2025 ASTRO Member Survey Results

Overall satisfaction among respondents increased in 2025. Looking at U.S. and International satisfaction separately also indicates an increase in satisfaction. The greatest jump in satisfaction is noted by U.S. Early Career respondents whose satisfaction increased from 48% in 2024 to 67% in 2025. U.S. Resident satisfaction also indicates a slight increase in 2025. Both ARRO and Early Career now have ex-officio seats on the ASTRO Board of Directors, which may account for the increase in satisfaction.

Current Challenges

This year’s survey asked various U.S. populations about the issues they face. The following are the top three challenges reported by each group:

Academically Affiliated Community Radiation Oncologists

1. Financial pressure and decreasing reimbursement: Declining reimbursement, rising costs, and misaligned compensation. Difficulty funding research, upgrading equipment, or supporting staff due to budget constraints.
2. Staffing shortages and administrative burden: Insufficient clinical and research staffing, overwhelming administrative tasks such as prior authorization, documentation and insurance approvals which reduce time for patient care, research, and academic duties.
3. Access, integration and academic infrastructure gaps: Difficulty in accessing clinical trials, research support, equipment and specialty services – especially at satellite or non-main sites. Poor coordination with academic centers and lack of protected time or institutional support.

Private Practice/Community-based Radiation Oncologists

1. Administrative and financial barriers: Time management, insurance issues, bureaucracy and financial constraints that affect operations and patient care.
2. Clinical and operational challenges: Overloaded patient numbers, staff shortages, limited access to advanced technology and poor integration between specialists, all impacting treatment quality and patient outcomes.
3. Systemic and structural issues: Problems related to research infrastructure, competition between centers and the decentralization of care, as well as economic and system inefficiencies.

Rural Radiation Oncologists

1. Access to care and workforce shortages: Access to timely care due to transportation challenges, limited access to specialists and weak referral networks. Staffing shortages across roles (physicians, RTTs, nurses, engineers) hinder care delivery and increase provider burnout.
2. Financial and operational strain: Declining reimbursement, unfavorable insurance mixes, and rising equipment and staffing costs. Many centers also struggle to afford necessary capital upgrades, maintain aging technology and meet increasing administrative demands.
3. Administrative and clinical burdens: Providers are overwhelmed by prior authorization requirements, documentation demands, and supervision rules that take time away from direct patient care. Shifting treatment paradigms and decreasing indications for radiation further complicate clinical decision making and long-term planning.

Physician Scientists

1. Unstable and inadequate research funding: Declining NIH support, limited non-federal and pharma funding, increasing competition and shifting priorities.
2. Erosion of protected time and increasing clinical burden: Increased patient loads, staffing shortages, RVU expectations and administrative burdens are reducing time available for research.
3. Workforce and infrastructure: Clinician-scientists are overwhelmed trying to juggle clinical care, academic research, and institutional responsibilities, with little institutional relief, undermining long-term career sustainability.

Social Media Preferences

Social media is a frequent tool ASTRO uses to communicate important and timely information. The survey asked members which social media platform they used most for professional purposes. LinkedIn ranked first for both U.S. and International respondents.

RADIOPHARMACEUTICAL THERAPY (RPT)

ASTRO continues to provide educational opportunities on the topic of radiopharmaceutical training. Coming in 2026 are the Multidisciplinary Radiopharmaceutical Therapy Symposium, Learning Collaboratives and Authorized User Training Centers.

Fifty-six percent of U.S. Medical Director respondents reported that their practice uses unsealed sources to treat patients with cancer. Sixty-seven percent of U.S. radiation oncologist respondents reported they are an authorized user who uses radioactive materials. More specifically, 89% indicated authorized user status for sealed sources and 65% for unsealed sources.

FUTURE OF THE FIELD

U.S. and International ROs, RO residents, and medical physicists shared what they are most excited and concerned about with regard to the future of the field.