Too Much of a Good Thing? Projecting the Need for Gynecologic Oncologists Over the Next 20 Years

There are currently 71 gynecologic oncology fellowship programs in the United States, with a rapid increase in the number of programs occurring within the last 5 years. Additionally, accreditation for these fellowships has shifted from the American Board of Obstetrics and Gynecology to the Accreditation Council for Graduate Medical Education. Although there are general guidelines for how to increase the full complement of fellowships, there is no definitive process for understanding the need for subspecialty trainees. Some considerations for this include having sufficient clinicians to meet demand, clinicians being able to sustain a volume of patients that will maintain their skills as well as allow them to provide quality care, and having enough patients for trainees to develop the required surgical skills. This article is a review and evaluation of the specialty of gynecologic oncology, its growth, and the projected need for these subspecialists in the future. Growth in gynecologic oncology trainees has been higher than expected in the last few years, far outstripping a prediction made by Wallace et al in 2010 that projected the growth of the profession through 2050 based on Society for Gynecologic Oncology membership, current number of fellows, and projected retirement for current practitioners. Additionally, recent studies have shown an increase in the incidence of gynecologic cancers that could not have been predicted at an earlier time. In order to project the growth and need for clinicians over the next 20 years, this analysis included estimating the number of currently practicing gynecologic oncologists, changes in cancer cases, and changes in number of fellows/trainees. This was done through annual estimations and sensitivity analyses. The number of people diagnosed with endometrial cancer is expected to increase by a total of roughly 10,000 cases annually by 2045. Ovarian cancer is also expected to increase, although minimally, by an estimated 2000 cases annually, and other gynecological cancers are expected to remain relatively stable. Surgical case volume is projected to increase by 14%, primarily due to the increase in endometrial cancer diagnoses. It is estimated that the number of practicing gynecologic oncologists during the same time period will increase by 70%, with no additional trainee increases; accounting for expected additional trainees, the increase is expected to be 101%. This means that the number of new gynecologic cancer cases per practicing subspecialist will decrease by approximately 30%, and by 41% when accounting for the increase in fellows. These results, in conjunction with already declining rates of cases requiring complex surgical intervention, indicate that new cases of gynecologic cancer may continue to decline, while practitioners will increase steadily. This is concerning among trainees, as this means fewer cases for each practitioner, fewer opportunities to maintain skills, and fewer opportunities to acquire them. As such, fellowships must institute requirements of volume for complex cases to ensure adequate training. In light of these trends, competency of trainees and clinicians must be monitored and maintained in order to ensure high quality of care. Further research is also needed to quantify case volume by stage and type of cancer, highlighting possible areas of deficiency for fellows in training. Additionally, more research should be done to assess other aspects of clinical practice for gynecologic oncologists rather than simply focusing on surgery.

Duke Scholars

Author Laura Jean Havrilesky Obstetrics and Gynecology, Gynecologic Oncology

Author Evan Robert Myers Obstetrics and Gynecology, Women's Community & Population He ...