NASHVILLE--The independence of hematologists/oncologists, including
the specialty's right to determine the size of its residency programs,
is being threatened by the changes occurring in health care, Daniel
Rosenblum, MD, said at a forum on health-care reform at the annual
meeting of the American Society of Hematology (ASH).
The estimated 2,500 to 3,500 hematologists in the United States
today are unevenly distributed throughout the population, he said.
The number of hematologists/oncologists per million population
ranges from about 5 in Chicago to 42 in Washington DC, for example.
"It is hard to say that these numbers are based on the need
for hematologists by incidence of disease," said Dr. Rosenblum,
of Suburban Hospital, Bethesda, Md, and chairman of the ASH committee
He noted that the number of hematologists required per million
population has been estimated at 5, and eliminating the number
of practicing hematologists in excess of that number could save
perhaps a half billion dollars a year. With that statement, Dr.
Rosenblum initiated a discussion on the "wisdom, apart from
the economic motivation," of limiting the proliferation of
specialists, including hematologists, as has been proposed.
John Adamson, MD, of the New York Blood Center, and president-elect
of ASH, said that the society has not critically evaluated the
need for future subspecialists in hematology/oncology "to
align ourselves with the community's real needs."
He noted that two subspecialties--cardiology and gastroenterology--have
voluntarily begun to reduce the number of trainees in their fields,
but he expressed concerns about how such reductions in hematology
would be achieved. "Who will set the target for the number
of hematologists who should be in the community practicing?"
Mark Chassin, MD, former commissioner of the New York State Department
of Health, addressed the possibility of downsizing by selectively
reducing the use of unnecessary health service.