Medical PhysicsLicensure Updat e

Jeffrey P. LimmerChairman,

Joint Medical Physics Licensure Subcommittee(AAPM and ACMP)

AAPM 29 July 2008 J Limmer

Why Licensur e?Why Licensure?

• We belie ve that the level ofcompl exity involved in medicalimaging and radia tion therapy issuc h, that it is necessary thatphysicists wi th special training,education, and experienc e must bea part of the team providing thesepro cedures.

• We believe it is the role of thephy sicist to oversee themeasur ement of dose, thecalibrat ion of equipment, theevalua tion of equipm ent, theestimat e of risk, the design ofimaging and radiation thera pyprotoc ols and procedu res, and theplanni ng, implementation whereappli cable for diagnostic imagingand radiation therapy.

• We belie ve that Medic al Physics isthe profession meeting thosegoals.

• For the benefi t of pat ients and thegeneral publi c, it is essent ial thatthe profession of Medica l Physicsbe both def ined and protec ted bylaw.

AAPM and ACMP Respons e

• In 2006, the ACMP merged itsMedical Phys ics Licen sure effortswith the AAPM’s Medical Physicslic ensure efforts into the JointMedical Phys ics Licen sure Sub-Comm it tee (JMPLSC)

JMPLSC

•• Reports to:Reports to:–– ACMP: Commission on Creden tialsACMP: Commis sion on Credential s–– AAPM: Clinical Prof essio nalAAPM: Clini cal Profes sional

CommitteeCommittee

ChargeChargeThe charge of this jo int subcommittee isThe charge of this joint subc ommittee is

to make available resource s to aid theto make availabl e resources to aid theadoption of Medica l Physicsadoptio n of Medical Physi csprofess ional lic ensureprofessional licens ure ** in the Unit edin the UnitedStates of America.States of Amer ica.

**to br ing about standards and gui dancefor qua lifying medica l physicis ts topractice (with or wit hout CARE)through licensu re or throug h a similarmechanism

ChargeCharge•• Coordinate the efforts of the AAPM andCoordinate the efforts of the AAPM and

the ACMP toward a common posit ion andthe ACMP toward a common position andstrat egystrate gy

•• Develo p recommended minimumDevelop recommended minimumstandar ds for state licensure law s.standar ds for state licensure laws.

•• Develo p recommendations contai ningDevelop recommendations containingbackgr ound informati on, suggestedbackground information, suggestedstrat egy, and a suggested Medicalstrate gy, and a suggested MedicalPhysic s Licensure Act and Rules, for usePhysic s Licensure Act and Rules, for useby medical physici sts and others engagedby medical physicists and others engagedin promoting the passage of medi calin promoting the passage of medic alphysics lic ensur e lawsphysics licensure law s

Axiom for this effortAxiom for this effort

•• It is imp ortant to patie nts and ourIt is important to patients and ourprofess ion that we work towa rd thi sprofession that we work toward thisaim / goal, independently of the CAREaim / goal, independent ly of the CAREBill.Bill.

Aim / GoalAim / Goal

•• To have State rules whereTo have State rules where MedicalPhysics servi ces are perf ormed only byqualified ind iv iduals .

At the helm of our ow n shipAt the helm of our own shi p•• The CARE Bil l is only a foot in the door, itThe CARE Bill is only a foot in the door, it

doesndoesn ’’ t spell outt spell out ““ what we dowhat we do ”” ; this would; this wouldbe the job of the indiv idual states.be the job of the indivi dual state s.

•• We would rather have an input than haveWe would rather have an input than haveothers deci de for us.others decide for us.

•• States can start this proc ess any time,States can start this process any time,independent of the CARE Bil l.independe nt of the CARE Bil l.

•• Work with the Conference of Radiat ionWork with the Conference of RadiationControl Program Direc tors (CRCPD) forControl Progr am Directors (CRCPD) fordefinit ions of a Qualified Medicaldefinitions of a Quali fied MedicalPhysicist.Physicist.

Our Regula tory Goals

• Establ ish some form of Licen sure forMedical Physi cist s in as many aspossible, if not all, states.

• Legally define a Qualified MedicalPhysicist.

• Define duties which requ ire a QualifiedMedical Physi cist .

• Define Supervisory Roles as well asAutho rity and Responsibility .

Overview of processOvervi ew of proc essAttain JointChargefrom ACMPand AAPM Review of

present Stateregulations(Licensure andRegistrations)

Recommend atemplate forStates to usewhen writinglegislation

Help develop orrecommenddevelopment ofspecific tools /guidelines /handbooks /support for Stateadoption ofregulations

Identify targetstates andlobbyists

Attain JointScope ofPracticefrom ACMPand AAPM

We are here

The cur rent state of affairs• 4 states have licensu re defin ing most aspects of

Medical Physics• The NRC has def ined an Aut horized Medical

Physicist for Gamma Stereotactic Radiosurg ery,HDR, and Teletherap y

• The FDA has def ined a Mammography Physicist• Many states requ ire a regist ration of physicists.

