Faculty of Radiation Oncology 2022 New Zealand Workforce Census

ABSTRACT

This study reports the findings of the 2022 Royal Australian and New Zealand College of Radiologists (RANZCR) workforce census, providing an updated overview of the New Zealand (NZ) radiation oncology workforce. The purpose was to assess workforce demographics, distribution, training, and service capacity, and highlight challenges that have persisted since the 2018 census.

Methods

A survey was distributed to all practicing radiation oncologists and trainees in NZ. Data were collected on demographics, qualifications, workload, practice setting, subspecialty involvement, training experiences, and the perceived impact of COVID‐19. Responses were collated and descriptive analyses performed.

Results

The census recorded a workforce with a median age of 51 years (range 33–71), and 43% female representation. Most worked across both public and private sectors, with high reported working hours. Brachytherapy practice participation declined compared with previous censuses. Among trainees, concerns included workload, job availability, and work–life balance, with many indicating a preference for part‐time and/or urban practice. COVID‐19 was associated with delays in service delivery, though the majority reported no exam or fellowship disruptions. Anticipated increases in hypofractionation use were noted.

Conclusions

The 2022 census highlights a workforce under strain from high clinical demand, limited growth, and looming retirements. Key challenges include inequitable representation of Māori and Pasifika clinicians, declining subspecialty capacity, and risks of burnout. Coordinated national workforce planning, with a focus on recruitment, retention, equity, and flexible models of training and employment, will be essential to ensure sustainable radiation oncology services in NZ. This census therefore reinforces the urgent need for coordinated national workforce planning to safeguard the future of radiation oncology services in NZ.

1. Introduction

This paper reports on responses from New Zealand (NZ) from the seventh Royal Australian and New Zealand College of Radiologists (RANZCR) workforce census of radiation oncologists and trainees in Australia, NZ and Singapore. Previous studies were undertaken in 1996, 2000, 2006, 2010, 2014 and 2018 [1, 2, 3, 4, 5, 6]. A paper pertaining to the full cohort in 2022 was published in JMIRO [7]. The 2014 survey was the first designed to enable analysis by country, so this is the third survey reporting NZ specific data [8, 9]. This was the first census conducted since the COVID‐19 pandemic which triggered unprecedented changes to health services globally. Several reviews and meta‐analyses have shown that a substantial proportion of healthcare workers experienced clinically significant levels of psychological distress during the pandemic [10].

The information obtained in this census will be used to analyse workforce trends, identify potential strengths and challenges, and understand the impact of the COVID‐19 pandemic on the workforce. Longitudinal analysis of the survey data may guide future staffing and training requirements. Country‐level data allowed comparisons to be made regarding work practices.

2. Methods

The 2022 workforce census was conducted from June to October 2022. All active radiation oncologists and trainees listed on the FRANZCR database were invited to participate. Questions were designed and tested by the Economics and Workforce Committee (EWC). A key purpose of the census was to analyse workforce trends, so many of the questions were repeated from the 2014 and 2018 census. There was a separate section for questions related to the impact of COVID‐19 on trainees.

The census was distributed via Survey Monkey with weekly email reminders. It was closed at the end of October 2022. Some respondents did not answer every question, and logical rules resulted in a differing number of respondents between questions. For example, for radiation oncologists who identified themselves as retired, questions regarding work hours or workplace were omitted. Duplicate responses were avoided by monitoring responses against RANZCR member identification numbers. The responses were analysed to highlight workforce trends. The analysis was done with Microsoft Excel. The actual census questions are included as Data S1.

3. Results

3.1. Radiation Oncologists

3.1.1. Eligible Study Sample

All radiation oncologists and trainees registered on the RANZCR database as of June 2020 were eligible. This included those retired, working overseas, and educational affiliates who work as practising radiation oncologists in NZ.

