Against this backdrop of unsustainable costs forcing economically driven changes in health care, there are also other forces at play. While resources are limited and diminishing, there are growing regulatory mandates to deliver health care in such a way that is personalized, evidence‐based, and value‐based. A suite of disruptive technologies based on automation, machine learning, and “big data” is also emerging. 12 , 13 These technologies threaten to replace many existing jobs within our society, and health care is no exception. 14 Changes in health care driven by political, economic, technological, and regulatory factors threaten to create a “perfect storm” in which traditional service models and even entire professions, including medical physics, are challenged.

The United States spends more per capita on health care than any other nation, and the total cost of health care as a percentage of GDP is increasing. 1 , 2 Despite this, when examining metrics such as life expectancy, preventable deaths per capita, and population coverage, it is clear that the US health care system lags behind those of comparably developed nations, 3 with identified causes that include high administrative complexity, overtreatment and non‐evidence‐based technology proliferation. 2 , 4 , 5 A major governmental response to this situation has been the Affordable Care Act (ACA). 6 The principal intentions of the ACA were to reduce the costs of health care and to increase the percentage of the population with healthcare coverage. 7 One of the mechanisms proposed to achieve this is a move away from the fee‐for‐service payment model, which reimburses clinical facilities and healthcare professionals for each service rendered, regardless of whether that service was necessary or effective. It has been described as “perhaps the single greatest obstacle to improving health care quality”. 8 The Center for Medicare and Medicaid Services (CMS) is currently testing alternative payment models, and has a goal of 50% of all payments being made through alternative payment models by 2018. 9 The most widely supported alternative payment mechanism is to use a bundled‐payment model, in which a provider is reimbursed with a single payment for a patient presenting with a given condition. Responding to this model, healthcare entities are motivated to increase the cost‐effectiveness and efficiency of medical care, research, and education, through business concepts such as Lean and Six Sigma. 10 , 11 In such an environment, it is crucial that individual disciplines can demonstrate their value and utility to the administration that will decide how to best utilize and allocate the finite resources.

Recognizing medical physics as a unique discipline can offer clarity to its contributing role in and value to the healthcare enterprise. At its core, medical physics is primarily the clinical application of scientific and physics principles to serve and foster human health. The word “clinical” here applies not only to clinical medical physics (applied physics toward clinical integration and translation) but also to other practices of the field, including research and education. Research is strongly informed and oriented toward clinical priorities, albeit often with a longer term application horizon. Education likewise is informed by the clinical and research practices, and thus likewise oriented. By contrast, other related and equally valuable disciplines take slightly different primary orientations than clinical, toward, for example, processes at the intersection of biology and physics(biophysics), the interaction of radiation with biological tissue (radiobiology), and the formation of biomedical technology (biomedical engineering). This nuanced distinction between disciplines which otherwise have highly diffuse and variable boundaries, depending on the practice and regional definitions, is not an endorsement of territorialism, but rather a recognition of the valuable complementary perspectives that each brings to sometimes similar objectives.

While changes ahead are likely to bring great challenges to medical physics, they will also bring great opportunities for enhanced safety, precision, and innovation within the clinic. The goal of MP3.0 is to devise strategies to navigate the unpredictable landscape ahead, ensuring that medical physicists are optimally positioned to grasp these new opportunities. This involves growing and building upon the skills of medical physicists in both the development and the practice of medicine. In this vision, MP3.0 is motivated by the conviction that medical physicists bring unique and crucial expertise to the table, that every patient's care can be improved by a medical physicist, and that every clinic should have a medical physicist. MP3.0 aligns with similar initiatives which have been launched in other areas of health, including radiology, 15 , 16 public health, 17 gastroenterology, 18 and nursing. 19

In this desired and required evolution of medical physics, it is crucial to clarify strategic goals and measures of success to motivate and unify progress. Medical Physics 3.0 (MP3.0) is an attempt to define and advocate a model of sustainable excellence in medical physics. It does so by embracing the current landscape of medicine while also re‐visiting the roots of the discipline: a medical physicist is both a scientist and a medical professional with a calling to use his/her expertise to contribute to human health. MP3.0 aims to devise strategies to foster a culture within medical physics to proactively and meaningfully engage in health care and to maximize the contribution of physics to human health.

The broad, profound, and accelerating changes in the delivery of health care can be significantly benefited if they can be informed by science, enabled by innovation, and monitored by quantitation. In facing these changes, medical physics is at a crossroads in either embracing the changes or being undermined by them. Recognizing that medical physics is grounded in science, innovation, and quantitation, it can not only navigate these changes but also meaningfully facilitate their adaptation to improve health care. This contribution, while having an economic dimension for the profession itself, is more fundamentally motivated by an ethical mandate: medical physicists, by the virtue of their “medical” designation, have a professional calling to ensure that their expertise is used for the betterment of human health. In other words, medical physicists can (as a matter of proficiency and capability), should (as an ethical obligation), and must (as a matter of survival) embrace and facilitate these changes in health care. Full realization of this potential, however, necessitates certain changes within the discipline and a renewed commitment to the practice of physics in medicine.

3 Rationale for and foundations of change

Physicists were among the originators of the medical specialties of radiology and radiation oncology. That role has been crucial in the research and development of new technologies in imaging and radiation therapy to this day. Medical physicists’ strong analytical and problem‐solving skills, technical expertise, and knowledge of clinical processes have also made them valued contributing members of corresponding clinical services. Medical physicists have committed enormous efforts to the highly specialized areas of safety and equipment evaluation. These contributions have matured the profession to a widely recognized status, with nationally implemented accreditation and certification processes that include standardized educational framework through the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) and competency qualification through the American Board of Radiology (ABR).

The standardization of the profession, while natural and tremendously beneficial, has also brought new challenges to the discipline. The dissonances between discovery and standardization, and between exploration and resource constraints, are realities of clinical practice in medical physics. Similar dilemmas exist in graduate education and clinical training for resolving the best allocation of finite time and resources. As scientists, medical physicists expect themselves and their trainees to explore, discover, and innovate while simultaneously practicing and mastering fundamental principles and clinical skills. But that balance is difficult to maintain in the midst of increased volume of material and the reality of limited resources. Furthermore, the ABR standardized testing format arguably reflects not the goal but only the minimum of what is actually needed to perform the job in a dynamic clinical setting. With the expansion of the expected work and competencies, there is the temptation to focus on the practice and mastery of the minimum, with critical thinking and clinical relevance taking a second seat. Conversely, a technically strong physicist can become too detail‐oriented in solving narrow physics problems with limited effect toward improving patient care in the larger clinical context. In both these cases, medical physicists are limiting themselves to being either compliance technicians or overly rigorous academicians out of touch with clinical realities and constraints.

To ensure a vibrant profession for the future, medical physicists today must be mindful of these tensions, and must address them thoughtfully and flexibly. New discoveries arrive every day, while the capacity of a training program to deliver educational content remains mostly fixed, often resulting in a zero‐sum problem when revising educational objectives. Adding new subjects or content to a graduate or residency program's requirements is difficult, as it is seldom acceptable to lengthen the duration of the program or to remove core subjects from the curriculum to accommodate these updates. The existence of formal curricula, standardized knowledge bases, and the need to learn prescriptive procedures and skills is well‐justified by the key role that the medical physicist plays in patient safety, and in practice, such structures arise in the form of professional standards, individual and institutional credentialing, and regulations. At the same time, these structures should not undermine the importance of the medical physicist being trained and practicing as a scientist first and foremost. The true strength of a physicist is the ability to precisely analyze their environment, detect problems or weaknesses, and create novel solutions. A medical physicist, in particular, should combine these abilities with a strong sense of clinical context to be effective in the healthcare practice as a whole (so called “systems‐based practice”). Qualifying such expertise is also critical. The ability to measure an individual's performance on a given well‐defined task or knowledge‐based learning objective is relatively straightforward. Meanwhile, present means of assessment do not function nearly as well to assess the ability or motivation to innovate, to be aware of context, or to engage in deep scientific thinking when learning or carrying out a prescriptive task. Medical physics has evolved to its present state from contributions across a wide array of disciplines, and so the structure that is needed must also accommodate and continue to invite new ideas from other scientific fields, within training programs and through life‐long learning.

