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

Demands for medical imaging and workforce Size: A nationwide population-based Study, 2000-2020

PURPOSE

The aim of this study was to investigate associations between workforce and workload among radiologists in Taiwan.

MATERIALS AND METHODS

Data for the period 2000-2020 describing the demand for imaging services and radiologists have been obtained from databases and statistical reports of the Ministry of Health and Welfare. The future demand for radiologists was based on Taiwanese people aged 40 and over.

RESULTS

The workforce of Taiwan's radiologists has increased by 6 % annually over the past 20 years (from 450 to 993), performing 2125, 3202 and 3620 monthly examinations (mainly conventional radiography and CT) in medical centers, regional hospitals and district hospitals. Between 2000 and 2020, the use of CT and MRI increased by more than 3.5 times. Demand for interventional radiology also increased by 1.77 times, 2.25 times, and 5 times, respectively. To maintain this volume of services in 2040, at least 1168 radiologists are needed, about 1.18 times more in 2020.

CONCLUSION

Taiwan has 2.4 to 2.9 times fewer radiologists than the United States and 3 times fewer than Europe, while the annual workload is approximately 2 to 3.4 times greater than that of the United States and 1.4 to 2.5 times greater than that of the United Kingdom. This report may serve as a reference for policy makers who address the challenges of the growing workload among radiologists in countries of similar situations.

Productivity evaluation of radiologists interpreting computed tomography scans using statistical process control charts

Radiology service managers search for efficient ways to monitor productivity and improve capacity. One way to assess radiologists' productivity is by measuring their time to complete reports. Radiology reporting times (RRTs) may be monitored using statistical tools, such as process control charts (CCs). This study was carried out in the radiology sector of a University-based general hospital with 850 inward beds. Productivity was monitored using CCs. The selected control variable was RRTs, and process capability was calculated using C_p and C_pk indices. Only chest computed tomography scans were analyzed, totaling 2862 exams over a 6-month period. Our objective was to develop a simple tool to monitor radiologist performance, as given by RRT, over time. For that, we constructed CCs using data from 10 radiologists to monitor the stability of their RRTs. Only 3 radiologists presented mean times below the group average; 6 displayed a trend in RRTs that characterized performance improvement, while 4 displayed the opposite trend. Capability measures for the group indicated a process that is not capable. We demonstrate that CCs may be a useful tool for monitoring radiologists' performances in CT scans interpretation. Results demonstrated that in the individual CT reporting process, common cause variability is the type of variability most frequently observed, being most likely related to natural variations in features of the images analyzed. Lastly, CCs may also assist in decision making in the sector, such as establishing minimum productivity goals based on historical performance.

Radiology education: a radiology curriculum for all medical students?

Diagnostic errors in radiology are frequent and can cause severe patient harm. Despite large performance differences between radiologists and non-radiology physicians, the latter often interpret medical images because electronic health records make images available throughout the hospital. Some people argue that non-radiologists should not diagnose medical images at all, and that medical school should focus on teaching ordering skills instead of image interpretation skills. We agree that teaching ordering skills is crucial as most physicians will need to order medical images in their professional life. However, we argue that the availability of medical images is so ubiquitous that it is important that non-radiologists are also trained in the basics of medical image interpretation and, additionally in recognizing when radiological consultancy should be sought. In acute situations, basic image interpretations skills can be life-saving. We plead for a radiology curriculum for all medical students. This should include the interpretation of common abnormalities on chest and skeletal radiographs and a basic distinction of normal from abnormal images. Furthermore, substantial attention should be given to the correct ordering of radiological images. Finally, it is critical that students are trained in deciding when to consult a radiologist.

Identifying error types in visual diagnostic skill assessment

BACKGROUND

Misinterpretation of medical images is an important source of diagnostic error. Errors can occur in different phases of the diagnostic process. Insight in the error types made by learners is crucial for training and giving effective feedback. Most diagnostic skill tests however penalize diagnostic mistakes without an eye for the diagnostic process and the type of error. A radiology test with stepwise reasoning questions was used to distinguish error types in the visual diagnostic process. We evaluated the additional value of a stepwise question-format, in comparison with only diagnostic questions in radiology tests.

