Building a Radiation Oncology Practice: Treatment Volume Growth 2023–2025
What the first three years of building a community radiation oncology practice look like in numbers
I started at Main Line Health in March 2023 with an empty schedule. The first partial year produced 1,185 treatment sessions—mostly building referral relationships and getting the word out. By 2024, that grew to 4,919. In 2025, the practice hit 7,331 sessions, passing the National Practice Benchmark (6,604 sessions/year) for the first time.
No single initiative drove the growth. It's the compound effect of tumor boards, referring physicians gaining familiarity, and patients telling other patients. That's how community practices grow: slowly, then all at once.
A few things worth noting. With hypofractionation driving the national average down to about 14 fractions per course (from 17.5 a decade ago), 7,331 sessions represents more individual patients than the same number would have historically. The estimated ~524 treatment courses and ~699 new consults are well above the ASTRO workforce median of 250 consults/year, though those benchmarks are a few years old.
This is all happening against declining reimbursement—Medicare rad onc payments are down about 25% since 2013, and the national workforce has grown 16% while patient volume grew only 4%. Volume growth isn't just a milestone, it's what keeps a practice viable. I'm curious to see what the next year looks like.
A note on the data: the treatment session counts come from Varian ARIA physician summary reports. Some of the derived metrics below (wRVUs, treatment courses, consult estimates) are extrapolated from those numbers using published national ratios—not pulled directly from billing data. I'm not the best at extracting clean reports from ARIA, so take the estimates for what they are: directionally useful, not precise.
Annual Summary
| Year | Sessions | Daily Avg | vs NPB | Est. wRVUs | Est. Courses |
|---|---|---|---|---|---|
| 2023* | 1,185 | 4.7 | 18% | ~1,552 | ~85 |
| 2024 | 4,919 | 19.5 | 74% | ~6,440 | ~351 |
| 2025 | 7,331 | 29.1 | 111% | ~9,600 | ~524 |
Annual Treatment Sessions
Growth trajectory from partial first year (2023*) through surpassing the NPB benchmark. Dashed line represents the National Practice Benchmark standard of 6,604 sessions per year. *2023 started March.
Monthly Breakdown: 2024 vs 2025
Month-by-month comparison showing consistent volume increase across the entire calendar year.
Average Daily Treatments by Month (2025)
Daily treatment census derived from monthly sessions and working days. Dashed line at 26 treatments per day represents the NPB standard for a full-time radiation oncologist.
Estimated wRVU Percentile Positioning
Estimated work RVUs based on a ~1.31 wRVU/session ratio (derived from NPB sessions and SCAROP wRVU correlation), plotted against SCAROP academic radiation oncology and MGMA community benchmarks.
Estimated Treatment Courses & New Consults
Estimated number of unique treatment courses (fractions ÷ avg fractions/course) and new consults (courses ÷ 0.75 conversion rate), compared to national workforce survey averages.
Workload Metrics vs National Benchmarks
Estimated 2025 workload compared to published national survey data from ASTRO, ASCO, and CMS workforce studies. Values shown as percentage of national median.
Data Sources & References
- Varian ARIA Physician Summary — No. of Treatments reports (2023–2025), Main Line Health System. *2023 is a partial year (started March).
- Hoverman JR, et al. The National Practice Benchmark for Oncology: 2015 Report for 2014 Data. JCO Oncology Practice. 2016;12(10):e906-e920.
- ASTRO Radiation Oncology Workforce Study, 2012 & 2017. Int J Radiation Oncology Biol Phys.
- Nabavizadeh N, et al. Trends in American Radiation Oncology Workforce, Patient Volume and Technology Utilization. Int J Radiation Oncology Biol Phys. 2023.
- SCAROP Financial Survey — Academic Radiation Oncology wRVU Benchmarks (25th: 6,803; 50th: 8,668; 75th: 10,208).
- ASCO 2019 Survey of Oncology Practice Operations (SOPO). JCO Oncology Practice. 2021.
- MGMA DataDive — Radiation Oncology Compensation and Production (median wRVUs ~9,079).
- Marit Health 2025 Physician Compensation Report — Radiation Oncology (median wRVUs ~9,524).
- CMS Medicare Physician Fee Schedule — CPT 77427 (weekly treatment management, ~1.09 wRVU per 5 fractions).
- Fung CY, et al. ASTRO 2017 Radiation Oncologist Workforce Study. IJROBP. 2019;104(4):849-858. (median 250 consults/year, 20 on-treatment patients).
- NY State Medicare Analysis — OTV billing by provider (median 196 CPT 77427/year, mean 240.5). Cureus. 2017.
- Decreases in Radiation Oncology Medicare Reimbursement Over Time: Analysis by Billing Code. PMC. 2023. (IMRT G6015: $574→$351, total spending -27%).
- Differential Use of RT Fractionation Regimens for Prostate Cancer (NCDB 2004–2020). PMC. 2023. (SBRT: 0.2%→12.4%).
- Changes in Employment and Practice Locations of Radiation Oncologists 2015–2023. Red Journal. 2025. (~5,000 ROs, solo -27%, large +51%).