In a recent study by the American Society of Clinical Oncology (ASCO)1, there is an anticipated supply and demand shortage of medical and radiation oncologists through 2025. This is an update of the 2007 study that estimated a 14% increase in services provided and a 48% demand for services by 2020. The impacts of the Accountable Care Act (ACA), changes in prevention and screening guidelines, social and economic factors including insurance availability and cost of care, physician retirement rates and productivity levels for hospitals and physician practices will all influence the reaction to impending shortages. The results of the current study indicate that the overall demand for oncologist services will be 40%, without the impact of the ACA, with supply growing 25% by 2025. When the expected impacts of the ACA are calculated into the study, an additional 500,000 visits to oncologists may occur.
An increasingly complex matrix
Given the complexity of cancer care delivery, The Oncology Group developed a proprietary Cancer Care Matrix that outlines the flow process from prevention to survival or end of life in the cancer journey. As cancer care becomes increasingly complex, understanding, defining and analyzing the complexity of care delivery is essential. Knowing the needs of patients, providers and care settings to address the increasingly complex matrix of cancer care is difficult. Matrices are found in many scientific fields. In physics, they are used to evaluate physical phenomena; in probability theory, stochastic matrices are used to describe sets of probabilities. While relatively new in healthcare applications, understanding that the continuum of cancer care is not linear and influences and factors along the way will dramatically impact outcomes becomes the new normal.2 Manpower shortages, financial challenges, operational inefficiencies and quality are all components of the matrix that must be addressed to effect optimal patient outcomes.
So what is a cancer program to do?
Planning is key! As programs and practices face financial challenges and an uncertain future, a new strategic vision for cancer care must emerge. Two levels of care exist in many areas of the country today with the insured and uninsured receiving different levels of cancer care—one group with early diagnosis and aggressive treatment while the other group presenting much later in the disease and consuming fewer resources with the potential for an earlier death. If almost everyone is offered access to healthcare through the ACA or other avenues, the burden on cancer programs and physician practices may dramatically increase while the shortage of oncologists grows. A careful assessment of existing services, future needs and services for the community, and the availability of resources to meet these future challenges are critical. The Oncology Group is well-positioned to offer academic, not-for-profit and for-profit health systems and physician practices assistance in determining current and future needs by working collaboratively with thought leaders to define the appropriate strategic vision and plan.
In addition to the strategic plan, facilities and practices need to develop accurate manpower plans. Medical oncologists, radiation oncologists, surgeons and specialists are integral to success. Do you have a sufficient supply? What is the future demand in your community? What is the expected incidence and prevalence of cancer in your market and what does that mean for recruitment? What is the role of Advanced Practitioners (APs) in supplementing your physician supply? A new society was launched in January of 2014 to acknowledge the increasing relevance of APs in cancer care. The Advanced Practitioners Society for Hematology and Oncology (APSHO)3 defines their target members as Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, Advanced Degree RNs and Pharmacists. Their goal is to promote collaboration between oncologists and advanced practice professionals to enhance cancer care. The Oncology Group will develop the Manpower Plan in conjunction with the program and practice and will also address needs related to the site of care.
Determining changes in care delivery patterns due to changes in practice patterns allows providers to adjust their operations to better meet the needs of patients and communities. A move to clinical pathways or standardized guidelines such as those developed by ASCO, the American Society for Radiation Oncology (ASTRO) or the National Comprehensive Cancer Network (NCCN) may contribute to physician productivity enhancements. Facilities and practices also need to evaluate the role of APs to enhance physician productivity as supply tightens since productivity enhancements are essential factors in supporting demand for services. Part of any manpower discussion is staffing and productivity in the cancer program or practice. Operational planning related to Infusion Centers, Inpatient and Outpatient Care, Radiation Centers, Invasive and Non-Invasive Surgical Services and Preventive and Screening Services are integral to successful cancer care. The Oncology Group has worked with Health Systems, Cancer Centers, Cancer Programs and Physician Practices all over the country allowing our consultants to bring a wealth of knowledge and benchmarking ability to clients.
The consultants of The Oncology Group are available to assist facilities and practices in addressing strategic and operational issues related to the complexity of cancer care delivery, including manpower shortages. For more information, call 512.583.8815 or send an email to [email protected].
Yang W, Williams JH, Hogan, PF, et al. Projected supply of and demand for oncologists and radiation oncologists through 2025: An aging, better-insured population will result in shortage. J Oncol Pract 10:39-46, 2014.
Bingham JW, Quinn DC, Richardson MG, Miles PV, Gabbe SG. Using a healthcare matrix to assess patient care in terms of aims for improvement and core competencies. Joint Commission Journal on Quality and Patient Safety. 2005 Feb;31(2):98-105
Advanced Practitioners Society for Hematology and Oncology, www.apsho.org