Gastroenterology

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

Trained gastroenterologists develop and run endoscopy [1] services for diagnostic, therapeutic and screening endoscopy [1].

All specialists are competent at upper gastrointestinal (GI) endoscopy [1]. Most will be trained in lower GI endoscopy [1] (flexible sigmoidoscopy [2] and colonoscopy [3]). Some will have had additional training in hepatobiliary endoscopy [1] (ERCP [4]) or small bowel endoscopy [1] (wireless capsule endoscopy [1] or enteroscopy). Most will participate in acute gastroenterology admissions and manage a broad range of gastrointestinal disease, either in outpatients or following admission.

Gastroenterologists treat conditions such as:

• gastrointestinal bleeding
• gastrointestinal cancer
• anaemia – a condition where the haemoglobin the blood (a pigment that carries oxygen) is below normal levels
• inflammatory bowel disease, eg Crohn’s disease (inflammation of the lining of the digestive system), ulcerative colitis (inflammation and ulceration of the lining of the rectum and colon)
• short bowel syndrome
• jaundice – a condition where the skin yellows due to an accumulation of bilirubin the blood and tissues
• management of alcoholic, viral hepatitis (Inflammation of the liver caused by a virus) and autoimmune liver disorders (where the body attacks its own cells)
• diverticulitis - inflammation of the diverticula (small pouches) in the intestine
• gastroenteritis
• hepatitis

Common procedures/interventions

These include:

• diagnostic and therapeutic upper and lower gastrointestinal endoscopy
• small bowel endoscopy
• endoscopic retrograde cholangiopancreatography (ERCP) – an [4] endoscopic technique mainly used to diagnose and treat bile duct and pancreatic duct conditions
• endoscopic ultrasound (EUS)
• intestinal and liver biopsy
• paracentesis (puncture of the wall of a cavity using a hollow needle)
• insertion of parenteral nutrition line (intravenous feeding lines)
• planning and aftercare of patients undergoing liver transplant

Sub-specialties

The CCT sub-specialty is:

• hepatology

Many gastroenterologists develop sub-specialty interests such as:

• hepatology (diseases of the liver)
• pancreaticobiliary diseases of the pancreas and biliary system),
• inflammatory bowel disease
• functional bowel disease
• tropical diseases
• gastrointestinal cancer and its prevention
• endoscopic surveillance
• upper GI disease (diseases of the oespahagus and stomach)
• small bowel disease
• pancreatic disease
• transplantation
• medico legal issues in medicine
• clinical pharmacology
• inherited cancer syndromes
• clinical nutrition

Want to learn more?

Find out more about:

• the working life [5] of someone in gastroenterology
• the entry requirements [6] and training and development [7]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.

  Find out more about the current pay scales for doctors [8], there's more information on the BMA website [9].

  NHS Employers [10] provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in gastroenterology, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [11] (CCT [12]). You will receive your CCT [12] at the end of gastroenterology.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the department
  • clinical director - lead NHS consultant for the directorate
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the regional cohort of trainee doctors eg foundation training [13] programme director. This role will be working within the HEE local office/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the HEE local office/deanery

  SAS doctor roles

  There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor. SAS doctors are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty. Find out more about SAS doctors roles [14]. [15]

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Less than full time training (LTFT)

  A significant proportion of UK gastroenterology trainees are undergoing training on a less than full time basis (LTFT); arrangements are made between the trainee and their HEE local office.

  Academic pathways

  If you have trained on an academic gastroenterology pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in gastroenterology. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

  Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [16]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine [17].

  The Clinical Research Network [18] (CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  There are currently a number of staff grade posts in clinical gastroenterology or specifically endoscopy. They provide an important role in many gastrointestinal (GI) teams.

  Teaching is an integral part of most posts and there are opportunities to do research.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  Gastroenterology had 1137 consultants in England (1370 in the UK, not including 20 locum consultants) and 617 gastro registrars in England (NHS Digital, 2016 [19]).

  Women make up 18% of the consultant workforce, and 40% of higher specialty trainees in the UK (2014/2015, RCP census, 2016 [20]).

  Gastroenterology and hepatology expanded the most of all medical specialties in 2013. The consultant workforce increased by 41 in England, Wales and Northern Ireland despite 48% of advertised consultant posts remaining unfilled. The British Society of Gastroenterology estimates that a further expansion will be needed to meet the demands of an aging expanding population,seven day services, out of hours on call rotas for GI bleedng and increased demand for endoscopy due to expanding screening programmes and lower thresholds for referral.

  The Society is also aware of regional variation in consultant gastroenterologist provision. North East England and London have the most consultant gastroenterologists per population while Yorkshire and the Humber, East Midlands and South East Coast/South Central England have the least.

  In 2016, the competition ratio for CT1 core medical training was 1.53, and for ST3 gastroenterology it was 2.71 (NHS specialty training 2016). [21]

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data [22]

  NHS Wales medical and dental workforce data [23]

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland [24]

  Where to look for vacancies

  All trainees apply through the online application system Oriel [25]. You will be able to register for training, view all vacancies, apply, book interviews and assessment centres, and manage offers made to you.

  All jobs will be advertised on the NHS Jobs website [26].

  The BMJ Careers website [27] also advertises vacancies.

• Further information

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  Organisations

  Royal College of Physicians [28]

  Royal College of Physicians of Edinburgh [29]

  Royal College of Physicians and Surgeons of Glasgow [30]

  British Society of Gastroenterology [31]

  Real-life stories

  Professor John Hunter, a gastroenterologist (UKFPO) [32]

  Specialty registrar in gastroenterology (RCPE) [33]

  Video case-studies

  Dr GuraAithal, medicine – gastroenterology (HEEM) [34]