Yu Catherine, Hsieh Kristin, Cherry Daniel R, Runnels Juliana, Rowley Jared P, Sindhu Kunal K
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Radiation Oncology, Maimonides Medical Center, Brooklyn, New York.
Int J Radiat Oncol Biol Phys. 2025 May 18. doi: 10.1016/j.ijrobp.2025.05.017.
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.
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.
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).
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.
近年来，放射肿瘤学（RO）住院医师中不到5%的人毕业后立即在非大都市地区接受了长期职位。在本研究中，我们试图确定与执业地点相关的因素，并研究这些社区的县级参数。
利用多个公开可用数据源，我们建立了一个2015年至2022年毕业的美国RO住院医师数据库。随后，我们确定了每位毕业生接受的第一份长期工作，并确定其城乡连续代码。使用逻辑回归模型来确定在非大都市县接受第一份工作的预测因素。利用地区卫生资源文件，我们进行了二次分析，以确定与大都市（metro）和非大都市队列中近期毕业生地理密度增加相关的县特征。
在2015 - 2022年的RO毕业生中，1396人中有60人（4.3%）在非大都市县接受了第一份工作，其中60人中有24人（40.0%）位于不与大都市地区相邻的非大都市县。在多变量分析中，规模较大的住院医师培训项目（由2015年至2022年毕业生总数定义）的毕业生在非大都市县接受第一份工作的可能性较小（优势比，0.96；95%置信区间，0.94 - 0.99；P <.01）。在大都市和非大都市队列中，近期毕业生的第一份工作都位于人口较多（P <.01）、人口密度较高（P <.01）、家庭收入中位数较高（P <.01）、医院护理可及性更高（P <.01）以及每10000人中有更多初级保健医生（P <.01）的县。
即使分别考虑大都市和非大都市社区，近期RO毕业生的地理分布似乎也与人口和医疗资源的几个指标相关。这些发现表明，未来旨在改善美国各地RO服务公平可及性的努力可能比仅仅解决大都市/非大都市差距更具挑战性。
