GI Fellow AMA

[jhamaican]

will answer anything

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[LebronManning]

Why GI over other lucrative IM subs like Cards or Onc?

 

[Lebowski9]

will answer anything

Hi. Tried PMing you but wouldn’t let me. Thanks.

 

[Zifish]

will answer anything

Do you think GI is a good option for older applicants?

 

[Psai]

Why is it that you can scope with minimal sedation in the suite but when you call an anesthesiologist you expect the patient to be under "mac" but also to not move at all in response to any stimulus

 

[afib123]

What are the things you had to do during IM to be competitive for a GI fellowship. Is the name of your institution the most important thing in getting a fellowship

 

[Frogger27]

Can you talk about what type of practice you envision yourself working in (private vs academic) and why?

Also talk about the day/lifestyle of a GI in either PP or academics

 

[PatchAdams25]

Assuming one can match into a decent university program, would it be unwise to go IM with the sole intention of going GI?

 

[Zifish]

Do you think it’s easier to match GI directly out of IM residency, or do you have a better chance matching if you work a year or two as a hospitalist?

 

[jhamaican]

Why GI over other lucrative IM subs like Cards or Onc?

Cards is too specialized. Less variety. Only one organ. Personality issues. More stress, almost the same money. Perhaps most importantly there is more free reign in GI. Less evidence = more freedom to practice as you wish. Too many studies in cardiology: good for the patient, less so for the practitioner. I can literally say we are doing XYZ because I am the GI doctor and no one can questions it.

Onc: have to study a great deal, only going to get worse as more immunotherapy comes on line. Hematology is amazing but the compensation is in oncology. Super sick patients and you become their eventual PCP for everything no thanks.

 

[jhamaican]

Do you think GI is a good option for older applicants?

honestly no, and for the following reasons

1. out in practice GI is chill. Fellowship is pretty rough. You WILL get called in the middle of the night and have to go in. Variceal bleeders, food impactions. Rough for a young person, even worse of an old person

2. Colonoscopies are more physically taxing than I had originally believed. My arm was sore for 1-2 weeks when starting. Most GI doctors have physical issues related to endoscopy at some point. Will be even worse if you are older.

people vastly underestimate how physically taxing it is to scope all day.

Just trying to be honest...

 

[jhamaican]

Hi. Tried PMing you but wouldn’t let me. Thanks.

?? no idea. You can post anything here though in this thread.

 

[jhamaican]

Why is it that you can scope with minimal sedation in the suite but when you call an anesthesiologist you expect the patient to be under "mac" but also to not move at all in response to any stimulus

we only call anesthesia when the patient is not a candidate for conscious sedation.

We titrate the conscious sedation such that the patient is not moving.

This post has passive-aggressive overtones of more a jab than a question.

How about anesthesia just does their job: it is your singular job to facilitate the work of other doctors such as surgeons and GI docs.

How can we be expected to scope when the patient is thrashing his head around?

 

[jhamaican]

What are the things you had to do during IM to be competitive for a GI fellowship. Is the name of your institution the most important thing in getting a fellowship

question 1: Lots of research and a good letter from your program director

question 2: yes. I 100% believe if you are a scrub at harvard IM you will still match GI easily.

 

[jhamaican]

Can you talk about what type of practice you envision yourself working in (private vs academic) and why?

Also talk about the day/lifestyle of a GI in either PP or academics

Not sure where I see myself.

Lifestyle is much better for academics. Money is much more for private practice, but no fellows to ease the burden.

Trade offs for everything.

Some of the private attendings I know start scoping early 6-7am and grind until 7-8pm. More procedures more money.

Academics has a much better lifestyle and is more rewarding overall other than the money aspect.

Then again, I am just a fellow, what do i Know.

 

[jhamaican]

Assuming one can match into a decent university program, would it be unwise to go IM with the sole intention of going GI?

No. It would not be unwise.

Go for what you want in life and don't let anyone tell you otherwise.

If you are a US graduate at a decent university program you will match GI if you put in the work.

I cannot speak for or know much about IMG, but a harder path for them I believe based on what I have seen. (then again they didn't have to take the MCAT and pay out the a$$ for college/med school)

 

[jhamaican]

Do you think it’s easier to match GI directly out of IM residency, or do you have a better chance matching if you work a year or two as a hospitalist?

Depends on what you do with the hospitalist year.

If you stay academic and crank out research, then yes you will be ahead with a hospitalist year I believe. But you had better be productive and developing positive relationships with the GI department there. (but this is only if you didn't work hard enough as a resident to publish enough).

