GI Fellowships

[triguy]

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Quick question for those who may have looked into GI fellowships this year. I have an interest in GI and am up to date on the threads discussing what to consider for fellowships (mentorship, etc.). It seems like there are a number of well-known people in the field. Any thoughts on what people experienced or are currently experiencing this year on the interview trail?

 

[yaah]

I didn't apply, but there were lots of applicants, lots of really good applicants. Most are looking to train academics - GI fellowships are traditionally for those with academic mindsets, which is not really consistent with what a lot of people want out of them. There is at least one private lab who has a GI fellowship (Ameripath I think).

GI path is a collegial and generally friendly field, doing away rotations is very helpful if you want to be considered. Our program, for example, the past three years took inside candidate (who went academic), inside candidate (who thought about academics then changed), and outside candidate (no internal candidates, the outside candidate came and spent a couple weeks).

A lot of GI fellowships include lots of research (like the Emory one). Some are pure clinical with some project opportunities (like michigan).

 

[triguy]

Thanks for the input. I am more clinically oriented, so I will see what I can find out about more service oriented fellowships vs. research based ones. Does anybody know about Michigan, CC, Mayo, UCSF, Hopkins? I am guessing the Boston fellowships are really research-minded. Thanks!

 

[yaah]

Michigan and Mayo (and I think CC as well) are almost definitely service oriented. If you want to do significant research (i.e. bench work) it will be tough. I don't know about UCSF or Hopkins. The Boston fellowships (particularly the BIDMC) are not necessarily research heavy. Antonioli and Goldman ran the BIDMC (maybe they still do) and their graduates generally went academic but as service oriented academics.

I don't really know of any fellowships except Emory that specifically look for researchers.

 

[Neddy]

Michigan and Mayo (and I think CC as well) are almost definitely service oriented. If you want to do significant research (i.e. bench work) it will be tough. I don't know about UCSF or Hopkins. The Boston fellowships (particularly the BIDMC) are not necessarily research heavy. Antonioli and Goldman ran the BIDMC (maybe they still do) and their graduates generally went academic but as service oriented academics.

I don't really know of any fellowships except Emory that specifically look for researchers.

When you say Michigan is "service oriented," you mean during residency, not that they aren't looking for people who want to do research postdocs, right? I only ask because my interview day at Michigan was very research-oriented (and impressive).

Oops, just realized thread was about fellowships.

 

[b&ierstiefel]

Michigan and Mayo (and I think CC as well) are almost definitely service oriented. If you want to do significant research (i.e. bench work) it will be tough. I don't know about UCSF or Hopkins. The Boston fellowships (particularly the BIDMC) are not necessarily research heavy. Antonioli and Goldman ran the BIDMC (maybe they still do) and their graduates generally went academic but as service oriented academics.

I don't really know of any fellowships except Emory that specifically look for researchers.

At BWH, the GI fellowship is predominantly service oriented. You do clinical and translational projects but I have not encountered anyone in the GI fellowship that did bench work...yet.

 

[LADoc00]

At the moment Im very disillusioned with Path "academic creds." The largest and most powerful pathology group on West Coast is run, owned and controlled by a group of former residents not from UCSF, UCLA, USC, San Diego, Stanford or UW but from Harbor.

Business savvy, interpersonal skills, connections seem to seriously trump ALL creds.

The only thing creds seem to be getting people these days is a better "gimp" job as a perma-employee.

Ive come to conclusion where you train is almost immaterial as your destiny is likely already set based on your personality, temperament and goals.

Why this is the case in Path and not the case in things like Surgery, Derm or IM for example is a confluence of a number of factors.

 

[yaah]

Yeah, I think people (especially residents) underestimate the importance of interpersonal skills, personality responsibility, and professionalism. You can't trump deficiencies in those areas with cytopath + hemepath or GI path + whatever.

 

[SLUsagar]

Michigan and Mayo (and I think CC as well) are almost definitely service oriented. If you want to do significant research (i.e. bench work) it will be tough. I don't know about UCSF or Hopkins. The Boston fellowships (particularly the BIDMC) are not necessarily research heavy. Antonioli and Goldman ran the BIDMC (maybe they still do) and their graduates generally went academic but as service oriented academics.

I don't really know of any fellowships except Emory that specifically look for researchers.

be a bit wary of UCSF's GI...not at ALL dogging it, just be aware that it's like 70% or so liver, understandibly with Linda Ferrell's stature...so it's a GI with an *, ........ * = liver heavy....

 

[Logos']

..

 

[SLUsagar]

Not sure why a Stanford trainee would advise people to be “wary” of a UCSF fellowship…. If you look on our website the fellowship is listed as a “Liver and GI fellowship” … notice which comes first.

dude, calm the heck down. Just letting people OUTSIDE the bay area know what's up...UCSF's GI fellowship is $, don't get me wrong alright. But not all fellowships formally incorporate 'liver' like they do, and that ain't nec. bad, just different. Hell, Ferrell is great lady too, one of the bigheads in liver path that's actually nice...(other being Beth Brunt).

