After Sarode K. Pundaleeka, MD, founder and longtime president of Joliet Oncology-Hematology in Illinois, announced in 2010 that he planned to retire in 5 years, the practice’s other physicians spent months debating how they would operate in the future. According to PJ Sidhu, the practice administrator, they decided to create new governance and compensation structures and eventually elected a new president.
Among their decisions: open the presidency and vice presidency to new candidates every 3 years to give more of the doctors opportunities to gain leadership skills. Yet, despite their understanding of the importance of preparing for leadership changes, the 140-employee practice still has no formal response plan for the loss of one of its most important people: Sidhu himself.
“I wear quite a few hats. I’m not just running the operations, but I am also very involved in strategic development, direction, growth, mergers and acquisitions, and hospital alliances. We don’t have a CFO, so I do all the finance work myself. I do not believe at this time we have a suitable backup to take over the responsibilities from me,” Sidhu said. “They need to have a second line in case of need. The physician leadership should think about those things.”
Planning for both leadership succession and unexpected staff departures has always been a good idea, but such preparations are becoming even more important as community oncology faces a workforce crunch. The number of oncologists at retirement age has been climbing for years, surpassing the number of younger doctors and incoming fellows. And as the population of cancer patients grows faster than the number of active physicians, providers in some areas are having difficulty attracting and retaining staff.
More than 18% of active oncologists are age 64 or older, compared with 13% who are 40 or younger, according to ASCO’s most recent State of Cancer Care in America report. Last year, 2236 oncologists were nearing retirement, but in 2015, just 586 oncology and hematology fellows were in their final year of training. In Delaware, Hawaii, Nevada, New Mexico, and West Virginia, more than a quarter of oncologists are close to retirement, and 3 states—Alaska, Hawaii, and Nevada—have particularly low numbers of younger oncologists.
At the same time, the business of medicine has become so complex that practices can ill afford any major disruptions of either their medical or administrative teams. At a successful office where everyone contributes their maximum, any sudden staff departure can be a blow, said Ray Page, DO, PhD, president of the Center for Cancer and Blood Disorders in Fort Worth, Texas. “It can really hurt a practice,” he said. “There are so many complexities in the delivery of cancer care. It’s hard to pick up and learn overnight.”
Two years ago, one of the busy physicians at Page’s practice died suddenly while on vacation, and the staff scrambled to accommodate the loss. “When somebody who is making a large contribution suddenly exits, there’s a big void there,” he said. With 19 oncologists at 9 offices, the practice was able to adjust, but a sudden loss can be devastating for a smaller practice with less backup, Page said. Even if a new doctor is hired, it can take 6 months or more for that person to gain hospital privileges and register with payers, he noted.
Practice leaders must—among other responsibilities—manage employees, finances, regulatory issues, drug inventory, and relationships with referring physicians and hospitals, said Robin Zon, MD, of Michiana Hematology Oncology in Indiana. It’s imperative to train multiple staffers to take over if necessary. “Oncology has become much more complicated, especially over the last 5 to 10 years,” said Zon, chair of ASCO’s Government Relations Committee. “For a number of reasons, the environment in which we’re practicing has become so complex that you can’t wing it.”
As a first step, Zon suggests that physicians consider their organizational structure, staff members’ ages, and retirement plans. They should review the responsibilities of physician leaders and identify others who can step in if a leadership position is vacated.
One tool for preparing for leadership changes, whether sudden or planned, is a committee structure that exposes younger partners to different aspects of operations. At Zon’s practice, “all of us have designated responsibilities. If somebody retires, somebody else knows what the retiree knows,” she said.
Page advises setting up physician-led committees; at his practice, physicians who become partners are required to rotate chairmanships every 2 years. Doctors who show good leadership potential are then nurtured further.