Gastroenterology
& Hepatology

At a glance

Gastroenterology sits, alongside cardiology, at the very top of the internal medicine fellowship hierarchy — and the pull is easy to understand. GI pairs longitudinal disease management with high-volume, well-reimbursed endoscopy; its signature procedure, screening colonoscopy, prevents cancer in a way you can watch happen on the monitor; and demand for gastroenterologists comfortably exceeds supply. The catch comes in two parts: a match that turned away 38.3% of the applicants who preferred it in the 2026 appointment-year Match¹, and a lifestyle that is more controllable than most procedural fields but decidedly not call-free.

What it involves

Gastroenterology covers the digestive tract and its organs — esophagus, stomach, small and large intestine, pancreas, biliary tree, and liver. The clinical menu runs from reflux, Barrett’s esophagus, and peptic ulcer disease through inflammatory bowel disease (Crohn’s disease and ulcerative colitis), irritable bowel and other motility disorders, GI bleeding, and pancreaticobiliary disease, to the full spectrum of liver disease — fatty liver (MASLD/MASH), viral hepatitis, cirrhosis and its complications. Hepatology is not a side interest; ACGME requires roughly five months of hepatology within the core clinical experience, and liver disease will follow you through every practice model you choose⁶.

What separates GI from the cognitive IM subspecialties is endoscopy. Most gastroenterologists split the week between clinic and an endoscopy suite — increasingly an ambulatory surgery center (ASC) — doing colonoscopy, upper endoscopy (EGD), and, with additional training, endoscopic ultrasound (EUS) and ERCP. The ACGME procedural core includes colonoscopy with polypectomy, EGD, upper and lower non-variceal hemostasis, variceal hemostasis, capsule endoscopy, PEG placement, esophageal dilation and foreign-body retrieval, sedation, and paracentesis; fellows also keep a continuity clinic for all three years — this is not a scope-only apprenticeship⁶.

The pathway is straightforward: a 3-year ACGME internal medicine residency, then a 36-month ACGME gastroenterology fellowship, then the ABIM gastroenterology certifying exam⁷ — which 94% of the 679 first-time takers passed in 2025⁸. From there, several sub-tracks are available, and they change the shape of the career considerably. Because GI is really six or seven different lives, the choice among them is where the decision-making actually happens:

One accreditation nuance worth knowing early: the transplant-hepatology dual pathway requires 12 dedicated months of clinical transplant hepatology, cannot begin before fellowship year two, and is described by ACGME as an intensive clinical pathway — built for committed hepatology careers, not as a research detour⁶.

A day in the life

A general gastroenterologist's day usually splits into a scope half and a clinic half. On a procedure morning you run a block of scheduled endoscopy — perhaps eight to fifteen cases: screening and surveillance colonoscopies, a few EGDs for reflux or dysphagia, a bleeding work-up, a PEG. Each is short, hands-on, and immediately gratifying: you find the polyp and remove it, you find the ulcer and treat it. The clinic half is the cognitive counterweight — a new IBD patient starting a biologic, a cirrhotic you are keeping out of the hospital, an abnormal liver panel to untangle, a positive stool test to counsel and schedule. Interleaved through both are inpatient consults and, on a call day, the pager: a GI bleed in the ICU, a cholangitis that needs an urgent ERCP. It is a rhythm that rewards people who genuinely like both doing and thinking — and it shifts markedly one sub-track over, toward the referral suite for an advanced endoscopist or the wards for a transplant hepatologist. The endoscopy-economics section explains why that scope half also drives the paycheck.

Competitiveness

GI is one of the two toughest IM fellowships to enter, and the numbers back the reputation. NRMP's 2026-appointment-year report can be tallied two ways: counting every GI track, 759 certified positions filled at 99.5% (755 filled, 4 unfilled); counting the main clinical track alone, 646 positions with 644 filled (99.7%). Either way, essentially everything fills, and the fill rate has held above 99% every year from 2022 through 2026 even as positions grew about 23%¹.

The competitiveness lives on the applicant side. In that Match, 1,241 applicants preferred GI; 60.8% matched to the specialty, 0.9% matched to a different specialty, and 38.3% did not match to any program — the highest non-match rate of any major IM subspecialty, cardiology included¹. That is roughly 1.6–1.7 preferred applicants per position, though advising sources describe the effective market as closer to 2.5–3.0 applicants per position once you count everyone who applies. A 2024 commentary noted that in 2023 only 62.7% of GI applicants matched — lower even than cardiology's 68.4%¹¹.

