Data from a professional society placement service as a measure of the employment market for physicians

Update on the diagnostic radiology employment market: findings through 2007-2008

PURPOSE

To describe the employment market for diagnostic radiologists in 2007-2008, with attention to differences among subspecialties.

METHODS

The authors conducted the most recent in a series of annual surveys of vacancies in academic departments and obtained data from the placement service of the ACR (its Professional Bureau) during its operation at the annual meeting of the Radiological Society of North America. The authors also obtained survey data on how radiologists' actual workloads compared with what they desired.

RESULTS

The ratio of job listings to job seekers at the placement service, which serves both community and academic positions, fell to 0.60 for 2008, compared with 1.1 to 1.2 for 2003 to 2006 and 0.22 to 3.8 in the preceding decade. In 2007, workload averaged 3% less than desired, unlike a close match in 2003. Vacancies per academic department have been growing slightly. Data on academic vacancies indicated that interventional, pediatric, and particularly breast imaging were the fields with the most intense shortages. General radiology and (marginally) neuroradiology were at the opposite end of the spectrum. At the placement service, there was a particularly high ratio of job listings to job seekers for interventional radiology and a particularly low ratio for nuclear medicine/radiology.

CONCLUSIONS

The overall job market remains very much intermediate between the highs and lows that have occurred since 1990, but finding highly desirable jobs is likely to be somewhat more difficult, and filling vacancies somewhat easier, in 2008 than in the past few years. There was a strong indication of a 3% surplus of radiologists in 2007. Interventional radiology, pediatric radiology, and particularly breast imaging are the subspecialties in which positions are most difficult to fill; neuroradiology, general radiology, and nuclear radiology may lie at the opposite end of the spectrum.

Update on the diagnostic radiology employment market: findings through 2006-2007

PURPOSE

To describe the employment market for diagnostic radiologists in 2006-2007, with attention to differences among subspecialties.

METHODS

The authors conducted the most recent in a series of annual surveys of vacancies in academic departments and obtained data from the placement service of the American College of Radiology (ACR), its Professional Bureau, during its operation at the annual meeting of the Radiological Society of North America. The two data series were correlated. The percentage of academic vacancies in each subspecialty was compared with the percentage of academic radiologists in that subspecialty.

RESULTS

Job listings per job seeker at the placement service, which serves both community and academic positions, were 0.72 for 2007 compared with approximately 1.1 to 1.2 for 2003 to 2006 and variation from 0.25 to 3.8 in the preceding decade. The correlation of the two data series was 0.84 (P = .08) for the 5 years for which both are available. Particularly high ratios of academic vacancies to academic radiologists were found for interventional radiology and breast imaging; particularly low ratios were found for neuroradiology and nuclear radiology.

CONCLUSIONS

The job market remains very much intermediate between the highs and lows that have occurred since 1990, but finding highly desirable jobs is likely to be somewhat more difficult, and filling vacancies somewhat easier, in 2007 than in the past few years. Interventional radiology and breast imaging are the subspecialties in which academic positions are most difficult to fill; neuroradiology and nuclear radiology seem to be at the opposite end of the spectrum. The same differences across subspecialties are probably found in community practice, given the strong correlation of the two data series.

Update on the Diagnostic Radiology Employment Market: Findings Through 2005

OBJECTIVE

The purpose of this study is to analyze and summarize the latest data describing the diagnostic radiologist employment market.

MATERIALS AND METHODS

Three sources of data--vacancies in academic radiology departments as of July 1, 2005; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in the American Journal of Roentgenology and Radiology-are presented and compared with previous data.

RESULTS

Vacancies in academic departments averaged 4.5 in 2005, an increase of 16% from 2004 but a decrease of 16% from the 2001 peak. Vacancies increased from 2004 in all specialties except nuclear medicine and "other," and vacancies decreased from 2001 in all specialties except pediatric radiology and purely research positions. Job listings per job seeker increased 8% from 2004 but remain far below peak levels. The total number of positions advertised decreased by 6% from 2004, reaching the lowest level since 1998. In 2005, 42% of the total advertised jobs were academic, as compared with 45% in 2004. Proportional decreases were seen between 2004 and 2005 in total advertisements per region except the Northwest and California. The largest proportional increases in subspecialties occurred in general radiology, abdominal imaging, and "other."

CONCLUSION

Data from the American College of Radiology Professional Bureau and a survey of academic radiology departments show an increased demand for diagnostic radiologists in 2005, whereas data from the help wanted index show a decrease. In addition, the regional distribution of advertisements and the proportion of advertisements for certain specialties have shown some shifting in 2005. We believe the job market remains strong, with regional and specialty shifting.

Update on the Diagnostic Radiologist Employment Market: Findings Through 2004

OBJECTIVE

The objective of this article is to summarize the latest information concerning the diagnostic radiologist employment market.

