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help me realize if GI is right for me?

Discussion in 'Gastroenterology' started by carson12, 01.26.12.

  1. carson12

    carson12

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    i'm a 3rd year trying to figure out what to do. i'm very interested in urology and GI, but don't know what to choose. i'm one of those weird guys who like both surgery and GI, but don't know which one to choose. haha

    i like urology because of the scope and laparscopic cases. i really like being in the OR, but i do miss the part where you work up patients and figure out what's going on with them (basically, the medicine aspect).

    for GI, lots of procedures and you get to have the opportunity to practice general medicine and at least know general medicine. i think i'd be really sad if i didn't use general medicine because i really enjoyed learning it during the 1st 2 years of med school.

    i guess i'm leaning more towards GI right now, but i just want to know if i'll regret not picking urology. anybody who went GI choose it over urology? i would appreciate any responses.... thanks!
  2. carson12

    carson12

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    Also I have another question

    What are GI clinics like? Urology clinic is pretty boring consisting of prostate exams incontinence etc

    The urology surgeries are awesome but realistically urologists do surgeries only 1-2x a wk so I think the clinic for either urology or GI will make or break my decision so any input in what GI clinic is like?
  3. DrVanNostran

    DrVanNostran

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    I would just take an outpatient GI and Urology elective early next year and decide that way. Things seem to make more sense 4th year. To get GI, it is nice to have a competitive IM residency and urology is competitive as is. So right now, try to learn the most medicine/surgery you can and rock your electives. Get the H in medicine and surgery and all options will be open to you.

    It sucks that urology is an early match, so I would try to get the urology match early. To cover everything, it might be nice to get involved in a nephrology project, you can spin in both medicine and urology research ;)
  4. scotchtapetest

    scotchtapetest

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    Sounds like you wanna be a surgeon dude! You also do realize that regardless of what "we" medicine people say about surgeons, they actually have "offices/clinics" and they have to "diagnose" patients (here I use the term "diagnose" VERY loosely)! All kidding aside there is a lot of medical management in post-op patients as well.

    If you really like the OR as you indicated in your post, just do general surgery and then subspecialize or even better do Gas (lot of medicine and procedures)! Ob is also an option but I'm guessing not for you!

    From your posts it doesn't sound like GI or Urology will make you happy! Remember to do GI you must do 3 yrs of medicine (NO OR and VERY little procedures). Besides GI procedures are no where near the same experience as surgery.
  5. carson12

    carson12

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    Hey Thanks for your response. I think you're right. In my heart I wanna be a surgeon and I dont' think anything else will suffice. I'm apprehensive about the training because the attrition rate is pretty high compared to medicine, so it's still something I have to think about....

  6. libertarian

    libertarian

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    Carson 12,

    Many years ago, I faced a similar crossroad as you. I come from a family of 3 surgeons, and I've always looked up to them and wanted to join "the club." During my 3rd year of med school, we were all together during Christmas and the topic of conversation shifted to what I was planning on doing. I told them surgery, and uniformly, all 3 family members told me not to do it unless I would absolutely die without it. They instead instructed me to go into GI. I'm happy I did.

    I also enjoyed medicine, at least the way it should be practiced. I also loved the aura of the operating room. The ability to cut somebody open, fix something, then sew them back up, was extremely tempting. However, I chose gastroenterology. I'm extremely satisfied with my decision. Yes, you do a lot of diagnostic procedures (EGD's and colonoscopies... all day). It can get quite monotonous. But my passion lies in therapeutic GI, and the field is expanding at a rapid clip. EUS has really tore down the last frontier in the GI realm, the GI lumen. Now with the ability to "see" outside of the GI lumen, the possibilities are endless. I just attended a meeting on performing TIPS under EUS-guidance. Another course next week on POEM (per-oral endoscopic myotomy) for treatment of achalasia. I'm in my final year of GI fellowship, and I am very excited about starting my life. Job opportunities are plentiful, and my email is flooded with job offers daily (probably 5-10 offers come in PER DAY, no joke). The starting salary ranges anywhere from 250K on the low-side in highly-competitive locations such as los angeles, all the way to a million in less-desirable locations. I was offered TWO jobs, both starting at $800K. Ridiculous. I didn't take them because after a while, you realize that life and family are far more important than money. Plus, you begin to realize that ethically, anyone making that kind of money is really pushing the limits... anyways, I digress.

