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Academic Pediatric Gastroenterology, with Dr. Shapiro

Session 108

Pediatric GI was a natural fit for Dr. Jason Shapiro, who was interested in diverse pathologies, performing procedures, and developing relationships with patients.

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[01:05] Interest in Pediatric Gastroenterology

Jason is a pediatric gastroenterologist at Brown. He initially got interested in GI during the first month of his intern year. He likes the diversity of the field. It has a lot of procedures involved as well as research, immunology, microbiome, medication, and optimizing medication effects.

[03:00] Traits That Lead to Being a Great PGI Physician

Most of Jason’s clinical time is dealing with kids with Crohn’s disease and ulcerative colitis, which are impactful conditions. You want to have as minimal effect on the child’s daily life as possible. So you need to be empathetic, compassionate, and a hard worker.

'At the end of the day, you just really have to care.'Click To Tweet

[04:00] Types of Patients

Most kids with IBD (inflammatory bowel disease) present themselves during early adolescence. But there’s an uptake of very early onset IBD where kids less than 5 years old come in with it. For the most part though, new diagnoses are in early teens although it can run the spectrum.

Their bread and butter cases for Pediatric GI include infants with gastroesophageal reflux, milk protein allergy, constipation, Coeliac disease, and functional abdominal pains. They’re also seeing a huge increase in an allergic condition called eosinophilic esophagitis.

At Brown, they work with a team of GI psychologists who help them manage some of those more complicated cases.

Most of the referrals they get from a blank canvas. The majority of their new patient referrals from a general pediatrician have not had too extensive of a workup just yet. So there’s a degree of diagnostic work that needs to be done.

'Most of the patients we see need to be worked up and you're really doing the detective work.'Click To Tweet

There isn’t a huge amount of patients that they do procedures on. Although they’re generally non-invasive, there are procedures that need general anesthesia. And this is something they don’t just do without a good reason to do it.

Out of the total numbers they see in clinic, Jason estimates 10% of them would be procedure-related. His typical week would involve doing endoscopies. When on call, they’re probably doing more procedures than they like. So there’s no lack.

[09:10] Academic vs Community Setting

For Jason, research is a very important part of his career. Even in residency, he was involved in an Ivy League research that he did all through fellowship and up until he was already an attending physician.

'If you're interested in research, you want to be affiliated with an academic institution.'Click To Tweet

As a PGI across the country, you need access to pediatric anesthesia, which means you need to be in an academic center. In New England, there’s not much practice in pediatric GI so most of them are affiliated with an academic institution. 

[10:08] Taking Calls and Work-Life Balance

Jason takes calls between 8-10 weeks a year. Calls are variable. Their fellows take the first call from the ER or the community doctors.

The calls may vary from a couple of calls overnight to a week of procedures, most of which are esophageal foreign bodies, mostly coins. Every now and then, they do a few GI bleeds and variceal bleeds.

Jason believes work-life balance is an acquired skill in terms of working on time management and trying to get as much done. Since having his kid over two years ago, he had adjusted his work schedule accordingly.

'I take on a little less things and I learned to say no, which is also a very hard skill to learn.'Click To Tweet

At every phase of the medical career, it’s a hard adjustment. But having been in faculty for several years now, Jason has learned to set priorities and make the necessary adjustments.

[14:05] Training Path

The path to becoming a ped-GI doctor requires three years of general pediatrics. On your second year, you apply for fellowship and then you get into three more years of pediatric GI fellowship.

Currently, some people are doing extra years within ped-GI. So there are advance fellowships in transplant hepatology, motility, and IBD.

'The traditional ped-GI path consists of three years of general pediatrics and three years of fellowship.'Click To Tweet

Competitiveness-wise, Jason thinks the subspecialty is generally competitive from a pediatrics field standpoint. Therefore, you want to have good letters of recommendation and good board scores.

