Those who are thinking of switching to medical physics, however, should not give up, as there are certainly ways to transition to the field. And, of course, where there’s a will, there’s a way. I am unable to publish the email we received, since it included a lot of personal specifics. Instead, I am publishing our response to the individual who contacted us with the hope that  it will help others who are in the same boat:

First, I have to tell you that if this was 30-40 years ago, you could switch from your current background to the medical physics profession with great ease. Many well-known medical physicists (including some of the ”greats” of our profession) who made seminal contributions to our field entered “medical physics” with backgrounds similar to yours. Back then, there were only a few academic programs in medical physics, such as Wayne State University (which dates back to the early 70’s), that offered a degree specifically in medical physics. If you had a Ph.D. in physics or a closely-related field (including engineering), you could switch to a career in medical physics by simply getting a job as a medical physicist in a hospital and working under the supervision of a physicist. Alternatively, you could complete a two-year fellowship program at a big cancer institution such as MD Anderson or Memorial Sloan-Kettering. In the late 80’s/early 90’s, more schools started offering degree programs in medical physics. As these programs started growing in number so did the demand for their graduates. Some job and fellowship descriptions started requiring applicants to have graduated from a medical physics program (and these days some have started requiring/giving preference to applicants who have graduated from a CAMPEP-accredited medical physics program).

The fact is, these days, the option to immediately get a job as a medical physicist with a physics degree after graduation is practically obsolete. Even most those with a degree in medical physics do not immediately obtain a job after graduation without any type of post-graduate training (such as a residency or fellowship). This leaves the other option, which is the route most taken: complete post-graduate training, such as a post-doc or residency. The problem is that most of the opportunities are limited to those who have completed a degree program or had graduate training specifically in medical physics. Medical physics residencies and fellowships are highly competitive these days, and as you said in your letter, candidates with medical physics degrees (especially from a CAMPEP-accredited program) have an edge. However, with your background, if you have strong recommendation letters and a compelling essay stating your enthusiasm and reasons for pursuing medical physics, I believe you have a chance to be accepted into a program. I wouldn’t say that it’s a lost cause by any means. What you must concentrate on is articulating the reason for your switch to medical physics. Your intentions should be clear and should be a natural extension of your background, experiences and interest. You must also look at your (what these days is considered a non-traditional) background as an asset rather than a liability. Try to leverage your background and experiences: you bring a lot to the table, but more importantly, you bring a lot to the table that the traditional medical physics Ph.D. does not. You have a chance to offer a different perspective (skill sets, experiences) to any program, which is always a plus in admissions. All these, however, must be articulated–no one reading your application is just going to assume all of this.

That said, you did not mention what particular branch of medical physics you are interested in. From your background, I believe that your odds of getting into a fellowship program in diagnostic physics are much higher rather than a fellowship program in therapeutic physics. Of course, you should pursue your own personal interest at the end of the day; however, you could best leverage your past educational and research experience as a diagnostic medical physicist as opposed to a therapeutic physicist. It is worth mentioning that there are a few residencies/training programs in diagnostic medical physics that do not require a degree in medical physics. Currently, for example, Mayo Clinic is accepting applications for a residency that may be a great fit for you: “The Department of Radiology, Mayo Clinic, Rochester, Minnesota, is offering a clinical medical physics training program focusing on imaging for diagnosis and image-guided interventional procedures … Candidates should possess a recent doctoral degree in medical physics, physics or engineering.” Notice that the program is not restricted to those with only a medical physics doctorate. When applying to residency programs, keep in mind that in 2012 you must have graduated from a CAMPEP-accredited medical physics degree program OR completed a CAMPEP-accredited medical physics residency to be qualified to sit for the boards (ABR certification). In 2014, the rules become such that you must have completed a CAMPEP-accredited medical physics residency to be qualified to sit for the boards (ABR certification).

