The digestive track of humans is a complex system made up of several individual organs or 'parts'. A gastroenterologist works with a variety of patients and deals with both common conditions and rare or more acute cases all revolving around the digestive tract. It's the job of gastroenterologists to provide diagnosis, treatment and health care plans to help patients deal with several digestive-related medical conditions.
According to the American College of Gastroenterology , 60 million Americans report having acid reflux at least once a month with many experiencing pain every day. Such a common disease can lead to much more life threatening symptoms if untreated or unmonitored. Gastroenterologists may also treat much more rare conditions, like Chron’s disease which affects 700,000 Americans and has no cure.
What is a Gastroenterologist?
A gastroenterologist specializes in treating patients that have chronic or acute issues within the digestive tract. These conditions can include maladies in the esophagus, stomach, intestines, colon and other parts of the digestive system. This area of the body includes the organs that are responsible for breaking down, processing and absorbing food and nutrients for the body to use. Good digestive health is necessary for nutrient absorption, intestinal motility, immune function and a balanced community of micro-organisms within the body.
The types of conditions that a gastroenterologist may come across can include both rare diseases and common conditions. Some of the common conditions that a gastroenterologist might come across include:
- Ulcers
- Heartburn
- Chron’s disease and Colitis
- Celiac disease
- Hepatitis
- Liver disease
Gastroenterologists may be involved in recommending a variety of treatments from nutrition therapy to medication or surgery depending on the diagnosis of the patient. Gastroenterologists are also trained and deliver preventative care information to their patients as well as perform tests like colonoscopies and endoscopies.
Educational Track
Educational Requirements for Becoming a Gastroenterologist
The minimum educational requirement for becoming a gastroenterologist is a doctorate degree and residency in internal medicine followed by a fellowship for training in gastroenterology.
Step-by-Step Education Path to Becoming a Gastroenterologist
The minimum requirement for a gastroenterologist is a doctorate degree. Physician licensure and board certifications can be obtained.
Bachelor’s Degree
To start an educational journey towards becoming a gastroenterologist, it is important to make good decisions at the undergraduate level. The first three years of undergraduate schooling should be used to prepare the student both for the Medical College Admissions Test (MCAT) and for continuing coursework once accepted into medical school. In order to do this, students should focus on the pre-requisite science requirements outlined by the medical school(s) they hope to attend.
These classes are usually part of an undergraduate degree in science, but they can be added to any degree the student wishes to pursue. Planning the courses ahead of time will ensure that they are all complete by the time testing and applications are due.
It is important for students who wish to attend medical school to obtain and maintain a high cumulative GPA and a high GPA in the sciences. This will show potential medical schools that the student is able to work hard and has the foundational knowledge necessary for continuing their studies in medicine.
Besides pre-requisites and GPA requirements, there are no specific requirements for the type of degree a student obtains during undergraduate coursework.
MCAT
Most commonly, those aspiring to enter medical school will take the MCAT their junior year of college. This test is designed to asses a student’s problem solving abilities, critical thinking skills, and knowledge of natural, behavioral and social science. These topics are the foundations continued training and the score received on the MCAT will directly affect the student’s ability to get accepted into medical school.
Because this test is so important, students are advised to take advantage of the many study aides that are available, join study groups prior to taking the test, and take online pre-tests and sample tests to familiarize themselves with the flow and style of questions. Preparation for the MCAT is never wasted as a great score will open doors for the student’s further studies and the knowledge needed to do well will be used in medical school and beyond for a successful medical career.
Medical School
Medical school admissions are extremely competitive with some schools being slightly more competitive than others. There are a number of requirements in order to submit an application to a medical school and they include: successful completion of all pre-requisite courses during undergraduate work, a high GPA in all undergraduate work, a high GPA in science related courses, a good MCAT score, letters of recommendation.
Students who wish to make themselves more competitive for placement in a good medical school should also be able to submit extracurricular activities and potential work in their field of choice or medicine in general. Volunteering at a hospital, for example, can help a student get patient experience and show their dedication to the medical field. Training and working as an EMT or CNA could also be beneficial.
During medical school students will train in a classroom setting, in a laboratory, and in a variety of clinical settings. The first two years of medical school are dedicated to learning the science and practice of medicine through course work while the second two years offer the student’s an opportunity to experience different clinical settings and specialties.
During the clinical years, students will likely find their interests and skills are suited for a specific type of medicine or medical specialty. Most medical schools are set up to give students a variety of experiences within several sub-specialties. Core rotations include internal medicine, pediatrics, obstetrics/gynecology, surgery, psychiatry, emergency medicine and ambulatory medicine. Additional electives may be chosen or offered to students as well.
Interests, desired salary, personality characteristics, skills and other factors may cause the student to gravitate towards a specific subspecialty which will inform their decision to move into a particular residency or future fellowship program.
Testing
In Medical School students will complete parts one and two of the United States Medical Licensing Exam (USMLE). This exam is set up to test a student’s knowledge a various points throughout their education and provide licensing credentials to passing students and physicians.
