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Training and Competence in Bronchoscopy When asked how many bronchoscopic procedures must be performed to become and to remain competent in the procedure, more than 60 percent of the respondents recorded that at least 50 procedures were necessary to become competent (Table 9). More than half the survey participants noted that one should perform at least 25 bronchoscopic procedures per year to remain competent. Comments: More than 60 percent of our survey respondents indicated that 50 or more bronchoscopic procedures were required to become proficient in the procedure, and nearly 90 percent indicated that 25 or more were necessary. More than half the participants indicated that at least 25 bronchoscopic procedures per year were necessary to maintain competence in the procedure. Several respondents commented that the question about the latter was “unfair” and that the number of bronchoscopic procedures performed per year had no relation to maintaining competence in the procedure. Bronchoscopy Charges More than half the survey participants (Table 10) were charging $300 to $450 for bronchoscopy. The next largest group (18 percent) charged $450 to $600 per procedure, and nearly 3 percent charged in excess of $750. A significant number (14 percent) charged less than $300. Comments: As indicated in Table 10, the charges were defined as physician fees and were exclusive of additional procedures (eg, brushing, biopsies, and laser procedures), other bronchoscopy-related procedures, and charges related to processing of bronchoscopy specimens, pathologic analysis, and culture of specimens. Since the question did not specify, it is unclear whether the charges were based on the time required to perform bronchoscopy. Of the 72 participants who wrote special comments, 16.7 percent felt that the reimbursement by Medicare and insurance was inadequate. Table 9—Number of Bronchoscopic Procedures Required to Become and to Remain Competent

Number of Procedures Required	Respondents, % (n)
To Become Competent
>50	61.1 (532)
26-50	28.6 (249)
<25	9.0 (78)
No response	1.4 (12)
	100.0 (871)
To Remain Competent
>50	8.5 (74)
26-50	33.4 (291)
=S25	50.9 (443)
No response	7.2 (63)
	100.0 (871)

Table 10—Physician Fee for Bronchoscopy

Fee	Respondents,  %(n)
>$750	2.8 (24)
$601-$750	5.1 (44)
$451-$600	17.9 (156)
$300-$450	54.1 (471)
<$300	13.7 (119)
No Response	6.5 (57)
	100.0 (871)