Purpose: To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO.Methods: New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000 -2002) of age-and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models.Results: Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists-roughly one-quarter to one-third of the 2005 supply. The baseline projections do not include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions.Conclusions: ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery.
Will the United States have sufficient numbers of qualified health professionals to provide for the future genetic health care and service needs of the population?This is a difficult question to answer. Continued scientific discoveries and new clinical applications will fuel a growing interest and demand for genetic services. At the same time, the very definition of genetic services is evolving. Clinical genetics services are highly specialized and currently constitute a focused area of overall medical care and public health programs. Yet, genetics-related discoveries are forecast to be one of the most significant factors affecting health care over the next decades.This summary presents key findings of a survey of medical geneticists that was one component of a 3-year national research project, Assessing Genetic Services and the Health Workforce. The goals of the overall project were to: (1) describe current models of providing clinical genetics services; (2) describe the roles of health professionals delivering services; (3) identify measures to monitor changes in demand for services; and (4) establish a framework and baseline description for ongoing and longitudinal studies of genetic services.A written survey of all American Board of Medical Genetics (ABMG) certified medical geneticists was conducted in February 2003; it included 67 questions organized into six sections. A 55% response rate was obtained. No response rate difference (bias) was found using comparisons by geographic location (US Census regions and divisions), and year and type of initial ABMG certification. When using comparisons by respondents' degree type, response rates varied from 51% to 63%, with a slight but statistically significant higher response rate for the PhD-only degree subgroup. We concluded from this analysis that the observed response rates showed variability but little evidence of bias. Thus, we present findings weighted for the entire population (1377) This commentary begins with a workforce summary that presents findings for the entire medical genetics workforce. Only limited subgroup analysis is presented (e.g., the geographic distribution of MD clinical geneticists, activities of clinical laboratory geneticists). This workforce summary approach allows one to describe the overall characteristics, professional practices, and aggregate contributions of the professional group.
Over the past twenty-five years the nation has struggled with a series of physician workforce issues: determining the appropriate number of physicians needed and the appropriate number to produce; the role of international medical school graduates; the mix of primary care and non-primary care physicians; efforts to increase the number of underrepresented minorities in medicine and the supply of physicians in rural areas; and the impact of the growing number of female physicians. This paper documents physician workforce trends over the past twenty years, especially as they relate to these issues.
Although many geneticists practice as generalist geneticists, this study provides an evidence base for distinguishing clinically relevant subgroups of geneticists. Geneticists provide similar numbers of new patient visits and far fewer follow-up visits than other medical specialists. These findings are relevant to geneticist workforce planning.
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