A National Survey of Medical Physicists: Part 2 - Assessing Work Effort and Perceived Challenges and Satisfaction in HDR Brachytherapy

To collect national data from medical physicists on work effort, challenges, and job satisfaction in HDR brachytherapy as a function of procedure complexity. A survey was administered in cooperation with IROC-Houston. Question topics included demographics, practice patterns, caseload, procedure complexity, relative time and effort required for simple and complex cases, and challenges/satisfaction associated with HDR. Of 429 completed responses, 365 performed HDR. The most commonly treated anatomic sites were gynecologic, prostate, and skin with 56% of respondents’ clinics performing interstitial procedures. Respondents indicated that the median time and intensity ratios of a single channel HDR, relative to a weekly chart check (CPT77336), were 5 and 3, respectively implying a work ratio of 15. When comparing the most complex procedure to a single-channel treatment, the median time and intensity ratios reported were both 5, implying a work ratio of 25. The time and intensity ratios scaled with increasing complexity for gyne procedures (i.e., 1, 2-3, and ≥4 channels). Most respondents reported that it was more stressful to cover HDR versus EBRT (82%) and to switch between services (73%). Job satisfaction was impacted most positively by direct patient contact and the experience level of authorized users but most negatively by increased stress compared to other services and maintaining skill levels due to infrequent cases. Only the subset of respondents at clinics treating complex gyne with a high caseload ( ≥ 25 patients/year) indicated that staff allocation was inadequate or that a colleague had left their position due to HDR. The results show a relationship between work effort and procedure complexity, which is currently not addressed in national staffing recommendations. To sustain a workforce capable of supporting HDR into the future, it is important that professional societies/leaders recognize the stress and intensity of complex cases and adjust staffing recommendations accordingly.