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.