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Gastroenterologist Lifestyle/pay/competion

Discussion in 'Gastroenterology' started by Finn, Oct 28, 2002.

  1. Finn

    Finn Member
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    Does anyone have any information on the subspeciality of GE? It sounds interesting but I don't know much about it. What kind of lifestyles does a GE lead? Is the compensation fair? How competitive are the fellowships?
     
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  3. Jon@COMP

    [email protected] Junior Member
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    GI (correct abbreviation) is a growing field. The lifestyle is what you make it. I spent a month with a GI doc and his lifestyle was terrible. But he did make a lot of money (said he makes 1.8 million a year). I believe it because he was doing about 25 colons/10 EGD/5 ERCP's per week. However, the compensations for the above procedures are dropping.

    As far as the pay, you decide what you want to make. You can be the aggressive doc that I just mentioned or you can be laid back. The average salary for GI docs is around 200G.

    GI fellowships are competitive. You must first obtain an IM residency before the fellowship. I would recommend in going to a program with fellowships. You have a better chance of getting the GI fellowship at a place where you did your IM residency. Hope this helps.
     
  4. slluurrrrpppp

    slluurrrrpppp Junior Member
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    i am a really naive undergraduate from india , please answer this if you have any information :

    how do i decide on what residency ( what speciality , what university ) to take if i have a fellowship already in mind to follow up ?

    what i mean is that i know that i want to do interventional cardiology/pulmonary medicine after my internal medicine residency , so what credentials should i look for in my im residency program that will help me later ?

    :confused:
     
  5. task

    task Senior Member
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    Pulmonary/CC is not a very competitive field to get except at top programs like Denver, Univ. of Washington, Penn. To that extent, going to a decent IM program with good exposure to Pulmonary attendings is key in order to get letters. The big lure of Pulmonary right now is the fact that in the "real world" any patient put on a ventilator gets a pulmonary consult. Critical Care keeps you up at night -- something to think about as well.

    The most competitive fields to get into out of IM are GI and Cards. I would argue that GI has become the most competitive field to get into out of IM, followed closely by Cards and Allergy. Why? There are only 200-250 GI spots nationwide, compared with 750-800 in Cards. This year, we had 10 people applying for GI spots nationwide, and 12 applying to Cards. So do the math across the country. Many people who thought they were doing Cards have switched to GI. GI procedures still pay pretty well, can be done in more volume since they're not sterile (except for complicated EUS/ERCP cases which are obviously not sterile but are time consuming), and GI affords a much better lifestyle than Cards (yes you get called in at night for bleeders sometimes or stones, but you don't maintain a large inpatient service, which as we all know is extremely time consuming and resource sapping).

    With these competitive fields, getting into as strong as an IM program as you can get into is key. PDs and faculty know each other and talk to each other, so going somewhere you can get to know faculty and maybe do some research to get good letters is pretty key. In addition, your best chance of matching in fellowship is where you are in residency (or your own med school, but as you're from India, that's not an issue). So a balance between all these factors is optimal.

    If you want to do interventional Cards, there are some things to think about. General Cards fellowships are 3-4 years after IM. Most programs allow those interested in EP to fold in their first year of EP into their last year of general Cards fellowship. None I've heard of allow anyone doing Intervention to do that. Also, many Interventional fellowships are now 2 years rather than 1 (after general Cards) because many fellowships are teaching peripheral vascular techniques as well. Basically, it's a way for programs to get another year out of you. You might say "screw peripheral intervention, I only want to do coronaries" but if you go into private practice, you won't be very marketable unless you know those peripheral skills. Remember that as an interventional Cardiologist you will be on call pretty frequently depending on the group you join, and most average size groups only have 2 or 3 interventionalists in their group -- so you do the math. Also, reimbursement for interventional procedures, like PTCA, have plummeted. One Cardiologist I spoke with said that 2-3 yrs ago he could bill $2-3000 for a 2v PTCA c stenting. In 2002, he said it's now $700-800. All your other costs of practice have stayed the same or gone up, but what you're getting paid has dropped pretty substantially. Bottom line, Interventional Cards (can be as long as 9 years in the worst case scenario, best case 7-8 years) is a pretty substantial time committment, so be prepared for this.

    But do what you like first -- whether its scoping or putting a wire in the bile duct, putting a wire down a coronary, or bronching someone.
     
  6. slluurrrrpppp

    slluurrrrpppp Junior Member
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    thanks task :clap:
    that was just the kind of thing i was looking for . i really did understand a lot friom what you wrote , but forgive my uneducation , what is EP .( i havn't come across that term :confused:
    just one more thing , does intervention cardiology always FOLLOW gen card ? is there no way to get into interventon directly ? what about invasive card ?

    thanks a lot :)
    - gurdesh .
     
  7. task

    task Senior Member
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    EP is short for Electrophysiology. This is a subspecialty of Cardiology that deals with the "electrical" system of the heart, so to speak. They do mapping, ablations, and implantations of AICDs/pacemakers. A very cool field, but very esoteric as it deals with the finer nuances of the conducting system of the heart. EP is 2 years of additional training after Cardiology, or many programs allow fellows who know they want to do EP to do their first year of EP as their final year of general Cards fellowship.

    Furthermore, interventional Cards ALWAYS follows general Cards -- there is NO way to get into intervention directly. INVASIVE Cardiology refers to a Cardiologist who does ONLY DIAGNOSTIC catheterization, not THERAPEUTIC. In other words, if you did a general Cards fellowship (which teaches you to be proficient in diagnostic Cath) and go into practice doing only diagnostic cath, then you are called an Invasive Cardiologist. An Interventional Cardiologist is one who has done additional training to do intervention -- PTCA/stents/rotablators/PMR, and other catheter based therapeutic techniques.
     
  8. slluurrrrpppp

    slluurrrrpppp Junior Member
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    thanks so much task .:) .
     
  9. souljah1

    souljah1 Attending
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    Task,

    Thanks for distinguishing invasive cardiology and interventional cardiology. What about non-invasive cardiology? Is the lifestyle less demanding? Are most in private practice? What are the major treatments and procedures that noninvasive cardiologists deal with? Is it mainly cardiology that deals with diagnosing and managing cardiovascular disease along with drug regimens and lifestyle? Any clarification would be greatly appreciated. And if you know the general disparity in salary between invasive and non-invasive..that would be interesting to see as well.

    Thanks.

    Souljah
     

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