2014 projecting the radiation oncology workforce

FACULTY OF RADIATION ONCOLOGY

PROJECTING THE RADIATION ONCOLOGY WORKFORCE: 2013 UPDATE

THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS

Projecting the radiation oncology workforce: 2013 update

Name of document and version: Projecting the radiation oncology workforce: 2013 update

Approved by: Faculty of Radiation Oncology Council

Date of approval: July 2014

ABN 37 000 029 863

Copyright for this publication rests with The Royal Australian and New Zealand College of Radiologists

The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Australia

Email: [email protected] Website: www.ranzcr.edu.au Telephone: +61 2 9268 9777 Facsimile: +61 2 9268 9799

Disclaimer: The information provided in this document is of a general nature only and is not intended as a substitute for medical or legal advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor.

Projecting the radiation oncology workforce: 2013 update

May 2014

Projecting the radiation oncology workforce: 2013 update i

Contents

Executive Summary .................................................................................................................. ii

1. Introduction ........................................................................................................................ 1

1.1 This project ................................................................................................................ 1

1.2 The medical radiation workforce ................................................................................. 1

1.3 Overview of the model ............................................................................................... 2

1.4 This report ................................................................................................................. 2

2. Predicted workforce shortfalls ............................................................................................. 3

2.1 Radiation Oncologists ................................................................................................ 3

2.2 Radiation Therapists .................................................................................................. 5

2.3 Radiation Oncology Medical Physicists ...................................................................... 7

2.4 Linacs needed ........................................................................................................... 9

2.5 Jurisdiction level data ............................................................................................... 12

3. Comparisons with 2012 .................................................................................................... 13

References ............................................................................................................................. 14

Acknowledgements ................................................................................................................. 14

Projecting the radiation oncology workforce: 2013 update ii

Executive Summary

The Royal Australian and New Zealand College of Radiologists (RANZCR), in collaboration with the Australian Institute of Radiography (AIR) and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM), prepared a Tripartite National Strategic Plan for Radiation Oncology. This plan, which was released in 2012, included analysis of the radiation oncology workforce. Specifically it considered the supply of, and demand for, the different skilled professionals needed to meet Australias needs in the provision of radiation oncology services.

The Allen Consulting Group was commissioned to develop a model to assist in the analysis of the medical radiation workforce covering the ten year period 20122022. Their report, which covers the three professional groups, radiation oncologists, radiation therapists and radiation oncology medical physicists (ROMPs), was published in May 2012. This document is an update to the 2012 Allen Consulting report, based on data obtained in 2013.

The demand side of the model estimates the future demand for medical radiation services, based on the increasing incidence of cancer, and allows the user to alter the utilisation rate to be achieved in 2017 and 2022. The supply side estimates future supply based on current entry and exit trends.

The optimal utilisation rate has been revised down from 52.3 to 48.3 per cent. Even with a four per cent reduction, significant workforce shortfalls would occur by 2022. These are summarised in the table below (figures in parentheses are those from the Allen Consulting report (2012)). This scenario would have significant implications for the funding of additional linear accelerators and clinical training positions.

Table ES1: Workforce shor tfa lls in 2022

Occupation Supply Demand Shortfall

Radiation Oncologists 484 (499) 494 (535) 10 (36)

Radiation Therapists 2141 (2135) 2468 (2673) 327 (538)

ROMPs 337 (327) 494 (535) 157 (208)

This table presents the shortfalls under one scenario onlyi.e. assuming the target utilisation rate of 48.3 per cent is reached by 2022. Using the model, RANZCR may choose to undertake analysis based on any utilisation rate.

Projecting the radiation oncology workforce: 2013 update 1

1. Introduction

Providing a skilled workforce to meet the growing needs of the medical radiation sector has been a matter of concern to Australian health authorities for more than a decade. The Baume report (2002) was a catalyst for action, on the part of government and the professions, for widespread reform of the sector.

1.1 This project

The current document provides an update of the Allen Consulting report (2012), which was used to inform the Tripartite (RANZCR, AIR and ACPSEM) National Strategic Plan for Radiation Oncology.

Data presented is based on information collected in the 2013 Faculty of Radiation Oncology facilities survey. The AIR and ACPSEM were unable to provide any data.\

1.2 The medical radiation workforce

Projections of the medical radiation workforce rely on assumptions regarding supply and demand.

