In light of the persistent disparity in the prevalence of radiation oncologists between rural and urban areas in the United States, we sought to characterize the geographic employment outcomes of the radiation oncology (RO) residency class of 2021.

Methods and materials:

We identified the employment positions accepted by 2021 RO residency graduates using publicly available information. We then classified each position as Academic or non-Academic. Next, we determined the rural-urban continuum code (RUCC) and core-based statistical area (CBSA) of each position, residency program, and medical school associated with the 2021 graduates. Lastly, we compared the geographic employment outcomes of the 2021 class with those of the 2019 class.


Most 2021 graduates accepted employment positions outside of the counties, CBSAs, and states in which they attended medical school or residency. 116 graduates accepted non-Academic positions and 65 graduates accepted Academic positions. 9 graduates accepted fellowships and were excluded from this analysis. As with the class of 2019, most 2021 graduates (N = 104, 57.5%) accepted positions in the largest metropolitan areas and few (N = 11, 6.1%) accepted positions in nonmetropolitan areas. Female residents were more likely to accept Academic (48.9% versus 31.3%, p = 0.03) and Academic main site (36.2% versus 21.6%, p = 0.05) positions than were male residents. The distribution of jobs in both the five and ten largest CBSAs was not significantly different from what would have been expected if jobs were equally distributed across the country on the basis of population (p = 0.81 and p = 0.87, respectively); however, it was significantly different from what would have been expected if the distribution of such positions reflected the number of residents who graduated from residency programs in those CBSAs (p < 0.01 and p < 0.01, respectively).


As with the class of 2019, the majority of graduates in the class of 2021 accepted employment positions in large metropolitan areas. Relatively few graduates accepted positions in nonmetropolitan areas. How key RO stakeholders respond to the challenge of maintaining a stable supply of rural radiation oncologists, while at the same time ensuring that the jobs available to graduating RO residents reflect their preferences, will have a significant impact on the field going forwards.

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Geographic Employment Outcomes for Graduating Residents in Radiation Oncology: 2021

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