing of the note, and we're
10:58
just clearing cleaning it up, for accuracy,
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which will allow us to spend more time
11:04
with our patients
11:06
than, continue to,
11:08
you know, notate what we need to to
11:11
meet so many different requirements from payers, from,
11:15
regulatory,
11:16
arenas.
11:18
Thank you. Take a second,
11:20
doctor Shah.
11:22
When you look at a multistate
11:24
large GI organization,
11:26
how do you balance sort of physician autonomy
11:29
with the need to standardize
11:31
operations and some discipline in infrastructure?
11:34
How do you balance that autonomy and and
11:37
sort of discipline and and standardization?
11:40
So I think if if I start by
11:42
saying,
11:43
I think it doesn't matter which organization you're
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at.
11:46
Most physician leaders wanna say in what decisions
11:50
are made at the organizational
11:53
level,
11:53
especially when it comes to patient care
11:57
and the efficiency of the organization.
12:00
So that's always been in the forefront.
12:02
And if you look at our initiative of,
12:05
you know, the
12:07
deploying AI within our endoscopy room,
12:10
it started with physicians.
12:12
It brought it was brought to our innovation
12:14
subcommittee,
12:16
which gets to listen and
12:18
hear about the newer technologies.
12:21
And then it comes to our monthly meeting
12:23
where the physician committee,
12:25
which I'm currently the chair of, and
12:28
all the our different division leaders
12:31
meet on that call. And we make not
12:33
only operational,
12:35
but any different ancillary
12:38
stream or best practices
12:40
because our goal ultimately is to pick from
12:43
each other
12:44
what's working well within certain division
12:47
versus the other. As we all know, health
12:49
care is very regional
12:51
and we're sensitive to that. Meaning, what works
12:54
in one division
12:56
may not always work in the other. So
12:58
I think having that autonomy of making those
13:00
decisions
13:02
somewhat division wide,
13:04
but keeping quality as sort of a system
13:07
wide goal
13:09
where we have quality subcommittee that holds all
13:12
of us accountable
13:13
for various metrics.
13:15
With the thank you. And take a moment
13:18
on
13:19
the biggest opportunity for growth in GI today.
13:23
Ancillaries,
13:23
ASCs,
13:24
technology,
13:25
more efficiency,
13:27
artificial intelligence. Where do you see the biggest
13:29
opportunities?
13:31
Yeah. I mean, I think, you know, we're
13:33
in my eyes, I think artificial intelligence hopefully
13:37
will have
13:38
lot of,
13:40
you know,
13:41
whether it's,
13:42
physician APP burnout. You know, those are really
13:47
the biggest issues that are in front of
13:49
us. So I think, you know, keeping
13:53
that in the forefront and deploying technology
13:57
such as artificial intelligence. So ambient listening has
14:01
been game changer for my friends and colleagues
14:03
that have really deployed it. You know, unfortunately,
14:07
this is a term that I've hear heard
14:08
more lately than ever before, which is called
14:11
pajama time and, you know, where physicians, APPs
14:15
are documenting after hours. And our goal would
14:17
be to implement that to improve number one,
14:20
you know,
14:22
the the burnout factor that most
14:25
physicians and different practices are going through. And
14:28
then when it comes to growth side,
14:30
certainly,
14:33
ASC continues to be in the forefront. There
14:35
needs to be operational improvement.
14:37
You know, the cost and margins are becoming
14:40
tighter at ASC too.
14:42
So small improvements
14:44
across the system really add up.
14:48
And on the,
14:49
you know,
14:51
having that
14:52
visibility
14:54
into
14:55
those improvement,
14:56
the the
14:58
quality improvements that come out of it
15:01
is really what we strive for.
15:04
And
15:05
I think ancillary wise, there are quite a
15:07
few opportunity,
15:09
within gastroenterology.
15:11
You know, chronic care management is in the
15:13
forefront.
