GI Job Market

[Turk]

Hi Everyone,

I was posting to inquire if anyone had information about the GI job market? I am interested in this specialty, but am concerned about finding a job in a desirable city (Ontario or BC). I've heard mixed things regarding the job market, so thought I would post here. Thanks!

[Bluberblubo]

I'll start off by saying that I am not in GI, but I do GIM in ontario. Not sure about BC either but I assume the situation is similar to ontario. Who are you hearing mixed things from? Everyone I know says the job market is shit. Almost all of my GI friends and even those the year ahead of me, needed to do extra training (think hepatology or ERCP or IBD) to get a job or are still doing extra training and looking for jobs. I know one person who got hired on as a staff at an academic centre and one person who go a job on the condition that they do an ERCP fellowship...in Nova scotia. The others have told me that "things are difficult but I'm optimistic"...

[shikimate]

My city just hired a GI few months ago, took a while to actually find one! But again I guess geographically we aren't as "desirable" lol.

I don't know how much GI makes in other places but the GI here makes 500-600K easy. Other GI in the province makes up to 900K. 

 

[bearded frog]

To be an effective GI you basically need to scope, and to scope you need hospital affiliation, so unlike say neurology you can't just open a clinic somewhere, and hospital OR/procedure space/time is limited, hence the difficulty. It's the same with any specialty where you rely on OR time really.

[Turk]

Thanks for the replies everyone.

[Edict]

My advice is just take a look at the recent hires, for example looking at the recent hires in some academic centers, you can see that people are doing 2-3 years of research/masters/phd and an advanced fellowship typically to land a job. So 3+2+3 seems to be the norm. Linkedin can be a resource here. 

 

[Turk]

 

18 hours ago, Edict said:

My advice is just take a look at the recent hires, for example looking at the recent hires in some academic centers, you can see that people are doing 2-3 years of research/masters/phd and an advanced fellowship typically to land a job. So 3+2+3 seems to be the norm. Linkedin can be a resource here. 

 

Good advice, thanks! I think I may consider an office based IM specialty. As much as I enjoy procedures, I think location is more important to me. 

[ACHQ]

On 1/9/2023 at 10:31 AM, skyuppercutt said:

I'll start off by saying that I am not in GI, but I do GIM in ontario. Not sure about BC either but I assume the situation is similar to ontario. Who are you hearing mixed things from? Everyone I know says the job market is shit. Almost all of my GI friends and even those the year ahead of me, needed to do extra training (think hepatology or ERCP or IBD) to get a job or are still doing extra training and looking for jobs. I know one person who got hired on as a staff at an academic centre and one person who go a job on the condition that they do an ERCP fellowship...in Nova scotia. The others have told me that "things are difficult but I'm optimistic"...

this 100%

I know of one GI that finally got hired at a site where he was locuming for like 8 years....

Most GI's are young-ish so the job market will be terrible for a long long time. even with advanced training you are looking at a long road.

Now hepatology on the other hand is in demand. That being said unless you find endo time to do OGDs and C-scope +/- GI call at a hospital the $ you make in hepatology isn't as much.

GI in Ontario at a *Busy* centre will easily make 800-900k. Mind you they also have there own office/possible private endo suite, where they pay overhead (roughly 20-35%)

[rrcc]

On 1/17/2023 at 5:56 PM, ACHQ said:

Now hepatology on the other hand is in demand. That being said unless you find endo time to do OGDs and C-scope +/- GI call at a hospital the $ you make in hepatology isn't as much.

 

What's hepatology like? Is there still a lot of scoping? I'm guessing centers with dedicated hepatology clinics (eg. Toronto), the doctors there do much less scoping. 

Would hepatology practice be more like say rheumatology, endocrinology, etc? Clinic based, labs, pharmacotherapy?

[ACHQ]

8 hours ago, rrcc said:

What's hepatology like? Is there still a lot of scoping? I'm guessing centers with dedicated hepatology clinics (eg. Toronto), the doctors there do much less scoping. 

Would hepatology practice be more like say rheumatology, endocrinology, etc? Clinic based, labs, pharmacotherapy?

I can't comment so much re: hepatology, but from what I can gather, unless you do GI call or have endo time its mostly clinics/diagnostics as you see with the other sub-specialties you have listed.

Most community GI's have some subset of liver cases depending on if there is hep available. At my site we have 1 known hepatologist so they get sent all the hepatology cases (even inpatient consults, unless they are unavailable or on vacation). But generally in other large sites in the GTA there isn't someone who specializes in hepatology available and *most* are straight forward cirrhotics or eleveated LFT's that you don't *really* need a hepatologist to see/follow. If you want to do hepatology it isn't for the money unless you do GI/scoping too.

