Career Stage and Location Found to Impact Oncology Coverage in the US

Rural populations and those with higher cancer burden and socioeconomic risk were found to have gaps in oncology care across the US.

While the US population is aging, and cancer continues to be diagnosed, the number of oncologists qualified to treat this population is declining, leading to gaps in geographic coverage, according to a study published in the Journal of Clinical Oncology: Oncology Practice.

In 2024, 14,547 hematologists/oncologists billed Medicaid, which represented a national oncologist density of 14.9 per 100,000 adults 55 years or older. Overall, the number of oncologists increased, but per capita, it decreased from 15.9 in 2014 to 15.1 in 2019, and finally 14.9 in 2024 (P <.01).

Oncologists identifying as female increased in 2024 to 37% compared with 34% in 2019 and 30% in 2014. While oncologists who identified as being in their late career increased over time from 4401 in 2014 to 4690 in 2019, and 4748 in 2024, there was a decline from 36% to 35% to 33%, respectively, relative to the workforce during this time frame.

Oncologists were identified to practice in either 1 (74%), 2 (19%), or 3 or more (7%) counties. Regarding state boundaries, only 4% worked across them. A total of 7% of oncologists worked in rural counties, which made up an oncologist density of 6.5 per 100,000; however, 16 million adults 55 years or older resided in rural counties. Of note, 92% of oncologists practiced in urban counties, with a density of 16.6 (P <.01).

When assessing for oncologists by state, Wyoming had the lowest number of oncologists, with 21, while California had the most, with 1573. Additionally, Nevada had the lowest density, with 7.6 per 100,000 compared with 49.3 for Washington, DC. Overall, 38 states had a lower density in 2024 when compared with rates in 2014.

Less than 25% of oncologists in Alabama, Oregon, South Dakota, and Utah were nearing retirement age. In Alaska, Hawaii, Montana, Nevada, North Dakota, and Rhode Island, 40% or more of oncologists were nearing retirement age. Wyoming had 70% of its residents aged 55 years or older living in rural counties, and 63% of its oncologists were working in those counties. When looking at Nevada, 10% of its residents lived in rural areas, and 1% or less of its oncologists worked in those areas.

When looking at counties in the US, 45% had oncologists present; in those counties with oncologists present, 89% of the population was 55 years or older. Of note, 67% of urban counties had oncologists compared with 32% of rural counties. Most counties with lower cancer mortality rates had oncologists, vs 32% of counties with high mortality rates.

The authors found that in most cases, counties identified as vulnerable lacked oncologists within or nearby. For rural counties, 10% lacked oncologists within or nearby compared with 0% for urban counties.

In 2024, 27% of oncologists were in the early phases of their careers, 41% were in the middle stages, and 33% were in the late stages. Overall, 46% of early-career oncologists identified as female vs 42% for mid-career, and 24% for late-career. Additionally, 3% of early-career, 7% of mid-career, and 15% of late-career oncologists worked in practices with 3 or fewer oncologists; 62% of early-career, 53% of mid-career, and 44% of late-career oncologists worked in practices with 30 or more oncologists.

A total of 5% of early-career oncologists practiced in rural sites vs 7% for mid-career, and 9% for late-career; 35% of early-career vs 39% for late-career worked in counties with high social vulnerability; 41% vs 48% practiced in health professional shortage areas; and 3% early-career, 4% mid-career, and 5% late-career practiced where there were high cancer mortality rates.

This study downloaded national provider data sets from Care Compare from March 2024, April 2019, and April 2014. The investigators allowed clinicians to have hematology, medical oncology, or hematology/oncology as their primary specialty, as well as those with a primary specialty of internal medicine and a secondary specialty of hematology, medical oncology, or hematology/oncology.

The oncologist's presence in 2024 was assessed to understand geographic access. To approximate career stage, the medical school graduation years of oncologists were utilized. Early career included those 16 years or less from graduation, mid-career was 17 to 29 years from graduation, and late career was 30 years or more from graduation.

Reference

Kirkwood MK, Balogh EP, Accordino MK, et al. Where have we been and where are we going? The state of the hematology and medical oncologist workforce in America. JCO Oncol Pract. Published online October 7, 2025. doi:10.1200/OP-25-00144