Layla Van Doren, MD, MBA, is an assistant professor of medicine at Yale School of Medicine and a classical hematologist at Smilow Cancer Hospital.

Valentina Restrepo-Espinosa, MD is a postdoctoral associate at Yale School of Medicine.

Burnout rates were 60% among hematology-oncology physicians who treat 

compared to 43% among those who did not, despite no significant difference in grit and resilience between groups.

Findings from a cross-sectional, nationwide survey highlight disparities among providers who treat SCD, including reduced job pride and recreation time directly associated with increased burnout, and 64% of these providers earn less than $350,000 annually compared to 40% of their colleagues.

“At a high level, our study shows that sickle cell providers experience more burnout despite no meaningful differences in the personal factors that typically drive it,” said study investigator Valentina Restrepo-Espinosa, MD, a postdoctoral associate at Yale School of Medicine. “What we conclude from that is that systemic factors are likely responsible.”

Study investigators deemed burnout as an important area of investigation due to its direct association with physician attrition, medical errors, decreased productivity, and their personal experiences.

“In this role, you're often a one-person show: advocate, educator, researcher, and administrator, all while delivering the highest level of care to medically complex patients,” Layla Van Doren, MD, MBA, assistant professor of medicine at Yale School of Medicine and a classical hematologist at Smilow Cancer Hospital, said in an interview with 

“Educating colleagues and entire institutions about sickle cell disease and healthcare bias typically falls to us as well.”

The survey included responses from 159 hematology-oncology physicians, 55 of whom treated SCD. Overall, 71% identified as female, and 59% of white and sickle cell providers were more likely to identify as Black than non-sickle cell providers (24% vs 4%).

Additionally, providers who treated SCD had more years in practice, and more often worked in academia or leadership roles (

< .05). Moreover, recreation and job pride mediated burnout in SCD physicians.

Van Doren and Restrepo-Espinosa are currently conducting a follow-up study examining the specific systemic factors driving burnout among sickle cell providers, including institutional infrastructure, compensation equity, emotional exhaustion, compassion fatigue, compassion satisfaction, and moral distress. Stay tuned for part 2 of our interview, where they discuss findings and the path forward.

For now, here’s part 1 of our Q&A with both investigators:

 What led you and your colleagues to assess burnout in hematology-oncology physicians treating sickle cell disease, and what were you expecting to see?

 The impetus came from my own experience treating sickle cell disease and recognizing that people living with this condition are medically complex, not only because of the disease process itself, but because of the significant social support needs that come with having a lifelong illness.

My own struggles with burnout were also a driving factor. In this role, you're often a one-person show: advocate, educator, researcher, and administrator, all while delivering the highest level of care to medically complex patients. Educating colleagues and entire institutions about sickle cell disease and healthcare bias typically falls to us as well.

We focused on hematology-oncology-trained sickle cell providers because we needed a control group, general hematology-oncology providers. Many non-hematology-trained clinicians also care for sickle cell patients, but a comparable control group was essential to the study design.

The results weren't unexpected to me, I live this every day. What did surprise me was the degree of burnout: 60%. I was also struck, though not surprised, that sickle cell providers showed just as much grit and resilience as their non-sickle cell counterparts.

 Can you walk us through the key findings and what they suggest about the lived experience of physicians who treat sickle cell disease?

 At a high level, our study shows that sickle cell providers experience more burnout despite no meaningful differences in the personal factors that typically drive it. What we conclude from that is that systemic factors are likely responsible.

We saw no difference in grit or resilience, key personal protective factors against burnout. We also found no significant differences in work hours, exercise, or sleep. So this does not appear to be a personal failing. It appears to be driven by the environment these providers work in. That distinction matters because it means there are actionable targets, things that can actually be improved within systems and processes to better support sickle cell providers.

 I want to emphasize that point. When people experience burnout, they often ask themselves, "What can I do differently? What do I need to change?" But when it's a systems problem, there's often very little an individual can do on their own. That's what this study reflects. The follow-up work will focus on identifying exactly which systematic and programmatic factors are driving this.

 For more context on the study design, how did you define grit, resilience, and burnout when examining individual versus systemic factors?