A last option also exists, which is to pursue a masters degree in medical physics. I have known several experienced Ph.D. scientists/physicists who switched to medical physics by going through a degree program and finishing a masters degree in medical physics. With your background, I believe you would have no problem gaining admissions to an MS program. While plowing out an extra 2 years of schooling may not be the most attractive option, it is your safest bet in terms of then being admitted to a residency program and (if you get an MS at a CAMPEP-accredited program) being certain you will be qualified for ABR certification when 2012 rolls around.

(This is a good time to ask yourself: do you want to work clinically as a medical physicist or do you see yourself doing research as a medical physicist? If you have no desire to work clinically, then you do not need to concern yourself with graduating from accredited programs. So long as you complete a residency or post-doc, you would be able to do research as a medical physicist without the need to sit for the ABR certification exam.)

I will assume that you do want to work clinically. So, in terms of making your application stronger, you may want to consider shadowing a medical physicist at a university hospital. Are there any hospitals associated with your university? Volunteering at a hospital is a good first step, but the most valuable clinical experience you will receive is being able to gain knowledge of the daily duties of a medical physicist. Also, while not a requirement, a strong letter of support from a medical physicist would be beneficial to your application.

Lastly, you mentioned you have been taking pre-med classes. Do not limit yourself to pre-med courses, which are mostly basic science classes (organic chemistry, biology, general chemistry+labs). Take an anatomy class, which while not a pre-med course, is indispensable for a physicist working clinically. I would suggest taking a look at the coursework at medical physics programs and trying to find equivalent or similar courses at your university (or another university nearby):
http://medicalphysics.duke.edu/files/MP-courses-040509.pdf,
http://www.uth.tmc.edu/gsbs/programs/medphys/courses.htm,
http://www.medphysics.wisc.edu/medphys_docs/courses.html

I hope this gives you some ideas in your decision making. I think you are taking some good steps, and I do believe your background will ultimately make you a better medical physicist. I personally believe that if you have a passion for what you are doing and work hard for it, you can achieve anything you want.

If anyone has any additional or supplemental advice for this individual or others looking to switch paths to medical physics, please feel free to share your thoughts by leaving a comment at the bottom of the post.

Duke University Medical Physics Residency Program

Number of Positions: 2

Start Date: 7/1/2010

Deadline: 11/30/2009

Henry Ford Health System Diagnostic Imaging Physics Residency Training Program

Number of Positions: 1

Start Date: 7/1/2010

Deadline: 1/1/2010

Kansas City Cancer Center Radiation Oncology Physics Residency

Number of positions: 1

Start Date: 7/1/2010

Deadline: 1/15/2010

Mayo Clinic Clinical Medical Physics Residency

Number of positions: 1

Start Date: 7/1/2010

Deadline: 1/15/2009

Rush University Residency Program in Medical Physics

Number of positions: 1

Start Date: 7/1/2010

Deadline: 2/15/2010

Stanford University Medical Physics Residency Program

Number of Positions: 1

Start Date: 7/1/2010

Deadline: 12/31/2009

Thomas Jefferson Medical Physics Residency Program

Number of positions: 1

Start Date: 7/1/2010

Deadline: 12/31/2009

University of Chicago Medical Physics Residency Training Program in Radiation Oncology Physics

Number of positions: 1

Start Date: 7/1/2010

Deadline: 12/15/2009

University of Iowa Clinical Medical Physics Residency Program in Radiation Oncology

Number of positions: 1

Start Date: 7/1/2010

Deadline: 12/15/2009

University of Louisville Radiation Oncology Physics Residency

Number of positions: 1

Start Date: 7/1/2010

Deadline: 12/15/2009

University of Pennsylvania Medical Physics Training Program

Number of Positions: 3

Start Date: 7/1/2010

Deadline: 12/15/2009

University of Texas M.D. Anderson Radiation Oncology Medical Physics Residency Program

Number of positions: 3

Start Date: 7/1/2010

Deadline: 12/31/2009

University of Texas Southwestern Clinical Medical Physics Residency Program

Number of Positions: 1

Start Date: 7/1/2010

Deadline: 12/15/2009

Virginia Commonwealth University Radiation Oncology Medical Physics Residency Program

