Specialty Description
Gastroenterology is the subspecialty of internal medicine that focuses on the evaluation and treatment of disorders of the gastrointestinal tract. Gastroenterology requires an extensive understanding of the entire gastrointestinal tract, including the esophagus, stomach, small intestine, liver, gall bladder, pancreas, colon, and rectum.
Some gastroenterology programs may choose to offer fellows intensive clinical experiences in transplant hepatology. Transplant hepatology is the study of the diseases leading to transplantation, the evaluation of patients pre-transplant, the evaluation and treatment of the post-transplant patient, and the management of the complications of transplantation (1).
What does a gastroenterologist do?
The subspecialty requires practitioners to have a wide array of skills, both procedural and cognitive. For example, good hand-eye coordination is required to perform endoscopic procedures, which are used to help diagnose and treat many diseases of the digestive system. Gastroenterologists also need good interpersonal skills to work as consultants and in multidisciplinary teams to care for both acutely and chronically ill patients.
Gastroenterologists work in many different practice environments. The type of practice environment— group practice, academic practice or solo practice— helps to determine the physician’s work-life balance. In most practice situations, gastroenterologists can expect to be busy when they are on call. The amount and type of call is dependent on the practice type. There are emergencies in gastroenterology, such as gastrointestinal bleeding, that must be responded to quickly including overnight.
Patients with diseases of the digestive system are seen by the gastroenterologist. This includes patients with symptoms such as difficulty swallowing, heartburn, stomach pain, nausea and vomiting, jaundice, diarrhea and constipation. Common diseases that are treated by gastroenterologists include gastrointestinal bleeding, esophageal reflux, celiac disease, bile duct stones, pancreatitis, inflammatory bowel disease, hepatitis, obesity and nutrition disorders. Many patients with complicated liver disease are treated by a hepatologist—a gastroenterologist with specialized training in treating diseases of the liver.
Gastroenterologists have 100 percent direct patient contact both in the evaluation and treatment of patients with digestive diseases. Patients with digestive illnesses are seen in the outpatient clinic, the procedures unit, the hospital and the emergency room. Gastroenterology is a consultative specialty, although patients with chronic gastrointestinal disease such as inflammatory bowel disease are followed on a long-term basis in the outpatient clinic. Patients with an acute gastrointestinal problem, such as a bleeding ulcer, may only be seen during the acute event.
Although a subspecialty of internal medicine, gastroenterologists and hepatologists often work closely with surgeons as well as radiologists, pathologists, oncologists, psychologists and dieticians.
How to become a gastroenterologist?
Physicians who wish to become gastroenterologists must complete a three-year residency in internal medicine, followed by a fellowship. Fellowship duration is 36 months, of which at least 18 months are clinical training. The other 18 months may be clinical or research training or a combination of both. Continuity clinic is carried out during the entire 36-month training period. Some training programs may offer an additional year of clinical or basic science research experience or advanced therapeutic endoscopy training, motility training, inflammatory bowel disease training or training in other clinical subspecialty areas within gastroenterology. Fellows may also opt to train in transplant hepatology, which may occur during an additional year of training or within the 36-month training period, depending on the program. Osteopathic medical students may specialize in gastroenterology after completing an accredited program in internal medicine.