– Many require certif icat ion or other demon stratio nof educatio n and experience in order to bereg istered.

– Registration may not apply in all areas of MedicalPhysics

Licensure StatesLicensure States

StateState AcceptAcceptBoards?Boards ?

FeeFee TimeTime

FLFL YesYes $500$500 2 yrs2 yrs

HIHI YesYes $30$30 2 yrs2 yrs

NYNY YesYes $450$450 2 yrs2 yrs

TXTX YesYes $250$250 2 yrs2 yrs

All Other StatesAll Other States

•• Some registrati on for Diagnostic andSome registr ation for Diagnostic andTherapyTherapy

•• Some registrati on for onl y Diagn osticSome registr ation for only Diagn osticOR TherapyOR Therapy

•• The rest: littl e or nothingThe rest: little or not hing

JMPLSC’s General Overvi ew

• Phase I –– Review initial con di tio ns– Determine project needs– Review existing legislati ve stru ctures– Coordinate AAPM and ACMP’s efforts

• Phase II– Develop a foundatio n– Determine type of licensur e to seek– Develop language to pro pose as a

codification template– Invo lve governm ent agencies and

lobbyists as appropr iate

• Phase III– Implement / sustain the plan– Refine / evaluat e as necessary

Phase One – Completed Tasks

• Develop a budg et.

• Begin an educ ational camp aign for ACMPand AAPM membe rshi p.

• Review and record the proc ess for each statethat has attained licen sure fo r Medic alPhysics.

Phase One - Completed Tasks

• Work with the AAPM website to pro vide a mapwhich li st s the present status of ever y statewith regar d to lice nsure or regist ration. Thegoa l is to eventually have a link for each statesregu lations, qualifica tions, related fees, for ms,etc.

• Keep current (ongoing task as well)

Phase One - Completed Tasks

• Investigate feasib il ity of reci procity – shouldthe state regulations have reci proc it y withothe r states, or is that not poli ticall y feas ibledue to the expected vari ation inimpl ementation (regi stration , licensure,etc .)?

• Result: Reciprocity is NOT a goal– Not a common prof essional licensur e model– A major diverge nce of our resources to

attempt this

Phase One - Completed Tasks

• Develop a joint AAPM/ACMP commentaryand suppor ting statement which conveys theorganiz ation's commitmen t to licensure .– Now being reviewed by the ACMP Boar d of

Chancell ors and the AAPM Board of Director s

Phase One - Completed Tasks

• Explor e the pros and con s of coordinatingeffor ts with Conference of Radiation ControlProgra m Directors (CRCPD) e.g., creation ofmodel regulations, usi ng regu lati ons tofurthe r our goal, etc.– Recom mendation to pursu e working throu gh

CRCPD for definin g Qualifie d Medical Physicistsand Qualified Expert and approp riate job duties

– Define the scope of practice for clinical MedicalPhysicists through SSRs (Suggested StateRegulation for Contro l of Radiatio n).

Need for CRCPD help

• Typica lly, over the last 30 yrs, thecatch -all term “Qualified Expert ” wasused to defin e the individual who wasrespon sib le to cal ibrate equipment,measure expo sure, desig n radiationshiel ding, etc.

Need for CRCPD help

• Examples of other terms used includeMedic al Physicist for one who doesmammography phys ics, Authoriz edMedic al Physicist as def ined by theNRC, and Radiatio n Therapy Physicistfor thos e physici sts working inRadiatio n Therapy

Need for CRCPD help• Trying to redefine “Qualified Expert ” to

include language similar to:“ …for exampl e, individ uals certified in

the appr opria te field by the AmericanBoard of Radiology, or the AmericanBoard of Health Physics, or theAmerican Board of Medical Phys ics, orthose havi ng equivalent qualificati ons .”

Phase One – Completed Tasks

• Review and record all present legislativelanguage for the states that havelicensur e or registration for MedicalPhysics (TX, FL, NY, and HI)

• Describe the current viable mechanism sfor licensure vs . regulatory method – e.g.,NJ registration and HI licensure (throughRadiation Protect ion div isi on) vs. TX, FLand NY (licens ure through a profes sionallicensing board)

Phase One – Complete d Tasks

• Develop categor ies and pro s and cons foreach appr oach, makin g a recommenda tionfor most ideal appr oach (resul ts)– Establish a true license for each Qualified Medical

Physicist• Individual state licensure board (e.g. not und er an RTT

board)– States reta in control, but expenses and manpow er needs

are the greatest, grea test public protection

– Establish Licensure by Recog nition• Medical Physicists lice nsed by anothe r state would be

recognized by another state as “ lic ensed ”– States lose control of lic ensure language but have less

state expense and manpower needs. Perhaps moresuitabl e for small er states.

