From the April 2020 issue of HealthCare Business News magazine
Measuring what counts
In laying out the basic landscape of possible medical physics services, reports like the AAPMs perform an important role for administrators seeking a balanced medical physics solution. The report divides that landscape into three levels:
Level 1. Services and duties mandated by regulatory bodies (these are relatively easy to identify and quantify);
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Level 2. Responsibilities and tasks not mandated by an outside entity, but still widely recognized as valuable (possible to identify and quantify);
and Level 3. Neither mandated nor well-defined, but still part of a medical physicist’s contribution — this comprises things like research, development, and exploration of new tools and methods (possible to identify, difficult to quantify).
These levels are useful both in informing decision-makers about what medical physicists already do and in reminding them that those duties, like the technology they’re based on, are always changing. In other words, the very presence of a “Level 3” demands that administrators acknowledge the intangible knowledge work, collaboration, and evolving skills medical physicists must do to succeed in the field. Or, as the report puts it: those same Level 3 activities that are less quantifiable “are also often those that are novel, emerging, or have not yet become a universal standard practice in all institutions. As such, they are growth opportunities for diagnostic medical physics.”
Striking the balance
When an institution decides to hire a consultant for some amount of Level 1 duties, where efficiency and accountability are paramount, they still need to decide who will handle those in Levels 2 and 3. Depending on the hospital’s size and focus, hybrid solutions work well when the in-house physicist or physicists handle the programmatic aspect of the work, overseeing quality assurance across the institution. On the diagnostic side this could mean managing several buildings’ worth of radiologic equipment; on the therapeutic side it could mean overseeing proper patient delivery and safety during radiation oncology treatments (while still relying on consultants to create efficiencies within the required regular tasks). In either case, having consultants take care of the Level 1 duties frees up the in-house physicist to take a broader view of their program.
What in-house employees do with that freedom is, of course, where both the greatest risk and the greatest potential reward lie. Medical physicists, as a whole, are adept, dedicated, and driven, and there are many instances where they contribute to an institution’s operations and mission in untold ways. If they aren’t making these contributions, however, that may also prove difficult for non-experts to recognize. For example, the Joint Commission requires that CT and fluoroscopic dose be optimized. Yet those efforts vary widely across institutions: some do a loose reporting of metrics while others create robust and structured programs where the data collected are continually used to improve quality and safety. Often, institutions in the former group will be found compliant — but those in the latter group are the ones meeting the true aims of the standard.