And this is a session called The Day in the Life of a Gastroenterologist. And we really have two of these sessions. The first one today is really designed to focus on the general aspects of a gastroenterologist's life. Tomorrow we'll have a session that's a little bit more focused on perhaps EOE and patient dynamics and care related to EOE. The way this is, it's meant to be interactive. If you have questions, raise your hand for the panel. We'll get things started with a series of questions that I'll post to the panel and try to navigate that discussion to inform you, particularly what it's like to be a gastroenterologist. All right, so I'm just gonna have you raise your hands. Of the following topic areas, which one would you like to hear more about from the ASG faculty? Changes in GI practice settings, resources being sought by gastroenterologists, optimizing working relations between GI physicians, pharmaceutical medical device companies, trends within endoscopy and other GI procedures, and types of GI patient states being evaluated and managed by a gastroenterologist, okay? So how about A? Raise your hand if it's A. Raise your hand if it's B. Not surprising. Raise your hand if it's C. Oh, interesting. And raise your hand if it's D. Okay, a little bit of everything. Okay, so I'm gonna just have our panel just briefly tell you what a typical clinical schedule is for a gastroenterologist. There's very different practices. When we just say a gastroenterologist, it could be in a community setting, it could be academic. Most, actually, essentially all of our panel here is academic, but we do have some variation in terms of adult versus pediatric and hospital versus ambulatory practice. So, let's see, John, I'll start with you. What's a typical schedule like for you in terms of the breakdown of your practice? Thanks, Bill. I have a rather extreme sort of schedule. I'm sort of on one far side of the spectrum at the institution where I work now. So I'm at Mayo Clinic in Minnesota, and there are about 100 of us on the gastroenterology faculty there. So, when it's a large practice like that, most of us tend to sort of operate in a narrow sliver of the pie, if that makes sense. Things get divided up, and there's a division of labor that tends to be very specific. And so, I'm about 85% clinical and 15% administrative. And 100% of my clinical time is spent in endoscopy. So, I actually no longer have a clinic practice, and I also don't see patients in the hospital in consultation either. So, that's a rather extreme representation of clinical gastroenterology practice. That being said, when I was at Northwestern here in Chicago as one of Dr. Gonsalves' colleagues for many years, or when I started my career at UPMC in Pittsburgh, I had a full clinic, and I admitted and consulted on patients in the hospital, and performed procedures probably about 60, 70% of the time. As a therapeutic endoscopist. And so, my career's evolved largely as a result of the practice pattern established in whatever institution I happen to be at for that span of my career. Right, and Femi, what's your practice like? At Loyola. Yeah, so, I am an academic center at Loyola, but I actually do have a community component to my practice as well. So, I spend about half of my time at Loyola, the main campus, and about half of my time at one of Loyola's satellite community hospitals. So, I can speak to that a little bit. But in general, I'm 100% clinical, so I don't have, all of my teaching academic responsibilities have to be, oh, thank you, wrapped into what I'm doing on a clinical basis. But a typical week for me, I spend two days out of the week at Loyola, the main campus, and that's doing procedures all day long. Then I spend one day a week, or two of the days of the week at the community hospital. One of the days that I'm at the community hospital is a clinic day, so I see patients in the office. And one of those days, I cover the inpatient service at the community hospital. So, that means, usually in the morning, I'm doing outpatient procedures, and in the afternoon, I'm rounding on consult patients, doing inpatient procedures as well. And then I also take call, meaning call after you leave the hospital, potentially getting called back about four to five weeks out of the year. So, maybe about half of your time doing endoscopy and half clinic? Yeah, it's actually three to one. So, three days out of the week, endoscopy, one day clinic, and one day is administrative. Great, Jennifer, from a pediatric practice standpoint, what is yours, and maybe share what you know about community practice pediatric? Sure, so I'm at a very large pediatric practice. I'm at Boston Children's Hospital. We just hired our 71st physician. So, and then we have nurse practitioners and PAs, and we also have psychologists and social workers and dieticians and nurses. So, it's a big practice, I don't know, 400 people-ish altogether. I mean, I'm personally chief, so I have my own schedule, but I will tell you that the goal right now in academics, and there's a lot of benchmarking going on across all of the big centers, so we could talk about those, but is about five to six clinical sessions a week plus one to two endoscopy sessions a week. That's sort of a typical pediatric clinical gastroenterologist. Obviously, at the academic centers like my own, the more grant funding you have, the less clinic you'll do, but pretty much everybody does some clinic, some