KEY POINTS
- The ESTRO Early Career Committee distributed an international mixed-methods workforce survey through ESTRO channels. 966 professionals from 53 countries responded; after excluding blank and demographic-only submissions, 788 respondents entered the descriptive analysis and 717 (91%) provided at least one open-text response for qualitative analysis.
- The analyzed multidisciplinary cohort included 359 radiation therapists, 187 medical physicists and 166 radiation oncologists, allowing the same organizational pressures to be compared across professions rather than studying each workforce in isolation.
- Framework analysis identified six recurring retention themes: workplace culture, leadership, career development, resource strain, recognition and value, and wellbeing/burnout. Culture and leadership repeatedly appeared as central factors connecting the other themes.
- Radiation therapists described the greatest burden from operational pressure, staffing shortages, negative workplace culture and burnout. Responses commonly described inadequate communication, blame-oriented environments and limited managerial support, with participants linking these conditions to both staff wellbeing and patient care.
- Medical physicists emphasized a somewhat different problem: limited recognition, low professional visibility and restricted career progression. Across groups, insufficient protected development time and unclear promotion or specialization pathways made retention more difficult even when day-to-day workload was manageable.
- Radiation oncologists more often described structural inefficiency, clinical workload, hierarchy, departmental politics and limited academic-development time than direct interpersonal conflict. Positive local culture, supportive leadership, mentorship and meaningful career-development opportunities were repeatedly described as protective factors.
- Interpretation needs caution. Participation was voluntary and distributed through ESTRO networks, later open-ended questions had far fewer responses—only 55 for incentives to remain and 49 for intentions to leave—and qualitative themes describe lived experience rather than measuring how much each factor causally increases attrition.
CLINICAL TAKEAWAY
The workforce problem is not simply “too much work.” The study suggests that how departments are led, whether staff feel valued and whether careers have somewhere to progress may determine retention as much as workload itself—and the pressure points differ meaningfully between RTTs, physicists and physicians.