GI training: where are we headed?

Gastroenterology (GI) fellowship training slots are not expected to increase over the next 10 years despite a 9% estimated US population growth. There is also no expected increase in the number of hours worked per gastroenterologist; instead, this number will probably decrease slightly, as GI will have continued growth in the percentage of women and of men in dual career families. The current trend of "sub-specialization" within GI is likely to continue, although this will not be formally recognized by further extension of the length of training or by additional board requirements. Current sub-specialties include hepatology, inflammatory bowel disease, motility, small bowel imaging, and interventional endoscopy. Most "sub-specialty" GI training will be incorporated within the 3-year fellowship, with the probable exception of interventional endoscopy, which will likely take an additional training year. End points for training and criteria for credentialing in the future will focus more on quality measures in both procedural and cognitive aspects of GI. Hopefully, this move to "competency evaluation with quality measures" will eliminate undertrained endoscopists such as the non-gastroenterologist performing occasional colonoscopy or the gastroenterologist performing occasional ERCP. Post-graduate GI training is also undergoing transformation, partly due to a decrease in industry support of graduate medical education, which has previously been heavily relied upon. The expected wider use of web-based training by the technology-comfortable younger generation of physicians may partly fill this gap. Despite the challenges facing GI training at both the fellowship and post-graduate level, GI is expected to remain a popular specialty choice. It is likely that sub-specialization within GI will continue to grow in both academic and private practices due in part to an increasing focus on quality patient outcomes.