ASH Clinical News December 2014 | Page 69

FEATURE Adapting to Changes in Practice-Based Hematology I t is not news that the practice of hematology today looks much different than it did in 1958 when the American Society of Hematology was established. As 2014 draws to a close, practicing hematologists are finishing their first year having been faced with new board certification requirements, reimbursement policies, and the launch of the Patient Protection and Affordable Care Act health exchanges. Faced with this changing landscape, throughout 2013, in an effort to be proactive and strategically focus the future initiatives of ASH’s Committee on Practice (COP), a planning task force was charged with examining the current COP activities, identifying and prioritizing the major issues affecting the practice of hematology, and providing specific recommendations to the COP for short- and long-term priorities. As part of that process, the COP initiated a research survey designed to gather a current and comprehensive understanding of its practice-based clinical community of members and their needs. “We decided to do this survey because of the challenges we felt are facing practicing hematologists,” said Steven Allen, MD, chair of the ASH Committee on Practice and associate chief of hematology at the North Shore-LIJ Cancer Institute. “The practice environment has changed tremendously over the past few years, and we felt it was important to determine what the current demographics of practicing hematologists are, and what issues they are facing so that ASH could align its programs and policies to meet the needs of the practicing hematology community.” Recently, ASH Clinical News spoke with Dr. Allen and other practice-based hematologists about the current state of their practices, the results of the ASH COP survey, and whether or not they feel the survey results accurately reflect the current state of practice-based hematology in the United States. What follows are some of the findings from the survey. ASHClinicalNews.org Many Hematologists Are Starting Down the Road to Retirement In 2013, a Survey of Practice-Based Hematology was sent to 5,081 physicians, who represented U.S. ASH members classified as practice-based/clinical physicians who see patients for at least 40 percent of their work week. The total number of physicians surveyed represented 36 percent of ASH’s entire membership. Seventy-six percent of respondents to the online survey were adult hematologists, and 18 percent were pediatric hematologists. For this analysis, 6 percent of respondents who self-identified as “retired” or “no longer in practice” were removed. The typical, or median, respondent to the survey completed his or her fellowship 18 years ago, in 1996. Overall, the proportion of respondents completing fellowship within each four-year increment since 1980 was consistent. According to Dr. Allen, one of the most surprising findings of the practice survey was that one in four respondents (24%) indicated that they are considering retiring in the next five years. “This indicates that in the near future there is going to be a manpower crisis in hematology, and the demands on the remaining practitioners and the patient loads are going to increase,” Dr. Allen said. Judith Kleinerman, MD, a practicing hematologist with Steward Medical Group Medical Specialists of Taunton, in Massachusetts, is among the group of physicians actively thinking about retirement. Dr. Kleinerman falls into the median age group of the respondents of this survey, having finished her fellowship in 1996. Until two years ago, Dr. Kleinerman worked with a partner in a two-person, private hematology/oncology practice; however, the practice is now owned by a larger medical group. “I do think about slowing down in a couple of years and, ultimately, retiring in five to six years,” Dr. Kleinerman said. “Doctors work unusually long, hard, and stressful hours and start to feel the need to slow down and enjoy life.” The Problems with Recruitment: Expectations Versus Reality With a number of hematologists considering retirement, it’s no surprise that 42 percent of respondents reported that they were actively recruiting new physicians to their groups, with the likelihood of recruitment correlating to the size of the practice (FIGURE). Eighty-three percent of respondents would only consider recruiting a physician who was board-certified or eligible in hematology by the American Board of Internal Medicine and/or board-certified or eligible in hematology-oncology by the American Board of Pediatrics. However, recruiting qualified candidates may be easier said than done. Although Dr. Kleinerman said her retirement is likely still a few years away,