Who succeeds? With Step 1 now pass/fail, NRMP does not publish GI-specific score or publication medians, so the most granular current data comes from a small survey of the 2024–2025 cycle: overall 76.2% matched, but every one of the ten chief residents matched, university-based applicants matched far above community applicants, applicants with more than ten interviews matched above 84%, and returns plateaued past roughly 100 applications; respondents credited networking, research, and mentorship most often¹². Read it as directional (63 applicants), but the direction is consistent with everything else: advocacy and scholarship move outcomes. Research expectations keep escalating — one program documented a roughly fourfold rise in mean publications among its GI interviewees from 2009 to 2018¹³.

An application timeline. GI rewards early, deliberate preparation more than almost any IM fellowship:

1. PGY-1: get onto a GI rotation or consult service early; identify a GI faculty mentor and start one scholarly project (a case series, a review, a QI project); protect Step 2 CK performance.
2. PGY-2: deepen the research thread toward tangible output; complete Step 3; seek a leadership or teaching role; line up faculty who can write specific, advocacy-grade letters; consider whether a chief year strengthens your case.
3. PGY-3 (application year): apply broadly and strategically; spend your 15 program signals on programs where you are genuinely competitive and where ties, geography, or IMG-match history make you credible¹⁴; and interview widely — the data reward reaching beyond ten interviews.

Signaling is now part of the game: GI uses 15 signals (3 gold, 12 silver), and program surveys indicate signals genuinely move interview odds¹⁴. The practical translation: get a GI rotation early, earn letters from GI faculty who have watched you work, build a genuine research thread, and find mentors who can vouch for you — this is a specialty where advocacy demonstrably moves outcomes.

Skills & personality

GI rewards a specific blend: manual dexterity and real comfort with procedures, because endoscopy is a hands-on craft with a genuine learning curve; stamina and efficiency, because high-volume scope days are physically repetitive and reward focus without corner-cutting; and decisiveness under pressure, because bleeds, cholangitis, and food impactions demand rapid triage and technical action — sometimes at 3 a.m. Business acumen helps more here than in most IM fields, since ASC ownership, ancillary services, and productivity structures drive private-practice income.

But do not mistake GI for a purely technical field. Liver disease and coagulopathy, GI bleeding in a patient with cardiopulmonary disease, a stubborn liver-enzyme puzzle, a motility workup — the cognitive internal medicine core stays with you, and IBD, hepatology, and functional disorders demand careful longitudinal reasoning and real communication skill. You will manage chronic disease for decades and deliver cancer diagnoses. And yes: you must be genuinely comfortable talking about bowel habits all day.

Who tends to be unhappy? Physicians who find repetitive endoscopy monotonous; those who want a purely cognitive, no-procedure practice; those seeking a truly closed-weekend, no-call lifestyle; and those uncomfortable with the physical toll of high-volume proceduralism. If you found your endoscopy elective tedious rather than satisfying, believe that signal.

Lifestyle & the physical job

GI carries a reputation for “high pay plus controllable lifestyle,” and there is truth in it — for the elective outpatient half of the job. Colonoscopies are scheduled, daytime, and predictable; many gastroenterologists build weeks of alternating clinic and procedure days, and some describe four-day weeks. Average reported hours run around 50 per week, with Medscape's 2025 report citing about 53¹⁵.

Now the stress test. GI call is not trivial: you cover GI bleeding, cholangitis (often requiring emergent ERCP), food impactions, and other after-hours emergencies, and weekend or urgent endoscopy is simply part of the job. Physicians commonly report call around every fifth or sixth weekend plus roughly one weekday per week, though this varies widely by group size and practice model. The controllable-lifestyle claim holds best if you deliberately build an outpatient-weighted practice — an IBD clinic, elective screening endoscopy — and it holds worst in transplant hepatology or advanced endoscopy at a referral center, where the pager earns its keep. A “GI hospitalist” model of dedicated inpatient coverage is emerging, which can concentrate or offload the inpatient burden depending on which side of it you sit.

