2019 ACR Commission on Human Resources Workforce Survey

Feasibility of Prospective Assignment of Initial Method of Detection of Breast Cancer: A Multicenter Pilot Study

OBJECTIVE

To determine the feasibility of standardized, prospective assignment of initial method of detection (MOD) of breast cancer by radiologists in diverse practice settings.

METHODS

This multicenter, retrospective study analyzed the rate of assignment of MOD in four geographically varied health systems. A universal protocol for basic MOD assignment was agreed upon by the authors before start of the pilot study. Radiologists at each site were instructed how to assign MOD. Charts were then reviewed to determine the frequency and accuracy of MOD assignment for all cases subsequently diagnosed with breast cancer. When available, data regarding frequency of tumor registry abstraction were also reviewed for frequency and accuracy.

RESULTS

A total of 2,328 patients with a new diagnosis of breast cancer were evaluated across the sites over the study period. Of these patients, initial MOD was prospectively assigned by the radiologist in 94% of cases. Of the cases in which MOD was assigned, retrospective review confirmed accurate assignment in 96% of cases.

CONCLUSIONS

Prospective, standardized assignment of initial MOD of breast cancer is feasible across different practice sites and can be accurately captured in tumor registries. Standard collection of MOD would provide critical data about the impact of screening mammography in the United States.

Practical Strategies to Retain Radiologists

Since the great resignation associated with the coronavirus disease 2019 pandemic, radiology practices are now challenged with maintaining adequate radiology staffing requirements to cope with increasing clinical workload requirements. The authors describe practical strategies for radiology practice leaders to retain radiologists in the current challenging job market, while mitigating their burnout.

Short-Term Strategies for Augmenting the National Radiologist Workforce

The current radiology landscape has an imbalance between the rising demand for radiology services and the national radiologist workforce available. More vacant radiology positions exist than graduating radiology trainees. The origins of this problem are complex and require long-term solutions. Rather than working longer and/or faster, radiologists can work smarter. In this article, we present multiple short-term strategies to increase the effective radiologist workforce and/or increase workforce efficiency, to alleviate the current workload challenges. These strategies are derived from an analysis of possible practice-level changes in personnel, process, and physical plant. The impacts of the potential changes are estimated. No single change addresses the mismatch between supply and demand for radiology services. By creating an inventory of potential solutions, practices can choose the potential mechanism(s) to address the workforce shortage that best fit their needs and local environment.

The Second Mountain: Climbing the Challenges of Midcareer Radiology

A radiologist's career can be divided into the early, middle, and late phases. The midcareer phase is a particularly difficult period and has the highest rate of burnout among radiologists. Often throughout the early phase of a radiologist's career, during residency, fellowship, and while a junior faculty member, there is an abundance of support to help in personal and professional growth, but this support often wanes as radiologists gain seniority. Unfortunately, this often leaves midcareer radiologists feeling forgotten, or "invisible." This lack of support can lead to burnout, decreased job satisfaction, and premature departure from the workforce. The purpose of this review is to bring to light the challenges, such as higher rates of burnout and career stagnation, in addition to the lack of emphasis placed on midcareer mentorship, sponsorship, and career development programs, facing radiologists while climbing the "second mountain" of their career, as well as to provide potential individual and institutional interventions to combat these challenges. In addition, emphasis will be placed on the difficulties experienced by midcareer female radiologists, whose challenges are particularly problematic and to our knowledge have received little attention in the imaging literature to date.

Young Professionals in Neuroradiology: Opportunities, Challenges, and Future Directions

The Young Professionals Committee of the American Society of Neuroradiology identifies and serves the interests of young professionals in neuroradiology, defined as those still in training or within 5 years of its completion. Being a young professional is an exciting, dynamic, and demanding stage of one's professional career. As the landscape of neuroradiology practice changes, new opportunities and challenges occur for those in the early stage of their career. It is important to recognize and support the needs of young professionals because an investment in their professional development is an investment in the future of our specialty. In this article, we aimed to address the most notable developments relevant to current and future young professionals in neuroradiology as well as highlight the work done by the Young Professionals Committee of the American Society of Neuroradiology in serving the needs of these young professionals, focusing on early neuroradiology engagement, flexible work arrangements, private practice, social media, artificial intelligence, and international collaborations.

The 2021 ACR/RBMA Workforce Survey: Practice Types, Employment Trends, and Hiring Needs

PURPOSE

The aim of this study was to analyze current radiology practice types, specific subspecialty needs, employment trends, and retirement trends.

METHODS

ACR members, nonmembers, and Radiology Business Management Association members were surveyed using predominantly structured closed-ended questions about a variety of current and recent radiology practice characteristics. Responses were group practice deduplicated and weighted.

