The terminal M.S. degree is no longer appropriate for students interested in a career in clinical medical physics in the United States Michael D. Mills, Howard R. Elson, and Colin G. Orton Citation: Medical Physics 38, 1737 (2011); doi: 10.1118/1.3533901 View online: http://dx.doi.org/10.1118/1.3533901 View Table of Contents: http://scitation.aip.org/content/aapm/journal/medphys/38/4?ver=pdfcov Published by the American Association of Physicists in Medicine Articles you may be interested in How U.S. Students Get a University Degree for Free in Germany Earning a university degree in Germany Phys. Teach. 53, 509 (2015); 10.1119/1.4933167 “Hybrid gold” is the most appropriate open-access modality for journals like Medical Physics Med. Phys. 42, 1 (2015); 10.1118/1.4895979 Practicing and aspiring medical physicists can safely disregard university rankings at no peril to them Med. Phys. 41, 050601 (2014); 10.1118/1.4866835 Leakage neutron radiation in a medical electron accelerator AIP Conf. Proc. 593, 140 (2001); 10.1063/1.1420477 The Ph.D. degree is a handicap in the job market for clinical medical physicists Med. Phys. 27, 2641 (2000); 10.1118/1.1328385
POINT/COUNTERPOINT Suggestions for topics suitable for these Point/Counterpoint debates should be addressed to Colin G. Orton, Professor Emeritus, Wayne State University, Detroit:
[email protected]. Persons participating in Point/Counterpoint discussions are selected for their knowledge and communicative skill. Their positions for or against a proposition may or may not reflect their personal opinions or the positions of their employers.
The terminal M.S. degree is no longer appropriate for students interested in a career in clinical medical physics in the United States Michael D. Mills, Ph.D. Department of Radiation Oncology, James Graham Brown Cancer Center, Louisville, Kentucky 40202 (Tel: 502-561-2700, E-mail:
[email protected])
Howard R. Elson, Ph.D. Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45219 (Tel: 513-584-9092, E-mail:
[email protected])
Colin G. Orton, Ph.D., Moderator 共Received 5 November 2010; accepted for publication 9 November 2010; published 8 March 2011兲 关DOI: 10.1118/1.3533901兴 OVERVIEW Entry into the medical physics profession in the United States is at a crossroads. In the past, the simplest and most common way to enter the field was to obtain a Medical Physics M.S. degree and to become certified as soon as possible thereafter. With the new American Board of Radiology examination requirements, however, this will no longer be possible: All applicants will have to be enrolled in or have graduated from an accredited medical physics residency program. No longer will entry into the profession be in the hands of graduate program directors; this responsibility will be transferred to the directors of residency programs. The concern has been expressed that these directors might accept trainees into their programs who have doctoral degrees in preference to those holding the M.S. and that many, if not most, M.S. graduates might not be able to secure residency positions. Consequently, it has been suggested that the terminal M.S. degree is no longer appropriate for students interested in a career in clinical medical physics in the United States. This is the Proposition debated in this month’s Point/ Counterpoint. Arguing for the Proposition is Michael D. Mills, Ph.D. Dr. Mills obtained his Ph.D. in Biomedical Science from the University of Texas Graduate School of Biomedical Sciences, Houston, Texas, in 1980. Since then, he has held clinical and faculty appointments in a number of institutions and is currently Chief of Physics and Associate Professor in the Department of Radiation Oncology, Brown Cancer Center, University of Lou1737
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isville, Kentucky. He has served on or chaired numerous committees and Task Groups in the AAPM and the ACMP and is currently Chairman of the ACMP Commission on Credentials and Vice-Chairman of the AAPM Professional Council. He has served on the Board of Directors and as Chairman of the Board of the ACMP. He is a Fellow of the ACMP and the AAPM and has received the Marvin M. D. Williams Award of the ACMP. Dr. Mills is certified by the ABR in Therapeutic, Diagnostic, and Nuclear Medicine Physics and by the ABMP in Radiation Oncology Physics.
Arguing against the Proposition is Howard R. Elson, Ph.D. Dr. Elson obtained his Ph.D. in Biomedical Nuclear Engineering from the University of Cincinnati, Ohio, in 1978 and has subsequently worked his entire career in the University of Cincinnati College of Medicine where he is currently Professor of Radiation Oncology in the Department of Radiation Oncology. He has served on several AAPM Committees and the Board of Directors and is certified by the ABR in Therapeutic, Diagnostic, and Nuclear Medicine Physics. Dr. Elson is the Director of the CAMPEPaccredited Medical Physics Graduate Program in the Radiology Department of the University of Cincinnati College of Medicine. He has been the Advisor or on the Research Committees of 28 M.S. and 8 Ph.D. students.
