Please keep reading and writing (on) cancer, Prof. Gubar. I learn from you with every word.
The fight against cancer will be won when physicians will know Oncological Terrain-Dependent, Inherited Real Risk of malignancy, that does really exist, bedside diagnosed from birth with a common stethoscope, and than removed by inexpensive Reconstructing Mitochondrial Quantum Therapy. Why now the positive to Oncological Terrain family members of cancer patients, aren't enrolled in such a efficient Primary Prevention? We must inform the USA President Trump, who unfortunately ignores Medicine advances.
I am fortunate to live in NYC with its many excellent medical centers. I had a wonderful gynecological oncologist surgeon and a good hematologist/oncologist who was part of a team-based review to decide the best chemo approach for my Fallopian tube cancer. But it seems these institutions limit the number of GYN oncologists on staff because in comparison to other "common" cancers, ovarian and other GYN cancers aren't that numerous. Due to the mergers of many medical centers into now just a few really big entities, doctors who don't have huge billings are pushed out or into more routine practices. The pressure is for more billings but fallopian/ovarian cancer cases are not as numerous as high $ cardiac surgery, for example. It seems New York is a magnet for talented young doctors and other cities need to come up with incentives, such as team-based programs and adequate compensation, to lure these doctors there. Thanks to the care of my doctors and luck, I'm healthy. I hope they'll still be here if I should need them again.
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I am lucky to live in the Lehigh Valley in Pennsylvania and have an excellent gynecological oncologist. One factor affecting the shortage of Oncologists is their success in keeping patients alive. Getting the best care for cancer can involve travel, as I learned when my husband spent 4.5 years fighting glioblastoma (brain cancer). His neurosurgeon was at Penn in Philadelphia and his neurooncologist was at the University of Pittsburgh. Telemedicine, as well as the use of NPs, may help in the future.
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This scary and depressing report goes a long way to explaining the packed waiting rooms and the standard five-minute consultations at many cancer centers.
What are the oncologists themselves doing to address the crisis in staffing and support?
I wonder if the problem is even addressed at annual meetings?
Your group is at least trying to make something happen, which is a welcome sign.
What are the oncologists themselves doing to address the crisis in staffing and support?
I wonder if the problem is even addressed at annual meetings?
Your group is at least trying to make something happen, which is a welcome sign.
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I was diagnosed with ovarian cancer in 2011. I live in extreme SW Colorado. I had 2 choices for a gynecological oncologist, one being in Grand Junction, a 250 mile RT with a Dr who had been there only 9 mos, or in Denver 650 mile RT. I went with the Denver doc. 5 yrs later following surgery, chemo no sign of cancer. I have lost 3 friends to ovarian cancer since that time. I have heard horror stories of botched surgeries by general surgeons, terrible care from gynecologists who have no clue what they are seeing or dealing with. Recently 2 women in our very small community have been diagnosed stage 4 Uterine cancer, facing the same dilemma as me of where to go for treatment. I sympathize with the young med student who suffers burnout and overwhelming debt.
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Medical Oncologist perspective here. One- a GYN Oncologist is a very distinct specialty- really more important to have their surgical expertise and have a medical oncologist supervise the chemotherapy. My group had 3 GYN oncs at one time but they only did the surgery. We did the chemo including clinical trials. I want my surgeon operating, not in the chemo suite. I can handle that. But that is just my opinion.
As for the "shortage" it depends where you live, but I can tell you that even those oncology practices who could use some help are too focused on profit to entertain the idea of adding more oncologists unless they are going to bring in more $$.
These same oncologists are going to burn out (flame out?) quickly.
I retired from a large practice after 30+ years. Moved away and was recruited to help out in a rural practice an hour from my new home. I go 3 days a week. But the drive is wearing me out and I do not need to work. I just love oncology patients. I know that the oncologists in my city are overworked and it would be wonderful to work closer to home, but they also show no interest in having more help.
Perhaps the move to value based care vs. volume based will make them more likely to add some part time help.
I am skeptical about the "shortage" in some cases.
As for the "shortage" it depends where you live, but I can tell you that even those oncology practices who could use some help are too focused on profit to entertain the idea of adding more oncologists unless they are going to bring in more $$.
These same oncologists are going to burn out (flame out?) quickly.
