Gastroenterology

[Stillwell]

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I was looking at some tables on physician compensation, and you see the usual Derm, Ortho, ENT, Radiology, Cardiology, etc. as the highest paying fields. These fields are also associated with higher USMLE scores by students applying to these fields.

GI was up there in salary, too, but I never hear about it being very competetive or needing high board scores to get into it. My question is whether this is true or am I assuming this?? I guess it's more important to do well on IM boards than USMLE since it's an IM subspec., but basically I am just wondering how competetive GI is since it pays a good amount?

 

[ckent]

GI and Cardio fellowships are very competetive to get. They actually cut the total number of GI fellowships by half or so a few years ago when a surplus of specialists and a shortage of PC providers was predicted (which never materialized). Now, there is actually a severe shortage of GI specialists with the new recommendations of screening colonoscopies for the elderly and such. A GI fellow told me that in order to get into a GI fellowship, research experience was important, your letters of recommendation are important, and if you can become chief resident, that helps too (I don't know how though, seeing as how you become chief resident after you have already applied, maybe someone could explain that to me).

 

[task]

GI has become THE most competitive IM subspecialty -- relatively decent lifestyle for a procedural field (compared to Cards), HIGH reimbursement, and something like 250-300 spots nationally have been key factors. As stated before, everybody freaked out a few years ago fearing an oversupply of GIs. The reasons are unclear, but apparently some big-wig GI guy published an article in the Red Journal (AGA journal) that there were too many GIs and there would be no jobs for all of them. So no one out of IM applied, and the field was filled by many IMGs up until 2 years ago. Then, the recs regarding screening c-scopes combined with the ever-widening applications of diagnostic and therapeutic endoscopy made the field hugely lucrative. And applications followed. This time the fellowship accred. body got smart and kept the number of spots small, keeping demand really really high.

Many people defer applying to fellowship for a year, applying during their third year of residency. Where I train, chiefs are selected around October/Nov from the 2nd year class. If you're in the middle of applying and interviewing, more than likely you'd defer for a year or reapply during your 3rd year of residency so you could then start fellowship after your chief year. For some reason, it's not been a problem where I train -- in recent years, most people selected for chief for one reason or another were waiting to apply for fellowship till 3rd year anyway.