In NZ, the census was sent to 74 radiation oncologists with responses from 49 (66%). This response rate was higher than for Australia (n = 235/461; 51%) and similar to 2018 (73%) [7, 9]. The survey cohort was representative of the full cohort, with gender ratios of respondents comparable to the membership at the time of the survey, as was the range of ages of respondents (33–71 in both, with averages of 49.8 in the membership vs. 50.7 in survey respondents). Table 1 outlines full respondent demographics.

TABLE 1.

Respondent demographics.

Variable	Radiation oncologist		Trainee
	n	%	n	%
Gender
Female	21	43	14	58
Male	28	57	10	42
Total	49		24
Male to Female Ratio	4:3		5:7
Age
25–34	1	2	14	58
35–44	13	27	10	42
45–54	19	39	0	0
55–64	7	14	0	0
> 65	9	18	0	0
Average age (Years)	50.7		34.5
Median age (Years)	51		34
Ethnicity
New Zealand	21	43	12	50
Asian	11	22	9	38
Australian	3	6	1	4
European	6	12	1	4
African	4	8	0	0
Other	4	8	1	4
FTE a
< 1.0	6	14	11	79
1	21	50	0	0
> 1.0	15	36	0	0
Unsure	0	0	3	21

^a Trainee respondents were asked what FTE they anticipate, compared with Radiation Oncologists who listed their total contracted FTE.

3.1.2. Personal and Demographic Data

According to the RANZCR database, 61% (n = 45/74) identified as male and 39% (n = 29/74) as female. The mean age was 51.0 years, with a median of 51 years (range 33–71).

Participants were asked to nominate the ethnicity with which they most strongly identified. The largest proportion reported being New Zealander (n = 21/49; 43%), with (n = 3/49; 6%) identifying as Australian. Other substantial groups included those of Asian origin (Chinese, Southeast Asian, Korean, or other; n = 8/49; 16%) and Indian (n = 4/49; 8%). No respondents identified as Māori or Pacific Islander in this census.

3.1.3. Special Interest Areas and Generalist vs. Subspecialist

Most respondents identified as subspecialists (n = 21/35; 60%), with 40% (n = 14/35) identifying as generalists. This distribution is comparable to the Australian cohort, where 64% (n = 106/165) reported subspecialisation [7].

Participants were asked to indicate their areas of subspecialty interest, revealing almost identical results to Australia (Table 2).

TABLE 2.

Special interest areas—Australia and New Zealand.

	New Zealand		Australia
	n	%	n	%
Stereotactic	22	45	104	44
Breast	20	41	104	44
Urological	17	35	87	37
Lung	16	33	76	32
Neurological cancers	15	31	56	24
Palliative	15	31	72	31
Brachytherapy	14	29	42	18
Gastrointestinal	14	29	75	32
Head and neck	14	29	62	26
Skin	13	27	85	36
Gynae‐oncology	11	22	43	18
Lymphoma	10	20	52	22
Sarcoma	9	18	26	11
Paediatrics	4	8	11	5
Other	4	8	10	4
Endocrine	2	4	3	1
Theragnostic	2	4	7	3

3.1.4. Leadership Positions

Fifty‐five percent (n = 24/44) of respondents held leadership positions. This figure has increased from 49% in 2018. Over half, 57% (n = 25/44), of male respondents held at least one leadership position, along with 50% (n = 22/44) of female respondents.

3.1.5. Practice Location

Respondents worked at an average of 2.1 sites with a median of 2.0 (range 1–7). More worked exclusively in the public sector (n = 23/49; 47%), over one‐third (n = 19/49; 39%) worked across both public/private and no respondents reported working solely in private practice. In 2018 these numbers were 63%, 32% and 5% respectively. Seven (14%) provided no response. In contrast, 13% (n = 31/235) of Australian respondents work exclusively in private practice.

3.1.6. Work Hours

Total number of hours worked (onsite and offsite), and clinical hours spent each week are reported in Table 3.

TABLE 3.

Reported total actual and clinical hours per week by geographical location for radiation oncologists.