Demand

A number of factors influence the medical radiation workforce demand. These include:

incidence of cancer;

availability of linear accelerators (linacs);

availability of clinical training positions;

actual and optimal utilisation rates; and

relevant state/territory and Commonwealth government policies.

Demand projections in the model factor in the increasing incidence of cancer and the utilisation rate. The utilisation rate is the proportion of new cancer patients who receive radiation therapy.

Supply

Factors influencing the supply of this workforce include:

the supply of newly qualified personnel;

participation rates;

flexible work arrangements;

work practices, including use of time for different purposes;

retirements from the existing workforce; and

relevant government policies.

The model calculates the supply of FTE professionals from which it is possible to derive headcount numbers. Advice on how to calculate headcounts from FTEs is given in Section 2.5.


1.3 Overview of the model

The model covers three professional groups.

Radiation Oncologists

Radiation Therapists

Radiation Oncology Medical Physicists (ROMPs).

The base year for the model is 2011. This update includes actual data for 2013 and projections through to 2022. Three main scenarios have been developed in the model in order to estimate

potential workforce shortfalls into the future.1

Demand estimates the future demand for medical radiation services, based on the increasing incidence of cancer, and allows the user to alter the utilisation rate to be achieved in 2017 and 2022.

Baseline supply estimates future supply based on current entry and exit trends.

Adjusted supply based on baseline supply, but allows the user to alter entry variables to estimate ways to close the gap between the baseline and the demand supply scenarios.

The data sources and assumptions underlying the model are discussed in detail in the Allen Consulting report (2012).

1.4 This report

This update report is structured so that the results of the modelling are presented first (Section 2) followed by a comparison of the current update with the original Allen Consulting report (2012) results (Section 3).

For details of the inputs and assumptions underlying calculations of supply and demand; comparisons of Allen Consulting results with a previous report on workforce projections for the occupations of interest; and a presentation of the results of some sensitivity analyses, refer to the original Allen Consulting report (2012).

1 The core assumptions underlying calculation of supply and demand are similar to those used in Stuckless et al 2012.


2. Predicted workforce shortfalls

This section describes some of the results of the model for each occupation. The results of the baseline supply model are described, as well as demand and shortfall results under different scenarios. Three different demand scenarios were tested.

Target utilisation: where the utilisation rate to be achieved is set to 43.2 per cent in 2017 and 48.3 per cent in 2022. This rate was updated in 2013 (Barton et al 2013) from the previous rate used in the Allen Consulting (2012) report where it was reported that a utilisation rate of 52.3 per cent is estimated to be the optimal rate (Delaney et al 2003), and 45.2 per cent was taken as the mid-point between the target rate and the current rate of 38.1 per cent. As with the original report, the revised mid-point is between the revised target utilisation rate and the current rate, which remains at 38.1 per cent.

Halfway between target and current utilisation: where the utilisation rate to be achieved is set to 40.7 per cent in 2017 and 43.2 per cent in 2022.

Current underutilisation: where the utilisation rate to be achieved is set to 38.1 per cent over the whole period. The current average utilisation rate is 38.1 per cent (HealthConsult 2009).

Using the adjusted supply scenario, the effect of increasing the intake of trainees (by per cent) on the gap between supply and demand has been estimated.

2.1 Radiation Oncologists

Starting from an adjusted base supply of 251.6 full time equivalent (FTE) professionals in 2013, the Radiation Oncologist baseline supply model, which assumes current entry and attrition trends continue, projects a supply of 344.6 FTE professionals in 2017 (a change of -31.2 FTE from the 2011 baseline results) and 483.6 FTE professionals in 2022 (-15.4 FTE). The precise difference between supply and demand depends, in large part, upon the utilisation rate that will be achieved in 2017 and 2022.

Target utilisation

In 2017, with a utilisation rate of 43.2 per cent, 391.3 FTEs would be required, resulting in a shortfall of 46.7 FTEs. If the target utilisation rate of 48.3 per cent is to be achieved by 2022, the model projects that 493.7 FTEs would be required in 2022, resulting in a workforce shortfall of 10.1 FTEs.

In order for supply to meet target utilisation in 2022, the intake of trainees needs to increase, on average, by around 2.7 per cent each year (see Figure 2.1). This would result in an inflow of 27.8 FTE trainees into the occupation in 2022, assuming the dropout rate from the trainee program remains at 15 per cent. Historical data indicates that the intake of trainees has been increasing at a rate of only 2 per cent per annum over the last 10 years.


