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,