GI Fellow AMA

[jhamaican]

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How does the GI lifestyle/pay compare to psych?

Opposite ends of the spectrum.

This is a silly question.

One is a procedural specialty about as close to being a surgeon as you can get without actually being one.

Other (psych) is mostly cognitive.

There can be some overlap if you choose to specialize in functional GI issues like IBS.

But on the whole: GI more competitive, more hours, more training, more money.

Pros and Cons to everything.

Whenever I get a functional GI patient it makes me happy I didn't go into psych.

 

[jhamaican]

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?

All research helps.

GI research in medical school is ideal.

If you can say: hey look I have been interested in GI since medical school and I have the research to back it up: this will make you a very strong candidate.

But you are right in that it is also getting face to face time with faculty as well as getting your name out there for recommendation letters.

 

[jhamaican]

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?

The story of your family friend matches similar stores and offers I get everyday. I would argue that GI is one of the best fields if you want to want to go all in for making cash in medicine (but pro tip: probably won't make you happy and your kids will hate you).

With regard to your second question:

GI is one of the few fields where you can be anywhere on the spectrum to almost a psychologist (dealing with functional IBS) patients all day to almost a surgeon (advanced endoscopist).

The microbiome research is taking off with fecal transplants and new research regarding the effects of the microbiome on diseases such as IBS/IBD.

They are already giving fecal transplants for refractory C. Dif...

You would definitely find a job that would honor your interests as described as above in GI. (and also, if your interests change over time and you have 10 kids: you can always scope for 7 figures cash like your family friend - not a bad back up plan!)

 

[jhamaican]

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

It is because in the time it takes a surgeon to do one operation, you can do several colonoscopies.

It is about the procedural throughput... That brings the cash.

 

[jhamaican]

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

But there are many variations on these.

What if I told you gastric sleeves can be performed endoscopically now? And that people pay cash money for these procedures?

What about ERCP and biliary/pancreatic stenting?

Endoscopic ultrasound?

Colonoscopy with palliative stenting and endoscopic mucosal resection for large polyps? Better outcomes than surgery.

Sky is the future for endoscopy and GI and only going to get better.

 

[jhamaican]

Thoughts on family docs who do screening colonoscopies?

Don't like it (compromises job security) but it is an inevitability in my opinion.

I believe in the future there will be more PCP/NP doing colonoscopies. GI will be referred to when large polyps are found or when the colon is technically difficult.

Don't want this to happen, but I think it will be inevitable. Screening age at 45 now, demand just too high.

From a monetary perceptive though, I think this will only help GI. GI doctor will supervise an army of NP performing procedures and will be called in when a case is difficult. Like anesthesia and CRNA right now.

Just too many people that need colonoscopies and not enough GI docs

More complicated procedures/patients will always go to the GI docs.

This demand does make for a killer GI job market at the moment though..

 

[jhamaican]

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

See my response above...

 

[afib123]

Don't like it (compromises job security) but it is an inevitability in my opinion.

I believe in the future there will be more PCP/NP doing colonoscopies. GI will be referred to when large polyps are found or when the colon is technically difficult.

Don't want this to happen, but I think it will be inevitable. Screening age at 45 now, demand just too high.

From a monetary perceptive though, I think this will only help GI. GI doctor will supervise an army of NP performing procedures and will be called in when a case is difficult. Like anesthesia and CRNA right now.

Just too many people that need colonoscopies and not enough GI docs

More complicated procedures/patients will always go to the GI docs.

This demand does make for a killer GI job market at the moment though..

How will it help GI monetarily if NPs and PCPs are doing the colonoscopies? For anesthesia, I am guessing they are compensation is staying stable for running more rooms even if the CRNAs do the bulk of the work

 

[jhamaican]

How will it help GI monetarily if NPs and PCPs are doing the colonoscopies? For anesthesia, I am guessing they are compensation is staying stable for running more rooms even if the CRNAs do the bulk of the work

I would argue because it turns into a business.

Would you rather do 10 colonoscopies a day your self and 100% of the money

Or supervise 3 NPs doing 10 colonoscopies a day working for you a get 50% of the money?


I am not an expert on this just a thought... Maybe someone with more experience can tell me how it works with the cRNA situation.

