Author ORCID Identifier
https://orcid.org/0000-0002-7722-7276
Date of Award
2025
Document Type
Thesis (Ph.D.)
Department or Program
Quantitative Biomedical Sciences
First Advisor
Erika Moen
Abstract
Nearly 20% of oncology physicians planned to move to new practices or leave practice altogether in 2023, with common stressors related to limited staffing and increased clinical burden. This combination of movement and departures is collectively referred to as turnover. High-quality cancer care relies on access to well-staffed and coordinated clinical teams, and thus, turnover within these teams can compromise care access, delivery, and quality. Prior research within primary care has demonstrated that turnover can result in delayed or worsened care and higher health care spending. However, there are limited studies of turnover within the oncology workforce. Understanding how oncology physician turnover impacts cancer care and care teams is critical for identifying system and team features that promote team resilience and maintain care quality amid workforce changes. The goal of this thesis work was to leverage Medicare claims to measure oncology physician movement and investigate its impact on patients and the remaining care teams. For Aim 1, I created a patient cohort of Medicare beneficiaries diagnosed with breast, lung, or colorectal cancer in 2016 – 2019, which informed an oncology physician cohort based on all medical oncologists, radiation oncologists, and surgeons involved in their cancer care. I identified oncology physicians who moved practices based on changes in their billing location, and assessed characteristics associated with physician- and region-level movement. Aim 2 used annual patient-sharing networks to assess how oncology physician departures impacted the structure of the remaining care team. Aim 3 examined how oncology surgeon departures affected the timeliness of breast cancer surgery. I found that physician connectedness was strongly associated with movement, where highly-connected oncology physicians had lower odds of moving. Oncology physician connectedness also changed after a colleague’s departure. Retained rural-practicing oncology physicians experienced an expansion and restructuring of their patient-sharing ties following a colleague’s departure while urban-practicing physicians experienced a consolidation. Lastly, breast cancer surgeon departures were associated with increased odds of surgical delay among patients with breast cancer. These three aims provide evidence that oncology physician movement can disrupt cancer care and care teams, yet increased collaboration and connectedness may mitigate these effects.
Recommended Citation
Cornelius, Sarah L., "Understanding oncology physician movement and its implications on cancer care teams and patients" (2025). Dartmouth College Ph.D Dissertations. 427.
https://digitalcommons.dartmouth.edu/dissertations/427
