Hepatology Fellowship

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drdorian

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Does anyone know of good resources regarding Hepatology Fellowships? I've received mixed information, hearing that it is sometimes a 1 year fellowship following IM residency or it can be a 1 year fellowship following a GI fellowship.

Any additional thoughts/info? Thanks in advance

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AASLD website has a list of Hepatology fellowships.Click on Education at the top, then on Tranining programs at the right side.Try this link: https://www.aasld.org/eweb/DynamicPage.aspx?Site=AASLD3&WebKey=f4c4c8ab-0ed2-4d70-9ab2-c03458f668a9

With the recent guidelines in place, all accredited Hepatology programs will be taking applicants who are board certified in Gastroenterology . So I doubt there will be too many programs taking people straight out of Medicine residency. But you can call these programs and ask.....
 
Hepatology fellowships i.e. Advanced Hepatology or Transplant Hepatology were tradationally non accredited One year 4th year felloship positions following a three year GI fellowship. Often these spots would go unfilled because most folks who train in GI would rather be a scope jockey or polyp plucker right away or do a 4th year in EUS/ERCP.
As of 2007 the ACGME as accredited 17 programs in the country here is the list below this message. You may be surprised to find several big names missing her such as Indiana U, Johns Hopkins, UCLA, Univ or Miami etc.
So what accreditation means is that starting in 2008 the programs can take ONLY folks with 3 years of GI training and not IM candidates. One need not necessarily be board certified in GI just proof of training is adeqate.
I personally called these programs and they absolutely will NOT consider an IM candidate even if it means that their position will go unfilled. You may try your luck at one of the other non accredited programs but they are all in the process of applying for ACGME accreditation.
The other thing to remember is that if by some chance you do get a Hepatology fellowship before a GI fellowship, you will not be eligible to sit for the CAQ exam in Hepatology by the ABIM.
I hope this helps.

Transplant hepatology

Program Number / Name / AddressSpecialtyDirectorPhone / Fax / Email[1580314014] College of Medicine, Mayo Clinic (Arizona) Program
Mayo School of Grad Med Ed-Mayo Clinic College of Medicine
2W, Med Ed
5777 E Mayo Blvd
Phoenix, AZ 85054
Transplant hepatology (IM)David D. Douglas, MD(480)342-1272

[1580514001] University of California (San Francisco) Program
University of California (San Francisco) School of
513 Parnassus Avenue
Room S-357
San Francisco, CA 94143
Transplant hepatology (IM)Nathan M. Bass, MBChB, PhD(415)476-3143
(415)476-0659
[email protected] [1580714029] University of Colorado Program
University of Colorado School of Medicine
4200 East Ninth Ave Campus Box B158
Denver, CO 80262
Transplant hepatology (IM)Gregory T. Everson, MD(303)372-8859
(303)315-5711
[1581114011] College of Medicine, Mayo Clinic (Jacksonville) Program
Mayo School of Grad Med Ed-Mayo Clinic College of Medicine
4500 San Pablo Road
Graduate Medical Education Davis 172 West
Jacksonville, FL 32224
Transplant hepatology (IM)Raj Satyanarayana, MD(904)953-0487
(904)953-0430
[email protected] [1581114018] University of Florida Program
University of Florida College of Medicine
1600 SW Archer Rd. Room M440 MSB
Gainesville, FL 32610
Transplant hepatology (IM)Roberto J. Firpi, MD(352)392-7353
(352)392-7393
[email protected] [1581614023] University of Chicago Program
University of Chicago
5841 S. Maryland Avenue,
Chicago, IL 60637
Transplant hepatology (IM)Donald Jensen, MD(773)702-2395
(773)834-1288
[email protected] [1581614033] University of Illinois College of Medicine at Chicago Program
University of Illinois College of Medicine at Chicago
840 S Wood St, 1029 CSB Bldg
Chicago, IL 60612
Transplant hepatology (IM)Jamie Berkes, MD(312)413-5882
(312)996-1334
[email protected] [1582414003] Beth Israel Deaconess Medical Center Program
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
Transplant hepatology (IM)Nezam Afdhal, MD(617)632-1070
(617)632-1054
[email protected] [1582414008] Massachusetts General Hospital Program
Massachusetts General Hospital
GI Unit, GRJ 724
55 Fruit Street
Boston, MA 02114
Transplant hepatology (IM)Raymond T. Chung, MD(617)724-7562

