You will practice general and advanced gastroenterology for an adult patient population across Merced County. Your time is split between clinic, a practice-owned endoscopy center (if you join a private practice), and the hospital endoscopy suite at Mercy Medical Center.
| Detail | Information |
|---|---|
| Patient Population | Adults |
| New Patient Wait | Less than one week |
| Exam Rooms | 4 or more per practice |
| Onsite Services | Labs and infusions |
| Hospital Endoscopy Suite | 1 room, 15 to 30 cases per day |
| Scopes | New Fujinon scopes in the hospital suite |
| Anesthesia | Anesthesiologists and CRNAs, 2 to 3 providers daily |
| Call | 1 in 3 (private practice) or 7 days per month (medical group) |
The private practice payer mix is weighted toward Medicare. Central California Alliance for Health, the local Medi-Cal plan, matches Medicare rates for procedures and reimburses endoscopy centers at a higher rate than Medicare.
| Payer | Share |
|---|---|
| Medicare | 55% |
| Central California Alliance for Health (Medi-Cal) | 25% |
| Commercial (Blue Cross Blue Shield and others) | 20% |
Top procedures:
The current gastroenterologists perform ERCP with stent placement and sphincterotomy, and they control GI bleeds with banding and clips. About half of hospital cases are double procedures, with an upper endoscopy and colonoscopy performed on the same patient.
EUS, pancreatic procedures, and pseudocyst drainage are not currently offered in Merced, and EUS cases are referred to Fresno. If you perform EUS, the hospital will support the equipment, and you would launch a new service line for the community. Hepatology, IBD, and motility are also areas where an incoming physician can build a focused practice.
All hospital endoscopy patients, inpatient and outpatient, are treated in the dedicated endoscopy suite. ERCP and cases that need fluoroscopy, dilation, or stent placement are performed in one of the hospital's 6 operating rooms. OR scheduling is flexible.
The two current gastroenterologists structure their days differently. These examples show the range of schedules the practice model supports.
| Dr. Munnangi | Dr. Kris | |
|---|---|---|
| Day Starts | 6:00 to 7:00 AM | 10:30 AM |
| Office Procedures | 25 to 30 per day | 5 to 7 per day |
| Clinic Patients | Seen between procedures, with NP support | About 20 per day |
| Hospital Cases | Arrives around 4:30 PM | Arrives around 7:00 PM |
| Detail | Information |
|---|---|
| Private Practice Rotation | 1 in 3 |
| Medical Group Rotation | 7 days per month |
| Hospitals Covered | 1 |
| Nurse Triage Line | Yes |
| Separate ERCP Call | No |
| APPs on Call | No |
| Hospitalist Service | Admits GI patients and consults GI |
The ER contacts GI for consults, and true emergency calls are rare.
Hospital: Oracle Cerner
Dr. Kris's practice: Provation for endoscopy and athenahealth for clinic
Dr. Munnangi works with a nurse practitioner who sees both new and follow-up patients. Dr. Kris plans to add one to two APPs to his practice.
There is no formal teaching or research component today. An academic component is expected in the future as medical education grows at UC Merced.