GI Hours/lifestyle

[sm522]

I'm a medical student exploring my options and I discovered I really like GI, but work-life balance is an important factor for me. I'm wondering what the work schedule would look like practicing in a non academic setting (ie hospital employed or private practice). I have no interest in academic medicine. I know it's not considered a "lifestyle" specialty like derm or allergy, but it doesn't seem as intense as surgery or cardiology. Is having an 8-5 schedule (not including call of course) possible in GI in a non-academic practice?

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[Scope guy]

I do 7 to 3 schedule(sometimes done 2.30) weekdays and call 1 in 6 weeks. non academic hospital employed practice

 

[cholangitis]

There are a lot of different employment models for GI. You can work 7-7 followed by 7 days off as a GI hospitalist. You can do private practice doing 8-5 type of deal M-F with weekend and weekday calls sprinkled or even choose to work 3-4 days a week. This will all be based on what kind of gig you find and how much you want to make. GI Is a competitive specialty because it’s a good balance of everything (including paying very well.

 

[ShiShiMD]

GI has one of the best life styles and pays. It all depends on the group, setting and volume. Some months like spring and summer are busy.

 

[painballer27]

I do 7 to 3 schedule(sometimes done 2.30) weekdays and call 1 in 6 weeks. non academic hospital employed practice

Approximate income?

 

[hemosuccus]

Approximate income?

 

[Scope guy]

Approximate income?

75th percentile

 

[sallyhasanidea]

75th percentile

Did you start at this or is this as partner? What area of the country? Do you find jobs with your hours + salary readily available?

 

[Scope guy]

Did you start at this or is this as partner? What area of the country? Do you find jobs with your hours + salary readily available?

2 years in, midwest. straight employed

 

[JP2740]

2 years in, midwest. straight employed

Is this in a competitive location? Sounds amazing

 

[Scope guy]

Is this in a competitive location? Sounds amazing

not competitive. city of 150k, hour away from big metro in midwest.

 

[1Cor1557]

not competitive. city of 150k, hour away from big metro in midwest.

the primo real estate to practice.

 

[aafisahar]

the primo real estate to practice.

Ya if you think Chipotle and trolling for ladies of Walmart is your thing

 

[ShuperNewbie]

Ya if you think Chipotle and trolling for ladies of Walmart is your thing

LOL This is clearly someone who hasn't spent time in a small-mid sized town? Or... even a suburb lol? 150k is pretty big my dude. To put it into perspective, New Rochelle, NY has a population of 79k. And the entire student body of UCLA is about 45k. Penn State has about 98k people. @Scope guy seems like he has a sweet gig. Mid sized town in close proximity to a major city. Having lived in NYC for quite some time, I'm... pretty tired of it and would be super down to live somewhere smaller

 

[1Cor1557]

Ya if you think Chipotle and trolling for ladies of Walmart is your thing

If making top dollar in a kingdom all to yourself when you still have easy access to all the amenities of a large cosmopolitan Metro within reach is your thing.... I wouldn't know I'm in downtown of a city near 2 million but I do get jealous

 

[Scope guy]

LOL This is clearly someone who hasn't spent time in a small-mid sized town? Or... even a suburb lol? 150k is pretty big my dude. To put it into perspective, New Rochelle, NY has a population of 79k. And the entire student body of UCLA is about 45k. Penn State has about 98k people. @Scope guy seems like he has a sweet gig. Mid sized town in close proximity to a major city. Having lived in NYC for quite some time, I'm... pretty tired of it and would be super down to live somewhere smaller

stumbled into this job as my top choice went with the other guy who interviewed there. So far happy. Zero traffic, not bad COL, taxes in this state is okay. I sometimes wish I can work more, but hampered by constraints in the practice.

 

[1Cor1557]

stumbled into this job as my top choice went with the other guy who interviewed there. So far happy. Zero traffic, not bad COL, taxes in this state is okay. I sometimes wish I can work more, but hampered by constraints in the practice.

Do you mean they won't add clinic or Endo spots you ask for? If no, why not?

 

[Scope guy]

Do you mean they won't add clinic or Endo spots you ask for? If no, why not?

practice has a set pace, turnover times, that cant be fixed

 

[ShiShiMD]

practice has a set pace, turnover times, that cant be fixed

Turn over time it actually depends on how well your nurses, staff and technician is trained also.

