A combination of factors may cause a shortfall of oncologists in the near future

With the aging Baby Boom generation entering its most cancer-prone years, physician groups are warning there is about to be a shortage of oncologists available to treat them.

A new survey by the Association of American Medical Colleges (AAMC) found a sharp mismatch between the growing demand for oncology services over the coming decade and the projected supply of doctors. The study results are in sharp contrast to previous surveys, which found equilibrium between supply and demand for oncology services.

Indeed, the latest survey, published in the March issue of the Journal of Oncology Practice, found the need for an additional 2,500 to 4,000 oncologists between now and 2020 — a 25 to 33 percent increase in the current supply. The need is being largely driven by an aging population and improvement in cancer survival rates.

“We’re likely to find a major shortfall in the number of oncologists that the nation would otherwise want and desire,” said Edward Salsberg, the researcher at AAMC’s Center for Workforce Studies, one of the lead researchers in the study group.
Another major factor driving the looming doctor shortage is changing work patterns among practicing oncologists.

“Young oncologists are providing fewer visits per year than older oncologists,” said Salsberg.

“We don’t know if they will increase their visits as they grow older. But if this reflects a changing attitude among younger oncologists, then the shortfall will be even greater,” he said.

Cancer incidence is closely related to age. According to the Census Bureau, the U.S. population 65 years and older is expected to double between 2000 and 2030, leading to a sharp increase in overall cancer rates. By 2020, the number of annual cancer visits is expected to grow to 60 million, a 48 percent increase in overall demand compared to 2005.

The good news is that many more of these patients will be living longer because of improvements in diagnosis and treatment. But that means each individual patient will be making more physician visits to deal with their medical needs as cancer survivors.

“Visits per patient have been growing,” said Salsberg. “It will get gradually tougher to get an appointment with oncologists as we go forward.”

The American Society of Clinical Oncology, which commissioned the study, has set up a task force to deal with the looming physician shortage. It will consider measures to postpone the inevitable wave of retirements as Baby Boomer oncologists retire. Over half of all oncologists were over 50 years old in 2005.

“Losing patients has always been difficult for people in this field. It forces people to retire early,” said Michael Goldstein of Beth Israel Medical Center in Boston, who chairs the ASCO Workforce in Oncology Task Force and led the research team. “But what really irks them is the paperwork and regulations that keep them from seeing patients.”

The task force will focus on improving the productivity of individual oncologists as a way to help deal with the physician shortage. It plans to come up with recommendations for reducing paperwork, moving to electronic medical records and shifting some responsibilities to either primary care physicians or hospice providers.

“The medical oncologist of the future will be more of a team leader and have less face-to-face contact with individual patients,” Goldstein predicts.

For instance, only 54 percent of oncologists currently work with nurse practitioners or physician assistants, according to the survey. Those who use PAs or NPs have higher weekly visit rates than those who do not, the study pointed out.

In addition, only 25 percent of oncologists use electronic medical records. However, the benefits of increasing that rate are unclear since, as the survey pointed out, there is limited evidence that EMR use substantially increases productivity.

Training more oncologists is one obvious solution to the looming shortage. The survey found that younger physicians see oncology as a rewarding field. Most have seen substantial progress made in their lifetimes, and most see the field making further strides in the near-term — always an inducement for younger physicians.

But the researchers identified a significant roadblock to upping the number of physicians entering the field. A 2005 survey of oncology training program directors found that planned expansions would increase the number of training slots by only 8 percent by 2010. Even a 50 percent increase in training slots would leave a significant shortfall in the number of oncologists compared to the need.
“There is a control on the number of slots,” said Dean Bajorin of Memorial Sloan-Kettering Cancer Center in New York. “You have to be trained in internal medicine.”

“It will be important for internal medicine to increase the number of people available for a whole range of sub-specialties,” Salsberg added.

The researchers pointed out that some adjustments in training programs and expectations will have to be made if oncology is going to successfully compete with other specialties for young doctors. “A balance between work life and family life is very important to new graduates,” Goldstein said. “Whether that results in fewer doctors going into oncology remains to be seen.”

Merrill Goozner is a contributing editor to Bay Area Oncology News.

—By Merrill Goozner

Posted on April 23, 2007 10:55 AM