The looming gastroenterologist shortage

By R. Fraser Stokes, MD, FACG Chairman, PSG Practice Management Task Force

The practice of gastroenterology is being compromised by a GI physician supply-demand mismatch that is upon us now and is projected to worsen.

The December 2021 AMA physician Masterfile showed that there were 15,678 active gastroenterologists with 14,116 providing patient care. In January 2023, Physician Thrive (a UPMC-based physician wellness program) released a survey projecting that by 2025 there would be a shortage of 1630 GI physicians. This shortage issue isn’t unique to gastroenterology, but it is particularly bad in our specialty. Recent data from the recruiting firm Merritt Hawkins showed that the top 3 specialties with the highest number of job openings are neurology, psychiatry, and GI.

Several factors are driving this gastroenterologist labor shortage. First, physicians are getting older. Data from 2021 found that 51% of gastroenterologists were 55 years of age or older. In the next ten years, the average age of a practicing gastroenterologist will continue to rise.

As physicians age, the number that transition into retirement naturally increases. COVID accelerated this process. A 2021 Doximity survey of 2000 physicians found the cumulative physician retirement rate went from 4% to 10% in in the preceding year. In addition, another 21% of physicians were considering early retirement. The drive toward retirement is due to several factors, including physician discontent from personal COVID health risks, practice finance hardships, burdensome electronic health record duties, and overwhelming administrative challenges. For some gastroenterologists, a new interest in retirement came from monetizing their practice via a practice and / or ASC sale that secured their retirement savings.

A third cause of the looming physician shortfall may be tied to different work patterns for younger physicians. Their economic circumstances and desires for better work-life balance are typically different from graduating fellows of more than 10 years ago. Younger GI’s (appropriately so!) give a higher priority to off-work quality time, maternity (and paternity!) leave, shorter workdays, and less on-call responsibilities.

In addition to a reduced supply of GI docs, we have seen an increased demand for gastroenterology care. The change in national colorectal cancer screening guidelines is an important part of this increased demand. Average risk screening colonoscopy is now recommended starting at age 45, instead of 50, and screening for healthy individuals is now often continued until age 85, instead of 75. Another factor driving increased demand for our services is the obesity epidemic, as this has led to higher incidence of GERD and nonalcoholic fatty liver disease.

As we increasingly face the GI physician shortage, this can lead to problems with quality of care. In many GI practices, wait times for consults and procedures are becoming longer. This results in many patients not getting care when needed and potentially worse outcomes. This problem is amplified even more in underserved rural and inner-city urban areas. Many GI physicians have been forced to work harder with longer hours to meet this heightened demand which results in significant physical and mental stress. This is not only bad for us, but also bad for our patients.

Ultimately, the solution to this problem is increasing the supply of gastroenterologists by funding a greater number of fellowship positions. Recently Congress approved funding for 1000 postgraduate medical training positions. Some of these will be allotted to GI, but many more GI fellowship spots will be needed. In the meantime, other strategies to cope with our increasing manpower shortage are being activated. Many practices are using more advanced practice providers (physician assistants and nurse practitioners) for care responsibilities as part of a GI team model. This permits gastroenterologists to spend more time on procedures and more clinically challenging cases.

Gastroenterology practices are committing to physician retention in several important ways. One is to reduce physician administrative responsibilities by joining supergroups or hospital systems where skilled business professionals assist with compliance, revenue cycle, recruitment, personnel, accounting, benefits, etc. Another strategy is to prioritize physician wellness practices and introduce measures to prevent burn-out. Some groups are intentionally making it easier for older GI doctors to stay in the workforce by increasing schedule flexibility, allowing for less call, shorter hours, part time work, and job sharing.

Hopefully, technological advances to reduce work demand, for example via effective blood testing for colorectal cancer screening or using artificial intelligence to streamline documentation. However, in the near term, the gastroenterologist supply-demand mismatch is an increasingly important issue for those in our profession. Meeting this challenge will not be easy but will need to be proactively dealt with over the next decade.

PSG Mentorship Program

We are looking for PSG members who are interested in serving as mentors to trainees and early-stage GI practitioners. This promises to be a mutually rewarding activity. Time commitment is variable, but interaction between mentor and mentee should be at least quarterly. In addition, the mentor should be willing to have contact (by email, text, telephone call) on an as needed basis.

Please contact Audrey Dean (adean@pamedsoc.org) or David Diehl (dldiehl@geisinger.edu) if you are interested in becoming a PSG Mentor or for any questions. Thanks for your participation in this!

Disease specific categories

Barrett’s esophagus

Eosinophilic esophagitis

Inflammatory bowel disease

Gastrointestinal Motility

Functional bowel diseases / GI Psychology

Pancreaticobiliary diseases

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PRESIDENT

Diversity and Inclusivity in GI

David L. Diehl, MD

Private practice issues and early practice

Advocacy

Clinical trials

Geisinger Medical Center

Gastroenterology/Nutrition

570-271-6856 dldiehl@geisinger.edu

Clinical research

@DavidDiehlMD

Invention and Innovation in GI

Work/Life Integration

1st Vice-President

Karen Krok, MD

Penn State Hershey

Gastroenterology

(717) 531-4950 kkrok@pennstatehealth.psu.edu

TREASURER

Neilanjan Nandi, University of 215-662-8900

Neilanjan.Nandi@pennmedicine.upenn.edu

@fitwitmd EDITOR

David L. Diehl, Geisinger Medical

Gastroenterology/Nutrition

570-271-6856 dldiehl@geisinger.edu @DavidDiehlMD