3485 - Beyond the City Lights: Mapping the Rural Training Terrain for U.S. Radiation Oncology Residency Programs

V. Cassidy, R. J. Brisson, and A. N. De Leo; Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL

Purpose/Objective(s): Exposure to patients from rural communities during residency training can enhance learning opportunities and increase the number of providers who ultimately pursue careers in rural practice. Rural populations often have increased risk of malignancy, decreased access to healthcare, and disparate socioeconomic burdens compared to residents of urban communities. The degree to which radiation oncology programs offers exposure to patients from rural communities has not been previously described. We developed a quantitative metric for the purpose of assessing a program’s access to rural patient populations based on geography. Materials/

Methods: We extracted information from the American Medical Association and Accreditation Council for Graduate Medical Education databases for 89 available radiation oncology residency programs. We geocoded department addresses to generate 120-minute drive-time catchment areas segmented into 10-minute subzones. We utilized Rural-Urban Continuum Codes (most urban = 1, most rural = 9) for 2023 provided by the US Department of Agriculture and county shapefiles provided by the US Census Bureau to calculate a composite rurality score. Recognizing that patient utilization of radiation services likely decreases with increasing commute time, we applied a Gaussian decay factor to progressively diminish the influence of subzones that approached the catchment periphery. We performed a sensitivity analysis by varying the decay factor between its root and its square.
Results: Of the 89 residency programs we evaluated, Loma Linda and Dartmouth had the lowest and highest composite rurality scores at 1.02 and 5.85, respectively. The first, second, and third quartile rurality scores were 1.40, 1.98, and 2.85, respectively. The Table (Rank, Program, Composite Rurality Score) displays the 5 most rural and the 5 least rural residency programs.
Conclusion: This study represents the first quantitative analysis assessing US radiation oncology residency programs’ access to rural patient populations based on geography. The rurality score can provide additional information when evaluating residency programs. Given the known regional geographic link between training and independent practice location, these results can be a valuable surrogate for future supply of radiation oncologists in historically underserved communities. In the event of future contraction of radiation oncology residency programs, this novel metric may be important to consider for maintaining high-quality and equitable care, in addition to preventing further declines in the supply of practicing radiation oncologists in rural locations.

Abstract 3485 – Table 1

1	Dartmouth (NH)	5.849
2	University of Iowa (IA)	4.708
3	University of Kentucky (KY)	4.526
4	Mayo Clinic (MN)	4.255
5	University of Arkansas (AR)	4.208
85	City of Hope (CA)	1.085
86	Stony Brook (NY)	1.044
87	University of California Irvine (CA)	1.037
88	University of California San Diego (CA)	1.025
89	Loma Linda (CA)	1.023