Introduction
In 2017, the American Society of Hematology (ASH) launched the largest and longest-running study of the hematology workforce ever conducted in the United States.1 The study arose from a growing concern, as articulated in a series of seminal articles by ASH, the American Society of Clinical Oncology (ASCO), the National Institutes of Health (NIH), and the National Heart, Lung, and Blood Institute (NHLBI), that a shortage in the adult hematology and medical oncology workforce was imminent, particularly in classical hematology (CH).2, 3, 4, 5, 6, 7 The study was designed to understand the scope of the workforce problem and highlight ways in which ASH might reshape medical education and clinical practice to meet these workforce challenges.
The ASH workforce study revealed the landmark observation that recruitment and retention in CH paled in comparison with those in malignant hematology or solid tumor oncology, given that <5% of fellows from all adult hematology and medical oncology (HO) training programs in the United States reported a specific career interest in CH.1 A deficit in the CH workforce in the United States was identified in relation to the very high demand for CH clinical care.5,8,9 Limited clinical exposure and research opportunities in CH compared with malignant hematology or solid tumor oncology contributed to this deficit. Trainees also viewed CH as having the lowest income potential and fewest job prospects among the 3 disciplines.
CH diseases exert tremendous societal impact. Iron deficiency affects ∼40% of menstruating women in the United States and about one-third worldwide.10,11 Gene variants for hemoglobin disorders are present in 7% of the world’s population and are responsible for 3.4% of deaths in children aged ≤5 years globally.12,13 Venous thromboembolism affects ∼1 million patients in the United States each year, and annual deaths from venous thromboembolism surpass those from motor vehicle accidents, breast cancer, and HIV combined.14 Against this backdrop, the societal burden of CH diseases is disproportionate to the level of trainee interest in the field, raising serious concerns about the ability of the emerging workforce to adequately meet patient care and research needs.
How did the field of CH, built on the legacy of legendary figures like Maxwell Wintrobe, Winifred Ashby, and others, reach this state?
In this viewpoint article, we examine how the fields of hematology and medical oncology, once a unified discipline, evolved into distinct fields, and how this evolution may have adversely impacted mentorship and training in hematology, contributing to its erosion as a field, particularly in CH. We explore the many factors shaping the US hematology workforce, the precarious landscape of hematology research funding, global hematology workforce needs, and ASH’s many initiatives to expand and advance the hematology workforce worldwide.
CH before it became classical: medical oncology’s rise and hematology’s identity crisis
Hematology during the first half of the 20th century, what Wintrobe called “The Golden Age of Hematology,” was rooted in basic science, with discoveries spanning every facet of medicine.15,16 Oncology did not exist as its own specialty yet, as hematologists provided all cancer care. James Tullis, former ASH president (1959-1960), observed the following: “Oncologists, originally, were one hundred percent just hematologists, because one of the major side effects of any chemotherapeutic drug is bone marrow depression.”17 In keeping with this, Blood was founded in 1946 and ASH in 1958, years before ASCO and the Journal of Clinical Oncology.18
Cancer funding received a major boost in 1955 with the inauguration of the Cancer Chemotherapy National Service Center by the National Cancer Institute (NCI) and formation of the NCI’s Clinical Trials Cooperative Group Program.19, 20, 21 In 1964, US president Lyndon B. Johnson established the President’s Commission on Heart Disease, Cancer, & Stroke, placing oncology front and center among the nation’s top health priorities.22 In 1971, US president Richard B. Nixon, spurred by American philanthropist Mary Lasker, signed the National Cancer Act as part of the “War on Cancer,” raising the total amount of NCI funding for cancer to $400 million in 1972 and $600 million in 1974.23,24
The magnitude of this national investment fueled the rise of investigators and clinicians dedicated entirely to cancer care. The ramifications were far-reaching, not only for cancer research but also for the emerging identity of hematology and medical oncology as a distinct discipline. In 1972, the American Board of Internal Medicine (ABIM) began offering subspecialty board examinations for hematology, endocrinology, infectious disease, nephrology, and rheumatology to formalize standards in clinical care.
