Leading Gastroenterology Through Innovation and Growth with Nirav Shah, MD

0:00This is where health care leadership comes together. Becker's 16th annual meeting brings more than 3500 hospital and health system executives and nearly 800 speakers to Chicago April 13th through the 16th. This series of events includes keynote conversations with Dallas Cowboys legend Troy Atman and former president George W. Bush. For the agenda and event details, visit Becker's Hospital Review.com and click on the events tab in the upper right. We're looking forward to hosting you. In Chicago. This is Scott Becker with the Becker's health care podcast. We're thrilled today to be joined by a brilliant physician leader. We're joined today by Dr. Nirov Shah. And Dr. Shah is the chief medical officer of clinical research at U.S. Digestive Health. U.S. Digestive Health is one of the most successful gastroenterology practices, a larger platform practices that's been built in the United States. Dr. Shah, can you take a moment and introduce yourself and tell us a little bit about your

1:02background and how you joined U.S. Digestive Health. I know you've also served on the board of the of the company. Just tell us a little bit about you and your background. Yeah, no. I really appreciate the invite and the time Scott and on behalf of all the physicians across the country. We truly appreciate everything you do for us and keeping us informed. Yeah, first and foremost, Nirov Shah board certified gastroenterologists with U.S. Digestive Health. I do have various roles I play within U.S. Digestive Health and my local group as well. As Scott you mentioned, I'm CMO for clinical research at U.S. Digestive Health and president of one of our larger divisions. I also serve as the chair of physician committee representing over 200 some APPs and physicians across Delaware and Pennsylvania.

2:02And I also serve on several endoscopy centers as a medical director in a hospital endoscopy unit as a medical director. Take a second, Dr. Shah. In today's world, the changing world of gastroenterology and endoscopy, what are some of the biggest operational and financial challenges facing gastroenterology practices? I mean, I think you're probably hearing this across every single specialty Scott. There is a looming shortage of physicians that are coming out of fellowship and training joining the workforce. There are more people retiring than joining. The number of fellowships, residency, as remains somewhat stagnant over the last couple of decades. And we continue to have more and more aging population and increased population that we're taking care of. So one of the biggest challenges that's going to come over next five to 10 years within gastroenterology, and it's already here, there's big shortage of GI physicians.

3:09So we've been fortunate enough to recruit top-notch gastroenterologists in this very competitive market over the last one to two years by being more transparent and open as to what our model is. I think that's the key for those of people listening online trying to figure out how to recruit in this very competitive market. So that's probably one of the biggest challenges. Other operational things you may have heard from your other colleagues in ASC anesthesia coverage for outpatient procedures and surgeries is becoming challenging as well. And same thing there, the number of anesthesiologists, CRNA is limited and we're taking care of greater population. But no surprise to everybody, reimbursement continues to decrease and our expenses continue to rise. So all of this is a big challenge, but I think as we move forward, we need to continue

4:12to think outside the box and how to deal with some of these things that are going to continue to come up. Thank you. And talk for a second, Dr. Schott, years ago, I served on the board of physicians in DOSCAPY, which ended up being a very large GI company and DOSCAPY company. And going back a long time ago, there was concern that colonoscopies, which drive so much of the strength of GI practice in the DOSCAPY centers, might no longer be the standard of care that it might move to something different. Now, 20 years later, it's still the standard of care. And so the core procedure, any sense of the future of the colonoscopy as sort of the gold standard of care, are there ever concerns that that will change? And it seems like there's been concerns for 20 years and it continues to be, if anything, it's become far more the gold standard for checking for colon cancer, any sense of what you see in the future. Yeah, I mean, I would be remiss to not mention this is, you know, colon cancer awareness

5:19month. So I'm a big advocate for colonoscopy. You know, I think like you mentioned, over the last two decades, even when I joined about 15 years ago, you know, at that time, CT callography was out there. I know there's still based test available, there are blood based tests available. But remember, there's only one detection and prevention strategy. And that's colonoscopy. Whether you do a stool test or a blood test, it is not picking up early stage polyps that may turn into cancer. So colonoscopy is truly the only modality that's allowing us to remove pre-cancerous polyps, which is the biggest benefit. And you may have heard it in the news too, that, you know, number one cause of death in patients under age of 50, when it comes to cancer related death, it's colon cancer. In this day and age, no one should pass away from colon cancer because how good technology

