Inr. .I. Radiation
Oncology
tliol.
Phgs.. 1977. Vol. 2. pp. 337-343.
Pergamon Press.
Printed in the U.S.A
??Special Feature RADIATION THERAPY TECHNOLOGY MANPOWER NEEDS, PROBLEMS, POTENTIAL-1976 C.
JULES
ROMINGER
M.D.
Associate Professor of Radiation Therapy, Jefferson Medical College of Thomas Jefferson University and Chairman, Department of Radiation Therapy and Nuclear Medicine, Mercy Catholic Medical Center, Philadelphia, PA 19143, U.S.A.
and DIANA Staff Consultant,
Joint
BROWNING,
R.T.
Review Committee on Education Chicago, IL 60601, U.S.A.
in Radiologic
Technology,
The shortage of radiation therapy technologists in the United States is reaching crisis proportions as documented in a recent survey? The shortage has developed over the last ten years as the number of technologists graduated falls short of the number that are necessary to staff radiation oncology departments of increasing sophistication. The separation of radiology into diagnostic and therapeutic sections, including residency and technology traintng programs, has hastened this crisis. The purpose of this paper is to review the current situation, its historical development and suggest approaches to a solution of this manpower shortage. Radiation
therapy technology
CURRENT
manpower
needs, Recruitment,
STATUS
A recent survey made by the American Society of Therapeutic Radiologists (ASTR) in May 1975’ achieved a 90% response of its members; the survey documented the shortage of radiation therapy technologists beyond any doubt and without any dilution of the statistics with diagnostic radiologic technologists. The results of this survey indicated that in the institutions responding, 250 positions for radiation therapy technologists were open, and further, 483 positions were filled by diagnostic radiologic technologists. There exists at present, a shortage of over 750 radiation therapy technologists; these posiReprint requests to: C. Jules Rominger, Mercy Catholic Medical Center, 5301
Programs.
tions are filled only partially by diagnostic radiologic technologists and nurses. This shortage is likely to increase, since an additional 825 positions for radiation therapy technologists are expected to become available by 1978. The results of this survey led to the conclusion that it will be necessary to graduate 500 radiation therapy technologists annually until 1985 to end this current shortage and keep up with the normal demand for qualified staff. This figure allows for a conservative 10% annual attrition rate. In May 1975, at the date of the survey, there were 1080 technologists registered in radiation therapy by the American Registry of
M.D., Cedar
Avenue, 337
Philadelphia,
PA 19143, U.S.A.
338
Radiation Oncology 0 Biology 0 Physics
Radiologic Technologists (ARRT).’ After the first examination in 1964, there were 88 registered technologists (oral communication, Roland McGowan, R.T., Executive Secretary, ARRT). The rate of increase in registration has been intolerably slow in view of the current situation and projected need. The existence of a need now seems well documented by the results of the survey shown in Tables l-3 and by the data related to Table 1. Manpower
March-April
1977, Volume 2, No. 3 and No. 4
the volume of cancer patients, number of radiation oncologists and radiation therapy facilities shown in Table 2. It must be pointed out that were a complete national survey possible, the numbers in Table 3 would be higher in all categories. For instance, using the information from “The Study of Patterns of Cancer Care in Radiation there are 1080 facilities with meTherapy,“’ gavoltage units identified in the United States.
supply of radiation
therapy technologistst Number Filled
Open
98 1032
98 824
0 208
483
483
0
154
148
148
0
83
239
197
42
1999
1750
250
Available
Radiation therapy technologists doing dosimetry Radiation therapy staff technologists Diagnostic technologists performing radiation therapy technology Nurses performing radiation therapy technology Supervisor radiation therapy technologists Total tFrom statistics May 1975.s,6 Table
accumulated
by the American
2. Radiation therapy technology genera1 information? Available
survey:
Number
Megavoltage units Other units Simulators Radiation theraoists reuresented Cases of cance; treate;l
672 535 138 818 209,483
tFrom survey made by American Society Therapeutic Radiologists, May 1975.‘,” Table 3. Current
manpower
of
2 RTTf per megavoltage unit (672) 2 RTT per radiation therapist (818) 2 RTT per 300 new patients tDerived from statistics accumulated Radiologists in a survey in May 1971j.~,” SRTT = radiation therapy technologists.
