Medical oncology is an incredibly interesting and rewarding field of medicine. In no other area has change been so dramatic over such a short time. Furthermore, in no other area have the fruits of basic scientific labor been applied in such a tangible way to improve the care of patients. As a community oncologist, it has been my pleasure to be on the frontlines, as a witness to and participant in this reformation. However, we do have our challenges. Community oncologists are being assaulted on several fronts, frequently in the context of the uncontrolled costs of cancer care. Community oncologists are often cast in the role of villain, as part of the problem rather than part of the solution.
In my role as a Medical Director for US Oncology, I have been involved in discussions and debates surrounding many of these contentious issues, from reimbursement reform to Centers for Medicare & Medicaid (CMS) and FDA policy to comparative effectiveness research. I have been frustrated by my perception that community oncologists are being marginalized in these discussions, despite the expectation that these same community providers will enthusiastically support, contribute to, and ultimately implement these programs.
At a recent meeting about what comparative effectiveness will actually look like, I asked in exasperation, “As a provider, what do you want me to do?”
I offer here a modest proposal for what we can and should do.