Endoscopy fellowship after GS

[desimd77]

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I just wanted to ask some of the practicing GS and chief residents out there what they though about the new Endoscopy fellowships for general surgeons. There are quite a few they teach the basic tenants of upper and lower scopes, but they also do ERCPs, ultrasound, stents, and some even teach the new NOTES procedures.

I'm not sure if its a fad or if this is going to be the next wave after MIS surgery. It also sounds appealing b/c of the reimbursement for scopes as a gen surgeon.

I want to do a 1 year fellowship that is something besides just bariatrics or colorectal. The endoscopy thing sounds cool and would afford a good lifestyle and make me stronger candidate when applying for a job.

If anyone has some insight please let me know.

 

[Sleeve]

What? Really? An endoscopy fellowship? Not needed out of residency in my program. I don't do ERCP but everything else I do on a daily basis and pretty well. Our GS and Colorectal attendings taught us hundreds of these and I haven't looked back.

Do not waste a year of your life for endoscopy. I would hope most programs are giving residents enough training.

Ther reimbursement isn't going to make you rich.. Mostly Medicare and its $205 for colonoscopy (that also includes the consult for a screening colonoscopy) and $137 for an EGD. But it isn't hard, I agree.

Advanced Laparoscopy is a good niche for one year fellowships. Breast is another.

Which part of general surgery do you enjoy the most? If its something you feel well trained at during residency do that. You may not need a fellowship although a fellowship will allow you to narrow your focus quicker.

 

[idiot07]

An endoscopy fellowship is useless only if it teaches you something you already know i.e. vanilla c-scope and egd. We have a 1 year fellowship at our program that focuses primarily on ERCP along with some other advanced procedures like enoscopic drainage of a pseudocyst and stenting. The primary attending is also a pancreatic-biliary specialist, and you get a fair bit of exposure to some pretty complicated pathology. It sets you up to be the expert ot all things biliary without having to consult gi.

I also disagree with previous poster. Scopes have made plenty gi docs rich, and many suregons in rural settings derive ~50% of their income from them.

 

[JackADeli]

...The endoscopy thing sounds cool and would afford a good lifestyle and make me stronger candidate when applying for a job...

I am all for folks expanding their horizons. I also agree scopes have made many a rich GI physician.

The issue is going to be what do you want to practice, where do you want to practice and can you recruit a referral base?

You might be able to get to GI faster/easier then 5yrs general surgery followed by a GI/scope fellowship.

If you are the only guy in a community, sure, you can get plenty of scopes. But, you are ultimately a surgeon. Do you want to operate?

Surgeons are very dependent on a referral base. GI is often an important component of that referral base. I have listened to many a GI doc state, "I am not going to refer this gallbladder to Dr x, y, z because he will take their screening scopes and follow-up EGDs". The GI doctors preffered practice is endoscopy. They will do large volumes of upper and lower scopes and EUS, ERCP, etc....

Also, I am not sure most hospitals are looking for fellowship trained scoping surgeons.

Yes, good scope skills can help you in NOTES.

 

[Winged Scapula]

Agree with JAD.

While the extra training won't hurt you (and yes, if you can run several rooms at a time, back to back, you can make more doing scopes than you can in the OR or office for the same amount of time. There are no operative RVUs or E&M codes which pay as much for 15 mins of time that I am aware of), you have to be very aware of the referral patterns.

I have heard much the same as JAD does - GS and Colorectal surgeons get patients from GI docs. You start doing screening scopes or even the diagnostic scopes and guess who won't be getting referrals for surgical patients?

 

[maxheadroom]

I have a friend in a mid-market city (~150,000 people). He's part of a multi-specialty group and he and his partners (general surgeons) had a huge issue with not being able to get GI to do an ERCP in a timely manner (less than 3 days). His group sent him away to do a 6 month endoscopy fellowship with a focus on ERCP and EUS. The GI guys said they were fine with it since he wasn't interested in doing colonoscopy. He came back and is super busy -- GI sends their ERCPs to him, even.

Unusual, but you have to know the local market.

 

[ESU_MD]

It's all about the market. Alot of mid-size places get all territorial over stuff like this and can really make it hard to get GI lab priveledges. yea, I guess you can still technically do them in the OR, but its more painful than an outpt GI lab setup. I know some colon-rectal surgeons who actually bought an outpt facility and set it up for scopes, etc.. very lucrative.

I guess if you trained in EUS as well as ERCP, it may be worth it.