    I'm obviously biased towards the field of GI, but in terms of lifestyle, income, and job satisfaction, it rates near the top.

    In terms of clinic... clinic is a necessary evil for every speciality (except radiology and pathology). Personally, I'm not a big fan of clinic, especially GI. It's been estimated that approximately 25% of your patients in clinic will be IBS (irritable bowel syndrome). The typical patient is a young female with other psychosocial issues presenting as IBS. Obviously, a very difficult cohort to work with, as any effective treatments typically require a lot of time, counseling, and reassurance. There are other fields of GI such as inflammatory bowel disorders (Crohns and ulcerative colitis) that typically require a little more clinic than average, and you can choose to subspecialize in these areas. Another option is to focus on hepatology. There's a HUGE need for hepatologists, as most of the gastroenterology fellows gravitate towards mostly luminal GI and neglect liver, for a variety of reasons. If you find a nitch in liver, there will be plenty of jobs looking for a medical transplant hepatologist, which pay pretty well too.

    Hope this helps. One of my good friends is a urologist and loves it. Both are good fields =)
  7. gooze

    gooze Removed

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    may i ask why type of surgeons are in your family?? and why did they not encourage you and told you to pursue GI? thanks.
  8. carson12

    carson12

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    hey libertarian,

    were your family members general surgery? did you consider ENT or urology before choosing GI?
  9. Silent Cool

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    I would imagine that GI is right for you if you like putting a camera up people's butts all (or most of the) day. Do you enjoy this activity? I mean..procedure?
  10. darkelven29

    darkelven29

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    How is colonoscopy not a procedure? It still is even if you don't break skin. Unless you think intubating is not a procedure either.

    You do have to not mind stool (smell+appearance). If you like being clean, go do psychiatry, heme-onc, endocrine, or allergy/immunology. Most fields deal with some form of body fluids.

    Upper endoscopy is a big part of it too. There are lots of clipping, banding, and taking biopsies in most scoping in tertiary hospital. GI is a quite exciting field, and those who like procedures can go for advanced endoscopy, and those who are more thinking-inclined can go to other ultra-sub-specialties that still do scopes but more clinics (liver, motility). IBD is also a great field with lots of basic science research/clinical trials.

    Salary can change in the next 10 years. I wouldn't choose by that.
    DermViser likes this.
  11. NeedBeats

    NeedBeats

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    Hey all,

    Not sure if this is the best forum to ask but here goes nothing: Can one do GI procedures while sitting in a chair/high stool (not a stool joke.)
    I'm an MS4 deciding between GI and another field. I love the procedures, but have a blown knee, that is unlikely to be fixed. I'm trying to figure out if it is reasonable to chase GI, all the research, and extra effort if I will not be able to do the job. I know its early, but my IM match list is heavily weighed in favor of strong GI programs and if I'm not able to do it then need to change the list. All opinions welcomed and appreciated.
  12. Linus2007

    Linus2007

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    Sounds like you would like surgery. I love GI (clearly biased) as it involves some thinking and there is instant gratification without stepping foot in an OR. I feel like you could tell who would do surgery based on if you loved being in the OR. I am leaning towards advanced endoscopy so again I think the procedures are awesome.

    NeedBeats yes you can do some some of the procedures using a chair. One of my attendings scopes using a chair, he trained that way. To me it would be difficult as I use my whole body when scoping. You use a pedal for irrigation and cautery but I only use one foot. Can you handle standing up for long periods of time?
  13. NeedBeats

    NeedBeats

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    [quote="NeedBeats yes you can do some some of the procedures using a chair. One of my attendings scopes using a chair, he trained that way. To me it would be difficult as I use my whole body when scoping. You use a pedal for irrigation and cautery but I only use one foot. Can you handle standing up for long periods of time?[/quote]

