Will there be an oncologist shortage by 2020?
In this Ask the Experts feature, Otis Brawley, MD, chief medical officer of the American Cancer Society, discusses the projected shortage of oncologists.
Describe the oncoming shortage of oncologists. When will the shortage peak?
The American Society of Clinical Oncology has done the best job of studying the workforce. They estimate that by 2020, the country will be short of oncologists by 2,350 to 3,800 physicians. With the aging population and increasing efficacy of cancer treatments, there will be a significant increase in the need for oncology services well beyond 2020.
Is there a potential solution, or is the shortage inevitable?
The shortage is inevitable, but there are solutions that will decrease the impact on patient care. The use of nurse practitioners and physicians assistants has been very successful in a number of academic and community practices. They have demonstrated that they can provide high quality care, and physicians and patients like them. Improvements in how we handle medical information primarily through use of electronic records is improving efficiency and increasing the number of patients a physician can see. We must be careful not to become impersonal.
How will it affect patient care?
I view this crisis as a challenge. It is an opportunity to actually improve patient care. I do believe that a lot of the activities traditionally done by physicians can be done by nurse practitioners and physician assistants, and in some cases, where they end up doing them on a consistent basis, the quality of care may improve. We are really talking about the physician becoming more of a coordinator of care provided by a team. This allows for more human checks and balances.
I am concerned that, as medicine changes, things will be more centralized, and rural, sparsely populated areas will have greater difficulty accessing cancer health care.
How can working oncologists prepare for increased burden?
Oncologists can best prepare for the shortage by becoming comfortable with the concept of the physician as a manager of a patient team and not necessary the direct patient caregiver. This requires administrative skills, management skills and medical skills.
I am concerned that this will dramatically change the practice of oncology. The small one- or two-doctor practice is likely to disappear in favor of offices with larger numbers of employees.