The 2017 ACR Commission on Human Resources Workforce Survey

Disparities in Radiologist Fee-For-Service Payments by Gender in Canada

Objective: To examine differences in fee-for-service (FFS) payments to men and women radiologists in Canada and evaluate potential contributors. Methods: Publicly available FFS radiology billing data was analyzed from British Columbia (BC), Ontario (ON), Prince-Edward Island (PEI) and Nova Scotia (NS) between 2017 and 2021. Data was analyzed by gender on a per-province and national level. Variables evaluated included year, province, procedure billings, and days worked (BC and ON only). The gender pay gap was expressed as the difference in mean billing payments between men and women divided by mean payments to men. Results: Data points from 8478 radiologist years were included (2474 [29%] women and 6004 [71%] men). The unadjusted difference in annual FFS billings between men and women was $126,657. Overall, payments to women were 81% of payments to men with a 19% gender pay gap. The difference in billings between men and women did not change significantly between 2017 and 2021 (range in gender pay gap, 17-21%) but did vary by province (highest gap NS). Compared to men, women worked fewer days per year (weighted mean 218 ± 29 vs 236 ± 25 days/year, P < .001, 8% difference). Conclusion: In an analysis of fee-for-service payments to radiologists in 4 Canadian provinces between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap. Payments were lower to women across all years evaluated. Women worked 8% fewer days per year on average than men, which did not fully account for the difference in FFS billing payments between men and women. Summary Statement: In an analysis of fee-for-service payments to Canadian radiologists between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap which is not fully accounted for by time spent working.

Radiologist age and diagnostic errors

PURPOSE

Previous investigations into the causes of error by radiologists have addressed work schedule, volume, shift length, and sub-specialization. Studies regarding possible associations between radiologist errors and radiologist age and timing of residency training are lacking in the literature, to our knowledge. The aim of our study was to determine if radiologist age and residency graduation date is associated with diagnostic errors.

METHODS

Our retrospective analysis included 1.9 million preliminary interpretations (out of a total of 5.2 million preliminary and final interpretations) of imaging examinations by 361 radiologists in a US-based national teleradiology practice between 1/1/2019 and 1/1/2020. Quality assurance data regarding the number of radiologist errors was generated through client facility feedback to the teleradiology practice. With input from both the client radiologist and the teleradiologist, the final determination of the presence, absence, and severity of a teleradiologist error was determined by the quality assurance committee of radiologists within the teleradiology company using standardized criteria. Excluded were 3.2 million final examination interpretations and 93,963 (1.8%) of total examinations from facilities reporting less than one discrepancy in examination interpretation in 2019. Logistic regression with covariates radiologist age and residency graduation date was performed for calculation of relative risk of overall error rates and by major imaging modality. Major errors were separated from minor errors as those with a greater likelihood of affecting patient care. Logistic regression with covariates radiologist age, residency graduation date, and log total examinations interpreted was used to calculate odds of making a major error to that of making a minor error.

RESULTS

Mean age of the 361 radiologists was 51.1 years, with a mean residency graduation date of 2001. Mean error rate for all examinations was 0.5%. Radiologist age at any residency graduation date was positively associated with major errors (p < 0.05), with a relative risk 1.021 for each 1-year increase in age and relative risk 1.235 for each decade as well as for minor errors (p < 0.05, relative risk 1.007 for each year, relative risk 1.082 for each decade). By major imaging modality, radiologist age at any residency graduation date was positively associated with computed tomography (CT) and X-ray (XR) major and minor error, magnetic resonance imaging (MRI) major error, and ultrasound (US) minor error (p < 0.05). Radiologist age was positively associated with odds of making a major vs. minor error (p < 0.05).

CONCLUSIONS

The mean error rate for all radiologists was low. We observed that increasing age at any residency graduation date was associated with increasing relative risk of major and minor errors as well as increasing odds of a major vs. minor error among providers. Further study is needed to corroborate these results, determine clinical relevance, and highlight strategies to address these findings.

