Learning ERCP on the job

[GastriqueGraffin]

How common or possible is it to learn ERCP in a private group practice? I want to be able to at least do simple stone cases but don’t really want an additional year of fellowship if I can help it.

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[IM2GI]

You can probably find a private group if they have a need that will "apprentice" you and "certify" you. However, I think that in the widespread era of a 4th training year and a glut of advanced trained people, that it is an increasingly sketchy position medicolegally. Keep in mind that a general person can often outbill an advanced provider as well.

A simple stone case can turn into a perforation or post-sphincerotomy bleed and you will need to be comfortable and have the skills to put in a stent, etc. If you have a bad outcome and get sued can you defend your credentials and competency?

A general surgeon is "certified" to do colonoscopy after 50 cases, and we all know how terrible you are after 50 colonoscopies. My opinion is if you want to start doing ERCP in 2019 you should do a 4th year.

 

[ShiShiMD]

How common or possible is it to learn ERCP in a private group practice? I want to be able to at least do simple stone cases but don’t really want an additional year of fellowship if I can help it.

If your program does not certify you and very few programs do, you need a 4th year. at least 400-800 ERCP in the advance (4th year is done).

There are currently a couple of STAR programs offered by ASGE but that is after 500 hours of work for other advanced procedures.
ASGE | STAR Certificate Programs

EUS forget about it, you need the 4th year for sure.

 

[Gastrapathy]

There are definitely groups that will train you. Whether that is adequate is something you’ll have to decide. The volume numbers for graduating fellows have no actual authority. If you are credentialed, you can do the procedure. Personally, I would worry about hurting people more than about getting sued. Your partners aren’t going to proctor hundreds of cases.

I think 7th year fellowships are going to become less common. There won’t be infinite jobs for these folks.

 

[Scope guy]

I tend to disagree that 7th year is becoming less competitive. There is a big era of retiring GI who all did diagnostic ERCPs during the age of no MRCPS and got certified to do them, just like EGD and Colon. Take a look in healthecareers about how many job listings in private groups now say "ERCP required". That is because the retiring partner was ERCP certified and was able to do most GI procedures with exception of EUS. ERCP is not rocket science, basic necessity is cannulation, plastic stent placement for overnight and weekend cholangitis. Rest everything can be managed by the "experienced" person in the group.

As more and more ERCP certified GI retire, it is gonna become a precious skillset in the next 10 years, if not already. The extra year is worth more for advanced ERCP skills than EUS(considering reimbursement cuts for EUS and limited indications, it is best served by high volume guys).

 

[IM2GI]

There are definitely groups that will train you. Whether that is adequate is something you’ll have to decide. The volume numbers for graduating fellows have no actual authority. If you are credentialed, you can do the procedure. Personally, I would worry about hurting people more than about getting sued. Your partners aren’t going to proctor hundreds of cases.

I think 7th year fellowships are going to become less common. There won’t be infinite jobs for these folks.

The lack of jobs won't slow down an extra year unless they stop filling. Job market is already stressed as it is depending on the region.

 

[Gastrapathy]

The lack of jobs won't slow down an extra year unless they stop filling. Job market is already stressed as it is depending on the region.

Not sure I follow. The lack of jobs will keep fellows from applying. The market corrects this sort of thing pretty quickly once fellows see that the advanced fellow has nowhere to go.

 

[GastriqueGraffin]

My worry is doing the extra year and then either finding a job that almost only wants someone doing the advanced stuff and not much else or finding a job where I don’t apply most or anything I’ve learned in the year and over time losing that skill. For example finding a job where there is an occasional ERCP but never EUS.

Do people in general practice ever go back for the additional training later? Maybe it didn’t make sense for the job they wanted originally but later it did.

 

[Gastrapathy]

There really aren’t many jobs you can leave for a year. And you won’t be willing to lose the income at that point.