RESULTS

Of 1,702 survey respondents, 64% were men, with a median age of 51 years. In 2021, 62% of responding practices hired radiologists, with the average practice hiring 2 radiologists and academic practices on average hiring the most (3.5). Most radiologists (87%) were hired for full-time positions, with independent practices hiring the largest proportion of part-time positions. Body and breast imagers represented the largest numbers of hired radiologists (17% each). Practices anticipated similar hiring patterns in 2022, prioritizing breast (37%) and body (35%) imaging. Of all practice types, academic groups were least likely to prioritize general radiologist hiring. A large majority (82%) of radiology practices permit remote work (teleradiology), more common at academic than other practices. Of currently employed radiologists, 16% plan to seek new employment in the next year; early-career radiologists indicated the highest likelihood (92%) and academic radiologists the lowest (66%) of remaining in the same practice for at least 5 years. A large majority of practices (80%) reported no radiologist retirements in 2021. Of those retiring, the average age was 75 years, and 66% worked full-time until retirement.

CONCLUSIONS

Radiologist recruiting remains robust. Current information on practice characteristics may help inform radiology practice leaders seeking to right-size their groups.

A pre-post study of stressors and burnout affecting breast radiologists before and during the COVID-19 pandemic

Rationale and objective

To compare burnout and stressors of breast radiologists prior to and during the COVID-19 pandemic.

Materials and methods

Members of the Society of Breast Imaging were emailed an IRB-approved survey in January 2021 during the COVID-19 pandemic. Survey included questions from the Maslach Burnout Inventory and specific stressors including work pace, work-life balance, care of dependents, and financial strain. Data were compared to previous surveys prior to the pandemic.

Results

The response rate was 25% (261/1061) for those who opened the email. Of the respondents, 74% (194/261) were female, 82% (214/261) were white, 73% (191/261) were full time, 71% (185/261) were fellowship trained, 41% (106/261) had more than 20 years of experience, and 30% (79/261) were in academic practice.Respondents in 2021 reported frequent levels of depersonalization (2.2) and emotional exhaustion (3.4) while reporting frequent levels of personal accomplishment (5.3), a protective factor. These values were nearly identical before the pandemic in 2020: (2.2, 3.5, 5.3, respectively, p = .9). Respondents rated practicing faster than they would like as the highest stressor; however, 5 of the 6 stressors improved after the pandemic onset (p < .05). Conversely, participants perceived these stresses had gotten slightly worse since the pandemic (p < .01). Almost 50% of respondents reported they were considering leaving their practice; the most common reason was work/life balance.

Conclusion

Burnout in breast radiologists remains frequent but unchanged during the COVID-19 pandemic. While participants perceived that some stressors were worse during the pandemic, there was slight improvement in most stressors between the pre-pandemic and pandemic cohorts.

Influential Radiology Figures and Organizations in Social Media

PURPOSE

With social media becoming a vibrant hub for the radiology community, highlighting expert leaders and trustful conduits of information in the virtual field is proving crucial. The aim of this study was to identify and describe the most prominent and influential figures and organizational accounts to follow in radiology.

METHODS

Influence scores for the topic "radiology" on Twitter (now known as X) were computed using the Right Relevance machine learning service. Top influencers were classified according to gender, geography, physician degree, areas of influence, subspecialization, influence score, title, affiliated institution, dual degree, medical school origin, content type, and research activity. Statistical analysis was performed assessing variable correlations.

RESULTS

In the top quartile of influential figures, 87% were physicians, 60% men, and 93% located in the United States. Prevalent backgrounds included neuroradiology (21%), abdominal imaging (12%), and artificial intelligence (11%). Of the top 100 figures, 81% were US graduates, 97% held medical degrees, and 28% had dual degrees. Fifty-eight percent provided educational content. A majority held leadership positions (58%) and academic professorship titles (70%). The median h index, publication number, and citation number were 14, 49, and 881, respectively. No significant correlation was noted between influence score and academic rank or research output.

CONCLUSIONS

Virtual presence is becoming integral to health care professions and academic spheres, unfolding great potential for enhancing the sense of belonging, advocacy, recruitment, and fostering new relationships. Having a core of influential leaders and organizations to follow can serve as a resource for the community members and aspiring students building a positive connected basis for radiology's thriving future.

The 2021 ACR/Radiology Business Management Association Workforce Survey: Diversity in Radiology

The landscape of the radiology workforce is changing, especially in the diversity of the demographics of practicing radiologists across subspecialties, practice types, and leadership positions in both academic and nonacademic settings. The 2021 ACR/Radiology Business Management Association Workforce Survey examines these facets in detail and contributes to our understanding of the current state of diversity in the radiology workforce and potential barriers to change. The results suggest opportunities and future directions for improving diversity, equity, and inclusion.

Beyond the Binary: Moving the Radiology Workforce Toward Gender Inclusion, From the AJR Special Series on DEI

Gender representation in radiology has traditionally been evaluated and reported through binary models, accompanied by advocacy efforts focused on increasing the number of women in radiology. A paucity of data exists to understand the entire gender composition of the radiology workforce, including representation of people who are transgender and gender diverse. Further, little information exists on how to provide a supportive work environment for radiologists and support staff who identify as belonging to an underrepresented gender minority group. Intentional efforts to comprehensively understand the gender representation of the radiology workforce can help to establish a diverse workforce that is more representative of the patient populations that we serve, while promoting high-quality inclusive health care. Moving beyond gender binary thought and practices can help foster a culture of inclusion and belonging in radiology. This article provides practical steps that radiology practices can take to understand and support gender diversity beyond the binary in the radiology workforce, including providing definitions and inclusive language, understanding limitations of historical methods of gender data collection in radiology and relevant published literature, establishing best practices for future data collection, and developing a strategic vision with action items to create a more inclusive work environment.