I retired from a large practice after 30+ years. Moved away and was recruited to help out in a rural practice an hour from my new home. I go 3 days a week. But the drive is wearing me out and I do not need to work. I just love oncology patients. I know that the oncologists in my city are overworked and it would be wonderful to work closer to home, but they also show no interest in having more help.
Perhaps the move to value based care vs. volume based will make them more likely to add some part time help.
I am skeptical about the "shortage" in some cases.
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This is the whole reason for team-based care--not only does it offload some of the work from the very burdened shoulders of the attending physician, it engenders bonding between the team members that is protective against burnout. More oncologists are surely needed. But if it were financially feasible for every oncologist to have 1-2 NPs or PAs and 1-2 social workers working with them to care for their patients, I bet you the burnout level would go way down and the quality of work life level would go way up. The oncologists at my institution are mainly researchers who offload about half of the routine clinical work to NPs. There is a marked difference in the quality of work life between the oncologists whose research funding affords them an NP and those who are earlier in their career and are shouldering the burden alone. Team-based care is the future of health care and this is just another reason why.
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All specialties that do not generate massive billing value are in danger in our current reimbursement structure.
If you perform surgeries or procedures, you earn a lot. If you examine a patient carefully, review their imaging and labs ahead of time, and then sit and talk with them, you are paid per hour less than an RN.
If an MD has debt, how can they choose a specialty where their income coes not permit them to work off their debt in a reasonable time frame?
If you perform surgeries or procedures, you earn a lot. If you examine a patient carefully, review their imaging and labs ahead of time, and then sit and talk with them, you are paid per hour less than an RN.
If an MD has debt, how can they choose a specialty where their income coes not permit them to work off their debt in a reasonable time frame?
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Another factor not mentioned is insurance networks. Even if an appropriate specialist exists, that specialist may not be in a patient's EPO or HMO network. If the patient can't afford to pay an inflated price out of pocket for treatment with the specialist, it means being condemned to inferior care or a death that might have been avoided.
As the need for an oncological specialist (or any other specialist) usually can't be predicted, it's not practical to make that a criterion when shopping for individual insurance. And many people are stuck with whatever health plan their employers choose.
That's just one failing of the uniquely American fragmented medical industry, in which decisions about access to care are made by third parties who care only about costs or profits.
As the need for an oncological specialist (or any other specialist) usually can't be predicted, it's not practical to make that a criterion when shopping for individual insurance. And many people are stuck with whatever health plan their employers choose.
That's just one failing of the uniquely American fragmented medical industry, in which decisions about access to care are made by third parties who care only about costs or profits.
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"...generalists who treat numerous cases of breast, prostate, lung and colorectal cancer."
Although for certain cancers like colorectal where the chemotherapies are pretty standardized, that's not the case with say, prostate cancer where the three big guns (surgery, chemo and radiotherapy) can be used in many different ways depending on rapidly changing treatment plans based on better and better diagnostic staging. I cannot see how an oncology generalist can possibly be as effective as a specialist. Better yet is a team approach with specialists from all three disciplines as well as providers who can best address quality of life issues.
Although for certain cancers like colorectal where the chemotherapies are pretty standardized, that's not the case with say, prostate cancer where the three big guns (surgery, chemo and radiotherapy) can be used in many different ways depending on rapidly changing treatment plans based on better and better diagnostic staging. I cannot see how an oncology generalist can possibly be as effective as a specialist. Better yet is a team approach with specialists from all three disciplines as well as providers who can best address quality of life issues.
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Yes, it's "best" to have a team of specialists from all three disciplines -- since the expert in each one will recommend HIS or HER specialty as the BEST treatment. Says my husband, who was diagnosed with prostate cancer. The recommendations of these specialists did not help him make his decision; he did his own research, and came to a conclusion on his own. He might have been better served by a generalist who actually took my husband's values and desires into account in deciding upon a treatment plan.
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Dr. J:
Kudos to your husband for doing his own research. Unfortunately for most men, confronting the world of prostate cancer treatment, based on a complex and recently revised staging process is not the most reliable way to come up with the best treatment plan. The team should be trained to incorporate the patient's needs and priorities but there is simply too much medical stuff coming at a man who has just been diagnosed with prostate cancer and now faces a range of options from do nothing to incorporating every treatment with their negative quality of life changes.
