# Changes in patient-sharing patterns after oncologist departures in rural and urban settings: a Medicare cohort study

## TL;DR

This study examines how oncologist departures affect patient-sharing patterns among remaining care team members in rural and urban areas.

## Contribution

The study reveals distinct rural and urban responses to oncologist departures, highlighting potential adaptive strategies in cancer care coordination.

## Key findings

- Rural-practicing oncologists expanded and restructured patient-sharing after colleague departures.
- Urban-practicing oncologists consolidated patient-sharing following departures.
- Network changes may ensure care continuity but reflect differing challenges in rural and urban settings.

## Abstract

Cancer care relies on effective coordination within a multidisciplinary care team. Changes to teams due to departures remain understudied despite rising oncologist turnover in the United States. In this study, we aimed to investigate the impact of oncologist departures on the remaining care team members. We used Medicare claims associated with beneficiaries aged 66–99 to identify physicians involved in care for common cancer types (i.e., breast, lung, and colorectal cancer). We restricted our analysis to medical oncologists, radiation oncologists, and surgeons specializing in oncology (collectively, “oncologists”). We identified oncologists who left a practice location in 2017–2019 using the Medicare Carrier file and linked them to retained oncologists based on shared patients. Multivariable hierarchical linear regression was used to investigate how retained oncologists’ patient-sharing patterns changed after a colleague’s departure. Our results support that retained rural-practicing oncologists experienced an expansion and restructuring of their patient-sharing ties following oncologist departures while retained urban-practicing oncologists experienced a consolidation. Network restructuring may demonstrate an adaptive response that ensures patient continuity of care, but it may also reflect unique challenges faced by oncologists practicing in rural versus urban settings.

The online version contains supplementary material available at 10.1007/s41109-025-00762-3.