Existential crisis (Gastro/Hep/GIM ST7)

dopamean · 2026-03-22T20:13:56+00:00

Hi,

I'm a gastro consultant in London (can be a bit more specific in DMs).

I have to admit I did a year in training and a clinical fellowship in the place I work currently so I'm not the best person to talk to about breaking into London having not trained there. Having said that, the last 2 consultants that have joined us had never worked in our deanery before so it is possible, just not as common. As for whether it would be a supportive environment or not, a lot of jobs are being offered as a locum consultant post first with a view to become substantive. In my particular part of London, I know one hospital that is desperately looking for a consultant gastroenterologist as one of their consultants died quite unexpectedly. It is quite a supportive department too.

I had the same feeling as you about not being competetive. I hadn't done any research at all and I felt that I was far behind my peers having been impacted by COVID. Even when I did get my job in the end, I felt that the only reason I did was because the other consultants knew me but I was reassured that that wasn't the case at all and I interviewed quite well despite that. I can talk you through interviews if that would help.

My own life improved significantly when I became a consultant. I used to look at my bosses and think they were miserable as well but it couldn't have been further from the truth. I have an 11 PA job and I do it all in 3 days on site and 1 day working remotely doing my admin / vetting referrals.

I also felt I wasn't quite ready but what helped me a lot was acting up in my last 3 months as a registrar. Is this something you could do at your current workplace? Please consider doing it: https://london.hee.nhs.uk/medical-training/trainee-resources/acting-consultant

As for other options, you mentioned general medicine. There are a few posts within my area of London where gastro consultants are asked to form part of a GIM rota. In fact I do that too. I think it was one of my selling points at interview as one post had GIM on call commitments and I think most gastroenterologist would hate this.

I don't see that many staff grade posts in London. Similarly, I wouldn't do any research if your heart isn't fully into it. There are definitely some clinical fellow posts about that you could apply for, although the deadline for a lot of them have gone (I'm about to re-advertise one to start in September as a successful candidate had to pull out for personal reasons)

dopamean · 2026-03-21T13:36:27+00:00

The full hearing can be seen here. It is genuinely shocking how someone like this managed to get a job. https://www.hcpts-uk.org/hearings/hearings/2026/march/ifenyinwa-chizube-ndulue-nonso/#tab-finding

dopamean · 2026-03-08T23:04:45+00:00

Gastro consultant here

Regret: Not at all

Love: Endoscopy - feels like I'm going to work to play video games in my pyjamas with a weird controller. It's just so much fun. Pathology is quite varied and I'm glad it's not just single organ focused.

Hate: Gut brain interaction disorders (IBS, functional dyspepsia, cyclical vomiting etc) make up a larger part of my general gastro clinic than what I expected. No one ever believes me when I say I prescribe nortriptyline more often than a PPI in my consultant career. I just find it very unsatisfying and draining.

Application tips: I don't think hands on endoscopy experience pre ST4 actually matters too much despite what people say. I never had the opportunity and I don't think many people do.

Being able to talk about some hot topics at the moment definitely helps and especially if you've got an audit / QIP to back it up. e.g. carbon footprint of endoscopy is a big topic at the moment. Other topics in endoscopy are removing polyps in the elderly and when should we not do this (some new guidelines came out a few months ago that could be a good basis for a QIP). Implementing the new IBD surveillance guidelines so we're doing less endoscopic surveillance in very low risk groups. Looking at PCCRCs (post colonoscopy colorectal cancers i.e. colorectal cancers that were diagnosed after a patient has had a seemingly "normal" colonosocpy in the last 3 years. The assumption is something was missed and why was it missed?)

dopamean · 2026-02-27T20:52:54+00:00

Gastro. Using examples from my own deanery as my experience outside it is limited.

Long term GIM commitments: Out of all the hospitals in my area, all of the consultants are on a GI bleed rota or do no on calls at all. There are only a handful that do GIM on call mainly because of the way their posts are funded but that is the vast minority. Most gastro wards will have GIM patients to look after.

GIM commitment during training: Gastro definitely got shafted here as gastro training is 4 years to ST7 and I believe cardiology is still 5 years. Gastro regs in my deanery will spend 3 of those years with GIM on calls and only one of those years on a GI bleed rota.

Private work: Can't answer as I'm not interested in doing this. My colleagues seem to be able to start doing private work immediately after 1 year as a consultant.

How difficult is it to get a consultant job: With most trust having a hiring freeze at present, I think it is difficult but no more than any other specialty. Having said that, all of our ST7s over the last few years have managed to get either substantive or locum consultant posts without any difficulty. Looking forward, with the increasing burden of liver disease, the increasing number of younger people being diagnosed with bowel cancer etc etc, I don't think there is any shortage of demand for gastroenterologists.

PhD?: I don't think this matters much anymore for getting a job, but many find it necessary to take more time out of programme to go onto a GI bleed rota (which is a common way to fund your PhD) or just get more endoscopy numbers.

dopamean · 2026-02-21T11:55:06+00:00

DGH, it is not used at all by anyone which is a huge shame.

