Enhancing the American Society of Clinical Oncology Workforce Information System With Geographic Distribution of Oncologists and Comparison of Data Sources for the Number of Practicing Oncologists

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. 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. 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. 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.

The American Society of Clinical Oncology (ASCO) published a study in 2007 that anticipated a shortage of oncologists by 2020. This study aims to update and better assess the market for chemotherapy and radiation therapy and the impact of health reform on capacity of and demand for oncologists and radiation oncologists.

The accuracy of geocoding hinges on the quality of address information that serves as input to the geocoding process; however errors associated with poor address quality are rarely studied. This paper examines spatial errors that arise due to incorrect address information with respect to physician location data in the United States. Studies of spatial accessibility to physicians in the U.S. typically rely on data from the American Medical Association's Physician Masterfile. These data are problematic because a substantial proportion of physicians only report a mailing address, which is often the physician's home (residential) location, rather than the address for the location where health care is provided. The incorrect geocoding of physicians' practice locations based on inappropriate address information results in a form of geocoding error that has not been widely analyzed. Using data for the Chicago metropolitan region, we analyze the extent and implications of geocoding error for measurement of spatial accessibility to primary care physicians. We geocode the locations of primary care physicians based on mailing addresses and office addresses. The spatial mismatch between the two is computed at the county, zip code and point location scales. Although mailing and office address locations are quite close for many physicians, they are far apart (>20 km) for a substantial minority. Kernel density estimation is used to characterize the spatial distribution of physicians based on office and mailing addresses and to identify areas of high spatial mismatch between the two. Errors are socially and geographically uneven, resulting in overestimation of physician supply in some high-income suburban communities, and underestimation in certain central city locations where health facilities are concentrated. The resulting errors affect local measures of spatial accessibility to primary care, biasing statistical analyses of the associations between spatial access to care and health outcomes. Copyright © 2012 Elsevier Ltd. All rights reserved.