2186 - Rural Practice Choice Among Radiation Oncology Graduates, 2015 to 2022

C. Yu¹, K. Hsieh¹, D. R. Cherry¹, J. Runnels¹, J. P. Rowley², and K. Sindhu¹; ¹Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, ²Department of Radiation Oncology, Maimonides Cancer Center, Brooklyn, NY

Purpose/Objective(s): An imbalance persists between rural and nonrural areas in terms of access to specialist care, including in radiation oncology (RO). In this study, we sought to characterize recent RO graduates who accepted clinical positions in rural U.S. counties, examine county-level parameters of these rural areas, and identify factors associated with rural practice choice. Materials/

Methods: Using publicly available data sources, we identified the first employment positions accepted by RO graduates between 2015 and 2022 and classified each position by its rural-urban continuum code. Descriptive statistics were used to summarize characteristics of graduates who accepted rural positions. County-level data on population characteristics were drawn from the Health Resources and Services Administration (HRSA). ?2 or Fisher’s exact tests were applied for univariate analyses comparing categorical variables and t-tests were applied for continuous variables.
Results: We identified 68 RO residents who graduated from residency between 2015 and 2022 and accepted clinical positions in rural counties. The majority obtained an M.D. from a medical school in the United States (N = 63, 92.6%) and were male (N = 53, 77.9%). At least 18 (26.5%) of the examined individuals have switched jobs at least once at the time of this analysis, of whom 16 (88.9%) switched to practice in a nonrural county. Univariate analysis demonstrated that RO graduates who chose rural practice were more likely to be graduates of small-sized residency programs (0-6 residents per class; P=0.020) as compared to graduates who chose nonrural practice. Rural counties where recent RO graduates accepted positions (N = 62) had a higher median income (P<.0001), percentage of the population that was non-Hispanic White (P<.0001), and population density (P<.0001), and more primary care physicians per 10,000 individuals (P<0.001), as compared to all other U.S. rural counties (N=1934). Additionally, these 62 rural counties were more populous (P<0.001) and had a lower percentage of the population in poverty (P=0.002) and younger than 65 years of age without health insurance (P<0.0001).
Conclusion: In this study, we found that RO residents who choose rural practice were more likely to be graduates of small-sized residency programs. Additionally, we found that the rural counties where recent RO graduates accepted clinical positions appear to represent a distinct subset of rural counties that is associated with higher income, larger population size, and lower poverty levels. These findings suggest that improving access to radiation therapy may prove more challenging than simply addressing urban-rural disparities. Further efforts to improve the retention of new graduates in rural practice and to examine the fundamental tension between maintaining a stable rural RO workforce while at the same time considering the employment preferences of graduating RO residents are necessary.