# Not enough oncologists, nurses, pathologists, physicists

Source: https://onco.cc/bottlenecks/b-workforce/  
OnCo record `b-workforce` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-08
- Stage: access-delivery
- Severity: major
- Metrics: Projected US shortage of oncologists by 2025 (ASCO workforce model): 2,258 full-time equivalents (Yang et al., Journal of Oncology Practice 2014); Change in the US pathologist workforce 2007-2017: -17.5% (Metter et al., JAMA Network Open 2019); US oncologists reporting at least one symptom of burnout (2013 survey): 44.7% (Shanafelt et al., JCO 2014)
- 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.

## Sources

- Yang et al., Projected supply of and demand for oncologists and radiation oncologists through 2025 (JOP 2014): https://doi.org/10.1200/JOP.2013.001319
- Metter et al., Trends in the US and Canadian pathologist workforces 2007-2017 (JAMA Netw Open 2019): https://doi.org/10.1001/jamanetworkopen.2019.4337
- WHO Global Strategy on Human Resources for Health: Workforce 2030: https://www.who.int/publications/i/item/9789241511131

## Connected records

- collections: [NCI-Designated Cancer Centers](https://onco.cc/collections/nci-cancer-centers/)
- ideas: [A chatbot for pre-test genetic counselling so counsellors see only who needs them](https://onco.cc/ideas/idea-prev-genetic-counselling-chatbot/), [A dietitian in every gastrointestinal and head and neck tumour board](https://onco.cc/ideas/idea-nl-dietitian-in-every-mdt/), [A randomised trial of AI scribes in oncology clinics measuring errors and time](https://onco.cc/ideas/idea-data-llm-documentation-rct-oncology/), [A randomised trial of AI-generated treatment recommendations versus tumour boards](https://onco.cc/ideas/idea-data-ai-vs-tumour-board-rct/), [A same-week expert second opinion for every rare cancer diagnosis](https://onco.cc/ideas/idea-bio2-rare-cancer-telepathology-network/), [Advanced-practice radiation therapists doing contouring and on-treatment reviews](https://onco.cc/ideas/idea-acc-advanced-practice-radiation-therapists/), [AI clears the normal lung screening scans so radiologists read only the suspicious ones](https://onco.cc/ideas/idea-prev-ldct-ai-negative-triage/), [AI-first reading for high-volume common cancer diagnoses, pathologist for the exceptions](https://onco.cc/ideas/idea-acc-ai-first-pathology-common-cases/), [Ambient AI note-taking to give oncologists back a day a week](https://onco.cc/ideas/idea-acc-ambient-ai-documentation-oncology/), [An 18-month oncology track for clinical officers and physician associates](https://onco.cc/ideas/idea-acc-clinical-officer-oncology-track/), [An open global model of cancer workforce supply and demand by country](https://onco.cc/ideas/idea-acc-open-oncology-workforce-model/), [Answer prior authorisation requests in seconds from the medical record](https://onco.cc/ideas/idea-cost-real-time-pa-fhir/), [Community health workers trained in cancer triage, navigation and home palliative care](https://onco.cc/ideas/idea-acc-community-health-workers-oncology/), [Community pharmacies as one-stop cancer prevention hubs](https://onco.cc/ideas/idea-prev-pharmacy-prevention-hub/), [Credentialed diaspora oncologists staffing remote tumour boards for home-country hospitals](https://onco.cc/ideas/idea-acc-diaspora-tele-tumour-boards/), [Double oncology capacity in low-resource settings with task-shifting and AI decision support](https://onco.cc/ideas/idea-moon-task-shifting-ai-oncology-capacity/), [Every cancer biology PhD begins with a funded replication of a published finding](https://onco.cc/ideas/idea-tr2-phd-replication-year/), [Evolutionary tumour boards with a modeller in the room](https://onco.cc/ideas/idea-bio1-evolutionary-tumour-boards/), [Exempt oncologists who follow the pathway from prior authorisation](https://onco.cc/ideas/idea-cost-gold-card-oncology/), [Fast-track relicensing for refugee, migrant and returning oncology professionals](https://onco.cc/ideas/idea-acc-fast-track-relicensing-oncologists/), [Fund investigators from under-represented communities and community sites to lead trials](https://onco.cc/ideas/idea-tr1-diverse-investigator-pipeline/), [Funded research pathways for surgeon-scientists and radiation oncologist-scientists](https://onco.cc/ideas/idea-fund-surgeon-scientist-pathway/), [Give subcutaneous immunotherapy in community clinics and at