Implications of Projections for Workforce Development
Interpreting the results
The estimates are conservative and likely under represent the demand for the workforce.
The projections of radiation oncology workforce numbers are conservative estimates for a number of reasons:
Linac throughput of 414 is used as a planning parameter, however, data from hospitals across Australia indicates that the actual throughput may be lower than that;
Trends towards more complex and time-consuming treatments may negate efficiency gains in other areas;
Generational changes that affect the Australian society generally are likely to also have an impact on the radiation oncology workforce. The most likely implication may be the increase in professionals working part time;
The increasing number of regional cancer centres may result in a misdistribution of the workforce, with an over-supply in metropolitan and an under-supply in regional areas.
Conversion of FTE projection into headcount (i.e. people) is likely to increase the numbers required.
The workforce projections are entirely contingent on the availability of the appropriate radiation oncology infrastructure.
In the absence of appropriate infrastructure, including facilities and equipment, the radiation oncology workforce will not be able to deliver radiotherapy services. This will result in unhealthy workforce dynamics and is likely to impact on the future ability of the sector to recruit top quality graduates into the professions.
The workforce projections cannot be viewed in isolation from each other.
The three radiation oncology professions are interdependent in the delivery of quality radiotherapy treatments. Significant shortage of any profession inhibits the provision of services by the others. This is over and above the link between the professions and the infrastructure availability.
Implications for the training programs
There are limits to the capacity of each training program to expand with the requisite urgency to achieve the target utilisation of 52.3%. Growth in training programs needs to be planned carefully to acknowledge the challenges the workforce is currently facing. Planning needs to recognise the need for sustainable growth in training programs and cannot be done independently of facility planning.
Impact on clinical supervisors and examiners
With training program expansion, the professions need to ensure that there are enough clinical supervisors to train trainees effectively, while effectively managing their clinical workload. The need to accommodate further increases in trainee numbers will challenge all three professions, because there are limited numbers of supervisors and examiners available.
Availability of educational resources
Many radiotherapy centres are already under considerable clinical training strain. Training and education are currently provided in addition to the normal duties of clinicians. There are limited education resources available that take advantage of improved technologies to reduce the burden on clinicians of providing didactic lectures.
Need for nationally coordinated training networks
Regional and rural training must be considered as an integral part of training. The allocation of training positions often depends on the individual facility’s capacity to provide comprehensive training. A pilot project for supported training networks for radiation oncology trainees is underway with funding from the Commonwealth Department of Health and Ageing. A nationally coordinated training network approach will enable provision of adequate breadth of training for trainees and would include new and established centres.
Specific issues – Radiation Oncologists
There is a greater need for Fellowship positions (with related funding required), to provide a post graduate training pathway for radiation oncologists.
Fellowship positions in this context refer to positions filled by recently graduated specialist Radiation Oncologists following their Registrar (vocational) training, undertaken as a transition to specialist level employment. These positions are usually filled for one year, although are of no defined duration. The positions can include any mix of clinical and research-based work and can involve the integration of other post-graduate qualifications. Fellowship positions can be undertaken locally or internationally with many Fellows using the role as an opportunity to practice in a different centre to the one in which they completed their specialist training, thus broadening their training experience.
Fellowships are a highly desirable component of post-graduate training through which Radiation Oncologists develop important clinical and research skills that allow them to remain at the forefront of cancer management and research, thereby ensuring that Australian and New Zealand cancer patients receive the best possible care.
Specific issues – Radiation Therapists
For service and workforce planning reasons, the radiation oncology sector clearly has a vested interest in student numbers entering medical radiation science courses In Australia. Effective workforce planning must also involves consideration of the need for clinical service providers to accommodate clinical education and training for students, an essential component of entry level training. Service providers themselves however exert only some influence over student numbers. Governments, universities themselves and educational, vocational and economic market forces arguably have far greater influence on total numbers in the available workforce.
Balancing student numbers with the number of available clinical placements will be an increasingly important issue in workforce planning. Wide and coordinated consultation between governments, universities, clinical services and those responsible for workforce planning will be necessary. This is particularly so given the workforce projections to 2022 prepared as part of this Tripartite National Strategic Plan and anecdotal evidence that suggests clinical centres are already under significant student training stress.
An example of the problems that result from ineffective consultation is a unilateral decision by a university in recent years to cease its undergraduate radiation therapy course and only offer a post graduate entry level course. Anecdotally, the graduate output from this school now appears to be declining and the viability of the course threatened whilst at the same time state RT workforce needs are increasing. The radiation oncology sector can ill afford such examples to be repeated and the matching of students with clinical placements and workforce needs will be critical to success.
The other priority issues for RT training are:
Further support and development of virtual learning environments base on the need to ease the burden on clinical services to provide for clinical placements and training;
For education and training to focus on supporting advanced and extended scopes of practice as a means of establishing enhanced and robust career pathways in the profession and a more skilled and knowledgeable workforce8;
Academic courses to include more emphasis on quality management and research;
Developing where applicable and appropriate assistant roles as is happening in other allied health professions and for which implementation frameworks are already in place in some jurisdictions9 with a view to: providing the space for RTs to develop into more value added advanced practice roles; and to provide a feeder for the profession for assistants to go on to undertake further training;
Development of strategies to attract more Indigenous and regional students into radiation therapy and tailor education and training to their needs;
Re-design the RT staffing model to ensure educational roles in staffing profiles are better matched to clinical training needs for both learners and qualified staff (re-design of the staffing model is underway).
Specific issues – Radiation Oncology Medical Physicists
The major workforce issue for ROMP’s is ensuring adequate postgraduate clinical and academic education and training. There is no specific undergraduate degree for ROMP’s and a career in Medical Physics relies on the completion of both an undergraduate (in physics or engineering) and a postgraduate degree with a major in medical physics. The post-graduate Training Education and Assessment Program (TEAP) generally takes three to five years to complete.
There are several challenges inhibiting the increases in the number of ROMPs:
Declining attractiveness of undergraduate science degrees majoring in physics10;
Lack of funding for ROMP registrar positions;
Lack of senior ROMP positions to appropriately supervise registrars;
Hospitals are increasingly concerned about rejecting funding for registrar positions, despite not having the supervisory capacity in place. This funding is often tied to clinical outcomes, diminishing the focus on training and education.
Some centres find it difficult to recruit senior medical physicists, even with the recent initiatives for experienced certification and certification of overseas-trained medical physicists. Medical Physics is likely to remain on the Australian Department of Immigration’s Skilled Occupation List.
As part of meeting the need for senior ROMPs to train ROMP registrars, the option of employing dedicated training preceptors has proven beneficial to improve the quality and governance of the TEAP. Where these preceptor positions provide support to a network of training sites, the ROMP registrars are able to access to a wide variety of training opportunities enabling the quality of the TEAP graduates to be more consistent. If the preceptor support were to include regional centres then additional resources are required to allow movement of preceptor and registrars between centres.