Addressing Workforce and Infrastructure Challenges to the Growth of Hematopoietic Cell Transplantation: The System Capacity Initiative

Navneet S. Majhail, MD, MS, [1] Jeffrey W. Chell, MD, [2] Edward L. Snyder, MD [3]

2012-05-01

1Medical Director, Health Services Research, National Marrow Donor Program, Minneapolis, MN 

2Chief Executive Officer, National Marrow Donor Program, Minneapolis, MN 

3Professor Laboratory Medicine, Yale University Medical School; Director, Transfusion/Apheresis/Tissue/Cell Processing Services, Yale-New Haven Hospital 

Approximately 20,000 patients receive either autologous or allogeneic hematopoietic cell transplantation (HCT) in the United States each year. The National Marrow Donor Program (NMDP) estimates that the demand for unrelated donor HCT will double over the next decade, but our health-care system lacks the capacity to accommodate this projected growth.1,2 To understand and address workforce shortages and infrastructure limitations, the NMDP, in collaboration with the American Society for Blood and Marrow Transplantation (ASBMT) and other professional organizations, has organized a multi-year program called “Hematopoietic Cell Transplantation in 2020: A System Capacity Initiative” (www.marrow.org/SCI).

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The program commenced in September 2009 and has utilized a deliberative process model to engage professional organizations, experts, and stakeholders in a national collaborative effort (Figure 1). A steering committee oversees seven working groups (WG). Each WG meets monthly via conference call and then all WGs convene annually for a symposium. WG recommendations are prioritized through roundtable discussions and member polling (Figure 2). The program is in its third year and has developed a number of approaches designed to increase efficiency, using current capacity to identify future capacity requirements and to ensure adequate reimbursement of HCT.3 SCI is funded by the NMDP with many experts and organizations volunteering their time and talent to the program. The National Heart, Lung, and Blood Institute partly funded the Year-II symposium (1R13HL110705-01).

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Year 1 focused on needs assessment. WGs calculated future capacity, and recommendations were reviewed and prioritized in a one-and-a-half-day symposium in September 2010. Year 2 emphasized data analysis and development of actionable pilot projects. Recommendations were further prioritized in a subsequent symposium in September 2011. Year 3 of the program is in progress and is focusing on establishment of metrics for program evaluation, implementation of pilot demonstration projects, and dissemination of findings (Fig. 2).

Beyond Year 3, the momentum created by the initiative will encourage target organizations to continue support of priority programs. For example, the Physician Workforce WG is chaired by Linda Burns, MD, ASH vice president, and includes representation from ASH, ASBMT, and transplant physicians. To identify HCT physician recruitment and retention barriers, the WG collected data from focus groups (targeting fellowship program directors and fellows) and webinars (targeting fellows) and conducted a survey of ASBMT members. Based on these assessments, an elective course for fourth-year medical students and first- and second-year residents is under development that would provide early exposure to HCT as a career path. Another byproduct of the assessments has been the incorporation of a new program for fellowship directors into the schedule of ASBMT’s annual meeting. Other initiatives are under development to aid in understanding workforce capacity and to improve recruitment and retention rates for physicians.

With the growing health-care needs of the U.S. population, workforce and infrastructure challenges are relevant for many medical specialties. Hematopoietic Cell Transplantation in 2020: A System Capacity Initiative can serve as a template for the transplant community and for other specialties that are experiencing or anticipating workforce and infrastructure shortages.

  1. Gajewski JL, LeMaistre CF, Silver SM, et al. Impending challenges in the hematopoietic stem cell transplant physician workforce. Biol Blood Marrow Transplant. 2009;15:1493-1501.
  2. Majhail NS, Murphy EA, Omondi NA, et al. Allogeneic transplant physician and center capacity in the United States. Biol Blood Marrow Transplant. 2011;17:956-961.
  3. Majhail NS, Murphy EA, Denzen EM, et al. The National Marrow Donor Program’s Symposium on Hematopoietic Cell Transplantation in 2020: a health care resource and infrastructure assessment. Biol Blood Marrow Transplant. 2012;18:172-182.

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