home](https://onco.cc/ideas/idea-cost-subcutaneous-community/), [Hospital-funded protected time for clinician-scientists, repaid by trial revenue](https://onco.cc/ideas/idea-fund-protected-time-physician-scientists/), [Locally prepared oral morphine solution, licensed for nurse prescribing](https://onco.cc/ideas/idea-acc-local-oral-morphine-production/), [Make six-weekly immunotherapy the default schedule](https://onco.cc/ideas/idea-cost-extended-interval-default/), [Micro-learning pushed to community oncologists within 30 days of a practice change](https://onco.cc/ideas/idea-data-thirty-day-practice-change-learning/), [Nurse-led chemotherapy day units with a doctor on a screen](https://onco.cc/ideas/idea-acc-nurse-led-chemotherapy-units/), [Nurse-led follow-up clinics for survivors, freeing oncologists for active treatment](https://onco.cc/ideas/idea-acc-nurse-led-follow-up-clinics/), [Offline decision support for generalists treating common cancers in low-resource settings](https://onco.cc/ideas/idea-data-offline-cds-lmic-generalists/), [Oncology pharmacists as protocol prescribers for supportive care and dose adjustments](https://onco.cc/ideas/idea-acc-oncology-pharmacist-prescribing/), [Oncology teams order germline tests; tele-genetic counsellors handle the results](https://onco.cc/ideas/idea-acc-mainstream-tele-genetic-counselling/), [One medical physicist covering many radiotherapy machines through remote quality assurance](https://onco.cc/ideas/idea-acc-remote-medical-physics-qa/), [Paid survivor peer-navigators as a recognised health workforce role](https://onco.cc/ideas/idea-moon-peer-navigator-workforce/), [Pathologist assistants plus AI triage to multiply pathologist capacity](https://onco.cc/ideas/idea-acc-pathologist-assistants-and-ai-triage/), [Project ECHO tele-mentoring for district clinicians managing cancer](https://onco.cc/ideas/idea-acc-echo-tele-mentoring-oncology/), [Publish the four numbers the NHS lung cancer pathway does not currently measure: reflex testing rate, genomic turnaround, surgical access and a lung-specific waiting time in every nation](https://onco.cc/ideas/idea-lung-uk-screening-testing-and-access-gaps/), [Radiotherapy for everyone who needs it by 2040](https://onco.cc/ideas/idea-moon-radiotherapy-for-everyone-2040/), [Regional training hubs that produce oncologists, physicists and radiographers in-region](https://onco.cc/ideas/idea-acc-regional-oncology-training-hubs/), [Retention packages so trained oncology staff stay: bonds, top-ups, working equipment](https://onco.cc/ideas/idea-acc-retention-packages-oncology/), [Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry](https://onco.cc/ideas/idea-acc-risk-stratified-follow-up/), [Roll out AI-supported mammography nationally as a stepped-wedge trial](https://onco.cc/ideas/idea-prev-mammography-ai-stepped-wedge/), [Round-the-clock remote treatment-planning hubs for clinics without physicists](https://onco.cc/ideas/idea-acc-remote-planning-hubs/), [Simulate each hospital's cancer pathway as a queue to find and remove the waits](https://onco.cc/ideas/idea-acc-pathway-capacity-simulation/), [Slide scanners in district hospitals wired to pathologists anywhere](https://onco.cc/ideas/idea-acc-telepathology-district-network/), [Structured mentorship so district general surgeons perform common cancer operations safely](https://onco.cc/ideas/idea-acc-district-surgeon-oncology-mentorship/), [The drugs that cure lymphoma, and the places that do not have them](https://onco.cc/ideas/lymphoma-ev-the-drugs-that-cure-and-the-places-without-them/), [Toxicity-management decision support for nurses and pharmacists](https://onco.cc/ideas/idea-data-toxicity-cds-for-nurses/), [Train and fund oncology clinicians as public content creators](https://onco.cc/ideas/idea-moon-clinician-creator-programme/), [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured](https://onco.cc/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/), [Two-year translational fellowships that pay scientists to develop their own discovery](https://onco.cc/ideas/idea-fund-translational-fellowships/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/), [Validate and reimburse AI contouring and planning to expand radiotherapy capacity](https://onco.cc/ideas/idea-fund-rt-planning-ai-capacity/), [Video palliative care as an equivalent default option for patients far from a team](https://onco.cc/ideas/idea-acc-tele-palliative-care-default/), [Volunteer-led neighbourhood palliative networks, the Kerala model, adapted elsewhere](https://onco.cc/ideas/idea-acc-neighbourhood-palliative-networks/)
- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/)
- technologies: [After treatment in Australia: a stated model of survivorship care](https://onco.cc/technologies/rejuv-access-survivorship-care-australia/), [After treatment in the UK: personalised care, and follow-up you lead yourself](https://onco.cc/technologies/rejuv-access-survivorship-care-uk/), [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [AI trial matching & clinical decision support](https://onco.cc/technologies/ai-trial-matching/), [Asking people how they are, every week, as a treatment in its own right](https://onco.cc/technologies/rejuv-measure-epro-as-treatment/), [Dermoscopy, total-body photography & AI skin analysis](https://onco.cc/technologies/dermoscopy-ai/), [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [Exercise is the best-evidenced thing on this front, and most survivors are not doing it](https://onco.cc/technologies/rejuv-access-exercise-programmes/), [Getting psychological help after cancer: the stepped-care model, and what is actually commissioned](https://onco.cc/technologies/rejuv-mind-access-to-psychological-care/), [Oncology nutrition assessment and medical nutrition therapy](https://onco.cc/technologies/nutrition-screening-mnt/), [Pathology & radiology foundation models](https://onco.cc/technologies/pathology-foundation-model/), [Referral to rehabilitation: the service most people who need it never see](https://onco.cc/technologies/rejuv-access-rehabilitation-referral/), [The carer's own recovery: what is known about the person who is not the patient](https://onco.cc/technologies/rejuv-life-carers/), [What has actually been implemented since those trials, and what has not](https://onco.cc/technologies/rejuv-measure-epro-implementation/)
- companies: [Aidoc](https://onco.cc/companies/aidoc/), [Lunit](https://onco.cc/companies/lunit/), [Paige AI](https://onco.cc/companies/paige/), [PathAI](https://onco.cc/companies/pathai/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Cancer Prevention and Research Institute of Texas](https://onco.cc/institutions/cprit/), [Damon Runyon Cancer Research Foundation](https://onco.cc/institutions/damon-runyon/), [European Cancer Organisation](https://onco.cc/institutions/ecco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Macmillan Cancer Support](https://onco.cc/institutions/macmillan-cancer-support/), [National Cancer Grid of India](https://onco.cc/institutions/national-cancer-grid/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/), [The new AIIMS network (PMSSY)](https://onco.cc/institutions/aiims-network/)
- key papers: [MASAI: AI-supported mammography screening finds more cancers with half the radiologist workload](https://onco.cc/key-papers/paper-masai-lancet-oncol-2023/), [Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage](https://onco.cc/key-papers/paper-yang-j-oncol-pract/), [Quality indicators for colonoscopy and the risk of interval cancer](https://onco.cc/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/), [Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis](https://onco.cc/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/), [Temel: early palliative care alongside chemotherapy improved quality of life, mood and survival in lung cancer](https://onco.cc/key-papers/paper-temel-early-palliative-care-nejm-2010/), [The mesorectum in rectal cancer surgery: the clue to pelvic recurrence?](https://onco.cc/key-papers/paper-heald-mesorectum-rectal-cancer-surgery-br-j-surg-1982/), [Trends in the US and Canadian Pathologist Workforces From 2007 to 2017](https://onco.cc/key-papers/paper-metter-jama-netw-open/), [VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer](https://onco.cc/key-papers/paper-vision-nejm-2021/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- roadmaps: [AI in oncology roadmap: pattern readers → foundation models → agents in the workflow](https://onco.cc/roadmaps/ai-oncology-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)
- people: [Sidney Kimmel](https://onco.cc/people/sidney-kimmel/), [Walter Winchell](https://onco.cc/people/walter-winchell/)
- trials: [Mumbai VIA cervical screening trial (Tata Memorial)](https://onco.cc/trials/mumbai-via-screening/)

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