Hepatology can be considered a sub-specialty of gastroenterology, or can be considered a solo specialty. Those wishing to train as a hepatologist will be able to gain valuable insights through their education that crosses both important fields. Because these fields are so closely related, many will find that clinical publications are research are focused on both hepatology and gastroenterology simultaneously.
What is a Hepatologist?
Hepatology focuses on the functions and parts of the body that include the liver, gallbladder, biliary tree, and pancreas. As a Hepatologist, the physician may come across patients that have dysfunction or disorders focused within these organs. For example, hepatitis B, liver disease or cancers, jaundice, damage caused by alcoholism, infections, and more.
A hepatologist will spend a great deal of time focusing on the liver as it is a critical and susceptible organ that can suffer from diseases like hepatitis and cirrhosis, needs to be monitored because of metabolism, and affects a person’s immune system.
Gastroenterology and hepatology are closely related. As such, patients may see both specialties depending on their condition and the doctors may work together on treatment plans, performing tests, and more. Most hospitals and universities have departments of Gastroenterology and Hepatology instead of distinguishing between the two and in many cases, hepatology is referred to as a subspecialty of gastroenterology. As such, some of the information contained here overlaps with what one would find when researching gastroenterology.
Other physicians who are working with patients that have liver problems can call on hepatologists for consults. Due to the varying ways that liver problems present, these patients may be referred to the hepatologist and seen in clinic if the case is not too acute, or may already be hospitalized with a serious illness. Hepatologists may also perform consultations for hospitalized patients who have developed liver disease because of other treatments or medications and may be involved in monitoring liver transplant patients to ensure that the body accepts the new organ and that the liver is functioning within the body properly.
Educational Requirements for Becoming a Hepatologist
The minimum educational requirements for becoming a hepatologist is a doctoral degree with specialized training in gastroenterology or hepatology.
Step-by-Step Educational Path to Becoming a Hepatologist
Bachelor’s Degree
To begin training as a physician, all students must start with a bachelor’s degree. The bachelor’s degree provides an initial foundation of scientific knowledge and laboratory experience that will be built upon in subsequent years of training. While there is no specific requirement for the type of degree the student seeks, many students who are looking towards medical school admissions will major in a science based degree program that will provide all of the pre-requisite science training necessary for both medical school admissions as well as successful completion of the Medical College Admissions Test (MCAT, see below).
During this period of training it is important that the student have a long term strategy for their education and is able to advance their knowledge and experience to make them competitive as a prospective medical student and physician. Some physicians recommend getting experience in a patient care setting during undergraduate training, like volunteering at a hospital, for example. This will show a dedication to the medical field as well as give student’s the confidence and experience they need as they continue their training and education.
To increase their competitiveness and solidify entry to a good medical school, students should pay close attention to the studies, obtaining at least a 3.0 cumulative GPA (3.5 for more competitive school) and a 3.0 or higher GPA for all science and lab work. They will also need to submit letters of recommendation and should work to establish personal relationships with teachers or mentors that can provide these materials and remark on the student’s work ethic, determination, intelligence, compassion and ability to be a successful physician after all training is complete.
Medical College Admissions Test (MCAT)
The MCAT is usually taken the junior year of undergraduate. The test is designed to evaluate the takers foundational knowledge of the applicable sciences, critical thinking skills and problem solving that will help them succeed as a physician. The test score from the MCAT will be sent along with other application materials to the student’s chosen medical schools as part of consideration for admission. Most schools accept MCAT scores for up to three years, which allows the student to gain valuable experience or additional training between obtaining their bachelor’s degree and beginning medical school.
Medical School
Medical school is a challenging and formative four years. Students generally find it to be demanding, informative and exciting as they take steps closer to their chosen career. The first two years of medical school are dedicated to expanding the student’s science knowledge through coursework and lab work. This time builds upon the foundation they received in undergraduate training and was reflected on their test scores and gives them an intellectual knowledge of anatomy, biology, chemistry, physiology and other sciences that will support the practical studies that make up the second two years of medical school.
After the first two years of medical school the student will take the United States Medical Licensing Exam Part 1. This test captures the student's intellectual knowledge and evaluates their readiness to begin working practically with direct supervision. Passing this exam is the first of three steps to licensure as a physician.
The second two years of medical school are dedicated to practical applications of the information learned and tested as part of the USMLE Part 1. Under supervision, the student will begin rotations where they will take part in patient care in a variety of settings and specialties. Core rotations include internal medicine, pediatrics, obstetrics and gynecology, surgery, psychiatry, emergency medicine and ambulatory medicine. During rotations the student will also have a chance to be involved in an elective rotation where they can get experience in their desired specialty or subspecialty.
