Excuse me while I continue to stuff my face with chocolate-covered macadamia nuts.

Aloooooha from the lovely state of Hawaii! 

View from the top of Diamond Head, a volcanic tuff cone

How you, too, can end up in the land of grass skirts and coconut bras: 

Family, networking, or completing a rotation at Tripler Army Base (if you are participating in the HPSP scholarship). One of my friends is rotating at Tripler in a few months, so it IS possible! Since I'm not in the military, I relied on the kindness of extended family. Don't be fooled, though: I had to jump through a number of legal paperwork hoops between the hospital and PCOM, so it wasn't always smooth sailing.


The rotation itself:

Koko Head = Nature's Stairmaster
(1,500 steps ascending 1200 feet; thank goodness
it was cloudy when we climbed it, or else I would
have collapsed from heat stroke)

The GI Clinic is located inside a hospital. The health system here is "open access," so when Dr. Smith (the PCP) tells Mr. Jones, "You need to get a colonoscopy," all Mr. Jones has to do is wait for a call from one of the GI staff to set up the appointment. Dr. Aloha (the GI doc) can look at Mr. Jones' e-chart (notes from the PCP, past procedures, etc) because everyone's within the same health system. Mr. Jones shows up, Dr. Aloha does the procedure, and Mr. Jones leaves with the promise of another date in 10 years. Dr. Aloha documents the procedure in the chart, which can be read by Dr. Smith whenever. Not all GI clinics operate this way; some bring in the patient for an initial consult, then do the procedure, then schedule a follow-up. Here, the GI docs rely on the clinical judgement of the PCP for the referral, and any follow-ups are done by the PCP (with the occasional phone appointment with one of the GI docs). 




Pros: 

I was more worried about breaking my phone than my head while
climbing the rocks at Laniakea Beach on the North Shore

• Hours are good (8-4ish)
• The cafeteria menu features Hawaiian and Asian dishes, a welcome change from the usual "mystery meat slathered in gravy." 
• The clinic is staffed by a handful of physicians, and about two dozen nurses, technicians, and MAs. It's always busy and there's always people around, which goes well with my self-diagnosed ADHD. When my attending's schedule is slow, I can easily hop on with another physician, or the physician that's on-call for the hospital. 
• It's straightforward. You walk in, say, "Hi, I'm Dr. Aloha, we're going to stick a scope in you, here are the risks involved," have them consent, and get down to business. When you're done, you brief them of your findings, and off they go. 
• During the procedure, the doctor has the support of (at the very least) a nurse and GI tech. More complicated procedures require more people. I like the team aspect; as the doctor, you can take comfort in knowing that should things go pear-shaped, you're not alone. 
• There's several branches of GI. Although the docs I work with do mostly screening procedures (EGDs and colonoscopies), you can go into transplant hepatology, hepatobiliary medicine, pediatric GI, or advanced endoscopy. 

Cons:

My friend's interpretation of when I told her
I went swimming in a shark cage last week 

• The usual risks of sticking a foreign object inside somebody: bleeding, perforations, etc. The other week, a patient's diverticulum was perforated, so she had to go for emergency surgery. Patching up a perf is a minor surgery, but still, it's an "Uh-oh" moment. 
• GI fellowships are highly competitive, so if I was dead-set, I'd probably do a couple more GI rotations, try and get an IMED residency at a hospital that has a GI fellowship, and network my butt off. 
• One of the downsides (depending on your personality) to being in a procedure-based practice is that there's little opportunity for building strong patient relationships, in contrast to family medicine.

Overall: I'm keeping GI as a viable career option. Regardless of what I end up choosing, this rotation has taught me that I would like to end up in a specialty with a lot of hands-on work and the opportunity to be a team player. Awesome weekend adventures (such as those featured in the photos), while obviously not required, would be a definite perk!