Need 1978
Unknown 825
Unknown 1062
Society of Therapeutic
Radiologists,
If the criteria used in Table 3 were applied to registered radiation this figure, i.e. two therapy technologists per megavoltage unit, and an estimate of 500 used for supervisors, educators and dosimetrists, the number of positions which should be filled by radiation therapy technologists would be 2660. HISTORICAL
DEVELOPMENT
Over the 12 years since the first examination in radiation therapy technology was given by
needs projected
Criteria
of positions
from statistics
Number of staff radiation therapy technologists 1344 \ 1636 1396 J by the
American
in Table 2t
Number of supervisors and dosimetrists 366
Society
Total I 1680 1972 1 1732
of Therapeutic
Radiation
therapy
technology
manpower
the American Registry of Radiologic Technologists (ARRT), the radiation therapy community has engaged in a number of activities to provide itself with qualified radiation therapy technologists. Some of these efforts have been successful on a temporary basis, others are beginning to bear fruit and should be expanded; new ideas are needed. The initial approach to the need for radiation therapy technologists proceeded in concert with, and parallel to, the approach to the need for physicians in the field of radiation therapy. Those individuals already working in the field of radiation therapy technology were identified, examined and certified by the ARRT. In most institutions, the two disciplines of therapeutic and diagnostic radiology have division. undergone an orderly This process now is nearly complete as indicated by the changes in accredited residency programs in radiology to almost exclusively straight programs in therapeutic radiology or diagnostic radiology. The one year training programs in radiation therapy technology which were established to accomplish the retraining of individuals who already were working in therapy, now are accepting students directly from radiologic technology training programs. The recruitment of students into the one year program is relying heavily on the exposure which radiologic technology students receive in the course of their training. This exposure now is limited (10 lecture hours in radiation therapy required and clinical education an elective); logically, it cannot be expected that large numbers will continue to choose to enter the therapy technology field by this route. The second approach to meeting this need initially was to import radiation therapy technologists, as well as therapeutic radiologists, from other countries. The main origin of these individuals have been the English speaking countries, e.g. Great Britain, Australia, Canada, South Africa, etc. This “brain drain” was not viewed with enthusiasm by the parent countries and recently has slowed as a result of a combination of factors: better employment opportunities in the home countries; difficulty in obtaining immigration visas to the United States; and the relative success of training programs in the United States.
needs 0 C. J. ROMINCER and D. BROWNING
339
ACCREDITATION AND CERTIFICATION MECHANISMS The American Society of Radiologic Technologists (ASRT) and the American College of Radiology (ACR) have cooperated with the Council on Medical Education of the American Medical Association (AMA) in developing two sets of Essentials for Accredited Training Programs in Radiation Therapy Techno1ogy.z.3 The “Essentials” for one year training programs in radiation therapy technology established the standards for those programs that accept students who are graduates of radiologic technology programs or registered “Essentials” nurses. The for two year programs establish the standards for programs that accept students with a minimum requirement of high school graduation. The ASRT and the ACR are currently reviewing the Essentials with the object of combining the two sets of Essentials into one set which will apply to either the one or two year programs.2.3 The Joint Review Committee on Education in Radiologic Technology (JRC) conducts site visits of these programs and makes recommendations on their accreditation status to the AMA. Therapeutic radiologists and radiation therapy technologists are represented on the JRC and many volunteer in the peer review system of accreditation organized by the JRC .5,6 The American Registry of Radiologic Technologists (ARRT) examines and certifies graduates of these AMA accredited programs. The ARRT utilizes therapeutic radiologists and radiation therapy technologists as examination writers and reviewers.’ All of these activities have been encouraged by the American Society of Therapeutic Radiologists through its Committee on Radiotherapeutic Technology. TRAINING PROGRAMS IN RADIATION THERAPY TECHNOLOGY The key to the future of radiation therapy technology lies in the training programs. Currently, there are 73 accredited programs in radiation therapy technology in the United States.5.6 In reviewing the current shortage of radiation therapy technologists, the number of
340
Radiation
Oncology
0 Biology
0 Physics
training programs, their utilization, augmentation, proliferation and support, the following points must be considered: (a) current utilization and recruitment, (b) geographic distribution and potential for new programs, (c) the need for qualified instructor preparation programs, (d) continuing education for all radiation therapy technologists. CURRENT UTILIZATION AND RECRUITMENT As noted in Table 4, the majority of accredited programs in radiation therapy technology are one year programs (S3). The 20 two year programs are divided equally between hospital based certificate programs (9) and associate degree programs (11). It is interesting to note that four of the two year certificate programs and one of the two year associate degree programs also sponsor one year certificate programs. Many of these programs have multiple major affiliates for clinical education of students, thereby involving 148 institutions in the training of radiation therapy technologists. According to JRC records’.’ these 78 programs have an authorized student capacity of approximately 500 annually. However, the ARRT reports only 184 applied for examination in radiation therapy technology in 1975; this suggests a much lower enrollment in these programs. Since one of the quickest ways of increasing the number of graduates in radiation therapy Table
4. Accredited radiation programs (Sept. Type
One Two Two Four Total
therapy 1976)
of program