	Actual hours (onsite + offsite)		Clinical hours
	Mean	Range	Mean	Range
Australia	42.5	5–80	34.1	4–96
ACT	43.4	32–65	37.0	29–46
NSW	40.8	5–68	31.1	4–96
QLD	42.0	12–70	36.3	10–85
SA	39.8	22–62	30.3	20–39
TAS	49.0	43–55	46.0	37–55
VIC	43.2	18–80	33.4	4–78
WA	52.5	30–71	45.3	32–57
NZ	50.4	25–74	37.9	8–69
Overseas	46.5	25–64	38.5	23–53

In line with Australian respondents, men reported longer actual hours and clinical hours compared to women: averages of 51.9 vs. 48.3 (median 50 vs. 48) and 41.6 vs. 32.5 (median 40 vs. 37.3), respectively.

NZ respondents reported working 7.9 actual hours and 3.8 clinical hours more per week on average compared to the Australian cohort and trail only Western Australia (52.5) in most actual hours (50.4) (Table 3). This also represents an increase in actual hours from 2018 (mean 47.4) [9]. Table 4 summarises weekly time spent on different tasks by NZ radiation oncologists.

TABLE 4.

Hours per week spent on activities for radiation oncologists—NZ.

New Zealand	Mean	Median	Range
MDT	4.4	4	1.5–10
New cases	6.6	6	2–16
Follow up cases	7.2	6	2–16
On treatment reviews	2.6	2	1–8
Simulation (hours per week)	1.8	1	0–5
Dosimetry (hours per week)	2.7	2	0–10
Contouring (hours per week)	6.9	6	2–25
Supervision of registrars (hours per week)	3.3	2	0–24
Research and trials (hours per week)	1.6	1	0–16
Practice management (hours per week)	3.5	2	0–30
Academic teaching (hours per week)	1.1	1	0–4
Jurisdiction/quality committees (hours per week)	1.3	1	0–6
Other (hours per week)	4.9	2	0–30

3.1.7. New Cases, Follow‐Ups, Treatment Reviews and Planning Hours

In comparison with Australia, NZ radiation oncologists reported on average spending more time on dosimetry (2.7 h vs. 2.3 h), MDT (4.4 h vs. 3.8 h), practice management (3.5 h vs. 2.7 h), and other (4.9 h vs. 4.2 h) which included college activities, triaging referrals, journal reading, administrative work and answering emails. They reported devoting a similar amount of time on new cases, simulation, jurisdiction/quality committees and academic teaching, and less time on follow‐up cases (7.2 h vs. 9.1 h), treatment reviews (2.6 h vs. 4 h), research (1.6 h vs. 2.5 h), and registrar supervision (3.3 h vs. 4.9 h).

Figure 1 shows the number of new patients consulted per radiation oncologist, per year comparing Australia and NZ. Notably, 54% (n = 19/35) of NZ respondents see 201–250 new cases per year, with the largest Australian respondent group (n = 44/165; 27%) seeing 151–200. Respondents averaged 57.0 min (m) for each new case, 21.8 m per follow‐up case and 12.8 m per treatment review, all of which were longer than in Australia (48.5 m, 17.2 m and 10.1 m, respectively).

FIGURE 1.

New patients consulted per year—NZ and Australia 2022.

Females averaged 66.4 m per new case compared with 51.0 m for men and reported spending more time on follow up cases (23.6 m vs. 20.7 m) and treatment reviews (13.9 m vs. 12.0 m).

3.1.8. Hypofractionation and SBRT

In line with Australia, most respondents use SBRT (n = 27/35; 77%) with the commonest sites lung, bone, and brain. Adoption of hypofractionation across disease sites is depicted in Table 5. Uptake of hypofractionation was reported using a Likert scale. Across all indications, NZ was more likely to use hypofractionation at least half the time compared to Australian respondents. Fifty‐eight percent (n = 22/34) of NZ radiation oncologists reported hypofractionation for breast (5 fractions) at least half the time, compared to 3% in Australia.

TABLE 5.

Hypofractionation use—New Zealand.

