At DDW 2025, I shared a message I’ve felt building for years: the disruption in GI isn’t just technological—it’s existential. We’re not waiting for change—we’re already in it. The wave isn’t coming—it’s overhead. Most won’t realize it until it’s too late.
The biggest barrier facing our field isn’t a lack of innovation. It’s our emotional and economic tether to single-procedure revenue streams like colonoscopy. We have to ask ourselves: Are we building a future-ready model—or clinging to a disappearing one?
Though we spoke of the future, the talk was really about the uncomfortable present—and the decisions we keep postponing.
A heartfelt thank you to American Gastroenterological Association (AGA) for making the full keynote available to everyone.
Watch the full keynote here (22 mins).
Top Takeaways from Keynote:
- Zoom Out: We’re Misreading the Present
The 2008 crash felt devastating—until you zoomed out. GI today is in a similar moment. We’re at an inflection point. We just don’t see it yet. - Digital Trends Start Quiet—Then Explode
Stool DNA testing went from “few data” to 18 million+ screenings. Like Netflix or Airbnb, it followed a digital curve—subtle at first, unstoppable later. - This Is the Wave
Disruption isn’t on the horizon—it’s here. Most can’t see it because they’re too close to the surface. - Our Identity Crisis Is Real
We’ve built GI around one procedure. When that’s challenged, we risk an identity void. It’s holding us back from evolving. - Reimbursement Is Already Signaling the Shift
Colonoscopy payments are down 40–50% in real dollars over 25 years. If it’s the “gold standard,” why isn’t it being valued that way? - Burnout Isn’t Just Fatigue. It’s Disillusionment.
73% of physicians cite burnout as a source of depression. Some say being a physician causes depression. The system is out of sync. - AI and Automation Are Already Here
From colonoscopy robots to AI agents to humanoids in factories—the tech is real. It’s active. And it’s accelerating. - The Big Shift: From Procedure-Led to Intelligence-Led GI
The gut is the new frontier for longevity, immunity, and mental health. The field must lead this revolution in gut intelligence. If we don’t, others will.