Modern Workforce in Academic Radiation Oncology: Challenges and Opportunities

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Cancer care for themodern patient has become increasingly complex with the competing need to deliver care in closer approximation to the home of the patient. This raises challenges for the modern department of radiation oncology in balancing geographically determined cancer care with academic growth. Career development had uniformly been symbiotic with practice locations at central academic medical centers. The modern workforce needs to adapt and achieve academic growth in centers aligned with health care networks. This manuscript addresses many of the challenges posed by this dichotomy and offers potential problem-solving strategies and solutions to ensure academic success.

The practice of radiation oncology has undergone significant change over the past thirty years. Today, over 60% of cancer patients receive curative/palliative radiation therapy as a component of their disease management. More than 75% of these patients receive radiation therapy with intent to cure, an increase from 50%, thirty years ago. This has significantly changed the modern practice of radiation oncology. Clinical decision strategies are now inherently more complex with influence from patient-specific medical comorbidities, tumor-related information, and image-based information of normal tissue function. These factors define the extent of normal tissue sparing and need for complex volumetric treatment planning. This has promoted, in part, subspecialty practice with multidisciplinary partners including radiation oncology. The time and effort associated with team-patient management should be acknowledged as part of team-oriented metrics for measuring clinical productivity and professional academic growth of each faculty member. 

The technology of radiation therapy has become exceptionally complex and patient expectations for both outstanding clinical service and clinical outcome have never been higher as measured by patient satisfaction surveys. Modern oncology patient care has become a concierge clinical practice. Because we interact with patients and almost all medical/surgical service subspecialties on a near daily basis, often radiation oncologists are called upon to bridge gaps in service between multiple health care providers, patients, and families. Radiation therapy treatment planning is volumetric and image driven with treatment execution uniquely image guided, making radiation oncology dependent on many imaging tools. As radiation oncology technology has evolved, the skill set of the modern radiation oncologist has had to adapt at multiple levels including acquiring personal real-time expertise in specific work-related information previously reserved for colleagues in other medical, surgical, and radiology practices. Radiation oncologists now often bridge information between surgical and medical colleagues to reconcile issues in daily patient care. To be an effective member of the oncology multidisciplinary team, the radiation oncologist must be fluent in the strengths and limitations of surgical and medical team members as well as understand how advanced technology imaging tools and other evolving biomarkers will affect modern practice. Although radiation oncology functions as a department, individual faculty are now woven into a matrix of patient-centered multidisciplinary partners. An important aspect of modern practice is to learn how to function in a team-oriented patient care approach when team members may not fully appreciate the strengths and training limitations of the radiation oncologist. As a result, radiation oncology department leaders need to understand the challenges imbedded within the workforce and apply guidelines for department function to 1) ensure patient care needs are met 2) the intradepartmental workforce and workflow needs are met and 3) productivity expectations are balanced with individual faculty academic growth and career development.