Life as a gastroenterologist

RE:

A gastroenterologist surgeon has a particular interest in diseases digestive tract. To become proficient in the treatment and management of these conditions, a gastroenterologist must undergo training in both internal medicine and advanced training in problems of the digestive tract.

gastroenterologist must first complete a 4-year college degree followed by 4 years of medical school at which time they receive a medical degree. The next step is a 3-year residency in internal medicine. At that time a physician may elect to continue on to a specialty in gastroenterology. A gastroenterology fellowship is 2 to 3 years during which a physician learns to evaluate and manage digestive diseases. This training encompasses conditions that may be seen in an office or in a hospital setting and instruction in how to perform diagnostic endoscopy procedures, such as colonoscopy. In all, a gastroenterologist has undergone a minimum of 13 years of formal classroom education and practical training before becoming a certified gastroenterologist.



A gastroenterologist that is certified by the American Board of Colon and Rectal Surgery must have proficiency in diagnosing and treating the following conditions:

• Anorectal conditions
  • Hemorrhoids
  • Colonic neoplasms
  • Cancer
  • Polyps
• Diverticulosis
• Esophageal reflux
• Gastritis
• Gastroesophageal Reflux Disease (GERD)
• Hepatitis
• Hiatal Hernia
• Inflammatory bowel disease
  • Ulcerative colitis
  • Crohn's disease
• Irritable bowel syndrome
• Ulcers

A gastroenterologist must also be proficient in treating and managing the following signs and symptoms:
Signs and Symptoms

• Abdominal pain
• Abnormal x-ray findings
• Constipation
• Diarrhea
• Difficulty swallowing
• Heartburn
• Indigestion
• Jaundice
• Liver Disease
• Malabsorption
• Nausea
• Post-operative colon tests
• Rectal bleeding
• Unexplained weight loss
• Vomiting

And in performing the following tests:
Diagnostic testing

• Colon screening exams
• Esophageal and intestinal dilation
• Hemostasis
• Polypectomy

Hope that helps.

GYN DOC said:

no gi docs around

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I didn't respond because I'm not in private practice and its a hard question. Everyone's practices are so different. Some GI docs work in ASC's, doing scopes and seeing clinic, no call. Others cover multiple hospitals, do advanced procedures, take frequent call.

As for the med stud's response above, thats a fairly abbeviated but representative list of diseases that we see. However, all GI fellowships are 3 years (many people do a fourth year now) and we are not colorectal surgeons. Therefore, we are boarded by the ABIM.

Hey Dr,

What med school did you graduate from, btw? How is the specialization process in gastroenterology from an IM background?

Thanks

I just finished my GI fellowship and went into private practice.

You are crazy if you want to manage post op bariatric patients. That is garbage medicine, sorry. We told our bariatric surgeon to manage all is own post op problems unless he needs a scope from us.

GI private practice life is awesome. Roughly 8-5 or 6 unless you're on call or doing your hospital week. We do 3 weeks outpatient scoping and clinic, then 1 week in house work--per month. I also get 8 weeks off starting and this will go up to 10 when I partner. The money in GI is decent for now as well bu this will not last. Overall my view is that medicine sucks and that I would discourage people from going into to med school. The future of medicine is poor in my opinion.

gida said:

GI private practice life is awesome....

Overall my view is that medicine sucks and that I would discourage people from going into to med school. The future of medicine is poor in my opinion.

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Gida-
Do you mean that lifestyle is awesome or are you happy with your life in private practice (ie, like your job too)? If you hadn't done medicine, what would you be doing?

I am happy with GI as a field because
1) I do not do primary care or admit to myself (hospitalists admit everything)
2) I like procedures
3) The money is decent
4) Call is not too bad...too unstable to scope...stable so they can wait till AM

I don't think a physician is a great career for most because...
1) the best specialties are super competitive to get
2) Student Loans are a joke, and when you go into practice the interest is no longer tax deductible
3) You can't REALLY save for retirement until in your 30's
4) You can't REALLY have a great lifestyle until your 30's (but you need to catch up on you retirement funds too!)
5) You miss out on your 20's

What would I have done....If I put HALF as much effort as I put into getting into med school, residency, and fellowship....I'm sure I'd be VERY successful in the business world, and would have had a lot more fun along the way!
Keep in mind so of what I think is opinion, in fairness.

