Urology vs. Gastroenterology

Discussion in 'Clinical Rotations' started by wes c. adle, Apr 8, 2002.

  1. wes c. adle

    wes c. adle Member
    7+ Year Member

    Oct 21, 2001
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    I'll be an MS1 come Fall and am interested in these two specialities. Can anyone give me any info as far as competitiveness/length of residency, amount of time spent doing procedures, lifestyle, salary,etc?
  2. task

    task Senior Member
    7+ Year Member

    Nov 30, 2001
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    GI is a subspecialty of internal medicine, requring completion of a 3 year internal medicine residency followed by a 3 year GI fellowship. GI has become THE most competitive IM subspecialty -- relatively decent lifestyle for a procedural field (compared to Cards), HIGH reimbursement, and something like 250-300 spots nationally have been key factors. Everybody freaked out a few years ago fearing an oversupply of GIs. The reasons are unclear, but apparently some big-wig GI guy published an article in the Red Journal (AGA journal) that there were too many GIs and there would be no jobs for all of them. So no one out of IM applied, and the field was filled by many IMGs up until 2 years ago. Then, the recs regarding screening c-scopes combined with the ever-widening applications of diagnostic and therapeutic endoscopy made the field hugely lucrative. And applications followed. This time the fellowship accred. body got smart and kept the number of spots small, keeping demand really really high. Fellowship applications ask for Step scores and med school transcripts. I have often said on this board that to get the fellowship you want, you should go to the best IM program you can get into -- names, research, letters, reputation are all key in applying and coming from a name place helps immensely for all these. GIs attraction comes from a mix of very sophisticated endoscopic procedures with the intellectual rigors and cognitive skills of being Internal Medicine trained. Many endoscopic procedures are done for therapeutic puposes (e.g. ERCP with stent placement or stone extraction, ablative procedures, polypectomy, etc. etc.) and to that end the field has (to the chagrin of many GIs :p ) earned a reputation of being a very surgically minded field. GI training is 3 years and procedurall in those 3 years you are trained in upper and lower endoscopic procedures. The more sophisticated procedures they do, known as advanced therapeutic endoscopy or interventional endoscopy, usually require an additional year of training -- but it depends, because some fellowship programs have such high volume that you can get enough "advanced therapeutic" endoscopic cases (ERCP for diagnostic purposes or therapeutic purposes like stenting, stone extraction, lithotripsy, laser procedures, the new endosuture devices, and so on and so forth) under your belt as a general GI fellow that you feel proficient enough not to want further training. At other places, those procedures are given to an advanced therapeutic fellow, so you don't get as much exposure, so if you want to be skilled in them, you do another year. If you want a balance of procedures and medical therapeutics and want to be Medicine trained first, this is a great field to pursue.
    They do VERY well (I've seen starting salaries in the $250K range) and from a lifestyle standpoint, things can be hectic while you are at work. Except for bleeding, there aren't all that many GI emergencies, so there are times you would be up at night, but most of the time you are seeing patients in clinic and on consult and doing procedures during the day. Definitely better than Cards as far as lifestyle.

    Urology is a surgical subspecialty typically requiring 1-2 years of general surgical training and another 3-4 years of Urology. From what I understand, most residencies are going to a 1+4 model or a 1+5 model (1 research year). The field is very small -- something like 200 spots nationally from what I understand. There is a wide spectrum of urological disease, including, oncology, stone disease, obstructive uropathy, incontinence, fertility, transplant, pediatric (congenital and reconstructive as well as some plastics type stuff), some trauma as well as others that I am probably missing. But that's the bulk of it. Because of the small # of spots, the procedural nature of the field, and the pretty good lifestyle after residency (not a lot of urologic emergencies) it is one of the most competitive specialties to get into. One thing is that GU residents are much more laid back and less intense than their general surgical colleagues -- at least the ones I've met. GU is one of the fields that pioneered the use of endoscopy and minimally invasive procedures. In the real world, most private practice urologists spend the bulk of their time doing endoscopic procedures -- you can volume these vs. taking someone to the OR and spending all day on a radical prostate or cystectomy. Not that private guys don't do these, but you need to do a lot to stay competent in these procedures, and for the most part private guys don't exactly volume these procedures. One of my friends in urology training tells me that more and more their "open" procedures are going by the wayside in favor of minimally invasive endoscopic, laparoscopic or external treatments (e.g. shock waves for stones). $$-wise they also do very well, and from a lifestyle standpoint things are very decent -- but remember, this is a surgical field and surgical patients have complications that can happen day or night, so be ready for that.
    nonick123 likes this.

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