	Always	Most times	Half the time	Sometimes	No	N/A	Total responses
Breast (15/16 fractions)	6	7	5	7	0	11	36
Breast (5 fractions)	5	10	7	3	0	11	36
GBM (elderly 15 fractions)	7	9	1	2	2	13	34
Preoperative rectum (5 fractions)	2	7	4	5	1	17	36
Prostate (20 fractions)—excluding ultra‐hypofractionation (e.g., 7 or less)	11	7	0	2	0	13	33
Single fraction for bone metastases—excluding SBRT	10	19	3	2	1	2	37
Curative intent lung cancer (excluding SBRT; e.g., 20 fraction schedule)	4	7	1	7	1	15	35

3.1.9. Brachytherapy

Respondents practising brachytherapy reduced from 19 in 2018 to 14 in 2022. Mean age was 50.5 years (median 50.1 years.; range 33–71). Eleven of 14 planned to continue working in brachytherapy. The average percentage of time spent doing brachytherapy work was 43% (range 0%–100%). This consists of 28% Gynae‐oncology, 2.5% Uro‐oncology‐LDR and 12.6% Uro‐oncology‐HDR.

3.1.10. Remuneration

Remuneration was mostly via fixed income (n = 23/35; 66%) with the remainder a mix of fixed and incentive‐based (Table 6). More females reported fixed income compared to males (77% vs. 59%) in line with Australia, where more overall were on a mixed income (45% vs. 26% in NZ).

TABLE 6.

Renumeration types—New Zealand.

	Public		Public/Private		Private
	n	%	n	%	n	%
Fixed	19	100	4	25	0	0
Mixed	0	0	9	56	0	0
Incentive	0	0	3	19	0	0
Total respondents	19	100	16	100	0	0
	New Zealand (Total)		Female		Male
Income type
Fixed	23	66	10	77	13	59
Incentive Based	3	9	1	8	0	0
Mixed	9	26	2	15	9	41
Total	35	100	13	100	22	100

3.1.11. Employment and Future Practice

Over two‐thirds of employed respondents (n = 25/35; 72%) indicated no intention to change their work hours over the next 3 years with 26% (n = 9/35) intending to reduce hours (n = 43/165; 26% in Australia). No NZ respondents reported unemployment at census time.

One‐third (n = 12/35) of respondents had no intention to retire in the foreseeable future (n = 81/165; 49% in Australia). A minority (n = 5/35; 14%) intended to retire within 5 years (age range 56–65; mean 63). Twenty‐two percent (n = 8/35) intend to retire in 6–10 years (age range 51–71; mean 60) with 29% (n = 12/35) intending to retire in 11–15 years (age range 48–57; mean 51).

3.1.12. Early Career

No respondents reported a period of unemployment after admission to fellowship. Respondents became a consultant (n = 21/49, 43%) or fellow (n = 19/49; 38%) or engaged in locum work (n = 9/49; 18%).

3.1.13. Impact of COVID‐19

Respondents commented on the impact of COVID‐19 on their working habits, with 37% (n = 18/49) suggesting their personal work patterns remained the same, with 22% (n = 11/49) spending more time working from home but managing the same workload. Twenty‐seven percent (n = 13/49) reported travelling less often to external clinics but managing the same workload remotely. One quarter (n = 8/49) reported absorbing extra workload due to unavailable colleagues, compared to 20% in Australia.

Sixty‐nine percent of respondents (n = 24/35) agreed that COVID‐19 drove their adoption of hypofractionation “a little”. In a follow up question, most respondents (n = 24/35; 69%) acknowledged that they will either continue to increase hypofractionation regardless of COVID‐19 or stay at COVID‐19 impacted levels (n = 8/35; 23%).

Seventy percent (n = 26/37) noted an increased workload. The mean increase was 10.4% (range −40% to +50%). More respondents indicated waiting times remained the same (n = 19/36; 53%), with 42% (n = 15/36) reporting an increase. In comparison, 75% of Australian respondents reported waiting times remained the same, with 15% reporting an increase. Other changes due to COVID‐19 included an increased use of telehealth, suspension of certain services, staff shortages, and changes to multidisciplinary meetings.