 

[Frogger27]

Thanks for your responses. What is your call schedule like as a fellow and what about the academic attending physicians?

Do the private guys take call or do they just scope 12 hours a day?

 

[Dwight Snoot]

How significant is the difference in pay between private practice and academics?
What is the thing that most attendings dislike the most about GI/ complain about the most?
How is the patient population in GI compared to other specialties?

Thank you so much

 

[LebronManning]

Cards is too specialized. Less variety. Only one organ. Personality issues. More stress, almost the same money. Perhaps most importantly there is more free reign in GI. Less evidence = more freedom to practice as you wish. Too many studies in cardiology: good for the patient, less so for the practitioner. I can literally say we are doing XYZ because I am the GI doctor and no one can questions it.

Onc: have to study a great deal, only going to get worse as more immunotherapy comes on line. Hematology is amazing but the compensation is in oncology. Super sick patients and you become their eventual PCP for everything no thanks.

Thank you! Love your straight up answers throughout this post btw.

What do you mean by the personality issues with Cards?
Do you eventually get used to the poop smell during colonoscopy?
Income potential in GI vs. Interventional Cards?

 

[Zifish]

What is the job market looking like now and projecting in the future? Do you think Gastroenterology Nurses will have a similar impact on jobs like Nurse anesthetists have on anesthesiology?

 

[Disciple of Sattar]

is it stinky

 

[jhamaican]

is it stinky

not as stinky as your mother.

More serious:

Do medical students not realize patients have to undergo prep for a colonoscopy? Do you think a scope can see through all the poop?

The patients undergo preparation: There are no smells. I do feel terrible for the nurses on the floor however...

The only smell I frequently encounter are melena and C. Dif. I can make those 2 diagnoses from the door.

 

[jhamaican]

What is the job market looking like now and projecting in the future? Do you think Gastroenterology Nurses will have a similar impact on jobs like Nurse anesthetists have on anesthesiology?

Sky is the future.

2-3 jobs all over the USA for every 1 GI graduate.

GI nurses will never be able to scope and perform endoscopy well.

it is technically quite difficult and requires many years.

Yes nurses and PCP in the boonies perform screening colons, but I cringe at the thought of their polyp detection rate. If they find anything worth while it will come to a GI doctor eventually.

Perfect scenario: more nurses to see patients and consults on the floor while the GI docs stay in the endo suite all day: i think this is the situation we are coming to.

 

[jhamaican]

Thank you! Love your straight up answers throughout this post btw.

What do you mean by the personality issues with Cards?
Do you eventually get used to the poop smell during colonoscopy?
Income potential in GI vs. Interventional Cards?

1. Birds of a feather flock together. GI is much more laid back. Cardiologists try too hard to have that surgeon attitude.

2. See my post above. No smells

3. If you want money in this doctor game, it is there. patient care will inevitably suffer however. The saying is that if you make less the 700k in GI Private practice you are doing it wrong or are very lazy. I don't know how much interventional cards gets paid, but I think GI has much more potential for business. GI is the greatest utilizer of outpatient surgery centers. High compensation for endoscopies, part ownership of an outpatient surgical center, nurses to see the consults that need to be scoped. Now we are talking. Lots more potential in GI compared to cardiology. Mass production of outpatient procedures with possibility of cash procedures ( bariatrics , hemorrhoids)

 

[jhamaican]

How significant is the difference in pay between private practice and academics?
What is the thing that most attendings dislike the most about GI/ complain about the most?
How is the patient population in GI compared to other specialties?

Thank you so much

1. pay difference see above: Academics start 200, 300 at best (rare). private practice 500-800+
2. Most complaints are system issues: Patients not going in and out of endoscopy efficiently. Communication issues between nursing, obtaining an OR with anesthesia support for a case at night.
3. Depends on what you do. GI is such a large field. You want to do functional: 20 year olds with psych issues. You want to scope all day: you can have straight cancer pancreaticobiliary malignancies. Or general GI normal outpatient screening colons. GI runs the gamut.

 

[jhamaican]

Thanks for your responses. What is your call schedule like as a fellow and what about the academic attending physicians?

Do the private guys take call or do they just scope 12 hours a day?

Private guys scoping all the time long hours expect perhaps 1-2 half days for clinic.

Call schedule depends on program. some more evenly spaced throughout fellowship. Some are massively front loaded.

Academic attendings call is quite light it seems. On service only every several months. And it gets better the more senior you get. No call above age 65+. Weekends a rarity, and even then you have a fellow buffer.

