Blood specialists in demand as caseloads grow

It might not have the TV glamour of emergency medicine or the wonder of neurosurgery. But hematology—the study of blood diseases—could be among the medical specialties in highest demand, as the numbers of such specialists dwindle while caseloads grow yearly.

That could mean longer wait times for patients with thrombotic and hemorrhagic disorders, such as anemia, sickle cell disease, obstetric hematologic conditions and rare genetic hematologic diseases.

A 2019 survey of 2,500 practicing hematologists conducted by the American Society of Hematology and George Washington University found that 46% reported a shortage of so-called “classical hematologists”—those who specialize in the study, diagnosis, treatment and prevention of non-cancerous blood disorders.

Cancerous blood disorders, on the other hand, are usually handled by oncologists, sometimes called “hematology oncologists.” The demand for both hematology and oncology specialists is increasing due to the growing elderly population, more cancer cases and a swell of retirements in the field.

The dearth of classical hematologists “has left many patients stranded and health care systems struggling to cope,” said a September 2023 article in MDedge, a network of specialty-specific websites and publications.

In response, an Indianapolis medical practice is trying to train more early-career physicians in the field of hematology to reverse the trend of dwindling numbers of physicians entering the field.

Innovative Hematology/Indiana Hemophilia & Thrombosis Center runs a Partners Physician Academy where top hematology leaders from across the country offer expertise and support to young physicians.

This year’s academy, which ran last month, offered topics such as coagulation labs, platelet disorders, hemophilia management, and women’s health and reproductive bleeding.

Dr. Amy Shapiro, the organization’s CEO and co-medical director, said the training in academies such as hers is needed to stem the decline in national training for hematologists.

“Over time, the number of people who have specialized in what we call classical hematology has dwindled,” Shapiro said. “That’s affected the training of fellows when they do their fellowship so that they get not only less patient volume … but less mentoring and expertise in terms of teaching in those areas.”

Physicians who find mentors are more likely to specialize in hematology, physicians say.

Dr. Mukul Singal trained at Rochester General Hospital, where he did his residency and fellowship, and found several mentors who encouraged his study in the field.

“I was exposed to people who were focusing on classical hematology, who were focusing on bleeding and clotting disorders,” he told IBJ. “And I found it to be fascinating.”

Singal, who got his medical degree in India, originally wanted to be a cardiologist. But when he was exposed to hematology, “that sort of ignited the passion and then just one thing led to another.”

A few years ago, he learned about Shapiro’s five-day program in Indianapolis. He applied and was accepted for a training spot.

After attending the academy and completing his fellowship in New York, he was offered a position with Shapiro’s organization, based on the northwest side of Indianapolis, where he now serves as an adult hematologist.

The Indiana Hemophilia and Thrombosis Center, which has 22 physicians and about 250 employees, is the only federally recognized hemophilia treatment center in Indiana and one of the largest in the U.S., Shapiro said.

It treats about 3,000 patients with bleeding disorders and about 3,500 patients with thrombosis, which are blood clots within blood vessels.

“So we treat patients throughout the state, all over the state, with bleeding and clotting disorders and all sorts of different bleeding disorders,” Shapiro said.

In addition to treating patients who have appointments at the organization’s large clinic on Naab Road, the center also takes its care on the road in the form of outreach clinics.

“We have care providers, including nurses and advanced practitioners, who are embedded within communities around the state that help provide local care and follow-up as well,” Shapiro said. “And this includes the plain community or the Amish community, and that is how we have leveled their standard of care to a national standard of care. Otherwise, their access to care was very limited.”

But the shortage of hematologists is causing a pinch in hospital systems and medical practices across the United States. A report from the American Society of Clinical Oncology projects a shortage of 2,250 hematologists/oncologists by next year.

The cause of the classical hematology shortage can be traced to a dramatic reduction in the number of physicians trained in this field, Dr. Leonard Valentino, president of the National Bleeding Disorders Foundation in New York, said in an interview last year with MDedge.

“There is a vicious cycle where there’s not enough classical hematologists to be program directors, and therefore trainees are often steered to fellowships in oncology,” he said.

Another reason: Financial pressures are diverting medical students from becoming classical hematologists, as hematologist-oncologists can make three times the salary, Valentino said.

“Malignant diseases and oncology are, I hate to say this, more lucrative than non-malignant diseases,” Shapiro said. “And so people may, I think, gravitate towards that.”

She added: “They also may feel intrinsically that taking care of individuals with cancer or malignancy is of greater interest to them. You feel like you know, you’re, oh, you’re helping someone at one of the worst times of their lives.”

Meanwhile, non-malignant bleeding disorders, which are largely attended by classical hematologists, are often chronic diseases that need treatment for years.

So what does that mean for patients?

“Oh, that’s a hard one to categorize,” Shapiro said. “A lot of these patients with these hematologic disorders end up getting seen by what we call hematology oncology physicians without necessarily expertise in this particular area—say, bleeding or thrombosis. And so they may be able to access the provider, but they’re not necessarily accessing best care or somebody who really specializes in that area.”

Perhaps in response to the growing need for more trained hematologists, some medical schools are punching up their websites to make the field look more attractive.

“All hematologists solve mysteries,” says the UCLA School of Medicine website. “Acting as blood detectives, they trace a patient’s symptoms to their causes. They might explain a low white blood cell count before unraveling a confounding clotting issue.”

Several medical schools and hospitals were featured in an hour-long documentary that aired on Discovery Health in 2008 (and is still available on YouTube) called “Blood Detectives,” which focuses on the medical mysteries and lifesaving work of hematologists, “as they race against time to unravel medical mysteries and save lives, from leukemia to blood clots and more,” one promo said.

And many hematologists express a note of pride when they discuss their field.

“I live, eat and drink bleeding disorders,” Singal said. “So this was the natural choice.”•