A Shortage of Oncologists? The American Society of Clinical Oncology Workforce Study

If you’ve recently tried to fill a training slot or recruit an oncologist to your practice, you know all too well the “graying of America” has already had a significant impact on our specialty. It’s hard to pick up a journal or newspaper without seeing commentary on the impact of our aging population. Because cancer is a disease of the elderly, such demographic trends hold particular significance for oncology. Advances in treatment have greatly improved survivorship statistics, but with that comes a wide range of new issues as cancer survivors live long enough to experience late effects of their treatment or other age-related health issues. With a shrinking pool of trainees and many of us nearing the age of retirement, how will we as a community respond to what many view as a looming crisis? With these concerns in mind, the American Society of Clinical Oncology (ASCO) Board of Directors formed a special task force to study the oncology workforce. Chaired by Michael Goldstein, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center (Boston, MA) the group consulted workforce experts from the Association of American Medical Colleges (AAMC) Center for Workforce Studies (Washington, DC) to analyze supply and demand, as well as the professional challenges facing cancer care specialists. Program directors, oncology fellows, health services researchers, community oncologists, academic oncologists, and workforce specialists joined the effort to conduct a comprehensive analysis of the oncology workforce. The Journal of Oncology Practice’s March 2007 issue summarizes the results of this study and opens a dialogue on next steps. The full report is available on ASCO’s Web site (www.asco.org/workforce). For some time, anecdotal evidence has suggested a shortage, but many of us were surprised at the substantial shortfall of oncologists predicted by AAMC’s workforce analysts. Projections show that by 2020 demand for oncology services will significantly outpace the supply of oncologists available to provide patient care. Driven principally by the aging population and an increasing number of cancer survivors, demand for oncology services will increase by 48%. Because of our aging workforce and projected retirement rates, the supply of services provided by oncologists will grow by only 14% in that same period. This translates into a shortage as high as 3,800 oncologists—roughly one-third of the 2005 supply. To confirm these findings, the task force employed an alternate forecasting methodology. Analysis by hematologist and medical workforce expert Richard A. Cooper, MD, of Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA), demonstrates that demand for physician services closely tracks with economic trends. A robust economy correlates with high demand, whereas leaner economic times correlate with less demand. Dr Cooper’s analysis projects a nearly 56% growth in demand, coupled with a 14% growth in supply of services—leading to a slightly larger gap than the one projected by the AAMC. In response to these dramatic findings, ASCO has initiated a thorough assessment of its entire portfolio of programs and services to determine what steps the Society should take to address the anticipated shortage. The Workforce Implementation Group, composed of volunteers from nearly all ASCO committees, will report directly to the Board on strategies that can both sustain and revitalize our workforce. This initial study focused on services provided by oncologists, but that is only one aspect of the complex array of skills necessary for cancer research, for the care of cancer patients, and for dealing with survivor issues. The projected shortage of oncologists is a challenge not only to the entire cancer care delivery system, but also to our clinical trials networks. Cancer care and research occurs in a collaborative environment, delivered by multidisciplinary teams of professionals. There are already significant shortages of oncology nurses and research scientists, and many other disciplines have similar concerns. Addressing these shortages will take a multifaceted approach and visionary thinking. The Workforce Implementation Group will focus initially on several key areas, including modifications to fellowship programs, joint initiatives with nonphysician oncology and primary care physician groups, collaborations with specialty societies, ongoing data collection, increased ASCO technical support to members, and additional areas for research. The group will report its recommendations to the Board in 2007, and the Society will continue to provide updates on workforce-related initiatives, as well as ongoing workforce data and projections. Just as this study could not have been accomplished without your help, we will need your input to find solutions to these important issues. Whether it is completing a survey, participating in a committee or task force, or some other form of service, I hope you will continue to give of your time and talent. It will take all of us—together with patients, survivors, and our colleagues across all professional disciplines—to continue delivering the care our patients deserve. JOURNAL OF CLINICAL ONCOLOGY COMMENTS AND CONTROVERSIES VOLUME 25 NUMBER 12 APRIL 2