Med Phys Workforce:

Despite being known by a select few as the brains behind the scenes in radiation oncology and radiology, medical physicists’ work has an impact across medicine. The work of medical physicists affects “nearly every citizen”.¹ In spite of this fact, this important cohort of the medical workforce has suffered losses throughout North America. Medical physicists have subspecialties in one or more areas including radiation therapy, imaging, nuclear medicine and health physics. Their role is instrumental in ensuring the safe and effective delivery of external beam radiotherapy or brachytherapy, radiation protection of employees and the public, and educating trainees, patients and the public about radiation. During the pandemic, a number of physicists retired while at the same time radiation oncology practices expanded and demand increased. This has left some centers with unfilled positions and a need to understand more fully the current state of the medical physics workforce.

By Carlos Cardenas, PhD, UAB Medicine, The University of Alabama at Birmingham

Artificial Intelligence (AI) is rapidly becoming a cornerstone in the field of medical physics, offering promising solutions to alleviate the pressing staffing issues highlighted in Dr. Pollard-Larkin’s article. AI, with its potential for automating routine and time-consuming tasks, holds the promise of significantly reducing the burden on medical physicists, thus addressing the increasing demand for qualified medical physicists (QMPs) in the long term.

The medical physics profession is uniquely positioned to play a critical role within and beyond our specialties. Our clinical and technical training equips QMPs to be highly involved in patient care while also contributing to the overall clinical workflow. This bird’s-eye view, combined with our strong foundation in math and sciences, provides an excellent basis for understanding and implementing AI technologies effectively.

However, it’s crucial to recognize that the integration of AI into clinical practice requires careful planning and additional resources in the near term. Implementing AI solutions necessitates the recruitment of QMPs who have expertise in AI, as well as the upskilling of current staff to work alongside these new technologies. Moreover, ensuring the quality and safety of AI-driven processes demands rigorous validation and continuous oversight by QMPs. Several professional groups (AAPM, ASTRO, ESTRO, ACR) have established or are establishing task groups to develop recommendations for the safe implementation of AI and automation. These efforts will play a critical role in ensuring the safe utilization of AI in medicine.

To summarize, while AI holds great potential to mitigate staffing challenges in radiation oncology by automating routine tasks and enhancing efficiency, its implementation will initially require additional investment in both human and technological resources. By strategically integrating AI, we can build a more resilient and efficient medical physics workforce, with the promise of improving patient care and outcomes.

The American Association of Physicists in Medicine (AAPM) is the largest organization of medical physicists in North America and has approximately 10,000 members.² Nearly 76% of this workforce is employed doing radiation oncology work. Most (55%) medical physicists surveyed by ASTRO and AAPM in 2015 worked in cities and 12% worked in rural settings.3 This 2015 survey also showed that the average work week was about 48 hours for respondents.³

In order to do the work of a medical physicist, one must follow the educational path of becoming what is known as a “qualified medical physicist” or QMP. The pathway to becoming a QMP typically involves first getting a bachelor of science undergraduate degree in physics or a similar field with enough physics coursework to suffice the next step, obtaining a masters of science or doctorate in Medical Physics from a Commission on Accreditation of Medical Physics Education Programs (CAMPEP)-accredited program, then a two- or three-year clinical residency program and finally, passing the American Board of Radiology (ABR) three-part exam in the subspecialty of choice. Currently, there are over 120 CAMPEP-accredited clinical residency programs in Therapeutic Medical Physics and 41 programs in imaging physics. There are a few exceptions that QMP hopefuls can use to sidestep this process, but they still require going through an accredited postdoctoral certificate program, on-the-job training, a clinical residency and/or the ABR board certification process.³

Many have considered these lengthy educational requirements and the restrictions on who can sit for the board exams as a reason for the lack of supply in new QMPs. This issue is further complicated due to the field having an increase in residency programs to attempt to meet the demand, but this demand has grown exponentially and nowhere near the rate of interest in the specialty. In 1988, there were only two CAMPEP-accredited graduate programs in Medical Physics, whereas in 2019, there were 54.³ However, the students’ demand for these programs far exceeded that. In 2019, 1,914 applications were submitted for these programs of which 677 were offered positions and only 284 matriculated.³ Medical Physics as a field is as hot as the sources we use to treat patients!

