Honey, They're Sending Me to Kathmandu!

What It's Really Like to be an APEx Surveyor

"Honey! They're sending me to Kathmandu. Or is it Kalamazoo? Oh wait, it’s Kuruvilla. Somewhere cool, I’m sure. Can you help me look at flights?"

My wife barely looks up. She's heard this before.

Every time ASTRO staff reach out with a new APEx facility visit assignment, there's a familiar flurry. Pull up the clinic schedule, figure out which colleagues can cover, check flight options, debate whether to try for the red-eye home or spend another night. There's logistics. There's calendar Tetris. And honestly? There's always a little bit of jitters, a new facility, a new team, a new city, and a responsibility not taken lightly.

She gives me that look. "Why do you keep putting yourself through this?"

It's a fair question. Busy clinic, a kid with after-school and weekend activities, commitments, a life. Nobody's really making me do this. So why do I keep saying yes?

Service to ASTRO. They've given me a lot; this is a way to give back.

Quality is my jam. Literally in my job title.

It's actually fun. After the logistics part, anyway.

The people are really, really nice.

And sometimes... it's Kathmandu. Or somewhere else pretty cool.

Let me back up and explain what this is all about, and why more radiation oncologists should consider joining the APEx Surveyor corps.

What is APEx and What do Surveyors Actually do?

For those unfamiliar, APEx — Accreditation Program for Excellence®, is ASTRO's practice accreditation program. It's a comprehensive, peer-reviewed process designed to help radiation oncology practices measure themselves against established standards of quality and safety. Think of it as a structured opportunity for a practice to critically review its processes, with the help of trained colleagues who understand the complexities of what we do each day.

That's where surveyors come in. We're the colleagues who show up (in person or virtually), review the practice against APEx Standards, and provide feedback. Not inspectors. Not there to play "gotcha." We’re peers, radiation oncologists and medical physicists, who volunteer our time because we believe in improving the quality of radiation oncology care.

A Day in the Life: What a Facility Visit Actually Looks Like

Getting There

ASTRO staff do a great job regionalizing the process and minimizing travel times. Sometimes it's just a quick flight and cab ride. Sometimes it’s a longer drive to a rural community practice. Either way, there’s an opportunity to meet colleagues who might not cross our paths at national meetings.

Staff provide a fair bit of lead time before a scheduled facility visit, which helps greatly with the juggle of carving time out from a busy work and personal life.

The Survey Day

The on-site portion is nearly a full day, which is structured but not rigid. Here's the general flow:

• Meeting the clinical team. The facility visit starts by sitting down with the radiation oncologists, physicists, dosimetrists, therapists, nurses and administrative leaders. Right away, there’s a sense of the practice culture: how they communicate, how they approach patient care, what they're proud of, and where they know they have room to grow.
• Medical Record Review. This is the core part of the compliance assessment. Records are reviewed against established APEx Standards, including documentation, treatment planning, quality assurance, safety protocols and more. It's detailed work, but it's the kind that ensures quality care delivery.
• Physics Interview. At the same time as the medical record review, a medical physicist surveyor meets with the practice’s medical physics team, reviewing equipment and QA processes.
• Team Interview. Often, the best part. We sit down with the broader clinical and administrative team for a real conversation about how they practice. What are their workflows? How do they handle incidents? What does their peer review look like? It's structured, but it feels like a professional dialogue rather than an interrogation.
• Wrap-up. Preliminary observations are not shared on site. The details are submitted back to ASTRO for a more detailed review and assessment through the Practice Accreditation Subcommittee. Practices are notified later regarding overall results and potential areas for improvement.

Getting Home

Sometimes it’s possible to get back the same night, a bit late, but ready for clinic the next morning. Other times, geography and flights don’t cooperate, and it's an evening to explore the local town before traveling home the next morning.

Why I Keep Doing It

There’s always something to learn.

