title: Improving our understanding of the surgical oncology workforce.
abstract: OBJECTIVE
  This study characterizes the surgical oncology workforce as a baseline for future workforce projections.
  
  
  BACKGROUND
  Measuring the capacity of the surgical oncology workforce is difficult due to the wide variety of surgeons who contribute to surgical cancer care. We hypothesize that the bulk of surgical oncology care is provided by general surgeons.
  
  
  METHODS
  Using Medicare claims data linked to the North Carolina Central Cancer Registry, all patients 65 years or older who had a diagnosis of incident cancer of the bladder, breast, colon/rectum, esophagus, gallbladder, kidney, liver, lung, skin (melanoma-only), ovary, pancreas, prostate, small bowel, stomach, or uterus in 2005 and who underwent an extirpative procedure for cancer were identified. The proportion of procedures performed by different types of providers was examined.
  
  
  RESULTS
  A total of 7759 patients underwent 16,734 extirpative surgical procedures. Excluding procedures for gynecologic/urologic malignancies, the proportion of procedures performed by general surgeons and surgical oncologists was 48% and 12%, respectively. Patients treated by general surgeons were more likely to be older, female, minority, and from areas of high poverty. For each tumor type, travel distances were shorter for patients treated by general surgeons than those treated by specialists.
  
  
  CONCLUSIONS
  Workforce projections must account for the significant overlap in the scope of services delivered by providers of different specialties and for the large contribution of general surgeons to cancer care. Efforts to improve the quality of cancer care need to move beyond centralization and focus on educating the surgeons who are providing the bulk of oncology care.
authors.affiliation: *Department of Surgery †Department of Health Policy and Management ‡Lineberger Comprehensive Cancer Center §Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill ¶Department of Surgery, Dartmouth University Hanover, New Hampshire Departments of ‖Epidemiology **Family Medicine, University of North Carolina, Chapel Hill.
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.forename: YunKyung
authors.initials: Y
authors.lastname: Chang
authors.forename: Raphael
authors.initials: R
authors.lastname: Louie
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Groves
authors.forename: Danielle
authors.initials: D
authors.lastname: Durham
authors.forename: Erin F
authors.initials: EF
authors.lastname: Fraher
mesh_terms: D000368:Aged; D005260:Female; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000639:trends*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000601:surgery*; D009657:North Carolina; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States