Ensuring Quality Cancer Care Through the Oncology Workforce Sustaining Care in the 21st Century: Workshop Summary (2009) / Chapter Skim
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Solutions to the Oncology Workforce Shortage
Solutions to the Oncology Workforce Shortage
Pages 23-64
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Dr. Benz stated that there is great importance in focusing on solutions to the shortage in the oncology workforce because of the high prevalence of cancer in the U.S.
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This section of the workshop summary outlines the major solutions suggested by the various speakers to minimize the impact of the oncology workforce shortage on the quality of care. These included solutions focused on (1)
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Improving Efficiency One way that implementing new models of care can address the oncology workforce shortage is by improving the efficiency of health care.
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Increase Reduction of paperwork and regulations 61 efficiency Improved IT such as electronic medical records 43 Increase/ Increased use of NPs/PAs 36 extend Train more clinical oncologists 34 oncology Increased use of oncology nurses and CNS 32 workforce Create incentives to delay retirement 28 Increase use Hospice and palliative care providers 26 of related care Social workers, counselors, and patient educators 24 providers Hospitalists 20 Pain and symptom management specialists 17 Primary care providers to care for patients in remission 15 SOURCE: Salsberg presentation (October 20, 2008) and 2006 Practitioner Survey, ASCO.
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Teamwork Another strategy for bolstering the oncology workforce by changing the traditional models of care is to integrate and expand the role of physician assistants (PAs) and nurse practitioners (NPs)
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Smith, Massey Endowed Professor for Palliative Care Research Medical Director, Thomas Palliative Care Unit, VCU-Massey Cancer Center, expressed frustration that there is no agreed-upon reimbursement rate among insurance companies and Medicare for NP services. Medicare and
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Building on both the concept of team science and translational research, Dr. Mooney suggested more partnerships between nursing research scientists and physician scientists to broaden the clinical research being conducted in cancer and cancer centers.
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. A treatment plan and summary could bolster the use of primary care physicians or nonphysician health care workers to provide cancer or survivorship care, pointed out Dr.
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Dr. Bajorin added that, if survivorship care was shifted from the oncologist to the primary care physician, there would still be a substantial difference between supply and demand.
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She added that when survivorship care is done at a large institution, such as an academic cancer center, it will generate downstream revenue for that institution because of the additional care provided by radiologists, cardiologists, and other specialists. Several survivorship clinics exist within cancer centers and academic institutions.
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They are informed of what they need, and we're helping them inform the providers that are caring for them." Partnership between private oncology practices and other local medical offices, hospitals, or cancer centers may be a more efficient and economical way to provide cancer patients with the full continuum of care they need, including psychosocial support, nutritional counseling, and palliative and end-of-life care, Dr. Goldstein suggested.
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Palliative and Hospice Care In the 2006 ASCO survey of practicing oncologists, more than onequarter suggested that increasing the use of hospice and palliative care providers is a way of addressing workforce shortages (AAMC, 2007)
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. In addition, many terminally ill patients do not receive adequate palliative care and are given chemotherapy treatments instead.
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Smith. Another disadvantage of transferring patients to palliative care or hospice facilities is that the patient must shift from one known health care team to a team with which the patient is not acquainted.
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Dr. Shulman commented that as much as he and other oncologists like to see their patients who are cancer survivors, as well as administer palliative care, "those options are going to disappear over the next couple of years because the reality is not going to allow it -- there's no way we're going to be able to provide active cancer therapy in centers like Dana-Farber if they are filled up with survivors and patients that should be in hospice.
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Dr. Smith concurred, noting that palliative care is currently a low-paying profession, with most full-time palliative care physicians only generating about $70,000 a year in income after taxes, in part because of Medicare's cap of $150 per day for palliative care.
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Ms. Suanna Bruinooge, Director of the Research Policy Division, C ancer Policy and Clinical Affairs Department at ASCO, suggested considering ways that nurses, or other nonphysician staff, can support family caregivers to reduce the number of visits that are required in an oncology practice.
