Who's Overworked and Who's Underworked among Radiologists? An Update on the Radiologist Shortage

Estimating the productivity of radiologists in Brazil: the search for a benchmark

Objective

To determine the average productivity of radiologists, as measured by number of reports issued per 6-h shift, evaluating variables that could affect the results.

Materials and Methods

This was a study utilizing an online questionnaire sent to radiologists affiliated with the Brazilian College of Radiology and Diagnostic Imaging. The questions were related to the demographic profile and professional practice characteristics (form of remuneration, primary imaging method employed, and subspecialty) of the radiologists, as well as their individual productivity (average personal productivity) and the productivity considered reasonable in a 6-h shift. The association between productivity and the practice characteristics of the radiologists was determined by using Poisson regression to calculate the prevalence ratio.

Results

A total of 510 radiologists completed the questionnaire. The great majority of the respondents (84%) reported that their remuneration is directly related to their productivity. The productivity varied according to the subspecialty, work environment, and remuneration model.

Conclusion

We demonstrated that the productivity of radiologists is associated with the characteristics of their employment. We hope that this study will encourage other studies aimed at evaluating the productive capacity of the radiologists in Brazil, addressing the various functions they perform in their daily routine, including activities other than issuing reports.

National Survey to Identify Subspecialties at Risk for Physician Shortages in Canadian Academic Radiology Departments

Purpose

To identify subspecialty fields in Canadian academic radiology departments that are at risk for future manpower shortages. To determine reasons for the potential shortages and suggest potential solutions.

Methods

An anonymous online survey was sent by e-mail to radiology residents and academic radiology department heads in Canada. The survey was open from April 1 to August 1, 2006. Statistical analysis by using the SAS Frequency Procedure was performed on the results.

Results

Interventional radiology, neuroradiology, mammography, cardiac imaging, and pediatric radiology were identified as areas in which there will be increasing workforce demands. Mammography, pediatric radiology, and cardiac imaging were identified as areas in which there will be a potential decrease in supply. Of the residents, 65.83% intended on pursuing subspecialty training. Priorities were interesting work, job availability, and work schedule. Nuclear medicine, mammography, pediatric radiology, and interventional radiology were identified as the top 4 areas in which residents specifically did not want to pursue further subspecialty training. Only 15% of resident respondents received career counseling during residency, and only 50% of those residents thought it was adequate.

Conclusions

Our survey results indicate that mammography, cardiac imaging, and pediatric radiology are at risk for manpower shortages, and interventional radiology may be at risk. Increased efforts to recruit trainees may be necessary to ensure that these subspecialties maintain their presence in the future. Only 15% of the surveyed residents received career counseling during residency. This is a relatively untapped forum that academic staff could use to help recruit new trainees into these underserved subspecialties.

'Sleeping with the enemy?' Expectations and reality in imaging children in the emergency setting

As an introduction to the ALARA conference titled "Building Bridges between Radiology and Emergency Medicine: Consensus Conference on Imaging Safety and Quality for Children in the Emergency Setting," it is important for us to understand the landscapes of both the pediatric radiology and emergency medicine subspecialties. Recognizing potentially different practice patterns, including perspectives on pediatric care, as well as shared and sometimes unique professional pressures, can help us identify common concerns and problems and facilitate the development of strategies aimed at correcting these issues.

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.

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.

A survey of radiology practices' use of after-hours radiology services

PURPOSE

The study's purpose was to identify the characteristics of and the motives behind radiologists' use of after-hours services.

METHODS

From August of 2005 to June of 2006, 300 nonspecialty hospitals randomly selected from the 2005 American Hospital Association Directory of Hospitals were contacted by phone, e-mail, and mail, with an attempt made to speak to the chiefs of radiology. We obtained 115 responses, a 38.3% response rate, including 64 from practices that used an external after-hours service. These 64 are the subject of this study. Responses were analyzed using descriptive statistical analyses.

RESULTS

Practices gave convenience as the most important reason they use after-hours services, with value for recruiting ranked second and shortage of radiologists for off-hours coverage ranked third. Three-fourths of practices said they receive 5% or less of their reads from these services. Two-thirds of practices paid the service approximately as much as they collected or more. Approximately 40% of respondents used an after-hours service located internationally. Of these, 56% said that the radiologists reading internationally were either all Americans or mostly Americans and 40% did not know the proportion of foreigners. Regardless, in-state licensure of all interpreting teleradiologists is essentially universal.

CONCLUSION

Most radiology groups using after-hours services do so for convenience rather than shortage of staff to provide coverage. Most practices send a small percentage of their studies to the services. Although overseas-located services are commonly used, there is little evidence of other than American radiologists or American-trained radiologists at these services.

Development of a Google-based search engine for data mining radiology reports

The aim of this study is to develop a secure, Google-based data-mining tool for radiology reports using free and open source technologies and to explore its use within an academic radiology department. A Health Insurance Portability and Accountability Act (HIPAA)-compliant data repository, search engine and user interface were created to facilitate treatment, operations, and reviews preparatory to research. The Institutional Review Board waived review of the project, and informed consent was not required. Comprising 7.9 GB of disk space, 2.9 million text reports were downloaded from our radiology information system to a fileserver. Extensible markup language (XML) representations of the reports were indexed using Google Desktop Enterprise search engine software. A hypertext markup language (HTML) form allowed users to submit queries to Google Desktop, and Google's XML response was interpreted by a practical extraction and report language (PERL) script, presenting ranked results in a web browser window. The query, reason for search, results, and documents visited were logged to maintain HIPAA compliance. Indexing averaged approximately 25,000 reports per hour. Keyword search of a common term like "pneumothorax" yielded the first ten most relevant results of 705,550 total results in 1.36 s. Keyword search of a rare term like "hemangioendothelioma" yielded the first ten most relevant results of 167 total results in 0.23 s; retrieval of all 167 results took 0.26 s. Data mining tools for radiology reports will improve the productivity of academic radiologists in clinical, educational, research, and administrative tasks. By leveraging existing knowledge of Google's interface, radiologists can quickly perform useful searches.

