Fatigue is an underestimated cause of underperformance among physicians. There is evidence that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy.

To investigate the practices and perceptions of U.S. endoscopists regarding the effect of production pressure on the performance of colonoscopy.

We conducted a 40-question online survey to assess endoscopists' practices and perceptions concerning production pressure.

A total of 5030 U.S. American Society for Gastrointestinal Endoscopy members.

The proportion of endoscopists responding positively to questions pertaining to the impact of production pressure on colonoscopy practice.

Ninety-two percent of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included (1) postponing polypectomy for a subsequent session (2.8%), (2) reducing the length of time spent inspecting the colon (7.2%), and (3) proceeding with colonoscopy in a patient with an unfavorable risk/benefit ratio (69.2%). Forty-eight percent of respondents reported witnessing the effects of production pressure on a colleague. Respondents working fee-for-service and those with >10 years since completion of fellowship were more likely to describe their weekly workloads as excessive compared with those who were salaried (81.3% vs 71.3%; P = .01) and <10 years out of training (81% vs 72.7%; P = .01).

Nonresponse bias due to low response rate (22.3%).

Production pressure influences the conduct of colonoscopy for many endoscopists and could have an adverse effect on the outcome of colorectal cancer screening. (Clinical trial registration number: RE:GIE D 11-01288R1.) The study was an Internet study and did not involve human subjects.