Rural Oncologists' Perceptions of Specialty Scarcity and Repercussions for Care Delivery: A Qualitative Study.

Abstract

To understand oncology physician perceptions of and experiences with specialist scarcity in their referral networks, strategies for delivering care after the departure of a colleague who they view as critical to their cancer care networks (ie, a linchpin colleague), and impacts of shortages on patient care. We conducted semistructured interviews with oncologists who practice in health systems that serve a predominantly rural patient catchment area. We used deductive and inductive approaches to predetermine codes and then performed a thematic analysis. We interviewed 20 oncology physicians from five sites. We identified three major themes related to specialist scarcity. The first theme described the effects of physician shortages on care team expertise, collaborative relationships, and patient volume. The second theme uncovered strategies oncologists use when facing physician shortages, including referrals to outside health systems or generalists, practicing outside their subspecialization, and reallocating time from other responsibilities. The third theme identified unintended consequences of adaptive strategies, including greater patient travel burden, less optimal or delayed treatment, reduced access to clinical trials, and increased physician burnout and lower job satisfaction. Oncology physician shortages lead to myriad adaptive strategies and downstream consequences to patient and physicians. Mapping these cascades can help guide resources to mitigate the negative effects of departures and shortages.