Geographic Disparities in GI Specialist Availability Suggest Limited Access to Care

New research is shedding light on state- and local-level geographic disparities in the availability of gastroenterologist care, highlighting limited access to care in rural areas and areas with low household incomes relative to urban areas.1

Study findings point to substantial disparities in the availability of specialist care, particularly in the Midwest and Southwest regions and rural and impoverished areas, all of which had fewer gastroenterologists than patients with inflammatory bowel disease (IBD) needing care.1

“To the best of our knowledge, this is the first nationwide study to comprehensively assess the density of GI specialists at a granular, local level across the US,” Jonathon Casey Chapman, MD, a gastroenterologist at Gastroenterology Associates in Baton Rouge, Louisiana, and colleagues wrote.1 “In addition, this study is the first to evaluate the local-level density of patients with IBD, providing novel insights into geographic disparities in both specialist availability and patient distribution.”

The evolving management of IBD continues to bring both opportunities and challenges, particularly as it pertains to patient access, individualized care, and navigating an expanding therapeutic pipeline. Despite advances in treatment options, most recently with the US Food and Drug Administration (FDA) approvals of a single-injection, once-monthly maintenance regimen of Omvoh (mirikizumab-mrkz) for subcutaneous use in adults with moderately to severely active ulcerative colitis (UC) and upadacitinib (Rinvoq) for the treatment of adults with moderately to severely active UC and Crohn's disease after they have received ≥ 1 approved systemic therapy, barriers such as insurance restrictions, cost, and access to specialist care continue to create hurdles for patients.2,3

The descriptive retrospective analysis assessed the availability of GI specialists using multiple data sources to depict GI specialist density at both state and local levels using the first 3 digits of US postal codes (ZIP codes) as geographical markers. For each first 3-digit ZIP code tabulation area (ZCTA) and state in the US, investigators calculated the density of patients with IBD per 100,000 population, gastroenterologists per 100,000 population, and gastroenterologists per 100 patients with IBD. They used 2022 claims data to identify patients with IBD, the 2022 National Provider Identifier registry for provider details, and the 2020 US Census for area-level variables.1

Overall, 520,020 patients with IBD were included in the study. At the national level, the density of patients with IBD per 100,000 population was 156.9. At the state level, the density of patients with IBD per 100,000 population varied, with Maine (337.1) and Rhode Island (251.4) having the highest density and New Mexico (58.2) and Hawaii (63.6) having the lowest density. At the local level, 65.7% of the 3-digit ZCTAs had a density of 100 to <250 patients with IBD per 100,000 general population, whereas 24.6% had a density of patients lower than 100.1

A total of 21,611 GI specialists were identified from the 2022 NPI registry. At the national level, there were 6.5 GI specialists available per 100,000 population. Kansas (2.0) and Wyoming (3.1) had the lowest GI specialist density per 100,000 population, while New Jersey (11.2) and Rhode Island (10.8) had the highest GI specialist density. Investigators pointed to similarly considerable disparity in the geographic availability of GI specialists at the local level.1

The GI specialist density per 100 patients with IBD at the national level for gastroenterologists was 4.2. At the state level, Kansas (1.4) and Maine (1.9) had the lowest density for gastroenterologists per 100 patients with IBD. While Michigan was among the top 10 states with the highest number of patients with IBD (n=23,969), it had a low density of gastroenterologists (per 100 patients with IBD) of 2.2.1

Further analysis revealed one-fifth of ZIP codes had a gastroenterologist density (per 100 patients with IBD) of <1, and more than one-third had a density of 1 to <5. Across the US, 130 3-digit ZCTAs had 0 gastroenterologists/100 patients. Investigators noted 62% of these ZIP codes were in rural areas and 25% had household income <150% of the poverty line.1

Additionally, they pointed out ZIP codes with ≥5 gastroenterologists/100,000 population tended to have lower poverty rates and were more urban than those with 1 to <5 gastroenterologists/100,000 population.1

“This study shows that despite the burden of IBD in the US, the geographic distribution of gastroenterologists varies widely. Rural areas and areas with low household incomes have fewer gastroenterologists than urban areas, indicating disparities in the availability of GI specialists,” investigators concluded.1 “The results may help inform healthcare policies that impact resource allocation for underserved patients with IBD throughout the US.”

References

1. Upadhyay N, Vadhariya A, Gorritz M, et al. Geographic Distribution of Gastroenterologists and Patients With Inflammatory Bowel Disease in the United States. Clin Transl Gastroenterol. doi:10.14309/ctg.0000000000000953

2. Livingston R. FDA Approves Single-Dose Formulation of Mirikizumab-mrkz for Ulcerative Colitis. HCPLive. October 27, 2025. Accessed November 28, 2025. https://www.hcplive.com/view/fda-approves-single-dose-formulation-of-mirikizumab-mrkz-for-ulcerative-colitis

3. Brooks A. FDA Approves Updated Indication for Upadacitinib (Rinvoq) in IBD. HCPLive. October 13, 2025. Accessed November 28, 2025. https://www.hcplive.com/view/fda-approves-updated-indication-for-upadacitinib-rinvoq-in-ibd