Medical workforce in the United States

This section focuses on the professional workforce comprised of the primary medical specialties that utilize ionizing radiation in their practices. Those discussed include the specialties of radiology and radiation oncology, as well as the subspecialties of radiology, namely diagnostic radiology, interventional radiology, nuclear radiology, and nuclear medicine. These professionals provide essential health care services, for example, the interpretation of imaging studies, the provision of interventional procedures, radionuclide therapeutic treatments, and radiation therapy. In addition, they may be called on to function as part of a radiologic emergency response team to care for potentially exposed persons following radiation events, for example, detonation of a nuclear weapon, nuclear power plant accidents, and transportation incidents. For these reasons, maintenance of an adequate workforce in each of these professions is essential to meeting the nation's future needs. Currently, there is a shortage for all physicians in the medical radiology workforce.

Analysis of gender in radiology in Australia and its importance to the profession and workforce planning

Medical workforce diversity is important with gender constituting a significant role. Male and female medical practitioners participate in the workforce differently: understanding the cultural and social expectations, economic productivity, professional opportunities, and the effects on workforce supply, will aid workforce planning. Having a workforce that reflects the diversity of the community is important in providing patient-centred care. As more than half of medical graduates are female, it would be expected that this is reflected in radiology specialty. We analyse the Australian gender-specific data from the Royal Australian and New Zealand Clinical Radiology (RANZCR) clinical radiology workforce census from 1992 to 2020, focusing on changes in gender representation, number of hours worked per week, differences in subspecialisation and geographical distribution. This analysis found that the proportion of the female radiologists increased from 13% to 29%: still an underrepresentation of women radiologists when compared with the gender distribution of medical students and junior doctors. This will persist in the short to medium term, given the tapering of female doctors entering radiology training. In terms of workforce planning, women are more likely to work less than their male counterparts in the early to mid-career. Women are underrepresentated in interventional and neurointerventional radiology. There is more self-reported subspecialty interest in breast and women's imaging. A review of the literature demonstrated a similar situation in comparable countries. We also considered the reasons, potential solutions for this, and knowledge gaps where research is needed.

Academic Radiology in the United States: Defining Gender Disparities in Faculty Leadership and Academic Rank

RATIONALE AND OBJECTIVES

Female physicians in academic medicine have faced barriers that potentially affect representation in different fields and delay promotion. Little is known about gender representation differences in United States academic radiology departments, particularly within the most pursued subspecialties.

PURPOSE

To determine whether gender differences exist in United States academic radiology departments across seven subspecialties with respect to academic ranks, departmental leadership positions, experience, and scholarly metrics.

MATERIALS AND METHODS

In this cross-sectional study from November 2018 to June 2020, a database of United States academic radiologists at 129 academic departments in seven subspecialties was created. Each radiologist's academic rank, departmental leadership position (executive-level - Chair, Director, Chief, and Department or Division Head vs vice-level - vice, assistant, or associate positions of executive level), self-identified gender, years in practice, and measures of scholarly productivity (number of publications, citations, and h-index) were compiled from institutional websites, Doximity, LinkedIn, Scopus, and official NPI profiles. The primary outcome, gender composition differences in these cohorts, was analyzed using Chi² while continuous data were analyzed using Kruskal-Wallis rank sum test. The adjusted gender difference for all factors was determined using a multivariate logistic regression model.

RESULTS

Overall, 5086 academic radiologists (34.7% women) with a median 14 years of practice (YOP) were identified and indexed. There were 919 full professors (26.1% women, p < 0.01) and 1055 executive-level leadership faculty (30.6% women, p < 0.01). Within all subspecialties except breast imaging, women were in the minority (35.4% abdominal, 79.1% breast, 12.1% interventional, 27.5% musculoskeletal, 22.8% neuroradiology, 45.1% pediatric, and 19.5% nuclear; p < 0.01). Relative to subspecialty gender composition, women full professors were underrepresented in abdominal, pediatric, and nuclear radiology (p < 0.05) and women in any executive-level leadership were underrepresented in abdominal and nuclear radiology (p < 0.05). However, after adjusting for h-index and YOP, gender did not influence rates of professorship or executive leadership. The strongest single predictors for professorship or executive leadership were h-index and YOP.