Prevalence of Burnout of Radiologists in Private Practice

PURPOSE

The aim of this study was to evaluate the prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologists within the largest coalition of independent wholly physician-owned diagnostic radiology practices within the United States.

METHODS

The study cohort included practicing radiologists within the largest coalition of wholly radiologist-owned, independently practicing diagnostic radiology groups within the United States. Practicing radiologists within all 31 radiology private practices within the organization were electronically mailed a web link to a confidential institutional review board-approved survey in August and September 2021. The survey included validated questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care. Radiologists were classified as being burned out and professionally fulfilled on the basis of established cutoffs from the Professional Fulfillment Index.

RESULTS

The overall response rate was 20.6% (254 of 1,235). The overall rate of radiologist burnout was 46% (Cronbach's α = 0.92), and professional fulfillment was 26.7% (Cronbach's α = 0.91). The inverse association between professional fulfillment and burnout was highly significant (r = -0.66, P < .0001) on the basis of average scores. Radiologists who took call (evenings, overnight, and weekends) were statistically most likely to be burned out. Older radiologists were less likely to experience burnout. Factors statistically significantly associated with professional fulfillment were eating nutritious meals and exercising at least four times per week. No statistically significant association was seen between either burnout or fulfillment with gender, ethnicity, practice geography, or practice size.

CONCLUSIONS

In the largest coalition of independent wholly physician-owned diagnostic radiology practices across the United States, about one-half of radiologists were burned out, and just over one-quarter were professionally fulfilled. Taking call was significantly associated with radiologist burnout. Self-care habits were associated with professional fulfillment.

Reflexive thematic analysis of job-related problems associated with pharmacist suicide, 2003-2019

BACKGROUND

Few qualitative studies have focused on suicide and specific job-related problems associated with suicide in pharmacists. Greater knowledge of specific work-related stressors amongst pharmacists could inform suicide prevention strategies.

OBJECTIVE

To identify job-related stressors associated with pharmacist suicides and compare stressors to those previously reported in physicians and nurses.

METHODS

Free-text law enforcement and medical examiner data for pharmacist suicides were extracted from the National Violent Death Registry (NVDRS) for 2003-2019. Reflexive thematic analysis was deployed via a deductive approach utilizing codes and themes found in previous research on nurse and physician suicides. New codes were also identified through inductive coding.

RESULTS

A total of 291,872 suicides occurred between 2003 and 2019, of which 392 were pharmacist deaths. Of these, 62 pharmacist suicides were coded with job-related problems. Almost all deductive themes/codes extracted from nurses and physicians were present in pharmacists. Common codes found in the pharmacist dataset that were also found previously in physicians and nurses were: history of mental health, substance use disorder, hopelessness impending or proceeding job loss, and access to lethal weapons and/or drugs. Novel codes were added through inductive content analysis. Codes novel to pharmacists were: verbalized suicidal ideation (SI) or intent, diversion for the purpose of suicide, and the fear of job loss. Disciplinary action at the institutional level was associated with the fear of job loss and cited as the event triggering suicide completion.

CONCLUSION

Pharmacists have similar job-related stressors associated with suicide as physicians and nurses. Evaluating the process of disciplinary action is warranted. Future research is indicated to evaluate causal relationship between work-related stressors and mental health outcomes leading to suicide in pharmacists.

Gender disparity in academic advancement: exploring differences among adult and pediatric radiologists

BACKGROUND

Gender imbalance in research output and academic rank in academic radiology is well-documented and long-standing. Less is known regarding this imbalance among pediatric radiologists.

OBJECTIVE

To characterize gender differences for academic rank and scholarly productivity of pediatric radiologists relative to adult radiologists.

MATERIALS AND METHODS

During summer 2021, faculty data for the top 10 U.S. News & World Report ranked adult radiology programs and the top 12 largest pediatric hospital radiology departments were collected. Information regarding self-reported gender, age, years of practice and academic rank was accessed from institutional websites and public provider databases. The h-index and the number of publications were acquired via Scopus. Group comparisons were performed using Mann-Whitney and chi-square tests.

RESULTS

Three hundred and sixty-four (160 women) pediatric and 1,170 (468 women) adult radiologists were included. Compared to adult radiologists, there were significantly fewer pediatric radiologists in advanced ranks (associate or full professor) (P = 0.024), driven by differences between male (P = 0.033) but not female radiologists (P = 0.67). Among pediatric radiologists, there was no significant difference in years in practice (P = 0.29) between males and females. There also was no significant difference in academic rank by gender (P = 0.37), different from adult radiology where men outnumber women in advanced ranks (P < 0.001). Male pediatric radiologists displayed higher academic productivity (h-index: 9.0 vs. 7.0; P = 0.01 and number of publications: 31 vs. 18; P = 0.003) than their female colleagues.

