EUS and ERCP requirement

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As a prospective medical student, I always like to spend time searching the internet and educating myself about different specialties.

I have noticed that many GI jobs require EUS and/or ERCP skills. I have also learned that there is a number of one year subfellowships in which GI fellows receive more focused training in these endoscopic procedures.

Is it the norm now that in order to land good jobs post residency and fellowship, one must also endure another year in EUS and ERCP training? or are the regular GI fellowships providing sufficient exposure to these procedures?

Thank you,

There is a push among the big university-based GI fellowship programs to make ERCP and EUS training 4th year mandatory. I think the majority of GI fellowship programs currently expose their fellows to ERCP, and I believe the last estimate I heard was about 20% of programs will actually certify their fellows in ERCP because they get enough numbers during their 3 years.

The problem with simply being "exposed" to ERCP is that #1), you are not competent to perform arguably the highest-risk procedure that gastroenterologists perform, and #2) you take cases away from other gastroenterologists that SHOULD be performing them. Thus, you dilute the pool of "qualified" therapeutic endoscopists.

Another thing to consider is that ERCP is a technically challenging procedure, much more so than your standard EGD and colonoscopy. In my opinion, there are a few gastroenterologists that should never handle a scope, just like there are surgeons who should never operate. Not all gastroenterologists are blessed with the same skill set, and ERCP requires a certain level of technical "giftedness." That's OK, and I'm not trying to sound elitist, as there are some doctors that shine in a clinic-setting, but suck in the endoscopy suite. Everyone has their own skills that they bring to the table, and we should build our practice around those skills instead of trying to be something that we are not.

I think you also asked about EUS. Here's the low down... the vast majority of programs require a 4th year to train in EUS, with some exposure to EUS during your 3 years being standard. The problem is, not all 4th year fellowship programs are the same. There are a few (such as Indiana University and University of California Irvine) that have phenomenonal EUS training. And then there are others (not going to name them cause I'll get in trouble) that are useless. It really depends on WHO is training you during that 4th year. IMHO, EUS is even more specialized than ERCP, and diluting out the pool of people who perform EUS would be a mistake.

This still leaves the question whether you need ERCP/EUS to be competitive for a job....?