Advanced practice radiation therapist program improves efficiency, reduces burnout
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As part of an effort to combat unprecedented levels of provider burnout, Mount Sinai’s radiation oncology department has introduced the first advanced practice radiation therapist role in the United States.
The new care model has been named a recipient of a 2023 Association of Community Cancer Centers Innovator Award.
“There’s been quite a bit of momentum around radiation therapists in the field asking for this,” Samantha Skubish, MS, RT(R)(T), chief technical director of radiation oncology at Mount Sinai Health System, told Healio.
“Up until now, there’s been no clinical advancement opportunity beyond a high-level senior or lead therapist,” she added. “We’ve seen a lot of people leaving the field to pursue higher clinical responsibilities.”
Skubish spoke with Healio about the impetus for the new model, its benefits in terms of cost and time optimization, and her hopes that this type of position will become more widespread.
Healio: What motivated your department to develop this new role?
Skubish: Quite a few factors are at play, both nationally in the field of radiation oncology, but also within our institution. Nationally, there’s quite a bit of innovation and technologic advancement that takes place in radiation oncology. Our field moves quickly, pushing the radiation therapist skill set or scope toward maximization. When you look internationally, there are existing advanced practice radiation therapy models that have been very successful, such as in the U.K. and Canada. The United States is a couple of decades behind in getting this off the ground.
There are other challenges we see that create the need for a new model of care. Our patients are living longer with their disease, and more complex decision-making is required. Radiation oncology is moving toward subspecialization, and that’s affecting what the whole multidisciplinary team looks like — it’s not just our physicians.
There is also a need to retain more people within the field. Our assistant chief therapist in our department, Clodagh Starrs, was pursuing a master’s degree in advanced clinical practice in the U.K., and we greatly benefited from her expertise. We identified several gaps in care, and elevating the radiation therapist skill set could be a possible solution. We followed some of the international models in focusing on a certain patient population or cohort, which, in our case, is palliative care for our inpatient population. Then our entire team contributed their own levels of knowledge, motivation and expertise in this area. Our leadership vice president Kimberly Smith and chairman Kenneth Rosenzweig, MD, were instrumental, as well as our physician mentors Karyn Goodman, MD; Sheryl Green, MBBCh; and Kavita Dharmarajan, MD. All of the pieces came together. We’re really trying to decrease some of the waste — the inefficiencies — and create a better-quality process of care for patients receiving palliative radiation who are admitted to our hospital.
Healio: What international models did you follow?
Skubish: The U.K. has a four-pillar framework for advanced clinical practice, and that’s what we used to build our model and our position description. The U.K.’s four-pillar framework is based on education, higher level clinical judgement, research and knowledge dissemination, and leadership.
Healio: What are some of the benefits of having an advanced care practice radiation therapist on your team?
Skubish: We have two grant-funded research initiatives currently in place. Our radiation therapy researchers and educators — Maria Dimopoulos, PhD, MBA, RT(T), and Danielle McDonagh, MS, RT(T) — have really led the way toward analyzing the [Advanced Practice Respiratory Therapist (APRT)] through an evidence-based practice lens. One grant is funded through the American Society for Radiologic Technologists, which is the radiation therapy national professional society. There, we’re really looking to the APRT to improve our inpatient throughput and reduce inefficiencies — specifically, can we reduce the number of patients who are scheduled and then never simulated for their treatment and patients who are simulated for their treatment but never start or complete treatment. Associated with those two metrics is a time savings analysis to identify the cost of such inefficiencies. We’re still in the first year of our initiatives but, preliminarily, we have seen a reduction in both, which is great.
Our second grant-funded research initiative is an internal grant from Icahn School of Medicine's Office of Wellbeing and Resilience. It’s looking to see whether the APRT can improve our physicians’ wellness by reducing some of the burden of clerical tasks. Our APRT goes to the inpatient floor, meets the patient and does an initial therapy assessment before the patient even gets to our department. That lends itself to better care once they do reach our department, as all can be fully prepared. It also saves our physicians time.
We’re still collecting data for that study, but we did a thematic analysis of our preliminary results and the physicians really appreciate the coordination with the other disciplines. Just having the APRT as a touch point has created better continuity and bridges communication every step of the way.
Healio: Congratulations on the ACCC Innovator Award. Does this speak to the importance of new care models like this?
Skubish: Thank you! Yes, I believe it does. We also have and lead a national advanced practice radiation therapy working group here in the U.S. We’re up to about 50 participants across 30 institutions. It’s grassroots, but it’s here — advanced practice radiation therapy is here in the United States. There is a need that has been identified at a national level.
What the role ultimately looks like in each department can be very specific to gaps in care or inefficiencies that exist within that department. By learning from our international colleagues with successful models, we can begin to show an impact. It all lends itself to value-based care, which is on the top of everyone’s minds right now. The focus is on doing more with less, but creating a new model that provides better care and cost savings.
The career progression opportunities this creates for radiation therapists is unique. Just as we can elevate nursing level education to provide advanced practice nursing, providing radiation therapists with higher level education and competency can do the same. We were incredibly fortunate to have a multidisciplinary group of experts who were focused on this and believed in the value of the radiation therapy-specific skill set to clinical care and there is a lot of momentum around this beyond Mount Sinai.
Healio: How has this model impacted physician burnout?
Skubish: Our Office of Wellbeing and Resilience grant is focused on this. We’re still in data collection for that study, but I think it is obviously a focus for our physicians. This model is helping them practice at the top of their license and is taking away some of those lower-level tasks. Based on our preliminary results, I believe we are making an impact. We will see full results within the next year. As far as burnout and keeping people engaged in the profession, I think there is a lot to be evaluated. This model provides career progression opportunities for radiation therapists.
Healio: Is there anything else you’d like to mention?
Skubish: There is a lot of opportunity to build advanced practice radiation therapy models to meet various needs. We focus on the palliative inpatient population, but looking internationally, brachytherapy advanced practice radiation therapists are a very successful model. They provide patient care end-to-end for patients receiving brachytherapy by bridging the gaps and creating a better treatment experience. Another interesting model is working with a physician within their practice as a physician-extender, like a breast specialist or a head/neck specialist. In this model, we can tailor the expertise of a radiation therapist to that patient population.
There is also a good deal of momentum around adaptive planning and adaptive treatment workflows on an MR Linac or an Ethos machine, and on elevating the therapist skill set to manage those patients end-to-end. The current model is to have the physician at the machine. Many institutions across the U.S. see the APRT as being a way to save time at the machine, and that technology lends itself to elevating the skill set of therapists beyond current technical scope. I think adaptive planning is another great model to look forward to. There is a lot more to come.
Reference:
An advanced practice radiation therapist role improves quality, efficiency, wellness & administrative outcomes (press release). Available at: https://www.accc-cancer.org/home/about/awards/accc-innovator-awards/accc-innovator-awards-2023/mount-sinai-health-system. Published Sept. 7, 2023. Accessed Nov. 7, 2023.
For more information:
Samantha Skubish, MS, RT(R)(T), can be reached at Mount Sinai Department of Radiation Oncology, 1184 Fifth Ave., 1st Floor, New York, NY 10029; email: samantha.skubish@mountsinai.org.
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