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I know many of you have a hate boner for Bridge Oncology, but they have a great newsletter which gave some pretty great insights about handling the lack of RTTs with assistants rather than adanced practioners.
RTT Assistant
Vs.
RTT - Advanced Practioners
RTT Assistant
Staffing - Radiation Therapists
The Case for a Radiation Therapist Assistant: Addressing Today’s Staffing Crisis
Radiation oncology is facing a staffing challenge unlike any seen before. Conversations with administrators and therapists at ASTRO, ASRT, and SROA confirm what data and daily operations already reflect: this is not a temporary shortage or a familiar cyclic trend. Instead, it is a structural workforce problem shaped by new clinical, financial, and operational realities.
Why Today’s Shortage Is Different
Previous staffing shortages occurred in an era when radiation oncology margins were healthier. Departments could absorb fluctuations in staff availability because revenues were buffered by more prolonged treatment courses. The advent of hypofractionation and declining reimbursement, however, have reduced revenues while patient needs remain constant.
Geographic maldistribution compounds the problem. Therapists are increasingly drawn to urban or suburban centers where lifestyle amenities and job security are greater, leaving rural hospitals and community practices struggling. At the same time, the high pay rates now demanded by radiation therapists have had an unintended consequence: therapists often prefer working PRN or part-time, forcing departments to hire more staff to cover the same workload.
Even if all vacancies were filled with full-time therapists, margins would collapse. As one administrator noted, “At current market rates, staffing to full complement would push expenses beyond sustainability.” This economic bind underscores the urgency of finding cost-effective alternatives.
A Path Forward: The Radiation Therapist Assistant
The solution is not to pursue an Advanced Practice Radiation Therapist (APRT) model. An APRT, while valuable in academic discussions, would demand even higher wages and risk pulling therapists away from the treatment machine. Instead, the clear need is for a Radiation Therapist Assistant (RTA)—a support role designed to extend the reach of credentialed and licensed therapists without undermining their scope of practice.
This mirrors successful models in healthcare. Nursing assistants, surgical techs, and physical therapy assistants have all proven to be cost-effective workforce extenders, enabling specialists to focus on complex tasks while ensuring safe and efficient patient care. The same logic applies in radiation oncology, where many routine and repeatable tasks could be delegated under supervision.
Evidence of Scope Utilization Inefficiency
Studies of treatment delivery teams show that when multiple therapists are assigned to a single machine, one therapist typically performs at 80–90% of their trained scope, while the second functions at half or less. This inefficiency highlights how the structure of current staffing doesn’t match actual workload distribution. A radiation therapist assistant could safely assume many of those “half-scope” responsibilities, improving efficiency and alleviating cost pressures.
The Educational Challenge
A common suggestion—expanding school enrollment—presents its own pitfalls. Training programs face limits in clinical placement capacity, faculty availability, and accreditation requirements. Even if numbers were expanded, the new baseline of higher enrollment would create pressure for sustained throughput, making it financially unsustainable for schools to modulate in response to future workforce changes.
Rural and Low-Volume Centers at Greatest Risk
The pain is most acute in rural practices and in lower-volume centers. These sites cannot compete with urban wages, and their patient volumes don’t justify multiple full-time therapists at today’s pay scales. Without intervention, vacancy rates will climb and access to care will suffer.
Conclusion
Radiation oncology has entered a new staffing era where traditional solutions will no longer suffice. Margins cannot absorb the cost of filling vacancies at current wage rates, and geographic maldistribution shows no sign of easing. The creation of a Radiation Therapist Assistant role offers a sustainable, patient-centered answer. By following proven models from nursing, surgical, and rehabilitation care, radiation oncology can redefine its workforce structure to ensure safe, accessible, and financially viable treatment delivery.
Vs.
RTT - Advanced Practioners
The APRT Issue: Radiation Oncologist You Must Start Engaging or You Will See the Negative Effects
The APRT: A Tone-Deaf Role
The push for the Advanced Practice Radiation Therapist (APRT) role in the U.S. continues to surface, most recently through a poster presented at ASTRO’s 67th Annual Meeting by Mount Sinai. While the authors frame the APRT as a solution to clinician burnout and inefficiency in palliative radiation therapy, the case presented is largely subjective, narrow, and misaligned with the actual needs of the field.
A Study Rooted in Subjectivity, Not Evidence
The Mount Sinai poster relies almost entirely on survey responses, anecdotal quotes, and local operational metrics. There is no objective demonstration of clinical need, no randomized comparison, no outcomes analysis, and no cost-effectiveness evaluation. Burnout correlations and “perceptions of improvement” do not equate to proof of clinical value. At best, this is a single-institution pilot that reflects the views of a few salaried physicians in one environment—not a foundation for national policy change.