Burnout data are mixed and instrument-dependent, so here is the honest spread: Medscape's 2025 report put GI burnout at about 29% — below the all-specialty average¹⁵ — while an analysis of a 2017 ACG survey using the more stringent Maslach Burnout Inventory found about 49%¹⁶; other surveys using different instruments have reported figures in between. The drivers are consistent: bureaucratic and EHR burden, high volume, and work-life conflict, with burnout tracking work-life balance more than practice type. Yet satisfaction stays high: 92% of gastroenterologists would choose the specialty again¹⁵.

The physical job: ergonomics and injury

The most under-discussed occupational fact in GI is that endoscopy hurts the people who do it, cumulatively. A 2024 systematic review and meta-analysis pooled 26 studies and 6,246 endoscopists and found an endoscopy-related-injury prevalence of 67.9% — rising to 77.8% among advanced endoscopists — with neck pain (36.7%), low-back pain (35.6%), and thumb pain (33.1%) the most common, and only 19.1% of endoscopists reporting any prior ergonomic training¹⁷. Repetitive scope torque, thumb and wrist load, awkward monitor and table heights, and long hours standing drive it; advanced endoscopists carry the additional burden of fluoroscopy and lead aprons during ERCP, adding the same spine loading and radiation concerns that interventional cardiologists face. This is a career-length issue, not a nuisance: plan for it. When you evaluate a group, ask concretely about ergonomics — adjustable-height beds and monitors, anti-fatigue mats, scheduled breaks between cases, case-volume caps, ergonomic training, and whether the ASC's design was built around the endoscopist or the throughput. During fellowship itself, ACGME caps work at 80 hours per week averaged over four weeks and requires one day in seven free; expect the early years to run near those limits.

Compensation & endoscopy economics

GI is consistently one of the best-paid destinations in internal medicine, usually a notch below or beside cardiology — but the headline average understates the real story, which is how much practice structure drives the number. First the headlines, read as ranges rather than payroll:

These are self-reported survey averages, not audited payroll; several are subscription-gated and attributed by name and data year, not reproduced²³. Note the 2024 dip: GI pay is high, not monotonically rising.

Now the part that actually determines your income: endoscopy economics. GI is one of the clearest examples in medicine of procedure- and productivity-driven pay, and three levers dominate both your income and your schedule. Procedure volume: full-time targets commonly run about 8,000–12,000 work RVUs per year, at conversion factors typically around $55–$75 per wRVU (roughly $59–$63 in 2025 benchmark data)¹⁸. RVU mix: a diagnostic colonoscopy generates about 3.18 wRVU, one with snare polypectomy about 4.46, while ERCP and EUS run roughly 8–12 wRVU per case — so mix and throughput shape everything. Ambulatory surgery center ownership: the single biggest income differentiator in the field. ASC equity adds facility-fee distributions on top of professional fees; recruiting and advisory sources estimate buy-ins around $100,000–$300,000 and annual distributions of $75,000–$200,000 or more, so a high-volume physician with equity can reach well past the survey averages. The same levers set your schedule: the physician earning at the top of these ranges is the one running high-volume scope days, taking call, and covering weekends.

By setting: private-practice partners with ASC equity earn the most, often materially above employed peers; hospital-employed non-academic roles commonly run in the mid-to-high $400,000s to mid-$500,000s; academic positions run lower, traded against research, teaching, and subspecialty depth (recruiter and advisory estimates). Underserved and rural markets frequently out-pay prestige coastal metros because that is where the access gaps are.

Intellectual scope

The intellectual appeal of GI is the pairing of immediate procedural gratification — find the polyp, stop the bleed, relieve the obstruction — with genuinely complex longitudinal medicine. One day you are titrating immunosuppression for Crohn's disease, the next you are managing decompensated cirrhosis, the next you are scoping a bleeder. A typical procedural day runs perhaps 8–15 cases, and roughly 70–80% of work RVUs come from endoscopy, but the 20–30% of clinic time carries most of the diagnostic puzzles.

The field is also innovating fast: EUS-guided therapeutics, third-space endoscopy, endoscopic bariatrics, an active pharmaceutical pipeline in IBD biologics, MASH therapeutics, and GLP-1s, and growing AI applications such as computer-aided polyp detection. Guidelines churn constantly — colorectal cancer screening, IBD biologic sequencing, hepatitis therapy — so you will never coast. The major societies (AGA, ACG, ASGE, AASLD) sustain large research foundations and meetings, and academic tracks support basic, translational, and clinical research. If you want a career with both hands and head fully engaged, few IM fields balance the two this evenly.