I here many places do not have trained GI technicians or even trained GI - endoscopy nurses or NP's so they crossing the surgery staffs,

It is in the best interest of the hospitals to train these staff in endoscopy and gastroenterology services.

Some places turn overtime for upper endoscopy is over 1 hour for non moderate sedation, so if anyone falls in to this, get the CEO or CMO of the hospital to make sure your nurses, technicians get the adequate training

 

[nolayup]

How feasible is it to have a 3 day work week in GI? Not concerned on income.

 

[1Cor1557]

How feasible is it to have a 3 day work week in GI? Not concerned on income.

It can be done but be mindful alot of partnership and employed opportunities are not interested in 0.5 FTE positions, places have staffing needs and most aren't only 3d/week, so will narrow your options, but if look wide enough, maybe.

 

[Scope guy]

How feasible is it to have a 3 day work week in GI? Not concerned on income.

can easily find employed positions. difficult in partnership

 

[nolayup]

Thanks for the replies. I see a few postings for 4 day work week positions on the NEJM listings. Hoping for good quality of life in the near future.

 

[hemosuccus]

Thanks for the replies. I see a few postings for 4 day work week positions on the NEJM listings. Hoping for good quality of life in the near future.

4 is very common, most places give one to two half days sessions for admin/ protected time even as full time (1.0 FTE). Some academic places even offer 3 half day sessions protected for clinical/ non-research faculty and still count as 1 FTE! With a resultant significant pay cut.

I don't think 3 days is very hard to find, what I'd be wary of a a place that allows 3 days a week, is part time without benefits, and you spend an additional 2 half day (uncompensated) doing work that would've been protected ergo you work 4 days but don't get the benefits/ salary/ protection- you can imagine why this may be attractive to some employers.

 

[cabergoline2]

the commonest i heard is 4-4.5 days a week..

@Scope guy do you do ERCP/EUS ? if so does that give you any bargaining chips with partners ?

BTW How common is to look for investing in ASC/endo center in early career ?

 

[Scope guy]

the commonest i heard is 4-4.5 days a week..

@Scope guy do you do ERCP/EUS ? if so does that give you any bargaining chips with partners ?

BTW How common is to look for investing in ASC/endo center in early career ?

4 day work week positions are not hard to find.

I dont do advanced scopes. In private practice, it might be a bargaining chip if the group has to refer advanced patients to outside practice and end up losing the patient to a competing practice in town. Most PP are looking for ERCP certified ones so they dont have to cover biliary call for you. But the volume for EUS is questionable and reimbursement has been cut in the past 2 years. Most advanced are best done in the hospital endoscopy so reimbursement is better.

Just like any investment, look at the books, make sure you have clear path to profit before doing ASC investments. most PP will offer after 2 years but you can negotiate to 1 -1.5 year

 

[Meowster007]

4 day work week positions are not hard to find.

I dont do advanced scopes. In private practice, it might be a bargaining chip if the group has to refer advanced patients to outside practice and end up losing the patient to a competing practice in town. Most PP are looking for ERCP certified ones so they dont have to cover biliary call for you. But the volume for EUS is questionable and reimbursement has been cut in the past 2 years. Most advanced are best done in the hospital endoscopy so reimbursement is better.

Just like any investment, look at the books, make sure you have clear path to profit before doing ASC investments. most PP will offer after 2 years but you can negotiate to 1 -1.5 year

Hey sorry for the late question- incoming med student possibly interested in GI- do you know for your colleagues or yourself the chance of malpractice and the estimate insurance pay for that? (rough figure?) I understand surgery is higher than medicine- was curious for procedural speciliaties that arent surgery such as GI! Thanks

 

[hemosuccus]

Should goo

Hey sorry for the late question- incoming med student possibly interested in GI- do you know for your colleagues or yourself the chance of malpractice and the estimate insurance pay for that? (rough figure?) I understand surgery is higher than medicine- was curious for procedural speciliaties that arent surgery such as GI! Thanks

Can google this. What would you do with this info? Is this a reason now to do GI/ Surgery?

 

[Meowster007]

Should goo

Can google this. What would you do with this info? Is this a reason now to do GI/ Surgery?