 I'll let Valentina speak to the specifics, but I'll note that adding grit and resilience to the study was her idea, and I loved it. Around the time we were designing the study, I had read Angela Duckworth's 

, and I was struck by how she described the concept and developed a validated tool to measure it. I'll hand it over to Valentina to explain how these measures have been validated in the physician workforce.

 We wanted objective, validated instruments, nothing subjective. For grit, we used Angela Duckworth's Short Grit Scale, an 8-item instrument that has been extensively validated across healthcare workers, including physicians and nurses. For resilience, we used the Connor-Davidson Resilience Scale, or CD-RISC.

The CD-RISC has three versions: 25-item, 10-item, and 2-item, all by the same author. To avoid survey fatigue, we used the 2-item version, which has also been extensively validated in physicians. That version focuses specifically on the ability to bounce back after hardship, which was the dimension most relevant to our questions.

 We used the single-item burnout instrument from the Physician Work Life Study, which is widely used in physician surveys precisely because it's a single item, minimizing survey fatigue, and has been extensively validated in physicians and healthcare workers.

The more commonly known alternative is the Maslach Burnout Inventory, which measures burnout across three domains. But we weren't interested in parsing which domain was most affected. We wanted a clear yes-or-no answer: are these providers burned out? From there, we could focus on understanding why, which meant casting a wide net around contributing factors rather than drilling into burnout subtypes.

Editor’s Note: Van Doren and Restrepo report no relevant disclosures.

Restrepo-Espinosa V, Van Doren L. Burnout in Sickle Cell Physicians Linked to Systemic Barriers. 

https://doi.org/10.1182/bloodadvances.2025018338/567099

Higher burnout rates among physicians who treat sickle cell disease. EurekAlert! Published March 12, 2026. Accessed March 30, 2026. 

https://www.eurekalert.org/news-releases/1119293

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Burnout in Sickle Cell Physicians Hits 60% While Grit and Resilience Stand Strong

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

Eingun James Song, MD, is the director of clinical research for Frontier Dermatology. 

Evaluating Treatment Selection in Psoriasis

In "Evaluating Treatment Selection in Psoriasis," our panel delves into the decision making process for selecting the most appropriate biologic therapy for patients with moderate to severe plaque psoriasis, and the growing challenges posed by insurance driven treatment requirements and biosimilar step therapy.

The panel begins by outlining a practical framework for treatment selection, starting with identifying contraindications such as active inflammatory bowel disease, malignancy, or multiple sclerosis to narrow down viable options. From there, the discussion centers on categorizing patients as skin predominant, joint predominant, or both. For skin predominant disease, IL-23 and IL-17 inhibitors are both considered excellent options. For joint predominant disease, IL-17 inhibitors or occasionally TNF inhibitors are favored, with IL-17 inhibitors being the clear preference when axial disease is present. Patient preferences around dosing frequency and speed of response are also noted as important personalization factors.

The panel largely agrees that TNF inhibitors have been largely phased out of routine practice due to concerns around long term efficacy loss, laboratory monitoring requirements, and potential risks such as skin cancer in sun damaged patients, though a small subset of patients with predominantly joint disease may still respond best to this class.

The conversation then shifts to the impact of biosimilars and insurance formulary restrictions on clinical practice. The panel expresses measured acceptance of initiating biosimilar therapy when formulary access is limited, but raises concerns about forced switching between biosimilars, particularly given the immunogenicity risks and the potential for drug antibody formation that can reduce efficacy over time. The panel also questions whether biosimilar step therapy truly saves money in psoriasis when more effective therapies will likely be needed eventually, and highlights the lack of robust interchangeability data between biosimilars as an additional concern.

Our next episode, "Analyzing IL-23 Inhibitors in Psoriasis," further explores psoriasis highlighting the emerging pipeline of IL-23 targeted therapies, including a promising oral IL-23 receptor blocker and next generation TYK2 inhibitors, alongside a candid discussion of the real world adherence and efficacy considerations of oral versus injectable biologics.

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Luisa Campos, Global Heme Lead, Medical & Scientific Affairs at Thermo Fisher Scientific.

Cancer care has changed substantially in the past few years, and molecular diagnostics have been central to that shift. However, 

, such as acute myeloid leukemia (AML), multiple myeloma, and certain lymphomas, remain challenging to manage.

