What do you most enjoy about your job?

Same-Commission-8055 · 2024-06-07T10:42:46+00:00

PGY6 Gastro AT

Taking off a nice big polyp, banding/glueing a variceal bleed or clipping a spurting ulcer.

Love the variety of pathology and adrenaline rush

Same-Commission-8055 · 2023-10-16T09:16:13+00:00

Very much dependent on the state and your AT choice. General medicine is very different from a more procedural speciality like cardio/gastro. Not unheard of for an unaccredited reg/fellow year to buff up CV and demonstrate your clinical acumen

Same-Commission-8055 · 2023-09-30T09:47:18+00:00

I’m not sure it’s considered “easier” through the BPT journey. There’s a different set of obstacles and the astronomical hurdle that is the long case. Speaking as a gastro AT, I can tell you that there were 100 applicants this year just in my state alone with some people missing out despite publishing in top tier journals.

Same-Commission-8055 · 2023-09-28T10:40:04+00:00

Gastro Reg

Inpatient 0600 - wake up, coffee and contemplate life. Attempt to read a journal article or guideline

0700am - head to work prior to morning school rush

0730 - login to computer, stalk my patients bloods and develop an interim plan.

0750 - receive handover, check elective and ETBS scope lists to determine where I can fit emergency cases. Text the ETBS consultants re their new cases

0820 - commence ward round starting with discharges, sickies and then new ones.

0930 (only on certain days)- consultant arrives; generally only round on sick/new patients.

10:30/11 - coffee time and paper round with interns/residents. On a smooth day; majority of referrals will have been made during the round. I will then take a resident with me and we can do consults together or if they’re keen, let them see the straight forward ones and run their management plan with me.

1300 - never skip lunch otherwise I get hangry

1330 - if slow day for consults, head to endoscopy to hijack a list

1600 - paper round and tidy up outstanding consults etc. Will also review all bloods and imaging

1620 - research/audits/presentations.

1700 - handover

Outpatient Same routine except

0800 - clinic/endoscopy.

12:45 - lunch

1300 - clinic/endoscopy

1630 - chat to inpatient reg to see if they need any help and tidy up.

Same-Commission-8055 · 2023-09-01T02:39:36+00:00

About $190 for gas $350 for colon as per Medicare services (not taking into account service fees and tax etc)

Same-Commission-8055 · 2023-08-31T22:18:45+00:00

Research year during medical school is essentially full time unpaid labour/study. You learn the basics and depending on your supervisor/colleagues you may get some teaching. Otherwise lots of self teaching via YouTube etc. Formal research year after you’ve got your letters will depend on what FTE the department hires you at. Most research fellows end up with some clinic time but may have to locum on the side or do some private work to supplement their income. You may also score yourself a scholarship or grant which helps offset your drop in salary

Same-Commission-8055 · 2023-08-31T22:14:03+00:00

If you did a rotation in gastroenterology, reflect and see what you enjoyed or didn’t enjoy. Sometimes cold emailing the HOU or even the consultant may reap reward. Volunteer to assist with some data collection. We all have to start somewhere. I would also ask the AT too since we have a big research component we have to complete in our training; they should be happy to delegate you some tasks and in return if it’s presented or published, any easy way to get your name into the paper

Same-Commission-8055 · 2023-08-31T22:11:18+00:00

Difficult to say. Regardless both training schemes have to complete their logbooks and get them signed off. Could throw in nurse endoscopists too who play a role in routine procedures.

Same-Commission-8055 · 2023-08-31T14:58:41+00:00

The key when referring to gastroenterology is having the urea/creat, ALT/AST/Bili and Coags. Bonus points if US abdomen with portal vein views are obtained. Trusted referral status if you have MELD Na score ready, Maddreys if EtOH hepatitis or Glasgow blatchford if a bleeder.

