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Published on: March 11, 2021
Understanding retention in radiation oncology: qualitative findings from an international workforce survey
Danielle Fairweather1, Azadeh Abravan2, Daniel Portik3
1Radiotherapy and Proton Beam Therapy, University College London Hospital, London, United Kingdom.
Background:
Retention of the radiation oncology workforce is a growing global concern amid rising cancer incidence, workforce shortages, and escalating service demands. While recruitment initiatives remain essential, ongoing attrition across the professions threatens long-term workforce sustainability. This qualitative study explored the lived experiences surrounding organisational, professional, and individual factors shaping retention across the multidisciplinary radiation oncology workforce.
Methods:
A cross-sectional mixed-methods survey was distributed internationally via the European Society for Radiotherapy and Oncology communication channels. Optional open-text responses were analysed using framework analysis, a systematic qualitative method involving familiarisation, framework development, iterative coding, and thematic interpretation.
Results:
Six themes influencing retention were identified: workplace culture, leadership, career development, resource strain, recognition and value, and wellbeing and burnout. Workplace culture and leadership emerged as central determinants of retention. Radiation therapists reported the greatest burden of operational pressure, negative workplace culture, and burnout. Medical physicists highlighted limited recognition, professional visibility, and career progression opportunities, while radiation oncologists emphasised structural inefficiencies, workload, and restricted academic development. Across all groups limited protected development time, unclear career pathways, and poor recognition compounded retention challenges. Supportive leadership, meaningful professional development, and positive workplace culture were consistently identified as protective factors.
Conclusions:
Retention in radiation oncology is shaped by complex, interrelated systemic factors rather than isolated individual decisions. Sustainable workforce retention strategies must prioritise leadership development, mentorship, protected career progression, improved recognition, and structural investment in staffing and resources. Profession-specific interventions are essential to support long-term workforce resilience and maintain high-quality patient care.
