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Planning for the future workforce in hematology research

W. Keith Hoots, Janis L. Abkowitz, Barry S. Coller and Donna M. DiMichele

Article Figures & Data

Figures

  • Figure 1

    New Investigator–initiated R01 principal investigator awards. Shown are the numbers of principal investigators applying to (PIs Apps, red) and funded by (PIs Awarded, blue) the NHLBI DBDR beginning in fiscal year (FY) 2000 and ending September 30, 2013 (FY 2013). Each funded principal investigator is included only in the first year during which he or she applied or was funded. This includes new and established principal investigators who were funded prior to FY 2000. The graph may be said to represent the “steady-state” of new or reentering hematologic PIs funded by the NHLBI DBDR over the represented time period.

  • Figure 2

    Average age of principal investigators. Graph plots the average age of principle investigators unfunded (red) and funded (blue) by the NHLBI DBDR between the years 2000 and 2008.

  • Figure 3

    Ranking of published papers authored by investigators funded by the NHLBI DBDR in the years 1980-2010. For ranking purposes, all articles cited in Web of Science are evaluated by a proprietary algorithm developed by Thompson Reuters. The denominator is the total of top 10% (A) or top 1% (B) of papers published by any investigator funded by NHLBI in that year.

Tables

  • Table 1

    Suggested strategies for future enhancement of hematology in the United States

    1. The hematologist of the future would be
     • Expert in
      o Malignant and nonmalignant disorders of the hematopoietic, hemostatic, and lymphatic systems, and disorders of the interaction between blood and blood vessel wall
      o Hematopoietic stem cell transplantation, stem cell biology, and cellular therapies; genetics, genomics, and gene therapy; transfusion and laboratory medicine; and coagulation and vascular biology
      o The statistical and computational methods of epidemiology, quality assessment, and comparative effectiveness research applied to hematology
     • Facilitated by
      o A multidisciplinary strategy for the scientific and clinical integration of hematology with other medical and surgical fields
      o Innovative and flexible training programs
      o Board certification and recertification policies that encourage research careers
     • Supported by
      o Expanded and innovative roles in the hospital health system and laboratory
      o Funding opportunities from governmental and nongovernmental sources for
       ■ Institutional and individual training of junior physicians
       ■ Training of physician-scientists
       ■ Mentoring
       ■ Retraining
       ■ Generation and analysis of data to support this mission
    2. The recruitment of more physicians into the field of hematology requires
     • Introducing the excitement of hematologic practice and discovery to high school students through NOVA-type programming
     • Broadly demonstrating to medical students, in the classroom and hospital/clinic settings, the wide range of hematologic practice and the high impact of hematologic discoveries
     • Developing mechanisms to provide early experience in hematology research to medical students
     • Providing incentives through secure mentored research training programs that are sufficiently long to increase the likelihood of successful research funding in hematologic research
     • Providing a diverse choice of career options for residents and fellows who are considering careers in the field, including
      o Teaching the field
      o Service line specialization
      o Epidemiology and Comparative Effectiveness Research/Hospital Quality Reporting research career alternatives
    3. The primary elements of Hematology Center of Research and Training Excellence would include the following
     • Hematology research and training partnerships that would provide outstanding
      o Multidisciplinary, mentored research opportunities
      o Mechanisms to allow trainees to acquire a broad range of expertise through training opportunities at several institutional partners
      o Balanced training in malignant and nonmalignant hematology disorders
      o Opportunities for cross-training in medical and pediatric hematology for lifecycle care
      o Training in hematologic disease related to global health
      o Physical proximity between clinical and research training venues, allowing the trainee to move easily between clinic and laboratory
      o Maximized integration of hematology with other medical, surgical, and basic research disciplines to allow for
       ■ Generalized practice opportunities for those desiring a clinical career pathway
       ■ Consultative specialization
       ■ Clinical laboratory medicine and blood-banking expertise
       ■ Cross-disciplinary research opportunities with opportunities to collaborate with PhD scientists
      o Sustained and integrated NIH support for the training pathway
    4. Potential partners and strategies ensuring the future hematology workforce include
     • ASH and allied professional societies
     • Integrated support from all federal agencies including the Health Resources and Services Administration, US Food and Drug Administration, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and Agency for Healthcare Research and Quality
     • Patient-interest organizations that would encourage
      o Harnessing the collective advocacy power of patients with rare diseases
      o Partnership with genetics colleagues
     • Mobilization within the profession to
      o Advocate on behalf of itself with the support of multidisciplinary colleagues by
       ■ Capitalizing on advocacy training through ASH
       ■ Increasing national awareness through initiatives focused on national standards of hematologic health
       ■ Creating a congressional caucus on hematology
       ■ Engaging state governments and public health agencies
      o Lead the way in developing fields such as regenerative and personalized medicine
  • Table 2

    Possible work groups to address strategic goals for enhancing the specialty of hematology in the United States

    Clinical
     • Exploring hospitalist and other career enhancement opportunities through engagement of hospitals
     • Engagement with and assessing the impact of regulatory entities such as the ABIM, ABP, American Board of Legal Medicine, Accreditation Council for Graduate Medical Education, The Joint Commission, and others
     • Impact of the Patient Protection and Affordable Care Act and the Patient-Centered Outcomes Research Institute
     • Enhancing mentorship of the clinical hematologist
    Training
     • Research training: exploring opportunities for redesigning the pathway to research independence
     • Enhancing flexibility in training along clinical/translational/basic pathways with requisite “entry and exit ramps” to protect the trainee against time penalties
     • Exploring opportunities for special trainee pathways (eg, medicine/pediatrics; critical care across the age spectrum; chronic disease management across the age spectrum)
     • Fostering/expanding/supporting mentorship for research and career development
    Research
     • Enhancement of basic and clinical research mentorship
     • Centers of Excellence creation/expansion for specialized training and broadened mentorship
     • Establishment of an integrated longitudinal pathway for researcher development
     • Exploration of public-private partnership opportunities for research support
     • Creation of funding mechanisms that encourage established scientists to take risks and that support innovation
     • Development of funding mechanisms to bridge established investigators when needed to maintain a science workforce
     • Consideration of other ways to make the pursuit of translational or basic research a securer career option
    Data collection and analyses
     • Database creation and tracking of trainees in hematology
     • Modeling of societal needs and trends
     • Assessment of who should be partnering with whom and what data are critical
     • Education of the public about how hematology care and research impact their health and well-being