Is GI surgery as exiting as it sounds

[drjaymehta]

Hello,

Is GI surgery as exiting as it sounds??

Dont the GI medicine guys take away most of the endoscopic procedural work of the GI surgeons..

Dont the general surgeons eat up most of the simple appendicetomies and hernia surgeries??

then what is so lucrative??

someone told me that the Interventional radiological procedures are now being given to the GI surgeons..

Please cast your views everyone..

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[SocialistMD]

What do you mean, GI surgery? (and what do you mean, "exiting?")

Do you mean upper GI? Yes, most of the endoscopy is done by the gastroenterologists (though, at some centers, it is still heavily invested by the surgeons), but the Heller's, fundoplications, gastric bypasses, complex ventral hernia repairs and hepatopancreatobiliary surgeries belong to the surgeons (by the way, those procedures listed are divided into at least two different general surgery fellowships).

Do you mean lower GI? The initial colonoscopies are done by the gastroenterologists, but the postoperative ones are generally done by their surgeons. The colectomies also belong to the colorectal surgeons, particularly the more distal procedures (LAR, APR). Plus, the colorectal guys get the anorectal work that no one else really wants.

In short, there are three areas of specialization in "GI surgery," and none of them are short of work.

Also, I'm not sure if you are trolling or just new, but making multiple posts with the same question in multiple forums is a violation of the terms of service.

 

[drjaymehta]

oh ****.. I am sorry i was not aware of that rule...will be deleting the other posts today only..

by the way i did mean Gastro Intestinal Surgery Mch..

What I heard was that all the endoscopic procedures like banding, polypectomy, sclerotherapy..etc..are done by GI meds which was earlier a domain of GI surgery...

and things like TIPS, Shunts are all done by the GI surgeons..

 

[SocialistMD]

I'll admit that my career in medicine is still in it's first decade, but upper endoscopy has been the domain of the gastroenterologists since I've been in training and there are no upper GI surgeons starving for a lack of work. If you search the gastroenterology literature, you'll find they have been performing these procedures for quite a while. In fact, I'm not sure endoscopy was ever really predominantly performed by surgeons, but rather that we are the ones intruding into their territory.

 

[Winged Scapula]

oh ****.. I am sorry i was not aware of that rule...will be deleting the other posts today only..

Cursing is a violation of the TOS as well (in some cases). 😉

You cannot delete your posts unless you are an SDN donor; I have closed the post in the GI forum.

What I heard was that all the endoscopic procedures like banding, polypectomy, sclerotherapy..etc..are done by GI meds which was earlier a domain of GI surgery...

and things like TIPS, Shunts are all done by the GI surgeons..

Hate to break it to ya but TIPS are done by interventional radiologists. I hear rumor that surgeons still do shunts. 😉

 

[drjaymehta]

thank you for closing the post...

It will be nice if this discussion continues at this post as will help to clear out a lot of doubts for me and ma friends who are interested for surgery...

thanks again..

 

[drjaymehta]

hey thanks socialist MD..but U know what..there was some other post somewhere, i dont know if on this site..

but it says that even endoscopic bariatric surgery and endoscopic polyp removal is gonna be done by the GI med guys..
is it true??

But I always thought that Bariatric surgery in any form be it endoscopy or laparoscopy was a specialization only for Mch Gastrointestinal Surgeons..

and it was on the same post that we read someone posting that the GI surgeons are gonna be totally out of good work in the future..
it was heavily debated but then too, was hard to gulp..


Anyways, thanks for your nice posts..we hope you keep on posting and guide us..thanks a lot..

 

[SocialistMD]

but it says that even endoscopic bariatric surgery and endoscopic polyp removal is gonna be done by the GI med guys..
is it true??

Only time will tell. They do the polypectomies now, but we have the referral base for bariatric surgery, so we should be able to maintain our hold. We currently have an RCT ongoing with the endoscopic bariatric surgery and the PI is a surgeon. We'll see...

and it was on the same post that we read someone posting that the GI surgeons are gonna be totally out of good work in the future..

Sure, when we have tricorders and don't need to operate, GI surgeons will need a new job. However, no medical or endoscopic advances will be putting GI surgeons' jobs in jeopardy in the forseeable future. How long we continue to let the media direct the future of surgery (NOTES) and how well we maintain control of what is currently ours will determine how much of the pie we can continue to eat and how much we have to give away.

 

[Gastrapathy]

I don't think most NOTES procedures will take hold on the GI side. We may take simple things (along the lines of PEGs, other procedures we already do) but most NOTES require lap surgical skills that we don't have.

In a good center, GI and surg work together. We treat each other's complications and there is relatively little competition.

 

[drjaymehta]

ok..

though GI surgery is a long way to go for me..

I read in an article saying that in 5 years from now..

GI med is gonna be the highest earning med branch and

GI surg is gonna be the highest paid surg branch..

if that is true then man, GI is the way to go..!!!!

surgeons here are already starting endoscopies in private practice..but there is some understand with GI med guys which I m not totally aware of..

Dont these general surgeons eat up GI surgery practice by doing all the hernias and appendictomies, man thats a total GI thingy, aint it..

 

[drjaymehta]

hey and as far as NOTES is concerned...I suppose it has some time before it hits the markets full fledge due to some ethical issues and substantial lack of research on it.....

But i hope it does soon...

 

[Winged Scapula]

ok..

though GI surgery is a long way to go for me..

I read in an article saying that in 5 years from now..

GI med is gonna be the highest earning med branch and

Perhaps. Procedural specialties do pay more. However, in the US, reimbursement continues to go down for procedures. Rad Onc is probably in contention for being the highest reimbursed medical specialty (although it is its own field and not a medicine subspec.)

GI surg is gonna be the highest paid surg branch..

Unlikely. Most true GI surgery (see list above) is paid for by insurance and is not very highly reimbursed. The money makers will continue to be neuro and ortho spine, and plastics.

surgeons here are already starting endoscopies in private practice..but there is some understand with GI med guys which I m not totally aware of..

Surgeons have done endoscopies for years. I'm not sure where you are at, but private practice surgeons doing their own EGD, colonoscopies is VERY COMMON and has been for years. As a matter of fact, in academics its much less common except for colorectal surgeons for surgeons to do their own scopes...they don't get paid extra for it, so why should they? Let GI do them is the attitude.

Dont these general surgeons eat up GI surgery practice by doing all the hernias and appendictomies, man thats a total GI thingy, aint it..

I suppose. But most people who are fellowship trained in Upper GI/Abdominal Surgery are not the least bit interested in doing hernias (which isn't really GI but rather considered abdominal wall) and appys. I'm sure they are glad to leave those to the general surgeon and concentrate on what they trained for.

 

[drjaymehta]

Ok..I am from India..

out here, there are very few good places which offer Mch or a super specialization in GI surgery..and hence, GI surgeons are very few..

they do endoscopies here as well, but only in private practice..not much in Institutions..

However, I do know a few general surgeons who do only hernias and all, though i think the situation is changing..

Have heard that due to lawsuites and claims, a little more than few GI surgeons practice as consultants in private..does that hold true..

Since you are a US graduate, do you have any idea why it is so difficult for FMGs to get into the surgery programs in the US...

 

[drjaymehta]

Here is a list of the endoscopic procedures discovered by surgeons

Polypectomy,

ERCP stenting,

Variceal Banding,

Hemorrhage management,

endoscopic dilatation of sphincter of Oddi..

Is anyone aware if there is any such degree for advanced endoscopic procedure...can a surgeon MS get into any such degree...