Figure 2.1: Radiat ion oncolog is t workforcetarget u t i l isat ion scenar io

Halfway utilisation

Halfway utilisation was estimated to be the achievement of 40.7 per cent utilisation in 2017 and 43.2 per cent in 2022. The model projects that in 2017, 368.7 FTEs would be required (shortfall of 24.1), and 441.5 in 2022 (surplus of 42.1) (see Figure 2.2Error! Reference source not found.). The current intake of trainees is sufficient to meet demand over the next 10 years under this scenario.

Figure 2.2: Radiat ion oncolog is t workforcehalfway ut i l isat ion scenar io

Projection

Projection


Current underutilisation

If the current utilisation rate was maintained over the entire projected period at 38.1 per cent, then the demand requirements would be commensurately lower, with 345.1 FTE professionals required in 2017 and 389.4 in 2022 (see Figure 2.3). Given the adjusted baseline supply projections, this amounts to a deficit of 0.5 FTE in 2017 and a potential surplus of 94.2 FTEs in 2022.

Figure 2.3: Radiat ion oncolog is t workforcecurrent underut i l isat ion scenar io

2.2 Radiation Therapists

Starting from an adjusted base supply of 1535.3 FTE professionals in 2013, the Radiation Therapist baseline supply model projects a supply of 1827.4 FTE professionals in 2017 (an increase of 101.4 FTE from the 2011 baseline results) and 2141.4 in 2022 (an increase of 191.4 FTE).

Target utilisation

In 2017, with a predicted utilisation rate of 43.2 per cent, 1956.7 FTEs would be required, resulting in a shortfall of 129.3 FTEs. If the target utilisation rate of 48.3 per cent is to be achieved by 2022, the model projects that 2468.4 FTEs would be required in 2022, resulting in a workforce shortfall of 327 FTEs.

In order for supply to meet target utilisation in 2022, the intake of trainees over the years 2014 to 2021 needs to increase, on average, by around 3.8 per cent each year (see Figure 2.4). This will result in an inflow of 213.5 FTE trainees into the occupation in 2022, assuming the dropout rate from the clinical trainee program remains at 1 per cent).

Projection


Figure 2.4: Radiat ion therapist workforcetarget ut i l isat ion scenar io

Halfway utilisation

Halfway utilisation was estimated to be the achievement of 40.7 per cent utilisation in 2017 and 43.2 per cent in 2022. The model projects that in 2017, 1843.4 FTEs would be required (shortfall of 16), and 2207.7 in 2022 (shortfall of 66.3).

In order for supply to meet halfway utilisation in 2022, the intake of trainees over the years 2014 to 2021 needs to increase, on average, by around 0.9 per cent each year (see Figure 2.5). This will result in an inflow of 162.0 FTE trainees into the occupation in 2022, assuming the dropout rate from the trainee program remains at 1 per cent).

F igure 2.5: Radiat ion therapist workforcehalfway ut i l isat ion scenar io

Projection

Projection



If the current utilisation rate was maintained over the entire projected period at 38.1 per cent, then the demand requirements would be lower, with 1725.7 FTE professionals required in 2017 and 1947.1 in 2022, with surpluses of 101.7 and 194.3 FTEs respectively (see Figure 2.6). This suggests that current intake into the trainee program would be sufficient to meet demand by 2022 if the utilisation rate remains unchanged.

Figure 2.6 : Radiat ion therapist workforcecur rent underut i l isat ion scenar io

2.3 Radiation Oncology Medical Physicists

Starting from an adjusted base supply of 226.2 FTE professionals in 2013, the ROMP baseline supply model projects a supply of 267.7 FTE professionals in 2017 (an increase of 1 FTE from the 2011 baseline) and 336.5 in 2022 (an increase of 9.5).

Target utilisation

In 2017, with a utilisation rate of 43.2 per cent, 391.3 FTEs would be required, resulting in a shortfall of 114.6 FTEs. If the target utilisation rate of 48.3 per cent is to be achieved by 2022, the model projects that 493.7 FTEs would be required in 2022, resulting in a workforce shortfall of 157.2 FTEs.

In order for supply to meet target utilisation in 2022, the intake of trainees over the years 2014 to 2017 needs to increase, on average, by around 38.7 per cent each year (see Figure 2.7). This will result in an inflow of 96.5 FTE trainees into the occupation in 2022, assuming the dropout rate from the trainee program remains at 17 per cent. Historical data indicates that the intake of trainees has been increasing at a rate of approximately 6 per cent per annum over the last decade.

Projection


Figure 2.7: ROMP workforcetarget ut i l isat ion scenar io

Halfway utilisation

Halfway utilisation was estimated to be the achievement of a 40.7 per cent utilisation rate in 2022, and 43.2 per cent in 2017. The model projects that in 2017 368.7 FTEs would be required (shortfall of 92), and 441.5 in 2022 (shortfall of 105).

In order for supply to meet halfway utilisation in 2022, the intake of trainees over the years 2014 to 2017 needs to increase, on average, by around 29.3 per cent each year (see Figure 2.8). This will result in an inflow of 67.1 FTE trainees into the occupation in 2022, assuming the dropout rate from the clinical trainee program remains at 17 per cent.

Figure 2.8: ROMP workforcehalfway ut i l isat ion scenar io

Projection

Projection



If the current utilisation rate was maintained over the entire projected period at 38.1 per cent, then the demand requirements would be lower, with 345.1 FTE professionals required in 2017 and 389.4 in 2022 (see Figure 2.9). However, this still amounts to a shortfall of 68.4 FTEs in 2017 and 52.9 in 2022. This suggests that intake into the training program needs to increase by around 17.5 per cent each year over the years 2014 to 2017, resulting in an inflow of 39.6 FTE trainees into the occupation in 2022.

Figure 2.9: ROMP workforcecurrent underut i l isat ion scenar io

2.4 Linacs needed

The Faculty of Radiation Oncology 2013 facilities survey identified that there were 167 linacs nationally. Confidential-in-nature figures from the Department of Health identified 183 registered to 69 LSPNs; however this figure includes the likes of gamma knives. Where inconsistencies in sites were observed, data were checked against information on websites and/or contacting departments directly. The number of linacs is sensitive to the demand scenarios described above. Table 2.1 below summarises the differences in workforce and linac requirements under each scenario.

The industry-accepted useful life of a linear accelerator is 10 years (Zhang 2010). The 2013 Faculty of Radiation Oncology facilities survey identified that 10 linacs (6.0% of the reported total) were older than 10 years. The number of linacs needed does not take into account machine retirements.

Projection


Table 2.1: L inacs required

Demand scenario 2017 2022

Target utilisation

Linacs 196 247

Radiation Oncologists 391.3 493.7

Radiation Therapists 1956.7 2468.4

ROMPs 391.3 493.7

Halfway utilisation

Linacs 184 221



ROMPs 368.7 441.5


Linacs 173 195



ROMPs 345.1 389.4

The sections below show the number of linacs needed in the target utilisation, halfway utilisation and current underutilisation demand scenarios. The number of linacs is based on an assumption of one linac per 414 cases (see ROJIG 2002).

Target utilisation

Figure 2.10 shows the number of linacs and staff in each occupation needed in order to achieve a target utilisation rate of 48.3 per cent in 2022. By 2022, 247 linacs will be required to meet increasing demand, which equates to an increase of 80 on the current supply reported in the facilities survey (167).

Figure 2.10: L inacs Needed w ith Target u t i l isat ion


Halfway utilisation

If a utilisation rate of 43.2 per cent is to be achieved by 2022 then 221 linacs will be required, as shown in Figure 2.11. This is an increase of 54 on the current reported 167.

Figure 2.11: L inacs needed w ith ha lfway ut i l isat ion


Even under the current underutilisation scenario where the utilisation rate is held constant, the increasing number of patients requiring radiation therapy treatment over the next 10 years is forecast to require 28 more linacs on the current supply195 required in 2022 (Figure 2.12).

Figure 2.12: L inacs needed w ith cur rent underut i l isat ion


2.5 Jurisdiction level data

The model provides numbers by state and territory. However, the results should be interpreted with caution. In many cases, the national assumptions have been applied to each jurisdiction, because data was not available by state/territory. This can have significant effects on the small numbers in some jurisdictions. In addition, we are dealing with a national labour market and there is potential for a shortage in one jurisdiction to be filled in part by movement from another jurisdiction experiencing a surplus.

Converting FTEs to headcount numbers

The model outputs professional FTEs. However, headcount numbers can be calculated by the user if necessary. The equation is:

Headcount = (FTEs/average hours worked per week) standard hours

According to the FairWork Ombudsman, standard full-time weekly hours in Australia are 38. The below table (Table 2.2) contains average hours worked per week for each occupation.

