Characteristics of Radiologists' Clinical Practice Patterns by Career Stage

Developing a Late-Career Roadmap to Continued Career Engagement

Professional development needs span the entirety of a radiologist's career. Great strides have been made in the creation of an infrastructure for early career development. Work is ongoing to develop such resources for mid-career radiologists, given the recent recognition of the needs of this group. Unfortunately, even less attention has been paid to late-career radiologist development needs as a bridge to retirement. As part of the Career Conversations series, this article will highlight the needs and currently available resources for this group.

Osteopathic Versus Allopathic Radiologist Workforce Characteristics: A Medicare Administrative and Claims Data Analysis

PURPOSE

Radiologist medical school pathways have received little attention in recent workforce investigations. With osteopathic enrollment increasing, we assessed the osteopathic versus allopathic composition of the radiologist workforce.

METHODS

Linking separate Medicare Doctors and Clinicians Initiative databases and Physician and Other Supplier Files from 2014 through 2019, we assessed (descriptively and using multivariate panel logistic regression modeling) individual and practice characteristics of radiologists who self-reported medical degrees.

RESULTS

Between 2014 and 2019, as the number of osteopathic radiologists increased 46.0% (4.7% to 6.0% of total radiologist workforce), the number of allopathic radiologists increased 12.1% (representing a relative workforce decrease from 95.3% to 94.0%). For each year since completing training, practicing radiologists were 3.7% less likely to have osteopathic (versus allopathic) degrees (odds ratio [OR] = 0.96 per year, P < .01). Osteopathic radiologists were less likely to work in urban (versus rural) areas (OR = 0.95), and compared with the Midwest, less likely to work in the Northeast (OR = 0.96), South (OR = 0.95), and West (OR = 0.94) (all P < .01). Except for cardiothoracic imaging (OR = 0.78, P = .24), osteopathic radiologists were more likely than allopathic radiologists to practice as general (rather than subspecialty) radiologists (range OR = 0.37 for nuclear medicine to OR = 0.65 for neuroradiology, all P < .01).

CONCLUSIONS

Osteopathic physicians represent a fast-growing earlier-career component of the radiologist workforce. Compared with allopathic radiologists, they more frequently practice as generalist radiologists, in rural areas, and in the Midwest. Given recent calls for greater general and rural radiology coverage, increasing osteopathic representation in the national radiologist workforce could improve patient access.

Orthopaedic Group Practice Size Is Increasing

PURPOSE

To analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020.

METHODS

We performed a retrospective cross-sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database.

RESULTS

Although we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020.

CONCLUSIONS

This study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices.

CLINICAL RELEVANCE

The impact of these changes should be examined to determine large-scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.

Radiologist-Practice Separation: Recent Trends and Characteristics

PURPOSE

To assess recent trends and characteristics in radiologist-practice separation across the United States.

METHODS

Using the Medicare Physician Compare and Medicare Physician and Other Supplier Public Use File data sets, we linked all radiologists to associated group practices annually between 2014 and 2018 and assessed radiologist-practice separation over a variety of physician and group characteristics. Multivariate logistic regression modeling was used to estimate the likelihood of radiologist-practice separation.

RESULTS

Of 25,228 unique radiologists associated with 4,381 unique group practices, 41.1% separated from at least one group practice between 2014 and 2018, and annual separation rates increased 38.4% over time (13.8% from 2014 to 2015 to 19.2% from 2017 to 2018). Radiologist-practice separation rates ranged from 57.4% in Utah to 26.3% in Virginia. Separation rates were 42.8% for general radiologists versus 38.2% for subspecialty radiologists. Among subspecialists, separation rates ranged from 43.0% for breast imagers to 33.5% for cardiothoracic radiologists. Early career status (odds ratio [OR] = 1.286) and late (OR = 1.554) career status were both independent positive predictors of radiologist-practice separation (both P < .001). Larger practice size (OR = 0.795), radiology-only (versus multispecialty) group (OR = 0.468), academic (versus nonacademic) practice (OR = 0.709), and abdominal (OR = 0.820), musculoskeletal (OR = 0.659), and neuroradiology (OR = 0.895) subspecialization were independent negative predictors (all P < .05).

CONCLUSIONS

With over 40% of radiologists separating from at least one practice in recent years, the US radiologist workforce is highly and increasingly mobile. Because reasons for separation (eg, resignation, practice acquisition) cannot be assessed using administrative data, further attention is warranted given the manifold financial, operational, and patient care implications.

