The Insiders Scoop – Gastroenterology & Healthcare Social Media

Name: Austin Chiang, MD, MPH

Specialty/Interests: Gastroenterology (GI), Advanced/Bariatric Endoscopy, Healthcare Social Media

Education/Training:

Duke University (BS)

Columbia University College of Physicians and Surgeons (MD)

New York Presbyterian Hospital/Columbia University Medical Center (Internal Medicine Residency)

Brigham and Women’s Hospital (GI Fellowship, Bariatric Endoscopy Fellowship)

Harvard T.H. Chan School of Public Health (MPH)

Thomas Jefferson University Hospital (Advanced Endoscopy Fellowship)

Current Position: Assistant Professor of Medicine, Chief Medical Social Media Officer, Director of Bariatric Endoscopy

Connect with Dr. Chiang: Instagram, YouTube, Twitter

1 | What drew you to gastroenterology?

The journey to discovering gastroenterology as a specialty was not straightforward for me. I kept an open mind throughout medical school and entertained a variety of specialties before deciding on internal medicine, in part because I admired the degree of critical thinking the residents I worked with demonstrated. However, I was still very much interested in procedures and after exploring critical care and cardiology, I ultimately decided on gastroenterology for several reasons.

First, GI offers an exciting variety of organ systems and disease conditions (not just the gut but also the liver, pancreas, biliary system, and more recently obesity and metabolic diseases).

Second, GI offers a good balance between procedures and critical thinking. For my subspecialty in advanced and bariatric endoscopy, I am heavily procedural (3 days of the week, with 1 day of clinic) doing procedures that are minimally invasive yet pushing the envelope of what borders on the invasiveness of surgery (e.g. endoscopic suturing to close defects or sew down certain areas, performing ERCP for biliary access and stenting, enteral stenting for esophageal/intestinal obstructions, endoscopic ultrasound guided diagnostic and therapeutic procedures like diagnosis of pancreatic cancers or endoscopic drainage of fluid collections). Because of this, I also think GI has a tremendous amount of innovation and cool technology constantly coming down the pipeline.

Third, I enjoyed the personalities of the gastroenterologists I encountered. In fact, most of my closest friends in residency also became gastroenterologists, which I might also be telling. Given how competitive GI has become, I’m sure many other GIs share the same motivations for entering the field.

2 | What is the training path to become a gastroenterologist?

GI is a subspecialty of internal medicine. That means, after 4 years of med school and 3 years of internal medicine residency, there’s an additional 3 years of GI fellowship. By fellowship match statistics, GI fellowship is likely the most competitive of the internal medicine subspecialties (alongside cardiology). Most GI fellowship enter practice as general gastroenterologists after completing GI fellowship. A general gastroenterologist sees all things GI such as esophageal disorders, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), liver disease, and more. GI bleeding, esophageal food impactions, acute liver failure are among the most common general GI emergencies.

General GI procedures are generally limited to straightforward endoscopy and colonoscopy. However, some may choose to sub-subspecialize further. There are dedicated fellowships for advanced endoscopy, inflammatory bowel disease, transplant hepatology, and motility. I pursued a bariatric endoscopy fellowship that was unconventionally built into my GI fellowship, as well as an additional year of advanced endoscopy fellowship after GI fellowship. I would say that step 3, which is taken during residency, has little bearing on your candidacy as a GI fellowship applicant. I think for GI, the most important elements of an application are your residency program, ample research, and strong letters of recommendation from faculty who are prominent in the GI community.

3 | How did your gastroenterology fellowship compare to internal medicine residency?

In general, gastroenterology fellowship was more enjoyable for me than internal medicine residency solely because it involved far more procedures and because it was more specialized. On the inpatient side during GI fellowship, I enjoyed being a specialist and consultant who was called upon only to address GI concerns (although some GI programs have primary GI patients on their own GI service for hospitalized patients). However, residency was interesting because rotations were vastly different, with one month being on the cardiology service to the next month, which could have been on the hematology/oncology service. For outpatient care, I was able to focus only on GI conditions as a specialist, whereas during internal medicine residency, I served as the primary care doctor for my clinic patients, and treated their general medicine concerns.

GI fellowship was also more enjoyable because it was a much smaller crew of 5 fellows per year compared my residency class of 40 residents per year. The bond between 5 fellows a year (or 15 in total) was much stronger in my experience, especially because these co-fellows would be direct colleagues who I will encounter at conferences for the rest of my career.   

