Gastroenterology: A Deep Dive Into GI Workforce Strategy

Article originally published through the American Association of Provider Compensation Professionals (AAPCP).

Introduction

Gastroenterology stands at a pivotal crossroads in the U.S. healthcare landscape. Driven by an aging population, rising rates of chronic gastrointestinal conditions, and expanded screening guidelines, the demand for GI services has never been higher. Yet, the supply of gastroenterologists has struggled to keep pace, leading to significant disparities in access—especially in rural and underserved areas. More than half of practicing GI physicians are over the age of 55, while the number of fellowship training slots remains tightly constrained, intensifying concerns about long-term sustainability. As the specialty grapples with workforce aging, limited training capacity, and evolving physician expectations, the future of gastroenterology depends on the industry’s ability to adapt.

With an aging population and almost half of the GI physician population nearing retirement, a shortage of GI physicians will likely cause pressure on future compensation. Most of the shortage will be felt in rural markets. Compensation demands will continue to be offset by a growth in GI focused surgery centers over the next five years. The implementation of artificial intelligence can help reduce some of the shortage as machine learning helps improve diagnostic precision,” says Curtis Bernstein, Partner, Pinnacle Healthcare Consulting.

Current Landscape of the GI Workforce

Gastroenterology is a high-demand specialty in the United States, fueled by an aging population, increasing rates of chronic gastrointestinal conditions, and expanded screening guidelines for colorectal cancer. Despite this mounting demand, the growth of the GI workforce has not kept pace, creating widespread access challenges. As of 2025, there are an estimated 18,756 active gastroenterologists nationwide, including 17,147 adult and 1,609 pediatric GI physicians. However, the distribution of these specialists is uneven, with a significant concentration in urban and suburban areas and many rural regions left critically underserved.

Demographic trends further complicate this picture. As noted earlier, more than half of practicing gastroenterologists are over the age
of 55, positioning the specialty among those most vulnerable to near-term retirements. At the same time, while gender diversification is
slowly improving, only 17% of currently practicing gastroenterologists are women—a figure that underscores persistent disparities in representation and leadership within the field. These factors raise urgent concerns about long-term sustainability, especially as patient demand for GI services continues to grow.

Interest in the Specialty

Interest in the specialty remains robust among medical trainees, but fellowship capacity is limited. In the 2023 NRMP Gastroenterology
Fellowship Match, 1,121 applicants competed for just 727 positions. Although the fill rate was a near-perfect 99.6%, approximately 35% of qualified applicants went unmatched due to the scarcity of available training spots. Structural barriers—such as capped GME funding, the procedural intensity of GI training, and shortages of qualified faculty—have constrained the ability of academic centers to expand the pipeline.

In recent years, the employment structure of GI physicians has also shifted dramatically. Roughly 60% of gastroenterologists are now employed by hospitals or health systems, a notable change from the historically independent practice model that once dominated the field. Private equity investment has further accelerated consolidation, particularly in high density metropolitan markets. While academic centers continue to play a vital role in education and research, they often struggle to retain physicians due to less competitive compensation packages compared to private and PE-backed settings.

Geographic disparities in access to care are among the most pressing workforce issues. Over two-thirds of U.S. counties have no practicing gastroenterologist at all, and nearly 50 million Americans live more than 25 miles from the nearest GI provider. These gaps delay screenings,
hinder chronic disease management, and increase the risk of late-stage diagnosis for preventable conditions such as colorectal cancer. While telehealth has expanded access to consultative services, it cannot replace the need for local procedural capacity—particularly for colonoscopy,
endoscopy, and advanced therapeutic interventions.

In summary, the U.S. gastroenterology workforce stands at a critical inflection point. With strong demand and interest in the field, but limited training capacity, aging demographics, and uneven geographic distribution, strategic interventions are needed. Expanding fellowship opportunities, promoting equitable practice models, and targeting underserved regions are all essential to ensure the long-term viability and accessibility of high-quality GI care.

Survey Demographics and Respondent Profile

To support a nuanced analysis of compensation and productivity, this report draws on proprietary data collected through a joint survey
conducted by the American Association of Provider Compensation Professionals (AAPCP) and Pinnacle Healthcare Consulting. The survey
was designed to capture real-world practices from a broad spectrum of organizations that directly employ or contract with gastroenterology providers.

