The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study

doi:10.1016/j.ijrobp.2018.10.020

International Journal of Radiation OncologyBiologyPhysics

Volume 103, Issue 3, 1 March 2019, Pages 547-556

https://doi.org/10.1016/j.ijrobp.2018.10.020 Get rights and content

Purpose

The aim of this study is to report the American Society for Radiation Oncology 2017 radiation oncologist (RO) workforce survey results; identify demographic, technology utilization, and employment trends; and assess the profession's ability to meet patients' needs, offer job satisfaction, and attract high-caliber trainees.

Methods

In spring 2017, the American Society for Radiation Oncology distributed an online survey to 3856 US RO members. The questionnaire was patterned after the 2012 workforce survey for trend analysis. The 31% response rate yielded 1174 individual responses (726 practices) for analysis.

Results

ROs’ mean age was 50.9 years. Compared to 2012, female representation (28.9%) increased and white representation (69.8%) dropped. The proportion in rural practice (12.6%) decreased, whereas the number of suburban ROs (40.6%) increased and urban ROs (46.8%) remained high. Most ROs worked full-time, averaging 51.4 h/wk. Stereotactic body radiation therapy, cone beam computed tomography, and magnetic resonance/positron emission tomography-computed tomography fusion utilization increased, whereas low-dose-rate brachytherapy decreased by >15 percentage points. Hypofractionation utilization was 95.3% and was highest in academic/university systems and lowest in private solo practices (P < .001). More respondents were concerned about an RO oversupply rather than shortage. ROs reported 250 consults (median) and 20 on-treatment patients (median) in 2016 and greater time allocation to electronic health record management compared with 3 years earlier. Approximately 15% of ROs reported job vacancies, which were more prevalent in urban practices and academic/university systems. ROs were employed by academic/university systems, private practices, and nonacademic hospitals in a respective ratio of 2:2:1. Comparison with 2012 survey findings showed a shift from private practice toward academic/university systems and nonacademic hospitals. Compensation was predominantly productivity-based at private practices and a fixed salary or a base salary at academic/university systems and nonacademic hospitals. Practice merger/buyout was the lead reason for ROs to change employers.

Conclusions

Since 2012, race and gender gaps narrowed, but geographic disparities persisted, with ROs gravitating toward resource-rich suburban and urban locations over rural practices. The workforce has shifted from predominantly private practice to more equal balance with academic/university systems. These findings reflect the current US RO landscape and serve to underscore the need for collective action to ensure equitable RO care for all patients.

Introduction

The American Society for Radiation Oncology (ASTRO) has conducted several workforce studies to assess whether the US radiation oncologist (RO) profession meets patients' needs, provides a balanced workload and job satisfaction, attracts high-caliber trainees, and values diversity. These studies characterize practice structure and behaviors and help inform ASTRO positions. The first study in 1996 examined RO “manpower needs” using professional organizations’ statistics;¹ the 2002 survey polled ROs on physician and nonphysician personnel staffing,² and the 2012 study surveyed ROs and allied professionals on demographics, supply and demand, and other concerns and needs.3, 4, 5

The 2017 study results are presented here in four sections: (1) demographics, (2) technology utilization, (3) supply and demand, and (4) employment and compensation models. Where available, results from the 2012 survey are included for comparison.

Section snippets

Survey development and testing

The ASTRO Board of Directors and Workforce Subcommittee commissioned the current study in 2016. The 2012 ASTRO workforce survey was used as a basis for survey design to allow some comparison over time. The Workforce Subcommittee convened in person at the 2016 ASTRO Annual Meeting and several times remotely (via conference calls and email exchanges) thereafter to optimize the survey questionnaire. The questionnaire was pilot-tested for clarity, time to complete, and relevance. The questionnaire

Demographics

Table 1 shows demographic results. ROs’ mean age was 50.9 years (range, 24-97), slightly lower than 2012 respondents (51.4 years). More than half of the ROs (56.3%) were aged 40-59 years and nearly one-quarter (23.6%) were aged ≥60 years. Women comprised 28.9% of the workforce, up from 25.8% in 2012. The male-to-female ratio was 2.5:1 and varied by age, ranging from 2.0:1 in the <40 years group to 2.7:1 in the ≥50 group (P = .001). Ratios also varied by US region; the gap was narrowest in the

Demographics

The 2017 survey respondents are comparable to the 2012 respondents in terms of age, with roughly three-quarters of the respondents over the age of 40 years and thus in mid- to late-career. Although men outnumbered women 2.5-fold, the gender gap was narrower among the quarter of respondents aged <40 years. With over 50% female representation among medical school matriculants today,⁸ however, female representation in RO remains disappointingly low. Unsurprisingly, the RO profession comprises

Conclusions

Racial/ethnic minorities and women continue to be under-represented in our specialty, although the narrowing gender gap in those aged <40 years allows for some optimism. Comparison with 2012 survey results suggests ROs are gravitating to urban and suburban settings, reflecting a maldistribution that could be further exacerbated by the higher propensity of rural ROs to retire or go part-time, in addition to the skew in job vacancies toward urban settings. Survey results corroborated known

Acknowledgments

The study represents the work of the American Society for Radiation Oncology Workforce Subcommittee, chaired by Erli Chen, MS, (past) and Claire Fung, MD, (current), in collaboration with the Society of Chairs of Academic Radiation Oncology Programs, Association for Directors of Radiation Oncology Programs, and Association of Residents in Radiation Oncology. The authors thank Marina Demas for providing administrative support.

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: Conflicts of interest: A.A., T.S., and L.G. stated they are employees of ASTRO and receive a salary.

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The ProfessionThe American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Survey development and testing

Demographics

Demographics

Conclusions

Acknowledgments

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Adv Radiat Oncol

Eur Urol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Pract Radiat Oncol

Int J Radiat Oncol Biol Phys

Pract Radiat Oncol

Pract Radiat Oncol

Lancet Oncol

Lancet Oncol

Practical Radiation Oncology

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

J Am Coll Radiol

The Profession
The American Society for Radiation Oncology 2017 Radiation Oncologist Workforce Study