A meeting to address this question was held in late January and appropriately focused on ensuring the future of our field. In a joint effort by ASH and the National Heart, Lung, and Blood Institute (NHLBI), members of the two organizations met to launch a new initiative aimed at recruiting and retaining hematologists, particularly in non-malignant areas of expertise. I had the opportunity to attend this meeting, which was led by Dr. J. Evan Sadler, ASH president-elect, and Dr. Keith Hoots, director of the NHLBI Division of Blood Diseases and Resources. The primary goal was to identify ways our organizations can work independently and together to strengthen hematology as a profession. The group discussed emerging opportunities in hematology, projected workforce needs, barriers to trainees pursuing and sustaining a career in hematology, and current programs and resources.

Four major topics emerged:

  1. We need to increase the pool of trainees entering the field by reaching out to “undecided” trainees and sharing the enthusiasm and vision we have for the field of hematology.

  2. For those interested in pursuing hematology as a career, we must identify opportunities for broadening the practice of hematology, both in academic and non-academic settings.

  3. In order to sustain life-long careers in hematology, we need to diversify sources of funding to include institutions, reimbursement from public and private insurers, and programs that attract NIH funding.

  4. We must enhance the profile (“value-added”) of a hematologist’s involvement in patient care to patients, referring physicians, and payors.

To encourage early-career trainees to enter hematology, two short-term strategies will be explored. The first is a Visiting Professor Program for medical schools. Nationally and internationally recognized hematologists would be recruited and made available to visit schools and meet with students in order to convey enthusiasm for a career in hematology, serve as positive role models and mentors,

and help students overcome the barriers that may be preventing them from entering hematology. The second strategy is to address the increasing problem of debt burden borne by medical school graduates that causes many to enter more procedurally oriented, higher paying fields. Jointly, ASH and NHLBI will consider development of a loan repayment program, particularly for trainees choosing an academic research career in non-malignant hematology.

One of the major barriers to recruitment and retention identified by the group is the lack of a viable business model for non-malignant hematology practice. The group suggested that hematologists need to develop a practice model, similar to those that have been implemented by hospitalists, diabetologists, and infectious disease specialists (e.g., antibiotic utilization teams) to provide specialized inpatient and consultative care delivery in the hospital (especially in ICU-type settings) and outpatient clinics that includes reimbursement for “gate-keeper” services inherent to quality hematologic care. The model would be based on the concept that hematologists can more effectively manage care, reduce associated care costs, and increase quality of care for patients with abnormal blood counts and/or hemostasis/thrombosis problems. The ASH Committee on Practice and its Subcommittee on Quality have already initiated a research project to determine the value added by a hematologist. As pilot programs would need to be created and tested, ASH will need to identify health systems, payors, and large practice groups with which to collaborate.

Many graduates of training programs enter practices in which they care for patients with diverse hematologic and oncologic diseases. As time passes, hematology skills may diminish and ultimately be lost. In discussing how best to assist hematologists in maintaining their skills and knowledge base, the group suggested that ASH develop refresher courses in hematology. The group recommended that ASH develop an educational program for hematologists on how to diagnose and manage classical hematologic problems, including a plan for how to reach other non-hematology health practitioners who need education on the management of common hematology-related illnesses and when to request a hematologist consult.

Improving the recruitment and retention of hematologists will require the collaborative efforts of ASH and NHLBI and both short- and long-term strategies. A multifaceted approach that engages all ASH members and involves many committees of the Society will be needed. ASH is eager to partner with NHLBI in the development and implementation of the short-term strategies as outlined above and to begin seeking innovative solutions to ensure the future of the hematology profession.