Okay, good morning, everyone. So my name is Sush Guha. I was at UT Health Science Center for 21 years and then decided to take a different path now. I'm more interested in entrepreneurship, so I took an early retirement and joined Houston Regional Gastroenterology and the medical director there. And I also pursue my interest in the application of artificial intelligence, which you probably have heard, but mostly the generative part of the artificial intelligence in improving office space practice. So that's my whole kind of part of my research and as well as interest. And I was trained as an interventional gastroenterologist and I did interventional procedures for many years, mostly as a GI hospitalist, but gave up all that now and mostly do coding. Thank you. Hi, good morning, everyone. My name is Bianca Chang. I'm located at Cedars-Sinai Medical Center. I specialize in motility disorders. So 100% of my outpatient practice is second opinion motility. So I specialize in complex end-stage patients. I run a lot of clinical trials. A lot of my research is involving microbial overgrowth and its contribution to irritable bowel syndrome, but we do a lot of esophagus, small bowel, and colonic dysmotility. So I like to say that we specialize in lips-to-cheek motility. I think that's it for me. Hi, good morning, everyone. I'm Tiffany Chua. I'm at University of Florida, where Milton is about to mow us down, but I'm here. I'm not a morning person, so if you're not either, but I woke up just for you guys. I'm an interventional endoscopist, so that means bread and butter ERCP, endoscopic ultrasound. My particular interest is third space endoscopy, like ESD, and interventional EOS. I spend most of my days in my endoscopy suite, and we come out maybe about once a week to do a clinic and see our follow-ups. So first of all, I guess we can just ask the group, is there anything in particular that you would want to hear more about us, more from about us? So things, for example, changes in GI practice settings, optimizing working relationships between physicians and pharmaceutical and medical device companies, trends within endoscopy and other GI procedures, and types of disease states that were being evaluated. So is there anything out of that that kind of jumps out at you, because then we can focus our discussion on that. And if not, then we can go along with the questions that we had. For all of them, it's an option, too. Okay, yeah, that's what usually people want to hear about, so that sounds good. So I guess we can go start with kind of the questions that we had kind of set, and then if anything comes to mind, any of you have any questions for us, then we can go ahead. So I guess, so the first question is basically talking about what a typical clinical schedule is for each of us, and you've heard that we are all in kind of, well, somewhat varied clinical settings, but we've all kind of been in the range of academic to community and private. So I guess I can talk about my clinical schedule, which is an academic, well, a clinical academic gastroenterologist, which means that I work at an academic medical center, but I'm 100% clinical, meaning I do not do any research. So for me, my typical schedule is about two days a week, full-day endoscopies, so doing upper endoscopies, but mostly colonoscopies for colon cancer screening, and also diagnostic procedures as well, and about one and a half to two days of clinic where I see patients who are coming in for new consultations, referrals from primary care doctors, and also follow-up patients. And then I also do inpatient consult service, but not that frequently, maybe about four weeks a year. And during those blocks, you're basically on 24-7 for seven days straight, seeing all of the consults in the hospital for general gastroenterology. So we're going to talk a lot about these conditions later on today, but things like GI bleeding, other disorders, other acute disorders of the GI tract are what we tend to deal with on-call. Okay. So my schedule obviously changed. I was also in very much an academic environment, but I did a lot of research. So now in the community, I spend one and a half days with the procedures and two days of clinic. But I also, we have actually just started a fellowship program, GI fellowship in a community-based hospital. I'm the program director, so I'm busy with that too, training fellows, and mostly they're in my clinic or doing procedures with me. Do cover inpatient, maybe four to six weeks a year. I haven't said that yet, but that's the plan. And other than that, mostly I do academic, I'm sorry, administrative and some academic work for my research, but that's my typical week. I don't do any weekend calls or any after-hour calls anymore. All right. So similar to Femi, I am also an academic gastroenterologist. Even though I run a lot of clinical trials and do a lot of research, I'm also 100% clinical, so I get to do all of that in my quote-unquote free time. I am slightly less endoscopy-heavy in my schedule, I do about a half a day a week of endoscopy. We're one of the few centers in the U.S. where all of our gastroenterologists personally perform every manometry. So I used to have two, now I have one half day of just dedicated manometry a week, and the rest of my week is taken up with either admin time, teaching time, or clinic. So I have a lot of clinic time. I have