[email protected] [1582514013] University of Michigan Hospitals and Health Centers Program
University of Michigan Hospitals and Health Centers
1500 E Medical Center Drive
3912 Taubman Center
Ann Arbor, MI 48109
Transplant hepatology (IM)Hari J. Conjeevaram, MD(734)615-8468
(734)936-7392
[1582614006] College of Medicine, Mayo Clinic (Rochester) Program
Mayo School of Grad Med Ed-Mayo Clinic College of Medicine
200 First Street, SW
Rochester, MN 55905
Transplant hepatology (IM)John J. Poterucha, MD(507)266-4056

[1582614017] University of Minnesota Program
University of Minnesota Medical School
MMC 36
420 Delaware Street, S.E.
Minneapolis, MN 55455
Transplant hepatology (IM)Jack Lake, MD(612)625-0684
(612)625-5620
[email protected] [1583514002] Mount Sinai School of Medicine Program
Mount Sinai School of Medicine
1425 Madison Avenue, Room 11-70
New York, NY 10029
Transplant hepatology (IM)Meena Bansal, MD(212)659-9519
(212)849-2574
[1583514019] New York Presbyterian Hospital Program
New York Presbyterian Hospital
Center For Liver Disease and Transplantation
PH-14 622 W 168th Street
New York, NY 10032
Transplant hepatology (IM)Robert S. Brown, MD, MPH(212)305-0915
(212)305-4343
[1583514022] New York Medical College at Westchester Medical Center Program
New York Medical College at WMC
Munger Pavilion
Suite 206
Valhalla, NY 10595
Transplant hepatology (IM)Leona Kim-Schluger, MD(914)493-7337
(914)594-4317
[email protected] [1583814025] University Hospital Inc Program
University Hospital Inc
Mail Location 0595
231 albert sabin way
Cincinnati, OH 45267-0595
Transplant hepatology (IM)Stephen D. Zucker, MD(513)558-3944
(513)558-1744
[email protected] [1584114028] Thomas Jefferson University Program
Thomas Jefferson University Hospital
Suite 480 Main
132 South 10th Street
Philadelphia, PA 19107
Transplant hepatology (IM)Victor J. Navarro, MD(215)955-5271
(215)503-2146
[email protected] [1584814007] Baylor University Medical Center Program
Baylor University Medical Center
3500 Gaston Avenue
1st Floor Roberts, Medical Education
Dallas, TX 75246
Transplant hepatology (IM)Robert Perrillo, MD(214)820-2234
(214)820-7272
[email protected] [1585114005] Virginia Commonwealth University Health System Program
Virginia Commonwealth University Health System
1200 East Broad Street
PO Box 980341
Richmond, VA 23298-0341
Transplant hepatology (IM)Arun Sanyal, MD, MBBS(804)828-6314
(804)828-2992
[1585414030] University of Washington Program
University of Washington School of Medicine
1959 NE Pacific Street
Box 356424
Seattle, WA 98195
Transplant hepatology (IM)David J. Kearney, MD(206)277-1445
(206)764-2232
[email protected] [1585614024] University of Wisconsin Program
University of Wisconsin Hospital and Clinics
600 Highland Ave
Madison, WI 53792
Transplant hepatology (IM)Michael Lucey, MD(608)263-7322
 
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That was a good overview, hematemesis. Although programs want GI fellows, its hard to find GI fellows who are interested in doing another year of training. So, my guess is that many of these programs go unfilled and they then try to recruit IM guys. I got similar response as hematemesis when I called these programs. The best bet, if you are interested, would be contacting the non accredited programs. If you have any doubt, send the application (its free!! except postal charges) and wait and see. This way if they are unfilled they might call you later.
 
That was a good overview, hematemesis. Although programs want GI fellows, its hard to find GI fellows who are interested in doing another year of training. So, my guess is that many of these programs go unfilled and they then try to recruit IM guys. I got similar response as hematemesis when I called these programs. The best bet, if you are interested, would be contacting the non accredited programs. If you have any doubt, send the application (its free!! except postal charges) and wait and see. This way if they are unfilled they might call you later.
The problem is that only GI physicians with additional hepatology training are eligible for transplant hepatology subspecialty certification. CMS requires each program to have at least one certified transplant hepatologist (as of 2010 I believe). So even if you could get into a program you could not get certified which is what you really need. On the other hand there was a discussion about this in Liver. The thrust of the article was that it was time to separate hepatology from GI and make it a separate specialty. The AASLD has looked at this but I don't think they have come to any conclusion.