B. J. Kennedy, former ASCO president (1987-1988), launched a public relations campaign petitioning ABIM to recognize medical oncology as its own subspecialty.16 The request was initially met with skepticism from ABIM and many Department of Medicine chairs, but after repeated efforts by Kennedy, ABIM eventually acquiesced, and the first medical oncology board examination was held in 1973.16,25 For these reasons, Kennedy has often been lauded as the “Father of Medical Oncology.”26
Why was there initial resistance to the idea of medical oncology as its own subspecialty? Part of this was a sense that well-trained internists or other subspecialists could sufficiently perform the work of oncologists. The American Cancer Society, in a 1961 letter, called cancer specialists “a non-entity,” whose scope of clinical care was defined on the basis of being “an internist, or a surgeon, clinical pathologist, radiologist, etc.”27 Hematologists felt particular ownership over cancer care.
Joseph Ross, former ASH president (1962-1963), recalled that the separation of medical oncology from hematology was “initially opposed rather halfheartedly by the hematologists [and] later … opposed much more vigorously.”28 Shortly after the first medical oncology certification examination in 1973, ASH passed a formal motion deploring the separation of hematology and oncology, with Helen Ranney, former ASH president (1974-1975), declaring that “The separation of the two boards is itself a denial of the capabilities and dedication of a large number of practicing hematologists to the care of patients with neoplastic disease.”16 Kennedy disagreed, writing that “If the hematologist has not participated in the progress of cancer chemotherapy and other methods of controlling cancer, he lacks the qualifications and competence of the medical oncologist to meet the needs of cancer patients, including those with leukemia, lymphoma and multiple myeloma.”29
Far from its golden age, hematology in the second half of the 20th century became progressively fragmented. Blood banking, coagulation, and thrombosis were subsumed by other fields.15,16 Lockard Conley, former ASH president (1976-1977), called medical oncology “the next great threat to hematologists.”15 Ernest Beutler, former ASH president (1979-1980), accused oncologists of wresting the “care of patients with lymphomas and leukemias,” “the very life-blood, so to speak, of clinical practice of hematology,” from hematologists, which “left the hematologist with almost nothing.”30 Reflecting on this, Kennedy wrote that “The conflict seemed to be due to an oversupply of hematologists with a decrease in demands for pure hematology. Hematologists contended that fellows could not be obtained if they could not be certified in oncology.”31 Without medical oncology, hematologists in the later 20th century did not believe that their profession could survive on its own.
To obviate this worry, Ranney, Wintrobe, and other hematologists proposed a joint hematology and medical oncology board examination, an idea that ABIM rejected.16 Instead, joint HO fellowship training with separate board examinations for hematology and medical oncology became the norm, a concept that Kennedy thought “was and still is a poor compromise.”31 By 1977, the number of candidates certified in oncology outpaced hematology, a trend that has continued ever since.32
A shared theme among former ASH presidents who were active during the years in which medical oncology gained ABIM recognition was a sense of regret over losing oncology as a profession.17,30 Conley mourned that “classical hematologists” did not “have very much left” as a result of the separation of medical oncology from hematology, leaving “relatively few hematologists, classical hematologists, who are now practicing.”15 Disparities in reimbursements for clinical care between hematology and medical oncology services raised particular concern. Beutler conjectured that the administration of “expensive chemotherapy” “gave oncologists a position of power in many medical schools, where administrators said, ‘We need more oncology,’” to the extent that it was “not feasible now for a young person to go out into practice in a community and say, ‘I take care of only patients with blood disease.’”30 Tullis decried that billing practices in the United States rendered oncologists “in control of vast amounts of money” in comparison to their hematology counterparts.17
In summary, multiple factors contributed to the diminution of hematology as a standalone profession in the second half of the 20th century, all coincident with the rise of medical oncology as its own specialty. By the new millennium, it was clear that the field of hematology needed fresh vision. Although never an advocate for hematology, Kennedy himself issued an important charge and challenge to the field, writing presciently in The Lancet in 1999: “The old concept of hematology is changing.”33
Unpacking the hematology workforce in the United States: the ASH workforce study
In 2007, ASCO conducted a large-scale study of the US oncology workforce that predicted major physician shortages in the subsequent decade based on emerging workforce trends.2 Since then, a persistent deficit in the oncology workforce has been reported in repeated studies based on supply and demand models using cancer registry data and other large data sources.7,34 Although both oncologists and hematologists have been included in these analyses, demand for clinical care in hematology has not been quantifiable because of the heterogeneity of diagnoses and practice patterns in CH.
