Update on ACRO’s Position on Supervision in Radiation Oncology

The American College of Radiation Oncology (ACRO) is pleased to release the following update concerning our position on supervision requirements for the delivery of radiation therapy. Since 2019, ACRO has advocated for a uniform level of supervision across sites of service with reasonable exceptions. This topic has been the source of significant discussion over recent months. As such the College has taken a deliberate, methodical, and informed approach to gather feedback from the radiation oncology community. ACRO has conducted two separate surveys on this matter gathering input from both member and non-member radiation oncologists in every state and every practice setting.  

The findings conveyed include the following:

1. Direct and general supervision have a role in safe, quality care delivery when used responsibly. 
2. Some degree of flexibility at the discretion of the Radiation Oncologist is warranted in all sites of service. 
3. Certain treatments demand direct supervision at each session, while other treatments may only require direct supervision at the initiation of therapy.
4. Supervision requirements with reasonable exceptions should be unrelated to site of service and geographic location.  
5. Variations in supervision requirements based on advances in technology (e.g. “virtual direct supervision”) should be considered after further review in the future. 

At the end of 2023, ACRO performed the most robust nationwide survey of which we are aware, conducted over five months with participation from over 500 Radiation Oncologists in all practice settings and representing every state across the USA. The study, entitled, “Consensus on Payment Model Reform amongst Radiation Oncologists: The Radiation Oncology Payment Reform Survey” was authored by Dr. Joseph Wilding and colleagues, and presented at the 2024 ACRO Summit with the following key finding: 

• 69% of practicing U.S. Radiation Oncologists agree or strongly agree with site-neutral direct supervision requirements with limited exceptions. This finding reflected general agreement across the community and included responses from Radiation Oncologists in academic hospitals and veterans’ healthcare centers as well as hospital-based and freestanding sites-of-service. 

ACRO most recently conducted a second survey to gather additional feedback directly from its members. With 142 respondents, the key findings from the survey are as follows:

• 94% of ACRO Members surveyed believe Radiation Oncologists are the only healthcare providers comprehensively trained in treatment and management of radiation therapy patients.
• 64% of respondents believe direct supervision should be the standard across sites-of service at the initiation of radiation therapy.
• 86% of respondents indicated general supervision should be allowed at the discretion of the Radiation Oncologist, after the initiation of radiation therapy.
  
  

We are grateful for this feedback from the Radiation Oncology community. An informed and thoughtful approach to these complex issues is essential. This feedback will be incorporated into an updated consensus statement to be released by ACRO in the coming days.

Sincerely,

Tarita Thomas, MD, PhD, MBA, FACRO

Chair, ACRO Government Relations & Economics Committee

Dwight E. Heron, MD, MBA, FACRO, FACR, FASTRO

ACRO President