Throughout his pediatric hepatology career, John Bucuvalas, MD, has led liver care programs at major academic hospitals and collaborated on critical research projects, including a recent trial of immunosuppression withdrawal with Sandy Feng, MD. When met with challenges like hierarchical department structures and inefficient clinic layouts, Dr. Bucuvalas looked beyond medicine for answers. He collaborated with professors at Harvard Business School and the Massachusetts Institute of Technology (MIT), and architects from urban design nonprofit LA Más to create management and communication efficiencies in clinical settings.

"If you go back 150 years in medicine, it was the most senior people who knew the most. But millennials are growing up in a completely different world. You learn from different sources," says Dr. Bucuvalas, chief of hepatology and vice chair of faculty affairs in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital in New York. "I look for effective internal communications strategies and goals for our team, and we have bi-directional communications."

Before coming to Mt. Sinai, he spent more than 25 years at Cincinnati Children’s Hospital, where he was trained by hepatologists Bill Balistreri, Fred Suchy and Ron Sokol. At first, few treatment options were available for his seriously ill young patients.

"In my first year as a fellow, I had nine or 10 kids die due to biliary atresia or acute tumors. It was a challenge to take care of these kids," he says. "I thought, ‘How do we get them to live and go on to live full, meaningful lives? But I hit it at the right time, because treatment of viral hepatitis and transplantation became possible."

Cincinnati Children’s was the only pediatric hospital awarded a Robert Wood Johnson Foundation grant to help transform healthcare. To achieve that goal, he studied business management and social science. “I started learning concepts that are completely outside of medicine and applying them to health care. It has been really cool to integrate knowledge across many disciplines.” His perspective has been shaped by collaborating with leaders like Scott Hamlin, Uma Kotagal, Tom Boat, Jim Anderson, Tom Nolan and Lloyd Provost.

Dr. Bucuvalas noticed that his Cincinnati Children’s staff encountered frequent interruptions during rounds, so he consulted architect Elizabeth Timme. Her solution was disarmingly simple: Placing tape on the floors to create paths for people to follow as they went through daily routines. Visual paths helped to increase efficiency. He also studied Harvard Professor Ethan Bernstein’s theories, including "the need for privacy and transparency in business. When people make decisions, they need privacy or a safe place to do it," he says. "How do you apply the integration of complementary care and interdisciplinary care? You need to have new knowledge filtered into traditional research. How do we work together? That’s what we have learned from social scientists. Now, I am cognizant of when people on my staff need privacy so they can do their jobs more effectively."

The longtime AASLD member become a Fellow (FAASLD) in 2014. “Recognition from a great organization like AASLD that I made a contribution to my field is a special honor,” he says. The Boston area native and his wife, Connie, have two grown children, Abby and Zach, and they enjoy traveling and rooting for the New England Patriots.

While a medical student at Universidade Federal do Rio de Janeiro in her native Brazil, Cynthia Levy realized that her calling was to be a hepatologist.

"I was assigned to a rotation in the hepatology clinic, and I was inspired by the hepatologist in charge," says Dr. Levy. "I was very impressed with his knowledge and professionalism, and the way he talked to his patients as well as to the medical students."

After completing her medical school and residency in Brazil, Dr. Levy came to the University of Miami to pursue further training. She says that she does not regret having to complete her internal medicine residency again, because during her time in Miami, she first interacted with Eugene Schiff, MD, FAASLD, a Past-President of the AASLD. She found Dr. Schiff to be a tremendously charismatic individual who reinforced her vision of a career in hepatology research and clinical care.

Dr. Levy left Miami's sunny beaches to complete a gastroenterology fellowship at the Mayo Clinic in Rochester, Minnesota, where she was mentored by another AASLD Past-President, Keith Lindor, MD, FAASLD.

"My academic career really began there. As soon as I started working with [Dr. Lindor] on cholestatic and autoimmune liver diseases research, I was assigned to write my first review, which was on primary biliary cholangitis," she recalls. "It is funny how, once you write a review, you are automatically seen as an expert! That certainly encouraged me to deepen my knowledge and expertise in this area and develop a niche. I had a great mentor and sponsor for that in Dr. Lindor." While at Mayo Clinic, Dr. Levy completed her Clinical Research Certificate on clinical trial design, which became her professional passion.