Number of Positions: 1

Start Date: 7/1/2010

Deadline: 12/31/2009

Washington University Physics Residency Program

Number of positions: 2

Start Date: 7/1/2010

Deadline: 12/15/2009

According to NRC 10 CFR part 35.690, if you are not a board certified radiation oncologist, the law requires that you have the following training in order to be listed as an AU in the HDR material license and to treat patients with HDR independently:

You must have completed a structured educational program in basic radionuclide techniques applicable to the use of a sealed source in a therapeutic medical unit that includes:

(i)  200 hours of classroom and laboratory training in the following areas—
(A) Radiation physics and instrumentation;
(B) Radiation protection;
(C) Mathematics pertaining to the use and measurement of radioactivity; and
(D) Radiation biology; and

ii) 500 hours of work experience, under the supervision of an authorized user who meets the requirements in §35.690 or, equivalent Agreement State requirements at a medical institution, involving—
(A) Reviewing full calibration measurements and periodic spot-checks;
(B) Preparing treatment plans and calculating treatment doses and times;
(C) Using administrative controls to prevent a medical event involving the use of byproduct material;
(D) Implementing emergency procedures to be followed in the event of the abnormal operation of the medical unit or console;
(E) Checking and using survey meters; and
(F) Selecting the proper dose and how it is to be administered;
(G) Device operation
(H) Safety procedures for the device use
(I) Clinical use of the device

For more information, visit: http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/part035-0690.html

Considering the above guidelines, these are some useful tips to the following groups of individuals:

For ASTRO: Inform all the Radiation Oncology Residency Program Directors about the law.

For Residency Program Directors:  If you don’t have an HDR in your facility, try to get one. HDR training should be a part of every physics residency program.

For Residents: If your program does not have an HDR after-loader or offer HDR after-loader training, make arrangements with sites nearby that possess an HDR after-loader and arrange to complete your 500 hours training there during your residency program.

For Medical Physicists: Share this information with your radiation oncologist colleagues. If you are responsible for amending the material license and are expecting a new radiation oncologist to join the group, be sure he or she has all the relevant paper work (documenting the necessary training) available before leaving his/her institution.

Finally, there is a similar law for medical physicist to be listed as an Authorized Medical Physicist that was previously posted on this blog. Click on this link for further information.

Have you ever heard of a school losing CAMPEP accreditation? I am concerned about an institution losing its accreditation, which would not be a very good thing, especially for those people who are intending to take the first part of the ABR exam next year and possibly find a job by June 2010…

Our response: The CAMPEP accreditation–like any other type of accreditation–is given only for a fixed period of time. After that period, the institution goes through a process of re-accreditation to demonstrate continued fulfillment of the standards and requirements set forth by CAMPEP. I believe the re-evaluation process is very similar to the initial application except that an on-site visit is usually not needed for the re-evaluation. However, the review committee reserves the right to require an on-site visit in the re-accreditation process.

There are three outcomes when an institution applies for re-accreditation: 1) Accreditation continued, 2) Probation or 3) Accreditation withdrawn. I have never heard of an institution getting accreditation immediately withdrawn after applying for re-accreditation. I think there must have been some very significant (i.e. negative) changes to the medical physics program for it to be placed on probation or to have its accreditation withdrawn. Being placed on probation, however, while not the greatest thing, does not imply the eventual loss of accreditation. Probationary status grants the program some time to comply with the CAMPEP recommendations and to re-establish accreditation.

Your letter brings up an important issue that I’m certain is of interest to all students–that is, what happens to the student if his/her program loses accreditation before graduation? Your question is especially timely given the new rules in 2012. For example, what happens if your program loses accreditation one year prior to your graduating in 2013? Does this make you ineligible to take the ABR exam? Is it the school’s accreditation status when you graduate that matters (i.e. gives you the right to say you graduated from a CAMPEP-accredited program) or is it the school’s accreditation status when you are admitted that matters?

