Radiation Oncology Physician Workforce Concerns: A Snapshot from the 2025 ASTRO Annual Member Survey

The US radiation oncology (RO) workforce comprises diverse physician populations working in varied geographic and clinical settings. Data related to concerns of specific non-mutually exclusive groups, including academically affiliated community providers (AACP), private practitioners (PP), physician-scientists (PS), and rural providers (RP) are sparse. The ASTRO Workforce Committee utilized the 2025 Member Survey to characterize these cohorts and identify their unique professional challenges.

The 2025 ASTRO Member Survey included targeted questions for specific physician populations regarding practice roles, effort distribution (clinical, administrative, academic), funding, and their "top three" profession concerns. Responses were cross-referenced with demographic data from the survey for further context. Descriptive analysis was employed to summarize the qualitative and quantitative trends across subgroups.

From 875 total responses, 433 members answered some workforce-related questions, including 100 AACP, 162 PP, 92 PS, and 68 RP radiation oncologists. AACPs reported a median clinical effort of 80%. AACP concerns included: time/funding for academics (41%), increasing administrative burdens (37%), decreasing reimbursement/increasing expenses (27%), staffing challenges (21%), and AMC support for research/clinic (14%). PP and RP reported a median clinical effort of 80% with 20% effort on administration/non-clinical work. PP concerns included: administrative and regulatory burdens (56%), decreased relative reimbursement (47%), challenges recruiting/maintaining staffing (21%), and maintaining/replacing equipment (14%). Physician scientists reported median clinical effort of 60%; 20% for basic/translational. Consistent PS concerns focused on the unstable research funding climate (85%), decreased protected time (48%), followed by challenges recruiting staff/trainees (12%). Representing subsets of the other 3 groups, RP concerns included barriers to timely specialty care, declining reimbursement and poor payor mix, along with administrative/clinical burdens.

While administrative burden, staffing challenges, and reimbursement volatility were universal concerns across the US radiation oncology workforce, each physician subgroup faced specific pressures. AACP and PP struggle with the friction between clinical volume and non-clinical work. PS are primarily threatened by funding and time constraints. RP are additionally challenged by barriers to timely and optimal care. These findings provide a roadmap for ASTRO and practice leaders to develop targeted advocacy and support strategies to sustain a diverse and healthy workforce.