supply be addressed by increasing physicians. GME is the direct source of practicing physicians in the US caring for cancer patients. To become a he- matologist/oncologist requires com- pletion of medical school, followed by a residency training program and then a fellowship in that specialty. We analyzed the residency feeder programs and trends over the last 15 years as shown in Figure 2, lacking sustained growth. Table 1 shows data from the AMA master file and the US Census Bureau from 2010 illustrating there are about 10,000 physicians in the adult care of hematology/oncol- ogy patients and approximately two physicians for every 100,000 people. In Louisiana, there were 146 adult hema- tology/oncology specialists, in equal proportion to that of the United States. Table 2 shows the total hematology/ oncology fellows in the US in 2011 per the Accreditation Council for Gradu- ateMedical Education (ACGME) data resource book. There are 1,570 fellows currently training in adult hematol- ogy/oncology. There are 637 fellows who complete their training and are added to the oncology workforce an- nually after completion of five to six years of post-graduate training. The number of practicing hema- tology/oncology physicians in the United States who are trained in a GME program in Louisiana and the number who remain in Louisiana after training is also relevant, shown in Table 3 with a net retention of 41%. The number of specialists practicing in Louisiana currently who did not
Figure 1: The supply of hematology/oncology specialists comparing the United States to Louisiana, related to a proportion of a population.
Figure 2: The residency feeder programs and trends over the last 15 years.
tems. This is overall complex and difficult to define and has been done by a number of methods, but regardless of vari- ous methods, we found there is a consensus as illustrated by the Association of American Medical Colleges (AAMC) 2008 workforce report. 9 The findings were “under any set of plausible assumptions, the United States is likely to face a growing shortage of physicians…” They also published a report in 2011 summarizing recent publications and sum- maries around the country from 33 states and six national organizations, as well as 22 different specialties that have all reached this same conclusion. 10 RESULTS Replacement of Physicians and Increasing Supply One answer to this growing demand is that short
train in Louisiana is 77, so this adds another dimension to examining needs and sources. This begs the question: how many hematology/ oncology doctors will be training in Louisiana in the next 10 years, and how many will practice in Louisiana? Likely, trends will continue, but increase is uncertain. Incidence rates of cancer in the United States and Loui- siana are integral to this analysis. Figure 3 shows a map of the incidence rates in the United States in 2008 per state as observed fromSurveillance, Epidemiology, and End Results Program (SEER) data. Specifically noted is that Louisiana is higher compared with most of the country, with an inci- dence of 468-487 cases per 100,000 people. So compared to the country as a whole, Louisiana has comparable numbers of hematologists/oncologists; however, there is a higher incidence of cancer overall.
J La State Med Soc VOL 166 January/February 2014 11
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