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© 2011 Am. Assoc. Phys. Med.
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Mills and Elson: Point/Counterpoint
FOR THE PROPOSITION: Michael D. Mills, Ph.D. Opening Statement
“Dad! I’ve been accepted to Medical School!” How exciting! But wait; the Medical School is out-of-state! More investigation reveals some distressing information. There are 200 entry slots, 50 for in-state and 150 for out-of-state students, but only 50 clinical rotation slots! At the beginning of year three, 150 of the students are dismissed! Of the 50 rotation positions, 40 are reserved for in-state students! There are 50 in-state students who therefore have an 80% chance of landing a clinical rotation slot. However, there are only ten rotation slots for the remaining 150 out-of-state students; only a 7% chance of your daughter actually landing a clinical rotation slot and finishing! “I’m sorry. You just can’t go to this school. This medical school seems to be running a racket! They are collecting money to run a big program on the promise of training you to be a doctor but they are not keeping that promise! Fewer than ten percent of students in your position will actually enter rotations and Medical practice. And you will waste two years of your life if you fail to make this almost impossible cut. I cannot recommend that you try to become a physician there. You will need to look for another opportunity.” While no analogy is perfect, if you replace Medical School with the M.S. program in Medical Physics; the clinical rotation slot with a medical physics residency position; the out-of-state students with M.S. medical physics students; in-state students with Ph.D. medical physics students; medical doctor with medical physics professional, then the analogy of terms and numbers is complete. “But wait, Dad! I can always be a physician’s assistant, or sell pharmaceuticals!” Oh, the other employment alternatives! Yes, we can justify that the M.S. Medical Physics students can always go on for a Ph.D., work for industry, or work as dosimetrists or physics assistants. However, M.S. medical physics students entered our academic programs expecting to become clinical medical physicists, just ask them! And ask your graduates if they are happy working in a medical dosimetry position they landed by agreeing to work for $10K less than the Certified Medical Dosimetrist 共C.M.D.兲. While you are at it, ask the unemployed C.M.D.s what they think as well! Two years graduate academic training plus two years training in a clinical residency is a Professional Doctorate. Examples are Physicians, Dentists, Podiatrists, and Optometrists. Medical Physics must credential its professionals accurately as Professional Doctorates in Medical Physics 共D.M.P.兲. Continuing to award the M.S. degree in Medical Physics without guaranteeing entry into an appropriate residency program is a catastrophic disservice to our students and our profession. We are forcing our best candidates to choose other professions. We must create D.M.P. programs now to be fair to our future students. I therefore urge the immediate elimination of all M.S. Medical Physics programs to be replaced by D.M.P. programs. CAMPEP should accredit only D.M.P. and ResiMedical Physics, Vol. 38, No. 4, April 2011
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dency programs, and immediately set a date beyond which M.S. Medical Physics programs will no longer be accredited.
AGAINST THE PROPOSITION: Howard R. Elson, Ph.D. Opening Statement
To advocate that “less education is adequate” rather than “more education is better” in a field that values education puts us at a disadvantage. We will make the case that the Medical Physics Master’s degree continues to be of value. This justification is based on four claims: The M.S. physicist plays a valuable role in clinical departments, requiring a more advanced degree would not advance the level of performance, the profession does not demand the elimination of the degree, and the profession does not control the degrees granted by educational institutions. Much of the work that we perform is relatively routine in which diligence and attention to detail is more important than the ability to perform independent research. How do we measure the value of the M.S. physicist? One measure of value is an employer’s willingness to pay. A review of the 39 positions recently advertised in the AAPM Placement Service list showed only 17 required a Ph.D. Of the 17, the majority were academic positions. With the profession’s history of service by M.S. educated physicists, nonacademic employers feel confident that M.S. physicists are competent in clinical positions. The same conclusion is apparent in the small salary difference between the holders of the two degrees. Would raising the entrance requirements beyond the M.S. have prevented the recent well-publicized radiation events? No! In fact, many of the incidents occurred in environments staffed by physicists educated beyond the M.S. Physicians, administrators, and regulators have not demanded an increase in educational experience for medical physicists to furnish a more sophisticated pool of physicists. If the profession invoked a new minimum of the doctorate of medical physics 共D.M.P.兲 or the Ph.D. for entry into the profession, what would be the potential consequences? Would the students entering the field through M.S. programs suddenly matriculate into the alternate programs? Would the alternated programs expand to accommodate increased populations? Would the present M.S. program be able to convert to granting a more advanced degree? At many institutions presently granting the M.S., including ours, it is not economically feasible to convert to the more advanced degree. Would the AAPM, ABR, or CAMPEP be able financially to overcome the economic barriers for conversion of these programs? If there were an insufficient number of graduates, what would be the response of the employers in need of the services of our profession? Our clinical work would still have to be done to support patient care. A likely result of a shortage of physicists, caused in part by additional impediments to entry into the field, is that the work would be performed by less qualified individuals.
