Medical Physicist Workforce Study

Transcription

1 Medical Physicist Workforce Study September 2012

2 Health Workforce Australia This work is copyright. It may be reproduced in whole or part for study or training purposes only, provided that the acknowledgment below is included. Any reproduction for purposes other than those indicated above, or otherwise not in accordance with the provisions of the Copyright Act 1968 or any other legal obligation, requires the written permission of Health Workforce Australia (HWA). ISBN: Enquiries ing this report and its reproduction should be directed to: Health Workforce Australia GPO Box 2098, Adelaide SA 5001 T F E hwa@hwa.gov.au Citation: Health Workforce Australia 2012: Medical Physicist Workforce Study

3 Contents 1 Introduction Medical physicists their role and responsibilities Workforce dynamics indicator methodology Medical physicist workforce dynamics assessment Context for workforce assessment Potential paths forward Appendix 1 National Minimum Data Set References Medical Physicist Workforce Study iii

4 List of tables Table 1: Workforce dynamic indicators Table 2: ROMPs and DIMPs summary of workforce dynamics indicators Table 3: Average age workforce dynamic rating assessment, ROMPs Table 4: Average age workforce dynamic rating assessment, DIMPs Table 5: Training pathway, ROMPs Table 6: Number of ROMPs intending to retire, Table 7: Replacement rate workforce dynamic rating assessment, ROMPS Table 8: Training pathway, DIMPs Table 9: Number of DIMPs intending to retire, Table 10: Replacement rate workforce dynamic rating assessment, DIMPs Table 11: Vacancy rate, ROMPs, 2006 and Table 12: Vacancy rate workforce dynamic rating assessment, ROMPs Table 13: Vacancy rate, DIMPs, 2006 and Table 14: Vacancy rate workforce dynamic rating assessment, DIMPs Table 15: Origin of qualification by year of qualification, ROMPs Table 16: Dependence on ITPs workforce dynamic rating assessment, ROMPs Table 17: Duration of training program workforce dynamic rating assessment, ROMPs and DIMPs.. 21 Table 18: Employed ROMPs and DIMPs in Australia, 2006 and Table 19: Calculation of DIMP workforce trends with and without intakes Medical Physicist Workforce Study iv

5 List of figures Figure 1: Professions survey ROMPs (including registrars), age by sex, Figure 2: DIMPs, age by sex, Figure 3: ROMPs (including registrars), average weekly hours worked by sex, Figure 4: ROMP workforce projections to Figure 5: DIMP workforce trends with and without intakes Medical Physicist Workforce Study v

6 1 Introduction In 2002, the Report of the radiation oncology inquiry: A vision for radiotherapy 1 was published. The aim of this inquiry was to examine and make recommendations on Australia's usage of radiation therapy as a cancer treatment modality with reference to current capacity, international best practice, clinical efficacy, as well as other cancer treatment modalities. Within this, the role of radiation oncology medical physicists (along with radiation oncologists and radiation therapists) was examined. For radiation oncology medical physicists, the inquiry found existing workforce shortages, with increasing attrition rates. Recommendations in relation to the workforce included better career paths, competitive remuneration and the introduction of a formal training pathway (which was subsequently established). Since then, s have continued in relation to the radiation oncology medical physicist workforce. For example, in 2009, a Department of Health and Ageing commissioned review of the radiation oncology workforce 2 confirmed a shortage of radiation oncology medical physicists. Then, in 2010, the Health Workforce Principal Committee also highlighted a about a shortage of medical physicists, particularly of diagnostic imaging medical physicists. It was agreed that Health Workforce Australia (HWA) would consider this matter. This occurred at the same time as the implementation of the cancer care initiatives announced in the 2009 Federal Budget. In addition, HWA is concurrently developing a broader National Cancer Workforce Strategy, and the radiation oncology medical physicist workforce is incorporated within this work. The purpose of this report is to examine the radiation oncology and diagnostic imaging medical physicist workforces and highlight if there is cause for. Firstly, this report provides an overview of medical physics and the specialties within the profession. To examine the medical physicist workforces, an assessment is conducted against five separate workforce dynamics indicators the indicators are first described and then the assessment against each is presented. It should be noted HWA did not conduct a new data collection to be able to undertake the assessments. Rather, existing information about the workforces was used. The assessment is followed by information on other key factors to assist in interpreting the significance of the assessment results. Finally, potential paths forward are presented. 1 Report of the radiation oncology inquiry: A vision for radiotherapy, Commonwealth of Australia, Accessed at 2 HealthConsult. Radiation Oncology Workforce Planning. Final Report for Department of Health and Ageing. Sydney: HealthConsult, November Medical Physicist Workforce Study 6