In rapidly progressing blood cancers, treatment decisions often need to be made within days, and genomic data is most valuable when biomarker results are available early enough to inform the initial treatment plan. The challenge in precision oncology is delivering actionable molecular insights to clinicians quickly enough. Rapid, reliable diagnostic tools are essential to ensure the right information is available precisely when it matters most for patient care.

Molecular characterization with precision diagnostics

Hematologic malignancies frequently demonstrate complex clonal architectures, with co-occurring mutations that can influence disease behavior, including treatment response. This means 2 patients with the same diagnosis may end up needing different treatment plans.

Comprehensive, multi-gene testing with sensitive next-generation sequencing (NGS) panels allows simultaneous detection of clinically relevant variants in a single assay. When designed appropriately, targeted panels balance breadth and depth, capturing key alterations while maintaining analytical sensitivity for low variant allele frequency (VAF) events. The utility of such testing is highly dependent on timing.

Establishing clinical value with a rapid turnaround time

2022 European LeukemiaNet (ELN) recommendations

 emphasize that molecular results identifying therapeutically actionable targets should be available as quickly as possible—ideally within 3–5 days—to inform initial treatment strategy.

Rapid NGS can meaningfully reduce the turnaround time to actionable results while providing broad molecular profiling, helping clinicians align patients with therapies targeted to their specific alterations. For instance, early identification of 

 mutations can support timely consideration of approved target therapies in the appropriate setting or match patients to an optimal clinical trial. Rapid-NGS panels complement other established core diagnostics, such as cytogenetics and flow cytometry, by capturing additional molecular alterations that are not detectable by these tests.

Similar considerations can apply across other hematologic malignancies, where molecular features are increasingly incorporated into classifications, risk models, and treatment selection. Depending on panel design and sensitivity, NGS can also support diagnosis in challenging cases (e.g., suspected “triple-negative” myeloproliferative neoplasm or complex lymphoma cases), detect low-level adverse subclonal variants (e.g., 

), Ig/TCR clonality assessment, informing risk and treatment decisions. In selected settings, profiling may also identify trackable biomarkers for minimal residual disease response monitoring.

In each case, for rapid testing to translate into clinical value, results need to be clear, consistent, and integrated into the established clinical workflows. Unclear reporting can delay decisions and may require confirmatory or additional testing, adding time in situations where decisions are time-sensitive.

The technical capability for rapid NGS now exists in many regions. Automation, streamlined library preparation, and integrated bioinformatics have reduced hands-on time and improved reproducibility.

Yet, adoption remains uneven. Often, barriers to precision medicine in hematology are operational: staffing, interpretation capacity, validation and reporting, and funding or reimbursement determine whether genomic data arrives in time and is usable.

Running these technologies requires specialist expertise and resources to validate assays, manage high-throughput analysis, and interpret findings. However, expertise is not evenly available across institutions. While professional guidelines exist, reporting practices vary across laboratories.

Roadblocks around affordability and equitable access are persistent challenges across healthcare that also complicate the adoption of NGS. While large academic centers are often better positioned to build and maintain in-house NGS services, community hospitals and rural clinics rely more on regional networks or external testing and may have limited local specialist capacity. As a result, access to rapid genomic profiling can vary widely.

Another contributing factor to the slower integration of NGS technologies is that coverage and funding haven’t been consistent across payers and health systems. Even when testing is clinically indicated, inconsistent coverage and prior authorization can delay ordering and make it difficult for laboratories to sustain rapid, in-house workflows and for smaller labs to justify the investment.

Enabling broader access to rapid molecular profiling

Wider access to NGS technologies is achievable. Automated specimen-to-report systems can reduce manual steps, support more predictable turnaround times, and enable standardized analysis and reporting across laboratories. While automation does not solve everything, such as reimbursement, local policies, and the availability of clinical expertise, it can make decentralized in-house rapid molecular profiling more feasible.

Curated disease-focused targeted panels are often the most practical choice for rapid clinical decision-making. By concentrating on clinically actionable genes, they reduce interpretive burden and allow faster analysis without compromising clinical relevance. Partnerships with academic institutions and regional networks can also extend interpretive expertise to community settings, helping bridge disparities in access.

The precision-medicine trials program myeloMATCH (Myeloid Malignancies Molecular Analysis for Therapy Choice) in AML and MDS illustrates how rapid molecular profiling can be operationalized at scale. Early reports demonstrate the feasibility of collecting and returning clinical and molecular data quickly to support the matching of patients to genomically defined treatment studies.