CONCLUSION

Academic pediatric radiology seems to have more equitable academic advancement than academic adult radiology. Despite similar time in the workforce, academic output among female pediatric radiologists lags that of their male colleagues.

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.

Implementation of Clinical Artificial Intelligence in Radiology: Who Decides and How?

As the role of artificial intelligence (AI) in clinical practice evolves, governance structures oversee the implementation, maintenance, and monitoring of clinical AI algorithms to enhance quality, manage resources, and ensure patient safety. In this article, a framework is established for the infrastructure required for clinical AI implementation and presents a road map for governance. The road map answers four key questions: Who decides which tools to implement? What factors should be considered when assessing an application for implementation? How should applications be implemented in clinical practice? Finally, how should tools be monitored and maintained after clinical implementation? Among the many challenges for the implementation of AI in clinical practice, devising flexible governance structures that can quickly adapt to a changing environment will be essential to ensure quality patient care and practice improvement objectives.

Overcoming Midcareer Malaise: The Value of Personal Rediscovery

Midcareer faculty development is critical for continued career vitality and retention. However, limited formal programming exists to meet the needs of this group, which is at risk of experiencing a lack of career self-identity and a sense of being stuck. These feelings may lead radiologists to consider a change in practice type or location or even to exit the radiologist workforce. This viewpoint describes stressors and potential solutions to assist midcareer radiologists in regaining workplace engagement.

Prevalence of burnout in private practice radiology leaders

RATIONALE AND OBJECTIVES

To evaluate prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologist leaders within the United States.

MATERIALS AND METHODS

The study cohort was the largest coalition of wholly radiologist owned, independently practicing radiology groups within the United States. Two designated leaders within each of the 30 radiology private practices within the organization Strategic Radiology were electronically mailed a weblink to a confidential IRB-approved survey in July 2021. Surveys included questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care.

RESULTS

The overall response rate was 67% (40/60). Fulfillment and burnout scores were calculated from the individual questions, and radiologists were classified as being fulfilled or not and burned out or not based upon score cutoffs previously validated from the Stanford Professional Fulfillment Index (PFI). The overall professional fulfillment rate of staff was 43% and the overall burnout rate was 33%. (Cronbach's α = 0.90 for fulfillment and 0.91 for burnout). The inverse correlation between professional fulfillment and burnout was highly significant (r = -0.42, p = 0.007). No statistically significant association was seen between either burnout or fulfillment and age, gender, ethnicity, practice geography or practice size.

CONCLUSION

Utilizing the validated Stanford PFI for assessment, the prevalence of burnout in private practice radiologist leaders was 33%. The prevalence of professional fulfillment was 43%, with a mild inverse association between professional fulfillment and burnout.

SUMMARY

In private practice leaders, the prevalence of burnout was 33% and the prevalence of professional fulfillment was 43%.

Microaggressions in our daily workplace encounters: a barrier to achieving diversity and inclusion

Originally coined in 1970 by Dr. Chester Pierce, the term "microaggression" encompasses any subtle insult or informal degradation of a member of any socially marginalized group. While incidents of blatant racism and sexism might be deterred by zero-tolerance policies in the workforce, microaggressions still plague our daily interactions with colleagues and patients alike. In this paper we define and categorize microaggressions using real-world examples, describe their repercussions and provide ways to appropriately respond to microaggressions on a personal and institutional level.

New England Women in Radiology (NEWR) Invited Lectureship Series: A Novel Program to Advance the Careers of Junior Female Faculty in Academic Radiology

RATIONALE AND OBJECTIVES

The purpose of this study is to assess the impact of the New England Women in Radiology (NEWR) program, a new program aimed to generate speaking and networking opportunities for junior women radiologists in New England, by providing opportunities to speak at other academic institutions in the region.

MATERIALS AND METHODS

A total of 12 academic radiology departments and 20 faculty members at various New England institutions participated in the program during its first year. An institutional survey was sent to all participating institutions and a faculty survey was sent to all participating faculty to assess their experience with the program. Experience was measured using a Likert scale. A word cloud was used to visualize common themes in free response survey questions.

RESULTS

Hundred percent of participating institutions and 67% of participating faculty responded to the corresponding surveys. Hundred percent of responding faculty indicated that they would participate in the program again. Ninety-two percent of faculty said that they would recommend the program to a colleague. Fifty-eight percent found the networking opportunity valuable; while 83% believed that participation in the NEWR program would help them achieve a promotion. Hundred percent of the participating institutions who completed the survey strongly agreed that 1) the program was easy to administer, 2) participating in the program was valuable to their educational mission, and 3) participating in the program benefited the promotion of junior women faculty in their department.

CONCLUSION

Initial experience with the NEWR program in its first year was positive amongst both faculty and institutional participants. To further help female junior faculty advance their careers in academia, the NEWR program could be adapted to other geographical locations to incorporate a greater number of institutions and faculty.

