Can anyone who is training in these fellowships tell us pros and cons of each and versus the other. If you could please share why you did NOT want to do the other one? THANKS🙂
GI vs. Pulm/Critical Care Specialists
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Do you want to be a real doctor or not?
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I keed, I keed . . .
Pros and cons . . .
Well. Do you like mucous or ass hole better?
Kind of shooting from the hip here . . .
From my perspective GI has largely turned into a "scope-based" practice and they try do everything else around their procedure schedule, where as pulm is still more based around the medicine of pulmonary with scopes taking a back seat, but with EBUS on the rise this could change a little (it's becoming SoC for lung cancer staging). Both specialties have to deal with the generalists not thinking enough about a problem and turfing diarrhea or a cough to you. If you can't stand these turfing consults, you shouldn't do either. EVERYONE thinks that you need to scope their patient too, and both Pulm and GI sometimes disagree, so you have to be able to deal with saying no in both. GI has gotten so busy in the procedure area that in many (most?) places they no longer have a primary service. As the critical care guy, you will admit and keep alive the GI patient until they can come in and do their magic. In this respect, critical care is kind of the bitch of GI, but you probably wouldn't want them running your critical illness anyway. As the critical care guy, you (and general medicine to some extent) will take care of GI's liver patients, while they will consult agree the patient does have a ****ty liver and may or may not be a transplant candidate. Scopes make good money - at least for the moment - and this means that GI will have more say in hospital politics somewhere behind the CV surgeons, orthopods, and cardiologists.
I like pulmonary medicine and the more I do the more I like it. I like the imaging. By the time I'm down with fellowship, I'd put my ability to read the lungs on a chest CT against a finishing radiology resident any day of the week. Treatments can be a bit depressing though. We've got steroids and three types of inhalers (sometimes immuno-modulators) but that's it. Usually if your lungs suck, they suck and you can't make them better once scarred. Diagnosis can be hard/challenging (which I do like), but sometimes requires a biopsy that the pathologists can't agree on the diagnosis - so you end up giving a patient steroids and hoping for the best (which I don't find as satisfying). Bronchs are cool and generally safe. You get to do a lot of biospy for lung cancer. EBUS is . . . meh. Some people love and others don't care for it. I think it takes too long, but some of this come in the context of the fact that I usually have 3 or 4 consults pending on the floor while I "waste" 2 hours trying to get enough tissue from a LN for the pathologist to be happy.
Critical care is cool at first but it can get old. If it super excites you now, it will stop. You get paid well to do it. The one thing I DO still like about critical care is that you are still a generalist, but at the extreme ends of the physiology spectrum - you do some ID, some renal, some cards, some GI, some endo, etc. with every MICU patient. I think this kind of keeps you a little more centered as a specialist, and you lose less of your internist reflexes when thinking about problems on the pulmonary side of things. Too often, I think some services like cards or renal forget there is any other organ in the body.
Anyway, GI fellowship looks like HELL, and this is coming from a guy in a busy, busy fellowship in pulm/crit. But the guys once out seem to generally enjoy their work and they get paid well to do it. Pulm/crit doesn't make as much as GI in general, but we do better than most, but you're going to work for every dime of that while covering the MICU. If you're looking for a specialty where you can get off of the pager pulm/crit, it is not.
At the end of the day, you're going to like what you're going to like, or you're just a masochist like me. 😀
Pros and cons . . .
Well. Do you like mucous or ass hole better?
Kind of shooting from the hip here . . .
From my perspective GI has largely turned into a "scope-based" practice and they try do everything else around their procedure schedule, where as pulm is still more based around the medicine of pulmonary with scopes taking a back seat, but with EBUS on the rise this could change a little (it's becoming SoC for lung cancer staging). Both specialties have to deal with the generalists not thinking enough about a problem and turfing diarrhea or a cough to you. If you can't stand these turfing consults, you shouldn't do either. EVERYONE thinks that you need to scope their patient too, and both Pulm and GI sometimes disagree, so you have to be able to deal with saying no in both. GI has gotten so busy in the procedure area that in many (most?) places they no longer have a primary service. As the critical care guy, you will admit and keep alive the GI patient until they can come in and do their magic. In this respect, critical care is kind of the bitch of GI, but you probably wouldn't want them running your critical illness anyway. As the critical care guy, you (and general medicine to some extent) will take care of GI's liver patients, while they will consult agree the patient does have a ****ty liver and may or may not be a transplant candidate. Scopes make good money - at least for the moment - and this means that GI will have more say in hospital politics somewhere behind the CV surgeons, orthopods, and cardiologists.
