FAST FACTS:
Number of fellowship positions offered in 2011: 383
Competitiveness: Moderate, 65.5 % match rate for US grads
Competitive applicants have: ability to do procedures, electives during internal medicine residency Length of training: 3 years (after completing a 3 year internal medicine residency)
Number of fellowship programs: 157
Number of fellows in training: 933
Number in US Board Certified in Gastroenterology: 12,907
Mean starting compensation: $ 180,000
Mean compensation for all physicians in specialty: $ 246,663
Average work hours per week: 57
GASTROENTEROLOGY IS A SUBSPECIALTY OF INTERNAL MEDICINE dealing with the diagnosis and treatment of diseases and disorders related to the digestive system—the esophagus, stomach, gall bladder and biliary tract, liver, pancreas, and small and large intestines. Traditionally, a significant part of gastroenterology has involved the evaluation of psychosomatic complaints as they affect the gastrointestinal tract, but the introduction of fiberoptic peroral endoscopy and colonoscopy has changed the orientation of this specialty making it second only to interventional cardiology of the internal medicine sub-specialties in procedural activities.
The number of self-designated gastroenterologists tripled from 4046 in 1980 to 12,722 in 2008.1 A mid-1990s workforce study2 predicted a large oversupply and recommended a 25 to 50 percent decrease in fellowship positions over a five-year period. However, factors such as media publicity about the need for early detection of colon cancer has increased the number of patient visits and consultations requested by other physicians and this specialty now is considered to be undersupplied.
Further Information. The American College of Gastroenterology, P.O. Box 342260, Bethesda MD 20827. Telephone: (301)263-9000. Internet address: www.acg.gi.org.
More than any other internal medicine subspecialists, gastroenterologists begin by trying to be nonspecialists. In 2000 10.9% of their patient care time was spent in primary care activities, more than any of the other internal medicine subspecialists 3. All the respondents chose this field during their residencies and were positively influenced by gastroenterologists under whom they trained.
Cardiology was a strong second choice for a career, but respondents indicate that there were "too many already in that field.'' Hospital-based specialties, such as radiology and pathology, have little attraction because they restrict independence and have little patient contact. Surgery and obstetrics are described as "too mechanical and not intellectually challenging enough." One respondent would not want to practice intensive care medicine because "I don't want to be married to a building or practice. I have a hard time refusing care or leaving patients if there is any question of their medical stability.'
Procedures, especially endoscopy, are the most enjoyable aspect of gastroenterology because they allow the physician to ". . . markedly alter a patient's evaluation and/or treatment." There is a sense of accomplishment in technical skill in addition to the intellectual challenges of diagnosis. More gastroenterologists are "dissatisfied" (19.5 percent) and less are "very satisfied" (38.5 percent) than all physicians. 4
"Emotional disorders are hard to manage." Gastroenterologists are frustrated by the "necessity at times to deal with psychophysiological problems without a clear-cut endpoint of success or failure."
Half of each 10 to 12 hour day is spent in the hospital, consulting on patients and performing procedures. Most patients are middle aged or older and are referred by primary care physicians. The most common problem is irritable bowel syndrome.
Those gastroenterologists who restrict their practice to their subspecialty (and don't provide primary care for general medical problems) report infrequent after-hours calls: "I take my own call during the week and rarely have a call. I may have one emergency requiring evening or weekend patient care. This is the benefit of doing 100 percent gastroenterology and no primary patient care."
Respondents report attending courses to learn new techniques and continuing medical education meetings to keep abreast of new knowledge in the field more so than many other physicians.
Unlike most other areas of internal medicine, it is important to have the technical ability to do procedures, especially endoscopy. Coupled with this is the ability to analyze problems and data.
Gastroenterologists describe themselves as "generally less intense than surgeons, but more intense than internists." In addition, they have a supportive attitude toward patients, and are willing to listen to and tolerate patients with "functional" complaints.
"There is the danger of thinking about gastroenterology in terms of procedures. It is important to be a good general internist first since 70 percent of the diagnosis is made through the history with the additional 30 percent supplied by the physical examination and testing procedures."
"I suggest that anyone considering gastroenterology as a specialty should also be aware of the need to be a 'total' physician. The gastroenterologist may see patients with symptoms related to cardiology, pulmonary medicine, or infectious disease and must be able to recognize these when caring for the patient."
Government intervention in medicine, cost factors, and technological advances are all described as challenges. "Decisions must be made on the appropriate use of new techniques and procedures in diagnosis and therapy, particularly considering cost factors."
You can complete the questionnaires and obtain your scores for all specialties online at http://www.sdn.net/schools/selector.
Physician Characteristics and Distribution in the United States, 2010, Chicago, American Medical Association, Table 6.2, p. 439.
Meyer GS, Jacoby I, Krakauer H, Powell DW, Aurand J, McCardle P. Gastroenterology workforce modeling. JAMA 1996;276(9):689-694.
Physician Socioeconomic Statistics 2000-2002 edition. American Medical Association, Figure 26, p. 102.
Leigh JP, Kravitz RL, Schembri M, Samuels SJ,, Mobley S. Physician career satisfaction across specialties. Arch Intern Med 2002; 162:1577-1584.