Wednesday, March 14, 2007

March 14, 2007 - A Doctor Shortage?

News articles about the aging of my own "baby boomer" generation abound. The news media has been sounding that particular drumbeat for so long, I hardly notice it any more. Yet, one article I saw today made me sit up and take notice.

It comes from Newsweek, and has to do with a predicted shortage of oncologists in the years to come. It's not that the absolute numbers of these specialists is decreasing (although the article does talk about "a slowing growth in the supply"). The bigger issue is that the demand for their services is going up.

Three factors seem to be exacerbating the problem. First, as we boomers age, there are getting to be more older people in general – and we all know that, statistically speaking, the likelihood of contracting cancer increases with age. Second, people who do have cancer are living longer – a good thing, to be sure, but it also means that oncologists' relationships with their patients are continuing over much longer periods. Third, as cancer treatment becomes more complex, fewer and fewer family-practice physicians are directly involved in treating cancer patients. Nearly all cancer patients are now being referred to oncologists, who manage most aspects of their care.

As the doctor shortage worsens, it will become harder to get an appointment with an oncologist in the future. Some oncologists may begin referring patients back to their primary-care physicians for some aspects of their care, with the oncologist consulting from a distance – although the continuing trend toward highly-specialized cancer treatments makes this move problematic.

The Newsweek article also reports on a troubling personal characteristic of many younger doctors entering the oncology field today: they evidently don't have as strong a work ethic as their elders. Younger oncologists see significantly fewer patients per week, on the average. Some are intending to retire early, and others are seeking to work part-time during certain phases of their careers.

I'm aware of how hard Dr. Lerner works to keep up with his roster of patients – and, in talking with other cancer survivors, I hear similar stories about their own doctors. The need is great, and growing bigger all the time. The medical establishment is only just beginning to wake up to this looming problem, and to take steps to address it (increasing the number of oncology residency slots in teaching hospitals, for example).

A year ago, slogging though chemotherapy side effects, I was wondering whether my treatments would succeed in putting me into remission. The fact that I now have the luxury of worrying whether, years into the future, I'll still be able to get in to see my oncologist speaks volumes about how far I've come. Yet, it's a worry, all the same.


lzeitlin said...

Dear Pastor,

I saw a link to your blog on my daughter-in-law's blog, and I enjoyed reading your diary, and was happy to read you are in remission.

I just want to say, I wish you the best in the future, and that your cancer stays in remission.

My beautiful daughter-in-law was diagnosed a year ago, and will soon start radiation, and I hope and pray she too will be in remission soon.

Anonymous said...


I saw your blogspot on Leroy Sievers,My Cancer.I also had large cell B Non-Hodgkin's.Your informative journal is especially interesting to me because during my R-CHOP 6 treatment protocol I didn't meet anyone who had the same cancer,thus I had no one with whom to compare notes as it were.

My treatment ended mid-Dec.The Retucsen zapped me after the first shot which I barely survived. I was dying (according to my docs) because the pressure of the tumor on my pancreas was pressing on my liver and bile duct which was kept open by a stent.I was in the hospital to deal with that problem when the diagnosis of lymphoma,not pancreatic cancer,was received.Chemo began immediately.I trusted the docs as I had no time to prepare myself mentally or emotionally.

Fortunately I didn't have to have a port.During the 4 months of treatment I was out of it as expressed by your friend Cindy.I was aware of the outside world but couldn't participate in it.

I have read only up to the picture of you having your head shaved (I began losing my hair after just a week but I was too vain to allow a photo to be taken.)I will continue to read all of your daily reports,which to me is like reading a page turner,except I know the ending.I'm happy that you have been in remissions for many months.

I will no doubt write again after I continue with your engaging story.

Annette from New Mexico

Carlos ("Carl") said...

Sorry, folks, but the e-mail notices from Blogger that tell me there's a message waiting were getting caught in my spam filter. I've now corrected that problem.

To lzeitlin: I'm glad you've found my diary to be a source of help - and, I pray that your daughter-in-law may have a good result. I feel fortunate not to have had to have radiation therapy. I hear that, depending on where the tumor is, there can be some pretty nasty side effects from that. Hope she's spared the worst of those.

BTW, I'd love to see a URL for your daughter-in-law's blog, especially since it links here. Would you mind sharing that?

To Annette from New Mexico:
Isn't Leroy's blog remarkable? He's an inspiration.

I'm surprised to learn that your Rituxan reaction was so intense. I'm told that such a reaction is relatively rare. My doc had directed that my Rituxan be administered verrrrry slowly, so as to minimize the prospect of any reaction. It meant that my infusions took 7 or 8 hours all told, but things worked out OK for me.

It must have been a huge relief to have the diagnosis changed from pancreatic cancer to lymphoma. There's a world of difference in the typical prognosis, between those two forms of cancer.

You evidently had a hard time, also, with the chemo side effects in general. It was no picnic for me, but at least I was able to function more or less normally for one week out of three (though I didn't feel too great, even that week).

Hope you're getting back to things, now! Blessings to you.

Tom Clarke said...

Pastor Carl,

I disagree with the premise that many draw from the younger oncologists seeing fewer patients. I fired my older, more experienced, oncologist in part because he didn't have any time for me, rushing from one appt. to the next.

Indeed, it seems to me that that in my experience, that it is the older physicians, those in their late 50's or so, who have forotten their way, their mission, and their oath. They are either busy trying to maximze profits or force ignorant people into studies for their own self aggrandizement(sp?).

You can check out my blog at

Fair warning: I do use language that is rather crude sometimes, so if you're easily offended you might want to skip it.

Very truly yours,

Tom Clarke

Carlos ("Carl") said...


I have experience with only two oncologists, myself - both of them at mid-career - and I've been very happy with both. I was just passing on the information from the news article, which purports to be based on some broad-based studies. I'm glad your experience has been otherwise.

Thanks for the URL to your blog. I'll check it out.