Endoscopy Future: Need Advice

[Redpancreas]

It seems inevitable that the routine screening colonoscopy will not be done as commonly. I am interested in GI because of the diversity of pathology, I want to learn to do scopes, and I want to medically manage patients. The diversity is amazing and you can deal with psych stuff (IBS/GERD), motility disorders, autoimmune processes, cancer, and behaviorally induced pathology. That said, I really want to earn a good income and work as many hours as needed and prioritize lifestyle less to prioritize income. I was wondering if someone could answer the following questions.

1.) Is doing a 7th year (opportunity cost of 230k) an effective safe guard against the diminishing routine endoscopy. I really like the very simple ultrasound guided procedures I have done so far and feel I would enjoy learning ERCP/EUS, but what do those who have done GI feel about this?

2) Do you feel like routine screening colonoscopy will diminish? I read an AGA opinion article projecting that lowered testing due to the pill endoscopy will be offset by the fact that pill will attract more people and some in higher risk groups will need the actual colonoscopy. Will that happen?

3.) I’m not afraid of working long hours and was at one point considering an IC/PCCM/surgical residency. Would hustling and finding ways to increase income (more hours, etc) make up for the possible drop in GI income we may see in the future?

4.) Another source mentioned that the advanced endoscopy procedures significantly increases your employability according to 92% of new GI physicians (i.e. more areas I’m eligible to work in with my spouse), but doing these procedures full time would also simultaneously decrease your salary. Do you feel like this is accurate?

I would love any answers to this. Feel free to PM me too.

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[IM2GI]

1. No. EUS is a loss leader for hospitals. Advanced market is saturated.

2. Probably. Who knows how this new age 45 recommendation will play out. Cologuard is a mediocre test but patients and PCPs seem to like it so its a threat. Regardless theres no question that reimbursment will continue to go down and overhead/expenses will continue to go up.

3. Typically there are ways to supplement your income, depends on your group model

4. No I dont think so. By the time you are done there will be even more young advanced people out there. If all you are doing is standard EUS/ERCP unlikely. There may be a market for some of the new endoscopic bariatric procedures, ESD, POEM. Again though you make money on the secondary income those patients generate so needs to be a part of a large system with a stipend from the hospital to support it. The bariatric stuff is all cash pay right now too which is challenging.

 

[funkreatitis]

Great answer above, from what I have heard:
1. Some people are hedging that EUS etc will broaden its access like IR has, and with time bariatrics will be a big player, but I think right now its just a gamble
2. Colonoscopy has continued to be validated as the best thing to get, but there's already 6 tests (5 if you take out flex sig) and more on the way. The idea, as IM2GI mentions is to try to increase the rate of screening (by any modality) to offset this.

4. I don't know the origin of the "92%" statistic, but if you look at the ASGE survey, the numbers paid a different picture. There is indeed a lot of difficulty finding advanced jobs, as IM2I said, its a saturated market, and the survey backs that.

 

[Anicetus]

It seems inevitable that the routine screening colonoscopy will not be done as commonly. I am interested in GI because of the diversity of pathology, I want to learn to do scopes, and I want to medically manage patients. The diversity is amazing and you can deal with psych stuff (IBS/GERD), motility disorders, autoimmune processes, cancer, and behaviorally induced pathology. That said, I really want to earn a good income and work as many hours as needed and prioritize lifestyle less to prioritize income. I was wondering if someone could answer the following questions.

1.) Is doing a 7th year (opportunity cost of 230k) an effective safe guard against the diminishing routine endoscopy. I really like the very simple ultrasound guided procedures I have done so far and feel I would enjoy learning ERCP/EUS, but what do those who have done GI feel about this?

2) Do you feel like routine screening colonoscopy will diminish? I read an AGA opinion article projecting that lowered testing due to the pill endoscopy will be offset by the fact that pill will attract more people and some in higher risk groups will need the actual colonoscopy. Will that happen?

3.) I’m not afraid of working long hours and was at one point considering an IC/PCCM/surgical residency. Would hustling and finding ways to increase income (more hours, etc) make up for the possible drop in GI income we may see in the future?

4.) Another source mentioned that the advanced endoscopy procedures significantly increases your employability according to 92% of new GI physicians (i.e. more areas I’m eligible to work in with my spouse), but doing these procedures full time would also simultaneously decrease your salary. Do you feel like this is accurate?

I would love any answers to this. Feel free to PM me too.

Are you my cointern?