3.2. Trainees

3.2.1. Eligible Study Sample and Demographics

In comparison to the 2018 census, there was an increase of 11 trainees, with 33 invited to respond. The responding cohort, both in NZ and Australia, reflects the demographics of the RANZCR trainee membership in 2022. The age of trainees (mean 34.5) was similar to Australia, with a higher proportion of female trainees in NZ (58% vs. 44%).

Respondents were evenly distributed across the 5 years of training, with three respondents indicating they were beyond their fifth year of training.

Prior to medicine, over one third (n = 9/24; 38%) held another degree, with the most common being a Bachelor of Medical Science (n = 7) followed by Bachelor of Science (n = 2).

3.2.2. Perceptions of Radiation Oncology as a Career

Most (n = 18/24; 75%) were satisfied with their choice of career, and with their training network (n = 18/24; 75%). One quarter (n = 6/24) would have reconsidered joining the specialty if they were aware of a perceived oversupply.

The top factors influencing career choice were work hours, interest in oncology patients, lifestyle after training, lifestyle during training, and family considerations.

3.2.3. Duties and Protected Time

Most trainees reported spending 36–45 h (n = 11/21; 52%) on clinical duties, with 14% (n = 3/21) reporting each of 16–25 h, 26–35 h, and 46–55 h per week. One trainee reported spending over 55 h on clinical duties. Most respondents (n = 12/21; 57%) were on call after hours for 6–10 h per week, with 19% (n = 4/21) reporting 11–15 h and 24% (n = 5/21) reporting ≤ 5 h per week. This represents a higher on‐call workload than Australian respondents, where 58% were on call ≤ 5 h per week.

In line with the overall cohort, trainees had a median of 2 h (range 0–≥ 4) per week of protected time for teaching, but a median of 0 h (range 0–≥ 4) for research and other activities. Most NZ trainees (n = 19/21; 90%) reported spending ≤ 5 h per week on planning, compared with 77% in Australia. Similarly, 81% (n = 17/21) of NZ trainees spent ≤ 5 h per week contouring, compared with 66% in Australia.

At census time, no NZ trainees were working or intending to work part time, in contrast to seven trainees in Australia. However, 59% (n = 14/24) of NZ trainees expressed a desire to train part time, with women more likely to prefer this option.

3.2.4. Challenges Associated With Training

The most difficult aspects of radiation oncology training perceived by trainees were measured using a Likert scale from strongly disagree to strongly agree.

The greatest sources of stress were training demands (n = 20/24; 83%), balancing family/work responsibilities (n = 14/24; 58%), job demands (n = 10/24; 42%), and job prospects (n = 7/24; 29%). These mirror Australian respondents, excepting stress due to job prospects (n = 7/24;29% in NZ vs. n = 33/52; 63% in Australia). Seventy‐six percent (n = 18/24) found a mentor to be useful.

3.2.5. Impact of COVID‐19 on Training

Most trainees (n = 15/21; 71%) reported that COVID‐19 had a negative impact on their training. Most trainees (n = 18/21; 86%) indicated that COVID‐19 did not delay their exams. A smaller proportion (n = 4/21; 19%) indicated that the pandemic influenced their future career decisions, particularly in relation to work location and work–life balance.

3.2.6. Future Plans

Most (n = 18/21; 86%) intended to continue in radiation oncology with 29% (n = 6/21) wanting to complete a fellowship after training. These numbers are lower than the Australian cohort (98% and 52% respectively) and lower than NZ trainees in 2018 (100% and 67% respectively). Reasons for pursuing a fellowship were to gain special skills and expertise and to ease the transition into a consultant position (both n = 5/21; 24%), and to be more competitive in the job market (n = 3/21; 14%).

Most (n = 14/21; 67%) expressed interest in future teaching and becoming a director of training and/or examiner, 43% (n = 9/21) wish to participate in college committee work (n = 9/21; 43%) are interested in clinical trials and (n = 3/21; 15%) aim to have a higher degree completed during training.

