Interview with a Gastroenterologist: Day in the Life of a Physician

What is it Like to be a Gastroenterologist? Find Out First-hand from Dr. Cohen

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Dr. Michael Cohen was kind enough to share some of his life story and professional journey. Dr. Cohen practices in the Chicago area, and following is his perspective on life as a gastroenterologist.

How did you get into medicine, and what motivated you to become a doctor?

I was determined to be a doctor since I was a little kid. I had a tumor (thankfully benign), removed from my shoulder when I was five. The timing of the surgery was critical, since the tumor was near the growth plate. A mistake in judgement could have a major impact on the growth of the bone. The orthopedic surgeon who cared for me was a wise man and a real gentleman, and left a big impression on me. Seeing how grateful my Mom and Dad were for his expertise also left a lasting impression on me.

How did you decide on Gastroenterology as a specialty?

Gastroenterology was a natural for me. I believe that each specialty tends to attract certain personality types. I noticed that the personality types in GI tended to fit mine: generally laid back compared to certain specialties. Next was the fact that GI is a great blend of cognitive skills and manual skills (endoscopy). I love to work with my hands, and was even an avid woodworker back in the day.

Finally, GI encompasses all forms of pathology, from infectious to auto-immune to neoplastic to metabolic. So while you specialize in one organ system, you still feel like you're taking full advantage of all of your medical training.
I love seeing office patients, and I love working in the endoscopy lab. I don't think I'd like to do one or the other exclusively, so GI is a perfect blend for me.

Tell me about your practice.

I have been in practice for 18 years, all in the same practice. There are currently 9 physicians in the practice, soon to be 10. We are a single specialty practice, meaning that all of our physicians specialize in Gastrointestinal and Liver Disorders. I am one of the eight physician owners of the practice. The physician associates in our practice will eventually become co-owners as well.

Our practice employs about 45 people, including three mid-level providers (physician assistants in our case). We have three offices. Our main office has a fully accredited endoscopy center with two suites, and full anesthesia capabilities. I am on staff at three community hospitals in the area. When I joined my practice, I was the fifth doctor. The practice has grown primarily through word of mouth. The culture of our practice is one of treating patients with kindness and excellence. Thankfully, it has worked well for us.

What is a typical workweek like for you personally?

Our practice is unique, in the sense that we take a weekday off each week, so if we are not on call for the weekend, we work a four day work week. Some people think we're nuts, since clearly we'd earn more if we worked five days a week. But our practice philosophy is that we'd rather maintain some quality of life than chase every last dollar.

On a typical work week, we may spend two days in the office, and two days based at one of the hospitals. A typical office day would include procedures in the morning, and office patients in the afternoon. We do about 7-8 procedures in a half-day session. A typical half day in the office means seeing about 10-12 patients. An average hospital day would include doing about 5 outpatient endoscopies, 1-2 inpatient endoscopies, seeing 10-12 patients on rounds, and 3-5 new consultations. You can see why we're ready for a day off each week!

What do you like most about your career?

Patients are great. While you occasionally get someone who is crabby or abusive, I'd say 99% are a pleasure to work with, and make all the hard work worthwhile.

One of the things I think is special about GI is the fact that we're making major inroads into getting people to get screened for colon cancer. Over the years, I've seen a huge improvement in that area, in large part due to the tireless work of the gastrointestinal societies that represent our specialty, such as the American College of Gastroenterology. They have influenced Congress to support colon cancer screening by Medicare, which has made a big impact. Being a part of the effort to reduce the death rate for the number 2 cancer killer in America is very gratifying. Finally, GI gives the opportunity to make a tangible difference, such as helping to control a massively bleeding ulcer, and sparing the patient a major operation, for example.

In your opinion, what are the most difficult or challenging aspects of your career as a gastroenterologist?

I think that the most challenging aspect is one that is shared in all specialties of medicine: the constant pressure by third party payers like Medicare and private insurance companies to reduce reimbursement, and increase paperwork and regulation. Keeping up with new developments and trying to stay on the cutting edge of your specialty is also a challenge, but it is part of the program.

What advice would you give someone considering a career as a physician, particularly in gastroenterology?

It is a great profession, even with all of the pressures doctors face today. Just make sure you know what you are getting into. It is an enormous commitment, so you have to be sure you're in it for the right reasons. Do some "shadowing" so you see what a typical "day in the life" is really like.
You have to enjoy working with people, because you'll be interacting with many patients, referring physicians, other specialists, and staff. You should be comfortable working at a brisk pace.

How do you think that the field of gastroenterology is going to change over the next 10 years, and how will that impact GIs?

Colon cancer screening may shift from the current standard of colonoscopy to imaging studies such as "virtual colonoscopy", genetic blood tests, or even stool tests. Endoscopic surgical procedures may also replace many of the most common general surgery procedures performed today. Gastroenterologists will need to be flexible enough to adapt.

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