A total of 56 organizations participated in the survey, representing a diverse cross-section of healthcare structures. The composition of
respondents by organization type includes:

• Academic Medical Centers: 4 organizations (8%)
• Health Systems: 42 organizations (79%)
• Physician Group Practices: 9 organizations (17%)
• Rural Health Systems: 1 organization (2%)

Note: Some organizations were categorized in more than one type (e.g., a rural system that is also part of an integrated network).

In addition to organizational type, participants reported the size of their medical group based on the total number of employed physician and advanced practice provider (APP) full-time equivalents (FTEs). The distribution is as follows:

• 250 or fewer employed physicians and APPs: 19 organizations (36%)
• 251-999 employed physicians and APPs: 18 organizations (34%)
• 1,000-1,999 employed physicians and APPs: 14 organizations (26%)
• 2,000 or more employed physicians and APPs: 5 organizations (9%)

The average size of participating organizations was 1,283 employed physician and APP FTEs, indicating that the survey sample is largely
composed of mid-sized to large integrated medical groups. These organizations typically support multispecialty practices, hospital-employed
GI teams, and formal GI service lines. The inclusion of smaller, academic, practices and rural systems adds essential diversity to the data and allows for a more comprehensive view of how compensation strategies vary across different care delivery environments.

Survey respondents also reported the primary geographic regions they serve. The regional distribution was as follows:

• South: 18 organizations (24%)
• Northeast: 9 organizations (11%)
• West: 11 organizations (21%)
• Midwest: 17 organizations (32%)

This regional diversity enables benchmarking across multiple markets and ensures the data reflects varied payer environments, workforce availability, and cost structures. It is important to keep in mind that many organizations operate across multiple regions.

To better understand productivity benchmarking practices, organizations were also asked to identify which CMS Physician Fee Schedule (PFS) version they use for wRVU calculations. Responses showed notable variation:

• 2025 PFS: 21 organizations (40%)
• 2024 PFS: 11 organizations (21%)
• 2023 PFS: 6 organizations (11%)
• 2022 PFS: 2 organizations (4%)
• 2020 PFS: 16 organizations (30%)

These results highlight the continued diversity in PFS adoption. While 40% of respondents use the most current (2025) values, a meaningful portion (30%) continue to rely on legacy schedules like 2020, reflecting a combination of strategic choice, operational alignment, and contractual lag.

Organizations also provided data on their gastroenterology physician staffing, including general GI, advanced endoscopy, and GI hospitalist roles. Among the 56 organizations that responded to this question, the total reported workforce nearly 1,000 gastroenterology physician FTEs.

Key statistics include:

• Average: 15.3 GI physician FTEs per organization
• Median: 8.0 GI physician FTEs per organization

While many organizations operate lean GI teams supported by a small number of APPs, others reported 30 or more APPs as part of a team-based model. This range reflects the growing role of APPs in procedural prep, post-procedure care, clinic access, inpatient support, and care coordination across GI service lines.

This comprehensive demographic profile establishes a strong foundation for the compensation, productivity, and staffing insights presented in the following sections.

Compensation and Productivity Benchmarks

Understanding how compensation aligns with productivity remains central to strategic planning in gastroenterology. While total cash compensation can vary widely based on organizational type, payer mix, regional demand, and ancillary income opportunities, a more standardized comparison point is compensation per work Relative Value Unit (wRVU)—particularly under production-based models.

To isolate true productivity-driven pay structures, the survey asked organizations to report compensation per wRVU under active production-based models only, explicitly excluding salary-based plans. These figures represent what a physician could reasonably earn under the model, assuming standard performance, and include bonus eligibility tied to quality, patient satisfaction, and service excellence. This payment amount per wRVU is inclusive of all bonuses, APP collaboration stipends, and call coverage payments. However, it is worth noting that this would exclude compensation for excess call.