Forty‐three percent (n = 9/21) indicated they wanted a job where a subspecialty clinical interest could be pursued.

Two thirds (n = 14/21) anticipate working part‐time for the first 10 years post‐training. This included all 11 female respondents. They indicated plans to work 0.5–0.6 FTE (n = 2/21; 10%), 0.7 to 0.9 FTE (n = 9/21; 43%), or a desire for part time work but unsure of hours (n = 3/21; 14%).

More prefer to work in an urban department (n = 10/21; 48%), with 33% (n = 7/21) undecided; 14% (n = 3/21) intend a combination of urban and rural practice, with one intending to work in a rural department. Fifty‐seven percent (n = 12/21) expressed an intent to work in both public and private with 43% (n = 9/21) wanting to work solely in public. One third (n = 7/21; 33%) intend to practice in the city that they trained in, 19% (n = 4/21) intend to work in a different city to which they trained, and 47% (n = 10/21) are undecided.

3.2.7. Future Concerns

The most common concern was job availability (n = 14/24; 58%), followed by concerns about declining government resources (n = 13/24; 54%), fellowship opportunities (n = 3/24; 13%), and the possibility of being required to work in a rural centre (n = 3/24; 13%). Concern regarding fellowship opportunities was less of a concern in NZ than Australia (13% vs. 47%). Conversely, concern about declining government resources was higher in NZ (54% vs. 25%).

3.3. Comments by All Respondents

All respondents were given the opportunity to add further comments. There were 12 responses from NZ, some of which addressed multiple issues. There were seven comments on increasing workload, four suggestions/criticisms of the census, three comments on department staffing/resourcing, two comments on the impact of COVID‐19, and one comment on increasing volume and contouring with advanced techniques.

4. Discussion

Previously, differences in the smaller NZ workforce were masked by the overall cohort. Analysis here of the third iteration of NZ specific data has provided further insight into longitudinal trends. This census represents a snapshot partway through a predicted forecast of a significant NZ radiation oncology workforce shortfall [11].

In line with prior surveys, the NZ response rate was higher than the overall cohort (65% vs. 52%) but mirrored the overall cohort in a declining response rate over time (73% in 2018; 86% in 2014).

Age distribution has remained consistent over time. In 2018, 23% of NZ radiation oncologists were > 60, while 12% were under 40 [9]. The 2022 survey shows similar proportions, indicating no recent influx of younger practitioners. RANZCR records show that average age is increasing, from 48.5 (range 33–68) in 2018 to 50.3 (range 33–72) in 2022. This trend is concerning, making succession planning essential at both departmental and national levels.

The number of radiation oncologists across the cohort increased by 17% between 2014–2018 and 15% between 2018–2022. In contrast, NZ growth had been slower, with a 7% increase between 2014 and 2018 (from 56 to 60). Encouragingly, the 2022 data show an 18% increase to 71.

Despite this, there has not been a corresponding reduction in hours worked (median 50 in 2014, 2018 and 2022), and the proportion working > 10 overtime hours per week continues to increase (35% in 2014, 45% in 2018, 55% in 2022). Radiation oncologists in NZ and Western Australia reported the highest working hours, highlighting the need to address workforce shortages in these areas. The average number of new patients per year in NZ has increased since 2018 (n = 249 in 2022 vs. n = 235 in 2018), though the median has remained stable (n = 230).

A survey of NZ senior medical doctors by the Association of Salaried Specialists in 2020 showed radiation oncologists have the highest rates of work‐related and personal burnout among 24 specialties surveyed [12]. Burnout rates correlate with increased working hours and longitudinal comparison to a 2015 survey showed that little had changed in addressing this [13].

A quarter of the workforce plan to reduce working hours over the next 3 years. In NZ, nearly half of respondents intend to retire within 15 years, compared with 36% in Australia. The proportion planning to retire within 5 years has decreased slightly, but the proportion planning to retire in 6–10 years has risen to 30% from 12% in 2018, highlighting a medium‐term shortfall that requires proactive workforce planning.

