Introduction by Croakey: Workforce pressures amid a global shortage in medical radiation sciences were among big issues discussed at the recent Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference in Sydney.
In the final #ASMIRT2023 article for Croakey’s Conference News Service, Marie McInerney reports on those concerns, amid reports that many people want to leave the profession, particularly in Victoria where pay rates are much lower than jurisdictions like Queensland.
This long-read also wraps a number of presentations, looking at the need for better care for autistic and older people, for remote cancer patients, and to recruit more Aboriginal and Torres Strait Islander people into the medical radiation sciences.
Bookmark our coverage of #ASMIRT2023 here.
Marie McInerney writes:
Workforce shortages in the medical radiation sciences in Australia and globally have put the profession in a “state of stress” which risks further depleting numbers and is pitting jurisdictions against each other, clinical and union leaders in the sector have recently reported.
Delegates at the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) Conference heard that an existing global shortage of radiation therapists and nuclear medical technologists had been exacerbated by the COVID-19 pandemic, which brought additional stress and moral injury and disrupted student placements and capability.
The concerns have been underscored by a recent survey of 319 radiation therapists (RTs) in Victoria, where government wage ceilings have been particularly tough compared to other states and territories, only lifted last month to three percent from a 1.5 percent cap.
The survey, conducted by the Victorian Allied Health Professionals Association (VAHPA) and released to Croakey, revealed that more than 60 percent of the RTs surveyed wanted at least a 50 percent pay rise, and barely any (3.2 percent) felt their wages and entitlements reflected their roles and responsibilities compared to other health professions.
Worryingly, between 50 and 60 percent of 258 RTs reported having considered leaving the public healthcare sector, leaving the state to work elsewhere, and/or leaving the profession entirely.
“These are big numbers,” said John Ryan, Assistant Secretary of the Victorian Allied Health Professionals Association (VAHPA). Victorian public sector employers and the State Government would have to act early to address the issue, he added.
“They can’t say ‘wait till the next EBA’ (enterprise bargaining agreement), which is not until 2026,” he told Croakey.
Ryan pointed to much higher levels of renumeration in other states, particularly in Queensland which last week announced further incentives for interstate and overseas medical practitioners to move there.
He said that a base grade radiation therapist in Queensland currently receives $145,130 a year (wages plus allowances) compared with $84,984 in Victoria, a difference of around $60,000. A similar difference applies to the earnings of the higher level charge radiation therapists in Queensland vs Victoria, he said.
“We’re seeing from the survey that people are thinking of getting out now,” Ryan said of the Victorian sector, warning that the state will struggle to attract others from interstate and internationally to “fill the void”.
Among comments in the survey from respondents were concerns at the disparity in Victorian pay rates particularly with Queensland, saying it was unfair there was not a national rate.
“I know that the majority of long-term staff at my centre are considering leaving the profession. Myself included,” said one participant.
ASMIRT president Carolyn Heyes, who is a paediatric radiographer at The Royal Children’s Hospital in Melbourne, said she was “not at all” surprised by the survey results, characterising the medical radiation sciences in Australia as being “in a state of stress” due to continual shortages.
“People are stretched,” she said, talking about one major service, which she could not identify, that currently had 20 vacancies in a team of 60.
Shortages meant people were having to work to capacity at all time. “You don’t get any downtime, because patients don’t stop getting sick because you’ve got someone missing,” she told Croakey.
This also disrupts efforts to advance careers or skills, she said, including contributing to the need for more medical radiation sciences research, also a focus of the conference.
Heyes said ASMIRT has met with universities to try to boost graduate numbers, with numbers down last year to 647 from 1,100 ten years ago. The universities reported that courses were now fuller but are struggling to set up enough student placements, she said.
“If you’re 20 staff down, you don’t have the people to supervise (students),” she said. “It’s a vicious circle.”
The extent of that problem was highlighted in a presentation at the conference on the ongoing impact of COVID-19 on the clinical education of Australian medical radiation science students, which reported on a national survey last year of 55 clinical educators in medical imaging and radiation therapy.
The respondents reported that 65 percent of first year students and 61 percent of second year students had lost more than a quarter of their clinical placements during COVID. Nearly one in six educators (58 percent) reported that their students were “underprepared to enter the workforce”.
