I totally forgot about this paper in the madness of 2021. They do an EXCELLENT job summarizing the history of how we got here:
A number of significant events made the field of radiation oncology ripe for expansion in the 1970s to 1980s: increased medical school enrollment in the 1970s, the invention of Computed Tomography in 1972, the development of 3-dimensional conformal radiation in the 1980s, and a shortage of radiation oncologists over this period resulting in NCI training grant subsidies. After these events, the number of radiation oncology residents in training programs doubled from 248 in 1972 to 541 in 1994, and the number of practicing radiation oncologists increased accordingly. In the early to mid-1990s, concerns of a surplus of practicing radiation oncologists and high levels of job market dissatisfaction and unemployment rates in recent graduates led to a decline in radiation oncology applicant numbers between 1993 and 1998. Declining applicant numbers resulted in 30% to 42% unfilled residency positions in 1997 and 1998, which coincided with voluntary contraction of residency program positions from 139 positions per year in 1993 to 94 positions per year in 1998, progress toward improved quality of residency training, and an increased required duration of residency program training from 3 years to 4 years in 1998. Subsequent surveys from graduates and program directors inspired more confidence in the job market. IMRT was developed in the 1990s and widely adopted in the early 2000s, which led to increased reimbursements and presumably an overall improved job market outlook. The total number of applicants rapidly expanded from 96 in 1998 to 214 in 2001, leading to 2 applicants for every residency position between 2000 and 2003. Starting in 2002, the number of radiation oncology residency positions began to expand.
An aging US population sparked predictions that the demand for radiation therapy in between 2010 and 2020 would grow 10 times faster than the supply of radiation therapy. To balance the forecasted shortage of radiation oncologists, one study projected that residency training classes would have to double in size. Indeed, between 2001 and 2019, residency positions gradually doubled from 93 per year to 207 per year. Increasing residency positions and graduates during this period forebode a potential oversupply of practicing physicians, which might adversely affect the radiation oncology workforce. Updated projections for 2015 to 2025 suggested that, contrary to previous projections, the supply of radiation therapy is growing faster than the demand for radiation therapy. Currently, there are increasing concerns from multiple stakeholders about the number of residents being trained and a resulting oversupply in practicing physicians.
The number of radiation oncology residency positions has fluctuated widely during the past 3 decades but has not stabilized at its equilibrium value. The equilibrium value of radiation oncologists entering practice (including domestic resident graduates and those entering the workforce after graduating from an international residency) has previously been estimated at approximately 130 per year. Different studies have cited concern that direct collaborative manipulation of radiation oncologist supply would violate antitrust laws. Instead, a market-based correction in the supply of physicians involves medical students learning of workforce difficulties in radiation oncology and electing to apply to fields with more favorable job markets. The results of the present study suggest that this effect may already be taking place. There are several limitations to a market-based approach. The duration of residency training causes a delay between changes in training rates and the effect on the job market. Unfilled positions can be filled by SOAP, resulting in the same number of total trainees even after fewer medical students apply. In fact, the majority of unfilled positions in 2019 and 2020 were filled by SOAP; this permitted the entry of record high numbers of residents into the field and ultimately prevented a market-based contraction. Unfilled positions in an application cycle can signal a decrease in competitiveness in the field of radiation oncology, which may encourage increased applications from less qualified medical students in subsequent application cycles. The proportion of US allopathic senior applicants has decreased from 87% in 2018 to 70% in 2020. Other previously proposed solutions include transparent reporting of employment statistics, independent residency program self-contraction, more stringent Accreditation Council for Graduate Medical Education accreditation standards, restrictions in government funding to residency programs, congressional action, and balancing the geographic distribution of practitioners.
I totally forgot about this paper in the madness of 2021. They do an EXCELLENT job summarizing the history of how we got here:
A number of significant events made the field of radiation oncology ripe for expansion in the 1970s to 1980s:
increased medical school enrollment in the 1970s, the invention of Computed Tomography in 1972, the development of 3-dimensional conformal radiation in the 1980s ,
UNC, Joel Tepper, George Sherouse ("PLUNC"), and MGH at forefront
and a shortage of radiation oncologists over this period resulting in NCI training grant subsidies.
