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A Look Ahead at the Radiation Oncology Workforce in the United States

By Bruce Haffty, MD, FASTRO,1 Chair; Chirag Shah, MD,2 and Pranshu Mohindra, MD,3 Co-chairs, ASTRO Workforce Task Force
Posted: March 1, 2022

Issues around the state and future of the radiation oncology workforce have taken on more urgency in the recent years given the imbalance in residency positions secured during the Match and Supplemental Offer and Acceptance Program (SOAP) process. In an effort to better inform medical students about the specialty, ASTRO updated the medical student section of the website to include a Journals collection, which provides a range of studies and perspectives specific to the specialty, including workforce issues. Additionally, recognizing and respecting diverse viewpoints, ASTRO offers many channels for thoughtful and transparent debates and discussions, including ROhub, the ASTRO Blog and ASTRO’s suite of scientific journals.

The ASTRO Board of Directors has long shared our concerns about the future radiation oncology workforce. In fact, in each of the past three years, the Chair of the ASTRO Board provided updates to members about why addressing workforce issues are critical to the health of the specialty. Links to past Chairs’ remarks are at the end of this post. In January 2021, the Board released a position statement that was shared with ASTRO members, and it is worth revisiting.

  • ASTRO Position Statement on the U.S. Radiation Oncology Workforce (January 2021)

    Radiation oncology has long been a critical component of multidisciplinary cancer management, driven by clinical and scientific innovation. Recent advances in technology and our understanding of cancer biology have allowed radiation oncologists to offer more accurate and effective therapies, often in fewer total treatments than before, resulting in improved patient care.

    ASTRO has observed growth in residency training positions over the past two decades. With more efficient treatment delivery, fewer radiation oncologists may be needed in the coming years. Residency training positions should be reserved for those who are enthusiastic about the field and should reflect the anticipated societal need for radiation therapy services. As we prepare the next generation of radiation oncologists for independent practice, we encourage stakeholders to carefully consider these aspects affecting our specialty as they review the size and scope of their training programs.

    Additionally, ASTRO acknowledges the continued need to grow and nurture diversity within the next generation of our workforce. We serve diverse peoples, and our trainees and faculty should reflect that diversity. We are committed to addressing all aspects of bias as we seek to ensure equity and inclusion within our specialty and to improve health outcomes for all our patients.

Recognizing that more could be done, the ASTRO Board approved the creation of a task force to analyze the current and projected future status of the radiation oncology workforce, the potential oversupply of radiation oncologists and ways to inform and attract an appropriate number of interested medical students to the field. The task force, which we co-chair, includes representatives from ASTRO’s Workforce Subcommittee, ADROP, ARRO, CHEDI and SCAROP, as well as community practices.

Our first recommendation to the Board was to authorize a Request for Proposal (RFP) for an outside, independent analysis of the future requirements for the radiation oncology workforce. We felt an external independent analysis by professionals experienced in these complex studies would minimize bias and provide the most credible data to assess the supply and demand over the coming decade. The ASTRO Board approved the RFP, and we are pleased to report that after a national search, the Workforce Task Force recommended, and the Board approved, the funding and selection of an independent firm, Health Management Associates, to execute the study.

The task force also crafted a supplement to the ASTRO Position Statement, which provides more context about issues impacting residency training programs, including the size, selection process and scope of training programs. This new position statement is:

  • ASTRO Statement on the U.S. Radiation Oncology Workforce (February 2022)

    ASTRO continues to support the critical role of high-quality residency training to optimally educate and prepare our future workforce. It is a foundational principle that residency training positions should be filled by qualified candidates who are enthusiastic about the field. To that end, we encourage stakeholders to carefully consider the following factors as they evaluate the size, selection process and scope of their training programs:

    1. The quality and extent of each candidate’s interest in radiation oncology.
    2. How the specialty, as a whole, as well as individual programs, can engage, recruit and retain diverse applicants.
    3. Availability of sufficient resources for clinical operations so that the priority for residents is education.
    4. The future expected need for radiation oncologists.
    5. Whether participation in the SOAP is warranted and in the best long-term interest of providing quality training, innovation and patient care.


The ASTRO Board is committed to maintaining distance from the analysis to ensure that there are no perceptions of any internal influence. It is the intention of the ASTRO Workforce Task Force to regularly update ASTRO members about the progress of the study while maintaining the boundaries required to ensure that the analysis and recommendations remain the independent domain of the outside firm. Until then, we hope that programs take our updated position statement into consideration as they plan their programs for the years ahead.

Read previous posts:
The Future of our Field – Dr. Thomas Eichler, January 5, 2021
A Commitment to the Field  - Dr. Theodore DeWeese, March 10, 2020
The Residency Training Landscape, Continued - Dr. Paul Harari, May 28, 2019
The Residency Training Landscape - Dr. Paul Harari, March 20, 2019

1. Robert Wood Johnson and NJ Medical School, New Jersey
2. Cleveland Clinic, Cleveland, Ohio
3. University of Maryland School of Medicine, Baltimore, Maryland

Topics:  Workforce
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