Replenishing the Ranks: We Need Some New Hematologists …

Associate professor in the Department of Medicine, Division of Hematology and Oncology, at the University of North Carolina School of Medicine in Chapel Hill

One of my attendings once mourned that we – non-neoplastic hematologists, that is – were the dinosaurs in the last days before the asteroid hit. I was flattered that I, as a mere fellow, was included in the select soon-to-be extinct group. I was, and am still, excited to pursue a career path that relatively few people seem to find as inspiring as I do.

The longer I’ve lumbered along through my career, though, the more I’ve come to the realization that we hematologists have to evolve, or we really will face the fate of the dinosaurs. We have to open up more viable career paths for junior trainees or we won’t be able to attract the critical mass of successors we will need to if we are to survive. We need to inspire trainees to become hematologists. The time to do this is in medical school or residency, since it is rare for a fellow to turn his or her sights away from oncology and toward non-malignant hematology.

Plenty of people much smarter than me have been working on the problem of recruitment and retention for years. In 2012 and 2013, the National Heart, Lung, and Blood Institute held workshops on the future workforce in hematology research, the conclusions of which have been published in Blood.1 I’d like to offer a few additional measures to help us spread the good word about hematology.

It Starts with the Medical Students

To attract new talent, we have got to make ourselves the coolest specialists out there. We have to have the best-taught courses and the most enthusiastic instructors – the people who show how our specialty is the easiest to understand and apply.

Students are drawn to the things they are good at, so we should strive to make them good at hematology. This calls for hematologists who know how to educate.

To this end, I am eternally grateful that ASH has decided to sponsor the Medical Educators Institute (MEI) to, essentially, teach the teachers how to teach, how to get funded to teach, and how to show the value of their teaching. We will be inspiring the folks whom we want to inspire the next generation of students to become hematologists. In my opinion, this is supremely cool.

There’s More Than One Way to Be a Hematologist

To grow our ranks, we also have to demonstrate that there are viable career paths for people who love hematology but who don’t necessarily want to be R01-funded basic science or translational investigators. Great kudos to the people who are, though, as it’s getting harder and harder to become one of these precious few, but this is definitely a topic for another day.

Let’s highlight some of the other career paths that hematologists could be pursuing, including, but not limited to:

  • Educators: Hematology and medical education go hand in hand, which is another reason that the MEI is so interesting: It draws attention to a career pathway for students who want to be medical educators. That ASH (and, to my knowledge, no other medical sub-specialty) would sponsor such an enterprise only serves to emphasize that ASH places a priority on medical education.
  • Systems-based clinicians: ASH’s idea of the systems-based hematologist is brilliant. These individuals would be funded by the hospital to provide critical, hospital-based consultations on patients with complex disorders of hemostasis, thrombosis, and cytopenias. They could serve as medical directors for stewardship of costly, potentially dangerous drugs for use in bleeding and clotting disorders (e.g., prothrombin complex concentrates, recombinant activated factor VII, idarucizumab, recombinant porcine factor VIII, and clotting factor concentrates). They could also function as arbiters of laboratory testing for disorders such as heparin-induced thrombocytopenia or atypical hemolytic-uremic syndrome. And they would be primarily hospital system-based hematologists, rather than community oncologists. (Editor’s note: For more information about the role of the systems-based hematologist, see our article from the March 2015 issue.)
  • Other health systems positions: Many hematologists undergo additional fellowship training in either coagulation, transfusion medicine, or vascular medicine to acquire skills that make them valuable to health systems (for example, administering for a blood bank or working in a coagulation laboratory or pharmacy). These are useful skills and vital positions – not to mention that they also come with “hard money” (i.e., funds not dependent on grants).

These are just a few ideas to help ensure that my colleagues and I don’t end up as the last hematologists standing. What else should we do to make sure we don’t end up going the way of the dinosaurs? Let us know your ideas at [email protected].


Reference

  1. Hoots WK, Abkowitz JL, Coller BS, DiMichele DM. Planning for the future workforce in hematology research. Blood. 2015;125:2745-52.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

Have a comment about this editorial? Let us know what you think; we welcome your feedback. Email the editor at [email protected].

SHARE