Resident/attending/practicing rad onc expansion, 15 years

[scarbrtj]

An expansion factor (EF) for radiation oncologists was calculated in various scenarios using the following criteria. From ten Internet Archive-sampleable academic programs (Stanford, UTHSCA, Emory, WUSTL, UCLA, UCSF, MGH, OSU, IU, UNC) the number of active clinical MD attendings in radiation oncology were recorded from the years 2004 and 2019 respectively. An EF was calculated for each program. (E.g., Emory had 11 attendings in 2004 and 26 attendings in 2019 for an EF of 26/11 or 2.36). In 2004, there were 96 attendings in these 10 programs and 208 now for an average EF of 2.17 (range 0.83, 4.5).

Using NRMP match data, 128 radiation oncology residency spots were offered in 2004 and 207 in 2019 for an EF of 1.62. Using available workforce data and ASTRO data, there were 3997 active practicing radiation oncologists in the United States in 2004 and 5000 in 2019 for an EF of 1.25.

Using the Mann-Whitney test, EFs were compared between groups. Given that MD numbers only increase over time, a one-sided p-value of <0.05 was assumed to be significant. An EF of 1.62 for residency slots was assumed per program, consistent with historical data mentioned above.

Academic Attendings vs Residency Slots, 2004 vs 2019
EF=2.17 vs 1.62, p=0.24
Academic Attendings vs Practicing Rad Oncs, 2004 vs 2019
EF=2.17 vs 1.25, p<0.05
Residency Slots vs Practicing Rad Oncs, 2004 vs 2019
EF=1.62 vs 1.25, p<0.05

There's been a non-signficant trend of increasing attendings vs residents over time, although the increase in residency slots has generally attempted to keep pace with the increased number of attendings. However, given the author's personal laziness and desire not to waste HUGE amounts of time, only 10 programs were sampled. With more samples, the academic and residency EF discrepancy could likely become significant. That said, there has been a significant increase in attendings, and residency slots, vs practicing rad oncs in the US, over the last 15 years. (On a side note, the EF for residency slots 2000-2003 was exactly 1.0.)

Hope to get published in Red Journal. Should be a chip shot. (I said "chip" not "cheap.")

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[seper]

Once radiation oncologists become folded into academic practice, they cause residency expansion?

 

[scarbrtj]

Once radiation oncologists become folded into academic practice, they cause residency expansion?

It's possible? I owe this line of inquiry to some guy somewhere on here who recently said something like "attending number should catch up with resident expansion" and I thought, hey, you know what... it feels like there are a lot more attendings around nowadays than when I got out of residency. BUT... not that many more rad oncs "out in the wild."

So many different causes/effects possible. Perhaps rad onc had a "boom" in the 2004-19 period such that puny, ignored departments suddenly became the targets of positive attention/adulation/funding and were able to expand. And if you build it, they will come; every new attending needs his/her resident executive assistant. Thus it would seem this would be the trend: more academic rad oncs, begat more residents, begat more radiation oncologists overall. Eventually. In a way, this makes sense. If "outside academics" is the true free market, there are much more different market forces at work inside academics than in the free market, in rad onc, it seems. Eventually however the academic market forces will reach some sort of equilibrium with the free market overall. I've probably read too much "Freakonomics." Stories like ours, booms, usually precede busts. Hard to know what the bust will be.

Needless to say, the residency expansion seems to have been shunting much of itself into academics, and academics has obviously been the real growth market in rad onc for the last 15 years. I wish I had a better way of getting at department numbers, residents and attendings, from 15 years ago. It's kinda difficult/annoying TBH.

 

[evilbooyaa]

Don't forget that the increase in number of 'academic' attendings due to those that are listed as faculty but staff satellite positions. This is correlated with the explosion of satellite facilities from academic programs. The total faculty network is 3-7 larger than the number of physicians who practice at the mothership.

The premise of attemping to have any and all academic attending at the mother ship to have 100% resident coverage is the reason for residency expansion. The next step is to have 'academic' physicians at satellites have increasing amounts of resident coverage.

 

[scarbrtj]

Don't forget that the increase in number of 'academic' attendings due to those that are listed as faculty but staff satellite positions. This is correlated with the explosion of satellite facilities from academic programs. The total faculty network is 3-7 larger than the number of physicians who practice at the mothership.

The premise of attemping to have any and all academic attending at the mother ship to have 100% resident coverage is the reason for residency expansion. The next step is to have 'academic' physicians at satellites have increasing amounts of resident coverage.

Thus, we recommend that the faculty:resident ratio be increased from 0.67:1 to 1:1 and that it be further clarified that this ratio applies to clinical physician faculty. We think that this size-agnostic metric would help improve quality across all programs.

Harari doesn't seem to realize that the faculty:resident ratio is ALREADY way greater than 0.67:1, or 1:1, nationwide at least. So I think his idea here is a bit toothless/meaningless. Given the large increase in attendings vs residents the last 15 years, If you're at a program where the ratio is not already 0.67:1 or greater, there are likely core problems there outside the educational aspects of the residency in other words... and increasing the faculty:resident ratio at such a program will actually do nothing for quality. Unless you abolish the program, I guess.

 

[TDDro]

Harari doesn't seem to realize that the faculty:resident ratio is ALREADY way greater than 0.67:1, or 1:1, nationwide at least. So I think his idea here is a bit toothless/meaningless.

Maybe someone who has experience in ACGME accreditation can offer some insight into this. It was my understanding that several hoops had to be jumped through (including site visit) for a satellite to be approved for resident training (e.g. cannot send a resident to a satellite unless it has been formally accredited). It would thus follow that a clinician who is at a non-accredited site cannot be included in the "faculty clinician" numbers. There is likely some workaround (like if the non-accredited site faculty also rotates one day at the primary accredited site). Just curious if anyone knows the requirements for counting physician faculty?

My understanding right now is that "faculty clinician" numbers only count primary site faculty. The definition of "primary site faculty" is vague however.

 

[Chartreuse Wombat]

I spent six years on the RRC for Radiation Oncology. The definitions have changed over the years but the most recent Program Requirements distinguish between the "primary clinical site" and "participating sites".

The primary clinical site (mothership) must have at least two linacs with CT simulator, adequate conference room and associated medical services (medical oncology, surgical oncology, pediatric oncology, radiology, pathology, etc). At least 50% of the resident educational experience must take place at the primary clinical site.

Participating site requirements are lower-PD responsible for rotation schedule, (at least one) faculty member in charge, faculty member(s) must have appointment from primary clinical site or Sponsoring Institution, some means for direct participation of residents in joint conference (electronic OK), prior approval must be obtained before sending residents but no site visit required.

 

[TDDro]

How do they count primary site clinicians though, and does that matter for the ratio (primary vs. participating site)? For example, if Dr. X works at satellite 4 days a week and comes to main site 1 day, do they count as 'primary site'? Likewise, if they're at satellite full-time, but have privileges at main site, does that still count?