As frequent readers of this blog know, we often use it as a vehicle to share the answers to questions we receive frequently from our members. One question that has been coming across my inbox a lot recently, in various permutations, relates to the demand for key oncology physicians, particularly medical oncologists. Sometimes the questions is around estimating the true demand for physicians based on population and utilization, other times it's more specific to the volumes seen at a particular institution. While there is no perfect answer I thought I'd share a few numbers for those working through this issue.
Supply of physicians as a function of population
The most straightforward way to tackle this question is to take a supply side approach - the underlying assumption being that supply equals demand. I think we can all agree that this is flawed, but it's a helpful place to start. As most of you know, ASCO recently did a large workforce study, and they found there are approximately 10,000 medical oncologists and hematologists oncologistsin the US. If you add in pediatric oncologists and gyn oncs, the number is closer to 12,500. As a function of US population, this gets you to about 3.3-4.0 medical oncologists per 100,000 (assuming a US population of 308 million).
For radiation oncologists, the most comprehensive work I've seen completed is a study recently done at MD Anderson.They cite about 3,943 radiation oncologists nationally, equivalent to 1.28 per 100,000 US Population.
Supply does not equal demand
Estimating the Demand for Oncology Physicians
Throughout our research on patient-centered care, we've frequently highlighted the roadblocks patients often encounter when seeking to access care. They either don't know where to get care - what specialist to see etc- or can't get an appointment. Some data published at ASCO by researchers at the University of Pennsylvania quantify this reality and paint a bleaker picture than many realized. For the study, researchers attempted to call 160 U.S. hospitals under 3 different insurance scenarios, and in each case they had inoperable liver cancer. While they reached a scheduler 79% of the time, only 29% actually received appointments. Of the those appointments scheduled eventually, 35% required multiple calls. And in 25% of cases they failed to reach staff after 3 attempts. Numerous reasons were cited for denial of appointmetns including:
- Demand for medical records (30%)
- Inability to reach appropriate scheduler (24%)
- Referral requirements (18%)
Strategies for Addressing the Issue
Recognizing this is a major issue for both patients and cancer centers, we conducted some dedicated research on the topic last year in a presentation entitled Elevating Referral Strategy- the formal publication will be hitting desks in the next months, so keep you eyes open for it.
It seems like every month there is a new study out discussing cancer patients' poor adherence to oral drug regimens. The barriers are numerous and well documented: patients may be concerned about the costs of the drugs, they may wish to avoid unpleasant side effects, they may not understand or be aware of proper administration and safe handling procedures, or they may have difficulty even just obtaining the drugs.
My colleague Jane Herzeca recently ran across a resource from the Oncology Nursing Society (ONS) which may be of interest to those of you who work with patients on oral therapies. It includes an excellent toolkit which provides everything from patient education materials to information about reimbursement to guidance for using motivational interviewing techniques to promote adherence to prescribed regimens. You can access the toolkit here.
For more information, please see the Roundtable's web conference "Managing Patients on Oral Chemotherapy" and the research brief "Oral Anticancer Agents".