From private practice to academic medicine: My journey and lessons learned
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03/15/2023
Loyalty.
This is a quality that I value in relationships. Loyalty was a significant factor contributing to my postfellowship commitment to private practice. In 2001, I graduated from physician assistant school and accepted a job with a private practice GI group in Omaha. I was fortunate to work with supportive gastroenterologists who encouraged me to pursue further training after I expressed an interest in medical school. My goal was to become a gastroenterologist but like every medical student, I would keep an open mind. My decision did not waver, and the support from my first mentors continued. As I graduated from fellowship in 2014, I gravitated toward the same private practice largely based on loyalty and my experience as a PA.
COURTESY AMERICAN GASTROENTEROLOGICAL ASSOCIATION
My experience in private practice was positive. My focus at that time and currently is clinical medicine with a focus on inflammatory bowel disease (IBD) patients. My colleagues were supportive, and I worked with a great team of nurses and APPs. I cared for many patients in both the inpatient and outpatient setting and had an opportunity to complete a high volume and variety of procedures. Overall, the various aspects of my job were rewarding. However, something was missing, and I made personal and professional adjustments. My schedule pulled me from valued family time with my kids (mostly) in the early mornings, therefore, I altered my work schedule. My clinical interest in IBD was diluted by the emphasis to see mostly general GI patients, as is the case for many in private practice. I missed the academic environment, especially working with medical students, residents, and fellows, so I occasionally had residents shadow me. Unfortunately, adjustments did not “fix” that missing component – to me, this was a job that did not feel like a career. I was not professionally fulfilled and on several occasions during the 6 years in private practice, I connected with mentors from my medical training to explore career options while trying to define what was missing.
During the latter part of years 5 and 6, it became apparent to me that loyalty pulled me toward working with a great group of supportive gastroenterologists, but it became increasingly more apparent that this job was not in line with my career goals. I had identified that I wanted to actively participate in medical education while practicing as a gastroenterologist in an academic setting. Additionally, time with my family was a critical part to the work-life integration. These tenants became part of my personal and professional mission statement, and I made the decision to further my gastroenterology career in the academic setting.
My approach to the next step in my journey was different than my initial job. My goal was to define what was important, as in what were my absolute requirements for career satisfaction and where was I willing to be flexible. Each of us has different absolute and relative requirements based on our values, and I neglected to clearly identify these components with my first job. Admittedly, I have (at times) struggled to acknowledge my values, because I might somehow appear less committed to a career. Owning these values has provided clarity in my path from private practice to academic medicine. During the 3 years I have been in my current position, I have stepped into a leadership role in the University of Nebraska Medicine GI fellowship program while providing clinical medicine at the Fred Paustian IBD Center at Nebraska Medicine. In addition, I continue to have an active endoscopy schedule and derive great satisfaction teaching the fellows how to be effective endoscopists. Personally, the difference in compensation between academic medicine and private practice was not an important factor, although this is a factor for some people (and that’s okay).
When I graduated from fellowship, my path seemed clear, and I did not anticipate the road ahead. However, with each hurdle, I was gifted with lessons that would prove to be valuable as I moved ahead. Thank you for giving me the space to share my story.
Lessons that have helped in my journey from private practice to academics
Mentorship: Find mentors, not just one mentor. Over the years, I have had several mentors, but what I recognize is that, early in my career, I did not have a mentor. Although a mentor cannot make decisions for you, he/she can provide guidance from a place of experience (both career and life experience).
Define a mission statement: My mentor pushed me to first define my values and then my mission statement. This serves as the foundation that I reference when making decisions that will impact my family and my career. For example, if I am invited to participate on a committee, I look at how this will impact my family and whether it aligns with my mission. This helps to clarify what I am willing to say yes to and what to pass along to another colleague. Remember that last part ... if you are saying no to something, suggest another colleague for the opportunity.
Advocate for yourself: Only you know what is best for you. Sometimes the path to discovering what that is can be tortuous and require guidance. Throughout my journey, I worked with colleagues who were supportive of my journey back to medical school and supportive of my job in private practice, but only I could define what a career meant to me.
Assume positive intent: In medicine, we frequently work in a high-stakes, stressful environment. Assume positive intent in your interactions with others, especially colleagues. This will serve you well.
Life happens: Each of us will experience an unexpected event in our personal life or career path or both. This will be okay. The path forward may look different and require a pivot. This unexpected event might be that you find your job leaves you wanting something more or something different. Your journey will be right for you.
Dr. Hutchins is an assistant professor in the division of gastroenterology and hepatology at the University of Nebraska Medical Center, Omaha. She reported no conflicts of interest.
Summary content
7 Key Takeaways
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Developed a paper-based colorimetric sensor array for chemical threat detection.
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Can detect 12 chemical agents, including industrial toxins.