Along with getting patient care experience throughout the core specialties and obtaining some experience in their subspecialty, students gain experience in a variety of work settings including hospital inpatient and outpatient, private practices, government clinics, even rural medical centers. These experience will inform the student’s choices moving forward and help them solidify their chosen path by highlighting their strengths and skills and revealing where they are most effective because of their individual personality characteristics and other traits.
After the fourth year of medical school, students will take the United States Medical Licensing Exam, Part 2. This second of three tests in the series will evaluate the knowledge the student has obtained during their rotations and ensure that the student is prepared to move on to a residency program that will have less overall supervision and more responsibility.
Residency
Every physician goes through a two to four year residency program. Most hepatologists complete their residency in internal medicine, which gives them the experience and broad knowledge they need to further specialize. An internal medicine residency will help the student develop their skills, confidence, and diagnostic abilities and have both the textbook knowledge and personal ability to be an excellent physician.
Fellowship
As stated previously, hepatology is often combined with gastroenterology. While the field is growing into an autonomous subspecialty, this overlap may mean that aspiring hepatologists complete a combined fellowship program. Some universities, like the Missouri University School of Medicine, have begun offering one to two year Hepatology-only fellowship programs.
No matter which route the physician goes in order to gain knowledge about hepatology, this fellowship will be the focused portion of education and training for those seeking the subspecialty. Fellowships include an in depth knowledge base, pathophysiology, clinical manifestations, management of diseases, procedures, and more – all focused on the organs included in Hepatology with a significant focus on the liver.
Licensing and Continuing Education Requirements
The American Board of Internal Medicine does not offer specific certification in hepatology. Most hepatologists complete their board certification in internal medicine and following the continuing education requirements for that certification. The complete details and requirements of the certification can be found at the American Board of Internal Medicine Website.
Understanding the Career Path
Due to the overlaps in the specialties, the following information is taken from the Gastroenterology Compensation Report published my Medscape. Hepatology is a growing field that is just recently being considered its own subspecialty and doctors specializing in this field may find slightly variations to the information provided below.
Work Environments
Hepatologists can expect to spend more time with direct patient care than some of the other medical specialties that exist. Between 30 and 50 hours per week seeing patients, is normal according to recent reporting. This works out to between 25 to 124 patients per week depending on the clinic, caseload, location and procedures that are performed under the care of the physician. Some hospitals and offices employ a significant number of physicians, which will lower the case load carried by an individual while other locations, due to lack of funding or structure, employ fewer physicians and require that each doctor see more patients over the course of their day or week.
On average, 13 to 20 minutes with each patient can be expected with the occasional visit lasting over 25 minutes. Again, the fluctuation in patient time may be due to the needs of the patient, the size of the support team, or the particular phase of care that is being administered.
Hepatologists can find work in a variety of settings and should strive to work with one that is the best fit for their career goals, personality and other competencies. Group practices, healthcare organizations, outpatient clinics, solo practices, hospitals and academic or research settings are all viable employment centers for hepatologists.
Salary
Hepatology, as a function of Gastroenterology, is one of the highest paid medical careers. Gastroenterology is below only orthopedics, cardiology and urology in terms of salary and benefits and hepatologists should expect similar compensation.
According to MedScape, average pay is $348,000 per year with a slight fluctuation between male and female physicians. The Great Lakes region of the United States has the highest average pay of $382,000 while the mid-Atlantic region of the United States average $63,000 lower, to make the lowest average pay in the country.
Self-employed physicians make an average of $95,000 more per year than those who are employed by a hospital or other practice. The practice setting compensation averages are as follows:
Office-based multi-specialty group practice: $404,000
Office-based single specialty group practice: $395,000
Healthcare organization: $392,000
Outpatient clinic: $366,000
Office-based solo practice: $339,000
Hospital: $266,000
Academic, research, military or government: $239,000
Liver Disease
The liver is the largest organ in the body and is responsible for removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into what the body needs to function. Around 25 million Americans have been affected with a liver disease and experience the complications of the disease or even death.
One of the leading causes of death worldwide is alcoholic liver disease, or ALD. If an individual consumes “excessive” amounts of alcohol over many years they can be susceptible and may lose liver function all together. ALD can be diagnosed by reviewing a person’s drinking history, conducting blood tests and studying the liver to make sure the patient does not have other liver diseases. Since alcohol can destroy the liver if there is more present than the liver can process, this can lead to scare tissue and a failure of the liver to regenerate.
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