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Thank you for your response.
These all require fluoroscopy and superfellowships in IC or EP right? How do you feel about studies showing increased rates of cancer in IC? And what would you choose if you could only do Gen cards
Regarding your last sentence, I can definitely see how Cards has more exciting and more rapid advances in innovation and research but kinda curious how cards has more diverse pathology when you're dealing with so many different organs in GI, at least in Advanced Endoscopy, no?
EBUS, chest tubes, POCUS, ECMO, intubationTon of cards bias on here. They are assuming the diversity when it comes to the Subspecialties of cardiology and not just general cards. General Cardiology has little diversity with procedures (at least in big coastal cities with higher saturation).
If we are going by subspecializations of these medical specialties I’d argue advanced endoscopy from GI. However if I were to compare General GI to General Cardiology, id have to say General GI takes the cake on diversity of procedures since a lot of gen GI docs perform a lot of the unique procedures that technically fall under advanced.
Pulm/CC not even close to the above ones. Mostly central lines/A-lines inpatient and a rare bronchoscopy that lasts minutes.
Depends on the institution. At least at my uni hospital, chest tubes done by surgery, pocus by a tech or by anyone with a YouTube video, ecmo by the vascular surgeons, and intubation by anesthesia.EBUS, chest tubes, POCUS, ECMO, intubation
with IP year rigid bronch, pleuroscopy, cryo/laser stuff, trachs, PEG tubes etc.
And the bolded is basically the answer to the OP.Depends on the institution. At least at my uni hospital, chest tubes done by surgery, pocus by a tech or by anyone with a YouTube video, ecmo by the vascular surgeons, and intubation by anesthesia.
Ton of cards bias on here. They are assuming the diversity when it comes to the Subspecialties of cardiology and not just general cards. General Cardiology has little diversity with procedures (at least in big coastal cities with higher saturation).
If we are going by subspecializations of these medical specialties I’d argue advanced endoscopy from GI. However if I were to compare General GI to General Cardiology, id have to say General GI takes the cake on diversity of procedures since a lot of gen GI docs perform a lot of the unique procedures that technically fall under advanced.
Pulm/CC not even close to the above ones. Mostly central lines/A-lines inpatient and a rare bronchoscopy that lasts minutes.
Agreed with lots of card bias here. We all have within us that excites us to do the job we choose. At least for me, as a fellow who’s still training, I feel excited scrubbing into an ICD placement or a PCI. I’m sure someone here feel something similar when going into a colonoscopy. OP just have to find that for her/himself and go for it. There’s no right answer or a right way to gauge it.
I honestly get excited and look forward to my day in cardiology fellowship. Will I feel the same when I’m 57 and with a BMI of 38? Prob not. But that’s not the point. There’s no guarantee that I’ll ever make it to 57 so you just got do what you ❤️ in the moment, whether that’s to stent or scope. My 2 cents.I bet there are lots of guys super excited to shover a large scope in the back end. Like it gets them up in the morning excited with a half-boner excited.
Actually . . . no. I don't bet that. Not for a moment. I think it's that future GI monies getting folks out of bed in the morning to show scopes in butts as fellows and its the same thing that keeps them shoving scopes in butts when done.
I honestly get excited and look forward to my day in cardiology fellowship. Will I feel the same when I’m 57 and with a BMI of 38? Prob not. But that’s not the point. There’s no guarantee that I’ll ever make it to 57 so you just got do what you ❤️ in the moment, whether that’s to stent or scope. My 2 cents.
And at my institution finding a GI to do anything besides a scope is impossible. If IR could do endoscopy they would be equally as useful at managing GI/hepatology problems.Depends on the institution. At least at my uni hospital, chest tubes done by surgery, pocus by a tech or by anyone with a YouTube video, ecmo by the vascular surgeons, and intubation by anesthesia.
You are doing cardiology wrong if you still have to work by the time you get arthritis.I may be wrong, but my perception is that it's easier to get stuff done in the tube that is the gut (more forgiving, easier to maneuver) than the arteries. No idea how pulm stacks in that.
Dentists work in a small space and can tell you, among other specialist docs, that working 20-40 yrs in certain enclosed spaces of the human body is more or less wrecking on you.
So I consider ease of working in the space. I consider diversity more to consider risk of repetitive strain injury vs how adept and "easy" a procedure could come to feel. There's a sweet spot I feel.