After her time in Minnesota, Dr. Levy returned to the Sunshine State when she was awarded AASLD’s Advanced Hepatology Fellowship to train for one year at the University of Florida in Gainesville. At UF, she worked under the guidance of David Nelson, MD, FAASLD, who encouraged her to pursue research efforts in her preferred niche, cholestatic liver diseases. She went on to design her first clinical trial to evaluate treatment of primary biliary cholangitis (PBC) patients who did not respond to the standard of care. Dr. Levy recalls that her time at UF and the success of this clinical trial helped crystallize her ultimate career path: to become a thought leader in the field of cholestatic and autoimmune liver diseases. After the PBC trial ended, Paul Martin, MD, FASSLD, recruited her to return to the University of Miami.

"At the Schiff Center for Liver Diseases, I’ve been able to establish a team of coordinators and students who help me nourish national and international research collaborations, including registries and clinical trials in cholestatic liver diseases," says Dr. Levy. "It’s all come together nicely, but only because of the mentors I’ve had along the way who have pointed me in the right direction or told me when it was wise to wait until the right time to do certain trials." Patience, she realized, is a powerful tool in the world of clinical trials, where funding opportunities are driven by so many different forces.

Dr. Levy’s current research program mainly focuses on rare cholestatic diseases like PBC and primary sclerosing cholangitis (PSC). Her team’s research explores potential treatments, advancing the management of symptoms like pruritus and improving the quality of life for liver disease patients, "including after a liver transplant, because the disease can recur," she notes.

As Program Director of the Transplant Hepatology Fellowship, Dr. Levy has embraced the role of mentor, guiding young physicians and researchers. She is the Principal Investigator for the NIH Porphyria Consortium at UM and a Fellow of the American Gastroenterology Association, and she was honored to be named a Fellow of the AASLD in 2017, where she has served on various committees. Her experience with AASLD shaped her into a better leader, she says. Due to her achievements in clinical care and her commitment to liver research, Dr. Levy was also endowed with the Arthur Hertz Chair in Liver Diseases at the University of Miami Miller School of Medicine in June 2019.

Dr. Levy enjoys Miami’s international flavor, diverse population, tropical climate, and direct flights to and from Brazil. Dr. Levy enjoys playing the piano and is an avid reader, including novels, histories and books on leadership theory. She listens to podcasts and audiobooks during her daily, 45-minute highway commute. "I love to travel, so I like reading up about the place I’m going to visit, its culture and history, before I go."

Hepatology appealed to Alexander L. Gerbes, MD because it is a specialty that encompasses “a broad spectrum of relevant diseases and the development of novel treatment options,” he says.

"Education determines the quality of medicine in the future. And the interaction with younger colleagues is often challenging and always rewarding."

Treating a patient with liver disease early in his training inspired him to explore the field. Looking back, it was the “care of a patient with unclear etiology of ascites in my second year as an intern which prompted my first clinical studies and papers on differential diagnosis of ascites,” he says. While attending the University of Munich Medical School, he traveled to the United States to complete an internship at the University of California, San Francisco Medical Center’s Moffitt Hospital, now Moffitt-Long Hospital in 1979. He completed a second internship at the Royal Hallamshire Hospital in Sheffield, the United Kingdom in 1981. Prof. Gerbes graduated magna cum laude from medical school in 1982. He now serves as the Vice Chief in the Department of Medicine II at the Klinikum der Ludwig-Maximilians-University (LMU) of Munich in Germany.

Early on in his career, several influential mentors inspired Prof. Gerbes and helped guide his career as a hepatology researcher.

“I was fortunate to train with several very dedicated clinical teachers, such as Tilman Sauerbruch and Gustav Paumgartner, who was an outstanding mentor guiding me toward a scientific, hypothesis-driven approach,” he says. “He taught me to always strive for clarity and precision in medicine and in science.”

