The role of hematologists in a changing United States health care system

Abstract

Major and ongoing changes in health care financing and delivery in the United States have altered opportunities and incentives for new physicians to specialize in nonmalignant hematology. At the same time, effective clinical tools and strategies continue to rapidly emerge. Consequently, there is an imperative to foster workforce innovation to ensure sustainable professional roles for hematologists, reliable patient access to optimal hematology expertise, and optimal patient outcomes. The American Society of Hematology is building a collection of case studies to guide the creation of institutionally supported systems-based clinical hematologist positions that predominantly focus on nonmalignant hematology. These roles offer a mix of guidance regarding patient management and the appropriate use and stewardship of clinical resources, as well as development of new testing procedures and protocols.

Associations between hematology/oncology fellows’ training and mentorship experiences and hematology-only career plans

“…7 Despite these indicators that hematology/ oncology fellowships are attractive to trainees in general, that nearly all future hematologists train in combined fellowship programs has caused concern in the hematology community that hematology/ oncology fellows do not receive adequate preparation and exposure to hematology patients to motivate them to choose careers in hematology. 8,9 Further, some observers have suggested that declines in National Institutes of Health funding for new investigators may discourage aspiring physician-scientists from pursuing careers in fields such as hematology that place a strong emphasis on academic practice and research grant funding. 10 These concerns about whether fellows will pursue hematology are particularly acute given perceptions that the specialty is likely to lose many practicing hematologists to retirement, whereas the demand for hematology services continues to increase.…”

Development of a virtual benign hematology consultation service: results of a pilot project involving 5 medical centers

“…There is a need for physicians with adequate training, experience, interest, and expertise in assessing and treating patients with these disorders. [1][2][3] Some hematologic issues are complex and require in-person histories and examinations, whereas others can be handled with advice electronically after a thorough chart review. 4 To improve the quality of the care provided to these patients, a virtual benign hematology consultative service was created.…”

“…The future of benign hematology as a specialty is being shaped by restructured reimbursement models, changes in the workforce supplying this care, and fellowship programs developing an emphasis on training physicians in malignant hematology and oncology. 3 Opportunities to leverage the expertise of fewer physicians with experience in caring for patients with benign hematologic conditions would add significant value to health care systems. This was a pilot program to assess the feasibility of a virtual hematology consultative service, whereby a larger number of patients with hematologic abnormalities can have their cases reviewed by an expert.…”

Impact of Hematology Electronic Consultations on Utilization of Referrals and Patient Outcomes in an Integrated Health Care System

“…2,4,10,11 E-consults may be a cost-effective tool to the address the growing demand for hematologists. 4,[11][12][13] A report on early experiences in our health care system found rapid uptake of hematology e-consults among clinicians and quicker response times than face-to-face (FTF) consults. 6 Other reports have suggested that e-consults averted FTF visits, 10,14 were appropriate in the nature of the referral question, 10 and were useful in questions about gammopathy, 15 thrombosis, 16 and peripheral blood smear interpretation.…”