Too much of a good thing? Projecting the need for gynecologic oncologists over the next 20 years

To estimate the effect of growth in gynecologic oncology fellowships in the United States on surgical volume for trainees and practicing gynecologic oncologists over the next 20 years.

Using 2010-2019 age-specific gynecologic cancer incidence estimates from US Cancer Statistics, significant changes in incidence were identified with Joinpoint software. Statistically significant changes in annual rates were projected forward five years, and these estimates were used to generate projections of cancer cases in the population from the U.S. The number of practicing gynecologic oncologists was projected through 2045 based on current fellowship enrollment. For sensitivity analysis, we varied the number of new fellows and fellowships based on data trends from the last five years.

Over the next 20 years, cancer cases will increase by 14 % with the majority being endometrial. With current trainee numbers, the average annual number of new surgical cancer patients per practicing gynecologic oncologist will decrease from 73 to 51 (30 % decrease). An increase of one fellow per year nationally to the total number of trainees will further decrease new surgical cancer cases to 43 cases/gynecologic oncologist annually (41 % decrease). When accounting for one additionally trainee nationally per year over the next 20 years, the average number of oncologic surgical cases per fellow/year will decrease from 208 to 160 (23 % decrease). Under the assumption of no additional fellowship positions, surgical cases will increase from 208 to 226 per fellow/year (9 % increase).

The gynecologic cancer caseload of practicing gynecologic oncologists is estimated to decrease by nearly 41 % and trainee case volume will drop by 23 % over the next 20 years with minimal continued addition of training positions. Careful consideration should be given to creating an appropriate balance between the number of practicing gynecologic oncologists, potential dilution of programs' case volume per trainee, and the effects on the needs of future patients.