about eight weeks a year of call. So similar to the call that was described as 24-7 for a week at a time, during call I take off my motility hat, or I try to, and I put on my general GI hat. It's mostly bleeders and inpatient consults and more teaching time with our fellows, residents and medical students. I also, we have our own advanced motility fellowship at Cedars, so I am the APD of that, so a lot of my time is spent teaching our advanced fellow how to be a motility expert. UF is a pretty traditional university-style academic center, so I think I kind of touched on this a little bit. Three days of my week is spent in endoscopy. I'm primarily interventional endoscopy, but maybe every other week I will go to the general suite and do, help out with routine colonoscopies, upper endoscopies, which is also a nice way of staying in touch with your local population and seeing what type of pathology we're dealing with. One day a week is clinic, and then the remaining day for administration, and I'm technically 100% clinical also, like you, but paperwork and then any extra time left over in the admin day research or your nighttimes or weekends. I do less inpatient because of the interventional hat. I think only about two weeks of inpatient with our fellows per year. The reason for that is probably the frequency of advanced call. There's four of us in the group, so we tend to take a call a little bit more frequently than our colleagues who are not doing ERCP. That's typically the primary reason for a separate interventionalist to be on call. Other stuff that goes in our group that we also encounter, things like esophageal perforations, and we'll talk about that more during today's talks. So unless anyone has any questions about this topic, we can move on to the next. The next question is, so yes, so how do we see the role of industry as it relates to your practice? So I'm very curious to hear what everyone else's thoughts are on this, because it really is institution dependent. So currently in my current role, I'm at an academic medical center where the relationship with our industry partners is very structured, in the sense that Northwestern as an institution is welcoming to industry, but in a very kind of scheduled, structured manner, and there are several levels of folks that you have to go through before you get access to physicians. Now that's been opening up slightly more from what I can tell. Northwestern is a little bit more restricted to where I previously worked, which is at Loyola, which is another academic hospital that is just outside of Chicago, but typically the most common industry representatives that I interact with on a daily basis are pharmaceutical reps that will often come to my clinic, who I should have explained actually, my clinic is technically in a community setting off site. So oftentimes we'll have pharmaceutical representatives come by. With my patient population, a very common point of discussion for me is patient access. That's really my number one concern always, so it's always great to meet folks from some of your companies actually, to hear about how we can best get our patients access to these very important drugs. And then oftentimes we'll also have device representatives that will come through the GI lab, however they're usually more kind of focused on talking with our endoscopy director and making sure that we have the equipment we need and talking about new potential orders as well too. So for me in the community, actually we have a very good relation with the different types of industries, so mostly in the clinic, as Mimi was mentioning, we interact a lot with the pharmaceutical reps. So we do have dedicated time, especially during lunch or after clinic, when we interact with them. It is very important because I feel some of our pharmaceutical reps help us a lot with the prior authorizations, a lot of specialty pharmacies that I have to deal with, those help, very much appreciated, and also sometimes giving us samples to try on patients and get feedbacks on. So that's in the clinic side when we work in the hospital where obviously I interact a lot with the device companies. Because of my experience with several device companies in the past, when I was at UT, they are heavily also supporting our GI fellowship, so we do have excellent relationship from the point of education, training, and also trying out different newer products. And finally, we are actually having some meetings to start some of these unrestricted grants to even start research in the community base. And these are all with the device companies. I'll echo the prior comments. In terms of my clinic, I think the role of industry with regards to the pharmacologic companies, it's helpful for specialty pharmacies, for newly FDA-approved medications or devices and how to get patients access to those. Our clinic is pretty strict about having pharma representatives come. We're not allowed to give out samples, we're not allowed to give out coupons. So when we talk to them, it has to be sort of off campus or not allowed to like step foot into our clinic, unfortunately. Our relationship is mostly in my practice with the device reps. So I've got a couple of them on speed dial, especially when I'm having issues with different devices, malfunctions, or catheters that aren't working. It's also important, I think, to have a good relationship