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TOPLINE:

The proportion of gastroenterologists practicing in rural areas in the US remained stable at approximately 7% from 2014 to 2025 despite a growth in the overall workforce. Late-career clinicians and those in the Midwest were more likely to practice rurally, whereas women, hepatology specialists, and physicians with academic affiliations were less likely to practice rurally.

METHODOLOGY:

• A substantial portion of the US population lives in rural areas and faces worse gastrointestinal diagnosis, care patterns, access, and mortality, with recent analyses showing uneven geographic access to gastroenterologists and widening urban-rural gaps.
• To determine trends in the proportion of gastroenterologists practicing in rural areas and to identify factors associated with rural practice, researchers selected all physicians reporting a primary specialty of gastroenterology from annual versions of the Physician Compare Database from 2014 to 2025 in the US.
• They identified 19,901 unique gastroenterologists and collected covariates, including graduation year, region of practice, zip code of practice, practice academic affiliation, group size, and sex; years of practice were derived from subtracting an assumed 6-year training period from the time between the graduation year and the current year.
• Rural/urban status was determined from rural-urban commuting area (RUCA) codes derived from the practice location, with RUCA scores 1-3 defined as urban and 4-10 defined as rural; clinicians linked to both rural and urban practices were classified as rural.

TAKEAWAY:

• The total number of gastroenterologists rose from 12,636 in 2014 to 14,939 in 2025 (P < .001); however, the percentage of rural gastroenterologists did not change (7.3% vs 7.7%; P = .84).
• Hepatology subspecialty was associated with decreased odds of rural practice (adjusted odds ratio [aOR], 0.62; 95% CI, 0.41-0.93), as were female sex (aOR, 0.64; 95% CI, 0.54-0.76) and academic affiliation (aOR, 0.50; 95% CI, 0.42-0.60).
• A late-career stage (≥ 25 years of practice) was associated with increased odds of rural practice (aOR, 1.53; 95% CI, 1.29-1.82), and the Midwest region showed higher odds of rural practice (aOR, 1.69; 95% CI, 1.45-1.97).
• Working in small-sized practices (one to nine physicians; aOR, 0.57; 95% CI, 0.45-0.71) and very large-sized practices (≥ 100 physicians; aOR, 0.82; 95% CI, 0.71-0.96) were both associated with decreased odds of rural practice compared with working in medium-sized practices (10-99 physicians).

IN PRACTICE:

“[M]onitoring of practice trends is important to ensure patient populations treated by retiring late-career gastroenterologists are covered by the recruitment of other qualified gastroenterologists,” the authors wrote.

SOURCE:

The study was led by Thomas B. Cwalina, West Virginia University, Morgantown, West Virginia. It was published online in Digestive Diseases and Sciences.

LIMITATIONS:

Medical specialty within the database may contain inaccuracies if misreported or not updated appropriately, and years in practice may have been overestimated for those with training gaps or further training due to the assumed 6-year training period. The Physician Compare Database only includes gastroenterologists participating in Medicare. Urban/rural status may have been misclassified because practice location is self-reported. 

DISCLOSURES:

No funding sources relevant to this work were reported by the authors. The authors disclosed no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.