The Emerging Diverse Radiology Workplace: Case Studies on the Importance of Inclusion in Radiology Training Programs

Radiology remains one of the least diverse fields in medicine. With increasing understanding of the benefits of workforce diversity on health care outcomes, radiology society leadership and radiologists are engaging in necessary efforts to improve diversity, equity, and inclusion. To date, much of the initiatives have focused on pipeline development and recruitment strategies. Literature from organizational psychologists, human resources and business strategists suggest that incorporation of inclusion could overcome some of the persistent barriers to workforce diversity. Using case studies from real-life residency programs, we describe challenges associated with being a member of an underrepresented minority group in radiology. We illustrate concepts in inclusion, proposing concrete ideas for personal and institutional growth in this area, as a strategy for improving workforce diversity and team effectiveness.

Childbearing in radiology training and early career: Challenges, opportunities, and finding the best time for you

For many women, radiology residency occurs during the childbearing years and they often question when is the best time to have children. Anxiety regarding fertility and pregnancy-related complications contribute to early career burnout in women physicians and many have fertility regrets. Supporting radiologists in training and early in their career as they navigate pregnancy and childbearing is critical to achieving a diverse workforce and leadership. Herein, we explore career-related challenges of childbearing and highlight opportunities for radiologists in residency, fellowship, and early in their career, so that they can make an informed childbearing decision.

Summary of the proceedings of the International Forum 2021: “A more visible radiologist can never be replaced by AI”

The ESR International Forum at the ECR 2021 discussed effects of artificial intelligence on the future of radiology and the need for increased visibility of radiologists. The participating societies were invited to submit written reports detailing the current situation in their country or region. The European Society of Radiology (ESR) established the ESR International Forum in order to discuss hot topics in the profession of radiology with non-European radiological partner societies. At the ESR International Forum 2021, different strategies, initiatives and ideas were presented with regard to radiology community’s response to the changes caused by the emerging AI technology.

Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists

RATIONALE AND OBJECTIVES

Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals.

MATERIALS AND METHODS

A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption.

RESULTS

50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05).

CONCLUSION

Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.

Equal pay for equal work in radiology: Expired excuses and solutions for change

The gender pay gap is not a problem of the past. Women continue to receive less pay for equal work and radiology is one of four medical specialties with the largest gender pay gap. Numerous social factors contribute to the gender pay gap; however, radiology can close the gender pay gap through intentional strategies, including acknowledging the gender pay gap, eliminating bias and minority taxes through progressive compensation and parental leave models, devaluing overwork, developing longitudinal mentorship and sponsorship, and demanding transparent institutional policies. Patient care and overall organizational success will improve when the barriers resulting in the gender pay gap are eliminated.

Representation of women among leadership and honorees within the Society of Abdominal Radiology, past and present

PURPOSE

To evaluate gender diversity over time within the leadership and honorees of the Society of Abdominal Radiology with comparison to other radiologic societies.

METHODS

This was a retrospective, observational study of the gender distribution of presidents and gold meal awardees within the Society of Abdominal Radiology (SAR) compared to three national radiology organizations: the American College of Radiology (ACR), the American Roentgen Ray Society (ARRS), and the Radiological Society of North America (RSNA). Data were collected from the inception of each society through 2020. Societies were directly contacted for president and Gold Medal awardee names when this information was not available on society websites. Differences in the proportion of female presidents and Gold Medal awardees before and after 2012, by society, were performed using χ² test; 2012 was selected as a threshold year as this represented when SAR was created.

RESULTS

The proportion of female past presidents was 5%, 9%, and 33% for the SGR, SUR, and SAR, respectively, and 5%, 4%, and 7% for the ACR, ARRS, and RSNA, respectively. The proportion of female Gold Medal awardees was 5%, 4%, and 10% for the SGR, SUR, and SAR, respectively, and 5%, 7%, and 7%, respectively, for ACR, ARRS, and RSNA. There was a statistically significant increase in the proportion of women presidents and honorees in all societies after 2012 compared to before 2012, but no significant difference between societies in either time period.

CONCLUSION

A higher proportion of female presidents and honorees were demonstrated across all societies after 2012.

Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds and scholarly activities

BACKGROUND

Pediatric interventional radiology has grown as an advanced subspecialty with increased demand, number and complexity of cases, and number of pediatric institutions offering a pediatric interventional radiology service. Despite the overall increase in the number of pediatric interventionalists over the past two decades, there is a heterogeneity in their academic backgrounds and a lack of uniform training pathways.

OBJECTIVE

To analyze the demographics, academic backgrounds and scholarly activities of pediatric interventionalists across the United States (U.S.) and Canada.

