Brian Hudes is a board-certified gastroenterologist with more than 30 years of clinical experience, serving as chief of gastroenterology and medical director of GI and endoscopy at Ascension Sacred Heart Hospital in Pensacola, Florida, a 550-bed Level I trauma center, and as assistant professor of medicine at Florida State University College of Medicine. A recipient of his specialty board’s 30-year certification award, he has spent his career at the intersection of complex clinical care and the structural forces that shape how medicine is practiced, financed, and delivered.
Dr. Hudes brings a rare dual perspective to health care commentary: that of a frontline proceduralist who has navigated decades of declining reimbursement, rising administrative burden, and accelerating system consolidation, and that of a health care technology entrepreneur who has spent years studying why the systems around medicine so often fail the people practicing it. His health care IT work began during his GI fellowship in 1995, when he co-developed one of the first Windows-based endoscopy reporting systems in the United States.
Having practiced through every era of modern health care technology, from paper charts and handwritten orders to early electronic health records and today’s enterprise systems, Dr. Hudes writes with a grounded perspective on administrative cost growth, physician workforce shortages, end-of-life ethics, and the widening gap between what clinicians need and what the industry builds. Professional updates are available on LinkedIn.
From 1992 to 1995 I was a GI fellow. Nothing on the market made clinical sense for endoscopy reporting. The tools available were designed by people who had apparently never performed a procedure or written a note for one. I met a colleague in Australia, and together we built one of the first Windows-based endoscopy reporting systems in the country.
Microsoft Access. It worked.
It worked well until the United States moved …
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The case for an AI-native health care platform
If you have spent any time with the current generation of artificial intelligence (AI)-assisted documentation tools, you have probably noticed something that is difficult to articulate but impossible to ignore. The notes they produce are correct, grammatically, structurally, and medically, and yet they feel wrong. They read like a summary written by someone who has read every clinical textbook ever published but has never stood at a bedside at 2 …
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How artificial intelligence documentation hurts patients
You open the chart. You start clicking. Labs here. Imaging there. Notes in four different tabs, none of them organized in any order a clinician would have chosen. Prior hospitalizations buried three levels down behind a menu that requires two clicks just to find the menu. Medication reconciliation on a screen you have to navigate to separately. Problem list in one place, active diagnoses in another, allergies somewhere a third …
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Severe note bloat is fueling dangerous physician burnout
For years, the conversation about board certification has centered on fairness, cost, and evidence. But there is another consequence that gets far less attention: how these systems affect the supply of practicing physicians.
America’s physician shortage isn’t theoretical anymore. It is here. Hospitals are scrambling to fill call schedules, rural communities are waiting months for specialist appointments, and medical groups are watching senior clinicians retire earlier than planned. Among the many …
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How board certification fuels the physician shortage crisis
If you asked ten physicians to explain how they maintain board certification, you’d get at least ten different answers, maybe more. Some take quarterly quizzes. Some submit CME attestations every five years. Some do both. Others, grandfathered in before time-limited certification existed, do nothing at all. Yet every one of them carries the same professional label: board-certified physician.
That simple title, once synonymous with competence, now hides a dizzying patchwork of …
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Why maintenance of certification varies widely: a system in crisis
Every major policy in medicine is supposed to rest on evidence. We track outcomes for new drugs, devices, and procedures. We measure hospital mortality, infection rates, and adherence to guidelines. Yet one of the most time-consuming and expensive physician policies of all, Maintenance of Certification (MOC), has never been held to that same standard.
For decades, the American Board of Internal Medicine (ABIM) and other specialty boards have argued that recertification …
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MOC patient outcomes: Why recertification doesn’t guarantee quality
The tension between physicians and the American Board of Internal Medicine (ABIM) has simmered for a decade. What began as a professional debate over maintenance of certification (MOC) has evolved into a broader question of fairness, autonomy, and accountability. Now, the courts are involved, and the legal battles are revealing as much about the profession’s frustration as they are about the structure of American medicine.