 

[LADoc00]

dude, calm the heck down. Just letting people OUTSIDE the bay area know what's up...UCSF's GI fellowship is $, don't get me wrong alright. But not all fellowships formally incorporate 'liver' like they do, and that ain't nec. bad, just different. Hell, Ferrell is great lady too, one of the bigheads in liver path that's actually nice...(other being Beth Brunt).

Stanford v. UCSF..........

CRIPPLE FIGHT!!!!

You guys should duke it out...at a neutral venue, maybe at the Burlingame Hyatt? Next Saturday.

 

[b&ierstiefel]

A brawl is juvenile.

Steel cage match is for slightly more mature folks.

But real men settle it with two 2L bierstiefels and the one to chug the fastest wins and has bragging rights.

 

[Neddy]

What's the volume of a standard-issue biersteifel? Do they vary?

 

[b&ierstiefel]

What's the volume of a standard-issue biersteifel? Do they vary?

They come in various sizes...the most common being 1 or 2 liters. I don't know which one is standard but considering that it was the 2 liter boot that was showcased in the movie, Beerfest, maybe the 2 liter one is standard.

 

[yaah]

I think GI fellowships should be liver heavy. GI bxs are much more run of the mill, you distinguish yourself by being good at liver, IMHO. Especially in academics.

 

[DarksideAllstar]

I think GI fellowships should be liver heavy. GI bxs are much more run of the mill, you distinguish yourself by being good at liver, IMHO. Especially in academics.

Actually, my inside source at UCSF is quite happy that they are seeing more liver than tubular GI, because in his opinion, liver is much more difficult.

I agree with AM though, the bierstiefel challenge is much more legit than a simple steel cage match.

 

[b&ierstiefel]

Actually, my inside source at UCSF is quite happy that they are seeing more liver than tubular GI, because in his opinion, liver is much more difficult.

I agree with AM though, the bierstiefel challenge is much more legit than a simple steel cage match.

If I were to do a GI fellowship, I would want to see a lot of liver too. I'm almost done 2nd year and I still don't feel completely comfortable with liver core bx's.

 

[LADoc00]

The problem is this: even with a VERY active Hepatobiliary service, the number of difficult liver cases you really see vs. say difficult Endobronchial biopsies is miniscule.

What you are talking about is non-neoplastic liver essentially: PSC and PBC. You arent sending UCSF your Chronic Viral Hep cases or any neoplastic stuff outside of a well differentiated HCC. Yes there are tons of rare entities in the liver: storage diseases, infectious things, but essentially you are spending a fellowship year, which is INSANELY valuable, to cover a small number of entities.

The GI focus is a simple marketing ploy, of course liver is much harder when it is hard, but GI docs like GI trained people and GI$ is your bread and butter.

Ive begun to rethink my opinion of different non-boarded fellowships and while still believing that GU is by far the best, I would move Pulmonary up alot. There are just WAY the hell too many difficult endobroncial biopsies for non-neoplastic interstitial fibrosing disease and the consulting side of Pulmonary is insanely lucrative (for biopharma that is).

A good practice built from the ground up would be:
1xHeme, 1xCyto, 1xDerm, 1xGU, 1xGI and 1xPul but considering vast majority of the hospitals are 150-250 beds which could support 4 pathologists then the Heme, Cyto, Derm and GU team would be the base.

NOTE: of course, the best pathology group would be 4xbad azz pathologists but this is assuming all else is equal.

Other random thoughts on the matter:
~There is a niche for female gyn pathologists, someone who can go out and really smooze with gyn clientele for cervical biopsies/paps/ECCs and EMBs.
~There is also a niche for AP/SurgPath/Neuropath in very large groups >15. The key here is doing a full surg path year after NP. I would suggest forgoing CP to keep the time down to a bearable amount. Personally, I would change NP to one year and close all low volume fellowships.

 

[triguy]

I am very pleased with how drinking large amounts of beer has entered into the discussion of liver/GI fellowships, as they are intimately related. Bottoms up!

 

[DarksideAllstar]

I am very pleased with how drinking large amounts of beer has entered into the discussion of liver/GI fellowships, as they are intimately related. Bottoms up!

My thoughts exactly, but then again when EtOH is involved its almost a lock its gonna be a good time (aside from driving, of course).

 

[yaah]

I don't get why pulmonary fellowships aren't more popular. Here we have one with one of the best pathologists in the world and not much interest. I considered doing it for awhile, in place of general surg path, because there is so much overlap, then apply for GU. But they gave me GU so I didn't do it. The thing about pulmonary is that every medical pulmonary biopsy is difficult unless:

1) All they biopsy is cartilage or blood clot, in which case it's easy
2) There are some granulomas, at which point you can stain it and sign it out
3) It's obvious cancer.

