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Having spent some time on the other sub-specialty forums, I thought it would be good to start a thread on discussing the positives of GI as a subspecialty. Having wanted to do GI since medical school, spent over 7 months on various GI services across the country, and having recently matched to an awesome GI program in Canada, my point of view is a little biased, but perhaps also a little more informed.
Internal Aspects
Balance of Procedures and Medicine
This is big one. Most of my colleagues who applied for GI stated this aspect of the subspecialty as being one of the biggest attracting elements. Not only is GI procedural, but it is the kinds of procedures that make it fun. Endoscopy requires dexterity, hand-eye coordination, attention, problem solving in 3 dimensions (i.e. understanding and overcoming loop formation). The visual element of GI brings to life an otherwise highly theoretical specialty. Futhermore GI is an instant gratification speciality i.e acute GI bleeds via epi injection/gold probe/sclerotherapy, argon plasma coagulation (APC) for AVMs or radiation proctatitis, banding for esophageal varices, glueing gastric varixes, polypectomies, cancer surveillance and endoscopic tatooing, biliary cannulation and stenting with ERCP, sphincterotomies, stricture dilatation etc, etc, etc these are the common tools in your toolbag, with newer technologies and approaches being developed (many of which are in the research phase, i.e. NOTES) or are already being adopted (i.e endoscopic mucosal resection) every day.
When you are not in the endoscopy suite, the medicine part of GI is also satisfying as we not only diagnose patients, but can also treat them with vast array of drugs (the reason why drug reps are usually hanging around GI offices/conferences, etc) . The medical management of IBD is fascinating (with the large armamentarium of drugs available to treat) There are a number autoimmune GI tract disorders i.e. GVHD, autoimmune pancreatities, microscopic colotitis, autoimmune pancreatitis, pernicious anemia, celiac disease, etc, etc, all of which are highly treatable. The list goes on and on....
Consultant
This is another awesome part of being a gastroenterologist. I love the idea of being a pure consultant. A physician (i.e. family doc, hospitalist) has a question, you initiate the proper workup and make a diagnosis. And if you don't have a diagnosis, you have effectively ruled out GI pathology and refer the patient back to the referring doc.
That being said, some programs do admit patients under the GI service, this is usually in academic settings. Although most academic settings usually work only as consultants, or admit a very limited number of patients.
Salary
Gastroenterologists are one the best paid physicians in Medicine. And by medicine, I mean to say the entire medical establishment, not just internal medicine. The reason for this is twofold. The procedures in GI are highly lucrative, although people of been talking about diminishing compensation in procedure based specialties - this is true for all procedure based specialties across the board. Nevertheless, GI docs are in a unique position to adapt and adjust to financial stresses by adopting and changing their practices (i.e becomming ercp/eus/emr trained) working/owning Ambulatory Surgical Centers (ASC) or expanding on the medical side of your practice. Agreed, compensation will go down and eventually plateau (if they haven't already) but the key is to maintain an evolving practice.
Internal Medicine Trained
This is a double edged sword. Many people don't like or even hate internal medicine. The opposite was true for me. Having almost completed my internal medicine training, I am grateful to be able to have the exposure and training in all aspects of adult medicine. I love having been trained as a generalist first, because it has helped me become a better physician. Furthermore, because GI disorders encompass all aspects of pathology i.e. autoimmune, heme, cancer biology, endocrine, surgical, congenital... that is why being a good gastroenterologist invariably entails having a strong understanding of internal medicine.
