US Radiation Oncology Research Articles

MSOR09 Presentation Time: 8:40 AM: Individuals Who Graduate from a US Radiation Oncology Residency Program and Subsequently Complete a Brachytherapy Fellowship: Who Are They?

MSOR09 Presentation Time: 8:40 AM: Individuals Who Graduate from a US Radiation Oncology Residency Program and Subsequently Complete a Brachytherapy Fellowship: Who Are They?

Understanding Burnout Among US Radiation Oncology Residents

Burnout is a significant concern among medical residents in the United States, including those in radiation oncology. This study aims to understand the extent of burnout among radiation oncology residents and identify modifiable factors within program structure and benefits that may help improve overall wellness and reduce burnout. A Qualtrics-based survey was administered to US radiation oncology program directors and coordinators, utilizing contact information gathered in FREIDA, with a request to forward to all residents. The survey included questions on benefits and program structure as well as the Maslach Burnout Inventory. Data was analyzed using descriptive statistics. To date, 82 of 736 residents (11.1%) completed the survey with representation from all PGY-levels. Median participant age was 31, and 53% identified as male. 20% of surveyed residents feel emotionally drained from work a few times a week and 6% feel emotionally drained daily. 59% feel burned out from work at least a few times a month, with 6% feeling burned out daily. Despite this, 85% feel they are positively influencing other people's lives through their work at least weekly and 77% feel they have accomplished many worthwhile things in this job at least weekly. 65% have salaries between $60,000-$74,999, and 35% have the opportunity to moonlight for supplemental income. 49% have 3 weeks of vacation and 48% have 4 weeks. 27% reported their department had funded wellness events. 61% reported dual coverage rotations, with 40% requiring coverage of multiple attendings in one day. 65% reported protected academic time on all rotations, and 7% have no protected academic time. 48% of respondents have 12 months of research time. 85% and 36% of those with research and protected academic time, respectively, can complete this off-site. Respondent concerns include the job market (62%), declining personal fertility in residency (46%), and cost of living (40%). The most reported ways to decrease stress and anxiety were exercise (35%), a strong support system (34%), and spirituality (10%). Increased salary was identified as the top benefit that could improve wellness by 41 residents, while retirement matching (32), paid gym memberships (23), a personal wellness stipend (30), and free/subsidized childcare (16) were also ranked among the top 5 benefit changes that could improve wellness. Increased mid-level support (16), more protected academic time during the week (15), and flexibility with work location during academic/research time (13) were the top aspects of program structure that were reported as opportunities to improve wellness. Burnout is prevalent among US radiation oncology residents, and changes to residency programs and expanded institutional benefits are strongly perceived as the key components to improved resident wellness. This study highlights the need for further investigation into the root causes of burnout and the development of evidence-based strategies.

Academic U.S. Radiation Oncology Department Chairs: Who are They?

Historically, there has been a gender imbalance in the composition of the academic radiation oncology (RO) workforce. Given the increasing diversity of patients treated by academic radiation oncologists across the US, sufficient representation of women in academic RO, especially in leadership, is of paramount importance. In this study, we sought to better understand the characteristics of individuals currently serving as academic RO chairpersons whose departments are affiliated with ACGME-accredited RO residency training programs. We created a comprehensive database of academic RO chairpersons in the US by utilizing information from publicly available sources, including residency training program websites, hospital/institutional websites, Doximity, LinkedIn, the American Society of Radiation Oncology (ASTRO) website, the American College of Radiation Oncology (ACRO) website, and the National Plan and Provider Enumeration System National Provider Identifier Registry. We used the Mann-Whitney U test and two-proportion z tests to evaluate for statistical significance among medians and proportions, respectively. We identified 85/90 chairpersons (94.4%) whose departments are affiliated with an ACGME-accredited RO residency program. 4/85 (4.7%) chairpersons hold interim positions and were excluded from further analyses. Of the remaining 81 chairpersons in permanent positions, 10 (12.3%) are females and 71 (87.7%) are males (p < 0.01). 77 (95.1%) chairpersons are full professors and 19 (23.5%) hold dual MD-PhD degrees. 33 (40.7%) chairpersons hold an official leadership role, such as "director" or "chair," in the cancer institution affiliated with their institution; while such titles are more common among male than female chairpersons, the difference is not statistically significant (43.7% vs 20%, p = 0.15). 74/81 chairpersons secured their current positions a median of 16 years (range 6-33 years) after completing RO residency, with no statistically significant difference between male and female chairpersons (median 16 vs 18 years, respectively; p = 0.38). 36 (44.4%) chairpersons were promoted to chair from another position at their respective institutions (men 70.0% vs females 40.8%, p = 0.08). The majority of chairpersons are ASTRO Fellows (61.7%); notably fewer are ASTRO (3.7%) or ACRO (2.5%) Gold Medalists. There are no statistical differences among male and female chairpersons in the proportion who have received an ASTRO Fellow designation (60.6% vs 70.0%, p = 0.57) or ASTRO (4.2% vs 0.0%, p = 0.51) or ACRO (2.8% vs 0.0%, p = 0.59) Gold Medal. In our benchmark study of the characteristics of current academic US RO chairpersons, we found that significantly more men than women currently serve as RO chairpersons. Future interventions that promote the recruitment, retention, and promotion of talented female academic RO physicians through the academic pipeline are warranted.

