Wednesday, 4 February 2015

So You Want to Be a Medical Physicist: Part 4 - Career Outlook

So You Want to Be a Medical Physicist
Part 4: Career Outlook

Is Medical Physics a good career to be considering?

I obviously think so, otherwise I wouldn't be writing this.  It offers a profession that allows one to make a real, tangible difference in peoples' lives for one.  It strikes a nice balance between clinical responsibility and academic inquiry.  In other words you provide clinical services, but you also get to do research.  It's challenging and stimulating.  And rarely are two days the same.

But it's not for everyone.

Medical Physics can be extremely stressful.  A Medical Physicist carries a lot of responsibility.  A single mistake can affect large cohorts of people.  The hours will be long.  I rarely leave my office at the official quitting time.  The training path is about as long as that of most physicians, but the pay is not nearly as high.

If that doesn't scare you away, maybe you should read on.


Growth in Medical Physics and Cancer Treatment Fields

No one can see into the future with perfect accuracy, but I would say that growth in the Medical Physics field is going to be rather stable and predictable for the foreseeable future, particularly if your baseline for comparison is fields in physics or even the technology sector.  My reasoning for this is the following.
  1. Clinical Medical Physics is directly tied to the diagnostic testing for and the treatment of cancer with radiation.  It can deal with other diseases, but to first order, cancer runs the show in this profession.
  2. Cancer incidence rates are growing despite the fact that we're getting better at preventing and treating it. This is because (a) the population is growing,  (b) less people are dying from heart disease, and (c) generally the population is getting older and the single most significant risk factor for cancer is age.  Across the world a growth rate of 3.4 %/yr across all cancers is expected up to 2030 (Bray et al. 2012).  In my province the growth rate is about 4 %/year according to the Alberta Cancer Foundation.  Conservative estimates for the USA fall around 2%/yr.
  3. Nearly 2/3 of all cancer patients will receive radiation therapy during their illness (and of course nearly all of them will be imaged).  This percentage is likely to either increase or at least remain constant for several reasons including cost (radiation is relatively cheap), and its effectiveness (any new treatments that come out have to do better than that status quo before they will be adopted on a large scale).  In addition to radical or curative treatments, radiation is also very effective for palliation (symptom control/relief).
  4. The clinical Medical Physics workload is not only tied to the number of cancer patients treated, but the complexity of the treatments and number of different types of treatments offered.  Across the USA there are roughly a dozen proton treatment facilities that have come online (or will soon) in the last decade or so.  We've seen a lot of growth in new techniques like stereotactic body radiotherapy (SBRT).  And even in fairly straight-forward treatments, image-guidance has recently become the standard of care.  On the horizon we have exciting developments like linac-MRI hybrid imaging-therapy units that will present a revolution in the ability to see what you're trying to treat, but will also require a lot of technical problem-solving since charged particles moving in a magnetic field and change the physics that underlie a lot of conventional practices.  All of this points to an increasing demand for Qualified Clinical Medical Physicists.

Supply and Demand

Demand

For reference, there are at present roughly 6000 Medical Physicists in the USA.  In Canada we scale down from the USA by an order of magnitude.  In my province, Alberta, there are roughly 40 of us.  These numbers have large error bars depending on definitions and what numbers you look at, but that will put you in the right ballpark to understand the approximate size of the profession.

From that size of field a few things should be apparent.  Because we're dealing with small numbers, you're not going to find a "Medical Physics" section in your local want ads.  On top of that, job vacancies are not going to be subject to a lot of fluctuation. We're dealing with low N Poisson statistics.  So if there's a particular city or cancer centre you want to work it, it could be years before a job comes available there.  In short - you have to be willing to move.

As a whole, the field is a little more predictable.

With respect to professional demand, Mills et al. (2010) assessed the profession and predicted the minimum number of new qualified Medical Physicists specializing in radiation oncology required to meet the growth rate in the field (assuming 2%/yr growth in new cancer cases over the coming decade) was 125 per year, with an ideal number at somewhere between 150 - 175.

Using a simplified "back of the envelope" calculation the American Cancer Society has estimated about 1.7 million new cancer cases will have been diagnosed in 2014 and this will be growing at a rate of somewhere between 34,000 and 68,000 more cases each year.  Between 23,000 and 45,000 of those will receive radiation.  A typical linac should handle about 300 patients per year - this means somewhere between 75 and 150 new linacs (beyond those that are being replaced) should be installed in the USA per year.  And as a rough staffing rule of thumb, you should have at least one physicist per linac.  So that's 75 - 150 new physicists per year that have to be added to the system due to growth.  That doesn't account at all for retirements (you're probably losing 20 - 30 physicists per year, if not more), nor the increasing complexity of treatments or the introduction of new and specialize treatment modalities.

If you want to expand this to North American demand, you can multiply by a factor or 1.1 to account for Canada (Mexico just doesn't appear to be on the radar yet).  These numbers also focus on radiation oncology, so you have to multiply again by 1.25 to cover the other branches of the field.  So I don't think numbers in excess of 200 new Medical Physicists needed per year are exaggerated at all.