Because I knew I was going to pursue an additional fellowship in advanced endoscopy, I knew that finishing GI fellowship would not be the end of my training. Therefore, graduation didn’t seem quite like the culmination of events as I had anticipated. I should add that my GI fellowship was structured to be very research heavy, leaving lots of unstructured time during the latter half of my fellowship, which allowed me to complete the MPH and the bariatric endoscopy fellowship.

4 | How did you get involved with social media? How do you use each platform and what directions do you hope to take with social media?

My medical social media journey began 5 years ago when I was spending some time at ABC News as a resident, learning how journal publications were vetted before being broadcast on the nightly news. At the time there were weekly Twitter chats that were hosted by the network, during which many important organizations and health leaders were engaging online. I later began using social media heavily to disseminate GI knowledge and live tweet conferences, and I founded the GI division Twitter account during fellowship. During that time, I completed multiple research projects looking at social media and GI, and from there was appointed onto multiple society committees. As more and more GI doctors made their way onto Twitter, many looked to me for guidance on social media. I made the professional switch onto Instagram much later during the late Fall of 2017 and since then have gotten to know a great community of like-minded health professionals. I also was since appointed a new position of Chief Medical Social Media Officer at Jefferson Health, where I am charged with helping inspire more clinicians to get on social media to help combat the misinformation disseminated by untrained individuals. A part of this passion led to the #VerifyHealthcare social media campaign last year, which ultimately has morphed into the creation of the first 501(c)(3) professional society focused on health professional social media use, launching May 2019..

5 | There are only 24 hours in a day. How do you manage to be an attending gastroenterologist in addition to being so active on social media?

Having grown up with social media, I always enjoyed scrolling aimlessly. I think my adoption of social media as a public health tool allows me to be productive using time that I otherwise would have been on social media anyway. Balance is difficult to achieve, and I still have to prioritize patient care. It’s important for students and trainees to understand that maintaining a social media should not get in the way of developing your career foundation.

6 | What has surprised you about being an attending gastroenterologist?

I have had the fortune of staying where I trained for my advanced endoscopy fellowship. With joining the practice with the mentors who taught me, I can more comfortably ask for advice when I need to. I think there’s an added layer of visibility once you’re an attending. Patients Google me before they come see me. They find my Instagram account and they follow me. That has certainly changed how I approach my presence on social media. I think it’s important to note that every attending has a different schedule, different expectations depending on their specialty, their institution, and their practice setting (academic vs. hospital-employed vs. private practice). I think shifts in anything that allow my job to work are also out often of my control: anesthesiology, nursing and other staff, hospital IT, marketing efforts for my practice, institutional politics, the landscape of gastroenterology in my region (other practices/institutions).

7 | What advice do you have for students interested in a career in gastroenterology?

Rather than shadowing a single gastroenterologist, I would suggest you shadow gastroenterologists in various subspecialties if your institution allows. GI is such a vast field that your experience with a transplant hepatologist is going to be incredibly different than if you were spend a day with me as an advanced endoscopist. Because some of the things you see with subspecialists at academic centers are so specific or rare (and not necessarily available at other centers), I would think about all the “bread and butter” diseases and procedures and ask yourself whether or not you find that interesting. Don’t be afraid to ask questions or contact a faculty member who is a gastroenterologist; most of us don’t bite and actually really enjoy fostering more bright minds to join our field!

8 | What is a typical day like for you?

It really depends on the day! Three days out of the week I’m doing procedures (2 days of outpatient procedures, and 1 day handling inpatient procedures for patients who are hospitalized). I have one full day of seeing clinic patients, and the last day dedicated to academic time. On my procedure days, it’s basically one procedure after another. Immediately before the procedure I’m entering orders and consenting the patient, and after the procedure I’m documenting what I saw in a procedure note. There’s very little downtime if all the patients show up! In clinic, my schedule is also pretty tight, as I try to stay on schedule. That often means, documentation comes after I see all the patients. Then, there’s handling my inbox of test results and returning patient phone calls. After hours I’m often responding to emails with regards to research, preparing talks, and conference calls for other endeavors I have going on (and my involvement in the various professional societies). I know the biggest question often is how I find time to do social media stuff, and really it’s within all the gaps I can find — usually after hours!