Radiation oncologists across the country should be asking a key question: what exactly is the driving endorsement for the APRT, and who benefits? Based on the comments, it appears the APRT functions primarily as a tool to shield physicians from tasks they would rather not perform. This is self-serving, not system-serving.
An Answer to the Wrong Problem
The true bottlenecks in radiation oncology today are not the clinical tasks APRTs are being asked to absorb. Instead, payer prior authorization, billing complexity, and documentation requirements slow down care. Introducing another specialized mid-level role does nothing to solve those systemic issues. Technology—AI-enabled scribes, agentic workflow platforms like MedLever, and improved EHR integration—are the solutions to administrative burden. Residents, advanced practice providers (APPs), nurses, and therapists already exist and cover these scopes.
Creating APRTs is an answer in search of a problem.
Undermining Physician Responsibilities
Tasks like simulation setup, treatment verification, and palliative radiation planning are central to radiation oncology—not “non-complex” functions to be delegated away. Poor simulations can compromise entire courses of therapy. Palliative patients require nuanced medical judgment, balancing comorbidities, prior treatments, and end-of-life care goals. These decisions cannot and should not be reduced to checkbox protocols executed by non-physicians.
The ACR’s stance on radiologist assistants is instructive: no diagnosis, no prescribing, no image interpretation. Radiation oncologists should demand the same guardrails here. Decision-making and prescribing are physician roles, full stop.
A Misfit for the U.S. Context
Unlike in the U.K. or Canada, APRTs in the U.S. are not filling a genuine workforce void. The U.S. has radiation oncologists, APPs, therapists, and nurses already in place. Repackaging existing duties under a new title adds redundancy, confusion, and cost. Worse, it risks eroding the central role of the physician by normalizing the idea that radiation oncologists are “too busy” to manage their core duties.
The current landscape demands more treating therapists, not more niche specialist roles with undefined scope. The staffing crisis is not solved by inventing new ladders but by investing in the frontline workforce, addressing maldistribution, and creating scalable, cost-effective staffing solutions.
The National Risk of Premature Adoption
The Mount Sinai experience reflects a highly resourced institution with unique infrastructure. Context-specific gains do not equal proof of concept for a national model. With no consensus guidelines, no defined scope, and no reimbursement pathway, the APRT remains squarely in the “figuring it out” stage. To push for adoption now is premature at best—and reckless at worst.
A Call to Action for Radiation Oncologists
Radiation oncologists must engage ASTRO directly and ask the hard questions:
The time savings argument is not enough. The APRT role, as currently conceived, is a threat—not a supplement.
- Where does ASTRO stand on preventing role creep that undermines the physician’s role?
- Why endorse a role that lacks standards, guidelines, or demonstrated national need?
- How will this impact current RVUs and Salary of the Radiation Oncologist
- How will this be weaponized to do more for less to maintain margins
- How does the APRT fit with existing reimbursed roles and pathways?
Conclusion
While the enthusiasm of the Mount Sinai authors is commendable, their case is unconvincing and out of step with the realities of the U.S. market. The priorities today are clear: support the treating radiation therapist workforce, integrate technology to reduce administrative burden, and preserve the physician’s role as the central driver of decision-making and care delivery.
The APRT does not address these priorities. Instead, it risks adding complexity, cost, and liability while undermining the integrity of radiation oncology. The field should not let a subjective, single-institution pilot dictate the future of practice.
The other issue is where are the radiation oncologists at Mount Sinai that fully support this role? What is their side of the story as to the "why"? This is something fellow radiation oncologists should be asking them directly. Likely it is a passive support.
Other debunked claim. The APRT allows physicians to see more patients. This is simply not true. The data is clear that from referral to consult time remains 3-5 days. Consult to sim and sim to start times also remain consistent, with some influence by payers and prior authorization.
Side Bar:
The claim that “it’s up to the institution” whether to adopt an APRT role is a false narrative. Once a curriculum, certification, or licensure pathway is created—as is being pursued here—this is no longer a localized decision. It becomes a national issue, with regulatory, reimbursement, and workforce implications that extend well beyond a single hospital.
If the true goal were institutional flexibility, the answer would be to expand or adapt the existing scope of radiation therapists within each program—something that could be addressed through local privileging, training, and role clarification. That preserves responsiveness to local needs without imposing a top-down national certification that reshapes the profession across the board.
In short, expanding therapist duties can and should remain a localized solution. Creating an APRT license and curriculum is an attempt to formalize a new national role—and that is a very different, far-reaching proposition.