year certificate year certificate year associate year bachelor programs
degree degree
Program sponsors (some institutions sponsor both one and two year programs Major affiliates Total institutions involved in radiation therapy education and training
technology
Number 56 9 11 2 78
74 74
148
March-April
1977, Volume
2, No. 3 and No. 4
technology would be to increase the number of students graduating from existing programs, an attempt has been made to discover the reason for this low enrollment. There are several contributing factors: 1. Stipend-Many of the one year programs feel they must offer a stipend to students who already have an R.T. in radiologic technology and would be earning a good salary if they were not in training. The budget set for the school then becomes a limiting factor in the enrollment of students. This policy of the stipend becoming a limiting factor in student enrollment is carried over to many of the two year programs, where one year and two year programs exist in the same institution. Programs which have reduced or completely dropped their stipends have found that their application rate has remained stable. Revision in stipend policy may enable a program to increase its student enrollment, without increasing the overall cost of the program. 2. Recruitment-The number of applications received by programs appears to vary incredibly. Some programs report that they have 50 applications for 6 positions; other programs report that they have not received enough applications to fill their available positions. There are several reasons for this variation in recruitment across the United States: (a) The one year programs may be suffering because the Essentials and curriculum for radiologic technology programs no longer require rotation through the radiation therapy department, thus removing a considerable recruitment opportunity for radiation therapy training programs. The one year training programs have overcome this lack of opportunity by recruiting their students from many different radiologic technology training rather than relying on the one programs, particular group of students who rotated through their department. (b) The two year programs have had difficulty in making the opportunities in radiation therapy known to high school graduates. Many guidance counselors and recruiting personnel do not understand the field of radiation therapy. There is a wide-spread
Radiation
therapy
technology
manpower
misconception that all radiation therapy patients are terminally ill and that an 18 year old will not be able to cope with this situation. Many educators fail to realize that 80% of the patients who receive radiation therapy attend as outpatients and are leading a relatively normal life. They also grossly underestimate the empathy and capabilities of young high school graduates. Those who are interested enough to seek a career in radiation therapy are well able to handle any difficult situation they may encounter once they are prepared adequately for the situation by their instructors. (c) Because of the small size of the programs and the number of students involved, it usually is impractical for the programs to recruit directly from high school via career day, etc. The solution to recruitment programs is complex, but the following approaches are suggested: (1) In the future, the primary source for radiation therapy technologists should not be the graduates of radiologic technology programs. Radiation therapy technology training should always be open to radiologic technologists via the one year program, but eventually, the primary source of radiation therapy technologists must be the graduates of two year programs, since this shortens the overall training period for a technologist from three years to two years. (2) Recruitment efforts into two year programs should be concentrated on the high school group by the use of the following: (a) Recruitment brochures-most colleges who sponsor associate degree programs have these and the ASRT is developing one as a career brochure. (b) Visual aids for recruitment, such as slides, filmstrips and motion pictures to be shown at career days. There is at least one current attempt to develop a motion picture for this purpose. (c) Information days for guidance counselors and recruitment officers of educational institutions so they may become familiar with the field of radiation therapy and career opportunities for radiation therapy technologists.
needs 0 C. J. ROMINGERand D. BROWNING
341
(d) Participation of radiation therapy technologists and therapeutic radiologists in career days in high schools as a cooperative effort for radiation therapy technology in general rather than one school in particular. (e) Recruitment of candidates already in collegiate settings but looking for a rewarding science oriented career. (3) Secure more cancer program grant and contract monies for technology and technology education development. GEOGRAPHIC DISTRIBUTION AND POTENTIAL FOR NEW PROGRAMS While all regions of the country are served, there is a need for more programs in certain obvious areas of the country (Fig. 1). The recent survey of technologist needs conducted by the ASTR indicates clearly that many major institutions qualify as cancer management centers (ACR, 1965)4 and are, therefore, eligible to participate in programs in radiation therapy technology, but that they are not involved in technologist training. The major impediments in this regard are: (1) Cost per student. This might be solved by a variety of means, e.g. multiple hospitals affiliating into a single program, with one hospital sponsoring the program and accepting the responsibility for the didactic portion of the program. Multiple hospitals affiliating into a single program sponsored by a junior college or university. Encouragement of seed grants to start programs in areas of need. (2) The lack of qualified radiation therapy technology program directors and instructors. Many institutions which meet the standards for major cancer management centers and would like to participate in training programs are unable to do so because they do not have qualified radiation therapy technologists on staff. 3. Interest on the part of the radiation therapy community in starting programs. This must be encouraged and fostered by organizations through editorials, articles, etc. Radiation therapy departments that are interested in establishing a training program should be encouraged to find support for their technologists who desire to attend training programs for instructors.
