Routine blood draws during a doctor's visit can reveal disorders or diseases and as the number of patient caseloads inches upward as the population ages, the Hoosier State is facing a shortage of hematologists, the doctors who treat abnormal blood conditions.

It means patients may experience delayed access to treatment.

Dr. Mukul Singal, hematologist at the Indiana Hemophilia and Thrombosis Center in Indianapolis, believes hematologists need to be trained to break the cycle which draws many to only the study of hematology oncology, or blood cancer, after their initial hematology training.

"More and more medical students, and even more than medical students, internal medicine residents, need to be exposed to hematology clinics, to inpatient hematology," Singal contended. "Once they go there and they get exposure to that, it is something that draws people in."

Singal pointed out one way to meet the need is to increase the number of mentors. He added the American Society for Hematology has started 10 fellowship programs to train 50 hematologists over the next 10 years. Four years of medical school, three years of residency, and two to four years of fellowship for adult, pediatric hematology/oncology or pathology training are required to become a hematologist.

Singal argued bureaucrats and decision-makers should allocate more funding for mentoring as a path to increasing the number of hematologists per patient. Doing so would allow more time for patient-doctor engagement during appointments. Singul stressed the average physician spends just 15 to 20 minutes per patient.

"That sort of leeway has to be available to physicians, so they don't have the financial disincentive when they talk to patients, they spend time with patients," Singal emphasized. "That is something that is a little beyond me, but that needs to change as well."

Singal added hematology patients can expect 30 to 60 minutes on average for new patient appointments and longer to ask questions if a patient's condition is complex or if additional exams are needed right away. The Indiana Hemophilia and Thrombosis Center is the only federally recognized hemophilia treatment center in Indiana.

May is Lyme Disease Awareness Month and the latest state data show Wisconsin recently recorded the highest number of Lyme disease cases in state history.

Experts are urging residents to be mindful of the ticks carrying it as they become more active across the state. There are 16 confirmed tick species in Wisconsin and experts are focused on the "black-legged tick," or "deer tick," in the transmission of Lyme disease. Experts recommended taking preventive measures when spending time outdoors like wearing protective clothing and using insect repellent. They added you should perform tick checks and shower after any outdoor activity.

Dr. Xia Lee, public health entomologist at the Wisconsin Department of Health Services, said some ticks, especially younger ones, may be harder to spot.

"Those are usually the ones that we associate with a lot of the cases of Lyme disease or tick-borne diseases, most active in June and July," Lee explained. "This is also reflected in the number of people who go into the emergency department or go into the physician for tick bite-related illness."

The number of reported Lyme disease cases has tripled over the past 15 years, according to state data. Lee noted the Wisconsin Department of Health Services conducts surveillance and tracking of ticks for the public, including a tick identification service and a dashboard reporting ER visits for tick bites.

Deer ticks have spread from northwestern Wisconsin to every county in the state over the past 30 years. Experts said changes in land use, wildlife management and the environment have helped spread the disease.

PJ Liesch, entomologist at the University of Wisconsin-Madison, said the deer tick is a generalist feeder and can be found on many small mammals, in addition to deer. He added the increasing prevalence of the species has led to an emerging health threat.

"They are still spreading outwards," Liesch pointed out. "They seem to be moving into newer areas, in some cases that can be more like suburban backyards, areas where we haven't seen them historically. And they're still potentially expanding and we don't know when they are going to stop."

Liesch stressed if you are bitten by a tick in Wisconsin, there's about a 50-50 chance it is carrying Lyme disease. He emphasized the risk of Lyme disease transmission increases with the duration of tick attachment, which is why prevention and detection are so important.

"That's a pretty high rate of infectivity, kind of a scary number," Liesch acknowledged. "Even if you have a deer tick that is Lyme-positive, if you are checking yourself and making sure they are not attached to you for very long, that's going to greatly reduce the chances of transmission."

Some early symptoms of Lyme disease include fever, headache, fatigue, swollen lymph nodes, joint and muscle pain and a rash. If left untreated, more complicated conditions can develop.


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A new study showed in 2022, more than 240,000 hospitalizations in California could have been prevented with proper outpatient care.

Researchers said most of the patients had poorly-controlled chronic conditions like diabetes, heart disease or COPD.

Rhonda Smith, executive director of the California Black Health Network, which cosponsored the report, said her organization helps patients learn to advocate for themselves.

"I can tell you countless stories that we hear about patients who just are not listened to and then end up being hospitalized or misdiagnosed," Smith explained.

The report showed patients who rely on Medi-Cal or are Black, Native American, or English-language learners are affected the most. The report found the state could save $400 million a year if Medi-Cal members had the same rate of preventable hospitalizations as people with private insurance.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, also a co-sponsor of the report, said the savings would help the state's taxpayers.

"Each preventable hospitalization has a significant cost to the system, and that's the cost that's ultimately borne by all of us, by all health care consumers," Savage-Sangwan emphasized. "We pay for our insurance right? Those rates are determined by how much money is being spent in hospitals, etc., and so it comes at a cost."

The report authors suggested policymakers resist calls to cut Medicaid nationally and to eliminate coverage for undocumented people in California. They also recommended hiring more culturally and linguistically responsive primary care physicians.

A new report from the Commonwealth Fund showed between 8,000 and 12,000 Kentuckians could lose their jobs as a result of the state implementing Medicaid work requirements, which would cause more people to lose health coverage.

Leighton Ku, professor of health policy and management at George Washington University and co-author of the report, said around half of job losses would occur in health care and the other half downstream, in other industries connected to hospitals and doctor's offices. He added many rural health care providers rely heavily on patients with Medicaid to operate, noting without the funds, they will have to make tough choices.

"Health care providers, they have to compensate for that by doing things like laying off staff and by buying less from people who they purchase things from," Ku pointed out. "Whether it's medical equipment or whether that's how they pay the rent for their space."

Rep. Brett Guthrie, R-Ky., heads the committee spearheading the effort to slash $880 billion in federal funding for Medicaid over the next decade. In a recent op-ed, Guthrie argued, "Washington can't afford to undermine the program further by subsidizing capable adults who choose not to work."

The Commonwealth ranks sixth-highest among states in its share of its population covered by Medicaid, according to the Kentucky Center for Economic Policy. Of the 435 congressional districts across the nation, four of Kentucky's rank within the top 100 for the largest share covered by Medicaid.

Ku stressed Kentucky should brace for a billion dollars in economic losses, if health care workers are laid off.

"Relatively speaking, the state of Kentucky gets hurt more than almost any other state in the country," Ku added.

This week, the American Association of American Medical Colleges expressed concern the cuts would limit coverage and access to care for many of the 70 million Americans, including those of its member hospitals, who account for 29% of all Medicaid inpatient days.


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