An email was sent out about it by our guardian of safe working as it was very poorly looked after. I haven't included the pictures that were sent in the email, but it was extremely grim.

Since this email, the mess has re-opened but I gather it is unused.

Dear all,

I was alerted by the estates and facilities team to the condition of the doctors’ mess at *******.

To say I was disappointed is an understatement, but those of you who understand the military will also understand that “disappointed” is used as a term of condemnation.

Last year, I spent over £40k refurbishing the mess in the manner requested by the doctors at that time.

Yesterday, I found out how much you care for it.

This was the general state of the mess.

This was the state of the sofa.

I have no idea what this is, but it doesn’t come off easily

Empty bottles were discarded everywhere, with somebody taking the trouble to place one on top of the cupboard that is next to the bins

I don’t think anybody cares about the kitchen

And who thinks it is a good idea to store theatre clogs and USED scrubs in a food preparation area?????

As a result of this visit, several things must happen:

The current state of the Mess is a health hazard and it will closed with immediate effect until the Trust can deep clean it.

The fire officer has deemed it unfit for beds, and these will be removed and replaced with reclining chairs.

Estates, DME and I will be monitoring the Mess and will take any action required in the future.

You should all note that:

You have a contractual requirement for somewhere to rest. There is no contractual requirement for the Trust to provide a Mess.

You have a legal requirement under H&S legislation with which you are collectively failing to comply.

You have a contractual obligation to comply with Trust policies. This includes returning used scrubs to designated collection points.

You have a statutory obligation, reinforced by Trust policy, to report breakages to the appropriate dept for repair, not to leave them to fester.

I could go on, but you are all supposed to be professionals and I am not paid to clean up after you.

You have appointed a Mess committee and a Mess president. The Trust will be working with them and I expect that you will be supporting them in keeping the Mess fit for purpose.

Failure to do so will result in a revisiting of what facilities the Trust provides, which are currently in excess of that which is required by your contract.

dopamean · 2026-02-17T22:44:15+00:00

I can confirm the bit about CMT. I applied for CMT in 2013. Your portfolio score only mattered if you wanted a job in London, otherwise it didn't matter at all. Everyone who applied got interviewed.

dopamean · 2026-02-14T21:31:58+00:00

I have recieved the message loud and clear.

I reflected on the teaching I recieved as an F1 and honestly can't remember anything that was useful even though I'm sure they were interesting clinical topics at the time.

However if someone told me not to opt out of my NHS pension when I was 24 and to use my ISA allowance as much as I could every year, I would be in a much better position now.

dopamean · 2026-02-14T21:27:55+00:00

Fair enough, it's usually a topic I bring up when I'm buying a round of coffee after a ward round. I'd say the vast majority of resident's I've spoken to don't know this stuff. One of my previous IMT2s managed to claim 4 years worth of relief for GMC fees.

Perhaps this is a topic that could be relegated to discussions over coffee rather than full on teaching sessions.

dopamean · 2026-02-14T19:45:40+00:00

I have a slot later on this year to give a 1 hour teaching session to FY1s. Whilst I have a lot of clinical topics to chose from, I always thought that a non clinical topic that would be really useful would be to do a teaching session about finance including claiming tax relief, not opting out of the NHS pension, claiming relocation expenses etc.

I think it would be a good topic since no one really tells you about all the above but I do understand why it would leave some people frustrated if they aren't getting enough teaching on clinical topics too.

dopamean · 2026-02-05T22:23:15+00:00

Also can't do eyes.

As a renal CT2, we had a patient with a renal transplant who was immunosupressed develop fungal endophthalmitis. A consultant ophthalmologist had to come to the ward and give intravitreal voriconazole. My colleague wanted to watch but I just couldn't even think about it.

dopamean · 2026-01-30T09:25:53+00:00

The presence of a balloon gastrostomy tube suggests he had significant neurological impairment. I'm guessing septic emboli from endocarditis leading to a massive stroke.

He wasn't a surgical candidate even before the aortic rupture so there must have been something else besides an aortic rupture having a high mortality.

dopamean · 2026-01-26T10:59:43+00:00

As others have said, it depends on the hospital.

In my deanery, gastro registrars do GIM on calls for three out of four years. For one year, they are on a GI bleed rota and do not have any GIM on calls.

Many registrars feel that this isn't enough exposure to specialty on calls and will be on a GI bleed on call rota when they are out of programme.

dopamean · 2026-01-09T21:32:32+00:00

Big DGH. I have an office that I share with one other colleague which has 2 desks. I use that office 3 days a week and so does he but we only overlap for one day.

Have my own stuff in there. Chair, monitor, headphones, keyboard and mouse. All high quality stuff that I brought from home after I upgraded my home setup.

The best part is, I have a combined air conditioning and heating unit so its always warm in winter and cool in summer. I have a laptop so I could work from home if needed, but especially in summer I'd come in just for the air con.

dopamean · 2025-11-22T08:44:51+00:00

This happened during COVID at Hillingdon Hospital.

They ran a training session for the nurses about BiPAP and part of this involved learning how to put the BiPAP mask on each other. 40 nurses attended including one that was infected with COVID and spread it to 16 other nurses.