342
Radiation Oncology 0 Biology 0 Physics
GEOGRAPIIIC
DISTRIBUTION
OF
March-April
RADIATIOK
One year TWO year Tuo year
1977, Volume 2, No. 3 and No. 4
THERAPY
certificate certificate degree
PROGRAMS programs programs programs
52 10 10
,i.:\
Fig. 1. Geographic distribution of educational programs in radiation therapy technology (May, 1976). Each dot indicates the location of a Radiation Therapy Technology Educational Program. INSTRUCTOR PREPARATION AND TRAINING There is at the present time, only one B.S. degree program in radiation therapy; apart from this program there are no formal post graduate programs in education or administration in radiation therapy. Most program directors in radiation therapy technology either have not had any education and instructor preparation courses, or have completed courses that were not designed specifically for the specialty. At least 25% of the technical directors assume the position and responsibilities because they are the only registered technologists on the staff; another 25% assume positions of this sort immediately after graduation with no experience. The establishment of short term instructor preparation courses, and B.S. degree programs for administrators and educators must be encouraged. As programs increase in number and tend to move into the junior college setting, it is essential that the supply of
educational directors who are adequately qualified expand to meet this need.
CONTINUING EDUCATION Continuing education is as much a vital part of the professional life of the radiation therapy technologist, as it is for the physician. The ASRT has established a program for evidence of continuing education for technologists, and developed continuing educational requirements. Opportunities and support for technologists should be provided by: (1) Encouraging attendance at technologist programs of the ASTR (first to be held in Atlanta, Oct. 1976). (2) Encouraging attendance at institutes of the ASRT (first radiation therapy institute held in Chicago, Feb. 1976). (3) Encouraging attendance at the annual of the ASRT which provides meeting programs for radiation therapy technologists. (4) Encouraging formation of and at-
Radiation therapy technology
manpower needsOC.
tendance at local radiation therapy technology society meetings. (5) Encouraging continuing educational programs at institutions sponsoring programs, especially those with a large body of alumni. (6) Personal support of these programs by radiation therapists including program participation and financial support of attendance
J. ROMINCER and D. BROWNING
by personnel measures.
through
appropriate
343
budgetary
SUMMARY
A crisis in radiation therapy technology is upon us. The number of technologists, their geographic distribution and the potential remedies for the problem are explored.
REFERENCES 1. American Registry of Radiologic Technologists Radiologic Technology, Radiologic Technology, Annual Report, 1975 Minneapolis, Minnesota. Vol. 47, No. 4. Baltimore, Maryland, Williams & 2. Essentials of An Accredited School of Radiation Wilkins, Jan.-Feb. 1976, pp. 263-265. Therapy Technology. Radiologic Technology, 6. Joint Review Committee Profile of Education in Vol. 40, No. 6. Baltimore, Maryland, Williams & Radiologic Technology, Radiologic Technology, Wilkins, May 1969, pp. 374-377. Vol. 47, No. 5. Baltimore, Maryland, Williams & 3. Essentials of An Approved Educational ProWilkins, Mar.-Apr. 1976, pp. 311-312. gram for the Radiation Therapy Technologist7. Kramer, S.: The Patterns of Cancer Care in Two Year Program, Radiologic Technology, Clinical and Research Radiation Therapy, Vol. 45, No. 1, Baltimore, Maryland, Williams & JAMA Med. News, 235, No. 4, 26 Jan. 1976, pp. Wilkins, July-Aug. 1973, pp. 23-33. 363-364. 4. Guides for Determining Standards of Radio8. Rominger, C.J.: Radiation Therapy Technology therapy in Approved Cancer Centers. Adopted Need Survey, American Society of Therapeutic by American College of Radiology, Chicago, Radiology Committee on Radiation Therapy Illinois, Feb. 1965. Technology, 1975. 5. Joint Review Committee Profile of Education in
Oncology
tliol.
