Gastroenterology practices are struggling to secure anesthesia coverage for endoscopy, and a new American College of Gastroenterology task force report points to staffing, cost and training gaps behind the strain.
The report comes from ACG’s Workforce of the Future Task Force and was published in a September supplement to The American Journal of Gastroenterology. The subgroup surveyed ACG members by email in June 2025 and at ACG’s annual meeting in October 2025, drawing 362 responses from 48 states and Puerto Rico. The email wave had a 2.9% response rate.
Here are nine things to know:
1. Anesthesia now dominates GI sedation. Sixty-five percent of respondents use only anesthesia-supported sedation, 31% run a hybrid model with moderate sedation and 4% use only moderate sedation. Anesthesia assistance for outpatient colonoscopy climbed from about 17% of procedures in 2006 to more than 58% in 2015. The authors say current rates are likely higher.
2. Staffing is the biggest barrier. Among respondents, 66.5% named limited availability of anesthesia staff as a challenge. Cost followed at 42%, then procedural delays at 32% and slow room turnover at 31%.
3. ASCs lean on anesthesia more than hospitals do. Studies cited in the report found ASCs had higher odds of using anesthesia assistance for colonoscopy than hospital outpatient departments, with roughly 26.5% vs. 19.1% anesthesia use in some comparisons.
4. The supply outlook is worsening. A separate Medicus Healthcare Solutions white paper projects a shortage of 6,300 anesthesiologists by 2036. The authors note that estimates like these are based mainly on surgical demand and don’t account for anesthesia needed for GI procedures.
5. CRNA costs are climbing. CRNAs are the predominant sedation model in endoscopy-focused ASCs. Many are nearing retirement, and more are moving to locum tenens work for higher pay. Rising CRNA wages are putting financial pressure on independent endoscopy centers, the authors wrote.
6. Many GI physicians would give propofol themselves. One in five respondents said they would administer GI-directed propofol sedation. Another 35% said they would after online or in-person training, and 36% said they would not.
7. Fellows are graduating without sedation skills. The subgroup surveyed 100 GI program directors, 41% of the 242 contacted, and 52 senior fellows, 8% of the 655 contacted. About 30% of each group said fellows weren’t competent in moderate sedation by the end of training, even though ACGME requires it. Only 54% of fellows said they received hands-on sedation instruction.
8. Hospital policy frustrates physicians. “Hospital makes more from the MAC than the procedure. The hospitals will never give up that massive revenue stream,” one respondent wrote. The report does not name individual respondents.
9. The task force wants to reduce reliance on anesthesia providers. Its recommendations include:
- Backing nurse-administered propofol sedation as an accepted standard for appropriate patients
- Standardizing moderate sedation competency for physicians and fellows
- Pushing Medicare and private payers to fairly reimburse gastroenterologist-directed propofol sedation
- Separating ASC sedation payment from bundled facility fees
- Using mixed CRNA and certified anesthesiologist assistant staffing and PRN providers instead of costly locums
- Tracking anesthesia cost per case
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