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Production cost is under 20 cents per chip.
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Utilizes dye-loaded silica particles on self-adhesive paper.
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Provides rapid, simultaneous identification through image analysis.
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Inspired by the mammalian olfactory system for pattern recognition.
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Future developments include a machine learning-enabled reader device.
The guidelines emphasize four-hour gastric emptying studies over two-hour testing. How do you see this affecting diagnostic workflows in practice?
Dr. Staller: Moving to a four-hour solid-meal scintigraphy will actually simplify decision-making. The two-hour reads miss a meaningful proportion of delayed emptying; standardizing on four hours reduces false negatives and the “maybe gastroparesis” purgatory that leads to repeat testing. Practically, it means closer coordination with nuclear medicine (longer slots, consistent standardized meal), updating order sets to default to a four-hour protocol, and educating front-line teams so patients arrive appropriately prepped. The payoff is fewer equivocal studies and more confident treatment plans.
Metoclopramide and erythromycin are the only agents conditionally recommended for initial therapy. How does this align with what is being currently prescribed?
Dr. Staller: This largely mirrors real-world practice. Metoclopramide remains the only FDA-approved prokinetic for gastroparesis, and short “pulsed” erythromycin courses are familiar to many of us—recognizing tachyphylaxis limits durability. Our recommendation is “conditional” because the underlying evidence is modest and patient responses are heterogeneous, but it formalizes what many clinicians already do: start with metoclopramide (lowest effective dose, limited duration, counsel on neurologic adverse effects) and reserve erythromycin for targeted use (exacerbations, bridging).
Several agents, including domperidone and prucalopride, received recommendations against first-line use. How will that influence discussions with patients who ask about these therapies?
Dr. Staller: Two points I share with patients: evidence and access/safety. For domperidone, the data quality is mixed, and US access is through an FDA IND mechanism; you’re committing patients to EKG monitoring and a non-trivial administrative lift. For prucalopride, the gastroparesis-specific evidence isn’t strong enough yet to justify first-line use. So, our stance is not “never,” it’s just “not first.” If someone fails or cannot tolerate initial therapy, we can revisit these options through shared decision-making, setting expectations about benefit, monitoring, and off-label use. The guideline language helps clinicians have a transparent, evidence-based conversation at the first visit.
The guidelines suggest reserving procedures like G-POEM and gastric electrical stimulation for refractory cases. In your practice, how do you decide when a patient is “refractory” to medical therapy?
Dr. Staller: I define “refractory” with three anchors.
1. Adequate trials of foundational care: dietary optimization and glycemic control; an antiemetic; and at least one prokinetic at appropriate dose/duration (with intolerance documented if stopped early).
2. Persistent, function-limiting symptoms: ongoing nausea/vomiting, weight loss, dehydration, ER visits/hospitalizations, or malnutrition despite the above—ideally tracked with a validated instrument (e.g., GCSI) plus nutritional metrics.
3. Objective correlation: delayed emptying on a standardized 4-hour solid-meal study that aligns with the clinical picture (and medications that slow emptying addressed).
At that point, referral to a center with procedural expertise for G-POEM or consideration of gastric electrical stimulation becomes appropriate, with multidisciplinary evaluation (GI, nutrition, psychology, and, when needed, surgery).
What role do you see dietary modification and glycemic control playing alongside pharmacologic therapy in light of these recommendations?
Dr. Staller: They’re the bedrock. A small-particle, lower-fat, calorie-dense diet—often leaning on nutrient-rich liquids—can meaningfully reduce symptom burden. Partnering with dietitians early pays dividends. For diabetes, tighter glycemic control can improve gastric emptying and symptoms; I explicitly review medications that can slow emptying (e.g., opioids; consider timing/necessity of GLP-1 receptor agonists) and encourage continuous glucose monitor-informed adjustments. Pharmacotherapy sits on top of those pillars; without them, medications will likely underperform.
The guideline notes “considerable unmet need” in gastroparesis treatment. Where do you think future therapies or research are most urgently needed?
Dr. Staller: I see three major areas.
1. Truly durable prokinetics: agents that improve emptying and symptoms over months, with better safety than legacy options (e.g., next-gen motilin/ghrelin agonists, better-studied 5-HT4 strategies).
2. Endotyping and biomarkers: we need to stop treating all gastroparesis as one disease. Clinical, physiologic, and microbiome/omic signatures that predict who benefits from which therapy (drug vs G-POEM vs GES) would transform care.
3. Patient-centered trials: larger, longer RCTs that prioritize validated symptom and quality-of-life outcomes, include nutritional endpoints, and reflect real-world medication confounders.
Our guideline intentionally highlights these gaps to hopefully catalyze better trials and smarter referral pathways.
Dr. Staller is with the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston.