The study also identified interest in expanding into nontraditional domains that offer opportunities to address unmet needs in the cancer patient’s journey and elevate radiation oncology within the increasingly value-based US health care system. Advocacy for open communication and meaningful interdisciplinary collaboration presents an actionable solution toward a more balanced relationship with other specialties as ROs strive to better fulfill the vision of being leaders in oncologic care and being our best for our patients. Actual practice commonly comprised a mixed approach, including the least favored scenario of delivering radiation at the referring physician’s request one-quarter of the time, highlighting the influence of interspecialty politics on practice behavior. For most ROs, to provide an independent opinion on treatment options represented the ideal approach to care, but barriers such as concern of alienating referring physicians prevented many from fully adhering to their ideal in practice. These results provide insight regarding US ROs’ scope of practice and attitudes on the ideal role of the RO. Radiopharmaceuticals administration, medical marijuana and anticancer medications prescribing, and RO inpatient service represented areas of interest for expansion but also knowledge gaps. Respondents interested in expanding scope of practice were on average earlier in their career (average years in practice 13.3) than those who were not interested (average years in practice 17.2, P <. One-fifth of respondents expressed a desire to expand the scope of service though interspecialty politics and insufficient training were potential barriers. Reasons for the mismatch included fear of alienating referring physicians and concern for offering an unwelcome opinion. For the remaining majority, actual practice did not always match the ideal and comprised a mix of approaches that included providing radiation at the referring physician’s request 24.0% of the time on average. Actual practice fully matched the ideal approach in 18.2% of respondents. Nearly all respondents agreed that “ROs should be leaders in oncologic care.” Respondents indicated the ideal approach to patient care was to provide “an independent opinion on radiation therapy and other treatment options” (82.5%) or “an independent opinion on radiation therapy but not outside of it” (16.1%), with only 1.4% favoring provision of “radiation therapy at the request of the referring physician” as the ideal approach.

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