Curious about the thinking out there. It would seem that the lucrative nature of GI Endoscopy would make it a point of contention between Gen. Surgeons and GI docs -- who does it better, who should mostly be doing it, etc. But this probably varies from school to school and city to city. Where I went to med school, the surgery program was stronger in terms of faculty and residents than the medicine program (though that is probably changing now with the downswing in apps to GS programs). But as a result, GS tended to be very dominant in doing endoscopy. The surgeons even have their own ERCP fellowship. As a result, something like 50% of GI endoscopy in the town where I went to school is done by surgeons. However, where I am in training for Medicine is a top 5 program in IM and is much stronger than surgery, so GI endoscopy is pretty much under the auspices of GI -- not that the surgeons don't do their own in their Units and for colorectal cases, but the vast majority is done by GI. As with any procedural field, numbers help build proficiency and would seem to make complications less likely. GI docs could argue that procedurally speaking, because they train in all facets of endoscopy, and only endoscopy, they should be the one's doing most of it on a daily basis. Theoretically, they should be better at passing the pylorus with greater speed and proficiency, or have a quicker time to cecum on c-scopes, as some examples. Surgeons might argue that "I can open the abdomen, so why shouldn't I be just as good as putting a tube into the GI tract and moving it around, plus if there is a perforation, I can fix that too". However, what is the rate of perforations for a given endoscopic procedure (including ERCP) that might require operative intervention? From what I've read, the % are pretty small. Most of it is waiting and abx. It would seem that in private practice, many sugeons steer away from endoscopy not because they don't feel proficient at it, but because it would be biting the hand that feeds them (GI doc referrals). I would also think it would take away from OR time. But maybe there is a proficiency issue. But many of my GI colleagues argue that operating on someone and using an endoscope involve a different set of skill sets, and that being good at one may not make you automatically good at the other. Wonder what the surgeons out there think of that?