Gida,

I'll be going into GI eventually. I was just wondering how the finances will change in the next ten years. I'll still be interested in this field as I've ruled out almost everything else . But what about efforts to reduce reimbursements outpatient centers will receive? What about reducing reimbursement for colonoscopies? Do you see this happening? Are GI doctors planning for this? Thanks.

No one can predict the future, per se. But change in everything is inevitable.
GI is in its glory days right now I think, and the glory days will not last long.

Fact, unless congress reverses (which they usually do last minute) reimbursement will be decreased by 10% in 2008 for GI. I suspect congress will reverse this again this month, but always a chance they don't.

Fact, Medicare reimbursment GI procedures in ASC will be decreased to 65% of what they will pay for the same procedure done in a Hospital!!!
This is total BS, but these cuts will come gradually from 2008-2012. Because ASC are more efficient, patients like them, and are already cheaper for a patient...now they will be financially punished!!! This a complete joke as hospitals charge much more for a procedure to be done in a hospital already!! Not fair to the GIs or the patients....but hospitals have a HUGH lobby in Congress. GIs should unite and fight back, but the AGA is a candyass organization that doesn't care about private practice docs, even though we are the ones paying for their academic rhetoric.

I"m not sure if GIs are planning for this. Obviously salaries will go down for those with ASCs. Surely ASCs that can't meet the bills will close-- forcing GIs to go back to the inefficient, bullcrap, over political, waste of time, hospital setting.

That being said, its a great field because of the reasons I mentioned before in a previous post. But the ASC glory days will come to end very soon.

there is no happiness that i can pick up on, therefore, i would never do it! to each his own....

miss alessandra..i'm not quite sure if u are a professional or a high school volunteer, so if this is above your head, i'm sorry. but i'm wondering if the private practice GI docs u work with are happy? i like the field and i plan on going to it. but sometimes i worry being in private practice doing screening colonoscopy after screening colonoscopy can get routine. do you notice this? how is the career satisfaction

also anyone know what part time jobs are like for GI docs?

especially if you are a woman and want to have a family...are there many private part time jobs available?

Just wondering, what is the average step 1 score for GI residents? Btw, if someone has to take the step 1 after missing by a point the first time, do you think he/she has a chance at GI? I know it's important also to get into a good IM program first , what can we do to better insure that?

Hi, I am a medical student in my final year, not from the US. I am really torn between what to choose, I can't even make the simple decision of surgical vs non-surgical. I read that a lot of GI are content with being an internist but doing a lot of procedures as well. Is this true ? Do colonoscopies give you the sense of 'I really did something today' ? That is the most important thing for me, I don't want to read EKGs for the rest of my life, I'd just feel useless.

For a long time I thought I wanted to be a surgeon, but I don't want that lifestyle. My colleagues and friends say I am rather a thinker,talker rather than a doer. This is true, I think I was never aggressive enough for surgery.

pdannysan13 said:

Hi, I am a medical student in my final year, not from the US. I am really torn between what to choose, I can't even make the simple decision of surgical vs non-surgical. I read that a lot of GI are content with being an internist but doing a lot of procedures as well. Is this true ? Do colonoscopies give you the sense of 'I really did something today' ? That is the most important thing for me, I don't want to read EKGs for the rest of my life, I'd just feel useless.

For a long time I thought I wanted to be a surgeon, but I don't want that lifestyle. My colleagues and friends say I am rather a thinker,talker rather than a doer. This is true, I think I was never aggressive enough for surgery.

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Well I was talking to a GI resident and he made the decision between surgery and medicine and he chose medicine obviously. He wants to be a therapeutic endoscopist and he loves it. By final year though you should have had some experiences in the OR and scopes and have talked to people about it. I think you are more suited to endoscopy. If you can't stand the lifestyle you really don't want to do surgery.

Hi all,
I have applied for GI fellowship this year. Got 4 IVs and I have a very good chance of matching in my home program (>95%) which is a University affiliated Comm. program, most fellows go for private practice.
However, I have some concerns about pursuing GI fellowship. May be those with more experience can throw some light.
Recently, I spoke to one of GI fellows and he told me that it's difficult to get GI jobs after fellowship because of cost cutting and Obama care. So if anyone is looking to stay in sort after places in CA like LA, San Diego, SF etc then they should reconsider pursuing fellowship as Primary care/hospitalist jobs will be more easily available than GI jobs. Also, 3-4 years from now, things will be tougher as it will be difficult for a private GI doc to sustain himself/herself by private practice alone.
Is that true? Guys, as much as I like GI, I do not want to go out of job after fellowship. This is really confusing. Help!!