To better understand the hematology workforce, in 2016, ASH hosted a series of focus group discussions about the state of hematology at the 58th annual ASH meeting in San Diego, CA.5 Hematology section chiefs, HO fellows and fellowship program directors, and practicing hematologists and oncologists participated in these discussions. The discussions elicited high concern about the hematology workforce, particularly in CH, with many participants raising fears regarding an imminent deficit of hematologists for clinical care in CH. Among HO fellowship program directors, 7 themes emerged, all pertaining to low interest in CH among HO fellows and poor perceptions of job and research funding opportunities in hematology compared with oncology (Table 1).
Single-subspecialty training in hematology was raised as a possible solution for mitigating the perceived hematology workforce shortage.Table 1.Themes from focus group discussions with HO fellowship program directors at the 58th annual ASH meeting in San Diego, CA, 2016ThemeQuotesClinical care in hematology exceeds the current workforce supply, particularly in CH•“I was told recently that we had 600 new patient referrals in 6 months for benign hematology. That’s 100 new patients per month and I think there are 5 of us with variable numbers of clinics. And so you can do the math.
There is a need for benign hematologists.”Interest in CH is extremely low among HO fellows•“The biggest problem that we have been having is actually retaining and maintaining people for growing … benign hematology. Malignant hematology has not held much [of a] problem, at least for our institution.”Fellows perceive lower job availability and security in hematology compared with solid tumor oncology•“I think the problem with general hematology is that … even fellows that are very well trained in general hematology are very concerned about job opportunities down the road, [whereas] they see job security in solid tumor oncology.”•“I have fellows that would love to do hematology. And I could train them to be a hematologist, but then they could not find jobs.”•“People do want to become hematologists.
They love it…. They love hematology, but ultimately, they are told by program directors, by peers, by other people that they cannot make a career on this.”•“So if the jobs [in hematology] exist, the message with the trainees is that they don’t exist. That’s a big problem.”CH has lower income potential and less funding than oncology•“Naturally, we’ve got a huge push for cancer.
So you’re not going to get your CEO and all those people to say, ‘We’re going to put more money in hematology’ … Because they know that the money [comes] from cancer.”•“I think we should really come up with ideas on how to … have more funding to benign hematology. Because that’s not where the money is.”Trainees often become interested in hematology early, yet transition to solid tumor oncology during fellowship•“Something happens during fellowship that changes people who passionately wanted to do hematology into [saying], ‘Well solid tumor isn’t that bad and I could do that and still do some hematology on the side.’ That’s what happens during fellowship.”•“I think that a disproportionate number of [fellowship] applicants are interested in malignant hematology, and then during fellowship they see the landscape a little bit more clearly and get switched to solid tumor oncology.”Single-subspecialty training in hematology may improve the hematology workforce•“If we had a program that could dissect out heme-only and really offer the curriculum that does not require them to be exposed to the solid tumor biology of having a combined heme/onc program, I think we’d be more successful in training really good heme malignancies as well as non-malignant heme folks who might want to do everything short of transplant.”•(When asked how to produce more trainees in hematology if provided with unlimited resources:) “I would create a fellowship program solely for heme.”Adapted from Sharma et al.5CEO, Chief Executive Officer; heme, hematology; HO, hematology and medical oncology; onc, oncology.
Based on these findings, ASH launched its workforce study in 2017, focusing on the adult hematology workforce, in collaboration with the Fitzhugh Mullan Institute for Health Workforce Equity at The George Washington University (Table 2).5,35 The central aim of the study was to compare perspectives among trainees and practicing physicians regarding CH, malignant hematology, and solid tumor oncology, a balance that had never before been rigorously evaluated. The study ran from 2017 to 2021 and consisted of multiple surveys and focus group discussions (Table 2).1,36, 37, 38, 39, 40 The major themes were as follows (Table 3):•Nearly half of all practicing hematologists and oncologists in the United States believed that there was a workforce shortage in CH: among practicing hematology and oncology physicians, 46% expressed concerns about a shortage of CH services compared with 31% for malignant hematology and 27% for solid tumor oncology.•Very few fellows reported having career interest in CH: during the first year of the ASH workforce study, data from a national survey of adult US HO fellows in 2018 revealed that <5% were interested in CH, a number that had not changed in 15 years (Figure 1).1,41 The low career interest in CH among HO fellows stood in stark contrast to national data showing that CH accounted for 30% to 40% of clinical care among practicing hematologists and medical oncologists.8,9,42•Fellows had fewer research and mentorship experiences in hematology compared with solid tumor oncology: fellows reported the highest levels of engagement in research and mentorship activities related to solid tumor oncology, followed by malignant hematology, with CH being a distant third option (Figure 1).•Fellows reported inadequate clinical training in CH compared with malignant hematology or solid tumor oncology: HO fellows across all years of training reported having the most clinical exposure to solid tumor oncology, followed by malignant hematology, with CH being a distant third option (Figure 1). Practicing physicians who were 1 year out of fellowship were far more likely to report insufficient fellowship training in CH (33%) than in malignant hematology (18%) or solid tumor oncology (16%).•Fellows had poor perceptions of income potential and work-life balance in hematology: fellows viewed CH as having the lowest income potential and malignant hematology as having the worst work-life balance (Figure 1).•Career interest among HO fellows began early in the training pathway: although the majority of HO fellows first began considering their chosen subspecialty during their fellowship (23%) or residency (32%) training, many could trace the origins of their career interests to medical school (29%) or earlier (13%).1•Mentorship and clinical exposure in hematology were associated with career interest in hematology: among HO fellows, interest in a hematology-focused career was significantly associated with participation in a hematology research project or having robust mentorship in or clinical exposure to hematology during fellowship training (Table 4).