CONCLUSION

Women academic radiologists in the United States are underrepresented among senior faculty members despite having similar levels of experience as men. Gender disparities regarding the expected number of women senior faculty members relative to individual subspecialty gender composition were more pronounced in abdominal and nuclear radiology, and less pronounced in breast and neuroradiology. Overall, h-index and YOP were the strongest predictors for full-professorship and executive leadership among faculty.

KEY RESULTS

● Though women comprise 34.7% of all academic radiologists, women are underrepresented among senior faculty members (26.1% of full professors and 30.6% of executive leadership) ● Women in junior faculty positions had higher median years of practice than their male counterparts (10 vs 8 for assistant professors, 21 vs 13 for vice leadership) ● Years of practice and h-index were the strongest predictors for full professorship and executive leadership.

Approaching diversity and inclusion in the radiology department

There are numerous benefits to increasing diversity and inclusion within our radiology departments, and both areas need to be a part of our core mission to garner real change. A diverse and inclusive radiology department not only benefits the radiology department, but also our patients and society as a whole. Our paper provides our thoughts on a practical step-by-step guide on how to increase both diversity and inclusion within the radiology workplace, such that every voice can be heard, and every person can be seen.

Impact of Biases in Selection and Evaluation on the Composition of the Radiology Physician Workforce

Lack of diversity in Radiology is a public health problem and may be self perpetuating as diverse candidates view the field as hostile to their entry and advancement, and consequently do not apply into the field. Solutions require understanding the obstacles, which range from enrollment in medical school to achieving leadership positions in Radiology. An understanding of the effect of demographic data on diversity in Radiology, disparate effects of Step examinations, medical school grades and induction into academic honor societies, and existing faculty disparities will allow us to better recruit, train, and retain a diverse group of physicians in our field. The downstream effect of a diverse workforce is improvement in health outcomes and disparities in medical care for our communities.

Medical Student Ultrasound Education: The Radiology Chair Weighs In

ABSTRACT

To assess the radiology department chairs' opinions concerning current status and plans for teaching ultrasound to medical students, the American College Taskforce on Radiology Ultrasound Education, commissioned by the American College of Radiology, distributed a survey to 142 radiology chairs and a medical school dean subgroup.The response rate was 30% (42/142), and 76% indicated ultrasound was currently part of the medical student curriculum. In preclinical years, radiology involvement was only 6.4%. During clinical years, radiology led ultrasound education with 51.7% in general and 82.9% in elective rotations. Regarding actual content, top 4 results were evenly distributed between learning hands-on scanning (81.1%), diagnostic use of ultrasound (75.7%), anatomy/pathology (75.7%), and ultrasound guidance for procedures (54.0%). Educational leaders in preclinical courses were emergency medicine (72.7%) followed by radiology (45.4%) physicians. During clinical years, leaders were radiology (52.6%) and emergency medicine (47.4%) physicians. Most chairs stated that knowledge of diagnostic ultrasound should be mandatory (76.2%), stressing the importance of teaching the diagnostic capabilities and uses of ultrasound as the primary goal (78.8%). Perceived barriers to implementation were evenly distributed between lack of space in the curriculum (55.6%), lack of faculty (48.2%), lack of resources (44.4%), and lack of institutional support (40.7%). The American College Taskforce on Radiology Ultrasound Education survey shows that radiology's role in ultrasound undergraduate education occurs almost exclusively during clinical years, and the chairs voice a desire to improve upon this role. Barriers include both intradepartmental (faculty and resources) and institutional (curricular) factors.

The Current State of Nuclear Medicine and Nuclear Radiology: Workforce Trends, Training Pathways, and Training Program Websites

BACKGROUND

Nuclear medicine (NM) is a multidisciplinary field. Its overlap with nuclear radiology (NR) creates unique training considerations, opportunities, and challenges. Various factors impact the workforce, training needs, and training pathways. This state of flux may be perplexing to prospective NM/NR trainees.

PURPOSE

To evaluate the state of NM/NR training by assessing the (1) workforce trends and job prospects for NM/NR trainees, (2) NM and NR training pathways, and (3) applicant-accessible online presence of training programs.

