Oncology Rounds

Estimating the Demand for Oncology Physicians

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

The challenge with this approach is that we all know that supply is not the same as demand.  So the better question to look at is how many physicians do we actually NEED?  This is a harder question to answer.  The ASCO workforce study goes into detail on this at a population level, so I won't repeat their work here. But do look at the study if you haven't already.  The MD Anderson study does not go into the same level of detail, but they do state that if the supply of radiation oncologists doesn't increase we will likely have a shortage given the fact that volumes are expected to rise based on demographics alone, and treatments are only getting more complex.

Translating to hospital specific demand

In terms of translating this to a specific hospital and how many they might need, here are a few thoughts.  First, starting with medical oncologists.  The most definitive data I have seen to date on patient load continues to be from Oncology Metrics recently published in the Journal of Oncology Practice.  Their survey data indicates, that on average, a medical oncologist will see about 350 new patients annually (counted as new patients and consulations both in the office and the hospital). It's important to note that their survey focuses primarily on private practice physicians who may be more productive than those employed by a hospital.  Some hospital administrators have told me they find that benchmark aggressive - in which case you may want to dial it back to 250 or 300.  I think that one of the reasons this is high is the way they define new patients - it counts all new patient visits and consultations, both in the office and in the hospital. 

For radiation oncology, we can take a similar approach. The average number of patients per radiation oncologist is about 250 (usually equal to one radiation oncologist per LINAC). This benchmark comes from a survey the Oncology Roundtable did of our membership 2-3 years ago.

Again, keep in mind these are estimates and will vary by practice structure, case mix etc.  For instance, data in the ASCO study demonstrates that academic hem oncs spend only 47% of their time on patient care, while private practice physicians spend 76%. And men between the ages of 45 and 64 in private practice average over 100 visits per week, while women in that age group average only 90.

Why all the interest? Accountable care perhaps...

As I was pulling the data for the post I began thinking about why we've seen a huge surge in volumes of requests of this kind and I think it has to do with two major trends.  First, the general uptick in interest in employment - more physicians are interested in employment and hospitals are trying to determine if they should take the plunge and employ and so they'll want to know if they have enough patients to support these physicians. A second, and related driver is accountable care. For those organizations setting up an ACO and striving to manage a population of patients, they'll want to know how many of each specialist they'll need to meet the demand of their specific patient population. 

Learn more at our National Meeting

We'll be tackling both of these issues (amongst many others) at our 2011-2012 National Meeting series.  The agenda and dates can be found here. Register now to save your seat!