Workforce Issues and Impact on Providers Results of ASCO led Studies on the Oncology Workforce: New and existing data on workforce supply and practice trends Amy Hanley Senior Workforce and Health Policy Specialist American Society of Clinical Oncology
Summary of Presentation 1. Background data on physician workforce shortages 2. Presentation of recent ASCO workforce studies including the 2014 ASCO Census 3. How the ASCO Workforce Advisory Group (WAG) is using this information 4. Q & A regarding workforce
225 215 205 195 185 175 165 Mortality Good News Five-Year Survival 70 65 60 55 50 1988 1991 1994 1997 2000 2003 2006 2009 1975 1977 1979 1981 1983 1985 1987 1989 Year of Death Source: National Cancer Institute 45 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 Year of Diagnosis 1973 1976 1979 1982 1985 1970 Cancer Deaths per 100,000 People % of Patients Surviving Five Years Source: National Cancer Institute
Survivorship Care Last Year - Cancer 5% Last Year - Other Cause 3% Initial Year 24% Continuing 68% By 2020, 81% increase in cancer survivorship Oncologists Survey: 68% of oncologist visits are for patients 1 or more years post-diagnosis
2009 2007 What s Ahead New Cancer Cases 1973 1975 1977 1979 1981 1983 1985 1987 1989 524 504 484 464 444 424 404 384 364 New Cancer Cases per 100,000 People 1991 1993 1995 1997 1999 2001 2003 2005 Year of Diagnosis Source: National Cancer Institute
Cancer Care Challenges By 2025, new US cancer cases up by 42% ACA adds 25 million newly insured Cancer survivors increasing to 18 million
Projections Point to Likelihood of Significant Shortages by 2020 65 Total Annual Visits (in millions) 60 55 50 45 40 Deman d Supply Demand Supply 35 2005 2010 2015 2020
Supply-Demand Perspective 300 New Patients/per year x 1,487 Oncologist Shortage 446,100 New Patients Face Challenges
13,400 U.S. Medical Oncologists
2014 Supply and Demand Study 22.0 21.0 21.3 20.0 FTE Oncologists (Thousands) 19.0 18.0 17.0 16.0 15.0 14.0 15.3 15.5 15.7 16.0 16.3 16.6 16.9 17.3 17.6 18.0 18.3 18.6 19.0 Total Oncology Demand (FTE) Total Oncology Supply (FTE)
More Oncologists Over 64 Than Under 40
Aging of the Oncologist Workforce 2007 2012 Age Count % Count % <34 344 3% 471 3% 35-39 1571 14% 2178 14% 40-49 3524 30% 4804 30% 50-59 3974 34% 4788 30% 60-69 1897 17% 3494 22% 70+ 567 5% 612 4% > 50% Note: 2007 data includes 4 oncology specialties & 2012 data includes 4 specialties and radiation oncology
Age Distribution of Oncologists (2013) 4% 16% 30-39 40-49 21% 50-59 60-69 30% Over 70 29%
Geographic Challenges Oncologists per 100,000 Population by State
Cancer Care in Rural America Oncologists per 100,000 Population by State 1 in 5 Americans live in rural areas 1 in 33 oncologists practice in rural areas
Oncologists by Age & Location
Oncologists in New Jersey 355 hematologists/oncologists billed from 141 practice locations in 2014 Source: Physician Compare, Centers for Medicare & Medicaid Services
State of Cancer Care in America 2014 ASCO National Oncology Census Results
The Big Picture www.asco.org/stateofcancercare
Participation 1253 respondents including 974 practices, representing over 10,000 oncologists 530 practices participated in 2013 representing nearly 8,000 oncologists Participation once again varied by geographic location & practice size Results being analyzed and will be published in March 2015
Total respondents (n=1253) Physician-owned practice Hospital/health system-owned practice Academic practice Industry International Locum Tenum/Retired Government 0 50 100 150 200 250 300 350 400 450 # of respondents
Practices by census region and practice setting (n=971) 160 140 120 # of practices 100 80 60 40 20 0 Midwest Northeast South West Census Region Academic practice Hospital/health system-owned practice Physician-owned practice
Location of Oncologists from the 2014 Census
1,600 Number of APNs & PAs by practice setting 1,400 1,200 # of APNs & PAs 1,000 800 600 400 200 0 Academic practice Hospital/health system-owned practice Physician-owned practice # APN (n=2752) # PA (n=1136)
Reported use of electronic health records by oncology practices 2012 2013 2014 Have advanced EHR/EMR 61% 68% 67% Have basic EHR/EMR 16% 18% 22% Looking to implement in 15% 9% 6% next 6 months Do not use 8% 5% 5%
Services provided by practice setting Hematology (malignant) and Oncology Hematology (benign) Medical Oncology (without hematology) Radiation Oncology Gynecologic Oncology Surgical Oncology Internal Medicine Hospitalist Gynecology Other Pediatrics Pediatric Hematology/Oncology 0 50 100 150 200 250 300 350 # of practices Academic practice Hospital/health system-owned practice Physician-owned practice
100.0% Payer mix by year 4.8% 7.3% 5.7% 90.0% 80.0% 70.0% 38.7% 36.1% 31.5% 60.0% 50.0% 9.2% 11.4% 12.4% 40.0% 30.0% 20.0% 47.4% 48.4% 50.4% 10.0% 0.0% 2012 2013 2014 Medicare (FFS & HMO) Medicaid Private/Commercial Uninsured/Self-pay
Is practice participating in ACO? (n=686) Academic practice 72.7% 27.3% Hospital/health system-owned practice 69.0% 31.0% No Yes (describe below) Physician-owned practice 78.7% 21.3% 0% 20% 40% 60% 80% 100%
