Contradictory....

[XxdtxX]

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How come in Iserson's book, he states that Cardio, GI, and Allergy/Imm. are all very easy to get into???? Seems to go against what I have read on this board.

 

[ckplay]

Iserson was smoking @#$%.

 

[neo]

or his info is outdated

maybe it was true when he wrote it but its definitely not true now.

 

[prominence]

how old is his book? i was thinking of getting it, but if its outdated...

 

[vitaminj]

There is a new Iserson that just came out...it has a red cover. The one you are talking about is about 3 years old and has a blue cover. The new one just came out within the last month...haven't seen it but I assume it will be more, "up to date".

Cheers

 

[XxdtxX]

-It was for either 2001 or 2002.....I believe it was the 2002 edition but re-published in 2001

-Despite the year written, when have you ever seen someone say either Cardio or GI was easy to get into....Isn't this Iserson guy supposed to be the authority on this subject

-I'm not trying to start anything here nor am I interested in IM subspec....But I want to know if I should buy this guy's book and take his advice.


.....thanks for the replys guys

 

[Celiac Plexus]

Originally posted by XxdtxX
-It was for either 2001 or 2002.....I believe it was the 2002 edition but re-published in 2001

-Despite the year written, when have you ever seen someone say either Cardio or GI was easy to get into....Isn't this Iserson guy supposed to be the authority on this subject

-I'm not trying to start anything here nor am I interested in IM subspec....But I want to know if I should buy this guy's book and take his advice.


.....thanks for the replys guys

GI got pretty competitive in the last 3-4 years due to an increase in demand driven in no small part by medicare covering colonoscopies, and a tightened supply of GI fellows due in no small part to the gross miscalculation of the need for GI types by the specialty leaders. Starting aroun 1999 the forces clashed and viola, a competitive field emerges. However many programs are adding spots now, and reimbursement for colonoscopy is falling. These forces may make GI a less compettive field once again.... who knows? Iserson rated GI as "one star" for competitiveness but that was probably due to the fact that he based his rating on old data (I have the 5th edition).

Cardiology also received a "one star" from Iserson probably because he did not take into account the relatively recent developments of cathing/stenting being done increasingly by cards types.

Interestingly, Iserson rated ER medicine as "5 stars" for the MOST competitve field along with dermatology, and neurosurgery received only "4 stars". This might have something to do with the fact that Iserson is a former ER program director. I think everyone would agree that ER is defintely not the most competitve field, and certainly way less competitve than neurosurgery or derm. Either way, don't use the 5th edition (the blue book)... it's outdated. Also, don't treat his assessments as gospel.

 

[task]

I talked to some GI faculty here a few weeks ago, and they said there are no plans to increase the # of GI spots nationally in the next few (5-7 years), mainly because of funding issues and politics within the field (there are Gastroenterologists and Hepatologists who have different, sometimes competing agendas). Also, I don't think they want to get into the position they were in in the 90s with creating a perception that there are too many GIs out there. Better to be like GU or ENT, where the #s trained have remained low and there is always good demand as a result. And while reimbursement for colons has gone down, you can always do more of them in a day (or make your day longer) to keep up the cash flow.

PCI (percutaneous intervention) has been done for 20+ years, and diagnostic cath for longer than that. Iserson was/is on crack, in that Cards has always been competitive to get into because of good reimbursement for procedures.

 

[Celiac Plexus]

Originally posted by task
I talked to some GI faculty here a few weeks ago, and they said there are no plans to increase the # of GI spots nationally in the next few (5-7 years), mainly because of funding issues and politics within the field (there are Gastroenterologists and Hepatologists who have different, sometimes competing agendas). Also, I don't think they want to get into the position they were in in the 90s with creating a perception that there are too many GIs out there. Better to be like GU or ENT, where the #s trained have remained low and there is always good demand as a result. And while reimbursement for colons has gone down, you can always do more of them in a day (or make your day longer) to keep up the cash flow.

PCI (percutaneous intervention) has been done for 20+ years, and diagnostic cath for longer than that. Iserson was/is on crack, in that Cards has always been competitive to get into because of good reimbursement for procedures.

Interesting. The GI attendings I spoke with claim that there is a trend underway to add GI fellowship spots. In fact at my univ, and the 2 others nearby, there will be a total of 6 more GI spots next year.

As for cathing and cards... Cards types are cathing a lot more now than they did 20 years ago. Just one example is how angio has encroached on CABG so much in the last 5-7 years. And with new stenting technology, cards can look forward to continuing this trend of increasing the number/type of cathing.

 

[task]

I know the Cardiology fellowship program at Parkland added a spot for the incoming class this July due to RRC regulations. Perhaps the GI programs you are referring to have the same stipulations? The GI program director here told me that he knew of no plans to substantially increase #s of trainees, but maybe there is program to program variability, or funding for these spots was found a few years ago?

One has to distinguish between diagnostic and therapeutic cath. There have always been tons of diagnostic caths done. The # to pay attention to is the # of PCI (interventions) or therapeutic procedures, which is now at a million per year in the US. Specifically, it is advancement in coronary stenting that has allowed interventional Cardiologists to increasingly manage patients by PCI that were previously referred for CABG. Tortuous lesions or significant stenoses more prone to reoccuding after balloon can now be held open by stent(s) of varying caliber. With the advent of "drug-eluting" stents, the phenomena of in-stent stenosis has been reduced from 22% to 7% over 1 year of f/u.

There will always be patients with surgical coronary artery disease, just not as many as before.

My only point was/is that diagnostic cath has been around forever, and has always been fairly lucrative, so the competition for Cardiology fellowship has always been brisk.

Interestingly, as the reimbursement for intervention has diminshed (coupled with a hectic lifestyle at a minimum), competition for interventional spots is not what it used to be.