The doctor for everything between the mouth and the other end. Fourteen years of training, and one of the best paid jobs in medicine.
Click through it
Pay, the path, pros and cons and the facts on one printable page. Good for a wall or a guidance counsellor.
Or read the whole thing here
What you earn and what it costs to get there.
Median
$236,000
Bottom tenth
$66,260
Where the survey stops
$239,200
The federal wage survey has no gastroenterology category. It files the specialty under Physicians, All Other, where the median is $236,000 a year and the bottom tenth sit near $66,260. There is no published top figure at all: once pay passes $239,200 a year the survey stops counting and reports everyone above that as one lump. So the high number here is a cut-off, not a ceiling.
About $70,000 to $85,000
Salary as a resident and then a fellow, six years of it
Residents and fellows are salaried hospital employees. It is real money for long hours, and you are paying interest on medical school debt the whole time.
Above the cut-off
Working gastroenterologists in practice
Two things push real earnings past the published figure. The survey only counts employed physicians, so doctors who are partners or self-employed are largely missing from it. And gastroenterology is procedure-heavy, which pays more than office-only specialties. Physician pay surveys run by recruiting firms consistently place the specialty well above the $239,200 line, which is exactly why the survey stops publishing there.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is four years at an in state public university, then a public medical school in your own state, plus the MCAT (Medical College Admission Test), applications and the three steps of the national licensing exam. The high end is a private or out of state medical school at up to $70,000 a year all in, with no in state discount anywhere. The residency and fellowship years after medical school are paid jobs, so they add no tuition to this figure. What the numbers hide is interest, which is serious on a balance this size, and Public Service Loan Forgiveness, which can cancel the rest after ten years of payments at a nonprofit hospital.
Medical school debt commonly lands around $200,000 by graduation. Two things blunt it: Public Service Loan Forgiveness, where residency and fellowship years at a nonprofit hospital count toward the ten years, and the fact that this specialty earns enough afterward to clear the rest quickly.
Hospital or health system salary
The most common arrangement now, often with a production bonus.
Private group partnership
Join a gastroenterology group, become a partner after a few years, and share in the practice's profit.
Endoscopy center ownership
Partners in a procedure center earn from the facility as well as the professional fee. This is the single biggest reason the specialty pays what it does.
Call pay
Covering nights and weekends for bleeding emergencies is paid separately in most contracts.
Signing bonuses and loan repayment
Rural and underserved hospitals offer large recruitment packages because they cannot find specialists.
The exact path from high school to qualified.
One of the longest training routes on this site. Fourteen years from high school to practicing on your own is normal.
High school
Grades 11 and 12
Top grades in biology, chemistry, physics and math. You need a strong average to get into a competitive undergraduate program.
Bachelor's degree
4 years
Any major is allowed if you finish the science prerequisites. Keep the GPA high, get clinical and research experience, and sit the MCAT (medical school admission test).
Medical school
4 years
Four years for either the MD (doctor of medicine) or the DO (doctor of osteopathic medicine). Two years of science, then two years of clinical rotations. Acceptance rates are around 40 percent of applicants overall and far lower at individual schools.
Internal medicine residency
3 years
Matched through the national residency match. Three years of paid hospital training in adult medicine before you can even apply to specialize.
Gastroenterology fellowship
3 years
Three more years, matched separately and highly competitive. This is where you learn endoscopy, liver disease and the procedures the job is built on.
Biology and chemistry
Required for every pre-medical route, and the base of everything that follows.
Physics
Tested on the medical school admission exam and useful for understanding scopes and imaging.
Calculus and statistics
Statistics especially. Reading medical evidence is a daily skill.
English and psychology
The admission exam has a reasoning section and a behavioral science section, and the job is mostly talking to frightened people.
To practice you need a medical license from the medical board of the state you work in. Every state requires the three steps of the United States Medical Licensing Examination, or the osteopathic equivalent, plus completed residency training and a clean record. That license is state by state, so moving means applying again. Separately from the license, the American Board of Internal Medicine certifies you first in internal medicine and then in gastroenterology as a subspecialty. Certification is not legally required to practice, but hospitals and insurers effectively demand it, and you keep it current with ongoing assessment for your whole career.
Any accredited medical school
There are around 170 accredited medical schools in the United States and Canada, listed by the Association of American Medical Colleges.
Your own state's public medical school
In-state tuition is far lower and many public schools give preference to residents of the state.
Osteopathic medical schools
The osteopathic degree is a full medical degree with the same licensing and the same access to gastroenterology fellowships.
Where the fellowship is
Gastroenterology fellowships sit at teaching hospitals. Getting one depends far more on your residency performance and research than on where you went to college.
Things you don't need, but that help.
Advanced endoscopy
An extra year learning the hardest procedures, on the bile ducts and the pancreas. Very few people do it and they are in demand everywhere.
Hepatology
Liver disease and transplant medicine. Its own extra training and its own board certification.
Inflammatory bowel disease
Long-term care of younger patients with Crohn's disease and colitis. More relationship, fewer procedures.
Motility and functional disorders
The patients nobody else has been able to help. Difficult, and quietly one of the most valued corners of the field.
Pediatric gastroenterology
A different route entirely: pediatrics residency first, then a pediatric gastroenterology fellowship.
Research and publications
Gastroenterology fellowships are competitive. Research during residency is what separates applicants.
Steady hands and good spatial sense
Endoscopy is a physical skill. Some doctors take to it immediately and some never enjoy it.
Spanish or another second language
Screening conversations go better in a patient's own language, and it matters in most of the country.
Time spent in a hospital before you commit
Volunteer, scribe or work as a technician. Fourteen years is too long to find out late that you dislike the building.
You will be in your early thirties before you earn a full salary, while people who picked a trade at eighteen have a house and twelve years of savings. The training years are long, tightly controlled and sometimes miserable. The trade at the end is real: high pay, permanent demand, and work where you find cancers early enough to remove them. But go in knowing the cost, and know that plenty of people are just as happy doing three years of training in a related health career instead.
Day to day, pros and cons, where you'd work.
Most weeks split between the procedure room and the clinic. A procedure day starts around 7am: eight to fifteen colonoscopies and upper endoscopies back to back, each one 15 to 30 minutes, removing polyps as you find them, dictating between cases. A clinic day is 20 or so appointments: reflux, abdominal pain, liver numbers that came back wrong, inflammatory bowel disease follow-ups. Add hospital consults for bleeding and liver failure, and a call rota where somebody has to come in at 3am to stop a bleed.
The good
The hard parts
Things people don't tell you.
The US Preventive Services Task Force lowered the age to begin colon cancer screening from 50 to 45 in 2021, because the disease kept appearing in younger adults. That single change added millions of people to the screening population and made this one of the busiest specialties in medicine.
The wall of the digestive tract contains hundreds of millions of nerve cells that can run digestion without any instruction from the brain. Researchers call it the enteric nervous system, and popular writing calls it the second brain.
For most of the twentieth century stomach ulcers were blamed on stress and spicy food. In 1984 an Australian researcher swallowed a culture of the bacterium he suspected, gave himself gastritis, and proved ulcers were an infection. He shared a Nobel Prize for it in 2005, and ulcers became curable with antibiotics.
A modern endoscope is a steerable flexible tube carrying a camera, a light, a water jet and a channel for tools. Through that one channel a gastroenterologist can biopsy tissue, snare a polyp, clip a bleeding vessel or place a stent, all without a single incision.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.