METHODS

Medical students in a radiology elective (n=109) took a radiology test including 11-13 cases in stepwise question-format: marking an abnormality, describing the abnormality and giving a diagnosis. Errors were coded by two independent researchers as perception, analysis, diagnosis, or undefined. Erroneous cases were further evaluated for the presence of latent errors or partial knowledge. Inter-rater reliabilities and percentages of cases with latent errors and partial knowledge were calculated.

RESULTS

The stepwise question-format procedure applied to 1351 cases completed by 109 medical students revealed 828 errors. Mean inter-rater reliability of error type coding was Cohen's κ=0.79. Six hundred and fifty errors (79%) could be coded as perception, analysis or diagnosis errors. The stepwise question-format revealed latent errors in 9% and partial knowledge in 18% of cases.

CONCLUSIONS

A stepwise question-format can reliably distinguish error types in the visual diagnostic process, and reveals latent errors and partial knowledge.

Social networks and expertise development for Australian breast radiologists

Background

In this study, we explore the nexus between social networks and expertise development of Australian breast radiologists. Background literature has shown that a lack of appropriate social networks and interaction among certain professional group(s) may be an obstacle for knowledge acquisition, information flow and expertise sharing. To date there have not been any systematic studies investigating how social networks and expertise development are interconnected and whether this leads to improved performance for breast radiologists.

Methods

This study explores the value of social networks in building expertise alongside with other constructs of performance for the Australian radiology workforce using semi-structured in-depth interviews with 17 breast radiologists.

Results

The findings from this study emphasise the influences of knowledge transfer and learning through social networks and interactions as well as knowledge acquisition and development through experience and feedback. The results also show that accessibility to learning resources and a variety of timely feedback on performance through the information and communication technologies (ICT) is likely to facilitate improved performance and build social support.

Conclusions

We argue that radiologists’ and, in particular, breast radiologists’ work performance, needs to be explored not only through individual numerical characteristics but also by analysing the social context and peer support networks in which they operate and we identify multidisciplinary care as a core entity of social learning.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1938-9) contains supplementary material, which is available to authorized users.

A systems life cycle approach to managing the radiology profession: an Australian perspective

OBJECTIVE

Although the medical system has expanded considerably over the past two decades in almost all countries, so too has the demand for health care. The radiology specialisation may be an early system indicator, being especially sensitive to changes in supply and demand in both rural and urban environments. The question is whether the new policies of increasing the number of radiologists can be a proper long-term solution for the imbalance of workforce supply and demand or not.

METHODS

Using system dynamics modelling, we present our integrated descriptive models for the supply and demand of Australian radiologists to find the actual gap. Followed by this, we pose a prescriptive model for the supply in order to lessen the identified imbalance between supply and demand. Our system dynamics models compare the demand and supply of Australian radiologists over 40 years between 2010 and 2050.

RESULTS

The descriptive model shows that even if the radiology training program grows at a higher rate than the medical training growth rate and its own historical growth, the system will never be able to meet demand. The prescriptive model also indicates that although changing some influential factors (e.g the intake rate) reduces the level of imbalance, the system will still stay unstable during the study period.

CONCLUSION

We posit that Australia may need to design a new system of radiology provision to meet future demands for high-quality medical radiation services. We also suggest some strategies, such as greater development of radiographers' role, are critical for enabling sustainable change over time. What is known about the topic? Long-term workforce planning for medical services at the national level has been very challenging for policy makers of the 21st century. The current demographic imbalance in the supply and demand of the Australian radiologist workforce makes it difficult to plan the effects of extra inflow of radiology students over time.

Radiation knowledge and perception of referral practice among radiologists and radiographers compared with referring clinicians

Objectives

To explore if the perception of radiologists and radiographers on referral practice differs from that of referring clinicians, and to see if knowledge of radiation issues and referral guidelines differ between these groups.