Just wondering- adds to pros and cons of specialities

 

[hemosuccus]

Just wondering- adds to pros and cons of specialities

Reasonable to add on to a pro/ con list, but this really shouldn't sway you in any meaningful way IMO. If you liked GI and Gen Surg exactly the same amount in every way and this was the tie breaker question... it would not anything meaningful to your list.... hence I wouldn't worry about it. From a pay standpoint probably the few places where this is meaningful is in a specialty like Ob/ Gyn (super high risk ). The training and lifestyle is pretty different between surgery and IM subspecialities (though the pure advanced endoscopists resemble the surgeons more closely than any other IM subspecialists- but you really can't know that this what you'll do as a med student), go for what interests you and what you see yourself doing long term. Despite what I hear from med students, I am always surprised by those who say they are between GI and Gen Surg, or GI and Cards even, during my time I often saw these as mutually exclusive. Curious to see what others think.

 

[Meowster007]

Reasonable to add on to a pro/ con list, but this really shouldn't sway you in any meaningful way IMO. If you liked GI and Gen Surg exactly the same amount in every way and this was the tie breaker question... it would not anything meaningful to your list.... hence I wouldn't worry about it. From a pay standpoint probably the few places where this is meaningful is in a specialty like Ob/ Gyn (super high risk ). The training and lifestyle is pretty different between surgery and IM subspecialities (though the pure advanced endoscopists resemble the surgeons more closely than any other IM subspecialists- but you really can't know that this what you'll do as a med student), go for what interests you and what you see yourself doing long term. Despite what I hear from med students, I am always surprised by those who say they are between GI and Gen Surg, or GI and Cards even, during my time I often saw these as mutually exclusive. Curious to see what others think.

Thanks for the insight! Def gonna be looking forward to keeping an open eye for everything!

 

[robellis]

GI is unreal in terms of lifestyle and income..they make 700k for 40 hours per week of work..absolutely unreal

 

[hemosuccus]

GI is unreal in terms of lifestyle and income..they make 700k for 40 hours per week of work..absolutely unreal

And the procedures seem fun without many emergencies that need immediate intervention!

GI is definitely one of the best IM subspecialties and there are many reasons to be positive on the outlook, but this comment is definitely not accurate. The reason it is unreal... is because it is not real. None of the private guys I know are not working 40 hrs to make 700, they are working more hours for much less than this, and much of it (like everyone) is uncompensated- path letters, patient messages/ calls etc. For most in academics it is less than half that. Could you make 700? Yes, 8?9? 1 mil+? Yes, there are folks out there doing it, and working accordingly. 40 might be what you do on paper- and of course anyone who says 40 automatically means no call. There are hospitalists who take extra shifts in their off weeks and make more than gastroenterologists, and still end up with 4 times the amount of vacation- so many ways to look at this. However, the point is well taken, GI is amongst the better compensated and in the right setup you can find reasonable work-life balance. The threats to the profession have been discussed here multiple times but should not dissuade anyone.

However, anyone who thinks GI doesn't have emergencies that need immediate intervention is wholly uninformed and should be dissuaded. There are plenty of all outpatient/ no-call jobs out there, if that's what you end up choosing to do (definitely less fun though)

 

[robellis]

GI is definitely one of the best IM subspecialties and there are many reasons to be positive on the outlook, but this comment is definitely not accurate. The reason it is unreal... is because it is not real. None of the private guys I know are not working 40 hrs to make 700, they are working more hours for much less than this, and much of it (like everyone) is uncompensated- path letters, patient messages/ calls etc. For most in academics it is less than half that. Could you make 700? Yes, 8?9? 1 mil+? Yes, there are folks out there doing it, and working accordingly. 40 might be what you do on paper- and of course anyone who says 40 automatically means no call. There are hospitalists who take extra shifts in their off weeks and make more than gastroenterologists, and still end up with 4 times the amount of vacation- so many ways to look at this. However, the point is well taken, GI is amongst the better compensated and in the right setup you can find reasonable work-life balance. The threats to the profession have been discussed here multiple times but should not dissuade anyone.

However, anyone who thinks GI doesn't have emergencies that need immediate intervention is wholly uninformed and should be dissuaded. There are plenty of all outpatient/ no-call jobs out there, if that's what you end up choosing to do (definitely less fun though)

There’s a GI in this exact thread who says that is his setup..40 hrs per week making around 700k

 

[cabergoline2]

GI is unreal in terms of lifestyle and income..they make 700k for 40 hours per week of work..absolutely unreal

this is an oversimplification ... It is a great specialty and I am sure many people with the above profile exist. But it only coveys part of the story. You are not going to graduate fellowship and have the above profile the next day. It probably took them 4-5 years of 60-70 hours work week sometimes more of slogging to get anywhere close to what you mentioned... That level of income work hour ratio usually means decent amount of ancillary revenue stream from shares in ASCs , infusion centers etc... A more realistic picture out of fellowship is 450-500 with 60-70 odd hours of work... chop of 75k if its in a big city ... add 100k if it is rural...

