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Cultivating the Human Pipeline for Succession, Innovation, Resilience

August 29, 2023

September 2023

Sandra Kurtin, PhD, ANP-C, AOCN, is a hematology/oncology nurse practitioner, assistant professor of clinical medicine, and adjunct clinical assistant professor of nursing at the University of Arizona Cancer Center in Tucson.Sandra Kurtin, PhD, ANP-C, AOCN, is a hematology/oncology nurse practitioner, assistant professor of clinical medicine, and adjunct clinical assistant professor of nursing at the University of Arizona Cancer Center in Tucson.



The longevity of medical professionals within hematology and oncology is foundational to the robust scientific discovery and remarkable evolution of the diagnostic, prognostic, and therapeutic strategies we enjoy today. We are familiar with scientific pipelines in this context and often highlight development over time for individual diseases. A compilation of “50 Years in Hematology: Research That Revolutionized Patient Care,” published in 2008 in celebration of the 50-year anniversary of the American Society of Hematology (ASH), provides insights into the foundational work required for the innovation that has followed in the 15 years since that publication.1

What about the human pipeline? Imagine a generational timeline that incorporates scientific discovery with a parallel timeline of critical events in history that define life experiences and shape the beliefs and perspectives of the current and future hematology workforce. This generational mapping is necessary for effective succession planning, sustainability of innovation, and maintenance of an agile workforce.

Now add the current demographics of the hematology workforce. Among the 4,457 current members of the Advanced Practitioner Society for Hematology and Oncology (APSHO), 37%% are Gen Xers (1965-1980) and 47% are Gen Y, also known as Millennials (1981-1996), with a shrinking number of Boomers (15%; 1946-1964) and few Gen Zs (1997-2010). The majority of APSHO members identify as female and white (93%).2

In 2022, the U.S. oncology workforce comprised 13,365 oncologists engaged in patient care across 1,602 practices, with 601 oncology fellowship graduates.3 Twenty-two percent of oncologists are over the age of 63, and 13.9% are under the age of 40. The largest cohort, 64.1%, is between 41 and 63 years of age, a cross section of young Boomers, Gen Xers, and older Millennials. Only 35.8% of oncologists identify as female.

Among the estimated 21,652 oncology nurses in the U.S., the average age is 43 years, and 91% are female. Forty-two percent are under the age of 40 (Millennials and Gen Zers), with 59% over the age of 40 (older Millennials, Gen Xers, and Boomers).4

Collectively, these data describe a workforce comprised primarily of Millennials and Gen Xers, with a predominance of females working as nurses and advanced practitioners (APs) and more males in the oncology workforce. Although there are trends suggesting a more ethnically diverse workforce, ethnic minorities remain underrepresented across disciplines, as a majority identify as white (63-93%).2,3

Millennials and Gen Xers grew up in a time defined by terrorist attacks, wars, recession, digital dominance, reproductive rights, artificial intelligence, 24/7 information and connectedness, unchecked gun violence, and the sustained effects of the pandemic. While each generation develops its own perspectives regarding world views, work ethic, work-life balance preferences, and risks of burnout, these outlooks are not scientifically based and do not account for the normal evolution of beliefs and perspectives. However, generational mapping and generational assessment provide contextual life experiences that contribute to career and lifestyle choices and resilience. We are all now experiencing a tumultuous political and legal climate, unprecedented climate change with resulting weather disasters, and the persistent distortion of science and truths, challenging all generations to re-evaluate their beliefs, preferences, lifestyles, and professional goals.

Cultivating the next generation of scientists and clinicians requires an understanding of the generational workforce and an intentional process for the meaningful transfer of knowledge through formal and informal education that is sensitive to the diversity of the entire interdisciplinary care team and also focuses on priming individuals to sustain and grow the human and scientific pipelines. Since its inception in 1958, ASH has grown to more than 18,000 members globally and is dedicated to growing the next generation of hematologists/oncologists through fellowships and mentoring programs. Similarly, APSHO has grown from 396 inaugural members in 2014 to 4,457 members in 2023, with a commitment to mentoring and excellence in clinical practice, research, practice transformation through quality improvement, and development of AP leaders.

Maintaining the professional hematology pipeline across disciplines requires strong leaders and strong organizational and professional society support. Tailored education, training, and onboarding must be guided by the challenges each discipline faces, coupled with an appreciation of current events that will shape Gen Z and likely transform Gen Xers and Millennials. The future hematology workforce will soon be devoid of Boomers, at least in the day-to-day operation of clinical practice. Maintaining an appreciation of foundational work with an eye toward innovation will serve this transition well. Attention to the ever-present risk of burnout will be necessary, particularly with the anticipated generational transition and challenges of current events. Implementing and sustaining these efforts through the lens of interprofessional and intergenerational practice will be essential.

I would like to close with a focus on leadership. Being a leader in hematology is no small task. While colleagues play a large role in framing our professional experience, leaders play a significant role in our professional trajectory. Inspiring innovation; building a strong and resilient workforce with the capability to navigate life and professional events, particularly those they cannot control; and implementing strategies to reduce burnout and promote work-life balance are just a few of the challenging tasks hematology leaders face. They also must define and advocate for the complex, ever-changing work of professionals in hematology and take that message to the C-Suite to enact change.

APSHO has recently conducted a series of membership surveys that provide insight into the state of the hematology/oncology AP workforce, covering topics like burnout, work-life balance, benchmarks for productivity and compensation, practice transformation through quality improvement, role in clinical research, prescribing privileges, and the role of AP leaders in building the AP pipeline. This work will be published in a supplement in the Journal of the Advanced Practitioner in Oncology (JADPRO) in conjunction with JADPRO Live in November 2023, the annual meeting for APSHO.

Sandra Kurtin, PhD, ANP-C, AOCN
Associate Editor


  1. American Society of Hematology. 50-Years. Accessed July 25, 2023.
  2. Vogel W, et. al. 2022 APSHO Compensation Survey. J Adv Pract Oncol. 2023 (Supplement).
  3. ASCO. 2022 Snapshot: State of the Oncology Workforce in America. JCO Oncol Pract. 2022;18(5): p. 396.
  4. Oncology Nurse Demographics and Statistics in the US. ZIPPIA. Published June 29, 2023. Accessed July 17, 2023.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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