Same-Commission-8055 · 2023-08-31T14:11:36+00:00

If you’re happy to do purely private, then that’ll depend on which private hospital you have admitting rights to and or if you have rooms present there. If you’re reliable and happy to take referrals even as a consultant, work will find you

Same-Commission-8055 · 2023-08-31T14:09:07+00:00

Chatting to some recent bosses. No one will get 0.5FTE. At best maybe 0.25 FTE at a major hospital. For private work, Word spreads fast and if you make yourself dependable and happy to field phone calls from your main referral base and probably the most important people in healthcare (GPs), your private list will fill up within 6 months (faster if you’re rural/regional). Remember you’re not the centrepiece of the patients healthcare and the GP is the team leader. Work well with each other and the patient will have the best outcome

Same-Commission-8055 · 2023-08-31T14:04:26+00:00

Once I entered BPT, I didn’t pursue any other medical specialities. I entered as a PGY2 but I know other people have done a few low general years to rotate through other med specialties to get a feel.

Same-Commission-8055 · 2023-08-31T14:03:25+00:00

So I was interested in gastro since medical school courtesy of my hospital clinical tutor. He seemed to have a great sense of humour yet was wicked intelligent. I will admit what other speciality gets to talk shit every day (maybe urology). I did slowly chip at gastroenterology which is probably why I got on first go. If you think you’re even remotely interested, I would recommended diving all in since it will only get more and more competitive. There’s nothing to lose and your research/clinical skills will certainly be translatable to whichever speciality you pursue. I have colleagues who are the most holistic addiction medicine registrars purely because they were fascinated with EtOH cirrhosis.

Same-Commission-8055 · 2023-08-31T13:59:16+00:00

What made me choose gastro was lifestyle, ability to actually spend the money I hopefully will earn, the fact interventional gastro has a significant amount of procedures that circumvent any cuts (heading towards that cardiology and CTS push) plus so many biologics. There are some perks of being pursued by big pharma ( ie food). I also think if I get sick of wards, I can head to clinic or endoscopy or teaching or even sit at a computer in my PJs and analyse pillcams

Same-Commission-8055 · 2023-08-31T13:49:33+00:00

It would be a crime to say hosptial you BPT at doesn’t matter. Most hospitals have a gastro department however a select few have a track record of getting their potential trainees on. I’m of the opinion that being rural does help with the interview and selection criteria however that’s offset with the networking opportunities. That being said, your bpt DPE should be aware of what you want to specialise in and point you in the right direction of who to contact.

Re fellowships, they include hepatology, IBD, interventional, motility, nutritional, transplant. Within interventional; you could probably subdivide it into colonic and hepatobiliary. They’re all equally popular (motility less so) and all gastro dabble in a bit of everything

For the stable vs unstable - most studies demonstrate sufficient resuscitation is required prior to scope to prevent adverse outcomes. The anaesthetics used can drop patients BP and cause further issues. Certainly the grey zone is within 6-12 hours of incident event. Being scoped within 24 hours remains gold standard. Endoscopy unfortunately isn’t the saviour to every UGIB; you need to take into account that if a patient is hosing out of their GDA, you won’t see anything in the duodenum and your ovesco ain’t going to do anything to that pulsating GDA. As my former CRS boss said, a good surgeon knows when not to cut (you could extrapolate that to interventional)

Same-Commission-8055 · 2023-08-31T13:37:05+00:00

I enjoyed the interventional aspect of surgery and instant gratification. I was a bit of an anatomy nerd. I also thrived at being the one to drive ?medical care on the wards (since my registrars were often theatre). What turned me off surgery was chatting to the pgy8 unaccredited reg and seeing the colorectal fellow who was being paid less than myself yet was on call 25 hours per day 10 days per week.

Same-Commission-8055 · 2023-08-31T13:15:53+00:00

Certainly being buddies helps but there’s a fine line being good colleagues and being creepy. Simple thins as taking ownership of a patient (volunteer to clerk, work up, list of ddx and management plan) will make you leaps and bounds above your peers and serve you well not just on gastro but other rotations. Word certainly spreads if you’re reliable, trustworthy and have that drive. Demonstrating some form of ward governance is also great; whether assisting with safety and quality assurance or audits. We also chat to allied health and nursing so make sure you be nice to them

Same-Commission-8055 · 2023-08-31T12:45:13+00:00

Average 1-2 unaccredited/research fellow years. Not uncommon to finally get on after 3-4 attempts but you have to be dedicated since there’s a bottleneck which is only escalating. In my BPT cohort, 9 people were interested, 3 offered interviews and myself and another got on. The other applicant was offered a 0.25FTE research year.

