Volume 3, Issue 2 | January 2016
Letter from the Editor

Choosing a Post-Fellowship Path

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Matthew Stotts, MD

Saint Louis University School of Medicine, St. Louis, MO

ACG Case Rep J 2016;3(2):74-75. http://dx.doi.org/10.14309/crj.2016.1. Published online: January 20, 2016.

Stotts2While the gastroenterology career path is by no means short, for many of us it was relatively straightforward. If, like me, you knew you wanted to pursue gastroenterology, you moved from medical school to residency to fellowship relatively seamlessly, without need for significant pause or reflection. Yet during fellowship, there is a looming fork in the road. Mentors ask about your career goals. Family and friends probe to see if you’ll be moving to a job near them. Emails arrive from recruiters around the country.The good news is that there are options. The challenge is sorting through them to find a job that fits your needs, both personally and professionally. Key considerations for both academic and private careers include career goals, financial planning, expectations for work-life balance, family needs, and more. How you weigh these considerations will depend on your personal priorities and preferences.

Career Goals and Passions
Career ambitions typically fall into two categories—academic and private. The question of which to choose surfaces almost immediately during fellowship. If, after years of training in the academic setting, you envision a career that involves conducting clinical research, performing procedures not typically done in the community setting, or teaching future generations of gastroenterologists, then a faculty position at an academic institution may be a great fit for you. You’re already well-poised to understand the role—most fellowships provide consistent opportunities for fellows to hone their academic credentials and conduct research.

By contrast, if you know that you want to spend a sizable majority of your time providing hands-on patient care, you may consider private practice. And there’s certainly no shortage of private options—these jobs make up the bulk of recruiting mail that floods our inboxes during fellowship. But the functions of academic and private jobs aren’t always so neatly divided. Many academic positions offer the opportunity to work primarily as a clinician–educator. Similarly, research and teaching opportunities are available at some practices and healthcare organizations associated with academic centers.

Financial Considerations
Let’s face it, for the vast majority of us, financial considerations will play a role in our decision. The burden of educational debt and corresponding lack of savings is a concern for many. On the whole, gastroenterologists have a strong return on investment and are well-positioned to tackle debt, regardless of whether they choose academic or private medicine. According to the 2015 Medscape Gastroenterologist Compensation Report, gastroenterologists are among the most highly compensated physicians with a reported annual income of $370,000—ranking third in comparison to 25 other medical specialties.1 The highest gastroenterologist incomes were reported in the Northwest and Southwest United States, and jobs with healthcare organizations were reported to be the most lucrative.

While academic salaries are reported to be lower than those in private practices, the salary gap is smaller than you may expect. In its Report on Medical School Faculty Salaries, the AAMC lists the 2013-2014 median faculty salaries for assistant professors, associate professors, and professors in gastroenterology at $283,000, $328,000, and $347,000, respectively.2 In addition, academic settings often offer other “hidden” benefits, including retirement plan matching and low healthcare premiums.

Another consideration is the potential for student loan forgiveness under the Public Service Loan Forgiveness Program (PSLF). Check your eligibility for the program and research potential jobs to confirm whether the institutions are “qualifying employers.” Keep in mind that PSLF is not a sure bet—there is some political push underway to cap the amount of debt forgiveness or eliminate the program altogether.

Work-Life Balance
Work-life balance is an important consideration. Stress and burnout can lead to decreased job satisfaction and a reduced quality of life. Studies show more depersonalization among gastroenterologists in academic practice and higher levels of emotional exhaustion and depersonalization among gastroenterologists with fewer years of experience.

In your job interviews, try to get a good understanding of clinical, administrative, and educational expectations. Gauge the level of control you’ll have over practice management and managing your own schedule. Know what’s important to you and envision yourself working in this environment. Is the group supportive and team-oriented? Is the geographic location one that works well for you? Are the call expectations reasonable? How manageable is the commute? Above all, do you see yourself happy working here?

Navigating the Job Market
If you’re interested in private practice, the good news is that there is a clear demand for gastroenterologists in the community. The ABIM estimates that there are about 16,000 certified gastroenterologists in the United States—that’s roughly 1 per 20,000 U.S. residents.3 But keep in mind that private practice models vary considerably. You’ll be choosing between specialty groups and hospital employers, and practices across both entities will vary markedly in size and structure. Start by looking at online job listings (check the ACG, AGA, and other sites), networking at conferences and with current and former colleagues, or by responding to the variety of emails you receive from recruiters.

Academic job hunting, however, requires a different approach. While academic job offers may be posted to the public, they often require a network connection to secure an interview. Networking will be critical to your job hunt success. Reach out to your faculty mentors in fellowship—their influence may be a huge help to you. Moreover, it is imperative that you make yourself marketable. Key credentials include strong proficiency in mentoring, teaching, and research. Most faculty positions will be predominantly clinical or research focused, so you’ll need to demonstrate your interest and expertise in both areas.

Taking the Next Step
While choosing the next step is a big decision, keep in mind that your first job is unlikely to be your last—and you can apply lessons from this job search to your next one. So while you should enter your job search with a good sense of what you want out of it, you should also feel excited. This first job is only the beginning of a bright future ahead.

Matthew Stotts, MD
Saint Louis University School of Medicine

Associate Editor
ACG Case Reports Journal


  1. Medscape. Medscape gastroenterologist compensation report 2015. http://www.medscape.com/features/slideshow/compensation/2015/gastroenterology. Published April 21, 2015. Accessed January 3, 2016.
  2. Association of American Medical Colleges. Report on medical school faculty salaries, 2013-2014. https://www.aamc.org/data. Accessed January 3, 2016.
  3. American Board of Internal Medicine. Candidates certified: All candidates. http://www.abim.org/pdf/data-candidates-certified/all-candidates.pdf. Published March 10, 2015. Accessed January 3, 2016.

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