METHODS

Workforce trends were analyzed using data collected from the 2017 American College of Radiology Commission on Human Resources Workforce Survey. Information regarding the training pathways leading to board certification(s) for NM and NR physicians were obtained through the American Board of Nuclear Medicine, the American Board of Radiology (ABR), and the Society of Nuclear Medicine and Medical Imaging. Each Accreditation Council for Graduate Medical Education-accredited NM residency or NR fellowship training program's website was reviewed for 20 content items to assess its comprehensiveness for those seeking information regarding eligibility, applications, training curriculum, and program characteristics.

RESULTS

Number of hires for NM/NR physicians has exceeded the projected number of hires from 2014 to 2017. In the last decade, there has been a greater than 25% decrease in the combined number of traditional NM residencies and NR fellowships (79-58 programs) and a greater than 50% decrease in the combined number of NM and NR trainees (173-82 trainees). In 2017, the ABR redesigned its 16-month pathway leading to specialty certification in diagnostic radiology and subspecialty certification in NR. As of March 24, 2019, there are 36 diagnostic radiology or IR residency programs with 64 trainees participating in this redesigned NR pathway. Of the 93.1% (54/58) of traditional Accreditation Council for Graduate Medical Education-accredited NM and NR training programs having websites in the 2017-2018 academic year, the mean number of online criteria met per program was 7.74 ± 3.2 of 20 (38.7%).

CONCLUSION

Recruitment into the traditional NM/NR training pathways has been steadily declining, but there has been a renewed interest with the redesigned ABR 16-month pathway. There is a paucity of online information available to prospective NM/NR applicants. In this rapidly evolving and unique field, it is important to streamline NM/NR training and bolster the information accessible to potential NM/NR applicants as they weigh career options.

Do Gender Disparities Among Major Radiological Society Award Recipients Exist?

RATIONALE AND OBJECTIVES

To investigate gender representation among recipients of physician awards presented by major radiological societies.

MATERIALS AND METHODS

We analyzed records of distinguished awards recipients given by four major radiological societies from 2000 to 2018. Included awards were those intended for attending physician recipients primarily involved in clinical and educational work which recognized accomplishments over the course of a career. Awards were assigned into one of two categories: awards focused on education or awards focused on leadership or overall contributions. Primary outcome measure was total numbers and proportions of award recipients by gender.

RESULTS

During the entire study period, the proportion of female academic radiologists increased from 23.6% in 2000 to 29.6% in 2018 (25.4%). Of the 164 awards recognizing leadership or overall contributions, 35 were awarded to females (21.3%) and 129 to males (78.7%). Of the 29 awards recognizing excellence in teaching, 13 were awarded to females (44.8%) and 16 to males (55.2%). Men were significantly more likely than women to receive leadership awards over the entire study period (p < .001).

CONCLUSION

Females are underrepresented among recipients of prestigious leadership awards. In contrast, females are overrepresented among recipients of major teaching awards suggesting a general perception among members of major radiological societies that females are superior teachers and inferior leaders. This finding underscores the importance of continued improvement in female representation in radiology in order to foster a high quality teaching environment as well as continued attention to the fact that females are underrepresented in leadership roles.

Variation in Technical Quality of Breast MRI

PURPOSE

Breast magnetic resonance imaging (MRI) quality may vary across the United States. Our aim was to investigate the quality of outside breast MRIs presenting for second opinion at a tertiary cancer center following implementation of the American College of Radiology (ACR) Breast MRI Accreditation Program.

MATERIALS AND METHODS

We retrospectively reviewed the technical quality of the MRI studies of 100 consecutive cases submitted for second opinion in 2013. The image quality was blindly reviewed per ACR Breast MRI Accreditation Program by three fellowship-trained breast radiologists and one breast imaging fellow.

RESULTS

In total, 88 of the 100 cases were referred from facilities in the United States. Sixty (68%) of the 88 cases had at least one technical deficiency. In 10 cases (11%), more than five different technical deficiencies occurred. The most frequently encountered deficiencies were related to artifacts (74%), with shimming (N = 17) and motion (N = 16) being the most common. In total, 38% of cases (N = 33) had a deficient T2-weighted sequence, mostly due to low signal to noise ratio (N = 25). A total of 27% cases (N = 24) had deficiencies in the delayed phase postcontrast T1-weighted sequence, mainly due to low signal to noise ratio (N = 21) and 23% had deficiencies in the early phase postcontrast T1-weighted sequence, predominantly due to low signal to noise ratio as well. (N = 19).

