Gastroenterology is one of the fastest-growing procedure categories in ambulatory care and one of the most understaffed. Earlier colorectal cancer screening guidelines are expanding the eligible patient population. Younger-onset GI cancers are driving higher case complexity. And the number of new gastroenterologists entering the field has dropped nearly 40% over the past three decades, from roughly 1,000 certified annually to about 600 today. (Source: KevinMD — “The gastroenterologist shortage: Why supply is falling behind demand”)

For endoscopy centers and GI-focused ASCs, the math is uncomfortable: more patients, more procedures, and a thinner workforce to support them.

What’s driving the gap

Three forces are converging on GI staffing in 2026:

  1. Demand is accelerating. The global colon screening market was estimated at $40 billion in 2025 and is projected to grow steadily through 2033. (Source: Grandview Research) Earlier screening guidelines, which now recommend colonoscopies beginning at age 45, have expanded the eligible population significantly, adding years of procedure demand to an already strained system.
  2. Procedures are moving to ASCs. GI has become a dominant share of Medicare ASC volume as procedures continue shifting out of hospital settings. That’s good for efficiency and patient experience, but it concentrates staffing pressure on outpatient centers that don’t have the float pool infrastructure of a health system.
  3. The endoscopy tech pipeline is leaking. High turnover among endoscopy technicians, driven by limited career advancement and inconsistent training, creates persistent day-of gaps. When a tech calls out, the options are limited: cancel procedures, delay scope turnaround, or scramble for coverage.

What leading GI centers are doing

The endoscopy centers managing volume growth most effectively share one common trait: they’ve built a flexible staffing layer before they needed it.

Data from UNC illustrates the leverage point. A targeted scheduling and staffing improvement by adding just one person to manage utilization filled an average of 11.7 vacant slots per week and pushed utilization from 83–87% to consistently above 95%. That translates to 550–600 additional procedures per year, without new equipment or facility expansion.

The infrastructure to do that, a bench of credentialed, available per diem GI techs and nurses, doesn’t appear overnight. Centers that build it during stable periods are the ones that keep their schedules intact when staffing gets tight.

The staffing waterfall for GI

A practical approach for endoscopy centers:

  • Core staff handle regular procedure days
  • Per diem flex fills predictable volume spikes (Monday morning colonoscopy surge, post-holiday backlog, summer surge)
  • On-demand contingent covers same-day sick calls and unexpected gaps

Each layer reduces dependence on the one above it. Centers that rely entirely on core staff run at capacity until they don’t and then they cancel procedures.

The bottom line

GI volume isn’t slowing down. The screening population is larger than it’s ever been, case complexity is rising, and procedures are accelerating into outpatient settings. The centers that invest in flexible staffing infrastructure now will be the ones absorbing that demand and the revenue that comes with it.

The ones that wait will be managing a waitlist.

Ready to explore flexible staffing at your endoscopy center? Get started here.