Significant Oncologist Shortage Predicted By 2020

FOR IMMEDIATE RELEASE:
March 13, 2007
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-- New Study Predicts Shortfall of up to 4,000 Cancer Doctors --

Alexandria, VA – A new study commissioned by the American Society of Clinical Oncology (ASCO) projects a significant shortage of medical and gynecologic oncologists in the United States by 2020.  The study found that an aging and growing population, increasing numbers of cancer survivors, and slower growth in the supply of oncologists will result in a shortage of 2,550 to 4,080 oncologists by 2020.  At that time, the total supply of oncologists is projected to be roughly 12,500.

The study conducted for ASCO by the AAMC (Association of American Medical Colleges) Center for Workforce Studies is a comprehensive analysis of future supply and demand for oncologist services. The study, entitled “Future Supply and Demand for Oncologists: Challenges to Assuring Access to Oncology Services,” was published online today in ASCO’sJournal of Oncology Practice.  The study is available online at www.asco.org/workforce. ASCO also has formed a special working group to develop recommendations to address the projected shortfall.  Those recommendations will be issued later this year. 

“The last several decades have been a time of extraordinary progress in cancer research and patient care,” said Michael Goldstein, MD, Chair of the ASCO Workforce in Oncology Task Force and an oncologist at Beth Israel Deaconess Medical Center in Boston.  “But unless we address the coming shortage of oncologists now, we will face a major challenge in ensuring that all patients receive high-quality care, and benefit from recent advances.”

Cancer is the second-leading cause of death in the United States.  It is estimated that nearly 1.4 million people will be diagnosed with cancer this year, and more than 560,000 will die of the disease. 

The study projects a significant increase in patients who will require oncologist services by 2020.  The study draws upon National Cancer Institute (NCI) analyses of Medicare data to estimate future demand and utilization of oncologist services. The incidence of cancer rises rapidly with age, especially after the age of 65. The projected rise in demand is driven by the doubling of the number of Americans over age 65, as well as growth in the number of cancer survivors due to improvements in screening and treatment.  The study predicts a 48% increase in cancer incidence and an 81% increase in people living with or surviving cancer between 2000 and 2020.

At the same time, the supply of oncologists available to provide services is not expected to increase fast enough to meet this additional demand. This limited growth is due to the disproportionate number of oncologists near retirement today and the limited number of oncology fellowship training slots.

As a result, while visits to oncologists are expected to increase by 48% by 2020, the number of visits provided by the projected supply of oncologists is expected to rise by only 14% – leaving a shortfall of 9.4 to 15.1 million visits. 

“This study uses the most current information on the supply, use and demand for oncologist services, said Edward Salsberg, Director, AAMC Center for Workforce Studies.  “While there are many uncertainties in forecasting supply and demand more than 10 years out, almost all future scenarios that we evaluated indicate a significant shortage of oncologists is likely.”

The study drew from both original and existing data.  AAMC Center for Workforce Studies and ASCO surveyed oncology fellows, oncology fellowship program directors, and 4,000 practicing oncologists from across the country about current practice activities, work hours, visit rates, practice setting, use of nurse practitioners and physician assistants, and options for addressing future workforce shortages.  Survey respondents were also asked for their views on potential ways to address the shortage and focused on a number of strategies to increase the efficiency of oncologists’ practices, including: the reduction of paperwork, increased use of electronic medical records, and increased use of nurse practitioners and physician assistants.

Factors Influencing the Supply and Demand of Oncology Services 

The study projections assume the continuation of present patterns in oncology care.  However, the study also considered ways in which those patterns may change and what impact those changes could have on the gap between supply and demand.  Several scenarios would shrink the gap, but no single action, including very aggressive scale-up in fellowship training slots, would bring supply and demand into equilibrium. 

Supply 

Factors that could increase the supply of oncologist visits:

  • Increasing fellowship training positions
  • Improving efficiency, such as through delivery system redesign and increasing the use of electronic medical records
  • Increasing the use of nurse practitioners and physician assistants for oncology care
  • Delaying the retirement of existing oncologists   

Factors that could decrease the supply of oncologist visits:

  • Possible lower productivity among oncologists in the future (the surveys found that younger oncologists provide fewer visits than older oncologists  but assumes that visit volume will increase as they get older; this may not be the case)

Demand   

Factors that could increase demand for oncologist visits: 

  • Increases in the percent of cancer patients seeing an oncologist
  • Increases in the average number of visits to an oncologist, such as might result from new adjuvant therapies

Factors that could decrease demand for oncologist visits:

  • Increasing use of primary care physicians
  • Increasing use of hospice     

Next Steps

ASCO has created a 14-member Workforce Implementation Group with expertise in clinical practice, cancer education, research, and oncology training, to develop recommendations to address the projected shortfall.  The Group is expected to make recommendations by the end of the year, with an initial focus on the following areas:

  • Increased ASCO guidance and technical support to its members to increase productivity and efficiency
  • Joint initiatives with non-physician oncology professionals and general practice physicians
  • Modifications to oncology fellowship training programs
  • Ongoing collection of workforce data to monitor trends to help prevent shortfalls
  • Follow-up research to further specify the nature, extent, and implications of the projected shortfall

“This research provides us with evidence that the ‘graying of America’ will result in a substantial increase in demand for cancer-specific health care in the next 10 to 15 years, a potential crisis that must be addressed prospectively,” said Dean Bajorin, MD, Co-chair of ASCO’s Workforce Implementation Group and an oncologist at Memorial Sloan-Kettering Cancer Center in New York.  “Enhancing health care delivery to meet this demand is complex, and the Workforce Implementation Group will focus on identifying strategies that will ensure continued excellence in cancer care for Americans well into the future.”

Study Design

In addition to original research, the study analyzed existing data sources, including the American Medical Association Physician Masterfile, a national database of physicians; cancer incidence and prevalence data and Medicare claims data from the National Cancer Institute; U.S. Census Bureau population projections; and board certification data from the American Board of Internal Medicine and the American Board of Gynecology.

The study focuses exclusively on supply and demand for medical oncologists, hematologist/oncologists, and gynecologic oncologists, who make up the majority of practicing oncologists.  It does not include pediatric hematologist/oncologists, radiation oncologists, or surgical oncologists.

ASCO is the world’s leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. ASCO’s nearly 25,000 members from the United States and abroad set the standard for patient care worldwide and lead the fight for more effective cancer treatments, increased funding for clinical and translational research, and, ultimately, cures for the many different types of cancer that strike an estimated 10 million people worldwide each year. ASCO publishes the Journal of Clinical Oncology (JCO) and Journal of Oncology Practice (JOP), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces People Living With Cancer, an award-winning website providing oncologist-vetted cancer information to help patients and families make informed healthcare decisions.

The AAMC Center for Workforce Studies collects and analyzes data to promote a supply and distribution of physicians consistent with the demands and needs of the U.S. population and to inform the medical education and training community, policy makers and the public.

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