 

[hemosuccus]

There’s a GI in this exact thread who says that is his setup..40 hrs per week making around 700k

There's bookseller with a net worth of 200 billion, might want to look him up, Jeff Bezos. n of 1 is not n=all or even average, hence the length/ nuance/ detail of the post... and many others in this forum from folks who went thru the process, and the MGMA data, and Medscape physician surveys, or the Merritt Hawkins repo- oh why do I do this to myself.

 

[cabergoline2]

I however think that we should very much take money and lifestyle x account while making specialty choices. Medicine is the only branch of human endeavor (besides maybe politics) where money is a taboo word... An average GI begins practicing when is reaches early/Mid 30s ..At that stage in career a good engineer /coroporate fat kat , will have a base pay of 300k+ with stock options... the stock options is the key... I know for a fact that top of the ladder conputer engineers in silicon valley/ east coast retire with net worth of 15-20 million dollars..Docs of no specialty routinely make that much...sure exceptions exist... but on an average we have not figured out a good way to monetize the years of blood and sweat we give to patient care... I do believe that we need a lot lot lot more discussion on money in medicine...

 

[Osteoth]

I however think that we should very much take money and lifestyle x account while making specialty choices. Medicine is the only branch of human endeavor (besides maybe politics) where money is a taboo word... An average GI begins practicing when is reaches early/Mid 30s ..At that stage in career a good engineer /coroporate fat kat , will have a base pay of 300k+ with stock options... the stock options is the key... I know for a fact that top of the ladder conputer engineers in silicon valley/ east coast retire with net worth of 15-20 million dollars..Docs of no specialty routinely make that much...sure exceptions exist... but on an average we have not figured out a good way to monetize the years of blood and sweat we give to patient care... I do believe that we need a lot lot lot more discussion on money in medicine...

Nobody could have predicted the rise of tech to what it is today.

Corollary to this is we should all have been able to predict the demise of healthcare reimbursements. We were just not smart enough to see that far ahead.

 

[cabergoline2]

In tech /finance etc the total compensation = basepay (sweat equity) +bonus + stock options... In a country like US ownership of equity == security... In medicine if you are employed all you make is basepay + rvu bonus... there is no equity ownership because of which we don't enjoy rise in wealth proportionate to growth of economy / stock market. We are effectively blue collar workers.. What we make is only the sweat equity or the hours we put in... very few folks have been able to break these chains...

 

[hemosuccus]

I however think that we should very much take money and lifestyle x account while making specialty choices. Medicine is the only branch of human endeavor (besides maybe politics) where money is a taboo word... An average GI begins practicing when is reaches early/Mid 30s ..At that stage in career a good engineer /coroporate fat kat , will have a base pay of 300k+ with stock options... the stock options is the key... I know for a fact that top of the ladder conputer engineers in silicon valley/ east coast retire with net worth of 15-20 million dollars..Docs of no specialty routinely make that much...sure exceptions exist... but on an average we have not figured out a good way to monetize the years of blood and sweat we give to patient care... I do believe that we need a lot lot lot more discussion on money in medicine...

Fully agree. I think we are seeing this in medicine in some respects with physicians wising up about personal finance, but corporate medicine seems an impossible beast to change. Do you think the answer is in equity for doctors?

At the same time, medicine will always be different, there will always be an element that mandates some service and selflessness and can't have the rigidity of a pure business enterprise. I realize this is always how the admins see us and take advantage of this I guess. It is also why APP scope creep is acceptable, and this talk of 'hours of clinicals' by the NP organizations to suggest equivalence. What do you think?

 

[cabergoline2]

Physicians have been too bogged down and brainwashed by scams like "empathy" , "consicentiousness" , "putting service before self" or whatever the buzzword of the day is to describe underpaid labor...

 

[adagio]

Great discussion. I am both gi and advanced endo trained. Scope guy description is pretty accurate. However one in six can be cumbersome. I do one in 2 for advanced and pretty much come to the hospital for an ercp almost every Saturday I'm on. I still do one in seven general gi call but my partner and I are going to negotiate being out of it because it's getting too much. Unfortunately despite the advanced training I get paid the same as gen gi however I have much more control on my clinic and endo slots.