6:25and colonoscopy has become and our skills in removing bigger and larger polyps that used to even require surgery in the past. So I think it still remains the gold standard. Yes, the other modalities are going to be there and certain patients that are truly apprehensive, certainly that option is available. But to me, I think detection and prevention should be the strategy and not just waiting to colon cancer develop. This is one of the only cancers we can pick up prior to it turning into anything. And in fact, intervene and remove that pre-cancerous growth to ever turn into cancer. So I truly feel passionate that I think colonoscopy is a gold standard. And certainly, if another test comes that is able to give us a very high sensitivity of large polyps, right, gold should not be only to detect cancer. It should be to detect large polyps that may turn into cancer.

7:28And you ask me two different questions up this sort of avenue. First is, what does pancreatic cancer fit in? I know there's been such growth in colorectal cancer, colon cancer and deaths, pancreatic cancer. How closely tied is that to the gastroenterologist and so forth or completely really a whole different avenue? No, so, you know, I'm also an advanced endoscopist. So I've also trained an endoscopic ultrasound in ERCP, which are the two procedures that deal with the bile duct in the pancreas among other organs. But you know, gastroenterologist play instrumental role in also diagnosing pancreatic cancer. And there are some New York guidelines that discusses, you know, some high risk patients that should be screened for pancreatic cancer as well, such as Brackle on or Bracket 2, which are involved with breast cancer.

8:30So I think in pancreatic cancer, we have ways to go in order to pick up the cancer at an earlier stage as it is one of the most difficult surgery and over decades, outcomes in pancreatic cancer has not improved greatly. Part of it is by the time the symptoms come, it's too late and, you know, and we're intervening at a much later stage compared to colon cancer. Thank you. Fascinating. And talk about artificial intelligence in gastroenterology and colon cancer. What are you seeing there? What's helping? What are your thoughts? Yeah, so I'm happy to say that, you know, usually healthcare is one of the last ones to, you know, take on any newer technologies. And I think artificial intelligence, as you see across every single specialty within medicine, is really, you know, getting adopted very rapidly.

9:34In fact, at U.S. Digestive Health, we were proud in 2021. We actually deployed something that's artificial intelligence, which is polyp detection, which enhances your colonoscopy system wide. And we were one of the first in the country to deploy that across the organization with help of our physician group and colleagues in really getting behind, seeing a technology that will enhance and improve quality of care, which has improved our adenoma rate, which are the pre-cancerous polyps that we can remove earlier. So, you know, from artificial intelligence side, we were one of the first in the country to widely adopt that technology in the endoscopy room. And now our next phase is to, you know, deploy that on our practice side or our clinic side, because, you know, as you are aware, there are quite a few EMRs out there, or electronic

10:36medical records, that have artificial intelligence capability, which will improve our, you know, front office, back office, billing, and most importantly, during the patient interaction with the physician or the APP, where ambient listening is going to do the majority of the writing of the note, and we're just cleaning it up for accuracy, which will allow us to spend more time with our patients than continue to, you know, notate what we need to, to meet so many different requirements, from pairs, from regulatory arenas. Thank you. And take a second, Dr. Shaw, when you look at a multi-state, large GI organization, how do you balance sort of physical autonomy with the need to standardize operations and some discipline and infrastructure, how do you balance that autonomy and sort of discipline and

11:38synergization? So I think if I start by saying, I think it doesn't matter which organization you're at, most physician leaders want to say in what decisions are made at the organizational level, especially when it comes to patient care and the efficiency of the organization. So that's always been in the forefront. And if you look at our initiative of, you know, the deploying AI within our endoscopy room, it started with physicians. It brought, it was brought to our innovation subcommittee, which gets to listen and hear about the newer technologies. And then it comes to our monthly meeting where the physician committee, which I'm currently the chair of and all the, our different division leaders meet on that call. And we make not only operational, but any different ancillary stream or best practices, because

