Abstract
The evolution of practice of Radiation Therapy in the United States (U.S.) is inevitable. The scope of a radiation therapists role has progressed with advancing technology, implementation of special procedures and patient care requirements. Internationally, Canada, Australia and the United Kingdom have formalized this evolution through the Advanced Practice Radiation Therapist (APRT) role to provide new models of care, to meet growing demands in the practice of Radiation Oncology, to increase efficiency, decrease cost and retain skilled staff (Harnett et al., 2018; Society of Radiographers; Linden et al., 2019; Coleman et al., 2014) [1], [2], [3], [4]. Through evidence based practice, the APRT role has proven to provide benefits for multiple stakeholders including service-reconfiguration to reduce wait times, developing and retaining highly skilled radiation therapists, treatment review and most importantly improving patient care within much needed patient cohorts such as the palliative population (Duffton et al., 2019) [5]. The U.S. is no exception to requiring innovative care models and solutions to similar complex, care delivery challenges experienced internationally. The U.S. is experiencing an increase in demand for cancer services and a rapid rate of technological and treatment advancements. Under the current infrastructure, this has impacted the daily tasks of physicians; increasing workload, increasing the complexity of clinical decision making, increasing movement toward site specific subspecialty practice and pushing the scope of radiation therapists informally toward maximization, increased autonomy and a higher level of education and specialized skills (American Society of Clinical Oncology, 2016; ARRT, 2020; Vu et al., 2018) [6], [7], [8]. Objective The following reviews the current radiation therapy practice and professional landscape in the United States as it relates to advanced practice, exploring opportunities and challenges under the U.S. health care infrastructure. This broad analysis provides comparison to other countries and disciplines such as the Radiologist Assistant and Nurse Practitioner for potential pathways to establishing the role and describes current needs and value of the expanding scope of RT's practicing in the U.S.
Highlights
Introduction to existingAP roles in the U.S.Within the United States (U.S.) healthcare system, Advanced Practice models are widely utilized via Nurse Practitioners (NP’s) and Physician Assistants (PA’s) whom are often physician extenders to Radiation Oncologists in the clinic
A systematic evidence-based approach in establishing the Advanced Practice Radiation Therapist (APRT) role in the U.S should be viewed as a solution to the growing complexity of the field of Radiation Oncology and the unique pressures of the U.S health care system, including bundled payments, mounting financial pressures on Radiation Oncology departments and increased physician workload
While those practicing radiation therapy are elevated to new clinical and educational standards and look for clinical opportunities on the professional advancement ladder, there is no regulatory, educational or structural framework that offers a pathway for expanding the clinical role of the radiation therapist in the U.S
Summary
The following reviews the current radiation therapy practice and professional landscape in the United States as it relates to advanced practice, exploring opportunities and challenges under the U.S health care infrastructure. In 2019, the Centers for Medicaid and Medicare (CMS) expanded the scope of PA’s under new regulations, largely deferring to individual state laws and allowing more flexibility of duties [10] This signals a growing level of support for AP roles within the U.S payment infrastructure and perhaps a response to the anticipated physician shortages on top of an increase in sub-specialization [11]. Radiation therapists hold a distinct technical skill set required for an AP role to support patients daily through continuity of care and to support physicians in a different but important domain of daily Radiation Oncology practice such as with the ever expanding IGRT workload It can be understood, that just as elevating nursing education has created successful AP nursing roles in the field, elevating therapists education can create the same level of support and outcomes with a distinct place for both in U.S departments such as the treatment review clinics that are run by AP’s in international institutions.
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