We will let CAMPEP know of this post.

The first rule when it comes to interviewing is answer honestly.

The second rule is be yourself and answer naturally–don’t memorize answers and then try to recite them verbatim during the interview. If they wanted to hire a robot, you wouldn’t have been called in for an interview. Memorizing answers to interview questions also has a way of backfiring in most cases. For example, what if the interviewer decides to ask you a question for which you didn’t memorize an answer? You can bet that your impromptu answer to this unexpected question will sound extremely different from your other rote responses; as a result, the interviewer will realize you’re a “memorizer”–and that’s not a good thing.

The third rule of interviewing is practice, practice, practice (but, again, don’t memorize). Practicing is immensely helpful in articulating your thoughts and just plain getting your comfort level up. Practicing is also helpful in cases when the interviewer decides to throw out a question that may have taken you 10 minutes to answer had you NOT practiced. Because of the importance of practice, it’s absolutely vital to go over sample questions (the more, the better).

As you progress through your interviews at various institutions, you will start to realize that (more or less) the same questions are asked of you. The reason for question recycling is not necessarily because interviewers are unoriginal creatures that cannot think of unique things to ask you, but rather it’s because the questions being recycled are particularly good at evaluating you as an applicant (your abilities, your skills, your personality). As a starting point for you, here are a list of questions from a pamphlet I received a while ago by the Burroughs Wellcome Fund and Howard Hughes Medical Institute:

For evaluating experience and skills:

1. What is (are) your most significant accomplishment(s)?
2. Describe the part you played in conducting a specific project or implementing a new approach or technology in your department/lab?
3. I see you have worked with [a specific technology or technique]. Tell me about its features and its benefits.

For evaluating commitment and initiative:

1. Why do you want to attend (or work) at this university/institution/department/in this lab?
2. Where do you see yourself in 5 (or 10) years?
3. What kinds of projects do you want to do? Why?
4. Tell me how you stay current in your field.
5. Describe a time when you were in charge of a project and what you feel you accomplished.
6. Describe a project or situation in which you took initiative.

For evaluating working and learning styles:

1. What motivates you to work?
2. Would you rather work on several projects at a time or on one project?
3. Do you learn better from books, hands-on experience or other people?
4. Describe a time or project when you had to work as a part of a team?  What was the outcome of the team’s effort?
5. How would you feel about a leaving a project for a few hours to help someone else?
6. If you encountered a problem at work/in the lab, would you ask someone for help or would you try to deal with it yourself?
7. Would it be a problem to work after hours or on the weekends, should the project need it?

For evaluating time management:

1. How do you prioritize your work?
2. How do you deal with multiple priorities competing for your time?

For evaluating decision making and problem solving:

1. What is the biggest challenge in your current job?  How are you dealing with it?
2. Describe a time when you had to make a decision that resulted in unintended/unexpected (good or bad) consequences.
3. Describe a situation where you found it necessary to gather other opinions before you made a decision.

For evaluating interpersonal skills:

1. How important is it to you to be liked by your peers/colleagues and why?
2. If you heard through the grapevine that someone didn’t care for you, what would you do, if anything?
3. Describe a situation in which your work was criticized–how did you react to and address the situation?
4. Name a scientist whom you like and respect.  What qualities do you like about this person?

Feel free to share your medical physics interview experiences with the other readers by leaving a comment on this post. Also, add your interview questions to this list by leaving a comment so that those with upcoming interviews for medical physics grad school or post-doctoral/residency positions can get a bit more practice.

In case you are wondering what the list looks like this year, the schools are listed below. The universities with CAMPEP programs are bolded.