 

[afib123]

I would argue because it turns into a business.

Would you rather do 10 colonoscopies a day your self and 100% of the money

Or supervise 3 NPs doing 10 colonoscopies a day working for you a get 50% of the money?


I am not an expert on this just a thought... Maybe someone with more experience can tell me how it works with the cRNA situation.

I guess. Idk I wouldn't feel comfortable with anyone else doing those procedures if I were to go into GI. But I am also just guessing; I don't really know how this works in anesthesia and if it can be translated to GI safely without any monetary loss

 

[LebronManning]

Do you think the fact that GI spots are much lower than other specialists is what’s keeping the demand so high and will continue to do so?

Do you fear CMS cuts because of how lucrative GI is?

What does the general public think of GI docs?

Do you need to have further training after GI fellowship to do bariatric gastric sleeves?

Can/do GI fellows moonlight during fellowship?

 

[deleted87051]

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...

Most doctors peak their earnings in their 40s and 50s. And procedure skills and eyesight start declining once you hit a certain age. I’ve been in PP doing anesthesia for over 20 years. I know a few cardiologists over 65 who are still working because they love it but they have cut back or completely eliminated their procedural work. I don’t know any GI’s that old and it would take a special 65yo to still be scoping like a young buck. At that age they should be traveling and enjoying the grandkids.

My anesthesia group is self insured and we have a mandatory retirement age of 70 because we don’t want the liability of someone practicing beyond the point when they should stop. Most people should and do retire before that age. The only ones who look for work after their age-forced retirement are people who didn’t plan well.

 

[MedicineZ0Z]

Don't like it (compromises job security) but it is an inevitability in my opinion.

I believe in the future there will be more PCP/NP doing colonoscopies. GI will be referred to when large polyps are found or when the colon is technically difficult.

Don't want this to happen, but I think it will be inevitable. Screening age at 45 now, demand just too high.

From a monetary perceptive though, I think this will only help GI. GI doctor will supervise an army of NP performing procedures and will be called in when a case is difficult. Like anesthesia and CRNA right now.

Just too many people that need colonoscopies and not enough GI docs

More complicated procedures/patients will always go to the GI docs.

This demand does make for a killer GI job market at the moment though..

NPs doing it? Cmon.. no...

 

[subdermallight]

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

Any pointers on that front in terms of ECs? Will GI research and letters in med school help me get into a competitive IM residency? Or will be being too laser focused on GI hurt me in interviews?

 

[jhamaican]

Any pointers on that front in terms of ECs? Will GI research and letters in med school help me get into a competitive IM residency? Or will be being too laser focused on GI hurt me in interviews?

Do not say you want to go into GI. They don't like this.

Go in saying you want to be the best IM doctor possible.

Once you are in IM residency then gun for GI.

 

[Frogger27]

Do not say you want to go into GI. They don't like this.

Go in saying you want to be the best IM doctor possible.

Once you are in IM residency then gun for GI.

When it comes to “gunning for GI” once residency starts, does this just include research, connections and being best internist you can be? What else is sets a resident up to be successful in the fellowship match

Also, do fellowship applications go out during PGY2 or PGY3?

 

[On Eagle's Wings]

Thanks for doing this!

What is your opinion on a chief year? My program picks their chiefs a year and a half ahead of time, or halfway through PGY2. Is it better to do a chief year, or try to match straight into GI out of residency? What factors would sway you in one direction or the other?

 

[xerei]

Which bowel is the best bowel

 

[subdermallight]

Do not say you want to go into GI. They don't like this.

Go in saying you want to be the best IM doctor possible.

Once you are in IM residency then gun for GI.

Any tips for being competitive for IM? What kind of research do they like?

Thanks for doing this, it is very helpful

 

[jhamaican]

NPs doing it? Cmon.. no...

What if I told you NPs already perform the majority of screening scopes in some settings (see VA hospitals...)

It's already happening.

 

[jhamaican]

Most doctors peak their earnings in their 40s and 50s. And procedure skills and eyesight start declining once you hit a certain age. I’ve been in PP doing anesthesia for over 20 years. I know a few cardiologists over 65 who are still working because they love it but they have cut back or completely eliminated their procedural work. I don’t know any GI’s that old and it would take a special 65yo to still be scoping like a young buck. At that age they should be traveling and enjoying the grandkids.