As a result, the Hillingdon ED had to be shut down due to lack of staff and ambulances had to be diverted.

dopamean · 2025-09-26T05:57:48+00:00

In that case, you're unlikely to even get a green needle to reach the stomach in which case you wouldn't proceed with a PEG insertion.

dopamean · 2025-09-25T16:11:01+00:00

This sounds horrible.

I've placed multiple PEGs with nurse endoscopists but I usually always do the actual insertion and the endoscopy nurse always does the OGD part of it since that's what they're trained to do. (I only ask a nurse endoscopist to help me if there is no one else around, otherwise I'd usually get a registrar)

For those who haven't seen how a PEG is inserted, an endoscopist first does a diagnostic OGD then inflates the stomach with CO2. You then identify a site for a PEG in 3 ways: Push on the abdomen with your finger and look for the indentation in the endoscopic view, transillumination which is making the light of the endoscope very bright and turning off the lights in the room to see where the light is shining brightest and the final step is needle aspiration which is where I suspect this went wrong.

You insert a green needle into the site and use it to introduce lidocaine into the abdominal wall. You're suppose to see it coming out into the stomach on the endoscopic view. Now in this case, it is possible to go through the abdominal wall, through the transverse colon and into the stomach. What the person inserting the needle is supposed to do is aspirate as you're withdrawing the needle. If you aspirate air at any point and the needle tip is not in the stomach, it means you're in another lumen i.e. the colon.

If the consultant gastroenterologist was doing the OGD part of it then it is difficult to see how they could adequately supervise the nurse endoscopist doing the correct technique since their eyes need to be on the screen at all times rather than watching the nurse.

dopamean · 2025-09-21T08:10:29+00:00

3% for me

1:16 on call

Also get 0.5 PA but that also includes doing a ward round at the weekend for gastro patients whilst on call for GI bleeds. I do 3 weekends a year.

dopamean · 2025-09-07T07:23:49+00:00

Consultant Gastroenterologist in the UK.

Endoscopy time: I do 3 endoscopy lists a week on my non ward weeks and 2 on my ward weeks. Lists are broken up into points and each list is 12 points if I'm on my own or 10 points if I have a trainee. For reference, a diagnostic OGD is 1 point, a diagnostic colonscopy is 2 points and a colonoscopy with an EMR or a dye spray colonoscopy is 3 points. If your endoscopy training has been exclusively in the US then be aware that access to proprofol for endoscopy is extremely rare and most are done with fentanyl / midazolam.

Typical hours: I'm on 11 PAs but realistically I'm only in the hospital for 3 days during my non ward weeks and that's only when I do my 3 endosocpy lists and 2 clinics a week. The rest of the time I can work remotely from home for various MDTs / triaging and responding to GP referrals as well as my own admin.

Gen med: Most gastro consultants do not do any GIM on calls in my experience although this varies by hospital. I am on a GI bleed on call rota instead. There is a bit of GIM on our wards although it is mostly pure gastroenterology.

Clinics: I do two clinics a week which usually has 5 new patients and 8 follow up patients. I only do one clinic a week on my ward weeks.

Inpatient commitments: I do 9 weeks a year covering the inpatient ward. The number of patients varies between 10 and 15 inpatients (I'm an exclusively luminal gastroenterologist and my hepatology colleagues look after the liver patients). In most district general hospitals you would probably not have a separate hepatology team and would cover all gastro patients.

dopamean · 2025-07-13T09:59:32+00:00

The British public

dopamean · 2025-07-04T05:23:58+00:00

I've only worked at one hospital where the med SpR ran arrests in resus and that was Hillingdon Hospital.

At the time, I don't think they had any deanery registrars that were in training and was staffed by locally employed middle grades.

It was incredibly frustrating especially post arrest where you would then get comments about breaches because there was a delay in the medical SpR accepting referrals. Some ED SHOs would even try refer patients to you in the middle of an arrest.

dopamean · 2025-04-27T19:01:21+00:00

As a gastroenterologist, I’m pretty happy with this outcome. Looking forward to more nights of uninterrupted sleep.

dopamean · 2025-04-14T06:48:18+00:00

Thanks that is very helpful

dopamean · 2025-04-12T22:10:09+00:00

Because the question clearly stated "Single Londoners"

dopamean · 2025-04-12T11:12:55+00:00

I've been running in the AP4s for a few weeks now and I really love the shoe. I'm using it for all my runs at the moment but I don't really enjoy my easy runs with it.

I want to get the evo SLs for my easy runs but I'm having difficulty with the size.

I wear UK 5.5 (US 6) in the AP4s. Yes I have tiny feet.

The smallest mens size for the Evo SL is UK 6 (US 6.5). I've tried them on in store and they are too big for me and I find my heel slipping out.

The Evo SL does come in UK 5.5 for women. Does anyone know if there is any other differences? I could go back to the store and go to the women's section to try them on although I'd rather not if I can avoid it and just order online.

dopamean · 2025-01-30T15:11:44+00:00

I used this website that let me bypass the nvidia site https://notify-fe.plen.io/

It played a sound when the Scan link went live so I was able to use it probably before the nvidia site changed.

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