Understanding retention in radiation oncology: quantitative findings from the retention survey by the ESTRO Early Career Committee.

Abstract

Workforce pressures are intensifying across radiation oncology. Staff retention has become a priority, yet workplace factors driving retention across radiation oncology disciplines remain insufficiently understood. This study aimed to quantify intent to leave and identify workplace factors associated with intent to leave in radiation oncology. An international cross-sectional online survey, by the ESTRO Early Career Committee, was developed based on staff retention literature, and distributed to professionals across radiation oncology disciplines, between May and August 2025. Workplace factor scales were constructed from a theoretically derived Qualitative framework based on open-ended responses. Binary logistic regression models, adjusted for demographic covariates identified independent predictors of intent to leave. Robustness was assessed through multiple sensitivity analyses. Of the 788 responses across 53 countries, 696 completed the question regarding intent to leave; 51.7% reported intent to leave their current position. This exceeds general healthcare benchmarks (20-40%). Turnover intent was highest among RTTs (50.4%), with overall pronounced country-level variation (range 16.7-92.3%). Three workplace scales independently predicted intent to leave: Team Culture and Collaboration (OR 0.35, 95% CI 0.22-0.55, p < 0.001), Wellbeing (OR 0.37, 95% CI 0.24-0.57, p < 0.001), and Career Development (OR 0.61, 95% CI 0.43-0.86, p = 0.004). RTTs showed nearly twofold higher adjusted odds of reporting intent to leave than radiation oncologists (OR 1.78, p = 0.057). Findings remained consistent across sensitivity analyses. Intent to leave in radiation oncology is alarmingly prevalent. It was most strongly associated with team culture and collaboration, wellbeing and career development. These potentially modifiable factors represent actionable targets for retention efforts.