Aging Population, Burnout Continue to Drive Oncology Workforce Shortage
Julie Gralow, MD, shed light on the factors contributing to the growing shortage of oncologists in the US and what can be done to address it.
Julie Gralow, MD
As the demand for cancer care continues to rise, the US is facing a growing shortage of oncologists. Julie Gralow, MD, chief medical officer at the American Society of Clinical Oncology (ASCO), recently shed light on the factors contributing to this crisis and what can be done to address it. Gralow discussed the challenges of burnout, the impact of administrative burdens, and the need for systemic changes to support oncologists and improve patient care during an interview with Targeted Oncology.
Two Key Drivers of the Shortage
One of the primary drivers of the oncologist shortage, according to Gralow, is the aging population.
“As more people live longer, the number of cancer cases is increasing, placing greater demand on oncology services. At the same time, the physician workforce is shrinking,” Gralow said. Many oncologists are leaving clinical practice earlier than expected, a trend exacerbated by burnout and the stresses of the COVID-19 pandemic, according to a survey by Schenkel and colleagues.1 A total of 5892 US-based oncologists were surveyed to determine their career intentions.1 Findings were compared with results from a 2013 survey of 1345 oncologists conducted by Shanafelt et al.2
“Before the pandemic, we were already seeing a trend of physicians retiring early or reducing their clinical practice,” Gralow explained. “But the pandemic accelerated that. It’s clear that this is a stressful time, and we need to help keep people who want to keep working and seeing patients fulfilled in their jobs.”
Hand of doctor reassuring her female patient. Medical ethics and trust concept: © rogerphoto - stock.adobe.com
Gralow highlighted alarming data on professional well-being and satisfaction among oncologists.1 Compared with the Shanafelt et al survey conducted in 2013,2 the results from this latest survey revealed a significant increase in burnout. In 2013, 34% of oncologists reported symptoms of burnout; by 2023, that number had risen to 59%. Emotional exhaustion and depersonalization—feeling callous toward patients—also saw sharp increases over the decade.1
“Oncologists are reporting higher fatigue, lower quality of life, and less satisfaction with work-life integration,” Gralow said. “The top factor contributing to joy in their work is the patient relationship, but with the increasing administrative burden, time spent with patients is shrinking.”
Administrative Burdens
The survey also identified key stressors contributing to burnout, including staffing shortages, the use of electronic medical records, and payer policies. Oncologists are spending more time on paperwork and less time with patients, leading to frustration and dissatisfaction.
“Enhanced practice and administrative support, as well as better patient care staffing, were cited as top factors that could improve oncologists’ work,” Gralow said. “We need to reduce unnecessary work and streamline processes to allow oncologists to focus on what they do best—caring for patients.”
Efforts to Alleviate the Crisis
ASCO is actively working to address these challenges. Gralow said the organization is advocating policy changes, such as expanding telemedicine flexibilities and reducing prior authorization requirements, which have been a significant source of frustration for clinicians.
A recent compilation report provided the state of professional well-being among oncologists, burnout trends among oncology fellows in training, strategies to improve professional wellness, a policy brief describing past efforts to improve oncology workforce well-being and opportunities for improvement.3
Gralow also emphasized the importance of team-based care, where tasks are optimally distributed among medical assistants, nurses, and advanced practice providers to allow oncologists to work at the top of their scope of practice.
“We’re promoting team-based care and better task distribution,” Gralow said. “We need to ensure that everyone is working at the top of their scope of practice, but also that tasks aren’t being pushed up to the physician unnecessarily.”
Rural Communities: A Growing Concern
The oncologist shortage is particularly acute in rural areas, where access to cancer care is limited. Gralow pointed to a pilot program in Montana as an example of innovative solutions. The Increasing Access to Cancer Care in Rural Montana, a pilot program that enlists Bozeman Health, Barrett Hospital & HealthCare, and Montana State University, is a hub-and-spoke model of cancer care launched in 2022.4
The initiative established small clinics in remote areas, allowing patients to receive chemotherapy and consultations via telemedicine. This model aims to reduce the burden on rural patients who would otherwise have to travel long distances for care. “Rural communities are very underserved,” Gralow said. “We need more models like this to ensure that patients in these areas have access to quality cancer care.”
Next Generation of Oncologists
To address the long-term workforce shortage, efforts to attract more medical students and residents to the field of oncology are ongoing. ASCO offers free membership to students and trainees and supports oncology clubs at medical schools. Gralow emphasized the importance of mentorship and early exposure to the field.
“We need to show medical students that oncology is not just about cancer being depressing,” Gralow said. “It’s about building long-term relationships with patients and their families. Once they see that, they realize how rewarding it can be.”
Looking Ahead
ASCO is also focusing on promoting wellness and career fulfillment among oncologists. The organization has published recommendations for academic medical centers to support clinicians and reduce burnout. These include providing flexibility in daily schedules, reducing administrative burdens, and fostering a sense of community and connection among staff.
“Flexibility in daily schedules can make a big difference,” Gralow said. “Something as simple as allowing a clinician to adjust their hours to drop their child off at school can improve work-life balance.”
The oncologist workforce shortage is a complex issue that requires systemic changes at multiple levels. From reducing administrative burdens to promoting team-based care and expanding access in rural areas, there is much work to be done. Urgent action is needed to support oncologists and ensure that patients continue to receive the high-quality care they deserve.
“We need to support those people who want to keep working and seeing patients fulfilled in their jobs. That’s how we’ll address this crisis,” Gralow concluded.