David Carpenter, PA-C
 
Thanks for all the info, discussion, and feedback!! That was quite informative
 
One need not necessarily be board certified in GI just proof of training is adeqate.

One would have to complete 3 years of training in a GI fellowship program and be at least board-eligible to get into an accredited Hepatology program. That is the only way the fellowship would be accredited. Otherwise, their fellows would not be able to take the Hepatology boards (I did a Hepatology fellowship recently from one of these accredited fellowships mentioned by Hematemesis, but am in the same situation others have mentioned ...cannot take the boards and be a complete Hepatologist until I do GI fellowship-and these changes occured while I was in training, so I did not know what I was getting into when I started the fellowship !!!)
 
One need not necessarily be board certified in GI just proof of training is adeqate.

One would have to complete 3 years of training in a GI fellowship program and be at least board-eligible to get into an accredited Hepatology program. That is the only way the fellowship would be accredited. Otherwise, their fellows would not be able to take the Hepatology boards (I did a Hepatology fellowship recently from one of these accredited fellowships mentioned by Hematemesis, but am in the same situation others have mentioned ...cannot take the boards and be a complete Hepatologist until I do GI fellowship-and these changes occured while I was in training, so I did not know what I was getting into when I started the fellowship !!!)


I think you could work as a Hepatologist without board certification until 2010 (correct me if I am wrong) but I agree ultimately you would need GI training. Why board certification is so important? Is it good for practicing Liver MD's?

What is your situation this year for GI www? If you don't mind me asking, how many interviews did you get?
 
I think you could work as a Hepatologist without board certification until 2010 (correct me if I am wrong) but I agree ultimately you would need GI training. Why board certification is so important? Is it good for practicing Liver MD's?

What is your situation this year for GI www? If you don't mind me asking, how many interviews did you get?

Working is a different matter altogether from training. You could work as a Hepatologist anywhere as long as someone will take you (even after 2010- 2010 is the last year that you could take the certification exam without actually doing a formal Heaptology fellowship), but you would not be able to scope. Some programs will not even let you do do liver biopsies, if you are interested in them. You could always join a private practice and see only liver patients, or join programs in the midwest or remote areas since they are open to taking Hepatologists even without GI training. Board certification is important, because you will be competing with GI trained Hepatologists for jobs....

So far only 4 interviews (including one from my own fellowship program)-don't know what the future holds....
 
Working is a different matter altogether from training. You could work as a Hepatologist anywhere as long as someone will take you (even after 2010- 2010 is the last year that you could take the certification exam without actually doing a formal Heaptology fellowship), but you would not be able to scope. Some programs will not even let you do do liver biopsies, if you are interested in them. You could always join a private practice and see only liver patients, or join programs in the midwest or remote areas since they are open to taking Hepatologists even without GI training. Board certification is important, because you will be competing with GI trained Hepatologists for jobs....

So far only 4 interviews (including one from my own fellowship program)-don't know what the future holds....


Board certification might be important even from the payer stand point (private insurances). Anyhow, recently GI has become so competitive that prior Hepatology training is of minimal help. This is my feeling, I don't know how other people in the forum think about it. All the best www and all other doing Hepatology who are aspiring for GI fellowship.
 
I personally feel a hepatology fellowship will give a candidate an edge over someone who is equally qualified but not done the extra year, especially if its done from one of the big name programs like Mayo, Mass Gen, Hopkins, Mt. Sinai. I know of several hepatology fellows who got into GI.
 
I personally feel a hepatology fellowship will give a candidate an edge over someone who is equally qualified but not done the extra year, especially if its done from one of the big name programs like Mayo, Mass Gen, Hopkins, Mt. Sinai. I know of several hepatology fellows who got into GI.


That is little reassuring to all current and prospective Hepatology fellows. I agree that big names really matter. Now that things have changed with Hepatology, IM residents won't have a chance to get into the big brand name Hepatology programs.
Hematemesis, are you a current Hepatology fellow or did you do one? I remember you doing well with the number of interviews based on your posts in the forum. what is your status, if you don't mind?
 