endoscopy, and everybody takes turns being on service at any given time at our hospital. We have about eight people who are on service. That's very different from smaller programs. I did spend eight to nine years at UMass. I built us from, I got there, there was one pediatric gastroenterologist in central Massachusetts. When I left, we were up to six, and I made sure to leave them with people I recruited my own follower, so it's a group of six there. And very similar, though, they do like five to six clinical sessions and one to two endoscopy sessions a week, and again, cover the inpatients, so a lot of coming in to take out foreign objects in the middle of the night, dealing with bleeding, things like that. So community-based, just the smaller you are, the more you're on call all the time. You're the person that they're calling all the time. Okay, and Nimi at Northwestern? Yeah, so I'm a professor of medicine at Northwestern in gastroenterology, and focus primarily on esophageal disorders. There's five of us that focus on esophageal disorders, and two of us mainly focus on eosinophilic GI disease, and we co-direct the EGID program at Northwestern. There's a total of, I want to say, 61 different faculty, but similar to Mayo, we all have our own unique specialties. My practice is a balance of seeing patients in clinic, doing endoscopy, but I also have research grant funding and some administrative activities, so that takes care of about 50% of my time. So a typical week, Mondays, I'm in procedures all day, so we do about 16 cases a day. The majority of my cases are EOE patients, or non-EOE EGID, with a lot of esophageal dilations. Tuesday is my primary clinic day, so I see about 25 patients during that time. Again, 90% of those are EGID. Wednesday morning, another endoscopy block, so about eight patients, and then Wednesday afternoon, finally, I get to breathe and catch up on all the early part of the week. Thursday mornings are my academic time. Thursday afternoon, I have an EOE-specific multidisciplinary clinic, and Fridays are another academic day. And on those academic times, I do a lot of conference calls and NIH conference calls because I do have grant funding for EOE research. So you can see there's a bit of a, especially in the academic environment, there's a bit of a richness of the diversity of the roles that gastroenterologists will have, and my colleagues can affirm or attest what I'm about to state, and that is in community practice, gastroenterologists are really 100% clinical, for the most part. I mean, there's some that actually have some research projects, industry-sponsored research enterprises, but 100% clinical, and they are rushing from the endoscopy lab to the clinic and back and forth. Their mornings start often at 6, 7 in the morning. They finish at sometimes 6, 7 in the evening. And so the reason I point that out is as you, for those of you that are in the field, and I know we have a lot of different roles here at this meeting, for those of you that are in the field trying to catch up with gastroenterologists, you gotta like hang on to their coattails and drag them down and tackle them to actually get a chunk of their time because they are often, and we are as well in different roles, rushing from place to place to place. And I wanna touch also about what Jennifer said earlier is that even in academic centers, there is a tremendous transition now for clinical productivity. They're all nodding their heads because even in academic centers, there is a very big change in the way compensation systems work to the point where clinical productivity is tied to the compensation. And so that means that there's no longer this concept of academic docs sitting in their office eating bonbons and reading New England Journal of Medicine. That happened maybe when my mentors were in medicine. We all miss that time. Yeah. But we are under benchmarks that we have to live up to in terms of clinical productivity, just like I'm sure that you folks have benchmarks and targets in your field. The field of gastroenterology and in many areas of medicine is now very much driven on metrics that are designed to show that you're being productive. And in the clinical realm, that often means RVUs, relative work value units, and procedures or clinic visits or number of visits, whatever benchmark is being used is something that practices whether academic or community is being held up to. Any questions for the panel about the life and their clinical roles that they have? Yes, and please use the microphone. Sure. Generally speaking, it sounds like it's a very busy time, especially in the community. Is there a best of the times to try to connect with someone if we have updates or new information that we want to share? I would say for me, so definitely my days at the community hospital are definitely the busiest during the week, and it is really tough. I think it depends on the person. So, you know, first thing in the morning, I usually get there around seven, but that's to get ready for my procedures. Then throughout the day, we're fielding consult pages from anywhere in the hospital. During lunch, in theory, there's a day on time because we don't have procedures scheduled then, but that's usually when I go around. And then in the afternoon, we're doing procedures as well. So for me, I mean, for me personally, I would say usually late afternoon would be the best. But there are some doctors that actually do take