Faculty of Radiation Oncology survey of work practices.

The aim of the present paper was to determine the current working conditions of practising radiation oncologists (RO) in Australasia and their attitudes towards their work and work environment. The authors were requested by the Faculty of Radiation Oncology to conduct a survey of Fellows' work conditions and attitudes. The need for such a survey arose from a workshop of the Faculty held in Sydney in 1995, to determine future directions of the Faculty. Issues of potential interest were identified at the workshop and supplemented by the authors into a survey consisting of both directed and open questions. Respondents were free to remain anonymous. An address list of RO was supplied by the Royal Australian and New Zealand College of Radiologists (RANZCR). Two mailouts were performed to increase the response rate. The survey was completed during the second half of 1996 and analysed in 1997. The response rate was 79% (63-100% according to state/country). The age range was 30-69 years (median: 43 years; mean: 44 years), and 78% of the respondents were male. A public centre was identified as the sole or main place of work for 84% of respondents. The number of RO per practice varied from one to 25 (median: 5). The estimated hours worked per week ranged from 20 to 79 (mean: 52 h; median: 50 h). There were significant differences in allocation of hours between public and private (more clinical hours for private (P = 0.008), more teaching hours for public (P = 0.007)) but no difference in total hours. The responses for clinical work profile were: 'general' 39%, 'largely subspecialty' 37% and both 2% (23% did not respond). The proportion whose practice was 'largely subspecialty' differed between public and private (53% vs 13%, respectively; P = 0.06), and varied according to the number of RO in the practice (62% for > five RO vs 35% for < or = five RO, P = 0.03). The need for subspecialization for the treatment of common tumours (breast, gynaecological etc.) was held by 78% of respondents and was related to the number of RO in the practice (100% for > five RO vs 81% for < or = five RO, P = 0.002). The number of new patients seen per RO in 1995 ranged from 0 to 700 (mean: 342; median: 350), with a significant difference between the mean numbers seen in public versus private settings (331 vs 409, respectively; P = 0.008). Administration of cytotoxics was supervised by 36% of RO across Australasia but was dependent strongly on the state/country of practice (P = 0.0002). The current and preferred roles in clinical management were scored as means of 7.9 and 8.7, respectively, on a linear scale from 1 (mainly technical role) to 10 (significant role in overall management). A total of 40% of RO were content with their current time allocation; the remainder generally wished to reduce clinical time and increase self-education and/or clinical research. Most indicated that they wanted some 'protected time'. Most were content to be called a 'radiation oncologist' and wished to retain this title; the most common alternative was 'clinical oncologist'. Much of the general comment related to perceived loss of control of clinical and academic aspects of oncology to other specialties. The present survey is the first to define current work practices and to explore attitudes to work. It is clear that many RO consider clinical workloads to be excessive, to the exclusion of other work-related activities. There was a strong feeling that significant changes will be required if RO are to maintain the role in cancer management for which they are trained.