Medical Physics Shadowing at UAB

[The_Sarco]

Greetings Physics Forums,

It has been a while since I last contributed to these forums. However, I had the opportunity to job shadow some of the Medical Physicists at U.A.B. yesterday and I thought I would pass on what I learned to prospective Medical Physics students.

First off, shadowing was a great opportunity to talk with professionals in the field and learn more about the day-to-day operations of a Radiation Oncologist Medical Physicist. I spoke with one of the residents and two Physicists, one specializing in Brachytherapy and the one chiefly working with External Beam Therapy, with most of my time spent with the latter Physicist. For anyone out there who wants to set up a shadowing, I would suggest asking about 2 months in advance for that was how long it took for mine to get set up. The people at U.A.B. were glad to have me shadow and I would expect that any other program would be willing to have you come aboard as long as you work with their schedules and give them appropriate time to schedule a shadowing.

During my time there yesterday, which was around 5 hours, I got to see treatment planning, beam Q.A., brachytherapy, and E.B.R.T. All of these experiences were quite interesting and, if you enjoy helping people and are good in math and science, you will probably think the same about those processes and the field in general. The Q.A. process is one that is done daily, with monthly and yearly chart checks also being a part of the process. Routine work, yes, but quite necessary. Learning brachytherapy was interesting and it is mainly used for breast, cervical, and prostate cancers. Interesting trade-off between brachy and external beam therapies is that the former's main problem arises after the therapy, due to the patient movement during sleep possibly moving the catheter around, and the latter having its main concerns arises during the actual therapy itself, due to patient movement on the treatment couch and even involuntary movements such as the bladder filling (an obvious issue with prostate E.B.R.T.). They get around the latter issue by designing treatment masks to fix the patient in place so that the computer treatment model does not get thrown off with the movement of the patient.

As I stated above, if you're good at math and science and you want to help people, being a clinical Medical Physicist may be what you're looking for in a career. However, if you want to do research on the hard science behind Medical Physics, the clinical environment is not for you, as any and all research has to do with improving treatment modalities and planning in the clinic. Go for the academic environment if that's what you would like to do. Also, the biggest issue that may frustrate you (one of the Physicists told me this was for him) is that dealing with something as complex as the human body can get to you sometimes, so you must be patient and detail-oriented to ensure mistakes are not made and that everything is functioning as it should be. If you enjoy seeing your research being applied, as the clinical environment is heavily applied physics, then you will probably enjoy the job, as opposed to other theoretical-based fields of physics.

Finally, as it pertains to the best path to becoming a fully-certified Medical Physicist (A.B.R., etc.) is to get a Ph.D. and then obtain a residency slot, according to the opinions of the resident and the physicist I shadowed for most of the day. However, it was interesting to hear their takes on what is causing the bottleneck in the profession, with the resident saying it is the residency slots (he said around 1/3 of graduates are getting residencies) and the physicist saying it is degree over-saturation (a lot of programs, even the good ones, are letting too many people into make money).

How to separate yourself from the crowd and get yourself a residency positions, though? Get good grades in your degree program and get as much clinical experience as you can, with research being a definitive bonus. But chiefly it will be your coursework and experience that gets you in one, with residencies being in clinical environments, for the most part. Also, and this was just his opinion, but the physicist was not too fond of the D.M.P. programs that are out there nowadays (Vanderbilt, Cincinnati, and U.T. - San Antonio recently), for they give one the impression that they don't need you to work (because you're paying them for a residency). Time will tell on that issue, though, with the A.B.R. exam passing rates determining the validity of that argument. Also, he was not fond of the so-called "spoke-and-wheel" residency programs where they "guarantee" their graduates a residency slot, such as a L.S.U. or Kentucky.

Lastly, and this may not apply to all of you (as I am interested in proton therapy), but he said M.D. Anderson and Florida have really good proton programs and research, especially the latter. So I will definitely be looking into those two programs, along with a couple of others, as I look at where I want to pursue my studies. I asked if I could came back and I was told I could, so I will be looking forward to that opportunity again to learn more and possibly pass on the information to all of you. Thanks for reading this rather long post! :-)

 

[Choppy]

Thanks for reporting your experience, Sarco. I think more students interested in Medical Physics should attempt job shadows. One of the concerns though is that in some places it may not be possible due to policy concerns regarding patient confidentiality.

Is UAB the University of Alabama, Brimingham? Or the University of Alberta?

The Q.A. process is one that is done daily, with monthly and yearly chart checks also being a part of the process.

Just a note that "chart checks" generally refers to patient-specific QA. When a radiotherapy treatment is planned a Medical Physicist will often play a role in verifying aspects of the treatment plan itself - making sure that the calculated monitor units are correct, evaluating any measurements of the intended fluence pattern, etc. This is usually done before a treatment is delivered or at least within the first few fractions. Machine QA is performed on a daily, monthly and annual basis.

Finally, as it pertains to the best path to becoming a fully-certified Medical Physicist (A.B.R., etc.) is to get a Ph.D. and then obtain a residency slot, according to the opinions of the resident and the physicist I shadowed for most of the day. However, it was interesting to hear their takes on what is causing the bottleneck in the profession, with the resident saying it is the residency slots (he said around 1/3 of graduates are getting residencies) and the physicist saying it is degree over-saturation (a lot of programs, even the good ones, are letting too many people into make money).

In 2015 there were 115 matches reported for 280 applicants - so about a 40% placement rate from the matching system. But not all programs that had residencies available were part of the matching process. In actuality it's probably about a 50% chance at getting a residency. Still, that's not the "knocking down your door" condition that most students want.

How to separate yourself from the crowd and get yourself a residency positions, though? Get good grades in your degree program and get as much clinical experience as you can, with research being a definitive bonus. But chiefly it will be your coursework and experience that gets you in one, with residencies being in clinical environments, for the most part.

I would agree with this. If you can, try to get experience commissioning something new too.

Also, and this was just his opinion, but the physicist was not too fond of the D.M.P. programs that are out there nowadays (Vanderbilt, Cincinnati, and U.T. - San Antonio recently), for they give one the impression that they don't need you to work (because you're paying them for a residency). Time will tell on that issue, though, with the A.B.R. exam passing rates determining the validity of that argument.

I agree with this as well, although it's not just the certification exam that will determine success. You also have to look at the long term impact on the profession. My main concern is that it's setting up a system where either residents are not getting the experience they need, or they're not being paid for services they provide. During a residency you shouldn't just learn how to do something and then move on - you need to do it and solve problems related to it - effectively working as a Medical Physicist.

 

[The_Sarco]

Thanks for your advice, Choppy! At U.A.B. (Alabama - Birmingham), where I shadowed, I had to sign a few documents relating to H.I.P.A.A. I would expect that most places would have those confidentiality agreements in place, seeing as it is a federal government act, so I personally wouldn't see it being much of a problem.

Right on the Q.A. differences! Everything you said is correct, as I remember hearing all of it yesterday. On the residency issue, most students have the idea that a residency slot is automatically allotted to them upon completion of their degree program and it is not. I would also add the statistic that around 65%-75% of individuals being awarded residency positions are Ph.D. degree holders, which is probably due to over-saturation of the degree marketplace and a limited number of residency slots still out there relative to the number of graduates.

As for the what happens after the residency...if one fails the part 2 or even part 3 of the A.B.R. exams, then the residencies have not done their job in preparing their graduates to be a complete Medical Physicist. On the other hand, if one does somehow pass those exams coming out of a residency that did not provide a complete training and experience program, then it will be obvious in their profession that they were not prepared at the level they should have been.