Key Responsibilities and Required Skills for Upper GI Specialist

🎯 Role Definition

This role requires a board-certified/board-eligible Upper GI Specialist with focused expertise in disorders of the esophagus and stomach, including reflux disease, Barrett's esophagus, motility disorders, and complex diagnostic and therapeutic endoscopy. The Upper GI Specialist will deliver high-quality outpatient and inpatient care, perform advanced endoscopic procedures, interpret physiologic testing (manometry and pH-impedance), lead multi-disciplinary care pathways for upper GI malignancies and pre-malignant disease, and contribute to quality improvement, education, and clinical research initiatives. Ideal candidates will have strong procedural skills, excellent communication, and demonstrated ability to work effectively in a hospital and ambulatory setting.

📈 Career Progression

Typical Career Path

Entry Point From:

Gastroenterology Fellowship (General GI training)
Advanced Endoscopy Fellowship (for EMR/ESD/EUS/POEM-focused roles)
General Internal Medicine or Surgical background with GI specialty training

Advancement To:

Director, Upper GI / Esophageal Program
Section Chief, Gastroenterology / Advanced Endoscopy
Medical Director, Endoscopy Unit
Vice Chair / Chief of Digestive Diseases

Lateral Moves:

Motility Specialist / Esophageal Physiology Director
Advanced Therapeutic Endoscopist (EMR/ESD/EUS-focused)
Clinical Research Lead in Esophageal Disease

Core Responsibilities

Primary Functions

Diagnose and manage the full spectrum of upper gastrointestinal disorders, including gastroesophageal reflux disease (GERD), Barrett’s esophagus, peptic ulcer disease, achalasia, gastroparesis, eosinophilic esophagitis, and functional upper GI disorders using evidence-based medical and endoscopic therapies.
Perform diagnostic and therapeutic esophagogastroduodenoscopy (EGD) with competency in complex interventions such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and advanced hemostasis techniques for upper GI bleeding.
Interpret high-resolution esophageal manometry studies and ambulatory pH/pH-impedance testing to guide diagnosis and individualized management plans for reflux and motility disorders.
Provide patient-centered pre-procedure assessments and informed-consent discussions that explain risks, benefits, alternatives, and expectations for upper GI procedures and interventions.
Manage inpatient consults and coordinate acute care for upper GI emergencies including variceal and non-variceal bleeding, perforation work-up, and urgent decompression or feeding tube placement (PEG/PEJ).
Lead multi-disciplinary tumor board presentations and collaborate with surgical oncology, medical oncology, radiation oncology, radiology, and pathology to develop evidence-based care plans for esophageal and gastric neoplasia.
Perform and interpret endoscopic ultrasound (EUS) for staging and diagnostic sampling of esophageal and gastric lesions, including fine-needle aspiration (FNA) when indicated (if credentialed).
Provide endoscopic therapy for Barrett's esophagus surveillance and treatment including radiofrequency ablation (RFA), cryoablation, and endoscopic eradication strategies in accordance with current guidelines.
Evaluate and manage complex reflux patients considering medical therapy optimization, troubleshooting anti-reflux device outcomes, and coordinating care for patients being considered for surgical intervention (fundoplication, LINX).
Diagnose and provide medical and endoscopic management for gastroparesis and other gastric motility disorders, including pyloric interventions (e.g., gastric peroral endoscopic myotomy, G-POEM) where credentialed or in collaboration with advanced endoscopists.
Supervise and perform periprocedural anticoagulation management with careful risk assessment and communication with referring clinicians and primary care providers.
Maintain accurate, timely electronic medical record documentation of consults, procedures, orders, and discharge summaries, including appropriate procedure coding and compliance with institutional documentation standards.
Participate in call coverage for inpatient GI service and on-call endoscopy emergencies, providing timely remote and on-site clinical decisions and procedure performance when necessary.
Train, mentor, and evaluate gastroenterology fellows, residents, advanced practice providers (NPs/PAs), and endoscopy nursing staff in diagnostic and therapeutic upper GI care and procedural technique.
Participate in quality assurance and improvement programs for the endoscopy unit, including adverse event review, infection control, credentialing maintenance, and procedure volume and outcomes tracking.
Develop and implement clinical pathways and standardized order sets for common upper GI conditions to improve care consistency, efficiency, and patient outcomes.
Engage in patient education, shared decision-making, and longitudinal outpatient follow-up for chronic upper GI disease management and surveillance strategies.
Contribute to clinical research protocols, investigator-initiated studies, and/or industry trials related to esophageal and gastric disease, including patient recruitment, data collection, and scholarly dissemination.
Collaborate with nutrition services, speech-language pathology, and rehabilitation for integrated care of patients with dysphagia, aspiration risk, and chronic malnutrition related to upper GI disease.
Ensure compliance with institutional, local, and national regulatory requirements for endoscopy practice, including equipment maintenance, sedation safety protocols, and infection prevention standards.
Lead initiatives to optimize procedural efficiency, throughput, and patient experience in the endoscopy unit while preserving high standards of safety and clinical care.
Review pathology and radiology reports in coordination with pathologists and radiologists to confirm diagnoses and adjust treatment plans for complex upper GI conditions.
Provide second-opinion consultations and telemedicine visits for complex upper GI cases, expanding access to specialized esophageal and gastric care.
Coordinate transitions of care, discharge planning, and outpatient follow-up to minimize readmissions and ensure continuity for patients treated for upper GI conditions.

