Linda Burns, MD
2010-04-27
Professor of Medicine and Fellowship Director of the
Hematology, Oncology, and Transplantation Program at the University of
Minnesota
Are there enough hematologists to advance the
science and care for patient needs?
A meeting to address this question was
held in late January and appropriately focused on ensuring the future of our
field. In a joint effort by ASH and the National Heart, Lung, and Blood
Institute (NHLBI), members of the two organizations met to launch a new
initiative aimed at recruiting and retaining hematologists, particularly in
non-malignant areas of expertise. I had the opportunity to attend this meeting,
which was led by Dr. J. Evan Sadler, ASH president-elect, and Dr. Keith Hoots,
director of the NHLBI Division of Blood Diseases and Resources. The primary
goal was to identify ways our organizations can work independently and together
to strengthen hematology as a profession. The group discussed emerging opportunities
in hematology, projected workforce needs, barriers to trainees pursuing and
sustaining a career in hematology, and current programs and resources.
Four major topics emerged:
- We need to increase the pool of
trainees entering the field by reaching out to “undecided” trainees and sharing
the enthusiasm and vision we have for the field of hematology.
- For those interested in pursuing
hematology as a career, we must identify opportunities for broadening the
practice of hematology, both in academic and non-academic settings.
- In order to sustain life-long
careers in hematology, we need to diversify sources of funding to include
institutions, reimbursement from public and private insurers, and programs that
attract NIH funding.
- We must enhance the profile
(“value-added”) of a hematologist’s involvement in patient care to patients,
referring physicians, and payors.
To
encourage early-career trainees to enter hematology, two short-term strategies
will be explored. The first is a Visiting Professor Program for medical
schools. Nationally and internationally recognized hematologists would be
recruited and made available to visit schools and meet with students in order
to convey enthusiasm for a career in hematology, serve as positive role models
and mentors,
and
help students overcome the barriers that may be preventing them from entering
hematology. The second strategy is to address the increasing problem of debt
burden borne by medical school graduates that causes many to enter more procedurally
oriented, higher paying fields. Jointly, ASH and NHLBI will consider
development of a loan repayment program, particularly for trainees choosing an
academic research career in non-malignant hematology.
One of the major barriers to
recruitment and retention identified by the group is the lack of a viable
business model for non-malignant hematology practice. The group suggested that
hematologists need to develop a practice model, similar to those that have been
implemented by hospitalists, diabetologists, and infectious disease specialists
(e.g., antibiotic utilization teams) to provide specialized inpatient and
consultative care delivery in the hospital (especially in ICU-type settings)
and outpatient clinics that includes reimbursement for “gate-keeper” services
inherent to quality hematologic care. The model would be based on the concept
that hematologists can more effectively manage care, reduce associated care
costs, and increase quality of care for patients with abnormal blood counts and/or
hemostasis/thrombosis problems. The ASH Committee on Practice and its Subcommittee
on Quality have already initiated a research project to determine the value
added by a hematologist. As pilot programs would need to be created and tested,
ASH will need to identify health systems, payors, and large practice groups
with which to collaborate.
Many graduates of training programs
enter practices in which they care for patients with diverse hematologic and
oncologic diseases. As time passes, hematology skills may diminish and
ultimately be lost. In discussing how best to assist hematologists in
maintaining their skills and knowledge base, the group suggested that ASH
develop refresher courses in hematology. The group recommended that ASH develop
an educational program for hematologists on how to diagnose and manage
classical hematologic problems, including a plan for how to reach other
non-hematology health practitioners who need education on the management of
common hematology-related illnesses and when to request a hematologist consult.
Improving the recruitment and retention of
hematologists will require the collaborative efforts of ASH and NHLBI and both
short- and long-term strategies. A multifaceted approach that engages all ASH
members and involves many committees of the Society will be needed. ASH is
eager to partner with NHLBI in the development and implementation of the
short-term strategies as outlined above and to begin seeking innovative
solutions to ensure the future of the hematology profession.
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