24. University of Virginia (tie)

24. University of California–Los Angeles (tie)

23. Georgetown University

22. Carnegie Mellon University

21. University of California–Berkeley

20. University of Notre Dame

17. Vanderbilt University (tie)

17. Rice University (tie)

17. Emory University (tie)

16. Brown University

15. Cornell University

14. Johns Hopkins University

12. Washington University in St. Louis (tie)

12. Northwestern University (tie)

11. Dartmouth College

10. Duke University

8. University of Chicago (tie)

8. Columbia University (tie)

4. University of Pennsylvania (tie)

4. Stanford University (tie)

4. Massachusetts Institute of Technology (tie)

4. California Institute of Technology (tie)

3. Yale University

1. Princeton University (tie)

1. Harvard University (tie)

If you are interested in seeing some specs and a nice little photo of each school, check out WalletPop’s slideshow at http://www.walletpop.com/college-finance/americas-best-colleges/

Details on the residency program and a link to the application can be found here.

http://www.mudphudder.com/2009/07/an-apt-comparison/

Medical Physics Standardizes Clinical Training
By Toni Feder

Public safety is the motivation behind new requirements for becoming certified as a medical physicist.

New certification rules intended to improve the quality and uniformity of medical physics training go into effect in a few years. In preparation, the field is scrambling to create enough residency slots for the first classes that fall under the tightened rules.

Starting in 2012, to sit for the board exams the American Board of Radiology will require that people be enrolled in or have graduated from an accredited medical physics master’s, PhD, or clinical residency program. At the urging of the American Association of Physicists in Medicine (AAPM), two years later that requirement will be superseded, and test takers will have to be enrolled in or have completed an accredited residency. Passing the ABR exams confers certification that a person is qualified to independently practice radiologic physics and advise physicians about the physical aspects of radiation therapy, diagnostic radiology, or nuclear medicine. Certification for the specialty areas of medical health physics and magnetic resonance imaging is done separately, through the American Board of Medical Physics. Accreditation for degree programs and residencies is by the nonprofit Commission on Accreditation of Medical Physics Educational Programs Inc (CAMPEP).

“All about public safety”

Among other things, medical physicists calculate radiation dose and beam shape for tumor treatment, check that medical imaging equipment—involving x rays, radionuclides, magnetic resonance, computed tomography, ultrasound, and fluoroscopy—is calibrated and used properly, help in selecting new equipment, and train technologists and others to use the equipment. In addition to working in universities, hospitals, and clinics, they serve as independent contractors in practice groups, routinely checking and calibrating mammography equipment or dental x-ray machines, for example. In some cases, medical physicists interact closely with patients.

Each state sets its own requirements for medical physicists. In the four states—Florida, Hawaii, New York, and Texas—that require a license,  ABR certification is one way to get it. In many states medical physicists must register to practice. In other states a physicist with no prior clinical training, or even no classroom background in medical physics, might be hired by a hospital or clinic and trained on-site. “A lot of people have learned on the job. Smart people can always get the education they need. But the profession is mature enough for some standards,” says Ehsan Samei, Duke University’s director of medical physics graduate studies. “There are places that don’t do as good a job as they should at making sure their image quality and dose management is where it needs to be,” adds CAMPEP chair John Hazle, an imaging physicist at the University of Texas’s M. D. Anderson Cancer Center in Houston. Currently, to sit for the ABR exams, a medical physicist “needs three years of experience and someone ready to vouch for you,” says Hazle.

“There is much interest and excitement about the upcoming changes,” says AAPM president-elect Michael Herman, a radiation oncology physicist at the Mayo Clinic in Rochester, Minnesota. “If they [ABR] require accredited training before you sit for boards, it closes the loop.” Even in states that do not require certification, he adds, “most practice groups and academics expect their medical physicists to become certified at some point.” The CARE bill, which an alliance of nearly two dozen professional societies is hoping to reintroduce to Congress this spring, would mandate minimum standards in education and training for anyone involved in irradiating humans. As federal law, CARE (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy) would help raise the uniformity and level of practicing medical physicists. “You have to be licensed for many professions that involve public health, including cutting hair,” says Herman. “Why not to deliver radiation to people?”