A landscape of lawsuits
Since 2018, multiple …
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The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know
At two o’clock in the morning, the emergency department doors open to a familiar story. A middle-aged man arrives with massive gastrointestinal bleeding, severe jaundice, and advanced cirrhosis from decades of alcohol use. He has no insurance, no primary care provider, no stable home, and no ongoing addiction treatment. The next 10 days bring mechanical ventilation, endoscopic procedures, dialysis, and intensive care. The total bill will exceed $100,000, nearly all …
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End-of-life care cost substance use: When compassion meets economic reality
The story of gastroenterology in 2025 is no longer about productivity or reimbursement, it’s about manpower. Hospitals and practices across the U.S. are struggling to recruit, retain, or even temporarily staff the specialists who manage digestive diseases, perform colon cancer screening, and handle emergency procedures like ERCP. What we’re facing isn’t simply a staffing issue; it’s a structural shortage decades in the making.
The shrinking pipeline of gastroenterologists
In the mid-1990s, roughly …
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The gastroenterologist shortage: Why supply is falling behind demand
The United States faces a worsening physician shortage despite increases in medical school enrollment and residency growth. This article provides a comprehensive, data-driven analysis of the multifactorial forces reducing effective physician supply. These include training-pathway inflation, declining board-certification throughput, shorter physician career duration, reduced reimbursement, the collapse of private practice, feminization of the workforce, declining IMG participation, and accelerating population aging. Tables and figures throughout this article illustrate how these …
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Multifactorial drivers of the U.S. physician shortage: a data analysis
The phrase “board-certified” once carried a universal meaning. A physician had met rigorous training and testing standards and could practice confidently anywhere in the country. That clarity has faded. Today, certification and recertification requirements differ not only by specialty but also by which board you happen to fall under. What was once a single national standard has splintered into a patchwork of rules, fees, and timelines that seem designed less …
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The patchwork era of medical board certification
The American Board of Internal Medicine (ABIM) made headlines in late 2024 when it announced the elimination of its unpopular two-year Maintenance of Certification (MOC) point requirement. On paper, this looked like progress, a gesture toward simplification after years of criticism from physicians who felt trapped in an expensive, time-consuming cycle that added little value to their actual practice. But beneath the surface, the reform raises a harder question: Has …
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Did ABIM MOC reform actually fix the problem for physicians?
The story of gastroenterology in 2025 is no longer about productivity or reimbursement; it’s about manpower. Hospitals and practices across the U.S. are struggling to recruit, retain, or even temporarily staff the specialists who manage digestive diseases, perform colon cancer screening, and handle emergency procedures like ERCP. What we’re facing isn’t simply a staffing issue; it’s a structural shortage decades in the making.
The shrinking pipeline of gastroenterologists
In the mid-1990s, roughly …
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The U.S. gastroenterologist shortage explained
In the modern world, physicians are respected and highly regarded for their compassion, dedication, skill, and knowledge. People value the effort physicians put into taking care of others often before taking care of themselves. While this noble profession was once lucrative, many now find it challenging to make ends meet, given falling reimbursements, lack of independence, and exorbitant student loans. Achieving financial independence is not just a personal goal; it …
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Why physicians need financial independence and how to achieve it
The field of gastroenterology in the United States has undergone a significant transformation over the past 5 to 10 years, driven by a confluence of historical changes in training programs, changing demographics among GI doctors due to the relatively new specialty of GI endoscopy, and a dwindling supply of gastroenterologists. These factors have culminated in a notable impact on gastroenterology physician salaries and have raised important questions about the future …
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The shifting landscape of gastroenterology manpower and compensation
Physician burnout and the shortage of physicians are pressing issues within the health care industry, often unnoticed by the general public until their own health is at stake. The erosion of the title “doctor” and the increasing encroachment on physician authority have contributed significantly to this problem. Physicians have allowed the interference of the federal government, burdensome regulations, and insurance company restrictions to impede their ability to provide quality care. …
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The core problem behind physician burnout: loss of independence
The American Board of Internal Medicine (ABIM) has long been responsible for setting standards and ensuring the competence of internal medicine practitioners. However, the practice of mandatory recertification has faced increasing scrutiny and debate within the medical community. This article explores some of the key reasons why eliminating recertification requirements imposed by the ABIM could have significant benefits for physicians and patient care.
Lack of evidence for improved patient outcomes
One of …
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The case for eliminating recertification by the ABIM
