Nancy Berliner, MD: Why I Chose Hematology
||American Society of Hematology President - 2009
Chief, Division of Hematology, Brigham and Women's Hospital
Professor of Medicine, Department of Medicine, Harvard Medical School
Q: When was the moment you chose hematology?
A: My decision to become a hematologist evolved over my first year of training in medicine. I found that I loved taking care of patients with hematologic diseases, because they had illnesses that were complex and challenging, and because caring for them required a broad base of knowledge of general medicine. The rewards of taking care of these patients was enhanced by the fact that it was a field where it was easy to make a link between the patients' illnesses and the basic research that could enhance their therapy. Finally, and perhaps most importantly, my most revered mentors were hematologists who inspired me with their clinical skill and their grasp of the basic biology of the diseases they treated.
Q: Why do you think it is important for people to get involved in this field?
A: Hematology is an incredibly exciting field where current discoveries at the bench are offering promise to make a real impact on the survival of patients with life-threatening hematologic diseases. Furthermore, hematologic problems are an accompaniment to disease in nearly every realm of medicine, and hematology consultative expertise plays a vital role in the spectrum of clinical care in every specialty in medicine. Hematology offers exciting opportunities in basic science as well as in clinical and translational medicine. It offers the opportunity to do compelling and relevant cutting edge research, to care for patients with fascinating hematologic disorders, and to contribute to the care of complex patients with the full spectrum of primary diseases outside of hematology.
Q: In your experience, what is the most difficult or challenging aspect of becoming a hematologist in the United States?
A: Benign hematology offers primary care to a small patient population and is otherwise mostly devoted to consultative medicine. Consequently, individuals with a primary focus on hematology must almost always find their "home" in academia. Those in clinical practice must combine hematology with another subspecialty to have an adequate volume of practice, usually oncology. In a busy clinical hematology/oncology practice, hematology is frequently the least popular and relatively neglected part of the practice. This is aggravated by the fact that the care of hematology patients does not allow for as much income from procedures and drug infusions as oncology. Consequently, although hematology care is critically important both to patients with primary hematologic disease and as a consultative resource to patients with a wide range of other primary diseases, there is a growing shortage of physicians with the necessary expertise to provide that care.
Q: How do you feel advances in technology (recent or past) have helped you along the way, be it in your studies or in general practice?
A: Hematology research has flourished in the era of molecular medicine. The explosion in molecular biology and genomic technology has transformed research into hematologic questions and provided critical insights into disease mechanisms. This has had an immediate impact on clinical care, with the advent of targeted therapies, developed in response to our understanding of the molecular basis of disease. The "poster child" for such advances is the development of imatinib for the treatment of chronic myelogenous leukemia (CML). Discovery of the molecular abnormality that causes CML led to the demonstration of altered enzyme activity induced by the mutation gave rise to the disease. From there, scientists developed an enzyme inhibitor that could be administered as an oral pill, transforming this almost uniformly fatal disease into a chronic and treatable illness with patients kept in long term remission with a daily pill.
Q: What do you find to be most rewarding about a career in hematology?
A: Hematology is a fascinating field in which to do research and care for patients. I have had a very fulfilling career dividing my time among a varied collection of pursuits: primary research on blood cell development, clinical care of patients in an academic medical center, and the opportunity to teach and mentor trainees in medicine and hematology.
Q: Finally, what advice might you have for a younger person who will be pursuing a career in this field?
Almost all hematology training is accomplished through combined training with oncology. If you are especially interested in hematology, make sure to find a program that allows for excellent and intensive hematology training in the context of a combined fellowship.