A total of 56 organizations submitted production model data. Recognizing that organizations utilize different versions of the CMS Physician Fee Schedule (PFS) to calculate wRVUs, we normalized all responses to the 2021 PFS and later, which reflect updated E/M code valuations and broader wRVU increases. For respondents using the 2020 PFS, we applied an upward normalization adjustment of 3.9% to account for the average increase in wRVUs that would occur under newer schedules. This adjustment ensures fair comparison across all submissions, regardless of which PFS is operationally in use.

The normalized results reveal a compensation landscape that is variable, yet strongly clustered around key market reference points:

• Average compensation per wRVU: $69.89
• Median (50th percentile): $68.00
• 25th percentile: $63.00
• 75th percentile: $75.66
• 90th percentile: $81.76

The amounts above represent the amount of compensation per wRVU that an individual gastroenterologist could receive under a production model (inclusive of all reasonable types of income). If your organization utilizes the 2020 PFS, increase your amount paid per wRVU by 3.9% to compare to the table above.

These benchmarks demonstrate that while most organizations compensate between $63 and $76 per wRVU, a meaningful subset operate above or below that range. Contributing factors likely include local market dynamics, the use of ancillary compensation incentives (call, APP collaboration, etc.), and philosophical differences in how closely compensation is tied to individual productivity.

These findings highlight that even at the highest ends of compensation, most organizations are not paying close to the 75 percentile compensation per wRVU in national dataset tables under their actual production models. This is consistent with market norms in that the actual compensation earned per wRVU is much closer to the median and below median utilizing national tables.

One other issue to note is that there was some correlation with lower compensation per wRVU and other income opportunities. In other words, organizations that offered more ancillary income in the model, typically paid less per wRVU in the model itself.

Incentive Compensation for Value-Based Metrics

As the healthcare industry continues to evolve toward outcomes focused reimbursement, many organizations are incorporating value-based incentives into their compensation models, rewarding providers for contributions beyond pure productivity. These metrics often include patient satisfaction, quality outcomes, care coordination, access, and adherence to evidence-based clinical protocols. While the numbers outlined in the compensation per wRVU percentiles include this income, below highlights what percentage of organizations include portions of the model dedicated to non-production metrics.

Among the 56 organizations surveyed:

• 55.4% (31 organizations) reported providing additional compensation tied to value-based performance measures
• 44.6% (25 organizations) stated that their compensation model does not include separate value-based incentives

For organizations that do provide value-based pay, incentives are most commonly layered onto production and compensation models in the form of the following:

• Quality bonuses linked to hospital or departmental scorecards
• Patient satisfaction targets (e.g., CG-CAHPS or Press Ganey)
• Access metrics, such as timely scheduling or follow-up compliance
• Composite value-based performance pools, distributed annually or semi-annually

These incentives are generally modest relative to base compensation, but they reflect an increasing emphasis on aligning physician behavior with broader system goals. Notably, the presence of value-based incentives does not appear limited to either production or salary-based models—respondents from both categories reported using these tools to shape performance expectations.

As GI practices face growing scrutiny from payers and systems alike, particularly in bundled payment or value-based care arrangements (e.g., for colorectal cancer screening or chronic liver disease management), we anticipate continued growth in the use of nonvolume-based performance incentives.

Call Coverage Compensation Practices

Call coverage remains a critical and often nuanced component of gastroenterology compensation. While some organizations include call expectations within base salary or productivity models, others offer distinct compensation for excess, after-hours, or specialized call responsibilities.

Among the 56 organizations surveyed:

• 55.4% (31 organizations) reported providing additional compensation for call coverage
• 44.6% (25 organizations) that call is embedded within their existing compensation model without supplemental pay

This reflects a wide range of strategies in balancing fairness, burden, and financial sustainability.

To better understand how call is compensated when paid separately, we analyzed detailed responses from the 31 organizations offering additional pay. After removing entries related only to restricted or on-site trauma level coverage, 29 organizations provided usable hourly pay data related to general GI, ERCP, or excess call.

