Opening Statement

Although medical physicists work in teams that must include physicians and facility administrators, in practice one individual always has the greatest influence over the physicist's attention, effort, and resources. To best achieve growth of the profession and successful navigation of the transition to value‐based healthcare, medical physicists should actively seek increased alignment with physicians, which should be reflected in their employment arrangements.

Employment of medical physicists by physicians reinforces the core principle of primacy of patient care achieved in partnership with other providers. It also enhances their long‐recognized status as experts and authorities on safety. Physicians are just as concerned with compliance and safety as facilities are, and physician‐employed physicists are likely to continue to play key roles here.

Whether as staff or consultants, physicists usually engage with facility administrators and are charged with maintaining compliance and taking care of the complex, expensive equipment that is vital to patient care. Facility‐based job postings prominently list equipment types and inventories; less often, they briefly mention patient treatment volumes and types (for therapy jobs). This indicates a facility focus on volume‐based medicine (and medical physics), whose days are numbered. The Medical Physics 3.0 initiative1 encourages medical physicists to realize new ways to add value to patient care using physics. Medical physicists cannot be complacent with tasks that will readily be commoditized, outsourced, or automated in the near future.

Physicians recognize the value of partnering with medical physicists.2 Physicists’ skills in data collection and analysis can create revenue and cost‐avoidance opportunities for physicians in value‐based healthcare. Physician practices can also offer comprehensive, bundled professional services, integrating physicians and physicists, for improved revenue and competitive advantage. As fellow professionals, physicians share an understanding of duty with physicists and are more likely to support physicists who speak up about unsafe situations.

In 2016, the AAPM reported 4.6% full‐time employment with physician practices,3 which had steadily declined from 6.9% in 2001.4 There are no available data but, anecdotally, the majority of physics consulting agreements are made with facilities, not physicians. This suggests a low and declining diversification of employment arrangements that could be problematic as the transition to value‐based healthcare plays out. Hospitals, free‐standing clinics, and physician practices are likely to experience different challenges on different timelines, and having “all our eggs in one basket” could lead to crisis for medical physicists. We would do well to study and emulate the successes of those few physicists who are employed or contracted by physician practices, including those employed within in‐house physician practices in health systems and those who hold medical staff status and privileges as medical physicists.

Medical physicists should be mindful of the concept of “corporate practice of medicine,”5 which is expressly prohibited in some states. Employment by facilities could lead to “corporate practice of medical physics,” which undermines the autonomous judgment afforded to professionals. In particular, the physicist's important role as a gatekeeper for safety can lead to apparent conflicts of interest with an employer who does not adequately prioritize safety above competing interests (frequently cost).