Trends in American Radiation Oncology Workforce, Patient Volume and Technology Utilization

<h3>Purpose/Objective(s)</h3> Concerns have arisen within the US radiation oncology (RO) community regarding the current workforce supply-demand imbalance and the future impact of the Centers for Medicare and Medicaid Services (CMS) alternative payment model (APM) on reimbursement and practice patterns. We evaluated trends in RO providers and technology utilization before the RO-APM implementation based on CMS data. <h3>Materials/Methods</h3> We used publicly available CMS Physician and Other Provider Public Use Files from 2012 to 2019. We identified RO providers by the "provider type" field. New patient visits (NPVs) were determined by the 99203, 99204, 99205 CPT codes, treatment plans by the 77261, 77262, and 77263 CPT codes, and on-treatment visits (OTVs) by the 77427, 77431, 77432, and 77435 CPT codes. The total number of yearly fractions per RT modality was defined by relevant CPT codes. We report descriptive statistics and trends in these metrics. These numbers do not include patients enrolled on Medicare Advantage plans, the prevalence of which has increased over the study period. <h3>Results</h3> From 2012 to 2019, the number of RO providers per year in the CMS database increased from 4,135 to 4,612 (+11.5%); the number of Medicare NPVs per year by provider increased by 17% over the same time (220,569 to 257,408). Consequently, the ratio of new patients per provider per year increased slightly (+4.6%); in contrast, the number of treatment plans per provider per year declined (-5.3%). <b>Table 1</b> shows these data numerically. The number of IMRT fractions per year slightly declined (-5.1%); the total number of proton and SBRT/SRS fractions per year increased by 343% and 182%, respectively. Total 3D conformal radiotherapy fractions per year nearly halved (-41%). The number of OTVs per treatment plan declined annually, suggesting a decrease in treatment duration (4.3 to 3.8, -7.3%). In absolute terms, Medicare payments to RO providers declined marginally from 2012 ($1.50 billion USD) to 2019 ($1.43 billion USD); but, when accounting for inflation, this resulted in a 14% decline in RO reimbursement from CMS. <h3>Conclusion</h3> The stable ratio of new patient visits to RO providers suggests that, as of 2019, growth in patient volume resembles growth in ROs; however, there has been an uncoupling of increase in NPVs and treatment plans that may reflect increased omission of RT in situations where RT was previously utilized. RO reimbursement declined before the introduction of the RO-APM. Upon enacting the RO-APM, the appropriate use of technology and hypofractionated courses should be closely monitored in the setting of monetary incentives.

The Current State of Departmental Diversity, Equity, and Inclusion Efforts Within US Academic Radiation Oncology Departments