Pressures cited by practices by practice setting in 2014 (select top two) Payer pressures Cost pressures Competitive pressures Drug pricing Staffing issues Clinical research issues Local economic pressures Other Drug shortages Access to genomic testing 0 20 40 60 80 100 120 140 160 180 200 # of responses Academic practice Hospital/health system-owned practice Physician-owned practice
Pressures cited by practices by year Access to genomic testing Drug shortages Other Local economic pressures Clinical research issues Staffing issues Drug pricing Competitive pressures Cost pressures Payer pressures 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 2014 2013 2012
Pressures cited by practices by year 2014 21.9% 17.2% 16.0% 14.8% 2.6% 9.0% 7.4% 6.4% 4.0% 0.7% Payer pressures Cost pressures Competitive pressures 2013 21.2% 24.2% 18.4% 12.1% 0.9% 10.8% 7.2% 5.1% Drug pricing Staffing issues Clinical research issues Local economic pressures Other Drug shortages Access to genomic testing 2012 26.2% 24.3% 14.7% 8.6% 5.4% 6.5% 9.4% 5.0% 0% 20% 40% 60% 80% 100%
Biggest Pressures in NJ Other Access to genomic testing Clinical research issues Staffing issues Payer pressures Local economic pressures Drug shortages Drug pricing Inc Expenses Comp pressures 0 1 2 3 4 5 6 7 8
Potential for staff layoffs by year Administrative staff 8.1% 17.9% 18.0% Other clinical staff 5.1% 12.9% 15.5% LPN/LVNs 3.8% 6.2% 8.1% Certified oncology nurses 3.1% 5.6% 7.6% 2012 Physician assistants 1.6% 1.9% 4.3% 2013 2014 Nurse practitioners 2.9% 2.6% 5.4% Non-oncology physicians Oncology physicians 1.8% 1.9% 2.6% 4.1% 4.9% 6.4% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0%
100% Likelihood of changing patient volume in next 12 months (n=647) 90% 80% 32.6% 29.0% 19.4% 70% 60% 50% 38.4% 42.0% 24.2% Very likely to increase patient volume Somewhat likely to increase patient volume Unlikely to change patient volume 40% 30% 20% 19.8% 18.6% 34.5% 10.6% Very likely to decrease patient volume Somewhat likely to decrease patient volume 10% 0% 5.8% 5.6% 3.5% 4.8% Academic practice Hospital/health system-owned practice 11.2% Physician-owned practice
Administrative staff Other clinical staff LPNs/LVNs Certified oncology nurses Physician assistants Nurse practitioners Non-oncology physicians Oncology physicians Likelihood of reducing salaries in next 12 months (response range 623-632) 0 100 200 300 400 500 600 700 # of practices N/A Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely
Likelihood of raising salaries in next 12 months (response range 616-627) Administrative staff Other clinical staff LPNs/LVNs Certified oncology nurses Physician assistants Nurse practitioners Non-oncology physicians Oncology physicians 0 100 200 300 400 500 600 700 # of practices N/A Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely
Likelihood of change in level of clinical trials participation in next 12 months Increase number of open trials (n=526) 16% 7% 19% 25% 32% Decrease number of open trials (n=509) 47% 17% 19% 9% 8% Begin conducting private clinical trials (n=459) 31% 8% 22% 19% 20% Very Unlikely Eliminate private clinical trials (n=480) 68% 12% 15% 3% 2% Somewhat Unlikely Neither Likely or Unlikely Begin conducting federal clinical trials (n=435) 38% 8% 26% 12% 15% Somewhat Likely Very Likely Eliminate federal clinical trials (n=467) 68% 9% 13% 4% 6% Eliminate all clinical trials (n=517) 75% 8% 11% 3% 0% 20% 40% 60% 80% 100%
Community Practices At Risk In the next 12 months, how likely is your practice to Physician-owned practice Close the practice (n=377) Sell the practice (n=381) Merge with another practice (n=382) Purchase another practice (n=380) 0 50 100 150 200 250 300 350 # of practices Very Likely Somewhat Likely Neither Likely or Unlikely Somewhat Unlikely Very Unlikely
In the next 12 months, how likely is your practice to Close the practice (n=827) 82% Sell the practice (n=834) Merge with another practice (n=840) 63% 77% Very Unlikely Somewhat Unlikely Neither Likely or Unlikely Somewhat Likely Very Likely Purchase another practice (n=833) 73% 0% 20% 40% 60% 80% 100%
In the next 12 months in NJ, how likely is your practice to Close the practice Sell the practice Merge with another practice Very Likely Somewhat Likely Neither Likely or Unlikely Somewhat Unlikely Very Unlikely Purchase another practice 0 2 4 6 8 10 12 14
Rough Waters for Practices Economic pressures Political turbulence General disruption across medicine Sequestration ICD-10 PQRS, Meaningful Use Health Reform ACOs, shifts in practice environment Performance based payment Wave of newly insured Uncertainty
How is ASCO using this information?
How the Census feeds into other ASCO Programs: ASCO s efforts on Capitol Hill and in the states ASCO s efforts in the Patient Centered Medical Home for Oncology Payment Reform Cost of Cancer Care and Value CancerLinq ASCO University
Questions??
For more information, visit www.asco.org/workforce www.asco.org/census or contact: workforce@asco.org amy.hanley@asco.org