WHY ARE WE EVEN TALKING ABOUT THIS?
IN 2014, the president of the National Council on Radiation Protection and Measurements (NCRP), John Boice, launched the “Where are the Radiation Professionals?” initiative, highlighting the abysmal state of the radiation protection profession. Most speakers at the 2016 NCRP annual meeting echoed this refrain, and several presented and discussed aspects of enrollment data for health physicists (HP) gathered and published annually by Oak Ridge Institute for Science Education. It is important to note that other than a short upward blip in enrollments in the 1990s, there has been a fairly consistent and ongoing decline in the number of HP students since recordkeeping began in the 1970s. One could argue that the underlying cause was the shrinking of the nuclear weapons complex as well as the nuclear power industry’s march toward increased efficiency and reliability. Both events reduced the need for health physicists. The declining incidence of severe industrial radiation accidents, with most over-exposures now occurring in medicine, also seemed to buttress the argument that fewer health physicists are needed in the workforce (Coeytaux et al. 2015).
Although concern has been voiced numerous times about the shrinking and greying of the HP profession, there has not been a successful effort to alter the trend. It makes one wonder if there is an underlying presumption that market forces will provide sufficient human capital if a substantial radiation protection need suddenly arises. The unspoken assumption is that if you need them, they will magically appear fully formed from the ether. But this ignores the reality of how HP professionals have been, and currently are, created.
WHERE DO HEALTH PHYSICISTS COME FROM?
First, it is important to recognize that at best, health physics (HP) is a diffuse, ill-defined field. There is no single, agreed upon list of knowledge, skills, and abilities that can be used to define a health physicist. The accrediting body for certified health physicists, the American Board of Health Physics (ABHP), provides domains of practice where an individual must demonstrate competency in order to be certified (ABHP 2016), but academic programs are all over the map in where, what, and how they offer HP curricula. Within the discipline of HP, one could argue there are many different specializations, such as radiation safety, internal dosimetry, radiation biology, radiochemistry, instrumentation, environmental, shielding, standards and more. Additionally, HP has strong ties to many other disciplines, and often HP programs can be found tucked within them. These include physics, chemistry, mathematics, biology, medicine, public health, industrial hygiene, policy, nuclear engineering, chemical engineering, and statistics, just to name a few. Consequently, HP education is often very non-uniform or multidisciplinary. Students can be exposed to some or all of these topics, depending on the program they enter. This can be fortuitous for both the student and the subsequent employer because a student who is broadly educated can move between specializations as the needs of the employer or the job market demand.
Because HP education hasn’t consistently resided in one single academic area, employers have been used to filling in knowledge gaps through mentoring, additional coursework, or added training. Thirty or more years ago, students in an aligned field, such as nuclear engineering or chemical engineering or public health, more easily transitioned into HP if their job required it. The Health Physics Society (HPS) was robust, there were many training opportunities for new health physicists, and importantly there were large cadres of health physicists in industry, government, and academia to serve as mentors and role models. Today the picture is much bleaker. There are far fewer health physicists in all employment sectors, few large “stables” of health physicists exist anymore, and generally companies are loathe to allow employees to attend technical meetings where mentoring, networking, and continued education are offered.
Today, employers faced with a radiation protection need may choose not to, or be unable to, hire an individual that possesses a broad HP education. But the radiation protection need remains. The question then becomes if you have someone with “health physics-enough like” education, can you turn them into a health physicist? Can training fill the need?
WHAT DOES TRAINING ACCOMPLISH?
Training is generally intended to instill specific knowledge and skills within a well-defined framework (Garavan 1997). However, those skills become less relevant and robust the further they are removed from the problem they were originally designed to address and the individual’s core knowledge. Abraham Maslow, the noted psychologist, once stated (Maslow 1966): “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”
Training is like a hammer, good for a lot of situations, but not for everything. Consider the preponderance of rules of thumb used in the HP field—for example, the 6CEN rule used to estimate exposure rates (Shleien et al. 1998). This rule estimates roentgens per hour and only requires four pieces of information: the source activity (in curies), the energy of the gamma, and the fractional number of gammas per disintegration. This is a very useful means to quickly estimate exposure rate, but it’s only good for gamma emitters within a defined energy range. Another example is the “roentgen equals a rad equals a rem.” But this statement, while a reasonably close approximation, is not exact. Someone well educated in HP can appreciate when the approximation is acceptable and when it should not be used.
The point is that training, focused on addressing very specific circumstances, will likely suffice a lot of the time. But a trained individual should never be considered as a substitute for a well-rounded, knowledgeable health physicist. There remains a need for educated health physicists, particularly when something goes wrong and the ability to think outside the confines of training is paramount.
WHAT CAN BE DONE TO ENSURE CONTINUED AVAILABILITY OF HEALTH PHYSICISTS?
As previously noted, there is an obvious decline in the number of individuals with formal education in HP. This decline in and of itself is not necessarily worrisome. In the 100‐plus years since the discovery of x rays, there has been a substantial increase in our understanding of radiation protection and control. We’ve become more efficient at managing workplace safety. Federal research efforts into nuclear weapons production, and the safety concerns that accompany this work, have declined. The nuclear power industry has become streamlined and redundancies eliminated. We can do the work with far fewer people, so the number of HP jobs has declined. However, there remains a fundamental need for some baseline number of health physicists, not just individuals cross-trained in specific aspects of the field. So the question becomes, can the United States (or the world, for that matter) continue to provide health physicists in necessary numbers to address safety issues and emergency response needs?
THE CHANGING ECONOMIC MODEL IN HIGHER EDUCATION
While industry has undergone several fundamental shifts to reduce expenses and enhance productivity, a related, but less visible change has been taking place in academia. State funding for higher education (colleges and universities) has been declining for several years, although the trend seems to show some evidence of leveling off (SHEEO 2016). Many institutions are contemplating the complete loss of state dollars in the next decade. Tuition now represents the major source of revenue for many institutions of higher learning (NSF 2016). Consequently, colleges and universities are taking a very hard look at where they spend their money. New budget models are being tried, and no single method has been adopted for academic institutions across the country. But one thing is certain: Academic programs that are small, or those who do not pay their own way, are at great risk of being closed.
In this new economic environment, higher education is facing resource constraints and competing needs. While state funds are flat or declining, student enrollment (particularly in science, technology, engineering and math fields) has continued to climb. The federal government, in a desire to increase accountability for academic institutions, has requested that academic programs publish (and therefore improve) student retention figures. This means a limited pool of funds has to be stretched to enable more students to complete their degrees. Added to the federal effort, states like Oregon have set specific higher education graduation targets for their populace (Oregon Learns 2011). In an effort to increase the overall education of it citizenry, individuals with limited experience with higher education will be entering academia. First generation students (where they are the first in their family to attend college) and students that are less prepared for the requirements of academia are now part of the student body. Often their learning styles may be different and need to be addressed (Pascarella et al. 2004). Finally, costs for faculty (and staff) continue to increase, putting enormous pressure on governing bodies to increase tuition, but parents and students alike are pushing back against the enormous financial burden they are expected to shoulder in order to attain a degree.
All of this means that deans and university presidents seek to maximize the return (i.e., graduates) from the limited financial resources at their disposal. Popular degrees, which attract the maximum number of students to the institution, are the simplest way to ensure profitability. It also means that productivity of individual programs must continually be assessed and a determination made as to the overall contribution of the program to the mission and strategic goals of the university.
The metrics for evaluating viability of academic programs vary but fundamentally come down to a budgetary argument. For example, the University of North Carolina assessed its programs based on this metric (Saffron 2014): “A bachelor’s program is considered to be ‘low productive’ if 1) it has awarded fewer than 20 degrees in the previous two years; 2) upper division (juniors and seniors) enrollment is less than 26 students; and 3) fewer than 11 degrees have been conferred in the most recent year.” For master’s and doctoral programs, those numbers change, but the focus is still on degrees awarded and enrollment.
Metrics such as these are fundamentally problematic for small niche programs such as HP.
HEALTH PHYSICS PROGRAMS, DEGREES, AND A REALITY CHECK
In 2014 (the most recent year for which data are available), the Oak Ridge Institute for Science and Education tabulated the number of HP graduates (ORISE 2015). There were approximately 13 bachelor’s programs, granting 67 B.S. degrees. The maximum number of students per program was 18. On average, there were five students per HP program at the undergraduate level. Master’s programs were only slightly better. There were 20 reported programs, granting 81 degrees. The largest program had 22 students per program. There were a reported 17 doctoral programs in HP. In 2014, only 10 Ph.D. degrees were granted. Only eight institutions graduated Ph.Ds. (no single institution graduated more than two doctoral students). Only three institutions awarded more than 10 M.S. degrees, and the same was true for B.S. students. With higher education shifting to a return on investment model, HP programs are not financially sustainable. Nearly every one of these programs would run afoul of the productivity metric of the University of North Carolina.
Research funds awarded to HP faculty were equally small. In 2015, the U.S. Department of Energy Integrated University Programs provided $15 M to university faculty. Only $2 M of this money was awarded to HP programs (Kirner 2016). In academic institutions where research is expected, tenure line faculty must teach, do research, and provide service to the university and the profession in exchange for the granting of indefinite tenure. Research expectations for tenured faculty are on the order of $500,000 to $1,000,000 per year. However, federal funding for academic research is becoming much more difficult to obtain (Howard and Laird 2013). Without substantial research prospects, new HP faculty are not likely to receive tenure, and administrators are unlikely to rehire into the same discipline.
WHAT ARE OPTIONS FOR HP PROGRAMS IN ACADEMIA?
Because small programs generally cannot make a financial profitability argument, there are limited numbers of ways to make a case to keep them. Simply put, HP programs need to evolve, collaborate, or perish. Possible ways to keep programs include sharing courses across institutions (including offering joint degrees and pooling curriculum). There currently exist examples of interuniversity doctoral degrees in both New York and Montreal. Because collaborative efforts involve some ceding of institutional autonomy, resistance is expected from faculty and administrators alike (Cole 2016). HP academic programs must, at a minimum, demonstrate that there are jobs for their graduates. Otherwise there is simply no reason for their continued existence.
THE ROLE OF RADIATION PROTECTION SOCIETIES
Professional societies, like HPS, ABHP, and the American Academy of Health Physics, can provide a much needed voice to marshal support for academic programs. While they may choose not to lobby, they can certainly inform regulatory bodies and industry about the need to support HP in academia. HPS can also play an important role in giving necessary feedback to academia on what should constitute core competencies for health physicists. Only a few academic programs are accredited by the Accreditation Board for Engineering and Technology, presumably due to the cost associated with accreditation and the effort necessary to maintain it. HPS may consider offering an alternative route (and a less costly one) for program accreditation or certification.
THE ROLE OF FEDERAL AGENCIES
U.S. federal agencies, such as the Department of Energy, the Nuclear Regulatory Commission, the Environmental Protection Agency, and others, have historically hired a substantial number of health physicists. The U.S. Office of Personnel Management (OPM) has the responsibility for establishing the classification and qualifications of personnel hired by federal agencies. Health physicists are classified under series 1306 (OPM 2016). In the federal system, health physicists are considered “physical scientists” under the OPM job classification. The specifics of a health physicist under the OPM classification are: “Degree: natural science or engineering that included at least 30 semester hours in health physics, engineering, radiological science, chemistry, physics, biology, mathematics, and/or calculus; or Combination of education and experience – courses as shown in above, plus appropriate experience or other education; or certification as a health physicist by the American Board of Health Physics, plus appropriate experience and other education that provided an understanding of sciences applicable to health physics comparable to that described in paragraph A.”
Unlike nuclear engineering classifications and qualifications, HP positions do not require graduation from an accredited program. Instead, the minimum requirement for health physicists requires 30 h of science classes, with HP courses identified as a subset. The unintended consequence of this is the potential for individuals with only a limited education in HP being placed into positions where substantial HP knowledge is required.
Thirty years ago, this would not have been of great concern. Back then, the opportunity for continued education, collaboration, and learning was substantial. Many federal agencies (and national laboratories) had large HP groups where HP neophytes could learn. New hires would be matched with several mentors, who ensured that they had the opportunity to learn in-depth the fundamental aspects of the discipline. Today, health physicists are more like an “army of one,” and there are very modest opportunities for continuing education.
At a minimum, OPM should revise the qualifications for health physicists and place them more in line with the classification of engineering professions. Qualifications should include a minimum number of credit hours in HP, with specific course content such as dosimetry, radiobiology, instrumentation, and shielding being required. Coursework needs to be delivered from an accredited academic program. Additionally, for jobs with substantial radiation safety management or assessment responsibility, advanced HP degrees and or board certification must be mandated.
Finally, federal programs with substantial radiation safety obligations have to carve out funds for academic research and student internships. Establishing mentor opportunities for both staff within federal agencies as well as students and faculty would help ensure a well-educated workforce.
INDUSTRY ROLES AND RESPONSIBILITIES
Employers of health physicists in industry are a diverse group—from small construction firms and biotech startups to the larger nuclear power industry. It is difficult to recommend a single action that applies to all these employers. However, the best recommendation would be to hire health physicists that are best able to address radiation protection needs for both routine and off-normal events within the industry.
One previously substantial employer of health physicists was the nuclear power industry, often represented by the Institute of Nuclear Power Operations (INPO). The mission of INPO is “to promote the highest levels of safety and reliability—to promote excellence—in the operation of commercial nuclear power plants” (INPO 2016). INPO also established performance objectives, criteria, and guidelines for the nuclear power industry. INPO and the greater nuclear industry must require accreditation of their health physicists and support knowledge transfer through internships, partnering with academic institutions, and encouraging HP faculty internship experiences so that it can be reflected back in the classroom. INPO, a long standing supporter of education, must require accreditation of HP professionals in the nuclear industry. Industry in general must do more to support knowledge transfer efforts by teaming with approved academic institutions to provide student internship opportunities and support faculty sabbaticals or cooperative research efforts. Industry is best suited to train and produce the job-specific skills needed for competent health physicists.
Medical institutions, like private industry, need skilled radiation safety professionals to serve as radiation safety officers, x-ray technicians, technologists, and more. The skill set required of these individuals is different than the medical physicists supporting radiation oncology, therapy, and diagnosis; however, budgetary pressures often force a combination of these roles. The medical industry needs to ensure that its health physicists have the necessary knowledge and skills to address the changing radiation exposure situations and equipment in hospital settings.
THE FUTURE OF HEALTH PHYSICS
Without specific and immediate steps, HP as a discipline will be relegated to a subspecialty footnote within other academic programs, if it survives at all. The broad interdisciplinary education that is the hallmark of great health physicists will be lost. While training may help temporarily fill employer needs, it is not sufficient, particularly when “off-normal” events occur. As health physicists, we are the victims of our own successes in minimizing accidents and controlling doses. No one sees the need to have a health physicist on staff.
LEARNING FROM THE PAST
For many decades, people came into HP through other disciplines such as chemistry, nuclear engineering, industrial hygiene and physics, but there used to be a robust HP community where all could share and learn. That community is now severely fragmented. Consequently, the vibrant, after-college learning environment has been decimated. We see similar concerns being raised for radiochemists, nuclear forensics, and even nuclear engineering (Corradini et al. 2000; Carnesdale 2010; Press 2012).
(MIS) INFORMED POLICIES AND STANDARDS
Radiation accidents in the United States are increasingly rare (Ricks et al. 2005). Radiation protection practices have largely been standardized and highly regulated. The limits for radiation protection of personnel have been set so low that even scientific studies of large populations of exposed individuals are unable to observe significant radiation dose effects. This raises the question—do we even need health physicists anymore?
Under routine operations, when everything goes as it should, there is arguably little need for health physicists. The problem is that life is full of unanticipated events, and when these events include radiation accidents, it is essential to have sufficient personnel with the knowledge, skills, and abilities to deal with the problem. Without a critical mass of well-educated radiation protection professionals, the capacity to respond safely to unanticipated events, even on a small scale, is compromised. For example, the alpha contamination event that occurred in 2010 at Bruce Power Nuclear Plant was a consequence of over-reliance on past practices and inadequate radiation protection planning (RSIC 2011). The polonium poisoning of Alexander Litvinenko in 2006 was very nearly undiagnosed and required enormous resources to investigate, protect, and reassure the public (Perkins 2007). The accident at Fukushima Daiichi exposed weaknesses within the U.S. radiological response community (Fitzgerald et al. 2012). The most recent survey by the Association of Public Health Laboratories (APHL) and the Conference of Radiation Control Program Directors indicates that a broad area of the country lacks the ability to rapidly analyze radiological samples (APHL 2015). The U.S. Government Accountability Office (GAO) concluded that gaps in early response abilities warrant federal attention (USGAO 2013). All of these factors point to the need to have HP professionals in the workforce for the foreseeable future.
The recent petitions for rulemaking with the U.S. Nuclear Regulatory Commission requested that the basis of regulations be changed from the linear no-threshold model to one that incorporates radiosensitivity (Hirsch and Fettus 2015; Makhijani 2015). There are several ongoing developments that may impact how standards and radiation protection recommendations are developed, including linear no-threshold, epigenetics and long-term risks, individual human radiosensitivity, high linear-energy transfer radiation in space flight, and detriment. Regulators lacking in-depth knowledge of HP, radiobiology, or epidemiology (or access to individuals with this expertise) risk promulgating rules and regulations that are completely nonsensical and unworkable (not to mention untethered from sound science).
THREE SUGGESTED STEPS
It’s always nice to envision clean and simple ways to solve problems. But as H.L. Mencken once said (Mencken 1982): “Explanations exist; they have existed for all times, for there is always an easy solution to every human problem—neat, plausible, and wrong.”
There are several specific steps that must be taken to keep the HP academic discipline alive. The ABHP in conjunction with HPS must identify minimum curriculum content for HP programs at the graduate and undergraduate levels. Academic institutions should share curricular content to make program delivery more cost effective and to minimize redundancies. This should include establishing joint degrees and academic exchanges to enhance student mentoring and faculty experience. The ABHP must require applicants for board certification (CHP) to have graduated from an approved academic program.
At the federal level, we need to recognize the discipline of HP as meeting a “strategic national need.” The basic requirements for health physicists in OPM’s Classifications and Qualifications System (job series 1306) (USOPM 2016) need to be revised and strengthened. Applicants for federal HP jobs must have a minimum number of credit hours in HP or radiation safety and have graduated from an approved program or hold CHP certification. At the federal and state level, we need to mandate advanced radiation protection degrees and/or CHP certification for jobs with substantial radiation safety management or assessment responsibility. Federal programs with considerable radiation safety obligations must carve out funds for academic research for faculty from approved HP programs. Internship opportunities for undergraduate and graduate HP students must be established and sustained.
INPO, a longstanding supporter of education, must require accreditation of HP professionals in the nuclear industry. Industry in general must do more to support knowledge transfer efforts by teaming with approved academic institutions to provide student internship opportunities and support faculty sabbaticals or cooperative research efforts. Industry is best suited to train and produce the job-specific skills needed for competent health physicists.
Without these very specific steps, HP will be relegated to a subspecialty footnote within other academic programs, if it survives at all. The broad, interdisciplinary education that is the hallmark of a great health physicist will be lost. HP, as an academic discipline and as a profession represents a strategic national need. But it is in peril, and there is no single “silver bullet” that will save it. Multiple actions must be taken, and soon.
The author would like to acknowledge that she has been fortunate to learn from, and work alongside some of the greatest health physicists in modern times. She would like to state her respect and gratitude to Ron Kathren, Jack Corley, Joe Soldat, Gene Schreckhise, and Ward Whicker for their guidance and wisdom over the years. Her colleagues, including Bruce Napier, Bill Kennedy, Dan Strom, and John Boice, have been an incredible source of insight and advice. Finally, she would like to acknowledge that there are many, many HP professionals who are not named but who have contributed to her growth and education as an HP.