Promoting a diverse workforce of healthcare professionals that delivers equitable patient care is an important goal in oncology, as in all of medicine. While most medical schools have a diversity office and associated initiatives, little is known about radiation oncology (RO) department-level efforts to promote diversity, equity, and inclusion (DEI). We describe the current state of DEI leadership and initiatives in RO departments in the US to guide future policies and programs. A total of 124 US RO departments affiliated with a medical school were contacted to identify departmental DEI leadership. Identified DEI leaders were asked to complete an anonymous survey assessing characteristics of their departmental DEI leadership, committee/organizational structure, activities, and perceived barriers to, and impact of, their work. Descriptive statistics are reported. Among 85 RO departments that responded (68.5% response rate), 48 (56.5%) reported having a departmental DEI leader. Thirty-four DEI leaders completed the survey (70.8%). Most DEI leaders were assistant or associate professors (n=28, 82.2%), women (n=25, 73.1%), and identified with at least one non-White race or Hispanic ethnicity (n=18, 53.6%). Nineteen (55.9%) had an associated departmental DEI committee; with 10 (52.6%) starting in 2020 or later. Few DEI leaders had administrative support (38.2%), funding (29.4%), protected time (23.5%), or increased compensation for added duties (23.5%). Seventeen (51.7%) believed their DEI-focused efforts were considered for promotion. The most reported initiatives included offering programming/education, supporting students from backgrounds underrepresented in medicine, improving recruitment practices/hiring, and implementing pipeline/pathway projects. The perceived impact of DEI initiatives included an increased culture of respect (89.7%), improved healthcare disparity awareness (75.9%), and improved systematic/structural racism awareness (79.3%). Departmental DEI efforts are increasingly common within RO, however, the structure, resources, and recognition associated with DEI work are variable. Additional dedicated resources and recognition for these efforts will help ensure a culture of inclusive excellence for the RO workforce and patients.

Disparities in Radiation Therapy: Practice Patterns Analysis of Deep Inspiratory Breath Hold Use in Non-English Speakers

Our purpose was to examine current practice patterns in non-English-speaking patients with breast cancer undergoing deep inspiratory breath hold (DIBH). An anonymous, voluntary REDCap survey was distributed to 60 residency program coordinators of US radiation oncology departments to survey their faculty and recent graduates. Eligibility was limited to board-certified radiation oncologists who had treated breast cancer within the prior 6 months. There were 69 respondents, 53 of whom were eligible. Forty-two percent (n=22) of eligible respondents were from the main site at an academic center, with 28% (n=15) representing a satellite site and 30% (n=16) from private practice. Fifty-three percent reported at least 10% of their patients were non-English speaking. Ninety percent offered DIBH at their institution; of those, 74% used DIBH for at least one-fourth of their patients with breast cancer. Ninety-eight percent of those who use DIBH performed coaching at simulation, with 32% answering they would be "less likely" to use DIBH for non-English speakers. When used, 94% take into consideration potential language barriers for proper execution of DIBH. However, 51% had an interpreter present 76% to 100% of the time at computed tomography simulation, which decreased to 31% at first fraction and 11% at subsequent treatments. For non-English-speaking patients undergoing DIBH coaching without a certified interpreter, 55% of respondents indicated that they provided verbal coaching in English, 32% indicated "not applicable" because they always use a certified interpreter, 11% used visual aids, and 32% indicated "other." Of those who answered "other," the most commonly cited response was using therapists or staff who spoke the patient's native language. Disparities in the application of DIBH exist despite its established utility in reducing cardiac dose. This study provides evidence that language barriers may affect physician treatment practices from initial consideration of DIBH to subsequent delivery. These data suggest that breast cancer treatment considerations and subsequent execution are negatively affected in non-English-speaking patients.

Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation and Medical Oncology Faculty Over 5 Decades

