Tuesday, May 08, 2007

Future oncologist shortage

Tuesday, April 10, 2007
Breast enhancement, yes; cancer treatment, no
A shortage of cancer doctors is anticipated, in part because other specialties are easier and pay better.

The United States will suffer a significant shortage of cancer doctors over the next two decades, coinciding with an increased need for these specialists by aging Americans, a new report warns.

Experts predict a shortfall of up to 4,080 oncologists by 2020.

The shortage is being fueled, on the demand side, by an aging population and more cancer survivors and, on the supply side, by slowed growth in the number of oncologists available as more reach retirement age.

It's unclear if the shortage will hit relatively affluent communities like much of Orange County. But key trends that drive the expected shortage – the difficulties of working as a cancer doctor and the comparative wealth to be found in other specialties – are at play locally and nationally.

"The graying of America will result in substantial increase in demand for cancer care," said Dr. Dean Bajorin, an oncologist with Memorial Sloan-Kettering Cancer Center in New York City and co-chairman of the American Society for Clinical Oncology's (ASCO) Workforce Implementation Working Group. "This is a looming crisis that already needs to be addressed prospectively."

The study published last month in the Journal of Oncology Practice was commissioned by ASCO.

Experts estimate that nearly 1.4 million Americans will be diagnosed with cancer this year and more than 560,000 will die of the disease, making cancer the second-leading cause of death in the United States after heart disease.

Cancer is primarily a disease of older people and the number of Americans aged 65 and older is expected to double between 2000 and 2030.

Right now, supply and demand for oncologists is relatively balanced but that equilibrium is already showing signs of strain, the report's authors said.

"In 2003, it was apparent that oncologists' workload was increasing and we were having problems locating medical oncologists to hire for academic or community practices," noted Dr. Michael Goldstein, a cancer specialist with Beth Israel Deaconess Medical Center in Boston and chairman of the ASCO Workforce in Oncology Task Force.

This study, actually part one of a two-part project, predicts a 48 percent increase in cancer incidence and an 81 percent increase in people living with or surviving cancer, but only a 14 percent increase in the number of patient visits provided by the projected supply of oncologists between 2000 and 2030.

That leaves a shortfall of 9.4 million to 15 million visits -- or 2,550 to 4,080 oncologists -- about one-quarter to one-third of the total 2005 supply. By 2020 there will be a total of about 12,500 oncologists practicing in the United States.

"The bottom line is no matter which scenario we looked at, it is likely that we'll be facing a shortage," said Dr. Edward Salsberg, director of the Association of American Medical Colleges' Center for Workforce Studies.

One outside expert agreed that U.S. cancer care faces real challenges.

"The article points out obvious issues that are going to be facing the country as we get toward 2020," said Martin Brown, chief of the health services and economics branch at the U.S. National Cancer Institute. "I wouldn't say it's a crisis but it puts on the table a set of problems that need to be solved. They do suggest some pretty major changes in the way medical care is delivered."

"There's certainly room for uncertainty," added Brown, whose department contributed information to the ASCO report. "The demand side might not increase quite as fast as the data suggested. It's the aging that's the overwhelming driver. Other things to offset aging would have to be pretty dramatic."

No one thing is going to remedy the problem, but there are a number of initiatives that may ease the burden, the report's authors said.

On the supply side, the study mentioned increasing fellowship training positions, improving efficiency (for example, by increasing the use of electronic medical records), increasing the use of nurse practitioners and physician assistants in cancer care, and delaying the retirement of oncologists currently practicing.

The demand for oncologists could also be decreased by making more use of primary-care physicians and of hospices, the experts said.

"There are some potential strategies that can be very helpful but we don't see any single strategy being sufficient to fill the gap," Salsberg said. "Some of the scenarios we looked at could lead to an even greater gap. For example, we've noted that younger physicians, including oncologists, are providing fewer visits per year than older physicians."

And it will take years for any changes to actually take effect.

"When you put it all together, we think this is a very serious situation that requires some response sooner rather than later," Salsberg said. "It's important to point out that changing physician supply takes several years. If the decision was made today to increase the number of oncologists, it would take several years to increase training positions and several more years for those oncologists to complete training."

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