The Role Of A Gastroenterology Doctor
A gastroenterologist is a doctor who specialises in managing patients with diseases affecting the GI tract (stomach and intestines) and hepatic system (liver, gallbladder, biliary tree, and pancreas) (1).
Numerous conditions have been identified that gastroenterologists may diagnose and treat, including (1):
Inflammatory bowel disease, e.g. Crohn’s disease (inflammation of the lining of the digestive system), ulcerative colitis (inflammation and ulceration of the colon and rectum)
Short bowel syndrome
Diverticulitis (inflammation of the small pouches – diverticula – in the intestine)
Autoimmune liver disorders
In addition to usual history-taking and meticulous physical examinations, all gastroenterologists perform endoscopy services for diagnostic, therapeutic, and screening purposes.
All gastroenterologists are trained in upper GI endoscopy, and most are competent in lower GI endoscopy. Some complete additional training in hepatobiliary endoscopy or small bowel endoscopy (1).
Common procedures and interventions are (1):
Upper and lower GI endoscopy
Small bowel endoscopy
Endoscopic retrograde cholangiopancreatography (ERCP; used to diagnose and treat conditions of biliary and pancreatic ducts)
Gut and liver biopsy
Insertion of parenteral nutrition line (intravenous feeding line)
Planning and aftercare of patients undergoing liver transplant
Long-term care is a crucial aspect of a gastroenterology doctors job as patients often require continued monitoring. In outpatient clinics, they could therefore see up to 12 follow-up patients per four-hour clinic, or eight new patients, or a mix of both. As a gastroenterologist, you also conduct ward rounds and outpatient clinics, along with admitting new patients.
A specialist doing two endoscopy lists may see 12 to 24 patients in a day; although, this may be lower if cases are more complex and involve longer procedures, such as the removal of gallstones or polyps. Gastroenterologists work within a diverse multidisciplinary team consisting of surgeons, diagnostic and interventional radiologists, specialist nurses, oncologists, pathologists, A&E doctors, clinical research teams, as well as administrative staff (1).
Apart from the necessary skill set required by all doctors, aspiring gastroenterologists should demonstrate certain qualities and traits. As a gastroenterologist, you will often be put in a position to make decisions under pressure, necessitating excellent clinical judgement.
You should also exhibit enthusiasm for hands-on work since there is a substantial amount of practical work. Some patients present with incurable functional disorders, thus requiring you to demonstrate empathy and impeccable communication skills to help them come to terms with living with these problems (1).
Gastroenterologists can make a big difference to a patient’s life without surgery, thanks to improved treatments facilitated by continuing scientific advances (1). Moreover, recognising the underrepresentation of women in this specialty, the British Society of Gastroenterologists (BSG) launched the ‘Supporting Women in Gastroenterology (SWiG)’ initiative in 2014 in an effort to recruit more women and provide a supportive environment in which they can develop into senior leadership roles (2).
A Typical Week
A gastroenterologist’s working week is highly varied. Most consultants alternate between running specialist gastrointestinal and liver clinics, fulfilling a number of duties, including conducting endoscopies, attending clinical and multidisciplinary meetings, and ward rounds. The vast majority of gastroenterologists take part in on-call rotas, with around 60% providing cover at weekends on a routine basis.
On-calls can be demanding as they usually involve carrying out emergency endoscopy. Furthermore, most consultants’ on-call rota does not only include gastroenterology, but also acute general medicine; this means they additionally manage acute non-gastro admissions.
Consequently, hours and workload can be challenging. While most days would involve direct clinical care, some time is allocated to management, teaching, and clinical governance (1).
The Route To Becoming A Gastroenterologist
Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues. You may also want to consider joining associated societies, institutes or professional bodies such as the BSG and the British Medical Association (BMA) (1).
During your foundation years, if a rotation in gastroenterology is not possible, aim to do it in related fields, such as general internal medicine. You can also contact the gastroenterology department at your hospital and ask how you can get involved, e.g. tasters, research projects, audits (1).
After completion of your foundation programme, you are required to either complete a three-year internal medicine training (IMT) – formerly a two-year core medical training (CMT) – or three-year acute care common stem (ACCS). Programmes must comprise four to six placements in specialties which include direct involvement in the acute medical intake (3). Although both routes meet the entry requirements for specialty training (ST3) recruitment to gastroenterology, IMT and ACCS trainees emerge with different skill sets.
For instance, IMT provides a more diverse grounding in medical specialties, but compromises procedural skills, whereas ACCS focuses on handling acute and critically ill patients, but puts less emphasis on chronic illnesses (4). Once either is completed, you must obtain full Membership of the Royal College of Physicians (MRCP) prior to ST3 (1).
Completion of IMT or ACCS and MRCP does not guarantee an ST3 training post due to the level of competition; in 2019, there were 2.97 applications per place (5). Be ready to move to a different location as certain hospitals – such as the Lancashire Teaching Hospital, Preston – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (6).
Once you acquire a post, training normally lasts five years (ST3-ST7), of which one may consist of pure research whilst the remaining four are usually combined with general internal medicine. Trainees are expected to complete at least one year in a busier hospital. At least six months of training in each, specialised liver disease and nutrition, is also required. Academic-minded gastroenterologists may choose to pursue a research degree, usually an MD (2-3 years) or a PhD (3-4 years), before or during specialty training; however, this is not as common as in other specialties, such as neurology, which is regarded as a ‘more academic’ medical specialty.
At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant gastroenterologist (1,3).
Hepatology is the only recognised CCT subspecialty; training is undertaken during specialty training, usually in your penultimate year, with a total of two years spent in liver disease. Apart from this, many gastroenterologists develop specific interests and complete post-CCT training, for example in pancreaticobiliary diseases, inflammatory bowel disease, transplantation, tropical diseases, upper/lower GI diseases, and clinical nutrition.
Note that paediatric gastroenterology is a separate paediatric specialty and not a subspecialty of gastroenterology. (1,3).
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant gastroenterologists may also wish to run private practices to supplement their salary. On average, gastroenterologists can make a profit of an additional 60% of their NHS salary by working in the private sector. This is higher than most specialties, e.g. cardiothoracic surgery (50%) or obstetrics and gynaecology (47%), placing gastroenterology in the top 12 specialties for private earning potential (7).
For more information on doctor's salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in gastroenterology, you may find it useful to consult relevant journals, such as the ones listed below:
Nature Reviews Gastroenterology and Hepatology
The Lancet Gastroenterology and Hepatology
Clinical Gastroenterology and Hepatology
The following societies offer a wealth of information on conferences, podcasts, awards and bursaries, research, tutorials, masterclasses, and learning resources relevant to gastroenterology:
Other Complete Guides By BMJ Careers
Related Job Sources With BMJ Careers
1. Gastroenterologist [Internet]. Healthcareer | NHS. [cited 2020 Jun 24]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/gastroenterology
2. Training [Internet]. British Society of Gastroenterologists. [cited 2020 Jun 24]. Available from: https://www.bsg.org.uk/strategic-areas/training/
3. Gastroenterology [Internet]. Joint Royal College of Physicians Training Board. [cited 2020 Jun 24]. Available from: https://www.jrcptb.org.uk/specialties/gastroenterology-includes-sub-specialty-hepatology
4. Nazir MS, Sharp C, Fryer J, Edwards M. Acute care common stem pathway. BMJ [Internet]. 2011 Dec 2;d7640. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.d7640
5. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
6. Gastroenterology [Internet]. Lancashire Teaching Hospital. [cited 2020 Jun 24]. Available from: https://www.lancsteachinghospitals.nhs.uk/gastroenterology/
7. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004