7 2 Medical physicists their role and responsibilities The medical applications of x-rays and radioactivity have given rise to the discipline of medical physics. Accordingly, medical physicists are health professionals with specialised training in the medical applications of physics. Their work involves the use of: x-rays; gamma rays; electron and charged particle beams; neutrons; and radiations from sealed and unsealed radionuclide sources in the diagnosis and treatment of human diseases. There are three medical physicist specialties radiation oncology, radiology and nuclear medicine. Radiation oncology medical physics pertains to the: therapeutic application of x-ray, gamma rays, electron and charged particle beams, neutrons and radiations from sealed radionuclide sources equipment associated with their production, use, measurement and evaluation proper calibration and quality control of equipment used for therapeutic purposes and radiation dosimetry. Radiation oncology medical physicists (ROMPs), that is, people who practice radiation oncology medical physics, design and implement the quality assurance program in radiation oncology. Their primary roles are to ensure: therapy radiation doses are delivered accurately; radiation safety of patients, staff and the general public; and compliance with relevant regulations and standards. Radiology medical physics pertains to the: diagnostic application of x-ray, gamma rays from sealed sources, ultrasound, radio frequency radiation and magnetic fields in medical imaging equipment associated with the use of radiation for diagnostic imaging quality of images and radiation dose associated with the use of imaging equipment. Nuclear medical physics pertains to the: therapeutic and diagnostic application of radioactive isotopes for medical purposes equipment associated with the production, use, measurement and evaluation of radioactive isotopes quality of images and patient dose resulting from the use of radioactive isotopes. Collectively, radiology medical physicists and nuclear medical physicists are referred to as diagnostic imaging medical physicists (DIMPs). DIMPs play an important role in the quality assurance of imaging equipment and ensuring optimum image quality 3, with the diagnostic parameters derived from images paramount in the management of patients treatment. 4 DIMPs also ensure that radiation exposure from radioactive sources, x-rays and other radiation emitters is measured or calculated appropriately for dosimetric and safety purposes. As with ROMPs, the role of DIMPs also encompasses the radiation safety of patients, staff and the general public, and ensuring compliance with relevant regulations and standards. Regulatory responsibilities The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is responsible for protecting the health and safety of people, and the environment, from the harmful effects of ionising and non-ionising radiation. ARPANSA developed the Code of Practice for Radiation 3 For further detail see 4 Personal communication, John Cormac, September For further detail see medicalphysics. Medical Physicist Workforce Study 7

8 Protection in the Medical Applications of Ionizing Radiation (2008) (the Code), a regulatory document that covers the practices of radiotherapy, diagnostic and interventional radiology and nuclear medicine. The Code identifies that all health facilities using radiation must have access to a qualified expert, this being a qualified medical physicist. Specifically, the qualified expert is defined as a person who: is qualified in the application of the physics of therapeutic or diagnostic uses of ionizing radiation, and has been recognised by the relevant regulatory authority as being able to perform the dosimetric calculations, radiation measurements and monitoring relevant to the person s area of expertise. 5 The qualified expert needs to be available for consultation on optimisation, dosimetry and quality assurance; and to give advice on matters relating to radiation protection in medical exposure. In addition, for radiotherapy the Code outlines that calibration, dosimetry and quality assurance requirements are conducted by, or under the supervision of, a qualified expert. This means each health facility using radiation must have access to a medical physicist who ensures that the radiation exposure from radioactive sources, x-rays and other radiation emitters is measured or calculated appropriately for dosimetric and safety purposes. 5 Australian Radiation Protection and Nuclear Safety Agency, Medical Physicist Workforce Study 8

9 3 Workforce dynamics indicator methodology HWA has adapted Health Workforce New Zealand s (HWNZ) medical discipline vulnerability ranking method to highlight aspects of the current workforce that may be of now and into the future. In this method, HWNZ use a traffic light approach to score workforces against four indicators (age and trainee numbers, dependence on general registrants, dependence on international medical graduates and level of vacancies). Scores against each indicator are then combined into an overall rating to demonstrate the vulnerability of the workforce. HWA renamed the method workforce dynamics indicator as the term vulnerability has an implied meaning which was not appropriate for the assessment being made, and selected the following indicators for scoring. Average age workforces with a higher average age are of more due to the potential for higher exit rates (through retirement). Replacement rate this item calculated the ratio of newly accredited medical physicists to workforce exits in a given year. This indicates whether the number gaining accreditation is sufficient to replace those presently leaving the workforce. Note: this is an indicator for workforce dynamics assessment purposes only and is not intended to guide training numbers for the future. Vacancy rate workforces with a higher percentage of vacancies are of more due to the inability to fill existing workforce positions. Dependence on internationally trained professionals (ITPs) workforces with high percentages of ITPs are of greater due to their dependence on a less reliable supply stream (for example, changes in immigration policy may impact on supply, migrants may choose to settle in other countries). Duration of training program the greater the duration of training, the longer it takes to train a replacement workforce. The indicator range boundaries were selected as an extension of the HWNZ ranking method. In this initial development of the workforce dynamics indicator, the ranges for each indicator rating were set to be relatively equal, rather than being established using a statistical base. Unlike HWNZ, an overall rating is not generated in HWA s scoring. This reflects the view that the focus should be on each individual indicator, and understanding the drivers of the results for those indicators, rather than on an amalgamated rating. To be able to score against the workforce dynamics indicators, an extensive range of data is required. Where a score cannot be allocated due to insufficient data, the indicator is not assessed. It should be noted this is a first iteration of the workforce dynamics indicator within HWA. The indicators used are basic measures only ideally as data availability improves, more sophisticated measures can be developed. Medical Physicist Workforce Study 9

10 Table 1 summarises the workforce dynamics indicator and the score ranges. Table 1: Workforce dynamic indicators Minimal Significant Average age of existing workforce < Ratio of accreditations to workforce exits 130+% 110-<130% 90% - 110% 70% < 90% <70% Vacancy rate <4% 4% - <6% 6% - <8% 8% - <10% 10+% Dependence on ITPs (ITPs as a percentage of employed practitioners) 0-14% 15-29% 30-44% 45-59% 60+% Duration of training program (years) < Medical Physicist Workforce Study 10

11 4 Medical physicist workforce dynamics assessment In this section, the ROMP and DIMP workforces are assessed against each workforce dynamic indicator. As noted earlier, HWA did not conduct a new data collection to obtain information on these workforces. Rather, the assessments have been based on existing information. For ROMPs, two key data sources were used. 1. The Radiation Oncology Workforce Planning Final Report (prepared by HealthConsult in 2009). This was a review of the radiation oncology workforce commissioned by the Department of Health and Ageing, and included both primary data collection (with 80 percent coverage of the ROMP workforce) and consultations with key stakeholders. 2. The 2006 and 2009 Round Survey of the Australasian clinical medical physics and biomedical engineering workforce, which reviewed the profile, salary levels and number of vacant positions in the surveyed workforces. For DIMPs, the Round surveys were also key data sources, along with data made available to HWA from the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM). Summary of indicator results A summary of the indicator results for ROMPs and DIMPs is provided in Table 2. Reflecting the fact that data availability is greater for ROMPs, each indicator for ROMPs was able to be assessed. This is because of the greater focus on the ROMP workforce stemming from the 2002 Report of the radiation oncology inquiry: A vision for radiotherapy. The ROMP workforce has a low average age (less than 40) and more ROMPs being accredited than leaving the workforce (with retirement intentions used as a proxy for exits). Consequently both these indicators received the lowest rating in the workforce dynamics assessment, that is, they are areas of minimal. ROMPs had a vacancy rate of more than 10 percent (receiving the highest rating for this indicator, and therefore an area of significant ), and a medium rating for dependence on internationally trained professionals (with approximately 40 percent of ROMPs receiving their qualification overseas). For DIMPs, one indicator (dependence on ITPs) was not assessed due to data availability. This suggests improved data collection is an area for future improvement for this workforce. Of the assessed indicators, the replacement rate received the highest rating (and is an area of significant ), with no DIMP accreditations over the period 2006 to The average age (44 years) and vacancy rate (approximately seven percent) indicators both received medium ratings. With the majority of the workforce dynamics indicator assessments falling within the medium rating, this suggests areas of for both the ROMP and DIMP workforces. Medical Physicist Workforce Study 11

12 Table 2: ROMPs and DIMPs summary of workforce dynamics indicators ROMPs DIMPs Average age of existing workforce Ratio of accreditations to workforce exits Vacancy rate Dependence on ITPs (ITPs as a percentage of employed practitioners) n.a.* Duration of training program (years) *n.a. not assessed As noted earlier, an extensive range of data is required to be able to conduct the indicator assessment. With one indicator not able to be assessed for DIMPs, the replacement rate indicator using a proxy data item (retirement intentions rather than actual exits) and key data sources for the ROMP and DIMP workforces being collected on a different basis, with different data items, there is scope for improved data collection. Improvements in data collected would allow for more robust and comparable assessments, as well as monitoring and planning. For information, Appendix 1 contains the Australian Health Ministers Advisory Council endorsed national minimum data set items along with a proposed data dictionary for medical physicists. Average age ROMPs Average age information was not directly available from either of the ROMP key data sources. However, the 2009 HealthConsult report provided an age and sex distribution of the ROMP workforce (Figure 1). This showed ROMPs have a relatively young age profile more than half (54 percent) were aged less than 40 years, with only 11 percent aged more than 55 years. On the basis of the age distribution, the average age of ROMPs in 2009 can be estimated to fall within the 35 to 39 year age bracket (the lowest range in the workforce dynamics indicator score, Table 3). Medical Physicist Workforce Study 12

13 Male Female Number Age Group (years) Figure 1: Professions survey ROMPs (including registrars), age by sex, 2008 Source: HealthConsult, 2009 Table 3: Average age workforce dynamic rating assessment, ROMPs Minimal Significant Average age of existing workforce < DIMPs The average age of DIMPs in 2011 was 44 years (calculated from unpublished data provided to HWA by ACPSEM). Figure 2 shows the age and sex distribution of the DIMP workforce in Unlike ROMPs, where most were aged less than 40 years, the highest number (and proportion) of DIMPs were aged between 40 and 55 years. This is reflected in the average age result. Medical Physicist Workforce Study 13

14 Number Male Female Age Group (years) Figure 2: DIMPs, age by sex, 2011 Source: Unpublished data, ACPSEM, November 2011 With an average age of 44 years, the DIMP assessment for average age falls within the second rating. Table 4: Average age workforce dynamic rating assessment, DIMPs Minimal Significant Average age of existing workforce < Replacement rate This indicator is assessed by calculating the ratio of newly accredited medical physicists to workforce exits. ACPSEM provided data on Training, Education and Accreditation Program (TEAP) enrolments and accreditations from 2006 to 2011 (for both ROMPs and DIMPs). The number of workforce exits was not available for either workforce. However for both workforces, information on intention to retire was available from the 2009 HealthConsult survey for ROMPs and from unpublished data collected by ACPSEM in November 2011 (and provided to HWA) for DIMPs. In the absence of other information this measure was used as a proxy for those exiting the workforce. It should be noted that intention to retire, when compared with actual workforce exits, tends to overestimate those leaving the workforce. It also does not take into account people exiting for reasons other than retirement, such as change of career, illness or injury. Therefore, this assessment should be used with caution and is indicative only. Medical Physicist Workforce Study 14

15 ROMPs Number of trainees and accreditations Table 5 provides an overview of the TEAP training pathway from 2006 to 2011 for ROMPs. New TEAP enrolments occurred each year over the period, along with an increasing (but relatively small) number of new accreditations. These data are consistent with the funding of fifteen ROMP registrars commencing their first year of training in under the Department of Health and Ageing Strengthening Cancer Care budget measure. Table 5: Training pathway, ROMPs New TEAP enrolments Accreditations Source: Prof Eva Bezak, Personal communication October 2011 Workforce exits As noted above, exit information was not available for the ROMP workforce. However, the 2009 HealthConsult survey collected data on ROMPs intention to retire, and in the absence of other information this measure is used as a proxy. Table 6 shows that at the time of the survey, 16 ROMPs (eight percent) intended to retire between 2009 and 2013, with a further 18 (or nine percent) intending to retire between 2014 and Assuming the retirements occur at an equal rate across those years, this equates to approximately three people exiting per annum. Table 6: Number of ROMPs intending to retire, and beyond Australia Note: Excluding registrars. Source: HealthConsult, 2009 Using an average of the accreditations over the period 2009 to 2011, the ratio of accreditations to workforce exits for ROMPs falls into the lowest rating bracket on the assessment scale (Table 7). Table 7: Replacement rate workforce dynamic rating assessment, ROMPS Minimal Significant Proportion of accreditations to workforce exits 130+% 110- <130% 90% - 110% 70% < 90% <70% Medical Physicist Workforce Study 15

16 DIMPs Number of trainees and accreditations For DIMPs, there have only been a small number of nuclear medicine TEAP enrolments in recent years, with no enrolments for radiology. There have been no accreditations for DIMPs over the period 2006 to 2011 (Table 8). Table 8: Training pathway, DIMPs New TEAP enrolments Radiology Nuclear medicine (a) Total DIMPs (a) (a) Enrolled in Diagnostic Imaging under the TEAP for DIMPs. Source: Prof Eva Bezak, Personal communication October 2011 Workforce exits Table 9 provides information on DIMPs intentions to retire with 11 DIMPs intending to retire in the next two years (from the time of the survey) and a further three in the next five years. Using the same process as was used for ROMPs, that is, assuming the retirements occur at an equal rate across those years, this equates to approximately three people exiting per annum. Table 9: Number of DIMPs intending to retire, 2011 In the next 2 years In the next 5 years In the next 10 years Australia Source: Unpublished data, ACPSEM, November 2011 With no accreditations, the replacement rate indicator is assessed at the highest rating bracket on the assessment scale (Table 10). Table 10: Replacement rate workforce dynamic rating assessment, DIMPs Minimal Significant Proportion of accreditations to workforce exits 130+% 110- <130% 90% - 110% 70% < 90% <70% Vacancy rate The 2006 and 2009 Round surveys provided information on the number of vacancies for both ROMPs and DIMPs. Medical Physicist Workforce Study 16

17 ROMPs Table 11 provides the vacancy rate for the ROMP workforce. Nationally, there was a relatively high proportion of vacancies for ROMPs in both 2006 (14 percent) and 2009 (11 percent). The vacancy rate varied substantially across states and territories, ranging from a low of approximately six percent in Western Australia to a high of 27 percent in the Australian Capital Territory in Large variability in vacancy rates occurred within states and territories across survey years. For example, in the Australian Capital Territory the vacancy rate increased from zero in 2006 to 27 percent in This is because of the size of the ROMP workforce, where only a small change in the number of vacancies has a large percentage impact. ROMP services are provided remotely to the Northern Territory. This is reflected in Table 11 with the Northern Territory having no vacancies or positions. Table 11: Vacancy rate, ROMPs, 2006 and Vacancies Total positions (a) Vacancy rate Vacancies Total positions (a) Vacancy rate State/Territory FTE FTE % FTE FTE % NSW Vic Qld SA WA Tas ACT NT Australia (a) Including vacancies. Source: Round, 2007 and 2010 Medical Physicist Workforce Study 17

18 As an average across the two survey years, the ROMP vacancy rate was approximately 12 percent. This falls into the highest range on the workforce dynamic rating scale (Table 12). Table 12: Vacancy rate workforce dynamic rating assessment, ROMPs Minimal Significant Vacancy rate <4% 4% - <6% 6% - <8% 8% - <10% 10+% DIMPs The DIMP vacancy rates for 2006 and 2009 are provided in Table 13. The national DIMP vacancy rate increased slightly from 2006 (six percent) to 2009 (eight percent). The same as the ROMPs, the DIMP workforce is small, so a small change in the number of vacancies has a large percentage impact on the vacancy rate. Also the same as ROMPs, the vacancy rate for DIMPs varied across all states and territories. Both Tasmania and the Northern Territory had no vacancies or positions in In Tasmania, this is because DIMP services are provided by Hunter New England Imaging, where quality control and auditing of on-site technicians is conducted approximately twice a year 6. DIMP services in the Northern Territory are also provided remotely, for example Breastscreen NT use a fly-in/fly-out DIMP from Queensland. 6 Personal communication, John Cormack, April Medical Physicist Workforce Study 18

19 Table 13: Vacancy rate, DIMPs, 2006 and Vacancies Total positions (a) Vacancy rate Vacancies Total positions (a) Vacancy rate State/Territory FTE FTE % FTE FTE % NSW Vic Qld SA WA Tas ACT NT Australia (a) Including vacancies. Source: Round, 2007 and 2010 As an average across the two survey years, the DIMP vacancy rate was approximately seven percent. This falls within the third bracket on the workforce dynamics rating scale (Table 14). Please note, advice from ACPSEM was that this rating should be at the highest level. They suggested longterm, unfilled positions have fallen off the vacancy list, leading to an under-estimation of the number of vacancies (and consequently a lower workforce dynamics indicator rating). They also suggested there is a shortfall in existing workforce numbers required to provide an appropriate quality service. Table 14: Vacancy rate workforce dynamic rating assessment, DIMPs Minimal Significant Vacancy rate <4% 4% - <6% 6% - <8% 8% - <10% 10+% Medical Physicist Workforce Study 19

20 Dependence on internationally trained professionals ROMPs The HealthConsult survey identified that approximately 40 percent of ROMPs received their qualification overseas (Table 15). This proportion was relatively consistent across ROMPs regardless of workforce entry year. This indicates there is reliance in the workforce on internationally trained professionals. Table 15: Origin of qualification by year of qualification, ROMPs Workforce entry year Before Total Place of qualification no. % no. % no. % no. % Australia Overseas Total Note: Excludes registrars and 20 origin of qualification not stated. Source: HealthConsult, 2009 Based on the information in Table 15, the ROMP workforce falls within the third bracket on the workforce dynamics rating scale for dependence on ITPs (Table 16). Table 16: Dependence on ITPs workforce dynamic rating assessment, ROMPs Minimal Significant Dependence on ITPs 0-14% 15-29% 30-44% 45-59% 60+% DIMPs Information was not available on ITPs for the DIMP workforce, therefore this indicator was not assessed. ACPSEM suggested this indicator would fall within the middle assessment ranges based on their workforce modelling. Medical Physicist Workforce Study 20

21 Duration of training program To become a medical physicist, a person must: complete an undergraduate degree with a major in physics obtain a training position at a clinical department apply for a place as a registrar in the TEAP in one of three specialty areas (upon obtaining a training position), and complete a post-graduate degree in medical physics, normally at Masters level (undertaken concurrently with TEAP completion). 7 Upon successful completion of the above steps, the ACPSEM accredits a person as a medical physicist. For the purpose of this indicator, the assessment is based on the post-graduate training time (that is, the TEAP), not the entire training pathway. TEAP initially commenced for ROMPs in It was first developed as a response to the 2002 Report of the radiation oncology inquiry: A vision for radiotherapy, which recommended the introduction of a formal five-year training program for ROMPs. The program was expanded to encompass radiology and nuclear medicine (DIMPs). The ACPSEM website notes the TEAP standard program is expected to take four to five years. For this assessment the longest training time is assumed. Therefore, both the ROMP and DIMP rating falls in the third bracket on the assessment scale for this indicator. Table 17: Duration of training program workforce dynamic rating assessment, ROMPs and DIMPs Minimal Significant Duration of training program (years) < < accessed 13 September Medical Physicist Workforce Study 21

