Radiation oncology is a complex multidisciplinary service and requires interaction between a range of professionals. Workforce has historically been a rate-limiting step in radiation oncology. At facility level, workforce profile is considered in terms of risk management as it can be a causal factor in adverse patient care incidents. Specific emphasis is needed to match workforce strategies to service expansion plans to provide a quality service, ensure that investment in workforce is used effectively and to grow the facilities infrastructure sustainably.
The specialist workforce
Radiation oncology treatment is delivered by three core professional groups: Radiation Oncologists (RO), Radiation Therapists (RT) and Radiation Oncology Medical Physicists (ROMP). This essential team must be supported by a broader inter-professional team which include: engineers, IT support, data managers, oncology nurses, social workers, dietitians and other allied health professionals. Although detailed workforce analysis for the broader team supporting cancer care is outside the scope of this plan, these groups are essential to optimising outcomes for patients and the access to allied health staff is explored in the section on rural and regional access.
Radiation Oncologists (ROs) are the medical specialists responsible for the treatment of patients with cancer through the use of ionizing radiation. A Radiation Oncologist is a medical specialist who has specific postgraduate training in management of patients with cancer, in particular, involving the use of radiation therapy. They are responsible for assessing the patient by clinical evaluation, and organising imaging and other tests, in order to establish and implement a management plan for an individual. Patient management may include assessment, treatment, follow-up, and psychosocial and physical care coordination.
Radiation Therapists (RTs) are responsible for working with patients throughout their treatment course, to localise the area to be treated, develop dosimetry and accurately deliver radiation therapy, as prescribed. In conjunction with the Radiation Oncologists they are responsible for the design, accurate calculation and delivery of a prescribed radiation dose over a course of treatment to the patient.
Radiation Oncology Medical Physicists
A Radiation Oncology Medical Physicists (ROMPs) are medical physicists who establish, implement and monitor processes which allow optimal treatment using radiation, taking account of the protection and safety of patients and others involved in the treatment process. In their role, a ROMP:
Consults on optimisation of medical exposures;
Performs or supervises radiotherapy calibration, dosimetry and quality assurance; and
Gives advice on matters relating to radiation protection4.
Estimating workforce requirements and projecting future need
The Tripartite Committee has commissioned the Allen Consulting Group to develop an analysis of the medical radiation workforce and projections covering the next ten years. This work covers three professional groups:
Radiation Therapists; and
Radiation Oncology Medical Physicists (ROMPs).
Previous studies have been conducted on radiotherapy workforce, in particular, the 2009 Health Consult for the Department of Health and Ageing. However, the Tripartite Committee did not find that previous work provided the answers to the key questions underpinning the Plan. Therefore, the Allen Consulting Group was commissioned to work on updated data and makes more variables available for analysis. Workforce and linac projections in this section of the Plan are based on the Allen Consulting Group work.
In order to estimate potential workforce shortfalls for each occupation into the future, demand for, and supply of, full-time equivalent (FTE) professionals has been estimated over the period 2012 to 2022. The base year is 2011 and projections start from 2012 and extend through to 2022. Projections of the medical radiation workforce rely on assumptions regarding supply and demand.
Factors that influence workforce demand
A number of factors influence the medical radiation workforce demand. These include:
Incidence of cancer;
Availability of linacs;
Availability of clinical training positions;
Actual and optimal radiotherapy utilisation rates;
Relevant State/Territory and Commonwealth government policies.
Projections are further based on the number of linacs required to service patients, which are calculated based on the industry accepted average number of courses of treatment (414) each linac can accommodate per year.
Target utilisation for radiation oncology- closing the gap in patient access
The demand projections in the Plan factor in the increasing incidence of cancer and the utilisation rate. Target utilisation was set to 45.2 % in 2017 and 52.3 % in 2022. A utilisation rate of 52.3 % is estimated to be the optimal rate, and 45.2 % was taken as the mid-point between the target rate and the current under-utilisation rate of 38.1%4,6
Factors that influence workforce supply
Factors which influence the supply of this workforce include:
The supply of newly qualified personnel;
Flexible work arrangements;
Work practices, including use of time for different purposes;
Retirements from the existing workforce; and
Relevant government policies.
Baseline workforce supply – business as usual
The projections calculate the supply of FTE professionals from which it is possible to derive headcount numbers. The baseline supply estimates the supply of professional FTEs into the future assuming that current entrant and attrition trends continue. The projections build on the base year’s supply of professional FTEs, with inflows into the occupation due to trainees, immigration and re-entry added each year, and outflows due to retirement and other factors such as emigration and career change removed each year. The inflow due to trainees is the intake of trainees each year minus the average loss rate from the trainee program. The entry and attrition inputs have been determined based on historical data sources. They are held constant across future years, but the calculations are conducted year on year.