Cancer care demand to outpace oncologist supply

By 2020, there won't be enough oncologists to care for a graying nation.

As the U.S. population ages, it also is growing. And the number of cancer survivors is increasing. A new study predicts that the supply of oncologists will not keep up with the changes, resulting in a shortage of 2,550 to 4,080 oncologists in 13 years.

Having primary care physicians play a bigger role in monitoring patients in remission could help lessen the burden, researchers said. But that may be asking a lot, considering a waning interest in primary care and fears of shortages in that specialty as well. Fewer U.S. medical graduates are choosing family medicine and internal medicine, despite a growing demand for such doctors.

"The pressure on [primary care physicians] to see more patients will be high. The problem is, they won't be able to handle it because of the sheer numbers" of patients, said Albert B. Einstein Jr., MD, executive director of the Swedish Cancer Institute at Swedish Medical Center in Seattle.

The study in the March Journal of Oncology Practice is the latest prediction of a physician shortage. A 2006 study showed a national shortage of child and adolescent psychiatrists, and several specialty groups said they expect a shortage among some specialties, including cardiologists, critical care physicians and geriatricians.

Pointing to an aging work force and a growing population, the Assn. of American Medical Colleges last year said U.S. allopathic medical schools should increase enrollment by 30% by 2015. "There's a shortage of other specialists, not just oncologists. It's going to get worse, because we're not training enough doctors," said Richard A. Cooper, MD, senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania in Philadelphia.

The new oncologists study, which the American Society of Clinical Oncology paid for, focused on supply and demand of medical oncologists, hematologist-oncologists and gynecologic oncologists. It predicts a shortage of up to 4,080 oncologists by 2020, when there would be about 12,500.

A growing need

Oncologists see more older patients than younger ones. Therefore, the aging population likely will increase demands for oncologists, the study said. The number of Americans 65 and older will double from 2000 to 2030. An age-related growth in cancer rates and more cancer survivors will require monitoring and care.

As oncologist visits rise, the cancer specialists will struggle to handle the patient load. Demands for visits are expected to leap by 48% by 2020, but the number of visits provided by oncologists would rise just 14%, the study said. That would mean a shortage of 9.4 million to 15.1 million visits.

"This is a real problem. It shouldn't be taken lightly," said study co-author Michael Goldstein, MD, chair of the ASCO Workforce in Oncology Task Force and an oncologist at Beth Israel Deaconess Medical Center in Boston.

The study examined several approaches to narrow the gap between supply and demand of oncologists, including more fellowship training positions, greater use of primary care doctors and nurse practitioners, and delayed retirement. Relying on nurse practitioners and physician assistants more often could improve efficiency, but other specialties will compete for such nonphysicians.

More oncologists could be trained, but current plans for oncology program expansion would mean only an 8% boost in training slots by the 2010-2011 school year, the study said.

Even with that boost, oncologists ages 45 to 64 see more patients than do oncology colleagues at the start of their careers, the study said. Younger physicians are striving for more balance between their private and work lives, so young oncologists may practice fewer hours, leaving less time for patient visits.

Lee S. Rosen, MD, founder and president of Premiere Oncology, agrees that more young oncologists want a good personal life without long hours. "It's getting harder to recruit people," said Dr. Rosen, whose practice in Santa Monica, Calif., hopes to expand from five to 10 oncologists.

With more than half of oncologists 50 and older, delayed retirement could help. But the study said it's unclear how likely doctors would be to accept such delays or how willing practices would be to offer incentives.

In the meantime, ASCO has formed a group to make recommendations to address the shortage, and it expects to issue its report later this year.

"This task force is going to look at the range of possibilities and say what should the oncologist community do so we don't have a crisis in 2020," said study co-author Edward Salsberg, director of the AAMC's Center for Workforce Studies.

Physician leaders said many solutions will be needed to avoid a significant shortage. "There's no one solution that's going to solve this," Dr. Goldstein said. "But I am optimistic. I think the profession as a whole will rise to meet the challenge."