Customized advanced endoscopy job

[SelfDefecatingJoke]

Hello everyone,

I am currently a GI fellow who wants to do advanced therapeutics.

I have a potential job offer in an advanced therapeutics role that is a bit atypical and I was looking for advice.
The group/hospital I would be joining was open to taking me on but they already have enough people doing ERCP and EUS but wanted someone to fill in the rest of therapeutics (EMR, endoscopic management of Barrett’s, deep enteroscopy, endoluminal stenting,…) along with doing general GI. The job otherwise checks a bunch of the other boxes for me (location and good group) and although I’d prefer to do EUS, I can live without it and I do genuinely find the proposed role interesting. I am however worried that I am cornering myself by not doing ERCP/EUS if ever I want to move and practice therapeutics elsewhere and also whether I am taking on the less well compensated aspects of therapeutics.
Thanks for any advice!

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[Scope guy]

take a job that you can do the full breadth of whatever you are training for. you can get choosy after few years and drop privileges for whatever procedures you don't enjoy. Wouldn't take a narrow scope of practice job as first out of training

 

[cabergoline2]

I am interested in Interventional as well... What are ways to effectively monetize EUS? It pays relatively poorly for the amount of time ,effort and skills. But I enjoy doing it... I want bang for buck as well.. one strategy I heard is to get hospital to pay u more considering the downstream revenue from imaging , chemo and surgery... any other strategy ?

 

[hemosuccus]

Hello everyone,

I am currently a GI fellow who wants to do advanced therapeutics.

I have a potential job offer in an advanced therapeutics role that is a bit atypical and I was looking for advice.
The group/hospital I would be joining was open to taking me on but they already have enough people doing ERCP and EUS but wanted someone to fill in the rest of therapeutics (EMR, endoscopic management of Barrett’s, deep enteroscopy, endoluminal stenting,…) along with doing general GI. The job otherwise checks a bunch of the other boxes for me (location and good group) and although I’d prefer to do EUS, I can live without it and I do genuinely find the proposed role interesting. I am however worried that I am cornering myself by not doing ERCP/EUS if ever I want to move and practice therapeutics elsewhere and also whether I am taking on the less well compensated aspects of therapeutics.
Thanks for any advice!

I'm assuming you are in an advanced fellowship, question, are you comfortable doing all these things they are asking of you? I wouldn't take EMR, balloon enteroscopy, Barretts lightly. Yes many Gen GI can do this but make sure you are comfortable first. How often do you expect these procedures are actually needed by a private group? Get an idea of volumes because otherwise you are just Gen GI and if anything else is there that they don't want to do they will send your way. Who would do these if you didn't? The academic center? Another private group? ERCP is arguably your most profitable skill and you are giving it up. You need to maintain volumes to get good and remain good. EUS will continue to expand in role. IMO if you take up another job it will likely have less advanced therapeutics and more Gen GI rather than less depending on the job.

 

[zargar]

The group/hospital I would be joining was open to taking me on but they already have enough people doing ERCP and EUS but wanted someone to fill in the rest of therapeutics (EMR, endoscopic management of Barrett’s, deep enteroscopy, endoluminal stenting,…) along with doing general GI.

Personally, I think you you are getting the short end of the stick with this arrangement. You will train for a 1-2 years, spending 95% of your time, learning ERCP and EUS, and 5% learning the other advanced procedures (where the volume is generally low, even at large academic centers) - only to to join a practice where they will send you 1-2 enteroscopies a month, 2-3 stents a month and, 1 barrettes ablation every 2 months.
-You will lose your ERCP and EUS skills
-You will barely maintain your skills in the non-ERCP/EUS advacned procedures
-The practice will gain a General GI that will do mainly general GI stuff -
-When you realize that you are not getting the volume of cases that you need to be good at what they are asking you to do, you will have already have lost your skills and will relegate yourself to general GI for the remainding of your career

Personally, an arrangement like that would be a hard pass.