Secondary Functions

Participate in institutional committees related to gastrointestinal services, quality, safety, credentialing, and clinical operations.
Support program development and marketing for an Upper GI program or esophageal clinic, including community outreach, referring physician education, and patient outreach materials.
Assist in selecting, evaluating, and implementing endoscopy equipment and technologies (e.g., high-definition endoscopes, pH-impedance systems, motility platforms).
Provide expert input for clinical guideline adoption, local protocol development, and incorporation of new evidence into clinical practice for upper GI care.
Serve as a medical resource for nurse-led triage lines and triage of acute upper GI symptoms to appropriate levels of care.
Participate in training and competency assessments for endoscopy nursing and technical staff, including simulation and emergency airway management drills.
Contribute to departmental revenue cycle improvement by ensuring appropriate documentation, coding, and charge capture for upper GI procedures and consults.
Support institutional initiatives for patient safety, medical education, and research compliance by completing required trainings and reporting quality metrics.
Mentor junior faculty and community gastroenterologists through regional educational programs, case conferences, and collaborative networks.
Assist in grant writing, protocol development, and institutional review board (IRB) submissions for clinical trials and quality improvement projects.

Required Skills & Competencies

Hard Skills (Technical)

Proficiency in diagnostic and therapeutic upper GI endoscopy (EGD) with demonstrated experience in advanced interventions such as EMR and ESD where credentialed.
Experience with esophageal physiologic testing including high-resolution manometry (HRM) and ambulatory pH/impedance testing and the ability to interpret results clinically.
Competence in endoscopic ultrasound (EUS) and EUS-guided tissue acquisition (FNA/FNB) for upper GI lesion staging (preferred or collaborative).
Training or experience with peroral endoscopic myotomy (POEM) and/or gastric POEM (G-POEM) is highly desirable for motility-focused roles.
Strong clinical diagnostic skills for GERD, Barrett's esophagus, eosinophilic esophagitis, achalasia, gastroparesis, and other upper GI disorders.
Ability to manage endoscopic hemostasis techniques including clipping, banding, injection therapy, and thermal coagulation for upper GI bleeding.
Proficiency with sedation practices and airway safety in endoscopy; familiarity with moderate sedation and monitored anesthesia care protocols.
Clinical experience with enteral access procedures (PEG/PEJ) and post-procedural management of feeding devices.
Familiarity with electronic medical records (e.g., Epic, Cerner), procedure documentation workflows, and accurate procedural coding (CPT/ICD).
Prior involvement in clinical research, data collection, and interpretation of outcomes relevant to upper GI disease (preferred).
Competence in multidisciplinary coordination for oncology staging, surveillance protocols, and endoscopic therapy planning.

Soft Skills

Excellent patient-centered communication skills with ability to explain complex procedures and diagnoses in lay terms and obtain informed consent.
Strong clinical judgment and decision-making under time pressure, particularly in acute inpatient and emergency endoscopy settings.
Collaborative teamwork: ability to work effectively with surgeons, oncologists, radiologists, pathologists, nurses, and allied health professionals.
Teaching and mentorship aptitude: experience instructing fellows, residents, and advanced practice providers in clinical care and endoscopic technique.
Leadership and program-building capability to develop and expand upper GI services, motility labs, and advanced endoscopy programs.
Attention to detail and commitment to high-quality documentation, patient safety, and regulatory compliance.
Time management and organizational skills to manage clinic volume, procedure schedules, and administrative responsibilities efficiently.
Empathy and cultural competence when delivering care across diverse patient populations and handling difficult conversations regarding cancer or chronic disease.
Continuous learning mindset and adaptability to adopt new technologies, guidelines, and evidence-based practices.
Problem-solving and quality improvement orientation with experience participating in morbidity and mortality reviews and process optimization.

Education & Experience

Educational Background

Minimum Education:

MD or DO degree from accredited medical school.
Completion of Internal Medicine residency.
Completion of Gastroenterology fellowship with documented procedural competency in upper GI endoscopy.

Preferred Education:

Fellowship training in Advanced Endoscopy (EMR/ESD/EUS/POEM), Esophageal/Motility fellowship, or additional advanced training in upper GI disease.
Additional credentials such as MPH, MS in Clinical Research, or certification in quality improvement/healthcare leadership are a plus.

Relevant Fields of Study:

Gastroenterology
Internal Medicine
Advanced Endoscopy / Therapeutic Endoscopy
Esophageal Physiology / Motility

Experience Requirements

Typical Experience Range: 2–10+ years post-fellowship clinical experience depending on role level (faculty, senior specialist, program director).

Preferred:

3–5+ years of focused upper GI experience for independent specialist roles; 5+ years for leadership positions.
Demonstrated volume and outcomes in diagnostic and therapeutic upper endoscopy (EGD, EMR/ESD, EUS) and esophageal physiology testing.
Experience leading quality improvement projects, participating in multidisciplinary care teams, and mentoring trainees.
Proven track record of peer-reviewed publications, clinical trial participation, or guideline development is advantageous.