time to eat lunch, which is a good thing. Everyone should take a break and eat lunch. I just don't do that. And for them, that may be the best time. So I think it would be really building a relationship with the doctor that you're working with and getting them comfortable with you and seeing what works with them. I would add to that. I think what can be helpful is someone's like, I'll come and page you or find you and wherever you are, I'll come to you. Because I think pinning me down is probably the toughest thing because I'm moving around more than I want to. Yeah, I would also add, you know, pre-schedule it. You know, it's really difficult to chat sort of on the fly. And so usually when I meet with folks in industry, we'll have pre-arranged a meeting for a certain date and time, which is much better for both of us. And I would completely agree with that. I think trying to find us during endoscopy blocks or clinical blocks is just too difficult. So pre-scheduling is really important. Question. So to kind of piggyback off of that, you're obviously very tight scheduling. So whenever we do schedule those types of meetings with you, what type of information do you see to be most valuable, considering that you're obviously, you know, very, very busy? I'll start. You guys can take it. I mean, so I do find people, I totally agree with the pre-scheduling because in some ways, ideally, I've picked a day that I am physically in one place. So that's better. But people will come and they have glossy, beautiful things and you're just not 100 percent sure. You're like, OK, I think I can understand what you're getting at. I personally, if you can say to me, here's a great article or we think this, that that actually will resonate more. So and I'm happy to take reprints, you know, old enough to like paper. And I would say I would also add to that and say, you know, 15 minutes snippets are really like ideal and being very focused on either what you're asking of us in terms of our experience with different types of therapies or what you're going to share with us in terms of latest data and being very focused on those things will be really, really helpful, because then that will be the most high yield time for both of us. I think it's also worthwhile to to put some effort into knowing and understanding your audience, which is to say that. Well, let me use an example. You know, I've gotten a few queries from marketing professionals regarding a product for liver disease. The bile ducts connected to the liver, but I don't treat liver disease. So I'm not their right audience, but I know who their right audience is. So, you know, sometimes asking a question helps. So, doctor, is this something that might be useful to you? Or if not, might there be a colleague that you can suggest who this might be useful for? You know, and most of us are going to be very approachable about that because we don't want to waste your time either. We know that your time is valuable and what you're doing what you're doing in pharmaceutical or medical device sales is a lot different from sales of other items. You know, you have to have patients interests in mind and to help those patients, you need to get to the right doctor audience or provider audience. And that some of the busiest providers are not even physicians. You know, like in our liver practice, there are some incredibly knowledgeable nurse practitioners and PAs that do a lot of patient management. And so, you know, I might tell you to, you know, go go talk to Andrea Gossard, you know, who's a nurse practitioner. She sees a lot of liver patients every day. And that might be the right audience for the person who contacted me about liver disease pharmaceuticals. Yeah, one thing I agree with everything that's been said. One thing I would say is that particularly if this is an established drug, you know, that you are fairly confident that the physician is familiar with. Oftentimes with my patient population, my decisions unfortunately do come down to access issues. And so having a general sense of, okay, so, you know, the hospital that this doctor practices in sees primarily Medicare and Medicaid patients. What are we able to do in terms of obtaining access for this drug for those patients can be really, really helpful. Aside from, yes, and I definitely love when people can just say, here's a paper, here's the comparative effectiveness data. You can review it on your own time. Okay, question. I was wondering, guys, if you can comment on this new movement towards GI hospitalists because you guys are so busy. And I know just to help audience to understand that specific sub-sub-specialty. I can start off because our division is moving a little bit towards that. So like I said, we have about 61 different gastroenterologists and hepatologists and we have an inpatient service. And it's typically run by many of the academic faculty and we used to all rotate on that service. Now that's moving really towards a general GI service and within that they're even going to be hiring GI hospitalists. So there will be one physician that will basically take care of the patients in house. I don't know if that's a movement across all academic centers and I'm curious to hear your thoughts but that is something that is happening. Anybody else have GI hospitalists in their facility? We don't, but we are also kind of moving in that direction. So historically at a busy community hospital you would have