One of the most significant findings is that over half (52%) of these organizations reported paying for call only after a minimum threshold of call days per month—typically between 5 and 10 shifts. These tiered or threshold-based models are designed to distinguish between shared departmental expectations and excess burden. For example:

• Weekday and weekend call pay often begins only after 5–7 shifts/month
• Advanced Endoscopy and ERCP call compensation frequently starts only after 10 shifts/month
• Some organizations increase hourly rates after certain thresholds are met (call above 5 days = X Dollars and call above 10 days = X+Y
  Dollars), creating progressive financial incentives

Across all valid entries, the range and distribution of hourly rates were as follows:

• Average hourly call rate: $47.57
• Median (50th percentile): $41.66
• 25th percentile: $33.33
• 75th percentile: $58.33
• 90th percentile: $66.13

The highest hourly rates—those exceeding $60 per hour—were often tied to multi-facility coverage, with physicians responsible for simultaneous availability across two or more hospitals. For instance:

• One organization paid $66.66/hour when covering two facilities, compared to $45.83/hour for one
• Another paid $31/hour for the first five days of three-hospital coverage, escalating to $41.66/hour thereafter

This trend suggests that higher compensation is not solely a reflection of call frequency or intensity, but also of logistical complexity and broader geographic responsibility.

Additional compensation strategies observed include offering differentials for weekend vs. weekday call coverage. This is common and is consistent with past surveys performed by the AAPCP. Further, it was common to have unique pay for unique coverage. For example, ERCP
only call was typically lower in the range above whereas more complex and complete call (advanced endoscopy or full scope call) was associated with higher rates.

A key takeaway is that not all organizations paid incrementally for additional call and for those that did, most only did so after a certain amount of gratis call.

Overall, this data demonstrates a shift toward structured, equitable compensation frameworks that reflect not only time on call but also the scope and scale of responsibility. In an era of workforce strain and rising burnout, such models play a vital role in supporting physician engagement and operational reliability.

Compensation for Collaborating with Advanced Practice Providers (APPs)

As the role of Advanced Practice Providers (APPs) expands across gastroenterology service lines, organizations are increasingly evaluating if it is appropriate to compensate physicians for their time spent collaborating. In surgical and procedural specialties, it is not uncommon for this work to be considered “part of the job” and therefore not an incremental income opportunity.

Among the 56 organizations surveyed:

• 28.6% (16 organizations) provide additional compensation for collaborating with APPs
• 71.4% (40 organizations) include collaboration responsibilities within the core compensation model without separate pay

Of those providing separate payment, a variety of models emerged, including:

• Per-wRVU supervision credits, such as $20 per supervised wRVU or $5 per APP-generated wRVU (with annual caps)
• Flat annual stipends per APP FTE, sometimes contingent on documentation or performance metrics
• Scaled stipends based on the number of APPs supervised, including first-APP and add-on rates

Focusing on stipend-based models, 12 organizations reported clear per 1.0 FTE APP annual amounts, with the following key benchmarks:

• Average annual stipend: $13,167
• Median annual stipend: $12,000
• 25th percentile: $10,000
• 75th percentile: $16,500

Some organizations also set caps—such as a maximum total of $20,000 annually per physician—or require documentation of specific tasks performed in support of APP oversight. The most common single value reported was $12,000 per 1.0 APP FTE, underscoring a growing consensus around this figure as a market midpoint.

This data suggests that while a majority of organizations still include APP collaboration as a baseline expectation, a meaningful minority are recognizing the time and effort involved through structured, scalable payments. It is important to note that organizations with lower compensation per wRVU rates in models were more likely to offer this incremental compensation, whereas those with higher rates did not.

Gastroenterology Hospitalist Models

As inpatient demand grows and GI service lines expand, some organizations are adopting dedicated gastroenterology hospitalist models. In this structure, physicians work exclusively in inpatient settings—often on a shift-based schedule—separate from outpatient clinic responsibilities. These models aim to improve consult responsiveness, increase procedural efficiency, and support more sustainable work-life balance.

Among the 56 organizations surveyed:

• 23.2% (13 organizations) reporting having a dedicated GI hospitalist model
• 76.8% (43 organizations) do not use this model, instead assigning inpatient duties to general GI physicians on rotation

For those with a GI hospitalist model, organizations were asked to define a 1.0 FTE in terms of annual hours and shifts. Responses reflected
both hour-based and shift-based structures, with several common models:

• 182 12-hour shifts annually (~2,184 hours)
• 168 12-hour shifts annually (~2,016 hours)
• 182 10-hour shifts annually (~1,820 hours)

Across the respondents, 1.0 FTE expectations include the following annual hours:

• Median: 2,016
• 25th percentile: 1,872
• 75th percentile: 2,184

The most common 1.0 FTE requirement was 168 – 12 hour shifts; however, it was clear that a significant number of organizations require 182 – 12 hour shifts annually.