Phgs.. 1977. Vol. 2. pp. 337-343.
Pergamon Press.
Printed in the U.S.A
??Special Feature RADIATION THERAPY TECHNOLOGY MANPOWER NEEDS, PROBLEMS, POTENTIAL-1976 C.
JULES
ROMINGER
M.D.
Associate Professor of Radiation Therapy, Jefferson Medical College of Thomas Jefferson University and Chairman, Department of Radiation Therapy and Nuclear Medicine, Mercy Catholic Medical Center, Philadelphia, PA 19143, U.S.A.
and DIANA Staff Consultant,
Joint
BROWNING,
R.T.
Review Committee on Education Chicago, IL 60601, U.S.A.
in Radiologic
Technology,
The shortage of radiation therapy technologists in the United States is reaching crisis proportions as documented in a recent survey? The shortage has developed over the last ten years as the number of technologists graduated falls short of the number that are necessary to staff radiation oncology departments of increasing sophistication. The separation of radiology into diagnostic and therapeutic sections, including residency and technology traintng programs, has hastened this crisis. The purpose of this paper is to review the current situation, its historical development and suggest approaches to a solution of this manpower shortage. Radiation
therapy technology
CURRENT
manpower
needs, Recruitment,
STATUS
A recent survey made by the American Society of Therapeutic Radiologists (ASTR) in May 1975’ achieved a 90% response of its members; the survey documented the shortage of radiation therapy technologists beyond any doubt and without any dilution of the statistics with diagnostic radiologic technologists. The results of this survey indicated that in the institutions responding, 250 positions for radiation therapy technologists were open, and further, 483 positions were filled by diagnostic radiologic technologists. There exists at present, a shortage of over 750 radiation therapy technologists; these posiReprint requests to: C. Jules Rominger, Mercy Catholic Medical Center, 5301
Programs.
tions are filled only partially by diagnostic radiologic technologists and nurses. This shortage is likely to increase, since an additional 825 positions for radiation therapy technologists are expected to become available by 1978. The results of this survey led to the conclusion that it will be necessary to graduate 500 radiation therapy technologists annually until 1985 to end this current shortage and keep up with the normal demand for qualified staff. This figure allows for a conservative 10% annual attrition rate. In May 1975, at the date of the survey, there were 1080 technologists registered in radiation therapy by the American Registry of
M.D., Cedar
Avenue, 337
Philadelphia,
PA 19143, U.S.A.
338
Radiation Oncology 0 Biology 0 Physics
Radiologic Technologists (ARRT).’ After the first examination in 1964, there were 88 registered technologists (oral communication, Roland McGowan, R.T., Executive Secretary, ARRT). The rate of increase in registration has been intolerably slow in view of the current situation and projected need. The existence of a need now seems well documented by the results of the survey shown in Tables l-3 and by the data related to Table 1. Manpower
March-April
1977, Volume 2, No. 3 and No. 4
the volume of cancer patients, number of radiation oncologists and radiation therapy facilities shown in Table 2. It must be pointed out that were a complete national survey possible, the numbers in Table 3 would be higher in all categories. For instance, using the information from “The Study of Patterns of Cancer Care in Radiation there are 1080 facilities with meTherapy,“’ gavoltage units identified in the United States.
supply of radiation
therapy technologistst Number Filled
Open
98 1032
98 824
0 208
483
483
0
154
148
148
0
83
239
197
42
1999
1750
250
Available
Radiation therapy technologists doing dosimetry Radiation therapy staff technologists Diagnostic technologists performing radiation therapy technology Nurses performing radiation therapy technology Supervisor radiation therapy technologists Total tFrom statistics May 1975.s,6 Table
accumulated
by the American
2. Radiation therapy technology genera1 information? Available
survey:
Number
Megavoltage units Other units Simulators Radiation theraoists reuresented Cases of cance; treate;l
672 535 138 818 209,483
tFrom survey made by American Society Therapeutic Radiologists, May 1975.‘,” Table 3. Current
manpower
of
2 RTTf per megavoltage unit (672) 2 RTT per radiation therapist (818) 2 RTT per 300 new patients tDerived from statistics accumulated Radiologists in a survey in May 1971j.~,” SRTT = radiation therapy technologists.