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Mills and Elson: Point/Counterpoint
In conclusion, the aims of the medical physics graduate education are fourfold: 共1兲 To provide the knowledge required to provide medical physics services in patient care, 共2兲 to develop the skills necessary to implement new technologies, 共3兲 to accomplish medical physics research and development, and 共4兲 to produce the next generation. My position is that the first two can be satisfied by “well-trained” M.S.-educated physicists, while the latter two might better be suited to Ph.D.-educated physicists. Rebuttal: Michael D. Mills, Ph.D.
We agree that every aspiring medical physicist must master the content currently contained within the M.S. degree curriculum, and the student must complete a CAMPEPaccredited residency to be eligible for entry into the profession. The debate is over what we name this education pathway and fairness to those that enter the education path to become medical physicists. Let us examine these claims to see if they stand up to scrutiny: 共1兲 The argument is not over value, but proper valuation. Medical physicists have mastered a body of clinical knowledge radiation oncologists or radiologists do not and cannot master. The medical physicist’s role has proper value only if the naming of accomplishments 共D.M.P. or Ph.D.兲 recognizes this and puts the medical physicist in proper standing with physicians. 共2兲 The level of performance required for medical physics practice increases every year. Routine medical physics practice is often more complex than routine medical practice and no one would argue that because much of radiation-medical practice is routine, an M.D. 共professional doctorate兲 degree is not required in order to practice as a radiologist or radiation oncologist. 共3兲 The debate is whether the profession should demand the elimination of the M.S. Medical Physics degree. Training 140 M.S. medical physicists that cannot enter CAMPEP residencies each year benefits none of these individuals, nor does such training benefit radiation oncology or radiology, or the patient. In the long run, it will not benefit the program directors either. 共4兲 The profession does control which programs are CAMPEP accredited and therefore recognized as a path-
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way into clinical practice. The M.S. in Medical Physics fails in this regard. Those who advocate continuing the M.S. in Medical Physics must consider the immediate and irreparable harm that is being done to our profession, our graduates, and our patients. We should eliminate CAMPEP accreditation for all M.S. Medical Physics programs immediately. Rebuttal: Howard R. Elson, Ph.D.
As was stated by my opponent: “No analogy is perfect,” but let us consider the analogy in the inverse. Years ago, a medical residency training system was set in place, which resulted in an excess of clinical spots and an insufficient number of medical school graduates to fill them. Did the creators of this system envision the large number of clinical spots being filled by foreign medical graduates? Did they predict the number of Americans matriculating in foreign medical schools? Did they envision the effect on medical care in this country and the brain drain on the rest of the world? What would have been the consequences if a rigorous system for regulating physicians’ licensure had not been in place? Although this scenario is obviously different from the present medical physics issue, is there a lesson to be learned? What might be the unintended consequences of a drastic reduction in the number of individuals entering the field by the M.S. route, bearing in mind that we do not have the protection of rigorous licensure requirements? Furthermore, we do not control the number of institutions granting the D.M.P. We can, and should, encourage the creation of new D.M.P. programs. However, at this time, do we understand the consequences of adding another impediment for entry into the field? The discussion raised in this Point/Counterpoint may be of interest to the field in general but ultimately at this point in time, the fate of the M.S. is in the hands of the medical physics residency program directors. Will those directors grant admission to applicants holding the M.S. at a rate sufficient to warrant the continuation of M.S. programs? If not, the only option will be the elimination of the M.S. as a mode of entry into the field.