In an earlier article, Professor Geoff Currie, Professor in Nuclear Medicine at Charles Sturt University in Wagga Wagga, told Croakey there was also a “chronic shortage” of nuclear medicine technologists/scientists in Australia.
“We are graduating across the country less than half the number of students annually than required to fill job vacancies,” he said, adding there has been a push to bring people out of retirement or recruit internationally to fill local “voids”.
Global workforce issues
Dr Christina Malamateniou, Director of Postgraduate Radiography program at City, University of London, Chair of the AI Advisory Group, Society and College of Radiographers, told the conference that workforce issues were a major problem in Europe.
Describing medical radiation sciences as “the eyes of medicine”, she said it is a new profession with increasing complexity of patients and technology, where occupational burnout had been accentuated by COVID-19, leading to “moral injury” where practitioners were often forced to perform their roles in ways that were “against our nature and values”.
“We are seeing many people exiting the profession in Europe, seeing many bright minds leave, which is really a threat,” she told the conference. “There is low staff morale, low job satisfaction and this ultimately impacts on patient experience,” she said, also referring to it being “a vicious circle”.
Also during COVID-10, many radiography clinical researchers and academics chose to return to full-time clinical roles to support the frontline workforce, Malamateniou has written, with colleagues.
Many research projects were terminated due to COVID-19-related data collection or funding restrictions, they said, adding that the only type of research that was prioritised and funded during the peak of the pandemic was COVID-19 related.
“For the remainder of the projects, timelines were largely disrupted, the process of recruiting participants became more challenging and, in many cases, resulted in less representative samples,” they said, though adding researchers often found innovative and creative ways to continue their work.
See also this Twitter thread on workforce issues from the conference.
Building cultural safety
Researchers hope that early lessons from a mentoring project in New South Wales seeking to build greater numbers of Aboriginal and Torres Strait Islander nurses and midwives in a rural area will be taken up in other health regions and by other health disciplines, #ASMIRT2023 was told.
Angela Damm, a Ngunnawal woman and clinical nurse specialist at Murrumbidgee Local Health District (MLHD), and Dr Jessica Biles, a senior lecturer in nursing at Charles Sturt University, spoke to the conference about the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) program. (Damm is the co-lead of the project and Biles is co-Chief Investigator).
They told the conference Aboriginal and Torres Strait Islander nurses and midwives were fundamental to providing culturally safe care but that nationally they make up only 2.1 percent of the nursing and midwifery workforce versus the target of 4.5 percent based on population parity.
The DANMM research cites several reasons why Aboriginal and Torres Strait Islander people don’t enter nursing and midwifery, including lack of cultural safety within tertiary education organisations and health services, limited access to tertiary education centres, conflicting obligations to family and community and financial barriers.
These systemic barriers then continue to manifest in the workplace leading to low retention rates, according to Damm and Biles.
They told the conference that the program showed that mentoring can be an avenue for providing appropriate clinical and cultural support and a safe space for Aboriginal and Torres Strait Islander nurses and midwives, and can also be a “catalyst for organisational cultural change”.
Damm said she would have benefited from such a program in her earlier days in nursing in response to racism in the workplace, “the elephant in the room”, where she would feel unsupported and not able to talk about the impact.
The DANMM pilot was founded on work by the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and has now evolved to an online program.
The research is premised on the Ngaa-bi-nya evaluation framework developed by Wiradjuri academic Professor Megan Williams, Damm told Croakey. Half of the research team identifies as Aboriginal and the project has already employed four Aboriginal nurses, she said.
Terms of Reference for the program were co-created with local Elders to ensure the research benefited both Aboriginal nurses and midwives within the MLHD footprint and community members more widely. Meetings were held at each key stage of the research, such as ethics approval and data analysis to ensure feedback from Elders could be applied.
Damm and Biles were invited to present at #ASMIRT2023 because Aboriginal and Torres Strait Islander people were also under-represented across all of the medical radiation science professions, conference convenor Johnathan Hewis told Croakey.
The mentoring project is a “novel workforce intervention that tries to address this critical issue” and was “potentially transferrable” to medical radiation sciences, he said.
Damm told Croakey that each discipline needs to consider its own unique needs, however she also believed some of the projects early lessons could apply more broadly.
Biles encouraged non-Indigenous health professionals, like herself, to “be brave”, to “sit in the discomfort” of exploring cultural safety, to investigate their own biases, and to “listen and learn”.