Fellows with prior clinical exposure to HO as part of their core internal medicine or pediatrics rotations during medical school were also more likely to be interested in hematology-focused careers.•Although the vast majority of practicing hematology and medical oncology physicians provided clinical care in CH, only a small percentage specialized in CH: among practicing hematologists and oncologists, 91% provided some amount of clinical care in CH; however, only 10% reported CH as representing the majority of their clinical practices, and only 2% exclusively specialized in CH care.•Burnout was widely prevalent among practicing hematologists and oncologists in the United States before the COVID-19 pandemic: using a validated, single-item burnout instrument from the Physician Work-Life Study, 37% of practicing hematology and oncology physicians reported burnout in 2019, whereas 12% reported a high level of burnout.36 In multivariable analyses, high burnout was significantly associated with compensation plans based solely on relative value unit generation, suggesting that clinical care incentives might have been fueling burnout (Table 5). In contrast, physicians who often worked with advanced practice providers (APPs) were less likely to have high burnout, suggesting that incorporation of APPs into clinical practice might mitigate physician burnout (Table 5).•Before the COVID-19 pandemic, fellows had strong interest in virtual mentorship: among second-year HO fellows surveyed before the COVID-19 pandemic, 79% expressed interest in virtual or external mentorship if a local mentor was not an option.Table 2.ASH workforce study from 2017 to 2021YearStudyDetails and participants2017-2018Survey of all US adult HO fellows1Survey of 626 adult HO fellows, with questions on clinical training and mentorship experiences, career interests and perceptions, and job market experiencesFocus groups of hematology section chiefs and medical directorsFour focus groups with 18 academic and community practice hematologists, exploring hematology workforce needs, recruitment, and solutions for addressing perceived shortages in the CH workforce2018-2019Survey of AMA Physician Masterfile hematologists and oncologists36Survey of 631 hematologists and oncologists in the AMA Physician Masterfile, with questions on clinical care, practice scope and support, compensation, telemedicine, mentorship, job satisfaction, and burnoutSurvey of US adult HO fellowship program directors37Survey of 90 adult HO fellowship program directors, with questions on perceptions regarding single-subspecialty training in hematologySurvey of second-year US adult HO fellows38Survey of 212 second-year adult HO fellows, with questions on clinical training, mentorship needs and experiences, career interests and perceptions, and job market perceptionsSurvey of recent US adult HO fellowship graduatesSurvey of adult HO fellowship graduates who were <1 y out of fellowship, with questions on clinical care, practice scope and support, compensation, telemedicine, mentorship, job satisfaction, burnout, and adequacy of HO fellowship trainingSurvey of ASH member medical students and residentsSurvey of 203 medical students and residents who were members of ASH, with questions on career interests and perceptions, prior HO experiences, mentorship, and interactions with ASH and other professional societies2019-2020Pandemic survey of US adult HO fellows (joint study by ASH and ASCO)39Survey of 548 adult HO fellows, with questions on training experiences and burnoutPandemic survey of US adult HO fellowship program directors (joint study by ASH and ASCO)40Survey of 103 adult HO fellowship program directors, with questions on training experiences and burnout2020-2021Survey of all US adult HO fellowsSurvey of 548 adult HO fellows, with questions on clinical training and mentorship experiences, career interests and perceptions, job market experiences, and burnoutSurvey numbers indicate the total number of respondents.AMA, American Medical Association; HO, hematology and medical oncology.Table 3.Major themes from the ASH workforce studyASH workforce study themesUS HO fellows reportedExtremely low career