Future Supply and Demand for Oncologists Challenges to Assuring Access to Oncology Services
Future Supply and Demand for Oncologists Challenges to Assuring Access to Oncology Services
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DOI：
10.1200/jop.0723601
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发表时间：
2007-03-01
影响因子：
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通讯作者：
Goldstein, Michael
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文献类型：
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作者：
Erikson, Clese;Salsberg, Edward;Goldstein, Michael
目的：对到2020年的肿瘤学服务的供需进行全面分析。这项研究是委托董事会ASCO.Methods：新的数据收集的医生供应的调查执业肿瘤学家，肿瘤学研究员，奖学金计划主任进行了分析，沿着2005年美国医学会主文件数据执业医学肿瘤学家，血液学家/肿瘤学家，妇科肿瘤学家，以确定基线能力和预测访问能力，到2020年。就诊需求的计算方法是将国家癌症研究所对1998年至2002年监测、流行病学和最终结果（SEER）数据库的分析中的年龄、性别和诊断就诊率数据应用于国家癌症研究所的癌症发病率和患病率预测。癌症发病率和患病率预测是通过将SEER中年龄和性别特异性癌症发病率的3年平均值（2000-2002年）应用于2004年3月发布的美国人口普查局人口预测来计算的。基线供需预测假设癌症护理提供和医生实践模式没有变化。通过改变基线models.Results中的假设，构建了替代方案：肿瘤服务的需求预计将迅速上升，人口老龄化和增长的推动下，癌症生存率的提高，在同一时间的肿瘤劳动力老龄化和退休人数越来越多。预计2005年至2020年需求将增长48%。根据肿瘤学家当前的年龄分布和执业模式以及肿瘤学奖学金职位的数量，预计在此期间肿瘤学家提供的服务供应量将增长缓慢，约为14%。这意味着940万到1500万人次的就诊短缺，或者说2,550到4,080名肿瘤学家的短缺，大约是2005年供应量的四分之一到三分之一。基线预测不包括基于实践模式，服务使用或癌症治疗变化的任何变更。还开发了各种替代方案，以显示如何供应和需求可能会改变在不同的assumptions.Conclusions：ASCO，政策制定者和公众有重大的挑战摆在他们面前，以防止可能短缺的能力，以满足未来的肿瘤服务需求。需要一个多方面的战略来确保美国人在2020年获得肿瘤服务，因为没有单一的行动可以填补供需之间可能存在的差距。可以考虑的选择包括增加肿瘤学奖学金职位的数量，增加非医生临床医生的使用，增加初级保健医生在缓解患者护理中的作用，以及重新设计服务提供。
Purpose: To conduct a comprehensive analysis of supply of and demand for oncology services through 2020. This study was commissioned by the Board of Directors of ASCO.Methods: New data on physician supply gathered from surveys of practicing oncologists, oncology fellows, and fellowship program directors were analyzed, along with 2005 American Medical Association Masterfile data on practicing medical oncologists, hematologists/oncologists, and gynecologic oncologists, to determine the baseline capacity and to forecast visit capacity through 2020. Demand for visits was calculated by applying age-, sex-, and time-from-diagnosis-visit rate data from the National Cancer Institute's analysis of the 1998 to 2002 Surveillance, Epidemiology and End Results (SEER) database to the National Cancer Institute's cancer incidence and prevalence projections. The cancer incidence and prevalence projections were calculated by applying a 3-year average (2000-2002) of age-and sex-specific cancer rates from SEER to the US Census Bureau population projections released on March 2004. The baseline supply and demand forecasts assume no change in cancer care delivery and physician practice patterns. Alternate scenarios were constructed by changing assumptions in the baseline models.Results: Demand for oncology services is expected to rise rapidly, driven by the aging and growth of the population and improvements in cancer survival rates, at the same time the oncology workforce is aging and retiring in increasing numbers. Demand is expected to rise 48% between 2005 and 2020. The supply of services provided by oncologists during this time is expected to grow more slowly, approximately 14%, based on the current age distribution and practice patterns of oncologists and the number of oncology fellowship positions. This translates into a shortage of 9.4 to 15.0 million visits, or 2,550 to 4,080 oncologists-roughly one-quarter to one-third of the 2005 supply. The baseline projections do not include any alterations based on changes in practice patterns, service use, or cancer treatments. Various alternate scenarios were also developed to show how supply and demand might change under different assumptions.Conclusions: ASCO, policy makers, and the public have major challenges ahead of them to forestall likely shortages in the capacity to meet future demand for oncology services. A multifaceted strategy will be needed to ensure that Americans have access to oncology services in 2020, as no single action will fill the likely gap between supply and demand. Among the options to consider are increasing the number of oncology fellowship positions, increasing use of nonphysician clinicians, increasing the role of primary care physicians in the care of patients in remission, and redesigning service delivery.