MATERIALS AND METHODS

Three sources of data are presented and compared with previous data: vacancies in academic radiology departments as of July; the ratio of job listings to job seekers at a major placement service; and the number of positions advertised in Radiology and the American Journal of Roentgenology.

RESULTS

Vacancies in academic radiology departments averaged 3.9 in 2004, down 29%, and decreased for all subspecialties as compared with 2001, but the number of vacancies remained very similar to that for 2003. Job listings per job seeker were 1.1 in 2004, stable over the past 2 years but at the lowest level since 1997. The overall number of positions advertised declined by 14% in 2003 compared with 2002 and by an additional 17% in 2004, reaching the lowest level since 1998. In 2004, 45.3% of positions advertised were academic. Comparing 2003-2004 with 2001-2002, all geographic regions exhibited absolute declines in advertisements except the Northeast, which showed a 1.5% increase. Absolute increases occurred for musculoskeletal and emergency radiology positions. Statistically significant proportional decreases occurred for general radiology, vascular/interventional radiology, and pediatric radiology.

CONCLUSION

Three separate data sources confirm a substantial and broad-based multiyear decline in the strength of the demand for diagnostic radiologists, with some shifting in relative demand for subspecialties. It is not clear if the decrease continued in 2004 or if 2004 demand was similar to that of 2003. Data are relative and do not indicate the employment market is weak in absolute terms.

Workload of radiologists in the United States in 2002-2003 and trends since 1991-1992

PURPOSE

To measure the workload of radiologists in the United States in 2002-2003, variations in workload according to practice characteristics, and trends since 1991-1992.

MATERIALS AND METHODS

Non-individually identified data from the American College of Radiology (ACR) 2003 Survey of Radiologists were compared with data from previous ACR surveys; all statistics were nationally representative. Workload according to individual practice characteristics, such as size, type, location, and setting, was tested for statistically significant differences from the overall average. Time trends and the independent effect on workload of practice characteristics were measured with regression analysis. Changes in average procedure complexity were calculated in physician work relative value units (RVUs) per Medicare procedure.

RESULTS

In 2002-2003, the average workload per full-time equivalent (FTE) radiologist was 13,900 procedures annually (standard error of mean, 200), an increase of 8.1% since 1998-1999 (P < .05) and 25.1% since 1991-1992 (P < .01). Academic practices performed 9900 procedures per FTE radiologist, and private radiology practices performed 15,200 procedures per FTE radiologist. Within most practice categories, radiologists at the 75th percentile of workload typically performed at least 50% more procedures than radiologists at the 25th percentile. Average physician work RVUs per Medicare procedure increased by 6.2% between 1998 and 2002 and by 21.6% between 1992 and 2003, mainly because of an increase in the share of more complex techniques such as magnetic resonance imaging and computed tomography in the procedure mix.

CONCLUSION

Workload per radiologist measured in procedures and RVUs increased steadily between 1991-1992 and 2002-2003. Because there is much unexplained variation, averages or medians should not be used as norms.

Neurosurgical workforce trends in the United States

OBJECT

The purpose of this study was to evaluate the US neurosurgery workforce by reviewing journal recruitment advertisements published during the past 10 years.

METHODS

The number of available academic and private neurosurgical staff positions was determined based on recruitment advertisements in the Journal of Neurosurgery and Neurosurgery for the 10-year period from 1994 to 2003. Advertisements were evaluated for practice venue, subspecialization, and location. The numbers of active neurosurgeons and graduating residents also were reviewed. The number of advertised neurosurgical positions increased from 141.6 +/- 38.2 per year from 1994 through 1998 to 282.4 +/- 13.6 per year from 1999 through 2003 (mean +/- standard deviation, p < 0.05). The mean number of academic positions increased from 50.6 +/- 11.1 to 95 +/- 17.5 (p < 0.05), and the mean number of private positions rose from 91 +/- 30.4 to 187.4 +/- 6.8 (p < 0.05). Subspecialty positions represented a mean of only 15.6 +/- 5% per year during the first time period and 18.8 +/- 3% per year in the second period (p = 0.22), and therefore the majority of positions advertised continued to be those for generalists. The number of practicing neurosurgeons declined after 1998, and by 2002 it was less than it had been in 1991. The numbers of incoming and matriculating residents during the study period were static.

CONCLUSIONS

The number of recruitment advertisements for neurosurgeons during the last 5 years has increased significantly, concomitant with a severe decline in the number of active neurosurgeons and a static supply of residents.

Types of Procedures Performed by Diagnostic Radiology Practices:Past Patterns and Future Directions

OBJECTIVE

The purpose of our study was to determine the types of imaging procedures performed by diagnostic radiology practices and the patterns and differences related to practice characteristics.

