With the plethora of new targeted agents, immuno-oncologic therapeutics, and next-generation sequencing, there has never been a better time to be a hematologist/oncologist, as the armament is rich. That said, the army of physicians needed to do battle with cancer in the community setting is becoming a scarce commodity. Policy makers, healthcare organizations, providers, and payers are failing to recognize the value of the delivery of that care in the cancer patient’s community, close to home and a support system of family and friends.

In the not too distant past, almost 85% of cancer care was delivered in the private practice, community oncology setting. Fast forward to 2018, and that percentage dwindles to a little more than 50% of patients being treated in their own communities. A number of factors account for the shift from community to hospital outpatient setting, including important issues that fellows should learn about, such as the 340B Drug Discount Program, site payment parity, and the sequester cut to drug payments. But the message coming out of Washington, DC, and from policy makers is that the era of corporate hospital-based cancer centers monopolizing the healthcare system is on its way out. Fellows would be wise to look to the future and consider the community practice option.

As we advance toward producing an integrated cancer model, the value of the practicing community oncologist has revealed itself to be an integral piece of the puzzle. Medicare’s health reform think tank, the Center for Medicare & Medicaid Innovation, has invested significant resources in the Oncology Care Model (OCM), which aims to both provide higher-quality, more highly coordinated oncology care and achieve cost efficiencies for Medicare and bene ciaries. Close to 200 oncology practices and 16 payers across the country treating more than 150,000 Medicare beneficiaries currently participate in this oncology-specific payment-and-delivery reform model.

The Community Oncology Alliance (COA) is focused on helping practices succeed and thrive in the OCM. The alliance also has invested significant resources to its proposed OCM 2.0 model, addressing several issues identified by participants and charting a path for incorporating value-based payments. Among all specialties, community oncology is much further along with producing an integrated care model that exemplifies high-quality, well-coordinated cancer care to patients that also reduces costs for Medicare and beneficiaries.

It is precisely for those reasons that the COA launched its COA Fellows Initiative, seeking to engage and educate hematology-oncology fellows about the value of practicing in the community setting. The program is designed to explore all practice setting options, inclusive of research, academia, government agency, and hospital-and community-based care, showcasing the array of choices post fellowship.

Current research shows that in just 2 short years, this country will experience a shortage of as many as 3800 oncologists. At the same time, an aging population, coupled with increased survivorship, will accelerate the need for even more hematology/oncology subspecialists.

Thriving community oncology practices exist throughout the United States, as evidenced by the COA job board and chatter among practices. The need for new physicians is real, and practices are eager to welcome new faces into the community.

COA looks forward to meeting with fellows across the country during 2018 to discuss the bene ts of community practice, as well as connect them with employment opportunities that fit their specific needs. There are a number of opportunities for first-, second-, and third-year fellows to join COA and for our members to attend national conferences, meetings, Capitol Hill lobbying days, and more to learn about the value of community oncology and its importance in the US cancer care system.

At a recent joint meeting of the North Carolina and South Carolina Oncology Associations, several fellows from nearby schools joined practicing oncologists at a relaxed dinner program discussing both the risks and benefits of joining a private community oncology practice. It became immediately evident just how much is not taught about real world oncology, which was readily acknowledged by program directors at other COA fellows programs. The Fellows Educational Initiative addresses precisely that problem, offering an opportunity to learn about the differences in practice, whether it be academia, hospital, or private practice community oncology. Only then can a fellow be armed to choose wisely the best personal fit.

You can learn more about COA and our Fellows Initiative at 

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As we advance toward producing an integrated cancer model, the value of the practicing community oncologist has revealed itself to be an integral piece of the puzzle.

The Community Option: The Road Less Traveled 

The Community Oncology Alliance (COA) has embarked on a journey to educate and inform the men and women undertaking hematology/oncology fellowships across the country about the employment choices awaiting them.

 readers may know, most Americans being treated for cancer are cared for in their own communities by independent oncology care teams. Such care is delivered not only at the highest quality but also at significantly lower cost compared with other care settings. And, as we all know, achieving that perfect balance of quality, value, and affordability is the universal challenge for tomorrow’s healthcare delivery system.

However, recent estimates suggest that by 2020 the country will experience a shortage of as many as 3800 oncologists. At the same time, with the aging patient population and a growing number of survivors, thanks to more successful cancer treatment, the need for oncology services will increase significantly. This community- based system can be sustained only if physicians completing the 3-year hematology/oncology fellowships are presented with independent practice as an alternative to employment with large teaching institutions or hospitals.

Recognizing this challenge, COA recently launched the Fellows Initiative, a multifaceted effort aimed at presenting the case for a career in private practice. COA will host free, local, interactive roundtables across the country, covering issues such as the current census and future outlook for hematologists and oncologists; educational opportunities; cancer care policy updates, such as the status of oncology payment models; career choices and guidance, including the interview process and the importance of employment contracts. Presentations are planned in Georgia, North Carolina, Ohio, Oklahoma, South Carolina, and Texas, with more to follow.

Fellows are also being invited to join COA members at regularly scheduled board of director meetings, Payer Exchange Summits, the annual Community Oncology Conference, and other key events. Limited scholarships are available to support travel and participation. To help fellows connect with community oncology practices, COA has created an exclusive Listserv and a regularly updated job board.

Launched earlier this month, the Fellows Initiative is off to a great start. COA member practices and state oncology societies contacted us in droves to host educational events in their states or post career opportunities. It is clear that community oncology practices are looking for the next generation of hematologists and oncologists. This initiative seeks to support them in finding and engaging those eager professionals.

We are extremely proud of this latest initiative under the COA umbrella. There is no place like home when you are sick, and strengthening the community cancer-care system for the future helps support our goal of keeping those fighting cancer close to their homes, families, and support networks.

Mary Kruczynski is director of policy analysis at COA and coordinator of the Fellows Initiative. If you are interested in scheduling a fellows educational event in your area, please write to maryk@coacancer.org.

The Community Oncology Alliance has embarked on a journey to educate and inform the men and women undertaking hematology/oncology fellowships across the country about the employment choices awaiting them.

Mary Kruczynski

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