12:41our goal ultimately is to pick from each other what's working well within certain division versus the other. Because we all know healthcare is very regional and we're sensitive to that, meaning what works in one division may not always work in the other. So I think having that autonomy of making those decisions somewhat division wide, but keeping quality as sort of a system wide goal where we have quality subcommittee that holds all of us accountable for various metrics. But thank you. And take a moment on the biggest opportunity for growth and GI today. Ancillary's ASCs, technology, more efficiency, artificial intelligence, what do you see the biggest opportunities? Yeah, I mean, I think, you know, we're, I, in my eyes, I think artificial intelligence hopefully will have a lot of, you know, whether it's physician, APP, burnout, you know,

13:45those are really the biggest issues that are in front of us. So I think, you know, keeping that in the forefront and deploying technology such as artificial intelligence. So ambient listening has been game changer for my friends and colleagues that have really deployed it. You know, unfortunately, this is a term that I've heard more lately than ever before, which is called pajama time and, you know, where physicians, APPs are documenting after hours. And our goal would be to implement that to improve number one, you know, the, the burnout factor that most physicians and different practices are going through. And then when it comes to growth side, certainly ASC continues to be in the forefront, there needs to be operational improvement, you know, the cost and margins are becoming tighter at ASC too. So small improvements across the system really add up.

14:48And on the, you know, having that visibility into those improvement, the quality improvements that come out of it is really what we strive for. I think, ancillary wise, there are quite a few opportunity within gastroenterology, you know, chronic care management is in the forefront, certainly you may have heard of something called mash or fatty liver, which is a huge epidemic that goes hand in hand with diabetes. So we're seeing more patients with diabetes and fatty liver that have issues with their liver. So having sort of liver center of excellence, having other technology that improves detection of fibrosis, I think all those ancillaries are something that we're actively evaluating. Thank you.

15:49And you've had this fantastic career as a physician leader, as a physician, and as a thinker in all the way around. What advice would you give to emerging physician leaders to have impactful and satisfying careers? Yeah, I mean, I think number one, I always tell, and you know, I talked to my kids, I tell them the same thing. I've number one at the forefront for a physician should be empathy, you know, having that empathy really will resonate with your patients. And I keep a drawer full of my thinking notes from over the years, whether diagnosing somebody with cancer, helping them through their, you know, Crohn's colitis condition. And the days I have a tough day, all I do is at the end of the day, take out one of those letters, read it, and that kind of resets my mind of why I'm doing this. And then being on the leadership side, I think you really need to be transparent, open,

16:53and honest, especially with younger physicians. I think, you know, compared to what, you know, how it was pre-COVID, I think younger physicians are looking for better quality, you know, greater transparency. Not everyone is looking for just the bottom line as far as comp is concerned, but the call schedule, having some of this AI technology that would improve their lifestyle and their, you know, after our work, that's required. I think having that at the forefront really helps gaining that trust and helps you recruit. And ultimately, that will resonate with your patients and, you know, that will continue to grow your practice. I think it's being simple, making sure that you're transparent, open with your communication with your colleagues, and, you know, I've noticed that that goes long ways, compared

17:54to everything else. I love that, Dr. Shaw, one last question, is we head into the rest of this year, we're almost through the first quarter, what are you most focused on and excited about? Yeah, I mean, I think our biggest initiative for this year is certainly the focus in deploying our electronic medical record across the organization. We're on quite few different EMRs, which is kind of, it has harmed us in some ways in centralizing and, you know, focusing on growth. So, you know, that is our biggest next six to nine months, that's our big initiative. And again, you know, we're involving physicians to be involved early on, trialing a pilot project to make sure it really works with their workflow. And, you know, continue to recruit.

18:55Our motto has always been try to recruit prior to the huge need arises, because when we're scrambling last minute, that becomes difficult to find the right, you know, colleague physician that's going to fit well within your system. Dr. Shaw, what a pleasure to visit you today, what a remarkable career, what a remarkable leader. Thank you so much for taking the time with us on the Becker-SouthCare podcast today. I really enjoyed it and I'm really thankful. Thank you so much, Scott.