It remains unclear how the historical exclusion of women and racial and ethnic minority groups from medical training, and therefore the oncologic subspecialties, has contributed to rates of faculty diversity among oncology departments over time. Oncologic faculty diversity is an important initiative to help improve care and address health disparities for an increasingly diverse US population with cancer. To report trends in academic faculty representation by sex and by race and ethnicity for radiation oncology (RO) and medical oncology (MO) departments and to describe comparisons with the general US population, medical students, RO and MO trainees, clinical department chairs, and faculty in other departments. This cross-sectional analysis used data from the Association of American Medical Colleges to analyze trends by sex and by race and ethnicity among full-time US faculty in RO and MO departments from 1970 through 2019. Data were analyzed between October 2020 and April 2021. Proportions of women and individuals from underrepresented in medicine (URM) racial and ethnic groups (Black, Hispanic, and Indigenous individuals) were calculated among RO and MO academic departments; trends were analyzed over 5 decades. These proportions were compared with cohorts already described. In addition, proportions of women and URM individuals were calculated by faculty rank among RO and MO departments. In 1970, there were 119 total faculty in RO (10 women [8.4%] and 2 URM [1.7%]) and 87 total faculty in MO (11 women [12.6%] and 7 URM [8.0%]). In 2019, there were 2115 total faculty in RO (615 women [29.1%] and 108 URM [5.1%]) and 819 total faculty in MO (312 women [38.1%] and 47 URM [5.7%]). Total faculty numbers increased over time in both RO and MO. Faculty representation of URM women proportionally increased by 0.1% per decade in both RO (95% CI, 0.005%-0.110%; P <. 001 for trend) and MO (95% CI, -0.03% to 0.16%; P = .06 for trend) compared with non-URM women faculty, which increased by 0.4% (95% CI, 0.25%-0.80%) per decade in RO and 0.7% (95% CI, 0.47%-0.87%) per decade in MO (P < .001 for trend for both). Faculty representation of URM men did not significantly change for RO (0.03% per decade [95% CI, -0.008% to 0.065%]; P = .09 for trend) or MO (0.003% per decade [95% CI, -0.13% to 0.14%]; P = .94 for trend). Representation of both women and URM individuals among both specialties was lower than their representation in the US population in both 2009 and 2019. Across all cohorts studied, RO faculty had the lowest URM representation in 2019 at 5.1%. At every rank in 2019, the number of total URM faculty represented among both MO and RO remained low (MO: instructor, 2 of 44 [5%]; assistant professor, 18 of 274 [7%]; associate professor, 13 of 177 [7%]; full professor, 13 of 276 [5%]; and RO: instructor, 9 of 147 [6%]; assistant professor, 57 of 927 [6%]; associate professor, 20 of 510 [4%]; full professor, 18 of 452 [4%]). This cross-sectional study suggests that RO and MO academic faculty have increased the representation of women over time, while URM representation has lagged. The URM trends over time need further investigation to inform strategies to improve URM representation in RO and MO.

Integrating a Grassroots Well-Being Curriculum into a Radiation Oncology Residency Program

PurposeThe burnout rate among US radiation oncology residents was 33% in 2016. To our knowledge there are no published interventions addressing burnout among radiation oncology residents. We describe the implementation of a well-being curriculum, cocreated by a psychologist, a medical humanities professional, and radiation oncology attending and resident physicians. Methods and MaterialsRadiation oncology residents at our institution were surveyed to determine themes that induced burnout. A curriculum was developed, with monthly small group sessions focused on 1 identified topic. Sessions alternated between psychological tool-focused approaches and humanities exercises. These were led by a psychologist or medical humanities professional. Residents were given protected time to attend sessions during business hours. Participation was optional. Participants were assigned a random identifier, and the Stanford Professional Fulfillment Index (PFI) was assessed at baseline and 3-month intervals. PFI trends were analyzed after 1 year. At the end of the year, a focus group was held to evaluate work satisfaction and self-reported interactions with patients and coworkers. This information was used to improve the curriculum. ResultsAll 12 residents in the radiation oncology program participated in the curriculum. There was an equal number of residents of postgraduate years 2 through 5. Six of the participants were female. Of the participants, 11 completed the PFI. At baseline, 80% of residents met criteria for burnout. This decreased to 67%, 50%, and 33% at 3, 6, and 9 months, respectively. The proportion of residents meeting criteria for very good professional fulfillment was 30%, 56%, 38%, and 22% at baseline and 3, 6, and 9 months, respectively. On average, 9 of 12 residents attended each session. ConclusionsOur experience demonstrates the feasibility of collaborating with residents in the development of a well-being curriculum to cater programming to their needs, which we believe led to excellent engagement and attendance at each session.

The Rise of Open Access Journals in Radiation Oncology: Are We Paying for Impact?