My anesthesia group is self insured and we have a mandatory retirement age of 70 because we don’t want the liability of someone practicing beyond the point when they should stop. Most people should and do retire before that age. The only ones who look for work after their age-forced retirement are people who didn’t plan well.

maybe you are right.

Sounds like you have more experience than me.

I am still in training so thank you for this perspective! interesting...

 

[jhamaican]

When it comes to “gunning for GI” once residency starts, does this just include research, connections and being best internist you can be? What else is sets a resident up to be successful in the fellowship match

Also, do fellowship applications go out during PGY2 or PGY3?

Yes to all three things.

from most to least important in my opinion from someone who has just gone through this successfully.

1. Being the best intern you can and creating an awesome reputation for yourself at your residency program (this will lead to a good program director letter which is very important)
2. Positive letters of recommendation from prominent academic GI faculty (if they recognize the writers name before even reading the letter this is what you want...). unfortunately I would say name recognition trumps content in most cases as long the letter is positive. This is just reality.
3. prestige of IM residency
4. GI research that you can talk about during the interview. Published > posters at major conferences (i.e. DDW, ACG), > case reports and ongoing projects.

 

[jhamaican]

Thanks for doing this!

What is your opinion on a chief year? My program picks their chiefs a year and a half ahead of time, or halfway through PGY2. Is it better to do a chief year, or try to match straight into GI out of residency? What factors would sway you in one direction or the other?

Context: i was not a chief resident.

Most chief residents I know did/do it for one of two reasons
1. wanted to stay at their specific home program for personal reasons
2. wanted top of the top top tier programs.

other than the above reasons, I do not think it is a good idea. It is a brutal and unforgiving job dealing with whining residents all day.
No exaggeration, I do not believe people are ever the same after a chief year: i have watched it change people! and usually not for the better. It destroys you.

From what I understand, they usually give you a "nod and a wink" that you will be able to stay at your home program as long as you do a decent job. It is like a guaranteed "in" at your home program so you can stay with your family or significant other etc... This is why most people do a chief year I believe...

 

[jhamaican]

Any tips for being competitive for IM? What kind of research do they like?

Thanks for doing this, it is very helpful

See my above post, thanks

 

[jhamaican]

Do you think the fact that GI spots are much lower than other specialists is what’s keeping the demand so high and will continue to do so?

Do you fear CMS cuts because of how lucrative GI is?

What does the general public think of GI docs?

Do you need to have further training after GI fellowship to do bariatric gastric sleeves?

Can/do GI fellows moonlight during fellowship?

Yes. They are less than half GI spots vs cardiology from what I understand last match statistics. Only allergy has less if I remember correctly?

Doesn't most of medicine fear cuts? I don't know much about reimbursement and reimbursement models to really give you a good answer here. Still in training.

They are specific sleeve fellowships although rare (see Brigham I believe?). You mostly get exposure during advanced endoscopy fellowship. But a general GI can do these I believe just go to the training course, learn how to do the suture lines endoscopic and you are all set. (don't forget to put your billboards all over the city with your smiling face next to a beautiful woman before/after picture)

Yes GI fellows can moonlight. Most programs I know about and interviewed at say only after the first year (year 2+3 only). First year is very busy learning to see consults and scope. It is like learning to perform surgery.

 

[MedicineZ0Z]

What if I told you NPs already perform the majority of screening scopes in some settings (see VA hospitals...)

It's already happening.

Lol oh god. I did not know this. Who trained them??

 

[NYCdude]

Yes to all three things.

from most to least important in my opinion from someone who has just gone through this successfully.

1. Being the best intern you can and creating an awesome reputation for yourself at your residency program (this will lead to a good program director letter which is very important)
2. Positive letters of recommendation from prominent academic GI faculty (if they recognize the writers name before even reading the letter this is what you want...). unfortunately I would say name recognition trumps content in most cases as long the letter is positive. This is just reality.
3. prestige of IM residency
4. GI research that you can talk about during the interview. Published > posters at major conferences (i.e. DDW, ACG), > case reports and ongoing projects.