Need 1978
Unknown 825
Unknown 1062
Society of Therapeutic
Radiologists,
If the criteria used in Table 3 were applied to registered radiation this figure, i.e. two therapy technologists per megavoltage unit, and an estimate of 500 used for supervisors, educators and dosimetrists, the number of positions which should be filled by radiation therapy technologists would be 2660. HISTORICAL
DEVELOPMENT
Over the 12 years since the first examination in radiation therapy technology was given by
needs projected
Criteria
of positions
from statistics
Number of staff radiation therapy technologists 1344 \ 1636 1396 J by the
American
in Table 2t
Number of supervisors and dosimetrists 366
Society
Total I 1680 1972 1 1732
of Therapeutic
Radiation
therapy
technology
manpower
the American Registry of Radiologic Technologists (ARRT), the radiation therapy community has engaged in a number of activities to provide itself with qualified radiation therapy technologists. Some of these efforts have been successful on a temporary basis, others are beginning to bear fruit and should be expanded; new ideas are needed. The initial approach to the need for radiation therapy technologists proceeded in concert with, and parallel to, the approach to the need for physicians in the field of radiation therapy. Those individuals already working in the field of radiation therapy technology were identified, examined and certified by the ARRT. In most institutions, the two disciplines of therapeutic and diagnostic radiology have division. undergone an orderly This process now is nearly complete as indicated by the changes in accredited residency programs in radiology to almost exclusively straight programs in therapeutic radiology or diagnostic radiology. The one year training programs in radiation therapy technology which were established to accomplish the retraining of individuals who already were working in therapy, now are accepting students directly from radiologic technology training programs. The recruitment of students into the one year program is relying heavily on the exposure which radiologic technology students receive in the course of their training. This exposure now is limited (10 lecture hours in radiation therapy required and clinical education an elective); logically, it cannot be expected that large numbers will continue to choose to enter the therapy technology field by this route. The second approach to meeting this need initially was to import radiation therapy technologists, as well as therapeutic radiologists, from other countries. The main origin of these individuals have been the English speaking countries, e.g. Great Britain, Australia, Canada, South Africa, etc. This “brain drain” was not viewed with enthusiasm by the parent countries and recently has slowed as a result of a combination of factors: better employment opportunities in the home countries; difficulty in obtaining immigration visas to the United States; and the relative success of training programs in the United States.
needs 0 C. J. ROMINCER and D. BROWNING
339
ACCREDITATION AND CERTIFICATION MECHANISMS The American Society of Radiologic Technologists (ASRT) and the American College of Radiology (ACR) have cooperated with the Council on Medical Education of the American Medical Association (AMA) in developing two sets of Essentials for Accredited Training Programs in Radiation Therapy Techno1ogy.z.3 The “Essentials” for one year training programs in radiation therapy technology established the standards for those programs that accept students who are graduates of radiologic technology programs or registered “Essentials” nurses. The for two year programs establish the standards for programs that accept students with a minimum requirement of high school graduation. The ASRT and the ACR are currently reviewing the Essentials with the object of combining the two sets of Essentials into one set which will apply to either the one or two year programs.2.3 The Joint Review Committee on Education in Radiologic Technology (JRC) conducts site visits of these programs and makes recommendations on their accreditation status to the AMA. Therapeutic radiologists and radiation therapy technologists are represented on the JRC and many volunteer in the peer review system of accreditation organized by the JRC .5,6 The American Registry of Radiologic Technologists (ARRT) examines and certifies graduates of these AMA accredited programs. The ARRT utilizes therapeutic radiologists and radiation therapy technologists as examination writers and reviewers.’ All of these activities have been encouraged by the American Society of Therapeutic Radiologists through its Committee on Radiotherapeutic Technology. TRAINING PROGRAMS IN RADIATION THERAPY TECHNOLOGY The key to the future of radiation therapy technology lies in the training programs. Currently, there are 73 accredited programs in radiation therapy technology in the United States.5.6 In reviewing the current shortage of radiation therapy technologists, the number of
340
Radiation
Oncology
0 Biology
0 Physics
training programs, their utilization, augmentation, proliferation and support, the following points must be considered: (a) current utilization and recruitment, (b) geographic distribution and potential for new programs, (c) the need for qualified instructor preparation programs, (d) continuing education for all radiation therapy technologists. CURRENT UTILIZATION AND RECRUITMENT As noted in Table 4, the majority of accredited programs in radiation therapy technology are one year programs (S3). The 20 two year programs are divided equally between hospital based certificate programs (9) and associate degree programs (11). It is interesting to note that four of the two year certificate programs and one of the two year associate degree programs also sponsor one year certificate programs. Many of these programs have multiple major affiliates for clinical education of students, thereby involving 148 institutions in the training of radiation therapy technologists. According to JRC records’.’ these 78 programs have an authorized student capacity of approximately 500 annually. However, the ARRT reports only 184 applied for examination in radiation therapy technology in 1975; this suggests a much lower enrollment in these programs. Since one of the quickest ways of increasing the number of graduates in radiation therapy Table
4. Accredited radiation programs (Sept. Type
One Two Two Four Total
therapy 1976)
of program