His body of research includes studies on hepatocellular carcinoma, cirrhosis, and other potentially life-threatening liver diseases. He describes why these challenging, complex conditions appealed to him as a scientist and a doctor.

“During most of my research, I was fascinated by a translational approach, investigating parameters, methods and tools with potential benefits for our patients. This may explain why I focused on these diseases, which still represent major challenges,” he says. His current and future focus includes researching drug-induced liver injury (DILI), which is “still a major cause of severe, acute liver injury. In particular, the idiosyncratic type, although rare, can lead to death or the need for a liver transplant. Diagnosis is done by exclusion of other well-defined causes and by expert adjudication. However, many patients regularly take several drugs, and often, it is impossible to determine the culprit. Because of this, all medication in these subjects regularly are discontinued, putting the patient at additional risks.”

DILI also is a frequent cause of attrition of innovative compounds in drug development, and of restrictions or postmarketing withdrawal of the drugs, he says. More accurate tests could help overcome these barriers.

“My group has developed an in vitro test using the white blood cells of individual patients with suspicion of DILI which are transformed into hepatocyte-like cells reflecting the patient’s individual drug intolerance,” says Prof. Gerbes. “This test can diagnose and exclude DILI with good accuracy, and identify the culprit drug in polymedicated individuals. We now focus on using this novel tool as the basis to enable the development of DILI biomarkers.”

When he isn’t working, he enjoys exploring the beauty of nature outside the walls of a laboratory or clinic and spending time with his family. He is married and has one child. He is fond of jazz music and classic cars.

Prof. Gerbes has been a member of AASLD since 1987 and was named a Fellow in 2014. He is also a Fellow of the American Gastroenterological Association and of the European Board of Gastroenterology. He has served as the Associate Editor and Deputy Editor of GUT. Most recently, he was elected President 2018 at the annual meeting of the Society for Gastroenterology in Bavaria (GfGB) in Garmisch-Partenkirchen. He believes that involvement in the AASLD and other medical societies that support research and medical education are important and personally fulfilling.

“Being an active member of these societies is almost like being part of a big family with similar interests and values. The annual meetings are like family gatherings, and are an ideal opportunity to meet with colleagues who have become friends for a long time,” he says. “Education determines the quality of medicine in the future. And the interaction with younger colleagues is often challenging and always rewarding.”

He urges young hepatologists and gastroenterologists now in training to find challenging research topics that personally interest them, regardless of their commercial aspects.

Prof. Gerbes advises trainees to “Hang on, and when doing clinical research, never forget the individual patient’s problems that you are caring for.”

Early in his career, Oren K. Fix, MD, MSc attended an AASLD trainee workshop where he was urged to find a mentor.

"I didn’t really know what the word meant. But in medical school, I was randomly paired with a gastroenterologist who specialized in hepatology, Dr. Thomas Mahl. He was an inspiration to me. Most of us probably choose our specialty because of the people we meet early on who take us under their wing," he says. "This was a guy I wanted to be like. He loved the work he was doing with his patients. He was having fun doing it."

Dr. Fix, who was named a Fellow of the AASLD in 2017, earned his medical degree at State University of New York at Buffalo School of Medicine. He completed his Internal Medicine internship and residency, then a Gastroenterology fellowship and a Clinical Research Training (CREST) fellowship at Boston University School of Medicine. He now serves as Medical Director of the Liver Transplant Program at Seattle's Swedish Medical Center. His cross-country journey included training in medical education, clinical medicine, research, epidemiology and clinical informatics.

Second Chance At Life

As a GI fellow, Dr. Fix spent a month at Beth Israel Deaconess Medical Center to learn more about liver transplantation, then unavailable at Boston University. "Seeing patients who were at death's door receive a transplant and a second chance at life, I realized that I had to get involved in transplantation."

Both his program director, Dr. Robert Lowe, and his research mentor, Dr. David Nunes, encouraged him to earn a Master of Science degree in epidemiology from BU’s School of Public Health and pursue a CREST fellowship. "That set me on a path to work in academic hepatology. I didn’t plan on going into academics when I started medical school. I didn’t know what I wanted to be when I was in residency. I was like a sponge."