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Mr. Salsberg agreed that a medical home model should be considered when addressing the oncology workforce shortage, but added that such a system should not preclude patients from having their oncologist or oncology team act as their medical home.
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Marketing Health Care and Oncology Careers To increase the number of people who choose oncology as a career, Dr. Buerhaus suggested a national advertising campaign that emphases the positive aspects of oncology professions, including job opportunities.
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Providing good role models is a recruitment technique that could be used across multiple professions involved in oncology care. Several academic cancer centers are currently trying to provide these role models.
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. A recent two-day nursing expo held by Duke University Hospital was so successful that similar expos are planned for other allied health care workers, Mr.
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In addition, Duke University Hospital is strongly committed to career and leadership development of its health care workers as a way to improve retention. It offers a year-long program during which 20 employees with leadership or managing potential are coached and mentored.
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One innovative example of the use of retired health care workers is the Retirement Institute Program that Duke University Hospital is currently developing. This program is aimed at helping their retirees stay engaged in the workforce by serving as mentors, supporting the telephone triage of patients that call in, or by performing other work tasks.
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Greater oncology expertise must be built into the general curriculum of health science and health administrative programs, he noted, since cancer and cancer survivorship will be too pervasive to be provided only in an oncology context. Cancer centers have the critical mass to support such efforts.
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Dr. Bednash suggested embedding oncology and palliative care training into nursing schools' core curriculums to ensure that all nurses have some knowledge of oncology care.
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candidates are older and have family obligations that preclude long commutes or relocation. In addition, many cancer nurses wish to stay in their cancer centers and to extend their research interest to the center, without interrupting their career or relocating.
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Paul Mazmanian, Professor, Continuing Medical Education and Family Medicine, Virginia Commonwealth University Medical Center, noted a recent study that found learning can be achieved equally well with Internet-based distance programs as it can be with more standard onc ampus programs (Cook et al., 2008)
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teaching and research faculty in cancer nursing could be used as a model to address other oncology workforce training needs. Physicians A second educational solution proposed at the workshop was to increase the number of oncologists.
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D Anderson Cancer Center has taken proactive steps to close the gap between the health care supply and demand of allied health care workers by undertaking its own education and training programs.
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Ahearn noted. "Students receiving our training at the Cancer Center are able to make a seamless transition into the oncology workforce.
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D Anderson Cancer Center's health sciences education programs.
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Mazmanian pointed out. One study found that printed educational materials and formal continuing medical education programs did not foster significant behavioral change (Davis et al., 1995)
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Dr. Benz suggested that cancer centers, the NIH, foundations, and other sources of research training support need to work with one another to expand training opportunities for faculty across all disciplines related
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and the National Cancer Institute. Figure 12 New
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SOURCE: Wiest presentation (October 20, 2008) and the National Cancer Institute.
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POLICY SOLUTIONS Two policy experts at the workshop discussed possible policy solutions to the crisis in the oncology workforce. One long-term solution that was offered to help counter impending oncology workforce shortages was to boost the numbers of physicians who receive GME, especially those that pursue internal medicine residencies and oncology fellowships.
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. "We're at a point where we certainly aren't able to grow at the rate or to the extent at which the population requires additional health care workers trained," he said.
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and the Association of American Medical Colleges. care physicians, for which there is a heightened perceived need to expand.
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An additional bill not passed by Congress was the Quality of Care for Individuals with Cancer Act,15 introduced in 2002 and 2004, which included provisions to establish grants to support cancer curriculum development, programs to promote an adequate and diverse cancer workforce, and a plan to assist health care workers in professions facing the most severe shortages.
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Patel and Grover pointed out that any current efforts to devise legislation that fosters a growth in the oncology workforce may be dwarfed by both the new administration's focus on making major health care reforms and an economy on the downturn that cannot support major funding for new programs and initiatives. However, Dr.
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Ms. Schwartz suggested building synergy by supporting other organization efforts related to oncology, such as the National Priorities Partnership, which recently released a document that stresses making palliative care a health care priority.
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She also suggested that the numerous consumer advocacy groups for various types of cancers join this unified effort to address oncology workforce issues.
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