Analysis of Classified Advertisements for Gastroenterology in NEJM over 20 Years; 1985–2004

Abstract

Purpose: Colonoscopy is considered the preferred method for colon cancer screening. Since July 2001, medicare program reimburses for screening colonoscopy every 10 years in average-risk persons, resulting in the increase in the number of colonoscopies performed (AJG 2003; 98:194–199), causing increased demands for gastroenterologists' services. We evaluated the no. of classified advertisements (Ads) for Gastroenterology (G) in NEJM and compared them with Ads for Cardiology (C), the other procedure-oriented subspecialty of Internal Medicine, over the 20 year period from 1985–2004. Methods: Ads for C and G from NEJM were manually counted on a weekly basis. The C/G ratio was calculated. The smallest and largest no. of Ads for C and G in a week were noted. The total no. of Ads for C and G were added up. Statistical method used for evaluating mean monthly Ads was time series analysis. The changes in C/G ratio during different periods were evaluated by first order auto-correlation model. The Shapiro-Wilk test statistics using the lower and upper Scheffe band was utilized. Results: During these 1042 weeks there were 76713 Ads for C; mean 73.76 (range 14–218) per week. There were 26130 Ads for G; mean 25.12 (range 1–122) per week. The C/G ratio was 2.93 (range 1.37 – 18.20) per week. The smallest no. of Ads for G (one) occurred in 6/13/85 issue; the largest no. of Ads for G (122) occurred in the 11/4/99 issue. The smallest no. of Ads for C (14) occurred in the 1/24/85 issue and the largest no. of Ads for C (218) occurred in the 11/4/99 issue. The largest no. of Ads for both C and G occurred in the months of September to November; the smallest no. of Ads for C and G occurred in April to July. Probably these Ads are targeted to Fellows in training. The C/G ratio from 1985 to 1997 was in the range of 3.10 – 5.81 (95% confidence) and it was significantly higher than the C/G ratio from 1998 to 2004 which was in the range of 1.85 – 2.79 (95% confidence). The mean C/G ratio from 1997 to 2001 was 2.40 which was not different from the one from 2002 to 2004 which was 2.48. However, C/G ratio from 2002 to 2004 did not decrease any further. Conclusions: The no. of Ads (and presumably demand for GI services) have increased since 1997 correlating with the use of screening colonoscopy. 2. The number of Ads for C is three times that for G. 3. The largest no. of Ads for C and G are placed during Sept. to Nov; the lowest in April to July.