Methods

A questionnaire was handed out to 46 radiologists and 36 radiographers in Norway. Findings were compared to corresponding results from a similar already published study on clinicians. Questions dealt with referrals unlikely to affect treatment as well as respondents’ radiation and referral guideline knowledge.

Results

Radiographers estimated the highest proportion of referrals most unlikely to affect treatment (median 20 %) in comparison to radiologists (10 %) and clinicians (5 %). Lack of time, compensating for limited clinical examination and patient expectations were rated as more important reasons for such referrals by radiologists than by clinicians. Radiologists and radiographers possessed significantly better radiation knowledge than clinicians, and were more familiar with referral guidelines.

Conclusions

The perception of radiologists and radiographers differs from that of clinicians, concerning the use of imaging most unlikely to affect treatment, and the reasons for such referrals. Radiologists and radiographers possess better radiation knowledge than referring clinicians, but all groups have a potential in improving their radiation protection knowledge.

Main Messages

• Radiographers estimated the highest proportion of referrals most unlikely to affect treatment.

• Radiologists rated “getting the patient discharged” as an important reason for such referrals.

• Radiologists and radiographers possess significantly better radiation knowledge than clinicians.

Current perspectives in medical image perception

Medical images constitute a core portion of the information a physician utilizes to render diagnostic and treatment decisions. At a fundamental level, this diagnostic process involves two basic processes: visually inspecting the image (visual perception) and rendering an interpretation (cognition). The likelihood of error in the interpretation of medical images is, unfortunately, not negligible. Errors do occur, and patients' lives are impacted, underscoring our need to understand how physicians interact with the information in an image during the interpretation process. With improved understanding, we can develop ways to further improve decision making and, thus, to improve patient care. The science of medical image perception is dedicated to understanding and improving the clinical interpretation process.

Historical review of occupational exposures and cancer risks in medical radiation workers

Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.

Radiology practices' use of external off-hours teleradiology services in 2007 and changes since 2003

OBJECTIVE

Our objective is to report patterns of utilization of external off-hours teleradiology services (EOTSs) in 2007 and changes since 2003.

MATERIALS AND METHODS

We analyzed non-individually identified data from the American College of Radiology's 2007 Survey of Member Radiologists and its 2003 Survey of Radiologists. Responses were weighted to be nationally representative of individual radiologists and radiology practices. We present descriptive statistics and multivariable regression analysis results on the use of EOTSs in 2007 and comparisons with 2003.

RESULTS

Overall, 44% of all radiology practices in the United States reported using EOTSs in 2007. These practices included 45% of all U.S. radiologists. Out-of-practice teleradiology had been used by 15% of practices in 2003. Regression analysis indicates that, other practice characteristics being equal, in 2007, primarily academic practices had lower odds of using EOTSs than private radiology practices. Also, large practices (>or= 30 radiologists) had lower odds of using EOTSs than practices with 15-29 radiologists. Small practices (1-10 radiologists) had high odds, but nonmetropolitan practices did not. There were no significant differences by geographic region of the United States.

CONCLUSION

Use of EOTSs was widespread by 2007, and it had been increasing rapidly in the preceding few years. Patterns of use were generally as might be expected except that nonmetropolitan practices did not have high odds of using EOTSs.

Health disparities among America's health care providers: evidence from the Integrated Health Interview Series, 1982 to 2004

OBJECTIVE

To examine whether health status and obesity prevalence differ by race or ethnicity and health care workforce category.

METHODS

Data representing US health care workers aged 20 to 64 between 1982 and 2004 were retrieved from the Integrated Health Interview Series. Trends, as well as disparities, in health status and obesity are examined by workforce category using logistic regression.

RESULTS

Self-reported health status of health care workers has declined over time and the prevalence of obesity is rising. Moreover, there is a clear social gradient across workforce categories, which is widening over time. Within workforce categories, there are significant racial disparities in health status and prevalence of obesity.

CONCLUSIONS

Health of health care workers needs to be taken into account when setting policies intended to increase access to health care and create a healthy diverse workforce.

