Jobs, patients, and trends: not good

[scarbrtj]

(updated the figure)

Sources
1. Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025. "In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections."
2. AAMC Physician Specialty Data Report.
3. Projected Supply of and Demand for Oncologists and Radiation Oncologists Through 2025: An Aging, Better-Insured Population Will Result in Shortage. "We found that approximately 16,347 oncologists and radiation oncologists were clinically active and filing medical claims for patients with cancer diagnoses in 2012. Among these, there were 13,070 oncologists and 3,277 radiation oncologists. We found that 16% of oncologists and 5% of radiation oncologists provided clinical care on a part-time basis. These oncologists and radiation oncologists engaged in part-time clinical care delivered 48% of the patient care visits that their peers in full-time patient care provided. This finding is consistent with those of prior surveys showing academic oncologists, on average, spent 48.3% of their time on clinical activities.18 As a result of lower clinical productivity, we estimated by experience and sex the number of oncologists and radiation oncologists providing FTE patient care in the beginning of 2012 to be 15,190, including 12,000 oncologists and 3,190 radiation oncologists."
4. Decreasing radiation therapy utilization in adult patients with glioblastoma multiforme: a population-based analysis.
5. Trends in Radiation Therapy among Cancer Survivors in the United States, 2000–2030. "In 2016, there were an estimated 10.5 million 5-year cancer survivors, of whom 3.05 million received radiation therapy... The fraction of all cancer survivors who received radiation increased from 24% in 2000 to a projected maximum of 29% in 2020. After 2020, the fraction of radiation-treated survivors is projected to slightly decline to 28% by 2030."
6. Declining Use of Radiotherapy for Adverse Features After Radical Prostatectomy: Results From the National Cancer Data Base.
7. The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?
* "Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand."
* "We conducted a sensitivity analysis to determine how changes in the utilization of radiation therapy and in the incidence of cancer would impact the relative increase in demand for radiation therapy between 2010 and 2020. To estimate appropriate parameters for the sensitivity analysis of radiation therapy utilization, we conducted a historical analysis using SEER data spanning 1990 to 2006 and found that, compared with the years 2003 to 2005, radiotherapy utilization rates generally varied no more than approximately ± 10% during this time period (Fig 1).4 With regard to the cancer incidence sensitivity analysis, previously published historical data indicated that cancer incidence has both increased and decreased in a statistically significant manner between 1975 and 2006; recently however, cancer incidence has been slowly decreasing at a rate of 0.4% per year from 1997 to 2006, and this rate increases to 0.7% per year if only the years 2002 to 2006 are considered.
8. NRMP Report Archives.
9. United States Cancer Statistics: Data Visualizations.
10. American Cancer Society Facts & Figures.
11. Radiotherapy Utilization and Fractionation Patterns During the First Course of Cancer Treatment in the United States From 2004 to 2014. "We found a steady decrease in the percent of patients receiving radiotherapy in their first course of treatment, and a global decline in the mean number of fractions delivered per patient receiving EBRT, compared with an increase in systemic therapy and stable surgery utilization. "

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[thecarbonionangle]