interest in CH (<5%)Early origins of career interests, beginning in medical school or earlier in many instances (>40%)Fewer research and mentorship experiences in CH than in malignant hematology or solid tumor oncologyPoorer perceptions of income potential and work-life balance in hematology than in solid tumor oncologyLess clinical exposure to CH than malignant hematology or solid tumor oncology during fellowship trainingStrong interest in virtual mentorship, even before the COVID-19 pandemicIncreased likelihood of pursuing hematology-focused careers among fellows with robust mentorship and early clinical exposure to hematologyUS practicing hematologists and medical oncologists reportedWidespread perception of a workforce shortage in CHFew CH specialists despite most hematologists and oncologists providing clinical care in CHWidespread belief that many new CH consultations could have been managed by the referring providerWidespread burnout, even before the COVID-19 pandemic, with high burnout correlating directly with RVU-based compensation plans and inversely with APP supportHO, hematology and medical oncology; RVU, relative value unit.Figure 1.HO fellows’ engagement in research and mentorship activities, 2018 vs 2021. (A) Fellows’ chosen fields of interest.
(B) Fellows’ clinical exposure. (C-F) Percentages of fellows who reported specific research and mentorship activities in CH, malignant hematology, or solid tumor oncology, including the following: had a mentor (C); participated in a research project (D); wrote a paper (E); and mentor helped with career decisions (F). (G-H) Percentages of fellows who had positive perceptions of income potential (G) and work-life balance (H).
HO, hematology and medical oncology.Table 4.Associations of training and mentorship experiences with interest in hematology-only careers among HO fellows, 2018Training or mentorship experienceOR (95% confidence interval)Medical schoolParticipated in elective rotation in hematology or HO1.15 (0.63-2.09)Participated in HO rotation as part of an internal medicine or pediatrics clerkship1.87 (1.01-3.43)ResidencyEncouraged by a hematologist to pursue a career in hematology1.79 (0.92-3.51)Had a clear vision of a career path in hematology2.88 (1.52-5.48)FellowshipFellowship program director’s clinical or research focus was in hematology1.12 (0.61-2.03)Had outpatient clinical exposure to hematology patients in the current year of training7.07 (0.78-64.03)Total amount of clinical exposure to hematology patients was greater than the median for all survey respondents in the current year of training1.96 (1.08-3.45)Participated in a hematology research project or conference7.06 (2.42-30.63)MentorshipConducted research or wrote a paper with a hematology mentor, spent time with a hematology mentor outside of formal training curricula, or had a hematology mentor who facilitated networking or who provided coaching and career advice6.95 (3.13-5.44)Adapted from Masselink et al.1 The reference group consisted of fellows pursuing careers in either medical oncology–only or in combination with HO.HO, hematology and medical oncology; OR, odds ratio.Table 5.Associations of clinical practice characteristics and physician demographics with high burnout among practicing hematologists and oncologists, 2019Practice characteristic or physician demographicOR (95% confidence interval)Age, y≤400.23 (0.07-0.80)≥560.69 (0.33-1.46)CompensationRVU-only4.37 (2.00-9.58)RVU plus salary1.06 (0.41-2.75)Clinical focusCH0.86 (0.23-3.22)Malignant hematology0.82 (0.19-3.57)Solid tumor oncology1.55 (0.70-3.43)MentoringInvolvement in any kind of mentoring0.75 (0.33-1.69)Race/ethnicityUnderrepresented in medicine1.56 (0.34-7.07)ResearchInvolvement in any kind of research0.52 (0.22-1.22)SexFemale2.56 (1.24-5.28)On-callHigh amount of weeknight call0.49 (0.15-1.62)High amount of weekend call0.99 (0.33-2.92)Work hoursHigh work hours2.14 (0.68-6.73)High work hours at home0.87 (0.40-1.87)Years in current job, y≥101.52 (0.71-3.30)Often works with APPs0.40 (0.20-0.80)Adapted from Lee et al.36 The reference group consisted of physicians who did not have high burnout.OR, odds ratio; RVU, relative value unit.