I like pulmonary medicine and the more I do the more I like it. I like the imaging. By the time I'm down with fellowship, I'd put my ability to read the lungs on a chest CT against a finishing radiology resident any day of the week. Treatments can be a bit depressing though. We've got steroids and three types of inhalers (sometimes immuno-modulators) but that's it. Usually if your lungs suck, they suck and you can't make them better once scarred. Diagnosis can be hard/challenging (which I do like), but sometimes requires a biopsy that the pathologists can't agree on the diagnosis - so you end up giving a patient steroids and hoping for the best (which I don't find as satisfying). Bronchs are cool and generally safe. You get to do a lot of biospy for lung cancer. EBUS is . . . meh. Some people love and others don't care for it. I think it takes too long, but some of this come in the context of the fact that I usually have 3 or 4 consults pending on the floor while I "waste" 2 hours trying to get enough tissue from a LN for the pathologist to be happy.
Critical care is cool at first but it can get old. If it super excites you now, it will stop. You get paid well to do it. The one thing I DO still like about critical care is that you are still a generalist, but at the extreme ends of the physiology spectrum - you do some ID, some renal, some cards, some GI, some endo, etc. with every MICU patient. I think this kind of keeps you a little more centered as a specialist, and you lose less of your internist reflexes when thinking about problems on the pulmonary side of things. Too often, I think some services like cards or renal forget there is any other organ in the body.
Anyway, GI fellowship looks like HELL, and this is coming from a guy in a busy, busy fellowship in pulm/crit. But the guys once out seem to generally enjoy their work and they get paid well to do it. Pulm/crit doesn't make as much as GI in general, but we do better than most, but you're going to work for every dime of that while covering the MICU. If you're looking for a specialty where you can get off of the pager pulm/crit, it is not.
At the end of the day, you're going to like what you're going to like, or you're just a masochist like me. 😀
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jdh, I thought the view of GI fellowship is that while it's not Rheum, it's not Pulm/CC or Cards either.
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Well. Then you'll want to do it in a place where you don't do any hepatology 😉
Livers will kill your will to live.
(It wouldn't be as bad if most of them weren't dirt bags)
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Who...the livers, patients, or the fellows?
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Most liver patients didn't get that way because they are sweet, little old ladies with PBC. 😉
Most O2 dependent patients who go into respiratory failure at 2am in the ER aren't sweet, little old ladies with idiopathic pulmonary fibrosis either. 😱 Your specialty has its fair share and more of people who abused themselves.
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What's your point per this discussion?
I was asked why the GI fellows have a hell of a time in fellowship, and it's the liver patients. And most liver patients are dirt bags. Smokers did the damage to themselves, and while there is a certain amount of overlap between the the dirtbag population, smokers as a group aren't "dirt bag" per se, as much as less eduated and usually poor.
Resp failure patients aren't that big of a deal or a pain in the ass like a bad liver. I take care of both, so I would know.
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Liver pts suck. They did it to themselves, most I've met were also abusive (to family, nursing, etc). It usually isn't their first rodeo. They've had interventions and are on meds but usually non-compliant. They're back in the Unit most of the time due to UGI bleeds from bleeding varices, they may also have hepatic congestion, ESLD, etc etc.
Oh, and they're demanding. They want a TIPS, or maybe, a new liver to burn through.
I'd take an end-stage COPDer over this *******s.
Oh, and they're demanding. They want a TIPS, or maybe, a new liver to burn through.
I'd take an end-stage COPDer over this *******s.
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