GI Fellowship Program Research Articles

Choosing Academic versus Private Practice Careers for US GI Fellows: Cash Is King

Purpose: Choosing between an academic career and a private practice career is a difficult and critical decision for GI fellows. Many complex factors come into play when making this career choice. We conducted a nationwide survey of US GI fellows to identify key demographics and job-related factors to analyze this decision making process. Methods: A survey was emailed to all US GI Fellowship program directors and distributed at several fellows' endoscopy courses. Fellows filled out surveys via one of these two routes only. The survey queried respondents on their personal, educational, professional, and financial backgrounds and goals, and included a free response area where other factors could be addressed. No remuneration was offered for participants. Data was compiled and evaluated via univariate and multivariate analysis. Results: 184/404 (46%) US GI fellows submitted completed surveys. Univariate analysis identified one factor that predisposed fellows to pursue private practice: the perception that an academic salary would not meet their financial needs (p=0.04). Univariate analysis identified 4 factors that predisposed fellows to pursue academic practice: Age >35 years (p=0.003), prior attainment of a Master's degree (p=0.01), advanced fellowship training (p=0.0001), and a perception that academicians worked fewer hours (<60 per week) than private practice physicians (p=0.008). All of these factors except the perception regarding work hours were also statistically significant on the multivariate analysis. If salaries were equal, 108/131 (82%) fellows who answered the question would choose academic practice over private practice (p<0.0001). Fellows selecting academic practice were strongly motivated to publish and conduct research. The desire to teach was not a strong motivator for either group. Surprisingly, existing level of debt, the presence of a positive relationship with a mentor, and research experience were not significant factors in the decision. Conclusion: Salary plays a key role in the decision to pursue academic versus private practice, with those desiring more money strongly favoring private practice. Fellows choosing academic practice tended to be older, plan to pursue advanced training, desire fewer work hours per week, and appear to have a stronger preexisting academic background as evidenced by a high rate of prior graduate study. If salaries were equal in both academic medicine and private practice, the overwhelming majority (82%) of fellows would choose academic medicine.

GI Fellowship programs

GI Fellowship programs

Do Gender Disparities Persist in Gastroenterology After 10 Years of Practice

Cross-sectional studies confirm gender disparity in many aspects of the practice of medicine and surgery. Some data suggest the disparities diminish after 10 yr of practice. This study aims to examine gender discrepancies in income, social, and professional status of gastroenterologists after 10 yr of practice. Prospective, observational, cohort study of gastroenterologists incepted upon graduation from a U.S. GI fellowship program in 1993 and 1995. A 36-item questionnaire was sent to the cohort at 3, 5, and 10 yr after graduation from GI fellowship training. The following are the results of the final, 10th year survey. A total of 168 men and 25 women (mean age 45.5 yr) responded. Men and women were equally likely to be board certified and married, however, women had fewer children. Men earned a mean annual gross income of $375,000 versus$245,000 for women (P= 0.001). After adjusting for practice setting, work hours, practice-ownership, free endoscopy center practice, and vacation time, female gastroenterologists earned $82,000 (22%) less per year than their male colleagues (95% CI $34,000-130,000, P= 0.001). Women were more frequently in academic practice (38%vs 17%), but were less likely to hold the most advanced academic positions. After 10 yr of practice, significant economic, professional, and social disparities persist between male and female gastroenterologists in this cohort. Women were more likely to practice in a setting with flexible work hours, a family leave provision, and in a practice with other women. Initiatives to equalize pay and ensure opportunities for professional advancement for women may diminish the significant practice disparities incurred by women in gastroenterology.

EUS accessories

EUS accessories

GI Fellowship Programs

GI Fellowship Programs

Attitudes and Expectations of the 2006 Incoming GI Fellowship Class Towards Advanced Endoscopic Training (AET)

Background: Rapid technological advancements in endoscopic procedures such as ERCP and EUS have transformed GI practice and training. However, training in these procedures is demanding, and fellowship opportunities are limited. This study aimed to assess attitudes and expectations of the 2006 incoming GI fellowship class towards AET. Methods: A 23 question survey assessing interest in AET was developed and tested on 20 GI fellows and internal medicine residents interested in GI at our institution. Ambiguous questions were modified and the survey was then administered at the ASGE-sponsored First Year Fellows' Endoscopy Course, which was attended by 298 of 415 (72%) 1 st year fellows from accredited GI fellowship programs throughout the United States. Results: Responses were obtained from 252 (85%) of attendees. 183 (73%) expressed interest in AET, 50 (20%) were unsure, and 19 (8%) were not interested. Reasons for interest included “to be a complete gastroenterologist” (72%), marketability (51%), interest in pancreaticobiliary disease (54%), interest in technology (54%), and interest in endoscopic research (21%). Among those interested in AET, 138 (77%) desired both EUS and ERCP training, and 132 (73%) rated access to AET during a 3 year fellowship as important to their fellowship program choice; 114 (64%) and 124 (71%) were not sure of or underestimated the number of ERCPs and EUSs, respectively, required to meet competency guidelines; 62 (34%) and 75 (43%) were not sure how many ERCPs and EUSs, respectively, are performed at their institution annually. 119 (65%) of those interested do obtain some AET during their three year fellowship, yet 130 (72%) do not expect to be fully trained or are not sure. If not fully trained, 115 (64%) said they would then seek alternative ways to learn (e.g. weekend hands-on courses, videotapes, web-based learning) and eventually practice advanced endoscopic procedures. Conclusions: While interest in AET is high among 1 st year fellows, interest in endoscopic research is low. A majority of these fellows are unsure of the recommended guidelines or how many advanced procedures are performed at their institution. Fellowship training directors should consider educating incoming fellows about AET. Moreover, formally structured AET programs should be created to fully train those committed to AET in order to promote more endoscopic research and limit AET in a non-fellowship format.