Sources
1. Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025. "In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections."
2. AAMC Physician Specialty Data Report.
3. Projected Supply of and Demand for Oncologists and Radiation Oncologists Through 2025: An Aging, Better-Insured Population Will Result in Shortage. "We found that approximately 16,347 oncologists and radiation oncologists were clinically active and filing medical claims for patients with cancer diagnoses in 2012. Among these, there were 13,070 oncologists and 3,277 radiation oncologists. We found that 16% of oncologists and 5% of radiation oncologists provided clinical care on a part-time basis. These oncologists and radiation oncologists engaged in part-time clinical care delivered 48% of the patient care visits that their peers in full-time patient care provided. This finding is consistent with those of prior surveys showing academic oncologists, on average, spent 48.3% of their time on clinical activities.18 As a result of lower clinical productivity, we estimated by experience and sex the number of oncologists and radiation oncologists providing FTE patient care in the beginning of 2012 to be 15,190, including 12,000 oncologists and 3,190 radiation oncologists."
4. Decreasing radiation therapy utilization in adult patients with glioblastoma multiforme: a population-based analysis.
5. Trends in Radiation Therapy among Cancer Survivors in the United States, 2000–2030. "In 2016, there were an estimated 10.5 million 5-year cancer survivors, of whom 3.05 million received radiation therapy... The fraction of all cancer survivors who received radiation increased from 24% in 2000 to a projected maximum of 29% in 2020. After 2020, the fraction of radiation-treated survivors is projected to slightly decline to 28% by 2030."
6. Declining Use of Radiotherapy for Adverse Features After Radical Prostatectomy: Results From the National Cancer Data Base.
7. The Future of Radiation Oncology in the United States From 2010 to 2020: Will Supply Keep Pace With Demand?
* "Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand."
* "We conducted a sensitivity analysis to determine how changes in the utilization of radiation therapy and in the incidence of cancer would impact the relative increase in demand for radiation therapy between 2010 and 2020. To estimate appropriate parameters for the sensitivity analysis of radiation therapy utilization, we conducted a historical analysis using SEER data spanning 1990 to 2006 and found that, compared with the years 2003 to 2005, radiotherapy utilization rates generally varied no more than approximately ± 10% during this time period (Fig 1).4 With regard to the cancer incidence sensitivity analysis, previously published historical data indicated that cancer incidence has both increased and decreased in a statistically significant manner between 1975 and 2006; recently however, cancer incidence has been slowly decreasing at a rate of 0.4% per year from 1997 to 2006, and this rate increases to 0.7% per year if only the years 2002 to 2006 are considered.
8. NRMP Report Archives.
9. United States Cancer Statistics: Data Visualizations.
10. American Cancer Society Facts & Figures.

WOW. End is near

 

[RickyScott]

Thank you for this.

 

[scarbrtj]

WOW. End is near

Once you think about it... maybe. Most optimistic projections I can make put us at about 1 to 2 new patients per week per rad onc in the U.S. by 2025.

 

[deleted573262]

this information should be readily available for all specialties and distributed to third and fourth year students choosing a career path. i would guess fields like medical oncology, hospitalist work, EM, and radiology would become (even) more competitive.

 

[scarbrtj]

this information should be readily available for all specialties and distributed to third and fourth year students choosing a career path. i would guess fields like medical oncology, hospitalist work, EM, and radiology would become (even) more competitive.

Right now, on our society's job search webpage there are optimistically 40 radiation oncologist jobs listed (still have to sort through a lot of non- rad onc jobs even with this filter). There are 207 radiation oncologists produced per year. For rad onc, this makes the job availability ratio 0.19. On the ACR site, there are 977 DR or interventional jobs listed. There are ~1250 DR/interventional radiologists produced per year. Their job availability ratio is 0.78. These are vastly different ratios (e.g. imagine a disease site where one tx has 19% LC and another tx 78% LC). I am still looking for a medical specialty where this job availability ratio is anywhere near as bad as ours. I honestly don't understand how new residents can expect >95% likelihood of full practice employment in the future. Simply does not compute. Say nothing for rad oncs out in practice looking to make moves.

 

[PhotonBomb]

Scar - if you want to do hard numbers, why would you talk about job postings that are active now? Next year from July 1 2020 - June 30 2021, you should keep a tally of total postings over a year period, to match with the 190-200 people that are graduating in June 2021. That’s the way to do it.

 

[scarbrtj]

Scar - if you want to do hard numbers, why would you talk about job postings that are active now? Next year from July 1 2020 - June 30 2021, you should keep a tally of total postings over a year period, to match with the 190-200 people that are graduating in June 2021. That’s the way to do it.

First of all, this would be impractical and almost take a FTE of effort to do what you're suggesting (track all job postings, screen against previous job posting for repeats, track de-listings over time, etc.). Second of all, the equivalent of what number I'm posting is akin to measuring that the outside temperature is 423 degrees F and saying "I really need a 365-daily average for you to convince me it's getting hot outside."

 

[PhotonBomb]

It’s just a meaningless thing though to measure how many job postings there are right now on a website that doesn’t keep listings for More than three weeks and try to make a ratio and say there are only jobs to supply 20 percent of the grads lol. Like how pathetically nonsensical.

 

[scarbrtj]

It’s just a meaningless thing though to measure how many job postings there are right now on a website that doesn’t keep listings for More than three weeks and try to make a ratio and say there are only jobs to supply 20 percent of the grads lol. Like how pathetically nonsensical.

