50 million Americans lack access to a gastroenterologist

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Nearly 50 million Americans — particularly those in rural communities — must travel at least 25 miles to see a gastroenterologist, according to a new study from Weill Cornell Medicine, published in Gastroenterology on February 6, 2025. This shortage could place greater responsibility on primary care physicians (PCPs), who may need to bridge the gap.

The study highlights critical geographic disparities in gastroenterology access, leaving many patients without local options for screening and treatment of conditions, including colorectal cancer, inflammatory bowel disease, acid reflux and liver disease.

Researchers analyzed data from the Health Resources & Services Administration and the 2020 U.S. Census, finding that over two-thirds of the country’s 3,149 counties have no gastroenterologists, leaving approximately 49 million Americans without adequate access to care. Another 17% of counties have fewer than five gastroenterologists.

“While there is adequate access to gastroenterologists at the national level with most people living within 25 miles of a gastroenterologist, more attention is needed to increase access in underserved areas,” said Xiaohan Ying, MD, co-first author of the study and a clinical associate in medicine at Weill Cornell Medicine and resident in internal medicine at NewYork-Presbyterian/Weill Cornell Medical Center. “Geographic disparities in access to physicians have widened, and unmet needs in gastroenterology care persist and are likely to worsen with an aging population.”

The study found that 80% of counties without a gastroenterologist were in non-metropolitan areas, which tend to have older populations, lower median incomes, fewer insured individuals and higher proportions of white residents.

States with the lowest gastroenterologist-to-population ratios included Alaska, North Dakota and Wyoming, while Massachusetts, Connecticut and New York had the highest.

Further complicating matters, gastroenterologists in rural counties are aging. “Gastroenterologists in non-metropolitan counties were more likely to be older, with more than two-thirds of them older than age 55 and nearly half of those older than 65 years of age,” said Leah Yao, MD, co-first author, a clinical associate in medicine at Weill Cornell Medicine and resident in internal medicine at NewYork-Presbyterian/Weill Cornell Medical Center. “As these gastroenterologists retire, we will likely see worsening access in less populated areas exacerbating existing access disparities.”

Addressing this shortage will require systemic solutions, and PCPs or advanced practice clinicians may be looked at to fill the gaps. Arun Jesudian, MD, associate professor of clinical medicine and transplant hepatologist at NewYork-Presbyterian/Weill Cornell Medical Center, pointed to incentives to practice in underserved areas, including loan repayment or increased reimbursement, as methods to increase access to care.

“Policy interventions and other strategies to expand the gastroenterologist workforce and increase access in underserved areas are needed now,” Jesudian said. Without intervention, the imbalance in gastroenterologist distribution may continue to worsen, leaving millions of Americans without adequate access to digestive care, and worsening the burden on PCPs.