Career Development

Hepatology Career Guide

A field-defining shortage, an intellectually demanding specialty, and a training path that begins earlier than most students realize. Every stage — from MS1 to fellowship — with the information you need.

7 sectionsMS1 through GI Fellowship
Why This Field

Why Hepatology?

62%
ACGME transplant hepatology fellowship positions unfilled in 2023
35%
Projected shortage of hepatology providers by 2033
777
Transplant hepatologists for >106,000 US transplant recipients (ABIM, 2025)

Hepatology is one of the most intellectually demanding, procedurally rich, and socially impactful fields in medicine. Transplant hepatologists sit at the intersection of chronic disease management, acute critical illness, surgical interventions, and transplant immunology — caring for patients from diagnosis through the transplant evaluation, the operation, and years of post-transplant follow-up.

The shortage is structural, not incidental. It reflects years of underexposure at the medical school level. LIMES™ was built to change that pipeline from the beginning.

Training Arc

The Full Training Arc

Tap any stage below to see what happens there. Tap TH Fellowship to see pathway options.

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By Training Stage

By Training Stage

Select your current stage to see what to prioritize now.

Build the Foundation

The habits and connections you build in the first two years shape your trajectory.

→Complete the LIMES™ curriculum — all 25 structured topics
→Join AASLD and AST as a student member (combined under $30/year)
→Attend hepatology grand rounds at your institution — or reach out for observerships
→If no hepatologists at your institution: connect through GI faculty referral networks
→Reach out about a summer research project — even a retrospective chart review builds your CV
Building toward: A hepatology-focused elective in MS3/MS4 · A research project suitable for abstract submission at a national conference.
ACGME Training Pathways

ACGME Training Pathways

Two ACGME-accredited routes lead to board certification in transplant hepatology through the ABIM.

Pathway A — 'The Fourth Year'

Complete a standard 3-year ACGME-accredited GI fellowship, then apply separately for a 1-year ACGME-accredited Transplant Hepatology Fellowship.

7 yr post-graduation2 board certs

Requirements

  • Completion of 3-year ACGME GI fellowship required for entry
  • ~80% of year devoted to clinical activities
  • Required: inpatient hepatology ward & consult, outpatient transplant clinic, liver pathology, liver radiology, multidisciplinary tumor board
  • Scholarly activity: ≥1 project suitable for abstract or manuscript submission

Application Process

  • Submit through AASLD Fellowship Application System (aasldapp.org)
  • Application window: January–March of the year prior to start
  • Interviews: March–April · Match Day: May
  • Apply during the 2nd year of GI fellowship

Best Suited For

  • Academic hepatology trainees
  • Those planning significant research or an advanced degree during GI
  • Those wanting flexibility to train at a different institution
  • Trainees who want more GI time before specializing
Non-ACGME Programs

Non-ACGME Hepatology Fellowship Options

Non-ACGME hepatology fellowships provide clinical training in liver disease but do not qualify graduates to sit for the ABIM Transplant Hepatology Certification Examination. Understand this distinction before applying.

Despite this, non-ACGME fellowships can serve important purposes and remain active at several institutions.

ProgramDurationFocus
NIH / NIDDK (Bethesda, MD)2–3 yrClinical + research
Temple University (Philadelphia, PA)1 yrInpatient + outpatient
Loyola University Medical Center (Maywood, IL)1 yrOutpatient-focused
University of Missouri1 yrInpatient + outpatient; sponsored rotation at Wash U
Carolinas Medical Center / Atrium Health (Charlotte, NC)1 yrClinical + research
UNMC1 yrGeneral and transplant hepatology
Program availability changes year to year. Always verify directly with the program coordinator before applying. Non-ACGME fellowships do not use ERAS — applications are submitted directly to the program. If you require visa sponsorship, confirm availability with the program coordinator explicitly before applying, as sponsorship policies vary by institution and year.

NIDDK Program — Special Note

The NIDDK Hepatology Fellowship is a 2–3 year combined clinical and research fellowship with a long tradition of training academic hepatologists. Prior fellows have made foundational contributions to viral hepatitis, liver fibrosis, and MASLD research. Best suited for trainees with a strong research interest committed to an academic career. Applications reviewed on a rolling basis.

The Role

What Does a Transplant Hepatologist Do?

The scope varies by practice setting, but across most academic programs:

  • →Manage acutely decompensated cirrhosis (ascites, SBP, HE, variceal bleeding, HRS)
  • →Consult on complex liver disease throughout the hospital (ICU, oncology, surgery)
  • →Manage acute liver failure — highest-acuity hepatology scenario
  • →Manage patients post-liver transplant
References

References

  1. Kobashigawa, J., Levitsky, J., Taber, D., et al. (2025). AST Task Force Report on the state of transplant medicine education. American Journal of Transplantation. doi:10.1016/j.ajt.2025.05.007
  2. Asrani, S. K., Devarbhavi, H., Eaton, J., & Kamath, P. S. (2019). Burden of liver diseases in the world. Journal of Hepatology, 70(1), 151–171. doi:10.1016/j.jhep.2018.09.014
  3. American Board of Internal Medicine. (2024). Transplant hepatology certification policies. abim.org
  4. American Association for the Study of Liver Diseases. (2024). Hepatology training pathways. aasld.org
  5. American Association for the Study of Liver Diseases. (2024). Transplant hepatology fellowship application system. aasldapp.org