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Oncologist Forecast Highlights Need for Team-Based Care

 |  By jfellows@healthleadersmedia.com  
   March 27, 2014

Advances in cancer diagnosis and treatment and longer-term survival rates point to a growing need for interdisciplinary provider teams to meet the needs of patients as the supply of oncologists is predicted to decline.

We've been hearing dire warnings about physician shortages to come. Now we're starting to see specifics. A report on cancer released by the American Society of Clinical Oncology this month projects a shortage of 1,487 oncologists by 2025.


Richard Schilsky, MD
Chief Medical Officer of ASCO

An aging workforce, longer survivorship of cancer, and an increased need for oncology services will all contribute toward the future gap in supply and increased demand, the report finds. Closing that gap would require a bigger care team that is clinically trained and educated to care for cancer patients, says Richard Schilsky, MD. He is ASCO chief medical officer.

"We think it's important that the oncology care team in the oncologist's office be expanded to include nurse practitioners, and physician assistants, [and] advanced practice providers," says Schilsky. "They can see the uncomplicated patients; the patients who are in for a follow-up visit, leaving more time for the oncologist to deal with the very sick and very complex cases."

Giving NPs, PAs, and APNs a bigger role with patients probably sounds familiar. That's because these roles are also being pointed to as an answer to a projected PCP shortage, though some PCPs are not as open to the idea.

Oncology nurses are embracing the move to play a bigger part in patient care, says Mary Gullatte, PhD, RN, ANP, president of the Oncology Nursing Society.

"With advances in diagnosis and treatment, long-term survival has significantly increased, which requires more long-term care," says Gullatte. "Advanced practice oncology nurses are in an ideal position to work collaboratively as part of the interdisciplinary oncology team to meet the needs of patients with cancer and to fill the gap left by the shortage of other members of the cancer care team."

Because oncology nurses are already a key part of cancer care, Schilsky says it may be easier for his peers to accept and expect nursing's expansion in oncology.

"Part of it relates to the fact that oncologists are used to working with highly skilled nurses every day in our practices," says Schilsky. "Every oncology practice employs oncology certified nurses who give the chemotherapy, who are essential members of the oncology care team."

Shifting Oncology Workforce
An analysis of the current oncology workforce shows 13,400 medical oncologists and/or hematologists. But, the oncology specialty also mirrors the trend of medicine in general of an aging workforce. In 2008, there were more oncologists 64 or older, and that gap has continued to widen.

Also, demand for oncology services is currently projected to grow by 42%, while the workforce is expected to grow by only 28%. Those figures do not include demand from additional patients who will need and receive services through the Patient Protection and Affordable Care Act. Factoring those patients into the mix means an even bigger strain on oncologists and patients.

In addition to giving oncology nurses more responsibility, Schilsky envisions a bigger role for PCPs, too, especially when a cancer patient becomes a cancer survivor.

"In most medical communities, the PCP is the coordinator of care and therefore does have strong relationships with any number of medical specialists," he says. Educating PCPs on cancer care and follow-up is key to including them as part of a cancer team.

PCMH to the Rescue?
The looming shortage of oncologists boosts one physician's view that patient-centered medical homes may be an answer. John Sprandio, MD, FACP, who has developed a PCMH for his oncology practice in Pennsylvania, says ASCO's report supports the same goals as an oncology PCMH: efficient, consistent, personalized, and better patient care.

"It makes the case for an Oncology Patient-Centered Medical Home model of care that drives the consistency of cancer care delivery, leverages technology to maximally support physician oversight and efficiency, while meeting the needs of our patients and their families."

Sprandio's Consultants in Medical Oncology and Hematology (CMOH) was the first oncology practice to be certified as a level 3 PCMH by the National Committee for Quality Assurance, back in 2010. But it took years before it attained the level of highly coordinated care that exists in his three-location practice today. And that may be a barrier too high for some oncology practices to cross, says Schilsky.

"It's certainly a great idea, and it's certainly difficult to adopt," says Schilsky who notes that the ASCO worked with Sprandio on a grant to expand the oncology PCHM to other practices across the country. It didn't get funded, though they are looking for alternative funding alternatives.

"It requires a substantial investment in staff, and health IT infrastructure," says Schilsky.

In addition to expanding nursing's role in oncology and exploring alternative care models, ASCO's report also recommends trying to prevent professional burnout.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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