Shortage of oncologists is nationwide

Strides in prevention, early detection and treatment of cancer are being made every day. The work being done in research and clinical trials is contributing to an increased survival rate for people with cancer.

At the same time, the incidence of lymphoma is increasing and UNMC and oncologists around the country face a shortage of doctors entering and staying in the profession.

The American Society of Clinical Oncology (ASCO), the world’s leading professional organization representing physicians who treat people with cancer, is embarking on an oncologist workforce study.

ASCO said a combination of factors calls for a study to gather data and make projections about the challenges facing physicians delivering cancer care in the United States. UNMC oncologist Julie Vose, M.D., chief of the section of hematology/oncology in UNMC’s Department of Internal Medicine, welcomes the study.

UNMC also has been impacted by the shortage. The section has 11 oncologists, but is looking to hire five to six more, mainly in the area of lung, breast, gastrointestinal and head and neck cancers, Dr. Vose said.

“Our business has gone up 30 percent – resulting in the need for more specialists in hematology/oncology,” she said.

The delivery of cancer care is impacted by a number of factors, said Michael Goldstein, M.D., chair of ASCO’s Workforce Task Force, which is overseeing the workforce study. Those factors include: projected increases in cancer incidence and prevalence, particularly among the elderly, a need for ongoing care and surveillance associated with increasing number of cancer survivors, a stable number of oncologists in training over the past decade, and the impact of changes in Medicare reimbursement for cancer care.

“ASCO decided to embark on this study out of concern that the number of oncologists is not increasing proportionate to future cancer incidence and prevalence, therefore we’ll have a shortage of oncologists,” Dr. Goldstein said.

“No one really has a handle on how many oncologists there are in the field — who is providing patient care, who is in academic research or industry,” he said. “ASCO is very concerned about the adequacy of future cancer care and is embarking on a workforce study to not only gauge the present workforce, but also to examine the factors that will dictate cancer care needs in future years.”

The study will have three elements: the first is a demographic and geographic assessment of the present post-graduate oncologist workforce, which will include medical, gynecological and pediatric oncologists. Secondly, the study will examine factors affecting oncology training programs and their ability to attract and adequately train the next generation of oncologists. Finally, the study will develop a working model to predict future workforce needs.

ASCO President David Johnson, M.D., said there is a lack of solid data on the number of oncologists practicing in the United States or projections of the number of likely oncologists entering the field. He said ASCO has concerns about the increase in cancer incidence and prevalence and the factors causing stress and burnout in the current pool of oncologists.

“We don’t have any scientific data, just anecdotal information,” Dr. Johnson said. “Based on a survey we conducted several years ago, there is a sizable group of oncologists who are at retirement and may be making considerations of career changes.”

One potential effect on patients, he said, is the risk of satellite clinics closing. Patients in these communities would likely seek care at larger referral centers, which would have a difficult time managing the increased patient load. “Cancer patients are vulnerable,” he said. “Shortages in rural areas could mean delays in care or missed care in those cases where someone doesn’t have the means to get treatment farther away.”

There is an increase in demand for oncologists in many areas, including academic medicine, Dr. Vose said. “There are many attractive points about working in academics, including treating patients, doing research, teaching and attending educational and research seminars,” she said.
ASCO plans to study these and other issues related to the pressures facing oncologists. The group anticipates presenting data at its annual meeting in May 2006.