physicians who were either employed by the hospital or a private group that was coming to the hospital to first of all do outpatient procedures. So your screening colonoscopies, upper endoscopies. But then they would also see any consult. So any patient admitted to the hospital who has a GI issue. Whether or not they need a procedure or not. And so it's a little aside from just being very busy it's difficult to kind of predict the workload. So you know you can schedule half a day's worth of patients assuming they're going to have half a day's worth of inpatient work in the afternoon. But sometimes there just doesn't happen to be any patients in your hospital that have GI issues and then it's kind of a wasted time. So the idea is that you're going to hire someone who's 100% focused on the inpatient service. They come in, it's usually going to be a shift something like 7 a.m. to 7 p.m. They only see consult patients and do those procedures. And then in the evening it may or may not be another consult or sorry hospitalist who takes the call in the evenings. There's different structures but it's usually seven days at a time. That work is very intense. However the benefit for them is that they're not having to divide their attention between their outpatient work and their inpatient work which is one of the things that I think any of us who are doing inpatient and outpatient work struggle with. Now the hospitalist kind of name was borrowed from internal medicine which has been doing this for quite a while. And hospitalists that do it they tend to like it because it's usually a schedule something like seven days on, seven days off. Because those seven days are incredibly intense and you actually do need that time to recover. Also at least in internal medicine and pretty much for the few GI hospitalists that I know it tends to be a younger kind of field to go into because of the intensity of the work. So for those seven days you have to basically be okay with not having any sort of external responsibilities. As you get older, more wear and tear on your body, families, other things, it's just not practical. But we'll see, it's definitely a newer concept in GI. Yeah, the whole concept is really kind of the compartmentalization of care and carving out the inpatient from the outpatient, really from an efficiency workflow and tactical perspective. But there are some obstacles to this, and for example, in EOE, a patient comes in, food bolus, impaction, the hospitalist is the one that takes care of them, maybe does the biopsies at the first endoscopy, and then gets the PATH report, but then they need outpatient follow-up, right? And so there's gotta be a process, an effective process of handing that patient over to somebody in the outpatient arena. So we're learning in GI about this concept of GI hospitalists and sort of fragmenting or separating the care from inpatient to outpatient and some of the obstacles to good patient care in that setting, yes. Can you hear me? Yes. Okay, great. So I assume you all get hundreds of emails a day, and you're triaging them based on importance and significance and urgency, and looking through that, you see some names popping up from the industry. How do you prioritize among those, and how would you describe the best examples of people that you would call maybe trusted advisor, where you're available to them more frequently? I would say anyone who helps, you know? So somebody who I feel like I've reached out to to say I'm having trouble getting Dupixent for my patient, you know? And then they're able to somehow figure out how to help me. Now that person just became very useful. And I'll say for our practice, and again, I'm very EOE focused, so the medical science liaisons are mostly my contacts and will reach out to me about various things, but there was a lot of activity in Flurry when medications come on board in terms of how to make it more accessible for patients and make it easier to do that workflow. But it's the medical science liaisons that tend to interface with me. Question? Yeah, to play off of that comment that you made, being medical affairs, we don't really deal with the coverage. There are many folks in here who do, but for the medical affairs folks, we don't deal with coverage issues. So having had interaction with MSLs, you guys are a little bit unique because we run into people all the time who don't really understand the divisions within pharma. So what interactions have you had or do you have any examples of where you've been able to identify a specific value, like for some of the sales and marketing folks, maybe it was access questions. Is there something specific that you've had from MSLs that you're like, those are my people for this specific need or what can we do to serve you better? Yeah, I mean, I think specifically to your therapies, I mean, access is the biggest problem, right? And I think we're, as many of us here, are in a very unique situation in that we're in academic centers. We have IBD groups that have already gone through biologic therapy and vetting out. At Northwestern, we have a specific specialty pharmacy and we have a very easy line to do all that and it's been kind of done before. So we are able to model that very well. And many people on the Sanofi Regeneron area were able to help also support that. I think the challenges, I'm curious to hear your thoughts, are people out in the community who don't have that easy access and kind of