11 Feb Weill Cornell Study Finds Geographic Disparities in Access to Gastroenterologists due to Greater Demand for Services and Limited Number of Providers
MedicalResearch.com Interview with:
Dr. Jesudian
Arun B. Jesudian, MD
Associate Professor of Clinical Medicine Medicine
Weill Cornell Medical Center
Transplant hepatologist at NewYork-Presbyterian/Weill Cornell Medical Center
MedicalResearch.com: What is the background for this study?
Response: In recent years, the demand for gastroenterologists continues to increase due to an aging population, increase in the prevalence of gastrointestinal and hepatology diseases, updates in screening and surveillance recommendations, and advances in therapeutic techniques. In this study, we set out to examine geographic distributions of gastroenterologists in the United States.
MedicalResearch.com: What are the main findings?
Response: We found that on a national level, over 80% of the population lives within 25 miles of the closest gastroenterologist. However, 2,183 (69%) of the US counties do not have a practicing gastroenterologist, and 454 of the 1,167 metropolitan counties in the US do not have a gastroenterologist. Additionally, gastroenterologists in non-metropolitan counties tend to be older, with almost a third over the age of 65.
Response: Why is the supply of Gastroenterologists constrained? Is there difficulty settling two-career families in more remote areas?
Response: There are many potential reasons behind a mismatch between supply and demand in gastroenterology, and unfortunately this problem is pervasive throughout different specialties in medicine. While the total number of practicing gastroenterologists has increased, this increase was not able to keep up with the demand driven by aging population, updates in colorectal cancer screening, and increased prevalence of gastrointestinal and hepatology diseases. Supply for gastroenterologists is also constrained, and will likely remain constrained because a large portion of currently practicing gastroenterologists are nearing retirement age, the long training requirement to become a gastroenterologist, and the limited number of fellowship spots.
It is definitely an interesting point you brought up about two-career families in remote areas, while we didn’t specifically look into that, I would imagine this is likely one of the reasons that it’s harder to attract physicians to remote areas. Another reason could be due to lack of infrastructure (e.g. Rural hospital closures and physician office consolidations in recent years),
MedicalResearch.com: Are there other providers who can do some procedures ie colonoscopies?
Response: In the United States, colonoscopies are largely performed by gastroenterologists and surgeons. However, studies have shown that in certain regions in the US, a small number of internists and family physicians may also perform colonoscopies.
MedicalResearch.com: Is specialized imaging also limited in these areas?
Response: While this was outside the scope of our study, there are studies that noted geographic disparities in radiology and imaging. While there have been initiatives for remote imaging reads for patients in rural areas, there are still limitations to both staffing as well as facilities with the specialized machines.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: One important area of research is to better understand how supply demand mismatch impacts patient outcomes. One study published in Gastroenterology in 2022 found that GI cancer mortality was higher in rural areas. Other studies have also found worsening urban-rural disparities in patients with other conditions such as cardiovascular, pulmonary, and GI comorbidities. Additionally, we hope this will drive policy makers to further investigate initiatives that will improve healthcare infrastructure in rural areas.
Disclosures: Dr. Jesudian does not have disclosures that are relevant to this study but does serve as a consultant for Salix Pharmaceuticals and conducts speaking services for Salix Pharmaceuticals, Madrigal Pharmaceuticals and Mallickrodt Pharmaceuticals. The other authors have no disclosures.
Citation:
Ying X, Yao L, Mathis WS, Congly SE, Jesudian AB. Geographic Disparities in Access to Gastroenterologists in the United States. Gastroenterology. 2025 Feb 1:S0016-5085(25)00339-7. doi: 10.1053/j.gastro.2025.01.232. Epub ahead of print. PMID: 39922544.
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Last Updated on February 11, 2025 by Marie Benz MD FAAD