In 2005, he switched coasts to pursue a Transplant Hepatology Fellowship at the University of California, San Francisco. But he had to come up with his own funding, so he applied for the AASLD Advanced Hepatology Training Award.

"The training pathway I was seeking is now established and most programs have internal funding, but at the time, it was new and UCSF didn’t provide the funding. My mentor told me to apply for it, and I got it," he says. "Without the award from AASLD, I would not have been able to train at UCSF."

After a short stint at the University of Washington, he returned to UCSF to work in medical education, completing a two-year Teaching Scholars Program focused on educational research, curriculum design and leadership. He was also the Program Director for UCSF’s Transplant Hepatology Fellowship. "Something crystallized for me in that moment. It was the excitement of being a part of the next generation of doctors."

Trainee-Centered Education

As Chair of AASLD's Training and Workforce Committee, Dr. Fix led AASLD's pilot program for training hepatologists, which has long required three years of GI training followed by one year of transplant hepatology training.

"Some people have found that extra year of training to be a barrier to hepatology certification, and the three years of GI training to be excessive and not aligned with their ultimate career goals," he says. In 2012, the American Board of Internal Medicine (ABIM) invited applications for pilot programs that focused on competency, or outcomes-based training. The AASLD's proposed program incorporated transplant hepatology training in the third year of GI fellowship. Now in its eighth year, the program was recently approved by ABIM as a formal training pathway. "Pilot fellows are able to combine their GI and hepatology training into three years that's more trainee-centered and focused on their career goals," he says.

In addition to serving as Medical Director of Swedish's liver transplant program and as a member of the Internal Medicine Review Committee for the Accreditation Council for Graduate Medical Education (ACGME), Dr. Fix has a new passion: the emerging field of clinical informatics, an evolving field that applies data and information technology to patient care, and includes population health, clinical decision support and optimization of the electronic health record.

"EHRs can be so clunky, and many physicians hate interacting with them, in part because they’re not designed by us. So, let's get physicians more involved in the design and optimization process," says Dr. Fix, now a board-certified Clinical Informaticist and Epic-certified Physician Builder. "This is a new specialty that is still relatively uncharted for practicing clinicians. It's a glimpse into the future of patient care, as more and more patients are gaining access to their own health data, and large health systems see how the data can be used to improve the quality and skyrocketing cost of health care. I’m an outlier. I have embraced the EHR because I realize it's here to stay, but I want to make it better for physicians."

Dr. Fix and his wife, Amy, a cardiac intensive care nurse at Swedish, live in Seattle's Capitol Hill district with Frank, their 12-year-old chihuahua/terrier mix. They enjoy hiking, camping and snowboarding.

"Another thing we do together is the New York Times crossword puzzle. It's kind of a nerdy activity, but it's become a ritual for us. We love it."

Hepatology is a journey, says Vijay H. Shah, MD, a Fellow of AASLD since 2018 and the Chair of Gastroenterology and Hepatology Division at the Mayo Clinic Department of Internal Medicine in Rochester, Minnesota.

"The vision that inspires me is to develop a world where people don’t suffer from liver disease. That is a big vision. That’s the vision of the leaders at AASLD." Achieving that goal will take leaders with skills like careful listening, teamwork, delegating tasks, time management and compassion, which are not taught in medical school, he says.

"Successful leaders need different skills at different points in their career. Early on, trainees depend on grit. That’s how the medical system works. You succeed because you work hard, have a high IQ and achieve goals. But, as people reach mid-career, you realize that grit is not scalable. It’s at that point that you recognize the value of teamwork or ‘EQ,’ emotional intelligence. It’s the ability to work as a team and to inspire teams, that is more scalable. You mentor and inspire the team, and everyone benefits," he says.