I have yet to see a piece of data, no matter how much of an outlier that data point might be in comparison to other data, to sway you from ad homineming that any individual data point re: rad onc is valid or true. On the other hand, simply saying something is "pathetically nonsensical" won't convince people not to believe their lying eyes. And to claim I'm saying " there are only jobs to supply 20 percent of the grads" is way incorrect. You can make two similar measurements from two different populations, compare those two, and let interpretation follow that. The only interpretation I made is that job availability is different between radiation oncology and radiology (and different for any rad onc vs radiology job seeker who might be seeking a job--wherever he or she may be, whoever he or she may be) at this particular point in time.

 

[PhotonBomb]

‘And to claim I'm saying " there are only jobs to supply 20 percent of the grads" is way incorrect’

If that’s not what you’re meaning to imply then I apologize.

I will say that we have a weird small
Field with lots of word of mouth type jobs, and even when the job market was good, say like 2010 for example, I still bet our ‘ratio’ by your method was very low and definitely lower than radiology
Or other fields. That is to say- our job market is problematic but I’m not sure the ratio method you have used is the way to show it.

 

[PhotonBomb]

If medgator was still alive this is where he would say ‘the Astro board is pointless and not where people should look for jobs, even in my day’

(See his repeating himself does have its benefits)

 

[Lamount]

Maybe I am reading this wrong... but how are there 2000 new rad oncs in 7 years if there has been an average of ~200 residents trained/year? By my math, not only must no one have left the field, but some of us must have divided.

 

[RadOncDoc21]

Maybe I am reading this wrong... but how are there 2000 new rad oncs in 7 years if there has been an average of ~200 residents trained/year? By my math, not only must no one have left the field, but some of us must have divided.

Or multiplied right? Guess either way, there’s always more rad oncs around!

 

[RollTideRadOnc]

To claim that conclusions drawn by examining the ASTRO board are invalid because that board does not reflect “word of mouth” jobs is such bs imo. Where is there any evidence that our field somehow magically has more “word of mouth” jobs than other fields? Everyone I know got a job through that board. And jobs not on our board are very bad for recent grads bc it requires brown nosing the the very same academic leaders who got us into this awful mess. Jobs that require networking ninjitsu in this awful employment environment should not be held up as a plus about our field or even as a meaningful counterpoint to anything.

 

[PhotonBomb]

To claim that conclusions drawn by examining the ASTRO board are invalid because that board does not reflect “word of mouth” jobs is such bs imo. Where is there any evidence that our field somehow magically has more “word of mouth” jobs than other fields? Everyone I know got a job through that board. And jobs not on our board are very bad for recent grads bc it requires brown nosing the the very same academic leaders who got us into this awful mess. Jobs that require networking ninjitsu in this awful employment environment should not be held up as a plus about our field or even as a meaningful counterpoint to anything.

The job market is not good. That’s not the point of contention.

The point was that the ratio may be 20 percent now but could have quite easily been 30 percent in Jan 2011, when things were ‘good’. It’s not a sensitive or specific measure in radiation oncology.

 

[scarbrtj]

Maybe I am reading this wrong... but how are there 2000 new rad oncs in 7 years if there has been an average of ~200 residents trained/year? By my math, not only must no one have left the field, but some of us must have divided.

You are reading it right (and I'm saying ~5200 in 2020... a guess on my part... so it's really ~1900 in 8 years, but your point stands). And I don't wholly get it either (I report, you decide, as they say), and it's a big weak spot because different sources disagree wildly on rad onc numbers (once in 2015 ASTRO said there were 5000 rad oncs and then ~4 years later they said there were 4000). There needs to be better society record-keeping on this IMHO. Not really shown in first graphic, but is in the second one, forward-projecting is from ~3900 rad oncs in 2012 vs 3277 or 4600. But the graphic is intended to show one thing: the incidence of radiation oncologists is growing significantly faster than the incidence of new radiation patients. Data points like residents-in-training seeing 13% less EBRT patients over time hint at this, "the rapid expansion of residency training positions may be a contributing factor to the decline in case numbers per resident" (and we have to remember rad onc care in general has been migrating into academics over the last decade, so 13% may seem small but it's probably >>13% outside academics); if resident EBRT cases had increased over time, I'd say the graphic is questionable as it only takes one strong contradictory piece of data to invalidate a theory. But I'm really yet to see any significantly contradictory data. All the arrows point in one direction. And we know what direction that is... we can quibble over its magnitude, implications, etc.

The job market is not good. That’s not the point of contention.