No I am not a hepatology fellow nor have I completed a hepatology fellowshp. I really wanted to do one as plan B if GI did'nt work out, but now because of the new ACGME regulations, all IM hepatology aspirants are screwed. I still cannot beleive that programs are willing to go unfilled rather than take an IM candidate.
I have got only 2 interviews and 24 rejects. So that is not doing well. I have not heard from a the other 18 programs I applied to and I'm sure I have been rejected as others in the forms have received interviews from them. They just have not had the courtesy to let me know.
 
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I personally feel a hepatology fellowship will give a candidate an edge over someone who is equally qualified but not done the extra year, especially if its done from one of the big name programs like Mayo, Mass Gen, Hopkins, Mt. Sinai. I know of several hepatology fellows who got into GI.

Just be prepared to discuss and promote your GI interest in the fellowship interviews for GI. You must be very clear in defining your future goals. A lot of GI programs think that either you did the Hepatology training to get into GI or you are only interested in Hepatology and just doing a GI fellowship to become a Hepatologist. I have been asked this question several times in my interviews. So it is not necessarily an advantage to do a Hepatology fellowship for a GI fellowship,although sometimes it may be...
 
www I did not realize that GI programs thought that way..... I know several people who did a heart failure fellowship and then did Cards in good places.
From my perspective I would think that programs would be happy to have someone with that extra year no matter what the motivation was....but I guess you know better. I have seen several GI programs with strong liver disease / liver transplant facilities grab fellows trained in hepatology. I guess it really would not matter to small programs which are predominantly GI.
 
www I did not realize that GI programs thought that way..... I know several people who did a heart failure fellowship and then did Cards in good places.
From my perspective I would think that programs would be happy to have someone with that extra year no matter what the motivation was....but I guess you know better. I have seen several GI programs with strong liver disease / liver transplant facilities grab fellows trained in hepatology. I guess it really would not matter to small programs which are predominantly GI.

That is true. Programs with liver transplant would not mind and maybe welcome someone with Hepatology training. On the other hand, community and GI programs without transplant Hepatology are generally looking for hard core GI guys, so if interviewing there, you must be able to convince them that GI is your first love....
 
Quite interesting discussion in the Hepatology forum. I don't understand why Hepatology is being treated as a separate specialty. Traditionally, Hepatology has been a part of GI. Lot of GI faculty have special interest in Liver, so its hard to believe that we have to convince PD's that we are interested in GI. I thought doing Hepatology rather indicates interest in GI. Although the recent drive is to separate Hepatology from GI, I still feel that Hepatology is a part of GI.
 
Things are slowly changing with the AGA and AASLD. There are ongoing discussions about separating GI and Hepatology as two different specialties, but it is still too premature, with a lot of opposition to it in both societies. Some GI faculty have interest in Hepatology, but these are few and far -in-between. If you look around you at Liver transplant programs, you will see that most Hepatologists don't see regular GI patients. In other programs, faculty with Hepatology interests would want to take the Hepatology boards ASAP since they can become certified without formal training until 2010.

It will be interesting to see what happens after 2010.....
 
All those people doing hepatology or done hepatology, give us your opinion (s) about doing hepatology if not matched into GI. I know that Hepatology fellowship has changed but still there are few programs that take IM residents and few accredited programs who could take IM grads later if they go unfilled.

Do you think that doing Hepatology helps more than doing some research, if not matched this year? Is it worth to call Hepatology fellowship programs and see if they would take IM residents after the match day?
 
Hepatology does not participate in the Fellowship Match (at least not as of this year). Its still a paper and pencil application for most programs. I think in one of my earlier posts I had mentioned that I contacted all the ACGME accredited programs as well as some non accredited programs (which are by the way in the process of applying for accreditation) and they said absolutely no to IM grads EVEN if they go unfilled. Maybe things will change once they realize almost no GI fellow wants to do Hepatology.
As far as research goes, I guess thats a really hard question. When I asked a senior GI faculty at one of the top medical centers in the country, he said that just doing research was not enough, one actually had to show productivity ie publications in good journals (not even posters) to be considered competitive, and this is easier said than done if one is planning on doing this for a year, unless one has prior research experience and is working with someone who is churning out several publications a year. He also said that one needs to be either first or second author and being lower down is really not well appreciated. I hope this helps.

