News in brief: Medical oncologist numbers increase revealed by AHPRA; Neuroendocrine cancer rates increasing – but so is OS; Specialty training colleges’ ‘dirty secret’

29 Nov 2021

Medical oncologist numbers increase revealed by AHPRA

The medical oncology workforce has grown by an additional 230 physicians over the last five years, with 865 practitioners now registered in the specialist physician category of medical oncology field of practice, according to the latest statistics on medical registration released by AHPRA.

The figures show that numbers of medical oncologists have increased from 635 registered in 2016. As well as the 1060 adult medicine
medical oncologists there are also 70 specialists in paediatric oncology field of practice,
445 radiation oncologists and 52 in gynaecological oncology.

The locations of practice of medical oncologists include 14 in the ACT, 267 in NSW, five in the Northern Territory, 134 in Queensland, 63 in South Australia, 19 in Tasmania, 286 in Victoria, and 58 in WA.

Overall, there are 130,476 registered medical practitioners in total in Australia, and 11,114 practitioners registered as specialists.

Neuroendocrine cancer rates increasing – but so is OS

Australia is seeing an increasing incidence of neuroendocrine neoplasms (NEN) but overall survival rates are also improving, oncologists say.

A review of 8,106 NEN cases listed in the Victorian Cancer Registry from 1982–2019 showed the number of new diagnoses increased three-fold over time from 3.1/100,000 in 1982–1989 to 9.7/100,000 in 2010–2019.

The annual standardised rate also increased, particularly in pancreatic NENs (4.3 fold) and differed between genders, Associate Professor Michael Michael and his team at Peter MacCallum Cancer Centre wrote in the Asia Pacific Journal of Clinical Oncology.

Fortunately, five-year overall survival (OS) rates and median increased over time, from 52% to 67% and 5.9 years to not reached over the first and last decades (P < 0.001 for both). This is likely due to improvements in physician NEN awareness and diagnostic imaging, early localised disease detection and aggressive metastatectomy, they suggested.

OS was greater in city-dwellers than regional/remote residents, the authors noted (P = 0.01), possibly reflecting differences in socioeconomic status, delays in diagnosis and specialised healthcare access.

“This population-wide analysis with over 38 years of data has confirmed the international trends of the increased incidence, prevalence, and OS of NEN patients regardless of primary site or histological grade,” they concluded.

Specialty training colleges’ ‘dirty secret’

Training colleges, consultants, and hospital executives have been blamed for enabling ongoing abuse and overwork of registrars, in an article about speciality training written by an anonymous junior doctor deploring what they describe as medicine’s ‘dirty secret’.

Published in mainstream newspapers this week, the article entitled ‘Distressed doctors don’t bend, so they break’ describes a training regime that encourages mental distress and suicide among registrars who are given a heavy workload and responsibilities but no support from senior doctors or management.

“They are the first to arrive at the hospital and the last to leave. You are told not to make waves, to keep your head down, to get through it. You are often working unsupervised with vast responsibilities and unsupportive distant supervisors. The less you complain, the more you’re willing to endure, the more attractive and hireable you become. Troublemakers do not get hired,” it says.

The article says the current approach by training colleges is flawed because “the focus has been on coping with abuse rather than ending abuse.’

“The medical fraternity needs to host a meaningful discussion about how to fix our training system to provide more support for doctors and improve their wellbeing. Workload is an issue but the crux of the problem is the lack of support from those in authority,” it concludes.

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