Closing the gap between capability and access

Further transformation in the care of hematologic malignancies is likely to occur over the coming years, as rapid genomic testing becomes more integrated into routine practice. For many disease settings, the technology is ready for broader use, and the body of clinical evidence supporting its use continues to expand.

Because access, turnaround time, and consistency still vary across health systems, closing this gap will require investment in molecular diagnostic capacity, including validated workflows, quality systems, staffing, and automation. Equally important are education and ongoing support so clinicians and laboratory teams can order and interpret results consistently. Clearer reimbursement pathways and continued progress toward more standardized reporting can further reduce delays and variability across sites.

For hematologic malignancies, precision medicine is no longer aspirational—it is increasingly embedded in classification systems, risk models, and many treatment pathways. The remaining imperative is ensuring that genomic insight arrives in time to influence the decisions that matter most.

Döhner H, Wei AH, Appelbaum FR, et al. Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. 

Rapid NGS and streamlined workflows are critical to delivering timely, actionable genomic insights in blood cancers, but access, reimbursement, and expertise gaps persist.

Timing Is Everything: Advancing Genomic Testing in Hematologic Malignancies

Understanding the Psoriasis Treatment Landscape and Available IL-23 Inhibitors

In this episode, "Understanding the Psoriasis Treatment Landscape and Available IL-23 Inhibitors," the expert dermatologists explore the current state of treatment options for moderate to severe plaque psoriasis and the practical considerations that guide therapy selection.

The panel opens by surveying the available treatment landscape, noting that while both oral and injectable biologic options exist, the newer IL-17 and IL-23 inhibitors lead in efficacy, achieving high PASI responder rates in a relatively short timeframe. Oral therapies are acknowledged as an option for milder disease or for patients with a strong preference for a pill, but the panel notes that infrequent injection schedules of every 8 to 12 weeks are no longer a significant barrier for most patients, in part due to the widespread normalization of injectable medications for other conditions such as weight loss. The limitations of oral agents, including broader immunosuppression and less favorable efficacy, safety, and tolerability profiles compared to biologics, are also discussed.

The panel then provides a focused overview of the three FDA approved IL-23 inhibitors currently available. Risankizumab and guselkumab are noted as strong performers in achieving high therapeutic outcomes with similar onset of action and meaningful data in psoriatic arthritis as well. Tildrakizumab is characterized as somewhat slower in onset but capable of maintaining high levels of efficacy over time, with the added advantage of eligibility for Medicare benefit, making it a useful option for older patient populations.

The panel concludes that while no single therapy controls every patient, IL-23 inhibitors collectively handle a significant portion of the treatment burden in clinical practice, with the majority of patients able to achieve complete or near complete clearance with these agents.

The next episode in this series, "Evaluating Treatment Selection in Psoriasis," features the panelists advancing their conversation on psoriasis and focusing on the practical framework for choosing between TNF, IL-17, and IL-23 inhibitors based on patient specific factors, as well as the clinical and practical implications of biosimilar use and formulary driven treatment decisions.

Positive Results Identified for Risankizumab and Other Psoriasis Drugs, With David Cotter, MD, PhD

, David Cotter, MD, PhD, assistant clinical professor at the University of Nevada, shared his perspective on new data and recent developments in psoriasis management highlighted during the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 on the floor of the 2026 AAD meeting, Cotter offered an enthusiastic and candid tour of what he sees as the most clinically meaningful developments in psoriasis currently, from new site-specific data on established biologics to a landmark oral treatment approval he anticipates could change prescribing habits significantly.

“We have a number of new molecules that are going to be entering soon, and we have some updated data from some of our old favorite molecules, some things that are particularly exciting and have dedicated studies looking at high impact sites,” Cotter expressed.

Among the findings that stood out most to Cotter, new data on risankizumab (Skyrizi) aimed specifically at high-impact sites, including scalp and genital psoriasis, were spotlighted. The availability of dedicated endpoints for these notoriously difficult areas has already shifted his practice, Cotter noted, pointing out that his own initiation of risankizumab more frequently for patients with genital involvement as the new results emerged.

