Purpose/Objective(s): Recent literature has demonstrated conflicting predictions for the future of the radiation job market. Residents and practicing radiation oncologists (ROs) report perceptions of an increasingly saturated market. An additional factor contributing to the job landscape is the potential geographic maldistribution of ROs in the United States. Given the importance of the evolving job market and appropriate supply and demand for future radiation oncologists, we investigated whether residency training location influenced employment location and analyzed whether “portability” of a residency has changed over time (2003-2015).

Materials/Methods: Residency graduates were identified from archived Association of Residents in Radiation Oncology (ARRO) directories from 2003 and 2012. This information was cross-referenced with the American Society for Radiation Oncology directory to determine location of current employment. To determine graduation year and location of first employment, an internet based survey was distributed to attending physicians identified in the ARRO directories. From the survey, two cohorts were identified, an early cohort which graduated from 2003-2006 and a contemporary cohort which graduated from 2012-2015. The location of residency training and employment were categorized in four regions per the US Census Bureau: Northeast (NE), South (S), Midwest (MW), and West (W).

Results: A total of 848 graduates were surveyed, of which 198 responded (23% response rate). Graduation year and location of first job were available for 145 ROs. Analysis of training location revealed that 26%, 27%, 34%, and 13% were trained in the NE, S, MW, and W regions, respectively. Analysis of first employment location demonstrated that 23%, 24%, 30%, and 23% were employed in the NE, S, MW, and W regions, respectively. Graduating residents were more likely to remain employed in the region in which they trained (p<0.05), with 54% finding their first job in the region of their residency training. Of the 145 ROs, 139 graduated between 2003-2006 (n=47) or 2012-2015 (n=92). Portability of residency was not significantly associated (p=0.50) with year of residency graduation. Of the early cohort, 49% secured their first job in the region in which they trained, compared to 57% of the contemporary cohort (p=0.39). Of the 848 graduates, 817 had current employment in the United States. Graduating residents in the S and W were more likely (p<0.05) to be employed in their respective training regions when compared to those trained in the MW and NE. 70% of residents from W programs and 66% of residents from S programs were employed in their respective regions compared to 50% of residents from NE and MW programs.

Conclusion: This analysis suggests that graduates are more likely to settle into practice within the region in which they trained. Over a ten year period, there was no appreciable shift in employment by geographic region.