Exploring the Utility and Significance of an Adult Academic Non-Cancer Hematology Clinic

Background:

Current projections suggest that the demand for adult hematologists will exceed the existing supply in the United States. Despite this, academic centers' hiring practices and fellows' future career choices appear to place an emphasis on oncology over non-cancer hematology.

Objective:

The primary objective of this study was to assess the overall utility and importance of a clinic dedicated to non-cancer blood disorders within a single academic center by analyzing referral characteristics and select patient demographics.

Methods:

This study is a retrospective chart review of 755 adults seen in a new single-provider clinic for adults with non-cancer blood disorders within the division of hematology oncology at an academic center between February 2020 and July 2023. This clinic was telemedicine only (video visit or phone visit) between February 2020 and August 2022, after which the clinic switched to a hybrid format. Data analysis included specialty of referring provider, reason for referral, and patient demographics including age, sex, and geographic location. Financial returns for the clinic in the fiscal years 2020-2023 were also analyzed.

Results:

Of the 755 patients analyzed, 318 were male and 437 were female, with a median age of 53 years (minimum 17 years and maximum 100 years). Referred patients were from 209 unique zip codes in 92 unique cities with a catchment radius of 340 miles to the north and south, and 94.5 miles to the east and west. One third of referrals were from outside of the UCI Health system. Of the 31 referring specialties, Family Medicine (21.25 %), Internal Medicine (18.19 %), and Hem Onc (17.75%) were the top referrers. The most common reason for referrals were anemia (30.58%), cytopenia (23.23%), and thrombosis/hemostasis (including pre-op clearance) (22.32%). The productivity averaged over the last 3 years the clinic was open was 40% above the defined clinic operation target benchmark. The top 3 common health insurances for the fiscal year 22-23 were managed care (33.78%), Medicare (31.65%), and commercial contracted (28.12%).

Conclusion:

This data analysis demonstrates the growing need for adult hematologists with expertise in non-cancer blood disorders and the high utility and financial revenue potential for non-cancer hematology clinics. Given the vast catchment area of patients being seen, the expertise necessary in the diagnosis and management of non-cancer blood disorders truly shows its value. Furthermore, with such a sizable proportion of referrals originating from other hematology/oncology doctors (3rd highest volume of referrals), it can be inferred that a 2nd opinion from a benign hematologist is valued by those in the field as critical in the diagnosis and management of their patients.