Everything else is tough (which is over half of the transbronchs and all of the medical lung open bxs). But it isn't marketable because the volume is not so high out of the large academic centers, and even then it isn't that high. But even pulmonary pathologists say that it isn't a marketable subspecialty, although they also say that none of them have trouble finding a job because they are usually excellent pathologists. As I have said before, this is a factor that is often overlooked by young trainees when it comes to job related issues: Being a good pathologist is important. Even more important than fellowships!

I went and looked at job postings out of curiosity, it seems like the majority of the ones looking for "GI" are looking for someone with "GI interest or expertise" and less than half of them ask for a "GI fellowship." Personally, I plan to spend a lot of my fourth year and fellowship year learning about GI also, but not doing a fellowship in it.

 

[djmd]

IThe thing about pulmonary is that every medical pulmonary biopsy is difficult unless:

1) All they biopsy is cartilage or blood clot, in which case it's easy
2) There are some granulomas, at which point you can stain it and sign it out
3) It's obvious cancer.

I haven't been following medical pulm, but are people pushing specific DXs on trans bronchs? I thought wedges were needed?

 

[yaah]

I haven't been following medical pulm, but are people pushing specific DXs on trans bronchs? I thought wedges were needed?

Well, a lot of that is probably the culture here. On almost every medical lung case, they do a transbronch and do a lavage and biopsy. Even if the radiology shows an interestitial process. They are very stubborn. Transbronchs are good for sarcoid and tumors, not for interstitial disease, yet they try anyway. Usually they get a standard signout which lists pertinent negatives (granulomas, infection, tumors). And then they go to open bx. But you can pick up some things on transbronch like organizing pneumonia or DAD or whatever, so it is useful. Seems like every time I am on the service with lung biopsies we take one or two a day to the pulmonary guy - more than thyroid, head and neck, even soft tissue sometimes.

 

[djmd]

Oh thats what I am used to as well... But the hardness is mostly academic, in that it is mostly rule out the above and some vauge comment regarding fibrosis....


Oh and Yaah, please change you Avatar... the old one has a more pleasing personality... 😀
It Stinks!

 

[LADoc00]

I don't get why pulmonary fellowships aren't more popular. Here we have one with one of the best pathologists in the world and not much interest. I considered doing it for awhile, in place of general surg path, because there is so much overlap, then apply for GU. But they gave me GU so I didn't do it. The thing about pulmonary is that every medical pulmonary biopsy is difficult unless:

1) All they biopsy is cartilage or blood clot, in which case it's easy
2) There are some granulomas, at which point you can stain it and sign it out
3) It's obvious cancer.

Everything else is tough (which is over half of the transbronchs and all of the medical lung open bxs). But it isn't marketable because the volume is not so high out of the large academic centers, and even then it isn't that high. But even pulmonary pathologists say that it isn't a marketable subspecialty, although they also say that none of them have trouble finding a job because they are usually excellent pathologists. As I have said before, this is a factor that is often overlooked by young trainees when it comes to job related issues: Being a good pathologist is important. Even more important than fellowships!

I went and looked at job postings out of curiosity, it seems like the majority of the ones looking for "GI" are looking for someone with "GI interest or expertise" and less than half of them ask for a "GI fellowship." Personally, I plan to spend a lot of my fourth year and fellowship year learning about GI also, but not doing a fellowship in it.

The one thing that ALWAYS seems to go out for consult is Pulmonary. That is a sleeper fellowship, no one talks about but is very useful stuff. I used to bag on it, now no more....

You are absolutely right, unlike every other organ system (save for Neuropath) Pul is either very easy or azz hard. There is no middle ground.

 

[PathOne]

The one thing that ALWAYS seems to go out for consult is Pulmonary. That is a sleeper fellowship, no one talks about but is very useful stuff. I used to bag on it, now no more....

You are absolutely right, unlike every other organ system (save for Neuropath) Pul is either very easy or azz hard. There is no middle ground.

I second that. Pulmonary is often really challenging, and with the right volume, could be both interesting and lucrative in a big way. Also, there's probably the largest # of biopsies per pt.
In addition, advances in radiology will likely increase volume over time, as the rads people find more and more interesting stuff with their fancy machines - but still depend on the path dx for the final verdict.

Yes, pulmonary is a great line of work in my mind. But it would also require a top teacher to learn the stuff. If I was to do it for a living, I would probably donate a arm or a leg to train with Colby at Mayo.

 

[Adrian Cocot]

^^^ I'd second that. Even Andy Churg told me that the best place to spend some time to learn pulmonary would be with Tazelaar and Colby. Although Yousem at UCSF isn't a bad choice either. Those guys seem to be getting a majority of the pulm consults.

As for GI, I'm mildly surprised that nobody ever mentions Robert Riddell's fellowship in Toronto. I mean, the guy does run one of the more popular ASCP courses, and is a frickin' maven.