The long-standing narrative that there is a shortage of gastroenterologists in the U.S. is starting to shift, as recent data reveal more details about exactly where access to GI care is the most strained.
A task force report from the American College of Gastroenterology, published Sept. 22 in a supplement to the American Journal of Gastroenterology, cites federal data putting GI physician supply at 98% of need nationally and 109% in metropolitan counties, while nonmetropolitan counties face what the report calls a severe shortage.
In many of those rural communities, the outpatient side of GI care now rests largely on advanced practice providers, Amy Oxentenko, MD, vice dean of practice and chief patient experience officer at Rochester, Minn.-based Mayo Clinic, told Becker’s. She convened the task force during her term as ACG president.
The pressure starts with the procedure schedule. Rural gastroenterologists are in such demand for colonoscopies and other endoscopic procedures that their clinic time is shrinking.
“The gastroenterologists in those rural areas, I can tell you, are being concentrated into doing procedures. They’re getting pulled, so they almost don’t have an outpatient practice because people want them to be doing all of the procedures, which leaves a big gap,” Dr. Oxentenko said.
APPs are filling that gap, often managing increasingly complex patient needs. Dr. Oxentenko said ACG members raised that concern repeatedly in the years before her presidency, and she has seen it in her own practice.
“We have APPs out there across the country providing very complex care for our GI patients, but we probably have not really equipped them and supported them in the way that we need to,” she said.
Rural gastroenterologists face their own version of the problem. At academic centers, physicians typically narrow into a subspecialty. Newly trained gastroenterologists who go into rural practice are expected to handle nearly everything, from inflammatory bowel disease to complex liver care.
“They’re going to go out into a practice as a gastroenterologist and be expected to do complex IBD care, complex liver care, complex — you name it — GI care. But we don’t ask that of our folks in the academic center where they pick one area to really have a focus niche,” Dr. Oxentenko said.
The model she sees as most promising for both groups is “hub-and-spoke,” which connects rural clinicians to academic specialists so complex patients can stay in their communities. One example is Radius, short for rural APPs delivering IBD care in the United States, a program developed by Corey Siegel, MD, at Lebanon, N.H.-based Dartmouth Health and presented at ACG’s 2025 annual meeting. Many patients with complex IBD live in rural communities around Dartmouth and would rather not travel to the academic center for routine care.
“In their communities, they have GI APPs who are very much willing to see those patients but need that expertise at the elbow to support them,” Dr. Oxentenko said.
Under the model, APPs continue to see patients locally while the academic team remains close at hand.
“In this Radius model, Dartmouth has an association with all of these rural practices where APPs have regular touch points with the IBD experts at Dartmouth to run cases by to say, ‘I have this patient, here’s my plan, here’s some things I’m thinking about,’ and to get that expertise from the specialist directly,” she said.
Other academic centers are now adopting the approach for IBD, and there is interest in building similar models for liver care, another highly specialized area. When APPs in rural practices were surveyed about which area should come next, motility emerged as a priority.
“I do think that’s going to be the solution that we would probably see as most sustainable in helping to support rural GI outpatient practices,” Dr. Oxentenko said.
Some support can also come from outside the practice. GI dietitians and psychologists are in short supply, and digital platforms can make those services available to rural patients virtually. Dr. Oxentenko said those platforms can be valuable, but only if there is bidirectional communication with the treating practice, so a dietitian’s recommendations end up where the clinician can see them.
“Without it, you’re kind of relying on the patient to absorb the complexity of that and being able to translate back and forth,” she said.
That emphasis on support is why the task force gave APPs one of its three work groups, alongside groups on the physician workforce and anesthesia. The APP work group called for structured training, standardized GI-specific core competencies, retention strategies and clear, state-compliant job descriptions.
“We needed to make sure that we’re supporting them, we’re equipping them with the right tools and clinical skills, and then like I said, we’re making sure that we can retain them in that practice because they are essentially that outpatient practice in that rural community in many cases,” Dr. Oxentenko said.
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