Issues with workforce supply have been noted for some time, with prior efforts and investment struggling to keep pace with historical utilisation rates rather than repairing deficiencies and allowing planning for future demand [13]. Data from the RANZCR Facilities Survey 2010–2020 showed growth in treatment courses outstripping growth in full‐time equivalent radiation oncology positions by 19% [14]. Regarding infrastructure, and in the context of population growth, the number of LINACs per million population dropped from 6.4 to 6.1, noting the optimum for a high‐income country like NZ is around 7. More than half of the 31 LINACs were at an age where they should be replaced.

The reliance on overseas trained radiation oncologists has only intensified. The proportion gaining their specialist qualification outside NZ was 32% in 2018. More recent data from the MCNZ 2022 workforce survey suggests that 51.5% of radiation oncologists are international medical graduates [15].

Gender balance has shifted: 39% of radiation oncologists in the membership database were female in 2022, compared with around one‐third in 2014 and 2018. This brings NZ closer to Australia (46%; n = 107/235).

In future surveys, it is essential we explore a more detailed breakdown of NZ ethnicity, to ascertain the proportions of Māori and Pasifika within the workforce. Within the general medical workforce, Māori and Pasifika make up 4.6% and 2.2% of doctors respectively compared with 16.5% and 8.1% of the population [15].

When questioned, most respondents indicated that COVID‐19 had little overall influence on their use of hypofractionation, consistent with earlier survey data suggesting the pandemic did not materially change practice patterns in this cohort. While a proportion of respondents reported that COVID‐19 contributed “a little” to their adoption of hypofractionation, this was not perceived as a primary driver of practice change. This contrasts with experiences reported in other jurisdictions, such as the UK, where the pandemic prompted rapid and widespread adoption of shorter treatment schedules [16, 17]. In the present context, the limited impact of COVID‐19 may reflect a workforce that had already incorporated hypofractionation into routine practice prior to the pandemic, potentially driven by longstanding workforce pressures, service demand, and access constraints. Respondents reported that patient treatment waiting times increased more frequently in NZ than in Australia during the pandemic (42% vs. 15%).

The facilities survey 2010–2020, the 2018 census, and this census have highlighted that the number practicing brachytherapy has fallen, which is a significant concern [9, 14]. A brachytherapy working group has now been created within the College with the remit to review current workforce practices and look for opportunities to strengthen services going forward.

There continues to be a trend towards working privately. However, in contrast to Australia, this is exclusively reported in combination with public work. The proportion working only in the public sector dropped from 72% in 2014 to 63% in 2018 and 47% in 2022. Correspondingly, the proportion working in a combination of public and private has risen from 26% in 2014 to 32% in 2018 to 39% of respondents in 2022.

Reassuringly, all five censuses this century have revealed low unemployment, with no NZ radiation oncologist reporting being unemployed at census time.

4.1. Trainees

Trainee numbers in NZ have increased (n = 33) compared to 2018 (n = 22). This represents a 50% increase which was higher than the overall cohort (16%; n = 167 in 2022, n = 140 in 2018). The average age of trainees was comparable to the overall cohort with a female representation in NZ (58% vs. 44% in Australia). Most (86%) indicated an intention to continue their career in radiation oncology but fewer than one‐third (29%) intended to undertake a fellowship. Both figures are lower than those reported in Australia (98% and 52%, respectively), and represent a decline compared with NZ trainees in 2018 (100% and 66.7%, respectively).

These findings may reflect shifting trainee priorities, limited fellowship opportunities, or the impact of COVID‐19 or broader workforce pressures in NZ. The reduced interest in undertaking fellowship training could have long‐term implications for subspecialty development and academic leadership within the workforce.

Most trainees felt that COVID‐19 had a negative impact on training (71%) which is similar to Australia (75%) and significantly higher compared with oncology trainee experiences in Canada (46%) [18, 19] and Europe (43%) [20, 21]. One fifth reported that COVID‐19 influenced their decision regarding future career choices. Notably, the impact of COVID‐19 appeared to be felt more keenly by trainees when compared to their consultant colleagues.