There is one other point to consider with respect to demand.  So far, I have confined the numbers to North America.  One area where we're going to see a lot of growth in the coming decades are in developing countries, where there is not the same level of training, but the demand for cancer care is great.  For example, about a year ago Varian Medical Systems announced they had won a tender with the government of Brasil to provide 80 linear accelerators.Press Release I don't know much about the details or time frame, but that means there will be a lot of demand for qualified Medical Physicists in the coming years.

Supply

Now we come to the other side of the coin.  According to the CAMPEP Annual Graduate Program Report (2013), there are roughly 45 accredited graduate programs (34 in the US, 10 in Canada and 1 in Korea).  With regards to admissions in 2013, in total 1801 applications were reviewed, 545 offers of admission were made, and 289 students enrolled.  On the other end, 288 graduated - 162 MSc, 113 PhDs, 4 DMPs, and 9 post-PhD certificate students.  On the surface that looks like we could be training and graduating more students than the profession needs, but there are a few issues to consider...

  1. According to the CAMPEP reports, roughly 15 - 25% of MSc graduates return for a PhD.
  2. You also lose about 10% of graduates to "industry" - this can mean anything from staring or joining a new entrepreneurial venture to getting a job doing R&D, technical support, or technical sales with some of the big name corporations in the field.
  3. Some PhDs will go into academia: 15 - 20% will go straight into post-doctoral work (although at least half of those will want a clinical position eventually).
  4. Some students will not complete their programs.  CAMPEP numbers have this at 2-3%, although I can't help but wonder if this is under-reported.  Maybe my experience is just with tough programs.
  5. Some students complete the program and then choose to leave the field altogether.  Or, they find that even though they can pass, they just aren't cut out for it.
When you put all of that together, it seems that the supply is roughly meeting the demand.

Unfortunately, there's a problem... residencies.

The ABR requires students to be enrolled in or have graduated from an accredited Medical Physics residency in order to write the second part of their exam.  The CCPM will require graduation from either an accredited residency or a graduate program by 2016.  There were several reasons for this.  The passing rates for the board examinations were not great, some "residency" positions may have been using residents to advance specific projects only and not properly exposing them to all dimensions of the profession, and there was no standard or independent monitoring for what a residency was supposed to cover.  Board examinations are supposed to be an independent demonstration of clinical competence, not a lone bar to get over by rolling the dice.

While introducing these new rules, was a good idea, it came with a major consequence.  There are roughly 120 accredited residency positions in North America - roughly half of what's needed.  And that's imaging and therapy residencies combined.  There are only about 60 accredited radiation therapy residencies available at last count.

For the past few years this has been creating an artificial bottleneck in the system. Competition for the available residencies is tough.  It's not difficult to see why we have MSc graduates who are desired as clinical Medical Physicists complaining that its extremely tough to compete against PhD graduates who come to the table with more research publications, and more experience in the field.  And even then graduating with a PhD doesn't guarantee one a residency.

The are, however, several initiatives underway to address this issue.

  • The AAMP has instituted a residency matching program.  The will centralize the residency application process and reduce the administrative burden of running these programs.  It will also help to ensure a better match of graduates with the programs they want and avoid the stress of accepting the first offer that comes in the mail.
  • There has been a lot of encouragement of "hub and spoke" models to come online that have come by way of workshops at conferences.  In such scenarios the teaching and administrative aspects of a residency would be handled by a larger academic centre, but the hands on training would come from smaller clinics that couldn't independently support a program.
  • Agencies such as the AAPM and RSNA have recognized the need to fund such programs and have put over a half a million dollars towards a grant to help with funding imaging of nuclear medicine residencies.
  • The AAPM officially has a student and 'trainee' (I strongly dislike that term) subcommittee now to ensure that students and residents have a direct voice on such matters.  COMP has had a student committee for several years now as well.
  • CAMPEP has been working in overdrive for the past few years, accrediting programs that were previously unaccredited.  Many unaccredited programs have recently become accredited.  I don't have exact numbers, but the number of institutions offering accredited residencies has quadrupled over the last five or six years.
  • If a program becomes accredited while a resident is in it, the resident will get full credit for having completed an accredited program.

Bottom Line

A career in Medical Physics is filled with all sorts of opportunities.  The growth in the field is likely to be steady, but from a student perspective, expect it to be highly competitive.  

5 comments:

  1. This comment has been removed by the author.

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  2. Given the bleak job market for physics all over the world in general, I once considered medical physics a candidate for a decent, fulfilling physics related career. After some very basic estimates based on number of accredited programs and job posting that popped up on google, I concluded that that medical physics is a lucrative career with good pay, physics related work and personal satisfaction (helping ill people and all). I only backed out because I was uncomfortable with the hospital setting - couldn't stand the sight of blood. Later on, judging by this article and some online research, it seems that I was completely wrong and dodged a major bullet there. And so my search continued... in the process I ditched biological physics out of distaste for academia, never started that phd, failed to break into solid-state physics/semiconductor engineering and elected not to settle in programming & engineering with my engineering degrees as most of it doesn't feed my hunger for physics. It's been a long decade and optics is my final attempt... sigh.. Is there any hope for us physics lovers?????

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