Medical Physics Staffing Premise
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1 Justification of Medical Physics Staffing for Quality Radiation Oncology Services Kenneth R Hogstrom, PhD Professor and Director Medical Physics and Health Physics Program Department of Physics and Astronomy Louisiana State University Chief of Physics Mary Bird Perkins Cancer Center Baton Rouge, LA Medical Physics Staffing Premise Operating a first-class medical physics program requires appropriate staffing allocations for: Qualified medical physicists (Board certified & licensed) Support staff (medical dosimetrists, QA dosimetrists, etc.) Appropriate staffing is a necessary, but not sufficient condition. Purpose of Presentation Review why appropriate staffing is important to the radiation oncology practice. Look at different Abt-based models to estimate appropriate staffing (QMPs and support staff) for a radiation oncology physics group. Apply these models to an example free standing cancer center. Review other factors that impact staffing Reasons Appropriate Staffing is Important to Radiation Oncology Practice Provide best possible treatment to the individual patient. Commission appropriate new technology in a timely manner. Provide timely information to radiation oncologists during treatment planning and treatment delivery processes. Ensure technical aspects of facility operate as efficiently as possible. Ensure errors are minimal in number and magnitude. Ensure safety of patients, staff, and visitors. Fulfill regulatory requirements. 1
2 Determining Staffing Levels Medical Physics Group Professional Positions Medical Physicists (MS and PhD) Medical Dosimetrists or Junior Medical Physicists QA Dosimetrists (Physics Tech) Scope of Activities Clinical Support Educational Teaching Research Administration Clinical Practice Factors Impacting Clinical Medical Physics Staffing Main Facility Number of Patients Treated Annually Number of Radiation Oncologists Scope of Practice Number of Physics Billing Procedures Number of Special Procedures Number of Treatment Machines Satellite Facilities Travel Time Contracted Effort Sources of Staffing Information Abt-I Study (ACMP & AAPM, 1995) Survey of Special Procedures (ACMP, 1998) Abt-II Study (ACMP & AAPM, 2003) Reimbursement vs. Effort (JACMP, Herman, Mills, & Gillin, 2003) Abt-III Study (AAPM, in progress) Free-Standing Cancer Center Clinical Indicators 1,755 Patients Treated 6 Radiation Oncologists Treatment Facilities Main Facility (5 linacs-imrt, IGRT) 2 Satellite Facilities (1 linac each) 1 Contracted Satellite Facility Special Procedures Brachytherapy: HDR, Prostate, MammoSite TSEI 2
3 Abt-II Median Statistics (Table 9) QMP Effort Analysis (Procedural Effort=13.4 FTE) Physics Staffing Patients/QMP QMP/Rad Onc Overall Private Hospital Med School University MP Consulting Physician Group Group Our practice has an academic partnership and offers similar technology (applicable more and more to non-academic facilities). Our radiation oncology staff is lean more common to the general environment. QMP Effort Analysis (Non-Procedural Effort=2.0 FTE) Qualified Medical Physicists Clinical Staffing s MP Area Clinical Travel (Satellites) Contractual Travel (Contractual) Total Patients (1,755) Rad Oncs (6.0) Abt-based
4 Observations Clinical QMP Staffing Estimates Estimate of # QMP based on Abt procedural & nonprocedural data unrealistically large: (114 patients/qmp << 325 patients/qmp-survey median). Estimate of # QMP based on Abt number of radiation oncologist seems reasonable, but is low in our case due to recognized shortage of radiation oncologists in Estimate of # QMP using Abt median patients/qmp for medical school or university hospital recommended. Why is estimate of # of QMPs based on Abt procedural & nonprocedural data so large? New complex procedures (IMRT) are initially low in volume & high in effort, but as technology matures, this reverses. Professionals tend to overestimate level of effort in surveys continuing medical physics consultation is 1.5 h. Mathematical anomaly due to using median values? Free-Standing Cancer Center Academic Indicators Medical Physics Staffing s Graduate medical physics program ( FTEs) Teach 1.5 clinical courses Supervise clinical rotations (2 semesters) MP Area Clinical Patients (1,755) 7.8 Rad Oncs (6.0) 6.3 Actual Positions 6.5 Research (1.9 FTEs) 4 Research Agreements Supervise 3-4 research thesis/year Research Education Administration Total
5 Abt-II Median Statistics (Estimated from Table 9) Support Staff Effort Analysis (Procedural Effort=9.1 FTE) Dosimetry Staffing Med Dos/QMP* Physics Asst/QMP* Overall 0.71 * Ratio of median values Private Hospital Med School University MP Consulting Group Physician Group Support Staffing s Patients (1,755) Support Staff Medical Dosimetrists Physics Assistants Block Room Tech Total QMP (7.8) Abt-based n/a n/a n/a 9.1 Actual Positions * ** 7.5 Observations Support Staff Staffing Estimates Estimate of # support staff based on Abt procedural & non-procedural data not unrealistically different ( 20% larger). Estimate of # support staff using Abt median support staff/qmp for medical school or university hospital recommended. * Quality Assurance Dosimetrist (BS Physics with OJT) ** Non-college degree with OJT 5
6 Other Factors Impacting Qualified Medical Physics Staffing Expertise of Medical Physics Staff ABR Certification Full License (States with licensing requirement) Years Experience Experience in Special Procedures Other Factors Necessary for a First Class Medical Physics Program Adequate Equipment & Support Staff Treatment Planning Computers Dosimetry Labs & QA Equipment IS Support in Data Management & Computing Resources Proactive Strategic Planning Clear Direction Adequate Budget Time to Fill Vacant Positions & Acquire Equipment Center & Group Morale Proactive Planning & Recruiting Plan staffing & recruit in advance Use projected annual volume for planning Assume a 12-month recruiting and orientation period Plan staffing to allow for staff vacancies Assume average position occupancy of 10 years Positions needed = positions occupied X (1.1) Assume a 12-month recruiting and orientation period Failure to proactively plans impacts (procedural clinical work & teaching receive priority) Clinical implementation of new technology Research productivity Summary Abt data can be used in different ways to estimate appropriate medical physics staffing for your institution. Abt-based estimates are based on median staffing, and medical physics staffing at your Center might be more or less depending on the scope of radiation oncology practice, staffs abilities, etc. Abt data is a valuable resource for a baseline from which to justify appropriate staffing for your Center. 6
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