Role of Multimodality Imaging in Gastroesophageal Reflux Disease and Its Complications, with Clinical and Pathologic Correlation

Gastroesophageal reflux disease (GERD) is a common condition and impairs the quality of life for millions of patients, accounts for considerable health care spending, and is a primary risk factor for esophageal adenocarcinoma. There have been substantial advances in understanding the pathogenesis of GERD and its complications and much progress in diagnosis and management of GERD; however, these have not been comprehensively discussed in the recent radiology literature. Understanding the role of imaging in GERD and its complications is important to aid in multidisciplinary treatment of GERD. GERD results from prolonged or recurrent reflux of gastric contents into the esophagus. Common symptoms include heartburn or regurgitation. Prolonged reflux of gastric contents into the esophagus can cause erosive esophagitis. Over time, the inflammatory response related to esophagitis can lead to deposition of fibrous tissue and development of strictures. Alternatively, the esophageal mucosa can undergo metaplasia (Barrett esophagus), a precursor to dysplasia (which can lead to adenocarcinoma). Conventional barium esophagography has long been considered the primary imaging modality for the esophagus, and the fluoroscopic findings for diagnosis of GERD have been well established. Multimodality imaging has a clear role in detection and assessment of the complications of GERD, specifically reflux esophagitis and Barrett esophagus; differentiation of benign and malignant strictures; and detection, staging, and posttreatment surveillance of esophageal adenocarcinoma. Given the dramatic changes in utilization of abdominal imaging during the past 2 decades, with significantly declining volume of fluoroscopic procedures and concomitant increase in CT and MRI studies, it is crucial that modern radiologists appreciate the value of barium esophagography in the workup of GERD and recognize the key imaging features of GERD and its complications at CT and MRI.

Characteristics of COVID-19 Community Practice Declines in Noninvasive Diagnostic Imaging Professional Work

PURPOSE

The operational and financial impact of the widespread coronavirus disease 2019 (COVID-19) curtailment of imaging services on radiology practices is unknown. We aimed to characterize recent COVID-19-related community practice noninvasive diagnostic imaging professional work declines.

METHODS

Using imaging metadata from nine community radiology practices across the United States between January 2019 and May 2020, we mapped work relative value unit (wRVU)-weighted stand-alone noninvasive diagnostic imaging service codes to both modality and body region. Weekly 2020 versus 2019 wRVU changes were analyzed by modality, body region, and site of service. Practice share χ2 testing was performed.

RESULTS

Aggregate weekly wRVUs ranged from a high of 120,450 (February 2020) to a low of 55,188 (April 2020). During that -52% wRVU nadir, outpatient declines were greatest (-66%). All practices followed similar aggregate trends in the distribution of wRVUs between each 2020 versus 2019 week (P = .96-.98). As a percentage of total all-practice wRVUs, declines in CT (20,046 of 63,992; 31%) and radiography and fluoroscopy (19,196; 30%) were greatest. By body region, declines in abdomen and pelvis (16,203; 25%) and breast (12,032; 19%) imaging were greatest. Mammography (-17%) and abdominal and pelvic CT (-14%) accounted for the largest shares of total all-practice wRVU reductions. Across modality-region groups, declines were far greatest for mammography (-92%).

CONCLUSIONS

Substantial COVID-19-related diagnostic imaging work declines were similar across community practices and disproportionately impacted mammography. Decline patterns could facilitate pandemic second wave planning. Overall implications for practice workflows, practice finances, patient access, and payment policy are manifold.

Differences by Practice Year in Numbers of U.S. Female Neurosurgeons

OBJECTIVE

We sought to determine the proportion and number of female neurosurgeons in the workforce at different stages of practice.

METHODS

The Physician Compare National Downloadable File data set was obtained from the Centers for Medicare & Medicaid Services for physicians who indicated "neurosurgery" as their primary specialty. Physician duplicates, physicians with no listed medical school graduation year, and physicians expected to be in residency (graduation years 2013-2019) were removed, yielding 4956 neurosurgeons. Five-year intervals were used to measure the number of male and female neurosurgeons by different stages of their careers. For example, graduates from years 2008-2012 were expected to be in their first 1-5 years of practice.

RESULTS

There were 405 female (8.2%) and 4551 male (91.8%) neurosurgeons. At 1-5 years of practice, 13.8% (105/760) were women; 6-10 years, 11.5% (94/820) women; 11-15 years, 8.9% (64/720) women; 16-20 years, 8.7% (59/682) women; 21-25 years, 7.4% (46/619) women; 26-30 years, 3.8% (20/520) women; 31-35 years, 3.6% (15/413) women; and 36 years or more, 0.5% women (2/422). The number of female neurosurgeons varied among states, ranging from 0 in Hawaii to 53 in California. The states with the lowest percentage of female neurosurgeons were Hawaii (0%), Oklahoma (3.1%), and Nevada (3.6%). The states with the highest percentage of female neurosurgeons were New Hampshire (20.0%), Vermont (16.7%), and Rhode Island (15.8%).

CONCLUSIONS

The number of practicing female neurosurgeons within the United States is increasing, as shown by the growing percentage of women who are earlier in their surgical careers.