Does Oncology Have a Recruitment Problem?

Victoria Stern, MA

Disclosures

December 16, 2014

In This Article

Introduction

In its 2014 inaugural "State of Cancer Care in America" address, the American Society of Clinical Oncology (ASCO) forecasted an impending oncology shortage as the demand for cancer care continues to grow in the coming years.

"We have experienced tremendous success in advancing cancer treatments—progress that has led to 14 million cancer survivors today," Peter Yu, MD, president of ASCO, told Medscape. "But an aging population and better treatments will lead to greater demands on the oncology workforce."

The report, which highlights findings from ASCO's 2013 annual census of US oncology practices, among other sources, predicted that the increase in new cancer cases in the United States in the next 10 years will far outstrip the growth in oncology specialists. By 2025, the number of new cancer cases will rise by 42% and the number of survivors, currently at around 13.7 million, will expand to an estimated 18 million by 2022, thanks to improvements in cancer care.

The oncology workforce, however, is predicted to grow by only 28% in that time, leaving a projected deficit of 1487 physicians. Given that an oncologist sees an average of 300 new patients each year, nearly 450,000 new patients are likely to face obstacles in getting life-extending, life-saving care, Dr Yu said.

One reason for this predicted shortage may be that fewer and fewer young doctors are interested in pursuing oncology.

Recruitment and Medical School Culture

"Recruitment to oncology is a problem," said Matthew Farber, director of provider economics and public policy at the Association of Community Cancer Centers (ACCC). "Cancer care is a growth area, but I don't think the interest is keeping pace with the need."

One factor, Mr Farber noted, is the intensive training and time commitment required to become an oncologist. "Training requires 6 to 8 additional years of an internship, residency, and one or more fellowships, which is asking quite a lot of a physician," he said.

These additional years of training also mean delaying when oncologists can begin earning good salaries and paying off their hefty medical school debt.

"Student debt is so high that further training often isn't worth it given that compensation in oncology isn't as good as in some other specialties," said Amanda Shreders, MD, a hematology/oncology fellow at the Mayo Clinic in Jacksonville, Florida.

According to Medscape's 2014 Oncologist Compensation Report, oncologists earned on average $290,000 in 2013, falling in the middle of the pack of the 25 other specialties surveyed. The highest-earning specialties were orthopedics ($413,000), cardiology ($351,000), and urology and gastroenterology (both $348,000).

The real issue, said David Regelmann, MD, assistant program director of the internal medicine residency program at a Connecticut hospital, may be persuading students to pursue a residency in internal medicine, which is necessary to apply for a hematology/oncology fellowship.

"The culture of many medical schools quietly sways students away from internal medicine—and from all primary care residencies, for that matter—in favor of more lucrative residencies or of residencies that are (falsely) considered more prestigious academically, such as surgery or dermatology," Dr Regelmann said.

Dr Shreders experienced more than a gentle nudge away from internal medicine and oncology. "Some classmates and my supervising physicians were very vocal in their efforts to talk me out of pursuing oncology," Dr Shreders said.

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