Journal of the Louisiana State Medical Society
Table 1: Data from the AMA master file and the US Census Bureau for 2010 US
Louisiana
Type of practicing specialty
N 100k population
N
100k population
Hematologist
1,512 4,275 4,268 1,255
0.49 1.38 1.38 0.41
21 58 67 18
0.46 1.28 1.48 0.40
Hematologist/Oncologist
Oncologist
Pediatric-Hematologist/ Oncologist
TOTAL
11,310
3.66
164
3.62
Table 2: The total hematology/oncology fellows in the United States in 2011 per the ACGME Data Source Book Total Hematology & Oncology Residents/Fellows in the United States Specialty N Hematology 32 Hematology & Oncology 1,450 Oncology 97 Pediatric - Hematology & Oncology 400 Total 1,979 Table 3: The practicing hematology/oncology physicians in the United States who are trained in Louisiana, 2004-2012 Retention of hematology/oncology fellows in Louisiana N Total hematology/oncology physicians trained in a Louisiana GME program 135 Total hematology/oncology physicians trained in a Louisiana GME program & practicing in state as hematologist/oncologist (direct patient care) 55 % retention 41
The analysis of SEER data for Louisiana (Figure 4) in a breakdown by parish shows that many areas have a higher incidence than that illustrated for Louisiana as a whole. There are also a number of rural areas in Louisiana where it is illustrated there is a high incidence of cancer without hematology/oncology practices in those vicinities, bring- ing up the issue of access to care. Other complexities and challenges of this situation include a high percentage of impoverished and underserved, lower socioeconomic status, and lower health literacy, making the task of delivering care even greater. DISCUSSION The surprise is that Louisiana hematology/oncology physicians are quantitatively proportional to the average of the United States, despite the displacements and distrac- tions of Hurricane Katrina. 11 Loss of physicians was early, and replacement was gradual. Production from supply is somewhat less than half of practicing physicians in Louisi-
ana, comparing recruitments. GME programs in the state had not reconstituted until after Katrina, which closed one program for several years (Louisiana State University School of Medicine inNewOrleans). Recruitment of types of hema- tology/oncology specialists, distribution and geography is also similar to corresponding US characteristics. The comparison of individual states data to the US averages is perhaps the best marker of the present quan- titative requirement. If the prediction of hematology/ oncology specialist’s shortage in the United States is actual, then Louisiana is also likely to experience a shortage. The characteristic of programs and physician mobility means recruitment across boundaries increases competition. Many changes occurring presently and simultaneously in specialty GME programs, not just hematology/oncology, increase complexity and hide unintended consequences. Expan- sion of hematology/oncology specialty programs should be considered in future planning to alleviate impending shortages, especially since the production time is many years in duration.
12 J La State Med Soc VOL 166 January/February 2014
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