Present status of Medical Physics practice in Mexico: An occupational analysis

Highlights

• There are 360 clinical Medical Physicists positions, occupied by 283 professionals.

• Challenges: insufficiency of manpower, gender imparity, multishifting and wage gap.

• Only 40% of Medical Physicists in Mexico fulfill the recommended academic profile.

• There is practically an absence of Medical Physicist for D&IR in Mexico.

• Public positions could be covered by professionals with adequate academic profile.

Abstract

Purpose

To present an overview of the status of Medical Physics practice in Mexico, promote the legal recognition of Medical Physics high-end training, and provide information that will potentially improve the Mexican healthcare system.

Methods

For the purpose of this research, the concept of “Medical Physics Professional/s” (MPP) is introduced to refer to any person/s executing the role of a clinical medical physicist (cMP) in whole or in part independent of academic profile, training or experience. A database of MPP in Mexico was built from official sources and personal communication with peers. Database records included the following fields: employer/s, specialty, academic profile, and annual income (when available).

Results

133 centers in Mexico employ MPP, 49% of which are public institutions. 360 positions involving cMP roles were identified at the National Healthcare System (occupied by 283 MPP), 77% of which corresponded to radiation therapy. Public healthcare services hold 65% of the reported positions. Only 40% of MPP hold a graduate degree in Medical Physics, 46% of whom were located in the most densely populated region of Mexico. Of all MPP, 32% were women.

Conclusions

This work allowed to clearly identify the current challenges of Medical Physics practice in Mexico, such as: insufficiency and uneven geographical distribution of qualified manpower, gender imparity, multishifting and wage gap. The products derived from this work could be used to guide the efforts to improve the Mexican healthcare system.

Introduction

Medical Physics is the use of Physics principles, methods and techniques applied to Medicine, in order to prevent, diagnose and treat human diseases [1]. Despite having a wide range of applicability, it is mainly utilized in three major medical specialties: Radiation Therapy, Nuclear Medicine and Diagnostic and Interventional Radiology. In these fields, the use of ionizing radiation could compromise patients, medical personnel and general public wellness. Responsibility to assure the safe and effective delivery of radiation to achieve a diagnostic or therapeutic result as prescribed in patient care relies on qualified clinical Medical Physicists (cMP) [2].

Medical Physics as a profession is recognized as part of the Health Workforce by the International Labour Organization [3], [4]; however, it has not been fully developed in low- and middle-income countries due to adverse economic and political circumstances [5]. Moreover, few standards of Medical Physics practice have been established in countries where such discipline was recently introduced.

As opposed to the European Federation of Organisations for Medical Physics (EFOMP), which encourages its National Member Organizations to ensure the roles and responsibilities of the Medical Physicists in their respective States [6], in Latin America there are few initiatives to endorse the acknowledgment of the role of medical physicist, and it is mainly for radiation therapy [7].

In Mexico, legal frameworks acknowledge the role of “Medical Physicist” since 2011 [8], [9], [10]; nonetheless, the definition of such a figure is significantly different from international recommendations [1], [11], [12], [13], [14], and subject to interpretation. While graduate Medical Physics studies are strongly encouraged by most international organizations, Mexican regulations accept as a valid academic profile a bachelor’s degree in Physics or “related engineering degrees” [sic]. In addition, the scope of practice of the cMP in the Mexican healthcare system is limited to radiation therapy facilities, nuclear medicine services in use of “complex” [sic] imaging equipment (e.g. SPECT and PET scanners) and radiology services equipped with mammography units.

Graduate Medical Physics programs in Mexico are relatively new (created in the late ′90s), and are small in number and size. To date, only two graduate Medical Physics programs are offered nationwide [15], [16], from which 229 students have obtained a Master’s degree. Moreover, half of the Medical Physics graduate degree holders opt for non-clinical jobs. For these reasons, a large number of professionals playing cMP roles do not have the academic profile suggested by international organizations. Recently, Medical Physics undergraduate programs and specializations have emerged to mitigate this problem; however, these academic alternatives have not proven to be equivalent to career paths suggested by international organizations. In addition, the emergence of undergraduate Medical Physics programs could incite unfair competition among bachelor and graduate degree holders. Table 1 summarizes the available career paths to learn Medical Physics in Mexico.

Clinical training programs (after academic degree completion) are also available in Mexico; however, they are limited in number and size, and are only offered for radiation therapy and nuclear medicine specialties. Moreover, such training programs have not proven to be equivalent to a Medical Physics residency program [17], [18], [19]. Only three hospitals have official recognition to train personnel in the field of radiation therapy: Instituto Nacional de Cancerología, IMSS Centro Médico Nacional Siglo XXI and Hospital General de México. A minimum of 6 months-training in any of these institutions is required by law to practice as a medical physicist. Admission to such programs does not necessarily require an academic degree in Medical Physics (see Table 1).

To the best of our knowledge, the practice of Medical Physics in Mexico has not been subject of a comprehensive, systematic and rigorous occupational analysis. Even though the International Atomic Energy Agency (IAEA) has made efforts to make public directories of radiation therapy [20] and nuclear medicine [21] centers worldwide, such resources are based on voluntary participation and do not include occupational statistics. Previous works [22], [23], [24] have also provided some insight on the status of Medical Physics practice in Mexico, however, such studies have been mainly focused on the analysis of radiation therapy centers and can be considered outdated. The absence of an updated occupational database of the Medical Physics practice in Mexico not only raises radiation safety concerns but also imposes challenges to work-policy making. Particularly, it has become challenging to state the definition, roles and responsibilities of a cMP in legal terms.

For the reasons explained above, it is of major importance to determine the current occupational status of Medical Physics practice in Mexico. This work presents an initial effort to conduct such a task. Our motivations and final goals are to support, based on data, the legal recognition of Medical Physics high-end training, and to provide information that will potentially improve the Mexican healthcare system. For the purpose of this research, any person/s executing the role of a cMP will be referred to as “Medical Physics Professional/s” (MPP), in whole or in part independent of academic profile, training or experience.