Hiring of diagnostic radiologists in 1998

Abdominal imaging and patient education resources: enhancing the radiologist-patient relationship through improved communication

INTRODUCTION

The relative ease of Internet access and its seemingly endless amount of information creates opportunities for Americans to research medical diseases, diagnoses, and treatment plans. Our objective is quantitative evaluation of the readability level of patient education websites, written for the lay public, pertaining to common radiologic diagnostic test, and radiologic diagnoses specific to abdominal imaging.

METHODS

In October 2015, 10 search terms were entered in the Google search engine, and the top 10 links for each term were collected and independently examined for their readability level using 10 well-validated quantitative readability scales. Search terms included CT abdomen, MRI abdomen, MRI enterography, ultrasound abdomen, X-ray abdomen, cholecystitis, diverticulitis, hepatitis, inflammatory bowel disease, and pancreatitis. Websites not written exclusively for patients were excluded from the analysis.

RESULTS

As a group, the 100 articles were assessed at an 11.7 grade level. Only 2% (2/100) were written at the National Institutes of Health (NIH), and American Medical Association (AMA) suggested 3rd to 7th grade level to meet the 8th grade average reading level in the United States. In fact, 49% were written at a level that required a high school education or higher (greater than 12th grade).

CONCLUSIONS

With websites like radiologyinfo.org, generating over a million visitors a month, it is that clear there is a public interest in learning about radiology. However, given the discordance between the level of readability of the majority of the Internet articles and the NIH and AMA guidelines noted in this study on abdominal imaging readability, it is likely that many readers do not fully benefit from these resources on abdominal imaging.

Are we failing to communicate? Internet-based patient education materials and radiation safety

INTRODUCTION

Patients frequently turn to the Internet when seeking answers to healthcare related inquiries including questions about the effects of radiation when undergoing radiologic studies. We investigate the readability of online patient education materials concerning radiation safety from multiple Internet resources.

METHODS

Patient education material regarding radiation safety was downloaded from 8 different websites encompassing: (1) the Centers for Disease Control and Prevention, (2) the Environmental Protection Agency, (3) the European Society of Radiology, (4) the Food and Drug Administration, (5) the Mayo Clinic, (6) MedlinePlus, (7) the Nuclear Regulatory Commission, and (8) the Society of Pediatric Radiology. From these 8 resources, a total of 45 articles were analyzed for their level of readability using 10 different readability scales.

RESULTS

The 45 articles had a level of readability ranging from 9.4 to the 17.2 grade level. Only 3/45 (6.7%) were written below the 10th grade level. No statistical difference was seen between the readability level of the 8 different websites.

CONCLUSIONS

All 45 articles from all 8 websites failed to meet the recommendations set forth by the National Institutes of Health and American Medical Association that patient education resources be written between the 3rd and 7th grade level. Rewriting the patient education resources on radiation safety from each of these 8 websites would help many consumers of healthcare information adequately comprehend such material.

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.

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.

A Portrait of Breast Imaging Specialists and of the Interpretation of Mammography in the United States

OBJECTIVE

Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms.

MATERIALS AND METHODS

We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average.

CONCLUSION

Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

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.

A portrait of interventional radiologists in the United States

OBJECTIVE

In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional 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 oversampled interventionalists and 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 compared information about interventionalists with that for other radiologists.

RESULTS

Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists.

CONCLUSION

Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.

A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology's 1999 Survey

OBJECTIVE

This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses.

RESULTS

Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs.

CONCLUSION

Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

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.

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.

Financial Ratios in Diagnostic Radiology Practices: Variability and Trends

PURPOSE

To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends.

RESULTS

All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings.

CONCLUSION

The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive effect.

The Relationship of Managed Care To Business, Professional, and Organizational Aspects of Radiology Practices

OBJECTIVE

We sought to determine the extent of managed care involvement among radiology practices of different types, locations, and sizes; the factors associated with differences in involvement; and the impact of managed care on professional, organizational, financial, and hospital-relations aspects of radiology practices.

MATERIALS AND METHODS

A survey was mailed in 1999 to a sample of 970 radiology practices; completed, usable surveys were returned by 66% of the practices. Three indicators of managed care were used: a practice's percentage of managed care (HMOs plus preferred provider organizations), local area HMO penetration rate, and self-reported perceived effect of managed care.

