Revealing the Rurality Rank: A novel evaluation of training opportunities in US radiation oncology residency programs

Purpose: Exposure to patients from rural communities during residency training can enhance learning opportunities and increase the number of providers who ultimately pursue careers in rural practice. Rural populations often have increased risk of malignancy, decreased access to healthcare, and disparate socioeconomic burdens compared to residents of urban communities. The degree to which radiation oncology programs offers exposure to patients from rural communities has not been previously described. This analysis was completed to define and quantify a novel metric of residency program evaluation.

Methodology: Information for radiation oncology residency programs was extracted from American Medical Association and Accreditation Council for Graduate Medical Education databases. Department addresses were geocoded and used to generate 120-minute drive-time catchment areas segmented into 10-minute subzones. Rural-Urban Continuum Codes (most urban = 1, most rural = 9) provided by the US Department of Agriculture and county shapefiles provided by the US Census Bureau were used to calculate a composite rurality score adjusted with a Gaussian decay factor by subzone to give less weight to the portions of counties nearing the edge of the catchment area.

Results: Eighty-nine residency programs were evaluated. The least and most rural composite rurality scores were Loma Linda and Dartmouth at 1.02 and 5.64, respectively. The first, second, and third quartile rurality scores were 1.36, 1.93, and 2.77, respectively. Table 1 displays the 10 most rural and the 10 least rural residency programs.

Conclusions: This study represents the first quantitative analysis of US radiation oncology residency programs based upon the rurality of surrounding populations. The rurality score can provide additional information when evaluating residency programs. Given the known regional geographic link between training and independent practice location, these results can be a valuable surrogate for future supply of radiation oncologists in historically underserved communities. In the event of future contraction of radiation oncology residency programs, this novel metric may be important to consider for maintaining high-quality and equitable care, in addition to preventing further declines in the supply of practicing radiation oncologists in rural locations.

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