**The Escalating Shortage of Gastroenterology Professionals in 2025**

By 2025, the realm of gastroenterology is characterized not by talks of efficiency or reimbursement strategies but by a severe manpower deficiency. Medical facilities and gastroenterology clinics throughout the United States are facing extraordinary challenges in attracting, keeping, or even temporarily providing specialists. These practitioners, essential for addressing gastrointestinal disorders, conducting colon cancer screenings, and managing urgent procedures like ERCP (endoscopic retrograde cholangiopancreatography), are critically lacking. This predicament transcends mere staffing issues and represents a structural deficit that has been unfolding over many years.

### The Diminishing Pool of Gastroenterologists

In the mid-1990s, approximately 1,000 new gastroenterologists received board certification annually. Fast forward to now, and this figure has dropped by nearly 40 percent, with only about 600 certifications granted each year despite the rising demands of an aging population. This decline can be traced to a significant change; in 1994, gastroenterology fellowship training was extended from two years to three, and advanced procedures such as ERCP and EUS (endoscopic ultrasound) necessitated an additional one-year fellowship. Nonetheless, there has been no equivalent rise in funding for new training slots due to Medicare’s caps on Graduate Medical Education (GME) funding, which have not changed since 1997. At that time, there was a mistaken belief that the field was oversupplied with specialists. This error has now led to dire consequences. The same cohort who was trained in abundance is now nearing retirement, facing a net loss of about 400 gastroenterologists each year as 1,000 doctors retire or reduce their practice while only approximately 600 new entrants come into the field. Furthermore, stringent requirements set by the American Board of Internal Medicine (ABIM) for ongoing certification and recertification are prompting many older gastroenterologists to retire sooner than anticipated.

### Transitioning from Diagnostic to Therapeutic: The ERCP Progression

ERCP has considerably changed since the 1980s and early ’90s, when 40 – 50 percent of gastroenterologists were involved in both its diagnostic and therapeutic functions. Initially utilized to visualize bile and pancreatic ducts before advanced imaging technologies emerged, the procedure has now transitioned with MRCP (magnetic resonance cholangiopancreatography) taking over most diagnostic ERCP roles with non-invasive imaging alternatives. Today, the focus of ERCP has shifted mainly to therapeutic procedures, with only around 8 percent of newly trained gastroenterologists possessing proficiency in its application. Extended training periods, increased procedural complexity, and stagnant fellowship funding have created significant barriers to training adept therapeutic endoscopists.

### A Maturing Workforce Amidst Heightened Demand

The scenario is aggravated by the fact that nearly 50 percent of the active gastroenterologists are over 55 years of age, resulting in an increasing number of retirements or reduced work hours. Combined with the rising colorectal cancer screening age of 45 and an increase in liver disease prevalence, the demand for gastroenterologists is on the rise. A 2025 report from Weill Cornell Medicine highlights that roughly 50 million Americans live more than 25 miles away from the nearest gastroenterologist.

### The Economics of Shortage

The financial repercussions of this scarcity are evident:

– **2015:** Average gastroenterologist salary was around $370,000.
– **2020:** Increased to approximately $417,000.
– **2023-2024:** Rose to about $514,000, reflecting a 35 percent increase from 2020.
– **2025:** General gastroenterologists are now earning over $600,000+, while those specialized in ERCP/EUS command $800,000-$900,000+.

These rising salaries illustrate the growing discrepancy between supply and demand, with new hires today seeking permanent salary assurances rather than temporary income guarantees in employment agreements. Once able to negotiate higher facility fees, hospitals now face the challenge of high costs necessary to attract and retain medical professionals.

### Temporary Staffing: The Expense of Delay

Due to ongoing permanent recruitment hurdles, hospitals are increasingly depending on locum tenens for coverage:

– **Outpatient Only Locum Coverage:** $400-$450 per hour.
– **Inpatient with Call:** $450-$500+ per hour or $3,000-$4,500 per day.
– **Advanced ERCP/EUS:** $500-$600+ per hour, or $4,000-$5,500 per day.

When considering agency fees, malpractice, and travel expenses, the overall cost for locum coverage can range from $7,000 to $8,000 per day.

### The Impact of Private Equity

Consolidations backed by private equity have transformed outpatient gastroenterology services, causing many physicians to step back from hospital on-call responsibilities. Hospitals are compelled to either hire directly or contract for these services,