Miriam J. Atkins, MD, FACP, president of the Community Oncology Alliance, discusses the challenges facing oncology today, such as physician and nurse recruitment and minority clinical trial enrollment.
In this interview from the 2023 COA Payer Exchange Summit, Miriam J. Atkins, MD, FACP, president of the Community Oncology Alliance and practicing partner at AO Multispecialty Clinic in Augusta, Georgia, highlights the critical challenge of the physician and nurse shortage in the United States—discussing the lack of guidance for health care professionals regarding job offers—and obstacles in improving minority enrollment in clinical trials, including strict inclusion/exclusion criteria that often exclude real-world patients with multiple health issues.
Can you speak to what you believe is the biggest challenge the field of oncology is facing today?
The biggest challenge we face right now is physician recruitment and nurse recruitment. Because if we don't have physicians or nurses, we can't take care of any patients. So that's a huge challenge. Right now, we're working on strategies for that. There's a shortage of doctors in the United States. So I don't know.... We'll need help from all levels to work on that particular issue.
Then I have some people who are getting out of nursing and people finishing fellowship. They're getting pulled by hospitals, pulled by academic centers, pulled by private groups. They don't know what to do, and no one really shows them all the opportunities. I don't know about nursing, but physicians, when you’re training, you're focusing on patient care. No one tells you how to navigate the job offers. And I think part of that is intentional, because academic centers want to keep all the doctors there. But there are enough patients for everybody, and each one of us needs everyone else.
What are some potential solutions to improving minority enrollment in clinical trials?
One huge way to improve minority enrollment in clinical trials is to keep practices in the community, as I mentioned. Many of my patients are in rural areas. They know me, they trust me, they don't want to go to a big academic center. One other obstacle [is] the inclusion/exclusion criteria for these trials. The real patients are the ones that come in with kidney disease, diabetes, hypertension, a lot of other issues, and many of those patients don't qualify for clinical trials.
They have certain things. For instance, you have to have a certain creatinine clearance. They may have too many issues that make them not qualify for a trial. Because the flipside of a clinical trial is, if a patient dies or gets very sick on a clinical trial, it may not be related to trial or the drugs, but the company has to prove that the patients were not harmed by the trial. That's why the inclusion/exclusion criteria are so strict.