The medical profession has been facing a difficult challenge in recent years: a workforce shortage. Across the board, many specialties are seeing a decline in the number of physicians available to meet a growing demand. Because of an aging population, there are more elderly patients searching for care and more physicians are getting older and hitting prime retirement age. These factors are greatly affecting oncologists’ ability to treat patients.

In 2007, the American Society of Clinical Oncology (ASCO) published a study projecting a 48% increase in overall demand for oncologist visits by 2020.1 Although the supply of new oncologists will continue to grow, it is not expected to keep up with the increased demand for services. In the study, a 20% increase in the number of oncologists is projected but that will only lead to a 14% growth in visit capacity, not quite enough to keep up with demand.1

“The supply of oncologists will continue to grow, but it just won’t grow as fast as the expected demand for services,” said Clese Erikson, MPAff, lead author of the study and director of the Center for Workforce Studies at the Association of American Medical Colleges (AAMC) in Washington, D.C.

Erikson and colleagues offered a few supply scenarios to help address the workforce shortage. Suggestions included increasing the number of available fellowships, using nurse practitioners (NPs) and physician assistants (PAs), and delaying the retirement of current oncologists. These solutions were projected to lead to anywhere from a 0.5 million to a 5 million increase in visit capacity for oncologists (new and current patients). The demand scenario assumptions included an increase in cancer cases, a higher number of patients older than age 70 years, and an increase in hospice for cancer patients. The authors noted that no one solution is likely to address and solve a future shortage but there are options to alleviate it.1

The current challenge lies in assessing the state of the oncology workforce in a difficult economic climate. Since 2008, the economy has shifted dramatically causing a change in behavior for both physicians and patients. There is concern that physicians approaching retirement age may practice longer because retirement benefits and portfolios are not at the level they expected. Longer-practicing physicians may mean less available career options for new oncologists. Meanwhile, patients are waiting longer before seeing a doctor to help cut costs, which can translate to more care down the road, depending on how severe the aliment.

These factors create a climate that can give a false sense of the situation. “People can’t afford care or are delaying seeking care, so there appears to be an artificially low demand for services, as well as an artificially high supply that could change when the economy recovers,” said Mr. Erikson.

Current estimates indicate that the supply of oncologists has not decreased in the manner described in ASCO’s 2007 study. As such, ASCO is looking to re-evaluate the state of oncology physicians and create a new survey that will project a better outlook on oncology jobs and fellowships.

“The supply [of physicians] perhaps has not dwindled as much … and while the number of training slots has not contracted, it hasn’t grown either,” said Michael Kosty, MD, medical director at the Scripps Cancer Center at Scripps Clinic and Scripps Green Hospital in San Diego. “The supply of graduates has been virtually flat over the past 5 to 10 years.”

Dr. Kosty, the fellowship director of ASCO’s Workforce Advisory Group, said ASCO is working to redo the supply and demand modeling and design a better projection of physician supply and demand. He expects this to be completed within the next few years. He noted that because of the growing complexity of oncology treatments and new treatment options, the demand for oncologists would not decrease. “There continues to be a need for oncologists. In 5 years I don’t see a significant decline or an increase for that matter. What will impact the demand for oncologists are the increased use of non-physician providers and the changing types of therapy,” he said. “Many of the new therapies are oral drugs and oral drugs don’t require as much nursing intervention.”

ASCO also has been involved in examining collaborative models between physician and nonphysician providers, such as NPs and PAs, and how those individuals are integrated into practice settings. Specifically, ASCO is investigating what it means for the future of patient care.

Shine Chang, PhD, director, Cancer Prevention Research Training Program at the University of Texas MD Anderson Cancer Center in Houston, agreed that oncologists are not the only physicians able to treat cancer patients. “Patients love their oncologist but with more people getting cancer, a patient in remission can be cared for by their normal physician, while the oncologist can treat the patient who has cancer.”

Cancer prevention and control also is an important component to help alleviate a shortage. “It is critical to strengthen our oncology workforce. We need to focus and look at what we can do for the prevention of cancer in our communities,” said Dr. Chang, author of a study assessing cancer prevention and control mechanisms in context of a projected decline of oncologists.

Chang and colleagues noted that there is a lack of physicians pursuing cancer prevention as a viable career path. Fellows have little awareness about cancer prevention career opportunities.2 There is a growing desire to address careers in cancer prevention and organizations like the National Cancer Institute offer funding for cancer prevention training to postdoctoral candidates.3 However, Dr. Chang argues that not enough is being done to target more candidates and to recruit strong individuals who can excel in cancer prevention. By not making cancer prevention a highly visible and desirable career path, the authors suggest that qualified professionals may be lost.2

“We need people who are able to review and synthesize the literature and then get the message out,” said Dr. Chang. “Training will be different for new doctors going into [cancer prevention]. With many newer drugs and technologies coming out daily, training will be harder and the demands of these new doctors will be high. We want individuals who will have a great impact on our society’s health.”

Because cancer prevention is a critical component in addressing the looming workforce shortage, fellowships are increasingly important in helping oncologists to prepare for the next step. “People going into their training [or already training] now really have opportunities that have never existed,” said Dr. Kosty. “The future of oncology is bright. The structure will change but everybody has to stay tuned and keep their ears to the ground because a lot of good, and some difficult changes, will come along too.”

The AAMC anticipates a significant shortage of physicians across almost all specialties by 2020 and believes it will require a multistrategy approach for addressing the problem. Increasing the supply of physicians, bringing in other team members to help provide care, and creating innovative delivery models are among the factors that may help to alleviate the shortage.

“Overall, there has been a definite push in the medical education community at large to increase the number of US medical students that are going into medical school,” said Mr. Erikson. “Medical schools are on track to increase enrollment 30% by 2016, so there is a lot of effort and advocacy around increasing the number of residency and fellowship training positions.”

References

1.     Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Prac. 2007;2(3):79-86.

2.     Chang S, Cameron C. Addressing the future burden of cancer and its impact on the oncology workforce: where is cancer prevention and control? J Cancer Educ. 2012;(suppl 2):S118-127.

3.     National Cancer Institute. The center for cancer training: postdoctoral fellows and mentored new faculty. http://www.cancer.gov/researchandfunding/cancertraining/outsidenci/postdoc. Accessed October 1, 2012.