Wednesday, March 12, 2014
QD: News Every Day--ASCO asks Congress to address oncology access shortage
Patient access to cancer care will be threatened as cost pressures force the closure of small physician practices that form the backbone of care in many communities, reported representatives of the American Society of Clinical Oncology (ASCO) in a Congressional briefing.
Advances in cancer treatment, screening and prevention have resulted in a record 13.7 million cancer survivors living in the U.S. But an aging population and lifestyles could drive new cancer cases to increase by as much as 42% by 2025 and the cost of care to rise by 40% to $175 billion by 2020, ASCO said in a press release.
“We’re facing a collection of challenges, each one of which could keep cancer treatment advances out of reach for some individuals.” said ASCO President Clifford A. Hudis, MD, FACP. “Collectively, they are a serious threat to the nation’s cancer care system, which already is straining to keep up with the needs of an aging population. Without immediate efforts to address these threats to oncology practices, we’re at real risk of failing tomorrow’s cancer patients.”
The State of Cancer Care in America: 2014 appeared online March 11 at the Journal of Clinical Oncology.
Despite a near doubling of demand for cancer care services, the number of oncologists will likely grow by only 28%, creating a potential deficit of nearly 1,500 physicians in the next 10 years. Nearly 450,000 new patients may have problems accessing care.
An aging oncology workforce and physician retirements play a role, the report stated. Currently, nearly 1 of every 5 cancer specialists is over the age of 64. In 2008, the number of oncologists over age 64 exceeded those under 40 for the first time, and ASCO projects this gap will widen.
Oncologists are already in short supply in many rural communities. Only 3% practice in rural areas, where nearly one-fifth of Americans live. More than 70% of U.S. counties have no medical oncologists at all.
Further complicating the supply of cancer care services is a growing concern about survival of smaller independent practices, especially in American’s rural communities. According to an ASCO survey of 530 U.S. oncology practices representing more than 8,000 oncologists, practices with 6 or fewer physicians face recent cuts to Medicare physician payments and other factors. These practices, concentrated in the South and West, serve more than one-third of new patients, according to ASCO’s research.
Nearly two-thirds of oncology practices with 2 or fewer physicians reported that they are likely to merge, sell or close in the next year. In small towns and rural communities, small practices are often the primary providers of cancer care, enabling people to receive high-quality, personalized treatment close to home. Closure of these practices will worsen potential workforce shortages, making access to care that is already uneven worse still.
ASCO also pointed out that use of physician extenders and experiments with new delivery models and reimbursement systems may help alleviate the problem, and asked Congress for legislative support.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
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Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.