7 Threats to Cancer Care

Gabriel Miller; Peter P. Yu, MD; Jennie R. Crews, MD; Matthew Farber

Disclosures

September 10, 2014

In This Article

Shortage of Oncologists

Key Facts:

ASCO estimates that by 2025, demand for oncology services will grow by 42% or more, while the supply of oncologists will grow by only 28%. In this scenario, there could be a shortage of more than 1487 oncologists in 2025.

In 2008, for the first time, the proportion of oncologists 64 years of age or older surpassed the proportion under 40 years of age.

Dr. Yu: It's kind of hard to ignore the fact that we are really dependent on a group of oncologists who are not likely to stay practicing for more than another five years. And then you look at the demographics of the country, the aging of the baby boomers. If you run those numbers, you see predictions of a ~40% increase in the number of cancer diagnoses over the next 10 years. That is just purely a factor of the aging population and the incidence of cancer, which is virtually a rule of nature and not likely to change all that much.

It does not take into account the increasing survivorship of patients -- the good news is that they are living longer. But living longer, often with the disease or the toxicities of therapy, means that there is a larger number of patients who need to be taken care of. That is going to add to the shortage and can't be accounted for -- because we really can't predict that -- in our assessment of the looming shortage problem. The looming shortage problem has been predicted to be about a 10% short supply of oncologists in the next few years; I think that is an underestimate of the workforce problem.

Dr. Crews: We're victims of our own success. We have more people surviving cancer, which is wonderful, but that means that they are going to need caregivers to follow them long-term.

I think this is something that has impacted most practices. In my own practice, we haven't had the need right now to hire any additional staff, but what we have projected for our needs in the future will mean taking a different approach and trying to recruit more advanced practice clinicians -- physician assistants, nurse practitioners -- and looking at ways that we can utilize that workforce to fill gaps.

I think that the challenge is more prominent in smaller communities or rural communities and in places that may not be quite as desirable to live in for people coming out of practice. That's where I think the biggest impact is -- in the smaller groups and rural areas where it's harder to recruit.

Mr. Farber: It is becoming more difficult to recruit. One of the things that we are seeing is that a lot of the younger doctors coming out don't necessarily have that same desire to be entrepreneurs. By that I mean there are a lot of physicians who are looking to sell to the next generation of doctors, sell their portion of the practice, and there isn't as much interest as there used to be. I think part of that is how our physicians are trained; residencies, fellowships, and internships are all, for the most part, done in hospital settings, so that is what these younger doctors know. Also, younger physicians now are opting for more of a work-life balance, and many times hospitals are able to offer that a little more than practices, so you sometimes have difficulty finding the next crop of younger physicians going into the practice setting as partners. That is definitely part of it.

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