MATERIALS AND METHODS

The American College of Radiology (ACR) surveyed 970 practices by mail, using a 65-item questionnaire, in 1999. A response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. Trends were explored by making comparisons with data from a 1991-1992 ACR study.

RESULTS

Among the types of procedures studied, the highest percentage of multiradiologist diagnostic-radiology-only practices performed mammography (95%) and sonography (94%). (General conventional radiography and fluoroscopy were not studied.) The lowest percentage of these practices performed interventional procedures (69%) and MRI (77%). Solo practices showed less diversity in types of procedures performed than did multiradiologist practices and were a good deal less likely to perform each type of procedure except mammography and sonography. Generally, higher percentages of practices in nonmetropolitan cities or towns and rural practices performed various types of procedures than practices in metropolitan areas. Practice size, types of settings served (hospital or nonhospital), and practice type also influenced the number of types of procedures performed by a practice. The fraction of practices performing CT decreased from 91% to 83% between 1991-1992 and 1999. Percentages for other types of procedures were generally stable over time.

CONCLUSION

Certain practice characteristics play a role in determining the types of imaging procedures a diagnostic radiology practice performs. The decline in the percentage of practices providing CT and the failure during the 1990s of percentages for MRI and interventional radiology to increase from a relatively low base is worrisome. Future analyses based on a subsequent ACR survey will provide further insights into trends.

ACR and ASRT development of the radiologist assistant: concept, roles, and responsibilities

ACR and ASRT joined forces to address the workforce shortages of radiologists and radiological technologists with the development of a radiologist assistant. This paper discusses the rationale for the evolution and development of the radiologist assistant as designed by ACR and ASRT. With the profession of radiology experiencing workforce shortages among radiologists and radiological technologists many radiological groups were beginning to hire ancillary personnel to fill efficiency gaps in practices. Many academic institutions were in the process of considering programs to initiate advanced practice status for radiologic technologists. Several state legislatures were considering laws that would provide extended scope of practice technology with additional training. The ACR and ASRT entered into discussions to address these concerns in order to: (1) assure patient safety by allowing only properly trained personnel to provide radiological service to patients; (2) assure that these ancillary personnel are not allowed to practice without appropriate physician supervision; (3) assure that there are not 50 different state scope of practice laws based more on political expediency than quality patient care; (4) alleviate workforce shortages for radiological technologists by creating a professionally satisfying career path; (5) alleviate some of the time pressures placed on radiologists as a result of their workforce shortages. The ACR had a choice to lead on the development of the roles and responsibilities of the radiologist assistant or continue to allow the process to evolve as market and political pressures warranted. As a leader in the profession, the ACR believed that it was in the best interest of its members and the profession to be at the table with the development of the roles and responsibilities of the radiologist assistant to assure the best for our patients. The roles and responsibilities of the RA as approved by the ACR Council are presented.

After-hours coverage: Problems and solutions

Among the problems facing many radiology groups today is how to cover after-hours studies, because the demand is increasing while the number of available radiologists is still relatively low. There are a number of possible solutions, each of which has its own pros and cons, and no solution is right for every group. Recently, there have been a number of companies whose sole business is providing outside teleradiology coverage of after-hours radiology studies, sometimes referred to as "nighthawk" services. This article describes one group's decision-making process in choosing to hire a nighttime teleradiology provider as well as its subsequent experiences and ideas for future solutions.

Update on the diagnostic radiologist shortage

OBJECTIVE

The purpose of this study is to present the latest information available on the shortage of diagnostic radiologists.

MATERIALS AND METHODS

Four sources of information are available, and we present their data: first, the number of jobs for diagnostic radiologists advertised in Radiology and the American Journal of Roentgenology; second, vacancies in academic radiology departments as of July 1, 2003, ascertained by a survey of these departments; third, the ratio of job listings to job seekers at a major professional placement service, the Professional Bureau of the American College of Radiology (ACR); and fourth, diagnostic radiologists' self-reported workload burden, from the ACR's 2003 Survey of Diagnostic Radiologists.

RESULTS

Jobs advertised in September-November 2003 (latest data available) were 28% fewer than in the same months of 2002. Vacancies per department averaged 3.9 in 2003, compared with 5.4 in 2001 and 5.1 in 2002. Listings per seeker were 1.4 in 2002 (latest data available) compared with 3.0 or more in 1999 and 2000. Responses to a question directly tying changes in workload to changes in income indicated that reported desires for workload reduction and workload increase were approximately equal.

CONCLUSION

All four information sources have important limitations, but all indicate that the shortage has considerably eased. We plan to study the causes of this easing and continue to monitor the situation.

