Biology of Blood and Marrow Transplantation
Volume 15, Issue 12 , Pages 1493-1501 , December 2009

Impending Challenges in the Hematopoietic Stem Cell Transplantation Physician Workforce

  • James L. Gajewski

      Affiliations

    • Center for Hematologic Malignancies, Oregon Health & Science University, Portland, Oregon
    • Corresponding Author InformationCorrespondence and reprint requests: James L. Gajewski, MD, FACP, Oregon Health & Science University, Center for Hematologic Malignancies, Mail Code L-586, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
    • ,
  • C. Frederick LeMaistre

      Affiliations

    • Texas Transplant Institute, San Antonio, Texas
    • ,
  • Samuel M. Silver

      Affiliations

    • Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
    • ,
  • Michael C. Lill

      Affiliations

    • Blood and Marrow Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
    • ,
  • George B. Selby

      Affiliations

    • Department of Medicine/Hematology-Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
    • ,
  • Mary M. Horowitz

      Affiliations

    • Divison of Neoplastic Disease and Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin Clinical Cancer Center, Milwaukee, Wisconsin
    • ,
  • J. Douglas Rizzo

      Affiliations

    • Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
    • ,
  • Helen E. Heslop

      Affiliations

    • Center for Cell and Gene Therapy, Baylor College of Medicine, The Methodist Hospital and Texas Children's Hospital, Houston, Texas
    • ,
  • Claudio Anasetti

      Affiliations

    • Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
    • ,
  • Richard T. Maziarz

      Affiliations

    • Center for Hematologic Malignancies, Oregon Health & Science University, Portland, Oregon

Received 16 August 2009 ,Accepted 17 August 2009.