Pathways & career arc

Four practice models dominate. Private single-specialty groups offer the highest earning potential through partnership, ASC equity, and ancillaries, with more autonomy but more business risk. Hospital-employed and health-system roles trade a lower ceiling for a stable base, defined call, and less administrative exposure. Academic centers pay less but concentrate transplant hepatology, advanced endoscopy, IBD referral practice, and research. And private-equity-backed platforms have consolidated a large share of GI private practice, offering competitive bases with equity or earn-out structures that reshape call and administrative expectations — read those contracts carefully. Beyond clinical work, GI supports locums, telehealth, industry roles in pharma and devices, informatics, administration, and entrepreneurship.

Geography is the quiet headline. A 2025 study found 69.3% of U.S. counties — 2,183 of 3,149 — had no gastroenterologist, leaving roughly 49 million people without local care; about 45 million Americans travel more than 25 miles for GI care⁵. Willingness to practice outside saturated metros translates directly into pay and job choice.

The five-year outlook is strongly favorable. Demand drivers are durable: an aging population, the USPSTF's May 2021 move lowering the colorectal-cancer screening start to age 45 (adding roughly 19 million people aged 45–49 to the screening pool)²¹, rising early-onset colorectal cancer, and the MASLD/obesity epidemic. Supply is constrained: HRSA projected a ~1,630 FTE gastroenterologist shortage for 2025⁴; 51% of gastroenterologists were 55 or older per 2021 AMA Masterfile data²²; and ABIM issued 659 new GI certificates in 2025²³, still modest against the retiring cohort. Training is expanding — 2,152 active fellows in 2024–2025, up 16.7% from 2020–2021²⁴; first-year fellows rose from 507 to 704 over a decade²⁵ — but not fast enough to close the gap. Net: the market favors gastroenterologists for the foreseeable future, tempered by reimbursement pressure and consolidation.

The career arc, honestly. Endoscopy is a physically finite skill, and the ergonomic data above make that concrete. In your thirties and forties the high-volume proceduralist life is at full tilt; by the fifties and sixties, many gastroenterologists deliberately shift the mix — more clinic and cognitive practice (IBD, hepatology, motility), fewer high-volume scope days, less bleed call — and some move toward endoscopy-unit medical direction, ASC governance, administration, industry, or education. GI's deep cognitive core is what makes that second act realistic: the same person can run 12 colonoscopies a day at 40 and a busy hepatology or IBD clinic at 62. If you are choosing GI for the procedures, choose it knowing the scope years are finite, protect your body early, and build the cognitive muscles that will carry the back half of the career.

Choosing a fellowship & first job

GI asks you to choose twice: first a fellowship, then — three years later — a first attending job. The through-line is the same: decide what matters for your direction, evaluate the program or group against it, and negotiate the terms.

Choosing the fellowship. Beyond prestige, weigh endoscopic volume and breadth (will you graduate confident, and can you get EUS/ERCP exposure if you want advanced training?), depth in the areas you care about (transplant hepatology, IBD, motility), academic-versus-community orientation, geography, research support, and — for IMGs — documented visa sponsorship and recent IMG-match history. Let your 15 signals follow that logic, not raw program rank.

Choosing the first job. When the offers come, the employer's name and the headline salary matter less than the operating model, the ownership terms, and the contract. Normalize competing offers to the same terms and get the details in writing:

• The clinical model: clinic-to-endoscopy ratio, expected wRVU target and case mix, call structure (how often you cover bleeds and cholangitis, and whether ERCP call is yours), and inpatient vs outpatient weighting.
• The economics: base versus productivity (the wRVU threshold and conversion factor), and — critically — whether the offer includes a real, diligenced ASC ownership path (buy-in amount and financing, valuation, vesting, distributions and what they depend on, buy-out) and ancillary participation; plus sign-on, retention, and CME.
• The contract: non-compete scope (which can bar you from the region's ASCs), without-cause termination, malpractice coverage and tail, and who actually employs you (private group, hospital, PE platform, or academic department) — which determines your autonomy, income drivers, and what happens if the group is acquired.
• The ergonomics: ask directly about unit design, case caps, breaks, and whether the group treats endoscopist longevity as its problem or yours (see above).

