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New Data Reveal Mismatched Need and Supply of Oncology Physicians and Pharmacists in America

JHOP - June 2021 Vol 11, No 3 - From the Literature
Commentaries by Robert J. Ignoffo, PharmD, FHOPA, FASHP, FCSHP
Clinical Professor Emeritus, University of California, San Francisco; Professor Emeritus, Touro University–California, Mare Island, Vallejo, CA
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BACKGROUND: Previous analyses have pointed to alarming shortages of oncology providers in the face of growing demand. No oncology workforce study, however, has assessed the link between geographic need for oncology services and the codependency between oncologists and nonphysician health professionals with an oncology subspecialty. A recent report on the state of cancer care in the United States examined the availability of physicians and oncology pharmacists and their geographic distributions throughout the country and compared it with the need for oncology services in each county.

METHODS: The researchers used data from the 2019 National Provider Identifier using the healthcare provider taxonomy codes and categorized the oncology workforce into 2 groups: oncology physicians and oncology pharmacists with an oncology subspecialty. They calculated the availability of the physician and pharmacist oncology workforce in each geographic county and the percentages of counties and their surrounding counties without primary oncology practices, and the percentages of counties with, and then analyzed the cancer rates for each county and categorized them into quartiles, to designate the level of demand for oncology workforce.

RESULTS: Of the 30,553 healthcare providers in the oncology workforce in 2019, a total of 28,681 were medical oncologists and 1090 were oncology pharmacists, using the 2019 National Provider Identifier. By comparison, 2014 data from the American Society of Health-System Pharmacists reported 1863 board-certified oncology pharmacists. Our analysis of 2019 data showed that more than 65% of the oncologists were in the South Atlantic, Middle Atlantic, Pacific, and East North Central. The mean density of oncologists by county was 2.94 per 100,000 persons. The analysis of the oncology workforce showed that 64% of US counties had no oncologists with a primary practice site located in that county, and 12% of counties did not have any oncologists within that county or in the adjacent counties.

“Using county cancer rates as proxies of demand for oncology care, we found an alarming pattern that oncologists tended to be less available in counties with higher demand, suggesting that patients with cancer residing in higher-demand counties will either need to travel farther to receive cancer treatment or rely on physicians or other health professions not specialized in oncology to provide the cancer care they need,” the researchers noted.

Counties in the top quartile of cancer rates had the highest percentage without any primary oncology practice located in the county (75%) or without any oncologists in the local and adjacent counties (16%) versus counties in the lowest quartile without oncologists (52%) or in the adjacent counties (11%). A large discrepancy in the supply of oncologists across geographic regions was also observed. The researchers noted that one strategy is to expand the role of nonphysician health professionals, such as pharmacists, “to alleviate shortage in the supply of oncologists, especially for survivorship and palliative care.”

“This highlights the importance to develop and standardize core competencies for health professions not specialized in oncology to deliver quality cancer care,” they concluded.

Source: Shih YCT, Kim B, Halpern MT. State of physician and pharmacist oncology workforce in the United States in 2019. JCO Oncol Pract. 2021;17(1):e1-e10.

Commentary by Robert J. Ignoffo

In the background of the study by Shih and colleagues discussed here, the authors mention 2 previous publications,1,2 noting that the American Society of Clinical Oncology “formed a special task force to study the oncology workforce in 2007. A report from this task force sounded the alarm of a shortage of oncologists; this 2007 report predicted a 14% increase in the number of oncologists between 2005 and 2020 despite a 48% increase in the demand for oncology services.”3 The complexity of cancer care has inspired allied health professionals, such as pharmacists, nurses, nurse practitioners, and physician assistants, to subspecialize in oncology, to be able to improve their service for patients with cancer.

The study by Shih and colleagues is one of the few studies that discusses the role of oncology pharmacists in cancer care. Shih and colleagues relied on National Provider Identifier data sourced from the Centers for Medicare & Medicaid Services National Plan and Provider Enumeration data. The authors approached this analysis of the oncology workforce using taxonomy codes provided by National Provider Identifier data. However, this approach grossly underestimated the number of oncology pharmacists serving patients with cancer.

In a letter to the editor of JCO Oncology Practice about the Shih article, Knapp and Ignoffo reported that according to the Board of Pharmaceutical Specialties (BPS), there were an estimated 2761 board-certified oncology pharmacists (BCOPs) in 2019.4 Furthermore, at the end of 2020, BPS records showed that there were 3074 BCOPs (based on data provided by BPS staff in January 2021). Knapp and Ignoffo propose that BPS standards and reports support the reliability of their data. Trend data in their study show that BCOP numbers have been growing at a rate best described by an exponential (rather than linear) model. BCOPs were projected to reach 4955 and be able to provide more than 4.1 million 30-minute patient visits by 2024.4

In summary, as a result of this increasing oncology pharmacy workforce capacity and growth, oncology pharmacy training programs and certification strategies, it is suggested that oncology pharmacists could contribute more to the oncology care shortage than the Shih study suggests.

  1. Hortobagyi GN. A shortage of oncologists? The American Society of Clinical Oncology workforce study. J Clin Oncol. 2007;25:1468-1469.
  2. Erikson C, Salsberg E, Forte G, et al. Future supply and demand for oncologists: challenges to assuring access to oncology services. JCO Oncol Pract. 2007;3:79-86.
  3. Shih YCT, Kim B, Halpern MT. State of physician and pharmacist oncology workforce in the United States in 2019. JCO Oncol Pract. 2021;17(1):e1-e10.
  4. Knapp K, Ignoffo R. Oncology pharmacists can reduce the projected shortfall in cancer patient visits: projections for years 2020 to 2025. Pharmacy (Basel). 2020;8:43. DOI:10.3390/pharmacy8010043.
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