Compensation for gastroenterology hospitalists was also surveyed. Organizations reported the total hourly rate earned by physicians under the model, inclusive of all performance-related bonuses (e.g., quality, patient satisfaction, access).

Across the respondents, hourly rate opportunity includes the following:

• Median: $293.50
• 25th percentile: $287.00
• 75th percentile: $345.00

This highlights that most models paid annual total cash compensation around $591,696 ($293.50 x 2,016 Hours).

Higher hourly rates—those exceeding $340/hour—were generally tied to higher FTE workloads or expectations for weekend and holiday availability, particularly in programs requiring procedural availability across multiple facilities. Lower hourly rates often aligned with models requiring fewer total hours or providing greater scheduling flexibility.

Taken together, these results indicate that while dedicated GI hospitalist models are still emerging, a core compensation and workload range has begun to take shape. Most organizations define full-time service between 1,800 and 2,200 hours annually, and compensate between $287 and $345 per hour. For health systems considering these models, this benchmark data provides a foundational reference for workforce planning and financial modeling.

It is also critical to note that nationally GI hospitalist models are less common, but this is also the best available data in this space.

Recruitment Compensation for General Gastroenterologists

To understand how organizations are attracting gastroenterologists in today’s competitive labor market, we surveyed participants on the total cash compensation being offered to new recruits. Respondents were instructed to include base salary, sign-on bonuses, student loan forgiveness, moving expenses, and other financial incentives, prorated over the term of the initial employment contract.

Among the 56 organizations surveyed:

• Average total compensation for new recruits: $629,500
• Median compensation: $625,500
• 25th percentile: $575,500
• 75th percentile: $681,625
• 90th percentile: $750,500

The most commonly reported range clustered between $600,000 and $700,000, though nearly 20% of organizations indicated packages exceeding $750,000, particularly when sign-on bonuses and loan assistance were generous. One organization reported packages reaching nearly $925,500, reflecting highly aggressive incentives to attract talent in high-demand or hard-to-recruit markets.

These findings reinforce the intensity of competition for GI talent and underscore how recruitment compensation strategies have evolved beyond base salary alone. Many organizations are now offering multifaceted packages that reflect the long-term value of the recruit, while attempting to align incentives with retention goals.

Compensation Differentiation for Advanced Endoscopy-Trained Physicians

Advanced endoscopy procedures—such as EUS, ERCP, and complex polypectomies—require additional fellowship training and carry greater procedural complexity, risk, and call burden. In recognition of this expanded role, many organizations are beginning to offer differentiated compensation for gastroenterologists with advanced endoscopy training.

Among the 56 organizations surveyed:

• 48.2% (27 organizations) reported offering higher compensation to physicians with advanced endoscopy fellowship training
• 51.8% (29 organizations) do not currently differentiate pay, compensating these physicians at the same level as general GI providers

The majority of organizations that differentiate compensation reported applying a 5% to 10% premium. This increase may be structured as:

• A base salary premium at the time of recruitment, or
• A higher wRVU rate for productivity-based models, resulting in elevated earnings for equivalent clinical output

To illustrate how these premiums affect total cash compensation, we applied both 5% and 10% increases to the reported benchmarks for general gastroenterology recruits (which already included salary, bonuses, student loan repayment, and moving expenses, prorated over the contract period):

Metric	GI General	Advanced Endoscopy (5%)	Advanced Endoscopy (10%)
Average	$629,500	$660,975	$692,450
Median	$625,500	$656,775	$688,050
25th Percentile	$575,500	$604,275	$633,050
75th Percentile	$681,625	$715,706	$749,788
90th Percentile	$750,500	$788,025	$825,550

 

This analysis shows that with a 10% premium, advanced endoscopy trained recruits may see starting total compensation approaching or exceeding $1 million, particularly in markets where loan forgiveness and bonus structures are used aggressively.