IMG considerations

Start with the encouraging fact: gastroenterology is a genuinely open pathway for international medical graduates, at meaningful scale. In the 2026 appointment-year Match, non-U.S.-citizen IMGs filled 23.6% of the main clinical track and U.S.-citizen IMGs another 8.2% — roughly one matched GI fellow in three trained abroad; counting all GI tracks together, the figures were 21.5% (162 of 755 positions) and 7.7%²⁶. The non-U.S. IMG share has grown every year since 2022. One caution: NRMP does not break out IMG-specific GI match rates, so any industry estimate of the within-class IMG rate should be verified against the primary report before you lean on it.

Visa sponsorship is the central practical variable. Many academic programs sponsor J-1 (through ECFMG)²⁷, some sponsor H-1B, and a meaningful number sponsor neither — some prominent programs state explicitly that they sponsor no visa for clinical fellowship. Build your program list around documented sponsorship policy and recent IMG match history from the start, not as an afterthought. Any federal tightening of J-1 or H-1B policy would compress the non-U.S. IMG share quickly; that is a real risk to monitor, not a hypothetical. (Two companion analyses take up the wider questions: whether international graduates take U.S. graduates' spots, and the H-1B for physicians in training; practical planning lives on the IMG guide.)

Spend your signals like the scarce currency they are. With only 15 signals (3 gold, 12 silver), IMG applicants are best served concentrating them on programs that have matched IMGs recently, where geographic or personal ties exist, or where their residency has placed fellows before¹⁴. And strengthen the parts of the profile you control: a chief-residency year is one of the strongest levers available, strong Step 2 CK and a completed Step 3 help, and a focused, sustained research thread materially improves odds. Two sub-track notes: advanced-endoscopy programs have historically included a high share of foreign medical graduates — about 55% in 2020 data — and some sponsor J-1⁹; transplant-hepatology programs vary widely in visa policy. For an IMG willing to train hard, target programs strategically, and practice where the shortage actually is, GI is demanding but decidedly reachable.

Bottom line

Consider this path if you love both thinking and doing — you want procedures with immediate, visible results and the longitudinal management of complex chronic disease; you want top-tier compensation with real upside through volume, ASC equity, and ancillaries (understanding it as a business return with business risk); you value a durable job market with geographic leverage; and you are competitive enough — strong performance, research, letters, ideally a chief year — to face one of the hardest matches in internal medicine with open eyes.

It may not fit if you dislike procedures or would find your ten-thousandth colonoscopy tedious rather than satisfying; you need a genuinely call-free, closed-weekend life — GI-bleed and cholangitis call are structural, not incidental; the physical repetitiveness and cumulative injury risk of high-volume endoscopy worry you; or a roughly 38% chance of not matching anywhere among applicants who preferred GI is a risk you cannot absorb, especially layered on visa uncertainty.

A last mentor's note. Do the GI elective early and let it tell you the truth — and sample all of it, not just the scope suite. If scoping feels like a chore, believe that. But if the idea of preventing a cancer before lunch and untangling a cirrhosis puzzle after it genuinely excites you, gastroenterology may be your calling. Then do the second half of the work: choose the sub-track for the life it produces, protect your body from the first day, and, when the offers come, diligence the ownership and the contract as carefully as you chose the field.

