Revolutionizing GI Care Through Equity, Innovation, and Prevention

Our panel of GI experts highlights the urgent need for equitable care, workforce solutions, and breakthrough technologies like AI.

What do you feel are the biggest gaps that need to be addressed in gastrointestinal (GI) care right now?

• The GI physician shortage is critical, and it is going to get worse over the next few years. Over half the U.S. counties don’t have a qualified gastroenterologist. The impending retirement of physicians over age 55 is going to make it worse. Rural areas are and will be affected hard.
• Racial and ethnic minorities, along with individuals of lower socioeconomic status, face significant barriers to GI care.
• Decreasing reimbursements, insurance, and financial barriers to care.
• Precision medicine to predict prognosis as well as response to a particular medication in each person.
• Fragmentation of care. Most physicians are moving out of providing care in the hospital due to difficult work hours and work environment, impediment to work-life balance, challenging patient population, decreasing financial incentives, etc.

What is the most innovative technology in the GI space right now, and how is it impacting the standard for clinical excellence?

The GI space is very exciting at this moment, and it is the right time to be a gastroenterologist. AI-powered tools such as GI Genius are enhancing polyp detection, which will further lead to decreased colon cancer in the United States. There is a 53% reduction in colon cancer in the United States due to the removal of polyps via colonoscopy.

AI-based scribing of clinical notes is a boon for a busy GI physician. Virtual care via telehealth is making it possible to provide care to patients who lack the resources to visit a physician’s office, such as transportation and patients in rural areas who have no access to a gastroenterologist.

Inflammatory bowel disease and fatty liver disease care are being transformed with the addition of multiple effective treatments to our armamentarium.

What is one thing you want the healthcare community to rally behind to help drive change in the field together?

One unifying initiative the healthcare community can rally behind is advocating for equitable access to colorectal cancer screening. In spite of all the progress we have made, colorectal cancer remains a leading cause of cancer-related deaths, and disparities in screening access contribute significantly to preventable morbidity and mortality.​ We need to form partnerships among healthcare providers, policymakers, and patient advocacy groups to develop and promote strategies that increase screening rates and reduce disparities.​ There are issues, such as insurance companies not covering a surveillance colonoscopy and not covering preps for colonoscopies. Policy changes need to be made to overcome these barriers. Colon cancer is a highly preventable cancer due to its very nature, as there is a long dwell time between polyp formation and cancer, and it gives us the opportunity to act by removing the polyps with colonoscopy during this time, preventing cancer.

What do you feel are the most significant gaps that need to be addressed in GI care right now?

The increase in gastroenterological cancers, especially in young adults, is alarming. Reaching this population is a gap we need to address. The GI societies have decreased the initial age of colonoscopy screening from 50 to 45. Certain ethnic and racial populations are at higher risk for colon cancer. Providing education on behaviors that increase the risk of developing colon and rectal cancers and identifying signs and symptoms can provide the knowledge that these populations need. Colon cancer screening is the best prevention tool the GI community has to decrease colon cancer in all age and racial groups.

What is the most innovative technology in the GI space right now, and how is it impacting the standard for clinical excellence?

Two innovative technologies in the GI space currently are third-space procedures and the increased use of AI in colon cancer screening. An example of third-space procedures is the peroral endoscopic myotomy, which is used to treat swallowing disorders in the esophagus, such as achalasia. This procedure is minimally invasive, using an endoscope passed through the mouth into the esophagus. The endoscopist then cuts a small incision through the esophageal muscle to create a third space. They then tunnel to the muscles that create the sphincter to the stomach and cut them to allow food to pass into the stomach. This procedure paved the way for advancements in utilizing this third space to treat a broader range of disorders and conditions in a safer, less invasive manner, thereby impacting clinical excellence in the field of GI medicine.

The use of AI in colonoscopy procedures is the second innovative use of technology in GI care. An AI processor is used during colonoscopic procedures to aid the endoscopist by identifying potential polyps. The endoscopist then examines the area to determine if a polyp is present and can remove it if identified. This technology can increase adenoma detection and aid in identifying early colon cancers.

What is one thing you want the healthcare community to rally behind to help drive change in the field together?

The importance of gut health. Current studies are revealing how the health of the gut affects overall health, from weight management to skin health and immune function. As the scientific community researches gut function and health, they are identifying how the gut helps other body systems perform at optimal levels. As a GI community, we can drive change towards healthier living and better gut health by teaching our patients the importance of clean, healthy diets, regular exercise, and adequate hydration.

What do you feel are the biggest gaps that need to be addressed in GI care right now?

There are a number of gaps in GI healthcare currently, and some of the biggest gaps include access to care, workforce challenges, colorectal cancer screening gaps, increasing administrative burden, and the impact of federal orders and federal funding. 