22 5 Context for workforce assessment While the assessment in chapter 4 highlights a number of areas of in both the ROMP and DIMP workforces, it is important to understand other factors that may influence the interpretation of the assessment. Three additional aspects are presented for information in this chapter: Size and other characteristics of the workforces Demand for ROMPs and DIMPs Workforce projections. Size and other characteristics Size The absolute size of a workforce is not necessarily a measure of in itself how would the threshold below which a workforce is considered vulnerable be determined? However, when combined with other indicators the size of a workforce can contribute to areas of. Table 18 presents the size of the ROMP and DIMP workforces. ROMPs accounted for the majority of employed medical physicists in 2009 (78 percent or FTE), with DIMPs accounting for the remaining 22 percent. The DIMP category was split almost equally between radiology medical physicists (32.4 FTE) and nuclear medicine medical physicists (37.2 FTE). As can be seen, both workforces (particularly the DIMP workforce) are very small. This means they are likely to be more affected by areas of significant (highlighted by the workforce dynamics indicator) than larger workforces. For example, the ROMP workforce has a high vacancy rating. In a sustained period of high vacancies, the impact on the ROMP workforce could be expected to be more significant when compared with a larger workforce. This is because the larger workforce would have some capacity to absorb high vacancies in the short-term, while interventions could be established. Table 18: Employed ROMPs and DIMPs in Australia, 2006 and 2009 Employed (FTE) Radiation Oncology (ROMPs) Diagnostic imaging medical physicists Radiology Nuclear Medicine Total DIMPs Total medical physicists Source: Round, 2007; Round, 2010 Medical Physicist Workforce Study 22

23 Average hours worked and gender distribution ROMPs Figure 3 presents average weekly hours worked by gender for ROMPs. The majority of ROMPs worked between hours per week, with only small proportions working 50 or more hours per week (eight percent) and less than 30 hours per week (six percent). Almost half (49 percent) of female ROMPs worked less than 40 hours per week, compared with approximately one-third (32 percent) of males. Figure 1 earlier in this report showed there are approximately equal numbers of male and female ROMPs in the younger age groups, with the older age groups dominated by males. Combined with the average hours worked results, this will likely have an impact on ROMP supply Male Female Number Average Weekly Hours Worked Figure 3: ROMPs (including registrars), average weekly hours worked by sex, 2008 Source: HealthConsult, 2009 DIMPs Average hours worked information was not available for DIMPs, however it can be assumed that a similar pattern of female and male average hours worked would exist, that is, female average weekly hours worked are lower than males. Similar to ROMPs, there are also approximately equal numbers of male and female DIMPs in the younger age groups (Figure 2, earlier in this report, noting also the very small numbers). A similar effect as described above may be expected, with an impact on DIMP workforce supply. So, being small workforces with increasing female participation (that may impact average weekly hours worked), the areas of highlighted by the workforce dynamics indicator could be expected to affect the ROMP and DIMP workforces more than workforces with greater absolute numbers. Medical Physicist Workforce Study 23

24 Demand for ROMPs and DIMPs If demand for the ROMP and DIMP workforces is not expected to continue, high workforce dynamics indicator ratings may be of less than if demand is expected to continue or grow. In the latter instance, high workforce dynamics ratings may indicate a need for workforce intervention. There are two key factors influencing the demand for the ROMP and DIMP workforces increasing incidence of cancer and increasing cancer care infrastructure. Incidence of cancer According to the Australian Institute of Health and Welfare, the number of new cancer cases more than doubled between 1982 (47,350 new cases) and 2007 (108,368 new cases). 8 The incidence rate for all cancers combined also increased (by 27 percent) from 383 cases per 100,000 people in 1982 to 485 cases per 100,000 people in Further to this, Cancer Australia noted in their Annual Report: In 2010 about 115,000 Australians were expected to be diagnosed with cancer, and by the age of 85 years, one in two men and one in three women will have been diagnosed with cancer in their life. Cancer is estimated to be the leading cause of burden of disease in Australia, accounting for approximately 19 per cent of the total disease burden in Similar over the demand for services has been expressed by Victoria with an expected increase of over 20 percent in cancer incidence over the next decade 10. From such statements, it can be expected the incidence of cancer will continue, and consequently there will be a continuing, if not growing, demand for ROMP and DIMP services. Infrastructure The Federal Budget included a number of initiatives related to the Cancer Care System. New infrastructure announced included national centres at the Royal Prince Alfred Hospital in Sydney, the Parkville Comprehensive Cancer Centre in Melbourne and an expansion of the Garvan St Vincent s Cancer Centre in Sydney, plus the building of a network of regional cancer centres. This increase in infrastructure will particularly impact on the demand for ROMPs, whose role encompasses ensuring that therapy radiation doses are accurately delivered. The impact on DIMPs will not be as great, however some increase in demand is expected, reflected in the funding of fifteen additional diagnostic imaging training positions. Workforce projections Workforce projections are a tool to assist with workforce planning. In the context of this report workforce projections can be used to highlight any significant anticipated changes to the future workforce that may impact on the workforce dynamics assessment. ROMPs In the 2009 HealthConsult report, a workforce projection was conducted using 2009 as the baseline (by age profile), with expected recruitment and estimated attrition rates. Parameters and assumptions in the projection included: there would be 97 new registrars in each five year period of the projections 38 percent of Australian patients diagnosed with cancer received radiation treatment (per the 2002 Report of the radiation oncology inquiry: A vision for radiotherapy) 8 Accessed 2 May Ibid 10 Victorian Government. Department of Human Services, Victorian Radiotherapy Service Plan, July Medical Physicist Workforce Study 24