Bright Future/Research Opportunities
Both from a procedural and medical standpoint, GI has a very bright future. There are a number of endoscopic procedures in the research pipeline that have not yet been accepted in the mainstream, but are almost there. An example is gastric baloon placement for bariatric patients that has already made it to the mainstream. There are many other procedures that are highly investigational but will eventually make their way to the market in one way or another in the future. Being the masters of endoscopy, gastroenterologists will be in a unique position to lead the way, though I suspect further training in advanced/therapeutic endoscopy will be required. Medically speaking, many new drugs (that will likely be exclusively used by gastoenterologists) are either already on, or almost on the market. These include drugs like anti-TNF agents for IBD, immunomodulators and antivirals for HCV, antivirals for HBV (although the hayday for this was likey in the first decade of the 21st century)
Make a Difference Immediately and Long Term
This is important from a personal satisfaction point of view. Acutely, there are many things you can do to make an immediate difference, i.e Save someone's life by stop a GI bleed, put a patient into remission with their IBD (and make them feel drastically better), dilate an esophagus and alleviate their obstructive symptoms, deploy a biliary/esophagea stent to improve someone quality of life with invasive cancer.
Chronically, there are just as many things you can do to make a difference. I.e endoscopic surveillance for colon cancer/barrett's. Preventing Chirrorsis by treating someones HCV, HBV. Treating someone's IBD so that you postpone (and in the future prevent) a surgical resection. The list goes on and on
External Aspects
Varied Work Schedule
Unlike EM docs, General Surgeons, OBS/Gyn, Cardiologists, Neurosurgeons, etc. The life of gastroenterologist is fairly predictable. You are busy but your day ends at 5PM (or whenever you are done clinic). When you are on call, you do have to come in occasionally overnight, but that patient needs to be stable and adequately resuscitated and that when you come in. There is no mental masturbation in the middle of the night. You are called to provide endoscopic management.
Private/Academic Practice
Gastroenterologists are in a unique position to work in both privately and academically. For the business minded Gastroenterologists, investing in or founding an outpatient endoscopy unit can by highly lucrative. If the academic life is more your cup of tea, you can always purusue a fellowship and work in an academic center. Though most gastroenterologists I know, do both and make a killing.
Job Prospects
In Canada, the Job market is pretty tight. Access to endoscopy time across the country is limited, which is forcing many of us to either pursue private practice and work in Ambulatory surgical Centers or seek opportunities in the US, where the job market in GI is booming. Because of the flexibility of practice, gastroenterologists are well position to work in most settings, and do well.
Cheers!
Smartreader
Internal Aspects
Balance of Procedures and Medicine
This is big one. Most of my colleagues who applied for GI stated this aspect of the subspecialty as being one of the biggest attracting elements. Not only is GI procedural, but it is the kinds of procedures that make it fun. Endoscopy requires dexterity, hand-eye coordination, attention, problem solving in 3 dimensions (i.e. understanding and overcoming loop formation). The visual element of GI brings to life an otherwise highly theoretical specialty. Futhermore GI is an instant gratification speciality i.e acute GI bleeds via epi injection/gold probe/sclerotherapy, argon plasma coagulation (APC) for AVMs or radiation proctatitis, banding for esophageal varices, glueing gastric varixes, polypectomies, cancer surveillance and endoscopic tatooing, biliary cannulation and stenting with ERCP, sphincterotomies, stricture dilatation etc, etc, etc these are the common tools in your toolbag, with newer technologies and approaches being developed (many of which are in the research phase, i.e. NOTES) or are already being adopted (i.e endoscopic mucosal resection) every day.
When you are not in the endoscopy suite, the medicine part of GI is also satisfying as we not only diagnose patients, but can also treat them with vast array of drugs (the reason why drug reps are usually hanging around GI offices/conferences, etc) . The medical management of IBD is fascinating (with the large armamentarium of drugs available to treat) There are a number autoimmune GI tract disorders i.e. GVHD, autoimmune pancreatities, microscopic colotitis, autoimmune pancreatitis, pernicious anemia, celiac disease, etc, etc, all of which are highly treatable. The list goes on and on....
Consultant
This is another awesome part of being a gastroenterologist. I love the idea of being a pure consultant. A physician (i.e. family doc, hospitalist) has a question, you initiate the proper workup and make a diagnosis. And if you don't have a diagnosis, you have effectively ruled out GI pathology and refer the patient back to the referring doc.
