The Incredible Shrinking Oncology Workforce

LC1, the insured lung cancer patient whose search for an oncologist described in
last week’s post, is not alone. If more Americans realized that they might not
find an oncologist or other specialist provider, they could help drive changes
that could remedy the situation.

Studies have consistently shown that cancer is strongly related to increasing patient age. Policymakers, lawmakers, and the oncology profession, are well aware that there is a crisis in cancer care that will escalate as the number of Americans age 65 and over continues to rise. The US Census Bureau projects that the population over age 65 will double between
2005 and 2030. Therefore, overall cancer rates will rise dramatically.

Here are some illuminating specifics from an analysis of supply and demand for
oncologists performed by the Association of American Medical Colleges Center for
Workforce Studies to the American Society of Clinical Oncology (ASCO) on the
Oncology Workforce. The study, which focused on supply and demand between 2005
and 2020, reveals:

  • a 48 percent increase in demand for oncology visits, assuming that there is no change in cancer incidence or use of services, whereas the number of oncologists will rise by only about 14 percent;
  • In terms of availability to see patients, this translates into a shortage of 9.4 to 15 million visits, or 2,550 to 4,080 oncologists (or about one-third of the 2005 supply of oncologists).
  • At the same time, there will be an 81 percent increase in cancer survivors; many of these people will not need regular visits to an oncologist.

How serious this shortage is right now remains unclear. Already, reports of Medicaid patients finding no specialists to see are increasing. LC1 has health insurance and he has not been able to retain an oncologist. So people should not be caught off guard if they have trouble finding an oncologist to follow them.

I asked Thomas J. Lynch, MD, director of the Yale Cancer Center, what he thought of
LC1’s difficulty finding an oncologist. He wrote in an email: “Gosh— this is not
my experience in lung cancer.  The reality is that in 10-20 years we will have
MD shortages in oncology and we will have to develop new strategies to deal with
the ever increasing survivors (good problem to have).  But I am surprised to see
this now.”

Solutions for the Shortfall in Oncologists

Readers may want to think about whether healthcare reform can help fix this crisis
or whether market forces will correct this. Health policymakers need to reach
out to Americans to educate them so they can weigh in about any programs that could potentially change this outlook. Is this a problem in your community?

Oncology care could look very different for many Americans in the coming years.
In addition to work by the American Association of Medical Colleges and American
Society of Clinical Oncology, the Institute of Medicine’s National Cancer Policy
Forum, the federal government’s Health Resources and Services Administration(HRSA) have been examining the issue. All of these groups are thinking about arange of strategies that could correct the situation, including:

  1. Ways to improve recruitment and retention of oncology-related professionals;
  2. New models of care to cancer survivors (some might reduce access to oncologists and have other health professionals follow patients. This is suggested, especially for people receiving palliative care, and family caregivers);
  3. Offering potential oncologists scholarships or loan repayment programs;
  4. Encouraging multidisciplinary cancer care payment models; and
  5. Promoting use of electronic health records as a way to improve efficient delivery of care.
  6. Changing physician reimbursement to encourage care for Medicaid patients.

What do you think about some of these plans? Do you know of any specific programs that could help people who develop cancer who may not be able to find an oncologist? What about patients on Medicaid, or patients without insurance?

1 Response

  1. Anne Polta May 4, 2011 / 11:03 am

    Most of the workforce efforts seem directed at primary care rather than oncology – not that this is necessarily bad, but it can obscure the need for specialists.

    The future of smaller oncology programs is concerning. When we think of cancer care, the academic centers and large organizations such as MD Anderson, Dana Farber and Mayo generally come to mind, but the statistics I’ve seen indicate that the majority of cancer care in the U.S. is actually delivered through smaller community-based programs.

    Smaller programs don’t always have the economy of scale as the large cancer centers, and can be disproportionately hurt by cutbacks in Medicare and Medicaid reimbursement. Attracting and retaining qualified staff is also a huge issue. If a key person leaves, or if the organization has trouble replacing key people, the entire program can be jeopardized. I suppose the philosophical question here is whether people should be able to receive cancer care close to home. Maybe there should only be a handful of specialty cancer centers, like transplant programs – if you want the care, you have to travel and seek it out. But I’d hate to think of the financial and physical burden this would impose on people at a vulnerable time, not to mention issues about continuity of care or unexpected treatment-related complications.

    We seem to be in the same boat when it comes to survivorship care. A handful of places now have survivorship programs but it’s a real challenge for the information and knowledge to trickle down to the community level where most people actually live and receive ongoing care.

    I had non-Hodgkin’s lymphoma when I was in my 30s, and I think it’s important to point out that cancer is not solely a disease of older adults; young people are affected too, and they are often overlooked or ignored when it comes to designing programs and setting policies. In fact the young adult population is the only age group that has not seen improvements in cancer-related outcomes and survival. Although many aspects of the cancer experience are universal, the issues faced by 30-somethings are not the same as issues faced by 70-somethings, and it’s a mistake to think that one size is going to fit all.

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