MATERIALS AND METHODS

A list of all members of the Society for Pediatric Interventional Radiology was obtained and pediatric interventionalists at academic and private practice institutions in the U.S. and Canada were included. Publicly available online sources were used to gather demographic and educational information about each pediatric interventionalist, which included the online curriculum vitae, the HealthGrades.com and Doximity.com websites, and Elsevier's Scopus database. Demographic and educational data including age, gender, educational background, additional degrees, academic rank, previous leadership positions, and metrics of scholarly activities were recorded. Fellowships in diagnostic pediatric radiology, adult interventional radiology and/or pediatric interventional radiology were recorded. Mann-Whitney U tests and Kruskal-Wallis tests were used to compare differences between groups.

RESULTS

One hundred and twenty-five pediatric interventionalists were included, of whom 24 (19.2%) were female. The mean age was 48.6 years (standard deviation [SD]: 10.6, median: 45 years, range: 36-82 years). There was no statistical difference between median age for male versus female pediatric interventionalists (44.5 years vs. 45 years, P=0.89). A majority of pediatric interventionalists were American medical school graduates (96, 76.8%), while 29 (23.2%) were international medical graduates. Eighty-three percent (104) of the pediatric interventionalists completed diagnostic radiology residency training in the U.S., most commonly at the University of Cincinnati in Ohio (6.4%) and Washington University in St. Louis, MO (5.6%). Among fellowship training, pediatric interventionalists completed a pediatric radiology fellowship (61.6%), adult interventional radiology fellowship (40%) and/or a dedicated pediatric interventional radiology fellowship (57.6%). The mean±SD (median) publications, citations and Hirsch index (h-index) for pediatric interventionalists were 32±45 (12), 68±1,317 (120) and 9±10 (5), respectively. There was a statistically higher number of publications, citations and h-index with increasing academic rank at the assistant, associate and professor levels (P<0.001 for all groups). International medical graduate pediatric interventionalists had a higher, but not statistically significant, median publication count (26 vs. 11, P=0.0.25), citation count (236 vs. 93, P=0.36) and h-index (9.0 vs. 5, P=0.24) compared to pediatric interventional radiologists from American medical schools.

CONCLUSION

Pediatric interventionalists in North America are predominantly male, with about a quarter having graduated from international medical schools. Pediatric radiology fellowship, followed by pediatric interventional radiology fellowship, was the most frequently pursued training pathway.

Radiologist Characteristics Associated with Interpretive Performance of Screening Mammography: A National Mammography Database (NMD) Study

Background Factors affecting radiologists' performance in screening mammography interpretation remain poorly understood. Purpose To identify radiologists characteristics that affect screening mammography interpretation performance. Materials and Methods This retrospective study included 1223 radiologists in the National Mammography Database (NMD) from 2008 to 2019 who could be linked to Centers for Medicare & Medicaid Services (CMS) datasets. NMD screening performance metrics were extracted. Acceptable ranges were defined as follows: recall rate (RR) between 5% and 12%; cancer detection rate (CDR) of at least 2.5 per 1000 screening examinations; positive predictive value of recall (PPV1) between 3% and 8%; positive predictive value of biopsies recommended (PPV2) between 20% and 40%; positive predictive value of biopsies performed (PPV3) between the 25th and 75th percentile of study sample; invasive CDR of at least the 25th percentile of the study sample; and percentage of ductal carcinoma in situ (DCIS) of at least the 25th percentile of the study sample. Radiologist characteristics extracted from CMS datasets included demographics, subspecialization, and clinical practice patterns. Multivariable stepwise logistic regression models were performed to identify characteristics independently associated with acceptable performance for the seven metrics. The most influential characteristics were defined as those independently associated with the majority of the metrics (at least four). Results Relative to radiologists practicing in the Northeast, those in the Midwest were more likely to achieve acceptable RR, PPV1, PPV2, and CDR (odds ratio [OR], 1.4-2.5); those practicing in the West were more likely to achieve acceptable RR, PPV2, and PPV3 (OR, 1.7-2.1) but less likely to achieve acceptable invasive CDR (OR, 0.6). Relative to general radiologists, breast imagers were more likely to achieve acceptable PPV1, invasive CDR, percentage DCIS, and CDR (OR, 1.4-4.4). Those performing diagnostic mammography were more likely to achieve acceptable PPV1, PPV2, PPV3, invasive CDR, and CDR (OR, 1.9-2.9). Those performing breast US were less likely to achieve acceptable PPV1, PPV2, percentage DCIS, and CDR (OR, 0.5-0.7). Conclusion The geographic location of the radiology practice, subspecialization in breast imaging, and performance of diagnostic mammography are associated with better screening mammography performance; performance of breast US is associated with lower performance. ^©RSNA, 2021 Online supplemental material is available for this article.

Representation of Women in Diagnostic Radiology Residency Programs: Does National Institutes of Health Program Ranking Matter?

PURPOSE

Women are consistently underrepresented in the radiology workforce. The authors examined recent trends in the gender distribution of residents entering diagnostic radiology residency programs.

METHODS

A retrospective review was performed of residents entering US diagnostic radiology residency programs for graduate medical education years 2009 to 2018. Demographic and program data were obtained from the Association of American Medical Colleges GME Track Resident Survey. National Institutes of Health (NIH) ranking was determined according to the Academy for Radiology & Biomedical Imaging Research. Descriptive statistical analyses were performed to evaluate the gender distribution of residents according to residency program ranking.

