Hepatology and Pancreatic Science

Introduction: In light of the growing focus on medicine's representation, we wanted to find out how gastroenterology (GI) and hepatology professionals in the United States perceive the current state of racial and ethnic workforce diversity and health care disparities.

Methods: A 33-item electronic cross-sectional survey was developed and distributed to members of five national GI and hepatology societies. The survey's topics were broken down into thematic modules, and respondents were asked to share their thoughts on racial and ethnic diversity in the workforce, health care disparities in GI and hepatology, and possible strategies to increase diversity in the workforce and increase health equity.

Results: Of the 1219 people who took the survey, 62.3% were men, 48.7% were non-Hispanic White, and 19.9% were from underrepresented medical backgrounds. Insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n=431; 35.4%), in professional leadership (n=340; 27.9%), and among practicing GI and hepatology professionals (n=324; 26.6%) were the most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology. There were 545 [44.7%] opportunities for career mentorship, 520 [42.7%] opportunities for medical students, and 473 [38.8%] leadership roles in programs and professional societies for underrepresented racial and ethnic minority groups as suggested interventions.

Conclusion: The perspectives that professionals in gastrointestinal and hepatology hold regarding health equity and racial and ethnic representation were examined in our survey. The findings ought to serve as a springboard for professional societies, academic institutions, and other organizations aiming to increase diversity, equity, and inclusion in our field. They should also inform future interventions to address workforce diversity and establish priorities toward improving health equity.

Due to the rising prevalence of its common lifestyle-related metabolic risk factors-obesity, inactivity, smoking, and alcohol consumption-addressing primary care's low confidence in detecting and managing chronic liver disease (CLD) is becoming increasingly important. Although liver blood tests are frequently used to manage long-term conditions, their interpretation rarely focuses on specific risk factors for liver disease. Primary care education should emphasize that isolated minor LFT abnormalities are unreliable in estimating risk of fibrosis progression, emphasize the use of pragmatic algorithms like FIB-4 to differentiate between patients who require referral for further fibrosis risk assessment and those who can be managed in the community, and outline how liver fibrosis is the flag of pathological concern. Utilizing existing frameworks for long-term condition care, measures to increase primary care's interest and engagement should incorporate liver disease consideration alongside other metabolic disorders, type 2 diabetes, cardiovascular disease, chronic kidney disease, and so on. Reduced reflex repeat testing of minor abnormalities, improved secondary care referrals, and improvements in the patient's journey through long-term multimorbidity care are selling points when considering the necessary investment in developing local fibrosis assessment pathways. When pathways are aligned with community lifestyle support services, it is likely that focusing on improving CLD will have a wide range of benefits for metabolic disorders that coexist. The most important message for primary care is to increase the value of the monitoring that is already in place rather than creating more work.