The point was that the ratio may be 20 percent now but could have quite easily been 30 percent in Jan 2011, when things were ‘good’. It’s not a sensitive or specific measure in radiation oncology.

To be precise, I'm counting ~33 full time rad onc clinical jobs on the ASTRO board right now (a ~16% ratio). To get closer to radiology, e.g., this number wouldn't need to double (i.e. go to ~30%). Or triple. Even quadruple wouldn't put it in the "radiology ratio" ballpark. Now make of this what you will, "explain it away" as you will with furious hand-waving, but...

 

[PhotonBomb]

You’re getting real worked up lol. Global warming exists, but if you say your basement is hot, that isn’t a good marker of that either.

 

[RickyScott]

To claim that conclusions drawn by examining the ASTRO board are invalid because that board does not reflect “word of mouth” jobs is such bs imo. Where is there any evidence that our field somehow magically has more “word of mouth” jobs than other fields? Everyone I know got a job through that board. And jobs not on our board are very bad for recent grads bc it requires brown nosing the the very same academic leaders who got us into this awful mess. Jobs that require networking ninjitsu in this awful employment environment should not be held up as a plus about our field or even as a meaningful counterpoint to anything.

Many large institutions mandate available jobs are posted (even internal candidate favored) Since our specialty is increasingly dominated by these kind of institutions,( what percentage of radoncs are “academic”- greater than half, more so with new jobd )we likely have greater proportion of jobs posted online than other specialties like derm where most docs not employed by university like entities.

myth of a hidden job reservoir (presumably for connected white males to access with secret handshakes) is lazy way for apologists to mislead....

 

[OTN]

Many large institutions mandate all
Jobs be posted (even if they have favorite internal candidate) And since our specialty is increasingly dominated by these kind of institutions,( what percentage of radoncs are “academic” )we are probably more likely to have jobs posted online than other specialties like derm where most docs not employed by university like entities.

hidden job reservoir (presumably for connected white males to access with secret handshakes) is lazy way for apologists for present disaster to mislead....

Well done on the attacks on a particular ethnic group there. Doesn't seem warranted to me whatsoever.

 

[RollTideRadOnc]

The job market is not good. That’s not the point of contention.

The point was that the ratio may be 20 percent now but could have quite easily been 30 percent in Jan 2011, when things were ‘good’. It’s not a sensitive or specific measure in radiation oncology.

You're really getting hung up on this sensitivity/specificity thing, which is fairly irrelevant. Taken as a lone metric, the sensitivity and specificity of public job postings as markers of job market health may in fact be meaningless, but that's besides the point.

In the context of an abundance of well paying jobs in a variety of good locations, when every other indicator is in favor of job seekers (such as 2011), it probably doesn't matter very much at all what portion of jobs are posted on ASTRO. If there are more jobs than applicants, things will work out quite naturally.

However, *in a totally different context*, in which there is an increasing oversupply of physicians, fewer indications for xrt, rising hypofractionation, decreased supervision requirements, falling reimbursement, and ample evidence that people are having difficulty finding good jobs, it is a dire warning sign to people entering this field that so few good jobs are publicly posted. If the only way to find a good job is via the favoritism of your chair as you exit residency or being related to a radonc luminary, applying medical students need to be appropriately warned.

 

[radoncgrad2019]

You're really getting hung up on this sensitivity/specificity thing, which is fairly irrelevant. Taken as a lone metric, the sensitivity and specificity of public job postings as markers of job market health may in fact be meaningless, but that's besides the point.

In the context of an abundance of well paying jobs in a variety of good locations, when every other indicator is in favor of job seekers (such as 2011), it probably doesn't matter very much at all what portion of jobs are posted on ASTRO. If there are more jobs than applicants, things will work out quite naturally.

However, *in a totally different context*, in which there is an increasing oversupply of physicians, fewer indications for xrt, rising hypofractionation, decreased supervision requirements, falling reimbursement, and ample evidence that people are having difficulty finding good jobs, it is a dire warning sign to people entering this field that so few good jobs are publicly posted. If the only way to find a good job is via the favoritism of your chair as you exit residency or being related to a radonc luminary, applying medical students need to be appropriately warned.

seems like you guys are in agreement that the job market is not good. I think the point is that number of ASTRO job postings is not really that reflective, which I agree with. But whatever, as long as we all are on same page that the market isn't good.

