The growing prevalence of liver diseases in the United States highlights the importance of the medical specialists who treat these complex conditions: hepatologists. Tracking the number of these specialized providers is crucial for health policy, as it helps identify potential gaps in patient care and informs strategies for medical education and resource allocation. Understanding the current workforce is the first step in ensuring that specialized treatment for liver conditions remains accessible to all who need it.
What is a Hepatologist
A hepatologist is a physician who specializes in the diagnosis, management, and treatment of disorders affecting the liver, gallbladder, bile ducts, and pancreas. They address a wide array of conditions, including various forms of hepatitis, cirrhosis, liver cancer, and the growing epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD). Hepatology is traditionally considered a subspecialty of gastroenterology, but it has increasingly developed into a distinct area of expertise.
The path to becoming a hepatologist is lengthy and rigorous, requiring extensive post-graduate training after medical school. Physicians first complete a three-year residency in internal medicine, followed by a three-year fellowship in gastroenterology. To attain specialized hepatology credentials, many complete an additional one-year fellowship in advanced or transplant hepatology. This focused training ensures they possess the deep knowledge required to manage complicated cases of liver failure and transplantation.
The Current Workforce Count
Determining a precise, universally agreed-upon number of practicing hepatologists is complicated by the overlap with the broader field of gastroenterology. Many gastroenterologists manage general liver conditions, but a true hepatologist dedicates a substantial portion of their practice to liver-specific care. Workforce studies often define a hepatology provider as a physician or advanced practice provider (APP) who dedicates 50% or more of their clinical time to hepatology.
Based on a 2018 workforce analysis conducted by the American Association for the Study of Liver Diseases (AASLD), the estimated adult hepatology workforce included approximately 7,296 providers. This total count encompasses board-certified hepatologists, gastroenterologists, and APPs meeting the 50% practice threshold. The pediatric hepatology workforce was significantly smaller, estimated at 824 providers. This methodology attempts to capture the functional workforce rather than just those with the “transplant hepatology” board certification.
Geographic Distribution and Access
The current count of hepatology providers is not distributed evenly across the United States, creating significant disparities in patient access to specialized care. These specialists tend to concentrate heavily in major metropolitan areas, particularly those with academic medical centers and liver transplant programs. This concentration leaves large sections of the country, especially rural and non-metro areas, with very few or no local hepatology experts.
Patients in these underserved regions often face barriers, including long travel distances and extended wait times, to receive consultation for complex conditions like advanced cirrhosis. The geographic maldistribution directly impacts health outcomes, as patients living far from a transplant center have been shown to experience higher mortality rates. Efforts to address this disparity often focus on expanding telemedicine access or developing models that integrate hepatology expertise into primary care settings.
Factors Affecting Future Supply
The future supply of hepatology providers faces pressure from both increasing demand and limitations in the training pipeline. Demand is rising significantly due to demographic shifts, such as the aging general population, and the increasing prevalence of liver disease. The most significant driver of future need is the growing epidemic of metabolic dysfunction-associated steatotic liver disease (MASLD), which is becoming the most common cause of chronic liver disease.
On the supply side, the physician workforce is aging, with a number of current practitioners expected to retire in the coming decade. Furthermore, the capacity of accredited fellowship programs to train new specialists remains constrained. Modeling studies project that this imbalance will lead to a substantial shortage of adult hepatology providers, potentially reaching a deficit of 35% by the year 2033.