Kudos to your husband for doing his own research. Unfortunately for most men, confronting the world of prostate cancer treatment, based on a complex and recently revised staging process is not the most reliable way to come up with the best treatment plan. The team should be trained to incorporate the patient's needs and priorities but there is simply too much medical stuff coming at a man who has just been diagnosed with prostate cancer and now faces a range of options from do nothing to incorporating every treatment with their negative quality of life changes.
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Even more, the shortage of palliative care specialists (oncologists sometimes enter that role) and the reimbursement for palliative. A remarkable specialty.
One of the best teams I ever worked with, the palliative team. Unfortunately many rural areas have no palliative service and suffer the loss of a better, more comfortable, course of humane options.
One of the best teams I ever worked with, the palliative team. Unfortunately many rural areas have no palliative service and suffer the loss of a better, more comfortable, course of humane options.
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As a palliative care doctor, I really appreciate you highlighting this. I worry about the lack of reach for both oncology and palliative care.
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I wouldn't know the specifics for Indiana, but I am sure part of the problem is economic incentive and lifestyle. Like medicine in general and most medical specialties, the path to oncology is long and arduous one. Four years of undergrad, four years of medical school which include 4 major licensing exams (Steps 1-4).... then 5 years of Surgical residency with again a major Board Certification exam and then another two years for a fellowship in Oncology, again with another certification. It takes a great deal of training which takes a long time, a lot of dedication and the ability to delay gratification in terms of reaching ones professional goals to become a Dr. in general and a specialist in particular. It also takes a lot of money to become a Doctor, wiht many a person leaving medical school with over 2000,000 in debt. As residents they have the privilege of earning little over 50,000.00/year. If you calculate that against the number of hours worked-well it wouldn't be much of an hourly wage.
The shortage you are finding is not unique and will probably increase in the medical profession. The social/economic environment has been one that looks to find ways to reduce the incentives for an intelligent hard working individual to go through all of the above, whether it be by pressures against highly paid incomes, oversight regulation by "experts" who are not necessarily medical experts but instead statistical experts, I know this as a parent of 2 young Doctors.
The shortage you are finding is not unique and will probably increase in the medical profession. The social/economic environment has been one that looks to find ways to reduce the incentives for an intelligent hard working individual to go through all of the above, whether it be by pressures against highly paid incomes, oversight regulation by "experts" who are not necessarily medical experts but instead statistical experts, I know this as a parent of 2 young Doctors.
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Just graduated Medical School, and make $39,500 a year st my specialist residency program. I figured out that the other month I was on call, I made approximately two dollars less than the minimum wage in the state where my residency is based. While in Medical School, my debts accrued an average of 6.7% interest due to the Obama administration eliminating subsidized graduate loans, and I currently owe $275,000. I am told by uneducated patients that I must make "a ton of money", while enjoying the hazing and pimping of Senior Residents and Attendings.
I understood the term "delayed gratification" before I entered Medical School, but now am experiencing what it means to see your non-medical friends build their lives while you live in practical indentured servicetude. It is no wonder why there is a paucity of Oncological Specialists.
I understood the term "delayed gratification" before I entered Medical School, but now am experiencing what it means to see your non-medical friends build their lives while you live in practical indentured servicetude. It is no wonder why there is a paucity of Oncological Specialists.
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As it happens, it was Congress and not the Administration that eliminated subsidized graduate loans, as part of 2011's Budget Control Act.
The situation is hard on you now, but it's temporary. Surely you know that in the long run you will be far better off than the average American.
Those who are truly interested in and committed to truth, logic, and fairness don't let ideological biases cause them to make unfounded claims aimed at supporting a predetermined conclusion (such as, "the Obama administration is to blame for everything that ails the US and its economy").
The situation is hard on you now, but it's temporary. Surely you know that in the long run you will be far better off than the average American.
Those who are truly interested in and committed to truth, logic, and fairness don't let ideological biases cause them to make unfounded claims aimed at supporting a predetermined conclusion (such as, "the Obama administration is to blame for everything that ails the US and its economy").
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Alex---we've been there. And it was back in the days when duty hours aren't capped like now. We were fortunate that we had no debt, because we took advantage of public universities. But even though our kids were dressed in Consignment shop clothes, and my clothes weren't fashionable, and our house would have been a "before" on HGTV, it was truly the best time of our lives. Don't let it get you down, don't let patients anger you. Life's too short, and any day when you aren't the patient is a great one!
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