Australia’s oncology workforce is reportedly at a breaking point, with experts raising alarms over the growing disconnect between the number of trained oncologists and available positions. This crisis emerges as cancer survival rates improve, placing additional pressure on an already stretched system.
Associate Professor James Lynam, chair of the Medical Oncology Group of Australia (MOGA), highlighted that Australia faces more severe challenges in its oncology workforce compared to the United States. This statement follows a study revealing that 68% of the U.S. population resides in counties where over a quarter of oncologists are nearing retirement age. The study, published in JCO Oncology Practice, found that 11% of adults aged 55 and over live in 55% of counties without oncologists.
Disparities in Access to Oncology Care
The U.S. study underscores significant disparities in access to oncology care, particularly in counties with high cancer mortality rates, which are twice as likely to lack practicing oncologists. These trends are exacerbated by factors such as rurality, insurance status, and smoking prevalence, affecting some of the most vulnerable populations.
Professor Lynam emphasized that Australia’s oncology workforce is approximately five times smaller per capita than that of the U.S. He noted, “There’s not enough positions being generated to meet the increasing workforce demands or workload demands in cancer care.”
The Growing Demand for Oncology Services
The demand for oncology services is outpacing supply, as more cancer patients survive longer due to advancements in treatment. “For every one new person coming into the system, there’s three or four people at the end who are living longer and still require ongoing care and monitoring,” Professor Lynam explained.
This situation raises critical questions about resource allocation: should focus be placed on newly diagnosed patients, or should continued care be prioritized for long-term survivors?
Challenges in Rural and Indigenous Communities
Patients in rural areas and Aboriginal populations face significantly worse cancer outcomes compared to urban residents, partly due to limited access to oncologists. Rural patients often travel hundreds of kilometers for treatment or clinical trials, a burden that highlights the need for expanded workforce capacity.
Professor Lynam warned, “Unless we expand the medical oncology workforce to meet the emerging requirements of the cancer population, we will start getting much worse outcomes.”
Barriers to Workforce Expansion
Despite training sufficient numbers of oncologists, Australia struggles to create enough positions to accommodate them. “We’ve got 40 new oncologists registering with AHPRA every year, but that is not translating into 40 new senior staff specialist positions,” Professor Lynam said.
The fractionation of full-time positions further complicates the issue, with many oncologists working part-time. “Positions are increasingly being fractionated, especially in metro areas,” he noted, adding that this practice often leads to increased workloads outside of paid hours.
Funding and Systemic Constraints
At the heart of the issue lies funding. “We’re in a fiscally constrained situation where there’s not enough money to go around,” Professor Lynam explained. The system is nearing a breaking point, with clinicians facing burnout and few new positions being created to manage the workload.
Innovative models of care are often suggested as solutions, but Professor Lynam argues that these are insufficient without more publicly funded positions. The alternative could see post-chemotherapy care shifted to general practitioners, raising concerns about the continuity and quality of care.
Data and Oversight Challenges
Accurate data on oncology workloads is scarce, complicating efforts to assess and address disparities in service provision. A 2008 Canadian model suggested an appropriate workload of 140 to 180 new patients per year for medical oncologists, but this is outdated given current survival rates and treatment complexities.
Professor Lynam highlighted the lack of comprehensive data across different oncology units, making it difficult to gauge workload disparities and resource allocation needs.
Opportunities for Improvement
Despite these challenges, Australia’s oncology workforce has a younger demographic compared to the U.S., reducing concerns about imminent retirements. “We still have more young oncologists than old, so we don’t face the same retirement crisis,” Professor Lynam stated.
With strong foundations in place, there is potential for Australia to build a more robust oncology workforce capable of sustaining its world-leading cancer care outcomes. However, this requires strategic planning, increased funding, and a commitment to addressing systemic barriers.
