Unveiling oncologists' geographical journey: Analyzing hematology/oncology fellowship graduates' relocation patterns and their impact on regional disparities in cancer care.
Authors: Patel Raag , Keruakous Amany R. , Vuppala Rohan , Nulu Chakravarth , Weeks Charlie , Reategui-Almonacid Yazmin , Bhave Aditya , Saminath Gandhi Maru , Anil Vishwanath , Yakoub Danny 
Published: June 2024

9006

Background: The geographical distribution of Hematology/Oncology fellowship graduates (HOFs) is essential for shaping healthcare delivery and illuminating regional health disparities in cancer care. This study explores the relocation patterns of HOFs during key transitions: from medical school to residency (T1), residency to fellowship (T2), and fellowship to the first attending position (T3). The aim is to gain insights into the geographical aspects of cancer care disparities. Methods: This study analyzes the transitions of 329 graduates from 61 ACGME-accredited HOF programs that offered public data about their alumni from 2019-2022. Geographical relocation was measured by the straight-line distance in miles, with the U.S. divided into four regions for retention assessment. A Welch two-sample t-test was conducted to compare average travel distance between each transition. Additionally, relocation patterns were compared between graduates from top 50 NIH-funded medical schools (T50MS) and others (nonT50MS). Results: During T1, HOFs covered a significant distance (661.7 miles), which decreased during T2 (436.5 miles) and T3 (344 miles) (p<.001). Retention analysis revealed a decrease in the percentage of trainees traveling more than 200 miles from T1 (57%) to T2 (46%) to T3 (35%). No significant distance difference was observed between T50MS and nonT50MS during T1 (616 vs 693 miles) and T2 (431 vs 439 miles). However, T3 showed T50MS graduates traveling less (262 miles) compared to their nonT50MS counterparts (401 miles, p<.05). Regional retention increased from T1 (57.5%), to T2 (70%) to T3 (75.4%), with the Western region demonstrating the highest retention across all transitions (T1: 78%, T2: 92%, T3: 83%). The Southern region displayed the lowest retention rates during T1: (44%) and T2: (48%), whereas the Northern region had the lowest during T3 (62%). Conclusions: The preference for relocation beyond 200 miles during T1 reflects a commitment to expanding clinical expertise and gaining varied perspectives critical in addressing complex cancer challenges. As trainees progress, a shift towards establishing roots near previous training sites suggests the allure of established professional and personal networks. T50MS graduates' inclination to stay within a smaller radius during T3 suggests expertise retention in resource-rich areas, potentially exacerbating regional disparities. Marked retention differences, particularly the Southern region’s low retention during training and the Northern region's during practice establishment, reveal a concerning workforce distribution trend. These findings emphasize the necessity for targeted policy interventions aimed at improving equitable distribution of the oncology workforce, thus ensuring uniform access to quality cancer care nationwide.