The new certification rules, says Hazle, “are all about public safety. They are better for the public and better for the profession. It will make the demonstration of competency for medical physicists more equivalent to physicians.” Entering the field via alternative pathways will still be possible under the new certification rules, says the University of Iowa’s John Bayouth, the radiation oncology physicist who chairs the AAPM working group that coordinates activities of program directors for medical physics residencies.

“Our field has been enormously rewarded from optical physicists, atomic physicists, nuclear physicists—they’ve made substantial contributions. It’s important that we do not dissuade those who bring additional skills from entering the field. This is a challenge.”

Meeting demand

Some 20 graduate programs across the US and Canada are currently accredited, with a handful more in the works. “We are not too concerned” about meeting the 2012 deadline, says Hazle. “We are turning out enough graduates. But when we look at 2014, we start running into challenges.” The US demand is for about 250 new medical physicists per year. Some 31 residencies, 28 in therapy and 3 in imaging, are accredited, up from 19 about a year and a half ago. “We’ve seen dramatic growth in the number of residencies,” says Bayouth. “If we continue that over the next four years, I think it’s very likely that we’ll have enough residency programs.” The more common view, though, is that it’s unlikely that enough accredited residency slots will be available in time despite the efforts of AAPM, the ABR, and others. “I think we could get to 100 or 150 residents,” says Hazle.

“It’s a great long-term plan to have everyone go through clinical residency who wants to work in a clinic,” says Jennifer O’Daniel, a new assistant professor of radiation physics at Duke University Medical Center and a member of the AAPM’s student subcommittee. “The main concern is the short-term consequences of our long-term plan.” The people currently in CAMPEP-accredited programs are affected only by the 2014 deadline—depending on timing, they’ll need to do a residency before they sit for the boards. But the people who started a non-CAMPEP-accredited PhD after 2006 will likely need to do an accredited residency. “If you need to do one, and you cannot get into a residency program, you are out. There is no recourse,” says Samei. There are not enough residency programs in imaging physics, he adds. And master’s graduates “cannot currently compete adequately [against PhDs] for the limited number of residency slots. No matter what we do, some people will fall off the cliff.”

AAPM, the ABR, and CAMPEP, among others, are urging hospitals, clinics, and practice groups that offer clinical training to become accredited and those that already are to take on more than the typical one or two residents. The hurdles are money and manpower. Residents are typically paid, but unlike with medical residents, whose salaries come from Medicare, the host institution foots the bill. As for manpower, Samei says, “My idea is to hand [new hosts] a person, perhaps a retired medical physicist, for a month or two to help start up” residency programs. “This will help institutions that may have enough manpower to maintain a residency program but not enough to start one.” Some places are discussing a hub-and-spoke model, whereby an established training center helps administer and oversee residencies in remote locations.

New degree

Another proposal would turn the residency from an expense for the host institution into a moneymaker: Instead of being paid during their clinical training, residents would pay. Charles Coffey, who is launching a clinical doctorate of medical physics (DMP) at Vanderbilt University this fall, says it’s “part of their education. It’s a professional degree, not a research degree.” The university’s existing two-year master’s program would be supplemented with courses in ethics and in-depth diagnostic and radiation calculations, in addition to two years of clinical training. The program is off to a running start, Coffey says. At steady state the program aims for about five new students each year. The DMP will only incrementally help meet the immediate need for residency slots. But, says Coffey, “I really think by 2020 it will play a major role.”

Samei recently surveyed students, residents, faculty, and directors of medical physics programs about their opinions about DMP degrees. “The results were mixed,” he says. “The majority of students said they would apply to such a program. But overall there was a feeling that it could be detrimental to research because the people who in the past would have gotten a PhD would do this instead.”

Samei himself worries that the DMP might create two classes, “PhDs that are the ‘real’ doctors and DMPs that are sort of doctors.” But, he says, to meet the need for the 2014 certification requirements “we need a multifaceted approach. I personally feel we are not moving fast enough.”