Radiologist supply and workload: international comparison--Working Group of Japanese College of Radiology

PURPOSE

The aim of this study was to compare radiology statistics and procedures across the world with an eye to lightening the workload of radiologists in Japan.

METHODS

Literature and data in the public domain were obtained for Organization for Economic Cooperation and Development (OECD) member countries. This study collected and analyzed the number of (diagnostic) radiologists and physicians, computed tomography/magnetic resonance (CT/MR) units, CT/MR examinations, and workload of radiologists.

RESULTS

Data for the number of radiologists and CT/MR units were obtained from 26 countries and, among them, data for the number of CT/MR examinations for 17 countries. The study found that in 2004 Japan had only 36 radiologists per million population, which is one-third the national average of the 26 countries surveyed, making Japan one of the lowest ranked countries. The workload of a radiologist (CT/MR examinations/year) in Japan was calculated at 6130. This is 4.3 times the global average (1440 for the 17 countries).

CONCLUSIONS

This comparison showed that the number of radiologists in Japan is the lowest among the 26 countries, and the workload is the highest. The study also showed that for Japan to provide sustainable and quality health care 8614 diagnostic radiologists--2.5 times the present number- -would be required.

Radiologists' clinical practice of neuroimaging

PURPOSE

Because of the importance of neuroimaging as a radiology subspecialty, the aim of this study was to provide a detailed portrait of the demographics, clinical activities, and practices of radiologists heavily involved in neuroimaging.

METHODS

The authors analyzed data from the ACR's 2003 Survey of Radiologists, a large, stratified random-sample survey in which respondents were guaranteed confidentiality. The survey achieved a 63% response rate, and responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Three-fourths of US radiologists reported doing neuroradiology; 9% reported that neuroradiology was their main subspecialty, and 9% reported spending more than 50% of their clinical work time doing neuroradiology. Of these latter two categories, more than about 75% had certificates of added qualification (CAQs) in neuroradiology, and more than 80% had done neuroradiology fellowships. However, of those spending more than 50% of their clinical work time doing neuroradiology, 7% neither had CAQs nor had done fellowships in the field. One-fourth of radiologists with CAQs or who had done neuroradiology fellowships spent less than 30% of their clinical work time doing neuroradiology. One-third to one-half of neuroimaging was performed by radiologists not heavily involved in the field. Only 6% to 8% of radiologists heavily involved in the field were women, compared with 22% in other subspecialties.

CONCLUSIONS

Neuroimaging has the great strength of being a relatively well-integrated subspecialty in that a very large majority of those heavily involved in its practice have CAQs and did fellowships in the field. Among possible concerns are the relatively few women in the field and the apparent waste of expertise resulting from one-fourth of those with neuroradiology subspecialty training or certification being relatively little immersed in its practice.

Enhancing CT productivity: strategies for increasing capacity

OBJECTIVE

This article will identify strategies and tactics that can be used to enhance CT capacity. The potential financial benefits to the organization and the impact on market share will be discussed.

CONCLUSION

Many organizations are challenged to meet stakeholder demands of providing additional CT capacity and reduction of patient waiting lists. However, much can be achieved through workflow redesign, the addition of key personnel, and implementation of information system platforms and databases.

The growing size of radiology practices

PURPOSE

To describe trends in the size of radiology practices from 1990 to 2007.

METHODS

Data from the American College of Radiology's 1990, 1995, 2000, and 2003 surveys of radiologists and radiation oncologists and its 2007 survey of radiologist members are compiled to describe the changing distribution of radiologists by practice size over time. All estimates are weighted to be representative of all radiologists in the United States.

RESULTS

The fraction of radiologists in small practices (1-4 radiologists) decreased from 29% in 1990 to 22% in 2007. The fraction in medium-sized practices (5-14 radiologists) decreased from 51% in 1990 to 38% in 2007. The fraction in practices with 15 to 29 radiologists increased from 14% in 1990 to 21% in 1995 and has since remained constant. The fraction in practices with 30 or more radiologists grew from 5% in 1990 to 19% in 2007, but since 2000, growth among these practices has largely been limited to practices with 60 or more radiologists. The median radiologist was in a 7-radiologist practice in 1990. This size increased to 11 in 2000 and was the same in 2007. The size of a practice at the 90th percentile of radiologists increased from 22 in 1990 to 45 in 2007.

