Although the Canadian province of Ontario has sufficient radiation therapy facilities to meet patient demand, only a third of Ontarians who need this therapy are able to start it within 4 weeks of referral.
The chief reason for this bottleneck is a shortage of techniciansor radiation therapists as they are called in the U.S. and Canadawho staff the machines. According to Tom McGowan, M.D., of Cancer Care Ontario (the provincial governments umbrella agency for cancer treatment), Ontario is experiencing rapid population growth. That growthalong with rising numbers of elderly has contributed to the shortage by increasing the demand for radiotherapy by about 4% a year. But he termed "a change in educational policy" the immediate precipitating cause.
Until recently, Ontario trained its technicians through vocational training in diploma programs at cancer treatment centers. But McGowan, radiation treatment coordinator for his agency, explained that Ontario has been phasing out its diploma programs and replacing them with an academically more rigorous 3-year bachelor-level program to match training in other parts of the world. (The rest of Canadas provinces are expected to follow suit.)
The program, a joint venture of the University of Toronto and the Michener Institute, also in Toronto, will not graduate its first group of baccalaureates until May 2002, so the production line has slowed to a trickle. Where it was usual to have about 50 people a year enter diploma-level training, only 20 did so in 1996 and none have since.
New Recruits
Still, Ontarians needing radiotherapy are not entirely high and dry. For one thing, Cancer Care Ontario succeeded in recruiting 39 new technicians last year, bringing its total to about 400. An advertising campaign aimed at technicians in England, Australia, and New Zealand as well as Hong Kong, South Africa, Singapore, and other former British possessions helped the recruitment.
Also, breast and prostate cancer patients who face long waits for radiation can opt for out-of-town treatment, and about half do. For the most part, McGowan reported, this has meant that patients from southern Ontario get their radiation therapy at a northern Ontario cancer center, but there are, in addition, some being sent across the border to the United States.
To date, such patients are a distinct minority. Between April 1, 1999, and the end of September some 12,000 Ontarians received radiation therapy in the province and about 400 at such places as the Buffalo (N.Y.) General Hospital or the Cleveland Clinic in Ohio.
The trip to the United States generally involves 5-days-a-week treatment for 6 or 7 weeks, and rings up a bill that can total $15,000 (about $21,000 Canadian). Some of that, typically $2,500-$3,500 U.S., goes for travel and outpatient accommodation (lodging and meals), all of it paid for by the Ontario government. "It is a principle of the Canadian system," said McGowan, "that travel be no financial barrier to care."
Other provinces health plans including Albertas, Quebecs, and Manitobas have been considering or actually sending some radiation candidates to the United States for treatment because of similar technician shortages.
In addition, some Canadian patients turn to companies like the Free Trade Medical Network Inc. to avoid treatment delays. This Toronto firm negotiates discounted rates with U.S. providers that have excess capacity and makes its profit by charging patients, their private insurers (if any) or both a percentage of the savings thus realized. (All Canadians have publicly financed health insurance, but many also have private supplemental coverage either individually or in connection with their jobs.) Though the Free Trade Medical Network is not solely for cancer patients, Doug Hitchlock, its president, explained that they figure prominently in its clientele.
The United States may soon have its own radiation therapist shortage, making these various U.S.-Canadian arrangements short-lived. The American Society of Radiologic Technologists (the occupations professional organization) reports, for example, that there are already urban areas where openings for therapists are hard to fill. Moreover, James Cassady, M.D., of the Lahey Clinic Medical Center in Burlington, Mass. he heads the manpower committee of the American Society for Therapeutic Radiology and Oncology sees signs of worse to come, the more so because radiation therapy is warranted for about half of all cancers.
One sign, he said, is that between 1994 and 1998 the number of radiation therapist training programs in the United States dropped from 125 to 84, chiefly because of declining enrollments. The result is that there are now fewer than 400 new radiation therapists a year down from a typical 1,100. Moreover, he predicts that a third or so of the current radiation therapists will be gone in 5 to 10 years because people in this occupationmost of them womentend to retire in their fifties.
One reason for declining U.S. enrollment is that the profession is not desirable from an economic standpoint, Cassady continued. "Most hospital employees havent had raises in 3 or 4 years and probably the top salary that a radiation therapist could earnand that only with a bachelors degree and after 20 yearswould be about $50,000," he said. "Kids coming out of college or even high school can go straight into the computer industry and, on average, fare much better. And they are doing just that."
It used to be, Cassady recalled, that a radiation therapist could, after starting in a staff position, become a chief therapist and go on from there into a post in hospital administration. But with the pressures of managed care and hospital administration jobs now going to those with business and management degrees, he said, that upward career path has disappeared.
Meanwhile, confident that Ontarios radiation therapist shortage will further ease as the baccalaureate program gathers steam, Cancer Care Ontarios McGowan and his colleagues are gearing up for what they expect to be next: a need for more medical physicists early in the new millennium and one for more radiation oncologists soon after that.
"Theres a close relationship between the number of therapists you have and the number of physicists and oncologists that should be available to work with them," he said. "The two cannot be divorced. Given the near certainty that Ontarios population will continue to grow rapidly, and that that, in turn, will increase the cancer incidence, wed be foolish not to be starting to make provisions for that eventuality now."
|
![]() |
||||
|
Oxford University Press Privacy Policy and Legal Statement |