References 

  1. Applebaum FR. The current status of hematopoietic cell transplantation. Annu Rev Med. 2003;54:491–512
  2. Ferrara JLM, Anasetti C, Stadtmauer E, et al. Blood and Marrow Transplant Clinical Trials Network State of the Science Symposium 2007. Biol Blood Marrow Trans. 2007;13:1268–1285
  3. Erikson C, Salsberg E, Forte G, et al. Future supply and demand for oncologists challenges to assuring access to oncology services. J Oncol Pract. 2007;3:79–86
  4. Warren JL, Mariotto AB, Meekins A, et al. Current and future utilization of services from medical oncologists. J Clin Oncol. 2008;26:3242–3247
  5. Aschan J. Allogeneic haematopoietic stem cell transplantation: current status and future outlook. Br Med Bull. 2006;77-78:23–36
  6. Attal M, Harousseau J, Stoppa A, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. N Engl J Med. 1996;335:91–97
  7. Giralt S. Allografting older patients: myths and realities. Biol Blood Marrow Transplant. 2008;15(1 Suppl):146–148
  8. Champlin R, Khouri I, Anderlini P, et al. Nonmyeloablative preparative regimens for allogeneic hematopoietic transplantation: biology and current indications. Oncology (Williston Park). 2003;17:94–100
  9. Ferrara JL, Levine JE, Reddy P, et al. Graft-versus-host disease. Lancet. 2009;373:1550–1561
  10. Petersdorf EW, Longton GM, Anasetti C, et al. The significance of HLA-DRB1 matching on clinical outcome after HLA-A, -B, -DR–identical unrelated donor marrow transplantation. Blood. 1995;86:1606–1613
  11. Majhail NS, Brunstein CG, Tomblyn M, et al. Reduced-intensity allogeneic transplant in patients older than 55 years: unrelated umbilical cord blood is safe and effective for patients without a matched related donor. Biol Blood Marrow Transplant. 2008;14:282–289
  12. Baron F, Storb R, Storer BE, et al. Factors associated with outcomes in allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning after failed myeloablative hematopoietic cell transplantation. J Clin Oncol. 2006;24:4150–4157
  13. Mattsson J. Recent progress in allogeneic stem cell transplantation. Curr Opin Mol Ther. 2008;10:343–349
  14. Center for International Blood and Marrow Transplant Research Newsletter, December 2007, page 1, slide 5. Available from: http://www.cibmtr.org/PUBLICATIONS/Newsletter/DOCS/2007Dec.pdf. Accessed August 24, 2009.
  15. Gratwohl A, Baldomero H, Frauendorfer K, et al. Joint Accreditation Committee of the International Society for Cellular Therapy ISCT, European Group for Blood and Marrow Transplantation EMBT (JACIE). Why are there regional differences in stem cell transplantation activity? An EBMT analysis. Bone Marrow Transplant. 2008;42(Suppl 1):S7–S10
  16. Giralt SA, Arora M, Goldman JM, et al. for the Chronic Leukemia Working Committee, Center for International Blood and Marrow Transplant Research Impact of imatinib therapy on the use of allogeneic haematopoietic progenitor cell transplantation for the treatment of chronic myeloid leukaemia. Br J Haematol. 2007;137:461–467
  17. Gratwohl A, Passweg J, Baldomero H, et al. Accreditation Committee of the European Group for Blood and Marrow Transplantation (EBMT) Economics, health care systems and utilization of haematopoietic stem cell transplants in Europe. Br J Haematol. 2002;117:451–468
  18. Kollman C, Weis T, Switzer GE, et al. Non-HLA barriers to unrelated donor stem cell transplantation. Bone Marrow Transplant. 2001;27:581–587
  19. Mitchell JM, Meehan KR, Kong J, et al. Access to bone marrow transplantation for leukemia and lymphoma: the role of sociodemographic factors. J Clin Oncol. 1997;15:2644–2651
  20. US Census Bureau. Health insurance coverage: 2007. Available from: http://www.census.gov/hhes/www/hlthins/hlthin07/hlth07asc.html. Accessed June 26, 2009.
  21. Gajewski JL, Robinson P. Do affluent societies have the only options for the best therapy?. Leukemia. 2007;21:387–388
  22. Nietfeld JJ, Pasquini MC, Logan BR, et al. Lifetime probabilities of hematopoietic stem cell transplantation in the US. Biol Blood Marrow Transplant. 2008;14:316–322
  23. Council on Graduate Medical Education. Physician Workforce Policy Guidelines for the United States, 2000-2020. Available from: http://www.cogme.gov/report16.htm#future. Accessed June 16, 2009.
  24. US Census Bureau. National population projections, released 2008 (based on Census 2000). Available from: http://www.census.gov/population/www/projections/summarytables.html. Accessed June 16, 2009.
  25. National Marrow Donor Program. 2008 report to the community. Available from: http://www.marrow.org/ABOUT/Who_We_Are/Publications/index.html. Accessed June 23, 2009.
  26. Karanes C, Nelson GO, Chitphakdithai P, et al. Twenty years of unrelated donor hematopoietic cell transplantation for adult recipients facilitated by the National Marrow Donor Program. Biol Blood Marrow Transplant. 2008;14(9 Suppl):8–15
  27. National Marrow Donor Program. Trends in allogeneic transplant. Available from: http://www.marrow.org/PHYSICIAN/URD_Search_and_Tx/Number_of_Allogeneic_Tx_Perfor/index.html#transplant. Accessed June 16, 2009.
  28. Lara PN, Higdon R, Lim N, et al. Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J Clin Oncol. 2001;19:1728–1733
  29. Simoens S, Hurst J. The supply of physician services in OECD countries. Organization for Economic Cooperation and Development Health Working Papers. Available from: http://www.oecd.org/dataoecd/27/22/35987490.pdf. Accessed June 16, 2009.
  30. Salsberg E, Grover A. Physician workforce shortages: implications and issues for academic health centers and policymakers. Acad Med. 2006;81:782–787
  31. Blumenthal D. New steam from an old cauldron: the physician supply debate. N Engl J Med. 2004;350:1780–1787
  32. Sox HC. Leaving internal medicine. Ann Intern Med. 2006;144:57–58
  33. Cooper RA. There's a shortage of specialists: is anyone listening?. Acad Med. 2002;77:761–766
  34. Starfield B, Fryer GE. The primary care physician workforce: ethical and policy implications. Ann Fam Med. 2007;5:486–491
  35. American Association of College of Nurses. Nursing shortage fact sheet. Available from: http://www.aacn.nche.edu/Media/pdf/NrsgShortageFS.pdf. Accessed June 16, 2009.
  36. Jones MD, McGuinness GA, First LR, et al. Residency Review and Redesign in Pediatrics Committee. Linking process to outcome: are we training pediatricians to meet evolving health care needs?. Pediatrics. 2009;123(Suppl 1):S1–S7
  37. David AK. Preparing the personal physician for practice (P(4)): residency training in family medicine for the future. J Am Board Fam Med. 2007;20:332–341
  38. Association of American Medical Colleges. Total US medical school enrollment by race and ethnicity within sex, 2003-2008. Available from: http://www.aamc.org/data/facts/2008/enrllbyraceeth0308.htm. Accessed June 16, 2009.
  39. Potee RA, Gerber AJ, Ickovics JR. Medicine and motherhood: shifting trends among female physicians from 1922 to 1999. Acad Med. 1999;74:911–919
  40. Watson DE, Slate S, Buske L, et al. Intergenerational differences in workloads among primary care physicians: a ten-year, population-based study. Health Affairs. 2006;25:1620–1628
  41. Eapen M, Logan BR, Confer DL, et al. Peripheral blood grafts from unrelated donors are associated with increased acute and chronic graft-versus-host disease without improved survival. Biol Blood Marrow Transplant. 2007;13:1461–1468

 Financial disclosure: See Acknowledgments on page 1500.

PII: S1083-8791(09)00388-7

doi: 10.1016/j.bbmt.2009.08.022

Biology of Blood and Marrow Transplantation
Volume 15, Issue 12 , Pages 1493-1501 , December 2009

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