The Rural Landscape: Navigating Workforce Challenges
Diane Kean, Senior Communications Manager, ASTRO
Workforce issues like recruiting and retention are nothing new for radiation oncology practices, and we know the problems outlined in the other articles in this issue of ASTROnews are especially exacerbated in rural facilities. We took this opportunity to talk with three radiation oncologists practicing in rural or rural-suburban areas spanning coast to coast to better understand their situations and glean potential solutions from their experiences on how to manage shortages and remote workers.
Anna Paulsson, MD, a radiation oncologist with the large multispecialty group Providence, is based out of a three-facility branch, located about 40 miles north of San Francisco. While the facility itself is more suburban, many patients travel from locations all along the northern California coast. These locations are typically rural and underserved, with patients traveling upwards of three hours for treatments, with no public transportation options available. In terms of hiring among the three radiation oncology offices, where four radiation oncologists split their time, the most difficult positions to fill have been radiation therapists. “Most of our therapists right now are locums, with about two or three permanent staff across the three offices,” said Dr. Paulsson. In her experience, locums staff stay on for about a month, but a couple have stayed four or five months, but that is unusual.
Similarly, David Beyer, MD, FASTRO, Medical Director, Radiation Oncology at Cancer Centers of Northern Arizona Healthcare, Sedona and Flagstaff, shared, “I think staffing is one of the most difficult problems facing rural clinics. We have a one doc[tor] single linac center with a similar sister center in the next county. We share a lot of staff. We have been actively trying to recruit an RTT for at least a year. We are trying to staff three RTTs at each site and require two in order to treat. While this job is posted on the ASTRO site, we have tried elsewhere as well. We have an RTT who keeps trying to retire and we keep bringing her back as a PRN. She is now retiring for real, and our need is acute. I think this is our biggest challenge. We have used travelers on many occasions but finding a reliable tech is tough, particularly for a long stretch of time.”
For dosimetrists, and in some cases medical physicists, many facilities have had to embrace remote work to stay fully staffed. Dr. Beyer added, “Two of our three dosimetrists do not even live in Arizona, much less our town. Similarly, we almost never have two on-site physicists but our three [physicists] share in-person and remote work.” Without the flexibility in scheduling and openness to new working situations, “We never would have survived the past few years,” said Dr. Beyer. “I worry about what will happen when inevitably one of our physicists gives notice. These positions are hard to fill, and I know we have been lucky.” Dr. Beyer’s team carefully works the schedule to ensure that all positions are filled for SBRT, brachytherapy and other cases, which can sometimes impact patients’ treatment times or days.
Christopher Jahraus, MD, a radiation oncologist in Alabaster, Alabama, shared his perspective as a solo-practitioner who has worked in rural and rural-suburban settings. For his practice, nursing staff have been the hardest to fill, followed by therapists. “I’m blessed to have a great team that includes a long-time physicist who works with me, mostly remotely, and on site when needed,” said Dr. Jahraus. “I’ve outsourced dosimetry, because it’s very hard to find employees who are willing to really commit to both the busy and the not-so-busy times.” The expectation of on-site employees tends to be full salary when it’s slow, but 40-hours per week max, even when it’s busy. Again, outsourcing has been our enemy with respect to expectations, but for me, I happen to have a phenomenal dosimetrist with whom I work remotely, so there are winning opportunities.”
A common theme across all offices is how vacancies impact the practice. Many staff have to work overtime, long into the evenings to manage the patient load, and vacancies can impact the length of time between a patient consult and treatment starting. A practice needs to devise creative solutions when not fully staffed. In this scenario, Dr. Jahraus observed, “It’s all about technology [for my practice] and trying to get it at a cost that is sustainable. For dosimetry, AI normal tissue contouring has been a huge help. It lets our dosimetrist operate much more efficiently by reviewing generally well-devised contours, but that too adds to the overall cost, often quite substantially.”
“We currently have a therapist in dosimetry school,” said Dr. Paulsson. At her practice, they’ve found that hiring individuals with connections to the local area, such as family nearby for example, has proven to make them more likely to stay at the job longer. In addition, reaching out to training programs has been helpful. Dr. Paulsson, who is vice-chair of the ASTRO Early Career Committee shared a final thought. “When thinking of physicists, mentorship is a particularly strong need. Transitioning from an academic or training setting to a practice, the departments are inherently smaller with fewer colleagues. We don’t often recognize how challenging that is and need to support people better through that transition.” Whether in a rural or urban setting or something in between, Dr. Paulsson conveys that flexible and creative thinking is critical for practices to optimize their staff availability.