CONCLUSION

Radiology practices grew in size throughout the 1990 to 2007 period. In general, changes were more rapid in 1990 to 2000 than since. The most conspicuous growth was in practices with 30 radiologists or more. This category almost quadrupled its share of radiologists. In contrast, the share of very small practices (1-4 radiologists) declined relatively little, by only approximately one-fourth.

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.

The use of CT for screening: a national survey of radiologists' activities and attitudes

PURPOSE

To investigate the activities, motivations, and attitudes of radiologists regarding specific computed tomographic (CT) screening examinations by using a survey.

MATERIALS AND METHODS

All study activities were approved by the institutional review board. A self-administered, mailed survey was used to collect data on the practices and attitudes of U.S. radiologists regarding three CT screening tests--coronary artery calcium scoring (CACS), lung cancer screening CT, and whole-body screening CT. The survey was sent to 1000 diagnostic radiologists who were randomly sampled from the American Medical Association Physician Masterfile.

RESULTS

A total of 398 (41.4%) of 961 eligible radiologists completed the survey. Among respondents, 33.6% reported reading CT screening studies, the most common being CACS (26.7%), followed by lung screening (19.2%) and whole-body screening (9.5%). Among respondents, 34.1% supported CACS and 29.9% supported lung CT screening for particular patients, while 1.9% supported whole-body CT screening. The most common reasons reported for reading CT screening studies were responses to requests from physicians (83.3%) or patients (75.0%), while fewer (40.8%) cited patient benefit from screening as a reason.

CONCLUSION

A substantial proportion of a nationally representative sample of radiologists in the United States reads CT screening studies of the heart, lungs, and whole body and holds favorable attitudes toward CACS and lung CT screening. These attitudes may allow for the premature diffusion of new screening tests into practice before higher-level evidence demonstrates their benefits for population mortality.

Radiology report turnaround: expectations and solutions

The ultimate work product of a radiology department is a finalized radiology report. Radiology stakeholders are now demanding faster report turnaround times (RTAT) and anything that delays delivery of the finalized report will undermine the value of a radiology department. Traditional reporting methods are inherently inefficient and the desire to deliver fast RTAT will always be challenged. It is only through the adoption of an integrated radiology information system (RIS)/picture archiving and communication system (PACS) and voice recognition (VR) system that RTAT can consistently meet stakeholder expectations. VR systems also offer the opportunity to create standardized, higher quality reports.

Maximizing outpatient computed tomography productivity using multiple technologists

PURPOSE

A key radiology stakeholder demand is to increase patient access to computed tomography (CT) and reduce waiting lists. However, the number of patients that a single technologist can scan is limited because of the many tasks required to process a patient through a CT scan. However, many tasks could be performed simultaneously by using additional personnel. This study evaluated how many additional patients can be scanned using a 2- or 3-technologist model with outpatient multidetector CT and its impact on CT capacity.

METHODS

The number and type of individual technologist tasks were initially evaluated. The time to perform these tasks was then measured using 1-, 2-, and 3-technologist models, including the time a patient was within the CT scanner room, to determine the hourly patient throughput on a CT scanner. Two theoretic CT operations were then developed to evaluate the impact on CT capacity.

RESULTS

Thirty-four technologist workflow tasks were identified. A total of 205 outpatients were evaluated. The total time to perform all tasks for 1-, 2-, and 3-technologist models was 27, 23, and 22 minutes, respectively. CT room time per patient for 1-, 2-, and 3-technologist models was 12, 9.7, and 8.0 minutes, respectively. However, the number of patients scanned per hour for 1-, 2-, and 3-technologist models was 2.2, 5.2, and 7.5, respectively. There was an increase of more than 12,000 potential patient CT slots made available using 2 technologists 7 days per week and 22,000 additional slots for a 3-technologist model when compared with a single-technologist model on weekdays only.