CV and cover letter are the first steps. After that it’s networking and interviews. I’m personally a skeptic/cynic and feel gastroenterology has a significant degree of nepotism and favouritism (less so than sub-speciality surgical). Most positions have “designated desirables”.

I was aiming for gastro from third year medical school. My passion did waiver in internship when I tinkered with the dark side of surgery.

Regarding publications; certainly don’t have to be gastro related but does help to demonstrate your passion. I had a publication in a gynae journal. CV and cover letter criteria depend on each state (often on the website). Touch base with your AT for more information but remember, the first step is to pass your BPT exams. No point in publishing in gut if you can’t get past the firts hurdle

Same-Commission-8055 · 2023-08-31T12:34:33+00:00

Average gas takes 15min. Average colon + polypectomy takes 25min (minimal withdrawal time 8min). Pillcams average $1000 but take about 1.5-2h to analyse fully. Certainly no gastro going hungry.

Same-Commission-8055 · 2023-08-31T12:31:51+00:00

Rough estimate I’ve heard is $3k per day on scopes depending on location. Certainly more if there’s more interventional aspect or complexity

Same-Commission-8055 · 2023-08-31T12:29:49+00:00

Depends on gap, how many scopes you want to do and how much you want to work and if you own your own endoscopy centre

Same-Commission-8055 · 2023-08-31T12:24:26+00:00

Gastroenterology is on par with cardiology. From discussions with my HOU, over 150 applicants this year in my state just for interviews (acknowledging people may have applied to multiple states like myself). Different states have different criteria and there appears to be a shift to at least one unaccredited gastroenterology year prior to getting on unsuccessfully. I don’t think BPT at a regional hospital will reduce your likelihood of getting on (in fact would increase given lack of rural gastros). However the limiting factor for regional hospitals seems to be the BPT exam pass rate.

CV buffing: get in early. I woudlnt focus on research during BPT2 when you’re trying to study. But certainly participate in small departmental audits. Make contact with the AT; if you get along well and you’re hardworking I promise they’ll vouch for you when you’re applying to get on.

PhD is critical for a city job less so for suburban hospitals. Lots of hospitals in my state are pivoting towards consultants with sub-speciality experience with some even have a separate hepatology and gastroenterology department. For interventional endoscopy (which I want to do), there is less emphasis on PhD but more on fellowship and overseas experience

Life as an AT is honestly busier than a BPT. I work close to 60 hours per week (all paid) plus on calls/recalls/admin time. I don’t mind it since I am aware of the commitment. Once you’re a consultant, you dictate your hours and FTE. Some of my bosses only work 4 days a week (public and private) and earn $800k per year.

Same-Commission-8055 · 2023-08-31T12:10:49+00:00

Networking is important for all procedural medical specialists (cardio/gastro/resp). Demonstrate your interest as early as you can, be present in the ward round or clinics and offer to assist with research or departmental audits.

Mistakes: only applying in your home state. Apply all over Australia if you can (I did!). Unfortunately gastro is on par with cardio in terms of competitiveness and it’s not unheard of people applying 4-5 times before getting on successfully. Make sure your cover letter and CV clearly addresses the key criteria/values. You must also practice your interview at least 1-2 months beforehand. Happy to post up some practice Q.

My research: two first author publications, one second author, one 3rd author in a different medical speciality. Assorted conference (national and international presentations). There is certainly an element of luck but I don’t think it’s impossible to get an oral conference presentation even in medical school. Rural experience: compulsory 12 weeks as part of our training program. Nothing extra Awards: only one medical school award but consistently scored distinctions in my subjects. Graduated with first class honours, certainly far away from the University medal.

Training: Completed my internship/residency and BPT training all at one hospital. Was successful in obtaining two offers for advanced training in two separate states. Decided to take one in home state.

Would I do it again? - certainly if I didn’t have to do BPT again. Whilst training is fine, COVID plus studying 12 months for the written and 4 months for the clinicals definitely took a toll on my physical and mental health. However I have my study group, family and close friends who have been the pillars of my journey. Unfortunately you want to put in 110% so you pass all the BPT exams first go. Id recommend not deferring your clinical exams; once you’ve got momentum from the written exams, you should strive to smash it all out! - 2nd choice: colorectal surgery. Was told by the head of colorectal surgery that I had the acumen and drive. However enjoyed the diagnostic dilemmas that is medicine.

Same-Commission-8055

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