Consider ergonomics and how your body'll hold up when you start getting arthritis.
Procedures in PulmCC seem pretty diverse. Just saw a blood clot suctioned out of a lung. It was cool until it came out and then I saw how small it was and was disappointed.
Depends where you are, academics will subsidize your niche of choosing, I have colleagues who perform endoscopic myotomy, submucosal dissection for esophageal/colorectal T1b CA, large small bowel/gastric NETs, endoscopic gastrojejunostomy for malignant outlet obstruction with lumen opposing stents, endoscopic pancreatic debridement/necrosectomy, endocut/endostitch, endoscopic choledocoduodenostomy for biliary drainage, others in academics do endoscopic fundoplication and endoscopic sleeve gastrectomy, this is barely scratching the surface and every single one of these procedures is a surgical sparing endoscopic procedure for a previously given surgical intervention and in many non referral centers, still is treated with surgery only. The CT/pancreaticobiliary/CRS have multidisciplinary boards with interventional GI to determine who goes to minimally invasive third space endoscopy. This is academic centers, but alot of them. Can argue GI has the greatest diversity of procedures that is still rapidly growing if that is what you want, and if you want to live in the community endo lab doing the same general luminal cases over and over while the NP is seeing consults and refer out anything you don't want to do or deal with, can do that too. TL;DR you can make of it what you choose, like any specialty, spend time around it and find out for yourself, good luckIs this a futile question considering probably nobody is double boarded in these specialties? What about IM docs who practiced in the 80s or earlier?
I always see people talking about how enjoyable it is to scope as a gastroenterologist and you can see / fix a variety of pathologies. Could you make the same career out of doing that in Pulm? I've heard the volume is too low to do an Interventional Pulm practice but I'm sure someone's gonna be out there doing it. Are they having as much fun as someone doing GI scopes all day? Are they seeing/taking care of as diverse of an array of pathologies / screenings?
And how do Cards procedures compare
When you have fathered five children through four separate ex wives though.You are doing cardiology wrong if you still have to work by the time you get arthritis.
My god the smell...the constant stank of poo during c scope, the incessant flatus in the room and endless rectal exams on every patient.I bet there are lots of guys super excited to shove a large scope in the back end. Like it gets them up in the morning excited with a half-boner excited.
Actually . . . no. I don't bet that. Not for a moment. I think it's that future GI monies getting folks out of bed in the morning to shove scopes in butts as fellows and its the same thing that keeps them shoving scopes in butts when done.
Even without money in the picture, GI is a literal escape from the vey things most people hate about general IM. You don’t have to sit and pontificate over a sodium level, you don’t have to deal with social work placement and you don’t get figuratively dumped on (see what I did there?) in the inpatient or outpatient setting. I still believe it then comes down to what you hate least. If I had to admit one more heart failure patient who forgot to take their lasix, or deal with the guy who had CABG, high risk PCI and is now calling for chest pain for the nth time, I’d change careers. If I had to convince another family at 9PM that their loved one in the icu is brain dead, I’d change careers. And for the rest of the IM specialties, sitting and looking at numbers on a screen makes me question my life choices. The downsides to GI, however don’t seem nearly as bad to me personally because I avoid more bad things about medicine in this sub specialty that I previously could not STAND in IM. I would also rather view 30 colons from the inside than 30 sets of lab values, but that may be just me.My god the smell...the constant stank of poo during c scope, the incessant flatus in the room and endless rectal exams on every patient.
The ONLY reason most anyone is excited to do GI is $$$
This is really sad to read. I remember getting so many OSH transfers as resident because the local GIs just basically didn't want to or didn't know how to deal with hepatology or IBD patients, yet these same people had no qualms about doing four colonoscopies within a year on a patient for what is clearly hemorrhoidal bleeding.Even without money in the picture, GI is a literal escape from the vey things most people hate about general IM. You don’t have to sit and pontificate over a sodium level, you don’t have to deal with social work placement and you don’t get figuratively dumped on (see what I did there?) in the inpatient or outpatient setting. I still believe it then comes down to what you hate least. If I had to admit one more heart failure patient who forgot to take their lasix, or deal with the guy who had CABG, high risk PCI and is now calling for chest pain for the nth time, I’d change careers. If I had to convince another family at 9PM that their loved one in the icu is brain dead, I’d change careers. And for the rest of the IM specialties, sitting and looking at numbers on a screen makes me question my life choices. The downsides to GI, however don’t seem nearly as bad to me personally because I avoid more bad things about medicine in this sub specialty that I previously could not STAND in IM. I would also rather view 30 colons from the inside than 30 sets of lab values, but that may be just me.
