The Practicing Hematologist

By Daniel Rosenblum, M.D.
Dr. Rosenblum is currently a Medical Officer in the Department of Hematology-Oncology for the U.S. Food and Drug Administration.

With this issue, the American Society of Hematology launches a new venture, a publication designed in large part to target the practicing hematologist, as well as academicians and scientists. It is the intention of this publication and of the Society as well to address the interests and concerns of members who devote a substantial part of their professional lives to the practice of the discipline of Hematology. We have spent a long time searching our souls in pursuit of a description of those members. What are their interests? What are their concerns? What do they want from their Society? What can the Society give them?

ASH's surveys have shown that roughly two thirds of our membership spends at least half of its time delivering patient care in private offices, outpatient facilities, and hospital settings. A small segment confines itself to a subspecialty within hematology, another group includes “pure hematologists,” but the bulk spend a substantial part of their time delivering care to patients with solid “non-hematologic” tumors. Beyond that, the diversity increases.

For some, hematology is the exciting part of their lives and the Society enables them to maintain intellectual currency with scientific advances in which hematology remains at the cutting edge. They flock to the educational sessions at the annual meeting in December and treasure the Education Book. No effort by the Society in recent years has been more enthusiastically endorsed by the members.

For others, hematology has been a tough way to make a living. To be effective, the hematologist must remain an intellectually competent problem-solver with a continually refreshed fund of knowledge, able to recognize and treat rare entities and their even rarer variants. The task is difficult, the overhead high, and the remuneration ebbing. From this perspective, the practitioner is overworked and underpaid and the Society is an expected source of support.

Once again diversity complicates the issue. Some of us work in areas saturated with hematologists; others are among a handful in a population of a million or more. Some compete with large centers; others work in those centers. Some of us are on institutional salaries, some receive part of our income based on productivity, some are self-employed, some are employee-owners of professional associations, some are contractors with regional or national networks, some are entirely fee-for-service. For some of us, the majority of our income is derived from the government (Medicare or Medicaid, Veterans Administration, U.S. Military, Public Health Service, Health and Human Services, National Institutes of Health). For others it is derived from private indemnity insurance plans, HMOs, or self-insured. Some of us have used our skills to great economic advantage while others have found health care economics confusing and burdensome, a distraction from our professional interests. Thus, while the state of being overworked and underpaid is pervasive, the conditions under which it occurs and the remedies may be quite different.

The challenge of this publication is to seek ways to address our diverse needs, to create a forum for discourse, and to move us forward in these trying times when health care costs are soaring and payment for cognitive skills is plummeting. Just as our scientific curiosity has led us to direct the course of medicine into a cellular, subcellular, and molecular understanding of normal and pathologic function, so our problem-solving skills should enable us to lead physicians to solve the problems associated with the delivery of health care so that hematologists and other “cognitive” physicians can expect a reasonable work load and fair remuneration.

If the problems were simple, others would have solved them. It is when the problems are difficult to comprehend that others call upon us. It is a characteristic of our discipline that we have worked on those problems until we found solutions.