 

[Reader88]

What percentage of patients (roughly) do you see for hepatology and pancreatic concerns?

Do you think further advanced training in ERCP and other procedures is worth it?

 

[nimbus]

No call above age 65+. Weekends a rarity, and even then you have a fellow buffer.

If you’re still working above age 65, you did something terribly wrong. Unless you’re just working for kicks.

 

[Frogger27]

The NRMP data shows the average matched GI step score is 235. Is it the other parts of the app that make GI such a competitive match (being a good resident, research, letters, etc)

 

[Frogger27]

Did you know you wanted to go into GI in medical school or did you just decide upon IM and then find out you liked GI?

What other fields did you consider in Med school/residency if any?

 

[LebronManning]

Do you ever get anything as acute as STEMI response? Like maybe for some GI bleeds or no?

 

[Frogger27]

Do you find what you do interesting? Rewarding? Are there any advancements for the field on the new horizon that you or colleagues are excited about? I get that this is an anonymous AMA but I’m a little bit disappointed that most of the questions have revolved around money and lifestyle, even if they are important aspects

We’re only 30 posts in, chill G. Figured we might as well get all of the lifestyle Qs out of the way because they will inevitably be asked

 

[usctrojans24]

1. pay difference see above: Academics start 200, 300 at best (rare). private practice 500-800+
2. Most complaints are system issues: Patients not going in and out of endoscopy efficiently. Communication issues between nursing, obtaining an OR with anesthesia support for a case at night.
3. Depends on what you do. GI is such a large field. You want to do functional: 20 year olds with psych issues. You want to scope all day: you can have straight cancer pancreaticobiliary malignancies. Or general GI normal outpatient screening colons. GI runs the gamut.

Is this really true the bold? Does this apply to major metro areas or the boonies where you make 700k +

 

[YouEverHadOurSausages?]

Do you know how peds GI compares to adult in terms of day-to-day work, salary, lifestyle, and job outlook?

 

[mymembernames]

How does the GI lifestyle/pay compare to psych?

 

[Zifish]

It seems like a big emphasis is placed on research when screening applicants for GI fellowship. Does research during medical school count when applying to GI fellowship? How about if it’s GI related research during med school? Or is the point to just have research during residency so you’re getting your face known in the community?

 

[thegreengreatdragon]

Is this really true the bold? Does this apply to major metro areas or the boonies where you make 700k +

I'm obviously not the OP and am but a humble med student but I have a family friend in GI who's racking up the dough. Works private practice in New York City, makes more than 700k every year...his boss/original owner of the practice gave him a Mercedes as a congratulations gift when he made partner. That said, he advises me against GI and against medicine in general (I think this is more because private practice in general is not as satisfactory as it was when he started in the 90s).
OP, I do have a question. I find GI really interesting from a research/physiological perspective. Of all the systems we've done so far, GI seems most interesting. Really not interested in procedures, though. Really enjoy the history taking, "80% of your diagnosis should come from the history and physical exam" aspect of medicine (which I feel like most specialties seem not to do). You said there's a lot of flexibility in GI, but would I be able to ultimately find a job that honors my interests? Also want a fairly laid-back life. Also, in terms of all of the cool immunological research going on in GI, plus gut-brain, gut microbiome, etc research, do you feel like you're able to clinically do much with that stuff yet or do you forsee being able to do so in the future?

 

[usctrojans24]

I'm obviously not the OP and am but a humble med student but I have a family friend in GI who's racking up the dough. Works private practice in New York City, makes more than 700k every year...his boss/original owner of the practice gave him a Mercedes as a congratulations gift when he made partner. That said, he advises me against GI and against medicine in general (I think this is more because private practice in general is not as satisfactory as it was when he started in the 90s).
OP, I do have a question. I find GI really interesting from a research/physiological perspective. Of all the systems we've done so far, GI seems most interesting. Really not interested in procedures, though. Really enjoy the history taking, "80% of your diagnosis should come from the history and physical exam" aspect of medicine (which I feel like most specialties seem not to do). You said there's a lot of flexibility in GI, but would I be able to ultimately find a job that honors my interests? Also want a fairly laid-back life. Also, in terms of all of the cool immunological research going on in GI, plus gut-brain, gut microbiome, etc research, do you feel like you're able to clinically do much with that stuff yet or do you forsee being able to do so in the future?

Yea I'm just shocked tbh I wasn't aware they made that much lol. But you're right you have to find a specialty that interests you and find satisfaction.

