Dr. Lynch and his Fred Hutch team navigated the changing landscape together, pivoting to make the necessary adjustments so as to never lose sight of their mission: eliminating cancer.
Five years later, and in the face of a potentially changing healthcare landscape again, Dr. Lynch is ever committed and steadfast in his vision for the NCI-designated cancer center.
He recently shared with Becker’s what that vision entails and how Fred Hutch is preparing for the future of cancer care.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How is Fred Hutch navigating the evolving oncology workforce?
Dr. Thomas Lynch: Oncology is still a very popular speciality to go into. We’re still training oncologists. Medical oncology, radiation oncology and even surgical oncology are all still very popular. As the original oncologists are all starting to retire, we are seeing some transition, but it’s still an incredibly exciting, rewarding career to go into.
Oncology has been slightly privileged compared to other areas in medicine because people enjoy their jobs a lot. Yes, it’s got high pressure, it’s got the same kind of burnout issues that so much of society has now. But oncology is special, particularly because of how the profession evolves.
Practicing oncology in 2025 is way different than it was in 2022, way different than it was in 2018. It’s always changing, it’s dynamic. It really does reward people who like to see progress made. That’s one of the reasons we’ve been successful in recruiting not just oncologists but also advanced practice providers into the profession.
Q: With 26 million cancer survivors expected in the U.S. by 2040, how is Fred Hutch tackling survivorship care?
TL: There are several ways we’re going to do that, it’s not going to be just one plan. First, survivorship clinics have a real role, but that role is not being the be-all and end-all source of care. Survivorship clinics can make a big difference in helping people adjust to their life after cancer and after treatment.
In terms of actually caring for the survivors, it’s really going to happen in two places. For diseases where the risk of relapse is fairly high, care is going to happen at the cancer center. For other types of early-stage cancers or pre-cancers, the primary care physician is going to continue to play an important role in survivorship care.
But it’s not a one-size-fits-all. When I was practicing, I had some patients who wanted to see me every year for a scan, even though I felt that a really good internist could do a great job with their care. Patients have a connection to their cancer providers, and they sometimes don’t want to give that up.
Take a disease like multiple myeloma, which used to have an 18-month average survival. It now has an eight- to nine-year average survival. That’s a ton of visits with doctors, nurse practitioners and physician assistants along the way. In regard to a workforce shortage, it’s not because fewer doctors are going into the specialty; it’s because the demand for oncology has gone way up, and that’s a really good thing.
Q: Could you share a bit about Fred Hutch’s expansion strategy?
TL: From a research standpoint, we have been very lucky and are in a really good position. We were able to acquire some additional laboratory buildings in Seattle. As we bring new scientists in to study cancer and viral diseases, we have our laboratory footprint set for the next 10 to 15 to 20 years.
We have received an incredibly generous amount of philanthropy from the people of Seattle, including the Bezos family and the Sloan family, that has helped us recruit great scientists to Seattle.
From a clinical standpoint, what we’re finding is the need to keep up with the demand for both outpatient space and inpatient space.
Fred Hutch has revolutionized outpatient care. We do outpatient leukemia care, we do outpatient bone marrow transplants, we do outpatient CAR-T, yet there are still circumstances when you need a hospital and where having inpatient facilities is really important as well.
In a city like Seattle or our broader area of Puget Sound, we really are short on hospital beds. I’ve practiced in Boston, where there are twice as many beds per citizen as there are in Washington state, and we really need more inpatient beds. We’ll be working on ways of accommodating our inpatient profile as well as expanding our outpatient setting.
Q: As a leader of an NCI-designated cancer center, how do you stay focused on Fred Hutch’s mission to prevent and eliminate cancer amidst changes in the political landscape and the healthcare industry at large?
TL: Listen, politics change. It’s part of the nature of our world. We’ve been very proud that in the past, Democrats and Republicans have been pretty unified in their support of cancer research. As we all know, cancer does not discriminate based on political party or philosophy. I hope that we get to that position in the future where Democrats and Republicans find that supporting cancer research makes sense for everyone.
Some of the problems we’re worried about are the Executive Order to cap indirect rates at 15%, though there is a stay on implementing that. For a center like us, which is very dependent upon federal funding and has a large portfolio of National Cancer Institute grants, we would have a significant financial challenge to be able to do cancer research at the Fred Hutch if we were to see that cap go down to 15%. All comprehensive cancer centers around the country are in that same position.
The reason this cap on indirect rates is so critical, is that indirect rates don’t go into a slush fund. They pay for the actual laboratories where the science is done — the benches and the chairs and the centrifuges and the electricity and the gas and the computer lines — all the things you need in a laboratory to make science happen. All of those things are examples of what indirect rates fund.
I was talking to someone who said, “Oh, that’s just to support the football coach.” Well, we don’t have a football team at our cancer institute, and we don’t have anyone who could play football.
Another issue that we’re looking at is called site neutrality.
There’s a difference in the way healthcare is paid for in an outpatient setting versus in the hospital. Cancer centers are very dependent upon the rate being paid at the hospital rate because it supports the nursing care we have, the social work care we have, and the cost of buying expensive drugs.
There are proposals to make it so the rate paid by Medicare is the same whether it’s in the hospital or a doctor’s office. If that were to happen, it could be a big economic hit to cancer centers. It could impair our ability to care for patients and to do cancer research. That is something we’re very worried about and trying to advocate for as the budget is being put together.
Don’t get me wrong, I think most cancer center directors know that there has to be some changes to the way healthcare is reimbursed. We know that there are some places where it’s gone out of whack. We think using a scalpel as opposed to using a hatchet is probably the better way to look at making some of these changes. We don’t want to ruin a system that’s led to such remarkable advances in cancer care and cancer cures.