CONCLUSION

Our study demonstrates variability of breast MRI quality across the United States. Radiologists should become familiar with the requirements of the ACR breast MRI accreditation program and strive to meet the expected standards in order to enhance patient quality and safety.

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.

Characteristics of Radiologists' Clinical Practice Patterns by Career Stage

PURPOSE

To assess characteristics of radiologists' clinical practice patterns by career stage.

METHODS

Radiologists' 2016 billed services were extracted from the Medicare Physician and Other Supplier Public Use File. Billed clinical work was weighted using work relative value units. Medical school graduation years were obtained from Medicare Physician Compare. Practice patterns were summarized by decades after residency.

RESULTS

Among 28,463 included radiologists, 32.7% were ≤10 years postresidency, 29.3% 11-20 years, 25.0% 21-30 years, 10.5% 31-40 years, 2.4% 41-50 years, 0.1% ≥51 years. Billed clinical work (normalized to a mean of 1.00 among all radiologists) ranged 0.92-1.07 from 1 to 40 years, decreasing to 0.64 for 41-50 years and 0.43 for ≥51 years. Computed tomography represented 34.7%-38.6% of billed clinical work from 1 to 30 years, decreasing slightly to 31.5% for 31-40 years. Magnetic resonance imaging represented 13.9%-14.3% from 1 to 30 years, decreasing slightly to 11.2% for 31-40 years. Ultrasonography represented 6.2%-11.6% across career stages. Nuclear medicine increased steadily from 1.7% for ≤10 years to 7.0% for 41-50 years. Mammography represented 9.9%-12.9% from 1 to 50 years. Radiography/fluoroscopy represented 15.1%-29.8% from 1 to 50 years, but 65.9% for ≥51 years.

CONCLUSION

The national radiologist workforce declines abruptly by more than half approximately 30 years after residency. Radiologists still working at 31-40 years, however, contribute similar billed clinical work, both overall and across modalities, as earlier career radiologists. Strategies to retain later-career radiologists in the workforce could help the specialty meet growing clinical demands, mitigate burnout in earlier career colleagues, and expand robust patient access to both basic and advanced imaging services.

Attitudes toward artificial intelligence in radiology with learner needs assessment within radiology residency programmes: a national multi-programme survey

INTRODUCTION

We aimed to assess the attitudes and learner needs of radiology residents and faculty radiologists regarding artificial intelligence (AI) and machine learning (ML) in radiology.

METHODS

A web-based questionnaire, designed using SurveyMonkey, was sent out to residents and faculty radiologists in all three radiology residency programmes in Singapore. The questionnaire comprised four sections and aimed to evaluate respondents' current experience, attempts at self-learning, perceptions of career prospects and expectations of an AI/ML curriculum in their residency programme. Respondents' anonymity was ensured.

RESULTS

A total of 125 respondents (86 male, 39 female; 70 residents, 55 faculty radiologists) completed the questionnaire. The majority agreed that AI/ML will drastically change radiology practice (88.8%) and makes radiology more exciting (76.0%), and most would still choose to specialise in radiology if given a choice (80.0%). 64.8% viewed themselves as novices in their understanding of AI/ML, 76.0% planned to further advance their AI/ML knowledge and 67.2% were keen to get involved in an AI/ML research project. An overwhelming majority (84.8%) believed that AI/ML knowledge should be taught during residency, and most opined that this was as important as imaging physics and clinical skills/knowledge curricula (80.0% and 72.8%, respectively). More than half thought that their residency programme had not adequately implemented AI/ML teaching (59.2%). In subgroup analyses, male and tech-savvy respondents were more involved in AI/ML activities, leading to better technical understanding.

CONCLUSION

A growing optimism towards radiology undergoing technological transformation and AI/ML implementation has led to a strong demand for an AI/ML curriculum in residency education.

Development of an early warning resilience survey for healthcare organizations

OBJECTIVE

To design and validate a brief set of measures identifying staff and work areas exhibiting low levels of resilience within healthcare organizations.