Andrew Turrisi one of many ROs that benefited from this in that era, I believe Eli Glatstein obtained his NCI grant
After these events, the number of radiation oncology residents in training programs doubled from
248 in 1972 to 541 in 1994, and the number of practicing radiation oncologists increased accordingly. In the early to mid-1990s, concerns of a surplus of practicing radiation oncologists and high levels of job market dissatisfaction and unemployment rates in recent graduates
Mayo Jacksonville had a "fellowship" (like the Island of Lost Toys in Rudolph) where new grads w/o jobs would go up until ~2003
led to a decline in radiation oncology applicant numbers between 1993 and 1998. Declining applicant numbers resulted in 30% to 42% unfilled residency positions in 1997 and 1998, which coincided with
voluntary contraction of residency program positions from 139 positions per year in 1993 to 94 positions per year in 1998,
Vanderbilt abandoned its rad onc program in 1997, restarted around 2002
progress toward improved quality of residency training, and an increased required duration of residency program training from 3 years to 4 years in 1998. Subsequent surveys from graduates and program directors inspired more confidence in the job market.
IMRT was developed in the 1990s and widely adopted in the early 2000s, which led to increased reimbursements and presumably an overall improved job market outlook.
Especially in academics!
The total number of applicants rapidly expanded from 96 in 1998 to 214 in 2001, leading to 2 applicants for every residency position between 2000 and 2003. Starting
in 2002, the number of radiation oncology residency positions began to expand.
Academic positions actually expanded (immediately) before resident positions expanded
An aging US population sparked predictions that the demand for radiation therapy in between 2010 and 2020 would grow 10 times faster than the supply of radiation therapy. To
balance the forecasted shortage of radiation oncologists,
one study projected that residency training classes would have to double in size. Indeed, between 2001 and 2019,
residency positions gradually doubled from 93 per year to 207 per year. Increasing residency positions and graduates during this period forebode a potential oversupply of practicing physicians, which might adversely affect the radiation oncology workforce.
Updated projections for 2015 to 2025 suggested that, contrary to previous projections, the supply of radiation therapy is growing faster than the demand for radiation therapy. Currently, there are increasing concerns from multiple stakeholders about the number of residents being trained and a resulting oversupply in practicing physicians.
Cancer incidence leveled off and RT utilization, as a percent of frontline cancer therapy for newly dx pts at least, began declining
The number of radiation oncology residency positions has fluctuated widely during the past 3 decades but has not stabilized at its equilibrium value. The equilibrium value of radiation oncologists entering practice (including domestic resident graduates and those entering the workforce after graduating from an international residency) has previously been
estimated at approximately 130 per year.
95% C.I. 70-130 imho
Different studies have cited concern that direct collaborative manipulation of radiation oncologist supply would violate antitrust laws. Instead, a market-based correction in the supply of physicians involves medical students learning of workforce difficulties in radiation oncology
~2 firm job offers per new grad per ARRO data
and electing to apply to fields with more favorable job markets. The results of the present study suggest that this effect may already be taking place. There are several limitations to a market-based approach. The duration of residency training causes a delay between changes in training rates and the effect on the job market. Unfilled positions can be filled by SOAP, resulting in the same number of total trainees even after fewer medical students apply. In fact,
the majority of unfilled positions in 2019 and 2020 were filled by SOAP; this permitted the entry of record high numbers of residents into the field and ultimately prevented a market-based contraction. Unfilled positions in an application cycle can signal a decrease in competitiveness in the field of radiation oncology, which may encourage increased applications from less qualified medical students in subsequent application cycles. The proportion of US allopathic senior applicants has decreased from 87% in 2018 to 70% in 2020. Other previously proposed solutions include transparent reporting of employment statistics, independent residency program self-contraction, more stringent Accreditation Council for Graduate Medical Education accreditation standards, restrictions in government funding to residency programs, congressional action, and balancing the geographic distribution of practitioners.
With rising hypofx I am not sure RO has any glaring maldistributions; we can't seem to agree on definition of "radiotherapy deserts"
www.sciencedirect.com
