3099 - Job Turnover Among Radiation Oncologists: 2015 to 2023

Purpose/Objective(s): The radiation oncology workforce has undergone shifts in practice patterns over the past decade. No previous objective population-based study has investigated how recent trends in workforce changes has affected existing geographic disparities between nonmetropolitan and metropolitan areas in the United States. In this study, we used Medicare data to characterize patterns in job turnover within radiation oncology and to quantify the number of nonmetropolitan ROs in the past decade.

Materials/Methods: We utilized the Medicare Doctors and Clinicians National Downloadable File to identify employers and practice locations of ROs who practiced between 2015 and 2023. Employers were identified using tax-identification numbers. To qualify as a job change, we required an RO to have changed his or her employer and practice location (zip code) across consecutive years. Additionally, we defined practices as nonmetropolitan or metropolitan using rural-urban continuum codes from the United States Departments of Agriculture and Housing and Urban Development.

Results: Between 2015 and 2023, the total number of practicing radiation oncologists increased from 4,399 to 5,087, most of whom were employed in metropolitan areas (mean 91.0%, SD 0.4%). 1,180 radiation oncologists in total underwent a job change, yielding an average annual rate of 4.2% (SD 0.7%, range 2.9% – 5.2%). Only 10.0% (SD 2.6%) of ROs undergoing job changes remained at a practice of similar size. ROs were equally likely to move to larger (45.7%, SD 4.8%) or smaller (44.3%, SD 4.0%) practices in year-to-year comparisons. Among nonmetropolitan ROs who changed jobs, 63.5% (SD 11.3%) relocated to metropolitan practices annually, while only 13.8% (SD 3.0%) of metropolitan ROs relocated to nonmetropolitan practices annually. Additionally, retirement rates from nonmetropolitan areas (mean 3.6%, SD 0.7%) exceeded rates of new entry (mean 2.3%, SD 0.6%) throughout the study period. However, due to the significantly larger absolute number of metropolitan ROs, job changes ultimately resulted in a 30.9% increase in the total number of nonmetropolitan ROs, from 353 to 462.

Conclusion: Geographic disparities persist in radiation oncology as the vast majority of ROs continue to practice in metropolitan areas. Nonmetropolitan areas continue to face higher retirement rates, lower rates of new entry, and higher rates of migration of physicians to metropolitan practices. However, the pipeline of physicians from metropolitan areas who changed jobs ultimately resulted in a larger nonmetropolitan RO cohort between 2015 and 2023.