NP in Gastroenterology

core0 · Mar 1, 2007

Hello All. I was wondering if there were an NP's currently specializing in Gasteroenterology. If so, could you briefly explain your practice? Like whats a typical day like for you? I am interested in this area but am unsure of how to get there. Would I have to attend an FNP program and then specialize or an ACNP program and specialize? I am from Atlanta, Ga so if anyone has any information on the job market for this type of NP, that'd be great too:smilecoffeecup: Thanks!

Not an NP but work in GI. I know a couple of NP's working in other groups. It really depends on the environment. In one of the practices the NP only does inpatient medicine. In the other groups they work both clinic and inpatient coverage. For inpatient you do consults and follow up on the inpatients. Mostly you would write notes and put out fires. Our physicians are doing 6-11 procedures per day so this is definitely appreciated. In the clinic it will depend on the practice. Some clinics see only follow ups while others see new patient consults or follow ups. Pretty much every NPP in GI does a lot of Hep C.

There are also university jobs that are more specialized. Here we have NP's working in hepatology. There is an NP in the south that runs an IBS clinic. What I like about GI is there a chance to do a tremendous amount of education about the patient's disease process. One of the ways that a NPP works in the practice is to see those patients with chronic disease. Every physician accumulates these patients and the more you have the more this interferes with new patient consults and procedures which is where the money is. This is another area that NPP's can shine.

I see a lot of jobs in Atlanta, but they are mostly PA only. Not sure why. Part of the issue is that as you have discovered you may need both a ACNP to see inpatients and a FNP to see outpatients. Not sure what the environment is in Georgia. You might consider doing an ANP with some inpatient work or a FNP with ACNP post graduate work or vice versa. GI is definitely a growing area and both AGA and ACG offer NPP's associate membership and the AGA has a special assoicates course. Also AASLD is one of the only physican organizations that offer full membership for PA's and NP's.

Good luck

David Carpenter, PA-C

Editorial Team / Admin · Mar 1, 2007

You might consider doing an ANP with some inpatient work or a FNP with ACNP post graduate work or vice versa.

Agree with you, David.

I am FNP and worked with GI specialist for a while.

jolleygirl · Mar 1, 2007

Hi, I too work in GI, We have 6 docs and 2 CRNP's, our NP's do clinic only, they have no inpt, and see usually on average 20 or more pts daily.(usually more) one specializes in hep c management, the other in ibs/gerd, but both do general GI as well. If you check out some hospitals web sites, look up gastro and read bios of the np's if they have them, it would list the schooling/specific training, etc. Both our NP's had previous experience in the hosp/clinic non gi related before coming to gi.

hope it helps.

ashfost, BSN, RN · Mar 1, 2007

Thanks for the input. When you say the NP has no input, are you saying that the NP sees the "usuals" and takes care of just those patients? Hmm....I was talking to a CNS today and she was telling me that alot of NP's are dissatisfied with their career because they say its mundane and repetitive. If I interpreted your statement correctly, I can see their point. But it still sounds like a rewarding career. I love nursing but I feel that it being heavily task oriented will get on my nerves really quickly. I'd like a bit more autonomy and independence. I am on the road for CRNA but just looking into other options. Like I said, I am also interested in GI so I was just seeing what was out there. Thanks for the replies!

Trauma Columnist · Mar 2, 2007

ashfost - I don't think the poster meant "no input" she meant "no inpts" meaning they don't see hospitalized patients. Hope this helps.

core0 · Mar 2, 2007

Thanks for the input. When you say the NP has no input, are you saying that the NP sees the "usuals" and takes care of just those patients? Hmm....I was talking to a CNS today and she was telling me that alot of NP's are dissatisfied with their career because they say its mundane and repetitive. If I interpreted your statement correctly, I can see their point. But it still sounds like a rewarding career. I love nursing but I feel that it being heavily task oriented will get on my nerves really quickly. I'd like a bit more autonomy and independence. I am on the road for CRNA but just looking into other options. Like I said, I am also interested in GI so I was just seeing what was out there. Thanks for the replies!

I can't speak for NP practice, but what I like is the variety. We have 8 docs and 4 PA's so you are exposed to a lot of different practice styles. It helps that they are all decent people. We do see a lot of "usuals" but we also see patients that need to be seen immediately. These are great learning experiences since you start the work up but then usually get input from the physician and execute the plan. I personally like the variety when moving back and forth between the hospital and the clinic. The clinic is where you develop relationships with patients and the hospital is where you get immediate feedback.

I will say that one of the differnences that I see locally between NP's and PA's in GI is that the PA's tend to move around while the NP's tend to stay in one place. We have a group of cardiology NP's that we work with that have been with the group on average more than 10 years. On the other hand PA's nationally change jobs every 5 years. Of the PA's in our practice I came from Peds GI, one from hospitalist, one from neurosurgery and one from plastic surgery. Our group looks for hospital experience since they feel that area has the highest risk and liability.

On the subject of autonomy, in specialty practice this is different. You will never be in independent practice, and your autonomy will be determined by the confidence that the physicians have in you and the amount of control they are willing to give up. Within those limits you have a lot of opportunity for growth and the ability to sub-specialize within the specialty. A great opportunity is to look for patients that require a lot of time and teaching and adopt these. The physicians will be happy for you to take an interest and to unload their schedules. On of my coworkers does a lot of IBS. The practice allows her extra time to deal with these patients and the patients appreciate the extra attention. I do a lot of liver disease and am doing some work in transplant medicine. The opportunities are out there.

As far as mundane and repetitive you have to understand what you are getting into. In GI you consider something mundane, then you are not looking hard. Somtimes the unusual is found in the mudane. I saw two patients in a row that both had polio in 1941 that affected the right foot last week. Figure the odds. I also had to tell three patients they had cancer . You take the good with the bad. Prior to becoming a PA I was a CST. This is a very technical job, which I enjoyed, but I like to see the whole picture. Surgery is just a snapshot in time. I like to be able to follow the patient, good or bad. Speaking of technical, while I appreciate the job they do, there is no way that I could be a CRNA. A friend described the Army (pre Iraq) as long periods of boredom interspersed by short periods of pure panic. This describes a CRNA to me. I like my action a little more spread out and I am past the time when I like to do procedures.

GI is a great profession. It straddles the border between cerebral medicine like ID and procedure based medicine such as urology. Ultimately your ability to get a job is going to depend a lot on the local market.

David Carpenter, PA-C