Louisville, Kentucky! MEDICAL PHYSICS WORKFORCE ASSESSMENT 2012 AAPM SPRING CLINICAL MEETING. List of Topics. Complexity, Safety and Quality Assurance

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List of Topics Complexity, Safety and Quality Assurance Where is the QA

1 Louisville, Kentucky! Michael D. Mills MEDICAL PHYSICS WORKFORCE ASSESSMENT 2012 AAPM SPRING CLINICAL MEETING List of Topics Complexity, Safety and Quality Assurance Where is the QA Knowledge? Staffing Models Supply and Demand Models for Medical Physicists and Medical Dosimetrists Complexity, Safety and Quality Assurance 1

2 Where is the QA Knowledge? Where is the QA Knowledge? Safety and QA: Where should it be taught? Safety and QA is Device, Manufacturer and Procedure Specific Safety and QA involves Ongoing Training to Maintain Competency Safety and QA involves the development of Model QA Programs with clear operational lines of responsibility Safety and QA must be taught in a Residency Program and it must be a primary feature How should the Medical Physics Community Respond? One possible response could be a functioning proof of concept web site providing peer review of training, commissioning, QA and special procedures documents These documents could be used as a component of practice and residency program accreditation Open source software (Linux, PKP scripting language, MySQL database, Public Knowledge Project application) will be the peer-review platform for these documents 2

Blind Spots Do we always know everything we need to know when we commission new procedures? Do we document and test local training to perform special procedures?

3 Blind Spots Do we always know everything we need to know when we commission new procedures? Do we document and test local training to perform special procedures? Do we maintain patient procedure records to prove our skills are up to date? Do we maintain continuing education records that are procedure specific? Staffing Models Sources and Initiatives for US Staffing Recommendations in Radiation Oncology Revision of CROS Blue Book International Atomic Energy Agency ASTRO ACR Database ABT II and ABT III Reports AAMD Workforce Study Canadian Workforce Study AAPM Diagnostic Physics Study Where is the Staffing Data? 3

4 What does the ASTRO ACR Database and Abt Report Reveal? Practice venue largely does not matter Community based centers, Freestanding centers and University centers require similar staffing The only variable that affects staffing is the number of patients treated in the facility on an annual basis These are reported for facilities treating > 600, and < 200 patients annually What does the ASTRO ACR Database and Abt Report Reveal? pts pts 200- pts New patients/rad Onc New Patients/Physicist New Patients/Dosimetrist New CROS Blue Book An Oversimplification? How can we use the Abt III Report? Profession 1991 Blue Book Annual 2011 Blue Book Annual? Radiation Oncologists 1 per patients 1 per 250 patients? Physicists 1 per 400 patients 1 per 250 patients? Dosimetrists 1 per 300 patients 1 per 250 patients? Therapists 2 per unit - 25 patients/day 3.5 per megavoltage unit? Nurses 1 per 300 patients 1 per 250 patients? 4

5 Median staffing results for medical physicists Practice Type # Patients per QMP Private Community Hosp. 368 Med School Univ. Hosp. 220 MP Consult. Group 464 Physicians Group 260 Overall 304 Median overall staffing information? # Patients treated per year 595 # Qualified Medical Physicists 2.0 # Radiation Oncologists 3.0 # Dosimetrists or Junior Medical Physicists 3.0 # Maintenance Engineers 0.0 # Radiation Therapists 8.0 # Radiation Oncology Nurses 3.0 Median staffing normalized to 800 Patients/Year? Practice Type Medical Physicists Radiation Oncologists Dosimetrists Private Hospital Med Sch. Hosp M. P. Consult. Grp Physicians Group OVERALL How can we use the Abt III Report? The Abt III survey establishes the work performed by the qualified radiation oncology physicist The Abt III survey allows the QMP to argue for staffing, quantity of work and compensation The Abt Associates report empowers the medical physicist to negotiate from a middle ground for compensation - between direct billing and a nonprofessional salary We can use the data in Abt III to negotiate with employers in the same manner that Physicians negotiate with CMS by using the time and work required to deliver patient procedures 5

Population 34 Million Ontario Model Inputs Clinical Procedures and Services Clinical Procedures and Services All radiation beam/source therapy includes external beam and brachy therapy Complexity

6 Population 34 Million Ontario Model Inputs Clinical Procedures and Services Clinical Procedures and Services All radiation beam/source therapy includes external beam and brachy therapy Complexity bonus increment for IMRT, TomoTherapy, Gating, Fusion, Cl. Trials External Beam special procedure bonus increment TBE, TSE, SRS Brachytherapy LDR or HDR Brachytherapy interstitial seeds London Ontario Canada Next slide 21 Ontario Model Inputs Radiotherapy Equipment Support Ontario Model Inputs Training and Education of Specialists Radiotherapy Equipment Support Number of accelerators including TomoTherapy and Robotic units Major ancillary RT equipment includingtps, PET-CT, MR-Sim, 4-DCT-Sim, HDR Minor ancillary RT equipment including X-ray Sim, CT Sim, Gating, Ultrasound Training and Education of Specialists Radiation Oncology Residents Radiation Therapy Students Clinical Physics Residents MedicalPhysics Graduate Students 6

Ontario Model Inputs Administration & Other Duties Ontario Model Outputs Staffing by Category Administration and Other Duties Administrative Workload per Staff Category

(FTE per Employee) Staffing by Category Model Predicts Actual at BCC Physicist 6.51 6.0 Physics Assistant 2.95 3.0 Dosimetrist 3.80 5.

7 Ontario Model Inputs Administration & Other Duties Ontario Model Outputs Staffing by Category Administration and Other Duties Administrative Workload per Staff Category Administration (By Chief Physicist, Radiation Safety Officer) Clinical Development, Conference Attendance, Courses, Site Visits Time Away for Paid Holidaysand Vacations (FTE per Employee) Staffing by Category Model Predicts Actual at BCC Physicist Physics Assistant Dosimetrist Physicists vs Annual Caseload Algorithm Predictive Power Canadian Survey Detailed algorithm prediction Inverse slope: Ontario: 278 treated cases/physicist Canada: 255 treated cases/physicist

How many patients annually per Qualified Medical Physicist Updated Demand and Supply Models Abt I 1995 421 Abt II 2003 325 Abt III 2008 304 When was the big Demand?

8 How many patients annually per Qualified Medical Physicist Updated Demand and Supply Models Abt I Abt II Abt III When was the big Demand? How many therapy physicists pass the ABR in TRP by year? 200 # Passing # Passing

9 Projected ABR TRPs through If we graduate 100 TRPs 2020 If we graduate 125 TRPs 2020 If we graduate 150 TRPs 9

10 2020 If we graduate 200 TRPs SUNY Albany Workforce Study Therapy Physicists Early Career Mid Career Late Career Final Stella Models Thank You! Mills Model Albany Model 10

3/20/2012. Presentation Outline. Objectives Abt Associates Model (2008) Abt-III? What (who) is that?

3/20/2012. Presentation Outline. Objectives Abt Associates Model (2008) Abt-III? What (who) is that? Presentation Outline Michael D. Mills, Ph.D., Ph.D.(c) Chair, AAPM Workforce Assessment Committee Current Manpower Resources and Models Abt Model Battista Model Mills Model (work in progress) Current Manpower