How many radiation oncologists will be needed under health care reform

Several years ago I wrote an editorial for the ASTRO Newsletter expressing the opinion that there was a surplus of radiation oncologists in this country, and that this surplus was hurting the specialty. At the time, there was considerable disagreement in the radiation oncology community regarding this issue. Some radiation oncologists agreed that we were training too many radiation oncologists, whereas others felt that there was not an oversupply and that the demand for our services would increase in the coming years to match the available manpower. My editorial was written following a 199 1 analysis of our manpower needs (3). It was based on estimates of the numbers of radiation oncologists entering and leaving the work force and the numbers of patients being treated with radiation therapy annually. Previous analyses had been performed by the Graduate Medical Education National Advisory Committee (GMENAC) (1) and the Education Committee of the American College of Radiology (ACR) Commission on Radiation Oncology (2). The GMENAC report and the ACR Committee on Education had come to different conclusions regarding the manpower needs in radiation oncology. The GMENAC report had concluded that there would be a shortage of radiation oncologists until 1990, at which time the manpower supply would essentially match the demand. The ACR Education Committee, on the other hand, estimated an oversupply of -540 radiation oncologists by 1990. These reports were prepared in the early 1980s and did not project manpower needs beyond 1990. Our analysis indicated that the ACR Education Committee prediction had come closer to predicting the actual manpower needs of radiation oncology in 1990 than did the GMENAC report. The major problem with the GMENAC report was that it did not foresee the large influx of physicians into radiation oncology, and therefore, it underestimated the manpower supply. The GMENAC report assumed that 110 r+ation oncologists would enter the field each year in the late 1980s and that -60 would retire. This would represent a gain of -50 radiation oncologists per year. However, radiation oncology became a much more popular specialty in the late 1980s. During this period, the average number of radiation oncologists entering practice each year averaged 1.55 and -50 have retired. Thus, there was a net gain of 105 radiation oncologists per year during the late 1980s instead of 50 as projected by the GMENAC report. As might be expected, there was a similar increase in the membership of ASTRO during this period. In 1985, there were 1,800 active radiation oncologist members in ASTRO, compared to 2,3 18 in 1990. This was an increase of 103 active radiation oncologists per year, or -5.5% per year. During the same period, there was only a 2.2% increase in the number of new radiation oncology patients each year according to the Patterns of Care Study Facilities Master List (4). The surplus of radiation oncologists has persisted throughout the early 1990s. In fact, there has been an even greater increase in the numbers of radiation oncologists produced since my previous editorial (Fig. 1). In 1990, there were 2,3 18 active radiation oncologist members of ASTRO, and today there are 2,972. This is a net increase of 163 radiation oncologists per year, or -7% per year. There seems to be greater agreement on the radiation oncology manpower issue today than there was in 1991. Most of us believe that we are training too many radiation oncologists and feel that the surplus has caused problems for our specialty. These problems include increased competition between various private groups, increased competition between private groups and academic centers, and decreased number of patients available for clinical research, and increased costs for patients (3). The critical question is: What will be our manpower needs in the coming decade? Medicine today is undergoing a tremendous state of change. How will these changes affect the manpower needs for radiation oncology? Will we need more radiation oncologists in the year 2000, or fewer? Conceptually, the manpower issue is relatively simple.