Session 108 Pediatric GI was a natural fit for Dr. Jason Shapiro, who was interested in diverse pathologies, performing procedures, and developing relationships with patients. Also, please check out all our podcasts on Meded Media for more resources to help you along your premed and medical school journey! [01:05] Interest in Pediatric Gastroenterology Jason is a pediatric gastroenterologist at Brown. He initially got interested in GI during the first month of his intern year. He likes the diversity of the field. It has a lot of procedures involved as well as research, immunology, microbiome, medication, and optimizing medication effects. [03:00] Traits That Lead to Being a Great PGI Physician Most of Jason's clinical time is dealing with kids with Crohn's disease and ulcerative colitis, which are impactful conditions. You want to have as minimal effect on the child's daily life as possible. So you need to be empathetic, compassionate, and a hard worker. [04:00] Types of Patients Most kids with IBD (inflammatory bowel disease) present themselves during early adolescence. But there's an uptake of very early onset IBD where kids less than 5 years old come in with it. For the most part though, new diagnoses are in early teens although it can run the spectrum. Their bread and butter cases for Pediatric GI include infants with gastroesophageal reflux, milk protein allergy, constipation, Coeliac disease, and functional abdominal pains. They're also seeing a huge increase in an allergic condition called eosinophilic esophagitis. At Brown, they work with a team of GI psychologists who help them manage some of those more complicated cases. Most of the referrals they get from a blank canvas. The majority of their new patient referrals from a general pediatrician have not had too extensive of a workup just yet. So there's a degree of diagnostic work that needs to be done. There isn't a huge amount of patients that they do procedures on. Although they're generally non-invasive, there are procedures that need general anesthesia. And this is something they don't just do without a good reason to do it. Out of the total numbers they see in clinic, Jason estimates 10% of them would be procedure-related. His typical week would involve doing endoscopies. When on call, they're probably doing more procedures than they like. So there's no lack. [09:10] Academic vs Community Setting For Jason, research is a very important part of his career. Even in residency, he was involved in an Ivy League research that he did all through fellowship and up until he was already an attending physician. As a PGI across the country, you need access to pediatric anesthesia, which means you need to be in an academic center. In New England, there's not much practice in pediatric GI so most of them are affiliated with an academic institution.  [10:08] Taking Calls and Work-Life Balance Jason takes calls between 8-10 weeks a year. Calls are variable. Their fellows take the first call from the ER or the community doctors. The calls may vary from a couple of calls overnight to a week of procedures, most of which are esophageal foreign bodies, mostly coins. Every now and then, they do a few GI bleeds and variceal bleeds. Jason believes work-life balance is an acquired skill in terms of working on time management and trying to get as much done. Since having his kid over two years ago, he had adjusted his work schedule accordingly. At every phase of the medical career, it's a hard adjustment. But having been in faculty for several years now, Jason has learned to set priorities and make the necessary adjustments. [14:05] Training Path The path to becoming a ped-GI doctor requires three years of general pediatrics. On your second year, you apply for fellowship and then you get into three more years of pediatric GI fellowship. Currently, some people are doing extra years within ped-GI. So there are advance fellowships in transplant hepatology, motility, and IBD. Competitiveness-w