{"entity":{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","aka":[],"tldr":"The number of people with cancer is rising faster than the workforce trained to treat them.","summary":"Cancer incidence is rising with ageing populations while the workforce that delivers care is growing slowly, ageing itself and burning out. ASCO projected a shortfall of more than 2,000 US oncologists by 2025; the US and Canadian pathologist workforce shrank by about a sixth between 2007 and 2017 while case complexity rose; radiotherapy physicists, radiation therapists and oncology nurses are short even in wealthy systems; and in many low- and middle-income countries a single oncologist serves thousands of new patients a year. Training pipelines take a decade, maldistribution concentrates specialists in cities, and burnout affects around half of oncologists. Every other bottleneck, from trial enrolment to genomic testing to palliative care, is rate-limited by people. Task-shifting, advanced practice roles, AI triage and reporting, tele-oncology and international training programmes are the levers.","asOf":"2026-09-08","links":[{"label":"Yang et al., Projected supply of and demand for oncologists and radiation oncologists through 2025 (JOP 2014)","url":"https://doi.org/10.1200/JOP.2013.001319"},{"label":"Metter et al., Trends in the US and Canadian pathologist workforces 2007-2017 (JAMA Netw Open 2019)","url":"https://doi.org/10.1001/jamanetworkopen.2019.4337"},{"label":"WHO Global Strategy on Human Resources for Health: Workforce 2030","url":"https://www.who.int/publications/i/item/9789241511131"}],"tags":[],"related":["nci-cancer-centers","idea-acc-clinical-officer-oncology-track","idea-acc-remote-medical-physics-qa","idea-acc-echo-tele-mentoring-oncology","idea-acc-retention-packages-oncology","idea-acc-regional-oncology-training-hubs","idea-acc-ambient-ai-documentation-oncology","idea-acc-advanced-practice-radiation-therapists","idea-acc-pathologist-assistants-and-ai-triage","idea-acc-open-oncology-workforce-model","idea-acc-fast-track-relicensing-oncologists","idea-acc-mainstream-tele-genetic-counselling","idea-acc-district-surgeon-oncology-mentorship","idea-moon-task-shifting-ai-oncology-capacity"],"cancers":[],"sections":["ai-computation"],"technologies":["radiology-ai-screening","digital-pathology-ai","pathology-foundation-model","ai-trial-matching","dermoscopy-ai"],"targets":[],"drugs":[],"companies":["lunit","paige","pathai","aidoc"],"institutions":["asco","esmo","tata-memorial","iarc"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-yang-j-oncol-pract","paper-metter-jama-netw-open"],"journals":[],"dependsOn":[],"notes":[],"stage":"access-delivery","severity":"major","metrics":[{"label":"Projected US shortage of oncologists by 2025 (ASCO workforce model)","value":"2,258 full-time equivalents","source":"Yang et al., Journal of Oncology Practice 2014","url":"https://doi.org/10.1200/JOP.2013.001319"},{"label":"Change in the US pathologist workforce 2007-2017","value":"-17.5%","source":"Metter et al., JAMA Network Open 2019","url":"https://doi.org/10.1001/jamanetworkopen.2019.4337"},{"label":"US oncologists reporting at least one symptom of burnout (2013 survey)","value":"44.7%","source":"Shanafelt et al., JCO 2014","url":"https://doi.org/10.1200/JCO.2013.51.8480"}],"causes":["Specialist training takes ten or more years and training places have not expanded with demand.","Ageing of the workforce and early retirement, accelerated by burnout, remove capacity faster than it is replaced.","Specialists concentrate in cities and high-income countries, leaving rural and poor regions unserved.","Administrative burden, electronic record documentation and prior authorisation consume clinical time.","Pathology and physics are under-recruited because they are less visible and, in some systems, less well paid."],"currentEfforts":["The NHS Long Term Workforce Plan (2023) commits to expanding training places, including in oncology and diagnostics.","The WHO Global Strategy on Human Resources for Health: Workforce 2030 sets targets for health workforce density.","AI tools for mammography triage (Lunit, and the MASAI trial), pathology screening (Paige, PathAI) and radiotherapy auto-contouring extend the reach of scarce specialists.","Advanced practice providers and oncology pharmacists take on follow-up, toxicity management and survivorship visits.","The ESMO/ASCO Global Curriculum and the IAEA training programmes standardise oncology and physics training internationally.","Project ECHO and tele-oncology models connect community clinicians to specialist centres for case review."],"successLooksLike":"Oncology, pathology, nursing and physics workforce growth keeps pace with incidence in every region, burnout prevalence falls below a quarter, and no country has fewer than one oncologist per 500 new cancer cases."},"route":"/bottlenecks/b-workforce/","neighbours":{"collection":[{"id":"nci-cancer-centers","kind":"collection","name":"NCI-Designated Cancer Centers","route":"/collections/nci-cancer-centers/"}],"idea":[{"id":"idea-prev-genetic-counselling-chatbot","kind":"idea","name":"A chatbot for pre-test genetic counselling so counsellors see only who needs them","route":"/ideas/idea-prev-genetic-counselling-chatbot/"},{"id":"idea-nl-dietitian-in-every-mdt","kind":"idea","name":"A dietitian in every gastrointestinal and head and neck tumour board","route":"/ideas/idea-nl-dietitian-in-every-mdt/"},{"id":"idea-data-llm-documentation-rct-oncology","kind":"idea","name":"A randomised trial of AI scribes in oncology clinics measuring errors and 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