3086 - Geographic Distribution of Radiation Oncology Workforce in Underserved Regions: A Cross-Specialty Analysis

Purpose/Objective(s): Radiation oncology requires both specialized physicians and costly equipment, limiting its availability in Medically Underserved Areas (MUAs). Despite the need for cancer care in these regions, radiation oncology specialists are scarce. This study analyzes the distribution of radiation oncology graduates practicing in MUAs compared to other oncologic specialties.

Materials/Methods: We used De-identified information regarding residency graduation year, specialty, and location of employment was analyzed. Radiation Oncology residents were compared to other oncologic specialties including Gynecologic Oncology, Hematology and Oncology, Oncology, Complex General Surgical Oncology, Pediatric Hematology/Oncology, Musculoskeletal Oncology, and Micrographic Surgery and Dermatologic Oncology. We analyzed the AAMC report 'Number of Individuals Who Completed Residency and Are Practicing in Federally Designated Medically Underserved Areas, by Last Completed GME Specialty,' comparing graduate cohorts from 2008-2019 and 2014-2023. We defined MUAs using AAMC criteria: primary care physician-to-population ratio, infant mortality rate, percentage of population below poverty level, and proportion of individuals aged 65 and older. We used a chi-square analysis to identify significance. To account for the overlapping time interval in our data, we used a linear interpolation method assuming changes in MUA representation were linear over time to compare only 2008-2013 and 2020-2023.

Results: A total of 6,424 graduates were analyzed in the 2008-2019 dataset of which 1,579 (24.6%) serve in MUAs. In the 2014-2023 dataset, 6,885 graduates were included with 1,767 (25.6%) serving in MUAs. From the 2008-2019 cohort, 1,267 Radiation Oncology graduates had data available to be analyzed versus 1,297 in the 2014-2023 cohort. The rate of Radiation Oncology graduates serving in MUAs slightly increased from 23.3% up to 23.9%. All other oncologic specialties serving in MUAs increased at a faster pace from 24.9% up to 26.1%. The proportion of radiation oncology graduates in MUAs was significantly lower compared to all other combined oncologic specialties in both the 2008-2019 dataset (p=0.038) and 2014-2023 dataset (p=0.042). When comparing only 2008-2013 and 2020-2023, percentage of radiation oncology graduates serving in MUAs increased 23.1% to 24.1% (+1%) while other oncologic specialties increased 23.75% to 25.73% (+1.98%).

Conclusion: Radiation Oncology graduates serving in MUAs increased over the examined time periods but at a significantly slower rate than the combined other oncologic specialties. More work is needed to better understand how to increase Radiation Oncology graduates in MUAs.