DATA SOURCES/STUDY DESIGN

Primary data were gathered via survey administration between April and August of 2016 from 33,622 respondents across 123 facilities. These surveys included pilot items designed to measure resilience and were administered to all employees alongside employee engagement surveys.

DATA COLLECTION/EXTRACTION METHODS

Following the data collection period for the pilot survey, data from all organizations were integrated into a single analytical dataset. Factor analyses were used to determine the underlying constructs of healthcare worker resilience. Cronbach's alpha and correlation analyses tested the internal consistency and validity of the instrument.

PRINCIPAL FINDINGS

A brief set consisting of eight items was identified as a psychometrically validated measure of resilience. This measure consists of two subscales, Activation and Decompression. These measures exist independent of employee engagement, indicating an empirical distinction between the two concepts. Resilience was found to predict 38% of variance in engagement scores.

CONCLUSIONS

An eight-item instrument can accurately measure resilience to identify burnout risk and serve as a predictor of other workforce outcomes such as engagement.

The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at Work

Physician wellness is recognized as a critical component of enhancing the quality of health care. An epidemic of symptoms related to stress and burnout among medical professionals, including radiologists, in the workplace is threatening not only health care providers at a personal level but also the entire health care system. In this review, the authors highlight recognized stressors in the contemporary radiology workplace and offer practical suggestions for mitigating burnout, improving professional engagement, and promoting wellness. Thematic goals to focus on include fostering an integrated and harmonious community at work, diminishing workplace detractors, creating opportunities to cultivate positive attitudes and intellect, and implementing effective leadership practices. ^©RSNA, 2018.

Navigating Generational Differences in Radiology

Generations are cohorts of individuals born in a particular time period who share similar values or value systems owing to historic events that occurred at crucial times during their development. Generations are defined to study how views and values change over time and to assess the differential impact that formative experiences have on groups. Understanding and navigating generational differences will be a critical skill for radiology leaders in the coming decade, as four distinct generations are working side by side for the first time in history. The four generations currently in the workforce are categorized as traditionalists, baby boomers, Generation Xers, and millennials. Beginning in 2016, millennials became the largest generation in the U.S. workforce, surpassing the number of Generation Xers. This major demographic shift will have a profound impact on workplace culture, recruitment efforts, and trainee education. While each generation has similar basic needs, meeting those needs and motivating individuals of different generations are best accomplished using different approaches. Radiology leaders must encourage and support these varied generations to work harmoniously to foster high-performance organizations. ^©RSNA, 2018.

Addressing Needs of Women Radiologists: Opportunities for Practice Leaders to Facilitate Change

Women are, and have always been, underrepresented in radiology. This gender disparity must be addressed. Women bring a different perspective to the workplace; and their collaborative, empathetic, and compassionate approach to patient care and education is an asset that the radiology community should embrace and leverage. Radiologic organizations should focus on removing barriers to the entry of women physicians into radiology as a specialty and to their career advancement. Organizations should address bias, promote physician well-being, and cultivate a safe and positive work environment. Radiology leaders committed to increasing gender diversity and fostering an inclusive workplace have the opportunity to strengthen their organizations. This article outlines the key steps that practice leaders can take to address the needs of women in radiology: (a) marketing radiology to talented women medical students, (b) addressing recruitment and bias, (c) understanding and accommodating the provisions of the Family and Medical Leave Act of 1993 and the Fair Labor Standards Act for both trainees and radiologists in practice, (d) preventing burnout and promoting well-being, (e) offering flexible work opportunities, (f) providing mentorship and career advancement opportunities, and (g) ensuring equity. ^©RSNA, 2018.

Changes in factors influencing fellowship choices among radiology residents from 2008 to 2018 and methods that may increase interest in the pediatric radiology subspecialty

BACKGROUND

Fewer residents are choosing a career in pediatric radiology, which is contributing to an ongoing shortage of pediatric radiologists.

OBJECTIVE

To identify potential causes of reduced interest in pediatric radiology as a career given a projected worsening of a nationwide shortage of pediatric radiologists.