 

[thecarbonionangle]

I don’t recall a time in the past years when there were enough jobs posted on that board for most graduating residents. Secret hand shake word of mouth magic fountain jobs, may or may not be out there, i certainly never saw them or know anybody who got a job like that. At the very least it is concerning to me that over past few years i have been looking at the job board seems to be not enough jobs. I don’t think anybody on here would disagree...

 

[PhotonBomb]

I don’t recall a time in the past years when there were enough jobs posted on that board for most graduating residents. Secret hand shake word of mouth magic fountain jobs, may or may not be out there, i certainly never saw them or know anybody who got a job like that. At the very least it is concerning to me that over past few years i have been looking at the job board seems to be not enough jobs. I don’t think anybody on here would disagree...

That’s the entire point I made is that if you looked in 2010 there wouldn’t be ‘enough’ jobs posted lol

 

[scarbrtj]

You're really getting hung up on this sensitivity/specificity thing, which is fairly irrelevant. Taken as a lone metric, the sensitivity and specificity of public job postings as markers of job market health may in fact be meaningless, but that's besides the point.

In the context of an abundance of well paying jobs in a variety of good locations, when every other indicator is in favor of job seekers (such as 2011), it probably doesn't matter very much at all what portion of jobs are posted on ASTRO. If there are more jobs than applicants, things will work out quite naturally.

However, *in a totally different context*, in which there is an increasing oversupply of physicians, fewer indications for xrt, rising hypofractionation, decreased supervision requirements, falling reimbursement, and ample evidence that people are having difficulty finding good jobs, it is a dire warning sign to people entering this field that so few good jobs are publicly posted. If the only way to find a good job is via the favoritism of your chair as you exit residency or being related to a radonc luminary, applying medical students need to be appropriately warned.

what he said

I don’t recall a time in the past years when there were enough jobs posted on that board for most graduating residents. Secret hand shake word of mouth magic fountain jobs, may or may not be out there, i certainly never saw them or know anybody who got a job like that. At the very least it is concerning to me that over past few years i have been looking at the job board seems to be not enough jobs. I don’t think anybody on here would disagree...

There's never been "enough" jobs on ASTRO, you're right (you get it I know). But like every human, we're all gonna engage in a bit of pattern recognition. And I see a pattern, that's all I'm saying friends. There are 6-7 times as many radiologists, and new radiology residents per year, than there are similar numbers of rad oncs. But they have about 20-30 times as many job postings on their website as we will at any given point in time. And in my limited attempts to compare us to other specialties (NSG e.g.), I have never seen a ratio this low for any other specialty. Have we always been the lowest? Maybe/probably so, and that'd be helpful to know, but if the delta between us and next lowest has been widening... widening... widening over time... that's cause for further concern.

 

[RickyScott]

Exactly. Job market was never a cake walk even in the best of times! But to say it is bad now, but it was also bad then is false. It was bad then and worse now, and will be downright horrible 5 years from now.

 

[PhotonBomb]

 

[scarbrtj]

Exactly. Job market was never a cake walk even in the best of times! But to say it is bad now, but it was also bad then is false. It was bad then and worse now, and will be downright horrible 5 years from now.

In my home state, I have seen maybe 2-4 new jobs open up over the past 5 years. (and saw no one retire). However, we are making 20 new rad oncs per state every 5 years, and if the projections hold (residency expansion continues; it accelerated 2018->2019) we will be at 25 new rad oncs needing jobs per state, per 5 years, 5 years from now. That sounds insane. We are gonna need Obama-level, magic-wand-waving job creating in rad onc.

 

[scarbrtj]

Yeah I never said the average rad onc sees 145 patients/year. I'm talking newly diagnosed patients. But math is math.
To reiterate:
There will be ~550,000 new rad onc cases in 2020. There are ~5200 rad oncs in the U.S. in 2020. This works out to, on average, ~105 new patients per rad onc in the U.S. in the ~2020 time frame. There are many rad oncs who see more new patients than this per year. But from a sheer maths perspective, many will see less.

I'm throwing out the best data I have at the moment. Other people are welcome to throw out other data. The number could be really bad off. But I'm making a point about trends more than I am hard numbers, and I will say again that the incidence of radiation oncologists appears to be significantly outgrowing the incidence of new radiation patients. I'm opening up a discussion: if the incidence of cancer is falling, and the utilization rate of XRT is steady/falling, but the growth rate of rad oncs is increasing... what does that look like.

