Updated findings from a help wanted index of job advertisements and an analysis of the policy implications: is the job-market shortage for diagnostic radiologists stabilizing?

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.

Trends in market demand for internal medicine 1999 to 2004: an analysis of physician job advertisements

BACKGROUND

The health care marketplace has changed substantially since the last assessment of demand for internal medicine physicians in 1996.

METHODS

We reviewed internal medicine employment advertisements published in 4 major medical journals between 1996 and 2004. The number of positions, specialty, and other practice characteristics (e.g., location) were collected from each advertisement.

RESULTS

Four thousand two hundred twenty-four advertisements posted 4,992 positions. Of these positions, jobs in the Northeast (31% of positions) or single specialty groups (36.8% of positions) were most common. The relative proportion of advertisements for nephrologists declined (P < .001), while the relative proportions of advertisements for critical care specialists (0.5% in 1996 to 1.7% in 2004, P = .004) and hospitalists (1.0% in 1996 to 12.1% in 2004, P < .001) increased. Advertisements for outpatient-based generalist positions (i.e., Primary Care and Internal Medicine) declined (-2.7% relative annual change, 95% confidence interval [95% CI] -4.1%, -1.2%) between 1996 and 2004, a decrease largely due to a substantial decline in advertisements noted between 1996 and 1998. However, over the entire time period, the combined proportion of advertisements for all generalists (hospitalists and outpatient-based generalists) did not change (0.5% relative annual change, 95% CI -0.8% to 2.0%).

CONCLUSIONS

Since 1996, demand for the majority of medical subspecialties has remained constant while relative demand has decreased for primary care and increased for hospitalists and critical care. Increase in demand for generalist-trained hospitalists appears to have offset falling demand for outpatient generalists.

Update on the Diagnostic Radiology Employment Market: Findings Through 2005

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Determinants of Radiologists’ Productivity in Private Group Practices in California

PURPOSE

The purpose of this study was to determine factors that would affect radiologists' productivity in private group practices in California.

METHODS

Individual productivity data were collected for 236 private practice radiologists from 6 private radiology groups in California. The data included information on physician characteristics, facility indicators, and group practice factors that were hypothesized to affect providers' productivity. Statistical tests including chi-square testing and multivariate linear regression were used to analyze the effect of the 3 groupings of factors on the productivity of the radiologists.

RESULTS

With increases in age, the number of years in practice, and the number of years in affiliation with the group practice, productivity seemed to decrease. On the other hand, productivity tended to increase if a radiologist was a shareholder, with an increase in the number of facilities served by the radiologist per day, in the proportion of imaging examinations and interventional procedures conducted, and in the proportion of those examinations stored in picture archiving and communication systems.

CONCLUSIONS

To improve radiologists' productivity, group practices must invest in data-reporting infrastructure for tracking productivity, contract with outpatient imaging centers, and review group practice partnership composition and incentive models to ensure higher productivity. Future studies might consider examining the effect of other factors, such as time spent on nonclinical duties and the use of paramedical assistants in the practice.

Update on the Diagnostic Radiologist Employment Market: Findings Through 2004

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

The private-practice perspective of the manpower crisis in radiology: Greener pastures?

Rising consumer expectations and a rapidly aging population point to a long-term shortage of all physicians, including radiologists. While attention has been drawn to the escalating manpower crisis in academic radiology departments, the private-practice perspective has been generally overlooked. Although clinical workloads and income are higher in private practice, studies have shown higher satisfaction levels (likely because of a greater variety of work) among academic radiologists. As the distinction between community and teaching hospitals has become increasingly blurred, there is now considerable overlap in the skill sets, sources of job satisfaction, and stresses that are encountered in both practice settings. Perhaps more than at any time in the recent past, diagnostic radiologists in academic and private practice share more in common than any perceived differences. Both groups must work together in concert with the ACR to address the growing manpower shortage, as well as the other challenges that confront diagnostic radiology at the beginning of the 21st century.

Emergency Department Image Interpretation Services at Private Community Hospitals

PURPOSE

To investigate the methods used at private community hospitals for delivering emergency department (ED) image interpretation services.

MATERIALS AND METHODS

The authors contacted a random national sample of 114 hospitals by telephone and administered an "ED Radiology Coverage" questionnaire. The questionnaire included queries about daytime image interpretation duties, nighttime radiology coverage arrangements, and radiologist staffing needs. Results were stratified on the basis of ED patient volumes and trauma center designation and were analyzed statistically by using multivariate and logistic regression analyses.

RESULTS

Representatives of 97 EDs responded to the questionnaire. Community hospital radiologists performed daytime primary interpretation of radiographs at 39 (40%) of 97 EDs, computed tomographic (CT) scans at 91 (95%) of 96 EDs, and ultrasonographic images at 87.5 (93%) of 94 EDs. "ED-dedicated" radiologists performed this emergency radiology work in only two (2%) of 97 EDs. During the nighttime, eight (8%) of 97 EDs had no radiology coverage, 80 (82%) of 97 EDs used teleradiology services in some form, and nine (9%) of 97 EDs employed in-house, rotating "non-ED-dedicated" radiologists. Analysis of participant responses revealed that clinicians at 37 (38%) of 97 EDs were able to consult radiologists for nighttime radiography questions, and 87 (92%) of 95 EDs had nighttime CT scans read by radiologists in time for patient care decisions. Twenty-four (25%) of 97 EDs reported radiologist staffing shortages, but only one indicated that it was actively trying to recruit ED-dedicated radiologists. Results of logistic regression analysis indicated that higher ED patient volumes (P =.005) and the presence of a trauma center (P =.02) each significantly increases the probability of higher nighttime levels of radiologist coverage.

CONCLUSION

There is great variation in the current provision of emergency radiology services in private community hospitals.

Update on the diagnostic radiologist shortage

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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