MATERIALS AND METHODS

An online questionnaire using previously published questions was approved and distributed by the Program Directors in Diagnostic Radiology to diagnostic radiology residents on behalf of the Society for Pediatric Radiology (SPR). Descriptive statistics including means with standard error and independent t-tests were used to compare mean scores between survey years.

RESULTS

Nearly all of the 353 respondents (90.9%) planned on pursuing a fellowship. The majority (57.7%) identified their fellowship subspecialty before the 3rd year of residency with only 5.7% selecting pediatric radiology. Overall, 18.2% of survey respondents favored academic practice compared to 40% in the pediatric radiology subgroup. Fellowship choices were most strongly based on area of strong personal interest, marketability and area of strong personal knowledge, while the pediatric radiology subgroup emphasized area of strong personal interest, increased interaction with other physicians and enjoyable residency rotations. The pediatric radiology subgroup believed their impact on patient care was more significant than other subspecialties. Pediatric radiology job opportunities were thought to be more limited, geographically confining, and to have lower salaries than other subspecialties. More flexible job opportunities and higher demand were identified as factors needing to change before a resident would consider a pediatric radiology career.

CONCLUSION

The influence on fellowship selection is multifactorial. By emphasizing the favorable job market and marketability of pediatric radiology in all practice types/geographic locations, correcting perceived salary gaps and stressing the impact on patient care as early as medical school, the number of residents choosing a career in pediatric radiology may grow.

Structured Curriculum Vitae Scoring as a Standardized Tool for Selecting Interview Candidates for Academic Neuroradiology Faculty Positions

BACKGROUND AND PURPOSE

Interview selection of candidates for academic radiology faculty positions is variable and subject to unconscious biases. The purpose of this study was to retrospectively apply a quantitative curriculum vitae (CV) rubric as a screening tool to identify qualified candidates for further consideration in the hiring process.

MATERIALS AND METHODS

Archived CVs submitted by applicants between 2012 and 2017 for neuroradiology faculty positions at our institution were anonymized. One blinded reviewer scored resumes based on categories that included education, work experience, extracurricular/teaching experience, and research. Logistic regression and receiver operating characteristics analysis were performed. This study was IRB exempted.

RESULTS

Of the total 102 applicants, 17 interviews were conducted and 10 candidates were offered a position. Maximum score of the model was 24 points. Mean score was 14 ± 4 (n = 102, range 5-22). Higher total CV score (P = 0.01), medical school ranking (P = 0.03), and number of published manuscripts (P = 0.03) were significantly associated with interview selection. The area under the curve in the ROC analysis for differentiating interview selection based on total CV scoring was 0.69 (95% confidence interval 0.56-0.82). At a cutoff of 14, the model is 82.4% sensitive, and 54.1% specific.

CONCLUSION

Standardized CV scoring is feasible with a cut-off score of 14 points providing high sensitivity in identifying candidates eligible for interview. This tool can potentially be applied in the future to the hiring process as it is neutral to factors such as gender and race and provides an opportunity to address diversity in academic medicine.

Emergency Radiology: Current Challenges and Preparing for Continued Growth

The escalation of imaging volumes in the emergency department and intensifying demands for rapid radiology results have increased the demand for emergency radiology. The provision of emergency radiology is essential for nearly all radiology practices, from the smallest to the largest. As our radiology specialty responds to the challenge posed by the triple threat of providing 24-7 coverage, high imaging volumes, and rapid turnaround time, various questions regarding emergency radiology have emerged, including its definition and scope, unique operational demands, quality and safety concerns, impact on physician well-being, and future directions. This article reviews the current challenges confronting the subspecialty of emergency radiology and offers insights into preparing for continued growth.