 

[theradiator]

This great scholar has the answer to this and related threads

 

[goodkerma]

Not debating any of the points raised by the figure; however, while incidence may be on the decline... the prevalence (patient's living with disease) of cancer is certainly increasing. How many patient's do we see coming back after definitive treatment for round 2, 3, 4 or 5 of XRT? Not an insignificant number of patients... Just not sure if new patients is a good surrogate anymore.

 

[RickyScott]

Not debating any of the points raised by the figure; however, while incidence may be on the decline... the prevalence (patient's living with disease) of cancer is certainly increasing. How many patient's do we see coming back after definitive treatment for round 2, 3, 4 or 5 of XRT? Not an insignificant number of patients... Just not sure if new patients is a good surrogate anymore.

that is a fair point (and great argument for growth/future potential of medical oncology). Anecdotally, I notice this (melanoma and lung), but it is not a large component of my patient volume vs early on in career. Incidence/utilization not withstanding- throw all the data out the window-\ we all intuitively know the USA just cant absorb 1000 radoncs (20 per state) over the next 5 years.

 

[scarbrtj]

This great scholar has the answer to this and related threads

Hmmm. 5 major reasons for society decline:
1. Human impacts on environment/resources (overutilization of IMRT?, protons+)
2. Climate change (the incidence of cancer began to decline)
3. Relationship to friendly society (drive to separate from radiology)
4. Relationship to enemy society (collapsed in rad onc w/ urology, IR, med onc?, etc.)
5. Social/financial/cultural decline (infighting in rad onc, shift from pp->academics bringing about residency expansion, fractionation decline, intrasocietal drive to eliminate or lower rad onc utilization)

 

[scarbrtj]

Not debating any of the points raised by the figure; however, while incidence may be on the decline... the prevalence (patient's living with disease) of cancer is certainly increasing. How many patient's do we see coming back after definitive treatment for round 2, 3, 4 or 5 of XRT? Not an insignificant number of patients... Just not sure if new patients is a good surrogate anymore.

Yes that I can't account for; if rad oncs begin to be more re-irradiators than neo-irradiators, then great. However, the rise in re-irradiation business would need to offset the rise in radiation oncologists (and decrease in cancer incidence... which is blunting the rise in prevalence).

 

[Neuronix]

Scarb I've always appreciated the quality of your figure presentations. What software did you use for these plots?

 

[Palex80]

Interesting figures.

Here's my experience.
I work in a rather small clinic. 4 radiation oncologists + 3 residents (2 of whom are in their final year). We treat about 800-900 patients / year.

It's an academic site.

 

[scarbrtj]

Scarb I've always appreciated the quality of your figure presentations. What software did you use for these plots?

Thanks man. Hand sketched, Adobe Illustrator. Took some graphic design courses in college, school newspaper editor, etc. But just like David Carson still uses a 1990's version of QuarkXpress, for most MDs I recommend StatView if you can get a copy. I keep a Windows 7 PC alive just for that purpose.

Interesting figures.

Here's my experience.
I work in a rather small clinic. 4 radiation oncologists + 3 residents (2 of whom are in their final year). We treat about 800-900 patients / year.

It's an academic site.

Palex, this sounds very reasonable. I keep repeating about ~550K new rad onc patients in the U.S. per year spread over ~5000 U.S. rad oncs gives us an average much lower than this (e.g. 800-900 patients/4 rad oncs). Can you give for your country 1) new cancer cases/year, 2) rad onc utilization rate (and new rad onc patients/year), 3) number of residents produced/year, and 4) total number of rad oncs? Would love to compare quick and dirty like.

 

[Palex80]

Palex, this sounds very reasonable. I keep repeating about ~550K new rad onc patients in the U.S. per year spread over ~5000 U.S. rad oncs gives us an average much lower than this (e.g. 800-900 patients/4 rad oncs). Can you give for your country 1) new cancer cases/year, 2) rad onc utilization rate (and new rad onc patients/year), 3) number of residents produced/year, and 4) total number of rad oncs? Would love to compare quick and dirty like.

Roughly 40k patients per year. RT utilization is hard to tell, no good numbers for that, I presume around 50% of all cases. Resident "production" is not stable, since positions open and close variably, about 8-10 new radoncs/year. Total number of (registered) radoncs is currently 210.
It's important to state that quite a few of those radoncs don't work full-time.

