Hematology Workforce Shortage Poses Challenges for Cancer Care

Srikanth Nagalla, MD, MS

Demand for hematology professionals – both physicians and advanced practice providers (APPs), including nurse practitioners (NPs) and physician associates (PAs), has never been greater, yet the current and future supply continues to dwindle.

The shortage of classical hematologists is especially acute. A 2019 study, Associations between hematology/oncology fellows’ training and mentorship experiences and hematology-only career plans, found that only four percent of hematology-oncology fellows from the classes of 2018-2020 indicated an interest in focusing on non-malignant hematology.

Furthermore, over the past 25 years, the fellowship training landscape has changed dramatically, the study says. While in 1995 there were 74 accredited U.S. hematology training programs and 75 hematology-oncology programs, in 2018, there were only two single-specialty hematology programs compared to 146 combined hematology-oncology programs.¹

The study’s senior author is Alfred Lee, MD, PhD, a hematologist at Yale School of Medicine in New Haven, Connecticut. Dr. Lee leads the recruitment and retention working group at the American Society of Hematology (ASH), which was created to examine the workforce and spearhead the Society’s efforts to ensure a strong pipeline of talent in hematology, specifically non-malignant hematology.

“The changing landscape of hematology fellowship programs over time is a concern for ASH, as fellows may not be receiving adequate preparation and exposure to hematology patients with non-malignant diseases, which are often complex and require specific expertise to manage,” said Dr. Lee.

Developing future leaders in hematology education

As a classical hematologist myself, I have a compelling interest in educating and supporting future professionals – both classical and malignant specialists. A logical starting point in this endeavor is to assure an ample supply of qualified and enthusiastic hematology educators.

I co-chaired the 2022 ASH Medical Educators Institute (MEI) with Erin Reid, MD, of the University of California, San Diego. MEI helps develop future leaders in hematology education. MEI offers a "boot camp" in teaching techniques, medical education scholarship, and career development for hematologists and fellows who are new to or in the early phases of medical education careers. Approximately 15 to 20 people from the United States (US) and Canada are accepted into the program annually.

Hematologists and fellows interested in medical education careers add value to the subspecialty by sharing their excitement about hematology with medical students and residents and by ensuring that these same trainees possess the fundamental knowledge of hematology necessary for whatever careers they enter.

Participants attend a three-day, in-person workshop at ASH headquarters; complete an intensive webinar series; and benefit from regular mentorship by program faculty. (The MEI webinar series, covering nearly 20 topics, is also available to all ASH members at no charge.)

Funding for Hematology fellowships

ASH has created and fully funded a Hematology-Focused Fellowship Training Program (HFFTP) that offers physicians the opportunity to pair comprehensive classical hematology training with career-enhancing education in transfusion medicine, sickle cell disease, hemostasis/thrombosis, as well as fields like medical education, systems-based hematology, outcomes research, health equity research, global health, safety/quality improvement, lifespan hematology, and more.

HFFTP includes 10 new hematology-focused fellowship tracks within existing hematology-oncology programs at nine rigorously selected institutions accredited by the Accreditation Council for Graduate Medical Education (ACGME) across the United States. HFFTP aims to strengthen the next generation of hematologists, with the goal of producing 50 new academic hematologists by 2030.

Training and mentoring physician extenders

Advanced practice providers (APPs), including Nurse Practitioners and Physician Assistants, are playing an increasingly vital role in the practice of hematology. It behooves us to nurture and support these professionals as they assume even greater responsibility in patient care.

Ariela L. Marshall, MD, was primary presenter of a recent ASH study, Advanced Practice Providers (APPs) in Hematology: Work Practices, Interactions with Physicians, and Opportunities for Collaboration within the American Society of Hematology.² In this study, the ASH Hematology Task Force lead by Dr. Marshall, in collaboration with researchers at the GW Mullan Institute for Health Workforce Equity, conducted a series of focus groups with APPs and collaborating physicians practicing in hematology-oncology in the US.

The APPs reported receiving relatively extensive on-the-job training in their clinical focus areas, with most sites creating their own training programs due to limited availability of outside resources. While most APPs reported feeling trusted and respected by physician colleagues, some also reported current or past experience working with physicians who minimized APP contributions. Many reported limited career advancement opportunities.²

There is much work still to be done to address these concerns. Miami Cancer Institute (MCI), where I practice, has made significant progress. MCI currently has a staff of 10 classical hematology APPs. They undergo a rigorous, three-month onboarding process that includes self-study, mentoring, and daily rounding with physicians and other APPs. The APPs along with the hematology providers are able to provide quality hematology care to thousands of patients with classical hematology needs in the South Florida region.

Miami Cancer Institute and other centers across the country are reaping the benefits from all the ASH initiatives mentioned above. The classical hematology care models at centers like the Miami Cancer Institute could help alleviate the hematology workforce shortage and increase access to hematology providers.

REFERENCES:

Survey of U.S. fellows suggests exposure to hematology in medical school, mentorship vital to future of the field. News release. American Society of Hematology. October 13, 2019. Accesses January 9, 2023. https://bit.ly/3QmHwbT

Masselink LE, Erikson CE, Moses G, et al. Advanced Practice Providers (APPs) in Hematology: Work practices, interactions with physicians, and opportunities for collaboration within the American Society of Hematology (ASH). Blood. 2022; 140 (suppl 1): 1617–1618. 10.1182/blood-2022-157185