By the way if there are any current or past Hepatology fellows could you please post if your program will accept IM grads this year. You dont have to give your program name to conceal your identity.
 
Thanks for the info Hematemesis! I didn't expect that the GI PD's would expect a resident or a candidate out of residency to be a first or second author. I agree that publications really matter the most.

Any Hepatology fellows out there in the forum, please shred some light on this issue.
 
i totally agree with hematemesis. GI PD at my institute also told me that research is not enough and that productivity is what matters most, and by productivity that means quality of publications, which author, what journal etc...
 
Agree with hematemesis-quality research with publications in peer-reviwed journals as first or second author would improve your chances significantly.

My hepatology fellowship program will absolutely not be taking any IM applicants.That may be because they are accredited. The place where I work currently will be starting a Hepatology fellowship this year, and this year they are taking an IM candidate who will be going into a GI fellowship. But they are clear that after that they will take only candidates with GI training.
 
Just got back from interviews and learnt something interesting: the 17 acccredited Hepatology fellowships are having a hard time filling up their spots with GI trained applicants. So far they are firm on their requirements for taking only GI trained applicants, but I have a feeling this may change in the next 2-3 years if this continues... some GI programs are thinking of adding a 4 year GI fellowship spot with Hepatology integrated into it.
 
Just got back from interviews and learnt something interesting: the 17 acccredited Hepatology fellowships are having a hard time filling up their spots with GI trained applicants. So far they are firm on their requirements for taking only GI trained applicants, but I have a feeling this may change in the next 2-3 years if this continues... some GI programs are thinking of adding a 4 year GI fellowship spot with Hepatology integrated into it.

That is interesting and expected. I think that there would be some resistance to take IM grads but eventually it will happen.
 
I just happened to find this website by a search in google. I'm also a third year IM resident who wants to do hepatology. I have never applied for a GI residency (for personal issues) but am in the process of applying to a hepatology fellowship. If it were up to me I would just do hepatology and work as a hepatologist. Having a large Income is not that big a deal for me, so I wouldn't mind not being able to scope. It sounds like, just from reading everyone's comments, if I want to do hepatology (even if it's just clinic and consult), I pretty much have to do three years of GI. would everyone agree? Even if I get into the hepatology fellowship, I'm still going to have to do the three years of GI to work.
 
been lurking....

You are all speculating....and for the most part, incorrect. I am a GI fellow. Will be doing "Advanced Hepatology"/Transplant year after GI fellowship this year.

Anybody can be a "hepatologist"....even an internist without training...ie. treat hbv, hcv, evaluate and treat most cirrhotics until things get complicated and require referral. The GI specialty training (3 years) gives one an expertise in liver disease. The fourth year is designed to be for subspecialty training in the care of pre/peri and specifically post transplantation. It's edge is in creating future academic hepatologists and it's benefit would only be for this purpose....why make $50,000 in a PGY-7 year when one can go work as an attending in a university hospital and practice gen GI +/- liver diseases or make >$200,000 doing the same in private practice after GI fellowship?

I can tell you there is a demand for GI fellows doing the fourth year. I know of at least a few who have done, are doing, and will do. I know the larger programs are interviewing 5-10 candidates per spot, but not the smaller ones. But is not for everyone as the fate of "CAQ" board exam is not quite understood. The liver world is slowly breaking from the GI world, but they will never break as the amount of patient load is way greater than the hepatology field could handle. What I suspect you will see in the next few years (ie 5-15 from now) is something more along the lines of Heme/Onc dual certification.

IM hepatology training year is a waste, IMHO. The care of liver disease patients requires an understanding of GI diseases as well as basic endoscopy. The extra year after GI fellowship is likely to be redundant for those in GI training programs that have a liver focus. But at this point a necessary evil if one wishes to be an academic liver doctor

I know some programs still are taking IM people, but I believe that is more for the slave labor aspect as they all want GI people but as of 2008 cannot fill as fellows have been grandfathered in the CAQ exam until this year. I suspect this practice of taking IM people will end by 2009-2010 as it delegitimizes the 4th yr training purpose (with the exception of foreign trained GI specialists and those already accepted into 3 year GI fellowships.)

be happy to lurk back and answer any ?, but no specifics, please.
 
hey
what if we do hepatology (non-accredited) fellowship before the Gastroenterology fellowship. Can we still give hepatology board after completing the GI fellowship or do we have to repeat the year? Just a lil confused
Thanks
 
No you will not be able to sit for the transplant CAQ exam and will not be eligible for certification. Only those who have completed a 3 yr GI fellowship and those already accepted into a 3yr fellowship (but can do the training year before the 3 years) are eligible to take the CAQ after GI board certification and the additional yr of training at one of the accrediated sites (currently 17 i believe and more on the way). This applies to all GI fellows who graduated after 2007....those before were grandfathered.