    Thanks Linus2007, I can stand for some time but I've noticed the length of time diminishing as I get a little older. I assume by the time I'm in my 40's the interval will likely be a limiting factor. I really love advanced GI, there is so much potential in ERCP/EUS they really are the main procedures that make me want to go into the field. I've spent 4 months rotating in GI but have never seen anyone work while seated, especially the advanced stuff.
    I guess depending on where I end up for IM I can try to find a mentor to see if there is a reasonable chance for me to do GI or put my energy into other interests.
  14. wjs010

    wjs010

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    Thanks Linus2007, I can stand for some time but I've noticed the length of time diminishing as I get a little older. I assume by the time I'm in my 40's the interval will likely be a limiting factor. I really love advanced GI, there is so much potential in ERCP/EUS they really are the main procedures that make me want to go into the field. I've spent 4 months rotating in GI but have never seen anyone work while seated, especially the advanced stuff.
    I guess depending on where I end up for IM I can try to find a mentor to see if there is a reasonable chance for me to do GI or put my energy into other interests.[/quote]
    Maybe start a strength/ endurance program at the gym? Seems like a bad reason to avoid a specialty you like. Just a suggestion :)
  15. Silent Cool

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    Wow. Uro vs GI. Dic vs. Poop. That's a tough call. Both fields, however, will have you putting your finger up a butt, just for different medical reasons. Flip a coin, maybe? Both are procedural and both pay bank. Do you like surgery or scoping? GI is more of a one-trick pony. I would probably pick Uro.

    good luck.
  16. IM2GI

    IM2GI

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    Except you have to do a surgical residency, which can be fairly brutal.

    The risk in going after GI is that it is so competitive. If you dont like general internal medicine, and don't get a GI spot, you are left with plan B. Most people these days are turning to hospital medicine, which is a pretty darn good gig.
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  17. wjs010

    wjs010

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    If one does research and has adequate boards, the chances are decent that they will get in SOMEwhere , right?
  18. IM2GI

    IM2GI

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    No not really unfortunately. Imagine ~400 applications, ~40 get invited for interviews, for ~3-4 spots at most programs, of which half will go to internal applicants, so you are typically fighting for ~1-2 external positions. It is brutally competitive these days. A lot of it comes down to a) Where you did your residency b) Letters/personal connections c) Research.
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  19. DermViser

    DermViser

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    You don't choose whether GI is right for you, GI chooses whether you are right for GI.
    Last edited: 03.11.14
  20. DermViser

    DermViser

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    Hospitalist medicine is like being in residency forever.
  21. DermViser

    DermViser

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    Wow, it's just like Derm, except a) would be where you went to med school.
  22. IM2GI

    IM2GI

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    Except you get every other week off and at least triple the salary, with no long rounds/conferences/etc to deal with. Hospitalist medicine is a good gig.
  23. DermViser

    DermViser

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    Yes, but there is a reason burnout is high in hospitalist medicine. I don't think one can do decades and decades of hospitalist medicine without burning out - hence why it's usually just a brief stint before going on to fellowship.
  24. Linus2007

    Linus2007

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    Thanks Linus2007, I can stand for some time but I've noticed the length of time diminishing as I get a little older. I assume by the time I'm in my 40's the interval will likely be a limiting factor. I really love advanced GI, there is so much potential in ERCP/EUS they really are the main procedures that make me want to go into the field. I've spent 4 months rotating in GI but have never seen anyone work while seated, especially the advanced stuff.
    I guess depending on where I end up for IM I can try to find a mentor to see if there is a reasonable chance for me to do GI or put my energy into other interests.[/quote]


    For advanced procedures you have to be standing as it involves your whole body movement plus you have to wear lead for some of the cases. Agree I would consider doing strength exercises. THere are things you can do to make things easier. One of our advanced attendings has back problems so he wears lighter lead and scopes on top of a special mat. Its incredible how big a difference that mat makes. My feet would be killing me after a day of scoping but that mat was like scoping on a cloud :)

    Medicine isn't too bad I was a hospitalist for a year, worked only 10 ****s a month, was awesome. But having done GI I can't imagine doing a career in medicine
    NeedBeats likes this.
  25. bobsmith

    bobsmith

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    Sounds like you need a little more fiber in your diet, man.

    Is it fair to say that little slip-ups and typos like this become more and more common after you go into GI? :p

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