Gastroenterologist Compensation 2026: General GI, Hepatology, Advanced Endoscopy — Pay Tables, Endoscopy Volume

Gastroenterology in 2026 is one of the highest-earning medical (non-surgical) specialties. The combination of high-volume procedural workflow (colonoscopy + EGD), strong professional fees, and ASC ownership opportunities makes it a top-quartile compensation field across all settings.

This guide covers what gastroenterologists are actually earning across all major subspecialty paths in 2026, with detailed scope-volume benchmarks and partnership economics.

National compensation by subspecialty — 2026

Scope volume and RVU math

The economics of GI revolve around scope volume:

• Colonoscopy (screening): 25–35 min total time, 4.5 wRVU
• EGD: 15–25 min, 2.0 wRVU
• ERCP (advanced): 60–90 min, 8–12 wRVU
• EUS (advanced): 45–75 min, 5–8 wRVU

A typical productive general GI does 15–25 scopes per scope-day, working 2–3 scope days/week (60–80 scopes/week, ~3,500 scopes/year). At 4.0 average wRVU per scope, that's 14,000+ wRVU annually from procedures alone — before clinic visits.

RVU targets by setting

• General GI employed: 11,500–14,000 wRVU target, $58–$72/wRVU
• Advanced endoscopy: 11,000–13,500 wRVU, $72–$92/wRVU (procedure-rich)
• Hepatology: 7,500–9,500 wRVU (less procedural), $58–$72/wRVU
• Pediatric GI: 7,500–9,500 wRVU, $52–$65/wRVU

ASC ownership — the big-comp lever

Most successful private GI practices own their endoscopy ASC. Standard structure:

Endoscopy ASCs are particularly profitable because most procedures are high-volume, well-reimbursed, and short-duration. A screening colonoscopy generates a $450–$750 facility fee on Medicare, more on commercial. A high-throughput GI ASC processing 25–35 scopes/day across 2 rooms generates $5M–$8M/year in facility fees.

Partnership track economics

Standard private GI group partnership:

• Year 1: W-2 employee, $475K–$575K base
• Year 2: Performance review
• Year 2–3 buy-in: $150K–$400K equity buy-in to professional corp + ASC
• Post-buy-in (year 3+): 1099 K-1, total comp $725K–$1.05M for general GI, $895K–$1.4M for advanced endoscopy

The crossover between employed and private GI typically happens at year 3–4 post-partnership. Employed roles pay better in years 1–2, private partnership pays significantly better in year 4+.

Top-paying states — 2026

• South Dakota: General GI $675K — rural premium
• Iowa / Nebraska: $665K general GI
• Mississippi: $655K general GI, $865K advanced endoscopy
• Alabama: $645K general GI
• Oklahoma: $635K general GI

Coastal states pay below median: California $495K, New York $525K, Massachusetts $515K. Florida and Texas are roughly at median.

Locum tenens rates

• General GI: $2,400–$3,200/day, $300–$400/hour
• Hepatology: $2,200–$2,900/day
• Advanced endoscopy: $3,000–$4,200/day
• Pediatric GI: $2,200–$2,900/day

What we see at Ava Health

For GI candidates we work with, the partnership track decision is the single biggest career inflection point. The 5-year NPV math typically favors private partnership by $400K–$800K for high-volume scope readers. The trade-off is year 1–2 cash flow — a $250K buy-in spread over 24 months means $125K/year of "shadow earnings" during ramp.

The fastest-moving GI placements: general GI in growing Sun Belt metros (Tampa, Charlotte, Nashville, Phoenix, Austin) where private groups are actively recruiting partnership-track candidates. We've placed 8 GI physicians into Florida groups in the last 18 months at total first-year comp $475K–$565K and post-partnership trajectories $850K+.

For physicians considering hepatology fellowship: the comp delta is negative ($475K hepatology vs $565K general GI median) but the lifestyle is significantly better — hepatology is mostly clinic-based with limited night/weekend call. Career-trajectory-wise, hepatology positions you for transplant center academic roles which can later transition to senior administrative positions ($600K+ for medical directors).

Related: Gastroenterologist Salary 2026, Physician Contract Negotiation Levers, General Surgeon Compensation 2026.