r3 PennState Health

House Professional Licensure Committee

Public Hearing - House Bill 1344

February 26, 2018

Good afternoon Chairman Mustio, Chairman Readshaw and members of the House Professional Licensure Committee, my name is Steven King and I am the radiation safety officer (medical health physicist) forthe Penn State Health Milton S. Hershey Medical Center in Hershey, PA. I have worked at the Medical Center since September 1983. I am certified by the American Board of Health Physics for the comprehensive practice of Health Physics and certified by the American Board of Medical Physics as a Diplomate in Medical Health Physics. I am currently a Senior Instructor for Radiology and Director of Health Physics. I am also an Imaging Physicist. Since I have a dual position at the Medical Center I am interested in House Bill 1344, and I appreciate the opportunity to provide further background on the field of medical physicists for the purposes of this legislative proposal. I will not speak about Diagnostic Physics activities as I am not practicing in that area.

Background

Hospitals in the United States must be voluntarily inspected by an accreditation organization on a regular basis to ensure quality health care. The predominant accrediting organization, the Joint Commission, was formed in 1951.

In order for a healthcare organization to receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements including compliance with mandated Conditions of Participation (CoPsl and Conditions for Coverage. The Centers for Medicare & Medicaid services (CMS) has granted "deeming" authority to accreditation organizations, like the Joint Commission, that enforce standards that meet or exceed Medicare's CoPs.

As of July 1, 2015, the Joint Commission issued diagnostic imaging requirements that stipulate what diagnostic imaging equipment must be surveyed and the requirements of performance for that equipment survey. In addition, the Joint Commission defined who can survey that equipment, and the education and board certification requirements of imaging physicists who support these CT scanners and their performance. These definitions are similar to the qualified medical physicist defin itions given by the American Board of Physicists in Medicine (MPM).

Mammography imaging has been regulated by Congress via the Mammography Quality Standards Act and the FDA, which became law on October 27, 1992. Congress enacted MQSA to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. The Act refers to the MQSA as amended by the Mammography Quality Standards Reauthorization Acts of 1998 and 2004 (MQSA).

Congress tasked the FDA with developing and implementing MQSA regulations. Interim regulations issued in December 1993 became effective on October 1, 1994. The FDA began enforcing the accreditation and certification provisions of the Act on that date, and began annual inspections of mammography facilities in January 1995. On October 28, 1997, the FDA issued more comprehensive

final regulations, which became effective on April 28, 1999. Reauthorizations of MQSA came with new requirements, which were incorporated into the regulations. If you are not an FDA approved medical imaging physicist, you may not perform quality control surveys on mammography equipment.

Current Conditions

Currently, Medical Physicist licensing in the United States is limited to four states: New York, Texas, Florida and Hawaii. The rest of the states rely on the current state of physicist requirements through the Joint Commission and MQSA as well as any state regulations. The Pennsylvania Department of Environmental Protection, Bureau of Radiation Protection oversees the safe use of ionizing radiation with radiation workers. Through inspections and testing, the bureau reviews the qualifications of all individuals who survey any machines at a facility or act as a Radiation Safety Officer.

Currently, the medical physics field has set up a variety of subspecialties. The Health Physics Society, the American Association of Physicists in Medicine and the American Board of Medical Physics all support professional membership and each offers professional certification. These societies have set up qualifications for work in the medical field:

• For the Health Physics Society, the American Board of Health Physics provides for an examination, the Certified Health Physicist exam (CHP}, which requires a scientific degree from an accredited college. The ability to qualify for the exam is a combination of degree and years of experience (see prospectus from the American Board of Health Physics). This certification along with the appropriate experience allows the person to qualify with the Nuclear Regulatory Commission (NRC) and thus the Pennsylvania DEP as a Medical Radiation Safety Officer (Medical Health Physicist} . The American Board of Health Physics has established an agreement with the American Board of Medical Physics whereas a CHP qualifies to take the part three oral boards to become a diplomate of the American Board of Medical Physics if the correct job experience is present.