15:15
Certainly,
15:15
you may have heard of something called MASH
15:18
or fatty liver,
15:19
which is a huge epidemic that goes hand
15:22
in hand with diabetes.
15:24
So we're seeing more patients with diabetes
15:28
and fatty liver
15:29
that have issues with their liver. So having
15:33
sort of liver center of excellence,
15:36
having other technology that improves detection of fibrosis,
15:40
I think all those ancillaries
15:42
are
15:43
something that we're actively evaluating.
15:48
Thank you.
15:49
And
15:50
you've had this fantastic
15:52
career as a physician leader, as a physician,
15:57
and as a thinker,
15:59
and all the way
16:00
around, what advice would you give to emerging
16:02
physician leaders
16:04
to have impactful and satisfying careers?
16:07
Yeah. I mean, I think number one, I
16:10
always
16:11
tell
16:12
and, you know, I talk to my kids.
16:15
I tell them the same thing.
16:17
I have number one at the forefront for
16:19
a physician should be empathy.
16:21
You know, having that empathy really
16:24
will resonate with your patients. And I keep
16:27
a drawer full of my thank you notes
16:29
from over the years, whether diagnosing somebody with
16:33
cancer,
16:34
helping them through their, you know, Crohn's colitis
16:37
condition.
16:38
And the days I have a tough day,
16:40
all I do is, at the end of
16:41
the day, take out one of those letters,
16:43
read it, and that kind of resets my
16:45
mind of why I'm doing this.
16:48
And then being on the leadership side,
16:50
I think you really need to be transparent,
16:53
open, and honest,
16:55
especially with younger physicians.
16:57
I think, you know, compared to what
17:00
you know, how
17:02
it was pre COVID,
17:04
I think younger physicians are looking for better
17:07
quality, you know, greater transparency.
17:10
Not everyone is looking for
17:12
just the bottom line as far as comp
17:14
is concerned.
17:16
But the call schedule, having some of this
17:18
AI technology that would improve their lifestyle and
17:22
their, you know, after hour work that's required,
17:26
I think having that at the forefront really
17:28
helps
17:29
gaining that trust and helps you recruit.
17:33
And, ultimately,
17:34
that will resonate with your patients, and,
17:37
you know, that will continue to grow your
17:39
practice.
17:40
I think it's being simple, making sure that
17:43
you're transparent and open with your communication,
17:47
with your colleagues. And,
17:49
you know,
17:50
I've noticed that that goes long ways
17:53
compared to everything else.
17:56
I I I love that.
17:58
Doctor Schott, one last question.
18:01
As we head into the rest of this
18:03
year, we're almost to the first quarter.
18:05
What are you most focused on and excited
18:07
about?
18:09
Yeah. I mean, I think our biggest initiative
18:11
for this year is, certainly the focus in
18:15
deploying our
18:16
electronic medical record across
18:18
the organization.
18:20
We're on quite few different EMRs,
18:23
which is kinda
18:25
it has harmed us in some ways
18:27
in centralizing
18:29
and,
18:30
you know, focusing
18:32
on growth.
18:34
So, you know, that is our biggest next
18:36
six to nine months. That's our big initiative.
18:39
And again, you know, we're involving
18:43
physicians to be involved early on
18:46
trialing a pilot project
18:48
to make sure it really works with their
18:50
workflow.
18:51
And, you know, continue to recruit.
18:55
Our
18:56
motto has always been try to recruit prior
18:58
to
18:59
the huge need arises. Because when we're scrambling
19:02
last minute,
19:04
that becomes difficult to find the right,
19:07
you know, colleague physician that's gonna fit well
19:10
within your system.
19:12
Doctor Shah, what a pleasure to visit you
19:14
today. What a remarkable career. What a remarkable
19:17
leader.
19:18
Thank you so much for taking the time
19:19
with us on the Becker's Healthcare podcast today.
19:21
I really enjoyed it, and I'm really thankful.
19:23
Thank you so much, Scott.