Love of poop obviously.This is really sad to read. I remember getting so many OSH transfers as resident because the local GIs just basically didn't want to or didn't know how to deal with hepatology or IBD patients, yet these same people had no qualms about doing four colonoscopies within a year on a patient for what is clearly hemorrhoidal bleeding.
If you want to escape from medicine/using your brain, why not go into IR or surgery?
In all seriousness, I have still not recovered my sense of smell from covid, Im not sure if to what extent it will if ever, I'd prefer to regain it, and I was already desensitized to the fragrance before......in GI you live out the "apocalypse now" clip/meme....."you smell that son? Melena. Nothing else in the world smells like it. I love the smell of melena in the morning..... smells like......victory"My god the smell...the constant stank of poo during c scope, the incessant flatus in the room and endless rectal exams on every patient.
The ONLY reason most anyone is excited to do GI is $$$
Not all of us had that choice based on the hundreds of reasons during medical school. IR is ultracompetitive with too much radiology. Surgery is also a tough pill to swallow. 5-6 years of general surgery residency, followed by essentially a required fellowship based on location preferences and the demand of the desired city. Some of us go into IM for the sole purpose of doing GI (not that it is the correct mindset) and with no passion for potassium levels and social work.This is really sad to read. I remember getting so many OSH transfers as resident because the local GIs just basically didn't want to or didn't know how to deal with hepatology or IBD patients, yet these same people had no qualms about doing four colonoscopies within a year on a patient for what is clearly hemorrhoidal bleeding.
If you want to escape from medicine/using your brain, why not go into IR or surgery?
Dang bro. Sorry to hear. Sounds like you really chose the wrong specialty. Should have done something besides IM if you could start over. Maybe optho, ent, urology, ortho, anesthesia or rads would be up your alley.Even without money in the picture, GI is a literal escape from the vey things most people hate about general IM. You don’t have to sit and pontificate over a sodium level, you don’t have to deal with social work placement and you don’t get figuratively dumped on (see what I did there?) in the inpatient or outpatient setting. I still believe it then comes down to what you hate least. If I had to admit one more heart failure patient who forgot to take their lasix, or deal with the guy who had CABG, high risk PCI and is now calling for chest pain for the nth time, I’d change careers. If I had to convince another family at 9PM that their loved one in the icu is brain dead, I’d change careers. And for the rest of the IM specialties, sitting and looking at numbers on a screen makes me question my life choices. The downsides to GI, however don’t seem nearly as bad to me personally because I avoid more bad things about medicine in this sub specialty that I previously could not STAND in IM. I would also rather view 30 colons from the inside than 30 sets of lab values, but that may be just me.
Board scores not high enough for most of those. Some of us without good board scores get stuck with what we have and have to make the most of the situation. Of the specialties within FM, IM, peds, psych, etc, GI was clearly the best choice from IM.Dang bro. Sorry to hear. Sounds like you really chose the wrong specialty. Should have done something besides IM if you could start over. Maybe optho, ent, urology, ortho, anesthesia or rads would be up your alley.
I don't think IR is more competitive than GI, at least not in today's age, maybe 10-20 years ago though, unless you were one of those people who bombed med school but then did amazingly well in residency. Also, given that GI is six years (at least), 5 years of gen surg is a steal lol. Not to mention fields like ophtho, urology, etc. that any med student good enough to get into GI eventually can get into (again, assuming you didn't bomb med school and then turn around in residency).Not all of us had that choice based on the hundreds of reasons during medical school. IR is ultracompetitive with too much radiology. Surgery is also a tough pill to swallow. 5-6 years of general surgery residency, followed by essentially a required fellowship based on location preferences and the demand of the desired city. Some of us go into IM for the sole purpose of doing GI (not that it is the correct mindset) and with no passion for potassium levels and social work.
I use to moonlight at a podunk community hospital. There was “GI coverage”. Any consult was all about $$$ scope. No interest in the pt care.This is really sad to read. I remember getting so many OSH transfers as resident because the local GIs just basically didn't want to or didn't know how to deal with hepatology or IBD patients, yet these same people had no qualms about doing four colonoscopies within a year on a patient for what is clearly hemorrhoidal bleeding.
