ASH Report: “Systems-Based” Hematologist Represents New Way to Provide Hematology Expertise
models of centralized position align with rapidly changing health-care system, offer
a sustainable approach to recruit and retain talent to field
Published on: March 06, 2015
March, 6, 2015) – A report released today from
the American Society of Hematology (ASH) in its journal, Blood, presents
an innovative, sustainable new role for hematologists, particularly those
specializing in non-malignant blood diseases, for today’s rapidly changing U.S.
health-care system. The report, published online as a Blood Forum article, outlines several models
for a “systems-based clinical hematologist,” a centralized position within
hospitals and health-care systems specializing in non-malignant blood disorders.
report, “The Role of Hematologists in a
Changing United States Health-Care System,” senior author and 2013 ASH
President Janis L. Abkowitz, MD, and colleagues note that while demand for
hematology expertise remains high nationwide, ASH and its members are concerned
that changes to academic training will hinder both the recruitment of new
talent to the field and the retention of seasoned experts. To address this issue, ASH partnered with health-care consulting firm The
Lewin Group to
identify emerging career opportunities for health system- and hospital-based
hematologists and to provide guidance on pursuing those initiatives. At the
core of this concept is the projected need for easily accessible hematology expertise
report the authors express concern that, despite rapidly advancing research in
the area of non-malignant blood disorders, today’s hematology trainees are
unlikely to receive the same non-malignant training as many “classic”
hematologists trained in prior decades. Dr. Abkowitz and colleagues add that training
shortfalls are further compounded by the fact that primary care physicians do
not have the expertise to manage common blood disorders, increasing referrals
to hematologists. This combination of factors results in higher demand for a
smaller pool of hematologists entering the field with adequate training to
effectively and efficiently manage non-malignant disorders.
the rapid evolution and complexity of the field, the time is appropriate to
identify career pathways that attract and enable physicians to practice
non-malignant hematology in a sustainable manner,” said Dr. Abkowitz, chief of
the hematology division at the University of Washington in Seattle.
report notes that, in response to these challenges, U.S. hematologists are
defining new paths and assuming more centralized positions in large and small
health-care systems. These roles, termed “systems-based hematologists,” involve
specialty-trained physicians, employed by a hospital, medical center, or health
system, that optimize individual patient care as well as the overall system of
health-care delivery for patients with blood disorders. For example, a
systems-based hematologist could work closely with surgeons to minimize perioperative
bleeding and could manage care pathways for patients with chronic blood
report offers four examples where the involvement of a systems-based
hematologist would lead to cost-effective decision-making. These were based
upon interviews with 14 early adoptors of the systems-based approach to
thrombocytopenia (HIT): A systems-based hematologist implements care pathways that focus
on HIT, a dangerous reaction some patients develop to the anticoagulant heparin,
by working to reduce unnecessary heparin exposure, optimize laboratory testing
for suspected HIT, and reduce unnecessary procedures in patients.
thrombocytopenic purpura (TTP): A systems-based hematologist optimizes testing for TTP, an
illness of blood plasma that can be deadly if not diagnosed and treated early.
This may reduce system-wide plasma utilization.
director for hemostasis and thrombosis: A systems-based hematologist fosters
appropriate and safe practices, including implementation and adherence to
preventive care for blood clots and optimal use of the novel and costly
hematology consultation in an Accountable Care Organization (ACO) environment: While the
formation of ACOs has enabled more patients to be served by a health system,
there are fewer incentives for physicians to manage common hematology-related
issues. A funded systems-based hematologist in a health system ensures that
patients have more timely access to hematology consultations.
“A systems-based hematologist position presents a unique
opportunity for hematologists to design new models for care delivery and
demonstrate their ability to improve clinical outcomes while maintaining or
reducing costs,” said Dr. Abkowitz. “Just
as blood must flow throughout the body, the expertise of hematology must flow
throughout the health-care system.”
As a next step, the
Society is inviting its members to share practice models they have
developed and examples
of how they have collaborated with others to improve health-care outcomes,
reduce complications, and eliminate unnecessary spending. In addition to the systems-based hematologist project,
ASH is committed to supporting recruitment and retention in hematology through
robust education, training, and award programs.
the most cited peer-reviewed publication in the field of hematology, is
available weekly in print and online. Blood
is the official journal of the American Society of Hematology (ASH) (www.hematology.org),
the world’s largest professional society concerned with the causes and
treatment of blood disorders.
mission is to further the understanding, diagnosis, treatment, and prevention
of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and
vascular systems by promoting research, clinical care, education, training, and
advocacy in hematology.
is a registered trademark of the American Society of Hematology.
Amanda Szabo, American Society of Hematology
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