Hi I'm dr. vivek kaul from the University of Rochester Medical Center and with me is dr. shivangi Qatari one of my colleagues and the senior author and also the corresponding author on this interesting paper here. Shivangi welcome thank you. The paper is titled career prospects and professional landscape for advanced endoscopy fellowship training a survey assessing graduates from 2009 to 2013. Now this was recently published in gie and it received a lot of attention. So what may. I ask prompted you to to take on a project like this. So it's a great question. We wanted with increasing number of advanced endoscopy of fellowships or positions throughout the country and increasing number of applicants as per ASG or the last 23 years fellows that are applying for these fellowships. I felt it necessary. To sort of bring it to the forefront that you know you hear everybody saying that the market is saturated but is it really and so we wanted to see what the the graduates from the last five years from advanced endoscopy training had to say about this and that was the main driving force was to bring to the forefront the landscape for the future prospective individuals who want to apply for these fellowships of these trainings. And the you know the landscape that is out there and you know how it would look in the next couple of years right. I remember having a discussion about how many fellowships there are currently and in the past last few years that how many have developed and I suspect that at some level discussion progressed into a research meeting around this topic and yeah it culminated into this. Very nice article yeah because I mean and Bo you know we contacted ESG and the number of fellowship programs have increased to over a hundred you know over 50 of these are ESG listed you know equal number are not listed on your ASG and the number of applicants for this has also increased going through the match it has gone up with just within two years from 90 to over 100 applicants right well does provide a very nice overview of the ASG match program as well as the non matched fellowships out there and what the applicant pool is and how it has exponentially grown in the last few years.

What were the main results of of your survey. So we surveyed the graduates who got formal advanced endoscopy training or the la-5 yourself from two thousand eight to two thousand two thousand nine to two thousand thirteen and we sent out surveys after getting permission from their programs and you know we reached out to them we sent them or sixteen questions away and asking them about you know whether they found it hard to find a job whether they're doing the same kind of procedures they were trained to and it was done over or four weeks. They got the survey every every week for four weeks and we had over forty three percent we will respond. That's a good response rate. Yeah for a survey. I think that was a great good response. Rate and over seventy percent of the respondents felt that the market for advanced endoscopy jobs is saturated nearly a forty six percent themselves found it difficult to find jobs and uh and you know there are mentors them in order to people who trained in the last five years our training fellows and over seventy percent of those felt that they're finding it hard to place their fellows into good advanced endoscopy jobs right so it sounds like the theme is that there are more applicants and fewer optimal jobs for these applicants and again to the mind the viewers the survey was based on practicing advanced and a scopus. Yes these are people who are not fellows these no no these are practicing. GI physicians were formally trained and who have been in practice now since 2008 to 2014. But it's interesting that even their mentors are finding that they're finding it hard to place these physicians in practices that they would ideally consider right the ideal practices so this is a bit different information. Then what may generally be known now.

This is mean formally studied so this is a fairly important implication that the study brings to the fore here it does and you know. I can. I will admit that it's not a big sample size but I think it does bring to the forefront the issue when you know I think we need to talk about it and you know maybe try to do something about it with the ESG leadership looking at it and you know it's very important for the next generation who are aspiring to you know become advanced and a scopus as to what the landscape looks like right and. I think one of the important things here is to recognize is that this is a relative is you know the first survey of its kind. It's a relatively small. You know a survey group but it does have a good response rate one of the things that I looked at the paper. It may be the case that there is a mail distribution of advanced endoscopy talent across the country. In other words. Both the costs are heavily populated. Some of the more remote areas may not have these services so there may be a more a question of imbalance rather than right again we did we did go into the geographic locations of the respondents no but I think that you know that that can certainly be looked at. That's a great area for you. Know a place we can no further get more information from because what we are what we know you know is that of course the course are heavily populated with advanced and a scopus and I think there are regions in this country which truly need an advance and ask for PC no people travel for ercp s for 3-4 hours still. That's correct so. I think what truly needs to be addressed is a we do need to train. A you know good number of trainees in advanced procedures but place them in areas which truly need them you know over saturating. The area that are already saturated makes it frustrating even for the graduating fellow to find a job who wants to stay in these oversaturated areas and the thing is they don't talk eep up with those procedures.

If you look at our results a lot of the fellows are not are not doing the same complexity of procedures. They were trained to do. I believe only about thirty nine percent in the private practice our physicians and private practice ieave the very high quality advanced. It has to be training only about thirty five thirty. Ninety-nine percent are doing they're actually performing the procedures at that level right and really striking and over fifty percent of our respondents are actually in small practices like zero to one right so there may be the only attending in that practice which is not ideal. They may not have the multidisciplinary platform that that they were used to in their training. So a lot of these questions are coming to light. I think this is the beginning of a very should be a very interesting conversation across the nation and some strategies will definitely will have to be looked at hopefully through the ages of the. Ste but I do congratulate you on this very interesting and offbeat topic and I think it's the first of its kind. And hopefully it'll get a discussion start congratulations.