25 a moderate target to aim to achieve was 45 percent treatment the desired, or best practice treatment rate was 52.3 percent rate. Figure 4 presents the supply projection and estimated demand scenarios. In the short to medium term, the level of supply remained at the no change demand level of meeting approximately 38 percent receiving treatment. This is substantially less than the moderate (45 percent) or best practice (52.3 percent) levels of treatment. In the longer term, the projection showed that workforce supply, with expected recruitment and estimated attrition, would be sufficient to meet the moderate level of treatment (but still below the best practice level of treatment). ROMP Workforce Projection Supply of ROMPs 200 Demand: Best Paractice (52.3% treatment) 150 Demand: Moderate (45% treatment) Demand: No change (38% treatment) Figure 4: ROMP workforce projections to 2019 Source: HealthConsult, 2009 DIMPs For DIMPs, a projection series was prepared (Cormack 2011) which provided a workforce supply trend if no intake is initiated, and the level of intake that would be required to increase the DIMP workforce to a fixed level. The tabulation used and the graphical presentation published in 2011 are provided in Table 19 and Figure 5. This illustrative approach to projecting workforce supply to meet a fixed demand provides an indication of the magnitude of the injection of new registrars required (assuming nothing else changes). This assists in providing short and medium term directions in the estimation of the number of new registrars. Medical Physicist Workforce Study 25

26 Year Table 19: Calculation of DIMP workforce trends with and without intakes Effective workforce (current trend) Workforce (required) Effective workforce (a) Effective registrar contribution intake 1 (b) Effective registrar contribution intake 2 (c) Effective registrar contribution ongoing (d) Intake of experienced DIMPs Attrition Rate % % % % % % % % % % (a) Effective workforce (with recruitment and training strategy) (b) Effective registrar contribution intake 1: 21 registrars, starting 2011 (c) Effective registrar contribution intake 2: 20 registrars, starting 2012 (d) Effective registrar contribution (ongoing): 4 new registrars per year, starting 2014 Source: John Cormack, Personal communication May 2011 Figure 5: DIMP workforce trends with and without intakes 120 Required level Effective workforce With recruitment/training strategy Current trend Source: Cormack, 2011 Limitations in the DIMP illustrative projections The projection series prepared by Cormack (2011) demonstrated a widening gap between the demand and supply of DIMP services. However there are a number of additional factors to consider in interpreting the projection series. Medical Physicist Workforce Study 26

27 The impact of the number of new TEAP recruits on the existing workforce. Two major intakes of registrars included in the projection would have a major impact of the need for supervision from the reducing pool of experienced DIMPs. This would impact on the provision of DIMP services. The impact in the changing proportion of female DIMPs. With approximately equal numbers of male and females in younger age groups, it can be anticipated that the FTE DIMP workforce would fall (due to females historically working less hours than males). The assumption of a fixed level of demand. From recent studies it is evident that demand will increase with the expected increase in incidence of cancer and the increase in infrastructure. In addition, with changing technology it can be expected that there would be an increase in DIMP workload to both implement and maintain these new technologies. HealthConsult (2009) identified that more complex technologies will require more staff. Notwithstanding the limitations outlined above, the projections suggest that the ROMP and DIMP workforces will not increase significantly the ROMP projections suggest no change in the short to medium term and the DIMP projections suggest falling workforce numbers. This indicates the workforce dynamics indicator assessment conducted in this report are not likely to be impacted. That is, the areas of significant are not likely to reduce in the future compared with current with the current assessment. Medical Physicist Workforce Study 27

