U.S. Oncologists are Working Shorthanded

U.S. Oncologists are Working Shorthanded

The relationship between cancer patients and their oncologists is an intense one.

The stakes are high for everyone involved, and cancer patients especially have very high expectations of their doctors (more info here). There are approximately 15 million cancer survivors in the U.S. right now, and as our population ages and cancer treatments become more and more effective, the number of cancer survivors needing precious time with their oncologist keeps increasing. That number is expected to reach 20 million by 2026.

But the demand for cancer doctors is outrunning supply: in 2016, there were 12,100 practicing oncologists in the U.S., approximately one-fifth of whom are due to retire within the next five years. At present, graduate programs can only supply about 600 new oncologists per year – and with increasing financial pressures on educational programs, there’s almost no potential to increase that output within the next decade (more info here).

And it isn’t simply a matter of current oncologists stepping it up, either: the average oncologist is already working 63 hours per week.

It was hoped that widespread implementation of computerized medical records would yield a boon of efficiency, but unfortunately that hasn’t materialized either. It’s currently estimated that oncologists now spend 50% or more of their time on computer work, leaving less (rather than more) time for patients. Maybe physicians haven’t yet climbed the steep computer learning curve to gain new efficiencies, or maybe current technologies (as implemented) aren’t designed to make physician work easier, but either way it’s been more burden than benefit so far.

So if the work’s hard, getting harder, and there’s more of it than ever before, who in their right mind would go into medical oncology in the first place?

Good question; I’ll try to answer it in my next blog.

For more information about the author of this blog: click here


Do We Have More Breast Cancer Here?

Do We Have More Breast Cancer Here?

It began simply enough. An inquisitive colleague asked me if we have more breast cancer in our area than elsewhere. I had been asked this before, and I still did not know. But I should know.

The “Big Three” cancers in the US are prostate, lung, and colorectal for males and breast, lung and colorectal for females. Together these problems encompass half of our cancer problems. Over 31,000 Wisconsin residents were diagnosed with cancer in 2013 and 30% of the females with cancer had breast cancer. (A little less than 1% of all breast cancers are in men.) We expect 4300 new Wisconsin women to be diagnosed with this in 2014. Breast cancer incidence started rising in 1981, reached a plateau from 1986-2000, then slowly fell. Breast cancer deaths fell slowly after 1991. Was this due to mammography, which took hold in 1980-1990? Largely so.

Breast cancer incidence declined in our state by 8% between 1995 and 2010. Wisconsin’s breast cancer mortality also declined 27.9% over that time frame. The efforts of many different groups are reflected in this improvement. There are the obvious factors of mammography, improved surgical and radiation techniques, advances in oncology drugs, and genetic testing. In addition, there is breast cancer awareness, self-examination, improved socioeconomic status, attention to obesity, and caution regarding menopausal hormone therapy.

Are all women at risk? Certain risk factors cannot be modified: age, heredity, ethnicity or race. Obviously female gender is the most notorious. Factors that are avoidable or can be manipulated include weight reduction, excess alcohol consumption, and exposure to hormones.

When analyzing a population’s incidence of cancer, it is important to also be aware of the age group involved. Aging is a distinct risk factor for cancer. If a woman is currently 20, her risk of developing breast cancer in the next ten years is less than 1 in 1700. But if she is 60, the risk is 1 in 29. Certain features modify a population’s risk: poverty, irregularities of reporting, and race. Additional factors exist too. It goes beyond “air and water quality.”

So, do we have more breast cancer here? Wisconsin’s incidence of breast cancer for 2006-2010 was 122.5 per 100 000 females. This contrasts with 128 for Brown County, 143 for Door, 100.7 for Kewaunee, and 123.7 for Outagamie. The statisticians interpret these numbers in light of a concept termed confidence intervals. That is the statistical way of asking if these numbers are different. When one applies confidence intervals, we discover these numbers are not different. The ranges overlap meaning the incidence of breast cancer in Brown, Door and Outagamie County is essentially equal to that of Kewaunee County or to Wisconsin overall. Although it shocks our awareness, it should not provoke the Door County residents to migrate 9 miles south to Kewaunee.

Why have people asked these questions about incidence? Are we more aware of friends’ health in our electronic age? Are we and our friends getting older, falling into the ever-higher risk groups? Is the rate truly rising and no one realizes it? We need to focus on the things we can control. Strides have been made in the past 20 years.




Hay más casos de cáncer del seno en nuestra ciudad? Es normal a preguntar esto. Cáncer del seno es muy común en los EEUU, lo más común afectando mujeres. La perspectiva para cáncer del seno ha mejorada durante las última 2 décadas.

La incidencia del cáncer del seno depende en muchos factores diferentes. Incluyen edad, herencia o raza. Tambień hay obesidad y uso de hormonas despues de la menopausa.

El riesgo de cáncer del seno en nuestra ciudad es semejante al resto de Wisconsin y EEUU. Latinas tienen 25-30% baja tasa comparada a blancas no hispanas.

Por más informacioń:



Infusing Substance into “Commitment”

Infusing Substance into “Commitment”

Among the topics tossed around the media is the word commitment. Television commercials, actors, product sales brochures are chock full of this word. Is it overused, attaining the stature of meaningless? Would it benefit us to infuse some substance into that word?

Your medical provider may have some insight into the word commitment. After all, they generally have been bestowed some amount of faith by the public. How is that earned? Is it years of schooling? Well, there are plenty of well-educated people in this community. Is it simply given to a person that is well compensated for their efforts? The relationship between financial gain and commitment is flimsy.

There is a balance between serving the public and receiving gratification in return. As youngsters, many people fantasize about glamorous life choices. Athletes, rock stars, astronauts all came to mind in my youth. I am not certain why I did not go one of those routes, beyond an obvious lack of talent. For whatever reason, I am glad I chose a meaningful profession that served others and is eminently interesting. And it is a long-lived choice, not something impossible after age 35. This balance occurs when effort is made and a sense of accomplishment results. It’s gratifying work. Your healthcare giver gets to experience that satisfaction regularly.

So why the commitment? There is impetus to serve, the possibility of a long career, a sense of doing something important every day, and receiving gratitude regularly.

The community of Green Bay has been a wonderful place to practice and raise a family. The quality of my practice could not be much better elsewhere. My family has felt welcomed here, received a good education, been raised in a safe environment, and been intertwined in the community. Relationships have spanned 2 or 3 generations in a short time. My fellow inhabitants have shown respect to me and my family, deepening my desire to help them. I can’t imagine my experience is unique; this community respects hard, benevolent efforts. I came with the willingness to help and the plans to continue helping long term. I did not expect that to be easy. Challenges arise each day; I hope my capabilities can match. The response of the patients lets me know these efforts are appreciated.

Now what about commitment? Clearly, many different facets enter into it. A 2 way street exists; there is a motivation to serve and appreciation is returned, triggering the process to repeat itself. It is almost mathematical, yet is anything but mathematical.

Jules H Blank; since 1984.