More info here from AASLD website
ABIM Requirements for Certification (this is for grandfathering)
To achieve certification in transplant hepatology, candidates must hold a current ABIM certificate in gastroenterology and fulfill the following requirements:
  • Have been previously certified in internal medicine by ABIM
  • Maintain a current underlying certificate in gastroenterology by ABIM
  • Satisfactory completion of the requisite practice experience or formal training requirements
  • Substantiation by local authorities of the candidate's clinical competence, procedural skills, and moral and ethical behavior in the clinical setting
  • A valid, unrestricted, and unchallenged license to practice medicine
  • Successful performance on the Transplant Hepatology Certification Examination
 
hey
what if we do hepatology (non-accredited) fellowship before the Gastroenterology fellowship. Can we still give hepatology board after completing the GI fellowship or do we have to repeat the year? Just a lil confused
Thanks

I believe the order of fellowships (GI first, then Hepatology or Hepatology followed by GI) does not matter as long as you do GI and become BC/BE in GI. Then you could take ABIM test and get certified in Hepatology. correct me if I am wrong.
 
I believe the order of fellowships (GI first, then Hepatology or Hepatology followed by GI) does not matter as long as you do GI and become BC/BE in GI. Then you could take ABIM test and get certified in Hepatology. correct me if I am wrong.


partially correct. All transplant fellowship accrediated programs are no longer supposed to accept a non-BE/BC gastroenterologist, unless they have been previously accepted to a 3 yr GI program and will enter this immeidately following 1yr tx hep year.
 
partially correct. All transplant fellowship accrediated programs are no longer supposed to accept a non-BE/BC gastroenterologist, unless they have been previously accepted to a 3 yr GI program and will enter this immeidately following 1yr tx hep year.

Gihep1, you are a GI fellow. I think you are in a better position to advice regarding Hepatology fellowship versus Research. Do you think doing Hepatology for an year after IM is a good idea if unmatched into GI this year. Or would you suggest doing research? I know Hepatology has changed with the new guidelines and there are not many programs offering Hepatology for IM grads. But if there is any scope for Hepatology, would you suggest doing Hepatology or research? Thanks in advance
 
I am not sure I can answer that question completely as I don't know exactly what program directors look for. And of course it depends on the program you are looking at. if it is a university based research program, then obviously, research with publications/DDW/Liver meeting/ACG poster presentations is what you should aim for. If it is a community program, they may find the hepatology training a bonus.

However, I believe you will be hard pressed to find hepatology training outside of your IM training program. You might as well be a hospitalist for a year and make some dough.
 
I am not in any GI fellowship program at the moment. My program has a non accredited hepatology fellowship. I am thinking about applying to it this year as long as I dont have to repeat the year incase I do my GI fellowship later. I think the order in which fellowships are done does not matter. If it does please let me know. Thanks
 
I am not in any GI fellowship program at the moment. My program has a non accredited hepatology fellowship. I am thinking about applying to it this year as long as I dont have to repeat the year incase I do my GI fellowship later. I think the order in which fellowships are done does not matter. If it does please let me know. Thanks

It does matter. In order to sit for the CAQ, you must be accepted to a 3 yr GI fellowship prior to starting the liver year....ie. only GI trained, or about to be GI trained will be allowed to do the year in accredited programs. Maybe not in a non-accredited program, but then why do the year?
 
Exactly that is what I wanted to know. Why do the year if i have to repeat it later. Thanks for the reply.
 
Don't believe what everyone tells you about hepatology jobs being "great pay" and "you can write your own ticket." GI's have no idea what they're talking about and the demand for hepatologists is greatly overstated.

The only reason to do hepatology is because you like it, period.
 
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