providing them with that education on how to best get these medications out to their patients. What are the hurdles they're gonna face? I think that's the biggest thing that I would say you could really help with. I actually wanna rip off John's discussion of the hepatologist and when somebody comes to him with something that should be for hepatology and he's sort of frustrated. I think it's incumbent upon us at our giant centers to make sure you get to the right people. So if you've come to us with something and we're not the right people, we should say, hey, we know who to connect you with. It's kind of similar when I reach out and you say, well, actually I'm in MSL and not, the truth is I don't know. I'm just reaching out. So the more that you can be like, oh, okay, I know exactly who can help you or let me get you to this person and frankly stay with it. Because now I'm like, oh, you've become my contact who was able to connect me to the right person. Now you're very valuable to me. Now I notice your emails to the hundreds that came in. It's interesting. I had a recent focus group with some of our trainees from recent years on a virtual meeting and asked them what was one thing that you would find beneficial in changing in our training program. And one of the top things that they identified was we don't really know how to interact with industry representatives. We never get trained on how to do that. And we don't understand the difference between somebody in medical affairs or somebody in marketing and sales. And so I think training programs have to do a better job of really highlighting the importance of the partnership and what the different roles are within industry when they then encounter folks in the field when they go into practice are more effective at doing that and communicating on their end. Let's see, a question. Hey, sorry, I just had a quick question. So when you take call, what's kind of the average number of call you would get per day? And then what is the most common reason for the call? So when I took call, I was a notorious black cloud. And I mean, this is why I got into EOE and we can talk about that tomorrow. But so I would always get called in. And at Northwestern, we take call as fellows. Fellows actually split it out, but as attendings, we take call a week at a time. So we're on call 24 hours a day, seven days a week. And it's a busy center, just like all of our centers. So we may come in for GI bleeders, patients come having a big ulcer that's bleeding. But a lot of times it's food impaction from EOE. And so it could be as few as one time per week overnight, or I've had weeks where I've come in six nights a week. And if it's a food impaction, it's always usually at two o'clock in the morning, a very lovely time to come in for a call. It varies, and that's in an academic center. We split it up week by week. And I'm curious about the community centers, how often you do that. Yeah, so at Loyola, so when we take call, we also do for a week at a time. So during that week, you're basically seeing patients during the day at the main center, like consults, so inpatients, and then at nighttime, you cover both hospitals. So both the main hospital and the academic center. And there's slight differences in the patient population around the different hospitals. And you'll see that, for example, where I did my training, or part of my training was at North Shore, which is a community hospital system just north of the city based in Evanston. And because Evanston is where Northwestern Undergrad is, so there are a lot of young males who aren't aware that they have EOE. And they'll go out, they'll eat some really dry chicken or something like that with their friends, and they will come in always at 2 a.m., because they kind of struggle with it, maybe dinner at 8 p.m., and they kind of struggle at home, they don't want to go to the hospital, all this stuff, and then you get called. So we had a lot of food inpatients, probably on average, one a night. So when you're on call at North Shore, you expect it to get called in. Whereas at Loyola, it's a big liver transplant center, so we do have a lot more urgent upper GI bleeding from varices, that's probably the most common reason why you would come in. And also at the community hospital that I work at, just the surrounding area, socioeconomically, is a little bit depressed, which is associated with addiction issues of all kinds, but particularly alcohol abuse. So we also come in pretty frequently for cirrhotic leavers. If I can go off that. So I think what Femi is talking about, which is really critical, is probably understanding the locale that your doctors are in. So as Liz mentioned, so I was at Boston Children's, living in Brookline, which is the town right next to Boston. I started driving to Worcester, which is only 30 miles, but everyone in Worcester couldn't believe I was driving from Brookline, and vice versa. People couldn't believe I was driving to Worcester. Totally different city, it's actually, it is a city, and different population of patients. So they weren't calling me as often. But I forgot to ask a critical question, which is where does our state of Massachusetts have its worst psychiatric facility? And it turned out it was right across the street from UMass Memorial. And so what we were getting called in for a lot, and so it was a small group, and we felt pretty abused by it, to be honest. Our kids were swallowing