Session Item

To identify and report radiation oncologist (RO) workforce characteristics (demographics, clinical workload, and employment details), equipment inventory and technology utilization in Canada.

The Canadian Association of Radiation Oncology (CARO) distributed an online survey to RO administrative leaders at 47 Canadian cancer centres providing radiotherapy services from May to September 2019 to capture workforce characteristics, including RO demographics, clinical workload, and employment/compensation models in 2017 and 2018, as well as equipment inventory and technology utilization in 2018. The questionnaire was modelled after the published 2017 workforce/equipment survey of 2016 data (Loewen et al. Int J Radiat Oncol Biol Phys 2019;105(1):42-51), re-analyzed here for all centres in common, to permit trend analysis.

Response rate was 79% representing 37 of 47 centres for analysis. In 2018, there were 411 ROs in practice compared with 379 ROs in 2016 from the 2017 survey for these same 37 centres, demonstrating an 8.4% increase in staffing. Approximately half (211 ROs) were ≥ 46 years old. The RO full-time equivalent (FTE) to RO ratio was 0.92 with 77 ROs (18.7%) having less than 1.0 FTE clinical activities due to administration, research, or part-time employment. National male-to-female ratio was 1.5:1 and was age-dependent. Regional male-to-female ratios varied widely with the highest ratio in Ontario (3.4:1) and lowest in Quebec (0.8:1). Average annual consultations per FTE-RO in 2018 was 261/year compared to 262/year in 2016 for these 37 centres. The majority of ROs were employed as contractors (53.0%) and remunerated with a hybrid fixed and performance-based compensation model (55.7%). Most centres (40.5%) reported an increase in compensation from 2016 to 2018, whereas 37.8% conveyed no change and 21.6% experienced lower compensation. Approximately one-quarter (24.7%) of the 190 reported linear accelerators in operation were older than 10 years and operating beyond the equipment’s recommended lifespan compared to 22.5% (42/187) in 2016 (P = 0.12). Lung SBRT utilization among Canadian centres was 91.9% (34 of 37 centres), while intracranial SRS and non-lung SBRT utilization rates were 51.4% (19/37 centres) and 59.5% (22/37 centres), respectively. Only 7 of 17 centres (41.2%) located in regions with ≤ 150,000 persons had SRS or non-lung SBRT practice compared to 16 of 20 centres (80.0%) in regions with > 150,000 persons (P = 0.02).

The Canadian RO workforce continues to demonstrate incremental growth in staffing with stable annual caseload in the short-term compared to the 2016 data. Government funding is required to replace aging equipment in Canada. Lower intracranial SRS and non-lung SBRT utilization in smaller community settings suggest geographic disparity of advanced technologies that may limit cancer care accessibility of modern practice techniques for Canadian cancer patients.