St. John’s Hospital pioneers colonoscopy training for family medicine physicians, expanding access to care
Given his family’s health history, Michael Stoltzman knew he needed a colonoscopy before 45, the recommended age for colorectal cancer screening. James Hougas, MD, family medicine physician with M Health Fairview, strongly advised the screening. But instead of simply referring Stoltzman to a specialist, Hougas offered to perform the procedure himself.
Stoltzman admits he was nervous about the idea of a colonoscopy but felt reassured knowing his trusted physician would be the one doing it.
“It’s intimidating to get a colonoscopy, but who better than someone I already trust?” Stoltzman said.
That sense of comfort and accessibility is exactly why Hougas is leading Minnesota’s only colonoscopy training program for family medicine residents at M Health Fairview St. John’s Hospital—helping expand care and improve early detection for patients like Stoltzman.
Bringing colonoscopies to underserved areas
Hougas, who is also an assistant professor at the University of Minnesota Medical School, has performed more than 900 colonoscopies in his 13-year career, a unique milestone as only 2 to 4 percent of family medicine providers are trained to perform colonoscopies.
A gastroenterologist typically performs colonoscopies. But in rural areas, access to specialty care, like gastroenterology, is limited. A recent study found that about 69% of U.S. counties have no gastroenterologist, forcing 49 million Americans to drive 25 miles or more for care.
“Having fully trained physicians is what keeps rural America healthy,” Hougas said. “There’s fairly intensive prep involved for colonoscopies, so it's not ideal for people to have to travel far to receive the procedure. We need to bring colonoscopies to people where they are.”
In 2017, Hougas began training residents in the St. John’s family medicine residency program to do colonoscopies, equipping them with the knowledge, skills, and experience to perform the life-saving procedures on their own. The St. John’s program consists of six to seven residents each year, and usually one moves on to practice in rural Minnesota.
'Who else better than someone I already trust?’
Hougas says that another benefit of a primary care physician performing the colonoscopy is the established relationship and trust between the patient and provider.
Stoltzman agrees. He’s received primary care from Hougas for seven years at M Health Fairview Clinic – Phalen Village. Hougas also cares for Stoltzman’s dad and brother, giving him unique insight into the family’s medical history and ensuring Stoltzman receives timely screenings. With colorectal cancer ranking among the most common cancers in the U.S. — and diagnoses rising among young adults—proactive, personalized care like this is essential to prevent cancer.
During Stoltzman’s colonoscopy, Hougas found pre-cancerous polyps and removed them for testing, which turned out to be benign. But if Stoltzman had waited five more years for screening, the polyps could have gotten larger and potentially developed into cancer.
The next generation
Tony Nguyen, MD, learned about the opportunity to perform colonoscopies during his family medicine residency at St. John’s Hospital. He was immediately interested because of his passion for family medicine and rural health.
“Being able to perform colonoscopies is one less barrier for our patients,” said Nguyen. “Patients are already seeing their primary care provider, which makes it easier and more comfortable to talk about colon health and get a scope done.”
Under Hougas’ guidance and leadership, Nguyen learned how to perform the exam and completed 30 colonoscopies. He graduated from the residency program in 2019 and is now in a fellowship program at Yale University and will continue to perform colonoscopies in his practice.
“Preventative measures, like colonoscopies, are the best form of medicine, and I want to make sure the next generation of family medicine physicians are equipped to offer life-saving screenings to improve patient outcomes, especially across underserved communities,” Hougas said. “Rural Minnesota needs this care, and we can safely and effectively bring it to them. It’s why we do what we do.”