A major goal of MP3.0 is for all clinical medical physicists to practice as scientists and as healthcare providers, with professional competency that utilizes scientific principles and an ethical mandate that advances the quality of care. As patient care is a multi‐disciplinary team endeavor, this requires not only just a mastery of physics but also deep clinical knowledge, strong communication, and leadership skills. Opportunities to improve patient care can only be found if one can communicate effectively in the language of the clinic. Unfortunately, the degree of medical physicists’ integration within the clinical environment is uneven across the field due to a wide variation in the level of clinical knowledge and professional interpersonal skills. Some medical physicists have become isolated from clinical decision‐making, being known largely as “machine physicists,” limiting their opportunities to engage in patient care improvement. Others have found themselves isolated from direct communication with administrators, leaving them with little voice in healthcare policy and strategy, although they are the ideal team members to deal with rapid technology‐driven change. Physicists also struggle to effectively demonstrate their value due to the lack of quantifiable key performance indicators of quality, safety, and value in the clinical practice.

In general, medicine should draw from all disciplines that advance its mission. When it comes to the foundational sciences of biology and chemistry, that contribution is well enacted and recognized. For example, most academic medical centers include basic science departments in medically otiented biology and chemistry reflecting that contribution. Physics, however, does not share the same recognition and broad scope of contribution. Instead, the scope of the practice of medical physics, in most countries including the United States, is presently focused on the science and technology of “radiation in medicine” and the associated fields of diagnostic radiology, radiation oncology, nuclear medicine, and medical health physics. Medical physics has enjoyed considerable success in this present scope. However, the applications of physics in medicine extend well beyond the radiological fields, with opportunities for contributions of physics to orthopedics, neuro‐science, ophthalmology, medical photonics, surgery, nano‐medicine, radiogenomics, dentistry, electrophysiology, and vascular medicine, naming just a few. Notwithstanding the notable efforts of some individual medical physicists in non‐traditional applications of medical physics, there remain significant unexplored opportunities to leverage the physical science expertise to shape the profession of medical physics and to further benefit human health. This is the potential by which every patient's care can be improved by a medical physicist. To enable this potential and to correspondingly expand the current scope of practice, the unexplored areas of physics in medicine should be built into the scientific and educational foundations of the discipline.

As healthcare professionals, medical physicists today make significant contributions to quality, safety, and innovation in many medical procedures. But both within and beyond the current scope of practice, these contributions can be more fully, broadly, and consistently realized in every medical procedure, either diagnostic or therapeutic. This provides for having each patient procedure performed optimally every time. This requires all clinical physicists to be both broadly‐ and scientifically‐oriented so they can effectively apply their expertise to new technical problems that are clinically driven. To do so, each physicist should attain the necessary clinical knowledge, get involved in the entire clinical process, and apply his/her problem‐solving and analytical skills to process improvement and patient‐outcome analysis. Much of science done in medical physics today does not get applied clinically. Scientific knowledge already within the discipline can be more explicitly purposed clinically to define, target, and monitor relevant quantitative indicators of quality and value in the clinical context of patient care.

There are threats facing the profession of medical physics if it cannot evolve. With increasing cost pressures, hospital administrators are more closely scrutinizing staffing levels and compensation expenses. Many of the care duties that are purely technological in nature could ultimately be commoditized and delegated to less costly workforces. If the field of medical physics does not keep pace with the evolving needs and economic realities of the clinic, it also opens the door to view the presence of medical physicists as a problem to be solved rather than an asset to be embraced by the changes in health care. If clinical medical physicists do not take the initiative to adapt and to find new ways to improve and integrate closely with patient care, they may not be “in the room” when a solution is finally devised. But even more importantly, effective health care needs scientists to deliver innovative, precise, and evidence‐based solutions to the wide range of emerging needs and problems brought about by the ever‐increasing integration of technology into the health care system—not just in medical imaging and radiation therapy. Thus, without the active presence of physicists and intentional re‐envisioning of medical physics, what is ultimately at stake is the quality of health science and practice, and a lost opportunity for improved care. Re‐envisioning medical physics also extends the physicist's stature, enabling direct involvement in clinical decision making, and in collaboration with physician peers, opportunities to bring in ideas from physics and related scientific disciplines, with ultimate benefit to patient care.