Might seem obvious but how do you do that? Besides killing ITE's I imagine. Would you say it's better to spend a lot of time to know patients or study a lot at home to have an impressive knowledge base. What sort of specific things?

 

[ChrisTurkletonMD]

Opposite ends of the spectrum.

[GI] is about as close to being a surgeon as you can get without actually being one.

This is a stupid question but do you think GI is more procedure oriented than cards, EM or IR?

 

[deleted87051]

This is a stupid question but do you think GI is more procedure oriented than cards, EM or IR?

Structural interventional cardiology has a bright future treating problems which were traditionally treated by surgeons. However, the training is long.

 

[JP2740]

Interesting thread

 

[Frogger27]

Interesting thread

Why is that?

 

[CyrusHabs7695]

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)

wait wut

Is this actually true, or just in rural parts of the country?

 

[afib123]

do people that go to a really competitive GI program, e.g duke or johns hopkins and get into competitive academic jobs, get paid less than the guy who goes to low tier fellowship but pumps out procedures in private practice?

I guess my overall question is does the competitiveness of the fellowship program have anything to do with your salary

For people that want are planning to go into private practice, how much does the prestige of the fellowship program matter for life after fellowship in terms of salary, job opportunities, etc. I know for IM programs, prestige matters because it determines your fellowship but I am curious as to how much prestige matters for fellowship programs

 

[aafisahar]

NPs doing it? Cmon.. no...

It's a procedure, you can train most anyone to do a procedure, yes even surgery. It's all about numbers. The difference is the thinking that goes into the procedure beforehand (eg why are we doing this) as well as "does endoscopy answer the question at hand". That's what separates you from the NPs/PAs.

 

[MedicineZ0Z]

It's a procedure, you can train most anyone to do a procedure, yes even surgery. It's all about numbers. The difference is the thinking that goes into the procedure beforehand (eg why are we doing this) as well as "does endoscopy answer the question at hand". That's what separates you from the NPs/PAs.

So GIs fight family docs over them doing it but train NPs to do it? uh...

 

[DoctwoB]

do people that go to a really competitive GI program, e.g duke or johns hopkins and get into competitive academic jobs, get paid less than the guy who goes to low tier fellowship but pumps out procedures in private practice?

I guess my overall question is does the competitiveness of the fellowship program have anything to do with your salary

For people that want are planning to go into private practice, how much does the prestige of the fellowship program matter for life after fellowship in terms of salary, job opportunities, etc. I know for IM programs, prestige matters because it determines your fellowship but I am curious as to how much prestige matters for fellowship programs

Academic jobs, especially prestigious ones at big names, pay much less. In private practice CPT codes pay the same regardless of where you went to fellowship.

 

[mrbreakfast]

do people that go to a really competitive GI program, e.g duke or johns hopkins and get into competitive academic jobs, get paid less than the guy who goes to low tier fellowship but pumps out procedures in private practice?

This has already been said in this thread, but in academics you pay for the institution name. The bigger the name, the lower the salary. As a mentor explained it to me, the most desirable academic jobs offer as low as half the salary of what less desirable ones do.

 

[Booze Aldrin]

So GIs fight family docs over them doing it but train NPs to do it? uh...

Can you blame them though? Brain of a doctor heart of a nurse brah, GPs can't compete with that. Learn it. Love it. Live it.

 

[Tozanzibarbymotorcar]

will answer anything

I feel this is the first post from you that I’ve seen that isn’t a troll post! nice

 

[jhamaican]

Might seem obvious but how do you do that? Besides killing ITE's I imagine. Would you say it's better to spend a lot of time to know patients or study a lot at home to have an impressive knowledge base. What sort of specific things?

I would focus on studying the conditions your patients have.

Most people find learning and reading in depth about a condition that you see in your own patients will help the knowledge stick more readily.

Know your patients well.

Be a team player, go out of your way to help your colleagues.

Have a good attitude, smile, do not take things personally, hustle, buy your team coffee in the morning.

Basically, be willing to do all the things that the whiners will complain is scut. Can't tell you how far I have gotten just cause willing to hustle and do things others are not.

 

[jhamaican]

This is a stupid question but do you think GI is more procedure oriented than cards, EM or IR?

You can do straight procedures all day every day if you wish in GI

In that fashion it is similar to interventional radiology or structural/interventional cardiology.

