Liver health is a growing concern in the United States, driven by rising rates of conditions like non-alcoholic fatty liver disease and alcohol-associated liver disease. This increasing burden places significant demand on the specialized medical field dedicated to treating the liver: hepatology. Understanding the size and composition of this workforce is important for assessing the healthcare system’s capacity to manage complex liver conditions and patient access to care. This article quantifies the current workforce in the US.
Defining the Specialty: The Role of a Hepatologist
A hepatologist is a physician who focuses on the diagnosis, management, and treatment of diseases affecting the liver, gallbladder, bile ducts, and pancreas. They are typically gastroenterologists who have pursued additional, specialized training in hepatology. While general gastroenterologists treat the entire digestive tract, a hepatologist’s practice is concentrated on the most complex liver disorders.
These specialists manage chronic conditions such as cirrhosis, viral hepatitis (like Hepatitis C), and the rapidly increasing metabolic dysfunction-associated steatotic liver disease (MASLD). A distinct subgroup is the transplant hepatologist, who completes an accredited fellowship to manage patients before, during, and after a liver transplant procedure. Their training makes them the appropriate providers for advanced stages of liver failure and related complications.
Current Workforce Statistics in the US
Determining the exact number of practicing hepatologists is complex because the specialization often falls under the broader umbrella of gastroenterology. The American Association for the Study of Liver Diseases (AASLD) provides comprehensive data by defining the hepatology workforce as providers who spend 50% or more of their clinical time caring for liver patients. This definition includes board-certified hepatologists, general gastroenterologists specializing in the liver, and advanced practice providers.
Based on a 2018 workforce study, the total adult hepatology provider workforce in the United States was estimated to be around 7,296. This figure encompasses a diverse group of professionals dedicated to liver care. The study also estimated an additional 824 pediatric hepatology providers were active in the workforce at that time. Given the rising prevalence of liver disease, this workforce size is projected to be insufficient to meet patient demand in the coming years.
Geographic Distribution and Patient Access
The overall count of hepatology providers does not reflect the significant geographic disparities in their distribution across the country. Over 80% of hepatologists, particularly those specializing in transplantation, are concentrated in major metropolitan areas and academic medical centers. This leaves large sections of the US, particularly suburban and rural regions, with minimal or no access to specialized liver care.
This unequal distribution severely affects patient access, forcing many individuals with progressive liver disease to travel long distances for appointments, which can delay diagnosis and treatment. For patients requiring liver transplantation, distance from a transplant center is a factor associated with increased mortality risk. Modeling suggests that the projected physician adequacy rate in non-metropolitan areas could be half that of metropolitan areas. Consequently, patients in underserved regions often rely on general practitioners or telemedicine for managing their complex liver conditions.