RESULTS

Percentage of managed care averaged 30% but was 40% for multispecialty groups. It was relatively high in large metropolitan areas, for practices with no hospital activity, and for practices with any owners who were not practice members. The three measures of managed care were only moderately correlated (correlation coefficient, 0.25-0.33). None of the managed care variables had a statistically significant effect on days provided for vacation and continuing medical education, promptness of payment, years required for practice ownership (partnership), and percentage of practice members who were owners. Higher percentage of managed care was associated with higher collection rates, whereas greater perceived impact of managed care had the opposite association. Two thirds of practices belonged to at least one managed care-related organization such as an independent practice association. Most radiology practices reported no involvement in the managed care negotiations of hospitals, which was true even when the hospital's negotiations included the radiologists' fees or when the practice determined its level of involvement.

CONCLUSION

Many negative outcomes most feared by radiologists regarding the effect of managed care have not materialized. Perceptions of practices as to the effect of managed care seem to reflect negative aspects of their general situation, not only realities of managed care.

Characteristics of mixed diagnostic radiology-radiation oncology practices

OBJECTIVE

Our objectives were to describe the characteristics of "mixed practices"-that is, practices performing both diagnostic radiology and radiation oncology services-and to compare mixed practices with multiradiologist diagnostic radiology-only practices.

MATERIALS AND METHODS

In 1999, the American College of Radiology surveyed 970 practices by mail, using a 65-item questionnaire. A response rate of 66% was achieved. Responses were weighted such that they were representative of all the radiology practices in the United States. The estimates cited in this article were primarily drawn from this 1999 survey.

RESULTS

Mixed practices were nearly evenly divided between large (area population, > or = 1 million) and small metropolitan areas (area population, from 50,000 to 1 million). We found that 63% of mixed practices were nonacademic private practices; 27% were academic. Approximately 50% contained 15 or more members. Mixed practices were predominantly owned by members of the practice and predominantly served both hospitals and nonhospital settings. At least 90% of mixed practices performed mammography, imaging-guided breast biopsy, sonography, and nuclear medicine. We found that compared with multiradiologist diagnostic radiology-only practices, mixed practices were larger and were more likely to be academic, to serve both hospital and nonhospital settings, and to perform interventional and nuclear medicine procedures.

CONCLUSION

The characteristics of a mixed practice differ from those of a multiradiologist diagnostic radiology-only practice.

Basic characteristics of radiology practices: results from the American College of Radiology's 1999 survey

OBJECTIVE

The basic characteristics of radiology practices in the United States are described. We defined radiology practices as diagnostic-radiology-only practices, either solo or multiradiologist practices. Findings were compared with those from other data sources.

MATERIALS AND METHODS

In May 1999, the American College of Radiology surveyed 970 practices by mail using a 65-item questionnaire. A final response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States.

RESULTS

Approximately 4400 radiology practices existed in the country; 39% were located in nonmetropolitan or rural areas. The greatest percentage of practices (85%) was private nonacademic radiology practices. The greatest percentage of practices (43%) served only hospitals. However, solo practices were particularly likely (p < or = 0.01) to serve only nonhospital sites. Of all multiradiologist practices, 87% were completely owned by their members, but approximately two thirds of academic multiradiologist practices had outside owners. Seventy percent of multiradiologist practices interpreted images from outside clinics or groups; these averaged 3.2 outside clinics or groups for which they interpreted images.

CONCLUSION

The basic characteristics of radiology practices in 1999 are described. Good agreement was seen with findings obtained from other data sources.

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.

Radiation oncologists in 2000: demographic, professional, and practice characteristics

PURPOSE

To describe the demographic, professional, and practice characteristics of radiation oncologists, emphasizing comparisons to data from a similar 1995 Survey.

METHODS AND MATERIALS

In spring 2000, we surveyed 603 randomly selected radiation oncologists by mail, using a one-page questionnaire-455 responded. We weighted responses to make answers representative of all radiation oncologists in the United States.

RESULTS

Approximately 45% of post-training, professionally active, radiation oncologists were <45 years old and 22% were women. Forty-two percent of radiation oncologists in training were women. Thirty-three percent of radiation-oncology-only practices were solo practices. The greatest percentage of post-training, professionally active, radiation oncologists were in nonacademic private radiation oncology practices. Fifty-three percent of post-training, professionally active, radiation oncologists reported that their workload was about right. Eighteen percent of individuals 60-64 years old and approximately two-thirds of those > or =65 years old were not working (retired). The full-time equivalency of those aged 55-74 fell by 12 percentage points between 1995 and 2000.

CONCLUSIONS

Most demographic, professional, and practice characteristics remained relatively constant between 1995 and 2000, with the exception of work status patterns. Radiation oncologists reported a more balanced workload than that reported by diagnostic radiologists. The surplus of radiation oncologists, which was predicted in the mid-1990s, was not demonstrated.

