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 Co nditions 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 definitions 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 Physi cs 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 America n Boa rd 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).

2 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.

3 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 Initial Accreditation

Therapy

Augusta Universitytt 2016 Baylor Scott & White 2009 Banner MD Anderson Cancer Center 2017 Beaumont Health 2017 BC Cancer 2011 CancerCare Manitoba 2009 Cancer Centre of Southeastern Ontario 2014 Cancer lnstitute of New Jersey, Rutgers Robert Wood Johnson 2010 Medical School Central Arkansas Radiation Therapy lnstiLute (CART!) Cleveland Clinic *** Cross Cancer Institute - University of Albe11a *** Duke University Medical Center 2009 Emory University School of Medicine* 2012 Fox Chase Cancer Center*** 2013 Geisinger Health System 2010 Genesis Healthcare Partners and Affi1iateU 2016 Grand River Regional Cancer Center 2017 Halifax Radiation Oncology Physics Residency Program 2014 Harvard Medical Physics Residency Program *** 2011 Henry Ford Health System 2011 Houston Methodist Hospital 2017 Indiana University 2014 Johns Hopkins University *** 2011 Karma.nos Cancer Center, Gershenson Radiation Oncology Center 2010 Landauer Medical Physics 2013 London Regional Cancer Program 2006 Loyola University Medical Center 2017 Mary Bird Perkins Cancer Center 2012 Mayo Clinic (AZ) 2013 Mayo Clinic (MN) *** 2003 McGill University 2000 Medical College of Wisconsin*** 2010 Medical University of South Carolina 2011 Mem0rial Sloan Kettering 2010 Montefiore Medical Center 2010 National Radiation Oncology Physics Residency Programme (Ireland) 2009 New York Presbyterian Hospital, Columbia University and Cornell 2013 University *** Northern Ontario School of Medicinet:I: 2016 Northwell Health 2014 Northwest Medical Physics Center 2010 Northwestern Memorial Hospital 2012 NYU Langone Medical Center ··2013 Ohio State University 2012 Oregon Health and Science University 2015 Provision Healthcare and Erlanger Health System 2017 Rhode Island Hospital *** 2014 Rush University Medical Center*** 2009 Scott and White Clinic 2009 Stanford University 2007 Stony Brook University Medical Center++ 2009 Texas Oncology 2014 The Ottawa Hospital Cancer Center 2007 Thomas Jefferson University Hospital-Bodine enter for Cancer 2008 Treatment Tom Baker Cancer Centre 2005 University Hospitals-Case Western Reserve University *** 2013 University of Alabama at Binningham 2013 University of Arkansas 2012 University of Arizona 2016 University of California Davis Cancer Center 2012 Uni versity of alifornia - Irvine Medical Ctr 2008 University of California Los Angeles+ 2013 University of California - San Diego 2010 University of California at San Francisco 2009 University of Chicago Medical Center 2004 University of Colorado Denver 2013 University of Florida*** 2000 University of Florida Health Cancer Center at Orlando Health 2006 University of Iowa 2007 University of Kansas Cancer Center 2009 University of Kentucky Medical Center 2011 University of Louisville School of Medicine 2003 University of Maryland 2015 University of Miami 2014 University of Michigan 2009 University of Minnesota Medical School 2000 University of Nebraska Medical Center 2008 University of Nevada, Las Vegas** 2017 University of No1th Carolina at Chapel Hill 2012 Uni versity of Oklahoma 2012 Universily of Pennsylvania 2009 University of Pittsburgh Cancer Institute and UPMC CancerCenter 2016 University of Texas HSC at San Antonio 2010 University of Texas M.D. Anderson Cancer Center* 2006 University of Texas Southwestern Medical Center 2009 University of Toledo 2017 University of Toronto U 2008 University of Vi rginia *** 2010 University of Washington 2014 University of Wisconsin 2004 Vanderbilt University School of Medicine** 2010 Vassar Brothers Medical Center 2012 Virginia Commonwealth University 2007 Washington University School of Medicine 1997 World Wide Medical Physics 2017 Yale- ew Haven Hospjtal & Yale Medical School 2014 Imaging

Cleveland Clinic 2017 Columbia University 2013 Corwin Health Physics, Inc. :tt 2017 Cross Cancer Institute - University of Alberta* 2005 Emorv University * .tt 2014 Duke University Medical Center 2016 Henry Ford Health System* 2009 lndiana University School of Medicine 2017 Mayo Clinic*** 2010 Medical College of Wisconsin:tt 2017 Memorial Sloan Kettering 2016 Stony Brook University Medical Center * 2009 University of Alabama at Birmingham 2016 University of Chicago 2014 University of Florida College of Medicine 2013 University of Oklahoma Health Science Center 2016 University of Texas McGovern Medical School*,U 2017 University of Texas M. D. Anderson Cancer Center* 2002 University of Wisconsin 2017 Upstate Medical Physics 2010 West Physics*** 2013