Declining rural oncologist supply in the United States: A workforce analysis from 2014 to 2025.

PURPOSE: Rural Americans experience higher cancer incidence and mortality than their urban counterparts, yet oncology physician supply to rural areas is incompletely characterized. We determined longitudinal trends in the proportion of oncologists practicing rurally and identified characteristics associated with rural practice. METHODS: Physicians reporting a primary specialty of hematology, hematology/oncology, or medical oncology were identified from annual archived versions of the CMS Physician Compare Database (2014-2025). Rural status was determined from Rural-Urban Commuting Area codes applied to practice ZIP code (codes 4-10 = rural). Temporal trends were assessed with Mann-Kendall tests. Rural and urban physician characteristics were compared using chi-squared tests and multivariable logistic regression. RESULTS: We identified 19,807 unique oncologists (14,272 in 2025). Despite a 26% workforce expansion, the rural proportion declined from 11.1% to 8.0% (τ = -0.73, P=0.001). Per capita, rural supply fell from 6.5 to 5.5 per 100,000 adults aged ≥55 (τ = -0.58, P=0.009) while urban supply rose from 11.7 to 13.1 (τ = +0.48), widening the urban-to-rural ratio from 1.8 to 2.4. Rural oncologists were more likely to be male, late career, and in mid-size groups (all P<0.001). Academic medical center affiliation (aOR 0.10) and large group size (aOR 0.40) were associated with decreased odds of rural practice, whereas late career stage (aOR 1.58) and Midwest region (aOR 1.62) were associated with increased odds. CONCLUSIONS: The rural oncology workforce is declining proportionally and per capita despite overall growth. Retirement of late-career rural oncologists without early-career replacement threatens to further erode rural cancer care access.