Andrew L. Pecora, MD
Oncology & Biotech News
Chief Innovations Officer, Professor, and Vice President
of Cancer Services
President, Regional Cancer Care Associates, LLC
John Theurer Cancer Center
at Hackensack University
It is hard to argue that there is not a revolution going on in oncology. Nearly every day, we hear about some new discovery of a molecular pathway that confers malignant potential or a novel therapeutic strategy to treat the disease. The pace of discovery is staggering, leaving oncologists bleary-eyed as they try to keep up. Running on a parallel track is another revolution in oncology: the business side of delivering oncology care. In fact, the cancer care delivery landscape may be changing faster than the science track.
A recent survey by the Oncology Roundtable shows that the number of independent oncology practices continues to diminish, and many physicians in small community practices are considering employment by hospitals or joining large specialty oncology groups like US Oncology, Regional Cancer Care Associates, or Florida Cancer Specialists, to name a few.
The principal reason stated for small practices to move to an employment model has been the shrinking margins on drug reimbursement and the escalating cost of “bureaucracy” in interacting with payers. This issue only promises to become more acute as cost savings are sought from the oncology delivery system as a greater number of drugs get FDA approval. Specifically, the increase in approvals will add to the expense of care by increasing unit cost and prolonging life, and in turn, the duration of therapy. Add to this the demographic of more patients reaching older age, and the forces driving change in oncology care delivery will accelerate.
In the May/June 2013 edition of Oncology Issues, Amanda Henson, MSHA, MBA, reported that a 2011 survey of cancer programs found that 51% of the responding programs were employing medical oncologists, and 33% and 37% of the programs employed surgical oncologists and radiation oncologists, respectively (http://bit.ly/11TRIHa). Another 25% of the programs were considering employing oncologists within the next year, wrote Henson, who is executive director of Oncology Services at the Central Baptist Hospital in Lexington, Kentucky.
The other less quantifiable variable is the quality of professional life. Many physicians—younger and older—are starting to reconsider their lifestyle. It was not uncommon for physicians in past decades, particularly in private practice, to work 12- to 15-hour days and cover many weekends to care for their patients, in part because of the culture of medicine at the time, and also the economics. Employment offers a new set of economics, and as a consequence, forces a greater consideration of quality of life, including work hours in total, numbers of patients seen per hour, and weekend and night calls.
With a looming shortage of physicians driven by many seasoned oncologists (ie, those older than age 50) considering retirement, the anticipated decrease in per-physician output due to employment models and the increasing prevalence and complexity of cancer care delivery in aggregate seem to be adding up to a problem. At some point, similar to what happened with polio, there might be little need for oncologists because we will have determined how to prevent most cancers. In the meantime, policymakers, payers, and physicians must all consider the unintended consequences of some revolutions.