As procedural demand increases and subspecialty-trained GI physicians remain in limited supply, compensation differentiation is emerging as a strategic tool for recruitment, retention, and service line development.

Gastroenterology Workforce Pressures and the Recruitment Pipeline

The future of the gastroenterology workforce faces mounting strain. Persistent physician shortages, regional disparities in access, and an aging population are converging at a time when the GI subspecialty pipeline is flat. According to recent AAMC data and national specialty workforce projections, demand for gastroenterologists is expected to outpace supply through at least 2035, driven by increased colorectal cancer screening, chronic liver disease management, and growing procedural complexity.

Despite rising compensation, many organizations report extended recruitment cycles, difficulty securing fellowship-trained physicians, and increasing reliance on locums or contract labor in underserved markets. The scarcity is especially acute for advanced endoscopy and rural GI placements, where few recruits seek out-call-heavy or lower-volume practices.

Shifting Physician Expectations

Today’s GI physicians are entering the workforce with evolving priorities. While compensation remains important, a growing number are prioritizing:

• Schedule flexibility
• Defined work-life balance
• Team-based care structures
• Clarity on call responsibilities and limits
• A mix of income security (base pay) and performance opportunity

This is driving increased interest in shift-based models (like GI hospitalists), hybrid scheduling, and reduced FTE commitments. Compensation models that incorporate base salary with layered incentives—rather than pure productivity structures—are seen as more sustainable by new entrants, particularly those with APP support or specialized procedural practices.

Evolving Care Delivery Models

To respond to patient demand and physician expectations, care delivery in gastroenterology is beginning to shift. Emerging innovations include:

• Virtual GI consults for triaging referrals or low-complexity cases
• Remote monitoring for inflammatory bowel disease or liver function
• Procedure-only roles to decouple cognitive work from endoscopic access
• Team-based care with APPs managing panels, follow-ups, and inpatient rounding

These models not only expand patient access but offer new pathways for physician workload distribution, recruitment, and retention—especially when combined with compensated collaboration frameworks and clearly structured call models.

Strategic Recommendations for GI Workforce Sustainability

1. Move beyond RVU-only models. Adopt blended structures that include base salary, quality incentives, call pay, and APP collaboration stipends to attract and retain a diverse GI workforce.
2. Use dedicated inpatient or procedural roles to optimize throughput, reduce burnout, and allow for differentiated FTE structures that appeal to early-career physicians.
3. Recognize the complexity and scarcity of advanced endoscopy-trained physicians with targeted compensation premiums and workload flexibility.
4. Use internal forecasting and succession planning to prepare for retirements, procedural volume growth, and evolving care models.
5. Strategic use of APPs and virtual models can buffer against shortages. Organizations mentioned utilizing APPs as primary care providers for many patients that lacked complexity for a physician intervention.

Sources

The Association of American Medical Colleges’ The Complexities of Physician Supply and Demand projects continued physician shortages, heightening recruitment challenges for gastroenterology. The American Gastroenterological Association’s GI Workforce Trends Report 2022 highlights aging demographics, workforce composition, and recruitment dynamics shaping the specialty. The Health Affairs blog post A Shift In Physician Compensation: From Volume To Value examines the broader transition toward value-based physician compensation models. The MGMA 2023 Physician Compensation and Production Report benchmarks wRVU-based compensation and productivity trends across specialties, including gastroenterology. Research published in JAMA Network Open on Trends in Characteristics and Workload of Gastroenterologists outlines increasing workloads, rising burnout risk, and evolving care delivery patterns in GI. The American Medical Association’s 2022 Benchmarking Data further reflects the shift toward team-based and hybrid physician practice models. The American Board of Internal Medicine’s Subspecialty Certification Trends documents stagnant growth in the number of certified gastroenterologists and advanced endoscopists. Kaufman Hall’s 2023 Physician Flash Report identifies compensation shifts and the rising prioritization of lifestyle-aligned roles among physicians. Finally, the American College of Gastroenterology’s Practice Management Toolbox provides practical models for implementing GI hospitalist structures and team-based care strategies.