RESULTS

The final analytic sample included 11,788 residents who entered diagnostic radiology residency programs during the study period, of whom 3,245 (27.5%) were women and 8,543 (72.5%) were men. A higher percentage of female residents entered programs ranked in NIH rank group 1st to 20th (351 of 1,185 [29.6%]) than entered programs that were ranked lower than 20th or were unranked (1,540 of 5,819 [26.5%]; P = .026).

CONCLUSIONS

The present findings confirm repeated reports that women are underrepresented in radiology. The results indicate a need for further study on why a greater proportion of female residents are entering programs with higher NIH rankings. Better understanding of factors and interventions that led to this rise in the percentage of women in higher ranked programs provides an opportunity to expand gender diversity across the field of radiology.

Mitigating Unconscious Bias in Recruitment and Hiring

Unconscious biases in recruitment and hiring can limit the potential for building a diverse academic and private radiology practice. In the private practice environment of radiology, especially in smaller firms, in which a dysfunctional team can lead to a dysfunctional practice overall, it is especially essential to find the best candidates for the team. Many strategies for mitigating these biases can be employed strategically at multiple levels of the hiring process.

Best Practices and Critical Factors in a Successful Private Practice

Independent private practice has historically been the predominant practice model in radiology. In the last two decades, this model has faced increasing pressures on both a micro and macro level, which threatens its existence. In the current health care environment, how does a practice stay independent? The authors address some of the critical factors needed for a successful practice. These factors are derived from the collective experience of the authors who are in private practice as well as best practices described in the literature. Strengths that already exist in the practice, opportunities that can be capitalized on, and looming or existing threats to the independence of a private group are discussed. Recommendations are provided on how to optimize an individual practice and reduce the risk of alternative practice penetration.

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.

Practical Tips for Creating a Diversity, Equity, and Inclusion Committee: Experience From a Multicenter, Academic Radiology Department

PURPOSE

Coronavirus disease 2019 and the publicly documented deaths of countless Black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve diversity and inclusion in radiology. Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systematically address DEI issues in radiology. However, there are few articles that provide departments with guidance on how to create DEI committees to comprehensively address DEI issues in radiology. The purpose of this review is to provide readers with a framework and practical tips for creating a comprehensive, institutionally aligned radiology DEI committee.

METHODS

The authors describe key components of the strategic planning process and lessons learned in the creation of a radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department.

RESULTS

A hospital-based strategic planning process defining the DEI vision, mission, goals, and strategies was used to inform the formation of the radiology department DEI committee. The radiology department performed gap analyses by conducting internal and external research. Strengths, weaknesses, opportunities, and threats analyses were performed on the basis of consultations with institutional and other departmental DEI leaders as well as DEI leaders from other academic medical centers. This framework served as the basis for the creation of the radiology departmental DEI committee, including a steering committee and four task forces (education, research, patient experience, and workforce development), each charged with addressing specific institutional goals and strategies.

CONCLUSIONS

This review provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee.

Update on establishing and managing an overnight emergency radiology division

Emergency department (ED) radiology divisions that serve to provide overnight attending coverage have become an increasingly common feature of radiology departments. The purpose of this article is to review the common ED radiology coverage models, describe desirable traits of emergency radiologists, and discuss workflow in the ED radiology setting. ED radiologists may be trained as ED radiologists or may develop the necessary skills and adopt the subspecialty. Choosing radiologists with the correct traits such as being a “night owl” and remaining calm under pressure and implementing an acceptable work schedule such as shift length of 9–10 h and a “one week on, two weeks off” schedule contribute to sustainability of the position. Strategies to address the unique stressors and workflow challenges of overnight emergency radiology coverage are also presented. Workflow facilitators including trainees, PAs, radiology assistants, and clerks all have roles to play in managing high case volumes and in making sure that the service is well staffed. Usage of artificial intelligence software is the latest technique to streamline workflow by identifying cases which should be prioritized on a busy worklist. Implementing such strategies will maintain quality of care for patients regardless of time of day as well as sustainability and quality of life for overnight emergency radiologists.

2020 ACR Data Science Institute Artificial Intelligence Survey

PURPOSE

The ACR Data Science Institute conducted its first annual survey of ACR members to understand how radiologists are using artificial intelligence (AI) in clinical practice and to provide a baseline for monitoring trends in AI use over time.

METHODS

The ACR Data Science Institute sent a brief electronic survey to all ACR members via email. Invitees were asked for demographic information about their practice and if and how they were currently using AI as part of their clinical work. They were also asked to evaluate the performance of AI models in their practices and to assess future needs.

RESULTS

Approximately 30% of radiologists are currently using AI as part of their practice. Large practices were more likely to use AI than smaller ones, and of those using AI in clinical practice, most were using AI to enhance interpretation, most commonly detection of intracranial hemorrhage, pulmonary emboli, and mammographic abnormalities. Of practices not currently using AI, 20% plan to purchase AI tools in the next 1 to 5 years.