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

PURPOSE

To determine whether data from a professional society placement service--the Professional Bureau of the American College of Radiology--are a valid measure of the employment market.

MATERIALS AND METHODS

For the United States from 1990 to 1998, the authors compared three placement service measures-the annual number of job listings, job seekers, and listings per seeker-with two presumably valid measures of the employment market-annual total jobs available (which was ascertained from surveys of hiring) and radiologist median income relative to the all-physician median. For the comparisons, both graphic displays of the data and correlation were used.

RESULTS

In graphs, patterns of change were similar. The correlation of job listings, which measure demand, with total jobs, which also measure demand, was 0.84 (P =.04). The correlation of (a) job seekers, a measure of supply, and (b) listings per seeker, which involve both supply and demand, with total jobs was substantial but lower: 0.58 (P =.23) and 0.76 (P =.08), respectively. Correlation of the three placement service measures with relative income, which presumably depends on both supply and demand, was 0.80-0.88 (P <.05 for each measure).

CONCLUSION

The statistical significance levels of the correlations and the pattern of findings--namely, stronger correlations among measures of the same aspect of the employment market--indicate that these placement service data are valid and reasonably accurate measures of the employment market.

Determinants of differences among radiologists in starting salaries

OBJECTIVE

We sought to ascertain the actual effect of each of a broad range of factors that plausibly might affect starting salary.

MATERIALS AND METHODS

We surveyed radiologists who completed training in 1997 and obtained 487 relevant responses. Multiple regression analysis was used to identify the independent effects of characteristics of the physician, his or her job and employment search, and market area characteristics of his or her practice locality.

RESULTS

Academic starting salaries were, other things equal, 6% below private practice. Residency-only graduates had incomes 7% below a typical fellowship income. Only a few fellowship fields garnered incomes that were significantly different from the typical income. More managed care in a locality was associated with lower income, and a higher percentage of elderly in the locality was associated with a higher income. We found no statistically significant (p < 0.05) effects of sex, job location constraints, local per capita income, local cost of living, or (generally) graduate quality as measured by the ranking of a graduate's residency program.

CONCLUSION

The determinants of income are multiple and varied, including physician characteristics, such as field of subspecialty training; job characteristics, such as academic versus private practice employment; and market area characteristics. However, the study yielded as many puzzling, negative findings, such as the lack of effect of physician quality or of even severe locational constraints, as positive, expected findings.

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.

Diagnostic radiologists in 2000: basic characteristics, practices, and issues related to the radiologist shortage

OBJECTIVE

We sought to describe radiologists and their practices, emphasizing trends in retirement age, practice size, and perceived workload burden.

MATERIALS AND METHODS

In spring 2000, we surveyed 3,027 randomly selected radiologists by mail, of whom 74% responded. We weighted responses to make answers representative of all radiologists and compared findings with a similar 1995 survey.

RESULTS

Thirty percent of radiologists age 65-69 were working full-time; 21% were working part-time. Overall, the full-time equivalency of radiologists age 55-74 was 67.6%, not significantly different from 1995. If current patterns of retirement and production of graduates continue, the workforce will grow at a rate of approximately 2% annually. Fifty-one percent of radiologists said that recognizing that income depends largely on work done, they had "much too much work" or "somewhat too much work"; 5% reported "somewhat too little work" or "much too little work." Six percent of posttraining professionally active radiologists were in solo practice, down from 8% in 1995; 15% were in two-to-four-radiologists groups, down from 17%; and 38% were in groups of 15 or more, up from 30%. Sixteen percent of posttraining professionally active radiologists were women. The percentage was highest (29%) for those younger than age 35 but was lower (22%) among trainees.

CONCLUSION

The findings of excess work are further evidence of a radiologist shortage. However, contrary to surveys of groups that are hiring, we found minimal evidence of earlier retirement. Nonetheless, workload currently is increasing faster than the workforce is likely to grow, so the shortage will probably intensify. The typical number of radiologists in a practice is increasing, but slowly.

Economic and demographic trends signal an impending physician shortage

It is widely believed that the United States is producing too many physicians. We have approached this issue by developing a new model for workforce planning based on assessments of the macrotrends that underlie the supply and use of physician services. These trends include economic expansion, population growth, physicians' work effort, and the provision of services by nonphysician clinicians. Contrary to earlier predictions, this model projects that the United States soon will have a shortage of physicians and that if the pace of medical education remains unchanged, the shortage will become more severe. A dialogue focused on that eventuality is imperative.