 

[slopes23]

Great discussion. I am both gi and advanced endo trained. Scope guy description is pretty accurate. However one in six can be cumbersome. I do one in 2 for advanced and pretty much come to the hospital for an ercp almost every Saturday I'm on. I still do one in seven general gi call but my partner and I are going to negotiate being out of it because it's getting too much. Unfortunately despite the advanced training I get paid the same as gen gi however I have much more control on my clinic and endo slots.

When you say you have a lot more control over your clinic and ends slots, can you be more specific as to what this looks like and why you find it personally valuable?

 

[adagio]

This is a good question. For example, no patient gets placed in my clinic without me approving. I see no patients other than Interventional endoscopy patients: this is either discussion for Interventional procedures, pancreas-related cases, or follow up after procedures. For my endoscopy slots, I decide how long the procedure lasts. I never cram my schedule. For klatskin cases ercp I dedicate at least 90 minutes at times 2 hours if all the sectors separate. For large resections, I book at least an hour sometimes 2 hours depending on the location of the lesion. I never do a procedure I'm not convinced of its indication. I worked in the past in a very major Academic Center. I was at times pressured to do cases I didn't necessarily feel indicated just to appease an oncologist or a surgeon because if they're not appeased they will either send all their other referrals somewhere else whether in the city or to other colleagues. This is not the case here, I decide what needs to be done and what I find ethical or useful for the patient. Now, this does not translate to more pay but it translates to peace of mind and I value that a lot.
However, I do work hard and I venture to say harder than the general GI colleagues. While they work 8:00 to 5:00 my phone is always on even on weekends I get calls from doctors all over the state on any day anytime even when im off (rarely i am off, by choice really!). If I get a call this may not generate a procedure for me, as all they may need is just advice. I may even spend a significant amount of time coordinating care so that the patient gets a procedure I do not offer with the right person in the referral center a couple of hours away. So there's nothing perfect, and I certainly do not make a million dollars however independence for me is very valuable.

 

[slopes23]

This is a good question. For example, no patient gets placed in my clinic without me approving. I see no patients other than Interventional endoscopy patients: this is either discussion for Interventional procedures, pancreas-related cases, or follow up after procedures. For my endoscopy slots, I decide how long the procedure lasts. I never cram my schedule. For klatskin cases ercp I dedicate at least 90 minutes at times 2 hours if all the sectors separate. For large resections, I book at least an hour sometimes 2 hours depending on the location of the lesion. I never do a procedure I'm not convinced of its indication. I worked in the past in a very major Academic Center. I was at times pressured to do cases I didn't necessarily feel indicated just to appease an oncologist or a surgeon because if they're not appeased they will either send all their other referrals somewhere else whether in the city or to other colleagues. This is not the case here, I decide what needs to be done and what I find ethical or useful for the patient. Now, this does not translate to more pay but it translates to peace of mind and I value that a lot.
However, I do work hard and I venture to say harder than the general GI colleagues. While they work 8:00 to 5:00 my phone is always on even on weekends I get calls from doctors all over the state on any day anytime even when im off (rarely i am off, by choice really!). If I get a call this may not generate a procedure for me, as all they may need is just advice. I may even spend a significant amount of time coordinating care so that the patient gets a procedure I do not offer with the right person in the referral center a couple of hours away. So there's nothing perfect, and I certainly do not make a million dollars however independence for me is very valuable.

Sounds like the hospital group who employs you is lucky to have you. You seems like you are earning every penny of whatever it is you earn, even if not $1MM. It seems to me like you value autonomy and freedom quite a bit, I’m curious if you have thought about starting your own practice to gain these? If you have, what made you decide against it? It sounds like you are either direct hospital employed or part of a hospital based group, but hard to be sure. Just trying to get a sense for different practice structures and what goes with them.

If you’re open to it, I’d be interested in learning roughly what your total compensation is? Given the niche nature of your setup, while I have no clue who you are, I wouldn’t ask you to mention this on a public forum in the event someone recognizes your practice set up. If you prefer not to disclose I understand, however. As someone interested in advanced endoscopy, you bring up a lot of important details to consider when thinking about pursuing an advanced year.