CONCLUSION

The survey results indicate a modest penetrance of AI in clinical practice. Information from the survey will help researchers and industry develop AI tools that will enhance radiological practice and improve quality and efficiency in patient care.

Diagnostic Radiology Residency Program Director Workforce in the United States: A Descriptive Analysis

PURPOSE

To investigate and describe the demographics, academic background, and scholarly activity of Diagnostic Radiology (DR) residency program directors in the United States.

METHODS

A list of all DR residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and corresponding program directors (PD) was obtained from ACGME website. Information about each PD was obtained from publicly available sources including program websites, Healthgrades and Doximity. Demographic and academic data including age, sex, educational background, subspecialty, tenure, interval between residency completion and appointment as PD, terms served, additional degrees, academic rank, prior leadership positions and metrics of scholarly activity were recorded. Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. Results are considered statistically significant at p < 0.05.

RESULTS

A total of 197 PDs were included in the study of which 139 (70.6%) were male. Average age of PDs was 47.56 years (SD 8.29, median 45, range 35-77). There was no significant difference in median age of male vs female PDs (45 vs 44.5, p = 0.655). Majority of PDs attended American medical schools (181/197, 91.9%), and 16/197 attended international medical schools. Nine PDs received DO degrees (9/197, 4.6%). Academic rank was available for 137 PDs, of which 4 (2.9%) were instructors, 63 (46.0%) were assistant professors, 47 (34.3%) were associate professors and 23 (16.8%) were professors. Fellowship information was available for 183 PDs, of which the most common subspecialties were neuroradiology (24.5%), musculoskeletal radiology (15.8%), abdominal radiology (10.3%), and interventional radiology (9.8%). Female PDs had a significantly higher median publications (13.5 vs 6.0, p = 0.003), median citations (133 vs 37, p = 0.19) and median h-index compared to male PDs (6 ± 3, p = 0.005).

CONCLUSION

Radiology PDs are mostly males who graduated from US allopathic medical schools. Female PDs had significantly higher scholarly metrics compared to male PDs. Twenty three percent PDs were appointed in the last 1 year.

Perceptions of Adequacy of Breast Imaging Training in the United States among Breast Radiologists

OBJECTIVE

To evaluate the perceptions of breast imaging training in the United States among practicing breast radiologists.

METHODS

An anonymous electronic survey was sent to physician members of the Society of Breast Imaging. Study participants were queried about why they practice breast imaging, what percentage of their clinical practice consists of breast imaging, details about their breast imaging training, and how well their training prepared them for their breast imaging practice. Results were stratified by whether respondents completed a breast imaging fellowship and length of time practicing breast imaging. Results were compared using the Chi-squared test or Fisher's exact test.

RESULTS

We received 271 completed survey responses. Of the survey respondents, 52.4% (141/269) were employed in private practice, 24.2% (65/269) in academic practice, and 23.4% (63/269) in a mixed/hybrid practice. Overall, 46.6% (125/268) of respondents reported practicing a greater proportion of breast imaging than anticipated during training and 18.7% (50/268) had not anticipated that their future practice would include breast imaging at all. The 62.3% (167/268) of survey respondents who had completed a breast or women's imaging fellowship were significantly more likely to report sufficient training in screening mammography, diagnostic mammography, breast procedures, and MRI interpretation.

CONCLUSION

Our study highlights perceived areas of insufficiency in breast imaging training. These were most notable among those who did not complete a breast imaging fellowship. These insufficiencies may be considered when updating the next version of the residency training curriculum.

Special Report of the RSNA COVID-19 Task Force: The Short- and Long-term Financial Impact of the COVID-19 Pandemic on Private Radiology Practices

The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread disruption to the global economy, including demand for imaging services. The resulting reduction in demand for imaging services had an abrupt and substantial impact on private radiology practices, which are heavily dependent on examination volumes for practice revenues. The goal of this report is to describe the specific experiences of radiologists working in various types of private radiology practices during the initial peak of the COVID-19 pandemic. Herein, the authors describe factors determining the impact of the pandemic on private practices, the challenges these practices faced, the cost levers leaders adjusted, and the government subsidies sought. In addition, the authors describe adjustments practices are making to their mid- and long-term strategic plans to pivot for long-term success while managing the COVID-19 pandemic. Private practices have crafted tiered strategies to respond to the impact of the pandemic by pulling various cost levers to adjust service availability, staffing, compensation, benefits, time off, and expense reductions. In addition, they have sought additional revenues, within the boundaries of their practice, to mitigate ongoing financial losses. The longer term impact of the pandemic will alter existing practices, making some of them more likely than others to succeed in the years ahead. This report synthesizes the collective experience of private-practice radiologists shared with members of the Radiological Society of North America COVID-19 Task Force, including discussions with colleagues and leaders of private-practice radiology groups from across the United States.

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.

Impact of Coronavirus Disease 2019 (COVID-19) on the Practice of Clinical Radiology

The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the "usual scope" of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.