CONCLUSION

A single-technologist model for outpatient multidetector CT is inefficient with limited opportunity for increased patient throughput. The use of multiple technologists (or other key personnel) optimizes CT throughput and capacity, particularly with a 3-technologist model, which can yield a greater than three-fold increase in CT productivity.

Challenges to radiology resident education in the new era

Over the past decade, there have been many developments that have changed the practice of radiology and the education of radiology residents. These include workforce issues, the institution of the Accreditation Council for Graduate Medical Education duty-hours restrictions, the increased use of night float systems, and the implementation of picture archiving and communication systems as well as voice recognition. This article reviews the impact on resident education, summarizes potential problems introduced by these changes, and examines proposed solutions.

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.

Radiation Oncologists in the United States

PURPOSE

To provide an extensive and detailed portrait of radiation oncologists, their professional activities, and the practices in which they work.

METHODS AND MATERIALS

We analyzed non-individually identified data from the American College of Radiology's 2003 Survey of Radiation Oncologists, a stratified random sample survey that guaranteed respondents' confidentiality and achieved a 68% response rate, with a total of 472 responses. Responses were weighted to make them representative of all radiation oncologists in the United States. We use two-tailed z tests of percentages and means to compare information from the current survey with those from a similar 1995 survey.

RESULTS

The number of posttraining, professionally active radiation oncologists grew from nearly 2900 in 1995 to nearly 3500 in 2003, an increase of approximately 21%. Twenty-three percent of posttraining, professionally active radiation oncologists were women. Among posttraining, professionally active radiation oncologists, 95% were board-certified. Forty-eight percent of radiation oncologists were in nonacademic, radiation-oncology-only private practices; 20% in academic practice; 14% in nonacademic, multispecialty practices; and 11% in solo practice. The largest percentage of radiation oncologists worked in the South (34%). The average annual number of patients treated (curative and palliative) per radiation oncologist was 264. On average, radiation oncologists preferred a 4% increase in their workload. The proportion of radiation oncologists planning a career change decreased from 8% in 1995 to 4% in 2003, and in 2003 34% said they were enjoying radiation oncology more than 5 years earlier, compared with 21% in 1995.

CONCLUSION

Despite concerns in 2003 about lower-than-optimal workload, professional satisfaction, if anything, increased since 1995.

Satisfaction of Radiologists in the United States: A Comparison between 2003 and 1995

PURPOSE

To prospectively ascertain what characteristics of radiologists, their practices, and their work environment affect professional satisfaction and to describe recent changes in satisfaction.

MATERIALS AND METHODS

Survey respondents were guaranteed confidentiality. Those who consented to participate were informed of the nature of the study. The authors analyzed nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a nationally representative, confidential, stratified random-sample mail survey of radiologists in the United States, which had a 63% response rate, with a total of 1924 responses. Data were weighted to be representative of all U.S. radiologists and were analyzed by using univariate and multivariate analyses. The five answer options to questions regarding level of satisfaction corresponded to scores of +2, +1, 0, -1, and -2. Results were compared with those of a similar 1995 survey.

RESULTS

Although 93% of radiologists enjoyed radiology very much or somewhat, the mean satisfaction score for posttraining professionally active radiologists decreased from 1.62 in 1995 to 1.47 in 2003. Thirty-two percent of radiologists reported enjoying radiology more than 5 years ago; 41% said they enjoyed it less. Excessive workload reduced current satisfaction and satisfaction relative to 5 years ago. Working in the Midwest enhanced current satisfaction and satisfaction relative to 5 years ago. Practice type and practice ownership had more varied effects on professional satisfaction; subspecialty type had relatively little effect. In 2003, medicolegal climate, workload, and reimbursement and/or financial pressures were the three most common reasons for decreased satisfaction. In 1995, interference from managed care; government regulations, control, and red tape; and increased administrative burden were the three most common reasons. Lifestyle and/or work hours, and income were the most common causes of increased satisfaction in 2003, but these were also often mentioned as causes of decreased satisfaction.