That being said, some programs do admit patients under the GI service, this is usually in academic settings. Although most academic settings usually work only as consultants, or admit a very limited number of patients.
Salary
Gastroenterologists are one the best paid physicians in Medicine. And by medicine, I mean to say the entire medical establishment, not just internal medicine. The reason for this is twofold. The procedures in GI are highly lucrative, although people of been talking about diminishing compensation in procedure based specialties - this is true for all procedure based specialties across the board. Nevertheless, GI docs are in a unique position to adapt and adjust to financial stresses by adopting and changing their practices (i.e becomming ercp/eus/emr trained) working/owning Ambulatory Surgical Centers (ASC) or expanding on the medical side of your practice. Agreed, compensation will go down and eventually plateau (if they haven't already) but the key is to maintain an evolving practice.
Internal Medicine Trained
This is a double edged sword. Many people don't like or even hate internal medicine. The opposite was true for me. Having almost completed my internal medicine training, I am grateful to be able to have the exposure and training in all aspects of adult medicine. I love having been trained as a generalist first, because it has helped me become a better physician. Furthermore, because GI disorders encompass all aspects of pathology i.e. autoimmune, heme, cancer biology, endocrine, surgical, congenital... that is why being a good gastroenterologist invariably entails having a strong understanding of internal medicine.
Bright Future/Research Opportunities
Both from a procedural and medical standpoint, GI has a very bright future. There are a number of endoscopic procedures in the research pipeline that have not yet been accepted in the mainstream, but are almost there. An example is gastric baloon placement for bariatric patients that has already made it to the mainstream. There are many other procedures that are highly investigational but will eventually make their way to the market in one way or another in the future. Being the masters of endoscopy, gastroenterologists will be in a unique position to lead the way, though I suspect further training in advanced/therapeutic endoscopy will be required. Medically speaking, many new drugs (that will likely be exclusively used by gastoenterologists) are either already on, or almost on the market. These include drugs like anti-TNF agents for IBD, immunomodulators and antivirals for HCV, antivirals for HBV (although the hayday for this was likey in the first decade of the 21st century)
Make a Difference Immediately and Long Term
This is important from a personal satisfaction point of view. Acutely, there are many things you can do to make an immediate difference, i.e Save someone's life by stop a GI bleed, put a patient into remission with their IBD (and make them feel drastically better), dilate an esophagus and alleviate their obstructive symptoms, deploy a biliary/esophagea stent to improve someone quality of life with invasive cancer.
Chronically, there are just as many things you can do to make a difference. I.e endoscopic surveillance for colon cancer/barrett's. Preventing Chirrorsis by treating someones HCV, HBV. Treating someone's IBD so that you postpone (and in the future prevent) a surgical resection. The list goes on and on
External Aspects
Varied Work Schedule
Unlike EM docs, General Surgeons, OBS/Gyn, Cardiologists, Neurosurgeons, etc. The life of gastroenterologist is fairly predictable. You are busy but your day ends at 5PM (or whenever you are done clinic). When you are on call, you do have to come in occasionally overnight, but that patient needs to be stable and adequately resuscitated and that when you come in. There is no mental masturbation in the middle of the night. You are called to provide endoscopic management.
Private/Academic Practice
Gastroenterologists are in a unique position to work in both privately and academically. For the business minded Gastroenterologists, investing in or founding an outpatient endoscopy unit can by highly lucrative. If the academic life is more your cup of tea, you can always purusue a fellowship and work in an academic center. Though most gastroenterologists I know, do both and make a killing.
Job Prospects
In Canada, the Job market is pretty tight. Access to endoscopy time across the country is limited, which is forcing many of us to either pursue private practice and work in Ambulatory surgical Centers or seek opportunities in the US, where the job market in GI is booming. Because of the flexibility of practice, gastroenterologists are well position to work in most settings, and do well.
Cheers!
Smartreader
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