Turbulence in the Oncology Workforce: A Silver Lining
Physicians are in the midst of a tectonic shift in workforce patterns that could have ramifications lasting decades.
In a few short months, the current administration has implemented policies that will drastically reduce federal funding for academic science. These massive cuts include hundreds of terminated grants and slashed funding for 'indirect costs' for National Institutes of Health (NIH) research grant recipients. Alongside the federal budget cuts, entire divisions of the NIH and National Science Foundation are also being reorganized.
Clinicians at many academic institutions have been advised to prepare for uncertainty, while physicians and scientists have been instructed to restrict research hiring and spending, even terminate staff without existing grants or contracts. On top of that, entire global health programs have been decimated, and 'reduction in force' emails at the FDA, CDC, or Centers for Medicare and Medicaid Services have left many experts without a job.
However, amid this turbulence and confusion, there's a potential silver lining. The assaults on research funding and government programs may inadvertently help address a major issue: the physician shortage.
As many of my colleagues at academic institutions contemplate their next move, I suspect that oncologists may find themselves returning to full-time clinical practice and patient care.
And that may not be a bad thing.
Prior to the Trump administration's policies, the proportion of clinicians-hours spent seeing patients had declined nearly 8% over a decade. The number of doctors who spent most of their time seeing patients had dropped considerably as well. In fact, a 2024 survey from the American Medical Association found that over 35% of physicians expressed at least some interest in leaving clinical practice altogether. This, coupled with a massive influx of physicians entering retirement, is likely to exacerbate a growing physician shortage problem.
But what if more of us now choose to increase our time in the clinic or start practicing full time?
For many of my colleagues who cannot sustain a non-clinical career, I think that a return to full-time patient care will be a practical, even enticing move. And considering the shortages of physicians across almost all specialties, including oncology, doctors seeking refuge in clinical practice would be a welcome development.
Would I be content with a career that is increasingly more clinical? I think I would be. For me, clinical practice represents the ultimate refuge, the source of stability in a career that could otherwise be ruled by frequent career transitions encountered in the business world. The patient exam room is the one place where I can focus on a one-on-one relationship instead of the hustle and bustle of grant applications and administrative tasks.
Since patient care is often a health system's top revenue source, if more oncologists return to full-time practice, we may have more leverage to negotiate solutions that reduce burnout, advance practice providers, or provide greater vacation time. I also suspect that many clinicians who choose to spend more time with patients will do so as part of a medical group or private practice — potentially reversing a decades-long trend of doctors leaving private practice to work as employed physicians.
There are several tools that can help physicians make this transition easier. For one, the emergence of ambient artificial intelligence (AI) scribing may curb the exodus from clinical practice by reducing excessive documentation burdens. Instead of hyperbolic claims of AI 'replacing' physicians, I suspect that the AI revolution will simply provide physicians the necessary tools to be more efficient.
The growth of telemedicine and remote patient care platforms is another enabling factor. The rise of these virtual clinics means that physicians are no longer limited by geographically boundaries when practicing medicine. Continuing COVID-era policies that allow physicians to practice across state lines would also help.
If more physicians contemplate a return to their clinical roots, we have an opportunity to reshape the patient care experience in ways that both serve our communities and that create more sustainable clinical careers.
The physician workforce has always been adaptable. Now, if we can find our way back to the exam room, we will bring with us diverse experiences from research, policy, and business that can improve clinical practice.
Perhaps the silver lining in today's uncertainty is the chance to rediscover what drew us to medicine in the first place — the profound privilege of caring for patients — while leveraging our broader perspectives to address the systemic issues that drove many away in the first place. The future of healthcare may depend on our ability to transform this moment of professional disruption into one of renewal and recommitment to our core mission.
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