Gastroenterology

Pediatric Gastroenterology

What does a Pediatric Gastroenterologist do?
What are the career opportunities?
What Board, if any, certifies a Pediatric Gastroenterologist?
What is the lifestyle of a Pediatric Gastroenterologist?
What is the compensation of a Pediatric Gastroenterologist?
How do I become a Pediatric Gastroenterologist?
Where do I find out about available programs?
When do I apply?
Why should I choose to become a Pediatric Gastroenterologist?

What does a Pediatric Gastroenterologist do?
A Pediatric Gastroenterologist manages digestive health in children. This field covers the entire gastrointestinal (GI) tract including the hepatobiliary-pancreatic systems (e.g., hepatitis and pancreatitis) and nutritional disorders (e.g., malnutrition and obesity). Specifically, patients may have a wide array of disorders ranging from acute (e.g., GI bleeding) or chronic disorders (e.g., Crohn disease), low (e.g., irritable bowel syndrome) or high acuity (e.g., liver failure) problems. The Pediatric Gastroenterologist also performs a variety of endoscopic and other diagnostic (e.g., motility) and therapeutic (e.g., foreign body removal, polypectomy, injection therapy, gastrostomy placement) procedures. Some patients have liver failure requiring artificial liver support or hepatic transplant, while others have short bowel syndrome and intestinal failure requiring chronic intravenous nutrition, enteral tube feeding, or small intestinal or multivisceral transplant. Pediatric Gastroenterologists typically work collaboratively with dieticians, speech therapists, psychologists, endocrinologists, pulmonologists, otolaryngologists, surgeons, other subspecialists, and primary care doctors to provide ongoing subspecialty care for their patients.

What are the career opportunities?
The majority of Pediatric Gastroenterologists practice in academic medical centers, with fewer in hospital-based or private practices. Most provide outpatient and inpatient consultation and procedures. In academic centers, the Pediatric Gastroenterologists have opportunities to provide clinical care, conduct clinical, translational or basic research (generally with protected time from clinical work) and/or participate in the education of fellows in pediatric gastroenterology, pediatric residents, medical students and general pediatricians. Specialists in liver disease often focus their academic practices and research on pediatric liver disease, including acute and chronic hepatitis, metabolic liver disease, liver failure and liver transplantation. Recently, more Pediatric Gastroenterologists are opting to specialize in other specific areas of gastroenterology, for example motility disorders, inflammatory bowel disease, nutrition, eosinophilic gastrointestinal disease, and aerodigestive disorders.

What Board, if any, certifies a Pediatric Gastroenterologist?
Pediatric Gastroenterologists must first be certified by the American Board of Pediatrics in General Pediatrics and then subsequently by the Sub-board of Pediatric Gastroenterology. Qualified physicians who have an additional year of training and who are certified in Pediatric Gastroenterology may also become certified in specialty care in Pediatric Hepatology and Transplantation, receiving a Certificate of Added Qualifications (CAQ) in Pediatric Transplant Hepatology. Advanced training in nutrition can also result in certification as a Certified Nutrition Support Clinician (CNSC).

What is the lifestyle of a Pediatric Gastroenterologist? 
Pediatric Gastroenterologists spend most of their time, typically about 2-4 days per week, seeing patients in an outpatient clinic setting. Another ½-1 day per week is usually spent in the endoscopy suite or operating room to perform procedures such as upper and lower endoscopy, percutaneous G-tube placement, polypectomy, foreign body removal, diagnosis and control of gastrointestinal bleeding, and treatment of strictures and varices. In academic practices, part or even the majority of time may be spent in research, education and/or administration. Night call is primarily phone call coverage, although occasional emergency situations (e.g., foreign body ingestion, GI bleeding, liver failure) may require urgent after hour consultations. In academic centers, shared call schedules and time for research, education and administration as well as support staff help reduce the clinical obligations proportional to the specific job expectations.

