From the April 2020 issue of HealthCare Business News magazine
Knowing what you need means taking into account the institution’s focus (e.g., cancer, cardiac disease, pediatrics) and overarching goals (e.g., research, growth in a certain area). In terms of medical physics, here are some examples of how these aspects can affect the proper medical physics service mix:
Some hospitals simply don’t have enough equipment and radiation-based procedures to have a physicist around 40 or 50 hours a week. A large academic institution, on the other hand, will undoubtedly need the specific expertise of a medical physicist (or several) on staff. In between is where a hybrid solution is most common: hospitals with in-house physicists might outsource routine tasks that nonetheless require meticulousness and expertise specific to a consultant, especially when the tasks can be identified and allocated for in advance. The in-house physicist oversees that work but is also available to handle unexpected problems, and tasks outside of routine monitoring and maintenance.
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Institutions that focus on cancer will usually need to have medical physicists on staff. The choice is more complicated at a large hospital focusing on cardiac issues: it will likely need in-house diagnostic medical physics expertise (for cardiac CTs, say), but might successfully manage a hybrid in-house/outsourced mix rather than employing numerous physicists. Pediatric hospitals, too, may feel they need in-house physicists to optimize radiation dosage and minimize exposure when diagnosing the hospital’s vulnerable patients, but might usefully pursue outsourcing assistance for other applications. The ROI here derives from ensuring that the radiation is optimized for the practitioners working with this sensitive cohort.
As administrators know all too well, the healthcare dollar is not infinite — hence reports like the AAPMs that seek to estimate the time and cost of necessary services. When the responsibilities of a medical physicist are understood as regular, easily anticipated, and discrete, then consultants on the whole are a safer investment: their job is to knowledgeably and consistently estimate the time a task will take, and to stick to that time. Knowing that the client will want to account for every minute of time they spend — and knowing that they’re in constant competition for that client’s business — consultants are contractually committed to efficiency. The institution can thus be assured that a consultant will not waste time on irrelevant meetings or matters where they can’t make a meaningful difference. This is not an assurance that an employed medical physicist can provide. Avoiding “pound foolishness” is, thus, more easily done when the institution relies on consultants to do the work. However, outsourcing these responsibilities completely also raises the chances of being “too pennywise”: missing out on the informal conversations that can lead to quality or process improvements, like a chance coffeeshop meeting between a cardiologist and physicist where they discuss ways to improve imaging of vessels, or the ability of a physician to call an in-house physicist in to witness an unusual case.