 

[RickyScott]

Germany has 210 total radoncs? And produce 8-10 a year? (Positions open and close variably!!!!)

 

[scarbrtj]

Roughly 40k patients per year. RT utilization is hard to tell, no good numbers for that, I presume around 50% of all cases. Resident "production" is not stable, since positions open and close variably, about 8-10 new radoncs/year. Total number of (registered) radoncs is currently 210.
It's important to state that quite a few of those radoncs don't work full-time.

Germany has 210 total radoncs? And produce 8-10 a year? (Positions open and close variably!!!!)

Ok ok ok ok something is really different then than the U.S. then.
US population ~300 million, ~550K new rad onc patients/year, 5000 rad oncs , ~210 new rad oncs a year.
Germany ~90 million, 40K new rad onc patients/year, 210 rad oncs, ~10 new rad oncs a year.

This is why it's hard to pin down: how many rad oncs are needed for a population. If you are truly talking about Germany, and I thought that's where you were but didn't want to say, and try to translate that experience in the U.S...
In the U.S. we'd have ~120K new rad onc patients/year, have ~650 rad oncs nationwide, and produce ~32 new rad oncs/year.

But be that as it may, we average ~105 new patients per rad onc in the U.S.
In Germany you are averaging ~190 per rad onc.
This is very different.

So what error am I making in calculations? Even with cancer incidence being lower in Germany.

 

[deleted1002574]

Why assuming it’s Germany?
Based in those numbers ... would think Holland or maybe Belgium. But Belgium probably would need even less.

If holland, then equivalent of 160-200
(20x smaller than us)

 

[RickyScott]

In pre hypofrac era, varian used to say 1 linac/ radonc 100,000 which many felt was a bit of stretch- probably needed more pop.
Assuming the German numbers are accurate -and a gov run national health system probably keeps more accurate stats- (they also have centralized care/less rural locations and No competiting systems) implications for our future are alarming.

 

[RickyScott]

Why assuming it’s Germany?
Based in those numbers ... would think Holland or maybe Belgium. But Belgium probably would need even less.

If holland, then equivalent of 160-200
(20x smaller than us)

Because I thought he said he was in Germany. Holland has only handful of departments and doesn’t offer residencies every year. Ben slotman just open slots if he thinks someone is nearing retirement age?

 

[taserlaser]

Or for comparison, use some of the Canadian data which has tracked their RO human resources needs nationally pretty closely

Released in 2016, but has a good synopsis http://caro-acro.ca/wp-content/uploads/2016/10/2016-CARO-AGM-HR-Report.pdf

Difference in practice models aside, 38 million vs 330 million gives a scaling factor of 8.7 (or round to 10) and compare.

 

[scarbrtj]

Or for comparison, use some of the Canadian data which has tracked their RO human resources needs nationally pretty closely

Released in 2016, but has a good synopsis http://caro-acro.ca/wp-content/uploads/2016/10/2016-CARO-AGM-HR-Report.pdf

Difference in practice models aside, 38 million vs 330 million gives a scaling factor of 8.7 (or round to 10) and compare.

Seems like Canada has job market agita too eh?
If you didn't round to 10, and Googled a few other things/countries, and stuff we've said so far, with ~30% rad onc utilization:

New patients/rad onc USA: ~105
New patients/rad onc UK: ~110
New patients/rad onc Canada: ~115
New patients/rad onc France: ~119
New patients/rad onc Australia: ~125
New patients/rad onc ?EU country @Palex?: ~190 95

So the ?EU Country? is an outlier, the others somewhat similar. If the projections hold true though US could dip (significantly) below ~100 over next 5y.

 

[Palex80]

Germany has 210 total radoncs? And produce 8-10 a year? (Positions open and close variably!!!!)

Im not in Germany.
(It would be great if Germany with 80 million inhabitants only had 40k cancer patients / year; they have roughly half a million actually / year...)

So, in my country:
40k cancer patients / year, around half of them get radiation therapy --> 20k radiation oncology patients / year.
210 registered radiation oncologists in the country. And "production" of new radiation oncologists is around 8-10/year.

