Radiation Oncology Clinics Struggling With Workforce Shortages, Survey Finds

Clinics are particularly challenged in finding technical staff such as radiation therapy technologists and physicists.

More than 9 in 10 radiation oncologists report that their practices face clinical staff shortages, according to a new national survey from the American Society for Radiation Oncology (ASTRO).

Workforce shortages are widespread in the healthcare sector. Nursing shortages are being reported across the country, and the physician labor market is reportedly tighter than ever.

The new national survey on radiation oncology staffing shortages is based on data collected from 249 ASTRO members. The survey was conducted from March 24 to April 11. The survey has several key data points:

• 93% of radiation oncologists reported that their practices are facing shortages of clinical staff, including nurses, therapists, physicists, and dosimetrists
   
• 53% of radiational oncologists said the shortages are creating treatment delays for patients and 44% said the shortages are causing increased patient anxiety
   
• On average, practice operating costs are up 23% compared to before the coronavirus pandemic, with 77% of radiation oncologists reporting that professional staffing is driving increased costs
   
• Radiation oncologists reported that staffing shortages are forcing their practices to reduce support services, with 48% of the doctors saying they had reduced patient navigation services

Radiation oncology clinics are experiencing shortages of nurses, medical assistants, and front desk staff like other specialties, but the most acute shortages are in technical staff, says Constantine Mantz, MD, health policy council chair at ASTRO, chief policy officer at GenesisCare, and a practicing radiation oncologist at GenesisCare.

"We are struggling to employ permanent technical staff—particularly radiation therapy technologists, who are critical and irreplaceable to the process of delivering radiation therapy to cancer patients. We are observing an undersupply of graduating and certified technologists to meet the needs of the growing cancer patient populations in our markets. Also, more technologists appear to be taking on locum tenens work to earn more as temporary employees, further exacerbating the problem of finding stable technical staff needed for high-quality care," he says.

The pandemic has exacerbated longstanding shortages of technical staff at radiation oncology clinics, Mantz says. "The training programs have not been producing enough radiation technologists and physicists as the field demands. The coronavirus pandemic prompted retirements, changes in career plans, and other departures from the field. The workforce shortages have become much more acute. We are struggling with workforce in many markets, particularly smaller communities."

Radiation oncology clinics have tried to backfill their staffing needs through locum tenens hires brought on through temporary staffing agencies, he says. "That solution is very costly compared to having a permanent hire to do the work. Temporary staffing also compromises the quality of care because the continuity of care is disrupted when you have to bring in new staff on a temporary basis."

Responding to the shortages

Radiation oncology clinics are trying to boost the pipeline for technical staff, Mantz says. "We are trying to work through the training programs and schools that develop staff for our needs by sponsoring scholarships and providing internships in clinics to offer real-world experience. We are also providing stipends for education and other needs as a way of trying to retain people. The real answer is going to be expanding the training programs, which can be done through the accrediting bodies allowing an expansion of the number of sites that earn accreditation and certification to provide this type of education. At this point, that is the bottleneck."

Staff retention has become a top priority for radiation oncology clinics, he says. "The most effective approach is increasing compensation for the work to discourage our technical staff from looking for locum tenens work, which might pay more on a per week or per month basis. We try to elevate compensation for the staff, so they feel it is worth their while to stay."

However, increasing compensation is a challenge, Mantz says. "The problem with increasing compensation is that we face diminishing reimbursement for our services. Medicare payment has been on a consistent decline over the past 20 years for outpatient specialty care services such as radiation therapy. As margins shrink, it becomes increasingly difficult to compensate existing staff more, and it creates operational challenges that impact the bottomline."

Workforce prospects

About 80% of radiation oncologists surveyed reported that workforce shortages are worse than last year. Severe staffing shortages are likely to continue for the foreseeable future, Mantz says. "With the exception of premier cancer centers in urban centers, the rest of the country is going to face workforce shortages and difficulty meeting the demand for services. For the rest of this year, we will see continued pressure on clinics identifying and hiring much-need technical staff, and that is likely to play out for the next two or three years."

The staffing shortages are going to put pressure on providing services as the country's population ages, he says. "The problem is enhanced by the growing Medicare-aged population, which is the group of people that is most likely to develop cancers that we would treat with radiation therapy. The last Baby Boomer born in 1964 is going to be turning 65 years old in a few years. Between now and then, the population base of cancer patients is expected to grow commensurately with the Medicare population. We are going to encounter struggles over the rest of the decade to provide our clinics with sufficient qualified staff to render services."