Armand Keating, MD
About two years ago, ASH initiated efforts directed at enhancing the recruitment and retention of hematologists, especially those trained in classic, non-malignant hematology. Subsequently, two ASH programs, including one co-hosted with the National Heart, Lung, and Blood Institute, identified several mechanisms by which careers in benign hematology could be encouraged, including the following: promoting nonmalignant hematology to trainees, identifying opportunities to broaden the practice of hematology, diversifying funding sources for the practice of nonmalignant hematology in both the academic and community setting, and enhancing to all stakeholders the profile of non-malignant hematologists in both patient care and research.
An area that merits the Society’s attention is the need to refresh knowledge and skills in hematology for the practicing clinician. With time, non-malignant hematology skills often diminish for those trained in hematology/oncology fellowship programs whose practice subsequently consists mainly of managing patients with maligancies. One solution to remaining current in classic hematology in the face of the ever expanding complexity of the field is the ASH refresher course. First introduced at the 2011 ASH annual meeting in San Diego, this program titled “Consultative Hematology Course” focused on challenging non-malignant hematology problems commonly encountered in both the inpatient and outpatient setting. The session attracted more than 250 attendees. Given the initial success of this program, a similar session is planned for the 2012 annual meeting in Atlanta, and, additionally, a course modeled on this format will be held in conjunction with the ASH State-of-the-Art Symposium meeting in Chicago, September 28-29, 2012.
The issue of diversifying reimbursement to the hematologist is challenging. Indeed, a major barrier to the recruitment and retention of classic hematologists is the problematic business model it creates for practices. In this context, the ASH Committee on Practice and its Subcommittee on Quality have initiated a research project to quantify the value added by a non-malignant hematologist to a group practice focused on management of patients with malignancies. As I wrote in my first column in the January/February 2012 issue of this publication, one approach to addressing the dilemma of maintaining the economic viability of non-malignant hematology is to identify new models for using these clinically essential specialists more effectively. For example, a position could be created for a hospital-based non-malignant hematologist, analogous to that of an infectious disease specialist who functions as the hospital infection control officer and who may also monitor antibiotic use. A possible title is “systems hematologist,” although that term may not fully explain the intended scope of the position. Opportunities exist to enhance the profile of classic hematology, reduce health-care costs, and improve patient care by enabling the hospital-based systems hematologist to control and monitor the use of a variety of expensive agents. Additionally, systems hematologists could deliver specialized inpatient care and provide consultative services for the hospital in both the inpatient and outpatient setting. The model would be based on the concept that hematologists can more effectively manage patients with abnormal blood counts and issues related to hemostasis and thrombosis. Such activities could include overseeing the appropriate administration of activated Factor VII, argatroban, and pro-coagulant clotting factors and managing the hospital’s apheresis program. The first step is to identify health-care systems, payors, and large practice groups with whom to collaborate and to ensure that existing reimbursement plans for consultative services to classic hematologists are not compromised but actually enhanced based on the value of their contributions to patient care and efficient use of resources.
The concept of a systems hematologist may not be new; in fact it may already may be operating successfully somewhere within our health-care system. ASH would like to have your input about what, in your personal experience, has worked (and not worked). Please contact me (firstname.lastname@example.org) or Mila Becker, senior director of Government Relations, Practice & Science (email@example.com) with your thoughts on these issues and how you have tackled the problem of sustaining non-malignant hematology in your academic program or private practice. Together, we can successfully enhance the recruitment and retention of the classic hematologist.
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