with your device reps for newer technologies that are coming out. So whether there is a new system available or new tools that you can do with your existing devices, I think that's really helpful. Just like Suj was saying, too, I think industry is important with regards to research, especially in academic practice. So if they're looking for new ways to use current available technologies, then we partner with them to run research trials, both for medications and devices. Probably because of my subspecialty and also regulations at my institution, I almost never see industry representatives in the clinic. UF is also considered a state facility. So for those of you who encounter sort of state run or government university related hospitals, you may run into extra red tape and probably have to check on a case by case basis. Mostly, I see our device reps in endoscopy. And I would say for an interventional endoscopist, industry is actually a really, really crucial partnership. They provide support to our nursing staff and our techs, as well as education. There are also some great opportunities for our fellows to go to courses and also for attendings as well. So we really consider them a partner and someone that's important if we have a difficult case or something interesting going on. I would say we have a pretty good relationship with our reps. It's not uncommon for us to shoot a text and say, hey, do you want to come? They will also reach out to us. Perhaps they have someone who's new to their company and ask if they can come in and get education. So it's quite symbiotic. And as I said, I can't really speak to non-device companies. I just don't encounter them anymore. Thank you. So since we just have a couple more minutes left for this session, I wanted to open it up and see if anyone had any specific questions for us, if there's anything that's come to mind after what we've discussed. What do you look for in a rep? Combination of not too much lingering, but support when needed. There's a balance between the provider, the facility, and the actual rep. We all have our certain jobs to do with respect to patients. What does that look like for each of you, as far as a good balance goes without overstepping? But showing interest as well. I think a good rep is very available. So if we're having problems with a certain device, someone who can be easily reached, someone who not only by phone, but like FaceTime. A good rep, and maybe some of my colleagues may disagree, is around a lot too. So some of our reps will ask us to let them know, keep them in the loop whenever we are using their device in certain procedures, especially when we're first doing it, so that they can just be around in case something comes up. At first I used to think that it was a burden on them, like, oh, do you really want to stand around watching? But a good rep is really interested, I would say, in what their technology is doing and how they can be there to support you. So I don't consider it burdensome to have them around, especially when I'm getting used to a new technology. I actually agree. And for us, obviously, when you're doing interventional procedures, you really have a good rep on your side, assisting on some newer devices or techniques, and also playing a big role in educating and training our techs, actually. See, what I usually sometimes use, again, a good rep, is to also train our endoscopy techs, and that's a huge part of our help with them, yeah. I think keeping an open line of communication and really talking to whoever you're going to see about their style, because not everybody has the same level of comfort to a visitor in their endoscopy suite, especially if you're a new face. I mean, some people don't mind if you pop in and out. Some people want to be contacted and asked, can I come from this time period to that time period? So I think in interventional endoscopy, some of the procedures are quite a bit higher risk and may require 100% of our focus. So we don't have as much time to talk and teach. You should definitely not underestimate having a good relationship with the nurses and technicians, especially the nurse manager, about the way the endoscopy suite is structured, kind of the different personalities of the doctors, what sort of devices are being used, what is low in stock, and anticipating maybe somebody needs a certain device for a specific patient. Because I think as a physician, we are sometimes notoriously bad at organizing our own and anticipating and looking forward. And I'm sure some of you have gotten that call that same day, oh, I need this thing for a patient that's coming in two hours. And it's possible that they knew earlier than two hours ago, but they just didn't think to call. So being in touch with kind of other members of the endoscopy suite can really help potentially avoid those sorts of situations. And then you come out looking like a hero. So I think our time is up for this half of the session, but again, we'll have another round of this in the afternoon. So the next block is actually going to be talking about several lectures going over the GI tract and health, and we'll be starting with Dr. Bianca Chang, who's going to be talking to us about the esophagus and stomach. Thanks, everyone.

gastroenterologists

industry partnerships

clinical roles

gastrointestinal health

private practice

pharmaceutical companies