Part one tests the basic science concepts and medical practices that will be needed as a student moves into patient care roles. This test is often the one that shows that the student has the proper foundation for moving forward with their studies. As the USMLE states, “Step one ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.”
Part two tests medical knowledge, skills and clinical science and is meant to show that the student is capable of patient care under supervision. “Step two ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.”[ii]
Residency
Residency is the next stage of education for aspiring physicians. At this point the student shifts from learning clinical principles and science and begins to apply that knowledge in a patient care setting and under the supervision of a teaching physician or team. For gastroenterologists, a residency in internal medicine is required. This residency generally lasts three years. During this time students will get hands on experience with patients, become familiar with the setting and team that is involved with patient care, and will begin to gain confidence applying all of the knowledge that had been gathered up until this point.
Residency can be a very trying time as it usually involves long hours, difficult shifts and stressful situations for students. There is always supervision and it is designed to give the student the necessary tools and applications that will take them further into their training and field.
Testing
After residency the third part of the USMLE is administered and passing students are then licensed as practicing physicians and can choose to continue their specialized education. The third part of the USMLE ensures that the student is ready to practice medicine unsupervised. The test covers general material that the student should have gathered both through their personal study and their experience in the clinical setting. For those who wish to specialize, this test provides the necessary licensure to apply for a fellowship, which is necessary for any gastroenterologist.
Fellowship
The fellowship is designed to help a physician gain the expertise they need to be considered a specialist. For gastroenterologists, the fellowship will last between two and four years depending on the program.
During a gastroenterology fellowship a physician will learn about the GI tract specifically including:
- Screening for gastrointestinal cancers
- Ulcer disease
- Gallbladder and bile duct diseases
- Cellular and molecular physiology
- Ethics
- Medical economics
- Geriatric gastroenterology
- Liver disease and pathology
- Inflammatory diseases of the intestines
- Infections of the intestines
- Motility and functional illnesses
- Nutrition and obesity
- Pediatric gastroenterology
- Radiology
- Research
- Surgery
- Women’s health issues
- Cancers of the esophagus, stomach, liver, pancreas, small intestines and colon
After the fellowship the physician can test for board certification and license in the state of their choice.
Understanding the Career Path
Among medical specialties, direct patient care can vary widely. Different types of physicians report spending different lengths of time with each individual patient as well as report spending varying hours per week with patients – versus doing paperwork or other administrative duties.
For gastroenterologists, 24% report spending 30-40 hours per week with patients, another 39% spend between 41 and 50 hours per week seeing patients. Immediately it is clear to see that this specialty has longer workweeks than others and more patient care time. The majority of gastroenterologists can see anywhere from 25 to 124 patients per week. The patient sweet spot for most of those in the specialty is between 50 and 75 patient visits per week.
Within these hours and patient load, the average gastroenterologist will spend between 13 and 20 minutes with each patient. Occasionally, more time is spent, over 25 minutes, but rarely is a patient seen for less than 12 minutes.
Beyond patient care, all physicians must complete at least some paperwork and administrative tasks including making notes in patient files, participating in business decisions or employer meetings, and other duties. For gastroenterologists, 65% of those who are self-employed spend between one and nine additional work hours on paperwork and administrative tasks. This is very comparable to those who are employed.
Gastroenterologists are one of the top paid physicians of all physicians. In 2014 they were 4 th , below only orthopedics, cardiology, and urology in pay. On average, a gastroenterologist makes $348,000 per year. Male gastroenterologists make slightly more than female gastroenterologists at $350,000 and $331,000, respectively.
Geographically, gastroenterologists in the Great Lakes region of the United States including Michigan, Wisconsin, Minnesota, Ohio, Illinois and Indiana are paid the most at an average of $382,000 a year while those practicing in the Mid-Atlantic region make an average of $63,000 less per year.
Another factor that significantly impacts the salary of a gastroenterologist is employment status. Those that are self-employed make an average of $95,000 more per year than those who are employed by a hospital or other practice. The practice setting compensation averages are as follows:
- Office-based multi-specialty group practice: $404,000
- Office-based single specialty group practice: $395,000
- Hospital: $266,000
- Academic, research, military or government: $239,000
Certifications
Gastroenterologists can become members of the American Gastroenterological Association. [viii] As an AGA member, the physician is able to stay completely up to date on GI news and research, connect and engage with colleagues, gain access to clinical, educational and research resources, take advantage of professional development opportunities and more.
Tips for Success
The American Gastroenterological Association (AGA) offers special benefits to students who are enrolled in medical school or are Ph.D. candidates. Annual dues for students are only $25 and membership provides the student with news and research in the field, access to the mentor and advisor program and member directory for the AGA, workshops and educational opportunities and grants award for travel. Beyond these direct benefits, students who are members of the AGA also show their dedication to the field which can serve them well when applying for fellowships or research positions and grants.
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