The findings from the ASH workforce study distilled into concrete, measurable terms what had long been suspected: there was a shortage in the hematology workforce, particularly affecting CH, which was rooted in decades of inadequate investment in research, mentorship, and clinical training. Imminent change was needed to boldly reimagine every facet of hematology training, mentorship, education, and research for the future of the field.
ASH’s hematology workforce initiatives
In response to the hematology workforce findings, ASH developed several initiatives to revitalize recruitment and retention efforts in hematology.
HFFTP
The most sweeping of ASH’s initiatives was the creation of the Hematology-Focused Fellowship Training Program (HFFTP), a 7-year, $19 million pilot project to establish hematology-focused training pathways within existing HO fellowship programs.43 Launched in 2022, the HFFTP provides salary support for 10 fellows per year to pursue hematology-focused training as part of existing combined HO fellowship programs in the United States. Nine fellowship programs were accepted as part of the HFFTP pilot; 3 additional programs elected to create their own independently funded hematology-focused fellowship training pathways, which are included in the broader HFFTP consortium. Together, these 12 HFFTP consortium institutions will train nearly 100 academic hematologists in the United States by 2030.
Summit on mentorship
ASH hosted a 2-day summit on mentorship in 2023, which was attended by clinicians, researchers, educators, administrators, thought leaders, and trainees from >2 dozen institutions and organizations in the United States and Mexico. Representatives from ASCO, NIH, the National Academy of Sciences, and the National Research Mentoring Network participated in the summit. The summit addressed the state of mentorship in hematology and also explored several innovative strategies to improve mentorship, particularly in CH.
CHAMP
ASH launched the Careers in Hematology Advancement Mentorship Program (CHAMP) in 2025, a virtual mentorship program for fellows interested in CH.44 CHAMP was modeled after an earlier pilot program, created by Soo J. Park (University of California, San Diego, CA) between 2021 and 2022 as part of the ASH Medical Educators Institute (MEI), in which fellows interested in CH were paired with established CH mentors from other institutions for virtual mentorship.45 The MEI pilot demonstrated improved academic productivity and career development among the participating fellows pursuing careers in CH, resulting in numerous publications, grants, and awards for the participating fellows.45 In developing CHAMP, ASH adopted and expanded the MEI pilot, pairing ∼3 dozen US HO fellows interested in CH with faculty from the United States and Canada for career development advice, research collaborations, and clinical mentorship. An initial in-person CHAMP group retreat, consisting of didactics, panel discussions, and interactive workshops focused on mentorship, was followed by individual monthly virtual mentee-mentor meetings.
Mentees reported increased confidence in formulating individualized career development plans after the initial retreat, and ∼50% of all CHAMP mentees received merit-based ASH research awards over the course of the academic year. Based on overwhelmingly positive feedback from the participating CHAMP mentees and mentors, ASH launched a companion virtual mentorship program in malignant hematology in 2026.
Hematology mentorship guide
ASH developed a mentorship guidebook in 2024, which provides best practices for mentees and mentors and includes examples of mentorship networks and contracts.46
Programs for medical students and residents
The ASH workforce study highlighted potential opportunities to foster recruitment and retention in hematology by engaging medical students earlier in the training pipeline than many grants, awards, and scholarly programs have historically prioritized. In response to the workforce study findings, ASH has developed the Horizons in Hematology initiative to engage and educate medical students and residents about careers in classical and malignant hematology. Horizons in Hematology, which debuted in 2026, features forums on hematology exposure, such as webinars, clinical case discussions, video conferences, and in-person conferences (https://ashconnections.hematology.org/page/horizons-in-hematology).
ASH also expanded its ASH Ambassador Program, which promotes engagement of medical students with the field of hematology through the creation of hematology student interest groups (SIGs) in multiple medical schools in the United States.47 Established in 2017, the ASH Ambassador Program appoints faculty (senior) and medical student (junior) ambassadors who are dedicated to growing hematology SIGs and developing SIG programming, including educational sessions, panel discussions, clinical skills workshops (eg, bone marrow demonstrations and blood smear reviews), and social events. The ASH Ambassador Program was broadened after the publication of the ASH workforce study findings to include a larger number of both allopathic and osteopathic medical schools (currently 50).
