It Takes a Team

The pandemic caused a seismic shift in work culture, significantly impacting health care. Many chose to retire early, prioritizing mental and physical well-being, and radiation oncology was not spared. In this edition of ASTROnews, we examine workforce challenges among the treatment team. While we fully acknowledge that nurses are a vital part of our teams, we are focusing on technical staff (radiation therapists, dosimetrists and medical physicists).

A recent ASTRO survey revealed that over 90% of clinics reported staff shortages leading to treatment delays, affecting both rural and urban clinics globally. While early retirements contributed to this, the field has simultaneously seen rapid advancements in complexity, equipment, modalities, and software demanding more skilled staff to maintain high-quality cancer care. Unfortunately, investments in technology have not been matched by an increase in training skilled professionals, exacerbating the shortage.

This issue of ASTROnews highlights personnel shortages from various perspectives. Members of the American Association of Physicists in Medicine (AAPM), the American Association of Medical Dosimetrists (AAMD), and the American Society of Radiologic Technologists (ASRT) have proposed solutions for their disciplines. Julianne Pollard-Larkin emphasizes that the elaborate educational requirements and restrictive board exam criteria limit the supply of new qualified medical physicists (QMPs). The AAPM has established a task force to study and address workforce shortages. The AAMD is increasing training programs through grant funding, while the ASRT has launched a public awareness campaign.

Paul Keall, Sandra Turner, and colleagues provide an international perspective, emphasizing job satisfaction, improved communication, staff engagement, career progression, and training quality. Diane Kean, Managing Editor of ASTROnews, notes the added difficulties for rural communities. Anna Paulsson, a radiation oncologist near San Francisco, highlights the challenge in filling radiation therapist positions. Dave Beyer and Chris Jahraus have adapted by relying on remote support or outsourcing technical services.

As work-life balance becomes more important, staffing models are evolving. Over 50% of medical dosimetry positions now adopt a hybrid on-site and remote work model. However, remote work can make team dynamics challenging and increase feelings of isolation. The pandemic-induced staff shortages have led to high levels of burnout among health care workers.

The shortage of these highly trained professionals not only delays treatments but also raises operational expenses, putting additional strain on health care systems and patients. It opens the door for outsourcing agencies and vendors to fill in the gaps. The Institute of Physics and Engineering in Medicine in the UK reported an 8% Medical Physics vacancy rate in their 2021 survey with a concerning 21% of entry level positions not being filled, calling the attention to additional training opportunities.1 It has been over a decade since ASTRO conducted a comprehensive review of the workforce landscape with respect to our technical staff.

Might the emergence of AI offer a glimmer of respite in bridging this chasm, reducing redundant work and improving work quality (Carlos Cardenas, page 11)? Definitely, but as Mark Littell et al., say in their article, “With the advancement of AI and workplace philosophies of doing more with less, it’s more important than ever to keep constant vigilance to promote patient safety.”

As we look forward to another exciting meeting discussing our scientific success, this year’s Annual Meeting theme is about provider wellness, and one prescription for burnout is gratitude. So, on behalf of our patients, we would like to say THANK YOU to the radiation therapists, dosimetrists and medical physicists who have such a tangible impact on our patients’ lives and make our job seem seamless and almost easy. Cancer care is a team effort and this issue is dedicated to your hard work. 

Correction: In the Spring 2024 ASTROnews article “What Goes Around Comes Around: Radiation Therapy of Nonmalignant Disorders,” the authors incorrectly cited Donaldson and Order as the authors of the “first textbook compilation” on the use of radiation in nonmalignant diseases. It has come to our attention that Stephen B. Dewing, MD, first published “Radiotherapy of Benign Disease” in 1965. We apologize for the incorrect citation and thank Edward Halperin, MD, for bringing this to our attention.