Table 2.2: Average hours worked per week

Occupation Average hours Data source

Radiation Oncologists 44.3 Leung & Vukolova, 2011

Radiation Therapists 32.6 AIR, 2012

ROMPs 40.0 HealthConsult, 2009

In the case of Radiation Oncologists, average hours worked appears to exceed standard hours, and converting FTEs to headcounts may not be appropriate. The Australian Bureau of Statistics (ABS) designates 35 hours per week to be full time. The Australian Institute for Health and Welfare (AIHW) also designates 35 hours per week, except for medical practitioners, where 45 hours per week is used.

In the case of Radiation Therapists, there would be a significant difference between headcount and FTE numbers.


3. Comparisons with 2012

This section compares the findings from the Allen Consulting report (2012) with the revised figures using data from the 2013 Faculty of Radiation Oncology facilities survey in tabular format.

Table 3.1: Baseline numbers (FTE)

2012

(Allen Consulting)

2013

(facilities survey)



ROMPs 189.2 226.2

Linacs 168 167

Table 3.2: Comparat ive pro ject ions (mid -way 2017)

Projections based on 2012 data

(Allen Consulting)


(facilities survey)

Target Halfway Under Target Halfway Under

Radiation Oncologists 410 378 345 319.3 368.7 345.1

Radiation Therapists 2047 1889 1726 1956.7 1843.4 1725.7

ROMPs 410 378 345 391.3 368.7 345.1

Linacs 205 189 173 196 184 173

Table 3.3: Comparat ive pro ject ions (2022)


(Allen Consulting)


(facilities survey)

Target Halfway Under Target Halfway Under

Radiation Oncologists 535 462 389 493.7 441.5 389.4

Radiation Therapists 2673 2310 1947 2468.4 2207.7 1947.1

ROMPs 535 462 389 493.7 441.5 389.4

Linacs 267 231 195 247 221 195


References

AIR 2012, Australian Radiation Therapists Workforce Survey 2011, unpublished data.

Allen Consulting Group 2012. Projecting the radiation oncology workforce. Input into the Tripartite National Strategic Plan for radiation oncology in Australia. Sydney.

Australian Institute for Health and Welfare 2010. Australias health 2010. Australias health series no.12. Cat.no. AUS122. Canberra: AIHW.

Baume, P 2002, A Vision for Radiotherapy, Commonwealth of Australia, Canberra.

Barton M, Jacob S, Shafiq J, Wong K, Thompson S, Hanna T, Delaney G. National & International Benchmarks set following study of delivery of Radiotherapy Services: Review of Radiotherapy Optimal Utilisation Rates. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, Australia, 2013. Accessed on 16 May 2014 at http://www.inghaminstitute.org.au/sites/default/files/RTU%20Review%20Final%20Dec%202012%20v2%2019032013.pdf

Delaney, G P, S Jacob, C Featherstone, and M B Barton 2003, Radiotherapy in cancer care: estimating optimal utilisation from a review of evidence-based clinical guidelines, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney.

FairWork Ombudsman 2014, Casual, part-time and full-time work, accessed on 14 May 2014 at http://www.fairwork.gov.au/employment/casual-full-time-and-part-time-work/pages/default

HealthConsult 2009, Radiation Oncology Workforce Planning Final Report, prepared for the Department of Health and Ageing, Canberra.

Leung, J and N Vukolova 2011, Faculty of Radiation Oncology 2010 workforce survey, Journal of Medical Imaging and Radiation Oncology, 55, 622-632

ROJIG 2002, A Vision for Radiotherapy: A report of the radiation oncology inquiry, Department of Health and Ageing, Canberra.

Zhang H, 2010, Victorian medical radiations: Workforce supply and demand projections (2010-2030), prepared for the Department of Health Victoria, Melbourne, accessed on 14 ay 2014 at http://docs.health.vic.gov.au/docs/doc/8327D7F888AC8588CA25785C000BE4DD/$FILE/medical-radiation.pdf

Acknowledgements

Thanks are expressed to the staff at all the radiation therapy centres and departments that took the time to complete the facilities survey; and those who provided additional information through follow-up calls and emails.

THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF RADIOLOGISTS

2014 projecting the radiation oncology workforce

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