Screening sigmoidoscopy is associated with a 45% to 80% reduction in colorectal cancer mortality. Although less than 50% of eligible Americans have been screened with flexible sigmoidoscopy (FS), the use of this procedure is rising rapidly. By the year 2000, as many as 10 million screening FS per year could be performed. To accommodate the increased demand, many medical centers have trained paramedical personnel (i.e. physician assistants, nurses, and gastroenterology technicians) to perform FS. However, as a result of the paucity of research about this practice, only physicians receive a professional fee for performing screening FS. Many state Boards of Nursing explicitly prohibit registered nurses (RNs) from performing this procedure. This review outlines research about the effectiveness of paramedical endoscopists, medico-legal and reimbursement issues, and outlines a training program in FS for paramedical personnel.