<h3>Purpose/Objective(s)</h3> We aimed to examine how the rise of open access (OA) journals in biomedicine has impacted resident research in radiation oncology. <h3>Materials/Methods</h3> We built a comprehensive database of first-author, PubMed-searchable articles published by US radiation oncology residents who graduated between 2015 and 2019. We then classified each journal in which these manuscripts appeared as either OA or non-OA, and obtained the current article processing charge (APC) for every publication that appeared in an OA journal. Lastly, we performed a secondary analysis to identify the factors associated with publishing an article in an OA journal. <h3>Results</h3> The US radiation oncology residents in this study published 2,637 first-author, PubMed-searchable manuscripts, 555 (21.0%) of which appeared in 138 OA journals. The number of publications in OA journals increased from 0.47 per resident for the class of 2015 to 0.79 per resident for the class of 2019. Likewise, the number of publications in OA journals with a 2019 impact factor of zero increased from 0.14 per resident for the class of 2015 to 0.43 per resident for the class of 2019. Publications in OA journals garnered fewer citations than those in non-OA journals (8.9 versus 14.9, <i>P</i> < 0.01). 90.6% of OA journals levy an APC for original research reports (median $1,896), which is positively correlated with their 2019 impact factor (r = 0.63, <i>P</i> < 0.01). Aggregate APCs totaled $900,319.21 for all US radiation oncology residency programs and appeared to increase over the study period. <h3>Conclusion</h3> The number of first-author, PubMed-searchable manuscripts published by graduating US radiation oncology residents in OA journals rose significantly over the study period. US radiation oncology residency programs appear to be investing increasing and significant sums of money to publish the work of their residents in these journals. A more substantive discussion about the proper role of OA journals in resident research is needed.

Academic Workforce Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation Oncology & Medical Oncology Faculty Over Five Decades

<h3>Purpose/Objective(s)</h3> A healthcare workforce that better reflects the demographics of those it serves can lead to improved patient trust, compliance and outcomes. It is unclear if the growing imperative to address disparities in racial/ethnic and gender representation in the medical field has resulted in corresponding progress in the composition of academic radiation and medical oncology (RO, MO) departments. Herein we report trends in RO and MO faculty diversity, overall and by academic rank, over the past 5 decades. <h3>Materials/Methods</h3> Data were acquired from the Association of American Medical Colleges (AAMC) Faculty Roster between 1970 and 2019 for academic RO and MO departments to determine sex and race/ethnicity trends over five decades. Underrepresented in Medicine (URM) was defined as individuals identifying as Black, Hispanic, and Native American. Linear regression models were used to estimate slopes and associated <i>P</i>-values. <h3>Results</h3> Total faculty complements grew over time in both RO and MO. The number of URM female faculty increased by 0.85/year in RO and 0.79/year in MO (P-trend < 0.001), compared to non-URM female faculty, which increased by 11.3/year in RO and 7.9 in MO (P-trend < 0.001). URM male faculty increased by 1.4/year in RO and 1.1/year in MO (P-trend < 0.001), compared to non-URM male faculty, which increased by 25.5/year for RO and 12.2/year for MO (P-trend < 0.001). Males represented the majority of URM and non-URM faculty for both RO and MO. The proportion of females grew more than that of URM faculty over the study period for both RO and MO. There were also significant differences in diversity by faculty rank. Female faculty members had a lower academic rank than their male counterparts in both specialties. At every rank, the number of URM faculty represented among both MO and RO was low (Table). <h3>Conclusion</h3> Gender and racial/ethnic diversity of academic RO and MO faculty has increased over time but has not kept pace with that of the US population, particularly with respect to URM status. The proportion of female faculty in both specialties demonstrates more promising growth, and may inform measures to achieve similar progress in recruiting and retaining URM faculty in MO and RO. Rank among RO and MO faculty through the decades.

Are They Ready? The Current Status of Canadian and US Radiation Oncology and Radiation Therapy Training Programs in Preparing Trainees for On-Call Emergencies and Interdisciplinary Teamwork

The aim of this study is to evaluate the current practices regarding radiation oncology emergencies training for radiation oncology residents and radiation therapy students and the presence of interdisciplinary curricula across Canadian and US training programs prior to putting trainees on-call. We also aim to evaluate the most significant needs in radiation oncology residency programs and radiation therapy training programs in regard to radiation oncology emergencies training in order to guide curriculum development.

Residents-as-Teachers Curriculum for Radiation Oncology: A Targeted Needs Assessment

