This commentary is by Randall Holcombe, M.D., of Burlington. He is the associate dean for cancer programs at the University of Vermont’s Larner College of Medicine and director of the UVM Cancer Center, Vermont’s only not-for-profit comprehensive clinical and research cancer center.
At a recent appointment, one of my patients asked me, “How long are you staying around?”
It wasn’t a casual question. In rural Vermont, folks have seen their share of “locums” — short-term doctors who come for a few weeks or months and then move on. For cancer patients, that revolving door can feel unsettling and leads to fragmented, poorly coordinated care. They want to know the person caring for them will be there for the long haul.
The truth is, recruiting oncologists to rural areas has always been difficult, and across the country the number of cancer doctors hasn’t kept pace with demand. A major study in the Journal of Clinical Oncology from 2007 predicted that demand for oncologists would increase by 48% by 2020. From 2015 to 2022, the number of medical oncologists grew by only 14.5%. This gap hits rural communities hardest.
And here’s the tough reality: nationwide, rural patients are more likely to die from cancer than those in cities. That’s not acceptable. At the UVM Cancer Center, our mission is to reduce the burden of cancer for everyone in Vermont and northern New York. That means making sure people in every corner of our catchment area, especially those in rural communities, have access to expert, academic-level cancer care.
So, what are we doing about it?
First, we’re planting seeds for a stronger oncology workforce. One big step we took this year is expanding our hematology and oncology fellowship program to include rotations in rural practices. We hope that by training fellows in rural settings they might one day establish or join an oncology practice in a rural community.
Also, this year we launched our BioMobile Laboratory program — a lab on wheels in our Cancer Center van that will be traveling to rural high schools around the state. By giving students an up-close look at cool cancer science and research, we hope to inspire them to become the next generation of doctors and scientists in Vermont.
Our van is also traversing the state to bring community skin checks, HPV vaccination clinics and educational programs that encourage colon cancer, breast cancer and lung cancer screening. We know that today’s efforts will reap long term benefits, when fewer of our family members and neighbors get diagnosed with advanced stage cancers.
And, starting next year, the UVM Cancer Center will lay the foundation for a statewide collaborative network that connects academic cancer experts at the UVM Cancer Center with primary care practices. We call it the “Vermont Cancer Care Model,” and it’s designed to improve cancer outcomes for rural patients while supporting a community of providers, leading to lower rates of physician burnout and a more stable healthcare workforce.
Under this system, rural providers can consult with disease-specific experts about how to help patients manage cancer treatment side effects. Meanwhile, rural cancer patients will receive as much of their care as possible close to home, which reduces costs and eliminates unnecessary travel. This system may even allow patients to participate in cutting-edge clinical trials run by the UVM Cancer Center, which today are only available if patients travel to Burlington or Berlin.
At the UVM Cancer Center, we are starting this work today, and we believe our efforts will improve the quality of care, reduce the burden of cancer on patients, and lower overall health care costs.
It’s true that big ideas and building a new infrastructure require investment — but don’t Vermonters deserve this? Cancer shouldn’t be harder to fight just because you live in a small, rural community. It’s time to change that and make Vermont a model for rural cancer care nationwide.
When my patient asked if I was staying, I told them, “I’m here to stay.” Their smile said it all. But wouldn’t it be something if, one day, no patient ever had to ask that question again?
