Wednesday, March 14, 2007

Shortage of Oncologists!? What about Shortage of Palliativists!

The US media has been hot on the article out of the Journal of Oncology Practice by Erikson yesterday about the forecasted shortage of oncologists. The study was well done and should be replicated by many disciplines, including hospice and palliative medicine, but since I don't have the time to write that article I will do a hastily written, poorly designed, non-blinded, utterly biased, uncontrolled case report of my opinion.

First looking at the JOP study (available free, so you don't have to rely on NBC news or USA Today to get your facts.), they looked at the following numbers*:

Existing Oncologists: 10,000
Annual Graduation of Fellows: 500 from 250 programs
2005 Capacity of Oncology Visits: 42 million
2020 Expected Demand of Oncology Visits: 65 million
2020 Expected Capacity of Oncology Visits: 47 million

They attribute much of the rapidly increasing demand to increased survivorship and increased incidence of cancer in a graying baby boomer population.

Well, in the hospice & palliative medicine world we already have a shortage of MD-patient interaction, but lets look closer at the numbers:

My hospice has this many doctors that do clinical visits with patients: 4
We see (optimistically and approximately) 20% of patients admitted to our hospice.
Hospices see roughly 30% of all patients who die (2.2mil non-traumatic) in the US.

So if all hospices had a single board certified physicians (they don't)
And that MD made home visits (very rare) or rounded at an inpatient hospice (kinda rare):

only 132,000 people (6%) who die each year
see a physician specialist
who could ease their suffering before they die!

Sinclair Formula for Estimating MD-Patient Interaction at the End of Life
2.2mil * 30% * 20% = 132,000

So we don't need to forecast a shortage, we already have one. Also with over 4,000 hospices nationwide, and with only 2,000+ board certified HPM docs, you have a pretty good chance your doctor running your hospice is not board certified.

Limitations of this crummy study include that I did not say a thing about hospital based Palliative Medicine, and a lot of people die in hospitals. Well, hopefully those docs are referring those patients to hospice so I did not want to double dip, and if they are seen by a HPM doc in the hospital and never make it to hospice that does not really bump that number up to high.

So why do I bring this up. Because I just got back from the AAHPM-led Fellowship Director's conference and it was very inspiring to be with such a great group of people who are going to teach all the future specialists in our field. I would encourage any of you who read Pallimed, and are not affiliated with any HPM Fellowship Training Program, to find your local one and ask them what you can do to help, time wise or money wise. Trust me they can use the support from and individual or your organization.


Also, I have nothing against oncologists. I am not trying to say their cause is frivolous, it is just that we already have a shortage and no one is making a big deal out of it. Besides some of my best friends are oncologists! Also, I am not advocating that everyone needs to see me or someone like me before they die, but we (HPM docs) should at least be available.

And if you decide to do this study in a decent way, feel free to give me some original idea credit!

*all numbers are rough for ease of understanding, look at the original article for exact numbers

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