Achieving competency as educators is increasingly recognized as a critical part of residents' training in graduate medical education across specialties. In addition to teaching medical students, radiation oncology residents often play a vital role in peer and interprofessional education. We conducted a survey to identify the needs of radiation oncology residents for developing skills in teaching. An anonymous, web-based survey was developed and distributed to resident physicians at US radiation oncology programs. Analyses describe respondent demographics, experiences with teaching, and interest in various aspects of a formal "residents-as-teachers" curriculum. There were 171 completed survey responses (27.5% response rate). A total of 146 residents (85.4%) reported receiving no formal training in teaching before residency, and 121 (70.8%) reported no formal training during residency. Residents who had formal training in teaching were significantly more likely to be "quite" or "extremely" confident about teaching compared with residents who had no prior formal training (76.0% vs 51.4%; P=.022). Residents most commonly taught other residents and medical students (163 [95.3%] and 160 [93.6%] respondents, respectively). The most common settings for teaching were one-on-one teaching (164 respondents [95.9%]), small-group lectures (135 respondents [78.9%]), and intradepartmental lectures (136 respondents [79.5%]). In response to open-ended questions regarding desired teaching opportunities and domains for teaching development, many residents expressed a lack of confidence in teaching and were interested in improvement across many aspects of teaching. Radiation oncology residents are expected and desire to teach in a multitude of settings across a wide variety of audiences. However, a significant proportion of radiation oncology residents lack formal training and rarely receive feedback for their teaching skills. The results of this national survey support the development of a residents-as-teachers curriculum for radiation oncology residents that would address the needs for and significant interest in this area.

United States Radiation Oncology Fellowship Growth From 2010 to 2020

To provide a comprehensiveanalysis of radiation oncology (RO) fellowship growth from 2010 to 2020. A collated database of RO fellowship programs and matriculants was created using (1) RO residency program (n=92) and graduate (n=2082) web searches, (2) prospective American Society for Radiation Oncology (ASTRO) Career Center postings database, (3) Association of Residents in Radiation Oncology Fellowship Directory, (4) RO fellowship survey data, (5) ASTRO Membership Directory, and (6) direct e-mail contact with fellowship program directors. Linear regression was used to assess the statistical significance of RO fellowship program, position, and matriculant growth over time. From 2010 to 2020, the number of RO fellowship programs and annual positions significantly increased from 20 to 37 (1.60 increase per year; 95% confidence interval, 1.32-1.89; P < .001) and 20 to 39 (1.81 increase per year; 95% confidence interval, 1.52-2.10; P < .001), respectively. The most commonly offered fellowship disciplines were proton therapy (n=10), brachytherapy (n=7), stereotactic radiosurgery/stereotactic body radiation therapy (n=6), general RO (n=5), and customizable to trainees' interests (n=3). Only 10 (27%) fellowships had a formal curriculum. All fellowships were unaccredited. Four (10.8%) programs were offered at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency training program, all established within the past 2 years. In addition, 54.8% (171 of 312) of available fellowship positions were filled between 2010 to 2020. Of these, 94 (55.0%) were graduates of US RO residency programs. The mean number of total fellows and US-residency trained fellows per year was 15 (range, 5-23) and 8 (range, 2-20), respectively. There was no significant increase in the number of annual matriculated fellows over time (P=.077). Among US-residency trained fellows, 27 (28.7%), 37 (39.4%), and 29 (30.9%) were from small (≤6), medium (7-12), and large (>12) residency programs, respectively. Twenty-eight (29.8%), 13 (13.8%), 25 (26.6%), and 27 (28.7%) trained in the Northeast, Midwest, South, and West, respectively. There has been significant growth in unaccredited RO fellowship programs and annual positions during the past decade, although the number of matriculants has remained stable. We report for the first time the recent establishment of fellowships at institutions without an Accreditation Council for Graduate Medical Education-accredited RO residency program. The impact of fellowship programs on the training of RO residents should be studied.

Quantitative Analysis of Practice Size Consolidation in Radiation Oncology: A Trend Toward Bigger and Fewer Practices