They have invited any services or professionals working in the Sydney, Western Sydney, Mid-North Coast, Western NSW and Murrumbidgee LHDs that want to be part of the project to email NSWH-DANMMproject@health.nsw.gov.au for further information.
When emergency responses fail
The tragic death of a Melbourne woman who had an allergic reaction to the contrast dye used during a CT scan and died from multiple organ failure in May 2019 has raised big questions about healthcare operations that put “profits over patients”.
The coronial inquest into Peta Hickey’s death – its findings were delivered in November 2021 – will also have “profound ramifications for all medical radiation science practitioners”, particularly around radiographers’ scope of practice, former ASMIRT president Alan Malbon told the conference.
Malbon, formerly Chief Medical Imaging Technologist at St Vincent’s Hospital in Melbourne, is leading ASMIRT’s response to the coronial inquiry. It has formed a Working Group, which held its first meeting in February and will survey Australian/New Zealand medical radiation practitioners about their priorities (see slide below).
The Victorian Coroner found two main issues arose from Peta Hickey’s death: whether she should have undergone the scan at all and whether staff at the clinic she attended should have been able to better manage her anaphylactic reaction to prevent her death.
The case and inquiry raise scope of practice issues for radiographers, who are not permitted to administer or required to act under the direction of radiologists in the administering of scheduled medicines, Malbon told Croakey.
But what happens, he said, if a radiologist is not on site, or cannot/does not make that direction?
“In those times the radiographer needs to be ‘able’ to inject IM adrenaline,” Malbon said, noting that teachers are trained to do so for their students who experience reactions to nuts and egg compounds as an example, with training and administration of IM adrenaline done under strict educational departmental protocols.
“Teachers are not trained allied health practitioners, and the legislation in state and territory Scheduled Medicines Acts do not mention them as a specific group being able to perform this function. The key question then is why can’t radiographers do so?” Malbon said.
Trauma informed care critical, particularly for children
The need for trauma informed care in radiography, particularly for at risk children – those who are being abused and those living in out-of-home care – was raised in a number of presentations.
Edel Doyle is a radiographer who is currently enrolled in a PhD at Monash University investigating if one low-dose CT can replace the Skeletal Survey X-ray series in the detection of non-accidental injury or suspected physical abuse in children.
Asked what led her to the research, Doyle told Croakey: “X-raying young children and feeling like I was adding to their trauma.”
Doyle said many children who need to be examined for abuse are under three years, so are not able to hold themselves in position for the 28 X-rays involved in detecting non-accidental injury.
“It might even be their abuser that we are asking to help hold them in position while we take the X-rays,” she said of the trauma involved.
“So if we can replace those 28 X-rays, which can take us 1-2 hours, with one CT scan that will take less than five minutes, it’s a lot less traumatic for the child.”
Doyle said having trained forensic radiographers is also important in relieving trauma for children in such circumstances, many of whom are being screened for legal rather than medical reasons.
They need to understand the law and where their images fit in the chain of evidence, “because the last thing we want is for our images to be inadmissible in court and the child gets put back into an unsafe environment”.
“But you also need to be a good paediatric radiographer, in order to get the child to cooperate as much as you can, so that it’s less stressful for them,” she said.
See this Twitter thread on Doyle’s presentation on non-accidental injuries and another that includes her work as the Disaster Victim Identification Coordinator for the Aust/NZ branch of International Association of Forensic Radiographers, as well as presentations on scope of practice issues for radiation therapists.
See also, via this Twitter thread, the work of Hunter New England Health radiographer Gary Denham on how modern neuroimaging is revealing the effects of childhood maltreatment, and his call, with wife Sharon Denham, a social worker, on the need for medical radiation practitioners to provide trauma-informed care to young people in out of home care.
Many patients at greater risk
Continuing a focus across the conference on patient centred care, the conference also heard calls for better experiences for patients who are elderly, particularly those with dementia, as well as for autistic people, those from CALD backgrounds, and for greater access to cancer care in remote areas.
Providing better care for older people in a rapidly ageing population, and particularly those with dementia, is a “huge challenge” for medical radiation science professionals, according to Dr Lucinda Morris, a consultant radiation oncologist at St George and The Sutherland Hospital in Sydney.