Not training these interested young potential future QMPs is a major issue that should be investigated and solved prior to the next large wave of medical physics QMP retirements taking place. According to a 2012 paper by Chen et al., 2.2% of the QMP workforce retire each year.3 Meanwhile, cancer incidence in the U.S. is expected to increase annually by about 2%. In addition to these facts, the rate of retirement tripled between 2010-2020 compared to 1990-2000.³ This steady and sizable loss of our most senior and experienced QMPs comes at the same time as a growing pool of medical physics PhD and MS graduates are waiting to get into a residency program. The supply of training programs in medical physics is occasionally connected to federal funding and research efforts, and until that is resolved, the number of programs will continue to grow at its current rate.

While there are no official statements on the status of the medical physics workforce from AAPM or another society, AAPM has created work groups to investigate the issue and provide context. Under the guidance of AAPM’s Professional Council, Erli Chen, MS, DABR and Brent Parker, PhD, DABR, created a summary titled “Opportunities, Challenges, and the Current Supply and Demand of the Radiation Oncology Medical Physicist Workforce.” They did this work under the title of the AAPM Therapy Workforce Subcommittee (TWS).⁴ They sent a survey to half of all AAPM members in the fall of 2020 and received 715 responses. Their survey showed that 15% of all respondents planned on retiring within 10 years and 25% of all AAPM members will be older than 65 by 2030.⁴ However, they noted that therapy physicist job demand on the AAPM job posting site has only increased by 4% from 2012 to 2021.⁴ Note: Only 50% of all therapy physicist jobs are posted on the AAPM job posting website.

TWS identified some key factors affecting medical physicist therapy job supply and demand: an increase in CAMPEP residency programs; automation within radiation oncology; potential reimbursement changes in radiation oncology; remote workflows popularized during the pandemic; and an increase in hypofractionation and complexity in treatment planning.⁴

Another key finding is that the staffing models for medical physics are now up for reevaluation due to an increase in hypofractionation, on-demand adaptive planning, and other special procedures that are more time intensive. Despite medical physicists treating fewer patients on average than they did in 2012, they are spending more time per patient with these more complex cases that typically require medical physicists’ direct involvement during simulation through treatment. TWS showed that patient treatment load in their respondents dropped to an average of just 20 patients per QMP in 2020 compared to 30 per QMP in 2012. Several centers base their hiring practices on patient volume per QMP and patient treatment complexity is rarely a factor used to impact hiring and reduce QMP burnout. TWS’ survey respondents indicated that 43% had challenges managing their current patient load.⁴ Across the field, several modalities are being used more routinely than ever before including cone beam CT, stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), proton, magnetic resonance-linac treatments, positron emission tomography (PET), automation, adaptive planning and artificial intelligence (AI).⁴

As a happily employed medical physicist and proud member of AAPM, I have some advice to offer centers and potential employers of QMPs in order to weather this new increase in demand for medical physicists. 

Advice to Hire Your Next QMP

1. Use AAPM to advertise: Nearly half of positions for physicists are posted on the AAPM Career Services website, but there are other ways to use AAPM to secure your next hire. You should also consider using the Annual Meeting as a means to highlight your center and its most important resource, your wonderful current staff of QMPs. Engage potential new hires by wearing your center’s logo or lanyard throughout the meeting and ensure all of your cohort at the meeting takes time to speak to graduating trainees and those looking for positions.
2. Look locally: Recent changes to state laws have caused some effects in interest in living in certain regions. QMPs have over 700 positions available across the U.S. according to Indeed.com (at the time of this writing). Make sure you strongly pursue future candidates already living in your region heavily as they are more likely to stay. Anecdotally, some managers and chief physicists have noticed that candidates are less mobile recently compared to years past. Both for training and career positions, candidates seem less apt to depart from the locations where they grew up or trained and relocate to new positions in different states or regions.
3. Make sure your current staff is happy: Check your center’s recruitment and retention data, climate surveys and in-depth one-on-one check-ins with your staff to ensure your center is indeed a good place to work with benefits that are attractive. If your current staff is unhappy, please address those concerns before they also choose to leave and or spread the word to your future candidates. A happy team will advertise well for you and be a great place for a new hire to learn, grow and develop roots.
4. Be upfront about job details: Ensure your job post explains the full expectation of the position you are trying to fulfill. Detail the responsibilities the physicist will have to manage (i.e., SBRT, brachytherapy, teaching, research, leadership, etc.). Also, highlight the benefits the job or your institution provide such as family medical leave, the radiation oncologist team they will work with, research opportunities, educational opportunities, opportunities to attend conferences and more.