year certificate year certificate year associate year bachelor programs
degree degree
Program sponsors (some institutions sponsor both one and two year programs Major affiliates Total institutions involved in radiation therapy education and training
technology
Number 56 9 11 2 78
74 74
148
March-April
1977, Volume
2, No. 3 and No. 4
technology would be to increase the number of students graduating from existing programs, an attempt has been made to discover the reason for this low enrollment. There are several contributing factors: 1. Stipend-Many of the one year programs feel they must offer a stipend to students who already have an R.T. in radiologic technology and would be earning a good salary if they were not in training. The budget set for the school then becomes a limiting factor in the enrollment of students. This policy of the stipend becoming a limiting factor in student enrollment is carried over to many of the two year programs, where one year and two year programs exist in the same institution. Programs which have reduced or completely dropped their stipends have found that their application rate has remained stable. Revision in stipend policy may enable a program to increase its student enrollment, without increasing the overall cost of the program. 2. Recruitment-The number of applications received by programs appears to vary incredibly. Some programs report that they have 50 applications for 6 positions; other programs report that they have not received enough applications to fill their available positions. There are several reasons for this variation in recruitment across the United States: (a) The one year programs may be suffering because the Essentials and curriculum for radiologic technology programs no longer require rotation through the radiation therapy department, thus removing a considerable recruitment opportunity for radiation therapy training programs. The one year training programs have overcome this lack of opportunity by recruiting their students from many different radiologic technology training rather than relying on the one programs, particular group of students who rotated through their department. (b) The two year programs have had difficulty in making the opportunities in radiation therapy known to high school graduates. Many guidance counselors and recruiting personnel do not understand the field of radiation therapy. There is a wide-spread
Radiation
therapy
technology
manpower
misconception that all radiation therapy patients are terminally ill and that an 18 year old will not be able to cope with this situation. Many educators fail to realize that 80% of the patients who receive radiation therapy attend as outpatients and are leading a relatively normal life. They also grossly underestimate the empathy and capabilities of young high school graduates. Those who are interested enough to seek a career in radiation therapy are well able to handle any difficult situation they may encounter once they are prepared adequately for the situation by their instructors. (c) Because of the small size of the programs and the number of students involved, it usually is impractical for the programs to recruit directly from high school via career day, etc. The solution to recruitment programs is complex, but the following approaches are suggested: (1) In the future, the primary source for radiation therapy technologists should not be the graduates of radiologic technology programs. Radiation therapy technology training should always be open to radiologic technologists via the one year program, but eventually, the primary source of radiation therapy technologists must be the graduates of two year programs, since this shortens the overall training period for a technologist from three years to two years. (2) Recruitment efforts into two year programs should be concentrated on the high school group by the use of the following: (a) Recruitment brochures-most colleges who sponsor associate degree programs have these and the ASRT is developing one as a career brochure. (b) Visual aids for recruitment, such as slides, filmstrips and motion pictures to be shown at career days. There is at least one current attempt to develop a motion picture for this purpose. (c) Information days for guidance counselors and recruitment officers of educational institutions so they may become familiar with the field of radiation therapy and career opportunities for radiation therapy technologists.
needs 0 C. J. ROMINGERand D. BROWNING
341
(d) Participation of radiation therapy technologists and therapeutic radiologists in career days in high schools as a cooperative effort for radiation therapy technology in general rather than one school in particular. (e) Recruitment of candidates already in collegiate settings but looking for a rewarding science oriented career. (3) Secure more cancer program grant and contract monies for technology and technology education development. GEOGRAPHIC DISTRIBUTION AND POTENTIAL FOR NEW PROGRAMS While all regions of the country are served, there is a need for more programs in certain obvious areas of the country (Fig. 1). The recent survey of technologist needs conducted by the ASTR indicates clearly that many major institutions qualify as cancer management centers (ACR, 1965)4 and are, therefore, eligible to participate in programs in radiation therapy technology, but that they are not involved in technologist training. The major impediments in this regard are: (1) Cost per student. This might be solved by a variety of means, e.g. multiple hospitals affiliating into a single program, with one hospital sponsoring the program and accepting the responsibility for the didactic portion of the program. Multiple hospitals affiliating into a single program sponsored by a junior college or university. Encouragement of seed grants to start programs in areas of need. (2) The lack of qualified radiation therapy technology program directors and instructors. Many institutions which meet the standards for major cancer management centers and would like to participate in training programs are unable to do so because they do not have qualified radiation therapy technologists on staff. 3. Interest on the part of the radiation therapy community in starting programs. This must be encouraged and fostered by organizations through editorials, articles, etc. Radiation therapy departments that are interested in establishing a training program should be encouraged to find support for their technologists who desire to attend training programs for instructors.