Evolution of the digital revolution: a radiologist perspective

The transformation from film-based to filmless operation has become more and more challenging, as imaging studies expand in size and complexity. To adapt to these changes, radiologists must proactively develop new workflow strategies to compensate for increasing work demands and the existing workforce shortage. This article addresses the evolutionary changes underway in the radiology interpretation process and reviews changes that have occurred in the past decade. These include a number of developments in soft-copy interpretation, which is migrating from a relatively static process, duplicating film-based interpretation, to a dynamic process, using multi-planar reconstructions, volumetric navigation, and electronic decision support tools. The result is optimization of the human-computer interface with improved productivity, diagnostic confidence, and interpretation accuracy.

Findings in 2002 from a help wanted index of job advertisements: is the job-market shortage of diagnostic radiologists easing?

OBJECTIVE

The goal of this study is to present the most recent data on the diagnostic radiology job market in the United States using a help wanted index of job advertisements.

MATERIALS AND METHODS

All diagnostic radiology positions advertised in the American Journal of Roentgenology and Radiology from January through December 2002 were coded by practice type, geographic location, and subspecialty. Data were compared with the previously published results from 1991 through 2001.

RESULTS

From January through December 2002, 5117 positions were advertised for diagnostic radiologists, representing a 10.4% decrease from 2001. The 12-month rolling average of job advertisements peaked at 488 in February 2002 and dropped to 432 by December 2002, a level not seen since August 2000. In 2002, 42.7% of positions advertised were academic, representing a steady increase from 34.0% in 1999. When comparing the 4-year periods 1999-2002 and 1995-1998, a statistically significant proportional increase was found for positions advertised in the Midwest. Statistically significant relative increases were also observed for the subspecialties of abdominal radiology, mammography, neuroradiology, pediatric radiology, chest radiology, and nuclear medicine. Statistically significant relative decreases were seen in general and vascular and interventional positions.

CONCLUSION

The absolute demand for diagnostic radiologists nationwide appears to have stabilized during 2002, albeit at a level much higher than in previous years, and may be decreasing. A split seems to have appeared in the market between academia and private practice. Current policy should be directed toward increasing the supply of diagnostic radiologists, especially academicians.

Workload of radiologists in the United States in 1998-1999 and trends since 1995-1996

OBJECTIVE

This article measures the workload of radiologists in the United States in 1998-1999, its variation by practice characteristics, and changes since 1995-1996.

MATERIALS AND METHODS

Data on procedures performed were collected from the American College of Radiology's 1999 Survey of Practices, and responses were weighted to make them representative of all radiologists in the United States. Workload measured as number of procedures per full-time equivalent diagnostic radiologist was tabulated by practice type, size, setting, and location and compared with corresponding survey results from 1995-1996. The independent effect of these factors on workload was measured using regression analysis. Changes in procedure complexity were calculated in terms of relative value units (RVUs) per procedure using Medicare files.

RESULTS

In 1998-1999, the average workload per full-time equivalent diagnostic radiologist had increased 8.5% since 1995-1996 to 12,800 (standard error = 200) procedures annually, with substantial variation by group type. For example, the average workload was 9400 procedures in academic groups and 13,600 in nonacademic private radiology practices. Even in relatively homogeneous categories of practices, radiologists at the 75th percentile of workload were typically performing at least 50% more procedures than radiologists at the 25th percentile. Average RVUs per Medicare procedure increased by 4% between 1995 and 1998, mainly because of an increase in the share of more complex techniques such as MR imaging and CT in the procedure mix.

CONCLUSION

The workload per radiologist measured in procedures and RVUs increased substantially between 1995-1996 and 1998-1999. Because much variation remains unexplained, averages or medians should not be used as norms.

Too few radiologists?

OBJECTIVE

The purpose of our study was to model the supply and demand for diagnostic radiologists over the next 30 years under alternative scenarios.

MATERIALS AND METHODS

We used responses from the American College of Radiology's 2000 Survey of Diagnostic Radiologists and Radiation Oncologists to determine the current age distribution and activity of diagnostic radiologists. The numbers entering the profession were projected using three assumptions: no change in training programs, reduction of residency to 3 years (or otherwise increasing the annual number of graduates by one third), and elimination of most fellowship programs. Demand projections assume a 5% shortage in 2001 and depend on growth rates of the population, aging, scenarios of growth of age-standardized demand, and the effect of possibly productivity-enhancing technologies such as PACS (picture archiving and communication systems).

RESULTS

Only a one-third increase in annual graduates materially increases the work-force relative to current training patterns. In all cases, the growth rate of the demand for radiologists far outstrips the supply over a 30-year horizon. In the shorter term, projections of current trends point to an increasing shortage, but rapid major productivity increases could produce a surplus.

CONCLUSION

Those in the field of diagnostic radiology should consider measures to mitigate the increasing shortage, while monitoring developments that might signal departures from current trends in supply and demand.