Programs for APPs
The hematology workforce study suggested that integration of APPs into clinical practice might mitigate burnout among hematology and oncology physicians. In response to this, ASH conducted a large national study of the APP hematology and oncology workforce, similar to the original hematology workforce study but focusing on APPs.42 The study found very positive experiences reported by physicians and APPs in collaborative care, leading to improvements in patient care and practice efficiency and reductions in physician burnout.42 Most of the APPs who were surveyed requested more educational materials and professional networking opportunities, which ASH addressed by expanding its membership and educational outreach to include APPs. ASH developed a comprehensive online educational resource for APPs with links to online learning modules, web-based seminars, podcasts, virtual classrooms, self-assessments, and other tools for interprofessional education.48
Research workforce study
In 2026, building on the insights from the hematology workforce study, ASH began a multiyear study on the hematology research workforce in order to identify strategies to bolster basic support for scientists and clinical researchers in hematology, foster expansion of the hematology research workforce, and advance hematology research on a global scale.
Pediatric hematology workforce study
The American Society of Pediatric Hematology and Oncology (ASPHO) has conducted periodic analyses of the PHO workforce based on surveys of PHO division directors and ASPHO members. Alarmingly, the total number of US PHO trainees, after rising steadily from 2009 to 2015, declined markedly from 2016 to 2025.49, 50, 51, 52 In light of these trends, ASH and ASPHO launched a collaborative pediatric hematology workforce study in 2026.
The future of hematology research in the United States: another crisis for CH?
The demand for investment in hematology research has never been greater, as gene therapies, cellular therapies, and personalized medicine all are poised to transform the treatment of chronic hematologic diseases, such as sickle cell disease, thalassemia, and hemophilia. Despite these advancements, looming cuts to US federal research funding threaten to sabotage these scientific advances at a time when ASH’s large-scale efforts to support CH training, research, and mentorship are beginning to take root.
NIH R01 funding success rates in 2025, after hovering in the 20% range for over a decade, plummeted to 13%.53 Recent increases in the awarding of multiyear or forward funding by the NIH have raised concerns about consequent reductions in the total number of new investigators being funded.54 Paylines for hematology and oncology grant applications have been particularly low, as R01 paylines for the 2025 fiscal year declined from the ninth to the fourth percentile at the NCI and declined from the 14th to the 12th percentile at the NHLBI.55,56 When adjusted for inflation, NIH funding has been flat for the last 2 decades, despite research costs outpacing inflation on many fronts.57,58 The average age of attaining the first R01 has risen in the last 2 decades; most investigators now are in their early 40s at the time of receiving their first R01-equivalent grant, and a second R01 is far from assured, creating a tremendous personal and financial challenge for anyone interested in a research career.59,60
The arduous physician-scientist training pathway has therefore become even more difficult than ever before, given that funding constraints, extended training duration, poor compensation, and lack of experienced research mentors all threaten to erode the leaky physician-scientist pipeline at this most critical juncture.61 Reflecting this strain, some MD/PhD programs in 2025 downsized or closed altogether.62,63 This is especially relevant in CH, where grant submissions have long been alarmingly low, to the extent that in 2019, the NIH Center for Scientific Review consolidated most CH and transfusion medicine grants into a single NHLBI study section (Hemostasis, Thrombosis, Blood Cells, and Transfusion).64
ASH, NHLBI, and other groups have proposed numerous interventions to reverse these trends, with many focusing on the same theme of mentorship identified in the ASH workforce study (Table 6).3,61 To combat potential reductions in NIH funding, in 2025 ASH launched its Fight4Hematology initiative, committing an unprecedented $12 million to support hematology research across all career stages. The initiative is expected to fund >600 investigators.65 Nearly half of the Fight4Hematology investment has been allocated either as bridge funding to support investigators whose NIH R01-equivalent awards were not funded or to sustain research in health disparities and health equity, which have been areas with recent funding challenges. ASH, ASCO, and other professional organizations have also been actively engaged in lobbying the US Congress to preserve the future of research funding.66,67 Coordinated advocacy among ASH and other professional societies may be a powerful way to ensure that research funding continues to be a public and political priority.Table 6.Strategies to improve the physician-scientist pipeline in hematologyExpand predoctoral hematology-focused research fellowships for undergraduates and medical studentsTeach hematology courses to medical students in the first year rather than the second year of medical school to augment early exposureExpand postdoctoral hematology-focused research fellowships for residents and fellowsOffer more travel awards for students, residents, and fellows to attend ASH and other hematology research meetingsDevelop new, innovative ABIM fellowship training pathways to attract more trainees interested in hematology researchIncrease salary support and resources for research training program directorsInvest in recruitment and mentorship of international medical graduatesPromote private-public and industry partnerships to support research experiences of students, residents, and fellowsExpand NIH K12 and K23 awards for hematology-focused research to facilitate the transition of young faculty to independent fundingExpand bridge programs to support young faculty with unfunded, hematology-focused NIH R01 proposalsExpand research funding by ASH and other professional societiesLaunch advocacy efforts by ASH in partnership with other professional societies for collective advocacyAdapted from Hoots et al3 and Williams et al.61
