What medical students need to know about pursuing a gastroenterology career

Retroflexion is a maneuver used during endoscopy or colonoscopy. I explain to my patients that this maneuver involves the scope being configured into a J- or candy-cane-like shape to allow the physician to look back on areas that might otherwise be missed, such as the rectum or the fundus (the top of the stomach). The goal is simple: to ensure nothing is overlooked.

Please join me as I “retroflex” on my career as a gastroenterologist, with the goal of providing a thorough overview of the specialty to students who are considering it.

The best of both worlds

Gastroenterology, in my opinion, is an amazing specialty.

It allows for the intelligence and differential diagnosis abilities of an internist combined with the procedural expertise of a surgeon. Like interventional cardiology, gastroenterology truly is one of the few specialties in which a physician can have one foot in two different continents.

Of all the medical subspecialties available to internal medicine physicians, gastroenterology is considered to be the most competitive, based on the large number of applicants and limited number of training positions.

The long ride

Gastroenterology is not an easy path. I was blessed to be the first DO gastroenterology fellow at the University of Miami, for which I thank my mentors every day. I did three years of internal medicine and worked hard to graduate among those at the top of my class. Ultimately, I was honored to spend another year as chief medical resident.

I completed three years of gastroenterology training, which is not for the faint of heart. I was fortunate to be able to also experience liver training and advanced endoscopy during that time. However, both of these subspecialties (hepatology and advanced GI) now require an additional year of training. In summary: Be ready for a long ride.

The bread & butter of GI

Beyond seeing patients in clinic, gastroenterologists do a variety of procedures, such as endoscopies and colonoscopies. Endoscopy is used to look at the upper GI tract with indications such as abdominal pain and GI bleeding. Colonoscopies are done to screen for colon cancer as well as to evaluate symptoms such as bleeding and diarrhea.

Advanced procedures range from endoscopic ultrasound, which can be used to biopsy pancreatic cancers, or an endoscopic retrograde cholangiopancreatography (ERCP), which is done to remove stones from the common bile duct.

New advances are continually being introduced. For instance, capsule endoscopy entails having the patient swallow a tiny camera that records images for the purpose of evaluating the small bowel.

Another example is transoral incisionless fundoplication (TIF), which allows a gastroenterologist to decrease a patient’s symptoms of reflux endoscopically with a procedure that previously was only possible through surgery.

Why I chose gastroenterology

Students often ask me why I chose gastroenterology. The short answer is I love procedures, I enjoy pathology and I love the patient population.

While all of those statements are facts, they are not the reason I ultimately chose my specialty. When I was a third-year medical student, I met a gastroenterologist named Ira Schmelkin, MD.

Dr. Schmelkin was kind to me, and I decided that I wanted to be like him. Why? He was kindhearted, he was funny, he loved medicine and he took an interest in me. Simple as that. If he was an OB/GYN, I’m convinced that’s what I’d be doing right now.

I am in private practice, which is certainly a minority of physicians in practice today, but I love it.  I wake up early, round in the hospital, do endoscopies and colonoscopies in my office suite and see patients in my clinic. In my free time, I do payroll, change lightbulbs and put together office furniture. Outside of work, when I’m not sleeping, I spend time with my family and try to make it to the gym and write articles for The DO.

The next generation

What advice would I give you if you are a student interested in the specialty? I would ask you to think about what you want from your career. I love GI, but it takes commitment to get a fellowship, get through that fellowship and even just be in practice. As a GI doctor, your work-life balance, in my opinion, will suffer a bit. If work-life balance is your priority, think long and hard before pursuing gastroenterology.

I would also say you must love internal medicine. If you don’t love internal medicine and wouldn’t be happy practicing it, gastroenterology might not be the best match for you. I keep my internal medicine certification for many reasons. For example, COVID-19 was a challenging time for all of us. My internal medicine certification allowed me to roll up my sleeves and help, and that was so fulfilling for me.

Is gastroenterology right for you?

If you only enjoy the procedural aspect, I advise that you thoroughly evaluate all the other spectacular surgical specialties available. Gastroenterologists spend a lot of time talking to patients, and if you don’t like spending time treating irritable bowel syndrome (IBS), a disease with symptoms which are felt to originate from brain-gut interaction, gastroenterology might not be for you.

Perhaps most importantly, I recommend shadowing a gastroenterology physician and seeing firsthand what they do. Finding the right mentor is the key.

In medicine, just like in a colonoscopy, the most valuable insights often come when we take the time to look back. My journey through gastroenterology has been a long ride, and the path isn’t easy. I encourage you to “retroflex” on your own goals. If you find that you enjoy the balance of clinical intuition and procedural skill, gastroenterology may be the specialty for you.

Related reading:

3 ways we can all promote DOs and the osteopathic medical profession

A recently retired DO shares what motivated her to take the next step confidently