But the beautiful aspect is, you always can just retreat to clinic if you get old or stop liking procedures.

 

[jhamaican]

Structural interventional cardiology has a bright future treating problems which were traditionally treated by surgeons. However, the training is long.

I think structural/interventional cardiology is in some ways very similiar to interventional GI with the stenting and angios (ERCP vs cath) etc...

 

[jhamaican]

wait wut

Is this actually true, or just in rural parts of the country?

I think there is a lot of money to be made in many aspects of medicine if you are willing to hustle.

But will your children ever see anyone other than a nannY?

 

[jhamaican]

do people that go to a really competitive GI program, e.g duke or johns hopkins and get into competitive academic jobs, get paid less than the guy who goes to low tier fellowship but pumps out procedures in private practice?

I guess my overall question is does the competitiveness of the fellowship program have anything to do with your salary

For people that want are planning to go into private practice, how much does the prestige of the fellowship program matter for life after fellowship in terms of salary, job opportunities, etc. I know for IM programs, prestige matters because it determines your fellowship but I am curious as to how much prestige matters for fellowship programs

it is hard to beat just repeating screening colonoscopies all day in terms of money. But things are changing and this cash cow may not be there forever. Furthermore, doing screening colons all day is draining. You will probably want to kill yourself. Many GI doctors have wrist/hand surgery from scoping all day.

No real relation as to prestige of fellowship program and compensation. Possible caveat is that some of the top private groups will preferentially recruit from better GI fellowship programs.

In short, I do not believe there is any drawback to going to a higher ranked, more "prestigious" residency or fellowship. Just opens more doors.

 

[jhamaican]

So GIs fight family docs over them doing it but train NPs to do it? uh...

to be honest, NP are my arch enemy in the hospital as a fellow:

Can immediately tell when the person calling the consult is an NP. You just know....


They are cocky as hell when managing routine consults and pretend to be your equal/superior and boss you around.

And at the same time,

When something goes wrong, "I am only NP, call the doctor!". or "I have no idea, my attending just told me to call, let me ask my attending."

They want it both ways...

and not to mention they almost assuredly make more money than me as well.

 

[jhamaican]

I feel this is the first post from you that I’ve seen that isn’t a troll post! nice

Please post examples of my previous troll posts.

No Troll here.

 

[Planes2Doc]

Favorite GI jokes?

 

[Dr. Black]

Trying to decide between a full ride to a new med school in new jersey vs. 30kyr at UAB in Birmingham. Im thinking Birmingham is the safe bet with established research labs, years of producing doctors and EC programs to help with residency match. But a full ride is hard to turn down. Should i go to New jersey and just work hard to find opportunities in GI or should i pay for UAB where opportunities and EC will be plentiful but have to pay more?

 

[DameJulie]

1) Did you prepare for matching into GI during medical school? before medical school? or during residency?

2) Is GI-specific research important? Or can you still match doing research in other IM specialties (e.g.infectious disease, cardio)

3) Is it possible to match GI as a DO? From a community hospital?

 

[BunnyMan17]

Trying to decide between a full ride to a new med school in new jersey vs. 30kyr at UAB in Birmingham. Im thinking Birmingham is the safe bet with established research labs, years of producing doctors and EC programs to help with residency match. But a full ride is hard to turn down. Should i go to New jersey and just work hard to find opportunities in GI or should i pay for UAB where opportunities and EC will be plentiful but have to pay more?

Is the new med school the one with Seton Hall? I am just a lowly MS4 but I am on a full ride of sorts and so far every attending I've met has said debt free is the way to go. The peace of mind that goes with it has been super nice and I really value the freedom to pick a specialty based on what I enjoy vs. what is best for the loans.

When I was applying the main problem I kept finding with new schools was a lack of rotation sites, access to clinical faculty. etc. It looks like Seton Hall has the school set up with an already very established health system. The med school itself looks pretty nice too. I understand there other things to note like established research and reputation.

I'm also interested in GI and all the attendings I've worked with have told me to chill with the whole GI or bust thing in med school. Just to focus on preparing myself to be the best intern possible and start working torwards GI when I get to residency.

Just my 0.02, sure someone farther along would more insight.