Can U.S. GI fellowship programs meet American Society for Gastrointestinal Endoscopy recommendations for training in EUS? A survey of U.S. GI fellowship program directors

American Society for Gastrointestinal Endoscopy (ASGE) EUS training and credentialing guidelines exist, but the capability of U.S. GI fellowships to meet these guidelines has not been assessed. To ascertain the capability of U.S. GI fellowship programs to meet ASGE guidelines for EUS training in the context of 3-year and advanced GI fellowships. U.S. GI fellowship programs were surveyed for the presence or the absence, type, and extent of EUS training. Demographics regarding the programs and the program directors were obtained. Data on the annual total EUS volume and data on EUS performed by 3-year and/or advanced-year fellows were collected and analyzed. Ninety-one of 142 contactable GI programs responded (64%); 72% of programs performed >200 EUS/y and thus could train >or=1 EUS trainee/y. For 3-year GI fellows, 55% received less than 3 months of training, with 43% not receiving actual "hands-on" EUS experience, and 61% not learning EUS-guided FNA. The median EUS performed by 3-year fellows was 50 (0-350). Programs that offer advanced endoscopy fellowship had a median advanced-trainee EUS volume of 200 procedures (range, 50-1100 procedures). Of advanced fellows, 20% failed to receive "hands-on" training and 52% performed <200 procedures. We observed a significant difference in the median EUS volume performed by 3-year versus advanced-year fellows (P<.001). Program director variables did not correlate with training EUS volumes. The majority of U.S. GI fellowship programs have established the EUS volume to train at least 1 EUS fellow, per ASGE guidelines; however, most 3-year and many advanced fellows are currently receiving insufficient EUS training.

GI Fellowship Programs

GI Fellowship Programs

GI Fellowship Match Returns

GI Fellowship Match Returns

What Will Be Needed for the New Gastroenterology Fellowship Match to Succeed?

What Will Be Needed for the New Gastroenterology Fellowship Match to Succeed?

Survey of clinical nutrition practices of Canadian gastroenterologists.

Nutrition education is a required part of gastrointestinal training programs. The involvement of gastroenterologists in clinical nutrition once their training has been completed is unknown. The aim of the present study was to determine the practice pattern of gastroenterologists in clinical nutrition and their perceived adequacy of nutrition training during their gastroenterology (GI) fellowship. The Canadian Association of Gastroenterology mailed a survey to all of its 463 Canadian clinician members and 88 trainee members. Components of the survey included knowledge of nutritional assessment and total parenteral nutrition, involvement in a nutrition support service, physician involvement in nutritional assessment and nutrition support teams, obesity management, insertion of gastrostomy (G) tubes and management of tube-related complications, and adequacy of training in clinical nutrition. Sixty per cent (n=279) of the Canadian Association of Gastroenterology clinicians and 38% (n=33) of the fellows responded. Of the clinicians, 80% were practicing adult gastroenterologists with the following demographics: those practicing full time in academic centres (42%), community practice (45%), completed training in the last 10 years (32%) and those that completed training in the United States (14%). Although only 6% had a primary focus of nutrition in their GI practices, 65% were involved in nutrition support (including total parenteral nutrition), 74% placed G tubes and 68% managed at least one of the major complications of G tube insertion. Respondents felt a gastroenterologist should be the physician's consultant on nutrition support services (89%). Areas of potential inadequate training included nutritional assessment, indications for nutrition support, management of obesity and management of G tube-related complications. The majority of clinicians (67%) and trainees (73%) felt that nutrition training in their GI fellowship was underemphasized. The majority of Canadian gastroenterologists are involved in nutrition support. However, this survey demonstrated that nutritional training is underemphasized in most training programs. It is important for GI fellowship programs to develop standardized nutrition training that prepares trainees for their practice.

Formal and Adequate EUS Training Remains Difficult to Obtain in US GI Three-Year Fellowships Despite Strong Demand for Instruction: Results of a Nationwide Survey of GI Fellowship Program Directors

Formal and Adequate EUS Training Remains Difficult to Obtain in US GI Three-Year Fellowships Despite Strong Demand for Instruction: Results of a Nationwide Survey of GI Fellowship Program Directors

Endoscopic colorectal cancer screening—can supply meet demand?

Endoscopic colorectal cancer screening—can supply meet demand?