Access to radiation oncology care varies by geographic location, with growing trends potentially threatening access to such services for rural cancer patients.

That’s according to the American Society of Radiation Oncology 2017 Radiation Oncologist Workforce Study released this month, which reported fewer radiation oncologists taking up positions in rural communities, as well as plans among a significant portion in such settings to retire or reduce hours in the next few years. Further exacerbating the situation is lack of recent radiation oncology graduates interested in procuring jobs in rural areas compared to major cities.

"It has been shown that three-quarters of radiation oncology graduates accept jobs near their training. Since training programs aggregate in large cities and urban communities, this would lead to radiation oncology graduates favoring large cities," Dr. Claire Y. Fung, chair of the ASTRO Workforce Subcommittee, which conducted the study, and a radiation oncologist at Beth Israel Deaconess Medical Center in Boston, told HCB News. "Secondly, our survey showed that the proportion of urban practices posting job vacancies was more than double that of suburban and rural practices, and that might be another reason that larger cities are drawing the new recruits."

About 60 million Americans live in rural communities, many of whom seek medical care close to their home. Access to such care marks the difference between receiving treatment or not for many.

Nearly nine in 10 radiation oncologists work outside of rural communities, with 47 percent in urban areas and 41 percent in suburban settings. The number in rural environments is 13 percent, a three percent decrease from the number recorded in the 2012 survey.

Adding to this burden is the increasing number of physicians choosing to leave these rural areas with a smaller amount of new ones coming in and replacing them. This includes close to 30 percent of radiation oncologists in rural settings who plan to retire or reduce hours in the next five years, compared to 18 percent in urban and suburban areas.

The study, however, did record a rise from 26 percent in 2012 to 29 percent in the number of female radiation oncologists, as well as newer cohorts among them. Thirty-three percent were under the age of 40, 30 percent were in their 40s and 50s, and 22 percent were age 60 and over.

Shifts from private practice to academic centers and hospitals are also on the rise, with 41 percent practicing at academic and university settings and 17 percent at nonacademic hospitals, compared to 38 percent at private ones. The finding marks the first example in which fewer than half of all doctors surveyed were working in a private practice.

"What the survey showed was that for radiation oncologists who changed jobs in the three years prior to the survey, the top reasons were practice mergers/buyouts and desire for stability," said Fung. "The shift from private practice to academic centers and hospitals may possibly be related to changes in the health care landscape, where health care delivery is increasingly consolidated and smaller radiation therapy practices are increasingly acquired by large systems."

In addition, a greater adoption of new technology was observed, with 95 percent of practices offering shortened, or hypofractionated, radiation therapy primarily for breast tumors (94 percent), bone metastases (92 percent) and brain metastases (74 percent), as well as techniques such as stereotactic radiation and real-time image guidance.

An initiative to identify the factors behind the shift and tactics for increasing and maintaining access is underway, with Beyer leading it.

The survey was conducted online, with results based on the responses of 1,174 radiation oncologists from 726 practices across the country. The response rate was 31 percent.

The findings were published in the March issue of the International Journal of Radiation Oncology • Biology • Physics (Red Journal).