NASPGHAN (the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition) also has an important role in the lives of pediatric gastroenterologists. This subspecialty society provides opportunities to encourage and embrace camaraderie through organized meetings, beginning with residents (PL-2s) invited to the society-sponsored Teaching and Tomorrow program at our national meeting, then through annual meetings specifically to enhance engagement and friendships among each year’s cohort of fellows with first, second and third-year fellows’ conferences that help establish life-long collaborations and communications, to the annual national meetings, publications, advocacy, and online education and communication opportunities that keep over 3000 pediatric gastroenterologists in North America and around the world connected and up to date.

What is the compensation of a Pediatric Gastroenterologist?
Compensation for Pediatric Gastroenterologists is generally in the upper quartile for pediatric subspecialties and increases with experience. Driving forces affecting compensation include experience and specific expertise in procedural skills, inflammatory bowel disease and/or liver disease. In the past, those in private-practice often had opportunities to earn substantially more compared with academic Pediatric Gastroenterologists. to coincide with increased clinical responsibilities. Recently under new medical care reimbursement, this difference has narrowed. For more information, click here or here.

How do I become a Pediatric Gastroenterologist?
Trainees enter fellowship in Pediatric Gastroenterology after completing a three-year pediatric residency program. However, those that choose the Accelerated Research Pathway may enter subspecialty training after 2 years of General Pediatrics residency. Programs that aim to train academic Pediatric Gastroenterologists often require trainees to complete one intensive year of clinical training and 2-3years of additional research training while other programs may apportion more time to clinical training. Some programs provide additional training in sub-subspecialty areas during the three year program including motility and functional GI disorders, nutrition and inflammatory bowel disease. Alternatively, fourth year fellowships in pediatric hepatology and transplantation, nutrition, and therapeutic endoscopy (generally adult-based) and other as yet unaccredited fellowships in inflammatory bowel disease and motility disorders are being established to provide sub-specialty training.

Where do I find out about available programs?
Information about Pediatric Gastroenterology fellowship programs is available through Frieda, the ACGME and ERAS Fellowships. The later has links to websites of participating programs. In addition, NASPGHAN supports an annual Teaching and Tomorrow Program that invites PL-2s to the annual NASPGHAN fall meeting to learn more about the subspecialty (check the website NASPGHAN.org).

When do I apply?
Pediatric Gastroenterology is participating in the pediatric subspecialty Fall Match. Applications for programs participating in the NRMP match are generally accepted beginning in the mid-summer of the year prior to the start of fellowship, usually during the beginning of the PL-3 year. Interviews are conducted in late summer and fall. Most Pediatric Gastroenterology programs participate in the NRMP Pediatric Subspecialties Fall Match (PL-3 year), and most also utilize ERAS for the applications. Programs not participating in the match program typically interview during the same time period.

Why should I choose to become a Pediatric Gastroenterologist?
Pediatric Gastroenterologists are excited about caring for a wide variety of patients in multiple clinical settings. They enjoy the gastrointestinal, hepatobiliary, and pancreatic physiology and associated disorders, but furthermore appreciate the frequent interaction with other subspecialists, especially around nutritional issues. Individuals are often procedure-oriented and interested in utilizing advanced diagnostic methods. Some like the high acuity of liver transplantation or the challenges of small intestinal rehabilitation. Yet others enjoy interactive pattern recognition of functional GI disorders. In addition, the opportunity to manage children with chronic disorders longitudinally is very rewarding. If you find these attributes appealing, then Pediatric Gastroenterology is the field for you!

For more information about Pediatric Gastroenterology, visit these websites:
Freida
ACGME
ERAS Fellowships
NASPGHAN Foundation
Children’s Digestive Health and Nutrition Foundation
American Academy of Pediatrics, Section on Gastroenterology, Hepatology and Nutrition

Subspecialty Journals:
Journal of Pediatric Gastroenterology and Nutrition (JPGN)
Gastroenterology
American Journal of Clinical Nutrition (AJCN)
Hepatology

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