Oh man - can't tell if you're joking or not lol. On the off chance you're not:
1) I would spend more time reading these forums
2) The gist of it is, since the early 2000s, residency spots more than doubled (going from a little less than 100 residents per year to around 200 residents per year). This was fine for a time because of IMRT, which made everyone monster cash. Then the government started to catch on to how much money individual RadOncs were making, which looked bad at first blush but in terms of cost to the system doesn't even touch Keytruda...but I digress. Anyway, things were done, and continue to be done, to reduce reimbursement. CMS keeps dancing around with implementing an Alternative Payment Model, the entire goal of which is to reduce RadOnc expenditures by at least 5%. There were still "linac babysitting" gigs because of puritan American rules, but now these rules are being relaxed. Finally, much of the research that has been done over the last 20 years has been aimed towards reducing (or elimating) the number of fractions patients are given, which is great for patients but considering reimbursement comes from # of fractions, not good for the provider side of the RadOnc equation.
So:
- doubled the number of RadOncs produced per year
- the specialty gets paid by fraction of radiation delivered (over simplification, of course), and cuts were made to reimbursement and more cuts coming
- guidelines have made significant cuts (or eliminated) to the number of fractions needed for common conditions
- supervision rules were relaxed meaning fewer docs needed
I think those are the major brush strokes? Obviously, glossing over a dissertation of nuance.