CONCLUSION

Radiologists have higher levels of professional satisfaction than do other physicians; however, as with physicians overall, their satisfaction has decreased over time.

The Academic RVU: A System for Measuring Academic Productivity

Despite the importance of teaching, research, and related activities to the mission of academic medical departments, no useful and widely agreed-on metrics exist with which to assess the value of individual faculty members' contributions in these areas. Taking the concept of the clinical relative value unit (RVU) as a model, the authors describe the development of an academic RVU (aRVU) system that assigns weights to and creates formulas for assessing productivity in publications, teaching, administrative and community service, and research. The resulting aRVU schema was implemented on a Web-based system that incorporates a number of novel tools, including a curriculum vitae manager that automatically maintains and calculates total aRVU scores and breaks out component elements for each individual and for the department as a whole. The benefits and limitations of this system are discussed, as well as the potential advantages in sharing this approach with other radiology departments and other medical disciplines. Wide acceptance and implementation would make the aRVU the appropriate counterpoint to the clinical work RVU in academic medicine.

Successful Recruiting of Radiologists

Hospital systems and radiology organizations often find it difficult to recruit new high-quality radiologists. This article discusses long-range planning for finding new radiologists, methods used to recruit prospective new members for a radiology department or group, how to carry out a satisfactory interview, and questions that are illegal to pose during an interview. The related topics of the state of the radiology job market and ways to reduce staff turnover are also addressed briefly.

Junior faculty satisfaction in a large academic radiology department

RATIONALE AND OBJECTIVES

Retention of academic faculty is a pressing issue for many radiology departments. The departure of junior faculty members to private practice may be driven in part by economics; however, the choice may be influenced by many other elements of faculty satisfaction. The purpose of this study was to evaluate how satisfied junior (assistant professors and instructors) and senior (associate professors and professors) faculty in an academic radiology department are with respect to their work and to determine which factors most affected the decision to stay in academics.

MATERIALS AND METHODS

We conducted a survey of junior and senior faculty in the department of radiology. Questions included attitudes regarding work, home, and family issues. Among the 27 junior faculty (73%) who responded to the survey, 14 were instructors and 13 were assistant professors. Among the 11 senior faculty (21%) who responded to the survey, 3 were associate professors and 8 were professors.

RESULTS

Academic radiology faculty are very happy with work and derive enjoyment and fulfillment from their work. The working week excluding call (average 52 hours) and including call (average 61 hours) was not regarded as too long. The average academic faculty works 72% clinical time (range 15% to 100%) and gets 0.96 day a week of professional development. Fifty-nine percent are funded at an average of 0.91 day a week. Forty-one percent are on tenure track, and of the remainder, 40% expressed a desire for tenure track. Fifty-five percent of faculty have mentors and 57% receive adequate mentoring. When it comes to teaching, 50% have enough time to teach juniors. Of the remainder, all but one cited high clinical workload as an impediment to teaching juniors. Forty-one percent of faculty reported not getting enough academic time. Fifty-nine percent felt pressure to publish and 34% felt pressure to obtain external funding. Seventy-six percent surveyed felt it has become more difficult to publish. The main reasons cited were increasing clinical workload (34%), higher standards required (25%), lack of academic time (25%), and institutional review board constraints (16%). Twenty-eight percent of faculty work on research projects during weekends, 25% during professional development time, and 21% on weekday evenings. However, 63% said they had too little time to spend at home, with family, or on hobbies. The main reasons cited were demands on time caused by clinical work (45%), research (42%), and teaching (24%). Fifty-three percent said that their work regularly causes conflicts at home.

CONCLUSIONS

The main reasons to stay in academics were the opportunity for teaching (68%), working with expert colleagues (58%), to pursue research (55%), and an interesting mix of cases (47%). Disincentives to stay in academics included insufficient financial remuneration (82%), the high clinical workload (45%), academic center "politics," and the lack of academic time (42%).

Women Radiologists in the United States: Results from the American College of Radiology's 2003 Survey

PURPOSE

To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists.

RESULTS

Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men.

CONCLUSION

Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.