• Access to Care: Significant disparities in access to GI care exist across the United States, with specialized services often concentrated in geographic pockets, leaving many communities as “healthcare deserts.” Patients in these underserved areas may not receive timely or adequate care, especially if travel is a barrier. In addition to geographic limitations, delays in scheduling appointments and endoscopic procedures hinder timely access to care. Innovative solutions are needed to ensure equitable access to high-quality GI care, regardless of a patient’s location.
• Workforce Challenges: The GI field faces both real and perceived workforce shortages, exacerbated by a decline in primary care providers, which can disrupt continuity of care and contribute to care fragmentation. Recruitment struggles persist across GI practices, as many clinicians retire or leave the field due to burnout or other factors. Shortages in anesthetic support are also impacting the availability of endoscopic procedures, including those critical for screening and diagnostics. Optimizing the use of care teams and improving workforce planning are essential to maintaining adequate access to GI services.
• Colorectal Cancer Screening Gaps: Despite significant progress — cutting colorectal cancer incidence in half through increased screening — it remains the second leading cause of cancer death in the United States. Expanding access to screening is critical, particularly considering the recent recommendation to begin screening at age 45, which adds a substantial population to the screening pool. Alarmingly, colorectal cancer is projected to become a leading cause of cancer death in individuals aged 20–49, making access to timely diagnostic procedures for symptomatic young adults even more imperative.
• Increasing Administrative Burden: Administrative tasks such as electronic health record documentation and prior authorization requests are consuming an increasing share of clinicians’ time. This burden not only impacts face-to-face patient care but also contributes to after-hours work and clinician burnout. Advocacy is needed to reform the prior authorization process and reduce unnecessary administrative overhead, ensuring clinicians can focus on delivering patient-centered care.
• Impact of Federal Policies and Research Funding: Recent cuts to federal research funding threaten to slow or halt progress in GI innovation, including cures, predictive modeling, and quality-of-care advancements. These reductions pose a dual threat: undermining the careers of researchers dedicated to advancing GI science and, more critically, delaying life-changing treatments and diagnostics for patients. Continued investment in research is essential to drive future breakthroughs and maintain momentum in improving GI health outcomes.

What is the most innovative technology in the GI space right now, and how is it impacting the standard for clinical excellence?

The use of artificial intelligence (AI) and augmented intelligence is poised to dramatically accelerate our ability not only to diagnose disease but also to predict it before it occurs. Whether through advanced endoscopic tools that enhance the visualization of abnormalities or data platforms that correlate a patient’s medical history with their risk of developing certain conditions, AI holds transformative potential. Leveraging the vast amounts of patient data available to us in meaningful ways — enabling earlier diagnoses or even prevention — will be one of the most significant advancements in healthcare in the coming years.

What is one thing you want the healthcare community to rally behind to help drive change in the field together?

We must come together to advocate for the needs of our patients and healthcare teams, both at the state and federal levels. Without a strong, unified voice sharing the real challenges clinicians and patients face, we risk the continued implementation of policies that limit access to care and make its delivery more difficult. It is essential that those in positions of authority understand the day-to-day impact of regulations on patient care, as well as their broader implications for the long-term health and well-being of our communities.

Additionally, we should rally to ensure equitable access to GI care for all patients, regardless of geography, socioeconomic status, or background. Whether it’s timely colorectal cancer screening, access to diagnostic procedures, or availability of specialists, we must collectively work to remove the barriers that prevent patients from receiving the care they need. By aligning around this shared goal, we can drive meaningful change that improves outcomes, reduces disparities, and strengthens the foundation of gastroenterology care across the country.

What do you feel are the biggest gaps that need to be addressed in GI care right now?

Patient access to care is always a concern. It’s important to ensure that there is an adequately skilled and talented gastroenterology and ancillary workforce. There is a well-documented shortage of GI physicians due to post-pandemic burnout and retirement, while demand for GI care and procedures has increased, particularly after the age to begin colorectal cancer screening for average-risk adults was lowered to age 45 (from age 50) in 2021.

Strategies to address this shortage include recruitment and retention of gastroenterologists, anesthesiologists, and endoscopy nurses; increasing GI training programs; and implementing reforms in reimbursement to better reflect current costs and inflation.

Another important gap is in recognition and focused research on the inequities in healthcare nationally and globally, particularly on the cost of preventive care and the availability of medications.

What is the most innovative technology in the GI space right now, and how is it impacting the standard for clinical excellence?

Artificial intelligence (AI) in GI is rapidly evolving. In endoscopy, this includes computer-aided polyp detection and diagnosis for colonoscopy, which aids in quality measures, patient care, and reporting. AI also helps to document conversations during patient appointments, which reduces the administrative burden of completing notes in the electronic medical record. Advances in our understanding of the microbiome and genetics will allow GI physicians to provide precision medicine and personalized care in therapeutics and preventive medicine.

What is one thing you want the healthcare community to rally behind to help drive change in the field together?

Equitable access to care, treatment, and medications.

What do you feel are the biggest gaps that need to be addressed in GI care right now?

Access to colorectal cancer screening is a critical gap that is impacted by disparities in access to quality colonoscopy in rural and socioeconomically disadvantaged communities. Workforce shortage challenges are also a concern. There are too few gastroenterologists in many parts of the country, which exacerbates disparities in access to care.

Another area we are working to address is the increasing incidence of metabolic-associated liver disease and GI cancers driven by the obesity epidemic. Access to obesity treatments is limited due to the high cost of GLP-1 medications and endoscopic interventions for obesity.

What is the most innovative technology in the GI space right now, and how is it impacting the standard for clinical excellence?

Artificial intelligence is becoming an integral part of GI practice and will help to further improve the quality of colonoscopies by allowing physicians to detect more pre-cancerous polyps. AI also has the potential to improve the efficiency of physician offices, improve diagnostics, and improve communication between specialists and primary care physicians.

Novel endoscopic devices for the management of type 2 diabetes and obesity are on the cusp of revolutionizing the management of diabetes and obesity, with the most important innovations being duodenal mucosal resurfacing and endoscopic sleeve gastroplasty. Additionally, novel endoscopic tools that allow for minimally invasive resection of pre-cancerous polyps and early cancers throughout the gastrointestinal tract are allowing patients to avoid digestive surgery.

What is one thing you want the healthcare community to rally behind to help drive change in the field together?

Improving access to high-quality healthcare for all Americans, which includes decreasing insurance preauthorization barriers for lifesaving medications and procedures, primarily for the management of chronic disease (such as inflammatory bowel disease, obesity, and diabetes) and cancer screening.