They recently graduated a DO fellow whom they think was one of the best fellows they’ve ever trained. For osteopathic students, just like any other traditional MD student, you have to have good letters and good scores. That said, he claims he doesn’t see a huge stigma against DO as much as it used to be. If you’re a good doctor, you’re going to be good doctor regardless.

'You take the basic substrate of your medical training from medical school and you flourish and develop your clinical skills and judgment in residency.'Click To Tweet

[17:30] Working with Primary Care and Other Specialties

What they wished primary care physicians knew was that they were able to spend more time and counsel some of the more basic stuff. He believes some of those cases could already be managed by a general pediatrician.

But he’s also aware that the primary care setting deals with a ton of patients to keep up with the demands.

Major stuff they could be counseling on would be constipation or functional abdominal pain. But can be difficult to get the message across to families so it takes time. And sometimes, hearing it from a subspecialist is important. 

Jason adds that there is an art to treating constipation. And explaining this to a family can take time. Investing time and energy early on is therefore important in terms of keeping the kid feeling well and helping the family understand the plan.

'In medicine, no matter what field you are, time is a commodity, time is a currency.'Click To Tweet

Jason works closely with pediatric surgery, pediatric psychology (specific to Brown), pathology, radiology, and hospitalists. For Crohn’s, he works closely with dermatology and neurology.

[20:54] Special Opportunities Outside of Clinical Medicine

There are a lot of opportunities in pharma. He knows a few people who practiced the subspecialty for a few years and ended up working at various pharmaceutical companies. Jobs in pharma can be widely varied. You can work on clinical trials or drug design, depending on your background and interest.

'In the world of inflammatory bowel disease, there are so many new drugs in development in various phases of being studied or trialed.'Click To Tweet

There is a need within the bigger pharma companies to have input from physicians with clinical experience treating these diseases.

[22:22] If He Had to Do It All Over Again…

With everything that he knows now, Jason would tell his old self not to be too distracted by the salary discrepancies within different fields of medicine. No matter how much money you make, if you’re not doing something you love, you’re not going to be happy. Money isn’t everything and it doesn’t buy happiness.

'At the end of the day, you've got to pick something you love.'Click To Tweet

Still, Jason would still have chosen the same field, if he had to do it all over again. He loves the patients and their families. It’s something he enjoys. He loves the science and the research aspects of the field. He loves the procedures.

[24:05] The Most and Least Liked Aspects

What he likes the most about his subspecialty is the ability to develop relationships with his patients and families. He finds it very rewarding.

'Seeing that appreciation from the families or getting a hug from a kid is very rewarding.'Click To Tweet

Jason has been in the same institution for 14 years in total now. He has seen kids from being small to graduating high school. He also likes the relationships he has built with colleagues and support staff.

On the flip side, what he likes the least is the EMR. He does think that the business side of medicine is necessary but it can be ugly. There is this sense that you need to bring more money and you need to do more and it’s tough.

He is lucky though for being a part of a department that’s really supportive and truly cares about child health.

[26:45] Final Words of Wisdom

Work hard. Find a good mentor. For Jason, having great mentors has been so important to him. Have somebody to guide you no matter what phase of career you’re in. Find somebody you trust and who cares about you and your career. Your mentor doesn’t have to be in your subspecialty.

Be honest. Always treat everybody with kindness – your colleagues, junior and senior people, nurses, secretaries. You can’t do your job if other people aren’t doing theirs. You’re a part of a team and it’s important for you to understand that.

[28:20] Final Thoughts for DOs

I just would like to point out to this discussion around how DOs are not respected. It’s not true. There are some programs out there that disrespect DOs but there’s a lot of disrespect happening in general. So it’s not a broad idea that if you’re a DO, you’re “lesser than.”

As mentioned by Dr. Shapiro, they have had DOs graduating from Brown and DO attending at Brown. So if you’re a DO interested in Pedia GI, there is hope for you. Just do your best.

'That's who matches into these residencies and fellowships are individual people – not individual MDs or DOs.'Click To Tweet

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