An estimated doubling of the number of people over age 65 over the next two decades and simultaneous increases in cancer incidence, prevalence, and survivorship are expected to create a situation where the number of cancer patients far outstrips the number of oncologists available to treat them, according to a new report released last week.

Developed for the American Society of Clinical Oncology (ASCO) by the Association of American Medical Colleges (AAMC), the report estimates that by 2020 visits to oncologists will increase by 48 percent, while the projected supply of oncologists is expected to grow by only 14 percent over the same time period. The result: A shortfall of 9.4 to 15.1 million visits annually.

“We think this is a very serious situation that deserves a response sooner rather than later,” said study co-author Dr. Edward Salsberg, director of the AAMC Center for Workforce Studies.

“The whole force of the medical care delivery system is going to really be challenged 10, 15 years from now to meet what we see is a greatly increased demand [for oncology services],” added Dr. Michael Goldstein, a study co-author from Beth Israel Deaconess Medical Center in Boston and chair of the ASCO Task Force on the Oncology Workforce.

To develop its work force supply estimates, AAMC used new and existing surveys of current oncology fellows, directors of oncology fellowship programs, and 4,000 practicing oncologists from across the country. The demand component of the study relied on incidence and prevalence estimates and oncologist visit rates developed by NCI staff from the Health Services and Economics Branch and the Statistical Research and Applications Branch in the Division of Cancer Control and Population Sciences (DCCPS), using data from the Surveillance, Epidemiology and End Results (SEER) program and the SEER-Medicare Linked Database (see the Director’s Update for more details).

A number of specialty physician organizations and other groups have released similar forecasts over the past few years, including projections of shortfalls in cardiology, critical/emergency care, and primary care.

For specialties like cardiology and oncology, the “graying” population is particularly concerning, because both heart disease and cancer are closely associated with older age. In addition, the available data suggest the physician pipeline isn’t robust enough to satisfy future demand. For example, according to a study published last year in Academic Medicine, the number of physicians retiring annually will swell from 9,000 in 2000 to more than 22,000 by 2020, with no expected corresponding growth in medical school graduates. And, Dr. Goldstein explained, based on the survey responses from oncology fellowship program directors, funding issues will limit any increase in the number of oncology fellowship slots to an estimated 8 percent by 2010-11.

In the ASCO/AAMC study, the baseline supply/demand analysis was performed assuming that current physician practices (number of patient visits, use of physician assistants and nurse practitioners) and care delivery patterns would remain the same. However, different scenarios were modeled to account for potential changes that could affect both supply and demand, including greater use of electronic medical records (EMRs), delaying retirement of existing physicians, and greater reliance on primary care physicians during certain care periods.

Some changes made the work force shortfall less severe, particularly expanded use of EMRs and creating more oncology fellowship positions. But no single measure or combination was a panacea, and there were also factors that could exacerbate the shortfall.

“The bottom line is that no matter which scenario we looked at, it is likely the shortage will continue,” Dr. Salsberg said.

ASCO has assembled an implementation group with expertise in clinical practice, cancer education, research, and oncology training to develop recommendations to address the projected shortfall. The recommendations, which are expected by the end of the year, will initially focus on areas like joint initiatives with nonphysician oncology professionals and general practice physicians, modifications to oncology fellowship training programs, and guidance from ASCO on how oncology practices can improve efficiency.

By Carmen Phillips