How Can Oncology Staffing Shortages Be Remedied?

Manali Patel, MD, MPH, MS, FASCO, discusses current gaps, projected needs, and actionable strategies for the US hematology and medical oncology workforce.

The hematology and medical oncology workforce has been declining, according to recent data found in a JCO Oncology Practice study.1 The entire specialty faces unprecedented challenges, including growing patient demands, persistent burnout, and projected shortages.

Manali Patel, MD, MPH, MS, FASCO, associate professor of medicine-oncology in the University Medical Line at Stanford University in California and author of this study, spoke about the core findings via email correspondence with CancerNetwork®.

The study showed that in 2024, 14,547 hematologist-oncologists billed Medicaid, which represented a national oncologist density of 14.9 per 100,000 adults who are 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 to 14.9 in 2024 (P < .01).

Overall, Patel highlighted that more guidelines are necessary to ensure that the oncology workforce remains functioning for all patients, no matter the location.

CancerNetwork: Given the 15.9 to 14.9 decline in oncologists per 100,000 population, what are the American Society of Clinical Oncology (ASCO)’s high-impact policies to immediately reverse this trend and meet the rising demand?

Patel: Key policies that ASCO advocates for are increased funding for oncology training programs, enhancing loan repayment and financial incentives to attract more trainees to pursue careers in oncology, promoting team-based care, addressing burnout, and utilizing data to inform workforce planning, such as studies like these.

With 68% of the population living in counties facing an oncologist retirement risk, what practical, system-level strategies can retain the expertise of these clinicians?

Flexible work arrangements could be considered to help clinicians reduce their hours as they approach retirement. [There is also] mentorship and succession planning, enhanced support for administrative tasks, incentives for retention that reward continued work, collaboration with other health care systems, and hub-and-spoke models of care. In addition, services such as telehealth remain crucial given the impact on patient care and the shortages of patients, as well as alternative models of care such as the ones that the VA [US Department of Veterans Affairs] has implemented, such as Close to Me, which brings oncology specialty care to patients. 

What specific, measurable incentives would be most effective in directing new graduates to rural and high-vulnerability counties?

There need to be system-level approaches to address the issue rather than directing new graduates to specific areas. While some opportunities to incentivize practicing in these areas exist, such as loan repayment programs, sign-on bonuses, relocation assistance, professional development opportunities, and state and federal grants, these are often not enough to ensure continued access for patients living in these areas. Larger, systemic changes are needed that help to address shortages through models of care such as those that the VA has implemented, such as through telehealth, team-based care, and Close to Me models. 

Based on your findings for states like Nevada and Idaho, what is the single most impactful legislative or regulatory change a state oncology society could pursue now to stabilize its declining workforce density?

It is unclear what the single most impactful legislative or regulatory change could be in these areas due to the complex issue of care and the many factors that may lead people to practice in other areas. Certainly, addressing financial barriers and attraction of clinicians to these areas is one approach that has been used; however, larger, multilevel system changes will be needed to sustain workforce capacity and access in these areas. The important legislative actions should be to encourage telehealth and reimbursement for such services, hub-and-spoke models of care, and potentially innovative models utilizing team-based services to deliver care [via] community health workers and other staffing models.

How rapidly and in what specific care domains (eg, survivorship, chronic management) should the training and scope of advanced practice providers (APPs) be expanded to cover the geographic gaps identified in the study?

Team-based care is certainly one approach to addressing coverage gaps. However, even APPs are in short supply. Alternative approaches to ensuring oncology clinician–driven care are needed in these areas to ensure high-quality care delivery without compromise on effectiveness. Currently, the reliance has been to off-load clinician capacity through the delivery of survivorship and other services to APPs, which is certainly an option. However, real system changes are needed to address ongoing access concerns nationally, especially in many of these rural areas. 

How do the pressures of serving high-need, low-resource communities directly fuel the national oncologist burnout epidemic, and what system changes are needed for long-term retention beyond individual wellness programs?

System-level changes will be of the utmost need to address ongoing burnout. However, burnout is not an issue that is particularly concerning for low-resource communities, but it is a prevalent, pervasive concern among all clinicians. A true overhaul of the way that care is delivered and financed will be needed to address the ongoing onslaught on clinicians. The JAMA piece by Donald M. Berwick, MD, MPP, regarding "Existential Greed in US Health Care" is one that resonates so clearly.2 Removal of the pursuit of profit and the systems that have been put into place to profit off people who are sick is at the fundamental core of addressing the pressure and burnout epidemic, which is likely to become a pandemic among oncologists.

References

1. 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
2. Berwick DM. Salve lucrum: the existential threat of greed in US health care. JAMA. 2023;329(8):629-630. doi:10.1001/jama.2023.0846