Morris, who is a Scientific Committee Member of the International Society of Geriatric Oncology (SIOG), told Croakey that older adults are a very diverse and growing patient group with unique needs and significant variability in terms of frailty, comorbidities, cognition, personal preferences and carer support.
Morris highlighted the unique needs for older patients with dementia in medical radiation environments, where the “unfamiliar, often loud, bustling radiation therapy or radiology department and multiple interactions with various staff can present a significant sensory challenge to a person with dementia, causing distress, disorientation, and delirium.”
She said it is the responsibility of the workforce to minimise these factors wherever practically possible, but there currently is very little training or education available. That makes for a real need, globally, to develop role-specific, tailored training for clinical medical radiation staff on caring for people with dementia.
Morris is also the founding Chair of Targeting Cancer, an internationally recognised public awareness campaign which aims to raise the profile of radiation therapy in the community and to increase patient access to radiation therapy globally. She addressed #ASMIRT2023 on leadership: see our Twitter thread which includes her address.
Professor Christina Malamateniou raised similar issues in radiotherapy for autistic people in a presentation on work that is pioneering an autism-friendly MRI scan.
She described her involvement in the work as “an act of peaceful, evidence-based activism”, to provide healthcare equity and inclusion for medical imaging and to help put an end to stigma for autistic people.
(See also this Twitter thread and watch this video)
Freshta Mohammad, from the Peter MacCallum Cancer Centre in Melbourne, raised issues for people from culturally and linguistically diverse backgrounds in cancer care.
She highlighted the distressing case of a 57-year-old female refugee from Venezuela who was diagnosed with early-stage breast cancer in a refugee camp in the Dominican Republic but received no follow up “due to her refugee status and lack of health insurance” and then presented in Australia with a more advanced recurrence.
Language barriers meant she struggled with care, including a recommended skincare regime which resulted in her experience a severe skin reaction and difficulty maintaining treatment.
Mohammad said Peter Mac has sought to address language barriers as part of a study with Monash University to develop an instant translation device.
Where you live should not determine outcomes
In another presentation, Marissa Morey, from the Western Cancer Centre in the remote New South Wales town of Dubbo, on Wiradjuri country, told delegates that her workplace was “one of the most geographically isolated radiotherapy departments in the world”.
As a result, people in the health district, which covered 250,000 square kilometres, face greater challenges when it comes to their health, including with cancer care and particularly with access to highly focused radiation treatment.
Morey said that usually in Australia a radiation oncologist would be present during stereotactic ablative body radiotherapy and stereotactic radiosurgery treatments.
“Unfortunately, in regional Australia many facilities do not have the luxury of having an oncologist on site,” she said. That meant, for example, that a patient might have to drive eight hours to Sydney and be away from family and work for more than a week.
To overcome this, a relationship has been built with metropolitan radiation oncologists who visit Dubbo once a fortnight, but work via video with radiation therapists at the centre to provide treatments, meaning patients themselves do not have to leave family and other commitments to get treatment in the city.
She talked about what that meant for one patient who was the sole carer of his wife, who had advanced dementia. The town they lived in had no respite services she could use, “so travelling to Sydney was not an option”.
“Providing this alternative enables him and patients like him better access to health care without significant strain on his daily life,” she said. “Where you live should not determine the type of cancer care you receive or the expected outcomes.”
#ASMIRT2023 Twitter threads
See also these additional #ASMIRT2023 Twitter threads from Croakey’s Alison Barrett and Marie McInerney:
- Introductions and pre-conference workshops: here
- Opening plenary, with Welcome to Country and sessions on on patient-centred care and research: here and here
- Image interpretation, improving the patient experience, advancing RT practice, medical imaging education and advances in imaging: here
- Patient centred care, LGBTIQ2S+ patients and professionals: here
- Concurrent session on: radiography ‘commenting’, disaster identification, student papers: here
- Key takeaways, Day 1: here
- Sessions on advancing planar radiography and on nuclear medicine: here
- Treating cancer in Ukraine: here
- Diversity, equity, inclusion and women in leadership: here
- Evidence based research and practice: here
- Champions of change: person centred care: here
- Artificial intelligence: here
More from Twitter
Read previous articles from #ASMIRT2023 for Croakey Conference News Service here. Follow this Twitter list for more conversations on medical imaging and radiation therapy sector post-conference.