AAMC Reporter: April 2007

Solutions Sought on Predicted Oncologist Shortage

Forecasting the Supply of and Demand for Oncologists This AAMC Center for Workforce Studies study, conducted for the American Society of Oncology, projects a shortage of 2,550 to 4,080 oncologists by 2020.

Oncology professionals are searching for ways to counteract a predicted national shortage of cancer physicians.

A recent study—conducted for the American Society of Clinical Oncology (ASCO) by the AAMC's Center for Workforce Studies—found that demand for oncology services is expected to rise 48 percent between 2005 and 2020. During the same period, the supply of oncologist services is expected to grow only by 14 percent, translating to a shortage of between 2,550 and 4,080 oncologists. That amounts to roughly one-fourth to one-third of the 2005 number.

"The increasing demand for more oncologists could outstrip the supply and limit the public's access to this specialty," said AAMC President Darrell G. Kirch, M.D. "These results unequivocally indicate that we must take steps today to prevent an acute shortage tomorrow." Michael Goldstein, M.D., an oncologist at Boston's Beth Israel Deaconess Medical Center, an assistant professor of medicine at Harvard Medical School, and chair of ASCO's Workforce in Oncology Task Force, which oversaw the study, said the projections affect the entire continuum of cancer care.

"The study should not come as a major shock to anyone in the cancer field, although the magnitude of the problem may come as a surprise," Goldstein said. "This is not only a problem for medical oncology but for the entire cancer care delivery system, from ambulance drivers to nutritionists. The entire panoply will be stressed by this increasing demand."

Goldstein noted that some cancer patients in high cost-of-living and underserved areas are already reporting difficulties in finding good or consistent oncological services.

As with other recent reports that project shortages in various specialties, America's aging population is a key factor. U.S. Census Bureau data show the number of Americans 65 years and older will double between 2000 and 2030. Because cancer largely affects older patients, the demand for oncology services is likely to rise as Americans age. Furthermore, as treatments continue to improve, the number of cancer survivors—and thus, the number of people requiring regular oncology care— will also go up. All of this will come at a time when the oncologist workforce itself is heading into retirement, according to the study.

"With America's aging population and physician workforce, the AAMC is very concerned about the potential shortage of all physicians serving the public," Kirch said. The AAMC has called for a 30 percent increase in first-year U.S. medical school enrollment by 2015. The study findings showed that the number of new oncologists will exceed the number of those retiring, leading to a 20 percent increase. However, the study interprets the increase as only 14 percent for actual visit capacity because a smaller percentage of the workforce will be in the so-called prime productivity cohort of physicians ages 45 to 64 years.

Indeed, the predicted shortage could be worse than expected if emerging evidence on younger physicians is any indication. According to the study, 60 percent of respondents to a 2005 survey of fellows completing oncology training rated work-life balance as extremely important in determining post-training plans. This may eventually lead to oncologists working shorter hours, and in turn lowering visit capacity.

Meanwhile, patients who saw an oncologist during the first 12 months post-diagnosis rose 12 percent between 1998 and 2002. According to the study, the increase could be due to the greater range and complexity of treatment options. A continued increase in visits—coupled with a decrease in the number of visits an oncologist will undertake—could further widen the predicted shortfall.

As a means of responding to the predictions, Goldstein said ASCO's Workforce in Oncology Task Force is studying possible solutions to the shortage. The study contained several suggestions, including raising fellowship positions; beefing up the role of primary care physicians, hospice, nurses, and nurse practitioners in cancer patient care; streamlining productivity by introducing electronic medical records; and delaying oncologists' retirement.

However, each proposal has limitations. Widening the educational pipeline can take a generation or more to affect the supply, and even a 50 percent increase in slots between 2010 and 2018 would leave significant shortages. Primary care physicians are experiencing a shortage of their own, and demand for nurses and nurse practitioners is and will remain high. Electronic medical records are not proven timesavers. And the potential success of various incentives to delay retirement—such as offering older physicians the chance to work part-time—are unknown. Thirty-two percent of physicians 50 to 64 years of age indicated that they were interested in part time hours, but did not have that option in their current position. Providing the option could simply reduce working hours sooner.

Goldstein said he envisioned a team approach.

"The future oncologist will be a different type of physician than we see now," Goldstein said. "They will have less time with the patient, and they will lead a group of professionals. They will be skilled not just in medicine but in group psychology and all the other things it takes to make a good administrator."

According to Goldstein, the task force is expected to recommend possible solutions within a year. "We're not facing an immediate crisis, but we need to act responsibly now to prevent a crisis from going forward," Goldstein said.

The study used statistics from the National Cancer Institute and AAMC Center for Workforce Studies surveys of practicing oncologists, oncology fellows, and oncology fellowship program directors. The study originally appeared in the Journal of Oncology Practice.

—By Scott Harris

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