Advanced endoscopy fellowship

[colo-no-guard]

I started working for my GI fellowship on day 1 of residency. I just matched into GI and I want to do the same thing for advanced fellowship. As I am an IMG on a visa, I want to be organized in the way I approach this fellowship. Any suggestions on what I should do to maximize my chances of matching in advanced?

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[ShiShiMD]

this topic is a real hot topic right now for many reason. One being matched to a program with advance fellowship and the other being the fellowship training having exposure and hands in clinical experience for the fellow to be competent in advance procedures.

I come from a program with advance fellowship but what I did was that I stayed extra hours and asked politely to first observe in first year and attended hands on program by ASGE. Than second year I got to go to ACG and ASGE advance courses and started staying 4-5 hours extra to get exposure both at the main institution and other sites where the preceptor allowed me to perform various advance procedures.
In advance month rotations I went in at 6 am came home at 9-10 pm and by end of second year had the numbers for all procedures. In fact by end of two years I had double of numbers of what ASGE explains as competency.
I also did one month IBD and one month motility fellowship in my elective months and for my Hep rotations did them all in transplant trying to graduate As pilot.

so will I spend extra year doing advance I don’t think so. But if I didn’t do all this the first two years by third year I would have a lot of trouble even navigating.

you need to buy the books. Look at the videos. First year purely just volunteer to view all advance cases as possible. Read and imagine the pancrease

I will for sure do all the Star programs from ASGE and again attend the hands on courses as possible to be in fine tune.

but if you want to do advance in order to be able to perform some non-invasive bariatric surgical procedure, pancreatic cyst drainage or even axios you have to do advance year. It doesn’t matter who you are or how many ercp or eus or rFA or even awards and EMR procedures you have done.

if you do not get the numbers by end of second year or even muddle of third you have to do advance.

Ways to match to advance:

publish and research about pancreas and biliary diseases.
- make connections with interventional gastroenterologist at home and other programs.
- publish , publish and publish
- let the PD know you want advance from day one and get a mentor who helps you make the connections and get you in.

I don’t know anyone who wanted advance and didn’t get it.

 

[ShiShiMD]

Sorry for the spelling and grammar

 

[ShiShiMD]

IMG on a visa - really depends on what visa you are on. H1 is still quite possible. J1 is a tough deal. The reason being, many places that offer advanced fellowships(all are non ACGME accredited), the salary for the advanced fellow comes from doing screening colonoscopy usually half day every week. On a J1, one cant do independent screening colonoscopies whereas folks on H1 can do. For that reason, on J1, one is restricted to big name programs that have enough funds to sponsor the advanced endoscopy spot.

You may be able to get numbers as above by Shishi and probably do ERCP by end of three years if you get the numbers. It really depends on the institution that you train and volume. But 4th year advanced on J1 is extremely hard due to funding issue and your best bet is high level connections early on, in advanced field and doing some big panc/bili/bariatric projects

oh yeah very true, it all depends on the program. I believe there is only 6 programs that sponsor J1 or allow for J1 sponsorship.

I think the best route for IM to GI is H1B or US IMG (GC or Citizen).

look I am not bashing on IMGs. There are IMGs doing advance right now at Harvard. In fact all 3 of them are IMG 2 from Canada one from Pakistan if I am not mistaken but I think they all on H1B or got that National interest waiver EB1 and have a GC. The Canadians I know are either in O1 or J1 paid by Canadian government so they have to go back to Canada to practice.

again I hate to be the messenger of bad news but in reality if your program doesn’t have Like all faculty doing some sort of interventional procedure and you in a J1 your chances are very slim to land a 4th year or even get the numbers.

But you can always do EUS or ERCP on your own time by paying for courses and having a preceptor when you start working. It may take another 3 years and is all about the hospital and how they will credential you and give you privileges of what procedures can be performed by you versus some one else who is more competent.

but I see a big change coming right now you can do the EUS course 6 weeks online than 6 weeks hands on to get the numbers.

soon the ERCP will come out and slowly the 4th year will be purely doing procedures that actually needs that 1 year advance work.

But everything regarding 4th year at almost 90-95% of places being a non visa sponsorship type of work is true (generating wRVU to pay for your training is true and a huge value point which will never change)

 

[colo-no-guard]

Thanks @ShiShiMD and @Suprep. I am going to a mid-tier University fellowship which has advanced procedures. I am on a J-1 visa. It sounds like that I have very low chances of matching into advanced unless I pull off a miracle. Your advice has been helpful and kind of puts things into perspective.

