By Alanna Kennedy
Is There a Doctor in the House?
Forecast calls for a shortage of medical oncologists
By Alanna Kennedy
When people get sick, they often take it for granted that they’ll be able to find a doctor to treat them. However, a recent study estimates a shortage of up to 4,000 trained medical oncologists in the U.S. by 2020, which could affect the quality of patient care for the country’s more than 10 million cancer survivors.
Two major factors are driving the shortage, says Michael Goldstein, a medical oncologist at Beth Israel Deaconess Medical Center in Boston and the chairman of the task force responsible for the study. One is the aging U.S. population: 78 million baby boomers are starting to enter an age bracket in which cancer incidence rises. Second, oncologists will be retiring faster than new oncologists can be trained to pick up the extra work. As a result, he says, “there is a widening gap between the demand for services and the ability to produce oncologists.”
The study, which was published on the website of the American Society of Clinical Oncology in March, found that the demand for medical oncologists is likely to grow 48 percent by 2020, but the supply of oncologists is projected to increase only 20 percent and the number of available doctor appointments is expected to grow by just 14 percent. More than half of all practicing oncologists will be 65 or older by 2020 and either retired or preparing to retire.
The forecasted shortage means cancer patients and long-term survivors may have less time with their oncologists. “Medical oncologists in the future may concentrate their efforts on the sicker, more complicated patients,” says Goldstein. However, he predicts that it’s most likely patients will be treated using a team approach. For example, “We expect there will be a greater utilization of nurse practitioners.”
A lack of medical oncologists may also put an increased burden on primary care physicians to monitor patients in remission. “By default, primary internists might be required to get more involved” and patients won’t get the benefit of an oncologist’s expertise, says oncologist William Hait, the senior vice president for hematology and oncology research and development for Johnson & Johnson in New Brunswick, N.J., who is also the president of the American Association for Cancer Research.
Patient advocates have their own concerns about the potential impact of the shortage. “Access to care is a clear issue,” says Eric Perakslis, a patient advocate for the Kidney Cancer Association, a national organization based in Evanston, Ill. An oncologist shortfall “really hits in the underserved areas,” he says. When Perakslis’ teenage niece was diagnosed with rhabdomyosarcoma, a type of cancer that forms in striated muscle tissue, there was only one pediatric oncologist serving the region where she lived. If the study’s predictions come true, such underserved communities may take a blow they cannot afford, he says.
Goldstein stresses that a shortage of medical oncologists is not inevitable. In addition to increasing the number of available oncology training positions, other possible ways to mitigate the projected shortage include creating oncology teams that share the burden of patient care and delaying the retirement of oncologists who are already practicing.
“This is not only a challenge of producing more oncologists,” he says.