Hematology as a global specialty: lessons for the international community
Although the ASH workforce study focused on hematology training and clinical care in the United States, many of the key challenges faced by the hematology workforce are international. Low- and middle-income countries (LMIC) have the largest share of the global disease burden, with anemias and hemoglobinopathies being especially common.68,69 Yet the per capita number of hematologists and medical oncologists in LMIC is far lower than in the United States.70,71 Outcomes for hematologic diseases are worse in LMIC than in high-income countries because of access-related delays in diagnosis and treatment and the lack of hematology-focused educational opportunities for clinicians.72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83 At the same time, the most cutting-edge therapeutic advances in hematology disproportionately benefit the United States, Europe, and other high-income countries.84
Expanding the international hematology workforce addresses several priorities, all designed to grow the global infrastructure and expertise needed to deliver high-quality hematology care and bolster hematology research efforts worldwide (Table 7). ASH and other organizations have launched numerous programs to advance these priorities on a global scale.84, 85, 86, 87, 88, 89, 90, 91, 92 ASH’s International Outreach Initiative distributes educational materials to hospitals and universities in LMIC. Expansion of ASH’s Clinical Research Training Institute and highlights of ASH programs at global venues bring expertise to Latin America, the Asia Pacific region, the Mediterranean, the Middle East, and North African regions.85,93, 94, 95, 96, 97 ASH’s Visitor Training Program, Latin American Training Program, and Stossel Award provide funding for individuals from LMIC to receive specialty training at select hematology centers of excellence.
ASH’s Health Volunteers Overseas program delivers on-site specialty training in LMIC. ASH’s Global Research Award provides research funding and mentorship to young investigators outside the United States and Canada. Virtual mentee-mentor platforms, modeled after the ASH CHAMP program, could be transformative in reducing disparities in hematology clinical care and research on an international scale.Table 7.Priorities for growing the hematology workforce on a global scaleExpand access to equitable, high-quality hematology clinical care in LMICBuild hematology clinical capacity by providing specialty hematology training at hematology centers of excellence and on-site in areas of needBuild hematology research capacity by creating and expanding opportunities for global research fundingGrow the international nonphysician workforce in hematologyDevelop new models for delivering hematology care globally, including virtual careBuild worldwide networking opportunities for clinical consultation and research collaborationBuild international virtual mentee-mentor platforms for students, trainees, and health professionals pursuing clinical or research careers in hematology
Summary and future directions
The hematology workforce faces critical challenges in recruitment and retention, particularly in CH, where large gaps in clinical training, research, and mentorship have created an alarmingly small pool of trainees to meet workforce demands. A remarkable renaissance is now unfolding with the development of the $19 million ASH HFFTP and other mentoring programs to attract and support trainees interested in CH. ASH’s $12 million expansion of hematology research funding is designed to prevent funding gaps and support new investigators at a time when NIH funding is precarious.
Another iteration of the ASH workforce study is presently underway to evaluate the impact of these interventions and reexamine any new hematology workforce trends. Collective action by ASH, NHLBI, other CH-focused professional societies (eg, International Society on Thrombosis and Haemostasis, Hemostasis and Thrombosis Research Society, Foundation for Women & Girls with Blood Disorders), and patient advocacy groups may heighten awareness of the societal impact of CH diseases and the need for continued investment in CH research and clinical care. Systems-based hematology, a field of study that examines the role of CH in optimizing clinical care delivery, cost effectiveness, and patient outcomes across health systems, may have the potential to reshape payer structures by quantifying the value that CH provides in supporting high-acuity and procedural services.98 Fostering early exposure to hematology, strengthening mentorship and research experiences, augmenting the nonphysician workforce, and investing in global education and outreach will all be crucial for the future of the field.
Conflict-of-interest disclosure: The authors declare no competing financial interests.
The current affiliation for A.I.L. is Division of Classical Hematology, Mass General Brigham Cancer Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA.