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Warren K. Sinclair Keynote Address

Thirteenth Annual Warren K. Sinclair Keynote Address

Where Are the Radiation Professionals (WARP)?

Toohey, Richard E.

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doi: 10.1097/HP.0000000000000611
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Abstract

INTRODUCTION

WORRIES ABOUT an inadequate supply of radiation professionals to meet current and anticipated needs are not new. In the area of health physics alone, 40 y ago, Moeller and Eliasen (1976) predicted a 50% shortfall in the number of health physics graduates that would be needed in the next 5 y. Twelve years later, Mossman and Poston (1988) noted that the U.S. Department of Energy (DOE) “reports current shortages of professional health physicists in the civilian nuclear industry and predicts a high potential for shortages during the next 15 years.” Thirteen years after that, the Health Physics Society (HPS 2001) issued Position Statement 15, “Human Capital Crisis in Radiation Safety,” which noted: “It is clear to the radiation safety community that the current imbalance between supply and demand will significantly worsen in the near term, after which it will soon become untenable.” A few years later, HPS Human Capital Task Force chair Kevin Nelson (2004) reported that a crisis can occur when any of the “four R’s” (recruiting, resources, retention, and retirement) are neglected,. Despite 40 y of awareness of this issue, it seems that all four “R’s” have not only been neglected but have fallen on very hard times. Meanwhile, the use of ionizing radiation has increased tremendously in medicine, and a concomitant increase in the number of procedures involving radiation has followed the increase in the consumption of medical care by an aging U.S. population.

As a Congressionally chartered institution to advise the U.S. government on radiological issues, the National Council on Radiation Protection and Measurements (NCRP) took note of this situation and convened a workshop featuring representatives from government (both state and federal), academia, professional organizations, and the private sector to discuss causes, effects, and potential solutions for the looming shortage of radiation professionals. The results of the workshop and NCRP Statement No. 12 summarizing the workshop and its recommendations were published by NCRP (2013, 2015). In addition, NCRP has established Council Committee 2 (CC 2) to monitor the situation, update recommendations, and increase awareness among all stakeholders of the effects that a shortage of radiation professionals would have on industry, medicine, national defense, and particularly radiological emergency response.

ACADEMIC PROGRAMS

With the dawn of the atomic age, the U.S. government sponsored a number of training programs to produce the needed cadre of radiation professionals (Ziemer 1996). The U.S. Atomic Energy Commission (AEC) began a graduate fellowship program in 1948 with 20 students selected by the National Research Council, half of whom studied at the University of Rochester and half at Oak Ridge National Laboratory. In 1949, the Oak Ridge Institute for Nuclear Studies (later renamed Oak Ridge Associated Universities) assumed management of the program and expanded it to 18 universities; between 1950 and 1973, 940 trainees completed the program. The U.S. Public Health Service managed a similar training program in radiation health from 1961–1972, incorporating 35 universities and producing approximately 1,800 trainees. In 1974, the AEC fellowship program was assumed by the Energy Research and Development Administration, and then in 1978 by DOE. Federal support dwindled, and in the 1980s, only a few (about five) students per year were supported. In 1990, DOE’s Office of Environment, Safety and Health began their applied health physics fellowship program at 17 universities and supported about 20 masters’ students annually, and in 1990, the U.S. Nuclear Regulatory Commission (NRC) began its graduate fellowship program, supporting a few students annually and entailing a service obligation.

Currently there are only 22 academic health physics programs in the United States, and of these, 12 programs graduate six or fewer students per year (ORISE 2015). Unfortunately, the smaller programs are seen as loss leaders by administration, and in many cases, programs that cannot support themselves from tuition and research funding are marked for elimination. State funding for universities has decreased markedly, resulting in tuition increases that are near or already past what the market will bear. Enrollments have been on a generally downward trend since 2007, and the number of bachelor’s degrees awarded in 2014 was 73% of those awarded in the mid-1990s and only 46% of those awarded in the peak years of the 1970s. Similar trends, although not as pronounced, are seen in graduate degrees awarded. This trend continued in 2015, when the number of bachelor’s degrees awarded fell by 27% from the previous year; the number of master’s degrees increased slightly but was still below the 2013 level, while the number of doctorates increased from 10 in 2014 to 18 in 2015. Perhaps the most concerning data are that 2015 undergraduate enrollment is the lowest number reported since 2002 (ORISE 2016).

In addition to declining student enrollment, many faculty members are in the cohort approaching retirement and so must be replaced to train future radiation professionals. There are two requirements for replacing these faculty members: they must have students to teach, and they must have extramural research support. Obviously faculty who retire from small programs that graduate just a few students annually are not likely to be replaced, and so declining student populations and faculty retirements form a synergistic death spiral for many small radiation-related academic programs. The history of enrollments that the Oak Ridge Institute for Science and Education (ORISE) maintains, when compared with the history of federal support programs, demonstrates that if you pay them, they will come. However, student support by itself is not enough to sustain a healthy program. Faculty are judged on the classic trio of teaching, research, and service; excellent teachers who cannot bring in research support for themselves and their students have little chance of gaining tenure. Consequently, federal research support is vital to maintaining academic programs capable of providing enough graduates to meet future national needs. Unfortunately, research funding in the fundamental radiological sciences, such as radiation biology, has decreased even as the need for answers to questions such as the health risks of radiation exposure at low doses and dose rates remains extremely important for societal acceptance of nuclear technologies, including diagnostic and therapeutic medical applications. As an example, funding for the DOE low-dose radiation research program was diverted to other programs a few years ago, and although a bill restoring funding was passed by the House of Representatives (USHR 2015), as of this writing, it still awaits approval in the Senate and will likely die with the end of the 114th Congress.

It must be noted that all radiological disciplines are affected by the same demographic and economic forces described above for health physics, as reported by the National Academies/National Research Council (NA/NRC 2012).

GOVERNMENT PROGRAMS

The federal government employs radiation professionals in a variety of roles in addition to the regulatory arena (U.S. Nuclear Regulatory Commission, U.S. Environmental Protection Agency, and U.S. Food and Drug Administration, to name a few). The military assigns radiation professionals and technicians to nuclear propulsion and nuclear weapons programs and to military hospitals; all military personnel rotate through different assignments in their careers. The U.S. Departments of Energy, Veterans’ Affairs, Health and Human Services, Agriculture, Homeland Security, and essentially every other agency employ radiation professionals in their hospitals, laboratories, and emergency response groups. The problem is, these employees are beginning a mass exodus. The U.S. Government Accountability Office (USGAO 2014) has estimated that 31% of the federal workforce will be able to retire by September 2017, and in the engineering and professional job categories, 41% will be able to retire by then.

State governments also employ radiation professionals in their radiation control programs, and the Conference of Radiation Control Program Directors predicts that over half of their technical staff will need to be replaced in the next 10 y (NCRP 2013). Even if an adequate supply of new graduates were available, it would take years for them to be able to perform at the level of the senior professionals they replace. In addition, the increasing use of radiation in medicine increases the workload of state regulators, as they license the use of radiation-producing machines, and also byproduct materials if they are Agreement States designated by NRC.

In some cases, federal and state employees may retire one day, and the next day they resume the same work as contract, rather than government, employees. Unfortunately, in many cases, including regulatory enforcement and emergency response, certain functions are required by law to be performed by government employees, and so contractors cannot replace retirees in these circumstances.

One specific scenario in which the potential shortfall of radiation professionals in government programs could have disastrous consequences for the United States is a major nuclear power plant accident or radiological terrorism attack on U.S. soil. In a paper presented at the 2012 NCRP meeting, Dr. Charles W. Miller (2013) described the perspective of the Radiation Studies Branch of the Centers for Disease Control and Prevention regarding the Fukushima Dai-Ichi nuclear power plant accident (Whitcomb et al. 2015). Gaps in the U.S. public health preparedness for a large-scale radiological emergency include insufficient equipment and personnel resources for population contamination monitoring; limited public health, medical expertise, and treatment capacity; an insufficient number of radiation health experts; inadequate public health communications regarding emergency preparedness, health effects, resilience and response actions; non-uniform national and international exposure standards, radiation measurements and units, and protective action guides; limited and complex access to radiation emergency monitoring data; and a need to revisit stockpiling potassium iodide in the Strategic National Stockpile. Although some progress has been made in the meantime, shortages of trained, experienced personnel to perform these functions have increased and will continue to do so without definitive and effective government actions.

PROFESSIONAL SOCIETIES

It has been said that professional societies today are an 18th-century model trying to recruit the “millennial generation” of recent graduates. We go to meetings, sit and listen to oral presentations, have a banquet, and enjoy the company of long-term friends. Although many students join as student members (at reduced dues levels), upon graduation they do not become full members of the society, failing to see any advantages to membership. Why travel to listen to papers when one can find everything one wishes to know online? Why travel to see friends when one can interact with them via social media? Why receive hard copies of professional journals that occupy shelf space and collect dust? Despite years of effort, many professional societies have not worked out answers to these questions and feel the issue quite acutely in their membership statistics (NCRP 2013). For example, HPS currently has about 4,200 members, about 64% of its membership in 1995. For the plenary members, the trend is even worse, falling from over 4,600 in 1995 to 2,140 in 2015, a decline of over 50%. If this trend continues, and there is no reason to expect that it will not, by the time this paper is published, professional health physicists will be a minority in their own professional society. A similar trend has been observed in the Radiation Research Society, whose professional membership has decreased by 27% in the 10 y spanning 2003–2012.

THE PRIVATE SECTOR

As mentioned above, many retirees leave one job when they reach the traditional retirement age, but they do not stop working completely. Many join consulting firms, work as independent consultants/contractors, or take part-time work; relatively few leave both their job and their profession simultaneously. Some opportunities may even be available that were not possible before retirement, such as litigation support, as retirement removes potential conflicts of interest. Consequently, the supply of radiation professionals available in the private sector currently appears adequate in the short term (5–10 y) but may not be so in the longer term (10–20 y).

Similarly, in the medical sector the supply of radiation professionals is currently adequate to meet short-term needs, but again it may not be so in the future. At the WARP Workshop (NCRP 2013), the American Society for Radiation Oncology estimated that by 2020, the number of patients receiving radiation therapy will increase by 22% over the 2010 level, while the number of radiation oncologists will increase by only 2%. The American Association of Physicists in Medicine expressed concern that although the training, experience, and credentialing requirements for a Qualified Medical Physicist have been defined and include board certification by the American Board of Radiology, there may be an inadequate number of clinical training opportunities available to meet anticipated needs.

The nuclear power industry has taken concrete steps to meet its staffing needs by supporting academic educational programs, establishing a nuclear uniform curriculum program, and using the military-to-civilian pipeline (NEI 2016). However, much of this effort is focused on 2–4 y programs for technicians.

RECOMMENDATIONS

A number of concrete recommendations emerged from the WARP Workshop to help alleviate the projected shortage of radiation professionals, but all require funding to implement, and due to the nationwide and international aspects of this situation, the federal government must take the lead in preventing this impending crisis. The federal government has already expressed its concern that science, technology, engineering, and mathematics (STEM) education programs at all grade levels are essential to future economic growth (NA/NRC 2011). The radiological sciences need to receive special emphasis in STEM support efforts; university programs must be enlarged, and adequate support for both students and faculty research must be restored and increased. The importance of public support for radiation research has already been explicitly emphasized in the Low-Dose Radiation Research Act of 2015 (USHR 2015).

An existing program that must be continued is the Integrated University Program education grants managed by NRC. This program provides scholarships, fellowships, faculty development, and research grants in nuclear science, engineering, technology, and related disciplines such as radiochemistry, health physics, seismology, and probabilistic risk analysis (USNRC 2015).

Academic education is not sufficient in and of itself to qualify radiation professionals. Consequently, support must also be provided for post-doctoral appointments, traineeships, practicums, and internships in both government and industry for students and recent graduates. A notable example of such a program is the National Nuclear Security Administration’s (NNSA) Stewardship Science academic program, which shares research initiatives and provides networking, collaboration, and community among students, faculty, NNSA laboratories, and the scientific community (NNSA 2016).

The federal government should also establish a joint program support office for federal radiation professionals in the Office of Personnel Management to increase awareness and centralize career management. This office can monitor and coordinate staffing needs and enhance interagency collaboration. This concept is not radically different from the past and current assignment of commissioned radiation health officers in the Public Health Service to agencies such as the U.S. Food and Drug Administration and the U.S. Environmental Protection Agency.

This issue is not limited to the United States. The Nuclear Energy Agency of the European Organization for Economic Co-Operation and Development has published a report (NEA 2012) that reached similar conclusions to the WARP initiative. A summary paragraph is reproduced here:

“Coherent intervention by governments, industry, universities and research and development organizations thus remains vital to avert the risk of human resource shortages in some countries and to maintain the stock of skilled and competent workers. It is also necessary in order to ensure a flow of new recruits which is sustainable in the long term and adequate, in particular, to offset impending retirements.”

NCRP will continue to monitor the situation, advocate for support, and advise the government on this specific issue in the radiation disciplines, and it has established CC 2 to perform these tasks. One essential task for CC 2 will be to collect and maintain current data on the need for radiation professionals in all disciplines across all employment sectors, so that government funding decisions can be based on hard data rather than anecdotal evidence. Failure to ensure an adequate and competent workforce will render all other aspects of the radiological sciences moot; there will be no one to accomplish them.

CONCLUSION

Some may feel that the need for radiation professionals is exaggerated. The Fukushima Dai-Ichi accident brought the so-called “nuclear renaissance” to a screeching halt (at least in the United States), exacerbated by rapidly falling fossil fuel prices. However, even if all nuclear plants and weapons facilities were closed, radiation professionals would still be needed for decontamination and decommissioning work. In fact, such work often proves more hazardous than normal operations. The presence of naturally occurring radioactive materials in water and other wastes from shale oil production may have surprised some, but the issue was identified along the U.S. Gulf Coast in the 1970s. Radioactive waste and spent fuel still must be disposed of somewhere, with adequate numbers of competent radiation personnel to monitor operations and environmental impacts. Industrial technologies such as sterilization, cross-link polymerization, and radiography require radiation professionals for their safe employment. National defense requirements for radiation professionals continue to increase for propulsion systems and stockpile stewardship. In case of a major radiological incident, the surge capacity of radiation professionals needed to monitor, decontaminate, treat victims, advise decision makers, and assess consequences is currently unavailable; the Medical Reserve Corps is a good start, but it is locally based, and with widespread contamination will not be available for deployment to the most highly impacted areas. Even if all of the above uses of radiation were to suddenly disappear, the future needs for radiation professionals in medicine alone fully justify the WARP initiative. The time to act is now.

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Keywords:

National Council on Radiation Protection and Measurements; education; radiation protection; safety standards

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