PurposeThere is evidence of practice consolidation in US health care in recent years. To our knowledge, a detailed quantitative study of recent changes in radiation oncology practice size has not been performed. We aim to evaluate radiation oncology practice size changes between 2012 and 2020 in the United States. Materials and MethodsUsing the Medicare Physician Compare Database, we identified practices employing radiation oncologists using their taxpayer identification number and individual radiation oncologists using their national provider identifier. We grouped individual radiation oncologists into categories by practice size (which includes the number of physicians of all specialties) and compared the number of radiation oncologists in each category between 2012 and 2020. Further analyses by US geographic census region, single-specialty practice, academic practice, and high- and low-population density areas were performed. ResultsBetween 2012 and 2020, the total number of practicing radiation oncologists increased by 9%, and the number of practices employing radiation oncologists decreased by 11.5%. The number of radiation oncologists in practices of size 1 to 2, 3 to 9, 10 to 24, and 25 to 49 decreased by 3.7%, 4.7%, 4.9%, and 2%, respectively, and the number of radiation oncologists in practices of size 50 to 99, 100 to 499, and 500+ increased by 1.4%, 2.1%, and 11.8%, respectively (all 500+ practices are multispecialty groups). The increase in practice size was significant in all regions, for single-specialty and multispecialty practices, academic and nonacademic practices, and for practices in high-, middle-, and low-population density areas (P < .05 for all comparisons). The proportion of single-specialty practices has decreased significantly (P < .001), and the proportion of academic practices increased significantly (P = .004). Additionally, the proportion of practices and physicians in high- and low-population density regions remained stable during this period (P > .05). ConclusionsOur analysis suggests that practice size consolidation has occurred within the US radiation oncology workforce from 2012 to 2020. The impact of this consolidation on quality, cost, and patient access deserves further attention.

The Impact of COVID-19 on US Radiation Oncology Residents.

The purpose of our study is to assess the impact of COVID-19 on the clinical responsibilities, training, and wellness of US radiation oncology residents. An anonymous cross-sectional survey was sent to all 91 radiation oncology residency programs in the USA. The survey included questions related to demographics, changes in clinical duties and training, job prospects, and wellness indicators. Univariate and multivariate logistic regression analyses were used to evaluate factors associated with residents endorsing high satisfaction with their departments’ response to COVID-19. A total of 96 residents completed the survey from 67 US radiation oncology programs. In the multivariate logistic regression model, remote contouring (OR: 3.91 (95% CI: 1.11, 13.80), p = 0.03) and belief that one will be adequately trained to independently practice after completing residency (OR: 4.68 (1.12, 19.47), p = 0.03) were significantly associated with high resident satisfaction with their department’s response to COVID-19. Most residents indicated that hypofractionation was encouraged to a greater extent (n = 79, 82.3%), patients were triaged by disease risk (n = 67, 69.8%), and most agreed/strongly agreed that they have been provided with adequate personal protective equipment (PPE) (n = 85, 88.5%). The COVID-19 pandemic has affected the training and wellness of radiation oncology residents. Our analysis suggests that radiation oncology programs might increase resident satisfaction with their department’s response to COVID-19 by enabling remote contouring and working with residents to identity and remedy possible concerns regarding their ability to independently practice post residency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13187-021-01993-5.

Chicken Little or Goose-is-Cooked? The State of the US Radiation Oncology Workforce: Workforce Concerns in US Radiation Oncology

Chicken Little or Goose-is-Cooked? The State of the US Radiation Oncology Workforce: Workforce Concerns in US Radiation Oncology

When in a Hole, Stop Digging

When in a Hole, Stop Digging

Frameworks for Radiation Oncology Global Health Initiatives in US Residency Programs.

PURPOSETo understand trends, pathways, and experiences and to establish a framework for radiation oncology (RO) programs interested in developing global health (GH) initiatives.METHODSAn in-depth interview was conducted of all US RO programs with established GH initiatives. Programs were identified by reviewing results of the 2018 Association of Residents in Radiation Oncology Global Health Resident Survey and individualized outreach to screen for additional programs meeting the following criteria: (1) active resident involvement in RO-specific GH opportunities, (2) active faculty involvement in these initiatives, and (3) department chair or program director awareness and support for ongoing opportunities. Among 88 residency programs, 11 were identified. Standardized questions explored the type of initiative, planning, staff and resident involvement, challenges, components to success, and history of programs through December 2018.RESULTSBetween 2010 and 2018, 11 programs started initiatives. Total resident participants ranged from one to 13 (median = 3) in each program's history. Initiatives spanned education (n = 9 [82%]), clinical mentorship (73%), innovative technology (55%), bilateral hosting programs (45%), clinical development and equipment (45%), promotion of local research (36%), clinical care (36%), industry partnerships (27%), and remote tumor board (18%). Faculty involvement included radiation oncologists (91%), medical physicists (55%), and non-RO department faculty (27%). Six programs (55%) had faculty with prior GH experience. Four (36%) programs reported medical student involvement in projects. Barriers included international communication (36%), time for faculty (18%), funding (9%), and legal (9%) concerns. Commonest components of success included fostering relationships with international sites and identifying needs before solutions.CONCLUSIONRO GH initiatives were reported as positive, educational, and feasible across 11 US residency programs. Growth is expected, representing opportunities for innovation and service among US programs.