Additionally, Cotter highlighted a recent label update for guselkumab (Tremfya) supporting its ability to inhibit radiographic progression in psoriatic arthritis (PsA), a development he believes shifts the calculation when selecting a first-line agent for patients managing both skin and joint disease.

On the question of head-to-head comparative data, Cotter pointed to 5 head-to-head trials on risankizumab against different mechanisms of action, including such drugs as apremilast and deucravacitinib. These data have resulted in risankizumab being his default biologic for plaque psoriasis.

In the PsA space, Cotter flagged bimekizumab as potentially the strongest option overall, citing topline data from the BE BOLD trial demonstrating superiority over risankizumab in attainment of rapid joint disease control. Turning to oral therapies, Cotter also noted the approval of icotrokinra (Icotyde) for moderate to severe plaque psoriasis down to age 12 as signifianct. He called it a game changer both therapeutically and regulatorily, noting its launch-day pediatric approval signals a great deal about the drug's safety profile and the rigor with which it was studied.

Disclosures: Cotter has previously reported serving as a consultant, speaker, and/or investigator for AbbVie, Alumis, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Castle, Dermavant/Organon, DermTech, Eli Lilly, Galderma, Johnson and Johnson, Journey, KOWA, Pfizer, Regeneron, and Sanofi, UCB.

Magnolo N, Soung J, Sivamani RK, et al. Risankizumab vs deucravacitinib in adults with moderate plaque psoriasis: week 16 subgroup results from the IMMpactful study. Poster presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO. Poster DV-017716.

Johnson and Johnson. FDA approves ICOTYDE (icotrokinra), the first and only targeted oral peptide IL-23 receptor antagonist, for the treatment of moderate-to-severe plaque psoriasis. Press release. Published March 18, 2026. Accessed March 18, 2026. 

https://www.jnj.com/media-center/press-releases

This interview with David Cotter, MD, PhD, highlights recent findings and new data in the psoriasis treatment space highlighted at AAD 2026.

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​​NEPTUNE and CureGN Driving Precision Nephrology Forward, With Alessia Fornoni, MD, PhD

CAR-T therapy in lupus may shift earlier in care, but challenges in access, logistics, and patient selection remain as the field moves toward precision treatment.

The Future of CAR-T in Lupus Nephritis Treatment, With Brad Rovin, MD

Priya Verghese, MBBS (MD), MPH, is the Division Head of Pediatric Nephrology, and Professor of Pediatrics at Northwestern University, Ann & Robert H. Lurie Children’s Hospital.

FSGS recurrence threatens transplant success, yet clinicians still lack reliable predictors, mechanisms, and effective prevention strategies.

The Search for Answers in FSGS Recurrence, With Priya Verghese, MBBS (MD), MPH

Melinda Gooderham, MD, is a dermatologist and the medical director at the SKiN Centre for Dermatology.

New late-breaking phase 3 data suggest zasocitinib may help reshape the oral treatment landscape for moderate-to-severe plaque psoriasis.

Sustained PASI Responses Observed Through Week 60 with Zasocitinib, With Melinda Gooderham, MD

William Fearon, MD, is a professor of medicine and the director of interventional cardiology at Stanford University School of Medicine.

Fearon discusses results from the ALL-RISE trial, which demonstrated the FFRangio’s efficacy in assessing lesions for patients with coronary artery disease.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

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Stay updated with the latest healthcare breakthroughs, including late breaking data from 3 conferences, in this week’s essential news roundup. 

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Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Results of the MOMENTUM trial suggest the prevalence of hypercortisolism in resistant hypertension could be greater than previous estimates have indicated.

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MOMENTUM: Hypercortisolism Present in 1-in-4 with Resistant Hypertension

Navin Kapur, MD, is the director of the Acute Circulatory Support Program and associate director of the Cardiac Catheterization Laboratory at Tufts Medical Center.

Although not statistically significant, the reduction represents a potential new pathway for treating patients with STEMI.

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LV Unloading Before Delayed PCI Reduces Infarct Size by 1%, With Gregg Stone, MD, and Navin Kapur, MD

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Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

The IMMpactful direct comparison provides prospective data in a moderate psoriasis population that previous MAICs could not fully capture.

Latest News

Burnout in Sickle Cell Physicians Hits 60% While Grit and Resilience Stand Strong

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Timing Is Everything: Advancing Genomic Testing in Hematologic Malignancies

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