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Improving Our Understanding of the Surgical Oncology Workforce

Stitzenberg, Karyn B. MD, MPH*,†,‡,§; Chang, YunKyung PhD, RN; Louie, Raphael MD, MPH; Groves, Jennifer S. MBA§; Durham, Danielle MPH‡,‖; Fraher, Erin F. PhD, MPP*,§,**

doi: 10.1097/SLA.0000000000000273
Original Articles

Objective: This study characterizes the surgical oncology workforce as a baseline for future workforce projections.

Background: Measuring the capacity of the surgical oncology workforce is difficult due to the wide variety of surgeons who contribute to surgical cancer care. We hypothesize that the bulk of surgical oncology care is provided by general surgeons.

Methods: Using Medicare claims data linked to the North Carolina Central Cancer Registry, all patients 65 years or older who had a diagnosis of incident cancer of the bladder, breast, colon/rectum, esophagus, gallbladder, kidney, liver, lung, skin (melanoma-only), ovary, pancreas, prostate, small bowel, stomach, or uterus in 2005 and who underwent an extirpative procedure for cancer were identified. The proportion of procedures performed by different types of providers was examined.

Results: A total of 7759 patients underwent 16,734 extirpative surgical procedures. Excluding procedures for gynecologic/urologic malignancies, the proportion of procedures performed by general surgeons and surgical oncologists was 48% and 12%, respectively. Patients treated by general surgeons were more likely to be older, female, minority, and from areas of high poverty. For each tumor type, travel distances were shorter for patients treated by general surgeons than those treated by specialists.

Conclusions: Workforce projections must account for the significant overlap in the scope of services delivered by providers of different specialties and for the large contribution of general surgeons to cancer care. Efforts to improve the quality of cancer care need to move beyond centralization and focus on educating the surgeons who are providing the bulk of oncology care.

This study used administrative claims data to better understand the surgical oncology workforce. Cancer care is provided by a wide array of surgeons, but predominantly by general surgeons, not surgical oncologists or other specialists.

*Department of Surgery

Department of Health Policy and Management

Lineberger Comprehensive Cancer Center

§Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill

Department of Surgery, Dartmouth University Hanover, New Hampshire

Departments of Epidemiology

**Family Medicine, University of North Carolina, Chapel Hill.

Reprints: Karyn B. Stitzenberg, MD, MPH, Surgical Oncology, University of North Carolina, 170 Manning Dr, 1150 POB, CB# 7213, Chapel Hill, NC 27599. E-mail:

Disclosure: Supported in part by the 2010 Lineberger Comprehensive Cancer Center Population Sciences Award, awarded to Dr Karyn Stitzenberg. Also supported by the Integrated Cancer Information and Surveillance System, UNC Lineberger Comprehensive Cancer Center, with funding provided by the University Cancer Research Fund via the North Carolina General Assembly. Dr Fraher's time was supported by a grant from the American College of Surgeons. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.