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.

Comparison of productivity and cost of full-time and part-time faculty members in an academic department of radiology

PURPOSE

To compare financial productivity and employment costs of full-time and part-time faculty members and to assess qualitative factors related to part-time employment.

MATERIALS AND METHODS

Financial productivity and employment costs were compared for full-time and part-time staff members on the basis of a review of financial records from fiscal year 2005. Part-time and full-time faculty members were interviewed to determine reasons for working part-time and to assess the attitudes of both full-time and part-time faculty members toward part-time status.

RESULTS

Part-time radiologists working an average 65% schedule constituted 13% of the total full-time equivalent faculty complement and performed 14% of the clinical work at an average of 0.88 physicians' component total relative value units while more than covering their costs. Part-time radiologists were more productive while interpreting examinations of lesser relative value unit value than full-time radiologists.

CONCLUSION

Part-time radiologists are an important resource for the specialty and should be nurtured to stay in practice.

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.

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.

The state of teleradiology in 2003 and changes since 1999

OBJECTIVE

The purpose of our study is to describe in detail the use of teleradiology in 2003 and to report on changes since 1999 in this rapidly evolving field.

MATERIALS AND METHODS

We analyze non-individually identified data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample mail survey that achieved a response rate of 63%, and data from the American College of Radiology's 1999 Survey of Practices. Responses were weighted to represent the distribution of individual radiologists and radiology practices nationwide. We present descriptive statistics and multivariable regression analysis results on the prevalence and uses of teleradiology in 2003 and comparisons with 1999.

RESULTS

Overall, 67% of all radiology practices in the United States, which included 78% of all U.S. radiologists, reported using teleradiology. A significant increase (p < 0.05) was seen in the prevalence of teleradiology or PACS, from 58% of practices in 1999 to 73% in 2003. Regression results indicate that, other practice characteristics being equal, in 2003, primarily academic practices were less likely to use teleradiology than private radiology practices, and medium-sized practices (5-14 radiologists) were more likely to have teleradiology than larger ones. In practices using teleradiology, home was the most frequent receiving site in both 1999 (81%) and 2003 (75%), the percentages being not significantly different.

CONCLUSION

Already a fixture of radiology practice in 1999, teleradiology increased in prevalence substantially by 2003. The primary use of teleradiology, transmission of images to home, did not change, suggesting that easing the burden of call remains the main use of teleradiology.

Retirement patterns and plans of radiologists

OBJECTIVE

The objectives of our study were to describe radiologists' recent retirement plans and patterns and to assess whether changes in radiologists' retirement patterns over the period of 1995-2003 explain the recent easing of the radiologist shortage.

MATERIALS AND METHODS

We present detailed information from 2003 about the planned retirement age of radiologists, their labor force participation late in their careers, and their actual retirement pattern based on data from the American College of Radiology's (ACR) 2003 Survey of Radiologists. To analyze changes over time, we compare these data with information from the ACR's 1995 and 2000 Surveys of Radiologists. Multivariate regression analysis was also used to identify the effects of radiologist and practice characteristics on radiologists' retirement plans.

RESULTS

The percentage of radiologists fully retired and the average retirement age were the same in 1995 and 2003. Overall, labor force participation rates were decreasing over the period 1995-2003 for both women and men. Standardized labor force participation rates for radiologists age 55-74 years appeared to decrease from 1995 to 2000 and remained at a lower level in 2003, but the changes were not statistically significant. As of 2003, radiologists retired at 64, approximately 2 years older than the average U.S. worker.

CONCLUSION

Radiologists remain active in their profession longer than the typical U.S. worker. There was no change in radiologists' pattern of gradually moving into retirement. If anything, radiologists were retiring earlier in 2003 than in the past. A delay in retirement is not an explanation of the recent easing of the radiologist shortage.

A Portrait of Pediatric Radiologists in the United States

OBJECTIVE

In recognition of the importance of pediatric radiology and the apparent shortage of radiologists in the field, the purpose of this study was to provide an extensive and detailed portrait of pediatric radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compare information about pediatric radiologists with that for other radiologists.

RESULTS

Approximately 3% of radiologists, some 800-900 physicians, are pediatric radiologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiologists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corresponding reduction in income) than desire an increase in workload. Pediatric radiologists who spend 70% or more of their clinical work time in their field are older than radiologists in general (average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is lower than for other subspecialists ( approximately 20% vs 37%). Pediatric radiologists are disproportionately women (one third or more, depending on definition, are women, vs 19% for other subspecialists and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one fifth for other subspecialists), and in the main cities of large metropolitan areas.

CONCLUSION

A shortage of pediatric radiologists exists and is likely to intensify. Access to pediatric radiologists is probably a problem except for children in large metropolitan areas who connect readily to academic hospitals. Means to overcome these problems need to be actively sought.

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.