When the Oncologist Shortage Meets the Rising Tide of Cancer

America’s oncologist shortage shows why patients must become partners, not passengers, in their own care.

When I was diagnosed with cancer, I was lucky. I had great insurance, access to major academic centers, and multiple specialists willing to see me quickly. My oncologist had time to think, and when he didn’t, another expert did. I had choices. Most Americans don’t.

According to the American Society of Clinical Oncology’s 2025 workforce report, 68 percent of Americans aged 55 and older live in counties where oncologist coverage is at risk. Only four percent of oncologists practice in counties with the highest cancer mortality. In 38 states, the number of oncologists per capita has fallen since 2014, even as cancer rates climb, especially among women and younger adults. By 2037, rural areas are projected to meet only 29 percent of their oncology demand. That isn’t a staffing issue. It’s a national emergency in slow motion.

The Bandwidth Crisis

For many people, “cancer care” now means one overworked oncologist supported by nurse practitioners racing through fifteen-minute appointments. The goal is to stay on schedule, not to rethink the plan. Patients assume that “standard of care” means “best care.” It doesn’t. It means “the treatment most oncologists would reasonably choose for this diagnosis.” For some cancers that standard works brilliantly; for others, particularly advanced or rare ones, response rates can hover below 30 percent. The standard of care is meant to be a baseline, yet too often it becomes the ceiling.

Every tumor is a fingerprint. Matching it to the right therapy demands genomic testing, cross-specialty input, and, above all, time to think. Precision medicine promises better outcomes, but it depends on cognitive space that community oncology may no longer have.

Unequal Access to Modern Care

Geography and choice were on my side. My care was coordinated across multiple institutions, and I could afford second opinions and genomic sequencing. I could message my oncologist and actually get an answer. That experience showed me how good cancer care can be when the system has room to breathe. That kind of access is rare in America.

Many patients travel long distances for routine infusions, wait weeks or months for genomic results that could change their treatment, and receive care in settings where clinicians juggle heavy caseloads with little access to multidisciplinary review. Few patients ever have their case discussed by a tumor board, which is still uncommon outside major cancer centers.

The difference between “cutting-edge” and “barely adequate” care isn’t biology or effort. It’s bandwidth. And most of the country is running out of it.

Patients as a Force Multiplier

If oncologists can’t multiply fast enough, patient understanding must. Informed patients aren’t a burden; they’re an untapped resource. Research shows that patients who grasp their treatment rationale are more likely to follow it, report side effects early, and spot administrative errors. Engagement isn’t a soft skill. It’s an intervention.

That’s why we built CureWise: to help patients prepare better questions and understand their options. The platform reads the same data doctors use, including pathology, imaging, labs, and genomic reports, and turns it into clear explanations that can change a treatment path.

CureWise surfaces the kinds of prompts an oncologist might not have time to raise: for instance, because the genomic analysis of my cancer shows the t(11;14) translocation, should we consider adding Venetoclax? Or given my compromised immune system, would intravenous immunoglobulins help reduce infection risk? Or if I don’t respond to the standard regimen, what targeted or off-label therapies make sense next? Questions like these do not challenge authority; they sharpen it. They make every minute with the doctor count.

The Paradox of Empowerment

There’s a common assumption that empowering patients will strain an already stretched system. At first glance it makes sense: more questions, more second opinions, more complexity. But my experience suggests the opposite. When patients get to the right therapy sooner, they often need less care overall.

The standard regimen for my disease was Daratumumab (Dara) plus CyBorD: effective for many, but not optimized for everyone. Genomic testing revealed I had a t(11;14) translocation, a genetic marker that made a different combination particularly effective: Dara plus Venetoclax. That precision mattered. It got me into remission and may have spared me a bone-marrow transplant. The approach required more analysis up front but ultimately meant less toxicity, fewer hospital visits, and lower costs.

That’s the paradox: empowering patients to push for individualized therapy can reduce long-term demand on oncologists and on the healthcare system as a whole. When patients are matched to what works sooner, they may stay healthier longer, require fewer rescue interventions, and free up scarce clinical capacity. Precision isn’t indulgence; it’s efficiency.

Designing Our Way Out

AI-assisted patient engagement can uncover optimal treatment paths earlier, reduce wasted cycles of ineffective therapy, and flag the need for specialist referral before complications mount. It can turn the deluge of clinical data—labs, imaging, genomics—into actionable insight that prevents missteps. Every avoided hospitalization, every sidestepped toxicity, every shortened diagnostic delay lightens the load on overburdened oncology practices.

Artificial intelligence can’t and shouldn’t replace physicians, but it can help them think faster, surface overlooked data, and extend expertise beyond major centers. One oncologist supported by intelligent reasoning tools can safely oversee more patients and tailor care more precisely. At CureWise, we think of AI as a prosthetic for understanding, a way to scale the kind of deep reasoning that used to require a full academic team.

Technology alone isn’t enough. Payment policy still favors urban hospitals over rural clinics. Oncologists in major cities can earn triple what rural doctors make for identical work. If policymakers want to fix the shortage, they must enact site-neutral payment reform and licensing reciprocity so expertise can travel. Programs like the VA’s “Close to Me” initiative prove that distributed oncology works when paired with central oversight. Add AI-enabled reasoning and patient-education tools, and you can democratize precision oncology nationwide.

A Culture Shift in Care

Patients are often told not to “bother” their doctors with too many questions. That attitude is outdated. The most common regret I hear from survivors is, I wish I’d known to ask. CureWise exists to end that sentence. It gives patients vocabulary, confidence, and context: the three elements of meaningful self-advocacy. When patients participate as partners, not passengers, outcomes improve and burnout decreases.

Healthcare loves the phrase “patient-centered care,” yet rarely equips patients to act on it. The oncologist shortage makes that omission untenable. Patient empowerment isn’t a slogan anymore; it’s part of system triage. It transforms passive recipients into active contributors, redistributing the cognitive load that one exhausted oncologist can no longer carry alone.

The ASCO report reads like a forecast, but it’s really a countdown. The workforce is aging, cancer incidence is climbing, and the cognitive load per physician keeps rising. We can’t train our way out of the gap. The only scalable resource left is knowledge: shared, structured, and amplified by technology.

I was fortunate. I had time, options, and doctors who listened. But the oncologist shortage means most patients won’t. That inequity isn’t inevitable; it’s designable. CureWise was born from gratitude and frustration in equal measure: gratitude for the doctors who saved my life, frustration that so many others may never get the same chance.

If we can’t put an oncologist in every town, we can at least put understanding in every patient’s hands. That’s how we outthink scarcity—and make precision medicine the rule, not the exception.