 

[hemosuccus]

oh yeah very true, it all depends on the program. I believe there is only 6 programs that sponsor J1 or allow for J1 sponsorship.

I think the best route for IM to GI is H1B or US IMG (GC or Citizen).

look I am not bashing on IMGs. There are IMGs doing advance right now at Harvard. In fact all 3 of them are IMG 2 from Canada one from Pakistan if I am not mistaken but I think they all on H1B or got that National interest waiver EB1 and have a GC. The Canadians I know are either in O1 or J1 paid by Canadian government so they have to go back to Canada to practice.

again I hate to be the messenger of bad news but in reality if your program doesn’t have Like all faculty doing some sort of interventional procedure and you in a J1 your chances are very slim to land a 4th year or even get the numbers.

But you can always do EUS or ERCP on your own time by paying for courses and having a preceptor when you start working. It may take another 3 years and is all about the hospital and how they will credential you and give you privileges of what procedures can be performed by you versus some one else who is more competent.

but I see a big change coming right now you can do the EUS course 6 weeks online than 6 weeks hands on to get the numbers.

soon the ERCP will come out and slowly the 4th year will be purely doing procedures that actually needs that 1 year advance work.

But everything regarding 4th year at almost 90-95% of places being a non visa sponsorship type of work is true (generating wRVU to pay for your training is true and a huge value point which will never change)

Thanks @ShiShiMD and @Suprep. I am going to a mid-tier University fellowship which has advanced procedures. I am on a J-1 visa. It sounds like that I have very low chances of matching into advanced unless I pull off a miracle. Your advice has been helpful and kind of puts things into perspective.

Shishi is spot on, but realistically, the path to getting enough procedures during fellowship is gone, limited to maybe 2-3 fellowships now. Its a not a question of hard work, this is intentional on the part of the ASGE and places with advanced fellowships to limit this ability. It is paradoxically worst at the best centers. ERCP/ EUS are not considered simply transferable and too complex to just let people get 50 and go. If you really enjoy advanced endoscopy, like ShiShi said, there are routes like the courses in the US and Canada, mentorship on the job, and newer offerings (ASGE just started another program for practicing clinicians for supervised training). Obviously if you have time, your applicant pool is much smaller for advanced fellowship, don't rule it out. I feel like I had seen a document from the ASGE about match statistics, don't know if thats still out there but may be able to put hard numbers to this.

 

[GastriqueGraffin]

I started working for my GI fellowship on day 1 of residency. I just matched into GI and I want to do the same thing for advanced fellowship. As I am an IMG on a visa, I want to be organized in the way I approach this fellowship. Any suggestions on what I should do to maximize my chances of matching in advanced?

Congrats, the hardest part is over. Any type of 4th year fellowship in GI is not too hard to obtain because you are sacrificing a big chunk of money (at least $250k) and time for it. That’s not to say every program is easy to get, just that every fellowship including advanced is relatively easy to match so take a deep breath in and relax.

 

[IM2GI]

Congrats, the hardest part is over. Any type of 4th year fellowship in GI is not too hard to obtain because you are sacrificing a big chunk of money (at least $250k) and time for it. That’s not to say every program is easy to get, just that every fellowship including advanced is relatively easy to match so take a deep breath in and relax.

Unless things have changed drastically recently, getting an advanced Endo 4th year is still somewhat difficult. If you want to do liver/nutrition/motility/esophagus/IBD yes anyone can do it.

 

[GastriqueGraffin]

Unless things have changed drastically recently, getting an advanced Endo 4th year is still somewhat difficult. If you want to do liver/nutrition/motility/esophagus/IBD yes anyone can do it.

I have never heard of anyone who applies broadly not getting it

 

[Suprep]

I have never heard of anyone who applies broadly not getting it

i have few examples of visa and non-visa requiring GI fellows not matching in advanced.

 

[GastriqueGraffin]

i have few examples of visa and non-visa requiring GI fellows not matching in advanced.

For the non-visa people, were they limited in program/location? I actually do know 1 person who basically limited to 5 programs, a couple of which took only from in-house.

 

[Suprep]

For the non-visa people, were they limited in program/location? I actually do know 1 person who basically limited to 5 programs, a couple of which took only from in-house.

not everyone of them. some applied in a specific radius. other ived in 10 plus programs still didnt match

 

[cabergoline2]

not everyone of them. some applied in a specific radius. other ived in 10 plus programs still didnt match

From what I understand getting x GI >>>> Advanced endo...You've made it my friend..relax...