28 6 Potential paths forward The workforce dynamics indicator assessment, combined with the additional contextual information, suggests areas of now and into the future for both the ROMP and DIMP workforces. As such, consideration of future paths forward for the workforces is appropriate. In considering the future pathway, it is important to recognise what is sustainable, and to examine a range of options. Applying the response framework adopted for Health Workforce , there are four areas of consideration: 1. Workforce reform and innovation 2. Reform of training pathways 3. Increased supply through immigration 4. Increased supply through domestic training. It is likely a combination of all these areas would be required to sustainably move forward. Workforce reform and innovation Workforce reform and innovation can be used to improve flexibility, productivity and retention. The ROMP and DIMP workforces are small and highly specialised professions with a long training pathway. As such, it is important they are employed as far as possible on tasks for which only they have the training and capability to perform. Other tasks can be safely undertaken by less specialised workers, under appropriate guidance and supervision. In the case of the medical physicist workforces there is an existing model of this approach DIMP services in Tasmania and the Northern Territory are provided by interstate-based DIMPs, who visit regularly to conduct quality control and audit on site technicians 12. There are also some centres in Australia employing medical physics technicians to undertake defined tasks, with discussions also occurring more broadly on the role medical physics assistants or medical physics technicians could play in easing workforce issues. 13 This suggests there is scope to look at alternative models of workforce deployment (also enabled by an existing nationally consistent training program). This could reduce the need for the profession to directly undertake tasks, rather, enabling the professions to supervise an assistant workforce. Such alternative models could have a large potential impact on the requirement for ROMPs and DIMPs, and hence on their workforce dynamics rating assessment. There is also a high degree of specialisation within such a small overall workforce, with three distinct sub-specialties (radiation oncology, radiology and nuclear medicine). An examination of whether this degree of specialisation is required may be appropriate. An option could be a more generalist medical physicist role, which may be particularly applicable in an environment where the role of the medical physicist may be more supervisory than operational. The suggestions above encompass both the ROMP and DIMP workforces. The Radiation Oncology Reform Implementation Committee (RORIC), responsible for advising on reform initiatives to support sustainable access to radiotherapy services, has developed the RORIC Workforce Reform Framework. This framework is specific to radiation oncologists, radiation therapists and ROMPs. The framework specifies four key areas of reform, one of which is Workforce reform for more effective, efficient and accessible service delivery. This is focused on improving the efficient and effective utilisation of available workforce, through business process improvements, effective application of 11 Health Workforce Australia 2012: Health Workforce 2025 Doctors, Nurses and Midwives Volume Personal communication, John Cormack, April Communication with HWA, ACPSEM, May Medical Physicist Workforce Study 28

29 new technology, clinical practice improvements and role redesign. While there are no specific reforms outlined for ROMPs within this, proposals include more actively engaging with stakeholders to inform best practice models of care, and that innovative approaches are shared across jurisdictions. Under the Workforce capacity building and skills development area of reform, advanced practice and extended scope of practice are promoted as ways to expand workforce numbers creating positions to perform less specialised tasks currently undertaken by skilled professionals. This is consistent with HWA s suggestion above, and while the framework does not suggest specific reforms, it proposes RORIC will provide information on job redesign potential and examine the feasibility of the concept (if the proposal is supported). One example already in existence is advanced roles for radiation therapists, which included the development and evaluation of a radiation engineering assistant role (with the evaluation report currently being written). Reform of training pathways In line with an approach of a more generalist workforce as outlined above, the existing training pathway for medical physicists could be examined particularly in terms of training posts which are currently specific to ROMP and DIMP roles. It should be noted some amalgamation of nuclear medicine and diagnostic radiology is already occurring, with the design of the DIMP TEAP taking this into account. The four to five year training pathway for medical physicists is also relatively long. In a situation where the profession is identified as potentially vulnerable it may be appropriate to examine whether it is possible to streamline training to reduce the overall length, while maintaining appropriate quality standards. This is consistent with the RORIC Workforce Reform Framework, which specifically mentioned streamlining existing training programs, and for the ROMP workforce in particular, it promoted the Queensland approach to training, which reduces the traditional ROMP training time by one year. Increased supply through immigration The ROMP workforce is already relatively reliant on ITPs (with no information available for the DIMP workforce). The continued or increased targeting of overseas supply may be useful in the short-term to fill supply gaps, while workforce and domestic training reforms are established. The medical physicist occupation is currently included on the general skilled migration skilled occupation list, which means overseas medical physicists can apply for a permanent visa in Australia without employer sponsorship, and it is also on the employer nomination scheme occupation list. By appearing on both these lists, the immigration of medical physicists into Australia is better enabled. Increased supply through domestic training For ROMPs, the replacement rate indicator is at the lowest workforce dynamics rating level, that is, of minimal. However for DIMPs, this indicator was at the highest workforce dynamics rating level (of significant ). Therefore it may be appropriate to examine whether additional training positions should be created to meet long-term supply issues. Any increase in domestic training should only be considered in combination with the options outlined above. This is to ensure the opportunity for appropriate reform is not lost by simply taking a more of the same approach, and that the option (or combination of options) chosen, results in a sustainable workforce and training pathway. Improved data collection In addition to the potential paths forward outlined above, there is scope for improved data collection on the medical physicist workforces, particularly for DIMPs. Reflecting the greater focus Medical Physicist Workforce Study 29

30 on the ROMP workforce as a result of the 2002 Report of the radiation oncology inquiry: A vision for radiotherapy, all indicators for ROMPs were able to be assessed (recognising retirement intentions were used as a proxy for exits). A key data source on the ROMP workforce was a detailed data collection conducted as part of the 2009 HealthConsult review of the radiation oncology workforce. However for DIMPs, no such data source exists and one of the five workforce dynamic indicators was not assessed due to data limitations (again also recognising retirement intentions were used as a proxy for exits). With key data sources for the ROMP and DIMP workforces also being collected on a different basis, with different data items, this indicates there is a need to improve the evidence base. Improved data collection would enable monitoring and planning, and a collection based on national health workforce data items (refer Appendix 1) would also enable comparability with other health professions. Medical Physicist Workforce Study 30