stuff, and they're swallowing everything, and it's awful. And so if, again, understanding what are the stressors for your doctors can make a big difference. I've returned to Boston. It's a much more type A crowd there, and they expect someone on call all the time. One thing we haven't talked about is we do have trainees in the academic centers. So we have fellows or residents. They have more and more protection. I think our residents are about to unionize. Our fellows are, I don't know, I can't figure out what they're doing at this point. And so a lot of that is now falling on attendings, and that is a big stressor going on in healthcare. I'll put that out there. Yeah, I call it the sandwich generation of gastroenterologists. That's us. That's us. Because I'm involved in our center with recruitment in my position of gastroenterologists and people coming out of training. The first question they ask is, do I have to take call? And of course the answer is yes, and then they say, okay, I'm not interested. So a lot of young trainees coming out are really not wanting that existence of having to do call. And of course you've got older individuals who have kind of aged out of doing call, and the folks that are still doing call are kind of the sandwich generation of being on call. So there is some changing dynamics in terms of generational changes in the field of gastroenterology. We'll have to see how it works out. I do want to, just on our slide here, we've kind of talked about the dos of interacting. What about the don'ts? What should industry representatives avoid doing? What should they not do when they're interacting with you in the field? Anybody want to take that? Charged issue. I'll make a comment. I think more frequent contact of shorter duration is far more effective than occasional contact of long duration. Most of us really just unfortunately don't have the ability to spend lots of time. But if we already work together and you're supporting my practice, I need some kind of contact once in a while. It really doesn't need to be anything more than, hey, how's it going? Anything you need from me? The answer might be no, but it might be yes. But if I don't hear from you for six months or a year, I'm gonna start to think you ditched me and I'm not gonna feel really good about that. And so it doesn't need to be long and I might not need anything. Frankly, it can't be long. But try to reach out once in a while and stay in touch. And if there's something to let us know about, let us know. But more frequent, less duration. Any other don'ts from our panelists? So, I mean, I doubt anyone here would be doing this. It's more on the device side, but I think a major don't is arriving unannounced, which we've had as an issue in our GI lab because we get really comfortable with the reps and they'll just stop by and we may have six docs who are scoping at one time and so someone shows up and then we might say, oh, hey, it's good to see you. I wasn't expecting you. Assuming that they arranged something with one of the other doctors, but then it turns out that actually, no, they just showed up. And you never know if you just show up and haven't contacted anyone before whether or not it's gonna be a good time. We don't know what the intentions are of the meeting and so that's the big don't. And so along those lines, I would also say like know your center that you're working with because Northwestern has kind of closed the open door policy to pharmaceutical reps. It used to be that you could come to clinic, you can come to endoscopy, mill around and like interface with the physicians. Now that's no longer allowed. So you really do have to have a scheduled time with somebody to come in. So just know the facility. I'll just, you know, especially this is, I think this happens a lot on the device side as well, but there's trying to don't gossip, you know, don't tell stories about other providers and avoid that temptation of kind of sharing that kind of information that's not necessarily relevant to clinical care. While we were talking about changes in policy, is anybody still running into COVID as the excuse that people are not getting into the healthcare environment? No, pretty much, or yes, I see yes, we still are. So COVID policies are still in place as an obstacle for folks to get into and connecting with GI healthcare providers. Sounds like it. It's hard to believe, but you know, obviously it was a very challenging time when COVID hit in terms of the industry representatives ability to connect with healthcare providers. We did have virtual presence, but we are, ASGE is in the final stages of editing a document on the role of the industry representative in both the clinic and in the endoscopy lab. And you'll see that we're trying to encourage folks to have a more open door policy now that the pandemic is waning. I want to close, and this has been a really rich discussion and we're running a little bit over, but I want to go down the line of our panelists here and just tell me your favorite part of your job. Let's start with your least favorite part of your job and then your favorite part of your job. John, we'll start with you. Well, I do procedures all day long, every day almost. And so I actually really enjoy meeting the patient before the procedure and chatting with the patient after the procedure and their family and what have you and finding out a little about them besides their medical issue, where they're