U.S. Radiation Oncology Workforce Opinions Regarding Residency Expansion in 2021: is This an Issue? Where Do We Go from Here?

Purpose/Objective(s) The number of U.S. radiation oncology residency positions has increased by ∼50% over the past 15 years. The impacts of this expansion have been vigorously debated. The objective of this study was to characterize workforce opinions regarding residency expansion and whether action should be taken to limit residency oversupply. This study also aims to characterize workforce opinions regarding the new Accreditation Council for Graduate Medical Education (ACGME) proposed changes, which may indirectly curb residency expansion by making program requirements more stringent. Materials/Methods An online survey was distributed to approximately 1400 radiation oncologists (∼1000 attendings and ∼400 residents). The survey asked respondents to rank how strongly they agreed with certain statements on a scale of 1-10. For the analysis 1-3 was binned as "disagree", 4-7 was binned as "neutral", and 8-10 was binned as "agree". The 21% response rate yielded 294 responses for analysis. Associations between respondent characteristics and survey responses were analyzed using chi-square test and binary logistic regression. Results 30% were residents, 60% were attendings, 5% were program directors, and 5% were department chairs. Most respondents were ≤40 years old (63%), male (76%), and non-Hispanic white (68%). 79% believed that there is a residency oversupply issue, and 82% were in favor of actions to limit residency expansion. On chi-square test, residents and attendings were more likely believe that there is a residency oversupply issue (84% and 85%) compared to program directors and department chairs (26% and 23%) (p < 0.01). There was more support for action to be taken limit residency oversupply by residents and attendings (91% and 83%) compared to program directors and department chairs (46% and 38%) (p < 0.01). These differences in response rates between residents vs. program directors and department chairs remained significant on binary logistic regression considering age, sex, and race. Regarding possible solutions, respondents were most in favor of limiting further residency expansion (83%), making program requirements more stringent (69%), and limiting the use of the Supplemental Offer and Acceptance Program (SOAP) (65%). Regarding the ACGME proposed changes, respondents were most in favor of mandating that all programs have capabilities for modern image guidance, stereotactic body radiation therapy (SBRT), stereotactic radiosurgery (SRS), and brachytherapy (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5 (79%). Conclusion The majority of radiation oncologists perceive there to be a residency oversupply issue and support interventions to limit residency expansion and make program requirements more stringent. This study is one of critical importance, as it is one of the first to demonstrate and quantify the difference in perception of those with the power to effect change as compared to those most directly impacted by such changes.