 

[thegreengreatdragon]

Yea I'm just shocked tbh I wasn't aware they made that much lol. But you're right you have to find a specialty that interests you and find satisfaction.

Yeah, I'm not sure why, is it because of the procedures?

 

[usctrojans24]

Yeah, I'm not sure why, is it because of the procedures?

To my knowledge to only procedures they perform are colonoscopies and endoscopies but I could be wrong.

 

[MedicineZ0Z]

Thoughts on family docs who do screening colonoscopies?

 

[Frogger27]

Thoughts on family docs who do screening colonoscopies?

curious to this as well... I was in a rural hospital and one of the family docs was bragging about how they were taught how to do colonoscopies and was planning on incorporating this into his practice @jhamaican

 

[jhamaican]

What percentage of patients (roughly) do you see for hepatology and pancreatic concerns?

Do you think further advanced training in ERCP and other procedures is worth it?

During fellowship? I think it depends program to program.

Some people get hepatology trained in 3 years. Other do an extra 4th.

Pancreatic stuff beyond the basics is the territory of biliary. So advanced endoscopy rotations and interventional 4th year fellowships.

Maybe 25-35% hepatology/pancreatic? Hard to give en estimate as it varies.

I think advanced training depends on the person. A lot of older GIs are retiring and the demand for ERCP will be there. The sky is the future for advanced procedures including new bariatric opportunities, EUS etc... There is no downside other than the year of opportunity cost.

 

[jhamaican]

If you’re still working above age 65, you did something terribly wrong. Unless you’re just working for kicks.

I disagree.

medicine is one of the few unique fields where your value grows as you age.
You become more established, more respected, make more money.

You would have a hard time telling an established GI partner making 7 figures at age 65 that they did something terribly wrong and should retire...

 

[jhamaican]

The NRMP data shows the average matched GI step score is 235. Is it the other parts of the app that make GI such a competitive match (being a good resident, research, letters, etc)

This is kind of too broad a question:

Just be the best candidate you can be:

Best residency you can get into (i.e. highest ranked academic center).

Do the most impactful research you can with the most well known faculty (this will lead to publications and rec letters).

Be the best resident you can, study hard and provide excellent care: This will allow you to do well on the ITE and get a good program director letter.

Don't neglect your step2 and step3.

To summarize: keep working to be the best that you can be

 

[jhamaican]

Did you know you wanted to go into GI in medical school or did you just decide upon IM and then find out you liked GI?

What other fields did you consider in Med school/residency if any?

Originally nephrology.

But we all know what state that field is in. I think it is unfortunate that the previous generation of nephrologists essentially sold out their field to Da Vita etc...

I am sure they made a lot of money when they sold out, but look at the poor opportunities for nephrology now. Read the nephrology board: doom and gloom.

Why do a nephrology fellowship when you can get paid more and have a better lifestyle as a hospitalist?

Sky is the future for GI. I saw the light pretty early on and made the switch.

At the end of the day: competitive fields are competitive for a reason
1. lifestyle
2. money
3. prestige.

Best fields have all 3. Good fields have 2/3. Some fields (i.e. nephrology) have none...

 

[jhamaican]

Do you ever get anything as acute as STEMI response? Like maybe for some GI bleeds or no?

Yes. I would argue an acute bleeder is just as urgent as a STEMI.

Active variceal bleed with massive transfusion protocol ongoing = if you miss that varix patient is gone.

Rare but happens every couple of months.

As a whole less stressful than cardiology but situations do arise...

 

[jhamaican]

Is this really true the bold? Does this apply to major metro areas or the boonies where you make 700k +

This is true. job market is amazing for GI at the moment.

I have been told by numerous providers that if you are not making at least 750K+ anywhere (large cities included), it is because you are either doing it wrong or have prioritized other aspects of your life.

Personally I would take $350 and work less hours and days per week and be able to spend time with family/friends.

But the money is there in GI if you want it.

I get multiple phone calls per day and e-mails with guaranteed super salaries.

Don't tell everyone, don't want GI getting too competitive.

But there is more to life than money. Taxes will take most of that change anyway...

 

[jhamaican]

Do you know how peds GI compares to adult in terms of day-to-day work, salary, lifestyle, and job outlook?

I don't know much about peds GI.

I can't really give you a good answer.

I will say compensation for pediatrics in general, subspecialities included, is poor due to insurance issues (medicaid?) which is beyond my knowledge base.

I will also say that the advanced (i.e. interventional endoscopy trained) adult guys that I have seen do the majority of the difficult pediatric cases