from, what they do or what they used to do, et cetera. I guess I miss my clinic and I don't get that sort of handholding part as a regular thing. So I've figured out a way to get that on a procedure schedule. So that's the favorite part. Probably the part that I hate the most is the occasional adverse event or complication. I always feel bad when I try to help someone and I hurt them in the process. Most of the time, the patients are understanding and they appreciate that you try and they understand the difference between a mistake and something that happens even if the process was correct, the outcome isn't ideal. They get that. But you still feel bad when you accidentally hurt someone, particularly if they've gotta be in the hospital for a while and stuff. And at least for me, that's never gone away. I still am traumatized by that psychologically. Yeah, I think that's natural for all of us. We all took an oath to do no harm to patients and you sort of feel responsible when somebody in your care has an adverse event regardless of whether it was necessarily a fault or not. And it can lead to a lot of moral injury and sleepless nights, for sure. Femi, your favorite and least favorite part. So I'll start with the least favorite. So I do do clinic, although it's getting to be less and less of my practice. It's not my favorite day. And it's not so much, I do really enjoy seeing patients and hearing their stories, coming up with a plan. It's the paperwork and documentation that has to happen afterwards. And I'm one of those people who probably spends a little bit too much time making sure that everything is well documented for myself, my own memory, and then also for other doctors that may see the patient in the future. So that's probably my least favorite, is the time after clinic when you're writing notes. My favorite part of my job is just doing endoscopy procedures, particularly colon cancer screening and prevention. It's a really good feeling, at least to me. Sounds cheesy, but it's a really good feeling to me when you can find a large polyp and resect it and you know it's the kind of polyp that, you know, not a teeny tiny polyp that may have taken 20, 30 years to become cancerous. Like, no, this is a polyp that may have become dysplastic or precancerous within a year or may already have precancerous changes. And you did the procedure and you intervened on it and you could have potentially prevented a cancer. That is the best feeling and makes everything else worth it. And Jennifer? Wow. So I'm with Femi with the part I hate. So, I mean, there's no doubt documentation, interacting with the electronic medical record in general, it is just, it's become very burdensome. And it's all the time, it's sort of, you live with it. So I would say, even here, I'm like, because I'm trying to walk the walk, I'm trying to keep my whole group going. And I just don't want to be myself in my, I've got my documentation optimization group. That's the dog. And then there's a whole thing that gets into, if you're late, that spells out house. But I'm trying not to be in the dog house. That's the worst part. I mean, we don't do colon cancer screening. But I think that concept of helping people is something that you do live for in medicine. It's why we all went into it to begin with. I personally really enjoy demystifying things. I demystify for my patients. I demystify for my colleagues. I'm here demystifying pediatric GI for my adult colleagues. I'm like, it's like, it is really fun to explain stuff to people and that they feel empowered understanding something that felt a little mysterious. So I think that happens all day long for me and I sort of live for it. And so I'm similar to everyone up here in that I really don't like the documentation and the medical record. It takes at least two to three hours for every kind of patient clinic afterwards to kind of do reasonable documentation. And I'm like Femi in that I probably spend way too much time, but I like to be accurate. I like to know what I'm thinking for the next time I see that patient. I don't like someone to be able to read that note and not have a whole bunch of like hodgepodge things in it. So I probably spend too much time, but I don't like that. The thing that I love the most about what I do is being able to have a direct impact on the patients with the research and the clinical care that we've done. And some of the more rewarding experiences have been like young kids that came to me transitioning from the pediatric hospital who couldn't swallow, had malnutrition, who started off with a four millimeter esophagus, which was really, really tiny. And we've worked through with them kind of retraining them how to eat, helping open up their esophagus, watching them go to law school, asking me for letters of recommendation for law school. Now they're married with kids. I mean, it's really fantastic. But having them participate in various research studies and giving them that direct kind of feedback back of what the outcomes of those studies were and how it is advancing the field. I feel like that's one of the greatest parts of academic medicine is the patient's story, the patient outcomes, and that's why a lot of us do what we do. Great. Please join me in thanking our panel. We will have the opportunity to do this again tomorrow. Thank you.

gastroenterologist

schedule

challenges

practice settings

patient care

communication

collaboration

job reflection