This might be the most selfish reason on the list, and the truest. We all get stuck in institutional ruts. Things get done in a certain way because that's how the practice has always done them. Workflows feel normal because they’re familiar. Whether there’s a better approach often doesn’t get asked because everyone’s busy executing the current one.

Surveying breaks that cycle.

Every practice visited reveals something different. A creative approach to clinic workflows. A robust peer review process. A novel safety culture initiative. What I’ve seen on facility visits has changed my sense of what’s possible, and that’s not a small thing.

We get to help.

On the flip side, there are times during a facility visit when practice patterns surface that could benefit from improvement. Maybe documentation is inconsistent. Maybe there's a gap in a safety protocol. Maybe a quality assurance process isn't quite aligned with current standards.

Being able to identify those opportunities, and share them constructively, so that a facility can genuinely improve the quality of care for its patients? That's deeply meaningful work. It's not about pointing fingers. It's about helping colleagues deliver the best possible care. Isn’t that why most of us went into medicine in the first place?

The people are genuinely great.

The ASTRO staff who coordinate surveys are professional, supportive and respectful of surveyors’ time. The facility teams are almost universally welcoming. They've volunteered for this process, after all. They want to be evaluated. They want to improve. That creates a dynamic that's collaborative rather than adversarial, and it makes the whole experience genuinely pleasant.

And fellow surveyors? They’re colleagues who share a commitment to quality, and who share the logistics jitters.

It's service and it matters.

ASTRO shapes our careers in so many ways: education, community, advocacy and professional identity. Serving as a surveyor is one of the most tangible ways to give back. It's direct. It's impactful. And it connects us to the mission of ASTRO. In recognition of this, each facility visit also awards surveyors service points toward the FASTRO designation.

What It Takes: The Practical Stuff

The path to becoming an APEx Surveyor varies. Some surveyors come through the Practice Accreditation Subcommittee route, which is how it started for me, nearly four years ago. Others volunteer directly. I’ve met colleagues who have been doing this since the APEx program first launched in 2014.

Each of us performs a different number of facility visits per year, depending on availability. ASTRO works hard to coordinate schedules. Surveyors can indicate their preferences and are never pressured to take on more than they can handle. On average, it works out to approximately one survey per quarter.

In terms of preparation, ASTRO provides thorough resources:

• Formal training before a first assignment
• Standards Guide and Surveyor Guide so surveyors know exactly what we’re evaluating
• Ongoing support from ASTRO staff throughout the process

APEx now offers both in-person and virtual facility visits, and surveyors can select the format that works best for them. About half of current surveyors do exclusively in-person visits, while the rest perform a mix of both.

The Data Backs It Up

Our specialty is data-driven, so it’s worth mentioning that ASTRO regularly evaluates both surveyor and facility experience. The satisfaction numbers are consistently high on both sides. Surveyors report that the experience is valuable and well-organized. Facilities report that their facility visit teams are professional, knowledgeable and constructive. That's not an accident. It reflects a program that's been thoughtfully designed and a community that takes this work seriously while keeping it collegial.

The Ask

So, here's the pitch, and yes, it’s a pitch.

APEx needs more radiation oncologist surveyors.

The program is growing. More practices are seeking accreditation. And the program’s quality depends on having a deep, diverse and engaged pool of physician surveyors who bring real-world clinical perspectives to every review.

If quality matters to you, and if you've read this far, I'm confident it does; this is one of the most direct, tangible ways to make an impact beyond your own clinic walls. You'll serve your profession. You'll sharpen your own practice. You'll meet great people. And occasionally, you'll get sent somewhere cool.

Maybe even Kathmandu.

Ready to learn more? Visit the APEx Surveyor page on astro.org or reach out to APEx Support to start the conversation.

William C. Chen, MD, Zucker School of Medicine at Hofstra/Northwell - Director of Clinical Affairs, Northwell Health Cancer Institute, Vice Chair of Radiation Medicine, Quality and Safety, and member of ASTRO's Practice Accreditation Subcommittee and an APEx Surveyor.