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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023
| Contributor Information
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
This report explores how oncologists, and some hematologists, replied to questions on several recent, broad Medscape physician surveys. Their responses provide insight on the workings of an oncology practice, including how much time oncologists must devote to patients and EHRs, whether their career path includes promotions and bonuses, and how they side on ethical issues, plus much more.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists saw a greater dip in patient load during the pandemic period (roughly early 2020 through March 2022) than did physicians overall, but they recovered more swiftly.
Annualizing to a 49-week year, oncologists averaged 3327 patients vs 3528 for physicians in general. A recent attempt by the Department of Veterans Affairs to calculate optimal panel size in primary care, which was inconclusive, noted that there was "strong evidence" that a panel size of 2500 per year was not feasible.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists were nearly twice as likely to spend at least 25 minutes on average with each patient than were physicians overall. How might devoting more time to patients affect EHR documentation and other desk work?
A recent American Medical Association study found that each hour of patient interaction typically triggers nearly an additional 2 hours spent on documentation
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
How does oncology stack up against some other medical specialties in this regard?
Nephrologists, internal medicine physicians, and physiatrists told Medscape that they invest 12 hours per week, on average, to EHR work.
Neurologists, critical care physicians, and endocrinologists needed 11 hours. Radiologists, ophthalmologists, and anesthesiologists spent only 5 hours per week, on average.
Oncologists, in particular, may be downplaying their EHR-related stress. According to a recent analysis of causes of burnout among oncologists, even though practitioners acknowledged feeling stressed and exhausted, the majority insisted that they had a good level of control over their workload.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists were more likely to be focused on career advancement in this regard than were physicians overall (34%).
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
"We're not seeing many employers go to a flat fixed salary," says Mike Belkin, JD, MSHA, divisional vice president at Merritt Hawkins, a physician recruitment firm. "There can be different types of incentive plans, but we still see the incentive bonus as a pretty important piece to physicians."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists were more than twice as likely to answer "yes" than were physicians as a whole (9%).
"Since 'no' is the morally correct answer, the only thing I can think of to explain why oncologists answer 'yes' more frequently is that the coding may not capture the complexity of the cancer," says Rebecca Pentz, PhD, professor of hematology and oncology in research ethics at Winship Cancer Institute at Emory University.
Particularly when seeking prior authorization, she says, many physicians want to help patients get the most from their insurance. "They will want to capture the complexities of the disease and make treatment with new targeted therapies possible."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists were nearly 1.5 times more likely to decline to provide treatment over insurance issues than were physicians overall (24% vs 10%). Thirty-one percent of physicians overall chose "it depends."
"This doesn't surprise me," says Pentz, regarding oncologists wrestling with insurability. "The financial toxicity of cancer treatments is overwhelming and can bankrupt a family, particularly the newest treatments."
Most oncologists try to consider the patient's overall quality of life, including finances, she says, "and if an effective but cheap treatment is available, they can order that."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists were more than twice as likely to answer "no" than were physicians generally (7%). The recent proliferation of new, life-saving cancer treatment and therapy options can also drive up drug costs.
Still, a discussion about prescription costs should be standard operating procedure, says Eric Mathison, PhD, a clinical ethicist at the University of Toronto.
"Physicians need to be careful about making judgments" about the value a patient would place on a high-priced medication, he says. "The physician needs to ask about the patient's priorities and take them into consideration in the conversation, along with the doctor's own recommendations."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Just like oncologists, physicians overall felt less obligated to consider the impact of prescription costs upon an insurer than upon their patient when recommending medications. Forty-six percent of all doctors answered "no" and 19% said "it depends."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
More than 4 in 5 physicians overall felt no obligation to make internal referrals. That doesn't surprise Pentz, due to the underlying ethical principle of "beneficence," or acting in the patient's best interest.
"You always recommend what will benefit your patient, even if the institutional pressure is to keep the patient internally," she says.
It's particularly important with complicated cancers, Pentz adds, when an oncology specialist may be the best option and may want to transfer the patient to an academic institution or a comprehensive cancer institute for clinical trials.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
While nearly half of all physicians said they had access to wellness programs, it's important not to anticipate a guaranteed solution. A study in JAMA concluded that such programs had no meaningful impact on clinical markers of health, healthcare spending, absenteeism, or job performance.
In some circumstances, they may even be detrimental. Forty-three percent of emergency medicine residents who participated in one wellness program said it worsened their overall burnout.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Like oncologists, approximately half of physicians overall told Medscape that they would sacrifice some income for a different lifestyle. That percentage was slightly higher than for American workers in general, 40% of whom, when surveyed, said that they would take a pay cut. The demands of medicine may make the trade-off more appealing, or it may be a more manageable decision given doctors' incomes.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
More than half of all physicians surveyed chose high-deductible plans or HSAs.
"There is a great deal of variability between health plans that different employers offer for health insurance, so there is no rule of thumb or blanket recommendation," says Joel Greenwald, MD, CFP, a wealth advisor at Pine Grove Financial Group in St. Louis Park, Minnesota. Though he offers to assist his physician clients during benefits enrollment, most end up selecting a plan on their own.
"I guess they feel comfortable choosing their own health insurance plan given that they work in medicine."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Oncologists' admissions of bad behavior at work mirrored those of physicians in general.
Over the 3 years that Medscape has asked doctors this question, they've been quite consistent in how often they'll admit to behaving poorly (either mistakenly or deliberately) during the prior year. There's something of a disconnect, however; 55% of physicians said a peer had misbehaved but only 14% acknowledged doing the same.
Drew Ramsey, MD, an assistant clinical professor of psychiatry at Columbia University in New York City, regards improvement in professional and personal behavior to be a career-long undertaking, akin to CME
"It's easy to see the problem in other people. But if you're a physician in America, you're part of the problem, and you need to have the mindset of being part of the solution," he says.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
In comparison to oncologists, the majority of physicians overall had witnessed bad behavior by their peers in recent years, both inside and outside the workplace. The degree of poor behavior in the profession is no surprise, said one Virginia physician.
"Just like the military, professions act as a microcosm of society. As society grew more coarse, demanding, and confrontational, so have professionals, including physicians."
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
Seventy percent or more of oncologists and of physicians generally said they steer clear of patient friendships.
The American Medical Association counsels physicians against treating friends on ethical grounds, for several reasons. These include difficulty in maintaining objectivity or being sufficiently candid, issues protecting patient confidentiality with the friend's significant other and family, and the potential emotional toll on the doctor.
As doctors strive to meet their profession's ethical guidelines, Karen Fingerman, PhD, cautions them against reflexively counting a patient as a friend on the basis of friendly conversation alone. Fingerman is a professor of human development and family sciences at the University of Texas who has researched friendships in American society.
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Medscape Oncology Practice Issues Report 2023
Hope Winsborough | November 8, 2023 | Contributor Information
When Practicing Medicine Becomes Unrewarding: Medscape Physicians and Nonclinical Careers Report 2023
Physicians who are poised for a major career shift away from clinical work reveal their motivations, expectations, timeframes, and potential roadblocks.Physicians who are poised for a major career shift away from clinical work reveal their motivations, expectations, timeframes, and potential roadblocks.Medscape Features Slideshow, Nov 2023
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