According to the Association of American Medical Colleges (AAMC), the United States is projected to face a shortage of 37,800–124,000 physicians by 2034.(1) Contributing factors include the growth of the U.S. population, alongside its increased age and need for healthcare, which will coincide with the retirement of a large portion of the healthcare workforce.
In addition, AAMC estimates there will be a shortage of 3,800–13,400 medical specialists by 2034, noting that “…an aging population requires more complex care, and, thus, greater reliance on specialized care.” These shortages will likely impact fields including cardiology, infectious diseases, pulmonology, and hematology/oncology.(2)
The hematology/oncology specialty combines two medical fields: hematology, the study and treatment of blood disorders, and oncology, the study and treatment of cancer. Once hematology/oncology fellows complete their training, they have a decision to make: pursue a career primarily focused on malignant disorders, which is perceived to have better job availability, job security, and income potential, or choose the less common route of classical hematology.
Classical hematology refers to a broad list of non-cancerous blood disorders such as thrombotic and bleeding disorders, hemoglobin disorders like sickle cell disease, thrombocytopenia, anemia, iron metabolism disorders, obstetric hematologic disorders, and rare genetic disorders of the blood.
THE URGENT NEED FOR CLASSICAL HEMATOLOGISTS
Training in classical hematology is highly competitive, and fellowships are scarce, leading fewer fellows to pursue this training route. In 1995, the Accreditation Council for Graduate Medical Education (ACGME) offered 74 hematology-only fellowship programs, 75 combined hematology-oncology programs, and 83 oncology-only programs. By 2018, only two single-specialty adult hematology programs remained while 146 combined hematology-oncology programs and seven oncology programs were offered.(3)
Fellows’ career paths often hinge on mentorship experience during their training. An American Society of Hematology (ASH) survey of hematology/oncology fellows found that “mentorship emerged as the single most important career determinant, with mentorship opportunities arising serendipitously, and oncology faculty perceived as having greater availability for mentorship than hematology faculty.”(4)
Survey participants also largely viewed classical hematology as less lucrative, with reduced funding for research, fewer available jobs, and less job security than oncology. As such, it’s not surprising that only 5% of hematology/oncology fellows go on to practice classical hematology as their primary specialty.(5)
Classical hematologists are urgently needed. As Americans’ life expectancy increases, so does the incidence rate of hematologic disease, including thrombosis and nonmalignant blood disorders. As people age, corresponding age-related changes occur in blood vessels and components of the blood, playing a substantial role in the development of blood-related diseases and thus a greater reliance on the hematology providers who have the expertise to treat them.
PARTNERS PHYSICIAN ACADEMY — MEETING THE NEED
Our challenge is clear: If new medical students have fewer classical hematology-focused training opportunities and are drawn to higher-paying and better-funded areas of medicine while their predecessors are retiring out of practice, what can be done to support the growing need for classical hematologists by the American population?
Classical hematology leaders have recognized that more exposure, more experiences, and more expert voices in the field are required for hematology/oncology fellows to consider the classical hematology field.
We’ve taken the challenge seriously, successfully launching Partners Physician Academy (PPA) in 2022. The academy is a classical hematology education program — the only of its kind in the United States — designed to support and accelerate the career development of physicians in fellowship, early career, or working in a leadership role at a hemophilia treatment center (HTC). Hosted in Indianapolis, the program is generously funded by a grant from The Hemophilia Alliance and The Alliance Pharmacy and is supported by Innovative Hematology/Indiana Hemophilia & Thrombosis Center staff.
The objectives of the Partners Physician Academy are to:
Support physicians working or intending to work as part of the U.S. federally recognized HTC network.
Assist with physician onboarding at HTCs.
Support physicians to effectively perform in an assistant or medical director role at an HTC.
Create a forum to address hemostasis educational and training gaps during or following fellowship.
Develop new, collaborative opportunities to support continued mentorship throughout the careers of PPA participants.
Deepen the commitment of participants to the bleeding disorder community and increase retention in the hematology field.
Since its inception, more than 50 participants from 30 institutions across 25 states have taken part in the PPA five-day interactive bleeding disorders-focused educational program.
Didactic presentations, challenging clinical dilemmas, interactive case discussions, debates, small-group breakouts, hands-on technical training, exchange with patients and community members, and direct interaction with nationally recognized HTC and organizational leaders are all designed to increase retention in the classical hematology field. These forms of engagement are unlike anything participants would have experienced in their hematology/oncology training.
The Partners Physician Academy improves participant knowledge of inherited bleeding disorders, classical hematology research, career development, national landscape, and HTC administration. More than 95% of participants strongly agree that the program increased their knowledge and confidence in treating patients with bleeding disorders.
In the 2024 program, knowledge assessment scores rose from 61% before PPA to 88% at the conclusion of the educational program. All participants stated they would recommend the program to their peers and indicated the program increased their level of connection and networking support within the bleeding disorders community. Studies are planned to determine if the program contributes to the retention of participants within the field of classical hematology.
LOOKING TO THE FUTURE
In the next 10 years, the U.S. population is expected to increase by 8.4%, from 331.9 million to 359.7 million people. The 65 and older group will increase by 34.1%, largely because of 54.7% growth of the 75 and older group. These groups are disproportionately affected by age-related diseases such as diabetes, cardiovascular disease, and cancer.(1)
As healthcare leaders in primary care, endocrinology, cardiology, pulmonology, and other specialties look ahead to the next decade, these and other fields of medicine could benefit from a similar approach to the one we adopted for classical hematology, to address projected workforce shortages.
Important questions to consider include whether prospective fellows expressed a desire for more hands-on experiences, mentorship, or training, and whether leaders in the field are willing to collaborate to share their expertise and offer meaningful programming to encourage greater interest and improve talent retention.
We are witnessing the U.S. population increase in size and live longer — but not necessarily healthier — lives. Current healthcare leaders can help plan for the next generations of physicians by providing them with the necessary experience to excel in their field through the next 20 to 30 years.
REFERENCES
GlobalData Plc. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. Washington, DC: AAMC; 2024. Accessed November 11, 2024. https://www.aamc.org/media/75236/download?attachment .
Association of American Medical Colleges. AAMC Report Reinforces Mounting Physician Shortage. AAMC Press Release. June 11, 2021. Accessed November 11, 2024. https://www.aamc.org/news/press-releases/aamc-report-reinforces-mounting-physician-shortage .
Masselink LE, Erikson CE, Connett NT, De Castro LM, et al. Associations Between Hematology/Oncology Fellows’ Training and Mentorship Experiences and Hematology-only Career Plans. Blood Adv. 2020;3(21):3278–3286. Accessed November 11, 2024. https://doi.org/10.1182/bloodadvances.2019000569
Sharma D, Wallace N, Levinsohn EA, et al. Trends and Factors Affecting the US Adult Hematology Workforce: A Mixed Methods Study. Blood Adv. 2019;3(22):3550–3561. https://pubmed.ncbi.nlm.nih.gov/31738829/ . Accessed November 11, 2024.
Association of American Society of Hematology. Classical Hematology: A Specialty in Decline? ASH Clinical News. November 2021. Accessed November 11, 2024. https://ashpublications.org/ashclinicalnews/news/1409/Classical-Hematology-A-Specialty-in-Decline .