Dr. Shah was inspired and guided by mentors throughout his career, starting with Peter Kahrilas, MD, of Northwestern University’s Feinberg School of Medicine, where Dr. Shah completed a combined six-year undergraduate and medical degree program, followed by his internal medicine residency. Another early influence was the late Andy Blei, MD, "who pointed me toward research in portal hypertension. I wanted to be just like him," he says. Dr. Shah completed a fellowship in digestive diseases at Yale University with mentors Roberto Grossman, MD and William C. Sessa, PhD. At Yale, he recognized the need to gain more molecular technology skills and sought that training.

As a trainee, Dr. Shah worked in inner-city hospitals where alcohol-related liver diseases were rampant. This inspired by many years of research on disease mechanisms in ARLDs, as well as identifying biomarkers that could translate to successful treatments.

"Patients were suffering with severe physical problems like encephalopathy, ascites and GI bleeding. They had coexisting psychological conditions. They had burned bridges with their families and lost social connections. Alcoholism bridges the physical, emotional and social aspects of health." At the time, most felt that little could be done for these patients, and there wasn’t much to study. "When we realized there was a genetic component to the disease, and that we can have a positive impact on people with treatments for substance abuse and for their physical disease, it all changed."

Despite the burden on so many patients’ lives, limited research funding was available. "It was really a mismatch. But at Mayo, we are exploring pathways for new drug development, and translational research through biospecimens, and a number of clinical trials are ongoing now. We’ve had success with specific molecules, and some potential treatments are very exciting, but more advanced trials are needed," he says. "Even with the potential blood biomarkers we have identified, we have to keep working to find better biomarkers and better treatments."

Dr. Shah embraces the role of "servant-leader," one who helps and inspires those around them, and by doing so, helps the organization as a whole. He learns leadership concepts from his wife, Pri Shah, PhD, who teaches organizational development and training at the University of Minnesota. "She’s taught me to focus on people. A common mistake is to focus on strategy, not people. Without engaged people on your team, your strategy will go nowhere."

Leadership does not require a title or years of experience, but the willingness to lead by example, he says. "The organizational chart doesn’t always match where people look for inspiration. At each step of my career where I’ve had to lead others – as the head of a care team, a laboratory team, as a chair or the chief of a division – I realized that some skills are universal. But you need so many new skills as you grow. Leadership is about learning. If you’re too busy, you’re probably doing the wrong things. We all need to ask ourselves, ‘Where am I spending my time?’ That’s what I discuss with our junior faculty."

The Shahs have two daughters, ages 20 and 17, and enjoy family skiing vacations. He plays guitar, and he’s jammed with Jonathan Dranoff, MD, also a Fellow of the AASLD. "I remember that when we were fellows, at our apartment in New Haven, Jon got on top of my living room coffee table and started playing guitar. My wife had questions!" Dr. Shah recalls. "I love all kinds of music, from opera to hard rock. When I’m exercising, I like to listen to hard rock. When I am contemplating, I listen to classical and opera."

During his internal medicine residency at Boston University and Boston City Hospital, Jonathan Dranoff, MD, already knew that he wanted to be a gastroenterologist. But his eventual career path included turns that he did not envision.

“I didn’t think I wanted to be an academic physician. Nothing had opened my eyes to that yet,” says Dr. Dranoff, an internationally known physician-scientist at the University of Arkansas for Medical Sciences (UAMS) in Little Rock. “The stuff about gastroenterology that seemed exciting to me as a resident was not hepatology.”

However, during a digestive diseases fellowship at Yale University Medical School in New Haven, a program with a strong tradition in hepatology, Dr. Dranoff began with a three-month inpatient liver service rotation. He cites “three wonderful, brilliant attending physicians” in the program for showing him the excitement of hepatology that he’d overlooked earlier. “I was hooked. I knew I was going to be a hepatologist.”

Among his mentors was former AASLD President Guadalupe “Lupe” Garcia-Tsao, MD, whose “consummate mastery of the field, from disease pathology to clinical manifestations, and a very good ability to devise practical and implementable interventions that actually help people” made strong impressions on him. He also cites Yale’s Michael Nathanson, MD, PhD, as an influential mentor. “With Mike, it was his supreme confidence, and a sense of really enjoying himself” that impressed him. Due to these mentors, Dr. Dranoff discovered the path to his current career. “Clinical medicine is a treat when it complements other academic activities.”