However several factors to weigh in:

1. Not all 210 radiation oncologists work full time, I imagine more than 1/3 of them doesn't actually.
2. There may be some hospital-employed radiation oncologists that don't pop up in those statistics (it's a complicated issue that has to do with registration if you work only in a hospital, but I image that number is quite low, perhaps 10-20 additional doctors).
3. "Production" of residents per year is not stable, because there are no strictly declared slots as there are in the US. It's pretty much like this in many European countries, the market / wishes of residents / needs of hospitals regulate that.
4. We both "export" and "import" radiation oncologists, meaning that people may finish residency and choose to leave the country to work somewhere else. But foreign radiation oncologists who trained abroad may come to work here too.

 

[RickyScott]

Seems like Canada has job market agita too eh?
If you didn't round to 10, and Googled a few other things/countries, and stuff we've said so far, with ~30% rad onc utilization:

New patients/rad onc USA: ~105
New patients/rad onc UK: ~110
New patients/rad onc Canada: ~115
New patients/rad onc France: ~119
New patients/rad onc Australia: ~125
New patients/rad onc ?EU country @Palex?: ~190

So the ?EU Country? is an outlier, the others somewhat similar. If the projections hold true though US could dip (significantly) below ~100 over next 5y.

Are canadian radoncs still doing 1-2 yrs of fellowships?

 

[scarbrtj]

Im not in Germany.
(It would be great if Germany with 80 million inhabitants only had 40k cancer patients / year; they have roughly half a million actually / year...)

So, in my country:
40k cancer patients / year, around half of them get radiation therapy --> 20k radiation oncology patients / year.
210 registered radiation oncologists in the country. And "production" of new radiation oncologists is around 8-10/year.

However several factors to weigh in:

1. Not all 210 radiation oncologists work full time, I imagine more than 1/3 of them doesn't actually.
2. There may be some hospital-employed radiation oncologists that don't pop up in those statistics (it's a complicated issue that has to do with registration if you work only in a hospital, but I image that number is quite low, perhaps 10-20 additional doctors).
3. "Production" of residents per year is not stable, because there are no strictly declared slots as there are in the US. It's pretty much like this in many European countries, the market / wishes of residents / needs of hospitals regulate that.
4. We both "export" and "import" radiation oncologists, meaning that people may finish residency and choose to leave the country to work somewhere else. But foreign radiation oncologists who trained abroad may come to work here too.

So then you're at an American level: 20000/210 = 95 new patients/rad onc

Thus I'm thinking my "metric," as low as the numbers sound everywhere, is valid. (That is to say you see about 200 new patients a year but mathematically speaking the average rad onc will see ~95/year in your country.) And all the more why 145/year in the U.S. just ~8 years ago was remarkable IMHO.

 

[Palex80]

So then you're at an American level: 20000/210 = 95 new patients/rad onc

Thus I'm thinking my "metric," as low as the numbers sound everywhere, is valid. (That is to say you see about 200 new patients a year but mathematically speaking the average rad onc will see ~95/year in your country.) And all the more why 145/year in the U.S. just ~8 years ago was remarkable IMHO.

Germany has 1420 radiation oncologists treating probably roughly 240k patients per year --> 170 patients / doctor.
So you see the ratio can be different too...

The question for me is however whether or not the estimation I made, that 50% of all patients receive radiation therapy, is valid. This can sometimes be country-specific and does not include retreatments.
In this article for example the authors added 25% for retreatments, an argument which seems reasonable.

Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database - PubMed

Radiotherapy is used for cure or palliation in around half of patients with cancer. We analysed data on radiotherapy equipment in 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database, managed by the International Atomic Energy Agency. As of July, 2012...

www.ncbi.nlm.nih.gov

 

[scarbrtj]

Germany has 1420 radiation oncologists treating probably roughly 240k patients per year --> 170 patients / doctor.
So you see the ratio can be different too...

The question for me is however whether or not the estimation I made, that 50% of all patients receive radiation therapy, is valid. This can sometimes be country-specific and does not include retreatments.
In this article for example the authors added 25% for retreatments, an argument which seems reasonable.

Radiotherapy capacity in European countries: an analysis of the Directory of Radiotherapy Centres (DIRAC) database - PubMed

Radiotherapy is used for cure or palliation in around half of patients with cancer. We analysed data on radiotherapy equipment in 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database, managed by the International Atomic Energy Agency. As of July, 2012...

www.ncbi.nlm.nih.gov

Good then to know my ~145/year calc ~8y ago for the US, and its decline to ~105 today, is neither a planetary aberration nor a bad systematic error on my part.