Bhudatt Paliwal, PhD, a medical physicist in the department of human oncology at the University of Wisconsin, expressed his concern that a lack of residency places might mean a compromise of patient safety. Concerns about patient safety have introduced improvements to the training of medical physicists in the U.S. However, these training advances, made in response to changes in the fields of radiology and radiation oncology, have had the unintended consequence of limiting the number of professionals suitable to enter the field, Paliwal explained.
Academic programs have expanded due to a substantial increase in the complexity of and knowledge required for many radiation oncology procedures. As a result, the number of courses needed to acquire the requisite knowledge base has increased.
"Students find themselves having to go through a longer period of formal academic training, only to find a lack of available residency positions," Paliwal said. "Due to the growth of the didactic program, there's a large population of students entering the field, but most of them have difficulty finding residence slots to obtain the on-the-job training to get a position as a medical physicist."
Changes in recent years have required that students earn a degree from an accredited medical physics program, and not just earn a degree in physics. More important, they also need to successfully complete a 24-month residency program. Completing an accredited residency is a prerequisite to take the American Board of Radiology (ABR) examination.
Last year, only 51 students entered medical physics residency programs in the U.S. "They can't get the training and therefore the certification, so nobody hires them," he said. "This is the effect of regulatory changes that were intended to improve the quality of care so people entering the field come with a strong background, but something needs to change to meet the needs of the profession."
There are now almost 30 accredited programs in the U.S. and 40 programs offering medical physics residencies, but these programs accept only one or two applicants. "The lack of residency positions is becoming a real issue. It will be even more critical in 2014 when the new requirements by the ABR go into effect," Paliwal said.
The American Association of Physicists in Medicine (AAPM) is proposing an alternative credentialing process with coursework that can be completed in 18 to 24 months. This will overlap with the residency program so that training can be completed in a four-year time frame following completion of a bachelor's degree in physics.
However, Paliwal has reservations. "The U.S. professional associations are trying to promote more residency spots. However, funding is harder to find," he said. "The alternative program does not exactly address the issues. It is more related to the issue of physicists who need additional education in medical physics because their degrees were not awarded through an accredited medical physics program."
Raising concerns about resident training on specialist topics in the U.S. and Europe, medical physicist Dr. Alberto Torresin, of the Niguarda Ca' Granda Hospital's department of medical physics in Milan, said that "training is really in only one field at a time because of the complexity of technology today. It's not possible to be an expert in all areas, even for instructors, but it is important to have a knowledge exchange among the various medical physics areas (radiology, nuclear medicine and radiotherapy)."
In response, Paliwal agreed. "Not only is their specialization in radiation oncology, but within this field there is further specialization, e.g., stereotactic radiotherapy. The boards of the certifying authorities do not recognize this currently."