The Path to Becoming a CTR

Vol. 17 •Issue 24 • Page 18
The Path to Becoming a CTR

To help with the cancer registrar shortage, NCRA is changing the path to entry, and some registrars are creating paths of their own.

Cancer registrars listen up–the job outlook for your profession is fantastic. The bad news: the registrar reading this is more likely to be thinking about retirement than graduation day.

As the number of cancer incidence rates is rising, the need for skilled registrars is increasing. Approximately 1.4 million new cases of cancer were diagnosed in 2006, according to the American Cancer Society, and as baby boomers are aging the number is expected to grow. The 2005 Study of the Cancer Registry Workforce, conducted by the National Cancer Registrars Association (NCRA) and the University of California, San Francisco (UCSF) Center for Health Professions, estimated that there will be a need for an additional 800 cancer registrars in the next 15 years to meet workforce demand.

But as the need for registrars is going up, their numbers are slowly declining. Cancer registrars are aging—the mean age is 48—and many are retiring, but very few are coming in to fill the positions. For every three new registrars to enter the field, one is lost, according to NCRA’s Journal of Registry Management. This means that the cancer registry profession, instead of booming, is facing a tight squeeze.

The workforce study found that some of the major causes behind the shortage of cancer registrars, which include lack of publicity, recognition and low pay, can be nailed down to one central issue: the lack of a degree requirement.

The lack of a degree has kept the pay low, making it a less attractive option for career seekers; and with no clear educational pathway into the profession, cancer registrars don’t experience the same influx of new graduates coming in to fill positions that other health care professions may.

Creating a New Pathway

NCRA’s Council on Certification has responded and is changing the path to entry by upping the degree requirement to sit for the certified tumor registrar (CTR) exam to a minimum of an associate degree by 2010. In the past, candidates could sit for the exam with the minimum of a high school or general education development (GED) diploma alone (Route 1 of the exam’s five eligibility routes). By the next exam in March 2008, candidates will need a minimum of 1 year college-level courses in anatomy and/or physiology; by 2009, courses in medical science/biology and medical terminology will be added to the 1-year requirement.

For all exams in 2010, the full 2-year associate degree in an allied health field will be required, and Route 1 will be eliminated. To see the complete eligibility routes, go to This is expected to make the path into the cancer registry profession look more like a one-lane highway onto a fast-paced career than a trail anyone can walk onto at any time.

Plowing Over Roadblocks

But, wait—doesn’t this sound contradictory? A profession trying to increase the number of registrars is actually upping the requirement to enter, and even eliminating a route that according to the 2006 CTR Exam Report the majority of candidates (58 percent) chose over all the others?

True, said Sue Vest, CTR, co-chair of NCRA’s Council on Certification eligibility committee, but the issue is not how many people sit for the exam, it’s how many are certified—and the better prepared the candidate is, the better chance at success. In fact, according to the workforce study, the NCRA certification test pass rate from 1983-2004 was consistently lower for those who chose Route 1 than all the others. “We may have less people sitting, but the quality of registrars coming out of those exams will be even better,” Vest noted.

Not to mention, building a steeper path to entry is expected to plow over some of the current roadblocks. For one, Amy Fremgen, CTR, PhD, administrator of the NCRA Council on Certification, hopes to see the educational requirement increase the financial picture for registrars. The U.S. Census Bureau of Labor Statistics and NCRA Workforce Study both demonstrate higher education in general equals higher annual income–with a $2,000 a year increase for an associate degree compared to high school and $4,800 for a bachelor’s degree. “We are hoping that’s what will happen here, which should help all cancer registrars in that ‘a rising tide floats all boats.'” Dr. Fremgen remarked.

Dr. Fremgen and Vest also expect the new educational requirement to increase public recognition and credibility of the profession, making it a more attractive career choice.

“As people realize our profession is updating its educational requirement, their perceptions of our contribution to cancer research and the care of the cancer patient hopefully will increase,” Dr. Fremgen remarked.

What these benefits all add up to in helping with the cancer registry shortage is greater ammunition to recruit into the profession. Armed with an educational pathway and (hopefully) higher salaries, NCRA will now be able to approach high school counselors to show this is a viable career option–an avenue they hadn’t been able to take in the past.

“That’s where we think our greatest growth will come from,” Dr. Fremgen said. “One of the problems with the field now is the aging population. We hope to attract younger people so they’ll be around for a longer time.”

