Training in Hepatology: Where Are We Now?

Over the past 3 years, I have had the pleasure of serving as an Associate Editor for Gastroenterology, especially in the context of clinical hepatology. This has been an enriching and educational experience and I hope the readership of the Journal and their patients have benefited from the exciting work that has been published. As a separate consideration, I have been interested in training and certification in gastroenterology as Chair of the American Board of Internal Medicine (ABIM) Gastroenterology Board from 1999 to 2003, and as the current Chair of the ABIM Transplant Hepatology Board since 2004. I have elected to write periodically about the evolution of hepatology as a distinct entity, which has taken place over the last 5–10 years. Currently, this evolution has culminated in a certifying examination given by the ABIM so that board-certified gastroenterologists who have special expertise in advanced/transplant hepatology (TH) can become board certified in TH. Two certifying examinations in TH were administered in November of 2006 and 2008 and 88% of both adult and pediatric gastroenterologists passed the examination. As a result, there are now nearly 380 board-certified transplant hepatologists (adult and pediatric combined). After the development of a certifying examination, the Accreditation Council for Graduate Medical Education (ACGME) developed criteria for accreditation of training programs. According to the ACGME, as of academic year 2007–2008, there were 21 TH programs accredited with a total of 36 slots allotted for training. Unfortunately, the ACGME has required that TH training be done after training in gastroenterology. It is my perspective that this requirement has negatively impacted the number of interested physicians willing to pursue this additional year of training. Another problem that has become apparent is that the ABIM, in its original development of the TH examination, required that all candidates be board certified in gastroenterology. These 2 requirements from the ACGME and from the ABIM have created a problem that was unforeseen as the discipline evolved while the certifying examination and the accreditation of programs were developed.