Future trends in hepatology: Challenges and opportunities

The tremendous progress in the science and practice of hepatology in recent decades, fostered by the AASLD, is a great success story. Effective vaccines, antiviral therapies, liver transplantation, and the bounty of emerging diagnostics and therapies reflect important dividends from investment in basic and clinical research, and point toward a golden era in the specialty in the coming years. Yet, many challenges must be overcome to realize this potential. These include: (1) epiderniologic trends that portend a rising incidence in several types of chronic and neoplastic diseases; (2) growing disparities between the need for advanced hepatology care and the availability of adequately trained practitioners to provide it; (3) limited options for supporting the salaries of hepatologists whose practices do not include either transplant hepatology and/or endoscopic procedures, reflecting a lack of sufficient recognition of the highly cognitive, demanding nature of clinical hepatology; (4) a growing focus on defining and implementing quality measures; and (5) constrained extramural funding for basic, translational, and clinical research. Key recommendations that have emerged from the 2008 Future Trends Conference include the need for the AASLD to: 1 Modify current training paradigms to accelerate the entry of motivated trainees into the specialty of hepatology, in order to expand the workforce to meet these growing needs. 2 Support evolving practice paradigms and regulatory changes to more fully recognize the unique skill set and demands of clinical hepatology, which should promote revised metrics for reimbursement. 3 Maintain a leading voice, in partnership with related societies and government agencies, in defining and implementing quality measures that will Improve outcomes for patients with liver disease. 4 Continue to seek new sources of research funding to complement the ongoing support from NIH and other federal agencies, in order to realize the research goals outlined in the NIH Action Plan for Liver Disease. These efforts will include new initiatives for independent fundraising by the AASLD from philanthropy and other sources, and partnership with sister organizations to create synergies that will accelerate basic, translational, and clinical research advances. These recommendations will be complemented by a Strategic Planning Initiative in 2009 to clarify priorities and optimize approaches to achieve these goals. The AASLD is committed to tackling these challenges and maximizing the opportunities with creativity and determination.