• The American Association of Physicists in Med icine (AAPM) also has defined subspecialties in medical physics. The AAPM has worked with the American Board of Radiology (ABR} to develop a path to certification. You must graduate from an accredited "Commission on Accreditation of Medical Physics Education Programs (CAM PEP)" graduate education program. Additionally, you must complete a CAM PEP accredited two-year residency and then must take and pass the certification exam (three parts). This would qualify you (depending on your education and residency) to be a qualified medical physicist with subfields in Therapeutic Medical Physics, Diagnostic Medical Physics, Nuclear Medical Physics, Medical Health Physics or Magnetic Resonance. ABR certification allows the person to qualify with the Nuclear Regulatory Commission (NRC) and thus the Pennsylvania DEP as a Medical Radiation Safety Officer (Medical Health Physicist). Attached is a listing of the approved residency programs.

• The American Board of Medical Physics also grants certification for Medical Health Physics and Magnetic Resonance Physics through its three part certification process. Physicists must have the proper education and relevant experience to qualify for the exam. Medical Health Physics diplomates coupled with the appropriate experience allows the person to qualify with the Nuclear Regulatory Commission (NRC) and thus the Pennsylvania DEP as a Medical Radiation Safety Officer (Medical Health Physicist).

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Discussion

As can be seen in the preceding paragraphs, there are extensive requirements needed to become a competent and qualified practicing medical physicist. For radiation safety officers (medical health physicists), the NRC dictates the degree, certification, training and experience required before they will accept that person. The Pennsylvania DEP Bureau of Radiation Protection follows the NRC guidelines.

In the case of imaging physicists surveying CT and mammography, there are legal requirements. Losing your hospital accreditation by employing substandard medical physicists can lead to substantial financial implications. State regulators who visit each licensed piece of equipment verify the background and credentials of medical physicists at each facility. Major medical centers and hospitals employ certified, competent physicists or companies that employ certified, competent physicists. Each physicist must also participate in continuing education and have these records available for the various certification organizations to review. In terms of the legislation, House Bill 1344 uses different language than the aforementioned certification groups to define and numerate the experience needed to practice medical physics, which may lead to confusion and further presents the question as to which language has precedence.

Thank you for the opportunity to provide further background on this topic, and I would be happy to provide you with further information or answer any questions for you at this time.

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CAMPEP Accredited Residency Programs in Medical Physics

Entries Last Updated February 5, 2018

* Indicates Institutions that also offer a nuclear medicine physics option

** Indicates Institutions offering a Professional Doctorate in Medical Physics (DMP), Therapy and Diagnostic Physics Tracks

***Indicates residency programs that may be greater than 24 months in duration. Such programs may include a research component. Please consult the websites of the individual programs for details.

t Indicates institutions that are accredited but have been found to be non-compliant with one or more CAMPEP standards. Public disclosure statements can be found at: http://www.campep.org/Publ icDisclosure.asp

:j::j:Provisional accreditation for a period of up to three years may be granted at the discretion of the CAMPEP Board if circumstances preclude awarding of initial or full accreditation. The most common reason for such provisional accreditation is in the case of a residency program that is reviewed for initial award of accreditation before a resident has been enrolled in the program. Such a program requires a site visit once a resident has been enrolled for a period of time. The site visit team can subsequently recommend to the Board that full accreditation be awarded.

Institution

Therapy

Augusta Universitytt

Baylor Scott & White

Banner MD Anderson Cancer Center

Beaumont Health

BC Cancer

CancerCare Manitoba

Cancer Centre of Southeastern Ontario

Cancer lnstitute of New Jersey, Rutgers Robert Wood Johnson Medical School

Central Arkansas Radiation Therapy lnstiLute (CART!)

Cleveland Clinic ***

Cross Cancer Institute - University of Albe11a ***

Initial Accreditation

2016

2009

2017

2017

2011

2009

2014

2010

Duke University Medical Center

Emory University School of Medicine*

Fox Chase Cancer Center***

Geisinger Health System

Genesis Healthcare Partners and Affi1iateU

Grand River Regional Cancer Center

Halifax Radiation Oncology Physics Residency Program

Harvard Medical Physics Residency Program ***

Henry Ford Health System

Houston Methodist Hospital

Indiana University

Johns Hopkins University ***

Karma.nos Cancer Center, Gershenson Radiation Oncology Center

Landauer Medical Physics

London Regional Cancer Program

Loyola University Medical Center

Mary Bird Perkins Cancer Center

Mayo Clinic (AZ)

Mayo Clinic (MN) ***

McGill University

Medical College of Wisconsin***

Medical University of South Carolina

Mem0rial Sloan Kettering

Montefiore Medical Center

National Radiation Oncology Physics Residency Programme (Ireland)

New York Presbyterian Hospital, Columbia University and Cornell University ***

Northern Ontario School of Medicinet:I:

Northwell Health

Northwest Medical Physics Center

Northwestern Memorial Hospital

NYU Langone Medical Center

Ohio State University

Oregon Health and Science University

Provision Healthcare and Erlanger Health System

2009 2012

2013 2010

2016

2017 2014

2011

2011

2017 2014 2011

2010

2013 2006 2017

2012 2013 2003

2000

2010

2011

2010 2010

2009

2013

2016

2014 2010

2012

··2013

2012 2015 2017

Rhode Island Hospital *** Rush University Medical Center***

Scott and White Clinic

Stanford University

Stony Brook University Medical Center++

Texas Oncology

The Ottawa Hospital Cancer Center

Thomas Jefferson University Hospital-Bodine enter for Cancer Treatment

Tom Baker Cancer Centre

University Hospitals-Case Western Reserve University ***

University of Alabama at Binningham

University of Arkansas

University of Arizona

University of California Davis Cancer Center

Uni versity of alifornia - Irvine Medical Ctr

University of California Los Angeles+

University of California - San Diego

University of California at San Francisco

University of Chicago Medical Center

University of Colorado Denver

University of Florida***

University of Florida Health Cancer Center at Orlando Health

University of Iowa

University of Kansas Cancer Center

University of Kentucky Medical Center

University of Louisvi lle School of Medicine

University of Maryland

University of Miami

University of Michigan

University of Minnesota Medical School

University of Nebraska Medical Center

University of Nevada, Las Vegas**

University of No1th Carolina at Chapel Hill

Uni versity of Oklahoma

2014

2009

2009

2007

2009

2014

2007

2008

2005

2013

2013

2012

2016

2012

2008

2013

2010

2009

2004

2013

2000

2006

2007

2009

2011

2003

2015

2014

2009

2000

2008

2017

2012

2012

Universily of Pennsylvania

University of Pittsburgh Cancer Institute and UPMC CancerCenter

University of Texas HSC at San Antonio

University of Texas M.D. Anderson Cancer Center*

University of Texas Southwestern Medical Center

University of Toledo

University of Toronto U University of Virginia ***

University of Washington

University of Wisconsin

Vanderbilt University School of Medicine**

Vassar Brothers Medical Center

Virginia Commonwealth University

Washington University School of Medicine

World Wide Medical Physics

Yale- ew Haven Hospjtal & Yale Medical School

Imaging

Cleveland Clinic

Columbia University

Corwin Health Physics, Inc. :tt Cross Cancer Institute - University of Alberta*

Emorv University * .tt Duke University Medical Center

Henry Ford Health System*

lndiana University School of Medicine

Mayo Clinic***

Medical College of Wisconsin:tt

Memorial Sloan Kettering

Stony Brook University Medical Center * University of Alabama at Birmingham

University of Chicago

University of Florida College of Medicine

University of Oklahoma Health Science Center

University of Texas McGovern Medical School*,U

2009

2016

2010

2006

2009

2017

2008

2010

2014

2004

2010

2012

2007

1997

2017

2014

2017

2013

2017

2005

2014

2016

2009

2017

2010

2017

2016

2009

2016

2014

2013

2016

2017

University of Texas M. D. Anderson Cancer Center*

University of Wisconsin

Upstate Medical Physics

West Physics***

2002

2017

2010

2013