If you want to escape from medicine/using your brain, why not go into IR or surgery?
Anesthesia is only 4 yr long and easy to get into (unless you graduated like two decades ago when it was more competitive).Board scores not high enough for most of those. Some of us without good board scores get stuck with what we have and have to make the most of the situation. Of the specialties within FM, IM, peds, psych, etc, GI was clearly the best choice from IM.
I really want to keep this thread from becoming a retrospective “what are my chances” but a step 1 of 230 isn’t great when going for integrated IR. It’s one of the most competitive specialties now since becoming integrated. Step 1 of 230 is enough to get you into “a” GI fellowship with comeback scores and research in residency. Surgery on the other hand, yes it’s only 5 years of gen surg if you want to be a general surgeon. Anything more than that is going to be much longer. Some of us simply just don’t like the bread and butter of general surgery or (like myself) had a poor surgery rotation in Med school that convincingly swings us away even if we have marginal stats to make it into gen surg. It is a gamble going for IM with the purpose of going for GI (in fact I highly recommend against this heavily) but that’s how life goes sometimes.I don't think IR is more competitive than GI, at least not in today's age, maybe 10-20 years ago though, unless you were one of those people who bombed med school but then did amazingly well in residency. Also, given that GI is six years (at least), 5 years of gen surg is a steal lol. Not to mention fields like ophtho, urology, etc. that any med student good enough to get into GI eventually can get into (again, assuming you didn't bomb med school and then turn around in residency).
Anesthesia is not even close to GI in terms of day to day. Personally hated anesthesia.Anesthesia is only 4 yr long and easy to get into (unless you graduated like two decades ago when it was more competitive).
wRVUs:How much does a colonoscopy actually pays? Is it more than say a PCI or an echocardiogram?
It’s not the payment per colonoscopy necessarily, it’s the ability to do many in an efficient fashion. You could line up the colonoscopies back to back and do tons in a day if you are efficient. In addition, you can do them in office/ambulatory surgery center and get the facility payment in addition to the wRVU. Could employ your own CRNA and make money off the anesthesia services too and also the pathology services in some cases.How much does a colonoscopy actually pays? Is it more than say a PCI or an echocardiogram?
Pulm/CC not even close to the above ones. Mostly central lines/A-lines inpatient and a rare bronchoscopy that lasts minutes.
Let's add a few:wRVUs:
Colonoscopy: 3.56
PCI (single vessel): 10.10
TTE: 1.13
Let's add a few:
Svt ablation 19
Tavr- 25.13 - (do 4-6 per day)
Impella implant 7ish (takes 10 min)
Impella reposition 3.5ish (usually 5 min)
Compare that to 70 minute admission which is 3.5 wrvu and you realize why proceduralists make a lot more money.
Yep since the invention of the RVU 30ish years ago E/M coding has been **** upon. The pandemic leading to hospitals overflowing with patients and somehow losing money despite doing the thing they were originally created to do is a huge problem completely linked to this ****ed up system we live in since they lost the elective stuff and inflated costs in the loss leaders (ICU/medicare patients). I know it wont happen but maybe the powers that be should repeal/replace RVUs while they are overhauling healthcare to make it so hospitals/doctors can actually make money thinking instead of doing.Let's add a few:
Svt ablation 19
Tavr- 25.13 - (do 4-6 per day)
Impella implant 7ish (takes 10 min)
Impella reposition 3.5ish (usually 5 min)
Compare that to 70 minute admission which is 3.5 wrvu and you realize why proceduralists make a lot more money.
Let's add a few:
Svt ablation 19
Tavr- 25.13 - (do 4-6 per day)
Impella implant 7ish (takes 10 min)
Impella reposition 3.5ish (usually 5 min)
Compare that to 70 minute admission which is 3.5 wrvu and you realize why proceduralists make a lot more
Lol can you imagine?Yep since the invention of the RVU 30ish years ago E/M coding has been **** upon. The pandemic leading to hospitals overflowing with patients and somehow losing money despite doing the thing they were originally created to do is a huge problem completely linked to this ****ed up system we live in since they lost the elective stuff and inflated costs in the loss leaders (ICU/medicare patients). I know it wont happen but maybe the powers that be should repeal/replace RVUs while they are overhauling healthcare to make it so hospitals/doctors can actually make money thinking instead of doing.