Radiation Oncology Resident Research Productivity in the United States: 2015 to 2019

Multiple efforts have been made in recent years to establish national benchmarks for research productivity among US radiation oncology residents. Morgan etal found a mean of 1.01 first-author, PubMed-searchable articles published by US radiation oncology residents over 4 years of residency between 2002 and 2007, whereas Verma etal found a mean of 1.97 first-author, PubMed-searchable articles published by members of the graduating US radiation oncology residency classes of 2014 and 2015. In this study, we sought to establish new national benchmarks for US radiation oncology resident research productivity and characterize the scholarly work produced by graduating US radiation oncology residents. We built a database of US radiation oncology residents who graduated between 2015 and 2019 using multiple sources of publicly available data. We subsequently searched the PubMed database to identify all first-author publications for every resident in our database from the start of residency until 3 months after the completion of residency. Publications were categorized by type (original research, review, case report, or commentary) and content. We performed a secondary analysis to identify factors associated with an increased probability of publishing during residency. We identified 909 US radiation oncology residency graduates from 89 residency programs between 2015 and 2019. Collectively, these graduates published 2637 first-author, PubMed-searchable articles (mean: 2.90; median: 2.0; range, 0-58; interquartile range, 1-4) in 392 distinct peer-reviewed journals during their residency, and 69.7% of the first-author publications comprised original research. On multivariable analysis, only residency size was predictive of publishing a first-author manuscript during residency. Among residents with at least 1 first-author manuscript, male sex, lack of a doctorate degree, and residency size were all significant predictors of the number of first-author manuscripts published during residency. US radiation oncology resident research productivity, as measured by the number of first-author, PubMed-searchable publications, has increased compared with historical data. However, substantial variability exists in resident research productivity nationwide.

High Yield Physics Video Series (Hi-Phy) Pilot for Radiation Oncology Trainees

Mastering the concepts of medical physics necessary for Radiation Oncology (RO) is challenging, especially for medical residents with a variety of backgrounds. Aside from didactic physics courses, preparation for the American Board of Radiology (ABR) radiation physics written exam for radiation oncology medical residents involves a comparatively narrow range of preparation materials or costly review courses. After the substantial failure rate of the 2018 exam, the heterogeneous quality of physics didactics and the adequacy of preparatory methods have been criticized. With the ABR’s commitment to the American Society for Radiation Oncology’s Physics Core Curriculum as the framework for the exam, preparation materials for this exam can be meaningfully expanded. The High Yield Physics Educational (Hi-Phy) initiative postulates that it is possible to develop and disseminate a series of free, high-value, case-based, and engaging videos specifically for RO trainees. The purpose of this study is to develop and test an educational e-learning series to bolster engagement in medical physics training and retention of knowledge. We hypothesize that the Hi-Phy videos will be used by a third of US radiation oncology trainees, whether as a preparatory “bridge” lesson for institutional didactics or a review during board exam preparation. A multi-institutional and multidisciplinary team of 7 medical physicists, a RO resident, a radiation oncologist, pedagogical experts at a center for teaching and learning, and graphic design experts from a broadcasting department has formed. Four videos are planned in the Hi-Phy pilot with expansion to 10-15 videos. The videos will be case-based, with strong graphic design elements, as well as the use of retrieval practice for maximum engagement and concept retention of learners. The hosting website’s data will track views and posted comments. In collaboration with pedagogical experts, validated survey tools will be used to assess indicators of user-acceptance of the e-learning. Likert scale responses on the tool regarding: comprehensibility, format, perceived ease of use, usefulness, and duration will be sought from users. The data collected will be analyzed to assess the depth and scope of material covered. We will solicit self-reported physics board pass rates from initial users longitudinally as they complete their ABR exam. The Hi-Phy initiative is feasible and the pilot will require minimum grant support for the purpose of video production. Hi-Phy is a unique, low cost-to-user initiative that is expected to fill a need of current trainees to learning medical physics at the level required for ABR physics board exams. By presenting physics material in a case-based and interactive format and stimulating ongoing retrieval practice, engagement with high rates of concept retention will be fostered. Using pilot project feedback, Hi-Phy will adapt topic depth, format, and video production.