Mark S. Soberman, MD, MBA
The shortage of doctors and other professionals to fill available positions in oncology practice is not news to practitioners—the American Society of Clinical Oncology has long chronicled the growing need for young oncologists to fill the ranks as senior ones retire or leave due to burnout. The rising population and growing access to care also contribute to this trend. But the dimensions of this workforce deficit became starkly clear with the release of 2017 survey data from the Association of Community Cancer Centers (ACCC).
The association polled 293 program administrators and providers from 209 cancer treatment institutions around the country—mainly hospitals and academic medical centers (89%)—and found that nearly half (47%) reported vacancies for medical oncologists. This is no idle statistic but a sign that oncology centers are struggling to find physicians, said Mark S. Soberman, MD, MBA, past president of the ACCC, in an interview with OncologyLive®
about the group’s 2017 Trending Now in Cancer Care Survey (FIGURE).1
Figure. Staffing Trends, Oncology Practices1
The findings underscore the need to train more oncologists, radiologists, and surgeons to fill available openings, but they also indicate a need to delegate more routine work to advanced practice providers (APPs) and other healthcare professionals, he said. “We have to be creative. We have to think outside the box in terms of what the current care model is if we’re going to meet the needs of the future, because the old way of doing things may not suffice.”
Soberman’s own cancer treatment program at Monocacy Health Partners at Frederick Regional Health System of Maryland has encountered this problem. “We have an incredible program and we have great compensation, and we’re finding folks,” he said, “but it’s taking us a long time, and it’s a lot of work to find physicians and advanced practitioners.”
Insights into staffing considerations were among the key findings in the survey. Other areas of interest include trends in the use of molecular tumor boards, the challenges of trying to improve care in the face of financial pressures, and intergrating new technology into practice.
Giving APPs Freedom to Act
Bringing APPs on board is 1 solution to the problem of not enough oncologists, but it entails cultural and procedural adaptation to ensure that APPs are satisfied with their roles and allowed to work at the top of their abilities, because they too are in demand and can switch jobs almost at will, according to Jason Astrin, PA-C, MBA, DFAAPA, director of Advanced Practice Provider Services for The US Oncology Network (see related story on page 56). One in 3 ACCC survey respondents reported open positions for APPs. In addition, 66% reported open full-time equivalent (FTE) positions for oncology nurses, and 1 in 4 reported FTE nurse navigator and registrar vacancies.
Another potential solution to the shortage of top-level medical expertise is for oncology practices to work more closely with primary care physicians, giving them a supporting role in cancer care, Soberman said. This could simply entail greater involvement in survivorship and follow-up care, or more responsibility than that. Survey respondents described APPs mainly as nurse practitioners (81%), physician assistants (41%), and clinical nurse specialists (21%); 12% said they do not use APPs. Among those who do, the top 3 tasks assigned to these healthcare workers are symptom management, follow-up patient visits in the outpatient clinic, and survivorship visits.
Nurses are heavily engaged in managing patients on oral therapies (63%), with physicians (49%) and APPs (43%) sharing that task. Pharmacists are doing a portion of this type of work, too, according to 41% of respondents.
Although oncologists may have large caseloads, in the infusion centers, nursing staff carry highly variable loads. Nurses might each be assigned 7 to 9 patients per day (46%), 10 to 12 patients (30%), or 4 to 6 patients (24%). At any given time, nurse navigators may have as few as 0 to 25 patients (13%) under their management or as many as 200 or more (8%).