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U.S. could face a shortage of cancer doctors, study says
Future demand for oncologists expected The United States faces a serious shortage of cancer doctors in coming years as the population ages and advances in medicine increase the number of people living with the disease, according to a new study.
The study, published online Tuesday in the Journal of Oncology Practice, projects a 55 percent increase in the demand for cancer treatment by 2020 but only a 14 percent increase in the time doctors have available to see patients. That translates to a shortfall of as many as 4,080 cancer specialists, or oncologists.
"This is a looming crisis," said Edward Salsberg, director of the Association of American Medical Colleges' Center for Workforce Studies, which conducted the study.
"If action isn't taken, we'll face a major challenge ensuring all patients receive timely care," Salsberg said. "We may have to (prioritize) those patients who need most urgent care."
To cope with the increased burden, the report's authors suggest nurse practitioners, physician assistants and hospices pick up some of the workload; primary-care doctors monitor patients who've finished treatment for recurrence; older oncologists delay retirement; more cancer specialists be trained; and technological advances, such as electronic medical records, be employed to free up more of doctors' time for patient care.
Salsberg said he thinks rural areas, many of which already suffer from a shortage of oncologists, will be hit harder than urban areas. Academic centers that train cancer doctors, like Houston, likely will do better than outlying areas, he said.
Support for findings
Nevertheless, officials at the University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine's Dan L. Duncan Cancer Center, Houston's two main oncology programs, expressed concern about the trend.
"The first thing I'd say, based on what we're seeing here is, the study looks on target," said Dr. Michael Fisch, medical director of the community clinical oncology program at M.D. Anderson. "You can tell by the growth in patient visits in recent years."
In 2004, because of growing waiting times, M.D. Anderson stopped providing second opinions to breast cancer patients who intend to be treated elsewhere. The center is in the midst of a major building expansion to meet expected inpatient demand.
"I think it's going to affect everyone," said Dr. Martha Mims, director of clinical trials at Baylor's Duncan Center. "Two ... programs here helps Houston, but if we're going to look to nurse-practitioners and primary-care physicians to help care for patients, that's going to require training."
About 10,400 oncologists practice in the United States, with roughly 500 new ones entering the work force each year. But more than half of the oncologists practicing are older than 50 and could retire soon, according to the study.
Young doctors are in the pipeline to replace them, but the study suggests they won't be able to keep up with the demand. For instance, training more oncologists is expected to provide only a modest bump because of a limited number of slots in training programs. There is also concern that younger oncologists may not see as many patients because of questionnaire answers indicating they value their free time more than older colleagues.
Meanwhile, the number of Americans diagnosed with cancer will grow from 11.7 million in 2005 to 18.2 million in 2020. Because of the oncologist shortage, that will leave a shortfall of 9.4 million to 15.1 million doctor visits, the study says.
The surge in cancer is twofold, according to the study. The incidence of cancer, which rises rapidly with age, particularly after age 65, will increase by 48 percent by 2020; and the number of people living with it will increase by 81 percent.
Distant doctors
The latter is a tribute to recent advances in cancer treatment, particularly drugs that target tumors at the molecular level, that often turn the disease into a chronic illness. But such treatment is more complex and often requires a team of doctors.
For that reason, study researchers said oncologists increasingly will become team leaders, spending more time directing care and perhaps less in face-to-face encounters with a single patient.
In any event, the study says the shortage of oncologists will emerge gradually between now and 2020. By then, it says, the shortage could amount to 2,550 to 4,080 doctors. At that time, the supply of oncologists is projected to be about 12,500.
"It's going to be a significant problem," said Dr. Ray DuBois, the incoming provost at M.D. Anderson. "There are going to be a lot of patients that need to be taken care of and a shortage of manpower."
Cancer is the second-leading cause of death in the United States, behind heart disease. The American Cancer Society estimates that nearly 1.4 million people will be diagnosed with cancer this year and more than 560,000 will die of the disease.
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作者:admin@医学,生命科学 2011-02-15 05:11
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