Training demands, balancing work and family responsibilities, and job demands were the three areas that caused the most stress to trainees. Identifying burn‐out in oneself and others is one of the roles in the CANMEDS framework and has been highlighted in a previous trainee survey by Leung et al. [22] as being highly prevalent (almost 50%) and deserves closer attention at a college and training network/department level.

Of concern, 81% of NZ trainees reported spending ≤ 5 h per week contouring, up from 61% in NZ in 2018 and higher than the 66% of Australian respondents. The average time spent contouring is lower in NZ than Australia (6 h vs. 8.4 h).

NZ trainees report less protected time across all activities when compared to Australian trainees; however, protected time is trending downwards in both countries. Of note, most NZ trainees did not express an interest in completing a fellowship, highlighting an opportunity for the faculty of radiation oncology to consider other means of enabling new fellows in NZ to sub‐specialise.

Of interest, half remain undecided on their preferred future workplace location which highlights the potential to implement strategies to attract new fellows to areas of need. When asked if they would prefer to work in public or private practice 57% responded both, and 43% public, mirroring employment trends seen in NZ consultants. Interestingly, two thirds of trainees wish to work part time in their first 10 years post‐training, compared to 39% in 2018 indicating a growing preference for flexible working arrangements. Only 19% of trainees intend to work in a different city to the one in which they trained, with most undecided. Future surveys should be more direct in questioning New Zealand trainees on whether they intend to leave NZ for work post fellowship to better comment on the issue of a “brain drain” in the NZ medical workforce.

5. Conclusion

The 2022 census provides an updated snapshot of the NZ radiation oncology workforce, highlighting areas of progress and persisting challenges. While there has been modest growth in overall numbers since 2018, the data reinforces ongoing concerns regarding sustainability, succession planning, and equity. The workforce remains relatively small, with a stable median age of 51 and a significant proportion planning retirement within 15 years. Despite an increase in female representation to 39% and growing alignment with the Australian workforce in gender balance, there has been little evidence of increased participation from Māori and Pasifika clinicians, a disparity that requires targeted attention.

Workload pressures remain a defining feature of the NZ context. Median hours worked have not decreased, and respondents continue to report some of the highest working hours in the region. The majority now work across both public and private sectors, reflecting structural shifts in service delivery. The declining number of clinicians practising brachytherapy further underscores the need for workforce planning to ensure the availability of specialised services. COVID‐19 introduced additional challenges to service delivery, with NZ respondents more likely to report increased waiting times.

Trainees reported similar concerns to those documented in 2018, but with added disruption related to the pandemic. Notably, a high proportion of trainees continue to express interest in part‐time work and urban practice, which will have important implications for workforce distribution.

Taken together, these findings point to a workforce under increasing strain, with ongoing risks of burnout and medium‐term shortfalls due to retirements and reduced working hours. Despite incremental increases in headcount, investment in infrastructure, recruitment, and retention, particularly of locally trained and indigenous practitioners, will be critical to ensuring service sustainability. Addressing gaps in subspecialty areas such as brachytherapy and supporting flexible training and employment models will be essential. This census therefore reinforces the urgent need for coordinated national workforce planning to safeguard the future of radiation oncology services in NZ.

Author Contributions

Jack Mitchell: writing – original draft, methodology, writing – review and editing, formal analysis. Melissa James: writing – original draft, methodology, writing – review and editing. Raphael Chee: writing – review and editing, methodology. Nathan Stevens: methodology, writing – review and editing, formal analysis, data curation. Ramesh Pandey: writing – review and editing, methodology. Edward Sia: writing – review and editing, methodology. Nicole Buddle: writing – review and editing, methodology.

Disclosure

This census was conducted as a voluntary survey of medical practitioners which involved no risk to themselves or patients. All results published are non‐identifiable.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: ara70094‐sup‐0001‐DataS1.pdf.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.