Understaffed and Overbooked: The Problems with Maintaining Specialty Care in Rural Areas

Dr. Chino welcomes Dr. Erika Moen and Dr. Dan Zuckerman to discuss new research highlighting how specialist scarcity is felt by oncologists practicing in rural environments. Dr. Moen is the first author on "Rural Oncologists' Perceptions of Specialty Scarcity and Repercussions for Care Delivery: A Qualitative Study, (ascopubs.org/doi/10.1200/OP-24-01065)" which is featured in JCO OP's January 2026 issue.
TRANSCRIPT
Dr. Fumiko Chino: Hello, and welcome to Put Into Practice, the podcast for the JCO Oncology Practice. I'm Dr. Fumiko Chino, an Associate Professor in Radiation Oncology at MD Anderson Cancer Center, with a research focus on access, affordability, and equity.
Rural oncology care has many challenges, including travel distance, limited specialty care, sparse clinical trial infrastructure, and financial barriers leading to worse outcomes and access for patients from diagnosis through survivorship care. Oncologists practicing in rural areas often have difficulties coordinating care with geographically distant providers and limited availability. This is made worse by known workforce gaps.
I'm happy to welcome two guests today to discuss new research highlighting how specialist scarcity is felt by oncologists practicing in rural environments. Dr. Erika Moen, MS, PhD, is an Assistant Professor of Biomedical Data Science at Dartmouth. She is a health services researcher and leads a multidisciplinary team working to leverage network analysis to optimize cancer care delivery and patient outcomes. The long-term goal of Dr. Moen's lab is to improve equitable access to coordinated cancer care with a particular focus on rural populations. She is the first author of the manuscript, "Rural Oncologists' Perceptions of Specialty Scarcity and Repercussions for Care Delivery: A Qualitative Study," which was featured in JCO OP's first issue of 2026.
Dr. Dan Zuckerman, MD, FASCO, is the director of GI oncology and staff medical oncologist at St. Luke's Cancer Institute in Boise, Idaho. The center encompasses eight locations and is the region's largest provider of cancer care, treating a catchment area of over 20 counties. He is past president of the Idaho Society of Clinical Oncology and has been active in ASCO, including past chair of the Clinical Practice and Innovation Committee.
Our full disclosures are available in the transcript of this episode, and we've already agreed to go by our first names for the podcast today.
Erika and Dan, it's really wonderful to speak to you today.
Dr. Erika Moen: Hi, Fumiko and Dan. It's great to meet you both, and I'm looking forward to this discussion.
Dr. Dan Zuckerman: Me as well. Thanks, Fumiko. Nice to meet you, Erika.
Dr. Fumiko Chino: Erika, do you mind starting us off on how you got interested on how to try to optimize multidisciplinary care and why your focus is specifically in rural populations?
Dr. Erika Moen: Yes, absolutely. When I was a new assistant professor, I knew I wanted to focus my research program on bringing together my methods expertise in patient-sharing network analysis, which involves using healthcare administrative data to identify networks of physicians who share the same patients, with my research interest in cancer care delivery.
I remember reading an oncology workforce report published by JCO OP, and in that paper, there was a map visualizing county-level metrics of the number of oncologists per capita. And one of the things that immediately struck me was what I was seeing in rural areas. There would often be one county that had a relatively high density of oncologists, and it would be surrounded by counties with none. I wondered what the multidisciplinary referral networks of those physicians looked like and how physician departures or retirements would impact those patients and care teams. And because rural areas have known workforce shortages, and the delivery of high-quality cancer care depends on relationships between multidisciplinary specialists, these networks of physicians seemed critical to study and to support to maintain access to care for rural communities.
Dr. Fumiko Chino: What a great summary about how you got interested in this and trying to marry the data science of it all with the actual care delivery, like what matters to patients on the ground, which is: "Am I going to be able to see a specialist focused on melanoma or am I just going to have to see a general oncologist?" So that's a phenomenal narrowing in on "this is the reason why I'm doing the research that I want to do."
Now, Dan, congratulations on your recent nomination for the ASCO Board of Directors. I know that you have been passionate about improving quality care delivery for decades. Can you speak to your efforts in your home state and within ASCO to ensure that the science and technology and practice pattern advancements that we see at academic centers actually make it into the community?
Dr. Dan Zuckerman: Yeah, I think about the 44 counties in Idaho, and I'd have to guess that most of us are concentrated in three or four of those. But you know, a great example: so I've been practicing out here for 18 years, when I left fellowship, we came to a center where we had autologous stem-cell transplant but not allo. And so you sort of ask about one of the greatest innovations recently in oncology has been CAR T-cell therapy. And we were thinking about and watching our patients with leukemias and lymphomas being sent to places like Seattle or Salt Lake and thinking about, as Idaho grew and our population, urban and rural, how could we provide for that?
And so, really back in 2015, when I was director of our Cancer Institute, we got buy-in from our leadership, thankfully, to start building an allogeneic stem-cell transplant program with an eye to do allo, but also with an eye to know that we needed sort of that expertise in cellular therapies, all the way from lab to processing, to having the physicians and APPs and pharmacists to do that, so that we could deliver CAR T-cell within Idaho. And it took three years to build an allo program, and then we had planned to deliver CAR T-cell in 2020 and the pandemic happened. That delayed us by a year or two. But, you know, it's an example we're proud of, but it took a massive lift. I think originally it was close to a two-million-dollar pro forma with 19 FTEs, and we were fortunate to have leadership at St. Luke's and also a group of physicians who were willing to make that lift because we're not an academic center. But that's sort of one example where we've been successful in being able to bring some subspecialty care to a rural area, but it is incredibly difficult. And we still have gaps. So obviously I'm highlighting a place where we've been successful.
Dr. Fumiko Chino: No, I love that you mentioned CAR T-cell because I know we did a recent podcast episode about access to CAR T and how providing CAR T within the community is obviously the next step, and yet it's so challenging. There's these logistic challenges, but you also have to have actual buy-in from the institutions to build the programs because they will not build themselves. And I think: Oh, you don't have CAR T-cell in your community within your county, within 10 counties? You didn't even have it within your state! And so, that's a phenomenal effort, and it required so much investments in people and dollars and just time. So, I completely respect that.
And it dovetails really nicely into the next question to Erika, which is: the manuscript on deck that we're talking about really talks about the access to specialty care and how that can be very challenging in rural areas. Do you mind giving us an overview of the manuscript, kind of what you did, what you found, what you're excited about in terms of the next steps?
Dr. Erika Moen: Sure. So, our study conducted and analyzed qualitative interviews from 20 oncology physicians across five sites that served a rural catchment area. And it was part of a larger …