[The Ace of Spades]

The GI job market is tight for the most part. If you want to work in a major center (e.g. Vancouver, Calgary, Toronto) you will definitely need an additional fellowship (Nutrition, Motility, IBD, Hepatology, Advanced Therapeutics) and even then there are no guarantees. If you are mobile and willing to work in a less "desirable" city (e.g. Nanaimo, Kamloops, Vernon, Red Deer, Regina, Winnipeg, Thunder Bay, Woodstock) there are definitely jobs available for community GI without additional fellowship training. In my year alone, at least 6 GI fellows landed community jobs straight out of fellowship.

In terms of hepatology practice, this varies widely. Major centers will have a separate hepatology consult service, while other centers just have GI which sees everything. Unless we're sending a patient off for an inpatient transplant evaluation, community GI specialists should really feel competent in handling 95% of liver issues. Liver definitely pays much less than doing scopes, so most hepatologists still maintain endoscopy time although you can do an Adult Hepatology Fellowship in Winnipeg after IM so you would just practice 100% hepatology with no scopes. Where you work with that is limited to larger centers though as smaller centers would rather hire a general GI who is more versatile and can do GI call, but some larger centers where endoscopy resources are limited do like dedicated hepatologists so they do not have to share endoscopy time with the GI group.

[Turk]

15 hours ago, The Ace of Spades said:

The GI job market is tight for the most part. If you want to work in a major center (e.g. Vancouver, Calgary, Toronto) you will definitely need an additional fellowship (Nutrition, Motility, IBD, Hepatology, Advanced Therapeutics) and even then there are no guarantees. If you are mobile and willing to work in a less "desirable" city (e.g. Nanaimo, Kamloops, Vernon, Red Deer, Regina, Winnipeg, Thunder Bay, Woodstock) there are definitely jobs available for community GI without additional fellowship training. In my year alone, at least 6 GI fellows landed community jobs straight out of fellowship.

In terms of hepatology practice, this varies widely. Major centers will have a separate hepatology consult service, while other centers just have GI which sees everything. Unless we're sending a patient off for an inpatient transplant evaluation, community GI specialists should really feel competent in handling 95% of liver issues. Liver definitely pays much less than doing scopes, so most hepatologists still maintain endoscopy time although you can do an Adult Hepatology Fellowship in Winnipeg after IM so you would just practice 100% hepatology with no scopes. Where you work with that is limited to larger centers though as smaller centers would rather hire a general GI who is more versatile and can do GI call, but some larger centers where endoscopy resources are limited do like dedicated hepatologists so they do not have to share endoscopy time with the GI group.

Thanks, that was very informative! Did you have trouble finding a job when you finished GI? And did you need to do a fellowship?

And have you heard of the job market in smaller cities near the GTA, but not necessarily Toronto (i.e. Hamilton, Oakville, Mississuaga etc...). Or do you think that would be similar to Toronto?

[The Ace of Spades]

5 hours ago, Turk said:

Thanks, that was very informative! Did you have trouble finding a job when you finished GI? And did you need to do a fellowship?

And have you heard of the job market in smaller cities near the GTA, but not necessarily Toronto (i.e. Hamilton, Oakville, Mississuaga etc...). Or do you think that would be similar to Toronto?

I had no trouble at all, had a contract signed during my PGY5 year. I was going to do a hepatology fellowship but cancelled that after I got a job offer. I'm out west so I'm not sure what the situation in Ontario would be, but there are postings on https://www.cag-acg.org/news/job-centre you can check out (I would guess only 1 out of 3 jobs get posted there, most are word of mouth and referrals from colleagues etc). In the past 6 months they were general GI postings in Oakville and Peterborough for example, and a locum posting in Toronto. Hamilton is pretty academic however because of McMaster.

[futureGP]

The thing is, even if you don’t have a full time job at a hospital, you aren’t going to starve, even in the GTA. 

you might be locuming through several hospitals in the GTA for several years before landing a full time position where you get slotted your own endo time.

but while you do that, there are plenty of private endo clinics where you can work and make your living. Sure you might pay overhead, but these clinics tend to be more efficient and you may make up for the difference with increased efficiency.

 

If you want to just scope and not do much medicine, GI is a great career. 
 

hepatology would be good if GI could get chronic disease premiums for cirrhotic patients (+50% $ for follow ups). But at the current state they don’t, so per hour wise, $ is not worth it.

You could probably do better having an efficient office doing Endocrine seeing simple diabetes pts q15 mins and bill easy $400-500/hr.