What Happens to a Practice When an Oncologist Leaves?
27% of patients reports that one physician or provider cancellation is enough to make them switch care.
How the departure of an oncologist affects those who remain behind varies by practice setting, a retrospective longitudinal cohort study found. “The goal of this study was to examine how patient-sharing patterns for oncology physicians changed after a colleague moved away, and whether physicians practicing in rural vs urban areas experienced different changes,” study coauthor Erika Moen, PhD, an associate professor in the Department of Biomedical Data Science at Dartmouth University’s Geisel School of Medicine in Lebanon, New Hampshire, told Oncology News Central (ONC).
The findings, published in Applied Network Science, show that rural physicians experienced an increased burden from patient volume and patient sharing after staff turnover. They took on new patients, built new patient-sharing ties, and strengthened existing ties to maintain care. In contrast, urban physicians largely reacted to an oncologist’s departure with care consolidation.
Data from Medicare fee-for-service claims showed that when a remaining rural oncologist practiced the same specialty as their departing colleague, their patient volume increased by five patients and their overall sum of shared patients across all ties increased by 32 with each departure.
Dr. Moen and colleagues correctly hypothesized that physicians in rural areas would have greater structural changes in their patient-sharing networks after a departure because of the more limited workforce. “We did find that physicians in rural areas experienced greater expansion of their patient-sharing ties, which was not observed for physicians in urban areas,” she explained.
The expansion was caused by both forming new ties and greater patient-sharing within existing ties. “Network expansion was enhanced when the physician was in the same specialty as the one who departed, suggesting they may be absorbing some of their colleague’s clinical work,” Dr. Moen said. The analysis used claims associated with Medicare beneficiaries aged 66–99 years (n=435,387) to identify physicians treating breast, lung, and colorectal cancers. Researchers focused on medical, radiation, and surgical oncologists (n=33,839), of whom 1517 moved practice one time during the study period (2016–19).
Departing oncologists were linked to retained oncologists on the basis of shared patients. The researchers looked at postdeparture measures of relationship change, including node strength (connectedness or extent of intranetwork patient sharing), local transitivity (proportion of an oncologist’s connections who also share patients triadically with each other), and linchpin score (extent to which a physician is locally unique in a specialty).
The results are in line with Dr. Moen’s recent qualitative study, published in JCO Oncology Practice, in which rural oncologists described several postdeparture adaptive strategies, such as establishing new referral pathways and assuming more clinical work.
Although urban physicians experienced network changes, these involved higher levels of network clustering after a colleague’s departure. “Urban practices likely have more redundancy in their workforce. So, the greater clustering in those networks could indicate resiliency among the remaining care team members to coordinate care without forming new ties,” Dr. Moen explained.
The findings also support what nonurban oncologists frequently report. “Dr. Moen and associates capture something those of us in rural oncology live every day: When an oncologist leaves, the burden is not simply redistributed, it’s magnified,” hematologist-oncologist Harsha Vyas, MD, founder of Cancer Center of Middle Georgia in Dublin, an independent community practice, told ONC. “It is actually much worse than the intellectual rumination of this paper. With no staff redundancy, distance is not just geographic and becomes a clinical problem,” he explained.
“When one physician departs, patients face longer travel and delayed care. A system that is already stretched must absorb even more,” added Dr. Vyas, who was not involved in the study. “Also, the supporting cast of doctors is rapidly disappearing, which makes specialties like oncology that require multidisciplinary care even worse by burdening the oncologist with primary care and surgical issues.”
The result is a cascade of added responsibilities, care coordination, infusion capacity strain, after-hours decision making, and the rebuilding of referral networks in real time, he added. “Rural healthcare is not failing due to lack of effort or quality. It’s structurally misaligned against those trying to deliver care.”
The study helps demonstrate how a departing rural oncologist affects the entire care ecosystem, and not just clinic volume. Remaining staff must rapidly absorb patients while preserving continuity of care. That entails extending clinic hours, stretching infusion capacity, redistributing call coverage, and rebuilding referral relationships with tertiary centers and local providers. “Much of this work is invisible but essential to prevent delays in diagnosis and treatment and maintain quality of care,” Dr. Vyas said.
Strategically, physician turnover in rural oncology must be anticipated – not reacted to – with resilience built in through cross-trained teams, stronger regional partnerships, tele-oncology support, and operational contingency plans, he noted. “Community physician-owned cancer centers have become a unicorn, as physicians like me assume administrative duties that rural hospital-site doctors don’t have to deal with additionally.”
Ultimately, this study suggests that rural cancer care operates with very little structural slack. “When one oncologist leaves, the impact is not isolated, it’s felt across an entire community. Because in rural America, when care disappears, distance becomes the diagnosis,” Dr. Vyas added.
Given the urban-rural differences, Dr. Moen agreed: “We likely need to develop strategies to support rural clinicians whose teams are disrupted by turnover. Challenges associated with forming new referral relationships will be different from challenges faced by teams that experience a consolidation.”