Examining Recent Employment Outcomes for Graduating Radiation Oncologists Across and Within the Metropolitan/Nonmetropolitan Continuum: 2015-2022

Purpose: In recent years, <5% of radiation oncology (RO) residents have accepted permanent positions in nonmetropolitan (nonmetro) areas immediately after graduation. In this study, we sought to identify factors associated with practice location and examine the county-level parameters of these communities. Methods and Materials: Using multiple sources of publicly available data, we built a database of US RO residents who graduated between 2015 and 2022. We subsequently determined the first permanent job accepted by each graduate and identified its rural-urban continuum code. A logistic regression model was used to identify predictors of accepting a first job in a nonmetro county. Using the Area Health Resource Files, we performed a secondary analysis to determine county characteristics associated with an increased geographic density of recent graduates in both metropolitan (metro) and nonmetro cohorts. Results: Among 2015-2022 RO graduates, 60 of 1396 (4.3%) accepted first jobs in a nonmetro county, and 24 of 60 (40.0%) of these graduates were located in a nonmetro county not adjacent to a metro area. On multivariable analysis, graduates of larger residency programs (defined by the total number of graduates between 2015 and 2022) were less likely to accept a first job in a nonmetro county (odds radio, 0.96; 95% CI, 0.94-0.99; P < .01). Within both metro and nonmetro cohorts, recent graduates’ first jobs were located in counties with higher population (P < .01), higher population density (P < .01), higher median household income (P < .01), more hospital care access (P < .01), and more primary care physicians per 10,000 individuals (P < .01). Conclusions: The geographic distribution of recent RO graduates appears to correlate with several indicators of population and health care resources, even when accounting for metro and nonmetro communities separately. These findings suggest that future efforts aimed at improving equitable access to RO services throughout the United States may prove more challenging than simply addressing disparities across the metro/nonmetro divide.