Survey of peer review programs among pediatric radiologists: report from the SPR Quality and Safety Committee

During the last 15 years, peer review has been widely incorporated into radiology quality improvement programs. However, current implementations are variable and carry concerns, including subjectivity of numerical scores and a sense of merely satisfying regulatory requirements. The Society for Pediatric Radiology (SPR) Quality and Safety Committee sought to evaluate the state of peer review programs in pediatric radiology practices, including implementation methods, perceived functions, strengths and weaknesses, and opportunities for improvement. We distributed an online 16-question survey to SPR members. Questions pertained to the type of peer review system, the use of numerical scores and comments, how feedback on discordances is given and received, and the use of peer learning conferences. We collected 219 responses (15% of survey invitations), 80% of which were from children's hospitals. Fifty percent of respondents said they use a picture archiving and communication system (PACS)-integrated peer review system. Comment-enhanced feedback for interpretive discordances was either very important or somewhat important to performance improvement in 86% of responses, compared to 48% with a similar perception of numerical scores. Sixty-eight percent of respondents said they either rarely or never check their numerical scores, and 82% either strongly or somewhat agreed that comments are more effective feedback than numerical scores. Ninety-three percent either strongly or somewhat agreed that peer learning conferences would be beneficial to their practice. Forty-eight percent thought that their current peer review system should be modified. Survey results demonstrate that peer review systems in pediatric radiology practices are implemented variably, and nearly half of respondents believe their systems should be modified. Most respondents prefer feedback in the form of comments and peer learning conferences, which are thought to be more beneficial for performance improvement than numerical scores.

Defining the abdominal radiologist based on the current U.S. job market

PURPOSE

The purpose of the study is to characterize current practice patterns of abdominal radiologists based on work descriptions within job postings on numerous national radiology specialty websites.

METHODS

Job postings for either "abdominal" or "body" radiologists were searched weekly on five society websites (SAR, SCBT-MR, ARRS, ACR, RSNA) over a 1-year period. Postings were reviewed for various characteristics.

RESULTS

Nine hundred and sixteen total ads for 341 unique abdominal radiologist positions were reviewed (34.6% academic, 64.2% private practice, 1.2% other). Postings occurred most commonly in March (12.3%) and least commonly in November (4.8%). States with most positions were Florida (27), California (26), and New York (24). Of postings delineating expectations of specific abdominal modalities, 67.4% mentioned MRI, 58.5% ultrasound, 41.1% fluoroscopy, 14.3% PET, and 54.0% interventions. Additional non-abdominal expectations included general radiology (28.7%), breast imaging (21.1%), and general nuclear medicine (9.7%). Additional skills included prostate MRI (7.0%), OBGYN ultrasound (5.0%), and CT colonoscopy (2.6%). 79.2% required an abdominal imaging fellowship (specifically a body MRI fellowship in 4.1%).

CONCLUSION

By using job postings for abdominal radiologists, we have taken a practical approach to characterizing the current status of this subspecialty, reflecting recent job expectations and requirements. The large majority of positions required a body fellowship, and the positions commonly entailed a variety of skills beyond non-invasive diagnostic abdominal imaging. Of note, expectations of considerable minorities of positions included abdominal interventions, general radiology, and breast imaging. These insights may guide the development of abdominal radiology fellowships and mini-fellowships, as well as assist radiologists entering or returning to the job market.

Overnight Resident versus 24-hour Attending Radiologist Coverage in Academic Medical Centers

Academic medical centers have long relied on radiology residents to provide after-hours coverage, which means that they essentially function with autonomy. In this approach, attending radiologist review of resident interpretations occurs the following morning, often by subspecialist faculty. In recent years, however, this traditional coverage model in academic radiology departments has been challenged by an alternative model, the 24-hour attending radiologist coverage. Proponents of this new model seek to improve patient care after hours by increasing report accuracy and the speed with which the report is finalized. In this article, we review the traditional and the 24-hour attending radiologist coverage models. We summarize previous studies that indicate that resident overnight error rates are sufficiently low so that changing to an overnight attending model may not necessarily provide a meaningful increase in report accuracy. Whereas some centers completely replaced overnight residents, we note that most centers use a hybrid model, and overnight residents work alongside supervising attending radiologists, much as they do during the day. Even in this hybrid model, universal double reading and subspecialist final review, typical features of the traditional autonomous resident coverage model, are generally sacrificed. Because of this, changing from resident coverage to coverage by an attending radiologist that is 24 hours/day, 7 days/week may actually have detrimental effects to patient safety and quality of care provided. Changing to an overnight attending radiologist model may also have negative effects on the quality of radiology resident training, and it significantly increases cost.