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Radiation Oncology 0 Biology 0 Physics
GEOGRAPIIIC
DISTRIBUTION
OF
March-April
RADIATIOK
One year TWO year Tuo year
1977, Volume 2, No. 3 and No. 4
THERAPY
certificate certificate degree
PROGRAMS programs programs programs
52 10 10
,i.:\
Fig. 1. Geographic distribution of educational programs in radiation therapy technology (May, 1976). Each dot indicates the location of a Radiation Therapy Technology Educational Program. INSTRUCTOR PREPARATION AND TRAINING There is at the present time, only one B.S. degree program in radiation therapy; apart from this program there are no formal post graduate programs in education or administration in radiation therapy. Most program directors in radiation therapy technology either have not had any education and instructor preparation courses, or have completed courses that were not designed specifically for the specialty. At least 25% of the technical directors assume the position and responsibilities because they are the only registered technologists on the staff; another 25% assume positions of this sort immediately after graduation with no experience. The establishment of short term instructor preparation courses, and B.S. degree programs for administrators and educators must be encouraged. As programs increase in number and tend to move into the junior college setting, it is essential that the supply of
educational directors who are adequately qualified expand to meet this need.
CONTINUING EDUCATION Continuing education is as much a vital part of the professional life of the radiation therapy technologist, as it is for the physician. The ASRT has established a program for evidence of continuing education for technologists, and developed continuing educational requirements. Opportunities and support for technologists should be provided by: (1) Encouraging attendance at technologist programs of the ASTR (first to be held in Atlanta, Oct. 1976). (2) Encouraging attendance at institutes of the ASRT (first radiation therapy institute held in Chicago, Feb. 1976). (3) Encouraging attendance at the annual of the ASRT which provides meeting programs for radiation therapy technologists. (4) Encouraging formation of and at-
Radiation therapy technology
manpower needsOC.
tendance at local radiation therapy technology society meetings. (5) Encouraging continuing educational programs at institutions sponsoring programs, especially those with a large body of alumni. (6) Personal support of these programs by radiation therapists including program participation and financial support of attendance
J. ROMINCER and D. BROWNING
by personnel measures.
through
appropriate
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budgetary
SUMMARY
A crisis in radiation therapy technology is upon us. The number of technologists, their geographic distribution and the potential remedies for the problem are explored.
REFERENCES 1. American Registry of Radiologic Technologists Radiologic Technology, Radiologic Technology, Annual Report, 1975 Minneapolis, Minnesota. Vol. 47, No. 4. Baltimore, Maryland, Williams & 2. Essentials of An Accredited School of Radiation Wilkins, Jan.-Feb. 1976, pp. 263-265. Therapy Technology. Radiologic Technology, 6. Joint Review Committee Profile of Education in Vol. 40, No. 6. Baltimore, Maryland, Williams & Radiologic Technology, Radiologic Technology, Wilkins, May 1969, pp. 374-377. Vol. 47, No. 5. Baltimore, Maryland, Williams & 3. Essentials of An Approved Educational ProWilkins, Mar.-Apr. 1976, pp. 311-312. gram for the Radiation Therapy Technologist7. Kramer, S.: The Patterns of Cancer Care in Two Year Program, Radiologic Technology, Clinical and Research Radiation Therapy, Vol. 45, No. 1, Baltimore, Maryland, Williams & JAMA Med. News, 235, No. 4, 26 Jan. 1976, pp. Wilkins, July-Aug. 1973, pp. 23-33. 363-364. 4. Guides for Determining Standards of Radio8. Rominger, C.J.: Radiation Therapy Technology therapy in Approved Cancer Centers. Adopted Need Survey, American Society of Therapeutic by American College of Radiology, Chicago, Radiology Committee on Radiation Therapy Illinois, Feb. 1965. Technology, 1975. 5. Joint Review Committee Profile of Education in
