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Why Gastroenterology and Therapeutic Endoscopy?

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. De Latour chose gastroenterology (specifically, therapeutic endoscopy) and why GI is a great field.

Words cannot express how much I love my job and my field. Advanced or therapeutic endoscopy is in many ways my dream career. It is the perfect combination of incredible pathophysiology, intricate, complicated procedures, and a patient population that is in dire need of help (tons of GI oncology). I always knew I wanted to be a doctor but I had no idea back in medical school that this would be the career I would eventually choose. I dabbled with the idea of being an interventional cardiologist or surgeon (ahem, I love procedures), but fate led me to gastroenterology and eventually advanced endoscopy where I am able to perform endoscopic surgical procedures which is extremely rewarding.

Recipe to get here:

- 4 Years of Medical School (Stony Brook University SOM)

- 3 Years of Internal Medicine Residency (NYU)

- 3 Years of Gastroenterology Fellowship (NYU)

- 1 Year Advanced/Therapeutic Endoscopy Fellowship (NYU)

- A dash of humility (think going from senior to freshman three times in a row)

- A pinch of hatred of sleep

Here are some of the reasons why I love what I do:

1. Procedure Based Field

I think all of us know deep down if procedure based fields are right for us. You may love to work with your hands or you may hate it. Gastroenterology as a subspecialty is definitely a field for someone who enjoys procedures as upper endoscopy and colonoscopy are the bread and butter of our field. Compared to most other medical subspecialties, gastroenterologists almost all do procedures (there are of course exceptions, but it is rare). Therapeutic endoscopy allows you to take these procedures a few steps further and thus requires extra training. I perform endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), bariatric endoscopy (endoscopic weight loss procedures/suturing), radiofrequency ablation (RFA), endoscopic mucosal resection (EMR), and luminal and transmural stenting, just to name few! Each of these procedures represent a less invasive intervention for patients that historically may have required surgical intervention, and perhaps the most exciting part of this field is the fact that it is continuously evolving to allow for even more interventions that represent alternatives to surgical interventions.

2. Fascinating Pathophysiology

I know I am biased, but I think that gastroenterology as a field has some of the most interesting pathophysiology within medicine and this was a major draw for me. From pancreatitis to achalasia and back to colon cancer, there isn’t an area within GI that doesn’t have a million layers of depth and things to learn.

You will never get bored with gastroenterology, there is simply too much going on from the mouth to the anus that we are the experts in.

I personally love that I can focus on GI oncology within my field, specifically colon cancer, pancreatic cancer and biliary malignancies, and many of my therapeutic interventions allow me to manage these patients (sampling tumors with EUS, stenting the bile duct when it has been narrowed by a biliary or pancreatic cancer, etc). On the flip side, if GI oncology does not interest you, there are numerous other options within the field of gastroenterology that you could focus on instead.

Having such diversity under the umbrella of gastroenterology allows for further subspecialization within the field. For some, this may seem daunting (I get it, you just spent so many years training, who would want to spend more time as a trainee…). Within saturated cities like NYC, for example, further sub-specialization, particularly for those who want to work at an academic center is sometimes necessary and makes you more sought after as your career progresses, something that you need to think about if you see yourself staying academic in a big city. This can be seen as both a plus and a minus, but my advice would be to ensure you only choose to further sub-specialize in something that interests you, never to do it just to make yourself more appealing as a potential hire, you will regret it.

3. Wide Variety in Phenotype

So you went through the motion of training to become a gastroenterologist, what does this mean? What will you do next? There are so many options - private practice, academics and multiple shades in between. This is true for many medicine subspecialties, but I can speak for GI in the fact that you can really do anything. I have friends who have gone on from my fellowship to private practice, private practice with academic privileges (still work on the consult service/teaching fellows), academic medicine within an RVU based system, pure academics, bench research, quality improvement work, administrative / hospital leadership, just to name a few. I personally wanted to work in an academic center for my first job and was fortunate enough to stay on as faculty at NYU. My job entails clinical, educational, and administrative work: patient care/procedures, teaching fellows, residents, medical students, and administrative work as the Director of Endoscopy at my hospital.

One thing to keep in mind is - when you do procedures you will typically have to take “call” and this means there will be times when you have to go in overnight (definitely during training). If this is a deal breaker for you, do not despair, there are private practice positions out there that are linked to academic centers where you won’t be the one scoping overnight, but prepare yourself for taking call if you go into gastroenterology.

4. The People!

I would be remiss if I did not mention the important role that the people within the field of GI have had on my decision to pursue a career as a gastroenterologists. As a medical student I felt the most comfortable and at ease with the GI folks.

It is hard to take yourself super seriously when you work with poop all day long.

I found the gastroenterologists to be some of the kindest and most humble doctors in the hospital despite all of the life saving interventions they were performing. Of course there are exceptions to every rule, but I know most people within the field and outside of it would agree with me - GI people are awesome!

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