ASCO Proposes Strategies for Oncology Workforce Shortage

The American Society of Clinical Oncology (ASCO) is calling for the development of “innovative practice arrangements” and an expansion of oncology fellowship programs to help ease the impact of a forecasted shortage of oncologists in the United States by 2020.

The steps are outlined in a new strategic plan released by the organization in November 2008. The plan was prompted by a 2007 ASCO-fund report by the Association of American Medical Colleges (AAMC) that projected a shortfall of as many as 4,080 medical oncologists by the end of the next decade.  

The cause of the forecasted shortage is multi-fold, explained Dr. Dean Bajorin of Memorial Sloan-Kettering Cancer Center, a co-chair of the working group that developed the strategic plan. But the primary causes driving the shortage are clear.

“Our country is getting older,” Dr. Bajorin said. “As the population ages, we will have more cases of cancer. The second aspect is that we’re getting better at treating cancer. More and more patients are surviving and they are surviving longer.”

Other factors are at play, including stagnation in the growth of oncology fellowship programs due in large part to a lack of funding, the 2007 ASCO/AAMC report concluded.

Among the changes to clinical practice advocated in the strategic plan, Dr. Bajorin said, is the expanded use of so-called nonphysician practitioners (NPPs) such as oncology nurses, nurse practitioners, and physician assistants.

According to Dr. Betty Ferrell, from the City of Hope Cancer Center and co-chair of an Institute of Medicine (IOM)-sponsored workshop on the oncology workforce held last year, the time for such arrangements has already arrived.

“Much of medical oncologists’ time is now spent with cancer survivors or patients with advanced disease, and we’re running into this dilemma where oncologists don’t have as much time to see newly diagnosed patients,” she said. In areas such as palliative care and survivorship, NPPs can provide valuable services, she stressed.

ASCO has launched a study to assess the extent to which these “physician extenders” are playing a role in oncology practices, and to determine their impact on the number of patients seen and the quality of care provided.

There are early clues about such arrangements from the surveys done as part of the 2007 workforce report, Dr. Bajorin explained. “Practices that used nurse practitioners and physician assistants were able to see more patients,” he said. “It turned out to be a ‘win-win-win’ for everybody involved. The patients preferred that model. The NPPs liked the model, and the oncologists did, as well.”

Other changes to clinical practice, Dr. Bajorin added, include finding ways to bring retired oncologists back into the workforce on a limited basis.

“The workforce problems we’re having now are only going to get worse in the future,” said Dr. Ferrell. Addressing the problem will require a broad range of activities, such as improved training for primary care physicians—a field that is already in the midst of a shortage—on meeting the unique needs of cancer survivors.

With established model programs in areas like training and palliative care, and the attention brought to topics like palliative care and survivorship through reports from the IOM and President’s Cancer Panel, there is an opportunity to make much needed changes that could also improve the overall quality of cancer care, Dr. Ferrell said.

“We have an opportunity to solve some serious problems and to much better serve patients and survivors,” she said.

—Carmen Phillips