Across the country, gastroenterologists are grappling with seismic changes in care delivery — from staffing shortages and evolving screening guidelines to declining reimbursement and payer dynamics.
Becker’s spoke with five gastroenterology leaders about the trends shaping their practices today.
Benjamin Levy, MD. Gastroenterologist and Clinical Associate of Medicine at University of Chicago Medicine: ASCs need to recruit more anesthesiologists and nurse anesthetists due to increased demand for colonoscopies. After the American Cancer Society and GI societies recently changed the screening guidelines to begin screening colonoscopies at age 45 instead of 50, approximately 19 million additional individuals entered the pool of patients needing procedures. Furthermore, the U.S. is experiencing a relative shortage of anesthesiologists and CRNAs due to preferences for propofol during GI endoscopy, increased surgical volume, in general at ASCs, the baby-boomer generation aging, and an aging workforce. It would be great if the federal government could increase funding for graduate medical education in order to expand the number of residency spots to train more anesthesiologists and physicians in general. In 1997, Medicare capped the number of residency positions it funds. In 2021 and 2023, Congress voted to expand Medicare support for graduate medical education and added a limited number of new residency slots. However, it has not been enough to keep pace with the number of anesthesiologists needed, especially when considering the increased needs in gastroenterology endoscopy. In gastroenterology, we are working hard to increase colorectal cancer screening rates nationally to remove polyps before they turn into cancer — so we need additional gastroenterologists and anesthesiologists to help this effort.
Omar Khokar, MD. Gastroenterologist of Illinois GastroHealth (Bloomington): This is ongoing, but the biggest change is collaborating with payers to demonstrate the value of care in the ASC setting. In terms of next steps, we need AI integration into “smart screening” strategies, and ultimately ASCs need to choose tighter payer alignment — choosing partners whose goals align with our clinical mission. That means saying no to low-performing contracts and yes to deeper partnerships with high-performing payers that reward value.
Amit Patel, MD. Gastroenterologist at GI Alliance of Illinois (Evanston): The most disruptive trend for physicians is the decrease in reimbursement coupled with the increasing expenses. It is particularly concerning for Medicare patients. The economics makes it almost impossible to care for these patients. For example, it is difficult for a Medicare patient to obtain spine consultations and treatments. It also affects the specialties and number of physicians in regions.
It is also leading to the closure of private practice offices, and hence less options for patients. This is not limited to Medicare. Commercial insurers also base their reimbursement to physicians on Medicare rates and with the decrease year after year leading to a critical break point. Reimbursement is a major factor in the decrease and in some regions lack of obstetric care. Only time will tell to what extent this will continue. There appears to be no solution from our legislators, who neglected the issue in the annual budget this year.
Sheldon Taub, MD, Gastroenterologist at Jupiter (Fla.) Medical Center: One of the biggest misconceptions that people have about physicians is that they have all the answers. Thats not necessarily true. Medicine is full of uncertainties, and doctors are human. It is so important that the physician takes a detailed, accurate history and that the patient reveals to the doctor everything that is factual, not what they think the doctor wants to hear. Doctors work very hard for the most part and take on much responsibility. The average patient does’’t understand that. They feel many doctors live a lavish lifestyle with limited hours that are dedicated to the practice. This is largely not true. Often, doctors take their work home with them, if not physically, mentally. The pressures of practicing medicine right now are enormous and unappreciated by the general public. Physicians have to deal with insurance regulations, government regulations and hospital issues. These facts are all taken into consideration when deciding to enter the field of medicine, and this partially explains the present state of affairs that exists in the medical field.
Michael Warne. CEO at Associated Gastroenterologists of Central New York (Camillus, N.Y.): People sometimes underestimate how committed ASCs are to quality care and clinical excellence. The setting is more intimate than a hospital, and that really builds a strong team dynamic. Everyone — from nurses to support staff — is invested in what we’re doing. It’s not just doctors or administrators paying attention to things like ADR or withdrawal times. The whole team understands why those quality measures matter, and we all work together to improve them. It’s not about hitting numbers for corporations — it’s about doing what’s right for the patients, and that’s something we all take seriously.
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