Subspecialty Careers: Hematology
From the Greek word haima, meaning blood.
The discipline of hematology relates to the care of patients with disorders of the blood, bone marrow, and lymphatic systems, including the anemias, hematological malignancies and other clonal processes, and congenital and acquired disorders of hemostasis, coagulation, and thrombosis.
Important procedural skills include therapeutic phlebotomy, bone marrow aspiration, core bone marrow biopsy, and delivery of chemotherapeutic agents and biological products. In addition, hematologists are expert at interpreting the peripheral blood smear, bone marrow aspiration and biopsy, clotting assays, hemoglobin electrophoresis, iron studies, lymph node biopsies and lymphoid cell immunophenotyping.
Hematology fellowship training requires two years of accredited training beyond general internal medicine residency. Of the two years, a minimum of 12 months must include clinical training in the diagnosis and management of a broad spectrum of medical diseases. In addition, a minimum of one half-day per week must be spent in a continuity outpatient clinic for the entire two-year curriculum. Dual certification in hematology and medical oncology requires three years of full-time combined fellowship training which must include:
- a minimum of 18 months of full-time clinical training with patient care responsibility,
- a minimum of 12 months in the diagnosis and management of a broad spectrum of neoplastic diseases including hematological malignancies, and
- a minimum of six months of training in the diagnosis and management of a broad spectrum of non-neoplastic hematological disorders.
During the entire three years the trainee must attend at least one outpatient clinic for a minimum of one half-day per week and have the responsibility for providing continuous care to a defined cohort of patients being managed for neoplastic and hematological disorders.
For the 2013-2014 academic year, there were three Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs with 24 active training positions in hematology. There are also 136 programs with 1,610 active positions in hematology and oncology.
The American Board of Internal Medicine offers certification in hematology. Candidates applying for certification in hematology and oncology must complete all three years of required combined training before being admitted to an examination in either specialty. Those candidates that have completed all three years of required combined training may take the hematology and medical oncology examinations in the same year or in different years.