Josh Friedman , 2025-05-15 18:00:00
Key takeaways:
- The radiation oncology workforce has increased over the last decade, but the number of hiring organizations has decreased.
- Many young radiation oncologists are not working in nonmetropolitan areas.
Increased consolidation and frequent job changes away from solo practices and out of rural communities could limit radiation oncology options for patients in the future, according to results of a retrospective study.
The number of radiation oncologists practicing in the U.S. increased 16% from 2015 to 2023, but the number of organizations that employed them decreased 13%.
Kunal K. Sindhu
“Consumer choice is declining over time,” study author Kunal K. Sindhu, MD, assistant professor in the department of radiation oncology at Icahn School of Medicine at Mount Sinai and New York Proton Center, told Healio. “There are fewer options for patients to go to. You may have some locations that are still intact, but your number of different options goes down. And institutions tend to think alike, even doctors among institutions.
“Your number of options for care are likely to decrease — in rural areas in particular,” he added. “This is a cause for concern. Maintaining access to these areas where patients often live very far away from care is important for the future of this country, and obviously the future of those patients.”
‘Starting point’
During their residency, Sindhu and fellow author Jared P. Rowley, MD, MSc, physician in the radiation oncology division at Maimonides Medical Center, developed an interest in the job market for graduates.
“We had published a couple papers in the past looking at how residents had done in terms of job outcomes after leaving residency,” Sindhu said. “That was kind of the starting point for this project. … We really wanted to see how many people were changing jobs in the field to get a sense of the robustness of the job market. And then, who those people were, and if there’s a particular group of physicians that were changing jobs more frequently.”
Their research into those issues raised more questions about supply, demand and consolidation.
One study estimated a 2% increase in radiation oncologists in the U.S. from 2010 to 2020, but updated projections increased that number to 27% from 2015 to 2025, according to study background.
Additionally, a paper published in International Journal of Radiation Oncology, Biology, Physics in 2021 found the number of practices with radiation oncologists fell 3.8% between 2013 and 2017.
Sindhu and colleagues consolidated their efforts into one study.
They used CMS’ Doctors and Clinicians National Downloadable File (NDF), which includes 90% of all practicing physicians, to investigate.
The researchers included data on employers and practice locations of all radiation oncologists in the NDF from 2015 to 2023.
Trends in practice consolidation, the supply of radiation oncologists in the workforce and job change rates among them served as primary endpoints.
‘Stark’ numbers
The number of practicing radiation oncologists in the U.S. rose from 4,399 to 5,087.
Radiation oncology had a 2.5% annual retirement rate between 2016 and 2022 (717 retired) and a 4.1% entry rate (1,194 joined the workforce).
Rural areas had higher rates of retirement (3.6%) and lower rates of new job entry (2.3%) than the rest of the country.
The number of practices that employed radiation oncologists decreased from 1,620 to 1,416.
Solo practices with radiation oncologists decreased 27% from 614 to 415. Their share of radiation oncologists in the U.S. dropped 16% (from 38% to 32%).
Conversely, large practices employing radiation oncologists increased 51% from 88 to 133. Their share of the workforce rose 74% (from 5.4% to 9.4%).
“There has been increasing consolidation and an increase in larger practices buying smaller practices, so we did expect to see that going in,” Sindhu said. “We didn’t quite expect to see the numbers as stark as they were.”
In all, 1,522 radiation oncologists changed jobs between 2015 and 2023, an annual rate of 4.2%.
Job changes occurred significantly more often for women compared with men (OR = 1.08; 95% CI, 1.02-1.14), early-career radiation oncologists compared with middle- and late-career ones (OR = 1.59; 95% CI, 1.48-1.71), new graduates compared with middle- and late-career radiation oncologists (OR = 1.38; 95% CI, 1.29-1.47) and middle-career radiation oncologists compared with late-career ones (OR = 1.26; 95% CI, 1.18-1.34).
These changes also occurred significantly more often for people who worked in solo practices compared with large practices (OR = 1.77; 95% CI, 1.62-1.94) and those who worked in rural areas compared with urban ones (OR = 1.26; 95% CI, 1.16-1.37).
“The starkness of the findings were really the surprise, rather than the directionality,” Sindhu said.
Researchers acknowledged study limitations, including lack of data on demand.
Supply, demand must be ‘balanced’
Sindhu called radiation oncology “the best field of medicine” and described himself as “proud” seeing the number of individuals who wanted to become radiation oncologists.
However, there could be a negative side to the supply increase.
“This has been a rapid increase in the workforce over a very short period of time,” he said. “You have to make sure that that increase in supply is really balanced by demand.”
Examining demand for radiation oncologists remains a critical part of future research. One way to do that will be through billing.
“If we can get a sense of how billing has changed over time, I think it’ll give us a better sense of how supply and demand have equilibrated over time,” Sindhu said.
Additionally, a closer look at where consolidation is happening could provide more insights into the future.
However, the data suggest certain areas should have heightened concerns.
“[From] 2015 to 2022, there were about 1,400 graduates within the field of radiation oncology from residency, and less than 5% of them actually took a job in these nonmetropolitan counties,” Sindhu said. “There’s a lot that needs to be done to help rural places maintain a robust, stable workforce.”
A possible solution includes screening applicants for residency who have connections to rural areas, Sindhu said.
“There has been some talk about pairing back some of the residency programs,” he added. “[Data] suggest programs that are larger actually are less likely to produce graduates who go into rural practice.”
The federal government also could enact policies — such as loan forgiveness — that encourage young radiation oncologists to practice in rural settings.
Sindhu said American Society for Radiation Oncology proposed a bill that would stabilize Medicare cuts to radiation oncology, which could allow smaller practices to stay financially viable in the future.
“As a country, we have to decide where we’re going to go,” Sindhu said. “Are we going to accept a world where there are fewer providers of care or fewer providers of essential services and makers of goods? Or do we want a broader marketplace where there are a lot more competitors, albeit smaller? Is that more advantageous than having fewer, bigger practices? I think that’s a philosophical question that the electorate and the government will have to make.”
References:
For more information:
Kunal K. Sindhu, MD, can be reached at kunal.sindhu@mountsinai.org.