Victor Navarro, MD, Chair of Hepatology at Einstein Healthcare Network in Philadelphia, was another influence on Dr. Dranoff during his fellowship at Yale in his late 20s.

“He’s very confident, and he seemed to get a kick out of doing things in a really high-quality way. It seemed more fun than I expected it to be, and it has been that way for my whole career,” he says. “Hepatology is just really fun and challenging, and it rewards people who do their homework and learn.”

After opening his own laboratory and working closely with the leadership at Yale Liver Center, Dr. Dranoff was happy with the status quo. But in his late 30s, he was offered a position as a division director in Little Rock. He decided to go for it, moving from the Ivy League campus in New England to the Deep South.

“I thought I had the right combination of skills and personality to thrive as a division director,” he says. The attractions of the new position included “ the ability to build an entire division based on what I believe in and what I have learned, to recruit talented people, and to bring first-class liver care to an area which had not had it before.”

Dr. Dranoff settled in quickly in Little Rock, and says he enjoys the laid-back, friendly nature of this sophisticated city, as well as its easy navigability. “I don’t ever want to take two hours to drive to work ever again!” He recognizes that Little Rock is a prosperous city, a state capital, filled with educated professionals and many amenities, in the midst of a rural region where gastroenterologists are scarce, and many patients have to drive up to three hours for care.

“We would rather compete on behalf of academic hepatology. We compete for grants and limited resources, but it’s more important for us to feel good about the field itself.”

His clinical work focuses on the cholangiopathies, a set of conditions that affect bile duct cells, including primary sclerosing cholangitis and primary biliary cirrhosis. He also has a strong interest in cirrhosis and its complications, and his NIH-supported research explored cirrhosis and liver fibrosis. He also devotes time to act as a mentor to young fellow trainees, continuing the cycle of guidance and support that he experienced early in his career.

“What I get from them is probably more than they get from me. I share my enthusiasm with them as they move forward in their careers,” he says. “I am able to find out what someone at that stage of career is thinking, and that knowledge helps me be a better division director and leader. I learn the problems that they encounter and it shows me things we might avoid in the future.”

Academic hepatology is a small, close-knit field and a true community where physician-scientists encourage rather than compete with each other, says Dr. Dranoff. “We would rather compete on behalf of academic hepatology. We compete for grants and limited resources, but it’s more important for us to feel good about the field itself.”

Limited funding is the biggest challenge facing the field today, and the National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases may not be counted on to provide the consistent research funding that is needed, he says. “It’s a little scary, and it should scare people. But I hope this leads us to look at new approaches” to funding.

He’s been involved with the AASLD since the mid-‘90s, when he went to his first meeting in Chicago. The camaraderie he experienced with colleagues there “made it feel like a wonderful use of my time,” he says. “There’s really nobody doing exactly what I do, because ours is a fairly diverse organization. People have many different opinions, and it’s good that there’s not a lot of hegemony in academic hepatology. I expect us to continue to have that combination of values.”

AASLD offers great value to its members, including advocacy, he says. The association’s leaders and staff devote time and attention to members’ needs. He completed the AASLD Schering Advanced Fellowship in 2000-2001, and served for a few years as the Chair of the Liver Fibrosis Scientific Investigator Group.

Outside of work, Dr. Dranoff is an avid guitarist and guitar collector. His genres include blues, rock and roll, jazz and country, and he play mostly electric guitar. He loves his three Heritage guitars, made in Kalamazoo, Michigan. While he’s performed on stage in the past, his most recent gig was at his Little Rock temple, where he played guitar in a band at a Purimshpiel, a musical play to commemorate the Jewish holiday of Purim.

“I’m not a good singer or actor. But if people want me to play, I’ll do it, and I take it seriously,” he says. “If I didn’t have young kids, I’d probably play guitar more often. At least I’m not a drummer. There’s nothing lonelier than carrying a drum kit to the car at 2 a.m.”