Showing HIM the CTR Avenue

The ability of the educational requirement to help with the cancer registry squeeze is hopeful, but may take a few years to be realized. NCRA currently has 12 accredited formal education programs, but some registrars have seen them cancelled due to a lack of interest.

So, until the educational requirement helps to increase the public image of the profession and build popularity of the cancer programs, some registrars are turning to already-successful HIM programs to show students seeking their registered health information technician/administrator (RHIT/RHIAs) credentials that the road to a CTR is a viable one to travel.

“There are a lot of people that have an interest in the field once they’re exposed to it, but because we’re such a small field, it’s not something most people know about,” said NCRA Recruitment and Retention Director Linda Mulvihill, RHIT, CTR. “This will provide them an entry way.”

That’s exactly what Susan Van Loon, RN, CTR, manager of the New Jersey State Cancer Registry, did when she saw Burlington County Community College (BCCC), Pemberton, NJ, cancel its certificate program for the spring session because it only had three students enrolled. She and a panel of registrars from the Oncology Registrars Association of New Jersey (ORANJ) conducted an information session in the HIM department on cancer registry as a career option in an effort to attract students to the cancer registry certificate program.

“NCRA can’t do it all,” Van Loon said. “Recruitment has to be done on the local level. We can’t depend on NCRA to staff our registries here in New Jersey.”

It was on her way to an RHIT that brought Shari Pifer, CCS, on the path to her CTR. Although Pifer previously worked in transcription and coding, she had never even heard of a cancer registrar until her HIM professor at Ferris State University, Big Rapids, MI, challenged them to sit in on a tumor board meeting.

“I was just fascinated by it,” Pifer said. “You get to see a whole different dynamic of the doctors, listening to them banter back and forth. If it wasn’t for [my professor] I never would have known about it.”

To help with this effort, the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention (CDC) and NCRA have developed a PowerPoint for CTRs to use as guest speakers in HIM programs. The presentation can be downloaded for free at

The Path Widens

For those who have found and started on the path to a cancer registrar career, be aware that once you have your CTR, the road widens. There are a number of job opportunities that stretch far beyond abstracting behind a computer.

Sandy Overton, CTR, started through the side-door like many registrars, first working for pharmaceutical companies before getting her CTR the first year the exam was given.

Now, as director of oncology services, quality improvement (QI) and education at Precyse Solutions, Overton’s days are spent in her home office designing quizzes for pre-employment testing and educational modules for her company’s 50-plus CTRs.

“It’s very rewarding to do the teaching and then see the results of education, as far as our CTRs doing well and really understanding the material,” Overton said. “It’s a whole new world of education for me. I had never worked with a Web CT platform before; it’s quite challenging to learn the new technology.”

With a team approach to the cancer registry, Toni Hare, RHIT, CTR, vice president of CHAMPS Oncology Data Services explained that the hospital’s cancer care leadership is her client. They hire her team to provide cancer registry staffing, management and consulting services, and through this, Hare and her staff of CTRs are uniquely positioned to link cancer registry data to the hospital’s strategic planning goals and play a huge part in the high-level executive decisions that are made.

“That part is definitely the most rewarding,” Hare said. “I love interpreting–looking at data and giving it a completely different perspective.”

Hare also gets to be involved in business operations that a typical registrar doesn’t, such as writing proposals and contract negotiations. It also makes good use of her enthusiastic and dynamic personality. “You have to be a communicator, not only to speak to your peers but to the medical leadership at the hospitals,” she said. “If you’re not passionate about what you’re doing, you’re not going to make it in this profession.”

Then there are the daring CTRs who have left everything secure to become entrepreneurs. Wendy Scharber, RHIT, CTR, started her company, Registry Widgets, as a private contractor to help population-based registries.

As a consultant, Scharber gets to focus on areas beyond coding and abstracting that a registry doesn’t have time for, such as facilitating requirements gathered for improving registry operations and automating processes.

Working from home has been great and allows her flexibility. “I have a 17 second commute!” she raved. But working as her own boss sometimes leads to a life of contradiction. “You can choose what you want to do but you also have to do what the client wants you to do,” she explained. “You can set your own hours but you have to be committed to working when clients need you.”

While these women may have started at the bottom with on-the-job training and went through the ranks to get where they are now, they all agreed that the game has changed.

“Gone are the days when cancer registry is strictly on-the-job training,” Hare said. “It’s too fast-paced. There is a huge difference in the type of information that needs to be collected from when I started. This requirement will produce a better quality of highly skilled people.”

Ainsley Maloney is an editorial assistant with ADVANCE.

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