Reasons for Declining Applicant Numbers in Radiation Oncology From the Applicants' Perspective: Results From the Applicant Concerns and Radiation Oncology Sources Survey (ACROSS).

Purpose: Applications to radiation oncology in the United States have decreased the past 3 years, resulting in unfilled residency positions (30 [14.5%] in 2019 and 35 [18.5%] in 2020). The aim of this study is to understand the concerns among radiation oncology applicants and whether these concerns may have led to a decline in applications.

Methods And Materials: An Internet-based survey was e-mailed to all radiation oncology applicants participating in the 2020 National Resident Matching Program Match for whom e-mail addresses could be obtained (n = 145, 78.8%). The survey was open from May to September 2020.

Results: Survey responses were received for 98 applicants out of 145 (67.6%) available applicant e-mails. Applicants' top-rated concerns were location of practice restrictions and residency expansion/oversupply of practicing physicians. Applicants were less concerned about a lack of exposure to the field of radiation oncology, competitiveness of the match, and the content of residency training. The sources of information which applicants used most, which applicants trusted most, and which promoted the most optimism among applicants were radiation oncology attending and resident physicians. The sources of information which applicants used least, which applicants trusted least, and which promoted the most pessimism among applicants were online resources. As a result of their concerns, 27 (28%) respondents strongly considered choosing a different field of medicine. Applicants identified 93 fellow graduating medical students who were interested in radiation oncology but chose not to apply; applicants reported that potential applicants chose not to apply most often due to concerns about location of practice restrictions and residency expansion/oversupply of practicing physicians.

Conclusions: Applicant concerns about residency expansion and location of practice restrictions are prevalent and may have led to declining applications to radiation oncology. To assuage applicant concerns, radiation oncology stakeholders must address these concerns by mitigating underlying problems.