 

[adagio]

Going into private practice as a therapeutic endoscopist will certainly be more challenging. First it requires certain savior faire re business aspects of Medicine which I must confess I'm completely ignorant of. I spend all my free time reading in Medicine or writing and I never had the inclination to develop this angle.
To me, one can not serve two masters. Furthermore, private practice cannot provide the loss leader backup an employed health system set up does. I have friends who are therapeutic endoscopists in pp set up subsidized by their large groups, and still they cannot be purely focused on their speciality and are asked to do lots of gen gi.
It would have been a nice thing to be an independent contractor for a big hospital but this is very very rare as all want their hired docs to cut on expenses. I generate lots of revenue to the hospital in tangible and intangible downstream revenue, let alone helping patients avoid long travel to solve a problem or save an organ, however admins don't care. Last year I did a 3 hour colonoscopy to remove an 9 cm circumferential polyp in the transverse colon, used multiple knives and snares and about 18 clips in addition to a special closure device, patient came back last week with no recurrence. To admins, if I had bailed and sent the patient to our surgeon the system would have definitely made much more money. A pp will not tolerate many of these procedures I can tell you that with confidence, your managing partner will have the "talk" with you and you won't survive for long with your pp group.
My situation is somewhat unique from a personal angle too: I'm single without dependants or debt so less worried about negotiating the highest salary possible. I have solid academic and non academic connections and can find a job very very easily if I get bothered and admins know that very well. While I wont share the actual number I'll tell I get paid 70th percentile of a general gi in the region and most of the general gis in practice will get shy of a double more of what I'm getting once they become partners.

 

[slopes23]

That’s a super helpful/thoughtful response and I appreciate the insight into your experience.

I suspect the unique aspect in your situation, is your willingness to take q2 call. I wonder if there wouldn’t be a large enough pp out there that covers enough volume to where they could provide you with similar wingspan to operate as you see fit recognizing the value of having therapeutics consistently covered. It would largely depend on the practice set up, but I can imagine more than a few scenarios where it would be worth it’s weight in gold to have someone like you. I don’t know this for sure, but my intuition tells me that most people including advanced guys don’t like sustaining that sort of call burden for the long term and would be willing to reimburse handsomely those that do. I perceive you having a substantial amount of unused leverage from a compensation standpoint in that respect but perhaps I have a skewed perception of the marketplace. Additionally, it sounds like you are likely exercising that leverage by pulling other levers that are important to you from a scheduling standpoint which is important and maybe evens out, as you said tough to have it all.

 

[adagio]

great comment. Its out of need to concentrate the volume. Otherwise, if i have 7 ERCPologists doing call they will also need to do it during the week to keep their skills. In my opinion, and after discussion with several high-level ERCPologists, for a serious interventional endoscopist, the minimum number to keep high-level skills for yearly ERCP is 250-300. Our hospital volume is 600-700 per year so we have to accept a more frequent calls if we are to keep our skills up.
This is a long subject and may warrant a post somewhere else, but I personally would not want my family member treated by a low-volume interventional endoscopist. some sacrifice is needed, and this sacrifice here is more frequent calls. Another option is to go the Dutch way, and have a few centers in every state that offer the service but this deprives patients that live far from the service (there are models that could be implemented to facilitate access to such centers as they exist in Europe, but this is very difficult in the US for many reasons). This is a digression, but all these issues should be thought of before choosing a career as a therapeutic endoscopist IMHO.

 

[IM2GI]

for a serious interventional endoscopist, the minimum number to keep high-level skills for yearly ERCP is 250-300. Our hospital volume is 600-700 per year so we have to accept a more frequent calls if we are to keep our skills up.

That is very high. Trying to target that number will only increase angst and anxiety for new advanced grads trying to "get their numbers." Would also further saturate the job market for new advanced grads.

 

[adagio]

I respectfully disagree. To be an all rounded highly skilled therapeutic endoscopist 250 is needed based on innumerable conversations I had with leaders in the field, nationally and internationally and based on my own experience. To be a non-lethal ercpologist 150 is the minimum. Clearly these are averages and some exceptionally talented people may need less but the number of devastating complications I have seen and dealt with attests to the fact that many are doing procedures that they shouldnt be doing. Similarly, I have seen my share of missed cancers from non focused endoscopists who just "picked eus up" to do simple biopsies.
150 is the consensus number for minimal simple ercp basic competency and some argue that 2 to 3 native papillas per week should be within that minimum. Unfortunately the literature on this is weak and all over the map.