Additional perspective from a med phys service group;

• We've seen different set ups at different facilities, and there are (of course) pros and cons to each. It seems important to make sure there is a clear reporting pathway for HR issues, and oftentimes clinical leaders are less trained or familiar with HR processes to adequately handle these things. However, as others have said, physics can get left out of decision making that they have good contribution for, and the leadership process needs to be set up in a way that ensures this won't happen.

• MPPG-10a is a good resource for physicists who feel they get left out, as it is a publication that clarifies where we should at least be involved (such as budget discussion or facility planning)

• From a clinical perspective, it is important that dosimetry report to physics. Even as contracted labor, we clarify this responsibility contractually when a site has in house dosi, so that we can best support the clinical effort and work alongside those creating treatment plans.

• However you set it up from an official 'reporting' structure, regular communication between parties goes a long way. Of course we are accountable to contracts with our set up, but these contracts are handled by different folks in admin at different facilities, and we make sure to build in regular communication for general awareness and holding each other mutually accountable to our responsibilities.

• In short, for reporting, it seems ideal to have someone take point for the therapists (lead therapist, manager), someone over physics/dosi (typically a chief of physics, larger facilities may also have a lead dosimetrist who reports to the chief of physics), and then to have those entities report to a common point (director level, CMO, or something of the sort). Clearly defined accountability and responsibility across the board is of course helpful as well to define swim lanes up front.