The ESTRO25 session on radiation therapist (RTT) recruitment and retention was  organised in cooperation with the International Atomic Energy Agency. The session followed a panel discussion on the RTT scope of practice, in which advanced practice and the professional/role development of RTTs in modern radiotherapy were discussed. This lively discussion linked nicely into this session, in which the speakers reported on their experiences of and approaches to specific challenges in RTT recruitment and retention. In many cases, these were linked to the reduced availability of human workforce in radiotherapy and the demographics of modern European society , which are issues in a lot of countries that cause challenges and strain.

The session was opened by Velimir Karadza from the University of Applied Science in Zagreb (Croatia). He gave an insight into the challenges of the situation in low- or middle-income countries, as well as those that are transitioning to become upper-income countries. Typically, these countries focus on increasing the availability of radiotherapy while simultaneously bringing it up-to-date in terms of technology. This results in an increased need for RTTs and the necessity to ensure that RTT education meets the needs of modern radiotherapy. While this in itself is a challenge, additional brain drain - well-educated or experienced RTTs leaving for better wages or working conditions – is making the situation ever more challenging. He summed up by underpinning the importance of offering adequate specialised RTT education and a professional identity to RTTs, and the need for formal recognition of higher levels of education and the implementation of career structures to reduce brain drain and address staff retention.

Lizanne Breedt from the Radiotherapy Department at the Erasmus Medical Center in Rotterdam (The Netherlands) followed as the second speaker. She reported on their experience of close collaboration with educators across topics that ranged from promotion of the profession through addressing students' needs to active addressing of opportunities for practical placements and the offering of attractive contracts to those who were unsure of the specialisation they were aiming for. Additionally, they collaborated with their human resources and communication departments to increase visibility and awareness of the profession among the public. Simultaneously, they worked to foster positive employer branding through emphasis on career opportunities and a collaborative work environment, the availability of flexible contracts, support for continuous education, commitment to personal and professional growth, and the possibility to train for and work with the latest radiotherapy equipment.

Following that, Elizabeth Joyce from the Radiotherapy Department of the Royal Marsden Hospital (London, UK) discussed the importance of adequate onboarding. She highlighted how structured onboarding would clearly define the job role and align expectations of the employee with those of the employer in order to reduce the chance of negative experiences. She also discussed how supervisors, given enough time, could not only help to consolidate new RTTs’ clinical skills but also offer strategies to cope with the emotional toll of cancer care and hence to prevent moral injury or burnout. She continued by highlighting the importance of career progression and continuing professional development, support to undertake, and dedicated time for lifelong learning.. Furthermore, she explained how preceptorship and mentorship programmes could be utilised not only to support early-career professionals but also to link RTTs throughout their different career stages within the department who had similar professional interests and could relate to each other. Such links would increase the likelihood that they would continue their RTT careers, and their professional growth would support radiotherapy service delivery.

Last but not least, Christoph Grubmüller from the University Clinic for Radiotherapy at the Salzburg County Hospital (Austria) gave an insight into health promotion. He set the scene by reporting how continuously changing, technology-driven working environments and the interaction-intensive work with cancer patients were affecting the radiotherapy team and especially RTTs. He highlighted that the rising number of absence days due to physical and mental issues was putting additional strain on the availability of staff and he explained the importance of occupational safety, ergonomic workspaces, as well as regulated working and rest times. While many employers manage to address those first steps, he clarified that health promotion goes beyond that, as it should address topics such as nutrition, physical activity and mental health. He highlighted the necessity to achieve a high rate of employee participation and visible commitment to these issues at all organisational levels. He demonstrated a few practical examples and discussed why health promotion was a desirable goal: it brought benefits for employers and employees and had positive impacts on staff retention.

The session resulted in a lively and positive discussion with interesting questions for the speakers, highlighting the importance of and interest in this topic. Audience members and speakers equally highlighted the importance of actively addressing the current shortage of RTTs through action at all possible levels, from professional identity and public awareness to education, training and addressing the needs of current RTT colleagues to improve retention rates.

Philipp Scherer
University Clinic for Radiotherapy and RadioOncology of the PMU
County Hospital Salzburg
Salzburg, Austria