The 2014 ACR Commission on Human Resources Workforce Survey

What Causes the Most Stress in Breast Radiology Practice? A Survey of Members of the Society of Breast Imaging

OBJECTIVE

The objective of this study is to determine the major stressors affecting practicing breast radiologists.

METHODS

All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work-life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators.

RESULTS

The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents.

CONCLUSION

The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.

Practice Characteristics of the United States General Radiologist Workforce: Most Generalists Work as Multispecialists

RATIONALE AND OBJECTIVES

While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists).

MATERIALS AND METHODS

US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters.

RESULTS

Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926).

CONCLUSION

The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.

Subspecialty Employment Needs in Academic Radiology Settings Across Canada

PURPOSE

The purpose of this survey was to identify current and projected subspecialty employment needs across Canadian academic radiology practices.

METHODS

An electronic survey was distributed to academic radiology department heads within the faculties of medicine at Canadian universities between September and October 2019. Respondents identified the number of partnership track radiologists hired in the last academic year, the number of fellowship-trained new hires, and the top 3 subspecialties for new and prospective hires. Descriptive statistics were used to summarize the data.

RESULTS

Nine academic radiology department heads responded to the survey (75% response rate) with good regional representation across Canada. Ninety-five percent of new hires within the last academic year were subspecialty fellowship trained. The top subspecialties for new hires in the last year were abdominal imaging and interventional neuroradiology, with 77.8% and 44.4% of academic leaders reporting them as one of the top 3 subspecialties, respectively. The top 3 subspecialties for prospective hires in the next academic year included musculoskeletal imaging (n = 6, 66.7%), followed by abdominal imaging (n = 5, 55.6%), with pediatric radiology (n = 3, 33.3%) and cardiothoracic imaging (n = 3, 33.3%) tying for third place. There was some variability in the subspecialty needs for hires between regions.

CONCLUSIONS

The survey results provide valuable information about the current and future subspecialty needs of academic radiology practices. The data obtained can provide guidance to trainees regarding fellowship training options that will optimize their future employability.

Imaging Practice Patterns: Referral Network Analysis of a Single State of Origination

PURPOSE

The aim of this study was to examine the referral pattern of imaging studies requested in a single state compared with the potential location of interpretation.

METHODS

Analysis of Medicare patients in a DocGraph data set was performed to identify sequential different physician services claims for the same patient for which the second claim was for services provided by a radiologist.

RESULTS

In the 2011 Medicare population, radiology referrals from physicians practicing in Georgia resulted in 76.5% of radiology interpretations by radiologists inside the state of Georgia. The states bordering Georgia accounted for 11.6% of interpretations in the Georgia market. The remaining interpretations were distributed throughout the remainder of the country.

CONCLUSIONS

A significant proportion of routine imaging interpretation occurs outside the state in which an examination is performed. Additional studies are needed to identify complex drivers of imaging referral patterns, such as patient geographic location and demographics, radiologist workforce distribution, contractual obligations, and social relationships.

Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets

RATIONALE AND OBJECTIVES

There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign.

MATERIALS AND METHODS

We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees.

RESULTS

Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand.

CONCLUSIONS

The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply.

Results of the 2015 Survey of the American Alliance of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Alliance of Academic Chief Residents in Radiology conducts an annual survey of chief residents in Diagnostic Radiology programs in North America. The survey serves as a resource for observing trends and disseminating ideas among radiology training programs.

MATERIALS AND METHODS

An online survey was distributed to chief residents at 181 residency programs, with questions on a broad range of topics including resident benefits, program and call structure, American Board of Radiology Core exam preparation, fellowships, and the job market.

RESULTS

A total of 193 individual responses were received from 120 programs, for a response rate of 66%. The responses were compared to data from prior years' surveys, principally from 2012 to 2014.

CONCLUSIONS

Programs are shifting resident benefits spending toward Core exam preparation resources and away from lead aprons. In addition, 24-hour attending coverage continues to spread among programs, and the fraction of programs providing face-to-face postcall readouts continues to decline. Finally, although resident perception of the job market is now improving, residents feel that the job market continues to discourage medical students from entering radiology, a fact borne out by the 2015 match results. How the upcoming change to a direct interventional radiology residency will affect medical student interest is as yet uncertain.