References

1. National Resident Matching Program. (2025). Results and data: Specialties Matching Service — Match Results Statistics, Medicine and Pediatric Specialties, 2026 appointment year. https://www.nrmp.org/match-data/ Positions, fill rates, and applicant match/non-match outcomes (matches conducted December 2025). ↩₁ ↩₂ ↩₃ ↩₄
2. Medscape. (2022, 2025, 2026). Gastroenterologist compensation reports (2021, 2024, 2025 earnings). Self-reported survey; subscription access required, not reproduced here. Specialty averages about $530,000 (2025 earnings, up ~3% YoY), about $495,000 (2024 earnings, a ~3% decline from about $512,000), and about $453,000 (2021 earnings). Only 37% of gastroenterologists felt fairly compensated (2025 report). ↩₁ ↩₂ ↩₃
3. Doximity. (2025). Physician compensation report 2025 (2024 data). https://www.doximity.com/reports/physician-compensation-report/2025 Self-reported/modeled survey. Gastroenterology specialty average about $537,870, up 3.7% year over year. ↩₁ ↩₂
4. HRSA National Center for Health Workforce Analysis. (2025). Physician workforce projections, 2023–2038. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/physicians-projections-factsheet.pdf Modeled a gastroenterologist shortage of about 1,630 FTE for 2025 (narrowing to about 1,390 FTE by 2037). Projection, not a guarantee. ↩₁ ↩₂
5. Ying, X., Yao, T., et al. (2025). Geographic distribution of gastroenterologists in the United States. Gastroenterology. https://www.gastrojournal.org/article/S0016-5085(25)00135-4/fulltext Published online February 2025: 69.3% of U.S. counties (2,183 of 3,149) had no gastroenterologist, leaving roughly 49 million people without local care. ↩₁ ↩₂
6. Accreditation Council for Graduate Medical Education. (2026). Program requirements for graduate medical education in gastroenterology. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/144_gastroenterology_2026.pdf Procedural core, hepatology months, continuity-clinic requirement, and the transplant-hepatology dual pathway (12 dedicated clinical months, not before fellowship year two). ↩₁ ↩₂ ↩₃
7. American Board of Internal Medicine. (n.d.). Gastroenterology certification policies. https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/gastroenterology/ ↩
8. American Board of Internal Medicine. (2025). Certification pass rates. https://www.abim.org/media/5hhbskg2/certification-pass-rates.pdf 94% of 679 first-time takers passed the gastroenterology certifying exam in 2025. ↩
9. American Society for Gastrointestinal Endoscopy. (n.d.). Advanced Endoscopy Fellowship (AEF) Match. https://www.asge.org/home/education-meetings/training-trainees/advanced-endoscopy-fellowship-(aef) Advanced-endoscopy pathway; foreign-medical-graduate share cited as about 55% in 2020 data. ↩₁ ↩₂
10. American Board of Internal Medicine. (n.d.). Transplant hepatology certification policies. https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/transplant-hepatology/ Separate ABIM certificate; dual-pathway rules allowing the transplant-hepatology year to fold into fellowship year three. ↩
11. Gumaste, V. (2024). The gastroenterology fellowship match. Digestive Diseases and Sciences. https://link.springer.com/article/10.1007/s10620-024-08420-x Match-competitiveness commentary: in 2023, 62.7% of GI applicants matched, below cardiology’s 68.4%. ↩
12. Bojja, D., et al. (2025). Factors associated with a successful gastroenterology fellowship match. American Journal of Gastroenterology (ACG 2025 abstract). https://journals.lww.com/ajg/fulltext/2025/10002/s3019_factors_associated_with_successful.3019.aspx Survey of the 2024–2025 application cycle, 63 respondents — read as directional, not definitive. 76.2% matched overall; all ten chief residents matched; networking (58.3%), research (45.8%), and mentorship (37.5%) most cited. ↩
13. Imam, Z., & Cappell, M. S. (2019). Publication trends among gastroenterology fellowship interviewees. BMC Medical Education. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1809-2 One program documented a roughly fourfold rise in mean publications among GI interviewees from 2009 to 2018. ↩
14. Association of American Medical Colleges. (2025). ERAS fellowship program signaling. https://students-residents.aamc.org/applying-fellowships-eras/eras-fellowship-program-signaling Gastroenterology uses 15 signals (3 gold, 12 silver). Program-use figures are self-reported by responding programs (96% reported using signals in deciding whom to interview, 2026 season). ↩₁ ↩₂ ↩₃
15. Medscape. (2023, 2025). Gastroenterologist lifestyle & burnout reports. Self-reported survey; subscription access required. GI burnout about 29% (2025 report, below the all-specialty average); 92% would choose the specialty again (2023 report); about 53 average weekly hours. ↩₁ ↩₂ ↩₃
