Journal of the Louisiana State Medical Society
The Supply of Hematology/Oncology Specialists
Genevieve F. Maronge, MD; Paragi Gururaja Ramnaryan, MD, MPH; Perry G. Rigby, MD
National hematology and oncology organizations and experts in the field, predict a shortage of hematology/ oncology specialists in the United States. Four types of hematology/oncology graduate medical education programs picked to represent direct patient care specialists are presented as physician supply in quantitative data proportional to the averages of the United States in this paper. The hematology/oncology physician production in Louisiana is similar to the average of all programs in the United States. The complexities of having several hematology/oncology graduatemedical education programs, alongwith other specialists, make physician supply more difficult to predict. The patient care demand will rise gradually as the population increases and aging of the population ensues. Technology proliferates, and reform adds patient numbers. As the US shortage of hematology/oncology specialists occurs, the state of Louisiana is tracking the United States in supply and will show the shortage in the same way, same timing, and for the same reasons.
INTRODUCTION There is a perpetual discussion and debate on the subject of physician shortage and particular attention paid to that of primary care. 1,2 The shortage in specialists’ fields is beginning to gain recognition, however. 3 This is quite relevant to the subspecialty of hematology/oncology in that cancer is a disease growing as the population increases and ages, and it requires a delicate and skillful approach to diagnosis and therapy, with lethal potential to the patient experiencing it. If we consider that the numbers of cancer deaths are decreasing over time, 4 along with increases in technology, we can infer that cancer care is improving. This does not indicate a decrease in patients or visits, however, as there are more patients surviving and living with can- cer, requiring more physicians. It is therefore vital that we assess our physician supply and how demand will be met now and in the future. Is there a shortage of physicians in the United States as a whole, what kind, and how is this assessed? Graduate Medical Education (GME) programs are ultimately the sup- ply line of physicians to renew the provision of healthcare, and these vary in size, type, and location. It is probable that they are not increasing the production of specialists fast enough as it relates to population change. 5 The demand is impacted by a population that is dynamic by growth and aging and complicated by technology and constant advancements in standards of care. Healthcare reform is an additional variable that is particularly relevant in this political climate. Quantitating a shortage of hematologists and oncolo-
gists is not a straightforward task and includes a number of factors, like number-per-population, number-per-cancer patients and cancer survivors, the geographic distribution among the states and rural and urban area, and the number of hematologists/oncologists in academics versus non- academic settings (in a field dependent on active research), cancer center locations and utilization, waiting time for appointments and visits, and quality of care in a setting where demand may outweigh supply. 6,7 Certainly there is a fraction of the cancer-patient population that suffer if they are delayed in receiving attention due to longwait times and delayed appointments, as well as other potential barriers, i.e., finance, transportation, and resources. METHODS A straightforward approach to begin an examination is to identify supply and demand. We used data from the 2010 AMA masterfile and the 2012 edition of Physician Characteristics and Distribution from the Division of Survey and Data Resources to examine the supply. 8 Figure 1 dem- onstrates the supply of hematology/oncology specialists as it relates to the population in the United States as compared to Louisiana. We evaluated four specialty programs that provide medical care to cancer patients: medical oncolo- gists, hematology alone, hematology/oncology, and oncol- ogy alone, as well as pediatric hematology/oncology. This demonstrates that Louisiana is comparable to the United States overall in supply. We then examined the demand. The demand is repre- sented by the current utilization patterns and delivery sys-
10 J La State Med Soc VOL 166 January/February 2014
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