Solo practices in radiation oncology dropped significantly between 2015 and 2023, while the number of large practices increased by more than half, according to a study published March 4 in the International Journal of Radiation Oncology, Biology, and Physics.
The finding supports the claim that radiation oncology is among the most consolidated specialties in health care, noted lead author Sifan Grace Lu, a medical student at SUNY Downstate Health Sciences University in Brooklyn, NY, and colleagues.
“Maintaining a practice in radiation oncology, a complex specialty requiring modern software, expensive equipment, and a large treatment team, is expensive. Additionally, close collaboration with other specialties, including medical oncology and surgical oncology, is essential to maintain patient volume,” the group wrote.
Quantifying trends in radiation oncology workforce patterns is important at this time, especially as the field considers new alternative payment models that will shift radiation oncology reimbursement from fee-for-service to bundled payments, the authors explained. Moreover, prior reports of practice patterns among radiation oncologists have been largely based on survey data, which can be subject to bias, they noted.
In this study, the researchers dove into Medicare records and culled data on recent changes in practice patterns, including rates of retirement, new entry, and job changes, without the use of survey data.
According to the analysis, between 2015 and 2023, the number of practicing radiation oncologists increased from 4,399 to 5,087 (16%) and the number of practices that employed the specialists decreased from 1,620 to 1,416 (13%).
Other key findings included the following:
- The mean number of radiation oncologists per practice increased from 3.5 to 4.6.
- The number and share of solo practices decreased by 27% (614 to 451) and 16% (from 38% to 32%).
- The number and share of large practices increased by 51% (from 88 to 133) and 74% (from 5.4% to 9.4%).
In addition, radiation oncologists retired (2.5% per year) and entered the workforce (4.1% per year) at steady rates, resulting in a 16% increase in the size of the workforce. Finally, radiation oncologists changed jobs at a mean annual rate of 4.2%, with women, early-career physicians, solo-practitioners, and specialists from rural practices most likely to undergo job changes, the authors reported.
“[Radiation oncologists] are increasingly working in fewer and larger practices, indicative of a trend in practice size consolidation between 2015 and 2023,” the group wrote.
Ultimately, to their knowledge, the authors noted the study is the first to quantify recent changes in practice patterns among radiation oncologists in the U.S., including rates of retirement, new entry, and job change, without the use of survey data.
The increase in practicing specialists and simultaneous decrease in practices represents consolidation, as smaller groups are likely merging into larger organizations, they added.
“Larger practices, which are more likely to benefit from interactions with multiple specialties and internal patient referrals, may be more financially viable and thus able to obtain significant market share. Large practices may also have greater bargaining power to negotiate higher reimbursement rates from insurance companies and attract a greater number of specialists,” the group suggested.
The full study is available here.