9 | If you could request the readers pick up one new habit, what would it be?

I admit I could be better at this myself, but I would say creating a calendar. I didn’t get into this until much later. This, along with organizing my emails is still a work in progress for me. We all have our own system, so whatever makes your life more efficient, the better! I used to think that I could organize everything in my head, and until recently I did a decent job at that. However, with the deluge of email and commitments being thrown at me, I had to start putting things down on my calendar app!  

10 | What is most exciting and on the horizon for the field of gastroenterology? Where do you see the field in the next 5-15 years?

I am biased as a bariatric endoscopist, but my hope is the prospect of endoscopic treatments for obesity. Obesity is still under-addressed and considering only 1% of patients who qualify for bariatric surgery getting the help they need, the more options the better. The technology will become even more intricate and hopefully our health systems can recognize the benefits of these novel therapies. I also think we will see exciting things in our understanding of the gut microbiome, as well as in the integration of technology such as virtual reality and AI in some areas in GI such as helping assist in the diagnosis of certain polyps or lesions.

11 | If you had to choose a specialty other than gastroenterology, what would you choose and why?

A big part of why I chose gastroenterology is the variety and procedural nature of the field. For that reason, I think plastic surgery would have been a good choice as well. Pulmonary/Critical Care would have also offered a certain degree of variety and procedures, but when considering the pathology I would encounter in the field, I had a greater affinity for gastroenterology. In fact, when I was in medical school I did a good amount of research in plastic surgery, but ultimately felt that long OR times were not for me.

12 | If you had to choose a career outside of medicine, what would you choose and why

I think it’s often difficult to find room to exercise one’s imagination in medicine, so sometimes I think creative careers that integrate problem solving speak to me. While critical thinking is called upon daily in medicine, creative outlets are either indirectly related to patient care or when they are, often arduous processes to see innovation through. When I was a kid, I wanted to be a residential architect. I collected floor plans from new developments for fun. Perhaps what I find interesting is the idea of problem solving and creating homes that I think are sensible and aesthetically appealing. Another one would be a music video director, cause I think it would be interesting figuring out the best way to match a visual to music.

13 | What is one thing you wish you had learned sooner? 

One thing I wish I learned sooner is the idea that things in life that are confusing, unusual, and scary are opportunities to thrive. Social media was once viewed as confusing to many medical professionals. Our generation may view it as an obvious way to reach people, but these benefits aren’t so obvious to those who don’t use it. Don’t be afraid of blazing your own trail.

Another thing I should mention is, don’t assume any specialty is easier/harder than another or that there is necessarily more financial benefit to one field over another. As I alluded to earlier, every single attending out there is different. Their contracts are different, their expectations are different, and their duties outside of their day job may be different. I’ve learned that being a primary care doctor is incredibly difficult and demanding. I’ve also learned that private practice gastroenterologists often see far more patients than I do to fulfill their business demands.

One pivotal moment for me was when a child psychiatrist in NYC took a group of our medical students out to dinner and revealed what he makes for how much he works in comparison to his wife who is a surgeon. So at the end of the day, I think you should always stick to what you think will make you happy. If you’re happy and productive, you’ll be satisfied and all the perks will follow.

14 | Knowing what you know now, what would you have done differently as a pre-med, medical student, resident, or fellow?

I would have been less afraid to ask questions. This improved over time, so in my later years of training I was much more proactive in asking for clarification and saying “I don’t know” a million times. Sometimes it takes a concept to be repeated several times before I truly internalized it.

Also, although I didn’t exactly go through the same social media environment when I was pre-med or in training, I think it’s important to note that social media following (even for attendings in practice) does not equate with credibility or capability. While many of these attending health influencers are solid role models, I think it behooves you to dig deeper and ask around to see if some of these individuals are well-respected in their fields. Likewise, this applies to other students or trainees who are “Instafamous,” so (like in other aspects of life) think about soliciting career advice from several people rather than just one person.

15 | Do you have any asks for the readers?

Please be mindful of what you do on social media and how it may not only impact your career but public health. Much of it is a gray zone at the moment, and I sincerely hope that those of you who are active on social media can join the Association for Healthcare Social Media at ahsm.org to help pioneer this and serve as an expert to your classmates and colleagues.