By Geraldine Jacobson, MD, MBA, MPH, FASTRO; Bruce Haffty, MD, FASTRO; Pranshu Mohindra, MD, MPH; and Chirag Shah, MD
On behalf of the ASTRO Board of Directors and the ASTRO Workforce Task Force, we are pleased to announce that the wait is over. The final report of the radiation oncology workforce study commissioned by ASTRO and conducted by Health Management Associates (HMA) is now out.
Let’s back up a bit for those of you who may be unfamiliar with the actions of the ASTRO Board more than a year and a half ago. In June 2021, then-ASTRO Chair Tom Eichler, MD, FASTRO, called for the formation of a Workforce Task Force to look into the concerns that many felt about a potential radiation oncologist supply and demand imbalance given a drop in interest in the specialty during the NRMP Match process. The Task Force was comprised of a diverse group of radiation oncologists, including representatives from the Society of Chairs of Radiation Oncology Programs (SCAROP), Association of Directors of Radiation Oncology Programs (ADROP), Association of Residents in Radiation Oncology (ARRO), ASTRO’s Committee (now Council) on Health, Equity, Diversity and Inclusion (CHEDI) and both community-based and academic practitioners.
Our first recommendation to the ASTRO Board was to authorize a Request for Proposal (RFP) to conduct an independent, unbiased workforce analysis. A formal RFP was issued to third-party consulting companies experienced in conducting this type of analysis. After a thorough evaluation of the proposals, the task force recommended, and the Board approved, hiring HMA, a research firm with strong expertise in this complex analysis. Specifically, HMA was tasked with evaluating the current and future supply of radiation oncologists, demand for radiation oncology services and projecting future trends through 2030. It is important to emphasize, while the study was funded by ASTRO, significant steps were taken to ensure an independent analysis, with ASTRO leadership maintaining an arm’s length from the HMA team. The task force served as representatives of the specialty who were available to HMA as resources to provide iterative feedback in the development of the model.
Meanwhile, the task force also proposed, and the Board approved, an updated ASTRO Workforce Statement in February 2022 focusing on issues impacting residency training programs, including the size, selection process and scope of training programs and published an editorial in the Red Journal that provided more context on the statement. ASTRO members also had the opportunity to learn more about the process and provide their feedback during the 2022 Annual Meeting, which resulted in meaningful changes to HMA’s methodology that reflected members’ real-world experiences.
We are pleased to announce the final HMA report, “Projected Supply and Demand for Radiation Oncologists in the U.S. in 2025 and 2030,” is now available. The analysis includes an evaluation of radiation oncologist supply (new graduates, exits from the specialty) and potential changes in demand (growth of Medicare beneficiaries, hypofractionation, loss of indications, new indications) as well as radiation oncologist productivity (measured as work RVUs produced per radiation oncologist) and demand per beneficiary. The results of the analysis and what HMA deemed the most likely scenario demonstrated a relative balance between radiation oncologist supply and demand for radiation services through 2030; the growth in radiation oncologists was balanced by the rapid growth of Medicare beneficiaries over the same time period. The primary factors driving the model were found to be growth of Medicare beneficiaries and changes in work RVU productivity, with hypofractionation and loss of indications having only a moderate impact. While the most likely scenario was a balance of workforce supply and demand, some scenarios did demonstrate the possibility of over- and undersupply.
While the analysis took into consideration multiple parameters and evaluated multiple scenarios, it is recognized that no model is perfect. Given the heterogeneity of our specialty, it is not surprising that the scenarios presented in the report lead to variable conclusions. HMA also developed a modeling tool that allows programs and practices to evaluate different scenarios. We encourage individuals to use this tool to assess the workforce using the unique variables specific to their own environment. We also recognize that continuing study will be needed as new data emerge, including Medicare beneficiary and wRVUs, to evaluate the balance of supply and demand in radiation oncology in the years beyond 2030. The ASTRO Board and Workforce Subcommittee remains vigilant in monitoring the need for future assessment.
We invite you to read the task force’s interpretation of the study, which is available online in the Red Journal as an open access Article in Press. The HMA final report is available as a supplement to the paper and the modeling tool is available for download. Please submit your questions in the comments below or on the ROhub.
Read previous posts:
A Look Ahead at the Radiation Oncology Workforce in the United States – Bruce Haffty, MD, FASTRO; Chirag Shah, MD; and Pranshu Mohindra, MD, MPH, March 1, 2022
The Future of our Field – Thomas Eichler, MD, FASTRO, January 5, 2021
A Commitment to the Field - Theodore DeWeese, MD, FASTRO, March 10, 2020
The Residency Training Landscape, Continued - Paul Harari, MD, FASTRO, May 28, 2019
The Residency Training Landscape - Paul Harari, MD, FASTRO, March 20, 2019