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ASTRO survey maps different workforce pressures across US radiation oncology practice

Administrative burden and staffing concerns were widespread, while reimbursement dominated private-practice concerns and unstable research funding dominated physician-scientist concerns.

RadOncToday · ·2 min read

KEY POINTS

  • The analysis used the 2025 ASTRO Annual Member Survey, distributed to 8,366 members. 875 responded, giving a response rate of only 10.4%, and 433 respondents answered at least some of the workforce-specific questions. The studied populations—including private practitioners, academically affiliated community providers, physician-scientists and rural radiation oncologists—were explicitly non-mutually exclusive.
  • Academically affiliated community radiation oncologists reported a median 80% clinical effort despite maintaining academic responsibilities. Their leading concerns were insufficient time or funding for academic work in 41%, administrative burden in 37%, declining reimbursement or increasing expenses in 27%, and staffing difficulties in 21%.
  • Private-practice physicians also reported roughly 80% clinical effort, with the remaining 20% devoted to administrative or other nonclinical work. Their dominant concern was administrative and regulatory burden in 56%, followed by declining relative reimbursement in 47%, staffing recruitment or retention in 21%, and maintaining or replacing equipment in 14%.
  • Physician-scientists reported a very different pressure profile. Across the subgroup, 85% identified instability in research funding as a major concern, 48% cited erosion of protected research time, and 12% cited difficulties recruiting research staff or trainees.
  • Clinical workload varied substantially within the physician-scientist population. Median clinical effort was only 20% for basic/basic-translational investigators, compared with 60% for translational investigators and 80% for non-basic/non-translational physician-scientists, illustrating how differently the “physician-scientist” label can translate into day-to-day work.
  • Rural radiation oncologists described an overlapping but distinct set of problems: delayed access to specialist care, transportation and referral barriers, staffing shortages, unfavorable payer mix, declining reimbursement and difficulty financing major equipment upgrades. 69% of rural respondents worked in community hospitals, emphasizing the operational importance of these centers for geographically underserved populations.
  • The study should not be interpreted as a prevalence survey of the entire US radiation oncology workforce. The 10.4% overall response rate, overlapping professional categories, qualitative survey design and inability to conduct follow-up questioning all create substantial potential for response and selection bias. The manuscript also reports varying subgroup denominators across sections, reinforcing the need for caution with absolute subgroup counts.

CLINICAL TAKEAWAY

There is no single US radiation oncology “workforce problem.” Clinically focused practices are being squeezed by administrative workload, staffing costs and reimbursement, while physician-scientists report a fundamentally different threat: loss of funding and protected research time. The survey is useful for identifying pressure points, but its low response rate means it should be treated as a snapshot rather than a definitive measurement of the specialty.

SOURCE

International Journal of Radiation Oncology, Biology, Physics