16. Barnes, E. L., et al. (2019). Physician burnout in gastroenterology. American Journal of Gastroenterology. https://journals.lww.com/ajg/abstract/2019/06000/physician_burnout_in_gastroenterology.11.aspx Analysis of a 2017 ACG survey using the Maslach Burnout Inventory found about 49% burnout; burnout tracked work-life balance more than practice type, running higher in younger physicians, women, and those with heavy procedure or weekend work. ↩
17. Prevalence of endoscopy-related injuries and their impact on clinical practice: A systematic review and meta-analysis. (2024). https://pubmed.ncbi.nlm.nih.gov/38365216/ Pooled endoscopy-related injury prevalence 67.9% across 26 studies (6,246 endoscopists); 77.8% among advanced endoscopists. Most common: neck pain 36.7%, low-back pain 35.6%, thumb pain 33.1%. Only 19.1% reported prior ergonomic training. ↩
18. MGMA. (2025). DataDive provider compensation (wRVU and conversion-factor benchmarks). Subscription-gated, not reproduced here. Cited directionally for full-time wRVU targets (about 8,000–12,000/year) and per-wRVU conversion factors (roughly $59–$63 in 2025). ↩
19. Centers for Medicare & Medicaid Services. (2024). Calendar year 2025 Medicare Physician Fee Schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule Conversion factor cut 2.83% to $32.35 (from $33.29 in 2024). ↩
20. Centers for Medicare & Medicaid Services. (2025). Calendar year 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f Published November 5, 2025 (Federal Register 2025-19787). Conversion factor rose to $33.57 for qualifying APM participants and $33.40 for others; CMS also finalized a 2.5% downward efficiency adjustment to the work RVUs and intraservice time of non-time-based services (E/M, care-management, behavioral-health and telehealth-list codes exempt; endoscopy is not). ↩
21. U.S. Preventive Services Task Force. (2021). Colorectal cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening May 2021 recommendation lowered the screening start age to 45, adding roughly 19 million people aged 45–49 to the screening pool. ↩
22. American Medical Association. (2021). Physician Masterfile (workforce-age data). 51% of gastroenterologists were 55 or older (2021). ↩
23. American Board of Internal Medicine. (2026). Gastroenterology diplomate report 2026. https://www.abim.org/media/tkrdtdec/gastroenterology-diplomate-report-2026.pdf 659 new gastroenterology certificates issued in 2025. ↩
24. Accreditation Council for Graduate Medical Education. (2025). Data resource book, 2024–2025. https://www.acgme.org/globalassets/pfassets/publicationsbooks/2024-2025_acgme_databook_document.pdf Active-fellow counts: 2,152 active GI fellows in 2024–2025, up 16.7% from 2020–2021. ↩
25. American Board of Internal Medicine. (n.d.). Number of first-year fellows by subspecialty. https://www.abim.org/about/data-and-reports/number-of-first-year-fellows-by-subspeciality/ First-year GI fellows rose from 507 (2014–2015) to 704 (2023–2024). ↩
26. National Resident Matching Program. (2025). Results and data: Specialties Matching Service, 2026 appointment year. https://www.nrmp.org/match-data/ Track-level fill and applicant-type (IMG) statistics, and the fellowship-match calendar for the 2027 appointment year. ↩
27. Educational Commission for Foreign Medical Graduates. (n.d.). Exchange Visitor Sponsorship Program (J-1): General information. https://www.ecfmg.org/evsp/applying-general.html ↩
28. Restriction on Entry of Certain Nonimmigrant Workers, Proclamation No. 10973. (2025, September 24). Federal Register. https://www.federalregister.gov/documents/2025/09/24/2025-18601/restriction-on-entry-of-certain-nonimmigrant-workers Signed September 19, 2025; effective September 21, 2025. Imposes a $100,000 payment requirement on certain new H-1B petitions for beneficiaries outside the United States, with national-interest exemptions and a twelve-month sunset absent extension. ↩
29. U.S. Citizenship and Immigration Services. (2025). H-1B: Frequently asked questions on the September 2025 proclamation. https://www.uscis.gov/newsroom/alerts/h-1b-faq USCIS guidance that the payment requirement applies to new petitions for beneficiaries outside the United States without a valid H-1B visa, and does not reach previously issued visas, earlier-filed petitions, renewals, or change-of-status, amendment, and extension petitions for people already in the country. ↩
30. State of California v. Mullin, No. 1:25-cv-13829-LTS (D. Mass. June 8, 2026) (Sorokin, J.), appeal docketed, No. 26-01699 (1st Cir. 2026). https://www.fragomen.com/insights/united-states-district-court-temporarily-stays-order-vacating-dollar100000-h-1b-fee.html The district court vacated the payment requirement on June 8, 2026 as an unlawful tax and Administrative Procedure Act violation, then temporarily stayed its own order on June 12, 2026 pending appeal; the government appealed to the First Circuit. The requirement therefore remains operational for affected petitions at this writing. A fast-moving matter — verify current status before relying. ↩

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