Phase Two - Completed Tasks

• Assis t and supp ort HQ in the hi ring of theState Legislati ve and Regul atory Affa irsSpecialis t– Hired Amanda Pot ter in February 2008

• Work with AAPM governmen t rela tions staffto develop infra stru cture, reso urce allo cationprocedur e, and commu nicati on archite ctu reneeded to move forward ; looki ng at stateregulatio ns, Medical Physicis ts in the state,and state lobb yists

Phase Two - Ongoing Tasks

• Coordin ate efforts with GRAC.

• Look into mechanisms that allow statesand insti tu tions to easily and reliab lyverify credential s and lic ensure statusfor Medica l Physicist s.

Phase Two - Ongoing Tasks

• Draft a generic templ ate for all statesthat provi des recomme nded sug gestedlangu age for a sta te to use indevelo ping legislative language.– In drafting stages now –

subcomm ittee membe rs are currentlyidentifying what an idea l bill wouldlook like …

…knowing that states WILL change it

Phase Two - Ongoing Tasks

• Develop a process and crit eriasurro undin g the identification of statesto work wi th, inc luding: interest,politic al viabili ty, iden tifyi ng key Statecontacts , and core grou ps of MedicalPhysicists

• Establ ish a formal comprehensi vegrassro ots program.

Phase Two - Ongoing Tasks• States are being identified and

categorized according to “Crite ria forSuccess ” (low hanging fruit first)– Influence with state radiological society– Influence with state legislators– Support of state regulatory agencies– Willingness to serve

• As a point person• On a state committee

– Number of medical physicists in that state

Phase Two - Ongoing Tasks• A questi onna ire will be going out to all

members hip soon to determine:– Influence with state radiological society– Influence with state legislators– Willingness to serve

• As a point person• On a state committee

Phase Two - Ongoing Tasks• Some states have been identified at the

JMPLSC Meeting on July 26, 2008 toapply the cri teria to determine iflicens ure coul d be possible– Kansas - Ohio– Kentucky - Michi gan– Minnesota - Wisco nsi n– Missouri - Washi ngton– Pennsyl vania

Phase Two - Ongoing Tasks

• AAPM HQ staff identifie d which stateradiolo gical societ ies have a statelobbyist under contract or retainer .– The lobbyists that are cur rently reta ined by

state radiologic al soci eties wil l becontacted regarding poten tiallyrepresenting AAPM (thes e lobbyi sts wouldalready have some unders tand ing of theMedical Physic s profess ion).

Phase Two - Ongoing Tasks

• AAPM has retained the services of agovernmen t relations firm (States ideAssociates) to identify other pote ntiallobbyis ts within the selected states.– The firm will pro vid e backg rou nd reports ,

clean conflict of interest checks and apreliminary cost analysi s. (we want thebiggest bang for our buck)

Phase Two - Ongoing Tasks• Potentia l lobby ists are needed to have the

most favorable outco me– There are many “on the scen e” tasks and “ in the

moment ” tasks that need the attention of alobbyist

– once the bill is in trod uced, they help make sur e itis picked up and passed … keeping it on thecalendar

• Retaining the lobb yists wi ll begin in 2008– The firs t sweep of licen sure bills will be

introd uced in the 2009 leg islative sessio ns– Most legislative session s begin in January

Phase Two - Ongoing Tasks

• Letters to AAPM chapter offic ers were sent inJune to notify the memb ers of poss iblelegislation to be introd uced in their state.

- There was an intro duction to the licen sure issueand a bri ef outline of futu re expectatio ns as thelicensur e efforts come to their state

• Information was also in trod uced at theChapter Leadership Breakfast thi s morning

Phase Two - Ongoing Tasks

• A Grass roots “How -To” Manual is currentl yin the drafting stag es

- Will be made available to all AAPM member s

Moving Forw ardMovi ng Forward•• Goals and estim ated timeGoals and estimated time --table:table:

–– Final recommended templ ate for StateFinal recommended templ ate for Statelicensure by end of Octob er, ready forlicensure by end of Octob er, ready forAAPM and ACMP approv alAAPM and ACMP approval

–– Draft Grassroots manu al by end ofDraft Grassroots manual by end ofSeptemberSeptember

–– Expect approv al of, or reco mmendedExpect appro val of, or reco mmen dedchanges to, the expan ded licensure policychanges to, the expanded licensure policyby ACMP and AAPMby ACMP and AAPM -- soonsoon

–– Ongoing commun icatio n wi th ACMP andOngoing communi catio n wi th ACMP andAAPM membershi p (Newsl etters, email,AAPM membershi p (Newsletters, email,Website, Chapter meetin gs, etc.)Website , Chapter meetin gs, etc.)

Moving Forwa rdMoving Forward•• Goals and estimated timeGoals and estimate d time--table:table:

–– ““ Passion and Proces sPassion and Process ”” presenta tions topresentations toChapters and states as requested/neededChapters and states as requested/nee ded

–– Identifying the target states based on theIdentifying the targ et states based on the““ Criteria for SuccessCriteria for Success ””

–– Hiring lobbyists for the 2009 legislativeHiring lobbyists for the 2009 legisla tivesessions by Novsessions by Nov --DecDec

–– Identifying memb er supp or ters for theIdentifying membe r supporter s for thetarg eted statestarg eted states

We are asking that youbecome act ively involv ed

in assisting licensur elegi slati on to beco me law

in your state .

Grassroots Netw ork

• Grassroo ts “b roade r” than justlicensu re, will be used for researchdollars, regula tory issues, educat ionaloutreach, resp ondi ng to “malevolentevents ”, etc.

• Working on a Grass roots Handbook

Grassroots Network• It is impera tive that the entire medic al

physics comm unity be organized toadvocate on behalf of the medical phy sicsprofession.

• Grassroots advocacy means prom ot ingthe professi on ’s interests and issu es bycomm uni cating with elected officials orregulat ors in an effective and efficientmanner.

Getti ng Invol ved is Easy!• Grassroots involv ement rare ly takes up

much of your tim e yet a few moments spentcould have a huge impa ct.

• If you have a pho ne or if you ’ve ever sent anemai l, you can be an active part of theproces s.

• It is AAPM’s recommend atio n that eachchapter (state ) have a grassro ots manager.– A primary point -of -con tact for both the chapt er

and Headquarters for quest ion s and inf ormat ion

Key Contact sAAPM Governm ent Relat ions Staff• Lynn e Fairobent , Legislative and Regulatory Affairs Manager

lynne@aa pm.org / 301-209-3364• Amanda Potter , State Legislati ve and Regulato ry Affair s

Speci alistamanda@aa pm.org / 301-209-3358

• Noel Crisman -Fillhart , Government Relatio ns Admi nistr ativeAssi stantnoel@aap m.org / 301-209-3334

AAPM Governm ent and Regula tory Affairs Committee (GRAC)• Doug Pfeiffer , GRAC Chairma n

dpfeif fer@bch.o rg / 720-854-7515

AAPM Join t Medica l Physicist s Licensur e Subco mmittee(JMPLSC)

• Jef frey Limme r, JMPLSC Chairmanjeffl@as piru s.org / 715-847-2685

JMPLSC Members• Frank J. Bova (Florida legis lati ve experience )• Mark C. Bruels (Former ACMP Licensu re Commit tee Member)• Sudarsha n N. Chamakuri (Member)• Lynne Fairob ent (Legisl ative and Regul atory Affairs Manager (ex officio,

nonvoting))• Martin W. Fraser (AAPM CP commi ttee vice chair)• David Lee Goff (ACMP Licens ure Commit tee Member)• Per H. Halvorsen (Chair, AAPM CP Commi ttee)• Michael G. Herman (Cons ultant (ex officio, nonvoting) )• David J. Keys (Liaiso n - AAPM Government and Regulatory Af fairs

Committee and ACMP Lic ensu re Commit tee Member)• Roy E. Landers, Jr. (Former ACMP Licensure Committ ee member)• Danny J. Landry (ACMP Licensure Committ ee Member)• Jeffrey P. Limme r (Chair)• Robert W. Luthm ann (Member)• Mary Ellen Masterson -McGary (Member - Consult ant (ex off icio , non vot ing))• Herbert W. Mower (Member - Consult ant (ex officio, nonv oting))• Yakov M. Pipm an (Member - Former ACMP Licensure Committee member,

New York State experienc e)• Robert Pizzutiello (ACMP Licensure Committee Member )• Amanda Potter (Legisl ative and Regul atory Af fairs Specialist (ex off ici o and

nonvoting ))

Joint Medical Physics Licens ureSubco mmi ttee Volun teers

• Max Amu rao• Brad Barh ors t• Tewfik Bic hay• Libb y Brateman• Jay Burmei ster• Jessica B. Clements• William Davros• D. Jay Freedman• David L. Goff• Sam Rhoades• Chuck Wissuchek• Marilyn Wexler• Lee Ann e Zarger

Thank you for your time